Mutual influences on maternal depression and child adjustment problems
Section snippets
Epidemiology
The problems are all too familiar to many families. Depressive disorders in mothers and behavioral and emotional problems in children are among the most common and debilitating mental health conditions. Many children are repeatedly exposed to maternal depressive episodes and consistently exposed to subclinical maternal distress. As well, about one in five parents lives with a child suffering from some form of emotional or behavioral disorder. This double dose of maternal and child maladjustment
Maternal depression affects child adjustment
There is ample cause for concern for the health and development of children of depressed mothers. Mood disorders are heritable, affect neuroendocrine and circulatory development during pregnancy, can be incompatible with good parenting behavior, and can cause significant life stress for children. Consequently, living with a depressed parent poses risk for social, psychological, and achievement deficits Downey & Coyne, 1990, Kurstjens & Wolke, 2001. Observational research shows that infants and
Who distresses whom?
Maternal depression contributes to parenting behavior that is either too intrusive or withdrawn, which may trigger a disruptive outburst in the child, which the depressed mothers have difficulty managing, thereby exacerbating the child's behavior, and so on. Certainly, the transactional nature of these conditions has implications for their course and treatment, but few studies have attempted to unravel temporal relations between maternal and child functioning. Forehand and McCombs (1988)
Mediating mechanisms
Current research has moved beyond the question of whether mutual influences on maternal depression and child adjustment problems exist to the mechanisms that mediate them. Herein lies a formidable task of identifying the active ingredients in a mix of interrelated mechanisms and overlapping constructs. Intergenerational transmission of psychopathology involves genetics, biological neuroregulatory systems, cognitive and interpersonal processes, family functioning, and other environmental
Genetics
The risk for a depressive disorder in adult first-degree relatives of depressed patients is higher (20–25%; Tsuang & Faraone, 1990) than in the general population, and twin studies indicate that genetic effect on depression accounts for 36% of the variance in child depressive symptoms (Sullivan, Neale, & Kendler, 2000). Indeed, environmental factors do not fully account for the risk posed to children of depressed mothers, but it should also be recognized that heritability estimates do not
Psychosocial mediation
Depression affects how people think and feel about themselves and about other people (Beck, 1967), so children of depressed mothers are regularly exposed to symptoms of dysphoric mood, irritability, confusion, helplessness, and hopelessness and are likely to experience the psychological unavailability of their mothers. Conversely, mothers of children with adjustment problems are regularly exposed to aggressive, hyperactive, delinquent, or emotionally disturbed behavior. Mutual influences on
Social capital
Mutual influences on maternal depression and child adjustment problems involve multiple, interwoven mechanisms that operate within the family context. However, these problems also tend to coexist with shared contextual factors, such as low income, social disadvantage, and low social support Curtis et al., 2001, Dodge et al., 1994, Pevalin et al., 2003. The classic Camberwell Study of women in north London shows the devastating effects of poverty and lack of access to the labor market on women's
Age, gender, and taxonomy
Three caveats in mutual family influences on psychological symptoms are their timing, sex differences, and the type and severity of symptoms on which they operate. First, certain mechanisms of mutual influences function differently across stages of child development. Goodman and Gotlib (1999, p. 459) noted that “researchers have tended to study children of depressed mothers either in one developmental period or in such a broad age range that two or more distinct developmental stages are
Clinical implications
Common mental health problems in mothers and children are intrinsically intertwined. Their mutual influences account for an important segment of a wide network of interrelations that includes fathers, siblings, schools, communities, and peers. Our focus in this article was on depressive illness in mothers and adjustment difficulties in children and multiple, overlapping pathways of mutual risk. The good news is that clinical interventions for either maternal depression or childhood disorders
Future research
Transactional models of family influences on psychopathology add another dimension to our understanding of how conditions, such as maternal depression and child emotional and behavioral problems, develop, sustain, and subside. However, it is an area of research built predominantly on descriptive, cross-sectional studies and in need of more rigorous study. Closer examination of key mediating mechanisms is needed to refine integrative models of mutual influences, making them more relevant to
Conclusion
Unraveling mutual influences on maternal and child health illuminates aspects of risk and resilience that are important to clinical practice. This article described the epidemiology and burden of maternal depression and child adjustment problems and presented a biopsychosocial model of their mutual influences. The practical implications of this model and an agenda for further research were also discussed. To conclude, in a research literature that is dominated by negative, even pathological,
Acknowledgements
This paper was supported by doctoral fellowships from the Hospital for Sick Children Foundation and Nova Scotia Health Research Foundation awarded to the first author, grants from the Canadian Institutes for Health Research awarded to the second author, and grants from the Children's Miracle Network/Canadian Psychiatric Research Foundation, IWK Foundation, Nova Scotia Health Research Foundation, and Social Sciences and Humanities Research Council of Canada awarded to the third author. We also
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