In the Journals

Persistent postpartum depression worsens outcomes for child

Elena Netsi

Longitudinal study findings revealed that persistent and severe maternal postpartum depression significantly increased the risk for behavioral problems, lower grades in math and depression in the child.

“Evidence suggests that both persistent [postnatal depression] and severe [postnatal depression] raise the risk of adverse child outcomes. However, [postnatal depression] that is both severe and persistent has not been well described in the literature,” Elena Netsi, DPhil, from the department of psychiatry, University of Oxford, and colleagues wrote in JAMA Psychiatry. “Elucidating the relative magnitude of the consequences for children of different levels of [postnatal depression] severity and persistence could help with targeting intervention resources, thereby limiting the time children are exposed to maternal depression and potentially compromised parenting.”

To determine the relationship between the persistence and severity of postpartum depression and long-term child outcomes, researchers conducted an observational study of 9,848 mothers and 8,287 children enrolled in the Avon Longitudinal Study of Parents and Children in the United Kingdom. Netsi and colleagues measured postpartum severity — categorized as moderate, marked or severe — using the Edinburgh Postnatal Depression Scale (EPDS) and persistent depression, defined as depression at both 2 and 8 months post-childbirth. They examined changes in EPDS scores at six points from 21 months to 11 years after childbirth and child outcomes, including behavioral problems at age 3.5 years, school-leaving mathematics grades at age 16 years and depression at age 18 years.

For all three severity levels, women with persistent postpartum depression showed higher depressive symptoms up to 11 years post-childbirth compared with those without persistent, severe postpartum depression. Postpartum depression doubled the risk for child behavior disturbance, regardless of persistence. The odds ratio for child behavioral disturbance born to mothers with moderate postpartum depression was 2.22 (95% CI, 1.74-2.83), 1.91 for marked postpartum depression (95% CI, 1.36-2.68), and 2.39 for severe postpartum depression (95% CI, 1.78-3.22). Persistence of severe postpartum depression significantly heightened the risk for child behavioral problems at age 3.5 years (OR = 4.84; 95% CI, 2.94-7.98), lower mathematics grades at age 16 years (OR = 2.65; 95% CI, 1.26-5.57) and higher prevalence of depression at age 18 years (OR, 7.44; 95% CI, 2.89-19.11).

“Our study shows that episodes of postnatal depression that are brief in duration, while understandably distressing to the mother, may not impact on children’s development. When depression, however, persists beyond the first 6 months after birth, and especially when the symptoms are severe, the risk for negative effects in the short- and long-term both for women and for their children is raised,” Netsi told Healio Psychiatry. “Screening both early and late in the postnatal year will help identify families where the depression is both persistent and severe and who should be prioritized for treatment. This is important, as good evidence-based treatments are available for depression.”

In an accompanying editorial, Myrna M. Weissman, PhD, from the division of epidemiology, Colombia University College of Physicians and Surgeons, New York State Psychiatric Institute, wrote that treating maternal depression should be evidence-based, long-term and available early, particularly for new mothers with persistent postpartum depression.

“To capture the persistence of postpartum depression, the screening for depression, which is now recommended during pregnancy, could be extended to 1 year after delivery and administered during well-baby visits,” Weissman wrote. “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.” – by Savannah Demko

Disclosures: Netsi and colleagues report no relevant financial disclosures. Weissman reports funding from the National Institute of Mental Health, the National Alliance for Research on Schizophrenia and Depression, the Sackler Foundation and the Templeton Foundation. She also received royalties from the American Psychiatric Association Press, MultiHealth Systems, Oxford University Press and Perseus Press.

Elena Netsi

Longitudinal study findings revealed that persistent and severe maternal postpartum depression significantly increased the risk for behavioral problems, lower grades in math and depression in the child.

“Evidence suggests that both persistent [postnatal depression] and severe [postnatal depression] raise the risk of adverse child outcomes. However, [postnatal depression] that is both severe and persistent has not been well described in the literature,” Elena Netsi, DPhil, from the department of psychiatry, University of Oxford, and colleagues wrote in JAMA Psychiatry. “Elucidating the relative magnitude of the consequences for children of different levels of [postnatal depression] severity and persistence could help with targeting intervention resources, thereby limiting the time children are exposed to maternal depression and potentially compromised parenting.”

To determine the relationship between the persistence and severity of postpartum depression and long-term child outcomes, researchers conducted an observational study of 9,848 mothers and 8,287 children enrolled in the Avon Longitudinal Study of Parents and Children in the United Kingdom. Netsi and colleagues measured postpartum severity — categorized as moderate, marked or severe — using the Edinburgh Postnatal Depression Scale (EPDS) and persistent depression, defined as depression at both 2 and 8 months post-childbirth. They examined changes in EPDS scores at six points from 21 months to 11 years after childbirth and child outcomes, including behavioral problems at age 3.5 years, school-leaving mathematics grades at age 16 years and depression at age 18 years.

For all three severity levels, women with persistent postpartum depression showed higher depressive symptoms up to 11 years post-childbirth compared with those without persistent, severe postpartum depression. Postpartum depression doubled the risk for child behavior disturbance, regardless of persistence. The odds ratio for child behavioral disturbance born to mothers with moderate postpartum depression was 2.22 (95% CI, 1.74-2.83), 1.91 for marked postpartum depression (95% CI, 1.36-2.68), and 2.39 for severe postpartum depression (95% CI, 1.78-3.22). Persistence of severe postpartum depression significantly heightened the risk for child behavioral problems at age 3.5 years (OR = 4.84; 95% CI, 2.94-7.98), lower mathematics grades at age 16 years (OR = 2.65; 95% CI, 1.26-5.57) and higher prevalence of depression at age 18 years (OR, 7.44; 95% CI, 2.89-19.11).

“Our study shows that episodes of postnatal depression that are brief in duration, while understandably distressing to the mother, may not impact on children’s development. When depression, however, persists beyond the first 6 months after birth, and especially when the symptoms are severe, the risk for negative effects in the short- and long-term both for women and for their children is raised,” Netsi told Healio Psychiatry. “Screening both early and late in the postnatal year will help identify families where the depression is both persistent and severe and who should be prioritized for treatment. This is important, as good evidence-based treatments are available for depression.”

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In an accompanying editorial, Myrna M. Weissman, PhD, from the division of epidemiology, Colombia University College of Physicians and Surgeons, New York State Psychiatric Institute, wrote that treating maternal depression should be evidence-based, long-term and available early, particularly for new mothers with persistent postpartum depression.

“To capture the persistence of postpartum depression, the screening for depression, which is now recommended during pregnancy, could be extended to 1 year after delivery and administered during well-baby visits,” Weissman wrote. “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.” – by Savannah Demko

Disclosures: Netsi and colleagues report no relevant financial disclosures. Weissman reports funding from the National Institute of Mental Health, the National Alliance for Research on Schizophrenia and Depression, the Sackler Foundation and the Templeton Foundation. She also received royalties from the American Psychiatric Association Press, MultiHealth Systems, Oxford University Press and Perseus Press.