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PEDIATRICS Vol. 113 No. 6 June 2004, pp. e523-e529

ELECTRONIC ARTICLE

Maternal Depressive Symptoms and Infant Health Practices Among Low-Income Women

Esther K. Chung, MD, MPH*, Kelly F. McCollum, MPH{ddagger}, Irma T. Elo, MPA, PhD§, Helen J. Lee, MA§ and Jennifer F. Culhane, PhD, MPH{ddagger}

* Division of General Pediatrics, A.I. duPont Hospital for Children and Thomas Jefferson Medical College, Philadelphia, Pennsylvania
{ddagger} Department of Obstetrics and Gynecology, Thomas Jefferson Medical College, Philadelphia, Pennsylvania
§ Department of Sociology, University of Pennsylvania, Philadelphia, Pennsylvania

Objectives. To determine the relationships between maternal depressive symptoms and the use of infant health services, parenting practices, and injury-prevention measures.

Methods. A prospective, community-based survey of women attending Philadelphia public health centers between February 2000 and November 2001 was conducted. Women were surveyed at 3 time points before and after parturition. Depressive symptoms were determined with the Center for Epidemiologic Studies Depression Scale at each time point. We studied 6 outcomes, clustered into 3 categories: 1) infant health service use (adequate well-child care and ever being hospitalized); 2) parenting practices (breastfeeding for ≥1 month and use of corporal punishment); and 3) injury-prevention measures (having a smoke alarm and using the back sleep position).

Results. The sample consisted of 774 largely single (74%), uninsured (63%), African American (65%) women, with a mean age of 24 ± 6 years and a mean annual income of $8063. Forty-eight percent of women had depressive symptoms at 1 or 2 time points (ever symptoms) and 12% had depressive symptoms at all points (persistent symptoms). Compared with women who never had depressive symptoms (without symptoms), women with persistent symptoms were nearly 3 times as likely to have their child ever hospitalized (adjusted odds ratio: 2.89; 95% confidence interval: 1.61–5.07) and twice as likely to use corporal punishment (adjusted odds ratio: 1.90; 95% confidence interval: 1.08–3.34). Mothers with persistent depressive symptoms were nearly three-quarters less likely to have smoke alarms in their homes (adjusted odds ratio: 0.28; 95% confidence interval: 0.11–0.70) and one-half as likely to use the back sleep position (adjusted odds ratio: 0.56; 95% confidence interval: 0.35–0.91), compared with women without symptoms. There was no association between maternal depressive symptoms and infant receipt of well-child care or the likelihood of breastfeeding for ≥1 month.

Conclusions. Maternal depressive symptoms persisting from the prepartum to postpartum periods were associated with increased risks of infant hospitalization and use of corporal punishment and with lower likelihood of having a smoke alarm and using the back sleep position. Additional efforts are needed to identify and evaluate mothers with depressive symptoms to improve the health and safety of young infants.

Key Words: maternal depression • health services use • preventative health measures • safety • well-child care

Abbreviations: CES-D, Center for Epidemiologic Studies Depression Scale • MDD, major depressive disorder

Received for publication Oct 3, 2003; Accepted Jan 26, 2004.


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