These results are consistent with the hypothesis that adverse outcomes in children exposed to maternal depression are also dependent upon the presence or absence of paternal psychopathology (Goodman & Golib, 1999
). Mothers who experienced depression in their toddlers’ lives were more likely to have spouses/partners who also experienced psychopathology in their toddlers’ lives, a finding that is consistent with numerous epidemiological studies that suggest the reciprocal influence of psychiatric illness on spouses (Dierker et al., 1999
; Merikangas, 1984
). As predicted, paternal psychopathology moderated the effects of maternal depression on toddlers’ behavior problems: Toddlers were more likely to have higher rates of behavior problems in the case where fathers have met criteria for a psychiatric illness and mothers have a history of depression at some point since the toddlers’ birth. However, it is important to note that these mean scores on the CBCL were within the normal range and not indicative of a psychiatric disorder. The absence of paternal psychopathology, however, was related to lower scores of behavior problems in toddlers whose mothers had experienced a past episode of depression but were not currently depressed.
Although similar findings have been reported in samples of older children and adolescents (Brennan, Hammen, Katz, & Le Brocque, 1999; Goodman et al., 1993
), this study adds to the developmental psychopathology literature by demonstrating the importance of fathers’ mental health history in assessing the effects of maternal depression on young
children. These findings point to the presence of psychopathology in fathers as a risk factor for toddlers’ externalizing behavior problems when mothers have been previously depressed, and for toddlers internalizing problems when mothers have either a history of or current depressive symptoms. In addition, this study is among the few that have investigated paternal internalizing disorders as a moderator of the relationship between maternal depression and young children’s behavior problems. Although paternal substance use disorder and antisocial personality disorder have been studied more extensively (see Phares, Fields, Kamboukos, & Lopez, 2005
), parental depression and/or anxiety may also present risk for toddlers’ behavior problems when mothers have a history of MDD. Paternal psychopathology may increase the likelihood of behavior problems in at-risk toddlers directly, as depressed and/or anxious fathers may provide inconsistent and permissive parenting, or indirectly, if they are less involved with caring for their children and leave depressed mothers sole responsibility for the daily behavioral management of toddlers.
Furthermore, maternal negativity was identified as a significant mediating pathway by which maternal depression predicted toddlers’ externalizing behavior problems. Higher levels of maternal negativity were significantly related to mothers’ current depressive symptoms, suggesting that maternal depression may manifest in high levels of irritability, which may be communicated to young children through mother–child interactions. High levels of negativity in the context of mother–child interactions may exacerbate young children’s non-compliance and poor emotion regulation and may negatively affect children’s emotional adjustment and behavioral problems in a manner similar to high levels of maternal criticism (Asarnow, Tompson, Hamilton, Goldstein, & Guthrie, 1994
; Goodman et al., 1994
; Hirshfeld, Biederman, Brody, Faraone, & Rosenbaum, 1997
). Maternal warmth did not differ between never depressed, past depressed, and current depressed mothers at Time 1 and did not mediate the relationship between maternal depression and later toddler behavior problems. This finding may suggest that positive aspects of maternal parenting are less influenced by maternal depression status and that maternal warmth may not be a strong pathway through which maternal depression negatively influences behavior problems in toddlers. Although maternal negative feedback at Time 3 did not mediate the relationship between maternal depression status at Time 1 and toddlers’ behavior problems at Time 3, it remained a significant, concurrent predictor of toddlers’ externalizing and internalizing problems. This suggests that high levels of concurrent maternal negative feedback are associated with toddlers’ behavior problems, above and beyond early exposure to maternal depression.
Findings from our study support the use of various indices of maternal depression for examining relationships between parental risk factors and toddlers’ maladjustment. Residual maternal depressive symptoms at Time 1, rather than a past episode of MDD, predicted more maternal negativity in mother–child interactions 7 months later (Time 2), suggesting that maternal negativity toward toddlers are more influenced by residual, more continuous symptoms of depression. Maternal negativity may be significantly reduced when mothers’ depressive symptoms remit, as evidenced by the comparable levels of negativity observed in mothers who experienced past episodes of MDD but were not currently depressed at Time 1 and mothers with no history of MDD. Similarly, there was a significant interaction between paternal psychopathology and residual maternal depression at Time 1 in predicting toddlers’ Internalizing behavior problems at Time 3.
In contrast, two significant interactions emerged between paternal psychopathology and past episodes of maternal depression in predicting toddlers’ externalizing and internalizing behavior problems. One interpretation of these findings suggest that maternal history of depression remains a salient risk factor for negative outcomes in young children, particularly in situations where there is an increased family loading for psychopathology, regardless of whether mothers experience residual depressive symptoms. However, this finding may be spurious and better accounted for by other correlates of paternal psychopathology, such as marital conflict (see Davies, Harold, Goeke-Morey, & Cummings, 2002
Limitations of This Study
The primary limitation of our study is that maternal report was used to obtain indices of maternal depression at Time 1 and paternal psychopathology status at Time 3, as well as the outcome measures of toddler behavior problems at Time 3. Data from multiple informants are necessary to reduce the likelihood of single reporter bias, particularly with depressed mothers (Chilcoat & Breslau, 1997
). However, there was no evidence of a pervasive negative bias in depressed mothers’ reports of paternal psychopathology and toddlers’ behavior problems. This may be related to the fact that the majority of mothers with a previous history of MDD were not currently depressed at the time these data were collected (67%). Although recently depressed mothers (and mothers with a history of MDD) reported higher rates of paternal psychopathology, recently depressed mothers did not rate their children as having higher rates of behavior problems than never depressed mothers. In addition, a significant correlation in the predicted direction between the observational measure of maternal negativity and maternal negative feedback during mother–child interaction and CBCL ratings suggest that mothers’ ratings of toddlers’ behavior problems were not simply a result of a negative reporting bias. Furthermore, regression analyses controlling for maternal depression status at Time 1 continued to yield significant relationships between paternal psychopathology, maternal behavior during mother–child interactions, and toddlers’ behavior problems.
Depressed mothers may still provide researchers valid information about children and family environments (Biederman, Mick, & Faraone, 1997
; Ingersoll & Eist, 1998
). For example, the validity of maternal reports of paternal psychopathology is supported and is a frequently used methodology in family studies of psychopathology (Caspi et al., 2001
). Despite the concern that maternal of report of fathers’ psychiatric history may inflate effects, maternal report have been found to provide more conservative
estimates of paternal psychopathology than fathers’ self-report (Connell & Goodman, 2002
). Thus, the findings presented in our study may underestimate, rather than overestimate, the effects of paternal psychopathology on toddlers’ behavior problems.
An additional limitation of our study is its generalizability to community samples of depressed mothers. The majority of mothers described in this article evidenced depressive symptoms so severe that they sought psychiatric treatment in the first 6 months of their infants’ lives and opted for a combination of psychotherapy and antidepressant medication to reduce their emotional distress and functional impairment. As the larger population of depressed mothers typically does not seek psychiatric treatment, one possibility is that the results presented in our study overestimate the negative affects of maternal depression on later toddlers’ externalizing and internalizing problems. However, depressed mothers who do not seek psychiatric treatment may have formidable psychosocial barriers that prevent them from receiving help and may still evidence severe symptoms that interfere with sensitive and effective parenting. Indeed, the clinical sample of mothers in this study had high education levels and consisted of predominantly middle to high socioeconomic status, which may have facilitated their receipt of treatment for depression.
Implications for Research, Policy, and Practice
Maternal depression and co-occurring family risk factors contribute to increased behavior problems in young children. In our study, negative maternal feedback mediated the effects of current maternal depression on toddlers’ behavior problems. Toddlers who experienced both maternal depression and paternal psychopathology in their lives had the highest scores of behavior problems. These findings suggest the importance of investigating other risks associated with maternal depression, particularly those in the family context. These results also argue for examining maternal negativity in the context of mother–child interactions and paternal psychopathology as respective mediators and moderators of maladjustment of young children who have experienced maternal depression.
Findings from this study also support the use of early psychosocial clinical interventions that target negative interaction styles in mothers who have experienced a postpartum depression to decrease toddlers’ risk for later behavioral problems. Existing parent training programs, such as Parent-Child Interaction Therapy (Eyberg, Boggs, & Algina, 1995
), Incredible Years Program (Webster-Stratton & Hammond, 1997
), and the Home Visiting Family Support Program (Lyons-Ruth & Melnick, 2004
), are examples of empirically-supported therapies for preschool children experiencing emotional and behavior problems. Although they do not address maternal depression or paternal psychopathology specifically, each are flexible enough to accommodate some discussion of how parental mood may affect negativity toward toddlers and increased negative feedback. Cicchetti and colleagues’ Toddler–Parent Psychotherapy (Cicchetti, Rogosch, & Toth, 2000
; Toth, Rogosch, Manly, & Cicchetti, 2006
) is another example of a psychosocial treatment for improving the attachment security of toddlers with depressed mothers. Future directions for intervention include an integrated psychosocial treatment that addresses and reduces both maternal depression and behavior problems in toddlers.