Association of Maternal Depressive Symptoms During the Perinatal Period With Oppositional Defiant Disorder in Children and Adolescents

Berihun Assefa Dachew,Jon E Heron,James G Scott,Getinet Ayano,Rosa Alati

doi:10.1001/jamanetworkopen.2021.25854

Abstract

An association between perinatal maternal depression and risk of oppositional defiant disorder (ODD) in offspring has not been established. Identifying early determinants of ODD can help inform preventative intervention efforts. To investigate the association between maternal perinatal depressive symptoms and the risk of ODD in offspring aged 7 to 15 years. This population-based longitudinal birth cohort study used data from the Avon Longitudinal Study of Parents and Children (ALSPAC), in Bristol, UK. All pregnant women residents in Avon, UK, with expected delivery dates from April 1, 1991, to December 31, 1992, were invited to participate in the study. The study cohort ranged from approximately 8000 (at 7 years of age) to 4000 (at 15 years of age) mother-offspring pairs. Data were analyzed from November 2020 to July 2021. Maternal depressive symptoms were measured using the Edinburgh Postnatal Depression Scale (EPDS) antenatally at 18 and 32 weeks of gestation and postnatally at 8 weeks and 8 months. This study primarily used a cutoff score of 12 or more on the EPDS to identify mothers with symptoms of depression, and the continuous EPDS scores were used to confirm the results of the main analyses. Offspring ODD at 7, 10, 13, and 15 years of age were diagnosed using the parent-reported Development and Well-Being Assessment. Of 7994 mother-offspring pairs for whom data were available on offspring ODD at 7 years, 4102 offspring (51.3%) were boys. The mean (SD) age of mothers was 28.6 (4.6) years. Maternal antenatal depressive symptoms (measured at 32 weeks of gestation) were associated with offspring ODD (adjusted odds ratio [AOR], 1.75; 95% CI, 1.33-2.31). Offspring of mothers with postpartum depressive symptoms at 8 weeks and 8 months were more than 2 times more likely to have a diagnosis of ODD over time (AOR at 8 weeks, 2.24 [95% CI, 1.74-2.90]; AOR at 8 months, 2.04 [95% CI, 1.55-2.68]), and maternal persistent depressive symptoms were associated with a 4-fold increased risk of offspring ODD (AOR, 3.59; 95% CI, 1.98-6.52). These findings suggest that perinatal depressive symptoms are associated with ODD in offspring and further support the need for early identification and management of prenatal and postnatal depression in women of childbearing age.

Highlights

Oppositional defiant disorder (ODD) is a disruptive behavior disorder characterized by a persistent pattern of angry/irritable mood, argumentative/defiant behavior, and/or vindictiveness[1] with a prevalence in children of 3.6%.[2]
Offspring of mothers with postpartum depressive symptoms at 8 weeks and 8 months were more than 2 times more likely to have a diagnosis of oppositional defiant disorder (ODD) over time (AOR at 8 weeks, 2.24 [95% CI, 1.74-2.90]; AOR at 8 months, 2.04 [95% CI, 1.55-2.68]), and maternal persistent depressive symptoms were associated with a 4-fold increased risk of offspring ODD (AOR, 3.59; 95% CI, 1.98-6.52)
These findings suggest that perinatal depressive symptoms are associated with ODD in offspring and further support the need for early identification and management of prenatal and postnatal depression in women of childbearing age

Summary

Introduction

Oppositional defiant disorder (ODD) is a disruptive behavior disorder characterized by a persistent pattern of angry/irritable mood, argumentative/defiant behavior, and/or vindictiveness[1] with a prevalence in children of 3.6% (95% CI, 2.8%-4.7%).[2] Symptoms generally begin during the preschool years, with diagnosis typically occurring during middle childhood (6 to 13 years of age).[3,4] Before adolescence, ODD is more prevalent in boys than in girls, with a ratio of male to female prevalence of 1.4:1.1. Children with ODD have difficulty functioning at school and home and are at increased risk of other comorbid disorders, including conduct disorder, attention-deficit/hyperactivity disorder (ADHD), and mood, anxiety, and substance use disorders.[5,6] Identifying early-life risk factors of ODD is, important to achieve a better understanding of the etiology of the disorder and devise targeted interventions for those affected.[7]. A prospective cohort study[15] based on 2 pregnancy cohorts, the Avon Longitudinal Study of Parents and Children (ALSPAC) and the Generation R Study, reported positive associations between maternal prenatal depressive symptoms and attention problems in offspring in both cohorts (odds ratio [OR] for ALSPAC, 1.33 [95% CI, 1.19-1.48]; OR for Generation R, 1.23 [95% CI, 1.05-1.43])

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