Methods: Study 1: 226 low-income, English-speaking mothers who scored 16 or above on the Center for Epidemiological Studies Depression scale (CES-D) were randomized to 5-months of adapted IPT or health education. Outcomes were measured at 14, 22, and 26 weeks and included the Hamilton Rating Scale for Depression (HRSD), the Structured Clinical Interview for DSM-IV (SCID), videotaped mothering interactions, child behaviors and other measures of social support and coping.
Study 2: 80 Spanish-speaking Latina mothers who scored 16 or above on the CES-D were randomized to either adapted IPT or to a wait-list/control condition. In addition to the adaptations for in-home delivery to low-income mothers, symptomatic Latina mothers, their family members and Latino community representatives identified key cultural modifications for the intervention. Intervention materials were translated and back-translated until linguistic and conceptual equivalence to the original materials was achieved. Outcomes were measured at the same times as Study 1 and included the CES-D, coded videotapes of maternal-child interactions and child behaviors, and the Child Behavior Checklist (CBCL), Aggression subscale.
Univariate, bivariate and multivariate analyses were used to examine data from both studies. The primary analysis for outcomes measured at multiple timepoints involved repeated measures analysis using general linear mixed effects models, examining both within-group and between group factors.
Findings: Study 1: Both the intervention and the health education conditions significantly reduced symptoms compared to baseline (p < .0001), but only mothers in the adapted IPT condition showed improvement in their observed positive involvement with their infants/toddlers (positive affect, playing, teaching, talking with, warm touch). Study 2: Latina mothers randomized to the adapted IPT intervention showed significantly greater reduction in CES-D scores at all timepoints (p ≤ .02) and in CBCL scores (p = .03) compared with control mothers, but did not show a significant difference in their mothering behaviors.
Implications: The adaptation approach that was used to fit the intervention to these underserved mothers and to identify unique issues of importance resulted in high retention and satisfaction with the intervention. Both studies resulted in promising, though different results. Improvement in parenting was identified in both studies. A discussion of why these culturally diverse, underserved populations responded differently to the same intervention and the role of adapted in-home IPT in addressing parenting with depressed mothers and implications for social work practice and policy will be presented.
