Impact of treating perinatal depression on infant HPA axis function

摘要 在全球范围内，大约20%的儿童在出生后的头几年就会受到母性抑郁症的影响，这增加了患抑郁症的风险 在整个生命过程中身体和发育状况都很差。确定可缓解 母亲抑郁对儿童的负面后果是缩小健康差距的关键，因此 这是一个重要的公共卫生优先事项。然而，对儿童发展的可衡量的影响可能不会立即显现。 因此，在干预之后，极有必要确定临时效果指标。这些指标将 提供有关干预的因果影响的早期信息，并指出其生物学机制 通过这些干预措施塑造未来的儿童发展。HPA轴是生物学上的一个强有力的标志 对压力的反应，越来越多的证据表明HPA轴生物标记物与母体抑郁 和婴儿的大脑发育。使用巴基斯坦的整群随机对照试验，这项研究利用了 头发衍生生物标记物数据(皮质醇和脱氢表雄酮)，来自104名母婴，以确定是否治疗母亲 抑郁可以改变婴儿HPA轴功能，并检查婴儿HPA轴功能预测到什么程度 未来的发展成果。这项试验的干预是同行传递的健康思维的版本 为怀孕后期被确认为抑郁症的妇女提供方案。该研究样本还包括一个 将怀孕期间未患抑郁症的妇女作为低风险对照组。母子情深 在产后36个月期间对DUADS进行了跟踪，结果数据集包含了丰富的与以下方面相关的数据 母亲的健康、社会人口因素、育儿方式和产后3至36个月的儿童发展。 随机设计使我们能够评估干预对婴儿皮质醇和脱氢表雄酮的因果影响。这个 令人感兴趣的主要结果是36个月大的儿童认知和社会情绪发展指标。 本项目的具体目标是：(1)评估围产期抑郁干预对 婴儿头发中的皮质醇；(2)检查12个月的婴儿皮质醇是否能预测24岁的儿童发育 和36个月；以及(3)检查干预对婴儿脱氢表雄酮水平的影响及其联系 12个月的婴儿脱氢表雄酮与24个月和36个月的儿童发育结果之间的关系。结果是 这项研究也将提高我们对母亲心理健康在儿童发展中的作用的理解 有助于确定改善早期干预评价的重要指标。

ABSTRACT Globally, about 20% of children are exposed to maternal depression in the first years of life, increasing risk for poor physical and developmental outcomes over the life course. Identifying interventions that can mitigate the negative consequences of maternal depression on children is key to reducing health disparities and is therefore a major public health priority. However, measurable impacts on child development may not emerge immediately after an intervention and so there is a great need to identify interim indicators of effect. Such indicators would provide early information about the intervention’s causal impact, as well as point to the biological mechanism through which these interventions shape future child development. The HPA axis is a robust marker of biological responses to stress, and there is growing evidence linking HPA axis biomarkers to both maternal depression and infant brain development. Using a cluster Randomized Control Trial in Pakistan, this study leverages novel hair-derived biomarker data (cortisol and DHEA), from 104 mother-infant dyads, to determine if treating maternal depression can alter infant HPA axis function, and to examine to what extent infant HPA axis function predicts future development outcomes. The trial’s intervention is a peer-delivered version of the Thinking Healthy Programme provided to women identified as depressed in their 3rd trimester. The study sample also includes a subset of women who were not depressed during pregnancy, as a low-risk comparison group. The mother-child dyads are being followed through 36 months post-partum, and the resulting dataset is rich with data related to mothers’ health, sociodemographic factors, parenting, and child development from 3 to 36 months post-partum. The randomized design allows us to assess the intervention’s causal effects on infant cortisol and DHEA. The main outcomes of interest are child cognitive and socioemotional development indicators at 36 months of age. The specific aims of this project are to (1) evaluate the impact of a perinatal depression intervention on infant cortisol in hair; (2) examine whether infant cortisol at 12 months predicts child development at 24 and 36 months; and (3) examine the impact of the intervention on DHEA levels in infants and the link between infant DHEA at 12 months and child developmental outcomes at 24 and 36 months. The results from this study will improve our understanding of the role of maternal mental health in child development as well as help identify important indicators to improve early intervention evaluation.