Skip to main content

Advertisement

SpringerLink
Log in

Associations Between Maternal Mental Health and Child Emotional and Behavioral Problems: Does Prenatal Mental Health Matter?

  • Published:
Journal of Abnormal Child Psychology Aims and scope Submit manuscript

Abstract

This study examined associations between elevated symptoms of prenatal depression or anxiety and offspring emotional and behavioral problems during mid to late childhood taking into account the impact of later maternal mental health symptoms. The sample consisted of 2,891 women and their children (49 % male) from a prospective, community-based study, the Avon Longitudinal Study of Parents and Children. Women completed measures of depressive (Edinburgh Postnatal Depression Scale) and anxious (Crown Crisp Experiential Index) symptoms at regular intervals beginning in pregnancy. Mothers and teachers assessed offspring emotional and behavioral problems using the Strengths and Difficulties Questionnaire when children were 10–11 years old. Multivariable regression models were fit to address study hypotheses. Exposure to elevated symptoms of maternal depression during pregnancy was associated with increased total offspring emotional and behavioral problems, even after controlling for later maternal mental health problems and a range of sociodemographic and psychosocial characteristics, according to mothers’ but not teachers’ reports. Similarly, children exposed to elevated symptoms of maternal anxiety during pregnancy were reported to have increased total emotional and behavioral problems by mothers but not by teachers. We found support for modest associations between elevated symptoms of maternal depression and anxiety during the prenatal period and certain domains of offspring emotional and behavioral problems in mid to late childhood above and beyond the impact of later maternal mental health problems. These findings highlight the need for additional clinical and research attention to the prenatal period and to both maternal depression and anxiety.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Achenbach, T. M., McConaughy, S. H., & Howell, C. T. (1987). Child/adolescent behavioral and emotional problems: implications of cross-informant correlations for situational specificity. Psychological Bulletin, 101, 213–232.

    Article  PubMed  Google Scholar 

  • Ackermann, R., & DeRubeis, R. J. (1991). Is depressive realism real? Clinical Psychology Review, 11, 565–584.

    Article  Google Scholar 

  • Allen, N. B., Lewinsohn, P. M., & Seeley, J. R. (1998). Prenatal and perinatal influences on risk for psychopathology in childhood and adolescence. Development and Psychopathology, 10, 513–529.

    Article  PubMed  Google Scholar 

  • Barker, E. D., Jaffee, S. R., Uher, R., & Maughan, B. (2011). The contribution of prenatal and postnatal maternal anxiety and depression to child maladjustment. Depression and Anxiety, 28, 696–702.

    Article  PubMed  Google Scholar 

  • Bennett, H. A., Einarson, A., Taddio, A., Koren, G., & Einarson, T. R. (2004). Prevalence of depression during pregnancy: systematic review. Obstetrics and Gynecology, 103, 698–709.

    Article  PubMed  Google Scholar 

  • Bora, S., Pritchard, V. E., Moor, S., Austin, N. C., & Woodward, L. J. (2011). Emotional and behavioural adjustment of children born very preterm at early school age. Journal of Paediatrics and Child Health, 47, 863–869.

    Article  PubMed  Google Scholar 

  • Boyle, M. H., & Pickles, A. (1997). Influence of maternal depressive symptoms on ratings of childhood behavior. Journal of Abnormal Child Psychology, 25, 399–412.

    Article  PubMed  Google Scholar 

  • Briggs-Gowan, M. J., Carter, A. S., & Schwab-Stone, M. (1996). Discrepancies among mother, child, and teacher reports: examining the contributions of maternal depression and anxiety. Journal of Abnormal Child Psychology, 24, 749–765.

    Article  PubMed  Google Scholar 

  • Brown, J. D., Wissow, L. S., Gadomski, A., Zachary, C., Bartlett, E., & Horn, I. (2006). Parent and teacher mental health ratings of children using primary care services: inter-rater agreement and implications for mental health screening. Ambulatory Pediatrics, 6, 347–351.

    Article  PubMed Central  PubMed  Google Scholar 

  • Cox, J. (1994). Origins and development of the 10-item Edinburgh Postnatal Depression Scale. In J. Cox & J. Holden (Eds.), Perinatal psychiatry: Use and misuse of the Edinburgh Postnatal Depression Scale (pp. 115–124). London: Gaskell.

    Google Scholar 

  • Cox, J. L., Holden, J. M., & Sagovsky, R. (1987). Detection of postnatal depression: development of the 10-item Edinburgh Postnatal Depression Scale. The British Journal of Psychiatry, 150, 782–786.

    Article  PubMed  Google Scholar 

  • Crown, S., & Crisp, A. H. (1966). A short clinical diagnostic self-rating scale for psychoneurotic patients: the Middlesex Hospital Questionnaire (MHQ). The British Journal of Psychiatry, 112, 917.

    Article  PubMed  Google Scholar 

  • Davis, E. P., Glynn, L. M., Schetter, C. D., Hobel, C., Chicz-Demet, A., & Sandman, C. A. (2007). Prenatal exposure to maternal depression and cortisol influences infant temperament. Journal of the American Academy of Child and Adolescent Psychiatry, 46, 737–746.

    Article  PubMed  Google Scholar 

  • Davis, E. P., Glynn, L. M., Waffarn, F., & Sandman, C. A. (2011). Prenatal maternal stress programs infant stress regulation. Journal of Child Psychology and Psychiatry, 52, 119–129.

    Article  PubMed Central  PubMed  Google Scholar 

  • de Bruijn, A. T., van Bakel, H. J., & van Baar, A. L. (2009). Sex differences in the relation between prenatal maternal emotional complaints and child outcome. Early Human Development, 85, 319–324.

    Article  PubMed  Google Scholar 

  • Deave, T., Heron, J., Evans, J., & Emond, A. (2008). The impact of maternal depression in pregnancy on early child development. British Journal of Obstetrics and Gynaecology, 115, 1043–1051.

    Article  PubMed  Google Scholar 

  • Elliott, S. A., Leverton, T. J., Sanjack, M., Turner, H., Cowmeadow, P., … Bushnell, D. (2000). Promoting mental health after childbirth: A controlled trial of primary prevention of postnatal depression. British Journal of Clinical Psychology, 39, 223–241.

  • Evans, J., Heron, J., Francomb, H., Oke, S., & Golding, J. (2001). Cohort study of depressed mood during pregnancy and after childbirth. British Medical Journal, 323, 257–260.

    Article  PubMed  Google Scholar 

  • Fergusson, D. M., Lynskey, M. T., & Horwood, L. J. (1993). The effect of maternal depression on maternal ratings of child behavior. Journal of Abnormal Child Psychology, 21, 245–269.

    Article  PubMed  Google Scholar 

  • Field, T., Diego, M., Hernandez-Reif, M., Figueiredo, B., Deeds, O., … Kuhn, C. (2010). Comorbid depression and anxiety effects on pregnancy and neonatal outcome. Infant Behavior & Development, 33, 23–29.

    Google Scholar 

  • Golding, J., Pembrey, M., Jones, R., & the ALSPAC study team. (2001). ALSPAC—the Avon longitudinal study of parents and children. I. Study methodology. Paediatric and Perinatal Epidemiology, 15, 74–87.

    Article  PubMed  Google Scholar 

  • Goodman, R. (1997). The strengths and difficulties questionnaire: a research note. Journal of Child Psychology and Psychiatry, 38, 581–586.

    Article  PubMed  Google Scholar 

  • Harold, G. T., Rice, F., Hay, D. F., Boivin, J., van den Bree, M., & Thapar, A. (2011). Familial transmission of depression and antisocial behavior symptoms: disentangling the contribution of inherited and environmental factors and testing the mediating role of parenting. Psychological Medicine, 41, 1175–1185.

    Article  PubMed  Google Scholar 

  • Hay, D. F., Pawlby, S., Waters, C. S., & Sharp, D. (2008). Antepartum and postpartum exposure to maternal depression: different effects on different adolescent outcomes. Journal of Child Psychology and Psychiatry, 49, 1079–1088.

    Article  PubMed  Google Scholar 

  • Hay, D. F., Pawlby, S., Waters, C. S., Perra, O., & Sharp, D. (2010). Mothers’ antenatal depression and their children’s antisocial outcomes. Child Development, 81, 149–165.

    Article  PubMed  Google Scholar 

  • Heron, J., O’Connor, T. G., Evans, J., Golding, J., Glover, V., & the ALSPAC study team. (2004). The course of anxiety and depression through pregnancy and the postpartum in a community sample. Journal of Affective Disorders, 80, 65–73.

    Article  PubMed  Google Scholar 

  • Ibanez, G., Charles, M. A., Forhan, A., Magnin, G., Thiebaugeorges, O., … the EDEN Mother-Child Cohort Study Group (2012). Depression and anxiety in women during pregnancy and neonatal outcome: Data from the EDEN mother-child cohort. Early Human Development, 88, 643–649.

    Google Scholar 

  • Kaufman, J., & Charney, D. (2000). Comorbidity of mood and anxiety disorders. Depression and Anxiety, 12, 69–76.

    Article  PubMed  Google Scholar 

  • Kinsella, M. T., & Monk, C. (2009). Impact of maternal stress, depression and anxiety on fetal neurobehavioral development. Clinical Obstetrics and Gynecology, 52, 425–440.

    Article  PubMed Central  PubMed  Google Scholar 

  • Korhonen, M., Luoma, I., Salmelin, R., & Tamminen, T. (2012). A longitudinal study of maternal prenatal, postnatal, and concurrent depressive symptoms and adolescent well-being. Journal of Affective Disorders, 136, 680–692.

    Article  PubMed  Google Scholar 

  • Lazinski, M. J., Shea, A. K., & Steiner, M. (2008). Effects of maternal prenatal stress on offspring development: a commentary. Archives of Women’s Mental Health, 11, 363–375.

    Article  PubMed  Google Scholar 

  • Leech, S. L., Larkby, C. A., Day, R., & Day, N. L. (2006). Predictors and correlates of high levels of depression and anxiety symptoms among children at age 10. Journal of the American Academy of Child and Adolescent Psychiatry, 45, 223–230.

    Article  PubMed  Google Scholar 

  • Loomans, E. M., van der Stelt, O., van Eijsden, M., Gemke, R. J., Vrijkotte, T., & den Bergh, B. R. (2011). Antenatal maternal anxiety is associated with problem behaviour at age five. Early Human Development, 87, 565–570.

    Article  PubMed  Google Scholar 

  • Luoma, I., Tamminen, T., Kaukonen, P., Laippala, P., Puura, K., … Almqvist, F. (2001). Longitudinal study of maternal depressive symptoms and child well-being. Journal of the American Academy of Child & Adolescent Psychiatry, 40, 1367–1374.

  • Marcus, S. M. (2009). Depression during pregnancy: rates, risks and consequences–Motherisk update 2008. The Canadian Journal of Clinical Pharmacology, 16, 15–22.

    Google Scholar 

  • Miller, G. E., Chen, E., & Parker, K. J. (2011). Psychological stress in childhood and susceptibility to the chronic diseases of aging: moving toward a model of behavioral and biological mechanisms. Psychological Bulletin, 137, 959–997.

    Article  PubMed Central  PubMed  Google Scholar 

  • Miner, J. L., & Clarke-Stewart, K. A. (2008). Trajectories of externalizing behavior from age 2 to age 9: relations with gender, temperament, ethnicity, parenting, and rater. Developmental Psychology, 44, 771–786.

    Article  PubMed  Google Scholar 

  • Munafò, M. R., Heron, J., & Araya, R. (2008). Smoking patterns during pregnancy and postnatal period and depressive symptoms. Nicotine & Tobacco Research, 10, 1609–1620.

    Article  Google Scholar 

  • Murray, L., & Carothers, A. D. (1990). The validation of the Edinburgh Post-natal Depression Scale on a community sample. The British Journal of Psychiatry, 157, 288–290.

    Article  PubMed  Google Scholar 

  • Murray, D., & Cox, J. L. (1990). Screening for depression during pregnancy with the Edinburgh Depression Scale (EPDS). Journal of Reproductive and Infant Psychology, 8, 99–107.

    Article  Google Scholar 

  • Najman, J. M., Williams, G. M., Nikles, J., Spence, S., Bor, W., … Shuttlewood, G. J. (2001). Bias influencing maternal reports of child behaviour and emotional state. Social Psychiatry and Psychiatric Epidemiology, 36, 186–194.

    Google Scholar 

  • O’Connor, T. G., Heron, J., Golding, J., Beveridge, M., & Glover, V. (2002a). Maternal antenatal anxiety and children’s behavioural/emotional problems at 4 years: report from the Avon Longitudinal Study of Parents and Children. The British Journal of Psychiatry, 180, 502–508.

    Article  PubMed  Google Scholar 

  • O’Connor, T. G., Heron, J., Glover, V., & the ALSPAC study team. (2002b). Antenatal anxiety predicts child behavioral/emotional problems independently of postnatal depression. Journal of the American Academy of Child and Adolescent Psychiatry, 41, 1470–1477.

    Article  PubMed  Google Scholar 

  • O’Connor, T. G., Heron, J., Golding, J., Glover, V., & the ALSPAC study team. (2003). Maternal antenatal anxiety and behavioural/emotional problems in children: a test of a programming hypothesis. Journal of Child Psychology and Psychiatry, 44, 1025–1036.

    Article  PubMed  Google Scholar 

  • O’Connor, T. G., Ben-Shlomo, Y., Heron, J., Golding, J., Adams, D., & Glover, V. (2005). Prenatal anxiety predicts individual differences in cortisol in pre-adolescent children. Biological Psychiatry, 58, 211–217.

    Article  PubMed  Google Scholar 

  • Pajulo, M., Savonlahti, E., Sourander, A., Helenius, H., & Piha, J. (2001). Antenatal depression, substance dependency and social support. Journal of Affective Disorders, 65, 9–17.

    Article  PubMed  Google Scholar 

  • Papageorgiou, V., Kalyva, E., Dafoulis, V., & Vostanis, P. (2008). Differences in parents’ and teachers’ ratings of ADHD symptoms and other mental health problems. European Journal of Psychiatry, 22, 200–210.

    Article  Google Scholar 

  • Pawlby, S., Hay, D. F., Sharp, D., Waters, C. S., & O’Keane, V. (2009). Antenatal depression predicts depression in adolescent offspring: prospective longitudinal community-based study. Journal of Affective Disorders, 113, 236–243.

    Article  PubMed  Google Scholar 

  • Pearlstein, T., Howard, M., Salisbury, A., & Zlotnick, C. (2009). Postpartum depression. American Journal of Obstetrics and Gynecology, 200, 357–364.

    Article  PubMed  Google Scholar 

  • Phillips, J., Sharpe, L., Matthey, S., & Charles, M. (2009). Maternally focused worry. Archives of Women’s Mental Health, 12, 409–418.

    Article  PubMed  Google Scholar 

  • Reck, C., Struben, K., Backenstrass, M., Stefenelli, U., Reinig, K., … Mundt, C. (2008). Prevalence, onset and comorbidity of postpartum anxiety and depressive disorders. Acta Psychiatrica Scandinavica, 118, 459–468.

    Google Scholar 

  • Rice, F., Jones, I., & Thapar, A. (2007). The impact of gestational stress and prenatal growth on emotional problems in offspring: a review. Acta Psychiatrica Scandinavica, 117, 171–183.

    Article  Google Scholar 

  • Rice, F., Harold, G. T., Boivin, J., Hay, D. F., van den Bree, M., & Thapar, A. (2009). Disentangling prenatal and inherited influences in humans with an experimental design. Proceedings of the National Academy of Sciences of the United States of America, 106, 2464–2467.

    Article  PubMed Central  PubMed  Google Scholar 

  • Robinson, M., Mattes, E., Oddy, W. H., Pennell, C. E., Van Eekelen, A., McLean, N. J., … Newnham, J. P. (2011). Prenatal stress and risk of behavioral morbidity from age 2 to 14 years: The influence of the number, type, and timing of stressful life events. Development and Psychopathology, 23, 507–520.

  • Ross, L. E., Evans, S. E. G., Sellers, E. M., & Romach, M. K. (2003). Measurement issues in postpartum depression part 1: anxiety as a feature of postpartum depression. Archives of Women’s Mental Health, 6, 51–57.

    Article  PubMed  Google Scholar 

  • Sandman, C. A., Davis, E. P., Buss, C., & Glynn, L. M. (2012). Exposure to prenatal psychobiological stress exerts programming influences on the mother and her fetus. Neuroendocrinology, 95, 8–21.

    Article  Google Scholar 

  • Soares, R. M., Nunes, M. A., Schmidt, M. I., Giacomello, A., Manzolli, P., … Duncan, B. B. (2009). Inappropriate eating behaviors during pregnancy: Prevalence and associated factors among pregnant women attending primary care in southern Brazil. The International Journal of Eating Disorders, 42, 387–393.

  • Spielberger, C. D. (1983). Manual for the state-trait anxiety inventory. Palo Alto: Consulting Psychologists Press.

    Google Scholar 

  • StataCorp. (2009). Stata statistical software: Release 11. College Station: StataCorp.

    Google Scholar 

  • Stuart, S., Couser, G., Schilder, K., O’Hara, M., & Gorman, L. (1998). Postpartum anxiety and depression: onset and comorbidity in a community sample. The Journal of Nervous and Mental Disease, 186, 420–424.

    Article  PubMed  Google Scholar 

  • Talge, N. M., Neal, C., & Glover, V. (2007). Antenatal maternal stress and long-term effects on child neurodevelopment: how and why? Journal of Child Psychology and Psychiatry, 48, 245–261.

    Article  PubMed  Google Scholar 

  • Van den Bergh, B. R. H., & Marcoen, A. (2004). High antenatal maternal anxiety is related to ADHD symptoms, externalizing problems, and anxiety in 8- and 9-year-olds. Child Development, 75, 1085–1097.

    Article  PubMed  Google Scholar 

  • Van den Bergh, B. R., Van Calster, B., Smits, T., Van Huffel, S., & Lagae, L. (2007). Antenatal maternal anxiety is related to HPA-axis dysregulation and self-reported depressive symptoms in adolescence: a prospective study on the fetal origins of depressed mood. Neuropsychopharmacology, 33, 536–545.

    Article  PubMed  Google Scholar 

  • Vedhara, K., Metcalfe, C., Brant, H., Crown, A., Northstone, K., Dawe, K., … Smith, G. D. (2012). Maternal mood and neuroendocrine programming: effects of time of exposure and sex. Journal of Neuroendocrinology, 24, 999–1011.

    Google Scholar 

Download references

Acknowledgments

We are extremely grateful to all the families who took part in this study and the whole ALSPAC team. The UK Medical Research Council (Grant ref: 74882), the Wellcome Trust (Grant ref: 076467), and the University of Bristol provide core support for ALSPAC.

Author information

Authors and Affiliations

  1. Department of Pediatrics, Johns Hopkins University School of Medicine, 200 North Wolfe Street, Baltimore, MD, 21287, USA

    Julie A. Leis

  2. School of Social and Community Medicine, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, UK

    Jon Heron

  3. Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD, 21205, USA

    Elizabeth A. Stuart & Tamar Mendelson

Authors
  1. Julie A. Leis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jon Heron
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Elizabeth A. Stuart
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tamar Mendelson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Julie A. Leis.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Leis, J.A., Heron, J., Stuart, E.A. et al. Associations Between Maternal Mental Health and Child Emotional and Behavioral Problems: Does Prenatal Mental Health Matter?. J Abnorm Child Psychol 42, 161–171 (2014). https://doi.org/10.1007/s10802-013-9766-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10802-013-9766-4

Keywords

Search

Navigation