Parental depression is one of the most important risk factors for the development of various forms of psychopathology in children (1–3), and this risk can be transmitted across generations (4–6). The severity and the chronicity of parental depression are strongly associated with more severe internalizing and externalizing problems in children (7, 8). Moreover, parental depression is linked to poorer functioning in children across a range of domains (9).

Emotion regulation is a complex process that involves the ability to identify, evaluate, and manage emotions in a way that is adaptive and socially suitable (10). In children, emotion regulation is influenced by many elements, including their developmental level, neurobiological factors, and social interactions with their parents (11, 12). Emotion dysregulation (ED) is an important transdiagnostic construct characterized by difficulties in regulating the quality and intensity of emotions (13). It is associated with psychopathology, including attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder, personality disorders, self-injurious behaviors, and suicidality (13, 14). ED can affect up to a third of children/adolescents who seek mental health services (15), carries significant morbidity, and increases the risk of developing adult psychiatric disorders (16). Indeed, ED-related behaviors, such as severe tantrums and outbursts, often forecast long-lasting mood/behavior problems and warrant early intervention (12). The relationship between ED and psychopathology is intricate as ED acts both as a mediator and a predictor of outcomes in psychiatric disorders among children/adolescents (13).

While a strong link exists between parental depression and an increased risk of psychiatric disorders in children (2, 3), emerging research is shedding light on the crucial and complex relationship between parental depression and ED in children (17). One recent study found that children of depressed parents exhibit less adaptive emotion regulation strategies compared with children of non-depressed parents (18). While this relationship is likely complex and multifaced, certain parenting behaviors haven been implicated, and parent–child interactions play a significant role in shaping children’s ability to self-regulate (19). Specifically, parental warmth, sensitivity, and proper scaffolding are significantly related to children’s adaptive self-regulation (20, 21). The literature also suggests that depressed parents tend to engage in more negative parenting behaviors (22–24), which may explain how parental depression impacts emotion regulation in children.

Moreover, ED has emerged as an important factor that could contribute to the intergenerational transmission of depression from parents to children, in addition to heritability, intrinsic neurobiology, negative parental behaviors/affect, and child-related stressful events (25). Research indicates that affective and cognitive (emotion regulation) difficulties in children of depressed parents increase their own risk of depression (18), and child dysregulation is a predictor of depression at later developmental time points (26–28).

Given the high-morbidity, transdiagnostic nature of ED and its role in the development of psychopathology, it is important, from an intervention and prevention perspective, to understand what variables mediate and moderate the complex relationship between parental depression and ED in children. This knowledge is, in turn, essential to developing prevention and intervention targets and strategies for children of depressed parents.

Mediators reflect the mechanisms of transmission from parental depression to ED in their children. Identifying these variables helps in determining potential targets of evidence-based interventions, especially early on (29). Moderators define groups of children who are at a higher or a lower risk of experiencing ED due to parental depression (29). Identifying these groups helps in directing interventions to those who need them the most. Mediators therefore highlight pathways that should be targeted by interventions, while moderators help identify who need these interventions.

A recent systematic review and meta-analysis summarized important preventive interventions for children of depressed parents and highlighted the need for more research on preventive intervention. The authors emphasized the importance of understanding which intervention characteristics are the most effective and called for further research into potentially moderating factors (30).

The aims of this study were to systematically explore the possible mediators and moderators of the relationship between parental depression and ED in children. To the best of our knowledge, there are no studies that examined this topic. The results would contribute to the development of effective prevention and intervention strategies.

The protocol of this systematic review was registered with the International Prospective Register of Systematic Reviews PROSPERO, registration no. CRD42024502390.

This study systematically reviewed moderators and mediators of the relationship between parental depression and ED in children. The child’s 5-HTTLPR genotype, the severity of parental depression, and the parent–child DBV were significant moderators. The child’s unhealthy diet at age 3 years, parenting stress, and infant EEG alpha asymmetry were significant mediators.

The genetic correlates of ED in the pediatric population remain relatively understudied. However, the finding of the child’s 5-HTTLPR polymorphism as a moderator is interesting and aligns with the existing literature on the genetic underpinnings of ED (42). The serotonin transporter gene (5-HTT) and a polymorphic serotonin transporter-linked polymorphic region modulate serotonin synaptic signaling during neurotransmission (43). There are three variants of 5-HTTLPR alleles: the short (S) allele, the long-rs25531(G) (La) allele, and the long-rs25531(A) (La) allele. Compared with the (La) allele variant carriers, the short (S) allele and the long (Lg) allele express lower mRNA transcriptions of the serotonin transporter (44). This polymorphism appears to be correlated with the severity of mood dysregulation and affective reactivity (45). A meta-analysis has indeed shown that 5-HTTLPR polymorphism is responsible for 10% of the variance in amygdala activation (46), a key brain region involved in the processing of emotions (47). Children who are carriers of S alleles exhibit increased amygdala during processing of emotionally negative stimuli compared with individuals with homozygous L alleles (48). It is worth noting that this genetic vulnerability to ED appears to be susceptible to the moderating and mediating influences of the environment (49).

Other genetic factors have been identified in relation to emerging emotion regulation problems in youth. For instance, one study showed that carriers of the Val158Met polymorphism of the catechol-O-methyltransferase (COMT) gene, which regulates frontal dopaminergic activity, tend to be more impulsive in decision-making than non-carriers (50). Another study found that the DRD2 Taq A1 allele of the dopamine receptor gene is associated with increased sensitivity and emotional responsiveness to negative feedback while simultaneously reducing sensitivity to positive feedback (51). To our knowledge, these studies did not incorporate the impact of parental mental health in their work. Depression characteristics such as severity, duration, and timing may play a role in the context of these genetic factors. Therefore, a better understanding of the interplay between parental depression and genetic vulnerability to dysregulation in children is a critical area for future research. The study identified in this review emphasizes the early impact of maternal depression on children who carry the S/LG genotypes. These children exhibited higher levels of dysregulation as a function of exposure to greater levels of prenatal depression. Consequently, interventions tailored to this population at a young age may be a promising area for future investigation.

Another biological variable identified was the infant’s PAA on EEG, which highlights a biological vulnerability to dysregulation beyond mother–child effects and environmental factors (39). Interestingly, PAA is also found among children with ADHD who experience ED (52). Further exploration of the genetic and biological background of ED is an important area of research in order to identify biomarkers and to develop tailored and personalized treatments for children and adolescents with mood disorders (42).

Two studies examined the potential moderating role of parental depression, but only one study found a statistically significant moderating effect. Although both studies assessed participants at several time points, the follow-up durations differed (4 vs. 2 years.), which may have accounted for the differences in the findings. Another potential explanation is that the youth were of different ages when the outcome was measured (teenagers compared to toddlers). It is well established that the severity and the chronicity of parental depression are correlated with more severe internalizing and externalizing problems in children (8), and given the association between ED and psychopathology (13), it is not surprising that maternal depression severity emerged as a moderator of dysregulation during adolescence. Adolescence is indeed a critical period for social and emotional development, and the parent–adolescent relationship specifically shapes adolescents’ social and emotional wellbeing (53). For example, adolescents who struggle to communicate with their parents about their difficulties are more likely to experience emotional/behavioral difficulties (54), and elevated levels of parent–teen conflict, including hostility, are associated with externalizing and internalizing disorders (55). Mothers who experience more severe depression may therefore engage in more negative interactions with their teenagers, potentially contributing to increased ED. Consistent with these findings, one of the included studies found that mothers’ parenting stress mediated the relationship between postnatal depression and child dysregulation. This finding is in line with the existing literature, which links parenting stress to child behavior problems (56). Notably, this study assessed parents when their children were very young (12 months old). This highlights the importance of evaluating parenting stress as part of the routine care of young children and during the evaluation and treatment of depressed parents of young children.

There is strong evidence in the literature suggesting that parenting factors, such as parental rejection and control, contribute to the relationship between parental depression and subsequent youth psychopathology (23, 24). This review found that DBV was associated with greater dysregulation among toddlers when their parents exhibited high levels of depression, emphasizing the significance of parent–child interactions across developmental years. The early years lay the stage for later emotion regulation, and the caregiver–child interaction is an important starting point as it influences children’s mental health. Positive caregiver–child relationships improve the emotional security and self-esteem of the child and promote the development of social skills and adaptive emotion regulation strategies (57). It is therefore important to consider parental depression whenever a child is experiencing deficits in emotion regulation strategies, as the root of their difficulties may be related to the parent rather than the child. It is equally important to be mindful of depressive symptoms in these children as negative interactions with parents appear to be more common among depressed preschoolers compared with healthy ones (58). While the study by Gonzalez did not find maternal affective discourse to act as a mediator, it did uncover an association between maternal depression and maternal availability (40), whereby mothers experiencing depression were less likely to be emotionally available or to promote positive affect toward their child. Research has shown that maternal emotional unavailability is associated with poor emotion regulation in children (59). One potential explanation for the results in Gonzalez may be the relatively short follow-up time and the impact of maternal affective discourse may not have been apparent on such a young population.

One of the included studies did not find a mediating effect for toddlers’ attachment insecurity. However, there was an indirect effect, whereby higher attachment insecurity in toddlers at 36 months predicted dysregulation at the age of 48 months. While this finding does not qualify as mediation, it highlights the role of a child’s attachment in shaping their regulation strategies. Research suggests that disorganized/controlling attachment, rather than insecure attachment, is correlated with maternal depression (60).

The finding that an unhealthy diet mediated the relationship between maternal depression and the subsequent ED is particularly noteworthy as it highlights the importance of considering parental care beyond parenting behaviors and extends to nutrition/diet. Studies examining the physical health of the children of depressed mothers suggest that maternal depression, specifically during the postpartum period, appears to be associated with more frequent acute child healthcare (emergency visits) than regular follow-up clinic visits (61). Furthermore, compared with infants of mothers who are not depressed, those of depressed mothers are more likely to experience illness, pain, and higher morbidity and mortality (62). Poor dietary habits can therefore be viewed as a component of maternal care that influences the health of a child. Incorporating education about the importance of diet during prenatal or postnatal care and screening for dietary habits in the children of depressed parents may be important for the prevention of ED. Indeed, a recent systematic review has highlighted a consistent cross-sectional association between unhealthy dietary patterns and worse mental health in childhood and adolescence (63), and one interesting pilot study on micronutrient treatment for children with emotional and behavioral dysregulation showed behavioral improvement through better communication with parents and less impulsivity (64).

This systematic review has a number of limitations. It was not possible to conduct a meta-analysis due to the heterogeneity of the included studies. Despite a comprehensive search strategy, only eight studies met the inclusion criteria after full screening. Because of the small number of studies, the obtained results cannot be generalized to various settings or across different cultural and socioeconomic backgrounds and may limit the strength of our conclusions. Due to the absence of gender-based breakdown of the results, we are unable to elaborate on a potential influence of children’s biological sex on the relationship between parental depression and children’s dysregulation. One of the included studies (36) incorporated an analysis of gender, with the results showing a differential impact of parental depression in girls (36). In general, women are more likely to experience internalizing problems such as anxiety and depression, while men tend to present with externalizing problems such as aggression and impulsivity (65). This distinct susceptibility to types of emotional and behavioral problems in women and men are potentially linked to the different forms of ED and may also have a differential impact on parental perceived self-efficacy, a key predictor of positive and successful parenting (66). There is therefore a need for more focused studies on the role of children’s gender in this relationship. Lastly, six out of the eight included studies focused exclusively on mothers, further limiting the generalizability of the findings to fathers. Paternal depression may entail distinct outcomes for children or involve different mechanisms in influencing children’s emotion regulation, and there is a need for more research on fathers.

In conclusion, this systematic review is, to our knowledge, the first to examine mediators and moderators of the relationship between parental depression and ED in children. The findings highlight the importance of focusing on the children of depressed parents as a vulnerable group who are at increased risk of developing ED. Parental depression severity, diet, and parenting stress emerged as important variables. Further research is needed to evaluate specific parenting factors as potential mediators. Future research should also explore how cultural and societal values and characteristics influence youth emotion regulation, which is important for the development of adequately tailored interventions.