The association between perceived social support and parenting self-efficacy among parents of children aged 0-8 years.

Strengthening social support has been recognized as a potentially effective strategy to enhance parenting self-efficacy, but empirical evidence is limited. This study examined the association between perceived social support and parenting self-efficacy.Data of 647 parents of children aged 0-8 years, gathered in the CIKEO cohort study in the Netherlands, were analysed. Data were collected between October 2017 and December 2019. Multivariable linear regression models were used to examine the association between social support and parenting self-efficacy. The mean age of the participants was 33.8 years (SD = 4.9); 94.9% mothers. At the start of the study, 15.1% parents perceived low to moderate social support. Parents who experienced lower levels of social support at the start of the study reported lower parenting self-efficacy at follow-up (ß: 0.13; 95% CI: 0.05, 0.21), independent of potential socio-demographic confounders. Experiencing an increase in perceived social support during the study period was associated with an increase in parenting self-efficacy (ß: 0.15; 95% CI: 0.10, 0.21). Our findings indicate perceived social support is associated with parenting self-efficacy among parents of children aged 0-8 years. Future longitudinal studies need to confirm our findings and may examine which social support interventions are effective in strengthening parenting self-efficacy.

Editorial Perspective: Prato Research Collaborative for change in parent and child mental health - principles and recommendations for working with children and parents living with parental mental illness.

Children whose parents have mental illnesses are among the most vulnerable in our communities. There is however, much that can be done to prevent or mitigate the impact of a parent's illness on children. Notwithstanding the availability of several evidence-based interventions, efforts to support these children have been limited by a lack of adequate support structures. Major service reorientation is required to better meet the needs of these children and their families. This editorial provides recommendations for practice, organisational, and systems change.

Associations between organised leisure-time activities and mental health problems in children.

Previous studies conducted mainly among adolescents have found associations between participation in sport organised leisure-time activities (OLTAs) and mental health problems (MHP). Fewer research studies have been performed to primary school-aged children and to organised non-sport OLTAs. Therefore, the objective is to examine whether there is an association between participation in sport and non-sport OLTAs and a high risk of MHP in 4- to 12-year-olds. Data were used on 5010 children from a cross-sectional population-based survey conducted between May and July 2018 in Rotterdam, the Netherlands. Associations between sport OLTAs, non-sport OLTAs and breadth of OLTAs and a high risk of MHP were explored using logistic regression models adjusting for sociodemographic characteristics, stressful life events and physical activity. Of all children, 58% participated in sport OLTAs and 22% in non-sport OLTAs. The proportion of children with high risk of MHP among participants in sport OLTAs is smaller than among non-participants (OR 0.66, 95% CI: 0.53, 0.81). The proportion of children with high risk of MHP among participants in non-sport OLTAs is smaller than among non-participants (OR 0.69, 95% CI: 0.53, 0.91). The proportion of children with a high risk of MHP among participants in 1 category of OLTAs (OR 0.61, 95% CI: 0.49, 0.76) and in 2-5 categories of OLTAs (OR 0.48, 95% CI: 0.32, 0.71) is smaller than among non-participants.  Conclusion: The proportion of children with high risk of MHP among participants in OLTAs is smaller than among non-participants. What is Known: • Around 10--20% of children and adolescents experiences mental health problems. • Sport organised leisure-time activities have been found to be associated with a lower risk of mental health problems in adolescents. What is New: • The proportion of children with a high risk of mental health problems in participants in organised leisure-time activities is smaller than among non-participants. • The proportion of children with a high risk of mental health problems in participants with a higher breadth of organised leisure-time activities is smaller compared to non-participants.

Socio-demographic characteristics associated with perceived social support among parents of children aged 0-7 years: the CIKEO study.

BACKGROUND: Social support has been associated with numerous positive outcomes for families' health, wellbeing and empowerment. This study examined which socio-demographic characteristics are associated with perceived social support among parents of children aged 0-7 years. METHOD: Cross-sectional data of 1007 parents of children aged 0-7 years, gathered in the CIKEO cohort study in the Netherlands, were analysed. Social support was assessed with the Multi-dimensional Scale of Perceived Social Support (MSPSS). Linear regression models were used to examine associations between socio-demographic characteristics and perceived social support. RESULTS: The mean age of the participants was 34.1 years (SD = 5.1); 92.9% were mothers. The multivariable regression model showed that fathers (ß: -0.15, 95% CI: - 0.22, - 0.08), parents with a low educational level (ß: -0.12, 95% CI: 0.18, - 0.06), parents with a low income (ß: -0.10, 95% CI: - 0.19, - 0.01), unemployed parents (ß: -0.14, 95% CI: - 0.20, - 0.07), and parents of older children (ß: -0.07; 95% CI: - 0.13, 0.00) perceived lower levels of social support. Interaction analyses showed that parents with a migration background and a low educational level were particularly susceptible to perceiving lower levels of support (ß: -0.34, 95% CI: - 0.52, - 0.15). CONCLUSION: Fathers, parents with a low educational level, parents with a low income, unemployed parents, parents of older children, and parents with both a migration background and a low educational level are at increased risk of perceiving lower levels of social support. IMPLICATIONS: We recommend to develop, implement and evaluate intervention strategies to strengthen perceived social support among the abovementioned subgroups of parents, in order to improve families' health, wellbeing and empowerment. TRIAL REGISTRATION: NTR7607 in the Netherlands trial registry.

Parental, child and socio-contextual factors associated with parenting self-efficacy among parents of children aged 0-7 years old: the CIKEO study.

BACKGROUND: A high parenting self-efficacy (PSE) has been associated with positive parenting and positive child development. However, there is limited and inconsistent information on factors associated with PSE. OBJECTIVE: To investigate factors associated with PSE in parents of children aged 0-7 years old, and to explore whether the associations were different between mothers and fathers. METHODS: We performed a cross-sectional analysis of the baseline data from a prospective cohort study: the CIKEO study. A total of 1012 parents (mean age = 33.8, SD = 5.0) completed self-reported measure of PSE and 18 potential factors associated with PSE. RESULTS: Multivariable models revealed that lower parenting stress, fewer child behavior problems, better eating behavior, better parental and child general health, a smaller number of children living in the household, higher perceived level of social support and having a migration background were associated with higher levels of PSE (p < 0.05). The association between family functioning and PSE differed between mothers and fathers (p for interaction = 0.003): with beta and 95% confidence interval being: 1.29 (- 2.05, 0.87), and 0.23 (- 0.46, 3.29), respectively. CONCLUSIONS: A range of parental, child and social-contextual factors in relation to PSE were identified. The patterns of associations for most of the factors were similar among mothers and fathers. However, the association between family functioning and PSE might differ for mothers and fathers. Our findings are relevant for tailoring and implementing successful interventions and effective policy making in child care. TRIAL REGISTRATION: Netherlands National Trial Register number NL7342. Date of registration: 05-November-2018, retrospectively registered.

Evaluation of the promising neighbourhoods community program to reduce health inequalities in youth: a protocol of a mixed-methods study.

BACKGROUND: Reducing socioeconomic health inequalities among youth is a major challenge for governments around the world and reports on successful attempts are scarce. Socioecological and integral approaches with collaborative partnerships and community engagement are recommended but knowledge about the effectiveness and effective and ineffective elements is limited. The Promising Neighbourhoods program employs such an approach aiming to reduce socioeconomic inequalities in health, safety and talent development in youth. We will evaluate the process-implementation, and effectiveness of the Promising Neighbourhoods program. METHODS/DESIGN: Core elements of Promising Neighbourhoods are a collaborative community programming approach with stakeholders, data-based priority setting, knowledge-, and theory-based policies and evidence-based interventions. Community stakeholders and key-leaders from the neighbourhoods are engaged in the program. For this evaluation study the program will be implemented in three intervention neighbourhoods. These neighbourhoods will be compared to three control neighbourhoods at baseline in 2018/2019 and at follow-up in 2020/2021 after full implementation of the Promising Neighbourhoods program. Intervention neighbourhoods receive a tailored intervention-package including evidence-based interventions and additional measures by community stakeholders. In control neighbourhoods, no special planning will take place thus interventions are offered as usual. A mixed-methods approach following the stages of the logic model from program is applied for this evaluation. Questionnaires, focus groups, and registration data will be collected among community stakeholders, key-leaders, and youth to evaluate the process-implementation of the program. Indicators of intermediate and ultimate outcomes will be studied among N = 818 children and N = 818 youngsters using difference-in-difference regression analysis to evaluate the effectiveness of the Promising Neighbourhoods program. DISCUSSION: Hypotheses are that a collaborative community approach with stakeholders leads to clear priority-setting and better tailored interventions of better quality. We further hypothesise a decline in socioeconomic inequalities in intermediate and ultimate outcomes for health, safety and talent development in the intervention neighbourhoods in comparison to control neighbourhoods. The results add knowledge about effective and ineffective elements of collaborative community programming approaches to reduce health inequalities in youth and thus are relevant for local and national public health authorities. TRIAL REGISTRATION: Netherlands National Trial Register number NL7279 . Date of registration: 26-Sept-2018.

Evaluation of effectiveness of (elements of) parenting support in daily practice of preventive youth health care; design of a naturalistic effect evaluation in 'CIKEO' (consortium integration knowledge promotion effectiveness of parenting interventions).

BACKGROUND: The number of interventions to support parents is growing. The level of evidence regarding these intervention varies. In this paper we describe a study that aims to assess the effectiveness of specific 'elements' within such parenting interventions for families with children up to 7 years. A naturalistic effect evaluation will be applied. Study questions are: 1. What is the exposure of parents to (elements of) parenting interventions in the daily practice of preventive youth health care? 2. What are the associations between the exposure to (elements of) parenting interventions and outcomes in parents/children related to parenting and child development? METHODS/DESIGN: Thousand parents/caregivers are recruited by preventive youth health care providers in the Netherlands. Measurements will be performed after inclusion and after 12-months follow up. Data regarding child/parent/caregiver characteristics, use of (parenting) interventions and care, and outcomes with regard to parenting skills, family functioning and child development will be collected. Outcomes will be compared between parents/children exposed and non-exposed to the (elements of) parenting interventions (adjusting for confounders). DISCUSSION: We hypothesize that parents/caregivers with exposure to (elements of) parenting interventions show (relatively more) improvements in parenting outcomes. Results will support intervention selection/development, and support communities/professionals to select appropriate intervention-elements. TRIAL REGISTRATION: Netherlands National Trial Register number NL7342 . Date of registration: 05-November-2018, retrospectively registered.

Assessing the quality of mental health promotion and prevention in Croatia: the case of Istria.

While the availability of mental health promotion and prevention programs worldwide is growing, there is divergence in their level of effectiveness that has led to increasing interest in the development of 'effect management' strategies. Mental health promotion and prevention science and practice has a relatively young history in Croatia, but major investments towards its development have been made over the last decade. This paper reports on a research project that took place within the Istrian Region. The long-term goal of the initiative is to establish quality assurance indicators for mental health promotion and prevention interventions. The current study involved adapting the Dutch Preffi 2.0 instrument for use in Croatia. The content of the Preffi reflects the literature regarding research-based effect predictors. An instrument allows users to assess whether programs have been designed and implemented in ways that maximize their ability to be effective. The Preffi scores can be used for improving a program and the quality with which it is implemented. The first aim of the study is to determine if independent researchers can use the Preffi reliably as a quality assessment instrument. The second aim is to use the Preffi to describe the quality of one cohort of mental health promotion and prevention programs. The study represents the first steps toward developing a strategy for quality assurance that strengthens community capacity for effective service delivery and that could inform other countries whose mental health promotion and prevention efforts are in early stages of development.

Parentification, Stress, and Problem Behavior of Adolescents who have a Parent with Mental Health Problems.

When adolescents live with a parent with mental illness, they often partly take over the parental role. Little is known about the consequences of this so-called parentification on the adolescents' internalizing and externalizing problems. This survey study examined this effect cross-sectionally and longitudinally in a sample of 118 adolescents living with a parent suffering from mental health problems. In addition, the study examined a possible indirect effect via perceived stress. Path analyses were used to examine the direct associations between parentification and problem behavior as well as the indirect relations via perceived stress. The results showed that parentification was associated with both internalizing and externalizing problems cross-sectionally, but it predicted only internalizing problems 1 year later. An indirect effect of parentification on adolescent internalizing and externalizing problems via perceived stress was found, albeit only cross-sectionally. These findings imply that parentification can be stressful for adolescents who live with a parent with mental health problems, and that a greater awareness of parentification is needed to prevent adolescents from developing internalizing problems.

Cost-effectiveness of preventive case management for parents with a mental illness: a randomized controlled trial from three economic perspectives.

BACKGROUND: The children of parents with a mental illness (COPMI) are at increased risk for developing costly psychiatric disorders because of multiple risk factors which threaten parenting quality and thereby child development. Preventive basic care management (PBCM) is an intervention aimed at reducing risk factors and addressing the needs of COPMI-families in different domains. The intervention may lead to financial consequences in the healthcare sector and in other sectors, also known as inter-sectoral costs and benefits (ICBs). The objective of this study was to assess the cost-effectiveness of PBCM from three perspectives: a narrow healthcare perspective, a social care perspective (including childcare costs) and a broad societal perspective (including all ICBs). METHODS: Effects on parenting quality (as measured by the HOME) and costs during an 18-month period were studied in in a randomized controlled trial. Families received PBCM (n = 49) or care as usual (CAU) (n = 50). For all three perspectives, incremental cost-effectiveness ratios (ICERs) were calculated. Stochastic uncertainty in the data was dealt with using non-parametric bootstraps. Sensitivity analyses included calculating ICERs excluding cost outliers, and making an adjustment for baseline cost differences. RESULTS: Parenting quality improved in the PBCM group and declined in the CAU group, and PBCM was shown to be more costly than CAU. ICERs differ from 461 Euros (healthcare perspective) to 215 Euros (social care perspective) to 175 Euros (societal perspective) per one point improvement on the HOME T-score. The results of the sensitivity analyses, based on complete cases and excluding cost outliers, support the finding that the ICER is lower when adopting a broader perspective. The subgroup analysis and the analysis with baseline adjustments resulted in higher ICERs. CONCLUSIONS: This study is the first economic evaluation of family-focused preventive basic care management for COPMI in psychiatric and family services. The effects of the chosen perspective on determining the cost-effectiveness of PBCM underscore the importance of economic studies of interdepartmental policies. Future studies focusing on the cost-effectiveness of programs like PBCM in other sites and studies with more power are encouraged as this may improve the quality of information used in supporting decision making. TRIAL REGISTRATION: NTR2569 , date of registration 2010-10-12.

'You are Okay': a support and educational program for children with mild intellectual disability and their parents with a mental illness: study protocol of a quasi-experimental design.

BACKGROUND: Children of parents with a mental illness or substance use disorder (COPMI) have an increased risk of developing social-emotional problems themselves. Fear of stigmatisation or unawareness of problems prevents children and parents from understanding each other. Little is known about COPMI with mild intellectual disabilities (ID), except that they have a high risk of developing social-emotional problems and require additional support. In this study, we introduce a program for this group, the effectiveness of which we will study using a quasi-experimental design based on matching. The program 'You are okay' consists of a support group for children and an online educational program for parents. The goal of the program is to increase children and parents' perceived competence with an aim to prevent social-emotional problems in children. METHODS/DESIGN: Children between ten and twenty years old with mild ID (IQ between 50 and 85) and at least one of their parents with a mental illness will be included in the study. The children will receive part time treatment or residential care from an institute for children with mild ID and behavioural problems. Participants will be assigned to the intervention or the control group. The study has a quasi-experimental design. The children in the intervention group will join a support group, and their parents will be offered an online educational program. Children in the control group will receive care as usual, and their parents will have no extra offer. Assessments will be conducted at baseline, post-test, and follow up (6 months). Children, parents, and social workers will fill out the questionnaires. DISCUSSION: The 'You are okay' program is expected to increase children and parents' perceived competence, which can prevent (further) social-emotional problem development. Because the mental illness of parents can be related to the behavioural problems of their children, it is important that children and parents understand each other. When talking about the mental illness of parents becomes standard in children's treatment, stigmatisation and the fear for stigmatisation can decrease. TRIAL REGISTRATION: Dutch Trial Register NTR4845 . Registered 9 October 2014.

Effectiveness of preventive support groups for children of mentally ill or addicted parents: a randomized controlled trial.

In various countries preventive support groups are offered to children of mentally ill and/or addicted parents to reduce the risk that they will develop problems themselves. This study assessed the effectiveness of Dutch support groups for children aged 8-12 years old in terms of reducing negative cognitions; improving social support, competence, and parent-child interaction (direct intervention goals); and reducing emotional and behavioural problems (ultimate intervention aim). Children from 254 families were randomly assigned to the intervention or a control condition. Parents and children completed questionnaires at baseline and 3 and 6 months later. Emotional and behavioural problems of intervention group children were also assessed 1 year after the start. Univariate analyses of variance showed that children in the intervention group experienced a greater decrease in negative cognitions and sought more social support, immediately after participation and 3 months later, as compared to control group children. They also remained stable in their feelings of social acceptance (competence aspect) immediately after the intervention, whereas these feelings declined in control group children. The intervention and control groups both improved over time in terms of cognitions, competence, parent-child interaction and emotional and behavioural problem scores. Additional improvement in terms of problem scores was found in the intervention group 1 year after baseline. Further enhancement of effectiveness requires re-consideration of the support group goals; it should be studied whether the goals reflect the most important and influential risk and protective factors for this specific population. Besides, effects should be studied over a longer period.

Longitudinal associations between parent, child, family factors and dyssomnias in children from birth to 8 years: The CIKEO study.

BACKGROUND: Dyssomnias, are the most common parent-reported sleep complaints in young children. The present study investigated the prevalence, one-year development (incidence and persistence) of dyssomnia in early childhood, and the parent, child, and family factors associated with dyssomnia. METHODS: Longitudinal data of 700 children aged 0-8, gathered in the CIKEO cohort study in the Netherlands were analyzed. Dyssomnias were defined as the presence of night awakenings ≥3 times per night or sleep-onset latency of >30 min. Least absolute shrinkage and selection operator (LASSO) was used to identify the parental, child, and family factors associated with the incidence and persistence of dyssomnias in children. RESULTS: The mean age of the children (47 % girls) was 3.2 ± 1.9 years at baseline and 4.4 ± 1.8 years at follow-up. The prevalence of dyssomnias was 13.3 % and 15.4 % at baseline and follow-up, respectively. The incidence and persistence rates of dyssomnias at follow-up were 12.0 % and 37.6 %, respectively. New incidence of insomnia was associated with being a girl, having medical conditions, experiencing stressful life events, and lower parenting self-efficacy at baseline (P < 0.05). Higher levels of parental psychological distress were associated with the persistence of dyssomnias in children (P < 0.05). CONCLUSIONS: Dyssomnias are common with a moderate persistent rate in young children. Several parental, child, and family factors in relation to the incidence and persistence of dyssomnias were identified. Preventive programs and interventions targeting modifiable factors, particularly parental psychological distress, parenting self-efficacy, and resilience to stressful life events, might benefit child sleep.

Early school outcomes for children of postpartum depressed mothers: comparison with a community sample.

Previous studies of the long-term effects of maternal postpartum depression (PPD) on child development have mostly focused on a limited set of outcomes, and have often not controlled for risk factors associated with maternal depression. The present study compared children of postpartum depressed mothers (n = 29) with children from a community sample (n = 113) in terms of a broad range of developmental outcomes in the early school period. Controlling for risk factors associated with maternal depression, we found that children of postpartum depressed mothers had lower ego-resiliency, lower peer social competence, and lower school adjustment than the community sample children. In addition, girls of postpartum depressed mothers showed lower verbal intelligence, and, unexpectedly, showed fewer externalizing problems than their counterparts in the community sample. Results show that children's capacities to deal with stress and interact with peers in the early school period may be particularly affected by their mothers' PPD.

Effectiveness of the Promising Neighbourhoods community program in 0-to 12-year-olds: A difference-in-difference analysis.

Objective: The purpose of this study was to evaluate a collaborative community-based program that aims to a) increase the health, safety and talent development of youth, and b) contribute to the reduction of socioeconomic inequalities. Methods: A difference-in difference design with two separate cross-sectional samples in 2018 (n = 984) and 2021 (n = 413) among 0- to 12-year-olds with an intervention and comparator condition was used. The program, called Promising Neighbourhoods, consists of collaboration with community stakeholders, data-based priority setting, knowledge-and theory-based policies, and evidence-based interventions. The program was implemented in three neighbourhoods which were compared with three similar comparator neighbourhoods in which the program was not implemented. Logistic difference-in-difference regression was used to test effectiveness of the intervention on informal parenting support, outdoor-play, sport club membership, general health and risk of emotional and behavioural difficulties and to examine differences in intervention effects between children with a lower or higher socioeconomic status. Results: A significant intervention effect of the Promising Neighbourhoods program after two-years was found for outdoor-play (OR 0.61; 95%CI 0.37, 0.99). No other significant intervention effects were found for other outcomes. No different interventions effects were found for children with a lower or higher socioeconomic status on outcomes. Conclusion: The findings of this study indicate a positive intervention effect for one of the outcomes in 0- to 12-year-olds. Further mixed-methods evaluation research and using longer follow-up periods are needed to examine the value of these type of programs. Further development of Promising Neighbourhoods seems warranted. Trial registration: This study was prospectively registered in the Netherlands National Trial Register (Number: NL7279) on 26 September 2018.

Factors associated with media use for parenting information: A cross-sectional study among parents of children aged 0-8 years.

AIM: Media use may strengthen parents' capacities to deal with parenting issues. This study examined which factors are associated with media use for parenting information. DESIGN: Cross-sectional data of 658 parents of children aged 0-8 years, gathered in the CIKEO cohort study in the Netherlands, were analysed. METHODS: Multivariable logistic regression models were used to examine which factors were associated with media use for parenting information. RESULTS: The mean age of the participants was 33.8 years (SD = 5.0); 94.7% were mothers; 77.4% used media for parenting information. Parents with more questions or concerns (OR: 1.40, 95% CI: 1.23, 1.59), and parents who received parenting information from their social contacts (OR: 5.57, 95% CI: 3.22, 9.61), had higher odds of media use for parenting information. Older parents (OR: 0.95, 95% CI: 0.91, 1.00), and parents of older children (OR: 0.84, 95% CI: 0.74, 0.95), had lower odds of media use for parenting information.

The Association between Stressful Life Events and Emotional and Behavioral Problems in Children 0-7 Years Old: The CIKEO Study.

BACKGROUND: Stressful life events (SLEs) are recognized risk factors for emotional and behavioral problems, but the association is understudied among young children. Our aim was to examine the association between exposure to SLEs and emotional and behavioral problems in young children up to 7 years old. METHODS: We analyzed baseline data from 959 children (mean age = 3.3 years; SD = 1.9; 47.5% girls) in the CIKEO study, a community-based longitudinal study in the Netherlands. Linear regression was used to assess the associations between the total as well as the individual exposure to SLEs experienced in the past 12 months, and emotional and behavioral problems assessed by CBCL 1.5-5. Interactions of SLEs and child age, sex, ethnic background, and socioeconomic status were explored. RESULTS: Higher total exposure to SLEs, as indicated by the number of SLEs, was significantly associated with higher CBCL total, internalizing and externalizing problem scores (p for trend < 0.05). The results did not differ by child age, sex, ethnic background, or family SES. Six out of the 12 SLEs explored were independently associated with greater CBCL total/externalizing/internalizing scores (p < 0.05). CONCLUSIONS: Exposure to SLEs is associated with higher levels of emotional and behavioral problems in young children, and the impact of SLEs may vary depending on the types of events. Stressful life events might be a useful target for interventions to improve emotional and behavioral well-being among young children.

Reducing the silent burden of impaired mental health.

Mental and behavioural disorders account for about one-third of the world's disability due to all ill health amongst adults, with unipolar depressive disorders set to be the world's number one cause of ill health and premature death in 2030, affecting high- and low-income countries alike. There is a range of evidence-based cost-effective interventions that can be implemented in parenting, at schools, at the workplace and in older age that can promote health and well-being, reduce mental disorders, lead to improved productivity and increase resilience to cope with many of the stressors that are facing the world. These facts need to be better communicated to policy makers to ensure that the silent burden of impaired mental health is adequately heard and reduced.

Which preventive interventions effectively enhance depressed mothers' sensitivity? A meta-analysis.

Improving depressed mothers' sensitivity is assumed to be a key element in preventing adverse outcomes for children of such mothers. This meta-analysis examines the short-term effectiveness of preventive interventions in terms of enhancing depressed mothers' sensitivity toward their child and investigates what type of intervention is most effective. Thirteen interventions, reported in 10 controlled outcome studies, met the inclusion criteria (N = 918). Meta-analytic results showed a small to medium, significant mean effect size (g = 0.32) with large variation in individual effect sizes (-0.56-1.76). Interventions including baby massage were highly effective in improving maternal sensitivity (g = 0.85). In contrast, individual therapy for the mother proved ineffective in terms of improving maternal sensitivity (g = -0.00). Two other significant predictors of greater effect sizes were the inclusion of a support group and the use of a higher number of intervention methods; however, the significance of these results was largely accounted for by one single study. Our meta-analysis confirms that depressed mothers' sensitivity can be improved by preventive intervention and suggests that baby massage may be an effective intervention method to evoke short-term changes in maternal sensitivity. It is unclear whether these changes are maintained over time.

Long-term effects of a home-visiting intervention for depressed mothers and their infants.

BACKGROUND: Whereas preventive interventions for depressed mothers and their infants have yielded positive short-term outcomes, few studies have examined their long-term effectiveness. The present follow-up of a randomised controlled trial (RCT) is one of the first to examine the longer-term effects of an intervention for mothers with postpartum depression and their infants at school-age. In early infancy, the intervention was found effective in improving mother-infant interaction and the child's attachment to its mother. METHODS: Twenty-nine mother-child pairs who completed the intervention are compared with 29 untreated mother-child dyads as to the quality of maternal interactive behaviour and the child outcomes of attachment security to the mother, self-esteem, ego-resiliency, verbal intelligence, prosocial behaviour, school adjustment, and behaviour problems at age 5 (M=68 months). RESULTS: In the total sample no lasting treatment benefits were found, but in families reporting a higher number of stressful life events, children in the intervention group had fewer externalising behaviour problems as rated by their mothers than children in the control group. CONCLUSIONS: In the context of multiple stressful life events the intervention served as a buffer by preventing the development of externalising problems in the child. The results warrant cautious interpretation because of the relatively small sample size and differential attrition revealing the mothers that completed the follow-up assessment to have improved less on maternal sensitivity following the intervention than the mothers who did not participate in the follow-up.