Associations between maternal depressive symptoms and child feeding practices in a cross-sectional study of low-income mothers and their young children
1 University of Michigan Medical School, Ann Arbor, MI, USA
2 Center for Human Growth and Development, University of Michigan, 300 North Ingalls Street, 10th Floor, 48109 Ann Arbor, MI, USA
3 Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
4 Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
5 Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA
6 Department of Nutrition, Harvard School of Public Health, Boston, MA, USA
7 Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, USA
8 Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA
International Journal of Behavioral Nutrition and Physical Activity 2014, 11:75 doi:10.1186/1479-5868-11-75Published: 16 June 2014
Maternal depression may influence feeding practices important in determining child eating behaviors and weight. However, the association between maternal depressive symptoms and feeding practices has been inconsistent, and most prior studies used self-report questionnaires alone to characterize feeding. The purpose of this study was to identify feeding practices associated with maternal depressive symptoms using multiple methodologies, and to test the hypothesis that maternal depressive symptoms are associated with less responsive feeding practices.
In this cross-sectional, observational study, participants (n = 295) included low-income mothers and their 4- to 8-year-old children. Maternal feeding practices were assessed via interviewer-administered questionnaires, semi-structured narrative interviews, and videotaped observations in home and laboratory settings. Maternal depressive symptoms were measured using the Center for Epidemiologic Studies-Depression scale (CES-D). Regression analyses examined associations between elevated depressive symptoms (CES-D score ≥16) and measures of maternal feeding practices, adjusting for: child sex, food fussiness, number of older siblings; and maternal age, body mass index (BMI), education, race/ethnicity, single parent status, perceived child weight, and concern about child weight.
Thirty-one percent of mothers reported depressive symptoms above the screening cutoff. Mothers with elevated depressive symptoms reported more pressuring of children to eat (β = 0.29; 95% Confidence Interval (CI): 0.03, 0.54) and more overall demandingness (β = 0.16; 95% CI: 0.03, 0.29), and expressed lower authority in child feeding during semi-structured narrative interview (Odds Ratio (OR) for low authority: 2.82; 95% CI: 1.55, 5.12). In homes of mothers with elevated depressive symptoms, the television was more likely audible during meals (OR: 1.91; 95% CI: 1.05, 3.48) and mothers were less likely to eat with children (OR: 0.48; 95% CI: 0.27, 0.85). There were no associations between maternal depressive symptoms and encouragement or discouragement of food in laboratory eating interactions.
Mothers with elevated depressive symptoms demonstrated less responsive feeding practices than mothers with lower levels of depressive symptoms. These results suggest that screening for maternal depressive symptoms may be useful when counseling on healthy child feeding practices. Given inconsistencies across methodologies, future research should include multiple methods of characterizing feeding practices and direct comparisons of different methodologies.