Brought to you by the Depression Is Real Coalition, The Down & Up Show is dedicated to the reality of depression. Our hosts will talk with some of the world's top experts on depression, as well as people who have been impacted by this illness. The reality of depression is that it is a debilitating and potentially deadly medical condition that affects more than 15 million Americans every year. The other reality of depression is that there is hope.

Down & Up Show #59: Maternal Depression and its Possible Effects on Children and Adolescents

DR. REEF KARIM:
Dr. Reef Karim Welcome to the Down and Up show on DepressionIsReal.org. I'm your host Dr. Reef Karim, psychiatrist, addiction specialist, and relationship therapist. Our guest today is Dr. William Beardslee, a board member of Mental Health America.

He's also the director of Baer Prevention Initiatives at the Department of Psychiatry at Children's Hospital in Boston and Gardner Monks professor of child psychiatry at Harvard Medical School. Dr. Beardslee has a long-standing research interest in the development of children at risk of the effects of parental mental illness.

He is the author of over 100 articles and wrote the book When a Parent Gets Depressed: How to Protect Your Children of the Effects of Depression in the Family which essentially is about how parents and caregivers can help families overcome depression.

We'll be talking to Dr. Beardslee about maternal depression and its possible effects on children and adolescents. So, thank you for joining us today, Dr. Beardslee.

DR. WILLIAM BEARDSLEE
Thank you very much. It's a pleasure to be with you.

DR. REEF KARIM:
So, let's start. Tell us about maternal depression in general. What is it? How common is it amongst women? And what are the signs and symptoms?

DR. WILLIAM BEARDSLEE
Well I think there are two... two sides to the story or two main themes. One is that maternal depression or depression in parents in general, that is paternal depression as well, are public health problems of major proportions. They're quite common. Configure

And without appropriate treatment and intervention, they can cause significant difficulties in youngsters. That's one half of the story. The other half is that we have excellent treatments for depression, and we have some very promising preventive interventions for families so that this is a condition if we can recognize it and get people the help they need, they can have a very good outcome.

So to the question of how common. Most estimates would say that depression is a common illness. One in five Americans will experience a major depression sometime during their lifetimes. And that depression is twice as common in adults in women than in men.

And for reasons that I think we're beginning to understand it's particularly likely to occur in mothers who are over stressed or face multiple risks. So, I think it's fair to say that there are millions of children in this country at any one time who are growing up with a depressed parents.

DR. REEF KARIM:
One thing I get asked as a psychiatrist frequently is if you look at the numbers that roughly 7 to 12%, 7 to 10% of men, and then they look at about 17-20% in general of women, having difficulties with mood instabilities from depression. Why so much higher in women?

DR. WILLIAM BEARDSLEE
It's a very good question, and I don't think that we have the definitive answer. I think that the one of the factors is that depression often is a result of loss, social adversity, or facing many risks at once, and women who are caregivers, particularly caregivers without adequate resources, are more likely to become depressed, and in our country, those are more likely to be women.

That's only part of the story. There may be some way in which expressions of distress appear differently in women than in men. Rates of conduct disorder and substance abuse are higher in men, and many people have speculated that those may be manifestations of some underlying disregulation similar to depression women but expressed differently because of socialization and possibly biological factors.

DR. REEF KARIM:
Yeah, the socialization I would think, especially if it's a stress response, is different based on the juggling of family life and work life. Women are so substantial in the workforce now compared to, say, previous times that I would think just that juggling alone is an increase in stress that you don't see as much or maybe as prominent in men.

DR. WILLIAM BEARDSLEE
I would agree with that, and I would add that, you know, one of the things that compared to 40 years ago, the number of women raising children alone, that is not married, has gone up.

And if you add one other risk-factor to that, raising children alone and being poor, that has gone up quite a bit, too. Being a caregiver, not having adequate resources and being pulled in multiple directions often results in depression.

DR. REEF KARIM:
Well, how does maternal depression impact children and other family members?

DR. WILLIAM BEARDSLEE
Well, and again, I think that there are two interesting stories there. We did one of the first major research studies of children who grow up with parents who are depressed, and we had one finding which is that there are higher rates of depression in children of parents who have depression when you compare them to children of parents who have no mental illness.

But the other side is that there a surprising number of children who are resilient in the face of parental depression, who do well despite the parental depression. They have three sets of characteristics. We went back to our risk study and identified those who were resilient and then talked to them at length.

And the three characteristics of their resilience are an ability to accomplish age-appropriate developmental tasks, they're activists and doers, a deep second, a deep commitment to relationships, and thirdly, these kids told us that they knew their parents had an illness, and they knew that they were not to blame for it and were free to go on with their own lives.

It's the striking fact that parents who are depressed can, in fact, be good parents. They can focus on their parenting and take good care of their kids even when depressed and also obviously can benefit from help whether it's from a spouse or a family member... other family member or whatever it takes to get through the depression. we also find a surprising number of kids who are resilient, and our message about parental depression fundamentally is that when it occurs, people need to get treatment for it, they need to get help with their parenting, but there's every reason to be hopeful.

DR. REEF KARIM:
Well, let's talk a little bit more about this resilience, the coping skills, the emotional protective factors or strengths that help an individual defend, you know, during times of stress, in crisis defend against the onset of depression.

DR. WILLIAM BEARDSLEE
the ability to take help from others or I would say some kind of inner-reflective dimension that may allow people to enter into religious faith or to envision the future differently, are factors.

On average, high intelligence is much more likely to be associated with resilience than below average intelligence. I think the really important message from neuroscience from all of the new work studies and development is the notion, the two notions of developmental plasticity and ecological context.

Developmental plasticity refers to the fact that whether we're at the level of the gene, the cell, or the whole child, developing children have an enormous capacity to reframe, to rethink, overcome adversities, even brain injury. And that's what's meant by developmental plasticity.

The ecological context refers to the fact that we know more and more that context, family relationships, school, neighborhood, can have a profound effect on developing children, and when organized in the right way, can be important resources for protective factors.

So to give one example, if someone is growing up with a parent with a depression, in addition to that parent being able to be an effective parent, it's often very helpful to have a relationship with someone else either the other parent or grandparent or a mentor or a teacher that can sort of help through the difficult... help see someone through the difficulties of having a depressed parent.

I think that in our work, I mentioned before, we found these three characteristics: the ability to engage in age-appropriate activities, engage in relationships and to understand what's happening and to recognize that one is not guilty or to blame.

And I think those are, in fact, characteristics that children who grow up in homes with depression do well, but they are also characteristics that preventive interventions can affect. In our own preventive interventions we've actually worked with parents and say what kinds of things got disrupted in the life of your child with depression?

And how can you sort of put those back with a particular focus on helping the child succeed in school and activities, helping the child have good relationships and helping the child understand that the depression is a biological illness and treatment's available and that no one is to blame and that everyone wants the child to go on with his or her own life.

DR. REEF KARIM:
So you have research that looks at resilience and the effects from a neuroscience standpoint on resilience?

DR. WILLIAM BEARDSLEE
I would say that I'm a student of that research. And the more we're aware that various kinds of influences can change the course of a child's life or even the course of the illness, I think, perhaps, the most striking in that regard is that we used to think many years ago think that, genes conveyed six inherited characteristics and that the environment had very little to do with it.

Now we know that the environment can actually influence which genes are turned off and turned on, and that, in turn, can have a great deal to do with depression. I'll give you the classic example of environmental influence which is what's the largest single and most important factor in the healthy development of a child's nervous system?

By far it's the relationship with the primary care giver. And supporting that relationship can foster effective long-term development. That's why I and many other people are very interested in effective interventions for children zero to five, early in the course of life.

DR. REEF KARIM:
Yeah, you know, I get many, many families that will come into my office or see me at UCLA, and they'll be like, you know, we were just... you know, our kids were dealt a bad hand. They're genetic, you know, that's just the way it is. They're gonna be in trouble or they're gonna have problems down the road.

And I don't think they realize that that environmental influence, that ecological context you mentioned, can so directly change or alter the road that perhaps the genetics even are sending somebody in a certain direction, and that can absolutely be altered.

DR. WILLIAM BEARDSLEE
Well, I'd agree, and I would say that, it's... certainly it's true that, family history or genes can convey risk. let's not talk about mental illness, but certainly some people are gonna be more prone to heart disease than others given family history.

But those... I think what developmental plasticity teaches us, those are increased risks, not inevitability. Someone at high risk for heart disease can take particular care of diet, exercise, blood pressure, regular physician visits, and if cholesterol is elevated, consider one of the (unint.) drugs.

So, in that instance in which there's an increased vulnerability because of a possible genetic vulnerability, there's still many things that can be done, and I think the same is true for many mental illnesses, but with this big difference.

DR. REEF KARIM:
Now, when we think of moms we think of mothers that are strong, that are raising their children that can do no wrong, that juggle and multi-task a million different things going on. Why is depression screening so important for mothers?

DR. WILLIAM BEARDSLEE
Well, I think it's so important, to go back to our conversation at the beginning, it's important because depression is highly prevalent among mothers raising children. And it's very often not recognized, only about a third of the women with depression get recognized and get treatment.

And above all, because if it's recognized, then we can effectively treat it. We have evidence-based treatments using medications, we have evidence-based treatments using talk therapies. Both work well in cases of severe depression, probably combinations will work best.

But unlike so many other situations, here's an illness that we can treat, and the treatment can have a multiplier effect because it affects not only individual, the mother, but also those around the mother, children, spouses, and so on.

If we're talking about mothers with limited income, possibly where they get services whether it be in daycare or in food stamp offices or whatever. And I emphasize the treatment coupled with some emphasis on parenting can really make a huge difference.

DR. REEF KARIM:
Now, what should a friend or family member do if they know someone living with paternal depression?

DR. WILLIAM BEARDSLEE
I think that what a friend or family member can do is very tactfully and respectfully acknowledge that the person is having a hard time and say that both the evidences the treatments work, and if that person has had some experience, knows someone who's gotten treatment and gotten better add that and say it's really important that this be evaluated.

Can I help you get evaluated? And very often coming from a family member who's trusted, that can go a very long way.

DR. REEF KARIM:
You also work with Mental Health America. What are you most proud of in working (inaud.)

DR. WILLIAM BEARDSLEE
Well, I think there are two things that... there are actually three things that I'm really immensely proud of in being part of Mental Health America. The first is that I've met an extraordinary group of people on the board and in the affiliates, people who are courageous in their advocacy for the best possible life for those who struggle with mental illness.

Also, of all the major advocacy organizations in mental health, we are the only ones who have strongly embraced prevention, and that came from the vision of the founder, Clifford Beers (ph.). But since I do prevention, I'm a preventionist by training and practice, and I believe we can do a great deal in the prevention of mental illness.

I'm particularly committed to Mental Health America because of its strong commitment to prevention. And finally, I think that Mental Health America recognizes that we need to do our advocacy, do our work, on many different fronts at once.

DR. REEF KARIM:
Well, that's great. I mean, you've been very helpful, very insightful today. I wanna thank you, Dr. Beardslee for speaking with us today.

I'm Dr. Reef Karim, psychiatrist, addiction medicine specialist and relationship therapist. Thank you for listening.