Depression is a widespread condition affecting approximately 7.5 million parents in the U.S. each year and may be putting at least 15 million children at risk for adverse health outcomes. Based on evidentiary studies, major depression in either parent can interfere with parenting quality and increase the risk of children developing mental, behavioral and social problems. Depression in Parents, Parenting, and Children highlights disparities in the prevalence, identification, treatment, and prevention of parental depression among different sociodemographic populations. It also outlines strategies for effective intervention and identifies the need for a more interdisciplinary approach that takes biological, psychological, behavioral, interpersonal, and social contexts into consideration.

A major challenge to the effective management of parental depression is developing a treatment and prevention strategy that can be introduced within a two-generation framework, conducive for parents and their children. Thus far, both the federal and state response to the problem has been fragmented, poorly funded, and lacking proper oversight. This study examines options for widespread implementation of best practices as well as strategies that can be effective in diverse service settings for diverse populations of children and their families.

The delivery of adequate screening and successful detection and treatment of a depressive illness and prevention of its effects on parenting and the health of children is a formidable challenge to modern health care systems. This study offers seven solid recommendations designed to increase awareness about and remove barriers to care for both the depressed adult and prevention of effects in the child. The report will be of particular interest to federal health officers, mental and behavioral health providers in diverse parts of health care delivery systems, health policy staff, state legislators, and the general public.

Contents

• THE NATIONAL ACADEMIES
• COMMITTEE ON DEPRESSION, PARENTING PRACTICES, AND THE HEALTHY DEVELOPMENT OF CHILDREN
• BOARD ON CHILDREN, YOUTH, AND FAMILIES
• Reviewers
• Preface
• Acknowledgments
• Tribute to Jane Knitzer
• Summary
• 1. Introduction and Magnitude of the Problem
  • SUMMARY
  • STUDY CHARGE, APPROACH, AND SCOPE
  • STUDY CONTEXT
  • IMPACT OF DEPRESSION
  • BARRIERS TO CARE
  • CONCLUSION
  • ORGANIZATION OF THE REPORT
  • REFERENCES
• 2. Approach to Research and Its Evaluation
  • SUMMARY
  • RESEARCH CHALLENGES IN CONFRONTING DEPRESSION IN PARENTS
  • ISSUES CONSIDERED IN SEARCHING THE LITERATURE
  • CHALLENGES IN THE EVALUATION OF THE LITERATURE
  • CONCLUSION
  • REFERENCES
• 3. The Etiology of Depression
  • SUMMARY
  • TIMING AND COURSE OF DEPRESSIVE DISORDERS
  • BIOLOGICAL PERSPECTIVES ON THE ETIOLOGY OF DEPRESSION
  • ENVIRONMENTAL AND PERSONAL CONTRIBUTORS TO DEPRESSION
  • CO-OCCURRING DISORDERS
  • RESILIENCE AND PROTECTIVE FACTORS
  • RESEARCH GAPS
  • CONCLUSION
  • REFERENCES
• 4. Associations Between Depression in Parents and Parenting, Child Health, and Child Psychological Functioning
  • SUMMARY
  • PARENTING PRACTICES AND THE DEPRESSED PARENT
  • DEPRESSION IN PARENTS AND CHILDREN’S FUNCTIONING
  • RESEARCH GAPS
  • CONCLUSION
  • REFERENCES
• 5. Screening for Depression in Parents
  • SUMMARY
  • PRIMARY CARE SETTINGS
  • SCREENING IN OTHER SETTINGS
  • CHALLENGES IN THE IMPLEMENTATION OF SCREENING FOR DEPRESSION
  • RESEARCH GAPS
  • CONCLUSION
  • REFERENCES
• 6. Treatment of Depression in Parents
  • SUMMARY
  • TREATMENT RATES
  • PHARMACOTHERAPY
  • INTERPERSONAL PSYCHOTHERAPY AND COGNITIVE-BEHAVIORAL THERAPY
  • ALTERNATIVE MEDICINE
  • IMPACT OF TREATMENT OF DEPRESSED PARENTS AND THEIR CHILDREN
  • INTERVENTIONS
  • VULNERABLE POPULATIONS
  • BARRIERS TO TREATMENT
  • ENGAGING VULNERABLE POPULATIONS
  • RESEARCH GAPS
  • CONCLUSION
  • REFERENCES
• 7. Prevention of Adverse Effects
  • SUMMARY
  • A FRAMEWORK FOR PREVENTIVE INTERVENTIONS
  • PREVENTION OF DEPRESSION IN PARENTS
  • PREVENTION OF ADVERSE OUTCOMES IN CHILDREN
  • UNIVERSAL AND PUBLIC HEALTH APPROACHES
  • PREVENTION FOR VULNERABLE FAMILIES
  • PREVENTION APPROACHES IN COMMUNITY SETTINGS
  • RESEARCH GAPS
  • CONCLUSION
  • REFERENCES
• 8. Working from the Present to the Future: Lessons Learned from Current Practice
  • SUMMARY
  • QUALITY IMPROVEMENT INTERVENTIONS AND THE TREATMENT OF ADULT DEPRESSION
  • ADDING A PARENT-CHILD DIMENSION TO DEPRESSION CARE INTERVENTIONS
  • SPECIAL ISSUES BY SERVICE SETTING
  • FEDERAL-LEVEL INITIATIVES
  • STATE-LEVEL INITIATIVES
  • EUROPEAN PREVENTIVE INTERVENTIONS WITH PARENTS AND CHILDREN
  • RESEARCH GAPS
  • CONCLUSION
  • RECOMMENDATIONS
  • REFERENCES
• 9. Strengthening Systemic, Workforce, and Fiscal Policies to Promote Research-Informed Practices
  • SUMMARY
  • SYSTEMIC OPPORTUNITIES
  • WORKFORCE CAPACITY AND COMPETENCY
  • FISCAL CHALLENGES
  • CONCLUSION
  • RECOMMENDATIONS
  • REFERENCES
• 10. Opportunities for Innovative Reforms and Knowledge Development
  • SUMMARY
  • RESEARCH OPPORTUNITIES
  • CREATING LEARNING ENVIRONMENTS THAT SUPPORT INNOVATION
  • CONCLUSION
  • RECOMMENDATION
  • REFERENCES
• Appendix A Acronyms
• Appendix B Depression and Parenting Workshop Agenda and Participants
• Appendix C Biographical Sketches of Committee Members and Staff

Suggested citation:

National Research Council and Institute of Medicine. (2009). Depression in Parents, Parenting, and Children: Opportunities to Improve Identification, Treatment, and Prevention. Committee on Depression, Parenting Practices, and the Healthy Development of Children. Board on Children, Youth, and Families. Division of Behavioral and Social Sciences and Education. Washington, DC: The National Academies Press.

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.

This study was supported by Grant No. 61299 between the National Academy of Sciences and the Robert Wood Johnson Foundation; by Grant No. 20062466 with The California Endowment; by Grant No. 205.0794 with the Annie E. Casey Foundation; by Contract No. HHSH250200446009I with the Health Resources and Services Administration; and by Contract No. 270-03-6002 with the Substance Abuse and Mental Health Services Administration. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the views of the organizations or agencies that provided support for the project.