Addressing maternal mental health to increase participation in home visiting

Maternal depression poses a significant threat to the healthy development of young children and is associated with increased child behavior problems and poorer cognitive development. Home visiting programs provide critical support for children and families during early childhood, but further research is needed to examine how programs address maternal depression and whether referral to outside mental health services impacts parental participation in home visiting. This study aimed to examine rates of depression among mothers in the national Parent as Teachers (PAT) home-visiting program, whether various high needs characteristics were associated with elevated depressive symptoms, and whether depressive symptomology and initiation of outside mental health treatment were associated with attendance and retention in services, particularly after considering important family risk factors. Data from all participating affiliates was collected nationally. Measures included family demographics, high needs characteristics, rates of depression screening, initiation of maternal mental health services, and PAT program attendance and retention. Several high needs characteristics were strongly associated with maternal depressive symptoms, including intimate partner violence exposure, parental substance abuse, and parental disability. Results also showed that mothers who screened in either the probable Major Depressive Disorder or subclinical depression range on the Edinburgh Postnatal Depression Scale were enrolled for fewer months in PAT. However, depressed mothers who accessed outside mental health services stayed enrolled for more months than mothers who did not access services. Results demonstrate that mothers with higher depressive symptoms, including those in the subclinical range, have a harder time participating in home-visiting services, even though they may need the support the most. However, when PAT home-visitors address maternal mental health and mothers initiate treatment, mothers appear to be better equipped to participate in home visiting.