Published online February 1, 2005
PEDIATRICS Vol. 115 No. 2 February 2005, pp. 306-314 (doi:10.1542/peds.2004-0341)
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Maternal Depressive Symptoms and Children's Receipt of Health Care in the First 3 Years of Life

Cynthia S. Minkovitz, MD, MPP*, Donna Strobino, PhD*, Dan Scharfstein, ScD{ddagger}, William Hou, MS*, Tess Miller, DrPH*, Kamila B. Mistry, MPH* and Karen Swartz, MD§

* Departments of Population and Family Health Sciences
{ddagger} Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
§ Department of Psychiatry, Johns Hopkins School of Medicine, Baltimore, Maryland

Background. Maternal depression is widely recognized to negatively influence mother-child interactions and children's behavior and development, but little is known about its relation to children's receipt of health care.

Objective. To determine if maternal depressive symptoms reported at 2 to 4 and 30 to 33 months postpartum are associated with children's receipt of acute and preventive health care services in the first 30 months.

Design. Cohort study of data collected prospectively as part of the National Evaluation of Healthy Steps for Young Children (HS). Data sources included medical records abstracted for the first 32 months, enrollment questionnaires, and parent interviews when children were 2 to 4 and 30 to 33 months old. Acute care use included hospitalizations and emergency department visits. Preventive care included well-child visits and vaccinations. Maternal depressive symptoms were assessed by using the Center for Epidemiologic Studies-Depression Scale. Generalized linear models (logistic regression for dichotomous outcomes and Poisson regression for count outcomes) were used to estimate the effect of maternal depressive symptoms on children's receipt of care. The models were adjusted for baseline demographic characteristics, child health status, participation in HS, and site of enrollment.

Results. Of the 5565 families enrolled in HS, 88% completed 2- to 4-month parent interviews, 67% completed 30- to 33-month parent interviews, and 96% had medical records abstracted. The percentages of mothers reporting depressive symptoms were 17.8% at 2 to 4 months, 15.5% at 30 to 33 months, and 6.4% at both. Children whose mothers had depressive symptoms at 2 to 4 months had increased use of acute care reported at 30 to 33 months including emergency department visits in the past year (odds ratio [OR]: 1.44; confidence interval [CI]: 1.17, 1.76). These children also had decreased receipt of preventive services including age-appropriate well-child visits (eg, at 12 months [OR: 0.80; CI: 0.67, 0.95]) and up-to-date vaccinations at 24 months for 4 doses of diphtheria, tetanus, pertussis, 3 doses of polio vaccine, and 1 dose of measles-mumps-rubella (OR: 0.79; CI: 0.68, 0.93). There was no association of maternal depressive symptoms at 30 to 33 months with children's preceding use of care.

Conclusions. Maternal depressive symptoms in early infancy contribute to unfavorable patterns of health care seeking for children. Increased provider training for recognizing maternal depressive symptoms in office settings, more effective systems of referral, and development of partnerships between adult and pediatric providers could contribute to enhanced receipt of care among young children.

Key Words: maternal depression • acute care • preventive services

Abbreviations: ED, emergency department • HS, Healthy Steps for Young Children • UTD, up-to-date • DTP, diphtheria, tetanus, pertussis • MMR, measles-mumps-rubella • CES-D, Center for Epidemiologic Studies-Depression Scale • OR, odds ratio • CI, confidence interval

Accepted Jul 9, 2004.




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