Paternal versus maternal depressive symptoms and child internalizing/externalizing problems: a comparative threshold...

Parental depression is a well-established risk factor for child psychopathology, yet most studies focus on mothers. Whether nonlinear patterns with thresholds exist, especially for fathers, remains unclear. This study examines these associations and identified optimal thresholds comparing mothers and fathers.

This cross-sectional study included 21,366 parents (16,258 mothers and 5108 fathers) of children aged 3-6 years in western China. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CESD). Child internalizing and externalizing problems were measured with the Strengths and Difficulties Questionnaire (SDQ). Piecewise logistic regression with grid search identified thresholds, adjusting for demographic and socioeconomic covariates.

Higher CES-D scores were associated with increased odds of child problems (all P < 0.001). The gender by CES-D interaction was significant for externalizing problems (P = 0.019), indicating a stronger association in fathers. For internalizing problems, the optimal threshold was a CES-D score of 17 for both mothers and fathers. For externalizing problems, the threshold was lower in fathers (16) than in mothers (21). Below these thresholds, each one-point increase in CES-D score was associated with 10-16% higher odds of child problems. Above the thresholds, the associations were attenuated. Piecewise models fitted significantly better than linear models (all P < 0.001).

Fathers' depressive symptoms were associated with child externalizing problems at a lower severity level compared with mothers, suggesting that screening for paternal depression even at subclinical levels may help identify families at elevated risk. The identified thresholds may help generate hypotheses for future longitudinal and clinical validation studies.