presents participant characteristics by maternal psychopathology category. There were no differences in age, gender distribution, maternal education, or exposure to the WTC attacks. However, mothers with depression and PTSD, and their children, were significantly more likely to have experienced other traumatic events. Approximately, 12% of the children in the sample met criteria for clinically significant emotionally reactive behaviors and for somatic complaints, 10% for anxious/depressed, 9% for withdrawn behavior and for attention problem, and 8% for aggressive behavior clusters.
Characteristics of Participants by Maternal Psychopathology Group
presents the rate of each behavioral problem cluster in children, based on mother’s report. When the rates of behavioral problems in children associated with each of three groups of mothers were compared, there were significant differences for all child behavioral problem clusters, except for withdrawn behavior and attention problems. There was a significant dose–response relation (i.e., where dose is defined as the number of maternal diagnoses) for all child behavioral domains, except withdrawn behavior. When the analyses were repeated using teacher reports, we found that the rates of child behavior problems associated with the maternal psychopathology groups were similar to those found based on the mother ratings of the children. However, teachers reported observing fewer child somatic complaints and more aggressive behavior. For teachers, as seen in , a significant dose–response relation in emotionally reactive, aggressive behavior, and attention problems was found. Fisher’s exact test was applied in all analyses.
Rates per 100 (SE) of Teacher’s Report of Her Child’s Behavioral Problems in Children According to Whether the Mother Has Neither, Depression Only, or Both Depression and Posttraumatic Stress Disorder (PTSD)
To confirm the increased risk based on maternal psychopathology category, a multiple logistic regression was performed. To minimize bias due to multicollinearity between mothers’ and children’s exposure to other trauma and maternal psychopathology group, first we entered potential confounders, including a priori determined demographic confounders and mothers’ and children’s exposure to the WTC and other trauma and then entered maternal psychopathology dummy variables in the model. presents the relative risks (RR) based on the mothers’ ratings and the teachers’ ratings of child behavior side by side. Whiskers at the end of the bars represent standard errors. Compared to the reference group of children of mothers with neither depression nor PTSD, depression and PTSD occurring together significantly increased the risk for aggressive behavior (RR = 11.0), emotionally reactive (RR = 5.9), anxious/depressed (RR = 4.8), and somatic complaints (RR = 4.1). In contrast, there was no significantly increased risk for behavioral problems in children of mothers with only depression with the exception of somatic complaints (RR = 3.4).
Risk for behavioral problems in children of mothers with only depression and with both depression and posttraumatic stress disorder (PTSD), based on mother’s and teacher’s reports.
Similar patterns were observed across rater type (mother, teacher) in emotionally reactive behavior and aggressive behavior. However, teachers were more likely to observe problems in withdrawn behavior (RR = 9.0, p = .006) among the children of mothers with depression and PTSD. Based on mothers reports, significant increased risk of somatic complaints were reported in children whose mothers had both PTSD and depression (RR = 4.1, p = .03) and children whose mothers had only depression (RR = 3.4, p = .04), whereas no significant increased risk was reported based on teachers report.
Finally, as shown in , we present the mean number of clinically significant behavioral problems (i.e., nontransformed), as rated by mothers and by teachers for each child. One-way ANCOVA (with child age, maternal education, and time passed since the WTC attacks used as covariates) shows that there was a significant difference in number of child behavioral problems by maternal psychopathology category, and by mother’s report based on nontransformed outcome variable, F(2, 110) = 15.1, p = .001, and transformed outcome variable, F(2, 110) = 4.1, p = .002. There was a similar significant difference in number of child behavioral problems by maternal psychopathology category by teacher’s report based on the nontransformed outcome variable, F(2, 96) = 5.4, p = .006, and the transformed outcome variable, F(2, 96) = 3.7, p = .004. Post hoc testing, based on the transformed outcome variable, demonstrated that children of mothers with depression alone had a larger number of behavioral problem clusters that met clinical significance than children of mothers with neither PTSD nor depression, rated by the mother (p = .04). Children of mothers with both depression and PTSD had a significantly larger number of behavioral problem clusters that met clinical significance criteria than children of mothers with depression alone, rated by mother (p = .04) or by teacher (p = .03). A test of the difference between the regression slopes associated with each informant type showed no significant difference (p = .78).