Half of the mothers who lived in the neighborhoods wracked by the civil unrest that followed the death of Freddie Gray in 2015 became so stressed by the circumstances that they suffered from insomnia, loss of appetite and other depressive symptoms, according to new research by the University of Maryland School of Medicine.
While the mothers weren't tested to see if they fit the clinical definition of depression, the researchers said the results found that the sight of burning buildings, looting, and the constant blue lights from police cars was enough to have a major emotional impact in neighborhoods located in the six ZIP codes where the brunt of the unrest took place.
Gray was found unconscious with fatal neck injuries suffered while in police custody on April 12, 2015. His subsequent death sparked the unrest.
The researchers said the findings published in the American Journal of Public Health are important because a mother's well-being has a direct impact on her ability to care for her children. The stress of the unrest, combined with the poverty and violence-stricken neighborhoods where many of these mothers reside, compounded the risk of depression.
"If you are in a constant state of vigilance, then there is a weathering process where you are always on alert and constantly wondering if something is going to happen," said senior author Maureen Black, a professor in pediatrics at the University of Maryland School of Medicine. "If a caregiver is experiencing stress and depressive systems, it is very unhealthy for the kids."
As part of their analysis, Black and a team of researchers used data from Children's HealthWatch, a database collected at doctors' offices and emergency rooms from mothers with children under age 4 who face economic hardship. The data, collected since 1998 and which includes questions about mental well-being, enabled the researchers to compare the mental health of mothers before and after the riots. Data from January 2014 to December 2015 was used in the study.
The study included surveys from 1,095 mothers; most of whom were African-American and either had health insurance through Medicaid, the government subsidized program, or were uninsured. About 30 percent of these women experienced symptoms of depression before the unrest, compared with 50 percent during the unrest. The mothers attributed their feelings in many cases directly to the anxiety and fear they felt over what was happening to their neighborhoods, Black said.
When mothers were surveyed five months after the unrest, the signs of depression had fallen to levels prior to the incident. The researchers don't know why it declined, but say one reason could be that the Baltimore Health Department made efforts to address the emotional instability residents might have faced, including directing people to a hot line that told them about available social services.
"We recognized there would be the impact of trauma on residents both in the short term and the long term," said Baltimore Health Commissioner Dr. Leana Wen.
The city also started to rebuild quickly, and students went back to school, perhaps bringing some normalcy to the neighborhoods and people's lives.
Maternal and mental health experts said the study gives further credence to existing findings that show one's environment can affect one's mental health. Parents with depression may have a hard time getting out of bed and being motivated to do everyday tasks. Good parenting may take a back seat, and mothers may have hard time connecting with their children.
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"Both the unrest and the context surrounding it is extremely stressful," said Tamar Mendelson, an associate professor in the department of mental health at the Johns Hopkins University Bloomberg School of Public Health. "We have a lot of research to show that depressed parents have more difficulty building attachments with their infants and children. It is hard to be an engaged and effective parent when you are suffering from depression."
Chronic stress levels in the body can also lead to pre-term births and even fetal deaths, said Dr. Shelly Choo, senior medical adviser for the bureau of maternal and child health at the Baltimore Health Department.
The researchers said that while it is important to help mothers cope with symptoms of depression, a broader public health approach is also needed where policies and programs reduce social injustices and inequalities that lead to unrest. Improving access to basic needs such as affordable housing, food, medications and services can also help. They also said more screening for maternal psychological symptoms is needed.
"We need a macro solution; a public health approach," Black said.