Citation

Silverstein M, Diaz-Linhart Y, Cabral H, Beardslee W, Broder-Fingert S, Kistin CJ, Patts G, Feinberg E. Psychiatr. Serv. 2018; 69(11): 1175-1180.

Affiliation

Dr. Silverstein, Dr. Broder-Fingert, Dr. Kistin, and Dr. Feinberg are with the Department of Pediatrics, Boston Medical Center, and the Department of Pediatrics, Boston University School of Medicine, Boston. Dr. Feinberg is also with the Boston University School of Public Health, Boston, where Dr. Cabral and Mr. Patts are affiliated, Dr. Feinberg with the Department of Community Health Sciences, Dr. Cabral with the Department of Biostatistics, and Mr. Patts with the Biostatistics and Epidemiology Data Analytics Center. Ms. Diaz-Linhart was with Boston Medical Center at the time of the study and is now with the Heller School of Social Policy and Management, Brandeis University, Waltham, Massachusetts. Dr. Beardslee is with the Department of Psychiatry, Children's Hospital Boston, Harvard Medical School, Boston.

Copyright

(Copyright © 2018, American Psychiatric Association)

DOI

10.1176/appi.ps.201800173

PMID

30256184

Abstract

OBJECTIVE:: The authors sought to determine whether a multicomponent, community-based program for preventing maternal depression also promotes engagement with mental health services for individuals with persistent symptoms.

METHODS:: Mothers of children enrolled in Head Start were randomly assigned between February 2011 and May 2016 to Problem-Solving Education (PSE) (N=111) or usual services (N=119) and assessed every two months for 12 months.

RESULTS:: Among 230 participants, 66% were Hispanic; 223 participants were included in the analysis. For all PSE participants, engagement with specialty mental health services increased from approximately 10% to 21% between two and 12 months. The PSE group was more likely than the control group to be engaged in specialty services at 12 months (adjusted odds ratio [AOR]=2.36, 95% confidence interval [CI]=1.07-5.20), and the rate of engagement with specialty services over time (treatment × time interaction) favored PSE (p=.016). Among PSE participants with persistent depressive symptoms over the follow-up period, engagement with specialty services increased from 12% (two months) to approximately 46% (12 months), whereas among control group participants, engagement fluctuated between 24% and 33%, without a clear trajectory pattern. At 12 months, PSE participants with persistent symptoms were more likely to engage with specialty care compared with their counterparts in the control group (AOR=6.95, CI=1.50-32.19). The treatment × time interaction was significant for the persistently symptomatic subgroup (p=.029) but not for the episodically symptomatic or the asymptomatic subgroups.

CONCLUSIONS:: Embedding mental health programs in Head Start is a promising strategy to engage parents with depressive symptoms in care, especially those with persistent symptoms.

Language: en

Keywords

Community mental health services; Depression; Engagement with care; Maternal Depression; Prevention