In general, depressed mothers experience greater environmental and family risks, and lead riskier lifestyles. Whether the exposure of these risks add to child maladjustment, beyond exposure to maternal depression, is an important unanswered question, and is examined in the present study.

In a total of 9,000 mother-offspring pairs in the Avon Longitudinal Study of Parents and Children, we examined (i) if children of depressed mothers had higher risk exposures than children of non-depressed mothers (32 weeks gestation, child age 1.5 years); (ii) whether maternal depression increased risk for diagnoses of externalizing and internalizing disorders (child age 7.5 years); (iii) the decrease in these odds when we controlled for the risk exposures; and (iv) whether risk exposure increased the odds of a diagnosis, above the influence of maternal depression.

Children of depressed mothers were exposed to higher levels of risks and maternal depression increased the risk for diagnoses of both externalizing and internalizing disorders. The decrease in these odds was between 25–50% when controlling for child risk exposures. At the same time, risk exposures to the child significantly increased the odds of both externalizing and internalizing diagnoses, above the influence of maternal depression.

Maladjustment in offspring of depressed mothers is influenced by risk exposures closely associated with maternal mental health, suggesting that these children are “doubly” hit by risk. It is suggested that the present results may aide in interpreting why treating depressed mothers shows certain levels of beneficial effects for children, but not complete remission.