Poverty, Depression, and Motherhood: An Unhealthy Combination

Last month the American Academy of Pediatrics gathered experts at its annual conference to discuss their agenda for combating one of the greatest threats to the health of children—poverty. They argued that continuing to ignore a main driver of many child health complications would never allow the Academy to achieve its goals fully. Reinforcing the rationale for this holistic approach, the Urban Institute’s recent analysis of national survey data highlights the relationship between poverty, children’s health, and a serious, but treatable common health condition—depression.

Research has shown that when left untreated, depression in parents is associated with an increased risk for preterm births, and young children’s’ low birth weight, poor physical health, physical endangerment, and developmental, emotional, and mental health problems. Despite the breadth of knowledge available on the potential impacts of a parent’s or mother’s depression on her children, little is known about its national prevalence among low-income mothers and the subsequent rates of different types of treatment and their relationship to insurance status. As a part of the Urban Institute’s “Linking Depressed Mothers to Effective Services” project, Marla McDaniel and Christopher Lowenstein attempt to address this information deficiency in a recent research brief.

In order to examine and estimate national trends on depression and its treatment, the authors combined the three recent rounds of data (2008-2010) from the National Survey of Drug Use and Health (NSDUH) with assistance from the U.S. Department of Health and Human Services’ Substance Abuse and Mental Health Services Administration (SAMHSA). Within this data, they specifically focused on low-income mothers with young children, which is defined as a woman 18 years of age or older with a biological child under the age of six and an income below 200 percent of the federal poverty level.

In terms of prevalence of major depression among low-income women as compared to higher-income women, a larger share of low-income women experienced a major depressive episode in the past year whereas the proportion experiencing major depression at one point in their lives does not vary by income. Approximately one in eleven low-income mothers with young children (or 8.8 percent) had major depression in the past year versus 7.5 percent of mothers across all income groups. Furthermore, low-income mothers were also more likely to have severe depressive symptoms that interfered with daily activities, with 69.7 percent of depressed low-income mothers compared to 54 percent of depressed higher-income mothers having a condition categorized as severe or very severe.

Similar patterns exist for treatment rates across different types of recommended treatments. Using a broadly defined definition for depression treatment, more than one-third of low-income mothers experiencing depression have not received prescription medication or therapy as a form of treatment. For higher-income mothers, the absence of these treatments is slightly smaller at 25.3 percent.

The report also found a relationship between insurance status and access to treatment. The lack of insurance resulted in much lower levels of treatment—51.6 percent of uninsured mothers with depression versus 66.9 percent of those insured with depression—although the level of severity remained relatively constant across groups with and without insurance. On the other hand, the authors estimated that low-income mothers on Medicaid had similar rates of treatments as mothers with private insurance.

Unfortunately, the authors note that the data is unable to address the quality and intensity of the treatment the mothers receive. They argue that while the data highlight the gaps in treating depression, the true severity of the situation could be worse since treatment is only effective if the mother goes into remission from the depression. Therefore, mothers—in particular low-income mothers—need access not only to treatment, but quality treatment in order to reduce a child’s risk for various health conditions. Nevertheless, the analysis provides an important first step in understanding how prevalent the situation is and the need to focus attention to mothers in poverty like the American Academy of Pediatrics.