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Alleviating perinatal depressive symptoms and stress: a nurse-community health worker randomized trial

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Abstract

To determine whether a Nurse-Community Health Worker (CHW) home visiting team, in the context of a Medicaid enhanced prenatal/postnatal services (EPS), would demonstrate greater reduction of depressive symptoms and stress and improvement of psychosocial resources (mastery, self-esteem, social support) when compared with usual Community Care (CC) that includes Medicaid EPS delivered by professionals. Greatest program benefits were expected for women who reported low psychosocial resources, high stress, or both at the time of enrollment. Medicaid eligible pregnant women (N = 613) were randomly assigned to either usual CC or the Nurse-CHW team. Mixed effects regression was used to analyze up to five prenatal and postnatal psychosocial assessments. Compared to usual CC, assignment to the Nurse-CHW team resulted in significantly fewer depressive symptoms, and as hypothesized, reductions in depressive symptoms were most pronounced for women with low psychosocial resources, high stress, or both high stress and low resources. Outcomes for mastery and stress approached statistical significance, with the women in the Nurse-CHW group reporting less stress and greater mastery. Women in the Nurse-CHW group with low psychosocial resources reported significantly less perceived stress than women in usual CC. No differences between the groups were found for self-esteem and social support. A Nurse-CHW team approach to EPS demonstrated advantage for alleviating depressive symptoms in Medicaid eligible women compared to CC, especially for women at higher risk.

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Acknowledgement

This work was supported by grant R50 MC 000 45-04 R2 from the Maternal and Child Health Bureau (Title V, Social Security Act), Health Resources and Services Administration, Department of Health and Human Services, the Spectrum Health Foundation, Grand Rapids, MI and in part by the Agency for Healthcare Research & Quality under grant 1R01 HS14206. The authors thank the community research assistants, the CHWs and nurses, and especially the pregnant women and new mothers who maintained participation in the study while often living in challenging life circumstances. Also, we thank Spectrum Health, Kent County Health Department, Cherry Street Health Services, and St. Mary’s Health Care (Clinica Santa Maria), and Marcia Gebben, BSN, MA, DeVos Children’s Hospital, Spectrum Health, project research coordinator.

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Authors and Affiliations

  1. Department of Obstetrics, Gynecology and Reproductive Biology, College of Human Medicine, Michigan State University, 226 West Fee Hall, East Lansing, MI, 48824, USA

    Lee Anne Roman

  2. Department of Epidemiology, College of Human Medicine, Michigan State University, B601 West Fee Hall, East Lansing, MI, 48824, USA

    Joseph C. Gardiner, Zhehui Luo & Nigel Paneth

  3. Department of Economics, College of Social Sciences, Michigan State University, 110 Marshall-Adams Hall, East Lansing, MI, 48824, USA

    John H. Goddeeris

  4. Department of Psychology, College of Social Sciences, Michigan State University, Psychology Building, East Lansing, MI, 48824, USA

    Lauren R. Barton & Hiram E. Fitzgerald

  5. Spectrum Health, 100 Michigan St. NE, Grand Rapids, MI, 49503, USA

    Judith K. Lindsay & Joseph S. Moore

  6. Grand Rapids Medical Education & Research Center, 1000 Monroe Avenue, NW, Grand Rapids, MI, 49503, USA

    Lawrence J. Baer & Allen L. Shoemaker

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  1. Lee Anne Roman
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  2. Joseph C. Gardiner
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Roman, L.A., Gardiner, J.C., Lindsay, J.K. et al. Alleviating perinatal depressive symptoms and stress: a nurse-community health worker randomized trial. Arch Womens Ment Health 12, 379–391 (2009). https://doi.org/10.1007/s00737-009-0083-4

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