Approximately 1 in 10 mothers (10.2%) suffered from major depressive disorder (MDD) in the past year. In fact, the 12-month prevalence of depression in mothers was elevated compared to all women in the NESARC (6.9%)2
and slightly higher than among women who were pregnant in the past year (9.3%).42
The prevalence of maternal depression translates into 1 in 10 children, or 7,667,637 children, exposed to mothers with MDD in the past year. Risk of depression was higher among younger mothers (≤35 years), white mothers, those who were divorced or separated, those with less than a college education, and those who were unemployed or with low household income. Sociodemographic factors associated with depression among mothers were similar to those found for the general population in recent large epidemiologic studies.1,2
The finding that depression is higher among young mothers and mothers with young children is particularly concerning given the persistence of early symptoms. In a large, longitudinal study, Horwitz et al.22,43
documented that of mothers with high depressive symptoms early in the child's life (11–42 months), almost half continued to have elevated symptoms 1 year later, and a significant portion continued to have high depressive symptoms when the child was entering kindergarten. Exposure to chronic maternal depression has a greater negative effect on children and the mother-child relationship compared to less chronic maternal depression.44–46
Depressed mothers reported more stressful life events in the past year, including marital dissolution, poverty, and events associated with economic hardship. Family disruptions and economic hardships are independent risk factors for adverse behavioral and psychologic outcomes in children, with influences on health observed to extend into adulthood.47–51
Depressed mothers were also more likely than nondepressed mothers to have other psychologic conditions. Depression comorbid with another psychopathology may exacerbate parenting difficulties.52
Multiple psychologic conditions, as well as high levels of stressful life events, increase the likelihood of persistent depressive symptoms among mothers of young children.22,43
Thus, children with depressed mothers are significantly more likely to be exposed to a range of adversities associated with compromised caregiving and adverse behavioral and health outcomes across the life course.
Only half of depressed mothers received services in the past year for their depression; this rate was even lower among black and Hispanic mothers. Service use rates among mothers were lower than the estimated 57% rate among all past-year depressed individuals.1
It is important to note that the measure of service use is broad (including seeing a counselor/therapist/doctor/other, visiting the emergency room or hospital, and doctor-prescribed medicine/drug for depression) and is self-reported; thus, it does not indicate type of treatment received, dose, duration, or quality, nor do we have verification that services were actually received. Successful treatment of maternal depression is crucial and has been shown to positively affect psychiatric symptoms and disorders in middle childhood and adolescence.53,54
However, there is evidence that treatments that focus solely on treating maternal depression may not adequately address problems in the mother-child relationship that emerge as a result of maternal depression.55,56
Consistent with the U.S. population of women in general, we found that Hispanic and black mothers were less likely to suffer from depression in the past year compared to non-Hispanic white mothers.2
This racial/ethnic pattern has also been reported for lifetime rates of depression in other samples not stratified by gender.32,34,57,58
An item-response examination in the NESARC dataset revealed few differences in response likelihood when comparing white, black, and Hispanic individuals, suggesting these observed differences are not explained by racial or cultural differences in experience or reporting of symptoms of depression.59
A similar study in the National Comorbidity Survey concluded that differences in response to depression questions did not account for the lower rates of depression among non-Hispanic black and Hispanic individuals compared to non-Hispanic white individuals.60
The reasons for these patterns are yet to be fully illuminated, although protective factors operating early in life have been hypothesized to play a role.32
For immigrants, one protective factor may be remaining in their home country through childhood.61
Future research should explore whether strong family or cultural ties, religious participation, and other social support networks play a protective role among black and Hispanic populations and if this helps account for their lower rates of depression.35,62
Such factors may be particularly powerful in promoting mental health among mothers.
Hispanic and non-Hispanic black mothers who were depressed experienced more adversities, had worse functioning, and were less likely to receive services for their depression compared to non-Hispanic white mothers. These patterns, again, reflect findings from studies not restricted to mothers58,63
yet raise important questions about the implications of these riskier profiles among racial/ethnic minority mothers for the children in their care. Exposure to multiple adversities in childhood may greatly increase risk of poor health and health-related behavior in adulthood.64
Research that addresses racial and ethnic disparities in the impact of maternal depression on children is needed and may lead to the formulation of targeted prevention and intervention efforts, particularly among children most at risk of adverse outcomes.
Several limitations of this study should be considered. NESARC focused on adults and their psychopathologies; thus, we have very little information about the children, precluding analysis of their health status, living conditions, and interactions with their mothers. Also, as NESARC does not ask participants directly if they are currently parenting children in the household, we relied on report of births or adoptions and household composition. Thus, it is possible that we included some women who were not the primary female caregiver of the children in the household. Inclusion of paternal depression was beyond the scope of this analysis; however, paternal depression is positively correlated with maternal depression and may pose additional developmental risk to children.65
All data are self-reported, and as it is a cross-sectional study, we cannot establish temporality or causal relations.