This pilot study provides preliminary evidence about mental health utilization of African American mothers with depressive disorders and their children. We found that 65% of the depressed African American mothers had utilized mental health services. These findings are similar to those of Weissman and colleagues,9
who found that 49% of depressed mothers had received treatment within the past month and that 75% of depressed mothers had received mental health treatment in their lifetime within an urban general medicine practice. Our study’s rate of maternal mental health utilization is higher than the utilization rates found for postpartum mothers.8,10,11
Perinatal women may have more physical limitations in getting mental health care in addition to the increased demands of pregnancy and newborn care, which limit the ability of the parent to seek care for herself. Further documentation of mental health utilization of subgroups of mothers with depression would clarify the variability in findings.
A major finding of this study is that mothers who were in treatment were more likely to have utilized mental health treatment within 3 months after the baseline assessment. It is reasonable to assume that mothers who were in treatment initially continued with their mental health services only 3 months later. In a study of an urban population, African Americans who utilized mental health services at baseline were more likely to use these services 12 to 15 years later.45
The finding of continued mental health utilization for depressed African American mothers is encouraging in light of the research indicating that African Americans have low mental health utilization and are more likely to drop out of mental health treatment.7,46,47
In a cross-sectional study with African American, Latina, and European American women, the 3 strongest predictors of lifetime mental health utilization are self-reported drug problem, greater belief that psychiatric disorder is caused by an imbalance within oneself or one’s environment, and less belief that psychiatric disorder is caused by religious or supernatural forces.48
Current substance dependence disorder was an exclusion criterion for the study; therefore, substance disorders cannot account for continued utilization of mental health services. Despite the various barriers to mental health services that the sample may encounter (eg, mental health stigma, racial discrimination in the health care system, lack of social support, competing demands of parenting/caregiving),47,49,50
the current study suggests that African American mothers with depression who initiate treatment in the face of these barriers can stay in treatment at least short term to address their mental health needs. Only 3 mothers were no longer in treatment at the follow-up interview.
We found that approximately 38% of the children received mental health services within the 3 months after the assessment interview. This rate was slightly higher than 24%, the rate of children with past-year mental health utilization rates noted in a study of children of mothers with severe mental illness.21
Our mental health utilization rate is similar to the 1-year utilization rate of 34.5% found by Mandell, Boothroyd, and Stiles51
in Medicaid records. Mental health utilization rates in this sample reflect the high risk status of the children, especially when there is evidence showing that African American children were less likely than white children to have utilized mental health treatment.21,51,52
Our results suggest that maternal reports of child behavior problems predicted child mental health utilization. Similarly, Mowbray et al21
demonstrated that maternal reports of child behavior problems as measured by the Child Behavioral checklist predicted child mental health utilization. In a recent review, parent perception of child problems was a predictor of child mental health utilization.53
A large body of evidence describes the behavioral profiles of the children of depressed mothers, with evidence suggesting that manifestations of behavioral symptoms vary by developmental stage, with disruptive behavior disorders and anxiety disorders being more common among school-aged children, depression being more common among adolescents and substance abuse being more common among young adults.15,54–56
Recent data from the Sequenced Treatment Alternatives to Relieve Depression study, assessing current and lifetime prevalence of psychiatric disorders among children of depressed mothers, suggests that as many as 45% of those children meet criteria for a psychiatric diagnosis.57
In another study, Wu and colleagues52
examined patterns of mental health services among depressed children and adolescents and looked for factors associated with service utilization. Among those who received treatment for depression, depressed youth whose mothers were receiving professional help were more likely to utilize mental health services than mothers who were not receiving professional mental health services; however, African American youth were less likely to receive professional help than other ethnic groups in this study.
Income had an effect on the results of the current study. Women with a yearly income of $20 000 or less were more likely to have services data collected and more likely to be in treatment at the baseline assessment. There have been limited studies on the effects of income on mental health service use, and results have been inconsistent.21
Women in the lower income level may have had a higher rate of treatment in this study due to the availability of health care services to those with income low enough to be on public insurance. Minorities are less likely to be insured, resulting in poor access to care in general,58
but those making higher incomes may be at a further disadvantage due to the high costs of insurance in the United States.21
Young minority women in particular are often uninsured, despite their high risk of depression.59,58
Thus, women with lower income may have higher rates of treatment due to increased economic stress impacting their psychiatric functioning, leading to greater need to use mental health services. Future research is warranted to understand the complex interactions of income, race, and mental health utilization.
There are limitations to the current study. First, the time period for mental health utilization is shorter than is typically reported in research literature. The current study assesses for mental health utilization in the past 3 months, while research literature more frequently report on utilization within either the past year or lifetime. It is unclear how the 3-month time span corresponds to past-year utilization. Second, data were not gathered about the child’s baseline treatment status, thus it is not known if children who received treatment within the 3-month period had been receiving treatment prior to the study. Third, the sample included a larger proportion of women who had lower income, although there was a range of income levels. Fourth, recruitment included mental health treatment facilities, thus recruitment strategies may have biased the sample of women who were in treatment. Finally, because the sample included only African American mothers, the results may not be generalizable to depressed mothers of other races and ethnicities or to depressed fathers.
These are important clinical implications of the study’s findings. This pilot study provides preliminary data to support the use of mental health treatments for depressed mothers and their children. With utilization of mental health services, benefits to both mothers and children can be demonstrated. For example, Weissman and colleagues57
found that 3 months of medication treatment for mothers with depression resulted in reductions in children’s diagnoses and symptoms supporting the benefits of maternal treatment for child psychiatric outcomes. Other studies examining the effectiveness of brief psychotherapeutic interventions for maternal depression—specifically, interpersonal therapy for depressed mothers whose children are receiving treatment—effectively reduced levels of maternal symptoms and improved child functioning.60
These studies suggest potential benefits of brief interventions for depressed mothers. Utilization of brief interventions might increase access and acceptability to needed mental health services. Improving mental health utilization for depressed mothers and their children who are exhibiting behavioral difficulties may lead to psychiatric benefits in both generations.