Nurse Home Visits Promoted Maternal-Infant Interaction and Decreased Depression Symptom Severity for Mothers with Postpartum Depression
Horowitz, June Andrews
Wojcik, Joanne Doller
Gregory, Katherine E.
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Purpose: Postpartum depression (PPD) interferes with mothers' ability to promote optimal infant development via interaction. Research to mitigate these effects is limited. The purpose of this study was to test the efficacy of the relationship-focused CARE intervention in increasing maternal-infant relational effectiveness between depressed mothers and their infants during the first 9 months postpartum. Methods: This randomized clinical trial (RCT) involved three phases. In Phase I mothers were recruited from obstetrical units and screened for PPD at 4 weeks postpartum. Women with elevated scores on the Edinburgh Postnatal Depression Scale who agreed were consented and received a diagnostic interview to confirm PPD. In Phase II, the clinical trial, eligible women were randomized to the treatment or control group. Data were collected during home visits from 6 weeks to 9 months. Maternal infant interaction was video-recorded and blind-coded. Phase III involved focus group and individual interviews. Results: The sample was composed of 134 postpartum women and their infants from New England in the United States and 125 completed all visits through the 9th month. Both groups had significant increases in quality of mother-infant interaction (RANOVA: F. = 21.46; p < .001), and decreases in depression severity and parenting stress (p <.001). Qualitative findings indicated presence of the nurse, empathic listening, focused attention and self-reflection during data collection, and assistance with referrals, likely contributed to improvements for both groups. Conclusion: Efficacy of the CARE intervention was only partially supported. Attention given to the control group likely confounded results and constituted an unintentional treatment.