© Blog First Steps, IDB’s Social Protection and Health Division

by Filipa de Castro and Jean Marie Place

depression.eng

Both in Mexico and on a global scale, depression is the main threat to mothers’ mental health, especially in contexts of socioeconomic vulnerability and marginalization [link in Spanish]. Several studies indicate that depression is preventable, detectable and treatable, thereby significantly reducing its negative short- and long-term effects.

How does maternal depression affect child development?

Caring for a baby or small child is a demanding task that can be stressful and exhausting even for a mom who is not depressed. Women with depression experience feelings of sadness and feel they have little power to meet the demands of the child. Besides feeling like she cannot take care of herself, a mom who is depressed feels like she cannot properly take care of her baby. Depression may compromise the mom’s ability to correctly interpret her baby’s needs and make her think that the baby is crying simply to annoy her. These thoughts can make her feel angry and impatient and may mean that she will have more difficulty soothing the baby when he cries or needs care.

The effects of maternal depression on neonatal and child health are particularly severe in the context of social disadvantage and poverty and are associated with malnutrition, higher rates of diarrheal disease, shorter duration of breastfeeding and stunting. The children of depressed mothers have a higher likelihood of being born premature and low birthweight. Depression is detrimental to the establishment of the mother-baby bond and the quality of the parental relationship. Children of depressed mothers have a greater likelihood of suffering from social-emotional problems and impaired cognitive and linguistic development. Consequently, these children tend to start school without being adequately prepared for the learning process, which compromises their academic performance. Children of depressed mothers are also at greater risk for abuse, neglect and accidents.

What do we know about maternal depression in Mexico?

In recent years, Mexico’s National Institute of Public Health has researched epidemiological and health system aspects related to the mental health of women of reproductive age. A community-based study of women attending an urban public hospital during the postpartum period estimated the prevalence of depression at 14%. More recent estimates indicate that, nationwide, one in five women with children under age 5 show symptoms of depression.

Our studies have consistently identified certain risk factors for maternal depression among Mexican women. Notably, interpersonal violence perpetrated by an intimate partner, including emotional, physical or sexual abuse, is one of the factors most strongly associated with maternal depression. Other risk factors include low social support, unintended pregnancy, low educational attainment, and lack of a loving partner.

Identifying the factors that put women at risk for depression is a fundamental step toward strengthening preventive programs. Our estimates indicate that the prevalence of postpartum depression could be reduced from 14% to 5.5% through programs focused on eliminating exposure to interpersonal violence, unintended pregnancy and low social support.

Where do we begin in order to reduce the negative effects of maternal depression?

The World Health Organization (WHO) and the United Nations Population Fund (UNFPA) recommend a set of coordinated actions to improve maternal and child health, which include reducing risk factors associated with maternal depression and increasing the availability of low-cost interventions to improve maternal mental health. Comprehensive implementation of these recommendations in Mexico is a pending task that requires the incorporation of mental health programs into existing health systems, stigma reduction, early detection, and investment in research on effective interventions.

In addition to interventions in a clinical context, it is very likely that maternal depression can also be prevented and treated through a combination of interventions based on sustainable and scalable evidence, aimed at the most vulnerable population. In countries with limited resources, such as Mexico, it makes sense to invest in low-cost, technically-undemanding approaches, including social support, therapeutic groups, and home visits by community workers, which have shown positive results in reducing the symptoms of depression in women in developing countries.

Lastly, policymakers must support actions that prioritize the care of women with depression, establishing clinical practice guidelines specifically aimed at maternal mental health problems, since the benefits of identifying and treating a case of maternal depression are most likely greater than the associated costs. Health professionals must recognize the intersection that exists between mental health, maternal health and child development.

What do you know about the prevention, detection and treatment of maternal depression in your country’s health system? Share this post to generate a dialogue on this important topic.

Filipa de Castro, PhD is a professor and researcher at the Center for Population Health Research, National Institute of Public Health, Mexico.

Jean Marie Place, PhD is a professor in the Department of Physiology and Health Sciences at Ball State University, Muncie, Indiana, USA.

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