seek less prenatal care or begin their care later in pregnancy than women without depression. Furthermore, depression symptoms, such as appetite or sleep disturbances, suggest that pregnant women with depression may get inadequate nutrition or sleep. All of these behaviors raise concern for fetal development. Among the empirical findings, depression during pregnancy has been associated with more smoking, greater consequences from alcohol use, and poorer overall health (Marcus et al., 2003; Zuckerman et al., 1989). Also, greater total sleep time during the third trimester predicted elevated depression symptoms postpartum (Wolfson et al., 2003). Among adolescent parents with depression, the poorer health behaviors are especially strong (Amaro and Zuckerman, 1991).

A much larger literature has shown depression, especially in mothers, to be associated with qualities of parenting of infants and toddlers. Researchers who observed mothers in face-to-face interaction with their babies or toddlers found higher levels of depressive symptoms to be associated with less maternal responsiveness or sensitivity, less verbal and visual interaction, and more intrusiveness (Campbell et al., 2004; Civic and Holt, 2000; Easterbrooks, Biesecker, and Lyons-Ruth, 2000; Ewell Foster, Garber, and Durlak, 2007; Horwitz et al., 2007; Marchand and Hock, 1998; Murray et al., 1996a; NICHD Early Child Care Research Network, 1999; Oztop and Uslu, 2007). Goodman and Brumley (1990), in a home observation study, found that depressed mothers were emotionally unavailable and withdrawn to the extent that they were less sensitive to their children’s behavior, relative to women with no depression. Palaez et al. (2008) found that mothers with elevated depressive symptoms were more likely to be classified as authoritarian or disengaged in their interactions with their toddlers in comparison to mothers with low levels of depressive symptoms. Although mostly limited to small samples and to studies of elevated depression symptom levels rather than diagnoses, and with typically moderate effect sizes, these findings provide consistent support for associations between depression in mothers and patterns of interaction with their infants or young children that are intrusive/harsh or withdrawn/disengaged or both. Each of these parenting styles presents significant risks to the development of infants and toddlers.

Parenting of infants is particularly of concern given its essential role in children’s development of secure attachment (Sroufe et al., 2005). Sensitive, responsive caregiving has been found to be the strongest predictor of secure attachment, which raises concerns given findings on depressed parents being less responsive and sensitive. Even beyond infancy, a sense of “felt security” has been found to be essential for healthy development and for preventing the development of psychopathology (Davies, Winter, and Cicchetti, 2006).

Other aspects of parenting of young children that have been found



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