Women's Health

Home visits help pregnant, Medicaid-insured women alleviate depressive symptoms

Depressive symptoms are a common complication for women both during pregnancy and in the 12 months after giving birth. Low-income pregnant women and mothers are most susceptible, with nearly half screening positive for depressive symptoms. Having a nurse-community health worker (CHW) team make home visits substantially reduces depressive symptoms according to a new study. Stress levels are also reduced for higher risk women with low psychosocial resources.

Michigan State University researchers Lee Anne Roman, Ph.D., R.N., and Joseph C. Gardiner, Ph.D., and colleagues studied 613 women who telephoned 1 of 5 prenatal clinics in a Michigan county. They randomly assigned 307 women to the nurse-CHW team intervention and 306 women to usual community care (CC) that included opportunity for professional visits. Both approaches were part of Medicaid-enhanced prenatal/postnatal services. The intervention consisted of a nurse and two CHWs who functioned as a team. Women received a first assessment visit from the entire team. The nurse member made a minimum of two visits during pregnancy, one immediately following delivery, and two visits during the first year after the mother gave birth. The two CHWs provided ongoing support through more frequent and regular visits, as well as telephone calls. Women in the intervention arm received an average of 24.4 face-to-face contacts, while women in the CC arm only received 8.5 contacts.

Women who received the home visits had significantly fewer depressive symptoms than women in the CC group. This was particularly true for women who had low psychosocial resources. Those with low psychosocial resources receiving home visits also had greater reduction in stress. According to the researchers, this intervention provides a practical, public-health approach to improving mental health in women by using existing State-sponsored Medicaid services. The study was supported in part by the Agency for Healthcare Research and Quality (HS14206).

See "Alleviating perinatal depressive symptoms and stress: A nurse-community health worker randomized trial," by Drs. Roman and Gardiner, Judith K. Lindsay, B.S.N., M.P.H., and others in the Archives of Women's Mental Health 12, pp. 379-391, 2009.

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