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Caregiver Depressive Symptoms Associated with Behavioral and Emotional Problems in Preschoolers



Depressive symptoms in parents are associated with increased risk for behavioral and emotional problems (BEP) in preschool-aged children. It is unclear if particular symptoms of child BEP are associated with parental depression. This study describes the prevalence of (1) self-reported depressive symptoms in parents and (2) BEP in children ages 3–5 years, both measured during pediatric well-visits. It also examines the relationship between parental depressive symptoms and BEP in preschool-aged children in primary care.


Caregivers (n = 2645) accompanying children ages 3–5 years old for well-visits completed the Early Childhood Screening Assessment (ECSA), a tool which assesses for child BEP and parental depressive symptoms. Spearman’s rho was used to examine correlations. Logistic regression was used to predict the dichotomous outcome of depressive symptoms among caregivers based on ECSA item responses covarying for caregiver type and child age, gender and race.


Screening indicated that 3.1% (n = 82) of caregivers reported parental depressive symptoms and 12.5% (n = 331) of children had a positive screen for BEP. One out of 2 children (56.1%) of caregivers with depressive symptoms had positive BEP screens compared to approximately 1 in 10 (11.1%) children of caregivers without depressive symptoms (p < 0.0001).


There was a significant relationship between caregiver depressive symptoms and child BEP symptoms, highlighting the importance of screening for both constructs. Early identification and treatment of both parental depressive symptoms and child BEP allows for appropriate referral and treatment that may mitigate adverse outcomes and promote optimal child development.

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Funding for this study comes from a Substance Abuse Mental Health Services Administration Grant # 5U79SM059939-04 to the Partnership for Child Health and from the Hall-Halliburton Foundation. The sponsors had no involvement in the study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication. The authors would like to thank the providers, patients, and families at Carithers Pediatric Group, Baptist Pediatrics–San Jose, and Jacksonville Pediatrics for their participation in this study. The authors also appreciate Lauren James MA, Kitty Leung, MD, and Valentina Bolanos MPH for their assistance with manuscript preparation.

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Authors and Affiliations



E.M.F.: designed and executed the study and wrote the paper. P.G.: collaborated with the design and writing of the study and assisted with the data analyses. P.A.: analyzed the data and wrote part of the results. E.R.B.: collaborated with the design and writing of the study and assisted with the data analyses.

Corresponding author

Correspondence to Elise M. Fallucco.

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The authors declare that they have no conflict of interest.

Ethical Approval

Ethical approval for the study was granted by the Nemours IRB.

Informed Consent

As the copies of the ECSA did not contain any patient-identifying information, the IRB granted a waiver for the requirement of documentation of written informed consent from caregivers.

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Fallucco, E.M., Greco, P., Aldridge, P. et al. Caregiver Depressive Symptoms Associated with Behavioral and Emotional Problems in Preschoolers. J Child Fam Stud 29, 62–70 (2020).

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  • Caregiver depression
  • Maternal depression
  • Paternal depression
  • Early childhood
  • Emotional and behavioral problems