the relation of depressive symptoms and marital quality to child ...

THE RELATION OF DEPRESSIVE SYMPTOMS
AND MARITAL QUALITY TO CHILD
ATTACHMENT: A GROWTH ANALYSIS
Andrea K. Wittenborn, Ph.D.
Virginia Tech University
Margaret K. Keiley, Ed.D.
Auburn University
Guy S. Diamond, Ph.D.
University of Pennsylvania
Douglas H. Sprenkle, Ph.D.
Purdue University
Judy Garber, Ph.D.
Vanderbilt University
Elizabeth McCauley, Ph.D.
University of Washington
Kelly Schloredt, Ph.D.
Vanderbilt University
Address correspondence to Andrea K. Wittenborn, Ph.D. at andreawittenborn@vt.edu. This
work was funded by a grant from the National Institute of Mental Health (Grant no. R01
MH57822; Judy Garber, Ph.D., Guy Diamond, Ph.D. and Elizabeth McCauley, Ph.D.,
Principal Investigators)

Abstract
We conducted a multiple-domain growth analysis
examining the relation of depressive symptoms and marital
quality of depressed and nondepressed mothers to
offspring’s perceived attachment. Results from the final
fitted model indicated that across 22 months of follow-up,
levels of marital quality and mother-child attachment for
families with women in treatment for depression were
significantly different from families with mothers not
suffering from depression. Future studies are needed to
examine if marital and family focused interventions in
addition to those aimed specifically at reducing depression
more directly affect the quality of their marital relationships
and mother-child attachment.

Literature Review
Depression is one of the most common psychiatric
disorders in adulthood
Depressive symptoms interfere with parenting
Links between maternal depression and adverse child
development
Increased risk of psychiatric disorders
Increased problems with peers, school, and familial
relationships
Increased self-criticism, low self-worth, and negative
cognitions

Literature Review
Depressed mothers experience difficulties related to
parenting
Increased sad and irritable affect
Engage in more intrusive and hostile interactions
Exhibit inconsistent parenting practices
Relation to parent-child relationships and children’s
attachment security
Marital conflict is often present in families where
parental psychopathology exists
Marital conflict repeatedly has been associated with
poor child attachment

Current Study
Examine how marital quality and maternal depression
are related to child’s perceived attachment to mother,
controlling for group membership, marital status, and
child’s age
Extends prior research by using:
Longitudinal data
Quasi-experimental design
Sophisticated growth modeling techniques
Examination of all constructs simultaneously

Procedures
Measures
Dyadic Adjustment Scale (DAS; Spanier, 1976)
Inventory of Parent and Peer Attachment (IPPA; Armsden &
Greenberg, 1987)
Beck Depression Inventory (BDI; Beck, Ward, Mendelson,
Mock, & Erbaugh, 1961)
Analysis
Multiple-domain growth modeling

Procedures
Parents received four months of treatment (cognitive
behavioral therapy and/or pharmacotherapy) for
depression
Mothers were used because of limited number of fathers
Multi-site study
University of Pennsylvania
Vanderbilt University
University of Washington

Procedures
Inclusion/Exclusion Criteria
Clinical group:
• Current Major Depressive Disorder (MDD)
• Scored ≥ 14 on the Hamilton Rating Scale for Depression (HRSD17;
Hamilton, 1967).
Nonclinical comparison group:
• No lifetime history of mood disorders, antidepressant use, psychotic
disorders, personality disorders, suicide attempt, adjustment disorders,
phobias, substance abuse/dependence, psychotherapy longer than
two months or eight sessions, or psychotropic medication use during the
child’s lifetime

Research Timeline
Months
0 2 4 10 16 22
Baseline End Tx Follow-ups

Demographic Characteristics at Baseline.
Treatment Group Comparison Group
Parents
N (%)
Children
N (%)
Parents
N (%)
Children
N (%)
Gender
Female 94 (100%) 55 (58.5%) 77 (100%) 43 (55.8%)
Male 0 (0%) 39 (41.5%) 0 (0%) 34 (44.2%)
Race
Caucasian 68 (72.3%) 62 (66%) 55 (71.4%) 54 (70.1%)
African American 22 (23.4) 22 (23.4%) 19 (24.7%) 18 (23.4%)
Asian 3 (3.2%) 1 (1.1%) 0 (0%) 0 (0%)
Biracial 0 (0%) 9 (9.6%) 0 (0%) 5 (6.5%)
Marital Status
Married 43 (45.7%)* 55 (71.4%)*
Single 19 (20.2%) 14 (18.2%)
Divorced 21 (22.3%)** 5 (6.5%)**
Separated 4 (4.3%) 1 (1.3%)
Widowed 7 (7.4%) 2 (2.6%)
Income
$0-19,999 24 (25.5%)** 5 (6.5%)**
$20-39,999 30 (31.9%)** 14 (18.2%)**
$40-59,999 11 (11.7%) 9 (11.7%)
$60-79,999 15 (15.9%) 12 (15.6%)
$80-99,999 6 (6.4%)** 18 (23.4%)**
$100,000+ 5 (5.3%)* 13 (16.9%)*
Age
Mean 40.27 11.66 42.46 12.08
Range 25-56 7.01-16.09 24-56 7.02-16.10
SD 7.04 2.44 6.58 2.13
SES
Mean 42.47** 47.65**
Range 17-66 14-66
SD 12.62 11.99
Note. T-tests and chi-square tests were conducted to examine differences between the treatment and comparison groups.
* p

Estimated growth parameters for the final fitted multiple-domain model (N = 171).
Growth Parameter and Effect of
the Predictor on the Parameter
Mean Level of True Initial Status:
Intercept
Effects of Group Membership
(mean=.55)
Effects of Marital Status
(mean=.57)
Effects of Child Age
(mean=11.79)
Estimated Average Rate of True
Change: Slope
Effects of Group Membership
(mean=.55)
Effects of Marital Status
(mean=.57)
Effects of Child Age
(mean=11.79)
Estimated Average Acceleration of
True Change: Quadratic
Logged Maternal
Depression (SE)
Marital Quality
(SE)
Child
Attachment (SE)
.29 (.30) 98.42* (10.50) 139.55* (6.36)
2.36* (.13) -22.96* (4.02) -7.93* (2.42)
-.02 (.13) 7.16~ (4.35) 2.19 (2.43)
.04~ (.02) .61 (.80) -2.74* (.50)
-.97* (.15) -5.91 (8.61) -.36 (.90)
- 7.53 (5.55) -
- 9.63 (6.40) -
- .08 (.46) -
.33* (.07) -2.31~ (1.26) -
Note. Fit statistics of final fitted model: χ 2 =130.67 (df=66, p

IPPA
120
100
80
60
Treatment
Comparison
40
20
0
0 4 16
Figure 2. Fitted attachment trajectory for a prototypical child in the treatment and comparison groups over 22 months,
controlling for all else in the model.
Note. The IPPA scores were summed, which means a score of 25 would mean almost never or never true, 26-50 would mean not
very often true, 51-75 would mean sometimes true, 76-100 would mean often true, and 101-125 would mean almost always or
always true on the original scale. Higher scores indicate greater attachment security.

DAS
120
100
80
60
Treatment
Comparison
40
20
0
0 4 10 16 22
Figure 3 Fitted marital quality trajectory for a prototypical mother in the treatment and comparison groups over 22 months,
controlling for all else in the model.
Note. DAS scores below 100 indicate relationship distress, while scores above 100 indicate nondistress.

Findings and Discussion
The levels of marital quality and depressive symptoms of
mothers who received treatment for depression were
consistently less optimal than the levels for nondepressed
mothers.
Treating mothers’ depressive symptoms did not improve their
marital quality and mother-child attachment security to the
level of mothers not suffering from depression.
Future studies are needed to examine if marital and family
focused treatment allow depressed mothers being treated
and their offspring to experience similar levels of marital
quality and mother-child attachment as nondepressed
mothers and their children.

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