Treating Maternal Depression: The Need for a Two-Generation Approach
A few weeks ago, the U.S. Preventive Service Task Force released a new proposal recommending that all women who are pregnant or within one year of giving birth be screened for depression. This is a positive development. Maternal depression encompasses the spectrum of depressive disorders that can affect mothers from the prenatal period to up to one year postpartum, including prenatal and postpartum depression, and postpartum psychosis. These disorders also frequently coincide with additional conditions and risk factors including other mental health disorders, substance abuse, chronic medical conditions, domestic violence and poverty, which can exacerbate depressive symptoms. Community Catalyst has recently completed a brief examining many of these issues and opportunities for positive policy changes.
Untreated maternal depression not only impacts the health of mothers, but also the health and well-being of their infants and young children. Maternal depression can negatively affect birth outcomes, parenting behaviors, and child development and school readiness. There are additional consequences for health plans including increased costs related to complicated deliveries, poor birth outcomes, and psychiatric hospitalizations. At least 15 million children in the United States are living with a parent who suffers from depression.
Maternal depression disproportionately affects low-income women and women of color, and they are also the least likely to receive treatment. Closing the coverage gap is an important step toward connecting depressed mothers and their children to health care coverage and additional services, but we also need to begin to think more creatively about transforming our approaches to maternal depression screening and treatment. For maternal depression treatment programs to have the greatest impact, providers must consider the needs of the mother as an individual and as a parent as well as the needs of her infants and young children, a concept known as a two-generation approach to care. The idea behind this model is that “…when opportunities for children and parents are addressed in tandem, the benefits may be greater than the sum of the separate parts.” Unfortunately, maternal depression is rarely considered within the two-generation context because health care for adults and children and for physical and mental health are frequently separated, at least in part due to lack of financial incentives for clinicians.
There are several services that already use a two-generation approach and are tailored to reach vulnerable, low-income families who face the greatest risk for maternal depression and its effects on children. These services offer excellent opportunities to incorporate maternal depression screening and referral to treatment. The Maternal, Infant, and Childhood Home Visiting Program, Head Start and Early Head Start Programs, Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), and the Supplemental Nutrition Assistance Program (SNAP) could all be leveraged to increase depression screening and to refer mothers with depressive symptoms to clinicians and additional services. Two-generation approaches can also be employed in the clinical setting by eliminating the division between primary and mental health care and between adult and pediatrics.
The way we care for pregnant women, mothers, and children is a good measure of the success of our health care system as a whole. We have major deficiencies in the way we address maternal depression, and we must rethink the way we support affected women and families in need. Better screening is an important step forward, but it must also be linked to treatment and services that incorporate a two-generation approach.
For more on this issue, check out the full brief, “Maternal Depression: Implications for Parents and Children and Opportunities for Policy Change.”
Taylor Lauren Frazier
Community Catalyst Children’s Health Team