There are many things that might keep a parent from raising a child as well as they’d like: long working hours, insecure housing, low literacy, to name a few. But depression can be one of the most insidious obstacles. Parental depression is detrimental to child development at all ages; maternal depression can harm a child even before they are born.

Depression is one of the most common forms of mental illness, and it is more common among women than men. Eight percent of U.S. women had a major depressive episode in 2014, and more than one in four of these women (28 percent) received no treatment. Younger women were more likely to have such problems, and were less likely to get help: among women ages 18-25 who experienced depression in 2014, nearly half received no treatment. The problem is so common, in fact, that the U.S. Preventive Services Task Force now recommends depression screening for all adults, and frequent re-screening for anyone who is high-risk. The problem is particularly common among those who are low-income.

This means that the time of life when people are statistically most at risk for depression (and least likely to get treatment) overlaps with the time many women are starting families. This is a serious danger: research indicates that maternal depression during pregnancy is associated with low birth weight, as well as developmental delays and behavioral problems in later childhood.

The risks continue after a child is born. Depression can inhibit parents’ ability to provide the nurturing interactions that children need, resulting in long-term consequences for schooling, behavior, and health.  Depression can cause parents to react to their children in ways that are hostile, intrusive, disengaged, or withdrawn, and such interactions are harmful to proper brain development. Most research currently focuses on maternal depression, perhaps because it is more common, but there is some evidence linking problematic parenting with fathers’ depression as well.

Alarmingly, there is a growing consensus that the children of depressed parents are more likely to have depressed children of their own. This means that if a person is depressed and doesn’t receive treatment, it can have direct consequences for their grandchildren. This generational cycle of depression is felt most strongly among the poor, who are both more likely to be depressed and less able to afford treatment.

So, what can be done?

Most obviously, we should increase access to treatment. The Affordable Care Act stipulates that insurance plans must cover mental health treatment along with other forms of health care. But many Americans, particularly adults, still lack any coverage at all, including about a quarter of poor and low-income adults. There is also a severe shortage of mental health care providers: we need about twice the current number of providers to meet our needs as a country.

But the problem of parental depression also highlights a larger truth about helping children grow and succeed: efforts to help needy children must address the problems around them, as well. It is true that child-centered policies are easier to get passed and implemented—witness the decade-plus gap between the passage of CHIP (universal health care coverage for poor children) and the Medicaid expansion under the Affordable Care Act (universal health care coverage for poor adults). But children cannot succeed if their caregivers and communities are failing.

Health care coverage for children is important, but it’s no substitute for coverage for a depressed parent who cannot get treatment. To help children, we must properly support their parents and communities.

P. Mae Cooper, Research Analyst