Lower income mothers who bring their children for mental health services also have high rates of depression and anxiety, yet few seek help. Maternal and child mental health are intimately intertwined; thus, the distress of both is likely to continue if the mother's needs are unaddressed. Because mothers overcome numerous instrumental challenges to help their children, the authors identify potential perceptual barriers to mothers' help seeking. An ethnographic analysis of in-depth qualitative interviews with 127 distressed mothers suggests several critical perceptual factors. For example, mothers attributed their distress to external causes (e.g., poverty, negative life stressors), which they believed individually focused mental health services could not affect. Interviewees also anticipated negative ramifications for seeking care, including being labeled unfit mothers, and thus potentially losing custody of their children. The authors discuss the implications of these and other key themes for engaging lower income mothers and their children.
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders(4th ed.). Washington, DC: Author.
2.
Angold, A., Erkanli, A., Farmer, E. M., Fairbank, J. A., Burns, B. J., Keeler, G., et al. (2002). Psychiatric disorder, impairment and service use in rural African American and White youth. Archives of General Psychiatry,59, 893-901.
3.
Arendell, T. (2000). Conceiving and investigating motherhood: The decade's scholarship. Journal of Marriage and Family,62, 1192-1207.
4.
Armstrong, H. E., Jr., Ishiki, D., Heiman, J., Mundt, J., & Womack, W. (1984). Service utilization by Black and White clientele in an urban community mental health center: Revised assessment of an old problem. Community Mental Health Journal,20, 269-281.
5.
Beardslee, W. R., Bemporad, J., Keller, M. B., & Klerman, G. L. (1983). Children of parents with major affective disorder: A review. American Journal of Psychiatry,140, 825-832.
6.
Beck, A. T. (1978). Depression inventory. Philadelphia; Center for Cognitive Therapy.
7.
Beck, A. T., Epstein, N., Brown, G., & Steer, R. A. (1990). An inventory for measuring clinical anxiety: Psychometric properties. Journal of Consulting & Clinical Psychology,56, 893-897.
8.
Bradley, R. H., Whiteside-Mansell, L., Brisby, J. A., & Caldwell, B. M. (1997). Parents' socioemotional investment in children. Journal of Marriage and Family,59, 77-90.
9.
Braverman, L. (1989). Beyond the myth of motherhood. In M. McGoldrick, C. M. Anderson, & F. Walsh (Eds.), Women in families: A framework for family therapy(pp. 227-243). New York: W. W. Norton.
10.
Brown, G. W., & Moran, P. M. (1997). Single mothers, poverty and depression. Psychological Medicine, 27, 21-33.
11.
Bruce, M. L., & Hoff, R. A. (1994). Social and physical health risk factors for first onset major depressive disorder in a community sample. Social Psychiatry and Psychiatric Epidemiology,29, 165-171.
12.
Callahan, M., & Lumb, C. (1995). My cheque and my children: The long road to empowerment in child welfare. Child Welfare,74, 795-819.
13.
Census Bureau. (2004). Current population survey 2004, annual social and economic supplement. Retrieved January 3, 2006, from http://www.census.gov/hhes/poverty/threshld/thresh03.html
14.
Coiro, M. J. (2001). Depressive symptoms among women receiving welfare. Women and Health,32, 1-23.
15.
Cummings, E. M., & Davies, P. T. (1994). Maternal depression and child development. Journal of Child Psychology & Psychiatry & Allied Disciplines,35, 73-112.
16.
Diamond, R. J., & Factor, R. M. (1994). Treatment-resistant patients or treatment-resistant systems? [Letter to the editor]. Hospital & Community Psychiatry,45, 197-197.
17.
Diaz-Caneja, A., & Johnson, S. (2004). The views and experiences of severely mentally ill mothers. Social Psychiatry and Psychiatric Epidemiology,39, 472-482.
18.
Dover, S. J., Leahy, A., & Foreman, D. (1994). Parental psychiatric disorder: Clinical prevalence and effects on default from treatment. Child: Care, Health & Development,20, 137-143.
19.
Downey, G., & Coyne, J. C. (1990). Children of depressed parents: An integrative review. Psychological Bulletin,108, 50-76.
20.
Earle, A., & Heymann, J. S. (2002). What causes job loss among former welfare recipients: The role of family health problems. Journal of the American Medical Women's Association,57, 5-10.
21.
Edlund, M. J., Wang, P. S., Berglund, P. A., Katz, S. J., Lin, E., & Kessler, R. C. (2002). Dropping out of mental health treatment: Patterns and predictors among epidemiological survey respondents in the United States and Ontario. American Journal of Psychiatry,159, 845-851.
22.
Ferro, T., Verdeli, H., Pierre, F., & Weissman, M. M. (2000). Screening for depression in mothers bringing their offspring for evaluation or treatment of depression. American Journal of Psychiatry,157, 375-379.
23.
Goodman, S. H., & Gotlib, I. H. (1999). Risk for psychopathology in the children of depressed mothers: A developmental model for understanding mechanisms of transmission. Psychology Review,106, 458-490.
24.
Greeno, C. G., Anderson, C. M., Shear, M. K., & Mike, G. (1999). Initial treatment engagement in a rural community mental health center. Psychiatric Services,50, 1634-1636.
25.
Hammen, C., & Brennan, P. A. (2003). Severity, chronicity, and timing of maternal depression and risk for adolescent offspring diagnosis in a community sample. Archives of General Psychiatry,60, 253-258.
26.
Heymann, S. J., & Earle, A. (1999). The impact of welfare reform on parents' ability to care for their children's health. American Journal of Public Health,89, 502-505.
27.
Katz, M. B. (1995). Improving poor people: The welfare state, the “underclass” and urban schools as history. Princeton, NJ: Princeton University Press.
28.
Kazdin, A. E. (2000). Perceived barriers to treatment participation and treatment acceptability among antisocial children and their families. Journal of Child & Family Studies,9, 157-174.
29.
Kendall, P. C., & Sugarman, A. (1997). Attrition in the treatment of childhood anxiety disorders. Journal of Consulting and Clinical Psychology,65, 883-888.
30.
Kovacs, M., Devlin, B., Pollack, M., Richards, C., & Mukerji, P. (1997). A controlled family history study of childhood-onset depressive disorder. Archives of General Psychiatry,54, 613-623.
31.
Kramer, R. A., Warner, V., Olfson, M., Ebanks, C. M., Chaput, F., & Weissman, M. M. (1998). General medical problems among the offspring of depressed parents: A 10 year follow-up. Journal of the American Academy of Child and Adolescent Psychiatry,37, 602-611.
32.
Lupton, D., & Fenwick, J. (2001). “They've forgotten that I'm the mum”: Constructing and practising motherhood in special care nurseries. Social Science & Medicine,53, 1011-1021.
33.
Lyons-Ruth, K., Wolfe, R., Lyubchik, A., & Steingard, R. (2003). Depressive symptoms in parents of children under age three: Sociodemographic predictors, current correlates, and associated parenting behaviors. In N. Halfon, K. T. McLearn, & M. A. Schuster (Eds.),Child rearing in America: Challenges facing parents with young children (pp. 217-259). New York: Cambridge University Press.
34.
Mann, C., Hudman, J., Salganicoff, A., & Folsom, A. (2002). Five years later: Poor women's health care coverage after welfare reform. Journal of the American Medical Women's Association,57, 16-22.
35.
Maslow, A. H. (1954). Motivation and personality. New York: HarperCollins.
36.
Maslow, A. H. (1987). Motivation and personality (3rd ed.). New York: HarperCollins.
37.
Maynard, C., Ehreth, J., Cox, G. B., Peterson, P. D., & McGann, M. E. (1997). Racial differences in the utilization of public mental health services in Washington State. Administration and Policy in Mental Health,24, 411-424.
38.
Mohr, W. K. (2000). Rethinking professional attitudes in mental health settings. Qualitative Health Research,10, 595-611.
39.
Mowbray, C. T., Oyserman, D., Bybee, D., McFarlane, P., & Rueda-Riedle, A. (2001). Life circumstances of mothers with a serious mental illness. Psychiatric Rehabilitation Journal,25, 114-123.
40.
Olfson, M., Marcus, S. C., Druss, B., Pincus, H. A., & Weissman, M. M. (2003). Parental depression, child mental health problems, and health care utilization. Medical Care,41, 716-721.
41.
Owens, P. L., Hoagwood, K., Horwitz, S. M., Leaf, P. J., Poduska, J. M., Kellam, S. G., et al. (2002). Barriers to children's mental health services. Journal of the American Academy of Child & Adolescent Psychiatry,41, 731-738.
42.
Park, J., Turnbull, A. P., & Turnbull, H. R. (2002). Impacts of poverty on quality of life in families of children with disabilities. Exceptional Children,68, 151-170.
43.
Pottick, K. J., & Davis, D. M. (2001). Attributions of responsibility for children's mental health problems: Parents and professionals at odds. American Journal of Orthopsychiatry,71, 426-435.
44.
Puig-Antich, J., Goetz, D., Davies, M., Kaplan, T., Davies, S., Ostrow, L., et al. (1989). A controlled family history study of prepubertal major depressive disorder. Archives of General Psychiatry,46, 406-418.
45.
Reading, R., & Reynolds, S. (2001). Debt, social disadvantage and maternal depression. Social Science & Medicine,53, 441-453.
46.
Rishel, C. W., Greeno, C. G., Marcus, S. M., & Anderson, C. M. (in press). The effect of maternal mental health problems on child treatment response in the community. Psychiatric Services.
47.
Sargent, C. F., & Johnson, T. M. (1996). Medical anthropology: Contemporary theory and method.Westport, CT: Praeger.
48.
Schulz, A., Williams, D., Israel, B., Becker, A., Parker, E., James, S. A., et al. (2000). Unfair treatment, neighborhood effects, and mental health in the Detroit metropolitan area. Journal of Health & Social Behavior,41, 314-332.
49.
Spitzer, R. L., Kroenke, K., & Williams, J. B. (1999). Validation and utility of a self-report version of PRIME-MD: The PHQ Primary Care Study. Journal of the American Medical Association,282, 1737-1744.
50.
Sturm, R., & Sherbourne, C. D. (2000). Managed care and unmet need for mental health and substance abuse care in 1998. Psychiatric Services,51, 177-177.
51.
Swartz, H., Shear, M. K., Wren, F. J., Greeno, C. G., Sales, E., Sullivan, B. K., et al. (2005). Depression and anxiety among mothers who bring their children to a pediatric mental health clinic. Psychiatric Services,56, 1077-1083.
52.
Verhulst, F. C., & van der Ende, J. (1997). Factors associated with child mental health service use in the community. Journal of the American Academy of Child and Adolescent Psychiatry,36, 901-909.
53.
Weissman, M. M., Feder, A., Pilowsky, D. J., Olfson, M., Fuentes, M., Blanco, C., et al. (2004). Depressed mothers coming to primary care: Maternal reports of problems with their children. Journal of Affective Disorders,78, 93-100.
54.
Weissman, M. M., Warner, V., Wickramaratne, P., Moreau, D., & Olfson, M. (1997). Offspring of depressed parents: 10 years later. Archives of General Psychiatry,54, 932-940.
55.
Young, B., Dixon-Woods, M., Findlay, M., & Heney, D. (2002). Parenting in a crisis: Conceptualizing mothers of children with cancer. Social Science & Medicine,55, 1835-1847.
