Depressed, rural moms face greater health challenges—and so do their kids

Research at Washington State University has linked chronic depression with increased health problems for moms and children in poor rural communities, revealing the need for better treatment based on teamwork and trust.

Using data from the ongoing, multi-state Rural Families Speak project, a team led by Yoshie Sano, associate professor in WSU's Department of Human Development, examined the experiences of 23 mothers with clinical depression across three years.

The findings, recently published in the Journal of Family Social Work, revealed that mothers who were constantly depressed experienced more health problems, distrusted doctors and had a worse outlook on their lives, compared with moms whose symptoms improved. The mothers' depression also affected those closest to them.

"Mothers are one of the main supports of the family," said Sano, the lead author on the paper. "They're raising children, paying bills, and organizing events. When they're depressed, the entire family is impacted."

More than one in five adults deal with depression, a mood disorder that causes persistent sadness, exhaustion and loss of interest, affecting relationships, work, and emotional and physical health. Women are twice as likely to have depression as men, and people in poverty are three times more likely to experience it.

"Depression affects everything—employability, parenting, how we deal with daily life," said Sano. "Mental health is the core of a productive life."

As part of her research into family relationships through Rural Families Speak, Sano kept encountering mothers from rural, low-income families who were dealing with depression.

While much prior research has found how depression affects childhood development, she sought to understand the broader context of maternal depression.

Both groups of moms, those who were depressed but improving as well as those who had chronic depression, had similar struggles in dealing with their children's health. But chronically depressed moms faced greater challenges in dealing with their children's emotional and behavioral issues, which were often compounded by a lack of childcare options, employment, concerns for delinquent behaviors and day-to-day behavioral management issues.

"We found that children's health—particularly their emotional and behavioral health—is one of the most challenging contributors to maternal depression," Sano said. "Depression doesn't happen in isolation. It happens in a family, community, and cultural context."

Policy makers often focus on physical health as a direct obstacle to self-sufficiency for low-income families, said Sano.

"But especially for moms, mental health is the major obstacle," she said. "There's a huge stigma around mental health, especially in rural areas. Women try to deal with it alone."

The scientists found that chronically depressed mothers expressed strong distrust of health-care professionals and their prescribed treatments.

"It's critical for mothers to find at least one provider with whom they can build a trusting relationship—someone who knows their overall health histories, understands their family histories, and listens to their concerns," Sano said.

For rural communities with limited care providers, Sano underlined the importance of coordination between doctors, mental health professionals and social workers as well as the need to incorporate mental health screening into existing support systems, such as schools and public assistance.

"We hope our results will inspire new conversations among health care providers, and raise awareness that this is a hidden but deep problem for low-income mothers," she said. "Once people recognize this issue, the stigma attached to mental health will decrease."