A Systematic Review and Meta-analysis on the Effectiveness of Home Visiting Programs on Postpartum Depression

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PROJECT SUMMARY/ABSTRACT Postpartum depression (PPD) is a non-psychotic depressive episode occurring after childbirth. PPD causes enormous suffering and disability in new mothers, negatively impacting child care and development. Women from lower socioeconomic status (SES) backgrounds are particularly vulnerable to developing PPD. The negative impact of PPD on low-SES mothers is further compounded by limited access to mental health services due to structural barriers and stigma toward mothers experiencing mental health conditions. Specifically, low SES African American and Latina mothers are significantly less likely to seek mental health services than their non-Hispanic white peers, making low-SES African American and Latina families more vulnerable to the adverse health and developmental impacts of PPD. One promising approach to addressing PPD among low-income mothers is home visiting. By delivering health care directly to mothers in their residence, home visiting reduces many of the structural and cultural barriers preventing new mothers from engaging with services for the prevention and treatment of PPD. Prior systematic reviews on the effectiveness of service delivery via home visiting for PPD found mixed results, ultimately concluding that there was insufficient evidence to support that the home visiting approach for service delivery significantly improves maternal mental health. However, the two most recent systematic reviews only included home visiting models that were delivered exclusively by nurses or midwives. The other two reviews were conducted more than ten years ago. Since then, there has been a proliferation of new research on early childhood home visiting programs. Moreover, the reviews published to date have not identified core components associated with effective home visiting models for PPD intervention. Knowledge of core components for success is critical for home visiting programs to address PPD more effectively and efficiently. Accordingly, there remains a need to integrate the latest research to evaluate the overall effectiveness of home visiting models on PPD and to identify core components predictive of the effectiveness of home visiting programs in reducing PPD. To determine the overall effectiveness of addressing PPD via home visiting, the research team will systematically search, select, and review existing empirical studies, evaluate them for rigor and potential bias, and quantitatively synthesize the effect sizes. To identify core components predictive of effective home visiting programs, associations between intervention effect and study-level characteristics will be analyzed with meta- regression analysis. Study-level characteristics—the potential core components— include the priority given to PPD intervention by a home visiting program, types of home visitors, the duration and intensity of a home visiting program, percentage of BIPOC participants in a home visiting program, and baseline level of and risk for depression among service recipients.