How to cite this article: Duarte-Raya F, Rico-Maldonado MA, González-Guzmán EG, Rossette López BC. Depression and risk factors associated in women with children in sessions with a child psychiatrist. Rev Med Inst Mex Seguro Soc. 2016;54(1):58-63.
Received: November 4th 2014
Accepted: April 7th 2015
Fidencia Duarte-Raya,a Marco Alejandro Rico-Maldonado,b Eloína Guadalupe González-Guzmán,c Betania C. Rossette Lópezd
aServicio de Epidemiología Hospitalaria
bServicio de Pediatría Médica
cServicio de Paidosiquiatría
dServicio de Psiquiatría, Hospital de Alta Especialidad 1, Instituto Mexicano del Seguro Social, León
a,b,cHospital de Gineco-Pediatría 48, Instituto Mexicano del Seguro Social, Guanajuato
Communication with: Fidencia Duarte-Raya
Thelephone: (477) 7174 800, extensión 31855
Background: Maternal depression entails cognitive, behavioral, affective and relational disorders with a great impact on the life quality of individuals, society and family. Our objective was to determine the prevalence and factors associated in women with children in paedopsychiatry treatment in a children’s hospital.
Methods: Descriptive, prospective and prevalence study with a sample of 194 women. We used Beck scale. We calculated the prevalence rate. We analyzed the association of risk factors with the maternal depression by using chi square and a relative risk with a 95 % confidence interval (p = 0.5).
Results: There was a maternal prevalence depression of 66 %: 45 % had a mild depression (58), 35 % moderate (45) and 20 % severe (25). According to the chi square analysis, married female variable was statistically significant (8.7408, p = 0.0031, Odds Ratio [OR] 2.48). Having five children had an OR of 2.09, and the diagnosis of delay in the development an OR of 1.75.
Conclusion: There was a higher prevalence than expected with a percentage difference of 6 points. Mild depression was more common; women from 31 to 40 years of age, married, and with five children were the most affected groups.
Keywords: Depression; Maternal behavior; Beck’s scale; Child psychiatry.
Depression is a disorder that affects millions of people worldwide. According to the World Health Organization (WHO), an estimated 120 to 200 million suffer from it, which corresponds to 3% of the world population, including varying degrees of disability; of these, less than 5% of patients receive effective treatment. Maternal depression is a serious public health problem because of its negative impact on both mothers and their children, which results in cognitive, behavioral, affective and attachment disorders.1
The risk of presenting a major depressive disorder over the course of a lifetime has varied between 10 and 25% for women and between 5 and 12% for men in general population samples. The prevalence percentage of major depressive disorder has varied between 5 and 9% for women and between 2 and 3% for men in general adult population samples.1 There is consequently interest in identifying women who are mothers who suffer from depressive symptoms or are at risk of developing a depressive syndrome, to simultaneously detect possible psychopathological effects on their children, which is valuable for health personnel to perform timely intervention to guide the mother and thus help the child not develop a depressive syndrome or have better psychological development,2 as early experiences within the family are crucial for human development and, when unfavorable, they may predispose the beginning of an emotional or behavioral disorder. Major depression has twice as high a frequency in adult women as in adult men.2
Overall rates of depression are higher among single and divorced people than among married people. Factors associated with major depression are more common in minority groups with higher disease burdens, lack of health care resources, and low socioeconomic status; however, depression may occur at any socioeconomic level. The nature of this association is unknown; more recent studies even show that an unfavorable socioeconomic position in childhood is associated with an increased risk of depression in adult life.3 It has also been proposed that factors such as crime, unemployment, drug abuse, family breakdown, overcrowding, adultery, and stressful life events can be triggering.4
Longitudinal studies in the world have also revealed systematic links between episodes of loss, especially parental separation or death, and an increased risk of depression during adult life.5 Traumatic life events (e.g., neglect) can cause a closer relationship with anxiety disorders.6,7 Studies have also consistently shown that having a history of any mental disorder at any time of life considerably increases the risk of onset of major depression and the probability of persistence, severity, and recurrence of the disorder.8
Stressful life events are among the best documented risk factors for major depression in adults in the general population; they have been consistently linked as triggers of depression.9 There are lines of research that point to an interaction between life events and genetic/family vulnerability to depression, coping styles, and personality traits.10 More recently, studies of early environmental factors have further identified the role of prenatal exposure to maternal anxiety with emotional disorders of children, even identifying it as subclinical.11-13
The Encuesta Nacional de Epidemiología Psiquiátrica (ENEP) used as target population the non-institutionalized population aged 18-65 living in urban areas. The weighted response rate at the household level was 91.3% and at the individual level, 76.6%. It showed that women have higher overall prevalence for any disorder (14.8 and 12.9%).14
According to the 2010 Census, two million children under one year of age reside in Mexico, 10.7 million aged 1 to 5, and finally 19.8 million aged 6 to 14.15
The aim of this study was to determine the frequency of depression in mothers of patients attending the Servicio de Paidopsiquiatría, and risk factors associated with this condition in the Hospital de Ginecología y Pediatría 48 of the Instituto Mexicano del Seguro Social, in Guanajuato, Guanajuato, México.
This is a transversal and descriptive prevalence study in the outpatient child psychiatry service of the hospital mentioned. The sample consisted of 203 women to whom the Beck scale for the diagnosis of depression was applied, classified as mild, moderate, and severe. A questionnaire was applied that included the following variables: mother's age, marital status (single, divorced, married, cohabiting, separated, widowed), schooling (elementary, middle, high school, undergraduate, graduate, illiterate), number of children, occupation (homemaker, laborer, employee, professional), family type (nuclear, single parent, extended, mixed) and the diagnosis of the child who attended the child psychiatry service (mental retardation, learning disorder, generalized developmental disorder, attention deficit hyperactivity disorder, and other behavioral disorders, such as substance use disorders, anxiety disorder, schizophrenia, and developmental delay). Mothers who attended the outpatient child psychiatry service for the first time and subsequent times were considered. Nine patients were excluded for the following reasons: they had incomplete answers in the questionnaires, the mother had experienced a loss in the last two months (death, loss of status or work), or having previous diagnosis of depression or postpartum depression. The final sample was of 194 women who met inclusion criteria: being the biological mother, over 18 years old, literate, and consenting to participate in the study by signing the informed consent.
The information was captured in an Excel database and codified to facilitate statistical analysis. EPIDAT 2004, version 3.1 OPS, was applied to obtain chi-squared, with Yates correction for the p-value. Chi-squared was applied with a 95% confidence interval and an alpha of 0.05 with one degree of freedom; therefore, a tabulated chi-squared of 3.842 was expected. Odds ratio (OR) was applied to establish an association of risk factors with the presence of depression in the study group. The prevalence rate was deduced: the number of mothers with depression per one hundred of the total number of mothers participating in the study; the results are presented in tables and graphs.
The sample was divided by age group. The mothers were most often in the 31 to 40 age group, which included 100 patients (51.5%); we found 61 patients in the 21 to 30 age group, with 32%. The average age was 33.5 years with a standard deviation (SD) of 7.0, a minimum age of 18 and a maximum age of 55.
As for schooling, it was observed that the percentage with the highest frequency was high school with 29.5% and secondary with 26%.
Regarding marital status, the highest percentage was of married women with 54.3% and women cohabiting with 22.1%.
Regarding the number of children, 35.5% had one child and 35% had two.
Maternal occupation presented the following distribution: 63 mothers were homemakers (32%), 29 were laborers (15%), 81 were employees (these had the highest percentage: 42%), and 21 were professionals with 11%.
The distribution by family type was as follows: 46.4% nuclear (90), 23.2% single parent (45), 26.3% extended (51), and 4.1% mixed (8).
As for the complaint of the children, the main reason found was attention deficit disorder with 26.8% (52), followed by anxiety disorder with 20.2% (39), generalized developmental delay with 17% (33), learning disorder with 10.8% (21), schizophrenia with 8.2% (16), mental retardation with 6.7% (13), non-generalized developmental delay with 6.1% (12), and substance use disorder with 4.2% (8) (Figure 1).
Figure 1 Diagnosis of children in child psychiatry treatment associated with maternal depression. ADHD = attention deficit hyperactivity disorder. Source: data collection sheet with Beck scale applied in the study.
A prevalence of maternal depression of 66% was obtained in the mothers of children attending the child psychiatry service. These were classified as mild depression in 45% (58), moderate depression in 35% (45), and severe depression in 20% (25).
Statistical analysis was performed with EPIDAT 2004, OPS version 3.1, and the marital status variable of married obtained a chi-squared of 8.7408, with p 0.0031 and OR 2.480377, which was considered statistically significant. In addition, an increasing trend in depression risk was observed if the mother belonged to the 31 to 40 age group (OR 1.320394) or had five children (OR 2.096774) (Figure 2), or their children presented diagnoses of generalized developmental delay (OR 1.759709) and schizophrenia (OR 1.147009) (Table I).
Figure 2 Relationship of number of children with the presence of maternal depression. Source: data collection sheet with Beck scale applied in the study.
|Table I Chi-squared with 95% confidence interval of socio-demographic data of mothers with depression included in the study (n = 194)|
|21 to 30 years||1.1234||0.2892||0.8041||0.3699||0.711538|
|40 31 years||0.8389||0.3597||0.5842||0.4447||1.320394|
|41 to 50 years||0.0058||0.9395||0.0238||0.8774||0.035714|
|50 years and more||0.0013||0.9712||0.1613||0.36880||1.032258|
|Number of children|
|Reason for seeking care|
|Learning disorder||0. 0050||0.9439||0.0301||0.8623||1.035088|
|Generalized developmental delay||1.6938||1.1931||1.2095||0.2714||1.759709|
|Substance use disorder||0.9492||0.3299||0.3519||0.5530||0.500000|
|Non-generalized developmental delay||0.3331||0.5638||0.5638||0.0690||0.705785|
|* With Yates correction
OR = odds ratio; ADHD = attention deficit hyperactivity disorder; NA = not applicable
A study conducted at Harvard University in Boston, Massachusetts, mentioned several factors that can predispose a mother to developing depression: a disintegrated family, being single or separated, or working outside the home;16 however, our study identified that being married and being a housewife are the factors that most affected mothers to develop depression.
Although the literature mentions that the mothers or women most affected by the pathology of depression are young women, with an average age of 21 (this according to studies conducted in the United States),19 our study noted that the population of women in middle age was the most affected, with the average age of 33.5 years.
A Canadian study by the Centre for Addiction and Mental Health and the Department of Psychiatry at the University of Toronto, shows that, compared with those who are married, single mothers are more likely to have an episode of depression as well as increased stress and a greater number of problems in their children’s health;24 conversely, our results show that in the Mexican population being married is a risk with a ratio 2.4 to 1 for the status of developing depression.
As for the variable of number of children of mothers with depression, no data is found in the literature; our study shows that the risk of depression in relation to the number of children is having five children (OR 2.1), if this figure is compared with other numbers of children.
As for employment status, mothers who are currently working within a company or other labor activity are those with increased risk of depression, as reported by two studies in the United States,23,26 which observe that a working mother has a 50% higher risk of depression compared to a mother who is not working. Our study found that mothers who had a profession and those who work in the home are those with an increased tendency to develop depression.
Regarding educational level, it would be expected that a lower level of schooling would find a greater presence of depression and vice versa, as noted by the study in our own country by the Universidad de Guadalajara.27 Our study shows that the largest percentage of mothers who are depressed have basic primary education or a higher degree of studies, such as a college degree.
Although there is no information found in the literature about the relationship of the type of family that a mother has, our study shows that the nuclear family type is the area with the most psychiatric disorders corresponding to depression, followed by the single-parent family.
Similarly, no studies have been conducted internationally comparing different psychiatric diagnoses and their relationship to the development of depression in mothers of children presenting them. Our work identified that the main psychiatric disorder with a growing relationship with the presence of depression is generalized developmental delay.
According to the hypothesis in this study, a prevalence of 60% was expected and higher prevalence was obtained with a difference of 6 percentage points. The depression most frequently encountered was mild depression, the most affected age group was 31 to 40 years old, in the married group, and with a number of five children.
In our country and in our institution there is no information about the mental state of mothers who have a child treated in the child psychiatry service. Such studies are necessary to detect and prevent in a timely manner any disorder in relation to maternal depression as a result of being a caregiver of chronic patients in order to improve the quality of care.
Conflict of interest statement: The authors have completed and submitted the form translated into Spanish for the declaration of potential conflicts of interest of the International Committee of Medical Journal Editors, and none were reported in relation to this article.