A broad range of psychological problems of parents places children at risk for the development of emotional and behavioural problems. A key example is the effect of maternal depression on child development. Not only is depression in children of depressed mothers more frequent and more severe than in children of non-depressed mothers, but these children also display more anxiety disorders, aggression, attention deficits, insecure attachment, poor self-esteem and poor peer relations [1, 2]. The relation between psychopathology of parents and child development is not limited to the mother–child relationship [3, 4]. For instance, postnatal paternal depression was associated with a higher likelihood of a psychiatric diagnosis in children at the age of 7 [5]. Next to the evidence for a postnatal effect of parental psychopathology on child development, there are also several reports suggesting a direct relation between maternal stress during pregnancy, such as depression and anxiety, and child development [6]. Interestingly, father s’ prenatal depression has also been associated with the child development such as excessive infant crying [7], child anxiety [8], and conduct problems [9]. Genetic effects, programming effects in utero and differentiation effects after birth may account for these prenatal and postnatal associations [10]. During pregnancy, the comparison of the effect of maternal risk factors on the likelihood of child internalizing problems with the effect of paternal risk factors has been used to investigate the causality of the underlying association [11]. If only a maternal prenatal relation is found, this may be the result of specific intra-uterine programming effects. A prenatal effect of paternal risk factors more likely reflects long lasting effects such as a genetic risk for psychopathology or residual confounding (i.e. unmeasured variables account for the association).

Like depression, parental hostility is also a significant threat to child development [12, 13]. Hostile behaviour of mothers and fathers is related to less optimal interactions with their children [14]. Parent–child hostility gives rise to fear, anger and distress, and increases the likelihood of aggressive behaviour and anxiety of the child [14, 15]. The actual effect of parental hostility seems to depend mainly on emotional and cognitive processes within the child, and on family processes such as the level of involvement of the child in parental disputes [16].

By way of daily interaction within families, parental psychopathology usually also affects contextual factors. In families with a depressed parent, the interaction between spouses is often characterized by increased hostility and tension [17]. These families report poor family functioning more frequently than families with no depressed parents [18]. Therefore, children in these families are not only at an increased risk of emotional and behavioural problems, because they have a parent with psychological problems, but also due to an increased likelihood of exposure to marital conflict and poor family functioning.

Previous research mostly focused on the interrelation of parental depression, hostility, marital conflict and family functioning on child development, and mediators of these associations [16, 19–21]. In a recent review in this field, it was suggested that parental psychopathology and family functioning have reciprocal effects without a causal primacy of one of the two [21]. The debate remains to what extent these apparent risk factors independently contribute to child problem behaviour when analysed simultaneously. Insight into the independent contributions of parental depression, parental hostility and family functioning to the risk of child problem behaviour is important for the development of effective prevention and intervention strategies.

In the present study, we aimed to test the following hypotheses: (1) prenatal psychological symptoms of parents are a risk factor for child emotional and behavioural problems independent of postnatal parental symptoms, (2) parental depressive symptoms and parental symptoms of hostility each contribute to the risk of emotional and behavioural problems in children. Given the dyadic nature of family functioning, we also expected to find an additional effect of family functioning on the risk of child problems, and (3) any prenatal effect of maternal psychological symptoms exceeds the effect of paternal psychological symptoms during pregnancy, due to the direct physiologic effects via the mother on the intrauterine environment of the foetus.

We tested these hypotheses in 2,698 families participating in an ongoing population-based cohort. To explore the specificity of our findings, we also examined the effect of other parental psychological symptoms, such as psychoticism and anxiety, on child emotional and behavioural problems. Furthermore, we examined the effect of parental depressive symptoms, parental hostility, and family functioning on subtypes of emotional and behavioural problems; emotionally reactive behaviour, anxious/depressed behaviour, somatic complaints, withdrawn behaviour, attention problems and aggressive behaviour.

Prenatal depressive symptoms, prenatal hostility, prenatal family functioning, postnatal depressive symptoms and postnatal hostility of the parents were significantly correlated (p value <0.001), and the highest correlation was found between depressive symptoms and symptoms of hostility (e.g. ρ_sp prenatal maternal depressive symptoms—prenatal maternal hostility 0.50, p value <0.001) (Appendix Table 1). Co-linearity among BSI sub-scales was indicated by correlations of 0.31–0.64. For instance, we found a correlation of 0.52 for BSI depression and BSI anxiety, for BSI depression with BSI phobic anxiety a correlation of 0.37, for BSI hostility with BSI anxiety a correlation of 0.48 and a correlation for hostility with phobic anxiety of 0.31.

The analyses of parental psychopathology symptoms and prenatal family functioning with subtypes of internalizing problems and externalizing problems showed that postnatal symptoms of hostility of mothers and fathers each significantly increased the likelihood of all six subtypes of child emotional and behavioural problems at the age of 3 years (OR range 1.15–1.37) (see appendix Tables 2 and Table 3). Next to these significant observations, prenatal depressive symptoms of the mother were primarily related to anxious/depressed behaviour and emotionally reactive behaviour. Prenatal symptoms of hostility of the mother predicted child aggressive behaviour, whereas prenatal symptoms of hostility of the father were significantly associated with emotionally reactive behaviour of the child. Furthermore, prenatal family functioning reported by the mother was associated with anxious/depressed behaviour, emotionally reactive behaviour and somatic complaints, whereas prenatal family functioning reported by the father was related to somatic complaints of children (see appendix Tables 2 and 3).

This study examined the risk of prenatal and postnatal parental depressive symptoms, prenatal and postnatal parental hostility and prenatal family functioning for emotional and behavioural problems in young children. We first evaluate prenatal and postnatal effects of parental psychological symptoms. The associations of parental prenatal depressive symptoms and prenatal hostility of the parents with child internalizing and externalizing problems were not independent of the effect of postnatal parental hostility with the outcome. This may suggest that parent–child interaction is essential to determine the impact of parental psychopathology on children, or that it is easier to detect an immediate effect than a distant effect of a stressor on child development. However, these findings make it also more likely that the effects of postnatal parental symptoms of hostility on child behaviour are causal, because some form of hostility in the parent was already present before birth of the child. Child emotional and behavioural problems can be a source of postnatal parental psychological problems [12, 13], but this reasoning cannot account for parental hostility prior to birth of the offspring, thus reverse causality is less likely.

Our second hypothesis posited that parental depressive symptoms, parental hostility and family functioning would have independent effects on child development. Although initially significant, the effects of parental depressive symptoms on child internalizing problems and child externalizing problems were accounted for by postnatal parental hostility. Hence, when analysed simultaneously with parental depressive symptoms, the impact of parental hostility after birth on child development seemed larger. However, we cannot conclude that depressive symptoms of the parents do not affect these families. It has been reported that persons with a depression show more nonverbal expressions of hostility in their interactions than non-depressed persons [31]. In our study, this comorbidity was reflected by moderately strong correlations between depressive symptoms and symptoms of hostility. Also, in the subtype analyses, prenatal maternal depressive symptoms significantly predicted child anxious/depressed behaviour and emotionally reactive behaviour, independent of parental hostility.

We also report that poor family functioning during pregnancy experienced by the mother increases the risk of child internalizing problems, independently of the increased risk associated with parental postnatal hostility. The association between family functioning and child behavioural problems has been previously documented [15, 32]. In this field of research, many studies, however, focused on the combined effect of family functioning and parental psychopathology on child development [14, 16, 19, 20, 32]. Our findings seem to underscore the importance of family life to child development, next to the effect of parental symptoms of psychopathology. Interestingly, this association may be specific for child internalizing problems, as we did not find an independent effect of prenatal family functioning on child externalizing problems.

To test the third hypothesis, we focused on the effects of maternal risk factors and the effects of paternal risk factors on child emotional and behavioural problems. Remarkably, the postnatal effect of father’s hostility was similar to the effect estimate of mother’s hostility on the likelihood of child internalizing and externalizing problems. These findings underscore the importance of father’s behaviour on child development, and point to the fact that even subtle hostility by father affects their children. In contrast, father’s experience of family functioning was not significantly associated with child internalizing problems. Fathers may have different views on family functioning compared to mothers. In our study, however, mothers and fathers report quite similar on family functioning in terms of total range of scores and mean scores. As both parents’ reports of family functioning were included in one regression model (Table 3), it may also be that the effect of father’s experience of family functioning is captured in mother’s experience of family functioning.

Two methodological considerations need to be discussed. First, we want to address the specificity of our findings. The associations of parental depressive symptoms and hostility with child internalizing and externalizing problems were not specific; other BSI subscales also predicted child problems. This indicates strongly that these scales partly represent general psychopathology. We also found similar effects of postnatal parental hostility on child internalizing and child externalizing problems. If anything, family functioning reported by the mother was associated with a somewhat higher risk of internalizing problems compared with externalizing problems. This absence of effect specificity is not surprising, given the high level of comorbidity among psychiatric disorders in children [33]. Recently, Kessler and colleagues [34] reported, even in adults, significant associations of “virtually all temporally primary lifetime disorders predicting subsequent onset of other disorders” in a study of lifetime comorbidity.

Secondly, the question of a multiple testing problem must be discussed. We studied the effect of several related risk factors on child emotional and behavioural problems. However, the tests do not constitute independent hypotheses. Hence we did not adjust for multiple testing. If we, however, would apply a Bonferroni correction, the corrected alpha for chance is 0.05/10 = 0.005 which would not change the interpretation of our findings. The p values of the significant associations of postnatal parental hostility and child problems presented in Tables 3 and 4 are smaller than 0.001. Moreover, appendix Tables 2 and 3 present additional analyses of syndrome scales that further explore the results obtained with the broadband scale Internalizing and Externalizing. Hence, the aim here was not to test more hypotheses, but to explain the results observed.

The present study has several strengths. First, both mother and father participated in this study, and thus information about depressive symptoms, hostility and family functioning of both parents was available. This enabled us to study the maternal and paternal effects on child development separately. Second, child emotional and behavioural problems were assessed separately by mother and father. Using multiple informants increased the reliability of our findings, and reduced the risk of reporter bias. Since assessment of behaviour will always be subjective, reporter bias may occur if, for instance, a depression of the mother influences her view on her child’s behaviour [35]. Third, our study was embedded in a large birth cohort, which made it possible to adjust for numerous confounders. Besides these strengths, this study has also limitations. First, our response analyses showed that selection occurred toward well functioning families with a higher social economic status (SES). As partner participation is higher in families with higher SES, our study was prone to represent more well-functioning families [36]. Second, observational measurements in this large cohort were not feasible. Therefore, we relied on report of mothers and fathers on psychological symptoms, family functioning and child behaviour. Yet, we used validated questionnaires with good reliability and validity. Third, as this study was performed in a fairly healthy population we should be careful generalizing our findings to clinical populations.

In conclusion, we found that family functioning experienced by the mother and postnatal hostile behaviour of parents independently contributed to the risk of internalizing problems in 3-year-old children. Parental postnatal hostile behaviour was also related to child externalizing problems. Interestingly, parental hostility accounted for the effect of parental depressive symptoms on child internalizing and externalizing problems. These findings suggest that prevention and intervention strategies should focus on the psychological symptoms of both mothers and fathers, in particular on hostile behaviour, in families with young children.