Research report
A longitudinal study of maternal prenatal, postnatal and concurrent depressive symptoms and adolescent well-being

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Abstract

Background

Maternal depression is known to be a risk for abnormal child development. Girls and boys have been found to respond differently to maternal depression. Although prenatal and postnatal depression has been widely studied, longitudinal studies of adolescent outcome are still rare.

Methods

The original sample of 349 mothers in this longitudinal study was collected in 1989–1990 in Tampere, Finland. At the latest stage, of the 327 contacted in 2006, 191 mothers and 192 adolescents aged 16 to 17 years participated in the study. Maternal depressive symptoms were screened using the Edinburgh Postnatal Depression Scale (EPDS) prenatally, postnatally and at the latest stage. Adolescent outcome was examined using the Child Behavior Checklist (CBCL) and the Youth Self Report (YSR).

Results

Maternal concurrent depressive symptoms were associated with adolescent behavioral and emotional problems in both genders. Maternal prenatal depressive symptoms were associated with Externalizing Problems in the YSR and boys' lower Social Competence in both the CBCL and YSR. Maternal postnatal depressive symptoms were associated with boys' lower Social Competence both in the CBCL and YSR and Externalizing Problems in the YSR.

Limitations

Being a longitudinal normal population sample, the number of symptomatic mothers and adolescents is relatively small and the number of drop-outs is relatively high. Clinical evaluation of mothers and adolescents is also lacking.

Conclusions

Maternal prenatal and postnatal depressive symptoms are a risk to adolescent boys' wellbeing and concurrent depressive symptoms a risk for both girls' and boys' well-being. This long-term influence should be noted when treating women with depressive symptoms throughout motherhood.

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.

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