Treatment for mothers with postnatal depression to improve child outcome: a randomised controlled trial. (360G-Wellcome-090139_Z_09_Z)

Maternal postnatal depression (PND) affects around 13% of mothers. Compared to children of non-depressed mothers, children of mothers with PND are more likely to have cognitive, behavioural, and attachment problems. Treating maternal depression alone does not improve child outcome. Thus attention should focus on improving mother-child interaction. We aim to examine whether a treatment to enhance mother-child interactions leads to improved child outcome. Mothers with PND will be randomised to one of two home-based treatments: video-feedback (index) to improve mother-child interactions, or relaxation training (control). Both will receive cognitive-behaviour therapy for depression. The two groups will be compared post-treatment and one year later. Further, we aim to test three hypothesised environmental mechanisms whereby PND adversely affects child outcome, by focusing treatment on key parenting capacities impaired in PND: (a) maternal focus of attention on the infant and associate d contingent responsiveness; (b) maternal emotional scaffolding; (c) capacity to treat the child as a psychological agent together with behavioural sensitivity to attachment cues. These mechanisms will be examined by comparing the effects of treatment on parenting, and then examining whether improved parenting mediates the effects of treatment on child outcome. Links between specific parenting capacities and particular child outcomes will be examined.