Home visitation is a prevention program for sociodemographically high risk, first-time mothers and their children that is designed to optimize maternal lifecourse and child trajectories. Research indicates that maternal depression (1) is a significant problem in home visitation with up to 45% of mothers experiencing clinically elevated symptoms while only 14% receive treatment, and (2) can significantly interfere with the efficacy of home visitation. Moreover, maternal depression negatively impacts mother-child interactions and child functioning thus potentially precluding the dyad from fully benefiting from home visitation. To address the high rate of maternal depression in existing home visitation programs, In-Home Cognitive Behavior Therapy (IH-CBT) was developed through an R34 grant as a treatment for mothers in home visitation experiencing depression postpartum. IH-CBT consists of the core features of CBT that have been adapted to address the unique needs and challenges of mothers receiving home visitation. Findings from the R34 indicate that IH-CBT is highly effective at reducing depression, with 66.7% of depressed mothers no longer obtaining a diagnosis of MDD at the end of treatment in contrast to a rate of 24.3% in mothers receiving home visitation alone. In addition, mothers receiving IH-CBT reported increased social support and reduction in other psychiatric symptoms, much of which was maintained at 3 month follow-up. This study seeks to replicate IH-CBT with a larger sample, compare the treatment to a more rigorous control condition (Present-Centered Therapy-PCT), and extend follow-up to 18 months in order to determine relapse rate. There is mixed evidence regarding the long-term effectiveness of home visitation on depressed mothers and their children-critical outcomes that, if adequately demonstrated, would significantly enhance the public health implications of home visitation. Accordingly, the study also seeks to examine the impact of IH-CBT and recovery from depression on parenting and children. Specifically, 220 mothers who are enrolled in home visitation will be recruited through initial screening and subsequent diagnosis of MDD. Subjects will be randomly assigned to IH-CBT + home visitation or PCT + home visitation. Both IH-CBT and PCT will be implemented in 15 sessions with two booster sessions provided 1 and 2 months after treatment. Measures of depression, psychiatric comorbidity, adaptive functioning, social support, parenting, and child functioning will be administered at pre-treatment, post- treatment and at 6, 12 and 18 month follow-ups after post-treatment. It is hypothesized that IH-CBT will be superior to PCT in (1) recovery from depression, (2) risk of relapse and recurrence, and (3) increasing social support and reducing overall psychiatric symptomatology. In addition, mothers who recover from depression will show improvements in parenting and the mother-child relationship, and their children will achieve improved cognitive, social, emotional, and biologic outcomes, relative to non-recovered mothers and their offspring.

Public Health Relevance

Maternal depression is prevalent in home visitation, leading to negative outcomes for children and mothers and preventing them from fully benefiting from services. In-Home Cognitive Behavior Therapy (IH-CBT) has the potential to reach mothers who otherwise would go untreated, enhance the impacts of home visitation, and improve developmental trajectories of young children. Results from this study will have profound public health implications through demonstrating the effectiveness of a readily disseminated treatment for sociodemographically high-risk mothers and their children.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Research Project (R01)
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Interventions Committee for Disorders Involving Children and Their Families (ITVC)
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Azrin, Susan
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Ammerman, Robert T; Mallow, Peter J; Rizzo, John A et al. (2017) Cost-effectiveness of In-Home Cognitive Behavioral Therapy for low-income depressed mothers participating in early childhood prevention programs. J Affect Disord 208:475-482
Goyal, Neera K; Folger, Alonzo T; Hall, Eric S et al. (2016) Multilevel assessment of prenatal engagement in home visiting. J Epidemiol Community Health 70:888-94
Folger, Alonzo T; Brentley, Anita L; Goyal, Neera K et al. (2016) Evaluation of a Community-Based Approach to Strengthen Retention in Early Childhood Home Visiting. Prev Sci 17:52-61
Goyal, Neera K; Hall, Eric S; Jones, David E et al. (2014) Association of maternal and community factors with enrollment in home visiting among at-risk, first-time mothers. Am J Public Health 104 Suppl 1:S144-51
Hall, Eric S; Goyal, Neera K; Ammerman, Robert T et al. (2014) Development of a linked perinatal data resource from state administrative and community-based program data. Matern Child Health J 18:316-25
Goyal, Neera K; Teeters, Angelique; Ammerman, Robert T (2013) Home visiting and outcomes of preterm infants: a systematic review. Pediatrics 132:502-16
Goyal, Neera K; Hall, Eric S; Meinzen-Derr, Jareen K et al. (2013) Dosage effect of prenatal home visiting on pregnancy outcomes in at-risk, first-time mothers. Pediatrics 132 Suppl 2:S118-25