I just read an interesting editorial entitled Why do depressed individuals have difficulties in their parenting roles? by L. Psychogiou and E. Parry in Psychological Medicine. This got me to thinking about how parenting assessment can help depressed parents.  It is quite likely that we’ve all encountered a parent with depression, or have been in that place ourselves.  Depression is the most common psychiatric disorder, and post-partum depression is particularly widespread.  According to the New York Department of Health, up to 80% of new mothers experience “Baby Blues” which resolve relatively quickly.  More critically, 10-20% of mothers will experience post-partum depression (for a helpful handout see Understanding Maternal Depression, A Fact Sheet for Care Providers). 

Consequences of Parental Depression for Children

Beyond the suffering of the parent, depression has consequences for the child. Practically, it negatively impacts the parent’s ability to care for the child, the parent-child interaction and potentially, the health and safety of the child.  Speaking of parent-child interaction, when filming parents and their children for the training for Keys to Interactive Parenting Scale (KIPS), we focused on natural interactions of real families.  However, because depression is so common, we wanted to show some examples of depressed parents.  Not surprisingly in hindsight, we found it hard to recruit depressed parents, so we asked a few parents to role play depression when interacting with their babies.  The response of the children was immediate and dramatic.  In every case when the mom acted depressed, the baby quickly became distraught.  This response is illustrated strikingly in a video in which Dr. Ed Tronick shows the dynamics of “rupture and repair” in parent-child interactions. Here is a link to a short video-showing “still face”, which is very similar.  After viewing such videos, we can understand how maternal depression can lead to insecure attachment.  Maternal depression can negatively impact the psychological development of the child, increasing internalizing and externalizing behavior problems, general psychopathologies and emotional impairments.  It’s not just moms, paternal depression also has long-term adverse emotional and behavioral impacts on children.  

When severe, parental depression can produce unsafe situations for children. The parent may become incapable of providing sufficient care and/or supervision for the child. This is especially alarming when children are infants, toddlers or preschoolers.  In some cases the parent can become at risk of harming the child or themselves when they are unable to rationally consider the consequences.  Therefore, there are both immediate and longer term reasons to screen caregivers for depression and help them access appropriate mental health services.  Those serving families have the opportunity to screen parents for depression.  Depression can be reliably screened using readily-available, validated survey tools.  The Beck Inventory is one commonly used survey instrument, and the Edinburgh Postnatal Depression Scale is a commonly used screening tool developed especially for postpartum depression.  

In their editorial, Psychogiou and Parry speculate about the mechanism by which depression has its varied impacts on children.  They consider parental affect, emotional regulation, motivation, rumination and executive function as important factors.  

Certainly, parents with depression should be encouraged to seek treatment.  Getting individuals with depression to the stage of seeking treatment is notoriously difficult.  Motivational interviewing techniques may prove useful in helping a depressed parent seek help.  For parents seeking help, finding the right mental health treatment can take time, and medications can take weeks to show effect. However, babies can’t wait; there are critical windows of child development that need to be met. 

Parenting Assessment Can Help

If the parent has yet to seek treatment, or before treatment has taken full effect, the parent-child interaction will likely be impaired.  Parenting intervention can still make a difference while parents are experiencing depression.  For examples, see this review of promising parent-child intervention strategies with families with depressed parents that resulted in positive behavior outcomes for children, improved parenting practices and more secure attachment for children.  

A parenting assessment can help in this situation.  One of the values of a well-constructed parenting assessment is that it identifies strengths.  Depressed individuals have a hard time seeing their strengths.  Families who have participated in the KIPS parenting assessment tell us that the fact that an objective, validated tool that shows his/her strengths helps convince the parent of their positive parenting skills.  We recommend using video for the assessment to better support parents by using personal examples.  The video provides an objective view for the parent of his/her words and actions, and you can use it to point out strengths in what the parent is actually doing with his/her child.  Finding video segments where the child is responding positively to the parent’s strengths might prove particularly helpful in showing the parent the positive consequences of his/her behavior. 

 A parenting assessment can identify easy successes.  By easy successes, I mean relatively easy changes the parent can make that will quickly show reward.  A parent who is depressed can benefit from being empowered by taking action that leads to improvement in some part of their life.  Generally, depressed parents may lack motivation and vigor, but supporting them to understand the importance of their being emotionally, intellectually and physically present for their children may help them rally the energy to be more available in their daily interactions with their children.  Though generally they may be feeling down, they may be able to rise to the occasion, if only for a few minutes each day, and be more present for their child.