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Head Start strategy effective for maternal depression prevention

A problem-solving education intervention was effective in preventing depressive episodes among low-income and minority mothers with depressive symptoms, particularly those with low depression levels at baseline.

“Because of disparities in access to mental health services for low-income and minority populations, embedding effective mental illness prevention strategies in accessible community- based venues such as Head Start is a potentially important public health strategy,” Michael Silverstein, MD, MPH, of Boston Medical Center, and colleagues wrote. “Our particular approach used the paradigm of screening, brief intervention, and referral to treatment, in which screening identified an at-risk population, a brief intervention aimed to prevent the emergence or worsening of depressive symptoms, and individuals with persistent or escalating symptoms were referred to formal behavioral health services.”

To assess efficacy of a depression prevention strategy embedded in Head Start, a federally funded early learning program that provides services to low-income families, researchers conducted a randomized controlled trial among 230 mothers at six Head Start agencies. Study participants had depressed mood, anhedonia or depression history but were not currently experiencing a depressive episode. Participants were randomly assigned to receive a problem-solving education intervention (n = 111) or usual Head Start services (n = 119).

Intention-to-treat analysis among 223 participants indicated no differences in problem-solving skills between treatment groups.

Participants who received problem-solving education had a mean number of depressive symptom elevations of 0.84, compared with 1.12 among participants who received usual services (adjusted IRR = 0.6; 95% CI, 0.41-0.9).

Analyses stratified according to baseline depressive symptoms indicated a preventive effect of problem-solving education among participants with lower levels of baseline symptoms, with a mean 0.39 elevations among the problem-solving education group vs. 0.88 among the usual services group (aIRR = 0.39; 95% CI, 0.21-0.75).

Researchers found no difference between participants with higher levels of baseline symptoms, with mean elevations of 2.06 among participants who received problem-solving education and 2 for those who received usual services (aIRR = 1.1; 95% CI, 0.67-1.8).

Similar results occurred for symptom scores, with an adjusted mean reduction of 1.33 (95% CI, 0.36-2.29) among participants with lower levels of baseline symptoms.

“The potential for addressing mental health issues in nontraditional community settings is an exciting direction for the field. Approaches will require close attention to the unique needs and challenges of low-income mothers and their families and novel models of intervention delivery,” Robert T. Ammerman, PhD, of Cincinnati Children’s Hospital Medical Center, wrote in an accompanying editorial. “The current study builds on and expands this line of work. There is a need to increase the types of settings that are leveraged to deliver mental health programs. Compelling options include pediatric primary care; the Women, Infants, and Children program; day care; and community institutions. Moving mental health services into the community holds promise to broaden the reach of evidence-based programs for mothers with or at-risk for depression and to guide the trajectories of children toward healthy emotional and behavioral development.” – by Amanda Oldt

Disclosure: The researchers report no relevant financial disclosures.