Effects of Maternal Depression On Adolescent Depression, Anxiety, and Cigarette Smoking: A Longitudinal Investigation of Chilean Mothers and Their Children

Background and Purpose: Depression is one of the most burdensome diseases in the world, and cigarette smoking is the leading cause of preventable death worldwide. Research has demonstrated a significant association between these two constructs among youth. A parent with depression is one of the strongest predictors of depression and substance use among adolescents. These findings, however, are primarily US based. There may be cross-cultural differences between the US and Latin America. Although rates of clinical depression are often lower in Latin-American countries than in the US, these have one of the highest youth smoking prevalence in the world. To contribute to understanding the link between maternal depression and smoking in Latin American families, we examined the longitudinal influence of maternal depression and smoking on youth smoking and mental health with Chilean adolescents.

Methods: Participants were 660 mother-adolescents pairs (adolescent mean age=14.3, SD=1.4) who participated in the NIDA-funded Santiago Longitudinal Study, Santiago, Chile. Mothers were evaluated at two time points. Mothers' depression, measured by the CES-D, and smoking (ever smoked) was assessed when their children were 10-years-old (Time 1) and when their children were between 12- to 17-years-old (Time 2). Adolescents' depression and anxiety, measured by the Youth Self-Report (YSR), and cigarette smoking were assessed at Time 2. Data were analyzed with structural equation modeling with latent variables using Mplus 6.1.

Results: Fit indices were excellent (CFI=0.970, TLI=0.968, RMSEA=0.026). Mean maternal depression at Time 1 (M=21.5, SD=9.83) and Time 2 (M=18.07, SD=7.84) were above the cutoff (a score of 16 or higher) for CES-D clinical depression. Results indicated that maternal depression and smoking at Time 1 were related to maternal depression and smoking at Time 2 (maternal depression β=0.597, p<.001, and smoking β =0.374, p<.001 respectively). In addition, maternal depression at Time 1 and 2 were positively associated with adolescent reports of depressive symptoms (β=0.148, p<.05, and β =0.164, p<0.05 respectively) but only maternal depression at Time 1 was related to adolescent anxiety symptoms at Time 2 (β =0.101, p<0.05). Tests for indirect effects suggested that adolescent depression mediated the association between maternal depression and adolescent smoking (indirect effect=0.113, p<.10).

Conclusions and Implications: Findings that maternal depression is involved in the simultaneous problems of adolescent depression and substance use suggest that addressing the symptoms of maternal depression would benefit not only the mothers themselves but also potentially reduce the development of depressive symptoms and cigarette use among adolescents. As a first step, these findings can be used to shape programs aimed at raising public awareness of the adverse long-term consequences of maternal depression and reduce stigma associated with help-seeking. Moreover, health care providers could be trained to quickly detect and treat maternal depression. Lastly, research is needed to evaluate the effectiveness of interventions used in Latin America to treat maternal depression. Adolescence is a period when many youth smoke cigarettes and experience depression or anxiety for the first time. Early intervention may prevent individuals from developing a number of later chronic mental and physical health problems.