Chronic Maternal Depression and Children's Injury Risk

Objective A substantial number of mothers of young children suffer from depression. One understudied consequence of maternal depression is how it affects toddlers’ injury risk. This study examined links between chronic maternal depression and child injury. Methods A national sample of 1,364 American children was studied. Results Chronic levels of severe maternal depression placed children at increased risk of concurrent injury from birth to age 3. The relation between chronic, severe maternal depression and child injury risk held even after controlling for variance from family SES, child sex, child temperament and externalizing behavior, and parenting. Chronic maternal depression during infancy and toddlerhood did not influence children’s subsequent risk for injury, between age 3 and first grade. Less severe symptoms of chronic maternal depression were unrelated to concurrent or future child injury. Conclusions Chronic, severe levels of maternal depression are linked to concurrent child injury risk during infancy and toddlerhood. Epidemiological data suggest roughly 15% of women are depressed at any one time (Elgar, McGrath, Waschbusch, Stewart, & Curtis, 2004), and some research suggests that mothers of young children may have rates of depression even higher than the general population of women. In one study of over 800 disadvantaged British mothers of young children, about a third of mothers reported high levels of depressive symptoms (Mulvaney & Kendrick, 2005). One consequence of maternal depression is its effect on children. There is considerable evidence that maternal depression is linked to children’s behavior, with children of depressed mothers demonstrating higher levels of behavior problems and psychopathology; academic problems; social problems and negative peer relationships; and internalizing pathology such as depression, low selfesteem, and poor self-regulation (see Elgar et al., 2004; Lovejoy, Graczyk, O’Hare, & Neuman, 2000; for reviews). The mechanism behind these links is likely bidirectional and via multifaceted mediated pathways, including genetic/biological lines, psychosocial influences, and presence of tangible resources and social capital. One area that is less well understood is the influence of maternal depression on children’s health. In particular, potential links between maternal depression and children’s risk of unintentional injury are poorly understood. Injury is the leading cause of pediatric mortality in the US (National Center for Injury Prevention and Control [NCIPC], 2008), and obtaining an accurate picture of behavioral risk factors—including parental traits—that might increase or decrease risk of injury is critical to development of empirically supported prevention programs. Two previous studies have directly examined links between maternal depression and child injury risk. The first, conducted by O’Connor and colleagues (O’Connor, Davies, Dunn, Golding, & the ALSPAC Study Team, 2000), used a prospective design with over 10,000 English families. The researchers discovered that mother’s selfreported symptoms indicative of potential clinical depression, assessed when children were 21 months of age, were related to risk of two or more significant injuries over the subsequent 3 months. The second, by Phelan and colleagues (Phelan, Khoury, Atherton, & Kahn, 2007), studied about 1,100 children and their parents in the US over 2 years. Severe levels of chronic depression, as measured at the start and end of the 2-year period, were related to child injury risk during the second year of the study. This finding was particularly strong among the boys in the sample. Phelan and colleagues (2007) tested child externalizing behavior as a possible mediating variable between