Depressed and Socioeconomically Disadvantaged Mothers' Progression Into a Randomized Controlled Mobile Mental Health and Parenting Intervention: A Descriptive Examination Prior to and During COVID-19

Kathleen M Baggett, Betsy Davis, Elizabeth A Mosley, Katy Miller, Craig Leve, Edward G Feil, Kathleen M Baggett, Betsy Davis, Elizabeth A Mosley, Katy Miller, Craig Leve, Edward G Feil

Abstract

Infants of low-income and depressed mothers are at high risk for poor developmental outcomes. Early parenting mediates infant experiences from birth, and early intervention can support sensitive and responsive parent practices that optimize infant outcomes via promoting developmental competencies. However, low-income and depressed mothers experience substantial challenges to participating in early intervention. They also have extremely limited access to interventions targeting depression. Interventions targeting maternal depression and parent practices can improve maternal and infant outcomes. Mobile internet-based interventions overcome numerous barriers that low-resource mothers face in accessing home-based interventions. Pandemic-related stressors likely reduce family resources and exacerbate distress of already heavily-burdened mother-infant dyads. During crises such as the COVID-19 pandemic, evidence-based remote coaching interventions are paramount. This article reports on a mobile intervention for improving maternal mood and increasing parent practices that promote infant development. An ongoing randomized controlled trial study provided a unique opportunity to monitor progression from referral to intervention initiation between two groups of depressed mothers: those prior to the pandemic and during the pandemic. The study also examines mother and infant characteristics at baseline. The sample consisted primarily of Black mothers experiencing extreme poverty who self-referred to the study in a large southern city, which is one of the most income disparate in the United States. Prior to the pandemic, 97% of study participants successfully progressed from consent to intervention, as compared to significantly fewer-86%-during the pandemic. Mother-infant dyads during COVID-19, as compared to those prior to COVID-19, displayed similar pre-intervention demographic characteristics and intrapersonal characteristics.

Keywords: COVID-19; infant; maternal depression; mobile intervention; parenting; remote coaching.

Conflict of interest statement

KB, BD and EF are the developers of the InfantNet program, the original intervention platform on which the ePALS Mom and Baby Net program application is based. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2021 Baggett, Davis, Mosley, Miller, Leve and Feil.

Figures

FIGURE 1
FIGURE 1
Referral to intervention engagement progression. Arrows from left to right signify participants moving from pre-pandemic experience into pandemic experience at each study progression point. *Prior to COVID, 320 mothers were referred over a 22-month period resulting in an average of 14.5 referrals per month, equivalent to less than an average of two referrals per day. During COVID, 118 mothers self-referred in response to a provider text blast. Over a 3-day period, 118 referrals are equivalent to an average of 39 mothers per day. Hence, mothers referred at a relative daily rate of 19.5 times higher during COVID as compared to non-covid. Referral was closed after this 3-day referral period. **It was not possible to consent all referred, screened, and eligible mothers during COVID because this number exceeded the number of open slots for targeted enrolment. Prior to COVID, a 2.43% of participants were lost to the study after consent as compared to 16.39% lost during pandemic. Hence, 6.75 times more mothers were lost to the study during the pandemic.

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