Reducing Postpartum Depression, Increasing Self-Efficacy Among Low-Income Mothers with a Home Visiting Intervention

Background and Purpose: Postpartum depression (PPD) is the most frequent cause of maternal morbidity in the U.S. Prevalence of PPD nearly doubles among low-income mothers. The high prevalence of postpartum depression among low-income mothers is a maternal health justice issue that signifies the need for early screening and accessible treatment. Problem Solving Therapy (PST) is an effective, affordable and accessible treatment for depression, and may be relevant for low-income, culturally diverse mothers. Motivational Interviewing (MI) increases awareness and self-efficacy when used as an add-on to a cognitive based therapeutic modality such as PST. The purpose of this study was to (1) assess the feasibility of implementing an intervention for mothers at risk for postpartum depression, (2) determine if the PST intervention lowers depression scores, and (3) gather information to inform the development of a standardized treatment manuals

Methods: Recruitment and intervention took place at a local residential treatment facility within a program for mothers recovering from substance abuse. The research used a one-group pre/post-test design. Edinburgh Postnatal Depression Scale (EPDS) and Patient Health Questionnaire (PHQ-9) were adopted to test depressive symptoms, and Score of New General Self-Efficacy Scale (NGSE) measured self-efficacy. No substance abuse measures were taken as all participants were abstinent. A bilingual case worker enrolled 36 new mothers  (44% African American, 37% Hispanic, and 19% White) with PPD and provided one motivational interview session for engagement and four PST sessions for symptom reduction on-site.

Results: Analysis revealed statistically significant improvements on depression scores and self-efficacy. The pre/post EPDS scores improved,(pre=16.04 (SD=4.88), post=9.64 (SD=5.48), t(df=35)=6.80, p<.001) as did the weekly scores from PHQ-9 (pre=13.19 (SD=6.13), post=8.11 (SD=6.52), t(df=35)=6.09, p<.001). Score of New General Self-Efficacy Scale (NGSE) shows statistically significant improvement of self-efficacy (pre=28.53 (SD=5.86), post=31.92 (SD=7.20), t(df=35)=6.09, p=.013).

Conclusions and Implications: This pilot study demonstrates success of the “PST4PPD” community-based, affordable intervention to lower postpartum depression. Feasibility of delivering this home based intervention in a residential treatment setting was demonstrated by completion of desired sample. However, challenges to recruitment in community treatment center were present and should be considered. Recommendations for reaching low-income mothers who are depressed and broadening cultural adaption of the intervention are discussed. 

Provding brief, evidence based interventions such as PST4PPD is an important step toward transforative maternal health justice. Recommendations for reaching low-income mothers who are depressed and broadening cultural adaption of the intervention are discussed.