Prof. June Andrews Horowitz (CSON)
CSON Researcher Takes CARE
Horowitz hopes 'coaching' can aid mothers with postpartum depression
By Kathleen Sullivan
The birth of a baby is a happy occasion, but for new mothers who suffer from postpartum depression it also can be a disconcerting time - and the effects can last a long while for both mother and child, says Prof. June Andrews Horowitz (CSON).
The infant whose depressed mother is unable to appropriately respond to her baby can run the risk of impaired health, behavioral and psychobiological development, and later social behavior and cognitive development, said Horowitz, while "a depressed mother can suffer from guilt after she gets healthy and realizes that important developmental time with her baby is forever lost."
Approximately 10-15 percent of new mothers are afflicted with postpartum depression, says Horowitz. There are no clear-cut or simple precursors for depression, and because multiple factors increase the risk of depression it is almost impossible to predict whether or not a woman will become depressed after giving birth, she said.
"Because postpartum depression is a common complication of childbirth and has the potential to place the well-being of many mothers and infants at risk," said Horowitz, "development of effective and economic early intervention strategies is a critical step in reducing its negative consequences."
Horowitz will test the efficacy of one such intervention approach through her work on the Communicating and Relating Effectively (CARE) Project, a four-year $1.39 million National Institutes of Health-funded study which seeks to show that coaching depressed mothers on ways to interact with and respond to their babies can alleviate negative effects of postpartum depression on infants' development.
Typically, Horowitz said, depressed mothers respond to babies' cues in one of two ways, neither of which is sensitive or positive for the babies. "One approach is to be over-anxious, giving too much stimuli. These moms need to learn to tone it down to be in sync with their babies' needs. At the other end of the spectrum are moms who are withdrawn and don't offer enough stimulation. They're unable to pick up on babies' cues or can't do so in a timely way."
Mothers in the study's treatment group will receive coaching from nurses during home visits to assist them in reading infants' signals and responding appropriately. The coaching will involve teaching the mothers how to purposely and sensitively use touch, positioning, eye contact, vocalization, play, soothing actions and mirroring. The nurses will teach the mothers how infants signal both readiness for engagement as well as the need for a break in interaction. They also will identify problematic maternal behaviors while encouraging mothers to try out suggested sensitive responses to baby cues and supporting mothers' positive behaviors.
The CARE Project is based on Horowitz's earlier findings on postpartum depression done under the auspices of the March of Dimes Birth Defects Foundation and is being conducted in conjunction with Brigham and Women's Hospital, where Horowitz holds a post as senior scientist in the Center for Excellence in Nursing Practice. As principal investigator, Horowitz is collaborating with Brigham's Nurse Manager Bernadette Quigley-Lavoie and Center for Excellence in Nursing Practice Executive Director Ann Hurley. CSON Dean and Prof. Barbara Hazard Munro and Assoc. Prof. Joyce Pulcini are co-investigators.
The project is underway with CARE Project staff nurses from Brigham and Women's recruiting mothers of full-term, healthy babies during their postpartum hospitalization who are willing to be contacted by research nurses four weeks after the birth. At four weeks postpartum, according to researchers, mild "baby blues" have faded so that the presence of any depression symptoms suggests postpartum depression. The study needs to have a pool of about 1,500 mothers for screening because a majority of them will not fit the profile for postpartum depression and be screened out. The desired number of women for the clinical trial is 120 or more.
The mothers who meet inclusion requirements and their babies will be enrolled in the study until the babies are nine months old. A baby's development is especially vulnerable to negative effects of postpartum depression during his or her first months, according to Horowitz.
"Babies' brains develop during this critical time and they learn to socialize and empathize. You can't get that time back. That's why this is so important," added Horowitz.
Study participants will receive home visits from the research nurses and will be videotaped to track their relationships with their babies. Horowitz hopes the mothers in the treatment group will show lower parenting stress and higher levels of responsiveness and connection to their infants than the control group. If the CARE Project is shown to be effective, Horowitz says, the intervention could be developed for wider use in pediatric practices, primary health care centers clinics and daycare centers.
The CARE Project entails a lot of research opportunities for CSON students, she adds. "We have two undergrads and four master's students working as research assistants and a doctoral candidate, Kate Gregory, working as a project director. Two of our doctoral fellows, who are qualified advanced practice psychiatric-mental health nurses, are conducting home visits to perform diagnostic interviews with women who have a positive depression screening score to validate that each women with a positive screen actually is experiencing depression."