INCOME AND BENEFITS POLICY CENTER BRIEF
Maternal Depression Associated with
Less Healthy Dietary Behaviors in
Young Children
Tracy C. Vericker
February 2015
Maternal depression threatens the well-being of millions of children in the United States: one out of five
women with at least one child suffered from depression in 2002 (NRC and IOM 2009). Maternal
depression can interfere with positive parenting practices, many of which may have lasting
developmental consequences for children. Maternal depression or depressive symptoms are associated
with such negative parenting behaviors as shortened duration of breastfeeding, fewer well-child visits,
neglect, psychological aggression, and physical assault.
1
Maternal depression’s effects on parenting can have long-reaching harmful effects on children and
2
may damage their cognitive, social, and emotional development. Mothers’ depressive symptoms and
depression have also been linked to children’s internalizing and externalizing behavior problems
throughout childhood and adolescence, and they may jeopardize a child’s own mental health in
3
adulthood.
Maternal depression may also affect children’s physical health, particularly their risk of childhood
4
obesity. Many obese children become obese adults and are burdened by adverse health conditions,
5
including type II diabetes, hypertension, and certain forms of cancer. The medical costs associated with
adult obesity may be as high as $209.7 billion a year (in 2005 dollars)—20.6 percent of total US health
care expenditures (Cawley and Meyerhoefer 2012). While private payers bear most of the burden of
obesity costs, the taxpayer burden is nontrivial: if adult obesity were eliminated, spending on Medicare
and Medicaid could be 8.5 percent and 11.8 percent lower, respectively (Finkelstein et al. 2009).
The link between maternal depression or depressive symptoms and childhood obesity may be a
result of poor eating habits, though evidence is scant. Duarte and colleagues (2012) find that severe
maternal depression symptoms at different points during childhood are associated with high body mass
index (BMI) z-scores for children in fifth grade; among boys, fewer healthy eating practices may mediate
the relationship between maternal depressive symptoms in kindergarten and BMI in fifth grade.
This research builds on the work of Duarte and colleagues by investigating the relationship
between maternal depression and eating habits earlier in childhood, when food preferences are
developing. Specifically, this research asks if maternal depression is associated with poor dietary
behaviors in young children.
Data, Measures, and Analyses
The data for this study come from the Early Childhood Longitudinal Survey–Birth Cohort (ECLS-B), a
nationally representative survey of 14,000 infants born in 2001, administered by the Department of
6
Education. This study uses data from the fourth round of the survey in 2006, when focal children were
approximately 5 years old, yielding a sample of 5,100.
The ECLS-B is a complex survey design, sampling children from both primary and secondary
sampling units. To account for this complexity, all analyses include sampling weights to account for
clustering, and the Survey procedures in SAS 9.2 are used to adjust standard errors. Sample sizes are
rounded to the nearest 50, per disclosure requirements of the National Center for Education Statistics.
The presence of maternal depressive symptoms is measured using data from the 2006 parent
interview and is based on mothers’ responses to a modified version of the Center for Epidemiologic
Studies Depression Scale, or CES-D (Radloff 1977). The CES-D is a commonly used scale that measures
the frequency of depressive symptoms during the prior week. It is not equivalent to a clinical diagnosis
of depression. The cut points used to identify the presence and severity of depressive symptoms (mild,
moderate, and severe) are provided in the CES-D user’s manual (Nord et al. 2004).
Measures of children’s dietary behaviors are also drawn from the 2006 parent interview. Parents
are asked how often their children consumed fruits, vegetables, milk, sweet snacks, salty snacks, fast
food, and sweetened beverages (e.g., sports drinks, fruit drinks, soda) over the past seven days.
Responses to these questions are used to develop seven continuous outcome measures of the number
of times a child consumed these foods and beverages over seven days. Responses are also recoded to
examine whether children consume these foods and beverages every day.
Bivariate analyses are used to examine differences in characteristics of children, mothers, and
households between children whose mothers report depressive symptoms and children whose mothers
do not. Chi-square tests are used to measure statistically significant differences in dichotomous
variables, and t-tests are used to measure differences in continuous measures.
The associations between the presence of maternal depressive symptoms and children’s dietary
behaviors are assessed using ordinary least squares models with rich covariates; logistic regression is
used to estimate models with dichotomous outcome measures. All models account for the following
characteristics: child’s gender; mother’s race/ethnicity; presence of two biological parents in the
household; number of children under age 18 in the household; mother’s age at first birth; mother’s fulltime employment status; if household income is below 185 percent of the poverty level; level of
mother’s social support; if child has had a well-child visit since the last interview; if child spends time in a
2
MATERNAL DEPRESSION AND DIET QUALITY
child care arrangement each week; if child attends kindergarten; and if child participated in the Special
Supplemental Nutrition Program for Women, Infants and Children (WIC) up to his or her fifth birthday.
Prevalence and Severity of Maternal Depression
More than one-third (38 percent) of kindergarten-age children in the sample have a mother who has
recently experienced depressive symptoms; the prevalence of maternal depressive symptoms is
significantly higher in low-income households—those with incomes less than 185 percent of the poverty
level—than in higher-income households (46 percent versus 32 percent; see figure 1). Among mothers
with depressive symptoms, many (38 percent) experience moderate to severe symptoms, though most
(62 percent) experience mild depressive symptoms. The presence of moderate to severe maternal
depressive symptoms is also more common in low-income households than in higher-income
households: 46 percent versus 30 percent.
FIGURE 1
Prevalence of Depressive Symptoms among Mothers of Kindergarten-Age Children by Income, 2006 (%)
Mild symptoms
Moderate to severe symptoms
45.9
38.2
21.0
32.3
14.5
9.6
23.7
24.9
22.7
All children
< 185% of poverty level
≥ 185% of poverty level
Source: Tabulations derived from the fourth round of the 2001 Early Childhood Longitudinal Study–Birth Cohort (ECLS-B).
Notes: Tabulations are weighted to be nationally representative of children born in 2001. The sample is 5,100 kindergarten-age
children in 2006. Per National Center for Education Statistics guidelines, unweighted samples have been rounded to the nearest
50. Maternal depression is measured using mothers’ responses to a modified version of the Center for Epidemiologic Studies
Depression Scale. The cut points used to identify symptom severity are from the user’s manual for the ECLS-B (Nord et al. 2004).
MATERNAL DEPRESSION AND DIET QUALITY
3
Thirty-eight percent of kindergarten-age children have a mother who has recently
experienced depressive symptoms; such symptoms are significantly more prevalent in lowincome households than in higher-income households (42 percent versus 32 percent).
Characteristics of Mothers, Households, and
Kindergarten-Age Children
Mothers of kindergarten-age children who experience depressive symptoms are more likely to have
characteristics associated with disadvantage than their peers without depressive symptoms (table 1).
Compared with mothers who do not exhibit depressive symptoms, mothers who exhibit depressive
symptoms are more likely to have had children before age 18, live without their child’s biological father,
not complete high school, and live in a low-income household.
Mothers with depressive symptoms also report worse health outcomes than their peers who do not
report depressive symptoms. Mothers with depressive symptoms are more likely to report fair to poor
health, experience household food insecurity, and binge drinking.
Social isolation is also associated with depressive symptoms. These mothers have fewer resources
available when they need help with such activities as getting their children to the doctor or accessing
cash for an emergency.
Mothers with depressive symptoms use more negative discipline with their children. More than half
(52 percent) report spanking their children, compared with 41 percent of mothers without depressive
symptoms. More than one-third (34 percent) of mothers with depressive symptoms report hitting,
making fun of, or yelling or threatening their children, compared with 27 percent of mothers without
depressive symptoms.
Despite these challenges, mothers with depressive symptoms interact with several service systems.
One in three of these mothers lives in a household receiving Supplemental Nutrition Assistance
Program (SNAP) assistance, and nearly one in five (18 percent) reports that her child received benefits
from WIC up to age 5. Nearly all mothers report that their children are insured (95 percent), many by
Medicaid (38 percent). Most (93 percent) report that their kindergarten-age child has had a well-child
check-up since their last interview. The majority of their children (72 percent) attend kindergarten, and
many (52 percent) spend some time in a child care arrangement in a typical week.
Yet, few mothers reporting depressive symptoms receive help for their depression. Roughly onefifth (22 percent) of mothers reporting depressive symptoms have spoken with a professional about
psychological health problems in the past 12 months, and fewer (13 percent) have taken medication for
these problems.
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MATERNAL DEPRESSION AND DIET QUALITY
TABLE 1
Characteristics of Mothers, Households, and Kindergarten-Age Children by Presence of Maternal
Depressive Symptoms
Characteristic
Depressive
symptoms reported
(n = 2,050)
No depressive
symptoms reported
(n = 3,050)
Maternal/household characteristics
Mother's race/ethnicity (%)
White, non-Hispanic
Black, non-Hispanic
Hispanic
Other
Two biological parents in the household (%)
Number of children under age 18 in the household
Mother's age at first birth (%)
< 18
18–24
25 or older
Mother employed full-time (%)
Highest level of education of parents in the household (%)
Less than high school
High school
Some college or technical training
Bachelor's degree or higher
Household lives below 185% of the poverty level (%)
Someone in household received SNAP benefits last year (%)
Discipline methods (%)
Spank
Hit back, make fun of, or yell or threaten child
57.0
17.1
20.1
5.8
61.9
2.6
60.5*
11.7**
22.6
5.2
76.8**
2.5
15.4
50.0
34.6
41.9
10.4**
43.0**
46.6**
43.4
11.9
26.2
32.9
29.0
52.4
33.1
7.7**
23.4
30.1
38.8**
38.2**
16.9**
51.7
34.2
41.4**
27.0**
14.6
18.5
5.2**
4.2**
21.7
6.4**
12.5
12.9
15.3
4.1**
8.8**
15.9**
94.5
37.7
93.2
51.5
72.1
18.2
96.5**
26.5**
95.9**
52.8**
71.4
14.3**
Maternal health (%)
Mother in fair or poor health
Household is food insecure
Mother spoke to a professional about emotional or
psychological problems in the last 12 months
Mother takes medication daily for anxiety, depression, or
other emotional problems
Mother had four or more drinks in one sitting in past month
a
Social support scale (0–18, 0 = no support; mean)
Child characteristics
Covered by health insurance
Covered by Medicaid
Had well-child visit since last interview
Spends time each week in a child care arrangement
Attended kindergarten in 2006
Received WIC benefits up to age 5
Source: Tabulations derived from the fourth round of the 2001 Early Childhood Longitudinal Study-Birth Cohort (ECLS-B).
Notes: Tabulations are weighted to be nationally representative of children born in 2001. Per National Center for Education
Statistics guidelines, unweighted samples have been rounded to the nearest 50. Maternal depression is measured using mothers’
responses to a modified version of the Center for Epidemiologic Studies Depression Scale. The cut point used to identify presence
of depressive symptoms is provided by the user’s manual for the ECLS-B (Nord et al. 2004).
a. Respondents were asked to rate their social support systems on a three-point scale (never true, sometimes true, and always
true) for six items. Ratings were converted into an 18-point scale, with 0 meaning no support and 18 meaning full support.
*p < 0.01., **p < 0.05.
MATERNAL DEPRESSION AND DIET QUALITY
5
Associations between Mothers’ Depressive Symptoms
and Their Kindergarten-Age Children’s Eating Practices
Reported maternal depressive symptoms are associated with poor eating habits, based on bivariate
comparisons of the consumption patterns of kindergarten-age children (table 2). Over seven days,
children whose mothers report depressive symptoms consume
vegetables less often (64 percent every day) than children of mothers reporting no depressive

symptoms (67 percent every day);
milk less often (14.3 times a week; 81 percent every day) than children of mothers reporting no

depressive symptoms (15.0 times a week; 85 percent every day);
sweetened beverages more often (5.1 times a week; 33 percent every day) than children of

mothers reporting no depressive symptoms (4.1 times a week; 26 percent every day); and
sweet snacks more often (6.6 times a week; 49 percent every day) than children of mothers

reporting no depressive symptoms (6.0 times a week; 44 percent every day).
Though children of mothers with depressive symptoms eat fruit the same number of times each
week as children of mothers with no depressive symptoms, children whose mothers report moderate to
severe depressive symptoms consume fruit less often than children whose mothers do not report
depressive symptoms (9.2 versus 10.1 times a week; data not shown). Consumption of salty snacks and
fast food does not differ between children whose mothers report depressive symptoms and those
whose mothers do not.
Reported maternal depressive symptoms are associated with a number of adverse conditions,
particularly low-income status, as shown in table 1. Models controlling for these adverse conditions as
well as other possible confounders better assess the relationship between maternal depression and
children’s consumption patterns (middle column of table 2). Even after holding these factors constant,
all statistically significant bivariate findings remain.
Discussion
Maternal depression affects the social, emotional, and physical health of many children. This study
examines the potential association between maternal depressive symptoms and consumption of
healthy and unhealthy foods by kindergarten-age children. Results suggest that many children live with
mothers who report depressive symptoms and few of their mothers receive treatment for their
symptoms. Mothers with reported depressive symptoms are faced with numerous challenges, including
having low income, food insecurity, and weak social support networks. Young children with mothers
reporting depressive symptoms consume more unhealthy foods and beverages and fewer healthy foods
6
MATERNAL DEPRESSION AND DIET QUALITY
and beverages than children with mothers who do not report depressive symptoms, even after
accounting for numerous confounding challenges such as low-income status.
Parents play an important role in establishing healthy eating habits for their children early in life
(Sealy and Farmer 2011; Ventura and Birch 2008). A mother’s depression, or the challenges that coexist
with depression, may interfere with her ability to provide healthy food and beverages for her children
and to model healthy eating behaviors, possibly leading to unhealthy eating habits that continue later in
her children’s lives.
TABLE 2
Consumption Patterns of Kindergarten-Age Children by Presence of Maternal Depressive Symptoms
Depressive symptoms reported
(n = 2,050)
Number of times consumed in previous
seven days
Fruits
Vegetables
Mean
9.8
8.9
Milk
Sweet snacks
Salty snacks
Fast food
Sweetened beverages
14.3**
6.6**
4.8
2.2
5.1**
Consumed every day in the previous
seven days
Fruits
Vegetables
Milk
Sweet snacks
Salty snacks
Fast food
Sweetened beverages
Mean
68.6
63.5*
81.0**
48.9*
33.5
7.2
33.1**
a
a
b
OLS estimate (SE)
-0.33 (0.275)
-0.28 (0.265)
-0.76** (0.343)
0.56* (0.308)
0.12 (0.232)
0.07 (0.113)
0.62** (0.239)
b
Odds ratio (SE)
0.93 (0.337)
0.85* (0.087)
0.77** (0.116)
1.22** (0.097)
1.07 (0.112)
1.03 (0.029)
1.22** (0.201)
No depressive symptoms
reported (n = 3,050)
Mean
10.1
8.9
15.0
6.0
4.5
2.0
4.1
Mean
70.7
67.1
85.4
44.4
30.1
6.9
25.8
Source: Tabulations derived from the fourth round of the 2001 Early Childhood Longitudinal Study-Birth Cohort.
Notes: Tabulations are weighted to be nationally representative of children born in 2001. Per National Center for Education
Statistics guidelines, unweighted samples have been rounded to the nearest 50. Maternal depression is measured using mothers’
responses to a modified version of the Center for Epidemiologic Studies Depression Scale. The cut points used to identify the
presence and severity of depressive symptoms are from the user’s manual for the ECLS-B (Nord et al. 2004).
SE = standard error.
a. The reference group is no depressive symptoms.
b. The model is estimated with the following controls: child’s gender; mother’s race/ethnicity; presence of two biological parents
in the household; number of children under age 18 living in the household; mother’s age at first birth; mother’s full-time
employment status; if household income is below 185 percent of the poverty level; level of mother’s social support; if child had
well-child visit since last interview; if child spends time in a child care arrangement each week; if child attends kindergarten; and if
child participated in WIC up to his or her fifth birthday.
* p < 0.1; **p < 0.05.
MATERNAL DEPRESSION AND DIET QUALITY
7
The link between maternal depression and unhealthy dietary patterns among children may shed
important light on the childhood obesity epidemic, a condition that partly stems from diets high in fats
and sugars and low in fresh fruits and vegetables and whole grains (Bradlee et al. 2010; Kröller and
Warschburger 2009). A mother suffering from a lack of energy, fatigue, or other depression symptoms
may feed her children more convenient, but often unhealthy, foods and beverages. Sweetened beverage
consumption may be particularly problematic, as some studies have shown a positive association
between consumption of sugar-sweetened beverages and child obesity (Grimes et al. 2013; Ludwig,
Peterson, and Gortmaker 2001). These unhealthy eating habits are an additional lens to examine the
harmful two-generational impact of maternal depression and to provide further motivation to better
link depressed mothers to effective treatment.
Two limitations of this research are noteworthy. First, this study uses cross-sectional data. While
every attempt has been made to control for potential confounding variables in the multivariate analysis,
omitted variables may explain the relationship between maternal depression and children’s food and
beverage consumption; therefore, results from this research should be cautiously interpreted as
associations and not causal effects. Second, because the measure of maternal depression is selfreported symptoms, not a clinical diagnosis of depression, this study likely overstates the number of
mothers who are clinically depressed.
Conclusions
This study provides further evidence that maternal depression may have a damaging effect on the
health of children. With so many mothers reporting depressive symptoms and so few receiving
treatment, the room for improvement is considerable. In particular, there are opportunities to better
serve low-income depressed mothers. Many of these mothers are newly eligible to receive Medicaid
coverage under the Patient Protection and Affordable Care Act, opening up the possibility of increasing
depression screenings and treatment.
Acknowledgments
The research upon which this brief is based was funded by the Doris Duke Charitable Foundation. The
author is grateful to Olivia Golden and Marla McDaniel for their thoughtful comments and review and
to Christopher Lowenstein for his research assistance.
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MATERNAL DEPRESSION AND DIET QUALITY
Notes
1.
For breastfeeding, see Dennis and McQueen (2009) and Henderson et al. (2003); for well-child visits, see
Minkovitz et al. (2005). For neglect, see Lovejoy et al. (2000) and Turney (2010); for psychological aggression,
see Feng et al. (2007); and for physical assault, see Berger (2005) and Silverstein et al. (2009).
2.
See, for example, Center on the Developing Child at Harvard University (2009), NRC and IOM (2009), and
Kiernan and Huerta (2008).
3.
See Turney (2011) and Weissman et al. (2006).
4.
See, for example, Wang et al. (2013), Milgrom et al. (2011), and Topham et al. (2010).
5.
“Basics about Childhood Obesity,” Centers for Disease Control and Prevention, accessed November 24, 2014,
http://www.cdc.gov/obesity/childhood/basics.html.
6.
The ECLS-B provides detailed information about the early life experiences of these focal children, following
them from birth through kindergarten. Information was collected from parents, child care providers, and
teachers as well as from direct assessments of children and home observations conducted by interviewers
when the focal children were 9 months, 24 months, 4 years, and 5 years old. Data collection for 5-year-olds
occurred in 2006, and a subset of data were collected in 2007 to capture early school experiences of children
who did not attend kindergarten in 2006. For more information on the ECLS-B, see Snow et al. (2009).
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About the Author
Tracy C. Vericker is a senior research associate at the Urban Institute with over a
decade of experience in policy research and evaluation. Focusing on policies and
service systems to support vulnerable children and families, she specializes in survey
and administrative data management and has led several projects involving complex
quantitative analyses. Vericker has substantive expertise in food and nutrition policy
and programs. Her work falls into two broad categories: research to support positive
health outcomes and research to support improvement of administrative procedures
to reduce inefficiencies and encourage participation in the federal food and nutrition
programs.
Before joining the Urban Institute, Vericker was a Presidential Management Fellow at
the Food and Nutrition Service and the Economic Research Service at the USDA. She
received her PhD in public policy and administration from The George Washington
University in 2011.
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11