Nonlinear associations between maternal depressive symptoms and children’s mental health: a cross-sectional study

Abstract Background While associations between maternal depressive symptoms (MDS) and offspring mental health have been documented, the precise nature of this relationship, particularly potential nonlinear patterns, remains insufficiently characterized. Objective This study sought to examine potential nonlinear dose-response relationships between MDS and child mental health among preschool-aged children. Methods We conducted a cross-sectional investigation enrolling 17,115 mother-child dyads from kindergartens in a city in western China. MDS were assessed using the Center for Epidemiologic Studies Depression Scale (CES-D). Children’s mental health was assessed via maternal reports using the Strengths and Difficulties Questionnaire (SDQ). Data were collected between February 28 and March 5, 2025. Results Among the 17,115 mother-child dyads, 16.14% (n = 2,763) of mothers (mean age: 34.49 ± 4.65 years) reported elevated depressive symptoms (CES-D score ≥ 16). A nonlinear dose-response relationship was observed, with turning points at maternal CES-D scores of 17 for total difficulties and internalizing problems, 21 for externalizing problems, and 14 for prosocial behavior problems. Below these thresholds, stronger associations were observed (OR = 1.20 for total difficulties, OR = 1.16 for internalizing problems, OR = 1.10 for externalizing problems, and OR = 1.11 for prosocial behavior problems), while above the thresholds, the associations were substantially weakened. Conclusion This cross-sectional study identified distinctive nonlinear dose-response associations between MDS and children’s mental health outcomes in a western Chinese city. The associations were stronger below specific thresholds while weakening above these thresholds. These findings warrant further investigation and validation.