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Family Mealtime Functioning, Maternal Depression, and Early Childhood Outcomes
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Susan Dickstein, PhD
Brown University Medical School
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 Maternal depression is a family matter. It is associated with a host of adverse outcomes for individual family members including very young children as well as problematic functioning for the family as a whole. There has been an abundance of research on the influence of maternal psychopathology, particularly depression, on child outcome. This is for good reason -- such research generally supports the notion that maternal illness is associated with disruptions in maternal behavior and mother-child interaction. Depressed mothers often report more dissatisfaction in relationships with their spouses and children, as well as more stress and uncertainty regarding their own role as parents. Further, children of depressed mothers exhibit a variety of impairments in social, psychological, and emotional functioning. Maternal depression is also associated with family difficulties that include disorganization in planning activities, less adaptability, less cohesion, and less clear allocation of individual responsibilities. Yet when maternal depression occurs in a family that functions well (for example, with low rates of stress and high perceived support), children seem to do better.
In order for the whole family to function well, a multitude of roles, tasks, and interactions need to be well coordinated and integrated among all family members. During times of transition or crisis, the family relies on these routines to maintain regulation, orienting members toward familiar patterns of relating and coping. Especially at these times, the functioning of the family as a whole may serve as a "gatekeeper" that is, family patterns may support competence of family members, or family patterns may perpetuate risks. In the case of maternal depression, family routines and patterns of interaction play a role in the transmission of risk across generations such that, healthy family routines may serve to interrupt the negative consequences of maternal depression for early childhood outcomes.
We have found that family mealtime provides a particularly good opportunity to observe routine family interactions that may be important in shielding the child from adversity related to maternal depression. It is a good time to observe how families negotiate a host of agendas, not the least of which is accomplishing the task of getting all families members fed. For many families, dinnertime may be the only predictable time that all family members gather together. As such, it is a time for updates about the day, discussions about family matters, and coordination of schedules and plans. It is a rich context in which families transact patterns of communication, problem solving, and role negotiations. Our research has aimed to focus on the manner in which families accomplish important tasks during the mealtime, rather than on the importance of having a meal together, per se. Mealtime patterns are considered to be a snapshot of family life, from which we make inferences about the functional abilities of the system as a whole.
We focus on the processes occurring within family systems that generate behaviors disruptive to everyday functioning of the family as well as strengths that families bring to these situations. This functional view of the family involves the manner in which the family provides a supportive structure within which to accomplish basic tasks (providing food and shelter); to negotiate developmental tasks (promoting growth and development of individuals as well as facilitating family stage transitions); and to cope with crises and changes such as illness or loss of employment. Even when a parent is showing signs of clinical depression, the family may display healthy functioning to the extent that family members compensate for the diminished capacities of the ill individual. This may occur by shifting roles and responsibilities as developmentally and pragmatically feasible; by facilitating the individual's access to appropriate mental health services; and/or by infusing the family with additional support (e.g., have grandmother come for a visit) in order to provide affective and pragmatic assistance.
The task of having a family dinner, particularly in families with young preschool-age children often requires the management skills of a top-notch CEO coupled with the negotiation finesse of a diplomat. Prior to eating a meal, pragmatic decisions need to be made including menu selection, procurement of ingredients, and meal preparation. During the meal, tasks and challenges often include coordinating the process of eating, communicating daily events, teaching about what is accepted (e.g., no throwing food) and expected (e.g., manners), managing relationship interactions, and generally meeting the various needs of each family member.
Functional interactions within families are profoundly affected by maternal depression. When a parent is depressed, symptoms such as sad or irritable mood, lack of interest in activities and relationships, lethargy, and feelings of low self-worth and helplessness can interfere with accomplishing even the most basic tasks of family life. There may be a general sense of disconnection among family members, and/or children may be required to take on responsibilities for which they are developmentally ill equipped. In our work, we found that intensity of maternal depressive symptoms is associated with unhealthy mealtime family functioning. Mealtimes of poorly functioning families are often quite painful and unsatisfying. The families seem disjointed, chaotic, and individuals may demonstrate significant symptoms of psychopathology that are left unchecked. Children are inadequately fed and/or nurtured, and adults do not get along. The meal seems to be an unpleasant experience for the family.
Alternatively, the healthy family's overall quality of meal interactions is high, and family members clearly enjoy each other's company. The tasks of the meal are accomplished smoothly, behavioral problems are handled without disrupting the meal, and there is generally time made during the meal for family members to talk about things that matter to them. Challenges are certainly apparent although behaviors do not become problematic to the point of disruption. Not surprisingly, children generally do better when their families function well. Healthy family functioning is related to the child's social-emotional competence and report of fewer behavioral difficulties during the toddler and preschool years. Further, healthier levels of family functioning are associated with significant improvement in depression symptom severity level over time. This intriguing piece of evidence suggests that finding ways to help the whole family function better may actually serve as a protective factor -- if not a component of effective depression treatment -- for women with young families.
Based on our results, there is reason to speculate that helping young families to improve their ability to effectively manage the functional aspects of family life such as those required to plan and bring about a family meal, may impact the developmental competence of children, and may also influence the expression and maintenance of maternal depressive symptoms over time.
References
Dickstein, S., Hayden, L. C., Schiller, M., Seifer, R., Sameroff, A. J., Keitner, G., Miller, I., Rasmussen, S., & Matzko, M. (1998). Levels of family assessment II: Family functioning and parental psychopathology. Journal of Family Psychology, 12, 23-40.
Dickstein, S., Hayden, L. C., Schiller, M., Seifer, R., & San Antonio, W. (1994) Providence Family Study mealtime family interaction coding system. Adapted from the McMaster Clinical Rating Scale. E. P. Bradley Hospital, East Providence, RI.
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