Home Visit Intervention Delivered by Lay Person Improves Postpartum Depressive Symptoms

A lay home visitor-delivered intervention was effective at reducing perceived stress and depressive symptoms among postpartum women. These findings were published in the Journal of Affective Disorders.

This study was conducted throughout the Florida Healthy Start home visiting (HV) network which promotes optimal health and development for pregnant women and their children in all counties in Florida. Pregnant women with mild to moderate depression were recruited at ≤32 weeks’ gestation in 2017. Participants were randomly assigned to receive the Mothers and Babies (MB) 1-on-1 intervention (n=446) or usual HV (n=571). The MB intervention included 12 sessions lasting 15-20 minutes which focused on mental health and child development. HV clinicians were trained in a train-the-trainer approach and attended a 1-and-a-half-day training session. The primary outcomes were changes in depressive symptoms and severity.

The intervention and control cohorts were a mean age of 28.0 (SD, 6.3) and 29.1 (SD, 7.5) years respectively, and 52.2% and 47.9% were White respectively. A total of 43.9% and 45.1% were first time mothers respectively, and 31.9% and 30.6% earned <$30,000 annually, respectively. The HV clinicians (n=243) were >99% women, 31.3% were White, 28.6% were Black, 24.2% were Hispanic, 29.7% had been working as a HV for >10 years, and 42.7% had a bachelor’s degree.

Among the women who were enrolled in the MB intervention (n=557), 24% received no sessions, 42% some sessions, and 34% received all sessions.

Compared with controls, mothers who received the MB intervention had Beck Depression Inventory II (BDI) scores that were 1.014 points lower at follow-up (P <.05). Stratified by the number of MB sessions received, individuals who received 1-5 sessions had 1.642 BDI points lower, 6-11 sessions had 2.1 BDI points lower (P =.05), and all 12 sessions had 2.422 BDI points lower (P =.03) than individuals who received no sessions.

The mothers who received the MB intervention reported more perceived social support and mood regulation, they engaged in more pleasant activities, and were able to reframe unhelpful thoughts more effectively than controls.

The HV clinicians reported making some fidelity-consistent adaptations (69.9%). The most common adaptations were time spent delivering the intervention (50.2%) and combining sessions (46.9%).

This study may have been limited by not using the Postpartum Depression Predictors Inventory to identify women who were at risk for postpartum depression.

The study authors concluded, “In response to the shortage of mental health professionals and the tendency for perinatal service providers to focus more extensively on postpartum depression treatment, greater attention must be placed on developing strategies that intervene with women at-risk for developing postpartum depression. Results from this study suggest that lay home visitors can generate reductions in depressive symptoms and perceived stress among low-income women at-risk for developing postpartum depression, thereby reducing a reliance on mental health professionals.”

Reference

Tandon SD, McGown M, Campbell L, Smith JD, Yeh C, Brady C. Results from an effectiveness-implementation evaluation of a postpartum depression prevention intervention delivered in home visiting programs. J Affect Disord. 2022;315:113-120. doi:10.1016/j.jad.2022.07.033

This article originally appeared on Psychiatry Advisor