Depression treatment delivered at the point-of-care: a qualitative assessment of the views of low-income US mothers

Abstract

Background/objective: Within the first months of childbirth, clinically significant depressive symptoms are experienced by 19% of mothers in the USA, and are even more prevalent among low-income and ethnic-minority women. Paradoxically, low-income and ethnic-minority mothers are faced with unique barriers that make them less likely to receive professional mental health care. To find ways to remove these barriers, a recent US trial extended the use of a UK intervention, Listening Visits, an evidence-based treatment delivered by home visitors/office nursing staff. Methods: A qualitative content analysis was conducted with participants’ (N = 19 in an open trial and N = 49 in a randomised controlled trial) responses to a post-treatment semi-structured interview assessing their views of Listening Visits. The percentage of participants endorsing each thematic code is presented. Results: When the provider first introduced the Listening Visits intervention, 77.9% of women retrospectively reported having positive views of trying this new approach. Recipients most frequently mentioned as helpful two aspects of Listening Visits: empathic listening/support and the collaborative style of the Listening Visits provider. Half of the women (50%) did not suggest changes to how Listening Visits was delivered. Among those who suggested changes, the most frequent (42.6%) suggestion was to increase the number/duration of sessions. Conclusion: Listening Visits is an acceptable depression treatment approach, as perceived by low-income, ethnic-minority mothers, which health and social service providers who serve this population can use.

Keywords:

• Depression
• depression treatment
• culture and psychotherapy
• qualitative research methods
• low-income, ethnic-minority mothers

Acknowledgements

The authors thank Sydney Farnsworth, Laura Houghton, Megan Leibforth, Elizabeth Tuchscherer and Karolina Wartalowicz for their invaluable assistance with coding; Nancy Grote, PhD, Cynthia Battle, PhD, Michael O’Hara, PhD, Briana Woods-Jaeger, PhD, Cheryl T. Beck, PhD, and Erica Prussing, PhD for their helpful suggestions and comments; Diana Colgan PhD, the College of Nursing editor; and the women who provided their views.

Notes

1. Participant’s responses were recorded in note form. Although interviewers were instructed to record women’s responses verbatim, the lack of audio-recording renders it impossible to verify that these were the women’s exact words. For this reason, we refer to these as ‘paraphrased participant responses’ as opposed to participant quotes.

2. In the Listening Visits Open trial study (Segre et al., 2010), a small part of the manuscript reports on treatment acceptability and suggested changes for treatment for this relatively small sample (N = 19). The findings reported in the current manuscript are much more comprehensive (N = 68) and the complete focus of this paper.