ARTICLES
Mothers' Mental Illness and Child Behavior Problems: Cause-Effect Association or Observation Bias?

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ABSTRACT

Objective

A number of studies have consistently found that a mother's mental health (particularly her level of depression) is a strong predictor of mental health problems experienced by her child(ren). However, the validity of this finding is in doubt because the majority of these studies have relied on maternal reports as indicators of children's behavior.

Method

This prospective, longitudinal study examines data on the mental health of the mother from prior to the birth of her child to when the child reaches 14 years of age. Child behavior is measured at 14 years of age using reports from mother and child. Mother and child responses are compared to provide an indication of the possible magnitude of maternal observation bias in the reporting of child behavior problems.

Results

Anxious and/or depressed mothers tend to report more cases of child behavior problems than do their mentally healthy counterparts or children themselves. Differences between mothers and youths in reporting behavior problems appear to be related to the mothers' mental health.

Conclusions

Current maternal mental health impairment appears to have a substantial effect on the reporting of child behavior problems by the mother, thereby raising questions about the validity of reports of child behavior by persons who are currently emotionally distressed.

Section snippets

Measurement of Child Mental Health

A wide range of assessment tools are available to measure child mental health. These include fully structured interviews (for example, Schedule for Affective Disorders and Schizophrenia for School-Age Children [K-SADS], Interview Schedule for Children [ISC]) and semistructured interviews (for example, Diagnostic Interview Schedule for Children [DISC], Diagnostic Interview for Children and Adolescents [DICA]). In addition to assessment of child behavior through interviews, there are rating

METHOD

The data for this study were taken from the Mater-University Study of Pregnancy and its outcomes. Of 8,556 women who presented at a major public hospital for their antenatal care who were approached to participate in the study, 8,458 agreed. Of these, 7,421 mothers gave birth to a live, single baby at the study hospital. Excluded from the study were patients who were under the care of private obstetricians and patients who were transferred from other hospitals. Interviewing for this first phase

RESULTS

The following results are presented for 2 subscales identified by Achenbach (1991a) as Internalizing, which comprises withdrawn, anxious/depressed, and somatic problems, and Externalizing, which comprises delinquent and aggressive behavior. Scores for Total Problems, which include Internalizing and Externalizing and a number of additional items, are also provided. It must, however, be noted that the Maternal Report CBCL and the YSR subscales do not always contain the same items. For the 14-year

DISCUSSION

In the absence of a “gold standard,” a problem that characterizes all psychiatric diagnosis (whether of adults or youths), the determination of bias in the maternal CBCL reports derived from emotionally disturbed mothers is necessarily a matter of inference. Richters' (1992) review suggesting that there was insufficient evidence to support a case of maternal bias in the reporting of their child's behavior problems has since been questioned by the findings of Fergusson et al. (1993), Boyle and

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    The authors thank NHMRC, Queensland Health, and the Australian Institute of Criminology for funding this project.

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