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PEDIATRICS Vol. 113 No. 2 February 2004, pp. 424

Maternal Depression and the Pediatrician

John M. Pascoe, MD, MPH
Adrienne Stolfi, MSPH
Wright State University; School of Medicine; Department of Pediatrics; Dayton, OH 45404, USA

To the Editor.—

One of the 3 "overarching goals" of the Future of Pediatric Education (FOPE) II is "to recommend essential changes in the educational process to meet the current and future health care needs of all infants, children, adolescents, and young adults."¹ The FOPE II Executive Summary notes that "prevention is a core value for pediatricians," and it describes the well-child visit as "a vehicle for focusing on immunizations and it allows pediatricians to promote healthy lifestyle choices, to monitor patients for physical and behavioral pathology and to provide age-appropriate and individualized anticipatory guidance."¹ It also notes that "one negative trend over the past two decades has been the increased number of children living below the poverty line."¹ In 2000, 17% of children lived in families with income below the poverty line²; however, 41% of children living in female-headed households live in poverty.³

Although the association between poverty, marital status, and women’s depressive symptoms is well described in the literature,^4,5 there is no explicit statement within the FOPE II report that parents’ mental health affects children and should be monitored as an important screening activity included during well-child visits. In fact, 43% of pediatricians in a recent survey did not believe it was their responsibility to identify depressed mothers.⁶

Of course, it is well established that high levels of depressive symptoms in mothers of young children are common and correlate with a number of morbidities in their children.⁷ For example, the National Survey of Families and Households⁸ was administered to a national probability sample of 13 007 adults interviewed in 1987–1988 (wave 1) and 10 005 adults reinterviewed in 1992–1994 (wave 2). There were 2380 African American, Hispanic American, and European American mothers interviewed in wave 2. "Mothers" were <50 years old with at least 1 child (biological, adopted, step, or foster) <19 years old living at home. A validated 3-item depression screen⁹ was included in the survey. The items address the amount of depressive symptoms in the past week, 1 year, and throughout the life of the respondent. If 2 of the 3 items are scored "positive," then the screen is scored positive.

The overall rate of a positive screen was one third of study mothers. Furthermore, single-parenthood was a significant risk factor for a positive screen. Almost half (47%) of unmarried mothers had a positive screen, and approximately one quarter of unmarried mothers had the maximum score of 3 on the depression screen, indicating depressive symptoms in the past week, at least 2 weeks in the past year, and at least 2 years during their life. This high rate of maximum depression-screen scores was reported by unmarried mothers in income subgroups both below and above poverty level.

Given the high rate of maternal depressive symptoms and their well-documented adverse impact on the growth and development of children,^4,7 the leaders of FOPE II have an excellent opportunity to include the early identification and treatment of maternal depression as an important objective in the education of future generations of pediatricians as we all strive to address effectively "the future health care needs of all infants, children, adolescents, and young adults."¹

REFERENCES

1. The Future of Pediatric Education II: Organizing pediatric education to meet the needs of infants, children, adolescents, and young adults in the 21st century. A collaborative project of the pediatric community. Task Force on the Future of Pediatric Education. Pediatrics.2000; 105 :157 –212
2. Population Reference Bureau. 2000 Census data: Key facts for United States. Available at: www.aecf.org/cgi-bin/aeccensus.cgi?action=profileresults&area=1. Accessed August 29, 2003
3. Population Reference Bureau. 2000 census data: living arrangements profile for United States. Available at: www.aecf.org/cgi-bin/aeccensus.cgi?action=profileresults&area=1&printerfriendly=0&section=4. Accessed August 29, 2003
4. Lanzi RG, Pascoe JM, Keltner B, Ramey SL. Correlates of maternal depressive symptoms in a national Head Start program sample. Arch Pediatr Adolesc Med.1999; 153 :801 –807[Abstract/Free Full Text]
5. Brown GW, Moran PM. Single mothers, poverty and depression. Psychol Med.1997; 27 :21 –33[CrossRef][Web of Science][Medline]
6. Olson AL, Kemper KJ, Kelleher KJ, Hammond CS, Zuckerman BS, Dietrich AJ. Primary care pediatricians’ roles and perceived responsibilities in the identification and management of maternal depression. Pediatrics.2002; 110 :1169 –1176[Abstract/Free Full Text]
7. Weissman MM, Jensen P. What research suggests for depressed women with children. J Clin Psychiatry.2002; 63 :641 –647[Web of Science][Medline]
8. Sweet JA, Bumpass LL. The National Survey of Families and Households—Waves 1 and 2: data description and documentation. University of Wisconsin, Madison, WI; Center for Demography and Ecology: 1996. Available at: www.ssc.wisc.edu/nsfh/home.htm
9. Kemper KJ, Babonis TR. Screening for maternal depression in pediatric clinics. Am J Dis Child.1992; 146 :876 –878[Abstract/Free Full Text]

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PEDIATRICS (ISSN 1098-4275). ©2004 by the American Academy of Pediatrics

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