Maternal Depression, Paternal Psychopathology, and
Toddlers’ Behavior Problems
Laura J. Dietz
Department of Psychiatry, University of Pittsburgh School of Medicine
Kay Donahue Jennings
Department of Psychology, University of Pittsburgh
Sue A. Kelley
Department of Psychology, Lycoming College
Department of Psychiatry, University of Pittsburgh School of Medicine
This article examined the effects of maternal depression during the postpartum
period (Time 1) on the later behavior problems of toddlers (Time 3) and tested if this
relationship was moderated by paternal psychopathology during toddlers’ lives and=or
or mediated by maternal parenting behavior observed during mother–child interaction
(Time 2). Of the 101 mothers who participated in this longitudinal study with their
toddlers, 51 had never experienced an episode of Major Depressive Disorder (MDD)
and 50 had experienced an episode of MDD during the first 18 months of their toddlers’
lives. Maternal depression at Time 1 was significantly associated with toddlers’ externa-
lizing and internalizing behavior problems only when paternal psychopathology was
present. As predicted, maternal negativity at Time 2 was found to mediate the relation-
ship between maternal depression at Time 1 and toddlers’ externalizing behavior
problems at Time 3.
Despite a large body of empirical studies illustrating
maternal depression as a risk factor for negative devel-
opmental outcomes in older children and adolescents,
less consistent findings have been demonstrated in
studies of the effects of maternal depression on infant
and toddler outcomes. Indeed, several studies of early
childhood have failed to find differences in markers of
socioemotional competence and adaptation in young
children based upon exposure to maternal depression.
In their study of maternal depression and toddler
attachment, Radke-Yarrow and colleagues did not find
differences in rates of infant attachment insecurity
between depressed and nondepressed mothers, although
higher rates of insecure attachment were evident in the
children of mothers with bipolar disorder (Radke-
Yarrow, Cummings, Kuczynski, & Chapman, 1985).
Likewise, Cohen and Campbell (1992) found that
maternal depression, in the absence of other risk factors,
did not predict poor infant responsiveness or insecure
attachment in infants. Toddlers with depressed mothers
did not differ from controls in their attachment security
and social competence (Seifer et al., 1996) and in attach-
ment security in preschool children with depressed
and nondepressed mothers (Frankel & Harmon, 1996).
This research was supported in part by a grant from the National
Institute of Mental Health (MH49419). We thank the mothers and
toddlers who participated in the study and David Brent for feedback
on the manuscript.
Correspondence should be addressed to Laura J. Dietz, 3811
O’Hara Street, Western Psychiatric Institute and Clinic, University
Pittsburgh, PA 15213. E-mail: email@example.com
Journal of Clinical Child & Adolescent Psychology, 38(1), 48–61, 2009
Copyright # Taylor & Francis Group, LLC
ISSN: 1537-4416 print=1537-4424 online
A more recent meta-analysis of studies on the effects of
early maternal depression on infant attachment high-
lighted the heterogeneity in the attachment security of
young children exposed to early maternal depression
(Martins & Gaffan, 2000). Taken together, these find-
ings suggest that maternal depression, as a single risk
factor, may not always predict child maladjustment
early in development.
Studies that do not find main effects for the impact of
maternal depression on child outcomes may be related
to the limited examination of family risk factors that
co-occur with maternal depression and increase predic-
tion of which children exposed to maternal depression
are most at-risk. Specifically, maternal depression may
be more likely to be associated with young children’s
maladjustment in the presence of paternal psychopath-
ology and negative maternal interaction styles. Recent
conceptual publications have proposed examining mul-
tiple contextual risk factors when investigating the
relationship between maternal depression and young
children’s maladjustment and have presented models
for understanding the more complex relationships
between maternal depression, family risk factors, and
children’s maladjustment (e.g., Goodman & Gotlib,
1999). However, empirical tests of the role of these fam-
ily risk factors have lagged behind theoretical advances
in conceptualizing the nature of multivariate interplay
between maternal depression and family risk factors.
Existing studies on the effects of maternal depression
on children’s outcomes also often do not examine differ-
ent indices of maternal depression. Early exposure to
maternal depression has been hypothesized to interfere
with children’s normative developmental processes and
several studies indicate that early exposure to maternal
depression has lingering detrimental effects on children’s
functioning (Hay, Pawlby, Angold, Harold, & Sharp,
2003; Hay et al., 2001) and mother–child interactions
(Stein et al., 1991), even after mothers’ depression
remit. Other studies suggest that chronic exposure to
maternal depression is more strongly associated with
increased maternal parenting stress (Cornish et al.,
2006) and negative child outcomes (McMahon, Barnett,
Kowalenko, & Tennant, 2006; Trapolini, McMahon, &
Ungerer, 2007). At the same time, a growing body of
evidence also suggests that a reduction in mother’s
depressive symptoms is associated with an improvement
in children’s functioning (Cicchetti & Schneider-Rosen,
1986; Field, 1992; Pianta, Erickson, Wagner, Kruetzer,
& Egeland, 1990) and in the quality of mother–child
interactions (Campbell & Cohn, 1997). Hence, the
examination of various indices of maternal depression
(e.g., history, chronicity, and recency of maternal
types of maternal depression confer the greatest risk to
The goal of this empirical study was to advance the
depression by testing two alternative multivariate for-
mulations (e.g., mediation, moderation) of the effects
of maternal depression, paternal psychopathology, and
negative maternal feedback on toddlers’ behavior pro-
blems. This study, involving a multimethod battery,
clinically identified sample of mothers and prospective
diagnostic assessment of maternal depression, attempts
to improve methodological characteristics highly rep-
resentative of the maternal depression literature to date
that typically rely on monomethod designs, community
samples of mothers, and single assessments of maternal
depression (e.g., lifetime history or current depression).
Epidemiological studies have consistently outlined a
higher likelihood for cooccurring psychopathology in
Merikangas, 1984). Because depressed women are more
likely to choose spouses with depression, substance use
disorders, or antisocial personality disorder (Gotlib &
Hammen, 1992), young children of depressed mothers
are more likely to have fathers with a psychological
disturbance. Paternal psychopathology has been asso-
ciated with high levels of behavior problems and mal-
adjustment in children and adolescents (see Kane &
Garber, 2004). The presence or absence of mental disor-
ders in fathers may modify the degree of risk these chil-
dren experience. Involvement with healthy fathers may
promote resilience in children with depressed mothers
and may buffer children from negative effects of
maternal depression (Field, Hossain, & Malphurs,
1999; Tannenbaum & Forehand, 1994). However,
involvement with impaired fathers may increase the like-
lihood for negative outcomes in young children with
depressed mothers (Jaffee, Moffitt, Caspi, & Taylor,
2003). Paternal psychopathology increases children’s
genetic vulnerability for developing psychiatric disor-
ders, exacerbates stress between family members, and
reduces cohesion in the family environments in which
these children are socialized (Dierker et al., 1999).
Hence, the combined risk of both maternal depression
and paternal psychopathology may pose a ‘‘double
whammy’’ for children already at risk for maladjust-
ment (Jaffee et al., 2003).
Goodman and Gotlib (1999) outlined a conceptual
model whereby the presence of paternal psychopath-
ology moderates the effect of maternal depression on
children’s risk for psychopathology. They proposed that
fathers may increase the risk for psychopathology in
children of depressed mothers if they too have
psychopathology. The rationale for exploring paternal
psychopathology as a moderator, rather than mediator,
is supported by a handful of empirical studies indicating
that school-aged children with two depressed parents are
at significantly greater risk for disorder than are school-
aged children with one depressed parent (Weissman,
Leckman, Merikangas, Gammon, & Prusoff, 1984)
and, conversely, that the presence of a healthy father
in the home is associated with low rates of disorder
among school-aged children with depressed mothers
(Conrad & Hammen, 1989). Connell and Goodman
(2002) also presented preliminary evidence in their
meta-analysis that paternal psychopathology moderates
the association between maternal psychopathology and
school age children’s maladjustment.
The role of paternal psychopathology to moderate
young children’s maladjustment when maternal de-
pression is present is a promising area of investigation.
However, the few studies that have examined paternal
psychopathology in relation to maternal depression in
young children have not found a moderating effect
(Goodman, Brogan, Lynch, & Fielding, 1993) or have
found this effect in community samples of mothers
who did not meet diagnostic criteria for depression.
For example, Eiden and Leonard (1996) found that
paternal psychopathology moderated the association
between maternal depression and toddlers’ attachment
security, as those mothers with elevated symptoms of
depression who had alcohol dependent husbands were
more likely to have insecurely attached toddlers.
Similarly, Carro and colleagues found that paternal
between maternal postpartum depressive symptoms
and toddlers’ behavior problems in situations where
maternal depressive symptoms were low (Carro, Grant,
Gotlib, & Compras, 1993). These findings, therefore,
need to be replicated in a clinical sample of depressed
mothers with young children.
Mothers’ verbal and nonverbal communication with
children in social interactions represents a primary
vehicle for young children’s developing social com-
petence (Maccoby, 1992). Positive communication styles
and maternalwarmth observed
behavior and positive self-concept development in
children (Kochanska, 1997). On the other hand, nega-
tive affectivity and communication styles observed in
mothers have been associated with negative self-concept
(Goodman, Adamson, Riniti, & Cole, 1994; Hammen,
Burge, & Stansbury, 1990), low perceived competence
(Jacquez, Cole, & Searle, 2004), and high levels of
externalizing and internalizing behavior in children
(Caspi et al., 2004; Nelson, Hammen, Brennan, &
Ulman, 2003; Vostanis, Nicholls, & Harrington, 1994).
Similar research on the construct of expressed emotion
also indicates that mothers of children with behavioral
disorders express more critical comments, fewer positive
comments, and less warmth toward their children than
do control parents when asked to provide a 5-min
speech sample about their children (McCarty, Lau,
Valeri, & Weisz, 2004; Nelson et al., 2003; Peris & Baker,
2000). Indeed, a high level of parental criticism in the 5-
min speech sample is strongly associated with problem-
atic parent–child interactions (McCarty et al., 2004).
Because depression negatively affects interpersonal
relationships, several studies have found that depressed
mothers demonstrate high levels of negative affect and
critical feedback and low levels of sensitivity and warmth
in interactions with their young children (Campbell,
Cohn, & Meyers, 1996; Cicchetti & Toth, 1995; Cohn,
Matias, Tronick, Connell, & Lyons-Ruth, 1986; Field,
1995; Shaw & Bell, 1993; Zahn-Waxler, Iannotti,
Cummings, & Dedham, 1990). As a part of their concep-
tual model for the intergenerational transmission of
depression, Goodman and Gotlib (1999) proposed that
parenting interactions mediate the effects of maternal
depression on children’s social and emotional develop-
and negative communication styles may be mechanisms
through which parenting interactions of depressed
mothers increase their children’s risk for behavior and
emotional problems. However, only a few empirical
studies have demonstrated negative maternal parenting
mediating the relationship between maternal depression
and maladjustment in young children (Campbell et al.,
1996; Cicchetti, Rogosch, & Toth, 1998).
RATIONALE OF PROPOSED STUDY
This study examined the associations among maternal
indices of maternal parenting in the context of
mother–child interactions (negativity, warmth, nega-
tive feedback) on toddlers’ externalizing and interna-
lizing behavior problems. A large clinical sample of
mothers who had experienced an episode of Major
Depressive Disorder (MDD) in the first 18 months
of their toddlers’ lives and a matched control group
were recruited to examine the effects of maternal
depression on various aspects of toddlers’ social and
emotional development. The sample was relatively
homogeneous, composed of mostly intact, middle-
class families, which allowed for isolating the influ-
ence of maternal depression from other high-risk
factors associated with poor child outcomes (e.g.,
low socioeconomic status [SES], divorce).
DIETZ, JENNINGS, KELLEY, AND MARSHAL
The longitudinal design of the study allowed for
examining the effects of maternal depression on toddler
behavior problems, and the potential of maternal par-
enting behavior to mediate this relationship, over a
mediation and moderation require a temporal precedent
(see Kraemer, Stice, Kazdin, Offord, & Kupfer, 2001),
maternal depression status when toddlers were approxi-
mately 18 months of age (Time 1) was used as our pri-
mary index of maternal depression. Retrospective and
current assessment of maternal depression at Time 1
allowed for the construction of a single index that
captured both history of maternal depression during
the first 18 months of toddlers’ lives and mothers’
current depressive symptoms. A measure of toddler
adjustment was administered when toddlers were
approximately 33 months of age (Time 3). The potential
mediators of maternal negativity and warmth reflected
data coded from videotaped mother–child interactions
conducted when toddlers were approximately 25 months
of age (Time 2). The third potential mediator examined,
maternal negative feedback, was coded from videotaped
mother–child interactions collected at Time 3. Although
this potential mediator is concurrent with the outcome
variables, maternal negative feedback was not coded
from mother–child interactions collected at Time 2.
Finally, paternal psychopathology status was collected
via maternal retrospective report at Time 3 and reflected
the presence or absence of any psychiatric illness in
fathers during toddlers’ lives.
Two primary hypotheses were tested: (a) Paternal
psychopathology was expected to moderate the relation-
ship between maternal depression and toddlers’ beha-
vior problems, and (b) negative maternal parenting
(negativity, low warmth, and negative feedback) was
predicted to mediate associations between maternal
depression and toddlers’ behavior problems. In the
course of testing these hypotheses, the univariate rela-
tionships among maternal depression, paternal psycho-
pathology, and maternal parenting variables were also
examined, as well as the relationships between these
predictors and toddlers’ adjustment.
One hundred and one mother–toddler dyads participated
in a longitudinal study of the effects of maternal
was conducted with approval from the University of
Pittsburgh’s Institutional Review Board and in accord-
ance with ethical standards in the treatment of human
participants as outlined by the American Psychological
Association. Of the 101 mothers, 51 had experienced
a clinical depression during their toddlers’ lives and 50
had never been depressed. The majority of mothers com-
posing the depressed group were recruited from a large
regional psychiatric hospital and its satellite outpatient
clinics. The majority of mothers in the nondepressed con-
trol group were recruited from a large urban obstetrics
hospital. All mothers in the depressed group met Diag-
nostic and Statistical Manual of Mental Disorders (4th
ed. [DSM–IV]; American Psychiatric Association, 1994)
criteria for a depressive disorder within the first 18
months of their toddlers’ lives that interfered with their
functioning tothepoint theyallsoughtoutpatientpsychi-
atric treatment for depression (therapy, medication, or a
combination of both). Of these mothers, 75.5% experi-
enced the onset of their depressive episode within the first
6 months of their infants’ lives. Relatively fewer mothers
experienced depression when their infants were 7 to 12
months of age (11.8%) and 13 to 18 months of age
(13.7%). Of mothers who experienced depression, 13%
received psychotherapy only, 11% chose to take antide-
pressant medication only, and 76% opted for combi-
nation treatment (therapy and medication). A small
percentageof mothers in thedepressedgroup experienced
an episode of depression so severe that they were admit-
ted to an inpatient psychiatric hospital for treatment
Mothers were excluded from the nondepressed con-
trol group if they met criteria for MDD since the birth
of their child or at any time in their lives, or met criteria
for any other Axis I disorder in the past 5 years. Mothers
were excluded from both depressed and nondepressed
groups if they met diagnostic criteria for schizophrenia,
bipolar disorder, or any substance use disorder.
Mothers in both the depressed and nondepressed con-
trol groups were matched on SES (Hollingshead, 1975),
minority status (ethnicity), parity (number of pregnan-
cies), and marital status. Mothers participating in the
study were predominantly middle class (mean Hollings-
head score¼1.96, SD¼1.04). However, the full range
of SES levels (1–5) was represented, with lower scores
representing higher SES. Families in both the depressed
and nondepressed groups were predominantly of nonmi-
nority ethnicity (96% Caucasian, 3% African American,
and 1% Latin American), and from intact families (94%
of fathers living with toddlers), with one or two children
in the home (78%). Eighty-three percent of parents had
attained an educational level beyond high school (partial
college or specialized training, college, or graduate
degrees). Toddlers in the sample consisted of 44 girls
and 57 boys, all from healthy, singleton births. None
of the toddlers had known disabilities, significant devel-
opmental delays or major medical illnesses at the time of
recruitment. Table 1 outlines additional demographic
depression status upon entry to the study (Time 1).
All mothers provided informed consent prior to parti-
cipating in this longitudinal study. Data for the longi-
tudinal study were collected at three time points (Time
1–3), when toddlers were approximately 18, 25, and 34
months of age. At Time 1, master’s-level interviewers
administered the Structured Clinical Interview for
DSM–IV Axis 1 Disorders (SCID-IV; First, Gibbon,
Spitzer, & Williams, 1995) to assess mothers’ lifetime
psychiatric history, episode(s) of major depression since
the birth of the study child, and current depressive
symptoms. After this interview, mothers engaged in a
5-min teaching task with their toddlers that were video-
taped for later observational coding. A laboratory
playroom visit was also conducted during which
mothers and their toddlers participated in a battery
of observational measures of attachment, joint-atten-
tion, persistence, and mastery motivation were video-
taped for later behavioral coding and analyses and
have been described in other publications (Dietz,
Jennings, & Abrew, 2005; Henderson & Jennings,
2003; Jennings, 2004; Jennings & Abrew, 2004; Kelley
& Jennings, 2003).
For both follow-up assessments (Times 2–3), the
affective disorder module from the SCID-IV was
repeated to determine whether mothers experienced
any episodes of depression in the previous data collec-
tion visit and to index current maternal depressive
symptoms. After these interviews, mothers again were
videotaped interacting with their toddlers in a 5-min
teaching task with their toddlers. At Time 3, mothers
were also administered a semistructured diagnostic
interviews about psychiatric disorders in toddlers’
biological fathers and a laboratory playroom visit was
completed during which toddlers’ mental development
was assessed and mothers completed rating of toddlers’
Maternal depression status.
history was assessed using the SCID-IV (First et al.,
1995). Although the reliability and validity of the
SCID-IV has not been reported, an earlier version of
this instrument, the SCID-III-R, produced reliability
coefficients of 0.61 and 0.68 for current and lifetime
Axis I diagnoses (Williams et al., 1992). The SCID-IV
yields a categorical diagnostic status of (a) absent, (b)
subthreshold, and (c) threshold for mood disorders,
anxiety disorders, psychotic disorders, substance abuse
disorders, eating disorders, and adjustment disorders.
mothers was excellent (j¼.98).
At Time 1, three diagnostic groups were defined: (a)
never depressed group, mothers with no history of
MDD and no current depressive symptoms (n¼50);
(b) past MDD group, mothers who experienced a
depressive episode in the first 18 months of their tod-
dlers’ lives but were not currently depressed (n¼27);
and (c) current MDD group, mothers who experienced
an episode of depression in the first 18 months of their
toddlers’ lives and were currently experiencing a sub-
threshold or threshold depression (n¼24).
Schedule and Criteria
Mannuzza, 1995), an interview derived from the
Family History-Research Diagnostic Criteria (Endicott,
Andreasen, & Spitzer, 1978), was used to assess fathers’
psychiatric history at Time 3. These semistructured
The Family Informant
for DSM–IV (Schleyer &
Demographic Characteristics of Maternal Depression Groups at Time 1
No. of Children
Birth Order, % First-Born
Maternal Employment, Time 1
Nonmaternal Care, % Center Care
Marital Status, % Married
Paternal Psychopathology in Toddlers’ Lives
Maternal BDI score, Time 1
Months in Therapy, Time 1
Months on Medication, Time 1
v2(6, N¼101)¼ 6.03
Note. Values are M (SD) or % unless noted. Means with different subscripts are significantly different (Least Significant Difference).
MDD¼Major Depressive Disorder; BDI¼Beck Depression Inventory (A. T. Beck, Ward, Mendelson, Mock, & Erbaugh, 1961).
DIETZ, JENNINGS, KELLEY, AND MARSHAL
diagnostic interviews have been used extensively in epi-
demiological and family studies of psychopathology
(e.g., Klein, Lewinsohn, Seeley, & Rohde, 2001; Kovacs,
Devlin, Pollack, Richards, & Mukerji, 1997; Williamson
et al., 1995), with good reliability of diagnostic modules
(j¼0.46–0.98) and validity (percent agreement of 87%
as compared to interviewing family members directly;
Andreasen, Endicott, Spitzer, & Winokur, 1977).
Mothers reported on fathers’ symptoms of mood, anxi-
ety, and substance disorders, as well as antisocial
personality disorder. Clinical interviewers determined
individual symptom ratings for each disorder and estab-
lished paternal diagnosis for each disorder on a 4-point
scale, ranging 1 (absent), 2 (possible diagnosis), 3 (prob-
able diagnosis), and 4 (definite diagnosis). Using video-
taped interviews, satisfactory interrater reliability was
obtained (average j¼.81).
Twenty-seven percent (27%; n¼27) of toddlers’
fathers met diagnostic criteria for at least one psychi-
atric disorder during toddlers’ lives based on maternal
report of fathers’ symptoms on the Family Informant
Schedule and Criteria for DSM–IV. The majority of
fathers met diagnostic criteria for an internalizing dis-
order, with 67% (n¼18) meeting criteria for a mood
and=or anxiety disorder during toddlers’ lives. Only
one third of fathers (n¼9) met criteria for an externaliz-
ing disorder, mostly consisting of substance use disor-
ders with comorbid conduct or antisocial personality
disorders. A dichotomous measure of paternal psycho-
pathology was established because the low number of
fathers meeting criteria for an externalizing disorder
prohibited a comparison of paternal psychopathology
by type of disorder. However, removing the nine fathers
who did not have any internalizing psychopathology
from subsequent analyses did not change the results
presented in this article.
behavior was assessed during a videotaped interaction
with their toddlers conducted in dyads’ homes at Times
1 to 3. Mothers and toddlers were presented with an
attractive but challenging toy. Mothers were prompted
to ‘‘help toddlers complete the task.’’ Mothers inter-
acted with their toddlers for 5min. Indices of Maternal
Negativity and Maternal Warmth were coded from
mother–child interactions at all three data collection
periods using a coding system developed for this project
(see Kelley & Jennings, 2003). Maternal Negativity
was defined as any behaviors displaying maternal
hostility, rejection, and=or unresponsiveness (e.g., nega-
tive tone of voice, anger, annoyance, frustration,
aggressive touches, and withdrawal from interaction).
Maternal Warmth was defined as behaviors that imply
acceptance and sensitivity toward toddlers (e.g., praise
and encouragement, smiles, and affectionate touches)
and that evidence involvement in toddlers’ actions.
Maternal Negativity and Maternal Warmth were coded
on separate 4-point scales, with higher scores indicating
higher levels of negativity or warmth. Ratings of
Maternal Negativity and Maternal Warmth were made
every 30 sec and were averaged across the number of
intervals in which mothers and toddlers interacted with
the toy. Coders blinded to maternal depression status
achieved satisfactory interrater reliability for both indi-
ces of maternal behavior on 20% of the sample at Times
1 to 3 (average j¼0.71, Maternal Negativity; average
j¼.75, Maternal Warmth).
In addition, the frequency of Maternal Negative
Feedback toward toddlers’ efforts to master the chal-
lenging task was coded for interactions at T1 and T3
to assess maternal evaluative feedback and helpless
behaviors in toddlers using a coding system developed
for this study (Kelley & Jennings, 2003). Maternal
Negative Feedback was operationalized as any verbali-
zation indicating that the toddlers were incorrect in their
actions, or statements that were negative about toddlers’
efforts in mastering the task (e.g., ‘‘No,’’ ‘‘That’s not
where the piece goes,’’ ‘‘That’s the wrong key,’’ ‘‘You
can’t get it that way,’’ and ‘‘It doesn’t go in there’’).
Although all mothers were expected to use some nega-
tive feedback to guide their toddlers’ efforts to master
the teaching task, it was predicted that our sample of
middle-class mothers would rely on more positive strate-
gies and esteem-enhancing feedback to encourage tod-
dlers’ persistence (Hart & Risley, 1995). Hence, higher
rates of maternal negative feedback were posited to
represent an aspectof criticism in mother–child
The frequency of Maternal Negative Feedback was
also coded in 30-sec intervals for the length of the
5-min interaction by trained coders who were unaware
of mothers’ psychiatric history. A single score for
Maternal Negative Feedback was calculated by dividing
the total frequency by the number of 30-sec intervals
coded (?10). Satisfactory interrater reliability was estab-
lished on 20% of the sample (percentage agreement¼
75; Spearman correlation of .95).
Internalizing Problems subscales of the Child Behavior
Checklist for Ages 2–3 (CBCL; Achenbach, 1992) were
used to measure toddlers’ adjustment, based on a strong
empirical precedent of using these subscales to index
early behavior problems (C. T. Beck, 1999; Campbell,
Shaw, & Gilliom, 2000). The CBCL 2–3 has good
test–retest reliability (r¼.87), and has demonstrated
mental health services scored higher than nonreferred
children on all scales) and predictive validity for t scores
greater than 70 to correspond with the presence of exter-
nalizing or internalizing disorders (Achenbach, 1992;
Achenbach, Edelbrock, & Howell, 1987).
At Time 3, mothers completed this 99-item question-
naire by rating their toddlers’ behavior during the past 2
months on a 3-point scale, ranging from not at all true
to very true or often. The t scores from the CBCL
Externalizing and Internalizing Problems subscales were
derived from a computer coding program and used in
subsequent analyses. Although strongly correlated
(r¼.71), both indices of toddlers’ behavior problems
were examined as separate outcomes to determine
whether maternal depression was more likely to be
associated with Externalizing or Internalizing behavior
problems in this sample of young toddlers.
Prior to analyses, all variables were examined for
normality, missing values, and outliers. Outliers were
and DFBETAS; Cohen, Cohen, West, & Aiken, 2003,
pp. 402–405), and 3 participants were missing data on
Time 2 indices of maternal negativity and warm, thus
sample sizes varied from 98 to 101 depending on the
analysis=model. Because there was a strong positive
skewness in the Maternal Negativity data that could
not be corrected with log or square-root transfor-
mations, we dichotomized codes into No Maternal
Negativity (87% of sample) and Some Maternal Nega-
tivity (13% of sample). Because the pattern of findings
was similar when using this dichotomized variable, we
opted to use the original codes for Maternal Negativity
for ease of interpretation. A square-root transformation
was used to successfully correct for positive skewness in
the frequency data for Maternal Negative Feedback.
Three sets of multiple regression analyses were
conducted to examine Maternal Negativity, Maternal
Warmth, and Maternal Negative Feedback as mediators
of the relationship between mothers’ depression at
Time 1 and toddlers’ Externalizing behavior problems at
Time 3. Another set of three multiple regression analyses
tested each of these proposed mediators on the relation-
ship between maternal depression at Time 1 and toddlers’
Internalizing behavior problems at Time 3. Because there
were significant associations between Time 1 and Time 2
indices of Maternal Negativity (r¼.42, p<.05) and
Maternal Warmth (r¼.57, p<.05), and between Time 1
and Time 3 indices of Maternal Negative Feedback
(r¼.19, p?.06), Time 1 indices of mother–child interac-
tion variables were included as covariates in these
multiple regression analyses. Separate multiple regression
analyses examined paternal psychopathology as a moder-
ator of mother’s depression on toddlers’ Externalizing
and Internalizing behavior problems. In all regression
analyses two dummy coded variables (see Cohen et al.,
2003, p. 303) were used to compare the effects of maternal
depression, specifically in mothers with either (a) a past
MDD diagnosis or (b) a current MDD diagnosis at Time
1, with never depressed mothers.
Analyses were conducted to determine whether demo-
graphic or child-specific variables would be significant
covariates in subsequent analyses. Demographic covari-
ates, including SES, minority status, toddler sex, number
of children in the home, birth order, maternal employ-
ment status, and nonmaternal care, were not significantly
associated with maternal depression group, paternal psy-
chopathology status, or the CBCL Externalizing or Inter-
nalizing subscales. However, SES (r¼.46, p<.000) was
significantly associated with Maternal Negativity, sug-
gesting mothers with lower SES demonstrated higher
negativity toward their toddlers. Similarly, SES (r¼
?.22, p<.05) and minority status (r¼?.22, p<.05) were
significantly related to Maternal Warmth, indicating that
mothers of higher SES exhibited higher warmth and eth-
nic=racial minority mothers demonstrated lower levels of
warmth toward their toddlers. These covariateswerecon-
trolled for in subsequent mediator analyses. In addition,
the number of children in the home and toddlers’ birth
order were significantly associated with higher levels of
Maternal Negativity and Maternal Negative Feedback
and associated with lower levels of Maternal Warmth.
Because these variables were collinear (r¼.98, p<.000),
only the number of children in the home was controlled
for in mediation subsequent analyses. No significant
associations were found between the two indices of tod-
dlers’ behavior problems and SES, toddler sex, minority
status, number of children in the home, birth order,
maternal employment status, nonmaternal care, and the
Mental Development Index from Bayley Scales of Infant
Development (Bayley, 1993).
Descriptive statistics for the three maternal parenting
variables and toddlers’ Externalizing and Internalizing
behavior problems are provided in Table 2. Table 2 also
provides the mean and standard deviations by maternal
depression group and indicates significant group differ-
ences in these variables as determined by analysis of
variance. A significant relationship between maternal
depression status and paternal psychopathology status
during toddlers’ lives was found, v2(2, N¼101)¼6.27,
DIETZ, JENNINGS, KELLEY, AND MARSHAL
p<.05. Specifically, 41% of mothers who experienced
current depression at Time 1 reported that toddlers’
fathers also experienced at least one clinically significant
psychiatric disorder duringtoddlers’ lives, compared with
only 16% of the spouses of never depressed mothers.
Tests of Moderation
Two multiple regression analyses were conducted to test
the hypothesis that paternal psychopathology would
moderate the effects of current or past maternal
depression at Time 1 on toddler’s Externalizing or Inter-
nalizing behavior problems at Time 3. Two interaction
terms, the products of paternal psychopathology and
each of the dummy-coded variables representing current
or past maternal depression status at Time 1, were
entered into Step 2 of each regression model. Paternal
psychopathology was centered (?0.27¼no, 0.73¼yes)
to reduce nonessential multicollinearity introduced by
the interaction terms (see Aiken & West, 1991).
results yielded a significant interaction between paternal
psychopathology and mothers’ past MDD diagnosis
(B¼13.08, SE¼4.89), t(100)¼2.68, p<.01, but not
between paternal psychopathology and mothers’ current
MDD diagnosis. The significant interaction was probed
to test the simple slopes and determine the nature of the
interaction (see Table 3 for mean CBCL scores by cell).
Simple slopes were estimated and tested using methods
described by Aiken and West (1991) for probing interac-
tions in regression that contain dichotomous variables
(see pp. 130–131). In short, the beta coefficient (simple
slope) for the effect of maternal depression on toddler’s
Externalizing behavior was reestimated in two new
regression equations. In these equations each of the
paternal psychopathology groups was recoded to 0
(the opposing group was recoded to 1) and a new inter-
action term was calculated and included in the corre-
sponding model. Results showed that in the presence
of paternal psychopathology, mother’s history of
depression was significantly associated with toddlers’
externalizing behavior problems (B¼11.49, SE¼4.16),
t(100)¼2.76, p<.01, whereas in the absence of paternal
psychopathology, mothers’ history of depression was
not significantly associated with toddlers’ externalizing
behavior problems (B¼–1.62, SE¼2.41), t(100)¼
?0.67, ns. Hence, there were significant effects of
maternal depression at Time 1 on toddlers’ externalizing
behavior problems at Time 3 only when fathers also
have a psychiatric diagnosis (see Figure 1).
Significant interactions between paternal psycho-
pathology and mothers’ current (B¼9.56, SE¼4.86),
t(100)¼1.96, p¼.05, and past depression (B¼10.73,
SE¼4.85), t(100)¼2.21, p<.05, were found to predict
Figure 2). Examination of the simple slopes for both
interactions yielded a similar pattern of results: Current
and past indices of maternal depression at Time 1 were
only significantly associated with toddlers’ Internalizing
behavior problems at Time 3 when fathers’ also had a
maternal depression (B¼7.61, SE¼4.14), t(100)¼
1.84, p<.07. Maternal depression status at Time 1 was
not significantly related to toddlers’ Internalizing beha-
vior problems at Time 3 when fathers did not have a
psychiatric diagnosis (current maternal depression,
Descriptive Statistics (M, SD) for Potential Mediator and Outcome Variables
Maternal Negative Feedback
CBCL Externalizing Behavior Problems
CBCL Internalizing Behavior Problems
F(2, 100) ¼2.99
Note. Means with different subscripts are significantly different (Least Significant Difference). MDD¼Major Depressive Disorder;
CBCL¼Child Behavior Checklist 2–3 (Achenbach, 1992; Achenbach et al., 1987).
Mean (SD) Toddlers’ Externalizing and Internalizing Behavior
Problems Score by Maternal Depression at Time 1 and Paternal
No Maternal Depression 46.95 (6.5)
Past Maternal Depression
Current Maternal Depression
Note. Nonitalicized values represent toddlers’ Externalizing beha-
vior problems scores; italicized values represent toddlers’ Internalizing
Child Behavior Checklist (Achenbach, 1992; Achenbach et al., 1987).
B¼2.84, SE¼2.67), t(100)¼1.07, ns; past maternal
depression (B¼–3.27, SE¼2.39), t(100)¼–1.37, ns.
Tests of Mediation
Mediation was tested based on the recommendations of
MacKinnon and colleagues (MacKinnon, Lockwood,
Hoffman, West, & Sheets, 2002), such that (a) there is
a significant relationship between the predictor variable
and the proposed mediator (path a), (b) there is a signifi-
cant relationship between the proposed mediator and
outcome variable (path b), and (c) the indirect effect or
product of these two pathways (a?(b) is also significant.
The ‘‘product of coefficients’’ method used to test the sig-
nificance of the mediated effect (originally proposed by
Sobel, 1982) was recommended in lieu of traditional
Baron and Kenny (1986) procedures which have been
shown to have low power to test mediating effects (see
MacKinnon et al., 2002). The product of coefficients
method was tested by approximating a Z score, repre-
senting the product of the unstandardized betas divided
by its standard error (MacKinnon et al., 2002).
Three sets of regression analyses were conducted to
test whether each of the proposed mediators (e.g.,
Maternal Negativity, Maternal Warmth, Maternal
Negative Feedback) significantly accounted for any
relationship between maternal depression at Time 1
and toddlers’ Externalizing or Internalizing Behavior
Problems at Time 3. First, the a paths in each of the mod-
els were estimated by regressing each of the proposed
mediators on the dummy-coded variables representing
mothers’ current and past MDD at Time 1. Next, the b
paths were tested by regressing each of the Time 3 out-
come variables (e.g., toddlers’ Externalizing and Interna-
lizing Behavior Problems) on the two dummy-coded
variables representing mothers’ current and past MDD
at Time 1 and each of the proposed mediators (e.g.,
Maternal Negativity, Maternal Warmth, Maternal
Negative Feedback). For analyses involving maternal
negativity, the total number of children in the home
and SES at Time 1 were included as covariates. Total
number of children in the home, SES, and minority sta-
tus were controlled for in analyses with maternal
warmth. Last, total number of children in the home
was included as a covariate in analyses involving
maternal negative feedback.
Mothers’ current depression at Time 1 was signifi-
cantly associated with Maternal Negativity at Time 2
(path a; B¼0.05, SE¼0.16), t(97)¼3.40, p<.001.
Maternal Negativity at Time 2 was significantly associa-
ted with toddlers’ Externalizing behavior problems (path
b), above and beyond maternal depression status at Time
1 and other covariates in the model (see Table 4). Thus,
results indicated that paths a and b were significant for
mothers’ current depression at Time 1. The mediated
effect was estimated by calculating the product of the
unstandardized beta coefficients that represent path a
FIGURE 1 Paternal psychopathology moderates the association
between past maternal depression at Time 1 and toddlers’ externalizing
behavior problems at Time 3. CBCL¼Child Behavior Checklist for
Ages 2–3; Dx¼diagnosis; MDD¼Major Depressive Disorder.
Regression of Toddlers’ Externalizing Behavior Problems (Time 3)
on Maternal Depression Status (Time 1) and Maternal
Negativity (Time 2)
B SE B
Past Maternal Depressiona
Current Maternal Depressiona
Maternal Negativity (Time 1)
No. of Children in Home
(Time 2) (Path b)
aFor the effects shown categorical predictor variables were coded
based on recommendations by Cohen et al. (2002) such that past
maternal depression: 0¼no depression, 0¼current Major Depressive
Disorder (MDD), 1¼past MDD; Current maternal depression:
0¼no depression, 1¼current MDD, 0¼past MDD.
FIGURE 2 Paternal psychopathology moderates the association
between current maternal depression at Time 1 and toddlers’ interna-
lizing behavior problems at Time 3. CBCL¼Child Behavior Checklist
for Ages 2–3; Dx¼diagnosis; MDD¼Major Depressive Disorder.
DIETZ, JENNINGS, KELLEY, AND MARSHAL
and path b (a?b). Approximate Z scores for the
mediated effect was estimated by dividing the product
by its standard error (SE (ab)), where SE (ab)2¼SE
2002). Results showed that the z score was significant
Maternal Negativity at Time 2 was asignificant mediator
of the relationship between mothers’ depression at Time
1 and toddlers’ Externalizing behavior problems at Time
3. Maternal Negativity at Time 2 was not significantly
associated with toddlers’ Internalizing behavior pro-
blems (path b) and could not be tested as a mediator of
the relationship between maternal depression status at
Time 1 and toddlers’ Internalizing problems at Time 3.
Neither current nor past maternal depression at Time
1 was significantly associated with Maternal Warmth at
Time 2 (path a). Similarly, Maternal Warmth at Time 2
did not predict toddlers’ Externalizing or Internalizing
behavior problems at Time 3 (path b). Hence, the con-
ditions were not satisfied to consider Maternal Warmth
as a mediator of the relationship between maternal
depression status at Time 1 and toddlers’ behavior
problems at Time 3.
No significant relationship emerged between current
maternal depression at Time 1 and Maternal Negative
Feedback at Time 3 (path a). However, Maternal Nega-
tive Feedback was significantly associated with toddlers’
Externalizing behavior problems (path b), above and
beyond maternal depression status at Time 1 and other
covariates included in the model (R¼.40, R2¼.16, D in
R2¼.08, p<.01). Similarly, Maternal Negative Feed-
back was also significantly associated with toddlers’
Internalizing behavior problems at Time 3 (R¼.43,
R2¼.19, D in R2¼.05, p<.05). Still, Maternal Negative
Feedback did not mediate the relationship between
maternal depression status at Time 1 and toddlers’
behavior problems at Time 3.
(see MacKinnon et al.,
p<.05) supportingthe hypothesisthat
These results are consistent with the hypothesis that
adverse outcomes in children exposed to maternal
depression are also dependent upon the presence or
absence of paternal psychopathology (Goodman &
Golib, 1999). Mothers who experienced depression in
their toddlers’ lives were more likely to have spouses=
partners who also experienced psychopathology in their
toddlers’ lives, a finding that is consistent with numerous
epidemiological studies that suggest the reciprocal influ-
ence of psychiatric illness on spouses (Dierker et al.,
1999; Merikangas, 1984). As predicted, paternal psycho-
pathology moderated the effects of maternal depression
on toddlers’ behavior problems: Toddlers were more
likely to have higher rates of behavior problems in the
case where fathers have met criteria for a psychiatric ill-
ness and mothers have a history of depression at some
point since the toddlers’ birth. However, it is important
to note that these mean scores on the CBCL were within
the normal range and not indicative of a psychiatric dis-
order. The absence of paternal psychopathology, how-
ever, was related to lower scores of behavior problems
in toddlers whose mothershad experienced a past episode
of depression but were not currently depressed.
Although similar findings have been reported in
samples of older children and adolescents (Brennan,
Hammen, Katz, & Le Brocque, 1999; Goodman et al.,
1993), this study adds to the developmental psychopath-
ology literature by demonstrating the importance of
fathers’ mental health history in assessing the effects of
maternal depression on young children. These findings
point to the presence of psychopathology in fathers as
a risk factor for toddlers’ externalizing behavior pro-
blems when mothers have been previously depressed,
and for toddlers internalizing problems when mothers
have either a history of or current depressive symptoms.
In addition, this study is among the few that have inves-
tigated paternal internalizing disorders as a moderator
of the relationship between maternal depression and
young children’s behavior problems. Although paternal
substance usedisorder and antisocial
disorder have been studied more extensively (see
Phares, Fields, Kamboukos, & Lopez, 2005), parental
depression and=or anxiety may also present risk for tod-
dlers’ behavior problems when mothers have a history
of MDD. Paternal psychopathology may increase the
likelihood of behavior problems in at-risk toddlers
directly, as depressed and=or anxious fathers may pro-
vide inconsistent and permissive parenting, or indirectly,
if they are less involved with caring for their children
and leave depressed mothers sole responsibility for the
daily behavioral management of toddlers.
Furthermore, maternal negativity was identified as a
significant mediating pathway by which maternal
depression predicted toddlers’ externalizing behavior
problems. Higher levels of maternal negativity were
significantly related to mothers’ current depressive symp-
toms, suggesting that maternal depression may manifest
in high levels of irritability, which may be communicated
to young children through mother–child interactions.
High levels of negativity in the context of mother–child
interactions may exacerbate young children’s non-
compliance and poor emotion regulation and may nega-
behavioral problems in a manner similar to high levels
of maternal criticism (Asarnow, Tompson, Hamilton,
Goldstein, & Guthrie, 1994; Goodman et al., 1994;
Hirshfeld, Biederman, Brody, Faraone, & Rosenbaum,
1997). Maternal warmth did not differ between never
depressed, past depressed, and current depressed mothers
at Time 1 and did not mediate the relationship between
maternal depression andlater toddler behavior problems.
Thisfindingmaysuggest thatpositive aspects ofmaternal
parenting are less influenced by maternal depression
status and that maternal warmth may not be a strong
pathway through which maternal depression negatively
influences behavior problems in toddlers. Although
maternal negative feedback at Time 3 did not mediate
the relationship between maternal depression status at
Time 1 and toddlers’ behavior problems at Time 3, it
remained a significant, concurrent predictor of toddlers’
externalizing and internalizing problems. This suggests
that high levels of concurrent maternal negative feedback
are associated with toddlers’ behavior problems, above
and beyond early exposure to maternal depression.
Findings from our study support the use of various
indices of maternal depression for examining relation-
ships between parental risk factors and toddlers’ mal-
adjustment. Residual maternal depressive symptoms at
Time 1, rather than a past episode of MDD, predicted
more maternal negativity in mother–child interactions
7 months later (Time 2), suggesting that maternal nega-
tivity toward toddlers are more influenced by residual,
more continuous symptoms of depression. Maternal
negativity may be significantly reduced when mothers’
depressive symptoms remit, as evidenced by the compa-
rable levels of negativity observed in mothers who
experienced past episodes of MDD but were not cur-
rently depressed at Time 1 and mothers with no history
of MDD. Similarly, there was a significant interaction
between paternal psychopathology
maternal depression at Time 1 in predicting toddlers’
Internalizing behavior problems at Time 3.
In contrast, two significant interactions emerged
between paternal psychopathology and past episodes
of maternal depression in predicting toddlers’ externaliz-
ing and internalizing behavior problems. One interpre-
tation of these findings suggest that maternal history of
depression remains a salient risk factor for negative out-
comes in young children, particularly in situations where
there is anincreased family loading for psychopathology,
regardless of whether mothers experience residual
depressive symptoms. However, this finding may be
spurious and better accounted for by other correlates
of paternal psychopathology, such as marital conflict
(see Davies, Harold, Goeke-Morey, & Cummings, 2002).
Limitations of This Study
The primary limitation of our study is that maternal
report was used to obtain indices of maternal depression
at Time 1 and paternal psychopathology status at Time
3, as well as the outcome measures of toddler behavior
problems at Time 3. Data from multiple informants
are necessary to reduce the likelihood of single reporter
bias, particularly with depressed mothers (Chilcoat &
Breslau, 1997). However, there was no evidence of a
pervasive negative bias in depressed mothers’ reports
of paternal psychopathology and toddlers’ behavior
problems. This may be related to the fact that the
majority of mothers with a previous history of MDD
were not currently depressed at the time these data were
collected (67%). Although recently depressed mothers
(and mothers with a history of MDD) reported higher
rates of paternal psychopathology, recently depressed
mothers did not rate their children as having higher
rates of behavior problems than never depressed
mothers. In addition, a significant correlation in the pre-
dicted direction between the observational measure of
maternal negativity and maternal negative feedback
during mother–child interaction and CBCL ratings sug-
gest that mothers’ ratings of toddlers’ behavior pro-
blems were not simply a result of a negative reporting
bias. Furthermore, regression analyses controlling for
maternal depression status at Time 1 continued to yield
significant relationships between paternal psychopath-
ology, maternal behavior during mother–child interac-
tions, and toddlers’ behavior problems.
Depressed mothers may still provide researchers valid
information about children and family environments
(Biederman, Mick, & Faraone, 1997; Ingersoll & Eist,
1998). For example, the validity of maternal reports of
paternal psychopathology issupported and isa frequently
used methodology in family studies of psychopathology
(Caspi et al., 2001). Despite the concern that maternal
of report of fathers’psychiatric history may inflate effects,
maternal report have been found to provide more con-
servative estimates of paternal psychopathology than
fathers’ self-report (Connell & Goodman, 2002). Thus,
the findings presented in our study may underestimate,
rather than overestimate, the effects of paternal psycho-
pathology on toddlers’ behavior problems.
An additional limitation of our study is its general-
izability to community samples of depressed mothers.
The majority of mothers described in this article evi-
denced depressive symptoms so severe that they sought
psychiatric treatment in the first 6 months of their
infants’ lives and opted for a combination of psycho-
therapy and antidepressant medication to reduce their
emotional distress and functional impairment. As the
larger population of depressed mothers typically does
not seek psychiatric treatment, one possibility is that
the results presented in our study overestimate the
negative affects of maternal depression on later tod-
dlers’ externalizing and internalizing problems. How-
ever, depressed mothers who do not seek psychiatric
treatment may have formidable psychosocial barriers
that prevent them from receiving help and may still
evidence severe symptoms that interfere with sensitive
and effective parenting. Indeed, the clinical sample of
DIETZ, JENNINGS, KELLEY, AND MARSHAL
mothers in this study had high education levels and
consisted of predominantly middle to high socioeco-
nomic status, which may have facilitated their receipt
of treatment for depression.
Implications for Research, Policy, and Practice
Maternal depression and co-occurring family risk fac-
tors contribute to increased behavior problems in young
children. In our study, negative maternal feedback
mediated the effects of current maternal depression on
toddlers’ behavior problems. Toddlers who experienced
both maternal depression and paternal psychopathology
in their lives had the highest scores of behavior
problems. These findings suggest the importance of
investigating other risks associated with maternal
depression, particularly those in the family context.
These results also argue for examining maternal nega-
tivity in the context of mother–child interactions and
paternal psychopathology as respective mediators and
moderators of maladjustment of young children who
have experienced maternal depression.
Findings from this study also support the use of early
psychosocial clinical interventions that target negative
interaction stylesinmothers who have experienceda post-
partum depression to decrease toddlers’ risk for later
behavioral problems. Existing parent training programs,
such as Parent-Child Interaction Therapy (Eyberg,
Boggs, & Algina, 1995), Incredible Years Program
(Webster-Stratton & Hammond, 1997), and the Home
Visiting Family Support Program (Lyons-Ruth &
Melnick, 2004), are examples of empirically-supported
therapies for preschool children experiencing emotional
and behavior problems. Although they do not address
maternal depression or paternal psychopathology specifi-
cally, each are flexible enough to accommodate some dis-
cussion of how parental mood may affect negativity
toward toddlersand increased
Cicchetti and colleagues’ Toddler–Parent Psychotherapy
(Cicchetti, Rogosch, & Toth, 2000; Toth, Rogosch,
Manly,& Cicchetti,2006) isanother example of a psycho-
social treatment for improving the attachment security of
toddlers with depressed mothers. Future directions for
intervention include an integrated psychosocial treatment
that addresses and reduces both maternal depression and
behavior problems in toddlers.
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