Longitudinal Study of Maternal Depressive Symptoms and Child Well-Being

doi:10.1097/00004583-200112000-00006

Journal of the American Academy of Child & Adolescent Psychiatry

Volume 40, Issue 12, December 2001, Pages 1367-1374

https://doi.org/10.1097/00004583-200112000-00006 Get rights and content

ABSTRACT

Objective

To investigate whether prenatal, postnatal, and/or current maternal depressive symptoms are associated with low level of psychosocial functioning or high level of emotional/behavioral problems in school-age children.

Method

As part of a prospective longitudinal study, maternal depressive symptoms were screened with the Edinburgh Postnatal Depression Scale prenatally, postnatally, and when the children were 8 to 9 years old. The original sample of 349 mothers was collected in 1989–1990 in Tampere, Finland. Of the 270 mother–child pairs at the latest stage of the study in 1997–1998, 188 mother–child pairs participated and 147 were included. The associations between maternal depressive symptoms at different points in time and the level of children's psychosocial functioning and problems reported on the Child Behavior Checklist and Teacher's Report Form were examined.

Results

Children's low social competence and low adaptive functioning were associated with concurrent maternal depressive symptoms. Maternal postnatal depressive symptoms predicted low social competence. The presence of prenatal depressive symptoms in the mother was a strong predictor of child's high externalizing and total problem levels (odds ratio 3.1, 95% confidence interval 1.1–8.9 and odds ratio 8.5, 95% confidence interval 2.7–26.5). Prenatal as well as recurrent maternal depressive symptoms were associated with the least favorable child outcome.

Conclusions

Maternal depressive symptomatology at any time, especially prenatally, is a risk factor for the child's well-being. This should be noted already in prenatal care. The timing and the recurrence of maternal depressive symptoms affect the outcome for the child.

Section snippets

Study Design

This study is a part of a prospective follow-up study that started in Tampere, Finland, in 1989. The target group consisted of healthy first-time mothers. The sample was collected from all maternity health clinics in the city of Tampere during a 6-month period in 1989–1990. The depressive symptoms of the mothers were screened by means of questionnaires during late pregnancy (T ₁) and three times postnatally (T ₂ = during the first week, T ₃ = 2 months and T ₄ = 6 months after delivery). A

Maternal Depressive Symptoms

The proportion of the mothers scoring high in the EPDS was 11% at T ₁, 9% at T ₂, 9% at T ₃, 10% at T ₄, and 7% at T ₆. Of the 16 mothers who scored high prenatally, only two scored high after delivery. Seven of the prenatally symptomatic mothers scored low at every subsequent time point. Only one mother was symptomatic at each of the five assessments and 101 mothers scored low at each time point. Thirty-two mothers scored high once, nine mothers twice, three mothers three times, and one mother

DISCUSSION

In this study, the follow-up time of the mothers and the children was extensive compared with previous studies on maternal depressive symptoms in relation to child psychosocial development. The sample was population-based and remained moderate in size and representative during follow-up. On the basis of the information available from the previous stages of follow-up, the attrition did not distort the findings.

The first unexpected finding in this study was the diversity and continuing changes in

REFERENCES (28)

HD Chilcoat et al.
Does psychiatric history bias mothers’ reports? An application of a new analytic approach
J Am Acad Child Adolesc Psychiatry
(1997)
JL Cox et al.
Validation of the Edinburgh Postnatal Depression Scale (EPDS) in non-postnatal women
J Affect Disord
(1996)
LC Dierker et al.
Influence of parental concordance for psychiatric disorders on psychopathology in offspring
J Am Acad Child Adolesc Psychiatry
(1999)
RD Todd et al.
Genetic studies of affective disorders: should we be starting with childhood onset probands?
J Am Acad Child Adolesc Psychiatry
(1993)
V Warner et al.
Grandparents, parents, and grandchildren at high risk for depression: a three-generation study
J Am Acad Child Adolesc Psychiatry
(1999)
CH Zeanah et al.
Infant development and developmental risk: a review of the past 10 years
J Am Acad Child Adolesc Psychiatry
(1997)
TM Achenbach
Manual for the Child Behavior Checklist/4–18 and 1991 Profile
(1991)
TM Achenbach
Manual for the Teacher's Report Form and 1991 Profile
(1991)
WR Beardslee et al.
Children of affectively ill parents: a review of the past 10 years
J Am Acad Child Adolesc Psychiatry
(1998)
SB Campbell et al.
Depression in first-time mothers: mother–infant interaction and depression chronicity
Dev Psychol
(1995)

D Cicchetti

A historical perspective on the discipline of developmental psychopathology

M Conrad et al.

Role of maternal depression in perceptions of child maladjustment

J Consult Clin Psychol

(1989)

J Cox

Origins and development of the 10-item Edinburgh Postnatal Depression Scale

EM Cummings et al.

Maternal depression and child development

J Child Psychol Psychiatry

(1994)

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: The study was supported by grants from the Finnish Child Psychiatric Research Foundation, the Foundation of Paediatric Research, and the Medical Research Fund of Tampere University Hospital.

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ARTICLESLongitudinal Study of Maternal Depressive Symptoms and Child Well-Being

ABSTRACT

Objective

Method

Results

Conclusions

Section snippets

Study Design

Maternal Depressive Symptoms

DISCUSSION

J Am Acad Child Adolesc Psychiatry

J Affect Disord

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

Manual for the Child Behavior Checklist/4–18 and 1991 Profile

Manual for the Teacher's Report Form and 1991 Profile

Children of affectively ill parents: a review of the past 10 years

J Am Acad Child Adolesc Psychiatry

Depression in first-time mothers: mother–infant interaction and depression chronicity

Dev Psychol

A historical perspective on the discipline of developmental psychopathology

Role of maternal depression in perceptions of child maladjustment

J Consult Clin Psychol

Origins and development of the 10-item Edinburgh Postnatal Depression Scale

Maternal depression and child development

J Child Psychol Psychiatry

ARTICLES
Longitudinal Study of Maternal Depressive Symptoms and Child Well-Being