In this large prospective community-based study, we investigated patterns of

In this large prospective community-based study, we investigated patterns of associations among pre- and postnatal maternal depression, somatic anxiety, and child verbal and nonverbal intellectual abilities at 49 months, as well as language development assessed by standardized direct measures and parents’ reports from 15 to 61 months. We also examined whether the availability of children’s books at home and the frequency of parent-child shared storybook reading moderated the adverse associations between maternal depression and child language skills. The present study is one of only a few to examine maternal depression and anxiety measured at multiple time points pre- and postnatally to track longitudinally potential negative associations with child cognitive and language development (Comaskey et al., 2017; Lin et al., 2017). We found that maternal mental health difficulties negatively impacted child cognitive and language development and that this association was more robust for prenatal exposure compared to post-natal exposure. These results are consistent with a fetal programming hypothesis that postulates that when a particular insult occurs during any sensitive period of in-utero development, it may harm the development of the fetus (e.g., Barker et al., 2013; Glover, 2014). As such, the present results add to the limited evidence from empirical studies showing a stronger negative association among prenatal maternal depression or anxiety and child cognitive and language development than does postnatal mental health difficulties (Comaskey et al., 2017; Lin et al., 2017). In line with the above findings, our modeling of the impact factor scores revealed that prenatal depression, particularly depression at 32-week gestation, had the highest negative impact on child language development across time. In contrast, the negative impact of postnatal depression timepoints differed depending on the child’s age. These results suggest that while the adverse impact of prenatal depression on a child’s language is consistent, the impact of postnatal depression may differ as a function of a child’s sensitivity to language exposure across time. Our results revealed a more robust negative association between maternal depression and child outcomes than was found for somatic anxiety. The current findings showed that the unique contribution of prenatal depression always remained statistically significant beyond the effects of maternal anxiety. In contrast, the negative association between prenatal somatic anxiety and child language skills disappeared after controlling for maternal depression. Moreover, prenatal maternal depression had an independent association to child verbal and performance IQ, whereas prenatal somatic anxiety showed no association with either skill. These findings are in accord with those of previous studies reporting a separate and robust negative association between maternal depression and child language skills (e.g., Brookman et al., 2020a) and other outcomes (e.g., Babineau et al., 2022; Field et al., 2010). Although we found a robust negative association among prenatal depression, child intellectual abilities, and language development assessed with norm-reference standardized measures, only postnatal depression, not prenatal depression, was associated negatively with parent reports of their child vocabulary knowledge. There are at least three possible explanations for this discrepancy in patterns of associations between pre- and postnatal depression and children’s language development. First, the RDLS, a direct measure of children’s language skills, may tap different aspects of language skills beyond vocabulary knowledge. The RDLS measures advanced language skills such as comprehending simple and complex sentences, grammatical inflections, and knowledge of pronouns and inferencing. Therefore, it is possible that maternal depression during the sensitive period of in-utero development may affect language abilities that require higher levels of linguistic processing. This possibility is supported by our current finding that only prenatal, not postnatal, maternal depression was associated negatively with a child’s intellectual ability, a task that requires a high level of cognitive processing. A second possible explanation is that postnatally depressed mothers model language less for their children due to limited interactions and/or insufficient conversations with their children (Brookman et al., 2020b, Lam-Cassettari et al., 2020; Sohr-Preston & Scaramella 2006). Third and final, mothers who have mental health difficulties may underestimate their child’s linguistic knowledge, even though there were significant positive correlations between mother reports of child vocabulary and direct measures of children’s language skills. At the very least, the latter suggests that, in general, parents were good reporters of their child’s skills. The sex-specific analyses revealed that girls of prenatally depressed mothers were at greater risk for adverse language outcomes than boys of depressed mothers. These results, once replicated, will extend to language development previous findings showing an increased vulnerability of female fetuses to prenatal depression and cortisol concentrations, which has been associated with affective problems (Buss et al., 2012), anxiety (Sandman et al., 2013), and depression in girls (Quarini et al., 2016). Concerning parent-child reading activities, our findings revealed a robust and positive association between the frequency with which children are read to and child language development and vocabulary knowledge from 24 to 61 months, even after controlling for child language skills at 15 months, and other covariates. These findings are in line with other empirical studies on the benefits of early child exposure to books, their language development, and a range of other outcomes (e.g., Sénéchal, 2017; Sénéchal & Lefevre, 2014). Despite the positive association between frequently shared reading and child language, our findings also revealed that the frequency with which children were read was significantly and negatively affected by mothers’ depression. These results highlight the importance of the quality of care provided by mothers to their children and support findings from other studies showing that parents’ responsivity and early cognitive stimulation influence children’s early language development above and beyond social disadvantages (Brookman et al., 2023, 2020a, 2020b; Law et al., 2019). The results also align with a social-interaction theoretical framework, indicating that language develops through caregiver-mediated interactions (Bruner, 1983). Depressed mothers’ emotional challenges may reduce their motivation to engage in interactive activities, such as shared book reading, and consequently, may limit their children’s exposure to rich linguistic interactions. Given the above, the most promising finding in the present study was that mother reports of the frequency of reading and the availability of storybooks at home significantly moderated the association between maternal depression and their child’s language skills. Our results, notably, suggest that when children of depressed mothers are not read to frequently, they may show reduced language skills. These findings also suggest the need for future intervention research to assess whether children’s early parent-child shared book reading as well as the availability of children’s books at home protect against or, at least, attenuate the negative association between maternal depression and child language development. There are limitations to this study that should be considered. First, the sample largely included a white population, which limits the generalizability of the findings to other ethnicities. Second, we did not consider the use of antidepressant medication during pregnancy. Previous studies have shown that antidepressant medication use during pregnancy may accelerate an infant’s speech perception trajectories (Weikum et al., 2012). However, this may not have an extreme impact on our findings because antidepressants were not routinely prescribed “de novo” to pregnant women in the United Kingdom in 1991-1992. Third, although we controlled for children’s early language skills in our analyses, we did not account for genetic influences on how children might experience maternal mental health differently and/or affect parent-child reading activities (Harlaar et al., 2014). Fourth, the obtained findings, albeit important, are modest in size. Another limitation of the present study is that we did not measure the quality of shared reading, even though our results revealed that mother reports of shared storybook reading frequencies were associated positively and robustly with child language skills. The interactions between children and parents during storybook reading sessions can enhance child learning (Sénéchal, 2017). Future research should explore additional mother-child activities that provide early cognitive stimulation. In addition, research is needed to assess whether the involvement of other care providers, like fathers, grandparents, or older siblings would also attenuate the negative association between poor maternal mental health and child language acquisition. Nonetheless, our findings underscore the significance of father characteristics, such as education, in children’s cognitive and language development. The present study primarily examined the impact of traditional shared book reading; however, technological devices are now frequently used by both parents and children. Assessing the impact of technology on parent-child interactions in general and during shared reading, in particular, are needed. Consequently, future research should consider technology use as a variable to understand its potential impact on the frequency and nature of parent-child shared reading, as well as on children’s cognitive and language development. The current study also has several strengths. First, the large prospective population-based sample of mothers and children allowed for robust assessments of risk and protective factors affecting children’s cognitive and language development. Second, the inclusion of maternal depression and anxiety scores measured in multiple time points pre- and postnatally allowed the assessment of time-specific as well as cumulative patterns of associations. This is particularly important given that the timing of prenatal insults on fetal neurodevelopment is critical. Third, the inclusion of depression and anxiety measures allowed us to account for the common comorbidity between maternal depression and anxiety, which is prevalent during and after pregnancy (Farr et al., 2014; Pollack, 2005). Fourth, the inclusion of longitudinal measures of child outcomes allowed for the description of patterns of associations between maternal mental health and children’s cognitive and language trajectories. Fifth, the inclusion of standardized measures of children’s cognitive and language development allowed us to corroborate with objective measures findings rather than relying only on parent reports. Sixth and final, even though the data were collected 30 years ago, the present findings describing specific patterns of negative associations between maternal pre- and postnatal mental health and children’s cognitive ability and language development are relevant today, given that the prevalence of maternal depression is rising (Pearson et al., 2018). Future studies are needed to replicate our findings using an alternative anxiety scale instead of limiting measurement to the somatic anxiety subscale of CCEI. Although somatic anxiety of CCEI has been shown to load with prenatal maternal affective symptoms (Szekely et al., 2021), it may still overlap with common symptoms during pregnancy. Future research could assess whether our findings, obtained from a community sample of mothers, replicate in samples of mothers who are clinically diagnosed with depression and anxiety. Moreover, the stigma against pre- and postnatal depression was probably stronger 30 years ago, which might have resulted in mothers’ underreporting mental health difficulties. As such, the strength of the negative associations between maternal mental health and child outcomes found in the present study might have been underestimated. In conclusion, the findings of this study showed a robust adverse association between maternal mental health, particularly prenatal depression, a child’s early intellectual abilities, and language development. Moreover, the findings suggest that screening for maternal depression should occur prenatally in addition to the postnatal period. Importantly, interventions aimed at preventing the deleterious impact of maternal depression on child development should also target prenatal depressive symptoms. The novel and promising results regarding the moderating and positive associations between child outcomes and their early experiences at home with shared reading and books highlight a potential protective activity that, once confirmed with intervention research, may reduce the adverse effects of maternal mental health difficulties on child language development. As such, these findings have the potential to offer informed models of risk and resilience in the face of maternal psychopathology and lead to clinical recommendations, as well as have implications for prevention and intervention programs. What is this article for? The article is introduced professionally (by author, title, date of publication, journal in which the article appears, volume of journal, page numbers) and the type of the article is stated (e.g., research report, theoretical analysis) and the rationale for selecting the article is stated. The contents of the article are clearly and precisely introduced (purpose and type of research, participants, data collected/analyzed/discussed, place where the research was conducted, research findings) and main points, findings or arguments are summarized and implications for teaching and further research are drawn. 2 Critique is thorough and clearly articulated in relation to the contents of the article, and arguments relate closely to the content and arguments are justified. Reflection includes experiences relating to the content of the article to arguments in the critique, and class content. Practical examples are provided for clarification

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