Depression in Parents, Parenting, and Children Opportunities to Improve Identification, Treatment, and Prevention (2009) / Chapter Skim
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The burden of depression and the barriers to quality of care for depressed adults are increasingly well understood, but the ways in which depression affects parenting, and children's health and psychological functioning, are often ignored. Many factors are associated with depression, including co-occurring medical and psychiatric disorders (such as substance abuse)
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STUDY SCOPE AND APPROACH Scope The Committee on Depression, Parenting Practices, and the Healthy Development of Children was charged with reviewing the relevant literature on parental depression, its interaction with parenting practices, and its effects on children and families. In conducting this study, the committee • clarified what is known about interactions among depression and its co-occurring conditions, parenting practices, and child health and development; • identified the findings, strengths, and limitations of the evidentiary base that support assessment, treatment, and prevention interven tions for depressed parents and their children; • highlighted disparities in the prevalence, prevention, treatment, and outcomes of parental depression among different sociode
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Through our review of the literature and discussions with service providers, policy makers, and stakeholder organizations, the committee identified four major issues that are faced in attempting to address the problems associated with the care of depressed parents. These are the integration of knowledge regarding the dynamics of parental depression, parenting practices, and child outcomes so that it is transdisciplinary and links research to practice; the need to recognize the multigenerational dimensions of the effects of depression in a parent so that the needs of both parent and the child are identified in research and practice; the application of a developmental framework in the study and evaluation of the effects of parental depression; and the need to acknowledge the presence of a constellation of risk factors, context, and correlates of parental depression.
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The distinctive features they describe include greater stigma associated with diagnoses, a less developed infrastructure for measuring and improving the quality of care, a need for a greater number of linkages among multiple clinicians, organizations and systems providing care to patients with mental health conditions, less widespread use of information technology, a more educationally diverse workforce, and a differently structured marketplace for the purchase of mental health and substance use health care. Although reducing these barriers is essential to improving the quality of care for depressed adults, it is also important to note that these barriers focus on the individual.
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Some questions remain regarding conditions that make these interactions stronger or weaker and the specific mechanisms or intermediate steps through which depression in the parent becomes associated with parenting or with outcomes in children; however, the research has clear implications for developing interventions for depressed parents and mitigating its consequences. Existing Screening and Treatment Interventions Are Safe and Effective for Depressed Adults But Are Rarely Integrated or Consider Their Parental Status or Its Impact on Their Child Effective screening tools are available to identify adults with depression in a variety of settings.
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Broader preventive interventions that support families and the healthy development of children also hold promise for improving parent and child outcomes, although such interventions have not been tested to demonstrate their effects in mitigating the consequences of a depressed parent within their families. Emerging Initiatives Highlight Opportunities and Challenges in Improving the Engagement and Delivery of Care to Diverse Families with a Depressed Parent The scope and compelling nature of depression in parents and its interaction with parenting and healthy child development supports the need to develop or adopt strategies to meet the needs of a diverse number of families with a depressed parent.
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Furthermore, numerous opportunities exist to continue to build a knowledge base that can enhance the development of future programs, policies, and professional practice. But overcoming systemic, workforce, and fiscal challenges and developing new knowledge to help in the design of innovative strategies are not sufficient to ensure its use in the routine efforts of service providers and practitioners to identify, treat, and prevent parental depression and to reduce the impact of this disorder on children.
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, and the Substance Abuse and Mental Health Services Administration (SAMHSA) , to support the Healthy People 2020 overarching goal of achieving health equity and eliminating health disparities by including the importance of identification, treatment, and prevention of depression and its potential impact on the healthy development of children of depressed parents.
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. Support Innovative Strategies To build on emerging community, state, and federal initiatives to improve the quality of care for depressed parents, further support is necessary to encourage the design and evaluation of innovative services in different settings for diverse populations of children and families.
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Finally, SAMHSA should promote interagency collaboration with other HHS agencies -- CDC, HRSA, the National Institute on Drug Abuse, the National Institute on Alcohol Abuse and Alcoholism, NIMH, the National Institute on Nursing Research, and the National Institute of Child Health and Human Development -- to develop coordinated strategies that support the design and evaluation of these demonstration projects. SAMHSA could identify an interagency committee to pool information about programs that are affected by parents with depression, programs that offer opportunities to engage parents and children in the treatment and prevention of this disorder, and research and evaluation studies that offer insight into effective interventions.
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Recommendation 5: The Substance Abuse and Mental Health Services Administration and the Health Resources and Services Administration, in collaboration with relevant professional organizations and accredit ing bodies, should develop a national collaborative training program for primary, mental health care, and substance abuse treatment pro viders to improve their capacity and competence to identify, treat, and prevent depression in parents and mitigate its effects on children of all ages. For this recommendation to be realized, the national collaborative training program should strengthen a workforce that is informed about
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Options for such training programs could include crossdisciplinary training with an emphasis on parental depression, parenting, and developmentally based family-focused concerns that arise in the treatment of depression. Such training programs should call attention to identifying children at risk to adverse health and psychological outcomes.
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Recommendation 7: Federal agencies, including the National Institutes of Health, the Centers for Disease Control and Prevention, the Health Resources and Services Administration, and the Substance Abuse and Mental Health Services Administration, should support a collaborative, multiagency research agenda to increase the understanding of risk and protective factors of depression in adults who are parents and the in teraction of depression and its co-occurring conditions, parenting prac tices, and child outcomes across developmental stages. This research agenda should include the development and evaluation of empirically based strategies for screening, treatment, and prevention of depressed parents and the effects on their children and improve widespread dis semination and implementation of these strategies in different services settings for diverse populations of children and their families.
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Ultimately depression is a good and effectively identified indicator of problems that could trigger a system of care that intervenes not only in treating depression in the parent, but also in enhancing parenting skills, in alleviating other stresses, co-occurring conditions, and social contexts, and in identifying and intervening with children at risk. Although little research has been focused on improving care for depressed parents and their children, there are both conceptual principles and promising practices that could guide large-scale efforts in a deliberate sequential approach for family-centered care.
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