Essential Reads: Evidence-Based Interventions for Depressed Mothers and Their Young Children

By | March 15, 2021

In a given year, about 10% of mothers in the United States experience a major depressive episode (MDE).  Roughly translated, this means about 1 in 10 children is exposed to maternal depression each year (Ertel et al, 2011).  While much attention has focused on postpartum depression, which affects about 10% to 15% of women, mothers with older children continue to be at increased risk for depression.  Furthermore, rates of depression are extremely high in certain populations of women — for example, those living in poverty — with almost 50% of low income mothers of infants and young children suffering from depression (Knitzer et al, 2008).

What is so alarming about these numbers is that the children of depressed mothers are more likely to experience delays in cognitive and socio-emotional development and are at increased risk of psychopathology as compared to the children of non-depressed mothers. Depression is a treatable illness, and there is ample data supporting the effectiveness of pharmacologic and psychotheraeutic treatments for major depression.  Effective empirically-based interventions for depression exist, yet we continue to observe that the depressed mothers of infants and young children are not in treatment, are unable to access care, or receive inadequate treatment.

While several studies have indicated that treatment of the mother’s depression may improve outcomes in children, reducing the severity of symptoms in affected children (Weissman et al, 2006), other studies indicate that treatment of maternal depression may not be adequate in preventing adverse outcomes in children.  For example, Forman and colleagues observed that the effective treatment of postpartum depression was not associated with improvements in internalizing and externalizing problems in infants assessed at 18 months of age (Forman et al, 2007).

Effective Interventions for Mothers and their Young Children

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While treating maternal depression has obvious benefits for the mother and is an important step in minimizing the impact of maternal depression on children’s wellbeing and family functioning, other integrated interventions may be required to prevent adverse outcomes in the children of depressed mothers.  An excellent article from Sherryl Goodman and Judy Garber (free text available HERE) explores the mechanisms by which maternal depression negatively affects children’s development and behavior and reviews interventions that may be helpful in minimizing the impact of maternal depression.  

Thus review outlines interventions which take a two-pronged approach, reducing maternal depression while at the same time strengthening parenting skills, and have been shown to improve children’s outcomes.  The article highlights integrated programs, such as the Enhanced Triple P – Positive Parenting Program, that address maternal depression and parenting simultaneously.  Somewhat more pessimistically, they note that in 2009, the National Research Council and Institute of Medicine  issued recommendations for a coordinated approach combining (1) treatment of the mother’s depression and (2) strategies to improve parenting skills; however, it appears that these programs are not yet routinely available to mothers in need.

Ruta Nonacs, MD PhD

References:

Ertel KA, Rich-Edwards JW, Koenen KC. Maternal Depression in the United States: Nationally Representative Rates and Risks. Journal of Women’s Health. 2011;20:1609–1617. 

Forman DR, O’Hara MW, Stuart S, Gorman LL, Larsen KE, Coy KC. Effective treatment for postpartum depression is not sufficient to improve the developing mother-child relationship. Development and Psychopathology. 2007;19:585–602.

Goodman SH, Garber J.  Evidence-Based Interventions for Depressed Mothers and their Young Children.  Child Dev. 2017 Mar; 88(2): 368–377.

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

National Research Council and Institute of Medicine. Depression in Parents, Parenting, and Children: Opportunities to Improve Identification, Treatment, and Prevention. Washington, DC: National Academies Press; 2009.

Weissman MM, Pilowsky DP, Wickramaratne PJ, et al.  Remissions in Maternal Depression and Child Psychopathology: A STAR*D-Child Report.  JAMA. 2006;295(12):1389-1398.

MGH Center for Women's Mental Health

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