The major study aim was to describe the emotional and behavioral symptoms of offspring of African American mothers with depressive disorders. To interpret our findings, we will compare them to other studies of offspring of parents with depression, which are comprised of predominantly European Americans. In regards to depression, our findings showed a slightly lower rate (6.3%) of a clinical level of depressive symptoms compared to a descriptive study of offspring (ages 7 to 17 years) of mothers treated for MDD which found that 10% of offspring had current depressive disorders [11
]. Similarly, we found a lower rate of a clinical level of depressive symptoms than a study of 6th
grade offspring (11.5% on the CDI) of mothers with a history of depression [64
]. Our sample appears to have less depression than samples of mostly European American offspring of mothers with depression.
On the other hand, our rate (20.6%) of a clinical level of externalizing symptoms was similar to the psychiatric rate of 22% of disruptive disorder among offspring of mothers treated for MDD [11
]. We found higher clinical rates of maternal report of offspring externalizing behavior symptoms on the CBCL than a study of mothers with high levels of depressive symptoms with 8- and 9- year-old offspring who reported 11% of externalizing symptoms above the clinical cut-off [65
]. Consistent with the research literature of offspring of parents with depression, some of the offspring were exhibiting behavioral difficulties.
Similar to behavioral problems, our findings showed evidence of high anxiety symptoms within the sample. Compared to a descriptive study of offspring of mothers treated for MDD with 16% of offspring having current psychiatric diagnoses of anxiety disorders [11
], our rate (15%) of clinical levels of anxiety symptoms was similar. Our mean score on the MASC was more than one SD above the mean (36.5) of a sample of 9- to 14- year-old females with mothers with recurrent depression [66
]. Our sample reported a higher rate of anxiety symptoms within the clinical range than the 4.8% 3-month prevalence rate of anxiety disorders found within a community sample of African American youth [67
]. We found that age demonstrated a significant association with anxiety despite the use of standardized T-scores that were normed based on age and gender. Younger age was associated with greater anxiety symptoms suggesting that the impact of maternal depression on younger offspring may be particularly salient. Based on the age of 7 – 14 years selected in this study, our sample population may more likely to be exhibiting anxiety than depressive disorders. In a longitudinal study of depressed parents in treatment and their offspring (ages 6 – 23), the peak age range for anxiety disorders was 5 – 10 years and declined after 12 years [5
Although the offspring did not endorse high levels of depressive symptoms, suicidal ideation was present in approximately a third of the sample. Our rate of suicidal ideation was similar to the 38% frequency of suicidal ideation, plans and attempts that occurred by early adolescence in offspring of predominantly European American parents with depression [68
]. A few studies have shown that offspring of depressed parents are more likely to have suicide ideation and attempts [6
] than offspring of non-depressed parents. Youth suicidal ideation is associated with psychopathology and future suicide attempts and completion [70
], thus this finding requires particular clinical attention and follow up with longitudinal studies.
Surprisingly, whether a mother was in treatment was associated with child anxiety symptoms, but maternal depression severity and substance abuse history were not. Mothers in treatment may exhibit more severe psychopathology, thereby putting their offspring at greater risk for anxiety. Another explanation might be that mothers in treatment may have a stronger genetic predisposition to depression thereby increasing their offspring risk for psychopathology. Nonetheless, treatment status seems to encompass a complex presentation of disorder that includes co-morbidity. For example, our findings showed that mothers in treatment had more co-morbid anxiety disorders. Pilowsky and colleagues [11
] demonstrated that panic disorder with agoraphobia was associated with increased offspring anxiety and depressive disorders. Parental anxiety disorders have been associated with psychiatric maladjustment, such as anxiety disorders, in offspring [72
]. Future research should examine the impact of co-morbid anxiety disorder and their possible differential impact on child psychiatric trajectories.
Mothers who experienced more depressive symptoms reported more offspring internalizing and externalizing behavior symptoms. This is in line with other studies that have shown that mothers with depression overreport their offspring’s behavior problems [39
]. Although there is behavioral impairment for offspring of mothers with depression, the depression may be negatively clouding the mothers’ perception of their offspring’s behavior. Interventions aimed at this population might focus on helping mothers form realistic expectations and interpretations of their children’s behavior. Another explanation for this finding is that the severity of maternal depression has been associated with child maladjustment [10
]. As a result, the severity of maternal depressive symptoms can lead to more current stressors and/or parenting difficulties thereby impacting the offspring’s internalizing and externalizing behavior problems.
If future research is to occur with this population, particular attention must be given to recruitment and retention. Barriers include: 1) symptoms of a depressive disorder (e.g., fatigue, anhedonia, concentration problems), 2) hectic parenting schedules as a result of being primary caregiver of children and other family members, 3) silence or stigma regarding psychiatric problems among African Americans [77
] and 4) mistrust of research based on past injustices within the African American community [78
]. In a primary care sample of low-income ethnicity minority women, Miranda and colleagues [79
] noted needing four phone calls before completion of diagnostic interviews and with 34% of the women being unreachable. We encountered similar challenges and thus we implemented persistent telephone calls and letters over three months for each mother which resulted in telephone screening with 89% of those interested and in person clinical interviews with 81% of those eligible. In addition, we strived to make a personal connection with each mother by the principal investigator conducting the diagnostic interviews and research staff collecting all self-report measure data as interviews. In addition to addressing logistical barriers, such as providing bus tokens and parking reimbursement, we were flexible in scheduling appointments and conducted some of the interviews in the home or mental health agencies. A critical aspect of recruitment was the provision of childcare, which was fun for the children and eased the childcare burden of the mother. We also assisted mothers with other resources and referrals to treatment if desired. Our intensive and personal engagement strategies for recruitment proved fairly successful in getting these African American mothers with depressive disorders and their offspring to participate in the research study.
There are several limitations to this study. First, the sample size is relatively small, although we were able to achieve statistically significant main effects in our regression and correlational models. However, the sample size may limit the power to detect significant associations in the multiple regression analyses thereby increasing the likelihood of Type II error. Second, without a non-clinical control group, we cannot compare offspring with and without exposure to maternal depression. Nevertheless, the sample is unique and one of the few to examine this population, being that there is a dearth of research on offspring of clinically depressed African American mothers. Third, we had only one reporter (the mother) on child behavior problems. This is a weakness as empirical evidence has demonstrated that depression symptoms negatively impact a mother’s perception of her offspring’s behavior [39
]. Additional reporters (e.g., teachers) and the use of a clinical interview would have strengthened our understanding of psychiatric status in this sample.
There are research and clinical implications of the findings from this preliminary study. These offspring are at risk for psychiatric maladjustment similar to the general population of offspring of clinically depressed parents; unfortunately African American parents with depression and their offspring are not adequately represented in the research samples. The particular barriers to engaging African American mothers with depression and their offspring into research and clinical treatment need to be aggressively addressed so that we can advance our understanding of this understudied and underserved population, as well as provide appropriate and culturally sensitive services. In particular, mothers in treatment offer a missed opportunity to implement clinical interventions aimed at the offspring. For example, psychiatric treatment for mothers with depression might offer clinical interventions focusing on parenting, educating parents on the impact of depression on children and/or including the offspring in treatment [80
]. There are several intervention models for parents with depression and their offspring that may be utilized in clinical settings and adapted for African American families.
The current study described the emotional and behavioral functioning of offspring of African American mothers with depressive disorders, an understudied population. Sixty three mother-child dyads completed the cross-sectional study. The offspring were between the ages of 7–14 years with 6.5% and 15% scoring within the clinical range for depression and anxiety symptoms, respectively, and a third reporting suicidal ideation. Compared to other samples of offspring of mothers with depression, our sample’s depressive symptoms were low, however anxiety symptoms and suicidal ideation were similar. Maternal psychiatric characteristic of treatment status was positively associated with offspring anxiety symptoms indicating greater anxiety symptoms among offspring whose mothers were currently in treatment. Offspring of African American mothers with depression appear to exhibit similar difficulties as observed of children from European American families with maternal depression. Nonetheless, there are barriers to recruitment and inclusion of African American families in maternal depression research.