The association of different presentations of maternal depression with children's socio-emotional development: A systematic review

Effect of a Tailored eHealth Physical Activity Intervention on Physical Activity and Depression During Postpartum: Randomized Controlled Trial (The Postpartum Wellness Study)

Background

Strong evidence suggests physical activity (PA) can ameliorate postpartum depression (PPD) symptoms; however, many postpartum individuals do not meet PA guidelines. Electronic health (eHealth) interventions are a promising approach to address common barriers to PA during postpartum.

Objective

To test the effectiveness of a tailored eHealth PA intervention for increasing PA and decreasing depressive symptoms in individuals at high risk for PPD.

Methods

We conducted a randomized controlled trial within the Kaiser Permanente Northern California integrated health care delivery system. From November 2020 to September 2022, individuals 2-6 months postpartum at high risk for PPD were randomized to an eHealth PA intervention (n=50) or usual care (n=49). The eHealth PA intervention group received access to an online library of 98 ten-minute workout videos developed for postpartum individuals, including interaction with their infants. At baseline, 3 months, and 6 months postrandomization, surveys were used to assess depressive symptoms, PA, sleep quality, anxiety symptoms, perceived stress, and mother-infant bonding. PA was also measured using a wrist-worn accelerometer for 7 days at each timepoint. Primary outcomes were depressive symptoms and device-measured moderate-to-vigorous intensity PA (dm-MVPA) at 3 months postrandomization. Secondary outcomes were self-reported MVPA (sr-MVPA) at 3 and 6 months postrandomization and depressive symptoms and dm-MVPA at 6 months postrandomization. Intent-to-treat and modified intent-to-treat (excluding participants in the intervention group who did not watch at least 1 video) analyses were conducted using linear regression adjusted for variables used in the randomization procedure and using multiple imputation to account for missing data.

Results

Participants were 4 months postpartum at baseline with moderately severe depressive symptoms (mean PHQ-8 [Patient Health Questionnaire-8] score=12.6), on average. Intent-to-treat analyses indicated no association between the intervention and change in depressive symptoms (mean difference=-0.9; 95% CI -3.3 to 1.5), dm-MVPA per day (mean difference=-4.5 minutes; 95% CI -23.5 to 14.5), or sr-MVPA per week (mean difference=3.8; 95% CI -1.9 to 9.5) at 3 months postrandomization or 6 months postrandomization (depressive symptoms: mean difference=-1.3; 95% CI -3.7 to 1.1; dm-MVPA: mean difference=1.3 minutes; 95% CI -18.9 to 21.5; sr-MVPA: mean difference=-1.8 MET-hours; 95% CI -7.7 to 4.2). Engagement with the intervention was suboptimal; although 52% (n=26) of participants allocated to the intervention group logged on to the intervention website and watched at least 1 video, the median minutes watched per week peaked at 10 minutes 2 weeks postrandomization, then fell to zero for the rest of the follow-up period. Results from modified intent-to-treat analyses were similar to those from intent-to-treat analyses.

Conclusions

An eHealth PA intervention tailored to postpartum individuals did not affect depressive symptoms or PA among those at high risk for PPD. Additional research to develop effective and engaging PA interventions is needed to help alleviate PPD symptoms and decrease PPD risk.

Are Children's Externalizing and Internalizing Behaviours at 5 Years Predicted by Maternal Perinatal Depression Trajectory Profiles?

Background/Objectives: Mothers' depressive symptoms are associated with their children's internalizing and externalizing behavioural problems. Because mothers' depressive symptoms can vary across the prenatal and postnatal periods, considering their trajectories is important when predicting children's behavioural problems. The purposes of this study were to: (1) identify profiles of mothers characterized by their prenatal and postnatal (up to 3 years postpartum) depressive symptom trajectories and (2) examine the associations between maternal depressive symptom profile trajectories and preschool children's internalizing and externalizing behavioural problems at 5 years of age. Methods: This study used data derived from the APrON Study. The Edinburgh Postnatal Depression Scale measured mothers' depressive symptoms in early (<27 weeks) and late (≥27 weeks) pregnancy and at 3, 6, 12, 24, and 36 months postpartum. The Behavioural Assessment Scales for Children, 2nd Edition, quantified children's internalizing and externalizing problems at approximately 60 months of age. Non-growth latent profile analysis determined the most suitable and parsimonious number of maternal depressive symptom profiles, and linear regression analysis quantified their associations with their 5-year-old-children's behavioural problems. Results: A three-profile structure characterized maternal depressive symptom trajectories: minimal, subclinical, and high. Unadjusted (n = 704) and adjusted (n = 621) analyses showed that: 1) mothers' subclinical and high depressive symptom profiles (p < 0.01) predicted children's internalizing problems and 2) mothers' subclinical depressive symptom profiles (p < 0.01) predicted externalizing problems. Conclusions: Maternal subclinical depressive symptoms were equally, if not more, important compared to high depressive symptoms in predicting children's behavioural problems. Overlooking mothers with subclinical depressive symptoms could have implications for their children's behavioural/mental health.

Examining the association between maternal prenatal psychiatric disorders and behavioural problems among offspring in early childhood: population-based study

BACKGROUND

Exposure to maternal mental illness during foetal development may lead to altered development, resulting in permanent changes in offspring functioning.

AIMS

To assess whether there is an association between prenatal maternal psychiatric disorders and offspring behavioural problems in early childhood, using linked health administrative data and the Australian Early Development Census from New South Wales, Australia.

METHOD

The sample included all mother-child pairs of children who commenced full-time school in 2009 in New South Wales, and met the inclusion criteria (N = 69 165). Univariable logistic regression analysis assessed unadjusted associations between categories of maternal prenatal psychiatric disorders with indicators of offspring behavioural problems. Multivariable logistic regression adjusted the associations of interest for psychiatric categories and a priori selected covariates. Sensitivity analyses included adjusting the final model for primary psychiatric diagnoses and assessing association of interest for effect modification by child's biological gender.

RESULTS

Children exposed in the prenatal period to maternal psychiatric disorders had greater odds of being developmentally vulnerable in their first year of school. Children exposed to maternal anxiety disorders prenatally had the greatest odds for behavioural problems (adjusted odds ratio 1.98; 95% CI 1.43-2.69). A statistically significant interaction was found between child biological gender and prenatal hospital admissions for substance use disorders, for emotional subdomains, aggression and hyperactivity/inattention.

CONCLUSIONS

Children exposed to prenatal maternal mental illness had greater odds for behavioural problems, independent of postnatal exposure. Those exposed to prenatal maternal anxiety were at greatest risk, highlighting the need for targeted interventions for, and support of, families with mental illness.

Modelling the associations between parental depressive symptoms, hypomanic traits, and infant socio-emotional development: The mediating role of parental reflective functioning

BACKGROUND

Although understanding of maternal hypomania in the postpartum period is gradually improving, the intergenerational pathways of risk associated with hypomania in the context of postpartum depression remain unknown. It is also unclear whether distinct or shared pathways of risk exist for infants exposed to different parental mood characteristics and whether these pathways are mediated by parental reflective functioning.

METHODS

An online survey was administered to 1788 parents (89 % mothers, 50 % White) who were primary caregivers of a child under 2. Structural equation modelling techniques were employed to model direct and indirect associations between parental depressive symptoms, hypomanic traits and infant socio-emotional development, investigating the mediating role of parental reflective functioning.

RESULTS

Elevated levels of parental depressive symptoms, in the presence of hypomanic personality traits, were directly associated with infant socio-emotional challenges, without affecting parental reflective functioning. However, higher levels of parental hypomanic traits in the postnatal period displayed a fully mediated pathway of risk transmission to infants' socio-emotional development via their negative association with parental reflective functioning.

LIMITATIONS

Results should be interpreted with caution as the reliance on self-and-parent-reported scales may have introduced biases influenced by individual perceptions and situational factors. Additionally, the cross-sectional design of this study inhibits establishing cause-and-effect relationships.

CONCLUSIONS

Overall, these results highlight the critical role of both parental depressive symptoms and hypomanic traits on infant socio-emotional development, suggesting that supporting parental mood regulation and mentalizing abilities in the postnatal period could reduce the risk of early maladaptive socio-emotional trajectories in children.

Peripartum Depression: What's New?

PURPOSE OF THE REVIEW

Peripartum depression (PPD), including both depression during pregnancy and postpartum, is the most frequent health disorder during the perinatal period. It is a significant public health issue in many countries due to its prevalence and its impact on women, as well as on their partners and offspring. Here, we will attempt to untangle the most recent studies and publications, considering what it is essential to know in 2024 about PPD as a specific perinatal issue.

RECENT FINDINGS

PPD appears to be a very heterogeneous disorder in which a complex interplay between different factors contributes to its pathophysiology. Thus, the need to enhance diagnosis and referral through a better understanding of its severity and co-morbidities has emerged as a major public health issue. Indeed, research has consistently shown that PPD negatively impacts parent-infant interactions and infants' cognitive, social, and emotional development. Evidence underlining its global risk has accumulated over the past three decades, but many questions remain, including how these vulnerable offspring developmental trajectories unfold.

The association of maternal mental health with vaccination coverage and timeliness in early childhood - A historical cohort study in England using electronic health records

BACKGROUND

Maternal mental illness (MMI) affects almost a quarter of mothers and may impact a child's development and physical health. It remains unclear whether MMI is associated with altered utilization of vaccination services. Understanding this association could help to identify families in need of additional support.

METHODS

Using primary care data from England, we conducted a historical cohort study of 397,519 children born in England between 2006 and 2014 with linked maternal records. Associations between different types of MMI (common mental disorders, severe mental illness and alcohol and substance use disorder) with childhood immunisation were explored using logistic regression for differences in coverage and accelerated failure time models for differences in timeliness before the child's fifth birthday.

RESULTS

While there were no differences in vaccination coverage at the age of one, children of mothers with common mental disorders had lower odds of being vaccinated at the ages of two (OR 0.95, 95 %CI: 0.93-0.98) and five (OR 0.86, 95 % CI 0.84-0.89) in comparison to children of mothers with no record of MMI. Vaccination coverage was even lower for children of mothers with comorbid substance disorder and common mental disorder (OR 0.70, 95 % CI: 0.62-0.78 at the age of five). There were no significant differences in timeliness of vaccine receipt by MMI.

CONCLUSIONS

Inequalities in vaccination coverage associated with MMI grow with increasing age of the child. Extending support services for women with MMI beyond the child's first year of life could offer potential to improve vaccination uptake and reduce childhood infections.

Thinking about the next generation: The case for a mentalization-informed approach to perinatal and intergenerational mental health

BACKGROUND

There has been substantial progress made across multiple disciplines to emphasize the importance of perinatal mental health both for parents and offspring. This focuses on what has been termed the 'First 1000 Days' from conception to the child's second birthday. We argue that our understanding of this issue can go further to create an intergenerational approach to mental health. Despite the existence of theoretical frameworks and practical approaches to implementation, there are gaps in the understanding of perinatal and intergenerational mental health including which psychological mechanisms are implicated in the transmission of risk and resilience within the perinatal period; and how to leverage these into treatment approaches.

AIMS AND METHODS

In this paper, we explore the potential for mentalization as a candidate psychological approach to intergenerational mental health.

RESULTS

We contextualize this issue in terms of the points of contact between mentalization and broader theoretical models such as the social determinants of health and the Developmental Origins of Health and Disease (DoHaD) model. Further, we provide an overview of the existing evidence base for the relevance of mentalization to perinatal mental health.

DISCUSSION

Finally, we sketch out an outline model for integrating mentalization into perinatal and intergenerational mental health, highlighting several areas of opportunity to develop research and practice from diverse geographies and demographics. Here, we suggest that integration of mentalization with other conceptual frameworks such as DoHaD can mutually enrich the understanding of each model, pointing the way towards more effective early and preventative interventions.

Understanding modifiable caregiver factors contributing to child development among young children in rural Malawi

This study examined modifiable caregiver factors influencing child development in Malawi using baseline data from 1,021 mothers and their children <2 years of age participating in a cluster-randomized controlled trial implemented in rural Malawi (2022-2025). We fit an evidence-based theoretical model using structural equation modelling examining four caregiver factors: (1) diet diversity (sum of food groups consumed in the past 24 h), (2) empowerment (assessed using the project-level Women's Empowerment in Agriculture Index), (3) mental health (assessed using the Self-Reported Questionnaire, SRQ-20), and (4) stimulation (number of stimulation activities the mother engaged in the past 3 days). Child development was assessed using the Malawi Development Assessment Tool (norm-referenced aggregate Z-score). The model controlled for child, caregiver, and household socioeconomic characteristics. Results showed that caregiver dietary diversity was directly associated with higher child development scores (standardized coefficient 0.091 [95% CI 0.027, 0.153]) and lower SRQ-20 scores -0.058 (-0.111, -0.006). Empowerment was directly associated with higher child development scores (0.071 [0.007, 0.133]), higher stimulation score (0.074 [0.013, 0.140]), higher dietary diversity (0.085 [0.016, 0.145]), and lower SRQ-20 scores (-0.068 [-0.137, -0.002]). Further, higher empowerment was indirectly associated with improved child development through enhancement of caregiver dietary diversity, with an indirect effect of 0.008 (0.002, 0.018). These findings highlight the important role that caregiver diet and empowerment play in directly influencing child development and other aspects of caregiver well-being. Interventions aimed at enhancing child development should consider these factors as potential targets to improve outcomes for children and caregivers.

Are social determinants associated with depression among married women of reproductive age? A mixed methods study from urban slums of Islamabad, Pakistan

Depression among married women of reproductive age is on the rise in Pakistan, owing to post-COVID-19 phase, super-inflation, increasing poverty, deteriorating law and order situation and perpetuating the uncertain political situation in the country. This study aimed to investigate the factors associated with depression among married women of reproductive age in Pakistan, using a mixed methods approach. The quantitative phase utilized the Urdu version of the Patient Health Questionnaire-9 (PHQ-9) to assess depression among 340 married women. Twelve women with higher scores on the PHQ-9 were selected for in-depth interviews in the qualitative phase. The quantitative analysis revealed a higher prevalence of depression among women with poor socioeconomic status, lower educational levels, larger family sizes, and recent deaths in the family. In the qualitative phase, the main themes identified were the impact of social conditions, such as societal expectations and gender roles, the influence of medical conditions on mental health, financial difficulties, the stress associated with caring for a larger number of children, and the emotional burden of recent deaths in the family. This study highlights the importance of addressing depression among married women of reproductive age in Pakistan. It is crucial to focus on early diagnosis and prompt treatment to mitigate the adverse effects of depression on the affected individuals and their families. Targeted interventions should consider the social determinants of depression, including improving socioeconomic conditions through safety nets, providing mental health support at the primary health care level, and addressing the specific health issues and needs of women in the reproductive age group. A multi-pronged approach and health system's thinking can reduce the burden of depression among women, ultimately enhancing their overall well-being, productivity and quality of life.