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Sebők-Welker T, Posta E, Ágrez K, Rádosi A, Zubovics EA, Réthelyi MJ, Ulbert I, Pászthy B, Bunford N. The Association Between Prenatal Maternal Stress and Adolescent Affective Outcomes is Mediated by Childhood Maltreatment and Adolescent Behavioral Inhibition System Sensitivity. Child Psychiatry Hum Dev 2024; 55:1-21. [PMID: 36738426 PMCID: PMC11362206 DOI: 10.1007/s10578-023-01499-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/16/2023] [Indexed: 02/05/2023]
Abstract
Prenatal maternal stress is linked to offspring outcomes; however, there is little research on adolescents, behavioral, transdiagnostic outcomes, or the mechanisms through which relations operate. We examined, in N = 268 adolescents (Mage = 15.31 years; SD = 1.063; 57.8% boys) whether prenatal maternal stress is associated with adolescent affective outcomes; whether this association is mediated, serially, by childhood home atmosphere and adolescent behavioral inhibition system (BIS) sensitivity; and whether mediational effects are moderated by adolescent attention-deficit/hyperactivity disorder or maternal internalizing symptomology. Prenatal maternal daily stress and major life events were associated with adolescent outcomes through childhood negative atmosphere/neglect and BIS sensitivity, with no evidence of moderation. Results have implications regarding the effect of prenatal maternal stress on offspring outcomes and regarding corresponding sensitive periods.
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Affiliation(s)
- T Sebők-Welker
- Developmental and Translational Neuroscience Research Group Developmental and Translational Neuroscience Research Group, Research Centre for Natural Sciences, Institute of Cognitive Neuroscience and Psychology, Magyar Tudósok Körútja 2, Budapest, 1117, Hungary
- Doctoral School of Mental Health Sciences, Semmelweis University, Balassa U. 6, Budapest, 1083, Hungary
| | - E Posta
- Developmental and Translational Neuroscience Research Group Developmental and Translational Neuroscience Research Group, Research Centre for Natural Sciences, Institute of Cognitive Neuroscience and Psychology, Magyar Tudósok Körútja 2, Budapest, 1117, Hungary
| | - K Ágrez
- Developmental and Translational Neuroscience Research Group Developmental and Translational Neuroscience Research Group, Research Centre for Natural Sciences, Institute of Cognitive Neuroscience and Psychology, Magyar Tudósok Körútja 2, Budapest, 1117, Hungary
| | - A Rádosi
- Developmental and Translational Neuroscience Research Group Developmental and Translational Neuroscience Research Group, Research Centre for Natural Sciences, Institute of Cognitive Neuroscience and Psychology, Magyar Tudósok Körútja 2, Budapest, 1117, Hungary
- Doctoral School of Mental Health Sciences, Semmelweis University, Balassa U. 6, Budapest, 1083, Hungary
| | - E A Zubovics
- Developmental and Translational Neuroscience Research Group Developmental and Translational Neuroscience Research Group, Research Centre for Natural Sciences, Institute of Cognitive Neuroscience and Psychology, Magyar Tudósok Körútja 2, Budapest, 1117, Hungary
| | - M J Réthelyi
- Department of Psychiatry and Psychotherapy, Semmelweis University, Balassa U. 6, Budapest, 1083, Hungary
| | - I Ulbert
- Integrative Neuroscience Research Group, Research Centre for Natural Sciences, Institute of Cognitive Neuroscience and Psychology, Magyar Tudósok Körútja 2, Budapest, 1117, Hungary
- Faculty of Information Technology and Bionics, Pázmány Péter Catholic University, Práter Utca 50/A, Budapest, 1083, Hungary
| | - B Pászthy
- 1st Department of Paediatrics, Semmelweis University, Bókay János U. 53-54, Budapest, 1083, Hungary
| | - N Bunford
- Developmental and Translational Neuroscience Research Group Developmental and Translational Neuroscience Research Group, Research Centre for Natural Sciences, Institute of Cognitive Neuroscience and Psychology, Magyar Tudósok Körútja 2, Budapest, 1117, Hungary.
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Horakova A, Kuklova M, Hrdlickova K, Nemcova H, Knytl P, Kostylkova L, Sebela A. Effectiveness of the mom supports mom peer support intervention in treating antenatal mental health difficulties in women. Midwifery 2024; 139:104198. [PMID: 39342905 DOI: 10.1016/j.midw.2024.104198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 09/20/2024] [Accepted: 09/23/2024] [Indexed: 10/01/2024]
Abstract
PROBLEM Up to 75 % of at-risk perinatal women do not receive treatment in Czechia. BACKGROUND Pregnant women with mental health difficulties are more likely to undergo less controversial nonpharmaceutical treatment during pregnancy, but structural and psychological barriers interfere with their capacity to seek professional help. AIM We tested the effectiveness of the telephone-based peer support intervention Mom Supports Mom (MSM) in Czech pregnant women at risk of mental disorder. METHODS The Edinburgh Postnatal Depression Scale (EPDS) was used to assess risk in women (EPDS ≥ 10). Women at risk were randomized into two groups; the intervention group received the MSM, while the control group received the care as usual, which did not contain any psychological support intervention. One month after completing the EPDS, the women's mental statuses were again measured and compared, this time with data before and after the intervention, using the Perinatal Anxiety Screening Scale (PASS) to measure anxiety, the EPDS to measure depression, the Prenatal Psychosocial Profile (PPP) to measure stress, and the Prenatal Attachment Inventory - Revised (PAI-R) to measure attachment. The trial was registered under the name Pregnancy without psychosocial stress (ClinicalTrials.gov ID NCT04853693). FINDINGS A total of 167 women were included in the study and randomized into two groups. Depressive symptoms did not decrease (Cohen´s d; 95 % CI = 0.48; 0.17-0.79; p = .002), but levels of anxiety (Cohen´s d; 95 % CI = 0.44; 0.13-0.75; p = .005) and psychosocial stress (Cohen´s d; 95 % CI = 0.55; 0.20-0.82; p = .002) were reduced in women in the intervention group compared with women in the control. In addition, prenatal attachment increased among intervened women (Cohen´s d; 95 % CI = 0.48; 0.17-0.79; p = .002). DISCUSSION The telephone-based peer support intervention MSM is effective in reducing stress and anxiety and increasing prenatal attachment but does not reduce depression among high-risk women.
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Affiliation(s)
- Anna Horakova
- National Institute of Mental Health, Topolova 748, Klecany 250 67, Czech Republic; Charles University, Faculty of Arts, Department of Psychology, Celetna 20, Prague 116 42, Czech Republic.
| | - Marie Kuklova
- National Institute of Mental Health, Topolova 748, Klecany 250 67, Czech Republic.
| | - Kristyna Hrdlickova
- National Institute of Mental Health, Topolova 748, Klecany 250 67, Czech Republic; Charles University, Faculty of Arts, Department of Psychology, Celetna 20, Prague 116 42, Czech Republic.
| | - Hana Nemcova
- National Institute of Mental Health, Topolova 748, Klecany 250 67, Czech Republic; Charles University, Faculty of Arts, Department of Psychology, Celetna 20, Prague 116 42, Czech Republic.
| | - Pavel Knytl
- National Institute of Mental Health, Topolova 748, Klecany 250 67, Czech Republic; Charles University, Third Faculty of Medicine, Ruska 2411, Prague 100 00, Czech Republic.
| | - Lenka Kostylkova
- National Institute of Mental Health, Topolova 748, Klecany 250 67, Czech Republic; Charles University, Third Faculty of Medicine, Ruska 2411, Prague 100 00, Czech Republic.
| | - Antonin Sebela
- National Institute of Mental Health, Topolova 748, Klecany 250 67, Czech Republic; Charles University, Third Faculty of Medicine, Ruska 2411, Prague 100 00, Czech Republic.
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Khanal P, Ståhlberg T, Upadhyaya S, Heinonen E, Ortin-Peralta A, Sourander A. Parental psychopathology and offspring anxiety disorders in childhood and adolescence: A Finnish nationwide register study. J Affect Disord 2024; 368:S0165-0327(24)01537-4. [PMID: 39303879 DOI: 10.1016/j.jad.2024.09.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 08/29/2024] [Accepted: 09/08/2024] [Indexed: 09/22/2024]
Abstract
BACKGROUND Research suggests an association between parental psychiatric disorders and offspring anxiety disorders, yet comprehensive studies are limited. This study aims to investigate the associations between various parental psychiatric disorders and anxiety disorders in their offspring. METHOD Using Finnish register data, this nested case-control study analyzed 867,175 singleton live births from 1992 to 2006, identifying 21,671 cases of anxiety disorders diagnosed between 1998 and 2016. Matched with four controls each (n = 72,414) based on age and biological sex, the study adjusted for demographic and prenatal factors using conditional logistic regression models to calculate odds ratios (aORs). RESULTS There was a significant association between parental psychiatric disorders and increased risk of anxiety disorders in offspring. The risk was notably higher when both parents had psychiatric disorders (aOR = 5.04; 95 % CI, 4.70-5.39; p < .001). Maternal psychiatric disorders were strongly associated with offspring anxiety than paternal disorders (aOR 1.52; 95 % CI 1.43-1.61; p < .001). This association was consistent regardless of timing of parental diagnosis. Significant associations were observed between any parental psychiatric disorder and increased risks in offspring for specific phobia, social phobia, generalized anxiety disorder, separation anxiety, and panic disorder. Maternal psychiatric disorders showed elevated risk for panic disorder and social phobia among girls and separation anxiety and generalized anxiety among boys. CONCLUSION The findings emphasize the significant impact of parental psychiatric health on offspring anxiety disorders, highlighting the influence of genetic and environmental factors. Addressing parental mental health is crucial in preventing childhood anxiety disorders.
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Affiliation(s)
- Prakash Khanal
- Research Centre for Child Psychiatry, University of Turku, 20014 Turku, Finland; INVEST Flagship Center, University of Turku, Turku, Finland.
| | - Tiia Ståhlberg
- Research Centre for Child Psychiatry, University of Turku, 20014 Turku, Finland; INVEST Flagship Center, University of Turku, Turku, Finland
| | - Subina Upadhyaya
- Research Centre for Child Psychiatry, University of Turku, 20014 Turku, Finland; INVEST Flagship Center, University of Turku, Turku, Finland
| | - Emmi Heinonen
- Research Centre for Child Psychiatry, University of Turku, 20014 Turku, Finland; INVEST Flagship Center, University of Turku, Turku, Finland
| | - Ana Ortin-Peralta
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA; Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Andre Sourander
- Research Centre for Child Psychiatry, University of Turku, 20014 Turku, Finland; INVEST Flagship Center, University of Turku, Turku, Finland; Department of Child Psychiatry, Turku University Hospital, Turku, Finland
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Hamad AF, Monchka BA, Bolton JM, Plana-Ripoll O, Roos LL, Elgendi M, Lix LM. The Intergenerational Transfer of Mental Disorders: A Population-Based Multigenerational Linkage Study: Le transfert intergénérationnel des troubles mentaux : une étude sur les liens multigénérationnels basée sur la population. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2024; 69:618-629. [PMID: 38747934 PMCID: PMC11298095 DOI: 10.1177/07067437241255096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/04/2024]
Abstract
OBJECTIVES The aetiology of mental disorders involves genetic and environmental factors, both reflected in family health history. We examined the intergenerational transmission of multiple mental disorders from parents and grandparents using population-based, objectively measured family histories. METHODS This population-based retrospective cohort study used administrative healthcare databases in Manitoba, Canada and included adults living in Manitoba from 1977 to 2020 with linkages to at least one parent and one grandparent. Index date was when individuals turned 18 or 1 April 1977, whichever occurred later. Mental disorder diagnoses (mood and anxiety, substance use and psychotic disorders) were identified in individuals, parents and grandparents from hospitalization and outpatient records. Cox proportional hazards regression models included sociodemographic characteristics, individual's comorbidity and mental disorder history in a grandparent, mother and father. RESULTS Of 109,359 individuals with no mental disorder prior to index date, 47.1% were female, 36.3% had a mental disorder during follow-up, and 90.9% had a parent or grandparent with a history of a mental disorder prior to the index date. Both paternal and maternal history of a mental disorder increased the risk of the disorder in individuals. Psychotic disorders had the strongest association with parental history and were mostly influenced by paternal (hazards ratio [HR] 3.73, 95% confidence interval [CI] 2.99 to 4.64) compared to maternal history (HR 2.23, 95% CI, 1.89 to 2.64). Grandparent history was independently associated with the risk of all mental disorders but had the strongest influence on substance use disorders (HR 1.42, 95% CI, 1.34 to 1.50). CONCLUSIONS Parental history of mental disorders was associated with an increased risk of all mental disorders. Grandparent history of mental disorders was associated with a small risk increase of the disorders above and beyond parental history influence. This three-generation study further highlights the need for family-based interventional programs in families affected by mental disorders. PLAIN LANGUAGE SUMMARY TITLE The Intergenerational Transfer of Mental Illnesses.
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Affiliation(s)
- Amani F. Hamad
- George & Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Barret A. Monchka
- George & Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada
| | - James M. Bolton
- Department of Psychiatry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Psychology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Oleguer Plana-Ripoll
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark
| | - Leslie L. Roos
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mohamed Elgendi
- Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Lisa M. Lix
- George & Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Pudasainee-Kapri S, Shrestha T, Dahan T, Wunnenberg M. Translation, validation, and factor structure of the Nepali version of postpartum bonding questionnaires (PBQ-N) among postpartum women in Nepal. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003469. [PMID: 38995922 PMCID: PMC11244797 DOI: 10.1371/journal.pgph.0003469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 06/19/2024] [Indexed: 07/14/2024]
Abstract
This study aimed to translate and test the psychometric properties of the Nepali version of the PBQ (PBQ-N) among postpartum mothers in Kathmandu, Nepal. Data was collected through semi-structured interviews with postpartum mothers (n = 128) of an infant aged one to six months visiting immunization clinics at two selected hospitals in Kathmandu, Nepal. The PBQ scale was translated into Nepali language and backtranslated to English with the help of language and content experts. The PBQ-N was then assessed for factor structure, validity, and reliability. The exploratory factor analysis (EFA) was conducted to examine construct validity of the PBQ-N in which 16 items (α = .75) of the original 25 items grouped into three subscales and were found suitable to measure mother-infant bonding among Nepalese women. Regarding convergent validity, a statistically significant, positive correlation was found between the PBQ-N and postpartum depression (r = .627, p < .001). In addition, a statistically significant, negative association was found between parenting self-efficacy and the PBQ-N (r = -.496, p < .001). The three subscales demonstrated good internal consistency. Findings indicate adequate estimates of validity and reliability for the PBQ-N in which 16-item measures were considered adequate for screening mother-infant bonding among Nepalese women and are useful for clinical and research purposes. Considering the crucial role of maternal-infant bonding relationships, the use of validated measures is recommended to screen high-risk infants in clinical settings.
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Affiliation(s)
- Sangita Pudasainee-Kapri
- School of Nursing-Camden, Rutgers, The State University of New Jersey, New Jersey, United States of America
| | - Tumla Shrestha
- Maharajgunj Nursing Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Thomas Dahan
- School of Nursing-Camden, Rutgers, The State University of New Jersey, New Jersey, United States of America
| | - Mary Wunnenberg
- School of Nursing-Camden, Rutgers, The State University of New Jersey, New Jersey, United States of America
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Tung I, Hipwell AE, Grosse P, Battaglia L, Cannova E, English G, Quick AD, Llamas B, Taylor M, Foust JE. Prenatal stress and externalizing behaviors in childhood and adolescence: A systematic review and meta-analysis. Psychol Bull 2024; 150:107-131. [PMID: 37971856 PMCID: PMC10932904 DOI: 10.1037/bul0000407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Accumulating evidence suggests that psychological distress during pregnancy is linked to offspring risk for externalizing outcomes (e.g., reactive/aggressive behaviors, hyperactivity, and impulsivity). Effect sizes across studies have varied widely, however, due to differences in study design and methodology, including control for the confounding continuation of distress in the postnatal period. Clarifying these inconsistencies is necessary to guide the precision of prevention efforts and inform public health policies. A meta-analysis was conducted with 55 longitudinal studies to investigate the association between prenatal psychological distress (anxiety, depression, and perceived stress) and offspring externalizing behaviors. Results revealed a significant but small effect (r = .160) of prenatal distress on externalizing behaviors. The magnitude of the prenatal effect size remained largely unchanged after adjusting for postnatal distress (r = .159), implicating a unique effect of psychological distress during the prenatal period in the etiology of externalizing behaviors. Moderation tests showed that prenatal effects did not vary based on type and timing of psychological distress during pregnancy. Greater instability of distress from prenatal to postnatal periods predicted larger effects. Prenatal effects were comparable across most externalizing outcomes, consistent with the common comorbidity of externalizing spectrum disorders, although effects appeared smaller for nonaggressive rule-breaking (vs. aggressive) behaviors. Significant associations persisted across all developmental periods, appearing slightly larger in early childhood. We discuss these results in the context of developmental and psychobiological theories of externalizing behavior, offer preliminary clinical and public health implications, and highlight directions for future research including the need for longitudinal studies with more racially and socioeconomically diverse families. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Irene Tung
- California State University Dominguez Hills, Department of Psychology
- University of Pittsburgh, Department of Psychiatry
| | - Alison E. Hipwell
- University of Pittsburgh, Department of Psychiatry
- University of Pittsburgh, Department of Psychology
| | - Philip Grosse
- University of Pittsburgh, Clinical and Translational Science Institute
| | | | | | | | | | | | - Megan Taylor
- University of Pittsburgh, Department of Psychiatry
| | - Jill E. Foust
- University of Pittsburgh, Health Sciences Library System
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Nishigori H, Nishigori T, Suzuki T, Mori M, Yamada M, Isogami H, Murata T, Kyozuka H, Ogata Y, Sato A, Metoki H, Shinoki K, Yasumura S, Hosoya M, Hashimoto K, Fujimori K. Maternal prenatal and postnatal psychological distress trajectories and impact on cognitive development in 4-year-old children: the Japan Environment and Children's Study. J Dev Orig Health Dis 2023; 14:781-794. [PMID: 38327072 DOI: 10.1017/s2040174424000011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
Maternal prenatal and postnatal psychological distress, including depression and anxiety, may affect children's cognitive development. However, the findings have been inconsistent. We aimed to use the dataset from the Japan Environment and Children's Study, a nationwide prospective birth cohort study, to examine this association. We evaluated the relationship between the maternal six-item version of the Kessler Psychological Distress Scale (K6) scores and cognitive development among children aged 4 years. K6 was administered twice during pregnancy (M-T1; first half of pregnancy, M-T2; second half of pregnancy) and 1 year postpartum (C-1y). Cognitive development was assessed by trained testers, using the Kyoto Scale of Psychological Development 2001. Multiple regression analysis was performed with the group with a K6 score ≤ 4 for both M-T1 and M-T2 and C-1y as a reference. Records from 1,630 boys and 1,657 girls were analyzed. In the group with K6 scores ≥ 5 in both M-T1 and M-T2 and C-1Y groups, boys had significantly lower developmental quotients (DQ) in the language-social developmental (L-S) area (partial regression coefficient: -4.09, 95% confidence interval: -6.88 - -1.31), while girls did not differ significantly in DQ for the L-S area. Among boys and girls, those with K6 scores ≤ 4 at any one or two periods during M-T1, M-T2, or C-1y did not have significantly lower DQ for the L-S area. Persistent maternal psychological distress from the first half of pregnancy to 1 year postpartum had a disadvantageous association with verbal cognitive development in boys, but not in girls aged 4 years.
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Affiliation(s)
- Hidekazu Nishigori
- Department of Development and Environmental Medicine, Fukushima Medical Center for Children and Women, Fukushima Medical University Graduate School of Medicine, Fukushima, Japan
- Fukushima Regional Center for the Japan Environmental and Children's Study, Fukushima, Japan
| | - Toshie Nishigori
- Fukushima Regional Center for the Japan Environmental and Children's Study, Fukushima, Japan
- Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Taeko Suzuki
- Department of Development and Environmental Medicine, Fukushima Medical Center for Children and Women, Fukushima Medical University Graduate School of Medicine, Fukushima, Japan
- Fukushima Regional Center for the Japan Environmental and Children's Study, Fukushima, Japan
- Department of Midwifery and Maternal Nursing, Fukushima Medical University School of Nursing, Fukushima, Japan
| | - Miyuki Mori
- Department of Development and Environmental Medicine, Fukushima Medical Center for Children and Women, Fukushima Medical University Graduate School of Medicine, Fukushima, Japan
- Fukushima Regional Center for the Japan Environmental and Children's Study, Fukushima, Japan
- Department of Midwifery and Maternal Nursing, Fukushima Medical University School of Nursing, Fukushima, Japan
| | - Mika Yamada
- Fukushima Regional Center for the Japan Environmental and Children's Study, Fukushima, Japan
- Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hirotaka Isogami
- Fukushima Regional Center for the Japan Environmental and Children's Study, Fukushima, Japan
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Tsuyoshi Murata
- Fukushima Regional Center for the Japan Environmental and Children's Study, Fukushima, Japan
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hyo Kyozuka
- Fukushima Regional Center for the Japan Environmental and Children's Study, Fukushima, Japan
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Yuka Ogata
- Fukushima Regional Center for the Japan Environmental and Children's Study, Fukushima, Japan
| | - Akiko Sato
- Fukushima Regional Center for the Japan Environmental and Children's Study, Fukushima, Japan
| | - Hirohito Metoki
- Division of Public Health, Hygiene and Epidemiology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Kosei Shinoki
- Fukushima Regional Center for the Japan Environmental and Children's Study, Fukushima, Japan
| | - Seiji Yasumura
- Fukushima Regional Center for the Japan Environmental and Children's Study, Fukushima, Japan
- Department of Public Health, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Mitsuaki Hosoya
- Fukushima Regional Center for the Japan Environmental and Children's Study, Fukushima, Japan
- Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Koichi Hashimoto
- Fukushima Regional Center for the Japan Environmental and Children's Study, Fukushima, Japan
- Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Keiya Fujimori
- Fukushima Regional Center for the Japan Environmental and Children's Study, Fukushima, Japan
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, Japan
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Waqas A, Nadeem M, Rahman A. Exploring Heterogeneity in perinatal depression: a comprehensive review. BMC Psychiatry 2023; 23:643. [PMID: 37667216 PMCID: PMC10478465 DOI: 10.1186/s12888-023-05121-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 08/18/2023] [Indexed: 09/06/2023] Open
Abstract
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.
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Affiliation(s)
- Ahmed Waqas
- Department of Primary Care & Mental Health, Institute of Population Health, University of Liverpool, Liverpool, UK.
| | | | - Atif Rahman
- Department of Primary Care & Mental Health, Institute of Population Health, University of Liverpool, Liverpool, UK
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Yu ZM, Van Blyderveen S, Schmidt L, Lu CH, Vanstone M, Biringer A, Sword W, Beyene J, McDonald SD. Do Psychological and Behavioural Factors Change Over Pregnancy? JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2023; 45:655-660. [PMID: 37271345 DOI: 10.1016/j.jogc.2023.05.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 05/24/2023] [Accepted: 05/26/2023] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To investigate how psychological and behavioural factors change from the first to the last half of pregnancy. METHODS In this prospective cohort study, we assessed the changes in psychological and behavioural factors across 10 domains among 445 women (mean age = 30.9 years) in Ontario, Canada. We collected data using 2 standardized questionnaires administered at <21 and 32-36 weeks of gestation. We computed intraclass correlation coefficients, percentages of no change, decrease, and increase, and mean differences between the 2 surveys. RESULTS Most psychological and behavioural factors had intraclass correlation coefficients < 0.50 between the first and the second half of pregnancy, suggesting remarkable changes over the course of pregnancy. We observed significant decreases in self-efficacy, compensatory health beliefs, guilt regarding binge eating, emotional eating, dietary restriction, pregnancy-related nausea and food cravings, sleep duration, and physical activity. We also found increases in anxious and depressive symptoms and the tendency to accept friends' and family's beliefs regarding pregnancy. CONCLUSIONS In the first prospective analysis, we found that many psychological and behavioural factors changed significantly over pregnancy.
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Affiliation(s)
- Zhijie Michael Yu
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON
| | - Sherry Van Blyderveen
- New Leaf Psychology Centre, Milton, ON; Eating Disorders Program at Homewood Health Centre, Guelph, ON
| | - Louis Schmidt
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON
| | - Cathy Huilin Lu
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON
| | | | - Anne Biringer
- Ray D. Wolfe Department of Family Medicine, Mount Sinai Hospital, Toronto, ON
| | - Wendy Sword
- School of Nursing, McMaster University, Hamilton, ON
| | - Joseph Beyene
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON
| | - Sarah D McDonald
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON; Department of Radiology, McMaster University, Hamilton, ON.
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O'Carroll J, Ando K, Yun R, Panelli D, Nicklin A, Kennedy N, Carvalho B, Blake L, Coker J, Kaysen D, Sultan P. A systematic review of patient-reported outcome measures used in maternal postpartum anxiety. Am J Obstet Gynecol MFM 2023; 5:101076. [PMID: 37402438 DOI: 10.1016/j.ajogmf.2023.101076] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 06/15/2023] [Accepted: 06/29/2023] [Indexed: 07/06/2023]
Abstract
OBJECTIVE This study aimed to conduct a systematic review and to evaluate the psychometric measurement properties of instruments for postpartum anxiety using the Consensus-Based Standards for the Selection of Health Measurement Instruments guidelines to identify the best available patient-reported outcome measure. DATA SOURCES We searched 4 databases (CINAHL, Embase, PubMed, and Web of Science in July 2022) and included studies that evaluated at least 1 psychometric measurement property of a patient-reported outcome measurement instrument. The protocol was registered with the International Prospective Register for Systematic Reviews under identifier CRD42021260004 and followed the Consensus-Based Standards for the Selection of Health Measurement Instruments guidelines for systematic reviews. STUDY ELIGIBILITY Studies eligible for inclusion were those that assessed the performance of a patient-reported outcome measure for screening for postpartum anxiety. We included studies in which the instruments were subjected to some form of psychometric property assessment in the postpartum maternal population, consisted of at least 2 questions, and were not subscales. METHODS This systematic review used the Consensus-Based Standards for the Selection of Health Measurement Instruments and the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines to identify the best patient-reported outcome measurement instrument for examining postpartum anxiety. A risk of bias assessment was performed, and a modified GRADE approach was used to assess the level of evidence with recommendations being made for the overall quality of each instrument. RESULTS A total of 28 studies evaluating 13 instruments in 10,570 patients were included. Content validity was sufficient in 9 with 5 instruments receiving a class A recommendation (recommended for use). The Postpartum Specific Anxiety Scale, Postpartum Specific Anxiety Scale Research Short Form, Postpartum Specific Anxiety Scale Research Short Form Covid, Postpartum Specific Anxiety Scale-Persian, and the State-Trait Anxiety Inventory demonstrated adequate content validity and sufficient internal consistency. Nine instruments received a recommendation of class B (further research required). No instrument received a class C recommendation (not recommended for use). CONCLUSION Five instruments received a class A recommendation, all with limitations, such as not being specific to the postpartum population, not assessing all domains, lacking generalizability, or evaluation of cross-cultural validity. There is currently no freely available instrument that assess all domains of postpartum anxiety. Future studies are needed to determine the optimum current instrument or to develop and validate a more specific measure for maternal postpartum anxiety.
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Affiliation(s)
- James O'Carroll
- Division of Obstetric Anesthesiology and Maternal Health, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA (Drs O'Carroll, Ando, Yun, Carvalho, and Sultan).
| | - Kazuo Ando
- Division of Obstetric Anesthesiology and Maternal Health, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA (Drs O'Carroll, Ando, Yun, Carvalho, and Sultan)
| | - Romy Yun
- Division of Obstetric Anesthesiology and Maternal Health, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA (Drs O'Carroll, Ando, Yun, Carvalho, and Sultan)
| | - Danielle Panelli
- Division of Maternal-Fetal Medicine and Obstetrics, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA (Dr Panelli)
| | - Angela Nicklin
- Department of Anaesthesia, Royal London Hospital, Whitechapel, London, United Kingdom (Dr Nicklin)
| | - Natasha Kennedy
- Department of Anaesthesia, Whipps Cross Hospital, Leytonstone, London, United Kingdom (Dr Kennedy)
| | - Brendan Carvalho
- Division of Obstetric Anesthesiology and Maternal Health, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA (Drs O'Carroll, Ando, Yun, Carvalho, and Sultan)
| | - Lindsay Blake
- University of Arkansas for Medical Sciences, Little Rock, AR (Ms Blake)
| | - Jessica Coker
- Departments of Psychiatry and Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR (Dr Coker)
| | - Debra Kaysen
- Department of Psychiatry and Behavioral Sciences Stanford University, Stanford, CA (Dr Kaysen)
| | - Pervez Sultan
- Division of Obstetric Anesthesiology and Maternal Health, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA (Drs O'Carroll, Ando, Yun, Carvalho, and Sultan)
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Fleck L, Fuchs A, Sele S, Moehler E, Koenig J, Resch F, Kaess M. Prenatal stress and child externalizing behavior: effects of maternal perceived stress and cortisol are moderated by child sex. Child Adolesc Psychiatry Ment Health 2023; 17:94. [PMID: 37550728 PMCID: PMC10408175 DOI: 10.1186/s13034-023-00639-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 07/04/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Externalizing behavior problems are related to social maladjustment. Evidence indicates associations between prenatal stress and child behavioral outcomes. It remains unclear how psychological distress vs. biological correlates of stress (cortisol) differentially predict externalizing behavior, and how their effects might differ as a function of child sex. METHOD 108 pregnant women from the community collected salivary cortisol and reported their perceived stress during each trimester of pregnancy. At child age 9 years (M = 9.01, SD = 0.55), 70 mothers and children reported on child behavior. Structural equation modelling was used to analyze how cortisol levels and perceived stress during pregnancy predicted current child externalizing behavior, considering the moderating effect of child sex. RESULTS Perceived stress predicted higher externalizing behavior in boys (β = 0.42, p = 0.009) and lower externalizing behavior in girls (β = - 0.56, p = 0.014). Cortisol predicted lower externalizing behavior in boys (β = - 0.81, p < .001) and was not related to girls' externalizing behavior (β = 0.37, p = 0.200). DISCUSSION/CONCLUSION Prenatal stress affected externalizing behavior differently in girls vs. boys. These response patters in turn differed for indicators of psychological vs. biological maternal stress, encouraging an integrated approach. Findings indicate that perceived stress and cortisol may affect child development via different trajectories.
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Affiliation(s)
- Leonie Fleck
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Anna Fuchs
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Silvano Sele
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Eva Moehler
- Department of Child and Adolescent Psychiatry, Saarland University Medical Center, Homburg, Germany
| | - Julian Koenig
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Franz Resch
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Michael Kaess
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany.
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
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12
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Johann A, Dukic J, Rothacher Y, Ehlert U. Trajectories of reproductive transition phase mood disorder from pregnancy to postpartum: A Swiss longitudinal study. WOMEN'S HEALTH (LONDON, ENGLAND) 2023; 19:17455057221147391. [PMID: 36748405 PMCID: PMC9909046 DOI: 10.1177/17455057221147391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Depressive symptoms are common in the peripartum period and pose a great risk to the well-being of the mother, the infant, and the entire family. Evidence from longitudinal studies suggests that affected women do not constitute one homogeneous group in terms of severity, chronicity, and onset of symptoms. To account for individual differences regarding the longitudinal course of depressive symptoms from pregnancy to the postpartum period, growth mixture models have proven to be useful. METHODS We conducted a group-based trajectory modeling analysis to identify perinatal depressive symptom trajectories in a Swiss sample (n = 151). Depressive symptoms were assessed six times, covering nearly 6 months from the third trimester of pregnancy to 3 months postpartum. In addition to determining perinatal depressive symptom trajectories, we aimed to examine whether these trajectories are linked to psychopathological risk factors such as a history of premenstrual syndrome (PMS), anxiety, prenatal stress, and somatic symptoms after delivery that are associated with hormonal fluctuations. RESULTS The findings revealed three trajectories of perinatal depressive symptoms that were relatively stable over time and differed in symptom load (low, medium, high), as well as one trajectory of decreasing symptoms, with a significant symptom reduction after giving birth. Women with a higher depressive symptom load experienced a greater degree of prior premenstrual symptoms, prenatal anxiety, and birth anxiety, as well as somatic symptoms after delivery. CONCLUSION Further research is needed to account for the distinct trajectories of perinatal depressive symptoms in order to provide appropriate care for affected women. A focus on somatic symptoms after delivery and their association with depressive mood is essential to better understand the potential shared etiopathology of reproductive transition phase mood disorders.
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Affiliation(s)
- Alexandra Johann
- Clinical Psychology and Psychotherapy, University of Zurich, Zurich, Switzerland
| | - Jelena Dukic
- Clinical Psychology and Psychotherapy, University of Zurich, Zurich, Switzerland
| | - Yannick Rothacher
- Psychological Methods, Evaluation and Statistics, University of Zurich, Zurich, Switzerland
| | - Ulrike Ehlert
- Clinical Psychology and Psychotherapy, University of Zurich, Zurich, Switzerland,Ulrike Ehlert, Clinical Psychology and Psychotherapy, University of Zurich, Binzmühlestrasse 14, 8050 Zurich, Switzerland.
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13
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Babore A, Trumello C, Lombardi L, Candelori C, Chirumbolo A, Cattelino E, Baiocco R, Bramanti SM, Viceconti ML, Pignataro S, Morelli M. Mothers' and Children's Mental Health During the COVID-19 Pandemic Lockdown: The Mediating Role of Parenting Stress. Child Psychiatry Hum Dev 2023; 54:134-146. [PMID: 34417927 PMCID: PMC8379586 DOI: 10.1007/s10578-021-01230-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/05/2021] [Indexed: 01/26/2023]
Abstract
The present study, carried out during the first peak of the COVID-19 outbreak in Italy, aimed at investigating the mental health of mothers and children during the nationwide lockdown. More specifically, the study investigated children's depression and mothers' individual distress and parenting stress, in comparison with normative samples. The mediating effect of mothers' parenting stress on the relationship between mothers' individual distress and children's depression was also explored. Finally, the study analyzed whether children's biological sex and age moderated the structural paths of the proposed model. A sample of 206 Italian mothers and their children completed an online survey. Mothers were administered self-report questionnaires investigating individual distress and parenting stress; children completed a standardized measure of depression. Mothers' individual distress and parenting stress and children's depression were higher than those recorded for the normative samples. Mothers' parenting stress was found to mediate the association between mothers' individual distress and children's depression. With respect to children, neither biological sex nor age emerged as significant moderators of this association, highlighting that the proposed model was robust and invariant. During the current and future pandemics, public health services should support parents-and particularly mothers-in reducing individual distress and parenting stress, as these are associated with children's depression.
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Affiliation(s)
- Alessandra Babore
- Department of Psychological, Health, and Territorial Sciences, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Carmen Trumello
- Department of Psychological, Health, and Territorial Sciences, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy.
| | - Lucia Lombardi
- Department of Psychological, Health, and Territorial Sciences, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Carla Candelori
- Department of Psychological, Health, and Territorial Sciences, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
| | | | - Elena Cattelino
- Department of Human and Social Sciences, University of Valle d'Aosta, Aosta, Italy
| | - Roberto Baiocco
- Department of Developmental and Social Psychology, Sapienza University of Rome, Rome, Italy
| | - Sonia Monique Bramanti
- Department of Psychological, Health, and Territorial Sciences, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Maria Luisa Viceconti
- Department of Psychological, Health, and Territorial Sciences, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Silvia Pignataro
- Department of Psychological, Health, and Territorial Sciences, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Mara Morelli
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Rome, Italy
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Morales-Munoz I, Ashdown-Doel B, Beazley E, Carr C, Preece C, Marwaha S. Maternal postnatal depression and anxiety and the risk for mental health disorders in adolescent offspring: Findings from the Avon Longitudinal Study of Parents and Children cohort. Aust N Z J Psychiatry 2023; 57:82-92. [PMID: 35234057 PMCID: PMC9791327 DOI: 10.1177/00048674221082519] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The impacts of postnatal psychiatric disorders on different types of mental health problems in offspring are unclear. We investigated the prospective associations of maternal postnatal depression, and anxiety, with offspring depression, anxiety, psychotic-like experiences and Borderline Personality Disorder symptoms, in adolescence, and examined whether these were independent of each other. METHODS Data were obtained from the Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort. Maternal postnatal depression and anxiety at 8 weeks were measured using the Edinburgh Postnatal Depression Scale and Crown-Crisp Index, respectively. Offspring mental health outcomes were measured at 10-13 years old, using a variety of questionnaire-based and interview assessments. Logistic regression analyses were used to assess the associations between maternal postnatal risk factors and offspring mental health, and path analysis was used to investigate the pathways of maternal postnatal factors to adolescent offspring outcomes. RESULTS Data were available for 14,054 mothers with information reported on postnatal depression and 13,892 on postnatal anxiety. Logistic regression analyses found significant associations between maternal postnatal depression and offspring anxiety at 10 years old (odds ratio = 1.039, 95% confidence interval = [1.005, 1.073], p = 0.022) and between maternal postnatal anxiety and offspring psychotic experiences at 12/13 years old (odds ratio = 1.042, 95% confidence interval = [1.008, 1.077], p = 0.016). These significant associations remained after applying path analyses, when we controlled for potential offspring psychopathological overlay. CONCLUSION These findings suggest that mothers with postnatal depression are more likely to have offspring with anxiety at 10 years old, and that mothers with postnatal anxiety are more likely to have offspring with psychotic experiences at 12/13 years old. Our findings suggest specific pathways in the association between postnatal anxiety/depression and offspring mental health and contribute to the importance of identifying mothers and their offspring with increased vulnerability to adverse outcomes resulting from postnatal mental health disorders.
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Affiliation(s)
- Isabel Morales-Munoz
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, UK
- Department of Public Health Solutions, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Brooklyn Ashdown-Doel
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, UK
| | - Emily Beazley
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, UK
| | - Camilla Carr
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, UK
| | - Cristina Preece
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, UK
| | - Steven Marwaha
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, UK
- Specialist Mood Disorders Clinic, Birmingham and Solihull Mental Health NHS Trust, Birmingham, UK
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15
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Bekkhus M, Lee Y, Samuelsen SO, Tsotsi S, Magnus P. Maternal and paternal anxiety during pregnancy: Comparing the effects on behavioral problems in offspring. PLoS One 2022; 17:e0275085. [PMID: 36190962 PMCID: PMC9529082 DOI: 10.1371/journal.pone.0275085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 09/09/2022] [Indexed: 11/18/2022] Open
Abstract
Prenatal maternal anxiety has been associated with both short and long-term mental health problems in the child. The current study aims to examine the association between maternal and paternal prenatal anxiety and behaviour problems in the child at 1.5 and 5 years, using three different approaches; (1) adjusting for covariates, (2) using fathers' anxiety during pregnancy as a negative control, and (3) using a sibling-comparison design, controlling for unmeasured family factors. We used data from the Norwegian Mother, Father and Child Cohort Study (MoBa) is used. MoBa is a cohort consisting of about 114 000 pregnancies (about 34000 siblings) recruited from 1999 to 2008. Self-reported measures on maternal anxiety were obtained twice in pregnancy and 6 months after birth, while paternal anxiety was reported prenatally at 17th weeks of gestation. Maternal reports on child behaviour problems were obtained at 1.5 and 5 years of age. Results suggests that prenatal exposure to maternal anxiety was associated with behaviour problems at 1.5 years: adjusted beta (β) = 0.13 (CI = 0.12, 0.15), and at 5 years: β = 0.11 (CI = 0.09, 0.14). However, paternal anxiety was also associated with behaviour problems at 1.5 years: β = 0.03 (CI = 0.01-0.03) and at 5 years β = 0.03 (CI = 0.02, 0.03). These associations were attenuated in the sibling comparison analyses: β = -0.02 (CI = -0.02-0.05) at 1.5 years and β = -0.05 (CI = -0.10, 0.02) at 5 years. In conclusions, the sibling analyses are not consistent with a direct effect of prenatal maternal anxiety on child behaviour problems. It is more likely that genetic or shared family environment explain this association.
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Affiliation(s)
- Mona Bekkhus
- Promenta Research Centre, Department of Psychology, University of Oslo, Oslo, Norway
- * E-mail:
| | - Yunsung Lee
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Sven Ove Samuelsen
- Department of Mathematics, University of Oslo, Oslo, Norway
- Department of Physical Health and Aging, Norwegian Institute of Public Health, Oslo, Norway
| | - Stella Tsotsi
- Promenta Research Centre, Department of Psychology, University of Oslo, Oslo, Norway
| | - Per Magnus
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
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16
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Reemst K, Ruigrok SR, Bleker L, Naninck EFG, Ernst T, Kotah JM, Lucassen PJ, Roseboom TJ, Pollux BJA, de Rooij SR, Korosi A. Sex-dependence and comorbidities of the early-life adversity induced mental and metabolic disease risks: Where are we at? Neurosci Biobehav Rev 2022; 138:104627. [PMID: 35339483 DOI: 10.1016/j.neubiorev.2022.104627] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 02/15/2022] [Accepted: 03/13/2022] [Indexed: 01/02/2023]
Abstract
Early-life adversity (ELA) is a major risk factor for developing later-life mental and metabolic disorders. However, if and to what extent ELA contributes to the comorbidity and sex-dependent prevalence/presentation of these disorders remains unclear. We here comprehensively review and integrate human and rodent ELA (pre- and postnatal) studies examining mental or metabolic health in both sexes and discuss the role of the placenta and maternal milk, key in transferring maternal effects to the offspring. We conclude that ELA impacts mental and metabolic health with sex-specific presentations that depend on timing of exposure, and that human and rodent studies largely converge in their findings. ELA is more often reported to impact cognitive and externalizing domains in males, internalizing behaviors in both sexes and concerning the metabolic dimension, adiposity in females and insulin sensitivity in males. Thus, ELA seems to be involved in the origin of the comorbidity and sex-specific prevalence/presentation of some of the most common disorders in our society. Therefore, ELA-induced disease states deserve specific preventive and intervention strategies.
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Affiliation(s)
- Kitty Reemst
- University of Amsterdam, Swammerdam Institute of Life Sciences, Center for Neuroscience, Brain Plasticity Group, Amsterdam, The Netherlands
| | - Silvie R Ruigrok
- University of Amsterdam, Swammerdam Institute of Life Sciences, Center for Neuroscience, Brain Plasticity Group, Amsterdam, The Netherlands
| | - Laura Bleker
- Amsterdam University Medical Center, University of Amsterdam, Department of Epidemiology and Data Science, Amsterdam, The Netherlands
| | - Eva F G Naninck
- University of Amsterdam, Swammerdam Institute of Life Sciences, Center for Neuroscience, Brain Plasticity Group, Amsterdam, The Netherlands
| | - Tiffany Ernst
- Wageningen University, Department of Animal Sciences, Experimental Zoology &Evolutionary Biology Group, Wageningen, The Netherlands
| | - Janssen M Kotah
- University of Amsterdam, Swammerdam Institute of Life Sciences, Center for Neuroscience, Brain Plasticity Group, Amsterdam, The Netherlands
| | - Paul J Lucassen
- University of Amsterdam, Swammerdam Institute of Life Sciences, Center for Neuroscience, Brain Plasticity Group, Amsterdam, The Netherlands; Centre for Urban Mental Health, University of Amsterdam, The Netherlands
| | - Tessa J Roseboom
- Amsterdam University Medical Center, University of Amsterdam, Department of Epidemiology and Data Science, Amsterdam, The Netherlands
| | - Bart J A Pollux
- Wageningen University, Department of Animal Sciences, Experimental Zoology &Evolutionary Biology Group, Wageningen, The Netherlands
| | - Susanne R de Rooij
- Amsterdam University Medical Center, University of Amsterdam, Department of Epidemiology and Data Science, Amsterdam, The Netherlands
| | - Aniko Korosi
- University of Amsterdam, Swammerdam Institute of Life Sciences, Center for Neuroscience, Brain Plasticity Group, Amsterdam, The Netherlands.
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17
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Zimmermann P, Antonelli MC, Sharma R, Müller A, Zelgert C, Fabre B, Wenzel N, Wu HT, Frasch MG, Lobmaier SM. Prenatal stress perturbs fetal iron homeostasis in a sex specific manner. Sci Rep 2022; 12:9341. [PMID: 35662279 PMCID: PMC9167276 DOI: 10.1038/s41598-022-13633-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 05/18/2022] [Indexed: 11/09/2022] Open
Abstract
The adverse effects of maternal prenatal stress (PS) on child's neurodevelopment warrant the establishment of biomarkers that enable early interventional therapeutic strategies. We performed a prospective matched double cohort study screening 2000 pregnant women in third trimester with Cohen Perceived Stress Scale-10 (PSS-10) questionnaire; 164 participants were recruited and classified as stressed and control group (SG, CG). Fetal cord blood iron parameters of 107 patients were measured at birth. Transabdominal electrocardiograms-based Fetal Stress Index (FSI) was derived. We investigated sex contribution to group differences and conducted causal inference analyses to assess the total effect of PS exposure on iron homeostasis using a directed acyclic graph (DAG) approach. Differences are reported for p < 0.05 unless noted otherwise. Transferrin saturation was lower in male stressed neonates. The minimum adjustment set of the DAG to estimate the total effect of PS exposure on fetal ferritin iron biomarkers consisted of maternal age and socioeconomic status: SG revealed a 15% decrease in fetal ferritin compared with CG. Mean FSI was higher among SG than among CG. FSI-based timely detection of fetuses affected by PS can support early individualized iron supplementation and neurodevelopmental follow-up to prevent long-term sequelae due to PS-exacerbated impairment of the iron homeostasis.
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Affiliation(s)
- Peter Zimmermann
- Department of Obstetrics and Gynecology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Marta C Antonelli
- Department of Obstetrics and Gynecology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Instituto de Biología Celular y Neurociencias "Prof. E. De Robertis," Facultad de Medicina, UBA, Buenos Aires, Argentina
| | - Ritika Sharma
- Department of Obstetrics and Gynecology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Helmholtz Zentrum Munich, Neuherberg, Germany
| | - Alexander Müller
- Innere Medizin I, Department of Cardiology, Klinikum Rechts Der Isar, Technical University of Munich, Munich, Germany
| | - Camilla Zelgert
- Department of Obstetrics and Gynecology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Bibiana Fabre
- Facultad de Farmacia y Bioquímica, Instituto de Fisiopatología y Bioquímica Clínica (INFIBIOC), Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Natasha Wenzel
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Hau-Tieng Wu
- Department of Mathematics, Duke University, Durham, NC, USA
- Department of Statistical Science, Duke University, Durham, NC, USA
- Mathematics Division, National Center for Theoretical Sciences, Taipei, Taiwan
| | - Martin G Frasch
- Department of Obstetrics and Gynecology and Center on Human Development and Disability (CHDD), University of Washington, Seattle, WA, USA.
| | - Silvia M Lobmaier
- Department of Obstetrics and Gynecology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
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18
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Advancing research on perinatal depression trajectories: Evidence from a longitudinal study of low-income women. J Affect Disord 2022; 301:44-51. [PMID: 34995707 DOI: 10.1016/j.jad.2022.01.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 08/02/2021] [Accepted: 01/02/2022] [Indexed: 01/13/2023]
Abstract
OBJECTIVES The current study aimed to describe and predict perinatal depression trajectories in a sample of low-income women from the first trimester of pregnancy to six months postpartum. METHODS The study sample consisted of 899 women in Wisconsin who received home visiting services. Eligible participants were screened for depressive symptoms by home visitors using the Edinburgh Postnatal Depression Scale at least three times across four time periods from the first trimester of pregnancy to six months postpartum. Growth Mixture Modeling was applied to identify distinct trajectory classes, and multinomial logistic regressions were performed to analyze predictors of class membership. RESULTS Mean depressive symptom scores in this racially/ethnically diverse sample of low-income women decreased significantly over time from a high of 8.1 at time1 to a low of 6.8 at time4. Four classes were identified, including a low-stable group (78.2% of sample), a high-stable group (10.6%) along with decreasing (7.1%) and increasing (4.1%) trajectories. Women with a history of abuse and mental health difficulties were more likely to be classified in the high-stable and decreasing depression groups than the low-stable group. Low social support was linked to an increasing trajectory that resulted in high levels of postpartum depression. CONCLUSIONS AND IMPLICATIONS Although most women exhibited stable and positive trajectories, more than one out of five presented with either persistently or intermittently high depression scores. Taken together, the findings underscore the importance of depression screening throughout the perinatal period and identifying factors that may be used to target resources to at-risk populations.
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Liu H, Liu Y, Huang K, Yan S, Hao J, Zhu P, Tao F, Shao S. Gender-specific associations of pregnancy-related anxiety with placental epigenetic patterning of glucocorticoid response genes and preschooler's emotional symptoms and hyperactivity. BMC Pediatr 2021; 21:479. [PMID: 34715840 PMCID: PMC8555194 DOI: 10.1186/s12887-021-02938-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 10/08/2021] [Indexed: 01/18/2023] Open
Abstract
BACKGROUD We have recently reported that maternal prenatal pregnancy-related anxiety predicts preschoolers' emotional and behavioral development in a gender-dependent manner. This study aims to test for this gender-specific effect in a different cohort and investigate whether the gender difference was specific to placental methylation of genes regulating glucocorticoids. METHODS A total of 2405 mother-child pairs from the Ma'anshan Birth Cohort Study were included in present study. The maternal pregnancy-related anxiety symptoms were evaluated with the Pregnancy-Related Anxiety Questionnaire in the third trimester of pregnancy. Child neurobehavior was assessed with the Strengths and Difficulties Questionnaire at 4 years old. Placental methylation of FKBP5, NR3C1 and HSD11B2 genes was quantified using the MethylTarget approach in 439 pregnant women. After exploratory factor analysis, the associations between methylation factor scores and pregnancy-related anxiety and child neurobehavior were examined using logistic regression analysis. RESULTS After controlling for confounding factors, pregnancy-related anxiety in the third trimester of pregnancy increased the risk of hyperactivity only in boys and emotional symptoms only in girls. Decreased scores of the factor characterized by FKBP5 methylation were associated with maternal pregnancy-related anxiety only in boys. Furthermore, increased scores of the factors characterized by NR3C1 and HSD11B2 methylation were associated with hyperactivity (NR3C1: adjusted OR = 1.80, 95%CI = 1.15-2.83) and emotional symptoms (HSD11B2: adjusted OR = 0.53, 95%CI = 0.29-0.97; NR3C1: adjusted OR = 1.64, 95%CI = 1.03-2.59) only in boys. However, the scores of the factor characterized by FKBP5, NR3C1 and HSD11B2 did not mediate the relationship between maternal pregnancy-related anxiety and preschoolers' emotional symptoms and hyperactivity. CONCLUSIONS Our results suggested that pregnancy-related anxiety in the third trimester of pregnancy predicted preschoolers' emotional symptoms and hyperactivity in a gender-dependent manner. Although we did not find the mediation role of the placental methylation of genes regulating glucocorticoids, we found it was associated with both maternal pregnancy-related anxiety and preschoolers' emotional symptoms and hyperactivity in a gender-dependent manner.
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Affiliation(s)
- Hui Liu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, Anhui, China.,Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei, 230032, Anhui, China.,NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, No 81 Meishan Road, Hefei, 230032, Anhui, China.,Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Yuwei Liu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, Anhui, China.,Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei, 230032, Anhui, China.,NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, No 81 Meishan Road, Hefei, 230032, Anhui, China.,Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Kun Huang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, Anhui, China.,Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei, 230032, Anhui, China.,NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, No 81 Meishan Road, Hefei, 230032, Anhui, China.,Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Shuangqin Yan
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, Anhui, China.,Maternal and Child Health Care Center of Ma'anshan, No 24 Jiashan Road, Ma'anshan, 243011, Anhui, China
| | - Jiahu Hao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, Anhui, China.,Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei, 230032, Anhui, China.,NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, No 81 Meishan Road, Hefei, 230032, Anhui, China.,Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Peng Zhu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, Anhui, China.,Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei, 230032, Anhui, China.,NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, No 81 Meishan Road, Hefei, 230032, Anhui, China.,Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Fangbiao Tao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, Anhui, China. .,Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei, 230032, Anhui, China. .,NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, No 81 Meishan Road, Hefei, 230032, Anhui, China. .,Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, Anhui, China.
| | - Shanshan Shao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, Anhui, China. .,Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei, 230032, Anhui, China. .,NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, No 81 Meishan Road, Hefei, 230032, Anhui, China. .,Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, Anhui, China.
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20
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Gustafsson HC, Young AS, Doyle O, Nagel BJ, Mackiewicz Seghete K, Nigg JT, Sullivan EL, Graham AM. Trajectories of perinatal depressive symptoms in the context of the COVID-19 pandemic. Child Dev 2021; 92:e749-e763. [PMID: 34448493 PMCID: PMC8652588 DOI: 10.1111/cdev.13656] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
This study sought to advance understanding of the potential long‐term consequences of the COVID‐19 pandemic for child development by characterizing trajectories of maternal perinatal depression, a common and significant risk factor for adverse child outcomes. Data came from 393 women (86% White, 8% Latina; mean age = 33.51 years) recruited during pregnancy (n = 247; mean gestational age = 22.94 weeks) or during the first year postpartum (n = 146; mean child age = 4.50 months; 55% female). Rates of depression appear elevated, relative to published reports and to a pre‐pandemic comparison group (N = 155). This study also provides evidence for subgroups of individuals who differ in their depressive symptom trajectories over the perinatal period. Subgroup membership was related to differences in maternal social support, but not to child birth outcomes.
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Affiliation(s)
| | - Anna S Young
- Oregon Health & Science University, Portland, Oregon, USA
| | - Olivia Doyle
- Oregon Health & Science University, Portland, Oregon, USA
| | - Bonnie J Nagel
- Oregon Health & Science University, Portland, Oregon, USA
| | | | - Joel T Nigg
- Oregon Health & Science University, Portland, Oregon, USA
| | - Elinor L Sullivan
- Oregon Health & Science University, Portland, Oregon, USA.,Oregon National Primate Research Center, Beaverton, Oregon, USA
| | - Alice M Graham
- Oregon Health & Science University, Portland, Oregon, USA
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21
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The relationship between conduct disorder and parents’ psychiatric disorders, social capital, lifestyle, and comorbid disorders: A structural equation modeling study. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-02229-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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22
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Ayano G, Lin A, Betts K, Tait R, Dachew BA, Alati R. Risk of conduct and oppositional defiant disorder symptoms in offspring of parents with mental health problems: Findings from the Raine Study. J Psychiatr Res 2021; 138:53-59. [PMID: 33831677 DOI: 10.1016/j.jpsychires.2021.03.054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 03/09/2021] [Accepted: 03/24/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Epidemiological data indicate that paternal and maternal mental health difficulties are predictors of conduct disorder (CD) and oppositional defiant disorder (ODD) in offspring. We tested the association between maternal anxiety and depressive symptoms and paternal emotional problems with CD and ODD symptoms in adolescent offspring aged 17. METHODS Data was from the Raine Study, a birth cohort study based in Western Australia. Offspring CD and ODD symptoms at age 17 years were measured using the DSM-oriented scales of the Child Behavior Checklist (CBCL). Depression, Anxiety, and Stress Scale (DASS) was used to assess maternal depressive and anxiety symptoms, and a self-reported questionnaire measured paternal emotional problems when the offspring was 10 years. Negative binomial regression model was used to explore associations. RESULTS Adjusting for potential confounding factors, we found an increased risk of CD symptoms in the offspring of mothers with anxiety [RR = 1.76 (95%CI; 1.08-2.86)], depressive [RR = 1.40 (95%CI; 1.01-1.95)], and comorbid anxiety and depressive symptoms [RR = 2.24 (95%CI 1.35-3.72)]. We also found an increased risk of ODD symptoms in offspring of mothers with depressive [RR = 1.24 (95%CI 1.02-1.52)], but not anxiety symptoms [RR = 1.23 (95%CI 0.92-1.67)]. No associations were seen with paternal emotional problems. CONCLUSION Our study showed that adolescents whose mothers reported anxiety, depressive, and comorbid anxiety and depressive symptoms had a higher risk of CD and ODD symptoms at age 17. The findings have implications for preventive strategies.
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Affiliation(s)
- Getinet Ayano
- School of Public Health, Curtin University, Perth, WA, Australia.
| | - Ashleigh Lin
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia.
| | - Kim Betts
- School of Public Health, Curtin University, Perth, WA, Australia.
| | - Robert Tait
- National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, WA, Australia.
| | | | - Rosa Alati
- School of Public Health, Curtin University, Perth, WA, Australia; Institute of Social Science Research, The University of Queensland, QLD, Australia.
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23
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Ayano G, Betts K, Lin A, Tait R, Alati R. Associations of maternal and paternal mental health problems with offspring anxiety at age 20 years: Findings from a population-based prospective cohort study. Psychiatry Res 2021; 298:113781. [PMID: 33592400 DOI: 10.1016/j.psychres.2021.113781] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 01/31/2021] [Indexed: 11/26/2022]
Abstract
Epidemiological studies indicate that children of parents with mental health problems are at an increased risk of developing anxiety disorders. Few studies have investigated this relationship in young adults. Participants were from the Raine Study, which is a multi-generational birth cohort study in Australia. Maternal anxiety and depression in late childhood were assessed using the Depression, Anxiety, and Stress Scale (DASS-42), and paternal lifetime mental health problems were assessed using a self-reported questionnaire. The short form of DASS-42 (DASS-21) was used to assess anxiety symptoms among offspring at age 20. Negative binomial regression model was used to quantify the association. Data were available for 1,220 mother-offspring and 1,190 father-offspring pairs. After adjusting for potential confounders, we found an increased risk of anxiety in young adult offspring exposed to maternal anxiety in late childhood and paternal lifetime mental health problems. However, we observed no increased risks of anxiety in offspring exposed to maternal depressive symptoms. Our sensitivity analysis based on the log-binomial model (binary outcome) as well as the linear model (log-transformed data) confirmed the robustness of the main results. Our findings suggest there can be value to consider and apply targeted screening and intervention programs of anxiety in the young adult offspring with parental mental health problems.
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Affiliation(s)
- Getinet Ayano
- School of Public Health, Curtin University, Perth, WA, Australia.
| | - Kim Betts
- School of Public Health, Curtin University, Perth, WA, Australia.
| | - Ashleigh Lin
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia.
| | - Robert Tait
- National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, WA, Australia.
| | - Rosa Alati
- School of Public Health, Curtin University, Perth, WA, Australia; Institute of social science research, The University of Queensland, QLD, Australia.
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24
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Ayano G, Betts K, Maravilla JC, Alati R. The risk of anxiety disorders in children of parents with severe psychiatric disorders: a systematic review and meta-analysis. J Affect Disord 2021; 282:472-487. [PMID: 33422825 DOI: 10.1016/j.jad.2020.12.134] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 11/10/2020] [Accepted: 12/23/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Several studies have investigated the association between parental severe psychiatric disorders and anxiety disorder risk in offspring, but the findings across these studies have been inconsistent. METHODS Using the PRISMA guideline, a rigorous electronic and manual search was conducted in four electronic databases EMBASE, PubMed, PsychINFO, and Scopus to identify relevant studies. All observation studies (cohort and case-control studies) that examined the association between parental severe psychiatric disorders and the risk of offspring anxiety disorders were identified. Summary risk ratios (RRs) and 95% confidence intervals (95%CI) were synthesized using a fixed and random effect meta-analysis. RESULTS Twenty-five studies were included in the final analysis (14 cohort and 11 case-control studies). The meta-analysis showed that parental severe psychiatric disorder was associated with a higher risk of social phobia, panic, obsessive-compulsive, post-traumatic stress, separation anxiety, and generalized anxiety disorders in the offspring. When considering specific severe psychiatric disorders in parents as exposure, parental bipolar disorder was associated with an increased risk of obsessive-compulsive and generalized anxiety disorders in the offspring, whereas parental depressive disorder was associated with an increased risk of social phobia, separation anxiety, and generalized anxiety disorders in the offspring. Conversely, parental schizophrenia was not associated with offspring anxiety disorder CONCLUSION: This review suggests that the offspring of parents with severe psychiatric, bipolar, and depressive disorders are at an increased risk of developing a range of anxiety disorders. These findings suggest that targeted early screening and intervention programs are imperative in exposed offspring.
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Affiliation(s)
- Getinet Ayano
- School of public health, Curtin University, WA, Perth, Australia; Research and Training Department, Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia.
| | - Kim Betts
- School of public health, Curtin University, WA, Perth, Australia.
| | | | - Rosa Alati
- School of public health, Curtin University, WA, Perth, Australia; Institute of social science research, The University of Queensland, Brisbane, Australia.
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25
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Ayano G, Betts K, Lin A, Tait R, Alati R. Maternal and paternal mental health problems and the risk of offspring depression in late adolescence: findings from the Raine study. J Ment Health 2021; 30:349-357. [PMID: 33522345 DOI: 10.1080/09638237.2021.1875423] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND There are limited studies on the risk of depressive symptoms in adolescent offspring exposed to parental mental health problems in middle childhood. AIM We investigated the association between parental mental health problems, particularly paternal emotional problems and maternal symptoms of anxiety and depression, and the risk of depressive symptoms in adolescent offspring aged 17. METHODS The study included 995 parent-offspring pairs from the 1989-91 birth cohort (the Raine Study) in Western Australia. Log-binomial regression was used to assess the associations. RESULTS An increased risk of depression symptoms was observed in the adolescent offspring of mothers with depressive [RR 1.45, 95% CI 1.13-1.86] as well as anxiety symptoms [RR 1.43, 95% CI 1.09-1.87].Compared to those non-exposed, offspring whose mothers reported comorbid anxiety and depressive symptoms were more likely to have developed depressive symptoms by late adolescence [RR 1.63, 95%CI 1.11-2.38]. An increased risk of depressive symptoms was also seen in the offspring of fathers with emotional problems [RR 1.29, 95%CI 1.01-1.53]. CONCLUSION Our findings suggest an increased risk of depressive symptoms in the adolescent offspring of parents with mental health problems, specifically paternal emotional problems (29%) and maternal anxiety (43%), depression (45%), as well as comorbid anxiety and depressive symptoms (63%).
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Affiliation(s)
- Getinet Ayano
- School of Public Health, Curtin University, Perth, WA, Australia
| | - Kim Betts
- School of Public Health, Curtin University, Perth, WA, Australia
| | - Ashleigh Lin
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Robert Tait
- Faculty of Health Sciences, National Drug Research Institute, Curtin University, Perth, WA, Australia
| | - Rosa Alati
- School of Public Health, Curtin University, Perth, WA, Australia.,Institute for Social Science Research, The University of Queensland, Brisbane, QLD, Australia
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Ayano G, Betts K, Maravilla JC, Alati R. A Systematic Review and Meta-Analysis of the Risk of Disruptive Behavioral Disorders in the Offspring of Parents with Severe Psychiatric Disorders. Child Psychiatry Hum Dev 2021; 52:77-95. [PMID: 32291561 DOI: 10.1007/s10578-020-00989-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Inconsistent results of the association between severe psychiatric disorders (SPD) in parents and the risk of disruptive behavioral disorders (DBD) including conduct disorders (CD) and oppositional defiant disorders (ODD) in the offspring have been found by previous epidemiologic studies. PubMed, EMBASE, PsycINFO, and Scopus were searched for relevant studies. Fourteen studies met the predefined criteria for inclusion. A meta-analysis of the included studies revealed an elevated risk of DBD in the offspring of parents with SPD, bipolar, and depressive disorders. Our further analysis considering the specific DBD as an outcome showed that parents with SPD are at an increased risk of having a child with ODD as well as CD. Moreover, the current meta-analysis found that the children of parents with bipolar disorder were also at increased risk of ODD and CD. Parental schizophrenia and depressive disorders were not associated with higher risks of ODD and CD in the offspring.
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Affiliation(s)
- Getinet Ayano
- School of Public Health, Curtin University, Perth, WA, Australia.
| | - Kim Betts
- School of Public Health, Curtin University, Perth, WA, Australia
| | | | - Rosa Alati
- School of Public Health, Curtin University, Perth, WA, Australia.,School of Social Sciences, The University of Queensland, Brisbane, QLD, Australia
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Social determinants of health, personalized medicine, and child maltreatment. Pediatr Res 2021; 89:368-376. [PMID: 33288877 DOI: 10.1038/s41390-020-01290-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 11/02/2020] [Accepted: 11/09/2020] [Indexed: 11/08/2022]
Abstract
This review begins with a brief summary of the importance of child maltreatment as a major public health problem, given its prevalence and the substantial human and economic costs involved. The focus then shifts to consideration of personalized medicine and child maltreatment, including genetic and genomics factors, as well as the role of social determinants of health. Research on epigenetics related to child abuse and neglect is presented, followed by that pertaining to a few specific social factors, such as poverty, parental depression and substance use, and domestic (or intimate partner) violence. The review ends with a discussion of interventions to help address social determinants of health with brief descriptions of several model programs, and thoughts concerning the role of personalized medicine in addressing child maltreatment in the foreseeable future. IMPACT: This paper synthesizes knowledge on social determinants of health and advances in genetics and genomics related to the prevention of child maltreatment. It provides examples of model approaches to addressing the prevention of child maltreatment in primary care practices.
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29
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Prenatal developmental origins of behavior and mental health: The influence of maternal stress in pregnancy. Neurosci Biobehav Rev 2020; 117:26-64. [DOI: 10.1016/j.neubiorev.2017.07.003] [Citation(s) in RCA: 438] [Impact Index Per Article: 109.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Revised: 04/09/2017] [Accepted: 07/11/2017] [Indexed: 01/17/2023]
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Exploring care from extended family through rural women's accounts of perinatal mental illness - a qualitative study with implications for policy and practice. Health Place 2020; 66:102427. [PMID: 32980675 DOI: 10.1016/j.healthplace.2020.102427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 08/19/2020] [Accepted: 08/20/2020] [Indexed: 11/24/2022]
Abstract
Extended family often have an important role in caring for women experiencing perinatal mental illness; but rural women's perspectives are under-researched. We explored women's experiences of living in rural northern England and receiving care from extended family during periods of perinatal mental illness through 21 qualitative interviews. Key findings were that companionship, practical support - informal childcare and transport, and emotional support were important forms of care - filling gaps in formal service provision. Findings highlight women's needs for support from extended families in rural areas. The rural infrastructure and inequity in formal services can create vulnerability for women.
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31
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Faisal-Cury A, Bertazzi Levy R, Kontos A, Tabb K, Matijasevich A. Postpartum bonding at the beginning of the second year of child's life: the role of postpartum depression and early bonding impairment. J Psychosom Obstet Gynaecol 2020; 41:224-230. [PMID: 31438746 DOI: 10.1080/0167482x.2019.1653846] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Background: We evaluated the association between mother-child bonding and maternal depression at 6-8 months after birth with bonding impairment at 12-15 months in a sample of mothers at high risk of postnatal depression.Methods: A prospective cohort study with 346 low-income postpartum women with antenatal depression. The Postpartum Bonding Questionnaire (PBQ) and the Patient Health Questionnaire-9 (PHQ-9) were used, at 6-8 and 12-15 months after delivery, to assess the mother-infant bonding and postnatal depression (PPD), respectively.Results: The percentage of the main outcome, bonding impairment (BI) at 12-15 months, was 9.9% (95% CI 6.6-13.7). Using logistic regression models, BI was associated with: having an occupation (OR = 2.82; 95% CI 1.00-7.94, p = .049), unplanned pregnancy (OR = 3.46; 95% CI 1.01-11.8, p = .047), and presence of BI at 6-8 months (OR= 13.0; 95% CI 3.76-45.4, p ≤ .001). Maternal depression was marginally associated with BI at 12-15 months.Conclusions: BI affects 1 in 10 mothers, and although BI and PPD are strongly associated at 6-8 and 12-15 months after delivery, BI at 6-8 months is the main predictor of later BI. Based on the study findings, PPD screening in combination with BI assessment is highly recommended during the first year of child's life.
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Affiliation(s)
| | | | | | - Karen Tabb
- School of Social Work, University of Illinois, Urbana, IL, USA
| | - Alicia Matijasevich
- Department of Preventive Medicine, University of São Paulo, São Paulo, Brazil
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Tirumalaraju V, Suchting R, Evans J, Goetzl L, Refuerzo J, Neumann A, Anand D, Ravikumar R, Green CE, Cowen PJ, Selvaraj S. Risk of Depression in the Adolescent and Adult Offspring of Mothers With Perinatal Depression: A Systematic Review and Meta-analysis. JAMA Netw Open 2020; 3:e208783. [PMID: 32602910 PMCID: PMC7327545 DOI: 10.1001/jamanetworkopen.2020.8783] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
IMPORTANCE Maternal depression during pregnancy is associated with emotional and behavioral difficulties of offspring during childhood that can increase the risk of depression in adolescence and adulthood. OBJECTIVE To investigate the association between perinatal maternal depression and an increased long-term risk of depression in their adolescent and adult offspring. DATA SOURCES A systematic search of the electronic databases of PubMed and PsycINFO was conducted from May 2019 to June 2019. STUDY SELECTION A total of 6309 articles were identified, of which 88 articles were extracted for full-text review by 2 reviewers. Only articles reporting data from prospective longitudinal studies that assessed maternal depression during antenatal and/or postnatal periods and resulting offspring 12 years or older with measures of established psychometric properties were included. Exclusion criteria consisted of all other study designs, mothers with other medical and psychiatric comorbidities, and offspring younger than 12 years. DATA EXTRACTION AND SYNTHESIS Data were extracted by 2 independent reviewers, and discrepancies were mediated by an expert third reviewer. Meta-analysis was performed using Bayesian statistical inference and reported using Meta-analysis of Observational Studies in Epidemiology (MOOSE) guideline. The association of depression timing with the sex of offspring was explored using metaregression. MAIN OUTCOMES AND MEASURES Offspring depression was evaluated using standardized depression scales or clinical interviews. RESULTS Six studies with a total of 15 584 mother-child dyads were included in the meta-analysis, which found the offspring of mothers who experienced perinatal depression to have increased odds of depression (odds ratio [OR], 1.70; 95% credible interval [CrI], 1.60-2.65; posterior probability [PP] [OR >1], 98.6%). Although metaregression found no evidence for an overall association between perinatal depression timing and offspring depression (antenatal vs postnatal, PP [OR >1] = 53.8%), subgroup analyses showed slightly higher pooled odds for the antenatal studies (OR, 1.78; 95% CrI, 0.93-3.33; PP [OR >1] = 96.2%) than for the postnatal studies (OR, 1.66; 95% CrI, 0.65-3.84; PP [OR >1] = 88.0%). Female adolescent offspring recorded higher rates of depression in metaregression analyses, such that a 1% increase in the percentage of female (relative to male) offspring was associated with a 6% increase in the odds of offspring depression (OR, 1.06; 95% CrI, 0.99-1.14; τ2 = 0.31). CONCLUSIONS AND RELEVANCE In this study, maternal perinatal depression, especially antenatal depression, was associated with the risk of depression in adolescence and adulthood. More research into the mechanisms of depression risk transmission and assessments of postinterventional risk reduction could aid in the development of future strategies to tackle depressive disorders in pregnancy.
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Affiliation(s)
- Vaishali Tirumalaraju
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston
| | - Robert Suchting
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston
| | - Jonathan Evans
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Laura Goetzl
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern School of Medicine, University of Texas Health Science Center at Houston
| | - Jerrie Refuerzo
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center at Houston
| | - Alexander Neumann
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Rotterdam, the Netherlands
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Deepa Anand
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston
| | - Rekha Ravikumar
- Department of Internal Medicine, Mercy Health St Vincent Medical Center, Toledo, Ohio
| | - Charles E. Green
- Center for Clinical Research and Evidence-Based Medicine, Department of Pediatrics, McGovern Medical School, University of Texas Health Science Center at Houston
| | - Philip J. Cowen
- Medical Sciences Division, Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Sudhakar Selvaraj
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston
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Chow A, Dharma C, Chen E, Mandhane PJ, Turvey SE, Elliott SJ, Becker AB, Subbarao P, Sears MR, Kozyrskyj AL. Trajectories of Depressive Symptoms and Perceived Stress From Pregnancy to the Postnatal Period Among Canadian Women: Impact of Employment and Immigration. Am J Public Health 2020; 109:S197-S204. [PMID: 31242008 DOI: 10.2105/ajph.2018.304624] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Objectives. To identify trajectory patterns of maternal depressive symptoms and perceived stress from midpregnancy to 2 years postpartum and determine relationships with selected sociodemographic factors including income, education, immigration, and postpartum employment. Methods. Pregnant women (n = 3307) recruited from the general population in 4 regions in Canada provided 6 waves of data from pregnancy to 2 years postpartum. The study was conducted from 2009 to 2015. Results. We determined 5 trajectory groups distinguished by time and magnitude for both depressive symptoms and perceived stress. Immigrants living in Canada for more than 5 up to 10 years, but not more recent arrivals, were at higher risk for persistent stress and depression independent of income status. Being employed at 1 year postpartum was associated with a lower likelihood of postpartum depression and perceived stress, while mothers reporting work exhaustion were substantially more likely to experience persistent depression and stress. Conclusions. The study highlighted the heterogeneous nature of depressive symptoms and perceived stress. Targeting interventions toward women 5 to 10 years after immigration and those experiencing exhaustion from postpartum work may be particularly beneficial.
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Affiliation(s)
- Angela Chow
- Angela Chow is with the Department of Applied Health Science, School of Public Health, Indiana University, Bloomington. Christoffer Dharma and Malcolm R. Sears are with the Department of Medicine, McMaster University, Hamilton, Ontario. Edith Chen is with the Department of Psychology and the Institute for Policy Research, Northwestern University, Evanston, IL. Piushkumar J. Mandhane and Anita L. Kozyrskyj are with the Department of Pediatrics, University of Alberta, Edmonton. Stuart E. Turvey is with the Department of Pediatrics, The University of British Columbia, and BC Children's Hospital, Vancouver. Susan J. Elliott is with the Department of Geography and Environmental Management, University of Waterloo, Waterloo, Ontario. Allan B. Becker is with the Manitoba Institute of Child Health, the Department of Pediatrics & Child Health, University of Manitoba, Winnipeg. Padmaja Subbarao is with the Departments of Pediatrics and Physiology, and the Hospital for Sick Children, University of Toronto, Toronto, Ontario
| | - Christoffer Dharma
- Angela Chow is with the Department of Applied Health Science, School of Public Health, Indiana University, Bloomington. Christoffer Dharma and Malcolm R. Sears are with the Department of Medicine, McMaster University, Hamilton, Ontario. Edith Chen is with the Department of Psychology and the Institute for Policy Research, Northwestern University, Evanston, IL. Piushkumar J. Mandhane and Anita L. Kozyrskyj are with the Department of Pediatrics, University of Alberta, Edmonton. Stuart E. Turvey is with the Department of Pediatrics, The University of British Columbia, and BC Children's Hospital, Vancouver. Susan J. Elliott is with the Department of Geography and Environmental Management, University of Waterloo, Waterloo, Ontario. Allan B. Becker is with the Manitoba Institute of Child Health, the Department of Pediatrics & Child Health, University of Manitoba, Winnipeg. Padmaja Subbarao is with the Departments of Pediatrics and Physiology, and the Hospital for Sick Children, University of Toronto, Toronto, Ontario
| | - Edith Chen
- Angela Chow is with the Department of Applied Health Science, School of Public Health, Indiana University, Bloomington. Christoffer Dharma and Malcolm R. Sears are with the Department of Medicine, McMaster University, Hamilton, Ontario. Edith Chen is with the Department of Psychology and the Institute for Policy Research, Northwestern University, Evanston, IL. Piushkumar J. Mandhane and Anita L. Kozyrskyj are with the Department of Pediatrics, University of Alberta, Edmonton. Stuart E. Turvey is with the Department of Pediatrics, The University of British Columbia, and BC Children's Hospital, Vancouver. Susan J. Elliott is with the Department of Geography and Environmental Management, University of Waterloo, Waterloo, Ontario. Allan B. Becker is with the Manitoba Institute of Child Health, the Department of Pediatrics & Child Health, University of Manitoba, Winnipeg. Padmaja Subbarao is with the Departments of Pediatrics and Physiology, and the Hospital for Sick Children, University of Toronto, Toronto, Ontario
| | - Piushkumar J Mandhane
- Angela Chow is with the Department of Applied Health Science, School of Public Health, Indiana University, Bloomington. Christoffer Dharma and Malcolm R. Sears are with the Department of Medicine, McMaster University, Hamilton, Ontario. Edith Chen is with the Department of Psychology and the Institute for Policy Research, Northwestern University, Evanston, IL. Piushkumar J. Mandhane and Anita L. Kozyrskyj are with the Department of Pediatrics, University of Alberta, Edmonton. Stuart E. Turvey is with the Department of Pediatrics, The University of British Columbia, and BC Children's Hospital, Vancouver. Susan J. Elliott is with the Department of Geography and Environmental Management, University of Waterloo, Waterloo, Ontario. Allan B. Becker is with the Manitoba Institute of Child Health, the Department of Pediatrics & Child Health, University of Manitoba, Winnipeg. Padmaja Subbarao is with the Departments of Pediatrics and Physiology, and the Hospital for Sick Children, University of Toronto, Toronto, Ontario
| | - Stuart E Turvey
- Angela Chow is with the Department of Applied Health Science, School of Public Health, Indiana University, Bloomington. Christoffer Dharma and Malcolm R. Sears are with the Department of Medicine, McMaster University, Hamilton, Ontario. Edith Chen is with the Department of Psychology and the Institute for Policy Research, Northwestern University, Evanston, IL. Piushkumar J. Mandhane and Anita L. Kozyrskyj are with the Department of Pediatrics, University of Alberta, Edmonton. Stuart E. Turvey is with the Department of Pediatrics, The University of British Columbia, and BC Children's Hospital, Vancouver. Susan J. Elliott is with the Department of Geography and Environmental Management, University of Waterloo, Waterloo, Ontario. Allan B. Becker is with the Manitoba Institute of Child Health, the Department of Pediatrics & Child Health, University of Manitoba, Winnipeg. Padmaja Subbarao is with the Departments of Pediatrics and Physiology, and the Hospital for Sick Children, University of Toronto, Toronto, Ontario
| | - Susan J Elliott
- Angela Chow is with the Department of Applied Health Science, School of Public Health, Indiana University, Bloomington. Christoffer Dharma and Malcolm R. Sears are with the Department of Medicine, McMaster University, Hamilton, Ontario. Edith Chen is with the Department of Psychology and the Institute for Policy Research, Northwestern University, Evanston, IL. Piushkumar J. Mandhane and Anita L. Kozyrskyj are with the Department of Pediatrics, University of Alberta, Edmonton. Stuart E. Turvey is with the Department of Pediatrics, The University of British Columbia, and BC Children's Hospital, Vancouver. Susan J. Elliott is with the Department of Geography and Environmental Management, University of Waterloo, Waterloo, Ontario. Allan B. Becker is with the Manitoba Institute of Child Health, the Department of Pediatrics & Child Health, University of Manitoba, Winnipeg. Padmaja Subbarao is with the Departments of Pediatrics and Physiology, and the Hospital for Sick Children, University of Toronto, Toronto, Ontario
| | - Allan B Becker
- Angela Chow is with the Department of Applied Health Science, School of Public Health, Indiana University, Bloomington. Christoffer Dharma and Malcolm R. Sears are with the Department of Medicine, McMaster University, Hamilton, Ontario. Edith Chen is with the Department of Psychology and the Institute for Policy Research, Northwestern University, Evanston, IL. Piushkumar J. Mandhane and Anita L. Kozyrskyj are with the Department of Pediatrics, University of Alberta, Edmonton. Stuart E. Turvey is with the Department of Pediatrics, The University of British Columbia, and BC Children's Hospital, Vancouver. Susan J. Elliott is with the Department of Geography and Environmental Management, University of Waterloo, Waterloo, Ontario. Allan B. Becker is with the Manitoba Institute of Child Health, the Department of Pediatrics & Child Health, University of Manitoba, Winnipeg. Padmaja Subbarao is with the Departments of Pediatrics and Physiology, and the Hospital for Sick Children, University of Toronto, Toronto, Ontario
| | - Padmaja Subbarao
- Angela Chow is with the Department of Applied Health Science, School of Public Health, Indiana University, Bloomington. Christoffer Dharma and Malcolm R. Sears are with the Department of Medicine, McMaster University, Hamilton, Ontario. Edith Chen is with the Department of Psychology and the Institute for Policy Research, Northwestern University, Evanston, IL. Piushkumar J. Mandhane and Anita L. Kozyrskyj are with the Department of Pediatrics, University of Alberta, Edmonton. Stuart E. Turvey is with the Department of Pediatrics, The University of British Columbia, and BC Children's Hospital, Vancouver. Susan J. Elliott is with the Department of Geography and Environmental Management, University of Waterloo, Waterloo, Ontario. Allan B. Becker is with the Manitoba Institute of Child Health, the Department of Pediatrics & Child Health, University of Manitoba, Winnipeg. Padmaja Subbarao is with the Departments of Pediatrics and Physiology, and the Hospital for Sick Children, University of Toronto, Toronto, Ontario
| | - Malcolm R Sears
- Angela Chow is with the Department of Applied Health Science, School of Public Health, Indiana University, Bloomington. Christoffer Dharma and Malcolm R. Sears are with the Department of Medicine, McMaster University, Hamilton, Ontario. Edith Chen is with the Department of Psychology and the Institute for Policy Research, Northwestern University, Evanston, IL. Piushkumar J. Mandhane and Anita L. Kozyrskyj are with the Department of Pediatrics, University of Alberta, Edmonton. Stuart E. Turvey is with the Department of Pediatrics, The University of British Columbia, and BC Children's Hospital, Vancouver. Susan J. Elliott is with the Department of Geography and Environmental Management, University of Waterloo, Waterloo, Ontario. Allan B. Becker is with the Manitoba Institute of Child Health, the Department of Pediatrics & Child Health, University of Manitoba, Winnipeg. Padmaja Subbarao is with the Departments of Pediatrics and Physiology, and the Hospital for Sick Children, University of Toronto, Toronto, Ontario
| | - Anita L Kozyrskyj
- Angela Chow is with the Department of Applied Health Science, School of Public Health, Indiana University, Bloomington. Christoffer Dharma and Malcolm R. Sears are with the Department of Medicine, McMaster University, Hamilton, Ontario. Edith Chen is with the Department of Psychology and the Institute for Policy Research, Northwestern University, Evanston, IL. Piushkumar J. Mandhane and Anita L. Kozyrskyj are with the Department of Pediatrics, University of Alberta, Edmonton. Stuart E. Turvey is with the Department of Pediatrics, The University of British Columbia, and BC Children's Hospital, Vancouver. Susan J. Elliott is with the Department of Geography and Environmental Management, University of Waterloo, Waterloo, Ontario. Allan B. Becker is with the Manitoba Institute of Child Health, the Department of Pediatrics & Child Health, University of Manitoba, Winnipeg. Padmaja Subbarao is with the Departments of Pediatrics and Physiology, and the Hospital for Sick Children, University of Toronto, Toronto, Ontario
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Pellowski JA, Bengtson AM, Barnett W, DiClemente K, Koen N, Zar HJ, Stein DJ. Perinatal depression among mothers in a South African birth cohort study: Trajectories from pregnancy to 18 months postpartum. J Affect Disord 2019; 259:279-287. [PMID: 31454590 PMCID: PMC6851529 DOI: 10.1016/j.jad.2019.08.052] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 06/24/2019] [Accepted: 08/17/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Perinatal depression affects 21-50% of women in South Africa and poses significant health risks to mothers and children. Trajectories of depressive symptoms change over time and have not been well characterized during the perinatal period in low and middle-income countries. METHODS Data from women enrolled in a population-based birth cohort study in Paarl, South Africa with at least 3 depression measures from pregnancy through 18 months postpartum (N = 831) were analyzed. Depressive symptoms were measured continuously using the Edinburgh Postnatal Depression Scale (EPDS). Group-based trajectory models were used to estimate trajectories of depressive symptoms during the perinatal period and multinomial multivariable models to identify predictors of trajectory group membership. RESULTS Five distinct trajectory patterns of depressive symptoms were identified: moderate levels of depressive symptoms during pregnancy but minimal postpartum (3.5%), minimal levels during pregnancy and increasing postpartum (3.7%), unstable levels peaking at 12 months postpartum (6.6%), mild levels with slight decrease postpartum (82.9%), and severe levels during pregnancy and postpartum (3.1%). Membership in the chronic severe symptom group was associated with stressful life events, sexual intimate partner violence and tobacco use. LIMITATIONS Modeling limitations prevented determining how changes in psychosocial predictors over time may influence depressive symptom trajectories. CONCLUSIONS Mild to severe depressive symptoms during pregnancy/postpartum were common among this South African cohort. Interventions to treat women with severe chronic depressive symptoms with co-occurring psychosocial issues are urgently needed.
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Affiliation(s)
- Jennifer A. Pellowski
- Department of Behavioral and Social Sciences, International Health Institute, Brown University School of Public Health, Providence, RI, USA,Corresponding author.
| | - Angela M. Bengtson
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Whitney Barnett
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and South African Medical Research Council (SAMRC) Unit on Child & Adolescent Health, University of Cape Town, South Africa
| | - Kira DiClemente
- Department of Behavioral and Social Sciences, International Health Institute, Brown University School of Public Health, Providence, RI, USA
| | - Nastassja Koen
- Department of Psychiatry and Mental Health and South African Medical Research Council (SAMRC) Unit on Risk & Resilience in Mental Disorders, Neuroscience Institute, University of Cape Town, South Africa
| | - Heather J. Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and South African Medical Research Council (SAMRC) Unit on Child & Adolescent Health, University of Cape Town, South Africa
| | - Dan J. Stein
- Department of Psychiatry and Mental Health and South African Medical Research Council (SAMRC) Unit on Risk & Resilience in Mental Disorders, Neuroscience Institute, University of Cape Town, South Africa
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Lim HA, Chua TE, Malhotra R, Allen JC, Teo I, Chern BSM, Tan KH, Chen H. Identifying trajectories of antenatal depression in women and their associations with gestational age and neonatal anthropometry: A prospective cohort study. Gen Hosp Psychiatry 2019; 61:26-33. [PMID: 31710855 DOI: 10.1016/j.genhosppsych.2019.09.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 09/11/2019] [Accepted: 09/11/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The present study sought to determine the longitudinal trajectories of antenatal depression and examine their associations with birth outcomes. METHOD 926 healthy women with uncomplicated singleton pregnancies within 14 weeks of gestation participated in this prospective cohort study. Women completed a sociodemographic and medical questionnaire and the locally-validated Edinburgh Postnatal Depression Scale (EPDS) in their first, second, and third trimesters, and prior to parturition. Gestational age and neonatal weight, length, and head circumference were recorded at birth. Group-based trajectory modelling characterized trajectories of antenatal depression. Analyses of covariance and covariate-adjusted linear regressions identified associations between trajectories and neonatal outcomes. RESULTS Four distinct non-fluctuating trajectories of depressive symptoms were identified, with 9% women suffering from probable clinical depression throughout the pregnancy. Women in this persistently-moderate depression trajectory delivered 2.48 days earlier than in other trajectories; a one-point increase in EPDS scores was associated with an adjusted reduction of 5.82 g in birthweight. CONCLUSIONS Although meaningful trajectories were identified, no clinically relevant associations between persistently-moderate depressive symptoms with neonatal outcomes were found. The stability of these trajectories, however, suggests the importance of screening for depressive symptoms early in pregnancy to identify women who may benefit from greater formal and informal support.
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Affiliation(s)
- Haikel A Lim
- Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore.
| | - Tze-Ern Chua
- Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore; KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore.
| | - Rahul Malhotra
- Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore.
| | - John C Allen
- Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore.
| | - Irene Teo
- Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore.
| | - Bernard S M Chern
- KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore.
| | - Kok Hian Tan
- Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore; KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore.
| | - Helen Chen
- Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore; KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore.
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Aktar E, Qu J, Lawrence PJ, Tollenaar MS, Elzinga BM, Bögels SM. Fetal and Infant Outcomes in the Offspring of Parents With Perinatal Mental Disorders: Earliest Influences. Front Psychiatry 2019; 10:391. [PMID: 31316398 PMCID: PMC6610252 DOI: 10.3389/fpsyt.2019.00391] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 05/17/2019] [Indexed: 12/16/2022] Open
Abstract
Mental illness is highly prevalent and runs in families. Mental disorders are considered to enhance the risk for the development of psychopathology in the offspring. This heightened risk is related to the separate and joint effects of inherited genetic vulnerabilities for psychopathology and environmental influences. The early years of life are suggested to be a key developmental phase in the intergenerational psychopathology transmission. Available evidence supports the idea that early exposure to parental psychopathology, during the pregnancy and first postpartum year, may be related to child psychological functioning beyond the postpartum period, up to adulthood years. This not only highlights the importance of intervening early to break the chain of intergenerational transmission of psychopathology but also raises the question of whether early interventions targeting parental mental disorders in this period may alleviate these prolonged adverse effects in the infant offspring. The current article focuses on the specific risk of psychopathology conveyed from mentally ill parents to the offspring during the pregnancy and first postpartum year. We first present a summary of the available evidence on the associations of parental perinatal mental illness with infant psychological outcomes at the behavioral, biological, and neurophysiological levels. Next, we address the effects of early interventions and discuss whether these may mitigate the early intergenerational transmission of risk for psychopathology. The summarized evidence supports the idea that psychopathology-related changes in parents' behavior and physiology in the perinatal period are related to behavioral, biological, and neurophysiological correlates of infant psychological functioning in this period. These alterations may constitute risk for later development of child and/or adult forms of psychopathology and thus for intergenerational transmission. Targeting psychopathology or mother-infant interactions in isolation in the postnatal period may not be sufficient to improve outcomes, whereas interventions targeting both maternal psychopathology and mother-infant interactions seem promising in alleviating the risk of early transmission.
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Affiliation(s)
- Evin Aktar
- Clinical Psychology Unit, Department of Psychology, Leiden University, Leiden, Netherlands
- Leiden Institute for Brain and Cognition, Leiden University, Leiden, Netherlands
| | - Jin Qu
- Department of Psychology, Clarion University of Pennsylvania, Clarion, PA, United States
| | - Peter J Lawrence
- Centre for Innovation in Mental Health, School of Psychology, University of Southampton, Southampton, United Kingdom
| | - Marieke S Tollenaar
- Clinical Psychology Unit, Department of Psychology, Leiden University, Leiden, Netherlands
- Leiden Institute for Brain and Cognition, Leiden University, Leiden, Netherlands
| | - Bernet M Elzinga
- Clinical Psychology Unit, Department of Psychology, Leiden University, Leiden, Netherlands
- Leiden Institute for Brain and Cognition, Leiden University, Leiden, Netherlands
| | - Susan M Bögels
- Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, Netherlands
- Developmental Psychology, Department of Psychology, University of Amsterdam, Amsterdam, Netherlands
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Webber E, Benedict J. Postpartum depression: A multi-disciplinary approach to screening, management and breastfeeding support. Arch Psychiatr Nurs 2019; 33:284-289. [PMID: 31227081 DOI: 10.1016/j.apnu.2019.01.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 10/13/2018] [Accepted: 01/24/2019] [Indexed: 01/16/2023]
Abstract
Postpartum depression (PPD) is a common condition affecting 11%-20% of all postpartum women. Depression can have significant consequences for both mother and infant. There are many risk factors associated with PPD, all of which contribute to an inflammatory response in the mother. An inverse relationship exists between PPD and breastfeeding; women with PPD are less likely to have a positive breastfeeding experience which can lead to early weaning, while long-term exclusive breastfeeding is associated with decreased rates of PPD. A multi-disciplinary approach to managing PPD, including strong breastfeeding support, will lead to improved mental health outcomes for women and their children.
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Affiliation(s)
- Elaine Webber
- University of Detroit Mercy, 4001 W McNichols Rd, Detroit, MI 48221, United States.
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Kott J, Brummelte S. Trick or treat? Evaluating contributing factors and sex-differences for developmental effects of maternal depression and its treatment. Horm Behav 2019; 111:31-45. [PMID: 30658054 DOI: 10.1016/j.yhbeh.2019.01.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 12/14/2018] [Accepted: 01/11/2019] [Indexed: 11/29/2022]
Abstract
Maternal depression and treatment with selective serotonin reuptake inhibitors (SSRIs), the most common form of pharmaceutical intervention, can both have an impact on infant development. As such, it is difficult for healthcare providers to recommend a course of treatment to expectant mothers suffering from depression, or to women on antidepressant medication prior to pregnancy. This review will discuss the existing research on the developmental impacts of maternal depression and its treatment with SSRIs, with a particular focus on contributing factors that complicate our attempt to disentangle the consequences of maternal depression and its treatment such as the timing or severity of the depression. We will explore avenues for translational animal models to help address the question of "Trick or Treat", i.e.: which is worse for offspring development: exposure to maternal depression, or the SSRI treatment? Further, we will explore sex-dependent outcomes for the offspring in human and animal studies as male and female offspring may react differently to the presence of maternal depression or antidepressant treatment. Without more clinical and preclinical data, it remains difficult for women to make an informed decision regarding their depression treatment before, during, and after their pregnancy.
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Affiliation(s)
- Jennifer Kott
- Department of Psychology, Wayne State University, Detroit, MI, USA
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Different trajectories of depressive symptoms during pregnancy. J Affect Disord 2019; 248:139-146. [PMID: 30731281 DOI: 10.1016/j.jad.2019.01.021] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 01/17/2019] [Accepted: 01/19/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Up to 10-15% of women experience high levels of depressive symptoms during pregnancy. Since these levels of symptoms can vary greatly over time, the current study investigated the existence of possible longitudinal trajectories of depressive symptoms during pregnancy, and aimed to identify factors associated with these trajectories. METHODS Depressive symptoms were assessed prospectively at each trimester in 1832 women, using the Edinburgh (Postnatal) Depression Scale (E(P)DS). Growth mixture modeling was used to identify trajectories of depressive symptoms during pregnancy. RESULTS Three trajectories of depressive symptoms (E(P)DS scores) were identified: low stable (class 1, reference group, 83%), decreasing (class 2, 7%), and increasing (class 3, 10%). Classes 2 and 3 had significantly higher mean E(P)DS scores (7-13 throughout pregnancy) compared to the reference group (stable; E(P)DS <4). Factors associated with trajectories 2 and 3 included previous depressive episodes, life events during pregnancy, and unplanned pregnancy. Notably, the only factor distinguishing classes 2 and 3 was the perception of partner involvement experienced by women during their pregnancies. Class 2 (with decreasing E(P)DS scores) reported high partner involvement, while class 3 (with increasing E(P)DS scores) reported poor partner involvement throughout pregnancy. LIMITATIONS Depressive symptoms were assessed by self-report rather than a diagnostic interview. The participants were more often both highly educated and of Caucasian ethnicity compared to the general Dutch population. CONCLUSIONS Poor partner involvement was associated with increasing depressive symptoms during pregnancy. Health professionals should focus on partner involvement during pregnancy in order to identify women who are potentially vulnerable for perinatal depression.
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Hicks LM, Swales DA, Garcia SE, Driver C, Davis EP. Does Prenatal Maternal Distress Contribute to Sex Differences in Child Psychopathology? Curr Psychiatry Rep 2019; 21:7. [PMID: 30729361 DOI: 10.1007/s11920-019-0992-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW Prenatal maternal psychological distress is an established risk factor for the development of psychopathology in offspring. The purpose of this review is to evaluate whether sex differences in fetal responses to maternal distress contribute to sex differences in subsequent psychopathology. RECENT FINDINGS Male and female fetuses respond differently to stress signals. We review recent evidence that demonstrates a sex-specific pattern of association between prenatal maternal distress and pathways associated with risk for psychopathology including offspring hypothalamic pituitary adrenocortical (HPA) axis regulation, brain development, and negative emotionality. Prenatal maternal distress exerts sex-specific consequences on the fetus. These differences may contribute to the well-established sex differences in psychopathology and in particular to greater female vulnerability to develop internalizing problems.
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Affiliation(s)
- Laurel M Hicks
- Department of Psychology, University of Denver, 2155 South Race Street, Denver, CO, 80208, USA
| | - Danielle A Swales
- Department of Psychology, University of Denver, 2155 South Race Street, Denver, CO, 80208, USA
| | - Sarah E Garcia
- Department of Psychology, University of Denver, 2155 South Race Street, Denver, CO, 80208, USA
| | - Camille Driver
- Department of Psychology, University of Denver, 2155 South Race Street, Denver, CO, 80208, USA
| | - Elysia Poggi Davis
- Department of Psychology, University of Denver, 2155 South Race Street, Denver, CO, 80208, USA. .,Department of Psychiatry and Human Behavior, University of California Irvine, One University Drive, Orange, CA, 92866, USA.
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Côté SM, Ahun MN, Herba CM, Brendgen M, Geoffroy MC, Orri M, Liu X, Vitaro F, Melchior M, Boivin M, Tremblay RE. Why Is Maternal Depression Related to Adolescent Internalizing Problems? A 15-Year Population-Based Study. J Am Acad Child Adolesc Psychiatry 2018; 57:916-924. [PMID: 30522737 DOI: 10.1016/j.jaac.2018.04.024] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Revised: 04/25/2018] [Accepted: 06/20/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Exposure to maternal depression during early childhood is a well-documented risk factor for offspring's internalizing problems, but the long-term risk and the psychosocial mechanisms underlying the association remain largely unknown. We examined whether maternal depression during early childhood was associated with offspring internalizing problems in adolescence, and the extent to which negative parenting, peer victimization, and poor friendship quality during middle childhood mediated this association. METHOD We report on a population-based sample of children (n = 1,443) followed-up from 5 months to 15 years. We use yearly assessments of the exposure variable, that is, maternal depression (5 months to 5 years); the putative mediators, that is, peer victimization, friendship quality, and parenting practices (6-12 years); and assessment of the outcome variables at 15 years: self-reported major depressive (MD), generalized anxiety (GA), and social phobia (SP) symptoms. Structural equation modeling was used to test mediation by peer and family relationships. RESULTS Exposure to maternal depression during early childhood was associated with higher levels of adolescent MD, GA, and SP. Peer victimization was the only significant mediator and explained 35.9% of the association with adolescent MD, 22.1% of that with GA, and 22.1% of that with SP. CONCLUSION Exposure to maternal depression prior to age 5 years was associated with depression, anxiety, and social phobia extending to adolescence via its impact on peer victimization during middle childhood. Particular attention should be paid to victimization as one potential psychosocial factor via which maternal depression is associated with adolescent internalizing problems.
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Affiliation(s)
- Sylvana M Côté
- University of Montreal, Québec, Canada; INSERM U1219, Bordeaux, France.
| | | | | | | | - Marie-Claude Geoffroy
- McGill University, Montreal, Québec, Canada, and the Douglas Mental Health University Institute, Montreal, Québec, Canada
| | - Massimiliano Orri
- McGill University, Montreal, Québec, Canada, and the Douglas Mental Health University Institute, Montreal, Québec, Canada
| | | | | | | | - Michel Boivin
- Laval University, Québec City, Québec, Canada, and Tomsk State University, Russia
| | - Richard E Tremblay
- University of Montreal, Québec, Canada; University College Dublin, Ireland
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Farré-Sender B, Torres A, Gelabert E, Andrés S, Roca A, Lasheras G, Valdés M, Garcia-Esteve L. Mother-infant bonding in the postpartum period: assessment of the impact of pre-delivery factors in a clinical sample. Arch Womens Ment Health 2018; 21:287-297. [PMID: 29046965 DOI: 10.1007/s00737-017-0785-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 10/03/2017] [Indexed: 11/30/2022]
Abstract
This study aims to examine the extent to which a variety of pre-delivery factors (demographic, reproductive, psychological, psychiatric, and psychopathological) predict disturbances in mother-infant bonding (MIB) in the postpartum period. Two hundred fifty-one pregnant women enrolled at a public perinatal psychiatric service were assessed between the first and second trimester of pregnancy and at 6-7 weeks after delivery. During pregnancy, the psychological risk factors were assessed with the Vulnerable Personality Style Questionnaire, the Marital Adjustment Scale, the Early Trauma Inventory, and the General Health Questionnaire. To detect psychopathology, the Edinburgh Postnatal Depression Scale and the State-Trait Anxiety Inventory were used. At the postpartum evaluation, MIB was measured by the Postpartum Bonding Questionnaire. The results of the final regression model showed that emotional abuse in childhood, family psychiatric history, previous psychiatric hospitalization, and anxiety during pregnancy were significant predictors of MIB disturbances in postpartum, explaining 10.7% of the variance. The evaluation of women's risk factors in pregnancy is important in order to prevent MIB disturbances and thus to ensure the welfare of mothers and their babies.
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Affiliation(s)
- Borja Farré-Sender
- Perinatal Psychiatry Program, Department of Psychiatry and Clinical Psychology, Hospital Clinic, C/ Sabino de Arana 1, 08028, Barcelona, Spain. .,Department of Psychiatry, Psychology and Psychosomatics, Dexeus University Hospital, Barcelona, Spain.
| | - Anna Torres
- Perinatal Psychiatry Program, Department of Psychiatry and Clinical Psychology, Hospital Clinic, C/ Sabino de Arana 1, 08028, Barcelona, Spain.,Institute of Biomedical Research August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Vulnerability, Psychopathology and Gender research group (SGR2014/1411), Generalitat de Catalunya, Catalonia, Spain.,Department of Psychiatry and Clinical Psychology, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Estel Gelabert
- Neuropsychopharmacology Programme, IMIM-Hospital del Mar, Barcelona, Spain
| | - Susana Andrés
- Perinatal Psychiatry Program, Department of Psychiatry and Clinical Psychology, Hospital Clinic, C/ Sabino de Arana 1, 08028, Barcelona, Spain
| | - Alba Roca
- Perinatal Psychiatry Program, Department of Psychiatry and Clinical Psychology, Hospital Clinic, C/ Sabino de Arana 1, 08028, Barcelona, Spain
| | - Gracia Lasheras
- Department of Psychiatry, Psychology and Psychosomatics, Dexeus University Hospital, Barcelona, Spain
| | - Manuel Valdés
- Vulnerability, Psychopathology and Gender research group (SGR2014/1411), Generalitat de Catalunya, Catalonia, Spain.,Department of Psychiatry and Clinical Psychology, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Lluïsa Garcia-Esteve
- Perinatal Psychiatry Program, Department of Psychiatry and Clinical Psychology, Hospital Clinic, C/ Sabino de Arana 1, 08028, Barcelona, Spain.,Institute of Biomedical Research August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Vulnerability, Psychopathology and Gender research group (SGR2014/1411), Generalitat de Catalunya, Catalonia, Spain
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Denckla CA, Mancini AD, Consedine NS, Milanovic SM, Basu A, Seedat S, Spies G, Henderson DC, Bonanno GA, Koenen KC. Distinguishing postpartum and antepartum depressive trajectories in a large population-based cohort: the impact of exposure to adversity and offspring gender. Psychol Med 2018; 48:1139-1147. [PMID: 28889814 PMCID: PMC5845817 DOI: 10.1017/s0033291717002549] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Distinguishing temporal patterns of depressive symptoms during pregnancy and after childbirth has important clinical implications for diagnosis, treatment, and maternal and child outcomes. The primary aim of the present study was to distinguish patterns of chronically elevated levels of depressive symptoms v. trajectories that are either elevated during pregnancy but then remit after childbirth, v. patterns that increase after childbirth. METHODS The report uses latent growth mixture modeling in a large, population-based cohort (N = 12 121) to investigate temporal patterns of depressive symptoms. We examined theoretically relevant sociodemographic factors, exposure to adversity, and offspring gender as predictors. RESULTS Four distinct trajectories emerged, including resilient (74.3%), improving (9.2%), emergent (4.0%), and chronic (11.5%). Lower maternal and paternal education distinguished chronic from resilient depressive trajectories, whereas higher maternal and partner education, and female offspring gender, distinguished the emergent trajectory from the chronic trajectory. Younger maternal age distinguished the improving group from the resilient group. Exposure to medical, interpersonal, financial, and housing adversity predicted membership in the chronic, emergent, and improving trajectories compared with the resilient trajectory. Finally, exposure to medical, interpersonal, and financial adversity was associated with the chronic v. improving group, and inversely related to the emergent class relative to the improving group. CONCLUSIONS There are distinct temporal patterns of depressive symptoms during pregnancy, after childbirth, and beyond. Most women show stable low levels of depressive symptoms, while emergent and chronic depression patterns are separable with distinct correlates, most notably maternal age, education levels, adversity exposure, and child gender.
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Affiliation(s)
- C. A. Denckla
- Harvard T. H. Chan School of Public Health, Cambridge, MA, USA
| | | | | | | | - A. Basu
- Harvard T. H. Chan School of Public Health, Cambridge, MA, USA
| | - S. Seedat
- Stellenbosch University, Cape Town, South Africa
| | - G. Spies
- Stellenbosch University, Cape Town, South Africa
| | | | - G. A. Bonanno
- Teacher’s College, Columbia University, New York City, USA
| | - K. C. Koenen
- Harvard T. H. Chan School of Public Health, Cambridge, MA, USA
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The Epigenetic Clock at Birth: Associations With Maternal Antenatal Depression and Child Psychiatric Problems. J Am Acad Child Adolesc Psychiatry 2018; 57:321-328.e2. [PMID: 29706161 PMCID: PMC6277971 DOI: 10.1016/j.jaac.2018.02.011] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 02/09/2018] [Accepted: 03/09/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Maternal antenatal depression may compromise the fetal developmental milieu and contribute to individual differences in aging and disease trajectories in later life. We evaluated the association between maternal antenatal depression and a novel biomarker of aging at birth, namely epigenetic gestational age (GA) based on fetal cord blood methylation data. We also examined whether this biomarker prospectively predicts and mediates maternal effects on early childhood psychiatric problems. METHOD A total of 694 mothers from the Prediction and Prevention of Preeclampsia and Intrauterine Growth Restriction (PREDO) Study provided information on history of depression diagnosed before pregnancy; 581 completed the Center for Epidemiological Studies Depression Scale throughout pregnancy, and 407 completed the Child Behavior Checklist at child's age 3.7 years (SD = 0.75 year). DNA methylation (DNAm) GA of fetal cord blood DNA was based on the methylation profile of 148 selected cytosine linked to guanine by phosphate (CpG) sites. Epigenetic GA was calculated as the arithmetic difference between DNAm GA and chronological GA and adjusted for chronological GA. RESULTS Maternal history of depression diagnosed before pregnancy (mean difference = -0.25 SD units, 95% CI = -0.46 to -0.03) and greater antenatal depressive symptoms (-0.08 SD unit per 1-SD unit increase, 95% CI = -0.16 to -0.004) were associated with child's lower epigenetic GA. Child's lower epigenetic GA, in turn, prospectively predicted total and internalizing problems and partially mediated the effects of maternal antenatal depression on internalizing problems in boys. CONCLUSION Maternal antenatal depression is associated with lower epigenetic GA in offspring. This lower epigenetic GA seems to be associated with a developmental disadvantage for boys, who, in early childhood, show greater psychiatric problems.
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Field T. Postnatal anxiety prevalence, predictors and effects on development: A narrative review. Infant Behav Dev 2018; 51:24-32. [PMID: 29544195 DOI: 10.1016/j.infbeh.2018.02.005] [Citation(s) in RCA: 140] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 02/12/2018] [Accepted: 02/12/2018] [Indexed: 01/23/2023]
Abstract
The increasing prevalence of postnatal anxiety highlights the need for summarizing the recent research on this condition to inform screening and intervention efforts. This narrative review of the literature was derived from a search on PubMed and PsycINFO for papers published since 2010. The demographic risk factors for postnatal anxiety include being a young mother, having more education and being employed. Childbirth risk factors include being primiparous in one sample and multiparous in another, caesarean delivery, fear of the birth and of death during delivery, lack of control during labor, low self-confidence for the delivery and the delivery staff, and premature delivery. Social support problems include the lack of family support, marital/family conflict, and social health issues. Psychiatric history risk factors include prenatal depression and anxiety. Postnatal anxiety has negative effects on breast-feeding, bonding, mother-infant interactions, infant temperament, sleep, mental development, health and internalizing behavior and on conduct disorder in adolescents. Unfortunately, only six postnatal anxiety intervention studies could be found including paternal education, music therapy during labor, mothers massaging their infants, cognitive behavior therapy and administering oxytocin. The negative effects of postnatal anxiety and the limitations of the research in this review highlight the need for further research.
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Affiliation(s)
- Tiffany Field
- University of Miami/Miller School of Medicine, Fielding Graduate University, United States.
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46
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MacKinnon N, Kingsbury M, Mahedy L, Evans J, Colman I. The Association Between Prenatal Stress and Externalizing Symptoms in Childhood: Evidence From the Avon Longitudinal Study of Parents and Children. Biol Psychiatry 2018; 83:100-108. [PMID: 28893381 DOI: 10.1016/j.biopsych.2017.07.010] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 07/12/2017] [Accepted: 07/13/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND It has been suggested that prenatal maternal stress may increase the risk of childhood externalizing disorders, yet no large cohort study has investigated this association across a large range of acute stressors. Our objective was to estimate the association between prenatal stressful events and risk of offspring conduct disorder and hyperactivity. METHODS We used data from 10,184 mother-offspring pairs from the United Kingdom-based Avon Longitudinal Study of Parents and Children. Mothers self-reported 42 prenatal stressful life events at 18 weeks' gestation. Symptoms of conduct disorder and hyperactivity in their offspring were measured at 6, 9, 11, 13, and 16 years of age using the Strengths and Difficulties Questionnaire. The primary outcome was membership in high-symptom trajectories of 1) conduct disorder and 2) hyperactivity throughout childhood, identified using latent class growth modeling. Multinomial logistic regression models estimated the association between prenatal stress and both conduct disorder and hyperactivity, after adjusting for sex, parental education, low birth weight, preterm birth, parental social class, maternal smoking and drinking, maternal mental health, offspring stressful life events, and offspring depressive and anxious symptoms. RESULTS Those exposed to the highest quartile of prenatal stress were more likely to belong to the high symptom trajectory for hyperactivity (B = 0.46, p < .05) and conduct disorder (B = 0.88, p < .01), respectively. Prenatal stress further demonstrated a positive, dose-response relationship with symptoms of externalizing disorders at independent time points. CONCLUSIONS The findings suggest that prenatal stressful events may be an independent risk factor for offspring externalizing symptoms, regardless of maternal mental health and offspring internalizing.
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Affiliation(s)
- Nathalie MacKinnon
- School of Epidemiology, Public Health, and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Mila Kingsbury
- School of Epidemiology, Public Health, and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Liam Mahedy
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Jonathan Evans
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Ian Colman
- School of Epidemiology, Public Health, and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada.
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47
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Kinser PA, Thacker LR, Lapato D, Wagner S, Roberson-Nay R, Jobe-Shields L, Amstadter A, York TP. Depressive Symptom Prevalence and Predictors in the First Half of Pregnancy. J Womens Health (Larchmt) 2017; 27:369-376. [PMID: 29240527 DOI: 10.1089/jwh.2017.6426] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Major depression during the peripartum (MDP) period carries significant public health impact due to the potential adverse effects on maternal, infant, and family outcomes. METHODS As part of a larger longitudinal study, this cross-sectional observational study sought to build upon the current literature on the prevalence and predictors of depression in the early second trimester of pregnancy, as related to generally accepted risk factors and other less explored risk factors. RESULTS The findings from this study suggest that in this sample of 230 black and white women at ∼14 weeks gestation, ∼19% endorsed depressive symptoms and that the most important predictors of depression in pregnancy were a preconception history of a mental health issue (e.g., lifetime depressive episode) and perceived stress. Other relevant predictors were pregnancy-related anxiety, income, and stressful life events. CONCLUSION/CLINICAL RELEVANCE It is important for clinicians not only to screen for MDP during prenatal visits by asking about current depressive, stress, and anxiety symptoms but also to identify patients at risk for MDP by asking simple questions about history of preconception/lifetime episodes of depression and stressful life events. Given the variance accounted for by lifetime depression, additional research into how clinicians may approach this important topic is warranted. For example, checklists given in the waiting room may be less likely to elicit endorsement compared with conversations aimed to normalize the range of depressive histories that may have relevance to obstetric health.
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Affiliation(s)
- Patricia Anne Kinser
- 1 Department of Family and Community Health Nursing, Virginia Commonwealth University School of Nursing , Richmond, Virginia
| | - Leroy R Thacker
- 1 Department of Family and Community Health Nursing, Virginia Commonwealth University School of Nursing , Richmond, Virginia.,2 Department of Biostatistics, Virginia Commonwealth University , Richmond Virginia
| | - Dana Lapato
- 3 Department of Human and Molecular Genetics, Virginia Commonwealth University , Richmond Virginia
| | - Sara Wagner
- 1 Department of Family and Community Health Nursing, Virginia Commonwealth University School of Nursing , Richmond, Virginia
| | - Roxann Roberson-Nay
- 4 Department of Psychiatry and Psychology, Virginia Commonwealth University , Richmond Virginia
| | - Lisa Jobe-Shields
- 5 Department of Psychology, University of Richmond , Richmond, Virginia
| | - Ananda Amstadter
- 4 Department of Psychiatry and Psychology, Virginia Commonwealth University , Richmond Virginia
| | - Timothy P York
- 3 Department of Human and Molecular Genetics, Virginia Commonwealth University , Richmond Virginia
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Maternal Psychological Distress and Offspring Psychological Adjustment in Emerging Adulthood: Findings from Over 18 Years. J Dev Behav Pediatr 2017; 37:746-752. [PMID: 27801723 DOI: 10.1097/dbp.0000000000000365] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the long-term prediction of psychological maladaptive (i.e., symptoms of anxiety and depression) and adaptive adjustment (i.e., self-efficacy) in emerging adult offspring from trajectories of maternal psychological distress from toddlerhood to adolescence. METHOD Trajectories of maternal psychological distress (low, moderate, high, and low-rising patterns) from toddlerhood (age 1.5 years) to adolescence (age 14.5 years) were used to predict psychological adjustment in emerging adult offspring (age 18-20 years) (n = 400). RESULTS Adverse maternal distress trajectories during childhood were linked to maladaptive and adaptive adjustment in adult offspring. Consistently high maternal distress levels experienced across childhood predicted higher symptoms of anxiety and depression and lower self-efficacy than low maternal distress trajectories. Two other adverse maternal distress trajectories (consistently moderate and low-rising patterns) compared with the low trajectory predicted higher offspring depressive symptoms. The findings persisted when adjusting for potential confounders: offspring gender and maternal education, relationship status, language, and economy. CONCLUSION The current study showed longitudinal multi-informant impact from adverse maternal distress trajectories to adult offspring maladjustment over 18 years, emphasizing the importance of early identification and prevention.
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49
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Aktar E, Bögels SM. Exposure to Parents' Negative Emotions as a Developmental Pathway to the Family Aggregation of Depression and Anxiety in the First Year of Life. Clin Child Fam Psychol Rev 2017; 20:369-390. [PMID: 28528457 PMCID: PMC5656709 DOI: 10.1007/s10567-017-0240-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Depression and anxiety load in families. In the present study, we focus on exposure to parental negative emotions in first postnatal year as a developmental pathway to early parent-to-child transmission of depression and anxiety. We provide an overview of the little research available on the links between infants' exposure to negative emotion and infants' emotional development in this developmentally sensitive period, and highlight priorities for future research. To address continuity between normative and maladaptive development, we discuss exposure to parental negative emotions in infants of parents with as well as without depression and/or anxiety diagnoses. We focus on infants' emotional expressions in everyday parent-infant interactions, and on infants' attention to negative facial expressions as early indices of emotional development. Available evidence suggests that infants' emotional expressions echo parents' expressions and reactions in everyday interactions. In turn, infants exposed more to negative emotions from the parent seem to attend less to negative emotions in others' facial expressions. The links between exposure to parental negative emotion and development hold similarly in infants of parents with and without depression and/or anxiety diagnoses. Given its potential links to infants' emotional development, and to later psychological outcomes in children of parents with depression and anxiety, we conclude that early exposure to parental negative emotions is an important developmental mechanism that awaits further research. Longitudinal designs that incorporate the study of early exposure to parents' negative emotion, socio-emotional development in infancy, and later psychological functioning while considering other genetic and biological vulnerabilities should be prioritized in future research.
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Affiliation(s)
- Evin Aktar
- Clinical Psychology Unit, Leiden University, Wassenaarseweg 52, 2333 AK, Leiden, The Netherlands.
- Research Institute of Child Development and Education, University of Amsterdam, Nieuwe Achtergracht 127, 1001 NG, Amsterdam, The Netherlands.
| | - Susan M Bögels
- Research Institute of Child Development and Education, University of Amsterdam, Nieuwe Achtergracht 127, 1001 NG, Amsterdam, The Netherlands
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50
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Baron E, Bass J, Murray SM, Schneider M, Lund C. A systematic review of growth curve mixture modelling literature investigating trajectories of perinatal depressive symptoms and associated risk factors. J Affect Disord 2017; 223:194-208. [PMID: 28763638 PMCID: PMC5592733 DOI: 10.1016/j.jad.2017.07.046] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 07/20/2017] [Accepted: 07/24/2017] [Indexed: 01/23/2023]
Abstract
BACKGROUND The aim of this study was to review the growth curve mixture modelling (GCMM) literature investigating trajectories of perinatal maternal depressive symptoms and associated risk factors. METHODS A systematic search of peer-reviewed articles published until November 2015 was conducted in seven databases. Articles using GCMM to identify trajectories of perinatal depressive symptoms were considered. Symptoms had to be assessed at least three times, anytime from pregnancy to two years postpartum (PROSPERO; 2016:CRD42016032600). RESULTS Eleven studies met inclusion criteria. All reported a low risk trajectory, characterised by stable low depressive symptoms throughout the perinatal period. A stable moderate-high or high symptom trajectory was reported in eight of 11 studies, suggesting a high-risk group with persistent depressive symptoms. Six studies also reported transient trajectories, with either increasing, decreasing or episodic depressive symptoms. None of the demographic, personality or clinical characteristics investigated systematically differentiated groups of women with different symptom trajectories, within or across studies. Thus, it is difficult to differentiate women at high or low risk of specific perinatal depression trajectories. LIMITATIONS A meta-analysis was not possible. The studies' settings and inclusion criteria limit the generalisability of the findings to low-risk, middle- to high-income women. CONCLUSIONS Relatively similar trajectories of perinatal depressive symptoms were identified across studies. Evidence on factors differentiating women assigned to different trajectories was inconsistent. Research with larger samples and in more diverse settings is needed to inform services and policies on how and when to effectively identify subgroups of women at high risk of perinatal depression.
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Affiliation(s)
- Emily Baron
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, South Africa.
| | - Judith Bass
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States
| | - Sarah M Murray
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States
| | - Marguerite Schneider
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, South Africa
| | - Crick Lund
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, South Africa; Center for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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