Moderators and Mediators of the Relationship between Parental Depression and Children's Emotion Dysregulation: A Systematic Review

Ahmad Sabalbal¹Samer El Hayek²Evelyne Baroud^1,3*Wael Shamseddeen^1,3

• ¹American University of Beirut, Beirut, Beirut, Lebanon
• ²American Center of Psychiatry and Neurology, Dubai, United Arab Emirates
• ³Faculty of Medicine, American University of Beirut, Beirut, Lebanon

Background:Parental depression is an important risk factor for the development of psychopathology in children/adolescents.Many children who suffer from psychopathology also experience Emotion Dysregulation,which is characterized by an inability to modulate the intensity and quality of emotions.Emotion dysregulation carries high morbidity and predicts ongoing mood/behavior problems.To develop more effective intervention and prevention programs,it's important to understand the variables mediating and moderating the relationship between parental depression and children' emotion dysregulation.This study aimed to systematically explore those possible mediators and moderators.Methods: PubMed,Scopus,PsycINFO, and Embase databases were systematically searched from day of inception until January 12,2024.Reference lists of reviews of interest identified during the screening were included.Two authors screened/collected articles through title and abstract screening followed by full-text screening. Results were qualitatively synthesized.Inclusion criteria were:Population:children/adolescents(ages 0-17 years);Exposure:parental depression;Outcome:emotion dysregulation;Study design:quantitative.Results:1,731 studies were identified,of which 556 were potentially eligible.After removing duplicates/retracted articles,380 records were screened (title/abstract) following which 315 records were excluded.Of the remaining 65 studies,8 met the inclusion criteria after full-text screening.Most studies(n=6)included mothers.Biological variables,variables related to the child,to parental depression severity,and to the child-parent interaction emerged.Biological variables(child's genotype,left parietal alpha asymmetry) highlight a biological vulnerability to dysregulation beyond parent-child effects and environmental factors:Left parietal alpha asymmetry was a partial mediator;genotype was a moderator as children carriers of the S/LG genotypes experienced higher levels of dysregulation as a function of exposure to higher levels of prenatal maternal depression.Depression severity and parent-child dyadic variability were moderators,as elevated levels of dysregulation among girls were predicted by greater maternal depression severity;and mothers who were more inconsistent in parenting behaviors were more likely to have toddlers with dysregulation,especially if mothers were depressed.Diet was a mediator,more severely depressed mothers were more likely to feed their children unhealthy diets,which in turn led to greater dysregulation in later years.Parenting stress mediated the relationship between maternal depression and dysregulation in toddlers.Children of depressed parents are a vulnerable group,prone to develop emotion dysregulation.Findings suggest that prevention/intervention programs should target children of more severely depressed parents as well as those of parents who engage in more negative interactions with them.Results also indicate that children's diet and parenting stress are potential evidence-based,modifiable intervention targets.