Depression, Violence Formula For Poor School Performance

Kindergarteners who have depressed mothers and also experience domestic or community violence do more poorly in school than those exposed to either condition alone, according to a study by Boston University researchers.

Boys whose mothers reported more depressive symptoms and exposure to violence scored 7 percent to 10 percent lower on standards of reading, mathematics, and general knowledge than their peers, an effect comparable to that of lead poisoning or low birth weight.

“From the perspective of child outcome, considering maternal depression without considering violence potentially means ignoring a significant part of the problem,” wrote pediatrician Michael Silverstein, M.D., M.P.H., and three colleagues from Boston University's School of Medicine and School of Public Health.

The combination of risk factors is cumulative, said Paul J. Fink, M.D., a professor of psychiatry at Temple University and chair of the Philadelphia Youth Homicide Committee, in an interview. Moreover, the combination is common, given that there are 2.5 million reported cases of domestic violence every year, he said.

The researchers drew on a national representative sample of children in the 1998-1999 school year, part of the Early Childhood Longitudinal Survey. Their research was based on 12,083 mother-child pairs. Most pairs did not have a depressed mother or exposure to violence. However, 779 of the sampled pairs were exposed to violence only, 1,564 pairs had a depressed mother, and 380 pairs had a depressed mother and were exposed to violence.

“Violence” was defined as any exposure to domestic or community violence, but the dataset did not permit distinguishing between violence against children directly or their witnessing violence.

Children in the study had an average age of 6.25 years, mothers had an average age of 32.8 years, and there were an average of 1.5 siblings in the home. Among families exposed to maternal depression and violence, mothers were younger and their socioeconomic status lower, but the number of siblings was higher.

Considered by itself, maternal depression was significantly associated with poorer interpersonal skills and decreases compared with those not exposed in scores for reading, mathematics, and general knowledge among their children. Adjusting for violence attenuated the effect of maternal depression on reading, general knowledge, and externalizing behavior.

Mean T scores for reading, math, and general knowledge were lower among the dually exposed than those exposed to one factor. Boys did significantly worse than girls.

Doubly exposed children had substantially worse self-control (adjusted odds ratio: 0.42) than those singly exposed.

“We know that maternal depression can jeopardize children's functioning, but this adds further evidence to a compelling case,” said Howard Dubowitz, M.D., M.S., a professor of pediatrics at the University of Maryland Medical School in Baltimore, in an interview. Dubowitz was not involved in the study.

Because maternal depression and violence exposure were statistically uncommon, the study had a limited ability to detect interactions between the two factors.

“Previous reports might have overestimated the association between maternal depression and child behavior by not controlling for violence exposure,” wrote silverstein and colleagues.

The connection between these two risk factors and the children's behavioral and academic outcomes lies in maternal trauma symptoms, they suggested.“ The nuances of a mother's depressive illness that is comorbid with violence exposure or trauma symptoms may suppress nurturing parent-child interactions more than depression existing on its own.”

There may be important policy implications behind the study's results, said Dubowitz. “The recent national emphasis on testing and accountability in school has meant that less attention has been paid to other factors in the family and in communities that are a key to school problems,” he said.

APA is developing a recommendation to have every physician and mental health worker take an abuse history, said Fink. The U.S. Preventive Services Task Force recommends screening adults in primary care for depression but found insufficient evidence in 2004 to recommend for or against routine screening of parents or guardians for the physical abuse or neglect of children, or of women for intimate partner violence.

The American Academy of Pediatrics (AAP) issued a policy statement on screening for intimate partner violence in 1998, but its implementation varies around the country, said M. Denise Dowd, M.D., M.P.H., a research professor at the School of Life Science at the University of Missouri-Kansas City, speaking for the AAP.

“It's an idealistic standard, but there's no handle on how to accomplish it in the real world,” she said.

An abstract of “Maternal Depression and Violence Exposure: Double Jeopardy for Child School Functioning” is posted at<http://pediatrics.aappublications.org/cgi/content/abstract/118/3/e792>.▪