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Patrick Mason, MD, PhD, FAAPPatrick Mason, MD, PhD, FAAP
Inova Fairfax Hospital for Children

In two prior articles, we have discussed both pre-adoption records and post-adoption evaluation. As pediatricians, we often only look at and think about the “little person” in the room. Most of us generally don’t think much about the “big people” who are also in the room. How the parents are doing, especially following an adoption, will have a direct impact on how successfully the child will be able to integrate into his or her new family. Fresh information is starting to emerge that looks at parents following international adoptions.

In a recent article, Senecky, et al (J Affective Disorder, 2009) examined the impact of international adoption on new mothers. They examined 39 Israeli women for depression both before, and six weeks after, their adoptions. Prior to the adoptions, researchers noted no difference in the rate of depression between the pre-adoptive mothers and the general population (25.5% vs. 26%). They also found no difference in depression between mothers six weeks post adoption and birth mothers (15.4% vs. 15%). Finally, they found that all women who were depressed following adoption were also depressed before their adoptions, suggesting that the adoption process was not the cause of the new mothers’ depression.

A study by Judge (2003) examined parental stress in families adopting children from Eastern Europe and found that child behavior problems were the single most significant correlate of parenting stress in both mothers and fathers. Few other studies have been conducted to date looking at rates of stress or depression following adoption.

To better understand whether post-adoptive families experienced stress following their adoption, we conducted a Web-based survey using the Parent Stress Index (PSI) (Narad & Mason, AAP, 2009). The PSI evaluates the parents’ perception of their stress and breaks it down into Parent domains (stress arising from a parent’s own issues or relationship with a partner) or Child domains (stress experienced due to the child). We surveyed 122 parents (90 mothers, 32 fathers) and found that 43.4% had total stress scores in the “high stressed” category, which is over the 85th percentile for stress. To our surprise, more fathers (50%) were in the high stressed category than mothers (41.3%). When we looked at the domains of stress, more parents were stressed in the Parent domain (39.3%) than in the Child domain (35.2%).

While there have been few studies to date looking at depression and stress for post- adoptive families, those that have been conducted suggest that this is an issue that merits further investigation. We will soon be looking into the rates of depression and stress in our families, both before and following their adoptions. As we see children and their families, we must always be aware of how the “big people” in the room are doing, since this will have a direct impact on the successful integration of the newly adopted child into the family.

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