Rates of maternal depression in pediatric emergency department and relationship to child service utilization

Abstract

This cross-sectional study aimed to (a) identify rates and correlates of untreated elevated depression in mothers of young children in a pediatric emergency department (ED) setting and (b) examine the association of depression and other key variables to child healthcare use. Mothers (n=176) bringing their child (<age 7) to the pediatric ED completed a screening survey assessing depression, demographic information, and select child healthcare information. Up to 31% of mothers screened evidenced elevated depression, and most were not being treated (78%). Elevated depression was related to both missed pediatric outpatient visits and greater use of pediatric ED services. Thus, the pediatric ED setting may provide the opportunity to identify mothers whose depressive symptoms have been obstacles to seeking routine primary care for their children. Detection of maternal depression in pediatric settings using a screening tool accompanied by appropriate follow through may be a reasonable strategy to improve health outcomes for both the mother and her child.

Introduction

Depression is common in women, affecting between 20% and 23% at some point during their lives, most often with onset during childbearing years [1], [2]. The substantial personal disability associated with depression for women is well-documented [3], [4]. Maternal depression also impacts child mental health and well-being. Beginning in the first few months of life, maternal depressive symptomatology has been shown to affect responsiveness to the child [5] behavioral problems and delayed cognitive and linguistic development [6], [7], [8]. Older children have multiple psychiatric difficulties, including increased rates of depression, substance abuse, and conduct disorders [9], [10], [11], [12], [13], [14]. Children's health and mental well-being may be affected by maternal depression through genetic, interpersonal, and environmental mechanisms [15].

Despite many safe and effective treatments for depression, less than one third of individuals with depression receive adequate treatment [16]. Pregnant women and women with young children may be particularly unlikely to seek care for their depression. A recent study found that only 15% of pregnant women who screened positive for depression risk reported receiving any form of treatment for depression [17].

In pediatric primary care settings, prevalence rates of maternal depressive symptoms range from 12% to 60% across a wide variety of communities [18], [19], [20], [21], [22], [23], [24], [25], [26]. These prevalence rates suggest that pediatric healthcare settings present an opportunity to identify mothers with depression or subsyndromal depression who would not otherwise seek care themselves. In pediatric emergency department (ED) settings, point prevalence rates of maternal depressive symptoms may reach 10–20% [27]. Other recent studies of pediatric ED use have found that depressive symptoms in mothers are associated with higher rates of ED service utilization [28], [29]. Thus, the pediatric emergency room may provide an ideal setting to identify women with depression who may not be receiving healthcare (including mental health services) for themselves.

The purpose of the present study was (a) to demonstrate rates of maternal depression and rates of treatment for depression in the pediatric ED, (b) to identify demographic and psychosocial factors associated with maternal depression in these settings, and (c) to examine the relationship of maternal depression and other demographic and health variables to two separate indices of child healthcare service utilization (i.e., missed pediatric outpatient appointments and visits to the pediatric ED). Results from this investigation provide information on mental healthcare needs of mothers of young children that may otherwise remain unaddressed, thus contributing to impairment for both the mother and her children. Based on prior research, we expect that most mothers with elevated depression will report no current mental health treatment, and that maternal depressive symptoms will be related to greater use of pediatric ED services.