Mediators and moderators in the relationship between maternal childhood adversity and children's emotional and behavioural development: a systematic review and meta-analysis

Abstract

Maternal experiences of childhood adversity can increase the risk of emotional and behavioural problems in their children. This systematic review and meta-analysis provide the first narrative and quantitative synthesis of the mediators and moderators involved in the link between maternal childhood adversity and children's emotional and behavioural development. We searched EMBASE, PsycINFO, Medline, Cochrane Library, grey literature and reference lists. Studies published up to February 2021 were included if they explored mediators or moderators between maternal childhood adversity and their children's emotional and behavioural development. Data were synthesised narratively and quantitatively by meta-analytic approaches. The search yielded 781 articles, with 74 full-text articles reviewed, and 41 studies meeting inclusion criteria. Maternal mental health was a significant individual-level mediator, while child traumatic experiences and insecure maternal-child attachment were consistent family-level mediators. However, the evidence for community-level mediators was limited. A meta-analysis of nine single-mediating analyses from five studies indicated three mediating pathways: maternal depression, negative parenting practices and maternal insecure attachment, with pooled indirect standardised effects of 0.10 [95% CI (0.03-0.17)), 0.01 (95% CI (-0.02 to 0.04)] and 0.07 [95% CI (0.01-0.12)], respectively. Research studies on moderators were few and identified some individual-level factors, such as child sex (e.g. the mediating role of parenting practices being only significant in girls), biological factors (e.g. maternal cortisol level) and genetic factors (e.g. child's serotonin-transporter genotype). In conclusion, maternal depression and maternal insecure attachment are two established mediating pathways that can explain the link between maternal childhood adversity and their children's emotional and behavioural development and offer opportunities for intervention.

Keywords: Child emotional and behavioural development; ecological framework; maternal childhood adversity; mediator; moderator.

Fig. 1.

The ecological framework for understanding the link between maternal childhood adversity and their children's mental health development.

Fig. 2.

The conceptualisation of the mediator and moderator relationships illustrated by a Directed Acyclic Graph (DAG). Moderator: A variable that affects the direction/or strength of the relation between the exposure and outcome. Mediator: A variable on the causal pathway between the exposure and outcome, which is influenced by the exposure and in turn influences the outcome.

Fig. 3.

PRISMA flow diagram of the systematic review and meta-analysis processes.

Fig. 4.

Pooled indirect effects of mediating pathways between maternal childhood adversity and their children's emotional and behavioural problems. (a) Mediating pathway: maternal depression. (b) Mediating pathway: negative parenting practices. (c) Mediating pathway: maternal insecure attachments. Note: ¹ Mediator: avoidant maternal attachment; ² Mediator: anxious maternal attachment.