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How maternal depressive symptoms prior to conception are related to children’s emotional wellbeing

Dr. Katrina Moss, 2019

Related to Child mental health, Depression, Infant mental health, Parental mental illness, Perinatal infant mental health

Resource Summary

This short article is a summary of the longer paper titled, ‘Testing competing mediators of the association between pre-conception maternal depression and child health-related quality of life.’

Moss, K. M., Loxton, D., Dobson, A. J., Slaughter, V., & Mishra, G. D. (2019). Testing competing mediators of the association between pre-conception maternal depression and child health-related quality of life: the MatCH study. Archives of women’s mental health, 1-10.

Parental mental health and children’s wellbeing
Parents can experience mental health issues, such as depression, at any stage of the family life cycle4. This can lead to increased marital conflict, can negatively impact the mental health of their partner, can affect parenting practices such as discipline, and can increase the risk of behavioural problems and developmental delays in children5.

The children of parents experiencing mental health concerns have an increased risk of poorer outcomes across a range of developmental areas. This includes internalising and externalising behaviour problems1,2, less healthy attachment3, and poorer cognitive development1,2. This short article will focus specifically on mothers given that it summarises the key findings of a research study conducted with data from the Australian Longitudinal Study on Women’s Health. However, it is important to highlight that paternal mental health is also integral to the health and wellbeing of families.

How is maternal mental health before conception related to children’s wellbeing?
Maternal depression is a well-known risk factor for poorer child health and development2,6. The majority of research has focused on what occurs after birth, for example how maternal depression is related to parenting, or how maternal depression during pregnancy can influence the developing fetus2,7. However, the strongest predictor of maternal depression during or after pregnancy is being depressed before conception8,9. Even if depressive symptoms subsequently subside, there can be an ongoing negative effect on parenting10,11. Clinical guidelines for perinatal mental health care5 recommend that psychosocial assessments specifically ask about previous mental health, as this can lead to higher rates of referral to supports/services than only assessing current symptoms12. It may be more effective to intervene before conception rather than during pregnancy, but preparation for pregnancy tends to focus on physical health, smoking and alcohol, and nutrition13.

What were the aims of the current study?
The current study aimed to:

  • Identify possible factors that can be targeted by maternal depression interventions
  • Understand the optimal timing for interventions.

What did the current study do?
The study used 20 years of survey data from 2,917 Australian mothers (collected since 1996 in the Australian Longitudinal Study of Women’s Health14). This was matched with survey data on 5532 children aged 0-12 years (collected from the same mothers in 2016/17 as part of the Mothers and their Children’s Health study15). The study measured mothers’ depressive symptoms16 and parenting17,18, as well as children’s psychosocial wellbeing19.

What did the current study find?
The study found that depressive symptoms before birth were the first link in a chain of risk. Mothers with higher depressive symptoms before birth were more likely to have higher depressive symptoms after birth, and their children were more likely to have poorer psychosocial outcomes, including:

  • Poorer emotional functioning, such as worrying and crying
  • Poorer social functioning, such as not getting along with other children
  • Poorer school functioning in school-age children, such as not paying attention or forgetting things.

Symptoms of depression before birth were also related to parenting. As the severity of depressive symptoms increased, warmth and positivity decreased and hostility and inconsistent discipline increased. Even though parenting practices played an important role in poorer psychosocial outcomes for children (i.e. emotional, social and school functioning), ongoing maternal depression had the biggest negative effect.

What are the implications of the current findings for approaches to maternal and child mental health?
Australian guidelines recommend mental health screening during pregnancy and in the first postnatal year5. However, the findings of our study suggest the ideal time for intervention for maternal depression is prior to conception: if depressive symptoms decrease before pregnancy, outcomes are better for both women and their children. Starting conversations about maternal mental health from when women and/or couples start trying to conceive, and including assessment of men’s mental health, could improve outcomes for parents and children.

While interventions (in both men and women, both pre- and post-conception) should primarily focus on reducing the symptoms of depression, support could also be provided to develop key parenting skills and foster warm interactions10,20.

References

1. Baker, C., Kuhn, L. (2017). Mediated pathways from maternal depression and early parenting to children’s executive function and externalizing behaviour problems. Infant and Child Development.
2. Ahun, M.N., Côté, S.M. (2018). Maternal depressive symptoms and early childhood cognitive development: a review of putative environmental mediators. Archives of Women’s Mental Health, 1-10.
3. Goodman, S.H. (2007). Depression in mothers. Annual Review of Clinical Psychology 3, 107-135.
4. Fisher, S.D, Brock, R.L., O’Hara, M.W., Kopelman, R., Stuart, S. (2015). Longitudinal contribution of maternal and paternal depression to toddler behaviors: Interparental conflict and later depression as mediators. Couple and Family Psychology: Research and Practice, 4(2), 61.
5. Austin, M-P., N. H, Group, E.W. (2017). Mental Health Care in the Perinatal Period: Australian Clinical Practice Guideline. Melbourne: Centre of Perinatal Excellence (COPE).
6. Galbally, M., Lewis, A.J. (2017). Depression and parenting: the need for improved intervention models. Current Opinion in Psychology 15, 61-65.
7. Cohen, K.E., Morgan, P.J., Plotnikoff, R.C., Hulteen, R.M., Lubans, D.R. (2017). Psychological, social and physical environmental mediators of the SCORES intervention on physical activity among children living in low-income communities. Psychology of Sport and Exercise 32, 1-11.
8. Chojenta, C., Loxton, D., Lucke, J. (2012). How do previous mental health, social support, and stressful life events contribute to postnatal depression in a representative sample of Australian women? Journal of Midwifery & Women’s Health 57(2), 145-150.
9. Underwood, L., Waldie, K., D’Souza, S., Peterson, E., Morton, S. (2016). A review of longitudinal studies on antenatal and postnatal depression. Archives of Women’s Mental Health 19(5), 711-720.
10. Hammen, C. Maternal Depression and the Intergenerational Transmission of Depression. In: Cohen NL, ed. (2017). Public Health Perspectives on Depressive Disorders. Baltimore: John Hopkins University Press, 147-170.
11. Lovejoy, M.C., Graczyk, P.A., O’Hare, E., Neuman, G. (2000). Maternal depression and parenting behavior: A meta-analytic review. Clinical Psychology Review 20(5), 561-592.
12. Reilly, N., Harris, S., Loxton, D., et al. (2013). Referral for management of emotional health issues during the perinatal period: Does mental health assessment make a difference? Birth 40(4), 297-306.
13. Stephenson, J., Heslehurst, N., Hall, J., et al. (2018). Before the beginning: nutrition and lifestyle in the preconception period and its importance for future health. The Lancet 391(10132), 1830-1841.
14. Lee, C., Dobson, A.J., Brown, W.J., et al. (2005). Cohort Profile: the Australian Longitudinal Study on Women’s Health. International Journal of Epidemiology 34(5), 987-991.
15. Mishra, G.D., Moss, K.M., Loos, C., et al. (2018). MatCH (Mothers and their Children’s Health) Profile: offspring of the 1973-78 cohort of the Australian Longitudinal Study on Women’s Health. Longitudinal and Life Course Studies 9(3), 351-375.
16. Andresen, E.M., Malmgren, J.A., Carter, W.B., Patrick, D.L. (1994). Screening for depression in well older adults: Evaluation of a short form of the CES-D. American Journal of Preventative Medicine 10(2), 77-84.
17. Elgar, F.J., Waschbusch, D.A., Dadds, M.R., Sigvaldason, N. (2007). Development and validation of a short form of the Alabama Parenting Questionnaire. Journal of Child and Family Studies 16(2), 243-259.
18. Zubrick, S.R., Lucas, N., Westrupp, E.M., Nicholson, J.M. (2014). Parenting measures in the Longitudinal Study of Australian Children: Construct validity and measurement quality, Waves 1 to 4. Canberra.
19. Varni, J.W., Seid, M., Rode, C.A. (1999). The PedsQL: Measurement model for the pediatric quality of life inventory. Medical Care 37(2), 126-139.
20. Stein, A., Pearson, R.M., Goodman, S.H., et al. (2014). Effects of perinatal mental disorders on the fetus and child. Lancet 384(9956), 1800-1819.

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