Perinatal Anxiety and Depressive Symptoms and Maternal Parenting Behavior During the First Three Years Postpartum: A Systematic Review

Background: Perinatal anxiety and depressive symptoms are prevalent and may influence parenting behaviors, yet their effects across distinct parenting dimensions remain unclear. Despite frequent co-occurrence, their combined impact is underexplored. Additionally, variability in how parenting behaviors are conceptualized hinders synthesis across studies. Categorizing parenting behaviors into protection, control, and guided learning provides a structured framework for understanding these associations.

Objectives: This review aimed to assess (1) the differential associations between perinatal anxiety,depressive symptoms, and parenting behaviors across the protection, control, and guided learning dimensions, and (2) associations between comorbid anxiety-depressive symptoms and parenting behaviors.

Methods: A systematic search was conducted across four databases in January 2024. Studies were included if they assessed perinatal anxiety and depressive symptoms and their associations with parenting behaviors during the first 3 years postpartum. Parenting behaviors were categorized into protection, control, and guided learning, and risk of bias was systematically evaluated. This review is registered with PROSPERO (CRD42023337333).

Results: From 9673 screened documents, 20 studies met inclusion criteria. Associations were most frequent in the protection dimension, with higher perinatal anxiety and depressive symptoms linked to lower maternal sensitivity and responsiveness. In the control dimension, findings were mixed, with some studies linking maternal anxiety and depressive symptoms to greater controlling behaviors, while others found no significant associations. In the guided learning dimension, null findings predominated, though some studies identified links between higher anxiety, depressive symptom levels, increased intrusiveness, reduced cognitive stimulation, and disengagement. Few studies examined comorbid anxiety and depressive symptoms, but preliminary findings suggest associations with lower maternal sensitivity and reduced guided learning behaviors.

Conclusions: Despite heterogeneity across studies, protection-related parenting behaviors were most consistently associated with perinatal anxiety and depressive symptoms. These findings highlight the need for targeted assessments and interventions to support affected mothers and their children.