Association of Persistent and Severe Postnatal Depression With Child Outcomes.
Association of Persistent and Severe Postnatal Depression With Child Outcomes.
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DOI：
10.1001/jamapsychiatry.2017.4363
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发表时间：
2018-03-01
期刊：
影响因子：
25.8
通讯作者：
Stein A
中科院分区：
文献类型：
--
作者：
Netsi E;Pearson RM;Murray L;Cooper P;Craske MG;Stein A
不同程度的产后抑郁症的持续性和严重性与儿童的长期结局有什么关系？这项对9848名患有不同程度产后抑郁症的妇女和8287名儿童进行的观察性研究发现，与患有产后抑郁症的妇女的孩子相比，无论是中度还是重度，持续性和重度抑郁症的妇女的孩子在3.5岁时出现行为问题的风险增加，以及数学成绩较低和青春期抑郁症。此外，患有持续性产后抑郁症的妇女可能会在分娩后至少11年内出现严重的抑郁症状。患有持续性和严重产后抑郁症的妇女应优先接受治疗，因为她们可能会继续经历高水平的抑郁症状，而且儿童发育不良的风险很高。产妇产后抑郁症（PND）是常见的，并与不良的儿童结局。这些影响并非不可避免，关键是要确定那些风险最大的人。以往的研究表明，当PND严重且持续时，不良结局的风险增加，但尚未对此进行系统研究。研究PND不同程度的持续性和严重程度与儿童长期结局之间的关系。这项观察性研究的样本包括英国雅芳父母和儿童纵向研究的参与者。PND严重程度的三个阈值-中度，显著和严重-使用自评爱丁堡产后抑郁量表（EPDS）定义。当产后2个月和8个月的EPDS评分高于阈值水平时，抑郁被定义为持续性。对于这些严重性和持续性类别中的每一个，检查以下内容：（1）后期EPDS评分的轨迹（分娩后21个月至11年的6个时间点）和（2）儿童结局-3.5岁时的行为问题，16岁时的离校数学成绩，以及18岁时的抑郁症。数据分析于2016年7月12日至2017年2月8日进行。在3.5岁时使用Rutter总问题量表的儿童行为问题，在16岁时从外部国家公开考试记录中提取的离校数学成绩，以及在18岁时使用临床访谈计划修订版的后代抑郁症。对于样本中的9848名母亲，分娩时的平均（SD）年龄为28.5（4.7）岁。在8 287名儿童中，4 227名（51%）是男孩，4 060名（49%）是女孩。与患有PND的女性相比，不持久的女性和评分不高于EPDS阈值的女性，对于所有3个严重程度，患有持续性PND的女性在分娩后11年内表现出抑郁症状升高。无论持续与否，PND都会使儿童行为障碍的风险增加一倍。中度PND母亲发生儿童行为障碍的优势比（OR）为2.22（95% CI，1.74-2.83），重度PND母亲为2.39（95% CI，1.78-3.22），重度PND母亲为1.91（95% CI，1.36-2.68）。严重PND的持续存在对儿童发育尤其重要，显著增加了3.5岁时行为问题的风险（OR，4.84; 95% CI，2.94 - 7.98），16岁时数学成绩较低（OR，2.65; 95%CI，1.26 - 5.57），18岁时抑郁症患病率较高（OR，7.44; 95%CI，2.89 - 19.11）。持续和严重的PND大大增加了所有儿童措施的不良后果的风险。在出生后的早期和晚期都符合抑郁症的标准，特别是当情绪障碍严重时，应该提醒医疗保健专业人员注意抑郁症可能是持续的，并且与多种不良儿童结局的风险特别高有关。应优先考虑对这一群体的治疗。本研究使用纵向研究的数据，以检查慢性和严重的产后抑郁症的母亲和他们的孩子的不良后果之间的关联。
What is the association of differing levels of persistence and severity of postnatal depression with long-term child outcomes? This observational study of 9848 women with varying levels of postnatal depression and 8287 children found that, compared with children of women with postnatal depression 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 as well as lower mathematics grades and depression during adolescence. Furthermore, women with persistent postnatal depression are likely to experience significant depressive symptoms until at least 11 years after childbirth. Women with persistent and severe postnatal depression should be prioritized for treatment because they are likely to continue to experience high levels of depressive symptoms and because of the high risk of adverse child development. Maternal postnatal depression (PND) is common and associated with adverse child outcomes. These effects are not inevitable, and it is critical to identify those most at risk. Previous work suggests that the risks of adverse outcomes are increased when PND is severe and persistent, but this has not been systematically studied. To examine the association between differing levels of persistence and severity of PND and long-term child outcomes. The sample for this observational study comprised participants in the Avon Longitudinal Study of Parents and Children in the United Kingdom. Three thresholds of PND severity—moderate, marked, and severe—were defined using the self-rated Edinburgh Postnatal Depression Scale (EPDS). Depression was defined as persistent when the EPDS score was above the threshold level at both 2 and 8 months after childbirth. For each of these severity and persistence categories, the following were examined: (1) the trajectories of later EPDS scores (6 time points between 21 months and 11 years after childbirth) and (2) child outcomes—behavioral problems at 3.5 years of age, school-leaving mathematics grades at 16 years of age, and depression at 18 years of age. Data analysis was conducted from July 12, 2016, to February 8, 2017. Child behavioral problems at 3.5 years of age using the Rutter total problems scale, school-leaving mathematics grades at 16 years of age extracted from records of external national public examinations, and offspring depression at 18 years of age using the Clinical Interview Schedule–Revised. For the 9848 mothers in the sample, the mean (SD) age at delivery was 28.5 (4.7) years. Of the 8287 children, 4227 (51%) were boys and 4060 (49%) were girls. Compared with women with PND that was not persistent and women who did not score above the EPDS threshold, for all 3 severity levels, women with persistent PND showed elevated depressive symptoms up to 11 years after childbirth. Whether persistent or not, PND doubled the risk of child behavior disturbance. The odds ratio (OR) for child behavioral disturbance for mothers with moderate PND was 2.22 (95% CI, 1.74-2.83), for mothers with marked PND was 1.91 (95% CI, 1.36-2.68), and for mothers with severe PND was 2.39 (95% CI, 1.78-3.22). Persistence of severe PND was particularly important to child development, substantially increasing the risk for behavioral problems at 3.5 years of age (OR, 4.84; 95% CI, 2.94-7.98), lower mathematics grades at 16 years of age (OR, 2.65; 95% CI, 1.26-5.57), and higher prevalence of depression at 18 years of age (OR, 7.44; 95% CI, 2.89-19.11). Persistent and severe PND substantially raises the risk for adverse outcome on all child measures. Meeting criteria for depression both early and late in the postnatal year, especially when the mood disturbance is severe, should alert health care professionals to a depression that is likely to be persistent and to be associated with an especially elevated risk of multiple adverse child outcomes. Treatment for this group should be prioritized. This study uses data from a longitudinal study to examine the association between chronic and severe postpartum depression in mothers and adverse outcomes in their children.
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