Beyond postpartum: Treating depression in mothers of older children

The results will be presented May 1 by lead author Carol C. Weitzman, M.D., associate professor of pediatrics and in the Child Study Center at Yale School at Yale School of Medicine, at the Pediatric Academic Societies (PAS) Annual Meeting in Vancouver, British Columbia Medicine.

Depression in underserved women of childbearing age is extremely common, and nearly one in five mothers of children age one and older reports moderate to severe depressive symptoms, according to Weitzman.

"This finding reinforces that depression in mothers is not restricted to the postpartum period, and in fact after the postpartum period as children get older, the prevalence of maternal depression may be higher," said Weitzman.

Maternal depression has been linked to health and developmental problems in children. Therefore, to optimize children's health, mothers who are depressed should be identified and treated, said Weitzman. As parents routinely bring their children for check-ups, this may present an opportunity to identify depressed mothers, as so many women do not seek treatment for their symptoms, she notes.

In the study, Weitzman and her colleagues asked 931 mothers to complete a 16-item measure of depression severity before a well-child visit in a clinic that care for disadvantaged children. Women who screened positive were interviewed to confirm that they had depressive symptoms.

Seventy-one mothers with depression were randomly assigned to receive either six sessions of on-site cognitive behavior therapy or case management, which consisted of speaking with a social worker and getting assistance with referrals. Their children's social-emotional functioning was measured before and after treatment.

Results showed that 45 percent of mothers screened positive for depressive symptoms (26 percent had mild symptoms, 13 had moderate symptoms and 6 percent had severe symptoms). All of the women who received treatment showed improvements in their depression symptoms. The scores improved greatly in women who received cognitive behavioral therapy, while those who received case management did not show a dramatic change.

Children under age four whose mothers received cognitive behavioral therapy also had fewer behavioral challenges. No significant changes were reported among the women who received case management or those with children older than age four.

"A depressed parent can have a significant effect on a child," said Weitzman. "Brief on-site treatment can help reduce symptoms of depression in a mother and may also improve her perspective about her child's behavior."

The study was funded by the Robert Wood Johnson, Finding Answers, Disparities Research for Change and the Children's Fund of Connecticut.