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

Among 17,115 mother-child dyads, 16.14% of mothers reported elevated depressive symptoms.

• Sample consisted of 17,115 mother-child dyads from kindergartens in a city in western China
• 2,763 mothers (16.14%) had elevated depressive symptoms defined as CES-D score ≥ 16
• Mean maternal age was 34.49 ± 4.65 years
• Data were collected between February 28 and March 5, 2025
• MDS were assessed using the Center for Epidemiologic Studies Depression Scale (CES-D)

Nonlinear dose-response relationships were identified between maternal depressive symptoms and all child mental health outcomes, with turning points varying by outcome domain.

• Turning point was at CES-D score of 17 for total difficulties
• Turning point was at CES-D score of 17 for internalizing problems
• Turning point was at CES-D score of 21 for externalizing problems
• Turning point was at CES-D score of 14 for prosocial behavior problems
• Children's mental health was assessed via maternal reports using the Strengths and Difficulties Questionnaire (SDQ)

Below the identified thresholds, maternal depressive symptoms showed stronger associations with children's mental health difficulties.

• OR = 1.20 for total difficulties below the threshold of CES-D score 17
• OR = 1.16 for internalizing problems below the threshold of CES-D score 17
• OR = 1.10 for externalizing problems below the threshold of CES-D score 21
• OR = 1.11 for prosocial behavior problems below the threshold of CES-D score 14
• Above each respective threshold, associations were substantially weakened

The associations between maternal depressive symptoms and children's mental health outcomes were substantially weakened above the identified threshold scores.

• This pattern was observed across all four child mental health outcomes assessed
• The weakening of associations above thresholds was observed for total difficulties, internalizing problems, externalizing problems, and prosocial behavior problems
• The study design was cross-sectional, limiting causal inference
• Authors noted these findings 'warrant further investigation and validation'