How Home Visiting Supports Maternal Mental Health

While the birth of a child brings joy and fulfillment to the lives of many, taking on the role of parent can also be exceptionally challenging and stressful. Some new parents experience postpartum depression (PPD) as one of a number of changes that accompany new motherhood. According to the National Institute of Mental Health (NIMH), symptoms of PPD include feelings of extreme sadness, anxiety, exhaustion, and difficulty caring for oneself or others.

Despite common knowledge that new mothers are at risk for depression, mothers of infants have, historically, had difficulty getting effective treatment for it. Stigma associated with seeking mental health services, an inability to find childcare for an appointment, and difficulties with transportation are just a few obstacles people might encounter while attempting to receive care. To support new mothers who want help for depression but find their path to care obstructed, a unique service delivery option called home visiting provides a way for them to receive treatment from mental health professionals in their own homes.

How Postpartum Depression Affects Mothers and Infants

Though many people find parenthood to be a positive experience, new babies also cause routine and lifestyle changes that require a great deal of adjustment. It is typical for new parents, particularly mothers, to experience:

• Fatigue
• Worry
• Mood swings
• Sadness related to the loss of freedom and changes in role associated with parenthood

Symptoms of postpartum depression are more intense than the feelings listed above and can make it difficult for new parents to care for themselves and their families. Signs of postpartum depression include:

• Feeling sad most or all of the time
• Crying more than usual or without reason
• Extreme worrying
• Long periods of moodiness, irritability, and restlessness
• Sleeping through important events or inability to sleep, even when the baby is sleeping
• Difficulty concentrating, focusing, and problem-solving
• Loss of interest in childcare, family life, and activities that used to be enjoyable
• Intense feelings of anger
• Unexplained physical problems that did not occur prior to pregnancy, such as headaches, muscle pain, or stomach problems
• Avoiding friends and loved ones
• Feeling emotionally detached from the baby
• Extreme feelings of doubt in ability to care for the baby
• Worry about harming the baby or self

Treating postpartum depression is important for both mothers and their children. In addition to causing a number of personal difficulties, PPD can also negatively affect child development. Mothers with postpartum depression often feel overwhelmed and exhausted, which can make it difficult for them to meet their newborn’s needs for affection, nurture, and physical care. Parent-child interactions form the foundations of an infant’s physical and neurological development, especially in the infant’s early life. When these interactions are impacted by depression, the development of the child may be impaired. Obtaining effective treatment for PPD can support new parents in providing an early care environment that fosters healthy infant development.

The History of Home Visiting to Support Mother and Infant Health

It has long been recognized that new mothers can have difficulty accessing mental health services. Home visitation programs seeking to meet the needs of new parents through household outreach have existed in various forms since the early 20th century. While many models of home visitation services exist, the central goals of these programs focus on helping parents take better care of themselves and their children. The programs help parents cope with the challenges of caring for infants and toddlers by identifying familial needs and offering services in an integrated manner.

Home visitation is part of a comprehensive national approach to early childhood health care in countries such as France, Ireland, Spain, Germany, and Belgium. In the United States, federal funding for home visitation services has been limited. However, in 2012, the United States Congress approved the Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV), which greatly expanded the availability of home visiting services. MIECHV prioritizes the treatment of postpartum depression and also works to promote child development through several comprehensive goals.

Home visiting programs address postpartum depression by helping mothers identify symptoms and receive care. PPD can be a hidden problem, because new mothers may feel guilt for experiencing depression and pressure to act happy and excited. Home visitors make sure new parents know postpartum depression is a common and treatable condition. In addition to providing education about symptoms and treatment of PPD, some home visiting programs have developed components that provide depression treatment from a trained mental health care provider in the home. The strategy of combining home visitation and mental health care can help many new parents overcome obstacles that prevent them from receiving care outside of the home.

Moving Beyond Depression: A Look at In-Home Cognitive Behavioral Therapy

Seeking to provide effective treatment through home visiting programs for mothers experiencing depression, Dr. Frank Putnam and Dr. Robert Ammerman of the Cincinnati Children’s Hospital Medical Center developed a form of cognitive behavioral therapy (CBT) that is delivered to mothers in their homes. The treatment, called Moving Beyond Depression, is described by its developers as “an evidence-based, comprehensive approach to identifying and treating depression in mothers participating in home visiting and related early childhood programs.”

Licensed therapists with a master’s degree can conduct Moving Beyond Depression. In addition to being trained in CBT, therapists who provide Moving Beyond Depression also have specialized knowledge of treating PPD, working with providers of home visiting services, and providing in-home mental health care. The effectiveness of Moving Beyond Depression has been studied and verified in clinical trials at the Cincinnati Children’s Hospital Medical Center. It is currently used in several states as a component of MIECHV funded home visiting services, which target economically disadvantaged mothers of infants and young children.

How to Help Yourself or Someone Else Experiencing Postpartum Depression

During the process of becoming a new parent, feelings of isolation can be common. Spending time with understanding friends and family members can help new mothers feel supported. If you think you or someone you know might be experiencing PPD, remember it can help to talk with others and recognize that PPD does not have to be a lonely experience. Home visiting programs in the United States and elsewhere acknowledge that many new parents need guidance and support from professionals as they begin navigating the challenges of raising a chold. These services can greatly contribute to reducing stress and feelings of overwhelm throughout the adjustment. As home visiting programs have become more widely funded and available, they are beginning to incorporate evidence-based treatments for depression into their programs.

References:

1. Ammerman, R. T., Putman, F. W., Teeters, A. R., and Van Ginkel, J. B. (2014). Moving beyond depression: A collaborative approach to treating depressed mothers in home visiting programs. Journal of Zero to Three, 34 (5), 20-28. Retrieved from https://eric.ed.gov/?id=EJ1125766
2. Postpartum depression facts. (n.d.). National Institutes of Health. Retrieved from http://www.nimh.nih.gov/health/publications/postpartum-depression-facts/postpartum-depression-brochure_146657.pdf

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