Problem-Solving Intervention May Prevent Maternal Depression

Delivering a cognitive behavioral program through Head Start may prevent increases in depressive symptoms for at risk, low-income mothers


A new study, published in JAMA Psychiatry, investigates the effect of a problem-solving education intervention, delivered through the community-based agency Head Start, on preventing depression in low-income mothers. The results of the randomized clinical trial suggest that a short-term, cognitive behavioral program may help prevent an increase in depressive symptoms for mothers with lower-level baseline depressive symptoms.

“The efficacy of problem-solving education demonstrates the promise of embedding maternal depression prevention programs in Head Start,” write the researchers, led by Michael Silverstein, a professor at the Boston University School of Medicine and doctor at Boston Medical Center.

U.S. Navy Photo by Mass Communication Specialist 2nd Class Yasmine T. Muhammad

Low-income and minority mothers experience maternal depression at disproportionately high rates. Recent research also suggests that transitioning into poverty may worsen mental health for mothers. In 2009, the Institute of Medicine called for community-based initiatives to treat parental depression in order to improve parents’ access to services. The researchers identified the federal program Head Start as a possible venue since it serves about 1 million low-income families a year.

They write, “Because of disparities in access to mental health services for low-income and minority populations, embedding effective mental illness prevention strategies in accessible community- based venues such as Head Start is a potentially important public health strategy.”

The authors sought to test the effectiveness of a 6-session cognitive behavioral program called Problem-Solving Education (PSE) for low-income mothers at risk of developing a major depressive episode. From 2011 to 2016, the authors conducted a randomized clinical trial at 6 Head Start centers in Boston, MA. They recruited 230 at risk mothers who were randomly assigned to PSE or usual Head Start services.

Mothers were considered “at risk” of a major depressive episode if they reported experiencing depressed mood or anhedonia, or had a history of depression. The authors report that this is the first study to “embed a lay-delivered intervention in a community-based agency charged with addressing the needs of low-income families.”

The average age of mothers was 31.4 years and 66% of participants were Hispanic. Forty-two percent of participants had a history of a major depressive episode. The intervention did not have an effect on problem-solving skills. However, improvement in problem-solving did not appear necessary to prevent increases in depressive symptoms.

The researchers found that for participants with mild depressive symptoms, the PSE intervention significantly prevented an increase in depressive symptoms. The adjusted incident rate ratio was 0.39, meaning for every 100 people in the control group who have an increase in depressive symptoms, only 39 people in the PSE group would experience symptom increases.

PSE did not have an effect on participants with moderate to severe depressive symptoms. PSE also did not have a significant effect on preventing the development of a major depressive episode within the 12 month follow up period. The researchers report, “The PSE intervention substantially reduced the rate of symptomatic person-time during a full calendar year, particularly for those with low symptom burdens at baseline.”

This study adds to the evidence that short-term psychosocial treatments (e.g., Interpersonal Therapy) may help prevent depression in mothers. The authors note that the intervention was not effective for mothers with more severe symptoms and suggest that “as a stand-alone intervention, PSE may not be intense enough to break through clinically significant symptoms to produce its effect.”

The researchers highlight that participants in depression prevention research “have rarely represented the US demographic groups with the poorest access to conventional treatment services.” They call for more research on the effectiveness of prevention programs in community-based settings in order to develop “meaningful public health programs” to support low-income and minority mothers.



Silverstein, M., Diaz-Linhart, Y., Cabral, H., Beardslee, W., Hegel, M., Haile, W., … & Feinberg, E. (2017). Efficacy of a maternal depression prevention strategy in Head Start: A randomized clinical trial. JAMA Psychiatry. Advance online publication. doi:10.1001/jamapsychiatry.2017.1001 (Abstract)

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Shannon Peters
MIA Research News Team: Shannon Peters is a doctoral student at the University of Massachusetts Boston and has a master’s degree in mental health counseling. She is particularly interested in exploring the impacts of medicalization and pathologizing the experiences of individuals who have been affected by trauma. She is engaged in research on the effects of institutional corruption and financial conflicts of interest on research and practice.


    • Not sure “finding a job” is completely “their own” issue. Affordable child care, too? While one is, if one is, working, who is going to provide that? I’d have to say, broadly speaking, their issues are tied up with our issues, and the resolving of one is intricately bound to the resolving of the other.

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      • “”””Not sure “finding a job” is completely “their own” issue. “””””” I agree more than you might think. I made documentaries and wrote books about this. My question was about the method of the intervention. The article does not address that. What did they teach them in terms of “problem-solving”? I thought maybe they tried to help them solve their financial and emotional situation.

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  1. I’d like to know why the people writing our welfare laws thought it was better to force me to work an exhausting, minimum wage labor intensive job and to pay more for my daughter to attend daycare than my job paid me, setting me up to be stressed and depressed. Wouldn’t a minimum income or at least a maternal income for the first few years that supported low income mothers and allowed them to stay at home and nurture their children be a better way to prevent maternal depression? I didn’t need job finding skills, I needed enough resources to not be homeless and to feed my child. Our home didn’t suffer from a lack of love, it suffered from a lack of money.

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    • A society that has spent numerous decades routinely drugging up new mothers, with mind altering and dumbing down psychotropic drugs, is a sick society. Wake up paternalistic DSM deluded doctors, wake up.

      Kindredspirit, the psychological and psychiatric professions have been targeting the stay-at-home mothers, too. Today’s psychological and psychiatric “professionals” have odd delusions that raising one’s children properly and volunteering to help lots of other children is “unemployed,” “w/o work, content, and talent” (prior to even looking at the art portfolio I was also working on, which was eventually confessed to be “insightful”), “irrelevant to reality,” and ultimately “a credible fictional story.” I guess the satanically led psychiatric industry wants the art history books to be filled only with the satanic pedophilia art and “Spirit Cooking art” for which our world’s current self professed “elite” have a penchant?

      I’m not certain today’s ungodly disrespectful, staggeringly unethical, and insanely delusional “mental health professionals” could behave in a much more destructive manner to our society than they currently are, especially given the completely iatrogenic “childhood bipolar epidemic” they also created.

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