Abstract
SummaryBackgroundEvidence exists that maternal depression in the perinatal period has an adverse effect on a range of early childhood outcomes and increases the risk of offspring depression during adolescence. However, the association between maternal depression during the perinatal period and offspring psychotic experiences has not been investigated. We aimed to investigate whether there is an association between maternal antenatal or postnatal depression and offspring psychotic experiences at 18 years of age.MethodsThis longitudinal study used data from the Avon Longitudinal Study of Parents and Children (ALSPAC), a prospective birth cohort, which recruited 14 541 pregnant women with an estimated delivery date between April 1, 1991, and Dec 31, 1992. Perinatal depression was measured using the Edinburgh Postnatal Depression Scale (EPDS); offspring psychotic experiences at 18 years of age were measured using the Psychosis-Like Symptom Interview. Offspring of mothers with complete data on maternal perinatal depression measures, and complete data on outcome (psychotic experiences) and confounding variables were included in the main analysis. For the main analysis, we used logistic regression to examine the associations between maternal depression (antenatal and postnatal) and offspring psychotic experiences at the age of 18 years. We used biprobit regression to model the association between maternal antenatal depression and the two offspring outcomes (psychotic experiences and depression) at 18 years of age jointly.Findings3067 offspring for whom data were available on maternal perinatal depression and offspring psychotic experiences aged 18 years were included in analyses. Maternal antenatal depressive symptoms were associated with offspring psychotic experiences at 18 years of age, with an unadjusted odds ratio (OR) of 1·38 (95% CI 1·18–1·61, p=0·0001) and after adjustment for confounders, an OR of 1·26 (1·06–1·49, p=0·0074). Maternal antenatal depressive symptoms were associated with both offspring psychotic experiences at the age of 18 years (n=2830, OR for a 5-point increase in EPDS score: 1·32 [95% CI 1·16–1·51], p<0·0001) and offspring depression at 18 years (OR for a 5-point increase in EPDS score: 1·18 [1·03–1·34], p=0·016). From joint modelling, there was no evidence that the association between maternal antenatal depression and offspring psychotic experiences differed in strength compared with offspring depression (p=0·19).InterpretationThe offspring of mothers who experience depression in the perinatal period are more likely to report psychotic experiences at 18 years of age. If the association is found to be causal, it would strengthen the case for identifying and treating maternal depression during and after pregnancy.FundingUK Medical Research Council and the Wellcome Trust.
Highlights
Increasing evidence suggests that psychosis is best viewed as a continuum and that psychotic experiences not meeting criteria for psychotic disorder are much more common in both the adolescent and adult populations than previously realised.[1]
Added value of this study In this analysis of a prospective birth cohort, we found that maternal depression during pregnancy and the postnatal period is associated with offspring psychotic experiences during adolescence
Another study in the same cohort found no association between maternal antenatal depression and offspring affective and schizotypal traits during adulthood;[12] surprisingly, this study found no association between familial risk of psychosis and offspring schizotypal traits
Summary
Increasing evidence suggests that psychosis is best viewed as a continuum and that psychotic experiences not meeting criteria for psychotic disorder are much more common in both the adolescent and adult populations than previously realised.[1]. Children and adults who report psychotic experiences during childhood are at higher risk of developing a psychotic disorder such as schizophrenia during adulthood.[1] There is evidence that psychotic experiences are not just related to psychotic disorders but are associated with more severe presentations of common mental health disorders such as anxiety and depression.[2] the study of psychotic experiences is relevant to both the early phases of development of psychotic disorders[1] and the more severe presentations of common mental health disorders. Maternal perinatal depression is known to have an adverse effect on several aspects of child development, including social, emotional, and cognitive function,[3,4] and is associated with offspring depressive symptoms in adolescence[5] and adulthood.[6] The neurodevelopmental hypothesis of schizophrenia proposes that abnormal brain development might contribute to the development of the disorder.[7] Maternal perinatal depression is a form of www.thelancet.com/psychiatry Vol 7 May 2020
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