The contribution of prenatal and postnatal maternal anxiety and depression to child maladjustment
TL;DR: In both the prenatal and postnatal periods, maternal depression had a wider impact on different types of child maladjustment than maternal anxiety, which appeared more specific to internalizing difficulties in the child.
Abstract: The adverse effect of both pre- and post-natal maternal anxiety and depression on the development of offspring is shown by a large body of research. No published studies, however, have simultaneously: (i) controlled for co-occurring prenatal risks that may influence maternal prenatal anxiety and depression; (ii) compared the relative contributions of prenatal and postnatal maternal anxiety and depression on child functioning; and (iii) assessed a full range of child psychopathology and functioning to determine the relative effects of prenatal and postnatal anxiety and depression in the mother.|Using 3,298 mother-offspring pairs, the authors examined these factors in a single-path analytic model. Measurements of maternal anxiety and depression were collected at two time points: 32 weeks prenatal and 1.5 years postnatal. Other prenatal risks were assessed between 8 and 32 weeks of gestation. Child outcomes included (a) ordered-categorical measures of DSM-IV externalizing and internalizing disorders, and (b) an assessment of verbal IQ.|In both the prenatal and postnatal periods, maternal depression had a wider impact on different types of child maladjustment than maternal anxiety, which appeared more specific to internalizing difficulties in the child. Of note, prenatal risks were prospectively associated with child externalizing difficulties and verbal IQ, beyond the effects of prenatal and postnatal maternal anxiety and depression.|The present results suggest that addressing both maternal anxiety and depression, in the prenatal and postnatal periods-as well as associated risk factors-may be the most effective approach to prevent adverse outcomes in the offspring.
Citations
More filters
TL;DR: Evidence for associations between parental disorders and offspring outcomes from fetal development to adolescence in high-income, middle- income, and low-income countries is summarized and the need for early identification of those parents at high risk and for more early interventions and prevention research is underlined.
1,427 citations
TL;DR: Results suggest perinatal anxiety is highly prevalent and merits clinical attention, and research is warranted to develop evidence-based interventions.
Abstract: BackgroundMaternal anxiety negatively influences child outcomes. Reliable estimates have not been established because of varying published prevalence rates.AimsTo establish summary estimates for the prevalence of maternal anxiety in the antenatal and postnatal periods.MethodWe searched multiple databases including MEDLINE, Embase, and PsycINFO to identify studies published up to January 2016 with data on the prevalence of antenatal or postnatal anxiety. Data were extracted from published reports and any missing information was requested from investigators. Estimates were pooled using random-effects meta-analyses.ResultsWe reviewed 23 468 abstracts, retrieved 783 articles and included 102 studies incorporating 221 974 women from 34 countries. The prevalence for self-reported anxiety symptoms was 18.2% (95% CI 13.6-22.8) in the first trimester, 19.1% (95% CI 15.9-22.4) in the second trimester and 24.6% (95% CI 21.2-28.0) in the third trimester. The overall prevalence for a clinical diagnosis of any anxiety disorder was 15.2% (95% CI 9.0-21.4) and 4.1% (95% CI 1.9-6.2) for a generalised anxiety disorder. Postnatally, the prevalence for anxiety symptoms overall at 1-24 weeks was 15.0% (95% CI 13.7-16.4). The prevalence for any anxiety disorder over the same period was 9.9% (95% CI 6.1-13.8), and 5.7% (95% CI 2.3-9.2) for a generalised anxiety disorder. Rates were higher in low- to middle-income countries.ConclusionsResults suggest perinatal anxiety is highly prevalent and merits clinical attention. Research is warranted to develop evidence-based interventions.
721 citations
TL;DR: Depression, anxiety, and stress during pregnancy are frequently undetected by health professionals, and untreated, so programs to help with this should eventually improve child outcome.
Abstract: Care for the emotional state of pregnant women remains a neglected aspect of obstetric medicine. Many prospective studies have shown that, if a mother is depressed, anxious, or stressed while pregnant, this increases the risk for her child having a wide range of adverse outcomes, including emotional problems, symptoms of attention deficit hyperactivity disorder, or impaired cognitive development. Although genetics and postnatal care clearly affect these outcomes, evidence for an additional prenatal causal component is substantial. Prenatal anxiety or depression may contribute 10–15% of the attributable load for emotional and behavioural outcomes. The Nurse Family Partnership remains the only intervention that starts in pregnancy and has been shown to have long-term benefits for the behaviour of the child. Several other interventions, however, are likely to be helpful. Depression, anxiety, and stress during pregnancy are frequently undetected by health professionals, and untreated. Programmes to help with this should eventually improve child outcome.
593 citations
TL;DR: Many prospective studies have shown that if a mother is depressed, anxious or stressed while pregnant, this increases the risk for her child having a wide range of adverse outcomes including emotional problems, symptoms of attention deficit hyperactivity disorder (ADHD) or impaired cognitive development.
Abstract: Many prospective studies have shown that if a mother is depressed, anxious or stressed while pregnant, this increases the risk for her child having a wide range of adverse outcomes including emotional problems, symptoms of attention deficit hyperactivity disorder (ADHD) or impaired cognitive development. Although genetics and postnatal care clearly affect these outcomes, evidence for a prenatal causal component also is substantial. Prenatal anxiety/depression may contribute 10–15 % of the attributable load for emotional/behavioural outcomes.
262 citations
TL;DR: Exposure to prenatal depression coupled with subsequent cortical thinning was associated with presence of externalizing behavior in preadolescent children and may be prodromal markers of risk for dysphoria.
179 citations
Cites background or result from "The contribution of prenatal and po..."
...Our finding of increased incidence of externalizing problems in children exposed to prenatal maternal depression is consistent with reports that prenatal maternal depression significantly increased the risk for externalizing behaviors in toddlers (29) and adolescents (31)....
[...]
...(29) reported that prenatal maternal depression, but not anxiety or postpartum depression,...
[...]
References
More filters
TL;DR: In this paper, two types of error involved in fitting a model are considered, error of approximation and error of fit, where the first involves the fit of the model, and the second involves the model's shape.
Abstract: This article is concerned with measures of fit of a model. Two types of error involved in fitting a model are considered. The first is error of approximation which involves the fit of the model, wi...
25,611 citations
TL;DR: In this article, a general null model based on modified independence among variables is proposed to provide an additional reference point for the statistical and scientific evaluation of covariance structure models, and the importance of supplementing statistical evaluation with incremental fit indices associated with the comparison of hierarchical models.
Abstract: Factor analysis, path analysis, structural equation modeling, and related multivariate statistical methods are based on maximum likelihood or generalized least squares estimation developed for covariance structure models. Large-sample theory provides a chi-square goodness-of-fit test for comparing a model against a general alternative model based on correlated variables. This model comparison is insufficient for model evaluation: In large samples virtually any model tends to be rejected as inadequate, and in small samples various competing models, if evaluated, might be equally acceptable. A general null model based on modified independence among variables is proposed to provide an additional reference point for the statistical and scientific evaluation of covariance structure models. Use of the null model in the context of a procedure that sequentially evaluates the statistical necessity of various sets of parameters places statistical methods in covariance structure analysis into a more complete framework. The concepts of ideal models and pseudo chi-square tests are introduced, and their roles in hypothesis testing are developed. The importance of supplementing statistical evaluation with incremental fit indices associated with the comparison of hierarchical models is also emphasized. Normed and nonnormed fit indices are developed and illustrated.
16,420 citations
"The contribution of prenatal and po..." refers background in this paper
...90)[44] and root mean square error of approximation (acceptable fit 5o0....
[...]
TL;DR: The development of a 10-item self-report scale (EPDS) to screen for Postnatal Depression in the community was found to have satisfactory sensitivity and specficity, and was also sensitive to change in the severity of depression over time.
Abstract: The development of a 10-item self-report scale (EPDS) to screen for Postnatal Depression in the community is described. After extensive pilot interviews a validation study was carried out on 84 mothers using the Research Diagnostic Criteria for depressive illness obtained from Goldberg's Standardised Psychiatric Interview. The EPDS was found to have satisfactory sensitivity and specificity, and was also sensitive to change in the severity of depression over time. The scale can be completed in about 5 minutes and has a simple method of scoring. The use of the EPDS in the secondary prevention of Postnatal Depression is discussed.
10,857 citations
TL;DR: A developmentally sensitive, integrative model for understanding children's risk in relation to maternal depression is proposed and three factors that might moderate this risk are considered.
Abstract: A large body of literature documents the adverse effects of maternal depression on the functioning and development of offspring. Although investigators have identified factors associated with risk for abnormal development and psychopathology in the children, little attention has been paid to the mechanisms explaining the transmission of risk from the mothers to the children. Moreover, no existing model both guides understanding of the various processes' interrelatedness and considers the role of development in explicating the manifestation of risk in the children. This article proposes a developmentally sensitive, integrative model for understanding children's risk in relation to maternal depression. Four mechanisms through which risk might be transmitted are evaluated: (a) heritability of depression; (b) innate dysfunctional neuroregulatory mechanisms; (c) exposure to negative maternal cognitions, behaviors, and affect; and (d) the stressful context of the children's lives. Three factors that might moderate this risk are considered: (a) the father's health and involvement with the child, (b) the course and timing of the mother's depression, and (c) characteristics of the child. Relevant issues are discussed, and promising directions for future research are suggested.
2,278 citations
TL;DR: A meta-analysis of 193 studies was conducted to examine the strength of the association between mothers’ depression and children’s behavioral problems or emotional functioning, with implications for theoretical models that move beyond main effects models in order to more accurately identify which children of depressed mothers are more or less at risk for specific outcomes.
Abstract: Although the association between maternal depression and adverse child outcomes is well established, the strength of the association, the breadth or specificity of the outcomes, and the role of moderators are not known This information is essential to inform not only models of risk but also the design of preventive interventions by helping to identify subgroups at greater risk than others and to elucidate potential mechanisms as targets of interventions A meta-analysis of 193 studies was conducted to examine the strength of the association between mothers’ depression and children’s behavioral problems or emotional functioning Maternal depression was significantly related to higher levels of internalizing, externalizing, and general psychopathology and negative affect/behavior and to lower levels of positive affect/behavior, with all associations small in magnitude These associations were significantly moderated by theoretically and methodologically relevant variables, with patterns of moderation found to vary somewhat with each child outcome Results are interpreted in terms of implications for theoretical models that move beyond main effects models in order to more accurately identify which children of depressed mothers are more or less at risk for specific outcomes
2,044 citations
"The contribution of prenatal and po..." refers background or result in this paper
...These results are interesting in that they support a recent finding of a ‘‘general effect’’ of postnatal maternal depression on multiple indices of child function;[5] as well as research in a risk high sample,[20] which also reported depression during pregnancy to negatively impact child verbal development....
[...]
...[25,26] A recent meta-analysis reported that the magnitude of the effects of maternal depression on child externalizing and internalizing difficulties is greater the younger the age of the child at first exposure.[5] As with depression, anxiety in the mother is reported to associate with poor parenting—anxious mothers have been reported to be negative and disengaged....
[...]
...[37,38] In addition, recent meta-analyses suggest that (a) the size of the effect of maternal depression on child outcomes, as measured by maternal reports on scale formats versus clinical diagnoses, do not significantly differ;[5] and (b) increased reliability and validity in continuous versus categorical measures of 697 Research Article: Maternal Anxiety and Depression...
[...]