There has long been thought to be an intergenerational component as regards the impacts of maternal depression in leading to emotional and behavioral problems in children. Youth with depressed mothers are more prone to developing depressive symptom profiles and in boys there are findings that indicate increased incidence of behavioral problems. Various genetic and environmental theories have been put forth to explain these findings.
Most recently, perinatal depression has been categorized an adverse childhood event (ACE) that has been found to lead to increased risks of an array of medical and mental health consequences. For any one family, however, it can be difficult to identify which factors cause depression to be “passed on”, or to define which interventions will be most helpful in mitigating risks. In the context of the current efforts to extend screening and treatment within the primary care setting, this article will seek to inform primary care providers of the relevant treatment interventions that can be proactively employed to secure the optimal health and development of children. Of particular note, is the recent finding that youth of depressed mothers are more often found to be the victims of bullying from their peers— a secondary causal factor in the progression of emotional and behavioral health difficulties for these youth.
The American Academy of Pediatrics recommends screening of mothers for perinatal depression be integrated into well-child checks at 1, 2, 4 and 6 months. Recommendations for intervention and treatment are laid out in the 2019 policy statement (Earls et al, 2019), which include counseling about treatment options to demystify the illness (reduce stigma, and provide normalization), providing referral to mental health resources and community supports for affected mothers. For many clinics, this represents a shift in work flow, and may require influx of resources, whether to establish a trusted referral network, increase follow-up capabilities, and enhance mental health training of primary providers. Locally, the SmartCare program is a resource that can assist in these processes – mothers presenting with depressive symptoms/illness can be referred to SmartCare for early intervention, appropriate referral and care coordination regarding both their and, when warranted, their children’s needs.
The impact of maternal depression is well documented, and therapy and, when indicated, psychopharmacologic treatment of the depressed mother can be quite effective. A recent study looked into co-factors that may be associated with maternal depression and the development of depression in adolescent children. Earls and others found that peer victimization may be a key factor, more significant than negatively parenting techniques. We might consider then, if a mother is depressed, in addition to treating her depression, we might want to screen for bullying, and to seek to intervene on behalf of the youth at school. While more studies are needed, this type information is essential to creating a more effective approach towards mitigating the impact of depression on the family. The articles referenced below provide further details about these concerns.
Cote, S et al (2018). “Why is Maternal Depression Related to Adolescent Internalizing Problems? A 15-Year Population-Based Study”. Journal of the American Academy of Child and Adolescent Psychiatry Vol 57 No. 12 Dec 2018
Earls, M et al (2019). “Incorporating Recognition and Management of Perinatal Depression Into Pediatric Practice”. Pediatrics January 2019, 143 (1) e20183259; DOI: https://doi.org/10.1542/peds.2018-3259