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