Maternal criticism from mothers who are themselves depressed is a significant risk factor for major depressive disorder (MDD) in their children, new research shows.

Investigators found that the level of express criticism from mothers with MDD toward their children with MDD was predictive of which children would have the highest depressive symptoms during follow-up.

These results, the investigators note, “highlight the salience of maternal criticism, as its impact on children’s depression levels was maintained for 17 months.”

Dr Brandon Gibb

“I think there is more and more evidence that if moms get treatment for depression, then the kids’ own risk will be reduced. So what our research suggests is that we may also want to focus specifically on their communication styles in addition to just focusing on mom’s depression,” study investigator Brandon E. Gibb, PhD, professor and director, Mood Disorders Institute, Binghamton University, Binghamton, New York, told Medscape Medical News.

The findings were presented at the Anxiety and Depression Association of America (ADAA) 2021.

Toward Depression Prevention

Although a maternal history of MDD is one of the strongest risk factors for the development of depression, most individuals who have a positive family history do not develop depression themselves, the researchers note.

Elana Israel

Study coinvestigator Elana S. Israel, a doctoral candidate who presented the research, said the primary goal of the study was to determine risk factors that make children more likely to develop depression.

“The ultimate goal would be to use these data to guide interventions to prevent the onset of depression or the exacerbation of depression in the children,” Israel told Medscape Medical News.

The researchers explored whether maternal criticism moderates the impact of maternal depression on their children’s trajectories of depressive symptoms over a 2-year period.

The study included 251 mother-child dyads. Of the mothers, 129 had a history of MDD during the child’s life, and 122 had no history of depressive disorders.

Participating children were between the ages of 8 and 14 years at study entry; 51% were girls, and 81% were Whites.

The Structured Clinical Interview for the DSM-IV Axis I Disorders was used to assess the women’s lifetime history of psychopathology. In addition, the mothers were asked to talk for 5 minutes about their child. This speech sample was then coded by the researchers for examples of critical speech or expressed emotion-criticism.

“Specifically, we said: ‘We’d like you to speak for 5 minutes, telling us about your child and how the two of you get along together,’ ” Gibb said.

Examples of critical speech included, “I don’t like this about my child” or “we don’t get along” or “my kid is impossible to deal with, I hate it when he does this, we argue all the time,” Gibb noted. “Basically, these mothers are expressing that there is something fundamentally not right about the relationship they feel they have with their child,” he added.

Depressive symptoms in the offspring were assessed using the Children’s Depression Inventory at the initial assessment and then at 6-, 12-, 18-, and 24-month follow-up visits.

Results showed that maternal criticism was predictive of which children of mothers with a history of MDD would have the highest depressive symptoms during the follow-up.

Children of mothers with MDD who were critical showed significantly higher levels of depression at baseline than children of mothers with MDD who were not critical or than children of never-depressed mothers.

Moreover, levels of maternal criticism continued to be predictive of higher levels of depressive symptoms up to 17 months after the initial assessment.

“That is a very long time in a child’s life, and we hope that our findings help provide evidence for ways to target the right interventions to help these families,” Gibb said.

For example, it may be possible to help mothers learn better ways of communicating with their child or learn more effective parenting skills, he noted.

Unstudied Form of Child Abuse

Commenting on the findings for Medscape Medical News, Charles B. Nemeroff, MD, PhD, Matthew P. Nemeroff Professor and chair, Department of Psychiatry and Behavioral Sciences, Dell Medical School, the University of Texas at Austin, said the poster is of particular interest “because it focuses on a relatively unstudied form of child abuse, which is verbal abuse or maternal criticism, on risk for major depression.”

Dr Charles Nemeroff

The study was well powered and confirms the well-documented finding that offspring of mothers with MDD are more likely to develop depression, noted Nemeroff, who is also president-elect of the ADAA.

The investigators “further advanced the field by demonstrating an increase of depressive symptoms in offspring with mothers who have a history of major depressive disorder who also expressed criticism,” he said.

“It was also interesting to see that criticism did not increase depressive symptoms in children of mothers who were never depressed. Maternal criticism if expressed could signal a need for early intervention to help both the mother and her child,” Nemeroff added.

The study was funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development. Israel, Gibb, and Nemeroff have reported no relevant financial relationships.

Anxiety and Depression Association of America (ADAA) 2021: Abstract S1-115. Presented March 18, 2021.

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