title: The Influence of Children's Cognitive Delay and Behavior Problems on Maternal Depression.
abstract: OBJECTIVE
  To determine the impact of children's cognitive delay and behavior on maternal depressive symptoms using a large national cohort of US families.
  
  
  METHODS
  Data were drawn from 2 waves of the nationally representative Early Childhood Longitudinal Study, Birth Cohort (n = 7550). Cognitive delay was defined at age 24 months by the lowest 10th percentile of the Bayley Short Form-Research Edition. At age 4 years, the children's behavior was assessed using the Preschool and Kindergarten Behavior Scales, administered to mothers and primary nonparental child care providers, and maternal depressive symptoms with the Center for Epidemiological Studies Depression Scale. Weighted generalized estimating equation models examined whether the children's behavior mediated the relationship between their cognitive delay status at 24 months and 4-year maternal depressive outcomes.
  
  
  RESULTS
  At age 4 years, 26.9% of mothers of children with cognitive delay reported high depressive symptoms, compared with 17.4% of mothers of typically developing children (P < .0001). When the children's behavior was accounted for, the effect of cognitive delay on maternal depressive symptoms decreased by 36% (P < .0001). These findings remained significant when the children's behaviors were assessed by their primary nonparental care providers.
  
  
  CONCLUSIONS
  Caring for a child with a cognitive delay influences maternal depressive symptoms in part through the child's behavior problems. Preventive interventions to ameliorate adverse outcomes for children with cognitive delay and their families should consider the impact of the children's behavior.
authors.affiliation: Department of Pediatrics, Harvard Medical School, Boston, MA; Division of General Academic Pediatrics, MassGeneral Hospital for Children, Boston, MA. Electronic address: erikarcheng@gmail.com.
authors.forename: Erika R
authors.initials: ER
authors.lastname: Cheng
authors.affiliation: Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI; Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, WI.
authors.forename: Mari
authors.initials: M
authors.lastname: Palta
authors.affiliation: Department of Human Development and Family Studies, Waisman Center, University of Wisconsin, Madison, WI.
authors.forename: Julie
authors.initials: J
authors.lastname: Poehlmann-Tynan
authors.affiliation: Division of Maternal and Child Health Research, Truven Health Analytics, Durham, NC.
authors.forename: Whitney P
authors.initials: WP
authors.lastname: Witt
mesh_terms: D000293:Adolescent; D000328:Adult; D002653:Child Behavior Disorders / Q000523:psychology*; D002675:Child, Preschool; D003072:Cognition Disorders / Q000523:psychology*; D015331:Cohort Studies; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology*; D002658:Developmental Disabilities / Q000523:psychology*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D017533:Marital Status; D009035:Mothers / Q000523:psychology*; D012923:Social Class; D014481:United States / Q000453:epidemiology; D055815:Young Adult