Rebecca M Pearson

Effects of perinatal mental disorders on the fetus and child

Perinatal mental disorders are associated with increased risk of psychological and developmental disturbances in children. However, these disturbances are not inevitable. In this Series paper, we summarise evidence for associations between parental disorders and offspring outcomes from fetal development to adolescence in high-income, middle-income, and low-income countries. We assess evidence for mechanisms underlying transmission of disturbance, the role of mediating variables (underlying links between parent psychopathology and offspring outcomes) and possible moderators (which change the strength of any association), and focus on factors that are potentially modifiable, including parenting quality, social (including partner) and material support, and duration of the parental disorder. We review research of interventions, which are mostly about maternal depression, and emphasise the need to both treat the parents disorder and help with associated caregiving difficulties. We conclude with policy implications and underline the need for early identification of those parents at high risk and for more early interventions and prevention research, especially in socioeconomically disadvantaged populations and low-income countries.

Maternal Depression During Pregnancy and the Postnatal Period: Risks and Possible Mechanisms for Offspring Depression at Age 18 Years

IMPORTANCE Some small studies suggest that maternal postnatal depression is a risk factor for offspring adolescent depression. However, to our knowledge, no large cohort studies have addressed this issue. Furthermore, only 1 small study has examined the association between antenatal depression and later offspring depression. Understanding these associations is important to inform prevention. OBJECTIVE To investigate the hypothesis that there are independent associations between antenatal and postnatal depression with offspring depression and that the risk pathways are different, such that the risk is moderated by disadvantage (low maternal education) with postnatal depression but not with antenatal depression. DESIGN, SETTING, AND PARTICIPANTS Prospective investigation of associations between symptoms of antenatal and postnatal parental depression with offspring depression at age 18 years in a UK community-based birth cohort (Avon Longitudinal Study of Parents and Children) with data from more than 4500 parents and their adolescent offspring. MAIN OUTCOMES AND MEASURES Diagnosis of offspring aged 18 years with major depression using the International Classification of Diseases, 10th Revision. RESULTS Antenatal depression was an independent risk factor. Offspring were 1.28 times (95% CI, 1.08-1.51; P = .003) more likely to have depression at age 18 years for each standard deviation increase in maternal depression score antenatally, independent of later maternal depression. Postnatal depression was also a risk factor for mothers with low education, with offspring 1.26 times (95% CI, 1.06-1.50; P = .01) more likely to have depression for each standard deviation increase in postnatal depression score. However, for more educated mothers, there was little association (odds ratio, 1.09; 95% CI, 0.88-1.36; P = .42). Analyses found that maternal education moderated the effects of postnatal but not antenatal depression. Paternal depression antenatally was not associated with offspring depression, while postnatally, paternal depression showed a similar pattern to maternal depression. CONCLUSIONS AND RELEVANCE The findings suggest that treating maternal depression antenatally could prevent offspring depression during adulthood and that prioritizing less advantaged mothers postnatally may be most effective.

Depressive symptoms in early pregnancy disrupt attentional processing of infant emotion

BACKGROUND Growing evidence suggests that perinatal depression is associated with disrupted mother-infant interactions and poor infant outcomes. Antenatal depression may play a key role in this cycle by disrupting the development of a maternal response to infant stimuli. The current study therefore investigated the impact of depressive symptoms on the basic cognitive processing of infant stimuli at the beginning of pregnancy. METHOD A total of 101 women were recruited by community midwives and tested at an average gestation of 11 weeks. An established computerized paradigm measured womens ability to disengage attention from infant and adult faces displaying negative positive and neutral emotions. Depressive symptoms were measured using a computerized interview (the Clinical Interview Schedule). RESULTS The effect of infant emotion on womens ability to disengage from infant faces was found to be influenced by depressive symptoms. Non-depressed pregnant women took longer to disengage attention from distressed compared with non-distressed infant faces. This bias was not, however, seen in women experiencing depressive symptoms. There was a difference of -53 (s.d.=0.7) ms (95% confidence interval -90 to -14, p=0.007) between those with and without depressive symptoms in this measure of attentional bias towards distressed infant faces. CONCLUSIONS Our results suggest that depressive symptoms are already associated with differential attentional processing of infant emotion at the very beginning of childbearing. The findings have potential implications for our understanding of the impact of depressive symptoms during pregnancy on the developing mother-infant relationship.

Emotional sensitivity for motherhood: late pregnancy is associated with enhanced accuracy to encode emotional faces.

Previous research suggests that female sex hormones can increase the sensitivity of womens emotion processing systems. The largest rises in sex hormone levels in a womans life are from early to late pregnancy. The current study, therefore, investigated whether changes in emotion processing are seen across pregnancy. Hypervigilant emotion processing has been implicated in the aetiology of anxiety. Therefore enhanced emotion processing across pregnancy has implications for womens vulnerability to anxiety. Ability to encode facial expressions of emotion was assessed in 101 women during early pregnancy and again in 76 of these women during late pregnancy. Symptoms of anxiety were measured using a clinical interview (The CIS-R). Consistent with previous research, the presence of anxiety symptoms was associated with greater accuracy to encode faces signalling threat (fearful and angry faces). We found that women had higher accuracy scores to encode emotional expressions signalling threat or harm (fearful, angry and disgusted faces) but also a more general negative emotion (sadness) during late, compared with early, pregnancy. Enhanced ability to encode emotional faces during late pregnancy may be an evolutionary adaption to prepare women for the protective and nurturing demands of motherhood by increasing their general emotional sensitivity and their vigilance towards emotional signals of threat, aggression and contagion. However, the results also suggest that, during late pregnancy, womens emotion processing style is similar to that seen in anxiety. The results have implications for our understanding of normal pregnant womens processing of emotional cues and their vulnerability to symptoms of anxiety.

Peer victimization during adolescence and risk for anxiety disorders in adulthood: a prospective cohort study.

Peer victimization is ubiquitous across schools and cultures, and has been suggested as one developmental pathway to anxiety disorders. However, there is a dearth of prospective studies examining this relationship. The purpose of this cohort study was to examine the association between peer victimization during adolescence and subsequent anxiety diagnoses in adulthood. A secondary aim was to investigate whether victimization increases risk for severe anxiety presentations involving diagnostic comorbidity.

The association between observed non-verbal maternal responses at 12 months and later infant development at 18 months and IQ at 4 years: A longitudinal study

BACKGROUND An infants early environment has an important influence on their development. For example, the sensitivity and warmth of a mothers responses towards her infant is associated with the infants later socio-emotional development. However, it is less clear whether maternal responses are associated with the infants later cognitive development. METHOD We used data from a large UK cohort study to investigate the association between non-verbal maternal responses and later infant development and IQ. Maternal responses were rated at 12 months during an observed mother-infant interaction. Infant development was assessed using the Griffiths scales at 18 months and IQ at 4 years was assessed using the Wechsler Preschool and Primary Scale of Intelligence (WPPSI). Data on the infants developmental level at 6 months (prior to the maternal response ratings) was also available. The complete case sample comprised 732 mother-infant pairs. RESULTS There was evidence for an association between positive maternal responses and infant development at 18 months. After adjusting for infant developmental level at 6 months and other confounders, we found a difference of 0.25 standard deviations (coef 2.0, 95% CI (0.8-3.2), p=0.002) on the Griffiths scales between infants whose mothers showed positive compared to neutral non-verbal responses at 12 months. However, an association between positive maternal responses and IQ at 4 years diminished following adjustment for maternal educational attainment. CONCLUSION The results provide evidence that positive maternal responses are associated with improved development in infants at 18 months. However, the association between maternal response and IQ at 4 years may be explained by higher educational attainment in mothers who show positive responses. Future studies are needed to explore the influence of maternal responses on different aspects of infant development as well as the role of maternal factors such as education.

Associations of maternal and paternal antenatal mood with offspring anxiety disorder at age 18 years

Objective Maternal antenatal depression and anxiety are associated with increased risk of childhood behavioural and emotional problems in offspring; it remains unclear to what extent this is due to a maternal biological impact on foetal development. Here, we compare associations between maternal and paternal antenatal depression and anxiety with offspring anxiety disorders, thus controlling for some genetic and shared environmental factors. Methods We used data from the ALSPAC population cohort including measures of antenatal parental depression and anxiety. At 18 years, offspring completed the CIS-R interview, yielding diagnoses for anxiety disorders. Results were adjusted for confounding variables including parental postnatal depression and anxiety. Results Children of women with antenatal depression (18 weeks gestation), had an increased risk of anxiety disorders at 18 years of age (11.1% vs. 6.2%; adj. OR 1.75 (1.19, 2.58); p=0.01). Children of women with antenatal anxiety had increased risk of co-morbid anxiety and depression (adj. OR 1.39 (1.06, 1.82); p=0.02). No such associations were found with paternal antenatal depression or anxiety. Limitations There was a high attrition rate from the original cohort to the CIS-R completion at 18 years postpartum. Parental mood was only assessed together at one time point during the antenatal period. Conclusions The differences in the association between maternal and paternal mood during pregnancy and child outcomes supports the hypothesis that foetal programming may account, at least in part, for this association. We highlight the potential opportunity for preventative intervention by optimising antenatal mental health.

Association between maternal depressogenic cognitive style during pregnancy and offspring cognitive style 18 years later.

Objective Understanding the origins of negative cognitive style could provide a means to prevent adult depression. Cognitive style is an important target for intervention because although it is not possible to remove the stress and adversities in people’s lives, it may be possible to modify interpretation of such adversities through cognitive style. Children may develop a negative cognitive style through modeling the style of their mothers. However, findings have been inconsistent on the association. The authors tested the hypothesis that there is an independent association between maternal and offspring depressogenic cognitive style. Method Data from over 4,000 mothers and children from the Avon Longitudinal Study of Parents and Children cohort study in the United Kingdom were used to investigate the association between maternal depressogenic cognitive style before the offspring’s birth and the offspring’s depressogenic cognitive style at age 18. Results A positive association was observed between maternal and offspring cognitive styles: a one-standard-deviation increase in maternal depressogenic cognitive style score during pregnancy was significantly associated with a mean increase of 0.1 standard deviations in offspring depressogenic cognitive style score at age 18. This effect remained after adjusting for maternal and offspring depression and explained 21% of the association between maternal and offspring depression. Conclusions Although the mechanisms remain to be elucidated, the findings are consistent with the idea that a mother’s cognitive style (irrespective of her depression status) influences that of her child. This suggests that interventions to improve a mother’s cognitive style could help prevent her offspring from developing depression during adulthood.

Are female children more vulnerable to the long-term effects of maternal depression during pregnancy?

Background Female fetuses are more vulnerable to high levels of maternal glucocorticoids. We examined whether exposure to prenatal maternal depression, a condition associated with high glucocorticoids, carries greater risk for depression at 12 and 18 years in girls. Methods Our sample comprised 7959 mothers and children from the Avon Longitudinal Study of Parents and Children following imputation for missing data. Maternal depression was assessed pre-and post-natally, and offspring depression at ages 12 and 18. We used logistic regression models to examine the relationship between exposure to prenatal and postnatal depression and offspring depression at 18 and 12 and interactions with gender. Results There was an interaction between prenatal depression and gender (P=0.027) and between postnatal depression and gender (P=0.027) for offspring depression at 18. Following adjustment in pre-natally depressed mothers, the odds ratio for offspring depression at 18 was 1.55 (95% c.i. 1.03–2.34) for girls and 0.54 (0.23–1.26) for boys. In post-natally depressed mothers, the odds ratio for offspring depression at 18 was 1.15 (0.70–1.89) in girls and 3.13 (1.52–6.45) in boys. However there was no evidence for interaction between prenatal or postnatal depression and gender (P=0.559 and 0.780 respectively) for offspring depression at 12. Limitations As expected with this large cohort spanning over 18 years, there was loss-to-follow-up. Conclusions This is the first evidence in humans that increased vulnerability of female fetuses to maternal stress responses during pregnancy persists into adolescence. One explanation for gender differences emerging later is more depressive symptomatology is attributed to heritable risk at 12, whereas biological processes involved in brain development at 18 may be influenced by foetal programming. If replicated, this study has potential to help understand intergenerational transmission of depression, a leading cause of morbidity worldwide.

Cortisol awakening response and subsequent depression: prospective longitudinal study

Background Some studies have found an association between elevated cortisol and subsequent depression, but findings are inconsistent. The cortisol awakening response may be a more stable measure of hypothalamic-pituitary-adrenal function and potentially of stress reactivity. Aims To investigate whether salivary cortisol, particularly the cortisol awakening response, is associated with subsequent depression in a large population cohort. Method Young people (aged 15 years, n = 841) from the Avon Longitudinal Study of Parents and Children (ALSPAC) collected salivary cortisol at four time points for 3 school days. Logistic regression was used to calculate odds ratios for developing depression meeting ICD-10 criteria at 18 years. Results We found no evidence for an association between salivary cortisol and subsequent depression. Odds ratios for the cortisol awakening response were 1.24 per standard deviation (95% CI 0.93-1.66, P = 0.14) before and 1.12 (95% CI 0.73-1.72, P = 0.61) after adjustment for confounding factors. There was no evidence that the other cortisol measures, including cortisol at each time point, diurnal drop and area under the curve, were associated with subsequent depression. Conclusions Our findings do not support the hypothesis that elevated salivary cortisol increases the short-term risk of subsequent depressive illness. The results suggest that if an association does exist, it is small and unlikely to be of clinical significance.