This study of low-income mothers of 4- to 8-year-old children found that mothers reporting elevated depressive symptoms exhibited different child feeding practices than those with lower levels of depressive symptoms: they self-reported more pressure to eat and demandingness; were more likely to express low authority in child feeding during a semi-structured narrative interview; and at home, were more likely to have the television audible during meals and less likely to eat meals with their children. Findings were independent of potential confounders, including: child sex, food fussiness, number of older siblings; and maternal age, BMI, education, race/ethnicity, single parent status, perceived child weight, and concern about child weight.
Collectively, our findings suggest a less contingently responsive feeding style in mothers with elevated depressive symptoms. Contingent responsive feeding involves reciprocity between caregiver and child, where the caregiver provides appropriate guidance while recognizing child hunger and satiety cues . In our study, some feeding practices associated with maternal depressive symptoms appeared controlling (more pressure to eat and demandingness), while others could be characterized as indulgent (lower authority narratives about feeding) or uninvolved (television audible during meals, mother not eating with child). Controlling, indulgent, and uninvolved feeding styles represent a lack of reciprocity between mother and child, and can be described as nonresponsive [45, 46]. Nonresponsive feeding practices may increase risk for child overweight/obesity [12, 47].
Our study expands on prior work by using multiple methods to assess maternal feeding practices, and we found the association between maternal depressive symptoms and feeding to be inconsistent across methodologies. Mothers with elevated depressive symptoms self-reported more pressure and demandingness, yet appeared lower authority in narrative interviews about child feeding and less engaged during home meal observations. Questionnaire, narrative interview, and video observation methods each have unique strengths and weaknesses. While our findings do not identify the ideal methodology for characterizing maternal feeding, they raise questions regarding the validity of relying on a single methodology for data collection.
Using self-report questionnaires, we found that mothers with elevated depressive symptoms reported more pressuring of their children to eat, while there was no association with restriction. These findings are consistent with other reports in the literature, which suggest that maternal depressive symptoms may be associated with pressuring children to eat , but are not associated with restrictive feeding practices [9, 13–16]. Most studies have examined white and/or middle-class populations [9, 10, 13–15, 22, 23]. There have been only two self-report studies in populations comparable to our sample, and one was restricted to infants less than 13 months old . The study most similar to ours reported differing results: It included 401 low-income mothers and their 5-year-old children, and found no association of maternal depressive symptoms with pressure to eat and an inverse association with restriction . Given evidence that maternal feeding practices differ based on race/ethnicity [29, 31], more research needs to be done in diverse populations to clarify the association of maternal depressive symptoms with pressuring and restrictive feeding practices.
Examining maternal feeding practices via alternative, non-questionnaire methods can help us better understand associations between maternal depressive symptoms and feeding. To our knowledge, there are no other published studies using interviews or videotaped home meal observations to examine these associations. We found that mothers with elevated depressive symptoms expressed lower authority in child feeding during a semi-structured narrative interview. During home mealtimes, elevated maternal depressive symptoms were positively associated with the television being audible and inversely associated with the mother eating with her child, suggesting a less engaged feeding style. These novel finding should be explored further.
Our study found that elevated maternal depressive symptoms were not associated with encouragement or discouragement of eating during interactions around food in the laboratory. Two prior studies observed standardized laboratory eating interactions to examine similar associations, and only one included low-income and minority mothers and children. This multi-site study of 1218 mother-child pairs in the United States found that maternal depressive symptoms were not associated with prompting feeding behaviors at child ages 15, 24, or 36 months . In contrast, the other study examined a British sample of 58 mothers of 3- to 4-year-old children and found an association between maternal depressive symptoms and pressure to eat, use of incentives, and maternal vocalizations about food during the observed meal . While evidence is limited, our findings support those of the first study, suggesting that self-report of controlling feeding practices may not be consistent with videotaped observations in mothers with depressive symptoms, as has previously been observed in non-depressed mothers [20, 21].
We hypothesize several behavioral mechanisms to explain the feeding practices associated with elevated maternal depressive symptoms in our study. The association between depressive symptoms and self-report of controlling feeding practices, in contrast to interview and video observation findings, may be due to the preferential recall of negative events that has been well-described in depression . Mothers with depressive symptoms may have enhanced recall of difficult feeding interactions eliciting more controlling feeding behaviors, as compared to mothers without depressive symptoms. The association between low parenting self-efficacy and depression [49, 50] may contribute to descriptions of lower authority feeding styles among mothers with depressive symptoms. If mothers with depressive symptoms perceive themselves as less competent parents, they may be less likely to establish rules and expectations around child feeding because they do not anticipate that such measures will be effective. Findings of a less engaged feeding style among mothers with depressive symptoms during home meal observations may simply reflect the core symptoms of depression, including low energy and diminished pleasure in activities . Depression can influence behavior in many ways, and it is important for clinicians to consider this when interacting with parents who may appear to be engaging in suboptimal feeding practices.
Our results should be interpreted in light of both our study’s strengths and limitations. The greatest strength of our study is that we characterized feeding in a detailed, multi-method manner, which allowed us to examine how associations between maternal depressive symptoms and maternal feeding practices vary depending on how feeding is measured. We also examined a more diverse, lower socioeconomic status population than most prior studies. Our study was limited in its cross-sectional design, which did not allow for assessment of temporality of associations. While we did control for many possible confounders in our analysis, it is possible that there were additional confounders for which we did not account. Finally, our results may not be generalizable to populations outside of low-income families in Southeastern Michigan.