Behavioral Health Symptom Profiles Among Mothers of Toddlers and Risk of Probable Major Depressive Episode 2 Years Later: The Role of Social Support

Introduction: Maternal behavioral health symptoms in the perinatal and early childhood periods can contribute to a negative trajectory for women and their families. Social support resources are likely important determinants of mothers’ mental health. This study sought to evaluate the relationship between behavioral health symptom profiles among mothers in their children’s 3^rd year and risk of probable major depressive episode (MDE) two years later, and whether risk of future MDE varied by level of instrumental social support.

Methods: This was a longitudinal study of the Fragile Families and Child Wellbeing study, a national birth cohort (N=4205) of racially diverse and mostly unmarried mothers in the U.S. In a prior study, latent class analysis described symptom profiles based on mothers’ depressive, anxiety, alcohol dependence, and drug dependence symptoms. Multivariate logistic regression was used to evaluate the relationship between Year 3 symptom profiles and Year 5 MDE. Potential moderation of instrumental social support was estimated with an interaction term.

Results: Mothers without symptoms in their children’s 3^rd year had an 11.1% risk of MDE two years later. Among mothers with clinically significant symptoms, MDE risk was increased by an additional 28.6% for those in the “Severe depression and anxiety” profile, 22.8% for “Depression and substance use,” 20.5% for “Depression only,” and 6.0% for “Anxiety only”. Instrumental social support slightly decreased the risk for future MDE overall, but that risk did not differ by symptom profile. Maternal characteristics independently associated with greater future disorder risk included being single or cohabitating (as opposed to married), reporting a recent fetal loss, having 3 or more children, current functional limitations, probable postpartum depression and smoking during pregnancy.

Conclusion: Behavioral health symptom profiles among mothers with toddlers differentially predicted MDE risk two years later, suggesting the potential of identifying higher-risk profiles in tailoring surveillance and treatment. Effective screening, referral and disorder management are critical during the prenatal and postpartum periods. Experiencing a recent fetal loss, having 3 or more children, and reporting functional impairment due to poor health were all associated with increased risk for MDE. Health practice and policy aimed at supporting women as they manage these competing health needs should be a top priority.