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Robert C. Whitaker, MD, MPH; Sean M. Orzol, MPH; Robert S. Kahn, MD, MPH

Arch Gen Psychiatry. 2006;63:551-560.

Context  Mental health disorders, substance use, and domestic violence often occur together. However, studies examining the impact of these conditions in mothers on the well-being of their children have focused only on isolated conditions.

Objective  To examine the cumulative effect of maternal mental health disorders, substance use, and domestic violence on the risk of behavior problems in young children.

Design  A birth cohort (1998-2000) followed up to age 3 years.

Setting  Eighteen large US cities.

Participants  At 3 years, 2756 (65%) were followed up from the population-based birth cohort of 4242. Thirty-six percent had annual incomes below the poverty threshold.

Main Outcome Measures  One year after delivery, mothers were asked questions about conditions in 3 categories: (1) mental health (major depressive episode and generalized anxiety disorder), (2) substance use (smoking, binge drinking, and illicit drug use), and (3) domestic violence (emotional and physical). At 3 years, mothers completed questions from the Child Behavior Checklist.

Results  Fifty percent of mothers had a condition in at least 1 of the 3 categories. The prevalence of child behavior problems increased with the number of categories (0, 1, 2, or 3) in which the mother reported a condition: respectively, 7%, 12%, 17%, and 19% for aggression (P<.001); 9%, 14%, 16%, and 27% for anxious/depressed (P<.001); and 7%, 12%, 15%, and 19% for inattention/hyperactivity (P<.001). This graded risk persisted after adjustment for sociodemographic and prenatal factors and for paternal mental health and substance use.

Conclusions  The risk of child behavior problems increased with the number of areas—mental health, substance use, or domestic violence—in which the mother reported difficulties. Preventing behavior problems in young children requires family-oriented strategies that address the needs of both parents and their children.

Author Affiliations: Mathematica Policy Research, Inc, Princeton, NJ (Dr Whitaker and Mr Orzol) and Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, (Dr Kahn) and Department of Pediatrics, University of Cincinnati College of Medicine (Dr Kahn), Cincinnati, Ohio.

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