Infant Health Care Use and Maternal Depression

Abstract

To determine whether women who frequently bring their neonates for problem-oriented primary care visits or emergency department visits are at elevated risk of having depressive symptoms. Design: Analysis of 2 prospective cohort studies of mothers and their infants: (1) a telephone interview study of mothers and infants after birth at an urban teaching hospital (the hospital cohort) and (2) the 1988 National Maternal and Infant Health Survey, a nationally representative sample of women who had live births in 1988. Participants: A total of 1015 women in the hospital cohort surveyed at 3 and 8 weeks post partum and 6779 women with data from the national survey. Main Outcome Measure: Depressive symptoms above the Center for Epidemiologic Studies Depression Scale cutoff score of 15. Results: After controlling for sociodemographic variables and parity, women exhibited high levels of depressive symptoms if their infants had more than 1 problemoriented primary care visit (hospital cohort: odds ratio, 2.0 [95% confidence interval, 1.1-4.3]; national survey cohort: odds ratio, 2.0 [95% confidence interval, 1.5-3.0]). Women were more likely to have high levels of depressive symptoms if their infants had even 1 emergency department visit (hospital cohort: odds ratio, 3.2 [95% confidence interval, 1.5-6.9]). Frequent wellchild visits were not associated with maternal depressive symptoms. Conclusions: Neonatal health care use patterns predict women at risk for postpartum depression. Recognition of these signature patterns of service use by pediatric health care providers may facilitate early diagnosis and treatment of postpartum depression and improve outcomes for women and their families.

Maternal psychosocial predictors of pediatric health care use: Use of the common sense model of health and illness behaviors to extend beyond the usual suspects

“…Additionally, the twelve-month prevalence rates of anxiety disorders were significantly greater for those patients deemed high utilizers of health care (29.3%) versus normal utilizers (11.9%; Schmitz & Kruse, 2002). Physically healthy adults experiencing depressive symptoms have been shown to utilize primary care services significantly more than nondepressed adults (Koopmans & Lamers, 2001;Mandl, Tronick, Brennan, Alpert, & Homer, 1999). In one study, patients experiencing depressive symptoms contacted their physicians more often than any other group with the exception of patients with heart disease (Koopmans & Lamers, 2001).…”

“…In looking beyond anxiety, several studies have documented significant positive relationships between parental depression and pediatric health care use in children ages three to eighteen (Kramer, Warner, Olfson, Ebanks, Chaput, Weissman, 1998;Mandl, et al, 1999;Olfson, Marcus, Druss, Pincus, & Weissman, 2003;Weissman, Merikangas, John, Wickramaratne, et al, 1986). Children ages two to sixteen years categorized as high users of care have been shown to be twice as likely as low users to have parents that reported significant depressive symptoms (i.e.…”

“…In an infant sample, Mandl et al (1999) reported a significant association between infant health care visits in primary care and/or emergency settings and level of maternal depressive symptoms based on two independent studies. One sample of 1,200 mother-infant pairs was interviewed via telephone regarding health services use at 3 and 8 weeks postpartum.…”

An Update on Mood and Anxiety Disorders During Pregnancy and the Postpartum Period

“…25,42,[47][48][49][50] Stressful newborn events, such as health problems and infant irritability, have also been associated with greater risk for postpartum depression. 25,44,51 Two prospective cohorts 52 were analyzed to determine whether women who frequently brought their neonates for (problem-oriented) primary care or emergency department visits were at an elevated risk of having depressive symptoms. Findings revealed that neonatal health care use-patterns predicted maternal risk for postpartum depression; mothers were more likely to have high levels of depressive symptoms if their infants had even 1 emergency department visit.…”

Well child care in the United States: racial differences in compliance with guidelines

“…The poorer compliance observed for depressed mothers is complementary to findings of more problemoriented and/or emergency visits for infants of depressed mothers. 66 The association of an unwanted pregnancy with incomplete well child care points to the importance of maternal attitude toward the child as a factor influencing the quality of care that the infant receives.…”