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National Research Council (US) & Institute of Medicine (US) Committee on Depression, Parenting Practices, & the Healthy Development of Children; England MJ, Sim LJ, editors. Depression in Parents, Parenting, & Children: Opportunities to Improve Identification, Treatment, & Prevention. Washington (DC): National Academies Press (US); 2009.
Depression in Parents, Parenting, & Children: Opportunities lớn Improve Identification, Treatment, và Prevention.
Show detailsNational Research Council (US) & Institute of Medicine (US) Committee on Depression, Parenting Practices, and the Healthy Development of Children; England MJ, Sim LJ, editors.
4Associations Between Depression in Parents and Parenting, Child Health, and Child Psychological Functioning
Depression is significantly associated with more hostile, negative parenting, & with more disengaged (withdrawn) parenting, both with a moderate effect size. Findings are primarily related to lớn mothers rather than to fathers.
Depression in mothers is significantly associated with less positive parenting (warmth), with a small effect size. Findings are primarily related khổng lồ mothers rather than lớn fathers.
The poorer parenting qualities may not improve to levels comparable lớn those of never-depressed parents, despite remission or recovery from episodes of depression.
These patterns of parenting have been found in depressed mothers of infants and young children as well as in depressed mothers of school-age children & adolescents.
Less is known about parenting in depressed fathers relative khổng lồ mothers, but most of the findings from the smaller number of studies are consistent with the findings about mothers.
Depression in parents is associated with children’s poorer physical health và well-being. Infants & young children of mothers with depression are more likely khổng lồ use a variety of acute health care services. For older children và adolescents, there is limited evidence khổng lồ suggest that depression plays a role in visits for stress-related health conditions and increased health care utilization. Adverse health outcomes of accidents, childhood asthma, child maltreatment, and adolescent tobacco và substance use occur more often when a parent is depressed.
Maternal depression symptoms (and stress) levels are high among caregivers of children with chronic conditions.
Depression in parents is associated with maladaptive patterns of health care utilization for children. Infants & young children of mothers with depression are more likely to use a variety of acute health care services. For older children & adolescents, there is limited evidence to suggest impact on health care utilization.
Depression in parents has been consistently found to lớn be associated with children’s early signs of (or vulnerabilities to) more “difficult” temperament; more insecure attachment; affective functioning (more negative affect, more dysregulated aggression và heightened emotionality, more dysphoric & less happy affect, particularly for girls; lower cognitive/intellectual/academic performance, cognitive vulnerabilities khổng lồ depression (more self-blame, more negative attributional style, lower self-worth); poorer interpersonal functioning; & abnormalities in psychobiological systems, including poorer functioning bít tất tay response systems (neuroendocrine & autonomic) and cortical activity.
Depression in parents has been consistently associated with a number of behavior problems và psychopathology in children, including higher rates of depression, earlier age of onset, longer duration, greater functional impairment, higher likelihood of recurrence, higher rates of anxiety, & higher rates & levels of severity of internalizing và externalizing symptoms and disorders in children và adolescents.
Mediators và Moderators
Depression in parents is more likely khổng lồ be associated with adverse outcomes in children with the presence of additional risk factors (e.g., poverty, exposure to lớn violence, marital conflict, comorbid psychiatric disorders, absence of father when the mother has depression, và clinical characteristics of the depression, such as severity and duration) than with depression that occurs in the context of more protective factors.
Parental functioning, prenatal exposure to stress & anxiety, genetic influences, and stressful environments appear khổng lồ play a role in the development of adverse outcomes in children.
This chapter review what is known about the associations among depression in parents và parenting, child health, & child functioning, based on the large number of epidemiological & clinical studies that have documented these associations. Throughout our work, the committee recognized that depression exists in a broader context of comorbidities, correlates, và contexts. In addition, there has been a growing body toàn thân of research that suggests that parenting styles và processes are not necessarily universal & may differ và have differential impact on children’s behavior based on culture & ethnic group variations (Deater-Deckard et al., 1996). Thus, the literature was approached with a caution against interpreting outcomes as owing solely to the depression in the parent as a single risk factor. With this in mind, the committee’s task was to review the literature that focused on (1) direct association between depression in parents & parenting, child health, and child functioning; (2) conditions that may make the association stronger or weaker (i.e., moderators); and (3) mechanisms or intermediate steps (i.e., mediators) through which depression in the parent becomes associated with parenting or with outcomes in children. Although a reviews of the effects of parents’ depression on the family (e.g., marital conflict) is not within the study scope, such effects are integrated into the literature summaries when findings bear on moderation (e.g., when maternal depression is more strongly associated with adverse child outcomes in the presence of high marital conflict rather than low marital conflict) or mediation (e.g., when maternal depression is associated with an increase in marital conflict, which is then associated with adverse child outcomes).
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PARENTING PRACTICES and THE DEPRESSED PARENT
Skills in parenting are key to lớn facilitating healthy development in children. Qualities of parenting that have been found to be related khổng lồ healthy development vary by age of the child. They range from the sensitive, responsive caregiving especially needed by infants khổng lồ the monitoring that is particularly needed by adolescents. Important aspects of effective parenting across development include providing age-appropriate levels of warmth and structure lớn help children feel safe và to help regulate their emotions (e.g., Cole, Martin, and Dennis, 2004). Children also are dependent on their parents to lớn facilitate their education and to obtain their medical care.
Parenting practices that vì chưng not meet infants’ or children’s needs to lớn sustain healthy development are one of the primary mechanisms through which parental depression exerts its effects on children (Goodman và Gotlib, 1999). As reviewed by Avenevoli và Merikangas (2006), there is evidence to tư vấn broad (e.g., stress), specific (e.g., parenting skills), & structural (e.g., divorce) family factors that explain or modify the association between depression in parents và children’s development of depression or other problems. Although more research is needed khổng lồ determine the effects of specific types of parent behaviors, it is evident that parenting behaviors associated with depression affect children’s adjustment.
Indeed, a few studies have tested and found tư vấn for a mediation role of parenting in associations between depression & outcomes in children. For example, in a large, longitudinal, population-based study of Canadian youth ages 10 to 15, children’s reports of both positive parenting behaviors (i.e., nurturance and monitoring) và negative parenting behaviors (i.e., rejection) mediated the relationship between parental depressive symptoms và children’s internalizing (e.g., anxiety, depressive symptoms) and/or externalizing (e.g., aggression, noncompliance) problems (Elgar et al., 2007). Also supporting mediation, Cummings et al. (2008) found that a community sample of 6-year-old children’s representations of their attachment to lớn their parents và of interparental conflict partially mediated the relation between parental depressive symptoms & the children’s externalizing problems that emerged over the following 3 years. Lim, Wood, & Miller (2008), in a study of mothers with depressive symptoms and their children (n = 242, ages 7–17) with asthma symptoms recruited from pediatric emergency departments, also found evidence consistent with negative parenting as a partial mediator of the relation between maternal depressive symptoms và children’s internalizing problems. However, despite the many strengths of this study, the reliance on a cross-sectional kiến thiết limits conclusions that can be drawn about mediation. In addition lớn this support for parenting as a mediator, others have found that parenting serves as a moderator of associations between depression in parents & outcomes in children. Among research supportive of moderation is the finding that more positive outcomes in youth with depressed mothers were found among the subset of depressed mothers who used less psychological control, more warmth, và less overinvolvement (Brennan, Le Brocque, and Hammen, 2003).
Researchers have accumulated strong evidence directly linking depression in parents with problematic parenting practices, primarily based on studies using direct observations of parents and children in families of depressed parents. In a meta-analysis of this research, Lovejoy et al. (2000) found significant và moderate effect sizes for the association between both maternal depressive symptoms and disorder và hostile negative parenting (e.g., negative affect, coercive, hostile behavior; mean d = 0.40), disengaged (withdrawn) parenting (e.g., neutral affect, ignoring; mean d = 0.29), & a small but significant adverse association with positive parenting behaviors (engaging a child in a pleasant or affectionate way; mean d = 0.16). These studies reflect the significance of disrupted parenting when a parent suffers from depression and underscore the usefulness of direct observations of parent-child interactions in these families. The authors conclude that depressed mothers who are preoccupied are more likely khổng lồ become angry when children misbehave or make normal demands on them. Lovejoy et al. (2000) argue that the “findings tư vấn the need for intervention with depressed mothers, as their parenting behaviors are a component of the risk associated with living with a depressed mother” (p. 588). Despite the strength of findings linking depression và parenting, the analyses were limited by the literature’s focus on younger children. Only 17 percent of the studies in the meta-analysis (n = 8) included children ages 6 or older, and none of the studies focused specifically on the high-risk period of early adolescence, a developmental period associated with increasing rates of depression and increasingly stressful parent-child interactions (Hankin & Abramson, 2001). A few more recent studies, however, have similarly supported link between depression và parenting even among parents of adolescents, as reviewed later in this chapter.
Parenting practices are also of concern because they are associated with depression not only during periods of elevated symptom levels or during episodes that meet diagnostic criteria for depression but also when parents who have experienced depression may be relatively symptom free. Negative parenting has been found to lớn persist even after controlling for the presence of major depressive disorder, suggesting that depressed parents continue lớn parent poorly following a depressive episode (Seifer et al., 2001).
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