Self-efficacy as a mediator between child hospitalizations and maternal depression

Several studies noted a positive association between maternal depression and child hospitalizations. However, the mechanisms for this association are not clear. We tested the hypothesis that depressed mothers with low self-efficacy will be more likely to delay seeking care for their children, thus bringing about more hospitalizations. Data from the Nurse-Family Partnership trial in Memphis, TN were used (n=432; control group only). Women were recruited at an obstetrical clinic and interviewed 12 months after their first child's birth. Depressive symptoms were measured by the Mental Health Inventory-5. A 10-item Likert scale, developed and validated for this study, measured self-efficacy. Child hospitalization data from birth to 24 months were available from medical records. All models controlled for children's chronic conditions, birth weight, and demographic factors. Twenty-two percent of children were hospitalized once and 9% were hospitalized two or more times, 14% of mothers had consistently high depressive symptoms, and 48% had lower maternal self-efficacy than the sample mean. Using linear regression, increased maternal depressive symptoms were found to predict lower self-efficacy (-0.188, 95% CI: -0.280, -0.097). Using ordered logistic regression, lower maternal self-efficacy was found to predict more child hospitalizations (OR: 1.54, 95% CI: 2.37, 0.995). When these two paths were combined by multiplying the coefficients, maternal self-efficacy was shown to be a mediator (p<0.001) between maternal depression and child hospitalizations in this urban, mostly minority, population. Interventions targeting maternal self-efficacy and adequate maternal depression treatment should be considered to decrease child hospitalizations.