Persistent, Severe Postnatal Depression Impacts Child Development

The study suggests that postnatal depression is associated with increased risks to children’s development, affecting a range of domains.

Alan Stein, FRCPsych

According to a recent study, persistent postnatal depression (PND) lasting longer than 6 months can have severe implications on child development.

The study found that compared with children of women with PND that did not persist, of either moderate or severe intensity, children of women with persistent and severe depression are at an increased risk for behavioral problems by age 3.5 years, developing depression during adolescence and achieving lower mathematics grades.

Additionally, women with persistent PND are likely to experience significant depressive symptoms until at least 11 years after childbirth.

“We know postnatal depression is commonly affecting approximately 1 in 10 women,” study authors Elena Netsi BSc, MSc, DPhil, and Alan Stein, FRCPsych, University of Oxford, told MD Magazine. “Frequent screening for depressive symptoms both early and late in the postnatal year will ensure women receive the treatment and help they need both to address the mother’s depression and to mitigate possible effects on children’s development. Given that there are evidence-based treatments for depression it is important that help is provided for these women.”

The observational study included 9848 women — the mean age of women delivery was 28.5 years — with varying levels of post-natal depression and 8287 children — 51% were boys and 49% were girls. Three thresholds of PND severity — moderate, marked and severe — were defined using the self-rated Edinburg Postnatal Depression Scale (EPDS).

In the study, PND was defined as persistent when the EPDS score was above the threshold level at both 2 and 8 months after childbirth. The study utilized data from various stages of children’s development ranging from preschool to late adolescence to examine the natural course of different levels of PND severity identified at 2 and 8 months after childbirth using growth curve modeling, the association of PND persistence and severity with child behavioral problems at 3.5 years of age, lower mathematics grades at 16 years of age and self-reported depression at 18 years of age.

The findings concluded that episodes of depression persisting for 6 months or more in duration may negatively impact children’s development. Identifying women most at risk is important for both women’s mental health and children’s development.

For 2 of the outcomes, lower mathematics grades and developing depression, when PND either did not persist or persisted only moderately, the odds of achieving lower mathematics grades or experiencing depression were similar to those children whose mothers did not experience depressive symptoms at all in the postnatal year. The findings suggest that long-term negative effects on mathematics grades and depression in adolescence occur primarily in the context of persistent depression, but not with shorter or less severe episodes.

“Our study highlights that screening both early and late in the postnatal year can help identify women whose depression persists,” Netsi and Stein added. “This should alert health care professionals to women whose depression may become chronic and such women should be prioritized for treatment.”

According to study authors, this specific group of mothers and children should be prioritized for treatment both to address maternal depression that’s more than likely going to continue and affect children development. Authors have shown that treatment for women with persistent PND can be delivered effectively with high rates of sustained remission utilizing home-based delivery of psychological therapy.

“There are good evidence-based treatments for depression and these include cognitive behavioral therapy, behavioral activation therapy and anti-depressant medication,” the authors said.

The study, "Association of Persistent and Severe Postnatal Depression with Child Outcomes" was published in JAMA Psychiatry January 2018.

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