Regina Canuso

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 masters-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.

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.

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.

Maternal Depression: The “Dual” Diagnosis of Mother and Child

With years of experience working in mental health with families, primarily depressed pregnant women and mothers with young children, I am frequently invited to speak locally about issues related to maternal depression. Recently I accepted an invitation to be interviewed about “postpartum depression” on a local radio station. When I arrived I was escorted to a studio crowded with microphones and other equipment. The show’s host, a young and efficient professional radio personality, brought me to my seat after a perfunctory greeting, a cool handshake, and details about how she wanted the program to proceed—nothing too deep; grab the audience in short clips; don’t lose them in detail. She went to the other side of a wide table, and I sat facing the screen of a laptop that displayed a section of the national play list. I could hardly see her face behind various wires, microphones, and laptops. She began her questioning. Did I think Britney Spears was “acting postpartum” by shaving her head and through her other antics? How well was Andrea Yates doing in jail? Should pregnant women who are depressed take more or less anti-depressants? I struggled to answer in ways that recognized the short attention span of my supposed audience, without overfocusing on celebrity gossip and horrifying national media reports alluded to by my seemingly bored and jaded interviewer. And I tried to convey my central message—that maternal depression is real, that it is broader than what we know as “postpartum depression,” that it can be treated, that not only medication but other factors such as social support and psychotherapy can be effective, that it is more frequent in low-income populations, and that its youngest victim can be the child.

Guiding the Hands That Hold the Child: Supportive Strategies for Low-Income Depressed Mothers and Their Children

Working in a community setting with depressed low-income mothers and their children provides the psychiatric nurse with an ideal forum to promote mental health of both mother and child by creating and enacting strategies that target the mothers depression and the childs development, enhancing the developmental and mental health trajectory of both. This article describes the work of one advanced-practice psychiatric nurse who built a presence within a community-based early childhood antipoverty program to promote preventive mental health for women and young children challenged by poverty and the effects of welfare-to-work policies. The author highlights the connection between psychiatric nursings phenomena of concern and the philosophy and the mission of Head Start and Early Head Start. Personal reflections and case study demonstrate that preventive interventions that promote healthy functioning for both mother and child are within the rich and diverse scope of psychiatric nursings practice. J Am Psychiatr Nurses Assoc, 2007; 13(5), 304-312. DOI: 10.1177/1078390307308311

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.