Health and social service professionals who care for adults with depression should not only tackle their clients' physical and mental health, but also detect and prevent possible spillover effects on their children, says a new report from the National Research Council and Institute of Medicine. To achieve this new family-focused model of depression care, federal and state agencies, nonprofits and the private sector will have to experiment with nontraditional ways of organizing, paying for and delivering services, said the committee that wrote the report.

“This report is designed to place the problem of depression and its effects on parents and children on the national health care agenda,” report co-author Bruce Compas, Patricia and Rodes Hart Professor of Psychology and Human Development at Vanderbilt University’s Peabody College, said. “The report summarizes research that documents the adverse effects of parental depression on children's mental health and outlines an agenda for research and health care services for the prevention of mental health problems in children of parents with depression.”
     
Emerging evidence for effective preventive interventions is highlighted, including two separate preventive interventions for children of depressed parents tested in randomized clinical trials supported by the National Institute of Mental Health and conducted at Peabody College and other locations. A report on one of those randomized clinical trials was recently released and was co-authored by Judy Garber, professor of psychology and human development at Peabody. That research found that a cognitive behavioral program helped teens at-risk of depression, but that teens participating in the program who had a currently depressed parent were three times more likely to experience a bout of depression than their cohorts in the group who did not.
         
Major depressive disorder affects 16 percent of Americans in their lifetime, and young adulthood during prime parenting years is a period of particularly high risk. It is estimated that 7.5 million parents in the U.S. suffer from depression, affecting over 15 million children who live with these parents. Children of depressed parents are at four times greater risk to develop depression and as many as 75 percent of these children develop some form of mental health problem. Effective tools and strategies exist to treat and prevent depression, but only one-third of adult sufferers get treatment.
     
Although many factors affect children's development, parental depression can increase the chances for health, emotional and behavioral problems in children. The report does not suggest that every parent with depression will inadvertently or deliberately cause harm to their children, but rather that parental depression increases the risks for spillover consequences during critical periods of child and adolescent development.

"To break the vicious circle of depression, we need to refocus our view of this illness through a broader lens that sees the whole family, not just the individual with depression," said committee chair and psychiatrist Mary Jane England, president, Regis College, Weston, Mass. "Our report describes a new vision for depression care that would provide comprehensive services not just to adults, but to their children as well. It will take significant policy changes to make this vision a reality, but the benefits warrant the effort."

Endeavors to increase the family focus on depression should aim to remove barriers that inhibit more coordinated care across organizations and among service providers. Children and adults are treated by separate health care providers who too often do not look at the whole family, and many health and social services are disconnected. Few programs and health care providers routinely ask patients with depression if they have children and if their depression has affected their family members. Health plans are not geared to pay for services delivered in nontraditional settings.

The report’s specific recommendations include:     

• Counseling for fathers and mothers to improve their parenting and coping skills;
• Treatment for children’s emotional, behavioral or physical problems;
• Services in a range of locations that include not just obstetrics-gynecology and pediatric clinics, but also Head Start facilities, schools, prisons, other community locations and even people's homes. This means that clinicians must gain experience in delivering services in a variety of settings;
• Revision of state policies that prohibit services outside of clinical settings;
• A federal program to improve the abilities of primary care providers, mental health professionals and those who treat substance abuse to identify, treat and prevent depression and lessen its effects on children of all ages;
• Support from public and private health insurance plans for access to screening, treatment and supportive services. For example, the Centers for Medicare and Medicaid Services could extend Medicaid services provided to new mothers to two years after birth, which includes a critical period of early childhood development;
• Leadership by public and private groups to tackle the insufficient numbers of care providers and facilities, difficulties that low-income individuals in particular confront in traveling to service providers and the stigma associated with mental illness; and
• Broad experimentation with service strategies given the variation in health and social services across states. Governors of each state should convene a task force of state and local agencies to coordinate efforts and to design and implement an array of programs involving multiple organizations and settings. State officials should document their activities and results so that they can learn from one another.

The study was sponsored by the Robert Wood Johnson Foundation, Annie E. Casey Foundation, California Endowment, U.S. Health Resources and Services Administration, and U.S. Substance Abuse and Mental Health Services Administration. The National Academy of Sciences, National Academy of Engineering, Institute of Medicine, and National Research Council make up the National Academies. They are private, nonprofit institutions that provide science, technology, and health policy advice under a congressional charter.

More information:
Full report: http://www.iom.edu/?ID=69567
Related story on impact of parental depression on children: http://tinyurl.com/qyj8ac
Bruce Compas Web site: http://www.vanderbilt.edu/psychological_sciences/compas
Peabody College: http://peabody.vanderbilt.edu
Vanderbilt news: www.vanderbilt.edu/news.

Media Contacts: Melanie Moran, (615) 322-NEWS
Melanie.moran@vanderbilt.edu

Christine Stencel, National Academies Press, (202) 334-2138
news@nas.edu