This study examined the effects of youth disorders on maternal depression, and explored whether this effect was accounted for by youth-related acute and chronic stress experienced by the mother. Such a perspective reverses the typical study of effects of maternal depression on offspring, suggesting that disorders of the mother and child could have mutually adverse effects. Findings revealed that child psychopathology does confer a prospective risk for maternal depression, in that mothers of children with a greater number of past diagnoses by age 15 were more likely to be depressed both at the youth age 15 interview and at the youth age 20 follow-up. In addition to conferring a risk for the presence of maternal depression, youth psychopathology also predicted a greater number of episodes of maternal depression and dysthymia during the 5-year follow-up period. Moreover, these prospective effects of child psychopathology on maternal mental health persisted despite controlling for youth gender, family income, and mothers’ prior history of depression.
These results are consistent with previous research illustrating that children’s externalizing behaviors can have negative effects on mothers’ future mental health (e.g., Gross et al., 2009
), and specifically, can exert an influence on the trajectory of maternal depressive symptoms (e.g., Gross et al., 2008
). However, the findings extend previous research by indicating that child psychopathology confers risk for clinical levels of depression in mothers, rather than just subclinical depressive symptoms. Moreover, mothers’ risk for clinically significant depression increased with the number of diagnoses of the youth, suggesting that families with children with multiple comorbid disorders might be at particular risk for the perpetuation of maternal depression. Also, the results show that child psychopathology confers risk for maternal depression over and above the effects of other challenging contexts within the family that might affect mothers’ risk for depression, including the family’s financial difficulties and the mother’s past struggles with depression. In particular, controlling for maternal history of depression allowed us to control for the effects of maternal mental health on children and to more specifically examine child effects on mothers.
The second hypothesis, that child psychopathology would lead to the generation of child-related stress for mothers, was also supported. Mothers of children with a greater number of past diagnoses experienced elevated levels of child-related acute stressors, such as difficulties in school or conflicts with peers. Mothers of children with more past disorders also reported increased chronic stress in the mother-child relationship, including more than typical conflict, poor communication, and poor parental control. Thus, not only are children with psychopathology more likely to generate stress in their own lives, but their disorders are also involved in the creation of elevated levels of stress exposure for their mothers. That is, the widespread effects of youth psychopathology on children’s behavior and peer relationships, as well as family dynamics, are likely to create a particularly stressful context for mothers, both in terms of the number of child-related acute stressors and chronic stress within the mother-child relationship.
Finally, results also supported the hypothesis concerning the mediating effects of child-related stress on the relationship between child psychopathology and risk for future maternal depression. Levels of chronic stress in the mother-child relationship and the number of child-related acute stressors each accounted for the relationship between the number of past youth disorders and the presence of maternal depression at the age 20 follow-up. Thus, it appears that youth psychopathology gives rise to higher levels of child-related stress for mothers, and these elevated levels of stress in turn increase the risk for maternal depression. These findings highlight objective stress levels as one important mechanism by which youth psychopathology affects maternal mental health and generates an increased risk for maternal depression. Although previous research has discussed stress as a potential mechanism for child effects on maternal mental health (e.g., Hastings, 2002
), this is the first known study to use a well-validated contextual assessment of objective stress levels in order to examine child-related acute and chronic stress as mediators of this relationship. Furthermore, the results indicate that objective levels of child-related stress play a role in the effects of youth psychopathology on clinical depression in mothers, and not just maternal reports of subclinical depressive symptoms.
Because certain youth disorders might be expected to contribute more to maternal stress and depression than others, descriptive analyses explored the differential effects of various types of youth psychopathology on our outcomes. For these analyses, youth were separated into groups that contained youth with one depressive disorder only, one anxiety disorder only, one externalizing disorder only, multiple disorders, or no disorders. Interestingly, both the externalizing disorder only group and the comorbid group predicted higher levels of maternal stress and depression than the other groups. Thus, in accordance with our finding that the number of youth diagnoses predicts maternal stress and depression, youth with comorbid disorders appear to be more severe and at particular risk for problematic behaviors that affect their mothers. However, youth externalizing disorders appear to play an especially important role in contributing to mothers’ risk for child-related stress and depression and are likely to be driving at least some of our findings of the effects of youth psychopathology on mothers.
While the current study underscores the effects of child psychopathology on mothers’ depression, several important limitations must be acknowledged. Firm directional conclusions about the effects of youth psychopathology on maternal depression cannot be made given our retrospective accounts of stressor occurrence and youth diagnoses, as well as the lack of information about long-term patterns in the previous timing of maternal depression and youth disorders. Although maternal history of depression was controlled for in all analyses, doubtless maternal depression and its correlated risk factors contribute to the onset of youth disorders, with most depressed mothers experiencing symptomatic periods throughout the youth’s life. In addition, genetic factors affecting both maternal depression and youth diagnoses are also important variables in the transactions under study.
Thus, the current study shows a significant association between mother and youth symptomatology, mediated by current child-related stressors, but the pattern is inherently transactional. Findings are consistent with the idea that mothers’ depression is at least in part reactive to the challenges of dealing with a child with psychopathology and the stressors that accompany life with the child, above and beyond the effect of mothers’ prior history of depression. However, the study examines only a slice of what is doubtless an early-developing and continuing reciprocal interaction between child and mother experiences. Future studies with frequent short-term follow-ups, beginning in early childhood, would be necessary to resolve issues of temporal associations.
It should also be acknowledged that there is some potential for bias in the retrospective measure of stressor occurrence due to the fact that it was based on interviews with mothers. Multiple steps were taken to ensure that final ratings of acute and chronic stress were as objective as possible. Independent raters blind to mothers’ diagnostic status and subjective reactions to events rated the objective severity of events using behaviorally-specific anchors. In addition, mothers’ history of depression was controlled for in all analyses to attempt to control for the effects of maternal depression on the relationships being studied. Nevertheless, it remains possible that depressed mothers might have responded to prompts about the mother-child relationship and the nature of past stressful events differently than non-depressed mothers, thereby affecting final ratings of objective stress.
It is also important to emphasize that maternal depression doubtless reflects responses to a variety of other factors besides child-related stressors. Thus, mothers were experiencing and likely reactive to non-child negative events and chronic conditions, in addition to child-related stressors. The onset and trajectory of maternal depression were therefore likely influenced by multiple risk factors, including stressors not examined in these analyses. Nevertheless, the results of the study indicated that stressors specific to the child are one mechanism by which child and mother disorders are associated, even when controlling for a stressful socioeconomic context. Finally, the current findings were limited to the mother-child relationship, and future research on the mutual influences of child behavior and paternal mental health is needed.
Despite these limitations, findings from the current study expand upon existing literature in several important ways. First, these results provide evidence for the effects of youth psychopathology on objective stress levels of multiple individuals within the family system. Adolescent individuals with depression have repeatedly been shown to generate elevated levels of acute stressors in their own lives (Hammen 1991
). However, the current study indicates that adolescents with a history of any psychopathology also generated elevated levels of acute and chronic stress in the lives of their mothers. Furthermore, stress generation within the mother-child relationship has significant implications for the mental health of mothers. That is, the current study highlights child-related stress as one specific mechanism of the effects of child psychopathology on maternal depression. Previous research has shown that children with elevated levels of externalizing behaviors increase parents’ subjective reports of stress (e.g., Baker et al., 2003
) and lead to more persistent and more severe trajectories of depressive symptoms in mothers (e.g., Gross et al., 2009
). However, this is the first known study to show that increases in stressful mother-child relationships (and not just mothers’ subjective experiences of stress) are one important pathway by which children’s behaviors increase mothers’ risk for depression.
These findings have important implications for the study and treatment of maternal depression, as well as child psychopathology. In particular, treatment needs to recognize the mutual effects of the child and parent on each other as one step in addressing the impact of child emotional and behavioral disorders on the entire family. Additionally, these results underscore the role of maladaptive cycles of psychopathology within the mother-child dyad in the onset and maintenance of maternal depression. Treatments for maternal depression might need to take into account problems in the mother-child relationship, including maladaptive interactions perpetuated by child misbehavior. In particular, it might be helpful to address the occurrence of child-related stressful events and/or chronic stress within the mother-child relationship in order to prevent some of the negative effects of youth psychopathology on maternal mental health.
Future studies in this area might explore whether certain types of child-related stressors are particularly detrimental to maternal mental health. For example, is confronting a child’s constant expulsions and suspensions from school more likely to lead to depression in mothers than dealing with repeated accidents due to the child’s careless behavior? The current study looked at all child-related stressors in aggregate, but research that explores child-related stress specificity could be especially useful in modifying current treatments for both youth psychopathology and maternal depression. In addition, it will be necessary to study the ways in which the effects of child psychopathology differ depending on the structure of the family. For example, it is possible that supportive intimate relationships might mitigate the effects of child psychopathology on maternal depression. Finally, future research might also employ more fine-grained measures of the onset and recurrence of child psychopathology, child related stressors, and maternal depressive episodes in order to gain a more detailed understanding of the subtle causal transactions among these three variables. Further exploration in each of these areas will create a more complete model of the complex family dynamics that play a role in the understanding and treatment of both child psychopathology and maternal depression.