Fortunately, some children escape the negative effects of maternal depression. In a review of several decades of research, Shonkoff and Phillips (2000) emphasize that many depressed women do raise children who demonstrate no social or behavioral difficulties. Some studies suggest ways to prevent or protect damaging processes from occurring in young children's lives. Early Head Start and Head Start programs are in a position to benefit from this research and intervene to support young children and their parents who might be experiencing depression. Their intervention efforts can be guided by research findings related to the complexity of maternal depression, the effects of maternal depression on young children, and the importance of prevention and early intervention.

The Complexity of Maternal Depression
Depressed mothers typically have difficulty providing optimal levels of stimulation for their babies. Mothers who suffer from untreated depression engage in two distinctive interaction styles with their infants (Field 2000). One style is characterized by the caregiver's withdrawal from the infant's cries or smiles, minimal display of facial expression, and difficulty expressing emotion or even talking to the infant. The other style is characterized by the caregiver's irritability, expressions of anger, and demands for a reaction from the child. It is unclear as to why mothers with depression display these differing interaction profiles; one, withdrawn, the other, intrusive. But, it is clear that each style is painful for the adult. One mother described the feeling of "moving through water" to reach her crying infant.

Effects on Young Children
Research suggests that each mother/child interaction style has different effects on the infant or young child (Field 2000). Infants of withdrawn mothers display low activity levels, inattentiveness to people, activities, and objects, and low expressiveness in response to the facial expressions of adults. In contrast, infants of intrusive mothers display higher activity levels, a mix of positive and negative facial expressions, and high attentiveness and expressiveness in response to the facial expressions of adults. Preschoolage children of withdrawn mothers appear less socially responsive, less able to regulate their own behavior and impulses, and more inhibited. They also show internalizing behaviors, such as liking to be alone. In contrast, preschoolers of intrusive mothers are more responsive, more able to regulate their behaviors, and less inhibited. Furthermore, they are likely to show externalizing behaviors, such as getting in fights and teasing others.

The Importance of Prevention and Early Intervention
Even though maternal depression may have negative developmental outcomes for children from a wide range of life circumstances and family environments, certain factors serve to minimize, or buffer, the effects of maternal depression on young children. For instance, research by Hossain and colleagues (1995) shows that involved, supportive, and emotionally healthy fathers and child care providers cushion children from negative effects of maternal depression.

In addition, when maternal depression occurs in a family experiencing marital harmony, mothers are better able to sustain positive and healthy interactions with their children. In turn, the children are more likely to display sound social-emotional behaviors. Recent studies also suggest that depressed mothers who use excessive verbal stimulation with their infants may actually facilitate better cognitive and language development. Understimulation may be worse than overstimulation during infancy. Furthermore, since the effects of maternal depression begin as early as pregnancy and appear to be long lasting, findings emphasize the importance of early intervention.

Implications for Programs
One of the primary goals of Early Head Start is to enhance infants' and toddlers' overall social, emotional, physical, cognitive, and linguistic development. Therefore, it is vital that Early Head Start as well as other Head Start programs promote the physical and mental health of mothers. Programs are in a unique position to support the mental health of pregnant women and mothers, but must be sensitive to the barriers depressed parents experience in receiving services.

Depression makes it difficult to mobilize and focus energy. Many parents experience shame and fear that professionals might see them as incapable of parenting. However, given that parents love their children, the birth of a child can provide the impetus to seek services to provide a better life for the new son or daughter. In addition to benefiting from the direct support and therapy offered them, depressed parents are reassured knowing that their infants and toddlers are receiving nurturance and support within center-based or family child care programs.

By looking for brief moments of positive interaction and reflecting on them with a parent, program staff help build the parent's confidence. Low self-esteem often accompanies depression and the home visitor and center-based teacher can provide positive images and reinforcement. For example, a home visitor could support a depressed mother with a more demanding interaction style by noting when the mother takes turns vocalizing with her baby and admiring the interactions when they occur. Or, a teacher working with a depressed mother with more withdrawn interactions could highlight when the parent smiles or talks in a lively way with the child.

Providing staff with access to mental health consultation can support timely and effective referral to mental health services. Regular, consistent mental health consultation services are key for supporting staff and families and can help distinguish the parent's or staff member's normal emotional ups and downs of life from clinical depression. A skilled mental health consultant can help staff find ways to connect with a depressed parent as well as support them through the parent's potential resistance to getting help. Furthermore, the mental health consultant acknowledges that staff and parents approach the issue of depression, or mental health, from their own beliefs, values, and family history with mental health services.

* The research discussed within this article is specific to mothers with depression. However, the mental health of the primary and other significant caregivers is important for the well-being of infants and young children. 

References
Field, T. M. 2000. Infants of depressed mothers. In Stress, coping, and depression, eds. S. L. Johnson, A. M. Hayes, T. M. Field, N. Schneiderman, & P. M. McGabe. Mahwah, NJ: Lawrence Erlbaum Associates.

Hossain, Z., T. Field, J. Pickens, & J. Gonzalez. 1995. Infants of "depressed" mothers interact better with their nondepressed fathers. Infant Mental Health Journal 15: 348-357.

Shonkoff, J. P. & D.A. Phillips, eds. 2000. From neurons to neighborhoods. Washington, DC: National Academy Press.

ADDRESSING MATERIAL DEPRESSION

Questions that programs could ask themselves

• What is the understanding of program staff around issues related to maternal depression?
• What is the understanding of program staff about the mental health of primary and other significant caregivers for the well-being of infants and young children?
• How does the Family Partnership Agreement include issues related to mental health?
• Do the mental health consultants train program staff to recognize symptoms of depression in mothers or other primary caregivers of young children?
• Do mental health consultants suggest strategies to program staff that correspond with the mother/child interaction profile?

Tisha Bennett is a Senior Early Childhood Associate at Early Head Start National Resource Center @ ZERO TO THREE. T: 214-767-8868; E: tbe@acf.hhs.gov.