Purpose: Maternal depression, substance dependence, and the co-morbidity of these conditions are highly prevalent among families investigated for child maltreatment and threaten children's healthy development. This paper tests the hypotheses that mothers with co-morbid conditions demonstrate more problematic parenting than mothers with a single or neither condition, and that children of mothers with co-morbid conditions have higher rates of mental health problems. Furthermore, we examined the role of co-morbidity on changes in parenting and child mental health over 36 months.
Methods: Using repeated measures logistic regression with GEE, data from the National Survey of Child and Adolescent Well-Being was analyzed to examine the influence of maternal substance dependence, maternal depression, and co-morbidity [substance dependence and depression] on parenting and child mental health outcomes over 36-months among children reported to Child Protective Services that remained in the home following the initial report (n = 2987). Parenting was assessed three times (baseline, 18-months and 36-months) with subscales of the Parent Child version of the Conflict Tactics Scale: neglect, physical assault, and psychological aggression. Child mental health was assessed three times through the Child Behavior Checklist (CBCL). Substance dependence and depression were measured at baseline through the Composite International Diagnostic Interview-Short Form. Interactions between co-morbidity and wave were analyzed to assess differences in rates of change between conditions.
Results: Separate analytic models were run for each parenting domain and mental health. Controlling for other variables in the model, a significant relationship was found between co-morbidity and scores on the neglect subscale, b=0.25, z=3.73, p<.0001. Predicted probabilities for self-reported neglect were highest for mothers with co-morbidity (.68) compared to substance dependent (.40), depressed (.48), and mothers with neither condition (.31). Overall, neglect declined over time but remained highest among mothers with co-morbidity at baseline. A positive relationship was found between co-morbidity and self-report of psychological aggression, b=0.18, z=2.66, p<.01. Predicted probabilities of psychological aggression at baseline were highest among mothers with co-morbidity (.76), followed by substance dependent (.70), and depressed mothers (.64) compared to .52 for mothers with neither condition. While all groups had a decline in psychological aggression over time , it remained .71 by 36 months for mothers with co-morbidity. There were no significant differences in rates of self-reported physical assault between groups. Finally, co-morbidity was associated with higher CBCL scores (b=2.28, z=11.19, p<.001). At baseline, children of mothers with co-morbidity scored in the clinical range on the CBCL, children of substance dependent or depressed only mothers were in the borderline range. Children of mothers with neither condition scored in the normal range.
Conclusions and Implications: Findings suggest that co-morbity is highly associated with higher self-reported neglect and psychological aggression, and poorer child mental health than either a single or neither condition. Although declining over time, neglect and psychological aggression remain a concern for comorbid mothers even three years after reported. Intensive targeted services are needed for mothers with comorbidity and their children to address severe needs in parenting and child mental health following entry into the child welfare system.
