Depression is frequently observed among young mothers who are low income who participate in home visitation programs that are focused on optimizing child development. Maternal depression can undermine such prevention programs, and mothers are faced with significant barriers to obtaining concurrent effective mental health treatment. This case study describes In-Home Cognitive Behavior Therapy (IH-CBT), an adapted treatment for depressed mothers in home visitation. IH-CBT provides an empirically based treatment in the home setting that is tightly integrated with ongoing home visitation. The treated mother presented with major depressive disorder in the postpartum period and poor attachment with her baby. After 15 sessions of IH-CBT, provided in conjunction with home visitation, significant improvement occurred in mood, self-sufficiency, and her relationship with her baby.
Altshuler, L.L., Cohen, L.S., Moline, M.L., Kahn, D.A., Carpenter, D., Docherty, J.P., et al. (2001). Treatment of depression in women: A summary of the expert consensus guidelines. Journal of Psychiatric Practice, 7, 185-208.
2.
Ammerman, R.T., Putnam, F.W., Altaye, M., Chen, L., Holleb, L.J., Stevens, J., et al. (2005). Course of depression in first-time mothers in home visitation. Unpublished manuscript, CincinnatiChildren's Hospital Medical Center, Cincinnati, OH.
3.
Ammerman, R.T., Putnam, F.W., Kopke, J.E., Gannon, T.A., Short, J.A., Van Ginkel, J.B., et al. (in press). Development and implementation of a quality assurance infrastructure in a multisite home visitation program in Ohio and Kentucky . Journal of Prevention and Intervention in the Community .
4.
Ammerman, R.T., Putnam, F.W., Stevens, J., Holleb, L.J., Novak, A.L., & Van Ginkel, J.B. (2005). In-Home Cognitive Behavior Therapy for depression: An adapted treatment for first-time mothers in home visitation. Best Practices in Mental Health, 1, 1-14.
5.
Arboleda-Florez, J., & Wade, T.J. (2001). Childhood and adult victimization as risk factor for major depression. International Journal of Law and Psychiatry , 24, 357-370.
6.
Beck, A.T., Rush, A.J., Shaw, B.F., & Emery, G. (1979). Cognitive therapy of depression. New York: Guilford.
Beck, J.S. (1995). Cognitive therapy: Basics and beyond. New York: Guilford.
9.
Daro, D.A., & Harding, K.A. (1999). Healthy Families America: Using research to enhance practice. Future of Children, 9, 152-176.
10.
Eckenrode, J., Ganzel, B., Henderson, C.R., Jr., Smith, E., Olds, D.L., Powers, J., et al. (2000). Preventing child abuse and neglect with a program of nurse home visitation: The limiting effects of domestic violence . Journal of the American Medical Association, 284, 1385-1391.
11.
Evans, J., Heron, J., Francomb, H., Oke, S., & Golding, J. (2001). Cohort study of depressed mood during pregnancy and after childbirth. British Medical Journal, 323, 257-260.
12.
Gilbody, S., Whitty, P., Grimshaw, J., & Thomas, R. (2003). Educational and organizational interventions to improve the management of depression in primary care: A systematic review. Journal of theAmerican Medical Association, 289, 3145-3151.
13.
Gloaguen, V., Gottraux, J., Cucherat, M., & Blackburn, I.-M. (1998). A meta-analysis of the effects of cognitive therapy in depressed patients. Journal of Affective Disorders, 49, 59-72.
14.
Goodman, S. H., & Gotlib, I. H. (Eds.). (2002). Children of depressed parents: Mechanisms of risk and implications for treatment. Washington, DC: American Psychological Association .
15.
Guterman, N.B. (2001). Stopping child maltreatment before it starts: Emerging horizons in early home visitation services. Thousand Oaks, CA: Sage.
16.
Hay, D.F., Pawlby, S., Angold, A., Harold, G.T., & Sharp, D. (2003). Pathways to violence in the children of mothers who were depressed postpartum. Developmental Psychology, 39, 1083-1094.
17.
Hobfoll, S.E., Ritter, C., Lavin, J., Hulsizer, M.R., & Cameron, R.P. (1995). Depression prevalence and incidence among inner-city pregnant and postpartum women. Journal of Consulting and Clinical Psychology, 63, 445-453.
18.
Hollon, S.D., DeRubeis, R.J., Shelton, R.C., Amsterdam, J.D., Salomon, R.M., O'Reardon, J.P., et al. (2005). Prevention of relapse following cognitive therapy vs. medications in moderate to severe depression. Archives of General Psychiatry,62, 417-422.
19.
Jacobson, N.S., Martell, C.R., & Dimidjian, S. (2001). Behavioral activation treatment for depression: Returning to contextual roots. Clinical Psychology: Science and Practice, 8, 255-270.
20.
Kessler, R.C., Berglund, P., Demler, O., Jin, R., Koretz, D., Merikangas, K.R., et al. (2003). The epidemiology of major depressive disorder: Results from the National Comorbidity Survey Replication (NCS-R). Journal of theAmerican Medical Association, 289, 3095-3105.
21.
Kroenke, K., Spitzer, R.L., & Williams, J.B.W. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16, 606-613.
22.
LeCroy, C.W., & Whitaker, K. (2005). Improving the quality of home visitation: An exploratory study of difficult situations. Child Abuse and Neglect, 29, 1003-1013.
23.
Lovejoy, M.C., Graczyk, P.A., O'Hare, E., & Newman, G. (2000). Maternal depression and parenting behavior: A meta-analytic review. Child Psychology Review, 20, 561-592.
24.
Margie, N. G., & Phillips, D. A. (Eds.). (1999). Revisiting home visiting: Summary of a workshop. Washington, DC: National Academy Press.
25.
Martins, C., & Gaffan, E.A. (2000). Effects of early maternal depression on patterns of infant-mother attachment: A meta-analytic investigation. Journal of Child Psychology and Psychiatry, 41, 737-746.
26.
Nemeroff, C.B., Heim, C.M., Thase, M.E., Klein, D.N., Rush, A.J., Schatzberg, A.F., et al. (2003). Differential responses to psychotherapy versus pharmacotherapy in patients with chronic forms of major depression and childhood trauma. Proceedings of the National Academy of Sciences, 100, 14293-14296.
27.
O'Hara, M.W. (1997). The nature of postpartum depressive disorders . In L. Murray & P. J. Cooper (Eds.), Postpartum depression and child development (pp. 3-31). New York: Guilford.
28.
O'Hara, M.W., & Swain, A.M. (1996). Rates and risk of postpartum depression: A meta-analysis . International Review of Psychiatry, 8, 37-55.
29.
Olds, D.L. (2002). Prenatal and infancy home visiting by nurses: From randomized trials to community replication. Prevention Science, 3, 153-172.
30.
Orkow, B. (1985). Implementation of a family stress checklist. Child Abuse & Neglect, 9, 405—410.
Saunders, D.G. (1999). Woman battering. In R. T. Ammerman & M. Hersen (Eds.), Assessment of family violence: A clinical and legal sourcebook (2nd ed., pp. 243-270). New York: John Wiley.
33.
Spitzer, R.L., Kroenke, R., & Williams, J.B.W. (1999). Validity and utility of a self-report version of PRIME-MD: The PHQ Primary Care Study. Journal of theAmerican Medical Association, 282, 1737-1744.
34.
Spitzer, R.L., Williams, J.B.W., Kroenke, K., Linzer, M., deGruy, F.V., III, Hahn, S.R., et al. (1994). Utility of a new procedure for diagnosing mental disorders in primary care. Journal of the American Medical Association, 272, 1749-1756.
35.
Stevens, J., Ammerman, R.T., Putnam, F., & Van Ginkel, J. (2002). Depression and trauma history in first-time mothers receiving home visitation. Journal of Community Psychology, 30, 551-564.
36.
Warner, R., Appleby, L., Whitton, A., & Faragher, B. (1997). Attitudes toward motherhood in postnatal depression: Development of the Maternal Attitudes Questionnaire. Journal of Psychosomatic Research, 43, 351-358.
37.
Whitton, A., & Appleby, L. (1996). Maternal thinking and the treatment of postnatal depression. International Review of Psychiatry, 8, 73-78.
38.
Zeskind, P.S., & Stephens, L.E. (2004). Maternal selective serotonin reuptake inhibitor use during pregnancy and newborn neurobehavior. Pediatrics, 113, 368-375.
