The mediating effect of parenting stress and couple relationship quality on the association between material hardship trajectories and maternal mental health status

Abstract

Background: Household material hardships could have a negative impact on maternal mental health. Understanding mechanisms by which material hardship trajectories affect maternal depression and anxiety could aid health care professionals and researchers to design better interventions to improve mental health outcomes among mothers.

Methods: The study identified family-level mechanisms by which material hardship trajectories affect maternal depression and anxiety using Fragile Families and Child Wellbeing Study data (n = 1,645). Latent growth mixture modelling was used to identify latent classes of material hardship trajectories at Years-1, -3, and -5. Parenting stress and couple relationship quality was measured at Year-9. The outcome measures included maternal depression and generalized anxiety disorder (GAD) at Year-15 based on the Composite International Diagnostic Interview - Short Form.

Results: Parenting stress mediated the association between low-increasing hardship (b = 0.020, 95% confidence interval (CI):0.003, 0.043) and maternal depression. Parenting stress also mediated the association between high-increasing hardship (b = 0.043, 95% CI:0.004, 0.092), high decreasing hardship (b = 0.034, 95% CI=0.001, 0.072), and low-increasing (b = 0.034, 95% CI:0.007, 0.066) and maternal GAD. In all models, current material hardship was directly related to maternal depression (b = 0.188, 95% CI:0.134, 0.242) and GAD (b = 0.174, 95% CI:0.091, 0.239).

Limitations: Study results need to be interpreted with caution as the FFCWS oversampled non-marital births as part of the original study design.

Conclusions: While current material hardship appears to be more related to maternal mental health, prior material hardship experiences contribute to greater parenting stress which places mothers at risk for experiencing depression and GAD later on.

Keywords: Couple relationships quality; Depression; Fragile families and child wellbeing study; Generalized anxiety disorder; Parenting stress.

Fig. 1.

Covariate-adjusted structure equation mediation model of the indirect effects of material hardship trajectory classes (experienced during 1–5 years after childbirth) on maternal depression diagnosis at year 15 thorough parenting stress and relationship quality (standardized estimates), using Fragile Families and Child Wellbeing Study data, 1999–2017; (n = 1645). Note: *** p < .001, ** p < .01, * p < .05. Path al & a2 = Effect of X on M; path a3 = Effect of M l on M2; b paths = Effect of M on Y; c paths = Total effect of X on Y; c’ paths = Direct effect of X on Y controlling for Ms. Higher scores on parenting stress indicates greater stress and higher scores on relationship quality indicates poorer relationship quality. All paths are controlled for race/ethnicity, nativity, age, marital status, education, employment, poverty status, health insurance, and depression at one year after childbirth. The paths predicting maternal depression Year-15 included material hardships score at Year-15 as an additional covariate (b = 0.183, 95% CI=0.134, 0.242, p < .001).

Fig. 2.

Covariate-adjusted structure equation mediation model of the indirect effects of material hardship trajectory classes (experienced during 1–5 years after childbirth) on maternal general anxiety disorder (GAD) diagnosis at year 15 thorough parenting stress and relationship quality (standardized estimates), using Fragile Families and Child Wellbeing Study data, 1999–2017 (n = 1645). Note: *** p < .001, ** p < .01, * p < .05. Path a I & a2 = Effect of X on M; path a3 = Effect of M l on M2; b paths = Effect of M on Y; c paths = Total effect of X on Y; c’ paths = Direct effect of X on Y controlling for Ms. Higher scores on parenting stress indicates greater stress and higher scores on relationship quality indicates poorer relationship quality. All paths are controlled for age, race/ethnicity, nativity, marital status, education, employment, poverty status, health insurance, and GAD diagnosis at one year after childbirth. The paths predicting maternal GAD at Year-’l 5 included material hardships score at Year-15 as an additional covariate (£> = 0.174, 95% CI=0.091, 0.239, p < .001).