Preliminary Effectiveness of Family Therapy for Perinatal Depressive Symptoms: Results From a Pilot Randomized Trial

A significant portion of mothers (pregnant and postpartum) enrolled in U.S. home visiting programs report clinically significant depressive symptoms. Non-violent family conflict precipitates and exacerbates their depressive symptoms. This pilot randomized trial tested the preliminary effectiveness of a family therapy intervention, Resilience Enhancement Skills Training (REST), compared to the standard of care in home-visited mothers with moderate to severe depressive symptoms and moderate to high conflict with family members. A total of 83 mothers and their family members (N = 166) were randomized to receive REST or the standard of care. Both interventions were delivered by clinicians using HIPAA-compliant video conferencing technology. Outcomes were assessed by research assistants, blinded to study group assignment, at post-intervention, 3, and 6 months later. Linear mixed-effects models were used to analyze changes in continuous outcomes in mothers and family members, separately. Mixed-effects logistic regression was used to analyze changes in maternal job attainment/school enrollment. Participants in both study groups showed improvements in outcomes. When compared to standard-of-care participants, REST participants had significantly greater reductions in family conflict (mothers ES = -1.19, family members ES = -0.77), maternal depressive symptoms (ES = -0.96) and co-occurring anxiety symptoms (ES = -0.59), and greater increases in family cohesion (mothers ES = 0.99, family members ES = 0.94) and maternal job attainment/school enrollment (ES = 0.70). The results highlight the value of family therapy for the treatment of moderate to severe depressive symptoms in home-visited mothers, including those with co-occurring moderate to severe anxiety symptoms. Trial Registration: Registered in ClinicalTrials.gov on 02/04/2021. NCT04741776 https://clinicaltrials.gov/ct2/show/NCT04741776.