Combined depression treatment and parenting training for mothers brings better outcomes for children

Two researchers, Professor Sherryl Goodman and Professor Judy Garber, argue that addressing a mother’s depression and her parenting skills at the same time can head off behavior problems in young children.

Children with depressed mothers have poorer outcomes, and poorer parenting is one reason for this. For example, depressed mothers may provide less-appropriate care, harsh parenting, or disengaged parenting.

Two well-established parenting programs have adaptations for depressed mothers. One—Home Visiting—focuses on infants, and the other—the Triple P program—on toddlers or preschool-age children.

Home Visiting can be combined with In-Home CBT (cognitive behavioral therapy)—a series of 15 weekly 60-minute sessions in the home, and a booster session a month later. In-Home CBT is highly effective in reducing mothers’ depression. However, evaluations have shown that adding In-Home CBT to the Home Visiting Program alone doesn’t improve children’s behavior. Still, as mothers’ depression improved, their parenting improved.

A program called Enhanced Triple P did improve children’s behaviour, compared with the standard Triple P. The enhanced version includes a cognitive behavioral element (for example, dealing with negative thoughts)—also as a series of 15 weekly 60-minute sessions—and engages with family members.

These programs focus on the preschool period, when maternal depression tends to be worse and mothers are spending a lot of time with their children. Children are developing rapidly at this time and are particularly vulnerable to maternal depression, which shows up in later cognitive and social outcomes.

Goodman and Garber argue that there are other ways to improve the effectiveness of these interventions:

• Before the intervention

Embed screening for poor mental health in routine care.

Provide a good system of referrals to other services according to the needs of the mother.

Address other sources of stress at the same time—for example, inadequate housing or intimate partner violence.

Ensure that support is affordable, physically accessible, and available at flexible hours.

• During

Offer routine mental health check-ups.

• After

Conduct periodic follow-ups.

Provide peer support groups, workbooks and online resources, and screening by health services if/when the mother uses them.