Cluxton-Keller Fallon, Xie Haiyi, Hegel Mark T, Donnelly Craig L, Bruce Martha L
Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA.
Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.
Fam Process. 2025 Jun;64(2):e70032. doi: 10.1111/famp.70032.
A significant portion of mothers (pregnant and postpartum) enrolled in U.S. home visiting programs report clinically significant depressive symptoms. Non-violent family conflict precipitates and exacerbates their depressive symptoms. This pilot randomized trial tested the preliminary effectiveness of a family therapy intervention, Resilience Enhancement Skills Training (REST), compared to the standard of care in home-visited mothers with moderate to severe depressive symptoms and moderate to high conflict with family members. A total of 83 mothers and their family members (N = 166) were randomized to receive REST or the standard of care. Both interventions were delivered by clinicians using HIPAA-compliant video conferencing technology. Outcomes were assessed by research assistants, blinded to study group assignment, at post-intervention, 3, and 6 months later. Linear mixed-effects models were used to analyze changes in continuous outcomes in mothers and family members, separately. Mixed-effects logistic regression was used to analyze changes in maternal job attainment/school enrollment. Participants in both study groups showed improvements in outcomes. When compared to standard-of-care participants, REST participants had significantly greater reductions in family conflict (mothers ES = -1.19, family members ES = -0.77), maternal depressive symptoms (ES = -0.96) and co-occurring anxiety symptoms (ES = -0.59), and greater increases in family cohesion (mothers ES = 0.99, family members ES = 0.94) and maternal job attainment/school enrollment (ES = 0.70). The results highlight the value of family therapy for the treatment of moderate to severe depressive symptoms in home-visited mothers, including those with co-occurring moderate to severe anxiety symptoms. Trial Registration: Registered in ClinicalTrials.gov on 02/04/2021. NCT04741776 https://clinicaltrials.gov/ct2/show/NCT04741776.
参与美国家访项目的很大一部分母亲（孕期和产后）报告有临床上显著的抑郁症状。非暴力家庭冲突会引发并加剧她们的抑郁症状。这项初步随机试验测试了一种家庭治疗干预措施——恢复力增强技能培训（REST）的初步效果，并将其与接受家访且有中度至重度抑郁症状以及与家庭成员有中度至高冲突的母亲的护理标准进行比较。共有83位母亲及其家庭成员（N = 166）被随机分配接受REST或护理标准。两种干预措施均由临床医生通过符合健康保险流通与责任法案（HIPAA）的视频会议技术提供。研究助理在干预后、3个月和6个月时对结果进行评估，研究助理对研究组分配情况不知情。线性混合效应模型分别用于分析母亲和家庭成员连续结果的变化。混合效应逻辑回归用于分析母亲就业/入学情况的变化。两个研究组的参与者在结果方面都有改善。与护理标准组的参与者相比，接受REST的参与者在家庭冲突方面有显著更大程度的减少（母亲效应量ES = -1.19，家庭成员效应量ES = -0.77）、母亲抑郁症状（效应量ES = -0.96）和同时出现的焦虑症状（效应量ES = -0.59），并且在家庭凝聚力方面有更大程度的增加（母亲效应量ES = 0.99，家庭成员效应量ES =
0.94）以及母亲就业/入学情况（效应量ES = 0.70）。结果突出了家庭治疗对于治疗接受家访母亲的中度至重度抑郁症状（包括那些同时有中度至重度焦虑症状的母亲）的价值。试验注册：于2021年4月2日在ClinicalTrials.gov注册。NCT04741776 https://clinicaltrials.gov/ct2/show/NCT04741776
