J. Child Psychol. Psychiat. Vol. 42, No. 5, pp. 623–636, 2001
Cambridge University Press
' 2001 Association for Child Psychology and Psychiatry
Printed in Great Britain. All rights reserved
0021–9630\01 $15n00j0n00
Effects of Maternal Depression on Cognitive Development of Children
Over the First 7 Years of Life
Sophie Kurstjens
Institut fu$ r Pa$ dagogische Psychologie und Empirische Pa$ dagogik, LMU Mu$ nchen, Germany
Dieter Wolke
University of Hertfordshire, Hatfield, U.K.
The effects of postnatal depression on cognitive test scores at 20 months and 4 ; 8 years of age
as well as the timing (onset in the early postnatal period versus later), severity, number of
episodes, duration of longest phase, recency, and chronicity of material depression on
children’s cognitive scores at 6 ; 3 years was investigated. In South Bavaria, Germany, 1329
mothers of singletons were screened when the children were 6 ; 3 years of age for the presence
of depressive symptoms since the birth of their infant. A standard interview (SADS-L) was
used to ascertain DSM-IV diagnosis and details of depressive episodes. Ninety-two mothers
were diagnosed as having suffered DSM-IV defined depression (7 %). Seven hundred and
twenty-one mothers had no depressive episodes or symptoms from their children’s birth until
6 ; 3 years and were used as control group. The children had been assessed with the Griffiths
Scales of Babies’ Abilities (20 months), the Columbia Mental Maturity Scales (CMM) at 4 ; 8
years, and the Kaufman Assessment Battery for Children (K-ABC) at 6 ; 3 years. No
significant main effects of severity, timing of onset, duration, or chronicity of depression of
the child’s cognitive development were found. Significant interactions of gender with
chronicity of maternal depression (i.e. early-onset major and repeated episodes) were
detected. Low SES boys or boys born at neonatal risk of mothers with chronic depression
had lower Achievement Scores in the K-ABC at 6 ; 3 years than children of mothers with less
severe depression or controls. It is concluded that maternal depression per se has negligible
effects on children’s cognitive development. Long-term effects may be found when maternal
depression is chronic, the child is a boy and neonatal risk-born, or the family suffers other
social risks.
Keywords : Postnatal depression, maternal depression, cognitive development, chronicity.
Abbreviations : AS : Achievement Scales ; BLS : Bavarian Longitudinal Study ; CMM :
Columbia Mental Maturity Scale ; DQ : developmental quotient ; GCI : General Cognitive
Index ; K-ABC : Kaufman Assessment Battery for Children ; MPC : Mental Processing
Composite ; RDCS : Research Diagnostic Criteria Symptomlist ; SADS : Schedule for
Affective Disorders and Schizophrenia ; SES : socioeconomic status.
been hypothesised that the sadness, irritability, and social
withdrawal that characterise depressed women compromise their ability to provide a responsive, sensitive, and
nurturing environment for their infants and children
(Cohn & Campbell, 1992 ; Field, 1992 ; Murray,
Kempton, Woolgar, & Hooper, 1993 ; Tronick, 1989).
Theoretically, then, one of the major mechanisms
through which maternal depression could influence infant
and child cognitive development is parenting behaviour
(Cummings & Davies, 1994). For example, the symptoms
of depression and the associated negative self-cognitions
(Teti & Gelfand, 1997) lead to less ability to support the
infant in regulating affect, less positive and synchronized
affect expression, and lower levels of maternal stimulation
and responsiveness (DeMulder & Radke-Yarrow, 1991 ;
Field, 1992 ; Murray, Fiori-Cowley, Hooper, & Cooper,
1996 ; Murray, Stanley, Hooper, King, & Fiori-Cowley,
1996 ; Stein et al., 1991). The infant is deprived of the
experience of expanding his or her states of consciousness
and intersubjectivity with the mother (Tronick & Field,
1987 ; Winnicott, 1960). This deprivation limits the
Introduction
Maternal depression, whether postpartum or later in
the life of the child, has been considered as a risk factor
for children’s development (Murray & Cooper, 1996 ;
Puckering, 1989 ; Rutter, 1990). Different pathways have
been suggested for the way in which an emotional
disorder of the mother with primarily social disabilities
might exert adverse effects on children’s cognitive development (Cummings & Davies, 1994 ; Hay, 1997 ;
Rutter, 1990, 1997). Central to most of the proposals are
that maternal depression, particularly in the postpartum
period, has a deleterious effect on mother-infant interaction insofar as the symptoms of depression interfere
with the mothering role (Murray, 1992 ; Radke-Yarrow,
Cummings, Kuczynski, & Chapman, 1985). It has thus
Requests for reprints to : Professor Dieter Wolke, University of
Hertfordshire, Department of Psychology, DWRU, College
Lane, Hatfield, Herts AL10 9AB, U.K.
(E-mail : D.F.H.Wolke!herts.ac.uk).
623
624
S. KURSTJENS and D. WOLKE
infant’s experience and forces the infant into self-regulatory patterns that eventually compromise the child’s
development (Tronick & Weinberg, 1997). Provision and
lack of contingency experiences and less emotional and
attention regulation has been speculated to be one route
to poorer learning experience and cognitive development
in infants of depressive mothers (Hay, 1997 ; Kaplan,
Bachorowski, Hoff, & Zarlengo-Strouse, in press). Others
suggest that it may be the lack of a variety of activities
and opportunities for play and conversation (Rutter,
1990). The mother is considered as the major framework
for these early learning experiences. Although the interactions of the infant are mutual they are not symmetrically regulated (Murray & Cooper, 1997). Moreover, maternal depression is often accompanied by social
adversities and conflictual environments, which could
discourage learning (e.g. marital conflict, lack of social
support) (Sameroff, Seifer, Baldwin, & Baldwin, 1993).
Although these suggestions are plausible, there is still a
paucity of longitudinal studies of whether maternal
depression impacts on cognitive development and how
persistent these effects are in the offspring. As far as we
are aware there is only one study that assessed the
cognitive development of children of depressed mothers
repeatedly during the first 5 years of life. Murray and
colleagues (Murray, 1992 ; Murray & Cooper, 1996 ;
Murray, Fiori-Cowley, et al., 1996 ; Murray, Hipwell,
Hooper, Stein, & Cooper, 1996 ; Murray et al., 1993),
in their Cambridge Longitudinal Study, assessed the cognitive development of the children of depressed and
control mothers at 9 months, 18 months, and 5 years of
age. At 9 months children of postnatally depressed
mothers showed significantly reduced performance on
Piaget’s Object Permanence task. Children of mothers
who experienced a major episode were more likely to fail
than children whose mothers suffered from a minor
episode (Murray, 1992). At 18 months there was a
significant overall effect of maternal group on Object
Concept tasks, but not on the Bayley Scales of Infant
Mental Development, a general measure of infant cognitive development. However, there was a significant
interaction between maternal depression and infant
gender, with boys of depressed mothers performing
poorly (Murray et al., 1993). Similarly, there was no
overall effect of maternal group on the Reynell Scales, a
test of expressive language and comprehension, but again
there was a significant interaction between maternal
group and infant gender as well as maternal group and
social class. Boys of depressed mothers and infants of
depressed mothers of lower social class performed poorly
compared to the others (Murray, 1992). Finally, assessment of cognitive functioning at 5 years of age using the
McCarthy Scales of Children Abilities (Murray, Hipwell,
et al., 1996) showed no association with maternal
depression. Neither of the five subscales nor the General
Cognitive Index (GCI) showed an overall effect of
maternal depression. Furthermore there was no interaction between maternal group and timing of depression
(postnatal depression vs. maternal depression at any
other time in the child’s lifetime), duration of depressive
episode, sex of infant, or socioeconomic status of family.
Cogill, Caplan, Alexandra, Robson, and Kumar (1986)
identified maternal depression through repeated interviews in pregnancy and throughout the year following the
birth of the child. Cognitive development of the children
was assessed at 4 years of age compared to a control
group. Cogill et al. reported a significant main effect of
maternal depression on overall GCI score and significant
decrements for children of depressed mothers on the
perceptual, memory, and motor subscales. The adverse
effects were only found for children whose mothers
became depressed in the first year postpartum. There
were no significant interactions between maternal group
and sex of child or maternal education. A second, more
detailed analysis of these data revealed that maternal
education also showed a significant main effect on child’s
cognitive development and the difference between the
children of depressed and nondepressed mothers was
only reliable when mothers were postnatally depressed
and had low educational level (Hay & Kumar, 1995).
Sharp et al. (1995) considered mothers to have postnatal depression if the mothers reported depression in the
first year of life (point prevalence) or retrospectively with
the Schedule for Affective Disorders and Schizophrenia
(SADS-L) when the child was 4 years old. They considered the retrospective SADS-L as accurate (p. 1322)
because the point prevalence interviews at 3 and 12
months may have missed episodes of illness between 3
and 12 months. Controls were children of mothers who
had reported no depressive episodes in the first year and
at the 4-year retrospective SADS-L interview. They found
an overall significant effect of depression on the
McCarthy Scales at 4 years of age, which was explained
by an interaction of gender and maternal mental illness.
Boys whose mothers were depressed in the first year
postpartum had lower scores than boys in the control
group or girls in either the depressive or the control
group. This interaction effect was found independent of
whether the mother was only postpartum depressed or
had repeated episodes of depression. It reduced somewhat
but was generally robust when other additional factors
like socioeconomic status of the family, maternal education, child behavior during the test, parental IQ, social
and intellectual situation at home (HOME-Inventory), or
mother-infant interaction were considered individually.
Social factors and intellectual stimulation at home as well
as harmony of mother-infant interaction also predicted
boys’ IQ scores on the McCarthy Scales. Further analysis
by Hay (1997, p. 95–96) indicated, however, that the
effect on cognitive scores was only discerned in boys who
came from families considered as working class.
Cross-sectional studies also reported about the cognitive development of children of depressed mothers.
Whiffen and Gotlib (1989) assessed 2-month-old infants
of postnatally depressed and control mothers with the
Bayley Scales of Infant Development. The infants of the
depressed women performed significantly less well on the
cognitive tasks than did the infants of the nondepressed
women. Weissman et al. (1986), in their Yale Family
Study of Major Depression, examined children between
the ages of 6 and 23 years, whose parents (either one or
both) had a history of a treated major depression. There
were no significant differences between the IQs of the
children of depressed and normal parents. Furthermore,
Stevenson and Fredman (1990) reported that maternal
depression and anxiety was a significant predictor of
reading problems in preadolescent twins.
The findings so far are inconsistent across different
studies or over time within the same sample (e.g., Murray,
Fiori-Cowley, et al., 1996 ; Murray, Hipwell, et al., 1996).
These can partly be accounted for by differences between
studies and methodological limitations. The sample sizes
of the existing studies lie between only 20 (Cogill et al.,
1986 ; Whiffen & Gotlib, 1989) and 60 depressed mothers
MATERNAL DEPRESSION AND CHILD COGNITIVE DEVELOPMENT
(Murray, Hipwell, et al., 1996 ; Sharp et al., 1995 ;
Weissman et al., 1986). When subsamples such as boys
with mothers with only postpartum depression were
considered in analyses (e.g. N l 13 in the Sharp et al.
sample), the cell sizes became very small. Comparisons
in small subsamples are susceptable to outliers. For
example, of the 135 children studied by Sharp et al., 8 had
IQ scores
70 ; 7 of these were children of depressed
mothers and 5 of the 7 were boys. The interaction effect
with sex may be related to these ‘‘ outliers ’’. Other samples
were socially homogeneous. The Murray et al. longitudinal study and the Cogill et al. study included only a
few subjects of lower socioeconomic background whereas
the Sharp et al. participants were nearly all of lower
socioeconomic background. Testing of the effects of SES
and the interactions of SES with depression status was
thus limited. Most significantly, Murray et al. report
repeated longitudinal observations. However, cognitive
assessments into middle childhood are necessary to
conclude that there are lasting and stable effects of
maternal depression on cognitive development (McCall,
Appelbaum, & Hogarty, 1973 ; Rutter, 1997 ; Moffitt,
Caspi, Harkness, & Silva, 1993).
Nevertheless, the following risk factors are promising
but require further replication in longitudinal research.
First, timing of depression may be crucial (Hay, 1997 ;
Rutter, 1997). Both Sharp et al. (1995) and Cogill et al.
(1986) found cognitive decrements only for children
whose mothers were postnatally depressed. Murray
(1992) reported the same for infants’ cognitive development until 18 months of age, however, reassessment at
5 years of age could not find any association with timing
of maternal depression.
Second, children of depressed mothers who belong to
the lower social class may be at greater risk than children
of depressed mothers of middle or high social class.
However, findings regarding this issue vary considerably :
some found main effects of socioeconomic status on
cognitive development (Murray, 1992 ; Sharp et al., 1995),
others interactions with maternal group (Murray, 1992 ;
Cogill et al., 1986), and others again found no association
with social class (Whiffen & Gotlib, 1989).
Third, the differential effects of maternal depression
according to infant gender have led to much attention.
Sharp et al. (1995) found effects of maternal depression
only for boys although Murray et al. (1993) did not find
a significant interaction between maternal group and sex
of child at 9 months or 18 months of age on Object
Concept Task. However, performance on Bayley Scales
(Murray et al., 1993) as well as on the Reynell Scales at 18
months of age (Murray, 1992) did show significant
interactions between maternal group and sex of child
with boys of depressed mothers scoring lower than girls.
Finally, the same children reassessed at 5 years failed to
show any association between maternal depression and
sex of child (Murray, Hipwell, et al., 1996). Cogill et al.
(1986) and the reanalysis of Hay and Kumar (1995)
reported no interaction effects with infant gender.
Finally, Cogill et al. (1986 ; Hay, 1997 ; Hay & Kumar,
1995) suggested that infant risk factors such as low
birthweight may potentiate the effect of postpartum
depression on cognitive development. However, this
finding is based on only six low birthweight infants in an
already small sample (Hay, 1997).
The heterogeneity of depressive illness and differential
effects on cognitive development have not been considered consistently within one or across studies
625
(Cummings & Davies, 1994 ; Rutter, 1990). Such features
are the timing of depression (Murray, Fiori-Cowley, et
al., 1996 ; Murray, Hipwell, et al., 1996 ; Sharp et al., 1995)
and the severity (Murray, 1992), duration, and number of
depressive episodes in the child’s lifetime. Recently, it has
been suggested that the chronicity rather than the
experience of depressive illness per se may be the crucial
factor for the child’s development (S. B. Campbell &
Cohn, 1997). Studies often have combined women with
short-lived minor depressions with those experiencing
major, repeated, and long-term depressions (Hopkins,
Campbell, & Marcus, 1987 ; O ’Hara, 1997). Campbell et
al. (S. B. Campbell, Cohn, & Meyers, 1995) demonstrated
less positive maternal interactions only for depressed
mothers who had chronic depression in the first 6 months
compared to controls. Depressed mothers with shorter
and minor depression did not differ from the control
group. It is thus likely that long-term effects on intellectual development may only be found where there is
chronicity or an accumulation of adverse social and
family factors (Blanz, Schmidt, & Esser, 1991 ; Sameroff
et al., 1993 ; Stanton, McGee, & Silva, 1991).
The objective of the present study was to examine the
effects of different features of maternal depression on the
intellectual development of children, assessed on three
occasions over the first 7 years in the children’s life (at 20
months, 4 ; 8 years, and 6 ; 3 years). The features of
depression include the timing, recency, severity, duration,
and number of depressive episodes as well as an index of
chronicity of depression. Furthermore, interactions of
child’s gender, infant neonatal risk, and family socioeconomic status with features of depression on child
cognitive development are evaluated.
Methods
Population Sample
The Bavarian Longitudinal Study (BLS ; Wolke & Meyer,
1999a, b)" investigates the development of children who were
born during the period 1 February 1985–31 March 1986 and
required admission to special care baby units within the first 10
days of life in South Bavaria as well as control children cared for
on normal postnatal wards. A total sample of N l 8421 children
and their mothers (N l 7505 at-risk children and N l 916
healthy born children) have been followed since birth and were
assessed several times until the 5th year of the children’s life
(Wolke, Meyer, Ohrt, & Riegel, 1995).
The population for the investigation reported here was a
subsample of the total study population of 1329 mothers and
their singleton offspring who were randomly selected from the
total sample within the stratification variables : gender (2), SES
(3), and neonatal risk (3), and assessed at 6 ; 3 years. Of these
children, 1011 (76n1 %) had been admitted to a children’s
hospital for neonatal special care (at-risk children : very preterm
32 weeks gestation N l 200 ; preterm 32–36 weeks gestation
N l 273 ; full-term 36 weeks gestation N l 538) and 318
(23n9 %) were full-term children who had normal postnatal care
in obstetric hospitals.
Maternal Psychiatric Interview
When the children were 6 ; 3 years of age, a structured and
standardised interview regarding maternal physical and mental
health was conducted with all mothers by trained clinical
psychologists, all of whom were unaware of children’s neonatal
risk status (Kurstjens & Wolke, 2001). This interview
included a screening for depressive symptoms from the SADS
" See ‘‘ Bavarian-Finnish Longitudinal Study ’’ :
www-homepage: http:\\psy.herts.ac.uk\DWRU\hmpage.html
626
S. KURSTJENS and D. WOLKE
(Endicott & Spitzer, 1978), a reliable and well-validated
instrument for assessing psychiatric history (O’Hara & Swain,
1996). The screening took 10 minutes and asked about
depressive symptoms (depressive mood, irritability, crying, and
loss of interest) in the last 7 years since pregnancy and birth of
the study child. Each screening question was rated on 4-point
scales (no, doubtful, moderate, definite\severe). Furthermore,
it was rated whether the symptoms led to significant social and
work dysfunction (‘‘ no social and work dysfunction ’’, ‘‘ social
and work dysfunction for 2–6 days ’’, ‘‘ social and work
dysfunction 7 days or more ’’). If the screening was positive
(moderate or definite\severe in at least one of the four screening
questions and social and work dysfunction), a detailed depression interview of about 30 minutes duration followed to
establish timing, number, severity, and duration of the depressive episodes and treatment experiences (German version of
the SADS of Endicott & Spitzer, 1978 ; translated and adapted
by Wolke, Leo! n-Villagra! , & Meyer, 1993). According to the
Research Diagnostic Criteria Symptomlist (RDCS ; Spitzer,
Endicott, & Robins, 1978), 24 symptoms (e.g. insomnia, lack of
appetite, thoughts of suicide) were explored on 3-point scales
(no, moderate, definite\severe). Based on these data a diagnosis
of Minor or Major episodes of depression according to DSMIV criteria (American Psychiatric Association, 1994) was made.
Features of Maternal Depression
The features of maternal depression were distinguished as
follows (O’Hara, 1997).
Timing. Those mothers who had a depressive episode within
the first year of the child’s life were labeled as ‘‘ postnatal
depression ’’, whereas those mothers who had a depressive
episode after the first year of the child’s life were labeled as
‘‘ later depression ’’.
Recency. Those mothers who were depressed during the
last year before the 6 ; 3-year assessment had a ‘‘ recent depression ’’ and those mothers whose last depressive episode was
more than 1 year before the 6 ; 3-year assessment had ‘‘ no recent
depression ’’.
Severity. According to DSM-IV criteria (specific core
symptoms have to be present for a defined duration), ‘‘ Major ’’
(five and more core symptoms) and ‘‘ Minor ’’ depressive
episodes (less than five core symptoms) were assessed.
Number. Mothers did experience a variable number of
episodes ranging from 1 episode only to more than 10 episodes
in the first 7 years of the child’s life. Number of episodes was
dichotomised as experience of one depressive episode only
(‘‘ single episode ’’) versus experience of two or more episodes
(‘‘ multiple episodes ’’).
Duration. The longest recorded depressive episode was
dichotomised as ‘‘ short ’’ when lasting 6 months or less and
‘‘ long ’’ when it lasted for more than 6 months.
Severe-chronically depressed group. To account for the
possibility that not one but the cumulation of several features of
depression may be related to cognitive development in the
children (S. B. Campbell & Cohen, 1997), we defined a severely
affected group of depressed mothers. The ‘‘ severe-chronic ’’
depressed mothers had to have had a major depression which
started in the postnatal period and involved multiple episodes.
Assessment of Child Cognitive Status
When children were 20 months of age (corrected for
prematurity) they were assessed using the Griffiths Scales of
Babies’ Abilities (1976) in its German version (Brandt, 1983).
These scales allow the computation of a General Developmental
quotient ; DQ l (Developmental age score\age at assessment)i100. At 4 ; 8 years of age (chronological age) cognitive
development was assessed with the Columbia Mental Maturity
Scales (CMM ; Burgemeister, Blum, & Lorge, 1972 ; German
version : Eggert, 1972). The CMM is a frequently used test
assessing the performance and reasoning component of in-
telligence and is similar to the Raven Progressive Matrices
allowing the computation of a Performance Score (100p15). At
6 ; 3 years of age children’s intellectual development was assessed
with the Kaufman Assessment Battery for Children (K-ABC ;
Kaufman & Kaufman, 1983) in its German version (Melchers
& Preuß, 1991) (see Wolke & Meyer, 1999a). This cognitive
assessment battery is based on neuropsychological theories of
intellectual functioning. General intelligence is measured with
the Mental Processing Composite (MPC ; eight subsets at this
age ; 100p15). The Achievement Score (AS ; 100p15) included
three subsets designed to measure what has been learned by the
child. The K-ABC is a widely accepted scale for measurement of
intellectual development in at-risk children (e.g. Achenbach,
Howell, Aoki, & Rauh, 1993 ; Li, Sauve, & Creighton, 1990 ;
Weisglass-Kuperus, Baerts, Smrkovsky, & Sauer, 1993)#. All
assessments were carried out by trained postgraduate psychologists, all of whom were blind to maternal group and children’s
risk status.
Statistical analysis. To test for effects of maternal
depression on children’s cognitive development, group comparisons were carried out using three-way univariate analysis of
variance (ANOVA). Independent factors for testing for the
effect of postnatal depression were ‘‘ maternal group ’’ (postnatally depressed vs. controls consisting of mothers who were
never depressed until their child was aged 6 ; 3 years), ‘‘ sex of
child ’’ (boys and girls), ‘‘ socioeconomic status (SES) ’’ of family
(low, middle, and high) and ‘‘ neonatal risk status ’’ of the child
(no risk and risk), respectively. All factors could not be tested
simultaneously but only in three-way ANOVAs due to cell size
and statistical power limitations. Thus maternal group was
tested with all the combinations of sex, SES, and neonatal risk
status separately for interaction effects. Dependent variables
were the measures of cognitive development at 20 months
(Griffiths Scales of Babies’ Development) and the CMM at
4 ; 8 years.
At 6 ; 3 years tests for the effects of the different features of
depression on K-ABC MPC and AS were carried out and these
comprised the following factors : timing : postnatal depression,
later depression, controls ; recency : recent depression, no recent
depression, controls ; number of episodes : single episode,
multiple episodes, controls ; duration of longest episode : short,
long, controls. To test for interaction effects of each feature of
depression, three-way analyses of variance of depression feature
by sex, SES, and risk status were carried out. Cognitive scores
over time are shown as z-scores in figures and additionally in
tables as raw IQ scores.
Results
Prevalence of Depression
The depression screening was positive for 109 (8n2 %)
of the 1329 mothers and required a full depression
interview according to criteria (Fig. 1). One hundred and
two mothers (7n7 %) received the full depression interview, however 7 cases (0n5 %) were missed due to
interviewer errors. For 1220 mothers (91n8 %) screening
was negative and therefore no depression interview was
necessary. Seven hundred and twenty-one mothers had
no depressive symptoms (none or only mild) until the
seventh year of their child’s life and served as controls.
Of the 102 mothers with the complete depression
interview, 92 (7n0 %) met diagnostic criteria for a minor
or major depressive episode. Ten mothers (0n7 %) had less
# A representative sample for Bavaria (the ‘‘ Normative
Sample ’’), sampled from the total BLS sample (see Riegel,
Ohrt, Wolke, & O$ sterlund, 1995 ; Wolke, Ratschinski, Ohrt, &
Riegel, 1994 ; Wolke & Meyer, 1999a, b), provided cohortspecific norms for the cognitive assessments (e.g. means and
standard deviations for computing z-scores).
MATERNAL DEPRESSION AND CHILD COGNITIVE DEVELOPMENT
Figure 1.
627
Prevalence of depression.
Table 1
Features of Depression
Features of depression
Timing
Postnatal
Later
Recency
Nonrecent
Recent
Severity
Minor
Major
Number
Single episode
Multiple episodes
Duration
Short ( 6 mths)
Long ( 6 mths)
Chronic-severe
Less severe
Chronic-severe
Depressed mothers
(N l 92)
Birth risk\no birth risk
(68\24)
44 (47n8 %)
48 (52n2 %)
35\9
33\15
40 (43n5 %)
52 (56n5 %)
30\10
38\14
26 (28n3 %)
66 (71n7 %)
23\3
45\21
29 (31n5 %)
63 (68n5 %)
19\10
49\14
53 (57n6 %)
39 (42n4 %)
39\14
29\10
68 (73n9 %)
24 (26n1 %)
50\18
18\6
severe depressive symptoms, which did not reach diagnostic status (depressive mood only, d.m. in Fig. 1).
Features of Depression
Frequency distributions of the features of depression are
presented in Table 1. Twenty-six (28n3 %) out of 92
depressed mothers met diagnostic criteria for a minor
depressive episode, and 66 (71n7 %) for at least one major
episode. Forty-four mothers (47n8 %) experienced the
first or only episode during the first year of the child
(postnatal depression, p.d.), 48 mothers (52n2 %) suffered
from a depressive episode for the first time in their life
after the first year of the child (later depression, l.d.).
628
S. KURSTJENS and D. WOLKE
Table 2
Compliance of Children of Depressed (Dep) and Control
(Con) Mothers from 20 Months to 6 ; 3 Years of Age with
Cognitive Assessment
Result (N )
Group
20 months
Griffiths
4 ; 8 years
CMM
6 ; 3 years
MPC
AS
Missing
Con
4
4
23
20
Dep
3
0
0
Con
Dep
711
90
695
87
715
715
90
90
Fifty-two (56n5 %) mothers had a depressive episode in
the year before the 6 ; 3 years assessment, 63 of depressed
mothers (68n5 %) had more than one depressive episode
(multiple episodes), and 39 mothers (42n4 %) had at least
one episode which lasted for more than 6 months. The
severe-chronic depressed group of mothers comprised 24
(26n1 %) women. They had already suffered from a major
depressive episode in the first year of life of their child
and had multiple depressive episodes.
Outliers and Dropouts
Two children of the depressed group and six children of
the control group scored more than 3n3 SDs below the
population mean (according to the normative sample of
the BLS) on the MPC scale of the K-ABC at 6 ; 3 years of
age as well as more than 3n3 SDs below the population
mean on the Griffiths Baby Scales, i.e. were moderately to
severely mentally retarded. All children had a high birth
risk and were significant outliers for statistical analysis.
They were excluded from analysis of IQ data as they
could have a biasing effect on the test of the effects of
maternal depression (see Hay & Kumar, 1995). Therefore
the IQ analysis is based on a maximum of N l 90
children of depressed and N l 715 children of control
mothers.
Individual children missed either the 20 months or 4 ; 8
years cognitive assessment (see Table 2). No child
participated in less than two of the three assessments. At
4 ; 8 years of age there were no differences in CMM IQ
scores between those children who had missed the
assessment at 20 months (N l 4) compared to those with
all assessments (N l 779) (t lk0n99, n.s.). At 20 months
of age there were also no significant differences in Griffiths
Baby Scales scores of those children who missed the 4 ; 8
years assessment (N l 23) and those children with all
assessments (N l 779) (t lk0n89 ; n.s.). At 6 ; 3 years of
age there were significant differences between the two
groups on the MPC scale and AS scale of the K-ABC
(MPC scale : t lk2n80, p n01 ; AS scale : t lk3n29,
p .01). On both scales children who did not participate
at 20 months assessment (MPC mean l 90 ; AS mean l
88) scored lower than children without missing data
(MPC mean l 97 ; AS mean l 98). However, in the
group of children with missing data, at 20 months or 6 ; 3
years there was no statistically significant difference in IQ
scores between children of the depressed (N l 3) versus
Table 3
Sociodemographic Characteristics of the Final Samples
Depressed mothers
(N l 90)
Sex of child
Boys
Girls
Gestation (weeks)
Mean
(SD)
Birthweight
Mean
(SD)
SES at birth
Low
Middle
High
SES at 6 ; 3 years
Low
Middle
High
Maternal age
Mean
(SD)
Marital status
Married
Education
Basic ( 10 yrs)
Moderate (10–12 yrs)
A-level\Univ.( 12 yrs)
Parity
Primiparous
48 (53 %)
42 (47 %)
37n7
(3n6)
2924n7
(841n8)
Control mothers
(N l 715)
383 (54 %)
332 (46 %)
p
n.s.
37n3
(3n6)
n.s.
2808n2
(879n9)
n.s.
34 (37n8 %)
27 (30n0 %)
29 (32n2 %)
258 (36n1 %)
273 (38n2 %)
184 (25n7 %)
n.s.
38 (42n2 %)
28 (31n1 %)
24 (26n7 %)
254 (35n5 %)
258 (36n1 %)
203 (28n4 %)
n.s.
28n1
(4n6)
28n4
(5n1)
n.s.
88 (97n8 %)
683 (95n9 %)
n.s.
12 (13n3 %)
58 (64n4 %)
20 (22n2 %)
85 (11n9 %)
503 (70n3 %)
127 (17n8 %)
n.s.
51 (56n7 %)
427 (59n7 %)
n.s.
MATERNAL DEPRESSION AND CHILD COGNITIVE DEVELOPMENT
Table 4
Impact of Postnatal Maternal Depression on Griffiths
Baby Scales General DQ at 20 months and CMM
Performance Score at 4 ; 8 Years of Age (Main Effects)
20 months
Controls
Postnatal depression
4 ; 8 years
N
Griffiths
N
CMM
711
43
104n8 (8n6)
104n7 (6n5)
695
42
97n1 (16n3)
97n0 (20n7)
control group (N l 20) (20 months Griffiths scales : t l
0n16, n.s. ; 6n3 years MPC scale : t l 0n01, n.s. ; 6n3 years
AS scale : t l 1n04, n.s.). Furthermore, there were no
significant differences between children with and without
missing assessments according to social class, χ#(2) l
0n91, n.s. Children with a missing assessment had significantly more often a birth risk than children without
missing data, χ# l 7n14 ; p n01.
Subject Characteristics
Means and standard deviations for the depressed and
control subjects with respect to demographic characteristics of the subjects are presented in Table 3. There
were no statistically significant differences between the
depressive and control group in terms of sex of child,
χ# (1) l 0n00 ; n.s., gestation, t(809) lk1n09 ; n.s., birthweight t(809) lk1n19 ; n.s., SES at time of the birth of
the study child, χ#(2) l 2n77 ; n.s., or SES at 6 ; 3 years
assessment, χ#(2) l 1n63 ; n.s. Nor did the two groups
differ with regard to maternal age, t(806) l 0n57 ; n.s.,
marital status at birth of study child, χ#(1) l 0n74 ; n.s.,
maternal education, χ#(2) l 1n41 ; n.s., or parity, χ#(1) l
0n31 ; n.s. The two groups were thus highly comparable
according to child and sociodemographic indices.
Maternal Depression and Risk Status of the Child
To test whether birth complications and neonatal risk
of the child lead to a higher prevalence of maternal
depression, we compared the rate of maternal depression
in the two subsamples (neontal risk vs. no neontal risk) in
the total sample. There were no differences in rates of
depression between mothers of neonatal at-risk children,
N l 1011 ; 6n7 %, and mothers of healthy born children,
N l 318 ; 7n5 % ; χ#(1) l 3n50 ; n.s., and no differences in
the composition of healthy born and neonatal at-risk
children in the depression and control group (see Fig. 1).
Infant Cognitive Development
Table 4 shows the means and standard deviations of
the postnatal depression group compared to the controls.
At 20 months there was no significant main effect of
maternal group, F(1) l 0n47, n.s. (see Table 4) and no
significant interaction effect between maternal group and
any of the other factors—maternal group by sex of child :
F(1) l 0n40, n.s. ; by SES at time of child’s birth : F(2) l
0n20, n.s. ; by risk status of the child : F(1) l 0n41, n.s.—
on general developmental quotient (DQ). Neither boys of
postnatally depressed mothers (M l 103n5, SD l 6n2),
nor children of socially disadvantaged families with a
postnatally depressed mother (M l 103n5, SD l 6n6),
nor children with birth risk and postnatally depressed
mother (M l 104n6, SD l 6n6) had lower scores than
629
children of control mothers (boys : M l 103n6, SD l 8n9 ;
low SES : M l 103n8, SD l 8n9 ; birth risk children : M l
104n3, SD l 9n1). There was also no significant three-way
interaction effect.
Similarly at 4 ; 8 years assessment, there was no
significant main effect of maternal group, F(1) l 0n12,
n.s. (see Table 4) nor any significant interaction effect
between maternal group and other factors—maternal
group by sex of child : F(1) l 0n43, n.s. ; by SES at time of
child’s birth : F(2) l 0n32, n.s. ; by risk status of the child :
F(1) l 0n01, n.s. Neither boys (M l 97n1, SD l 23n4),
nor socially disadvantaged children (M l 91n7, SD l
21n0), nor children with birth risk (M l 96n0, SD l 22n4)
of postnatally depressed mothers had lower CMM scores
than children of the control group (boys : M l 95n5,
SD l 15n9 ; low SES : M l 91n9, SD l 17n7 ; birth risk
children : M l 95n9, SD l 17n0).
At 6 ;3 years neither timing [postnatal depression vs.
later depression vs. controls ; MPC : F(2) l 0n98, n.s ; AS :
F(2) l 0n45, n.s.], nor recency [MPC : F(2) l 0n24, n.s. ;
AS : F(2) l 0n81, n.s.], severity [MPC : F(2) l 0n42,
n.s. ; AS : F(2) l 0n29, n.s.], nor number of episodes
[MPC : F(2) l 0n98, n.s. ; AS : F(2) l 1n01, n.s], nor
duration of longest depressive episode [MPC : F(2) l
0n22, n.s. ; AS : F(2) l 0n39, n.s.] showed any significant
influence on cognitive development at 6 ; 3 years of age
(Table 5). Neither children of postnatally depressed
mothers, nor children with mothers who had a depressive
episode in the last year before 6 ; 3 years cognitive
assessment, nor children of mothers with major depression or with multiple episodes, nor children of mothers
who had episodes that lasted longer than 6 months, had
lower MPC or AS scores in the K-ABC than children of
the later depressed, not recently depressed, minor depressed, or single episode or short episode depressed or
control mothers, respectively (see tables). Furthermore,
neither timing, recency, severity, number, nor duration of
depression had significant two- or three-way interactions
with sex of child, SES, or risk status of the child.
Chronic-severe Depression
The chronically affected group of depressed mothers
did not differ from less affected depressed mothers or
controls on the 6 ; 3 years cognitive assessment, neither on
the MPC nor on the AS scale of the K-ABC [MPC :
F(2) l 1n41, n.s. ; AS : F(2) l 0n54, n.s.] (see Table 5).
There were also no significant two-way interaction effects
between maternal group and sex of child [MPC : F(1) l
0n09, n.s. ; AS : F(2) l 1n22, n.s.), SES of family at time of
6 ;3 years assessment [MPC : F(2) l 0n74, n.s. ; AS :
F(4) l 2n05, n.s.] or risk status of the child [MPC :
F(1) l 0n23, n.s., AS : F(2) l 0n08, n.s.]. There was also
no significant three-way interaction effect for the MPC
scale. However, on the AS scale there were two significant
three-way interaction effects : chronicity of maternal
depression by sex of child by SES of family, F(6) l 2n27,
p n05, and chronicity of maternal depression by sex of
child by neonatal risk status of child, F(3) l 2n53, p l
n05. Boys of chronically depressed mothers of low SES
families (N l 9 ; M l 88n4, SD l 20n4) showed the lowest
scores compared to boys of chronically depressed
mothers in upper SES families (middle SES : N l 4 ; M l
90n3, SD l 6n0 ; upper SES : N l 4 ; M l 100n8, SD l
24n8) or boys and girls of the control group of any SES
status (boys : lower SES : N l 135 ; M l 93n2, SD l 13n8 ;
middle SES : N l 138 ; M l 97n9, SD l 13n5 ; upper SES :
630
S. KURSTJENS and D. WOLKE
Table 5
Different Features of Maternal Depression and K-ABC Mental Processing Component
(MPC ) and Achievement Score (AS ) Scores at 6 ; 3 Years of Age (Main Effects)
Controls
Timing
Postnatal depression
Later depression
Recency
Nonrecent
Recent
Severity
Minor
Major
Number
Single
Multiple
Duration
Short
Long
Chronicity
Less severe
Chronic-severe
N
MPC
715
96n7 (12n0)
p
AS
97n9 (14n6)
n.s.
43
47
95n5 (12n0)
98n2 (13n0)
40
50
99n2 (11n6)
95n1 (13n1)
25
26
99n8 (11n1)
95n8 (13n0)
29
61
99n6 (10n9)
95n6 (13n2)
53
37
96n0 (13n1)
98n2 (11n8)
67
23
98n5 (11n9)
92n3 (13n4)
p
n.s.
98n6 (16n5)
97n8 (15n7)
n.s.
n.s.
101n2 (15n9)
95n8 (15n8)
n.s.
n.s.
102n4 (15n4)
96n5 (16n0)
n.s.
n.s.
102n4 (13n0)
96n2 (16n9)
n.s.
n.s.
96n0 (17n1)
101n2 (13n9)
n.s.
n.s.
99n3 (14n9)
94n8 (18n7)
n.s. l not significant.
Figure 3. DQ\IQ scores of children of mothers of low, middle,
and high SES at 20 months, 4 ; 8 years, and 6 ; 3 years of age
(z-scores)
Figure 2. Three-way interaction of chronic depression, neonatal risk, and sex of child on the Achievement Score of the
K-ABC at 6 ; 3 years of age.
N l 110 ; M l 104n8, SD l 13n3 ; girls : lower SES : N l
118 ; M l 93n7, SD l 16n4 ; middle SES : N l 120 ;
M l 97n2, SD l 15n0 ; upper SES : N l 93 ; M l 102n8,
SD l 10n8). Furthermore, boys with neonatal risk and a
chronically depressed mother had significantly lower
scores (N l 14 ; M l 88n8 ; SD l 18n1) than boys with
neonatal risk and less severely depressed mothers (N l 3 ;
M l 105n7 ; SD l 19n5) or boys of control group mothers
with (N l 282 ; M l 97n1 ; SD l 14n0) or without birth
risk (N l 101 ; M l 101n2 ; SD l 14n6) (see Fig. 2)
DQ\IQ scores in different SES groups. To provide a
comparison for judging the relative impact of maternal
depression on children’s cognitive development, we deter-
mined the influence of SES, a factor known to affect
DQ\IQ scores over time. Figure 3 shows the average
DQ\IQ z-scores between 20 months and 6 ; 3 years of age
for the total sample (N l 804) of children (children of
depressed and control mothers) according to SES. SES
differences are statistically significant at all assessment
points. Children of low SES scored, on average, about 0n2
to 0n5 SD units lower than children of middle SES and
about 0n5 to 0n8 SD units below the children of high SES.
Discussion
In the present study we evaluated the effects of
postnatal depression on children’s cognitive development
over a 7-year period in a large sample of children.
Moreover we examined the effects of different features of
depression on children’s cognitive development at 6 ; 3
years of age. Our major findings are that (a) postnatal
depression per se has no adverse effects on cognitive
MATERNAL DEPRESSION AND CHILD COGNITIVE DEVELOPMENT
development of children during the first 7 years of life and
(b) no main effects of different features of depression are
found at 6 ; 3 years of age. However, (c) adverse effects on
scores were found for low SES boys or boys born at
neonatal risk of chronically depressed mothers in the
Achievement Score (AS) of the K-ABC at 6 ; 3 years.
Hay (1997) proposed that the effects on cognitive
development may be more pronounced if the onset of
maternal depression is in early infancy, a sensitive period
for the formation of the mother-infant relationship and
for learning to regulate arousal and attention mutually
(Tronick & Weinberg, 1997) and the acquisition of
awareness for contingencies (Dunham & Dunham, 1990).
Hay (1997) bases her proposal on findings of the Cogill et
al. (1986) study and her reanalysis of these data (Hay &
Kumar, 1995). This showed that children of mothers who
were depressed in the first year of the life had lower
McCarthy General Cognitive scores than did children
whose mothers were not ill at that time.
However, no long-term main effects of postnatal
depression compared to controls as found here were
reported in two other large studies (Murray, Hipwell, et
al., 1996 ; Sharp et al., 1995). Although Murray (1992)
found an overall effect of postnatal depression on an
Object Concept task when children were 9 and 18 months
of age, other measures of cognitive development at 18
months (Bayley Scales of Infant Development, Reynell
Language Scales ; Murray, 1992 ; Murray et al., 1993) or
at 5 years of age (McCarthy Scales ; Murray, Hipwell, et
al., 1996) did not indicate a difference between children of
postnatally depressed and control mothers. Our finding
that at no time from 20 months onwards did children of
postnatally depressed mothers show lower scores than
children of mothers who were later or not at all depressed
is highly consistent with Murray, Hipwell, et al. (1996),
who also found no evidence for a sensitive period of the
impact of maternal depression for longer-term cognitive
development. However, Murray, Hipwell, et al. found
evidence that insensitive maternal interactions at 2
months (e.g. mother’s speech), whether by depressed or
not depressed mothers, early developmental delay, and
poorer home environment were related to 5-year IQ
scores. This finding suggests that early maladaptive
interaction and parenting that can also occur in motherinfant dyads without postnatal depression affects cognitive development. Campbell (S. B. Campbell & Cohen,
1997 ; S. B. Campbell et al., 1995) reported that most
mothers, despite their postnatal depression, provide
‘‘ good enough mothering ’’ and depression does not
indicate an inevitable risk. Marked differences are mostly
observed in high-risk samples where postnatal depression
is accompanied by other family and social problems and
reflected in marked differences in maternal communication, infant distress, and avoidance (Field, Healy,
Goldstein, & Guthertz, 1990). The reanalysis of the
relatively affluent Cogill et al. (1986) sample (Hay, 1997 ;
Hay & Kumar, 1995) showed that the difference between
the children of depressed mothers and well mothers was
only reliable when the mothers themselves were less well
educated, providing further evidence for this interpretation. Differences in sensitivity and parenting styles have
been repeatedly reported to differ according to SES status
(Aylward, 1992 ; F. A. Campbell & Ramey, 1994 ;
Cichetti, 1996 ; Crittenden & Bonvillian, 1984 ; Dodge,
Pettit, & Bates, 1994 ; Duncan, Brooks-Gunn, &
Klebanov, 1994 ; Felner et al., 1995 ; Hashima & Amato,
1994 ; Morisset, Barnard, Greenberg, Booth, & Spiker,
631
1990 ; Rutter, 1981 ; Steele, 1990). We found, like many
other studies (e.g. Hernstein & Murray, 1994 ; Molfese,
DiLalla, & Bunce, 1997 ; Parker, Greer, & Zuckermann,
1988 ; Sameroff et al., 1993 ; Walker, Greenwood, Hart, &
Carta, 1994 ; Wolke & Meyer, 1999a), highly significant
effects of SES on cognitive scores from 20 months to 6 ; 3
years of age that were independent of postnatal depression.
Although a number of studies of postnatal depression
have found an increase in insecure attachment classification in infant-mother dyads where the mother suffered
postnatal depression (Murray, 1992 ; Radke-Yarrow et
al., 1985 ; Teti, Gelfand, Messinger, & Isabella, 1995),
there is little evidence for lower general cognitive abilities
in infants who are insecurely attached (Van Ijzendoorn,
Dijkstra, & Bus, 1995). Also, no long-term effects of
attachment security on academic performance have been
documented (Grossmann, Grossman, & Zimmermann,
in press). Cognitive development appears to be more
robust and less affected than emotional and behavioural
functioning under less than optimal caretaking conditions
(Rutter, 1985, 1987 ; Rutter & The ERA Study Team,
1998 ; Skuse, 1984).
A second issue previously raised is whether certain
infants are more vulnerable and affected by exposure to
maternal depression. Sharp et al. (1995) reported that
boys of mothers who had postnatal depression had IQ
scores (GCI) almost 1 SD below those of sons of women
who had been well. Cogill et al. (1986) further reported
that low birthweight children may be particular vulnerable to postnatal depression in their mothers.
In the present study we tested for interaction effects
with gender, neonatal risk status of the infant, and SES.
Two significant interaction effects were detected in our
study and both were interactions between gender and the
severe-chronic form of depression. Low SES boys and
boys with neonatal complications of severe-chronically
depressed mothers showed lower cognitive scores at 6 ; 3
years in the Achievement Scale of the K-ABC than
children of other subgroups. This result indicates a similar
finding to that by Sharp et al. (1995) that boys from lower
SES (Hay, 1997) or with neonatal complications (Cogill
et al. 1986), when growing up with a depressed mother,
are at increased risk for adverse affects on cognitive
development. At 18 months assessment, Murray (1992)
also found significant interaction effects between maternal group and sex of child as well as maternal group
and social class of family. Boys of postnatal depressed
mothers as well as children of lower social class families
reached significantly lower cognitive scores. However, at
5 years of age there were no more significant interactions
between maternal depression and sex of child or social
class (Murray, Hipwell, et al., 1996).
Although this is further evidence for the higher
vulnerability of boys, there is an important difference
compared to the findings reported by Sharp et al. (1995).
We did not find that the timing of maternal depression
was important for boys’ cognitive development ; rather it
was the chronicity of depression of socially or neonatally
compromised boys that mattered. Furthermore, the
synergistic effect of gender, SES, or neonatal complications and chronicity of depression was only found at
6 ; 3 years and confined to the Achievement Scale of the
K-ABC and not found for Mental Processing tapping the
g-factor of IQ (Melchers & Preuß, 1991). Thus the aspect
of cognitive function (achievement) that is more dependent on parental stimulation is affected. It appears
632
S. KURSTJENS and D. WOLKE
that the effects become only apparent after years of
exposure to maternal depression. Notable is that the
German children, although mostly attending half-day
kindergarten, had not yet started primary school. A
further follow-up in middle childhood should indicate
whether schooling provides new opportunities of interaction with adults and turning points for these boys
(Rutter & Rutter, 1992) or whether achievement scores
remain low (Moffit et al., 1993). Furthermore, although
Cogill et al. (1986) indicated that postnatal depression
may affect low birthweight children more than normal
weight infants we did not find that the timing of
depression mattered. Low birthweight has an adverse
main effect on cognitive development (Wolke, 1998 ;
Wolke & Meyer, 1999a, b) but mothers of children with
neonatal complications were neither more often clinically
depressed nor did neonatal complications interact with
postnatal depression for predicting cognitive scores.
Rather, achievement scores are only found to be lower in
boys requiring neonatal special care of mothers with
chronic depression.
Despite the finding that boys are a vulnerable group as
reported by others previously, the practical significance
of the three-way interactions detected here needs to be
considered with some caution. Considering the number
of comparisons carried out in our study and the fact that
these interactions were only found at the 6 ; 3 year
assessment and not in the earlier cognitive assessments,
they could also be accounted for by chance. Furthermore,
the number of children in the individual cells was small
although the differences were statistically significant. This
is also true for previous studies. Sharp et al.’s (1995) study
had 26 boys altogether, of whom 13 had mothers who
were only postnatally depressed. Altogether 7\26 boys
had significant cognitive deficits (GCI 70) and 5 of
these 7 were in the postnatal depression group (p. 1328).
Cogill et al. (1986) had only six infants of low birthweight.
Interactions in small samples are liable to outliers and
this should be considered in the interpretation of findings.
Similarly, it is important to consider methodological
factors that may explain differences of our findings to
previous reports of adverse effects of postnatal depression
on cognitive development (Hay, 1997 ; Murray & Cooper,
1996 ; Sharp et al., 1995).
First, although the cognitive assessments were carried
out prospectively, the mother reports of depression were
retrospective when the children were 6 ; 3 years of age and
the validity of recall data could be questioned. First, we
used a reliable and well-validated instrument (SADS,
Endiott & Spitzer, 1978 ; Murray, Hipwell, et al., 1996 ;
O’Hara & Swain, 1996) and had specially trained interviewers with regular review meetings of tape-recorded
interviews. For example, Sharp et al. (1995) used the
SADS-L when the children were 4 years of age to identify
most of the mothers with postnatal depression. They
concluded that ‘‘ the retrospective reports may well have
been accurate ’’ (p. 1322) compared to the lower point
prevalences found in prospective interviews at 3 and 12
months that may have missed cases occurring in between
these times. Second, comparison of prospective data on
psychological problems from the neonatal period until
4 ; 8 years of age (see Kurstjens & Wolke, 2001) indicated
good convergence of early self-reported (Psychological
Stress Index, PSI, Riegel et al., 1995 ; Wolke, 1997 ;
Wolke & Meyer, 1999a, b) and interviewer-rated psychological problems (Family Adversity Index, FAI, Riegel
et al., 1995 ; Wolke, 1997 ; Wolke & Meyer, 1999a, b) with
diagnosis of postnatal or later depression (see Appendix).
Mothers who at 6 ; 3 years reported a depressive episode
in the postnatal period had at that time (neonatal or at
5 months) significantly more psychological problems
than control mothers and mothers who got depressed
only later. There is a good match between the pattern
of prospective and retrospective data equivalent or
exceeding those reported by Sharp et al. (1995, p. 1321).
Moreover, during the lifetime of the child, 70 % of
mothers in the depressed group did receive treatment for
depression by a professional, 45 % had had pharmacological treatment for depression, and 23 % had been
admitted to hospital for psychiatric treatment.
Third, the lower prevalence rate for maternal depression in our sample compared to British and North
American studies may suggest that the interview missed
true cases (i.e. false negatives). O’Hara and Swain (1996)
found in a meta-analysis of rates of postpartum depression of mainly Anglo-American studies a mean
prevalence of 13 % (first year) for screening questionnaires but significantly lower rates (between 3n7 % to
10n7 %) in investigator-based interviews. There are several pieces of evidence that show that there are striking
differences in depression rates across countries
(Weissman et al., 1996 ; Wickberg-Johannssen,
Erlandsson, & Hwang, 1996) and they are lower in
Germany than, for example, the United States. The
differences in rates for depression across countries suggest
that cultural differences affect the expression of the
disorder (Weissman et al., 1996). The American National
Comorbidity Survey (NCS ; Kessler et al., 1994) found a
lifetime prevalence of major depressive episode of 21n3 %
and a 12-month prevalence of major depression of 12n9 %.
A German study carried out by the Max Planck Institute
of Psychiatry (EDSP ; Lieb et al., 1998) used the same
interview as the Kessler et al. (1994) study in a South
German community sample of 1023 mothers. The lifetime
rates (11n9 % in South Germany vs. 21n3 % in the NCS)
and 12-month prevalence rate for major depression
(2n6 % vs. 12n9 %) were substantially lower than those in
the U.S. sample. In our study, of the mothers identified
postnatally as depressed, 2n3 % (30\1329) had a major
depression and of the mothers with depression in the 12
months before the 6 ;3-year interview, 2n5 % (33\1329)
had a major depression. These prevalence rates for major
depression are so close to those of the German EDSP
study of mothers that we can be fairly confident not to
have missed cases of DSM-IV depression.
Fourth, results from this sample reported elsewhere
(Kurstjens & Wolke, 2001) impressively replicate
previous findings by other groups (Cooper, Campbell,
Day, Kennerley, & Bond, 1988 ; Cooper & Murray, 1995 ;
Hobfoll, Ritter, Lavin, Hulsizer, & Cameron, 1995 ;
Nieland & Rogers, 1997 ; O’Hara & Swain, 1996) that
depression, whether postnatal or later, is best predicted
by previous depressive illness (Bifulco, Brown, Morgan,
Ball, & Campbell, 1998), life events, and family adversity.
As found by Murray and Cartwright (1993) we also
found that only women who had previously been depressed and had perinatal complications were more likely
to develop postnatal depression (Kurstjens & Wolke,
2001). There are striking similarities across countries in
patterns of depression despite widely different rates as
noted previously (Weisman et al., 1996).
In summary, our findings using a retrospective interview method match up well with previous findings on
factors related to depression, rates of depression detected
MATERNAL DEPRESSION AND CHILD COGNITIVE DEVELOPMENT
using interview methods in South Germany, and the
effect of obstetric factors, life events, and family adversity
on postnatal depression, underlining the validity of the
interview used in this study. Finally, similarly to Sharp
et al. (1995), we contrasted the mothers who experienced
depression to those ‘‘ who were definitely free of illness ’’
(p. 1323), i.e. mothers who had no or single mild
symptoms without these ever affecting their social
functioning.
Our sample included 76 % of children who were
admitted for special care observation in the first 10 days
of life. The large group of children born after obstetric or
neonatal complications allowed for the assessment of
whether and how obstetric factors are related to the
occurrence of postnatal depression (Murray &
Cartwright, 1993). No differences in DSM-IV clinical
depression rates between mothers of at-risk children
(6n7 %) and mothers of full-term, healthy-born children
(7n5 % ; Kurstjens & Wolke, 2001) were found. Neonatal
risk was controlled for in the design (i.e. the control group
did not differ in regard to neonatal risk status and on any
of the family variables tested) and in the statistical
analysis and should thus not have affected findings.
Compared to other studies (Cogill et al., 1986 ; Murray,
1992 ; Sharp et al., 1995 ; Whiffen & Gotlib, 1989) the
sample size is large and the duration of follow-up long. As
far as we are aware this is the largest study on maternal
depression and cognitive development to date. DQ\IQ
assessments were standard and carried out by qualified
examiners and regularly checked for administrative objectivity via video recordings (Wolke & Meyer, 1999a). At
each age, different trained examiners assessed the children
to ensure that they were blind to children’s risk and
mother’s diagnostic status. We are thus confident that the
results are reliable and valid.
In conclusion, adverse effects of maternal depression
on cognitive development were only found in lower-SES
boys and neonatal risk-born boys if the depression started
early and was severe and chronic. Most women who
become depressed are less chronically depressed and the
effects on cognitive development in the children are
negligible or small. Furthermore, even if the mothers are
severely and chronically depressed the impact is smaller
than the impact of SES on the children’s cognitive
development. SES effects are already found at 20 months
and continue to be influential in childhood (Fig. 3). It
appears that the accumulation of adverse conditions (low
SES ; chronic-severe depression, neonatal risk) rather
than depression per se has a major impact on children’s
cognitive development (Sameroff et al., 1993).
Acknowledgements—Data collection was supported by the
Bundesministerium fu$ r Forschung und Technik (BMBF)
program grants PKE24 und JUG 14 (01EP9504) to K. Riegel,
D. Wolke, und B. Ohrt and the data analysis and writing of the
manuscript by the German Research Council (DFG) to R.
Oerter und D. Wolke (Fkz Oe 71\14-1\14-2). Thanks are due to
the participating neonatal hospitals in South Bavaria and the
University of Munich Children’s Hospital (study centre), the
psychologists who conducted the screening and depression
interviews or carried out the cognitive assessments. We especially thank Patricia Rios, who checked for objectivity and
reliability of psychometric assessments, Sabine Rieder, who
reviewed the tape-recorded interviews for objectivity and
reliability of administration and scoring, Renate Meyer, Brigitte
So$ hne, and Norbert Link, who helped with database maintenance in the BLS, and the parents and children who
633
participated so willingly. Part of the data presented has been
included in a Doctoral thesis (Dr Biol) by the first author under
the supervision of the second author to the Medical Faculty of
the Ludwig Maximilian University, Munich.
References
Achenbach, T. M., Howell, C. T., Aoki, M. F., & Rauh, V. A.
(1993). Nine-year outcome of the Vermont Intervention
Program for low birthweight infants. Pediatrics, 91, 45–55.
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC :
Author.
Aylward, G. P. (1992). The relationship between environmental
risk and developmental outcome. Developmental and
Behavioral Pediatrics, 13, 222–229.
Bifulco, A., Brown, G. W., Morgan, P., Ball, C., & Campbell,
C. (1998). Predicting depression in women : The role of past
and present vulnerability. Psychological Medicine, 28, 39–50.
Blanz, B., Schmidt, M. H., & Esser, G. (1991). Familial
adversities and child psychiatric disorders. Journal of Child
Psychology and Psychiatry, 32, 939–950.
Brandt, I. (1983). Griffiths Entwicklungsskalen (GES ) zur
Beurteilung der Entwicklung in den ersten beiden Lebensjahren.
Weinheim, Germany : Beltz.
Burgemeister, B., Blum, L., & Lorge, J. (1972). Columbia
Mental Maturity Scale. New York : Harcourt Brace
Jovanovich.
Campbell, F. A., & Ramey, C. T. (1994). Effects of early
intervention on intellectual and academic achievement : A
follow-up study of children from low-income families. Child
Development, 65, 684–698.
Campbell, S. B., & Cohn, J. F. (1997). The timing and
chronicity of postpartum depression : Implications for infant
development. In L. Murray & P. J. Cooper (Eds.), Postpartum depression and child development (pp. 165–197).
London : Guilford Press.
Campbell, S. B., Cohn, J., & Meyers, T. (1995). Depression in
first-time mothers : Mother-infant interaction and depression
chronicity. Developmental Psychology, 31, 349–357.
Cicchetti, D. (1996). Regulatory processes in development and
psychopathology. Development and Psychopathology, 8, 1–2.
Cogill, S., Caplan, H., Alexandra, H., Robson, K., & Kumar,
K. (1986). Impact of maternal postnatal depression on
cognitive development of young children. British Medical
Journal, 292, 1165–1167.
Cohn, J. F., & Campbell, S. B. (1992). Influence of maternal
depression on infant affect regulation. In D. Cichetti & S.
Toth (Eds.), Rochester Symposium on Developmental Psychopathology : Vol. 4. A developmental approach to affective
disorders (pp. 103–130). Rochester, NY : University of
Rochester Press.
Cooper, P., Campbell, E., Day, A., Kennerley, H., & Bond, A.
(1988). Non-psychotic psychiatric disorder after childbirth.
A prospective study of prevalence, incidence, course and
nature. British Journal of Psychiatry, 152, 799–806.
Cooper, P., & Murray, L. (1995). Course and recurrence of
postnatal depression : Evidence of the specifity of the diagnostic concept. British Journal of Psychiatry, 166, 191–195.
Crittenden, P. M., & Bonvillian, J. D. (1984). The relationship
between maternal risk status and maternal sensitivity.
American Journal of Orthopsychiatry, 54, 250–262.
Cummings, E., & Davies, P. (1994). Maternal depression and
child development. Journal of Child Psychology and Psychiatry, 35, 73–112.
DeMulder, E. K., & Radke-Yarrow, M. (1991). Attachment
with affectively ill and well mothers : Concurrent behavioral
correlates. Development and Psychopathology, 3, 227–242.
Dodge, K. A., Pettit, G. S., & Bates, J. E. (1994). Socialization
mediators of the relation between socioeconomic status and
child conduct problems. Child Development, 65, 649–665.
Duncan, G. J., Brooks-Gunn, J., & Klebanov, P. K. (1994).
Economic deprivation and early childhood development.
Child Development, 65, 296–318.
634
S. KURSTJENS and D. WOLKE
Dunham, P. J., & Dunham, F. (1990). Effects of mother-infant
social interactions on infants’ subsequent contingency task
performance. Child Development, 61, 785–793.
Eggert, D. (1972). Die Columbia Mental Maturity Scale als
Individualtest fu$ r normalentwickelte Kinder im Alter von
3–10 Jahren. In D. Eggert (Ed.), Zur Diagnose der
Minderbegabung (pp. 185–201). Weinheim, Germany : Beltz.
Endicott, J., & Spitzer, R. (1978). A diagnostic interview: The
Schedule for Affective Disorders and Schizophrenia. Archives
of General Psychiatry, 35, 837–844.
Felner, R. D., Brand, S., DuBois, D. L., Adan, A. M., Mulhall,
P. F., & Evans, E. G. (1995). Socioeconomic disadvantage,
proximal environmental experiences, and socioemotional and
academic adjustment in early adolescence: Investigation of a
mediated effects model. Child Development, 66, 774–792.
Field, T. (1992). Infants of depressed mothers. Development and
Psychopathology, 4, 49–66.
Field, T., Healy, B., Goldstein, S., & Guthertz, M. (1990).
Behavior-state matching and synchrony in mother-infant
interactions of nondepressed versus depressed dyads.
Developmental Psychology, 26, 7–14.
Griffiths, R. (1976). The abilities of babies: A study in mental
measurement. Amersham, U.K. : Association for Research in
Infant and Child Development.
Grossmann, K. E., Grossmann, K., & Zimmermann, P. (in
press). A wider view of attachment and exploration. In J.
Cassidy & P. Shaver (Eds.), Handbook of attachment : Theory,
research, and clinical applications (pp. 760–786). New York :
Guilford Press.
Hashima, P. Y., & Amato, P. R. (1994). Poverty, social support,
and parental behavior. Child Development, 65, 394–403.
Hay, D. F. (1997). Postpartum depression and cognitive development. In L. Murray & P. J. Cooper (Eds.), Postpartum
depression and child development (pp. 85–110). New York :
Guilford Press.
Hay, D., & Kumar, R. (1995). Interpreting the effects of
mothers’ postnatal depression on children’s intelligence : A
critique and re-analysis. Child Psychiatry and Human Development, 25, 165–181.
Hernstein, R., & Murray, C. (1994). The bell curve : Intelligence
and class structure in American life. New York : Free Press.
Hobfoll, S. E., Ritter, C., Lavin, J., Hulsizer, M. R., &
Cameron, R. P. (1995). Depression prevalence and incidence
among inner-city pregnant and postpartum women. Journal
of Consulting and Clinical Psychology, 63, 445–453.
Hopkins, J., Campbell, S. B., & Marcus, M. (1987). The role of
infant-related stressors in postpartum depression. Journal of
Abnormal Psychology, 96, 237–241.
Kaplan, P., Bachorowski, J., Hoff, A., & Zarlengo-Strouse, P.
(in press). A learning deficit in the infants of depressed
mothers. Child Development.
Kaufman, A., & Kaufman, N. (1983). Kaufman Assessment
Battery for Children. Circle Pines, MN : American Guidance
Service.
Kessler, R. C., McGonagle, K. A., Zhao, S., Nelson, C. B.,
Hughes, M., Eshleman, S., Wittchen, H. U., & Kendler, K. S.
(1994). Lifetime and 12-month prevalence of DSM-III-R
psychiatric disorders in the United States. Results from the
National Comorbidity Survey. Archives of General
Psychiatry, 51, 8–19.
Kumar, R., & Robson, K. (1984). A prospective study of
emotional disorders in childbearing women. British Journal
of Psychiatry, 144, 35–47.
Kurstjens, S., & Wolke, D. (2001). Postnatale und spa$ ter
auftretende Depressionen bei Mu$ ttern: Pra$ valenz und
Zusammenha$ nge mit obstetrischen, soziodemographischen
sowie psychosozialen Faktoren. Zeitschrift fuW r Klinische
Psychologie, 30, 33–41.
Li, A. K. F., Sauve, R. S., & Creighton, D. E. (1990). Early
indicators of learning problems in high-risk children. Journal
of Development and Behavioral Pediatrics, 11, 1–6.
Lieb, R., Lachner, G., Sonntag, H., Pfister, H., Hoefler,
M., Gander, F., & Wittchen, H. U. (1998). Projektteil
‘‘ Familiengenetik und familiaW re Sozialisation ’’ (Projekt
gefoW rdert durch das BMFBW, F-Kz. 01 EB9405) (Interim
report). Munich : Max-Planck-Institute for Psychiatry, Clinical Psychology and Epidemiology, Kraepelinstr. 10, D80804.
Lu$ tkenhaus, P., Grossmann, K. E., & Grossmann, K. (1985).
Infant-mother attachment at twelve months and style of
interaction with a stranger at the age of three years. Child
Development, 56, 1538–1542.
Matas, L., Arend, R., & Sroufe, L. A. (1978). Continuity of
adaptation in the second year : The relationship between
quality of attachment and later competence. Child Development, 49, 547–556.
McCall, R. B., Appelbaum, M. I., & Hogarty, P. S. (1973).
Developmental changes in mental performance. Monographs
of the Society for Research in Child Development, 38 (Serial
No. 150).
Meins, E. (1997). Security of attachment and social development
of cognition. Hove, U.K. : Psychology Press.
Melchers, P., & Preuß, U. (1991). Kaufman Assessment Battery
for Children K.ABC (German Version). Amsterdam : Swets &
Zeitlinger.
Moffitt, T. E., Caspi, A., Harkness, A. R., & Silva, P. A. (1993).
The natural history of change in intellectual performance :
Who changes? How much? Is it meaningful? Journal of Child
Psychology and Psychiatry, 33, 441–453.
Molfese, V. J., DiLalla, L. F., & Bunce, D. (1997). Prediction of
the intelligence test scores of 3- to 8-year old children by
home environment, socioeconomic status and biomedical
risks. Merrill-Palmer Quarterly, 43, 219–234.
Morisset, C. E., Barnard, K. E., Greenberg, M. T., Booth,
C. L., & Spiker, S. J. (1990). Environmental influences on
early language development: The context of social risk.
Development and Psychopathology, 2, 127–149.
Murray, L. (1992). The impact of postnatal depression on
infant development. Journal of Child Psychology and Psychiatry, 33, 543–561.
Murray, L., & Cartwright, W. (1993). The role of obstetric
factors in postpartum depression. Journal of Reproductive
and Infant Psychology, 11, 215–219.
Murray, L., & Cooper, P. (1996). The impact of postpartum
depression on child development. International Review of
Psychiatry, 8, 55–63.
Murray, L., & Cooper, P. (1997). Postpartum depression and
child development. New York : Guilford Press.
Murray, L., Fiori-Cowley, A., Hooper, R., & Cooper, P. (1996).
The impact of postnatal depression and associated adversity
on early mother–infant interactions and later infant outcome.
Child Development, 67, 2512–2526.
Murray, L., Hipwell, A., Hooper, R., Stein, A., & Cooper, P.
(1996). The cognitive development of five year old children of
postnatally depressed mothers. Journal of Child Psychology
and Psychiatry, 37, 927–936.
Murray, L., Kempton, C., Woolgar, M., & Hooper, R. (1993).
Depressed mothers’ speech to their infants and its relation to
infant gender and cognitive development. Journal of Child
Psychology and Psychiatry, 34, 1083–1101.
Murray, L., Stanley, C., Hooper, R., King, F., & Fiori-Cowley,
A. (1996). The role of infant factors in postnatal depression
and mother-infant interactions. Developmental Medicine and
Child Neurology, 38, 109–119.
Nieland, M., & Rogers, D. (1997). Symptoms in postpartum
and non-postpartum samples : Implications for postnatal
depression. Journal of Reproductive and Infant Psychology,
15, 31–42.
O’Hara, M. W. (1997). The nature of postpartum depression.
In L. Murray & P. J. Cooper (Eds.), Postpartum depression
and child development (pp. 3–31). London : Guilford Press.
O’Hara, M. W., Schlechte, J. A., Lewis, D. A., & Varner, M.
(1991). A controlled study of postpartum mood disorders :
Psychological, environmental, and hormonal variables.
Journal of Abnormal Psychology, 100, 63–73.
MATERNAL DEPRESSION AND CHILD COGNITIVE DEVELOPMENT
O’Hara, M., & Swain, A. (1996). Rates and risk of postpartum
depression—A meta-analysis. International Review of Psychiatry, 8, 37–54.
Parker, S., Greer, S., & Zuckerman, B. (1988). Double jeopardy :
The impact of poverty on early child development. The
Pediatric Clinics of North America, 35, 1227–1240.
Puckering, C. (1989). Annotation : Maternal depression.
Journal of Child Psychology and Psychiatry, 30, 807–817.
Radke-Yarrow, M., Cummings, M., Kuczynski, L., & Chapman, M. (1985). Patterns of attachment in two- and threeyear-olds in normal families and in families with parental
depression. Child Development, 56, 884–893.
Riegel, K., Ohrt, B., Wolke, D., & O$ sterlund, K. (1995). Die
Entwicklung gefaW hrdet geborener Kinder bis zum fuW nften
Lebensjahr. Die Arvo-YlppoW -Neugeborenen-Nachfolgestudie
in SuW dbayern und SuW dfinnland. Stuttgart, Germany : Enke
Verlag.
Rutter, M. (1981). Maternal deprivation reassessed (2nd ed.).
Harmondsworth, U.K. : Penguin.
Rutter, M. (1985). Family and school influences on cognitive
development. Journal of Child Psychology and Psychiatry, 26,
683–704.
Rutter, M. (1987). Psychosocial resilience and protective
mechanisms. American Journal of Orthopsychiatry, 57,
316–331.
Rutter, M. (1990). Commentary : Some focus and process
considerations regarding effects of parental depression on
children. Developmental Psychology, 26, 60–67.
Rutter, M. (1997). Maternal depression and infant development : Cause and consequence ; sensitivity and specificity. In
L. Murray & P. J. Cooper (Eds.), Postpartum depression and
child development (pp. 295–315). London : Guilford Press.
Rutter, M., & Rutter, M. (1992). Developing minds : Challenge
and continuity across the life span. Harmondsworth, U.K. :
Penguin.
Rutter, M., & The English and Romanian Adoptees (ERA)
Study Team. (1998). Developmental catch-up, and deficit,
following adoption after severe global early privation.
Journal of Child Psychology and Psychiatry, 39, 465–476.
Sameroff, A. J., Seifer, R., Baldwin, A., & Baldwin, C. (1993).
Stability of intelligence from preschool to adolescence : The
influence of social and family risk factors. Child Development,
64, 80–97.
Sharp, D., Hay, D., Pawlby, S., Schmu$ cker, G., Allen, H., &
Kumar, R. (1995). The impact of postnatal depression on
boys’ intellectual development. Journal of Child Psychology
and Psychiatry, 36, 1315–1336.
Shaw, D. S., & Emery, R. E. (1987). Parental conflict and other
correlates of the adjustment of school-age children whose
parents have separated. Journal of Abnormal Child Psychology, 15, 269–281.
Skuse, D. (1984). Extreme deprivation in early childhood—II.
Theoretical issues and a comparative review. Journal of Child
Psychology and Psychiatry, 25, 543–572.
Spitzer, R., Endicott, J., & Robbins, E. (1978). Research
diagnostic criteria : Rationale and reliability. Archives of
General Psychiatry, 35, 773–782.
Stanton, W. R., McGee, R., & Silva, P. A. (1991). Indices of
perinatal complications, family background, child rearing,
and health as predictors of early cognitive and motor
development. Pediatrics, 88, 954–959.
Steele, S. (1990). Quantitative and qualitative home assessment
of primary caretaker-child interactions in lower socioeconomic families. Issues in Comprehensive Pediatric Nursing,
13, 127–140.
Stein, A., Gath, D., Bucher, J., Bond, A., Day, A., & Cooper,
P. (1991). The relationship between post-natal depression
and mother-child interaction. British Journal of Psychiatry,
158, 46–52.
Stevenson, J., & Fredman, G. (1990). The social environmental
correlates of reading abilities. Journal of Child Psychology
and Psychiatry, 31, 681–698.
Teti, D. M., & Gelfand, D. M. (1997). Maternal cognitions as
635
mediators of child outcomes in the context of postpartum
depression. In L. Murray & P. J. Cooper (Eds.), Postpartum
depression and child development (pp. 136–164). London :
Guilford Press.
Teti, D. M., Gelfand, D. M., Messinger, D. S., & Isabella, R.
(1995). Maternal depression and the quality of early attachment : An examination of infants, preschoolers, and their
mothers. Developmental Psychology, 31, 364–376.
Tronick, E. Z. (1989). Emotions and emotional communication in infants. American Psychologist, 44, 112–119.
Tronick, E. Z., & Field, T. (1987). Maternal depression and
infant disturbance. San Francisco : Jossey-Bass.
Tronick, E. Z., & Weinberg, M. K. (1997). Depressed mothers
and infants : Failure to form dyadic states of consciousness.
In L. Murray & P. J. Cooper (Eds.), Postpartum depression
and child development (pp. 54–81). London : Guilford Press.
Van Ijzendoorn, M. H., Dijkstra, J., & Bus, A. G. (1995).
Attachment, intelligence, and language : A meta-analysis.
Social Development, 4, 115–128.
Van Ijzendoorn, M., Goldberg, S., Kroonenberg, P. M., &
Frenkel, O. J. (1992). The relative effects of maternal and
child problems on the quality of attachment : A meta-analysis
of attachment in clinical samples. Child Development, 63,
840–858.
Walker, D., Greenwood, C., Hart, B., & Carta, J. (1994).
Prediction of school outcomes based on early language
production and socioeconomic factors. Child Development,
65, 606–621.
Weinberg, W. A., Dietz, S. G., Penick, E. C., & McAlister,
W. H. (1974). Intelligence, reading achievement, physical
size, and social class. The Journal of Pediatrics, 85, 482–489.
Weisglas-Kuperus, N., Baerts, W., Smrkovsky, M., & Sauer,
P. J. J. (1993). Effects of biological and social factors on the
cognitive development of very low birthweight children.
Pediatrics, 92, 658–665.
Weissman, M. M., Bland, R. C., Canino, G. J., Faravelli, C.,
Greenwald, S., Hwu, H. G., Joyce, P. R., Karam, E. G., Lee,
C. K., Lellouch, J., Lepine, J. P., Newman, S. C., RubioStipec, M., Wells, J. E., Wickramaratne, P. J., Wittchen, H.,
& Yeh, E. K. (1996). Cross-national epidemiology of major
depression and bipolar disorder. JAMA, 276, 293–299.
Weissmann, M., John, K., Merikangas, K., Prusoff, B.,
Wickramaratne, P., Gammon, G., Angold, A., & Warner, V.
(1986). Depressed parents and their children. General health,
social, and psychiatric problems. AJDC, 140, 801–805.
Whiffen, V., & Gotlib, I. (1989). Infants of postpartum
depressed mothers : Temperament and cognitive status.
Journal of Abnormal Psychology, 98, 274–279.
Wickberg-Johansson, B., Erlandsson, B., & Hwang, C. (1996).
Primary health care management of postnatal depression in
Sweden. Journal of Reproductive and Infant Psychology, 14,
69–76.
Winnicott, D. W. (1960). The theory of the parent-infant
relationship. In M. Khan (Ed.), The international psychoanalytical library. The maturational processes and the
facilitating environment : Studies in the theory of emotional
development. London : Hogarth.
Wolke, D. (1997). Entwicklung sehr Fru$ hgeborener bis zum 7.
Lebensjahr. In T. Horstmann & C. Leyendecker (Eds.),
FruW hfoW rderung
und
FruW hbehandlung—wissenschaftliche
Grundlagen, praxisorientierte AnsaW tze und Perspektiven interdisziplinaW rer Zusammenarbeit (pp. 271–288). Heidelberg,
Germany : Universita$ tsverlag C. Winter.
Wolke, D. (1998). The psychological development of prematurely born children. Archives of Disease in Childhood, 78,
567–570.
Wolke, D., Leo! n-Villagra! , J., & Meyer, R. (1993). Psychologisches Eltern-Interview zur Kindesentwicklung im
Grundschulalter PIK-G. Unpublished manuscript.
Wolke, D., & Meyer, R. (1999a). Cognitive status, language
attainment and pre-reading skills of 6 year-old very preterm
children and their peers: The Bavarian Longitudinal Study.
Developmental Medicine and Child Neurology, 41, 94–109.
636
S. KURSTJENS and D. WOLKE
Wolke, D., & Meyer, R. (1999b). Ergebnisse der Bayerischen
Entwicklungsstudie: Implikationen fu$ r Theorie und Praxis.
Kindheit und Entwicklung, 8, 24–36.
Wolke, D., Meyer, R., Ohrt, B., & Riegel, K. (1995). The
incidence of sleeping problems in preterm and full-term
infants discharged from neonatal special care units : An
epidemiological longitudinal study. Journal of Child Psychology and Psychiatry, 36, 203–223.
Wolke, D., Ratschinski, G., Ohrt, B., & Riegel, K. (1994). The
cognitive outcome of very preterm infants may be poorer
than often reported : An empirical investigation of how
methodological issues make a big difference. European
Journal of Pediatrics, 153, 906–915.
Wolke, D., So$ hne, B., Riegel, K., Ohrt, B., & O$ sterlund, K.
(1998). An epidemiological study of sleeping problems and
feeding experiences of preterm and full-term children in
South Finland : Comparison to a South German population
sample. Journal of Pediatrics, 133, 224–231.
Zimmermann, P., Suess, G. J., Scheuerer-Englisch, H., &
Grossmann, K. E. (1999). Bindung und Anpassung von der
fruehen Kindheit bis zum Jugendalter : Ergebnisse der
Bielefelder und Regensburger Laengsschnittstudie. Kindheit
und Entwicklung, 8, 36–48.
Manuscript accepted 4 December 2000
Appendix
Psychological Symptoms in the Family Adversity Index (FAI ) or the Psychological Stress Index (PSI )
(1 item), or the FAI and PSI (Both items) at 5 Months, 20 Months, and 4 ; 8 years According to Timing
of Depression and Control Mothers
Psychological problems
At birth or 5
No item
1 item
Both items
20 monthsb
No item
1 item
Both items
4 ; 8 yearsc
No item
1 item
Both items
a
b
c
Postnatal depression
(N l 44)
Late depression
(N l 48)
Control mothers
(N l 721)
14 (31n8 %)
6 (13n6 %)
24 (54n5 %)
25 (52n1 %)
10 (20n8 %)
13 (27n1 %)
484 (67n7 %)
124 (17n3 %)
107 (15n0 %)
n001
12 (27n3 %)
16 (36n4 %)
16 (36n4 %)
21 (44n7 %)
17 (36n2 %)
9 (19n1 %)
464 (65n0 %)
199 (27n9 %)
51 (7n1 %)
n001
15 (34n9 %)
15 (34n9 %)
13 (30n2 %)
20 (44n4 %)
8 (17n8 %)
17 (37n8 %)
539 (77n0 %)
114 (16n3 %)
47 (6n7 %)
n001
monthsa
Missing : 6.
Missing : 7.
Missing : 20.
p