Beginning in the preschool years, maternal depression is also associated with children’s and adolescents’ higher levels of internalizing and externalizing behavior problems (attention deficit disorders and disruptive behavior disorders, including violence) and substance abuse (Brennan et al., 2002; Fergusson, Lynskey, and Horwood, 1993; Forehand et al., 1988), anxiety (social phobia, separation anxiety, and other anxiety disorders), and dys-regulated aggression and more externalizing problems, although some researchers have found the latter to be specific to daughters (Biederman et al., 2001; Luoma et al., 2001; Orvaschel, Walsch-Allis, and Ye, 1988; Weissman et al., 1984; Zahn-Waxler et al., 1990). The studies from Radke-Yarrow’s lab were also seminal in showing that even 5-year-olds of depressed mothers showed more dysregulated aggression and heightened emotionality and had more externalizing problems (Zahn-Waxler et al., 1984, 1990).
Moderators include the sex of the child, clinical characteristics of the parent’s depression, and whether the depression is in the mother or the father. For example, maternal depression was associated with higher rates of internalizing problems (e.g., depression, anxiety) in 4-year-old boys and girls, but with externalizing problems (e.g., conduct disorder, attention deficit disorder) only in girls (Marchand and Hock, 1998). In middle childhood and adolescence, daughters of depressed mothers may be more likely than sons to show depression (Davies and Windle, 1997; Fergusson, Horwood, and Lynskey, 1995; Hops, 1996), although others have not found sex differences (Fowler, 2002).
In terms of clinical characteristics, mothers who reported high levels of depressive symptoms reported higher levels of behavior problems in their 5-year-old children, with even stronger associations when those symptoms were severe, chronic, and recent (Brennan et al., 2000). Generally, as expected, longer exposure is associated with worse outcomes for children (NICHD Early Child Care Research Network, 1999; Sohr-Preston and Scaramella, 2006; Trapolini, McMahon, and Ungerer, 2007). Surprisingly, conclusions regarding severity of depression are mixed; some have found that severity is a strong predictor of children’s emotional and behavior problems (Hammen and Brennan, 2003), and others have found only small associations (Radke-Yarrow and Klimes-Dougan, 2002).
A few of the studies of psychopathology as an outcome for children or adolescents have tested the bidirectional or transactional role—to what extent do problems in the children contribute to the depression in the parents? In two seminal studies on this topic, based on two distinct samples (Gross et al., 2008; Gross, Shaw, and Moilanen, 2008), most associations between maternal and paternal depression and children’s internalizing or conduct problems revealed that higher levels of both mothers’ and fathers’ depressive symptoms predicted later increases in children’s internalizing or conduct problems. At the same time, a few findings, specific to particular