1
|
Vázquez-Vázquez A, Rougeaux E, Dib S, Fewtrell M, Wells JC. The impact of maternal mood and economic stress during Covid-19 pandemic on infant behaviour: Findings from the cross-sectional UK Covid-19 New Mum Study. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003095. [PMID: 38630667 PMCID: PMC11023226 DOI: 10.1371/journal.pgph.0003095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 03/18/2024] [Indexed: 04/19/2024]
Abstract
The UK Covid-19 New Mum Study (cross-sectional study) recorded maternal experience during the early stages of the pandemic. Our previous analyses showed that the pandemic and 2020 national lockdown negatively impacted maternal mental health. Here, we describe changes in infant behaviour (crying and fussiness) reported by the mother during the Covid-19 pandemic compared to beforehand, and test whether these changes are associated with maternal variables (mental health, coping, financial insecurity, income and household support). We included only responses of mothers whose infants were born before the pandemic started (n = 2,031). Composite scores for maternal mental health and coping were obtained using principal components analysis. Multivariable logistic regression analysis was used to test whether maternal mood and coping and household financial stresses were associated with changes in infant behaviour considered negative (becoming fussier, crying more). Adjusting for confounders, the odds of the infant being fussier and crying more increased by 52% (OR = 1.52, 95% CI = 1.35;1.72) and 64% (OR = 1.64, 95% CI = 1.38;1.95), respectively, if the mother experienced poorer mental health. If the mother coped better and had more time to focus on her health and interests, the odds of these outcomes decreased by 27% (OR = 0.73, 95% CI = 0.65;0.83) and 23% (OR = 0.77, 95% CI = 0.65;0.91), respectively. Mothers who reported that, during the lockdown, household chores were more equally divided 'to a high extent' had 40% (OR = 0.60, 95% CI = 0.39;0.92) lower odds of reporting that their babies became fussier. Reporting major/moderate impact on food expenses was associated with the infant crying more (OR = 2.52, 95% CI = 1.16;5.50). Our results are consistent with previous studies showing that maternal wellbeing plays a significant role in children's behavioural changes during lockdowns. We need strategies to improve mental health and enable women to develop the skills to maintain resilience and reassure their children in challenging times.
Collapse
Affiliation(s)
- Adriana Vázquez-Vázquez
- Childhood Nutrition Research Centre, Population, Policy & Practice Research and Teaching Programme, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Emeline Rougeaux
- Childhood Nutrition Research Centre, Population, Policy & Practice Research and Teaching Programme, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Sarah Dib
- Childhood Nutrition Research Centre, Population, Policy & Practice Research and Teaching Programme, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Mary Fewtrell
- Childhood Nutrition Research Centre, Population, Policy & Practice Research and Teaching Programme, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Jonathan C. Wells
- Childhood Nutrition Research Centre, Population, Policy & Practice Research and Teaching Programme, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| |
Collapse
|
2
|
Lahtela H, Flykt M, Nolvi S, Kataja EL, Eskola E, Tervahartiala K, Pelto J, Carter AS, Karlsson H, Karlsson L, Korja R. Mother-Infant Interaction and Maternal Postnatal Psychological Distress Associate with Child's Social-Emotional Development During Early Childhood: A FinnBrain Birth Cohort Study. Child Psychiatry Hum Dev 2024:10.1007/s10578-024-01694-2. [PMID: 38625659 DOI: 10.1007/s10578-024-01694-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/05/2024] [Indexed: 04/17/2024]
Abstract
We studied the effects of mother-infant interaction and maternal pre- and postnatal psychological distress on children's social-emotional problems and competences, as well as whether interaction quality moderates the association between distress and children's outcomes. Maternal pre- and postnatal psychological distress were measured using the SCL and EPDS questionnaires, whereas mother-infant interaction was measured when the child was 8 months old using the EA Scales. Children's social-emotional development was measured using the BITSEA questionnaire at 2 years old and using the SDQ questionnaire at 4 years old, where higher maternal structuring was associated with fewer social-emotional problems in children and higher maternal sensitivity was associated with greater social-emotional competence in children at 2 years old. Further, higher postnatal distress was found associated with greater social-emotional problems at 2 years old, though neither these effects nor moderating effects at 4 years old were observed after multiple-comparison corrections. Our findings support direct associations of both mother-infant interaction and maternal postnatal psychological distress with children's social-emotional development during toddlerhood.
Collapse
Affiliation(s)
- Hetti Lahtela
- FinnBrain Birth Cohort Study, Department of Clinical Medicine, Turku Brain and Mind Center, University of Turku, Turku, Finland.
- Department of Psychology, University of Turku, Turku, Finland.
- Centre for Population Health Research, Turku University Hospital and University of Turku, Turku, Finland.
| | - Marjo Flykt
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Faculty of Social Sciences (Psychology), Tampere University, Tampere, Finland
| | - Saara Nolvi
- FinnBrain Birth Cohort Study, Department of Clinical Medicine, Turku Brain and Mind Center, University of Turku, Turku, Finland
- Department of Psychology, University of Turku, Turku, Finland
- Turku Institute for Advanced Studies, University of Turku, Turku, Finland
- Centre for Population Health Research, Turku University Hospital and University of Turku, Turku, Finland
- Department of Psychology, University of Jyväskylä, Jyvaskyla, Finland
| | - Eeva-Leena Kataja
- FinnBrain Birth Cohort Study, Department of Clinical Medicine, Turku Brain and Mind Center, University of Turku, Turku, Finland
- Department of Psychology, University of Turku, Turku, Finland
- Centre for Population Health Research, Turku University Hospital and University of Turku, Turku, Finland
| | - Eeva Eskola
- FinnBrain Birth Cohort Study, Department of Clinical Medicine, Turku Brain and Mind Center, University of Turku, Turku, Finland
- Department of Psychology, University of Turku, Turku, Finland
- Department of Psychology, University of Jyväskylä, Jyvaskyla, Finland
- Expert Services, Turku University Hospital, Turku, Finland
| | - Katja Tervahartiala
- FinnBrain Birth Cohort Study, Department of Clinical Medicine, Turku Brain and Mind Center, University of Turku, Turku, Finland
- Department of Psychology, University of Turku, Turku, Finland
- Department of Psychology, University of Jyväskylä, Jyvaskyla, Finland
| | - Juho Pelto
- FinnBrain Birth Cohort Study, Department of Clinical Medicine, Turku Brain and Mind Center, University of Turku, Turku, Finland
- Department of Mathematics and Statistics, University of Turku, Turku, Finland
| | - Alice S Carter
- Department of Psychology, University of Massachusetts Boston, Boston, USA
| | - Hasse Karlsson
- FinnBrain Birth Cohort Study, Department of Clinical Medicine, Turku Brain and Mind Center, University of Turku, Turku, Finland
- Centre for Population Health Research, Turku University Hospital and University of Turku, Turku, Finland
- Department of Psychiatry, University of Turku and Turku University Hospital, Turku, Finland
| | - Linnea Karlsson
- FinnBrain Birth Cohort Study, Department of Clinical Medicine, Turku Brain and Mind Center, University of Turku, Turku, Finland
- Centre for Population Health Research, Turku University Hospital and University of Turku, Turku, Finland
- Department of Pediatrics, Turku University Hospital and University of Turku, Turku, Finland
| | - Riikka Korja
- FinnBrain Birth Cohort Study, Department of Clinical Medicine, Turku Brain and Mind Center, University of Turku, Turku, Finland
- Department of Psychology, University of Turku, Turku, Finland
- Department of Psychology, University of Jyväskylä, Jyvaskyla, Finland
| |
Collapse
|
3
|
Obikane E, Yamana H, Ono S, Yasunaga H, Kawakami N. "Association between perinatal mood disorders of parents and child health outcomes". Arch Womens Ment Health 2024:10.1007/s00737-024-01463-z. [PMID: 38589683 DOI: 10.1007/s00737-024-01463-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 03/28/2024] [Indexed: 04/10/2024]
Abstract
PURPOSE Perinatal mood disorders affect both parents, impacting their children negatively. Little is known on the association between parental perinatal mood disorders and pediatric outcomes in Japan considering relevant covariates. Our objective was to investigate the association between paternal and maternal perinatal mood disorders and adverse physical and psychological child outcomes by the age of 36 months, adjusting for covariates such as the child's sex, age of parent at child's birth, perinatal mood disorders of the other parent, and perinatal antidepressant use. METHODS We identified parents in the JMDC Claims Database in Japan from 2012 to 2020. Perinatal mood disorders were defined using International Classification of Diseases, 10th codes for mood disorders during the perinatal period combined with psychiatric treatment codes. We evaluated the association between parental perinatal mood disorders and pediatric adverse outcomes by the age of 36 months using Cox proportional hazard models adjusted for the covariates. RESULTS Of the 116,423 father-mother-child triads, 2.8% of fathers and 2.3% of mothers had perinatal mood disorders. Paternal perinatal mood disorders were not significantly associated with adverse child outcomes. After adjusting for paternal perinatal mood disorders and antidepressant use, maternal perinatal mood disorders were associated with delayed motor development, language development disorders, autism spectrum disorders, and behavioral and emotional disorders (adjusted hazard ratio [95% confidence interval]: 1.65 [1.01-2.69], 2.26 [1.36-3.75], 4.16 [2.64-6.55], and 6.12 [1.35-27.81], respectively). CONCLUSIONS Paternal perinatal mood disorders were not associated with adverse child outcomes in this population. Maternal perinatal mood disorders were associated with multiple child outcomes.
Collapse
Affiliation(s)
- Erika Obikane
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Bunkyo, Japan.
- Department of Social Medicine, National Center for Child Health and Development, Setagaya, Japan.
| | - Hayato Yamana
- Department of Clinical Epidemiology and Health Economics, Graduate School of Medicine, The University of Tokyo, Bunkyo, Japan
- Data Science Center, Jichi Medical University, Shimotsuke, Japan
| | - Sachiko Ono
- Department of Eat-loss Medicine, Graduate School of Medicine, The University of Tokyo, Bunkyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, Graduate School of Medicine, The University of Tokyo, Bunkyo, Japan
| | - Norito Kawakami
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Bunkyo, Japan
| |
Collapse
|
4
|
Gordon SH, Lee S, Steenland MW, Deen N, Feinberg E. Extended Postpartum Medicaid In Colorado Associated With Increased Treatment For Perinatal Mood And Anxiety Disorders. Health Aff (Millwood) 2024; 43:523-531. [PMID: 38560800 DOI: 10.1377/hlthaff.2023.01441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Perinatal mood and anxiety disorders (PMAD), a leading cause of perinatal morbidity and mortality, affect approximately one in seven births in the US. To understand whether extending pregnancy-related Medicaid eligibility from sixty days to twelve months may increase the use of mental health care among low-income postpartum people, we measured the effect of retaining Medicaid as a low-income adult on mental health treatment in the postpartum year, using a "fuzzy" regression discontinuity design and linked all-payer claims data, birth records, and income data from Colorado from the period 2014-19. Relative to enrolling in commercial insurance, retaining postpartum Medicaid enrollment was associated with a 20.5-percentage-point increase in any use of prescription medication or outpatient mental health treatment, a 16.0-percentage-point increase in any use of prescription medication only, and a 7.3-percentage-point increase in any use of outpatient mental health treatment only. Retaining postpartum Medicaid enrollment was also associated with $40.84 lower out-of-pocket spending per outpatient mental health care visit and $3.24 lower spending per prescription medication for anxiety or depression compared with switching to commercial insurance. Findings suggest that extending postpartum Medicaid eligibility may be associated with higher levels of PMAD treatment among the low-income postpartum population.
Collapse
Affiliation(s)
- Sarah H Gordon
- Sarah H. Gordon , Boston University, Boston, Massachusetts
| | | | | | | | | |
Collapse
|
5
|
Fan X, Wu N, Tu Y, Zang T, Bai J, Peng G, Liu Y. Perinatal depression and infant and toddler neurodevelopment: A systematic review and meta-analysis. Neurosci Biobehav Rev 2024; 159:105579. [PMID: 38342472 DOI: 10.1016/j.neubiorev.2024.105579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 01/30/2024] [Accepted: 02/07/2024] [Indexed: 02/13/2024]
Abstract
Many studies have focused on the effect of perinatal depression on neurodevelopment among children and adolescents. However, only a few studies have explored this relationship in infants and toddlers with inconsistent results. We performed a systematic review and meta-analysis to evaluate the association between perinatal depression and infant and toddler neurodevelopment during the first two postnatal years. Twenty-three studies were included in this meta-analysis. Perinatal depression was associated with poorer cognitive (Cohen's d = -0.19, SE= 0.06, 95% CI = -0.30 to -0.08), language (Cohen's d = -0.24, SE = 0.09, 95% CI = -0.40 to -0.07), and motor (Cohen's d = -0.15, SE = 0.05, 95% CI = -0.26 to -0.05) development. Subgroup analyses showed that the types of maternal depression (prenatal depression vs. postnatal depression), the method of measuring maternal depression (rating scale vs. diagnostic interview), and the time interval between assessment of exposure and outcome had an impact on the observed effect about neurodevelopment of infants and toddlers. In addition, the results of our study pointed to a stronger significant association between prenatal depression and cognitive, language, and motor delays in infants and toddlers, whereas the association between postnatal depression and cognitive, language, and motor delays in infants and toddlers was not statistically significant. In conclusion, this study provided convincing evidence that the perinatal window is a sensitive period for offspring neurodevelopment.
Collapse
Affiliation(s)
- Xiaoxiao Fan
- Wuhan University School of Nursing, Wuhan University, 169 Donghu Road, Wuhan 430071, China
| | - Ni Wu
- Wuhan University School of Nursing, Wuhan University, 169 Donghu Road, Wuhan 430071, China
| | - Yiming Tu
- Wuhan University School of Nursing, Wuhan University, 169 Donghu Road, Wuhan 430071, China
| | - Tianzi Zang
- Wuhan University School of Nursing, Wuhan University, 169 Donghu Road, Wuhan 430071, China
| | - Jinbing Bai
- Emory University Nell Hodgson Woodruff School of Nursing, 1520 Clifton Road, Atlanta, GA 30322, USA
| | - Ganggang Peng
- Shenzhen Second People's Hospital, Shenzhen 518000, China
| | - Yanqun Liu
- Wuhan University School of Nursing, Wuhan University, 169 Donghu Road, Wuhan 430071, China.
| |
Collapse
|
6
|
Seipp V, Hagelweide K, Stark R, Weigelt S, Christiansen H, Kieser M, Otto K, Reck C, Steinmayr R, Wirthwein L, Zietlow A, Schwenck C. Parenting stress in parents with and without a mental illness and its relationship to psychopathology in children: a multimodal examination. Front Psychiatry 2024; 15:1353088. [PMID: 38374978 PMCID: PMC10875068 DOI: 10.3389/fpsyt.2024.1353088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 01/18/2024] [Indexed: 02/21/2024] Open
Abstract
Objective Children of parents with a mental illness are at heightened risk to develop a mental illness themselves due to genetics and environmental factors. Although parenting stress (PS) is known to be associated with increased psychopathology in parents and children, there is no study investigating PS multimodally in a sample of parents with a mental illness. This study aims to compare PS of parents with and without a mental illness and further to examine the relationship between PS and psychopathology of children. Methods Participants were parents with a mental illness and parents without a mental illness and their children aged four to sixteen years. We assessed PS multimodally using a questionnaire, parents' evaluation of children's behavior (relational schemas) and psychophysiological arousal of parents during free speech task. Results Self-reported PS was increased, and evaluation of children's behavior was more negative and less positive in parents with a mental illness compared to parents without a mental illness. Children's psychopathology was associated with self-reported PS and relational schemas of parents. Regarding psychophysiological arousal, parents with a mental illness showed reduced reactivity in heart rate from baseline to free speech task in comparison to parents without a mental illness. Conclusions Our findings highlight the importance of implementing intervention programs to reduce PS for parents and children. In particular, parents with a mental illness might benefit from specific intervention programs in order to interrupt the transgenerational transmission of mental disorders.
Collapse
Affiliation(s)
- Vanessa Seipp
- Department of Clinical Child and Adolescent Psychology, Justus Liebig University Giessen, Giessen, Germany
| | - Klara Hagelweide
- Department of Rehabilitation Sciences, Technical University Dortmund, Dortmund, Germany
| | - Rudolf Stark
- Department of Psychotherapy and Systems Neuroscience, Justus-Liebig University Giessen, Giessen, Germany
| | - Sarah Weigelt
- Department of Rehabilitation Sciences, Technical University Dortmund, Dortmund, Germany
| | - Hanna Christiansen
- Department of Psychology, Clinical Child and Adolescent Psychology, Philipps-University Marburg, Marburg, Germany
| | - Meinhard Kieser
- Institute of Medical Biometry, University of Heidelberg, Heidelberg, Germany
| | - Kathleen Otto
- Department of Work and Organizational Psychology, Philipps-University Marburg, Marburg, Germany
| | - Corinna Reck
- Department of Psychology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Ricarda Steinmayr
- Department of Psychology, Technical University Dortmund, Dortmund, Germany
| | - Linda Wirthwein
- Department of Psychology, Technical University Dortmund, Dortmund, Germany
| | - Anna–Lena Zietlow
- Clinical Child and Adolescent Psychology, Department of Psychology, Technische Universität Dresden, Dresden, Germany
| | - Christina Schwenck
- Department of Clinical Child and Adolescent Psychology, Justus Liebig University Giessen, Giessen, Germany
| |
Collapse
|
7
|
Baird H, Harris RA, Santos HP. The Effects of Maternal Perinatal Depression on Child IQ: A Systematic Review. Matern Child Health J 2023:10.1007/s10995-023-03715-3. [PMID: 37278844 DOI: 10.1007/s10995-023-03715-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND Maternal perinatal depression has been shown to have long lasting effects on children's development. Studies have described the relationship of perinatal depression on children's cognition, especially negative effects on intelligence quotient (IQ). However, a recent examination of the current studies to discern the patterns and strength of associations between perinatal depression and child IQ is not available. OBJECTIVE The purpose of this systematic review is to discern the effects of perinatal depression, prenatally and within the first 12 months of the postpartum period, on the IQ of the child aged 0-18 years old. METHODS We searched the electronic databases: PubMed and CINAHL. We identified 1633 studies, and included 17 studies in the final review based on pre-determined criteria. After the data was extracted, we assessed the strength of the study using the national heart, lung, and blood institute quality assessment tool for observational cohort and cross-sectional studies. This systematic review had a total sample of 10,757 participants. RESULTS Across the studies, we identified a relationship between limited maternal responsiveness due to postpartum depression and a decrease in full IQ scores in younger children. Male children were found to be more sensitive to the postpartum depression, resulting in a decrease in IQs, in comparison to female children. CONCLUSIONS Policies should be implemented to identify women suffering from perinatal depression to mitigate the effects of the disorder for both the mother and her child.
Collapse
Affiliation(s)
- Hannah Baird
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Hudson P Santos
- School of Nursing & Health Studies, University of Miami, 5030 Brunson Dr, Coral Gables, FL, 33146, USA.
| |
Collapse
|
8
|
Blair LM, Wheeler E, Hutti MH. Social and Behavioral Problems in School-Aged Children After Maternal Postpartum Depression: A Secondary Analysis of Future of Families and Child Wellbeing Study. Matern Child Health J 2023; 27:1081-1088. [PMID: 36988793 PMCID: PMC10440803 DOI: 10.1007/s10995-023-03645-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2023] [Indexed: 03/30/2023]
Abstract
OBJECTIVES To examine the relation between perinatal depression at child age 1 year and behavioral issues and altered social functioning at school age. METHODS The Future of Families (formerly Fragile Families) and Child Wellbeing Study longitudinal cohort age 9 nationally representative urban sample was used to examine associations between maternal depression at child age 1 and child behavior and social functioning at age 9 (n = 2,305 children and their mothers). Measures included the Composite International Diagnostics Interview (depression), Child Behavior Checklist total score (child behavior problems) and social function subscale. Clinical significance of child behavior problems and social function problems were determined by normed T-scores. Analyses included chi square, t-tests, and linear regression using SAS 9.4 Survey procedures. RESULTS Higher household income was associated with lower behavior problem scores (F = 8.76, p < 0.0001, R2 = 0.07. School-aged children whose mothers had major depression at child age 1 (10.8%) were more than twice as likely to have clinically significant behavior problems (OR 2.46, p < 0.0001) than children whose mothers did not have depression (4.1%). Further, children with depressed mothers were more than twice as likely to have clinically significant social function problems than children whose mothers were not depressed (OR = 2.09, p < 0.0001). CONCLUSIONS FOR PRACTICE Children whose mothers were depressed at child age 1 have higher risk of having behavior problems and poor social functioning at age 9. Early and repeated maternal depression screening is needed to treat the disease sooner and attempt to avoid these outcomes.
Collapse
Affiliation(s)
- Lisa M Blair
- College of Nursing, Wayne State University, 5557 Cass Ave 364 Richard Cohn Building, Detroit, MI, 48202, USA.
- Perinatal Research and Wellness Center, University of Kentucky, Kentucky, USA.
| | | | | |
Collapse
|
9
|
Ivanova MY, Achenbach TM, Turner LV. Associations of Parental Depression with Children’s Internalizing and Externalizing Problems: Meta-Analyses of Cross-Sectional and Longitudinal Effects. JOURNAL OF CLINICAL CHILD & ADOLESCENT PSYCHOLOGY 2022; 51:827-849. [DOI: 10.1080/15374416.2022.2127104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
10
|
Smith RD, Shing JSY, Lin J, Bosanquet K, Fong DYT, Lok KYW. Meta-analysis of diagnostic properties of the Whooley questions to identify depression in perinatal women. J Affect Disord 2022; 315:148-155. [PMID: 35931230 DOI: 10.1016/j.jad.2022.07.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 06/16/2022] [Accepted: 07/17/2022] [Indexed: 10/16/2022]
Abstract
BACKGROUND This study's objective was to assess the diagnostic properties of the Whooley questions in identifying depression among perinatal women according to previously published studies. We conducted a systematic review and meta-analysis of studies investigating the diagnostic accuracy of the Whooley questions in perinatal women. METHODS Nine databases were searched in October 2021. All primary studies evaluated the diagnostic properties of the Whooley questions compared with a diagnostic gold standard in women during the perinatal period or, if not identified as being in the perinatal stage within the study, women between 20 weeks' gestation to 4 weeks post-delivery. A bivariate mixed-effects meta-analysis was performed to estimate pooled diagnostic properties and measure heterogeneity. Meta-regression was conducted to evaluate factors contributing to heterogeneity. RESULTS Six studies were included in the review; five were used in the meta-analysis. The pooled sensitivity (95 % confidence interval) was 0.95 (0.81-0.99), pooled specificity was 0.60 (0.44-0.74), pooled positive likelihood ratio was 2.4 (1.6-3.4), pooled negative likelihood ratio was 0.09 (0.02-0.32), and pooled diagnostic odds ratio was 27 (7-106); heterogeneity was substantial (I2 = 0.90, 0.81-1.00). Participant age and setting (community vs. hospital) significantly contributed to heterogeneity. CONCLUSIONS The Whooley questions have high sensitivity but moderate specificity for perinatal women. The Whooley questions are a short and acceptable tool for identifying depression in perinatal women. However, a potential risk exists of incorrectly identifying a high proportion of women as positive. Using the Whooley questions followed by a secondary case-finding tool could reduce the misdiagnosis risk.
Collapse
Affiliation(s)
- Robert D Smith
- School of Nursing, the University of Hong Kong, Hong Kong, China
| | | | - Jessie Lin
- Department of Rehabilitation Sciences, the Hong Kong Polytechnic University, Hong Kong, China
| | - Kate Bosanquet
- Department of Health Sciences, University of York, York YO10 5DD, UK
| | - Daniel Y T Fong
- School of Nursing, the University of Hong Kong, Hong Kong, China
| | - Kris Y W Lok
- School of Nursing, the University of Hong Kong, Hong Kong, China.
| |
Collapse
|
11
|
Reemst K, Ruigrok SR, Bleker L, Naninck EFG, Ernst T, Kotah JM, Lucassen PJ, Roseboom TJ, Pollux BJA, de Rooij SR, Korosi A. Sex-dependence and comorbidities of the early-life adversity induced mental and metabolic disease risks: Where are we at? Neurosci Biobehav Rev 2022; 138:104627. [PMID: 35339483 DOI: 10.1016/j.neubiorev.2022.104627] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 02/15/2022] [Accepted: 03/13/2022] [Indexed: 01/02/2023]
Abstract
Early-life adversity (ELA) is a major risk factor for developing later-life mental and metabolic disorders. However, if and to what extent ELA contributes to the comorbidity and sex-dependent prevalence/presentation of these disorders remains unclear. We here comprehensively review and integrate human and rodent ELA (pre- and postnatal) studies examining mental or metabolic health in both sexes and discuss the role of the placenta and maternal milk, key in transferring maternal effects to the offspring. We conclude that ELA impacts mental and metabolic health with sex-specific presentations that depend on timing of exposure, and that human and rodent studies largely converge in their findings. ELA is more often reported to impact cognitive and externalizing domains in males, internalizing behaviors in both sexes and concerning the metabolic dimension, adiposity in females and insulin sensitivity in males. Thus, ELA seems to be involved in the origin of the comorbidity and sex-specific prevalence/presentation of some of the most common disorders in our society. Therefore, ELA-induced disease states deserve specific preventive and intervention strategies.
Collapse
Affiliation(s)
- Kitty Reemst
- University of Amsterdam, Swammerdam Institute of Life Sciences, Center for Neuroscience, Brain Plasticity Group, Amsterdam, The Netherlands
| | - Silvie R Ruigrok
- University of Amsterdam, Swammerdam Institute of Life Sciences, Center for Neuroscience, Brain Plasticity Group, Amsterdam, The Netherlands
| | - Laura Bleker
- Amsterdam University Medical Center, University of Amsterdam, Department of Epidemiology and Data Science, Amsterdam, The Netherlands
| | - Eva F G Naninck
- University of Amsterdam, Swammerdam Institute of Life Sciences, Center for Neuroscience, Brain Plasticity Group, Amsterdam, The Netherlands
| | - Tiffany Ernst
- Wageningen University, Department of Animal Sciences, Experimental Zoology &Evolutionary Biology Group, Wageningen, The Netherlands
| | - Janssen M Kotah
- University of Amsterdam, Swammerdam Institute of Life Sciences, Center for Neuroscience, Brain Plasticity Group, Amsterdam, The Netherlands
| | - Paul J Lucassen
- University of Amsterdam, Swammerdam Institute of Life Sciences, Center for Neuroscience, Brain Plasticity Group, Amsterdam, The Netherlands; Centre for Urban Mental Health, University of Amsterdam, The Netherlands
| | - Tessa J Roseboom
- Amsterdam University Medical Center, University of Amsterdam, Department of Epidemiology and Data Science, Amsterdam, The Netherlands
| | - Bart J A Pollux
- Wageningen University, Department of Animal Sciences, Experimental Zoology &Evolutionary Biology Group, Wageningen, The Netherlands
| | - Susanne R de Rooij
- Amsterdam University Medical Center, University of Amsterdam, Department of Epidemiology and Data Science, Amsterdam, The Netherlands
| | - Aniko Korosi
- University of Amsterdam, Swammerdam Institute of Life Sciences, Center for Neuroscience, Brain Plasticity Group, Amsterdam, The Netherlands.
| |
Collapse
|
12
|
Sleep, Anxiety, and Vitamin D Status and Risk for Peripartum Depression. Reprod Sci 2022; 29:1851-1858. [DOI: 10.1007/s43032-022-00922-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 03/11/2022] [Indexed: 10/18/2022]
|
13
|
Franta G, Hersh AR, Cirino NH, Caughey AB. Prevention of perinatal depression with counseling in adolescents: a cost-effectiveness analysis. J Matern Fetal Neonatal Med 2022; 35:9593-9599. [PMID: 35282745 DOI: 10.1080/14767058.2022.2049746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The US Preventive Services Task Force recently recommended that clinicians refer all pregnant and postpartum individuals at increased risk of perinatal depression to a counseling intervention. Adolescents are considered a high-risk group for perinatal depression. Therefore, we examined whether it is cost effective for all pregnant adolescents to be referred for preventive counseling. STUDY DESIGN We developed a decision-analytic model using TreeAge Pro software to compare outcomes in pregnant adolescents who received versus did not receive counseling interventions. We used a theoretical cohort of 180,000 individuals, which is the estimated annual number of births to persons ≤ 19 years in the US. Outcomes included perinatal depression, chronic depression, maternal suicide attributed to depression, preterm delivery, neonatal death, cerebral palsy, and sudden infant death syndrome (SIDS), in addition to cost and quality-adjusted life years (QALYs). The willingness-to-pay (WTP) threshold was set to $100,000/QALY. We derived model inputs from the literature, and sensitivity analyses were used to assess robustness of the model. RESULTS A strategy of referral to counseling interventions was cost effective in our theoretical cohort, with 8935 fewer cases of perinatal depression, 1606 fewer cases of chronic depression, 166 fewer preterm deliveries, 4 fewer neonatal deaths, 1 fewer case of cerebral palsy, 20 fewer cases of SIDS. In total, there were 21,976 additional QALYs and cost savings of $223,549,872, making it the dominant strategy (better outcomes with lower costs). We found that counseling interventions remained cost saving until the annual direct and indirect cost of chronic, severe depression was set below $30,000, at which point it became cost effective (baseline input: $182,309). CONCLUSION We found it was cost effective to refer all pregnant adolescents for preventive counseling interventions. Clinicians should develop approaches to identify and refer pregnant adolescents for behavioral counseling to prevent perinatal depression.
Collapse
Affiliation(s)
- Gabriel Franta
- Department of Psychiatry, University of Washington, Seattle, WA, USA
| | - Alyssa R Hersh
- Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR, USA
| | - Nicole H Cirino
- Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR, USA
| | - Aaron B Caughey
- Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR, USA
| |
Collapse
|
14
|
[Personality Models in the Context of Child and Adolescent Psychiatry - Development, Change, Stability and Research Perspectives]. Prax Kinderpsychol Kinderpsychiatr 2022; 71:2-22. [PMID: 35023818 DOI: 10.13109/prkk.2022.71.1.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Personality models play an important role for the etiological understanding of abnormal development in clinical settings. In this selective review, relevant personality models are presented and, in particular, their developmental dynamics and adaptability over the life span, starting in childhood, are considered in detail. The focus is on the developmental psychopathological perspective of processes of ego-resiliency and self-regulation between the poles of disposition and social environment. This is particularly obvious in the discussion of developmental path models of personality dysfunction with experiences of abuse or disorganized attachment in the child's history. Psychopathologically, an ongoing impairment of self-regulation often results in stable patterns of maladaptation, which leads in the case of purely symptomatic treatment usually only to temporary behavioral modifications. On the other hand, the changeability of pathological personality traits through the use of targeted intervention approaches will favour of a positive outcome and contradicts a deterministic stability of personality characteristics. For future research perspectives in developmental psychopathology, various theoretical personality constructs are discussed and linked to clinical observations.
Collapse
|
15
|
Smith RD, Hung SC, Goh J, Ip HL, Fong DYT, Ali S, Wilson CA, Lok KYW. Protocol of a systematic review and network meta-analysis for the prevention and treatment of perinatal depression. BMJ Open 2021; 11:e048764. [PMID: 34635517 PMCID: PMC8506850 DOI: 10.1136/bmjopen-2021-048764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 10/01/2021] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Perinatal depression is common and can often lead to adverse health outcomes for mother and child. Multiple pharmacological and non-pharmacological treatments have been evaluated against usual care or placebo controls in meta-analyses for preventing and treating perinatal depression compared. It is not yet established which of these candidate treatments might be the optimal approach for prevention or treatment. METHODS AND ANALYSIS A systematic review and Bayesian network meta-analyses will be conducted. Eight electronic databases shall be searched for randomised controlled trials that have evaluated the effectiveness of treatments for prevention and/or treatment of perinatal depression. Screening of articles shall be conducted by two reviewers independently. One network meta-analysis shall evaluate the effectiveness of interventions in preventing depression during the perinatal period. A second network meta-analysis shall compare the effectiveness of treatments for depression symptoms in women with perinatal depression. Bayesian 95% credible intervals shall be used to estimate the pooled mean effect size of each treatment, and surface under cumulative ranking area will be used to rank the treatments' effectiveness. ETHICS AND DISSEMINATION We shall report our findings so that healthcare providers can make informed decisions on what might be the optimal approach for addressing perinatal depression to prevent cases and improve outcomes in those suffering from depression through knowledge exchange workshops, international conference presentations and journal article publications. PROSPERO REGISTRATION NUMBER CRD42020200081.
Collapse
Affiliation(s)
- Robert David Smith
- School of Nursing, University of Hong Kong Li Ka Shing Faculty of Medicine, Hong Kong, Hong Kong
| | - Sze Chai Hung
- School of Nursing, University of Hong Kong Li Ka Shing Faculty of Medicine, Hong Kong, Hong Kong
| | - Joyce Goh
- School of Nursing, University of Hong Kong Li Ka Shing Faculty of Medicine, Hong Kong, Hong Kong
| | - Hoi Lam Ip
- School of Nursing, University of Hong Kong Li Ka Shing Faculty of Medicine, Hong Kong, Hong Kong
| | - Daniel Yee Tak Fong
- School of Nursing, University of Hong Kong Li Ka Shing Faculty of Medicine, Hong Kong, Hong Kong
| | - Shehzad Ali
- Epidemiology and Biostatistics, University of Western Ontario, London, Ontario, Canada
| | | | - Kris Yuet-Wan Lok
- School of Nursing, University of Hong Kong Li Ka Shing Faculty of Medicine, Hong Kong, Hong Kong
| |
Collapse
|
16
|
Memon RI, Safdar B, Hafeez H, Abbas EF, Waqas A, Azeem MW, Naveed S. The Association Between Peripartum Depression and Childhood Resilience: A Systematic Review. Psychiatr Ann 2021. [DOI: 10.3928/00485713-20210614-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
17
|
Tuthill EH, Reynolds CME, McKeating A, O'Malley EG, Kennelly MM, Turner MJ. Maternal obesity and depression reported at the first antenatal visit. Ir J Med Sci 2021; 191:1241-1250. [PMID: 34131811 PMCID: PMC9135864 DOI: 10.1007/s11845-021-02665-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 05/26/2021] [Indexed: 11/28/2022]
Abstract
Background Maternal obesity and depression are common and both have been associated with adverse pregnancy outcomes. Aims The aim of this observational study was to examine the relationship between maternal body mass index (BMI) category and self-reported depression at the first antenatal visit. Methods Women who delivered a baby weighing ≥ 500 g over nine years 2009–2017 were included. Self-reported sociodemographic and clinical details were computerised at the first antenatal visit by a trained midwife, and maternal BMI was calculated after standardised measurement of weight and height. Results Of 73,266 women, 12,304 (16.7%) had obesity, 1.6% (n = 1126) reported current depression and 7.5% (n = 3277) multiparas reported a history of postnatal depression. The prevalence of self-reported maternal depression was higher in women who had obesity, > 35 years old, were socially disadvantaged, smokers, had an unplanned pregnancy and used illicit drugs. After adjustment for confounding variables, obesity was associated with an increased odds ratio (aOR) for current depression in both nulliparas (aOR 1.7, 95% CI 1.3–2.3, p < 0.001) and multiparas (aOR 1.8, 95% CI 1.5–2.1, p < 0.001) and postnatal depression in multiparas (aOR 1.4, 95% CI 1.3–1.5, p < 0.001). The prevalence of current depression was higher in women with moderate/severe obesity than in women with mild obesity (both p < 0.001). Conclusions We found that self-reported maternal depression in early pregnancy was independently associated with obesity. The prevalence of depression increased with the severity of obesity. Our findings highlight the need for implementation of strategies and provision of services for the prevention and treatment of both obesity and depression. Supplementary information The online version contains supplementary material available at 10.1007/s11845-021-02665-5.
Collapse
Affiliation(s)
- Emma H Tuthill
- UCD Centre for Human Reproduction, Coombe Women and Infants University Hospital, Dublin 8, Ireland.
| | - Ciara M E Reynolds
- UCD Centre for Human Reproduction, Coombe Women and Infants University Hospital, Dublin 8, Ireland
| | - Aoife McKeating
- UCD Centre for Human Reproduction, Coombe Women and Infants University Hospital, Dublin 8, Ireland
| | - Eimer G O'Malley
- UCD Centre for Human Reproduction, Coombe Women and Infants University Hospital, Dublin 8, Ireland
| | - Mairead M Kennelly
- UCD Centre for Human Reproduction, Coombe Women and Infants University Hospital, Dublin 8, Ireland
| | - Michael J Turner
- UCD Centre for Human Reproduction, Coombe Women and Infants University Hospital, Dublin 8, Ireland
| |
Collapse
|
18
|
Nix L, Nixon E, Quigley J, O'Keane V. Perinatal depression and children's developmental outcomes at 2 years postpartum. Early Hum Dev 2021; 156:105346. [PMID: 33744832 DOI: 10.1016/j.earlhumdev.2021.105346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 02/26/2021] [Accepted: 03/02/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Perinatal depression has been associated with a range of adverse outcomes for children's neurodevelopment. AIMS This study sought to examine the impact of maternal perinatal depression on 2-year-olds' social-emotional, cognitive, language, and adaptive behavioural development, using data collected at the fifth timepoint of a prospective longitudinal study, which followed participants from pregnancy through to toddlerhood. PARTICIPANTS 61 women and their children (M age = 26 months, SD = 1.83; 35 boys and 26 girls), of the original cohort of 98, who had been recruited during pregnancy, and stratified into three participant groups: 1. Depressed (those with a clinical diagnosis of Major Depressive Disorder [MDD]); 2. History (currently euthymic with a previous MDD episode); 3. Control (no history of psychiatric disorder). OUTCOME MEASURES Depression severity was assessed using the Hamilton Depression Rating Scale (HAM-D), and children's developmental outcomes were measured using the Bayley Scales of Infant and Toddler Development, 3rd Edition (BSID-III). RESULTS No direct associations between mothers' depression and children's social-emotional, cognitive or language development were observed. However, an unexpected positive association between maternal depression and children's social adaptive behaviour was found, which conferred an advantage on children whose mothers had suffered from depression. CONCLUSIONS The current findings contribute to the literature examining the impact of perinatal depression on early childhood outcomes. The unexpected positive association found between maternal depression and children's adaptive behaviour should prompt further research examining the adaptive resilience of young children exposed to maternal depression. This is discussed in the context of differential-susceptibility theory.
Collapse
Affiliation(s)
- Laura Nix
- Trinity College Institute of Neuroscience, Trinity College Dublin, Ireland.
| | | | - Jean Quigley
- School of Psychology, Trinity College Dublin, Ireland
| | - Veronica O'Keane
- Trinity College Institute of Neuroscience, Trinity College Dublin, Ireland
| |
Collapse
|
19
|
Chan AL, Guo N, Popat R, Robakis T, Blumenfeld YY, Main E, Scott KA, Butwick AJ. Racial and Ethnic Disparities in Hospital-Based Care Associated with Postpartum Depression. J Racial Ethn Health Disparities 2021; 8:220-229. [PMID: 32474833 DOI: 10.1007/s40615-020-00774-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 04/13/2020] [Accepted: 05/11/2020] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To estimate racial and ethnic differences in rates of hospital-based care associated with postpartum depression. METHODS This is a retrospective cohort study using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes within data from the Office of Statewide Planning and Development in California. We included primiparous women who underwent delivery hospitalization from 2008 to 2012. The primary outcome was the first postpartum hospital encounter with a ICD-9-CM code for depression over a 9-month period after delivery. We examined the cumulative incidence of hospital-based care for postpartum depression by race/ethnicity. Logistic regression was used to estimate relative risk. RESULTS The study cohort consisted of 984,167 primiparous women: 314,037 (32%) were non-Hispanic White; 59,754 (6%) were non-Hispanic Black; 150,855 (15%) were non-Hispanic Asian; 448,770 (46%) were Hispanic; and 10,399 (1%) were other races. The cumulative incidence of hospital-based care for postpartum depression was highest for Black women (39; 95% CI = 34-44 per 10,000 deliveries) and lowest for Asian women (7; 95% CI = 5-8 per 10,000 deliveries). Compared with White women, hospital-based care for postpartum depression was more likely to be provided to Black women (OR = 2.3; 95% CI = 1.9-2.7), whereas care was less likely for Asians (OR = 0.4; 95% CI = 0.3-0.5) and Hispanics (OR = 0.8; 95% CI = 0.7-1.0). Similar findings were observed after excluding women with antepartum depression, adjusting for sociodemographic and clinical variables, and stratifying according to care settings. CONCLUSION Compared with White women, hospital-based care for postpartum depression more frequently impacts Black women. Identifying and improving inequities in access to and utilization of mental health care for postpartum women should be a maternal health priority.
Collapse
Affiliation(s)
- Avis L Chan
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Nan Guo
- Department of Anesthesiology, Perioperative, and Pain Medicine (MC:5640), Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Rita Popat
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Thalia Robakis
- Department of Psychiatry, Icahn School of Medicine Mount Sinai, Manhattan, NY, USA
| | - Yair Y Blumenfeld
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - Elliott Main
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
- California Maternal Quality Care Collaborative, Stanford University School of Medicine, Stanford, CA, USA
| | - Karen A Scott
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Alexander J Butwick
- Department of Anesthesiology, Perioperative, and Pain Medicine (MC:5640), Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA.
| |
Collapse
|
20
|
Abstract
Perinatal care, including the management of mental health issues, often falls under the auspices of primary care providers. Postpartum depression (PPD) is a common problem that affects up to 15% of women. Most women at risk can be identified before delivery based on psychiatric history, symptoms during pregnancy, and recent psychosocial stressors. Fortunately, there have been a variety of treatment studies using antidepressants, nonpharmacologic interactions, and most recently, allopregnanolone (Brexanolone) infusion that have shown benefits. The most commonly used screening scale, Edinburgh Postnatal Depression Scale, a 10-item self-rated scale, has been translated into a variety of languages.
Collapse
|
21
|
Clinical and Obstetric Risk Factors for Postnatal Depression in HIV Positive Women: A Cross Sectional Study in Health Facilities in Rural KwaZulu-Natal. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228425. [PMID: 33202528 PMCID: PMC7697934 DOI: 10.3390/ijerph17228425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 11/06/2020] [Accepted: 11/09/2020] [Indexed: 02/06/2023]
Abstract
Postnatal depression (PND) remains underdiagnosed and undertreated in different socio-economic backgrounds in South Africa. This study determined the prevalence of and clinical and obstetric risk factors for PND symptoms among HIV positive women in health facilities in a rural health district in South Africa. The Edinburgh Postnatal Depression Scale was used to measure PND from 386 women who had delivered a live infant. More than half (58.5%) tested HIV positive during the current pregnancy. The prevalence of PND symptoms was 42.5%. Logistic regression analysis yielded significant associations between clinical and obstetric variables of pre-term baby (p-value < 0.01), baby health status p-value < 0.01), baby hospitalization, (p-value < 0.01), and knowing the baby’s HIV status (p-value = 0.047). Maternal variables associated with PND were level of education (p-value < 0.01), monthly income (p-value < 0.01), and source of income (p-value = 0.05). At multivariate analysis, none of the clinical and obstetrical risk factors were independently associated with the PND. The high prevalence of PND symptoms underscore the need to integrate routine screening for PND in prevention of mother to child transmission of HIV programmes to enable early diagnosing and treatment of PND.
Collapse
|
22
|
Changing parental depression and sensitivity: Randomized clinical trial of ABC's effectiveness in the community. Dev Psychopathol 2020; 33:1026-1040. [DOI: 10.1017/s0954579420000310] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
AbstractAttachment and Biobehavioral Catch-up (ABC) demonstrates efficacy in improving parent and child outcomes, with preliminary evidence for effectiveness in community settings. The objective of this study was to assess the effectiveness of a community-based ABC implementation in improving parent outcomes as well as to examine potential mediators and moderators of intervention effectiveness. Two hundred parents and their 5- to 21-month-old infants recruited from an urban community were randomly assigned to receive ABC or be placed on a waitlist. The majority of participants had a minority racial or ethnic background. Before intervention, parents completed questionnaires about sociodemographic risk and adverse childhood experiences. At both baseline and follow-up, parents reported depression symptoms and were video-recorded interacting with their infant, which was coded for sensitivity. The ABC intervention predicted significant increases in parental sensitivity and, among parents who completed the intervention, significant decreases in depression symptoms. Changes in parental depression symptoms did not significantly mediate the intervention effects on sensitivity. Risk variables did not moderate the intervention effects. The results indicate that ABC shows promise for improving parent outcomes in community settings, supporting dissemination.
Collapse
|
23
|
|
24
|
Paquin C, Côté SM, Tremblay RE, Séguin JR, Boivin M, Herba CM. Maternal depressive symptoms and children's cognitive development: Does early childcare and child's sex matter? PLoS One 2020; 15:e0227179. [PMID: 31923279 PMCID: PMC6953844 DOI: 10.1371/journal.pone.0227179] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 12/14/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Maternal depressive symptoms (MDS) have been associated with poorer child cognitive development. Some studies have shown that childcare attendance moderates associations between MDS and child behavior problems, but we do not know if this is the case for children's cognitive development. Furthermore, few studies have evaluated whether associations between MDS and child cognitive development differ for boys and girls at school entry. METHODS This study used data from a population-based cohort study (n = 1364) comprising well-validated measures of children's cognitive development including academic readiness and language development in kindergarten and reading and mathematics achievement in first grade. Information on MDS was collected repeatedly from the child's age of 5 months to 5 years and on childcare from 5 months to 4.5 years. Moderation analyses were conducted to evaluate the differential associations of MDS with children's outcomes depending on the type of childcare attended and the child's sex. RESULTS Childcare type or child's sex did not moderate associations between MDS and children's cognitive outcomes except for MDS being associated with lower scores on reading achievement in first grade for girls with a very small effect size (sr2 = .003). Childcare attendance was associated with higher scores for children's cognitive development, however these associations disappeared after adjusting for covariates including child, mother and family characteristics. Regardless of MDS and childcare type, boys had, even after adjusting for covariates, lower scores on academic readiness (sr2 = .029) and higher scores on mathematics achievement (sr2 = .004). CONCLUSIONS Children's cognitive development at school entry was more strongly associated with maternal education, children's age in kindergarten and number of months of schooling in first grade than MDS. Contrary to associations between MDS and child behavior problems, childcare attendance did not moderate associations between MDS and children's cognitive development at school entry.
Collapse
Affiliation(s)
- Chantal Paquin
- Department of Psychology, Université du Québec à Montréal, Montréal, Québec, Canada
- Centre de Recherche du Centre Hospitalier Universitaire Sainte-Justine, Montréal, Québec, Canada
| | - Sylvana M. Côté
- Centre de Recherche du Centre Hospitalier Universitaire Sainte-Justine, Montréal, Québec, Canada
- Department of Social and Preventive Medicine, University of Montréal, Montréal, Québec, Canada
- INSERM U1219 Bordeaux Population Health Unit (BPH), University of Bordeaux, Bordeaux, France
| | - Richard E. Tremblay
- Centre de Recherche du Centre Hospitalier Universitaire Sainte-Justine, Montréal, Québec, Canada
- Departments of Psychology and Pediatrics, University of Montréal, Montréal, Québec, Canada
- School of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin, Ireland
| | - Jean R. Séguin
- Centre de Recherche du Centre Hospitalier Universitaire Sainte-Justine, Montréal, Québec, Canada
- Department of Psychiatry and Addictology, University of Montréal, Montréal, Québec, Canada
| | - Michel Boivin
- School of Psychology, Laval University, Québec, Québec, Canada
| | - Catherine M. Herba
- Department of Psychology, Université du Québec à Montréal, Montréal, Québec, Canada
- Centre de Recherche du Centre Hospitalier Universitaire Sainte-Justine, Montréal, Québec, Canada
- Department of Psychiatry and Addictology, University of Montréal, Montréal, Québec, Canada
| |
Collapse
|
25
|
Letourneau N, Leung B, Ntanda H, Dewey D, Deane AJ, Giesbrecht GF. Maternal and paternal perinatal depressive symptoms associate with 2- and 3-year-old children's behaviour: findings from the APrON longitudinal study. BMC Pediatr 2019; 19:435. [PMID: 31722682 PMCID: PMC6852959 DOI: 10.1186/s12887-019-1775-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 10/07/2019] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Prenatal and postnatal depressive symptoms are common in expectant and new mothers and fathers. This study examined the association between four patterns of probable perinatal depression (mother depressed, father depressed, both depressed, neither depressed) in co-parenting mothers and fathers and their children's internalizing and externalizing behaviours at 24 and 36 months of age. The influence of sociodemographic, risk and protective factors was also examined. METHODS Depressive symptoms were measured during pregnancy and at 3 months postpartum and children's behaviour was assessed at 24 and 36 months of age. Families (n = 634) provided data on their children's internalizing (i.e. emotionally reactive, anxious/depressed, somatic complaints, withdrawn and total) and externalizing (i.e. attention problems, aggression and total) behaviour. Marginal models were employed to determine the relationship between children's behaviour over the two time points and the four patterns of probable parental depression. Sociodemographic variables as well as risk (stress) and protective (social support) factors were included in these models. RESULTS In the perinatal period 19.40% (n = 123) of mothers scored as probably depressed and 10.57% (n = 67) of fathers. In 6.31% (n = 40) of the participating families, both parents scored as probably depressed and in 63.72% (n = 404) neither parent scored as depressed. For children's emotionally reactive, withdrawn and total internalizing behaviours, both mothers' probable depression and mothers and fathers' co-occurring probable depression predicted higher scores, while for children's aggressive behaviour, attention problems, and total externalizing behaviours, only mothers' probable depression predicted higher scores, controlling for sociodemographic, risk and protective factors. CONCLUSIONS While probable perinatal depression in mothers predicted 2 and 3 year-old children's behavioural problems, co-occurrence of depression in mothers and fathers had an increased association with internalizing behavioural problems, after considering sociodemographic, risk and protective factors. Health care providers are encouraged to consider the whole family in preventing and treating perinatal depression.
Collapse
Affiliation(s)
- Nicole Letourneau
- Faculty of Nursing and Cumming School of Medicine, Departments of Pediatrics, Psychiatry, & Community Health Sciences, University of Calgary, Calgary, AB, T2N 1N4, Canada. .,Owerko Centre at the Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, T2N 1N4, Canada.
| | - Brenda Leung
- Cumming School of Medicine, Department of Community Health Sciences, University of Calgary, Calgary, AB, T2N 1N4, Canada
| | - Henry Ntanda
- Cumming School of Medicine, Department of Pediatrics, University of Calgary, Calgary, AB, T2N 1N4, Canada
| | - Deborah Dewey
- Cumming School of Medicine, Departments of Pediatrics & Community Health Sciences, University of Calgary, Calgary, AB, T2N 1N4, Canada
| | - Andrea J Deane
- Cumming School of Medicine, Department of Pediatrics, University of Calgary, Calgary, AB, T2N 1N4, Canada
| | - Gerald F Giesbrecht
- Cumming School of Medicine, Departments of Pediatrics, Psychology, & Community Health Sciences, University of Calgary, Calgary, AB, T2N 1N4, Canada
| | | |
Collapse
|
26
|
Children of parents who have been hospitalised with psychiatric disorders are at risk of poor school readiness. Epidemiol Psychiatr Sci 2019; 28:508-520. [PMID: 29633682 PMCID: PMC6998916 DOI: 10.1017/s2045796018000148] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
AIMS. Children of parents with psychiatric disorders are at risk of poor outcomes. However, there is limited evidence regarding the relationship between parental psychiatric disorders and child school readiness, which is linked to later academic achievement. This study aims to investigate these relationships and broaden the evidence underlying the rationale for family-focused interventions for parental psychiatric disorders. METHOD. This study used linked administrative data. Children's school readiness in multiple developmental domains (physical, social, emotional, communicative, cognitive) was measured by the Australian Early Development Census (AEDC) for 19 071 Western Australian children (mean age 5.5 years). Children scoring in the bottom 25% on any AEDC domain were considered developmentally vulnerable, or at risk of vulnerability, on that domain. Biological child-parent pairs were identified using birth records. Parents with psychiatric disorders were identified from hospital records, which included information on diagnosis and frequency/duration of psychiatric admissions. Logistic regressions, adjusted for parent age, mother's marital status, child Aboriginality, child English language status, local community remoteness and socioeconomic index, estimated the odds of children being vulnerable/at-risk on each of the AEDC domains. RESULTS. A total of 719 mothers and 417 fathers had a psychiatric hospitalisation during the study period (12 months prior to the child's birth, up to the end of 2009). Children whose parents had psychiatric disorders had increased odds of being classified as vulnerable/at-risk for school readiness. This increase in odds was evident for both maternal (adjusted odds ratio, aOR 1.37- 1.51) and paternal psychiatric disorders (aOR 1.38-1.50); and for a single admission of one day (aOR 1.32-1.59), a single admission of multiple days (aOR 1.30-1.47), and multiple admissions (aOR 1.35-1.63). Some variability in child outcome was found depending on the parents' psychiatric diagnosis (mood, anxiety, substance abuse or comorbid disorder). CONCLUSIONS. Children of parents who have been hospitalised with psychiatric disorders are at risk for poor school readiness. These findings add support to recommendations that mental health professionals consider dependent children in discharge and treatment planning for adult psychiatric inpatients. It is also important to ensure that the impact of psychiatric illness in fathers is not overlooked in assessment and intervention. Family-based approaches to adult psychiatric care could meet the dual needs of intervention for parents and preventative measures for children. These findings can inform policy regarding the importance of integrating and coordinating services to meet the needs of families.
Collapse
|
27
|
Sawyer KM, Zunszain PA, Dazzan P, Pariante CM. Intergenerational transmission of depression: clinical observations and molecular mechanisms. Mol Psychiatry 2019; 24:1157-1177. [PMID: 30283036 DOI: 10.1038/s41380-018-0265-4] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 08/16/2018] [Accepted: 08/20/2018] [Indexed: 02/06/2023]
Abstract
Maternal mental illness can have a devastating effect during the perinatal period, and has a profound impact on the care that the baby receives and on the relationships that the baby forms. This review summarises clinical evidence showing the effects of perinatal depression on offspring physical and behavioural development, and on the transmission of psychopathology between generations. We then evaluate a number of factors which influence this relationship, such as genetic factors, the use of psychotropic medications during pregnancy, the timing within the perinatal period, the sex of the foetus, and exposure to maltreatment in childhood. Finally, we examine recent findings regarding the molecular mechanisms underpinning these clinical observations, and identify relevant epigenetic and biomarker changes in the glucocorticoid, oxytocin, oestrogen and immune systems, as key biological mediators of these clinical findings. By understanding these molecular mechanisms in more detail, we will be able to improve outcomes for both mothers and their offspring for generations.
Collapse
Affiliation(s)
- Kristi M Sawyer
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Patricia A Zunszain
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Paola Dazzan
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Carmine M Pariante
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
| |
Collapse
|
28
|
Judd F, Lorimer S, Thomson RH, Hay A. Screening for depression with the Edinburgh Postnatal Depression Scale and finding borderline personality disorder. Aust N Z J Psychiatry 2019; 53:424-432. [PMID: 30309241 DOI: 10.1177/0004867418804067] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The aim of the study was to explore the range of psychiatric diagnoses seen in pregnant women who score above the 'cut-off' on the Edinburgh Postnatal Depression Scale when this is used as a routine screening instrument in the antenatal period. METHOD Subjects were all pregnant women referred to and seen by the Perinatal Consultation-Liaison Psychiatry Team of a tertiary public hospital over a 14-month period. Edinburgh Postnatal Depression Scale score at maternity 'booking-in' visit, demographic and clinical data were recorded and diagnoses were made according to Diagnostic and Statistical Manual of Mental Disorders (5th ed.) criteria following clinical interview(s) and review of documented past history. Data were analysed using descriptive statistics. RESULTS A total of 200 patients who had completed the Edinburgh Postnatal Depression Scale were seen for assessment; 86 (43%) scored ⩾13 on Edinburgh Postnatal Depression Scale. Of those scoring 13 or more on Edinburgh Postnatal Depression Scale, 22 (25.6%) had a depressive disorder. In total, 12 patients (14%) had an anxiety disorder, 14 (16.3%) had borderline personality disorder and 13 (15.1%) had a substance use disorder. An additional 23 women (26.7%) had two or more borderline personality traits. CONCLUSION Psychiatric assessment of women who scored 13 or more on the Edinburgh Postnatal Depression Scale at routine antenatal screening identified a significant number with borderline personality disorder or borderline personality traits rather than depressive or anxiety disorders. Clinical Practice Guidelines note the importance of further assessment for all women who score 13 or more on the Edinburgh Postnatal Depression Scale. The findings here suggest that this assessment should be made by a clinician able to identify personality pathology and organise appropriate and timely interventions.
Collapse
Affiliation(s)
- Fiona Judd
- 1 Tasmanian Health Service, Perinatal and Infant Mental Health Team, Child and Adolescent Mental Health Services-South, Hobart, TAS, Australia.,2 Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia.,3 Department of Psychiatry, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Stephanie Lorimer
- 1 Tasmanian Health Service, Perinatal and Infant Mental Health Team, Child and Adolescent Mental Health Services-South, Hobart, TAS, Australia
| | - Richard H Thomson
- 4 Monash Alfred Psychiatry Research Centre and Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Angela Hay
- 1 Tasmanian Health Service, Perinatal and Infant Mental Health Team, Child and Adolescent Mental Health Services-South, Hobart, TAS, Australia
| |
Collapse
|
29
|
Frieder A, Fersh M, Hainline R, Deligiannidis KM. Pharmacotherapy of Postpartum Depression: Current Approaches and Novel Drug Development. CNS Drugs 2019; 33:265-282. [PMID: 30790145 PMCID: PMC6424603 DOI: 10.1007/s40263-019-00605-7] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Postpartum depression is one of the most common complications of childbirth. Untreated postpartum depression can have substantial adverse effects on the well-being of the mother and child, negatively impacting child cognitive, behavioral, and emotional development with lasting consequences. There are a number of therapeutic interventions for postpartum depression including pharmacotherapy, psychotherapy, neuromodulation, and hormonal therapy among others, most of which have been adapted from the treatment of major depressive disorder outside of the peripartum period. Current evidence of antidepressant treatment for postpartum depression is limited by the small number of randomized clinical trials, underpowered samples, and the lack of long-term follow-up. The peripartum period is characterized by rapid and significant physiological change in plasma levels of endocrine hormones, peptides, and neuroactive steroids. Evidence supporting the role of neuroactive steroids and γ-aminobutyric acid (GABA) in the pathophysiology of postpartum depression led to the investigation of synthetic neuroactive steroids and their analogs as potential treatment for postpartum depression. Brexanolone, a soluble proprietary intravenous preparation of synthetic allopregnanolone, has been developed. A recent series of open-label and placebo-controlled randomized clinical trials of brexanolone in postpartum depression demonstrated a rapid reduction in depressive symptoms, and has led to the submission for regulatory approval to the US Food and Drug Administration (decision due in March 2019). SAGE-217, an allopregnanolone analog, with oral bioavailability, was recently tested in a randomized, double-blind, placebo-controlled phase III study in severe postpartum depression, with reportedly positive results. Finally, a 3β-methylated synthetic analog of allopregnanolone, ganaxolone, is being tested in both intravenous and oral forms, in randomized, double-blind, placebo-controlled phase II studies in severe postpartum depression.
Collapse
Affiliation(s)
- Ariela Frieder
- Department of Psychiatry, Women's Behavioral Health, Zucker Hillside Hospital, Northwell Health, 75-59 263rd Street, New York, NY, 11004, USA
| | - Madeleine Fersh
- Department of Psychiatry, Women's Behavioral Health, Zucker Hillside Hospital, Northwell Health, 75-59 263rd Street, New York, NY, 11004, USA
| | - Rachel Hainline
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Kristina M Deligiannidis
- Department of Psychiatry, Women's Behavioral Health, Zucker Hillside Hospital, Northwell Health, 75-59 263rd Street, New York, NY, 11004, USA.
- Departments of Psychiatry and Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
- Feinstein Institute for Medical Research, Manhasset, NY, USA.
| |
Collapse
|
30
|
MacKenzie LE, Uher R, Pavlova B. Cognitive Performance in First-Degree Relatives of Individuals With vs Without Major Depressive Disorder: A Meta-analysis. JAMA Psychiatry 2019; 76:297-305. [PMID: 30586133 PMCID: PMC6439825 DOI: 10.1001/jamapsychiatry.2018.3672] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
IMPORTANCE Findings of cognitive impairment in major depressive disorder (MDD), including remitted MDD, raise the question whether impaired cognition is part of preexisting vulnerability rather than a consequence of MDD or its treatment. To our knowledge, no meta-analyses have been published on cognitive impairment in first-degree relatives of individuals with MDD. OBJECTIVE To compare cognitive performance between individuals with and without family history of MDD. DATA SOURCES Medline/PubMed, PsycINFO, and Embase using combinations of search terms for depression, first-degree relatives, and cognition from January 1, 1980, to July 15, 2018. STUDY SELECTION Original articles that reported data on cognition in first-degree relatives of individuals with MDD compared with controls with no family history of major mental illness. DATA EXTRACTION AND SYNTHESIS Means and SDs were extracted, and standardized mean differences (SMD) between relatives and controls were calculated for each measure of cognitive performance. The relative-control differences in overall cognition and in specific cognitive domains were synthesized in random-effects meta-analyses with robust variance estimation that allows including multiple correlated measures of cognition within each study. Heterogeneity was quantified with τ2. Publication bias was assessed with funnel plots and Egger intercept. MAIN OUTCOMES AND MEASURES Performance on cognitive tests. RESULTS Across 284 measures of cognition in 54 nonoverlapping samples including 3246 relatives of people with MDD (mean age 15.38 years, 57.68% females) and 5222 controls (mean age 14.70 years, 55.93% females), relatives of people with MDD performed worse than controls across all measures of cognition (SMD = -0.19; 95% CI, -0.27 to -0.11; P < .001). Domain-specific meta-analyses showed similar size of relative-control difference in most domains of cognition, including Full-Scale IQ (SMD = -0.19), verbal intelligence (SMD = -0.29), perceptual intelligence (SMD = -0.23), memory (SMD = -0.20), academic performance (SMD = -0.40), and language (SMD = -0.29). Study characteristics were not significantly associated with observed between-group differences. There was no evidence of publication bias. CONCLUSIONS AND RELEVANCE A general impairment in cognition is a feature of familial disposition for MDD. Cognition may contribute to early identification of risk for depression and may be examined as potential target for early intervention.
Collapse
Affiliation(s)
- Lynn E. MacKenzie
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Rudolf Uher
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada,Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada,Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Barbara Pavlova
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada,Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| |
Collapse
|
31
|
Christiansen H, Bauer A, Fatima B, Goodyear M, Lund IO, Zechmeister-Koss I, Paul JL. Improving Identification and Child-Focused Collaborative Care for Children of Parents With a Mental Illness in Tyrol, Austria. Front Psychiatry 2019; 10:233. [PMID: 31057440 PMCID: PMC6478760 DOI: 10.3389/fpsyt.2019.00233] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 03/28/2019] [Indexed: 12/12/2022] Open
Abstract
Background: Children of parents with a mental illness (COPMI) are more likely to experience negative long-term adversities. However, interventions to support their needs early can significantly enhance adjustment and reduce negative outcomes. Approximately one in four children currently lives with a parent with mental illness worldwide. The lifelong impact for individuals, governments, and broader society is likely to be substantial. There are significant workforce barriers to the early identification of COPMI and addressing their needs, particularly within the adult mental health care system. The current study aims to reduce such barriers and to improve identification of COPMI in the current health care systems. Objectives: The project "The Village" is a multidisciplinary health and social care policy intervention and seeks to improve child development and well-being outcomes for children of parents with a diagnosed mental illness. This will be achieved through the co-development, implementation, and evaluation of a practice approach to the early identification and collaborative care for COPMI, through establishing child-focused support networks. This will be done with open innovation science (OIS) approaches engaging the public in Tyrol, a geographical region of Austria, throughout 4 years. As part of the co-development process, we will work with stakeholders to co-develop the practice approaches based on evidence-based approaches and determine the most appropriate study design to evaluate those, as well as the implementation processes we will undertake. Methods: The project is underpinned by theories from different disciplines (i.e., public health, psychology, sociology, linguistics, economic sciences) as well as drawing on different approaches (i.e., co-development, implementation science, symbolic interactionism, and realist evaluation). It is based on the seven content work packages (WPs): 1) management, 2) focusing on children and methods to understand their "voice," 3) scoping, 4) co-development, 5) implementation, 6) evaluating the practice approaches, and 7) knowledge dissemination. "Scoping" will involve exploring the existing evidence, practice, and current state of identification and collaborative care in Tyrol, Austria. "Co-development" involves the co-design of practice approaches to identify and support children in partnership with key stakeholders and service providers working in Tyrol. The "implementation" of practice approaches will be based on the results of the co-development phase and will involve working with organizations to develop support strategies that draw on known organizational drivers from the field of implementation science to support the rollout of the practice approaches. In "Evaluation" we will follow principles of a realist approach; this includes developing program theories and logic models for the practice approaches. Those will set out the outcomes hypothesized to achieve and the processes that are expected to lead to those changes. This will refer to changes in children, parents, and practitioners. We expect that the main focus will be on measuring child quality of life and mental health outcomes, and outcomes that are on the path to those (such as social support needs, resilience, mental health literacy, stigma, and help-seeking behavior) as well as costs. The "child voice" WP focuses on children's perceptions and needs as the importance of "assent" and support of children to develop their own "voice" in health care is increasingly recognized within child health research. The "dissemination" step focuses on reaching a broad public audience of different stakeholders, researchers, and families involved. Discussion: The research project aims to directly improve identification and support of vulnerable children across selected regions in Tyrol, Austria, and by doing so, improve the health and well-being of future generations, through breaking the cycle of intergenerational transfer of adverse childhood experiences.
Collapse
Affiliation(s)
- Hanna Christiansen
- Department of Clinical Child and Adolescent Psychology, Philipps University Marburg, Marburg, Germany
| | - Annette Bauer
- Personal Social Services Research Unit (PSSRU), London School of Economics and Political Science, London, United Kingdom
| | - Batool Fatima
- Human Development Programme, Aga Khan University, Karachi, Pakistan
| | - Melinda Goodyear
- School of Rural Health, Monash University, Melbourne, VIC, Australia
| | | | | | - Jean Lillian Paul
- Mental Health Research Program, The Village, Ludwig Boltzmann Gesellschaft, Innsbruck, Austria.,Division of Psychiatry I, Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, Innsbruck, Austria
| |
Collapse
|
32
|
Christiansen H, Reck C, Zietlow AL, Otto K, Steinmayr R, Wirthwein L, Weigelt S, Stark R, Ebert DD, Buntrock C, Krisam J, Klose C, Kieser M, Schwenck C. Children of Mentally III Parents at Risk Evaluation (COMPARE): Design and Methods of a Randomized Controlled Multicenter Study-Part I. Front Psychiatry 2019; 10:128. [PMID: 30971958 PMCID: PMC6443700 DOI: 10.3389/fpsyt.2019.00128] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 02/21/2019] [Indexed: 11/20/2022] Open
Abstract
Objectives: Mental disorders are frequent, associated with disability-adjusted life years, societal, and economic costs. Children of parents with a mental illness (COPMI) are at an increased risk to develop disorders themselves. The transgenerational transmission of mental disorders has been conceptualized in a model that takes parental and family factors, the social environment (i.e., school, work, and social support), parent-child-interaction and possible child outcomes into account. The goal of the "Children of Mentally Ill Parents At Risk Evaluation" (COMPARE) study will thus be twofold: (1) to establish the efficacy and cost-effectiveness of a high-quality randomized controlled trial (RCT) with the aim of interrupting the intergenerational transmission of mental disorders in COPMI, (2) to test the components of the trans-generational transmission model of mental disorders. Methods: To implement a randomized controlled trial (RCT: comparison of parental cognitive behavioral therapy/CBT with CBT + Positive Parenting Program) that is flanked by four add-on projects that apply behavioral, psychophysiological, and neuro-imaging methods to examine potential moderators and mediators of risk transmission (projects COMPARE-emotion/-interaction/-work/-school). COMPARE-emotion targets emotion processing and regulation and its impact on the transgenerational disorder transmission; COMPARE-interaction focuses especially on the impact of maternal comorbid diagnoses of depression and anxiety disorders and will concentrate on different pathways of the impact of maternal disorders on socio-emotional and cognitive infant development, such as parent-infant interaction and the infant's stress regulation skills. COMPARE-work analyzes the transmission of strains a person experiences in one area of life to another (i.e., from family to work; spill-over), and how stress and strain are transmitted between individuals (i.e., from parent to child; cross-over). COMPARE-school focuses on the psychosocial adjustment, school performance, and subjective well-being in COPMI compared to an adequate control group of healthy children. Results: This study protocol reports on the interdisciplinary approach of COMPARE testing the model of the transgenerational transmission of mental disorders. Conclusion: The combination of applied basic with clinical research will facilitate the examination of specific risk transmission mechanisms, promotion, dissemination and implementation of results into a highly important but largely neglected field. Clinical Trial Registration: DRKS-ID: DRKS00013516 (German Clinical Trials Register, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00013516).
Collapse
Affiliation(s)
- Hanna Christiansen
- Department of Clinical Child and Adolescent Psychology, Faculty of Psychology, Philipps University Marburg, Marburg, Germany
| | - Corinna Reck
- Department of Clinical Child and Adolescent Psychology, Faculty of Psychology, Ludwig-Maximilians-University München, Munich, Germany
| | - Anna-Lena Zietlow
- Center for Psychosocial Medicine, Institute of Medical Psychology, Heidelberg University Hospital, Heidelberg, Germany
| | - Kathleen Otto
- Department of Social Psychology, Business and Methods, Faculty of Psychology, Philipps University Marburg, Marburg, Germany
| | - Ricarda Steinmayr
- Department of Educational Psychology, Faculty of Education, Psychology, and Sociology, Institute of Psychology, Technical University Dortmund, Dortmund, Germany
| | - Linda Wirthwein
- Department of Educational Psychology, Faculty of Education, Psychology, and Sociology, Institute of Psychology, Technical University Dortmund, Dortmund, Germany
| | - Sarah Weigelt
- Department of Vision, Visual Impairment & Blindness, Faculty of Rehabilitation Science, Technical University Dortmund, Dortmund, Germany
| | - Rudolf Stark
- Department of Psychotherapy and Systems Neuroscience, Faculty of Psychology and Sports Science, Justus-Liebig-University Gießen, Gießen, Germany
| | - David D Ebert
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Claudia Buntrock
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Johannes Krisam
- Department of Medical Biometry, Institute of Medical Biometry and Informatics, Heidelberg University, Heidelberg, Germany
| | - Christina Klose
- Department of Medical Biometry, Institute of Medical Biometry and Informatics, Heidelberg University, Heidelberg, Germany
| | - Meinhard Kieser
- Department of Medical Biometry, Institute of Medical Biometry and Informatics, Heidelberg University, Heidelberg, Germany
| | - Christina Schwenck
- Department of Special Needs Educational and Clinical Child and Adolescent Psychology, Faculty of Psychology and Sports Science, Justus-Liebig-University Gießen, Gießen, Germany
| |
Collapse
|
33
|
[Personality Assessment as Contribution to Diagnostic Differentiation Between ADHD and RAD in Middle Childhood]. Prax Kinderpsychol Kinderpsychiatr 2018; 67:510-528. [PMID: 30182819 DOI: 10.13109/prkk.2018.67.6.510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Personality Assessment as Contribution to Diagnostic Differentiation Between ADHD and RAD in Middle Childhood Early and prolonged social and emotional deprivation can result in symptoms of both ADHD and attachment disorder (RAD). The present study compares children between 7 and 13 years of age diagnosed with either ADHD or RAD, regarding their disorder specific behavior by using the Conners Rating Scale, a RAD screening scale, the overall psychopathology in the CASCAP-D, and the children's personality using the California Child-Q-sort (CCQ). The RAD group showed an increased overall psychopathology score and both increased ADHD and RAD symptomatology. In addition, they also were characterized as lower in self-regulatory personality characteristics (e. g. ego-resiliency). The results suggest that children with a RAD diagnosis do not show two comorbid disorders (RAD plus ADHD) but are characterized by an even more intense deficit of self-regulation in social and emotional contexts, compared to the children of the pure ADHD group. This should be considered in diagnosis and treatment.
Collapse
|
34
|
Littlewood E, Ali S, Dyson L, Keding A, Ansell P, Bailey D, Bates D, Baxter C, Beresford-Dent J, Clarke A, Gascoyne S, Gray C, Hackney L, Hewitt C, Hutchinson D, Jefferson L, Mann R, Marshall D, McMillan D, North A, Nutbrown S, Peckham E, Pervin J, Richardson Z, Swan K, Taylor H, Waterhouse B, Wills L, Woodhouse R, Gilbody S. Identifying perinatal depression with case-finding instruments: a mixed-methods study (BaBY PaNDA – Born and Bred in Yorkshire PeriNatal Depression Diagnostic Accuracy). HEALTH SERVICES AND DELIVERY RESEARCH 2018. [DOI: 10.3310/hsdr06060] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Background
Perinatal depression is well recognised as a mental health condition but < 50% of cases are identified in routine practice. A case-finding strategy using the Whooley questions is currently recommended by the National Institute for Health and Care Excellence.
Objectives
To determine the diagnostic accuracy, acceptability and cost-effectiveness of the Whooley questions and the Edinburgh Postnatal Depression Scale (EPDS) to identify perinatal depression.
Design
A prospective diagnostic accuracy cohort study, with concurrent qualitative and economic evaluations.
Setting
Maternity services in England.
Participants
A total of 391 pregnant women.
Main outcome measures
Women completed the Whooley questions, EPDS and a diagnostic reference standard (Clinical Interview Schedule – Revised) during pregnancy (20 weeks) and postnatally (3–4 months). Qualitative interviews were conducted with health professionals (HPs) and a subsample of women.
Results
Diagnostic accuracy results: depression prevalence rates were 10.3% during pregnancy and 10.5% postnatally. The Whooley questions and EPDS (cut-off point of ≥ 10) performed reasonably well, with comparable sensitivity [pregnancy: Whooley questions 85.0%, 95% confidence interval (CI) 70.2% to 94.3%; EPDS 82.5%, 95% CI 67.2% to 92.7%; postnatally: Whooley questions 85.7%, 95% CI 69.7% to 95.2%; EPDS 82.9%, 95% CI 66.4% to 93.4%] and specificity (pregnancy: Whooley questions 83.7%, 95% CI 79.4% to 87.4%; EPDS 86.6%, 95% CI 82.5% to 90.0%; postnatally: Whooley questions 80.6%, 95% CI 75.7% to 84.9%; EPDS 87.6%, 95% CI 83.3% to 91.1%). Diagnostic accuracy of the EPDS (cut-off point of ≥ 13) was poor at both time points (pregnancy: sensitivity 45%, 95% CI 29.3% to 61.5%, and specificity 95.7%, 95% CI 93.0% to 97.6%; postnatally: sensitivity 62.9%, 95% CI 44.9% to 78.5%, and specificity 95.7%, 95% CI 92.7% to 97.7%). Qualitative evaluation: women and HPs were supportive of screening/case-finding for perinatal depression. The EPDS was preferred to the Whooley questions by women and HPs, mainly because of its ‘softer’ wording. Whooley question 1 was thought to be less acceptable, largely because of the terms ‘depressed’ and ‘hopeless’, leading to women not revealing their depressive symptoms. HPs identified a ‘patient-centred’ environment that focused on the mother and baby to promote discussion about mental health. Cost-effectiveness results: screening/case-finding using the Whooley questions or the EPDS alone was not the most cost-effective strategy. A two-stage strategy, ‘Whooley questions followed by the Patient Health Questionnaire’ (a measure assessing depression symptomatology), was the most cost-effective strategy in the range between £20,000 and £30,000 per quality-adjusted life-year in both the prenatal and postnatal decision models.
Limitations
Perinatal depression diagnosis was not cross-referenced with women’s medical records so the proportion of new cases identified is unknown. The clinical effectiveness and cost-effectiveness of screening/case-finding strategies was not assessed as part of a randomised controlled trial.
Conclusions
The Whooley questions and EPDS had acceptable sensitivity and specificity, but their use in practice might be limited by low predictive value and variation in their acceptability. A two-stage strategy was more cost-effective than single-stage strategies. Neither case-finding instrument met National Screening Committee criteria.
Future work
The yield of screening/case-finding should be established with reference to health-care records. The clinical effectiveness and cost-effectiveness of screening/case-finding for perinatal depression needs to be tested in a randomised controlled trial.
Funding
The National Institute for Health Research Health Services and Delivery Research programme.
Collapse
Affiliation(s)
- Elizabeth Littlewood
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, UK
| | - Shehzad Ali
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, UK
| | - Lisa Dyson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Ada Keding
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Pat Ansell
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, UK
| | - Della Bailey
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, UK
| | - Debrah Bates
- Northern Lincolnshire and Goole NHS Foundation Trust, Scunthorpe General Hospital, Scunthorpe, UK
| | - Catherine Baxter
- Leeds and York Partnership NHS Foundation Trust, Bootham Park Hospital, York, UK
| | - Jules Beresford-Dent
- Leeds and York Partnership NHS Foundation Trust, Bootham Park Hospital, York, UK
| | - Arabella Clarke
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Samantha Gascoyne
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, UK
| | - Carol Gray
- Northern Lincolnshire and Goole NHS Foundation Trust, Scunthorpe General Hospital, Scunthorpe, UK
| | - Lisa Hackney
- Leeds and York Partnership NHS Foundation Trust, Bootham Park Hospital, York, UK
| | - Catherine Hewitt
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Dorothy Hutchinson
- Northern Lincolnshire and Goole NHS Foundation Trust, Scunthorpe General Hospital, Scunthorpe, UK
| | - Laura Jefferson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Rachel Mann
- Department of Health Sciences, University of York, York, UK
| | - David Marshall
- Leeds and York Partnership NHS Foundation Trust, Bootham Park Hospital, York, UK
| | - Dean McMillan
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, UK
- Hull York Medical School, York, UK
| | - Alice North
- Patient and public involvement representative, York, UK
| | - Sarah Nutbrown
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, UK
| | - Emily Peckham
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, UK
| | - Jodi Pervin
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, UK
| | - Zoe Richardson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Kelly Swan
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, UK
| | - Holly Taylor
- Leeds and York Partnership NHS Foundation Trust, Bootham Park Hospital, York, UK
| | - Bev Waterhouse
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, UK
| | - Louise Wills
- Harrogate and District NHS Foundation Trust, Harrogate District Hospital, Harrogate, UK
| | - Rebecca Woodhouse
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, UK
| | - Simon Gilbody
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, UK
- Hull York Medical School, York, UK
| |
Collapse
|
35
|
Bernard K, Nissim G, Vaccaro S, Harris JL, Lindhiem O. Association between maternal depression and maternal sensitivity from birth to 12 months: a meta-analysis. Attach Hum Dev 2018; 20:578-599. [PMID: 29374991 DOI: 10.1080/14616734.2018.1430839] [Citation(s) in RCA: 112] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Maternal sensitivity plays a central role in shaping children's development across a number of domains, and may be disrupted by depression. The current meta-analysis quantified the magnitude of the association between depression and maternal sensitivity, defined broadly as timely, contingent, and appropriate responding to infants' cues, from birth to 12 months. Across k = 48 studies and n = 4,934 mother-infant dyads, the aggregate effect size between depression and maternal sensitivity was r = -.16, p < .0001, indicating that mothers with higher depression levels were less sensitive than mothers with lower depression levels. Studies that compared a depressed group with a nondepressed/control group had larger effect sizes (r = -.35, p < .0001) than studies that examined depression within a single sample of either unselected cases or clinical-only cases (r = -.11, p < .001), suggesting that clinical levels of depression may pose a particular threat to sensitive parenting. Clinical implications (e.g. screening, prevention) are discussed.
Collapse
Affiliation(s)
- Kristin Bernard
- a Department of Psychology , Stony Brook University , Stony Brook , NY, USA
| | - Galia Nissim
- a Department of Psychology , Stony Brook University , Stony Brook , NY, USA
| | - Suzanne Vaccaro
- a Department of Psychology , Stony Brook University , Stony Brook , NY, USA
| | - Jordan L Harris
- b Western Psychiatric Institute and Clinic , University of Pittsburgh Medical Center, PA, USA
| | - Oliver Lindhiem
- c Department of Psychiatry , University of Pittsburgh School of Medicine , PA , USA
| |
Collapse
|
36
|
Pizeta FA, Silva APC, Loureiro SR. Resilience to Cumulative Stressors: A Prediction Study of Schoolchildren Living With Maternal Depression. Perspect Psychiatr Care 2017; 53:321-328. [PMID: 27461760 DOI: 10.1111/ppc.12183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 06/23/2016] [Accepted: 07/03/2016] [Indexed: 12/01/2022] Open
Abstract
PURPOSE To identify the predictive effect of multiple variables of risk and resilience on the behavior of school-age children living with maternal depression. DESIGN AND METHODS In a cross-sectional predictive study, the influence of maternal depression, cumulative stressors, and resilience on the behavior of children was analyzed. FINDINGS In the univariate analysis, maternal depression and cumulative stressors were considered as risks, and resilience as protection for the children. In the multivariate analysis, resilience was a predictor of fewer problems in the presence of maternal depression and risks. PRACTICE IMPLICATIONS The degree of resilience was an indicator for the relevance of developmental actions involving effective coping skills for cumulative stressors, including maternal depression.
Collapse
Affiliation(s)
- Fernanda Aguiar Pizeta
- School of Medicine in Ribeirão Preto, University of São Paulo, is Forense Psychologist in Justice Court of the State of São Paulo, and Professor in Psychology Course, Paulista University, Ribeirão Preto, São Paulo, Brazil
| | - Ana Paula Casagrande Silva
- School of Medicine in Ribeirão Preto, University of São Paulo, is Psychologist, Clinical Hospital of School of Medicine in Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Sonia Regina Loureiro
- Department of Neurosciences and Behavior Sciences, School of Medicine in Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| |
Collapse
|
37
|
Høifødt RS, Nordahl D, Pfuhl G, Landsem IP, Thimm JC, Ilstad LKK, Wang CEA. Protocol for the Northern babies longitudinal study: predicting postpartum depression and improving parent-infant interaction with The Newborn Behavioral Observation. BMJ Open 2017; 7:e016005. [PMID: 28963284 PMCID: PMC5623488 DOI: 10.1136/bmjopen-2017-016005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 06/29/2017] [Accepted: 06/29/2017] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Postpartum depression (PPD) is a prevalent disorder. Studying the factors related to PPD will help to identify families at risk and provide preventive interventions. This can in turn improve the developmental trajectories for the children. Several previous studies have investigated risk factors for PPD. However, few studies have focused on cognitive vulnerability factors. The first aim of the present study is to explore a range of protective and risk factors, including cognitive factors, for PPD, parent-infant interactions and child development. The second aim of the study is to evaluate the effectiveness of The Newborn Behavioral Observation (NBO) as a universal preventive intervention delivered in routine practice. The NBO is a brief relationship-enhancing intervention that may reduce depressive symptomatology in mothers. METHODS The study is a longitudinal observational study with an intervention. The observational study uses a prospective cohort design, whereas the intervention study has a non-randomised cluster-controlled design comparing a group receiving NBO with a group receiving standard care. The intervention group will receive three NBO sessions within the first 4 weeks postdelivery. Between 2015 and 2018, approximately 200 families will be recruited in the municipality of Tromsø, Norway. Parents are recruited during pregnancy, and assessments will be performed during gestational weeks 16-22, 24-30 and 31, and at 6 weeks, 4 months and 6 months postdelivery. Predictor variables include several cognitive vulnerability factors including early maladaptive schemas, implicit attitudes and cognitive processing of emotionally valenced infant facial information. ETHICS AND DISSEMINATION The Regional Committee for Medical and Health Research Ethics in Northern Norway has approved the project. The research team has collaboration with local health services and can assist participants who need more extensive follow-up. Results from the project will be disseminated in international and national peer-reviewed journals, and at courses and conferences. TRIALS REGISTRATION NUMBER NCT02538497; Pre-results.
Collapse
Affiliation(s)
- Ragnhild Sørensen Høifødt
- Department of Psychology, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
- Division of Mental Health and Addiction, University Hospital of North Norway, Tromsø, Norway
| | - Dag Nordahl
- Department of Psychology, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
- Division of Child and Adolescent Health, University Hospital of Northern Norway, Tromsø, Norway
| | - Gerit Pfuhl
- Department of Psychology, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Inger Pauline Landsem
- Division of Child and Adolescent Health, University Hospital of Northern Norway, Tromsø, Norway
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Jens C Thimm
- Department of Psychology, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Linn Kathrin K Ilstad
- Division of Mental Health and Addiction, University Hospital of North Norway, Tromsø, Norway
| | | |
Collapse
|
38
|
Do preventive interventions for children of mentally ill parents work? Results of a systematic review and meta-analysis. Curr Opin Psychiatry 2017; 30:283-299. [PMID: 28505032 DOI: 10.1097/yco.0000000000000342] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW The transgenerational transmission of mental disorders is one of the most significant causes of psychiatric morbidity. Several risk factors for children of parents with mental illness (COPMI) have been identified in numerous studies and meta-analyses. RECENT FINDINGS Many interventions have been developed for this high-risk group, but data about their efficacy are heterogeneous. SUMMARY The current meta-analysis reports on 96 articles including 50 independent samples from randomized controlled trials quantifying effects of preventive interventions for COPMI. Random effect models resulted in small, though significant Effect Sizes (ES) for programs enhancing the mother-infant interaction (ES = 0.26) as well as mothers' (ES = 0.33) and children's (ES = 0.31) behavior that proved to be stable over the 12-month follow-up, except for infants' behavior. Interventions for children/adolescents resulted in significant small effects for global psychopathology (ES = 0.13), as well as internalizing symptoms (ES = 0.17), and increased significantly over time, with externalizing symptoms reaching significance in the follow-up assessments as well (ES = 0.17). Interventions addressing parents and children jointly produced overall larger effects. Higher study quality was associated with smaller effects. There is a dearth of high quality studies that effectively reduce the high risk of COPMI for the development of mental disorders.
Collapse
|
39
|
Leung BMY, Letourneau NL, Giesbrecht GF, Ntanda H, Hart M. Predictors of Postpartum Depression in Partnered Mothers and Fathers from a Longitudinal Cohort. Community Ment Health J 2017; 53:420-431. [PMID: 27826783 DOI: 10.1007/s10597-016-0060-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 10/25/2016] [Indexed: 11/26/2022]
Abstract
Postpartum depression (PPD) is a growing mental health concern in new mothers and fathers. The purpose of this study was to determine the predictors of depression at 3 months postpartum, comparing depressed couples to couples with only one depressed partner or no depressed partner, using data from the Alberta Pregnancy Outcomes and Nutrition study. Data from mothers and fathers were collected at second trimester and 3 months postpartum. Results showed predictors of PPD in mothers to be low household income, high prenatal depressive symptoms, and postnatally, low social support and higher number of stressful life events. Fathers had similar predictors, including low household income, high prenatal depressive symptoms, and postnatally low social support and smoking. Compared with non-depressed couples, factors that predicted PPD in both mothers and fathers in couples included low income, high prenatal depressive symptoms in mothers and low prenatal social support reported by fathers.
Collapse
Affiliation(s)
- Brenda M Y Leung
- Faculty of Health Sciences, University of Lethbridge, Lethbridge, AB, T1K 3M4, Canada.
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, T2N 4N1, Canada.
| | - Nicole L Letourneau
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, T2N 4N1, Canada
- Faculty of Nursing, University of Calgary, Calgary, AB, T2N 1N4, Canada
| | - Gerald F Giesbrecht
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, T2N 4N1, Canada
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, T2N 4N1, Canada
| | - Henry Ntanda
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, T2N 4N1, Canada
- Faculty of Nursing, University of Calgary, Calgary, AB, T2N 1N4, Canada
| | - Martha Hart
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, T2N 4N1, Canada
- Faculty of Nursing, University of Calgary, Calgary, AB, T2N 1N4, Canada
| |
Collapse
|
40
|
Pathogen-Host Defense in the Evolution of Depression: Insights into Epidemiology, Genetics, Bioregional Differences and Female Preponderance. Neuropsychopharmacology 2017; 42:5-27. [PMID: 27629366 PMCID: PMC5143499 DOI: 10.1038/npp.2016.194] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 08/28/2016] [Accepted: 09/08/2016] [Indexed: 12/25/2022]
Abstract
Significant attention has been paid to the potential adaptive value of depression as it relates to interactions with people in the social world. However, in this review, we outline the rationale of why certain features of depression including its environmental and genetic risk factors, its association with the acute phase response and its age of onset and female preponderance appear to have evolved from human interactions with pathogens in the microbial world. Approaching the relationship between inflammation and depression from this evolutionary perspective yields a number of insights that may reveal important clues regarding the origin and epidemiology of the disorder as well as the persistence of its risk alleles in the modern human genome.
Collapse
|
41
|
Lin Y, Xu J, Huang J, Jia Y, Zhang J, Yan C, Zhang J. Effects of prenatal and postnatal maternal emotional stress on toddlers' cognitive and temperamental development. J Affect Disord 2017; 207:9-17. [PMID: 27665073 DOI: 10.1016/j.jad.2016.09.010] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Revised: 09/13/2016] [Accepted: 09/18/2016] [Indexed: 01/17/2023]
Abstract
BACKGROUND Maternal stress is associated with impairments in the neurodevelopment of offspring; however, the effects of the timing of exposure to maternal stress on a child's neurodevelopment are unclear. METHODS In 2010, we studied 225 mother-child pairs in Shanghai, recruiting mothers in mid-to-late pregnancy and monitoring offspring from birth until 30 months of age. Maternal stress was assessed prenatally (at 28-36 weeks of gestation) and postnatally (at 24-30 months postpartum) using the Symptom-Checklist-90-Revised Scale (SCL-90-R) and Life-Event-Stress Scale to evaluate mothers' emotional stress and life event stress levels, respectively. Children's cognition and temperament were assessed at 24-30 months of age using the Gesell Development Scale and Toddler Temperament Scale, respectively. Multi-variable linear regression models were used to associate prenatal and postnatal stress with child cognitive and temperamental development. RESULTS Maternal prenatal and postnatal Global Severity Index (GSI) of SCL-90-R were moderately correlated (ICC r=0.30, P<0.001). After adjusting for relevant covariates, the increase in prenatal GSI was associated with decreases in toddlers' gross motor, fine motor, adaptive and social behavior development independently of postnatal GSI, while the increase in postnatal GSI was associated with changes in multiple temperament dimensions independently of prenatal GSI. The effects of prenatal and postnatal depression scores of SCL-90-R were similar to those of GSI. LIMITATION Relatively small sample size. CONCLUSIONS Compared with postnatal exposure, children's cognitive development may be more susceptible to prenatal exposure to maternal emotional stress, whereas temperamental development may be more affected by postnatal exposure to maternal emotional stress compared with prenatal exposure.
Collapse
Affiliation(s)
- Yanfen Lin
- Xinhua Hospital, MOE-Shanghai Key Laboratory of Children's Environmental Health, Department of Child and Adolescent Healthcare, Shanghai Institute for Pediatric Research, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jian Xu
- Xinhua Hospital, MOE-Shanghai Key Laboratory of Children's Environmental Health, Department of Child and Adolescent Healthcare, Shanghai Institute for Pediatric Research, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Jun Huang
- Minhang Maternal & Child Health Hospital, Shanghai, China
| | - Yinan Jia
- Xinhua Hospital, MOE-Shanghai Key Laboratory of Children's Environmental Health, Department of Child and Adolescent Healthcare, Shanghai Institute for Pediatric Research, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinsong Zhang
- Xinhua Hospital, MOE-Shanghai Key Laboratory of Children's Environmental Health, Department of Child and Adolescent Healthcare, Shanghai Institute for Pediatric Research, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chonghuai Yan
- Xinhua Hospital, MOE-Shanghai Key Laboratory of Children's Environmental Health, Department of Child and Adolescent Healthcare, Shanghai Institute for Pediatric Research, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Zhang
- Xinhua Hospital, MOE-Shanghai Key Laboratory of Children's Environmental Health, Department of Child and Adolescent Healthcare, Shanghai Institute for Pediatric Research, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| |
Collapse
|
42
|
Lebel C, Walton M, Letourneau N, Giesbrecht GF, Kaplan BJ, Dewey D. Prepartum and Postpartum Maternal Depressive Symptoms Are Related to Children's Brain Structure in Preschool. Biol Psychiatry 2016; 80:859-868. [PMID: 26822800 DOI: 10.1016/j.biopsych.2015.12.004] [Citation(s) in RCA: 156] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 12/08/2015] [Accepted: 12/09/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND Perinatal maternal depression is a serious health concern with potential lasting negative consequences for children. Prenatal depression is associated with altered brain gray matter in children, though relations between postpartum depression and children's brains and the role of white matter are unclear. METHODS We studied 52 women who provided Edinburgh Postnatal Depression Scale (EPDS) scores during each trimester of pregnancy and at 3 months postpartum and their children who underwent magnetic resonance imaging at age 2.6 to 5.1 years. Associations between maternal depressive symptoms and magnetic resonance imaging measures of cortical thickness and white matter structure in the children were investigated. RESULTS Women's second trimester EPDS scores negatively correlated with children's cortical thickness in right inferior frontal and middle temporal regions and with radial and mean diffusivity in white matter emanating from the inferior frontal area. Cortical thickness, but not diffusivity, correlations survived correction for postpartum EPDS. Postpartum EPDS scores negatively correlated with children's right superior frontal cortical thickness and with diffusivity in white matter originating from that region, even after correcting for prenatal EPDS. CONCLUSIONS Higher maternal depressive symptoms prenatally and postpartum are associated with altered gray matter structure in children; the observed white matter correlations appear to be uniquely related to the postpartum period. The reduced thickness and diffusivity suggest premature brain development in children exposed to higher maternal perinatal depressive symptoms. These results highlight the importance of ensuring optimal women's mental health throughout the perinatal period, because maternal depressive symptoms appear to increase children's vulnerability to nonoptimal brain development.
Collapse
Affiliation(s)
- Catherine Lebel
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada; Department of Child & Adolescent Imaging Research Program, University of Calgary, Calgary, Alberta, Canada; Department of Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.
| | - Matthew Walton
- Department of Medical Sciences Program, University of Calgary, Calgary, Alberta, Canada; Department of Child & Adolescent Imaging Research Program, University of Calgary, Calgary, Alberta, Canada; Department of Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Nicole Letourneau
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada; Department of Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada; Department of Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Gerald F Giesbrecht
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada; Department of Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Bonnie J Kaplan
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Department of Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Deborah Dewey
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Department of Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
43
|
Yator O, Mathai M, Vander Stoep A, Rao D, Kumar M. Risk factors for postpartum depression in women living with HIV attending prevention of mother-to-child transmission clinic at Kenyatta National Hospital, Nairobi. AIDS Care 2016; 28:884-9. [PMID: 27045273 DOI: 10.1080/09540121.2016.1160026] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Mothers with HIV are at high risk of a range of psychosocial issues that may impact HIV disease progression for themselves and their children. Stigma has also become a substantial barrier to accessing HIV/AIDS care and prevention services. The study objective was to determine the prevalence and severity of postpartum depression (PPD) among women living with HIV and to further understand the impact of stigma and other psychosocial factors in 123 women living with HIV attending prevention of mother-to-child transmission (PMTCT) clinic at Kenyatta National Hospital located in Nairobi, Kenya. We used the Edinburgh Postnatal Depression Scale and HIV/AIDS Stigma Instrument - PLWHA (HASI - P). Forty-eight percent (N = 59) of women screened positive for elevated depressive symptoms. Eleven (9%) of the participants reported high levels of stigma. Multivariate analyses showed that lower education (OR = 0.14, 95% CI [0.04-0.46], p = .001) and lack of family support (OR = 2.49, 95% CI [1.14-5.42], p = .02) were associated with the presence of elevated depressive symptoms. The presence of stigma implied more than ninefold risk of development of PPD (OR = 9.44, 95% CI [1.132-78.79], p = .04). Stigma was positively correlated with an increase in PPD. PMTCT is an ideal context to reach out to women to address mental health problems especially depression screening and offering psychosocial treatments bolstering quality of life of the mother-baby dyad.
Collapse
Affiliation(s)
- Obadia Yator
- a Department of Psychiatry , University of Nairobi , Nairobi , Kenya
| | - Muthoni Mathai
- a Department of Psychiatry , University of Nairobi , Nairobi , Kenya
| | - Ann Vander Stoep
- b Department of Psychiatry and Behavioral Sciences , University of Washington , Seattle , WA , USA.,c Department of Epidemiology , University of Washington , Seattle , WA , USA
| | - Deepa Rao
- b Department of Psychiatry and Behavioral Sciences , University of Washington , Seattle , WA , USA.,d Department of Global Health , University of Washington , Seattle , WA , USA
| | - Manasi Kumar
- a Department of Psychiatry , University of Nairobi , Nairobi , Kenya
| |
Collapse
|
44
|
Elevated burden for caregivers of children with persistent asthma and a developmental disability. Matern Child Health J 2015; 18:2080-8. [PMID: 24619226 DOI: 10.1007/s10995-014-1455-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
To evaluate how having a child with both persistent asthma and a developmental disability (DD) affects caregiver burden and quality of life (QOL). 3-10 year old children with persistent asthma in urban Rochester, NY. Cross-sectional baseline survey (2006-2009). Parent report of autism spectrum disorder or other behavioral disorder requiring medication. Caregiver burden and QOL as measured by scores on previously validated depression, parenting confidence, and asthma-related QOL scales as well as an assessment of competing demands on the caregiver. Bivariate and multivariate regression analyses controlling for caregiver age, education, marital status, race, ethnicity, and child asthma symptom severity. We enrolled 530 children as part of a larger study (response rate: 74; 63 % Black, 73 % Medicaid). Of this sample, 70 children (13 %) were defined as having a DD. There were no differences in asthma symptom severity between children with and without a DD diagnosis. However, even after adjusting for potential confounders, caregivers of children with a DD reported worse scores on the depression (p = .003), parenting confidence (p < .001), and competing demands (p = .013) scales and worse asthma-related QOL (p = .035) compared to caregivers of typically developing children with asthma. Despite having similar asthma symptom severity, caregivers of children with both persistent asthma and a DD diagnosis report more burden and lower QOL compared to that of caregivers of typically developing children and persistent asthma. Further attention to this subgroup is needed to promote optimal support for caregivers.
Collapse
|
45
|
Pinheiro E, Bogen DL, Hoxha D, Ciolino JD, Wisner KL. Sertraline and breastfeeding: review and meta-analysis. Arch Womens Ment Health 2015; 18:139-146. [PMID: 25589155 PMCID: PMC4366287 DOI: 10.1007/s00737-015-0499-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 01/04/2015] [Indexed: 01/16/2023]
Abstract
We examined the risk-benefit profile of sertraline treatment during breastfeeding, summarized the available literature on sertraline use, presented previously unpublished data, and performed a correlation-based meta-analysis of sertraline serum levels in mother-infant pairs. We conducted a search of PubMed and the National Library of Medicine LactMed database. We performed a meta-analysis to examine correlations between maternal and infant serum sertraline levels in the existing literature and in previously unpublished data. Of 167 available infant sertraline levels, 146 (87.4 %) were below the limit of detection, and the meta-analysis found no significant relationship between maternal and infant sertraline concentrations. Of 150 infant desmethylsertraline levels, 105 (70.0 %) were below the limit of detection. The correlation analysis revealed a significant relationship between maternal and infant desmethylsertraline concentrations, but this metabolite has only a fraction of the activity of sertraline. A significant relationship was also found for the sum of sertraline and desmethylsertraline, which stems primarily from the contribution of desmethylsertraline. Sertraline is a first-line drug for breastfeeding women due to documented low levels of exposure in breastfeeding infants and very few adverse events described in case reports. Based on the current literature, neither routine serum sampling nor genotyping is warranted for breastfeeding mothers taking sertraline and/or their infants. Routine pediatric care is appropriate monitoring for breastfed infants of women who take sertraline monotherapy.
Collapse
Affiliation(s)
- Emily Pinheiro
- Asher Center for the Study and Treatment of Depressive Disorders, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 676 N. St. Clair Street, Suite 1000, Chicago, IL, 60611, USA.
| | - Debra L Bogen
- Department of Pediatrics, University of Pittsburgh School of Medicine, 3420 Fifth Ave., Pittsburgh, PA, 15213, USA
| | - Denada Hoxha
- Asher Center for the Study and Treatment of Depressive Disorders, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 676 N. St. Clair Street, Suite 1000, Chicago, IL, 60611, USA
| | - Jody D Ciolino
- Department of Preventative Medicine, Northwestern University Feinberg School of Medicine, 680 N Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA
| | - Katherine L Wisner
- Asher Center for the Study and Treatment of Depressive Disorders, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 676 N. St. Clair Street, Suite 1000, Chicago, IL, 60611, USA
| |
Collapse
|
46
|
Stein A, Pearson RM, Goodman SH, Rapa E, Rahman A, McCallum M, Howard LM, Pariante CM. Effects of perinatal mental disorders on the fetus and child. Lancet 2014; 384:1800-19. [PMID: 25455250 DOI: 10.1016/s0140-6736(14)61277-0] [Citation(s) in RCA: 1269] [Impact Index Per Article: 126.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Perinatal mental disorders are associated with increased risk of psychological and developmental disturbances in children. However, these disturbances are not inevitable. In this Series paper, we summarise evidence for associations between parental disorders and offspring outcomes from fetal development to adolescence in high-income, middle-income, and low-income countries. We assess evidence for mechanisms underlying transmission of disturbance, the role of mediating variables (underlying links between parent psychopathology and offspring outcomes) and possible moderators (which change the strength of any association), and focus on factors that are potentially modifiable, including parenting quality, social (including partner) and material support, and duration of the parental disorder. We review research of interventions, which are mostly about maternal depression, and emphasise the need to both treat the parent's disorder and help with associated caregiving difficulties. We conclude with policy implications and underline the need for early identification of those parents at high risk and for more early interventions and prevention research, especially in socioeconomically disadvantaged populations and low-income countries.
Collapse
Affiliation(s)
- Alan Stein
- Section of Child and Adolescent Psychiatry, Department of Psychiatry, University of Oxford, Oxford, UK; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
| | - Rebecca M Pearson
- Section of Child and Adolescent Psychiatry, Department of Psychiatry, University of Oxford, Oxford, UK; Elizabeth Blackwell Institute for Health Research, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | | | - Elizabeth Rapa
- Section of Child and Adolescent Psychiatry, Department of Psychiatry, University of Oxford, Oxford, UK
| | - Atif Rahman
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | | | - Louise M Howard
- Health Service and Population Research Department, Institute of Psychiatry, King's College London, UK
| | - Carmine M Pariante
- Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, UK
| |
Collapse
|
47
|
Pizeta FA, Silva TBF, Cartafina MIB, Loureiro SR. Depressão materna e riscos para o comportamento e a saúde mental das crianças: uma revisão. ESTUDOS DE PSICOLOGIA (NATAL) 2013. [DOI: 10.1590/s1413-294x2013000300003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A depressão materna tem sido considerada um fator de risco para a saúde mental das crianças. Objetivou-se identificar e analisar na literatura indexada artigos empíricos recentes (2005 a 2012), que abordaram as associações da depressão materna ao comportamento e à saúde mental de crianças, escolares. Procedeu-se a uma busca sistemática nas bases PubMed, PsycInfo e LILACS, por meio das palavras-chave "Maternal Depression or Depression" e "Risk Factors". Foram selecionados e analisados 68 artigos, 23 transversais e 45 longitudinais. Independentemente dos delineamentos adotados, a depressão materna mostrou-se associada à presença de dificuldades emocionais e comportamentais em geral, de manifestações depressivas e de ansiedade. Além da depressão materna, outras variáveis contextuais mostraram-se associadas às dificuldades das crianças. O reconhecimento da ação de múltiplas variáveis permitiu a verificação de indicadores diversos, o que pode favorecer o planejamento de intervenções.
Collapse
|
48
|
Sullivan EL, Nousen EK, Chamlou KA. Maternal high fat diet consumption during the perinatal period programs offspring behavior. Physiol Behav 2012; 123:236-42. [PMID: 23085399 DOI: 10.1016/j.physbeh.2012.07.014] [Citation(s) in RCA: 147] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Revised: 07/20/2012] [Accepted: 07/30/2012] [Indexed: 12/16/2022]
Abstract
The environment that a developing offspring experiences during the perinatal period is markedly influenced by maternal health and diet composition. Evidence from both epidemiological studies and animal models indicates that maternal diet and metabolic status play a critical role in programming the neural circuitry that regulates behavior, resulting in long-term consequences for offspring behavior. Maternal diet and metabolic state influence the behavior of offspring directly by impacting the intrauterine environment and indirectly by modulating maternal behavior. The mechanisms by which maternal diet and metabolic profile shape the perinatal environment remain largely unknown, but recent research has found that increases in inflammatory cytokines, nutrients (glucose and fatty acids), and hormones (insulin and leptin) affect the environment of the developing offspring. Offspring exposed to maternal obesity and high fat diet consumption during development are more susceptible to developing mental health and behavioral disorders such as anxiety, depression, attention deficit hyperactivity disorder, and autism spectrum disorders. Recent evidence suggests that this increased risk for behavioral disorders is driven by modifications in the development of neural pathways involved in behavioral regulation. In particular, research indicates that the development of the serotonergic system is impacted by exposure to maternal obesity and high fat diet consumption, and this disruption may underlie many of the behavioral disturbances observed in these offspring. Given the high rates of obesity and high fat diet consumption in pregnant women, it is vital to examine the influence that maternal nutrition and metabolic profile have on the developing offspring.
Collapse
Affiliation(s)
- Elinor L Sullivan
- Department of Biology, University of Portland, Portland, OR, USA; Division of Neuroscience, Oregon National Primate Research Center, Beaverton, OR, USA.
| | | | | |
Collapse
|