women, Mapp (2006) found that the only route from experiencing maternal childhood sexual abuse to increased risk for committing child physical abuse, as quantified by the Parenting Stress Index, was through elevated maternal depression symptom levels as defined by a score of 16 or more on the Center for Epidemiologic Studies Depression Scale (CESD). In a sample of 107 sexually abused and 156 control first-time mothers recruited prenatally and followed up when their children were between 2 and 4 years of age, Schuetze and Eiden (2005) found that maternal depression (CESD ≥ 16) was significantly associated with harsh, punitive parenting when the mother was also experiencing domestic violence. They concluded that the relationship between maternal childhood sexual abuse and adverse parenting was indirect and was mediated by maternal depression and domestic violence.

Comparing CAP scores in physically abused adolescent and adult mothers, de Paúl and Domenech (2000) found a significant interaction between young maternal age, a history of severe physical abuse, and maternal depression that predicted significant risk for child maltreatment measured with the CAP. Using a structured clinical interview, Cohen, Hien, and Batchelder (2008) compared mothers diagnosed as substance abusing (n = 41), depressed (n = 40), and both depressed and substance abusing (n = 47) with control mothers (n = 48) and found that the combination of substance abuse and depression was significantly related to elevated CAP scores as well as to several other measures of aversive parenting. Banyard, Williams, and Siegel (2003), however, found that maternal depression was related only to poor parenting satisfaction but not to other measures of parenting dysfunction or to the actual incidence of child protection intervention in a sample of 174 low-income predominantly African American women, half of whom had documented histories of child sexual abuse. That finding may be explained by their use of a nonstandard measure of depression, a subscale of the Trauma Symptom Checklist, which may account for the lack of effect.

Research thus indicates that maternal depression increases risk for child maltreatment when it occurs in some combination with other factors, such as a maternal history of maltreatment, maternal substance abuse, or domestic violence.

Mediators and Moderators of Associations Between Depression and Parenting

Given the strong and consistent evidence linking depression and parenting, it is important to ask what factors might mediate the relations between parental depressive symptoms and parenting behaviors. For example, as part of a larger study of parents of children with attention deficit hyperac-



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