routinely recommended for women in primary care (Pignone, Gaynes, et al., 2002; U.S. Preventive Services Task Force, 2002). Specific screening tools exist for peripartum depression, such as the Edinburgh Postnatal Depression Scale (EPDS) (Cox and Holden, 2003), one of several tools recommended by the U.S. Department of Health and Human Services’ Agency for Healthcare Research and Quality (Gaynes, Gavin, et al., 2005). Such screening tools as the EPDS have the potential to be modified to identify pregnant women with elevated symptoms of depression who would benefit from indicated interventions.

In addition, some self-care tools can be useful as the first step in alleviating symptoms of depression (Bower, Richards, and Lovell, 2001). Such tools, commonly based on cognitive-behavioral therapy (CBT), have emerged in a variety of formats, including booklets, manuals, CD-ROMs, audiotapes, and videotapes (Blenkiron, 2001; Williams and Whitfield, 2001; Gega, Marks, and Mataix-Cols, 2004). CBT has a significant evidence base (e.g., Williams and Whitfield, 2001; Richards, Barkham, et al., 2003; Scogin, Hanson, and Welsh, 2003; Gega, Marks, and Mataix-Cols, 2004), and self-care tools have been successfully incorporated into stepped-care models of depression treatment in primary care settings (for patients with mild to moderate depression), with psychotherapy provided for those who fail to improve (Scogin, Hanson, and Welsh, 2003).

Maternal Sensitivity and Infant Attachment

Mother–infant attachment has been the focus of research and is a well-established influence on infants’ successful development (National Research Council and Institute of Medicine, 2000; see also Chapter 5). A meta-analysis of 51 studies that evaluated interventions to increase maternal sensitivity and infant attachment using randomized controlled designs found that on average, the interventions were moderately effective in enhancing sensitivity (Bakersman-Kranenburg, van Ijzendoorn, and Juffer, 2003). A total of 23 of the studies used a randomized design to assess impact on attachment and demonstrated a slight effect; interventions focused on directly enhancing sensitivity were significantly more effective than other types of interventions.

Home Visiting

Home visiting is an intensive intervention that targets successful pregnancies and infant development. In these highly variable programs, a nurse or paraprofessional begins visiting the mother during the pregnancy or just after birth and continues to do so through the first few years of the child’s life. The majority of programs provide parenting education, information

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