Maternal Emotional Health Topic New to Kidsdata
Kidsdata and the California Department of Public Health (CDPH) have partnered to share important new measures of maternal mental health before and after a live birth from the Maternal and Infant Health Assessment (MIHA) survey. A woman’s emotional well-being during this time is central to her health and to her infant’s development. Depression during and after pregnancy is a serious medical condition that requires culturally appropriate and trauma-informed support and treatment.
Guest authors, Christine Rinki and Amina Foda, Research Scientists with the California Department of Public Health, share important findings about symptoms of depression among women who recently gave birth in California:
Symptoms of depression during and after pregnancy
According to a recent Data Brief (PDF) from the California Department of Public Health’s Maternal and Infant Health Assessment (MIHA) survey, about one in five women who give birth in California experience symptoms of depression during or after their pregnancy.
Although relatively minor changes in mood the first few days after childbirth are common, depression that arises during or after pregnancy is a mood disorder characterized by intense feelings of sadness, anxiety or despair that last for two weeks or longer and prevent women from doing their daily tasks.
If untreated, depression during or after pregnancy increases the risk of cognitive and emotional development problems in infants, and may result in fundamental changes in the brain that can have lasting effects into childhood. Depression occurring after the baby is born can negatively impact women’s breastfeeding practices and ability to bond with their infants. Importantly, depression at any point during or after pregnancy increases the risk that women could develop chronic depression or die by suicide once the baby is born, which in turn have profound impacts on children.
Thankfully, with the appropriate care, most women can experience full recovery. Best practices to address maternal mental health include screening for depression throughout prenatal and postpartum care, and increasing the availability of services that are affordable, culturally and linguistically appropriate, and that acknowledge the history of trauma common among women with depression.
Prenatal and postpartum symptoms of depression in California
In California, 14.1% of women experienced prenatal symptoms of depression and 13.5% experienced postpartum symptoms of depression. Many, but not all, women who experienced symptoms of depression would be diagnosed with clinical depression.
There was substantial geographic variation among counties with data. Prenatal symptoms of depression ranged from 8.5% in San Mateo County to 20.2% in Stanislaus County, while postpartum symptoms of depression were 9.8% in Yolo County and 18.8% in San Joaquin County.
Prenatal Symptoms of Depression
See data on postpartum symptoms of depression »
Prenatal symptoms of depression: Important, but often overlooked
Despite the serious risks associated with prenatal depression, including low birth weight, premature delivery and changes in infant brain development, its importance is often overlooked. MIHA results (PDF) indicate that prenatal symptoms of depression often precede postpartum symptoms of depression in women. In California, 53% of the women who experienced prenatal symptoms of depression went on to report them in the postpartum period. In contrast, only 7% of women without symptoms of depression during pregnancy experienced them after pregnancy. In order to have the best chance of improving outcomes for the mother and infant, routine screening and treatment for depression should begin early in pregnancy, a time when women have increased contact with the health care system.
Disparities in prenatal symptoms of depression
Though symptoms of depression during and after pregnancy can affect women regardless of their background or circumstances, some groups in California experience them at disproportionately high levels. Women who are Black or Latina had higher rates of symptoms of depression compared to other racial or ethnic groups. During pregnancy, symptoms of depression were twice as common for Black (19.9%) and Latina (17.1%) women compared to White (9.5%) and Asian/Pacific Islander (10.3%) women. Reports of prenatal and postpartum symptoms of depression were highest among women with incomes below poverty (20.7% and 18.2%, respectively), and declined as income increased.
Prenatal Symptoms of Depression by Race/Ethnicity
See data on disparities in prenatal and postpartum symptoms of depression »
Programs that address perinatal emotional and mental health
The Maternal, Child and Adolescent Health Division of the California Department of Public Health strives to improve maternal emotional and mental health by tailoring primary prevention to address the social factors that lead to poor emotional and mental health and to promote individual protective factors. Additionally, many MCAH Division programs screen for symptoms of depression using validated tools, and provide appropriate referrals and support for women in need of care. For example, the Black Infant Health Program conducts group sessions with complementary case management that provide social support while helping women develop skills to reduce stress, enhance emotional well-being and develop life skills in a culturally affirming environment that honors the unique history of Black women. The California Home Visiting Program funds home visiting models throughout the state that use a strengths-based approach to enhance the mother-baby relationship. Home visitors address family needs such as financial struggles, relationships, and navigating the health care system, while support groups and mental health consultation directly address emotional well-being.
Striving for equity in perinatal emotional and mental health
The underlying causes of the maternal mental health disparities identified in the MIHA Data Brief are multifaceted. For example, Black and Latina women in California experience higher levels of risk factors for depression such as poverty and childhood hardships compared to other racial and ethnic groups. Institutional racism (the practices of social and political institutions that result in unfair treatment of Black, Latina and other minority groups) likely plays a role in explaining the concentration of risk factors, and the subsequent racial and ethnic disparities in depressive symptoms. Achievement of emotional and mental well-being for all California women during and after their pregnancies can have profound societal impacts. Action to address social factors can improve outcomes for low-income and minority families.
Recently Released Data
We are continuously updating our data. Click the links below to see the latest:
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Access to High Quality Health Care for California Children
Guest author, Holly Henry, PhD, is a Program Officer at the Lucile Packard Foundation for Children’s Health. She works to improve the system of care for children with special health care needs. Dr. Henry focuses on promoting effective care coordination, a practice that links children and their families with appropriate services and resources to support optimal health.
Every child deserves high quality health care that is accessible, family-centered, culturally competent, coordinated, continuous, compassionate, and comprehensive. Unfortunately, our current system of care for children is deeply fragmented and health needs are not being met. One approach to strengthening coordination of care is providing care through a medical home. The medical home recognizes the family as a constant in a child’s life and emphasizes partnership between health care professionals and families. It facilitates collaboration between patients, clinicians, medical staff, and families. More importantly, a medical home extends beyond the four walls of a clinical practice – it includes specialty care, educational services, and family support.
Receipt of Care Within a Medical Home, 2016
In 2016, 42% of California children received care within a medical home compared with 49% of children nationally. Receipt of care within a medical home varies across the state. The counties with the highest and lowest percentages of children receiving care within a medical home, among counties with data, are also noted in the graph above.
Children receiving care from a medical home have fewer outpatient visits and families report better child health status. Families also report increased satisfaction with their child’s care. For children with special health care needs this can also mean decreased length and frequency of hospitalizations and lower out-of-pocket spending.
All children would benefit from being cared for within a medical home. See how your county is faring.
Data in Action
Learn more about care coordination and how it can help reduce health care fragmentation. The Lucile Packard Foundation is hosting a webinar on care coordination for children with medical complexity on July 26 at 10 am PST. Audience Q&A is highly encouraged. Attendees can listen via web or phone. Learn more and register.
Recently Released Data
School Provides Services for Students with Special Needs (Staff Reported) [NEW]
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Childhood Adversity Data Available by County, City and School District
Children with Two or More Adverse Experiences (Parent Reported), 2016
ACEs by County
Adverse childhood experiences – such as family separation, abuse, exposure to violence, and poverty – can have negative, long-term impacts on the health and well being of a child. According to the American Academy of Pediatrics, separating children from their parents, for example, removes the buffer of a supportive adult or caregiver who can help mitigate stress and protect against chronic conditions like depression, post-traumatic stress disorder, and heart disease. The more intense, repetitive and long-lasting the events experienced, the greater and more sustained their impact.
Childhood adversity data based on parent responses about their child’s experiences are available on Kidsdata.org. The data come from the 2016 National Survey of Children’s Health, and cover many California counties, cities and school districts. For example, Placer County, which has among the lowest rates of childhood adversity in the state, can be explored further by looking at Roseville, a city within the county, or by school districts within the county. See what childhood adversity data are available in your local area by clicking the + icon next to the county name.
Data in Action
Consider attending the 2018 ACEs Conference & Pediatric Symposium: Action to Access, October 15-17 in San Francisco. The conference explores problems of access, and how to reduce children’s exposure to adversity and its traumatic effects. It is co-hosted by the Center for Youth Wellness and ACEs Connection.
Join a community of advocates and practitioners committed to reducing childhood adversity and increasing resilience, visit acesconnection.org.
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The Mental Health Journey of a Mother and Daughter
Mental health disorders affect as many as 1 in 5 U.S. children each year. The vast majority of mental health problems begin in adolescence, with depression being the most common. Many young people who need mental health treatment do not receive it. Sadly, even if mental health problems are identified, children often face challenges with stigma.
We are pleased to feature mother and daughter guest authors, Olga and Magaly. When Magaly was 11, her mother found suicide plans on her phone. Six years later, they continue to navigate the challenges of Magaly’s diagnosis of depression and psychosis. Their journey touches upon the importance of early identification, access to care and the struggles for support.
Here is their story.
Raising a daughter with depression and psychosis
Olga is a Family Resource Specialist at Support for Families in San Francisco.
Magaly was 11 years old when she planned to kill herself. I had noticed cuts on her arm for some time but she always told me they were scratches from falling. It wasn’t until the cuts went from a criss-cross to deep straight lines that I knew something was wrong. I looked through her phone and found detailed plans, ranging from which friend would get her belongings to notes saying goodbye to loved ones. She left in the middle of school that day, walking around for hours, looking for a highway to jump off. The earliest doctor’s appointment available was for the following Monday, which was extremely frustrating. I spent that weekend watching Magaly’s every move, but also careful not to alarm or scare her. I didn’t want her to run away.
On that Monday, Magaly was diagnosed with major depression and psychosis. She finally told us about the strong voices inside her head. She said she had been hearing them for as long as she could remember. It was then that I realized why, as a baby, Magaly would cry any time she was left alone. She once turned purple from crying when I left her momentarily to use the restroom. It was the voices that were scaring her.
Sending your child to a behavioral health center is not the same as to a regular hospital. That same day they put Magaly in the ambulance for transport and I was not allowed to ride with her. It was a state policy. Parents are only allowed to see their child during visiting hours, the rest of the time the doctors just call you with updates or requests for medication approval. I remember Magaly calling me from the center, scared and begging to come home. “Mom this is my fault, I’ll try to behave, please, I’ll do anything to come home,” she pleaded. What else could I tell her except to hang in there and that I would come during the next visiting hours.
For Magaly, every day feels like she is carrying a big stone on her back. I know this is why it’s not easy for her to do the simple everyday things like get out of bed, shower, and go to school. She always has this extra weight with her. This is something she will struggle with for the rest of her life.
There is a stigma around mental health that often feels like blame for you and your child. From the policies that dictate when a parent can be with their child during treatment to the way we question parents of children with mental illness, the entire experience can be extremely isolating. What parents need is support. From a peer-to-peer perspective, it is helpful to talk with parents about how to manage the stress. When we meet others who are surviving it gives the rest of us hope. From caregivers, parents need a safe place where their concerns are heard, not criticized. From our health care system, we must demand mental health services for our children. We cannot wait until they are planning suicide to intervene and we must find ways to care for our children beyond being stabilized in a hospital.
Magaly turns 18 in June, and with that comes the usual mother-daughter challenges. You know everything when you’re 18, right? She doesn’t trust me as much. Sometimes she won’t tell me how she’s feeling because she knows I’ll take action. These days I’m trying to step back more and let Magaly learn to ask for help on her own. I know she will be the best advocate for herself and other children just like her.
Living with depression and psychosis
Magaly, 17, is from San Francisco. She is a student at Galileo Academy of Science and Technology and a published poet.
The voices in my head are weird. Right now, there are five of them, two boys and three girls. The voices can be like whispers; those are constant. It sounds like a hissing noise, like a window that is open a crack on a windy day. The voices can also be clear, speaking distinct phrases. I’ll see a tree and the voices will say, “You can hang yourself from that tree.” My inner monologue is louder but sometimes the voices can defeat it. When that happens, I have to yell out loud to hear myself.
When I was 11, my mom found my suicide plans on my phone. I had done internet research beforehand and made three options for myself: 1. Take pills, 2. Get run over, 3. Slit wrists. When I was evaluated at the Children’s Crisis Center, they kept asking me how many times I had thought about killing myself, and how many times I had felt depressed. I remember staring at a plastic water bottle and thinking about why they make water bottles, who came up with that idea. I completely disassociated from what was happening; they were sending me to a hospital and I just wanted to ignore everyone. I was diagnosed with major depression, psychosis and post-traumatic stress disorder.
The hospital felt like a prison. Nobody was allowed to wear shoes with laces or hoodies with strings. The walls were painted a light yellow and the windows were covered with curtains held back with Velcro. I felt trapped and terrified. When I called my mom she told me, “We didn’t want to send you there. It probably doesn’t look like a prison.” But she wasn’t there, she didn’t know.
I’m not sure when I started to hear the voices. My mom told me I couldn’t be left alone when I was a baby. I remember having panic attacks and now I realize it’s the voices. When I really think about it, I actually have no memories of not being depressed, it’s always been there. Sometimes when people ask how I’m doing, I want to lie and say I’m fine. If I told people how I really feel, they would send me to a hospital.
Sometimes I consider suicide for the stupidest reasons. The voices will say, “You gotta do this, you gotta do this now.” I’ll feel it for a minute, maybe an hour, sometimes for a whole day. That’s when I use my inner monologue to remind me why I need to live. I think of my sister and how much she needs me. I think of Kasia, my mentor from the Big Sister, Big Brother program. They are rocks. Support from friends, school and home all help. These days I feel depressed but in a different way, it’s not numb like before, I can feel other things at the same time. That’s good because it means I haven’t gone the other way, the point of no return.
Special thanks to Olga and Magaly for sharing their story.
Recently Released Data
We are continuously updating our data. Click the links below to see the latest:
Health Insurance Coverage (Regions of 65,000 Residents or More), by Age Group
Health Insurance Coverage (Regions of 10,000 Residents or More), by Age Group
Receipt of Care Within a Medical Home (Regions of 65,000 Residents or More) [NEW]
School Provides Adequate Health Services (Staff Reported)
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Three Mental Health Bills for California Children
Mental Health Awareness month is a time to note that the emotional health of children is an integral part of overall health, as physical and mental health are intricately linked. Mental disorders affect as many as 1 in 5 U.S. children each year and are some of the most costly conditions to treat – mental health problems among young people under age 24 cost the U.S. an estimated $247 billion annually. Unfortunately, the majority of young people who need mental health treatment do not receive it, and mental health problems in childhood often have negative effects in adulthood.
The California Legislature has proposed several bills that address children’s mental health, from increased training and peer supports to early prevention and funding parity. Three current bills worth noting:
SB 906: Medi-Cal: mental health services: peer support specialist certification
This bill establishes a statewide peer support specialist certification program for health providers. The peer support specialist would have the experience and the formal training to promote mind-body recovery for adults or transition-age youth.
SB 1019: Youth mental health and substance use disorder services
This bill creates financial parity for children’s mental health and adult mental health funding. It requires at least half of all funds allocated to the Mental Health Services Oversight & Accountability Commission under the Investment in Mental Health Wellness Act of 2013 be used to expand mental health services for minors.
AB 2686: Early identification of pupil mental health issues: in-service training for certificated employees and classified staff
This bill requires each school district, county office of education, and charter school to provide in-service training to certificated employees and classified staff who provide instruction to or have regular personal contact with pupils in K-12th grades on the early identification of pupil mental health issues.
Kidsdata is a source for policy options that could promote children’s emotional health.
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How to View Data by School District
Curious to know how children’s health differs by school district? Data such as emotional health, school attendance and discipline, and drug use are available at the school district level. It’s just three easy steps from the left side of the visualization:
1. Click the “+” sign next to your county of choice
2. Click the “+” sign next to “School Districts” and all available school districts will appear
3. Select your district of interest
Data in Action
The Kidsdata team will be at the California School-Based Health Conference on Friday, May 18, in Sacramento, CA. The event brings together providers, educators, advocates, and other leaders in the school-based health care movement across the state. Be sure to stop by our booth to say hello!
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Rate of Depression is Double for Gay, Lesbian, Bisexual Youth
Depression-Related Feelings Among Gay, Lesbian, Bisexual Youth, 2013-2015
An alarming 61% of youth who identify as gay, lesbian or bisexual have felt depressed in the previous year in contrast to 29% of their peers who identify as straight. These students, who are in grades 7th, 9th, or 11th grade or are in non-traditional programs, felt so sad or hopeless almost every day for two weeks or more that they stopped doing their usual activities.
Disparities among youth who experience depression-related feelings vary widely across student groups. Students with particularly high percentages of depression-related feelings include those in non-traditional schools, those with low levels of school connectedness, those whose parents did not graduate from high school, and American Indian/Alaskan Native or Hispanic students.
The tables below call attention to disparities among groups of students in California. Use the links to see additional data by county and school district.
Depression-Related Feelings Among Student Groups, 2013-2015
By level of school connectedness »
This data release about emotional health is a part of Kidsdata’s Youth in Schools series. In partnership with WestEd, we are featuring data from the California Department of Education’s California Healthy Kids Survey.
Data in Action
The Stanford Center for Youth Mental Health and Wellbeing featured how to overcome cultural barriers to mental health care access at its Adolescent Mental Wellness conference.
The Kidsdata team will present on chronic stress and emotional health among California’s youth at the California Mental Health Advocates for Children and Youth Conference.
Recently Released Data
We are continuously updating our data. Click the links below to see the latest:
Youth Suicide and Self-Inflicted Injury
Suicidal Ideation (Student Reported), by Grade Level
Number of Youth Suicides, by Age
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Updated Data Show Over A Quarter Million Public School Students Homeless
Homeless Public School Students, 2015-2016
Data on homeless children and youth in California are now available on Kidsdata. Over a quarter million, or 4.4% of public school students, were recorded as homeless at some point during the 2015-2016 school year. Most homeless students stayed with friends or relatives because of loss of housing (85%), and the remainder were in a temporary shelter, motel, or were unsheltered.
Unaccompanied Homeless Youth (Point-in-Time Count), Ages 0-17: 2017
Recording homeless students during the school year is one way to measure homelessness. A second way to measure homelessness is with a point-in-time (PIT) count which is held nationwide on one night in January each year. In 2017, 1,649 youth who were under age 18 were found homeless without a parent or guardian. Most were unsheltered, meaning that they were found in a place not ordinarily used for sleeping.
Federal agencies, researchers, and advocates agree that the homeless youth population remains largely hidden. Current methods to measure homelessness are presumed undercounts. However, the data that are available suggest this is a statewide issue.
Earlier this month we released data on childhood poverty. Homelessness can be one of the tragic consequences of poverty. Data revealing homelessness among youth and research about the impact of homelessness can help raise awareness and drive solutions to ending homelessness among youth.
Learn about addressing youth homelessness »
Data in Action
Kidsdata shared how to access and use homeless data by legislative district at the Youth Empowerment Summit hosted by the California Coalition for Youth in Sacramento on April 16. The next day, participants met with state legislators in support of SB 918, the Homeless Youth Act of 2018. Estimates of homeless students, based on data from the California Department of Education’s Coordinated School Health and Safety Office, are available for your legislative district here.
The California Homeless Youth Project uses data to enhance their “voices from the street” series.
Recently Released Data
Homeless Public School Students
Unaccompanied Homeless Youth (Point-in-Time Count), by Age Group and Shelter Status
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California’s Child Poverty Rate Highest in Country
Kidsdata and Public Policy Institute of California (PPIC) have partnered to bring you the latest data on poverty among California’s children. Poverty and inequitable distribution of resources are fundamental impediments to healthy and well children. Addressing poverty among all children must be a key part of programs and policies that aim to maximize health and well being.
Guest author, Caroline Danielson, who is a senior fellow at the Public Policy Institute of California, shares important findings about poverty in California:
Measuring Poverty
Poverty is high in California, and it has not improved as much as the growing economy might suggest it should. In fact, California’s poverty rate and child poverty rate are both the highest in the country, according to Census Bureau estimates from the Supplemental Poverty Measure (SPM). The California Poverty Measure (CPM), an ongoing collaboration between the Public Policy Institute of California and the Stanford Center on Poverty and Inequality, is a state-specific, updated measure of the adequacy of the resources families have on hand to meet their basic needs. The CPM improves on official poverty statistics by accounting for sharply differing housing costs across counties and by incorporating major social safety net programs like the federal and state Earned Income Tax Credits (EITC), CalFresh food assistance, and CalWORKs cash assistance for low-income families with children.
Poverty in California
According to the CPM, 19.5% of Californians were poor as of 2015—that means 7.5 million people living below a basic needs threshold (on average less than $30,000 in total resources for a family of four). The poverty rate is higher for children at 22.8%, or over 2 million children in 2013-2015. Among counties with data, CPM poverty rates ranged from 11.8% in Placer County to over 28% in Los Angeles and Santa Barbara counties.
Poverty Increase without Safety Net
Without resources from the social safety net, we estimate that an additional 1.3 million children, or 14.3%, would live in poverty based on data from 2013-2015. This translates into over one-third of children in poverty (37.1%). In other words, social safety net programs are doing critical work to mitigate poverty in the state.
Deep Poverty
For children living in deep poverty (with family resources less than half of the poverty threshold), social safety net programs are even more consequential. We estimate 5.1% of children lived in deep poverty in 2013-2015, but that nearly three and one-half times that share would live in deep poverty absent resources from the social safety net (17.4%). Nonetheless, the vast majority of children in poverty live in families where at least one adult works (82.3%), and this share is high even for children in deep poverty (68.2%).
Addressing Poverty
Taken together, these data suggest that solutions to child poverty in the state must take account the ways in which family employment and social safety net programs dovetail and the ways that they could be jointly improved. These data also drive home the need to address poverty as we take action for the well-being of the state’s children.
Learn more about addressing poverty »
Caroline Danielson is a senior fellow at the Public Policy Institute of California. Her research focuses on multiple dimensions of the social safety net, including its role in mitigating poverty, program access and enrollment, and the integration and governance of programs. The Public Policy Institute of California is a nonprofit, nonpartisan think tank dedicated to informing and improving public policy in California through independent, objective, nonpartisan research.
Kidsdata in Action
First 5’s 2018 Child Health, Education, and Care Summit, April 11-12.
Along with several of our partners, we will discuss the relationship between poverty and adversity. Also, we will share new data on adversity and introduce county-level dashboards on adversity over the life course. We hope to see you there!
Recently Released Data
We are continuously updating data. Click the links below to see the latest:
Children with Two or More Adverse Experiences (Parent Reported)
- by Legislative District [NEW]
Children Who Are Resilient (Parent Reported)
- by Legislative District [NEW]
Prevalence of Childhood Hardships (Maternal Retrospective)
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Youth in Action
Some of the best advocates for children’s health are engaged and empowered youth. Creating a positive cycle of health, from optimal physical and mental health to positive social behaviors and supportive relationships requires all of us, adults and youth alike, to be engaged citizens.
Adolescence is the stage in human development when individuals begin to clarify and articulate their own values and operationalize their roles in the larger world. Their uncertainty motivates them to question those around them. Thus, it is natural for youth to challenge the status quo, identify hypocrisy, and encourage all of us to improve and hold society to a high standard.
This past month we have seen youth across the country take ownership of their own safety. They are speaking up because they implicitly understand that health and well being can only be achieved when their communities are safe and when they have ready access to physical and emotional supports. We are inspired to watch this generation of advocates work to improve society and protect their health.
Kidsdata is a powerful tool for demanding action, it provides comprehensive data on how children and youth are faring and information on how we can contribute to improving their health and well being. As our youth raise their voices to make a better world, we should take time to listen and support them. They too, are demanding action.
Photo by Lorie Shaull/CC BY-SA 2.0
Updated Data
We are continuously updating data. Click the links below to see the latest:
School Attendance and Discipline
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