Effect of home visiting support on maternal psychosocial needs and postnatal depression: emulating a target trial
Kaori Baba, Zui C Narita, Syudo Yamasaki, Tomohiro Shinozaki, Junko Niimura, Naomi Nakajima, Satoshi Yamaguchi, Gemma Knowles, Jordan Devylder, Satsuki Ayaya, Shin-ichiro Kumagaya, Daniel Stanyon, Nao Oikawa, Mariko Hosozawa, Miharu Nakanishi, Shuntaro Ando, Kiyoto Kasai, Mitsuhiro Miyashita, Mariko Hiraiwa-Hasegawa, Toshi A Furukawa, Vikram Patel, Susan M Sawyer, Atsushi NishidaBackground
Adolescent and young adult (AYA) mothers often experience unmet psychosocial needs, and those under 25 years of age are at increased risk of perinatal depression. Although home visiting programmes may be beneficial, no controlled trial has evaluated a programme co-designed with first-time AYA mothers and grounded in their lived experiences.
Objective
We evaluated the effect of the co-designed Early Partnership programme on perceived fulfilment of psychosocial needs and postnatal depressive symptoms among first-time AYA mothers.
Methods
We emulated a target trial using data from a pragmatic historically controlled study in four Tokyo municipalities. Participants were primiparous women aged 16–25 years. The intervention group included 151 participants and the control group included 158 participants. The intervention group received intensive tailored home visits by multi-professional family support workers from pregnancy to 12 months postnatally, and the historical control group received publicly funded health and social services.
Findings
Retention at 12 months was high in both groups (intervention group, 82.1%; control group, 82.9%). For the primary outcome analysis, the intervention group had greater improvement in perceived fulfilment of psychosocial needs at 6 months postnatally (difference in mean changes 4.16, 95% CI 1.35 to 6.97, Cohen’s d 0.40, 95% CI 0.13 to 0.67) and 12 months postnatally (difference in mean changes 3.93, 95% CI 0.63 to 7.23, Cohen’s d 0.39, 95% CI 0.06 to 0.72) than the control group. Postnatal depressive symptoms were lower in the intervention group at 6 months postnatally (mean difference −1.54, 95% CI −2.70 to −0.38, Cohen’s d −0.34, 95% CI −0.59 to −0.08) and 12 months postnatally (mean difference −1.55, 95% CI −2.74 to −0.36, Cohen’s d −0.34, 95% CI −0.61 to −0.07). Well-being also improved at each time point, but estimates were imprecise.
Conclusions
The Early Partnership programme, co-designed with young mothers and delivered by multi-professional teams, was acceptable and effective in improving perceived fulfilment of psychosocial needs and postnatal depressive symptoms.
Clinical implications
These findings suggest that a person-centred and relationship-based home visiting model, delivered through a non-stigmatising design, may represent a plausible model of maternal care.