Abstract
BackgroundMaternal 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.MethodsIn 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.ResultsThirty-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.ConclusionsMothers 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.
Highlights
Maternal depression may influence feeding practices important in determining child eating behaviors and weight
In homes of mothers with elevated depressive symptoms, children were less likely to eat at the kitchen/dining table, the television was more likely audible during meals, and mothers were less likely to eat with their children
This study of low-income mothers of 4- to 8-year-old children found that mothers reporting elevated depressive symptoms exhibited different child feeding practices than those with lower levels of depressive symptoms: they selfreported more pressure to eat and demandingness; were more likely to express low authority in child feeding during a semi-structured narrative interview; and at home, were more likely to have the television audible during meals and less likely to eat meals with their children
Summary
Maternal depression may influence feeding practices important in determining child eating behaviors and weight. Depressed mothers demonstrate less engagement and more irritability towards their children in general [5]; if such problematic interaction styles extend to the realm of feeding, this represents a potential pathway through which maternal depression may influence child eating and weight status. Parents shape children’s eating behaviors in many ways [6], and suboptimal feeding practices may promote dysfunctional eating behaviors in children and contribute to child obesity [7,8]. Given that both depressive symptoms and feeding practices are modifiable, understanding their relationships to child eating and weight status may be important for clinicians and researchers who seek to reduce child obesity. Not all studies find that mothers with depressive symptoms feed in a less responsive manner; others have found no significant associations between maternal depressive symptoms and any measures of pressuring or restrictive feeding practices [13,14,15,16,17]
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