Depression is a serious and prevalent public health condition in the United States, particularly among disadvantaged populations. As many as 15 million children live in households with parents who have major or severe depression. Findings from a study conducted by the Urban Institute indicated that among families in poverty, one in nine infants lives with a mother experiencing severe depression and more than half live with a mother experiencing some level of depressive symptoms.
While depression is highly treatable, many mothers do not receive treatment. This is especially true for low-income mothers — more than one-third of those with major depressive disorder get no treatment at all. Many mothers don't realize there are treatment options or don't have the money to afford them.
An important and relevant vehicle to promote treatment for maternal depression is the Affordable Care Act, which opened up coverage to many low-income mothers who did not have access to health insurance before. However, if Trump and Congress go through with repealing the ACA, programs addressing family mental health needs, such as the Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV), could lose their funding and low-income mothers with depression could lose access to treatment and services.
In addition to negatively impacting her own health, a mother’s depression can have long-lasting, harmful effects on the health and well-being of her children. This isn’t surprising considering the large body of evidence that shows the importance of relationships formed between children and adults in the earliest years of life.
Maternal depression has long been known to negatively affect parenting behaviors, child development, and school readiness. But a study published last month in the Journal of the American Academy of Child and Adolescent Psychiatry was the first to examine maternal depression and early caregiving as long-term predictors of children’s empathy. This study followed children of mothers with depression from birth to age 11 and tested depression's impact on children's empathic response to others' distress.
The study found that children of mothers with depression show disruptions in the development of empathic response to the distress of others. Specifically, the researchers found that the neural reaction to pain in children of depressed mothers stops earlier than in controls, so that they seem to be less able to process others' distress.
The authors explain, “the ability to process others’ distress signals and respond in prosocial ways is critical for social learning and psychological adjustment.” As this quote suggests, empathy is an important component of social and emotional development that all children need in order to form and sustain human relationships, achieve personal fulfillment, and contribute positively to society as a whole.
The findings also show the important role mother-child interactions play on this effect. Namely, when the mother and child seemed better attuned to one another and when mothers were less intrusive, children showed higher processing in an area of the brain that is related to socio-cognitive processing. (To measure maternal intrusiveness in this study, the authors looked at constructs such as maternal overriding, forcing, and parent-led interactions). “Depressed mothers are repeatedly found to show less synchronous and more intrusive interactions with their children, and so it might explain some of the differences found between children of depressed mothers and their peer controls in our study," explained Professor Ruth Feldman, lead author of the study.
Untreated maternal depression is damaging to the whole family. These findings can serve as a point of entry for future interventions to focus their strategies on effectively improving mother-child interactions for depressed mothers and their children.
In order to address maternal depression and close coverage gaps, policymakers and clinicians need to work together to establish and support a model of care that considers maternal depression within a two-generation context. That is, a model that addresses the mother’s own mental health needs and her caregiving roles along with her children’s healthy development.
Home visitation has been identified as a promising approach to reach and identify depressed mothers and connect them and their families to services. This is especially important given that mothers who are enrolled in home visitation programs are more likely than other mothers to have symptoms of depression.
Home visiting programs use a two-generation approach that generally involves regular, planned visits to pregnant women and mothers of young children by a trained professional. The goals of home visiting programs may include better maternal and child health and enhancing parents’ understanding of child development and behaviors.
The federal MIECHV program, established in 2010 under the Affordable Care Act, through voluntary, evidence-based home visiting, “seeks to improve maternal and child health, children’s development, and families’ economic self-sufficiency by supporting and educating families...” The MIECHV program has been shown to substantially improve future child and family outcomes throughout the country.
MIECHV and similar programs offer an excellent opportunity for the provision of preventive services such as maternal depression screening, as well as referral to treatment. While home visiting was not necessarily designed to treat maternal depression, and most home visitors do not have the clinical training to do so, certain states are enhancing their home visitation programs to explicitly target intergenerational health and maternal depression. For example, in South Carolina, home visitors are being trained in the fundamentals of Cognitive Behavioral Therapy (CBT) so that they can be familiar with the therapy protocol and can support mothers in need. And, after Louisiana’s state needs assessment revealed a lack of mental health services for pregnant mothers and kids under five, officials invested MIECHV funds in training home visitors to be able to provide mental health services to those groups.
In a study that added treatment to regular home visiting for mothers with major depressive disorders, 70 percent of those who received treatment recovered, compared to 30 percent of those who received only home visiting.
Two-generation programs, such as the federal home visiting program, offer important opportunities for reaching vulnerable mothers and children. The continued funding of successful models for prevention and treatment of maternal depression, particularly for women who are at increased risk for the disorder, must be an important policy priority. Along with the continued funding, home visiting programs should also continue to enhance their ability to treat maternal depression and use findings from studies to focus their strategies.