Child Trends 5

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Aug 23, 2017

Depression is one of the most common mental health disorders in the United States, affecting over 16 million adults. The prevalence of depression among parents of children under age 18 is similar to that in the adult population generally. Both mothers and fathers experience depression, and approximately 15.6 million children—1 in 5—live with an parent who is severely depressed.

Nearly a decade ago, a comprehensive report on the prevalence, treatment, and prevention of parental depression, by the National Research Council and Institute of Medicine, determined that untreated parental depression can impede children’s health and development. From that seminal report and more recent sources, here are five things to know about parental depression:

1

When left unaddressed, parental depression can undermine healthy parenting.

There is a strong link between parents’ mental health and their children’s development. Parents who are depressed may experience difficulties with their mood, thinking, and ability to engage in everyday activities, such as sleeping, eating, and working. Compared to parents who are not depressed, they are also more likely to engage in negative parenting behaviors (e.g., to be hostile, withdrawn, abusive, neglectful), and less likely to be warm, sensitive, and responsive to their children’s needs. Researchers have observed less-sensitive parenting in both mothers and fathers who are depressed, though much less research has been conducted with fathers.

2

Untreated parental depression can have harmful consequences for children.

A large body of research has shown that children of parents with untreated depression have higher rates of behavior problems, difficulty coping with stress and forming healthy relationships, academic problems, and mental illness, compared to children whose parents are not depressed. The chances of poor child outcomes are increased when a parent’s depression is severe or chronic, begins early in a child’s life, or is accompanied by other risk factors (e.g., poverty, family violence, discrimination, substance abuse, other health and mental health problems). Depression during pregnancy may also have adverse effects on the fetus. Therefore, early identification and treatment of parental depression is essential.

3

Treatment for depression is usually effective, yet rarely addresses depression’s potential impacts on parenting or children.

Even when it is severe, parental depression can be treated effectively, often through a combination of psychotherapy, medication, and mind-body practices (e.g., yoga, meditation, and other forms of self-care). However, current treatment approaches rarely address the effects of depression on parenting or children. The National Research Council and Institute of Medicine recommend a two-generation approach that simultaneously focuses attention on parent-child relationship quality and parental mental health.

4

A number of interventions have shown promise for improving outcomes among children with a depressed parent.

Evidence from scientifically rigorous studies demonstrates that two-generation interventions targeting parental depression (e.g., Family Talk; Family Group Cognitive Behavioral (FGCB) preventive intervention) can be especially effective for promoting resilience in children with a parent who is depressed. These interventions help children gain awareness that their parent has an illness, understand that the illness is not their fault, and develop coping skills. Service delivery strategies that focus more broadly on healthy parenting and child development (e.g., home visiting, mental health consultation, child and parent psychotherapy) also have better program outcomes when they address parental depression (e.g., through identification, screening, referral, and/or treatment). However, additional efforts are needed to develop and evaluate these interventions, and to make adaptations to address cultural and linguistic diversity and to reduce health disparities.

5

The federal government can play a leadership role in encouraging and facilitating comprehensive, two-generation approaches to treating parental depression.

Public and private programs and entities (e.g., Medicaid, managed care, health maintenance organizations, insurers, private employer health plans) do not provide adequate coverage or reimbursement for high-quality two-generational interventions. And, families face major barriers to treatment, such as the public’s lack of understanding about depression, stigma about mental illness and treatment, and disparities in access to care. Congress and the executive branch have multiple opportunities to support improvements in services and service coordination for families who struggle with parental depression. These include investments in (a) increasing public awareness; (b) supporting the design, implementation, and evaluation of two-generational interventions; (c) incentivizing interdisciplinary and cross-agency state and federal collaboration; and (d) improving mental health financing systems.

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