Literacy & Depression Across Generations
Sandra Smith, MPH CHES
Recently in this space, we reviewed the scientific evidence that babies can be depressed, especially when their mothers are depressed. Here we consider referring mothers to literacy enhancing services as a path to mental health, strong parenting and school readiness.
 Feeling worthless, lacking confidence, thinking someone or something else controls your life, and feeling guilt or shame for being worthless and out of control – these are defining symptoms of depression; they also are characteristic of low literacy (Weiss, et al., 2006). This article explores links between literacy and depression across generations and reviews the evidence behind a promising practice to simultaneously improve literacy, reduce depression and increase self-efficacy (confidence) in mothers, empowering them to promote development and school readiness in their children.
The Beginnings Guides Implementation Training includes learning to use a one-minute method to identify mothers at high risk for low literacy and refer them to literacy enhancing services. This brief intervention is based on evidence from a 1998 randomized trial with of parents of children in Head Start. Recent studies add to the evidence and point to the importance of interventions that jointly address maternal depression and literacy.
Maternal Literacy & Depression
 In the Head Start study (Poresky & Daniels, 1998), a control group obtained routine Head Start services. For comparison, an intervention group received special services to increase employability, with the focus on increasing literacy skills. At the start of the study, nearly half (48%) of parents tested positive for depression. Two years later, the percentage of parents with depression was unchanged in the control group; but in the group that received literacy training, only 23% remained depressed. These analyses suggested that literacy training might reduce depression. This beneficial ‘side-effect’ might be explained by improvement of skills that give mothers’ more access to information and learning and so increase feelings of control. Or literacy training, by itself, might increase self-esteem and confidence.
Maternal depression, parenting and child development
 In a 2001 study with 351 African American families with preschool children receiving Welfare benefits, Zaslow and colleagues found over half (52.3%) had basic or below basic literacy skills and 40% were depressed. One in four (24.6%) had both depression and low literacy. Zaslow documented significant effects of depression on child development, particularly though parenting behaviors. This study confirmed previous work (for example, Harnish et al., 1995) showing that regardless of their literacy level, depressed mothers had less interaction with their children and engaged less frequently in teaching or coaching. They were more negative and irritable and used harsher discipline. But Zaslow found that, compared to mothers who had low literacy and were not depressed, mothers with both low literacy and depression were more likely to have a stressed and controlling parenting style and to provide a less stimulating environment, which in turn predicted more depressive/withdrawn behavior in their children. These effects seem to be lasting.  Two years later, the children whose mothers had more depressive symptoms had more antisocial and withdrawn behaviors and behavioral problems, with significant implications for school readiness. However, when a depressed mother had higher literacy, her child showed the same level of withdrawn behavior as children whose mothers were not depressed. Said another way, a mother’s strong literacy skills seem to buffer the negative impacts of depression on her child; and improving literacy seems to simultaneously improve depression and child development.
Testing the links
In a 2003 study, (Weiss et al., 2006) 70 low-income adults who tested positive for both depression and low literacy received routine care for depression. In addition, the intervention group (N=33) was referred to literacy enhancing services. They attended as many sessions as they wished and used various literacy skill building methods. Participation in literacy training ranged from none at all (18% of those referred) to 74 hours with an average of 18 hours of training. Both control and intervention groups showed decreased depressive symptoms; and – here’s the promising part – those referred to literacy services had significantly greater decreases in depression symptoms. Again, literacy training seems to reduce depression, although the how this happens remains unclear.
Francis et al. reported in 2006 that for adults (N=31) who participated in literacy training, depressive symptoms decreased over time. By 12-15 months of training (average 67 hours), the mean score for the group was significantly reduced to below the threshold for detecting depression. This suggests there is a “dose-response” to literacy training, that is, as the duration or intensity of literacy training (skills) increases, depression decreases. In addition, literacy training participants showed a significant increase in self-efficacy – confidence in their ability to influence events affecting their lives, and the most significant factor in behavior change.
Small sample size and homogeneous populations limit these studies. The mechanism by which literacy training might reduce depression remains unclear, and may not be the result of improved literacy. Participation in literacy education, by itself, might enhance self-esteem and self-efficacy, and lessen feelings of guilt or shame associated with low literacy. Improving these factors may, in turn, reduce depression. Further research is needed to confirm this promising evidence of the benefit of literacy training on maternal depression and child development.
Our next issue will describe the brief intervention currently being tested by home visitors in the Home Visitors Research Network, and research in progress. We are currently analyzing links between literacy level, depression, child development and referral to literacy services among 3000 mothers served by home visitors who have taken the Beginnings Guides Implementation Training. Stay tuned.
References
- Francis, L., Weiss, B.D., Senf, J.H. Heiest, K. & Hargraves, R. (2007). Does Literacy Education Improve Symptoms of Depression and Self-efficacy in Individuals with Low Literacy and Depressive Symptoms? A Preliminary Investigation. Journal of the American Board of Family Medicine 20: 23-27.
- Poresky, R.H. & Daniels, A.M. (2001). Two-year comparison of income, education and depression among parents participating in regular Head Start or supplementary family services center services. Psychol Rep 88: 787-796
- Weiss, B.D., Francis, L., Snef, J.H., Heist,K. & Hargraves, R. (2006). Literacy Education as Treatment for Depression in Patients with Limited Literacy and Depression: A randomized trial. Journal of General Internal Medicine 21, 823-828.
- Zaslow, M.J., Hair, E.C., Dion M.R., Ahluwalia, S.K., & Sargent, J. (2001). Maternal Depressive Symptoms and Low Literacy as Potential Barriers to Employment in a Sample of Families Receiving Welfare: Are There Two-Generational Implications? In Women & Health 32 (3):211-251.
Program Profile - KIPS
Keys to Interactive Parenting Scale © (KIPS)
A Practical Parenting Assessment Tool with Online Training
 byMarilee Comfort, PhD, MPHPhil Gordon, PhDComfort Consults, LLCwww.ComfortConsults.com
 KIPS –Keys to
Interactive Parenting Scale is a practical, structured observational parenting
assessment to enhance parent-child interaction. KIPS reliably assesses
parenting quality during free play with a child 2 through 5 years of age. Both professionals and
paraprofessionals score KIPS reliably when assessing families they serve.
The tool has been tested with risk and non-risk, educationally, economically,
and ethnically diverse populations. KIPS scores correlate significantly
with other validated observational tools. KIPS is a brief tool with only 12
items.
| KIPS 12 Items |
|---|
| 1. Sensitivity of Responses | 7. Reasonable Expectations | | 2. Supports Emotions | 8. Adapts Strategies to Child | | 3. Physical Interaction | 9. Limits & Consequences | | 4. Involvement in Child Activities | 10. Supportive Directions | | 5. Open to Child's Agenda | 11. Encouragement | | 6. Engagement in Language Experiences | 12. Promotes Exploration & Curiosity |
KIPS eLearning offers easy, affordable access to KIPS training on the Internet. To date, 99.7% of KIPS eLearning participants have become certified by passing an exam. Annual recertification is required and available online.
The Beginnings Parent’s Guide is an excellent resource for family service agencies. The Guides, which are available in English and Spanish, provide timely and practical information to parents of children aged 0 to 3. (click here to preview online)
Would you like to see your program profiled here? If so, please contact us - we'd love to hear from you!
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