Effect of home visiting support on maternal psychosocial needs and postnatal depression: emulating a target trial

Clinical Snapshot

Key Findings

• P Value: Not explicitly reported in abstract; all primary CIs exclude the null, implying p<0.05 for primary and depressive symptom outcomes

• Effect Size: Psychosocial needs: Cohen's d = 0.40 at 6 months, 0.39 at 12 months (moderate effect); Postnatal depressive symptoms: Cohen's d = −0.34 at 6 months, −0.34 at 12 months (small-to-moderate effect); Well-being: direction favourable but estimates imprecise

• Primary Outcome: Perceived fulfilment of psychosocial needs: intervention group showed significantly greater improvement than controls at both 6 months (difference in mean changes 4.16) and 12 months postnatally (difference in mean changes 3.93)

• Nnt Or Sensitivity: Not reported; mean difference in depressive symptoms of approximately −1.5 points requires comparison against the Edinburgh Postnatal Depression Scale minimal clinically important difference (typically estimated at 3–4 points) to determine clinical significance at the individual level

• Confidence Interval: Psychosocial needs at 6 months: 95% CI 1.35 to 6.97; at 12 months: 95% CI 0.63 to 7.23. Depressive symptoms at 6 months: 95% CI −2.70 to −0.38; at 12 months: 95% CI −2.74 to −0.36

Clinical Application

Multi-professional home visiting from pregnancy to 12 months postnatally is resource-intensive and requires sustained workforce investment, inter-agency coordination, and municipal or health system infrastructure. Co-design processes require meaningful consumer engagement infrastructure. Scalability beyond pilot municipalities has not been demonstrated. Cost-effectiveness data are not reported. Australia has existing home visiting infrastructure through programmes such as the Australian Nurse-Family Partnership (ANFP) and state-based maternal and child health nursing services, but coverage for AYA mothers is inconsistent across jurisdictions. The RACGP and beyondblue guidelines identify AYA mothers as a high-risk group for perinatal depression warranting enhanced surveillance and support. The Edinburgh Postnatal Depression Scale is standard in Australian primary care. TGA-approved pharmacological options for postnatal depression exist, but psychosocial interventions are preferred first-line for mild-to-moderate presentations, particularly in young mothers where medication concerns (breastfeeding, stigma) are prominent. PBS does not fund home visiting programmes directly; funding would require state/territory health department or PHN commissioning. The co-design methodology aligns with Australian Commission on Safety and Quality in Health Care (ACSQHC) person-centred care principles and could inform future programme development for AYA mothers in metropolitan and regional settings. Primiparous adolescent and young adult women aged 16–25 years, particularly those with identified psychosocial vulnerabilities, limited social support, or residing in areas with concentrated socioeconomic disadvantage. The model may be most relevant for first-time mothers who are unlikely to engage with traditional clinic-based perinatal mental health services.

Abstract

BACKGROUND: 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.