Enhancing Parenting for Depressed Caregivers in Primary Care

Project Number: R40 MC 11267-01
Project Date: 2/1/2009
Grantee: Children's Hospital of Philadelphia
Department/Center: Pediatrics

Final Report

Pending

Principal Investigator

James Guevara MD, MPH,
Assistant Professor of Pediatrics, Children's Hospital of Philadelphia Pediatrics,
Joseph Stokes, Jr., Research Institute 3615 Civic Center Boulevard
Philadelphia, PA 19104-4318
guevara@email.chop.edu

Abstract

Depression is common among adult caregivers of young children in urban settings. Depression has a significant impact on caregivers’ ability to nurture their children and is associated with dysfunctional parenting. As a result, children of depressed caregivers are more likely to suffer from emotional and behavioral disorders. In addition, they are more likely to make acute care visits and less likely to receive routine health supervision than children of non-depressed caregivers. Although effective treatment for caregiver depression may improve parenting difficulties associated with depression, few caregivers seek formal mental health treatment. In addition, validated parenting interventions that could assist depressed caregivers have not been adapted for use with depressed caregivers or implemented in primary care settings where the majority of caregivers of young children attend. This proposal aims to (1) adapt a parenting intervention for depressed caregivers of young children in primary care, (2) assess the acceptability and feasibility of implementing a parenting intervention for depressed caregivers of young children in primary care, and (3) explore differences in depressive symptoms, parenting stress, parenting competence, social support, child functioning, health care use, and completion of mental health referrals among depressed caregivers who receive the intervention or control condition. In year one, two pediatric practices that serve a predominantly poor urban community and are affiliated with a children’s hospital will be recruited to participate. A validated group parenting education program, will be adapted for use with depressed urban caregivers by inclusion of psychoeducational depression materials and by recommendations from a study steering committee composed of parents, behavioral health specialists, primary care providers, and early childhood educators. In years two and three, caregivers attending their child’s 12- and 24-month well child visits at the participating practices will complete a brief validated depression screen. Parents who screen positive for depression at one of these two visits and who are not currently receiving depression treatment will receive mental health resource materials and be invited to participate in the intervention. One hundred twenty parents with positive depression screens will be consented and randomized to attend the parenting intervention plus enhanced mental health referrals or to enhanced mental health referrals only. Parents in both study arms will complete measures of depression severity, parenting stress, parenting competence, social support, and child functioning at baseline, two months, and six months using computer-assisted personal interviews. Parents in the intervention arm will also complete a measure of satisfaction at the conclusion of the intervention. In addition, parents will be contacted monthly to assess follow through and need for assistance with mental health referrals. Information on ambulatory visits, ED visits, and hospitalizations will be obtained from electronic health records. Information on the feasibility and acceptability of this intervention and its measures will be used to design future studies to test the effectiveness of parenting interventions for depressed caregivers in pediatric primary care practices. If proven effective, such interventions could be disseminated to other pediatric practices to assist them in caring for depressed urban caregivers. This application addresses MCHB’s Strategic Research Initiative #4: promoting the healthy development of MCH populations, since it targets depressed parents and their young children.

Publications

Pending

Keywords

Behavioral Pediatrics; Depression; Health Care Utilization; Maternal and Child Health Bureau; MCH Research; Parenting Skills; Primary Care; Urban Population