Maternal depression and anxiety disorders and child mental health outcomes

与母亲抑郁和焦虑障碍（MDAD）有关的问题很常见，并且已知会影响儿童的健康和发育。在英国，每个出生队列儿童围产期心理健康问题的费用估计为81亿英镑，其中72%的费用与对儿童的直接影响有关。我们提出的研究的总体目标是检查MDAD对儿童健康结果的影响，特别关注MDAD在青少年儿童抑郁和焦虑障碍（CDAD）发展中的作用。特别是，这项研究将提供强有力的经验证据，以了解抑郁症和焦虑症是如何从一代传给下一代的，并有助于设计旨在减少孕产妇心理健康状况不佳对儿童的负面影响的干预措施。为了实现这一目标，我们将解决以下研究问题：1)MDAD对儿童的负面影响是否完全由遗传传递和家庭背景特征来解释？或者这些负面影响也可以用孩子家庭环境的变化来解释？如果精神和焦虑障碍的传播完全由遗传特征和家庭背景特征来解释，那么旨在减少MDAD对产妇行为的负面影响的干预措施，例如通过认知行为疗法，将是无效的。相反，在控制了遗传和家庭背景特征后，MDAD的显著影响的证据表明，MDAD会导致儿童家庭环境的改变，例如母亲行为的改变，更严厉的养育方式和更少的时间投入，对儿童产生负面影响。2)学校政策和卫生实践是否在减轻母亲抑郁对儿童的负面影响方面发挥作用？我们将通过关注提早上学是否会伤害或保护暴露于MDAD的儿童，以及母亲抑郁症的早期诊断是否可以减轻儿童遭受的负面影响来回答这个研究问题。我们将开发和使用最先进的估计方法，并结合一个新的管理数据集，该数据集涵盖了一般实践和医院，该数据集是由合并来自英国的两个基于人口的健康数据库（即QResearch和医院事件统计）创建的。利用这个合并的数据库，我们将创建一个纵向的家庭数据集，这将使我们能够研究母亲及其孩子在孩子生命的不同阶段直到青春期的心理健康。我们是一个来自牛津大学和约克大学的多学科团队，由应用计量经济学方法、儿童和孕产妇心理健康、心理学、全科医学以及我们计划利用的数据方面的专家组成。我们将把我们的研究成果转化为政策制定者的建议，帮助他们设计新的干预措施，旨在为患有产妇心理健康问题的患者及其子女取得更好的结果。我们的研究也将对从事母亲和儿童工作的卫生从业人员、心理学家、学者和慈善机构产生影响。我们将编写针对学术界和非技术产出的论文，以吸引政策制定者和非学术受众。此外，通过向学术界分享和解释我们的数据和估计方法，我们将建立基于大型卫生数据集进行进一步研究的能力。该项目的最后一个中心要素将是建立早期职业研究人员承担和领导大型跨学科项目的能力。

Problems relating to Maternal Depression and Anxiety Disorders (MDAD) are common and are known to affect child health and development. In the UK, the cost of perinatal mental health problems has been estimated at £8.1 billion for each birth cohort of children, and 72 percent of this cost is related to the direct impact on the children. The overarching aim of our proposed research is to examine the effect of MDAD on child health outcomes, with a special focus on the role that MDAD plays in the development of child depression and anxiety disorders (CDAD) in adolescence. In particular, this research will provide robust empirical evidence to understand how depression and anxiety disorders are transmitted from one generation to the next and to help design interventions aimed at reducing the negative consequences of poor maternal mental health for children. To achieve this aim, we will address the following research questions: 1) Are the negative effects of MDAD on children exclusively explained by genetic transmission and family background characteristics? Or are these negative effects also explained by changes in the child's home environment?If the transmission of mental and anxiety disorders is explained exclusively by genetic traits and family background characteristics, then interventions targeted at reducing the negative effect of MDAD on maternal behaviour, e.g. through cognitive behavioural therapy, would be ineffective. On the contrary, evidence on significant effects of MDAD after controlling for genetic and family background characteristics would suggest that MDAD can lead to changes in the child home environment, e.g. changes in maternal behaviour, harsher parenting style and lower time investments in the child, with negative consequences on children. 2) Do school policies and health practices have a role in attenuating the negative effect of maternal depression on children? We will answer this research question by focusing on whether starting school earlier harms or protects children who are exposed to MDAD, and on whether an early diagnosis of maternal depression can attenuate the negative effects suffered by children.We will develop and use state-of-the-art estimation methods in combination with a novel administrative dataset covering general practices and hospitals created by merging two population-based health databases from England - namely QResearch and Hospital Episode Statistics. Using this merged database, we will create a longitudinal household dataset that will allow us to study the mental health of mothers and their children at different stages of the children's lives up to adolescence. We are a multi-disciplinary team from the Universities of Oxford and York, consisting of experts in applied econometric methods, child and maternal mental health, psychology, general practice, and on the data that we plan to utilise. We will translate our research findings into advice for policy-makers to help them design new interventions aimed at achieving better outcomes for patients suffering from maternal mental health issues and their children. Our research will also have an impact on health practitioners, psychologists, academics and charities working with mothers and children. We will produce papers aimed at academics as well as non-technical outputs to engage with policy-makers and a non-academic audience. Furthermore, by sharing and explaining our data and estimation methods to academics, we will build capacity for further research based on large health datasets.The final central element of the project will be to build the capacity of early career researchers to undertake and lead large interdisciplinary projects.