Maternal Depression: A Global Threat to Children’s Health, Development, and Behavior and to Human Rights

Depressive disorders are a common source of disability among women. In addition to the economic and human costs of maternal depression, children of depressed mothers are at risk for health, developmental, and behav­ ioral problems. Although most of the research examining the evidence and intergenerational aspects of maternal depres­ sion has been conducted in high-income countries, recent evidence suggests that rates of maternal depression may be higher in lowand middle-income countries, where nearly 90% of the world’s children live. This review examines the evidence from lowand middle-income countries that links maternal depression with children’s health, development, and behavior. We present recommendations for future policies and intervention programs related to maternal depression and examine how maternal depression affects the rights of millions of children living in these countries. KEYWORDS—maternal depression; child; low-income coun­ tries; development Depressive disorders are common (Lepine, 2001), chronic (Pincus & Pettit, 2001), and a principal source of disability throughout the world, especially among women (Moussavi et al., 2007). Research from high-income countries has documented that the economic and human costs of maternal depression are particularly insidious because they extend to the next generation, affecting children’s health, development, and behavior. The symptoms that characterize maternal depression, including sadness, negative affect, loss of interest in daily activities, fatigue, difficulty thinking clearly, and bouts of withdrawal and intru­ siveness may interfere with consistent, attentive, and responsive caregiving, thereby disrupting effective parenting (Paulson, Dauber, & Leiferman, 2006). Infants are particularly vulnerable because they depend on their mothers for the primary interactions that form the basis of healthy attachment and timely acquisition of developmental skills (Coyl, Roggman, & Newland, 2002). We focus on the nature and consequences of maternal depression in lowand middle-income countries, where the majority of the world’s children live. We examine whether the same intergenerational association between maternal depres­ sion and children’s health, development, and behavior described in high-income countries exists in lowand middleincome countries. We also make recommendations for policies and intervention programs and examine how international children’s rights policies are related to maternal depression. Given recent reviews on maternal depression in high-income countries (Flynn, 2005; Nylen, Moran, Franklin, & O’Hara, 2006; Sohr-Preston & Scaramella, 2006), our review of evidence from high-income countries is illustrative rather than systematic. MATERNAL DEPRESSION IN HIGH-INCOME