As a nurse, throughout my career, I have seen the effects of depression on both mothers and children. Children of depressed mothers are at risk for a vast range of poor physical, cognitive, and emotional problems. Community-based programs that target vulnerable families consistently identify maternal depression as a factor that negatively impacts maternal and child outcomes. These women have been found to be an increased risk for depression. Therefore, identifying and treating depressed mothers represents an opportunity not only to help the women affected, but also to improve developmental and behavioral outcomes for their children. The proposed K-application is designed to establish the candidate as an independent researcher whose work focuses on building community-based preventive interventions to address maternal depressive symptoms among mothers of young children who are enrolled in Early Intervention (El), a national home based program that serves approximately 280,000 at-risk children birth to three. I will use the award to 1) develop a strong foundation in maternal affective disorders; 2) enhance my understanding of problem solving approaches to depression prevention and self-management; and 3) develop expertise in the design, adaptation, and testing of community-based preventive mental health interventions. While effective preventative psychosocial treatments for depression exist, none have been delivered and evaluated in the contest of a home-based program specifically for mothers of infants and children with developmental and other chronic health conditions. Three studies are planned to adapt and test a specific problem solving intervention, Problem Solving Treatment (PST), to prevent the onset and reoccurrence of depressive symptoms among mothers whose children are enrolled in the Massachusetts El Program. I will use qualitative methods to explore both maternal and staff perceptions about addressing maternal mental health in El. The second study, using both qualitative and quantitative methods, will adapt PST to the El environment. The last project will be a quasi-experimental study, in which 6 El case workers, trained in PST, will treat 24 families, to test the effectiveness of PST to impact maternal depressive symptoms, the study's primary outcome, as well as maternal social function, parenting stress, and quality of maternal-child interactions. This project will be used to define the methodological parameters necessary to design a subsequent; appropriately powered cluster randomized clinical trial. My goal is use the information gained from these studies to design and seek funding for a longitudinal cluster RCT to test my hypothesis that integrating an evidenced-based preventive mental health intervention in El programs can decrease the burden of depressive symptoms among at-risk mothers. ? ? ?
