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Positive maternal mental health attenuates the associations between prenatal stress and children’s internalizing and externalizing symptoms

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Abstract

Positive maternal mental health can improve perceptions of stressful situations and promote the use of adaptive coping strategies. However, few studies have examined how positive maternal mental health affects children’s development. The aims of this study were to examine the associations between positive maternal mental health and children’s internalizing and externalizing symptoms, and to ascertain whether positive maternal mental health moderated the associations between prenatal stress and children’s internalizing and externalizing symptoms. This study is based on the Norwegian Mother, Father, and Child Cohort Study (MoBa), and comprised 36,584 mother–child dyads. Prenatal stress was assessed using 41 self-reported items measured during pregnancy. Positive maternal mental health (self-efficacy, self-esteem, and enjoyment) was assessed by maternal report during pregnancy and postpartum. Child internalizing and externalizing symptoms were assessed by maternal report at age 5. Structural equation modeling was used for analysis. Maternal self-efficacy, self-esteem, and enjoyment were negatively associated with internalizing and externalizing symptoms in males and females. The association between prenatal stress and internalizing symptoms in males was stronger at low than at high levels of maternal self-esteem and enjoyment, whereas for females, the association was stronger at low than at high levels of maternal self-esteem and self-efficacy. This study provides evidence of associations between positive maternal mental health and children’s mental health, and suggests that higher positive maternal mental health may buffer against the impacts of prenatal stress. Positive maternal mental health may represent an important intervention target to improve maternal–child well-being and foster intergenerational resilience.

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Acknowledgements

The Norwegian Mother, Father and Child Cohort Study is supported by the Norwegian Ministry of Health and Care Services and the Ministry of Education and Research. We are grateful to all the participating families in Norway who take part in this on-going cohort study. The consent given by the participants does not allow for storage of data on an individual level in repositories or journals. Researchers who want access to data sets for replication should submit an application to www.helsedata.no. Access to data sets requires approval from The Regional Committee for Medical and Health Research Ethics in Norway and an agreement with MoBa.

Funding

The present study was partially supported by the Research Council of Norway (RCN; project # 218373) and through RCN’s Centres of Excellence funding scheme, project # 262700, RCN’s guest research program, and the Canada Research Chairs program for Dr. Colman. Dr. Nilsen was supported by RCN (project # 296770). Dr. Torvik was supported by RCN (project #300668). Dr. Bekkhus was supported by RCN (project # 301004 and 288083). Dr. Gilman’s contribution to this research was supported by the Intramural Research Program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development. Dr. Khandaker acknowledges funding support from the Wellcome Trust, UK (grant code: 201486/Z/16/Z), the MQ: transforming Mental Health, UK (grant code: MQDS17/40), the Medical Research Council, UK (grant code: MC_PC_17213 and grant code: MR/S037675/1), and the BMA Foundation, UK (J Moulton grant 2019).

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Authors and Affiliations

  1. School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Room 308D, Ottawa, ON, K1G 5Z3, Canada

    Zahra M. Clayborne, Deshayne B. Fell & Ian Colman

  2. Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway

    Zahra M. Clayborne, Fartein Ask Torvik & Ian Colman

  3. Work Research Institute, OsloMet-Oslo Metropolitan University, Oslo, Norway

    Wendy Nilsen

  4. Department of Psychology, University of Oslo, Oslo, Norway

    Kristin Gustavson

  5. PROMENTA Research Centre, Department of Psychology, University of Oslo, Oslo, Norway

    Fartein Ask Torvik & Mona Bekkhus

  6. Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway

    Kristin Gustavson

  7. Social and Behavioral Sciences Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA

    Stephen E. Gilman

  8. Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Stephen E. Gilman

  9. Department of Psychiatry, University of Cambridge School of Clinical Medicine, Cambridge, UK

    Golam M. Khandaker

  10. Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK

    Golam M. Khandaker

  11. MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK

    Golam M. Khandaker

  12. Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK

    Golam M. Khandaker

  13. Children’s Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, ON, Canada

    Deshayne B. Fell

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  1. Zahra M. Clayborne
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  2. Wendy Nilsen
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  6. Stephen E. Gilman
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  9. Ian Colman
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Correspondence to Zahra M. Clayborne.

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This study was approved by The Regional Committees for Medical and Health Research Ethics (#2013/2061). The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008.

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Clayborne, Z.M., Nilsen, W., Torvik, F.A. et al. Positive maternal mental health attenuates the associations between prenatal stress and children’s internalizing and externalizing symptoms. Eur Child Adolesc Psychiatry 32, 1781–1794 (2023). https://doi.org/10.1007/s00787-022-01999-4

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