Ammerman Robert T, Altaye Mekibib, Putnam Frank W, Teeters Angelique R, Zou Yuanshu, Van Ginkel Judith B
Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Ave., MLC 3015, Cincinnati, OH, 45229, USA,
Arch Womens Ment Health. 2015 Jun;18(3):555-63. doi: 10.1007/s00737-014-0479-7. Epub 2014 Nov 5.
Research on older children and high-resource families demonstrates that maternal improvement in depression often leads to parallel changes in parenting and child adjustment. It is unclear if this association extends to younger children and low-income mothers. This study examined if In-Home Cognitive Behavioral Therapy (IH-CBT), a treatment for depressed mothers participating in home visiting programs, contributes to improvements in parenting and child adjustment. Ninety-three depressed mothers in home visiting between 2 and 10 months postpartum were randomly assigned to IH-CBT (n = 47) plus home visiting or standard home visiting (SHV; n = 46). Mothers were identified via screening and subsequent diagnosis of major depressive disorder (MDD). Measures of depression, parenting stress, nurturing parenting, and child adjustment were administered at pre-treatment, post-treatment, and 3 months follow-up. Results indicated that there were no differences between IH-CBT and controls on parenting and child adjustment. Low levels of depression were associated with decreased parenting stress and increased nurturing parenting. Improvement in depression was related to changes in parenting in low-income mothers participating in home visiting programs. IH-CBT was not independently associated with these improvements, although to the extent that treatment facilitated improvement; there were corresponding benefits to parenting. Child adjustment was not associated with maternal depression, a finding possibly attributed to the benefits of concurrent home visiting or measurement limitations. Future research should focus on longer-term follow-up, implications of relapse, and child adjustment in later years.
对大龄儿童和高资源家庭的研究表明，母亲抑郁状况的改善往往会带来育儿方式和孩子适应能力的同步变化。目前尚不清楚这种关联是否适用于幼儿和低收入母亲。本研究探讨了居家认知行为疗法（IH-CBT），一种针对参与家访项目的抑郁母亲的治疗方法，是否有助于改善育儿方式和孩子的适应能力。93名产后2至10个月参与家访的抑郁母亲被随机分配到接受IH-CBT（n = 47）加家访组或标准家访（SHV；n = 46）组。通过筛查和随后的重度抑郁症（MDD）诊断来确定母亲。在治疗前、治疗后和3个月随访时进行抑郁、育儿压力、关爱型育儿和孩子适应能力的测量。结果表明，在育儿方式和孩子适应能力方面，IH-CBT组与对照组之间没有差异。低水平的抑郁与育儿压力的降低和关爱型育儿的增加有关。抑郁状况的改善与参与家访项目的低收入母亲育儿方式的变化有关。尽管治疗在一定程度上促进了改善，但IH-CBT与这些改善并无独立关联；对育儿有相应的益处。孩子的适应能力与母亲的抑郁无关，这一发现可能归因于同时进行的家访的益处或测量限制。未来的研究应关注长期随访、复发的影响以及孩子在以后几年的适应情况。
