The first two years of a child’s life are critical for development, with mother-infant interactions playing a vital role. Sensitive interactions are particularly important, yet conditions like maternal depression can negatively impact these crucial early relationships. Assessing these interactions effectively is essential, but many current tools are complex, posing challenges for primary care mental health professionals. This study delves into the Child and Adult Relationship Observational tool (CARO), examining its effectiveness as a practical assessment method.
This research aimed to determine how the Caro Tool aligns with the CARE-Index, a well-established measure of mother-infant interaction known for its predictive validity. The study focused on mothers identified during pregnancy as having additional health and social care needs and who exhibited high depression scores six months postpartum. By comparing CARO to the CARE-Index within this specific group, the study sought to understand CARO’s concurrent validity. The research also explored the relationship between maternal sensitivity and depression, utilizing the Hospital Anxiety and Depression Scale (HADS-D) alongside both observational tools.
Data from 30 mothers participating in the THRIVE trial was analyzed. Researchers selected ten mothers with the highest depression scores from each of the trial’s three arms. Video recordings of 3-5 minute mother-infant interactions, previously evaluated using the CARE-Index, were then assessed using the CARO tool. Spearman’s correlations were used to analyze the concurrent validity between CARO and the CARE-Index, and to explore the relationship between depression scores and the measurements from both tools.
The findings revealed a non-significant association between CARO and the CARE-Index (rs=.119; p=.530). Interestingly, a moderate positive correlation was found between the CARE-Index and depression scores (rs= .407; p=.026), indicating that higher depression scores were associated with CARE-Index ratings suggesting less sensitive interactions. However, no significant relationship was observed between CARO scores and depression scores (rs= .221; p=.241).
In conclusion, this study suggests that the CARO tool does not demonstrate strong concurrent validity when compared to the CARE-Index in this sample of mothers with additional needs and postpartum depression. While the CARE-Index showed expected correlations with maternal depression, CARO did not reflect similar relationships in this study. Further investigation into CARO’s other psychometric properties is necessary to fully understand its clinical utility and determine its potential role in assessing mother-infant interactions, particularly in populations with complex needs.
