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Maternal Depressive Symptoms Are Associated With Low Fearfulness in Preschoolers Eszter Székely
a b f
, Henning Tiemeier
b c
, Pauline W. Jansen
b
Albert Hofman , Frank C. Verhulst & Catherine M. Herba a
b d
, Vincent W. V. Jaddoe
a e
,
b g
The Generation R Study Group , Erasmus Medical Center
b
Department of Child and Adolescent Psychiatry/Psychology , Erasmus Medical Center, Sophia Children's Hospital c
Departments of Epidemiology and Psychiatry , Erasmus Medical Center
d
Murdoch Children's Research Institute, Royal Children's Hospital
e
Departments of Epidemiology and Pediatrics , Erasmus Medical Center
f
Department of Epidemiology , Erasmus Medical Center
g
Department of Psychology , University of Québec at Montréal and Ste-Justine's Hospital Research Center Published online: 08 Jan 2014.
To cite this article: Eszter Székely , Henning Tiemeier , Pauline W. Jansen , Vincent W. V. Jaddoe , Albert Hofman , Frank C. Verhulst & Catherine M. Herba (2014) Maternal Depressive Symptoms Are Associated With Low Fearfulness in Preschoolers, Journal of Clinical Child & Adolescent Psychology, 43:5, 791-798, DOI: 10.1080/15374416.2013.862800 To link to this article: http://dx.doi.org/10.1080/15374416.2013.862800
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Journal of Clinical Child & Adolescent Psychology, 43(5), 791–798, 2014 Copyright # Taylor & Francis Group, LLC ISSN: 1537-4416 print=1537-4424 online DOI: 10.1080/15374416.2013.862800
Maternal Depressive Symptoms Are Associated With Low Fearfulness in Preschoolers Eszter Sze´kely The Generation R Study Group, Erasmus Medical Center and Department of Child and Adolescent Psychiatry=Psychology, Erasmus Medical Center, Sophia Children’s Hospital
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Henning Tiemeier Department of Child and Adolescent Psychiatry=Psychology, Erasmus Medical Center, Sophia Children’s Hospital, and Departments of Epidemiology and Psychiatry, Erasmus Medical Center
Pauline W. Jansen Department of Child and Adolescent Psychiatry=Psychology, Erasmus Medical Center, Sophia Children’s Hospital, and Murdoch Children’s Research Institute, Royal Children’s Hospital
Vincent W. V. Jaddoe The Generation R Study Group, Erasmus Medical Center and Departments of Epidemiology and Pediatrics, Erasmus Medical Center
Albert Hofman Department of Epidemiology, Erasmus Medical Center
Frank C. Verhulst Department of Child and Adolescent Psychiatry=Psychology, Erasmus Medical Center, Sophia Children’s Hospital
Catherine M. Herba Department of Child and Adolescent Psychiatry=Psychology, Erasmus Medical Center, Sophia Children’s Hospital, and Department of Psychology, University of Que´bec at Montre´al and Ste-Justine’s Hospital Research Center
The purpose of this study is to examine whether maternal depressive symptoms predict low positive emotionality and high temperamental fearfulness in preschool children. Maternal depressive symptoms were assessed prenatally and at 2, 6, and 36 months postnatally. Positive emotionality and temperamental fearfulness were assessed using laboratory observations in a large cohort of typically developing Dutch preschoolers (N ¼ 799; 404 boys) at age 36 months (M ¼ 37.53, SD ¼ 1.50). Children exposed to
The Generation R Study is conducted by the Erasmus Medical Center in close collaboration with the School of Law and Faculty of Social Sciences of the Erasmus University Rotterdam, the Municipal Health Services Rotterdam Area, the Rotterdam Homecare Foundation, and the Stichting Trombosedienst & Artsenlaboratorium Rijnmond (STAR). We gratefully acknowledge the contribution of general practitioners, hospitals, midwives, and pharmacies in Rotterdam. Correspondence should be addressed to Henning Tiemeier, Department of Child and Adolescent Psychiatry=Psychology, Erasmus Medical Center, Sophia Children’s Hospital, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands. E-mail: [email protected]
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elevated levels of maternal depressive symptoms in the first 3 years of life behaved less fearfully at age 3 years in a novel context that primarily elicited a startle response (B ¼ 0.08, SE ¼ 0.03, p ¼ .01). The severity rather than timing of or change in maternal depressive symptoms accounted for the observed effect. In the present sample, maternal depressive symptoms were not associated with positive emotionality in the offspring (p > .05). Findings suggest a relation between maternal depressive symptoms and decreased offspring fearfulness in a low-risk community sample of young children.
A large body of research has documented the adverse effects of maternal depression on child development from infancy through adolescence (Beardslee, Gladstone, & O’Connor, 2011; Downey & Coyne, 1990; Field, 1995). However, few studies have examined the effect of maternal depression on child temperament. Temperament generally encompasses biologically based individual differences in affect, activity, attention, and self-regulation (Rothbart & Bates, 2006). Because temperament may guide the adaptation to environmental circumstances (Clark & Watson, 1999), it is often included in risk models of psychopathology (Caspi & Shiner, 2008). According to Clark and Watson’s (1999) tripartite model of depression and anxiety, low positive emotionality (PE; the tendency for positive affect, environmental engagement, and sociability) is specifically linked to depression, whereas high negative emotionality (NE; proneness to sadness, fear, and anger) constitutes a nonspecific risk factor for multiple disorders (e.g., depression, anxiety, substance use, and conduct disorder). The temperamental construct of behavioral inhibition (BI; the tendency toward wariness, reticence, and high constraint; Kagan, 1989) is also implicated as a diathesis for developing depression (Fox, Henderson, Marshall, Nichols, & Ghera, 2005), although it is primarily viewed as a risk factor for anxiety disorders (Perez-Edgar & Fox, 2005). While PE and NE are independent, broadband dimensions (Clark & Watson, 1999), BI is a more specific temperamental trait that shares low approach=exploration with low PE in novel, fear-eliciting contexts (Laptook et al., 2008) and propensity for fearfulness with NE (Muris & Dietvorst, 2006). More recent studies of child temperament highlight the importance of parsing out temperament variables into finer-grained constructs (e.g., fearfulness), as these can contribute unique predictive information (Reynolds & Clark, 2001). Laboratory observations of child temperament are particularly useful when examining the influence of maternal depression, especially when maternal depression is assessed using self-reports. Furthermore, laboratory assessments are ideally suited to study behaviors (e.g., startle reaction) that occur at a low base-rate in naturalistic settings (Durbin, Hayden, Klein, & Olino, 2007). The literature on parental mood disorders and observed early child temperament is limited. Kochanska
(1991) found that parents with bipolar disorder were more likely to have behaviorally inhibited toddlers than nondepressed parents, whereas toddlers of parents with major depression did not differ from these two groups. In another study, children (2–6 years old) of parents with comorbid panic disorder and major depression had higher BI than control subjects, whereas children whose parents had either disorder alone did not significantly differ from any of the two groups (Rosenbaum et al., 2000). In a sample of 3-year-olds, low PE was linked to mothers’ but not fathers’ lifetime history of major depression and dysthymia. No association was found between maternal depression and child NE or BI (Durbin, Klein, Hayden, Buckley, & Moerk, 2005). Parental depressive disorders were related to high NE and BI in a large community sample of 3-year-olds, especially at moderate=high levels of PE (Olino, Klein, Dyson, Rose, & Durbin, 2010). Finally, Olino et al. (2011) reported that offspring of mothers with childhood-onset major depression had consistently lower PE than control peers as modeled with growth curve analysis from infancy through age 9 years. Variability across children in NE over time was insufficient to examine associations between maternal depression and child NE. In two of these studies, exploratory analyses were conducted at the lower order trait level. Although child fearfulness was not associated with parental depression in the smaller sample (Durbin et al., 2005), in the larger sample parental depressive disorders were linked to higher offspring fearfulness (Olino et al., 2010). All of the aforementioned studies included children of parents with a history of depressive disorder. Little is known about whether subclinical levels of maternal depressive symptoms, which are more prevalent in the general population, are also associated with offspring temperamental vulnerability. In addition, our longitudinal study design, which includes repeated assessments of maternal depressive symptoms, enables us to examine both general patterns in maternal depressive symptomatology and the impact of timing on child outcome. In a large community sample, we investigated whether exposure to maternal depressive symptoms in the first 3 years of life predicted observed PE and fearfulness in the offspring. Maternal depressive symptoms were assessed prospectively from before birth through to the child’s age of 3 years. We focused on the early
MATERNAL DEPRESSIVE SYMPTOMS AND CHILD TEMPERAMENT
preschool years, as temperament begins to stabilize during this period (Caspi, 2000), whereas depressive disorders are extremely rare before middle childhood (Lavigne, LeBailly, Hopkins, Gouze, & Binns, 2009). We expected that a greater exposure to maternal depressive symptoms early in life will be associated with lower PE and higher fearfulness in the offspring. Furthermore, we examined whether timing of or change in maternal depressive symptoms affects the association with child PE or fearfulness.
METHOD
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Setting The present investigation pertained to a subsample of children participating in the Generation R Study, a population-based prospective Dutch cohort from fetal life onwards (Jaddoe et al., 2012). The subsample, known as the Generation R Focus Cohort, is ethnically homogeneous to exclude possible confounding or effect modification by ethnicity. All children were born between February 2003 and August 2005 and form a prenatally enrolled birth cohort (Jaddoe et al., 2008). The study was conducted in accordance with the guidelines of the World Medical Association Declaration of Helsinki and approved by the Medical Ethics Committee of the Erasmus Medical Center. Parental written informed consents were obtained for all participants.
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MDS were assessed using the Depression scale of the Brief Symptom Inventory (BSI), the short version of the SCL-90-R (Derogatis & Melisaratos, 1983). The BSI is a 53-item validated self-report inventory in which participants rate the extent to which they have been bothered, from 0 (not at all) to 4 (extremely), in the past week by various symptoms. The BSI Depression scale1 includes six items: ‘‘feeling suicidal,’’ ‘‘feeling lonely,’’ ‘‘feeling blue,’’ ‘‘having no interest in anything anymore,’’ ‘‘feeling hopeless about the future,’’ and ‘‘feeling worthless.’’ Summed scores were divided by the number of completed items with a maximum of one missing item allowed as recommended in the manual (De Beurs, 2004). Internal consistencies of the depression scale for the present study ranged between .75 and .85. To indicate mothers’ overall tendency to experience depressive symptoms during the first 3 years of the offspring’s life, a composite was created by averaging raw maternal BSI depression scores across assessment waves.
Child Temperament Child temperament was assessed at 3 years using the following three episodes of the Laboratory Temperament Assessment Battery (Goldsmith, Reilly, Lemery, Longley, & Prescott, 1999; Goldsmith & Rothbart, 1999), a widely used, standardized observational instrument of early temperament.
Maternal Depressive Symptoms
Jumping Spider. The Jumping Spider episode is designed to elicit a startle=fear reaction based on an unexpected event, which is generally a predominant source of fear among preschool children. In this episode, the child and the experimenter were seated across from each other at a child-sized table on which there was a toy spider in a cage. The experimenter introduced the toy spider as a soft, fuzzy animal that does not bite, and prompted the child to pet it. When the child’s hand was approximately 5 cm away from the spider, the experimenter made it ‘‘jump.’’ This process was repeated four times. At the end, the experimenter explained to the child that it was a toy spider and asked the child if he or she wanted to make it jump. The episode was divided into five epochs for scoring. Intensity of fear expressions, vocal distress, bodily fear, approach, withdrawal, gaze aversion, and startle response were scored in each epoch. Parameters were averaged across all epochs. Interrater reliabilities (intraclass correlation coefficients [ICCs], single measures) for these averages ranged .66 to .95. A fear composite was formed by converting all averages
Information on maternal depressive symptoms (MDS) was obtained by postal questionnaires at 20 weeks of gestation, and at 2, 6, and 36 months postpartum.
1 At 2 months postpartum, women’s BSI depression scores were highly correlated to their scores on the Edinburgh Postnatal Depression Scale (r ¼ .67, p < .001).
Participants Of the 1,106 children who participated in the postnatal phase of the Generation R Focus Cohort, 862 visited our research center at age 36 months with an accompanying parent. Information on maternal depressive symptoms was available for 860 women in one or more assessment waves. Temperament was observed in 807 children at age 36 months using three episodes of laboratory observation. We randomly excluded one twin from the eight participating twin pairs to avoid biases due to paired data. Thus, in total 799 children participated in at least one analysis of child temperament, 754 in analyses of fearfulness and 786 in analyses of PE. Participating children’s average age was 37.53 months (SD ¼ 1.50; range ¼ 34.74–48.89). The sample included 404 (50.6%) boys. The majority of mothers completed higher education (66.3%), was married=cohabiting (94.4%), and had above-average net family income (83.1%).
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into z scores and taking the mean of these standardized averages. Internal consistency of the fear composite was .67. Popping Bubbles. In the Popping Bubbles episode the child engages in the pleasurable activity of blowing and popping bubbles. This episode is divided into a low- and a high-pleasure phase. In the low-pleasure phase, the experimenter demonstrated how to blow bubbles and asked the child to do the same. In the high-pleasure phase, the experimenter encouraged the child to engage in chasing and popping a series of bubbles first with the hands (3x), then with the feet (3x), and finally with both the hands and feet (3x). The episode included 11 epochs for scoring. Intensity of smiling, presence of laughter, and vigor of approach were scored in each epoch. Parameters were averaged across all epochs. ICCs for these averages ranged between .71 and .75. A PE composite for this episode was formed as previously described. Internal consistency of the PE composite for the Popping Bubbles episode was .77. Puppet Game. The Puppet Game episode is designed to measure enjoyment in response to social stimulation. The experimenter performed a standard dialogue in an animated, lively fashion using two hand puppets. During the dialogue, the experimenter tickled the child first with one hand puppet, then with the other, and finally using both puppets. Following the dialogue, the experimenter allowed the child to play with the puppets for 30 s. The episode was divided into five epochs for scoring. Intensity of smiling, presence of laughter, positive vocalizations, and positive motor acts were scored in each epoch. Parameters were averaged across all epochs. ICCs for these averages ranged between .66 and .95. A PE composite for this episode was formed as just described. Internal consistency of the PE composite for the Puppet Game episode was .64. Episodes were coded from DVD recordings according to the original coding systems described in the Laboratory Temperament Assessment Battery. We conducted regular checks to ensure that episodes closely followed the procedure described in the manual. Coders received extensive training, and their reliability was established on a set of 25 DVDs before data were coded. Coders were blind to information regarding MDS. The two PE episodes were significantly correlated (r ¼ .33, p < .001) and thus averaged into a single PE composite for further analyses.
(‘‘married=cohabiting’’ vs. ‘‘single’’) and net family income (‘‘low=average (2000 4=month)’’ vs. ‘‘above average (>2000 4=month)’’ for a two-person household). Other variables related to individual differences (e.g., child’s age and gender) that could have been linked to MDS or child temperament were also examined, but because these were not significantly associated with the predictor or outcome variables, they were dropped from the final model. Statistical Analyses Associations between the variables were explored using Pearson correlation coefficients. Separate linear regression models were run to examine whether the maternal depression composite predicts offspring PE and fearfulness. Hierarchical linear regressions were run to explore the effect of timing of MDS on child PE and fearfulness. To this aim, prenatal, postnatal, and concurrent MDS were entered as separate levels into a single model. Finally, to examine if change in MDS over time impacts offspring PE and fearfulness, MDS were modeled using latent growth curve analysis (Mplus version 7; Muthe´n & Muthe´n, 1998–2010). Time intervals between the repeated assessments were fixed to be equal for each participant: The prenatal assessment was fixed at 0, the subsequent postnatal assessments at 0.57, 0.90, and 3.38, reflecting the mean time intervals in years between subsequent assessments. Because raw MDS scores were highly skewed, we applied the square-root transformation. The model indicates rate of change in MDS over time by estimating a slope parameter for each participant. Model fit was determined based on the comparative fit index (acceptable fit 0.90) and root mean square error of approximation (acceptable fit 0.08; Browne & Cudeck, 1993). Offspring PE and fearfulness were regressed on the estimated slope parameters. All models were adjusted for maternal marital status and family income. Response Analysis Study participants (n ¼ 799) were compared along baseline characteristics with those who were postnatally eligible but did not participate in this study (n ¼ 307). Participating women were less often single (3.5% vs. 8%), v2(1) ¼ 9.68, p ¼ .002, and had more often above average family income (87.8% vs. 82.5%), v2(1) ¼ 4.76, p ¼ .029, than nonparticipants. The two groups did not differ on the MDS composite, t(396.28, corrected for unequal variances) ¼ 1.17, p ¼ .244.
Covariates Models were adjusted for maternal or child characteristics if they were significantly associated with the predictor (MDS) or the outcome (child temperament). These indicators included maternal marital status
RESULTS Information on MDS at each assessment is presented in Table 1. The percentage of women with clinically
MATERNAL DEPRESSIVE SYMPTOMS AND CHILD TEMPERAMENT
795
TABLE 1 Prenatal, Postnatal, and Concurrent Maternal Depressive Symptoms
Maternal BSI Depression Score Prenatal Postnatal Concurrent
N
M (SD)
Minimum
Maximum
>Clinical Cutoff a
749 738 699
0.11 (0.30) 0.13 (0.26) 0.09 (0.21)
0.00 0.00 0.00
3.50 2.67 2.00
3.3% 2.7% 2.0%
a A raw Brief Symptom Inventory (BSI) depression score of 0.80 was used as cutoff to indicate clinically significant depressive symptoms as recommended based on the available norms for Dutch female populations (De Beurs, 2009).
TABLE 2 Correlation Matrix Including Independent and Dependent Variables of Interest
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Variables 1. 2. 3. 4. 5. 6. 7.
1
2
3
4
5
6
Prenatal BSI Depression Score — — Postnatal BSI Depression Score .550 Concurrent BSI Depression Score .367 .356 — PE .009 .017 –.060 — y Fearfulness –.088 –.065 –.088 .089 — .038 — Family Income (Low=Average vs. High) –.170 –.114 –.156 –.039 Marital Status Mother (Married=Living Together vs. Single) .158 .158 .115 .056 –.022 –.322 Note: BSI ¼ Brief Symptom Inventory; PE ¼ positive emotionality. p < .05. p < .01. p < .001. y p < .1.
significant depressive symptoms was highest during pregnancy (3.3%) and gradually decreased after birth (2.7%), with the lowest rates observed concurrently (2%). These rates were lower than reported previously (Gavin et al., 2005). Bivariate and point-biserial correlations between predictors, outcomes, and covariates are presented in Table 2. Prenatal, postnatal, and concurrent MDS were moderately correlated, which is in line with earlier observations (e.g., Josefsson, Berg, Nordin, & Sydsjo¨, 2001). Results of the hierarchical regression analyses are shown in Table 3. MDS did not predict offspring PE. That is, neither the composite nor the single time point
measures of MDS were significantly related to child PE at age 3 years (Table 3). However, offspring of mothers with a higher MDS composite were less fearful in the Jumping Spider episode. Timing of MDS did not influence this relationship. Finally, good model fit was obtained for the initial growth model of MDS: comparative fit index ¼ 0.93 and root mean square error of approximation ¼ 0.08. In addition, the slope of the initial model was significant (s ¼ 0.009, p ¼ .011), indicating a small linear decrease in MDS over time. Table 4 summarizes the results of regressing offspring PE and fearfulness on the slope parameter of MDS. Change in MDS over time was not associated with children’s PE or fearfulness.
TABLE 3 Hierarchical Regression Analyses of Maternal Depressive Symptoms and Child PE and Fearfulness PE at Age 3 Years B
SE
Maternal Depressive Symptoms Composite –0.005 0.09 Prenatal –0.19 0.10 Postnatal 0.04 0.10 Concurrent –0.12 0.11
Fearfulness at Age 3 Years
p
R2 Change
F (df)
p
B
SE
p
R2 Change
F (df)
p
.957 .051 .698 .282
0.001 0.007 0.001 0.002
0.003 (1, 728) 3.81 (1, 575) 0.15 (1, 547) 1.16 (1, 573)
.957 .051 .698 .282
–0.28 –0.18 –0.03 –0.21
0.11 0.10 0.11 0.12
.010 .080 .794 .087
0.010 0.006 0.001 0.005
6.672 (1, 693) 3.08 (1, 548) 0.07 (1, 547) 2.94 (1, 546)
.010 .080 .794 .087
Note: Models were adjusted for maternal marital status and net family income, entered into Level 1. Prenatal, postnatal, and concurrent maternal depressive symptom scores were entered into the same regression model as separate levels. Results of the unadjusted analyses were essentially the same. PE ¼ positive emotionality.
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Unadjusted Adjusteda Unadjusted Adjusteda
Model Fit Indices
s
p
CFI
RMSEA
–5.21 –3.25 –0.55 –0.51
.73 .61 .90 .86
0.93 0.92 0.93 0.92
0.072 0.067 0.072 0.066
Note: Raw maternal Brief Symptom Inventory depression scores were square-root transformed. PE ¼ positive emotionality; s ¼ slope; CFI ¼ comparative fit index; RMSEA ¼ root mean square error of approximation. a Adjusted for maternal marital status and net family income.
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DISCUSSION The present study investigated associations between two important risk factors for child psychopathology— MDS and child temperament. There are several strengths of this study such as the large sample size and homogeneous age range of our young participants, the prospective assessment of MDS, and the observational assessment of child temperament. Contrary to our first hypothesis, MDS did not predict offspring PE. This finding was surprising in light of earlier reports of a direct link between maternal depression and low PE in offspring (Durbin et al., 2005; Olino et al., 2011). One explanation for this discrepancy may be that women in our study had relatively low, mainly subclinical depressive symptoms, whereas earlier studies typically included women with clinically relevant (past or current) depressive symptoms. These studies also had fewer participants (100–200) than the present study (800). In another large study, the authors did not find any direct link between parental depression and child PE (Olino et al., 2010). As suggested by the authors, these associations might manifest in interaction with other temperamental dimensions (e.g., NE or BI), but such interactions may remain hidden in smaller samples. In our study, we did not detect significant interactions between offspring PE and fearfulness in relation to MDS (data not shown here). Contrary to our second hypothesis, MDS were associated with decreased offspring fearfulness in an episode that assessed fear of an unfamiliar object=animal. Although earlier research has mainly focused on offspring BI in relation to parental anxiety (Rosenbaum et al., 2000), some studies reported higher BI and less effective fear-regulatory strategies in children of depressed parents (Feldman et al., 2009). The hypothesis that offspring of depressed women are more fearful tends to come from research documenting increased BI in these offspring. In our study, we assessed offspring fearfulness rather than BI. Fearfulness is a lower order trait shared by NE and BI. The Jumping Spider episode used to assess
fearfulness in this study elicits a startle reaction in children in response to a (toy) spider and thus may tap into phobia-like fears, whereas episodes classically used to assess BI may tap more into social anxiety-like behaviors. This division is in line with Gray and McNaughton’s (2000) revised Reinforcement Sensitivity Theory (RST), which advocates the distinction between two separate brain systems underlying fear-related behavior: the Behavioral Inhibition System and the Fear-Flight-Freeze System (FFFS). High Behavioral Inhibition System activity is associated with feelings of anxiety, behavioral inhibition, and internalizing problems, whereas FFFS is thought to underlie emotions of fear and panic as it promotes escape behavior. An overactive FFFS is implicated in panic disorder and specific phobias (Gray & McNaughton, 2000). Lower FFFS activity is inversely associated with the Behavioral Approach System, a third system of the RST (Heym, Ferguson, & Lawrence, 2008). Extreme Behavioral Approach System activity is implicated in externalizing problems (Gray & McNaughton, 2000). It is highly speculative but lower scores in the Jumping Spider episode might reflect decreased activation of the FFFS and be associated with externalizing problems. However, this idea cannot be directly tested in the present study, as the episodes we used were not designed to assess components of the RST. Our PE and fear composites mainly comprised measures of facial, vocal, and bodily expressions of emotion, whereas those scales that classically assess the main motivational systems of the RST typically measure sensitivity to reward=punishment and tendencies of approach= avoidance (Carver & White, 1994). We did not observe children’s sensitivity to reward=punishment but assessed their tendencies of approach=avoidance. Although there was a very small but significant positive correlation between children’s PE and fear scores, when we restricted analysis to the approach=avoidance parameters, avoidance in the Jumping Spider episode was negatively correlated with approach behavior in the Popping Bubbles and Puppet Game episodes (r ¼ .127, p ¼ .001; r ¼ .101, p ¼ .006, respectively).
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MATERNAL DEPRESSIVE SYMPTOMS AND CHILD TEMPERAMENT
Literature reviews demonstrate that maternal depression constitutes a nonspecific risk for a wide range of internalizing but also externalizing problems in childhood (Goodman et al., 2011). Decreased fearfulness has been concurrently and prospectively implicated in conduct problems, and fearless temperament has consistently been proposed as a precursor for later conduct problems with callous unemotional traits (Frick & Morris, 2004). Disinhibited children, who show little fear in novel situations, are also likely to develop other forms of disruptive behavior problems, particularly attention deficit=hyperactivity disorder (ADHD; HirshfeldBecker et al., 2002; Quay, 1997). Children and adolescents with ADHD are more likely than normal peers to engage in risky behavior (White, 1999). One study suggested that although children with ADHD have an intact ability to identify hazards, they may predict less severe consequences following risky behavior and be less well equipped with active injury prevention methods (Farmer & Peterson, 1995). Importantly, MDS have also been linked to childhood ADHD (Nigg & Hinshaw, 1998; Sagiv, Epstein, Bellinger, & Korrick, 2013). As our study is longitudinal in nature, we will be able to follow whether children whose lower scores in the Jumping Spider episode were linked to elevated levels of MDS will be more likely to develop externalizing problems later. Our results suggest that the effect of MDS on low offspring fearfulness extends across the pre- and postnatal period. More specifically, the strongest effect was observed for the composite indicating mothers’ overall tendency to maternal depression. Timing of and change in MDS over time did not affect the association between MDS and offspring fearfulness. Thus, prenatal influences were associated with comparable postnatal experiences, which is consistent with prior literature (Hammen & Brennan, 2003). In summary, we found that offspring of mothers with elevated depressive symptoms were less fearful as preschoolers observed in a novel, startle response-eliciting context. Although this association was relatively weak, small effects in low-risk community samples may be more pronounced and meaningful in clinical samples. Despite the strengths outlined earlier, we faced the following limitations. First, we relied on maternal self-reports of depressive symptoms. Self-report measures in community samples may be more reflective of general ‘‘distress’’ rather than ‘‘true depression’’ (Atkinson et al., 2000). However, self-report measures are commonly used in epidemiological studies and the fact that child temperament was independently observed minimizes any problems due to shared methods variance. Second, we did not observe child temperament at an earlier age, hence, causality cannot be inferred. Consistent with a transactional perspective, associations among the caregiving environment and child characteristics are likely bidirectional (Sameroff & MacKenzie,
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2003). Third, our assessment of PE and fearfulness was limited, as PE was assessed using two episodes, whereas fearfulness was assessed in a single episode. Nevertheless, the study’s large sample size may have improved our ability to detect robust associations. Fourth, high or clinically relevant depressive symptoms in the current low-risk sample were generally rare. Thus, it is difficult to speculate about the effect of severe or chronic maternal depression on child temperament. However, our finding of an association between MDS and offspring fearfulness in this low-risk community sample emphasizes the importance to study the link between maternal depression and offspring temperament and provides a conservative test of our hypothesis. Our observation that MDS are associated with decreased offspring fearfulness suggests a possible mechanism linking maternal depression to childhood externalizing behavior and emphasizes the importance of examining the links between maternal depression and child temperament at the lower order trait level, as this might reveal associations that are qualitatively different from those involving broadband temperamental dimensions.
FUNDING The first phase of the Generation R Study was made possible by financial support from the Erasmus Medical Center, Erasmus University Rotterdam, and the Netherlands Organization for Health Research and Development (ZonMw ‘Geestkracht’, grant no. 10.000.1003). The present study was supported by an additional grant from the Sophia Children’s Hospital Foundation for Scientific Research (grant no. SWO-2007-514). REFERENCES Atkinson, L., Paglia, A., Coolbear, J., Niccols, A., Parker, K. C. H., & Guger, S. (2000). Attachment security: A meta-analysis of maternal mental health correlates. Clinical Psychology Review, 20, 1019–1040. Beardslee, W. R., Gladstone, T. R. G., & O’Connor, E. E. (2011). Transmission and prevention of mood disorders among children of affectively ill parents: A review. Journal of the American Academy of Child and Adolescent Psychiatry, 50, 1098–1109. Browne, M. W., & Cudeck, R. (1993). Alternative ways of assessing model fit. In K. A. Bollen & J. S. Long (Eds.), Testing structural equation models (pp. 136–162). Beverley Hills, CA: Sage. Carver, C. S., & White, T. L. (1994). Behavioral inhibition, behavioral activation, and affective responses to impending reward and punishment: The BIS=BAS scales. Journal of Personality and Social Psychology, 67, 319–333. Caspi, A. (2000). The child is father of the man: Personality continuities from childhood to adulthood. Journal of Personality and Social Psychology, 78, 158–172. Caspi, R., & Shiner, R. L. (2008). Temperament and personality. In M. Rutter, D. V. M. Bishop, D. S. Pine, S. Scott, J. Stevenson, E.
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The Generation R Study: Design and cohort update 2012. European Journal of Epidemiology, 27, 739–756. Jaddoe, V. W., van Duijn, C. M., van der Heijden, A. J., Mackenbach, J. P., Moll, H. A., Steegers, E. A., . . . Hofman, A. (2008). The Generation R Study: Design and cohort update until the age of 4 years. European Journal of Epidemiology, 23, 801–811. Josefsson, A., Berg, G., Nordin, C., & Sydsjo¨, G. (2001). Prevalence of depressive symptoms in late pregnancy and postpartum. Acta Obstetricia et Gynecologica Scandinavica, 80, 251–255. Kagan, J. (1989). Temperamental contributions to social behavior. American Psychologist, 44, 668–674. Kochanska, G. (1991). Patterns of inhibition to the unfamiliar in children of normal and affectively ill mothers. Child Development, 62, 250–263. Laptook, R. S., Klein, D. N., Durbin, C. E., Hayden, E. P., Olino, T. M., & Carlson, G. (2008). Differentiation between low positive affectivity and behavioral inhibition in preschool-age children: A comparison of behavioral approach in novel and non-novel contexts. Personality and Individual Differences, 44, 758–767. Lavigne, J. V., LeBailly, S. A., Hopkins, J., Gouze, K. R., & Binns, H. J. (2009). The prevalence of ADHD, ODD, depression, and anxiety in a community sample of 4-year-olds. Journal of Clinical Child and Adolescent Psychology, 38, 315–328. Muris, P., & Dietvorst, R. (2006). Underlying personality characteristics of behavioral inhibition in children. Child Psychiatry and Human Development, 36, 437–445. Muthe´n, L. K., & Muthe´n, B. O. (1998–2010). Mplus user’s guide (6th ed.). Los Angeles, CA: Muthe´n & Muthe´n. Nigg, J. T., & Hinshaw, S. P. (1998). Parent personality traits and psychopathology associated with antisocial behaviors in childhood attention-deficit hyperactivity disorder. Journal of Child Psychology and Psychiatry, 39, 145–159. Olino, T. M., Klein, D. N., Dyson, M. W., Rose, S. A., & Durbin, C. E. (2010). Temperamental emotionality in preschool-aged children and depressive disorders in parents: Associations in a large community sample. Journal of Abnormal Psychology, 119, 468–478. Olino, T. M., Lopez-Duran, N. L., Kovacs, M., George, C. J., Gentzler, A. L., & Shaw, D. S. (2011). Developmental trajectories of positive and negative affect in children at high and low familial risk for depressive disorder. Journal of Child Psychology and Psychiatry, 52, 792–799. Perez-Edgar, K., & Fox, N. A. (2005). Temperament and anxiety disorders. Child and Adolescent Psychiatric Clinics of North America, 14, 681–706. Quay, H. C. (1997). Inhibition and attention deficit hyperactivity disorder. Journal of Abnormal Child Psychology, 25, 7–13. Reynolds, S. K., & Clark, L. A. (2001). Predicting dimensions of personality disorder from domains and facets of the five factor model. Journal of Personality, 69, 199–222. Rosenbaum, J. F., Biederman, J., Hirshfeld-Becker, D. R., Kagan, J., Snidman, N., Friedman, D., . . . Faraone, S. V. (2000). A controlled study of behavioral inhibition in children of parents with panic disorder and depression. American Journal of Psychiatry, 157, 2002–2010. Rothbart, M. K., & Bates, J. E. (2006). Temperament. In W. Damon, R. Lerner, & N. Eisenberg (Eds.), Handbook of child psychology: Vol. 3. Social, emotional, and personality development (6th ed., pp. 99–166). New York, NY: Wiley. Sagiv, S. K., Epstein, J. N., Bellinger, D. C., & Korrick, S. A. (2013). Pre- and postnatal risk factors for ADHD in a nonclinical pediatric population. Journal of Attention Disorders, 17, 47–57. Sameroff, A. J., & MacKenzie, N. J. (2003). Research strategies for capturing transactional models of development: The limits of the possible. Development and Psychopathology, 15, 613–640. White, J. D. (1999). Personality, temperament and ADHD: A review of the literature. Personality and Individual Differences, 27, 589–598.
Journal of Clinical Child & Adolescent Psychology Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/hcap20
Maternal Depressive Symptoms Are Associated With Low Fearfulness in Preschoolers Eszter Székely
a b f
, Henning Tiemeier
b c
, Pauline W. Jansen
b
Albert Hofman , Frank C. Verhulst & Catherine M. Herba a
b d
, Vincent W. V. Jaddoe
a e
,
b g
The Generation R Study Group , Erasmus Medical Center
b
Department of Child and Adolescent Psychiatry/Psychology , Erasmus Medical Center, Sophia Children's Hospital c
Departments of Epidemiology and Psychiatry , Erasmus Medical Center
d
Murdoch Children's Research Institute, Royal Children's Hospital
e
Departments of Epidemiology and Pediatrics , Erasmus Medical Center
f
Department of Epidemiology , Erasmus Medical Center
g
Department of Psychology , University of Québec at Montréal and Ste-Justine's Hospital Research Center Published online: 08 Jan 2014.
To cite this article: Eszter Székely , Henning Tiemeier , Pauline W. Jansen , Vincent W. V. Jaddoe , Albert Hofman , Frank C. Verhulst & Catherine M. Herba (2014) Maternal Depressive Symptoms Are Associated With Low Fearfulness in Preschoolers, Journal of Clinical Child & Adolescent Psychology, 43:5, 791-798, DOI: 10.1080/15374416.2013.862800 To link to this article: http://dx.doi.org/10.1080/15374416.2013.862800
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Journal of Clinical Child & Adolescent Psychology, 43(5), 791–798, 2014 Copyright # Taylor & Francis Group, LLC ISSN: 1537-4416 print=1537-4424 online DOI: 10.1080/15374416.2013.862800
Maternal Depressive Symptoms Are Associated With Low Fearfulness in Preschoolers Eszter Sze´kely The Generation R Study Group, Erasmus Medical Center and Department of Child and Adolescent Psychiatry=Psychology, Erasmus Medical Center, Sophia Children’s Hospital
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Henning Tiemeier Department of Child and Adolescent Psychiatry=Psychology, Erasmus Medical Center, Sophia Children’s Hospital, and Departments of Epidemiology and Psychiatry, Erasmus Medical Center
Pauline W. Jansen Department of Child and Adolescent Psychiatry=Psychology, Erasmus Medical Center, Sophia Children’s Hospital, and Murdoch Children’s Research Institute, Royal Children’s Hospital
Vincent W. V. Jaddoe The Generation R Study Group, Erasmus Medical Center and Departments of Epidemiology and Pediatrics, Erasmus Medical Center
Albert Hofman Department of Epidemiology, Erasmus Medical Center
Frank C. Verhulst Department of Child and Adolescent Psychiatry=Psychology, Erasmus Medical Center, Sophia Children’s Hospital
Catherine M. Herba Department of Child and Adolescent Psychiatry=Psychology, Erasmus Medical Center, Sophia Children’s Hospital, and Department of Psychology, University of Que´bec at Montre´al and Ste-Justine’s Hospital Research Center
The purpose of this study is to examine whether maternal depressive symptoms predict low positive emotionality and high temperamental fearfulness in preschool children. Maternal depressive symptoms were assessed prenatally and at 2, 6, and 36 months postnatally. Positive emotionality and temperamental fearfulness were assessed using laboratory observations in a large cohort of typically developing Dutch preschoolers (N ¼ 799; 404 boys) at age 36 months (M ¼ 37.53, SD ¼ 1.50). Children exposed to
The Generation R Study is conducted by the Erasmus Medical Center in close collaboration with the School of Law and Faculty of Social Sciences of the Erasmus University Rotterdam, the Municipal Health Services Rotterdam Area, the Rotterdam Homecare Foundation, and the Stichting Trombosedienst & Artsenlaboratorium Rijnmond (STAR). We gratefully acknowledge the contribution of general practitioners, hospitals, midwives, and pharmacies in Rotterdam. Correspondence should be addressed to Henning Tiemeier, Department of Child and Adolescent Psychiatry=Psychology, Erasmus Medical Center, Sophia Children’s Hospital, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands. E-mail: [email protected]
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elevated levels of maternal depressive symptoms in the first 3 years of life behaved less fearfully at age 3 years in a novel context that primarily elicited a startle response (B ¼ 0.08, SE ¼ 0.03, p ¼ .01). The severity rather than timing of or change in maternal depressive symptoms accounted for the observed effect. In the present sample, maternal depressive symptoms were not associated with positive emotionality in the offspring (p > .05). Findings suggest a relation between maternal depressive symptoms and decreased offspring fearfulness in a low-risk community sample of young children.
A large body of research has documented the adverse effects of maternal depression on child development from infancy through adolescence (Beardslee, Gladstone, & O’Connor, 2011; Downey & Coyne, 1990; Field, 1995). However, few studies have examined the effect of maternal depression on child temperament. Temperament generally encompasses biologically based individual differences in affect, activity, attention, and self-regulation (Rothbart & Bates, 2006). Because temperament may guide the adaptation to environmental circumstances (Clark & Watson, 1999), it is often included in risk models of psychopathology (Caspi & Shiner, 2008). According to Clark and Watson’s (1999) tripartite model of depression and anxiety, low positive emotionality (PE; the tendency for positive affect, environmental engagement, and sociability) is specifically linked to depression, whereas high negative emotionality (NE; proneness to sadness, fear, and anger) constitutes a nonspecific risk factor for multiple disorders (e.g., depression, anxiety, substance use, and conduct disorder). The temperamental construct of behavioral inhibition (BI; the tendency toward wariness, reticence, and high constraint; Kagan, 1989) is also implicated as a diathesis for developing depression (Fox, Henderson, Marshall, Nichols, & Ghera, 2005), although it is primarily viewed as a risk factor for anxiety disorders (Perez-Edgar & Fox, 2005). While PE and NE are independent, broadband dimensions (Clark & Watson, 1999), BI is a more specific temperamental trait that shares low approach=exploration with low PE in novel, fear-eliciting contexts (Laptook et al., 2008) and propensity for fearfulness with NE (Muris & Dietvorst, 2006). More recent studies of child temperament highlight the importance of parsing out temperament variables into finer-grained constructs (e.g., fearfulness), as these can contribute unique predictive information (Reynolds & Clark, 2001). Laboratory observations of child temperament are particularly useful when examining the influence of maternal depression, especially when maternal depression is assessed using self-reports. Furthermore, laboratory assessments are ideally suited to study behaviors (e.g., startle reaction) that occur at a low base-rate in naturalistic settings (Durbin, Hayden, Klein, & Olino, 2007). The literature on parental mood disorders and observed early child temperament is limited. Kochanska
(1991) found that parents with bipolar disorder were more likely to have behaviorally inhibited toddlers than nondepressed parents, whereas toddlers of parents with major depression did not differ from these two groups. In another study, children (2–6 years old) of parents with comorbid panic disorder and major depression had higher BI than control subjects, whereas children whose parents had either disorder alone did not significantly differ from any of the two groups (Rosenbaum et al., 2000). In a sample of 3-year-olds, low PE was linked to mothers’ but not fathers’ lifetime history of major depression and dysthymia. No association was found between maternal depression and child NE or BI (Durbin, Klein, Hayden, Buckley, & Moerk, 2005). Parental depressive disorders were related to high NE and BI in a large community sample of 3-year-olds, especially at moderate=high levels of PE (Olino, Klein, Dyson, Rose, & Durbin, 2010). Finally, Olino et al. (2011) reported that offspring of mothers with childhood-onset major depression had consistently lower PE than control peers as modeled with growth curve analysis from infancy through age 9 years. Variability across children in NE over time was insufficient to examine associations between maternal depression and child NE. In two of these studies, exploratory analyses were conducted at the lower order trait level. Although child fearfulness was not associated with parental depression in the smaller sample (Durbin et al., 2005), in the larger sample parental depressive disorders were linked to higher offspring fearfulness (Olino et al., 2010). All of the aforementioned studies included children of parents with a history of depressive disorder. Little is known about whether subclinical levels of maternal depressive symptoms, which are more prevalent in the general population, are also associated with offspring temperamental vulnerability. In addition, our longitudinal study design, which includes repeated assessments of maternal depressive symptoms, enables us to examine both general patterns in maternal depressive symptomatology and the impact of timing on child outcome. In a large community sample, we investigated whether exposure to maternal depressive symptoms in the first 3 years of life predicted observed PE and fearfulness in the offspring. Maternal depressive symptoms were assessed prospectively from before birth through to the child’s age of 3 years. We focused on the early
MATERNAL DEPRESSIVE SYMPTOMS AND CHILD TEMPERAMENT
preschool years, as temperament begins to stabilize during this period (Caspi, 2000), whereas depressive disorders are extremely rare before middle childhood (Lavigne, LeBailly, Hopkins, Gouze, & Binns, 2009). We expected that a greater exposure to maternal depressive symptoms early in life will be associated with lower PE and higher fearfulness in the offspring. Furthermore, we examined whether timing of or change in maternal depressive symptoms affects the association with child PE or fearfulness.
METHOD
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Setting The present investigation pertained to a subsample of children participating in the Generation R Study, a population-based prospective Dutch cohort from fetal life onwards (Jaddoe et al., 2012). The subsample, known as the Generation R Focus Cohort, is ethnically homogeneous to exclude possible confounding or effect modification by ethnicity. All children were born between February 2003 and August 2005 and form a prenatally enrolled birth cohort (Jaddoe et al., 2008). The study was conducted in accordance with the guidelines of the World Medical Association Declaration of Helsinki and approved by the Medical Ethics Committee of the Erasmus Medical Center. Parental written informed consents were obtained for all participants.
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MDS were assessed using the Depression scale of the Brief Symptom Inventory (BSI), the short version of the SCL-90-R (Derogatis & Melisaratos, 1983). The BSI is a 53-item validated self-report inventory in which participants rate the extent to which they have been bothered, from 0 (not at all) to 4 (extremely), in the past week by various symptoms. The BSI Depression scale1 includes six items: ‘‘feeling suicidal,’’ ‘‘feeling lonely,’’ ‘‘feeling blue,’’ ‘‘having no interest in anything anymore,’’ ‘‘feeling hopeless about the future,’’ and ‘‘feeling worthless.’’ Summed scores were divided by the number of completed items with a maximum of one missing item allowed as recommended in the manual (De Beurs, 2004). Internal consistencies of the depression scale for the present study ranged between .75 and .85. To indicate mothers’ overall tendency to experience depressive symptoms during the first 3 years of the offspring’s life, a composite was created by averaging raw maternal BSI depression scores across assessment waves.
Child Temperament Child temperament was assessed at 3 years using the following three episodes of the Laboratory Temperament Assessment Battery (Goldsmith, Reilly, Lemery, Longley, & Prescott, 1999; Goldsmith & Rothbart, 1999), a widely used, standardized observational instrument of early temperament.
Maternal Depressive Symptoms
Jumping Spider. The Jumping Spider episode is designed to elicit a startle=fear reaction based on an unexpected event, which is generally a predominant source of fear among preschool children. In this episode, the child and the experimenter were seated across from each other at a child-sized table on which there was a toy spider in a cage. The experimenter introduced the toy spider as a soft, fuzzy animal that does not bite, and prompted the child to pet it. When the child’s hand was approximately 5 cm away from the spider, the experimenter made it ‘‘jump.’’ This process was repeated four times. At the end, the experimenter explained to the child that it was a toy spider and asked the child if he or she wanted to make it jump. The episode was divided into five epochs for scoring. Intensity of fear expressions, vocal distress, bodily fear, approach, withdrawal, gaze aversion, and startle response were scored in each epoch. Parameters were averaged across all epochs. Interrater reliabilities (intraclass correlation coefficients [ICCs], single measures) for these averages ranged .66 to .95. A fear composite was formed by converting all averages
Information on maternal depressive symptoms (MDS) was obtained by postal questionnaires at 20 weeks of gestation, and at 2, 6, and 36 months postpartum.
1 At 2 months postpartum, women’s BSI depression scores were highly correlated to their scores on the Edinburgh Postnatal Depression Scale (r ¼ .67, p < .001).
Participants Of the 1,106 children who participated in the postnatal phase of the Generation R Focus Cohort, 862 visited our research center at age 36 months with an accompanying parent. Information on maternal depressive symptoms was available for 860 women in one or more assessment waves. Temperament was observed in 807 children at age 36 months using three episodes of laboratory observation. We randomly excluded one twin from the eight participating twin pairs to avoid biases due to paired data. Thus, in total 799 children participated in at least one analysis of child temperament, 754 in analyses of fearfulness and 786 in analyses of PE. Participating children’s average age was 37.53 months (SD ¼ 1.50; range ¼ 34.74–48.89). The sample included 404 (50.6%) boys. The majority of mothers completed higher education (66.3%), was married=cohabiting (94.4%), and had above-average net family income (83.1%).
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into z scores and taking the mean of these standardized averages. Internal consistency of the fear composite was .67. Popping Bubbles. In the Popping Bubbles episode the child engages in the pleasurable activity of blowing and popping bubbles. This episode is divided into a low- and a high-pleasure phase. In the low-pleasure phase, the experimenter demonstrated how to blow bubbles and asked the child to do the same. In the high-pleasure phase, the experimenter encouraged the child to engage in chasing and popping a series of bubbles first with the hands (3x), then with the feet (3x), and finally with both the hands and feet (3x). The episode included 11 epochs for scoring. Intensity of smiling, presence of laughter, and vigor of approach were scored in each epoch. Parameters were averaged across all epochs. ICCs for these averages ranged between .71 and .75. A PE composite for this episode was formed as previously described. Internal consistency of the PE composite for the Popping Bubbles episode was .77. Puppet Game. The Puppet Game episode is designed to measure enjoyment in response to social stimulation. The experimenter performed a standard dialogue in an animated, lively fashion using two hand puppets. During the dialogue, the experimenter tickled the child first with one hand puppet, then with the other, and finally using both puppets. Following the dialogue, the experimenter allowed the child to play with the puppets for 30 s. The episode was divided into five epochs for scoring. Intensity of smiling, presence of laughter, positive vocalizations, and positive motor acts were scored in each epoch. Parameters were averaged across all epochs. ICCs for these averages ranged between .66 and .95. A PE composite for this episode was formed as just described. Internal consistency of the PE composite for the Puppet Game episode was .64. Episodes were coded from DVD recordings according to the original coding systems described in the Laboratory Temperament Assessment Battery. We conducted regular checks to ensure that episodes closely followed the procedure described in the manual. Coders received extensive training, and their reliability was established on a set of 25 DVDs before data were coded. Coders were blind to information regarding MDS. The two PE episodes were significantly correlated (r ¼ .33, p < .001) and thus averaged into a single PE composite for further analyses.
(‘‘married=cohabiting’’ vs. ‘‘single’’) and net family income (‘‘low=average (2000 4=month)’’ vs. ‘‘above average (>2000 4=month)’’ for a two-person household). Other variables related to individual differences (e.g., child’s age and gender) that could have been linked to MDS or child temperament were also examined, but because these were not significantly associated with the predictor or outcome variables, they were dropped from the final model. Statistical Analyses Associations between the variables were explored using Pearson correlation coefficients. Separate linear regression models were run to examine whether the maternal depression composite predicts offspring PE and fearfulness. Hierarchical linear regressions were run to explore the effect of timing of MDS on child PE and fearfulness. To this aim, prenatal, postnatal, and concurrent MDS were entered as separate levels into a single model. Finally, to examine if change in MDS over time impacts offspring PE and fearfulness, MDS were modeled using latent growth curve analysis (Mplus version 7; Muthe´n & Muthe´n, 1998–2010). Time intervals between the repeated assessments were fixed to be equal for each participant: The prenatal assessment was fixed at 0, the subsequent postnatal assessments at 0.57, 0.90, and 3.38, reflecting the mean time intervals in years between subsequent assessments. Because raw MDS scores were highly skewed, we applied the square-root transformation. The model indicates rate of change in MDS over time by estimating a slope parameter for each participant. Model fit was determined based on the comparative fit index (acceptable fit 0.90) and root mean square error of approximation (acceptable fit 0.08; Browne & Cudeck, 1993). Offspring PE and fearfulness were regressed on the estimated slope parameters. All models were adjusted for maternal marital status and family income. Response Analysis Study participants (n ¼ 799) were compared along baseline characteristics with those who were postnatally eligible but did not participate in this study (n ¼ 307). Participating women were less often single (3.5% vs. 8%), v2(1) ¼ 9.68, p ¼ .002, and had more often above average family income (87.8% vs. 82.5%), v2(1) ¼ 4.76, p ¼ .029, than nonparticipants. The two groups did not differ on the MDS composite, t(396.28, corrected for unequal variances) ¼ 1.17, p ¼ .244.
Covariates Models were adjusted for maternal or child characteristics if they were significantly associated with the predictor (MDS) or the outcome (child temperament). These indicators included maternal marital status
RESULTS Information on MDS at each assessment is presented in Table 1. The percentage of women with clinically
MATERNAL DEPRESSIVE SYMPTOMS AND CHILD TEMPERAMENT
795
TABLE 1 Prenatal, Postnatal, and Concurrent Maternal Depressive Symptoms
Maternal BSI Depression Score Prenatal Postnatal Concurrent
N
M (SD)
Minimum
Maximum
>Clinical Cutoff a
749 738 699
0.11 (0.30) 0.13 (0.26) 0.09 (0.21)
0.00 0.00 0.00
3.50 2.67 2.00
3.3% 2.7% 2.0%
a A raw Brief Symptom Inventory (BSI) depression score of 0.80 was used as cutoff to indicate clinically significant depressive symptoms as recommended based on the available norms for Dutch female populations (De Beurs, 2009).
TABLE 2 Correlation Matrix Including Independent and Dependent Variables of Interest
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Variables 1. 2. 3. 4. 5. 6. 7.
1
2
3
4
5
6
Prenatal BSI Depression Score — — Postnatal BSI Depression Score .550 Concurrent BSI Depression Score .367 .356 — PE .009 .017 –.060 — y Fearfulness –.088 –.065 –.088 .089 — .038 — Family Income (Low=Average vs. High) –.170 –.114 –.156 –.039 Marital Status Mother (Married=Living Together vs. Single) .158 .158 .115 .056 –.022 –.322 Note: BSI ¼ Brief Symptom Inventory; PE ¼ positive emotionality. p < .05. p < .01. p < .001. y p < .1.
significant depressive symptoms was highest during pregnancy (3.3%) and gradually decreased after birth (2.7%), with the lowest rates observed concurrently (2%). These rates were lower than reported previously (Gavin et al., 2005). Bivariate and point-biserial correlations between predictors, outcomes, and covariates are presented in Table 2. Prenatal, postnatal, and concurrent MDS were moderately correlated, which is in line with earlier observations (e.g., Josefsson, Berg, Nordin, & Sydsjo¨, 2001). Results of the hierarchical regression analyses are shown in Table 3. MDS did not predict offspring PE. That is, neither the composite nor the single time point
measures of MDS were significantly related to child PE at age 3 years (Table 3). However, offspring of mothers with a higher MDS composite were less fearful in the Jumping Spider episode. Timing of MDS did not influence this relationship. Finally, good model fit was obtained for the initial growth model of MDS: comparative fit index ¼ 0.93 and root mean square error of approximation ¼ 0.08. In addition, the slope of the initial model was significant (s ¼ 0.009, p ¼ .011), indicating a small linear decrease in MDS over time. Table 4 summarizes the results of regressing offspring PE and fearfulness on the slope parameter of MDS. Change in MDS over time was not associated with children’s PE or fearfulness.
TABLE 3 Hierarchical Regression Analyses of Maternal Depressive Symptoms and Child PE and Fearfulness PE at Age 3 Years B
SE
Maternal Depressive Symptoms Composite –0.005 0.09 Prenatal –0.19 0.10 Postnatal 0.04 0.10 Concurrent –0.12 0.11
Fearfulness at Age 3 Years
p
R2 Change
F (df)
p
B
SE
p
R2 Change
F (df)
p
.957 .051 .698 .282
0.001 0.007 0.001 0.002
0.003 (1, 728) 3.81 (1, 575) 0.15 (1, 547) 1.16 (1, 573)
.957 .051 .698 .282
–0.28 –0.18 –0.03 –0.21
0.11 0.10 0.11 0.12
.010 .080 .794 .087
0.010 0.006 0.001 0.005
6.672 (1, 693) 3.08 (1, 548) 0.07 (1, 547) 2.94 (1, 546)
.010 .080 .794 .087
Note: Models were adjusted for maternal marital status and net family income, entered into Level 1. Prenatal, postnatal, and concurrent maternal depressive symptom scores were entered into the same regression model as separate levels. Results of the unadjusted analyses were essentially the same. PE ¼ positive emotionality.
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Unadjusted Adjusteda Unadjusted Adjusteda
Model Fit Indices
s
p
CFI
RMSEA
–5.21 –3.25 –0.55 –0.51
.73 .61 .90 .86
0.93 0.92 0.93 0.92
0.072 0.067 0.072 0.066
Note: Raw maternal Brief Symptom Inventory depression scores were square-root transformed. PE ¼ positive emotionality; s ¼ slope; CFI ¼ comparative fit index; RMSEA ¼ root mean square error of approximation. a Adjusted for maternal marital status and net family income.
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DISCUSSION The present study investigated associations between two important risk factors for child psychopathology— MDS and child temperament. There are several strengths of this study such as the large sample size and homogeneous age range of our young participants, the prospective assessment of MDS, and the observational assessment of child temperament. Contrary to our first hypothesis, MDS did not predict offspring PE. This finding was surprising in light of earlier reports of a direct link between maternal depression and low PE in offspring (Durbin et al., 2005; Olino et al., 2011). One explanation for this discrepancy may be that women in our study had relatively low, mainly subclinical depressive symptoms, whereas earlier studies typically included women with clinically relevant (past or current) depressive symptoms. These studies also had fewer participants (100–200) than the present study (800). In another large study, the authors did not find any direct link between parental depression and child PE (Olino et al., 2010). As suggested by the authors, these associations might manifest in interaction with other temperamental dimensions (e.g., NE or BI), but such interactions may remain hidden in smaller samples. In our study, we did not detect significant interactions between offspring PE and fearfulness in relation to MDS (data not shown here). Contrary to our second hypothesis, MDS were associated with decreased offspring fearfulness in an episode that assessed fear of an unfamiliar object=animal. Although earlier research has mainly focused on offspring BI in relation to parental anxiety (Rosenbaum et al., 2000), some studies reported higher BI and less effective fear-regulatory strategies in children of depressed parents (Feldman et al., 2009). The hypothesis that offspring of depressed women are more fearful tends to come from research documenting increased BI in these offspring. In our study, we assessed offspring fearfulness rather than BI. Fearfulness is a lower order trait shared by NE and BI. The Jumping Spider episode used to assess
fearfulness in this study elicits a startle reaction in children in response to a (toy) spider and thus may tap into phobia-like fears, whereas episodes classically used to assess BI may tap more into social anxiety-like behaviors. This division is in line with Gray and McNaughton’s (2000) revised Reinforcement Sensitivity Theory (RST), which advocates the distinction between two separate brain systems underlying fear-related behavior: the Behavioral Inhibition System and the Fear-Flight-Freeze System (FFFS). High Behavioral Inhibition System activity is associated with feelings of anxiety, behavioral inhibition, and internalizing problems, whereas FFFS is thought to underlie emotions of fear and panic as it promotes escape behavior. An overactive FFFS is implicated in panic disorder and specific phobias (Gray & McNaughton, 2000). Lower FFFS activity is inversely associated with the Behavioral Approach System, a third system of the RST (Heym, Ferguson, & Lawrence, 2008). Extreme Behavioral Approach System activity is implicated in externalizing problems (Gray & McNaughton, 2000). It is highly speculative but lower scores in the Jumping Spider episode might reflect decreased activation of the FFFS and be associated with externalizing problems. However, this idea cannot be directly tested in the present study, as the episodes we used were not designed to assess components of the RST. Our PE and fear composites mainly comprised measures of facial, vocal, and bodily expressions of emotion, whereas those scales that classically assess the main motivational systems of the RST typically measure sensitivity to reward=punishment and tendencies of approach= avoidance (Carver & White, 1994). We did not observe children’s sensitivity to reward=punishment but assessed their tendencies of approach=avoidance. Although there was a very small but significant positive correlation between children’s PE and fear scores, when we restricted analysis to the approach=avoidance parameters, avoidance in the Jumping Spider episode was negatively correlated with approach behavior in the Popping Bubbles and Puppet Game episodes (r ¼ .127, p ¼ .001; r ¼ .101, p ¼ .006, respectively).
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MATERNAL DEPRESSIVE SYMPTOMS AND CHILD TEMPERAMENT
Literature reviews demonstrate that maternal depression constitutes a nonspecific risk for a wide range of internalizing but also externalizing problems in childhood (Goodman et al., 2011). Decreased fearfulness has been concurrently and prospectively implicated in conduct problems, and fearless temperament has consistently been proposed as a precursor for later conduct problems with callous unemotional traits (Frick & Morris, 2004). Disinhibited children, who show little fear in novel situations, are also likely to develop other forms of disruptive behavior problems, particularly attention deficit=hyperactivity disorder (ADHD; HirshfeldBecker et al., 2002; Quay, 1997). Children and adolescents with ADHD are more likely than normal peers to engage in risky behavior (White, 1999). One study suggested that although children with ADHD have an intact ability to identify hazards, they may predict less severe consequences following risky behavior and be less well equipped with active injury prevention methods (Farmer & Peterson, 1995). Importantly, MDS have also been linked to childhood ADHD (Nigg & Hinshaw, 1998; Sagiv, Epstein, Bellinger, & Korrick, 2013). As our study is longitudinal in nature, we will be able to follow whether children whose lower scores in the Jumping Spider episode were linked to elevated levels of MDS will be more likely to develop externalizing problems later. Our results suggest that the effect of MDS on low offspring fearfulness extends across the pre- and postnatal period. More specifically, the strongest effect was observed for the composite indicating mothers’ overall tendency to maternal depression. Timing of and change in MDS over time did not affect the association between MDS and offspring fearfulness. Thus, prenatal influences were associated with comparable postnatal experiences, which is consistent with prior literature (Hammen & Brennan, 2003). In summary, we found that offspring of mothers with elevated depressive symptoms were less fearful as preschoolers observed in a novel, startle response-eliciting context. Although this association was relatively weak, small effects in low-risk community samples may be more pronounced and meaningful in clinical samples. Despite the strengths outlined earlier, we faced the following limitations. First, we relied on maternal self-reports of depressive symptoms. Self-report measures in community samples may be more reflective of general ‘‘distress’’ rather than ‘‘true depression’’ (Atkinson et al., 2000). However, self-report measures are commonly used in epidemiological studies and the fact that child temperament was independently observed minimizes any problems due to shared methods variance. Second, we did not observe child temperament at an earlier age, hence, causality cannot be inferred. Consistent with a transactional perspective, associations among the caregiving environment and child characteristics are likely bidirectional (Sameroff & MacKenzie,
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2003). Third, our assessment of PE and fearfulness was limited, as PE was assessed using two episodes, whereas fearfulness was assessed in a single episode. Nevertheless, the study’s large sample size may have improved our ability to detect robust associations. Fourth, high or clinically relevant depressive symptoms in the current low-risk sample were generally rare. Thus, it is difficult to speculate about the effect of severe or chronic maternal depression on child temperament. However, our finding of an association between MDS and offspring fearfulness in this low-risk community sample emphasizes the importance to study the link between maternal depression and offspring temperament and provides a conservative test of our hypothesis. Our observation that MDS are associated with decreased offspring fearfulness suggests a possible mechanism linking maternal depression to childhood externalizing behavior and emphasizes the importance of examining the links between maternal depression and child temperament at the lower order trait level, as this might reveal associations that are qualitatively different from those involving broadband temperamental dimensions.
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