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Combined Effect of Mothers' and Fathers' Mental Health Symptoms on Children's Behavioral and Emotional Well-being
Robert S. Kahn, MD, MPH;
Dominique Brandt, MA;
Robert C. Whitaker, MD
Arch Pediatr Adolesc Med. 2004;158:721-729.
Background Few studies have examined the effects on children of maternal mental health symptoms other than depressive symptoms or have examined the joint effects of mothers' and fathers' mental health symptoms.
Objective To examine whether the father's mental health symptoms may modify the association between the mother's mental health and the child's behavioral and emotional health.
Methods Cross-sectional data from a national longitudinal survey of families provided information on 822 children aged 3 to 12 years who were living with both parents. The main child outcomes were the Behavior Problems Index–Externalizing (BPI-EXT) and–Internalizing (BPI-INT) subscales. The mother's and father's mental health were each assessed by self-report using the K10, a new, validated 10-item screen for serious mental illness, including mood or anxiety disorder. Parents with scores in the upper quartile were considered to be in poorer mental health and those with scores in the other 3 quartiles were considered to be in better mental health.
Results Adjusted for covariates, having both parents in poorer mental health was associated with a 1-SD increase in the children's BPI-EXT scores ( coefficient, 5.2; SE, 0.9; P<.001) compared with neither parent reporting poorer mental health. This effect was substantially weakened if the mother was in poorer mental health but the father was not ( coefficient, 1.8; SE, 0.5; P<.01). There was no statistically significant effect if only the father was in poorer mental health ( coefficient, 0.1; SE, 0.6; P = .88). The risk of a child having a high BPI-EXT score ( 90th percentile for the cohort) was elevated if both parents reported poorer mental health (odds ratio, 9.2; 95% confidence interval [CI], 4.8-17.8), but was less elevated if only the mother reported poorer mental health (odds ratio, 2.3; 95% CI, 1.1-4.9), and was not elevated if only the father reported poorer mental health (odds ratio, 0.6; 95% CI, 0.2-1.9). Similar patterns emerged for children's BPI-INT scores.
Conclusions A father in better mental health may buffer the influence of a mother's poorer mental health on a child's behavioral and emotional problems, and these problems seem to be most severe for children who have 2 parents with poorer mental health. The form and intensity of pediatric approaches to mothers with poorer mental health may need to consider the mental health of fathers.
From the Division of General and Community Pediatrics (Drs Kahn and Whitaker), Center for Epidemiology and Biostatistics, Cincinnati Children's Hospital Medical Center (Ms Brandt), Cincinnati, Ohio; and the Department of Pediatrics, University of Cincinnati College of Medicine (Drs Kahn and Whitaker). Dr Whitaker is currently with Mathematica Policy Research, Inc, Princeton, NJ.
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