Sex differences in the association between maternal depression and child and adolescent cognitive development: a systematic review and meta-analysis

Abstract

Background Maternal depression is negatively associated with cognitive development across childhood and adolescence, with mixed evidence on whether this association differs in boys and girls. Herein, we performed a systematic review and meta-analysis of sex-specific estimates of the association between maternal depression and offspring cognitive outcomes. Method Seven databases (PubMed, EMBASE, PsycINFO, ERIC, CINAHL, Scopus, ProQuest) were searched for studies examining the longitudinal association between maternal depression and offspring (up to 18 years) cognitive outcomes. Studies were screened and included based on predetermined criteria by two independent reviewers (Cohen's κ = 0.76). We used random-effects models to conduct a meta-analysis and used meta-regression for subgroup analyses. The PROSPERO record for the study is CRD42020161001. Results Twelve studies met inclusion criteria. Maternal depression was associated with poorer cognitive outcomes in boys [Hedges’ g = –0.36 (95% CI −0.60 to −0.11)], but not in girls [−0.17 (–0.41 to 0.07)]. The association in boys varied as a function of the measure of depression used (b = –0.70, p = 0.005): when maternal depression was assessed via a diagnostic interview, boys [−0.84 (–1.23 to −0.44)] had poorer cognitive outcomes than when a rating scale was used [−0.16 (–0.36 to 0.04)]. Conclusions This review and meta-analysis indicates that maternal depression is only significantly associated with cognitive outcomes in boys. Understanding the role of sex differences in the underlying mechanisms of this association can inform the development of targeted interventions to mitigate the negative effects of maternal depression on offspring cognitive outcomes.

Current perspectives on perinatal mental health and neurobehavioral development: focus on regulation, coregulation and self-regulation

“…Recent meta-analyses have found associations between in utero exposure to maternal distress and (self-)regulation problems at the cognitive, behavioral and social-emotional level, that is, for: (i) postpartum bonding problems [with depression ( r = 0.20 to 0.25), anxiety ( r = 0.16), stress ( r = 0.15) and preconception stress ( r = −0.17)] [62]; (ii) internalizing problems in infancy (associated with maternal internalizing ( r = 0.17) as well as with paternal internalizing problems ( r = 0.13) [63]; (iii) cognitive problems in infancy and childhood , for example, cognitive problems (neonates–60 months) ( r = −0.05) [64], lower executive function (6 months–9 years ( r = 0.07) [65], lower general cognitive ability (3 months- 9 years) (effect sizes between −0.041 to 0.15) [66]; (iv) social-emotional and behavioral problems including emotional dysregulation, aggressive behavior, internalizing and externalizing problems) in infancy and childhood ( r = 0.16) (2 months–8.5 years) [67 ▪▪ ]; (v) negative socio-emotional and cognitive outcome from infancy to late adolescence : social-emotional problems (2 months–17 years) (OR = 1.66), more so in depression than anxiety [68]; motor ( r = −0.07), cognitive ( r = −0.12), language ( r = −0.11), social-emotional ( r = 0.21), and adaptive behavior ( r = −0.26) (4 weeks–17 years) [69]; poorer cognitive outcomes only for boys (infancy to 18 years) [boys; Hedges’ g = −0.36, girls: Hedges’ g : = −0.17) and outcome was poorer when a diagnostic interview was used compared to the use of a rating scale [70]. (vi) Finally, one meta-analysis included psychopathological outcome : increased risk of both ASD (pooled OR 1.64) and ADHD (pooled OR 1.72) was confirmed in a meta-analysis including 2–27 year old offspring [71].…”

Association between maternal reflective function and preschool children’s cognitive abilities

“…Extensive research has linked maternal depression to poorer cognitive abilities in children, such as lower receptive vocabulary ( Letourneau et al, 2013 ; Kingston et al, 2015 ; Liu et al, 2017 ). Child sex has also been associated with children’s cognitive abilities; for example, boys have performed lower on a measure of cognitive abilities (Bayley Scales of Infant and Toddler Development and McCarthy Scales of Children’s Abilities; McCarthy, 1972 ), than girls in the context of maternal depression (see Ahun et al, 2021 for meta-analysis). Consequently, SES, maternal depression, and child sex should be considered as a covariate in analyses of pre-schoolers’ cognitive abilities.…”

Theory of Mind in Pre-school Aged Children: Influence of Maternal Depression and Infants’ Self-Comforting Behavior

“…Furthermore, male infants show greater difficulties than female infants in maintaining interactive regulation, and mother–son dyads take longer to repair interactive errors ( Weinberg et al, 1999 ). Gender differences seem also evident when considering the effects of maternal depression, as mother–son dyads have a less well-adapted interaction than mother–daughter dyads with highly depressive mothers ( Weinberg et al, 2006 ) and maternal depression is only significantly associated with cognitive outcomes in boys ( Ahun et al, 2021 ). Moreover, male infants may be more sensitive to distress due to differences in hormonal function and cortisol responses ( Elsmén et al, 2004 ).…”