Why more help is needed for depressed, postpartum parents

The profound and sometimes deadly impact of postpartum depression on mothers, children and their families was recently highlighted in a short series in the New York Times. The articles attempted to shed some light on the mental illness in a constructive way following a string of sensational stories in the news over the past couple of years of depressed and disordered parent harming their children, including an Atlanta toddler who died after being left all day in a hot car last month.

The Times series featured a couple of very powerful individual stories, one about a mother's struggle with recurring thoughts of harming her child, the help she received, and the ongoing mixed feelings of depression, despair and guilt about her own feelings.  The second case, which was more extreme, involved an accomplished, well-educated individual who was described as generous, and clearly someone who cared for others in her family. This woman became obsessively convinced that minor bumps and bruises that her infant son experienced had somehow damaged him beyond help, despite reassurances by her family and physicians that he was fine.  She wrote a lengthy final note blaming herself for her son's brain damage, strapped him to herself with a baby carrier, and died after she jumped out an eighth floor window.  Her son survived and was developing normally at the time of the article.

Case studies such as these bring our attention to how severe some problems can become for individuals.  However, for every mother who harms herself or her child, there are dozens affected by depression that results not in direct harm, but in apathy, neglect and sadness. Parents who are emotionally blunted by their own depression and simply cannot respond effectively to their children.  Perhaps the basic needs of food, naps, and diaper changes get met, but other emotional and developmental needs are not fulfilled.

There are many possible causes of depression in parents. Certainly, this disorder sometimes occurs in high frequency in families. At other times, uncontrollable events in lives cause depressive behaviors, and finally we have a growing body of research that early traumatic events in life can shape depression in the long term.

The Adverse Childhood Experiences Study (ACES) has documented that common early traumas often result not only in depression and anxiety, but other health problems including cardiovascular and metabolic disorders. Emotional and physical neglect and abuse, sexual abuse, witnessing violence are all too frequent events for children and we now know that experiencing  several of these events greatly increases the odds of becoming depressed, anxious ineffective and passing the problems on to the children.

We don't know the early histories of the mothers whose stories were published in the Times, but we do know that many mothers, and fathers, suffered early trauma and it impacts their ability to function effectively as parents.

Fortunately, we are starting to also find out that there are solutions to these problems, and that the impact of parental depression can be ameliorated with known interventions. Rahil Briggs, PsyD, a psychologist at Montefiore Hospital in New York has conducted a large study using Healthy Steps, a program that includes a child development specialist visit as part of a well baby pediatric visit, parent groups, home visits, on site treatment at the pediatric office for maternal depression, all carried out in the first three years. Briggs' families are from the poorest sections of New York City, young single mothers in poverty.  She assesses both early adverse childhood experiences (ACES) in these mothers and depression.

While the Healthy Steps program has been around for some time, this is one of the first implementations as part of routine health care. What Briggs has found to date is that for depressed moms, most of them have high ACES scores, also have the children who have the most difficult behaviors.  The three factors of depression, early trauma, and difficult child behavior typically occur together.

The Healthy Steps program encouragingly,has the biggest positive gain in this highest risk groups of mothers. For the other mothers who generally were doing well and had not experienced early trauma, Healthy Steps provided some slight improvement.  More importantly, based on this initial trial, the hospital and clinics have seen the benefit and are expanding the program. In our new era of health care where outcome counts, Montefiore is seeing value in improving child outcome and helping parents with their emotional health.

We know hat programs like Healthy Steps are relatively inexpensive work well and have positive impact on both mother and child. We need to fund and implement these or bear the costs of failing to provide this help

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