Thirty years of research suggests that when children are exposed to parental depression may be as important as whether they are actually exposed to depression, with pregnancy emerging as a key period for maternal influence and a key period for paternal influence.
Study: Timing of exposure to parental depression from pregnancy to adolescence and adult offspring’s mental health. Image credit: N Universe / Shutterstock
In a recent comprehensive longitudinal study published in JAMA network openresearchers analyzed data from more than 5,000 adult children to investigate whether the timing of a child’s exposure to parental depression is associated with mental health outcomes decades later. Findings revealed that cumulative exposure to depression in both mothers and fathers was associated with higher odds of anxiety and depression in adulthood.
Most notably, the results highlight a uniquely sensitive period during pregnancy. Maternal depression during late pregnancy was found to be associated with psychotic symptoms in their adult children. In contrast, the influence of paternity was more pronounced during middle childhood. These findings suggest that other, potentially biological and environmental mechanisms specific to parents influence offspring mental health outcomes.
Background of parental depression and sensitive period
Decades of psychiatric and psychological research have shown that parental depression is a major risk factor for mental illness in children. However, recent reviews have highlighted that this research has mainly focused on the immediate postnatal period or specific stages of childhood.
Although these temporal snapshots are useful in informing pediatric care, they cannot identify potential “sensitive periods” – times when the developing brain is particularly vulnerable to external stress, or distinguish between the effects of maternal and paternal depression on children’s mental health outcomes later in life.
Additionally, the previously unresolved “nature vs. nurture” debate often complicates research results, as studies cannot always fully distinguish whether children’s mental health challenges are due to common genetic factors or the environment of growing up with a depressed parent.
Research plans and measures regarding parental depression
This study aimed to investigate how the timing of parental depression exposure is associated with children’s adult mental health outcomes, while considering the genetic risk profiles of both mothers and their children.
This study utilized longitudinal data (September 1990 to July 2020) from the Avon Longitudinal Study of Parents and Children (ALSPAC). The study is a UK cohort comprising records of 5,329 adult offspring (61.5% female) who were followed from conception until age 27 years.
Study exposure (depression) was measured using the Edinburgh Postnatal Depression Scale (EPDS). This is a 10-item survey, with higher scores indicating more severe symptoms, and was repeated over a 20-year period. Mothers were assessed at 12 time points from 18 weeks of gestation to the child’s 21st birthday. Fathers (biological partners) were assessed at 10 time points.
This study focused on four major clinical (psychiatric) outcomes in adult children: 1. Depression at age 27, 2. Anxiety at age 25, 3. Psychotic experiences at age 24, and 4. Alcohol use disorder (AUD) at age 22. In addition, the study incorporated participants’ socio-economic data and maternal and child polygenic risk scores (PRS) as covariates.
For statistical analysis, distributed lag models (DLM) were used to determine which years of exposure contributed most to the observed outcomes.
Related findings in pregnancy and infancy
The most striking finding of this study was that maternal depression during pregnancy, particularly at 32 weeks of gestation, was statistically associated with a 20% increased odds of a child experiencing psychotic symptoms in their 20s (adjusted odds ratio (AOR), 1.20, p<0.05). Remarkably, this association remained significant even after accounting for the child's own genetic risk for schizophrenia.
Additionally, the study found that maternal symptoms from late pregnancy to age 18 years were associated with increased risk of depression in offspring (2.36-fold increase), and maternal symptoms after 8 months postpartum were associated with increased odds of anxiety (2.58-fold increase).
In contrast, paternal depression during pregnancy was not found to be significantly associated with any of the four mental health outcomes examined in this study. Parental influences on children’s depression and anxiety were observed to become prominent only when children reached the age of 5 years (mid-infancy) and became stronger as children entered young adulthood.
Specifically, offspring exposed to paternal depression over a 20-year period were 2.13 times more likely to experience depression themselves (p < 0.05). Unexpectedly, this study failed to identify a statistically significant association between parental depression and child AUD. However, this may suggest that substance use follows a different developmental path or may be influenced by other external factors.
Impact on maternal and paternal mental health
This study shows that the timing of the association between parental mental health and child psychiatric outcomes differs between mothers and fathers.
The findings suggest that the association between mothers and mental illness may begin during pregnancy, and suggest that this association may reflect biological mechanisms such as synaptogenesis, a period of peak synapse formation in the fetal brain. In contrast, the emergence of paternal influences in middle childhood suggests that these exposures are more closely linked to environmental pathways and potentially involve social modeling mechanisms.
Taken together, these findings indicate that pregnancy and early childhood are critical periods in the association between parental depression and subsequent severe psychiatric outcomes (such as psychosis) in the offspring, while highlighting that parental mental health support should extend beyond the ‘first 1,000 days’ to ensure the best possible adult mental health outcomes for children.
Reference magazines:
- Fabel, A., Pham, H., Glover, V., O’Connor, T. G., and O’Donnell, K. J. (2026). Timing of exposure to parental depression from pregnancy to adolescence and adult children’s mental health. JAMA Network Open, 9(4), e264892. DOI – 10.1001/jamanetworkopen.2026.4892. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2847640
