Sara Agnafors

Symptoms of depression postpartum and 12 years later-associations to child mental health at 12 years of age.

Children of depressed mothers have been shown to express behaviour problems to a greater extent than children of non-depressed mothers. The purpose of this study was to examine the persistence of depressive symptoms in mothers and to evaluate the relative importance of symptoms of postpartum depression (PPD) and concurrent maternal symptoms of depression, on child behaviour at age 12. A birth cohort of 1,707 children and their mothers was followed from 3xa0months after birth to 12xa0years after birth. Self-reported symptoms of depression in mothers were assessed at baseline and 12-year follow-up where 893 mothers (52.3xa0%) and their children participated. The mothers’ reports on the behaviour of their children at age 12 were used. Multivariate analysis was used to assess factors that increased the risk of child behaviour problems. At baseline, 10.4xa0% scored above the cutoff for symptoms of postpartum depression. At follow up, 18.2xa0% scored above the cutoff for depressive symptoms. Multivariate analysis showed that ongoing maternal symptoms of depression, as distinct from PPD-symptoms, was the strongest predictor of child behaviour problems at age 12. The gender of the child and socio-demographic factors at baseline were additional factors that affected the risk of behaviour problems in the 12xa0year old children. Children of mothers who reported symptoms of depression, both postpartum and at follow-up, were at a greater risk of behaviour problems compared to children of women with no depressive symptoms on either occasion. Our findings indicate that recurrent and ongoing maternal depressive symptoms significantly increase the risk of child behaviour problems as reported by mothers, while symptoms of PPD do not seem to result in an increased risk of behaviour problems in 12xa0year olds. High maternal socio-demographic life stress at childbirth constitutes an important risk factor for later child behaviour problems.

Self-reported mental health in 12-year-old second-generation immigrant children in Sweden.

Background: Today 29.3% of all newborns in Sweden are second-generation immigrants. Studies on mental health among these children are few, inconclusive and vary widely with regard to the informant used and the age of the immigrant. The majority of previous studies focus on study groups that cover a wide age span but since mental health varies considerably during the preadolescent and adolescent years, more age-specific studies are needed. Additional focus on the health and well-being of these children is necessary if a well-functioning society is to develop. Aim: To investigate whether and how second-generation immigrant children in Sweden differ from non-immigrant children in their presentation of self-reported mental health at the age of 12. Methods: Second-generation immigrant children (n = 142) from a birth cohort in southern Sweden, subjects of the SESBiC-study (the South East Sweden Birth Cohort-study) were compared with non-immigrant children (n = 1036) from the same cohort in their presentation of self-reported mental health at the age of 12 using the Strengths and Difficulties Questionnaire. Gender, family structure and parents’ educational level were controlled for. Results: Second-generation immigrant children did not differ from the non-immigrant children in their own presentation of mental health at the age of 12 in any of the categories of immigrant groups. Conclusion: It is a promising sign for future integration that second-generation immigrant childrens self-reported mental health at the age of 12 was quite similar to that of non-immigrant children.

Effect of gene, environment and maternal depressive symptoms on pre-adolescence behavior problems – a longitudinal study

BackgroundDepression is a common and disabling condition with a high relapse frequency. Maternal mental health problems and experience of traumatic life events are known to increase the risk of behavior problems in children. Recently, genetic factors, in particular gene-by-environment interaction models, have been implicated to explain depressive etiology. However, results are inconclusive.MethodsStudy participants were members of the SESBiC-study. A total of 889 mothers and their children were followed during the child’s age of 3xa0months to 12xa0years. Information on maternal depressive symptoms was gathered postpartum and at a 12xa0year follow-up. Mothers reported on child behavior and traumatic life events experienced by the child at age 12. Saliva samples were obtained from children for analysis of 5- HTTLPR and BDNF Val66Met polymorphisms.ResultsMultivariate analysis showed a significant association between maternal symptoms of depression and anxiety, and internalizing problems in 12-year-old children (OR 5.72, 95% CI 3.30-9.91). Furthermore, carriers of two short alleles (s/s) of the 5-HTTLPR showed a more than 4-fold increased risk of internalizing problems at age 12 compared to l/l carriers (OR 4.73, 95% CI 2.14-10.48). No gene-by-environment interaction was found and neither depressive symptoms postpartum or traumatic experiences during childhood stayed significant in the final model.ConclusionsConcurrent maternal symptoms of depression and anxiety are significant risk factors for behavior problems in children, which need to be taken into account in clinical practice. Furthermore, we found a main effect of 5- HTTLPR on internalizing symptoms in 12-year-old children, a finding that needs to be confirmed in future studies.

Psychiatric symptoms in adolescents: FKBP5 genotype-early life adversity interaction effects

Psychiatric disorders are multi-factorial and their symptoms overlap. Constitutional and environmental factors influence each other, and this contributes to risk and resilience in mental ill-health. We investigated functional genetic variation of stress responsiveness, assessed as FKBP5 genotype, in relation to early life adversity and mental health in two samples of adolescents. One population-based sample of 909 12-year-old adolescents was assessed using the Life Incidence of Traumatic Events scale and the Strengths and Difficulties Questionnaire. One sample of 398 17-year-old adolescents, enriched for poly-victimized individuals (USSS), was assessed using the Juvenile Victimization Questionnaire and the Trauma Symptom Checklist for Children (TSCC). The FKBP5 rs1360780 and rs3800373 polymorphisms were genotyped using a fluorescence-based competitive allele-specific PCR. Most prominently among poly-victimized older male adolescents, the least common alleles of the polymorphisms, in interaction with adverse life events, were associated with psychiatric symptoms, after controlling for ethno-socio-economic factors. The interaction effect between rs3800373 and adverse life events on the TSCC sub-scales—anxiety, depression, anger, and dissociation—and with the rs1360780 on dissociation in the USSS cohort remained significant after Bonferroni correction. This pattern of association is in line with the findings of clinical and neuroimaging studies, and implies interactive effects of FKBP5 polymorphisms and early life environment on several psychiatric symptoms. These correlates add up to provide constructs that are relevant to several psychiatric symptoms, and to identify early predictors of mental ill-health.

Early predictors of behavioural problems in pre-schoolers – a longitudinal study of constitutional and environmental main and interaction effects

BackgroundThe early environment is important for child development and wellbeing. Gene-by-environment studies investigating the impact of the serotonin transporter gene-linked polymorphic region (5-HTTLPR) and the Brain Derived Neurotrophic Factor (BDNF) Val66Met polymorphisms by life events on mental health and behaviour problems have been inconclusive. Methodological differences regarding sample sizes, study population, definitions of adversities and measures of mental health problems obstacle their comparability. Furthermore, very few studies included children. The aim of this study was to examine the associations between a broad range of risk factors covering pregnancy and birth, genetic polymorphism, experience of multiple life events and psychosocial environment, and child behaviour at age 3, using a comparably large, representative, population-based sample.MethodsA total of 1,106 children, and their mothers, were followed from pregnancy to age 3. Information on pregnancy and birth-related factors was retrieved from the Medical Birth Register. Questionnaires on depressive symptoms, child behaviour and child experiences of life events were filled in by the mothers. Child saliva samples were used for genotyping the 5-HTTLPR and BDNF Val66Met polymorphisms. Multiple logistic regression was used to investigate the association between psychological scales and genetic polymorphisms.ResultsSymptoms of postpartum depression increased the risk of both internalizing and externalizing problems. Experience of multiple life events was also a predictor of behavioural problems across the scales. No gene-by-environment or gene-by-gene-by-environment interactions were found. Children of immigrants had an increased risk of internalizing problems and parental unemployment was significantly associated with both internalizing and externalizing type of problems.ConclusionThis study shows the importance of the psychosocial environment for psychosocial health in preschool children, and adds to the literature of null-findings of gene-by-environment effects of 5-HTTLPR and BDNF in children.

Multi-informant reports of mental health in Swedish-born children of immigrants and children born to non-immigrants - the SESBiC-study

BackgroundThe European literature on mental health of the children of immigrants is limited. Therefore this study aims to investigate gender-specific mental health reported by teachers, parents and the children themselves in 12-year old children of immigrants and non-immigrants and also to study the level of agreement between the different informants.MethodsThis cross-sectional study is a part of the longitudinal South East Sweden Birth Cohort-study (the SESBiC-study) on children’s health. All children born in town in the south of Sweden 1995-1996 were invited to take part. The mothers of 1723 children (88%) consented. In this part 87 Swedish-born 12-year old children of immigrants and 687 12-year old children of non-immigrants were investigated regarding gender-specific differences in mental health as reported by teachers (Teacher-report form), parents (Child behavior checklist), and children (Strengths and Difficulties Questionnaire) and the agreement reached between the informants.ResultsParental immigrant status was not associated with mental health in any of the groups, but living arrangements and parental educational level were mainly found to have an effect on the health status of boys (TRF-Internalizing βu2009=u2009.77 95% CIu2009=u2009.02-1.52; TRF-Externalizing.βu2009=u20092.31 95% CIu2009=u2009.63-3.99; TRF-Total βu2009=u20096.22 95% CIu2009=u20092.27-10.18) The agreement between different informants was generally low, except for externalizing problems among boys (Boys of immigrant parents: Parent and teacher correlation ρu2009=u2009.422 and Child teacher correlation ρu2009=u2009.524, p-valueu2009<u2009.05, respectively). The correlation between teachers and parents were lower in the index group compared to the reference group. In the index group, the correlations between teacher’s and children’s assessments were fairly high for boys but not for girls (ρ Totalu2009=u2009.400, ρ Internalizingu2009=u2009.240 and ρ Externalizingu2009=u2009.524, p-valueu2009<u2009.05 for Total and Externalizing).ConclusionThis study confirms previous findings that the mental health of children of immigrants is similar to that of children of non-immigrants. We found that family factors have a greater impact on the reported mental health than immigrant status does. This might be of clinical importance for healthcare workers to recognize when investigating and treating children from other cultures.

A Biopsychosocial Approach to Risk and Resilience on Behavior in Children Followed from Birth to Age 12

An increasing prevalence of mental health problems calls for more knowledge into factors associated with resilience. The present study used multiple statistical methodologies to examine a biopsychosocial model of risk and resilience on preadolescence behavior. Data from 889 children and mothers from a birth cohort were used. An adversity score was created by combining maternal symptoms of depression, psychosocial risk and children’s experiences of life events. The proposed resilience factors investigated were candidate genetic polymorphisms, child temperament, social functioning, and maternal sense of coherence. The l/l genotype of the serotonin transporter linked polymorphic region was associated with lower internalizing scores, but not mainly related to the level of adversity. An easy temperament was associated with resilience for children exposed to high adversity. Social functioning was found to be promotive independent of the risk level. The results support a multiple-level model of resilience indicating effects, though small, of both biological and psychosocial factors.

Anxiety in women - a Swedish national three-generational cohort study

BackgroundFindings from animal and human studies indicate that anxiety and stress have a negative influence on the child and mother. The aim of this study was to explore the risk for having an anxiety diagnosis and the impact of the diagnosis in a three generational perspective.MethodsThe information was retrieved from Swedish population-based registries. All women who gave birth between 1973 and 1977 (n 169,782), their daughters (n 244,152), and subsequently also the offspring of the daughters (n 381,953) were followed until 2013.ResultsWe found that 4% of the mothers and 6% of the grandmothers had been diagnosed with anxiety. Women who had mothers with an anxiety disorder were more than twice as likely to have an anxiety disorder themselves compared to all other women (ORu2009=u20092.20, 95% CIu2009=u20092.04–2.30). In the third generation, the children born to mothers with an anxiety disorder, the odds ratio of being diagnosed with anxiety was more than twice as high than for the rest of the population (ORu2009=u20092.54, 95% CIu2009=u20092.01–3.20). If both the mother and the grandmother had had an anxiety disorder the odds ratio for the child having a diagnosis of anxiety was three times higher (ORu2009=u20093.11, 95% CIu2009=u20092.04–4.75). Anxiety diagnosis in the two previous generations also increased the likelihood of the child having either more than two inpatient visits or more than 10 outpatient visits (ORu2009=u20092.64, 95% CIu2009=u20092.40–2.91 and ORu2009=u20092.21, 95% CIu2009=u20092.01–2.43, respectively).ConclusionsThe intergenerational effect on anxiety is high. In order to minimize the risk for further transmission of anxiety disorders, increased awareness and generous use of effective treatment regimes might be of importance.