Maternal and Child Health Journal

, Volume 17, Issue 6, pp 1030–1037

Characteristics of Mothers with Depressive Symptoms Outside the Postpartum Period

  • David G. Rosenthal
  • Nicole Learned
  • Ying-Hua Liu
  • Michael Weitzman


Numerous studies have investigated the deleterious effects of maternal depression on child outcomes. Knowledge of characteristics of these mothers is incomplete, as most studies utilize small samples or limit investigation to the postpartum period. Utilizing data from a nationally representative sample of 7,211 fathers and mothers living in households with children aged 5–17 years who participated in the Medical Expenditure Panel Survey (MEPS) 2004–2006, the Patient Health Questionnaire-2 (PHQ-2) was used to assess parental depressive symptoms, the Short Form-12 (SF-12) was used to examine paternal and maternal physical health, and the Columbia Impairment Scale was used to measure child behavioral or emotional problems. In multivariate analyses, maternal unemployment (AOR 1.76, 95 % CI 1.31–2.35); living with smokers (AOR 1.82, 95 % CI 1.12–2.94); poor maternal physical health (AOR 2.31; 95 % CI 1.81–2.94); living with children with behavioral or emotional problems (AOR 2.95, 95 % CI 2.30–3.96); and paternal depressive symptoms (AOR 5.11, 95 % CI 1.97–13.25) each were independently associated with increased rates of maternal depressive symptoms. This paper is the first we are aware of to use a nationally representative sample to investigate characteristics associated with maternal depressive symptoms and found that maternal unemployment, living with smokers, poor maternal physical health, having children with behavioral or emotional problems, and paternal depressive symptoms are each independently associated with maternal depressive symptoms. In these data, paternal depressive symptoms are associated with the greatest risk of mothers exhibiting depressive symptoms, a finding that we believe has never before been shown.


Maternal depressive symptoms Child behavior Child emotional problems 



Adjusted odds ratio


Medical expenditure panel survey


Confidence interval


Composite international diagnostic interview


Columbia impairment scale


Children with special health care needs


Diagnostic and statistical manual of mental disorders IV


Hypothalamic pituitary adrenal


Mental component score


National Institute of Child Health and Human Development


National health interview survey


Physical component scale


Patient health questionnaire-2


Short-form 12


Secondhand smoke


  1. 1.
    Wang, L., Wu, T. J., Anderson, J. L., & Florence, J. E. (2011). Prevalence and risk factors of maternal depression during the first three years of child rearing. Journal of Womens Health, 20(5), 711–718.CrossRefGoogle Scholar
  2. 2.
    Ohara, M. W., & Swain, A. M. (1996). Rates and risk of postpartum depression—a meta-analysis. International Review of Psychiatry, 8(1), 37–54.CrossRefGoogle Scholar
  3. 3.
    Hobfoll, S. E., Ritter, C., Lavin, J., Hulsizer, M. R., & Cameron, R. P. (1995). Depression prevalence and incidence among inner-city pregnant and postpartum women. Journal of Consulting and Clinical Psychology, 63(3), 445–453.PubMedCrossRefGoogle Scholar
  4. 4.
    Elgar, F. J., McGrath, P. J., Waschbusch, D. A., Stewart, S. H., & Curtis, L. J. (2004). Mutual influences on maternal depression and child adjustment problems. Clinical Psychology Review, 24(4), 441–459.PubMedCrossRefGoogle Scholar
  5. 5.
    Ashman, S., Dawson, G., Panagiotides, H., Yamada, E., & Wilkinson, C. (2002). Stress hormone levels of children of depressed mothers. Development and Psychopathology, 14(2), 333–349.PubMedCrossRefGoogle Scholar
  6. 6.
    Da Costa, D., Larouche, J., Dritsa, M., & Brender, W. (2000). Psychosocial correlates of prepartum and postpartum depressed mood. Journal of Affective Disorders, 59(1), 31–40.PubMedCrossRefGoogle Scholar
  7. 7.
    Field, T., & Diego, M. (2008). Maternal depression effects on infant frontal EEG asymmetry. International Journal of Neuroscience, 118(8), 1081–1108.PubMedCrossRefGoogle Scholar
  8. 8.
    Field, T., Diego, M., Hernandez Reif, M., Schanberg, S., & Kuhn, C. (2002). Right frontal EEG and pregnancy/neonatal outcomes. Psychiatry, 65(1), 35–47.PubMedGoogle Scholar
  9. 9.
    Weissman, M. M., John, K., Merikangas, K. R., et al. (1986). Depressed parents and their children. General health, social, and psychiatric problems. American Journal of Diseases of Children, 140(8), 801–805.PubMedGoogle Scholar
  10. 10.
    Weissman, M., Feder, A., Pilowsky, D., et al. (2004). Depressed mothers coming to primary care: Maternal reports of problems with their children. Journal of Affective Disorders, 78(2), 93–100.PubMedCrossRefGoogle Scholar
  11. 11.
    World Health Organization. (2009). Mental health aspects of women’s reproductive health: A global review of the literature. Geneva: World Health Organization.Google Scholar
  12. 12.
    Rahman, A., Harrington, R., & Bunn, J. (2002). Can maternal depression increase infant risk of illness and growth impairment in developing countries? Child: Care, Health and Development, 28(1), 51–56.CrossRefGoogle Scholar
  13. 13.
    Weissman, M., Pilowsky, D., Wickramaratne, P., et al. (2006). Remissions in maternal depression and child psychopathology: A STAR*D-child report. JAMA (Chicago, Ill.), 295(12), 1389–1398.Google Scholar
  14. 14.
    Giles, L. C., Davies, M. J., Whitrow, M. J., Warin, M. J., & Moore, V. (2011). Maternal depressive symptoms and child care during toddlerhood relate to child behavior at age 5 years. Pediatrics, 128(1), E78–E84.PubMedCrossRefGoogle Scholar
  15. 15.
    Jesse, D. E., & Swanson, M. (2007). Risks and resources associated with antepartum risk for depression among rural southern women. Nursing Research, 56(6), 378–386.PubMedCrossRefGoogle Scholar
  16. 16.
    Rosenthal, D. G., Learned, N., Liu, Y-H., & Weitzman, M. (2012). Characteristics of fathers with depressive symptoms. Maternal and Child Health Journal. doi:10.1007/s10995-012-0955-5.
  17. 17.
    Cohen, S. (2003) Design strategies and innovations in the medical expenditure panel survey. Medical care 41(7 Suppl), III5–III12.Google Scholar
  18. 18.
    Weitzman, M., Rosenthal, D. G., & Liu, Y.-H. (2011). Paternal depressive symptoms and child behavioral or emotional problems in the United States. Pediatrics, 128(6), 1126–1134.PubMedCrossRefGoogle Scholar
  19. 19.
    Bronfenbrenner, U. (1977). Toward an experimental ecology of human-development. American Psychologist, 32(7), 513–531.CrossRefGoogle Scholar
  20. 20.
    US Bureau of Labor Statistics. (2009). How the government measures unemployment. U.S. Bureau of Labor Statistics: Labor Force Statistics from the Current Population Study.Google Scholar
  21. 21.
    Jenkinson, C., Chandola, T., Coulter, A., & Bruster, S. (2001). An assessment of the construct validity of the SF-12 summary scores across ethnic groups. Journal of Public Health Medicine, 23(3), 187–194.PubMedCrossRefGoogle Scholar
  22. 22.
    Jenkinson, C., Layte, R., Jenkinson, D., et al. (1997). A shorter form health survey: can the SF-12 replicate results from the SF-36 in longitudinal studies? Journal of Public Health Medicine, 19(2), 179–186.PubMedCrossRefGoogle Scholar
  23. 23.
    Lam, C. L. K., Tse, E. Y. Y., & Gandek, B. (2005). Is the standard SF-12 health survey valid and equivalent for a Chinese population? Quality of Life Research, 14(2), 539–547.PubMedCrossRefGoogle Scholar
  24. 24.
    Kroenke, K., Spitzer, R., Williams, J. B. W., & Lwe, B. (2010). The Patient Health Questionnaire Somatic, Anxiety, and Depressive Symptom Scales: a systematic review. General Hospital Psychiatry, 32(4), 345–359.PubMedCrossRefGoogle Scholar
  25. 25.
    Arroll, B., Goodyear-Smith, F., Crengle, S., et al. (2010). Validation of PHQ-2 and PHQ-9 to screen for major depression in the primary care population. Annals of family medicine, 8(4), 348–353.PubMedCrossRefGoogle Scholar
  26. 26.
    Richardson, L., Rockhill, C., Russo, J., et al. (2010). Evaluation of the PHQ-2 as a brief screen for detecting major depression among adolescents. Pediatrics, 125(5), e1097–e1103.PubMedCrossRefGoogle Scholar
  27. 27.
    Bird, H. R., Andrews, H., & Schwab-Stone, M. (1996). Global measures of impairment for epidemiologic and clinical use with children and adolescents. International Journal of Methods in Psychiatric Research, 6, 295–307.CrossRefGoogle Scholar
  28. 28.
    Bird, H. R., Shaffer, D., Fisher, P., Gould, M., & Staghezza, B. (1993). The Columbia Impairment Scale (CIS): Pilor findings on a measure of global impairmet for children and andolescents. International Journal of Methods in Psychiatric Research, 3, 161–176.Google Scholar
  29. 29.
    Winters, N., Collett, B., & Myers, K. (2005). Ten-year review of rating scales, VII: Scales assessing functional impairment. Journal of the American Academy of Child and Adolescent Psychiatry, 44(4), 309–338.PubMedCrossRefGoogle Scholar
  30. 30.
    Poole-Di Salvo, E., Liu, Y-H., Brenner, S., & Weitzman, M. (2010). Adult household smoking is associated with increased child emotional and behavioral problems. Journal of Developmental and Behavioral Pediatrics, 31(2), 107–115.Google Scholar
  31. 31.
    Research Triangle Institute. (2005). SUDAAN release 9.0.1. Research Triangle Park NRTI.Google Scholar
  32. 32.
    Cohen, J., Cohen, P., West, S. G., & Aiken, L. S. (2003). Applied multiple regression/correlation analysis for the behavioral sciences (3rd edn). Mahway, NJ: Laurence Erlbaum Associates.Google Scholar
  33. 33.
    Menard, S. W. (2003) Applied Logistic Regression (2nd edn) Thousand Oaks, CA: Sage Publications.Google Scholar
  34. 34.
    Ramchandani, P., O’Connor, T., Evans, J., Heron, J., Murray, L., & Stein, A. (2008). The effects of pre- and postnatal depression in fathers: A natural experiment comparing the effects of exposure to depression on offspring. Journal of Child Psychology and Psychiatry and Allied Disciplines, 49(10), 1069–1078.CrossRefGoogle Scholar
  35. 35.
    Ramchandani, P., & Psychogiou, L. (2009). Paternal psychiatric disorders and children’s psychosocial development. The Lancet, 374(9690), 646–653.CrossRefGoogle Scholar
  36. 36.
    Ramchandani, P., Stein, A., Evans, J., & O’Connor, T. (2005). Paternal depression in the postnatal period and child development: a prospective population study. The Lancet, 365(9478), 2201–2205.CrossRefGoogle Scholar
  37. 37.
    Ramchandani, P., Stein, A., O’Connor, T., Heron, J., Murray, L., & Evans, J. (2008). Depression in men in the postnatal period and later child psychopathology: A population cohort study. Journal of the American Academy of Child and Adolescent Psychiatry, 47(4), 390–398.PubMedCrossRefGoogle Scholar
  38. 38.
    Barkley, R. A., Guevremont, D. C., Anastopoulos, A. D., & Fletcher, K. E. (1992). A comparison of three family therapy programs for treating family conflicts in adolescents with attention-deficit hyperactivity disorder. Journal of Consulting and Clinical Psychology, 60(3), 450–462.PubMedCrossRefGoogle Scholar
  39. 39.
    Gao, W., Paterson, J., Abbott, M., Carter, S., & Iusitini, L. (2007). Maternal mental health and child behaviour problems at 2 years: findings from the Pacific Islands families study. Australian and New Zealand Journal of Psychiatry, 41(11), 885–895.PubMedCrossRefGoogle Scholar
  40. 40.
    Lovejoy, M. C., Graczyk, P. A., O’Hare, E., & Neuman, G. (2000). Maternal depression and parenting behavior: A meta-analytic review. Clinical Psychology Review, 20(5), 561–592.PubMedCrossRefGoogle Scholar
  41. 41.
    Cummings, E. M., & Davies, P. T. (1994). Maternal depression and child development. Journal of Child Psychology and Psychiatry and Allied Disciplines, 35(1), 73–112.CrossRefGoogle Scholar
  42. 42.
    Gerkensmeyer, J. E., Perkins, S. M., Day, J., Austin, J. K., Scott, E. L., & Wu, J. W. (2011) Maternal depressive symptoms when caring for a child with mental health problems. Journal of Child and Family Studies, 20(5), 685–695.Google Scholar
  43. 43.
    Gerkensmeyer, J., Perkins, S., Scott, E., & Wu, J. (2008). Depressive symptoms among primary caregivers of children with mental health needs: Mediating and moderating variables. Archives of Psychiatric Nursing, 22(3), 135–146.PubMedCrossRefGoogle Scholar
  44. 44.
    Webb, D., Bloch, J., Coyne, J., Chung, E., Bennett, I., & Culhane, J. (2008). Postpartum physical symptoms in new mothers: Their relationship to functional limitations and emotional well-being. Birth, 35(3), 179–187.PubMedCrossRefGoogle Scholar
  45. 45.
    Coyle, S. (2011). Maternal concern, social support, and health-related quality of life across childhood. Research in Nursing & Health, 34(4), 297–309.CrossRefGoogle Scholar
  46. 46.
    Darcy, J. M., Grzywacz, J. G., Stephens, R. L., Leng, I., Clinch, C. R., & Arcury, T. A. (2011). Maternal depressive symptomatology: 16-Month follow-up of infant and maternal health-related quality of life. Journal of the American Board of Family Medicine, 24(3), 249–257.PubMedCrossRefGoogle Scholar
  47. 47.
    Ali, J., & Avison, W. R. (1997). Employment transitions and psychological distress: The contrasting experiences of single and married mothers. Journal of Health and Social Behavior, 38(4), 345–362.PubMedCrossRefGoogle Scholar
  48. 48.
    Cooklin, A., Canterford, L., Strazdins, L., & Nicholson, J. (2011). Employment conditions and maternal postpartum mental health: Results from the longitudinal study of Australian children. Archives of Women’s Mental Health, 14(3), 217–225.PubMedCrossRefGoogle Scholar
  49. 49.
    Avison, W. R. (2002) Family structure and mental health. In: A. R. J. Maney (ed.) Socioeconomic conditions, stress and mental disorders: Toward a new synthesis of research and public policy (pp. 1–38). Bethesda, MD: NIH Office of Behavioral and Social Research.Google Scholar
  50. 50.
    Rosenthal, D. G., & Weitzman, M. (2011). Examining the effects of intrauterine and postnatal exposure to tobacco smoke on childhood cognitive and behavioral development. The International Journal of Mental Health, 40(1), 39–64.Google Scholar
  51. 51.
    Bandiera, F., Caban Martinez, A., Arheart, K., et al. (2010). Secondhand smoke policy and the risk of depression. Annals of Behavioral Medicine, 39(2), 198–203.PubMedCrossRefGoogle Scholar
  52. 52.
    Klungsyr, O., Nygrd, J., Srensen, T., & Sandanger, I. (2006). Cigarette smoking and incidence of first depressive episode: An 11-year, population-based follow-up study. American Journal of Epidemiology, 163(5), 421–432.CrossRefGoogle Scholar
  53. 53.
    Sobotova, L., Liu, Y. H., Burakoff, A., Sevcikova, L., & Weitzman, M. (2011). Household exposure to secondhand smoke is associated with decreased physical and mental health of mothers in the USA. Maternal and Child Health Journal, 15(1), 128–137.PubMedCrossRefGoogle Scholar
  54. 54.
    Bandiera, F. (2011). What are candidate biobehavioral mechanisms underlying the association between secondhand smoke exposure and mental health? Medical Hypotheses, 77(6), 1009–1010.PubMedCrossRefGoogle Scholar
  55. 55.
    Paulson, J., & Bazemore, S. (2010). Prenatal and postpartum depression in fathers and its association with maternal depression A meta-analysis. JAMA (Chicago, Ill.) 303(19), 1961–1969.Google Scholar
  56. 56.
    Bielawska-Batorowicz, E., & Kossakowska-Petrycka, K. (2006). Depressive mood in men after the birth of their offspring in relation to a partner’s depression, social support, fathers’ personality and prenatal expectations. Journal of Reproductive and Infant Psychology, 24(1), 21–29.Google Scholar
  57. 57.
    Goyal, D., Gay, C., & Lee, K. (2010). How much does low socioeconomic status increase the risk of prenatal and postpartum depressive symptoms in first-time mothers? Women’s Health Issues, 20(2), 96–104.PubMedCrossRefGoogle Scholar
  58. 58.
    Miyake, Y., Tanaka, K., Sasaki, S., & Hirota, Y. (2011). Employment, income, and education and risk of postpartum depression: the Osaka maternal and child health study. Journal of Affective Disorders, 130(1–2), 133–137.PubMedCrossRefGoogle Scholar
  59. 59.
    Mayberry, L., Horowitz, J., & Declercq, E. (2007). Depression symptom prevalence and demographic risk factors among U.S. women during the first 2 years postpartum. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 36(6), 542–549.Google Scholar
  60. 60.
    Barnet, B., Joffe, A., Duggan, A. K., Wilson, M. D., & Repke, J. T. (1996). Depressive symptoms, stress, and social support in pregnant and postpartum adolescents. Archives of Pediatrics and Adolescent Medicine, 150(1), 64–69.PubMedCrossRefGoogle Scholar
  61. 61.
    Bergemann, E., & Boles, R. (2010). Maternal inheritance in recurrent early-onset depression. Psychiatric Genetics, 20(1), 31–34.PubMedCrossRefGoogle Scholar
  62. 62.
    Shastry, B. (2005). Bipolar disorder: An update. Neurochemistry International, 46(4), 273–279.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • David G. Rosenthal
    • 3
  • Nicole Learned
    • 3
  • Ying-Hua Liu
    • 1
  • Michael Weitzman
    • 1
    • 2
  1. 1.Department of PediatricsNew York University School of MedicineNew YorkUSA
  2. 2.Department of Environmental MedicineNew York University School of MedicineNew YorkUSA
  3. 3.New York University School of MedicineNew YorkUSA

Personalised recommendations