Preventing Maternal depression, Intimate Partner Violence, and Substance Use through Relationship Education during Home Visiting

QING LI, MD, DrPH
University of Colorado

Our study aims to evaluate the effectiveness of a nurse home visiting program augmented with relationship education on maternal depression (MD), intimate partner violence (IPV), and substance use (SU). Relationship education (RE) from family psychology has addressed marital distress, dating violence, and IPV. Through modeling and monitoring a vision of commitment, teaching skills, and empowering future-oriented decision-making (self-efficacy), RE programs (Hawkins, 2018; Stanley et al., 2020) address precursors of relationship instability, reduce antecedents and triggers of IPV, and thus can disrupt the occurrence of IPV and prevent MD. However, gaps remain in implementing RE in home visiting. One trial (Feder et al., 2018) was the first attempt to integrate RE into home visiting workflows to prevent IPV but the effectiveness on MD and SU were not evaluated. Although the Home Visiting Collaborative Improvement & Innovation Network increased RE service from 41% to 58%, RE was not comprehensive or standardized across models.

We performed secondary data analyses of a longitudinal randomized controlled trial at three waves from 2005 to 2011. In the NFP program in Oregon, 238 first-time, low-income mothers were randomized to a standard or augmented program when nurses delivered Within My Reach relationship education curriculum during pregnancy.

During pregnancy, and 1- year and 2-year follow-up, research assistants interviewed mothers with the Edinburgh Depression Inventory, Alcohol Use Disorder Identification Test and Drug Abuse Screening Test, and the Revised Conflict Tactics Scale. IPV was a count of victimization and/or perpetration of physical assault, sexual coercion, and physical injury. Multilevel zero-inflated negative binomial regression models and mediation analyses (using PROC NLMIXED and CAUSALMED) were performed, adjusting for race, age, education, and nativity status.

At baseline, participants in the augmented (n=133) and standard (n=105) programs did not differ in maternal age or nativity status (p>0.05). However, more Hispanic mothers (56%) were in the augmented program (p=0.03), and more White mothers (36%) in the standard program (p=0.04). The augmented program did not reduce MD, IPV, or SU at the 1-year or 2-year follow-up points. It affected MD at 2-year follow-up through IPV as a mediator at 1-year follow-up.

The NFP program augmented with relationship education did not affect MD, IPV, or SU, but IPV was a mediator to reduce MD. Study findings inform hypothesis generating in future trials. Meanwhile, other evidence-based interventions need to be included, for example engaging fathers in mother-father dyads. This study extended nursing’s role of caring for abused women to include relationship education. Large trans-disciplinary studies are needed to perform mediation analyses to delineate mechanisms of change and improve home visiting models to prevent MD, IPV,