MATERNAL DEPRESSION, CHANGING PUBLIC ASSISTANCE, FOOD SECURITY, AND CHILD HEALTH STATUS

Authors: CASEY, PATRICK - DELTA NIRI; GOOLSBY, SUSAN - DELTA NIRI; BERKOWITZ, CAROL - HARBOR-UCLA MED CTR; FRANK, DEBORAH - BU SCHO OF MED/PUB HEALTH; COOK, JOHN - BU SCHO OF MED/PUB HEALTH; CUTTS, DIANA - HENNEPIN COUNTY MED CTR; BLACK, MAUREEN - UNIV OF MARYLAND SCH MED; ZALDIVAR, NIEVES - MARY'S CTR MATERNAL&CHILD; LEVENSON, SUZETTE - BU SCHO OF MED/PUB HEALTH; HEEREN, TIM - BU SCHO OF MED/PUB HEALTH; MEYERS, ALAN - BU SCHO OF MED/PUB HEALTH; C-SNAP STUDY GROUP - BU SCHO OF MED/PUB HEALTH

Submitted to: Journal of Pediatrics
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 6/13/2003
Publication Date: 2/20/2004
Citation: Casey, P., Goolsby, S., Berkowitz, C., Frank, D., Cook, J., Cutts, D., Black, M.M., Zaldivar, N., Levenson, S., Heeren, T., Meyers, A., C-SNAP Study Group. 2004. Maternal depression, changing public assistance, food security, and child health status. Pediatrics. 113(2):298-304.

Interpretive Summary: Depression is common in women of all ages, particularly among women who are mothers of young children. Depressive symptoms are more common in women in low-socioeconomic-status, and a related risk factor includes financial distress. Implementation of the Personal Responsibility and Work Opportunity Reconciliation Act has resulted in the loss of cash assistance, food stamps, or both in many families. Maternal depression is associated with increased probability of problems in behavior, emotion, and development in their children across the developmental age span. To date, however, little is known about the association of maternal depression or depressive symptoms with child health or on family characteristics such as food insecurity that may influence child health. Food insecurity, like maternal depression, is more common in impoverished families. To date, there are no reports that assess the potential association of maternal depression and household food insecurity. This study assessed the relationship of self-reported depressive symptoms to reported child health status, and loss of welfare and the nutritional assistance of food stamps. Results of this study show that maternal depression is associated with reported poorer child health status, food insecurity, and loss of federal financial support and food stamps. Child health providers need to be aware of the potential importance of maternal depression on the child's health, nutrition, development, and behavior in the context of welfare reform.

Technical Abstract: Objective: To examine the association of positive report on a maternal depression screen (PDS) with loss or reduction of welfare support and foods stamps, household food insecurity, and child health measures among children aged '36 months at urban hospitals and clinics. Methods: A convenience sample of 5306 mothers, whose children <36 months old were being seen in hospital general clinics or emergency departments (EDs) at medical centers in 5 states and Washington, District of Columbia, were interviewed from January 1, 2000 until December 31, 2001. Questions included items on sociodemographic characteristics, federal benefits, child health status rating, child's history of hospitalizations since birth, household food security status, and a 3-question PDS. For a subsample interviewed in the ED, whether the child was admitted to the hospital that day was recorded. Results: PDS status was associated with loss of reduction of welfare support and food stamps, household food insecurity, fair/poor child health rating, and history of child hospitalization since birth but not low child growth status measures or admission to the hospital at the time of ED visit. After controlling for study site, maternal race, education, and insurance type as well as child low birth weight status, mothers with PDS were more likely to report fair/poor child health (adjusted odds ratio [AOR]:1.58; 95% confidence interval [CI]: 1.33-1.88)and hospitalizations during the child's lifetime (AOR:1.20; 95% CI: 1.03-1.39), compared with mothers without PDS. Controlling for the same variables, mothers with PDS were more likely to report decreased welfare support (AOR: 1.52; 95% CI: 1.03-2.25), to have lost food stamps (AOR: 1.56; 95% CI: 1.06-2.30), and reported more household food insecurity (AOR: 2.69; 95% CI: 2.33-3.11) than mothers without PDS. Conclusion: Positive maternal depression screen status noted in pediatric clinical samples of infants and toddlers is associated with poorer reported child health status, household food insecurity, and loss of federal financial support and food stamps. Although the direction of effects cannot be determined in this cross-sectional survey, child health providers and policy makers should be aware of the potential impact of maternal depression on child health in the context of welfare reform.