Sex-specific associations between prenatal maternal mental health and child behavior problems at age 7: A (multi-center) longitudinal study of socially disadvantaged mother-child dyads

Mental health issues are highly prevalent in socially disadvantaged populations, impacting both mothers and children. Maternal mental health plays a crucial role in child development and well-being. This study aimed to assess the association between maternal symptoms of depression, anxiety and stress during pregnancy and child behavioral problems at age 7 in a socially disadvantaged population. Data from the German longitudinal Pro Kind study were analyzed using the Depression-Anxiety-Stress Scale (DASS-21) to assess maternal distress in pregnancy and the Child Behavior Checklist (CBCL 6-18R) to measure internalizing and externalizing problems at age 7. Logistic regression models were applied, adjusting for potential confounders, including sex-stratified analyses. The study sample included 508 socially disadvantaged mother-child dyads, with a high prevalence of maternal mental distress and a substantial proportion of children exhibiting behavioral problems. In female children, moderate to severe maternal depression, anxiety, and stress during pregnancy increased the likelihood of internalizing problems as well as the total behavior problems at age 7. In male children, only mild, but not moderate or severe symptoms of maternal stress were associated with an increased likelihood of an elevated total problem score at age 7. The results of this study highlight the importance of maternal mental health in pregnancy as a predictor for child mental health, and also point to potential sex/gender differences in susceptibility to child problem behavior associated with maternal distress. Our findings underscore the need for targeted prenatal mental health interventions, especially within socially disadvantaged populations.