Parental Depression Affects the Entire Family
August 09, 2004
Seattle Post-Intelligencer

WHEN ANGIE HOFFPAUIR GETS gets a new class of psychology students at Antioch University in Seattle, she typically asks the same first- day question: Who in here would be willing to share the fact if you were depressed?

"Nobody raises their hands," said Hoffpauir, a faculty member who previously asked the same question - to no avail - as a teacher at New Hampshire, Tulane and Louisiana State universities.

Remember, this is a roomful of psychology students. They are actively learning that mental health is as precious as it is fragile.

Yet admitting to the symptoms of depression remains a tough sell even as health officials make it clear that depression is increasingly common and treatable.

One finding is that every birth group born since World War II is significantly more at risk for depression than the previous group. (For research purposes, a birth group covers about two to five years.) A federal Centers for Disease Control and Prevention study indicated that most Americans report feeling "sad, blue or depressed" three days a month, on average.

"We are recognizing depression more and more," said Hoffpauir. "But the stigma is no less."

Depression hits women harder than it does men and statistics show women are twice as likely to be diagnosed. In the CDC study, women reported one extra day of feeling blue each month.

What's more, women with three or more kids under age 12 are especially prone to depression, said Hoffpauir, who has a Bainbridge Island private practice specializing in depression and group therapy work,

"Being a woman is a risk factor," she said. "Being a mother with young children is a risk factor. Lack of social support is a risk factor, which can be a problem for mothers who spend their days with a young child or two."

Pediatric researchers are keenly aware of these trends. The effects of maternal health - especially such topics as mental stability and smoking/drinking patterns during pregnancy - are well documented in medical literature.

Dr. Robert Kahn doesn't disregard the power of the maternal link in raising healthy children. But it bothers him that research is thin on paternal health. He set out to do something about it with a new study published in this month's issue of the Archives of Pediatrics & Adolescent Medicine.

Kahn and his colleagues evaluated surveys from 822 children between ages 3 and 12 living with both parents. It showed - no surprise - that kids whose mothers and fathers both showed signs of poor mental health were at eight to nine times the risk for behavioral or emotional problems than children living with two mentally stable parents.

Poor mental health was defined as answering yes to questions about feeling hopeless, depressed, that everything is an effort, that you are too sad for anything to cheer you or too anxious for anything to calm you.

Past studies have shown that if the father was depressed but the mom was stable, the children could be completely unaffected. Kahn's study confirmed this finding.

What's news - and myth-busting in some circles - is that children in homes with a mentally stable dad and a depressed mother are almost as unaffected and free from behavioral and emotional problems as kids with a depressed father and stable mom.

"There is intuitive appeal here for every father who works hard at contributing to the health and well-being of his children," said Kahn, a pediatrician based at the highly regarded Cincinnati Children's Hospital Medical Center. He and his wife, Jessica, who practices adolescent medicine at the same center, have children ages 9, 6 and 18 months.

Kahn said there are several factors that help explain how the father can play such a major role when the mother is emotionally vulnerable. One is the man taking on increased caregiving responsibilities. The husband can help by allowing his wife the time and understanding to seek treatment for her depression. Plus, there is the simple matter of passing on "healthy genes" related to mental health.

"The biggest lesson here is that fathers need to take stock of their own well-being and seek care when they need it," said Kahn, clearly poised to become a rising star in the issue of paternal health as it relates to child development.

He is equally passionate about pediatricians focusing more on depression symptoms in both children and their parents.

Kahn endorsed the suggestion that perhaps pediatricians will have to take a more active role in determining the mental well-being of parents.

"It's difficult to do with fathers because traditionally we see a lot more moms in our offices," said Kahn. "But we see kids too late in the game who have their own emotional and behavioral difficulties. We have to somehow evaluate parents in the process."

There is a problem with any depression diagnosis that bothers both Kahn and Hoffpauir.

"We tried not to get too prescriptive in our study," said Kahn, "because the availability of (routinely covered) mental health care in this country borders on pathetic. I've always found it interesting that Europe is far more generous than the U.S. with paternal care. Their society puts a higher priority on fulfilling the role of raising healthy, happy children by allowing the parents the time and effort required."

Hoffpauir is part of a research team that is proposing a study to the federal government's National Center for Complementary and Alternative Medicine that will consider the value of massage, acupuncture and energy work (using Chinese and Indian models) in alleviating depression.

Other research indicates regular exercise and even food changes can help relieve mild to moderate depression.

"If there is one message that everyone needs to know," said Hoffpauir, "it's that seeking preventive help or support is so effective.

"Too many people don't go to see a therapist or counselor until they feel so bad. We can do more in the early stages."