The effect of early stimulation on maternal depression: a cluster randomised controlled trial

Aim: To determine the effect of early childhood stimulation with undernourished children and their mothers on maternal depression. Methods: Mothers of 139 undernourished children (weight for age <= -1.5 z-scores) aged 9 - 30 months were recruited from 18 government health centres in the parishes of Kingston, St Andrew, and St Catherine, Jamaica. They received weekly home visits by community health aides for one year. Mothers were shown play activities to do with their child using home made materials, and parenting issues were discussed. Frequency of maternal depressive symptoms was assessed by questionnaire. Child development was also measured. Results: Mothers in the intervention group reported a significant reduction in the frequency of depressive symptoms (b = -0.98; 95% CI -1.53 to -0.41). The change was equivalent to 0.43 SD. The number of home visits achieved ranged from 5 to 48. Mothers receiving >= 40 visits and mothers receiving 25 - 39 visits benefited significantly from the intervention ( b = -1.84, 95% CI -2.97 to -0.72, and b = -1.06, 95% CI -2.02 to -0.11, respectively) while mothers receiving < 25 visits did not benefit. At follow up, maternal depression was significantly negatively correlated with children's developmental quotient for boys only. Conclusions: A home visiting intervention with mothers of undernourished children, with a primary aim of improving child development, had significant benefits for maternal depression. Higher levels of maternal depression were associated with poorer developmental levels for boys only.