John D. McLennan

Prevalence, Persistence, and Correlates of Depressive Symptoms in a National Sample of Mothers of Toddlers

OBJECTIVES To examine the prevalence, persistence, and correlates of depressive symptoms in mothers of toddlers in a nationally representative sample. METHOD The self-report components of two linked databases were used for this study, the 1988 National Maternal and Infant Health Survey and the 1991 Longitudinal Followup. Depressive symptoms of 7,537 mothers were measured by the Center for Epidemiologic Studies-Depression Scale (CES-D) at both time points. Weighted bivariate and multivariate analyses were used to assess the stability of maternal depressive symptoms across two time points and maternal and child predictors of elevated depressive symptoms. RESULTS Twenty-four percent of mothers at time 1 (mean child age 17 months) and 17% at time 2 (mean child age 35 months) had elevated depressive symptoms (CES-D score > or =16). Thirty-six percent of those with elevated scores at time 1 also had elevated scores at time 2. Not having breast-fed, a mistimed or unwanted pregnancy, and poor child health status were related to elevated depressive symptoms but not persistence. CONCLUSIONS Elevated depressive symptoms are common in mothers of toddlers. Given the potential magnitude of need, a systematic clinical and public health approach may be required.

Should Postpartum Depression Be Targeted to Improve Child Mental Health

OBJECTIVE To evaluate whether postpartum depression (PD) is an appropriate target to prevent poor child outcomes. METHOD Criteria are proposed for evaluating the appropriateness of targeting PD. The target factor should (1) be a causal factor for the negative outcome, (2) have high attributable risk for the negative outcome, (3) be alterable, and (4) be easily and accurately identified through screening. The associated intervention should (5) have characteristics to facilitate dissemination, (6) have low risk for adverse impact, and (7) be acceptable to key stakeholders. RESULTS PD is given a mixed endorsement as an appropriate target for a prevention intervention. Positive characteristics include that PD is moderately prevalent, it is linked with poor child outcomes, it requires inexpensive screening for detection, it is alterable through treatment interventions that may be realistically disseminated, and its treatment is likely to have popular and political support. However, efforts to detect syndromal depression may be costly, strength of the link between PD and poor child outcomes is undetermined, and risks associated with the intervention have not been investigated. CONCLUSIONS Further study is required to assess the appropriateness of PD as a prevention target for improving child outcomes. These provisional criteria may be useful for evaluating other proposed prevention targets.

Canada's programs to prevent mental health problems in children: the research–practice gap

The increased number of prevention activities directed at reducing child mental health problems in Canada is welcome. However, practitioners and policy-makers should reflect on 2 questions that were posed 20 years ago by Michael Rutter: “How much do we really know about prevention in the field of