Maternal mental health, substance use, and domestic violence in the year after delivery and subsequent behavior problems in children at age 3 years.

CONTEXT: Mental health disorders, substance use, and domestic violence often occur together. However, studies examining the impact of these conditions in mothers on the well-being of their children have focused only on isolated conditions.

OBJECTIVE: To examine the cumulative effect of maternal mental health disorders, substance use, and domestic violence on the risk of behavior problems in young children.

DESIGN: A birth cohort (1998-2000) followed up to age 3 years.

SETTING: Eighteen large US cities.

PARTICIPANTS: At 3 years, 2756 (65%) were followed up from the population-based birth cohort of 4242. Thirty-six percent had annual incomes below the poverty threshold.

MAIN OUTCOME MEASURES: One year after delivery, mothers were asked questions about conditions in 3 categories: (1) mental health (major depressive episode and generalized anxiety disorder), (2) substance use (smoking, binge drinking, and illicit drug use), and (3) domestic violence (emotional and physical). At 3 years, mothers completed questions from the Child Behavior Checklist.

RESULTS: Fifty percent of mothers had a condition in at least 1 of the 3 categories. The prevalence of child behavior problems increased with the number of categories (0, 1, 2, or 3) in which the mother reported a condition: respectively, 7%, 12%, 17%, and 19% for aggression (P<.001); 9%, 14%, 16%, and 27% for anxious/depressed (P<.001); and 7%, 12%, 15%, and 19% for inattention/hyperactivity (P<.001). This graded risk persisted after adjustment for sociodemographic and prenatal factors and for paternal mental health and substance use.

CONCLUSIONS: The risk of child behavior problems increased with the number of areas--mental health, substance use, or domestic violence--in which the mother reported difficulties. Preventing behavior problems in young children requires family-oriented strategies that address the needs of both parents and their children.