39. Parents of Preschoolers: Why Parent Mental Health Matters!

Did you know that PARENTS of preschoolers are at HIGH risk for depression? 
*In the first 4 years of a child's life, 1 in 10 dads and 1 in 4 moms experience depression.*
And depression in parents increased the risk of behavioral and emotional problems in children.  In this episode, we talk about why and how to support parents of preschoolers... so that we can help preschoolers with their own social and emotional development.

Check out our website PsychEd4Peds.com for more resources.
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Transcript

Dr. Elise Fallucco: 0:21

Welcome back to PsychEd4Peds the child mental health podcast for pediatric clinicians. And for all of us taking care of kids. We're helping you help kids. I'm your host Dr. Elise Fallucco, child psychiatrist and mom. So last episode, we talked about preschoolers and about identifying significant behavioral and emotional problems in preschool aged kids. Specifically, we talked about how to use a free parent form called the brief ECSA or the brief early childhood screening assessment. And this parent report forms, screens for behavioral and emotional problems in preschoolers kids five years and younger, and also looks at symptoms of caregivers, stress and caregiver, depression. Today. I wanted to talk about why it is so important to routinely check in with parents of preschool aged kids to assess their stress level and their wellbeing. And what I want to say is. Most pediatric practices have gotten so good and consistent about routinely screening moms at postpartum visits at 1, 2, 4 and six month visits for signs of postpartum depression and or postpartum anxiety. This is something that most pediatric clinicians are already very good at. But what I'd like you to consider is that it's important to look at parental well-being and parental stress levels later in the child's life specifically during preschool. but don't just take my word for it. I'm going to review a little bit of the data and important research that talks about the close association between behavioral and emotional problems in kids and symptoms of depression in caregivers. And spoiler alert. I'm going to share interesting findings from a study that some colleagues and I did about this specific area. So. Why should pediatric clinicians care about parental stress and depression? And I've heard a lot of people argue strongly and rightly that the parent is not your patient. And that is 100% true. The parent is not our patient. However, obviously the parent is a strong part of the child's development and wellbeing in parents is strongly associated with social and emotional development in kids. And this is particularly important during child's. Sensitive period of emotional and social development, which is five years and younger. So, what we know is there is a super strong relationship between behavioral and emotional problems in kids and depressive symptoms in parents. So let's think about that. So that means that the kids that have significant behavioral and emotional problems are much more likely to have parents with depressive symptoms. And vice versa that the parents who have symptoms of depression and symptoms of stress are much more likely to have kids with behavioral, emotional problems. In some ways, this makes a lot of sense, but I just want to talk to you about kind of how I think through that. We know that the parental depression negatively impacts child wellbeing because the parent, when you're depressed, you were much less responsive to your child's needs. And your child is looking to you to help them when they fall down, when they cry, when they're upset to be their security blanket, to be their buffer there. It's somebody to help them regulate their own emotions. And when as a parent, that's difficult for you to do because of depression, that's going to affect the child's emotional regulation in a negative way. That's going to make children. At higher risk of being irritable of having a low mood of having anxiety. We are disrupting the critical attachment system between the parent and the child. During their critical time of development. So in short depression and parents increases the risk of behavioral, emotional problems in kids. And of course, this is not just a one-way street as any of us who have parented young children. No, in our core. The parenting young children is very stressful. And particular if you're parenting a child with behavioral and emotional problems that adds extra stress on top of that, that can exacerbate or potentially precipitate depression in the parents. I wanted to share two really fascinating statistics about the prevalence of depression symptoms in parents of very young kids, like preschool aged kids. So. One out of 10 dads of preschool aged kids. Has experienced a depressive episode in the first four years of their child's life. That is really high, especially because we know that men typically are at lower risk of depression than women. So one out of 10 dads experiences, a depressive episode in the first four years of their child's life. Now we talk about moms who already have an increased risk of depression. And we know in the first four years of their child's life, one out of four moms has experienced of depressive episode. Oh, my goodness. So the bottom line is that parents of very young kids. Particularly those ages four and under are at high risk of developing depression. And when a parent or caregiver has depression. This increases the risk of the child having behavioral and emotional problems and negatively impacts the child's own social and emotional development during the preschool period. And so this is why it is so important to have a systematic tool like the brief ECSA to be able to assess for not only. Child behavioral and emotional problems, but also symptoms of caregiver, depression.. So when we hear data like this, it's really interesting. And I often hear from my pediatric colleagues. That they want to know what does this relationship between caregiver, depression, and preschool behavioral problems look like in a pediatric primary care setting. And so to answer that, I'm going to tell you about a study that our team published in the journal of child and family studies, and for this study, we went into a number of pediatric primary care practices to look at the relationship between preschool, behavioral problems and caregiver symptoms of depression. We examined a total of over 2,600 caregiver, child dyads. And we had them complete the ECSA so that we could assess for behavioral and emotional problems in kids. As well as symptoms of depression in parents. And here's what we found. 12 percent of kids ages three to five years old, had positive, excess, so a positive screen concerning for emotional and behavioral problems that could benefit from further assessment. That sounds normal about, because we know about one in 10 preschool aged kids have significant behavioral and emotional problems. Also, we found boys were more likely to have positive screens than girls. Again, also expected in this age group. But the things that surprised us. We're what we found out about caregiver depressive symptoms. In our sample. What we found out is that dads were just as likely to have symptoms of depression as moms. And this is unusual because women typically experienced depression. At a rate that is much higher. Than men. Other things that we found or that those caregivers who identified as African-American Asian or Pacific Islander or multiple races were much more likely to endorse depressive symptoms than those who identified as white. As expected what we found is that children with significant behavioral and emotional problems were much more likely to also have a caregiver with depression. About 14% of the parents whose kids had positive screens for behavioral and emotional problems had depressive symptoms. In other words, more than one in 10 of the parents who had children with behavioral problems. Endorsed depression in the parents themselves. And it didn't matter if the parent was a dad or a mom, they were equally as likely to experience symptoms of depression. So again, emphasizing parenting kids in early childhood is hard and stressful and symptoms of stress and depression are potentially higher than we would expect. And are strongly associated with childhood behavioral and emotional problems. And we really got into the weeds to try to figure out if there were particular symptoms that were more likely to predict caregiver, depression. What we found is that. Three of the child's symptoms that were most strongly. Predictive of caregiver depressive symptoms were. Having a child with any sort of developmental delay. Which we would expect because we know there's higher rates of. Caregiver stress. And caregiver mental health problems among those caregivers who are taking care of little kids. With developmental delays. The other two. Child symptoms that predicted depressive symptoms and parents were my child doesn't seem to have much fun. And my child is irritable and easily annoyed. So both of those symptoms. Especially taken together. Are typically not found frequently in. Healthy developing young kids. I mean, if you think about preschoolers, they are the epitome of fun. And certainly not when they're having their temper tantrums. But. They love to explore. They're excited about new things. Sometimes they even think looking for bugs is fun. So having a child whose parent says that they don't seem to have much fun. That is a definite red flag and can be specific for a hallmark symptom of preschool depression. The other symptom of my child is irritable and easily annoyed. Again, You wouldn't expect to see frequent irritability in a preschool age child, apart from the temper tantrums., and times where they're completely. Exhausted and or hungry or hangry. Typically developing children would not be described as frequently irritable. So as clinicians, what I would say is if you have a child who you're concerned about significant irritability. Or even potentially anhedonia the child doesn't seem to enjoy things. Doesn't seem to have fun. Those two particular child's symptoms on the ECSA are concerning for a major mood disorder, something more serious, and should be taken really seriously. If you're interested in learning more about this study, certainly message me on our website at site, the number four paeds.com or check us out online journal of child and family studies. But what I would say is a take-home message from all of this is that depressive symptoms and stress among parents of preschoolers are very common and using an instrument like the brief exa or the exa that assesses for child behavior problems. And. Caregiver stress and depression can open the door to having a discussion with families who may be struggling. So it may be easier for the parents to fill out a checklist, asking them about their stress and symptoms of depression. Then perhaps being asked coldly at their child's well visit. And if they endorse having symptoms of stress and depression, it's easier to know that before you even go in the room to be able to see it on the completed exa. And use that to open a discussion with them, to check in and see how they're doing. Say, Hey, I noticed you. You mentioned that you're sometimes getting more irritable than you want to with your child. And validate that this is a really hard time and check in to see how they really are doing and to see if they need more support. And we know, of course the parent is not our patient. It's not our job to fix them or to help them get better. But what can be incredibly helpful as pediatric clinicians is just having a conversation with the parent and validating how hard it is to be taking care of young kids. And if you feel like it's reasonable to share the data and the stats that we know about parents of young kids. Being at really high risk of experiencing depression and stress. That could normalize that this is part of why we're checking in with you, because we know it is really hard. And then the next step is just. Encouraging them to reach out to their support system, their family, their friends, their OB GYN, their primary care doctor, to make sure that they're getting the support that they need to be able to take care of their little ones. And to be able to help their own child social and emotional wellbeing. I hope you find this useful or something to try out as part of your practice, I'd strongly encourage you to download the brief ECSA available for free on our websites. Like the number four Peet's. It's on the resource page and you just click the blue button there that says get a copy of the brief ECSA. And I think opening the door to these conversations about child emotional behavioral problems and parent wellbeing is so important. And could be a really big step in trying to encourage kids and parents to get the help that they need for their own. Emotional wellbeing. Alright, thanks again for joining us at site for paeds. If you liked this episode, please give us a five-star rating and review. Or share this episode with a friend, continue to follow us. On apple podcast, Spotify or on social media@sitethenumberfourpeatsandcheckoutourwebsiteatsitethenumberfourpaeds.com. All right, take care. See you next week.