Objective: To follow mothers9 mood through pregnancy and after childbirth and compare reported symptoms of depression at each stage. Design: Longitudinal cohort study. Setting: Avon. Participants: Pregnant women resident within Avon with an expected date of delivery between 1 April 1991 and 31 December 1992. Main outcome measures: Symptom scores from the Edinburgh postnatal depression scale at 18 and 32 weeks of pregnancy and 8 weeks and 8 months postpartum. Proportion of women above a threshold indicating probable depressive disorder. Results: Depression scores were higher at 32 weeks of pregnancy than 8 weeks postpartum (difference in means 0.88, 95% confidence interval 0.79 to 0.97). There was no difference in the distribution of total scores or scores for individual items at the four time points. 1222 (13.5%) women scored above threshold for probable depression at 32 weeks of pregnancy, 821 (9.1%) at 8 weeks postpartum, and 147 (1.6%) throughout. More mothers moved above the threshold for depression between 18 weeks and 32 weeks of pregnancy than between 32 weeks of pregnancy and 8 weeks postpartum. Conclusions: Symptoms of depression are not more common or severe after childbirth than during pregnancy. Research and clinical efforts need to be moved towards understanding, recognising, and treating antenatal depression.

https://www.bmj.com/content/bmj/323/7307/257.full.pdf

Cohort study of depressed mood during pregnancy and after childbirth

Objective: The Edinburgh Postnatal Depression Scale (EPDS) is the most widely used screening tool for postpartum depression (PPD). We systematically reviewed the published evidence on its validity in detecting PPD and antepartum depression (APD) up to July 2008.

Method:  Systematic review of validation studies of the EPDS included 1987–2008. Cut-off points of 9/10 for possible PPD, 12/13 for probable PPD and 14/15 for APD were used.

Results:  Thirty-seven studies met the inclusion criteria. Sensitivity and specificity of cut-off points showed marked heterogeneity between different studies. Sensitivity results ranged from 34 to 100% and specificity from 44 to 100%. Positive likelihood ratios ranged from 1.61 to 78.

Conclusion:  Heterogeneity among study findings may be due to differences in study methodology, language and diagnostic interview/criteria used. Therefore, the results of different studies may not be directly comparable and the EPDS may not be an equally valid screening tool across all settings and contexts.

A systematic review of studies validating the Edinburgh Postnatal Depression Scale in antepartum and postpartum women.

Background: The effects of marital conflict on children's adjustment are well documented. For the past decade research has increasingly focused on advancing a process-level understanding of these effects, that is, accounting for the particular responses and patterns embedded within specific contexts, histories, and developmental periods that account for children's outcomes over time. Methods: As a vehicle for presenting an update, this review follows the framework for process-oriented research initially proposed by Cummings and Cummings (1988), concentrating on recent research developments, and also considering new and emerging themes in this area of research. Results: In this regard, areas of advancement include (a) greater articulation of the effects of specific context/stimulus characteristics of marital conflict, (b) progress in identifying the psychological response processes in children (e.g., cognitive, emotional, social, physiological) that are affected and their possible role in accounting for relations between marital conflict and child outcomes, (c) greater understanding of the role of child characteristics, family history, and other contextual factors, including effects on children due to interrelations between marital conflict and parenting, and (d) advances in the conceptualization of children's outcomes, including that effects may be more productively viewed as dynamic processes of functioning rather than simply clinical diagnoses. Conclusions: Understanding of the impact of marital conflict on children as a function of time-related processes remains a gap in a process-oriented conceptualization of effects. Based on this review, a revised model for a process-oriented approach on the effects of marital discord on children is proposed and suggestions are made for future research directions.

Effects of marital conflict on children: recent advances and emerging themes in process‐oriented research

¶The incidence of postpartum depression (PPD) in Western societies is approximately 10–15% and its cause multi-faceted. Because mothers largely constitute infants’ social environment and mediate their experience of the external world, it is imperative to investigate the effects of PPD on child growth and development. PsycInfo, Medline, Embase, CINAHL, ProQuest, and Health Star databases were searched with key terms for English language abstracts from 1990 onwards, and key contents were searched. There are small effects of PPD on cognitive development such as language and IQ, seen particularly among boys. Behavioral effects are variably supported, but may persist up to 5 years postpartum and beyond. However, chronic or recurrent maternal depression, rather than postpartum depression per se is likely related to later effects on the child. These adverse effects of PPD based on sex of infant are discussed.

The effect of postpartum depression on child cognitive development and behavior: A review and critical analysis of the literature

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(05)66778-5.pdf

Paternal depression in the postnatal period and child development: a prospective population study

A community sample of depressed and well mothers, recruited at 2 months postpartum and assessed through to 18 months, was followed up at 5 years. The quality of mother-child interactions was assessed, as was the children's behavioural and social adjustment, using maternal reports and observations of child behaviour during free play at school. Several aspects of child outcome were found to be associated with postnatal depression, even when taking account of current adverse circumstances (maternal depression and parental conflict). These included the child's behaviour with the mother, the presence of behavioural disturbance at home, and the content and social patterning of play at school. These associations with postnatal depression were independent of the child's gender. The child's relationship with the mother appeared to be mediated by the quality of infant attachment at 18 months. The mother's behaviour with her child was more affected by current difficulties, in particular by conflict with the child's father. Together these findings suggest that, while maternal behaviour varies with changing circumstances, exposure to maternal depression in the early postpartum months may have an enduring influence on child psychological adjustment.

The Socioemotional Development of 5‐year‐old Children of Postnatally Depressed Mothers

BACKGROUND Little is known of the behavioural adjustment of children of postnatally depressed mothers. Previous studies have relied on maternal reports, and have produced inconsistent findings.

METHOD In a prospective, longitudinal study of the five-year-old children of a community sample of postnatally depressed and well women, evidence was collected concerning the children's adjustment in the context of school, teachers being asked to complete questionnaires after the children had finished their first term.

RESULTS Family social class and the child's gender had the most pervasive influences on adjustment. However, both postnatal and recent maternal depression were associated with significantly raised levels of child disturbance, particularly among boys and those from lower social class families.

CONCLUSIONS The findings indicate a persistent effect of postnatal depression on child adjustment. They highlight the need for resources devoted to supporting mothers of young children and particularly routine screening and treatment for postnatal mood disorder.

Dana Sinclair

Papers

The Socioemotional Development of 5‐year‐old Children of Postnatally Depressed Mothers

Effects of postnatal depression on children's adjustment to school. Teacher's reports.