Research reportA longitudinal study of maternal prenatal, postnatal and concurrent depressive symptoms and adolescent well-being
Introduction
Children of depressed mothers are at risk for abnormal development (Beardslee et al., 1998) and subsequent psychiatric problems (Lewinsohn et al., 2005, Nomura et al., 2002, Weissman et al., 2006). Maternal depression has an impact on the whole family system (Burke, 2003) and it is likely that there is a reciprocal relation between maternal depression and child adjustment problems (Elgar et al., 2004). There are many theories about why and how maternal depression has such an influence on child development (Goodman and Gotlib, 1999), and the mediating factors have been the focus of research in many recent studies (Ashman et al., 2008, Duggal et al., 2001, Elgar et al., 2007, Hammen et al., 2004, McCarty et al., 2003).
Some studies estimate that adolescent girls are more susceptible to maternal depression and distress than boys (Crawford et al., 2001, Davies and Windle, 1997, Duggal et al., 2001, Fergusson et al., 1995, Jenkins and Curwey, 2008). Contrary to this, studies of infants and children of depressed mothers suggest that boys are more susceptible to maternal depression at infancy than girls (Carter et al., 2001, Essex et al., 2003, Murray et al., 1993, Weinberg et al., 2006).
The recurrent nature of depression is known, likewise the range from subsyndromal depression or elevated depressive mood to Major Depressive Disorder (Goodman, 2007). It is also common that over time patients' diagnosis change from one depression subtype to another (Chen et al., 2000, Judd et al., 1997).
Prenatal depression is beginning to attract more attention in studies of depressed mothers and child outcome, while postnatal depression was earlier the focus of research. Depression is often chronic or at least recurrent, which has led to suggestions that postnatal depression may actually often begin during pregnancy or even earlier (Verkerk et al., 2002). A study on a birth cohort in Northern Finland showed that among the male offspring of prenatally depressed mothers there was a significant increase in criminality in adulthood (Mäki et al., 2003), indicating that prenatal depression may have long-term effects on the child.
Studies of prenatal depression have lately been focused on biochemical effects of maternal depression. Studies have shown that newborns of prenatally depressed mothers replicate mother's biochemical profile by having elevated cortisol and norepinephrine levels and lower dopamine levels than the newborns of nondepressed mothers (Field et al., 2006, Weinstock, 2008). Studies have shown elevated hypothalamic pituitary adrenal (HPA)-axis activation in the newborns of prenatally depressed mothers (Field et al., 2006, Weinstock, 2008) and elevated cortisol levels even at the age of 7 years (Ashman et al., 2002) and 14–15 (Van den Bergh et al., 2008), suggesting a long-term effect of prenatal depression on the neuroendocrine functioning of the offspring. Elevated cortisol levels were found to be associated with internalizing symptoms or depression in children and adolescents, although Van den Bergh et al. (2008) found the association only among adolescent females.
There are, however, some suggestions that prenatal stress and anxiety rather than depression are a risk for behavioral/emotional problems (Luoma, 2004, O'Connor et al., 2002, Talge et al., 2007), ADHD (Van den Bergh and Marcoen, 2004), as well as HPA-axis functioning (Van den Bergh et al., 2008) in children, but it is known that stress and anxiety often co-exist and overlap with depression and depressive symptoms.
Postnatal depression and its effects on child development have been widely studied. It is beginning to be well documented that postnatal depression affects not only the mother–infant relationship and infant's well-being and early development (Murray and Cooper, 1997, Weinberg and Tronick, 1998) but also the development of the child over a longer period of time (Luoma et al., 2001, Murray and Cooper, 1997, Murray et al., 1999, Sohr-Preston and Scaramella, 2006). However, only few studies have been carried out among adolescents and longitudinal studies are even rarer.
Abbott et al. (2004) find in their retrospective follow-up study that young adult offspring of mothers with severe puerperal disorder (of whom 52% with depression) are at high risk of psychiatric illness. Halligan et al. (2004) have reported that adolescents exposed to maternal postnatal depression show elevated cortisol levels and elevated rates of affective disorders by 13 years of age (Halligan et al., 2007a) and have more depression at the age of 16 (Halligan et al., 2007b). Another study on the same longitudinal sample reports heightened emotional sensitivity and raised social maturity in 13-year-old girls whose mothers had experienced postnatal depression (Murray et al., 2006). High emotional sensitivity was associated with adolescent's depressed mood. Additionally, the academic performance was poorer among 16-year-old boys whose mothers' had had postnatal depression (Murray et al., 2011). Hay et al. (2001) also documented that children of postnatally depressed mothers had poorer cognitive ability and more attention problems than other children at the age of 11. The impact was even greater for boys than for girls. This effect was already apparent at the age of four in the same community sample (Cogill et al., 1986). In another study conducted by Hay et al. (2003), postnatally depressed mothers' children were reported to be more violent at the age of 11, in addition to having problems in regulating attention and emotion.
Child and adolescent well-being have been documented by various measures to be associated with maternal concurrent depression, also including other than maternal reports (Malcarne et al., 2000, Nelson et al., 2003). Children of depressed mothers are at higher risk of experiencing a depressive episode and they tend to do so in close proximity to maternal depression (Hammen et al., 1991). However, although maternal concurrent depressive symptoms affect adolescents' present life, the influence may diminish over time, especially if reduction or remission of maternal depressive symptoms is achieved (Gunlicks and Weissman, 2008).
Studying maternal concurrent depression differs from longitudinal studies of prenatal and postnatal depression. First, studies of concurrent depression are cross-sectional and therefore only possible associations between mother's depression and adolescent's symptoms can be examined, not the causal impact of mother's depression on the child. Second, concurrent depression may have an impact on mother's reports on herself and the child. Depressed mothers may see their children differently than non-depressed mothers do. There is evidence for associations between mothers' mental state and observation bias in their ratings of child problems. Although most studies support the theory of depression–distortion (Bergen-Nielsen et al., 2003, Chilcoat and Breslau, 1997, De Los Reyes et al., 2008, Najman et al., 2000), there are also opposing findings that depressed mothers are more accurate in evaluating their children (Conrad and Hammen, 1989).
The first aim of this study was to examine whether maternal prenatal, postnatal or concurrent depressive symptoms are associated with adolescent's poorer psychosocial functioning or emotional/behavioral problems. The second aim was to examine whether there are differences in these associations between girls and boys. Including both concurrent and pre- and postnatal maternal depressive symptoms makes it possible to explore and compare both the long lasting and concurrent effects on adolescent's present psychosocial functioning level and emotional/behavioral problems. We also wanted to explore whether the possible associations between maternal prenatal, postnatal and concurrent depressive symptom are rather to be explained via the recurrence of maternal depressive symptoms. Our first hypothesis was that maternal concurrent depressive symptoms would have an effect on adolescent behavioral and emotional functioning. Our second hypothesis was that there would be a difference between adolescent boys' and girls' outcomes such that maternal depressive symptoms at infancy would have a stronger effect on adolescent boys psychosocial functioning than that of girls.
Section snippets
Method
This study is part of a longitudinal study begun in Tampere, Finland, in 1989. Study stages 1–4, including data collection points T1–T7 of the longitudinal study are shown in Fig. 1. For the purposes of this study we have used data collected prenatally during the last trimester (T1), 2 months after delivery (T3) and at the adolescent stage (T7) when the children were 16 to 17 years old. At all data collection points T1 through T6, mothers' depressive symptoms were screened by questionnaires. The
Results
The proportion of mothers scoring high on the EPDS was 7% (n = 14) prenatally, 8% (n = 12) postnatally and 11% (n = 19) concurrently. At study stage four, when the children were 16 to 17 years of age the mean Social Competence score of the boys was 45 (SD 9) in the CBCL and 44 (SD 10) in the YSR. For the girls both CBCL and YSR mean Social Competence scores were 48 (SD 10). On the problem scales the proportions of boys scoring over the cut-point ≥ 64 on the CBCL and YSR were 3% (n = 3) and 4% (n = 4) for
Discussion
The expected finding, which supported our hypothesis, was the association between maternal concurrent depressive symptoms and adolescents' psychosocial functioning and emotional/behavioral problems, assessed by both mothers and adolescents themselves. We do not know whether adolescents' internalizing and externalizing symptoms are a reaction to mothers' depressive symptoms or something else. Perhaps there is a reciprocal relation between maternal depression and adolescent behavior as was found
Role of funding source
This study was supported by grants from the Medical Research Fund of the Tampere University Hospital, the Foundation of Emil Aaltonen, the Foundation for Paediatric Research and the Academy of Finland. The funding sources had no further role in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication.
Conflict of interest
The authors report no conflicts of interest.
Acknowledgment
We thank for Mrs. Virginia Mattila who kindly redraw the grammar.
References (73)
- et al.
Maternal depression and comorbidity: Predicting early parenting, attachment security, and toddler social–emotional problems and competencies
Journal of the American Academy of Child and Adolescent Psychiatry
(2001) - et al.
Does psychiatric history bias mothers' reports? An application of a new analytic approach
Journal of the American Academy of Child and Adolescent Psychiatry
(1997) - et al.
Postnatal depression and infant cognitive and motor development in the second postnatal year: The impact of depression chronicity and infant gender
Infant Behavior & Development
(2005) - et al.
Validation of the Edinburgh Postnatal Depression Scale (EPDS) in non-postnatal women
Journal of Affective Disorders
(1996) - et al.
Mutual influences on maternal depression and child adjustment problems
Clinical Psychology Review
(2004) - et al.
Exposure to maternal depression and marital conflict: Gender differences in children's later mental health symptoms
Journal of the American Academy of Child and Adolescent Psychiatry
(2003) - et al.
Prenatal depression effects on the fetus and newborn: a review
Infant Behavior & Development
(2006) - et al.
The impact of postnatal and concurrent maternal depression on child behaviour during the early school years
Journal of Affective Disorders
(2009) - et al.
Changes in child psychopathology with improvement in parental depression: a systematic review
Journal of the American Academy of Child and Adolescent Psychiatry
(2008) - et al.
Exposure to postnatal depression predicts elevated cortisol in adolescent offspring
Biological Psychiatry
(2004)
Maternal depression and psychiatric outcome in adolescent offspring: A 13-year longitudinal study
Journal of Affective Disorders
Disturbances in morning cortisol secretion in association with maternal postnatal depression predict subsequent depressive symptomatology in adolescents
Biological Psychiatry
Family discord and stress predictors of depression and other disorders in adolescent children of depressed and nondepressed women
Journal of the American Academy of Child and Adolescent Psychiatry
Changes in adolescents' internalizing symptomatology as a function of sex and the timing of maternal depressive symptomatology
Journal of the American Academy of Child and Adolescent Psychiatry
The role and clinical significance of subsyndromal depressive symptoms (SDD) in unipolar major depressive disorder
Journal of Affective Disorders
Longitudinal study of maternal depressive symptoms and child well-being
Journal of the American Academy of Child and Adolescent Psychiatry
Criminality in the offspring of antenatally depressed mothers: a 33-year follow-up of Northern Finland 1966 birth cohort
Journal of Affective Disorders
Correlates of distress in children at risk for affective disorder: exploring predictors in the offspring of depressed and nondepressed mothers
Journal of Affective Disorders
Mothers' mental illness and child behavior problems: cause–effect association or observation bias
Journal of the American Academy of Child and Adolescent Psychiatry
Family discord, parental depression, and psychopathology in offspring: Ten-year Follow-up
Journal of the American Academy of Child and Adolescent Psychiatry
Antenatal anxiety predicts child behavioural/emotional problems independently of postnatal depression
Journal of the American Academy of Child and Adolescent Psychiatry
Antenatal depression predicts depression in adolescent offspring: Prospective longitudinal community based study
Journal of Affective Disorders
The long-term behavioral consequences of prenatal stress
Neuroscience and Biobehavioral Reviews
Long-term outcome of offspring after maternal severe puerperal disorder
Acta Psychiatrica Scandinavica
Manual for the child behavior checklist/4-18 and 1991 profile
Manual for the youth self-report and 1991 profile
Manual for the ASEBA school-age forms and profiles
Sex differences and adolescent depression
Journal of Abnormal Psychology
Stress hormone levels of children of depressed mothers
Development and Psychopathology
Trajectories of maternal depression over 7 years: Relation with child psychopathology and behavior and role of contextual risks
Development and Psychopathology
Children of affectively ill parents: A review of the past 10 years
Journal of the American Academy of Child and Adolescent Psychiatry
When adolescents disagree with their mothers: CBCL-YSR discrepancies related to maternal depression and adolescent self-esteem
Child: Care, Health and Development
The impact of maternal depression on familial relationships
International Review of Psychiatry
Empirical examination of current depression categories in population-based study: symptoms, course and risk factors
The American Journal of Psychiatry
Impact of postnatal depression on cognitive development in young children
BMJ
Role of maternal depression in perceptions of child maladjustment
Journal of Consulting and Clinical Psychology
Cited by (103)
A longitudinal study of the psychological impact of child-rearing difficulty and COVID-19 on mothers in the postpartum period in Japan
2023, Journal of Affective Disorders ReportsAssociations of Maternal Prenatal Stress and Depressive Symptoms With Childhood Neurobehavioral Outcomes in the ECHO Cohort of the NICHD Fetal Growth Studies: Fetal Growth Velocity as a Potential Mediator
2022, Journal of the American Academy of Child and Adolescent PsychiatrySex-dependence and comorbidities of the early-life adversity induced mental and metabolic disease risks: Where are we at?
2022, Neuroscience and Biobehavioral ReviewsPatterns and predictors of depressive and anxiety symptoms in mothers affected by previous prenatal loss in the ALSPAC birth cohort
2022, Journal of Affective DisordersPlacental DNA methylation marks are associated with maternal depressive symptoms during early pregnancy
2021, Neurobiology of Stress