Published online September 1, 2008
PEDIATRICS Vol. 122 No. 3 September 2008, pp. e621-e627 (doi:10.1542/peds.2007-3783)
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ARTICLE

Long-term Mother and Child Mental Health Effects of a Population-Based Infant Sleep Intervention: Cluster-Randomized, Controlled Trial

Harriet Hiscock, MDa,b,c, Jordana K. Bayer, PhDa,b,c, Anne Hampton, BSa,c, Obioha C. Ukoumunne, PhDb,c,d and Melissa Wake, MDa,b,c

a Centre for Community Child Health
d Clinical Epidemiology and Biostatistics Unit, Royal Children's Hospital, Parkville, Victoria, Australia
b Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
c Murdoch Children's Research Institute, Parkville, Victoria, Australia

OBJECTIVES. Maternal depression is an established risk for adverse child development. Two thirds of clinically significant depressive symptoms occur in mothers reporting an infant sleep problem. We aimed to determine the long-term effects of a behavioral intervention for infant sleep problems on maternal depression and parenting style, as well as on child mental health and sleep, when the children reached 2 years of age.

METHODS. We conducted a cluster-randomized trial in well-child centers across 6 government areas of Melbourne, Australia. Participants included 328 mothers reporting an infant sleep problem at 7 months, drawn from a population sample (N = 739) recruited at 4 months. We compared the usual well-child care (n = 154) versus a brief behavior-modification program designed to improve infant sleep (n = 174) delivered by well-child nurses at ages 8 to 10 months and measured maternal depression symptoms (Edinburgh Postnatal Depression Scale); parenting practices (Parent Behavior Checklist); child mental health (Child Behavior Checklist); and maternal report of a sleep problem (yes or no).

RESULTS. At 2 years, mothers in the intervention group were less likely than control mothers to report clinical depression symptoms: 15.4% vs 26.4% (Edinburgh Postnatal Depression Scale community cut point) and 4.2% vs 13.2% (Edinburgh Postnatal Depression Scale clinical cut point). Neither parenting style nor child mental health differed markedly between the intervention and control groups. A total of 27.3% of children in the intervention group versus 32.6% of control children had a sleep problem.

CONCLUSIONS. The sleep intervention in infancy resulted in sustained positive effects on maternal depression symptoms and found no evidence of longer-term adverse effects on either mothers' parenting practices or children's mental health. This intervention demonstrated the capacity of a functioning primary care system to deliver effective, universally offered secondary prevention.

Key Words: sleep • mental health • maternal depression • cluster randomized trial

Abbreviations: EPDS—Edinburgh Postnatal Depression Scale • MCH—Maternal and Child Health • OR—odds ratio • CI—confidence interval

Accepted May 7, 2008.


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