Parental depression is a pervasive problem, and a large and growing body of research shows that it is a major risk factor for difficulties in a child’s life, says Megan Smith, PhD, co-director of the Parenting Center at the Yale Medicine Child Study Center and director of the New Haven Mental Health Outreach for Mothers (MOMS) Partnership.

“Depression disrupts a parent’s ability to work, parent, and participate in the community,” she says, defining “parent” broadly to include not only mothers and fathers, but also pregnant women, grandmothers, and other kin caring for children. “It’s incredibly functionally impairing.”

Parental depression shapes not only a parent’s perception of the world, but also a child’s experience of the world internally and externally, Smith says. Depressed parents have been found to interact with their children differently, in ways that affect child development. For example, Smith says, “Depressed mothers have been found in some studies to use less emotion and expressivity in their language with their babies. And they make less eye contact.”

Parental depression can impact many activities of parenting. Even a simple activity such as reading a storybook to a child may be affected. A depressed parent may not be as lively or as expressive, she says. He or she won’t change voices for different characters or make sound effects, for example. 

Of particular concern, Smith says, is isolation that may occur for parent and child, which she calls one of the “largest impacts, limiting the social networks of both the adults and the child.”

Studies link parental depression (including prenatal depression) with a wide range of difficulties, some lifelong. Depression not only interferes with parental bonding and nurturing, it also means parents may not be as likely to do the things that are necessary to keep their children safe and healthy (such as using a car seat or getting immunizations). School-age children with depressed parents may not perform as well academically, have been found in some studies to be more likely to have behavior problems, and have poorer overall health.

Depression affects a parent’s mood, sleep, appetite, and energy level. Typical symptoms of depression include persistent sadness and the loss of interest in activities that used to bring pleasure, along with sleeping too little or too much, difficulty concentrating, changes in appetite (eating a lot or very little), poor energy and thoughts of suicide. Untreated depression raises the risk of substance abuse.

Signs of depression that are specifically related to parenting include:

• Lack of responsiveness to a child. “Parents with depression are less likely to respond appropriately to the cues (such as crying or eye contact or gesturing) of their young children,” Smith says.
• Inappropriate parenting behaviors. Some depressed parents are neglectful and disengaged from their children, while others are hyper-intrusive and over-engaged, Smith says. What these seemingly opposite behaviors have in common, she says, is the fact that neither is sensitive to a child’s cues. 
• A child’s tardiness or truancy at school. Children may consistently arrive late or miss school because their parents don’t have the energy or organizational skills to get out the door on time.

Generally speaking, doctors (including primary care doctors, ob-gyns and pediatricians) are increasingly aware of the many health risks linked to depression. Most doctors screen for it at regular appointments by looking for symptoms (such as weight gain or loss, or lethargy) and asking specific questions designed to help identify it. Some people go to the doctor on their own because they feel depressed, while others may be urged to do so by concerned friends or family members.

Research shows that psychotherapy, particularly in the form of cognitive behavioral therapy (CBT), can be a very effective treatment for depression. CBT challenges negative and unproductive thought patterns that reinforce depression, helping people reframe them in more positive and productive ways. “CBT is one of the most effective forms of psychotherapy because it focuses on building skills around managing thoughts and behaviors,” Smith says. 

Additional treatment approaches, used when necessary and appropriate, may include sessions with parent and child together, focused on helping the parent learn to build attachment and be more sensitive to the child’s cues. Home visitation and substance abuse treatment are also available for those who would benefit. Also, many parents benefit from taking medication for their depression.

In addition to advancing research on how parental depression affects children and families, the Yale Child Study Center at Yale Medicine does groundbreaking work in increasing awareness of and screening for parental depression – especially among the under-reached and underserved inner-city population in New Haven.

The MOMS Partnership program, a nationally recognized program for innovation in parental mental health intervention, posts trained community ambassadors at a variety of local sites, where they ask parents for permission to do a screening and obtain information on parenting more broadly. People identified as being potentially depressed are invited to a structured appointment in a clinical setting to determine whether or not they would benefit from treatment, which is offered in the same location.

“The idea is that a mom can drop her children off at school and then go in and receive mental health care right there,” Smith says. “We are co-locating high-quality, evidence-based care for parents, removing the stigma and increasing the convenience of mental health care by putting it in places where parents interact with their children.”

Other programs in the MOMS Partnership now couple mental health services with workforce training and job readiness programs and offer home visitation services (including depression screening) to young families. The programs are designed to increase early detection of depression in people who might otherwise escape notice, she says, and the services are delivered in convenient community settings to ensure that people diagnosed with depression follow through on their treatment.

Smith credits those ambitious community intervention programs to the Child Study Center’s international reputation and its long history of providing high-quality, community-based services. “We have been able to build upon the history and trust that come with the Yale Child Study Center name in our community,” she says.