Graduation Year


Document Type




Degree Granting Department

Public Health

Major Professor

Melinda S. Forthofer, Ph.D.

Committee Member

Jeannine Coreil, Ph.D.

Committee Member

Stanley N. Graven, M.D.

Committee Member

Peter A. Gorski, M.D.

Committee Member

Charles S. Mahan, M.D.


Postpartum, Mental health, Child development, Maternal sensitivity, Attachment theory


Postpartum depression is a significant public health problem facing women, children, and families in the United States with an estimated 10-15% of U.S. mothers experiencing an episode of non-psychotic depression within six months of delivery. The purpose of this study was to investigate the associations between maternal depression during the first three years postpartum and child social competence and display of problem behaviors at first grade. The impact of several characteristics of maternal depression were examined including general exposure, timing of initial onset in the postpartum period, severity of symptoms along the trajectory of initial onset, and chronicity of symptoms. This study also explored the mediating and moderating influences of maternal sensitivity, as well as the moderating influence of exposure to nonmaternal care. This study was based upon secondary analysis of data from the National Institute of Child Health and Human Development Study of Early Child Care (NICHD SECC), a multi-site, prospective, three-phase longitudinal study. The sample consisted of 679 infants and their families that participated in both Phase I and Phase II of the NICHD SECC, had compete data on all variables of interest in the study, and had non-depressed mothers at first grade. Results identified the first six months postpartum as a sensitive period of risk for depression initiation. Severity of symptoms was also found to be important. In some instances depression alone did not increase risk for lower levels of social competence, but severity of symptoms above cut points indicating depression did. Chronic depression at 24 months rather than 36 months postpartum was found to pose the greatest magnitude of negative influence on outcome. Maternal sensitivity partially mediated the negative impact of maternal depression on child outcome only when averaged across the first 36 months postpartum, or when assessed at later time points in the postpartum period (24 or 36 months. All mediations were modest in magnitude. Higher levels of maternal sensitivity buffered the negative impact of maternal depression among earlier onset episodes (six months), and ever exposure to nonmaternal care by 24 months was found to buffer the negative impact of chronic depression at 24 months on both mother and teacher reports of social competence.