Elsevier

Early Human Development

Volume 88, Issue 8, August 2012, Pages 651-655
Early Human Development

Does maternal depression predict developmental outcome in 18 month old infants?

https://doi.org/10.1016/j.earlhumdev.2012.01.013Get rights and content

Abstract

Aim

Our aim was to examine the associations between maternal depression in the first 6 months postpartum, home environment and cognitive, language and motor development in infants at 18 months of age.

Study design and methods

This article reports results from the control group (n = 312 full term; n = 48 preterm) of the prospective Docosahexaenoic acid (DHA) to Optimise Maternal Infant Outcome (DOMInO) Randomised Controlled Trial. Mothers in South Australia completed the Edinburgh Postnatal Depression Scale (EPDS) at 6 weeks and 6 months postpartum. Infant development was assessed when children were 18 months old with the Bayley Scales of Infant and Toddler Development Version III and mothers completed the Home Screening Questionnaire at this assessment.

Results

There were no significant associations between maternal depression in the first 6 months postpartum and cognitive, language or motor development after controlling for infant prematurity, breastfeeding status and socio-economic level. Home environment remained a significant predictor of development after controlling for potential confounding variables. Using mediation models, we did not find an association between maternal depression and developmental outcome through home environment.

Conclusions

Maternal depression in the first 6 months postpartum was not associated with infant development at 18 months of age. Further studies should focus on women with chronic depression.

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,

References (39)

  • D.F. Hay et al.

    Intellectual problems shown by 11-year-old children whose mothers had postnatal depression

    J Child Psychol Psychiatry

    (2001)
  • Network NIoCaHDECCR

    Chronicity of maternal depressive symptoms, maternal sensitivity, and child functioning at 36 months. NICHD Early Child Care Research Network

    Dev Psychol

    (1999)
  • S. Kurstjens et al.

    Effects of maternal depression on cognitive development of children over the first 7 years of life

    J Child Psychol Psychiatry

    (2001)
  • L. Murray

    The impact of postnatal depression on infant development

    J Child Psychol Psychiatry

    (1992)
  • L. Murray et al.

    The cognitive development of 5-year-old children of postnatally depressed mothers

    J Child Psychol Psychiatry

    (1996)
  • D. Sharp et al.

    The impact of postnatal depression on boys' intellectual development

    J Child Psychol Psychiatry

    (1995)
  • S.A. Kelm et al.

    A prospective study of maternal anxiety, perceived stress, and depressive symptoms in relation to infant cognitive development

    Early Hum Dev

    (2011)
  • A.G. Bus et al.

    Joint book reading makes success in learning to read: a meta-analysis on intergenerational transmission of literacy

    Rev Educ Res

    (1995)
  • A. Haydari et al.

    Relationship between affordances in the home environment and motor development in children age 18–42 months

    J Soc Sci

    (2009)
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