Depression in parents really does matter

In an editorial review in Psychological Medicine, Psychogiou & Parry have managed to capture the essence of our current understanding of the effects of depression on parenting and implications for children. They note that these implications may also exist for some other conditions such as anxiety, ADHD and Borderline Personality.

Some of the highlights of the article note:

* Parents with low positive affect interact less with their children;
* Parents high on negative affect tend to be intrusive or excessively critical;
* Depressed mothers may show  poorer emotion-regulation strategies;
*They may lower parenting motivation;
* Mothers and fathers with post partum depression may not interact as well with their infants and may, as a result, not build some of the brain circuitry that play a key role in a parent's motivation to be responsive and involved caregivers;
* Rumination in parents affects motivation but it may be more so with fathers;
* Depressed parents may also have lower cognitive flexibility to deal with the demands of parenting.

The authors also note that contextual or environmental factors that a parent operates within also are important. This would include marital conflict, single parenthood or socio-economic realities.

This review certainly brings increased credence to the need to ensure that we are intervening with depressed parents quickly and effectively so that their emotional awareness, regulation and interactions can be encouraged towards a child development lens.

In another recent report, Lewandowski and colleagues note how important the self esteem and resiliency of a child is in buffering the effects of depressed parents. Thus, our interventions need to look beyond the parents to also ensure that we are focused on what the child needs to build internal strengths. Parenting is bi-directional and thus, both parts of the interactional equation, parent and child, should be the focus of attention.

Properly treated, the vast majority of cases of depression respond positively to intervention. These recent publications help us to see that they are useful ways to think about avoiding the need for child protection involvement when other health care systems can see the problem and act quickly and effectively.

References:

Lewandowski, R.E., Verdel, H., Wickramartne, P., Warner, V., Mancini, A. & Weissmann, M. (2013).  Predictors of positive outcomes in off spring of depressed and non-depressed parents across 20 years. Journal of Child and Family Studies, early view, doi: 10.1007/s10826-013-9732-3

Psychogiou, L. & Parry, E. (2013). Why do depressed individuals have difficulties in their parenting role? Psychological Medicine, early view. doi: 10.1017/S0033291713001931

As a result of the comment below, I am adding a link to their rather excellent info graphic

Depressed Mothers in the child welfare system

Kohl, Kagotho and Dixon have just published a rather interesting piece of research regarding depressed mother's parenting. They looked at a child protection population. As they note, women are more likely to experience depression as compared to men. Further, those referred to a child protection system will more likely have cumulative stressors that may add to the problems. Women are more likely to be the caregivers in child welfare families and depression is a common concern. Depression has also been found to have a relationship with dysfunctional parenting.

These researchers looked at 92 sampling units across 36 states in the USA. The sample was robust with 5501 children. The families were followed for 36 months and comprised those where the children spent no more than 5% of time in an out of home placement. Thus, while this is a child welfare population, it is one where family preservation is occurring. This might suggest that the population is less severe than might other samples be, but it also afforded the researchers a chance to see what unfold with parenting when the parent stays in that active role. Given the focus of the research, the mother also needed to be the primary caregiver, but could be biological, adoptive or step mother.

The results showed some surprising conclusions, the most important being that it did not replicate the previously seen conclusion that there is a connection between depression and harsh parenting. However, it did increase from 9% to 14% over the course of the study. That is a statistically significant increase. Even so, harsh parenting was a rare event. This is an important result.

The connection between neglectful and emotionally abusive parenting was found. The latter grew over time which is of course, rather concerning. As these authors note,

These high rates of ongoing emotional maltreatment after a CPS referral are a concern, given the long-term adverse consequences of experiencing this type of maltreatment in child- hood. Emotional maltreatment has been found to be an important contributor of psychological adjustment in young adulthood, with higher levels of emotional maltreatment being associated with poorer outcomes (Miller-Perrin, Perrin, & Kocur, 2009).(p.223). 

In their discussion about the implications of their work for clinical practice, the authors note that parents in child protection system are much less likely to receive mental health services as opposed to the overall population. That is worrisome given the implications for these families. This result comes from the USA and may vary across jurisdictions. None the less, it is an acute reminder that assessing for mental health concerns remains a priority in child protection populations. Getting mental health services in place may well serve to increase family preservation outcomes and also reduce such parenting practices as emotional abuse and neglect.

This research underlies the value of good assessment and then connection to needed services.

Reference:

Kohl, P.L., Kagotho, J.N. & Dixon, D. (2011). Parenting practices among depressed women in the child welfare system. Social Work Research, 35, (4), 215-225.