Addressing parental depression in non-traditional care environments

Can access to mental health services be improved by providing services outside of mental health settings?

By Carmen Valdez, PhD

Carmen R. ValdezDepression is a common experience that affects a large segment of the population. The lifetime prevalence of depression is 16.2 percent, with women being 70 times more likely than men to be affected by depression in their lifetime (Kessler et al., 2005; Kessler et al., 2003; National Institute of Mental Health, 2014). Age also matters in depression, in that women are at highest risk for depression during their child rearing years. In fact, among first-time mothers, the risk for hospitalization or outpatient contact due to depression is highest between 10-19 days after child birth (Munk-Olsen, Laursen, Pedersen, Mors, & Mortensen, 2006). Not detecting or treating depression during this time period could lead to devastating consequences for both mothers and their infants. Longitudinal studies show that children of parents with depression grow up experiencing a host of emotional, behavioral, social and academic difficulties, as well as medical concerns, that persist into adulthood (Timko et al., 2009; Weissman et al. 2006). Thus, there is an acute need for the effective detection and treatment of depression targeting mothers and children (Valdez, Abegglen, & Hauser, 2013).

Unfortunately, the majority of mothers with depression remain underserved by the mental health system. Results from a national survey showed that only 57 percent of adults with depression received treatment, and only 38 percent of those adults received minimally adequate treatment (Wang et al., 2005). This means that only 21 percent of adults with depression receive efficacious treatment. Rates of mental health treatment are lower for low income women, many of whom are ethnic or racial minorities, and for whom there is a heightened risk for depression (Cardemil, Kim, Pinedo, & Miller, 2005). In a study of mental health use among Latinos, those who were uninsured, foreign-born or language minorities were particularly at risk for not using traditional mental health services (Alegría et al.. 2007). Thus, if we want to reach disadvantaged and psychologically vulnerable populations, in addition to improving the quality of services, we need to improve accessibility and cultural congruence of services (Cardemil et al., 2005, Valdez et al., 2013).

As psychologists, we have an opportunity to improve these dismal rates of mental health use among mothers with depression by developing models of detection and treatment in the settings that women already encounter. Depression in pregnant women could be recognized more readily during obstetrics visits prior to childbirth, and in new mothers during pediatric visits. Beyond medical settings, we could develop detection models and intervene in community settings such as Head Start or the YWCA, where low-income women typically receive child wellness care and parenting education. The three main articles in this newsletter focus on non-traditional systems of care for pregnant women with depression, or for new mothers and their young children. The first article by Riley and Weiss-Laxer highlights the importance of perinatal depression screening in obstetrics. Their article makes specific recommendations for how psychologists can be part of medical teams in obstetrics and train obstetricians in the depression screening process. The second article in this newsletter is by Lovell, Roemer and Talmi, and describes a model program for pregnancy-related depression screening and services in pediatric primary care. The third article is by Mendez, Paymon, LaForett, Eddington, Keane and Cupito, and provides a rationale for re-locating mental health services to settings such as YWCA, where new teenage mothers with depression can receive support and enhance their likelihood of returning to school, graduating from school and decreasing likelihood of subsequent pregnancies.

In the spotlight section of this newsletter are two articles offering resources for families and clinicians. Sherman lists bibliotherapy resources for family members when a parent is experiencing depression; Singley offers tools for detecting and treating depression in new fathers. Finally, in our Next Generation section dedicated to graduate student perspectives, Anderson and Hussain discuss the role of discrimination in parental depression among low-income Black families.

References

Alegría, M., Mulvaney-Day, N., Woo, M., Torres, M., Gao, S., & Oddo, V. (2007). Correlates of past-year mental health service use among Latinos: Results from the National Latino and Asian American Study. American Journal of Public Health, 97, 76-83. doi:  10.2105/AJPH.2006. 087197

Cardemil, E. V., Kim, S., Pinedo, T. M., & Miller, I. W. (2005). Developing a culturally appropriate depression prevention program: The Family Coping Skills program. Cultural Diversity and Ethnic Minority Psychology, 11, 99–112. doi:10.1037/1099-9809.11.2.99.

Kessler, R.C., Berglund, P.A., Demler, O., Jin, R., Merikangas, K.R., & Walters, E.E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Archives of General Psychiatry, 62, 593-602.

Kessler, R.C., Berglund, P.A., Demler, O., Jin, R., Koretz, D., Merikangas, K.R., Rush, A.J., Walters, E.E., & Wang P.S. (2003). The epidemiology of major depressive disorder: Results from the National Comorbidity Survey Replication (NCS-R). Journal of the American Medical Association, 289, 3095-3105.

Munk-Olsen, T., Laursen, T.M., Pedersen, C.B., Mors, O., & Mortensen, P.B. (2006). New parents and mental disorders: a population-based register study. Journal of the American Medical Association, 296, 2582-2589.

National Institute of Mental Health (2014, March). Major depressive disorder among adults. Retrieved from http://www.nimh.nih.gov/statistics/1MDD_ADULT.shtml

Timko, C., Cronkite, R. C., Swindle, R., Robinson, R. L., Sutkowi, A., & Moos, R. H. (2009). Parental depression as a moderator of secondary deficits of depression in adult offspring. Child Psychiatry and Human Development, 40, 575–588. doi:10.1007/s10578-009-0145-x.

Valdez, C. R., Abegglen, J., & Hauser, C. (2013). Fortalezas Familiares Program: Building sociocultural and family strengths in Latina women with depression and their families. Family Process, 52, 378–393. doi:10.1111/famp.12008

Wang, P.S., Lane, M., Olfson, M., Pincus, H.A., Wells, K.B., Kessler, R.C. (2005). Twelve month use of mental health services in the United States. Archives of General Psychiatry. 62, 629-640.

Weissman, M. M., Wickramaratne, P., Nomura, Y., Warner, V., Pilowsky, D., & Verdeli, H. (2006). Offspring of depressed parents: 20 years later. The American Journal of Psychiatry, 163, 1001–1008. doi:10.1176/appi.ajp.163.6.1001.

About the Author

Carmen R. Valdez is an associate professor in the department of counseling psychology at the University of Wisconsin — Madison (UW). She is also a licensed professional psychologist. Valdez serves on the American Psychological Association Committee on Children, Youth and Families. She is the faculty director of the Advancing Health Equity and Diversity program in the UW School of Medicine and Public Health, where she provides mentoring and training to early career scholars and investigators in health disparities research. Her research is focused on the impact of family stress and sociocultural context on Latino children’s academic, social and emotional functioning.