Background
The etiology of mental health problems in young children has garnered growing research and clinical interest (
1). Early childhood is a period marked by critical emotional, social and behavioral development; in the early years, mental health problems can manifest as internalizing behaviors such as fearfulness and social withdrawal, and externalizing behaviors such as irritability, temper outbursts and oppositional, non-compliant behavior (
2,
3). Young children with such concerns continue to have difficulties as they grow older; over time, these difficulties are associated with poor academic, employment and health trajectories (
4,
5).
Our understanding of early modifiable risk factors for mental health problems in preschool-aged children is incomplete. In older children, parenting stress has been reported as a risk factor for parent and child psychopathology (
6,
7). Although the literature is limited, some studies have explored the impact of parenting stress in children under 10 years of age and have found links with child behavior problems (
8,
9). However, previous studies focused on parenting stress in the context of children with neurodevelopmental difficulties, chronic illnesses, or developmental delays (
10,
11). Thus, the impact of early parenting stress on typically developing preschool-aged children is unclear.
There are confounding factors that impact the relationship between parenting stress and mental health problems in preschool-aged children that should be considered. Namely, temperament or biologically-based differences in child behavior patterns, have been identified as early risk factors of mental health problems in children (
12,
13). In particular, high negative affect, evidenced as irritability, and low effortful control or poor impulse self-control, have been linked to subsequent diagnoses of Attention Deficit Hyperactivity Disorder (ADHD), Oppositional Defiant Disorder (ODD), anxiety disorders and depression (
14,
15). As well, children who have high scores on inhibition are at a greater risk of anxiety disorders than those with lower scores on this temperamental domain (
14). Moreover, there is increasing interest in the relationship between sleep and mental health in this age group (
16,
17). Some studies link child sleep problems, bedtime resistance, and parental perceptions of child’s sleep as problematic, with higher parenting stress (
18).
The relationship between parenting stress in infancy and development of mental health problems in preschool-aged children is understudied. Parenting stress is a potentially modifiable factor that may contribute to mental health problems in young children. Findings could lead to including regular assessments of parenting stress as part of developmental assessments for children, thereby informing practitioners to assist parents with managing and alleviating parenting stress, and to identify and support children at higher risk for mental health problems.
The objective of our study was to evaluate the association between early parenting stress and mental health problems in preschool-aged children.
Results
Table
1 outlines descriptive characteristics. The mean (±SD) age of children was 11.4 (±3.1) months at baseline, and 37.2 (±1.7) months at outcome; 49% of children included in this study were male. Parents scored an average of 60.0 ± 15.5 on parenting stress, well below scores considered high. Approximately 2% of parenting stress percentile scores fell within the high or clinically significant range. Parents were relatively well educated and financially secure as 96% of mothers had a college/university degree, and 94% reported an annual household income >$60,000.
Table 1
Descriptive Characteristics
Age, mo, mean ± SD (min-max) |
Baseline | 11.4 ± 3.1 (0–16.0) |
Outcome | 37.2 ± 1.7 (36.0–47.0) |
Male, n (%) | 73 (49.3) |
Mental Health Problemsa, mean ± SD (min-max) | 8.8 ± 4.4 (1.0–26.0) |
Parenting stressb, mean ± SD (min-max) | 60.0 ± 15.5 (36.0–105.0) |
Temperamentc, mean ± SD (min-max) |
Negative affect | 3.7 ± 0.9 (1.8–6.1) |
Effortful control | 5.4 ± 0.7 (3.5–6.7) |
Sleep durationd, mean ± SD (min-max) | 11.6 ± 1.1 (8.0–14.0) |
Maternal education high school or less, n (%) | 5 (3.4) |
Household incomee < $60,000, n (%) | 7 (4.7) |
A statistically significant correlation was identified between parenting stress and mental health problems (Pearson correlation coefficient = 0.44, 95% CI = 0.29–0.56,
p = 0.001). Significant correlations between parenting stress and negative affect, as well as between both temperament traits and mental health problems, were also found. See Table
2.
Table 2
Correlation Matrix
1. Mental health problems | 1.0 | 0.41* | −0.37* | 0.44* |
2. Negative affect | 0.41* | 1.0 | −0.10 | 0.38* |
3. Effortful control | −0.37* | −0.10 | 1.0 | −0.01 |
4. Parenting stress | 0.44* | 0.38* | −0.01 | 1.0 |
After accounting for child age at baseline, sex, household income, and sleep duration (model 1), negative affect and effortful control (model 2), parenting stress during infancy (model 3) was associated with total mental health problems in children at 3 years (β = 0.35; 95% CI = 0.20–0.49,
p < 0.001). Model 3 explained significant variance in the outcome (adjusted R-squared = 0.39, F (7,140) = 14.35,
p < 0.001) and significantly more variance than Model 1 (adjusted R-squared = 0.06, F (4,143) = 3.67,
p = < 0.01) and Model 2 (adjusted R-squared = 0.29, F (6,141) = 11.46,
p < 0.001). See Table
3.
Table 3
Hierarchical linear regression for association between parenting stress and mental health problems in 3-year-old children
Agea | −0.01 | − 0.06, 0.04 | − 0.01 | − 0.06, 0.03 | − 0.03 | −0.07, 0.01 |
Sex, female | −0.28 | −0.60, 0.03 | − 0.16 | −0.45, 0.12 | − 0.25 | −0.52, 0.02 |
Household income,b low | 1.19* | 0.45, 1.94 | 0.89* | 0.24, 1.55 | 0.50 | −0.13, 1.14 |
Sleep duration | 0.01 | −0.15, 0.17 | −0.01 | − 0.15, 0.13 | −0.00 | − 0.13, 0.13 |
Negative affect | | | 0.34* | 0.21, 0.49 | 0.23* | 0.09, 0.37 |
Effortful control | | | −0.31* | −0.46, − 0.17 | −0.31* | − 0.45, − 0.18 |
Parenting Stress | | | | | 0.35* | 0.20, 0.49 |
Adjusted Rb | 0.06* | | 0.29* | | 0.39* | |
Model F-statistic (df) | 3.67 (4, 143) | | 11.46 (6, 141) | | 14.35 (7, 140) | |
Change in F-statistic (p-value) | 0.007 | | < 0.001 | | < 0.001 | |
In addition, a one standard deviation increase in parenting stress during infancy was associated with twice the odds of the child being at high risk of total mental health difficulties at 3 years (OR = 2.26, 95% CI = 1.69–2.83,
p < 0.01). See Table
4.
Table 4
Adjusted logistic regression for association between parenting stress and mental health problems in 3-year-old childrena
Ageb | 0.91 | 0.77, 1.04 |
Sex, female | 0.96 | 0.02, 1.94 |
Household incomec, low | 3.17 | 1.23, 5.10 |
Sleep duration | 0.99 | 0.45, 1.52 |
Negative affect | 1.67* | 1.15, 2.18 |
Effortful Control | 0.44* | 0.08, 0.94 |
Parenting stress | 2.26* | 1.69, 2.83 |
Discussion
We found that stress in the parent-child system during infancy was associated with subsequent mental health problems in preschool-aged children. Indeed, while parenting stress during infancy is associated with negative affect, its contribution to preschool mental health problems is beyond that of temperament factors known to be linked. This finding expands our understanding of modifiable predictors during infancy and toddlerhood, and suggests that parenting stress is an important potential target for intervention (
30).
Conceptually, the observed relationship between parent-child systems under stress and emotional and behavioral problems in children is well described. Parents under stress are less likely to be engaged, more irritable and distant with their young children (
31). Particularly in the early years, positive bonding experiences and interactions between parent and child are fundamental for building competencies that support growth and development. A lack of early parental nurturance, parental negativity or over-reactivity can impact emotional and behavioral development in children, and have deleterious long-term consequences including, but not limited to, negative adjustment outcomes (e.g. social-emotional and peer difficulties), and increased risk for mental health and substance use problems as they grow older (
32,
33).
In addition, it is important to highlight the bidirectional associations between parenting stress and child behavior. Stress can negatively affect parents’ interpretations of child behaviors, shaping subsequent parent-child interactions, potentially reducing parental responsiveness and sensitivity towards children, thus, impacting child behavior (
34,
35). While the associations are difficult to disentangle, it is also well established that excessive stress that hinders parents’ abilities to appropriately manage their own moods and reactions can perpetuate ongoing difficulties for parents and their children (
36). Finally, this relationship could be reflective of genetic variants that affect both a vulnerability to experience stress in parents, and emotional and behavioral problems in their children (
37).
To our knowledge, much of the existing research has been completed in clinical settings (e.g. parents have post-partum psychosis or children are experiencing psychiatric disorders); this study is novel as it is documenting the association between parenting stress during infancy and mental health problems in a typically developing population. The impact of early parenting stress reinforces that mental health interventions for children must regularly assess parental well-being and include programs to assist parents in managing parenting-related stress in order to effectively benefit young children. In addition, regular assessment of parenting stress can support clinicians in identifying preschool children at higher risk of clinical mental health problems. Mental health interventions with parenting programs (aimed at improving parent-child interactions, managing parenting stress, and promoting mindful parenting) can be valuable contributions to early mental health management in families (
38,
39). Some of these early interventions have identified improvements in child internalizing and externalizing behaviors, as well as reductions in parenting stress (
40).
Strengths and limitations
A strength of this study was the prospective analysis of parenting stress during infancy, and subsequent assessment of mental health problems in typically developing 3-year-old children. An additional strength of this study was controlling for several important covariates, such as temperament traits, sleep duration and sociodemographic characteristics. Due to our primary care setting, our study was limited by reliance on parent-report measures, which could have common method bias. Parenting stress can affect parents’ perceptions of child behavior, and it is possible that parents who experience early parenting stress are more likely to perceive their preschool child’s behavior as problematic. Future research could include measures completed by additional caregivers, as well as more intensive observational data collection such as clinical assessments. In addition, few families that participated in our study experience high levels of socioeconomic risk and are largely of middle-higher socio-economic status. Therefore, the results may not be generalizable to less-advantaged populations. Similarly, most of the reports of parenting stress measured in our study are considered typical. Yet, the relative lack of financial stressors and clinically significant parenting stress strengthens the importance of our findings – even in relatively affluent families, and among parents experiencing typical parenting stress, early parenting stress is associated with child mental health outcomes in preschool years.
Conclusion
Mental health problems in children emerge early and can have adverse and long-lasting impact on social, emotional and behavioral outcomes. This study highlights the role of early parenting stress as a risk factor for mental health problems in preschool-aged children. Our initial findings support further exploration of the relationship among parenting stress, child temperament and the emergence of mental health problems in early childhood. Study findings also underline the importance of identifying parents experiencing stress to help ameliorate mental health problems in preschool-aged children.
Acknowledgements
The authors thank all participating families for their time and involvement in TARGet Kids! and are grateful to all practitioners who are currently involved in the research network.
Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit
http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (
http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.