Maternal depression was something Dr. Michael Silverstein found often in his clinical work. A pediatrician at Boston Medical Center, he knew that some mothers didn’t call it depression. It was stress. Or loneliness. It was “feelings of sadness” after putting the kids to bed.
Many didn’t know they were depressed.
And yet, maternal depression affects approximately 12 million women in the United States each year, according to the National Institute of Mental Health.
It disproportionately impacts low-income and minority women. The US Department of Health and Human Services found that depression affects almost half of all mothers with kids in Head Start, which provides low-income children early-education and other social services.
Silverstein, who serves as associate chief medical officer for research and population health at BMC, is part of a research team that partnered with Action for Boston Community Development’s Head Start program to develop a model to prevent maternal depression.
The result was a five-year study published this month in The Journal of the American Medical Association Psychiatry.
It used problem-solving techniques adapted from other depression therapies to reduce the rate of highly significant depressive symptoms in research subjects by 40 percent.
More than 2,200 mothers at Boston-area Head Start centers were screened for their depression risk. Because the project was intended to focus on prevention, researchers could not recruit mothers who were currently dealing with a major depressive episode. Instead, they helped those individuals find formal care.
Researchers focused on local families with children between 0 to 5. The majority were Latino living at or below the federal poverty line.
“The most surprising thing,” Silverstein said, “[was that] approximately 1 out of 5, or 20 percent of women couldn’t participate in the study because they already had a level of symptoms that would already be considered clinical depression. That was really eye-opening.”
The numbers were whittled down to 230 mothers who met the study criteria, including low to mild depressive symptoms such as sadness and lack of energy.
Service providers for the study began meeting with the mothers at home or at one of the local Head Start facilities soon after they signed up. Half of the mothers got access to the conventional Head Start nutrition, health screenings, and social services. The other half, in addition to usual services, were taught problem-solving techniques.
“I think one of the fundamental premises of our project was to bring an evidence-based prevention intervention to where people are every day,” Silverstein said. “Kids go to Head Start five days a week, parents drop them off and pick them up. They come into the medical center and doctor’s office far less.”
The providers met their clients every one to two weeks for six sessions, and talked about challenges in the mothers’ lives. Issues ranged from problems with a spouse or children to concerns about food insecurity and housing. Providers helped the women identify and break down big challenges into smaller, more manageable tasks. By doing so, some subjects felt more in control of their circumstances and their moods improved.
‘This structured approach reinforced the process by picking a problem, picking a goal, evaluating pros and cons, and choosing a solution.’
The techniques were found to help prevent some symptoms, researchers said, though more studies need to be done.
“Everyone has some level of problem-solving skills,” said Yaminette Diaz-Linhart, program director for the Center for Family Navigation and Community Health Promotion at Boston Medical Center. “This structured approach reinforced the process by picking a problem, picking a goal, evaluating pros and cons, and choosing a solution.”
Worries, such as marital complaints or getting kids to do homework, didn’t go away of course.
But the training gave subjects a way to address difficulties one step at a time.
Researchers have heard anecdotally that some mothers are still using the techniques. Kelly Victoria Herrera, now 26, got involved in the study in 2012, shortly after she arrived in the United States from Colombia. What she learned helped her in raising her now 6-year-old son, she said.
“[The provider] would give me advice on what I could work on or change,” Herrera said. “And we’d come up with solutions together.”Cristela Guerra can be reached at firstname.lastname@example.org. Follow her on Twitter @CristelaGuerra.