Skip to main content

Advertisement

SpringerLink
Log in

Impact of a Health Promotion Intervention on Maternal Depressive Symptoms at 15 months Postpartum

  • Published:
Maternal and Child Health Journal Aims and scope Submit manuscript

Abstract

Given that diet, physical activity, and social support are associated with depression, we examined whether a health promotion intervention designed to modify these factors in low-income, postpartum women would reduce depressive symptoms. This study used a randomized, controlled design to examine the effect of the Just for You (JFY) Program, an educational intervention promoting healthy lifestyles through home visits by nutrition paraprofessionals and motivational telephone counseling, on postpartum depressive symptoms. A total of 679 women income-eligible for the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) were recruited at 6-20 weeks post delivery and randomized to Usual WIC Care or JFY. Using an intention-to-treat analysis, the authors modeled depressive symptoms on the Center for Epidemiologic Studies Depression Scale (CES-D) among 403 women (59%) completing follow-up at a mean of 15 months infant age, adjusting for baseline CES-D, age, household income and randomization strata (body mass index (BMI), race/region). As a secondary analysis, the authors evaluated potential mediators related to social support and self-efficacy to change one or more health behaviors targeted by the intervention. Women randomized to JFY reported 2.5 units lower CES-D score (P = 0.046) compared with those receiving Usual WIC Care alone. This relationship was attenuated by change in self-efficacy (β = −2.3; P = 0.065), suggesting this construct may partially have mediated the effect of JFY on maternal depressive symptoms. A health promotion intervention delivered through home visits and telephone calls can reduce depressive symptoms at 15 months postpartum among low-income, ethnically diverse women.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. O’Hara, M. W. (1986). Social support, life events, and depression during pregnancy and the puerperium. Archives of General Psychiatry, 43(6), 569–573.

    Article  PubMed  Google Scholar 

  2. US Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau (2006). Women’s Health USA 2006. Rockville, MD: US Department of Health and Human Services.

  3. Georgiopoulos, A. M., Bryan, T. L., Yawn, B. P., Houston, M. S., Rummans, T. A., & Therneau, T. M. (1999). Population-based screening for postpartum depression. Obstetrics and Gynecology, 93(5 Pt 1), 653–657.

    Article  PubMed  CAS  Google Scholar 

  4. Ballard, C. G., Davis, R., Cullen, P. C., Mohan, R. N., & Dean, C. (1994). Prevalence of postnatal psychiatric morbidity in mothers and fathers. British Journal of Psychiatry, 164(6), 782–788.

    Article  PubMed  CAS  Google Scholar 

  5. MacArthur, C., Lewis, M., & Knox, E. G. (1991). Health after childbirth. British Journal of Obstetrics and Gynaecology, 98(12), 1193–1195.

    Article  PubMed  CAS  Google Scholar 

  6. Josefsson, A., Berg, G., Nordin, C., & Sydsjo, G. (2001). Prevalence of depressive symptoms in late pregnancy and postpartum. Acta Obstetricia et Gynecologica Scandinavica, 80(3), 251–255.

    Article  PubMed  CAS  Google Scholar 

  7. Pearlstein, T., Howard, M., Salisbury, A., & Zlotnick, C. (2009). Postpartum depression. American Journal of Obstetrics and Gynecology, 200(4), 357–364.

    Article  PubMed  Google Scholar 

  8. Yonkers, K. A., Ramin, S. M., Rush, A. J., Navarrete, C. A., Carmody, T., March, D., et al. (2001). Onset and persistence of postpartum depression in an inner-city maternal health clinic system. American Journal of Psychiatry, 158(11), 1856–1863.

    Article  PubMed  CAS  Google Scholar 

  9. O’Hara, M. W., Schlechte, J. A., Lewis, D. A., & Varner, M. W. (1991). Controlled prospective study of postpartum mood disorders: Psychological, environmental, and hormonal variables. Journal of Abnormal Psychology, 100(1), 63–73.

    Article  PubMed  Google Scholar 

  10. Morris-Rush, J. K., Freda, M. C., & Bernstein, P. S. (2003). Screening for postpartum depression in an inner-city population. American Journal of Obstetrics and Gynecology, 188(5), 1217–1219.

    Article  PubMed  Google Scholar 

  11. Gaynes, B. N., Gavin, N., Meltzer-Brody, S., Lohr, K. N., Swinson, T., Gartlehner, G., et al. (2005). Perinatal depression: Prevalence, screening accuracy, and screening outcomes. Evidence Report/Technology Assessment (Summ), 119, 1–8.

    Google Scholar 

  12. Kahn, R. S., Zuckerman, B., Bauchner, H., Homer, C. J., & Wise, P. H. (2002). Women’s health after pregnancy and child outcomes at age 3 years: A prospective cohort study. American Journal of Public Health, 92(8), 1312–1318.

    Article  PubMed  Google Scholar 

  13. Cooper, P. J., & Murray, L. (1995). Course and recurrence of postnatal depression. Evidence for the specificity of the diagnostic concept. British Journal of Psychiatry, 166(2), 191–195.

    Article  PubMed  CAS  Google Scholar 

  14. Carney, R. M., Freedland, K. E., Miller, G. E., & Jaffe, A. S. (2002). Depression as a risk factor for cardiac mortality and morbidity: A review of potential mechanisms. Journal of Psychosomatic Research, 53(4), 897–902.

    Article  PubMed  Google Scholar 

  15. American College of Sports Medicine (2006). Impact of physical activity during pregnancy and postpartum on chronic disease risk. Medicine and Science in Sports and Exercise, 38(5), 989–1006.

    Google Scholar 

  16. Lovejoy, M. C., Graczyk, P. A., O’Hare, E., & Neuman, G. (2000). Maternal depression and parenting behavior: A meta-analytic review. Clinical Psychological Review, 20(5), 561–592.

    Article  CAS  Google Scholar 

  17. Petterson, S. M., & Albers, A. B. (2001). Effects of poverty and maternal depression on early child development. Child Development, 72(6), 1794–1813.

    Article  PubMed  CAS  Google Scholar 

  18. Bloch, M., Daly, R. C., & Rubinow, D. R. (2003). Endocrine factors in the etiology of postpartum depression. Comprehensive Psychiatry, 44(3), 234–246.

    Article  PubMed  Google Scholar 

  19. Ogrodniczuk, J. S., & Piper, W. E. (2003). Preventing postnatal depression: A review of research findings. Harvard Review of Psychiatry, 11(6), 291–307.

    PubMed  Google Scholar 

  20. Dennis, C. L. (2005). Psychosocial and psychological interventions for prevention of postnatal depression: Systematic review. BMJ, 331(7507), 15.

    Article  PubMed  Google Scholar 

  21. Leis, J. A., Mendelson, T., Tandon, S. D., & Perry, D. F. (2009). A systematic review of home-based interventions to prevent and treat postpartum depression. Archives in Womens Mental Health, 12(1), 3–13.

    Article  Google Scholar 

  22. Dennis, C. L., & Hodnett, E. (2007). Psychosocial and psychological interventions for treating postpartum depression. In Cochrane database of systematic reviews, Issue 4. Art. No.: CD006116. doi:10.1002/14651858.CD006116.pub2.

  23. Shaw, E., Levitt, C., Wong, S., & Kaczorowski, J. (2006). Systematic review of the literature on postpartum care: Effectiveness of postpartum support to improve maternal parenting, mental health, quality of life, and physical health. Birth, 33(3), 210–220.

    Article  PubMed  Google Scholar 

  24. Surkan, P. J., Peterson, K. E., Hughes, M. D., & Gottlieb, B. R. (2006). The role of social networks and support in postpartum women’s depression: A multiethnic urban sample. Maternal and Child Health Journal, 10(4), 375–383.

    Article  PubMed  Google Scholar 

  25. Larun, L., Nordheim, L. V., Ekeland, E., Hagen, K. B., & Heian, F. (2006). Exercise in prevention and treatment of anxiety and depression among children and young people. Cochrane Database Systems Review 3, CD004691.

  26. Sjosten, N., & Kivela, S. L. (2006). The effects of physical exercise on depressive symptoms among the aged: A systematic review. International Journal of Geriatric Psychiatry, 21(5), 410–418.

    Article  PubMed  Google Scholar 

  27. Armstrong, K., & Edwards, H. (2003). The effects of exercise and social support on mothers reporting depressive symptoms: A pilot randomized controlled trial. International Journal of Mental Health Nursing, 12(2), 130–138.

    Article  PubMed  Google Scholar 

  28. Carter, A. S., Baker, C. W., & Brownell, K. D. (2000). Body mass index, eating attitudes, and symptoms of depression and anxiety in pregnancy and the postpartum period. Psychosomatic Medicine, 62(2), 264–270.

    PubMed  CAS  Google Scholar 

  29. Appleton, K. M., Hayward, R. C., Gunnell, D., Peters, T. J., Rogers, P. J., Kessler, D., et al. (2006). Effects of n-3 long-chain polyunsaturated fatty acids on depressed mood: Systematic review of published trials. American Journal of Clinical Nutrition, 84(6), 1308–1316.

    PubMed  CAS  Google Scholar 

  30. Hibbeln, J. R. (2002). Seafood consumption, the DHA content of mothers’ milk and prevalence rates of postpartum depression: A cross-national, ecological analysis. Journal of Affective Disorders, 69(1–3), 15–29.

    Article  PubMed  CAS  Google Scholar 

  31. Kamphuis, M. H., Geerlings, M. I., Tijhuis, M. A., Kalmijn, S., Grobbee, D. E., & Kromhout, D. (2006). Depression and cardiovascular mortality: A role for n-3 fatty acids? American Journal of Clinical Nutrition, 84(6), 1513–1517.

    PubMed  CAS  Google Scholar 

  32. Leung, B. M., & Kaplan, B. J. (2009). Perinatal depression: Prevalence, risks, and the nutrition link–a review of the literature. Journal of the American Dietetic Association, 109(9), 1566–1575.

    Article  PubMed  CAS  Google Scholar 

  33. Norman, E., Sherburn, M., Osborne, R. H., & Galea, M. P. (2010). An exercise and education program improves well-being of new mothers: A randomized controlled trial. Physical Therapy, 90(3), 348–355.

    Article  PubMed  Google Scholar 

  34. Peterson, K. E., Sorensen, G., Pearson, M., Hebert, J. R., Gottlieb, B. R., & McCormick, M. C. (2002). Design of an intervention addressing multiple levels of influence on dietary and activity patterns of low-income, postpartum women. Health Education Research, 17(5), 531–540.

    Article  PubMed  CAS  Google Scholar 

  35. Ebbeling, C. B., Pearson, M. N., Sorensen, G., Levine, R. A., Hebert, J. R., Salkeld, J. A., et al. (2007). Conceptualization and development of a theory-based healthful eating and physical activity intervention for postpartum women who are low income. Health Promotion Practice, 8(1), 50–59.

    Article  PubMed  Google Scholar 

  36. Institute of Medicine. (2006). WIC Food Packages: Time for a Change. Washington, DC: National Academies Press.

  37. Brink, M., & Sobal, J. (1994). Retention of nutrition knowledge. Journal of nutrition education, 26(74–78).

    Google Scholar 

  38. Dickin, K. L., Dollahite, J. S., & Habicht, J. P. (2005). Nutrition behavior change among EFNEP participants is higher at sites that are well managed and whose front-line nutrition educators value the program. Journal of Nutrition, 135(9), 2199–2205.

    PubMed  CAS  Google Scholar 

  39. McLeroy, K. R., Bibeau, D., Steckler, A., & Glanz, K. (1988). An ecological perspective on health promotion programs. Health Education Quarterly, 15(4), 351–377.

    Article  PubMed  CAS  Google Scholar 

  40. Vella, J. (2002). Learning to listen, learning to teach: The power of dialogue in educating adults. San Francisco: Jossey-Bass.

    Google Scholar 

  41. Miller, W., & Rollnick, S. (1991). Motivational interviewing: Preparing people to change addictive behaviors. New York: Guilford Press.

    Google Scholar 

  42. Breger, R., DeFrancesco, C., & Elliot, D. (2005). Training coders using motivational interviewing treatment integrety coding system. MINT Bulletin, 12(2), 14–16.

    Google Scholar 

  43. Markush, R. E., & Favero, R. V. (1973). Epidemiologic assessment of stressful life events, depressed mood, and psychophysiologic symptoms: A preliminary report. In B. S. Dohrenwend & B. P. Dohrenwend (Eds.), Stressful life events: Their nature and effects. New York: Wiley.

    Google Scholar 

  44. McQuaid, J. R., Stein, M. B., McCahill, M., Laffaye, C., & Ramel, W. (2000). Use of brief psychiatric screening measures in a primary care sample. Depress Anxiety, 12(1), 21–29.

    Article  PubMed  CAS  Google Scholar 

  45. Roberts, R. E. (1980). Reliability of the CES-D Scale in different ethnic contexts. Psychiatry Research, 2(2), 125–134.

    Article  PubMed  CAS  Google Scholar 

  46. Guarnaccia, P. J., Angel, R., & Worobey, J. L. (1989). The factor structure of the CES-D in the Hispanic Health and Nutrition Examination Survey: The influences of ethnicity, gender and language. Social Science and Medicine, 29(1), 85–94.

    Article  PubMed  CAS  Google Scholar 

  47. Wilson, E. O. (1998). Consilience. New York: Alfred A. Knopft.

    Google Scholar 

  48. Kotelchuck, M. (1994). An evaluation of the Kessner Adequacy of Prenatal Care Index and a proposed Adequacy of Prenatal Care Utilization Index. American Journal of Public Health, 84(9), 1414–1420.

    Article  PubMed  CAS  Google Scholar 

  49. Sherbourne, C. D., & Stewart, A. L. (1991). The MOS social support survey. Social Science and Medicine, 32, 705–713.

    Article  PubMed  CAS  Google Scholar 

  50. Barrera, M., Sandler, I. N., & Ramsey, T. B. (1981). Preliminary development of a scale of social support: Studies on college students. American Journal of Communication Psychiatry, 58(3), 304–309.

    Google Scholar 

  51. Sorensen, G., Stoddard, A. M., Dubowitz, T., Barbeau, E. M., Bigby, J., Emmons, K. M., et al. (2007). The influence of social context on changes in fruit and vegetable consumption: Results of the healthy directions studies. American Journal of Public Health, 97(7), 1216–1227.

    Article  PubMed  Google Scholar 

  52. Seeman, T. E., Berkman, L. F., Blazer, D., & Rowe, J. W. (1994). Social ties and support and neuroendocrine function: The MacArthur studies of sucessful aging. Annals of Behavioral Medicine, 16(2), 95–106.

    Google Scholar 

  53. Pereira, M. A., FitzerGerald, S. J., Gregg, E. W., Joswiak, M. L., Ryan, W. J., Suminski, R. R., et al. (1997). A collection of Physical Activity Questionnaires for health-related research. Medicine and Science in Sports and Exercise, 29(6 Suppl), S1–S205.

    PubMed  CAS  Google Scholar 

  54. Wilkinson, S., Huang, C. M., Walker, L. O., Sterling, B. S., & Kim, M. (2004). Physical activity in low-income postpartum women. Journal of Nursing Scholarship, 36(2), 109–114.

    Article  PubMed  Google Scholar 

  55. Willett, W. C., Sampson, L., Stampfer, M. J., Rosner, B., Bain, C., Witschi, J., et al. (1985). Reproducibility and validity of a semiquantitative food frequency questionnaire. American Journal of Epidemiology, 122(1), 51–65.

    PubMed  CAS  Google Scholar 

  56. Baron, R. M., & Kenny, D. A. (1986). The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51(6), 1173–1182.

    Article  PubMed  CAS  Google Scholar 

  57. Rosen, L., Manor, O., Engelhard, D., & Zucker, D. (2006). In defense of the randomized controlled trial for health promotion research. American Journal of Public Health, 96(7), 1181–1186.

    Article  PubMed  Google Scholar 

  58. Goyal, D., Gay, C., & Lee, K. A. (2010). How much does low socioeconomic status increase the risk of prenatal and postpartum depressive symptoms in first-time mothers? Womens Health Issues, 20(2), 96–104.

    Article  PubMed  Google Scholar 

  59. Weiss, B. D., Sheehan, C. P., & Gushwa, L. L. (2009). Is low literacy a risk factor for symptoms of depression in postpartum women? Journal of Reproductive Medicine, 54(9), 563–568.

    PubMed  Google Scholar 

  60. Rich-Edwards, J. W., Kleinman, K., Abrams, A., Harlow, B. L., McLaughlin, T. J., Joffe, H., et al. (2006). Sociodemographic predictors of antenatal and postpartum depressive symptoms among women in a medical group practice. Journal of Epidemiology and Community Health, 60(3), 221–227.

    Article  PubMed  Google Scholar 

  61. Davila, M., McFall, S. L., & Cheng, D. (2009). Acculturation and depressive symptoms among pregnant and postpartum Latinas. Maternal and Child Health Journal, 13(3), 318–325.

    Article  PubMed  Google Scholar 

  62. Moscicki, E. K., Locke, B. Z., Rae, D. S., & Boyd, J. H. (1989). Depressive symptoms among Mexican Americans: The Hispanic Health and Nutrition Examination Survey. American Journal of Epidemiology, 130(2), 348–360.

    PubMed  CAS  Google Scholar 

  63. Kuo, W. H., Wilson, T. E., Holman, S., Fuentes-Afflick, E., O’Sullivan, M. J., & Minkoff, H. (2004). Depressive symptoms in the immediate postpartum period among Hispanic women in three U.S. cities. Journal of Immigrant Health, 6(4), 145–153.

    Article  PubMed  Google Scholar 

  64. Sussner, K. M., Lindsay, A. C., Greaney, M. L., & Peterson, K. E. (2008). The influence of immigrant status and acculturation on the development of overweight in Latino families: A qualitative study. Journal of Immigrant and Minority Health, 10(6), 497–505.

    Article  PubMed  Google Scholar 

  65. Dubowitz, T., Smith-Warner, S. A., Acevedo-Garcia, D., Subramanian, S. V., & Peterson, K. E. (2007). Nativity and duration of time in the United States: Differences in fruit and vegetable intake among low-income postpartum women. American Journal of Public Health, 97(10), 1787–1790.

    Article  PubMed  Google Scholar 

  66. Markides, K. S., & Coreil, J. (1986). The health of Hispanics in the southwestern United States: An epidemiologic paradox. Public Health Reports, 101(3), 253–265.

    PubMed  CAS  Google Scholar 

  67. Fuentes-Afflick, E., & Lurie, P. (1997). Low birth weight and Latino ethnicity. Examining the epidemiologic paradox. Archives of Pediatrics and Adolescent Medicine, 151(7), 655–674.

    Article  Google Scholar 

  68. Dennis, C. L. (2010). Postpartum depression peer support: Maternal perceptions from a randomized controlled trial. International Journal of Nursing Studies, 47(5), 560–568.

    Article  PubMed  Google Scholar 

  69. Muñoz, R. F., Le, H.-N., Ippen, C. G., Diaz, M. A., Urizar, J. G. G., Soto, J., et al. (2007). Prevention of postpartum depression in low-income women: Development of the Mamás y Bebés/Mothers and Babies Course. Cognitive and Behavioral Practice, 14(1), 70–83.

    Article  Google Scholar 

  70. Armstrong, K. L., Fraser, J. A., Dadds, M. R., & Morris, J. (2000). Promoting secure attachment, maternal mood and child health in a vulnerable population: A randomized controlled trial. Journal of Paediatrics and Child Health, 36(6), 555–562.

    Article  PubMed  CAS  Google Scholar 

  71. Morrell, C. J., Spiby, H., Stewart, P., Walters, S., & Morgan, A. (2000). Costs and effectiveness of community postnatal support workers: Randomised controlled trial. BMJ, 321(7261), 593–598.

    Article  PubMed  CAS  Google Scholar 

  72. Reid, M., Glazener, C., Murray, G. D., & Taylor, G. S. (2002). A two-centered pragmatic randomized controlled trial of two interventions of postnatal support. BJOG, 109(1164–1170).

    Google Scholar 

  73. Lavender, T., & Walkinshaw, S. A. (1998). Can midwives reduce postpartum psychological morbidity? A randomized trial. Birth, 25(4), 215–219.

    Article  PubMed  CAS  Google Scholar 

  74. Shields, N., Reid, M., Cheyne, H., Holmes, A. M., McGinley, M., Turnbull, D., et al. (1997). Impact of midwife-managed care in the postnatal period: An exploration of psychosocial outcomes. Journal of Reproductive and Infant Psychology, 15(2), 91–108.

    Article  Google Scholar 

  75. MacArthur, C., Winter, H. R., Bick, D. E., Knowles, H., Lilford, R., Henderson, C., et al. (2002). Effects of redesigned community postnatal care on women’s health 4 months after birth: A cluster randomised controlled trial. Lancet, 359(9304), 378–385.

    Article  PubMed  CAS  Google Scholar 

  76. Klebanov, P. K., Brooks-Gunn, J., & McCormick, M. C. (2001). Maternal coping strategies and emotional distress: Results of an early intervention program for low birth weight young children. Developmental Psychology, 37(5), 654–667.

    Article  PubMed  CAS  Google Scholar 

  77. Hayes, B. A., Muller, R., & Bradley, B. S. (2001). Perinatal depression: A randomized controlled trial of an antenatal education intervention for primiparas. Birth, 28(1), 28–35.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

The authors are grateful to Sara Schlotterbeck for assistance with literature review and manuscript revision and to Dr. Juhee Kim and Dr. Jorge Chavarro for consultation on analysis of mediators of the intervention effect. We thank the women who participated in the JFY study, numerous field and evaluation staff and co-investigators and the staff of the Massachusetts EFNEP and Massachusetts WIC Program, all of whom made this project possible. This study was supported in part by RO1 HD 37368 to KEP; 5 T32 MH073122-04 fellowship to PJS; and MCH-B 5T76MC00001 (formerly MCJ201) to MM.

Author information

Authors and Affiliations

  1. Division of Social and Behavioral Interventions, Department of International Health, Johns Hopkins School of Public Health, 615 North Wolfe Street, Baltimore, MD, 21205-2103, USA

    Pamela J. Surkan

  2. Brigham and Women’s Hospital, Department of Medicine, Division of General Medicine and Division of Women’s Health, Boston, MA, USA

    Barbara R. Gottlieb

  3. Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, MA, USA

    Marie C. McCormick

  4. Hunt Consulting Associates, Logan, UT, USA

    Anne Hunt

  5. Human Nutrition Program, Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA

    Karen E. Peterson

Authors
  1. Pamela J. Surkan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Barbara R. Gottlieb
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marie C. McCormick
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Anne Hunt
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Karen E. Peterson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Pamela J. Surkan.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Surkan, P.J., Gottlieb, B.R., McCormick, M.C. et al. Impact of a Health Promotion Intervention on Maternal Depressive Symptoms at 15 months Postpartum. Matern Child Health J 16, 139–148 (2012). https://doi.org/10.1007/s10995-010-0729-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10995-010-0729-x

Keywords

Search

Navigation