An Interpersonally-based Home Visiting Intervention: Tailoring Interpersonal Psychotherapy (IPT) for Low-Income, Limited English Proficiency (LEP) Latina Mothers

Background and Purpose:

A challenge facing mental health professionals is the translation of existing empirically-supported interventions, such as IPT (Weissman, 2001), to new populations with unique contexts. Up to 64% of low-income, Spanish-speaking Latina mothers of infants and toddlers experience clinically significant depressive symptoms. These mothers are confronted with economic hardship, loss of extended family and community support through immigration, LEP, parenting stress, and pressure to rapidly acculturate. Symptoms limit their ability to talk, play, comfort and offer appropriate stimulation and developmental support to their children – jeopardizing the child's optimal development and achievement. Many “new destination” areas in the US have inadequate Spanish-language mental health services. This study presents the results of a randomized controlled trial of an interpersonally-based home intervention and will explore modification of the intervention, compared with IPT, to meet the needs of LEP Latina mothers during the critical early years of their infant's/toddler's development

Methods:

Using a randomized controlled design, women, recruited from Early Head Start (EHS), who met criteria for elevated depressive symptoms (CESD ≥ 16) were randomly assigned to an interpersonally-based, in-home intervention or usual care group. The intervention was delivered over a 5-month period to 80 low-income LEP Latina mothers. The intervention, initially developed for low-income, English-speaking EHS mothers, was tailored and piloted with Latina mothers (Beeber, Perreira, Schwartz, 2007). The tailored intervention used a combination of strategies to help mothers reduce depressive symptoms, address chronic stressors, and improve social support and parenting effectiveness and was delivered by an English-speaking practitioner paired with an interpreter who met with the mother 16 times over 5 months. Mothers answered questionnaires/interview questions, and were videotaped in their homes interacting with their child.

Results:

Repeated measures analysis with Hochberg adjustment for multiple comparisons showed a significant decrease in mean depressive symptom scores (CES-D) in intervention mothers compared to attention control group at 14 weeks (11.4 point decrease v. 4.6 point decrease; p=.02), post intervention (14.4 point decrease v. 3.8 point decrease; p<.01) and 1 month post-intervention (15.1 point decrease v. 6.6 point decrease; p=.02). Significant differences were detected in intervention and control groups change in mean scores for maternal report of child aggression (Child Behavior Checklist subscale scores) between baseline and follow-up (intervention group, 5.5 point improvement compared to control group, worsening of 4.25 points; t=2.43, p=.03). Intervention mothers in poor physical health responded significantly better than those in good health (interaction of health/functional capacity [SF-12] and group membership F=7.21, p<.01), suggesting that in-home delivery reached especially vulnerable, difficult to engage mothers.

Conclusions and Implications:

Findings suggest an in-home, interpersonally-based intervention may reduce both maternal depression and maternal perceptions of child aggression and may reduce ethnic/economic disparities in access to mental health treatment. A discussion of the interpersonally-based model with adaptations is presented in comparison to traditional IPT for depression. Based on the promising results of this study, dissemination to social workers serving “new destination” Latina mothers is discussed.