Perinatal maternal mental health and offspring internalizing and externalizing difficulties from early childhood through adolescence: Rhea mother—child cohort in Crete, Greece

Longitudinal research assessing childhood mental health is limited, particularly in terms of tracking how early-life factors influence the development of emotional and behavioral disorders over time. The present study aimed to examine the influence of both antenatal and postnatal maternal mental health on children's emotional and behavioral development, with a focus on the trajectory of internalizing, externalizing and attention deficit hyperactivity disorder (ADHD) symptoms from early childhood through adolescence. The present study included 434 mother-child pairs of the Rhea mother-child cohort in Crete, Greece. Maternal depressive symptoms (EPDS), trait anxiety (STAI-Trait), and personality traits (EPQ-R) were assessed during the third trimester of pregnancy, while postnatal depressive symptoms (EPDS) were evaluated 8-10 weeks after childbirth. Children's internalizing, externalizing and ADHD-related symptoms were assessed at ages 4 (using the SDQ and ADHDT, respectively), and at ages 6, 11, and 15 (using the CBCL and CPRS-R:S, respectively). Multivariate mixed regression models, incorporating a random intercept for each child and a random slope for age at follow-up, were used to analyze the trajectories of symptoms from ages 4 to 15. Significant long-term associations were found between maternal mental health and child outcomes between the ages of 4 and 15. Specifically, higher levels of maternal trait anxiety and neuroticism were associated with an increase in children's internalizing, externalizing, and ADHD symptoms. Both antenatal and postnatal maternal depressive symptoms were linked to a greater likelihood of internalizing and externalizing symptoms over time, but only postnatal depression was related to a rise in ADHD symptoms. The findings emphasize the importance of perinatal maternal mental health in children's emotional and behavioral development and suggest the need for prevention and early intervention programs to support the mental health of both mothers and children.