PEDIATRICS Vol. 115 No. 2 February 2005, pp. 306-314 (doi:10.1542/peds.2004-0341)
Maternal Depressive Symptoms and Children's Receipt of Health Care in the First 3 Years of Life
* Departments of Population and Family Health Sciences
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.
CiteULike 
Connotea 
Del.icio.us 
Digg 
Facebook 
Reddit 
Technorati 
Twitter What's this?
This article has been cited by other articles:
|
|
 |
|
  M. Otsuki, M. N. Eakin, L. L. Arceneaux, C. S. Rand, A. M. Butz, and K. A. Riekert Prospective Relationship between Maternal Depressive Symptoms and Asthma Morbidity among Inner-City African American Children J. Pediatr. Psychol., October 22, 2009; (2009) jsp091v1. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Lanier, M. Jonson-Reid, M. J. Stahlschmidt, B. Drake, and J. Constantino Child Maltreatment and Pediatric Health Outcomes: A Longitudinal Study of Low-income Children J. Pediatr. Psychol., October 1, 2009; (2009) jsp086v1. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Nuruddin, W. C. Hadden, M. R. Petersen, and M. K. Lim Does child gender determine household decision for health care in rural Thatta, Pakistan? J Public Health, September 1, 2009; 31(3): 389 - 397. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Y. Choi, D. Bishai, and C. S. Minkovitz Multiple Births Are a Risk Factor for Postpartum Maternal Depressive Symptoms Pediatrics, April 1, 2009; 123(4): 1147 - 1154. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. E. Aitken, M. L. McCarthy, B. S. Slomine, R. Ding, D. R. Durbin, K. M. Jaffe, C. N. Paidas, A. M. Dorsch, J. R. Christensen, E. J. MacKenzie, et al. Family Burden After Traumatic Brain Injury in Children Pediatrics, January 1, 2009; 123(1): 199 - 206. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. A. Lipstein, J. M. Perrin, and K. A. Kuhlthau School Absenteeism, Health Status, and Health Care Utilization Among Children With Asthma: Associations With Parental Chronic Disease Pediatrics, January 1, 2009; 123(1): e60 - e66. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. N. Anderson, M. K. Campbell, O. daSilva, T. Freeman, and B. Xie Effect of maternal depression and anxiety on use of health services for infants Can Fam Physician, December 1, 2008; 54(12): 1718 - 1719.e5. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Clemans-Cope, C. D. Perry, G. M. Kenney, J. E. Pelletier, and M. S. Pantell Access to and Use of Paid Sick Leave Among Low-Income Families With Children Pediatrics, August 1, 2008; 122(2): e480 - 486. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. S. Wissow, A. Gadomski, D. Roter, S. Larson, J. Brown, C. Zachary, E. Bartlett, I. Horn, X. Luo, and M.-C. Wang Improving Child and Parent Mental Health in Primary Care: A Cluster-Randomized Trial of Communication Skills Training Pediatrics, February 1, 2008; 121(2): 266 - 275. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K Phelan, J Khoury, H Atherton, and R S Kahn Maternal depression, child behavior, and injury Inj. Prev., December 1, 2007; 13(6): 403 - 408. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. P. Rivara, M. L. Anderson, P. Fishman, A. E. Bonomi, R. J. Reid, D. Carrell, and R. S. Thompson Intimate Partner Violence and Health Care Costs and Utilization for Children Living in the Home Pediatrics, December 1, 2007; 120(6): 1270 - 1277. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. R. Sills, S. Shetterly, S. Xu, D. Magid, and A. Kempe Association Between Parental Depression and Children's Health Care Use Pediatrics, April 1, 2007; 119(4): e829 - e836. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Dubowitz, S. Feigelman, W. Lane, L. Prescott, K. Blackman, L. Grube, W. Meyer, and J. K. Tracy Screening for Depression in an Urban Pediatric Primary Care Clinic Pediatrics, March 1, 2007; 119(3): 435 - 443. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. H. Chaudron, P. G. Szilagyi, A. T. Campbell, K. O. Mounts, and T. K. McInerny Legal and Ethical Considerations: Risks and Benefits of Postpartum Depression Screening at Well-Child Visits Pediatrics, January 1, 2007; 119(1): 123 - 128. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. L. Olson, A. J. Dietrich, G. Prazar, and J. Hurley Brief Maternal Depression Screening at Well-Child Visits Pediatrics, July 1, 2006; 118(1): 207 - 216. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. T. McLearn, C. S. Minkovitz, D. M. Strobino, E. Marks, and W. Hou The Timing of Maternal Depressive Symptoms and Mothers' Parenting Practices With Young Children: Implications for Pediatric Practice Pediatrics, July 1, 2006; 118(1): e174 - e182. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. T. McLearn, C. S. Minkovitz, D. M. Strobino, E. Marks, and W. Hou Maternal Depressive Symptoms at 2 to 4 Months Post Partum and Early Parenting Practices Arch Pediatr Adolesc Med, March 1, 2006; 160(3): 279 - 284. [Abstract] [Full Text] [PDF]
|
|
