Severe, persistent postnatal depression ups risks of adverse child outcomes
Severe postnatal depression (PND), especially if persisting up to 11 years after birth, raises the risk of adverse child outcomes such as child behavioural and developmental disturbances, according to a recent study.
“This observational study … found that, compared with children of women with postnatal depression that did not persist, of either moderate or severe intensity, children of women with persistent and severe depression are at an increased risk for behavioural problems by age 3.5 years as well as lower mathematics grades and depression during adolescence,” said researchers.
“Women with persistent and severe postnatal depression should be prioritized for treatment because they are likely to continue to experience high levels of depressive symptoms and because of the high risk of adverse child development,” they added.
The self-rated Edinburgh Postnatal Depression Scale (EPDS) was used to evaluate the severity and persistence of depressive symptoms in 9,848 mothers (mean age at delivery 28.5±4.7 years). Participants whose EPDS scores remained above the threshold at the 2- and 8-month postnatal follow-up showed persistent depressive symptoms up to 11 years after birth. [JAMA Psychiatry 2018;doi:10.1001/jamapsychiatry.2017.4363]
Nonpersistent depression, identified in mothers whose EPDS scores were above the threshold at only the 2-month follow-up, was associated with a modest increase in the risk of behavioural disturbances at 3.5 years of age, regardless of PND severity. The risk was significantly higher for those born to mothers with moderate (odds ratio [OR], 2.22; 95 percent CI, 1.74–2.83), marked (OR, 1.91; 1.36–2.68) and severe (OR, 2.39; 1.78–3.22; p<0.001 for all) nonpersistent PND.
In comparison, persistent depression, regardless of severity, resulted in higher risks of behavioural problems at 3.5 years of age. The corresponding ORs for moderate, marked and severe persistent PND were 3.04 (2.10–4.38), 2.84 (1.71–4.71) and 4.84 (2.94–7.98; p<0.001 for all).
Severe and persistent PND was also significantly associated with higher risks of offspring depression at 18 years (OR, 7.44; 2.89–19.11; p<0.001) and lower mathematics grades at 16 years (OR, 2.65; 1.26–5.57; p=0.01). Persistent PND of other severities and nonpersistent PND of any severity did not show such associations.
In an accompanying editorial, Dr Myrna Weissman of the Division of Epidemiology at Columbia University College of Physicians and Surgeons noted that the current findings further expand on a field that already seemed thoroughly studied. “Just when it seemed that nothing new could be written about the clinical effects of maternal depression on offspring, an article has appeared that deepens our insight and raises new, interesting questions.” [JAMA Psychiatry 2018;doi:10.1001/jamapsychiatry.2017.4265]
Weissman argued that, despite its limitations, the study raised new and interesting points which fill in gaps in the current literature. Particularly, the higher risk of depression in children born to mothers with persistent and severe depression raises the question of whether these children in utero were exposed to antidepressants, which their mothers may have taken during pregnancy.
“This question might be answerable via further analysis of the [Avon Longitudinal Study of Parents and Children] data,” she added, noting that the present paper set the stage for many other such questions.
“Whether to treat maternal depression first, when to intervene with the mother and her infant and young children, and what treatment to use are open, researchable questions of considerable public health importance, which are worth expenditures of public funds. Anticipation of these future studies is stoked by this most interesting paper,” Weissman said.