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Thursday, August 15th, 2013
Moms who have young kids have lots of sources of stress – including unavoidable rites of passage of parenthood (sleep deprivation), everyday hassles (just can’t fit in that shower), and new responsibilities on top of old ones (how exactly do you take care of everything you need to do when you have to take care of a 6-month-old?). There are countless other streams of stress – including big “macro” society conditions like the economic recession – that impinge on everyday life and influence parenting. Now, you may be thinking – and this is a reaction I frequently encounter – that if stress is inevitable, why bother discussing it?
Well, there are four reasons.
First, stress takes its toll on moms. One of the strongest predictors of depression is high levels of stress. Given that women in general are at high risk for depression – some studies suggest nearly 1 in 3 women will experience clinical depression – the additional stresses of being a mom can have serious consequences. And keep in mind that one of the reasons that depression can become such a problem is that is a recurrent condition – it tends to come back after it subsides.
Second, children of depressed parents are at very high risk for early-onset depression as well as other behavioral problems. The process can start as early as infancy, accelerate in toddlerhood, and result in increased depressive symptoms in childhood, culminating with onset of clinical depression in the teen years. Chronic stress has other negative effects on childhood development that can lead to increased risk for health problems later in life. And there is some evidence that severe stress during pregnancy can have adverse effects on fetal development and contribute to things like low birth weight.
While stress and depression are insidious and impairing, there is, without question, hope. The third reason to reflect on all this is that depression is treatable. There is no one treatment, so it’s important to give yourself enough time to find the right mix of psychotherapy and/or pharmacology (antidepressants). The reality is that you can get a handle on depression and also lessen the risk of future depressive episodes with effective treatment.
Which leads to a fourth reason to talk about stress and depression – when moms get treated successfully, their kids improve as well. There have been large-scale studies showing that these positive effects can be long lasting, and include reductions in both child symptoms and actual diagnoses of depression and other disorders in the offspring. Other more fine-grained studies have shown how child symptoms of depression “mirror” parental levels – and when parental symptoms lessen with treatment, so do their kids’ symptoms. Note that no intervention needs to be done directly with the kids to gain a benefit – the effect comes simply from successfully treating the parent.
So, moms who are under lots of stress and feel like they are depressed should become aware of the symptoms of depression - and seek out well-qualified treatment. Doing this not only helps moms, but directly improves the lives of their kids.
Depressed Woman via Shutterstock.com
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Monday, December 26th, 2011
Depression is a common disorder. Who is at highest risk? Women of child bearing (and rearing) age. How common is it? Some studies suggest that 1 in 3 women may experience depression at some point in their life. Given this, I am writing a three-part series on moms and depression (in the near future I will do a similar series on dads and depression) – starting with the fundamental questions of why moms are at high risk, and which moms are at highest risk.
Let’s start with the first question: why do so many moms get depressed? A first reason is that women in general are at higher risk for depression than men (or technically speaking, higher risk for being diagnosed with depression). This gender difference becomes evident during adolescence (the most typical developmental period for the first onset of depression) and women are around twice as likely as men to experience depression. It’s not entirely clear why this is the case. There has been of course lots of research on female hormones and how they might partly explain this phenomenon, but to date the specifics remain elusive. That said, the bottom line is that being a female increases your risk of developing depression, starting during the teen years.
A second reason is the very real phenomenon of postpartum depression. Although the reported rates of postpartum depression can vary widely across studies, it is clear that a significant number of women experience some level of depressive symptoms after birth, and many (somewhere between 5% and 20%) experience some form of detectable postpartum depression.
A third reason is that the stress of being a mom can also increase the risk of depression. The sources of stress can be many and include physical stresses – for example, lack of sleep. Many women take on a number of new tasks and responsibilities with a new baby (whether they are working or not) and depression often results from accumulating stresses.
These are three basic reasons why many moms experience symptoms of depression. But what about the next question: why do some moms get depressed when others don’t?
One of the key factors is genetics. Although it’s not possible to screen for genetic risk for depression – especially since it is assumed that many genes contribute to risk for depression – some of the most persuasive work over the past decade has shown that specific “candidate” genes exert their influence during times of stress. So even though every mom has a lot of stress, one’s genetic make-up makes some women more likely to be susceptible to feeling depressed in the face of stress. Embedded in this risk is the very strong effect of having grown up with a depressed mom, which substantially increases the risk of developing depression, especially depression with an early onset (in the teen years).
A second important factor is the history of depression prior to becoming a mom. One of the features of depression is that it is likely to recur – each episode of depression increases the risk for a future episode (which often times is more severe than the last one). So if a woman has suffered from depression prior to becoming a mom, she is at higher risk of having another episode sometime in the future – including the time period when she is raising a child.
To review, there are two key points for moms (or moms-to-be). First, if you are female, you have a higher risk for depression than males (which is important to keep in mind because depression is so common). So any mom is, in some sense, at elevated risk for developing depression. But moms who have a family history of depression (especially in their mom) and/or have experienced prior depressive episodes are at especially high risk. Given all this, my next post will focus on how to recognize the signs of depression – especially those that might not be that obvious.
Image of sad woman via Shutterstock.com
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Monday, June 20th, 2011
My last two posts discussed recent studies that indicate how maternal depression can have a direct environmental effect on children. Today, I focus on the flip side: if moms get treatment that reduces their depression, there is good evidence that there are immediate benefits for their children.
Dr. Judy Garber and colleagues have added to this literature in a recent paper published in Child Development. They tracked parents (over 70% were moms) who were in treatment for depression along with their children (between 7 and 17 years of age) multiple times over a two-year period. The key take-home messages for parents were:
- reductions in parent depression were associated with immediate reductions in children’s depressive symptoms
- children of treated parents also showed improvements in social and academic functioning
- part of the improvement was due to parents becoming more accepting (and less critical) of their children
This study did not focus on a particular type of treatment for depression — treatment included drugs, therapy, and combinations. The key thing is that a mom finds a treatment that works for her – getting treatment only has a positive impact on children if the level of depression is lowered. In addition, anyone who has suffered from depression (or knows someone who has) understands that depression is episodic, so being vigilant about the recurrence of symptoms (and getting a head start on treatment) is also really important for moms.
As many moms indicated in multiple eloquent comments in response to my last post (see the Parents magazine facebook page to read these), fighting depression is not easy, and can be even tougher if you have children. The good news is that the courage and strength shown by depressed moms, and their attempts to help themselves by getting treatment, can directly and immediately also make life better for their children.
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Friday, June 17th, 2011
In my last post, I discussed a recent study that provided new evidence on how kids with depressed moms are at risk for depression. Another study (from the same issue of the Journal of the American Academy of Child and Adolescent Psychiatry) has provided novel evidence that some of this risk is environmental. First I’ll explain what they found — and then discuss why it’s important.
The researchers examined families in which children were conceived by assisted reproduction. In some families, the mom was biologically related to her child; in others, she wasn’t. From the scientific perspective, this is a modern twist on the adoption study method. The study could then look at the links between maternal depression and symptoms of depression in their kids when there was — and wasn’t — a genetic relationship between them.
They found significant associations between moms’ levels of depressive symptoms and those in their children, both in childhood and in early adolescence. These associations were not influenced by the genetic relationship — they were similar whether or not the mom was the biological mom. The conclusion is that there is an enviromental effect of being exposed to mom’s depression.
I feel that it is really important to highlight environmental pathways these days. So much of the scientific climate has been directed to genetic effects (on nearly everything). Certainly genes will play a role in determining which children and adolescents go on to suffer from recurrent or severe depression. There is also a long history of interest in “gene-environment” interaction — some youth may be genetically resilient to exposure, whereas others may be highly sensitive to it. All that said, there have been a number of studies over the last two decades that demonstrate purely environmental effects on depressive symptoms in children and young adolescents (I’ve done some of this work myself). And the important thing about that replicated finding is that is suggests there may be immediate ways of changing the environment to improve the emotional well-being of kids who have a depressed mom.
In my next post, I will focus on research that shows what happens to kids when their moms get treated for depression. Teaser: it’s a good thing for them.
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