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Pediatricians urged to focus on moms, too

Signs of depression can be detected, study says

Pediatricians usually ask a mother about her baby's sleep pattern or a toddler's eating habits. But a study published today suggests that at routine checkups, they should ask a few questions about the mother's own well-being, too.

Just two simple questions -- about whether a mother has lost interest and pleasure in doing things lately, and whether she has been feeling down -- can quickly and easily start the process of getting the estimated 10 percent of mothers who are depressed the help they need, according to the study in this month's issue of the journal Pediatrics.

A growing body of research suggests that such help can be crucial for both mother and child. Last month, researchers reported that well into adulthood, the children of very depressed parents remain about three times as likely as their peers to suffer from depression, anxiety, or addiction. On the positive side, a major study this spring found that when mothers' depression abated, their children showed improvement in their own psychiatric symptoms within three months.

The research is so convincing it practically ``screams" for pediatricians to get involved in treating parents' depression, said Dr. Myrna Weissman, the Columbia University psychiatry professor who oversaw both earlier studies.

Today, little screening of parents for depression actually takes place, researchers say. Parental depression and its effects on children tend to fall between the cracks in the medical system , between children's doctors and adults' doctors. And even if pediatricians suspect a problem, they are not set up to offer treatment options to parents.

``The convergence of the scientific evidence and the awareness that we can make a huge difference in a large number of people's lives . . . make this a moment of extraordinary opportunity," said Dr. William Beardslee , academic chairman of the psychiatry department at Children's Hospital Boston. ``And at the same time, the poignancy is that we have not yet done it, and a huge amount of unnecessary suffering in families continues to go on."

The study cited in Pediatrics enrolled doctors in rural practices in Vermont and New Hampshire, and found that the pediatricians generally considered the two-question survey quick and workable. A patient who answers yes to either question may need to be referred for counseling or other treatment for depression.

The Dartmouth professor who led the study noted that pediatricians are already trying to provide advice in a wide array of areas during routine office visits. ``They were willing to say, `You know, if I don't talk about [the importance of wearing] bike helmets, but I help a mom with depression, pow! I've made a difference,' " said Dr. Ardis Olson , a professor of pediatrics and community and family medicine.

For decades, researchers have documented the damage that depression can wreak on a mother, her child, and the bond between them.

Infants whose mothers are withdrawn tend toward feelings of sadness, anger, distrust, and helplessness, they have found. These children may develop more slowly than average, and encounter more trouble in the classroom and with their peers.

And depressed mothers are more likely to blame themselves when the child hits a bump in the course of developing. They tend to believe that ``the reason the baby is like that is because of their depression, so they feel, in a sense -- to use a strong word -- toxic to the baby," said Ed Tronick , director of the Child Development Unit at Children's.

Pata Suyemoto of Somerville, a former professor who volunteers for the group Families for Depression Awareness, describes the period when she struggled to raise her young daughter while experiencing depression as ``torturous."

``I remember being in the park and just crying, letting her play on the swings and just sitting back and crying, because I was in such a state but I knew I had to take care of her," she said. Even now, she said, with her daughter almost 12, she worries: ``I know I've given her the best I could, but was that good enough?"

Such concern is familiar to Beardslee. Depressed parents ``worry that they have damaged their kids irrevocably -- they have not, they absolutely have not -- but that is what they think," he said.

Weissman's long-term study on adult children of depressed parents does suggest long-term damage if nothing is done. Published in the June issue of the American Journal of Psychiatry, it followed 151 children -- 101 of them with depressed parents -- for 20 years, until an average age of 35.

The children of depressed parents not only had triple the risk of depression, anxiety, and addiction, they also were starting to show higher rates of medical problems such as heart disease, the study found.

But recognition and treatment of depression has improved since those children were young, researchers pointed out, and some of the children's problems were surely tied to genetics rather than parenting. Depression has a strong genetic element.

Weissman's other recent study offers more hope. It found that when a mother's depression went away within three months of treatment, her children's psychiatric symptoms -- such as behavior or mood problems -- tended to abate as well. Among the children of mothers who got better, there was a drop in those diagnosed with psychiatric problems, from 35 percent to 24 percent.

Weissman and her coauthors pointed out that, with all the concern these days about how to safely treat psychiatric disorders in children, one strategy may be to provide ``vigorous treatment" to depressed mothers.

Tronick has pioneered therapy that focuses on improving the parent-child bond, and Beardslee has led work on helping families cope with a parent's depression. He also works on preventing depression, both by finding support for parents and fostering resilience in children.

It helps, he said, for a parent to tell a child such things as, ``This is a medical illness, a biological illness, I'm getting treatment, and your life will be able to continue. This is not your fault, and you're not to blame, even though it's very confusing."

Carey Goldberg can be reached at