Postpartum depression, (PPD), a commonly experienced childbirth complication, jeopardizes mothers' ability to interact responsively with their infants. Onset during the critical period of the first months of infants' lives threatens the maternal-infant relationship and adversely affects infant development. Despite the clinical significance of the problem, limited information exists on the treatment of maternal-infant relational disturbances associated with PPD. The overall goal of this randomized clinical trial is to mitigate negative effects of PPD on infants' development by promoting responsive interaction between depressed mothers and their infants.
The specific aim i s to test the efficacy of the relationship-focused Communicating And Relating Effectively (CARE) intervention in increasing maternal-infant relational effectiveness, increasing infant clarity of cues and responsiveness to parent, and reducing parenting stress for the treatment group at 3-months, 6-months, and 9-months after delivery. This proposed study builds on preliminary studies that: (a) demonstrated the feasibility of screening women for postpartum depression, and (b) tested the efficacy of a coaching intervention delivered by nurses to promote responsiveness between depressed mothers and their infants. In this study, the CARE intervention is designed to teach depressed mothers to recognize and interpret Infants' engagement and disengagement cues, and to coach mothers to alter withdrawn and intrusive maternal-infant interactive behaviors that are associated specifically with PPD. Nurses will screen approximately 1,500 postpartum women for PPD, randomly assign a minimum of 116 eligible participants to either the treatment or control group, and confirm depression status with a diagnostic interview. Using a repeated measures design, data will be collected at 6-weeks, and 3, 6, and 9 months postpartum. Standardized instruments will evaluate depression symptoms and parenting stress; blind coding of videotaped maternal-infant interaction will measure maternal-infant relational effectiveness and infant behavioral responses. The CARE intervention will be conducted during home visits at 6-weeks, and 2, 3, 4, 6 months postpartum by teaching mothers to interpret their infants' behavioral cues and to respond effectively. R-ANOVA and R-MANOVA will be used to test the study hypotheses and to answer the research question. Outcomes are expected to contribute to knowledge of evidence-based nursing practice models for the treatment of maternal-infant relational problems associated with PPD.
| Horowitz, June Andrews; Murphy, Christine A; Gregory, Katherine et al. (2013) Nurse home visits improve maternal/infant interaction and decrease severity of postpartum depression. J Obstet Gynecol Neonatal Nurs 42:287-300 |
| Horowitz, June Andrews; Murphy, Christine A; Gregory, Katherine E et al. (2011) A community-based screening initiative to identify mothers at risk for postpartum depression. J Obstet Gynecol Neonatal Nurs 40:52-61 |
| Horowitz, June Andrews; Murphy, Christine A; Gregory, Katherine E et al. (2009) Best practices: community-based postpartum depression screening: results from the CARE study. Psychiatr Serv 60:1432-4 |
