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 Parental depression can result in a withdrawn,detached parenting style that interferes with attachments and harms the child's physical, psychological, and social development.It can also disrupt the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關(guān)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."

    醫(yī)學(xué)會(huì)指出，父母抑郁影響孩子的認(rèn)識(shí)上存在很大的缺口，需要多代人間的探討和關(guān)注。

    抑郁，通常是，或應(yīng)該被當(dāng)初家務(wù)事來(lái)看待。但是，美國(guó)保健系統(tǒng)的非系統(tǒng)性作為一個(gè)主要的單元，證實(shí)并考驗(yàn)著成千上萬(wàn)的父母?jìng)儯�這些父母的抑郁也許影響著孩子的將來(lái)，根據(jù)一份來(lái)自國(guó)家研究委員會(huì)和醫(yī)學(xué)會(huì)的報(bào)告。

    "父母抑郁是普遍的，但是對(duì)待這群沮喪的大人們并且防止問(wèn)題出現(xiàn)在孩子身上、出現(xiàn)在他們的關(guān)心上，這樣的綜合對(duì)策并沒(méi)有。"由Mary Jane組織的一只特別工作隊(duì)的報(bào)告說(shuō)到，（Mary Jane England,醫(yī)學(xué)博士，麻省韋斯頓瑞吉斯學(xué)院院長(zhǎng)，兼APA美國(guó)藥學(xué)協(xié)會(huì)前任會(huì)長(zhǎng)）她上個(gè)月在華盛頓一個(gè)記者會(huì)上發(fā)言并宣布了研究結(jié)果。

    報(bào)告估計(jì)，在美國(guó)有1600萬(wàn)18歲以下的孩子由75萬(wàn)抑郁的父母帶著。

    抑郁通常被稱(chēng)為個(gè)體失調(diào)，但是當(dāng)那個(gè)個(gè)體是一對(duì)父母時(shí)，抑郁也就能影響到其他家庭成員。父母抑郁導(dǎo)致一種逃避的、孤立的家教模式，這種模式干擾了彼此的依戀，并危害孩子身體的、心理的發(fā)展及社會(huì)的發(fā)展。它也會(huì)打破年輕人獨(dú)有的一套參照標(biāo)準(zhǔn)的結(jié)構(gòu)和常規(guī)，且導(dǎo)致孩子身體素質(zhì)差。 England說(shuō)，抑郁通常伴隨著其他身體或心理方面的共發(fā)癥，最顯著的有焦慮癥或藥物濫用，往往使受困的家庭的結(jié)果更糟。

    "我們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。"委員會(huì)成員William Beardslee補(bǔ)充道。William Beardslee獲醫(yī)學(xué)博士，既是波士頓兒童醫(yī)院精神科的副主任，也是加德納/蒙克斯教授的兒童醫(yī)學(xué)院的副主任。現(xiàn)階段，處理抑郁的方式都局限關(guān)注于個(gè)別的癥狀和診斷，然而卻忽視了對(duì)家庭更廣的影響。比如，目前的螢光屏檢查，治療和研究方案，都不考慮患者是父母的可能性。

    問(wèn)題比原本應(yīng)該得到的關(guān)注更少，原因在于它處在從研究到服務(wù)消費(fèi)的專(zhuān)業(yè)性和策略域的界線。

    報(bào)道指出，"極少有顯著針對(duì)抑郁父母的系統(tǒng)檢測(cè)".研究和關(guān)注往往集中在母親們身上，卻鮮少有關(guān)注在父親們身上的資料。婦女除了在懷孕期和此后的生產(chǎn)中接受外的熒光屏檢查很少，歸結(jié)于關(guān)于付還醫(yī)師的截止點(diǎn)的不充分的指導(dǎo)方針或保險(xiǎn)限制。在保健的過(guò)程中，有很多道檻：螢光屏檢查、渠道、治療和付還款項(xiàng)。

    England說(shuō)，綜合性的、多代性并以家庭為中心的保健存在的補(bǔ)救措施，將不僅僅確認(rèn)和治療這些抑郁的父母?jìng)儯�還會(huì)幫助他們提高他們的家教技巧，并為他們的孩子提供幫助。

    對(duì)于剛起的頭，伴隨著對(duì)危機(jī)和保護(hù)性因素及最終實(shí)證所得出評(píng)估的創(chuàng)新服務(wù)的協(xié)作研究，美國(guó)衛(wèi)生署長(zhǎng)應(yīng)該鼓勵(lì)那些聯(lián)邦健康機(jī)構(gòu)提高他們對(duì)抑郁父母親的認(rèn)識(shí)及其對(duì)孩子成長(zhǎng)的影響。

    美國(guó)物質(zhì)濫用和心理衛(wèi)生服務(wù)部及健康資源服務(wù)部應(yīng)專(zhuān)門(mén)為心理衛(wèi)生和藥物濫用的行家，建立起協(xié)作訓(xùn)練計(jì)劃，以打破分離專(zhuān)業(yè)群體的桎梏。

    對(duì)于公開(kāi)的和私自的付款人的支付規(guī)則，應(yīng)該被改成允許在非門(mén)診場(chǎng)所保健（如家庭走訪者、社區(qū)中心）,并且消除目前公共醫(yī)療補(bǔ)助制中存在的一些阻止了當(dāng)天對(duì)衛(wèi)生健康和主要保健服務(wù)求助的限制。

    這個(gè)群體對(duì)公共醫(yī)療補(bǔ)助制的阻礙性使用有"低付還率、對(duì)母性抑郁欠利益人口保障額、兒科醫(yī)生評(píng)價(jià)父母?jìng)兪艿降淖璧K，并且一個(gè)受限范圍的供應(yīng)者……"

    達(dá)成如此深廣之變化的前景是令人望而生畏，即便對(duì)IOM（醫(yī)學(xué)研究所）委員會(huì)的成員來(lái)說(shuō)。Beardslee在后面的采訪中說(shuō)道， " 我們知道我們?cè)撟龅模�但我們卻不知道如何去執(zhí)行。我們需要一個(gè)寬廣的公共健康的途徑，然而，仍需有切實(shí)的支付，由于這些抑郁者們的醫(yī)療結(jié)果往往都更糟，因此最好有動(dòng)機(jī)地去識(shí)別并治療自己的家庭成員。"