children raised by grandparents are also complicated by the often stressful circumstances that lead to that caregiving arrangement, such as father absence, maternal drug use or incarceration, high stress and low levels of support, exposure to trauma, and neglect (Gregory, Smith, and Palmieri, 2007). Given these added complications and the scarcity of the literature, we chose to not comprehensively review depression in grandparents who are primary caregivers. However, given the increasing frequency of such family arrangements, this lack of studies represents a critical research gap.

One concern raised about this literature is that often the mother is the reporter on both her own depression and the child outcome (Kraemer et al., 2003). This has particularly raised questions given that one might suspect that depression may negatively bias the mother’s perceptions. We took note of Richters’s helpful writing on concerns about depression influencing mothers’ reports on their children (Richters, 1992). Our review shows that researchers with well-designed studies to address this question continue to find small to moderate support for an association between higher levels of maternal depression and mother’s tendency to overreport child behavior problems, relative to a latent criterion variable (Boyle and Pickles, 1997; Fergusson, Lynskey, and Horwood, 1993). There remain important unresolved questions about how to interpret this association. Thus in our review we noted when researchers included additional sources of data, at least for the child outcome, which was more common than not.

Finally, another limitation of the research is that very few studies were designed to test transactional processes. In particular, little is known about the role of having a child with psychological problems on a parent’s depression, although there is more literature on the role of children’s physical health problems as a causal or exacerbating factor in parents’ depression, on which we touch. Children with emotional, behavioral, or physical health problems may contribute to the causes of depression in parents or may exacerbate or help to maintain it once the parent’s depression has emerged.

Physical Health and Health Care Utilization Consequences

The health-related outcomes for children when a parent is depressed have been studied in several key areas. First, studies describe the health of the neonate when the mother experiences mental health issues. Second, studies examine how the children of mothers with depressive symptoms have different patterns of physical illness and health care utilization. Third, studies have investigated the role of maternal depression when the child has a chronic health condition. Fourth, investigations explore how the presence of parental depression is linked to a home environment that presents more health risks to the child. Finally, a few studies report on the occurrence of adolescent health risk behaviors when their depressed parents exhibit health



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