Psychosocial factors associated with symptoms of depression, anxiety and stress among single mothers with young children: A population-based study

doi:10.1016/j.jad.2018.08.013

Journal of Affective Disorders

Volume 242, 1 January 2019, Pages 255-264

https://doi.org/10.1016/j.jad.2018.08.013 Get rights and content

Highlights

•
Single mothers of young children are twice as likely to report depressive or anxiety symptoms than partnered mothers.
•
Past exposure to maltreatment and inadequate social support significantly increase the likelihood of general and parenting stress.
•
Migrant background, young maternal age and Having a toddler-aged child contribute to depressive, anxiety and general stress symptoms.
•
Parenting stress is elevated among single mothers with young preschool children.
•
Psychosocial risk factors for stress correspond to those for depression and anxiety.

Abstract

Background

Abundant evidence highlights single parenthood as a common risk factor for depression, anxiety and stress but few studies have comprehensively examined psychosocial factors (adversities), particularly during early parenting. We investigated symptom prevalence and potential risk factors among mothers with very young children.

Methods

Data stem from the 2015 National Psychosocial Burdens Prevalence Study (KiD 0–3). Mothers with children up to 3 years of age (n = 6925) were recruited from random probability-sampled paediatric clinics (n = 271) across Germany and reported on depression or anxiety, general and parenting stress using the Patient Health Questionnaire (PHQ-4), Perceived Stress Scale (PSS-4) and Parenting Stress Index (PSI). Multivariable logistic regression models determined risk factors and quantified potential mediation of psychosocial factors for all 3 outcomes.

Results

Approximately 30% of single mothers (n = 517) reported depressive or anxiety symptoms and 37% general stress, twice as high compared to partnered mothers (n = 6408; p < 0.0001). Parenting stress was also elevated (p < 0.0001). Adjusted regression models confirm that single mothers are twice as likely to report symptoms of depression or anxiety (OR 1.9, CI_95% 1.4–2.5). Risk factors for stress correspond to those for depression and anxiety. Inadequate social support and history of partner or childhood maltreatment were also consistent risk factors across all outcomes.

Limitations

The study design and self-reported symptoms are limitations to consider.

Conclusions

Single mothers with young children are more predisposed to mental health disorders than partnered mothers, especially when facing financial, social or distal adversities. Appropriate social support programs and screening measures are necessary to reduce further disparities.

Section snippets

Background

The trend of single parent households has increased substantially over the past few decades and is anticipated to rise (OECD, 2011). Approximately 20% of German families in 2013 with a dependent child were headed by a single parent compared to 14% in 1996, and over 90% of such households are fronted by mothers (Statistisches Bundesamt, 2013). Similar trends are also found in other neighbouring countries such as the United Kingdom and Scandinavia (Chzhen and Bradshaw, 2012). Poorer health

Data collection and study sample

Our analyses are based on the data from the 2015 German National Psychosocial Burdens Prevalence Study in Early Childhood, Children in Germany (KiD 0–3). This large cross-sectional study covers various dimensions of psychosocial risks among families with young children including family structure, child behaviour and indicators of parental mental health. It is regarded as the first nationally representative study for family psychosocial burdens, particularly for capturing at-risk subgroups and

Study sample and characteristics

A higher proportion of single mothers were observed to be younger and not employed while a smaller proportion were highly educated compared to partnered counterparts (Table 1). Newborns (≤12 months) appeared as the predominant child age group, particularly among partnered mothers (63.0% vs. 52.1%, p < 0.001). As for social-structural factors, approximately 70% of single mothers with young children declared receipt of welfare benefits and 84.6% earned a net equivalised income of <1000 Euros per

Discussion

In this study, an alarming majority of those living under great adversity were single mothers with young children. This particular parent sub-group reported over twice the rate of depressive and anxiety symptoms than when parenting duties were shared, corresponding to trends found in other countries (Cairney et al., 2006, Kong et al., 2017, Targosz et al., 2003, Tobias et al., 2009). Our findings also compare well to findings from Germany, despite those being largely based on single mothers in

Limitations

There are limitations to this study. First, the observational study design does not allow a causal relationship between single parenthood and mental health outcomes to be established. Second, this study did not collect information on previous diagnoses of depression and anxiety among participants, which would aid in differentiating history of depression prior to or during early parenthood particularly for parenting stress. The utilisation of mental health screening tools, although validated,

Conclusions

Overall, despite growing awareness of mental health issues, single mothers with young children are at greater disadvantage during early parenthood compared to partnered mothers, which add to greater risks of poorer mental health. Our findings imply that the relevant risks for mental health disorders and stresses are exacerbated by lack of perceived social support, history of any maltreatment and exposure to financial hardship, which are either exacerbated by the greater demands of caring for a

Funding

This study was publicly supported by the Federal Association of Paediatricians and the Federal Ministry of Family Affairs, Senior Citizens, Women and Youth (BMFSFJ). The research conducted by the corresponding author was supported with a guest student scholarship from the German Youth Institute(DJI, e.V.) in Munich.

Conflict of interests

The authors declare that they have no conflict of interests.

Contributors

L.A.L. conceptualised the research paper, conducted literature review, conducted data analyses, interpreted the data and compiled the manuscript.

U.B. contributed to the data analyses planning, supervised the data analyses and interpretation of findings, provided feedback on the manuscript and provided additional literature.

C.B. was part of the team that designed and conducted the KiD 0-3 study, supervised the data analyses and interpretation of findings, contributed to the manuscript and

Acknowledgements

The national KiD 0–3 study was conducted by the National Centre for Early Prevention (NZFH), a joint collaboration between the DJI and German Federal Centre for Health Education (BZgA). A note of appreciation is dedicated to the KiD 0–3 team at the DJI in Munich, particularly Andreas Eickhorst, Andrea Schreier, Katrin Lang and Christoph Liel for their help and support.

Ethics approval and consent

The KID 0-3 pilot study, testing whether recruitment of parents for survey research during routine infant screening appointments was feasible, was reviewed favourably by the Ärztekammer Nordrhein ethics board (ref 2013247). Additional ethical approval for the national KiD 0-3 study was not deemed necessary as it was designed as a survey research project which followed national ADM (Arbeitskreis Deutscher Markt- und Sozialforschungsinstitute e.V.) guidelines and no concerns were raised by its

Availability of data and materials

The data that support the findings of this study are available from the German Youth Institute (DJI, e.V.) with permission from the National Centre for Early Prevention (NZFH) but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of the NZFH and the DJI.

References (67)

D. Baker et al.
Does employment improve the health of lone mothers? The ALSPAC Study Team. Avon longitudinal study of pregnancy and childhood.
Soc. Sci. Med.
(1999)
E. Flouri et al.
Stressful life events and depressive symptoms in mothers and fathers of young children
J. Affect. Disord
(2018)
S. Hope et al.
Does financial hardship account for elevated psychological distress in lone mothers?
Soc. Sci. Med
(1999)
S.-I. Kim et al.
Mental health and influencing social factors of parents in single parent families living at an urban community
J. Korean Neuropsychiatr. Assoc
(2012)
K. Kroenke et al.
An ultra-brief screening scale for anxiety and depression: the PHQ-4
Psychosomatics
(2009)
C.A. Lancaster et al.
Risk factors for depressive symptoms during pregnancy: a systematic review
Am. J. Obstet. Gynecol
(2010)
K.M. Nomaguchi
Parenthood and psychological well-being: clarifying the role of child age and parent-child relationship quality
Soc. Sci. Res
(2012)
P.N. Pfeiffer et al.
Efficacy of peer support interventions for depression: a meta-analysis
Gen. Hosp. Psychiatry
(2011)
S.M. Stith et al.
Risk factors in child maltreatment: a meta-analytic review of the literature
Aggress. Violent Behav
(2009)
G.R. Weitoft et al.
Mortality, severe morbidity, and injury in children living with single parents in Sweden: a population-based study
Lancet
(2003)

R.R. Abidin

Parenting Stress Index

(2012)

W.R. Avison et al.

Family structure, stress, and psychological distress: a demonstration of the impact of differential exposure

J. Health Soc. Behav

(2007)

M. Ballantyne et al.

Depressive symptoms among immigrant and Canadian born mothers of preterm infants at neonatal intensive care discharge: a cross sectional study

BMC Pregnancy Childbirth

(2013)

Beeghly, M., Weinberg, M.K., Olson, K.L., Kernan, H., Riley, J., Tronick, E.Z., Stability and change in level of...

L.F. Berkman et al.

Mothering alone: cross-national comparisons of later-life disability and health among women who were single mothers

J. Epidemiol. Community Health

(2015)

G.W. Brown et al.

Social support, self-esteem and depression

Psychol. Med

(1986)

T. Bull et al.

Work life and mental wellbeing of single and non-single working mothers in Scandinavia

Scand. J. Public Health

(2009)

P. Butterworth

Lone mothers’ experience of physical and sexual violence: association with psychiatric disorders

Br. J. Psychiatry

(2004)

J. Cairney et al.

Stress, social support and depression in single and married mothers

Soc. Psychiatry Psychiatr. Epidemiol

(2003)

J. Cairney et al.

Twelve-month psychiatric disorder among single and married mothers: the role of marital history

Can. J. Psychiatry

(2006)

Y. Chzhen et al.

Lone parents, poverty and policy in the European Union

J. Eur. Soc. Policy

(2012)

N. Codreanu et al.

Entwicklung Und Validierung eines Fragebogens zur Erhebung von Einstellungen von Müttern mit Kindern im Kleinstkindalter (EMKK)

(1984)

S. Cohen et al.

A global measure of perceived stress

J. Health Soc. Behav

(1983)

S. Cohen et al.

Stress, social support, and the buffering hypothesis

Psychol. Bull

(1985)

C. Cooper et al.

Family structure transitions and maternal parenting stress

J. Marriage Fam

(2009)

T. Crosier et al.

Mental health problems among single and partnered mothers. The role of financial hardship and social support

Soc. Psychiatry Psychiatr. Epidemiol.

(2007)

L. Davies et al.

Significant Life Experiences and Depression Among Single and Married mothers

J Marriage Fam

(1997)

Dennis, C.-L., Brown, H.K., Falah-Hassani, K., Marini, F.C., Vigod, S.N., Identifying women at risk for sustained...

D.M. Fergusson et al.

Exposure to single parenthood in childhood and later mental health, educational, economic, and criminal behavior outcomes

Arch. Gen. Psychiatry

(2007)

M. Franz et al.

Psychological distress and socioeconomic status in single mothers and their children in a German city

Soc. Psychiatry Psychiatr. Epidemiol

(2003)

E.M. Grundy et al.

Marital history, health and mortality among older men and women in England and Wales

BMC Public Health

(2010)

L.M. Howard et al.

Domestic violence and perinatal mental disorders: a systematic review and meta-analysis

PLoS Med

(2013)

L.F. Kerper et al.

Screening for depression, anxiety, and general psychological distress in pre-operative surgical patients: a psychometric analysis of the Patient Health Questionnaire 4 (PHQ-4)

Clin. Health Promot

(2014)

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Research paperPsychosocial factors associated with symptoms of depression, anxiety and stress among single mothers with young children: A population-based study

Highlights

Abstract

Background

Methods

Results

Limitations

Conclusions

Section snippets

Background

Data collection and study sample

Study sample and characteristics

Discussion

Limitations

Conclusions

Funding

Conflict of interests

Contributors

Acknowledgements

Ethics approval and consent

Availability of data and materials

Soc. Sci. Med.

J. Affect. Disord

Soc. Sci. Med

J. Korean Neuropsychiatr. Assoc

Psychosomatics

Am. J. Obstet. Gynecol

Soc. Sci. Res

Gen. Hosp. Psychiatry

Aggress. Violent Behav

Lancet

Parenting Stress Index

Family structure, stress, and psychological distress: a demonstration of the impact of differential exposure

J. Health Soc. Behav

Depressive symptoms among immigrant and Canadian born mothers of preterm infants at neonatal intensive care discharge: a cross sectional study

BMC Pregnancy Childbirth

Mothering alone: cross-national comparisons of later-life disability and health among women who were single mothers

J. Epidemiol. Community Health

Social support, self-esteem and depression

Psychol. Med

Work life and mental wellbeing of single and non-single working mothers in Scandinavia

Scand. J. Public Health

Lone mothers’ experience of physical and sexual violence: association with psychiatric disorders

Br. J. Psychiatry

Stress, social support and depression in single and married mothers

Soc. Psychiatry Psychiatr. Epidemiol

Twelve-month psychiatric disorder among single and married mothers: the role of marital history

Can. J. Psychiatry

Lone parents, poverty and policy in the European Union

J. Eur. Soc. Policy

Entwicklung Und Validierung eines Fragebogens zur Erhebung von Einstellungen von Müttern mit Kindern im Kleinstkindalter (EMKK)

A global measure of perceived stress

J. Health Soc. Behav

Stress, social support, and the buffering hypothesis

Psychol. Bull

Family structure transitions and maternal parenting stress

J. Marriage Fam

Mental health problems among single and partnered mothers. The role of financial hardship and social support

Soc. Psychiatry Psychiatr. Epidemiol.

Significant Life Experiences and Depression Among Single and Married mothers

J Marriage Fam

Exposure to single parenthood in childhood and later mental health, educational, economic, and criminal behavior outcomes

Arch. Gen. Psychiatry

Psychological distress and socioeconomic status in single mothers and their children in a German city

Soc. Psychiatry Psychiatr. Epidemiol

Marital history, health and mortality among older men and women in England and Wales

BMC Public Health

Domestic violence and perinatal mental disorders: a systematic review and meta-analysis

PLoS Med

Screening for depression, anxiety, and general psychological distress in pre-operative surgical patients: a psychometric analysis of the Patient Health Questionnaire 4 (PHQ-4)

Clin. Health Promot

Research paper
Psychosocial factors associated with symptoms of depression, anxiety and stress among single mothers with young children: A population-based study