A study on different maternal diagnoses and their weight on children functioning, considering paternal role

1. ORIGINAL ARTICLE
Mothers with Depression, Anxiety or Eating Disorders: Outcomes
on Their Children and the Role of Paternal Psychological Profiles
Silvia Cimino • Luca Cerniglia • Marinella Paciello
! Springer Science+Business Media New York 2014
Abstract The present paper aims to longitudinally assess
the emotional functioning of children of mothers with
depression, anxiety, or eating disorders and of mothers with
no psychological disorders and to evaluate the possible
mediating role of fathers’ psychological profiles on chil-dren’s
internalizing/externalizing functioning using SCID
I, SCL-90/R and CBCL/1!-5. The results showed maternal
psychopathology to be strongly related to children’s mal-adaptive
profiles. Children of mothers with depression and
anxiety showed higher internalizing scores than children of
other groups. These scores increased from T1 to T2.
Children of mothers with eating disorders showed higher
and increasing externalizing scores than children of other
groups. The data showed that fathers’ interpersonal sensi-tivity,
depression, anxiety and psychoticism significantly
predicted internalizing problems of the children. Moreover,
interpersonal sensitivity and psychoticism significantly
predicted externalizing problems. Our results confirmed the
impact of maternal psychopathology on maladaptive out-comes
in their children, which suggests the importance of
considering paternal psychological profiles.
Keywords Infancy ! Maladaptive functioning ! Paternal
psychological profile
Introduction
The international scientific literature points to parental
psychopathology as a crucial risk factor for the develop-ment
and maintenance of emotional and behavioral prob-lems
in children in the first years of life [1]. Douglas [2]
states that the more severe mothers’ and fathers’ mental
issues are, the faster the child will develop behavioral
problems. Additionally, Riahi Amini and Salehi Veisi [3]
found a positive correlation between maternal symptoms
and children’s behavioral problems. An intensification in
maternal symptoms increases their children’s behavioral
problems, especially when their fathers’ psychological
profiles are at risk and the paternal involvement in child
rearing is scarce. In particular, many studies have focused
on the influence of maternal depression on internalizing
problems in children, on the impact of maternal eating
disorders (EDs) on children’s mental health [4, 5], and
have considered the possible role of paternal psychopa-thology
as a mediating variable [6].
Some studies have found that mothers afflicted by major
depression or panic disorder most likely have children who
suffer from emotional behavioral problems. Moreover,
maternal depression is associated with depressive disorder,
social phobia, disruptive behavior, separation anxiety,
multiple anxiety disorder and compromised social function
in children; maternal panic disorder is associated with
panic disorder, acrophobia, separation anxiety and multiple
anxiety disorder in children [7, 8]. It is suggested that these
results are mediated by protective or risk factors related to
paternal psychological functioning and/or the quality of
father–infant attachment [9].
Murray et al. [10] demonstrated that maternal depres-sion
in the early postpartum months was the best predictor
of child behavioral problems, which were not influenced by
S. Cimino
Department of Dynamic and Clinical Psychology, ‘‘Sapienza’’
University of Rome, Rome, Italy
e-mail: silvia.cimino@uniroma1.it
L. Cerniglia (&) ! M. Paciello
Department of Psychology, International Telematic University
Uninettuno of Rome, Rome, Italy
e-mail: l.cerniglia@uninettunouniversity.net
M. Paciello
e-mail: m.paciello@uninettunouniversity.net
123
Child Psychiatry Hum Dev
DOI 10.1007/s10578-014-0462-6

2. current maternal depression but mediated by fathers’
involvement. Moreover, Luoma et al. [11] conducted a
longitudinal analysis in Finland, and the results showed
that prenatal maternal depression was associated with
higher levels of child behavioral problems and that prenatal
and recurrent maternal depressive symptoms led to the
most negative child outcomes in absence of protective
factors provided by the fathers. By the preschool years,
children exposed to chronic maternal depression had higher
levels of parent-reported internalizing and externalizing
behavioral problems.
A meta-analysis demonstrated that the relationship
between maternal depression and conduct problems
extends to adolescence. In addition, maternal depression
has been shown to mediate the relationship between
exposure to community violence and adolescent behavioral
problems, which highlights its powerful effect on long-term
child outcomes [12–17].
Regarding studies of maternal eating disorders, an
increased incidence of early feeding disorders has been
shown in children whose mothers were more intrusive and
controlling in the feeding context and had difficulties rec-ognizing
the child’s signals of hunger and satiety and
regulation of the affective states of the child [18–23].
These results proved to be particularly severe in the pre-sence
of psychopathological symptoms in the partners of
women with EDs because they appear to facilitate the onset
of emotional disorders in their children [24].
Indeed, Maldonado-Dura`n [25] found that caregivers
(both mothers and fathers) had more difficulties in
expressing positive affect in families with children with
feeding disorders. These caregivers showed more negative
affect and a lower ability to read the communication sig-nals
of the child. Furthermore, the children revealed
problematic characteristics in their feeding patterns, diffi-culty
regulating their state during meals, temperamental
difficulties, and behavioral problems such as opposition,
negativity, and stubbornness.
Although some researchers have found that children of
depressed or anxious parents are themselves at a substan-tially
increased risk (twofold to fivefold) of psychiatric
disorders [26–29], there are currently few studies that focus
on maternal anxiety disorder (not otherwise specified).
Moreover, there are few longitudinal studies that examine
the emotional-adaptive development of children with
mothers and/or fathers with psychopathological difficulties.
As shown above, the research that has examined pater-nal
psychopathology has suggested that it may play a
crucial role in the quality of caregiving by modulating and
integrating with interactional mother–infant patterns. In
particular, Elgar, Mills and McGrath [30] note that a father
with psychopathologic symptoms who shows a low level of
responsiveness to his children may be a risk factor for the
Child Psychiatry Hum Dev
onset of children’s maladaptive behavior. Indeed, Pinquart
and Teubert [31] state that a combination of maternal and
paternal psychopathologies may create a style of co-par-enting
dominated by negative interactive cycles with the
children. On the other hand, adaptive paternal psycholog-ical
functioning may be a protective factor against the
development of psychopathologies in children by facili-tating
mothers’ understanding of their children’s needs
[32]. However, although the role of fathers have been
increasingly considered in recent years, it seems useful to
deepen the study of paternal psychopathological risk as a
possible mediating variable in the onset of impaired
adjustment in children, especially in the presence of spe-cific
maternal psychological difficulties [33].
Based on these theoretical premises, a longitudinal study
is proposed here to assess the impact of specific maternal
psychopathology on specific frameworks of child func-tioning
that deepens the role of paternal psychopathologi-cal
risk over time.
In particular, the present prospective study has set the
following specific objective:
• to assess the adaptive emotional functioning (internal-izing,
externalizing) of children of mothers with
depression, anxiety, and eating disorders and of moth-ers
with no psychological disorder considering the
possible impact of the fathers’ psychological profiles
over time on children’s internalizing/externalizing
functioning.
Methods
Sample
To recruit the sample for our study, we planned two sub-sequent
sessions of assessment. In a period of 1 year (T1),
N = 251 families were recruited through nurseries, pri-mary
schools (N = 146) and mental health clinics
(N = 105) in Central Italy. Families with children in the
first 3 years of life were contacted by a group of trained
psychologists who described the purposes and methods of
the study, gave explanations about the questionnaires to be
administered and gathered an informant consent from all
the participants. Thanks to the collaboration of teachers
and mental health workers, all the parents in schools and
clinics were informed of the possibility of participating in
the research. We administered all the sections of the SCID I
(Non-Patient Edition) [34] to the mothers. The SCID II,
which assesses personality disorders, was not administered.
Our sample is divided into four subgroups: (a) three clin-ical
subgroups were composed by families in which the
mothers suffered from Anxiety Disorder (N = 42),
123

3. Depression Disorder (N = 39) or Eating Disorder
(N = 44) without a comorbidity disorder and (b) families
in which the mothers received no diagnosis (N = 126). We
chose not to include mothers who were pursuing treatment
to avoid the bias of the effect of a psychotherapeutic
intervention over time on the families’ dynamics (N = 9).
Consistent with several perspective studies [35], the
drop-off rate in the sample at the second time point (T2,
3 years after) was *45 % of the original number of sub-jects.
We excluded the families with missing data in their
administered questionnaires (N = 54). Thus, at T2 we
assessed N = 80 families. The four groups have been then
paired by age of the children, age of the mothers and the
families’ socio-economic status.
The sample presented for the present study is composed
of N = 80 families with firstborn children with a mean age
of T1 = 2.3 years (SD = 1.1) and T2 = 5.1 (SD = .08).
Most of the parents (87 %) were of middle socio-eco-nomic
status (SES) [36]. Sixty-eight percent of the parents
lived together; 88 % of the fathers and 71 % of the mothers
worked; 83 % of the children went to nursery or kinder-garten;
88 % of the children have been breast-fed. All the
partners of the mothers recruited for the present study were
the biological fathers of the children, and all parents were
Caucasian. The mean age of the fathers at T1 was
35.3 years of age (SD = 2.5), and the mean age of the
mothers at T1 was 33.2 years of age (SD = 3.1).
Tools and Procedures
The assessment was administered face-to-face by a group
of trained psychologists who visited the families at their
home or at mental health clinics. During these visits, a set
of self-report and report-form tools were administered, and
all the parents signed an informed consent for all the
procedures.
At the evaluation times (T1 and T2), the parents of both
the Clinical Groups and the Non Clinical Group were
administered the following tools:
SCL-90-R: The Symptom Checklist-90-Revised (SCL-
90-R) is a 90-item self-report symptom
inventory aimed to measure psychological
symptoms and psychological distress [37].
The main symptom dimensions are
Somatization, Obsessive–Compulsive, Inter-personal
Sensitivity, Depression, Anxiety,
Hostility, Phobic Anxiety, Paranoid Ideation
and Psychoticism. The internal coherence
tested within a sample of adolescent and
adults is satisfying (alpha between .70 and
.96), and the clinical cut-off =1 [38]
CBCL: The Child Behavior Checklist (CBCL) is a
questionnaire filled out by parents and
caregivers to assess a child’s abilities
and his/her specific behavioral/emotional
characteristics. The CBCL/1!-5 [39] is
composed of 100 items. The Internalizing
Problem Scale consists of the Emotionally
Reactive, Anxious/Depressed, Somatic
Complaints and Withdrawn Subscales. The
Externalizing Problem Scale is composed of
the Attention Problems and Aggressive
Behavior subscales. The CBCL/1!-5 has a
high test–retest reliability and a high internal
consistency [39] (Italian validated version
and Italian cut-offs, 40). Each parent
independently completed the questionnaires
at T1 and T2
Analyses
Before performing the analyses, the variables’ normality
and the congruence between the mothers’ and fathers’
evaluations of the child’s internalizing and externalizing
problems were preliminarily ascertained. All the variables
were normally distributed, and the correlations among the
mothers’ and fathers’ evaluations on the children’s CBCL
dimensions were highly and significantly correlated ([.30).
Thus, we decided to aggregate the mothers’ and fathers’
scores on the CBCL using mean scores.
We began the analyses by examining the stability and
change of the children’s internalizing and externalizing
problems over time for each group of mothers with a
specific disorder (anxiety, depression and eating disorders)
and without diagnosis (normative group). Specifically, we
examined the mean score differences from Time 1 to Time
2 on the children’s problems by performing repeated
measure analyses of variance using time as a within-subject
factor and group as a between subject factor. Moreover, a
one-way ANOVA was used to test the differences among
the groups on internalizing and externalizing dimensions
separately for each time. Then, we examined how the
fathers’ psychological profiles at T1 were associated with
the children’s internalizing and externalizing problems by
performing correlation analyses and standard regressions
with the fathers’ variables as predictors. Moreover, we
examined whether and how the fathers’ SCL-90-R sub-scales
were associated with the mothers’ disorders at Time
1 by analyzing the point-biserial correlation coefficients.
Finally, to test the influence of the mothers’ disorders and
the fathers’ psychological risk on internalizing and exter-nalizing
children’s problems, four hierarchical regression
analyses were performed separately for the two assessment
Child Psychiatry Hum Dev
123

4. points (T1 and T2). In all the regression models, the pre-sence/
absence of each specific disorder of the mother was
entered at step 1 and the fathers’ scores on the SCL-90-R
subscales were entered at step 2. We also evaluated the
influence of the interaction of the mothers’ and fathers’
characteristics on the children’s internalizing and exter-nalizing
problems by entering the product of each mothers’
disorders and each fathers’ SCL-90-R subscale at T1 at
step 3. These analyses revealed no statistically significant
interactions.
Results
Mothers’ Disorders and Children’s Internalizing
and Externalizing Problems
The repeated analyses results indicated that the children’s
internalizing and externalizing scores were not stable over
time [F(1,80) = 74,42; p= at p.001 with an eta square
of .48 and F(1,80) = 9,87; p= at p.01 with an eta square
of .11, respectively] and that there were significant inter-action
between time and group [F(1,80) = 12,31; p= at
p.001 with eta square .32 and F(1,80) = 11,81; p= at
p.001 with eta square .31, respectively]. More specifi-cally,
the multiple comparison tests indicated that the
internalizing problems tended to increase over time for all
the children. This result was particularly strong in the
group of mothers with depression, but the children’s
externalizing problems tended to increase over time only in
the group of mothers with an eating disorder (Table 1).
Analyses on the children’s psychological profile showed
significant differences on both internalizing [Time 1:
F(3,80) = 26,65; p= at p.001 with an eta square of .50;
Time 2: F(3,80) = 30; p= at p.001 with an eta square of
.53] and externalizing problems [Time 1: F(3,80) = 37,43;
p= at p.001 with an eta square of .58; Time 2:
F(3,80) = 34,27; p= at p.001 with an eta square of .56].
Child Psychiatry Hum Dev
The significant differences are that (a) the children of
mothers of the three clinical groups showed higher inter-nalizing
scores than did those of the normative group that
(b) the children of mothers with depression and eating
disorders showed higher externalizing scores than did those
of the normative group or anxiety group. More specifically,
at Time 2, the children of mothers with depression showed
higher internalizing scores than did other children, but the
children of mothers with an eating disorder showed higher
externalizing scores than did other children. The normative
group showed the lowest internalizing and externalizing
problems at both time points.
Fathers’ Psychological Profile and Their Child’s
Problems
Regarding the possible associations between the fathers’
psychopathological risk and their children’s psychological
problems at both T1 and T2, correlational analyses attested
that (a) interpersonal sensitivity and depression dimensions
were significantly and positively associated with both
internalizing and externalizing problems, that (b) obses-sive–
compulsive and anxiety dimensions were significantly
and positively associated with internalizing problems and
negatively associated with externalizing problems, and that
(c) psychoticism and hostility dimensions were particularly
associated with externalizing problems (Table 2). The
results of the regression analyses also attested to the
influence of the fathers’ psychological scores on their
child’s problems, which confirmed some associations. The
fathers’ interpersonal sensitivity, depression, anxiety and
psychoticism significantly predicted internalizing problems
of their child at both Time 1 (45 % of explained variance)
and Time 2 (48 % of explained variance). Moreover, at T1,
interpersonal sensitivity and psychoticism significantly
predicted externalizing problems (51 % of explained vari-ance),
and hostility and psychoticism significantly pre-dicted
externalizing problems at Time 2.
Table 1 Means (SD) of child’s internalizing and externalizing problems by mother’s group at Time 1 and Time 2
Internalizing problems (clinical cut off[16) Externalizing problems (clinical cut off[21)
T1 T2 T1–T2 T1 T2 T1–T2
Anxiety disorder 19.6 (6.2) a 21.2 (5.6) a ** 6.31 (5.7) a 5.71 (3.5) a ns.
Depression disorder 17.7 (5.5) a 23.1 (6.9) a *** 27.29 (13.0) b 26.54 (14.3) b ns.
Eating disorder 17.93 (8.0) a 19.1 (8.0) a * 25.57 (12.5) b 30.20 (15.2) b ***
Normative 5.24 (2.7) b 6.9 (3.1) b ** 2.98 (1.7) a 4.21 (2.1) a ns.
Total sample 15.12 (8.18) 17.61 (8.8) 15.55 (14.47) 16.62 (15.73)
The letters indicate significant differences among the group
T1 Time 1, T2 Time 2, T1–T2 difference from Time 1 to Time 2, Fisher F ANOVA at each time, g2 eta square
*** p.001; ** p.01; * p.05; ns not significant
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5. Child Psychiatry Hum Dev
Table 2 Regressions and point-biserial correlations on fathers’ dimensions, child’s problems and mothers’ disorders
Impact of Mothers’ Disorders and Fathers’
Psychological Profiles on Their Children’s Internalizing
and Externalizing Problems
The correlation results suggested that there were significant
associations between the fathers’ dimensions and the
mothers’ disorders. In particular, the fathers’ interpersonal
sensitivity and depression were very significantly and
positively related to the mothers’ depression disorder. The
fathers’ anxiety and obsessive–compulsive symptoms were
very significantly and positively related to the mothers’
anxiety disorder. Finally, the fathers’ hostility and psych-oticism
were very significantly and positively related to the
mothers’ eating disorder (Table 2).
As shown in Table 3, all the regression models attested
that the mothers’ disorder significantly predicts their chil-dren’s
outcomes, concurrently (51 and 60 % of the
explained variance for internalizing and externalizing
problems, respectively) and longitudinally (54 and 66 % of
the explained variance for internalizing and externalizing
problems, respectively). In particular, the mothers’ eating
disorders and depression significantly and positively
influence their children’s externalizing and internalizing
problems; instead, the mothers’ anxiety significantly and
positively influences only their child’s internalizing prob-lems.
Moreover, after controlling the mothers’ disorders,
the fathers’ psychological profiles significantly predicted
their children’s outcomes (explaining between 09 and
12 % of the variance) with the only exception of exter-nalizing
problems at Time 2. In particular, the fathers’
interpersonal sensitivity and anxiety are significantly and
positively associated with their child’s internalizing prob-lems
and mediate the influence of the mothers’ depression
disorder, but the fathers’ obsessive–compulsive dimension
is significantly and negatively related to their child’s
externalizing problems at Time 1.
Discussion
The present paper aimed to assess the impact of specific
maternal psychopathology on particular frameworks of
their children’s functioning by considering the role of
paternal psychopathological risk over time.
Our results are in line with the international scientific
literature that suggests that mothers’ psychopathology can
foster their children’s emotional and behavioral problems,
which increase in their severity during development [3]. In
fact, in our study, the children of mothers with a diagnosis
showed significantly higher scores on all internalizing and
externalizing dimensions than did the healthy group chil-dren
at both Time 1 and Time 2. In particular, the data
show that specific diagnoses in the mothers are related to
precise maladaptive emotional and behavioral patterns in
their children.
In Figs. 1, 2 and 3, we present a graphical representation
of our main findings from regression analyses:
As shown in Fig. 1, we did not find a significant and
direct effect of maternal depression on their child’s emo-tional/
behavioral functioning if considered together with
the paternal psychopathological risk. Rather, our results
show that the fathers’ interpersonal sensitivity predicts
their children’s internalizing problems. This result is con-sistent
with Lovejoy and colleagues’ work [41] that sug-gested
that, in specific family configurations, fathers’
psychopathological risk could have an even more severe
Mean
(SD)
Internalizing problems Externalizing problems Mother disorder
T1 T2 T1 T2 Anxiety Depression Eating
R b r b r b r b r R r
Somatization (F) .48 (29) .28** Ns .26** Ns .10 Ns .15* Ns -.04 .08 .07
Obsessive–
compulsive (F)
1.0 (1.0) .35*** Ns .27** Ns -.39*** -.37? -.38*** Ns .80*** -.25* -.30*
Interpersonal
sensitivity (F)
.86 (1.0) .24* .35* .40*** .36* .44*** .36* .37*** Ns -.33** .88*** -.32*
Depression (F) .99 (.98) .28** .31* .44*** .43** .46*** Ns .39*** Ns -.25* .90*** -.32*
Anxiety (F) .88 (.99) .40*** .57** .32** .56** -.34*** Ns -.33** Ns .79** -.24* -.28*
Hostility (F) .88 (.94) .22* Ns .13 Ns .45*** Ns .56*** .31* -.36** -.16 .81***
Phobic anxiety (F) .32 (.37) .06 Ns .09 Ns .16 Ns .17 Ns -.16 .22* -.07
Paranoid ideation (F) .53 (.42) .11 Ns .15 Ns .10 Ns .11 Ns -.20 .26* -.09
Psychoticism (F) .81 (1.0) .22* .38* .13 .39* .41*** .51*** .52*** .51** -.29* -.25* .88***
b regression beta coefficients, F fathers’ dimensions at Time 1, T1 Time 1, T2 Time 2
*** p.001; ** p.01; * p.05; ? p.06
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6. Table 3 Parents’ impact on their child’s internalizing and externalizing problems at Time 1 and Time 2
Child Psychiatry Hum Dev
Internalizing problems Externalizing problems
Time 1 Time 2 Time 1 Time 2
b1 b2 R Ch. b1 b2 R Ch. b1 b2 RCh. b1 b2 R Ch.
Step 1
Anxiety disorder (M) .67*** .49*** .51*** .59*** .45** .54*** Ns .52*** .60*** Ns Ns .66***
Depression disorder (M) .76*** Ns. .87*** Ns .75*** .67*** .49*** Ns
Eating disorder .68*** .66*** .57*** .59*** .73*** .51** .87*** .51***
Step 2
Somatization (F) Ns. .12* Ns. .10* Ns .09* Ns. .06
Obsessive–compulsive (F) Ns. Ns. -.45*** Ns.
Interpersonal sensitivity (F) .40** .36* Ns Ns.
Depression (F) Ns. Ns. Ns Ns.
Anxiety (F) .37? .38* Ns Ns.
Hostility (F) Ns. Ns. Ns Ns.
Phobic anxiety (F) Ns. Ns. .15? Ns.
Paranoid ideation (F) Ns. Ns. Ns Ns.
Psychoticism (F) Ns. Ns. Ns Ns.
R2 .62*** .64*** .69*** .73***
AR2 .57 .57 .64 .68
R Ch R change, b1 beta at step 1, b2 beta at step 2, R2 = R square, AR adjusted R2, Ns not significant, M mother’s disorders at Time 1
(1 = presence; 0 = absence), F fathers’ psychological dimensions at Time 1
*** p.001; ** p.01; * p.05;? p.06
Fig. 1 Conceptual model—mothers with depression Fig. 2 Conceptual model—mothers with anxiety
impact on their children’s psychological functioning than
does maternal depression. It is possible that the reciprocally
influencing relationship we found between the mothers’
depression and the fathers’ interpersonal sensitivity might
express a maladjustment in the couple functioning, which
in turn could reflect on the fathers’ capacity for quality
interactions with his son or daughter; poor caregiving has
been widely recognized to be a predictor of infants’
internalizing (and externalizing) problems [42].
Figure 2 shows that the mothers’ and fathers’ anxiety
significantly and directly predicts their children’s
internalizing problems. It is important to note that psy-chological/
psychopathological difficulties of mothers and
fathers are connected with a bidirectional influence in our
sample; thus, we can hypothesize in agreement with the
studies of Weissmann et al. [26] that parents often share a
specific psychological difficulty whose cumulative weight
impairs their child’s emotional and behavioral functioning
in the direction of internalizing problems.
Figure 3 shows that maternal eating disorders predict
externalizing problems in children. Paternal psychoticism
does not predict children’s problems, but it is reciprocally
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7. Child Psychiatry Hum Dev
connected to maternal disorders. In this case, it is possible
hypothesize that mothers’ eating disorders have such an
intense impact on their children’s psychological function-ing
that the weight of paternal psychopathological risk is
lost. In line with the studies of Sarkadi and colleagues [43],
we can suppose that the mother is most likely responsible
for feeding the child (with fathers less often involved in the
feeding of young children) and that this specific maternal
disorder powerfully impacts the child’s emotional and
behavioral functioning because the mother–infant dyad
interacts every day in supposedly difficult interactions
during meals.
These results highlight the importance of assessing the
whole family (mother, father and children) over time and
the significance of an early intervention because our study
indicates an increase in children’s maladaptive psycho-logical
profiles from T1 to T2 that could be avoided with
well-timed clinical work [25]. The interesting bidirectional
relationship between maternal and paternal psychopatho-logical
symptoms (as discussed above) must be more
specifically addressed in a future study because we
hypothesize that it influences the general functioning of the
family and particularly the parents’ caregiving quality,
which in turn is connected to possible maladaptive out-comes
in their children. This issue is relevant for the
organization of intervention practices that must involve the
whole family and assess possible marital maladjustment
[44] to better understand how various psychopathological
maternal and paternal symptoms can interact and impact
the psychological welfare of their children.
Our study has several strengths. It considered various
maternal diagnostic groups and their effects on their chil-dren’s
emotional/behavioral functioning over time, but it
also measured the possible mediating effect of paternal
psychopathology. Both parents completed the CBCL, but
many previous studies included self-report questionnaires
completed only by the mother. Our study has some limi-tations.
The study has a homogeneous sample, which
included only Caucasians of middle socio-economic status
with mainly two traditional working parents. Moreover, we
did not administer the SCID-II to assess personality dis-orders
in the mothers, and we did not evaluate the severity
of the mothers’ diagnosis with a specific tool. We did not
administer the SCID I to fathers but relied on the SCL-90-
R self-report questionnaire, whose scores were not con-firmed
by other tools and/or clinical interviews adminis-tered
by trained psychologists. We did not directly observe
the children’s behavior and characteristics but used a
widely used and validated report-form questionnaire. We
also did not address possible differences in the psycho-logical
functioning of the sons or daughters of mothers
with eating disorders or of mothers with other diagnoses as
the international literature suggests [45]. These limitations
constitute a motivation to continue our research and take
samples of mothers with comorbidities into consideration.
Summary
Several authors suggest that parents’ psychopathology can
foster the onset of maladaptive psychological profiles in
their children. It has been demonstrated that children’s
psychological difficulties tend to increase over time, par-ticularly
in families in which the mother suffers from
depression, anxiety or eating disorders. It has also been
suggested that fathers’ psychopathological risk may be a
risk factor for the onset of difficulties in their children. The
present study focused on assessing the emotional func-tioning
of the children of mothers with various diagnoses
and of mothers with no psychological disorder while con-sidering
the possible mediating role of the fathers’ psy-chological
profiles on their children’s internalizing/
externalizing functioning. We used the SCID I [25], SCL-
90/R [36], and CBCL/1!-5 [39]. The analyses showed that
the children’s internalizing and externalizing scores tended
to increase from T1 to T2. Maternal psychopathology
proved to be strongly related to their children’s maladap-tive
profiles. Specifically, the children of mothers with
depression showed higher internalizing scores than did
children of other groups, and these scores increased from
T1 to T2; the children of mothers with eating disorders
showed higher and increasing externalizing scores than did
other children. The children of mothers with a diagnosis
showed significantly higher scores in all internalizing and
externalizing dimensions than did the healthy group chil-dren
at both Time 1 and Time 2. In particular, the children
showed specific maladaptive profiles depending on what
diagnosis their mother received. Mothers with depression
were more likely to have a withdrawn child, and mothers
with eating disorders had a higher probability of having
aggressive children. Furthermore, the fathers’ interpersonal
Fig. 3 Conceptual model—mothers with eating disorders
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8. sensitivity, depression, anxiety and psychoticism signifi-cantly
predicted internalizing problems of their children at
both T1 and T2. Moreover, at T1, the fathers’ interpersonal
sensitivity and psychoticism significantly predicted their
child’s externalizing problems, and the fathers’ hostility
and psychoticism significantly predicted their child’s
externalizing problems at T2.
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