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Home Visiting and Antenatal Depression Affect the Quality of Mother and Child Interactions in South Africa.

  • Author(s): Christodoulou, Joan
  • Rotheram-Borus, Mary Jane
  • Bradley, Alexandra K
  • Tomlinson, Mark
  • et al.

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OBJECTIVE:To examine whether maternal depressed mood at birth moderated the protective effect of a home-visiting intervention on the quality of caregiving for children growing up in a low- and middle-income country. METHOD:Almost all pregnant mothers in 24 Cape Town neighborhoods were recruited into a cluster RCT matched by neighborhoods to either: the Philani home-visiting condition (HVC) or standard care (SC). At 3-years post-birth, the quality of mother-child interactions between HVC and SC mothers with and without antenatal depressed mood was assessed in a representative subset by rating videotaped observations of mother-child interactions on ten dimensions of caregiving. RESULTS:As predicted, maternal depressed mood at birth moderated the effect of the HVC on the quality of mother-child interactions. Among non-depressed mothers, mothers and their children in the HVC scored significantly higher on five of the ten dimensions of the maternal- child interaction scale than mothers in SC: mothers exhibited more maternal sensitivity, talked more, had more harmonious interactions, and had children who paid more attention and exhibited more positive affect. However, being in the HVC did not significantly affect the mother-child interaction scores among mothers with depressed mood. Among HVC children, those with mothers with depressed mood showed significantly less positive affect and talked less with their mothers than children with non-depressed mothers. SC children with mothers with depressed mood were more responsive and paid to their mothers than children with non- depressed mothers. CONCLUSION:Home visiting resulted in a better quality of caregiving for mothers without depressive symptoms. Future interventions need to specifically target maternal depression as well as positive mother-child interactions.

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