Archive for May, 2015


    Caring for Mothers and Children: a Holistic Approach

    Early Childhood Interventions May 08, 2015

    Perinatal depression. Many people, when they hear the term, are confused about its meaning. “Does it have to do with the baby blues? Is it the same as postpartum? What does the prefix ‘peri-’ mean?” Both this apparent lack of pertinent knowledge and the enduring stigma against mental illness contribute to the barriers parents face when this debilitating depression seeps into the joy that would usually surround the birth of their child.

    A diagnosis of perinatal depression indicates that a parent experiences a major or minor depressive episode, or the milder but longer-lasting dysthymia, during the months of pregnancy and/or within a year after birth (Field, 2011). Although there may not be widespread awareness about the issue, perinatal depression is not an uncommon condition, with both mothers and fathers experiencing symptoms. More prevalent than its male counterpart, maternal depression generally affects anywhere between 5 to 25 percent of pregnant and postpartum mothers, with rates steeply escalating to the range of 40 to 60 percent in populations of low-income and teenage mothers (Knitzer, 2008). While studies show that several other factors can also increase a mother’s risk for perinatal depression, a few commonalities emerge amidst the research, including a personal or family history of depression, stress from life events and circumstances, a lack of social networks and support, difficulties with or absence of a partner, and repercussions of an unplanned or unwanted pregnancy (Field, 2011). Also undoubtedly appearing more frequently within the Latina population, maternal depression nevertheless occurs across all races and classes, and thereby influences family life in a variety of households (Le, Perry, & Stuart, 2011). With these consequences of maternal depression reaching far into numerous homes, it is crucial that we research any impacts that negatively affect children and implement programs that simultaneously support mother and child.

    Because mothers experiencing perinatal depression often suffer from further medical symptoms and/or other external hardships at the same time, deciphering the direct effects of maternal depression on early development can be a difficult task. Nevertheless, many researchers have rigorously demonstrated that maternal depression increases a child’s risk for numerous different negative outcomes, both very early and later on in life. Several studies have shown that maternal depression is correlated with higher incidences of preterm delivery and low birth weight, both of which themselves can cause multiple complications for new babies as they develop (Field, 2011). The most commonly reported concerns of mothers experiencing perinatal depression are their infant’s excessive crying and disorganized sleeping patterns. These sleep problems can continue into childhood, along with other delays in cognitive, social-emotional, and behavioral development (Field, 2011; Earls, 2010). By decreasing a mother’s capability for positive interaction, attentiveness, and empathy with her child, perinatal depression can result in a child’s insecure attachment to their mother, which in turn can lead to the child’s later behavior problems (Earls, 2010). Depending on the gender of the child and the timing of the depressive episode, different research has found that maternal depression is associated both with externalizing behavior problems, like noncompliance and aggression, and with internalizing behavior issues, like anxiety and withdrawal, in preschool-age children. Similar findings demonstrate that perinatal depression even predicts a higher chance of these children later developing conduct disorder and major depression themselves (Field, 2011).

    With such strong associations between perinatal depression in mothers and adverse

    consequences for their children, one might think that the identification and intervention services for these populations would be equally as robust. Unfortunately, with several barriers to accessible treatment, including stigma, financial strain, and transportation difficulty, a large proportion of mothers diagnosed with perinatal depression obtain no mental health treatment (Le et al., 2011). Furthermore, as both Alvarez, Meltzer-Brody, Mandel, and Beeber (2015) and England and Simms (2009) point out, these services rarely integrate both parental mental health and children’s early intervention into one programs. Because developmental delays and perinatal depression are typically noticed and assessed in uncoordinated agencies (if at all), this disconnection ignores the “complex interplay” between the two factors (Alvarez et al., 2015). However, crafting comprehensive and creative approaches to simultaneously address both early child development and maternal mental health might offer numerous benefits for families, as some emerging initiatives have testified.

    These programs have adopted myriad strategies to incorporate the alleviation of maternal depressive symptoms, the promotion of child well-being, and the improvement of the mother-child relationship. In Pittsburgh, Pennsylvania, for example, The Helping Families Raise Healthy Children Initiative fostered increased communication and collaboration between separate service agencies by hosting cross-system trainings and networking meetings (Schultz, Reynolds, Sontag-Padilla, Lovejoy, Firth, & Pincus, 2013). The initiative’s findings suggest that, with well-defined protocol, “screening for parental depression can be integrated into routine care in the…early intervention system” of the Individual with Disabilities Education Act (Schultz et al., 2013). Having already then established relationships between these early intervention specialists, behavioral health practitioners, and maternal health organizations, the initiative increased the rate of appropriate referrals made, which in turn nearly doubled the rate at which mothers attained treatment or families engaged in relationship-based practices.

    Providing another strong example, Early Head Start, a federal “comprehensive family support and child development program,” is a major frontrunner in addressing maternal depression and its potential outcomes on children (Knitzer et al., 2008). With a growing number of Early Head Start programs successfully screening for maternal depression, Early Head Start concentrates on improving the mother-child relationship and enhancing parenting practices in their program. Utilizing home-visiting services allows Early Head Start the important opportunity to prevent or detect perinatal depression in mothers having trouble leaving their house due to transportation, mobility, or mental health issues (National Center on Parent, Family, and Community Engagement, 2013). Studies have shown that depressed parents participating in Early Head Start are more likely to lessen their depressive symptoms and to improve their parenting practices through more positive interactions and less harsh discipline. Meanwhile, compared to peers not enrolled in Early Head Start, their children demonstrate gains in vocabulary and engagement, along with decreases in aggression and negativity (Knitzer et al., 2008).

    With trial initiatives and nationwide programs alike showcasing the possibilities for comprehensive care, it is clear that both mothers and children benefit from integrated services addressing perinatal depression and its possible detrimental outcomes. With the collaboration of community organizations, the continuation of screening practices, and the provision of home visits, it is time to support both mothers and their children in the way best suited to their needs.

    References

    Alvarez, S. L., Meltzer-Brody, S., Mandel, M., & Beeber, L. (2015). Maternal depression and early intervention: A call for an integration of services. Infants and Young Children, 28 (1), 72-87. doi: 10.1097/IYC.0000000000000024

    Earls, M. F. (2010). Clinical report: Incorporating recognition and management of perinatal and postpartum depression into pediatric practice. American Academy of Pediatrics, 126, 1032-1039. doi: 10.1542/peds.2010-2348

    England, M. J. & Simms, L. J. (2009). Depression in parents, parenting, and children: Opportunities to improve identification, treatment, and prevention.Washington, D.C., National Academic Press.

    Field, T. (2011). Prenatal depression effects on early development: A review. Infant Behavior and Development, 34, 1-14. doi: 10.1016/j.infbeh.2010.09.008

    Knitzer, J., Theberge, S., & Johnson, K. (2008). Reducing maternal depression and its impact on young children: Toward a responsive early childhood policy framework. National Center for Children in Poverty, 2.

    Le, H., Perry, D. F., & Stuart, E. A. (2011). Randomized controlled trial of a preventative intervention for perinatal depression in high-risk Latinas. Journal of Consulting and Clinical Psychology, 79 (2), 135-141.

    National Center on Parent, Family, and Community Engagement. (2013). Family well-being: A focus on parental depression. Understanding Family Engagement Outcomes: Research to Practice Series.

    Schultz, D., Reynolds, K. A., Sontag-Padilla, L. M., Lovejoy, S. L., Firth, R., & Pincus, H. A. (2013). Transforming systems for parental depression and early childhood developmental delays: Findings and lessons learned from the Helping Families Raise Healthy Children initiative. Santa Monica, CA: RAND Corporation.

    Amber Rybnick
    Georgetown University,
    College, Class of 2016

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