1. Maternal Depression: A Risk Factor for Infant Mental Health Presented by: Dr. Deborah Perry Georgetown University Child Development Center

2. Outline for Presentation w Epidemiology of depression w Symptoms and assessments w Influence on child development w Implications for practice

3. Prevalence of Major Depression Kessler et al. (1994)

4. Prevalence of Post-Partum Depression w Estimated 50-80% of all mothers experience post-partum blues in 10 days following birth w 8-15% mothers experience post- partum depression within first year w 1 in 1,000 women experience post- partum psychosis during first year, most occur before third month

5. Syndromes and Symptoms w Post-partum Blues: tearfulness, fatigue, insomnia, feelings of loss or being overwhelmed w Post-partum Depression: Low mood, irritability, sleep/appetite disturbance, guilt, despair, worthlessness, etc. lasting at least 2 weeks w Post-partum Psychosis: hallucinations, paranoia, inability to care for self or baby, thoughts of suicide or infanticide

6. Assessment w Self Report w Observational techniques w Formal screening measures (e.g., CES-D, BDI) w Clinical interview

7. Consequences for Children w Children of depressed mothers have higher rates of depression, attention deficits, behavior problems, separation anxiety, and conduct disorder compared to control samples w Findings are consistent across different types of raters (parent report, child and teacher reports) w Also poorer social skills and peer relations w Insecure attachments

8. How depression affects development w Changes in hormones during fetal period w Specific aspects of parenting behavior: Maternal responsivity Maternal sensitivity Emotional availability Negative mood (intrusive/hostile) Inconsistency in discipline Modeling negative affect Inability to assist with emotional regulation

9. Maternal Depression Affects Most Children w 50% - 80% of offspring have significant problems w Exposure in early life appears to confer more risk w Duration and severity of mother’s depression affects children’s severity w Even mild depression associated with child problems Goodman & Gotlib, 1999; Timko et al., 2002; Anderson & Hammen, 1993

10. Maternal Depression Major Negative Effects on Children w Significantly worse school outcomes Lower cognitive functioning Significantly poorer reading achievement Significantly worse grades Significantly more behavior problems w ~50% of adolescents have a psychiatric disorder w ~2x the rate of physical problems Riley, et al, 2002; Goodman & Gotlib, 1999

11. Other Influences Other parentOther parent Other adultsOther adults SchoolSchool Out of homeOut of homeactivities MaternalDepression ServicesUse SocialRelations FamilyEnvironment LifeStressors Parenting Child Outcomes Well-Being Somatic health Social functioning Academic functioningAcademic functioning Behavior problems Psychiatric sx/dx Service utilization Child’s Biological/ Individual Factors TemperamentTemperament Cognitive abilityCognitive ability Automatic responsesAutomatic responses Pubertal developmentPubertal development Medical conditionsMedical conditions Child Cognitions/ Perceptions Self-conceptSelf-concept Problem solving skillsProblem solving skills World viewWorld view

12. Best Practices w Address needs within the community context w Develop program in the ‘real-world’ setting w Link with primary care providers, especially pediatricians

13. Implications for Practice w Early identification and intervention w Treatment of mother’s symptoms and provide parenting support w Model appropriate interactions w Strengthen social support w Reflective supervision for staff