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16392

Enhancing Parenting for Depressed Caregivers

Friday, October 19, 2012
Room R06-R09 (Morial Convention Center)
James P. Guevara, MD, MPH1, Marsha Gerdes, PhD2, Susan Dougherty, PhD1, Brooke Rothman, MSPP1 and Rhonda Boyd, PhD1, (1)Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, (2)General Surgery, The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia and The University of Pennsylvania School, Philadelphia, PA

"Purpose ". Depression is prevalent among parents of young children and significantly impacts their parenting behavior. The aim of this study was to determine the feasibility and outcomes of a validated parent coaching intervention adapted for depressed parents.

"Methods ". Randomized controlled trial was conducted at 7 urban primary care practices in Philadelphia. Parents of 1-3 year old children were screened for depressive symptoms using the PHQ-2 questionnaire at their child's 1-3 year old well visit. Parents who screened positive for depressive symptoms, were >18 years of age, and were the legal guardian of a 1-3 year old child were eligible to participate. Eligible parents were randomized to receive the 12-week group Incredible Years Parent and Toddler Program that had been infused with depression psychoeducation material immediately or after waiting for 3-4 months. Incentives for participation included transportation tokens, meals, and childcare. Two study visits were conducted at baseline and 3 months to assess depression symptoms, social support, parenting stress, and parenting competence. Differences in attendance at weekly sessions and outcomes were assessed using intention-to-treat analysis.

"Results ". Sixty-one parents were enrolled and randomized. There were no differences in characteristics of parents (Table 1) or in baseline outcome assessments between the two groups. Five parenting groups were held. Parents who received immediate intervention group were more likely to attend at least one parenting session (58% vs. 26%) but equally likely to attend half (30% vs. 21%) or all (6% vs. 5%) sessions as parents in the waitlist control group. At follow-up, parents in the immediate intervention group reported greater social support (MSPSS) and better parenting competence (PS) than parents in the waitlist control group (Table 2). There were no differences in depression symptoms (BDI-II) or parenting stress (PSI-SF) at follow-up.

"Conclusions ". It is feasible to integrate depression psychoeducation into an existing validated parenting program, but few parents complete the program even with standard incentives. Despite poor attendance, parents who were randomized to the intervention immediately reported greater social support and improved parenting competence. Future parenting interventions for depressed parents should consider alternatives to attendance at in-person group sessions.

Table 1. Demographic characteristics of parents

Character

Control

N=29(%)

Intervention N=32(%)

P-Value

Gender

Female

29(100)

31(96.9)

0.34

Race

 Black

27(93.1)

26(81.3)

0.64

Marital Status

Single/Divorced

20(69.0)

25(78.1)

0.71

Education level

²High School

20(69.0)

18(56.2)

0.54

Family Income

$5,000 - $29,999

26(89.7)

24(82.8)

0.32

Age

18-24

25-42

12(48.0)

13(52.0)

10(35.7)

18(64.3)

0.44

Table 2. Differences in outcomes at follow-up

Assessments 

Intervention N=32(%)

Control N=29(%)

P-Value

 BDI-II

Visit 2

16.9(11.41)

22.44(13.44)

0.1

 MSPSS (Total)

Visit 2

4.90(1.14)

4.15(1.40)

0.03

 PSI-SF (Total)

Visit 2

74.2(27.81)

84(16.43)

0.13

 PS (total)

Visit 2

3.14(0.60)

3.64(0.55)

0.002