RESUMO
OBJECTIVE: To determine the impact of children's cognitive delay and behavior on maternal depressive symptoms using a large national cohort of US families. STUDY DESIGN: Data were drawn from 2 waves of the nationally representative Early Childhood Longitudinal Study, Birth Cohort (n = 7550). Cognitive delay was defined at age 24 months by the lowest 10th percentile of the Bayley Short Form-Research Edition. At age 4 years, the children's behavior was assessed using the Preschool and Kindergarten Behavior Scales, administered to mothers and primary nonparental child care providers, and maternal depressive symptoms with the Center for Epidemiological Studies Depression Scale. Weighted generalized estimating equation models examined whether the children's behavior mediated the relationship between their cognitive delay status at 24 months and 4-year maternal depressive outcomes. RESULTS: At age 4 years, 26.9% of mothers of children with cognitive delay reported high depressive symptoms, compared with 17.4% of mothers of typically developing children (P < .0001). When the children's behavior was accounted for, the effect of cognitive delay on maternal depressive symptoms decreased by 36% (P < .0001). These findings remained significant when the children's behaviors were assessed by their primary nonparental care providers. CONCLUSION: Caring for a child with a cognitive delay influences maternal depressive symptoms in part through the child's behavior problems. Preventive interventions to ameliorate adverse outcomes for children with cognitive delay and their families should consider the impact of the children's behavior.