Factors Associated with Changes in Parental Depressive Symptoms: A Longitudinal Multilevel Analysis of Parents at High Risk for Child Maltreatment

Abstract

Depression interferes with a parent's ability to adequately care for a child, which can lead to adverse consequences such as child maltreatment (National Research Council & Institute of Medicine, 2009). Given this complex relationship, it is critical to understand factors associated with how depressive symptoms change over time. Home visiting programs are strategies for addressing child maltreatment and parental depression (Paxson & Haskins, 2009). The primary purpose of this study was to assess factors predicting changes in depressive symptoms for a sample of parents at high risk for child maltreatment participating in a home visiting and neglect prevention program. This dissertation used secondary data to explore (1) individual, (2) relationship, and (3) service delivery factors associated with changes in depressive symptoms over time for a diverse sample of 569 parents enrolled in the same program implemented across 7 sites and 18 different program types. Factors predicting the likelihood of child maltreatment reports or substantiations after program participation were also examined. Two- and three-level multi-level growth models were used to address three of the research questions. Across all the models, there was a significant decrease in depressive symptoms over time. The two-level models indicated that Black parents had lower levels of depressive symptoms, whereas Hispanic parents had higher levels. Parents with less than 12 years of education were more likely to have lower levels of depressive symptoms. Higher levels of parental stress and a greater need for social support were associated with higher levels of depressive symptoms in all models. Significant factors found in the three-level models included parent's history of abuse or trauma and assigned program duration; however findings are exploratory given the small sample size (n=18) at this level. Logistic regression was used to predict the likelihood of child maltreatment after program completion. Prior child maltreatment reports and increased need for social support were associated with a greater likelihood of subsequent reports or substantiations. Other parent demographic factors, level of depressive symptoms, and parental stress were not significant. Findings can be used to prioritize areas for depression screening, comprehensive assessments, worker training, and support needed for this vulnerable population.