The criteria for major depressive disorder as outlined in the DSM-IV include significant impairment in social functioning, interpersonal relationships, and work. Significant impairment in multiple domains is also associated with high but subthreshold levels of depressive symptoms. Overall, both depressive disorder and depressive symptoms in parents are accompanied by comorbid disorders, problems in families and communities, and disruptions in work, marital relationships, and parenting.

Developmental Approach

We take an explicitly developmental approach in our perspective on parental depression. The effects of depression may be dramatically different when a parent experiences an episode of depression when pregnant or while a child is in infancy, middle childhood, or adolescence. The different effects of parental depression may be due in part to the different developmental tasks that are central as children move through childhood and adolescence. Moreover, the characteristics of effective parenting change as children develop, and depression may affect different aspects of parenting. For example, the formation of fundamental attachment relationships may be impaired when a parent of an infant experiences an episode of depression. In contrast, depression may interfere with the provision of structure and monitoring when a parent of an adolescent is affected. The effects of depression may be greater when a parent experiences multiple episodes that occur throughout a child’s lifetime and disrupts parenting at multiple points in development.

Summary of Our Approach Searching the Literature

The committee reviewed multiple types of research or lines of investigation on depression in parents. First, we examined the literature on the effects of depression in parents on children. In this literature, we looked both at effects on physical health and health-related outcomes, such as use of health services, and also on children’s psychological outcomes. The latter included not only evidence of emotional or behavioral problems in association with depression in parents, but also problems in psychological functioning that might be early signs of psychopathology or vulnerabilities to the later development of psychopathology. Such vulnerabilities include behavior, psychophysiology, and neuroendocrine functioning. We took into account the full developmental spectrum of infancy through adolescence and also considered fetal development.

Given the understanding that not all children of depressed parents would be expected to develop problems, we made special note of studies that examined moderators—that is, factors that may affect the strength of

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