The report, released June 11, challenged the US Surgeon General to make treatment of parental depression a national priority and called on health organizations such as the National Institute of Mental Health, the Centers for Disease Control and Prevention, and local, state, and federal governments to address gaps and fragmentation in services for depressed parents.
"We need to support programs that treat parental depression and provide services that are community based and available to parents — services that not only screen and treat depressed adults but also enhance parenting practices," said Mary Jane England, MD, president of Regis College, in Weston, Massachusetts, and chair of the committee that wrote the report.
Depression affects 7.5 million parents each year, and at least 15.6 million children live with an adult who had major depression in the past year — and that does not include the many parents who have experienced milder forms of depression or dysthymia, the committee said.
Many parents with depression also have other comorbid conditions that affect their children, including anxiety disorders, substance abuse, and posttraumatic stress disorder.
A Family Illness
"Depression is primarily a family illness that leads to sustained family and societal costs. It interferes with the quality of parenting and puts children of all ages at risk for poor health and development," said Mareasa Isaacs, PhD, from the National Alliance of Multi-Ethnic Behavioral Health Associations, in Silver Spring, Maryland, and a member of the committee that wrote the report.
For instance, 20% to 40% of adolescents who grow up in a home with a depressed parent are likely to experience depression themselves, Dr. England said.
Unfortunately, parental depression is rarely treated. Many programs that treat depressed adults fail to address the fact that they are parents or treat the childhood health and development problems that can result from parental depression, according to Frank Putnam, MD, from the Cincinnati Children's Hospital Medical Center, in Ohio.
Many programs that could address the multigenerational effects of depression, such as Head Start and services for homeless women and substance abuse, do not routinely screen for parental depression or consider its effects on children, said Dr. Putnam.
Major barriers stand in the way of treating both parents and children caught in the web of depression. These barriers include stigma, language and cultural barriers, poverty, immigration status, and lack of mental-health services in underserved communities.
Although safe and effective therapies exist for treating depression, mental-health programs — especially in underserved communities — rarely target parents, according to the report.
"We have a pressing need to improve outcomes for both depressed parents and their children. We have to treat depression but also support parenting and healthy childhood development. We need too start thinking about parents who are depressed as parents first and depressed individuals second," said William Beardslee, MD, from Children's Hospital–Boston, in Massachusetts, and a member of the committee that wrote the report.
Many Barriers to Care
Ideally, programs that treat both depressed parents and their children would also address comorbid conditions in parents and would offer comprehensive services to address factors that can cause or exacerbate depression, including financial difficulties, social isolation, marital conflict, and exposure to family or community violence. Such programs should be accessible, developmentally appropriate for children, and focus on teaching parenting skills, the committee recommended.
While there are a few promising US programs that address parental depression and its effects on children, none has all the key features the committee identified as vital. "We just do not have a multigenerational response in our medical systems," Dr. Putnam said.
Another problem is the shortage of primary-care and mental-health providers who could help treat depressed parents and their families. Many primary-care providers are also uncomfortable with screening for or treating depression, and physician and other health-provider training often fails to provide the skills necessary for multigenerational family interventions for depression.
Depressed parents also often lack health insurance, and insurance policies do not provide reimbursement for multigenerational treatment or for treatment in nontraditional settings, such as schools or the home. Yet, according to the committee, these nontraditional settings, including Head Start and even prisons, are often the best places to screen for and treat parents with depression and their children.
Possible Solutions
As well as improving health-provider training in treating depression, the report called for a national demonstration project using the primary-care medical home as a model for addressing parental depression. It also highlighted the need for additional research on parental depression.
The scientific literature does not adequately address the question of parental depression, particularly in fathers, Dr. England said. "We need to have a multiagency research agenda on the national level — and policies that are aimed at getting families the services they need," she added.
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