Principal Investigator: Sue Pfefferle, PhD
Funder: National Institute of Mental Health (R34 MH083085-01)
Timeframe: 08/08-07/11
Affiliation: Center for Mental Health Services Research (CMHSR)
Project Staff:  Sue Pferrele, PhD, PI

                        Luis H. Zayas, PhD, Co-PI

Project Contact: 

Project Update as of  07/08/08
Stage: Pending

Description
Maternal depression in the postpartum period is a significant public health matter, particularly among poor urban minority women with limited access to mental health services.  Through research we know how to treat depression.  What we do not know is how to translate effective depression treatments into community nonspeciality mental health settings beyond office-based primary care.  Nurse home visitation programs provide an opportunity to efficiently increase access to depression treatment for low income disadvantaged mothers.  This study explores the co-location of depression treatment (Problem Solving Therapy) within nurse home visitation and the organizational changes needed to maintain access to evidence-based treatment.  Problem Solving Therapy (PST) is suited to use by non-specialists and for in-home use.  The brevity of the intervention (4-8 sessions) and its non-pathologizing approach should be acceptable to low income minority women.  Through multiple methodologies, this study will gather information from women and their providers to determine what system and treatment modifications are needed to effectively deliver acceptable depression treatment in home visitation programs as they strive to implement policy directives to identify and treat mothers with depression.  An expert panel which blends local and global knowledge will provide advice on decision regarding the intervention adaptation.  Once these adaptation decisions are made a small group of experts will adapt a PST manual for use in home visitation.  We will then carry out a small two-arm randomized trial comparing the effectiveness, acceptability, and practicality of PST provided by home visitation RNs versus usual care (referral to mental health specialty care).  Forty-six women will be matched and randomized into the two study conditions.  Outcomes will be measured using both quantitative and qualitative methods.  Depression outcomes will be measured using the Beck Depression Inventory and PHQ-9 at 6 and 12 months post intervention.  The Parenting Stress Index will be used to measure parental functioning.  Women in the usual care condition will be tracked to assess barriers to their accessing depression treatment once referred. Mothers will be interviewed regarding the acceptability and practicality of receiving PST at home from their regular nurse.  Nurse home visitors will be interviewed to assess the acceptability and practicality of their delivery of PST to mothers on their caseloads.  Effect sizes and information on the acceptability and practicality of the intervention to both mothers and nurses will be used to prepare a full scale R01.  PST delivered through home visitation holds promise for providing access to effective and acceptability depression treatment for poor urban minority mothers.  Significantly, our study has the potential to provide home visitation agencies with a viable means of access to effective and acceptable depression treatment for mothers in the face of policy mandates for depression screening.

Total Direct Cost: $461, 410