Characteristics of maternal depression and children's functioning: A meta-analytic review

The psychosocial experience of traumatic birth in couples: an interpretative phenomenological study

BACKGROUND

One-third of women report a psychologically traumatic event during birth; limited research exists on how couples experience and process self-reported traumatic birth.

AIMS AND OBJECTIVES

This study aimed to examine the lived experience and psychosocial impact of traumatic birth in couples.

METHODS

Interpretative Phenomenological Analysis was used to explore in-depth participants' lived experience during and after traumatic childbirth. Four couples were recruited, from women experiencing vaginal deliveries in the public hospital system in Australia during the past 5 years. Women and men were interviewed individually.

RESULTS

Three superordinate themes were identified: 'Compassionless care' (experiences of being dismissed, devalued and degraded by care providers), 'Violation and subjugation' (women's bodies and birthing experiences being violated) and 'Parenting after birth trauma' (challenges in caring for a newborn following trauma and recovery from trauma).

DISCUSSION

Couples described care providers' actions as a major contributing factor to trauma experiences. Couples contextualised care in terms of under-resourced wards and perceived women were treated as a means to an end. Women and men both described feeling fearful, distressed and devalued. Following birth trauma, individual cognitive factors, such as negative self-evaluations and avoidance of the trauma memory interacted with family system to shape trauma-related distress.

CONCLUSIONS

Future research would benefit from highlighting the systemic context in which compassionless care occurs, and the family system in which trauma is experienced and processed. Findings reinforce that psychosocial safety must be considered in addition to physical safety for both women and men in maternity care practices.

Parents' clinical depression and children's problem behaviors: A multi-level meta-analytic examination

BACKGROUND

Previous meta-analyses considering associations between parental depression (PD) and child symptoms have considered PD based primarily on self-report of depression symptoms. The present meta-analysis, in contrast, evaluated the effect of parents' clinically-diagnosed depressive disorders (PDD) on child internalizing and externalizing symptoms and considered both family- and study-level variables that influenced the strength of these effects.

METHODS

We examined 111 effect sizes nested in 40 studies including a clinical assessment of parents' major or persistent depressive disorder and measures of children's internalizing or externalizing behaviors published between 2000 and 2020. We used a multi-level meta-analytic framework to account for nesting of multiple effect sizes within studies.

RESULTS

PDD was associated with children's internalizing (weighted mean r = 0.211) and externalizing (weighted mean r = 0.204) behaviors. Family- and study-level variables moderated these relations, including the inclusion of fathers in the sample, the specific measure of internalizing behavior, reporting of diagnostic reliability, and informant for problem behaviors.

LIMITATIONS

Limitations include exclusive consideration of internalizing and externalizing symptoms (versus other symptom types or problems) and the limited number of father-only studies from which to base conclusions about the relative effect of maternal vs. paternal depression.

CONCLUSIONS

The similarity between the current findings and previous meta-analyses suggests that researchers studying the effects of PD may be able to bypass more exhaustive clinical interviews for less burdensome depression symptom inventories. Furthermore, our findings suggest that researchers and clinicians should consider how PD impacts not just child depressive symptoms, but myriad problem behaviors.

Summarising Quantitative Outcomes in Parental Mental Illness Research

A quarter of all children grow up in a family where a parent experiences a mental illness (FaPMI). Research activity in this area is growing rapidly and it is now critical to better understand the extant knowledge in the field. This scoping review of quantitative FaPMI literature parallels a qualitative literature review and a series of Delphi studies with key stakeholders (e.g. lived experience and clinicians), that is part of a larger program of research to achieve consensus regarding the direction of FaPMI research; including making recommendations about outcomes and measures. The programme of research aims to promote and facilitate greater comparison and learning across studies and settings. Initially this scoping review summarises the quality and focus (e.g. country and sampling) of 50 quantitative studies from 2000 to 2023 and then classifies studies according to outcomes for parents, children and families. Six to eleven years were the most common child sample group and girls were slightly underrepresented (49/51) and parents were 88% mothers. Analogous parent and child outcomes were; mental illness/psychopathology, wellbeing, mental health literacy, trauma and stressful experiences, coping, help seeking/service need, within family relationships and supports, outside family relationships and supports. Additional outcomes for parents were; parenting skills, parent competence and parenting stress and for children in relation to their; cognitive functioning and caregiving. The family related outcomes were the within and outside family relationships and supports. Since 2000 there have been 136 different survey instruments employed with approximately 80% used in only one study. This suggests that the broader goals of the program of research are warranted as there is a need for less heterogeneity in measures used. Suggested areas for future research include a sampling focus on fathers, economic evaluations of programs, parent mental health literacy, trauma, genetics and integrating well-being concepts into research designs. Child research should focus on mental health literacy, the level and impact of caring responsibilities, assessing past trauma and the roles of close family and external supports.

Maternal postnatal depressive symptoms and children's internalizing problems: The moderating role of mother-infant RSA synchrony

Maternal depressive symptoms are a crucial risk factor for children's internalizing problems, though positive mother-child relationships may buffer this risk transmission. Mother-child physiological coregulation (e.g., synchrony) has emerged as a potentially important mechanism of developmental psychopathology and may play a role in the transmission of internalizing symptoms. In this two-wave longitudinal study, we examined whether and how mother-infant physiological synchrony (of respiratory sinus arrhythmia; RSA) moderated the association between maternal postnatal depressive symptoms and children's internalizing problems in a rural, low-SES community sample (N = 166 dyads). At 6 months, mother-infant RSA synchrony and infant negative affect were assessed during free play. Mother reported their depressive symptoms at 6 months and children's internalizing problems at 24 months. Multilevel structural equation models indicated that mother-infant dyads demonstrated significant and positive RSA synchrony on average and RSA synchrony significantly moderated the association between maternal depressive symptoms and children's internalizing problems even after controlling for infant negative affect. Greater maternal depressive symptoms were associated with higher child internalizing problems when RSA synchrony was lower but not when it was higher. This finding suggests that mother-infant RSA synchrony may operate as a resilience factor for the intergenerational transmission of internalizing symptoms in community samples.

Prenatal depression outcomes in the next generation: A critical review of recent DOHaD studies and recommendations for future research

Prenatal depression, a common pregnancy-related risk with a prevalence of 10-20 %, may affect in utero development and socioemotional and neurodevelopmental outcomes in the next generation. Although there is a growing body of work that suggests prenatal depression has an independent and long-lasting effect on offspring outcomes, important questions remain, and findings often do not converge. The present review examines work carried out in the last decade, with an emphasis on studies focusing on mechanisms and leveraging innovative technologies and study designs to fill in gaps in research. Overall, the past decade of research continues to suggest that prenatal depression increases risk for offspring socioemotional problems and may alter early brain development by affecting maternal-fetal physiology during pregnancy. However, important limitations remain; lack of diversity in study samples, inconsistent consideration of potential confounders (e.g., genetics, postnatal depression, parenting), and restriction of examination to narrow time windows and single exposures. On the other hand, exciting work has begun uncovering potential mechanisms underlying transmission, including alterations in mitochondria functioning, epigenetics, and the prenatal microbiome. We review the evidence to date, identify limitations, and suggest strategies for the next decade of research to detect mechanisms as well as sources of plasticity and resilience to ensure this work translates into meaningful, actionable science that improves the lives of families.

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

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

Paternal and Maternal Depressive Symptoms and Sensitivity: Links with Trajectories of Socioemotional Problems in Toddlerhood

Parental depressive symptoms and sensitivity have well-documented consequences for children; however, studies considering both parents are still scarce. This longitudinal study aimed to investigate the respective roles of paternal and maternal depressive symptoms and sensitivity in predicting the development of child socioemotional problems during toddlerhood. We also investigated the buffering role of each parent's sensitivity in the associations between the other parent's depressive symptoms and toddlers' socioemotional problems. The sample consisted of 140 Canadian families who were visited in their homes when children were around 13 (T1), 19 (T2), and 27 (T3) months of age. At T1, both parents' sensitivity was assessed from observations of parent-child interactions at home and each parent reported on his or her own depressive symptoms. At T1, T2, and T3, maternal and paternal perceptions of their toddler's socioemotional problems were assessed and aggregated. Growth curve analyses revealed that paternal and maternal depressive symptoms as well as paternal sensitivity were unique and persistent predictors of child socioemotional problems and that sensitive fathering acted as a buffer in the context of maternal depressive symptoms. This study highlights the importance of considering both parents when studying risk and protective factors for young children's socioemotional problems.

Effect of Symptom Levels of Children's Food Allergy on Maternal Depression: A Cross-sectional and Cohort Study

BACKGROUND

Maternal depression may have negative impacts on children's behavior and mental health. Childhood food allergy is a common health issue, yet its relationship with maternal depression remains incompletely understood. This study aimed to analyze the association between children's food allergy symptoms and maternal depression through cross-sectional and cohort studies.

METHODS

This study selected a total of 580 children with food allergy and their mothers who met the inclusion criteria in Ganzhou Women and Children's Health Care Hospital from April 2015 to April 2022, evaluated the symptom levels of children's food allergy according to the guidelines, assessed the depressive symptoms of mothers using self-rating depression scale (SDS), and analyzed the relationship between the symptom severity of children's food allergy and the risk of maternal depression; at the same time, one-year follow-up of mothers without depression was carried out to measure the incidence of depression to further explore this relationship.

RESULTS

The 580 children with food allergies in the cross-sectional study consisted of 365 (62.93%) males and 215 (37.07%) females, aged (8.98 ± 2.30) years, with 298 (51.37%) experiencing Level-Ⅰ, and 282 (48.63%) experiencing Level-Ⅱ. A total of 56 (9.66%) mothers suffered from depression, aged (42.74 ± 5.42) years. Adjusting for confounders including mother's age, education level, marital status, family income, comorbidities, history of allergies, family history of food allergies, history of psychiatric disorders, current smoking status, current alcohol consumption, current regular exercise status, childhood food allergens and food allergy categorization, the mothers of children with child food allergy symptom Level-Ⅱ were found to have a higher risk of depression compared with mothers with child food allergy symptom Level-Ⅰ, odds ratio (OR) = 2.025 (95% confidence interval (CI): 1.319-3.128, p = 0.001). In the one-year cohort study, 38 (7.25%) mothers had new-onset depressive symptoms. Mothers of children with a child food allergy symptom Level-Ⅱ had an OR = 2.165 (95% CI: 1.612-2.902, p < 0.001) for depressive symptoms compared to mothers with a child food allergy symptom Level-Ⅰ.

CONCLUSION

Among children with food allergy symptom scores of Level-Ⅰ and Level-Ⅱ, higher levels were associated with a higher prevalence of depression in their mothers.

The Degree of Fluctuations in Maternal Depressive Symptoms in Early Childhood is Associated with Children's Depression Risk: Initial Evidence and Replication Between Two Independent Samples

Guided by life history theory, the present study examined whether the degree of fluctuations in maternal depressive symptoms in early childhood was prospectively linked to children's risk for depression. This was the first study to present preliminary evidence on this topic and replicated main findings across two large, independent longitudinal samples. Study 1 included 1,364 families where maternal depressive symptoms were longitudinally assessed at child ages 1, 6, 15, 24, and 36, and 54 months, where child depressed/anxious behaviors at Grade 1 were reported. Study 2 included 1,292 families where maternal depressive symptoms were assessed at child ages 2, 6, 15, and 24 months. At 36 months, child internalizing symptoms and inhibitory control were assessed. In Study 1, findings revealed that the degree of fluctuations in maternal depressive symptoms over 54 months was associated with higher child depressed/anxious behaviors at Grade 1, only when mothers had higher but decreasing depressive symptoms. Study 2 revealed that the degree of fluctuations in maternal depressive symptoms over 24 months was related to higher child internalizing symptoms at 36 months, for mothers whose depressive symptoms were higher but decreasing, higher and increasing, and lower and decreasing. In addition, the degree of fluctuations in maternal depressive symptoms over 24 months was related to lower child inhibitory control at 36 months, for mothers who had higher but decreasing depressive symptoms. Findings highlighted the degree of fluctuations in maternal depressive symptoms during early childhood can contribute to environmental unpredictability, which can increase children's depression risks.

Implementing and evaluating group interpersonal therapy for postnatal depression in Lebanon and Kenya-individually randomised superiority trial

BACKGROUND

Depression ranks as the foremost mental health concern among childbearing women. Within low- and middle-income countries (LMICs), between 20 and 25% of women encounter depression during pregnancy or soon after delivery. This condition impacts not only the mothers but also their offspring. Offspring of women suffering from postnatal depression (PND) exhibit suboptimal cognitive development and increased emotional and behavioural issues throughout their growth. This scenario becomes more pronounced in LMICs, where numerous adversities further jeopardise children's developmental progress. Despite antenatal services providing a pivotal platform to address women's mental health needs, PND treatment remains inaccessible in many LMICs. The World Health Organization advocates interpersonal psychotherapy (IPT) for treating depression. While research from high-income countries has established the efficacy of IPT and group-IPT (g-IPT) for PND, its effectiveness within the LMIC context and its potential benefits for child development remain uncharted. This study seeks to gauge the potency of g-IPT for women with PND in two LMICs.

METHODS

This multi-site randomised controlled trial is a continuation of two preceding phases-conceptual mapping and a feasibility study executed in Lebanon and Kenya. Insights gleaned from these phases underpin this comprehensive RCT, which contrasts the efficacy and cost-effectiveness of high-quality standard care (HQ-SC) augmented with g-IPT against HQ-SC in isolation. The trial, characterised as an individually randomised superiority assessment, targets women with postnatal depression in Beirut, Lebanon, and Nairobi, Kenya. It aims to determine if culturally tailored g-IPT, administered within community settings in both countries, outperforms HQ-SC in influencing child developmental outcomes, maternal depression, and the quality of the mother-child bond.

DISCUSSION

The SUMMIT trial, designed with pragmatism, possesses the magnitude to evaluate g-IPT within two LMIC frameworks. It seeks to enlighten policymakers, service commissioners, professionals, and users about g-IPT's potential to alleviate maternal PND and bolster child developmental outcomes in LMICs. Additionally, the trial will generate valuable data on the clinical and economic merits of high-quality standard care.

TRIAL REGISTRATION

ISRCTN, ISRCTN15154316. Registered on 27 September 2023, https://doi.org/10.1186/ISRCTN15154316.

Association of maternal and paternal personality disorders with risk of mental disorders in children: A nationwide, register-based cohort study of 1,406,965 children

BACKGROUND

Knowledge of the association between parental personality disorders and mental disorders in children is limited. To examine the association between parental personality disorders and the risk of mental disorders in offspring.

METHODS

We linked Danish health registers to create a cohort of children born from January 1, 1995, to December 31, 2016. Children were followed until their 18th birthday, diagnosis set, emigration, death, or December 31, 2016. Parental personality disorders according to the International Classification of Diseases (ICD) Eighth or 10th Revision. Poisson regression analyses were used to estimate the incidence risk ratio (IRR) and cumulative incidence of ICD 10th mental disorders in offspring (age 0-17).

RESULTS

The study cohort included 1,406,965 children. For girls, maternal or paternal personality disorder (MPD/PPD) was associated with mental disorders: MPD girls (IRR, 2.74; 95% CI, 2.59-2.89) and PPD girls (IRR, 2.10; 95% CI, 1.94-2.27). Likewise, the risk was increased for both MPD boys (IRR, 2.44; 95% CI, 2.33-2.56) and PPD boys (IRR, 2.04; 95% CI, 1.91-2.18). For girls and boys combined, exposure to two parents with a personality disorder was associated with the highest risk (IRR, 3.69; 95% CI, 3.15-4.33). At age 18, the cumulative incidence of any mental disorder in children of one or two parents with a personality disorder was 34.1% (95% CI, 33.0-35.1), which was twice the cumulative incidence of mental disorders in nonexposed children (15.2% [95% CI, 15.1-15.3]).

CONCLUSION

Children of parents with a personality disorder were at a 2 to 3.5 times higher risk of mental disorders compared with nonexposed offspring. Possible mechanisms of transmission of mental disorders from parent to child involve genetic, environmental, and gene-environment pathways. More research into these mechanisms and research into preventive interventions is warranted.

Group Interpersonal Psychotherapy for minoritized Head Start mothers with depressive symptoms: A mixed method study

This study explores minoritized mothers' experiences in group interpersonal psychotherapy (IPT-G) and relates their experiences to treatment outcomes. Quantitative and qualitative data were gathered from 26 Latinx and Black mothers who participated in IPT-G. Mothers were divided into three groups: (1) not depressed at follow-up, (2) depressed at follow-up, and (3) those with subclinical symptoms throughout the intervention, and similarities and differences across groups were examined. Results showed that mothers not depressed at follow-up reported high levels of emotional safety in IPT-G, facilitating emotional processing. Mothers depressed at follow-up referenced the impact of stigma and had greater difficulty sharing their feelings and also reported lower socioeconomic status and higher levels of trauma. It appears that high levels of environmental stressors and difficulty developing trusting therapeutic relationships were related to experiencing depression at the conclusion of treatment. Alternatively, for many mothers, IPT-G provided within head start was an effective therapeutic option.

Implementation of the "Healthy Moms, Healthy Kids" Program in Head Start: An Application of the RE-AIM QuEST Framework Centering Equity

BACKGROUND

Marginalized mothers are disproportionately impacted by depression and face barriers in accessing mental health treatment. Recent efforts have focused on building capacity to address maternal depression in Head Start; however, it is unclear if mental health inequities can be addressed by two-generation programs in Head Start settings. Therefore, this study examined the implementation outcomes and processes of a two-generation program called "Healthy Moms, Healthy Kids" (HMHK) that provided an evidence-based depression treatment to ethnic minority Head Start mothers.

METHOD

Quantitative and qualitative data were collected and merged in a convergent mixed method design in accordance with the RE-AIM Qualitative Evaluation for Systematic Translation (RE-AIM QuEST) framework. Qualitative data included interviews with 52 key stakeholders, including intervention participants and staff members, and 176 sets of meeting minutes from the implementation period. Quantitative data included intervention study data and administrative data.

RESULTS

It was difficult for HMHK to reach the target population, with only 16.8% of eligible mothers choosing to participate. However, mothers who participated experienced reductions in depressive symptoms and parenting stress and shared a variety of positive impacts in interviews. The program was also more successful in enrolling Latinx mothers who were Spanish-speaking or bilingual rather than English-speaking and Black/African American mothers, limiting its reach.

CONCLUSION

Providing IPT therapy groups was effective in reducing maternal depressive symptoms and stress for those who enrolled, but additional work should focus on reducing barriers to participation, considering other delivery models to meet participants' needs, and identifying culturally relevant ways to meet the needs of Black mothers.

Exploring Heterogeneity in perinatal depression: a comprehensive review

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

Neural activation to peer acceptance and rejection in relation to concurrent and prospective depression risk in adolescent and pre-adolescent girls

Neurobiological sensitivity to peer interactions is a proposed marker of risk for adolescent depression. We investigated neural response to peer rejection and acceptance in relation to concurrent and prospective depression risk in adolescent and pre-adolescent girls. Participants were 76 girls (Mage=13, 45% racial/ethnic minorities) varying in depression risk: 22 with current major depressive disorder (MDD), 30 at High Risk for MDD based on parental history, and 24 at Low Risk with no psychiatric history. Girls participated in the Chatroom-Interact task-involving rejection and acceptance feedback from fictitious peers-while undergoing functional magnetic resonance neuroimaging. Activation in response to peer rejection and acceptance was extracted from regions of interest. Depressive symptoms were assessed at 6- and 12-month follow-up. Girls with MDD showed blunted left subgenual anterior cingulate response to acceptance versus girls in High and Low Risk groups. Girls in the High Risk group showed greater right temporo-parietal junction (rTPJ) and right anterior insula (AI) activation to both acceptance and rejection versus girls in the MDD (rTPJ) and Low Risk (rTPJ, AI) groups. Greater rTPJ response to rejection was associated with fewer depressive symptoms at 12-months and mediated the association between High Risk group status and 12-month depressive symptoms; greater rTPJ response to acceptance mediated the association between High Risk and increased 12-month depressive symptoms. Our finding of associations between altered neural response to peer interactions and concurrent and prospective depression risk/resilience highlights the importance of neural underpinnings of social cognition as risk and compensatory adaptations along the pathway to depression.