The Role of Postpartum Depression in Child Maltreatment and Parental Home Environment. A Secondary Analysis of a Healthy Families America Program

Background: Postpartum Depression (PPD) affects roughly one in eight women in the US, but disproportionately affects about 25% of low-income mothers. PPD is associated with an array of negative outcomes, including aversive maternal and child interactions, decreased infant safety practices, and increased child depression and anxiety. Untreated PPD can also negatively impact maternal attitudes, emotional sensitivity, and responsiveness toward the child, thus putting the child at risk for maltreatment. Yet, little research exists on the specific factors associated with PPD among mothers who participate in programs aimed at reducing risk of child abuse and neglect.  The current study seeks to improve our understanding of the key factors affecting PPD among “overburdened” mothers enrolled in a Healthy Families America (HFA) program.  The research questions were: 1) how is risk of child abuse associated with PPD at 3 months? ; 2) how is PPD at 3 months associated with home environment at 12 months?

Method: This study focused on a sample of 7,922 mothers from a Healthy Families America program in Indiana, a home visiting program targeting families at risk for child abuse and neglect. Logistic regression models were used to examine the effects of risk of child maltreatment and other demographic characteristics on the likelihood of PPD at 3 months. Multiple regression analyses were then conducted to examine the effects of PPD at 3 months on overall home environment functioning at 12 months, including each specific domain: acceptance, responsivity, involvement, organization, learning & variety .

Results: Mothers exhibiting high risk for child maltreatment were twice as likely to have PPD as mothers who were low-risk (OR=2.08,p<0.05)—even after controlling for other demographic variables. Low educational attainment (OR=1.97) and living in a rural or suburban area (ORs=1.22 and 1.30, respectively) were both associated with increased odds of PPD. Conversely, being Black (OR=0.82), living with a partner (OR=0.82) and being under the age of 19 (OR=0.69) significantly lowered odds of depression when compared to their counterparts: white, married, and over 19. PPD was significantly negatively associated with participants’ overall home environment functioning at 12 months (B=-0.90), including lower levels of maternal acceptance (B= -0.16), involvement (B=-o.26) and learning (B=-0.180).

Conclusion and Implications: Our findings highlight the need for targeted screenings and interventions among mothers at high risk for child maltreatment, who tend to have a greater probability of having PPD. The current practice in the HFA program is to screen and refer for counseling yet there is no standardized method of intervention. Most notably, our results suggest that postpartum depression in the first three months may have long-term impact on the home environment, including negative effects on mother’s acceptance of child’s behavior, involvement in dyadic activities with child, and the physical and emotional developmental learning opportunities she provides. Better understanding of the impact of early PPD on later parenting behaviors may inform early home visiting intervention to prevent deleterious parenting practices.