Trajectories of Maternal Depressive Symptoms Following ASD Diagnosis

Background: Given the numerous challenges and demands involved in raising a child with ASD, mothers of these children are at an increased risk for elevated levels of depressive symptoms (Estes et al., 2009; Montes & Halterman, 2007). Such symptoms are concerning, as they are detrimental to mothers' long-term health (Vos et al., 2012) and are a robust correlate of children’s maladjustment (Goodman et al., 2011). In addition, children with ASD may be particularly vulnerable to maternal depression because they require more sensitive and supportive parenting, which might be compromised in mothers with depression. Thus, understanding maternal depressive symptoms and their predictors following ASD diagnosis is highly important. Several studies have highlighted heterogeneity in the way individuals respond to stressful experiences, such that some people experience ongoing, high levels of distress; some experience distress that gradually declines; and others experience little or no distress (e.g., Bonanno et al., 2012). Yet, there is lack of knowledge about longitudinal trajectories of depressive symptoms among mothers of children with ASD.

Objectives: The purpose of this study was two-fold: 1) to investigate longitudinal depressive symptom trajectories among mothers following children's ASD diagnosis, using Latent Growth Mixture Modelling (LGMM); and 2) to examine correlates of depressive symptom trajectories, including children's autism symptom severity, behavior problems, and mothers' coping resources.

Methods: Data were drawn from the Canadian Pathways in ASD study and included 247 children with ASD and their mothers. Mothers' depressive symptoms were assessed at four time points between ASD diagnosis (T1; children’s mean age was 39.02 months, SD=8.7) and when the children were between 7 and 8 years old (T4).

Measures: Maternal depressive symptoms were assessed with the Symptom Checklist-90-R (Derogatis, 1994). To assess coping resources, we used the Ways of Coping Scales (Folkman & Lazarus, 1988) and the Social Support Survey (NLSCY, 2008-2009). Children's behavior problems were measured with the Child Behavior Checklist (Achenbach & Rescorla, 2001). In addition, to assess autism symptom severity, we used the Social Responsiveness Scale (SRS; Constantino & Gruber, 2005) and the severity metric of the Autism Diagnosis Observation Schedules (ADOS; Lord et al., 2000).

Analysis: LGMM was employed to examine trajectories of depressive symptoms using LatentGold software. Predictors of membership of the identified trajectories (classes) were examined using a multinomial logit model.

Results: LGMM identified four discrete latent trajectory classes of depressive symptoms, including: No impact (no depressive symptoms across time; 33%), Minimal impact (low depressive symptoms across time; 36%), Moderate - Improved (medium depressive symptoms that decreased slightly across time, 25%), and High - Worsen (high symptoms that increased over time; 6%). Overall, trajectories were mostly stable across time (see Figure 1). Children's externalizing behavior, mothers' social support, and mothers’ utilization of coping strategies predicted membership in depressive symptom trajectories. Autism symptom severity and internalizing behavior problems were not significant predictors.

Conclusions: Trajectories of depression symptoms are heterogeneous and are relatively stable in mothers of children with ASD. Findings emphasize the importance of screening for mothers' well-being, making coping resources available, and early treatment addressing children's behavior problems.