The results of this open trial indicate that LV, as delivered by US home visitors, show considerable promise as an effective, acceptable, and accessible treatment option for low-income and ethnic-minority women with depressive symptoms. As predicted, women treated with LV showed statistically and clinically significant improvements in depression severity. This improvement was sustained through to the three-month post-LV follow-up interview. Additionally, of the seven women (36.8%) meeting DSM-IV-TR criteria for major depression prior to LV, none met criteria for MDE at the post-LV assessment. Of the two new cases of depression at the post-LV assessment, only one sustained this depression level at the follow-up. Thus, LV were an effective treatment for 18 of the 19 women (94.7%). Only one woman needed additional treatment after receiving LV.
Listening Visits were also associated with significant improvement in life satisfaction. Specifically, at the post-LV and follow-up interviews, women rated their quality of life using the Q-LES-Q. Several domains improved significantly, including how well they were getting along at work, at home, and with other people. Additionally their satisfaction with life in general, as assessed by the global Q-LES-Q item, improved significantly.
Most importantly, the results indicate that LV are an acceptable treatment option for low-income and ethnic-minority women who typically do not receive depression treatment from mental health professionals. The utilization data indicate that 394 women had elevated EPDS scores. Of these, 28.4% (112) elected to receive treatment from a mental health professional. Not all of the remaining 282 (394–112) women were suitable for LV (some were receiving treatment, others declined treatment completely, and others had diagnosis of bipolar disorder or schizophrenia). Nevertheless, for 74 of the 394 women identified (18.8%), LV provided one useful treatment option. Moreover, of those who received LV, the average total score on the CSQ was high, as were the ratings of individual components of LV. Notably, in this study, the average global satisfaction rating (
=30.1) was even higher than the average global satisfaction rating (
=27.1) that was reported in a large sample of treatment recipients (Nguyen, Attkisson, & Stegner, 1983
), although it is typical to find such negatively skewed results in studies of psychotherapy treatment outcomes. Similarly, on the View of LV Interview
, participants gave uniformly high ratings to the helpfulness of LV, as well as to the individual treatment components, including the treatment provider, place of treatment, and duration. The only recommended change was to provide either longer and/or more sessions.
Our study had some methodological limitations: a small sample, the lack of a comparison group, and, because all women received LV, diagnostic assessments were not blind to condition. The small self-selected convenience sample limits the generalizability of the results. Additionally, without a control group, the improvement in depression and life satisfaction cannot be definitively attributed to LV. For example, the home-visits alone may account for this improvement; therefore, it is not yet clear whether the implementation of this new practice is warranted. The next step in establishing empirical evidence is to conduct a larger randomized controlled trial.
Balancing the study's limitations were several strengths that increased its external validity and importance. The study subjects represented a difficult to reach group of women. Comprehensive depression and quality of life data were collected on nearly every subject, which is not often the case in similar studies with this population. Participants were compliant with the intervention and responded to their case manager treatment provider in the predicted manner – accepting and validating the treatment. This brief intervention demonstrated clinically significant effects. Finally, it was seamlessly implemented into the case management practice of the providers with no additional clinical resources required.
In conclusion, LV can be effectively delivered by home visitors, and appear to be acceptable to low-income and ethnic-minority women at risk for depression; thus, this alternative intervention has considerable potential to overcome the barriers inherent to depression treatments delivered by mental health professionals. While not replacing depression treatment by mental health professionals, LV are a tool that can be used by home visitors to stem the gap in treatment services for women who might not otherwise receive help.