Moderators and mediators of the relationship between parental depression and children’s internalizing and externalizing disorders: a systematic review

Abstract

Parental depression is one of the strongest, most consistent, well-replicated, and clinically important risk factors for the development of psychopathology in children. Parental depression is associated with poorer functioning in children across several domains. This paper aims to better understand the relationship between parental depression and youth’s internalizing and externalizing disorders by systematically evaluating possible mediators and moderators of this relationship. PubMed, Scopus, PsycInfo, and PsycArticles databases were systematically searched. Relevant articles were collected via title and abstract screening followed by full-text screening. A qualitative synthesis of the results was then conducted. A total of 6,056 potentially eligible studies were obtained after the electronic search. Of these, 66 studies were included in the qualitative synthesis. Most studies evaluated the impact of maternal depression on youth outcomes. Variables that emerged as moderators or mediators were grouped into categories, as follows (1) Biological factors (2) Social factors (3) Youth-related variables (4) Parental and familial psychopathology variables; (5) Parenting style and family-structure variables; and (6) Maltreatment and abuse variables. The major moderators were genetic predisposition, ethnicity, child’s gender, having a parent with a co-morbid psychiatric diagnosis, timing of parental depression, parenting style, and maltreatment/abuse. Important mediators included stressful life events, parenting stress index, family functioning, marital conflict, the parent-child relationship, childhood maltreatment and peer victimization. The findings of this review highlight mechanisms through which parental depression affects psychopathology among children, which offers avenues for targeted interventions that can improve children’s outcomes. Strengthening positive parenting practices, improving parent–child relationships and conflict resolution, and promoting social support and adaptive coping in both parents and youth may represent important targets for prevention and intervention. These strategies may be especially important for girls, who appear more vulnerable to the effects of parental depression.