Preschoolers' Depression Severity and Behaviors During Dyadic Interactions: The Mediating 'Role of Parental Support ANDY C. BELDEN, M.S. AND JOAN L. LUBY, M.D. ABSTRACT Objective: To investigate the relationship between preschool depression severity, observed behavior, and parental emo- tional support in a population of 3.0- to 5.6-year-olds and their mothers. Method: One hundred fifty preschoolers who underwent a comprehensive mental health assessment during which DSM-1V diagnoses were derived were included in this analysis. Child and parent behaviors during challenging structured dyadic tasks were systematically coded. Dyads with preschoolers in three diagnostic groups of interest were explored: depression, disruptive, and healthy. Depression severity sum scores were derived for children in all of the groups. Results: Depression severity accounted for a significant (p < .05) portion of the variance in preschoolers' persistence, compliance, and enthusiasm during dyadic tasks after con- trolling for the effects of age and gender. Depression severity was also significantly associated with parental emotional support, which was itself associated with all three preschool behaviors. When the effect of parental support was controlled for statistically, however, preschoolers' depression severity was no longer significantly assodiated with observed per- sistence or compliance, whereas the relationship between depression severity and enthusiasm remained significant. Conclusions: Maternal emotional support mediated the relationship between preschoolers' depression severity and their persistence and compliance but not the relationship between depression severity and enthusiasm. Findings have important clinical implications because they suggest that both external relational and internal child factors may be operating in pre- school depression. J. Am. Acad. Child Adolesc. Psychiatry, 2006;45(2):213-222. Key Words: preschool, depression, parenting, emotional support. Based on the increased recognition of affective distur- bances, high-risk states, and clinical mood disorders very early in life, it is necessary to investigate the ways in which psychopathology occurring in the preschool period, a time of rapid normative emotional, social, and cognitive development, may influence early devel- opmental trajectories. The present investigation was Accepted August 30, 2005. Both authors are affiliatedwith Washington University in St. Louis, St. Louis, MO; Mr. Belden is ako affiliated with Saint Louis University. Funding for the study of preschool depression was provided by National Institute of Mental Health grants K08-MHO1462 and ROl MH64769-01; Dr. Luby. Reprint requests to Dr. Joan Luby, Department of Psychiatry, Washington University in St. Louis School of Medicine, 660 S. Euclid Avenue, Campus Box 8134, St. Louis, MO 63110; e-maik lubyj@msnotes.wustl.edu. 0890-8567/0614502-0213©2006 by the American Academy of Child and Adolescent Psychiatry. DOI: 10.1097/01.chi.0000189133.59318.5e J. AM. ACAD. CHILD ADOLESC. PSYCHIATRY, 45:2, FEBRUARY 200 conducted in a sample of clinically depressed preschool children; "disruptive," and "healthy" comparison groups. Relationships between preschoolers' depression severity sum scores derived from the Diagnostic Interview Sched- ule Version 4, Young Children version (DISC-IV-YC) parent report, their behavioral responses during dyadic interactions with their mothers, as well as the quality and frequency of mothers' emotionally supportive strat- egies displayed during the tasks were examined. In ad- dition, maternal emotional support was tested as a possible mediator of the hypothesized relationships. Luby et al. (2003a, b) have previously demonstrated that a specific and stable constellation of depressive symptoms can be identified in preschool children be- tween the ages of 3.0 and 5.6 for which discriminant validity from other nonaffective psychiatric disorders has been established. Sensitive and specific symptoms of preschool depression included sadness or irritability, 06 213