Maternal depressive symptoms and infant health practices among low-income women

Objectives. To determine the relationships between maternal depressive symptoms and the use of infant health services, parenting practices, and injury-prevention measures. Methods. A prospective, community-based survey of women attending Philadelphia public health centers between February 2000 and November 2001 was conducted. Women were surveyed at 3 time points before and after parturition. Depressive symptoms were determined with the Center for Epidemiologic Studies Depression Scale at each time point. We studied 6 outcomes, clustered into 3 categories: 1) infant health service use ( adequate well-child care and ever being hospitalized); 2) parenting practices (breastfeeding for greater than or equal to1 month and use of corporal punishment); and 3) injury-prevention measures ( having a smoke alarm and using the back sleep position). Results. The sample consisted of 774 largely single (74%), uninsured (63%), African American (65%) women, with a mean age of 24 +/- 6 years and a mean annual income of $ 8063. Forty-eight percent of women had depressive symptoms at 1 or 2 time points ( ever symptoms) and 12% had depressive symptoms at all points ( persistent symptoms). Compared with women who never had depressive symptoms ( without symptoms), women with persistent symptoms were nearly 3 times as likely to have their child ever hospitalized ( adjusted odds ratio: 2.89; 95% confidence interval: 1.61 - 5.07) and twice as likely to use corporal punishment ( adjusted odds ratio: 1.90; 95% confidence interval: 1.08 - 3.34). Mothers with persistent depressive symptoms were nearly three-quarters less likely to have smoke alarms in their homes ( adjusted odds ratio: 0.28; 95% confidence interval: 0.11 - 0.70) and one-half as likely to use the back sleep position ( adjusted odds ratio: 0.56; 95% confidence interval: 0.35 - 0.91), compared with women without symptoms. There was no association between maternal depressive symptoms and infant receipt of well-child care or the likelihood of breastfeeding for greater than or equal to 1 month. Conclusions. Maternal depressive symptoms persisting from the prepartum to postpartum periods were associated with increased risks of infant hospitalization and use of corporal punishment and with lower likelihood of having a smoke alarm and using the back sleep position. Additional efforts are needed to identify and evaluate mothers with depressive symptoms to improve the health and safety of young infants.