Problem solving strategy can help prevent depression in low income mothersBMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j2909 (Published 15 June 2017) Cite this as: BMJ 2017;357:j2909
A simple problem solving education intervention shows promise in helping prevent depression in low income mothers, a randomised controlled trial published in JAMA Psychiatry has found.1
Maternal depression disproportionately affects low income and minority women. A cognitive behavioural programme was delivered to mothers who were enrolled in Head Start, an early learning programme that provides services for about a million low income families each year in the United States.
The study included 230 mothers who had depressed mood or a history of depression but were not in a current major depressive episode. Two thirds of the women were Hispanic, and the mean age was 31.4 years. All of the women received the usual Head Start services, which include home visits, parenting groups, and help in accessing community resources for food, job training, and housing.
The researchers randomly assigned 111 women to a series of six workbook based problem solving sessions lasting 30 to 60 minutes. These were delivered by a trained lay person who was not a mental health clinician.
Each session consisted of seven steps: defining a problem, goal setting, generating solutions, implementing decision making guidelines, evaluating solutions, implementing solutions, and evaluating outcomes.
Participants in the intervention group had fewer elevated depressive symptoms over 12 months than those in the control group: 0.84, compared with 1.12 (adjusted incident rate ratio 0.60 (95% confidence interval 0.40 to 0.90)).
The strategy was most effective in women with lower levels of depressive symptom episodes at baseline. In this subgroup the mean number of depressive symptom elevations was 0.39 in women receiving the problem solving intervention, compared with 0.88 in the control group (0.39 (0.20 to 0.75)). No difference was seen, however, among participants with a higher level of depressive symptoms at baseline.
In a linked editorial Robert Ammerman,2 of Cincinnati Children’s Hospital Medical Center in Ohio, commented, “Moving mental health services into the community holds promise to broaden the reach of evidence based programmes for mothers with or at risk for depression and to guide the trajectories of children towards health emotional and behavioural development.”
He said that such an approach could reach mothers who might otherwise not seek out mental healthcare and that women who may be reticent about seeking help for themselves may be open to participating in programmes that they see as benefiting their children.