Research That Matters (January 17 - 20, 2008)

Purpose: Postpartum mood disorders are experienced by roughly 13% of women who give birth (O'Hara & Swain, 1996). They are under-diagnosed and under-treated, leaving many mothers to suffer alone and infants to endure the ramifications of having a primary caregiver who is unable to offer the nurturance needed for positive development. Although current research evidence points to dyadic treatments for postpartum depression (PPD) (Nylen, 2006), we remain constrained by our limited knowledge of the processes of these interventions, particularly from the client's perspective. This study describes the experiences of women with PPD who were part of a home-based 3-month therapeutic intervention for mothers and infants developed by a social service agency. In particular, we were interested in how participants perceived the intervention and the specifics of its helpfulness for improving mood and the mother-infant relationship.

Methods: As part of a larger evaluation study, 22 mothers were interviewed at treatment termination. More than two thirds were first time mothers, approximately three quarters were Caucasian, mean age was 32, and all were severely depressed. Mean age of infants at intake was 11 weeks. All mothers participated in 1-1.5 hour audio-taped interviews. Questions focused on experiences of postpartum depression, relationships with infants, partners, family and friends, and specifics of the intervention. All interviews were transcribed. For this study, the focus of analysis was the intervention section of the transcript (Lieblich, Tuval-Maschiach, & Zilber, 1998). Two researchers worked inductively with data using grounded theory techniques (Charmaz, 2006), first coding line-by-line, then organizing the codes into larger categories, and ultimately into a framework that explained how the mothers experienced the intervention and identified the particular aspects that were helpful to them and their infants. The QDA program ATLAS.ti was used to manage the data and facilitate the coding process.

Results: Analyses yielded descriptive information about the mothers' perception of the intervention, the specific practices that were helpful, and how the mothers improved in mood and in caring for their infants. As a group, mothers felt overwhelmingly positive about the intervention. Practices they frequently mentioned as helpful, although differentially, included: 1) emotional support/validation, 2) focus on personal/family history, 3) parenting guidance, 4) modeling, 5) learning to understand their infants, and 6) the home-based nature of the program. At termination almost all mothers felt less depressed, more connected to their infants, more competent as parents, and increasingly confident in their mothering roles.

Conclusion: Participants in this study experienced significant improvements in their mood, mother-infant relationships, and subsequent maternal self-esteem. Although improvement associated with the intervention was reported by all mothers, each felt helped by similar and different clinical techniques. Central for all was support and validation, but some found the focus on family history most helpful and others found that learning to understand their babies was most significant in their improvement. As we continue to research models of best social work practices, it is crucial to remain flexible in our approaches and stay consonant with clients' experiences of treatment and process aspects of clinical research.