University of Southern California Dissertations and Theses

The link between maternal depression and adolescent daughters' risk behavior: the mediating and moderating role of family

(USC Thesis Other)

The link between maternal depression and adolescent daughters' risk behavior: the mediating and moderating role of family

PDF

Download a page range

Download transcript

Copy asset link

Request this asset

Transcript (if available)

Content
THE LINK BETWEEN MATERNAL DEPRESSION AND ADOLESCENT
DAUGHTERS’ RISK BEHA VIOR:
THE MEDIATING AND MODERATING ROLE OF FAMILY

by

Jina Sang

A Dissertation Presented to the
FACULTY OF THE USC GRADUATE SCHOOL
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
DOCTOR OF PHILOSOPHY
(SOCIAL WORK)

August 2012

Copyright 2012 Jina Sang
ii

DEDICATION
This dissertation is dedicated to the loving memory of my dear father, Hyung-Su
Sang (1941-2012), who passed away only two months before my graduation. I know you
are looking down on me with a big smile and are very proud of me for this
accomplishment. Thank you for instilling in me the importance of higher education for
women, and for teaching me that I can do anything I want to do in this world. Your
unconditional love and support have enabled me to fulfill my potential. I miss you every
day, but you will always be in my heart as I live my life as the independent woman whom
you always wanted me to be.

iii

ACKNOWLEDGEMENTS
This dissertation would not have been possible without the support of many
people. My utmost gratitude goes to my mentor, Dr. Michael Hurlburt, who believed in
me even when I questioned myself. He allowed me the freedom to explore my ideas, and
taught me how to think about problems and do research. His knowledge and expertise
inspired and motivated me, and I have been amazed by his infinite patience when
answering my endless questions. I sincerely thank him for caring and for always
encouraging me to have confidence in my abilities. He will always be my best role model
for a researcher, teacher, and mentor.
I am deeply grateful to Dr. Julie Cederbaum for allowing me to use her data for
my qualifying exam and for this dissertation. She has been instrumental in helping me
navigate the rough road to finishing my doctoral studies. I am extremely thankful for her
scholarly guidance and her constant encouragement, which have been invaluable to me. I
especially thank her for carefully reading, revising, and commenting on countless
revisions of this manuscript. Working with her has truly been a gift, and I will miss her
sense of humor.
I also thank Dr. Stanley Huey, Jr. for the thought-provoking questions and the
valuable insights he has shared with me while I was completing this dissertation. This
work has benefited greatly from his suggestions.
Dr. Dorian Traube deserves my special appreciation for giving me warm advice
and counsel. She was my go-to person whenever I needed advice or wisdom. She helped
me overcome some challenging moments during my doctoral studies, and I am deeply
iv

indebted to her for her encouragement and steadfast support. I hope I will be as good a
mentor to my students as she has been to me.
I would also like to acknowledge Dr. Michalle Mor Barak and Dr. Michal Sela-
Amit for their support, which has meant a lot to me. Dr. Mor Barak has shown strong
confidence in me, and I thank her for that and much more. I also thank Dr. Sela-Amit for
allowing me to co-teach her class; I have learned a great deal from her example,
especially what it means to be a good teacher, and I feel incredibly privileged to have
worked with her.
My thanks also go to Dr. Penelope Trickett and Dr. Ferol Mennen for providing
me with rich learning opportunities. Their help during the early stages of my doctoral
education truly helped to set the stage for the completion of this dissertation. I also thank
Beverly Lockwood-Conlan, who has been one of my biggest supporters throughout this
long journey. I owe her deep gratitude for always listening to me and supporting me
throughout my various endeavors over the years.
A very special thank you goes to the members of FAB 5—Gretchen Heidemann,
Jaymie Lorthridge, Melissa Edmondson, and Joey Estrada, Jr.—for their support all these
years. I greatly value their friendship and appreciate their emotional support. I could not
have survived the tough times without them. FAB 5 for life, no matter where life may
take us!
I have been fortunate to have friends who care about me, and I extend my
gratitude to them. In particular, Jaehee Yi has supported and encouraged me during the
most stressful times of my doctoral studies. She encouraged me when I was ready to
v

throw in the towel, and she helped me to cope with the tragic loss of my father. I feel
blessed to call her a friend. I also thank Min-Kyoung Rhee, Ahraemi Kim, and Min Ah
Kim for helping me get through difficult times over the years, and for crying with me
over the loss of my father. Their support has made all the difference. I thank Cara Ellis
Pohle for lending me a sympathetic ear and for supporting me when I needed it the most.
I also acknowledge my best friends, Hi-Joung Oh and Jung Ah Han, for providing
ongoing support from afar and for being true friends when I needed them most.
Most importantly, I could not have made it this far without the support and love of
my family. I would like to express my heartfelt gratitude to my parents, who believed in
me and longed to see this achievement come true. I deeply miss my father, who is not
here with me to share this joy and happiness. He was a source of unwavering support and
unconditional love for me, and he will always be the source of my innermost strength.
What’s more, no words can fully describe how much my mom has influenced me. She
has shaped the person I am today, and I am grateful to her for all she has taught me about
what it means to be an independent woman.
I would also like to thank my husband, Seung Woo Kang, for his love and
unequivocal support at all times. He has sacrificed so much to make my career a priority
in our lives, and words cannot express my gratitude to have his understanding, patience,
and love. I owe him a deep thank you for being my best friend and my greatest supporter,
not only during this doctoral process, but also over the past 18 years we have shared. He
is my source of inspiration and my guiding light, and I could not have completed this
achievement without him.
vi

Finally, I credit my three dogs for being by my side through the good and bad
times. I miss Toto, who passed on after seeing me through my bachelors, masters, and
PhD years, but am grateful that Choco and Maandu are helping me unwind from my
work, making me laugh every day.

vii

TABLE OF CONTENTS
DEDICATION................................................................................................................... ii

ACKNOWLEDGEMENTS ............................................................................................ iii

LIST OF TABLES ............................................................................................................ x

LIST OF FIGURES ........................................................................................................ xii

ABSTRACT .................................................................................................................... xiii

CHAPTER 1: INTRODUCTION
Overview of the Problem ................................................................................................. 1
Gaps in Literature ............................................................................................................ 3
Study Aims ...................................................................................................................... 4

CHAPTER 2: LITERATURE REVIEW
Maternal Depression in the United States ....................................................................... 6
Maternal Depression and Child Outcomes ...................................................................... 8
Mechanisms of Risk .......................................................................................................11
Adolescent Risk Behavior ............................................................................................. 19
Parental Influence on Adolescent Risk Behavior .......................................................... 21
Moderator of Risk .......................................................................................................... 28

CHAPTER 3: THEORETICAL FRAMEWORK
Constructs of Family Systems Theory ........................................................................... 34
Application of Family Systems Theory to Maternal Mental Health ............................. 36
Constructs of Family Systems Theory in the Current Study ......................................... 43

CHAPTER 4: METHODS
Research Questions and Study Hypotheses ................................................................... 46
Sampling Strategy ......................................................................................................... 48
viii

Procedure ....................................................................................................................... 49
Measures ........................................................................................................................ 50

CHAPTER 5: RESULTS
Data Analysis ................................................................................................................. 55
Descriptive Statistics ..................................................................................................... 57
Correlations ................................................................................................................... 60
Hypothesis Testing......................................................................................................... 61
Research Question 1 .................................................................................................. 61
Research Question 2 .................................................................................................. 66
Research Question 3 .................................................................................................. 74

CHAPTER 6: DISCUSSION AND CONCLUSION
Maternal Depression and Adolescent Daughters’ Risk Behavior .................................. 81
Family Factors as Mediators.......................................................................................... 86
Father Involvement ........................................................................................................ 88
Maternal Depression and Parental Characteristics ........................................................ 90
Limitations of the Study ................................................................................................ 91
Clinical Implications ..................................................................................................... 93
Conclusion ..................................................................................................................... 96

REFERENCES ................................................................................................................ 99

Appendix A: Correlations ............................................................................................ 123
Appendix B: RQ1 - Logistic Regression Analyses of Alcohol Use in Lifetime ......... 124
Appendix C: RQ1 - Logistic Regression Analyses of Alcohol Use in the Past 30 Days
..................................................................................................................................... 126
Appendix D: RQ1 - Logistic Regression Analyses of Marijuana Use in Lifetime ..... 128
Appendix E: RQ1 - Logistic Regression Analyses of Marijuana Use in the Past 30 Days
..................................................................................................................................... 130
Appendix F: RQ1 - Logistic Regression Analyses of Engagement in Sex in Lifetime
..................................................................................................................................... 132

ix

Appendix G: RQ1 - Logistic Regression Analyses of Engagement in Sex in the Past
Three Months ............................................................................................................... 134
Appendix H: RQ2 - The Influence of Maternal Depression on Family System Factors
..................................................................................................................................... 136
Appendix I: RQ2 - The Influences of Maternal Depression and Family System Factors
on Daughters’ Sex in Lifetime ..................................................................................... 140
Appendix J: RQ2 - The Influences of Maternal Depression and Family System Factors
on Daughters’ Sex in the Past Three Months............................................................... 145
Appendix K: RQ3 - Logistic Regression Analyses with Father Involvement as a
Moderator .................................................................................................................... 150

x

LIST OF TABLES

Table 1. Demographics - Parents ...................................................................................... 57

Table 2. Demographics - Child ......................................................................................... 59

Table 3. Pearson Correlations Among Parent Characteristics and Relationship Variables61

Table 4. Logistic Regression Analyses of Alcohol Use, Controlling for Parent
Characteristics Variables ................................................................................................... 63

Table 5. Logistic Regression Analyses of Marijuana Use, Controlling for Parent
Characteristics Variables ................................................................................................... 64

Table 6. Logistic Regression Analyses of Engagement in Sex, Controlling for Parent
Characteristics Variables ................................................................................................... 65

Table 7. The Influence of Maternal Depression on Adolescent Daughters' Lifetime
Engagement in Sex ........................................................................................................... 68

Table 8. The Influence of Maternal Depression on Parental Involvement ....................... 68

Table 9. The Infleunce of Maternal Depression on Parent-Child Communication .......... 69

Table 10. The Influences of Maternal Depression and Parental Involvement on
Adolescent Daughters' Lifetime Engagement in Sex ....................................................... 70

Table 11. The Influences of Maternal Depression and Parent-Child Communication on
Adolescent Daughters' Lifetime Engagement in Sex ....................................................... 71

Table 12. The Influence of Maternal Depression on Adolescent Daughters' Engagement in
Sex in the Past Three Months ........................................................................................... 72

Table 13. The Influences of Maternal Depression and Parental Involvement on
Adolescent Daughters' Engagement in Sex in the Past Three Months ............................. 73

Table 14. The Influences of Maternal Depression and Parent-Child Communication on
Adolescent Daughters' Engagement in Sex in the Past Three Months ............................. 74

Table 15. Summary of Father Involvement as a Moderaor Variable in the Relationship
between Maternal Depression and Adolescent Daughters' Risk Behavior ....................... 75

xi

Table 16. Results of Regression Models Testing the Moderating Effects of Father
Involvement in the Relationship between Maternal Depression and Adolescent Daughters'
Substance Use ................................................................................................................... 76

Table 17. Descriptive Statistics for Adolescent Daughters' Lifetime Alcohol Use
Depending on Father Involvement and Maternal Depression .......................................... 77

Table 18. Descriptive Statistics for Adolescent Daughters' Lifetime Marijuana Use
Depending on Father Involvement and Maternal Depression .......................................... 78

xii

LIST OF FIGURES

Figure 1. Individual with Impairment Influencing Various Family Subsystems .............. 38

Figure 2. The Role of Family System Factors in the Relationship between Impairment in
an Individual and Child Behavior ..................................................................................... 40

Figure 3. A Family Systems Conceptualization of the Relationship between Maternal
Depression and Adolescent Daughters’ Risk Behavior .................................................... 42

Figure 4. The Mediation and Moderation Models of Maternal Depression and Adolescent
Risk Behavior.................................................................................................................... 48

xiii

ABSTRACT
Children of mothers with depression are at increased risk for negative outcomes.
Little is known about how depressive symptoms in mothers are associated with
adolescent risk behavior. The current study investigated how maternal depression relates
to the development of adolescent engagement in substance use and sexual activity. This
study further examined the mechanisms by which maternal depression exerts negative
effects on adolescent risk behavior, with a particular focus on family factors such as
parent-child communication and parental involvement. This study also aimed to
understand the role of the involvement of a father as a potential protective factor against
risk behavior among adolescents living with a depressed mother.
Guided by family systems theory, the current study used a sample of minority
families to enhance our understanding of the relationship among maternal depression,
family factors, and adolescent risk behavior. Data were from a cross-sectional, cross-
generational study of 176 urban inner-city mother-daughter dyads, and the sample
included a subset of mothers with HIV .
Logistic regression analyses revealed that maternal depression was associated
with adolescent engagement in sex, but not substance use. Neither parent-child
communication nor parental involvement significantly mediated the relationship between
maternal depression and adolescent risk behavior. Father involvement was found to be a
statistically significant moderating factor in the relationship between maternal depression
and adolescent substance use, but in the opposite of the predicted direction: The

xiv

association between maternal depression and adolescent daughters’ substance use was
positive when fathers were involved, but negative when they were not.
This study provides the first empirical evidence that non-clinical depressive
symptoms in mothers are associated with adolescent sexual activity. The findings
partially support the negative influence hypothesized in family systems theory. The
findings underscore the importance of considering family systems in designing
interventions to reduce sexual activity among adolescent daughters in families with a
depressed mother.

1

CHAPTER 1: INTRODUCTION
Overview of the Problem
Children of mothers with depression are at elevated risk of negative outcomes.
These children are more likely to suffer from cognitive deficits and poor academic
performance (Hammen et al., 1987; Hay et al., 2001), higher rates of physical symptoms
(Lewinsohn, Olino, & Klein, 2005), higher levels of internalizing and externalizing
problems (Allen, Manning, & Meyer, 2010; Foster, Webster, et al., 2008; Ohannessian et
al., 2005), and increased risk of psychopathology across the life span (Beardslee, Versage,
& Gladstone, 1998; Downey & Coyne, 1990; Goodman & Gotlib, 1999; Hammen, 2009;
Weissman et al., 2006).
Nevertheless, many children living with mothers who have depression do not
experience adverse outcomes; several determinants, including biological factors, stressors,
and cognitive vulnerability, have been hypothesized to account for the association
between maternal depression and child outcomes (Goodman & Gotlib, 2002; Hammen,
2009). One such mechanism may be family factors, or more specifically, parent-child
communication and parental involvement. Evidence shows that the depressive symptoms
(e.g., irritability, anger, sadness, and hopelessness) of mothers are likely to interfere with
their parenting ability (Radke-Yarrow, Cummings, Kuczynski, & Chapman, 1985).
Mothers with depression are more irritable, critical, hostile, and controlling of their
children, as well as less warm and supportive compared with mothers without depression
(Lovejoy, Graczyk, O'Hare, & Neuman, 2000; McCarty, McMahon, & Conduct Problems
2

Prevention Research Group, 2003). Depressive symptoms such as irritability and anger
may result in harsh discipline, while sadness and hopelessness result in withdrawn and
unresponsive behavior (Lovejoy, Graczyk, O’Hare, & Neuman, 2000). The parenting
practices that arise from this situation may negatively affect the communication patterns
between mother and child. Meanwhile, lax parenting practices may decrease the
likelihood of parental involvement in rearing children. These family factors are
hypothesized to contribute to problems in child development.
Previous research has also identified factors that can buffer the detrimental effects
of maternal depression (Goodman, 2007). One of the protective factors suggested is the
involvement of a father (Phares, Duhig, & Watkins, 2002), which is associated with better
outcomes for children (Mezulis, Hyde, & Clark, 2004). In the United States, although
nearly one in four children lives apart from their fathers (U.S. Census Bureau, 2010),
many nonresident fathers continue to participate in rearing their children (Amato &
Sobolewski, 2004). When a mother is depressed, a healthy father may play a protective
role to the extent that he is involved in the child’s life (Goodman & Gotlib, 1999). A
good father-adolescent relationship can serve as a buffer of the negative influence of
maternal depression (Tannenbaum & Forehand, 1994). Although some studies have
examined the role of paternal involvement in moderating the effects of maternal
depression on child outcomes (Chang, Halpern, & Kaufman, 2007; Mezulis, Hyde, &
Clark, 2004; Tannenbaum & Forehand, 1994; Thomas, Forehand, & Neighbors, 1995), no
studies have looked into how involved fathers are in tempering risk behaviors, such as
substance use and sexual behavior, among adolescents. Considering whether the
3

involvement of a father affects adolescent risk behavior in the context of maternal
depression will, therefore, contribute to existing research.
Gaps in Literature
Although research has established a link between maternal depression and
negative child outcomes, most studies examining such links have focused on child
psychopathology, covering aspects such as internalizing (e.g., depression, anxiety; Rhode,
Lewinsohn, Klein, & Seeley, 2005) and externalizing disorders (e.g., conduct disorder,
ADHD; Allen et al., 2010; Brennan, Hammen, Katz, & Le Brocque, 2002). The
relationship between maternal depression and risk behavior in adolescents has not been
thoroughly studied. Furthermore, the mechanisms by which maternal depression affects
adolescent risk behavior, with particular emphasis on family factors, remain unclear.
Previous literature has also overlooked the role of paternal involvement as a potential
protective factor against risk behavior. The current study aims to address the
aforementioned gaps.
Another limitation is that many studies examining the relationship between
maternal depression and adolescent risk behavior have been conducted with White
samples (Cortes, Fleming, Mason, & Catalano, 2009; Lieb, Isensee, Hofler, Pfister, &
Wittchen, 2002; Nomura, Warner, & Wickramaratne, 2001; Ohannessian et al., 2005).
Although African Americans generally have equivalent or lower rates of major
depression than do Whites (Kessler et al., 2003), African American women are more
likely to report higher rates of depressive symptoms than are White women (Jackson &
4

Williams, 2006). This finding highlights the importance of examining the relationship
between maternal depression and adolescent risk behavior in minority families.
In addition, many scholars have investigated a wide age range of offspring,
including preadolescents, adolescents, and young adults, within one sample (Nomura,
Warner, & Wickramaratne, 2001), or have combined adolescents and young adults in one
sample (Klein, Lewinsohn, Rohde, Seeley, & Olino, 2004; Lieb, Isensee, Hofler, Pfister,
& Wittchen, 2002). These approaches are problematic because developmental
differences are potentially disregarded, thereby producing results that cannot be separated
accordingly. In the present study, therefore, a sample consisting only of adolescents was
chosen.
Study Aims
The goal of the original study was to elucidate the relationship between maternal
HIV status, maternal influence behaviors (sexual risk communication and monitoring),
and adolescent daughters’ HIV sexual risk beliefs and behaviors. Participants were
recruited through agency and participant referrals, and close to 37% of the mothers
reported being HIV-positive.
Guided by family systems theory (Minuchin, 1974), the current study extends
previous research by studying mothers and adolescent daughters in minority families to
aid the understanding of the relationship among maternal depression, family factors (i.e.,
parent-child communication and parental involvement), and adolescent daughters’ risk
behaviors (i.e., substance use and sex). Family factors were investigated for their
5

potential in exacerbating negative effects on risk behaviors, and father involvement was
explored for its moderating effect in the relationship between maternal depression and
adolescent daughters’ risk behavior.
The aims of the current study were:
1. To investigate the relationship among maternal depression, family factors (i.e.,
parent-child communication and parental involvement), and adolescent
daughters’ risk behaviors (i.e., substance use and sex)
2. To examine whether family factors mediate the relationship between maternal
depression and adolescent daughters’ risk behaviors
3. To examine whether father involvement moderates the relationship between
maternal depression and adolescent daughters’ risk behaviors

6

CHAPTER 2: LITERATURE REVIEW
Maternal Depression in the United States
Prevalence of depression in women. Depression, the most common psychiatric
disorder in adults, affects over 30 million people in the United States (Kessler et al.,
2003). According to the National Survey on Drug Use and Health (Substance Abuse and
Mental Health Services Administration, 2008), its prevalence for women is roughly twice
higher than that for men. One in five women is estimated to experience depression at
some point in her lifetime (Goodman, 2007). Depression is also a chronic or highly
recurrent disorder, with 80% of individuals experiencing relapses and recurrences
(Goodman & Gotlib, 2002). More than 50% of those who recover from depression
relapse within two years (Belsher & Costello, 1988).
Women are especially vulnerable to depression during their childbearing and
child-rearing years (Somerset, Newport, Ragan, & Stowe, 2006; Weissman & Jensen,
2002). An estimated 25% of women experience elevated levels of depressive symptoms
during pregnancy (Evans, Heron, Francomb, Oke, & Golding, 2001), and as many as 22%
of women have a major depressive episode in the postpartum period (O’Hara, Zekoski,
Phillips, & Wright, 1990). Furthermore, women typically experience depressive
symptoms during the menstrual cycle, as well as in the transition to menopause (Somerset
et al., 2006). Such high incidence of depression in women who are primary caregivers of
children suggests that a large number of children are exposed to maternal depression.
The negative effects of depression on children are a major public health issue.

7

Symptoms of depression. Depression is heterogeneous in its manifestations,
varying in frequency, duration, and intensity, as well as in the intervals between episodes
(Brennan et al., 2000). It is marked by persistent sadness and/or diminished interest or
pleasure in activities, and lasts for at least two weeks (American Psychiatric Association,
1994). Additional common symptoms of depression, as outlined in the Diagnostic and
Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), include significant
weight change, increased irritability and persistent anger, loss of energy, tiredness and
fatigue, change in appetite, sleep difficulties, poor concentration or indecisiveness,
psychomotor agitation or retardation (slowed speech), sense of worthlessness or
excessive guilt, memory difficulties, and thoughts of death and suicidal ideation or
attempts. An individual is diagnosed as depressed when he or she has five or more of
these symptoms and experiences significant distress or impairment in functioning.
Definition of depression. Depression has been conceptualized as both
categorical and continuous in past studies. Whether it is a discrete phenomenon or a set
of symptoms existing as regions on a continuum has been debated (Parker, 2000), but
there is a growing consensus that it is more appropriate to conceptualize depression as
dimensional in research (Cole, McGuffin, & Farmer, 2008; Lewinsohn, Solomon, Seeley,
& Zeiss, 2000). Depressive symptoms that are less severe than major depression can also
prevent an individual from functioning normally; individuals with depressive moods are
at increased risk of major depression and suicidal behaviors (Fergusson, Horwood,
Ridder, & Beautrais, 2005). Moreover, the rates of depressed moods may be higher than
those of major depression (Kessler, Zhao, Blazer, & Swartz, 1997; Kessler et al., 2003);
8

studies on mothers with depressed moods and investigations of those clinically diagnosed
as depressed typically yield similar results (Downey & Coyne, 1990).
Maternal Depression and Child Outcomes
Although maternal depression has long been established as related to negative
child functioning, early research in this area did not pay much attention to mothers with
depression and their children, who served as controls in studies investigating parental
schizophrenia (e.g., Cohler, Grunebaum, Weiss, Hartman, & Gallant, 1977; Fisher, Kokes,
Harder, & Jones, 1980). Researchers became aware of the adverse effects of maternal
depression on children when studies showed that these children may experience problems
similar to or greater than those experienced by children of mothers with schizophrenia
(Downey & Coyne, 1990).
Fetal functioning. Accumulating evidence shows that the children of mothers
with depression have a substantially increased risk of experiencing adverse outcomes at
all stages of development. Studies on children who were exposed prenatally to their
mothers’ depression provide strong evidence of the detrimental effects of maternal
depression. For example, Field, Diego, and Hernandez-Reif (2006) reported that the
fetuses of women with depression were at increased risk of growth retardation, as well as
having a smaller head circumference, abdominal circumference, biparietal diameter, and
lower fetal weight. Prenatal depression is also related to elevated heart rates (Allister,
Lester, Carr, & Liu, 2001), increased physiological reactivity (Monk et al., 2004), and
greater activity levels (Dieter et al., 2001). In a study on fetal movements in pregnant
women with depression, Dieter et al. (2001) found that prenatal depression affected fetal
9

activity as early as the fifth month of pregnancy. These findings suggest that maternal
depression can have consequences even before a baby is born.
Infants. The negative effects of maternal depression continue into infancy.
Studies on infants with depressed mothers reveal that these infants are more likely to be
underweight and small (Field et al., 2004; Hoffman & Hatch, 2000), as well as to have
developmental delays (Deave, Heron, Evans, & Emond, 2008), sleep disturbance
(Armitage et al., 2009), difficult temperaments (McGrath, Records, & Rice, 2008), and
poor psychomotor and cognitive development (Cornish et al., 2005). In a study on how
maternal depression affects infant responses to faces and voices, Hernandez-Reif, Field,
Diego, and Ruddock (2006) reported that the neonates of mothers with depression
received lower scores on orienting to the live face/voice stimulus, alertness items,
cuddliness, and hand-to-mouth activity items. Their findings indicate that these
newborns were less attentive compared with the babies of mothers without depression.
Early childhood. The effects of maternal depression have also been studied in
samples of toddlers and preschool children. Many have linked maternal depression with
higher levels of both internalizing and externalizing behavioral problems (Cummings,
Keller, & Davies, 2005; Dawson et al., 2003; Koblinsky, Kuvalanka, & Randolf, 2006;
Hoffman, Crnic, & Baker, 2006; Kiernan & Huerta, 2008; Middleton, Scott, & Renk,
2009). These children tend to show higher rates of sleep difficulties (Swanson et al.,
2010), fussiness (Natsuaki et al., 2010), language delay (Stein et al., 2008), atypical brain
activation (Dawson et al., 2003), fear and anxiety symptoms (Gartstein et al., 2010),
antisocial behavior (Kim-Cohen et al., 2005), and aggression (Malik et al., 2007). In a
10

sample of 4,953 mothers and their 5-year-old children, Brennan and colleagues (2000)
found that maternal depressive symptoms were related to more behavioral problems and
lower vocabulary scores in children, with even stronger associations when the symptoms
were severe, chronic, and recent. Such problems in early childhood are disturbing
because they may develop into more serious difficulties in later years.
Middle childhood. The school-age children of mothers with depression are at
considerable risk of a number of emotional and behavioral difficulties. Specifically, the
rates of depression are higher in these children than in their peers (Malcarne, Hamilton,
Ingram, & Taylor, 2000). These children are also at increased risk of other
psychopathology including attention deficit hyperactivity disorder (ADHD) and
adjustment disorder (Leschied, Chiodo, Whitehead, & Hurley, 2005). In addition, they
are more prone to impairment in peer relationships and school performance (Zahn-Waxler
et al., 2002). Hay et al. (2001) reported that 11-year-old children whose mothers were
depressed at three months postpartum were more likely to have lower IQ scores, attention
problems, difficulties in mathematical reasoning, and special educational needs. In a
longitudinal study on a sample of mothers with depression and their 8-9-year-old children,
Luoma and colleagues (2001) illustrated that the presence of prenatal depressive
symptoms in the mother was a strong predictor of the child’s high externalizing and total
problem levels. They also found that maternal postnatal depressive symptoms predicted
children’s low social competence, whereas concurrent depressive symptoms were related
to both low social competence and low adaptive functioning. These results indicate that
maternal depression at any time is a risk factor for a child’s well-being.
11

Adolescence. Adolescents whose mothers are depressed also exhibit higher rates
of depression; the relationship between maternal and adolescent depression has been
observed across genders, socioeconomic statuses, and ethnic groups (Corona, Lefkowitz,
Sigman, & Romo, 2005; Essau, 2004; Hammen, Shih, & Brennan, 2004; Jaser et al.,
2008; Klein et al., 2005; Lieb, Isensee, Höfler, Pfister, & Wittchen, 2002; Sarigiani,
Heath, & Camarena, 2003). Rohde et al. (2005) reported that maternal depression
predicted youth recurrence of depression among formerly depressed individuals.
Furthermore, these adolescents are more prone to poor adjustment (depression, anxiety,
and behavioral problems; Goodman, 2007; Goodman & Gotlib, 1999) and physical
symptoms (Lewinsohn, Olino, & Klein, 2005). Existing research has also shown that the
adolescent offspring of mothers with depression are more likely to exhibit externalizing
behavior (Allen et al., 2010; Brennan, Hammen, Katz, & Le Brocque, 2002) and conduct
disorder (Ohannessian et al., 2005), use alcohol, cigarettes, and marijuana (Cortes et al.,
2009), and have poor peer relationships and social skills (Hammen & Brennan, 2001).
In sum, the children of mothers with depression are at increased risk of a range of
behavioral and emotional symptoms and difficulties in functioning at all ages. This line
of research also demonstrates that maternal depression is associated with detrimental
child outcomes through specific mechanisms.
Mechanisms of Risk
Parenting. Past studies have identified multiple mechanisms as potential
mediators between maternal depression and child outcomes (e.g., genetic heritability,
dysfunctional in innate neuroregulation). One mechanism that has received the most
12

extensive empirical attention is the parenting behavior exhibited by mothers with
depression (Goodman & Gotlib, 1999). Beck’s cognitive theory of depression assumes
that individuals with depression experience negative cognition (Beck, 1987). That is,
they see themselves, the world, and the future through a negative lens. Such negatively
biased perceptions and cognitions extend to their parenting, affecting their abilities to
parent effectively (Cummings, Keller, & Davies, 2005; Goodman & Gotlib, 1999). These
mothers tend to see themselves as less competent (Webster-Stratton & Hammond, 1988)
and to feel more helpless and distressed in the parental role (Cornish et al., 2006;
Kochanska, Radke-Yarrow, Kuczynski, & Friedman, 1987).
Depressive symptoms, such as irritability, sadness, anger, and tiredness or fatigue,
may influence the ability to engage in positive parenting behavior and create a healthy
parent-child relationship (Lovejoy, Graczyk, O'Hare, & Neuman, 2000). For example,
mothers who are irritable and/or angry may have lower tolerance for their children’s
aversive behaviors and become overly critical or hostile toward their children. Mothers
who feel sad, tired, or fatigued may be less sensitive and attentive to a child’s social and
emotional needs. Parents struggling with depression therefore tend to alternate between
two types of maladaptive parenting; that is, harsh and unresponsive parenting (Langrock,
Compas, Keller, Merchant, & Copeland, 2002).
Parenting challenges are not specific to depression and can also be found among
parents with other chronic illnesses, such as HIV infection. Literature on maternal HIV
has repeatedly documented the association between maternal HIV infection and parenting
behavior because the physical deterioration associated with the disease may compromise
13

parenting quality (Kotchick et al., 1997). As an illustrative example, Reyland, McMahon,
Higgins-Delessandro, and Luthar (2002) found a significant relationship between
maternal HIV status and quality of the parent-child relationship in a sample of ethnic
minority children living with an HIV-seropositive mother. Their findings show that the
children of mothers with HIV perceived their infected mother as more unavailable,
indifferent, and hostile. In addition, these children reported greater disturbance in
psychological adjustment relative to controls. Similar findings were reported by
Forehand and colleagues (2002), who compared the psychosocial adjustment of children
of HIV-positive and HIV-negative mothers across four years. The authors found that the
children of mothers with HIV viewed their relationship with their mother as less warm
and supportive than that observed in their counterparts. A more positive mother-child
relationship quality also predicts fewer adjustment difficulties. Thus, a maternal chronic
illness, whether psychiatric or physical, may negatively affect parenting ability, which in
turn, may be related to harmful outcomes in children.
Numerous studies have documented problematic parenting practices among
mothers with depression (Cummings, Keller, & Davies, 2005; Lovejoy, Graczyk, O'Hare,
& Neuman, 2000; Lyons-Ruth, Lyubchik, Wolfe, & Bronfman, 2002). These mothers are
more likely to use severe punishment such as slapping or spanking (Kiernan & Huerta,
2008; McLearn et al., 2006). They have been found to display more authoritarian (verbal
or physical rejection and lack of positive encouragement) and disengaged (withdrawn,
uninvolved, unresponsive, or avoidant) behaviors (Field, Diego, & Hernandez-Reif, 2009;
Pelaez, Field, Pickens, & Hart, 2008). Furthermore, depression in mothers impedes their
14

positive interactive behaviors. Even when a mother is not experiencing a depressive
episode, she often continues to use negative parenting styles (Langrock, Compas, Keller,
Merchant, & Copeland, 2002).
Parent-child communication. Many studies have observed that individuals with
depression commonly have impaired communication patterns (Albright & Tamis-
LeMonda, 2002; Jocob & Johnson, 2001): they speak less often, respond more slowly,
and show more hostility and irritability in relationships with others (Downey & Coyne,
1990). Interpersonal impairment is a salient feature of depression so that even in periods
of remission, women with histories of depression are more likely to have dysfunctional
communication skills, thereby experiencing more significant interpersonal difficulties
with their children, friends, and family (Hammen & Brennan, 2002).
Research has explicitly investigated the communication patterns of mothers with
depression when interacting with their children. Mothers with depression tend to have
different interaction styles including withdrawal (avoidant, unresponsive to their
children’s needs) and intrusiveness (irritable toward children, overly involved in
children’s lives; Langrock, Compas, Keller, Merchant, & Copeland, 2002). They are
more likely to use criticism, psychological control, scolding, and threatening with their
children (Caughy, Huang, & Lima, 2009; Herr, Hammen, & Brennan, 2007; Schwartz,
Dorer, Beardslee, Lavori, & Keller, 1990). They are also more punitive, negative, and
retaliatory, as well as display conflictual behavior toward their children (Goodman,
Adamson, Riniti, & Cole, 1994; Larson & Richards, 1994). Sarigiani, Heath, and
Camarena (2003) reported that parental depression may co-occur with conflicts with
15

other family members, and adolescents of parents with depression are more likely to
experience parent-adolescent conflict. Such negative parental influences may heighten
negative emotionality in children, leading to vulnerability toward a host of problems
(Cummings & Davies, 1999).
Past research has proposed parent-child communication as a potential mechanism
that explains the link between parental depression and maladaptive outcomes in children.
For example, Caughy, Huang, and Lima (2009) examined conflict interaction between
depressed mothers and their toddlers and tested its mediating role in the relationship
between maternal depression and child development. The results show that mother-child
conflict interaction mediates the association between maternal depression and mother-
child attachment. Interactions between a parent and a child in early childhood is
especially important because conflicted interaction first starts to occur during this
developmental stage, when a child’s perception of the world is shaped and his or her
future behavioral patterns are formed (Barnard & Kelly, 1990).
Parent-child communication continues to affect the development of children and
adolescents in families with depressed mothers. In a sample of 204 mothers and their
young adolescent children, Foster, Garber, and Durlak (2008) examined the relationships
among maternal depression, maternal interaction behaviors, and children’s adjustment.
They found that maternal positivity (e.g., praise, smiles, warmth, positive statements) in
interactions with their children partially mediated the relationship between maternal
depression and children’s externalizing symptoms. In another study, McCarty, McMahon,
and the Conduct Problems Prevention Research Group (2003) tested mediation models
16

with family variables (including the quality of the mother-child relationship) and found
that children with poorer maternal relationships (more cold and hostile and less warm and
nurturing) had more disruptive behavior disorders, even when early externalizing
problems were controlled for. Similarly, Elgar, Mills, McGrath, Waschbusch, and
Brownridge (2007) found evidence of mediation involving children’s perceptions of their
relationships with their parents (e.g., parental nurturance and rejection) in links between
parental depression and child maladjustment. These findings suggest that the extent of
mother-child communication may be an important mechanism through which maternal
depression affects a child’s functioning.
Parental involvement. Another dimension of parenting postulated to be a
mechanism by which maternal depression contributes to child outcome is parental
involvement. Parental involvement refers to the engagement of a parent in daily
conversations and activities with children. Research has conceptualized parental
involvement in various ways, such as participating in school and home activities
(Gonzalez-DeHass, Wiilems, & Holbein, 2005) and maintaining a strong affective bond
with children (Eckshtain, Ellis, Kolmodin, & Naar-King, 2010). Although parental
involvement is thought to decrease as children move through developmental stages—
especially in the transition from childhood to adolescence, when children spend more
time with their peers and less time with their parents (Brown, Mounts, Lamborn, &
Steinberg, 1993)—all parents, to a greater or lesser degree, continue to show interest in
their children’s lives. However, depression presents barriers to involvement with others
because its symptoms, such as sadness, low energy, loss of interest or pleasure, lethargy,
17

and poor concentration, compromise one’s ability to be emotionally available and
respond effectively to others (Lovejoy, Graczyk, O'Hare, & Neuman, 2000). Such
depressive characteristics may hinder depressed mothers from being adequate social
partners by attending to the emotional needs and behavior of their children.
Mothers struggling with depressive symptoms exhibit lax parental involvement,
and this link has been supported by findings across developmental stages from infancy to
adolescence. Compared with healthy mothers, mothers with depression have greater
withdrawal affect (Feldman et al., 2009), speak less, make less eye contact, and respond
more slowly in their interactions with their children (Downey & Coyne, 1990). These
mothers also tend to provide lower amounts of and lower quality stimulation for their
infants (Livinggood, Daen, & Smith, 1983). Several studies (Albright & Tamis-LeMonda,
2002; Goldsmith & Rogoff, 1997; Lyons-Ruth, Lyubchik, Wolfe, & Bronfman, 2002;
McLearn, Minkovitz, Strobino, Marks, & Hou, 2006) have observed that maternal
depressive symptoms are associated with less engagement (less play and talk) with
toddlers and young children.
For school-age children and adolescents, evidence indicates that mothers with
depression spend time with them less often than do healthy mothers (Larson & Richards,
1994; Sarigiani, Heath, & Camarena, 2003). In a study of unipolar, bipolar, and healthy
mothers and their children, Tarullo, DeMulder, Martinez, and Radke-Yarrow (1994)
evaluated the mother-child engagement as measured through videotaped interactions.
Engagement included listening, encouraging dialogue, talking about feelings, and
showing sensitivity to affective cues. Lower levels of engagement were found among
18

affectively ill mothers relative to healthy mothers. A differential effect of maternal
diagnosis by child gender was also observed: affectively ill mothers with daughters were
less engaged than were affectively ill mothers with sons. These studies are significant in
establishing the extent of the relationship between maternal depression and lack of
parental involvement.
One of the areas in which parental involvement has been frequently studied is
school and academic involvement. For example, lower levels of parental academic
involvement have been associated with poor academic performance (Jeynes, 2007), less
favorable attitudes toward school (Trusty, 1996), decreased motivation (Gonzalez-
DeHass, Willems, & Holbein, 2005), and increased numbers of high school dropouts in
children (Jimerson, Egeland, Sroufe, & Carlson, 2000). With regard to the personal
dimension of parental involvement (e.g., knowing what a child did during the day),
Davidson and Cardemil (2009) studied a sample of Latino parent-adolescent dyads and
found that less parental involvement in both school and personal dimensions (along with
poorer parent-child communication) was associated with increased externalizing
behaviors in adolescents. Interestingly, when parent-child communication and parental
involvement were simultaneously examined in a regression model, parental involvement
in the personal dimension was the only significant predictor of child externalizing
symptoms. These findings indicate that low parental involvement (not showing interest
in children’s everyday lives) may have negative effects on a child’s well-being.
Only a handful of studies have examined parental involvement as a likely
mechanism that carries risk to children of mothers with depression. Kiernan and Huerta
19

(2008) found that relative to controls, mothers with depression spent less time with their
children, specifically on reading activities, which was associated with more conduct and
hyperactivity problems in children. In another study, Eckshtain, Ellis, Kolmodin, and
Naar-King (2010) reported that parental depressive symptoms had a significant effect on
youth depressive symptoms through parental involvement. Thus, some evidence suggests
that parental involvement is an important determinant of outcomes in children of mothers
suffering from depression.
Adolescent Risk Behavior
Adolescence is the developmental period when biological, psychological, and
social transformations occur in the transition to adulthood (Steinberg & Morris, 2001).
During this period, risk taking and sensation seeking also increase, and adolescents
normally experiment with alcohol and other drugs or engage in sex. Although common
and normative, substance use and sexual activity in adolescence are considered risky or
unsafe because they can lead to many negative health consequences. For example,
experimentation with substance use and sexual activity increase the likelihood of
depression and suicide, and the risk is even higher for females (Hallfors, Waller, Bauer,
Ford, & Halpern, 2005; Hallfors, Waller, Ford, Halpern, Brodish, & Iritani, 2004).
Significant evidence relates substance use to sexual risk behavior in adolescence (Brooks
et al., 2004; Kuortti & Kosunen, 2009; Parkes, Wight, Henderson, & Hart, 2007; Stueve
& O’Donnell, 2005). National survey data reveal that large proportions of sexually active
adolescents used alcohol or drugs before their most recent sexual intercourse (Centers for
Disease Control and Prevention, 2010). Adolescent sexual activity is particularly of
20

concern given its association with having multiple sexual partners and failure to use
condoms (Kuortti & Kosunen, 2009). Adolescents tend to engage in short-lived sexual
relationships, increasing the risk of having multiple sequential sexual partners, thereby
elevating the chances of exposure to HIV infection and other negative consequences of
sexual risk-taking behavior (Overby & Kegeles, 1994). National studies have
documented that 38.9% of currently sexually active adolescents had not used a condom
during their last sexual intercourse (Centers for Disease Control and Prevention, 2010).
The prevalence of inconsistent condom use appears to be higher among minority
adolescents than among Caucasian adolescents. Such unprotected sex heightens the risk
of negative outcomes, such as HIV/AIDS, other sexually transmitted diseases (e.g.,
gonorrhea, syphilis, chlamydia), and unintended pregnancies in adolescence (Buhi &
Goodson, 2007) as well as in adulthood (Scott, Wildsmith, Welti, Ryan, Schelar, &
Steward-Streng, 2011).
Youth in the United States are at significant risk of engagement in substance use
and sex (Centers for Disease Control and Prevention, 2010). This is also true for
minority adolescent females. For example, 70.2% of African American high school girls
nationwide reported having had alcohol in their lifetime; this is even higher for Hispanic
(78.5%) and White (75.6%) girls. In terms of lifetime marijuana use, the prevalence for
African American girls is 38% whereas those for Hispanic and White girls are 35.6% and
33.7%, respectively. In addition, African American girls (58.3%) are significantly more
likely to have had sexual intercourse during their lifetime than are Hispanic (45.4%) and
White (44.7%) girls. Considering such significant rates of risk engagement among
21

adolescent females, it is of concern that many adolescent females engage in risky
behavior that may interfere with normal development and lead to significant social,
health, and financial repercussions. For instance, early engagement in risky behavior
may put youth at risk of harmful outcomes later in life including delinquent and criminal
behaviors, increased risk of suicide, early pregnancy, and adult alcohol dependence or
abuse (Bonomo, Bowes, Coffey, Carlin, & Patton, 2004; Sher & Zalsman, 2005). To
develop effective interventions that prevent or delay instances of risk engagement, there
is a pressing need to identify and understand factors that increase the likelihood of
substance use and sexual behavior in adolescent females.
Parental Influence on Adolescent Risk Behavior
Previous studies have attempted to understand the potential factors related to
adolescent risk behavior, and one area of focus has been the family (Denton & Kampfe,
1994). For instance, ample evidence shows that parental substance use increases the
probability of substance use in children (Kilpatrick et al., 2000; Friedman, Terras, &
Glassman, 2000; Lieb et al., 2002); children living with parents who use alcohol and/or
drugs have a greater likelihood of using substances through modeling their parents’
behavior, increased exposure and access to substances, and poor monitoring (Kliewer &
Murrelle, 2007; Nomura, Wickramaratne, Warner, Mufson, & Weissman, 2002).
However, research has also shown that parental substance use alone is insufficient to
explain how the family influences adolescent substance use (Denton & Kampfe, 1994).
Negative family interaction patterns, particularly poor parent-child communication and

22

low levels of parental involvement, may play a significant role in explaining adolescents’
engagement in risk behavior.
An extensive body of research supports the association between growing up in
families with poor parent-child communication and adolescent risk behavior. Many
studies have identified parent-adolescent conflict or negative communication as a risk
factor for substance use, including alcohol and marijuana (Aquilino & Supple, 2001;
Corona, Lefkowitz, Sigman, & Romo, 2005; Hair et al., 2009; Nomura et al., 2002; Pasch
et al., 2006; Reimuller, Shadur, & Hussong, 2011; Walden, McGue, Iacono, Burt, &
Elkins, 2004), and sexual behavior (Kaye et al., 2009; Miller, 2002; Merten & Henry,
2011) in adolescents.
In addition to highlighting the importance of parent-child communication, past
studies have also sought to account for the relationship between lack of parental
involvement and adolescent risk behavior. Empirical findings demonstrate that lower
levels of parental involvement are linked with increased substance use (Loeber &
Stouthamer-Loeber, 1986) and earlier sexual initiation (Longmore, Manning, & Giordano,
2001; Pearson, Muller, & Frisco, 2006; Upchurch, Aneshensel, Sucoff, & Levy-Storms,
1999; Velez-Pastrana, Gonzalez-Rodriguez, & Borges-Hernandez, 2005).
Considerable research suggests that adolescents are likely to engage in risk
behavior when the family environment is characterized by a combination of parent-child
conflict and decreased parental involvement. Repetti, Taylor, and Seeman (2002)
referred to families with high levels of conflict, hostility, and aggression and consisting of
interpersonal relationships that are cold, unsupportive, and uninvolved as risky families.
23

Findings from research data reveal that children raised in risky families have increased
likelihood to engage in substance use and risky sexual behaviors. In an earlier study on
parental socialization factors and adolescent drinking behaviors, Barnes, Farrell, and
Cairns (1986) found that the adolescent children of mothers who provided a low level of
support (e.g., giving praise, doing things together, discussing personal problems) but
attempted to impose a high level of parental control (e.g., hitting, yelling, and screaming)
over their children’s behavior were more likely to engage in problem drinking than were
their counterparts. Less problem drinking was reported when mothers provided higher
levels of support and lower levels of control. Additionally, in a study that identifies
shared environmental contributions to early substance use in a sample of 14-year-old
male and female twins, Walden, McGue, Iacono, Burt, and Elkins (2004) reported that
parent-child conflict coupled with deficits in parental involvement may lead to a range of
problem behaviors, including substance use, because these children may seek affiliation
with antisocial peers. These findings suggest that adolescents may be prevented from
engaging in risk behavior if parents provide warmth, acceptance, support, and
involvement—a parenting style referred to as authoritative. Indeed, many studies have
identified authoritative parenting as protective against a variety of negative adolescent
outcomes (Baumrind, 1991; Steinberg & Morris, 2001).
Problematic interaction patterns within the parent-child subsystem, characterized
by conflictual communication and a lack of parental involvement, may lead to adolescent
risk behavior for several reasons. Parents, especially mothers, are viewed as an important
source of emotional support for adolescents (Steinberg & Silk, 2002). Parental
24

involvement communicates to children that parents provide a support system. In addition,
mothers who engage in good communication and are involved with their children may be
better able to serve as a positive role model, teach socially acceptable behaviors,
communicate positive values, offer guidance and structure, and foster responsibility in
their children (Kaye at al., 2009; Pearson, Muller, & Frisco, 2006). However, if mothers
are cold, overly controlling, or emotionally distant and unavailable, the children may be
less receptive to their mother’s guidance. Thus, they are less likely to internalize values
and adhere to the expectations of their mothers, thereby heightening the likelihood of
adolescent risk behavior.
Parental involvement demands more investment and effort on the part of the
parents; it entails showing interest and providing adequate attention to their children
(Davidson & Cardemil, 2009). Thus, being involved sends the message that the children
and their well-being are important to their parents. However, children whose mothers are
uninvolved and inattentive to their needs may seek support and attention from others such
as peers and romantic partners. Brody et al. (2001) found that nurturant or involved
parenting was inversely associated, and harsh parenting (e.g., shouting, hitting) was
positively associated, with a child’s relationship with deviant peers, even after controlling
for neighborhood factors that could affect choice of friends. Consequently, adolescents
who have problematic relationships with their mothers may spend more time with their
peers and/or romantic partners, which increases the opportunity to affiliate with deviant
peers and start experimenting with substances or engage in sex.

25

Adolescents who do not communicate well with their mothers may act out
because they do not have appropriate coping skills (Corona, Lefkowitz, Sigman, & Romo,
2005; Kliewer & Murrelle, 2007). When children encounter social and personal
challenges in their lives, parents can provide encouragement and teach strategies for
effectively dealing with stressors through communication. However, children in
conflictual and uninvolved families may not learn appropriate ways to cope with stressful
situations and consequently turn to the calming effects of substances such as alcohol and
marijuana. Furthermore, experiencing conflicts with their mothers may be additionally
stressful to these adolescents, making substance use a readily available response to the
stress produced by the conflicts.
Overall, these findings suggest that dysfunctional family interactions can
exacerbate youth engagement in substance use and sex. Given that parents with
depression tend to have poor communication patterns and less involvement with their
children, one may also expect the increased occurrence of risk behavior in adolescents of
mothers with depression. Through the patterns that guide family interactions, maternal
depression may contribute to engagement in risk behavior among adolescents.
Maternal depression and adolescent risk behavior. Although research has
highlighted the possibility that detrimental child outcomes are linked to maternal
depression, much less research has focused on risk behavior in adolescent children of
families with a depressed mother than on other potentially negative outcomes, such as
internalizing and externalizing problems. Moreover, the majority of research on the risk
behavior of this population has focused on substance use. One study that investigated the
26

relationship between maternal depression and adolescent sexual behavior was that
conducted by Bohon, Garber, and Horowitz (2007). The results revealed that the
interaction between father absence and chronicity/severity of maternal depression
significantly predicts adolescent sexual behavior.
Mounting evidence supports the link between maternal depression and adolescent
substance use. In a study with a sample of Latino adolescents and their mothers, Corona,
Lefkowitz, Sigman, and Romo (2005) demonstrated that adolescent children of depressed
mothers reported more substance use compared with those of healthy mothers. Maternal
behavior during a conflict conversation, as assessed by observer ratings, was found
related to adolescent substance use: adolescents whose mothers were more negative while
discussing conflict issues used more substances including alcohol and marijuana.
Nomura, Warner, and Wickramaratne (2001) examined the risk of psychopathology in
offspring of parents with depression. Only mothers with depression reported the highest
rate of alcohol and drug dependence in adolescent children and earlier onset of substance
use disorders.
Similar observations were made by Hammen, Burge, Burney, and Adrian (1990).
The authors evaluated the effects of maternal illness on children in a longitudinal study
and found that the children of unipolar depressed mothers fared the worst; these children
reported the highest rates of substance use disorder as well as conduct disorder. In line
with a family systems perspective of depression, Hammen et al. concluded that a parent’s
illness disturbs children and that depression may not merely be the illness of the
individual, but of the family.
27

Although these studies have supported the idea that maternal depression is related
to adolescent risk behavior, research on the mediating role of negative family interactions
in this relationship is scarce. Leinonen, Solantaus, and Punamaki (2003) investigated
family interactions as mediators in the link between maternal depression and adolescent
risk behavior. The authors tested whether the quality of parenting involving authoritative,
punitive, and non-involved parenting styles mediated the link between parental mental
health and children’s adjustment in a sample of 1,149 families with a 12-year-old child in
Finland. It was found that non-involved mothering mediated the association between
maternal depressive symptoms and sons’ substance use, as well as poor academic
performance. Their findings indicate that mothers suffering from depression are less
involved parents, which is reflected in their sons’ substance use and school performance.
Taken together, empirical evidence shows that negative family interactions may
be part of an etiological mechanism for the development of adverse child outcomes
including adolescent substance use and sexual behavior. However, the mediating effects
of these family factors have not been tested comprehensively in terms of the relationship
between maternal depression and adolescent risk behavior. Furthermore, to the best of
my knowledge, no study has examined the relationship between maternal depression and
engagement in risk behavior for adolescents in African American families. Examining
these associations in this particular ethnic group is important because family plays a
central role in the lives of African American adolescents; they receive the greatest
influence from their families and perceive their parents as the best source of support in
their lives (Clark, 1989). Thus, African American youth are particularly vulnerable to
28

dysfunction within the family system that threatens closeness and trust in parent-child
relationships (Kuperminc, Blatt, Shahar, Henrich, & Leadbeater, 2004). The current
study investigates maternal depression and the mediators of adolescent engagement in
substance use and sexual behavior with a sample of multi-ethnic families including
African American mothers and adolescent daughters.
Moderator of Risk
Despite overwhelming findings on the influence of maternal depression on
negative child outcomes, many children of mothers with depression are resilient and do
not experience adverse outcomes (Downey & Coyne, 1990). Previous studies have
observed that protective factors, such as socioeconomic status (Lovejoy, Graczyk,
O’Hare, & Neuman, 2000), child emotion regulation (Silk, Shaw, Forbes, Lane, &
Kovacs, 2006), child intelligence (Radke-Yarrow & Sherman, 1990), and child
temperament (Cutrona & Troutman, 1986), may mitigate the negative effects of maternal
depression. Thus, investigating the factors that contribute to positive outcomes in
children of mothers with depression is important (Johnson & Jacob, 2000), and the role of
the father is a moderating factor that may promote adaptive functioning in children with a
depressed mother (Phares, Duhig, & Watkins, 2002).
Father involvement. A considerable number of studies have investigated the role
and influence of fathers in children’s lives. Father involvement has been linked to
positive outcomes in children, including decreased behavioral problems (Carlson, 2006),
better educational performance (Flouri & Buchanan, 2004), decreased alcohol-related
problems (Goncy & Dulmen, 2010), drug refusal (Boyd, Ashcraft, & Belgrave, 2006),
29

and delayed onset of sexual intercourse (Regnerus & Luchies, 2006; Rink, Tricker, &
Harvey, 2007). Moreover, high levels of supportive fathering protect children against
psychological maladjustment (Flouri & Buchanan, 2003a) and bullying behavior (Flouri
& Buchanan, 2003b) in adolescents. In a longitudinal study, Ellis and colleagues (2003)
found that girls who lived in a home in which a father was present through age 13 had the
lowest rates of both early sexual activity and teenage pregnancy. The positive effects of a
father’s presence in the home remained significant even after family stress, harsh
discipline, parental monitoring, and neighborhood dangers were statistically controlled
for. These findings suggest that the mere presence of a father in the home may be
protective against girls’ engagement in sexual behavior.
Father involvement may not necessarily mean that the father shares a household
with the child. However, past research has generally concluded that living with a father
in the same home offers more advantages than does living apart from fathers (Teachman,
Day, Paasch, Carver, & Call, 1998; Carlson & Corcoran, 2001) because not sharing a
residence with children may impede the fathers’ ability to enact the paternal role (Amato
& Gilbreth, 1999). Many fathers who do not reside in the same household act more like
adult companions than parents; these fathers are more likely to engage in recreational
activities with children, such as going to the movies and restaurants, but are less likely to
engage in authoritative parenting practices, such as helping with homework, talking about
problems, or setting limits, which have a positive influence on child development (Amato
& Gilbreth, 1999). Although nonresident fathers may frequently visit and spend time
with their children, the father-child affective bonds may be weak, contributing little to
30

their children’s adjustment. Consistent with this reasoning, Carlson (2006) confirmed
that children with a resident father had lower levels of behavioral problems, including
delinquency and externalizing and internalizing problems, in adolescence compared with
children with a nonresident father. In a related study, Bohon, Garber, and Horowitz (2007)
similarly found that adolescents in families with a male head of household exhibited
decreased odds of engaging in sexual behavior, and whether the male head was the
adolescent’s biological father did not add significantly to the prediction. Thus,
involvement by fathers sharing a household with their children may have more positive
effects on adolescent behavior.
A good relationship with one parent has been identified as protective against the
negative effects of parental psychopathology (Rutter, 1985). When mothers are
depressed, healthy fathers may act as a buffer against poor outcomes in children
(Goodman & Gotlib, 1999). Several researchers have obtained support for a model of
moderation by father involvement in links between maternal depression and child
outcome. Chang, Halpern, and Kaufman (2007), for example, reported that higher levels
of positive paternal involvement moderated the longitudinal effect of maternal depression
on children’s internalizing and externalizing symptoms. Other similar empirical findings
also demonstrated that father involvement buffered the effects of maternal depressive
moods on internalizing and externalizing problems (Mezulis, Hyde, & Clark, 2004;
Tannenbaum & Forehand, 1994; Thomas, Forehand, & Neighbors, 1995), regardless of
whether such involvement was characterized as mere presence in the home, a positive
father-child relationship, or a father’s time spent with children. These findings suggest
31

that father involvement may mitigate the potentially deleterious effects of maternal
depression.
Although the role of a father has been frequently identified as an important
protective factor for children living with a depressed mother (Goodman, 2007; Phares,
Duhig, & Watkins, 2002), available research does not explain whether father involvement
is a protective factor against risk behavior engagement in adolescents with depressed
mothers. Such limited literature on the role of a father in mitigating the risk behavior of
adolescents living with depressed mothers is unfortunate because fathers may be a
particularly significant influence on child development for several reasons. First, fathers
who are warm and involved serve as a positive role model for their children (Belsky,
1984). The father’s presence and availability may afford children a higher sense of
emotional support (Cabrera, Tamis-LeMonda, Bradley, Hofferth, & Lamb, 2000).
Second, fathers typically set limits and rules and establish routines for their children.
Thus, father involvement may increase monitoring of children’s activities and
whereabouts, which may result in less engagement in risk behavior (Bohon, Garber, &
Horowitz, 2007). Research has emphasized the importance of parental monitoring in
reducing adolescent risk behavior including substance use and sexual behavior (Li,
Feigelman, & Stanton, 2000). Third, mothers tend to display more positive parenting
when supportive fathers are present and available than when fathers are not (Tamnis-
LeMonda & Cabrera, 2002). Fathers may offer support to the depressed mother, who can
in turn engage in more nurturing parenting behavior (Belsky, 1984). Fourth, fathers often
attempt to compensate for the mother with depression. In families where the mothers are
32

depressed, healthy fathers have been found to be more caring with their children (Hops et
al., 1987) and more positive in their interactions with the children (Hossain et al., 1994).
Thus, exploring the role of father involvement will elucidate whether it serves as a buffer
against adolescent risk behavior in families of mothers with depression.
The Current Study
On the basis of the literature discussed above, this study proposes that maternal
depression has a significant effect on adolescent outcomes. More specifically, depressive
symptoms may interfere with parenting ability, which precipitates poor communication
and low parental involvement in the mother-child relationship. These negative
interaction patterns, in turn, are hypothesized to act as mediators between maternal
depression and adolescent risk behavior, contributing to engagement in substance use
(alcohol and marijuana) and sexual activity of adolescent daughters. Furthermore, this
study investigates the possible moderating influence of father involvement in the
relationship between maternal depression and adolescent risk behavior, hypothesizing
that an involved father may buffer the negative effects of maternal depression.

33

CHAPTER 3: THEORETICAL FRAMEWORK
The current study is grounded in family systems theory (Minuchin, 1974), which
provides a valuable framework to explore how the family system can have an impact on
the development of children. Family systems theory is an extension of the more broadly
conceived general systems theory (Hess & Handel, 1959; Whitchurch & Constantine,
1993), which emphasizes a holistic viewpoint of a system in order to fully understand the
elements involved. As such, family systems theory approaches the individual in his/her
social context and conceptualizes the family as a unit influencing the functioning of each
family member (Minuchin, 1985). It posits that the causes of behavior derive not entirely
from the individual alone but from his/her interactions with family members. For
example, the mental illness of a parent is likely to have substantial, reverberating effects
on the whole family system (Miklowitz, 2004). More specifically, mothers with
depression tend to use negative parenting behavior (e.g., hostility, criticism, anger,
intrusiveness, coercion), which may lead to adverse outcomes in their children (Lovejoy,
Graczyk, O’Hare, & Neuman, 2000). Thus, in order to understand a child’s behavior,
one should examine not only the child, but also the patterns of interaction between the
child and other family members. This chapter begins with a description of the constructs
of family systems theory and subsequently considers the ways in which a family systems
approach might be applied in the maternal depression literature.

34

Constructs of Family Systems Theory
As framed in family systems theory, human behavior can only be fully understood
in the context of a family system (Minuchin, 1985). In order to understand human
behavior, family systems theory addresses transactional patterns, communication, conflict,
separateness and connectedness, cohesion, and adaptation to stress. The basic principles
are described below.
Holism. The principle of holism refers to the idea that the whole is greater than
the sum of its parts and that individuals are nested within the larger family system (Cox
& Paley, 1997). Family is conceptualized as an organized whole, in which all individuals
are interrelated and relationships are reciprocal in nature (Minuchin, 1985). Thus, the
theory suggests that an individual is never truly independent and, in order to understand
why an individual behaves the way he/she does, we must look at the interaction patterns
within the family. For example, in order to understand children’s development, a child
must be viewed from a broad perspective of a whole system—his/her relationships within
the family (Cox & Paley, 2003).
Hierarchical structure. This construct looks at family structure as being
comprised of various small units or subsystems. Each individual is a unique subsystem,
and dyads or groups of individuals may organize themselves into subsystems to perform
various functions or accomplish tasks of the family (Nichols & Schwartz, 2007). Such
subsystems are often organized by generation, gender, common interests, or functions
(Minuchin, 1974). Family systems theorists have paid particular attention to four primary
subsystems: spouse, parent, parent-child, and sibling subsystems (Minuchin, 1985).
35

Family systems theory proposes that every family develops behavioral patterns
(Minuchin, 1974). As these patterns are repeated over time and established, roles are
assigned to each family member and things become predictable. For example, if an
adolescent son has to get up early for school, the mother wakes him up; if a mother is
sick and cannot cook for the family, the oldest daughter prepares a meal; and if parents
have a fight, the children intervene. Such covert rules govern family interactions and
establish hierarchical structure within the family (Nichols & Schwartz, 2007). Thus,
looking at interaction patterns between subsystems within the family reveals family
structure and boundaries.
Adaptive self-stabilization. Adaptive self-stabilization refers to homeostatic
features that bring the family system into equilibrium (Minuchin, 1985). Families have a
tendency to maintain established patterns of behavior in response to challenge or
adversity. Although such a self-regulation process is adaptive for most families, if
maladaptive behavioral patterns are established to maintain homeostasis, the family
becomes dysfunctional.
Adaptive self-organization. During the life cycle, families inevitably face
challenges and developmental transitions such as the birth of a child, entrance of a spouse,
or death of a family member. Under such new circumstances, the family is affected at all
levels of the system and adaptively reorganizes itself by replacing its existing patterns of
interaction with new ones that are more appropriate to the new circumstances (Cox &
Paley, 2003; Minuchin, 1985).

36

Boundaries. Boundaries determine the degree of contact with others and
function to protect the autonomy of the family (Minuchin, 1974). Boundaries operate on
a continuum, which varies from rigid to diffuse. On one extreme, rigid boundaries permit
limited contact between subsystems leading to disengagement in the family. On the other
extreme, diffuse boundaries indicate enmeshment or over-involvement between
subsystems. In the middle are clear but flexible boundaries. An appropriate balance
between the two extremes defines an ideal and healthy functioning family with clarity of
boundaries becoming a major parameter in evaluating the family’s functioning. In
disengaged families, individuals or subsystems isolate themselves from one another. The
members of these families may be independent but have very little affection and nurture.
Enmeshed families, on the other hand, have no distinction between the parent and child
subsystems, promoting over-involvement with other family members or subsystems. In
both extreme cases, the family’s structure has to be altered by rearranging subsystems in
a functional hierarchy for the family to behave adaptively.
Application of Family Systems Theory to Maternal Mental Health
From a family systems perspective, psychopathology affects not just an individual
but the multiple levels within the family. Traditional family systems theorists originally
viewed schizophrenic symptoms in the context of dyadic interactions, usually between a
parent and a child, but then later included the context of triadic and whole family
interactions (Cox & Paley, 1997; Hoffman, 1981). Their assumption was that symptoms
of schizophrenia affected and shaped the organization of the larger family system.

37

Psychiatric symptoms in one family member do exert a significant influence on
the function of a larger family system structure. Studies of depression have frequently
found that families of individuals with depression tend to have greater family dysfunction
than families of individuals without depression (Lovejoy, Graczyk, O’Hare, & Neuman,
2000). For example, families with a depressed parent have higher levels of family
conflict (De Ross, Marrinan, Schattner, & Gullone, 1999; Sarigiani, Heath, & Camarena,
2003), and less family cohesion and warmth (De Ross, Marrinan, Schattner, & Gullone,
1999; Vandewater & Lansford, 2005) compared to families without a depressed parent.
In a study that compared the families of both currently and formerly depressed parents
with those in which neither parent was depressed or had ever been depressed, Herr,
Hammen, and Brennan (2007) reported that families with parental depression had poorer
family functioning (i.e., poorer marital functioning and poorer parent-child relationships).
Langrock, Compas, Keller, Merchant, and Copeland (2002) also examined families with
a depressed parent and found that family functioning remained impaired even after the
parent’s depression remitted. Such findings indicate that psychopathology in an
individual affects the family system, in which individuals are embedded.

38

Subsystems

Psychopathology, or more broadly, impairment in an individual also influences
various subsystems within the family such as parent, spouse, parent-child, and sibling
subsystems (See Figure 1). In particular, an extensive amount of research has been
devoted to examining the parent-child subsystem in various areas, including substance
abuse and chronic illness. For example, Godsall, Jurkovic, Emshoff, Anderson, and
Stanwyck (2004) examined children of alcoholic parents and found that relative to
controls, children of alcoholic parents were more likely to take on extensive parental
responsibilities within the family system, a concept referred to as parentification.
Alcoholism compromises parenting ability and such parental underfunctioning may lead
to role reversals within the parent-child subsystem. In a sample of children from families
affected by maternal HIV infection, Tompkins and Wyatt (2008) found that mothers with
HIV had significantly more conflictual relationships with their children compared to
mothers without HIV . Another example of maternal chronic illness affecting the parent-

Individual with
Impairment
Spouse
Sibling
Parent
Parent-Child
Figure 1. Individual with Impairment Influencing Various Family Subsystems
39

child subsystem is shown in Margaret, Bunston, and Elliot (1999), who conducted a
qualitative study of mothers with cancer and their adolescent children. In their study,
Margaret et al. revealed that mothers’ cancer experience may alter the parent-child
relationship; relationships between mothers with cancer and their adolescent daughters
became more distant. These findings demonstrate that, in the face of an adverse family
environment, the family system inevitably goes through self-organization, with new
interactional patterns within the parent-child subsystem replacing the prior organizational
balances that the family has established. Although potentially maladaptive, these new
patterns are acceptable to the family members (Minuchin, 2002).
The process of the family establishing new interactional patterns among different
subsystems is the family’s attempt to return the system to homeostasis or self-
stabilization (Minuchin, 1985). However, this construct indicates stability, not tranquility
(Minuchin, 2002). Thus, new vulnerabilities may ensue while the family system
reorganizes itself (Cox & Paley, 2003). This process may involve a series of reactions
from family members that are reciprocally dependent on one another, which underscores
the importance of assessing family system factors.

40

As depicted in Figure 2, family research has suggested that the effect of
impairment in an individual (e.g., maternal depression) on adjustment of another family
member (e.g., child) is shaped by numerous family system factors. In line with this
reasoning, much of the previous research has investigated diverse family system variables
such as marital discord (Cummings, Keller, & Davies, 2005; Du Rocher Schudlich &
Cummings, 2003; Hammen, Shih, & Brennan, 2004), family conflict (Dawson et al.,
2003; Koblinsky, Kuvalanka, & Randolph, 2006; Malik et al., 2007), family cohesion
(Foster et al., 2008b), and family warmth (Foster et al., 2008b; Vandewater & Lansford,
2005), and found significant associations with development and functioning of children
in families of mothers with depression, providing a rationale for further investigation of
family system factors. In particular, previous studies on family conflict have
demonstrated associations with child outcomes, including internalizing and externalizing
Risk
(Impairment in an Individual)
Family System
Factors/Variables
Outcome (Child Behavior)
Figure 2. The Role of Family System Factors in the Relationship between Impairment in
an Individual and Child Behavior
41

problems (Dawson et al., 2003; Koblinsky, Kuvalanka, & Randolph, 2006), aggression
(Malik et al., 2007), and depression (Hammen, Brennan, & Shih, 2004) in families of
mothers with depression. Such maladaptive child outcomes may be a reaction to
stressors occurring at multiple levels of the family system that threaten the fundamental
balance and stability of the family (Cummings, Davies, & Campbell, 2000). When
parents fail to maintain a strong hierarchical structure characterized by clear boundaries
within the parent-child subsystem, children may not learn consequences for deviant
behavior and engage in problematic behavior such as substance use (Shaw, Criss,
Schonberg, & Beck, 2004).
In families of mothers with depression, the parenting style of the mother may
create stress for other family members, especially the spouse and the child. In support of
this view, previous studies found that compared to controls, mothers with depression are
more likely to experience marital conflict (Cummings, Keller, & Davies, 2005) and
negative relationships with their children (Frye & Garber, 2005; McCarty et al., 2003;
Sarigiani, Heath, & Camarena, 2003; Vandewater & Lansford, 2005). In particular, the
presence of maternal depressive symptoms appears to impair parenting efforts, which, in
turn, may be then translated into dysfunctional interaction patterns in the relationship
between mothers and children (See Figure 3).

42

Parenting

Family System Variables

Depressive Symptoms in Mothers

Irritability Sadness
Anger Loss of Energy
Tiredness & Fatigue

Overreactive &
Harsh Discipline
Adolescent Daughters’
Risk Behavior

∙ Alcohol
∙ Marijuana
∙ Sex

Involvement
of a Father
Withdrawn &
Unresponsive Behavior

Poor Parent-Child
Communication

Low Parental Involvement

Figure 3. A Family Systems Conceptualization of the Relationship between Maternal
Depression and Adolescent Daughters’ Risk Behavior
43

Family systems theory postulates that the family’s ability to adapt to stress is
reflected in the clarity of boundaries: the emotional reactivity that negotiates the balance
of closeness and distance between subsystems (Steinglass, 1987). If family members
maladaptively respond to stress (e.g., impaired parenting by mothers with depression), for
example, with rigidity, the rigid boundary between a mother and a child may lead to
disengagement, implying dysfunction in the system. Moreover, if the mother has a
conflictual relationship with her spouse, it may increase the bond between the father (or
an adult male figure) and the child. The child’s emotional distance from the mother and
closeness to the father becomes established interactional patterns within the family.
Although the relationship with the mother may be paralyzing to the child, the relationship
with the father may satisfy the needs of the child, which may support optimal child
development (Minuchin, 1985). Indeed, research on the role of a father in child
development has generally concluded that greater paternal involvement and support is
linked to positive outcomes in children (Phares, Duhig, & Watkins, 2002). This
highlights the importance of considering the dynamic interplay of influences at multiple
levels in the family system in order to understand development of children.
Constructs of Family Systems Theory in the Current Study
The current study was designed to understand the relationship between maternal
depression and family system factors (i.e., parent-child communication & parental
involvement) and the effects of these factors on adolescent daughters’ risk engagement
(alcohol, marijuana, and sex). In addition, this study attempts to investigate how
involvement of a father may buffer the effects of maternal depression on daughters’ risk
44

behavior. The family systems approach provides a context to understand a “depressed
family,” in which depression and depression related behaviors of an individual impact
family systemic functioning and relational patterns of interaction between subsystems.
Maternal depression. In this study, maternal depression is modeled in order to
understand the relationship between mother’s depressive symptoms and family system
variables (i.e., parent-child communication & parental involvement), which in turn may
affect adolescent daughters’ risk behavior.
Family system factors. Two family system factors are examined in the study:
parent-child communication and parental involvement. Parent-child communication
refers to verbal exchanges between mother and daughter; whether they usually agree with
each other, enjoy their talks or feel frustrated, often get angry with each other, and yell
and scream at each other. Parental involvement is the mother’s level of involvement in
the daughter’s daily life; whether they spend much time together, feel close to each other,
mother is involved in daughter’s school and activities, and mother has a recent picture of
daughter. These family variables are hypothesized to mediate the relationship between
maternal depression and daughters’ risk behavior.
Father involvement. Father involvement is the presence of a biological father in
the child’s life. Having a biological father in the child’s life is hypothesized to be a
moderator between maternal depression and daughters’ risk behavior.
Adolescent daughters’ risk behavior. Adolescent daughters’ risk behavior
includes alcohol use, marijuana use, and engagement in sex. Information about daughters’

45

risk behavior was gathered in order to understand the impact of contextual risk factors in
the family system on the development of adolescent daughters.
Summary of Proposed Model
Using a family systems framework, this study examined individual functioning of
mother and daughter and the impact of maternal depression on the functioning of the
parent-child subsystem. This theory further helped us understand the family system
factors (parent-child communication & parental involvement), which may influence the
effect of maternal depression on adolescent daughters’ engagement in risk behavior. In
order to gain a broad perspective on the whole family, this study looked beyond the
mother-child relationship and gave consideration to the importance of other parts of the
family system by including a father. The addition of a father in this study recognizes the
importance of considering the multiple levels of the family system and the impact of
these levels on adolescent development. Thus, this model expands the potential for
understanding adolescent development and has implications for the design of
interventions or prevention programs with these populations.

46

CHAPTER 4: METHODS
This is a secondary data analysis of a cross-sectional, cross-generational study
whose original focus was examining the relationship between maternal HIV serostatus,
parent influence behaviors (mother-daughter communication and maternal monitoring),
and sexual risk intention of adolescent daughters. Mother-daughter subjects participated
in a two-phase study: Phase One included focus groups (Cederbaum, under review) and
Phase Two collected quantitative data through self-administered surveys (Cederbaum,
Hutchinson, & Jemmott, in process).
Research Questions and Study Hypotheses
Based on the literature review, the current study aims to investigate the following
research questions and hypotheses. The conceptual model for this study is shown in
Figure 4.
Research question 1 (Aim 1): Are adolescent daughters with depressed mothers
engaging in more risk behavior (i.e., alcohol, marijuana, & sex)?
Hypothesis 1: Adolescent daughters whose mothers have higher levels of depressive
symptoms will report more substance use and sex than those whose mothers have
lower levels of depressive symptoms.
Research question 2 (Aim 2): Do parent-child communication and parental
involvement mediate the relationship between maternal depression and adolescent
daughters’ risk engagement in substance use and sex?
Hypothesis 2.1: Adolescent daughters whose mothers have higher levels of
depressive symptoms will report poorer parent-child communication and lower
47

parental involvement than those whose mothers have lower levels of depressive
symptoms.
Hypothesis 2.2: Poorer parent-child communication and lower parental involvement
will be associated with adolescent daughters’ engagement in substance use and sex.
Hypothesis 2.3: The relationship between maternal depressive symptoms and
adolescent daughters’ engagement in substance use (alcohol & marijuana) and sex
will be significantly reduced (partial mediation) or eliminated (complete mediation)
when parent-child communication or parental involvement are accounted for.
Research question 3 (Aim 3): Is involvement of a father protective against
adolescent daughters’ risk engagement in substance use and sex?
Hypothesis 3: Involvement of a father will moderate the relationship between
maternal depression and adolescent daughters’ engagement in substance use
(alcohol & marijuana) and sex.

48

Mediation

Risk Outcome

Moderation

Figure 4. The Mediation and Moderation Models of Maternal Depression and Adolescent
Risk Behavior

Sampling Strategy
Non-probability sampling was utilized for this study. Participants in the original
quantitative study, and for these analyses, were 176 African-American and Hispanic
mother-daughter dyads from low-income families engaged with social service
organizations. Participants were recruited from clinics and service organizations in

Maternal
Depression

Family Variables

∙ Parent-Child Communication
∙ Parental Involvement

Adolescent Risk
Behavior

∙ Alcohol
∙ Marijuana
∙ Sex

Father Involvement
49

Philadelphia, PA, Newark, NJ, and New York City (see Cederbaum, under review;
Cederbaum, Hutchinson, & Jemmott, in process, for further details). The agencies that
participated targeted services to HIV-infected women, victims of intimate partner
violence, those in substance use recovery, and those receiving clinic/medical services.
Recruitment was accomplished through flyers and provider referrals. Inclusion criteria
for adults were as follows: (1) female, (2) living with an HIV-negative daughter between
the ages of 14 and 18, (3) self-identifying as African American/Black or Hispanic, and (4)
English speaking. Criteria for youth were: (1) having an HIV-negative status, (2) age 14-
18 years, (3) knowledge of mother’s HIV status (positive or negative), and (4) English
speaking. When the adult had more than one daughter between the ages of 14 and 18, the
child that was closest in age to 16 (measured in months) was selected to participate. The
protocol was approved by the institutional review board of the University of
Pennsylvania and the IRB at University of Southern California.
Procedure
Participants completed paper and pencil surveys in their homes or at a community
based service organization. The survey was devised, in part, from the synthesis of data
from qualitative work in Phase One. Participation was voluntary and participants were
informed that they could withdraw from the study at any time without affecting the
services they received at the recruitment site. Participants were assured of
confidentiality, and mothers and daughters were assured that their responses would not be
shared with each other. It was also explained that there was no requirement to answer
any of the questions they did not want to answer. Mothers consented to their own and
50

their daughters’ participation and the daughters provided assent. Mothers and daughters
completed the self-administered paper questionnaires individually and simultaneously.
To reduce the likelihood of participants minimizing or exaggerating the reports of their
experiences, the importance of responding honestly was emphasized. The self-
administered questionnaires took 45 minutes to one hour. Mothers received $20 and
daughters received $15 for their participation in the study.
Measures
Control variables.
Maternal HIV-status. Maternal HIV-status was controlled for in the analyses
because HIV infection has been found to be associated with reduced parenting skills,
altering the mother-child interaction (Reyland, McMahon, Higgins-Delessandro, &
Luthar, 2002). Maternal HIV-status was measured with a single item on the demographic
questionnaire: “Are you HIV-positive?” Mothers were asked to respond by stating “yes”
or “no.” Sixty five mothers (36.9%) indicated that they were HIV-positive.
Maternal physical symptoms. This study utilized maternal physical symptoms as
a covariate because the presence of physical symptoms can compromise the mother’s
ability to respond to her child. This construct was obtained using an adapted version of
the Physical Symptoms Inventory (Wahler, 1968) that assesses physical symptoms seen
most often in HIV-positive women. The modified version (Armistead, Tannenbaum,
Forehand, Morse, & Morse, 2001) consists of 23 items and was completed by all adult
participants. Examples include “nausea,” “headaches,” “shakiness,” “trouble sleeping,”
“burning, tingling or crawling feelings in the skin” “weakness in your muscles,” and
51

“chest pains.” Responses were based on a 5-point Likert scale. Higher scores indicated
more symptoms and scores ranged

from zero to 108 (Armistead et al., 2001). Total
symptoms were analyzed as an ordered categorical variable with four levels. As
measured by Cronbach’s alpha, the obtained reliability was .91 (Armistead et al., 2001).
In the current study, excellent internal consistency was observed, with Cronbach’s alpha
= .94
Maternal substance use. This construct was included as an additional covariate
because of evidence linking maternal substance use with adolescent substance use
(Kilpatrick et al., 2000). Maternal substance use was measured using the 11-item Risk
Assessment Battery (RAB; Metzger et al., 1993). The frequency of substance use was
elicited for both a lifetime and the past 30 days to distinguish between those who “had
ever used” and those who were “current” users. To assess mothers’ current use of alcohol
and marijuana, “used in the past 30 days” was utilized for this study. The Cronbach’s
alpha coefficient of the eleven items was .45.
Predictor.
Maternal depression. The 10-item short version of the Center for Epidemiologic
Studies Depression Scale (CES-D 10; Lorig, Sobel, Ritter, Laurent, & Hobbs, 2001) was
used as a measure of depression. Items were rated on a 4-point scale from zero to three
about how the individual had felt or behaved in the past week: (0) rarely or none of the
time (less than 1 day); (1) some or a little of the time (1-2 days); (2) occasionally or a
moderate amount of time (3-4 days); and (3) all of the time (5-7 days). Examples include
“I had trouble keeping my mind on what I was doing,” “I felt depressed,” “I felt hopeful
52

about the future,” and “My sleep was restless.” Scale scores ranged from one to thirty
(mean = 12.9). Although CES-D 10 has no established cutoff scores, both ≥ 8 and ≥ 10
have been used in past studies (Andresen, Malmgren, Carter, & Patrick, 1994). In this
study, a dichotomized variable was created using a cutoff score of eight, a median split,
to form lower (range 0-8) and higher levels (range 9-27) of depressive symptoms.
Internal consistency of the scale is .84 (Lorig et al., 2001). In the current study, the
Cronbach’s alpha coefficient was .82.
Mediators. The current study investigates two different possible mediators of
female adolescents’ risk behavior through influence of maternal depression: (a) parent-
child communication and (b) parental involvement. These measures were completed by
both mothers and daughters, but daughters’ reports will be used in the analyses because
mothers’ reports could possibly be colored by their own depressive symptoms.
Parent-child communication. General communication between mothers and
daughters was assessed using a subscale of the Conflict Behavior Questionnaire (CBQ;
Prinz, Foster, Kent, O’Leary, 1979). The ten items of the communication subscale are
responded to with a “true” or “false” answer, with higher scores indicating more negative
communication (more conflicts). Example items are “My mother and I almost never
seem to agree,” “Talking with my mother is very frustrating,” and “In general, I don’t
think my mother and I get along very well.” Reliability of the sum scale was found by
Prinz and colleagues (1979) to be .90. In the current study, the Cronbach’s alpha
coefficient was .86.

53

Parental involvement. Parental involvement was measured using the Parent-
Child Relationship Inventory (Gerard, 1994). Two subscales are derived from this
inventory: (a) involvement (α = .80) and (b) communication (α = .88). For the current
study, only the Involvement subscale was included in analyses. This subscale consists of
eight items, rated on a 4-point Likert scale (1 = disagree strongly, 2 = disagree, 3 = agree,
4 = agree strongly), with higher scores indicating more involvement. Examples are “My
mother and I spend a lot of time with one another,” “My mother is very involved in my
school and other activities,” and “I feel there is a great distance between me and my
mother.” This subscale has been used repeatedly and has shown consistent reliability.
Coefficient alpha values range from .70 to .88 with a test-retest reliability of .68 to .93
(Heinze & Grisso, 1996). Cronbach’s alpha coefficient was .80 in this sample.
Moderator.
Father involvement. Demographic information included data on the presence of
a biological father in the household and involvement of the father in the child’s life. The
data were coded as two dummy variables: (a) one representing the absence of a father in
the child’s life ( = 0) vs. a father who lives away but is still involved in the child’s life ( =
1); and (b) one representing the absence of a father in the child’s life ( = 0) vs. a father
who lives in the same household ( = 1).
Adolescent outcomes.
Substance use. Daughters ’ substance use was measured using eight items from
the Risk Assessment Battery (RAB; Metzger et al., 1993). They were asked whether they
had ever used different substances (i.e., tobacco, alcohol, cocaine/crack, and marijuana)
54

and to report the number of days or times in the past 30 days that they had used
substances. Variables of interest for this analysis include alcohol and marijuana use.
Both the “ever used ”/lifetime use variable (yes/no) and the “have used in the past 30 days ”
variable (yes/no) were used to assess daughters ’ substance use.
Engagement in sex. The index of adolescent daughters’ sexual intercourse was
based on their answers to the following two questions: “Have you ever had sex?” and
“Have you had a sexual intercourse in the past three months?” The data were coded as
dichotomous variables (yes/no) indicating whether the adolescent daughter had sexual
intercourse.

55

CHAPTER 5: RESULTS
This chapter presents descriptive statistics for each of the research and
demographic variables, correlations for the research variables, and logistic regression
analyses.
Data Analysis
Descriptive statistics were calculated for the research variables as well as for the
demographic data. Pearson product moment correlation coefficients were calculated to
determine whether the research variables were significantly correlated and, thus, needed
to be controlled for in regression models.
Next, simple regression analyses were conducted to determine whether maternal
depression (IV) correlates with adolescent risk behavior (DV; alcohol, marijuana, & sex)
(Research Question 1). Each of the three measures of adolescent risk behavior was
assessed in parallel analyses.
Regression analyses were then conducted to test Research Question 2, whether
parental involvement and parent-child communication mediate the relationship between
maternal depression and adolescent daughters’ risk behavior. The Mackinnon and Dwyer
(1993) approach was undertaken to assess for mediation of effects because the mediators
are continuous variables, whereas the dependent variables are categorical. Complete
mediation is considered when the relationship between maternal depression and
adolescent daughters’ risk behavior is no longer significant when parental involvement or
parent-child communication is accounted for. Partial mediation is considered when the
relationship between maternal depression and adolescent daughters’ risk behavior is
56

significantly reduced by including parental involvement or parent-child communication
in the model. In addition, Sobel tests (Preacher & Hayes, 2004) were conducted to
directly test the effect sizes and significance of the mediation effect in the relationship
between maternal depression and adolescent daughters’ risk behavior.
Finally, a series of binary logistic regression analyses were conducted to
determine whether involvement of a father moderates the relationship between maternal
depression and adolescent daughters’ risk behavior (Research Question 3). The
involvement of a father was coded as 0 = No father involvement, 1 = Father lives away
but is still involved, and 2 = Father lives in the same household. Binary logistic
regression was employed to contrast the moderating effects of father in the same
household (coded as “2”) vs. no father involvement (coded as “0”) and for father living
away but still involved (coded as “1”) vs. no father involvement (coded as “0”).
All analyses were conducted in two ways: (1) the IV as a continuous variable; and
(2) the IV as a binary variable of low vs. high levels of maternal depressive symptoms. A
cut-off score of eight (range 0-27) was used in this study to evenly split the sample.
This chapter presents the results from analyses conducted with the IV as a binary
variable (For those with the IV as a continuous variable, see Appendices). Logistic
regression analyses were also conducted with and without control variables (maternal
HIV-status, maternal alcohol use, maternal marijuana use, & maternal physical
symptoms). A total of six adolescent outcome variables (two for each risk behavior) were
modeled separately; “ever or lifetime” and “past 30 days (substance use) or three months
(sex)” variables.
57

Descriptive Statistics
Parent participants. Table 1 provides an overview of the demographic
characteristics of the parent participants. Mothers ’ ages ranged from 27 to 70 years old
(M = 40.89, SD = 7.13). Eighty-two percent of the mothers self-identified as African
American. The mothers had diverse educational backgrounds, ranging from less than 12
th

grade (34.1%) to college degree (1.7%). The majority of the mothers were currently
unmarried: never married (54.2%), or separated or divorced (14.1%). Almost half of the
mothers were employed. As a group, mothers reported relatively low levels of depression
(M = 9.89; range = 0-27) and low rates of physical symptoms (M = 15.91; range = 0-89).
Close to 37% reported that they were HIV-positive. One-third of the mothers reported
having had alcohol in the past 30 days and 12.5% reported having used marijuana in the
past 30 days. At the time of the survey, 32.8% of the biological fathers were living
together in the same household, 35.8% were living away but still involved in the child ’s
life, and 29% were not involved in the child ’s life.
Table 1
Demographics – Parents (N = 176)
Variable Frequency (percent)
Mother ’s age (years) M = 40.89 (SD = 7.13)
Mother ’s race
African American
White (Hispanic)
Native American
Asian

145 (82.4%)
20 (11.4%)
2 (1.1%)
1 (.6%)
Mother ’s Hispanic ethnicity
Hispanic

28 (15.9%)
Mother ’s work status
Employed

83 (46.9%)

58

Table 1 (Continued)
Demographics – Parents (N = 176)
Mother’s highest level of education
Less than12
th
grade
High school degree
Some college/vocational school
Associate degree
College degree

60 (34.1%)
71 (40.3%)
28 (15.9%)
5 (2.8%)
3 (1.7%)
Mother’s marital status
Never married
Married to daughter’s other parent
Married to someone other than daughter’s other
parent
Separated/divorced
Widowed

96 (54.2%)
21 (11.9%)
21 (11.9%)
25 (14.1%)
5 (2.8%)
Maternal depression
Low (n=81; range 0-8)
High (n=86; range 9-27)
M = 9.89 (SD = 6.22)
M = 4.52 (SD = 2.16)
M= 14.95 (SD = 4.31)
Maternal physical symptoms
Lowest (n=42; range 0-2)
Low (n=45, range 3-10)
High (n=42, range 11-24)
Highest (n=41, range 25-89)
M = 15.91 (SD = 16.60)
M = .40 (SD = .73)
M = 6.5 (SD = 2.19)
M = 17.9 (SD = 4.24)
M = 40.05 (SD = 13.66)
Parental HIV-status
Mothers with HIV-infection
Fathers with HIV-infection

65 (36.7%)
28 (15.9%)
Mother’s substance use in the past 30 days
Alcohol
Marijuana

58 (33%)
19 (12.5%)
Father’s involvement
Father lives in the same household
Father lives away but is still involved in child’s life
Father is not involved in child’s life

57 (32.8%)
63 (35.8%)
49 (29%)

Child participants. Table 2 describes demographic characteristics and risk
behaviors of child participants. Adolescent daughters ’ ages ranged from 14 to 18 years
old (M = 15.8, SD =1.55); 83% of the daughters self-identified as African American.
The majority of them (90.9%) were in school; 38.7% were in eighth or ninth grade,
59

25.6% in 10
th

grade, and 29.4% reported being in 11
th
or 12
th
grade. With regard to
substance use and sex, 39.2% reported ever having had alcohol, 28.4% reported having
had alcohol in the past 30 days, 22.2% reported ever having used marijuana, 19%
reported having used marijuana in the past 30 days, 42.6% reported ever having had sex,
and 34.1% reported having had a sexual intercourse in the past three months.
Table 2
Demographics - Child (N = 176)
Variable Frequency (percent)
Age (years) M = 15.8 (SD = 1.55)
Race/ethnicity
African American
White (Hispanic)
Native American

147 (83.1%)
19 (10.7%)
2 (1.1%)
Currently in school 160 (90.9%)
Current grade in school
Less than 8th
8th
9th
10th
11th
12th
More than 12th

3 (1.9%)
15 (15.6%)
37 (23.1%)
41 (25.6%)
14 (15%)
23 (14.4%)
7 (4.4%)
Alcohol use
Have ever used alcohol
Have used alcohol in the past 30 days

69 (39.2%)
50 (28.4%)
Marijuana use
Have ever used marijuana
Have used marijuana in the past 30 days

39 (22.2%)
33 (19%)
Engagement in sex
Have ever had sexual intercourse
Have had sexual intercourse in the past three months

75 (42.6%)
59 (34.1%)

60

Mediating variables.
Parental involvement subscale. For the parental involvement subscale, the mean
was 24.22 and standard deviation was 4.99. Scores on this measure were found to be
normally distributed and values ranged from 13 to 32.
Parent-child communication subscale. For the parent child communication
subscale, the mean was 5.33 and standard deviation was 3.29. Scores on this measure
were found to be normally distributed and values ranged from 0 to 10.
Correlations
Table 3 describes a correlation matrix summarizing associations between six
parent variables and maternal depression as a binary variable (See Appendix A for a
correlation matrix with maternal depression as a continuous variable). Among these
predictor variables, the strongest relationship was found between maternal HIV status and
physical symptoms (r = .41, p < .01) and the weakest relationship occurred between
maternal physical symptoms and parent child communication (r = -.009, p = .90).
Maternal depression was correlated with maternal HIV-status, maternal marijuana use,
maternal physical symptoms, and parent-child communication, but not with maternal
alcohol use. Contrary to expectation, parent-child communication had an inverse
relationship with maternal depression; higher scores of parent-child communication were
associated with lower levels of depression. The higher the scores on the parent-child
communication scale, the more negative communication (more conflict) the parent has
with her child. Although significant, this relationship was weak (r = -.16). In short,
mothers who reported higher levels of depressive symptoms were more likely to report
61

being HIV-positive, having used marijuana in the past 30 days, having high levels of
physical symptoms, and having more positive communication with their adolescent
daughters.

Table 3
Pearson Correlations Among Parent Characteristics and Relationship Variables
1 2 3 4 5 6 7
1. Depression
2. HIV
1.00

.16*
1.00
-.05
-.01
.22**
.10
.29**
.41**
-.16*
.10
-.10
.00
3. Alcohol 1.00 .25** .09 -.13 .08
4. Marijuana
5. PHSY
1.00 .17*
1.00
-.13
-.01
.05
.18*
6. PCCOM 1.00 .08
7. Involvement 1.00
Note. Significant results are in boldface. *p < .05, **p < .01.
PHSY = Physical Symptoms; PCCOM = Parent Child Communication Scale Score

Hypothesis Testing
Control variables. Maternal HIV-status, marijuana use, and physical symptoms
were found to be correlated with maternal depression and, thus, were controlled for in
analyses. These variables are also widely recognized as related to reduced parenting
skills. Maternal alcohol use was included as an additional covariate, as it is well
supported in the literature as an influence on adolescent substance use.
Research Question 1
RQ 1 (Aim 1): Are daughters living with depressed mothers engaging in more risk
behavior (i.e., alcohol, marijuana, & sex)?
62

Hypothesis 1
H1: Daughters whose mothers have higher levels of depressive symptoms will
report more substance use (alcohol & marijuana) and be more likely to engage in
sex.

Logistic regression analyses tested the first hypothesis and a total of 24 separate
logistic regression models were run, one each for the three risk behaviors, for lifetime and
past 30 days (alcohol, marijuana) or three months (sex), maternal depression (IV) as a
binary and continuous variable, and with and without control variables (maternal HIV-
status, alcohol use, marijuana use, and physical symptoms). The results below are from
analyses conducted with the IV as a binary variable (For those with the IV as a
continuous variable, see Appendices B through G).
Alcohol. No evidence was found to support a significant relationship between
maternal depression and adolescent daughters’ alcohol use with control variables (Table
4). The results remained non-significant when logistic regression analyses were
conducted without control variables (See Tables B1 & C1 in Appendices). Maternal
physical symptoms, however, were found to have a significant relationship with
adolescent daughters’ alcohol use in the past 30 days (p < .05), such that the more
physical symptoms the mothers had, the less alcohol use the daughters reported in the
past 30 days (OR = .22; 95% CI = .059, .825).

63

Table 4

Logistic Regression Analyses of Alcohol Use, Controlling for Parent Characteristics
Variables
Odds Ratio (95 % Confidence Interval)
Alcohol in lifetime Alcohol in the past 30 days
Control Variables
HIV-status
Maternal alcohol use
Maternal marijuana use
Physical symptoms
Physical symptoms (1)
Physical symptoms (2)
Physical symptoms (3)

1.28 (.582, 2.576)
1.88 (.882, 3.706)
1.00 (.348, 2.819)

.86 (.292, 2.539)
1.06 (.350, 3.207)
.55 (.154, 1.952)

2.15 (.940, 5.031)
1.70 (.812, 3.946)
.84 (.259, 2.639)

.97 (.318, 2.925)
.22 (.059, .825)
.25 (.060, 1.039)
Maternal depression 1.57 (.677, 3.332) 2.24(.877, 5.402)
Model χ2 5.41 13.13
Note. Significant results are in boldface.
For the physical symptoms variable, the lowest response level served as a reference
category.

Marijuana. No evidence was found to support a significant relationship between
maternal depression and adolescent daughters’ marijuana use with control variables
(Table 5). However, maternal HIV-status was a significant risk for adolescent daughters’
marijuana use (p < .05), such that daughters of HIV-positive mothers were more likely to
ever have used (OR = 2.39; 95% CI = 1.033, 5.632) or have used marijuana in the past 30
days (OR = 3.41; 95% CI = 1.349, 8.577). The relationships with maternal depression
remained non-significant when logistic regression analyses were conducted without
control variables (See Tables D1 & E1 in Appendices).

64

Table 5
Logistic Regression Analyses of Marijuana Use, Controlling for Parent Characteristics
Variables
Odds Ratio (95 % Confidence Interval)
Marijuana in lifetime Marijuana in the past 30 days
Control Variables
HIV-status
Maternal alcohol use
Maternal marijuana use
Physical symptoms
Physical symptoms (1)
Physical symptoms (2)
Physical symptoms (3)

2.39 (1.033, 5.632)
.88 (.369, 2.090)
.84 (.258, 2.845)

.81 (.203, 3.263)
.98 (.248, 3.884)
1.11 (.254, 4.864)

3.41 (1.349, 8.577)
.83 (.335, 2.136)
1.18 (.340, 4.035)

1.10 (.277, 4.345)
.57 (.127, 2.498)
.53 (.108, 2.567)
Maternal depression 1.79 (.723, 4.523) 1.90 (.695, 5.034)
Model χ2 10.00 10.42
Note. Significant results are in boldface.
For the physical symptoms variable, the lowest response level served as a reference
category.

Sex. No evidence was found to support the relationship between maternal
depression and adolescent daughters’ engagement in sex without control variables (See
Tables F1 & G1 in Appendices). However, when parent characteristics variables were
controlled for, a significant relationship was found between maternal depression and
adolescent daughters’ engagement in sex (Table 6). This finding indicates that
adolescent daughters whose mothers reported higher levels of depression were more
likely to report ever having had sex in their lifetime (OR = 2.51, 95% CI = 1.162, 5.834)
and having had sex in the past three months (OR = 2.80, 95% CI = 1.259, 6.887).
Maternal HIV-status was also found to be a significant risk for lifetime engagement in
sex (p < .05), such that adolescent daughters of HIV-positive mothers were more likely to
ever have had sexual intercourse (OR = 2.29; 95% CI = 1.107, 4.981) than daughters of
HIV-negative mothers.
65

Table 6
Logistic Regression Analyses of Engagement in Sex, Controlling for Parent
Characteristics Variables
Odds Ratio (95 % Confidence Interval)
Sex in lifetime Sex in the past three months
Control Variables
HIV-status
Maternal alcohol use
Maternal marijuana use
Physical symptoms
Physical symptoms (1)
Physical symptoms (2)
Physical symptoms (3)

2.29 (1.107, 4.981)
1.03 (.495, 2.152)
.67 (.233, 2.008)

.54 (.182, 1.592)
.48 (.157, 1.482)
.52 (.147, 1.832)

1.79 (.852, 4.014)
1.30 (.605, 2.763)
.60 (.208, 1.914)

.40 (.130, 1.234)
.36 (.111, 1.142)
.34 (.092, 1.250)
Maternal depression 2.51 (1.162, 5.834) 2.80 (1.259, 6.887)
Model χ2 13.03 10.99
Note. Significant results are in boldface.
For the physical symptoms variable, the lowest response level served as a reference
category.

Summary of research question 1. Based on the findings, when the parent
characteristics variables were controlled for, adolescent daughters whose mothers
reported higher levels of depressive symptoms were more likely to have engaged in sex.
The other two risk behaviors (alcohol & marijuana) were not found to have significant
relationships with maternal depression. Results showed that maternal physical symptoms
was related to adolescent daughters’ alcohol use in the past 30 days, such that daughters
of mothers with physical symptoms were less likely to have used alcohol in the past 30
days. In addition, maternal HIV-status was a significant risk for adolescent daughters’
marijuana use both in lifetime and in the past 30 days and lifetime engagement in sex.
Adolescent daughters having HIV-positive mothers had a higher odds of reporting
marijuana use and engagement in sex than adolescent daughters with HIV-negative
mothers.
66

Research Question 2
RQ 2 (Aim 2): Do parent-child communication and parental involvement mediate
the relationship between maternal depression and adolescent daughters’ risk
engagement in substance use and sex?
Hypotheses 2
H 2.1: Daughters whose mothers have higher levels of depressive symptoms will
report lower parental involvement and poorer parent-child communication than
those whose mothers have lower levels of depressive symptoms.
H 2.2: Poorer parent-child communication and lower parental involvement will be
associated with adolescent daughters’ engagement in substance use and sex.
H 2.3: Daughters whose mothers have higher levels of depressive symptoms will
report more substance use (alcohol & marijuana) and sex than those whose
mothers have lower levels of depressive symptoms.
H 2.4: The relationship between maternal depressive symptoms and adolescent
daughters’ engagement in substance use (alcohol & marijuana) and sex will be
significantly reduced (partial mediation) or eliminated (complete mediation) when
parental involvement or parent-child communication are accounted for.

As previously seen in Table 4 and Table 5, no significant relationships were found
between maternal depression and adolescent daughters’ substance use (alcohol &
marijuana) (p > .05). Thus, mediation was not tested for these models. However, logistic
regression analyses with engagement in sex as the DV (Table 6) revealed significant
67

relationships between maternal depression and adolescent daughters’ engagement in sex.
Therefore, regression analyses were conducted to determine whether parental
involvement or parent-child communication mediate this relationship.
Mediation tests were conducted in parallel to encompass the two sex outcome
variables (“have ever had sex” & “had sex in the past three months”), the two mediators
(parental involvement & parent-child communication), maternal depression (IV) as a
binary and continuous variable, and with and without covariates (HIV-status, alcohol use,
marijuana use, & physical symptoms). (For the results from the analyses conducted
without covariates, see Appendices H through J.)
Mediation effects were determined using logistic regression, following the
mediation model of Baron and Kenny (1986; MacKinnon & Dwyer 1993; MacKinnon,
Fairchild, & Fritz, 2007) and confirmed by a Sobel test of mediation. Note that the Sobel
test results reported here reflect the adjustment of MacKinnon and Dwyer (1993) to
account for the binomial outcome variable (yes/no).
Sex in lifetime. The first model was run previously with maternal depression and
the control variables as the IVs and adolescent daughters’ engagement in sex as the DV
(See Table 6). Maternal depression and maternal HIV-status were found to be
significantly related to adolescent daughters’ lifetime engagement in sex (p < .03). This
finding indicates that adolescent daughters with a depressed mother and a HIV-positive
mother were more likely to ever have had sex. Table 7 displays B coefficients, SE, Wald
Statistics, p-value, and odds ratios for the first model.
68

Table 7
The Influence of Maternal Depression on Adolescent Daughters' Lifetime Engagement in
Sex
Variable B SE Wald Sig. Exp (B)
Depression (dichotomous) .92 .41 4.96 .03 2.51
HIV .83 .39 4.59 .03
2.29
Maternal alcohol .03 .38 .01 .93
1.03
Maternal marijuana -.41 .55 .54 .46
.66
Physical Symptoms

1.80 .62
Physical Symptoms (1) -.62 .55 1.25 .26
.54
Physical Symptoms (2) -.73 .57 1.63 .20 .48
Physical Symptoms (3) -.66 .64 1.04 .31 .52
Constant -.24 .46 .28 .60
.78
Note. For the physical symptoms variable, the lowest response level served as a reference
category.

The second model included parental involvement as the DV , and maternal
depression and the control variables as independent predictors. Table 8 shows the results
of the linear regression model (See Table H1 in Appendix for those without covariates).

Table 8
The Influence of Maternal Depression on Parental Involvement
Variable B SE β t Sig.
Depression .13 .97 .01 .13 .90
HIV -1.79 .92 -.18
-1.95
.05
Maternal alcohol -.40 .90 -.04
-.45
.66
Maternal marijuana -.97 .1.33 .07 .73 .47
Physical Symptoms .26 .48 .06 .73 .59
Constant 25.22 .87 -
.13
.00

69

Table 9 shows the results of the linear regression model including parent-child
communication as the DV , and maternal depression and the control variables as
independent predictors (See Table H4 in Appendix for those without covariates).
Table 9
The Influence of Maternal Depression on Parent-Child Communication
Variable B SE β t Sig.
Depression -.82 .69 -.12 -1.18 .24
HIV .74 .65 .10
1.14
.26
Maternal alcohol -.97 .63 -.13
-1.55
.12
Maternal marijuana -.91 .93 -.09 -.98 .33
Physical Symptoms -.10 .34 -.03
-.28
.78
Constant 6.15 .61 -
10.07
.00

In the two models above (Tables 8 & 9), maternal depression was not significantly
associated with parental involvement (B = .13, SE = .97, β = .01, t = .13, p < .90), F(5,
130) = .83, p = .53, or parent-child communication (B = -.82, SE = .69, β = -.12, t = -1.18,
p < .24), F(5,133) = 1.62, p = .16, suggesting that step two of the meditational procedure
was not met. Thus, Hypothesis 2.1 was not supported.
The third regression model included maternal depression, the mediator variable
(parental involvement & parent-child communication), the control variables, and
adolescent daughters’ lifetime engagement in sex as the DV . Table 10 shows the results
of the binary logistic regression model including parental involvement as the mediator
variable, and no evidence of mediation was found (See Table I1 in Appendix for those
without covariates). A Sobel test statistic also demonstrated the non-significant

70

mediation effects of parental involvement in the link between maternal depression and
adolescent daughters’ lifetime engagement in sex (Z = -.13, p = .90).
Table 10
The Influences of Maternal Depression and Parental Involvement on Adolescent
Daughters' Lifetime Engagement in Sex
Variable B SE Wald Sig. Exp (B)
Depression .90 .42 4.53 .03
2.45
Parental Involvement -.03 .04 .43 .51 .98
HIV .79 .40 3.78 .05
2.19
Maternal alcohol .00 .39 .00 .99
1.00
Maternal marijuana -.38 .58 .43 .51
.68
Physical Symptoms

1.95 .58
Physical Symptoms (1) -.75 . 65 1.79 .18 .47
Physical Symptoms (2) -.66 .58 1.30 .25 .52
Physical Symptoms (3) -.58 .65 .80 .37
.56
Constant .40 1.08 .14 .71
1.49
Note. For the physical symptoms variable, the lowest response level served as a reference
category.

Table 11 includes parent-child communication as the mediator variable and results
showed no evidence of mediation. A Sobel test statistic also revealed that the mediation
effects of parent-child communication were not significant in the link between maternal
depression and adolescent daughters’ lifetime engagement in sex (Z = .90, p = .37).
Maternal depression (p < .03) and HIV-status (p < .04) continued to be significant
predictors of adolescent daughters’ lifetime engagement in sex.

71

Table 11
The Influences of Maternal Depression and Parent-Child Communication on Adolescent
Daughters' Lifetime Engagement in Sex
Variable B SE Wald Sig. Exp (B)
Depression .95 .43 5.03 .03
2.59
PCCOM -.08 .05 1.98 .16 .93
HIV-status .85 .40 4.47 .04
2.34
Maternal alcohol -.06 .39 .03 .87
.94
Maternal marijuana -.42 .57 .54 .46
.66
Physical Symptoms

1.31 .73
Physical Symptoms (1) -.57 .57 1.03 .31 .56
Physical Symptoms (2) -.57 .58 .98 .32 .56
Physical Symptoms (3) -.64 .66 .92 .34
.53
Constant .16 .55 .08 .78
1.17
Note. PCCOM = Parent-Child Communication
For the physical symptoms variable, the lowest response level served as a reference
category.

Logistic regression analyses conducted without control variables also yielded the
non-significant mediation effects of parental involvement and parent-child
communication in the relationship between maternal depression and adolescent daughters’
lifetime engagement in sex (See Table I4 in Appendix).
Sex in the past three months. The meditational model for engagement in sex in
the past three months was also tested by logistic regression analyses. The first model was
run previously with maternal depression and the control variables as the IVs and
adolescent daughters’ engagement in sex as the DV (See Table 6). Maternal depression
was found to have a significant relationship with adolescent daughters’ engagement in
sex in the past three months (p < .02). This finding indicates that adolescent daughters of
a mother with high levels of depressive symptoms were more likely to have had sex in
72

the past three months. Table 12 displays B coefficient, SE, Wald Statistics, p-value, and
odds ratios.

Table 11
The Influence of Maternal Depression on Adolescent Daughters' Engagement in Sex in
the Past Three Months
Variable B SE Wald Sig. Exp (B)
Depression 1.03 .44 5.57 .02
2.80
HIV-status .58 .40 2.12 .15 1.79
Maternal alcohol .26 .39 .45 .50
1.30
Maternal marijuana -.51 .58 .77 .38
.60
Physical Symptoms

3.64 .30

Physical Symptoms (1) -.92 .58 2.55 .11
.40
Physical Symptoms (2) -1.03 .60 3.02 .08 .36
Physical Symptoms (3) -1.08 .67 2.64 .10 .34
Constant -.41 .48 .71 .40
.67
Note. For the physical symptoms variable, the lowest response level served as a reference
category.
As shown previously in the second model including parental involvement (Table
8) and parent-child communication (Table 9) as the DV , and maternal depression and the
control variables as independent predictors, maternal depression was not a significant
predictor of parental involvement and parent-child communication, suggesting that step
two of the meditational procedure was not met.
The third regression model included maternal depression, the mediator variable
(parental involvement & parent-child communication), the control variables, and
adolescent daughters’ engagement in sex in the past three months. Table 13 shows the
results of the binary logistic regression model testing the mediating role of parental
involvement in the relationship between maternal depression and adolescent daughters’
73

engagement in sex in the past three months (See Table J1 in Appendix for those without
covariates). No mediation effects involving parental involvement were significant. A
Sobel test was utilized and also found non-significant mediation effects of parental
involvement in the link between maternal depression and adolescent daughters’ lifetime
engagement in sex (Z = -.13, p = .90).
Table 12
The Influences of Maternal Depression and Parental Involvement on Adolescent
Daughters' Engagement in Sex in the Past Three Months
Variable B SE Wald Sig. Exp (B)
Depression 1.01 .45 5.08 .02
2.74
Parental Involvement -.03 .04 .59 .44 .97
HIV-status .51 .42 1.52 .22
1.67
Maternal alcohol .26 .40 .41 .52 1.30
Maternal marijuana -.55 .61 .82 .37 .58
Physical Symptoms

3.90 .27
Physical Symptoms (1) -1.10 .59 3.48 .06 .33
Physical Symptoms (2) -.96 .60 2.56 .11 .38
Physical Symptoms (3) -.98 .67 2.13 .14 .37
Constant .36 1.09 .11 .74
1.44
Note. For the physical symptoms variable, the lowest response level served as a reference
category.
Table 14 includes parent-child communication as the mediator variable (See Table
J4 in Appendix for those without covariates). No evidence of mediation was found. This
null finding was confirmed by the Sobel test (Z = .76, p = .45).

74

Table 13
The Influences of Maternal Depression and Parent-Child Communication on Adolescent
Daughters' Engagement in Sex in the Past Three Months
Variable B SE Wald Sig. Exp (B)
Depression 1.01 .44 5.19 .02
2.75
PCCOM -.06 .06 1.02 .31 .95
HIV-status .56 .42 1.85 .17
1.76
Maternal alcohol .20 .40 .24 .62 1.22
Maternal marijuana -.47 .58 .64 .42 .63
Physical Symptoms

3.05 .38

Physical Symptoms (1) -.90 .59 2.37 .12 .41
Physical Symptoms (2) -.87 .60 2.10 .15 .42
Physical Symptoms (3) -1.02 .44 5.19 .02 2.75
Constant -.12 .56 .04 .84
.89
Note. PCCOM = Parent-Child Communication
For the physical symptoms variable, the lowest response level served as a reference
category.

Summary of research question 2. Regression analyses revealed no significant
mediating effects of parental involvement or parent-child communication on the
relationship between maternal depression and adolescent daughters’ engagement in sex.
This finding was consistent whether sex was operationalized as ever having had sex or as
having had sex in the past three months. Therefore, RQ2 was not supported.
Research Question 3
RQ 3 (Aim 3): Is involvement of a father protective against adolescent daughters’
risk engagement in substance use and sex?

75

Hypothesis 3
H 3: Involvement of a father will moderate the relationship between maternal
depression and adolescent daughters’ engagement in substance use (alcohol &
marijuana) and sex.
RQ 3 was tested using multiple regression statistics, following the moderator
model of Baron and Kenny (1986). For each of the three outcome variables (alcohol,
marijuana, & sex), the predictor, the moderators, and the interaction variables were
entered into the analysis. Each moderator analysis was conducted with and without
covariates (maternal HIV-status, alcohol use, marijuana use, and physical symptoms).
Results from RQ3 are summarized in Table 15 (See Table K2 in Appendix for those with
the IV as a continuous variable). Table 16 shows the results of the regression models for
adolescent substance use when covariates were included (See Table K1 in Appendix for
the results when covariates were not included).
Table 14
Summary of Father Involvement as a Moderator Variable in the Relationship between
Maternal Depression and Adolescent Daughters' Risk Behavior
Father
Involvement
Moderation Alcohol
in
lifetime
Alcohol
30 days
MJ
in
lifetime
MJ
30
days
Sex
in
lifetime
Sex
3
mos
Away vs.
Not
involved
no covariates + + +
w/ covariates + + +
At home vs.
Not
involved
no covariates (+) +
w/ covariates + + (+)
Note. + = statistically significant positive relationship, p < .05
(+) = non-significant positive trend, p < .10
MJ = Marijuana; Covariates = HIV-status, alcohol use, marijuana use, & physical
symptoms
76

Table 15
Results of Regression Models Testing the Moderating Effects of Father Involvement in the
Relationship between Maternal Depression and Adolescent Daughters' Substance Use
Alcohol in
Lifetime
Alcohol
30 Days
Marijuana in
Lifetime
Marijuana
30 Days
B OR B OR B OR B OR
HIV-status .34 1.40 .82+ 2.28 .93* 2.55 1.28* 3.61
Maternal alcohol .46 1.59 .44 1.55 -.31 .74 -.41 .66
Maternal MJ .18 1.20 -.02 .98 -.09 .91 .29 1.33
Physical symptoms
PS (1) -.16 .85 -.13 .88 -.20 .82 .09 1.09
PS (2) .14 1.15 -1.46* .23 -.18 .84 -.81 .45
PS (3) -.52 .60 -1.33+ .26 .08 1.09 -.75 .47
Depression -1.18 .31 -.29 .75 -1.05 .35 -.72 .49
FI 1 -.84 .43 -.47 .62 -1.21 .30 -1.11 .33
FI 2 -.88 .42 -2.04+ .13 -.90 .41 -1.41 .25
Depression x FI 1 2.40* 11.02 .84 2.32 2.91* 18.37 2.74* 15.49
Depression x FI 2 2.15* 8.59 3.22* 25.00 1.99+ 7.30 1.63 5.09
Note. Father involvement 1(FI 1) = Father living away vs. No father involvement; Father
involvement 2(FI 2) = Father in the same house vs. No father involvement; Reported
values are unstandardized betas. Significance levels are indicated by + (for p < .10) and *
(for p < .05).

Alcohol and marijuana use. As reported in Table 16, the interactions between
maternal depression and father involvement on adolescent daughters’ substance use were
significant (p < .05) or trend-level (p < .10), indicating that the relationships between
maternal depression and adolescent daughters’ substance use differ as a function of father
involvement. All the interactions were in the opposite of the predicted direction; the
association between maternal depression and adolescent daughters’ alcohol and marijuana
use was positive when fathers were involved, but negative when they were not. For
example, when the father was not involved, adolescent daughters had a higher likelihood
of using alcohol when maternal depression was low. When the father was involved, high
77

maternal depression was associated with increased alcohol use. Similarly, the
relationship between maternal depression and adolescent daughters’ marijuana use
differed for different levels of father involvement. When the father was not involved,
there was a greater likelihood of marijuana use for adolescent daughters whose mothers
reported low levels of depressive symptoms. On the other hand, when the father was
involved, adolescent daughters were more likely to have used marijuana when the
mothers were depressed than when they were not.
Together, these interaction results present a consistent pattern. Among adolescent
daughters whose father was involved, high maternal depression was linked with more
substance use. This interaction result indicates that the association between maternal
depression and adolescent substance use changes at different levels of father involvement.
Additionally, the effect of the maternal depression x father involvement
interaction was also checked using crosstabs.
Table 16
Descriptive Statistics for Adolescent Daughters' Lifetime Alcohol Use Depending on
Father Involvement and Maternal Depression
Father
Involvement
Maternal Depression
N (%)
Alcohol Use
N (%)
Odds Ratio
No Yes
No
Involvement
Low 29 (59.2%) 14 (48.3%) 15 (51.7%)
.31
High 20 (40.8%) 15 (75%) 5 (25%)
Total 29 (59.2%) 20 (40.8%)
Father Living
Away
Low 30 (48.4%) 22 (73.3%) 8 (26.7%)
2.74 High 32 (51.6%) 16 (50%) 16 (50%)
Total 38 (61.3%) 24 (38.7%)
Father in the
House
Low 17 (34.7%) 12 (70.6%) 5 (29.4%)
1.64 High 32 (65.3%) 19 (59.4%) 13 (40.6%)
Total 31 (63.3%) 18 (36.7%)
78

As seen in Table 17, alcohol use of daughters was different in the no father
involvement and in the father involvement (living away & in the house) groups. When
the father was involved in the child’s life, adolescent daughters with a highly depressed
mother used alcohol more than those whose mother reported low levels of depressive
symptoms. For example, when the father was living away but still involved, 50% of the
daughters whose mother was highly depressed reported having used alcohol, whereas
26.7% of those whose mother reported low levels of depressive symptoms.
The interaction terms effectively show how many times larger the odds ratio for
the depression/alcohol use relationship is at each level of father involvement as compared
to the strength of the odds ratio in the no father involvement category. The odds ratio at
no father involvement was .31, whereas those at father living away and in the house were
2.74 and 1.64, respectively.

Table 17
Descriptive Statistics for Adolescent Daughters' Lifetime Marijuana Use Depending on
Father Involvement and Maternal Depression
Father
Involvement
Maternal Depression
N (%)
Alcohol Use
N (%)
Odds Ratio
No Yes
No
Involvement
Low 29 (59.20%) 21 (72.4%) 8 (27.6%)
.66
High 20 (40.8%) 16 (80%) 4 (20%)
Total 37 (75.5%) 12 (24.5%)
Father Living
Away
Low 30 (48.4%) 27 (90%) 3 (10%)
5.4 High 32 (51.6%) 20 (62.5%) 12 (37.5%)
Total 47 (75.8%) 15 (24.2%)
Father in the
House
Low 17 (34.7%) 15 (88.2%) 2 (11.8%)
2.5 High 32 (65.3%) 24 (75%) 8 (25%)
Total 39 (79.6%) 10 (20.4%)
79

The descriptive results in Table 18 show the relationship between maternal
depression and adolescent daughters’ marijuana use within each level of father
involvement. As indicated in Table 18, within the no father involvement group, daughters
were more likely to have used marijuana when the mothers reported low levels of
depressive symptoms (27.6%) than when they were highly depressed (20%). In contrast,
within the father living away group, daughters with a highly depressed mother were more
likely to have used marijuana (37.5%) compared to those whose mothers reported low
levels of depression (10%).
As indicated in Table 16, maternal HIV-status was found to be associated with
adolescent daughters’ marijuana use. The odds ratios of 2.55 and 3.61 indicate that a
daughter with an HIV-positive mother was approximately three times more likely to have
used marijuana than a daughter with an HIV-negative mother.
Engagement in sex. Father involvement failed to significantly moderate the
relationship between maternal depression and adolescent daughters’ engagement in sex,
whether it is in lifetime or in the past three months, whether covariates were or were not
included, and whether father involvement was contrasting Father at Home to Father Not
Involved or contrasting Father Away to Father Not Involved or (each p > .05) (See Table
15 and Tables K5 & K6 in Appendix). The non-significant interaction terms indicate that
the relationship between maternal depression and adolescent daughters’ engagement in
sex does not differ whether fathers are or are not involved in the child’s life.
Summary of research question 3. The results indicate significant or trend-level
findings for all of the Maternal Depression x Father Involvement interactions for the
80

outcomes of alcohol and marijuana use, but not engagement in sex. All significant
interactions were in the opposite of the predicted direction; Substance use was found to
increase when the father was involved in the child’s life and the mother had higher levels
of depressive symptoms. The findings revealed that the effects of maternal depression on
adolescent daughters’ substance use differ significantly depending on father involvement.

81

CHAPTER 6: DISCUSSION AND CONCLUSION
The purpose of this study was to understand the relationship between maternal
depression and adolescent risk behavior (i.e., substance use and sex) among urban inner-
city mother-daughter dyads. Two dimensions of family factors—parent-child
communication and parental involvement—were examined as possible mediators of the
relationship between maternal depression and adolescent risk behavior. The hypothesis
was that the association between maternal depression and adolescent risk behavior would
be moderated by the involvement of a father. Minuchin’s family systems theory (1974)
provides the overarching framework used to guide this study.
Maternal Depression and Adolescent Daughters’ Risk Behavior
The first hypothesis investigated whether maternal depression would be
associated with adolescent risk behavior. This hypothesis was partially supported. There
was a direct association between maternal depression and adolescent daughters’
engagement in sex after controlling for maternal HIV-status, maternal substance use, and
physical symptoms. This result suggests that adolescent daughters whose mothers report
higher levels of depressive symptoms are more likely to engage in sex than those whose
mothers have lower levels of depressive symptoms. This finding is in accordance with
that of Bohon, Garber, and Horowitz (2007), who studied mothers with a diagnosis of a
depressive disorder and their adolescent children. The authors reported that the offspring
of mothers with severe depression were at increased risk of having sexual intercourse.
The current study builds on the existing literature because no previous studies have
examined sexual activity of adolescents whose mothers have depressive symptoms in a
82

non-clinical sample. This study provides the first evidence that even mild levels of
depression can be associated with adolescent daughters’ sexual behavior.
There are several explanations as to why maternal depression might increase the
likelihood of adolescent daughters’ sexual activity. One interpretation posits sex as a
coping mechanism. Mothers with depression may be less capable of providing the
attention and affection their children desire because of depressive symptoms including
sadness, loss of energy, irritability, and anger. When mothers are not a source of
emotional support and nurturing, adolescents may seek love and affection elsewhere; that
is, they may seek attention from their romantic partners by engaging in sexual
relationships. Previous research (Impett & Tolman, 2006; Ott, Millstein, Ofner, &
Halpern-Felsher, 2006; Paradise, Cote, Minsky, Lourenco, & Howland, 2001) has also
documented love and affection as a major motive that guides female adolescents in their
decisions to engage in sex. For these adolescents, sexual experience may be a way to
compensate for unsupportive relationships with their mothers.
Another potential interpretation is that depressed mothers may face difficulties in
monitoring their children; the lack of monitoring can lend to an adolescent’s increased
risk of engaging in sex because they have more opportunities to do so. If children do not
feel that their parents care about their activities and whereabouts, they may spend more
time outside their homes, which increases the likelihood of acting-out with sexual
behavior (Donenberg, Wilson, Emerson, & Bryant, 2002; Longmore, Manning, &
Giordano, 2001; Rosenthal, V on Ranson, Cotton, Biro, Mills, & Succop, 2001;
Sieverding, Adler, Witt, & Ellen, 2005; Stanton, Li, Pack, Cottrell, & Burns, 2002).
83

Although a large body of research has focused on adolescent risky sexual
behavior, a new perspective is emerging that focuses on the potentially positive aspects of
sexual development in middle or late adolescence (Zimmer-Gembeck & Helfand, 2008).
These literatures describe adolescent sexual activity as part of normal development, and
suggest that the majority of adolescents have engaged in, or are going to engage in, sex
before they graduate from high school. National data also evidence that sexual behavior
has become the norm among adolescents. One-third of 9
th
-grade, 40.9% of 10
th
-grade, 53%
of 11
th
-grade, and 62.3% of 12
th
-grade students have reported engaging in sexual
intercourse (Centers for Disease Control and Prevention, 2010). The overall prevalence
of sexual activity is higher for minority adolescent females; close to 60% of African
American and almost a half of Hispanic females report having sexual intercourse whereas
the prevalence among White females is 44.7%. In the U. S., close to 70% of adolescents
engage in sex by the age of 18 (Carver, Joyner, & Udry, 2004), which shows that sexual
behavior in later adolescence is fairly common and normal. Despite such widespread
sexual activity among adolescents, engaging in sexual intercourse puts adolescents at risk
for serious negative consequences, such as having multiple numbers of sexual partners,
acquiring sexually transmitted diseases, and unplanned pregnancies. The results of the
current study, therefore, can inform intervention and prevention for adolescents at risk of
sexual activity.
This study also hypothesized that living with a depressed mother is highly
stressful and potentially precipitates maladaptive coping responses such as substance use
in adolescent daughters. This was unsupported. Contrary to hypotheses and to other
84

studies, which have shown a link between maternal depression and adolescent substance
use (Corona, Lefkowitz, Sigman, & Romo, 2005; Cortes, Fleming, Mason, & Catalano,
2009; Lieb, Isensee, Hofler, Pfister, & Wittchen, 2002), data in the current work suggest
that youth whose mothers have depressive symptoms do not exhibit significantly
heightened rates of substance use. There are a number of potential ways to understand
this finding. Adolescent participants in the present study were all females; previous
studies, which have found the link between maternal depression and adolescent substance
use, included both male and female participants (Leinonen, Solantaus, & Punamaki,
2003). Coping in adolescent girls may be better because females have a higher tendency
to cope with distress by turning to friends, family, or other important people rather than
acting out by using substances. Evidence also suggests that female adolescents are more
likely to seek social support to cope with distress (Hampel & Petermann, 2005), which
would decrease their likelihood of utilizing substances to cope with stressors.
The characteristics of the sample may also help explain the lack of a relationship
between maternal depression and adolescent substance use. Studies on race differences
in family management style and adolescent substance use reveal that, relative to White
parents, African American parents have more proactive parenting styles and anti-drug use
attitudes (Peterson, Hawkins, Abbot, Catalano, 1994; Resnicow, Soler, Braithwaite,
Ahluwalia, & Butler, 2000). Given that the sample in this study is predominantly African
American, more youth may be exposed to abstinence models and norms and not choose
to use substances to cope with the stress induced by living with a depressed mother. In
addition, because the sample includes high-risk mothers with histories of substance use,
85

these mothers may be more articulate in their views regarding substance use and less
likely to talk about sex. Furthermore, substance use may be an easier topic for parents to
discuss with their adolescents than sex. Indeed, evidence suggests that compared with
White mothers, African American and Hispanic mothers are less likely to communicate
about sex-related topics and more likely to report discomfort in discussing sexuality with
their adolescent daughters (Meneses et al., 2006).
While maternal depression was not associated with substance use among
adolescents in this study, maternal HIV-status was an important influence on daughters’
marijuana use. One possible interpretation is that children of HIV-infected mothers may
also live in environments that expose them to the same risk factors for HIV to which their
mothers were exposed (e.g., high HIV seroprevalence in the community, prevalence of
drugs in the neighborhood, chronic poverty; Brackis-Cott, Mellins, Dolezal, & Spiegel,
2007). Given that mothers with HIV are more likely to be current or former drug users
(Lee, Lester, & Rotheram-Borus, 2002), children in households where there is a greater
history (or current use) may be at increased risk of substance use. Furthermore, HIV-
positive parents tend to seek support from other substance users rather than their partners
or relatives because relationships with their families may be strained, inconsistent, or
unstable (Knowlton, 2003), thereby increasing the potential exposure of their children to
drugs.
Another possibility is that knowledge of a mother’s HIV-status may present a
more heightened level of stress, and have a more critical effect on adolescents’ likelihood
of using drugs to cope. Children of HIV-infected parents are particularly vulnerable to
86

stress, such as anticipatory fears about the death of their parents, HIV-related stigma, and
increased family responsibilities due to the parent’s debilitating physical symptoms
(Rotheram-Borus, Weiss, Alber, & Lester, 2005; Stein, Rotheram-Borus, & Lester, 2007).
As such, these children may engage in destructive coping and acting-out behaviors by
using drugs to deal with their emotional distress. Previous research (Lee & Rotheram-
Borus, 2002) has found an association between learning about a parent’s HIV-infection
and adolescent substance use. On the other hand, it is unknown why alcohol use was not
associated with maternal depression in this study. Given that many mothers in this
sample were HIV-infected, it may be that marijuana was more accessible than alcohol to
these daughters. Maternal substance use was also unrelated to adolescent substance use
in the present study. This result is congruent with the findings of Wu and colleagues
(2011). The age group of the current sample (14-18 years) may have given rise to this
finding because peers are more influential in shaping adolescent behavior than are parents.
Family Factors as Mediators
The second hypothesis was that the associations between maternal depression and
adolescent risk behavior would be mediated by family factors (i.e., parent-child
communication and parental involvement). While the main effects between maternal
depression and adolescent daughters’ engagement in sex achieved statistical significance,
a mediation model was unsupported for adolescent sexual activity. Neither parent-child
communication nor parental involvement mediated the association between maternal
depression and adolescent daughters’ sexual activity. Logistic regression analyses
showed that the association of maternal depression with daughters’ engagement in sex
87

was still significant even when the probability of parent-child communication and
parental involvement was included in the model. Thus, the addition of family factors to
the model failed to attenuate the relationship between maternal depression and adolescent
sexual behavior. Although the findings of the current study do not support the notion that
these particular family factors may be potential mechanisms through which maternal
depression is transmitted to adolescent outcomes, no previous studies have examined the
mediating effects of family factors in relation to adolescent sexual activity in families of a
depressed mother. Thus, this relationship requires continued exploration.
The lack of mediating effects in the relationship between maternal depression and
daughters’ engagement in sex suggests that the process for adolescent sexual behavior is
complex. It may be that family issues other than parent-child communication and
parental involvement contribute to adolescent sex. For example, marital discord is
another important variable that may also serve as a mediator in the link between maternal
depression and maladaptive adolescent outcomes (Cummings & Davies, 1999; Davies et
al., 1999). Therefore, the relationship between maternal depression and daughters’ sexual
activity may operate through other mechanisms not measured in the current study.
Another possibility is that results may be attributed to the cultural family structure
of the sample, which was predominantly composed of African American mothers and
their daughters. African American families are known to be tightly organized into
extended families, and parenting by relatives, including grandparents, aunts, and uncles is
common (Taylor, Casten, & Flickinger, 1993). Mothers may not be the primary and only
caregiver for their children in this sample, especially when the mother is mentally and/or
88

physically ill. This may buffer the effects of maternal depression on mother-daughter
relationships and adolescent behavior. Pachter, Auinger, Palmer, and Weitzman (2006)
documented that the effects of maternal depression on child behavioral problems were
unmediated through parenting practices in an African American sample, whereas the
effects of maternal depression were partially mediated through parenting in a white
sample. As this study did not collect information on other influential adults in the lives of
these adolescent daughters, we are unable to examine whether our outcomes of interest
may operate through other family relationships.
Father Involvement
The third hypothesis was that father involvement would moderate the relationship
between maternal depression and adolescent daughters’ risk behavior. Logistic regression
analyses provided information about father involvement by considering the links between
maternal depression and adolescent daughters’ risk behavior. The results indicated
significant or trend-level findings for all of the Maternal Depression x Father
Involvement interactions for the outcomes in terms of adolescent daughters’ alcohol and
marijuana use, but not engagement in sex. We had anticipated that father involvement
would be beneficial to adolescent daughters with a depressed mother, but instead, more
involvement with the father was found to be linked with more substance use among
daughters of a mother with higher levels of depressive symptoms. On the other hand, the
opposite pattern is evident for daughters whose mothers reported lower levels of
depressive symptoms: daughters whose fathers were involved in their lives were less
likely to use substances in this group. Thus, the findings do not fully support what was
89

hypothesized for this study and challenge previously held beliefs that greater involvement
by fathers contributes to positively to the well-being of children (Boyd, Ashcraft, &
Belgrave, 2006; Goncy & Dulmen, 2010). The finding does not concur with previous
studies documenting that father involvement buffers against the negative effects of
maternal depression on adolescent outcomes (Chang, Halpern, & Kaufman, 2007;
Mezulis, Hyde, & Clark, 2004).
Though we are unable to fully account for the results in this study, a possible
explanation is that in families with a depressed mother, there may be more interparental
conflict. As depression is often referred to as “relational pathology” (Lyons-Ruth, Zoll,
Connell, & Grunebaum, 1986), individuals with depression tend to struggle with close
relationships such as spouses and children (Hammen, 2009). As such, depression and
interparental conflict frequently co-occur and this association has been well documented
(Rehman, Gollan, & Mortimer, 2008). Research has shown that more frequent, intense,
and prolonged exposure to interparental conflict may negatively affect children’s well-
being, for example, increasing the risk for internalizing and externalizing problems
(Davies and Windle, 2001). Greater conflict between parents often results in increased
parent-child conflict (Bradford et al., 2008) as well as inadequate parent discipline
(Buehler & Gerard, 2002). Furthermore, when there are additional stressors within the
family, such as poverty or violence, interparental conflict can lead to more significant
effects on the children (Cummings, Davies, & Campbell, 2000). Given that the
participants in this study were from low-income families receiving services from social
service organizations for reasons such as intimate partner violence, it may be the case that
90

many adolescents in these families were exposed to long-lasting interparental conflict,
which may have fostered in these adolescents a maladaptive means of coping with stress.
Previous research has also demonstrated that adverse family environments, such as those
characterized by interparental conflict, are associated with a higher level of drug use in
adolescents (Skeer, McCormick, Normand, Buka, & Gilman, 2009).
Another alternative explanation concerns the possibility of assortative mating.
That is, individuals are inclined to mate with others similar to them, and thus, spouses of
depressed mothers tend to be disturbed themselves. As has been suggested in prior
literature, women with depression often have husbands with mood disorders or substance
abuse problems (Mathews & Reus, 2001). Evidence suggests that dually affected couples
create dysfunctional family environments for their children (Dierker, Merikangas, &
Szatmari, 1999). As such, disturbed husbands may contribute to their spouses’
vulnerability to depression and negative functioning as well as their children’s substance
use.
Maternal Depression and Parental Characteristics
Descriptively, maternal depression was associated with maternal HIV-status,
maternal marijuana use, maternal physical symptoms, and parent-child communication.
Mothers with higher levels of depressive symptoms, relative to mothers with lower levels
of depressive symptoms, more often reported being HIV-positive, having used marijuana
in the past 30 days, and having higher levels of physical symptoms. Contrary to previous
findings suggesting that adolescents with depressed mothers are more likely to
experience negative communication patterns in their interactions with their mothers
91

(Kiernan & Huerta, 2008; Sarigiani, Heath, & Camarena, 2003), maternal depression was
associated with positive parent-child communication in the current sample. The
magnitude of the association between maternal depression and parent-child
communication in this study, however, was minimal and should be interpreted with
reservation.
Most of the previous studies on parental depression have documented an
association between mothers with elevated depressed moods and reduced levels of
parental involvement (Albright & Tamis-LeMonda, 2002; Lyons-Ruth, Lyubchik, Wolfe,
& Bronfman, 2002; McLearn, Minkovitz, Strobino, Marks, & Hou, 2006; Sarigiani,
Heath, & Camarena, 2003). In the present study, however, the severity of depressive
symptoms in mothers was unrelated to parental involvement. Finding no relationship
between maternal depression and parental involvement may say something about the lack
of variation in depressive symptoms and low levels of depression. Also, it is possible that
parental involvement is not associated with maternal depression, but that other factors
may be more relevant to maternal depression.
Limitations of the Study
Several limitations of the current study must be noted. First, the participants were
a convenience sample and may not be representative of the general population of
minority families. Because participants were limited to those who self-selected into the
study, families most at risk may be less represented. For example, we may be missing an
important subgroup of families with mothers who have more severe clinical levels of
depressive symptoms because their symptoms may have prevented them from
92

participating in the study. However, it must be noted that the main purpose of the parent
study was not to investigate maternal mental health, thereby not targeting women with
mental health issues.
Second, the cross-sectional and correlational nature of the research design
precludes any causal conclusions regarding the direction of the relationship between
maternal depression and adolescent daughters’ risk behavior. For example, adolescent
engagement in sex cannot be solely attributable to maternal depression. It is also possible
that adolescent daughters’ sexual activity could affect mother’s depression.
Third, the current study used self-report measures for assessing adolescent risk
behavior. Although the mothers and daughters completed the surveys simultaneously but
separately, and even though they were assured of confidentiality, the daughters may have
underreported substance or sexual behaviors.
Lastly, it is important to note that the current study did not focus on clinically
diagnosed maternal depression but rather used symptoms of depression. Thus, the
relationships found in this study might be different for mothers with a clinical diagnosis
of depression.
Nevertheless, the current study had a number of strengths. An important
contribution of this study is the finding that even mild levels of depressive symptoms in
mothers may be significantly related to adolescent daughters’ sexual activity. This study
also extends current knowledge concerning father involvement with adolescent children
by providing evidence that father involvement may have a negative effect on the well-
being of adolescent daughters when the mother is depressed. Moreover, the majority of
93

the sample in this study was an understudied and underrepresented group of minority
mothers and their adolescent daughters, predominantly African American. The use of a
non-clinical sample is also noteworthy. In addition, previous examinations of maternal
depression have not considered adolescent sexual activity. Earlier work has focused
primarily on internalizing and externalizing disorders related to depression in mothers.
Clinical Implications
The findings of this study provide important information for clinicians, who
provide services to families of mothers with depressive symptoms, or to families in which
there are mothers who may be at higher risk for depression. The findings address the
need for clinicians to have an increased awareness of the potential effects of maternal
depressive symptoms on adolescent engagement in sex. Given the findings, daughters in
families with mothers who are clinically depressed might have an even higher likelihood
of early engagement in sex. As such, findings from this study likely represent a lower
limit of depression’s effect on adolescents. Thus, clinicians need to be aware that even
depressive symptoms below the diagnostic threshold may have significant effects on
adolescent daughters’ sexual activity.
The results from this study are also important in identifying adolescents who are
at increased risk of engagement in sex. The results indicate that prevention programs
may target adolescent females living with a depressed mother as being particularly at risk
for sexual activity. Thus, when depressive symptoms are detected in mothers, clinicians
need to consider the possibility that the adolescent daughter may need intervention.
Although not all adolescent females living with a depressed mother are engaging in
94

sexual intercourse, the odds of identifying adolescents having sex increase among those
with a depressed mother. Identifying these at-risk families increases the likelihood that
an appropriate intervention is developed, which decreases engagement in risky behaviors
by adolescent females.
Interventions would be culturally sensitive and family-focused; that is, these
programs may include both depressed mothers and their adolescent daughters. When a
mother is depressed, family members with which the mother has relationships—
children—are also likely affected (or contribute to the mother’s depression). Family
systems would be considered in clinical intervention; treating the entire family and not
only the mother is imperative. In this model, for example, when a depressed mother
seeks treatment, a clinician would also assess the children within the family. Providing
support and intervention to families prior to adolescence will be critical, as this is the
time, developmentally, in which teens will be at increased risk of beginning to explore
their sexuality and engage in sexual behavior. This may be especially important for
adolescent females, who may seek love and attention through sexual relationships.
A primary approach to prevention would be to reduce the symptoms of depression
in mothers. Clinicians may work with depressed mothers using pharmacological
treatment and/or individual therapy so that improved moods in mothers can have a
positive influence on their children. The mother may be also educated about the potential
effects of depression on their children.
For secondary prevention, clinicians need to provide counseling to high-risk
female adolescents, who may be vulnerable to the effects of maternal depression,
95

especially those who exhibit early signs of sexual activity (e.g., dating). Before
intervening with them, it is important that the child is aware of his or her mother’s illness.
Individuals with depression may not want to disclose their condition to others because of
reasons such as fears of stigma associated with a mental illness and the misbelief that
depression should be under his or her control (Bell et al., 2011). Therefore, clinicians can
help the mothers share their depression diagnosis and condition with their children and
families.
In addition, clinicians can provide these adolescents with anticipatory guidance on
the possible effects of living with a depressed mother. Moreover, clinicians may adopt a
psychoeducational approach and inform children that depression is an illness that affects
the entire family and help them identify depressive symptoms and understand their
mother’s behavior.
The essential focus in adolescent treatment should be on providing emotional
support to adolescents. Family protective factors, such as having a close relationship
with a caring parental figure and connections to extended supportive family networks,
have been shown to promote resilience in children (Phares, Duhig, & Watkins, 2002).
Clinicians can help adolescents build close relationships with another maternal figure,
who can be a positive role model and provide affection and nurturing to the adolescent.
Thus, it is important to assess the child’s resilience by looking at his or her support
system, such as extended family members (e.g., grandmothers and aunts), who can
provide support that may be absent in the home. Previous studies also found that
adolescents of a depressed mother are more likely to be resilient if he or she receives
96

kinship social support (Shook, Jones, Forehand, Dorsey, & Brody, 2010; Taylor, Seaton,
& Dominguez, 2008). Such support may be further beneficial to the family with a
depressed mother because it may help alleviate the mother’s depressive symptoms,
thereby improving her relationship with the child. Taylor, Seaton, and Dominguez (2008)
support this notion and have noted a significant association between kinship support and
mother’s functioning; the more the depressed mother can rely on extended family for
emotional support, the more optimism she has about her future.
In this study, the association between maternal depression and positive parent-
child communication was relatively weak, albeit statistically significant. Furthermore,
maternal depression was unrelated to parental involvement. Given these findings, social
workers must be careful not to assume a negative relationship between a mother who has
depressive symptoms and her adolescent daughter. Adolescent daughters do not
necessarily experience more conflicts with their depressed mother or that their mothers
are less engaged in conversations and activities with their children. Together with
families, clinicians can explore how depressive symptoms in mothers have affected other
family members, especially adolescent daughters, whether their relationships have
changed, and how the individual members are trying to improve their relationships.
Conclusion
The current study examined the relationships among maternal depression, family
factors, and adolescent daughters’ risk behavior. The results of this study are partially
consistent with family systems theory (Minuchin, 1974), which assumes that maternal
depression is not just an individual illness but a family illness that may have
97

consequences on other family members. Most importantly, this study is the first to
provide evidence that depressive symptoms in mothers are associated with adolescent
daughters’ sexual activity. Thus, the results underscore the importance of the need to
consider female adolescents’ sexual activity within the context of the family. In this study,
family factors (i.e., parent-child communication and parental involvement) did not
mediate the link between maternal depression and adolescent daughters’ risk behavior.
This finding shows that these family factors in families with a depressed mother may not
contribute to the development of adolescent daughters’ risk behavior. In addition, the
relationship between maternal depression and adolescent daughters’ substance use was
found to vary by father involvement, but in the opposite of the predicted direction: A
greater likelihood of daughters’ substance use was found when the mother was highly
depressed and the father was involved in the child’s life. The findings have important
implications for the development of intervention programs for adolescent daughters of a
depressed mother.
The findings of the current study point to the importance of assessing parental
monitoring as a possible mediating factor in the relationship between maternal depression
and adolescent risk behavior. Future research should also assess family size and other
caregivers in the family, and explore adolescents’ relationships with them. Therefore,
research should follow families through time to examine whether any causal relationships
exist between these variables and the direction of the causation. Such a longitudinal
design would also be helpful in exploring whether there is an increase or decrease across
time in the number of adolescent daughters of mothers with depression engaging in risk
98

behaviors. In addition, replication with a clinically depressed sample is needed to fully
understand the relationship between maternal depression, family factors, and adolescent
risk behavior.

99

REFERENCES
Albright, M. B., & Tamis-LeMonda, C. S. (2002). Maternal depressive symptoms in
relation to dimensions of parenting in low-income mothers. Applied
Developmental Science, 6, 24-34.

Allen, J. P., Manning, N., & Meyer, J. (2010). Tightly linked systems: reciprocal relations
between maternal depressive symptoms and maternal reports of adolescent
externalizing behavior. Journal of Abnormal Psychology, 119(4), 825-835.

Allister, L., Lester, B. M., Carr, S., & Liu, J. (2001). The effects of maternal depression
on fetal heart rate response to vibroacoustic stimulation. Developmental
Neuropsycholgy, 20(3), 639-651.

Amato, P., & Rivera, F. (1999). Paternal involvement and children’s behavior problems.
Journal of Marriage and Family, 61, 375-384.

Amato, P. R., & Sobolewski, J. M. (2004). The effects of divorce on fathers and children:
Nonresidential fathers and stepfathers. In M. E. Lamb (Ed.), The Role of the
Father in Child Development (4th ed., pp. 341-367). Hoboken, NJ: Wiley.

American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental
Disorders, Fourth Edition. Washington, DC: American Psychiatric Association.

Andresen, E. M., Malmgren, J. A., Carter, W. B., & Patrick, D. L. (1994). Screening for
depression in well older adults: Evaluation of a short form of the CES-D.
American Journal of Preventive Medicine, 10(2), 77-84.

Armistead, L., Tannenbaum, L., Forehand, R., Morse, E., & Morse, P. (2001). Disclosing
HIV status: Are mothers telling their children? Journal of Pediatric Psychology,
26, 11-20.

Armitage, R., Flynn, H., Hoffmann, R., Vazquez, D., Lopez, J., & Marcus, S. (2009).
Early developmental changes in sleep in infants: The impact of maternal
depression. Sleep, 32(5), 693-696.

Aquilino, W. S., & Supple, A. J. (2001). Long-term effects of parenting practices during
adolescence on well-being outcomes in young adulthood. Journal of Family
Issues, 22(3), 289-308.

Banard, K. E., & Kelly, J. F. (1990). Assessment of parent-child interaction. In S. J.
Meisels & J. P. Shonkoff (Eds.), Handbook of early childhood intervention (pp.
278-302). New York, NY: Cambridge University Press.

100

Baumrind, D. (1991). The influence of parenting style on adolescent competence and
substance use. The Journal of Early Adolescence, 11(1), 56-95

Barnes, G. M., Farrell, M. P., & Cairns, A. (1986). Parental socialization factors and
adolescent drinking behaviors. Journal of Marriage and Family, 48(1), 27-36.

Baron, R. M., & Kenny, D. A. (1986). The moderator-mediator variable distinction in
social psychological research: Conceptual, strategic, and statistical considerations.
Journal of Personality and Social Psychology, 51(6), 1173-1182.

Beardslee, W. R., Versage, E. M, & Gladstone, T. R. G. (1998). Children of affectively ill
parents: a review of the past 10 years. Journal of the American Academy of Child
and Adolescent Psychiatry, 57(11), 1134-1141.

Beck, A. T. (1987). Cognitive models of depression. Journal of Cognitive Psychotherapy,
An international Quarterly, 1, 5-37.

Belsher, G., & Costello, C. G. (1988). Relapse after recovery from unipolar depression: A
critical review. Psychology Bulletin, 104, 84-96.

Belsky, J. (1984). The determinants of parenting: A process model. Child Development,
55(1), 83-96.

Bohon, C., Garber, J., & Horowitz, J. L. (2007). Predicting school dropout and
adolescent sexual behavior in offspring of depressed and nondepressed mothers.
Journal of the American Academy of Child and Adolescent Psychiatry, 46(1), 15-
24.

Bonomo, Y . A., Bowes, G., Coffey, C., Carlin, J. B., & Patton, G. C. (2004). Teenage
drinking and the onset of alcohol dependence: a cohort study over seven years.
Addiction, 99(12), 1520-1528.

Boyd, K., Ashcraft, A., & Belgrave, F. Z. (2006). The impact of mother-daughter and
father-daughter relationships on drug refusal self-efficacy among African
American adolescent girls in urban communities. Journal of Black Psychology,
32(1), 29-42.

Brackis-Cott, E., Mellins, C. A., Dolezal, C, & Spiegel, D. (2007). The mental health risk
of mothers and children: The role of maternal HIV infection. Journal of Early
Adolescence, 27(1), 67-89.

101

Brennan, P. A., Hammen, C., Anderson, M. J., Bor, W., Najman, J. M., & Williams, G. M.
(2000). Chronicity, severity, and timing of maternal depressive symptoms:
Relationships with child outcomes at age five. Developmental Psychology, 36,
759-766.

Brennan, P. A., Hammen, C. L., Katz, A. R., & Le Brocque, R. M. (2002). Maternal
depression, paternal psychopathology, and adolescent diagnostic outcomes.
Journal of Consulting and Clinical Psychology, 70(5), 1075-1085.

Brody, G. H., Ge, X. J., Conger, R., Gibbons, F. X., Murry, V . M., Gerrard, M., & Simons,
R. L. (2001). The influence of neighborhood disadvantage, collective socialization,
and parenting on African American children’s affiliation with deviant peers. Child
Development, 72, 1231 – 1246.

Brook, J. S., Adams, R. E., Balka, E. B., Whitman, M., Zhang, C., & Sugerman, R.
(2004). Illicit drug use and risky sexual behavior among African American and
Puerto Rican urban adolescents: the longitudinal links. Journal of Genetic
Psycholgy, 165, 203–220.

Brown, B., Mounts, N., Lamborn, S. D., & Steinberg, L. (1993). Parenting practices and
peer group affiliation in adolescence. Child Development, 64, 467-482.

Buehler, C., & Gerard, J. M. (2002). Marital conflict, ineffective parenting, and children’s
and adolescents’ maladjustment. Journal of Marriage and Family, 64(1), 78-92.

Buhi, E., & Goodson, P. (2007). Predictors of adolescent sexual behavior and intention: a
theory-guided systematic review. Journal of Adolescent Health, 40(1), 4-21.

Cabrera, N. J., Tamis-LeMonda, C. S., Bradley, R. H., Hofferth, S., & Lamb, M. E.
(2000). Fatherhood in the twenty-first century. Child Development, 71, 127-136.

Carlson, M. J. (2006). Family structure, father involvement, and adolescent behavioral
outcomes. Journal of Marriage and Family, 68(1), 137-154.

Carson, M. J., & Corcoran, M. E. (2001). Family structure and children’s behavioral and
cognitive outcomes. Journal of Marriage and Family, 63, 779-792.

Carver, K., Joyner, K., & Udry, J. R. (2004). National estimates of adolescent romantic
relationships. In P. Florsheim (Ed.), Adolescent romantic relations and sexual
behavior (pp. 23–56). Mahwah, NJ: Erlbaum.

Caughy, M. O., Huang, K., & Lima, J. (2009). Patterns of conflict interaction in mother-
toddler dyads: Differences between depressed and non-depressed mothers.
Journal of Child and Family Studies, 18, 10-20.
102

Cederbaum, J. A.(2012). The experience of communication, family roles, and behaviors
in families living with HIV . Manuscript submitted for publication.

Cederbaum, J. A., Hutchinson, M. K., & Jemmott, L. S. (2012). The influence of
maternal HIV serostatus on mother-daughter sexual risk communication and
adolescent engagement in HIV risk behaviors. Manuscript submitted for
publication.

Centers for Disease Control and Prevention. (2010). Youth Risk Behavior Surveillance—
United States, 2009. Surveillance Summaries. Morbidity Mortality Weekly Report,
59, SS-5.

Chang, J. J., Halpern, C. T., & Kaufman, J. S. (2007). Maternal depressive symptoms,
father’s involvement, and the trajectories of child problem behaviors in a US
national sample. Archives of Pediatrics & Adolescent Medicine, 161(7), 697-703.

Clark, M. L. (1989). Black adolescents. Berkeley, CA: Cobb & Henry Publishers.

Clark, D. B., & Winters, K. C. (2002). Measuring risks and outcomes in substance use
disorders prevention research. Journal of Consulting and Clinical Psychology, 70,
1207-1223.

Cole, J., McGuffin, P., & Farmer, A. E. (2008). The classification of depression: Are we
still confused? The British Journal of Psychiatry, 192, 83-85.

Cohler, B. J., Grunebaum, H. U., Weiss, J. L., Hartman, C. R., & Gallant, D. H. (1977).
Child care attitudes and adaptation to the maternal role among mentally ill and
well mothers. American Journal of Orthopsychiatry, 46, 123-133.

Cornish, A.M., McMahon, C.A., Ungerer, J.A., Barnett, B., Kowalenko, N., & Tennant, C.
(2005). Postnatal depression and infant cognitive and motor development in the
second postnatal year: The impact of depression chronicity and infant gender.
Infant Behavior and Development, 28, 407-417.

Cornish, A.M., McMahon, C.A., Ungerer, J.A., Barnett, B., Kowalenko, N., & Tennant, C.
(2006). Maternal depression and the experience of parenting in the second
postnatal year. Journal of Reproductive and Infant Psychology, 24(2), 121-132.

Corona, R., Lefkowitz, E. S., Sigman, M., & Romo, L. F. (2005). Latino adolescents’
adjustment, maternal depressive symptoms, and the mother-adolescent
relationship. Family Relations, 54(3), 386-399.

103

Cortes, R. C., Fleming, C. B., Catalano, R. F., & Brown, E. C. (2006). Gender differences
in the association between maternal depressed mood and child depressive
phenomena from grade 3 through grade 10. Journal of Youth and Adolescence,
35(8), 815-826.

Cortes, R. C., Fleming, C. B., Mason, W. A., & Catalano, R. F. (2009). Risk factors
linking maternal depressed mood to growth in adolescent substance use. Journal
of Emotional and Behavioral Disorders, 17(1), 49-64.

Cox, M. J., & Paley, B. (2003). Understanding families as systems. Current Directions in
Psychological Science, 12(5), 193-196.

Cummings, E. M., & Davies, P. T. (1994). Maternal depression and child development.
Journal of Child Psychology and Psychiatry, 35, 73-112.

Cummings, E. M., & Davies, P. T. (1999). Depressed parents and family functioning:
Interpersonal effects and children’s functioning and development. In T. Joiner & J.
C. Coyne (Eds.), The Interactional Nature of Depression (pp. 299-327).
Washington, DC: American Psychological Association.

Cummings, E. M., Davies, P. T., & Campbell, S. B. (2000). Developmental
psychopathology and family process. New York: Guilford Press.

Cummings, E. M, Keller, P. S., & Davies, P. T. (2005). Towards a family process model
of maternal and paternal depressive symptoms: exploring multiple relations with
child and family functioning. Journal of Child Psychology and Psychiatry, 46(5),
479-489.

Cutrona, D. E., & Troutman, B. R. (1986). Social support, infant temperament, and
parenting self-efficacy: A meditational model of postpartum depression. Child
Development, 57, 1507-1518.

Davidson, T. M., & Cardemil, E. V . (2009). Parent-child communication and parental
involvement in Latino adolescents. The Journal of Early Adolescence, 29(1), 99-
121.

Davies, P. T., Dumenci, L., & Windle, M. (1999). The interplay between maternal
depressive symptoms and marital distress in the prediction of adolescent
adjustment. Journal of Marriage and family, 61, 238-254.

Davies, P., & Windle, M. (2001). Interparental discord and adolescent adjustment
trajectories: The potentiating and protective role of intrapersonal attitudes. Child
Development, 72, 1163-1178.
104

Davila, J., Steinberg, S. J., Kachadourian, L., Cobb, R., & Fincham, F. (2004). Romantic
involvement and depressive symptoms in early and late adolescence: The role of
preoccupied relational style. Personal Relationships, 11, 161-178.

Davila, J., Stroud, C. B., Starr, L. R., Miller, M. R., Yoneda, A., & Hershenberg, R.
(2009). Romantic and sexual activities, parent-adolescent stress, and depressive
symptoms among early adolescent girls. Journal of Adolescence, 32, 909-924.

Dawson, G., Ashman, S. B., Panagiotides, H., Hessl, D., Self, J., Yamada, E., & Embry, L.
(2003). Preschool outcomes of children of depressed mothers: Role of maternal
behavior, contextual risk, and children’s brain activity. Child Development, 74(4),
1158-1175.

De Ross, R., Marrinan, S., Schattner, S., & Gullone, E. (1999). The relationship between
perceived family environment and psychological wellbeing: Mother, father, and
adolescent reports. Australian Psychologist, 34(1), 58-63.

Deave, T., Heron, J., Evans, J., & Emond, A. (2008). The impact of maternal depression
in pregnancy on early child development. BJOG: An international Journal of
Obstetrics & Gynaecology, 115(8), 1043-1051.

Denton, R. E., & Kampfe, C. M. (1994). The relationship between family variables and
adolescent substance abuse: A literature review. Adolescence, 29(114), 475-495.

Dierker, L. C., Merikangas, K. R., & Szatmari, P. (1999). Infleunce of parental
concordance for psychiatric disorders on psychopathology in offspring. Journal of
American Academy of Child and Adolescent Psychiatry, 38, 280-288.

Dieter, J. N. I., Field, T., Hernandez-Reif, M., Jones, N. A., LeCanuet, J. P., Salman, F. A.,
& Redzepi, M. (2001). Maternal depression and increased fetal activity. Journal
of Obstetrics and Gynaecology, 21, 468–473.

Downey, G., & Coyne, J. C. (1990). Children of depressed parents: An integrative review.
Psychological Bulletin, 108(1), 50- 76.

Du Rocher Schudlich, T. D., & Cummings, E. M. (2003). Parental dysphoria and
children’s internalizing symptoms: Marital conflict styles as mediators of risk.
Child Development, 74(6), 1663-1681.

Eckshtain, D., Ellis, D. A., Kolmodin, K., & Naar-King, S. (2010). The effects of parental
depression and parenting practices on depressive symptoms and metabolic control
in urban youth with insulin dependent diabetes. Journal of Pediatric Psychology,
35(4), 426-435.
105

Elgar, F. J., Mills, R. S. L., McGrath, P. J., Waschbusch, D. A., & Brownridge, D. A.
(2007). Maternal and paternal depressive symptoms and child maladjustment: The
mediating role of parental behavior. Journal of Abnormal Child Psychology, 35,
943-955.

Ellis, B. J., Bates, J. E., Dodge, K. A., Fergusson, D. M., Horwood, L. J., Pettit, G. S., &
Woodward, L. (2003). Does father absence place daughters at special risk for
early sexual activity and teenage pregnancy? Child Development, 74(3), 801-821.

Essau, C. A. (2004). The Association Between Family Factors and Depressive Disorders
in Adolescents. Journal of Youth and Adolescence, 33(5), 365-372.

Evans, J., Heron, J., Francomb, H., Oke, S., & Golding, J. (2001). Cohort study of
depressed mood during pregnancy and after childbirth. British Medical Journal,
323, 257-260.

Feldman, R., Granat, A., Pariente, C., Kanety, H., Kuint, J., & Gilboa-Schechtman, E.
(2009). Maternal depression and anxiety across the postpartum year and infant
social engagement, fear regulation, and stress reactivity, Journal of the American
Academy of Child and Adolescent Psychiatry, 48(9), 919-927.

Fergusson, D. M., Horwood, J., Ridder, E. M., & Beautrais, A. L. (2005). Subthreshold
depression in adolescence and mental health outcomes in adulthood. Archives of
General Psychiatry, 62, 66-72.

Field, T., Diego, M., & Hernandez-Reif, M. (2006). Prenatal depression effects on the
fetus and newborn: a review. Infant Behavior & Development, 29, 445-455.

Field, T., Diego, M.,& Hernandez-Reif, M. (2009). Depressed mothers’ infants are less
responsive to faces and voices. Infant Behavior & Development, 32(3), 239-244.

Field, T., Diego, M., Dieter, J., Hernandez-Reif, M., Schanberg, S., Kuhn, C., … &
Bendell, D. (2004). Prenatal depression effects on the fetus and the newborn.
Infant Behavior and Development, 27, 216–229.

Fishbein, M., & Ajzen, I. (1975). Belief, Attitude, Intention, and Behavior: An
Introduction to Theory and Research. Reading, MA: Addison-Wesley.

Fisher, L., Kokes, R. F., Harder, D., & Jones, J. E. (1980). Child competence and
psychiatric risk: IV . Summary and integration of findings. Journal of Nervous and
Mental Disease, 168, 353-355.

106

Flouri, E., & Buchanan, A. (2003a). The role of father involvement in children’s later
mental health. Journal of Adolescence, 26, 63-78.

Flouri, E., & Buchanan, A. (2003b). The role of mother involvement and father
involvement in adolescent bullying behavior. Journal of Interpersonal Violence,
18(6), 634-644.

Flouri, E., & Buchanan, A. (2004). Early father’s and mother’s involvement and child’s
later educational outcomes. British Journal of Educational Psychology, 74(2),
141-153.

Forehand, R., Jones, D. J., Kotchick, B. A., Armistead, L., Morse, E., Morse, P. S., &
Stock, M. (2002). Noninfected children of HIV-infected mothers: A 4-year
longitudinal study of child psychosocial adjustment and parenting. Behavior
Therapy, 33, 579-600.

Foster, C. J. E., Garber, J., & Durlak, J. A. (2008). Current and past maternal depression,
maternal interaction behaviors, and children’s externalizing and internalizing
symptoms. Journal of Abnormal Child Psychology, 36(4), 527-537.

Foster, C. E., Webster, M. C., Weissman, M. M., Pilowsky, D. J., Wickramaratne, P. J.,
Rush, A. J., et al. (2008). Course and severity of maternal depression:
Associations with family functioning and child adjustment. Journal of Youth and
Adolescence, 37, 906-916.

Friedman, A. S., Terras, A., & Glassman, K. (2000). Family structure versus family
relationships for predicting to substance use/abuse and illegal behavior. Journal of
Child & Adolescent Substance Abuse, 10(1), 1-16.

Frye, A. A., & Garber, J. (2005). The relations among maternal depression, maternal
criticism, and adolescents’ externalizing and internalizing symptoms. Journal of
Abnormal Child Psychology, 33(1), 1-11.

Gartstein, M. A., Bridgett, D. J., Rothbart, M. K., Robertson, C., Iddins, E., Ramsay, K.,
& Schlect, S. (2010). A latent growth examination of fear development in infancy:
Contributions of maternal depression and the risk for toddler anxiety.
Developmental Psychology, 46(3), 651-668.

Gerard, A. B. (1994). Parent Child Relationship Inventory (PCRI) Manual. Los Angeles,
WPS.

Gillmore, M. R., Archibald, M. E., Morrison, D. M., Wilsdon, A., Wells, E. A., Hoppe, M.
J., … Murowchick, E. (2002). Teen sexual behavior: Applicability of the theory of
reasoned action. Journal of Marriage and Family, 64, 885-897.
107

Godsall, R. E., Jurkovic, G. J., Emshoff, J., Anderson, L., & Stanwyck, D. (2004). Why
some kids do well in bad situations: Relation of parental alcohol misuse and
parentification to children’s self-concept. Substance Use & Misuse, 39(5), 789-
809.

Goldsmith, D. F., & Rogoff, B. (1997). Mothers’ and toddlers’ coordinated join focus of
attention: Variations with maternal dysphoric symptoms. Developmental
Psychology, 33, 113-119.

Goncy, E. A., & Dulmen, M. H. M. (2010). Fathers do make a difference: Parental
involvement and adolescent alcohol use. Fathering: A Journal of Theory,
Research, and Practice about Men as Fathers, 8(1), 93-108.

Gonzalez-DeHass, A. R., Willems, P. P., & Holbein, M. F. D. (2005). Examining the
relationship between parental involvement and student motivation. Educational
Psychology Review, 17(2), 99-123.

Goodman, S. H. (2007). Depression in women. Annaul Review of Clinical Psychology, 3,
107-135.

Goodman, S. H., Adamson, L. B., Riniti, J., & Cole, S. (1994). Mothers’ expressed
attitudes: Associations with maternal depression and children’s self-esteem and
psychopathology. Journal of the American Academy of Child and Adolescent
Psychiatry, 33, 1265-1274.

Goodman, S. H., & Gotlib, I. H. (1999). Risk for psychopathology in the children of
depressed mothers: a developmental model for understanding mechanisms of
transmission. Psychological Review, 106, 458- 490.

Goodman, S. H., & Gotlib, I. H. (2002). Introduction. In S. H. Goodman & I. H. Gotlib
(Eds.), Children of depressed parents: Mechanisms of risk and implications for
treatment (pp. 3-9). Washington, DC: American Psychological Association.

Goodman, S. H., & Tully, E. (2006). Depression in women who are mothers: An
integrative model of risk for the development of psychopathology in their sons
and daughters. In C. L. M. Keyes & S. H. Goodman (Eds.), Women and
depression (pp. 241-282). New York: Cambridge University Press.

Hair, E. C., Moore, K. A., Hadley, A. M., Kaye, K., Day, R. D., & Orthner, D. K. (2009).
Parent marital quality and the parent-adolescent relationship: Effects on
adolescent and young adult health outcomes. Marriage & Family Review, 45,
218-248.

108

Hallfors, D. D., Waller, M. W., Bauer, D., Ford, C. A., & Halpern, C. T. (2005). Which
comes first in adolescence—sex and drugs or depression? American Journal of
Preventive Medicine, 29(3), 163-170.

Hallfors, D. D., Waller, M. W., Ford, C. A., Halpern, C. T., Brodish, P. H., & Iritani, B.
(2004). Adolescent depression and suicide risk: association with sex and drug
behavior. American Journal of Preventive Medicine, 27(3), 224-231.

Hammen, C. L. (2009). Children of Depressed Parents. In I. Gotlib & C. L. Hammen
(Eds.), Handbook of Depression (V ol. 2, pp. 275-297). New York: Guilford Press.

Hammen, C. L., Adrian, C, Gordon, D., Burge, D., Jaenicke, C, & Hiroto, D. (1987).
Children of depressed mothers: Maternal strain and symptom predictors of
dysfunction. Journal of Abnormal Psychology, 96, 190-198.

Hammen, C. L., & Brennan, P. A. (2001). Depressed adolescents of depressed and
nondepressed mothers: tests of an interpersonal impairment hypothesis. Journal of
Consulting and Clinical Psychology, 69(2), 284-294.

Hammen, C. L., & Brennan, P. A. (2002). Interpersonal dysfunction in depressed women:
Impairments independent of depressive symptoms. Journal of Affective Disorders,
72(2), 145-156.

Hammen, C., & Brennan, P. A. (2003). Severity, chronicity, and timing of maternal
depression and risk for adolescent offspring diagnoses in a community sample.
Archives of General Psychiatry, 60, 253-258.

Hammen, C. L., Brennan, P. A., & Shih, J. H. (2004). Family discord and stress
predictors of depression and other disorders in adolescent children of depressed
and nondepressed women. Journal of the American Academy of Child and
Adolescent Psychiatry, 43, 994- 1003.

Hammen, C., Burge, D., Burney, E., & Adrian, C. (1990). Longitudinal study of
diagnoses in children of women with unipolar and bipolar affective disorder.
Archives of General Psychiatry, 47(12), 1112-1117.

Hammen, C. L., Shih, J. H., & Brennan, P. A. (2004). Intergenerational transmission of
depression: Test of an interpersonal stress model in a community sample. Journal
of Consulting and Clinical Psychology, 72, 511-522.

Hay, D. F., Pawlby, S., Sharp, D., Asten, P., Mills, A., & Kumar, R. (2001). Intellectual
problems shown by 11-year-old children whose mothers had postnatal depression.
Journal of Child Psychology and Psychiatry, 42(7), 871-889.

109

Heinze, M. C., & Grisso, T. (1996). Review of instruments assessing parenting
competencies used in child custody evaluations. Behavioral Sciences & the Law,
14(3), 293-313.

Hernandez-Reif, M., Field, T., Diego, M., & Ruddock, M. (2006). Greater arousal and
lesser attention by neonates of depressed vs non-depressed mothers on the
Brazelton Neonatal Behavioral Assessment Scale. Infant Behavior and
Development, 29, 594-598.

Herr, N. R., Hammen, C., & Brennan, P. A. (2007). Current and past depression as
predictors of family functioning: A comparison of men and women in a
community sample. Journal of Family Psychology, 21(4), 694-702.

Hess, R. D., & Handel, G. (1959). Family worlds. Chicago, IL: The University of
Chicago Press.

Hoffman, L. (1981). Foundations of family therapy. New York: Basic Books.

Hoffman, C., Crnic, K. A., & Baker, J. K. (2006). Maternal depression and parenting:
Implications for children's emergent emotion regulation and behavioral
functioning. Parenting: Science and Practice, 6(4), 271-295.

Hoffman, S., & Hatch, M. C. (2000). Depressive symptomatology during pregnancy:
Evidence for an association with decreased fetal growth in pregnancies of lower
social class women. Health Psychology, 19(6), 535-543.

Hops, H., Biglan, A., Sherman, L., Arthur, J., Friedman, L., & Osteen, V . (1987). Home
observations of family interactions of depressed women. Journal of Consulting
and Clinical Psychology, 55(3), 341-346

Hossain, Z., Field, T., Gonzalez, J., Malphurs, J., Valle, C. D., & Pickens, J. (1994).
Infants of “depressed” mothers interact better with their nondepressed fathers.
Infant Mental Health Journal, 15, 348–357.

Impett, E. A., & Tolman, D. L. (2006). Late adolescent girls’ sexual experiences and
sexual satisfaction. Journal of Adolescent Research, 21(6), 1-19.

Jackson, P. B., & Williams, D. R. (2006). Culture, race/ethnicity, and depression. In C. L.
M. Keyes & S. H. Goodman (Eds.), Women and Depression (pp. 328-359). New
York: Cambridge University Press.

Jacob, T., & Johnson, S. L. (2001). Sequential interactions in the parent-child
communications of depressed fathers and depressed mothers. Journal of Family
Psychology, 15, 38-52.
110

Jaser, S. S., Fear, J. M., Reeslund, K. L., Champion, J. E., Reising, M. M., & Compas, B.
E. (2008). Maternal sadness and adolescents’ responses to stress in offspring of
mothers with and without a history of depression. Journal of Clinical Child &
Adolescent Psychology, 37(4), 736-746.

Jeynes, W. H. (2007). The relationship between parental involvement and urban
secondary school student academic achievement. Urban Education, 42(1), 82-110.

Jimerson, S., Egeland, B., Sroufe, A., & Carlson, B. (2000). A prospective longitudinal
study of high school dropouts examining multiple predictors across development.
Journal of School Psychology, 38(6), 525-549.

Johnson, S. L., & Jacob, T. (2000). Moderators of child outcomes in families with
depressed mothers and fathers. In S. L. Johnson, A. M. Hayes, T. M. Field, N.
Schneiderman, & P. M. McCabe (Eds.), Stress, coping, and depression (pp. 51-
67). Mahwah, NJ: Lawrence Erlbaum.

Kaye, K., Moore, K. A., Hair, E. C., Hadley, A. M., Day, R. D., & Orthner, D. K. (2009).
Parent-marital quality and the parent-adolescent relationship: Effects on sexual
activity among adolescents and youth. Marriage & Family Review, 45, 270-288.

Kessler, R., Berglund, P., Demler, O., Jin, R., Koretz, D., Merikangas, K., et al. (2003).
The epidemiology of major depressive disorder: Results from the National
Comorbidity Survey Replication (NCS-R). Journal of the American Medical
Association, 289(23), 3095-3705.

Kessler, R., Zhaob, S., Blazerc, D., & Swartzc, M. (1997). Prevalence, correlates, and
course of minor depression and major depression in the national comorbidity
survey. Journal of Affective Disorders, 45(1), 19-30.

Kiernan, K. E., & Huerta, M. C. (2008). Economic deprivation, maternal depression,
parenting and children’s cognitive and emotional development in early childhood.
The British Journal of Sociology, 59(4), 783-806.

Kilpatrick, D. G., Acierno, R., Saunders, B., Resnick, H. S., Best, C. L., & Schnurr, P. P.
(2000). Risk factors for adolescent substance abuse and dependence: Data from a
national sample. Journal of Consulting and Clinical Psychology, 68(1), 19-30.

Kim-Cohen, J., Moffitt, T. E., Taylor, A., Pawlby, S. J., & Caspi, A. (2005). Maternal
depression and children’s antisocial behavior: Nature and nurture effects. Arch
Gen Psychiatry, 62, 173-181.

111

Klein, D. N., Lewinsohn, P. M., Rohde, P., Seeley, J. R., & Olino, T. M. (2005).
Psychopathology in the adolescent and young adult offspring of a community
sample of mothers and fathers with major depression. Psychol Med, 35, 353-365.

Kliewer, W., & Murrelle, L. (2007). Risk and protective factors for adolescent substance
use: Findings from a study in selected Central American countries. Journal of
Adolescent Health, 40, 448-455.

Knowlton, A. (2003). Informal HIV caregiving in a vulnerable population: toward a
network resource framework. Social Science & Medicine, 56(6), 1307-1320.

Koblinsky, S. A., Kuvalanka, K. A., & Randolph, S. M. (2006). Social skills and behavior
problems of urban, African American preschoolers: Role of parenting practices,
family conflict, and maternal depression. American Journal of Orthopsychiatry,
76(4), 554-563.

Kochanska, G., Radke-Yarrow, M., Kuczunski, L., & Friedman, S. L. (1987). Normal and
affectively ill mothers’ beliefs about their children. American Journal of
Orthopsychiatry, 57, 345-350.

Kotchick, B. A., Forehand, R., Brody, G., Armistead, L., Morse, E., Simon, P., & Clark, L.
(1997). The impact of maternal HIV infection on parenting in inner-city African
American families. Journal of Family Psychology, 11(4), 447-461.

Kuortti, M., & Kosunen, E. (2009). Risk-taking behaviour is more frequent in teenage
girls with multiple sexual partners. Scandinavian Journal of Primary Health Care,
27, 47-52.

Kuperminc, G. P., Blatt, S. J., Shahar, G., Henrich, C., & Leadbeater, L. J. (2004).
Cultural equivalence and cultural variance in longitudinal associations of young
adolescent self-definition and interpersonal relatedness to psychological and
school adjujustment. Journal of Youth and Adolescence, 33(1), 13-30.

Langrock, A. M., Compas, B. E., Keller, G., Merchant, M. J., & Copeland, M. E. (2002).
Coping with the stress of parental depression: parents' reports of children's coping,
emotional, and behavioral problems. Journal of Clinical Child and Adolescent
Psychology, 31(3), 312- 324.

Larson, R.W., & Richards, M. H. (1994). Family emotions: Do young adolescents and
their parents experience the same states? Journal of Research on Adolescence,
4(4), 567-583.

112

Lee, M., Lester, P., & Rotheram-Borus, M. J. (2002). The relationship between
adjustment of mothers with HIV and their adolescent daughter. Clinical Child
Psychology and Psychiatry, 7, 71–81.

Lee, M., & Rotheram-Borus, M. J. (2002). Parent’s disclosure of HIV to their children.
AIDS, 16, 2201-2207.

Leinonen, J. A., Solantaus, T. S., & Punamaki, R. (2003). Parental mental health and
children’s adjustment: the quality of marital interaction and parenting as
mediating factors. Journal of Child Psychology and Psychiatry, 44(2), 227-241.

Leschied, A. W., Chiodo, D., Whitehead, P. C., & Hurley, D. (2005). The relationship
between maternal depression and child outcomes in a child welfare sample:
implications for treatment and policy. Child and Family Social Work, 10(4), 281-
291.

Lester, P., Stein, J. A., Bursch, B., Rice, E., Green, S., Penniman, T., & Rotheram-Borus,
M. J. (2010). Family-based processes associated with adolescent distress,
substance use and risky sexual behavior in families affected by maternal HIV .
Journal of Clinical Child & Adolescent Psychology, 39(3), 328-340.

Lewinsohn, P. M., Olino, T. M., & Klein, D. N. (2005). Psychosocial impairment in
offspring of depressed parents. Psychological Medicine, 35, 1493-1503.

Lewinsohn, P. M., Solomon, A., Seeley, J. R., & Zeiss, A. (2000). Clinical implications of
“subthreshold” depressive symptoms. Journal of Abnormal Psychology, 109(2),
345-351.

Li, X., Feigelman, S., & Stanton, B. (2000). Perceived parental monitoring and health
risk behaviors among urban low-income African American children and
adolescents. Journal of Adolescent Health, 27, 43-48.

Lieb, R., Isensee, B., Höfler, M., Pfister, H., Wittchen, H. (2002). Parental major
depression and the risk of depression and other mental disorders in offspring: A
prospective-longitudinal community study. Archives of General Psychiatry, 59(4),
365-374.

Lieb, R., Merikangas, K. R., Hofler, M., Pfister, H., Isensee, & Wittchen, H.-U. (2002).
Parental alcohol use disorders and alcohol use and disorders in offspring: A
community study. Psychological Medicine, 32, 63-78.

Livinggood, A. B., Daen, P., & Smith, B. D. (1983). The depressed mother as a source of
stimulation for her infant. Journal of Clinical Psychology, 39, 369-375.

113

Loeber, R., & Stouthamer-Loeber, M. (1986). Family factors as correlates and predictors
of juvenile conduct problems and delinquency. In M. Tonry & N. Morris (Eds.),
Crime and Justice, (V ol. 7, pp. 29-149). Chicago, IL: University of Chicago Press.

Longmore, M. A, Manning, W. D., & Giordano, P. C. (2001). Preadolescent parenting
strategies and teens’ dating and sexual initiation: A longitudinal analysis. Journal
of Marriage and Family, 63(2), 322-335.

Lorig, K. R., Sobel, D. S., Ritter, P. L., Laurent, D., & Hobbs, M. (2001). Effect of a self-
management program on patients with chronic disease. Effective Clinical Practice,
4(6), 256-262.

Lovejoy, C. M., Graczyk, P. A., O'Hare, E., & Neuman, G. (2000). Maternal depression
and parenting behavior: A meta- analytic review. Clinical Psychology Review,
20(5), 561- 592.

Luoma, I., Tamminen, T., Kaukonen, P., Laippala, P., Puura, K., Salmelin, R., & Almqvist,
F. (2001). Longitudinal study of maternal depressive symptoms and child well-
being. Journal of the American Academy of Child & Adolescent Psychiatry,
40(12), 1367-1374.

Lyons-Ruth, K., Lyubchik, A., Wolfe, R., & Bronfman, E. (2002). Parental depression
and child attachment: Hostile and helpless profiles of parent and child behavior
among families at risk. In S. H. Goodman & I. H. Gotlib (Eds.), Children of
Depressed Parents: Mechanisms of Risk and Implications for Treatment (pp. 89-
120). Washington, DC: American Psychological Association.

Malcarnea, L., Hamilton, N. A., Ingram, R. E., & Taylor, L. (2000). Correlates of distress
in children at risk for affective disorder: exploring predictors in the offspring of
depressed and nondepressed mothers. Journal of Affective Disorders, 59(3), 243-
251.

Malik, N. M., Boris, N. W., Heller, S. S., Harden, B. J., Squires, J., Chazan-Cohen, R., …
Kaczynski, K. J. (2007). Risk for maternal depression and child aggression in
Early Head Start families: A test of ecological models. Infant Mental Health
Journal, 28(2), 171-191.

Margaret, F., Bunston, T., & Elliot, M. (1999). When mom’s sick: Changes in a mother’s
role and in the family after her diagnosis of cancer. Cancer Nursing: An
International Journal for Cancer Care, 22(1), 58-63.

Mathews, C. A., & Reus, V . I. (2001). Assortative mating in the affective disorders: A
systematic review and meta-analysis. Comprehensive Psychiatry, 42(4), 257-262.

114

McCarty, C. A., McMahon, R. J., & Conduct Problems Prevention Research Group.
(2003). Mediators of the relation between maternal depressive symptoms and
child internalizing and disruptive behavior disorders. Journal of Family
Psychology, 17(4), 545-556.

McGrath, J.M., Records, K., & Rice, M. (2008). Maternal depression and infant
temperament characteristics. Infant Behavior and Development, 31(1), 71-80.

McLearn, K. T., Minkovitz, C. S., Strobino, D. M., Marks, E., & Hou, W. (2006). The
timing of maternal depressive symptoms and mothers’ parenting practices with
young children: Implications for pediatric practice. Pediatrics, 118(1), e174-e182.

Meneses, L. M., Orrell-Valente, J. K., Guendelman, S. R., Oman, D., & Irwin, C. E.
(2006). Racial/ethnic differences in mother-daughter communication about sex.
Journal of Adolescent Health, 39, 128-131.

Merten, M. J., & Henry, C. S. (2011). Family structure, mother-daughter relationship
quality, race and ethnicity, and adolescent girls’ health risk. Journal of Divorce &
Remarriage, 52, 164-186.

Metzger, D., Woody, G. E., Navaline, H., McLellan, A. T., Meyers, K., Boney, T., et al.
(1993, October-November). The Risk Assessment Battery (RAB): Validity and
reliability. Paper presented at the Sixth Annual Meeting of National Cooperative
Vaccine Development Group for AIDS, Alexandria, V A.

Mezulis, A. H., Hyde, J. S., & Clark, R. (2004). Father involvement moderates the effect
of maternal depression during a child's infancy on child behavior problems in
kindergarten. Journal of Family Psychology, 18(4), 575-588.

Middleton, M., Scott, S. L., & Renk, K. (2009). Parental depression, parenting
behaviours, and behavior problems in young children. Infant and Child
Development, 18(4), 323-336.

Miklowitz, D. J. (2004). The role of family systems in severe and recurrent psychiatric
disorders: A developmental psychopathology view. Development and
Psychopathology, 16, 667-688.

Miller, B. C. (2002). Family influences on adolescent sexual and contraceptive behavior.
The Journal of Sex Research, 39(1), 22-26.

Minuchin, P. (1985). Families and individual development: Provocations from the field of
family therapy. Child Development, 56, 289-302.

115

Minuchin, P. (2002). Looking toward the horizon: Present and future in the study of
family systems. In J. P. McHale & W. S. Grolnick (Eds.), Retrospect and Prospect
in the Psychological Study of Families (pp. 259-281). Mahwah, NJ: Lawrence
Erlbaum Associates.

Minuchin, S. (1974). Families & family therapy. Cambridge, MA: Harvard University
Press.

Monk, C., Sloan, R. P., Myers, M. M., Ellman, L., Werner, E., Jeon, J., Tager, F., et al.
(2004). Fetal heart rate reactivity differs by women's psychiatric status: An early
marker for developmental risk? Journal of the American Academy of Child and
Adolescent Psychiatry, 43(3), 283-290.

Murphy, D. A., Marelich, W. D., Herbeck, D. M., & Payne, D. L. (2009). Family routines
and parental monitoring as protective factors among early and middle adolescents
affected by maternal HIV/AIDS. Child Development, 80(6), 1676-1691.

Natsuaki, M. N., Xiaojia, G., Leve, L. D., Neiderhiser, J. M., Shaw, D. S., Conger, R. D.,
… Reiss, D. (2010). Genetic liability, environment, and the development of
fussiness in toddlers: The roles of maternal depression and parental
responsiveness. Developmental Psychology, 46(5), 1147-1158.

Nichols, M. P., & Schwartz, R. C. (2007). Family therapy: Concepts and methods (8th
ed.). Boston, MA: Allyn & Bacon.

Nomura, Y ., Warner, V ., & Wickramaratne, P. (2001). Parents concordant for major
depressive disorder and the effect of psychopathology in offspring. Psychological
Medicine, 31, 1211-1222.

Nomura, Y ., Wickramaratne, P. J., Warner, V ., Mufson, L., & Weissman, M. M. (2002).
Family discord, parental depression, and psychopathology in offspring: Ten-year
follow-up. Journal of the American Academy of Child & Adolescent Psychiatry,
41(4), 402-409.

O'Hara, M. W., Zekoski, E. M., Phillips, L. H., & Wright, E. J. (1990). A controlled
prospective study of postpartum mood disorders: Comparison of childbearing and
nonchildbearing women. Journal of Abnormal Psycholgy, 99, 3–15.

Ohannessian, C. M., Hesselbrook, V . M., Kramer, J., Kuperman, S., Bucholz, K. K.,
Schuckit, M. A., & Nurnberger, J. I. (2005). The relationship between parental
psychopathology and adolescent psychopathology: an examination of gender
patterns. Journal of Emotional and Behavioral Disorders, 13(2), 67-76.

116

Ott, M. A., Millstein, S. G., Ofner, S., & Halpern-Felsher, B. L. (2006). Greater
expectations: Adolescents’ positive motivations for sex. Perspectives on Sexual
and Reproductive Health, 38(2), 84-89.

Overby, K. J., & Kegeles, S. M. (1994). The impact of AIDS on an urban population off
high-risk female minority adolescents: Implications for intervention. Journal of
Adolescent health, 15, 216-227.

Pachter, L. M., Auinger, P., Palmer, R., & Weitzman, M. (2006). Do parenting and the
home environment, maternal depression, neighborhood, and chronic poverty
affect child behavioral problems differently in different racial-ethnic groups?
Pediatrics, 117(1), 1329-1338.

Paradise, J. E., Cote, J., Minsky, S., Lourenco, A., & Howland, J. (2001). Personal values
and sexual decision-making among virginal and sexual experienced urban
adolescent girls. Journal of Adolescent Health, 28, 404-409.

Parker, G. (2000). Classifying depression: Should paradigms lost be regained? American
Journal of Psychiatry, 157, 1195-1203.

Parkes, A., Wight, D., Henderson, M., & Hart, G. (2007). Explaining associations
between adolescent substance use and condom use. Journal of Adolescent Health,
40, 180.e1-180.e18.

Pasch, L. A., Deardorff, J., Tschann, J. M., Flores, E., Penilla, C., & Pantoja, P. (2006).
Acculturation, parent-adolescent conflict, and adolescent adjustment in Mexican
American families. Family Process, 45(1), 75-86.

Pearson, J., Muller, C., & Frisco, M. L. (2006). Parental involvement, family structure,
and adolescent sexual decision making. Sociological Persepctives, 49(1), 67-90.

Pelaez, M., Field, T., Pickens, J. N., & Hart, S. (2008). Disengaged and authoritarian
parenting behavior of depressed mothers with their toddlers. Infant Behavior &
Development, 31, 145-148.

Peterson, P., Hawkins, J., Abbot, R., & Catalano, R. (1994).Disentangling the effects of
parental drinking, family management, and parental alcohol norms on current
drinking by African American and European American Adolescents. Journal of
Research on Adolescents, 4, 203-227.

117

Phares, V ., Duhig, A. M., & Watkins, M. M. (2002). Family context: Fathers and other
supports. Children of depressed parents: Mechanisms of risk and implications for
treatment. In S. H. Goodman & I. H. Gotlib (Eds.). Children of Depressed Parents:
Mechanisms of Risk and Implications for Treatment (pp. 203-225). Washington,
DC: American Psychological Association.

Prinz, R. J., Foster, S., Kent, R. N., & O'Leary, K. D. (1979). Multivariate assessment of
conflict in distressed and nondistressed mother-adolescent dyads. Journal of
Applied Behavior Analysis, 12, 691-700.

Radke-Yarrow, M., Cummings, E. M., Kuczynski, L., & Chapman, M. (1985). Patterns of
attachment in two- and three-year-olds in normal families and families with
parental depression. Child Development, 56(4), 884-893.

Radke-Yarrow, M., & Sherman, T. (1990). Hard growing: Children who survive. In J.
Rolf, A. S., Masten, D. Cicchetti, K. H. Nuechterlein, & S. Weintraub (Eds.), Risk
and Protective Factors in the Development of Psychopathology (pp. 97-119).
Cambridge, England: Cambridge University Press.

Regnerus, M. D., & Luchies, L. B. (2006). The parent-child relationship and
opportunities for adolescents’ first sex. Journal of Family Issues, 27(2), 159-183.

Rehman, U. S., Gollan, J., & Mortimer, A. R. (2008). The marital context of depression:
Research, limitations, and new directions. Clinical Psychology Review, 28, 179-
198.

Reimuller, A., Shadur, J., & Hussong, A. M. (2011). Parental social support as a
moderator of self-medication in adolescents. Addictive Behaviors, 36, 203-208.

Repetti, R. L., Taylor, S. E., & Seeman, T. E. (2002). Risky families: Family social
environments and the mental and physical health of offspring. Psychological
Bulletin, 128(2), 330-366.

Resnicow, K., Soler, R., Braithwaite, R. L., Ahluwalia, J. S., & Butler, J. (2000). Cultural
sensitivity in substance use prevention. Journal of Community Psychology, 28(3),
271-290.

Reyland, S. A., McMahon, T. J., Higgins-Delessandro, A., & Luthar, S. S. (2002). Inner-
city children living with a HIV-seropositive mother: Parent-child relationships,
perception of social support, and psychological disturbance. Journal of Child and
Family Studies, 11(3), 313-329.

118

Rhee, S. H., Hewitt, J. K., Young, S. E., Corley, R. P., Crowley, T. J., & Stallings, M. C.
(2003). Genetic and environmental influences on substance initiation, use, and
problem use in adolescents. Archives of General Psychiatry, 60, 1256–1264.

Rink, E., Tricker, R., & Harvey, S. M. (2007). Onset of sexual intercourse among female
adolescents: The influence of perceptions, depression, and ecological factors.
Journal of Adolescent Health, 41(4), 398-406.

Rohde, P. L., Lewinsohn, P. M., Klein, D. N., & Seeley, J. R. (2005). Association of
parental depression with psychiatric course from adolescence to young adulthood
among formerly depressed individuals. Journal of Abnormal Psychology, 114,
409-420.

Rosenthal, S. L.,V on Ranson, K. M., Cotton, S., Biro, F. M., Mills, L., & Succop, P. A.
(2001). Sexual initiation: Predictors and developmental trends. Sexually
Transmitted Diseases, 28(9), 527-532.

Rotheram-Borus, M. J., Weiss, R., Alber, S., & Lester, P. (2005). Adolescent adjustment
before and after HIV-related parental death. Journal of Consulting and Clinical
Psychology, 73, 221-228.

Rutter, M. (1985). Resilience in the face of adversity: Protective factors and resistance to
psychiatric disorder. British Journal of Psychiatry, 147, 598-611.

Sarigiani, P.A., Heath, P.A., & Camarena, P.M. (2003). The significance of parental
depressed mood for young adolescents' emotional and family experiences.
Journal of Early Adolescence, 23, 241-267.

Schwartz, C. E., Dorer, D. J., Beardslee, W. R., Lavon, P. W., & Keller, M. B. (1990).
Maternal expressed emotion and parental affective disorder: Risk for childhood
depressive disorder, substance use, or conduct disorder. Journal of Psychiatric
Research, 24(3), 231-250.

Scott, M. E., Wildsmith, E., Welti, K., Ryan, S., Schelar, E., & Steward-Streng, N. R.
(2011). Risky adolescent sexual behaviors and reproductive health in young
adulthood. Perspectives on Sexual and Reproductive Health, 43(2), 110-118.

Shaw, D. S., Criss, M. M., Schonberg, M. A., & Beck, J. E. (2004). The development of
family hierarchies and their relation to children’s conduct problems. Development
and Psychopathology, 16, 483-500.

Sher, L., & Zalsman, G. (2005). Alcohol and adolescent suicide. International Journal of
Adolescent Medicine and Health, 17, 197–203.

119

Shook, S. E., Jones, D. J., Forehand, R., Dorsey, S., & Brody, G. (2010). The mother–
coparent relationship and youth adjustment: A study of African American single-
mother families. Journal of Family Psychology, 24(3), 243-251.

Sieverding, J. A., Adler, N., Witt, S., & Ellen, J. (2005). The influence of parental
monitoring on adolescent sexual initiation. Archives of Pediatrics & Adolescent
Medicine, 159, 724-729.

Silk, J. S., Shaw, D. S., Forbes, E. E., Lane, T. L., & Kovacs, M. (2006). Maternal
depression and child internalizing: the moderating role of child emotional
regulation. Journal of Clinical Child and Adolescent Psychology, 35(1), 116-126.

Skeer, M., McCormick, M. C., Normand, S. T., Buka, S. L., & Gilman, S. E. (2009). A
prospective study of familial conflict, psychological stress, and the development
of substance use disorders in adolescence. Drug and Alcohol Dependence, 104,
65-72.

Somerset, W., Newport, J., Ragan, K., & Stowe, Z. N. (2006). Depressive disorders in
women: From menarche to beyond the menopause. In C. L. M. Keyes &
Goodman, S. H. (Eds.), A Handbook for the Social, Behavioral, and Biomedical
Sciences: Women and Depression. New York: Cambridge University Press.

Stein, A., Malmberg, L.E., Sylva, K., Barnes, J., Leach, P., and the FCCC team. (2008).
The influence of maternal depression, caregiving, and socioeconomic status in the
post-natal year on children's language development. Child: Care, Health, and
Development, 34(5), 603-612.

Stein, J. A., Rotheram-Borus, M. J., & Lester, P. (2007). Impact of parentification on
long-term outcomes among children of parents with HIV/AIDS. Family Process,
46, 317-333.

Steinberg, L., & Morris, A. S. (2001). Adolescent development. Annual Review of
Psychoology, 52, 83-110.

Steinberg, L., & Silk, J. S. (2002). Parenting adolescents. In M. H. Bornstein (Ed.),
Handbook of Parenting: Volume 1: Children and Parenting (pp. 103-134).
Mahwah, NJ: Lawrence Erlbaum Associates.

Steinglass, P. (1987). A systems view of family interaction and psychopathology. In T.
Jacob (Ed.), Family Interaction and Psychopathology: Theories, methods, and
findings (pp. 25-65). New York: Plenum Press.

120

Stueve, A., & O’Donnell, L. N. (2005). Early alcohol initiation and subsequent sexual
and alcohol risk behaviors among urban youths. American Journal of Public
Health, 95, 887–893.

Substance Abuse and Mental Health Services Administration (2008). Results from the
2007 National Survey on Drug Use and Health: National Findings (Office of
Applied Studies, NSDUH Series H-34, DHHS Publication No. SMA 08-
4343Findings). Rockville, MD.

Swanson, L. M., Flynn, H. A., Wilburn, K., Marcus, S., & Armitage, R. (2010). Maternal
mood and sleep in children of women at risk for perinatal depression. Archives of
Women’ s Mental Health, 13(6), 531-534.

Tamis-LeMonda, C. S., & Cabrera, N. (2002). Handbook of Father Involvement:
Multidisciplinary Perspectives. Mahwah, NJ: Erlbuam.

Tannenbaum, L., & Forehand, R. (1994). Maternal depressive mood: The role of the
father in preventing adolescent problem behaviors. Behaviour Research &
Therapy, 32, 321-325.

Tarullo, L. B., DeMulder, E. K., Martinez, P. E., & Radke-Yarrow, M. (1994). Dialogues
with preadolescents and adolescents: Mother-child interaction patterns in
affectively ill and well dyads. Journal of Abnormal Child Psychology, 22(1), 33-
51.

Taylor, R. D., Casten, R., & Flickinger, S. (1993). The influence of kinship social support
on the parenting experiences and psychosocial adjustment of African American
adolescents. Developmental Psychology, 29, 382–388.

Taylor, R. D., Seaton, E., & Dominguez, A. (2008). Kinship support, family relations, and
psychological adjustment among low-income African American mothers and
adolescents. Journal of Research on Adolescence, 18(1), 1-22.

Teachman, J., Day, R., Paasch, K., Carver, K., & Call, V . (1998). Sibling resemblance in
behavioral and cognitive outcomes: The role of father presence. Journal of
Marriage and the Family, 60, 835-848.

Thomas, A. M., Forehand, R., & Neighbors, B. (1995). Change in maternal depressive
mood: Unique contributions to adolescent functioning over time. Adolescence, 30,
43-52.

Tompkins, T. L., & Wyatt, G. E. (2008). Child psychosocial adjustment and parenting in
families affected by maternal HIV/AIDS. Journal of Child and Family Studies,
17(6), 823-838.
121

Trusty, J. (1996). Relationship of parental involvement in teens’ career development to
teens’ attitudes, perceptions and behavior. Journal of Research and Development
in Education, 30(1), 63-69.

U. S. Census Bureau. (2010, March). American’ s Families and Living Arrangements.
Retrieved from http://www.census.gov/population/www/socdemo/hh-fam.html

Upchurch, D. M., Aneshensel, C. S., Sucoff, C. A., & Levy-Storms, L. (1999).
Neighborhood and family contexts of adolescent sexual activity. Journal of
Marriage and the Family, 61, 920–933.

Upchurch, D. M., Lillard, L. A., Aneshensel, C. S., & Li, N. F. (2002). Inconsistencies in
reporting the occurrence and timing of first intercourse among adolescents.
Journal of Sex Research, 39, 197-206.

Vandewater, E. A., & Lansford, J. E. (2005). A family process model of problem
behaviors in adolescents. Journal of Marriage and Family, 67, 100-109.

Velez-Pastrana, M. C., Gonzalez-Rodriguez, R. A., & Borges-Hernandez, A. (2005).
Family functioning and early onset of sexual intercourse in Latino adolescents.
Adolescence, 40(160), 777-791.

Wahler, H. J. (1968). The Physical Symptoms Inventory: Measuring levels of somatic
complaining behavior. Journal of Clinical Psychology, 24(2), 207-211.

Walden, B., McGue, M., Iacono, W. G., Burt, A., & Elkins, I. (2004). Identifying shared
environmental contributions to early substance use: The respective roles of peers
and parents. Journal of Abnormal Psychology, 113(3), 440-450.

Webster-Stratton, C., & Hammond, M. (1988). Maternal depression and its relationship to
life stress, perceptions of child behavior problems, parenting behaviors, and child
conduct problems. Journal of Abnormal Child Psychology, 16, 299-315.

Weissman, M. M., & Jensen, P. (2002). What research suggests for depressed women
with children. Journal of Clinical Psychiatry, 63(7), 641-647.

Weissman, M. M., Wickramaratne, P., Nomura, Y ., Warner, V ., Pilowsky, D., & Verdeli, H.
(2006). Offspring of depressed parents: 20 years later. American Journal of
Psychiatry, 163(6), 1001-1008.

Welsh, D.P., Grello, C.M., & Harper, M.S. (2003). When love hurts: Depression and
adolescent romantic relationships. In P. Florsheim (Ed.), Adolescent romantic
relations and sexual behavior: Theory, research and practical implications (pp.
185-211). Mahwah, NJ: Lawrence Erlbaum.
122

Whitchurch, G. G., & Constantine, L. L. (1993). Systems theory. In P. Boss, W. J.
Doherty, R. LaRossa, W. R. Schumm, & S. K. Steinmetz (Eds.), Sourcebook of
Family Theories and Methods: A Conceptual Approach (pp. 325-355). New York:
Springer Science + Business Media.

Wu, N., Lester, P., Jiang, L., Weiss, R., Slocum, S., & Rotheram-Borus, M. J. (2011).
Substance use among adolescents of parents living with HIV in New York City.
Substance Use & Misuse, 46, 795-807.

Zimmer-Gembeck, M. J., & Helfand, M. (2008). Ten years of longitudinal research on U.
S. adolescent sexual behavior: Developmental correlates of sexual intercourse,
and the importance of age, gender, and ethnic background. Developmental Review,
28(2), 153-224.

123

APPENDIX A: CORRELATIONS

Table A1
Pearson Correlations Among Parent Characteristics and Relationship Variables
(Maternal Depression as a Continuous Variable)
1

2 3 4 5 6 7
1. Depression
2. HIV
1.00

.19*
1.00
-.08
-.01
.20*
.10
.30**
.41**
-.13
.10
-.15
.00
3. Alcohol 1.00 .25** .09 -.13 .08
4. Marijuana
5. PHSY
1.00 .17*
1.00
-.13
-.01
.05
.18*
6. PCCOM 1.00 .08
7. Involvement 1.00
Note. Significant results are in boldface. *p < .05, **p < .01.
PHSY = Physical Symptoms; PCCOM = Parent Child Communication Scale Score

124

APPENDIX B: RQ1—LOGISTIC REGRESSION ANALYSES OF ALCOHOL USE
IN LIFETIME

Table B1
Depression as Binary without Control Variables
Model Summary
-2 Log likelihood Cox & Snell R
2
Nagelkerke R
2
Chi
2
df p-value
224.02 .001 .001 .10 1 .75

Logistic Regression Coefficients
Source B S.E. Wald df Sig. Exp(B)
Depression
Constant
.10
-.48
.32
.23
.10
4.37
1
1
.75
.04
1.11
.62

Table B2
Depression as Continuous without Control Variables
Model Summary
-2 Log likelihood Cox & Snell R
2
Nagelkerke R
2
Chi
2
df p-value
223.24 .005 .007 .88 1 .35

Logistic Regression Coefficients
Source B S.E. Wald df Sig. Exp(B)
Depression
Constant
-.02
-.19
.03
.30
.87
.41
1
1
.35
.52
.98
.83
125

Table B3
Depression as Continuous with Control Variables
Model Summary
-2 Log likelihood Cox & Snell R
2
Nagelkerke R
2
Chi
2
df p-value
189.30 .031 .042 4.55 7 .72

Logistic Regression Coefficients
Source B S.E. Wald df Sig. Exp(B)
HIV .29 .38 .58 1 .45 1.34
Alcohol .61 .37 2.73 1 .10 1.84
Marijuana .15 .54 .08 1 .78 1.16
PS

.83 3 .84

PS (1) -.07 .56 .02 1 .90 .93
PS (2) .27 .56 .22 1 .64 1.30
PS (3) -.13 .67 .04 1 .84 .88
Depression -.02 .04 .33 1 .56 .98
Constant -.56 .50 1.26 1 .26 .57
Note. PS = Physical Symptoms
For the physical symptoms variable, the lowest response level served as a reference
category.

126

APPENDIX C: RQ1–LOGISTIC REGRESSION ANALYSES OF ALCOHOL USE
IN THE PAST 30 DAYS

Table C1
Depression as Binary without Control Variables
Model Summary
-2 Log likelihood Cox & Snell R
2
Nagelkerke R
2
Chi
2
df p-value
198.42 .000 .001 .08 1 .78

Logistic Regression Coefficients
Source B S.E. Wald df Sig. Exp(B)
Depression
Constant
.09
-.99
.35
.25
.08
15.60
1
1
.78
.00
1.10
.37

Table C2
Depression as Continuous without Control Variables
Model Summary
-2 Log likelihood Cox & Snell R
2
Nagelkerke R
2
Chi
2
df p-value
197.90 .004 .005 .60 1 .44

Logistic Regression Coefficients
Source B S.E. Wald df Sig. Exp(B)
Depression
Constant
-.02
-.73
.03
.32
.59
5.21
1
1
.44
.02
.98
.48
127

Table C3
Depression as Continuous with Control Variables
Model Summary
-2 Log likelihood Cox & Snell R
2
Nagelkerke R
2
Chi
2
df p-value
162.89 .069 .099 10.26 7 .17

Logistic Regression Coefficients
Source B S.E. Wald df Sig. Exp(B)
HIV .75 .43 3.03 1 .08 2.13
Alcohol .49 .40 1.47 1 .23 1.63
Marijuana .00 .59 .00 1 1.00 1.00
PS

6.33 3 .10

PS (1) .05 .56 .01 1 .93 1.05
PS (2) -1.23 .64 3.62 1 .06 .29
PS (3) -.89 .73 1.51 1 .22 .41
Depression .01 .04 .03 1 .87 1.01
Constant -.92 .53 3.08 1 .08 .40
Note. PS = Physical Symptoms
For the physical symptoms variable, the lowest response level served as a reference
category.

128

APPENDIX D: RQ1—LOGISTIC REGRESSION ANALYSES OF MARIJUANA
USE IN LIFETIME

Table D1
Depression as Binary without Control Variables
Model Summary
-2 Log likelihood Cox & Snell R
2
Nagelkerke R
2
Chi
2
df p-value
176.42 .016 .024 2.72 1 .10

Logistic Regression Coefficients
Source B S.E. Wald df Sig. Exp(B)
Depression
Constant
.62
-1.57
.38
.30
2.64
28.39
1
1
.10
.00
1.85
.21

Table D2
Depression as Continuous without Control Variables
Model Summary
-2 Log likelihood Cox & Snell R
2
Nagelkerke R
2
Chi
2
df p-value
178.74 .002 .004 .39 1 .53

Logistic Regression Coefficients
Source B S.E. Wald df Sig. Exp(B)
Depression
Constant
.02
-1.41
.03
.35
.39
15.87
1
1
.53
.00
1.02
.25
129

Table D3
Depression as Continuous with Control Variables
Model Summary
-2 Log likelihood Cox & Snell R
2
Nagelkerke R
2
Chi
2
df p-value
150.67 .058 .086 8.49 7 .29

Logistic Regression Coefficients
Source B S.E. Wald df Sig. Exp(B)
HIV .90 .43 4.29 1 .04 2.46
Alcohol -.12 .44 .08 1 .78 .88
Marijuana -.06 .61 .01 1 .93 .95
PS

1.00 3 .80

PS (1) -.14 .71 .04 1 .85 .87
PS (2) .18 .69 .07 1 .79 1.20
PS (3) .49 .77 .40 1 .53 1.63
Depression -.00 .04 .00 1 .95 1.00
Constant -1.64 .62 7.03 1 .01 .19
Note. PS = Physical Symptoms
For the physical symptoms variable, the lowest response level served as a reference
category.

130

APPENDIX E: RQ1—LOGISTIC REGRESSION ANALYSES OF MARIJUANA
USE IN THE PAST 30 DAYS

Table E1
Depression as Binary without Control Variables
Model Summary
-2 Log likelihood Cox & Snell R
2
Nagelkerke R
2
Chi
2
df p-value
161.33 .006 .010 .99 1 .32

Logistic Regression Coefficients
Source B S.E. Wald df Sig. Exp(B)
Depression
Constant
.40
-1.64
.40
.30
.98
29.27
1
1
.32
.00
1.48
.19

Table E2
Depression as Continuous without Control Variables
Model Summary
-2 Log likelihood Cox & Snell R
2
Nagelkerke R
2
Chi
2
df p-value
162.07 .002 .002 .25 1 .61

Logistic Regression Coefficients
Source B S.E. Wald df Sig. Exp(B)
Depression
Constant
.02
-1.58
.03
.38
.26
17.79
1
1
.61
.00
1.02
.21
131

Table E3
Depression as Continuous with Control Variables
Model Summary
-2 Log likelihood Cox & Snell R
2
Nagelkerke R
2
Chi
2
df p-value
136.92 .062 .096 9.04 7 .25

Logistic Regression Coefficients
Source B S.E. Wald df Sig. Exp(B)
HIV 1.20 .47 6.50 1 .01 3.33
Alcohol -.20 .47 .18 1 .67 .82
Marijuana .26 .63 .18 1 .67 1.30
PS

1.05 3 .79

PS (1) .14 .70 .04 1 .85 1.15
PS (2) -.41 .74 .31 1 .58 .66
PS (3) -.40 .82 .25 1 .62 .67
Depression .02 .04 .23 1 .63 1.02
Constant -1.87 .65 8.25 1 .00 .15
Note. PS = Physical Symptoms
For the physical symptoms variable, the lowest response level served as a reference
category.

132

APPENDIX F: RQ1—LOGISTIC REGRESSION ANALYSES OF ENGAGEMENT
IN SEX IN LIFETIME

Table F1
Depression as Binary without Control Variables
Model Summary
-2 Log likelihood Cox & Snell R
2
Nagelkerke R
2
Chi
2
df p-value
226.00 .017 .023 2.86 1 .09

Logistic Regression Coefficients
Source B S.E. Wald df Sig. Exp(B)
Depression
Constant
.53
-.53
.32
.23
2.83
5.32
1
1
.09
.02
1.70
.59

Table F2
Depression as Continuous without Control Variables
Model Summary
-2 Log likelihood Cox & Snell R
2
Nagelkerke R
2
Chi
2
df p-value
228.31 .003 .004 .56 1 .46

Logistic Regression Coefficients
Source B S.E. Wald df Sig. Exp(B)
Depression
Constant
.02
-.44
.03
.30
.56
2.22
1
1
.46
.14
1.02
.65
133

Table F3
Depression as Continuous with Control Variables
Model Summary
-2 Log likelihood Cox & Snell R
2
Nagelkerke R
2
Chi
2
df p-value
188.73 .062 .083 9.16 7 .24

Logistic Regression Coefficients
Source B S.E. Wald df Sig. Exp(B)
HIV .80 .38 4.37 1 .04 2.22
Alcohol .04 .37 .01 1 .91 1.04
Marijuana -.30 .55 .30 1 .59 .74
PS

1.28 3 .73

PS (1) -.57 .55 1.07 1 .30 .57
PS (2) -.56 .56 .99 1 .32 .57
PS (3) -.43 .66 .43 1 .51 .65
Depression .04 .04 1.21 1 .27 1.04
Constant -.33 .49 .45 1 .50 .72
Note. PS = Physical Symptoms
For the physical symptoms variable, the lowest response level served as a reference
category.

134

APPENDIX G: RQ1--LOGISTIC REGRESSION ANALYSES OF ENGAGEMENT
IN SEX IN THE PAST THREE MONTHS

Table G1
Depression as Binary without Control Variables
Model Summary
-2 Log likelihood Cox & Snell R
2
Nagelkerke R
2
Chi
2
df p-value
209.37 .015 .021 2.50 1 .11

Logistic Regression Coefficients
Source B S.E. Wald df Sig. Exp(B)
Depression
Constant
.52
-.91
.33
.25
2.47
13.59
1
1
.12
.00
1.69
.40

Table G2
Depression as Continuous without Control Variables
Model Summary
-2 Log likelihood Cox & Snell R
2
Nagelkerke R
2
Chi
2
df p-value
211.24 .004 .005 .62 1 .43

Logistic Regression Coefficients
Source B S.E. Wald df Sig. Exp(B)
Depression
Constant
.02
-.84
.03
.31
.62
7.22
1
1
.43
.01
1.02
.43
135

Table G3
Depression as Continuous with Control Variables
Model Summary
-2 Log likelihood Cox & Snell R
2
Nagelkerke R
2
Chi
2
df p-value
178.77 .049 .066 6.98 7 .43

Logistic Regression Coefficients
Source B S.E. Wald df Sig. Exp(B)
HIV .55 .39 1.95 1 .16 1.73
Alcohol .27 .39 .49 1 .49 1.31
Marijuana -.38 .57 .45 1 .50 .68
PS

2.79 3 .43

PS(1) -.88 .57 2.37 1 .12 .42
PS(2) -.84 .58 2.11 1 .15 .43
PS(3) -.86 .68 1.61 1 .21 .42
Depression .05 .04 1.74 1 .19 1.05
Constant -.51 .51 1.03 1 .31 .60
Note. PS = Physical Symptoms
For the physical symptoms variable, the lowest response level served as a reference
category.

136

APPENDIX H: RQ2--THE INFLUENCE OF MATERNAL DEPRESSION ON
FAMILY SYSTEM FACTORS

Table H1
The Influence of Maternal Depression as Binary on Parental Involvement (without
Control Variables)
Model Summary
R R Square Adjusted R
2
Std. Error of the Estimate
.095 .009 .003 4.916

Linear Regression Coefficients
Source B S.E. β t Sig.
Depression
Constant
-.94
24.99
.78
.56
-.10

-1.20
44.89
.23
.00

137

Table H2
The Influence of Maternal Depression as Continuous on Parental Involvement (with
Control Variables)
Model Summary
R R Square Adjusted R
2
Std. Error of the Estimate
.176 .031 -.006 4.853

Linear Regression Coefficients
Variable B SE β t Sig.
Depression -.01 .09 -.01 -.08 .94
HIV -1.77 .93 -.18
-1.91
.06
Maternal alcohol -.41 .90 -.04
-.45
.65
Maternal marijuana 1.01 .1.33 .07 .76 .45
Physical Symptoms .31 .49 .07 .62 .54
Constant 25.22 .87 -
.13
.00

138

Table H3
The Influence of Maternal Depression as Continuous on Parental Involvement (without
Control Variables)
Model Summary
R R Square Adjusted R
2
Std. Error of the Estimate
.153 .023 .017 4.881

Linear Regression Coefficients

Variable B SE β t Sig.
Depression -.12 .06 -.15
-1.93
.06
Constant 25.69 .72 -
35.61
.00

Table H4
The Influence of Maternal Depression as Binary on Parent-Child Communication
(without Control Variables)
Model Summary
R R Square Adjusted R
2
Std. Error of the Estimate
.161 .026 .020 3.318

Linear Regression Coefficients
Source B S.E. β t Sig.
Depression
Constant
-1.07
5.91
.52
.37
-.16

-2.06
16.04
.04
.00

139

Table H5

The Influence of Maternal Depression as Continuous on Parent-Child Communication
(with Control Variables)

Model Summary
R R Square Adjusted R
2
Std. Error of the Estimate
.228 .052 .016 3.481

Linear Regression Coefficients
Variable B SE β t Sig.
Depression -.05 .06 -.08 -.80 .43
HIV .77 .66 .11
1.17
.24
Maternal alcohol -.98 .63 -.14
-1.57
.12
Maternal marijuana -.97 .93 -.09 -1.04 .30
Physical Symptoms -.13 .35 -.04 -.37 .72
Constant 6.15 .61 -
10.07
.00

Table H6

The Influence of Maternal Depression as Continuous on Parent-Child Communication
(without Control Variables)

Model Summary
R R Square Adjusted R
2
Std. Error of the Estimate
.130 .017 .011 3.333

Linear Regression Coefficients
Variable B SE β t Sig.
Depression -.07 .04 -.13 -1.66 .10
Constant 6.06 .49 -
12.48
.00
140

APPENDIX I: RQ2--THE INFLUENCES OF MATERNAL DEPRESSION AND
FAMILY SYSTEM FACTORS ON DAUGHTERS’ SEX IN LIFETIME

Table I1
The Influences of Maternal Depression as Binary and Parental Involvement on
Adolescent Daughters' Lifetime Engagement in Sex (without Control Variables)
Model Summary
-2 Log likelihood Cox & Snell R
2
Nagelkerke R
2
Chi
2
df p-value
213.785 .017 .023 2.71 2 .26

Logistic Regression Coefficients
Variable B SE Wald Sig. Exp (B)
Depression .52 .33 2.53 .11 1.68
Parental Involvement -.01 .03 .06 .80 .99
Constant -.32 .86 .14 .71
.73

141

Table I2
The Influences of Maternal Depression as Continuous and Parental Involvement on
Adolescent Daughters' Lifetime Engagement in Sex (with Control Variables)

Model Summary
-2 Log likelihood Cox & Snell R
2
Nagelkerke R
2
Chi
2
df p-value
177.790 .073 .097 10.28 8 .25

Logistic Regression Coefficients
Variable B SE Wald Sig. Exp (B)
Depression .05 .04 1.59 .21 1.05
Parental Involvement -.02 .04 .40 .53 .98
HIV .73 .40 3.38 .07
2.08
Maternal alcohol .02 .39 .00 .96
1.02
Maternal marijuana -.31 .58 .28 .60 .74
Physical Symptoms

1.70 .64

Physical Symptoms (1) -.72 . 56 1.65 .20 .49
Physical Symptoms (2) -.51 .57 .82 .37 .60
Physical Symptoms (3) -.44 .67 .42 .52 .65
Constant .25 1.08 .06 .82
1.29
Note. For the physical symptoms variable, the lowest response level served as a reference
category.

142

Table I3
The Influences of Maternal Depression as Continuous and Parental Involvement on
Adolescent Daughters' Lifetime Engagement in Sex (without Control Variables)
Model Summary
-2 Log likelihood Cox & Snell R
2
Nagelkerke R
2
Chi
2
df p-value
215.656 .005 .007 .84 2 .66

Logistic Regression Coefficients
Variable B SE Wald Sig. Exp (B)
Depression .02 .03 .68 .41 1.02
Parental Involvement -.01 .03 .08 .78 .99
Constant -.24 .90 .07 .79
.79

Table I4
The Influences of Maternal Depression as Binary and Parent-Child Communication on
Adolescent Daughters' Lifetime Engagement in Sex (without Control Variables)
Model Summary
-2 Log likelihood Cox & Snell R
2
Nagelkerke R
2
Chi
2
df p-value
217.640 .030 .040 4.94 2 .09

Logistic Regression Coefficients
Variable B SE Wald Sig. Exp (B)
Depression .55 .32 2.88 .09 1.73
PCCOM -.06 .05 1.32 .25 .95
Constant -.21 .36 .32 .57
.82
Note. PCCOM = Parent-Child Communication
143

Table I5
The Influences of Maternal Depression as Continuous and Parent-Child Communication
on Adolescent Daughters' Lifetime Engagement in Sex (with Control Variables)
Model Summary
-2 Log likelihood Cox & Snell R
2
Nagelkerke R
2
Chi
2
df p-value
181.358 .077 .103 11.16 8 .19

Logistic Regression Coefficients
Variable B SE Wald Sig. Exp (B)
Depression .04 .04 1.02 .31 1.04
PCCOM -.08 .05 2.40 .12 .92
HIV .82 .40 4.29 .04
2.28
Maternal alcohol -.05 .38 .02 .90
.95
Maternal marijuana -.32 .56 .32 .57 .73
Physical Symptoms

.87 .83
Physical Symptoms (1) -.52 .56 .84 .36 .60
Physical Symptoms (2) -.40 .57 .49 .48 .67
Physical Symptoms (3) -.37 .68 .30 .59 .69
Constant .12 .57 .04 .84
1.12

Note. PCCOM = Parent-Child Communication
For the physical symptoms variable, the lowest response level served as a reference
category.

144

Table I6
The Influences of Maternal Depression as Continuous and Parent-Child Communication
on Adolescent Daughters' Lifetime Engagement in Sex (without Control Variables)

Model Summary
-2 Log likelihood Cox & Snell R
2
Nagelkerke R
2
Chi
2
df p-value
220.043 .016 .021 2.53 2 .28

Logistic Regression Coefficients

Variable B SE Wald Sig. Exp (B)
Depression .02 .03 .50 .48 1.02
PCCOM -.06 .05 1.75 .19 .94
Constant -.06 .41 .02 .88
.94
Note. PCCOM = Parent-Child Communication

145

APPENDIX J: RQ2—THE INFLUENCES OF MATERNAL DEPRESSION AND
FAMILY SYSTEM FACTORS ON DAUGHTERS’ SEX IN THE PAST THREE
MONTHS

Table J1
The Influences of Maternal Depression as Binary and Parental Involvement on
Adolescent Daughters' Engagement in Sex in the Past Three Months (without Control
Variables)

Model Summary
-2 Log likelihood Cox & Snell R
2
Nagelkerke R
2
Chi
2
df p-value
198.558 .017 .024 2.69 2 .26

Logistic Regression Coefficients

Variable B SE Wald Sig. Exp (B)
Depression .52 .34 2.29 .13 1.68
Involvement -.02 .04 .23 .63 .98
Constant -.51 .90 .32 .57
.60

146

Table J2
The Influences of Maternal Depression as Continuous and Parental Involvement on
Adolescent Daughters' Engagement in Sex in the Past Three Months (with Control
Variables)
Model Summary
-2 Log likelihood Cox & Snell R
2
Nagelkerke R
2
Chi
2
df p-value
168.241 .064 .087 8.80 8 .36

Logistic Regression Coefficients
Variable B SE Wald Sig. Exp (B)
Depression .06 .04 2.21 .14 1.06
Parental Involvement -.03 .04 .55 .46 .97
HIV .46 .41 1.25 .26
1.59
Maternal alcohol .28 .40 .49 .48
1.33
Maternal marijuana -.47 .61 .61 .44 .62
Physical Symptoms

3.51 .32
Physical Symptoms (1) -1.09 . 59 3.40 .07 .34
Physical Symptoms (2) -.79 .58 1.84 .18 .45
Physical Symptoms (3) -.85 .69 1.52 .22 .43
Constant .19 1.10 .03 .87
1.20
Note. For the physical symptoms variable, the lowest response level served as a reference
category.

147

Table J3
The Influences of Maternal Depression as Continuous and Parental Involvement on
Adolescent Daughters' Engagement in Sex in the Past Three Months (without Control
Variables)
Model Summary
-2 Log likelihood Cox & Snell R
2
Nagelkerke R
2
Chi
2
df p-value
200.086 .007 .010 1.17 2 .56

Logistic Regression Coefficients
Variable B SE Wald Sig. Exp (B)
Depression .02 .03 .79 .38 1.02
Parental Involvement -.02 .04 .23 .63 .98
Constant -.47 .94 .25 .62
.63

Table J4
The Influences of Maternal Depression as Binary and Parent-Child Communication on
Adolescent Daughters' Engagement in Sex in the Past Three Months (without Control
Variables)
Model Summary
-2 Log likelihood Cox & Snell R
2
Nagelkerke R
2
Chi
2
df p-value
202.182 .026 .035 4.14 2 .13

Logistic Regression Coefficients
Variable B SE Wald Sig. Exp (B)
Depression -.06 .05 1.17 .28 .95
PCCOM -.02 .04 .23 .63 .98
Constant -.59 .38 2.44 .12
.55
Note. PCCOM = Parent-Child Communication
148

Table J5
The Influences of Maternal Depression as Continuous and Parent-Child Communication
on Adolescent Daughters' Engagement in Sex in the Past Three Months (with Control
Variables)
Model Summary
-2 Log likelihood Cox & Snell R
2
Nagelkerke R
2
Chi
2
df p-value
173.005 .057 .077 7.93 8 .44

Logistic Regression Coefficients
Variable B SE Wald Sig. Exp (B)
Depression .05 .04 1.36 .24 1.05
PCCOM -.06 .05 1.42 .23 .94
HIV .54 .41 1.74 .19
1.71
Maternal alcohol .21 .40 .28 .60
1.23
Maternal marijuana -.36 .57 .39 .53 .70
Physical Symptoms

2.33 .51
Physical Symptoms (1) -.86 .58 2.18 .14 .42
Physical Symptoms (2) -.67 .58 1.35 .25 .51
Physical Symptoms (3) -.77 .69 1.25 .26 .46
Constant -.16 .58 .08 .78
.85
Note. PCCOM = Parent-Child Communication
For the physical symptoms variable, the lowest response level served as a reference
category.

149

Table J6
The Influences of Maternal Depression as Continuous and Parent-Child Communication
on Adolescent Daughters' Engagement in Sex in the Past Three Months (without Control
Variables)
Model Summary
-2 Log likelihood Cox & Snell R
2
Nagelkerke R
2
Chi
2
df p-value
204.014 .014 .020 2.30 2 .32

Logistic Regression Coefficients
Variable B SE Wald Sig. Exp (B)
Depression .02 .03 .51 .47 1.02
PCCOM -.06 .05 1.54 .22 .94
Constant -.47 .42 1.24 .27
.62
Note. PCCOM = Parent-Child Communication

150

APPENDIX K: RQ3—LOGISTIC REGRESSION ANALYSES WITH FATHER
INVOLVEMENT AS A MODERATOR

Table K1
Results of Regression Models Testing the Moderating Effects of Father Involvement in the
Relationship between Maternal Depression as Binary and Adolescent Daughters'
Substance Use (without Control Variables)

Alcohol in
Lifetime
Alcohol
30 Days
Marijuana in
Lifetime
Marijuana
30 Days
B OR B OR B OR B OR
Depression -1.17+ .31 -.75 .47 -.42 .66 -.77 .46
FI 1 -1.08+ .34 -.84 .43 -1.23+ .29 -1.19 .30
FI 2 -.94 .39 -2.42* .09 -1.05 .35 -1.81 .16
Depression x FI 1 2.18* 8.84 .84 2.32 2.11* 8.23 2.33* 10.29
Depression x FI 2 1.66+ 5.28 2.88* 17.75 1.34 3.81 1.86 6.40
Note. OR = Odds Ratio; Father involvement 1(FI 1) = Father living away vs. No father
involvement; Father involvement 2(FI 2) = Father in the same house vs. No father
involvement; Reported values are unstandardized betas. Significance levels are indicated
by + (for p < .10) and * (for p < .05).

Table K2
Summary of Father Involvement as a Moderator Variable in the Relationship between
Maternal Depression as Continuous and Adolescent Daughters’ Risk Behavior
Father
Involvement
Moderation Alcohol
in
lifetime
Alcohol
30 days
MJ
in
lifetime
MJ
30
days
Sex
in
lifetime
Sex
3 mos
Away vs.
Not
involved
no covariates +
w/ covariates + +
At home vs.
Not
involved
no covariates (+)
w/ covariates (+) +
Note. + = statistically significant positive relationship, p < .05
(+) = non-significant positive trend, p < .10; MJ = Marijuana
Covariates = HIV-status, alcohol use, marijuana use, & physical symptoms
151

Table K3
Results of Regression Models Testing the Moderating Effects of Father Involvement in the
Relationship between Maternal Depression as Continuous and Adolescent Daughters'
Substance Use (with Control Variables)

Alcohol in
Lifetime
Alcohol
30 Days
Marijuana in
Lifetime
Marijuana
30 Days
B OR B OR B OR B OR
HIV-status .45 1.57 .91* 2.48 .99* 2.68 1.27* 3.55
Maternal alcohol .48 1.62 .47 1.60 -.21 .81 -.33 .72
Maternal MJ .36 1.44 .03 1.04 .06 1.06 .47 1.61
Physical symptoms
PS (1) -.08 .92 .03 1.04 -.16 .86 .05 1.05
PS (2) .39 1.47 -1.05 .35 .01 1.01 -.61 .54
PS (3) -.11 .89 -.83 .43 .36 1.44 -.60 .55
Depression -.15* .86 -.05 .95 -.07 .93 -.06 .95
FI 1 -1.25 .29 -.23 .80 -.90 .41 -1.03 .36
FI 2 -1.18 .31 -1.99+ .14 -.31 .74 -1.05 .35
Depression x FI 1 .18* 1.20 .02 1.02 .13 1.14 .15+ 1.16
Depression x FI 2 .16+ 1.18 .20* 1.22 .05 1.05 .06 1.06
Note. OR = Odds Ratio; Father involvement 1(FI 1) = Father living away vs. No father
involvement; Father involvement 2(FI 2) = Father in the same house vs. No father
involvement; Reported values are unstandardized betas. Significance levels are indicated
by + (for p < .10) and * (for p < .05).

152

Table K4
Results of Regression Models Testing the Moderating Effects of Father Involvement in the
Relationship between Maternal Depression as Continuous and Adolescent Daughters'
Substance Use (without Control Variables)

Alcohol in
Lifetime
Alcohol
30 Days
Marijuana in
Lifetime
Marijuana
30 Days
B OR B OR B OR B OR
Depression -.12* .88 -.07 .93 -.02 .99 -.04 .96
FI 1 -1.38+ .25 -.62 .54 -.88 .42 -1.06 .35
FI 2 -1.12 .33 -2.14* .12 -.29 .75 -1.45 .23
Depression x FI 1 .16* 1.17 .02 1.02 .09 1.09 .12 1.12
Depression x FI 2 .12 1.13 .16+ 1.17 .01 1.01 .07 1.08
Note. OR = Odds Ratio; Father involvement 1(FI 1) = Father living away vs. No father
involvement; Father involvement 2(FI 2) = Father in the same house vs. No father
involvement; Reported values are unstandardized betas. Significance levels are indicated
by + (for p < .10) and * (for p < .05).

153

Table K5
Results of Regression Models Testing the Moderating Effects of Father Involvement in the
Relationship between Maternal Depression as Binary and Adolescent Daughters'
Engagement in Sex (with Control Variables)

Sex in Lifetime Sex in the Past 3 Months
B OR B OR
HIV-status .76+ 2.13 .59 1.81
Maternal alcohol .21 1.23 .36 1.43
Maternal marijuana -.56 .57 -.52 .59
Physical symptoms
Physical symptoms (1) -.45 .64 -.56 .57
Physical symptoms (2) -.68 .51 -.72 .49
Physical symptoms (3) -.52 .60 -.82 .44
Depression .96 2.62 .49 1.64
Father involvement 1 -.84 .43 -.24 .78
Father involvement 2 -1.53* .22 -.74 .48
Depression x FI 1 .14 1.15 .81 2.24
Depression x FI 2 .72 2.06 1.05 2.87
Note. OR = Odds Ratio; Father involvement 1(FI 1) = Father living away vs. No father
involvement; Father involvement 2(FI 2) = Father in the same house vs. No father
involvement; Reported values are unstandardized betas. Significance levels are indicated
by + (for p < .10) and * (for p < .05).

154

Table K6
Results of Regression Models Testing the Moderating Effects of Father Involvement in the
Relationship between Maternal Depression as Binary and Adolescent Daughters'
Engagement in Sex (without Control Variables)
Sex in Lifetime Sex in the Past 3 Months
B OR B OR
Depression .78 2.18 .10 1.11
Father involvement 1 -.92+ .40 -.37 .69
Father involvement 2 -1.61* .20 -.82 .44
Depression x FI 1 .07 1.07 .84 2.33
Depression x FI 2 .38 1.47 .85 2.35
Note. OR = Odds Ratio; Father involvement 1(FI 1) = Father living away vs. No father
involvement; Father involvement 2(FI 2) = Father in the same house vs. No father
involvement; Reported values are unstandardized betas. Significance levels are indicated
by + (for p < .10) and * (for p < .05).

Abstract (if available)

Linked assets

University of Southern California Dissertations and Theses

Conceptually similar

PDF

Factors and correlates of sexual behaviors among young adults from continuation high schools

PDF

The role of depression symptoms on social information processing and tobacco use among adolescents

PDF

Untangling the developmental relations between depression and externalizing behavior among maltreated adolescents

PDF

Parents' attunement: relation to adolescent problem behavior and the moderating role of marital conflict

PDF

Sociocultural stress, coping and substance use among Hispanic/Latino adolescents

PDF

Using observed peer discussions to understand adolescent depressive symptoms and interpersonal interactions

PDF

Cultural risk and protective factors for tobacco use behaviors and depressive symptoms among American Indian adolescents in California

PDF

Evaluating a cultural process model of depression and suicidality in Latino adolescents

PDF

A penta-dimensional longitudinal analysis of the predictors of compulsive internet use among adolescents using linear mixed model (LMM)

PDF

Maltreated adolescents and their families: a longitudinal examination of family functioning, parenting attitudes, & youth mental health

PDF

The impact of family structure and family process on adolescent sexual behavior: race and gender variations

PDF

The Internet activities, gratifications, and health consequences related to compulsive Internet use

PDF

Childhood cancer survivorship: parental factors associated with survivor's follow-up care behavior and mental health

PDF

Social self-control and adolescent substance use

PDF

A closer look at intention to use condoms and risky sexual behaviors among homeless people: application of the theories of reasoned action and planned behavior

PDF

Neighborhood context and adolescent mental health: development and mechanisms

PDF

Parenting practices among non-offending mothers of sexually abused girls and its impact on the abused girls' behavioral adjustment: perspectives from a multigenerational, longitudinal study

PDF

Family aggression, prosocial friends, and the risk of dating and friend victimization in late adolescence

PDF

Childhood adversity across generations and its impact on externalizing behavior

PDF

Individual, family, and peer influences on substance use, delinquency, and problem behaviors among at-risk Asian American and Pacific Islander adolescents

Asset Metadata

Creator Sang, Jina (author)

Core Title The link between maternal depression and adolescent daughters' risk behavior: the mediating and moderating role of family

School School of Social Work

Degree Doctor of Philosophy

Degree Program Social Work

Publication Date 07/25/2012

Defense Date 12/08/2011

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag adolescent risk behavior,adolescent sex,adolescent substance use,family systems theory,father involvement,maternal depression,OAI-PMH Harvest,parental depression,parental monitoring,parent-child communication

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Hurlburt, Michael S. (committee chair), Cederbaum, Julie A. (committee member), Huey, Stanley J., Jr. (committee member)

Creator Email jinasang@usc.edu,ttccjina@gmail.com

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c3-63568

Unique identifier UC11289513

Identifier usctheses-c3-63568 (legacy record id)

Legacy Identifier etd-SangJina-982.pdf

Dmrecord 63568

Document Type Dissertation

Rights Sang, Jina

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the a...

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus MC 2810, 3434 South Grand Avenue, 2nd Floor, Los Angeles, California 90089-2810, USA