Abstract
ObjectivesEvidence suggests that maternal psychological distress is an under-diagnosed condition that can have lasting impacts on child outcomes. Models based solely on maternal outcomes have not found screening to be cost-effective. This research explores the effects of self-reported maternal psychological distress on children’s language and behavioural development up to the age of 7.MethodsUsing longitudinal survey data from 10,893 families in the UK Millennium Cohort Study, multilevel models are used to explore the differential effects of maternal diagnosed and treated depression versus untreated maternal psychological distress during the postnatal year on longer-term child outcomes.ResultsBoth diagnosed and treated depression and self-reported maternal psychological distress have detrimental effects on child behavioural development. Behavioural outcomes up to age 5 were better for children of women who received treatment for depression, compared with children those whose mothers’ psychological distress was untreated, but this was not maintained to age 7. Little or no evidence of a difference was found between maternal psychological distress and child language development.Conclusions for PracticeThis research highlights the lack of effectiveness of existing treatment for maternal psychological distress both to benefit child development and to provide long-term symptom remediation for women. Future research could aim to identify more effective treatments for both women and children.
Highlights
Maternal postnatal depression is a major public health issue because of its globally high prevalence amongst women in both developed and developing countries (Halbreich and Karkun 2006)
NICE currently recommend the use of two case finding questions to aid in case detection, known as the Whooley questions (Whooley et al 1997) which ask; “during the past month, have you often been bothered by feeling down, depressed or hopeless?” and “during the past month, have you often been bothered by little interest or pleasure in doing things?” An affirmative response to one or both of these questions warrants further evaluation
Formal universal screening with a more structured case finding measure such as the Edinburgh Postnatal Depression Scale (Cox et al 1987) is not currently viewed as cost effective based on maternal outcomes alone, a decision driven by high costs associated with false positive results (Hewitt et al 2009)
Summary
Maternal postnatal depression is a major public health issue because of its globally high prevalence amongst women in both developed and developing countries (Halbreich and Karkun 2006). Considering that in the UK more than 700,000 women give birth each year (Office for National Statistics 2013) this estimate would suggest that around 98,000 women will fall into this category annually. Both effective and cost-effective treatments exist to relieve the symptoms of postnatal depression (Hendrick 2003; McCrone et al 2004), evidence suggests that it is an under-diagnosed condition (Hearn et al 1998). Formal universal screening with a more structured case finding measure such as the Edinburgh Postnatal Depression Scale (Cox et al 1987) is not currently viewed as cost effective based on maternal outcomes alone, a decision driven by high costs associated with false positive results (Hewitt et al 2009)
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