Effect of caregiver depression on adolescent internalising and externalising behaviour: findings from a longitudinal study in a high-risk South African environment

ABSTRACT

Adolescents living in low- and-middle incomeand middle-income countries are at a particular risk of poor mental health. Caregiver mental health plays a crucial role in a child’s emotional and behavioural development and may directly impact a child’s risk for future development of mental health problems. Data collected as part of a two-decade longitudinal multiphase research project were used. Participants, originally women in their third trimester of pregnancy (n = 449), were recruited from a peri-urban impoverished community outside of Cape Town, South Africa, and assessed at several time-points over subsequent years. Data collected during the three phases of the research were used to assess the effects of early and current caregiver depression on adolescent internalising and externalising behaviour. Analyses of Covariance models were used to explore the effect of caregiver depression on adolescent internalising and externalising behaviour, while controlling for multiple covariates. We analysed data for 313 adolescent participants and their primary caregivers. Caregiver depression patterns had a significant main effect on externalising behaviour, F(3,305) = 4.10 (p = 0.007), but not on internalising behaviour, F(3,305) = 2.71 (p = 0.09). Post-hoc analysis showed that those adolescents exposed to early and current caregiver depression scored on average 3.83 points (95% CI [0.99; 6.66]) higher in externalising behaviour than those exposed to no caregiver depression. Also, adolescents who experienced a change in caregiver, compared to those whose biological mother were still their primary caregiver, reported significantly higher levels of externalising behaviour F(1,305) = 5.10, p = 0.03. The study findings provide crucial insight into critical periods of risk, as well as opportunities for prevention. Preventive interventions should ideally target caregivers and adolescents to prevent or reduce behavioural problems and disrupt intergenerational cycles of mental disorders or behavioural problems.

KEYWORDS:

• Adolescence
• internalising behaviour
• externalising behaviour
• caregiver depression

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by the Grand Challenges Canada [Saving Brains # 0066-03]; Wellspring Philanthropic Fund [Grant No. 12830]; Wellcome Trust [B574100].

Notes on contributors

Stefani Du Toit

Stefani Du Toit holds a Master's degree in Psychology. She is a Senior Researcher in the HIV mental Health Research Unit, University of Cape Town.

Katharina Haag

Katharina Haag holds a PhD in Psychology. She currently works as a postdoctoral researcher at the Norwegian Institute of Public Health.

Mark Tomlinson

Mark Tomlinson is a Professor in the Department of Global Health, Stellenbosch University. He is the co-director of the Institute for Life Course Health Research, Stellenbosch University.

Lorraine Sherr

Lorraine Sherr is a Professor of Clinical and Health Psychology at the Institute of Global Health at University College, London, UK.

Marguerite Marlow

Marguerite Marlow holds a Master's degree in Psychology. She is Senior Researcher at the Institute for Life Course Health Research, Stellenbosch University.

Jackie Stewart

Jackie Stewart is an Associate Professor in the Division of Global Surgery, University of Cape Town.

Sarah Skeen

Sarah Skeen is an Associate Professor in the Department of Global Health, Stellenbosch University. She is the co-director of the Institute for Life Course Health Research, Stellenbosch University.