Skip to main content
SpringerLink
Log in

Maternal Relationship Insecurity and Depressive Symptoms as Moderators of Home Visiting Impacts on Child Outcomes

  • Original Paper
  • Published:
Journal of Child and Family Studies Aims and scope Submit manuscript

Abstract

The purpose of this study was to determine the extent to which maternal relationship insecurity and severe depressive symptoms moderate home visiting impacts on developmental and behavioral outcomes in 2-year old children. In an experimental trial of the Healthy Families Alaska home visiting program, families (N = 249) were randomly assigned to home visiting (n = 126) or community services as usual (n = 123). Maternal severe depressive symptoms (CES-D ≥ 24) and relationship insecurity were measured using the Center for Epidemiologic Studies Depression Scale and the Attachment Style Questionnaire at baseline. Child cognitive and psychomotor development and behavior problems were measured with the Bayley Scales of Infant Development and the Child Behavior Checklist at follow-up. The results revealed that home visiting significantly impacted three outcomes—child cognitive development, internalizing behavior, and externalizing behavior. Home visiting impacts were limited to subgroups defined by maternal depressive symptoms and relationship insecurity. Home visiting improved cognitive development (B = 6.02, p < .03), and decreased internalizing behavior (B = −3.83, p = .02) and externalizing behavior problems (B = −3.74, p = .03) in children of mothers with either severe depressive symptoms or high levels of discomfort with trust at baseline, but not both. Family engagement in home visiting seems to play a role in mediating these moderating effects. These findings reflect the importance of screening for maternal relationship insecurity and depressive symptoms to distinguish family subgroups likely to benefit from home visiting from those for whom an enhanced service model might be needed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  • Achenbach, T. M. (1991). Manual for the child behavior checklist and the 1991 profile. Burlington, VT: University of Vermont, Department of Psychiatry.

    Google Scholar 

  • Achenbach, T. M., & Rescorla, L. A. (2000). Manual for the ASEBA preschool forms and profiles. Burlington, VT: University of Vermont, Research Center for Children, Youth, and Families.

    Google Scholar 

  • Aiken, L. S., & West, S. G. (1991). Multiple regression: Testing and interpreting interactions. Newbury Park, CA: Sage.

    Google Scholar 

  • Ammerman, R. T., Peugh, J. L., Putnam, F. W., & Van Ginkel, J. B. (2012). Predictors of treatment response in depressed mothers receiving in-home cognitive behavioral therapy and concurrent home visiting. Behavior Modification, 36(4), 462–481.

    Article  PubMed  Google Scholar 

  • Ammerman, R. T., Putnam, F. W., Altaye, M., Stevens, J., Teeters, A. R., & Van Ginkel, J. B. (2013a). A clinical trial of in-home CBT for depressed mothers in home visitation. Behavior Therapy. doi:10.1016/j.beth.2013.01.002.

  • Ammerman, R. T., Putnam, F. W., Altaye, M., Teeters, A. R., Stevens, J., & Van Ginkel, J. B. (2013b). Treatment of depressed mothers in home visiting: Impact on psychological distress and social functioning. Child Abuse and Neglect. doi:10.1016/j.chiabu.2013.03.003.

  • Ammerman, R. T., Putnam, F. W., Kopke, J. E., Gannon, T. A., Short, J. A., Van Ginkel, J. B., et al. (2007). Development and implementation of a quality assurance infrastructure in a multisite home visitation program in Ohio and Kentucky. Journal of Prevention and Intervention in the Community, 34, 89–107.

    Article  PubMed  Google Scholar 

  • Ammerman, R. T., Putnam, F. W., Stevens, J., Holleb, L. J., Novak, A. L., & Van Ginkel, J. B. (2005). In-home cognitive behavior therapy for depression: An adapted treatment for first-time mothers in home visitation. Best Practices in Mental Health, 1, 1–14.

    Google Scholar 

  • Bair-Merritt, M. H., Crowne, S. S., Burrell, L., Caldera, D., Cheng, T. L., & Duggan, A. K. (2008). Impact of intimate partner violence on children’s well-child care and medical home. Pediatrics, 121(3), 473–480.

    Article  Google Scholar 

  • Bayley, N. (1993). Bayley Scales of infant development (2nd ed.). San Antonio, TX: The Psychological Corporation, Harcourt Brace & Company.

    Google Scholar 

  • Bowlby, J. (1973). Attachment and loss, Vol. 2: Separation. New York, NY: Basic Books.

    Google Scholar 

  • Bowlby, J. (1980). Attachment and loss, Vol. 3: Loss, sadness and depression. New York, NY: Basic Books.

    Google Scholar 

  • Bretherton, I., & Munholland, K. A. (2008). Internal working models in attachment relationships: Elaborating a central construct in attachment theory. In J. Cassidy & P. Shaver (Eds.), Handbook of attachment: Theory, research and clinical application (2nd ed.). New York: Guilford.

    Google Scholar 

  • Caldera, D., Burrell, L., Rodriguez, K., Shea-Crowne, S., Rohde, C., & Duggan, A. (2007). Impact of statewide home visiting program on parenting and on child health and development. Child Abuse and Neglect, 31, 829–852.

    Article  PubMed  Google Scholar 

  • Chaffin, M. (2004). Is it time to rethink healthy start/healthy families? Child Abuse and Neglect, 28, 589–595.

    Article  PubMed  Google Scholar 

  • Daro, D. A., & Harding, K. A. (1999). Healthy Families America: Using research to enhance practice. The Future of Children, 9, 152–176.

    Article  PubMed  Google Scholar 

  • Design Options for Home Visiting Evaluation (DOHVE) (September 2011). DOHVE compendium of measurement tools for MIECHV grantees. Retrieved from http://www.mdrc.org/dohve/DOHVE%20TA%20Compendium_Updated.pdf.

  • Diamond, G. S., & Stern, R. S. (2003). Attachment-based family therapy for depressed adolescents: Repairing attachment failures. In S. M. Johnson & V. E. Whiffen (Eds.), Attachment processes in couple and family therapy (pp. 191–212). New York: Gilford Press.

    Google Scholar 

  • Dolan, R., Arnkoff, D., & Glass, C. (1993). Client attachment style and the psychotherapist’s interpersonal stance. Psychotherapy: Theory Research and Practice, 30, 408–412.

    Article  Google Scholar 

  • Duggan, A. K., Berlin, L. D., Cassidy, J., Burrell, L., & Tandon, S. D. (2009). Examining maternal depression and attachment insecurity as moderators of the impacts of home visiting for at-risk mothers and infants. Journal Consulting and Clinical Psychology, 77, 788–799.

    Article  Google Scholar 

  • Duggan, A. K., Caldera, D., Rodriguez, K., Burrell, L., Rohde, C., & Crowne, S. S. (2007). Impact of a statewide home visiting program to prevent child abuse. Child Abuse and Neglect, 31, 829–852.

    Article  PubMed  Google Scholar 

  • Duggan, A. K., McFarlane, E., Windham, A. M., Rohde, C. A., Salkever, D. S., Fuddy, L., et al. (1999). Evaluation of Hawaii’s healthy start program. The Future of Children, Home Visiting: Recent Program Evaluations, 9, 66–90.

    Article  Google Scholar 

  • DuMont, K., Mitchell-Herzfeld, S., Greene, R., Lee, E., Lowenfels, A., & Rodriguez, M. (2006). Healthy Families New York (HFNY) randomized trial: Impacts on parenting after the first 2 years. Working Paper Series: Evaluating Healthy Families, OCFS Working Paper #1.

  • Feeney, J. A., Alexander, R., Noller, P., & Hohaus, L. (2003). Attachment insecurity, depression, and the transition to parenthood. Personal Relationships, 10, 475–493.

    Article  Google Scholar 

  • Feeney, J. A., Noller, P., & Hanrahan, M. (1994). Assessing adult attachment. In M. B. Sperling & W. H. Berman (Eds.), Attachment in adults: Clinical and developmental perspectives (pp. 128–152). New York: Guilford.

    Google Scholar 

  • Gomby, D. S. (2007). The promise and limitations of home visiting: Implementing effective programs. Child Abuse and Neglect, 31, 793–799.

    Article  PubMed  Google Scholar 

  • Guterman, N. B. (1999). Enrollment strategies in early home visitation to prevent physical child abuse and neglect and the “universal versus targeted” debate: A meta-analysis of population-based and screening-based programs. Child Abuse and Neglect, 23, 863–890.

    Article  PubMed  Google Scholar 

  • Halchuk, R., Makinen, J., & Johnson, S. M. (2010). Resolving attachment injuries in couples using emotionally focused therapy: A 3 years follow-up. Journal of Couple and Relationship Therapy, 9, 31–47.

    Article  Google Scholar 

  • Healthy Families America. (2001). Healthy families America training participant’s manual-program manager, supervisor, family support worker and assessment worker. Chicago, IL: Prevent Child Abuse America.

    Google Scholar 

  • Holmes, J. (1997). Too early, too late: Endings in psychotherapy—An attachment perspective. British Journal of Psychotherapy, 14, 159–171.

    Article  Google Scholar 

  • Kitzman, H., Olds, D. L., Henderson, C. R, Jr, Hanks, C., Cole, R., Tatelbaum, R., et al. (1997). Effect of prenatal and infancy home visitation by nurses on pregnancy outcomes, childhood injuries, and repeated childbearing: A randomized controlled trial. Journal of the American Medical Association, 278, 644–652.

    Article  PubMed  Google Scholar 

  • Liang, K. Y., & Zeger, S. L. (1986). Longitudinal data analysis using generalized linear models. Biometrika, 73, 13–22.

    Article  Google Scholar 

  • McDowell, I., & Newell, C. (1996). Depression. In I. McDowell & C. Newell (Eds.), Measuring health: A guide to rating scales and questionnaires (2nd ed., pp. 238–286). New York: Oxford University Press.

    Google Scholar 

  • McFarlane, E., Burrell, L., Crowne, S., Cluxton-Keller, F., Fuddy, L., Leaf, P. J., et al. (2013). Maternal relationship security as a moderator of home visiting program impacts on maternal psychosocial functioning. Prevention Science, 14(1), 25–39.

    Article  PubMed  PubMed Central  Google Scholar 

  • McFarlane, E., Burrell, L., Fuddy, L., Tandon, S. D., Derauf, D. C., Leaf, P., et al. (2010). Association of home visitors’ and mothers’ attachment style with family engagement. Journal of Community Psychology, 38, 541–556.

    Article  Google Scholar 

  • Mikulincer, M., & Shaver, P. R. (2007). Attachment in adulthood: Structure, dynamics, and change. New York: Guilford.

    Google Scholar 

  • Olds, D. L., Henderson, C. R., Kitzman, H. J., Eckenrode, J. J., Cole, R. E., & Tatelbaum, R. C. (1999). Prenatal and infancy home visitation by nurses: Recent findings. The Future of Children, 9, 44–65.

    Article  PubMed  Google Scholar 

  • Olds, D. L., Robinson, J., O’Brien, R., Luckey, D. W., Pettitt, L. M., Henderson, C., et al. (2002). Home visiting by paraprofessionals and by nurses: A randomized, controlled trial. Pediatrics, 110, 486–496.

    Article  PubMed  Google Scholar 

  • Piantadosi, S. (1997). Clinical trials: A methodologic perspective (Vol. 323). Hoboken, NJ: Wiley and Sons.

    Google Scholar 

  • Radloff, L. S. (1977). The CES-D Scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385–401.

    Article  Google Scholar 

  • Roberts, J. E., Gotlib, I. H., & Kassel, J. D. (1996). Adult attachment styles and symptoms of depression: The mediating role of dysfunctional attitudes and low self-esteem. Journal of Personality and Social Psychology, 70, 310–320.

    Article  PubMed  Google Scholar 

  • Roberts, R. E., Lewinsohn, P. M., & Seeley, J. R. (1991). Screening for adolescent depression: A comparison of depression scales. Journal of the American Academy of Child and Adolescent Psychiatry, 30, 58–66.

    Article  PubMed  Google Scholar 

  • Robinson, J., & Emde, R. N. (2004). Mental health moderators of early head start on parenting and child development: Maternal depression and relationship attitudes. Parenting: Science and Practice, 4, 73–97.

    Article  Google Scholar 

  • Slade, A. (1999). Attachment theory and research: Implications for the theory and practice of individual psychotherapy with adults. In J. Cassidy & P. R. Shaver (Eds.), Handbook of attachment: Theory, research, and clinical applications (pp. 575–594). New York: Guilford Press.

    Google Scholar 

  • Spieker, S., Nelson, D., DeKlyen, M., & Staerkel, F. (2005). Enhancing early attachments in the context of early head start: Can programs emphasizing family support improve rates of secure infant–mother attachments in low-income families? In L. J. Berlin, Y. Ziv, L. Amaya-Jackson, & M. T. Greenberg (Eds.), Enhancing early attachments: Theory, research, intervention and policy (pp. 250–275). New York: Guilford.

    Google Scholar 

  • St. Pierre, R. G., & Layzer, J. I. (1999). Using home visits for multiple purposes: The comprehensive child development program. The Future of Children, 9, 134–151.

    Article  PubMed  Google Scholar 

  • Strodl, E., & Noller, P. (2003). The relationship of adult attachment dimensions to depression and agoraphobia. Personal Relationships, 10, 171–185.

    Article  Google Scholar 

  • United States Congress. Patient Protection and Affordable Care Act, Public Law No. 111–148, Government publications office. Available at: http://www.gpo.gov:80/fdsys/pkg/PLAW-111publ148/pdf/PLAW-111publ148.pdf. Accessed 23 March 2010.

  • Wayment, H. A., & Vierthaler, J. (2002). Attachment style and bereavement reactions. Journal of Loss and Trauma, 7, 129–149.

    Article  Google Scholar 

  • Zayas, V., Mischel, W., Shoda, Y., & Aber, J. L. (2010). Roots of adult attachment: Maternal caregiving at 18 months predicts adult peer and partner attachment. Social Psychological and Personality Science, 000, 1–9.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Johns Hopkins School of Medicine, 1620 McElderry Street Suite 206, Baltimore, MD, 21205, USA

    Fallon Cluxton-Keller, Lori Burrell, Sarah S. Crowne, Elizabeth McFarlane, S. Darius Tandon & Anne K. Duggan

  2. Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Philip J. Leaf

Authors
  1. Fallon Cluxton-Keller
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lori Burrell
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sarah S. Crowne
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Elizabeth McFarlane
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. S. Darius Tandon
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Philip J. Leaf
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Anne K. Duggan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Fallon Cluxton-Keller.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Cluxton-Keller, F., Burrell, L., Crowne, S.S. et al. Maternal Relationship Insecurity and Depressive Symptoms as Moderators of Home Visiting Impacts on Child Outcomes. J Child Fam Stud 23, 1430–1443 (2014). https://doi.org/10.1007/s10826-013-9799-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10826-013-9799-x

Keywords

Search

Navigation