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Trajectories of maternal depressive symptoms during pregnancy and the first 12 months postpartum and child externalizing and internalizing behavior at three years.
PLoS One 2018; 13(4):e0195365Plos

Abstract

BACKGROUND

Most evidence of the association between maternal depression and children's development is limited by being cross-sectional. To date, few studies have modelled trajectories of maternal depressive symptoms from pregnancy through the early postpartum years and examined their association with social emotional and behavior functioning in preschool children. The objectives of this study were to: 1) identify distinct groups of women defined by their trajectories of depressive symptoms across four time points from mid-pregnancy to one year postpartum; and 2) examine the associations between these trajectories and child internalizing and externalizing behaviors.

METHODS

We analyzed data from the All Our Families (AOF) study, a large, population based pregnancy cohort of mother-child dyads in Alberta, Canada. The AOF study is an ongoing pregnancy cohort study designed to investigate relationships between the prenatal and early life period and outcomes for children and mothers. Maternal depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale. Children's behavioral functioning at age 3 was assessed using the Behavior Scales developed for the Canadian National Longitudinal Survey of Children and Youth. Longitudinal latent class analysis was conducted to identify trajectories of women's depressive symptoms across four time points from pregnancy to 1 year postpartum. We used multivariable logistic regression to assess the relationship between trajectories of maternal depressive symptoms and children's behavior, while adjusting for other significant maternal, child and psychosocial factors.

RESULTS

1983 participants met eligibility criteria. We identified four distinct trajectories of maternal depressive symptoms: low level (64.7%); early postpartum (10.9%); subclinical (18.8%); and persistent high (5.6%). In multivariable models, the proportion of children with elevated behavior symptoms was highest for children whose mothers had persistent high depressive symptoms, followed by mothers with moderate symptoms (early postpartum and subclinical trajectories) and lowest for minimal symptoms. After accounting for demographic, child and psychosocial factors, the relationships between depression trajectories and child hyperactivity/inattention, physical aggression (subclinical trajectory only) and separation anxiety symptoms remained significant.

CONCLUSION

These findings suggest both externalizing and internalizing children's behaviors are associated with prolonged maternal depressive symptoms. There is a good case for the need to move beyond overly simplistic clinical cutoff approaches of depressed/not depressed in screening for perinatal depression. Women with elevated depressive symptoms at clinical and subclinical levels need to be identified, provided with evidence-based treatment, and monitored with repeat screening to improve maternal mental health outcomes and reduce the risk of associated negative outcomes on children's early social-emotional and behavior development.

Authors+Show Affiliations

Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada.Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada.St John of God Health Care, Burwood, Australia. University of New South Wales, Sydney, Australia.Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada.Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada.Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada.Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada.Murdoch Childrens Research Institute, Parkville, Victoria, Australia.Department of Obstetrics and Gynecology, University of Iowa, Iowa City, Iowa, United States of Amreica.Murdoch Childrens Research Institute, Parkville, Victoria, Australia.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

29652937

Citation

Kingston, Dawn, et al. "Trajectories of Maternal Depressive Symptoms During Pregnancy and the First 12 Months Postpartum and Child Externalizing and Internalizing Behavior at Three Years." PloS One, vol. 13, no. 4, 2018, pp. e0195365.
Kingston D, Kehler H, Austin MP, et al. Trajectories of maternal depressive symptoms during pregnancy and the first 12 months postpartum and child externalizing and internalizing behavior at three years. PLoS ONE. 2018;13(4):e0195365.
Kingston, D., Kehler, H., Austin, M. P., Mughal, M. K., Wajid, A., Vermeyden, L., ... Giallo, R. (2018). Trajectories of maternal depressive symptoms during pregnancy and the first 12 months postpartum and child externalizing and internalizing behavior at three years. PloS One, 13(4), pp. e0195365. doi:10.1371/journal.pone.0195365.
Kingston D, et al. Trajectories of Maternal Depressive Symptoms During Pregnancy and the First 12 Months Postpartum and Child Externalizing and Internalizing Behavior at Three Years. PLoS ONE. 2018;13(4):e0195365. PubMed PMID: 29652937.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Trajectories of maternal depressive symptoms during pregnancy and the first 12 months postpartum and child externalizing and internalizing behavior at three years. AU - Kingston,Dawn, AU - Kehler,Heather, AU - Austin,Marie-Paule, AU - Mughal,Muhammad Kashif, AU - Wajid,Abdul, AU - Vermeyden,Lydia, AU - Benzies,Karen, AU - Brown,Stephanie, AU - Stuart,Scott, AU - Giallo,Rebecca, Y1 - 2018/04/13/ PY - 2017/07/09/received PY - 2018/03/17/accepted PY - 2018/4/14/entrez PY - 2018/4/14/pubmed PY - 2018/7/18/medline SP - e0195365 EP - e0195365 JF - PloS one JO - PLoS ONE VL - 13 IS - 4 N2 - BACKGROUND: Most evidence of the association between maternal depression and children's development is limited by being cross-sectional. To date, few studies have modelled trajectories of maternal depressive symptoms from pregnancy through the early postpartum years and examined their association with social emotional and behavior functioning in preschool children. The objectives of this study were to: 1) identify distinct groups of women defined by their trajectories of depressive symptoms across four time points from mid-pregnancy to one year postpartum; and 2) examine the associations between these trajectories and child internalizing and externalizing behaviors. METHODS: We analyzed data from the All Our Families (AOF) study, a large, population based pregnancy cohort of mother-child dyads in Alberta, Canada. The AOF study is an ongoing pregnancy cohort study designed to investigate relationships between the prenatal and early life period and outcomes for children and mothers. Maternal depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale. Children's behavioral functioning at age 3 was assessed using the Behavior Scales developed for the Canadian National Longitudinal Survey of Children and Youth. Longitudinal latent class analysis was conducted to identify trajectories of women's depressive symptoms across four time points from pregnancy to 1 year postpartum. We used multivariable logistic regression to assess the relationship between trajectories of maternal depressive symptoms and children's behavior, while adjusting for other significant maternal, child and psychosocial factors. RESULTS: 1983 participants met eligibility criteria. We identified four distinct trajectories of maternal depressive symptoms: low level (64.7%); early postpartum (10.9%); subclinical (18.8%); and persistent high (5.6%). In multivariable models, the proportion of children with elevated behavior symptoms was highest for children whose mothers had persistent high depressive symptoms, followed by mothers with moderate symptoms (early postpartum and subclinical trajectories) and lowest for minimal symptoms. After accounting for demographic, child and psychosocial factors, the relationships between depression trajectories and child hyperactivity/inattention, physical aggression (subclinical trajectory only) and separation anxiety symptoms remained significant. CONCLUSION: These findings suggest both externalizing and internalizing children's behaviors are associated with prolonged maternal depressive symptoms. There is a good case for the need to move beyond overly simplistic clinical cutoff approaches of depressed/not depressed in screening for perinatal depression. Women with elevated depressive symptoms at clinical and subclinical levels need to be identified, provided with evidence-based treatment, and monitored with repeat screening to improve maternal mental health outcomes and reduce the risk of associated negative outcomes on children's early social-emotional and behavior development. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/29652937/Trajectories_of_maternal_depressive_symptoms_during_pregnancy_and_the_first_12_months_postpartum_and_child_externalizing_and_internalizing_behavior_at_three_years_ L2 - http://dx.plos.org/10.1371/journal.pone.0195365 DB - PRIME DP - Unbound Medicine ER -