Depressed Persons and Their Children

Although the relationships of depressed women with their children have received less attention than have their marital relationships, results of a number of diverse studies suggest that this may be an important area of investigation. For example, epidemiological investigations indicate that women who are raising children and who are not employed outside the home are particularly vulnerable to depression (Brown & Harris, 1978; Gotlib, Whiffen, Mount, Milne, & Cordy, 1989). Depressed women have also been found to report difficulty being warm and consistent mothers, and they indicate that they derive little satisfaction in being mothers and feel inadequate in this role (Bromet & Comely, 1984; Weissman, Paykel, & Klerman, 1972). Interestingly, several studies have found currently depressed adults to report having experienced difficult early family environments and problems in their relationships with their parents (Gotlib, Mount, Cordy, & Whiffen, 1988; Parker, 1981). Given these findings, it is not surprising that accumulating evidence suggests that the children of depressed parents are at increased risk for a variety of psychological and social difficulties (Beardslee, Bemporad, Keller, & Klerman, 1983; Gotlib & Lee, in press-a). A number of studies have examined the relationships between depressed women and their children. Compared with their nondepressed counterparts, depressed mothers have been found to report being less involved, less affectionate, and more emotionally distant with their children, and to experience more irritability and resentment (Weissman et al., 1972). Depressed mothers have also been found to report various psychological and physical problems in their children, including depressed and anxious mood, suicidal ideation, and difficulties in school (Billings & Moos, 1983; Weissman et al., 1984). Furthermore, Billing and Moos (1986) found that depressed mothers continued to report problems in their children’s functioning even after remission of their own depressive symptoms. Several investigators have moved beyond the self-reports of depressed women to examine more directly and objectively both the interactions of depressed mothers and their children and the psychosocial functioning of the children themselves. Bettes (1988), for example, found that depressed mothers took longer to respond to their infants’ vocalizations than did nondepressed mothers and, further, failed to modify their own speech after their infants had vocalized. In addition, the speech of the depressed women was more monotonous, failing to provide “affective signals” that allow infants to regulate their affective state. 

In a study conducted in our laboratory, Whiffen and Gotlib (in press) examined the effects of postpartum depression on infant cognitive and socioemotional development. Depressed mothers in this study rated their infants as more temperamentally difficult than did nondepressed mothers. Independent observers also rated the infants of the depressed mothers as more tense, less happy, and deteriorating more quickly under the stress of testing (Cohn, Matias, Tronick, Connell, & Lyons-Ruth, 1986; Ghodsian, Zayicek, & Wolkind, 1984; Zekoski, O’Hara, & Wills, 1987). Two studies have attempted to delineate the specific characteristics of depressive mothering. Breznitz and Sherman (1987) reported that in a nonthreatening situation, depressed mothers of two- to three-year-old children spoke less than did nondepressed mothers. When placed in a more stressful situation, however, they increased their speech rate and decreased their response latency, a speech pattern indicative of anxiety. Breznitz and Sherman proposed that the children of depressed mothers were being socialized to respond to stress with exaggerated emotionality. In a similar study, Kochanska, Kuczynski, Radke-Yarrow, and Welsh (1987) compared the interactions of depressed and control mothers in situations in which the mother initiated an attempt to control or influence the child’s behavior. Kochanska et al. found that the depressed mothers were more likely than were the nondepressed mothers to terminate the attempt before resolution, and were less likely to reach a compromise solution. These investigators proposed that the premature termination of control attempts may have been due to the depressed mother’s fear of confrontation, a hypothesis consistent with the results of studies demonstrating that depressed adults cope by avoiding stressful situations (Coyne, Aldwin, & Lazarus, 1981). Studies of the older children of depressed mothers indicated that these children demonstrate poorer functioning than do children of nondepressed parents.

Weiner, Weiner, McCrary, and Leonard (1977) reported that the children of the depressed parents had more depressed mood, death wishes, frequent fighting, somatic complaints, loss of interest in usual activities, hypochondriacal concerns, and disturbed classroom behavior. The results of a recent observational study indicated that children of depressed mothers emit more irritated affect than do children in nondepressed families (Hops et al., 1987). Lee and Gotlib (1989a, 1989b) recently examined child adjustment in families in which the mother was diagnosed as suffering from a nonpsychotic, unipolar depression. Lee and Gotlib found that children of depressed mothers demonstrated higher rates of both internalizing and externalizing problems than did children of nondepressed psychiatric and medical control mothers. Clinical interviewers identified a greater number of psychological symptoms and poorer overall adjustment in the children of depressed mothers than they did in the children of community control mothers. 

Moreover, these deficits appeared to persist at a 10-month follow-up, even after the mothers’ depressive symptoms had dissipated (Hammen et al., 1987; Hirsch, Moos, & Reischl, 1985; Turner, Beidel, & Costello, 1987). Several investigators have demonstrated that a remarkably high proportion of children of depressed parents meet diagnostic criteria for psychiatric disorder. Beardslee, Schultz, and Selman (1987), Klein, Clark, Dansky, and Margolis (1988), and Orvaschel, Walsh-Ellis, and Ye (1988), for example, found that between 40 and 50 percent of the adolescent children of depressed parents met criteria for a diagnosis of past or current psychiatric disturbance. Hammen et al. (1987) obtained similar results in a more extensive investigation, but also reported that group differences were attenuated when psychosocial stresses were covaried. Finally, in a study described earlier, Lee and Gotlib (1989a, 1989b) reported that two-thirds of the children of the depressed mothers in their sample were placed in the clinical range on the Child Behavior Check List, an incidence three times greater than that observed in the nondepressed controls. Children of depressed mothers have been found in a number of studies, using a diverse range of methodologies, to demonstrate problematic psychosocial adjustment and functioning. Moreover, these difficulties are apparent at a wide range of ages. A consistent finding in this literature is that, even when their mothers are no longer overtly symptomatic, children continue to demonstrate behavioral difficulties, indicating that there may be a substantial lag between alleviation of maternal symptomatology and improvement in child functioning. This finding parallels results of studies reviewed earlier, suggesting that marital difficulties also persist beyond the depressive episode. Thus, alleviation of maternal symptomatology should not be taken as a signal that all family members are functioning adequately. Given the pervasiveness of the problematic interpersonal functioning of depressed persons, a number of interventions for depression have been developed that focus on the marital and family relationships of the depressed patient.