Maternal Perinatal Depression Research Articles

Treatment of maternal perinatal depression in a low-income setting does not lead to improved outcomes for children

ABSTRACT FROM: Maselko J, Sikander S, Bhalotra S, et al. Effect of an early perinatal depression intervention on long-term child development outcomes: follow-up of the Thinking Healthy Programme randomised controlled...

Maternal perinatal mental health and offspring academic achievement at age 16: the mediating role of childhood executive function.

BackgroundElucidating risk pathways for under‐achieving at school can inform strategies to reduce the number of adolescents leaving school without passing grades in core subjects. Maternal depression can compromise the quality of parental care and is associated with multiple negative child outcomes. However, only a few small studies have investigated the association between perinatal maternal depression and poor academic achievement in adolescence. The pathways to explain the risks are also unclear.MethodProspective observational data from 5,801 parents and adolescents taking part in a large UK population cohort (Avon‐Longitudinal‐Study‐of‐Parents‐and‐Children) were used to test associations between maternal and paternal depression and anxiety in the perinatal period, executive function (EF) at age 8, and academic achievement at the end of compulsory school at age 16.ResultsAdolescents of postnatally depressed mothers were 1.5 times (1.19, 1.94, p = .001) as likely as adolescents of nondepressed mothers to fail to achieve a ‘pass’ grade in math; antenatal anxiety was also an independent predictor of poor math. Disruption in different components of EF explained small but significant proportions of these associations: attentional control explained 16% (4%, 27%, p < .001) of the association with postnatal depression, and working memory explained 17% (13%, 30%, p = .003) of the association with antenatal anxiety. A similar pattern was seen for language grades, but associations were confounded by maternal education. There was no evidence that paternal factors were independently associated with impaired child EF or adolescent exams.ConclusionMaternal postnatal depression and antenatal anxiety are risk factors for adolescents underachieving in math. Preventing, identifying, and treating maternal mental health in the perinatal period could, therefore, potentially increase adolescents’ academic achievement. Different aspects of EF partially mediated these associations. Further work is needed, but if these pathways are causal, improving EF could reduce underachievement in math.

Peritraumatic Distress Mediates the Effect of Severity of Disaster Exposure on Perinatal Depression: The Iowa Flood Study.

Disaster exposure during pregnancy has received limited attention. This study examined the impact of the 2008 Iowa Floods on perinatal maternal depression and well-being, and the role of peritraumatic distress as a possible mechanism explaining this link. Perinatal women (N = 171) completed measures of depressive symptoms and general well-being at 5 timepoints from pregnancy to 30 months postpartum. Objectively assessed prenatal flood exposure was associated with greater depression (r = .15). Further, flood-related peritraumatic distress was uniquely associated with greater depression (r = .23), and was a key mechanism through which flood exposure led to depression. Prenatal flood exposure was also associated with general well-being (r = .18); however, a mechanism other than peritraumatic distress appears to have been responsible for the effect of flood exposure on well-being. We discuss the implications of these findings for informing etiological models and enhancing the efficacy of interventions for maternal psychopathology.

THE IMPACT OF DEPRESSION ON MATERNAL RESPONSES TO INFANT FACES IN PREGNANCY.

ABSTRACTResearch has suggested that prenatal depression may be associated with disrupted maternal responses to infant stimuli, with depressed pregnant women not showing the bias toward distressed infants as that observed in nondepressed pregnant women. The current study examined the effects of depression on self‐ reported responses to infant stimuli, in early pregnancy. Women with clinical depression (n = 38), and nondepressed women (n = 67) were recruited from a wider cognitive behavioral therapy trial. They completed Maternal Response Scales in which they were presented with images of distressed, neutral, and happy infant faces, with no time limit. The women rated their responses to these images along three dimensions—wanting to comfort, wanting to turn away, and feelings of anxiety—using Likert scales via a computerized task. There was evidence that women with depression in pregnancy showed different responses than did women without depression. Women with depression were substantially more likely to be in the highest quartile for ratings of wanting to turn away, odds (OR) ratio = 4.15, 95% confidence intervals (CIs) = 1.63–10.5, p = .003, and also were substantially less likely to be in the highest quartile for wanting to comfort a distressed infant face, OR = 0.22, 95% CIs = 0.09–0.54, p < .001. Findings are consistent with there being both a heightened avoidant and a reduced comforting response toward distressed infants in depressed pregnant women, providing some support that depression disrupts maternal preparations at a conscious level.

Treating Perinatal Depression

Treating Perinatal Depression

Partner support and maternal depression in the context of the Iowa floods.

A systematic investigation of the role of prenatal partner support in perinatal maternal depression was conducted. Separate facets of partner support were examined (i.e., received support and support adequacy) and a multidimensional model of support was applied to investigate the effects of distinct types of support (i.e., informational, physical comfort, emotional/esteem, and tangible support). Both main and stress-buffering models of partner support were tested in the context of prenatal maternal stress resulting from exposure to a natural disaster. Questionnaire data were analyzed from 145 partnered women using growth curve analytic techniques. Results indicate that received support interacts with maternal flood stress during pregnancy to weaken the association between stress and trajectories of maternal depression from pregnancy to 30 months postpartum. Support adequacy did not interact with stress, but was associated with levels of depressive symptoms controlling for maternal stress and received support. Results demonstrate the distinct roles of various facets and types of support for a more refined explanatory model of prenatal partner support and perinatal maternal depression. Results inform both main effect and stress buffering models of partner support as they apply to the etiology of perinatal maternal depression, and highlight the importance of promoting partner support during pregnancy that matches support preferences.

Treatment – Mother–infant relationship psychotherapy

In this chapter, we briefly describe several modes of parent-infant-psychotherapy, an efficient way of treating parent-infant relationship disorders. We then focus on treatment for postnatally depressed mothers. Perinatal depression defines an episode of major or minor depression occurring during pregnancy or the first 12 months after birth. Attachment-based parent-infant interventions are particularly helpful in the context of maternal perinatal depression, as postpartum depression has a special link with unresolved trauma and losses in the mother's childhood. The goal of treatment is to improve the mother's mood but also to prevent or reduce the effects of postpartum depression on the child. Infants of perinatally depressed mothers are at risk for a large array of negative outcomes, including attachment insecurity (particularly disorganised attachment), social-skills deficits, cognitive difficulties, behaviour problems, and later psychopathology. The 'ghosts in the nursery' concept refers to the painful or disturbed early childhood experiences coming from the mother's past, which haunt the present mother-infant relationship. By addressing the mother's unresolved attachment conflicts (in her relationship to her own parents), it is believed that the development of a more adaptive parenting and a more secure and less disorganised attachment between the mother and her infant is facilitated. Changes in parent- infant interaction are not dependent on the port of entry (e.g. child's behaviour, parent's representation or parent-infant relationship). The perspective of attachment is key to install a therapeutic alliance with parents.

Maternal perinatal depression is not independently associated with child body mass index in the Generation R Study: methods and missing data matter

ObjectivesTo advance the understanding of the relationship between maternal perinatal depression and child overweight, we used appropriate methodology to account for missing data; incorporated three exposure time points; and included adequate covariate adjustment in a large, sociodemographically diverse sample. Study Design and SettingWe used data from 6,782 mother–child pairs in a prospective population-based study. Maternal depression was assessed with the Brief Symptom Inventory at midpregnancy and 2 and 6 months postpartum. Child height and weight were measured at 36 months of age and converted to body mass index (BMI) z-scores. We compared the complete-case and multiple imputation (MI) analyses. ResultsFully adjusted complete-case models showed a positive association between depression at 2 months postpartum and child BMI z-score (β=0.19 [95% confidence interval (CI)=0.03, 0.36]; n=1,732), and no association between prenatal depression or 6-month postpartum depression and child BMI. Using MI (n=6,782), there was no association between perinatal depression and child BMI at any time point. ConclusionsOur study adds evidence that postpartum depression is not associated with child growth across the population in high-income countries. Our results highlight the importance of appropriate handling of missing data, adequate covariate control, and the value of studying the conditions that have produced conflicting evidence regarding perinatal depression and child weight.

Paternal perinatal depression: An overview and suggestions towards an intervention model

Although much research has been devoted to determining the nature and best treatment for maternal perinatal depression, paternal perinatal depression (PPND) has received comparatively little attention. The aim of the present literature review is to find empirical evidence to guide the development of a broad and preliminary intervention model for PPND. The nature of PPND is informed by a psycho-social conceptualisation of the disorder. PPND is often associated with significant morbidity within the fathers family, including depression in his partner, maladjustment to parenthood and future psychological problems in his children. Existing treatments developed for mothers with PND and perinatal parent education for fathers are informative. A multi-level intervention model for fathers with PPND is proposed for discussion.

Current considerations of the effects of untreated maternal perinatal depression and the National Perinatal Depression Initiative.

Postnatal and antenatal depression present significant public health concerns. Current opinion on the use of these terms is noted. Previous research findings demonstrate that detrimental effects of untreated maternal depression/anxiety are potentially severe and impact on the whole family; longer-term effects on child development are described. Australia has responded to such overwhelming empirical evidence by the implementation of the National Perinatal Depression Initiative. Key objectives and a brief overview of the work in progress of this Initiative are offered.

Maternal Perinatal Depression in the Neonatal Intensive Care Unit: The Role of the Neonatal Nurse

The onset of depressive symptoms during pregnancy or the first year postpartum, termed perinatal depression, occurs in approximately 15 percent of women. Perinatal depression can have a significant negative impact on health outcomes for the mother and her infant including maternal emotional distress and parenting difficulties and infant behavioral and developmental problems. Nurses caring for patients in the neonatal intensive care unit (NICU) are in a key position to affect positive change in the lives of families affected by perinatal depression. An overview of antepartum and postpartum depression is provided that has been tailored to the educational needs of the neonatal nurse. A discussion of the role of neonatal nurses in the identification and treatment of perinatal depression follows in order that neonatal nurses may improve both short- and long-term outcomes for mothers, infants, and families in the NICU affected by perinatal depression.

P2-367 Variations in perinatal depression, anxiety and severe mental illnesses by maternal age and socioeconomic group: a population-based study in UK primary care data

IntroductionMaternal perinatal mental illnesses are crucial public health issues and mostly addressed in UK primary care. This study was to assess whether there were variations in the burden of mental...

Association between perinatal depression in mothers and the risk of childhood infections in offspring: a population-based cohort study

BackgroundPrevious studies have suggested that children of mothers who experience depression during the perinatal period may have more infections, but such studies are few in number and none have been carried out in the United Kingdom (UK) population. The aim of this study was to investigate the association between perinatal depression in mothers and the risk of childhood infections in offspring in the UK general population.MethodsWe used data from The Health Improvement Network (THIN), a large database of electronic primary care medical records to conduct a cohort study among all first-born singleton children born and enrolled in THIN between 1988 and 2004. We used Poisson regression to compare the incidence of gastrointestinal infections and lower respiratory tract infections reported between birth and age 4 years among children of mothers with a record of perinatal depression with those born to mothers with no such history.ResultsChildren of mothers with perinatal depression had a 40% increased risk of gastrointestinal infections and a 27% increased risk of lower respiratory tract infections compared with children of mothers without perinatal depression (incidence rate ratios = 1.40 and 1.27; 95% confidence intervals 1.37-1.42 and 1.22-1.32, respectively). On restricting to antibiotic-treated infections there was a slight increase in the magnitude of association with gastrointestinal infections but a decrease in that with lower respiratory tract infections (incidence rate ratios = 1.47 and 1.19; 95% confidence intervals 1.34-1.61 and 1.11-1.27, respectively).ConclusionsMaternal perinatal depression is associated with increased rates of childhood gastrointestinal infections, particularly more severe infections, and lower respiratory tract infections in the UK. Preventing maternal perinatal depression may avoid substantial morbidity among offspring, although further work is also needed to investigate the detailed reasons for these findings.

Maternal omega-3 fatty acid supplementation and risk for perinatal maternal depression

Objective. A systematic review was conducted to assess the possible association between omega-3 polyunsaturated fatty acid (PUFA) supplementation and intake in the perinatal period and the risk of maternal perinatal depression.Methods. Two PubMed searches and a BIOSIS Preview, a Web of Science and a PsychInfo search were conducted with the search terms ‘DHA, pregnancy and depression’ and ‘omega-3 fatty acids, pregnancy and depression’.Results. Ten articles – three longitudinal cohort studies, five randomized controlled trials and two pilot trials– that met selection criteria were reviewed. Six found no association, two found mixed results, and two found a positive association between omega-3 PUFAs and reduced incidence of maternal perinatal depression. The heterogeneity of results can be explained by dissimilar study designs, including differences in study duration, time period of measurement and number of participants, and in varied dosages and types of supplemental PUFAs. Some of the larger studies and those that found a positive effect were more likely to be using higher doses, close to 2 g of docosahexaeonic acid (DHA)+ eicosapentaenoic acid (EPA), and began the supplementation earlier in pregnancy.Conclusions. Future RCTs to investigate the role of PUFA supplementation and risk for maternal perinatal depression should begin supplementation early in pregnancy and use a dosage closer to 2 g of DHA + EPA. Depression should also be measured using a diagnostic interview schedule in addition to a screener.

Mechanisms behind psychosocial stress-induced spontaneous colitis in male mice

To examine the association between prenatal stress and infant physical health in the first year of life within an understudied, racially and ethnically diverse, highly stressed community sample. We expected that greater stress exposure would predict higher rates of infant illness.Low-income, racially/ethnically diverse, overweight women with low medical risk pregnancies were recruited (2011-2014) during pregnancy. Pregnancy Stressful Life Events were assessed retrospectively (mean, 11.88 months postpartum). Perceived stress was assessed twice during pregnancy (at a mean of 17.4 weeks and again at a mean of 25.6 weeks) and at 6 months postpartum. Women with live births (n = 202) were invited; 162 consented to the offspring study. Medical records from pediatric clinics and emergency departments for 148 infants were abstracted for counts of total infectious illnesses, total noninfectious illness, and diversity of illnesses over the first year of life.The final analytic sample included 109 women (mean age, 28.08 years) and their infants. In covariate-adjusted negative binomial models, maternal perceptions of stress across pregnancy were positively associated with infant illness. Each 1-point increase in average stress was associated with a 38% increase in incidence of infant infections (Incidence rate ratio, 1.38; 95% CI, 1.01-1.88; P < .05), a 73% increase in noninfectious illness (IRR, 1.73; 95% CI, 1.34-2.23; P < .05), and a 53% increase in illness diversity (IRR, 1.53; 95% CI, 1.25, 1.88; P < .01); effect sizes were larger for perceived stress later in pregnancy. Stressful life events count and postnatal stress were not uniquely associated with illness.In line with recommendations from the American Academy of Pediatrics to screen for maternal perinatal depression, screening and support for stress reduction during pregnancy may benefit both maternal and child health.

Attachement désorganisé et sémiologie autistique

This paper firstly presents a literature review of the relationships between autistic symptomatology and disorganized attachment. Both have close semiological features but are distinct dimensions, arising within different context and may therefore be associated and be mistaken one for another. Recognition of their difference has important implications for both prognosis and treatment as for working alliance with parents. The discussion is highlighted by the case of Harry, who presented with a picture of autistic-like symptomatology but linked in fact with a disorganized attachment. His favourable evolution and the precisely acknowledged changes with this child during a four years treatment in a day care facility give weight to this hypothesis. An important therapeutic work can be done when early relation troubles exist between a mother and her child. The maternal perinatal depression screening and the child attachment troubles’ prevention are necessary, as it is often the case with migrant and impoverished population as recent meta-analyses show the impact of accumulated psychosocial risk factors on the increase of attachment disorganization.

S07-02 - Maternal perinatal depression: impact on infant emotion regulation and later toddler behavior problems

IntroductionPre-and Post-natal maternal stress and/or psychopathology can have negative effects on infant temperament and later toddler behavior (Buitelaar, Huizink, Mulder, Robles de Medina, &amp; Visser, 2003; Gutteling et al., 2005; Whitaker, Orzol, &amp; Kahn, 2006). Infant temperamental difficulties, such as shyness or emotional lability, have been associated with later behaviors problems as children develop (Olson, Bates, Sandy, &amp; Lanthier, 2000; Olson, Bates, Sandy, &amp; Schilling, 2002). In particular, infant emotionality and emotional reactivity has been suggested as an early precursor to externalizing problems in children (Crockenberg, 2005).Objectives/aimsThe goal of this research study is to explore the links and potential pathways between maternal perinatal depression and adverse infant and toddler behavior problems.MethodsThe present study utilizes data from a high-risk community sample and explores the links between maternal stress and depression during pregnancy and postpartum predicting to their infants’ emotion regulation problems at 7 months of age. On a smaller subset we further explore the associations between early emotion regulation problems and subsequent development of pre-school behavior problems.ResultsWe found that both maternal postpartum depression and problematic bonding uniquely predict problematic infant temperament at 7-months, and that in turn, infant emotion regulation problems were predictive of higher scores of toddler behavior problems 12 months later.ConclusionsOur preliminary data confirms that infant emotionality (in the context of maternal psychopathology and problematic bonding) may be an early precursor to the development of later toddler behavior problems.

CBT improves maternal perinatal depression in rural Pakistan

CBT improves maternal perinatal depression in rural Pakistan

Correlates of perinatal depression in HIV-infected women.

Maternal perinatal depression (PND) may interfere with effective perinatal HIV care. In order to begin examining the prevalence and characteristics of PND in HIV-infected women, we analyzed data from the medical records of all HIV-infected women who had received perinatal care in the Maternal-Child and Adolescent Center for Infectious Diseases and Virology at LAC/USC Medical Center from 1997 through 2006. Data from 273 individual women (328 live births) were analyzed. Demographic, medical history, psychosocial, pregnancy related, and HIV-related factors measured during the perinatal period were examined for an association with PND using multivariate logistic regression with generalized estimating equations to account for the within subject correlation due to multiple births per mother. The overall prevalence of PND was 30.8%. Multivariate analysis showed that PND was significantly associated with substance abuse during pregnancy (odds ratio [OR] = 2.81, 95% confidence interval [CI]: 1.35-5.82) and past history of psychiatric illness (OR = 3.72, 95% CI: 2.06-6.71). Compared to mothers with CD4 nadir greater than 500 cells/mm3, mothers with a CD4 nadir during pregnancy #200 cells=mm3 were 3.1 times more likely to experience PND (OR = 3.01, 95% CI: 1.32-6.88). Women who had antiretroviral (ARV) medications adherence problems during pregnancy were more likely to experience PND than women who were adherent (OR = 2.14, 95% CI: 1.08-4.23). These preliminary results suggest that rates of PND among HIV-infected women are substantial. We conclude that pregnant HIV-infected women should be routinely screened for PND. Prospective studies examining the bio-psycho-social markers of PND in HIV-infected women are indicated.

Aboriginal and Torres Strait Islander women's experience when interacting with the Edinburgh Postnatal Depression Scale: A brief note

The Edinburgh Postnatal Depression Scale (EPDS) is one of the most widely used screening instruments for maternal perinatal anxiety and depression. It has maintained its robust performance when translated into multiple languages, when used prenatally and when used with perinatal fathers; thus the tool is also known as the Edinburgh Depression Scale (EDS). However, there have been no published psychometric data on versions of the EPDS adapted for screening Australian Aboriginal and Torres Strait Islander women. We describe the development of 'translations' of the EPDS and report their basic psychometric properties. During the Queensland arm of the beyond blue National Postnatal Depression Program (2001-2005), partnerships with Aboriginal and Torres Strait Islander women were forged. At TAIHS' stand alone "Mums and Babies" unit 181 women of Aboriginal or Torres Strait Islander descent were recruited into the study through their antenatal and postnatal visits and 25 were recruited at Mt Isa. Participants completed either the translation or the standard version of the EPDS both antenatally and postnatally. The 'translations' of the EPDS demonstrated a high level of reliability. The was a strong correlation between the 'translations' and the EPDS. The 'translations' and the standard EPDS both identified high rates of women at risk of depression although the 'translations' identified higher rates. We argue that the 'translation' may have been a more accurate predictor of perinatal women at risk for depression, but acknowledge that a lack of validity evidence weakens this conclusion.