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Reducing maternal depressive symptoms through promotion of parenting in pediatric primary care.

ABSTRACT: We studied associations between 2 pediatric primary care interventions promoting parental responsiveness and maternal depressive symptoms among low-income mothers. This randomized controlled trial included 2 interventions (Video Interaction Project [VIP], Building Blocks [BB]) and a control group. VIP is a relationship-based intervention, using video-recordings of mother-child dyads to reinforce interactional strengths. BB communicates with parents via parenting newsletters, learning materials, and questionnaires. At mean (SD) child age 6.9 (1.2) months, depressive symptoms were assessed with the Patient Health Questionnaire-9 (PHQ-9), parental responsiveness was assessed with StimQ-I. A total of 407 dyads were assessed. Rates of mild depressive symptoms were lower for VIP (20.6%) and BB (21.1%) than Controls (32.1%, P = .04). Moderate depressive symptoms were lower for VIP (4.0%) compared to Controls (9.7%, P = .031). Mean PHQ-9 scores differed across 3 groups (F = 3.8, P = .02): VIP mothers scored lower than controls (P = .02 by Tukey HSD). Parent-child interactions partially mediated VIP-associated reductions in depressive symptoms (indirect effect -.17, 95% confidence interval -.36, -.03).

SUBMITTER: Berkule SB

PROVIDER: S-EPMC4435690 | biostudies-literature | 2014 May

REPOSITORIES: biostudies-literature

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Reducing maternal depressive symptoms through promotion of parenting in pediatric primary care.

Berkule Samantha B SB Cates Carolyn Brockmeyer CB Dreyer Benard P BP Huberman Harris S HS Arevalo Jenny J Burtchen Nina N Weisleder Adriana A Mendelsohn Alan L AL

Clinical pediatrics 20140501 5

We studied associations between 2 pediatric primary care interventions promoting parental responsiveness and maternal depressive symptoms among low-income mothers. This randomized controlled trial included 2 interventions (Video Interaction Project [VIP], Building Blocks [BB]) and a control group. VIP is a relationship-based intervention, using video-recordings of mother-child dyads to reinforce interactional strengths. BB communicates with parents via parenting newsletters, learning materials, ...[more]

PMID: 24707022

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Project description:Maternal depression affects 10% to 40% of mothers with young children and has negative consequences for children's health and development. The American Academy of Pediatrics (AAP) recommends that pediatricians identify women with maternal depression. The authors examined trends in inquiring about (asking informal questions) or screening for (using a standardized instrument) maternal depression by pediatricians in 2004 and 2013 and identified correlates of usually inquiring/screening to identify maternal depression.Data were ascertained from 778 nontrainee pediatricians exclusively practicing general pediatrics who completed the 2004 (n = 457) and 2013 (n = 321) AAP Periodic Surveys. Pediatricians answered questions about physician and practice characteristics, training, attitudes, and inquiring/screening to identify maternal depression. Sample weights were used to reduce nonresponse bias. Weighted descriptive and logistic regression analyses were conducted.The prevalence of usually inquiring/screening to identify maternal depression increased from 33% to 44% (p < .01). In both years, pediatricians who usually inquired about child/adolescent depression had increased odds of usually inquiring/screening to identify maternal depression. Patient race/ethnicity and training in adult Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnostic criteria for depression were associated with inquiring/screening in 2004, and believing that family screening is within the scope of the pediatrician was associated with inquiring/screening in 2013.Although inquiring/screening about maternal depression has increased since 2004, less than half of pediatricians usually screen or inquire about maternal depression, representing a missed opportunity to identify depression and manage or refer women for treatment. Further training on the importance of mental and family health to children's health may increase identification of maternal depression in pediatric primary care.

Project description:BACKGROUND:Depressive symptoms in older home care clients are common but poorly recognized and treated, resulting in adverse health outcomes, premature institutionalization, and costly use of health services. The objectives of this study were to examine the feasibility and acceptability of a new six-month interprofessional (IP) nurse-led mental health promotion intervention, and to explore its effects on reducing depressive symptoms in older home care clients (??70 years) using personal support services. METHODS:A prospective one-group pre-test/post-test study design was used. The intervention was a six-month evidence-based depression care management strategy led by a registered nurse that used an IP approach. Of 142 eligible consenting participants, 98 (69%) completed the six-month and 87 (61%) completed the one-year follow-up. Outcomes included depressive symptoms, anxiety, health-related quality of life (HRQoL), and the costs of use of all types of health services at baseline and six-month and one-year follow-up. An interpretive descriptive design was used to explore clients', nurses', and personal support workers' perceptions about the intervention's appropriateness, benefits, and barriers and facilitators to implementation. RESULTS:Of the 142 participants, 56% had clinically significant depressive symptoms, with 38% having moderate to severe symptoms. The intervention was feasible and acceptable to older home care clients with depressive symptoms. It was effective in reducing depressive symptoms and improving HRQoL at six-month follow-up, with small additional improvements six months after the intervention. The intervention also reduced anxiety at one year follow-up. Significant reductions were observed in the use of hospitalization, ambulance services, and emergency room visits over the study period. CONCLUSIONS:Our findings provide initial evidence for the feasibility, acceptability, and sustained effects of the nurse-led mental health promotion intervention in improving client outcomes, reducing use of expensive health services, and improving clinical practice behaviours of home care providers. Future research should evaluate its efficacy using a randomized clinical trial design, in different settings, with an adequate sample of older home care recipients with depressive symptoms. TRIAL REGISTRATION:Clinicaltrials.gov identifier: NCT01407926.

Project description:Rural African Americans are disproportionately exposed to numerous stressors such as poverty that place them at risk for experiencing elevated levels of depressive symptoms. Effective treatments for decreasing depressive symptoms exist, but rural African Americans often fail to receive adequate and timely care. Churches have been used to address physical health outcomes in rural African American communities, but few have focused primarily on addressing mental health outcomes. Our partnership, consisting of faith community leaders and academic researchers, adapted an evidence-based behavioral activation intervention for use with rural African American churches. This 8-session intervention was adapted to include faith-based themes, Scripture, and other aspects of the rural African American faith culture (e.g. bible studies) This manuscript describes a Hybrid-II implementation trial that seeks to test the effectiveness of the culturally adapted evidence-based intervention (Renewed and Empowered for the Journey to Overcome in Christ: REJOICE) and gather preliminary data on the strategies necessary to support the successful implementation of this intervention in 24 rural African American churches. This study employs a randomized one-way crossover cluster design to assess effectiveness in reducing depressive symptoms and gather preliminary data regarding implementation outcomes, specifically fidelity, associated with 2 implementation strategies: training only and training+coaching calls. This project has the potential to generate knowledge that will lead to improvements in the provision of mental health interventions within the rural African American community. Further, the use of the Hybrid-II design has the potential to advance our understanding of strategies that will support the implementation of and sustainability of mental health interventions within rural African American faith communities. TRIAL REGISTRATION:NCT02860741. Registered August 5, 2016.

Project description:BACKGROUND:Mobile apps are emerging as tools with the potential to revolutionize the treatment of mental health conditions such as depression. At the forefront of the community health sector, general practitioners are in a unique position to guide the integration of technology and depression management; however, little is currently known about how primary care patients with depressive symptoms are currently using apps. OBJECTIVE:The objective of our study was to explore the natural patterns of mobile app use among patients with depressive symptoms to facilitate the understanding of the potential role for mobile apps in managing depressive symptoms in the community. METHODS:Semistructured phone interviews were conducted with primary care patients in Victoria, Australia, who reported symptoms of depression and were enrolled in a larger randomized controlled trial of depression care. Interviews explored current depression management strategies and the use of mobile apps (if any). Interviews were audio-recorded and transcribed verbatim. Inductive thematic analysis was iteratively conducted using QSR NVivo 11 Pro to identify emergent themes. RESULTS:A total of 16 participants, aged between 20 to 58 years, took part in the interviews with 11 reporting the use of at least one mobile app to manage depressive symptoms and 5 reporting no app use. A variety of apps were described including relaxation, mindfulness, cognitive, exercise, gaming, social media, and well-being apps to aid with depressive symptoms. Among users, there were the following 4 main patterns of app use: skill acquisition, social connectedness, inquisitive trial, and safety netting. Factors that influenced app use included accessibility, perceptions of technology, and personal compatibility. Health care providers also had a role in initiating app use. CONCLUSIONS:Mobile apps are being utilized for self-management of depressive symptoms by primary care patients. This study provided insight into the natural patterns and perspectives of app use, which enhanced the understanding of how this technology may be integrated into the toolbox for the management of depression. TRIAL REGISTRATION:Australian New Zealand Clinical Trials Registry ACTRN12616000537459; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=367152 (Archived at WebCite at http://www.webcitation.org/71Vf06X2T).

Dataset Information

Reducing maternal depressive symptoms through promotion of parenting in pediatric primary care.

Publications

Reducing maternal depressive symptoms through promotion of parenting in pediatric primary care.

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