Premature infants are born at biological risk for poor health and developmental outcomes;premature infants of low-income families face additional social risks known to exacerbate these outcomes. Both impoverished mothers and mothers of premature infants have high rates of depression, often associated with poor general functioning. Families of premature infants also have difficulty navigating a complex healthcare system on their children's behalf, leading to suboptimal adherence to evidence-based, post-neonatal intensive care unit (NICU) care. In 2006, the Institute of Medicine recognized this public health problem by publishing its report, Preterm Birth, emphasizing the need to improve the quality of follow up NICU care for preterm infants. The underpinning of this proposal is that unaddressed maternal depression among families of premature infants adversely impacts children's developmental outcomes;it also contributes to suboptimal adherence to follow up services, which in turn exacerbates infants'existing risk for poor outcomes. Theory-based empowerment strategies have demonstrated effectiveness in a variety of settings for improving the mood and functioning of depressed adults, and for improving adherence to treatment;they therefore represent a family of potentially feasible interventions to improve the outcomes of this vulnerable NICU population. We propose a randomized feasibility study of one such strategy, Problem Solving Education (PSE), involving 50 low-income mothers at risk for depression, who have premature infants (= 33 weeks gestational age), in an urban hospital NICU. Specifically, we aim to: 1. Field-test key logistical aspects of the study, including recruitment and retention of subjects, intervention delivery, treatment fidelity, and the collection of baseline and follow-up data. 2. Obtain empirical estimates of study parameters that will inform the planning of an appropriately powered randomized controlled trial of the intervention model. These include: a. Within-group standard deviation of continuous outcome measures and proportion of control group subjects to experience discrete outcome events;b. Correlation over time of outcomes measured at both baseline and follow-up;and c. Effect size of the intervention on caregiver depressive symptoms and functioning;and adherence to health supervision and immunization schedules, vision screening, and early intervention evaluation.
