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. 2009 Aug;77(4):788-99.
doi: 10.1037/a0015709.

Examining maternal depression and attachment insecurity as moderators of the impacts of home visiting for at-risk mothers and infants

Anne K Duggan  1 , Lisa J Berlin, Jude Cassidy, Lori Burrell, S Darius Tandon
Affiliations

Examining maternal depression and attachment insecurity as moderators of the impacts of home visiting for at-risk mothers and infants

Anne K Duggan et al. J Consult Clin Psychol. 2009 Aug.

Abstract

Home visiting programs for at-risk mothers and their infants have proliferated nationally in recent years, yet experimental studies of home visiting have yielded mixed findings. One promising strategy for explicating the effects of early home visiting is to examine moderators of program impacts. This study assessed the roles of maternal depression and attachment insecurity as moderators of the impacts of Healthy Families Alaska home visiting services for at-risk mothers and their infants. At-risk families (N = 325) were randomly assigned to home visiting or community services as usual (n = 162 and 163, respectively). Maternal depression and attachment insecurity (attachment anxiety and discomfort with trust/dependence) were measured at baseline. Maternal psychosocial and parenting outcomes were measured when children were 2 years old via maternal self-report, observation, and review of substantiated reports of child maltreatment. Maternal depression and attachment insecurity interacted in their moderation of program impacts. For several outcomes, home visiting impacts were greatest for nondepressed mothers with moderate-to-high discomfort with trust/dependence and for depressed mothers with low discomfort with trust/dependence. Implications for practice and policy are discussed.

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Figures

Figure 1
Figure 1
Moderated program impacts on maternal psychosocial outcomes and parenting behaviors. Dotted lines represent AORs for mothers depressed at baseline. Solid line represents AORs for mothers not depressed at baseline. Bold portions of lines indicate regions of significance for home visited vs. control group mothers (p < .10). Panel A: Program impacts on partner violence as moderated by baseline maternal depression and discomfort with trust/dependence. Panel B: Program impacts on high parenting stress as moderated by baseline maternal depression and discomfort with trust/dependence. Panel C: Program impacts on maternal depression as moderated by baseline maternal depression and attachment anxiety. Panel D: Program impacts on maternal depression as moderated by maternal discomfort with trust/dependence. Panel E: Program impacts on poor HOME scores as moderated by baseline maternal depression and discomfort with trust/dependence. Panel F: Program impacts on maternal sensitivity to cues as moderated by baseline maternal depression and attachment anxiety. Panel G: Program impacts on substantiated child maltreatment as moderated by baseline maternal depression and discomfort with trust/dependence for mothers with low attachment anxiety (1 SD below the mean). Panel H: Program impacts on substantiated child maltreatment as moderated by baseline maternal depression and discomfort with trust/dependence for mothers with high attachment anxiety (1 SD above the mean).
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