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Premji S, McNeil DA, Santana MJ, Spackman E. Examining the Relationship Between Screening for Postpartum Depression and Associated Child Health Service Utilization and Costs: A Study Using the All Our Families Cohort and Administrative Data. Matern Child Health J 2024; 28:567-577. [PMID: 37938441 PMCID: PMC10914927 DOI: 10.1007/s10995-023-03831-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2023] [Indexed: 11/09/2023]
Abstract
INTRODUCTION Despite a recognized association between maternal postpartum depression (PPD) and adverse child health outcomes, evidence examining the relationship between PPD symptoms and associated child health service utilization and costs remains unclear. In addition, there is a paucity of evidence describing the relationship between early identification of maternal PPD and associated health service utilization and costs for children. This study aims to address this gap by describing the secondary associations of screening for maternal PPD and annual health service utilization and costs for children over their first five years of life. METHODS Mothers and children enrolled in the prospective All Our Families cohort were linked to provincial administrative data in Alberta, Canada. Multivariable generalized linear models were used to estimate the average annual inpatient, outpatient, physician, and total health service utilization and costs from a public health system perspective for children of mothers screened high risk for PPD, low/moderate risk for PPD, or unscreened. RESULTS Total mean costs were greatest for children during their first year of life than other years. Those whose mothers were not screened had significantly lower costs compared to those whose mothers were screened low/moderate risk, despite equivalent health service utilization. DISCUSSION Findings from this study describe the secondary associations of screening for maternal PPD using a public health system perspective. More research is required to fully understand variations in health costs for children across maternal PPD screening categories.
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Affiliation(s)
- Shainur Premji
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
- Centre for Health Economics, University of York, York, UK.
| | - Deborah Ann McNeil
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Alberta Health Services, Calgary, AB, Canada
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
| | - Maria Jose Santana
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Eldon Spackman
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Reid HE, Edge D, Pratt D, Wittkowski A. Working with suicidal mothers during the perinatal period: a reflexive thematic analysis study with mental health professionals. BMC Psychiatry 2024; 24:106. [PMID: 38326817 PMCID: PMC10848420 DOI: 10.1186/s12888-024-05537-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 01/18/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Suicide is the leading cause of death in mothers postpartum and one of the most common causes of death during pregnancy. Mental health professionals who work in perinatal services can offer insights into the factors they perceive as being linked to mothers' suicidal ideation and behaviour, support offered to mothers and improvements to current practices. We aimed to explore the experiences and perceptions of perinatal mental health professionals who have worked with suicidal mothers during the perinatal period. METHOD Semi-structured interviews were conducted face-to-face or via telephone with mental health professionals working in perinatal mental health inpatient or community services across England. Data were analysed using reflexive thematic analysis. RESULTS From the professionals' (n = 15) accounts three main themes were developed from their interview data. The first, factors linked to suicidal ideation and behaviour, overarched two sub-themes: (1.1) the mother's context and (1.2) what the baby represents and what this means for the mother. These sub-themes described factors that professionals assessed or deemed contributory in relation to suicidal ideation and behaviour when a mother was under their care. The second main theme, communicating about and identifying suicidal ideation and behaviour, which outlined how professionals enquired about, and perceived, different suicidal experiences, encapsulated two sub-themes: (2.1) how to talk about suicide and (2.2) types of suicidal ideation and attempts. The third main theme, reducing suicidal ideation through changing how a mother views her baby and herself, focused on how professionals supported mothers to reframe the ways in which they viewed their babies and in turn themselves to reduce suicidal ideation. CONCLUSION Professionals highlighted many factors that should be considered when responding to a mother's risk of suicide during the perinatal period, such as the support around her, whether the pregnancy was planned and what the baby represented for the mother. Professionals' narratives stressed the importance of adopting a tailored approach to discussing suicidal experiences with mothers to encourage disclosure. Our findings also identified psychological factors that professionals perceived as being linked to suicidal outcomes for mothers, such as self-efficacy; these factors should be investigated further.
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Affiliation(s)
- Holly E Reid
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Zochonis Building, Brunswick Street, M13 9PL, Manchester, UK
- Manchester Academic Health Sciences Centre, Manchester, UK
| | - Dawn Edge
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Zochonis Building, Brunswick Street, M13 9PL, Manchester, UK
- Manchester Academic Health Sciences Centre, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Daniel Pratt
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Zochonis Building, Brunswick Street, M13 9PL, Manchester, UK
- Manchester Academic Health Sciences Centre, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Anja Wittkowski
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Zochonis Building, Brunswick Street, M13 9PL, Manchester, UK.
- Manchester Academic Health Sciences Centre, Manchester, UK.
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK.
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Barrett S, Muir C, Burns S, Adjei N, Forman J, Hackett S, Hirve R, Kaner E, Lynch R, Taylor-Robinson D, Wolfe I, McGovern R. Interventions to Reduce Parental Substance Use, Domestic Violence and Mental Health Problems, and Their Impacts Upon Children's Well-Being: A Systematic Review of Reviews and Evidence Mapping. TRAUMA, VIOLENCE & ABUSE 2024; 25:393-412. [PMID: 36789663 PMCID: PMC10666514 DOI: 10.1177/15248380231153867] [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: 06/18/2023]
Abstract
INTRODUCTION Children exposed to parental intimate partner violence and abuse, mental illness, and substance use experience a range of problems which may persist into adulthood. These risks often co-occur and interact with structural factors such as poverty. Despite increasing evidence, it remains unclear how best to improve outcomes for children and families experiencing these adversities and address the complex issues they face. AIMS AND METHODS Systematic review of systematic reviews. We searched international literature databases for systematic reviews, from inception to 2021, to provide an evidence overview of the range and effectiveness of interventions to support children and families where these parental risk factors had been identified. RESULTS Sixty-two systematic reviews were included. The majority (n = 59) focused on interventions designed to address single risk factors. Reviews mostly focused on parental mental health (n = 38) and included psychological interventions or parenting-training for mothers. Only two reviews assessed interventions to address all three risk factors in combination and assessed structural interventions. Evidence indicates that families affected by parental mental health problems may be best served by integrated interventions combining therapeutic interventions for parents with parent skills training. Upstream interventions such as income supplementation and welfare reform were demonstrated to reduce the impacts of family adversity. CONCLUSION Most intervention approaches focus on mitigating individual psychological harms and seek to address risk factors in isolation, which presents potentially significant gaps in intervention evidence. These interventions may not address the cumulative impacts of co-occurring risks, or social factors that may compound adversities.
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Smith CG, Jones EJH, Wass SV, Jacobs D, Fitzpatrick C, Charman T. The effect of perinatal interventions on parent anxiety, infant socio‐emotional development and parent‐infant relationship outcomes: A systematic review. JCPP ADVANCES 2022. [DOI: 10.1002/jcv2.12116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Celia G. Smith
- Institute of Psychiatry, Psychology & Neuroscience King's College London London UK
| | | | | | | | | | - Tony Charman
- Institute of Psychiatry, Psychology & Neuroscience King's College London London UK
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Maternal mental health and caregiver competence of HIV-positive and negative women caring for their singleton newborns in KwaZulu-Natal Province, South Africa. S Afr Med J 2022. [DOI: 10.7196/samj.2022.v112i7.15833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background. Maternal mental health during the perinatal period has been of interest to many researchers, with antenatal depression and postnatal depression (PND) being a leading cause of morbidity. The adverse effects of maternal depression on the offspring throughout infancy, childhood and adolescence are well documented. Studies on the mental health of persons living with HIV have also reported a high prevalence of depression.
Objectives. To describe the prevalence of PND in a sample of HIV-positive and HIV-negative mothers delivering healthy singleton infants at one obstetric unit in KwaZulu-Natal (KZN) Province, South Africa, and the subsequent factors influencing neonatal behaviour and perceptions of caregiver competence. Correlations between the presence of PND and perceptions of caregiver competence (with the mother as caregiver), and between infant behaviour, the mother’s confidence in her competence as caregiver, and demographic and medical variables, were also examined.
Methods. Demographic and clinical data were collected from 132 mothers at initial contact and from 32 mothers at the 6-week follow-up appointment. Mothers independently completed the Edinburgh Postnatal Depression Scale at each time point, and the Mother and Baby Scales (MABS) at the 6-week follow-up appointment.Results. The prevalence of depression among all mothers at initial contact was 72.0%, remaining high (68.8%) among the mothers who returned for follow-up. There was a statistically significant correlation between depression and employment at follow-up (p=0.013), and between depression and delivery method (p=0.030). The majority of mothers reported being ‘able to laugh and see the funny side of things’ and ‘looking forward with enjoyment to things’ at initial contact and follow-up. Thoughts of self-harm were reported by 44.7% of mothers at baseline, and by 53.1% at follow-up. Although most infants scored in the average clinical band for neonatal behavioural factors in the MABS, mothers reported lack of confidence, globally and in caring for their infant.
Conclusion. This study of maternal mental health of a sample of HIV-positive and HIV-negative mothers of infants in KZN revealed a higher prevalence of PND than reported in other studies. This population of mothers and infants is at risk of adverse outcomes of maternal depression, in addition to other possible risk factors.
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Do Improvements in Maternal Mental Health Predict Improvements in Parenting? Mechanisms of the Mindful with Your Baby Training. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137571. [PMID: 35805226 PMCID: PMC9265470 DOI: 10.3390/ijerph19137571] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/16/2022] [Accepted: 06/18/2022] [Indexed: 02/01/2023]
Abstract
Postpartum mental health symptoms are associated with parenting difficulties, which have negative consequences for child development. Interventions for young mothers should target their mental health problems and parenting difficulties. Mindful with Your Baby (MwyB) is an intervention for parents, with a baby, who experience (mental) health problems and/or stress or insecurity in parenting. This study seeks to replicate previous effects of MwyB regarding mindfulness, mindful parenting, maternal (mental) health (psychological distress, depressive mood, physical health complaints) and parenting outcomes (parenting stress, parental self-efficacy, bonding), and gain insight into the working mechanisms of the training. Mothers with babies aged 1–18 months (n = 61) completed questionnaires at waitlist, pretest, posttest, and 8-week follow-up. No significant differences were seen between the waitlist and pretest. Significant improvements in all outcomes were shown in the posttest (except for physical health complaints) and follow-up, compared to the pretest. Improvements in depressive symptoms and physical health complaints were dependent on improvements in mindfulness. Improvements in parental self-efficacy were dependent on improvements in mindful parenting. Improvements in some (mental) health and parenting outcomes seemed to be bidirectional. The results suggest that both mindfulness and mindful parenting are important for mothers who experience psychological distress and/or stress or insecurity in parenting their babies.
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Wittkowski A, Emsley R, Bee PE, Camacho E, Calam R, Abel KM, Duxbury P, Gomez P, Cartwright K, Reid HE. A Feasibility Randomized Controlled Trial of a Parenting Intervention Offered to Women With Severe Mental Health Problems and Delivered in a Mother and Baby Unit Setting: The IMAgINE Study Outcomes. Front Psychiatry 2022; 13:815018. [PMID: 35651824 PMCID: PMC9149174 DOI: 10.3389/fpsyt.2022.815018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 03/28/2022] [Indexed: 11/13/2022] Open
Abstract
Background Approximately 1-2% of mothers may experience severe mental illness (SMI) requiring admission to an inpatient Mother and Baby Unit (MBU). MBUs aim to provide mental health assessment and treatment and strengthen the mother-infant relationship, essential for infant development. Whilst MBUs offer various interventions, they do not routinely offer structured parenting interventions. The Baby Triple P Positive Parenting Program (BTP) was developed to enhance parenting competence, psychological coping and the quality of partner and other social support. Guided by lived experience consultation, we aimed to determine the feasibility and acceptability of delivering BTP plus Treatment as Usual (TAU) in this setting. Method A multi-site, parallel-group, single-blind pilot randomized controlled trial (registration: ISRCTN12765736) comparing BTP+TAU to TAU in participants, recruited from two MBUs in England. The Baby Triple P intervention consisted of eight parenting sessions, with the final four being delivered over the telephone following MBU discharge. Feasibility outcomes were participant intervention engagement and study retention. Clinical outcomes including maternal parenting competence, bonding and mental health outcomes were assessed at baseline, post-baseline/intervention (10 weeks) and six-month follow-up. Data were analyzed using descriptive statistics and linear regression models. An economic feasibility analysis was also conducted. Results Thirty-seven of the 67 eligible participants consented; 34 were randomized (16 to BTP+TAU and 18 to TAU), of whom 20 were retained at post-intervention data collection and 21 at six-month follow-up. Twelve participants (75%) completed the intervention, which was rated as highly acceptable. Clinical outcomes signaled potential improvements in maternal parenting competence, bonding, mood and mental health symptomatology in participants who received the intervention. Healthcare resource use and EQ-5D-5L questionnaires were well-completed by participants. Delivering BTP in this setting is estimated to cost £443-822 per participant. Conclusions This is the first trial of a parenting intervention in a MBU setting. BTP is feasible and acceptable to mothers with SMI, with a promising signal for treatment efficacy. Although minor modifications may be required for the collection of observer-rated measures post-MBU discharge, the findings indicate that a larger, definitive trial could be conducted, especially if the setting is extended to include perinatal mental health community settings.
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Affiliation(s)
- Anja Wittkowski
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- Department of Clinical Psychology, Laureate House, Wythenshawe Hospital, Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
- Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
| | - Richard Emsley
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Penny E. Bee
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Elizabeth Camacho
- Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, School of Health Sciences, The University of Manchester, Manchester, United Kingdom
| | - Rachel Calam
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Kathryn M. Abel
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
| | - Paula Duxbury
- Department of Research and Innovation, Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Paula Gomez
- Department of Clinical Psychology, Laureate House, Wythenshawe Hospital, Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Kim Cartwright
- Department of Research and Innovation, Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Holly E. Reid
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
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Stolper H, van Doesum K, Steketee M. How to Support Parents of Infants and Young Children in Mental Health Care: A Narrative Review. Front Psychol 2021; 12:745800. [PMID: 34867627 PMCID: PMC8634941 DOI: 10.3389/fpsyg.2021.745800] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 10/15/2021] [Indexed: 01/30/2023] Open
Abstract
Objective: The aim of this narrative review is to gain insight into the appropriate intervention targets when parents of infants and young children suffer from psychopathology. Background: Psychopathology in parents is a risk factor for maladaptive parenting and is strongly related to negative cascade effects on parent-child interactions and relations in the short and long term. Children in their first years of life are especially at risk. However, in adult mental health care, this knowledge is rarely translated into practice, which is a missed opportunity for prevention. Methods: Electronic databases were searched for reviews and meta-analysis. In addition, sources were obtained via manual search, reference mining, expert opinion, and communications from conferences. In total, 56 papers, whereof 23 reviews and 12 meta-analyses were included. Results: Findings regarding targets of intervention were identified in different interacting domains, namely the parental, family, child, and environmental domains as well as the developing parent-child relationship. A "one size fits all" intervention is not appropriate. A flexible, tailored, resource-oriented intervention program, multi-faceted in addressing all modifiable risk factors and using different methods (individual, dyadic, group), seems to provide the best results. Conclusion: To address the risk factors in different domains, adult and child mental health care providers should work together in close collaboration to treat the whole family including mental disorders, relational, and contextual problems. A multi-agency approach that includes social services is needed.
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Affiliation(s)
- Hanna Stolper
- Department of Psychology Education and Child Studies, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Karin van Doesum
- Department of Clinical Psychology, Radboud University, Nijmegen, Netherlands
| | - Majone Steketee
- Department of Psychology Education and Child Studies, Erasmus University Rotterdam, Rotterdam, Netherlands
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Nicolaus C, Kress V, Kopp M, Garthus-Niegel S. The Impact of Parental Relationship Satisfaction on Infant Development: Results From the Population-Based Cohort Study DREAM. Front Psychol 2021; 12:667577. [PMID: 34421721 PMCID: PMC8378853 DOI: 10.3389/fpsyg.2021.667577] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 07/05/2021] [Indexed: 12/04/2022] Open
Abstract
Extensive literature has shown that interparental conflicts and violence have detrimental effects on children's adjustment in childhood and adolescence. It is not equally well-understood how parental relationship satisfaction impacts infant communicational and personal-social development during the first year of life. This longitudinal study examines (a) the impact of maternal and paternal relationship satisfaction on infant development, (b) whether this prospective association is mediated by parent-infant relationship, and (c) a potential moderating effect of infant gender. Data were derived from the population-based cohort study “Dresden Study on Parenting, Work, and Mental Health” (DREAM) including 1,012 mothers and 676 fathers. Relationship satisfaction and parent-infant relationship were assessed eight weeks postpartum, infant communicational and personal-social development were measured 14 months postpartum. Multiple linear regression, mediation, and moderation analyses were conducted for mothers and fathers separately. It was shown that paternal relationship satisfaction is a significant predictor of infant personal-social development. This prospective association was partially mediated by father-infant relationship. When postnatal depression was included in the analysis, however, father-infant relationship was not a significant mediator. The association in fathers is neither reduced nor increased as a function of infant gender. No similar effects were found in the mothers' sample. Parental relationship satisfaction did not significantly predict infant communicational development in either mothers or fathers. The study findings highlight the importance of paternal relationship satisfaction, father-infant relationship, and postnatal depression for infant personal-social development.
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Affiliation(s)
- Caroline Nicolaus
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Victoria Kress
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Marie Kopp
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Susan Garthus-Niegel
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany.,Department of Medicine, Faculty of Medicine, Medical School Hamburg, Hamburg, Germany.,Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway
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McMahon CA, Maxwell AM. Commentary on Guild et al. (2020): The Importance of Well-Designed Intervention Studies for Advancing Attachment Theory and its Clinical Applications. Res Child Adolesc Psychopathol 2021; 49:583-589. [PMID: 33294966 DOI: 10.1007/s10802-020-00702-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Guild and colleagues (this issue) report results of a long-term follow up after a randomized trial of the effectiveness of an attachment-theory-informed psychotherapeutic intervention for mothers with depression and their toddlers. Their paper shows the intervention can increase the likelihood of secure attachment in children of depressed mothers and that secure attachment explains more optimal social-emotional functioning in middle childhood in the treated group. This commentary discusses the contribution of the paper by Guild and colleagues and their broader body of work to our evolving understanding of developmental processes underpinning social-emotional competence in children of depressed parents, and to several ongoing controversies in the field: 1) the relevance of attachment-theory-informed interventions in the context of maternal depression; 2) the evidence gap regarding the efficacy and effectiveness of attachment-theory-informed interventions, particularly with respect to sustained benefits; 3) cost-benefits of early interventions; and 4) the need for theory driven research that explains how and under what circumstances attachment is related to later child outcomes.
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Affiliation(s)
- Catherine A McMahon
- Centre for Emotional Health, Department of Psychology, Macquarie University, North Ryde, NSW, 2109, Australia.
| | - Anne-Marie Maxwell
- Centre for Emotional Health, Department of Psychology, Macquarie University, North Ryde, NSW, 2109, Australia
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Guild DJ, Alto ME, Handley ED, Rogosch F, Cicchetti D, Toth SL. Attachment and Affect between Mothers with Depression and their Children: Longitudinal Outcomes of Child Parent Psychotherapy. Res Child Adolesc Psychopathol 2021; 49:563-577. [PMID: 33411233 PMCID: PMC8035282 DOI: 10.1007/s10802-020-00681-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The present investigation examined the longitudinal effects of Child-Parent Psychotherapy (CPP) for toddlers and their mothers with depression on: a) maternal affective expression, b) child affective expression, and c) mother-child cohesion. Mothers with depression (Mage = 31.7 years; 92.8% White, 3.5% Black, 2.1% Hispanic, 2.3% other) and their toddlers were randomized to receive CPP (DI; n = 66) or to a control group (DC; n = 64). Mothers without depression and their toddlers (NC; n = 68) were recruited as an additional comparison group. Dyads were assessed at baseline (T1; 20 months old), post-intervention (T2; 36 months old), and follow-up (T3; 9 years old). Data from a mother-child conflict task was coded as a measure of observed outcome variables. Change in post-intervention attachment security assessed via the Strange Situation was evaluated as a mediator between intervention condition and maternal and child affective expression and dyadic cohesion at T3. Change to secure attachment post-intervention significantly mediated the association between intervention condition and T3 maternal warmth and child anger/problem behavior. Toddlers of mothers with depression who received CPP showed higher rates of change to secure attachment compared to those in both the DC and NC groups. Dyads who changed to secure attachment at T2 displayed higher levels of maternal warmth at T3 and lower levels of child anger and problem behavior at T3. Implications for the use of CPP as a preventive intervention and the importance of attachment as a mediator of long-term outcomes are discussed.
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Affiliation(s)
- Danielle J Guild
- Mt. Hope Family Center, University of Rochester, 187 Edinburgh Street, Rochester, NY, 14608, USA
- Discovery Counseling and Assessment Center, 4006 East Highway, Sharpsburg, GA, 30277, USA
| | - Michelle E Alto
- Mt. Hope Family Center, University of Rochester, 187 Edinburgh Street, Rochester, NY, 14608, USA
| | - Elizabeth D Handley
- Mt. Hope Family Center, University of Rochester, 187 Edinburgh Street, Rochester, NY, 14608, USA
| | - Fred Rogosch
- Mt. Hope Family Center, University of Rochester, 187 Edinburgh Street, Rochester, NY, 14608, USA
| | - Dante Cicchetti
- Mt. Hope Family Center, University of Rochester, 187 Edinburgh Street, Rochester, NY, 14608, USA
- Institute of Child Development, University of Minnesota, Minneapolis, MN, USA
| | - Sheree L Toth
- Mt. Hope Family Center, University of Rochester, 187 Edinburgh Street, Rochester, NY, 14608, USA.
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Chow R, Huang E, Li A, Li S, Fu SY, Son JS, Foster WG. Appraisal of systematic reviews on interventions for postpartum depression: systematic review. BMC Pregnancy Childbirth 2021; 21:18. [PMID: 33407226 PMCID: PMC7789727 DOI: 10.1186/s12884-020-03496-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 12/11/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Postpartum depression (PPD) is a highly prevalent mental health problem that affects parental health with implications for child health in infancy, childhood, adolescence and beyond. The primary aim of this study was to critically appraise available systematic reviews describing interventions for PPD. The secondary aim was to evaluate the methodological quality of the included systematic reviews and their conclusions. METHODS An electronic database search of MEDLINE, Embase, and the Cochrane Library from 2000 to 2020 was conducted to identify systematic reviews that examined an intervention for PPD. A Measurement Tool to Assess Systematic Reviews was utilized to independently score each included systematic review which was then critically appraised to better define the most effective therapeutic options for PPD. RESULTS Of the 842 studies identified, 83 met the a priori criteria for inclusion. Based on the systematic reviews with the highest methodological quality, we found that use of antidepressants and telemedicine were the most effective treatments for PPD. Symptoms of PPD were also improved by traditional herbal medicine and aromatherapy. Current evidence for physical exercise and cognitive behavioural therapy in treating PPD remains equivocal. A significant, but weak relationship between AMSTAR score and journal impact factor was observed (p = 0.03, r = 0.24; 95% CI, 0.02 to 0.43) whilst no relationship was found between the number of total citations (p = 0.27, r = 0.12; 95% CI, - 0.09 to 0.34), or source of funding (p = 0.19). CONCLUSION Overall the systematic reviews on interventions for PPD are of low-moderate quality and are not improving over time. Antidepressants and telemedicine were the most effective therapeutic interventions for PPD treatment.
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Affiliation(s)
- Ryan Chow
- Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1N 6N5, Canada
- Department of Obstetrics and Gynecology, HSC-3N52D, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4K1, Canada
| | - Eileen Huang
- Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1N 6N5, Canada
| | - Allen Li
- Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1N 6N5, Canada
| | - Sophie Li
- Faculty of Health Sciences, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4K1, Canada
| | - Sarah Y Fu
- Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1N 6N5, Canada
| | - Jin S Son
- Faculty of Health Sciences, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4K1, Canada
| | - Warren G Foster
- Department of Obstetrics and Gynecology, HSC-3N52D, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4K1, Canada.
- Faculty of Health Sciences, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4K1, Canada.
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Fricke J, Bolster M, Ludwig-Körner C, Kuchinke L, Schlensog-Schuster F, Vienhues P, Reinhold T, Berghöfer A, Roll S, Keil T. Occurrence and determinants of parental psychosocial stress and mental health disorders in parents and their children in early childhood: rationale, objectives, and design of the population-based SKKIPPI cohort study. Soc Psychiatry Psychiatr Epidemiol 2021; 56:1103-1112. [PMID: 33337512 PMCID: PMC8192328 DOI: 10.1007/s00127-020-02004-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 11/25/2020] [Indexed: 01/09/2023]
Abstract
PURPOSE The postnatal period is a vulnerable time for parents and children but epidemiological and health care utilisation data for Germany on parental mental health during early childhood is scarce. This protocol describes the rationale, aim and study design of a population-based cohort study to assess the occurrence and determinants of psychosocial stress and mental health disorders, as well as the use and cost of health care and social services in early childhood. METHODS As part of the collaborative SKKIPPI project, we will contact a random sample of 30,000 infants listed in the residents' registration offices of three German towns and we expect to include 6,000 mother-child pairs. Both parents are invited to fill out an online screening questionnaire. Mothers with indications of psychosocial stress will be interviewed to assess mental health disorders, regulatory problems of their children, as well as health care and social services utilisation, with a follow-up assessment after 6 months. RESULTS After description of sociodemographic and health data, we will analyse occurrences, patterns, and potential determinants (maternal age, social status, household factors, migration status etc.) of psychosocial stress and mental health disorders in the mothers and their children in early childhood. CONCLUSIONS Our study will identify potential risk and protective factors for postnatal mental health and health care utilization of psychosocially burdened families. This will help to improve prevention and treatment strategies to strengthen the parent-child relationship, to reduce persisting vulnerability of children, and to improve health care and social services. TRIAL REGISTRATION The study has been registered in the German Clinical Trial Registry on February 8th 2019 (DRKS-ID: DRKS00016653).
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Affiliation(s)
- J. Fricke
- grid.6363.00000 0001 2218 4662Institute for Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Luisenstr. 57, 10117 Berlin, Germany
| | - M. Bolster
- grid.6363.00000 0001 2218 4662Institute for Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Luisenstr. 57, 10117 Berlin, Germany
| | - C. Ludwig-Körner
- grid.461709.d0000 0004 0431 1180International Psychoanalytic University, Berlin, Germany
| | - L. Kuchinke
- grid.461709.d0000 0004 0431 1180International Psychoanalytic University, Berlin, Germany
| | - F. Schlensog-Schuster
- grid.9647.c0000 0004 7669 9786Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University of Leipzig, Leipzig, Germany
| | - P. Vienhues
- Department of Psychiatry, Psychosomatics and Psychotherapy, Diakonissenkrankenhaus Flensburg, Flensburg, Germany
| | - T. Reinhold
- grid.6363.00000 0001 2218 4662Institute for Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Luisenstr. 57, 10117 Berlin, Germany
| | - A. Berghöfer
- grid.6363.00000 0001 2218 4662Institute for Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Luisenstr. 57, 10117 Berlin, Germany
| | - S. Roll
- grid.6363.00000 0001 2218 4662Institute for Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Luisenstr. 57, 10117 Berlin, Germany
| | - T. Keil
- grid.6363.00000 0001 2218 4662Institute for Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Luisenstr. 57, 10117 Berlin, Germany ,grid.8379.50000 0001 1958 8658Institute of Clinical Epidemiology and Biometry, University of Wuerzburg, Wuerzburg, Germany ,State Institute of Health, Bavarian Health and Food Safety Authority, Bad Kissingen, Germany
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14
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Lenze SN, Potts MA, Rodgers J, Luby J. Lessons learned from a pilot randomized controlled trial of dyadic interpersonal psychotherapy for perinatal depression in a low-income population. J Affect Disord 2020; 271:286-292. [PMID: 32479328 PMCID: PMC7365269 DOI: 10.1016/j.jad.2020.03.084] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 01/22/2020] [Accepted: 03/24/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Perinatal depression is a public health burden impacting mothers and their offspring. This study extended brief-Interpersonal Psychotherapy delivered during pregnancy by incorporating a postpartum attachment based dyadic-component to maintain mother's treatment gains and enhance the mother-infant relationship (called IPT-Dyad). The current report presents data from a pilot randomized controlled trial comparing IPT-Dyad to Enhanced Treatment as Usual (ETAU). METHODS Women, ages 18 and older, between 12-30 weeks gestation meeting criteria for a depressive disorder were eligible. Participants were randomized to either IPT-Dyad (n = 21) or ETAU (n = 21). Maternal and infant outcomes were assessed through one-year postpartum. RESULTS Participants were primarily African American (77%), single (80%), with low-incomes. Attrition was high in both groups (IPT-Dyad 30%; ETAU 40%). Depression scores improved from baseline in both groups and remained improved over the 12 month follow-up. There were no between group differences on measures of parenting stress, mother-infant interactions, and infant socioemotional functioning. LIMITATIONS The small sample size of this study was further reduced by attrition, despite efforts to maintain engagement. Reliance on self-report outcome measures is also a limitation. CONCLUSIONS IPT-Dyad may be a promising intervention for perinatal depression with potential benefit for mothers and babies. Treatment engagement and management of psychosocial needs were persistent challenges throughout the postpartum period. Further refinement of intervention content and schedule to better meet the needs and values of under-resourced mothers is needed. Earlier screening; better integration of care within OB settings; and delivering care in conjunction with social service resources may also improve outcomes.
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Affiliation(s)
- Shannon N Lenze
- Department of Psychiatry, Washington University School of Medicine, Campus Box 8504, 660 S Euclid, St. Louis, MO 63110, USA.
| | - Mary Anne Potts
- Department of Psychiatry, Washington University School of Medicine, Campus Box 8504, 660 S Euclid, St. Louis, MO 63110, USA
| | - Jennifer Rodgers
- Department of Psychiatry, Washington University School of Medicine, Campus Box 8504, 660 S Euclid, St. Louis, MO 63110, USA
| | - Joan Luby
- Department of Psychiatry, Washington University School of Medicine, Campus Box 8504, 660 S Euclid, St. Louis, MO 63110, USA
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15
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Nath S, Pearson RM, Moran P, Pawlby S, Molyneaux E, Howard LM. Maternal personality traits, antenatal depressive symptoms and the postpartum mother-infant relationship: a prospective observational study. Soc Psychiatry Psychiatr Epidemiol 2020; 55:621-634. [PMID: 31642966 DOI: 10.1007/s00127-019-01790-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 10/09/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE Maternal depression has been associated with bonding difficulties and lower maternal sensitivity in observed mother-infant interactions. However, little research has examined the impact of disordered personality traits in mothers on these outcomes. We investigated the association between disordered personality traits in mothers measured during pregnancy and postnatal (a) self-reported bonding with infant; (b) observational mother-infant interactions. METHODS Five hundred fifty-six women were recruited during early pregnancy and subsequently followed up at mid-pregnancy (approximately 28 weeks' gestation) and when infants were aged approximately 3 months (n = 459). During early pregnancy, data were collected on disordered personality traits (using the Standardised Assessment of Personality Abbreviated Scale) and depressive symptoms (using the Edinburgh Postnatal Depression Scale). At 3 months postpartum, self-reported perceived bonding (using the Postpartum Bonding Questionnaire) were collected. A sub-sample of women additionally provided observational mother-infant interaction data (n = 206) (coded using the Child-Adult Relationship Experimental Index). RESULTS Higher disordered personality traits was not associated with maternal perceptions of bonding impairment, but was associated with reduced maternal sensitivity during observational mother-infant interactions [adjusted for age, education, having older children, substance misuse prior to pregnancy, infant sex and gestational age: coefficient = - 0.28, 95% CI = - 0.56 to - 0.00, p < 0.05]. After adjusting for depressive symptoms, the association was attenuated [coefficient = - 0.19, 95% CI = - 0.48 to 0.11, p = 0.217]. CONCLUSIONS Mothers with disordered personality traits did not perceive themselves as having bonding impairments with their infants but were less sensitive during observed interactions, though depressive symptoms attenuated this relationship. Both depression and disordered personality traits need to be addressed to optimize mother-infant interactions.
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Affiliation(s)
- Selina Nath
- Section of Women's Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK.
| | - Rebecca M Pearson
- Centre for Academic Mental Health, Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2BN, UK
| | - Paul Moran
- Centre for Academic Mental Health, Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2BN, UK
| | - Susan Pawlby
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Emma Molyneaux
- Section of Women's Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Louise M Howard
- Section of Women's Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
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Batt MM, Duffy KA, Novick AM, Metcalf CA, Epperson CN. Is Postpartum Depression Different From Depression Occurring Outside of the Perinatal Period? A Review of the Evidence. FOCUS: JOURNAL OF LIFE LONG LEARNING IN PSYCHIATRY 2020; 18:106-119. [PMID: 33162848 DOI: 10.1176/appi.focus.20190045] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Whether a major depressive episode occurring in the postpartum period (i.e., postpartum depression [PPD]) is sufficiently distinct from major depressive episodes occurring at other times (i.e., major depressive disorder) to warrant a separate diagnosis is a point of debate with substantial clinical significance. The evidence for and against diagnostic distinction for PPD is reviewed with respect to epidemiology, etiology, and treatment. Overall, evidence that PPD is distinct from major depressive disorder is mixed and is largely affected by how the postpartum period is defined. For depression occurring in the early postpartum period (variably defined, but typically with onset in the first 8 weeks), symptom severity, heritability, and epigenetic data suggest that PPD may be distinct, whereas depression occurring in the later postpartum period may be more similar to major depressive disorder occurring outside of the perinatal period. The clinical significance of this debate is considerable given that PPD, the most common complication of childbirth, is associated with immediate and enduring adverse effects on maternal and offspring morbidity and mortality. Future research investigating the distinctiveness of PPD from major depressive disorder in general should focus on the early postpartum period when the rapid decline in hormones contributes to a withdrawal state, requiring profound adjustments in central nervous system function.
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Affiliation(s)
- Melissa M Batt
- Department of Psychiatry (all authors) and Helen and Arthur E. Johnson Depression Center (Batt), University of Colorado School of Medicine, Anschutz Medical Campus, Aurora
| | - Korrina A Duffy
- Department of Psychiatry (all authors) and Helen and Arthur E. Johnson Depression Center (Batt), University of Colorado School of Medicine, Anschutz Medical Campus, Aurora
| | - Andrew M Novick
- Department of Psychiatry (all authors) and Helen and Arthur E. Johnson Depression Center (Batt), University of Colorado School of Medicine, Anschutz Medical Campus, Aurora
| | - Christina A Metcalf
- Department of Psychiatry (all authors) and Helen and Arthur E. Johnson Depression Center (Batt), University of Colorado School of Medicine, Anschutz Medical Campus, Aurora
| | - C Neill Epperson
- Department of Psychiatry (all authors) and Helen and Arthur E. Johnson Depression Center (Batt), University of Colorado School of Medicine, Anschutz Medical Campus, Aurora
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Rayce SB, Rasmussen IS, Væver MS, Pontoppidan M. Effects of parenting interventions for mothers with depressive symptoms and an infant: systematic review and meta-analysis. BJPsych Open 2020; 6:e9. [PMID: 31928569 PMCID: PMC7001473 DOI: 10.1192/bjo.2019.89] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 10/11/2019] [Accepted: 11/10/2019] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Postpartum depression is common in the perinatal period and poses a risk for the development of the infant and the mother-infant relationship. Infancy is a critical developmental period of life and supportive parenting is crucial for healthy development, however, the effects of interventions aimed at improving parenting among mothers with depression are uncertain. AIMS To assess the effects of parenting interventions on parent-child relationship and child development among mothers with depressive symptoms with 0-12-month-old infants. METHOD We conducted a systematic review with the inclusion criteria: (a) randomised controlled trials of structured psychosocial parenting interventions for women with depressive symptoms and a child aged 0-12 months in Western Organisation for Economic Co-operation and Development countries, (b) minimum three sessions with at least half of these delivered postnatally and (c) outcomes relating to the parent-child-relationship and/or child development. Publications were extracted from 10 databases in September 2018 and supplemented with grey search and hand search. We assessed risk of bias, calculated effect sizes and conducted meta-analysis. RESULTS Eight papers representing seven trials were included. We conducted meta-analysis on the post-intervention parent-child relationship. The analysis included six studies and showed no significant effect. For individual study outcomes, no significant effects on the majority of both the parent-child relationship and child development outcomes were reported. CONCLUSIONS No evidence of the effect of parenting interventions for mothers with depressive symptoms was found on the parent-child relationship and child development. Larger studies with follow-up assessments are needed, and future reviews should examine the effects in non-Western countries.
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Affiliation(s)
- Signe B. Rayce
- Senior Researcher, VIVE – The Danish Center for Social Science Research, Denmark
| | - Ida S. Rasmussen
- Research Assistant, VIVE – The Danish Center for Social Science Research, Denmark
| | | | - Maiken Pontoppidan
- Senior Researcher, VIVE – The Danish Center for Social Science Research, Denmark
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The effectiveness of Nurture and Play: a mentalisation-based parenting group intervention for prenatally depressed mothers. Prim Health Care Res Dev 2019; 20:e157. [PMID: 31839012 PMCID: PMC7003526 DOI: 10.1017/s1463423619000914] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
AIM This randomised control trial (RCT) study examined the effectiveness of a mentalisation-based perinatal group intervention, Nurture and Play (NaP), in improving mother-infant interaction quality and maternal reflective functioning and in decreasing depressive symptoms. BACKGROUND Few preventive prenatal interventions have been developed for primary health care settings for mothers with depressive symptoms. Furthermore, previous prenatal intervention studies have only concentrated on reducing depressive symptoms and have not directly addressed enhancing optimal parenting qualities. METHODS The participants were 45 pregnant women with depressive symptoms. Women in the randomly assigned intervention group (n = 24) participated in the manualised, short-term NaP intervention group from pregnancy until the baby's age of seven months, whereas control group women received treatment as usual (TAU). Maternal emotional availability (EA), reflective functioning (RF) and depressive symptoms were measured before the intervention and at the infants' 12 months of age, and changes were evaluated using repeated measure analyses of variances (ANOVAs). FINDINGS The results showed that the intervention group displayed higher maternal sensitivity and RF and more reduction in depressive symptoms than the control group when babies were 12 months old. These findings provide preliminary support for the effectiveness of the NaP intervention.
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19
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Douglas PS. Pre-emptive Intervention for Autism Spectrum Disorder: Theoretical Foundations and Clinical Translation. Front Integr Neurosci 2019; 13:66. [PMID: 31798425 PMCID: PMC6877903 DOI: 10.3389/fnint.2019.00066] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 11/04/2019] [Indexed: 12/28/2022] Open
Abstract
Autism spectrum disorders (ASD) are an emergent public health problem, placing significant burden upon the individual, family and health system. ASD are polygenetic spectrum disorders of neural connectome development, in which one or more feedback loops amplify small genetic, structural, or functional variations in the very early development of motor and sensory-motor pathways. These perturbations trigger a 'butterfly effect' of unpredictable cascades of structural and functional imbalances in the global neuronal workspace, resulting in atypical behaviors, social communication, and cognition long-term. The first 100 days post-term are critically neuroplastic and comprise an injury-sensitive developmental window, characterized by a neural biomarker, the persistence of the cortical subplate, and a behavioral biomarker, the crying diathesis. By the time potential diagnostic signs are identified, from 6 months of age, ASD neuropathy is already entrenched. The International Society for Autism Research Special Interest Group has called for pre-emptive intervention, based upon rigorous theoretical frames, and real world translation and evaluation. This paper responds to that call. It synthesizes heterogenous evidence concerning ASD etiologies from both psychosocial and biological research literatures with complexity science and evolutionary biology, to propose a theoretical framework for pre-emptive intervention. This paper hypothesizes that environmental factors resulting from a mismatch between environment of evolutionary adaptedness and culture initiate or perpetuate early motor and sensory-motor lesions, triggering a butterfly effect of multi-directional cascades of atypical developmental in the complex adaptive system of the parent and ASD-susceptible infant. Chronic sympathetic nervous system/hypothalamic-pituitary-adrenal axis hyperarousal and disrupted parent-infant biobehavioral synchrony are the key biologic and behavioral mechanisms perpetuating these atypical developmental cascades. A clinical translation of this evidence is proposed, for application antenatally and in the first 6 months of life, as pre-emptive intervention for ASD.
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Affiliation(s)
- Pamela S. Douglas
- Transforming Maternity Care Collaborative, Griffith University, Brisbane, QLD, Australia
- Discipline of General Practice, The University of Queensland, Brisbane, QLD, Australia
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20
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Ride J. Is socioeconomic inequality in postnatal depression an early-life root of disadvantage for children? THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2019; 20:1013-1027. [PMID: 31140060 DOI: 10.1007/s10198-019-01073-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 05/13/2019] [Indexed: 06/09/2023]
Abstract
This paper investigates the role that socioeconomic inequality in postnatal depression might play in intergenerational transmission of inequality. Infants' development is thought to be particularly sensitive to mothers' mental health at this time, suggesting that greater early-life exposure to maternal depression among disadvantaged groups might be a root of later socioeconomic inequalities. Heightened contact with health services during this period presents opportunities for intervention, but higher unmet need for treatment of postnatal depression among the disadvantaged might be widening inequalities. The aim of this study is to quantify the potential contribution of postnatal depression to socioeconomic inequalities in adverse childhood health and development outcomes. Regression-based decomposition of the concentration index is used to explore the association between income inequality in postnatal depressive symptoms and income inequality in children's outcomes. Four problems of early adolescence are explored: emotional and conduct problems, special educational needs, and low self-assessed health. Data are taken from the UK Millennium Cohort Study, with a sample of 4359 mothers and children with complete data on outcomes and covariates, and a second sample of 5441 when missing covariates are filled using multiple imputation. The key finding is that socioeconomic inequality in maternal postnatal depression is a significant contributor to inequalities in special educational needs, emotional problems, and low self-assessed health for children at age 11 years, even after accounting for a range of other factors that might explain such associations. These findings highlight the importance of understanding the impact of postnatal depression interventions on inequalities, and the downstream influence on children's outcomes. Addressing inequalities in mothers' postnatal depression might be an avenue for reducing early-life disadvantage for children.
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Affiliation(s)
- Jemimah Ride
- Health Economics Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
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21
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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: 70] [Impact Index Per Article: 14.0] [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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Sanders A, Rackers H, Kimmel M. A role for the microbiome in mother-infant interaction and perinatal depression. Int Rev Psychiatry 2019; 31:280-294. [PMID: 30784334 DOI: 10.1080/09540261.2018.1548431] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Perinatal depression is a significant public health problem, due to its negative impact on maternal well-being and long-term adverse effects for children. Mother-infant interaction and maternal responsiveness and sensitivity are a hypothesized mechanism by which perinatal depression effects child development, and increasing research in the microbiota-gut-brain axis may provide a new avenue of investigation. There is limited efficacy for treatment of perinatal depression for improving the mother-infant relationship and child outcomes. The maternal microbiota may be the basis of child outcomes through foetal programming and sharing of microbes between mother and infant. There is evidence that less diversity of the intestinal microbial community is associated with neuropsychiatric disorders, including depression and anxiety in mothers and offspring. Assessing the maternal and child's microbial communities may be an important missing component in mother-infant attachment-based therapies during treatment of perinatal depression. Probiotics and prebiotics require further research as additions to mother-infant interventions. Further research may enable identification of bacterial genes that indicate specific pathways that could be targeted to improve outcomes for mother and child.
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Affiliation(s)
- Amanda Sanders
- a Department of Psychiatry , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - Hannah Rackers
- a Department of Psychiatry , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - Mary Kimmel
- a Department of Psychiatry , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
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23
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Paradžik L, Maršanić VB. Major Depressive Disorder in an Adolescent Girl Living with a Mother Who is Emotionally Unavailable. Psychiatr Ann 2019. [DOI: 10.3928/00485713-20181129-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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24
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Gurung B, Jackson LJ, Monahan M, Butterworth R, Roberts TE. Identifying and assessing the benefits of interventions for postnatal depression: a systematic review of economic evaluations. BMC Pregnancy Childbirth 2018; 18:179. [PMID: 29783936 PMCID: PMC5963067 DOI: 10.1186/s12884-018-1738-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 04/10/2018] [Indexed: 01/30/2023] Open
Abstract
Background Economic evaluations of interventions for postnatal depression (PND) are essential to ensure optimal healthcare decision-making. Due to the wide-ranging effects of PND on the mother, baby and whole family, there is a need to include outcomes for all those affected and to include health and non-health outcomes for accurate estimates of cost-effectiveness. This study aimed to identify interventions to prevent or treat PND for which an economic evaluation had been conducted and to evaluate the health and non-health outcomes included. Methods A systematic review was conducted applying a comprehensive search strategy across eight electronic databases and other sources. Full or partial economic evaluations of interventions involving preventive strategies (including screening), and any treatments for women with or at-risk of PND, conducted in OECD countries were included. We excluded epidemiological studies and those focussing on costs only. The included studies underwent a quality appraisal to inform the analysis. Results Seventeen economic evaluations met the inclusion criteria, the majority focused on psychological /psychosocial interventions. The interventions ranged from additional support from health professionals, peer support, to combined screening and treatment strategies. Maternal health outcomes were measured in all studies; however child health outcomes were included in only four of them. Across studies, the maternal health outcomes included were quality-adjusted-life-years gained, improvement in depressive symptoms, PND cases detected or recovered, whereas the child health outcomes included were cognitive functioning, depression, sleep and temperament. Non-health outcomes such as couples’ relationships and parent-infant interaction were rarely included. Other methodological issues such as limitations in the time horizon and perspective(s) adopted were identified, that were likely to result in imprecise estimates of benefits. Conclusions The exclusion of relevant health and non-health outcomes may mean that only a partial assessment of cost-effectiveness is undertaken, leading to sub-optimal resource allocation decisions. Future research should seek ways to expand the evaluative space of economic evaluations and explore approaches to integrate health and non-health outcomes for all individuals affected by this condition. There is a need to ensure that the time horizon adopted in studies is appropriate to allow true estimation of the long-term benefits and costs of PND interventions. Electronic supplementary material The online version of this article (10.1186/s12884-018-1738-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Binu Gurung
- Health Economics Unit, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Louise J Jackson
- Health Economics Unit, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - Mark Monahan
- Health Economics Unit, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Ruth Butterworth
- Cheshire and Mersey Specialist Perinatal Mental Health Service, Thorn Road Clinic, Thorn Road, Runcorn, WA7 5HQ, UK
| | - Tracy E Roberts
- Health Economics Unit, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
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Netsi E, Pearson RM, Murray L, Cooper P, Craske MG, Stein A. Association of Persistent and Severe Postnatal Depression With Child Outcomes. JAMA Psychiatry 2018; 75:247-253. [PMID: 29387878 PMCID: PMC5885957 DOI: 10.1001/jamapsychiatry.2017.4363] [Citation(s) in RCA: 358] [Impact Index Per Article: 59.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 12/01/2017] [Indexed: 01/14/2023]
Abstract
Importance Maternal postnatal depression (PND) is common and associated with adverse child outcomes. These effects are not inevitable, and it is critical to identify those most at risk. Previous work suggests that the risks of adverse outcomes are increased when PND is severe and persistent, but this has not been systematically studied. Objective To examine the association between differing levels of persistence and severity of PND and long-term child outcomes. Design, Setting, and Participants The sample for this observational study comprised participants in the Avon Longitudinal Study of Parents and Children in the United Kingdom. Three thresholds of PND severity-moderate, marked, and severe-were defined using the self-rated Edinburgh Postnatal Depression Scale (EPDS). Depression was defined as persistent when the EPDS score was above the threshold level at both 2 and 8 months after childbirth. For each of these severity and persistence categories, the following were examined: (1) the trajectories of later EPDS scores (6 time points between 21 months and 11 years after childbirth) and (2) child outcomes-behavioral problems at 3.5 years of age, school-leaving mathematics grades at 16 years of age, and depression at 18 years of age. Data analysis was conducted from July 12, 2016, to February 8, 2017. Main Outcomes and Measures Child behavioral problems at 3.5 years of age using the Rutter total problems scale, school-leaving mathematics grades at 16 years of age extracted from records of external national public examinations, and offspring depression at 18 years of age using the Clinical Interview Schedule-Revised. Results For the 9848 mothers in the sample, the mean (SD) age at delivery was 28.5 (4.7) years. Of the 8287 children, 4227 (51%) were boys and 4060 (49%) were girls. Compared with women with PND that was not persistent and women who did not score above the EPDS threshold, for all 3 severity levels, women with persistent PND showed elevated depressive symptoms up to 11 years after childbirth. Whether persistent or not, PND doubled the risk of child behavior disturbance. The odds ratio (OR) for child behavioral disturbance for mothers with moderate PND was 2.22 (95% CI, 1.74-2.83), for mothers with marked PND was 1.91 (95% CI, 1.36-2.68), and for mothers with severe PND was 2.39 (95% CI, 1.78-3.22). Persistence of severe PND was particularly important to child development, substantially increasing the risk for behavioral problems at 3.5 years of age (OR, 4.84; 95% CI, 2.94-7.98), lower mathematics grades at 16 years of age (OR, 2.65; 95% CI, 1.26-5.57), and higher prevalence of depression at 18 years of age (OR, 7.44; 95% CI, 2.89-19.11). Conclusions and Relevance Persistent and severe PND substantially raises the risk for adverse outcome on all child measures. Meeting criteria for depression both early and late in the postnatal year, especially when the mood disturbance is severe, should alert health care professionals to a depression that is likely to be persistent and to be associated with an especially elevated risk of multiple adverse child outcomes. Treatment for this group should be prioritized.
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Affiliation(s)
- Elena Netsi
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Rebecca M. Pearson
- School of Social and Community Medicine, University of Bristol, Oakfield House, Bristol, United Kingdom
| | - Lynne Murray
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, United Kingdom
- Department of Psychology, Stellenbosch University, Matieland, Stellenbosch, South Africa
- Department of Psychology, University of Cape Town, Rondebosch, Cape Town, South Africa
| | - Peter Cooper
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, United Kingdom
- Department of Psychology, Stellenbosch University, Matieland, Stellenbosch, South Africa
- Department of Psychology, University of Cape Town, Rondebosch, Cape Town, South Africa
| | - Michelle G. Craske
- Department of Psychology, University of California, Los Angeles
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | - Alan Stein
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Attachment security mediates the longitudinal association between child-parent psychotherapy and peer relations for toddlers of depressed mothers. Dev Psychopathol 2017; 29:587-600. [PMID: 28401848 DOI: 10.1017/s0954579417000207] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Numerous investigations have demonstrated that child-parent psychotherapy (CPP) promotes secure attachment between mothers and offspring. However, the role of postintervention attachment security as it relates to long-term child outcomes has never been evaluated. The present study therefore examined postintervention attachment status as a mediator of the association between CPP for depressed mothers and their offspring and subsequent peer relations among offspring. Depressed mothers and their toddlers were randomized to receive CPP (n = 45) or to a control group (n = 55). A prior investigation with this sample indicated that offspring who received CPP attained significantly higher rates of secure attachment postintervention, whereas insecure attachment continued to predominate for offspring in the control group. The present study examined follow-up data of teachers' reports on participants' competence with classroom peers when they were approximately 9 years old. Findings indicated that children who received CPP were more likely to evidence secure attachments at postintervention, which in turn was associated with more positive peer relationships at age 9.
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Field T. Prenatal Depression Risk Factors, Developmental Effects and Interventions: A Review. JOURNAL OF PREGNANCY AND CHILD HEALTH 2017; 4:301. [PMID: 28702506 PMCID: PMC5502770 DOI: 10.4172/2376-127x.1000301] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
This narrative review based on a literature search in PubMed and PsycInfo on the two terms prenatal and antenatal depression includes empirical studies, reviews and meta-analyses that have been published during the last 5 years on risk factors, developmental effects and interventions for prenatal depression. Risk factor studies that met criteria feature demographic measures (lower socioeconomic status, less education, non-marital status, non-employment, less social support and health locus of control, unintended pregnancy, partner violence and history of child abuse) and physiological variables (cortisol, amylase, and pro-inflammatory cytokines and intrauterine artery resistance). The negative effects include postpartum depression, paternal depression, and prematurity and low birth weight. Negative effects on infants include greater right frontal EEG, amygdala connectivity, cortical thinning and more difficult temperament. In childhood, externalizing and internalizing problems have been reported. The data on prenatal antidepressants (specifically SSRIs) reveal negative effects including internalizing problems as well as a greater risk for autism spectrum disorder. Prenatal interventions that have been effective include interpersonal psychotherapy, peer support, massage therapy, yoga, tai chi, and aerobic exercise. Potential underlying mechanisms are discussed as well as methodological limitations including homogeneity of samples and lack of randomization to intervention groups. Despite these limitations, the literature highlights the need for prenatal depression screening and intervention.
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Affiliation(s)
- Tiffany Field
- University of Miami/Miller School of Medicine, Fielding Graduate University, USA
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Sherr L, Macedo A, Cluver LD, Meinck F, Skeen S, Hensels IS, Sherr LTS, Roberts KJ, Tomlinson M. Parenting, the other oldest profession in the world - a cross-sectional study of parenting and child outcomes in South Africa and Malawi. Health Psychol Behav Med 2017; 5:145-165. [PMID: 30221074 PMCID: PMC6135096 DOI: 10.1080/21642850.2016.1276459] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Parenting quality is important in child development. In the presence of HIV poverty and life stress, parenting may be challenged and child development affected. METHODS This study examines cross-sectional associations of situational factors such as poverty, mental health, HIV status, living with a biological parent, and stigma with good parenting and child outcomes (n=989; age=4-13 years) within the Child Community Care study (South Africa and Malawi). A parenting measure was created from 10 variables comprising 6 child and 4 parent ratings. These were highly correlated. Total parenting score was generated on a 10 point continuous scale, with a good parenting cut off then defined as >=8 out of a possible 10. RESULTS Five factors were associated with good parenting. Positively associated with good parenting were being the biological parent of the child, parental mental health and dwelling in households with multiple adults. Poverty and stigma were negatively associated with good parenting. Using multiple mediation analysis, a positive direct effect of good parenting was found on child self-esteem, child behaviour and educational risks with a partial mediation via child depression and trauma. CONCLUSIONS These data highlight possible intervention points. Influences on parenting could be seen through being the biological parent, parental mental health, poverty and stigma. In these challenging environments, health, nutrition, mental health, education, and treatment to keep parents alive are all clearly identified as potential pathways to ensure child well-being.
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Affiliation(s)
- L Sherr
- Department of Infection and Population Health, University College London, London, UK
| | - A Macedo
- Department of Infection and Population Health, University College London, London, UK
| | - L D Cluver
- Department of Social Policy & Intervention, Centre for Evidence-Based Interventions, University of Oxford, Oxford, UK
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - F Meinck
- Department of Social Policy & Intervention, Centre for Evidence-Based Interventions, University of Oxford, Oxford, UK
| | - S Skeen
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - I S Hensels
- Department of Infection and Population Health, University College London, London, UK
| | - L T S Sherr
- Department of Infection and Population Health, University College London, London, UK
| | - K J Roberts
- Department of Infection and Population Health, University College London, London, UK
| | - M Tomlinson
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
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Drury SS, Scaramella L, Zeanah CH. The neurobiological impact of postpartum maternal depression: prevention and intervention approaches. Child Adolesc Psychiatr Clin N Am 2016; 25:179-200. [PMID: 26980123 PMCID: PMC4794751 DOI: 10.1016/j.chc.2015.11.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The lasting negative impact of postpartum depression (PPD) on offspring is well established. PPD seems to have an impact on neurobiological pathways linked to socioemotional regulation, cognitive and executive function, and physiologic stress response systems. This review focus on examining the current state of research defining the effect of universal, selected, and indicated interventions for PPD on infant neurodevelopment. Given the established lasting, and potentially intergenerational, negative implications of maternal depression, enhanced efforts targeting increased identification and early intervention approaches for PPD that have an impact on health outcomes in both infants and mothers represent a critical public health concern.
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Affiliation(s)
- Stacy S. Drury
- Department of Psychiatry and Behavioral Sciences, Tulane University
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