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Children’s behavioral problems tied to mothers’ postpartum depression

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Treat maternal depression early

This study raises new and interesting questions about the clinical effects of maternal depression on offspring, and identifies a particularly vulnerable group of mothers and their offspring. If anything, the findings are likely an underestimation of the true effect, because of high rates of study attrition, especially within the most vulnerable group.

However, this does not answer the question of what interventions to use, whom to treat, when to do so, and how to treat. Some would argue that clinicians should treat maternal depression first, as a woman with acute depression needs care before she can be helped with parenting. Others suggest that a better approach is to engage the unique mother-infant experience, as this can be a positive therapeutic interaction in itself.

Whatever the approach, the treatment of maternal depression should be evidence based and available early, particularly in new mothers with persistent depression.

Myrna M. Weissman, PhD, is affiliated with the division of epidemiology at Columbia University, New York. These comments are taken from an accompanying editorial (JAMA Psychiatry. 2018 Jan 31. doi: 10.1001/jamapsychiatry.2017.4265). Dr. Weissman declared funding from a variety of funding bodies and publishing companies outside the submitted work.



Persistent and severe postpartum depression in mothers may be associated with behavioral problems, poor mathematics grades, and a higher risk of depression in their offspring, research published Jan. 31 in JAMA Psychiatry showed.

In the study, Elena Netsi, DPhil, and her associates presented an analysis of data from 9,848 mothers and 8,287 children enrolled in the observational Avon Longitudinal Study of Parents and Children.

This analysis revealed that postpartum depression of any severity or level of persistence was associated with a two- to fourfold increase in the risk of children showing behavioral problems at age 3.5 years. In women with marked but not persistent postpartum depression, the odds ratio for child behavioral disturbance was 1.91, in mothers with severe but not persistent depression it was 2.39, and in mothers with severe persistent depression, the odds ratio was 4.84 – all of which were highly significant (P less than .001).

However, when it came to children’s mathematics grades at age 16 and their risk of depression at age 18, only severe persistent postpartum depression in mothers appeared to have a significant adverse effect, the authors reported.

It was associated with a 2.65-fold increase in the likelihood of a child having mathematics grades of D or below (P = .01), and a more than sevenfold increase in the prevalence of depression in offspring at 18 years (P less than .001). There also was a 2.3-fold increase in depression at 18 years in the children of mothers who experienced marked but not persistent postpartum depression (P = .04).

Dr. Netsi of the department of psychiatry at the University of Oxford (England) and her coauthors noted that, in women with persistent postpartum depression, mean Edinburgh Postpartum Depression Scale scores remained relatively stable, from 21 months to 11 years, suggesting an increased risk for prolonged depression.

“Identification of women with [postpartum depression] may be associated with increased treatment costs, but the overall cost to the public sector of perinatal mental health problems is five times more than the cost of improving services, further highlighting that early intervention and effective treatment of perinatal depression are a public health priority,” they wrote.

However, they acknowledged that there were mixed findings in the literature with respect to the impact on child outcomes of treating maternal depression.

“Treatments for [postpartum depression] have been relatively brief in duration and moderate in intensity; therefore, it is perhaps unsurprising that such interventions have not shown long-term benefits for either the mother or the child,” the investigators wrote.

The Avon Longitudinal Study of Parents and Children is supported by the U.K. Medical Research Council, the Wellcome Trust, and the University of Bristol. This study was supported by the Wellcome Trust, the National Institute for Health Research Biomedical Research Centre, the University of Bristol, and the NIHR Oxford Health Biomedical Research Centre. No conflicts of interest were declared.

SOURCE: Netsi E et al. JAMA Psychiatry. 2018 Jan 31. doi: 10.1001/jamapsychiatry.2017.4363.

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