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Analysis of Studies on Social Support and Children of Depressed Mothers: A Systematic Review

Análise de Estudos Sobre Suporte Social e Filhos de Mães Deprimidas: Uma Revisão Sistemática

Soporte Social y los Infantes de Madres con Depresión: Una Revisión Sistemática

Abstracts

Recognizing the conditions that minimize the impact of maternal depression on children has clinical relevance. The present review aimed to analyze recent empirical studies that have investigated the associations between maternal depression and different social support conditions for school-aged children. We systematically reviewed empirical articles indexed from 2007 to 2014 in the following databases: MEDLINE, PubMed, PsycINFO, Web of Science, LILACS and SciELO. Three keywords were used: maternal depression, social support and child behavior. Twenty-seven articles were included and analyzed. These studies included a broad range of contextual risk factors and social support conditions, and in their predictive models, it was found that less contextual risk and greater parental resources and social support were predictors of fewer problems for the children. The identification of social support sources that attenuate the effect of maternal depression on child outcomes has implications for the development of prevention and intervention programs.

depression; mothers; child psychology; psychosocial factors; literature review


Reconhecer condições que minimizem o impacto da depressão materna para as crianças tem relevância clínica. Objetivou-se analisar estudos empíricos recentes que investigaram as associações da depressão materna a condições de suporte social. Procedeu-se a revisão sistemática de artigos indexados no período de 2007 a 2014 nas bases de dados MEDLINE, PubMed, PsycINFO, Web of Science, LILACS e SciELO, utilizando-se as palavras-chave: maternal depression, social support e child behavior. Foram incluídos e analisados 27 artigos. Os estudos analisados incluíram uma ampla diversidade de condições de risco e de fontes de suporte social, e nos modelos preditivos utilizados, constatou-se que menos risco contextual, mais recursos parentais e suporte social foram preditores de menos problemas para as crianças. O suporte social atenuou o impacto da depressão maternal para os desfechos das crianças, o que tem implicações para o planejamento de programas de prevenção e intervenção.

depressão; mães; psicologia da criança; fatores psicossociais; revisão de literatura


Reconocer condiciones que minimicen el impacto de la depresión maternal para los niños tiene relevancia clínica. Se objetivó analizar estudios empíricos recientes que investigaron las asociaciones de la depresión materna a condiciones diversas del soporte social. Se realizó una revisión sistemática de artículos empíricos indexados en el período de 2007 a 2014 en MEDLINE, PubMed, PsycINFO, Web of Science, LILACS y SciELO, utilizando las palabras clave: maternal depression, social suport y child behavior. Fueron incluidos y analizados 27 artículos. Los estudios revisados incluyeron una amplia variedad de condiciones de riesgo y fuentes de soporte social, y en los modelos predictivos utilizados, se constató que menos riesgo contextual, más recursos parentales y soporte social fueran predictores de menos problemas para los niños. El soporte social atenúo el impacto de la depresión maternal para los desenlaces de los niños lo que tiene implicaciones para la planificación de programas de prevención e intervención.

depresión; madres; psicología infantil; factores psicosociales; revisión de literatura


Throughout development, children are exposed to numerous contextual risk factors and adverse conditions, including maternal depression. This contextual condition is associated with childhood problems because it negatively affects child development, thereby potentiating behavioral and emotional difficulties. Child exposure to maternal depression is associated with a greater frequency of both externalizing and internalizing symptoms, a greater incidence of psychiatric disorders, and lower social competence (Goodman et al., 2011Goodman, S. H., Rouse, M. H., Connel, A. M., Broth, M. R., Hall, C. M., & Heyward, D. (2011). Maternal depression and child psychopathology: A meta-analytic review. Clinical Child and Family Psychology Review, 14(1), 1-27. doi:10.1007/s10567-010-0080-1).

Mendes, Loureiro, and Crippa (2008)Mendes, A. V., Loureiro, S. R., & Crippa, J. A. S. (2008). Depressão materna e a saúde mental de escolares. Revista de Psiquiatria Clínica, 35(5), 178-186. doi:10.1590/S0101-60832008000500002 conducted literature reviews and reported that familial conditions, such as reductions in social support, parental care practices, environmental organization, socioeconomic status, and social support networks, are associated with maternal depression. The presence of maternal depression determines whether these associations are contextual risk or protective factors that influence behavioral outcomes in children. Elgar, Mills, McGrath, Waschbusch, and Brownridge’s (2007)Elgar, F. J., Mills, R. S. L., McGrath, P. J., Waschbusch, D. A., & Brownridge, D. A. (2007). Maternal and paternal depressive symptoms and child maladjustment: The mediating role of parental behavior. Journal of Abnormal Child Psychology, 35(6), 943-955. doi:10.1007/s10802-007-9145-0 literature review suggested that depressive symptoms were predictive of low parental nurturance and poor monitoring of the child’s activities, as well as greater rejection of the child, increasing the impact of parental psychopathology on child functioning.

In a meta-analysis, Goodman et al. (2011)Goodman, S. H., Rouse, M. H., Connel, A. M., Broth, M. R., Hall, C. M., & Heyward, D. (2011). Maternal depression and child psychopathology: A meta-analytic review. Clinical Child and Family Psychology Review, 14(1), 1-27. doi:10.1007/s10567-010-0080-1 stated that, despite the wide acceptance of the negative effects of maternal depression on child development, the field still lacks studies on the contextual risk factors (e.g., the conditions associated with maternal depression) that might influence child outcomes. One of these variables is social support, which has been considered a protective factor in individuals exposed to stressful events and may therefore moderate the effects of maternal depression on child adjustment.

Social support is defined by Gottlieb (1983)Gottlieb, B. H. (1983). Social support strategies: Guidelines for mental health practice. Beverly Hills, CA: Sage. as “verbal and non-verbal information or advice, tangible aid, or action that is proffered by social intimates or inferred by their presence and has beneficial emotional or behavioral effects on the recipients” (p. 28). From this perspective, social support encompasses multiple dimensions, including instrumental, emotional, informational, and tangible aid, as well as positive social interaction, affection, and esteem; it is also transactional – that is, it is affected by the nature of the stress factors and personal traits.

Considering the clinical relevance of recognizing the impact of social support for children who coexist with maternal depression, approaching the state of the art on this subject is justified. The present review sought to identify and analyze recent empirical studies investigating the associations between maternal depression and different social support conditions, focusing on the effects in school-age children.

Method

A systematic review of the literature was performed via a search of scientific articles published from 2007 to 2014 and abstracted in the following electronic databases: MEDLINE, PubMed, PsycINFO, Web of Science, LILACS (Literatura Latino-Americana e do Caribe em Ciências da Saúde [Latin American and Caribbean Health Science Literature]), and SciELO (Scientific Electronic Library Online). We used the following keywords: maternal depression, social support, and child behavior.

As inclusion criteria for the search, we used language (Portuguese, English, or Spanish) and the moment of evaluation (i.e., the child and his or her mother were evaluated at least once during the school years between six and 12 years of age, regardless of whether there were additional assessments before or after this period). Studies were excluded if they focused exclusively descriptions of programs involving institutional social support and interventions with specific at-risk populations or other age groups.

The empirical article search mentioned above was performed using different combinations of keywords (three at the same time or two by two). Then, 1,467 articles were identified in the search of electronic databases, and the inclusion and exclusion criteria were applied. The abstracts of the 241 papers identified in the search were systematically read. Based on this reading, 213 articles were excluded from the analyses. The remaining 27 papers, which met all the criteria, were selected and analyzed after full reading.

The content of the papers were then categorized with regard to study design, contextual risk factors, social support conditions, and major outcomes concerning the impact of social support on the behavior of children exposed to maternal depression. The methodological quality of the studies was evaluated using the Newcastle-Ottawa Scale (NOS). The data were independently extracted and categorized by the two authors, and any discrepancies between the authors were discussed and resolved in a consensus meeting. This categorization is described in the following section.

Results

Data regarding our analysis are introduced by initially emphasizing the general characteristics of the samples, the designs and instruments used, and the contextual risk factors and social support conditions. Next, the major outcomes from these studies are listed based on their cross-sectional and longitudinal designs; correlational or experimental studies are specified with regard to the latter design.

Regarding the evaluation of the methodological quality of the articles, it was found that none of the cross-sectional studies (8) had a case-control design; therefore, it was not possible to evaluate these articles through the NOS. Of the longitudinal studies (19), 12 were cohort studies, to which it was possible to apply the NOS criteria. Regarding the maximum possible rating (eight stars), it was verified that seven articles received excellent ratings (seven to eight stars) and five articles received sufficiently positive ratings (five to six stars). The representativity of the cohort, the specification of the inclusion and exclusion criteria for the participants exposed and not exposed to the problem, the use of validated instruments, and the adequacy of the follow-up were the main issues in evaluating the studies.

Twenty-seven studies were included in the present review, which included 29,903 dyads of participants. The sample size varied from 40 to 7,429 dyads with a median of 2,945 dyads. Most studies (23; 85.18%) were performed using community samples, and the samples used in five studies (18.51%) were considered high risk because they were mainly composed of low-income families (Allen‐Meares, Blazevski, Bybee, & Oyserman, 2010Allen-Meares, P., Blazevski, J., Bybee, D., & Oyserman, D. (2010). Independent effects of paternal involvement and maternal mental illness on child outcomes. Social Service Review, 84(1), 103-127. doi:10.1086/652989; Criss, Shaw, Moilanen, Hitchings, & Ingoldsby, 2009Criss, M. M., Shaw, D. S., Moilanen, K. L., Hitchings, J. E., & Ingoldsby, E. M. (2009). Family, neighborhood, and peer characteristics as predictors of child adjustment: A longitudinal analysis of additive and mediation models. Social Development, 18(3), 511-535. doi:10.1111/j.1467-9507.2008.00520.x; Fatori, Bordin, Curto, & de Paula, 2013Fatori, D., Bordin, I. A., Curto, B. M., & de Paula, C. S. (2013). Influence of psychosocial risk factors on the trajectory of mental health problems from childhood to adolescence: A longitudinal study. BMC Psychiatry, 13, 31. doi:10.1186/1471-244X-13-31; Goosby, 2007Goosby, B. J. (2007). Poverty duration, maternal psychological resources, and adolescent socioemotional outcomes. Journal of Family Issues, 28(8), 1113-1134. doi:10.1177/0192513X07300712; Mickelson & Demmings, 2009)Mickelson, K. D., & Demmings, J. L. (2009). The impact of support network substitution on low-income women’s health: Are minor children beneficial substitutes? Social Science & Medicine, 68(1), 80-88. doi:10.1016/j.socscimed.2008.09.057. Most of the participants in the studies were White Caucasian, and the studies were conducted in the following countries: USA (16), UK (3), Brazil (3), India (2), Canada (2), Norway (1) and Finland (1). Most of the studies examined males and females, except for three studies that only included boys (Brown, Barbarin, & Scott, 2013Brown, J., Barbarin, O., & Scott, K. (2013). Socioemotional trajectories in black boys between kindergarten and the fifth grade: The role of cognitive skills and family in promoting resiliency. American Journal of Orthopsychiatry, 83(2-3), 176-184. doi:10.1111/ajop.12027; Criss et al., 2009Criss, M. M., Shaw, D. S., Moilanen, K. L., Hitchings, J. E., & Ingoldsby, E. M. (2009). Family, neighborhood, and peer characteristics as predictors of child adjustment: A longitudinal analysis of additive and mediation models. Social Development, 18(3), 511-535. doi:10.1111/j.1467-9507.2008.00520.x; Gross, Shaw, Burwell, & Nagin, 2009Gross, H. E., Shaw, D. S., Burwell, R. A., & Nagin, D. S. (2009). Transactional processes in child disruptive behavior and maternal depression: A longitudinal study from early childhood to adolescence. Development and Psychopathology, 21(1), 139-156. doi:10.1017/S0954579409000091).

With regard to study design, there were eight correlational cross-sectional studies (29.62%) and 19 longitudinal studies (70.37%); of the latter, five were correlational, and 14 were experimental. Overall, the longitudinal studies had, on average, four to six evaluations over the follow-up, including periods of 3 months to 13 years.

Three cross-sectional studies included young childhood to adolescents (Gerkensmeyer, Perkins, Day, et al., 2011Gerkensmeyer, J. E., Perkins, S. M., Day, J., Austin, J. K., Scott, E. L., & Wu, J. (2011). Maternal depressive symptoms when caring for a child with mental health problems. Journal of Child and Family Studies, 20(5), 685-695. doi:10.1007/s10826-011-9445-4; Gerkensmeyer, Perkins, Scott, & Wu, 2008Gerkensmeyer, J. E., Perkins, S. M., Scott, E. L., & Wu, J. (2008). Depressive symptoms among primary caregivers of children with mental health needs: Mediating and moderating variables. Archives of Psychiatric Nursing, 22(3), 135-146. doi:10.1016/j.apnu.2007.06.016; Mickelson & Demmings, 2009)Mickelson, K. D., & Demmings, J. L. (2009). The impact of support network substitution on low-income women’s health: Are minor children beneficial substitutes? Social Science & Medicine, 68(1), 80-88. doi:10.1016/j.socscimed.2008.09.057. Most longitudinal studies monitored young children; among these studies, five focused on the behavior of children from 6 to 7.5 years old (Anhalt, Telzrow, & Brown, 2007Anhalt, K., Telzrow, C. F., & Brown, C. L. (2007). Maternal stress and emotional status during the perinatal period and childhood adjustment. School Psychology Quarterly, 22(1), 74-90. doi:10.1037/1045-3830.22.1.74; Ashman, Dawson, & Panagiotides, 2008Ashman, S. B., Dawson, G., & Panagiotides, H. (2008). Trajectories of maternal depression over 7 years: Relations with child psychophysiology and behavior and role of contextual risks. Development and Psychopathology, 20(1), 55-77. doi:10.1017/S0954579408000035; Barker, Copeland, Maughan, Jaffee, & Uher, 2012Barker, E. D., Copeland, W., Maughan, B., Jaffee S. R., & Uher, R. (2012). Relative impact of maternal depression and associated risk factors on offspring psychopathology. The British Journal of Psychiatry, 200(2), 124-129. doi:10.1192/bjp.bp.111.092346; Campbell, Matestic, von Stauffenberg, Mohan, & Kirchner, 2007Campbell, S. B., Matestic, P., von Stauffenberg, C., Mohan, R., & Kirchner, T. (2007). Trajectories of maternal depressive symptoms, maternal sensitivity, and children’s functioning at school entry. Developmental Psychology, 43(5), 1202-1215. doi:10.1037/0012-1649.43.5.1202; Heberle, Krill, Briggs-Gowan, & Carter, 2014Heberle, A. E., Krill, S. C., Briggs-Gowan, M. J., & Carter, A. S. (2014). Predicting externalizing and internalizing behavior in kindergarten: Examining the buffering role of early social support. Journal of Clinical Child & Adolescent Psychology. doi:10.1080/15374416.2014.886254), and the other six studies examined 12- to 13-year-old children (Barker & Maughan, 2009Barker, E. D., & Maughan, B. (2009). Differentiating early-onset persistent versus childhood-limited conduct problem youth. The American Journal of Psychiatry, 166(8), 900-908. doi:10.1176/appi.ajp.2009.08121770; Criss et al., 2009Criss, M. M., Shaw, D. S., Moilanen, K. L., Hitchings, J. E., & Ingoldsby, E. M. (2009). Family, neighborhood, and peer characteristics as predictors of child adjustment: A longitudinal analysis of additive and mediation models. Social Development, 18(3), 511-535. doi:10.1111/j.1467-9507.2008.00520.x; Fatori et al., 2013Fatori, D., Bordin, I. A., Curto, B. M., & de Paula, C. S. (2013). Influence of psychosocial risk factors on the trajectory of mental health problems from childhood to adolescence: A longitudinal study. BMC Psychiatry, 13, 31. doi:10.1186/1471-244X-13-31; Gross et al., 2009Gross, H. E., Shaw, D. S., Burwell, R. A., & Nagin, D. S. (2009). Transactional processes in child disruptive behavior and maternal depression: A longitudinal study from early childhood to adolescence. Development and Psychopathology, 21(1), 139-156. doi:10.1017/S0954579409000091; Hart, Atkins, & Matsuba, 2008Hart, D., Atkins, R., & Matsuba, M. K. (2008). The association of neighborhood poverty with personality change in childhood. Journal of Personality and Social Psychology, 94(6), 1048-1061. doi:10.1037/0022-3514.94.6.1048; Karevold, Roysamb, Ystrom, & Mathiesen, 2009Karevold, E., Roysamb, E., Ystrom, E., & Mathiesen, K. S. (2009). Predictors and pathways from infancy to symptoms of anxiety and depression in early adolescence. Developmental Psychology, 45(4), 1051-1060. doi:10.1037/a0016123).

Most of the cross-sectional (7; 87.5%) and longitudinal studies (16; 84.21%) used instruments adapted and validated to measure maternal depression and childhood behavioral problems, psychopathologies, or both. In addition, five cross-sectional (62.5%) and eight longitudinal (42.1%) studies used instruments adapted and validated as social support assessment resources. The Center for Epidemiological Studies Depression Scale (CES-D) and the Child Behavior Checklist (CBCL) were the most commonly used instruments to assess maternal depression symptoms (12; 44.44%) and child behavioral problems (15; 55.55%). A broad variety of social support instruments and procedures were used. The most frequently used measures were questionnaires developed by the authors (11; 40.74%), the Home Observation for Measurement of the Environment (HOME; 4; 14.81%), and other scales (5; 18.51%). In addition, four studies assessed social support via observations of mother-child interactions (Campbell et al., 2007Campbell, S. B., Matestic, P., von Stauffenberg, C., Mohan, R., & Kirchner, T. (2007). Trajectories of maternal depressive symptoms, maternal sensitivity, and children’s functioning at school entry. Developmental Psychology, 43(5), 1202-1215. doi:10.1037/0012-1649.43.5.1202; Dubois-Comtois, Moss, Cyr, & Pascuzzo, 2013Dubois-Comtois, K., Moss, E., Cyr, C., & Pascuzzo, K. (2013). Behavior problems in middle childhood: The predictive role of maternal distress, child attachment, and mother-child interactions. Journal of Abnormal Child Psychology, 41(8), 1311-1324. doi:10.1007/s10802-013-9764-6; Gross et al., 2009Gross, H. E., Shaw, D. S., Burwell, R. A., & Nagin, D. S. (2009). Transactional processes in child disruptive behavior and maternal depression: A longitudinal study from early childhood to adolescence. Development and Psychopathology, 21(1), 139-156. doi:10.1017/S0954579409000091; Wang, Christ, Milss-Koonce, Garrett-Peters, & Cox, 2013).

All studies included in the present review addressed contextual risk factors and social support conditions (Table 1).

Table 1
Contextual Risk Factors and Social Support Conditions

These studies addressed contextual risk factors across different domains. The most commonly studied variables (in order) were maternal clinical conditions, low economic status and negative parental practices.

The trajectories of maternal depression with regard to severity and chronicity (Ashman et al., 2008Ashman, S. B., Dawson, G., & Panagiotides, H. (2008). Trajectories of maternal depression over 7 years: Relations with child psychophysiology and behavior and role of contextual risks. Development and Psychopathology, 20(1), 55-77. doi:10.1017/S0954579408000035; Campbell et al., 2007Campbell, S. B., Matestic, P., von Stauffenberg, C., Mohan, R., & Kirchner, T. (2007). Trajectories of maternal depressive symptoms, maternal sensitivity, and children’s functioning at school entry. Developmental Psychology, 43(5), 1202-1215. doi:10.1037/0012-1649.43.5.1202; Fatori et al., 2013Fatori, D., Bordin, I. A., Curto, B. M., & de Paula, C. S. (2013). Influence of psychosocial risk factors on the trajectory of mental health problems from childhood to adolescence: A longitudinal study. BMC Psychiatry, 13, 31. doi:10.1186/1471-244X-13-31; Gross et al., 2009Gross, H. E., Shaw, D. S., Burwell, R. A., & Nagin, D. S. (2009). Transactional processes in child disruptive behavior and maternal depression: A longitudinal study from early childhood to adolescence. Development and Psychopathology, 21(1), 139-156. doi:10.1017/S0954579409000091; Parent, Jones, Forehand, Cuellar, & Shoulberg, 2013; Wang et al., 2013Wang, F., Christ, S. L., Milss-Koonce, W. R., Garrett-Peters, P., & Cox, M. J. (2013). Association between maternal sensitivity and externalizing behavior from preschool to preadolescence. Journal of Applied Developmental Psychology, 34(2), 89-100. doi:10.1016/j.appdev.2012.11.003; Zanca, Pizeta, Osório, & Loureiro, 2013) and the presence of comorbidities, especially those related to anxiety (Barker & Maughan, 2009Barker, E. D., & Maughan, B. (2009). Differentiating early-onset persistent versus childhood-limited conduct problem youth. The American Journal of Psychiatry, 166(8), 900-908. doi:10.1176/appi.ajp.2009.08121770; Boyd & Tervo-Clemmens, 2013Boyd, R. C., & Tervo-Clemmens, B. (2013). Exploring maternal and child effects of comorbid anxiety disorders among African American mothers with depression. Journal of Depression & Anxiety, 2(129), 1000129. doi:10.4172/2167-1044.1000129; Fatori et al., 2013Fatori, D., Bordin, I. A., Curto, B. M., & de Paula, C. S. (2013). Influence of psychosocial risk factors on the trajectory of mental health problems from childhood to adolescence: A longitudinal study. BMC Psychiatry, 13, 31. doi:10.1186/1471-244X-13-31; Karevold et al., 2009Karevold, E., Roysamb, E., Ystrom, E., & Mathiesen, K. S. (2009). Predictors and pathways from infancy to symptoms of anxiety and depression in early adolescence. Developmental Psychology, 45(4), 1051-1060. doi:10.1037/a0016123; Lau, Rijsdijk, Gregory, McGuffin, & Eley, 2007; Mickelson & Demmings, 2009Mickelson, K. D., & Demmings, J. L. (2009). The impact of support network substitution on low-income women’s health: Are minor children beneficial substitutes? Social Science & Medicine, 68(1), 80-88. doi:10.1016/j.socscimed.2008.09.057; Piché, Bergeron, Cyr, & Berthiaume, 2011Piché, G., Bergeron, L., Cyr, M., & Berthiaume, C. (2011). Interaction effects between maternal lifetime depressive/anxiety disorders and correlates of children’s externalizing symptoms. Journal of Child and Family Studies, 20(5), 596-604. doi:10.1007/s10826-010-9433-0), were identified as contextual risk factors for maternal clinical conditions. Twelve studies addressed negative parental practices including negligence, physical and psychological abuse, lax discipline, inconsistent punishment, and negative monitoring. Five of these studies focused on negligence (Criss et al., 2009Criss, M. M., Shaw, D. S., Moilanen, K. L., Hitchings, J. E., & Ingoldsby, E. M. (2009). Family, neighborhood, and peer characteristics as predictors of child adjustment: A longitudinal analysis of additive and mediation models. Social Development, 18(3), 511-535. doi:10.1111/j.1467-9507.2008.00520.x; Foster et al., 2008Foster, C. E., Webster, M. C., Weissman, M. M., Pilowsky, D. J., Wickramaratne, P. J., Talati, A., … King, C. A. (2008). Remission of maternal depression: Relations to family functioning and youth internalizing and externalizing symptoms. Journal of Clinical Child & Adolescent Psychology, 37(4), 714-724. doi:10.1080/15374410802359726; Gerkensmeyer, Perkins, Day, et al., 2011Gerkensmeyer, J. E., Perkins, S. M., Day, J., Austin, J. K., Scott, E. L., & Wu, J. (2011). Maternal depressive symptoms when caring for a child with mental health problems. Journal of Child and Family Studies, 20(5), 685-695. doi:10.1007/s10826-011-9445-4; Gerkensmeyer, Perkins, Scott, et al., 2008Gerkensmeyer, J. E., Perkins, S. M., Scott, E. L., & Wu, J. (2008). Depressive symptoms among primary caregivers of children with mental health needs: Mediating and moderating variables. Archives of Psychiatric Nursing, 22(3), 135-146. doi:10.1016/j.apnu.2007.06.016; Hart et al., 2008)Hart, D., Atkins, R., & Matsuba, M. K. (2008). The association of neighborhood poverty with personality change in childhood. Journal of Personality and Social Psychology, 94(6), 1048-1061. doi:10.1037/0022-3514.94.6.1048, four focused on punishment (Barker & Maughan, 2009Barker, E. D., & Maughan, B. (2009). Differentiating early-onset persistent versus childhood-limited conduct problem youth. The American Journal of Psychiatry, 166(8), 900-908. doi:10.1176/appi.ajp.2009.08121770; Fatori et al., 2013Fatori, D., Bordin, I. A., Curto, B. M., & de Paula, C. S. (2013). Influence of psychosocial risk factors on the trajectory of mental health problems from childhood to adolescence: A longitudinal study. BMC Psychiatry, 13, 31. doi:10.1186/1471-244X-13-31; Piché et al., 2011Piché, G., Bergeron, L., Cyr, M., & Berthiaume, C. (2011). Interaction effects between maternal lifetime depressive/anxiety disorders and correlates of children’s externalizing symptoms. Journal of Child and Family Studies, 20(5), 596-604. doi:10.1007/s10826-010-9433-0; Wang et al., 2013)Wang, F., Christ, S. L., Milss-Koonce, W. R., Garrett-Peters, P., & Cox, M. J. (2013). Association between maternal sensitivity and externalizing behavior from preschool to preadolescence. Journal of Applied Developmental Psychology, 34(2), 89-100. doi:10.1016/j.appdev.2012.11.003, and one focused on abuse (Piché et al., 2011)Piché, G., Bergeron, L., Cyr, M., & Berthiaume, C. (2011). Interaction effects between maternal lifetime depressive/anxiety disorders and correlates of children’s externalizing symptoms. Journal of Child and Family Studies, 20(5), 596-604. doi:10.1007/s10826-010-9433-0. Most of the studies assessed at least two contextual risk factors, and all studies examined between one and five variables.

The present review categorized social support conditions into two major groups: (1) environmental, family, and neighborhood resources; and (2) parental resources. Environmental, family, and neighborhood resources included conditions related to few stressors, social support from relationships with people in general, and the availability of community services. Parental resources included the following: (a) conditions related to positive parental practices and (b) maternal mental health resources. Most of the articles evaluated social support conditions with regard to environmental, family and neighborhood resources.

The present review identified eight cross-sectional studies that addressed maternal depression and its relationship to social support. Table 2 shows the major outcomes.

Table 2
Cross-Sectional Studies: Associations Between Social Support and Risks (n = 8)

Of the eight cross-sectional studies, seven found that more social support was significantly associated with fewer problems among children exposed to maternal depression. Five studies also identified associations with the presence of fewer risk variables.

Only one study (Piché et al., 2011Piché, G., Bergeron, L., Cyr, M., & Berthiaume, C. (2011). Interaction effects between maternal lifetime depressive/anxiety disorders and correlates of children’s externalizing symptoms. Journal of Child and Family Studies, 20(5), 596-604. doi:10.1007/s10826-010-9433-0) did not find correlations among social support, maternal depression, and child behavioral problems, psychopathologies or both; however, this study addressed many clinical, social, and familial variables. These authors reported that the contextual risk factors related to negative parental practices expressed by fewer maternal punishments were associated with fewer externalizing behavioral problems in children.

Of the 19 longitudinal studies examined, five adopted a correlational design that addressed maternal depression and its association with social support. Table 3 shows the major outcomes.

Table 3
Longitudinal Correlational Studies: Associations Between Social Support and Risks (n = 5)

Four of these five studies reported that more social support was correlated with fewer externalizing and/or internalizing behavioral problems. Campbell et al. (2007)Campbell, S. B., Matestic, P., von Stauffenberg, C., Mohan, R., & Kirchner, T. (2007). Trajectories of maternal depressive symptoms, maternal sensitivity, and children’s functioning at school entry. Developmental Psychology, 43(5), 1202-1215. doi:10.1037/0012-1649.43.5.1202 highlighted the relevancy of greater maternal sensitivity in her interactions with her child, including expressions of positive respect, low intrusiveness, greater supportive presence, more respect to autonomy, and low hostility.

Another study found that more social support was correlated with fewer internalizing behavioral problems by studying these variables in the context of positive maternal response to pharmacological treatments (i.e., the remission of maternal depressive symptoms) (Foster et al., 2008Foster, C. E., Webster, M. C., Weissman, M. M., Pilowsky, D. J., Wickramaratne, P. J., Talati, A., … King, C. A. (2008). Remission of maternal depression: Relations to family functioning and youth internalizing and externalizing symptoms. Journal of Clinical Child & Adolescent Psychology, 37(4), 714-724. doi:10.1080/15374410802359726).

Only one study (Fatori et al., 2013Fatori, D., Bordin, I. A., Curto, B. M., & de Paula, C. S. (2013). Influence of psychosocial risk factors on the trajectory of mental health problems from childhood to adolescence: A longitudinal study. BMC Psychiatry, 13, 31. doi:10.1186/1471-244X-13-31) failed to find an association between social support and the aggravation of child and adolescent mental health problems at a later assessment. The authors suggest that this finding might be due to the presence of severe physical abuse over an extended period of time, highlighting the deleterious effects of chronic violence.

Of the 19 longitudinal studies, 14 adopted experimental designs and addressed the variables that predicted fewer problems among children. Table 4 shows the major outcomes. Of the 14 studies analyzed, only one did not find social support to be a predictor of fewer behavioral problems and/or psychopathology.

Table 4
Longitudinal Experimental Studies: Social Support and Outcomes in Children (n = 14)

Eight of the nine studies that assessed behaviors revealed that social support predicted fewer behavioral problems. Variables such as greater paternal involvement, more informal social support, more maternal social support, less maternal risk (teenage motherhood, legal problems and maternal mental health), low levels of poverty, fewer environmental risks, fewer contextual risk factors, fewer controlling patterns (punitive or caregiving) and a higher quality of mother-child interactions in association with maternal depression were predictors of fewer behavioral problems.

While Brown et al. (2013)Brown, J., Barbarin, O., & Scott, K. (2013). Socioemotional trajectories in black boys between kindergarten and the fifth grade: The role of cognitive skills and family in promoting resiliency. American Journal of Orthopsychiatry, 83(2-3), 176-184. doi:10.1111/ajop.12027 verified that family support did not present a predictive effect in relation to the internalizing problems of black boys, they highlighted that increased early cognitive skills predict lower initial levels of internalizing problems.

Five studies found that social support predicted fewer psychopathologies in children and adolescents exposed to maternal depression. In these studies, less familial adversity, fewer stressors and less parental punitive discipline, and more parental resources when faced with continuous exposure to poverty in association with maternal depression were predictors of less psychopathology.

Discussion

The present review suggests that different types of social support may reduce behavioral problems and the risk for psychopathology in children exposed to maternal depression. These studies used different definitions and instruments to assess social support, including standardized instruments, questionnaires developed by the authors, observations of mother-child interactions, and indirect assessments to verify the infrequent occurrence of stressors within families. Therefore, it was not possible to identify a “gold standard” social support assessment from any of the studies included in the present review. Accordingly, Rueger, Malecki, and Demaray (2010)Rueger, S. Y., Malecki, C. K., & Demaray, M. K. (2010). Relationship between multiple sources of perceived social support and psychological and academic adjustment in early adolescence: Comparisons across gender. Journal Youth Adolescence, 39(1), 47-61. doi:10.1007/s10964-008-9368-6 indicated that the differences in the strategies used to measure social support in the studies may lead to different results and may prejudice the comparison of the results.

The analysis of the studies verified the absence of an unequivocal definition for support, given the diversity of instruments used for its evaluation, and little explanation related to the source of support and whether this support was perceived or actually received. An explanation of these points may provide greater clarity on this subject.

Given this diversity of measurements and the fact that the abovementioned authors addressed a broad set of heterogeneous conditions, generalizing the findings regarding the positive effect of social support is difficult. To understand this diversity, the present study used broad conditions to categorize the types of social support: (a) environmental, family, and neighborhood resources; and (b) parental resources.

Importantly, the broad combination of contextual risk factors domains and diverse conditions also hinders data comparison. This difficulty is inherent to the study of maternal depression, which is related to a wide variety of stressors and cumulative risk, the latter of which can increase the likelihood of negative child outcomes. Maternal clinical conditions (chronicity of maternal depression), low economic status (poverty) and negative parental practices were the most frequently assessed contextual risk factors, regardless of the type of child outcome assessed, in the analyzed studies.

Importantly, seven studies (25.92%) (Ashman et al., 2008Ashman, S. B., Dawson, G., & Panagiotides, H. (2008). Trajectories of maternal depression over 7 years: Relations with child psychophysiology and behavior and role of contextual risks. Development and Psychopathology, 20(1), 55-77. doi:10.1017/S0954579408000035; Barker et al., 2012Barker, E. D., Copeland, W., Maughan, B., Jaffee S. R., & Uher, R. (2012). Relative impact of maternal depression and associated risk factors on offspring psychopathology. The British Journal of Psychiatry, 200(2), 124-129. doi:10.1192/bjp.bp.111.092346; Barker & Maughan, 2009Barker, E. D., & Maughan, B. (2009). Differentiating early-onset persistent versus childhood-limited conduct problem youth. The American Journal of Psychiatry, 166(8), 900-908. doi:10.1176/appi.ajp.2009.08121770; Gross et al., 2009Gross, H. E., Shaw, D. S., Burwell, R. A., & Nagin, D. S. (2009). Transactional processes in child disruptive behavior and maternal depression: A longitudinal study from early childhood to adolescence. Development and Psychopathology, 21(1), 139-156. doi:10.1017/S0954579409000091; Lau et al., 2007Lau, J. Y. F., Rijsdijk, F., Gregory, A. M., McGuffin, P., & Eley, T. C. (2007). Pathways to childhood depressive symptoms: The role of social, cognitive, and genetic risk factors. Developmental Psychology, 43(6), 1402-1414. doi:10.1037/0012-1649.43.6.1402; Lengua, Bush, Long, Kovacs, & Trancik, 2008Lengua, L. J., Bush, N. R., Long, A. C., Kovacs, E. A., & Trancik, A. M. (2008). Effortful control as a moderator of the relation between contextual risk factors and growth in adjustment problems. Development and Psychopathology, 20(2), 509-528. doi:10.1017/S0954579408000254; Zanca et al., 2013)Zanca, C. G., Pizeta, F. A., Osório, F. L., & Loureiro, S. R. (2013). Percepção do apoio social de famílias que convivem com a depressão materna. Estudos de Psicologia (Natal), 18(2), 249-257. doi:10.1590/S1413-294X2013000200010 have considered the frequency or number of contextual risk factors as social support, referring to the presence of fewer stressors and negative conditions in family life or the surrounding environment. This finding indicates that the operational definitions of social support require additional delimitation.

Most of the selected studies used instruments to screen for maternal depressive symptoms. Only four studies (Allen‐Meares et al., 2010Allen-Meares, P., Blazevski, J., Bybee, D., & Oyserman, D. (2010). Independent effects of paternal involvement and maternal mental illness on child outcomes. Social Service Review, 84(1), 103-127. doi:10.1086/652989; Ashman et al., 2008Ashman, S. B., Dawson, G., & Panagiotides, H. (2008). Trajectories of maternal depression over 7 years: Relations with child psychophysiology and behavior and role of contextual risks. Development and Psychopathology, 20(1), 55-77. doi:10.1017/S0954579408000035; Boyd & Tervo-Clemmens, 2013Boyd, R. C., & Tervo-Clemmens, B. (2013). Exploring maternal and child effects of comorbid anxiety disorders among African American mothers with depression. Journal of Depression & Anxiety, 2(129), 1000129. doi:10.4172/2167-1044.1000129; Zanca et al., 2013)Zanca, C. G., Pizeta, F. A., Osório, F. L., & Loureiro, S. R. (2013). Percepção do apoio social de famílias que convivem com a depressão materna. Estudos de Psicologia (Natal), 18(2), 249-257. doi:10.1590/S1413-294X2013000200010 conducted a diagnostic evaluation. Four studies (Ashman et al., 2008Ashman, S. B., Dawson, G., & Panagiotides, H. (2008). Trajectories of maternal depression over 7 years: Relations with child psychophysiology and behavior and role of contextual risks. Development and Psychopathology, 20(1), 55-77. doi:10.1017/S0954579408000035; Campbell et al., 2007Campbell, S. B., Matestic, P., von Stauffenberg, C., Mohan, R., & Kirchner, T. (2007). Trajectories of maternal depressive symptoms, maternal sensitivity, and children’s functioning at school entry. Developmental Psychology, 43(5), 1202-1215. doi:10.1037/0012-1649.43.5.1202; Gross et al., 2009Gross, H. E., Shaw, D. S., Burwell, R. A., & Nagin, D. S. (2009). Transactional processes in child disruptive behavior and maternal depression: A longitudinal study from early childhood to adolescence. Development and Psychopathology, 21(1), 139-156. doi:10.1017/S0954579409000091; Fatori et al., 2013)Fatori, D., Bordin, I. A., Curto, B. M., & de Paula, C. S. (2013). Influence of psychosocial risk factors on the trajectory of mental health problems from childhood to adolescence: A longitudinal study. BMC Psychiatry, 13, 31. doi:10.1186/1471-244X-13-31 analyzed the trajectory (i.e., the length and severity) of maternal depression that predicted the variations in child outcomes. In their meta-analysis, Goodman et al. (2011)Goodman, S. H., Rouse, M. H., Connel, A. M., Broth, M. R., Hall, C. M., & Heyward, D. (2011). Maternal depression and child psychopathology: A meta-analytic review. Clinical Child and Family Psychology Review, 14(1), 1-27. doi:10.1007/s10567-010-0080-1 stated that the clinical evaluation of depression is not necessarily better than a symptom report. They emphasized the importance of assessing the trajectory of maternal depression and the child’s age at first exposure because depressive symptoms tend to vary over time and can have different effects on child behavioral problems, psychopathologies, or both. Therefore, medical conditions related to maternal depression were considered in most longitudinal studies.

Regarding the informants, eight studies used the mother as the sole source of information (Anhalt et al., 2007Anhalt, K., Telzrow, C. F., & Brown, C. L. (2007). Maternal stress and emotional status during the perinatal period and childhood adjustment. School Psychology Quarterly, 22(1), 74-90. doi:10.1037/1045-3830.22.1.74; Barker & Maughan, 2009Barker, E. D., & Maughan, B. (2009). Differentiating early-onset persistent versus childhood-limited conduct problem youth. The American Journal of Psychiatry, 166(8), 900-908. doi:10.1176/appi.ajp.2009.08121770; Boyd & Tervo-Clemmens, 2013Boyd, R. C., & Tervo-Clemmens, B. (2013). Exploring maternal and child effects of comorbid anxiety disorders among African American mothers with depression. Journal of Depression & Anxiety, 2(129), 1000129. doi:10.4172/2167-1044.1000129; Gerkensmeyer, Perkins, Day, et al., 2011; Gerkensmeyer, Perkins, Scott, et al., 2008; Goosby, 2007Goosby, B. J. (2007). Poverty duration, maternal psychological resources, and adolescent socioemotional outcomes. Journal of Family Issues, 28(8), 1113-1134. doi:10.1177/0192513X07300712; Mickelson & Demmings, 2009Mickelson, K. D., & Demmings, J. L. (2009). The impact of support network substitution on low-income women’s health: Are minor children beneficial substitutes? Social Science & Medicine, 68(1), 80-88. doi:10.1016/j.socscimed.2008.09.057; Zanca et al., 2013)Zanca, C. G., Pizeta, F. A., Osório, F. L., & Loureiro, S. R. (2013). Percepção do apoio social de famílias que convivem com a depressão materna. Estudos de Psicologia (Natal), 18(2), 249-257. doi:10.1590/S1413-294X2013000200010, and 13 studies did not specify the mothers’ depression status at the time of data collection (Barker et al., 2012Barker, E. D., Copeland, W., Maughan, B., Jaffee S. R., & Uher, R. (2012). Relative impact of maternal depression and associated risk factors on offspring psychopathology. The British Journal of Psychiatry, 200(2), 124-129. doi:10.1192/bjp.bp.111.092346; Barker & Maughan, 2009Barker, E. D., & Maughan, B. (2009). Differentiating early-onset persistent versus childhood-limited conduct problem youth. The American Journal of Psychiatry, 166(8), 900-908. doi:10.1176/appi.ajp.2009.08121770; Brown et al., 2013Brown, J., Barbarin, O., & Scott, K. (2013). Socioemotional trajectories in black boys between kindergarten and the fifth grade: The role of cognitive skills and family in promoting resiliency. American Journal of Orthopsychiatry, 83(2-3), 176-184. doi:10.1111/ajop.12027; Criss et al., 2009Criss, M. M., Shaw, D. S., Moilanen, K. L., Hitchings, J. E., & Ingoldsby, E. M. (2009). Family, neighborhood, and peer characteristics as predictors of child adjustment: A longitudinal analysis of additive and mediation models. Social Development, 18(3), 511-535. doi:10.1111/j.1467-9507.2008.00520.x; Dubois-Comtois et al., 2013Dubois-Comtois, K., Moss, E., Cyr, C., & Pascuzzo, K. (2013). Behavior problems in middle childhood: The predictive role of maternal distress, child attachment, and mother-child interactions. Journal of Abnormal Child Psychology, 41(8), 1311-1324. doi:10.1007/s10802-013-9764-6; Goosby, 2007Goosby, B. J. (2007). Poverty duration, maternal psychological resources, and adolescent socioemotional outcomes. Journal of Family Issues, 28(8), 1113-1134. doi:10.1177/0192513X07300712; Hart et al., 2008Hart, D., Atkins, R., & Matsuba, M. K. (2008). The association of neighborhood poverty with personality change in childhood. Journal of Personality and Social Psychology, 94(6), 1048-1061. doi:10.1037/0022-3514.94.6.1048; Heberle et al., 2014Heberle, A. E., Krill, S. C., Briggs-Gowan, M. J., & Carter, A. S. (2014). Predicting externalizing and internalizing behavior in kindergarten: Examining the buffering role of early social support. Journal of Clinical Child & Adolescent Psychology. doi:10.1080/15374416.2014.886254; Karevold et al., 2009Karevold, E., Roysamb, E., Ystrom, E., & Mathiesen, K. S. (2009). Predictors and pathways from infancy to symptoms of anxiety and depression in early adolescence. Developmental Psychology, 45(4), 1051-1060. doi:10.1037/a0016123; Lau et al., 2007Lau, J. Y. F., Rijsdijk, F., Gregory, A. M., McGuffin, P., & Eley, T. C. (2007). Pathways to childhood depressive symptoms: The role of social, cognitive, and genetic risk factors. Developmental Psychology, 43(6), 1402-1414. doi:10.1037/0012-1649.43.6.1402; Lengua et al., 2008Lengua, L. J., Bush, N. R., Long, A. C., Kovacs, E. A., & Trancik, A. M. (2008). Effortful control as a moderator of the relation between contextual risk factors and growth in adjustment problems. Development and Psychopathology, 20(2), 509-528. doi:10.1017/S0954579408000254; Piché et al., 2011Piché, G., Bergeron, L., Cyr, M., & Berthiaume, C. (2011). Interaction effects between maternal lifetime depressive/anxiety disorders and correlates of children’s externalizing symptoms. Journal of Child and Family Studies, 20(5), 596-604. doi:10.1007/s10826-010-9433-0; Wang et al., 2013)Wang, F., Christ, S. L., Milss-Koonce, W. R., Garrett-Peters, P., & Cox, M. J. (2013). Association between maternal sensitivity and externalizing behavior from preschool to preadolescence. Journal of Applied Developmental Psychology, 34(2), 89-100. doi:10.1016/j.appdev.2012.11.003. Because depressive symptoms may affect the quality of mothers’ reports, implying a potential methodological problem that limits the validity of the information provided, 18 studies employed multiple respondents including not only mothers but also children, fathers, and teachers, which increased the validity of the findings.

Another methodological issue worth discussing concerns the psychometric quality of the instruments used to assess social support. Thirteen studies (48.14%) referred to validated instruments; however, a wide variety of methods were used, suggesting the absence of standard testing instruments, which would favor direct comparisons between the different findings.

The studies analyzed in the present review most frequently addressed internalizing and externalizing behavioral problems assessed using the CBCL, which is widely used in the literature. Childhood depression was the most frequently addressed psychopathology (Goosby, 2007Goosby, B. J. (2007). Poverty duration, maternal psychological resources, and adolescent socioemotional outcomes. Journal of Family Issues, 28(8), 1113-1134. doi:10.1177/0192513X07300712; Lau et al., 2007Lau, J. Y. F., Rijsdijk, F., Gregory, A. M., McGuffin, P., & Eley, T. C. (2007). Pathways to childhood depressive symptoms: The role of social, cognitive, and genetic risk factors. Developmental Psychology, 43(6), 1402-1414. doi:10.1037/0012-1649.43.6.1402; Lengua et al., 2008Lengua, L. J., Bush, N. R., Long, A. C., Kovacs, E. A., & Trancik, A. M. (2008). Effortful control as a moderator of the relation between contextual risk factors and growth in adjustment problems. Development and Psychopathology, 20(2), 509-528. doi:10.1017/S0954579408000254), and this outcome was common among the children of mothers with depression (Mendes, Loureiro, Crippa, et al., 2012Mendes, A. V., Loureiro, S. R., Crippa, J. A. S., Gaya, C. M., García-Esteve, L., & Martín-Santos, R. (2012). Mothers with depression, school-age children with depression? A systematic review. Perspectives in Psychiatric Care, 48(3), 138-148. doi:10.1111/j.1744-6163.2011.00318.x). This finding might indicate the transgenerational nature of depression.

Most studies examined boys and girls, and four studies performed gender comparisons. One of these studies revealed that girls have more internalizing problems and boys more externalizing problems (Ashman et al., 2008Ashman, S. B., Dawson, G., & Panagiotides, H. (2008). Trajectories of maternal depression over 7 years: Relations with child psychophysiology and behavior and role of contextual risks. Development and Psychopathology, 20(1), 55-77. doi:10.1017/S0954579408000035). Other studies verified different predictors of the behavioral problems shown by boys (i.e., fewer stressors) and girls (i.e., more maternal social support) (Barker & Maughan, 2009Barker, E. D., & Maughan, B. (2009). Differentiating early-onset persistent versus childhood-limited conduct problem youth. The American Journal of Psychiatry, 166(8), 900-908. doi:10.1176/appi.ajp.2009.08121770). Karevold et al. (2009)Karevold, E., Roysamb, E., Ystrom, E., & Mathiesen, K. S. (2009). Predictors and pathways from infancy to symptoms of anxiety and depression in early adolescence. Developmental Psychology, 45(4), 1051-1060. doi:10.1037/a0016123, for example, observed that social support was predictive of fewer internalizing problems for girls but not for boys. Only one out of four studies failed to find a gender effect (Wang et al., 2013)Wang, F., Christ, S. L., Milss-Koonce, W. R., Garrett-Peters, P., & Cox, M. J. (2013). Association between maternal sensitivity and externalizing behavior from preschool to preadolescence. Journal of Applied Developmental Psychology, 34(2), 89-100. doi:10.1016/j.appdev.2012.11.003.

The samples of five studies (Allen‐Meares et al., 2010Allen-Meares, P., Blazevski, J., Bybee, D., & Oyserman, D. (2010). Independent effects of paternal involvement and maternal mental illness on child outcomes. Social Service Review, 84(1), 103-127. doi:10.1086/652989; Criss et al., 2009Criss, M. M., Shaw, D. S., Moilanen, K. L., Hitchings, J. E., & Ingoldsby, E. M. (2009). Family, neighborhood, and peer characteristics as predictors of child adjustment: A longitudinal analysis of additive and mediation models. Social Development, 18(3), 511-535. doi:10.1111/j.1467-9507.2008.00520.x; Fatori et al., 2013Fatori, D., Bordin, I. A., Curto, B. M., & de Paula, C. S. (2013). Influence of psychosocial risk factors on the trajectory of mental health problems from childhood to adolescence: A longitudinal study. BMC Psychiatry, 13, 31. doi:10.1186/1471-244X-13-31; Goosby, 2007Goosby, B. J. (2007). Poverty duration, maternal psychological resources, and adolescent socioemotional outcomes. Journal of Family Issues, 28(8), 1113-1134. doi:10.1177/0192513X07300712; Mickelson & Demmings, 2009Mickelson, K. D., & Demmings, J. L. (2009). The impact of support network substitution on low-income women’s health: Are minor children beneficial substitutes? Social Science & Medicine, 68(1), 80-88. doi:10.1016/j.socscimed.2008.09.057) were considered high risk because they were mostly composed of families with low socioeconomic status. These families might have introduced a pre-established condition of combined risks into the analysis.

Of the eight cross-sectional studies, only one did not find an association between social support and child behavioral problems, psychopathologies, or both (Piché et al., 2011Piché, G., Bergeron, L., Cyr, M., & Berthiaume, C. (2011). Interaction effects between maternal lifetime depressive/anxiety disorders and correlates of children’s externalizing symptoms. Journal of Child and Family Studies, 20(5), 596-604. doi:10.1007/s10826-010-9433-0). This study addressed symptoms of maternal depression and anxiety, focusing on punitive maternal care (including physical and/or sexual abuse). This variable was related to more externalizing problems, which emphasizes the presence of combined risks with regard to maternal depression and anxiety.

Regarding the study limitations, one of the five longitudinal correlational studies (Anhalt et al., 2007Anhalt, K., Telzrow, C. F., & Brown, C. L. (2007). Maternal stress and emotional status during the perinatal period and childhood adjustment. School Psychology Quarterly, 22(1), 74-90. doi:10.1037/1045-3830.22.1.74) examined perinatal maternal factors but did not assess whether a change occurred in the maternal depressive symptoms over the 7-year assessment period. Another study (Foster et al., 2008Foster, C. E., Webster, M. C., Weissman, M. M., Pilowsky, D. J., Wickramaratne, P. J., Talati, A., … King, C. A. (2008). Remission of maternal depression: Relations to family functioning and youth internalizing and externalizing symptoms. Journal of Clinical Child & Adolescent Psychology, 37(4), 714-724. doi:10.1080/15374410802359726) had a brief follow-up period of only 3 months.

The longitudinal experimental studies also assessed a broad range of variables, which hindered the data comparison due to the diversity of the results. Overall, however, the analyzed studies found that fewer contextual risk factors predicted fewer behavioral problems and depressive symptoms in children (Ashman et al., 2008Ashman, S. B., Dawson, G., & Panagiotides, H. (2008). Trajectories of maternal depression over 7 years: Relations with child psychophysiology and behavior and role of contextual risks. Development and Psychopathology, 20(1), 55-77. doi:10.1017/S0954579408000035; Barker & Maughan, 2009Barker, E. D., & Maughan, B. (2009). Differentiating early-onset persistent versus childhood-limited conduct problem youth. The American Journal of Psychiatry, 166(8), 900-908. doi:10.1176/appi.ajp.2009.08121770; Hart et al., 2008Hart, D., Atkins, R., & Matsuba, M. K. (2008). The association of neighborhood poverty with personality change in childhood. Journal of Personality and Social Psychology, 94(6), 1048-1061. doi:10.1037/0022-3514.94.6.1048; Karevold et al., 2009Karevold, E., Roysamb, E., Ystrom, E., & Mathiesen, K. S. (2009). Predictors and pathways from infancy to symptoms of anxiety and depression in early adolescence. Developmental Psychology, 45(4), 1051-1060. doi:10.1037/a0016123; Lau et al., 2007Lau, J. Y. F., Rijsdijk, F., Gregory, A. M., McGuffin, P., & Eley, T. C. (2007). Pathways to childhood depressive symptoms: The role of social, cognitive, and genetic risk factors. Developmental Psychology, 43(6), 1402-1414. doi:10.1037/0012-1649.43.6.1402; Lengua et al., 2008)Lengua, L. J., Bush, N. R., Long, A. C., Kovacs, E. A., & Trancik, A. M. (2008). Effortful control as a moderator of the relation between contextual risk factors and growth in adjustment problems. Development and Psychopathology, 20(2), 509-528. doi:10.1017/S0954579408000254; more parental resources predicted fewer behavioral problems and psychopathologies (Allen‐Meares et al., 2010; Criss et al., 2009Criss, M. M., Shaw, D. S., Moilanen, K. L., Hitchings, J. E., & Ingoldsby, E. M. (2009). Family, neighborhood, and peer characteristics as predictors of child adjustment: A longitudinal analysis of additive and mediation models. Social Development, 18(3), 511-535. doi:10.1111/j.1467-9507.2008.00520.x; Dubois-Comtois et al., 2013Dubois-Comtois, K., Moss, E., Cyr, C., & Pascuzzo, K. (2013). Behavior problems in middle childhood: The predictive role of maternal distress, child attachment, and mother-child interactions. Journal of Abnormal Child Psychology, 41(8), 1311-1324. doi:10.1007/s10802-013-9764-6; Goosby, 2007Goosby, B. J. (2007). Poverty duration, maternal psychological resources, and adolescent socioemotional outcomes. Journal of Family Issues, 28(8), 1113-1134. doi:10.1177/0192513X07300712; Gross et al., 2009)Gross, H. E., Shaw, D. S., Burwell, R. A., & Nagin, D. S. (2009). Transactional processes in child disruptive behavior and maternal depression: A longitudinal study from early childhood to adolescence. Development and Psychopathology, 21(1), 139-156. doi:10.1017/S0954579409000091; more social support predicted fewer behavioral problems (Barker & Maughan, 2009Barker, E. D., & Maughan, B. (2009). Differentiating early-onset persistent versus childhood-limited conduct problem youth. The American Journal of Psychiatry, 166(8), 900-908. doi:10.1176/appi.ajp.2009.08121770; Heberle et al., 2014Heberle, A. E., Krill, S. C., Briggs-Gowan, M. J., & Carter, A. S. (2014). Predicting externalizing and internalizing behavior in kindergarten: Examining the buffering role of early social support. Journal of Clinical Child & Adolescent Psychology. doi:10.1080/15374416.2014.886254; Karevold et al., 2009)Karevold, E., Roysamb, E., Ystrom, E., & Mathiesen, K. S. (2009). Predictors and pathways from infancy to symptoms of anxiety and depression in early adolescence. Developmental Psychology, 45(4), 1051-1060. doi:10.1037/a0016123; and greater maternal harshness correlated with more externalizing problems (Wang et al., 2013)Wang, F., Christ, S. L., Milss-Koonce, W. R., Garrett-Peters, P., & Cox, M. J. (2013). Association between maternal sensitivity and externalizing behavior from preschool to preadolescence. Journal of Applied Developmental Psychology, 34(2), 89-100. doi:10.1016/j.appdev.2012.11.003.

The nine predictive studies that addressed the role of contextual risk factors concerning children’s mental health included a variety of factors, which made direct comparisons across studies difficult. In general, however, they focused on the impact of cumulative risk in the presence of maternal depression and negative sociodemographic conditions, such as poverty and a risky neighborhood. The results suggested that the impact of maternal depression on children’s mental health was stronger than other risk factors. The results also highlighted the beneficial impact of social support on the mental health of depressed mothers’ children.

Two studies addressed biological variables: one study compared twin pairs (Lau et al., 2007Lau, J. Y. F., Rijsdijk, F., Gregory, A. M., McGuffin, P., & Eley, T. C. (2007). Pathways to childhood depressive symptoms: The role of social, cognitive, and genetic risk factors. Developmental Psychology, 43(6), 1402-1414. doi:10.1037/0012-1649.43.6.1402), and another measured brain potentials (Ashman et al., 2008Ashman, S. B., Dawson, G., & Panagiotides, H. (2008). Trajectories of maternal depression over 7 years: Relations with child psychophysiology and behavior and role of contextual risks. Development and Psychopathology, 20(1), 55-77. doi:10.1017/S0954579408000035). The former study did not find an association between genetic risk and social support; the latter study identified a moderate correlation between frontal brain activity and contextual risk factors. Importantly, a study of genetic variables is necessary to better understand the effect of gene-environment interactions on child outcomes (Rutter, 2007Rutter, M. (2007). Gene-environment interdependence. Developmental Science, 10(1), 12-18. doi:10.1111/j.1467-7687.2007.00557.x).

Conclusion

Having analyzed the positive influence of social support revealed by the studies in the present review, identifying the sources of social support that minimize the effect of maternal depression on child outcomes can contribute to the development of prevention and intervention programs. In-school assessments of school-age children and parents who experience situations of significant stress or difficulty might identify at-risk individuals for guidance and specialized care referrals.

In addition, because pregnancy encourages the early identification of contextual risk factors, the inclusion of instruments that screen for depression as part of the prenatal care provided by the healthcare services would enable the prevention and treatment of maternal depressive symptoms to prevent behavioral and psychopathological problems in children.

Identifying social support sources can also encourage prevention and intervention strategies for children exposed to maternal depression; such strategies include institutional programs that offer athletic and artistic activities (among others) as sources of child social support.

Future research should assess the influences of social support on the outcomes in children who live with maternal depression to obtain a clearer operational definition of social support. This research should explicitly analyze the different types of social support and explore contextual risk and protective factors that interact with the various dimensions: instrumental, emotional, informational, tangible aid, positive social interaction, affection, and esteem. Furthermore, future studies should also analyze the trajectory of maternal depression to better understand the influence of social support regarding clinical variables such as the severity and chronicity of this disorder.

Although the present review systematically selected the articles, an exhaustive review was not conducted, and only a few papers were included that addressed a wide variety of variables, thereby limiting the data comparison and conclusions. Only three keywords were used to systematically search the databases. Although these keywords returned the greatest number of papers, other words could also have been used.

The present review contributes to discussing the practical and theoretical implications of the interplay between contextual risk factors and maternal depression. We synthetized and integrated findings on the impact of maternal depression and contextual factors (such as demographic variables, parental practices and family conflicts) on children’s mental health, as well as the protective role of social support in this context. We anticipate that this review will be helpful in designing interventions for mental health promotion and prevention.

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Publication Dates

  • Publication in this collection
    Dec 2014

History

  • Received
    27 Mar 2014
  • Reviewed
    7 July 2014
  • Accepted
    22 July 2014
Universidade de São Paulo, Faculdade de Filosofia Ciências e Letras de Ribeirão Preto, Programa de Pós-Graduação em Psicologia Av.Bandeirantes 3900 - Monte Alegre, 14040-901 Ribeirão Preto - São Paulo - Brasil, Tel.: (55 16) 3315-3829 - Ribeirão Preto - SP - Brazil
E-mail: paideia@usp.br