Summary: According to researchers, postnatal depression that last longer than 6 months can have severe implications for children as they grow. The study reveals children of mothers who experienced persistent PND were more likely to have behavioral problems, achieve lower grades in exams and have an increased risk of developing depression by age 18.
Source: University of Bristol.
Postnatal depression which persists beyond 6 months after birth and is severe, increases the risk of children exhibiting behavioural problems, achieving lower GCSE mathematics grades at 16 years and having depression at 18 years of age. Postnatal depression which is persistent (whether moderate or severe) increases mothers’ risk of continuing to experience depressive symptoms beyond the postnatal year, with high levels found up until 11 years after childbirth.
Available research suggests that postnatal depression is associated with increased risks to children’s development affecting a range of domains. The effects are variable with some evidence suggesting that brief episodes, while distressing to the mother, may not impact negatively on children’s development. However, episodes of depression which persist for six months or more in duration may increase the risk for children. Identifying women at most risk is important both for women’s mental health and children’s development. The authors investigated whether depression has a similar impact when it is, or is not, persistent at either moderate or severe levels. Researchers from the Universities of Oxford, Bristol, Reading and UCLA in a new paper in JAMA Psychiatry tracked changes in mothers’ depressive symptoms following the postnatal year and differences in children’s development when postnatal depression was, or was not, persistent.
The sample consisted of 9848 mothers and 8419 children who were taking part in the Avon Longitudinal Study of Parents and Children (ALSPAC). The study utilises data from different stages of children’s development ranging from preschool to late adolescence; including behaviour problems at 3.5 years of age, GCSE mathematics grades at 16 years of age and depression at 18 years of age to determine potential effects both in the short and long term.
The study highlights for the first time that when postnatal depression is both persistent and severe the risk of negative outcomes to children’s development is raised. Furthermore, when depression persists beyond the first 6 months after birth, the risk for mothers continuing to experience depressive symptoms beyond the postnatal year is also increased. The authors report that these symptoms can continue up to 11 years after childbirth, but it is possible that they persist even longer. For two of the outcomes (GCSE mathematics grades at 16 and depression at 18 years), when postnatal depression either did not persist, or persisted only at moderate severity, the odds of achieving lower GCSE mathematics grades or experiencing depression at 18 years were similar to those of children whose mothers did not experience depressive symptoms at all in the postnatal year. This suggests that long term negative effects on mathematics grades and depression in adolescence principally occur in the context of persistent depression, but not with briefer and/or less severe episodes.
The study identifies a group of mothers and children who should be prioritised for treatment both to address maternal depression that is more likely to continue, and to mitigate the effects on children’s development. The authors have recently shown that treatment for women with persistent postnatal depression can be delivered effectively with high rates of sustained remission using home-based delivery of a psychological therapy.
Dr Elena Netsi from the Department of Psychiatry at Oxford University and lead author on the paper said: “Depression which persists beyond the first 6 months after birth should alert health care professionals to a depression which may become chronic. While screening for postnatal mental health problems in the UK already occurs within the first 3 months, screening once more in the second part of the postnatal year will help identify families who should be prioritised for treatment, both to address the mother’s depression and to mitigate potential effects on children’s development. Given that there are effective psychological therapies for depression it is important that help is provided for these women.”
Based at the University of Bristol, the Avon Longitudinal Study of Parents and Children (ALSPAC), also known as Children of the 90s, is a world-leading birth cohort study.
Between April 1991 and December 1992, the long-term health project recruited more than 14,000 pregnant women into the study and these women (some of whom had two pregnancies or multiple births during the recruitment period), the children arising from the pregnancy, and their partners have been followed up intensively over two decades.
ALSPAC is the most detailed study of its kind in the world and provides the international research community with a rich resource for the study of the environmental and genetic factors that affect a person’s health and development. Through our research we aim to inform policy and practices that will provide a better life for future generations. It receives core funding from the Medical Research Council, the Wellcome Trust and the University of Bristol.
Source: University of Bristol
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Original Research: Open access research in JAMA Psychiatry.
Association of Persistent and Severe Postnatal Depression With Child Outcomes
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.