SPREADING THE BLUES: Maternal depression can have long-lasting effects on the mother-child bond and on child development in general. Given depression's prevalence in women, researchers are working hard to find better ways to diagnose and treat it in hopes of improving outcomes for children as well. Image: ISTOCKPHOTO/QUAVONDO
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Vast amounts of research on postpartum depression have focused on difficulties facing new mothers, and studies of adult depression have focused on individual struggles. Depression in mothers with children over the age of six months, however, is less discussed but exceedingly common. At least 12 percent of women in any given year—many of whom are mothers—and 20 percent of disadvantaged mothers have depressive symptoms.
New findings, presented May 1 at the Pediatric Academic Societies meeting in Vancouver, Canada, provide hope, showing that proper screening and brief cognitive behavior therapy can be a big help to both the mothers and their children.
"Anyone can be depressed," says Carol Weitzman, an associate professor of developmental-behavior pediatrics at Yale University School of Medicine and lead researcher on the study. But when an adult is caring for children, depression can have large and lasting effects on the kids, making maternal depression "a big public health problem for children," she notes. "The effects of depression on children are very profound. We can't look at children's health and function without looking at parents' functioning."
Depressed moms, weak bonds
Maternal depression is not an isolated event but part of "a continuum that actually starts prenatally," explains Janice Cooper, interim director of the National Center for Children in Poverty at Columbia University's Mailman School of Public Health. Regardless of a child's age, "moms with depression are less able to bond well with their children," she says.
Many mothers with depression are less likely to engage positively with their children, such as playing, reading or singing. They may even have trouble managing basic child well-being tasks, such as arranging doctor's checkups, childproofing a home or buckling children up in cars. Additionally, Cooper points out, depressed parents tend to be less consistent in their parenting. As symptoms wax and wane, discipline and engagement can fluctuate, leaving children in less-stable environments. All of these behaviors can influence cognitive, social and physical development, she says.
In many instances, maternal depression can initiate what Cooper calls a "vicious cycle." When depressed mothers do not respond well to their children, the children tend not to respond well to the mother, adding to the mother's concern, anxiety and general malaise. And these feelings are more likely to increase as the child gets older, a finding that surprised even Weitzman. These growing anxieties might stem from increased concern about difficulties children might face as they get older, she hypothesizes.
Given the high rates of maternal depression and its impact on the mother-child bond, Weitzman and her colleagues are seeking to understand how it can be better diagnosed and treated. "I think that we should be sitting up and really taking notice when we see numbers like that," Weitzman says. "For certain kinds of disorders, we would be all over that, but we still carry a lot of stigma for mental health."
The issue of maternal depression is outsized in disadvantaged families, and depressed mothers are less likely to be employed, probably increasing stress. A combination of other factors, such as less educated parents, also put children at higher risk for poor developmental outcomes even without a depressed parent.
In the new randomized study of 71 underserved mothers with depressive symptoms, Weitzman and her team examined how several short, on-site cognitive behavior therapy sessions compared with traditional referrals for improving both maternal symptoms and how mothers rated their children's behavior.
Conventionally, observant doctors might suggest specialists for women who seem to be depressed. For the study, Weitzman and her group gave women who were randomized into this control group substantial case management, in which they spoke with a social worker and were helped with referrals. In the cognitive behavior therapy group, the social workers "tried to help people make the link from their moods and behavior to how it affected their children." The six two-hour therapy sessions covered the relationship between thought, mood, behavior and physical feelings. It got the mothers to identify stigmas, practice relaxation techniques, reduce negative thinking, and explore the link between maternal mood and behavior and child mood and behavior.
Both groups showed improvement, but the cognitive behavioral therapy group "significantly reduced their ratings of problem behavior in their young children," Weitzman and her colleagues conclude in their abstract.
"These are great findings," says Cooper, who was not involved in the study. "We know that depression is highly treatable," she notes, adding that these data give credence to other work showing the importance of diagnosing and treating disadvantaged mothers with depression.
The follow-up period for Weitzman's study did not provide long-term assessments of mother and child behavior, and as Cooper notes, not all mothers can be helped by cognitive behavior therapy. In some cases, she says, the best solution is including some joint parent-child therapy: "For some families, they really do need help developing that parent-child relationship, rebonding, reconnecting with their children."