Trajectories of maternal depression and offspring psychopathology at 6 years: 2004 Pelotas cohort study

Economic costs of perinatal depression and anxiety in a lower middle income country: Pakistan

BACKGROUND

Women's mental health during the perinatal period is a major public health problem in Pakistan. Many challenges and competing priorities prevent progress to address the large treatment gap. Aim To quantify the long-term impacts of untreated perinatal depression and anxiety in economic terms, thus highlighting its overall burden based on country-specific evidence.

METHODS

Cost estimates were generated for a hypothetical cohort of women giving birth in 2017, and their children. Women and children experiencing adverse events linked to perinatal mental health problems were modelled over 40 years. Costs assigned to adverse events included were those linked to losses in quantity and quality-of-life, productivity, and healthcare-related expenditure. Present values were derived using a discount rate of 3 %. Data were taken from published cohort studies, as well as from sources of population, economic and health indicators.

RESULTS

The total costs were $16.5 billion for the cohort and $2680 per woman giving birth. The by far largest proportion referred to quality-of-life losses ($15.8 billion). Productivity losses and out-of-pocket expenditure made up only a small proportion of the costs, due to low wages and market prices. When the costs of maternal suicide were included, total costs increased to $16.6 billion.

LIMITATIONS

Important evidence gaps prevented the inclusion of all cost consequences linked to perinatal mental health problems.

CONCLUSIONS

Total national costs are much higher compared with those in other, higher middle-income countries, reflecting the excessive disease burden. This study is an important first step to inform resource allocations.

Fluctuations in Maternal Depressive Symptoms, Anxiety, and Anger and Children's Depression Risks in Middle Childhood

Research suggests a robust link between the severity of maternal depression and children's depression risks in middle childhood. Variations among depressed mothers in terms of affective dysregulation and frequent mood changes are also observed. However, the understanding of how fluctuations in maternal depressive symptoms and negative affect influence children is limited. Guided by life history theory, the current study tested whether the degree of fluctuations in maternal depressive symptoms, anxiety, and anger contributed to depression risks among school-aged children. The sample included 1,364 families where maternal depressive symptoms, anxiety, and anger were longitudinally assessed when children were in Grades 1, 3, 5, and 6. Children's anxious depression and withdrawn depression behaviors were rated in Grades 1, 3, 4, 5, and 6 by two caregivers. Parallel latent growth curve analyses revealed that, first, fluctuations in maternal anxiety from Grade 1 to 6 were related to an increase in children's withdrawn depression over the same period. Second, mean maternal anger over time was related to higher mean levels of child anxious and withdrawn depression, yet fluctuations in maternal anger were not linked to child outcomes. Findings support life history theory by highlighting the degree of fluctuations in maternal anxiety as a source of environmental unpredictability and reveal different effects of maternal anxiety and anger in the intergenerational transmission of depression, with important theoretical and clinical implications.

Psychosocial Adjustment as a Mediator in the Relationship between Childhood Exposure to Maternal Depression and Subsequent BMI and Overweight Risk

OBJECTIVES

This study investigated the correlation between early exposure to maternal depression (from 1 month to Grade 3) and the body mass index (BMI) and potential for overweight in adolescents at age 15. It further examined if the pathway of this correlation was influenced by psychosocial adjustment during mid-childhood (Grade 3 to Grade 6), specifically through internalizing and externalizing behaviors.

METHODS

Our study utilized data from 844 participants in the NICHD Study of Early Child Care and Youth Development (SECCYD) to assess the effects of maternal depression, observed from when the children were one month old to Grade 3, on BMI and the likelihood of overweight or obesity in adolescents aged 15. We also explored whether the average scores of internalizing and externalizing behaviors between Grades 3 and 6 mediated the impact of early maternal depressive symptoms on subsequent health outcomes. The analysis was adjusted for demographic and socioeconomic factors.

RESULTS

Findings revealed that internalizing and externalizing behavioral issues significantly mediated the relationship between prolonged maternal depression exposure and subsequent BMI, as well as the risk of overweight or obesity, in adolescents at age 15. Notably, this mediating effect was predominantly evident in girls.

CONCLUSIONS

Our research demonstrated that the correlation between prolonged exposure to maternal depressive symptoms in childhood and increased BMI and overweight risk in adolescence was significantly mediated through psychosocial adjustment behaviors. We advocate for further exploration of additional mediating factors in future studies.

Maternal depression and offspring mental health at age 5: MINA-Brazil cohort study

OBJECTIVE

To identify longitudinal patterns of maternal depression between three months and five years after child's birth, to examine predictor variables for these trajectories, and to evaluate whether distinct depression trajectories predict offspring mental health problems at age 5 years.

METHODS

We used data from the Maternal and Child Health and Nutrition in Acre (MINA-Brazil) study, a population-based birth cohort in the Western Brazilian Amazon. Maternal depressive symptoms were assessed with the Edinburgh Postnatal Depression Scale (EPDS) at 3 and 6-8 months, and 1 and 2 years after delivery. Mental health problems in 5-year-old children were evaluated with the Strengths and Difficulties Questionnaire (SDQ) reported by parents. Trajectories of maternal depression were calculated using a group-based modelling approach.

RESULTS

We identified four trajectories of maternal depressive symptoms: "low" (67.1%), "increasing" (11.5%), "decreasing" (17.4%), and "high-chronic" (4.0%). Women in the "high/chronic" trajectory were the poorest, least educated, and oldest compared with women in the other trajectory groups. Also, they were more frequently multiparous and reported smoking and having attended fewer prenatal consultations during pregnancy. In the adjusted analyses, the odds ratio of any SDQ disorder was 3.23 (95%CI: 2.00-5.22) and 2.87 (95%CI: 1.09-7.57) times higher among children of mothers belonging to the "increasing" and "high-chronic" trajectory groups, respectively, compared with those of mothers in the "low" depressive symptoms group. These differences were not explained by maternal and child characteristics included in multivariate analyses.

CONCLUSIONS

We identified poorer mental health outcomes for children of mothers assigned to the "chronic/severe" and "increasing" depressive symptoms trajectories. Prevention and treatment initiatives to avoid the adverse short, medium, and long-term effects of maternal depression on offspring development should focus on women belonging to these groups.

Association between trajectories of maternal depressive symptoms and length of hospital stay, hospitalization costs, and adverse maternal and infantile outcomes: A longitudinal observational study

This study aimed to determine the trajectories of perinatal depression and their relationship with length of hospital stay (LOS), hospitalization costs, and adverse maternal and infantile outcomes. This longitudinal observational study included 525 participants. Perinatal depressive symptoms were assessed at four waves (from the first trimester to the postpartum period). LOS, hospitalization costs, and adverse maternal (sleep, fatigue, anxiety, perceived stress, and memory problems) and infantile outcomes of participants were obtained from medical records and self-reported questionnaires. Trajectories of perinatal depressive symptoms were explored with latent class growth analysis. Associations between trajectories and adverse maternal and infant outcomes were explored with multiple linear regression and binary logistic regression models. The participants' average age was 29.6 ± 3.9 years. Five heterogeneous developmental trajectories of perinatal depressive symptoms were identified as follows: high-level (7.05%), moderate-increasing (12%), remission (15.05%), moderate-level (37.14%), and low-level (28.76%). The average LOS was 5.78 ± 2.13 days, and the average hospitalization costs were 12,695.27 ± 5457.51 yuan. Compared with the trajectory of low-level depressive symptoms, the LOS, hospitalization costs, and likelihood of adverse outcomes of women with high-level and moderate-increasing depressive symptom trajectories increased. The findings capture the heterogeneity of perinatal depression in Chinese women. Women in the moderate-increasing and high-level trajectory groups had longer LOS, more hospitalization costs, and poor birth outcomes. Elucidating the trajectories of perinatal depression and their relationship with maternal and infant health outcomes provides important insights into the development of person-centred care planning for women during pregnancy and postpartum.

Childhood maltreatment, trait resilience and prenatal distress among expecting mothers and fathers in the FinnBrain Birth Cohort Study

BACKGROUND

In this study we examined the association between childhood maltreatment exposure (CME) and psychological distress, including symptoms of depression and anxiety, during pregnancy. Additionally, we explored the potential moderating effect of trait resilience on these associations.

METHODS

The study is part of the ongoing FinnBrain Birth Cohort Study. The sample consisted of 3016 mothers and 1934 fathers. The data were collected using self-report questionnaires, including EPDS, SCL-90, CD-RISC-10 and TADS. We conducted ANOVAs and linear logistic regression analyses to examine the associations between depression, anxiety, resilience, and CMEs.

RESULTS

CMEs were associated with increased psychological distress, including depression symptoms and anxiety, and decreased trait resilience among both mothers and fathers. Additionally, trait resilience had a moderating effect on the association between fathers' CMEs and psychological distress, while no significant moderating effect was found among mothers. Furthermore, among both mothers and fathers, higher trait resilience was associated with decreased anxiety and depressive symptoms.

LIMITATIONS

Due to cross-sectionality, it is not possible to establish a causal relationship between CMEs, resilience, and parental distress. Additionally, the study does not provide insights into the underlying factors or processes that contribute to the development of trait resilience.

CONCLUSIONS

Trait resilience may have a positive impact on parents' mental health during pregnancy. This study is the first to investigate the significance of fathers' trait resilience during pregnancy. In clinical settings, it is essential to identify parents with low levels of resilience and provide them with appropriate support, recognizing them as a vulnerable group.

Maternal Prenatal Depressive Symptoms and Fetal Growth During the Critical Rapid Growth Stage

Importance

Fetal growth in the critical rapid growth stage (CRGS) before delivery, approximately between 30 to 37 gestational weeks, carries significant implications for subsequent overweight, obesity, and arterial health. Previous evidence has demonstrated the association between maternal depressive symptoms and fetal growth trajectories from early to late pregnancy, but there remains limited understanding of the association of these symptoms with the longitudinal fetal growth change within the CRGS.

Objective

To investigate the association between maternal depressive symptoms and fetal growth during the CRGS before delivery.

Design, Setting, and Participants

This prospective birth cohort study was conducted from January 2018 to December 2020. Volunteer pregnant women were enrolled in their first trimester of prenatal visits. Women with severe disease before pregnancy and multiple births, fetuses with congenital anomalies, and preterm or postterm births were excluded. This multicenter study was based in 13 hospitals covering 81 counties across 12 cities in Sichuan Province, China. Follow-up visits were performed at the second trimester, the third trimester, and 24 hours after delivery. The analysis was conducted from January to May 2023.

Exposures

Maternal depressive symptoms, as a continuous variable, measured by the Edinburgh Postpartum Depression Scale (EPDS) at a median gestational week of 24 (range, 14 to 27) weeks of gestation. A higher score on the EPDS indicates worse depressive symptoms.

Main Outcomes and Measures

The main outcomes included ultrasonography-measured biparietal diameter (BPD), femur length (FL), and abdominal circumference (AC), along with calculated estimated fetal weight (EFW). These parameters were evaluated longitudinally at a median gestational week of 30 (range, 28 to 32) and 37 (range, 35 to 39) weeks. Linear mixed models were used to estimate the associations between maternal depressive symptoms and fetal growth parameters.

Results

A total of 2676 mother-offspring dyads were included, in which the mean (SD) age of mothers was 28.0 (4.4) years, and 1294 (48.4%) of the offspring were female. The median (IQR) maternal EPDS score was 5.0 (4.0 to 9.0). After adjustment for confounders, a significant correlation was found between a higher score of depressive symptoms in mothers and a slower rate of fetal growth across FL (β = -0.40; 95% CI, -0.58 to -0.22), AC (β = -1.97; 95% CI, -2.90 to -1.03), and EFW (β = -50.11; 95% CI, -68.46 to -31.75). These associations were stronger in female fetuses or those with better family socioeconomic conditions.

Conclusions and Relevance

In this prospective cohort study, maternal depressive symptoms were associated with slower fetal growth rate in the CRGS before delivery. Early screening for depressive disorders in pregnant women appears to be essential for fetal growth and later health.

Risk factors for executive function impairment in adolescence: an analysis of data from the 2004 Pelotas Birth Cohort study

OBJECTIVE

To investigate risk factors associated with impaired attention-related executive functions (EFs) at age 11 and working memory at age 15.

METHODS

Data from participants of the population-based 2004 Pelotas Birth Cohort at ages 11 (n=3,582) and 15 (n=1,950) were analyzed. The study measured attentional control, cognitive flexibility, and selective attention using the Test of Everyday Attention for Children (TEA-Ch). Spatial working memory was assessed by the Cambridge Neuropsychological Test Automated Battery (CANTAB). Logistic regression was employed to explore the relationship between perinatal and childhood exposures and EF impairment.

RESULTS

Low maternal education had a significant negative impact on EFs. At age 11, it was associated with decreased attentional control (OR = 3.04; 95%CI 2.09-4.43), and at age 15, it was linked to impaired spatial working memory (OR = 2.21; 95%CI 1.58-3.09). Additional risk factors included low household income, black or brown maternal skin color, high parity, prematurity, low birth weight, and multiple siblings. Breastfeeding, regardless of duration, was found to be a protective factor against impaired cognitive flexibility (OR = 0.38; 95%CI 0.22-0.65).

CONCLUSION

This study underscores the lasting impact of perinatal exposures on EF development. Policies that mitigate the negative effects of risk factors and promote EF development, especially among vulnerable populations, are needed.

Maternal depression trajectories in childhood, subsequent maltreatment, and adolescent emotion regulation and self-esteem: the 2004 Pelotas birth cohort

This study aimed to examine the impact of maternal depressive symptoms trajectories on 15-year-old adolescents' self-esteem and emotion regulation and test the mediating role of child maltreatment in this association. The 2004 Pelotas Birth Cohort is an ongoing cohort study originally comprised of 4231 live births in a southern Brazilian city. We examined a subsample of 1949 adolescents at age 15 years. Maternal depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale. Trajectories of maternal depression from 3 months until the 11-year follow-up were calculated using a group-based modeling approach. Child maltreatment at age 11 years was measured using the parent-report version of the Parent-Child Conflict Tactics Scale. Adolescent outcomes at age 15 years were assessed by the self-report version of the Rosenberg Self-esteem Scale and the Emotion Regulation Index for Children and Adolescents. Path model analysis was conducted using a structural equation modeling framework in Mplus software. All maternal depression trajectories were negatively associated with offspring self-esteem and emotion regulation compared to the reference group (low depression trajectory). There was a significant indirect effect of maternal depression trajectories on emotion regulation mediated via child maltreatment. No evidence of moderation by sex was found for any pathway. The effects of maternal depression on adolescents' emotion regulation are partly mediated by child maltreatment at age 11.

Exploring Heterogeneity in perinatal depression: a comprehensive review

Perinatal depression (PND) is a significant contributor to maternal morbidity globally. Recognized as a major cause of poor infant development, epidemiological and interventional research on it has increased over the last decade. Recently, studies have pointed out that PND is a heterogeneous condition, with variability in its phenotypes, rather than a homogenous latent entity and a concrete diagnosis, as previously conceptualized in psychometric literature and diagnostic systems. Therefore, it is pertinent that researchers recognize this to progress in elucidating its aetiology and developing efficacious interventions.This systematic review is conducted in accordance with the Meta-analysis of observational studies in epidemiology (MOOSE). It aims to provide an updated and comprehensive account of research on heterogeneity in phenotypes of PND and its implications in research, public health, and clinical practice. It provides a synthesis and quality assessment of studies reporting heterogeneity in PND using cutting-edge statistical techniques and machine learning algorithms. After reporting the phenotypes of PND, based on heterogeneous trajectories and symptom profiles, it also elucidates the risk factors associated with severe forms of PND, followed by robust evidence for adverse child outcomes. Furthermore, recommendations are made to improve public health and clinical practice in screening, diagnosis, and treatment of PND.

The relationship between parental mental health, reflective functioning coparenting and social emotional development in 0-3 year old children

Introduction

The transition to parenthood is a high-risk period for many parents and is an important period for child development. Research has identified that parental mental health, reflective functioning (capacity to consider mental states of oneself and others) and coparenting (capacity to work together well as a parenting team) may be particularly significant predictors of later child outcomes, however these factors have seldom been considered together. The present study therefore aimed to investigate the relationship between these factors and the extent to which they predict child social emotional development.

Methods

Three hundred and fifty parents of infants aged 0 to 3 years 11 months were recruited to complete an online Qualtrics questionnaire.

Results

Results indicate that both positive coparenting and parental reflective functioning (Pre-mentalizing and Certainty subscales) were found to significantly predict child development. General reflective functioning (Uncertainty subscale) predicted parental depression and anxiety, however unexpectedly, parental mental health was not a significant predictor of child development, but did predict coparenting. General reflective functioning (Certainty subscale) was also found to predict coparenting, which in turn was found to predict parental reflective functioning. We found an indirect effect of general reflective functioning (Certainty) on child SE development via parental reflective functioning (Pre-mentalizing). We also found an indirect effect of negative coparenting on child development via parental reflective functioning (Pre-mentalizing).

Discussion

The current results support a growing body of research highlighting the important role reflective functioning plays in child development and wellbeing as well as parental mental health and the interparental relationship.

Women's Mental Health up to Eight Years after Childbirth and Associated Risk Factors: Longitudinal Findings from the All Our Families Cohort in Canada

OBJECTIVE

This study examined the prevalence of elevated maternal anxiety and/or depression symptoms up to eight years after childbirth and the association between role and relationship strains during parenting and mental health challenges from three to eight years after childbirth.

METHODS

This study used data from the All Our Families longitudinal pregnancy cohort. Role and relationship strain factors and anxiety and depression symptoms were measured at repeated time points from four months to eight years after childbirth. The proportion of women with elevated anxiety and/or depression was calculated at each available time point. Generalized estimating equation models were used to examine the association between role and relationship strain factors and anxiety and/or depression from three to eight years after childbirth. Predicted probability of having anxiety and/or depression was estimated across those with and without challenges with roles and relationships. The models were adjusted for known risk factors such as maternal income and perinatal anxiety and/or depression.

RESULTS

The prevalence of elevated anxiety and/or depression ranged from 18.8% (at four months) to 26.2% (at eight years). The adjusted odds ratio of anxiety and/or depression was 3.5 (95% CI = 2.9, 4.3) for those juggling family responsibilities and 2.4 (95% CI = 2.0, 3.0) for those with stressful partner relationship compared to their counterparts. Similarly, experiencing financial crunch and poor partner relationship were associated with increased mental health difficulties. Women without challenges in roles or relationships had a 23% lower predicted probability of anxiety and/or depression than those with the challenges.

CONCLUSIONS

Monitoring mothers for anxiety and depression beyond the postpartum period and strategies that address role and relationship challenges may be valuable to women at risk of anxiety and depression.

Patterns of Maternal Distress from Pregnancy Through Childhood Predict Psychopathology During Early Adolescence

Capitalizing on a longitudinal cohort followed from gestation through adolescence (201 mother-child dyads), we investigate the contributions of severity and stability of both maternal depressive and perceived stress symptoms to adolescent psychopathology. Maternal depressive and perceived stress trajectories from pregnancy through adolescence were identified with latent class growth analyses, and associations with adolescent internalizing and externalizing symptoms were examined. For both depression and stress, the most common trajectory group comprised mothers displaying stable and low symptom levels over time, and adolescents of these mothers had the fewest internalizing and externalizing symptoms. Maternal membership to one or more aberrant trajectory groups predicted higher levels of internalizing and externalizing symptoms, determined by both maternal and adolescent self-report. This study indicates that profiles of multiple indicators of maternal psychopathology assessed across childhood, beginning prenatally, can provide critical additional insight into child psychopathology risk.

The association of different presentations of maternal depression with children's socio-emotional development: A systematic review

Maternal depression from the perinatal period onwards is a global health priority associated with an increased likelihood of suboptimal socio-developmental outcomes in offspring. An important aspect of this association is the extent to which sustained maternal depression impacts on these outcomes. The current review synthesised the evidence on maternal depression from the perinatal period onwards and offspring internalising, externalising, and social competence outcomes. We also identified sources of methodological bias. A systematic review following PRISMA guidelines was conducted. Longitudinal studies targeting biological mothers with depressive symptomology, detailing onset, using repeated validated measures, and assessing children's outcomes between three and 12 years were included. Twenty-four studies met inclusion criteria. Findings supported the validity of different presentations of maternal depression, including consistent identification of a group of chronically depressed mothers across countries. Mothers within this group reported poorer internalising, externalising, and social competence outcomes for their offspring, with the highest levels of child problems associated with greater maternal chronicity and symptom severity. Results differed by measurement type with mothers rating poorer outcomes in comparison to teachers reports. For timing of depression, evidence was inconsistent for independent effects of antenatal or postnatal depression on child outcomes. There was substantial variability in study quality assessment. Assessing different presentations of maternal depression is essential for capturing the longitudinal associations between maternal depression and offspring outcomes to inform targets of early intervention. Chronicity, severity, and concurrent maternal depression have important implications for children's development and should be targeted in future programme planning. Further research in low- and middle-income countries is warranted.

The interplay of childhood maltreatment and maternal depression in relation to the reward positivity in youth

Guided by developmental psychopathology and dual-risk frameworks, the present study examined the interplay between childhood maltreatment and maternal major depression history in relation to neural reward responsiveness in youth. The sample consisted of 96 youth (ages 9-16; M = 12.29 years, SD = 2.20; 68.8% female) drawn from a large metropolitan city. Youth were recruited based on whether their mothers had a history of major depressive disorder (MDD) and were categorized into two groups: youth with mothers with a history of MDD (high risk; HR; n = 56) and youth with mothers with no history of psychiatric disorders (low risk; LR; n = 40). The reward positivity (RewP), an event-related potential component, was utilized to measure reward responsiveness and the Childhood Trauma Questionnaire measured childhood maltreatment. We found a significant two-way interaction between childhood maltreatment and risk group in relation to RewP. Simple slope analysis revealed that in the HR group, greater childhood maltreatment was significantly associated with reduced RewP. The relationship between childhood maltreatment and RewP was not significant among the LR youth. The present findings demonstrate that the association between childhood maltreatment and blunted reward responsiveness is dependent on whether offspring have mothers with histories of MDD.

Trajectory of Perinatal Depressive Symptoms from the Second Trimester to Three Months Postpartum and Its Association with Sleep Quality

Purpose

Few studies have explored the association between sleep quality and depressive symptoms in perinatal women from the second trimester to the postpartum period. This study aims to explore this relationship using a longitudinal design.

Patients and Methods

Participants were enrolled at 15 gestational weeks. Demographic information was collected. Perinatal depressive symptoms were measured using the Edinburgh Postnatal Depression Scale (EPDS). Sleep quality was measured employing the Pittsburgh Sleep Quality Index (PSQI) at five timepoints from enrollment to three months postpartum. Overall, 1416 women completed the questionnaires at least thrice. A Latent Growth Curve (LGC) model was performed to identify the relationship between the trajectories of perinatal depressive symptoms and sleep quality.

Results

Of the participants, 23.7% screened positive at least once on the EPDS. The perinatal depressive symptoms trajectory, fitted by the LGC model, decreased at early pregnancy and increased from 15 gestational weeks to three months postpartum. The intercept of sleep trajectory positively affected the intercept of perinatal depressive symptoms' trajectory; the slope of sleep trajectory positively affected both the slope and the quadratic coefficient of perinatal depressive symptoms' trajectory.

Conclusion

The trajectory of perinatal depressive symptoms increased from 15 gestational weeks to three months postpartum following a quadratic trend. Poor sleep quality was associated with depression symptoms beginning at the onset of pregnancy. Moreover, rapidly declining sleep quality could be a significant risk factor for perinatal depression (PND). These findings call for greater attention to perinatal women who report poor and persistently deteriorating sleep quality. Additional sleep-quality evaluations, depression assessments, and referrals to mental health care providers may benefit these women and support PND prevention, screening, and early diagnosis.

The lifetime costs of perinatal depression and anxiety in Brazil

BACKGROUND

Each year, an estimated 860,000 Brazilian women experience depression and anxiety perinatally. Despite well-known devastating impacts of these conditions on mothers and children, they remain neglected in low- and middle-income countries. Knowing the costs of untreated perinatal depression and anxiety can inform decision-making.

METHODS

Simulation modelling is used to examine lifetime costs of perinatal depression and anxiety for a hypothetical cohort of women and their children, followed until children are aged 40 years. Costs are measured from a societal perspective, including healthcare expenditure, productivity and health-related quality of life losses; 2017 data are taken from country-specific sources. Present values are calculated using a discount rate of 3 %.

RESULTS

Lifetime cost of perinatal depression and anxiety in Brazil are USD 4.86 billion or R$ 26.16 billion, including costs linked to poorer quality of life (USD 2.65 billion), productivity loss (USD 2.16 billion) and hospital care (USD 0.05 billion). When the costs associated with maternal suicide are included, total costs increase to USD 4.93 billion.

LIMITATIONS

Several costs could not be included in the analysis because of a lack of data. The study is reliant of longitudinal data on associations between perinatal depression and anxiety and impacts on mothers and children. Therefore, no causality can be inferred.

CONCLUSION

Our findings illustrate the economic rationale for investment in this area. This is the first study that estimates the costs of perinatal mental health problems in a low- or middle-income country setting.

Postpartum depression and ADHD in the offspring: Systematic review and meta-analysis

BACKGROUND

Postpartum depression (PPD) is a disorder that has a severe impact on a woman's mental state and mood after birth. Research has shown that postnatal levels of family adversity and maternal psychopathology are associated with Attention Deficit Hyperactivity Disorder (ADHD). This paper is intended to examine the association among maternal PPD and the risk of ADHD in the offspring.

METHODS

Keyword search was conducted for PsycINFO, PubMed, Google Scholar, and Embase up to Feb 28, 2021; studies in English were deemed eligible. Random-effects meta-analysis and meta-regression analysis took place. Subgroup analyses by study design, geographical region, level of adjustment and study setting were performed.

RESULTS

Nine cohort studies and two case-control studies published from 2003 to 2019 were included in the qualitative synthesis; among them, eight studies were synthesized in the meta-analysis. Overall, maternal PPD was associated with an increased risk of ADHD in the offspring (pooled relative risk, RR = 1.69, 95%CI: 1.27-2.26). Significant associations were noted in the subsets of cohort studies, studies implementing multivariate analyses and registry-based surveys.

LIMITATIONS

Overall, a larger number of studies of the field are needed. Data collection relied on self-report and attrition bias limited the validity of eligible studies. Studies from developing countries were underrepresented. There was significant publication bias (p = 0.035, Egger's test).

CONCLUSIONS

The relationship between PPD and ADHD in children was found to be significant in this systematic review and meta-analysis and reveals the need for further investigation in various geographical regions.

Trajectories of depressive symptoms among mothers of preterm and full-term infants in a national sample

To examine postpartum depressive symptom trajectories from birth to age 5 and their risk factors in a national sample of mothers of preterm and full-term infants. The racially and ethnically diverse sample comprised 11,320 maternal participants (Mage = 29; SD = 5.9) in the Environmental influences on Child Health Outcomes (ECHO) Program in the USA with data on newborn gestational age at birth (≥ 22 weeks) and maternal depression symptoms during the first 5 years following childbirth. Growth mixture models determined the number and trajectory of postpartum depression classes among women in the preterm and full-term groups, and we examined predictors of class membership. Five trajectories described depressive symptoms for both groups; however, notable differences were observed. One in 5 mothers of preterm infants developed clinically relevant depressive symptoms over time compared with 1 in 10 mothers of full-term infants. Among women who delivered preterm compared with those who delivered full-term, symptoms were more likely to increase over time and become severe when offspring were older. Distinct subgroups describe mothers' depressive symptom trajectories through 5 years following childbirth. Mild to moderate depressive symptoms may onset or persist for many women beyond the initial postpartum period regardless of newborn gestational age at birth. For women with preterm infants, initially mild symptoms may increase to high levels of severity during the preschool and toddler years.

Maternal socioeconomic disadvantage, neural function during volitional emotion regulation, and parenting

The transition to becoming a mother involves numerous emotional challenges, and the ability to effectively keep negative emotions in check is critical for parenting. Evidence suggests that experiencing socioeconomic disadvantage interferes with parenting adaptations and alters neural processes related to emotion regulation. The present study examined whether socioeconomic disadvantage is associated with diminished neural activation while mothers engaged in volitional (i.e., purposeful) emotion regulation. 59 mothers, at an average of 4 months postpartum, underwent fMRI scanning and completed the Emotion Regulation Task (ERT). When asked to regulate emotions using reappraisal (i.e., Reappraise condition; reframing stimuli in order to decrease negative emotion), mothers with lower income-to-needs ratio exhibited dampened neural activation in the dorsolateral and ventrolateral PFC, middle frontal and middle temporal gyrus, and caudate. Without explicit instructions to down-regulate (i.e., Maintain condition), mothers experiencing lower income also exhibited dampened response in regulatory areas, including the middle frontal and middle temporal gyrus and caudate. Blunted middle frontal gyrus activation across both Reappraise and Maintain conditions was associated with reduced maternal sensitivity during a mother-child interaction task. Results of the present study demonstrate the influence of socioeconomic disadvantage on prefrontal engagement during emotion regulation, which may have downstream consequences for maternal behaviors.

It's not always binary: Connecting the continuum of caregiver depression with child adjustment in children who are high risk for maltreatment

BACKGROUND

Young children living with a depressed parent are at risk for developing social, behavioral, and emotional problems. The purpose of this study was to evaluate whether an increase in subclinical caregiver depression scores was associated with increases in internalizing and externalizing behavior in children who are at high risk for maltreatment.

METHODS

The 1019 U.S.-based dyads consisted of predominantly single (45.53%) and Black/African American (53.29%) caregivers and high-risk 4-year-olds from the LONGSCAN study. Multivariate regression analyzes were used to evaluate the relationship between caregiver Center for Epidemiological Studies-Depression (CES-D) scores, above and below the at-risk for depression CES-D score, and preschooler internalizing, externalizing, and total problem behaviors, measured with the Child Behavior Checklist (CBCL).

RESULTS

Caregiver CES-D score increases, above and below the at-risk for depression score, were significantly associated (p < 0.05) with increased child internalizing, externalizing, and total problem behaviors. After adjusting for covariates, among dyads whose caregivers had subclinical (CES-D < 16) scores, a one-unit score increase was significantly associated with a 0.43 increase (p = 0.00) in children's CBCL internalizing score.

LIMITATIONS

These findings are restricted to preschool children who are at risk for maltreatment, limiting generalizability.

CONCLUSIONS

Low and moderate levels of caregiver depressive symptomatology were associated with a negative influence on preschoolers' adjustment. Practitioners should consider that the link between caregiver depression and child wellbeing may lie on a continuum. With consideration of the full continuum of symptoms, early intervention and anticipatory guidance may decrease the impact of depression on the caregiver, child, and system.

The Longitudinal Impact of Maternal Depression and Neighborhood Social Context on Adolescent Mental Health

PURPOSE

Maternal depression and neighborhood characteristics are known to be associated both with each other and with adolescent mental health outcomes. These exposures are also subject to change throughout the life of a child. This study sought to identify multi-trajectories of maternal depression (MD) and self-reported neighborhood collective efficacy (NCE) over a 12-year period and determine whether these trajectories are differentially associated with adolescent mental health.

METHODS

Data from the Fragile Families and Child Wellbeing study, a longitudinal cohort study of new parents and their children, were used. Maternal depression (MD) and self-reported NCE when the child was 3, 5, 9, and 15 years of age were the primary exposures of interest. Adolescent depression and anxiety symptomology when the child was 15 years of age were the primary outcomes. Primary analyses were conducted using multi-trajectory modeling and linear regressions.

RESULTS

Five multi-trajectories were identified, two of which were characterized by no MD but either high or low NCE, and three of which were characterized by similarly moderate levels of NCE but either increasing, decreasing, or consistently high MD. Children of mothers with increasing or consistently high depressive symptomology and moderate NCE had significantly higher depression and anxiety scores compared to children of mothers with no depressive symptomology and high NCE.

CONCLUSION

Adolescents with consistent and proximal exposure to MD are most likely to suffer from adverse mental health and should be provided with appropriate support systems to mitigate these outcomes.

Maternal depression trajectories and offspring positive attributes and social aptitudes at early adolescence: 2004 Pelotas birth cohort

There is growing evidence that adolescent positive attributes and social aptitudes are associated with beneficial outcomes, including higher educational attainment and lower risk of later psychiatric disorder. Although maternal depression is a well-known risk factor for a variety of offspring adverse outcomes, less is known on its repercussion on children's positive behavioral traits. This study aimed to evaluate the impact of maternal depression trajectories on offspring positive attributes and social aptitudes, testing sex-moderated models for the studied association. The 2004 Pelotas Birth Cohort is an ongoing cohort originally comprised by 4231 live births from Brazil. We included 3465 11-year-old adolescents (48.6% female; maternal self-reported skin color: 27.0% non-white). Maternal depressive symptoms were assessed by the Edinburgh Postnatal Depression Scale (EPDS) at all follow-ups. Adolescent positive attributes and social aptitudes were ascertained by specific subscales of Development and Well-Being Assessment (DAWBA). Multivariate linear regression was used to examine the effect of maternal depression trajectories on offspring's outcomes, adjusting for potential confounding variables. Moderation was assessed with interaction terms. Adolescents from mothers who presented high-chronic levels of depressive symptoms during offspring's life have lower scores of positive attributes and social aptitudes. Boys exposed to maternal depression during their lifetime are more affected than girls regarding positive attributes, but this sex difference was not observed for social aptitudes. Interventions targeting the promotion of adaptive behavioral traits may represent an effective way to buffer the adverse impact of maternal depression on offspring development, especially for vulnerable groups such as male adolescents.

Dual trajectories of parenting self-efficacy and depressive symptoms in new, postpartum mothers and socioemotional adjustment in early childhood: A growth mixture model

Postpartum depression and low parental self-efficacy (PSE) are risk factors for poor child behavior. Little is known, however, about the course of dual trajectories of cooccurring depressive symptoms and PSE or its impact on children's socioemotional development. This study sought to identify trajectories of postpartum PSE and depressive symptoms in new, first-time mothers using growth mixture modeling. Results demonstrated a class of women with "low risk" (88.8%) who manifested low levels of depression and high levels of PSE during the postpartum period; a second group of women, labeled "early risk" (6.3%) with high levels of depression that decreased over time but lower levels of PSE that remained fairly stable; and a final trajectory group deemed the "late-risk" class (4.9%) with initially low levels of depression and high levels of PSE that significantly increased and decreased, respectively, over the period. Early childhood trauma, parenting stress, and poor parenting practices were associated membership in a high-risk class. Mothers in the high-risk groups reported children with more aggressive and defiant behavior at age 3. We conclude by discussing the implications of our findings for developing effective and sensitive interventions.

Effect estimate of time-varying social support and trust on the physical and mental health of mothers at 2.5 years postpartum: The Japan Environment and Children's Study (JECS)

BACKGROUND

Many epidemiological studies have reported the association between various social factors and health status in mothers during and after pregnancy. However, little is known about their joint and longitudinal impact. We therefore examined the association of lack of social support and trust during pregnancy and at 2.5 years postpartum with health status in mothers.

METHODS

To adequately address time-varying exposure, marginal structural models were fitted to a pseudopopulation constructed by inverse probability weighting. The model included records of 90,071 mothers participating in the Japan Environment and Children's Study. Social support and trust were measured using a 9-item questionnaire (Q1-9). Mental and physical health were measured using Mental and Physical Component Summary scores from the 8-item Short-Form Health Survey.

RESULTS

For the Mental Component Summary, the magnitude of the effect estimate was largest when participants lacked close friends/neighbors (Q4) at only 2.5 years postpartum (= -6.23), followed by a lack in emotional support (Q2) at the same time point (= -4.94). For the Physical Component Summary, effect estimates were negligible. The magnitude of the effect estimates of lack of social support and trust tended to be larger when there was a lack at only 2.5 years postpartum than at both time points.

CONCLUSIONS

These findings suggest that, after childbirth, a loss in social support, particularly in a concrete or instrumental aspect, carries high risk, especially for mental health. Our results highlight the importance of supporting mothers for more than a few years after pregnancy.

Analysis of Maternal Postnatal Depression, Socioeconomic Factors, and Offspring Internalizing Symptoms in a Longitudinal Cohort in South Africa

IMPORTANCE

Few studies from low-and-middle income countries have investigated long-term associations between maternal postnatal depression and offspring internalizing (ie, depressive and anxiety) symptoms, and none have investigated interactions in this association.

OBJECTIVE

To investigate the association between maternal postnatal depression and offspring internalizing symptoms from adolescence to adulthood and the interaction with exposure to socioeconomic adversity and with the child's sex.

DESIGN, SETTING, AND PARTICIPANTS

This secondary analysis used data from Birth to Twenty Plus (BT20+), a prospective birth cohort study of children born in Soweto, South Africa, and followed up until age 28 years. Data were collected from 1990 to 2018, and data were analyzed for this study from February 16 through December 15, 2020.

EXPOSURES

Maternal postnatal depression self-reported by mothers 6 months after childbirth.

MAIN OUTCOMES AND MEASURES

The main outcome was offspring internalizing symptoms, assessed at offspring ages 14 years, 22 years, and 28 years and modeled longitudinally. Participants with the highest probability of experiencing high internalizing symptoms (ie, those in the top 20% of the distribution) from age 14 to 28 years were categorized as belonging to the high internalizing symptoms trajectory (vs the low trajectory). Socioeconomic adversity was measured with an index (continuous variable) including low maternal education, household crowding, low assets, and low maternal age. This variable was further stratified into more than 1 SD above the mean index, more than 1 SD below the mean index, and from 1 SD below to 1 SD above the mean index to conduct subgroup analyses. Associations were investigated using multivariable regression models.

RESULTS

Among 1087 participants born in Soweto, South Africa (543 [50.0%] male participants; 544 [50.0%] female participants), 118 individuals (10.8%) showed a high trajectory of internalizing symptoms from age 14 to 28 years vs 969 individuals (89.1%) with a low trajectory. Children exposed to maternal postnatal depression had statistically significantly increased odds of following the high trajectory (adjusted odds ratio [aOR] per 1-SD increase in maternal postnatal depression, 1.20; 95% CI, 1.02-1.41). This increase in odds differed by exposure to socioeconomic adversity and by child sex: for male participants, the increase in odds was greater in a context of higher vs lower socioeconomic adversity (eg, for >1 SD above the mean: aOR, 3.28; 95% CI, 1.06-10.14 vs for >1 SD below the mean: aOR, 0.98; 95% CI, 0.64-1.50; P for interaction = .12), while for female participants, the increase in odds was greater in a context of lower vs higher socioeconomic adversity (eg, for >1 SD below the mean: aOR, 1.82; 95 % CI, 1.12-2.98 vs for >1 SD above the mean: aOR, 0.59; 95 % CI, 0.30-1.17; P for interaction = .002) (P for 3-way interaction = .003).

CONCLUSIONS AND RELEVANCE

This study found that postnatal depression was associated with higher odds of persistently increased internalizing symptoms among offspring from adolescence to adulthood in a middle-income country, with variation by socioeconomic adversity and sex. These findings suggest that better understanding of these associations is needed to implement targeted interventions and maximize the impact of public health initiatives aimed at breaking the intergenerational transmission of mental health problems.

Psychosocial and peripartum determinants of postpartum depression: Findings from a prospective population-based cohort. The ABCD study

BACKGROUND

Postpartum depression is prevalent and concerns a serious health problem for women and their families. The current large-scale birth cohort study investigated: (1) the associations of various potential determinants of postpartum depression using a multidimensional approach, and (2) the individual contribution of obstetric and perinatal determinants and pregnancy-specific anxiety to the risk of postpartum depression.

METHODS

This study was based on a large-scale birth cohort study in Amsterdam, the Netherlands (ABCD-study). In 5109 women depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (cut-off ≥16 indicating high risk of postpartum depression). Determinants were assessed using self-report or perinatal registries.

RESULTS

In the final multivariable model, other-Western and non-Western ethnic background, increased antepartum depressive symptoms, increased antepartum anxiety, increased pregnancy-specific anxiety, being unemployed, poor sleep quality, unwanted pregnancy, abuse, multiparity, and congenital abnormality were all independently related to an increased risk of postpartum depression. The strongest risk factors for postpartum depression were antepartum depressive symptoms (adjusted odds ratio (AOR) = 3.86, 95% confidence interval (CI) 3.02-4.92), having a baby with a congenital abnormality (AOR = 2.33, 95% CI 1.46-3.73), and abuse (AOR = 1.95, 95% CI 1.02-3.73). The final model accounted for 24.5% of the variance.

LIMITATIONS

Our dataset did not provide information on social support or maternal and family history of depression. Next to these determinants, future research should include biological factors.

CONCLUSIONS

The determinants identified provide opportunities for the development of multidimensional early screening and early intervention strategies for women with an increased risk of postpartum depression.

Multiple dimensions of sleep are consistently associated with chronically elevated depressive symptoms from late pregnancy to 3 years postnatal in Indigenous and non-Indigenous New Zealand women

INTRODUCTION

Poor sleep and depressive symptoms are common throughout the perinatal period, but little is known about the extended time course of depression and the sleep dimensions associated with these trajectories.

OBJECTIVE

This study investigated different depression trajectories in New Zealand Māori and non-Māori women from late pregnancy to 3 years postnatal. Relationships between multiple dimensions of sleep and these depression trajectories were also investigated.

METHODS

Data from 856 women (30.6% Māori and 69.4% non-Māori) from the longitudinal Moe Kura cohort study were used. Depressive symptoms and multiple dimensions of sleep (quality, duration, latency, continuity and daytime sleepiness) were collected at 36 weeks' gestation, 12 weeks postnatal and 3 years postnatal. Trajectory analysis was completed using latent class analysis.

RESULTS

Latent class analysis revealed two distinct groups of depressive symptom trajectories: 'chronic high' and 'stable mild' for both Māori and non-Māori women. Māori women in both trajectories were more likely than non-Māori women to have clinically significant depressive symptoms at every time point. Poorer sleep quality, latency, continuity and greater daytime sleepiness were consistently associated with the chronic high depressive symptom trajectory at all three time points, after controlling for sociodemographic factors.

CONCLUSION

A significant proportion of Māori and non-Māori women experience chronically high depressive symptoms during the perinatal period and the following years. Across this extended time frame, Māori women have a higher probability of experiencing clinically significant depressive symptoms compared to non-Māori women. These persistent patterns of depressive symptoms occur concurrently with multiple dimensions of poor sleep. Given the well-described impact of maternal depression on the mother, child, family and community, this highlights the importance of healthcare professionals asking about mothers' sleep quality, continuity, latency and daytime sleepiness as potential indicators of long-term mood outcomes.

The efficacy of probiotics and/or n-3 long-chain polyunsaturated fatty acids intervention on maternal prenatal and postnatal depressive and anxiety symptoms among overweight and obese women

BACKGROUND

Maternal depression and anxiety may endanger well-being of both mother and child. We investigated the efficacy of probiotics and/or fish oil (FO) in modifying pre- and postnatal depressive and anxiety symptoms. Symptom trajectories were identified and the influence of lifestyle factors on symptoms was evaluated.

METHODS

Overweight women (n = 439) were randomized to intervention groups (probiotics+FO, probiotics+placebo, FO+placebo, placebo+placebo) from early pregnancy until six months postpartum, and assessed for depressive and anxiety symptoms with Edinburgh Postnatal Depression Scale (EPDS) and Anxiety subscale of Symptoms Checklist (SCL-90) at early and late pregnancy and three, six and 12 months postpartum. Latent growth mixture modeling was used to model the symptom courses. Dietary quality and physical activity were assessed with validated indices.

RESULTS

Symptom scores were generally low. Statistically significant intervention effect was seen during pregnancy (p = 0.017): EPDS scores increased (by 1.11 points) in the FO+probiotics group and decreased (by 0.85 points) in the FO+placebo group. At 12 months postpartum, FO+placebo group had lower EPDS scores compared to probiotics+placebo group (p = 0.039). No differences in SCL scores were seen in response to the intervention. Irrespective of the intervention, three depressive and two anxiety symptoms trajectories were identified. Dietary quality correlated negatively with depressive symptoms in early pregnancy and six months postpartum and with anxiety symptoms in early pregnancy. Perinatal events including mother-reported colic were related to symptoms.

LIMITATIONS

Secondary outcomes of the primary trial.

CONCLUSIONS

Intervention had a modest impact on depressive symptoms. Diet and obstetric events were associated with depressive and anxiety symptoms.

A smartphone-assisted brief online cognitive-behavioral intervention for pregnant women with depression: a study protocol of a randomized controlled trial

Background

Pregnancy is strongly associated with increased risk for depression. Approximately 25% of pregnant women develop depression. Treatment for depression during pregnancy has several complexities: the use of psychiatric medications during pregnancy might result in developmental problems in the child and must be used with caution. Psychosocial interventions are effective, but they require specialized professionals. Low- and middle-income countries (LMIC) such as Brazil do not have enough mental health professionals needed to meet this demand. In this context, smartphone-based interventions show immense potential. We developed Motherly, a smartphone application (app) designed to treat maternal depression. We aim to test the efficacy of Motherly in addition to brief cognitive-behavioral therapies (CBT) to treat maternal depression.

Methods

We will conduct a 2-arm parallel-randomized controlled clinical trial in which 70 pregnant women aged between 16 and 40 years with depression will be randomized to intervention or active control. The intervention group will have access to Motherly, a smartphone app based on three concepts: psychoeducation, behavior monitoring, and gaming elements. Motherly is composed of a package of interventions composed of modules: mental health, sleep, nutrition, physical activity, social support, prenatal/postnatal support, and educational content. The main focus of Motherly is delivering behavioral activation (BA), a brief and structured psychological treatment. The app allows participants to schedule and engage in, and monitor activities according to a plan to avoid acting exclusively according to their mood. The active control group will have access to a simplified version of the app consisting of educational content about various aspects of pregnancy, maternal physical and mental health, and infant development (BA, activity scheduling, sleep hygiene, among other functionalities, will not be present in this version). Both groups will receive four sessions of brief CBT in 8 weeks. Participants will be evaluated by assessors blind to randomization and allocation status. Assessments will occur at baseline (T0), midpoint (T1, week 4–5), posttreatment (T2, week 8), and follow-up (T3, when the child is 2 months old). Maternal mental health (prenatal anxiety, psychological well-being, perceived stress, depression, depression severity, and sleep quality), quality of life, physical activity levels, and infant developmental milestones and social/emotional problems will be measured. Our primary outcome is the change in maternal prenatal depression from baseline to posttreatment (8 weeks).

Discussion

The potential of digital technology to deliver mental health interventions has been increasingly recognized worldwide. There is a growing literature on interventions using smartphone applications to promote mental health, both with or without the intermediation of a mental health professional. Our study adds to the literature by testing whether an app providing an intervention package, including CBT, psychoeducation, nutrition, physical activity, and social support, can promote maternal and child health and well-being. In particular, we aim to treat depression, for which the use of digital technologies is still scarce. Smartphone applications designed to treat maternal depression are especially relevant because of the potential to circumvent barriers that prevent pregnant women from accessing mental health care.

Trial registration

ClinicalTrials.gov NCT04495166. Prospectively registered on July 29, 2020.

Trajectories of maternal depressive symptoms and offspring's risk behavior in early adolescence: data from the 2004 Pelotas birth cohort study

BACKGROUND

This longitudinal study explored the relationship between trajectories of maternal depressive symptoms and offspring's risk behavior in adolescence contributing to an extremely scarce literature about the impacts of maternal depression trajectories on offspring risk behaviors.

METHODS

We included 3437 11-year-old adolescents from the 2004 Pelotas Birth Cohort Study. Trajectories of maternal depressive symptoms were constructed using Edinburgh Postnatal Depression Scale (EDPS) from age 3 months to 11 years. We identified five trajectories of maternal depressive symptoms: "low" "moderate low", "increasing", "decreasing", and "chronic high". The following adolescent outcomes were identified via self-report questionnaire and analyzed as binary outcome -yes/no: involvement in fights and alcohol use at age 11. We used logistic regression models to examine the effects of trajectories of maternal depressive symptoms on offspring's risk behavior adjusting for potential confounding variable.

RESULTS

Alcohol use and/or abuse as well as involvement in fights during adolescence, were not significantly associated with any specific trajectory of maternal depressive symptoms neither in the crude nor in the adjusted analyses.

CONCLUSION

Alcohol use and involvement in fights at age 11 were not associated with any specific trajectory of maternal depression.

Maternal Depression Trajectories Relate to Youths' Psychosocial and Cognitive Functioning at Adolescence and Young Adulthood

This study evaluated how patterns of mothers' depressive symptoms across their child's childhood relate to children's psychosocial adjustment at adolescence and young adulthood and to cognitive functioning at adolescence. Depressive symptoms were measured in 1,273 mothers when their children were 1, 5, 10, and 14.6 years of age. Children (53.5% male; n = 1,024) completed the Youth Self-Report at adolescence (M = 14.6y), and the Adult Self-Report in young adulthood (M = 20.5y; n = 817) to assess internalizing and externalizing symptoms. Adolescents also completed standardized cognitive tests to assess verbal and mathematical skills. Growth mixture modeling analyses identified four patterns of maternal depressive symptom trajectories: infrequent (55%), increasing at adolescence (20%), decreasing at adolescence (14%), and chronic severe (11%). Results indicated that exposure to maternal depression of any duration, severity or time period during childhood portended higher levels of externalizing and attention problems at both adolescence and adulthood and higher levels of internalizing problems at adulthood. Adolescents whose mothers had chronic severe depressive symptoms had lower language, vocabulary, reading comprehension and mathematical test scores than youth whose mothers had stable infrequent depressive symptoms. Findings illustrate the significance and long-term ramifications of mothers' depressed mood for their children's mental and psychosocial health into adulthood. Findings also demonstrate that the lower cognitive abilities among children of severely depressed mothers persist beyond childhood and pertain to a broad range of cognitive abilities.

Trajectories of Maternal Postpartum Depressive Symptoms

OBJECTIVES

To identify homogenous depressive symptom trajectories over the postpartum period and the demographic and perinatal factors linked to different trajectories.

METHODS

Mothers (N = 4866) were recruited for Upstate KIDS, a population-based birth cohort study, and provided assessments of depressive symptoms at 4, 12, 24, and 36 months postpartum. Maternal demographic and perinatal conditions were obtained from vital records and/or maternal report.

RESULTS

Four depression trajectories were identified: low-stable (74.7%), characterized by low symptoms at all waves; low-increasing (8.2%), characterized by initially low but increasing symptoms; medium-decreasing (12.6%), characterized by initially moderate but remitting symptoms; and high-persistent (4.5%), characterized by high symptoms at all waves. Compared with the high-persistent group, older mothers (maximum odds ratio [OR] of the 3 comparisons: 1.10; 95% confidence interval [CI]: 1.05 to 1.15) or those with college education (maximum OR: 2.52; 95% CI: 1.36 to 4.68) were more likely to be in all other symptom groups, and mothers who had a history of mood disorder (minimum OR: 0.07; 95% CI: 0.04 to 0.10) or gestational diabetes mellitus diagnosis (minimum OR: 0.23; 95% CI: 0.08 to 0.68) were less likely to be in other symptom groups. Infertility treatment, multiple births, prepregnancy BMI, gestational hypertension, and infant sex were not differentially associated with depressive symptom trajectories.

CONCLUSIONS

One-quarter of mothers in a population-based birth cohort had elevated depressive symptoms in 3 years postpartum. Screening for maternal depression beyond the postpartum period may be warranted, particularly after mood and diabetic disorders.

Maternal prenatal stress and postnatal depressive symptoms: discrepancy between mother and teacher reports of toddler psychological problems

PURPOSE

Maternal prenatal stress and postnatal depression are reported to increase the risk for early offspring psychological problems. We examined whether these two stressors predicted toddler emotional or behavioral problems based on the mother and teacher reports, respectively.

METHODS

A longitudinal study within the Odense Child Cohort (OCC). Prenatal stress was assessed (gestation week 28) using Cohen's Perceived Stress Scale (PSS). Depressive symptoms were assessed (3 months after birth) using the Edinburgh Postnatal Depression Scale (EPDS). Behavioral and emotional problems were assessed by mothers using the preschool version of Child Behaviour Checklist (CBCL) and by teachers using the caregiver-teacher report form (CTR-F).

RESULTS

N = 1302 mother-child dyads were included. CBCL (N = 1302) was collected at 29 months (SD 5.3) and C-TRF (N = 989) at 32.6 months (SD 6.9). N = 70 mothers (5.4%) were at high risk for postnatal depression (EPDS score > 12). Generalized additive models showed that prenatal stress (increase of + 1 on PSS-10 total score) predicted an increase in CBCL (+ 0.011) and C-TRF (+ 0.015) total scores. Postnatal depressive symptoms (increase of + 1 on EPDS total score) only predicted an increase in CBCL total score (+ 0.026).

CONCLUSION

Prenatal maternal stress was a significant predictor of both mother and teacher reported toddler emotional and behavioral problems, although effect sizes were small. Postnatal depressive symptoms were associated with increased maternal (but not teacher) reporting of toddler problems. Mothers reported more toddler psychological problems than teachers, and the mother-teacher discrepancy was positively correlated to maternal postnatal depressive symptoms.

Identification of clinical and psychosocial characteristics associated with perinatal depression in the south Indian population

BACKGROUND

Longitudinal perinatal depression (PND) data is sparsely available in the Indian population. We have employed Edinburgh Postnatal Depression Scale (EPDS) to assess the prevalence and identify characteristics associated with PND in the south Indian population. PND was assessed longitudinally using EPDS scores with traditional cut-off approach as well as a novel method of latent class mixture modeling (LCMM). The LCMM method, to the best of our knowledge, has been used for the first time in the Indian population.

METHODS

Three hundred and forty seven women, predominantly from economically-weaker sections of rural and urban South India were longitudinally assessed for antenatal depression (AD) and postnatal depression (PD) using EPDS cutoff-scores ≥13 and ≥10, respectively. Uni/multivariable analyses were used to identify PND associated characteristics. LCMM was then implemented, followed by risk characteristics identification.

RESULTS

PND prevalence from traditional approach was 24.50 % (12.68 % AD; 18.16% PD). Characteristics associated with PND were urban-site and recent adverse life events. Irregular menstrual history and chronic health issues were associated with AD and PD, respectively. Three distinct PND trajectories were observed from LCMM-analysis: low-risk (76.08%), medium-risk (19.89%) and high-risk (4.04%). Urban-site, recent adverse life events, irregular menstrual history and pregnancy complications were associated with medium-risk/high-risk trajectories.

LIMITATIONS

EPDS is a screening tool and not a diagnostic tool for depression. Since the study population included women from economically-weaker sections, the results need verification in other socio-economic groups.

CONCLUSIONS

Both the traditional cut-off-based approach and LCMM provided very similar conclusions regarding the prevalence of PND and characteristics associated with it. Higher PND prevalence was observed in urban women compared to rural women. In low-income countries, identifying risk characteristics associated with PND is a critical component in designing prevention strategies for PND related conditions because of the limited access to mental health resources.

Linking Mother and Offspring Depressive Symptoms: The mediating role of child appearance contingent self-worth

BACKGROUND

Adolescents exposed to maternal depression are more vulnerable to depressive symptoms. Less is known on the mediating role of children's self-worth construction processes, particularly those related to physical appearance. This study proposes and tests appearance contingent self-worth (ACSW) as a mediator linking depressive symptoms across generations.

METHODS

Our sample included 1,420 participants of the Great Smoky Mountain Study. Offspring depressive symptoms were prospectively assessed with DSM-IV for both the adolescent period (13-16) and adulthood period (19-26). Maternal depression was screened with the Short Mood and Feelings Questionnaire when the child was 13-16 years old. We used gender-stratified structural equation model in which offspring ACSW in adolescence and adulthood were specified as mediators linking maternal depression and offspring depressive symptoms in adolescence and adulthood, respectively. Mediation was tested using bias-corrected bootstrapped standard errors.

RESULTS

ACSW is associated with higher levels of depressive symptoms in both adolescent and adult females and males, but the link between maternal depressive symptoms and ACSW is only significant among females. ACSW partially mediates the effects of maternal depressive symptoms on adolescent and adult depressive symptoms in girls.

LIMITATIONS

Measurement of maternal depression was not based on diagnosis. Generalizability is limited due to the regional sample.

CONCLUSION

Our findings provide evidence that daughters of depressed mothers may stake their self-worth on body image, which may partially explain some of their higher susceptibility to depression.

Trajectories of maternal depressive symptoms from the antenatal period to 24-months postnatal follow-up: findings from the 2015 Pelotas birth cohort

BACKGROUND

Maternal depression may be chronic and recurrent, with negative effects both on the health of mothers and children. Many studies have shown trajectories of postnatal depressive symptoms but few studies in low- and middle-income countries have evaluated the trajectories of depressive symptoms starting during pregnancy. This study aims to identify the different trajectories of depressive symptoms among mothers in the Pelotas 2015 birth cohort, from pregnancy to the second year of the child's life.

METHODS

This study used data from the 2015 Pelotas Birth Cohort, a longitudinal study of all live births occurred in 2015 in Pelotas, Brazil. Maternal depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS). Mothers who completed the EPDS on at least three follow-up visits beginning to the antenatal follow-up visit were included in the analyses. The trajectory of maternal depressive symptoms was estimated through group-based trajectory modeling.

RESULTS

A total of 3040 women were included in the present analysis. We identified five groups of maternal depressive symptoms trajectories, with 23.4% of the mothers presenting persistent depressive symptoms and 3.9% showing chronic high depressive symptoms throughout the study period. The probability of having persistent depressive symptoms increased among mothers with greater socioeconomic vulnerability.

CONCLUSIONS

This study shown the persistence of maternal depressive symptoms since pregnancy until 2 years postnatal. Additionally, alongside the known risk factors, pre-gestational depression and antenatal depressive symptoms are important risk factors for the persistence and severity of depressive symptoms. These findings support the need to provide mental health evaluation and care for women from pregnancy to the late postnatal period.

Maternal depression trajectories from 3 months to 11 years postpartum and offspring body composition in early adolescence

OBJECTIVE

To investigate the effect of maternal depressive symptom trajectories, from 3 months to 11 years postpartum, on the offspring's body composition at 11 years of age.

DESIGN

Data from the Pelotas 2004 Birth Cohort, from the perinatal interview and from the 3-, 12-, 24- and 48-month and 6- and 11-year follow-ups.

SETTING

Community-based sample from the city of Pelotas, located in southern Brazil with approximately 350 000 inhabitants. The maternal depression symptom trajectories were identified through a semi-parametric group-based modelling approach, using the Edinburgh Postnatal Depression Scale (EPDS), with data from 3 months to 11 years postpartum.

PARTICIPANTS

A total of 3467 (81·9 % of the total cohort).

RESULTS

Five trajectory groups of EPDS scores were identified ('Low', 'Moderate low', 'Increasing', 'Decreasing' and 'Chronic high'). A total of 170 women (4·9 %) from the sample belonged to the 'Chronic high' group, having scored ≥13 EPDS points at every follow-up. Mean BMI in the 'Low' trajectory group was 0·77 (z-score 1·4), compared with 0·56 (z-score 1·4) in the 'Chronic high' group. Children from mothers in the 'Chronic high' group had lower fat mass (FM) (-1·34 ± 0·64 kg), FM% (-2·02 ± 0·85 percentage points) and FM index (-0·57 ± 0·27 kg/m2), compared with children from mothers in the 'Low' trajectory group. Adjusted analyses showed that sustained or transitory maternal depressive symptoms during childhood had no effect on the offspring's body composition indices at 11 years of age.

CONCLUSION

Children raised by chronically depressed mothers have body composition indices at 11 years of age that are similar to those of children whose mothers have never been depressed.

Prevalence of mental health problems in preschoolers and the impact of maternal depression

A large number of children of depressed mothers have one or more mental disorders. This study aimed to evaluate the impact of maternal depression on the mental health of 4-5-year-old children of adolescent mothers, according to the hypotheses generated from the model of accumulation. Between October 2009 and March 2011, all pregnant adolescents who received prenatal care from the public health system in Pelotas (southern Brazil) were invited to participate in the study and have been prospectively followed. Of these individuals, 413 participants were evaluated in the postpartum period and when the child was 2-3 years old and 4-5 years old (current stage). The Strengths and Difficulties Questionnaire was used to assess mental health problems in children, and the Mini International Neuropsychiatric Interview (MINI)-Plus version was used to assess maternal depression. We applied a structured modeling approach to examine the relations between three different hypothesized life course models (accumulation, critical period, and mobility) and maternal depression. After selecting the most appropriate model, we used a logistic regression analysis to assess the effect of depression on mental health problems in 4-5-year-old children of adolescent mothers. We used the Chi square test to estimate the prevalence of mental health problems in 4-5-year-old children. The longer the time of exposure to maternal depression, the greater the probability that the child would present behavioral problems. Investments in strategies to prevent mental disorders beginning in the gestational period are important.

Maternal mood symptoms in pregnancy and postpartum depression: association with exclusive breastfeeding in a population-based birth cohort

PURPOSE

This study aimed to evaluate the association between mood symptoms during pregnancy and exclusive breastfeeding at 3 months, as well as the association between exclusive breastfeeding at 3 months and maternal depression at 12 months postpartum.

METHODS

Data from the Pelotas 2004 Birth Cohort with 4231 live births were used. Maternal mood symptoms during pregnancy were assessed through the question "During pregnancy, did you have depression or nervous problems?" and depression symptomatology at 12 months postpartum was assessed with the Edinburg Postnatal Depression Scale (EPDS). Information on exclusive breastfeeding at 3 months was collected through a dietary recall questionnaire. Crude and adjusted relative risks (RR) with 95% confidence intervals (95% CI) were estimated by Poisson regression.

RESULTS

Prevalence of mood symptoms during pregnancy was 25.1% (95% CI 23.8; 26.4%) and prevalence of EPDS ≥ 10 at 12 months after birth was 27.6% (95% CI 26.2; 29.0%). Prevalence of exclusive breastfeeding at 3 months was 26.5% (95% CI 25.2; 27.9%). In crude analyses, maternal mood symptoms during pregnancy were associated with non-exclusive breastfeeding at 3 months and non-exclusive breastfeeding at 3 months was associated with postpartum maternal depression at 12 months. In the adjusted analyses, both associations were lost after the inclusion of maternal education (RR 0.92; 95% CI 0.81-1.04 and RR 0.92; 95% CI 0.81-1.03, respectively).

CONCLUSION

In our study, the crude association between mood symptoms in pregnancy, exclusive breastfeeding at 3 months, and postpartum depression was due more to the low maternal education than to a true relationship between them.

Population neuroscience: challenges and opportunities for psychiatric research in low- and middle-income countries

Objective:

Population neuroscience is an emerging field that combines epidemiology and neuroscience to study how genes and the environment shape typical and atypical brain functioning. The objective of this study was to review key studies on population neuroscience from low- and middle-income countries (LMICs) and to identify potential gaps vis-à-vis studies conducted in high-income countries.

Methods:

We conducted a systematic review to search for longitudinal cohort studies investigating the development of psychiatric disorders in children and adolescents in LMICs. We performed an electronic search in the EMBASE and MEDLINE databases from inception to July 5th, 2019.

Results:

We found six cohorts from four countries that met our search criteria: three cohorts from Brazil, one from China, one from South Africa, and one from Mauritius. Relevant examples of findings from these studies are reported.

Conclusion:

Our results demonstrate the impact of the valuable science output these cohort designs promote, allowing LMICs to have a share in frontline global psychiatry research. National and international funding agencies should invest in LMIC population neuroscience in order to promote replication and generalization of research from high-income countries.

Parenting Stress Plays a Mediating Role in the Prediction of Early Child Development from Both Parents' Perinatal Depressive Symptoms

Maternal postnatal depression has been associated with a broad range of developmental risk among children. However, there has been less focus on disentangling the effects of pre- and postnatal depressive symptoms, as well as examining the symptoms of both parents. This study aims to investigate the separate effects of pre- and postnatal depressive symptoms in mothers and fathers, and parents' differential effects on child social-emotional, cognitive, and language development at 18 months of age. Further, we investigate whether effects of depressive symptomatology on child outcomes are particularly strong when both parents evinced high symptom loads and whether parenting stress mediates associations between perinatal depressive symptoms and child developmental outcomes. The study used data from 1036 families participating in a community-based study from mid-pregnancy until 18 months postpartum. Depressive symptoms were assessed at seven time points (four prenatally). Within a structural equation framework, we found that parental perinatal depressive symptoms predicted child social-emotional functioning, specifically externalizing, internalizing, and dysregulation problems, as well as language developmental delay at 18 months. Controlling for postnatal symptoms we found no independent effect of prenatal depressive symptoms on any child outcomes. A differential effect was evident, linking maternal symptoms to social-emotional outcomes, and paternal symptoms to language outcomes. There was no evidence of stronger associations between depressive symptoms and child outcomes when both parents showed high symptom loads. However, parenting stress mediated most relations between parental depressive symptoms and child outcomes. Findings demonstrate the importance of including paternal depressive symptoms in both clinical and research contexts.

Gender discrimination and depressive symptoms among child-bearing women: ELSPAC-CZ cohort study

BACKGROUND

Depression is approximately two-fold more prevalent among women than men. Social theories suggest that discrimination is a pathway through which gender inequalities affect women's lives, but data are lacking. This cohort study evaluates whether perceived gender discrimination is linked to depressive symptoms among child-bearing women.

METHODS

Data were obtained from 4,688 participants enrolled in pregnancy in 1991-92 in the European Longitudinal Cohort Study of Pregnancy and Childhood, Czech Republic. Perceived gender discrimination was assessed in mid-pregnancy, year seven, and year eleven. Depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale at eight time-points between mid-pregnancy and year eleven post-delivery. Linear mixed error-component models of depressive symptoms were estimated.

FINDINGS

Perceived gender discrimination, reported by 10.7% of women, was related to higher depressive symptoms, both in the unadjusted analysis (b = 0.15 [95% confidence interval (CI): 0.12, 0.19], p < 0.001) and in the fully adjusted model (b = 0.12 [95% CI: 0.09, 0.16], p < 0.001). Covariates linked to higher depressive symptoms included financial hardship (b = 0.12 [95% CI: 0.10, 0.14], p < 0.001), childhood emotional/physical neglect (b = 0.18 [95% CI: 0.14, 0.22], p < 0.001), and childhood sexual abuse (b = 0.04 [95% CI: 0.03, 0.06], p < 0.001); an inverse relationship was evident for social support (-0.05 [95% CI: -0.07, -0.04], p < 0.001) and having a partner who performs female-stereotypical household tasks (b=-0.03 [95% CI: -0.05, -0.01], p = 0.001).

INTERPRETATION

The findings provide the first evidence that perceived gender discrimination is associated with depressive symptoms among child-bearing women. Social intervention programs aimed at reducing gender discrimination can potentially contribute to better mental health of women.

FUNDING

Bill and Melinda Gates Foundation.

Perceived Paternal Involvement, Relationship Satisfaction, Mothers' Mental Health and Parenting Stress: A Multi-Sample Path Analysis

Research has demonstrated the short- and long-term impacts of maternal mental health and well-being on children's emotional and behavioral outcomes. It is thus important to better understand the antecedents of maternal depression and stress. The aim of this study was to determine whether the contribution of perceived paternal involvement to account for mothers' depression and parental stress was mediated by relationship factors such as parenting alliance and dyadic adjustment. A second aim was to determine whether these relationships hold equally true in mothers of infants and young toddlers (0-24 months) and mothers of older children (25 months and older). Cross-sectional data were collected from 447 mothers. Mothers reported on their perceptions of paternal involvement with childcare responsibilities, dyadic adjustment, parenting alliance, parenting stress, and depression. Multi-sample path modeling analyses were conducted. Results revealed that perceived paternal involvement was positively related to both dyadic adjustment and parental alliance, that parenting alliance was negatively related to all three subscales of parenting stress and mothers' depression but that dyadic adjustment was negatively related to parenting distress (one subscale of parenting stress) and mothers' depression. Results from the multi-sample analyses indicated that the pattern of relationships was the same in the two groups, but that the model was not invariant. The most notable difference was that parenting alliance did not significantly account for depression in the mothers of younger children. Correlates of maternal mental health and well-being identified in this study could be useful when designing psychological interventions for mothers and fathers.

The Long-Term Impact of Maternal Anxiety and Depression Postpartum and in Early Childhood on Child and Paternal Mental Health at 11-12 Years Follow-Up

BACKGROUND

Postpartum maternal anxiety and depression can affect child development and family functioning. However, the long-term impact of postpartum maternal anxiety and depression on child and paternal mental health is understudied. The present large-scale prospective cohort study is one of the first to investigate whether maternal anxiety and depressive symptoms postpartum and at child age 5-6 years separately and synergistically increase paternal anxiety and depressive symptoms and child emotional problems in early adolescence at age 11-12 years. Secondly, we investigated whether concurrent paternal anxiety and depressive symptoms at child age 11-12 years moderated the association between maternal anxiety and depressive symptoms in the postpartum period and at child age 5-6 years with child emotional problems at age 11-12 years.

METHODS

This study is part of the Amsterdam Born Children and Development (ABCD) cohort study, the Netherlands (N = 2.298). Maternal postpartum anxiety and depressive symptoms were assessed using the State-Trait Anxiety Inventory (STAI) and the Center for Epidemiologic Studies Depression Scale (CES-D) at 13 weeks postpartum. Maternal anxiety and depressive symptoms at child age 5-6 years and parental anxiety and depressive symptoms at 11-12 years were assessed using the Depression Anxiety Stress Scale (DASS-21). Child emotional problems were reported by the child and a teacher using the Strengths and Difficulties Questionnaire (SDQ). Multivariable linear regression was conducted, adjusted for demographic, perinatal/obstetric confounders, and affective symptoms of the other family members at 11-12 years.

RESULTS

Neither maternal anxiety nor depressive symptoms were related to paternal depressive symptoms at child age 11-12 years, while maternal postpartum depressive symptoms, depressive symptoms at 5-6 years and maternal anxiety at 5-6 years were positively related to paternal anxiety at 11-12 years. However, effect sizes were small. Only maternal postpartum depression was positively but weakly associated with more child emotional problems at 11-12 years. Although paternal concurrent affective symptoms were positively related to more child emotional problems in early adolescence, they did not moderate the association between maternal symptoms and child emotional problems.

CONCLUSIONS

Our results indicate that fathers and children seem to be affected only to a small extent by maternal postpartum anxiety or depression.

Association between social and family support and antenatal depression: a hospital-based study in Chengdu, China

BACKGROUND

Antenatal depression (AD) is considered as one of the major health burdens and has adverse effects on the outcome of expectant mothers and newborns. The present study aims to investigate the prevalence of antenatal depression (AD), and to explore the potential risk factors of AD among pregnant women in Chengdu, including personal background, related social factors, family factors and cognitive factors.

METHODS

The prospective nested case-control study included pregnant women who were in their second pregnancy and attended prenatal care at three tertiary hospitals and one regional hospital in Chengdu, China, between March 2015 and May 2016. Self-designed questionnaires were given to participants in their second and third trimesters to collect information on clinical and demographic characteristics, and a modified edition of Edinburgh Postnatal Depression Scale (EPDS) were used to measure AD. The logistic regression was applicated in analyses.

RESULTS

A total of 996 pregnant women were included in analysis. Ninety-three women suffered from AD symptoms only in their second trimester, 96 only in their third trimester, and 107 displayed persistent depression in both trimesters. In the univariate analyses, age and marital relationships were linked with AD occurrence in both second and third trimester. In addition, increasing age, full-time job, higher education level, and no gender preference of spouse were associated with reduced persistent depression. Multivariate analysis showed that gender preference and marital relationship were the potential risk factors of persistent depression.

CONCLUSIONS

Age, marital relationship relationships, with parents-in-law, the negative recognition of this pregnancy and husband's gender preference were found as risk factors of AD occurrence in some specific trimester. Gender preference of husbands and marital relationships were independently associated with persistent depression. These findings suggest that stronger family support can help improve mental health of pregnant women.

Biological embedding of maternal postpartum depressive symptoms: The potential role of cortisol and telomere length

Although maternal postpartum depressive symptoms (PDS) are associated with child behavior problems, the underlying biological mechanisms are poorly understood. Thus, the current study focused on 193 healthy mother-child dyads and investigated child cortisol and telomere length as potential mediating factors. At 3 and 6 months postpartum, mothers reported on PDS. At age 6, children provided saliva and buccal swab samples. At age 10, mothers and children reported on child behavior problems. Structural equation modelling revealed (a) no association between PDS and child behavior problems and thus no possibility of mediation, but that (b) lower cortisol forecast more child-reported internalizing problems, and (c) shorter telomere length predicted more child-reported internalizing and externalizing problems. These findings raise mediational questions about the determinants of these biomarkers.

Type of delivery is not associated with maternal depression

Although many women experience depressive symptoms during the first year after childbirth, the relationship between type of delivery and maternal depression is not clear. The purpose of this study is to evaluate relationship between type of delivery and maternal depression, between 6 to 16 months after childbirth. We performed a prospective cohort study of 558 low-socioeconomic status pregnant women without depression. All participants were recruited from primary care clinics of the public sector in three administrative districts in the Western area of the city of São Paulo, Brazil. Depressive symptoms were assessed using the Self-Report Questionnaire (SRQ-20). Type of delivery was classified as uncomplicated spontaneous vaginal delivery (UVD) (no episiotomy and no more than a first-degree perineal laceration), complicated vaginal delivery (CVD) (episiotomy or more than a second-degree perineal laceration), and cesarean delivery (CD). Data about type of delivery were extracted from medical charts. Crude and adjusted risk ratios with 95% confidence intervals were estimated using Poisson regression with robust variance estimates to examine the association between type of delivery with maternal depression. Among 482 women reassessed during 6 to 16 months after delivery, 18% had symptoms of depression. According to the type of delivery, 250 (51.8%), 85 (21.7%), and 147 (30.5%) were UVD, CVD, and CD, respectively. There was no association between type of delivery and maternal depression. In comparison with women submitted to uncomplicated vaginal, women who had a cesarean or perineal trauma/episiotomy did not show greater risk of maternal depression, in the medium to long term after delivery.

Effects of antenatal depression screening and intervention among Chinese high-risk pregnant women with medically defined complications: A randomized controlled trial

AIM

High-risk pregnant women with antenatal depression are prone to postpartum depression. The purpose of this study was to evaluate the effectiveness of an antenatal depression screening and intervention among Chinese high-risk pregnant women with medically defined complications.

METHODS

Using a randomized controlled trial design, we enrolled 352 pregnant women with obstetrical complications and an Edinburgh postnatal depression scale (EPDS) ≥9 or postpartum depression screen scale (PDSS) ≥60. These participants were randomly assigned into the intervention group (n = 176) and control group (n = 176). The intervention group underwent a six-session group intervention with one session focused on the husbands; the control group received the usual care. Participants were assessed at baseline, late pregnancy (≥28 weeks), 3 days and 42 days after delivery with PDSS and EPDS.

RESULTS

Analysis of variance of repeated measures showed significant differences at each time point between groups. Analysis of the Kruskal-Wallis test showed that there was no statistically significant differences in the PDSS and EPDS scores at any time point among the high-risk pregnant women who attended different frequencies of the maternal intervention sessions (P > 0.05). Analysis of the Mann-Whitney U test showed that the PDSS and EPDS were also not impacted based on whether or not the husbands participated in Session 6 of the intervention (P > 0.05).

CONCLUSIONS

This study highlights the effectiveness of the screening and the targeted management of antenatal depression in Chinese high-risk pregnant women.