Maternal Depression, Child Care Predict Child Behavior Later

Recurrent maternal depressive symptoms when children are toddlers are linked to behavioral problems at age 5 years, but formal child care at age 2 years may ameliorate this effect, according to the results of a questionnaire study reported Online First June 13 in Pediatrics.

"Maternal depression in toddlerhood has been linked to increased behavior problems in children," write Lynne C. Giles, PhD, from the Lifecourse and Intergenerational Health Research Group at the University of Adelaide in Adelaide, South Australia, and colleagues. "However, there is little information on whether nonmaternal child care in toddlerhood may ameliorate the effect of maternal depression on subsequent child behavior."

The investigators assessed the effect of maternal depressive symptoms during toddlerhood on children's behavior at age 5 years, as well as any moderating influence on this association of formal or informal child care during toddlerhood. The study sample consisted of 438 mothers and their children (227 girls and 211 boys). Questionnaires were administered to the mothers when their children were infants, toddlers, and 5 years old.

Internalizing, externalizing, and total behavior problems at age 5 years were significantly associated with recurrent, but not intermittent, maternal depressive symptoms when the children were 2 years old and 3.5 years old.

For children who received formal child care at 2 years, there was an ameliorating influence on the effect of recurrent maternal depressive symptoms on total behavioral problems at age 5 years. However, informal child care in toddlerhood was not associated with any significant benefit on subsequent behavioral problems.

"Recurrent, but not intermittent, maternal depressive symptoms when children were toddlers were associated with child behavior problems at age 5 years," the study authors write. "As little as half a day in formal child care at the age of 2 years significantly modified the effect of recurrent maternal depressive symptoms on total behavior problems. Formal child care for toddlers of depressed mothers may have positive benefits for the child's subsequent behavior."

Limitations of this study include those inherent in use of the Center for Epidemiologic Studies Depression Scale to measure maternal depressive symptoms, reliance on maternal reports of child behavior at age 5 years, and failure to measure the quality of nonmaternal care.

"In addition to a clinical response, it is important to consider public health responses to maternal depression and promote other pragmatic ways to improve mental health outcomes for both mother and child," the study authors conclude. "Policy-makers must recognize that the 'early years' of a child's life extend beyond infancy, with critical developmental stages (and parenting demands) occurring for at least another 2 years.... If replicated in other studies, our findings indicate that an extension of the perinatal depression–screening program for another few years after infancy warrants consideration."

The National Health and Medical Research Council supported this study. Dr. Giles's salary was funded in part by a Centre for Intergenerational Health Postdoctoral Fellowship and the National Health and Medical Research Council Australian Based Public Health Training Fellowship. The other study authors have disclosed no relevant financial relationships.