The voices of Urban Institute's researchers and staff
April 17, 2013

Major Gaps in Treatment for Low-Income Mothers with Depression Put Kids at Risk

April 17, 2013

When a mother suffers from depression, her child often suffers too. Strong clinical evidence indicates that a mother’s untreated depression can damage her child’s cognitive, social, and emotional development and jeopardize the child’s long-term physical and mental health. Poor and low-income mothers likely face greater barriers to receiving effective treatment and more social and environmental stresses that can trigger depression, placing children in these families at particularly high risk.

The latest research from the Urban Institute’s series “Linking Depressed Mothers to Effective Services” provides a new and detailed look at depression prevalence, severity, and treatment among low-income mothers with young children across the country. The low-income mothers in our study had incomes less than 200 percent of the federal poverty level, or $22,314 for a family of four, and had children ages 0 to 5.

Our study found major gaps in treatment even for mothers who experienced a major depressive episode—a serious illness marked by symptoms such as prolonged sadness, tiredness, and feelings of worthlessness, often interfering with one’s ability to function in home, work or social environments —and striking disparities between mothers who are insured and those who aren’t.

Major depression was significantly more severe among low-income mothers than among higher-income mothers:

  • 69.7 percent of low-income mothers with young children who had a major depressive episode had an episode that was severe or very severe, compared with 53.5 percent of higher-income mothers with young children.

But far fewer low-income mothers received medication or talk therapy:

  • 37.3 percent of low-income mothers with young children reported that they did not get either form of treatment for their major depression, compared with 25.3 percent of higher-income mothers.

Among the low-Income mothers with young children in our study, uninsured mothers were significantly less likely than their insured counterparts to receive either type of treatment for their major depression:

  • nearly half (49.4 percent) of uninsured mothers had not received treatment, compared with one-third (33.1 percent) of those with health insurance.

Interestingly, we find that depressed low-income mothers with young children who are covered by Medicaid have comparable treatment rates to mothers with private or other type of health insurance, suggesting that Medicaid fills an important gap in providing mental health services to mothers who may not otherwise have access to it.

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While this finding is promising, it does not tell the entire story. Even if a mother receives treatment, living in poverty raises a variety of barriers that could make her treatment less effective or hinder her ability to keep these services. We know little about the quality, intensity, or duration of treatment received, and such factors undoubtedly influence the likelihood that depression is treated to remission.

Luckily, new provisions under the Affordable Care Act not only present opportunities to improve treatment access to these mothers by expanding Medicaid coverage, but also offer initiatives designed to better link them to the high-quality and effective mental health services necessary to minimize the risks of depression to themselves and their children.

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