Abstract

Infant and toddler mental health is jeopardized by depressive symptoms in the mother. These symptoms blunt the mother’s attentiveness, affectionate touch and developmental support that are essential to the secure attachment and subsequent emotional development of the infant or toddler. Low-income Latina mothers have a high incidence of depressive symptoms, an outcome of acculturation, isolation and separation from the accustomed cultural, familial and kinship supports in the country of origin. Furthermore, the low-income Latino mother may not have health insurance or access mental health providers who speak Spanish and have familiarity with Hispanic culture, leaving her to struggle with depressive symptoms in isolation. This places the child at even greater risk for long-term mental health problems. Early Head Start (EHS) programs reach out to Latino mothers by providing bilingual home visitors who provide culturally congruent child-development intervention. However, Latino mothers who have depressive symptoms may require additional mental health intervention in order to fully avail themselves of regular EHS resources.

Using a 2-group, repeated measures experimental design, the proposed study will test an intervention to help mothers develop self-efficacy so that they can function in the face of symptoms, solve difficult life issues, increase their use of social support and improve their parenting interactions with their infant or toddler. This home-visiting, manual-driven intervention has been fully tested with Early Head Start mothers, but the intervention content and materials will be tailored to Latino mothers and relevant materials will be translated into Spanish. The intervention will be brief (5 months), interpersonal and skill-focused, and will be delivered by a Masters-prepared psychiatric-mental health nurse and an EHS bilingual home visitor working as a team with the mother. The study will take place in three Early Head Start programs in North Carolina that serve Latino mothers. The 80 mothers will be randomized to treatment and usual care groups and the effects will be measured over four collection points (baseline, 14 weeks, 22 weeks and 26 weeks) using maternal outcome measures of depressive symptoms, self-efficacy, and videotaped parenting interactions, and infant/toddler outcomes of videotaped child interactions and social and emotional competence.

The positive outcomes of a mental health intervention with these at risk mothers are critical when the serious impact of maternal depressive symptoms on the infant/toddler’s mental health is considered. The use of strategies developed specifically for low-income mothers is predicted to result in better outcomes, and the short-term structure will use mental health intervention resources efficiently. Tailoring the intervention to the culture of Latina mothers is expected to increase participation in the intervention and strengthen the impact. The use of maternal-child interactions as a direct outcome measure, analysis of a mediator and moderators, and the monitoring of change over time are methodological strengths that will more clearly identify the components of effective intervention for these mothers. Reduction in maternal depressive symptoms is predicted to increase mothers’ participation in EHS, which will ultimately make the greatest impact on the mental health of the infant or toddler. By partnering with EHS, the short-term intervention is expected to increase mothers’ use of EHS, and in this way, extend the benefits to the mental health of infants and toddlers beyond the relatively brief duration of the intervention.