The Urban Institute held an event Dec. 13 in Washington, D.C. titled “Helping Depressed Low-Income Mothers Give Their Young Children a Good Start.” Speakers included SAMHSA Office of Policy Planning & Innovation senior advisor Larke Huang, Urban Institute Center on Labor, Human Services and Population senior research associate Marla McDaniel and Deborah Perry, Georgetown University associate professor.
The potential for eliminating barriers between child and adult systems provides a “big public health opportunity,” according to Urban Institute fellow Olivia Golden, who served as the moderator for the event. Exploring barriers between health and mental health systems may prove even more important, she added, because low-income mothers generally seek treatment for depression at lower rates than mothers with private insurance and higher household incomes.
“The issue of maternal depression and its effects on children is a promising opportunity to make a difference,” she said. “What are the reasons? What are the barriers in the ways our different services work?”
McDaniel summarized two Urban Institute studies, one still in draft form. In examining the prevalence of depression in mothers with infants, she said that one-in-nine displayed symptoms of severe depression, with tentative estimates of low-income mothers with severe depression numbering about 750,000. “The majority, or about 70 percent of them,” she added, “have a severe impairment that is enough to interfere with daily functioning.”
Data indicates that mothers with lower incomes access depression treatment at lower levels than mothers in households with higher incomes. Approximately 10 percent of low-income mothers received psychiatric treatment, compared to 20 percent of mothers with higher income. Some 42 percent — a significantly lower percentage than among mothers with higher incomes — reported receiving prescription medicine to treat depression. Seven percent reported receiving assistance from social workers, with the numbers increasing to eight percent for low-income mothers with Medicaid and decreasing to five percent for low-income mothers without health insurance.
Having health insurance was highly associated with accessing treatment, McDaniel noted, even among the sample of low-income mothers — 50 percent of uninsured, low-income mothers did not report receiving depression treatment of any kind.
A little over one-fifth of low-income mothers said they found prescription medication to be “very effective” in treating depression, a number McDaniel stated was significantly lower than the opinions held by higher-income mothers. Just 20 percent of low-income mothers that sought counseling treatments considered the experiences very effective, she added.
“We really need to be bringing screening and services to places where women are already getting services,” Perry stated. Noting the “unbelievable reach” of the WIC program — which she said serves approximately half of the nation’s infants — she suggests integrative health screenings could be used as a mechanism to encourage mothers with depression to actively seek out treatment.
“Stigma and myths are still a huge barrier to women accessing mental health services,” she said. Many mothers that breastfeed refuse to take prescription medicine to treat depression, and many more believe that seeking out depression treatment may lead to their children being removed by protective services or even their own deportation.
Low-income mothers that are taught mood management skills, she said, generally display fewer depression symptoms and are less likely to experience major depressive episodes than mothers that have not had similar training. Noting early data that indicates between 30 to 50 percent of low-income mothers with children enrolled in Head Start programs demonstrated “very high symptom scores” on depression screening questionnaires, she advises services to expand to focus on mothers that are ineligible for health care because their symptoms aren’t severe enough to be categorized as “functionally impairing.”
“We need to go beyond treatment,” she said, “and expand the continuum of services that includes prevention.”
Huang said that both sub-clinical and clinical depression were “pervasive” among low-income mothers, which can have major implications for their children’s development and wellbeing. She also advises using programs having more regular contact with low-income women, such as WIC services and Head Start early education, as a “delivery mechanism” for depression screening and treatment.
“We’re starting to put the pieces into place,” Huang said. She added that low-income mothers would benefit from screenings in primary care settings.
When mothers become aware of the possible neurological effects on their children, she said, many individuals that were formerly hesitant to seek treatment may become motivated to access screenings for depression.
“Treatment for the mother,” Huang concluded, “is often prevention for the child.”