"Monster in the crib", Keay Davidson, 25 Sept 94, SF Examiner,
p. A-2.

A recent report states that 42% of mothers of children between
the ages on one and two show some signs of depression,
strengthening the belief that raising toddlers is very
difficult.

"Depressive symptoms and work role satisfaction in mothers of
toddlers", A. L. Olson, MD, and L. A. DiBrigida, MD, September
94, Pediatrics, Vol. 94, No. 3, pp. 363-367.

Background:  Maternal depression is found in about one-third of
mothers studied, with higher depression rates among mothers in
poverty or those caring for handicapped children.  However,
recent studies have shown that high depression rates occur in
women of all social strata.  Because of the adverse effects of
maternal depression, which include newborn irritability,
parenting difficulties, severe temper tantrums, and other
behavioral problems, it is important to learn which mothers are
highest at risk for depression.

Objective:  "To determine the incidence of depressive symptoms
in mothers of toddlers in community pediatric practice.  The
interaction of employment and work role satisfaction with
depressive symptoms was also investigated."

Kind of study:  Observational study

Subjects:  233 mothers of toddlers (aged 12 to 24 months) who
brought their children to health supervision visits at two
community pediatric practices in New Hampshire.

Setting:  Depression screening measures were completed in two
community pediatric practices in New Hampshire.

Outcome measurements:  Depression screening measures,
consisting of a depressive symptom screening inventory for use
in primary care populations, were conducted using the Lickert
scale of satisfaction.  (Inventory modified from the Hopkins
Symptom Checklist by Barrett, Oxman, and Gerber)

Control variables:  Parents' socioeconomic variables, hours
worked, and whether the mother was satisfied with her current
role of either being employed or unemployed

Blindness:  None

Population:  Mothers who brought their one-year old children to
one of two community practices in New Hampshire for a health
supervision visit.

Statistical methods used:  Sociodemographic characteristics of
the population were examined by t-test, one-way ANOVA, or chi-
sq.  Proportions of the population with depression were
compared across categories by chi sq.  The distribution scores
were examined for skewness.  The interaction of significant
independent variables on the total depression score was
determined by univariate analysis, two-way ANOVA after log
transformation, or nonparametric analysis of two groups.  One
figure, three tables.

Stated conclusions:  Symptoms of depression were present in 42%
of mothers, and the rate of depressive symptoms varied
significantly with work role satisfaction.  Mothers
dissatisfied with their employment role were 3.7 times more
likely to be depressed.  Controlling for employment
satisfaction, mothers working part-time were half as likely to
be depressed as both mothers working full time and mothers not
employed.

Nonresponse:  The questionnaire was completed by 233 mothers,
90% of which were recruited by telephone contact.  The week
before the visit, 332 calls were placed, with 238 agreeing to
participate.  68 of the 332 could not be reached by multiple
phone calls.  209 of those who agreed to fill out the
questionnaire actually did so (the other 29 had some sort of
scheduling problem and had to back out), and 24 other mothers
were recruited at the time of a visit to the pediatric
practice.

Difficulties of generalizing to the real world:  The mothers
included in this study are predominantly white, married and
middle class, so this study may not be applicable to the
population of mothers in the US who do not fit the above three
categories.

Other problems:  Social support, specific stresses, and marital
tension were not investigated in this study, but may contribute
to maternal depression.  Also, this authors did not include any
control groups in the study (such as women of the same age with
no children); instead, they used historical controls.  Also,
measuring the socioeconomic values for the father and mother
separately resulted in large differences in values between the
two, as many more women were classified "lower-class" than were
men.  Since families share the money earned in the household,
it would have been more accurate to use a single family measure
of socioeconomic values instead of measuring for the father and
mother separately.

How does this relate to the rest of the scientific literature:
Past studies have only examined broad age ranges in children,
so minimal information existed on when mothers are most at risk
for depression.  Also, earlier studies which look at depression
rates have not been updated to account for the large increase
in numbers of mothers in the workforce.