The Impact of the Marital Relationship, Family Environment, and Child Behavior on Maternal Depression

Background: Mothers of children with autism report more stress and depression than mothers of typically developing children and children with other developmental disabilities (Griffith et al., 2010; Hamlyn-Wright et al., 2007). Previous studies have found that child behavior problems (Barker et al., 2011; Benson et al., 2011) and child symptom severity (Ingersoll et al., 2011) may contribute to these high maternal depression rates. Maternal distress can have detrimental effects on both maternal health and the effectiveness of child interventions (Gallagher et al., 2009; Osborne et al., 2008).

Objectives: Our primary aim was to examine demographic, child, and family/relational variables that may contribute to maternal depression maintenance after an autism diagnosis with the ultimate goal of identifying potential targets for intervention.

Methods: Participants included 75 mothers of children who received autism diagnoses an average of 1.4 years earlier as part of a research project at a midsized southern university. Fifty mothers who scored in the clinical depression range at baseline were included in these analyses. Mothers provided self-report information at one time point on current and post-diagnostic depression (Center for Epidemiological Studies – Depression scale; CES-D), demographic variables, dyadic adjustment (Dyadic Adjustment Scale; DAS), child behavior (Child Behavior Checklist; CBCL), and family interactions (Family Environment Scale; FES). 

Results: Mothers who reported depression at the time of diagnosis were split into two groups based on current depression status (still depressed vs. resolved). One-way ANOVAs revealed no differences between groups on demographic variables (race, maternal/paternal/child age, income, maternal/paternal education, parent marital status), child variables (age at diagnosis, ADOS severity, Vineland-II scales, IQ), number of interventions, and perceived intervention effectiveness.  Differences emerged for dyadic adjustment (F = 6.634, p = .01), internalizing behaviors (F = 7.34, p < .01), externalizing behaviors (F =7.87, p < .01), and three aspects of the family environment: intellectual/cultural orientation (F = 4.27, p < .05), cohesion (F = 7.50, p < .01), and conflict (F = 5.29, p < .05).

Conclusions: Mothers were more likely to report concerns regarding chronic or recurrent depression following ASD diagnosis in the context of lower family cohesion, poorer relationships with their spouses, fewer cultural enrichment opportunities, and higher family conflict. Both internalizing and externalizing child problem behaviors also related to ongoing depressed mood. Depression maintenance approximately one year after diagnosis was not related to demographic variables, child diagnostic characteristics, the number of supports put into place, or the perceived effectiveness of those supports. Further investigation of the factors that maintain depression after an autism diagnosis may provide more clearly defined targets for intervention that could benefit both mothers and their children.