Testing competing mediators of the association between pre-conception maternal depression and child health-related quality of life: the MatCH study
Maternal depression is a potent risk factor for poor child development across a number of domains but the mechanisms of transmission are poorly understood. This study aimed to test competing mediators of the association between pre-conception maternal depression and child psychosocial functioning. In 2016, mothers in the 1973–1978 cohort of the Australian Longitudinal Study on Women’s Health were asked to be part of the Mothers and their Children’s Health study and to complete surveys on the health of their three youngest children under 13 years. The current study includes children aged 0–12 years (N = 5532, M = 6.99 years, SD = 3.22 years) and their mothers (N = 2917). We used the CESD-10 to measure depression and the PedsQL to measure psychosocial functioning, and used multilevel structural equation modeling to test hypotheses. Pre-conception maternal depression was associated with poorer maternal mental health and parenting after birth. The effect of pre-conception maternal depression was mediated by post-birth maternal depression in children aged 0–4 years (unstandardized regression coefficient (B) = − 0.26, 95%CI − 0.38, − 0.13) and children aged 5–12 years (B = − 0.25, 95%CI − 0.34, − 0.16), and by post-birth maternal stress (B = − 0.04, 95%CI − 0.08, − 0.01), and parenting (B = − 0.03, 95%CI − 0.04, − 0.02) in children aged 5–12 years. Post-birth maternal depression was the strongest mediator. Pre-conception is the optimal time for depression intervention. Post-birth interventions should include a focus on reducing depression and improving negative parenting aspects such as hostility and discipline.
KeywordsMaternal depression Child health-related quality of life Mediators Parenting
The research on which this paper is based was conducted as part of the Australian Longitudinal Study on Women’s Health by the University of Queensland and The University of Newcastle. We are grateful to the Australian Government Department of Health for funding and to the women who provided the survey data.
MatCH is funded by the National Health and Medical Research Council (NHMRC) project grant (APP1059550). GM is supported by an NHMRC Principal Research Fellowship (APP1121844).
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
Ethics approval for this study was obtained from The University of Queensland and The University of Newcastle, and women provided written informed consent for themselves and their children. All procedures performed were in accordance with the ethical standards of the institutional and national research committees and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
- Ahun MN, Côté SM (2018) Maternal depressive symptoms and early childhood cognitive development: a review of putative environmental mediators. Arch Womens Ment Health. https://doi.org/10.1007/s00737-018-0870-x
- Australian Institute of Health and Welfare (2012) A picture of Australia’s children 2012. Canberra: AIHW. https://www.aihw.gov.au/getmedia/31c0a364-dbac-4e88-8761-d9c87bc2dc29/14116.pdf.aspx?inline=true. Accessed 14 Jan 2019
- Baker C, Kuhn L (2017) Mediated pathways from maternal depression and early parenting to children’s executive function and externalizing behaviour problems. Infant Child Dev 27:e2047. https://doi.org/10.1002/icd.2047
- Chojenta C, Loxton D, Lucke J (2012) How do previous mental health, social support, and stressful life events contribute to postnatal depression in a representative sample of Australian women? J Midwifery Womens Health 57:145–150. https://doi.org/10.1111/j.1542-2011.2011.00140.x CrossRefPubMedGoogle Scholar
- Chojenta C, William J, Martin MA, Byles J, Loxton D (2018) The impact of a history of poor mental health on health care costs in the perinatal period. Arch Womens Ment Health. https://doi.org/10.1007/s00737-018-0912-4
- Cohen NL (2017) Public health perspectives on depressive disorders. JHU Press, BaltimoreGoogle Scholar
- Dittrich K, Fuchs A, Bermpohl F, Meyer J, Führer D, Reichl C, Reck C, Kluczniok D, Kaess M, Hindi Attar C, Möhler E, Bierbaum AL, Zietlow AL, Jaite C, Winter SM, Herpertz SC, Brunner R, Bödeker K, Resch F (2018) Effects of maternal history of depression and early life maltreatment on children’s health-related quality of life. J Affect Disord 225:280–288CrossRefGoogle Scholar
- Field AP (2013) Discovering statistics using IBM SPSS statistics: and sex and drugs and rock ‘n’ roll, 4th edn. Sage, Los AngelesGoogle Scholar
- Furukawa T et al (1997) Screening for depression among first-visit psychiatric patients: comparison of different scoring methods for the Center for Epidemiologic Studies Depression Scale using receiver operating characteristic analyses. Psychiatry Clin Neurosci 51:71–78. https://doi.org/10.1111/j.1440-1819.1997.tb02910.x CrossRefPubMedGoogle Scholar
- Hammen C (2017) Maternal depression and the intergenerational transmission of depression. In: Cohen NL (ed) Public health perspectives on depressive disorders. John Hopkins University Press, Baltimore, pp 147–170Google Scholar
- Loxton D et al (2017) Cohort profile: the Australian Longitudinal Study on Women’s Health (ALSWH) 1989–95 cohort. Int J Epidemiol 47:391–392e. https://doi.org/10.1093/ije/dyx133
- Mishra GD, Moss K, Loos C, Dobson AJ, Davies PS, Loxton D, Hesketh KD, Koupil I, Bower C, Sly P, Tooth L (2018) MatCH (Mothers and their Children’s Health) Profile: offspring of the 1973-78 cohort of the Australian Longitudinal Study on Women’s Health. Longit Life Course Stud 9:351–375CrossRefGoogle Scholar
- Stephenson J, Heslehurst N, Hall J, Schoenaker DAJM, Hutchinson J, Cade JE, Poston L, Barrett G, Crozier SR, Barker M, Kumaran K, Yajnik CS, Baird J, Mishra GD (2018) Before the beginning: nutrition and lifestyle in the preconception period and its importance for future health. Lancet 391:1830–1841. https://doi.org/10.1016/S0140-6736(18)30311-8 CrossRefPubMedPubMedCentralGoogle Scholar
- US Department of Education (2001) Early Childhood Longitudinal Study, Birth Cohort. National Centre for Education Statistics, Washington, DCGoogle Scholar
- Zubrick SR, Lucas N, Westrupp EM, Nicholson JM (2014) Pareenting measures in the Longitudinal Study of Australian Children: construct validity and measurement quality, Waves 1 to 4. Department of Social Services, CanberraGoogle Scholar