Depression affects roughly 7.5 million parents—about one in five—in the United States annually. About 15.6 million children under 18 live with an adult who has had major depression in the past year, according to a report by the National Research Council (NRC) and the Institute of Medicine (IOM). This report, Depression in Parents, Parenting and Children: Opportunities to Improve Identification, Treatment, and Prevention (National Academies Press, 2009) was prepared by a committee convened from 2007 to 2009 by the NRC-IOM Board on Children, Youth, and Families.
Despite broad recognition that parental depression has had a serious impact on child health and development, "there was a real absence in the field of strategies that could address parental functioning and preventive interventions for their children, especially very young children," said Mary Jane England, M.D., president of Regis College, who chaired the study committee.
To address that shortcoming, the interdisciplinary Committee on Depression, Parenting Practices, and the Healthy Development of Children examined the incidence and treatment of parental depression, especially among underserved populations. The committee also identified strategies to foster best-practice interventions in settings that engage at-risk families, such as community health centers, pediatric practices, Head Start and the federal Women, Infants, and Children program.
Key Activities & Results
As part of its fact-gathering efforts, the committee:
- Conducted a comprehensive review of studies on depression among parents and the effects on their children; commissioned six papers analyzing the research and findings; and held five formal meetings that included presentations from experts
- Convened a public workshop to explore strategies and programs to provide mental health and child development services to families; it was attended by 70 providers, community leaders, representatives from health plans and others working with underserved populations
- Visited two residential centers providing treatment to women for substance abuse, one in Boston and one in Pomona, Calif., to gather information on programs that integrate a number of services for parents, including those that address mental health
See the Appendix for a list of members of the Committee on Depression, Parenting Practices, and the Healthy Development of Children.
The committee's report includes the following findings, among others:
- Parental depression can affect the physical, psychological and behavioral health and development of children at all ages.
- Community and clinical settings that serve adults at higher risk for depression do not routinely screen for depression. Settings that do provide such screening usually do not consider whether adults are parents and, therefore, do not consider the impact of their mental health on their children.
- Emerging preventive interventions for families with depressed parents show promise, but studies of the effectiveness of those interventions are limited.
- Services for depressed parents would ideally strengthen and support parent-child relationships, offer treatment and prevention services for children and provide comprehensive resources and referrals for problems linked to depression, such as substance abuse and trauma.
- Such services should be culturally and linguistically sensitive and available in multiple health care settings.
In Depression in Parents, Parenting, and Children, a brief version of the full report, the committee made the following recommendations:
- Improve awareness and understanding: Depression in parents and its effects on children should be a public health priority.
- Support innovative strategies: Public agencies should encourage the design and evaluation of innovative services in different settings for diverse populations of children and families.
- Improve collaboration and capacity building: Every state should develop local and regional strategies to expand its capacity to respond to parental depression with research-based practices.
- Improve provider education and training: The nation needs a collaborative training program to improve the capacity of providers of primary care, mental health and substance abuse services to address depression in parents and mitigate its effects on children.
- Improve service coverage and reimbursement strategies: Public and private payers should establish financing mechanisms to support access to treatment and support services for parents with depression and their children.
- Promote and support research: Public agencies should support a collaborative research agenda to develop and evaluate strategies for screening and treating parents for depression, and for mitigating the effects on their children.
The full report includes other recommendations targeted to specific federal agencies.
Project staff and committee members made more than 10 presentations on the report, including briefings at the Centers for Disease Control and Prevention in Atlanta, and at the 2009 annual meeting of the American Public Health Association in Philadelphia.
- Expertise from multiple disciplines is necessary to explore a multifaceted topic. To bridge the gap between efforts to identify and treat parents with depression and interventions for their children, the committee included members "who understood the children's situation, the parent's situation and the health services infrastructure," as well as individuals with expertise in the social, behavioral, and health sciences, said Leslie Sim, study director.
- Acknowledge shortcomings in existing research. The committee felt it was very "important that people understand the limitations and challenges of searching the literature in so many disciplines, and evaluating the studies," said Rosemary Chalk, M.D., director of the NRC-IOM Board on Children, Youth, and Families, especially since the committee found no clear evidence to support one consistent model for addressing the effects of depression on families.
The Robert Wood Johnson Foundation supported this project from August 2007 through September 2009 with a $500,000 grant to the National Academy of Sciences—the parent organization of the National Research Council and the Institute of Medicine. Other funding came from the California Endowment ($150,000); the Annie E. Casey Foundation ($100,000); and the Substance Abuse and Mental Health Services Administration ($50,000) and the Maternal and Child Health Bureau ($200,000) of the U.S. Department of Health and Human Services.
Project staff members are planning meetings with federal officials, leaders of community-based programs and health providers to raise awareness of the committee's findings. "We are trying to develop a broad, integrated strategy to direct resources to this area," said Chalk. "Ultimately, this is a foundational report that will be important in building integrated policy and practice, but it is a bit ahead of the curve."