Depressed mothers as informants in family history research—Are they accurate?

doi:10.1016/0165-1781(88)90115-1

Psychiatry Research

Volume 24, Issue 3, June 1988, Pages 345-359

https://doi.org/10.1016/0165-1781(88)90115-1 Get rights and content

Abstract

A sample of 333 mother-child dyads was used to examine the association between major depression in mothers and children's symptoms. Findings based on children's self-reports were compared to findings based on mothers' reports about the children. Children's data support a depression-specific transmission. In contrast, mothers' data show an increased risk for all psychiatric syndromes covered in the study (including depression, anxiety, oppositionalism, inattention, hyperactivity, impulsivity, and antisocial acts). Results from multivariate analysis support the hypothesis that the discrepancy between mothers and children is in part a function of the tendency of depressed mothers to view their children as more symptomatic. The use of probands as informants may lead to an overestimation of familial aggregation, if the affected probands suffer from major depression or depressive symptoms.

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Using validated cut-offs for the scores out of 10 (5 for emotional problems, 4 for conduct problems, 7 for hyperactivity and 4 for peer problems) (Goodman, 2001), binary variables were generated for each subscale. Parent-reported behaviour may be subject to biases, especially in the presence of mother’s psychological distress (Fergusson et al., 1993; Breslau, Davis & Prabucki, 1988). To address this point, a secondary analysis was conducted using teacher-reported TDS at age 11, where this information was available.
The association between low family income and socio-emotional behaviour problems in early childhood has been well-documented, and maternal psychological distress is highlighted as central in mediating this relationship. However, whether this relationship holds for older children, and the precise mechanisms by which income may influence child behaviour is unclear.
This study investigated the relationship between family income and child socio-emotional behaviour at 11 years of age, and examined the mediating role of maternal psychological distress over time using the UK Millennium Cohort Study.
The primary outcome was parent-reported behavioural problems, as captured by the Total Difficulties Score (TDS), derived from the Strengths and Difficulties Questionnaire (SDQ). Secondary outcomes were the emotional, peer-related, conduct, and hyperactivity/inattention problems subscales of the SDQ; and teacher-reported TDS. Permanent family income was the primary exposure variable; frequency of poverty up to age 11 years was the secondary exposure variable. Maternal psychological distress was operationalised to reflect the trajectory from child birth to age 11. Multivariable logistic regression models were used to estimate the effect of permanent family income on child behaviour at age 11, controlling for maternal psychological distress and other relevant covariates.
Results showed a statistically significant protective effect of increased permanent family income on the likelihood of behavioural problems at age 11. This finding was consistent for all SDQ subscales apart from emotional problems, and was strongest for teacher-reported behavioural problems. Maternal distress was an important mediator in the income-child behaviour relationship for parent-reported, but not teacher-reported, behavioural problems.
The results of this study strengthen empirical evidence that the child behaviour-income gradient is maintained in older childhood. Mother’s psychological distress, particularly longstanding or recurrent, appears to contribute to this relationship. These findings may validate calls for psychosocial and financial supports for families affected by parental mental health issues.
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Our mental health status measure does not reflect the severity, chronicity, and types of mental health and child functioning issues that affect families. Parents with mental health problems may over-report their children's problem behavior (Breslau, Davis, & Prabucki, 1988; Chi & Hinshaw, 2002; Chilcoat & Breslau, 1997), although there is also research showing no differences in reporting (Richters & Pellegrini, 1989). Caregiver perceptions are informative as they can still highly predict child outcomes (Armstrong, O'Donnell, McCallum, & Dadds, 1998).
The 2007 National Survey of Children's Health was used to determine the prevalence of poor mental health among U.S. mothers, fathers, and guardians, specific parenting experiences and children's functioning. More guardians (13.7%) reported poor mental health compared to mothers (7.7%) and fathers (5.3%), generalizing to 4.6 million U.S. caregivers with poor mental health. Caregivers with poor mental health were at least 3 times more likely to report children's problematic functioning after accounting for sociodemographic factors and parenting stress and experiences. Research and clinical activities should recognize poor caregiver mental health as a condition that affects parenting and children's functioning.
Trajectories of maternal depression and offspring psychopathology at 6 years: 2004 Pelotas cohort study
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Citation Excerpt :
A second limitation was that we did not have other informants regarding children’s psychiatric problems, such as teachers and fathers, and we had to rely on maternal report alone. It has been argued that measures of child behavior based on symptoms reported by depressed mothers may be affected by reporting bias (Breslau et al., 1988). However, one previous study showed that depressed mothers could be as accurate as other informants regarding their children behavior (Richters, 1992).
Few studies have addressed the course and severity of maternal depression and its effects on child psychiatric disorders from a longitudinal perspective. This study aimed to identify longitudinal patterns of maternal depression and to evaluate whether distinct depression trajectories predict particular psychiatric disorders in offspring.
Cohort of 4231 births followed-up in the city of Pelotas, Brazil. Maternal depressive symptoms were assessed with the Edinburgh Postnatal Depression Scale (EPDS) at 3, 12, 24 and 48 months and 6 years after delivery. Psychiatric disorders in 6-year-old children were evaluated through the development and well-being assessment (DAWBA) instrument. Trajectories of maternal depression were calculated using a group-based modelling approach.
We identified five trajectories of maternal depressive symptoms: a “low” trajectory (34.8%), a “moderate low” (40.9%), a “increasing” (9.0%), a “decreasing” (9.9%), and a “high-chronic” trajectory (5.4%). The probability of children having any psychiatric disorder, as well as both internalizing and externalizing problems, increased as we moved from the “low” to the “high-chronic” trajectory. These differences were not explained by maternal and child characteristics examined in multivariate analyses.
Data on maternal depression at 3-months was available on only a sub-sample. In addition, we had to rely on maternal report of child’s behavior alone.
The study revealed an additive effect on child outcome of maternal depression over time. We identified a group of mothers with chronic and severe symptoms of depression throughout the first six years of the child life and for this group child psychiatric outcome was particularly compromised.
Depressed mood and maternal report of child behavior problems: Another look at the depression-distortion hypothesis
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Caregiver depression has been described as leading to overreport of child behavior problems. This study examines this “depression–distortion” hypothesis in terms of high-risk families of young adolescents. Questionnaire data were collected from mothers, teachers, and fathers, and self-report information was obtained from youth between ages 10 and 14 years. First, convergent and discriminant validity were demonstrated for internalizing and externalizing multiagent constructs. Second, the depression–distortion hypothesis was examined, revealing a modest effect of maternal depression, leading to the inflation of reported son externalizing and daughter internalizing problems. The data suggest the need to consider multiple influences on parental perceptions of child behavior and psychopathology in research and clinical settings.
Depressive symptoms and parenting competence: An analysis of 13 regulatory processes
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Mechanisms that lead depressive symptoms to undermine parenting are poorly understood. This review examines cognitive, affective, and motivational processes thought to be responsible for the impact of depressive symptoms on parenting. We present a five-step, action-control model and review 152 studies relevant to 13 regulatory processes. Evidence suggests that depressive symptoms undermine parenting because they reduce child-oriented goals, undermine attention to child input, increase negative appraisals of children and parenting competence, activate low-positive and high-negative emotion, and increase positive evaluations of coercive parenting. Yet, this review reveals significant limitations in knowledge of these processes. Evidence that they mediate depression-parenting relations is scare; important processes remain unstudied; conceptions of regulation are undifferentiated; children’s contributions are largely unexamined; moderating variables are largely unexplored; and methods fail to capture the dynamics of processing input from children. Rigorous testing of such process models holds promise for clarifying the basis of depression-related parenting problems.
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^☆: An earlier version of this report was presented at the Annual Meeting of the American Psychiatric Association, Chicago, IL, May 14, 1987.

View full text

Depressed mothers as informants in family history research—Are they accurate?☆

Abstract

Journal of American Academy of Child Psychiatry

Journal of the American Academy of Child and Adolescent Psychiatry

Journal of the American Academy of Child Psychiatry

Journal of Affective Disorders

Journal of the American Academy of Child Psychiatry

Journal of the American Academy of Child Psychiatry

Journal of Affective Disorders

Journal of Affective Disorders

Behavior Research and Therapy

Journal of the American Academy of Child Psychiatry

Child/adolescent behavioral and emotional problems: Implications of cross-informant correlations for situational specificity

Psychological Bulletin

DSM-III: Diagnostic and Statistical Manual of Mental Disorders

The family history method using diagnostic criteria

Archives of General Psychiatry

The family history approach to diagnosis: How useful is it?

Archives of General Psychiatry

Children of parents with major affective disorder

American Journal of Psychiatry

A family study of patients with attention deficit disorder and normal controls

Journal of Psychiatric Research

Chronic stress and major depression

Archives of General Psychiatry

Siblings of disabled children: Effects of chronic stress in the family

Archives of General Psychiatry

The assessment of affective disorders in children and adolescents by semistructured interview: test-retest reliability of the Schedule for Affective Disorders and Schizophrenia for School-Age Children

Archives of General Psychiatry

The effects of instruments and informants on ascertainment

Symptoms of depression in two communities

Psychological Medicine

Development and Testing of the NIMH Diagnostic Interview Schedule for Children in a Clinic Population

Parent-child agreement on child psychiatric symptoms assessed via structured interview

Journal of Child Psychology and Psychiatry

Age differences in the reliability of the psychiatric interview of the child

Child Development