Maternal Depression
Prachi E. Shah
I. Description of the problem. Depression and depressive disorders are among the most prevalent mental health problems in the United States. For women 15-44 years of age, depression is the leading cause of disease burden worldwide. The effects of maternal depression on child development are well documented. Children of depressed parents are at risk for developing significant psychological, social, learning, and behavioral problems. The mechanisms by which maternal depression affects child development are multifactorial and may be related to a transaction between genetics, parent-child interactions, parenting behaviors, and child characteristics. Maternal mental health issues often go undetected, and pediatric clinicians are in an optimal position both to screen and to refer mothers at risk for further evaluation and treatment.
Maternal depression is a significant psychosocial risk factor with serious adverse implications for child development.
Adverse child health outcomes include increased risk of developmental delay, behavior problems, mental health disorders, including depression, poorer cognitive, social, and emotional functioning, asthma, and injuries.
Children may be at higher risk for adverse outcomes if both parents are in poor mental health. Alternatively, a father with better mental health can buffer the effects of maternal depression on the child’s behavioral and emotional outcomes.
Depressed mothers are more likely to utilize emergency department services and specialty health services and are less likely to engage in preventive parenting practices and utilize well-child care visits.
Increased rates of depression are seen in families with several young children or with a child with a chronic illness in the household.
Higher rates of depression are associated with living in the inner-city, lower socioeconomic status, immigrant status, poor marital relationships, drug and alcohol usage, and lower levels of education.
Estimates of maternal depressive symptoms in a variety of pediatric practice settings has ranged from 12% to 47%.
Postpartum depression has a reported incidence of 8%-15%.
II. Classification of Maternal Depression.
A. Depression (or major depressive disorder) is defined by the following Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria: Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning and at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.
Significant weight loss when not dieting, or weight gain, or decrease or increase in appetite nearly every day.
Insomnia or hypersomnia nearly every day.
Guilt (excessive or inappropriate) or feelings of worthlessness nearly every day.
Energy loss or fatigue nearly every day.
Concentration diminished or indecisiveness, nearly every day (by either subjective account or observation made by others).
Agitation (psychomotor) or retardation nearly every day.
Pleasure lost (anhedonia) in all, or almost all, activities most of the day, nearly every day as indicated by either subjective account or observation made by others.
Suicidal ideation or recurrent thoughts of death without a specific plan, or a suicide attempt, or a specific plan for committing suicide.
B. Postpartum mood disorders.
1. Postpartum blues is experienced by 40%-80% of new mothers and is characterized by rapid mood swings, emotional lability, anxiety, decreased concentration, and sleeping difficulties that occur within the first 2-3 days of delivery and that resolve by 2 weeks
postpartum. If symptoms persist for more than 2 weeks, a diagnosis other than postpartum blues must be considered.
2. Postpartum psychosis. Prevalence: 0.1%-0.2% and is characterized by severe sleeping disturbances, rapid mood swings, anxiety, delusions, hallucinations, racing thoughts, rapid speech, and thoughts of suicide or infanticide.
3. Postpartum depression. Prevalence: 8%-15% and is characterized by sleep disturbances, changes in appetite, profound lack of energy, anxiety, anger, guilt, feeling overwhelmed, sense of being unable to care for baby, or feelings of inadequacy. For a diagnosis of postpartum depression, depressive symptoms must occur within 4 weeks of childbirth.
III. Effects of maternal depression.
The symptoms of maternal depression are demonstrated in the mother but are also manifested in the children.
A. Mothers. The symptoms of depression interfere with effective parenting:
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