Mothers with depressive symptoms in the months after giving birth are less
likely to read to, talk to, or play with their newborns than mothers who are
not depressed, according to a new study.
Screening mothers of newborns could identify women with depressive symptoms
and allow pediatricians to counsel them in good parenting practices and refer
them to mental health professionals to treat their symptoms, wrote Kathryn
Taaffe McLearn, Ph.D., and colleagues in the March Archives of Pediatric
and Adolescent Medicine.
At the same time, pediatricians who inquire about parenting practices could
also gather valuable clues about the mother's mood status.
"Further efforts are needed to ensure that linkages exist between
adult and pediatric systems of care," said the authors. "Such an
approach has the potential to foster positive parenting, child health and
development, and family well-being."
The researchers based their analysis on data gathered from 15 sites (six
randomization sites and nine quasi-experimental sites) as part of the National
Evaluation of Healthy Steps for Young Children. Healthy Steps is a model of
pediatric care incorporating child development specialists and services in
pediatric practices. Mothers in the program completed forms at enrollment and
a follow-up telephone interview at two to four months.
The Center for Epidemiological Studies Depression Scale (CES-D) was used to
assess symptoms. Of the 5,565 families enrolled, 4,874 provided symptom data
and completed the survey. About 17.8 percent of the mothers reported
depressive symptoms by scoring 11 or above on the 14-question modified
The researchers then compared the self-reported safety, feeding, and
developmental practices with symptom status. After adjusting for demographic
and socioeconomic factors, five practices remained significantly associated
with depressive symptoms.
Depressed women less often used parenting practices believed important for
a child's development. They were less likely to read a picture book to their
child, play with the infant at least once a day, talk to the baby while
working around the house, and follow two or more mealtime, naptime, or bedtime
routines (see chart).FIG1
Depressive symptoms appear to reduce parenting practices that demand
greater interaction with infants, wrote McLearn and colleagues.
More symptomatic women were also less likely to continue breastfeeding
their babies than were women without depressive symptoms. However, both groups
of women were equally likely to give cereal, water, or juice to their babies
before four months of age despite American Academy of Pediatrics
recommendations not to introduce them until later.
The researchers were limited to the two practices selected by the original
study as markers for safety: putting children to sleep on their backs to
reduce risk of sudden infant death syndrome and turning down the temperature
of the household's hot-water heater to prevent burns. Depression symptoms were
not associated with these two practices. However, they may not be useful
indicators of mood, thanks to factors other than depression, said Linda
Chaudron, M.D., M.S., an assistant professor of psychiatry, pediatrics, and
obstetrics and gynecology at the University of Rochester.
"Mothers have been bombarded with reminders to put babies to sleep on
their backs so that it's become routine now," said Chaudron in an
interview. Similarly, water temperature may reflect socioeconomic patterns, if
young, vulnerable mothers are more apt to live in apartment buildings.
"Yes, there likely is a `ceiling effect' with regard to sleep
position given that 88 percent of the families used the correct sleep position
for their young infants," said co-author Cynthia Minkovitz, M.D.,
M.P.P., in an interview. "We have no information regarding access to
water temp controls. The lack of association of depressive symptoms and safety
practices in adjusted analyses, unlike prior studies, may be due in part to
the diversity of our sample and our ability to adjust for other
characteristics of families."
Demographic factors may also have played a role in the study. When compared
with nonrespondents, mothers who completed the survey were more likely to be
white, non-Hispanic, married, high school graduates and older than 20 years
and report that the baby's father was employed. However, mothers reporting
depressive symptoms were more likely to be from minority groups, younger than
age 20, Hispanic, and not living with the child's biological father and have
less than a high school education and a low income.
Besides the direct results of their study, the researchers said its design
demonstrates the validity of maternal reports as a source of data,"
without having to use expensive direct-observation methods."
"Are pediatricians asking questions about these practices?"
asked Chaudron, who agreed with McLearn and colleagues that pediatricians
should be encouraged to screen mothers for depression. "They're nice,
practical questions to ask new moms, and they could raise red flags for both
mothers and babies."
One obstacle to care is how pediatricians respond to the red flag, said
Chaudron. "We still don't know the best way for pediatricians to connect
these women—who are not their patients—to mental health care or to
their own [health care] providers."
The risks and benefits of treatment options for depressed women after they
have given birth should be carefully discussed, she said. Low levels of
antidepressants can be carried through the mother's milk to a nursing child,
but there have been few reports of problems from that exposure, she said. Some
women may prefer psychotherapy to medication, but as the current study shows,
symptomatic mothers can adversely affect a baby's development, so some
treatment is usually indicated.
McLearn and colleagues suggested that pediatricians' anticipatory guidance
to mothers with depressive symptoms can foster improved parenting practices
and thus the child's health and development.
"Maternal Depressive Symptoms at 2 to 4 Months Post Partum and
Early Parenting Practices" is posted at<http://archpedi.ama-assn.org/cgi/content/short/160/3/279>.▪