Why Care?
“Postpartum depression doesn't always go away on its own.”
- About
500,000 women in the United States experience postpartum depression
(PPD), and an estimated 50% of these women are not evaluated or treated.
- Infants
with mothers with PPD are at an increased risk for impaired
psychological and behavioral development, and later social and academic
problems when compared to infants whose mothers are unaffected by PPD,
according to research.
- While medication and psychotherapy
offer promising results for treating PPD, treatments to reduce the
negative effects of PPD on the mother-infant relationship have largely
been ignored.
Goals
The
CARE nursing intervention aims to alleviate the negative effects of
postpartum depression on infants’ development by promoting interactions
between depressed mothers and their infants. Funded by a $1.34 million
grant from the National Institutes of Health’s National Institute of
Nursing Research, the CARE Intervention for Depressed Mothers and Their
Infants (Grant No.: 1R01 NR08033) is a clinical study designed to
assess if the treatment group participating in the CARE intervention,
when compared to the control group, demonstrates significantly:
- higher maternal-infant relational effectiveness
- increased infant clarity of cues and responsiveness to parent
- lower parenting stress
METHODOLOGY
- Postpartum
mothers are recruited from Brigham and Women’s Hospital and
Massachusetts General Hospital to identify women with elevated PPD
symptoms.
- Four weeks after delivery, mothers are contacted
by nurse screeners via telephone or postage-paid mail-in survey. Those
who have a positive Edinburgh Postnatal Depression Score (EPDS) screen
(score ≥ 10) are invited to have a home visit.
- An
Advanced Practice Nurse (APRN) obtains consent and conducts a
diagnostic interview (Structured Clinical Interview for DSM-IV Axis I
Disorders) during a home visit to confirm eligibility for clinical
trial.
- After being randomized to control or treatment
groups, mothers receive home visits from research nurses through 9
months postpartum. The research nurses video-record mother-infant
interactions. The tapes are coded via NCAST (Nursing Child Assessment
Satellite Training) by research nurses who are blinded to the subject’s
treatment or control condition.
- Mothers are also asked to
complete several assessments during the home visits, including:
demographic information and updates, Edinburgh Postnatal Depression
Score (EPDS) screen, Postpartum Depression Screening Scale (PDSS), and
Parenting Stress Index / Short Form (PSI / SF).
SELECT METHODOLOGY RESOURCES
CARE brochure
