Patterns and Trajectories of Parental Depression Among Child Welfare-Involved Families

Background & Purpose: Parental depression (typically examined as maternal depression) carries a host of implications for both parents and their children. Maternal depression has been linked to neglectful parenting practices and may often be part of presenting concerns among families coming into contact with child welfare (CW) services. CW-involved parents commonly report depressive symptoms, ranging from mild-moderate to, at times, severe levels. The degree to which depression is a concern among CW-involved families, however, is little understood, and identification of mental health needs for CW-involved families is a public health priority.

In this paper, we first examine basic patterns of depression among CW-involved parents who are actively receiving SafeCare®(SC), an in-home, evidence-based parenting curriculum specifically designed to reduce child neglect. We then use growth mixture models to identify trajectory “classes” hypothesized to have distinct etiologies. Finally, we explore indicators linked to different trajectories, including intervention dosage, working alliance with a home visitor, and external sources of stress, such as employment and housing issues.

Methods: Data for this analysis come from the Interagency Collaborative Team (ICT) Study, an implementation study focused on understanding inner and outer context factor associated with the effective implementation and sustainment of an EBP. The sample for the current study includes 1410 parents with active CW cases within a large, county-wide system, whose primary referral consists of child neglect. Clients enrolled in the ICT study at the outset of receiving SC.  

Measures: Depression was measured with the Centers for Epidemiologic Studies Depression Scale (CESD). It was measured at up to four time points: baseline, six weeks, 12 weeks, and 18 weeks (i.e. end of services/conclusion of parenting curriculum). Clients completed a Working Alliance Inventory as an indicator of the parent-home visitor relationship. We examined service dosage by constructing an indicator of “completeness” of the intervention and of components of the intervention completed. Finally, clients completed a weekly questionnaire regarding other types of stressors they encountered while receiving the intervention.

Results: Baseline rates of depression in the CW-involved population in this study were consistent with those found in previous research on CW-involved or low-income parents, with approximately 25% of parents above the CESD threshold. We did not find differences in depression by race, ethnicity, marital status or education. However, number of children was strongly associated with more depressive symptoms. Several distinct trajectories of depression appeared over time among families receiving SC.

Conclusions & Implications: Our findings indicate that depressive symptoms are indeed a concern among CW-involved families, with rates of depression nearly three times that of the general population. Identifying the mental health needs, and highlighting key indicators, for this population is an important step toward a continued commitment to addressing positive parenting practices. Further, the effective implementation of EBPs – achieving an ideal dose for the target population into these types of service systems – may result in unintended, positive consequences, such as a decline in depressive symptoms.