Maternal Depression as a Mediator of Intervention in Reducing Early Child Problem Behavior Abstract Maternal depression has been consistently linked to the development of child problem behavior, particularly in early childhood, but few studies have examined whether reductions in maternal depression serve as a mediator in relation to changes associated with a family-based intervention. This study addressed this issue with a sample of 731 families receiving services from a national food supplement and nutrition program. Families with toddlers between ages 2 and 3 were screened and then randomized to a brief family intervention, the Family Check Up, which included linked interventions that were tailored and adapted to the families needs. Follow-up intervention was provided at age 3 and follow-up of child outcomes occurred at ages 3 and 4. Latent growth models revealed intervention effects for early externalizing and internalizing problems from 2 to 4, and reductions in maternal depression from ages 2 to 3. In addition, reductions in maternal depression mediated improvements in both child externalizing and internalizing problem behavior after accounting for the potential mediating effects of improvements in positive parenting. Introduction and Rationale Substantial evidence supports relation between maternal depression and negative child outcomes across childhood and adolescence, particularly during early childhood (Beardslee et al., 1998; Cummings & Davies, Despite recognition of maternal depression in early childhood in relation to child behavior and parenting (Belsky, 1984), most early intervention programs focus more explicitly on improving parenting skills (e.g., Eyberg, Webster-Stratton). As the toddler period is characterized by increases in parental stress because of a more active and mobile child, it is a target of opportunity for addressing maternal depression as a way to modify child problem behavior The current study examined whether a brief family-centered intervention designed had effects on maternal depression, and if so, whether reductions in maternal depression mediated improvements in externalizing and internalizing problems. We also examined whether the mediating effects of maternal depression were independent from mediating effects associated with changes in positive parenting. The Family Check-up Following 2.5-hour home assessment at age 2 (child’s age) Initial get-to-know-you visit with parent consultant at home (30-50 minutes) Feedback with family at home (1-1.5 hours) 78 % of families randomly assigned to treatment group had get-to-know-you visit and feedback session Eliciting goals Menu of options Varied in intensity and content With focus on goals that will promote child’s well being Average number of sessions 3.7 per family in multisite study Recruitment Process at WIC All families needed to have at least one risk factor present in 2 of 3 domains Sociodemographic Risk WIC status ensures low income but not educational attainment Child Risk Conduct problems (Eyberg; intensity & problem) Negative emotionality/Unresponsiveness (Bates) Conflict in parent-child relationship (Pianta) Parent/Family Risk Maternal psychopathology: depression (CES-D), drug/alcohol use Teen parent Parenting Hassles Early Steps Project: Design Random assignment to intervention and control groups Screen WIC Clinics in Pittsburgh (urban), Eugene, OR (suburban) and in and outside of Charlottesville, VA (rural) for toddlers age 2 – 2.9 yrs. on risk factors to ensure SES, family, and child risk Baseline assessment (T1) of observed parenting, maternal depression, and child problem behavior Family Check-Up Intervention for 2-6 months Follow-Up assessment of parenting, family environment and child problem behavior 1 and 2 years following T1 assessment Early Steps Project: Timeline Age 2.0 – 2.9 Sample = 731 boys and girls Recruitment Initial assessment Intervention group gets GTKY & Feedback sessions, and follow-up Age 3.0 – 3.9 Sample = 659 (90%) 1-year follow up assessment Intervention group gets GTKY & Feedback sessions, and follow-up Age 4.0 – 4.9 Sample = 620 (85%) 2-year follow up assessment Intervention group gets GTKY & Feedback sessions, and follow-up Measures Maternal Depression. Center for Epidemiological Studies on Depression Scale (Radloff, 1977). Administered at child ages 2 & 3. Child Problem Behavior. CBCL ages 1.5 to 5 version (Achenbach & Rescorla, 2000) using Internalizing and Externalizing factors and administered to mothers at child ages 2, 3, and 4. Positive Behavior Support. Based on 4 observed indicators, including Involvement scale of the HOME, observed duration proportions of positive behavior support and engagement using Relationship Process Code (Jabson et al., 2004), coder impressions of proactive parenting. One factor generated from 4 indicators. Results Effects of Family Check Up (FCU) on child problem behavior extended to 2-year intervention effects on child internalizing problems; Unlike Early Steps Pilot Study, FCU found to be associated with improvements on maternal depression between child ages 2 and 3; Reductions in child internalizing and externalizing problems were at least partially mediated by improvement in maternal depression; Maternal depression continued to be a significant mediation of intervention effects for child externalizing and internalizing problems when positive behavior support included as a dual mediator of intervention effects Mediation of Intervention on CBCL Internalizing From Ages 2 to 4 via Improvements in Maternal Depression from Ages 2 to 3 Mediation of Intervention on CBCL Internalizing from Ages 2 to 4 via Improvements in Maternal Depression and Positive Behavior Support from Ages 2 to 3 Summary and Conclusions Findings extend collateral effects of Family Check Up (FCU) to maternal depression and child internalizing problems; Interesting that FCU successful in modifying maternal depression even though only a minority of parents explicitly addressed this issue Could be attributed to changes made in parenting, but appear to mediate independent variance related to change in problem behavior; Changes in depression could be related to generic aspects of the establishment of the parent-parent consultant relationship, including trust, having a confidant to talk to, and access to an expert to discuss challenges of raising a toddler Novel finding that changes in maternal depression mediated effects of intervention on both externalizing and internalizing problem behavior Limitations Reporter bias as mothers reported on both their well being and child problem behavior Effect sizes modest between.18 to.23. Will effects on child behavior transfer to other settings and remain when children reach school-age? To be continued… Daniel S. Shaw, University of PittsburghThomas J. Dishion, University of Oregon Arin M. Connell, Case Western Reserve University Melvin N. Wilson, University of Virginia Frances Gardner, University of Oxford, UK