Maternal Mental Health, Substance Use, and Domestic Violence in the Year After Delivery and Subsequent Behavior Problems in Children at Age 3 Years

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Mental health disorders, substance use, and domestic violence often occur together. However, studies examining the impact of these conditions in mothers on the well-being of their children have focused only on isolated conditions.


To examine the cumulative effect of maternal mental health disorders, substance use, and domestic violence on the risk of behavior problems in young children.


A birth cohort (1998–2000) followed up to age 3 years.


Eighteen large US cities.


At 3 years, 2756 (65%) were followed up from the population-based birth cohort of 4242. Thirty-six percent had annual incomes below the poverty threshold.

Main Outcome Measures

One year after delivery, mothers were asked questions about conditions in 3 categories: (1) mental health (major depressive episode and generalized anxiety disorder), (2) substance use (smoking, binge drinking, and illicit drug use), and (3) domestic violence (emotional and physical). At 3 years, mothers completed questions from the Child Behavior Checklist.


Fifty percent of mothers had a condition in at least 1 of the 3 categories. The prevalence of child behavior problems increased with the number of categories (0, 1, 2, or 3) in which the mother reported a condition: respectively, 7%, 12%, 17%, and 19% for aggression (P<.001); 9%, 14%, 16%, and 27% for anxious/depressed (P<.001); and 7%, 12%, 15%, and 19% for inattention/hyperactivity (P<.001). This graded risk persisted after adjustment for sociodemographic and prenatal factors and for paternal mental health and substance use.


The risk of child behavior problems increased with the number of areas—mental health, substance use, or domestic violence—in which the mother reported difficulties. Preventing behavior problems in young children requires family-oriented strategies that address the needs of both parents and their children.

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