Implementing mental health interventions in perinatal home visiting programs: a systematic review of the literature

Abstract

Purpose

Perinatal home visiting programs are well positioned to deliver mental health interventions to those at high risk for adverse mental health outcomes. The purpose of this review was to examine home-based mental health interventions, their effectiveness, and how they have been implemented in perinatal home visiting programs.

Methods

Following PRISMA guidelines, we searched PubMed, CINAHL, PsycInfo, and Social Work Abstracts for reports of experimental or quasi-experimental studies evaluating outcomes of a mental health intervention delivered in the home setting as part of a perinatal home visiting program in the United States. Data extracted included the study demographics, design, characteristics of the interventions, evidence of intervention effectiveness, implementation strategies, and implementation outcomes and determinants.

Results

Data abstractors screened 3,500 articles published from January 2010 to January 2024. Of these, 25 articles reporting findings of 12 distinct mental health interventions met the criteria for inclusion. Interventions were based on a variety of therapeutic approaches such as cognitive behavioral therapy, collaborative problem solving, and motivational interviewing. Interventionists ranged from paraprofessionals such as community health workers to professionals such as registered nurses, nurse practitioners and licensed clinical social workers, in addition to others. Recipients of the interventions were predominantly white women; high risk groups including American Indian/Alaskan Native and Asian/Pacific Islander populations were underrepresented in studies. Studies demonstrated evidence of effectiveness in reducing symptoms of depression. Few studies systematically evaluated implementation outcomes or strategies, or followed standard recommendations for reporting implementation outcomes, limiting synthesis.

Conclusions

Mental health interventions delivered through perinatal home visiting programs show effectiveness at reducing depressive symptoms, and in a subset of studies, anxiety symptoms, though evidence for reduction in anxiety is more limited. Variations in how implementation measures were reported limited synthesis demonstrating that further research is needed in implementation.