Effect of an early perinatal depression intervention on long-term child development outcomes: follow-up of the Thinking Healthy Programme randomised controlled trial
Effect of an early perinatal depression intervention on long-term child development outcomes: follow-up of the Thinking Healthy Programme randomised controlled trial
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DOI：
10.1016/s2215-0366(15)00109-1
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发表时间：
2015-07-01
影响因子：
64.3
通讯作者：
Rahman, Atif
中科院分区：
文献类型：
--
作者：
Maselko, Joanna;Sikander, Siham;Rahman, Atif
围产期抑郁症与有害的儿童发育结果有关，但尚未显示孕产妇抑郁症干预对儿童发育有持久影响，并且没有来自低收入或中等收入国家的证据。2006- 2007年，在“健康思维计划”的随机分组对照试验中，对巴基斯坦的围产期抑郁干预进行了评估。与对照组相比，干预措施显着降低了产后12个月的抑郁水平。我们的目的是评估这种相同的干预对儿童的认知，社会情绪和身体发育的影响，在7岁左右。方法母子二人组谁参加了健康的思维方案集群随机对照试验进行了采访时，索引儿童约7岁。一个由300名没有产前抑郁症的母亲组成的参考组，因此没有接受原始干预，与他们的孩子同时登记。主要认知结果是韦氏学龄前和初级智力量表（WPPSI-IV）的评分;主要社会情绪结果包括优势和困难问卷（SDQ）和Spence儿童焦虑量表（SCAS）的评分;主要身体结果是年龄别身高、年龄别体重和年龄别体重指数（BMI）Z评分。广义线性模型与随机效应，以考虑集群的主要分析方法。分析是通过意向治疗。思维健康计划集群随机试验注册在ISRCTN.com，编号ISRCTN 65316374。结果在思维健康计划随机对照试验结束时采访了705名参与的母子二人组，584（83%）二人组被招募。289名母亲接受了干预措施，295名母亲接受了由加强日常护理组成的对照措施。儿童的平均年龄为7.6岁（SD 0.1）。总体而言，认知，社会情感，或身体发育的结果并没有干预组或对照组的母亲有产前抑郁症的儿童之间的差异。与母亲没有产前抑郁症的儿童对照组相比，健康思维计划试验儿童的社会情绪结果更差; SDQ总困难的平均得分显著更高（11.34 vs 10.35;平均差异0.78，95% CI 0.09-1.47; p=0.03）和焦虑的SCAS（21.33 vs 17.57;平均差异2.93，1.15-4.71; p=0.0013）。认知和身体的结果并没有different.Interpretation我们的研究结果表明，在7岁的母亲有产前抑郁症的儿童的认知，社会情绪和身体发育的结果并没有显着差异，那些谁收到了健康的思维方案干预和那些谁收到了控制。需要进一步调查，以了解需要哪些类型的复杂干预措施或方法来实现孕产妇和儿童福祉的长期收益。所有干预措施都需要长期、详细和频繁的随访。
Background Perinatal depression has been linked with deleterious child development outcomes, yet maternal depression interventions have not been shown to have lasting effects on child development, and evidence is not available from countries of low or middle income. In the Thinking Healthy Programme cluster-randomised controlled trial, a perinatal depression intervention was assessed in Pakistan in 2006-07. The intervention significantly reduced depression levels 12 months post partum compared with a control. We aimed to assess the effect of this same intervention on the cognitive, socioemotional, and physical development of children at around age 7 years.Methods Mother-child dyads who participated in the Thinking Healthy Programme cluster-randomised controlled trial were interviewed when the index child was about 7 years old. A reference group of 300 mothers who did not have prenatal depression and, therefore, did not receive the original intervention, was enrolled with their children at the same time. The primary cognitive outcome was the score on the Wechsler Preschool and Primary Scale of Intelligence (WPPSI-IV); primary socioemotional outcomes included scores on the Strengths and Difficulties Questionnaire (SDQ) and the Spence Children's Anxiety Scale (SCAS); and primary physical outcomes were height-for-age, weight-for-age, and body-mass index (BMI)-for-age Z scores. Generalised linear modelling with random effects to account for clustering was the main method of analysis. Analyses were by intention to treat. The Thinking Healthy Programme cluster-randomised trial was registered at ISRCTN.com, number ISRCTN65316374.Findings Of 705 participating mother-child dyads interviewed at the end of the Thinking Healthy Programme randomised controlled trial, 584 (83%) dyads were enrolled. 289 mothers had received the intervention and 295 had received a control consisting of enhanced usual care. The mean age of the children was 7.6 years (SD 0.1). Overall, cognitive, socioemotional, or physical development outcomes did not differ between children in the intervention or control groups whose mothers had prenatal depression. When compared with the reference group of children whose mothers did not have prenatal depression, the Thinking Healthy Programme trial children had worse socioemotional outcomes; mean scores were significantly higher on the SDQ for total difficulty (11.34 vs 10.35; mean difference 0.78, 95% CI 0.09-1.47; p=0.03) and on the SCAS for anxiety (21.33 vs 17.57; mean difference 2.93, 1.15-4.71; p=0.0013). Cognitive and physical outcomes did not differ.Interpretation Our findings show that cognitive, socioemotional, and physical developmental outcomes of children at age 7 years whose mother had prenatal depression did not differ between those who received the Thinking Healthy Programme intervention and those who received the control. Further investigation is needed to understand what types of complex interventions or approaches are needed for long-term gains in maternal and child wellbeing. Prolonged, detailed, and frequent follow-up is warranted for all interventions.