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PEDIATRICS Vol. 113 No. 2 February 2004, pp. 298-304

Maternal Depression, Changing Public Assistance, Food Security, and Child Health Status

Patrick Casey, MD*, Susan Goolsby, MS*, Carol Berkowitz, MD{ddagger}, Deborah Frank, MD§, John Cook, PhD§, Diana Cutts, MD||, Maureen M. Black, PhD, Nieves Zaldivar, MD#, Suzette Levenson, MEd, MPH§, Tim Heeren, PhD§, Alan Meyers, MD, MPH§ the Children’s Sentinel Nutritional Assessment Program Study Group§

* Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
§ Boston University School of Medicine/Public Health, Boston, Massachusetts
{ddagger} Harbor-University of California Los Angeles Medical Center, Los Angeles, California
|| Hennepin County Medical Center, Minneapolis, Minnesota
University of Maryland, School of Medicine, Baltimore, Maryland
# Mary’s Center for Maternal and Child Health, Washington, District of Columbia

Objective. To examine the association of positive report on a maternal depression screen (PDS) with loss or reduction of welfare support and foods stamps, household food insecurity, and child health measures among children aged ≤36 months at 6 urban hospitals and clinics.

Methods. A convenience sample of 5306 mothers, whose children <36 months old were being seen in hospital general clinics or emergency departments (EDs) at medical centers in 5 states and Washington, District of Columbia, were interviewed from January 1, 2000 until December 31, 2001. Questions included items on sociodemographic characteristics, federal program participation and changes in federal benefits, child health status rating, child’s history of hospitalizations since birth, household food security status, and a 3-question PDS. For a subsample interviewed in the ED, whether the child was admitted to the hospital that day was recorded.

Results. PDS status was associated with loss or reduction of welfare support and food stamps, household food insecurity, fair/poor child health rating, and history of child hospitalization since birth but not low child growth status measures or admission to the hospital at the time of ED visit. After controlling for study site, maternal race, education, and insurance type as well as child low birth weight status, mothers with PDS were more likely to report fair/poor child health (adjusted odds ratio [AOR]: 1.58; 95% confidence interval [CI]: 1.33–1.88) and hospitalizations during the child’s lifetime (AOR: 1.20; 95% CI: 1.03–1.39), compared with mothers without PDS. Controlling for the same variables, mothers with PDS were more likely to report decreased welfare support (AOR: 1.52; 95% CI: 1.03–2.25), to have lost food stamps (AOR: 1.56; 95% CI: 1.06–2.30), and reported more household food insecurity (AOR: 2.69; 95% CI: 2.33–3.11) than mothers without PDS.

Conclusion. Positive maternal depression screen status noted in pediatric clinical samples of infants and toddlers is associated with poorer reported child health status, household food insecurity, and loss of federal financial support and food stamps. Although the direction of effects cannot be determined in this cross-sectional survey, child health providers and policy makers should be aware of the potential impact of maternal depression on child health in the context of welfare reform.

Key Words: welfare reform • food insecurity • child health status • maternal depression

Abbreviations: C-SNAP, Children’s Sentinel Nutritional Assessment Program • PDS, maternal depression screen • ED, emergency department • OR, odds ratio • AOR, adjusted OR

Received for publication Jan 24, 2003; Accepted Jun 13, 2003.




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