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Background: Parental depression and anxiety are relevant factors that may influence child externalizing and internalizing behavior; also influenced by stigmatized knowledge about such mental illnesses. Objectives: To identify which instruments were used in studies on the effects of parental depression and anxiety on child behavior from 6 to 12 years old; to analyze the main results in offspring’s behaviors on articles published between 2011 to 2019. Methods: we did a literature review searching PubMed, BVS, ISI, and Scopus databases; keywords: “Maternal Depression”, “Maternal Anxiety”, “Paternal Depression”, “Paternal Anxiety”, “Mother’s (also Mothers’) Depression”, “Mother’s (also Mothers’) Anxiety”, “Father’s (also Fathers’) Depression”, “Father’s (also Fathers’) Anxiety”, “Parental Depression”, “Parental Anxiety” AND “Child Behavior”, in Portuguese and English. Results: We found 1,500 articles, after applying the inclusion criteria, n = 23 were selected and analyzed. 78.3% of studies were performed with mothers, 17.4% with both parents, and 0% with fathers alone. Different instruments were used to assess depression or anxiety in parents, and child behavior. Discussion: studies that included both parents and parental anxiety assessments were scarce; no study in this review evaluated only fathers. Social abilities, personality traits, self-conceptions, and knowledge about anxiety and depression could enhance the quality of studies' results. Gabriel RSN et al. / Arch Clin Psychiatry. 2020;47(6):192-198 193 Gabriel RSN et al. / Arch Clin Psychiatry. 2020;47(6):192-198 The DALYs are the key metric to assess the Global Burden of Disease (GBD)10. Regarding depression and anxiety, no YLL is attributed directly to these conditions in the GDB analyses. Therefore, estimates of YLD represent the total estimated DALYs for these two disorders, accounting depression, the principal contributor to suicide (categorized in GDB as intentional injuries) that represents a total 54,215 YLD10. The World Mental Health Surveys (WMHS)14,15 confirms that in several countries, anxiety disorders are more prevalent than other disorders as mood, substance use, and impulse control disorders. Clinical reports have focused on separation anxiety in children with less attention in adult groups, whereas WMHS presents anxiety as a condition in adults that appears around one-third of childhoodonset cases persisting into adulthood16, 8. Symptoms of anxiety may cause embarrassment, and survey questionnaires may not adequately assess this. Furthermore, differences in the prevalence of mental disorders across the world may indicate different meaningful factors in risk and resilience16. Anxiety disorders frequently precede severe outcomes, such as suicidality in people with depression and are associated with reduced educational succeeding, unstable marriage, decreased health-related quality of life, lower employability, and significant direct and indirect economic costs16,17. Gelaye et al.18 report that perinatal depression in low-income and middle-income countries is prevalent impacting one in four women antepartum and one in five women postpartum. Both antepartum depression and postpartum depression bring severe consequences to offspring’s behaviors, from infancy to adolescence. Maternal depression predicts externalizing behaviors in younger children. Infancy e toddlers may represent periods in which children are more dependent and closer to their parents. Additionally, the environmental risk, such as the pattern of parenting, interactions among genes, cognitive and affective conditions, interpersonal relationships, and biological systems, may relate to externalizing behaviors rather than internalizing behaviors19,3. Moreover, children in middle childhood with mothers that present depressive symptomatology have shown higher rates of mood disorders, internalizing and externalizing problems, and hindrances in emotional development than children of nondepressed mothers3. The middle childhood, represented from 6 to 12 years old, is a difficult period of behavioral, emotional, social, cognitive, and physical development. Positive parenting strategies may model child behavior, prevent conduct problems, and the emergence of depressive symptoms, as well as decrease parental anxiety20,21. Yap and Jorm22 suggest that parenting, children internalizing behaviors, depression, or anxiety may have bidirectional influence; that is, children's behaviors can evoke or bolster some parental behaviors, consequently triggering off a disturbance in children’s mental health. Similarly, Lawrence et al.7 reinforce the need for studies on depression and anxiety via dimensional constructs, such as measures of symptoms and traits, as well the broader domains of such pathologies, to highlight the features of anxiety and depression explained by different mechanisms. Furthermore, the common sense related to the diagnosis of anxiety and depression is usually associated with lack of knowledge, misunderstanding, and stigmas about mental illness, becoming barriers to the promotion of mental health.23,24,25 Based on the evidence elucidated in previous studies on child behavior and parental anxiety and depression, this review aims to: Identify which instruments were used in studies on the effects of parental depression and anxiety on child behavior from 6 to 12 years old, as well as to analyze the main findings in offspring’s externalizing and internalizing behaviors on articles published between 2011 to 2019.

The effects of parental depression and anxiety on child behavior from 6 to 12 years old: a review