Summary: Women who suffered from eating disorders are at increased risk of developing depression during pregnancy and up until 18 years after the birth of their child.
A history of eating disorders and body image concerns before or during pregnancy are associated with future depressive symptoms among mothers, finds a new UCL-led study published in the British Journal of Psychiatry.
“We found that women who have had an eating disorder at any point before childbirth, even if it was years earlier in adolescence, were more likely to experience depressive symptoms during pregnancy and up to 18 years after the birth of their child,” said the study’s lead author Dr Francesca Solmi (UCL Psychiatry).
“This finding suggests that many people with eating disorders might not fully recover since we know that eating disorders and depression often happen at the same time.”
The researchers used data from the ‘Children of the 90s’ cohort study, including 9,276 women.
Previous studies had suggested that depressive symptoms among mothers with eating disorders might improve after the perinatal period, but those studies didn’t have such a long follow-up time to confirm that the increased risk of depressive symptoms does, in fact, persist for women who have had an eating disorder.
The research team found that women who had ever had anorexia nervosa or bulimia nervosa experienced more depressive symptoms over an 18-year follow-up than those who had never had an eating disorder.
“Depressive symptoms in mothers have been shown to be associated with a number of negative outcomes for their children, such as emotional and behavioural problems. It is therefore important, to identify and treat eating disorders early, as these could be one potential cause of the depressive symptoms,” said Dr Solmi.
“We should also identify pregnant women with an eating disorder so that they can be provided with mental health support. This could benefit both mother and child in the long run.”
Dr Abigail Easter, one of the authors of the paper who has developed training materials to help identify eating disorders in pregnancy, added: “There is a need for more training for practitioners and midwives on how to recognise eating disorders in pregnancy, which could help to reduce the long-term impact of mental ill-health.”
Current guidelines from the National Institute for Health and Care Excellence (NICE) recommend that health care professionals use a questionnaire to identify depressive symptoms in pregnant women. The current study supports the value of this, as well as for identifying eating disorders.
“There’s a lot of stigma around both depression and eating disorders, so many people might not feel comfortable talking about it or seeking help. Assessment of mental illness in pregnancy, as standard practice, could help health professionals pick up on signs of depression and/or eating disorders at this crucial stage of life,” said first author Yu Wei Chua, who began the study at UCL before moving over to the University of Strathclyde.
The study was conducted by researchers at UCL, University of Strathclyde and King’s College London, and was funded by Wellcome and the National Institute for Health Research UCLH Biomedical Research Centre.
Chris Lane – UCL
The image is credited to the NIH and is for illustrative purposes only.
Original Research: Open access
“Eighteen-year trajectories of depressive symptoms in mothers with a lifetime eating disorder: findings from the ALSPAC cohort” Yu Wei Chua, Gemma Lewis, Abigail Easter, Glyn Lewis, Francesca Solmi.
British Journal of Psychiatry. doi:10.1192/bjp.2019.89
Eighteen-year trajectories of depressive symptoms in mothers with a lifetime eating disorder: findings from the ALSPAC cohort
Two longitudinal studies have shown that depressive symptoms in women with eating disorders might improve in the antenatal and early postnatal periods. No study has followed up women beyond 8 months postnatal.
To investigate long-term trajectories of depressive symptoms in mothers with lifetime self-reported eating disorders.
Using data from the Avon Longitudinal Study of Parents and Children and multilevel growth curves we modelled trajectories of depressive symptoms from the 18th week of pregnancy to 18 years postnatal in women with lifetime self-reported anorexia nervosa, bulimia nervosa or both anorexia and bulimia nervosa. As sensitivity analyses we also investigated these trajectories using quintiles of a continuous measure of body image in pregnancy.
Of the 9276 women in our main sample, 126 (1.4%) reported a lifetime diagnosis of anorexia nervosa, 153 (1.6%) of bulimia nervosa and 60 (0.6%) of both anorexia and bulimia nervosa. Women with lifetime eating disorders had greater depressive symptoms scores than women with no eating disorders, before and after adjustment for confounders (anorexia nervosa: 2.10, 95% CI 1.36–2.83; bulimia nervosa: 2.28, 95% CI: 1.61–2.94, both anorexia and bulimia nervosa: 2.86, 95% CI 1.81–3.90). We also observed a dose–response association between greater body image and eating concerns in pregnancy and more severe trajectories of depressive symptoms, even after adjusting for lifetime eating disorders which also remained independently associated with greater depressive symptoms.
Women with eating disorders experience persistently greater depressive symptoms across the life-course. More training for practitioners and midwives on how to recognise eating disorders in pregnancy could help to identify depressive symptoms and reduce the long-term burden of disease resulting from this comorbidity.
Declaration of interest