Society for Social Work and Research

Sixteenth Annual Conference Research That Makes A Difference: Advancing Practice and Shaping Public Policy
11-15 January 2012 I Grand Hyatt Washington I Washington, DC

16726 Reducing Maternal Depression and Improving Parenting: Results From Two Randomized Controlled Trials of An In-Home Adaptation of Interpersonal Psychotherapy for Depression

Friday, January 13, 2012: 10:30 AM
Independence B (Grand Hyatt Washington)
* noted as presenting author
Sarah E. Bledsoe, PhD, MSW, MPhil, Assistant Professor, University of North Carolina at Chapel Hill, Chapel Hill, NC
Linda S. Beeber, PhD, PMHCNS, BC, Professor, University of North Carolina at Chapel Hill, Chapel Hill, NC
Maria Martinez, Doctoral Student, University of North Carolina at Chapel Hill, Chapel Hill, NC
Todd Schwartz, DrPH, Research Assistant Professor, University of North Carolina at Chapel Hill, Chapel Hill, NC
Diane Holditch-Davis, PhD, RN, FAAN, Professor, Duke University, Durham, NC
Virginia Lewis, Project Manager, University of North Carolina at Chapel Hill, Chapel Hill, NC
Regina Canuso, MSN, RN, PMHCNS, Research Instructor, University of North Carolina at Chapel Hill, Chapel Hill, NC
Low-income mothers have a high prevalence (48-52%) of depressive symptoms that can compromise parenting and result in their infants/toddlers showing language delays, developmental lags, conduct disorders and adult vulnerability to depression. Despite the prevalence of depressive symptoms, low-income mothers have not utilized mental health services because barriers such as stigma, transportation and childcare. Providing in-home psychotherapy is one alternative that can facilitate timely intervention. This paper presents the results from two studies in which interpersonal psychotherapy (IPT) was adapted for in-home delivery to low-income mothers and newly-immigrated Latina mothers with limited English language proficiency. We aimed to test the efficacy of adapted IPT to reduce depressive symptoms and improve parenting outcomes compared to attention control.

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.