February 3, 2016 – Last week, the U.S. Preventive Services Task Force updated its recommendations on depression screening to include all adults and specifically all pregnant and postpartum women. The recommendation also states that “screening should be implemented with adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up.”
The national recommendation for universal depression screenings for pregnant and postpartum women makes perfect sense. We have known for some time that moms who are depressed will have a harder time bonding with their babies to support optimal development. We have also known that maternal depression is a significant risk factor for child maltreatment and that children growing up with a family member with an untreated or poorly treated mental illness are more likely to struggle into adulthood. In fact, many adverse childhood experiences (ACEs) that might stem from maternal depression are closely linked to the Centers for Disease Control’s ACE score and poor adult health outcomes stemming from those experiences. This leads to long-term health costs down the road.
The well-being of parents has lasting consequences on the well-being of their children, positive and negative. During the earliest years of life, a parent’s emotional capacity to provide the nurturing care their children need for optimal development is crucial. I recently had the opportunity to collaborate with some infant mental health experts at the University of Michigan School of Social Work and learned a tremendous amount about how early life experiences influence brain wiring for life. While advocates have known this for a while, what has not been as widely discussed is the parent-child relationship which creates those experiences. When you stop to think about this, it’s clearly a no-brainer (no pun intended). It is those early parent-child interactions that build the foundation for healthy social-emotional development from which all other learning and experiences stem from.
Unfortunately, current public services for young children have not consistently included appropriate support for parents and other caregivers who may struggle with mental health issues, creating potential barriers to a strong parent-child bond. Our expectation of new moms returning to work after just a few weeks is reflected in a lack of paid leave at many low-wage jobs, as well as the two-month work exemption from Michigan’s Family Independence cash assistance program, making it more difficult for low-income moms to be their child’s first and best teacher. Michigan has increased public investment in evidence-based parent coaching and support programs through home visits that would target new moms with certain risk factors, yet we still only reach about 20% of eligible families. And while these programs may be effective in looking for symptoms of mental health concerns, they are not equipped to provide those more intensive services when depression is identified. Instead, we rely on access to public and private mental health services to provide necessary intervention and treatment for moms and children – services like infant mental health that focus on eliminating barriers to a strong parent-child relationship like parents’ mental health issues – yet those services continue to be inadequately funded and supported in both the public and private sectors.
The research is clear. Children of moms with depression face more challenges, and our systems that provide mental health services to children and families with the most risk factors must do more. Investing in the emotional health of women is truly one of those early investments that will pay-off in the long-term for them and for their children.