Social Psychiatry and Psychiatric Epidemiology

, Volume 50, Issue 11, pp 1743–1751 | Cite as

Mediated moderation of the relation between maternal and adolescent depressive symptoms: role of adolescent physical health

  • Mark A. Ferro
Original Paper



To examine the mediating effect of family functioning on the relation between maternal and adolescent depressive symptoms and determine whether the magnitude of the mediating effect is different for adolescents with and without chronic physical health conditions.


Data come from the National Longitudinal Survey of Children and Youth. A representative survey of 11,813 adolescents and their mothers was included. Maternal and adolescent depressive symptoms were measured using the 12-item Center for Epidemiological Studies Depression Scale. Family functioning was measured using the McMaster Family Assessment Device. Multilevel multiple-group path analysis was used to examine potential mediating and moderating effects.


Family functioning measured when adolescents were 14–15 years mediated the relation between maternal depressive symptoms (measured at 10–13 years) and adolescent depressive symptoms (measured at 16–19 years) for both adolescents with [αβ = 0.02 (0.02, 0.03)] and without chronic health conditions [αβ = 0.01 (0.00, 0.01)]. These findings provided evidence to suggest mediated moderation, Δαβ = 0.02 (0.01, 0.03), that is, the mediating effect of family functioning was significantly larger for adolescents with chronic health conditions.


The mediating effect of family functioning in the relation between maternal and adolescent depressive symptoms is larger for adolescents with chronic health conditions. Within the framework of family-centered care, maternal depressive symptoms and family functioning are suitable targets for preventive intervention for adolescents with chronic health conditions.


Adolescent Chronic condition Chronic illness Depression Family functioning Mothers Path analysis Stress 



This study was funded by a Hamilton Health Sciences New Investigator Grant (NIF-14355) awarded to Dr. Ferro. Dr. Ferro is also supported by the Hamilton Health Sciences Research Early Career Award.

Compliance with ethical standards

Conflict of interest

Hamilton Health Sciences had no involvement in the conduct of the research or the preparation of the manuscript. The author has no conflicts of interest to disclosure.


  1. 1.
    Goodman SH, Rouse MH, Connell AM, Broth MR, Hall CM, Heyward D (2011) Maternal depression and child psychopathology: a meta-analytic review. Clin Child Fam Psychol Rev 14(1):1–27. doi: 10.1007/s10567-010-0080-1 CrossRefPubMedGoogle Scholar
  2. 2.
    Garber J, Rao U (2014) Depression in children and adolescents. In: Lewis M, Rudolph KD (eds) Handbook of developmental psychopathology, 3rd edn. Springer Science + Business Media, New YorkGoogle Scholar
  3. 3.
    Elgar FJ, McGrath PJ, Waschbusch DA, Stewart SH, Curtis LJ (2004) Mutual influences on maternal depression and child adjustment problems. Clin Psychol Rev 24(4):441–459. doi: 10.1016/j.cpr.2004.02.002 CrossRefPubMedGoogle Scholar
  4. 4.
    Schmitt F, Santalahti P, Saarelainen S, Savonlahti E, Romer G, Piha J (2008) Cancer families with children: factors associated with family functioning—a comparative study in Finland. Psychooncology 17(4):363–372. doi: 10.1002/pon.1241 CrossRefPubMedGoogle Scholar
  5. 5.
    Shiner RL, Marmorstein NR (1998) Family environments of adolescents with lifetime depression: associations with maternal depression history. J Am Acad Child Adolesc Psychiatry 37(11):1152–1160CrossRefPubMedGoogle Scholar
  6. 6.
    Bond L, Toumbourou JW, Thomas L, Catalano RF, Patton G (2005) Individual, family, school, and community risk and protective factors for depressive symptoms in adolescents: a comparison of risk profiles for substance use and depressive symptoms. Prev Sci 6(2):73–88CrossRefPubMedGoogle Scholar
  7. 7.
    Wood BL, Miller BD, Lim J, Lillis K, Ballow M, Stern T, Simmens S (2006) Family relational factors in pediatric depression and asthma: pathways of effect. J Am Acad Child Adolesc Psychiatry 45(12):1494–1502. doi: 10.1097/01.chi.0000237711.81378.46 CrossRefPubMedGoogle Scholar
  8. 8.
    Queen AH, Stewart LM, Ehrenreich-May J, Pincus DB (2013) Mothers’ and fathers’ ratings of family relationship quality: associations with preadolescent and adolescent anxiety and depressive symptoms in a clinical sample. Child Psychiatry Hum Dev 44(3):351–360. doi: 10.1007/s10578-012-0329-7 CrossRefPubMedGoogle Scholar
  9. 9.
    Sellers R, Harold GT, Elam K, Rhoades KA, Potter R, Mars B, Craddock N, Thapar A, Collishaw S (2014) Maternal depression and co-occurring antisocial behaviour: testing maternal hostility and warmth as mediators of risk for offspring psychopathology. J Child Psychol Psychiatry 55(2):112–120. doi: 10.1111/jcpp.12111 PubMedCentralCrossRefPubMedGoogle Scholar
  10. 10.
    Hammen C, Brennan PA, Shih JH (2004) Family discord and stress predictors of depression and other disorders in adolescent children of depressed and nondepressed women. J Am Acad Child Adolesc Psychiatry 43(8):994–1002. doi: 10.1097/01.chi.0000127588.57468.f6 CrossRefPubMedGoogle Scholar
  11. 11.
    Westbrook TR, Harden BJ (2010) Pathways among exposure to violence, maternal depression, family structure, and child outcomes through parenting: a multigroup analysis. Am J Orthopsychiatry 80(3):386–400. doi: 10.1111/j.1939-0025.2010.01042.x CrossRefPubMedGoogle Scholar
  12. 12.
    Jaser SS, Whittemore R, Ambrosino JM, Lindemann E, Grey M (2008) Mediators of depressive symptoms in children with type 1 diabetes and their mothers. J Pediatr Psychol 33(5):509–519. doi: 10.1093/jpepsy/jsm104 PubMedCentralCrossRefPubMedGoogle Scholar
  13. 13.
    Lim J, Wood BL, Miller BD (2008) Maternal depression and parenting in relation to child internalizing symptoms and asthma disease activity. J Fam Psychol 22(2):264–273. doi: 10.1037/0893-3200.22.2.264 CrossRefPubMedGoogle Scholar
  14. 14.
    Lim J, Wood BL, Miller BD, Simmens SJ (2011) Effects of paternal and maternal depressive symptoms on child internalizing symptoms and asthma disease activity: mediation by interparental negativity and parenting. J Fam Psychol 25(1):137–146. doi: 10.1037/a0022452 PubMedCentralCrossRefPubMedGoogle Scholar
  15. 15.
    Perrin JM, Bloom SR, Gortmaker SL (2007) The increase of childhood chronic conditions in the United States. JAMA 297(24):2755–2759. doi: 10.1001/jama.297.24.2755 CrossRefPubMedGoogle Scholar
  16. 16.
    Ontario Association of Community Care Access Centres (2013) Health comes home: a conversation about children with complex health needs part 3Google Scholar
  17. 17.
    Pinquart M, Shen Y (2011) Depressive symptoms in children and adolescents with chronic physical illness: an updated meta-analysis. J Pediatr Psychol 36(4):375–384. doi: 10.1093/jpepsy/jsq104 CrossRefPubMedGoogle Scholar
  18. 18.
    Ferro MA, Gorter JW, Boyle MH (2015) Trajectories of depressive symptoms during the transition to young adulthood: the role of chronic illness. J Affect Disord 174(2015):594–601CrossRefPubMedGoogle Scholar
  19. 19.
    Ferro MA, Gorter JW, Boyle MH (2015) Trajectories of depressive symptoms in Canadian emerging adults. Am J Public Health. doi: 10.2105/AJPH.2015.302817 PubMedGoogle Scholar
  20. 20.
    Rhee H, Wenzel J, Steeves RH (2007) Adolescents’ psychosocial experiences living with asthma: a focus group study. J Pediatr Health Care 21(2):99–107. doi: 10.1016/j.pedhc.2006.04.005 CrossRefPubMedGoogle Scholar
  21. 21.
    Jacoby A, Austin JK (2007) Social stigma for adults and children with epilepsy. Epilepsia 48(suppl 9):6–9. doi: 10.1111/j.1528-1167.2007.01391.x CrossRefPubMedGoogle Scholar
  22. 22.
    Neurath MF (2014) Cytokines in inflammatory bowel disease. Nat Rev Immunol 14(5):329–342. doi: 10.1038/nri3661 CrossRefPubMedGoogle Scholar
  23. 23.
    Li G, Bauer S, Nowak M, Norwood B, Tackenberg B, Rosenow F, Knake S, Oertel WH, Hamer HM (2011) Cytokines and epilepsy. Seizure 20(3):249–256. doi: 10.1016/j.seizure.2010.12.005 CrossRefPubMedGoogle Scholar
  24. 24.
    Mills NT, Scott JG, Wray NR, Cohen-Woods S, Baune BT (2013) Research review: the role of cytokines in depression in adolescents: a systematic review. J Child Psychol Psychiatry 54(8):816–835CrossRefPubMedGoogle Scholar
  25. 25.
    Barnes PJ (2008) The cytokine network in asthma and chronic obstructive pulmonary disease. J Clin Investig 118(11):3546–3556. doi: 10.1172/JCI36130 PubMedCentralCrossRefPubMedGoogle Scholar
  26. 26.
    Juster RP, McEwen BS, Lupien SJ (2010) Allostatic load biomarkers of chronic stress and impact on health and cognition. Neurosci Biobehav Rev 35(1):2–16. doi: 10.1016/j.neubiorev.2009.10.002 CrossRefPubMedGoogle Scholar
  27. 27.
    McEwen BS (1998) Stress, adaptation, and disease. Allostasis and allostatic load. Ann N Y Acad Sci 840:33–44CrossRefPubMedGoogle Scholar
  28. 28.
    Bayliss EA, Steiner JF, Fernald DH, Crane LA, Main DS (2003) Descriptions of barriers to self-care by persons with comorbid chronic diseases. Ann Fam Med 1(1):15–21PubMedCentralCrossRefPubMedGoogle Scholar
  29. 29.
    Gijsen R, Hoeymans N, Schellevis FG, Ruwaard D, Satariano WA, van den Bos GA (2001) Causes and consequences of comorbidity: a review. J Clin Epidemiol 54(7):661–674CrossRefPubMedGoogle Scholar
  30. 30.
    Le TK, Curtis B, Kahle-Wrobleski K, Johnston J, Haldane D, Melfi C (2011) Treatment patterns and resource use among patients with comorbid diabetes mellitus and major depressive disorder. J Med Econ 14(4):440–447. doi: 10.3111/13696998.2011.588507 PubMedGoogle Scholar
  31. 31.
    Reigada LC, Bruzzese JM, Benkov KJ, Levy J, Waxman AR, Petkova E, Warner CM (2011) Illness-specific anxiety: implications for functioning and utilization of medical services in adolescents with inflammatory bowel disease. J Spec Pediatr Nurs 16(3):207–215. doi: 10.1111/j.1744-6155.2011.00292.x CrossRefPubMedGoogle Scholar
  32. 32.
    Richardson LP, Russo JE, Lozano P, McCauley E, Katon W (2008) The effect of comorbid anxiety and depressive disorders on health care utilization and costs among adolescents with asthma. Gen Hosp Psychiatry 30(5):398–406. doi: 10.1016/j.genhosppsych.2008.06.004 PubMedCentralCrossRefPubMedGoogle Scholar
  33. 33.
    Ferro MA, Avison WR, Campbell MK, Speechley KN (2011) Prevalence and trajectories of depressive symptoms in mothers of children with newly diagnosed epilepsy. Epilepsia 52(2):326–336. doi: 10.1111/j.1528-1167.2010.02899.x PubMedGoogle Scholar
  34. 34.
    Pak L, Allen PJ (2012) The impact of maternal depression on children with asthma. Pediatr Nurs 38(1):11–19, 30Google Scholar
  35. 35.
    Singer GH (2006) Meta-analysis of comparative studies of depression in mothers of children with and without developmental disabilities. Am J Ment Retard 111(3):155–169. doi:10.1352/0895-8017(2006)111[155:MOCSOD]2.0.CO;2Google Scholar
  36. 36.
    Burke L (2003) The impact of maternal depression on familial relationships. Int Rev Psychiatry 15(3):243–255. doi: 10.1080/0954026031000136866 CrossRefPubMedGoogle Scholar
  37. 37.
    Burke P, Elliott M (1999) Depression in pediatric chronic illness. A diathesis-stress model. Psychosomatics 40(1):5–17. doi: 10.1016/S0033-3182(99)71266-1 PubMedGoogle Scholar
  38. 38.
    Reichman NE, Corman H, Noonan K (2004) Effects of child health on parents’ relationship status. Demography 41(3):569–584CrossRefPubMedGoogle Scholar
  39. 39.
    van Dyck PC, Kogan MD, McPherson MG, Weissman GR, Newacheck PW (2004) Prevalence and characteristics of children with special health care needs. Arch Pediatr Adolesc Med 158(9):884–890. doi: 10.1001/archpedi.158.9.884 CrossRefPubMedGoogle Scholar
  40. 40.
    Noonan K, Riechman NE, Corman H (2005) New fathers labor supply: does child health matter? Soc Sci Q 85(suppl 1):1399–1417CrossRefGoogle Scholar
  41. 41.
    Ferro MA, Boyle MH, Avison WR (2015) Associations between trajectories of maternal depression and subsequent psychological functioning in youths with and without chronic illness. Health Psychol 34(8):820–828. doi: 10.1037/hea0000226 CrossRefPubMedGoogle Scholar
  42. 42.
    Pearlin LI (1999) The Stress Process Model revisited. In: Aneshensel CS, Phelan JC (eds) Handbook of the sociology of mental health. Kluwer Academic/Phenum Publishers, New YorkGoogle Scholar
  43. 43.
    Avison WR, Aneshensel CS, Schieman S, Wheaton B (eds) (2010) Advances in the conceptualization of the stress process. Essays in honor of Leonard I. Pearlin. Springer, New YorkGoogle Scholar
  44. 44.
    Mitrani VB, Lewis JE, Feaster DJ, Czaja SJ, Eisdorfer C, Schulz R, Szapocznik J (2006) The role of family functioning in the stress process of dementia caregivers: a structural family framework. Gerontologist 46(1):97–105PubMedCentralCrossRefPubMedGoogle Scholar
  45. 45.
    Avison WR, Turner RJ (1988) Stressful life events and depressive symptoms: disaggregating the effects of acute stressors and chronic strains. J Health Soc Behav 29(3):253–264CrossRefPubMedGoogle Scholar
  46. 46.
    Ferro MA, Avison WR, Campbell MK, Speechley KN (2011) The impact of maternal depressive symptoms on health-related quality of life in children with epilepsy: a prospective study of family environment as mediators and moderators. Epilepsia 52(2):316–325. doi: 10.1111/j.1528-1167.2010.02769.x PubMedGoogle Scholar
  47. 47.
    Cairney J, Rigoli D, Piek J (2013) Developmental coordination disorder and internalizing problems in children: the environmental stress hypothesis elaborated. Dev Rev 33(3):224–238CrossRefGoogle Scholar
  48. 48.
    Mossakowski KN (2013) Disadvantaged family background and depression among young adults in the United States: the roles of chronic stress and self-esteem. Stress Health 31(1):52–62. doi: 10.1002/smi.2526 CrossRefPubMedGoogle Scholar
  49. 49.
    Statistics Canada (2007) Microdata user guide: National Longitudinal Survey of Children and Youth, cycle 8 September 2008 to July 2009. Statistics Canada. Accessed 15 February 2013
  50. 50.
    Radloff LS (1977) The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas 1(3):385–401CrossRefGoogle Scholar
  51. 51.
    Poulin C, Hand D, Boudreau B (2005) Validity of a 12-item version of the CES-D used in the National Longitudinal Study of children and youth. Chronic Dis Can 26(2–3):65–72PubMedGoogle Scholar
  52. 52.
    Byles J, Byrne C, Boyle MH, Offord DR (1988) Ontario child health study: reliability and validity of the general functioning subscale of the Mcmaster family assessment device. Fam Process 27(1):97–104CrossRefPubMedGoogle Scholar
  53. 53.
    Epstein NB, Baldwin LM, Bishop DS (1983) The McMaster Family Assessment Device. J Marital Fam Ther 9(2):171–180CrossRefGoogle Scholar
  54. 54.
    Stein RE, Silver EJ (1999) Operationalizing a conceptually based noncategorical definition: a first look at US children with chronic conditions. Arch Pediatr Adolesc Med 153(1):68–74CrossRefPubMedGoogle Scholar
  55. 55.
    MacKinnon DP (2008) Introduction to statistical mediation analysis. Erlbaum Psych Press, HobokenGoogle Scholar
  56. 56.
    Muller D, Judd CM, Yzerbyt VY (2005) When moderation is mediated and mediation is moderated. J Pers Soc Psychol 89(6):852–863. doi: 10.1037/0022-3514.89.6.852 CrossRefPubMedGoogle Scholar
  57. 57.
    Zou GY, Donner A (2008) Construction of confidence limits about effect measures: a general approach. Stat Med 27(10):1693–1702. doi: 10.1002/sim.3095 CrossRefPubMedGoogle Scholar
  58. 58.
    Schreiber JB, Nora A, Stage FK, Barlow EA, King J (2006) Reporting structural equation modeling and confirmatory factor analysis results: a review. J Educ Res 99(6):323–337CrossRefGoogle Scholar
  59. 59.
    Sterne JA, White IR, Carlin JB, Spratt M, Royston P, Kenward MG, Wood AM, Carpenter JR (2009) Multiple imputation for missing data in epidemiological and clinical research: potential and pitfalls. BMJ 338:b2393. doi: 10.1136/bmj.b2393 PubMedCentralCrossRefPubMedGoogle Scholar
  60. 60.
    Weersing V, Brent DA (2010) Treating depression in adolescents using individual cognitive-behavioral therapy. In: Weisz JR, Kazdin AE (eds) Evidence-based psychotherapies for children and adolescents, 2nd edn. Guilford Press, New YorkGoogle Scholar
  61. 61.
    Szigethy E, Kenney E, Carpenter J, Hardy DM, Fairclough D, Bousvaros A, Keljo D, Weisz J, Beardslee WR, Noll R, DeMaso DR (2007) Cognitive-behavioral therapy for adolescents with inflammatory bowel disease and subsyndromal depression. J Am Acad Child Adolesc Psychiatry 46(10):1290–1298. doi: 10.1097/chi.0b013e3180f6341f CrossRefPubMedGoogle Scholar
  62. 62.
    Thompson RD, Craig A, Crawford EA, Fairclough D, Gonzalez-Heydrich J, Bousvaros A, Noll RB, DeMaso DR, Szigethy E (2012) Longitudinal results of cognitive behavioral treatment for youths with inflammatory bowel disease and depressive symptoms. J Clin Psychol Med Settings 19(3):329–337. doi: 10.1007/s10880-012-9301-8 CrossRefPubMedGoogle Scholar
  63. 63.
    Szigethy E, Whitton SW, Levy-Warren A, DeMaso DR, Weisz J, Beardslee WR (2004) Cognitive-behavioral therapy for depression in adolescents with inflammatory bowel disease: a pilot study. J Am Acad Child Adolesc Psychiatry 43(12):1469–1477. doi: 10.1097/01.chi.0000142284.10574.1f CrossRefPubMedGoogle Scholar
  64. 64.
    American Academy of Pediatrics (2012) Patient- and family-centered care and the pediatrician’s role. Pediatrics 129(2):394–404. doi: 10.1542/peds.2011-3084 CrossRefGoogle Scholar
  65. 65.
    Institute of Medicine (2001) Crossing the quality chasm: a new health system for the 21st century, vol 6. National Academy Press, WashingtonGoogle Scholar
  66. 66.
    De Los Reyes A, Kazdin AE (2005) Informant discrepancies in the assessment of childhood psychopathology: a critical review, theoretical framework, and recommendations for further study. Psychol Bull 131(4):483–509. doi: 10.1037/0033-2909.131.4.483 CrossRefGoogle Scholar
  67. 67.
    Ferro MA, Boyle MH (2013) Self-concept among children and adolescents with a chronic illness: a meta-analytic review. Health Psychol 32(8):839–848CrossRefPubMedGoogle Scholar
  68. 68.
    Avison WR, Davies L, Willson AE, Shuey KM (2008) Family structure and mothers’ mental health: a life course perspective on stability and change. In: Turner HA, Schieman S (eds) Stress processes across the life course. Advances in life course research, vol 13. vol 1. Elsevier, New York, pp 233–255Google Scholar
  69. 69.
    Steeger CM, Gondoli DM (2013) Mother-adolescent conflict as a mediator between adolescent problem behaviors and maternal psychological control. Dev Psychol 49(4):804–814. doi: 10.1037/a0028599 PubMedCentralCrossRefPubMedGoogle Scholar
  70. 70.
    Elgar FJ, Curtis LJ, McGrath PJ, Waschbusch DA, Stewart SH (2003) Antecedent-consequence conditions in maternal mood and child adjustment: a four-year cross-lagged study. J Clin Child Adolesc Psychol 32(3):362–374CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  1. 1.Department of Psychiatry and Behavioural NeurosciencesMcMaster UniversityHamiltonCanada
  2. 2.Department of PediatricsMcMaster UniversityHamiltonCanada
  3. 3.Department of Clinical Epidemiology and BiostatisticsMcMaster UniversityHamiltonCanada

Personalised recommendations