News Release

Home-visits before and after birth can benefit caregiving in low- and middle-income settings

Increasing evidence supports positive associations with mother-child bonding experiences during the pre- and post-natal periods, and in the early years of a child's life

Peer-Reviewed Publication


Washington, DC, November 14, 2019- A study in the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP), published by Elsevier, reports that home-visiting by trained community workers during and after pregnancy can improve mother-child interactions in the first years of life. However, this benefit was not found for mothers who experienced depressive symptoms during pregnancy.

"The quality of close relationships early in life has a lasting impact on children's development," said lead author Joan Christodoulou, a postdoctoral scholar at University of California, Los Angeles's Global Center for Children and Families in Los Angeles, CA, USA. "Caregiving that is sensitive, or responsive to a child's needs and engages the child, with limited hostility, may be a particularly important factor in mediating the adverse effects on development for children growing up in poverty."

The findings are based on the results of a cluster randomized controlled trial, jointly-investigated by researchers at UCLA and South Africa's Stellenbosch University. Evaluating the Philani Program in Cape Town, South Africa, pregnant mothers in 24 local township neighborhoods were recruited into the study; 98 percent were enrolled and followed from pregnancy through to five-years post-birth. A representative cohort of 1,239 pregnant township mothers were studied.

Mothers in the intervention received home visits by community workers trained by the Philani Program from May 2009 to September 2010. Over the next five years, researchers tracked data related to maternal- and child-health including depression, HIV, food security, caregiving, as well as the quality of mother-child interactions.

The authors found that mothers who received home visits displayed more maternal sensitivity, talked to the infant more and had more harmonious interactions with their children. They also have children who paid more attention and were happier than their peers at three years post-birth. However, mothers who had depressive symptoms during pregnancy did not experience these benefits.

Home-visiting by trained community health workers resulted in a better quality of caregiving for mothers without depressive symptoms in a low and middle income country. Future maternal and child health interventions need to specifically target maternal depression during and after pregnancy.


Notes for editors
The article is "Home Visiting and Antenatal Depression Affect the Quality of Mother and Child Interactions in South Africa," by Joan Christodoulou, PhD, Mary Jane Rotheram-Borus, PhD, Alexandra K. Bradley, BA, Mark Tomlinson, PhD ( It currently appears on the JAACAP Articles In Press page and will appear in the Journal of the American Academy of Child and Adolescent Psychiatry, volume 58, issue 12  (December 2019), published by Elsevier.

Dr. Christodoulou is a postdoctoral scholar at UCLA who investigates risk and protective factors influencing development from early childhood into early adulthood in at-risk, underserved, and disenfranchised children and their families.

Copies of this paper are available to credentialed journalists upon request; please contact Mary Billingsley at or +1 202 587 9672. Journalists wishing to interview the authors may contact Joan Christodoulou, PhD, at">

Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP) is the official publication of the American Academy of Child and Adolescent Psychiatry. JAACAP is the leading journal focusing exclusively on today's psychiatric research and treatment of the child and adolescent. Published twelve times per year, each issue is committed to its mission of advancing the science of pediatric mental health and promoting the care of youth and their families.

The Journal's purpose is to advance research, clinical practice, and theory in child and adolescent psychiatry. It is interested in manuscripts from diverse viewpoints, including genetic, epidemiological, neurobiological, cognitive, behavioral, psychodynamic, social, cultural, and economic. Studies of diagnostic reliability and validity, psychotherapeutic and psychopharmacological treatment efficacy, and mental health services effectiveness are encouraged. The Journal also seeks to promote the well-being of children and families by publishing scholarly papers on such subjects as health policy, legislation, advocacy, culture and society, and service provision as they pertain to the mental health of children and families.

About Elsevier

Elsevier is a global information analytics business that helps scientists and clinicians to find new answers, reshape human knowledge, and tackle the most urgent human crises. For 140 years, we have partnered with the research world to curate and verify scientific knowledge. Today, we're committed to bringing that rigor to a new generation of platforms. Elsevier provides digital solutions and tools in the areas of strategic research management, R&D performance, clinical decision support, and professional education; including ScienceDirect, Scopus, SciVal, ClinicalKey and Sherpath. Elsevier publishes over 2,500 digitized journals, including The Lancet and Cell, 39,000 e-book titles and many iconic reference works, including Gray's Anatomy. Elsevier is part of RELX, a global provider of information-based analytics and decision tools for professional and business customers.

Media contact

Mary Billingsley
JAACAP Editorial Office
+1 202 587 9672

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