| Summary: | Background: Crises like a pandemic can exacerbate maternal and child depressive symptoms. The relationship between a pre-existing maternal dangerous world belief (BDWPre) with subsequent maternal (DEPPost_Mat) and child depressive symptoms (DEPPost_Child) during the actual crisis, and related mechanisms, remain unclear. This study 1) examines associations between BDWPre, DEPPost_Mat and DEPPost_Child, and 2) explores moderating and mediating roles of COVID-19 stress and pre-pandemic maternal depressive symptoms (DEPPre_Mat), along with the mediating effect of household conflict (HCpost). Methods: This cohort data were from the Singapore PREconception Study of Long-Term Maternal and Child Outcomes, including 90 complete cases and 373 imputed cases. Multiple linear regression detected longitudinal associations between BDWPre, DEPPost_Mat, and DEPPost_Child, with COVID-19 stress and DEPPre_Mat as moderators. Structural equation modeling tested mediating roles of COVID-19 stress, DEPPre_Mat, and HCpost; insensitive maternal behavior was examined as an additional mediator. Results: There were total associations of BDWPre with DEPPost_Mat (β = 0.172, 90 % CI [0.039, 0.306]) and DEPPost_Child (β = 0.161, 90 % CI [0.031,0.291]). DEPPre_Mat directly associated with an increase in DEPPost_Mat (β = 0.361, 90 % CI [0.248, 0.475]) and DEPPost_Child (β = 0.262, 90 % CI [0.121, 0.401]). COVID-19 stress and HCPost sequentially mediated the association between DEPPre_Mat and DEPPost_Mat, and this relationship could be independently mediated by the HCPost. Conclusions: Early interventions for pre-existing maternal depressive symptoms and BDW are critical to protect maternal and preschooler mental health during crises. Interventions prioritizing household conflict, alongside crises-related stress, livelihood impacts, and media exposure, may be beneficial for susceptible preschoolers and their mothers during crises.
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