Does maternal depression predict developmental outcome in 18 month old infants?
Introduction
Maternal depression in the postpartum period is an important public health issue, not only because of its high prevalence, but also because of its adverse consequences. Postnatal depression (PND) has commonly been reported in 10–15% of mothers [1], [2], [3]. Some studies have reported that PND is associated with poorer developmental outcomes [4], [5], [6], [7], [8], [9]. Other studies have reported no associations [10], [11], [12], [13] and some have reported that these associations were significant only for boys [8], [10], [13] or for children from low socio-economic status (SES) areas [10], [11]. Results across studies have been inconsistent and this may be due to different definitions of “chronic depression”, period of follow-up, timing of assessment, assessments used for maternal mental health and child development, and the lack of controlling for key confounding variables [6], [14].
Whilst a number of studies have controlled for SES, they have often not taken into consideration other home environmental risk factors that may affect the risk of adverse developmental outcomes in the child. For example, a child's development can be influenced by the level of environmental stimulation in the home, including the availability of stimulating objects, books and play materials [15], [16], [17]. Research has suggested that depressed mothers are less likely to provide stimulating objects and books, and are less likely to engage in imitation, singing, playing, reading and telling stories [18]. The only study to date to assess the relationship between maternal depression, home environment and child development by Zajicek-Farber [19] reported that maternal depressive symptoms and risky parental practices did not directly impact the child's language development. However, maternal depressive symptomology had a stronger impact on the child's engagement in stimulating activities in the home, which in turn influenced the child's language development. Thus, as well as investigating the direct effects of maternal depression on a child's development, it is necessary to consider the indirect paths through which maternal depression may lead to poorer child development. To our knowledge, no studies to date have considered whether maternal depressive symptomology is associated with a poorer home environment, which in turn may be associated with poorer developmental outcome.
We hypothesised that (a) infants of mothers with depression in the first 6 months postpartum would have poorer developmental outcomes at 18 months of age compared with infants of mothers with no depression, after controlling for demographic variables, infant prematurity and home environment factors; and (b) maternal depression in the first 6 months postpartum would be associated with poorer home environment at 18 months of age and this would be associated with poorer infant development at 18 months (see Fig. 1).
Section snippets
Method
A detailed methodology of the DOMInO trial, which aimed to determine the effect of supplementing the maternal diet with docosahexaenoic acid (DHA) during the last half of pregnancy on maternal postpartum depression and cognitive development in young children, has been previously published [20]. The current paper focuses on the control group (n = 312 full term; n = 48 preterm) who had Edinburgh Postnatal Depression Scale (EPDS) data collected at 6 weeks and 6 months postpartum, and Bayley Scales of
Results
In total, 69 (19%) mothers showed depressive symptoms in the postnatal period. Of these, 26 (38%) showed symptoms at 6 weeks only, 32 (46%) at 6 months only, and 11 (16%) at both time points. Mothers with any depression were more likely to have a history of depression and more likely to have a child who was formula fed at 6 weeks of age, but there were no significant differences between groups for the other variables (see Table 1).
There were no significant differences between maternal depression
Discussion
In this study we observed that any PND in the first 6 months postpartum was not associated with poorer infant development at 18 months of age. This is similar to results found by some [10], [11], [12], [13] but in contradiction to others [6], [9]. This may relate to the chronicity of PND. In our study only 16% of women who showed depressive symptoms in the postnatal period were depressed at both 6 week and 6 months post-partum, and it may be that maternal depression for short periods does not
Role of funding/support
This work was supported by grant 349301 from the Australian National Health and Medical Research Council.
Conflict of interest
Professor Makrides serves on scientific advisory boards for Nestle, Fonterra, and Nutricia. Associated honoraria for Professor Makrides are paid to her institutions to support conference travel and continuing education for postgraduate students and early career researchers. No other authors reported any financial disclosures.
Acknowledgements
We would like to thank the Steering Committee and the DOMINO Study Team for their assistance in conducting the Trial. Steering Committee: Maria Makrides (chair); Robert A Gibson (deputy chair), Andrew J McPhee, Lisa Yelland, Julie Quinlivan, Philip Ryan. Members of the DOMInO Investigative Team in SA included Shao Zhou, Carmel T Collins, Zoe Gulpers, Suzanne McCusker, Nicola Naccarella; Karen Best and Helen Loudis from the Women's and Children's Health Research Institute, Adelaide SA,
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