Depressed and Socioeconomically Disadvantaged Mothers’ Progression Into a Randomized Controlled Mobile Mental Health and Parenting Intervention: A Descriptive Examination Prior to and During COVID-19

Infants of low-income and depressed mothers are at high risk for poor developmental outcomes. Early parenting mediates infant experiences from birth, and early intervention can support sensitive and responsive parent practices that optimize infant outcomes via promoting developmental competencies. However, low-income and depressed mothers experience substantial challenges to participating in early intervention. They also have extremely limited access to interventions targeting depression. Interventions targeting maternal depression and parent practices can improve maternal and infant outcomes. Mobile internet-based interventions overcome numerous barriers that low-resource mothers face in accessing home-based interventions. Pandemic-related stressors likely reduce family resources and exacerbate distress of already heavily-burdened mother-infant dyads. During crises such as the COVID-19 pandemic, evidence-based remote coaching interventions are paramount. This article reports on a mobile intervention for improving maternal mood and increasing parent practices that promote infant development. An ongoing randomized controlled trial study provided a unique opportunity to monitor progression from referral to intervention initiation between two groups of depressed mothers: those prior to the pandemic and during the pandemic. The study also examines mother and infant characteristics at baseline. The sample consisted primarily of Black mothers experiencing extreme poverty who self-referred to the study in a large southern city, which is one of the most income disparate in the United States. Prior to the pandemic, 97% of study participants successfully progressed from consent to intervention, as compared to significantly fewer–86%–during the pandemic. Mother-infant dyads during COVID-19, as compared to those prior to COVID-19, displayed similar pre-intervention demographic characteristics and intrapersonal characteristics.

Optimizing Social-Emotional-Communication Development in Infants of Mothers with Depression: A Randomized Controlled Trial Protocol of a Mobile Intervention Targeting Depression and Responsive Parenting (Preprint)

BACKGROUND Postpartum depression interferes with maternal engagement in interventions shown to be effective in improving infant social-emotional and communication outcomes. There is an absence of integrated interventions with demonstrated effectiveness in both reducing maternal depression and promoting parent-mediated practices that optimize infant social-emotional and communication competencies. Interventions targeting maternal depression are often separate from parent-mediated interventions. To address the life course needs of depressed mothers and their infants, we need brief, accessible, and integrated interventions that target both maternal depression and specific parent practices shown to improve infant social-emotional and communication trajectories. OBJECTIVE Evaluate the efficacy of a mobile internet intervention, Mom and Baby Net (MBN), with remote coaching to improve maternal mood and promote parent practices that optimize infant social-emotional and communication development. METHODS This is a 2-arm, randomized controlled, intent-to-treat trial. Primary outcomes include maternal depression symptoms and observed parent and infant behavior. Outcomes are measured via direct observational assessment and standardized questionnaires. The sample is being recruited within the urban core of a large southern city in the U.S. Study enrollment was initiated in 2017 and concluded in 2020. Participants are biological mothers with elevated depression symptoms, 18 years of age or older, who have custody of an infant less than 12 months of age. Exclusion criteria at the time of screening include maternal homelessness or shelter residence, inpatient mental health and/or substance abuse treatment, or maternal or infant treatment of a major mental or physical illness that would hinder meaningful study participation. RESULTS The start date of this grant-funded randomized controlled trial was September 1, 2016. Data collection is underway. Following IRB-approved pilot work, the randomized controlled trial was IRB- approved on November 17, 2017. Immediately following IRB approval, recruitment was initiated. Between February 15, 2018 and March 11, 2021, we successfully consented a sample of 184 women and their infants into the randomized controlled trial. The sample is predominantly African American and socioeconomically disadvantaged. CONCLUSIONS Data collection is scheduled to conclude in March 2022. We anticipate that relative to the attention control condition, which is focused on education around maternal depression and infant developmental milestones with matching technology and coaching structure, mothers in the MBN intervention will experience greater reductions in depression and gains in sensitive and responsive parent practices, and that their infants will demonstrate greater gains in social-emotional and communication behavior. CLINICALTRIAL Clinicaltrials.gov, identifier NCT03464630, https://clinicaltrials.gov/ct2/show/NCT03464630

Human infancy and parenting in global perspective: specificity

We address three long-standing fundamental questions about early human development and parental caregiving within a specificity framework using data from 796 infant–mother dyads from 11 societies worldwide. Adopting a cross-society view opens a vista on universal biological origins of, and contextual influences on, infant behaviours and parenting practices. We asked: how do infant behaviours and parenting practices vary across societies? How do infant behaviours relate to other infant behaviours, and how do parent practices relate to other parent practices? Are infant behaviours and parent practices related to one another? Behaviours of firstborn five-month infants and parenting practices of their mothers were microanalysed from videorecords of extensive naturally occurring interactions in the home. In accord with behavioural specificity, biological expectations and cultural influences, we find that infants and mothers from diverse societies exhibit mean-level society differences in their behaviours and practices; domains of infant behaviours generally do not cohere, nor do domains of maternal practices; and only specific infant behaviours and mother practices correspond. Few relations were moderated by society.

Parenting practices are associated with fruit and vegetable consumption in pre-school children

ObjectiveParents may influence children’s fruit and vegetable (F&V) consumption in many ways, but research has focused primarily on counterproductive parenting practices, such as restriction and pressure to eat. The present study aimed to assess the association of diverse parenting practices to promote F&V and its consumption among pre-school children.DesignAn exploratory analysis was performed on cross-sectional data from 755 Head Start pre-school children and their parents collected in 2004–5. Data included parent practices to facilitate child F&V consumption (grouped into five categories); parent-reported dietary intake of their child over 3 d; and a number of potential correlates. K-means cluster analysis assigned parents to groups with similar use of the food parenting practice categories. Stepwise linear regression analyses investigated the association of parent clusters with children’s consumption of F&V, after controlling for potential confounding factors.ResultsA three-cluster solution provided the best fit (R2 = 0·62), with substantial differences in the use of parenting practices. The clusters were labelled Indiscriminate Food Parenting, Non-directive Food Parenting and Low-involved Food Parenting. Non-directive parents extensively used enhanced availability and teachable moments’ practices, but less firm discipline practices than the other clusters, and were significantly associated with child F&V intake (standardized β = 0·09, P < 0·1; final model R2 = 0·17) after controlling for confounders, including parental feeding styles.ConclusionsParents use a variety of parenting practices, beyond pressuring to eat and restrictive practices, to promote F&V intake in their young child. Evaluating the use of combinations of practices may provide a better understanding of parental influences on children’s F&V intake.