Children whose mothers report difficulties with mental health, substance use and domestic violence one year after delivery appear more likely to have behavior problems at age 3 years, according to an article in the May issue of Archives of General Psychiatry, one of the JAMA/Archives journals.

A mother’s mood and anxiety disorders, smoking, problem drinking, drug use and exposure to domestic violence may contribute to her children’s behavior problems, according to background information in the article. Although more than one of these conditions often occur in the same woman, their combined effects on children have not been previously studied. Understanding how these problems in mothers affect children could help prevent behavior problems, the authors write.

Robert C. Whitaker, M.D., M.P.H., Mathematica Policy Research Inc., Princeton, New Jersey, and colleagues followed for three years 2,756 children born between 1998 and 2000 in 18 large U.S. cities. Mothers and fathers each answered survey questions shortly after their child was born and also completed a follow-up survey about their well-being one year later. Mothers’ health conditions were split into three categories: mental health, substance abuse and domestic violence. Three years later, researchers surveyed the mothers about their children’s behavior, asking about instances of aggressive, anxious/depressed or inattention/hyperactive conduct.

After one year, half of the mothers had a condition in at least one of the three categories and 22 percent of children had at least one type of behavior problem. The more areas in which a mother reported difficulties, the more likely her child was to develop behavior problems by age 3 years. When mothers reported difficulties in zero, one, two or three areas, reports of aggression among their children at age 3 years increased from 7 percent to 12 percent to 17 percent to 19 percent, respectively; anxiety and depression increased from 9 percent to 14 percent to 16 percent to 27 percent; and inattention and hyperactivity increased from 7 percent to 12 percent to 15 percent to 19 percent. The increased risk remained significant even after the researchers considered other factors, including sociodemographic characteristics of the family, prenatal habits of the mother and whether the father had mental health or substance abuse problems.

Because mental health problems, substance abuse and domestic violence tend to accompany each other and have cumulative negative effects on children, physicians should provide family-oriented care, the authors write. “Those providing health care to children face many barriers in identifying and responding to these conditions, but there is evidence that mothers appear open to empathic inquiries about how they are doing and that mothers also understand that their own well-being is related to that of their children,” they write.

“Our study suggests that, by 3 years of age, there is already evidence of the effect of adverse childhood experiences, occurring in this study in the form of parental mental health problems, substance use and domestic violence,” they conclude. “Whether a clinician is focused primarily on the care of children, adults or pregnant women, there is the potential to help disrupt this intergenerational transmission of poor health.”

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