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The Institute of Medicine notes there are large gaps in knowledgeabout the effects of parental depression on children and a need for multigenerational approaches to care.
Depression is too often a family affair and ought to be viewedthat way, but the unsystematic nature of the U.S. health caresystem serves as a major block to identifying and treating millionsof parents whose depression may affect their children's future,according to a report from the National Research Council andthe Institute of Medicine.
"[P]arental depression is prevalent, but a comprehensive strategyto treat the depressed adults and prevent problems in the children in their care is absent," said the report from a task forcechaired by Mary Jane England, M.D., president of Regis Collegein Weston, Mass., and a former president of APA. She spoke ata press conference in Washington, D.C., last month announcingthe study's results.
The report estimates that there are 7.5 million parents with depression in the United States caring for 16 million childrenunder age 18.
Depression is usually addressed as a disorder in individuals,but when that individual is a parent, it can affect other family members as well. Parental depression can result in a withdrawn,detached parenting style that interferes with attachments and harms the child's physical, psychological, and social development.It can also disrupt the structure and routine that provide a framework for young lives and is associated with poorer physical health in children. Depression is often accompanied by other physicalor psychological comorbidities, most prominently anxiety orsubstance abuse, often worsening outcomes for affected families,said England.
"We need to think about depressed parents as parents first andthen as depressed people," added panel member William Beardslee,M.D., academic chair in the Department of Psychiatry at Children'sHospital Boston and the Gardner/Monks Professor of Child Psychiatryat Harvard Medical School. Current approaches to depression focus too narrowly on symptoms and diagnoses in individuals while ignoring broader effects on families. Existing screening, treatment,and research protocols, for instance, do not take into accountthe possibility that the patient is a parent.
The problem has received less attention than it should because it falls along the boundaries of professional and policy domains,from research to payment for services.
"There is remarkably little systematic examination of depressionin parents," said the report. Research and attention usually focus on mothers, with little data available on fathers. Women关are screened during pregnancy and shortly following birth, but seldom beyond that point, due to inadequate guidelines or insurancelimitations involving cut-off points for reimbursing the physician.Numerous barriers to care stand in the way of screening, access,treatment, and reimbursement.
The remedy lies in comprehensive, multigenerational, family-centeredcare that will not only identify and treat parents with depression,but also help them improve their parenting skills, and providesupport for their children, England said.
For a start, the U.S. Surgeon General should encourage federalhealth agencies to increase their recognition of depressionin parents and its effects on children's development, alongwith collaborative research into risk and protective factorsand, ultimately, demonstration projects to evaluate innovative services.
The Substance Abuse and Mental Health Services Administration and the Health Resources and Services Administration should develop collaborative training programs for primary, mentalhealth, and substance abuse professionals to break down the silos that isolate professional groups.
Payment rules for both public and private payers should be changed to permit care in nonclinical settings （such as home visitsor community centers） and eliminate current restrictions in Medicaid that prohibit same-day visits for mental health and primary care services.
Impeding use of Medicaid for this group are "low reimbursement rates, lack of benefit coverage to assess for maternal depression,prohibitions against pediatricians assess[ing] parents, anda restricted range of eligible providers…"
The prospect of achieving such widespread change is daunting,even for members of the IOM committee. "We know what we shoulddo, but we don't know how to implement it," said Beardslee ina follow-up interview. "We need a broad public-health approach.However, there will be a real payoff because medical outcomesare worse in people with depression, so there ought to be anincentive to identify and treat family members."
医学会指出，父母抑郁影响孩子的认识上存在很大的缺口，需要多代人间的探讨和关注。
抑郁，通常是，或应该被当初家务事来看待。但是，美国保健系统的非系统性作为一个主要的单元，证实并考验着成千上万的父母们，这些父母的抑郁也许影响着孩子的将来，根据一份来自国家研究委员会和医学会的报告。
"父母抑郁是普遍的，但是对待这群沮丧的大人们并且防止问题出现在孩子身上、出现在他们的关心上，这样的综合对策并没有。"由Mary Jane组织的一只特别工作队的报告说到，（Mary Jane England,医学博士，麻省韦斯顿瑞吉斯学院院长，兼APA美国药学协会前任会长）她上个月在华盛顿一个记者会上发言并宣布了研究结果。
报告估计，在美国有1600万18岁以下的孩子由75万抑郁的父母带着。
抑郁通常被称为个体失调，但是当那个个体是一对父母时，抑郁也就能影响到其他家庭成员。父母抑郁导致一种逃避的、孤立的家教模式，这种模式干扰了彼此的依恋，并危害孩子身体的、心理的发展及社会的发展。它也会打破年轻人独有的一套参照标准的结构和常规，且导致孩子身体素质差。 England说，抑郁通常伴随着其他身体或心理方面的共发症，最显着的有焦虑症或药物滥用，往往使受困的家庭的结果更糟。
"我们首先需肯定抑郁父母的父母身份，其次才是抑郁人群的身份。"委员会成员William Beardslee补充道。William Beardslee获医学博士，既是波士顿儿童医院精神科的副主任，也是加德纳/蒙克斯教授的儿童医学院的副主任。现阶段，处理抑郁的方式都局限关注于个别的症状和诊断，然而却忽视了对家庭更广的影响。比如，目前的萤光屏检查，治疗和研究方案，都不考虑患者是父母的可能性。
问题比原本应该得到的关注更少，原因在于它处在从研究到服务消费的专业性和策略域的界线。
报道指出，"极少有显着针对抑郁父母的系统检测".研究和关注往往集中在母亲们身上，却鲜少有关注在父亲们身上的资料。妇女除了在怀孕期和此后的生产中接受外的荧光屏检查很少，归结于关于付还医师的截止点的不充分的指导方针或保险限制。在保健的过程中，有很多道槛：萤光屏检查、渠道、治疗和付还款项。
England说，综合性的、多代性并以家庭为中心的保健存在的补救措施，将不仅仅确认和治疗这些抑郁的父母们，还会帮助他们提高他们的家教技巧，并为他们的孩子提供帮助。
对于刚起的头，伴随着对危机和�；ば砸蛩丶白钪帐抵に贸銎拦赖拇葱路竦男餮芯�，美国卫生署长应该鼓励那些联邦健康机构提高他们对抑郁父母亲的认识及其对孩子成长的影响。
美国物质滥用和心理卫生服务部及健康资源服务部应专门为心理卫生和药物滥用的行家，建立起协作训练计划，以打破分离专业群体的桎梏。
对于公开的和私自的付款人的支付规则，应该被改成允许在非门诊场所保�。ㄈ缂彝プ叻谜摺⑸缜行模�,并且消除目前公共医疗补助制中存在的一些阻止了当天对卫生健康和主要保健服务求助的限制。
这个群体对公共医疗补助制的阻碍性使用有"低付还率、对母性抑郁欠利益人口保障额、儿科医生评价父母们受到的阻碍，并且一个受限范围的供应者……"
达成如此深广之变化的前景是令人望而生畏，即便对IOM（医学研究所）委员会的成员来说。Beardslee在后面的采访中说道， " 我们知道我们该做的，但我们却不知道如何去执行。我们需要一个宽广的公共健康的途径，然而，仍需有切实的支付，由于这些抑郁者们的医疗结果往往都更糟，因此最好有动机地去识别并治疗自己的家庭成员。"
