Skip to main content

Advertisement

SpringerLink
Log in

Self-Efficacy as a Mediator Between Maternal Depression and Child Hospitalizations in Low-Income Urban Families

  • Published:
Maternal and Child Health Journal Aims and scope Submit manuscript

Abstract

The objective of this study is to examine the role of maternal self-efficacy as a potential mediator between maternal depression and child hospitalizations in low-income families. We analyzed data from 432 mother–child pairs who were part of the control-group for the Nurse-Family Partnership trial in Memphis, TN. Low-income urban, mostly minority women were interviewed 12 and 24 months after their first child’s birth and their child’s medical records were collected from birth to 24 months. We fit linear and ordered logistic regression models to test for mediation. We also tested non-linear relationships between the dependent variable (child hospitalization) and covariates (depressive symptoms and self-efficacy). Elevated depressive symptoms (OR: 1.70; 90% CI: 1.05, 2.74) and lower maternal self-efficacy (OR: 0.674; 90% CI: 0.469, 0.970) were each associated with increased child hospitalizations. When both maternal self-efficacy and depressive symptoms were included in a single model, the depressive symptoms coefficient decreased significantly (OR decreased by 0.13, P = 0.069), supporting the hypothesis that self-efficacy serves as a mediator. A non-linear, inverse-U shaped relationship between maternal self-efficacy and child hospitalizations was supported: lower compared to higher self-efficacy was associated with more child hospitalizations (P = 0.039), but very low self-efficacy was associated with fewer hospitalizations than low self-efficacy (P = 0.028). In this study, maternal self-efficacy appears to be a mediator between maternal depression and child hospitalizations. Further research is needed to determine if interventions specifically targeting self-efficacy in depressed mothers might decrease child hospitalizations.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Notes

  1. This estimate is based on the following values: average hospitalization cost per child ($466 if public or no insurance [9]), prevalence of maternal depression in low-income populations (lowest estimate: 27% [10]), odds ratio (OR) of hospitalization for children of depressed mothers (1.8 [2]), and number of children (5.3 million under 6 years old living in poverty [11]).

References

  1. Chung, E. K., McCollum, K. F., Elo, I. T., Lee, H. J., & Culhane, J. F. (2004). Maternal depressive symptoms and infant health practices among low-income women. Pediatrics, 113(6), e523–e529.

    Article  PubMed  Google Scholar 

  2. Guttmann, A., Dick, P., & To, T. (2004). Infant hospitalization and maternal depression, poverty and single parenthood—a population-based study. Child: Care, Health and Development, 30(1), 67–75.

    Article  CAS  Google Scholar 

  3. Sills, M. R., Shetterly, S., Xu, S., Magid, D., & Kempe, A. (2007). Association between parental depression and children’s health care use. Pediatrics, 119(4), e829–e836.

    Article  PubMed  Google Scholar 

  4. Weil, C. M., Wade, S. L., Bauman, L. J., Lynn, H., Mitchell, H., & Lavigne, J. (1999). The relationship between psychosocial factors and asthma morbidity in inner-city children with asthma. Pediatrics, 104(6), 1274–1280.

    Article  PubMed  CAS  Google Scholar 

  5. Kahn, R. S., Zuckerman, B., Bauchner, H., Homer, C. J., & Wise, P. H. (2002). Women’s health after pregnancy and child outcomes at age 3 years: A prospective cohort study. American Journal of Public Health, 92(8), 1312–1318.

    Article  PubMed  Google Scholar 

  6. Minkovitz, C. S., Strobino, D., Scharfstein, D., Hou, W., Miller, T., Mistry, K. B., et al. (2005). Maternal depressive symptoms and children’s receipt of health care in the first 3 years of life. Pediatrics, 115(2), 306–314.

    Article  PubMed  Google Scholar 

  7. Flores, G., Abreu, M., Chaisson, C. E., & Sun, D. (2003). Keeping children out of hospitals: Parents’ and physicians’ perspectives on how pediatric hospitalizations for ambulatory care-sensitive conditions can be avoided. Pediatrics, 112(5), 1021–1030.

    Article  PubMed  Google Scholar 

  8. Hakim, R. B., & Bye, B. V. (2001). Effectiveness of compliance with pediatric preventive care guidelines among medicaid beneficiaries. Pediatrics, 108(1), 90–97.

    Article  PubMed  CAS  Google Scholar 

  9. Todd, J., Armon, C., Griggs, A., Poole, S., & Berman, S. (2006). Increased rates of morbidity, mortality, and charges for hospitalized children with public or no health insurance as compared with children with private insurance in Colorado and the United States. Pediatrics, 118(2), 577–585.

    Article  PubMed  Google Scholar 

  10. Chaudron, L. H., Szilagyi, P. G., Kitzman, H. J., Wadkins, H. I. M., & Conwell, Y. (2004). Detection of postpartum depressive symptoms by screening at well-child visits. Pediatrics, 113(3 Pt 1), 551–558.

    Article  PubMed  Google Scholar 

  11. DeNavas-Walt, C., Proctor, B. D., & Smith, J. C. (2009). U.S. census bureau, current population reports, P60–236, income, poverty, and health insurance coverage in the United States: 2008. Washington, DC: U.S. Government Printing Office.

    Google Scholar 

  12. Mandl, K. D., Tronick, E. Z., Brennan, T. A., Alpert, H. R., & Homer, C. J. (1999). Infant health care use and maternal depression. Archives of Pediatrics and Adolescent Medicine, 153(8), 808–813.

    PubMed  CAS  Google Scholar 

  13. Phelan, K., Khoury, J., Atherton, H., & Kahn, R. S. (2007). Maternal depression, child behavior, and injury. Injury Prevention, 13(6), 403–408.

    Article  PubMed  CAS  Google Scholar 

  14. Poehlmann, J., Schwichtenberg, A. J., Bolt, D., & Dilworth-Bart, J. (2009). Predictors of depressive symptom trajectories in mothers of preterm or low birth weight infants. Journal of Family Psychology, 23(5), 690–704.

    Article  PubMed  Google Scholar 

  15. Guttmann, A., Dick, P., & To, T. (2004). Infant hospitalization and maternal depression, poverty and single parenthood—a population-based study. Child: Care, Health and Development, 30(1), 67–75.

    Article  CAS  Google Scholar 

  16. Bartlett, S. J., Kolodner, K., Butz, A. M., Eggleston, P., Malveaux, F. J., & Rand, C. S. (2001). Maternal depressive symptoms and emergency department use among inner-city children with asthma. Archives of Pediatrics and Adolescent Medicine, 155(3), 347–353.

    PubMed  CAS  Google Scholar 

  17. Logan, J. E., Riley, A. W., & Barker, L. E. (2008). Parental mental and pain-related health and pediatric ambulatory care sensitive emergency department visits and hospitalizations. Health Services Research, 43(2), 656–674.

    Article  PubMed  Google Scholar 

  18. Janicke, D. M., & Finney, J. W. (2003). Children’s primary health care services: Social-cognitive factors related to utilization. Journal of Pediatric Psychology, 28(8), 547–557.

    Article  PubMed  Google Scholar 

  19. Bandura, A. (1997). Self-efficacy: The exercise of control. New York: W.H. Freeman and Company.

    Google Scholar 

  20. Maddux, J. E., & Meier, L. J. (1995). Self-Efficacy and depression. In J. E. Maddux (Ed.), Self-Efficacy, adaptation, and adjustment: Theory, research, and application (pp. 143–169). New York: Plenum Press.

    Google Scholar 

  21. Howell, E., Mora, P., Dibonaventura, M., & Leventhal, H. (2009). Modifiable factors associated with changes in postpartum depressive symptoms. Archives of Women’s Mental Health, 12(2), 113.

    Article  PubMed  Google Scholar 

  22. Teti, D. M., & Gelfand, D. M. (1991). Behavioral competence among mothers of infants in the first year: The mediational role of maternal self-efficacy. Child Development, 62(5), 918–929.

    Article  PubMed  CAS  Google Scholar 

  23. Butterworth, P., Rodgers, B., & Windsor, T. D. (2009). Financial hardship, socio-economic position and depression: Results from the PATH through life survey. Social Science and Medicine, 69(2), 229–237.

    Article  PubMed  Google Scholar 

  24. Bjelland, I., Krokstad, S., Mykletun, A., Dahl, A. A., Tell, G. S., & Tambs, K. (2008). Does a higher educational level protect against anxiety and depression? The HUNT study. Social Science and Medicine, 66(6), 1334–1345.

    Article  PubMed  Google Scholar 

  25. Matheson, F. I., Moineddin, R., Dunn, J. R., Creatore, M. I., Gozdyra, P., & Glazier, R. H. (2006). Urban neighborhoods, chronic stress, gender and depression. Social Science and Medicine, 63(10), 2604–2616.

    Article  PubMed  Google Scholar 

  26. Chaudron, L. H., Kitzman, H. J., Szilagyi, P. G., Sidora-Arcoleo, K., & Anson, E. (2006). Changes in maternal depressive symptoms across the postpartum year at well child care visits. Ambulatory Pediatrics, 6(4), 221–224.

    Article  PubMed  Google Scholar 

  27. Reis, J. (1989). The structure of depression in community based young adolescent, older adolescent and adult mothers. Family Relations, 38(2), 164–168.

    Article  Google Scholar 

  28. Schempf, A. H., Minkovitz, C. S., Strobino, D. M., & Guyer, B. (2007). Parental satisfaction with early pediatric care and immunization of young children—The mediating role of age-appropriate well-child care utilization. Archives of Pediatrics and Adolescent Medicine, 161(1), 50–56.

    Article  PubMed  Google Scholar 

  29. Schuster, M. A., Wood, D. L., Duan, N. H., Mazel, R. M., Sherbourne, C. D., & Halfon, N. (1998). Utilization of well-child care services for African-American infants in a low-income community: Results of a randomized, controlled case management home visitation intervention. Pediatrics, 101(6), 999–1005.

    Article  PubMed  CAS  Google Scholar 

  30. Grus, C. L., Lopez-Hernandez, C., Delamater, A., Appelgate, B., Brito, A., Wurm, G., et al. (2001). Parental self-efficacy and morbidity in pediatric asthma. Journal of Asthma, 38(1), 99–106.

    Article  PubMed  CAS  Google Scholar 

  31. Silver, E. J., Heneghan, A. M., Bauman, L. J., & Stein, R. E. (2006). The relationship of depressive symptoms to parenting competence and social support in inner-city mothers of young children. Maternal and Child Health Journal, 10(1), 105–112.

    Article  PubMed  Google Scholar 

  32. Newman, R. D., Grupp-Phelan, J., Shay, D. K., & Davis, R. L. (1999). Perinatal risk factors for infant hospitalization with viral gastroenteritis. Pediatrics, 103(1), e3.

    Article  PubMed  CAS  Google Scholar 

  33. Dennehy, P. H., Cortese, M. M., Begue, R. E., Jaeger, J. L., Roberts, N. E., Zhang, R., et al. (2006). A case-control study to determine risk factors for hospitalization for rotavirus gastroenteritis in U.S. children. Pediatric Infectious Disease Journal, 25(12), 1123–1131.

    Article  PubMed  Google Scholar 

  34. Escobar, G. J., Greene, J. D., Hulac, P., Kincannon, E., Bischoff, K., Gardner, M. N., et al. (2005). Rehospitalization after birth hospitalisation: patterns among infants of all gestations. Archives of Disease in Childhood, 90(2), 125–131.

    Article  PubMed  CAS  Google Scholar 

  35. Flynn, H. A., Davis, M., Marcus, S. M., Cunningham, R., & Blow, F. C. (2004). Rates of maternal depression in pediatric emergency department and relationship to child service utilization. General Hospital Psychiatry, 26(4), 316–322.

    Article  PubMed  Google Scholar 

  36. Sadler, L. S., & Clemmens, D. A. (2004). Ambivalent grandmothers raising teen daughters and their babies. Journal of Family Nursing, 10(2), 211–231.

    Article  Google Scholar 

  37. Kitzman, H., Olds, D. L., Henderson, C. R., Jr., Hanks, C., Cole, R., Tatelbaum, R., et al. (1997). Effect of prenatal and infancy home visitation by nurses on pregnancy outcomes, childhood injuries, and repeated childbearing. A randomized controlled trial. JAMA, 278(8), 644–652.

    Article  PubMed  CAS  Google Scholar 

  38. Black, M. M., Papas, M. A., Hussey, J. M., Hunter, W., Dubowitz, H., Kotch, J. B., et al. (2002). Behavior and development of preschool children born to adolescent mothers: Risk and 3-generation households. Pediatrics, 109(4), 573–580.

    Article  PubMed  Google Scholar 

  39. Bennefield, R., & Bonnette, R. (2003). Structural and occupancy characteristics of housing: 2000. Retrieved from http://www.census.gov/prod/2003pubs/c2kbr-32.pdf.

  40. Friedman, B., Heisel, M., & Delavan, R. (2005). Validity of the SF-36 five-item mental health index for major depression in functionally impaired, community-dwelling elderly patients. Journal of the American Geriatrics Society, 53(11), 1978–1985.

    Article  PubMed  Google Scholar 

  41. Ostroff, J. S., Woolverton, K. S., Berry, C., & Lesko, L. M. (1996). Use of the mental health inventory with adolescents: A secondary analysis of the rand health insurance study. Psychological Assessment, 8(1), 105–107.

    Article  Google Scholar 

  42. Rumpf, H. J., Meyer, C., Hapke, U., & John, U. (2001). Screening for mental health: Validity of the MHI-5 using DSM-IV axis I psychiatric disorders as gold standard. Psychiatry Research, 105(3), 243–253.

    Article  PubMed  CAS  Google Scholar 

  43. Evans, G. W., Ricciuti, H. N., Hope, S., Schoon, I., Bradley, R. H., Corwyn, R. F., et al. (2010). Crowding and Cognitive Development: The mediating role of maternal responsiveness among 36-month-old children. Environment and Behavior, 42(1), 135–148.

    Article  Google Scholar 

  44. Anderson, L. N., Campbell, M. K., daSilva, O., Freeman, T., & Xie, B. (2008). Effect of maternal depression and anxiety on use of health services for infants. Canadian Family Physician, 54(12), 1718–17195.

    PubMed  Google Scholar 

  45. Perrin, J. M., Kuhlthau, K. A., Gortmaker, S. L., Beal, A. C., & Ferris, T. G. (2002). Generalist and subspecialist care of children with chronic conditions. Ambulatory Pediatrics, 2(6), 462–469.

    Article  PubMed  Google Scholar 

  46. Royston, P. (2005). Multiple imputation of missing values: Update of ice. The State Journal, 5(4), 527–536.

    Google Scholar 

  47. Barnes, C. R., & Adamson-Macedo, E. N. (2007). Perceived maternal parenting self-efficacy (PMP S-E) tool: Development and validation with mothers of hospitalized preterm neonates. Journal of Advanced Nursing, 60(5), 550–560.

    Article  PubMed  Google Scholar 

  48. Maddux, J. E., & Lewis, J. (1995). Self-Efficacy and adjustment. In J. E. Maddux (Ed.), Self-efficacy, adaptation, and adjustment: Theory, research, and application (pp. 37–68). New York: Plenum Press.

    Google Scholar 

  49. Gross, D., Garvey, C., Julion, W., Fogg, L., Tucker, S., & Mokros, H. (2009). Efficacy of the Chicago parent program with low-income African American and Latino parents of young children. Prevention Science, 10(1), 54–65.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA

    Margaret L. Holland & Peter G. Szilagyi

  2. School of Nursing, University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, Box SON, Rochester, NY, 14642, USA

    Margaret L. Holland & Harriet Kitzman

  3. Department of Community and Preventive Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA

    Byung-Kwang Yoo & Helena Temkin-Greener

  4. Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA

    Linda Chaudron

Authors
  1. Margaret L. Holland
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Byung-Kwang Yoo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Harriet Kitzman
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Linda Chaudron
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Peter G. Szilagyi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Helena Temkin-Greener
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Margaret L. Holland.

Additional information

M. L. Holland acknowledges support from an NRSA Institutional Research Training Grant (T32 HS000044-16) and a Health Services Research Dissertation Award (R36 HS017737), both from the Agency for Healthcare Research and Quality. The authors would like to thank Constance Baldwin, PhD for her assistance in critically revising this manuscript.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Holland, M.L., Yoo, BK., Kitzman, H. et al. Self-Efficacy as a Mediator Between Maternal Depression and Child Hospitalizations in Low-Income Urban Families. Matern Child Health J 15, 1011–1019 (2011). https://doi.org/10.1007/s10995-010-0662-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10995-010-0662-z

Keywords

Search

Navigation