Limiting Home Visiting Effects: Maternal Depression as a Moderator of Child Maltreatment
Limiting Home Visiting Effects: Maternal Depression as a Moderator of Child Maltreatment
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DOI：
10.1542/peds.2013-1021k
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发表时间：
2013-11-01
期刊：
影响因子：
8
通讯作者：
Jacobs, Francine H.
中科院分区：
文献类型：
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作者：
Easterbrooks, M. Ann;Bartlett, Jessica Dym;Jacobs, Francine H.
目的：以青少年母亲（16-20岁）及其第一胎婴儿/幼儿（平均年龄1岁）为样本，检验母亲抑郁是否会调节家访（HV）儿童虐待预防项目的影响。方法：研究设计是马萨诸塞州健康家庭的随机对照试验，这是一个全州范围的儿童虐待预防计划。共有707名首次生育的母亲被随机分配到hiv组或对照组。HV组接受了非专业家庭访视。对照组的母亲被转介到其他服务提供者。结果变量包括国家儿童保护服务机构关于儿童虐待和忽视的报告（母亲或其他人作为犯罪者）。通过母亲报告（流行病学研究中心抑郁问卷）对母亲抑郁进行评估。结果：相当比例的家庭有虐待儿童的报告（占样本的30%）和母亲抑郁（38%有临床显著症状）。大多数虐待都是忽视。在对照组的母亲中，虐待的报告并没有因抑郁症状而有所不同。对于携带艾滋病毒的母亲，报告的可能性随抑郁症状的程度而变化。与有临床抑郁症状的艾滋病毒母亲相比，无症状的艾滋病毒母亲所生孩子遭受虐待的可能性更小。结论：该样本中母亲抑郁症状的患病率，以及抑郁与儿童虐待预防计划有效性之间的联系，提示家访人员应警惕母亲抑郁。项目也应该意识到与母亲抑郁相关的可能的监控效果。
OBJECTIVE: To test, with a sample of adolescent mothers (16-20 at childbirth) and their first-born infants/toddlers (average age 1 year), whether the impact of a home visiting (HV) child maltreatment prevention program was moderated by maternal depression.METHODS: The study design was a randomized controlled trial of Healthy Families Massachusetts, a statewide child maltreatment prevention program. A total of 707 first-time mothers were randomly assigned to the HV or control group. The HV group received visits from paraprofessional home visitors. Mothers in the control group were referred to other service providers. The outcome variable consisted of state Child Protective Services reports of child abuse and neglect (mother or other person as perpetrator). Maternal depression was assessed by maternal report (Center for Epidemiologic Studies-Depression questionnaire).RESULTS: A considerable proportion of families had child maltreatment reports (30% of sample) and maternal depression (38% had clinically significant symptoms). Most maltreatment was neglect. Among control group mothers, reports of maltreatment did not vary according to depressive symptoms. For HV mothers, probability of reports varied with levels of depressive symptoms. Nonsymptomatic HV mothers were less likely to have a child who was reported for maltreatment compared with HV mothers who endorsed clinical levels of depressive symptoms.CONCLUSIONS: The prevalence of maternal depressive symptoms in this sample, and the link between depression and child maltreatment prevention program effectiveness, suggest that home visitors be alert to maternal depression. Programs also should be aware of possible surveillance effects related to maternal depression.