Intergenerational Effect of Maternal Childhood Maltreatment on Next Generation’s Vulnerability to Psychopathology: A Systematic Review With Meta-Analysis

Abstract

Many studies have identified the multiple negative consequences of childhood maltreatment on subsequent mental health. However, research on the intergenerational effect of maternal childhood maltreatment has not been systematically synthesized. This meta-analysis aimed to provide a quantitative estimate of the intergenerational effect of maternal childhood maltreatment on their offspring’s psychopathology. Electronic databases and gray literature were searched for English-language prospective cohort studies. Two reviewers independently extracted data and assessed study quality with the Newcastle-Ottawa Scale. This review only included those studies with (1) maternal childhood maltreatment occurring prior to 18 years of age, (2) using a clear and reliable assessment for maltreatment exposure and offspring’s mental health problems prior to age 18. Random-effect models were used to calculate the pooled effect size of maternal childhood maltreatment on offspring’s psychopathology, and meta-regression was used to explore potential confounders. Twelve studies met eligibility criteria. Significant heterogeneity was found across selected studies. Maternal childhood maltreatment was found to have a small but significant effect on the offspring’s depression and internalizing behaviors (r = .14, 95% confidence interval [.09, .19]). Two moderators were found, maternal depression and ethnicity. Maternal depression reduced the effect size of maternal maltreatment on offspring’s depression and internalizing disorders. The offspring of non-Caucasian mothers who had a history of childhood maltreatment faced a higher risk of mental health problems. There was no evidence of publication bias. This review provides robust evidence to reinforce the need for policies to reduce its occurrence, as it can influence not just one but two or possibly more generations.

Keywords

childhood maltreatment psychopathology intergenerational transmission prospective cohort study meta-analysis

Childhood maltreatment significantly increases the risk of subsequent psychiatric disorders, including depression (Li et al., 2016; Widom et al., 2007), anxiety (Nanda et al., 2016), alcohol misuse (Elliott et al., 2014), and emotional and behavioral functioning difficulties (Choi et al., 2019). The World Mental Health Surveys compared data on childhood maltreatment and psychiatric problems in 21 countries and confirmed this association existed across all sociocultural samples (Kessler et al., 2010). The economic and societal implications of both maltreatment and severe psychiatric disorders are considerable (Gilbert et al., 2009; Vigo et al., 2016). The World Health Organization (WHO) report showed that 12% of the global burden of diseases was attributable to mental disorders, and that estimate is expected to reach 15% by 2020 (WHO, 2001). The cumulative economic loss associated with mental disorders is projected to be US$16.3 trillion worldwide between 2011 and 2030, making the economic loss related to mental disorders higher than that of cancer, chronic respiratory diseases, and diabetes (Trautmann et al., 2016). The long-term socioeconomic effects of childhood maltreatment in later-on life may be due to the occurrence of mental disorders (Barrett et al., 2014). Those with childhood maltreatment reported lower family incomes and reduced labor force participation (A. Goodman et al., 2011; Stith et al., 2009).

Recent studies of childhood maltreatment have suggested that the deleterious sequela of childhood maltreatment may be transmitted from one generation to the next (Buss et al., 2017). A strong link has been documented between a maternal history of childhood maltreatment and mental health problems in offspring, including depression, anxiety, autism, suicide attempts, and poorer behavioral trajectories across the time (Brent et al., 2004; Brodsky et al., 2008; Collishaw et al., 2007; Plant et al., 2013; Roberts et al., 2013). The offspring of victimized mothers, even without suffering any childhood maltreatment themselves, may experience an increased risk of psychiatric disorders (Plant et al., 2013; Rijlaarsdam et al., 2014). Noteworthy, the association between a history of maternal maltreatment and offspring’s mental disorders appears to be particularly pronounced when mothers suffered the abuse during their childhood compared to the later stage of their lives (Thompson, 2007).

Several theoretical frameworks have been proposed to explain the intergenerational transmission of maternal childhood maltreatment to their children’s mental illness. One theory explores how the environmental effect of maternal childhood maltreatment could potentially influence the normal development of offspring. Caregiving patterns are the putative mediating mechanism that has been postulated to explain the link (Collishaw et al., 2007; Plant et al., 2015). Mothers, who had a history of maltreatment, are less likely to provide adequate opportunities to observe healthy caregiving behaviors, leading to intrusiveness, hostility toward children, increased use of harsh and intensive discipline and rejection, decreased sensitivity to children’s need, and decreased mother–children involvement (Bert et al., 2009; Bosquet Enlow et al., 2018; Lomanowska et al., 2017). These negative environmental factors could influence normal fetal programming to produce a less emotionally labile offspring temperament, which may increase the offspring’s vulnerability of being maltreated, thus increasing the risk for mental illness (Madigan et al., 2019; Pariante, 2014). From an environmental perspective, disadvantaged caregiving, inability to protect children, and aggregated domestic risks may directly put children at higher risk of mental illness (Plant et al., 2015). Epigenetic vulnerability is also theorized as an explanation of the intergenerational transmission of vulnerability to psychopathology. In animal studies, maternal care (grooming) was found to alter the expression of genes that govern behavior and stress responses (Meaney, 2001). Maternal care has also been shown to affect the subsequent maternal care exhibited by offspring (Meaney, 2001). More recently, in mice studies, Dias and Ressler (2014) demonstrated how a behaviorally induced trauma experience was inherited biologically through the offspring’s parental gametes. They observed changes in Ribonucleic Acid (RNA) being passed down through sperm so that the offspring mice inherited what was initially a behavioral trauma fear through their fathers. Subsequent studies showed that with extinction-based behavioral strategies, this fear could be reversed both behaviorally and biologically in offspring and in the parental germ line (Aoued et al., 2019). In human studies, an interdisciplinary framework proposed by Buss and colleagues (2017) suggested that the primary model of intergenerational transmission is biological. Genetic predispositions of the corticotropin-releasing hormone receptor 1 gene and FK506 binding protein 5 DNA demethylation have been found to render children to be more vulnerable to negative consequences of maternal maltreatment when these genes were passed onto offspring (Buss et al., 2017; Heim et al., 2009; Klengel et al., 2013). Therefore, adverse environmental factors might have more than one pathway linking maternal childhood maltreatment and offspring’s mental health.

Given the importance of childhood maltreatment in the development of psychiatric disorders and the possible link between maternal childhood maltreatment and offspring’s psychopathology, it is important to understand to what extent maternal childhood maltreatment may impact their children’s psychopathology (Miranda et al., 2013; Plant et al., 2017). Even though the knowledge about the role of intergenerational transmission effect of maternal childhood maltreatment on offspring’s mental health is increasing (Collishaw et al., 2007), few intergenerational studies have been conducted to explore the consequences of maternal maltreatment on the offspring’s physical and mental health outcomes. We were not aware of any systematic review being conducted to summarize the impact of maternal childhood maltreatment on offspring’s psychopathology. There is one narrative review conducted by Plant et al. (2018) covering the literature to October 2015 that reported an association of maternal childhood maltreatment with the risk of next generation’s psychological well-being; in addition to not being a systematic review, the review was not specific to studies on depression/internalizing disorders—common adolescent psychiatric disorders. The epidemiological evidence provided in the review did not provide a basis for a firm conclusion on the intergenerational effect of maternal childhood maltreatment.

This present systematic review and meta-analysis aimed to (1) quantitatively synthesize the intergenerational effect of maternal childhood maltreatment on offspring’s psychopathology and (2) improve inferences about the temporal order (cause) and reduce selection bias. The current review only included prospective studies thus dealing with the issue of temporal order. A pooled effect size was calculated to indicate the magnitude and overall strength of the association. We also examined a range of covariates, factors potentially moderating the relationship between maternal childhood maltreatment and offspring’s psychopathology.

Method

This systematic review and meta-analysis are guided by the meta-analysis of observational studies in epidemiology (MOOSE) checklists. MOOSE is an evidence-based tool consisting of a checklist of 35 items, which is designed to respond to the issue of increasing diversity and variability of meta-analyses of observational studies by standardizing a reporting checklist, thus improving the usefulness of research (Stroup et al., 2000; see Online Appendix A). The MOOSE checklist is one of several guidelines that are part of a larger initiative to improve the reliability and value of published research by using standardized guidelines to promote accurate and transparent reporting of research (see https://www.equator-network.org).

Search Strategy and Inclusion Criteria

Eligible studies were identified by computerized and manual searches. Five bibliographic databases were searched: MEDLINE, PubMed, Web of Science, Embase, and Cochrane Library. The literature search comprised articles published between January 1980 and January 2019. The detailed search strategies for each database are fully described in Online Appendix B. The “published after 1980” criterion was used because the first research on the impact of childhood adversity on mental health was published during the 1980s. Figure 1 presents a flowchart of the literature search and screening based on the preferred reporting items for systematic reviews and meta-analyses checklist (Moher et al., 2009).

Figure 1.

A summary of the literature search in this systematic review.

The inclusion criteria were if the study (1) used a prospective cohort study design; (2) assessed maternal childhood maltreatment exposure prior to the age of 18 with clear information defining the abuse as physical, sexual, or emotional abuse; physical or emotional neglect; and exposure to domestic violence; (3) had a measure on either depression or internalizing behaviors (which comprise anxious/depressed, withdrawn-depressed, and somatic complaints) among offspring prior to the age of 18; (4) used generally accepted diagnostic criteria for the presence of depression and internalizing behaviors; and (5) was published in English. The exclusion criteria were if the study (1) only included relatively common punishments (e.g., spanking or yelling), which may or may not be considered as maltreatment exposures due to cultural variability, and (2) did not provide sufficient information to extract necessary data to calculate the results on any type of childhood maltreatment and the mental health outcomes.

Data Extraction and Quality Assessment

Two reviewers (YS and XM) independently assessed articles to analyze eligible titles, abstracts, and full-text articles, with differences resolved by group discussions. A standardized data extraction sheet was used to collect data from eligible studies. The following study characteristics were extracted from those selected studies: authors(s); year of publication; age of offspring; study site (coded as North America, Europe, and Asia); sample size; source of the study sample (clinical samples vs. community samples); sex of offspring (% females); ethnicity (% Caucasian); type of abuse (physical abuse, sexual abuse, emotional abuse, and neglect); measures of maternal childhood maltreatment exposures; type of mental health outcomes (diagnoses); and psychopathology measures (questionnaires or scales used for offspring’s mental health outcomes). To enable a comparison of the results from the diverse studies, zero-order correlation coefficients were extracted to indicate the correlation between maternal childhood maltreatment and the offspring’s mental outcome. Articles that met the inclusion criteria were then assessed for their methodological quality and potential bias based on the Newcastle-Ottawa Scale (NOS; Wells, 2001), a widely used scale consisting of eight questions, with a maximum of 10 possible points for each type of study. The NOS scores were categorized into two groups based on the mean score of all included studies: above the mean score—high risk of bias and below the mean score—low risk of bias (Lo et al., 2014).

Meta-Analysis

Calculation of effect sizes

To achieve comparable effect sizes for analyses, we used the zero-order correlation coefficient as the common effect size measure in the present study. Effect size coefficients were either directly obtained from studies or first computed and transformed from the reviewed articles (Lipsey & Wilson, 2001). Coefficients (rs) were then converted with Fisher’s Z transformation to avoid the standard error skew in correlational analyses. Effect sizes were weighted by their inverse variance, and subsequently, the Z values were converted back to coefficients for the interpretation of the results (Fischer, 1944; Hedges & Olkin, 2014; Lipsey & Wilson, 2001). A positive effect size indicates a positive association with r values of .10, .30, and .50 representing small, moderate, and large effects, respectively (Cohen, 1992). Individual studies could generate multiple effect sizes concerning the relationships between different subtypes of maternal maltreatment and outcomes, therefore these within-study effects were dependent on each other. Cheung and Chan (2008) have suggested a sample-wise approach to handle dependent correlations, simply analyzing them by within-sample mean procedures. This sample-wise method can generate an average effect size based on each set of dependent effect sizes from the same sample (Hunter & Schmidt, 2004).

Statistical analyses and moderators

Random-effect models were performed to synthesize overall effect sizes given the amount of variances produced by differences between and within studies and taking the heterogeneity test results into account. Further, effect sizes could vary across studies as a function of potential moderators. The random variance component was determined using maximum-likelihood estimation (Lipsey & Wilson, 2001). Cochrane’s Q statistic was used to test the heterogeneity (Higgins & Thompson, 2002). Heterogeneity of the results was assumed if Q was significant at p < .05, allowing for testing of potential moderators. Categorical factors including age of offspring, study site, source of the study sample, type of maltreatment, measures of maltreatment exposure, and type of outcome were tested using procedures analogous to analysis of variance with a between-group test of homogeneity (Q_between; Lipsey & Wilson, 2001). The results indicated that effect sizes significantly differed across the categories of the moderator. The impact of continuous variables (publication year, sex, ethnicity, and maternal depression) on the results was assessed by meta-regression. We considered the above four variables as continuous due to the availability of data and the feasibility of explanation. A significant slope indicated the moderation effect on the overall effect. Sensitivity analyses were also performed to test the effect of individual studies on overall effect sizes. Finally, publication bias was assessed by funnel plots and quantitatively evaluated by Egger’s regression and Begg’s correlation (Begg & Mazumdar, 1994; Sterne et al., 2001). A trim-and-fill test was performed to estimate the unbiased pooled effect size while taking publication bias into account (Duval & Tweedie, 2000).

All analyses were conducted using the Comprehensive Meta-Analysis Version 2.0 (Biostat, Englewood, NJ), IBM SPSS Statistics Version 21 (IBM Corp, NY), and the macros statistical program written by Lipsey and Wilson (2001) to calculate effect sizes from different measures of statistical association. A p value less than .05 is considered statistically significant.

Results

A total of 12 articles covering 29,682 subjects were included in this meta-analytic review. Figure 1 presents the selection process of the literature search. Table 1 summarizes the study characteristics of these selected studies. All studies were published within the last 20 years. All studies but one were from developed countries, with that exception being from China. Overall, the quality of these studies was moderate as assessed by the NOS with a mean score of 6.75 (range from 4 to 8; see Online Appendix C). These studies targeted a wide age range of offspring varying from 1 year to 16 years, but most of them focused on age from 8 to 14 years old. The offspring cohort had about half females (50.1%) and Caucasian (48.8%).

Table 1.

Study Characteristics of the Selected Studies in This Systematic Review.

Authors	Year	Offspring Age	Study Site	Sample Size	Sample Source	Sex No. (% Female)	Ethnicity No. (% Caucasian)	Type of Abuse	Maternal Childhood Maltreatment Measurements	Offspring Psychopathology Measures	Type of Outcome
Plant et al.	2013	11 and 16 years	United Kingdom	125 mother–child dyads	Clinical	68/125 (54.0)	90/125 (72.0)	PA/SA/EN/PN	Maternal Self-Report Questionnaire	DSM-IV symptoms of depression	Depression
Roberts et al.	2015	9–14 years	United States	mothers = 8,882; children = 11,402	Clinical	6,462/11,402 (56.7)	10,645/11,402 (93.4)	PA/EA/SA	CTQ	CESD-10	Depressive symptoms
Min et al.	2013	9 years	United States	231 mother–child dyads	Clinical	120/231 (51.9)	NA	PA/SA/EA/EN/PN	CTQ	CBCL for ages 6–18	Internalizing behaviors
Plant et al.	2018	11 years	United Kingdom	9,397 mother–child dyads	Community	4,558/9,397 (48.5)	9,087/9,397 (96.7)	PA/SA/EA/EN/PN	Maternal Self-Report Questionnaire	SDQ; DSM-IV	Internalizing behaviors
Liu et al.	2019	14 months	China	207 mother–child dyads	Clinical	102/207 (49.3)	0/207 (0.0)	PA/EA/SA	CTQ-SF	ITSEA	Internalizing behaviors
Linde-Krieger and Yates	2018	4 and 8 years	United States	225 mother–child dyads	Community	108/225 (48.0)	45/225 (20.0)	SA	A verbal administration of the Early Trauma Inventory	TOF	Internalizing behaviors
Pereira et al.	2018	5 years	Canada	96 mother–child dyads	Community	45/96 (47.0)	79/96 (82.3)	PA/SA/EA/EN/PN	CTQ-SF	CBCL for ages 1.5–5	Internalizing behaviors
Choi et al.	2019	12 years	United Kingdom	mothers = 1,016; children = 2,032	Community	1,036/2,032 (51.0)	NA	PA/SA/EA/EN/PN	CTQ	CBCL	Internalizing behaviors
Rijlaarsdam et al.	2014	6 years	The Netherlands	4,438 mother–child dyads	Community	2,241/4,438 (50.5)	3,333/4,438 (75.1)	PA/SA/EA/EN/PN	CTQ	CBCL	Internalizing behaviors
Dubowitz et al.	2001	6–7 years	United States	419 mother–child dyads	Clinical	207/419 (49.4)	NA	PA/SA	Study-developed measure	CBCL	Internalizing behaviors
Koverola et al.	2005	8 years	United States	203 mother–child dyads	Clinical	98/203 (48.3)	NA	PA/SA	Study-developed measure	CBCL	Internalizing behaviors
Letourneau et al.	2019	2 years	Canada	907 mother–child dyads	Community	423/907 (46.6)	788/907 (86.9)	PA/SA/EN/PN	ACE Questionnaire	CBCL	Internalizing behaviors

Note. PA = physical abuse; SA = sexual abuse; EA = emotional abuse; EN = emotional neglect; PN = physical neglect; NA = not available; ACE = Adverse Childhood Experiences; CTQ = Childhood Trauma Questionnaire; CTQ-SF = Childhood Trauma Questionnaire–Short Form; CESD-10 = Center for Epidemiological Studies Depression Scale–10; CBCL = Child Behavior Checklist; SDQ = Strengths and Difficulties Questionnaire; ITSEA = Infant-Toddler Social and Emotional Assessment; TOF = Test Observation Form.

Overall Effects of Maternal Childhood Maltreatment on Offspring Psychopathology

A composite effect size of maternal childhood maltreatment on offspring’s psychopathology was calculated using 12 mean effect sizes weighted by the study’s sample sizes. As shown in Figure 2, the pooled effect size from the selected studies was in the small but significant range (r = .14, 95% confidence interval [CI] [.09, .19], p < .001). However, it should be noted that 4 of the 12 studies reported significant moderate effect sizes in the .30 range. The heterogeneity test was significant across the studies (Q = 117.45, p < .001). Therefore, a random-effect model was used in the meta-analysis. Sensitivity analyses were used to assess the influence of each study on the pooled effect size by omitting one study at a time. The overall correlation between maternal childhood maltreatment and the offspring’s psychopathology was not influenced by the inclusion or exclusion of any specific study (r = .15, 95% CI [.04, .26], p = .006).

Figure 2.

Pooled effect sizes for the association between maternal childhood maltreatment and the offspring’s psychopathology.

Both funnel plot (Online Appendix D) and Egger’s test (τ = .12, p = .58) and Begg’s test (t = .76, p = .47) did not show publication bias. In addition, the trim-and-fill test was conducted to estimate a pooled effect size after adjusting the potential missing publications that might exist in the meta-analysis. After considering the potential missing publications, a small but significant effect size was found (r = .12, 95% CI [.11, .14]).

Moderator Analyses

Table 2 presents the results on the moderation analyses. We found two variables had significant moderation effects: ethnicity (% Caucasian) and maternal depression. Meta-regression analyses showed that ethnicity significantly moderated the relationship between maternal childhood maltreatment and offspring’s psychopathology (p = .001). The correlation between maternal childhood maltreatment and offspring outcomes was much stronger among studies with higher proportions of non-Caucasians than those with more Caucasians. We also found a significant moderating effect for maternal depression (p = .001). Maternal depression reduced the correlation between maternal childhood maltreatment and the offspring’s disease outcome. No significant moderating effect was found for the rest of the categorical variables (child age, study site, source of study subjects, type of maltreatment, maltreatment assessment, and type of outcome; p > .05). Similarly, publication year and sex of offspring did not have a moderating effect in this association (p > .05).

Table 2.

Potential Moderators of the Meta-Analytic Association Between Maternal Childhood Maltreatment and Offspring Psychopathology.

Moderator	k	Number of Participants	Fisher’s Z	Effect Size Estimate		Test of Homogeneity		Slope (p Value)
Moderator	k	Number of Participants	Fisher’s Z	r [95% CI]	p Value	Cochran’s Q	p Value
All studies	12	29,682	5.71	.14 [.09, 0.19]	<0.001	117.45	<.001
Categorical moderator
Age
0–8 years	7	6,495	2.89	.15 [.05, 0.25]	.004	0.09	.76
9–16 years	5	23,187	2.14	.13 [.01, 0.24]	.032	0.09	.76
Study site
North America	7	13,483	2.90	.15 [.05, 0.25]	.004	0.42	.81
Europe	4	15,992	2.27	.15 [.02, 0.27]	.023
Asia	1	207	0.38	.05 [−.22, 0.33]	.703
Source of sample
Clinical	5	12,462	3.13	.18 [.07, 0.30]	.002	0.93	.23
Community	7	17,220	2.23	.11 [.01, 0.21]	.026	0.93	.23
Type of maltreatment
Abuse only	5	12,456	2.24	.14 [.02, 0.26]	.025	0.01	.93
Abuse and neglect	7	17,226	2.81	.14 [.04, 0.24]	.005	0.01	.93
Maltreatment assessment
Self-report	8	15,792	3.46	.16 [.07, 0.26]	<.001	0.75	.39
Interview	4	13,890	1.47	.09 [−.03, 0.22]	.143	0.75	.39
Type of outcome
Depression	2	11,527	0.63	.06 [−.12, 0.24]	.529	0.92	.34
Internalizing behavior	10	18,155	3.78	.16 [.08, 2.34]	<.001	0.92	.34
Continuous moderator
Publication year	12	29,682	1.51					.031 (.130)
Gender	12	29,682	0.74					.004 (.460)
Ethnicity(Caucasian)	9	26,797	−3.33					−.002 (.001)
Maternal depression	6	23,959	−3.22					−.006 (.001)

Note. CI = confidence interval.

Discussion

This systematic review and meta-analysis quantitatively summarized the relationship between maternal childhood maltreatment and the offspring’s depression and internalizing behaviors. A maternal history of maltreatment in childhood was found to have a small but significant detrimental impact on the offspring’s mental health, with 4 of the 12 studies reporting negative impact in the moderate effect size range. Because this systematic review included studies with high heterogeneity, the findings of this review should be carefully interpreted. The findings of this current review are generally in line with previous literature, suggesting maternal child maltreatment has a small but negative consequence on offspring’s mental health outcomes (Bosquet Enlow et al., 2018; Collishaw et al., 2007; Plant et al., 2018).

We found both ethnicity and maternal depression moderated the relationship between maternal childhood maltreatment and offspring’s psychopathology. Children of non-Caucasians were more susceptible to their mother’s exposures of child maltreatment. Considering the etiological nature of depression and internalizing disorders, these differences might be caused by multiple factors including biological factors, environmental exposures, and gene–environment interplay. Caucasians and non-Caucasians may have different genetic susceptibilities and psychosocial risk factors. The implication for genotypes is that psychiatric disorders may have varying levels of heritability for different ethnic groups, which determines the offspring’s susceptibility to mental health outcomes (Gatt et al., 2015; Hernandez et al., 2005). Compared to Caucasians, non-Caucasians were more likely to have lower socioeconomic status, higher rates of unemployment, and other social stressors (e.g., exposure to crime). All these factors expose offspring to highly stressful and stigmatized environments (Turner & Lloyd, 2004; Ulbrich et al., 1989). Also, maternal depression moderated the relationship between maternal childhood maltreatment and offspring’s psychopathology. As expected, maternal depression reduced the effect size of maternal maltreatment on offspring’s depression and internalizing disorders. Clearly, maternal depression and maternal childhood maltreatment were competing risk factors for offspring’s psychopathology. The association between maternal depression and adverse child outcomes could be explained by intergenerational epigenetic transmission, effects of environmental mechanisms, gene–environment interactions, and the effects of depression treatment interventions (Goodman & Gotlib, 1999; Wilson & Durbin, 2010). The treatment of maternal depression may increase awareness of factors contributing to depression and thus increase awareness of the possibility of the intergenerational transmission of depression and trigger clinical interventions to ameliorate these effects. What this review adds to the literature is that it emphasizes the importance of maternal depression in offspring’s mental health outcomes. Meng et al. (2018) in their systematic review alluded to the point that the influence of maltreatment on mental health might become less important as more proximal competing factors come into place.

There are several hypotheses proposed to explain the intergenerational transmission of maternal childhood maltreatment to offspring’s psychopathology. First, the transmission effect could be inherited through epigenetic alterations in genes encoding for proteins that regulate the process, such as the serotonin-transporter polymorphism (5-HTTLPR), which moderates the effects of environmental factors on the risk of childhood expression of endophenotypes that are associated with depression (Bouvette-Turcot et al., 2015). Second, the transmission may be mediated through gestational biology, with the developing feto-placental unit sensing and responding to biological cues in the maternal compartment (Buss et al., 2017). Third, exposure to negative social/psychological environment may increase the risk of developing mental disorders. Mothers with a history of childhood maltreatment have been found to be more likely to demonstrate depressive behaviors, especially at the earliest two-generation intersection points; this may fundamentally contribute to maltreatment in the next generation (Plant et al., 2013). Fourth, maternal childhood maltreatment is often related to marital discord, parenting styles, and tense interpersonal relationships (Dixon et al., 2005; Fleming et al., 1999; Ornduff, 2000). These negative environmental influences may lead to disruptions in stress regulation abilities and change the brain structures and functioning (Bosquet Enlow et al., 2018). Fifth, the findings from clinical samples indicated that the relationship between parental childhood abuse and offspring psychopathology was mediated by the experience of abuse in the offspring generation (Brent et al., 2004). Children of abused mothers were more likely to experience maltreatment via mechanisms such as inadequate maternal care, dysfunctional mother–child relationships, and family instability (Collishaw et al., 2007). Intergenerational continuities in offspring abuse combined with these adverse conditions can culminate in elevated vulnerability in offspring to psychiatric illness (Plant et al., 2015). Sixth, offspring with victimized mothers were more likely to be exposed to an accumulation of stressors and psychosocial adversities associated with their mental health problems, for example, unstable housing, acquisition of new friends’ figures, which may contribute to the transmission of risk for psychopathology associated with maternal childhood abuse (Wickrama et al., 2005). Finally, the intergenerational transmission may also be seen as a result of the complex interplay between genetic and psychosocial environmental factors binding parents to their children (Mason et al., 2017).

Strengths and Limitations

This systematic review and meta-analysis comprehensively synthesized and provided the first estimation of the negative consequence of maternal childhood maltreatment on the offspring’s psychopathology, specifically depression and internalizing behaviors. The findings of this review suggest that future research and prevention efforts on childhood maltreatment should be extended, if possible, to two generations or more generations.

There are several study limitations to be noted. First, there are a relatively small number of studies in this emerging research field, with few studies being eligible for this review. The meta-analysis was limited in terms of its statistical power, which may increase the chance of having a false positive effect (Dumas-Mallet et al., 2017). The review was also restricted in its ability to explore potential moderators. Second, the generalizability of findings warrants careful interpretation, as most of the included studies measured general childhood maltreatment rather than individual subtypes of maltreatment. It remains unclear how individual subtype of maltreatment during maternal childhood would predict offspring’s psychopathology. Third, the variables in the studies reviewed were limited, which in turn limited what characteristics could be examined for their potential roles as moderators. Fourth, this review included mostly studies from developed countries. The findings may not apply to developing countries. Finally, this review had high heterogeneity across studies. These selected studies included a mix of moderators and used both self-report and in-person interviews to collect information on child maltreatment, as well as symptoms and diagnostic measures. Interpretations of these results should be made cautiously.

Conclusion

This systematic review demonstrates that the experience of maternal childhood maltreatment has a small but significant impact in increasing the risk of psychopathology among those mothers’ children. Improving maternal mental health may help reduce the offspring’s risk of depression and internalizing behaviors. This review further informs research examining the long-term consequences of childhood maltreatment and exploring its potential moderators. It is encouraging to know that not all maternal childhood abuse leads to negative mental health outcomes for their children. So, the question arises as to what contributes to the transmission of negative mental health experiences from one generation to the next and conversely what interrupts or mitigates against such transmission. In addition, what is the impact of paternal childhood abuse? How does it affect their children’s mental health? Unfortunately, research is scarce on this topic; much more is required. The role of parent–child gender symmetry and asymmetry and type of abuse and how it impacts offspring’s mental health need further exploration. Finally, a wider range of mental health outcomes need to be explored.

Critical Review Findings

The meta-analytic review of 12 studies showed that maternal childhood maltreatment resulted in a small but significant increased risk of psychopathology (depression and internalizing disorder) among offspring (r = .14, 95% CI [.09, .19]).

Meta-regression analyses found that ethnicity played a moderating role in the relationship between maternal childhood maltreatment and offspring’s psychopathology, suggesting non-Caucasian children were more vulnerable to their mother’s exposures of child maltreatment.

Maternal depression acted as a competing factor and a moderating factor, reducing the impact of the experience of maternal childhood maltreatment on offspring’s depression and internalizing disorders.

Implications for Practice, Policy, and Research

Strengthen the capacity of health professionals and specialists to detect childhood maltreatment among mothers and their children and develop effective and timely interventions to reduce the risk of psychopathology and promote positive mental health of the future generations.

Intervention strategies should be developed and widely disseminated to ultimately break the cycle by which the consequences of childhood maltreatment are passed down from one generation to the next.

Future research and prevention efforts should recognize the potential intergenerational impact of parents’ (maternal or paternal) experience of childhood maltreatment and not just focus on the current generation.

Future studies exploring the relationship between the subtypes of maternal and paternal maltreatment and offspring’s mental health are needed.

More research is needed on the impact of parent–child gender symmetry and asymmetry and their effects on the parental child abuse and offspring’s mental health relationship.

Future studies should also incorporate biological information into studies to complement explaining the process of transmission of maltreatment.

Supplemental Material

Supplemental Material, Appendices - Intergenerational Effect of Maternal Childhood Maltreatment on Next Generation’s Vulnerability to Psychopathology: A Systematic Review With Meta-Analysis

Supplemental Material, Appendices for Intergenerational Effect of Maternal Childhood Maltreatment on Next Generation’s Vulnerability to Psychopathology: A Systematic Review With Meta-Analysis by Yingying Su, Carl D’Arcy and Xiangfei Meng in Trauma, Violence, & Abuse

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by a grant from the Canadian Institutes of Health Research (PJT-148845), a discovery grant from the Canada First Research Excellence Fund provided to McGill University for Healthy Brains for Healthy Lives, and a scholar award from the Fonds de recherche du Québec–Sante, Canada, awarded to Xiangfei Meng.

ORCID iD

Yingying Su

Xiangfei Meng

Supplemental Material

Supplemental material for this article is available online.

References

Aoued

H. S.

Sannigrahi

Doshi

Morrison

F. G.

Linsenbaum

Hunter

Walum

Baman

Yao

Jin

Ressler

K. J.

Dias

B. G.

(2019). Reversing behavioral, neuroanatomical, and germline influences of intergenerational stress. Biological Psychiatry, 85, 248–256.

Barrett

Kamiya

O’Sullivan

(2014). Childhood sexual abuse and later-life economic consequences. Journal of Behavioral and Experimental Economics, 53, 10–16.

Begg

C. B.

Mazumdar

(1994). Operating characteristics of a rank correlation test for publication bias. Biometrics, 50, 1088–1101.

Bert

S. C.

Guner

B. M.

Lanzi

R. G.

, & Centers for Prevention of Child Neglect. (2009). The influence of maternal history of abuse on parenting knowledge and behavior. Family Relations, 58, 176–187.

Bosquet Enlow

Englund

M. M.

Egeland

(2018). Maternal childhood maltreatment history and child mental health: Mechanisms in intergenerational effects. Journal of Clinical Child & Adolescent Psychology, 47, S47–S62.

Bouvette-Turcot

A. A.

Fleming

A. S.

Wazana

Sokolowski

M. B.

Gaudreau

Gonzalez

Deslauriers

Kennedy

J. L.

Steiner

Meaney

, & MAVAN Research Team. (2015). Maternal childhood adversity and child temperament: An association moderated by child 5-HTTLPR genotype. Genes, Brain and Behavior, 14, 229–237.

Brent

D. A.

Oquendo

Birmaher

Greenhill

Kolko

Stanley

Zelazny

Brodsky

Melhem

Ellis

S. P.

Mann

J. J.

(2004). Familial transmission of mood disorders: Convergence and divergence with transmission of suicidal behavior. Journal of the American Academy of Child & Adolescent Psychiatry, 43, 1259–1266.

Brodsky

B. S.

Mann

J. J.

Stanley

Tin

Oquendo

Birmaher

Greenhill

Kolko

Zelazny

Burke

A. K.

Melhem

(2008). Familial transmission of suicidal behavior: Factors mediating the relationship between childhood abuse and offspring suicide attempts. The Journal of Clinical Psychiatry, 69, 584.

Buss

Entringer

Moog

N. K.

Toepfer

Fair

D. A.

Simhan

H. N.

Heim

C. M.

Wadhwa

P. D.

(2017). Intergenerational transmission of maternal childhood maltreatment exposure: Implications for fetal brain development. Journal of the American Academy of Child & Adolescent Psychiatry, 56, 373–382.

10.

Cheung

S. F.

Chan

D. K. S.

(2008). Dependent correlations in meta-analysis: The case of heterogeneous dependence. Educational and Psychological Measurement, 68, 760–777.

11.

Choi

K. W.

Houts

Arseneault

Pariante

Sikkema

K. J.

Moffitt

T. E.

(2019). Maternal depression in the intergenerational transmission of childhood maltreatment and its sequelae: Testing postpartum effects in a longitudinal birth cohort. Development and Psychopathology, 31, 143–156.

12.

Cohen

(1992). Quantitative methods in psychology: A power primer. Psychological Bulletin, 112, 1155–1159.

13.

Collishaw

Dunn

O’CONNOR

T. G.

Golding

, & Avon Longitudinal Study of Parents and Children Study Team. (2007). Maternal childhood abuse and offspring adjustment over time. Development and Psychopathology, 19, 367–383.

14.

Dias

B. G.

Ressler

K. J.

(2014). Parental olfactory experience behavior and neural structure in subsequent generations. Nature Neuroscience, 17, 89–96.

15.

Dixon

Hamilton-Giachritsis

Browne

(2005). Attributions and behaviours of parents abused as children: A mediational analysis of the intergenerational continuity of child maltreatment (Part II). Journal of Child Psychology and Psychiatry, 46, 58–68.

16.

Dubowitz

Black

M. M.

Kerr

M. A.

Hussey

J. M.

Morrel

T. M.

Everson

M. D.

Starr

R. H.

(2001). Type and timing of mothers’ victimization: Effects on mothers and children. Pediatrics, 107, 728–735.

17.

Dumas-Mallet

Button

K. S.

Boraud

Gonon

Munafò

M. R.

(2017). Low statistical power in biomedical science: A review of three human research domains. Royal Society Open Science, 4, 160254.

18.

Duval

Tweedie

(2000). Trim and fill: A simple funnel-plot–based method of testing and adjusting for publication bias in meta-analysis. Biometrics, 56, 455–463.

19.

Elliott

J. C.

Stohl

Wall

M. M.

Keyes

K. M.

Goodwin

R. D.

Skodol

A. E.

Krueger

R. F.

Grant

B. F.

Hasin

D. S.

(2014). The risk for persistent adult alcohol and nicotine dependence: The role of childhood maltreatment. Addiction, 109, 842–850.

20.

Fischer

(1944). Statistical methods for research workers, 1925. Oliver and Boyd.

21.

Fleming

Mullen

P. E.

Sibthorpe

Bammer

(1999). The long-term impact of childhood sexual abuse in Australian women. Child Abuse & Neglect, 23, 145–159.

22.

Gatt

J. M.

Burton

K. L.

Williams

L. M.

Schofield

P. R.

(2015). Specific and common genes implicated across major mental disorders: A review of meta-analysis studies. Journal of Psychiatric Research, 60, 1–13.

23.

Gilbert

Widom

C. S.

Browne

Fergusson

Webb

Janson

(2009). Burden and consequences of child maltreatment in high-income countries. The Lancet, 373, 68–81.

24.

Goodman

Joyce

Smith

J. P.

(2011). The long shadow cast by childhood physical and mental problems on adult life. Proceedings of the National Academy of Sciences, 108, 6032–6037.

25.

Goodman

S. H.

Gotlib

I. H.

(1999). Risk for psychopathology in the children of depressed mothers: A developmental model for understanding mechanisms of transmission. Psychological Review, 106, 458.

26.

Hedges

L. V.

Olkin

(2014). Statistical methods for meta-analysis. Academic Press.

27.

Heim

Bradley

Mletzko

Deveau

T. C.

Musselmann

D. L.

Nemeroff

C. B.

Ressler

K. J.

Binder

E. B.

(2009). Effect of childhood trauma on adult depression and neuroendocrine function: Sex-specific moderation by CRH receptor 1 gene. Frontiers in Behavioral Neuroscience, 3, 41.

28.

Hernandez

Plant

E. A.

Sachs-Ericsson

Joiner

T. E.

Jr . (2005). Mental health among Hispanics and Caucasians: Risk and protective factors contributing to prevalence rates of psychiatric disorders. Journal of Anxiety Disorders, 19, 844–860.

29.

Higgins

J. P.

Thompson

S. G.

(2002). Quantifying heterogeneity in a meta-analysis. Statistics in Medicine, 21, 1539–1558.

30.

Hunter

J. E.

Schmidt

F. L.

(2004). Methods of meta-analysis: Correcting error and bias in research findings. Sage.

31.

Kessler

R. C.

McLaughlin

K. A.

Green

J. G.

Gruber

M. J.

Sampson

N. A.

Zaslavsky

A. M.

Aguilar-Gaxiola

Alhamzawi

A. O.

Alonso

Angermeyer

Benjet

Bromet

Chatterji

Girolamo

G. D.

Demyttenaere

Fayyad

Florescu

Gal

Gureje

… Williams

D. R.

(2010). Childhood adversities and adult psychopathology in the WHO World Mental Health Surveys. The British Journal of Psychiatry, 197, 378–385.

32.

Klengel

Mehta

Anacker

Rex-Haffner

Pruessner

J. C.

Pariante

C. M.

Pace

T. W. W.

Mercer

K. B.

Mayberg

H. S.

Bradley

Nemeroff

C. B.

Holsboer

Heim

C. M.

Ressler

K. J.

Rein

Binder

E. B.

(2013). Allele-specific FKBP5 DNA demethylation mediates gene–childhood trauma interactions. Nature Neuroscience, 16, 33–41.

33.

Koverola

Papas

M. A.

Pitts

Murtaugh

Black

M. M.

Dubowitz

(2005). Longitudinal investigation of the relationship among maternal victimization, depressive symptoms, social support, and children’s behavior and development. Journal of Interpersonal Violence, 20, 1523–1546.

34.

Letourneau

Dewey

Kaplan

B. J.

Ntanda

Novick

Thomas

J. C.

…APrON Study Team. (2019). Intergenerational transmission of adverse childhood experiences via maternal depression and anxiety and moderation by child sex. Journal of Developmental Origins of Health and Disease, 10, 88–99.

35.

D’Arcy

Meng

(2016). Maltreatment in childhood substantially increases the risk of adult depression and anxiety in prospective cohort studies: Systematic review, meta-analysis, and proportional attributable fractions. Psychological Medicine, 46, 717–730.

36.

Linde-Krieger

Yates

T. M.

(2018). Mothers’ history of child sexual abuse and child behavior problems: The mediating role of mothers’ helpless state of mind. Child Maltreatment, 23, 376–386.

37.

Lipsey

M. W.

Wilson

D. B.

(2001). Practical meta-analysis. Sage.

38.

Liu

Zhou

Dong

Wang

Hao

(2019). Maternal childhood emotional abuse predicts Chinese infant behavior problems: Examining mediating and moderating processes. Child Abuse & Neglect, 88, 307–316.

39.

C. K. L.

Mertz

Loeb

(2014). Newcastle-Ottawa Scale: Comparing reviewers’ to authors’ assessments. BMC Medical Research Methodology, 14, 45.

40.

Lomanowska

Boivin

Hertzman

Fleming

A. S.

(2017). Parenting begets parenting: A neurobiological perspective on early adversity and the transmission of parenting styles across generations. Neuroscience, 342, 120–139.

41.

Madigan

Cyr

Eirich

Fearon

R. P.

Rash

Poole

J. C.

Alink

L. R.

(2019). Testing the cycle of maltreatment hypothesis: Meta-analytic evidence of the intergenerational transmission of child maltreatment. Development and Psychopathology, 31, 23–51.

42.

Mason

W. A.

Chmelka

M. B.

Trudeau

Spoth

R. L.

(2017). Gender moderation of the intergenerational transmission and stability of depressive symptoms from early adolescence to early adulthood. Journal of Youth and Adolescence, 46, 248–260.

43.

Meaney

M. J.

(2001). Maternal care, gene expression, and the transmission of individual differences in stress reactivity across generations. Annual Review of Neuroscience, 24, 1161–1192.

44.

Meng

Fleury

M. J.

Xiang

Y. T.

D’Arcy

(2018). Resilience and protective factors among people with a history of child maltreatment: A systematic review. Social Psychiatry and Psychiatric Epidemiology, 53, 453–475.

45.

Min

M. O.

Singer

L. T.

Minnes

Kim

Short

(2013). Mediating links between maternal childhood trauma and preadolescent behavioral adjustment. Journal of Interpersonal Violence, 28, 831–851.

46.

Miranda

J. K.

de la Osa

Granero

Ezpeleta

(2013). Multiple mediators of the relationships among maternal childhood abuse, intimate partner violence, and offspring psychopathology. Journal of Interpersonal Violence, 28, 2941–2965.

47.

Moher

Liberati

Tetzlaff

Altman

D. G.

(2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. Annals of Internal Medicine, 151, 264–269.

48.

Nanda

M. M.

Reichert

Jones

U. J.

Flannery-Schroeder

(2016). Childhood maltreatment and symptoms of social anxiety: Exploring the role of emotional abuse, neglect, and cumulative trauma. Journal of Child & Adolescent Trauma, 9, 201–207.

49.

Ornduff

S. R.

(2000). Childhood maltreatment and malevolence: Quantitative research findings. Clinical Psychology Review, 20, 997–1018.

50.

Pariante

C. M.

(2014). Depression during pregnancy: Molecular regulations of mothers’ and children’s behaviour. Biochemical Society Transactions, 42, 582–586.

51.

Pereira

Ludmer

J. A.

Gonzalez

Atkinson

(2018). Mothers’ personal and interpersonal function as potential mediators between maternal maltreatment history and child behavior problems. Child Maltreatment, 23, 147–156.

52.

Plant

D. T.

Jones

F. W.

Pariante

C. M.

Pawlby

(2017). Association between maternal childhood trauma and offspring childhood psychopathology: Mediation analysis from the ALSPAC cohort. The British Journal of Psychiatry, 211, 144–150.

53.

Plant

D. T.

Pariante

C. M.

Sharp

Pawlby

(2015). Maternal depression during pregnancy and offspring depression in adulthood: Role of child maltreatment. The British Journal of Psychiatry, 207, 213–220.

54.

Plant

D. T.

Pawlby

Pariante

C. M.

Jones

F. W.

(2018). When one childhood meets another–maternal childhood trauma and offspring child psychopathology: A systematic review. Clinical Child Psychology and Psychiatry, 23, 483–500.

55.

Plant

D. T.

Barker

E. D.

Waters

Pawlby

Pariante

(2013). Intergenerational transmission of maltreatment and psychopathology: The role of antenatal depression. Psychological Medicine, 43, 519–528.

56.

Rijlaarsdam

Stevens

G. W.

Jansen

P. W.

Ringoot

A. P.

Jaddoe

V. W.

Hofman

Ayer

Verhulst

F. C.

Hudziak

J. J.

Tiemeier

(2014). Maternal childhood maltreatment and offspring emotional and behavioral problems: Maternal and paternal mechanisms of risk transmission. Child Maltreatment, 19, 67–78.

57.

Roberts

A. L.

Chen

Slopen

McLaughlin

K. A.

Koenen

K. C.

Austin

S. B.

(2015). Maternal experience of abuse in childhood and depressive symptoms in adolescent and adult offspring: A 21‐YEAR longitudinal study. Depression and Anxiety, 32, 709–719.

58.

Roberts

A. L.

Lyall

Rich-Edwards

J. W.

Ascherio

Weisskopf

M. G.

(2013). Association of maternal exposure to childhood abuse with elevated risk for autism in offspring. JAMA Psychiatry, 70, 508–515.

59.

Sterne

J. A.

Egger

Smith

G. D.

(2001). Investigating and dealing with publication and other biases in meta-analysis. British Medical Journal, 323, 101–105.

60.

Stith

S. M.

Liu

Davies

L. C.

Boykin

E. L.

Alder

M. C.

Harris

J. M.

Som

McPherson

Dees

J. E. M. E. G.

(2009). Risk factors in child maltreatment: A meta-analytic review of the literature. Aggression and Violent Behavior, 14, 13–29.

61.

Stroup

D. F.

Berlin

J. A.

Morton

S. C.

Olkin

Williamson

G. D.

Rennie

Moher

Becker

B. J.

Sipe

T. V.

Thacker

S. B.

(2000). Meta-analysis of observational studies in epidemiology: A proposal for reporting. Journal of the American Medical Association, 283, 2008–2012.

62.

Thompson

(2007). Mothers’ violence victimization and child behavior problems: Examining the link. American Journal of Orthopsychiatry, 77, 306–315.

63.

Trautmann

Rehm

Wittchen

H. U.

(2016). The economic costs of mental disorders: Do our societies react appropriately to the burden of mental disorders? EMBO Reports, 17, 1245–1249.

64.

Turner

R. J.

Lloyd

D. A.

(2004). Stress burden and the lifetime incidence of psychiatric disorder in young adults: Racial and ethnic contrasts. Archives of General Psychiatry, 61, 481–488.

65.

Ulbrich

P. M.

Warheit

G. J.

Zimmerman

R. S.

(1989). Race, socioeconomic status, and psychological distress: An examination of differential vulnerability. Journal of Health and Social Behavior, 30, 131–146.

66.

Vigo

Thornicroft

Atun

(2016). Estimating the true global burden of mental illness. The Lancet Psychiatry, 3, 171–178.

67.

Wells

(2001). The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. http://www.ohri.ca/programs/clinical_epidemiology/oxford.Asp

68.

Wickrama

K. A. S.

Conger

R. D.

Abraham

W. T.

(2005). Early adversity and later health: The intergenerational transmission of adversity through mental disorder and physical illness. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 60, S125–S129.

69.

Widom

C. S.

DuMont

Czaja

S. J.

(2007). A prospective investigation of major depressive disorder and comorbidity in abused and neglected children grown up. Archives of General Psychiatry, 64, 49–56.

70.

Wilson

Durbin

C. E.

(2010). Effects of paternal depression on fathers’ parenting behaviors: A meta-analytic review. Clinical Psychology Review, 30, 167–180.

71.

World Health Organization. (2001). Mental health: a call for action by world health ministers. In Mental health: a call for action by World Health Ministers. https://www.who.int/mental_health/media/en/249.pdf

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