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Reducing Maternal Depression and Its Impact on Young Children Toward a Responsive Early Childhood Policy Framework

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Reducing Maternal Depression and Its Impact on Young Children Toward a Responsive Early Childhood Policy Framework PROJECT THRIVE Issue Brief No. 2 Reducing Maternal Depression and Its Impact on Young Children Toward a Responsive Early Childhood Policy Framework Jane Knitzer n Suzanne Theberge n Kay Johnson January 2008 The National Center for Children in Poverty (NCCP) is the nation’s leading public policy center dedicated to promoting the economic security, health, and well-being of America’s low-income families and children. Founded in 1989 as a division of the Mailman School of Public Health at Columbia University, NCCP is a nonpartisan, public interest research organization. Reducing Maternal Depression and Its Impact on Young Children: Toward a Responsive Early Childhood Policy Framework by Jane Knitzer, Suzanne Theberge, and Kay Johnson This issue brief reflects NCCP’s continuing commitment to ensuring that every low-income child enters school with the skills to succeed, and that policymakers have access to the very best research to create policies that use public resources in the most effective, smartest way. It is based on a meeting convened through NCCP’s Project THRIVE to identify and promote solutions to emerging issues that impact young children’s healthy development and school readiness. The brief is being jointly published by Project THRIVE, through which NCCP serves as a resource to the Maternal and Child Health Bureau-funded State Early Childhood Comprehensive Systems (ECCS) systems program and Pathways to Early School Success, NCCP’s on-going project to help policymakers, program administrators and practitioners ad- dress barriers that get in the way of reducing the achievement gap for young low-income children. AUTHORS Jane Knitzer, EdD, is the director at NCCP and Clinical Professor of Population and Family Health at Columbia University’s Mailman School of Public Health. She has contributed many important studies on how public policies can promote the healthy development of low-income children and better support families, particularly those who are most vulnerable. Kay Johnson, MPH, MEd, is a consultant to NCCP and director of Project THRIVE, which links policies for child health, early learning, and family support. She has broad expertise in many areas of maternal and child health and has led numerous studies of maternal and child health and early childhood policy, finance, and infrastructure issues. Suzanne Theberge, MPH, is the research analyst for Project THRIVE. ACKNOWLEDGMENTS NCCP is deeply grateful to the participants at the NCCP meeting who shared insights, challenges and ideas so willingly (See Appendix), to our other key informants who shared their programs and experience with us, to Janice Cooper for her comments, and to Mareasa Isaacs whose analysis, Community Care Networks for Low-Income Communities and Communities of Color, guided and inspired this work. We are also especially grateful to Phyllis Stubbs-Wynn, who oversees our Project THRIVE work through the Maternal and Child Health Bureau. Copyright © 2008 by the National Center for Children in Poverty PROJECT THRIVE ISSUE BRIEF 2 Reducing Maternal Depression and Its Impact on Young Children: Toward a Responsive Early Childhood Policy Framework Jane Knitzer n Suzanne Theberge n Kay Johnson l January 2008 “Dollars invested in moms are dollars that really pay off.” – Dr. Frank Putnam, Professor of Pediatrics and Psychiatry, University of Cincinnati. 20061 Introduction Framing the Challenge Maternal depression is a significant risk factor affecting Depression is increasingly recognized as major world- the well-being and school readiness of young children. wide public health issue. It has a negative impact on Low-income mothers of young children experience par- all aspects of an individual’s life – work and family ticularly high levels of depression, often in combination – and can even lead to suicide. Typically, depression with other risk factors. This policy brief provides an is discussed as an adult problem affecting women or overview of why it is so important to address maternal men, and increasingly, it is recognized as a significant depression as a central part of the effort to ensure that problem for children.2 But far too rarely is depression, ALL young children enter school ready to succeed. It particularly maternal depression, considered through a highlights: lens that focuses on how it affects parenting and child outcomes, particularly for young children; how often n what research says about the impact of maternal de- pression on young children, particularly infants and it occurs in combination with other parental risks, like toddlers, and how prevalent maternal depression is; post-traumatic stress disorder; and what kinds of strate- gies can prevent negative consequences for parents, for n examples of community and programmatic strategies their parenting and for their young children. to reduce maternal depression and prevent negative cognitive, social emotional and behavioral impacts on young children; Defining Depression through a Parenting Lens n key barriers to focusing more attention to maternal In the context of parenting, depression can be defined depression in policies to promote healthy early child as: development and school readiness; n a combination of symptoms that interfere with the n state efforts to address policy barriers and craft more ability to work, sleep, eat, enjoy and parent (italics appropriate policy responses; and ours) and that affects all aspects of work and family life; n recommendations for national, state and local poli- n an illness that frequently starts early in life, that may cymakers. have a biological component and that produces sub- stantial disability in functioning (whether it is defined as Major Depressive Disorder or depressive symptoms);3 n a common but invisible pathway to a cluster of adver- sities for adults who are parents, and their children, particularly mothers and their young children; n a condition that responds to prevention and treatment.4 National Center for Children in Poverty Reducing Maternal Depression and Its Impact on Young Children 1 “If Mama ain’t happy, no one is happy.” – Participant in a focus group for low-income women of color. Dr. Mareasa Isaacs, Executive Director, NAMBHA. 20045 1) Maternal depression is widespread, particularly but the exact nature of the interaction is unclear. Afri- among low-income women with young children. can American women have very high rates of depres- sion; rates among Latino women vary from high to very Maternal depression is widespread across class and race, low, although rates in Latina adolescents are uniformly and has been linked to genetic composition, situational high.14 But research also suggests that poverty is a more risk factors and circumstances, and environmental gene powerful predictor. For poor women, rates of depres- interaction.6 Disproportionately, it impacts low-income sion are high regardless of ethnicity. One study showed parents, whose depression is embedded in their life equal rates of depression among African American and circumstances, poverty, lack of social supports and European American low-income women, and a study of networks, substance abuse, intimate partner violence, TANF recipients did not find a difference in prevalence childhood abuse, and stress linked to a life of hardship, between ethnic groups.15 In effect, poverty trumps race and too often, no hope. (See box.) Research has shown as a factor in maternal depression.16 correlations between race and ethnicity and depression, 2) Maternal depression, alone, or in combination with other risks can pose serious, but typically un- Prevalence Data on Maternal Depression recognized barriers to healthy early development and school readiness, particularly for low-income n Approximately 12 percent of all women experience depression in a given year.7 young children. n For low-income women, the estimated prevalence doubles to at least 25 percent.8 Maternal depression threatens two core parental func- tions: fostering healthy relationships and carrying out • Estimated rates of depression among pregnant and postpartum and parenting women in general range the management functions of parenting. The result, from 5 to 25 percent.9 long tracked in child development research, has been • Low-income mothers of young children, pregnant linked to demonstrable reductions in young children’s and parenting teens report depressive symptoms in behavioral, cognitive, and social and emotional func- the 40 to 60 percent range. tioning. The impact of depression varies by its timing – Over half the mothers (52%) in a study of 17 (maternal depression during infancy has a bigger impact Early Head Start programs reported depressive on a child’s development than later exposure), its sever- symptoms.10 ity, and the length of time it persists.17 – Another study found that an average of 40 per- cent of young mothers at community pediatric health centers screened positive for depressive Negative effects can start before birth symptoms (site specific rates ranged from 33% The negative effects of maternal depression on children’s to 59%).11 health and development can start during pregnancy.18 – Studies of women participating in state welfare- While the biological mechanisms are not clearly under- to-work programs indicate that depression and stood, research on untreated prenatal depression finds elevated levels of depressive symptoms range from 35-58 percent.12 links to poor birth outcomes, including low birth- weight, prematurity, and obstetric complications.19 The NOTE: Some studies report clinical
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