Summary of the Effects of ECE Interventions on Maternal Depression

All ten of the programs that reported on maternal depression started during pregnancy or soon after the birth o f the infant. The results are mixed. Only five studies reported significant benefits o f intervention on maternal depression. However, in one o f these projects the interviewers were not blind to the mother’s treatment status and depression was measured by four isolated questions - only three o f which were significantly different between the groups (Johnson et al, 1993), in one it is unclear if initial differences between the groups were controlled (Duggan et al, 1999) and in one the gains were short-lived (Armstrong et al, 2000). Hence there is no clear evidence that parent-focused early childhood interventions can help to alleviate maternal depressive symptoms.

Table 1.6. Details of parent-focused early childhood interventions which examine the effect of intervention on maternal mental health

Study Sample Intervention Short term effects Longitudinal Effects

Mother infant transaction program, USA (Rauh et al, 1988; Nurcombe et al, 1984; Achenbach et al, 1990, 1993) 78 low birthweight (< 2,250g), preterm (gestational age < 37 weeks) infants spending > 10 days in intensive care randomized at birth to intervention (E n = 38) or control (C n = 40) 67% followed up at age 4 yrs (66%E & 70%C) 72% followed up at age 7 yrs (63%E & 80%C) 70.5% followed up at age 9 yrs (63%E & 77.5% C)

Intervention from birth to 90 days.

A neonatal intensive care nurse conducted 11 one hour sessions with the mother and infant (7 in hospital and 4 at home at 3,

14, 30 and 90 days)

Sessions involved increasing the sensitivity and responsivity of the mother to her infant.

Child outcomes IQ:

E = C at 6, 12 & 24 months on the Bayley scales of mental

development

Maternal outcomes Parenting:

E > C on maternal self-confidence and satisfaction in mothering role at 6 months

Psychosocial function:

E = C on maternal depression and anxiety at hospital discharge and at 4 months

Child outcomes IQ:

E > C at 36 & 48 months on the McCarthy Scales of children’s abilities (9.5 & 12 points respectively) E > C on Kaufman mental processing composite at ages 7 & 9 years (.96 sd at 7 yrs; .7z scores at 9 yrs). E = C on PPVT at 7 & 9 yrs

Behaviour:

E > C on parent and teacher ratings of school functioning at 9 years

E < C on teacher ratings of attention problems at 9 yrs

Schooling:

E = C in academic achievement at 7 years E > C in maths & riddles (but not reading) at 9 yrs. E < C in special educational placement (9 vs. 21) Twice as many C as E children had been retained in grade but the difference was not significant._______ USA

(Finello et al, 1998, 1998b)

81 very low birth weight (750-1759g) from high risk families randomized to: HV - home visiting (n

= 20)

HH = home health care (n = 21)

HV/HH (n = 20) C = control (n = 20) 78% followed up to 12 months

Intervention from birth to 1 year.

Home health care: health

care was provided at home for up to 1 month after discharge

Home visiting: involved

monitoring the health and development of the infants, providing support to parents and providing referral to other health and social services.

Maternal outcomes Parenting:

HH/HV & HV > C on overall HOME at 1 month, 6 months and

12 months

(HV + HH/HV) > (HH + C) on parenting satisfaction at 6 months

Psychosocial function at 12 months:

HH = HH/HV = HV = C on depression (CES-D)

HH = HH/HV = HV = C on family adaptability and cohesion scales

Table 1.6. Details of parent-focused early childhood interventions which examine the effect of intervention on maternal mental health

Study Sample Intervention Short term effects Longitudinal Effects

Infant Health 8 site randomized Intervention from birth to 3 years involved Child outcomes Child outcomes

and trial. home visits and centre based care IQ: IQ:

Development 985 low E C at on Bayley mental 12 months E = C on WPPSI at 5 & 8 years Program, USA birthweight (< Home visits: & Bayley motor at 12 & 24 months E = C on PPVT at 5 & 8 years (IHDP, 1990; 2,500g), preterm Weekly for U* year and fortnightly from 1 to 3 E > C on Bayley mental at 24 months

Brooks-Gunn et (gestational age < years. Two pronged approach involving (9.3 points, .59SD) But heavier low birth weight infants al, 1992, 1993, 37 weeks) teaching problem solving skills to the mother E > C on Stanford Binet at 36 months (HLBW) (> 2,000g) in E group had 1994, 1994b; randomized to and early stimulation activities. (9.75 points; .59 SD) significantly higher IQ than HLBW McCarton et al intervention (n = E > C on PPVT at 36 months (6.4 infants in C group at 5 & 8 years (3.7 1997; 377) or control (n Child development centres: points) & 4.4 points respectively) & PPVT at 5 McCormick et = 608). Child attended centre for five days a week Adjusted odds ratio of having an IQ < & 8 years (6 points & 6.7 points al, 1998) from I to 3 years. Staff child ratios of 1:3 and 70 was 2.7 times greater in the control respectively)

93%, 82% & 89% 1:4 for I and 2 yr olds respectively group. followed up to age

3 years, age 5 Parent groups: Behaviour: Behaviour:

years & age 8 Parent groups were held every other month E group had fewer behaviour problems E = C on child behaviour checklist years respectively from 12 months than C group (-.2SD) at 36 months.

13.9% of E group vs. 18.8% C group

(parent rating) at 8 years

8% E and 12 % C had scores above the

Implementation info: had scores above the cut off indicating clinically cut off

Mean# home visits: clinically significant behaviour

3 / month in year I problems. Schooling:

1.5 / math in years I & 2 E = C on reading and mathematics

Mean # days in centre: Health: scores

130-135 days/yr for a minimum of 4 hrs/day E > C on morbidity But HLBW in E group > HLBW in C

Mean # parent groups: group on mathematics score

2 / year Maternal Outcomes E = C on grade retention and

21.5% of families didn’t participate in the Maternal life course: placement in special education at 8 intervention (defined as at least I home visit E > C on employment at 3 years years

and I day / year in the centre.

Psychosocial function:

E < C on maternal distress at I & 3 yrs (-0.18 SD at year I, -O.I5sd at year 3) E = C on coping strategies at 3 yrs

Table 1.6. Details of parent-focused early childhood interventions which examine the effect of intervention on maternal mental health

Study Sample Intervention Short term effects

Australia (Armstrong et al, 1999, 2000; Fraser et al, 2000)

181 high risk families randomized to intervention (E n = 90) or control (C n = 91)

88% followed up to 4 months 76% followed up to 12mths

Intervention from birth to 6 months.

Home visits by child health nurses weekly for 6 weeks, fortnightly to 3 months and monthly to 6 months. Focus on raising the self-esteem of the mother, providing anticipatory guidance on child rearing issues, promoting health and providing referrals to other services.

Maternal outcomes Parenting:

E > C on HOME at 4 months

E > C on 3 subscales of the parent domain of the parenting stress index at 4 months

E - C on HOME at 12 months

E = C on child abuse potential inventory at 18 months

Psychosocial function:

E < C on depression scores & % classified as clinically depressed at 6 weeks

E = C on depression at 4 months & 12 months Child-Parent Enrichment Project, USA (Barth et al, 1988)

65 families at risk for child abuse randomized to intervention (E n = 29) or control (C n = 36)

Intervention from pregnancy for 6 months

The intervention involved home visits twice a month by paraprofessionals. The home visitors helped the mothers identify goals and plan how to meet them and provided referral to other services.

Maternal outcomes Psychosocial function:

E = C on depression (CES-D) and anxiety (The State-Trait Anxiety Inventory) E = C on social support STEEP (Steps to Enjoy Effective Parenting), USA (Erikson et al, 1992)

154 low income pregnant women randomly assigned to intervention (n = 74) or control (n = 80)

Intervention from pregnancy to 1 year

The intervention involved fortnightly home visits and fortnightly group meetings. Focus is on increasing maternal sensitivity to her infants needs and increasing her responsiveness.

Child outcomes Behaviour:

E = C on child attachment

Maternal outcomes Parenting:

E > C on understanding babies needs E > C on HOME

Psychosocial function:

E < C on depression and anxiety

Life course:

E > C on life management skills