Self-Efficacy as a Mediator Between Maternal Depression and Child Hospitalizations in Low-Income Urban Families

Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
Maternal and Child Health Journal (Impact Factor: 2.24). 10/2011; 15(7):1011-9. DOI: 10.1007/s10995-010-0662-z
Source: PubMed


The objective of this study is to examine the role of maternal self-efficacy as a potential mediator between maternal depression and child hospitalizations in low-income families. We analyzed data from 432 mother-child pairs who were part of the control-group for the Nurse-Family Partnership trial in Memphis, TN. Low-income urban, mostly minority women were interviewed 12 and 24 months after their first child's birth and their child's medical records were collected from birth to 24 months. We fit linear and ordered logistic regression models to test for mediation. We also tested non-linear relationships between the dependent variable (child hospitalization) and covariates (depressive symptoms and self-efficacy). Elevated depressive symptoms (OR: 1.70; 90% CI: 1.05, 2.74) and lower maternal self-efficacy (OR: 0.674; 90% CI: 0.469, 0.970) were each associated with increased child hospitalizations. When both maternal self-efficacy and depressive symptoms were included in a single model, the depressive symptoms coefficient decreased significantly (OR decreased by 0.13, P = 0.069), supporting the hypothesis that self-efficacy serves as a mediator. A non-linear, inverse-U shaped relationship between maternal self-efficacy and child hospitalizations was supported: lower compared to higher self-efficacy was associated with more child hospitalizations (P = 0.039), but very low self-efficacy was associated with fewer hospitalizations than low self-efficacy (P = 0.028). In this study, maternal self-efficacy appears to be a mediator between maternal depression and child hospitalizations. Further research is needed to determine if interventions specifically targeting self-efficacy in depressed mothers might decrease child hospitalizations.

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    ABSTRACT: Maternal self-efficacy (MSE) has been shown to be important, yet little is known about how it develops over time and whether increasing knowledge about child development and parenting results in feeling more efficacious, especially for first-time mothers. Furthermore, research is lacking about whether increased maternal self-efficacy results in better child outcomes such as more receptive and expressive language. Using a randomized three-group design, this study explores whether educational books, embedded with information about typical child development and optimal parenting, increase MSE for women over the first year and a half of motherhood and whether these increases result in better language skills for children at 18 months of age. Hierarchical linear model analyses show that MSE starts high and remains high and that providing educational books further increases the development of MSE. Increases in MSE have a positive impact on children's language skills, as does providing books, irrespective of educational content. These findings support the importance of MSE and demonstrate an inexpensive way to increase MSE and improve child outcomes. Copyright © 2013 John Wiley & Sons, Ltd.
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