The effects of trauma on perinatal depression: Examining trajectories of depression from pregnancy through 24 months postpartum in an at-risk population

BACKGROUND

Research suggests that trauma exposure is associated with perinatal depression; however, little is known about the nature of the relation between trauma history and trajectory of depression, as well as the predictive power of trauma history beyond other risk factors. Additionally, more research is needed in at-risk samples that are likely to experience severe traumatic exposure.

METHODS

Secondary data analysis was conducted using demographic and depression data from the Healthy Start and Empowerment Family Support programs in Des Moines, Iowa. Hierarchical linear modeling was used to examine trajectories of perinatal depressive symptoms, from pregnancy to 24 months postpartum, and clarify whether trauma exposure, relationship status, and substance use uniquely contribute to trajectories of symptoms over time.

RESULTS

On average, depressive symptoms decreased from pregnancy to 24 months postpartum; however, trajectories varied across women. Single relationship status, substance use, and trauma history were each predictors of higher depression levels at several points in time across the observed perinatal period. Single relationship status was also associated with decline in depressive symptoms followed by a rebound of symptoms at 22 months postpartum.

LIMITATIONS

These data were not collected for research purposes and thus did not undergo the rigorous data collection strategies typically implemented in an established research study.

CONCLUSIONS

History of trauma, substance use and single relationship status represent unique risk factors for perinatal depression. For single women, depressive symptoms rebound late in the postpartum period. Single women are at greater risk for substance use and traumatic exposure and represent a sample with cumulative risk. Eliciting social support may be an important intervention for women presenting with these risk factors.

Multiple modifiable lifestyle factors and the risk of perinatal depression during pregnancy: Findings from the GUSTO cohort

BACKGROUND

Studies have identified lifestyle risk factors for perinatal depression, but none have examined the cumulative effect of these risk factors in pregnant women.

METHODS

We considered the following six factors during pregnancy: poor diet quality (Healthy eating index for Singapore pregnant women<median), poor sleep quality (global Pittsburgh sleep quality index score > 5), physical inactivity (<600 MET-minutes/week), vitamin D insufficiency (<50 nmol/l), smoking before or during pregnancy, and the perceived need for social support. Probable depression was assessed using the Edinburgh postnatal depression scale during pregnancy (>15) and at three months postpartum (≥13). Prevalence risk ratios were calculated with Poisson regressions while adjusting for potential confounders.

RESULTS

Of 535 pregnant women, 207 (39%) had zero or one risk factor, 146 (27%) had two, 119 (22%) had three, 48 (9%) had four, and 15 (3%) had ≥5 risk factors at 26-28 weeks' gestation. These six lifestyle habits contributed to 32% of the variance in depressive symptoms during pregnancy. The prevalence of being probably depressed was 6.4 (95% CI 2.1, 19.8; p_trend < 0.001) for expecting women who had ≥4 risk factors compared to women who had ≤1 risk factor. No association was observed between the number of risk factors and depressive symptoms at 3 months postpartum (p_trend = 0.746).

CONCLUSION

Pregnant women with ≥4 lifestyle risk factors showed a higher prevalence of depression during pregnancy, while no associations were observed for postpartum depression.

CLINICAL TRIAL REGISTRATION

This cohort is registered under the Clinical Trials identifier NCT01174875; http://www.clinicaltrials.gov/ct2/show/NCT01174875?term=GUSTO&rank=2.

A Qualitative Investigation of the Experiences of Women with Perinatal Depression and Anxiety during the COVID-19 Pandemic

OBJECTIVES

The COVID-19 pandemic has had significant impacts on maternal mental health. We explored the lived experiences of women with perinatal depression and anxiety to elucidate their perceptions of how the pandemic influenced their mental health and access to care.

METHODS

We conducted a qualitative descriptive study using semi-structured interviews. From March to October 2021, purposive sampling was used to recruit a socio-demographically diverse sample of women with self-reported perinatal depression or anxiety who were pregnant or within one year postpartum between March 2020 and October 2021. Interviews were conducted remotely and thematically analyzed.

RESULTS

Fourteen women were interviewed. Three major themes arose. Theme 1, Negative impacts of COVID-19 on symptoms of depression and anxiety, described how the pandemic magnified underlying symptoms of depression and anxiety, increased social isolation, generated anxiety due to fears of COVID-19 infection, and caused economic stress. In theme 2, Negative impacts of COVID-19 on access to and quality of health care, women described stressful and isolating delivery experiences, negative psychological impact of partners not being able to participate in their perinatal health care, interruptions and barriers to mental health treatment, and challenges in using telehealth services for mental health care. Theme 3, Positive impacts of COVID-19 on mental health, identified advantages of increased telehealth access and ability to work and study from home.

CONCLUSIONS FOR PRACTICE

The COVID-19 pandemic negatively affected women with perinatal depression and anxiety by magnifying underlying symptoms, increasing stress and social isolation, and disrupting access to mental health care. Findings provide support for policies and interventions to prevent and address social isolation, as well as optimization of telehealth services to prevent and address gaps in perinatal mental health treatment.

The risk of attention deficit hyperactivity disorder symptoms in offspring of mothers with perinatal depression: A systematic review and meta-analysis

BACKGROUND

The existing epidemiological evidence on the link between maternal depression and the risk of attention deficit and hyperactivity disorder (ADHD) symptoms in children lacks consistency. This systematic review and meta-analysis aimed to comprehensively synthesise the existing evidence on the relationship between maternal depression during the antenatal and postnatal periods and the risk of ADHD symptoms in offspring.

METHODS

We systematically searched PubMed, Medline, Embase, Scopus, CINAHL, and PsychINFO to identify relevant articles. Random-effects meta-analysis models were employed to estimate the pooled odds ratio (OR) along with 95 % confidence intervals (CI). Statistical heterogeneity was assessed using Cochrane's Q-test and I2-test. Subgroup analysis was conducted to explore potential sources of variation within the included studies. Publication bias was assessed using a funnel plot and Egger's test for regression asymmetry.

RESULTS

Twenty-one observational studies, comprising 796,157 mother-offspring pairs, were included in the final analysis. Our meta-analysis found a 67 % (OR = 1.67, 95 % CI = 1.35-2.00) and a 53 % (OR = 1.53, 95 % CI = 1.27-1.78) increased risk of ADHD symptoms in the offspring of mothers experiencing antenatal and postnatal depression, respectively.

CONCLUSION

Our systematic review and meta-analysis identified an elevated risk of ADHD symptoms in the offspring of mothers who experienced both antenatal and postnatal depression. These findings underscore the importance of early screening and targeted intervention programs for at-risk children and adolescents.

Social and Behavioral Problems in School-Aged Children After Maternal Postpartum Depression: A Secondary Analysis of Future of Families and Child Wellbeing Study

OBJECTIVES

To examine the relation between perinatal depression at child age 1 year and behavioral issues and altered social functioning at school age.

METHODS

The Future of Families (formerly Fragile Families) and Child Wellbeing Study longitudinal cohort age 9 nationally representative urban sample was used to examine associations between maternal depression at child age 1 and child behavior and social functioning at age 9 (n = 2,305 children and their mothers). Measures included the Composite International Diagnostics Interview (depression), Child Behavior Checklist total score (child behavior problems) and social function subscale. Clinical significance of child behavior problems and social function problems were determined by normed T-scores. Analyses included chi square, t-tests, and linear regression using SAS 9.4 Survey procedures.

RESULTS

Higher household income was associated with lower behavior problem scores (F = 8.76, p < 0.0001, R2 = 0.07. School-aged children whose mothers had major depression at child age 1 (10.8%) were more than twice as likely to have clinically significant behavior problems (OR 2.46, p < 0.0001) than children whose mothers did not have depression (4.1%). Further, children with depressed mothers were more than twice as likely to have clinically significant social function problems than children whose mothers were not depressed (OR = 2.09, p < 0.0001).

CONCLUSIONS FOR PRACTICE

Children whose mothers were depressed at child age 1 have higher risk of having behavior problems and poor social functioning at age 9. Early and repeated maternal depression screening is needed to treat the disease sooner and attempt to avoid these outcomes.