Promoting Long-Term Parent and Caregiver Mental Health Through Universal Postnatal Nurse Home Visiting: Intervention Effects and Mechanisms of Action.

Abstract

Poor mental health affects millions of parents and caregivers each year. In the absence of intervention, the duration and magnitude of mental health symptoms can have an adverse impact on parent and caregiver well-being, parenting practices, and subsequent children's development. Although home visiting is hypothesized to impact parent mental health, most studies do not demonstrate sustained benefits over time. Family Connects (FC) is a short-term, universal postnatal nurse home-visiting program designed to support children and families. Evaluations of FC demonstrate 6-month impacts on parent mental health, but longer-term (5-years post intervention) benefits have not been investigated, nor the potential mechanisms of the sustained effect. Every resident birthing family in Durham, NC, over an 18-month period (total n = 4777) was randomly assigned by birth date to FC or control condition. Implementation was strong, allowing an intent-to-treat evaluation of the model on maternal mental health. At infant age 60 months, a random, representative sample of parents (FC n = 201; control n = 200) was interviewed by condition-blind researchers with two screening instruments, the Center for Epidemiological Studies Depression Scale (CES-D) and the Mental Health Continuum scale (MHC - SF). Regression analyses with relevant covariates tested hypothesized (one-tailed) effects on these self-report scales. Parents randomly assigned to FC were significantly (p < .02) less likely to receive a depression score in the clinical range, reported a lower number of depressive symptoms (p < .04), and received better scores for social well-being (p < .04). Quality of the home environment (p < 0.10) was a significant mediator of intervention impact on later parent mental health.