Trajectories of maternal depressive symptoms during pregnancy and the first 12 months postpartum and child externalizing and internalizing behavior at three years
Trajectories of maternal depressive symptoms during pregnancy and the first 12 months postpartum and child externalizing and internalizing behavior at three years
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DOI：
10.1371/journal.pone.0195365
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发表时间：
2018-04-13
期刊：
影响因子：
3.7
通讯作者：
Giallo, Rebecca
中科院分区：
文献类型：
--
作者：
Kingston, Dawn;Kehler, Heather;Giallo, Rebecca
背景大多数关于母亲抑郁症与儿童发育之间关系的证据都是有限的。到目前为止，很少有研究模拟了从怀孕到产后早期的母亲抑郁症状的轨迹，并研究了它们与学龄前儿童社会情绪和行为功能的关系。本研究的目的是：1）确定不同的妇女群体定义的轨迹抑郁症状在四个时间点，从怀孕中期到产后一年;以及2）检查这些轨迹与儿童内化和外化行为之间的关联。方法我们分析了来自我们所有家庭（AOF）研究的数据，AOF是阿尔伯塔的一个基于人口的母子二人组的大型妊娠队列，加拿大AOF研究是一项正在进行的妊娠队列研究，旨在调查产前和生命早期与儿童和母亲结局之间的关系。产妇抑郁症状进行了评估，使用爱丁堡产后抑郁量表。儿童在3岁时的行为功能进行了评估，使用行为量表开发的加拿大国家儿童和青年纵向调查。进行纵向潜在类别分析，以确定从怀孕到产后1年的四个时间点妇女抑郁症状的轨迹。我们使用多变量逻辑回归来评估母亲抑郁症状和儿童行为轨迹之间的关系，同时调整其他重要的母亲，儿童和心理社会因素。我们确定了四个不同的轨迹产妇抑郁症状：低水平（64.7%），产后早期（10.9%），亚临床（18.8%）和持续高（5.6%）。在多变量模型中，母亲有持续高度抑郁症状的儿童行为症状升高的比例最高，其次是中度症状（产后早期和亚临床轨迹）的母亲，最低的是最小症状。后占人口，儿童和社会心理因素，抑郁症的轨迹和儿童多动症/注意力不集中，身体侵略（亚临床轨迹）和分离焦虑症状之间的关系仍然显着。ConclusionThese研究结果表明，外化和内化儿童的行为与长期的母亲抑郁症状。有一个很好的情况下，需要超越过于简单的抑郁/不抑郁的筛选围产期抑郁症的临床截断方法。需要识别临床和亚临床水平抑郁症状升高的妇女，提供循证治疗，并通过重复筛查进行监测，以改善孕产妇心理健康结果，降低儿童早期社会情感和行为发展相关负面结果的风险。
BackgroundMost 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.MethodsWe 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.Results1983 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.ConclusionThese 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.