Depressive symptoms and compromised parenting in low-income mothers of infants and toddlers: distal and proximal risks.

Low-income mothers develop depressive symptoms at higher rates than the general population, adding to the existing risk that economic hardship places on their infants and toddlers. Emphasizing a few key intervention targets, an approach that is especially relevant to mothers when depressive symptoms compromise their energy and concentration, can improve interventions with populations facing adversity. The goal of this study was to identify contextual risk factors that significantly contributed to depressive symptoms and that, in combination with depressive symptoms, were associated with compromised parenting. Using baseline data from 251 ethnically diverse mothers from six Early Head Start programs in the Northeastern and Southeastern US, who were recruited for a clinical trial of an in-home intervention, Belsky's ecological framework of distal to proximal levels of influence was used to organize risk factors for depressive symptoms in hierarchical regression models. Under stress, mothers of toddlers reported more severe depressive symptoms than mothers of infants, supporting the need for depressive symptom screening and monitoring past the immediate postpartum period. Multivariate models revealed intervention targets that can focus depression prevention and intervention efforts, including helping mothers reduce chronic day-to-day stressors and conflicts with significant others, and to effectively handle challenging toddler behaviors, especially in the face of regional disciplinary norms. Presence of a live-in partner was linked to more effective parenting, regardless of participants' depressive symptom severity.

Interpersonal Psychotherapy With a Parenting Enhancement Adapted for In-Home Delivery in Early Head Start.

Formidable barriers prevent low-income mothers from accessing evidence-based treatment for depressive symptoms that compromise their ability to provide sensitive, responsive parenting for their infant or toddler. Interpersonal psychotherapy (IPT), an evidence-based psychotherapy for depression, was tailored for in-home delivery to mothers navigating economic hardship and other intense stressors, and for Latina mothers with limited English language proficiency. Psychiatric-mental health nurses delivered the adapted IPT in randomized clinical trials that were conducted in partnership with Early Head Start (EHS). The authors discuss the results of these studies and the impacts on EHS staff members and programs, and they provide additional implications for current early childhood-focused programs.

Parenting enhancement, interpersonal psychotherapy to reduce depression in low-income mothers of infants and toddlers: a randomized trial.

BACKGROUND: Depressive symptoms and clinical depression are highly prevalent in low-income mothers and negatively affect their infants and toddlers. OBJECTIVES: The aim of this study was to test interpersonal psychotherapy combined with parenting enhancement on depressive symptoms and parenting behavior, compared with an equal attention-control condition. METHODS: Mothers (n = 226) of Early Head Start infants and toddlers from the southeastern and northeastern United States were randomized to the intervention delivered in-home by psychiatric mental health advanced practice nurses or an equal attention-control condition delivered by generalist nurses. Rigorous clinical depressive symptom and depression assessments and videotaped, coded mother-child interactions were used as baseline and 14-, 22-, and 26-week postintervention measures. RESULTS: Both the intervention and control groups had significantly reduced Hamilton Rating Scale for Depression scores at each subsequent time point compared with baseline (p < .0001). However, only mothers receiving the intervention showed a significant increase in positive involvement with their child, as measured by closeness, positive effect, affection, and warm touch at T4 (t = 2.22, df = 156, p < .03). DISCUSSION: Both intervention and control conditions resulted in symptom reduction, but only the intervention mothers showed significant interaction changes with their child, an essential step in reducing the negative child outcomes associated with maternal depressive symptoms. Results suggest that a combination of generalist and specialist nurses could be used to treat depressive symptoms in these mothers. Further study with longer postintervention observation is needed to see if, over time, the intervention led to longer-lasting symptom reduction.

Short-term in-home intervention reduces depressive symptoms in Early Head Start Latina mothers of infants and toddlers.

Depressive symptoms may compromise the ability of low-income Latina mothers with limited English language proficiency to parent their infants or toddlers. Eighty Early Head Start Latina mothers with limited English language proficiency were randomized to an advanced practice nurse-delivered, culturally tailored, in-home psychotherapy intervention, or to usual care. Repeated measures regression analysis showed a significantly greater decrease in depressive symptoms for intervention mothers compared to the usual care group at 22 and 26 weeks (4 weeks post intervention). Intervention mothers' reports of their child's aggression diminished significantly from T1 to T4 compared to usual care mothers (p = .03). Self-efficacy appeared to only partially mediate the intervention effect, and maternal health moderated the intervention impact. Results indicate that the intervention reduced depressive symptoms and, compared to previous studies in this population, retention of mothers in both intervention and control conditions was improved.

Flying under the radar: engagement and retention of depressed low-income mothers in a mental health intervention.

A randomized trial of in-home psychotherapy for depressive symptoms that targeted low-income mothers of infants and toddlers used innovative design features to reduce stigma and enhance acceptability. Despite these features, advanced practice psychiatric mental health nurses used specialized, relationship-based strategies to engage and retain these high-risk mothers in the intervention. Data revealed that the nurses needed to diligently maintain contact, provide encouragement, use empathy for rapid assessment and response, and control the intensity of the relationship-based contacts in order to retain mothers.

Strengthening social support for the low-income mother: five critical questions and a guide for intervention.

The visit to the nurse can become a vehicle for low-income mothers to develop one of the most critical health resources available to them: social support. Economic limitations require low-income mothers to create social support structures that are functional but may not match notions of ideal social support. Extensive experience of two advanced practice psychiatric mental health nurse-clinicians revealed that low-income mothers' social support was characterized by concern for basic necessities, precarious situations, self-replicating patterns, entrepreneurial requirements, and demonstrations of strengths. Five key questions during the encounter between nurse and mother can assist the nurse in planning interventions that fit these mothers' needs and benefit their health and that of their children.

Instrumental inputs: moving the interpersonal theory of nursing into practice.

Instrumental inputs, the units of energy that are passed from nurse to client in therapeutic encounters, stimulate the client to develop new competencies. This article develops the concept, part of the Interpersonal Theory of Nursing, and discusses its use in 2 clinical trials of an advanced practice psychiatric-mental health intervention with high-risk mothers with significant depressive symptoms. Systematic documentation of instrumental inputs in the strategic interactions between advanced practice psychiatric-mental health nurses and clients has provided cumulative empirical examples that are presented. The concept has great utility for clinical practice and research and continuing development and testing of the Interpersonal Theory of Nursing.

In-home intervention for depressive symptoms with low-income mothers of infants and toddlers in the United States.

Depressive symptoms in low-income mothers negatively affect infant-toddler development. This pilot study tested a short-term, home-based depressive symptom intervention with 16 African American and White, Non-Hispanic mothers in Early Head Start (EHS) programs who were randomly assigned to intervention and usual care/waiting list conditions. Mothers met in their homes with master's-prepared psychiatric mental health nurses who worked with them to improve their management of depressive symptoms and life issues, use of social support, and parenting. The intervention group showed a significantly greater decrease from baseline in depressive symptom severity at 8 and 16 weeks in contrast to the mothers receiving usual care. Observations of maternal interactions showed improvement in the intervention mothers. The results support testing on a larger scale.

Low-income pregnant mothers' experiences of a peer-professional social support intervention.

This article describes 7 low-income mothers' experiences of attending a motivational event that combined peer and professional support in a baby-shower luncheon. The event provided a group context that reinforced health-enhancing messages presented by nurses and other professional staff in home visits. Important themes that emerged in qualitative analysis include reduction of isolation and promotion of bonding; information sharing and modeling to others; and enhancement of self-esteem. A discussion of how community health nurses can use these strategies in caring for pregnant women is presented.