University of Bristol | July 2018 | Depression in pregnancy rises in a generation
Findings of research undertaken by researchers at the University of Bristol indicate that the rates of depression in expectant mothers has increased by 51 per cent in a generation. Dr Rebecca Pearson, lecturer in Psychiatric Epidemiology at Bristol, makes a distinction between how young pregnant women are experiencing depression:
“These new data give a more accurate picture of what our current population of young pregnant women are facing. But the “research shows that depression in today’s young women may be driven by rises in feeling overwhelmed and stress rather than feelings of being down and flat.”
The study, published in journal JAMA Open Network, shows depression is more prevalent in pregnant women today than in the 1990s: 25 per cent of the pregnant women experienced depression compared to 17 per cent of their mothers’ generation.
The cohort study used data from Avon Longitudinal Study of Parents and Children, with the participants the original mothers (the original sample) and their offspring. The scientists used the Edinburgh Postnatal Depression Scale to measure prenatal depression in self-reported surveys in both generations, with a score of 13 or more on a scale of 0 to 30 indicated depressed mood (via University of Bristol).
The research is particularly novel as it is the first time scientists have been able to compare mental health symptoms in pregnancy across generations. The research team found that if their mother was depressed in pregnancy, daughters were also more than three times as likely to be depressed in their pregnancy.
Importance Depression during pregnancy (prenatal depression) is common and has important consequences for mother and child. Evidence suggests an increasing prevalence of depression, especially in young women. It is unknown whether this is reflected in an increasing prevalence of prenatal depression.
Objective To compare the prevalence of depression during pregnancy in today’s young mothers with their mothers’ generation.
Design, Setting, and Participants In a longitudinal cohort study, we compared prenatal depressive symptoms in 2 generations of women who participated in the Avon Longitudinal Study of Parents and Children. Participants were the original mothers (recruited when they were pregnant) and their female offspring, or female partners of male offspring, who became pregnant. Both groups were limited to the same age range (19-24 years). The first generation of pregnancies occurred in 1990 to 1992 (n = 2390) and the second in 2012 to 2016 (n = 180). In both generations, women were born in the same geographical area (southwest England).
Main Outcomes and Measures Depressed mood measured prenatally using the Edinburgh Postnatal Depression Scale in self-reported surveys in both generations. A score of 13 or greater on a scale of 0 to 30 indicated depressed mood.
Results Of 2390 pregnant women in the first generation who were included in analysis (mean [SD] age, 22.1 [2.5] years), 408 (17%) had high depressive symptom scores (greater than or equal to 13). Of 180 pregnant women in the second generation who were included in the analysis (mean [SD] age, 22.8 [1.3] years), 45 (25%) had high depressive symptom scores. Having high depressive symptom scores was more common in the second generation of young pregnant women than in their mothers’ generation, with imputation for missing confounding variable data and adjustment for age, parity, education, smoking, and body mass index not substantially changing this difference. Results were essentially the same when analyses were restricted to the 66 mother-offspring pairs. Maternal prenatal depression was associated with daughters’ prenatal depression.
Conclusions and Relevance In this unique study of 2 generations of women who answered identical questionnaires in pregnancy, evidence was found that depressed mood may be higher in young pregnant women today than in their mothers’ generation. Because of the multiple and diverse consequences of prenatal depression, an increase in prevalence has important implications for families, health care professionals, and society.
Pearson R.M, Carnegie RE, Cree C, et al.| 2018| Prevalence of Prenatal Depression Symptoms Among 2 Generations of Pregnant MothersThe Avon Longitudinal Study of Parents and Children |JAMA Network Open |1(3)| e180725| doi:10.1001/jamanetworkopen.2018.0725
Science Daily| April 2018| Mother’s depression may do the same to her child’s IQ
The children of mothers who experience depression may not provide toys and books to support their learning or be as emotionally available to their child, compared to mothers who did not report depression. Researchers studied mothers and 700 children in Chile assessing them every five years, until the children were 16. They observed the mothers with their children, noted their interactions and any learning materials they provided for them. Alongside this the mothers also completed questionnaires which asked them about their emotions and mental health. The researchers found that the children of mothers with severe depression had a lower average verbal IQ score (7.30) compared to a score of 7.78 in children without depressed mothers. They surmise that the children’s IQ measured at 1, 6, 11 and 16 was affected by this. (via Science Daily)
This study examined the associations among maternal depression, mothers’ emotional and material investment in their child, and children’s cognitive functioning. Middle‐class Chilean mothers and children (N equal to 875; 52% males) were studied when children were 1, 5, 10, and 16 years (1991–2007). Results indicated that highly depressed mothers provided less emotional and material support to their child across all ages, which related to children’s lower IQ. Children with lower mental abilities at age 1 received less learning‐material support at age 5, which led to mothers’ higher depression at child age 10. Mothers’ low support was more strongly linked to maternal depression as children got older. Findings elucidate the dynamic and enduring effects of depression on mothers’ parenting and children’s development.
The article is published in Child Development. Rotherham NHS staff can request the article here
Doing aerobic exercise can reduce the level of depressive symptoms experienced by women who have had a baby in the past year | British Journal of General Practice |via National Institute for Health Research (NIHR)
This review of 13 studies showed that involving new mothers in group exercise programmes, or advising them on an exercise of their choice, reduced depressive symptoms compared with usual care. The effect was moderate but significant. Examples of exercise were pram walks, with dietary advice from peers in some studies. The benefits were shown whether or not the mothers had postnatal depression.
The NIHR reports that the evidence does have some limitations regarding its quality but is the best research currently available. This review should give additional confidence to health visitors and GPs to advise women that keeping active after birth can benefit their mental and physical health.
It is well-established that women in low-income households have an increased risk of developing mental health problems, in particular depression | The Mental Elf
Studies have found that these women are around twice as likely to develop the disorder compared with those from higher-income households (Hobfoll et al, 1995). Low-income women are also less likely to seek and receive appropriate treatment, in part because of the associated costs (Lennon et al, 2001).
For women who are mothers, this is especially consequential: parental depression has been linked with developmental, emotional and mental health problems in children (McDaniel et al., 2013). In the United States this has been highlighted as a public health concern, and it is increasingly being recognised that community-based services offer valuable opportunities to reach those for whom help is less accessible.
Head Start is a US government-funded service aimed at families at or below the federal poverty level with young children under five. They use a case-management structure to establish a healthy family environment in order to look after the child’s development and wellbeing. Depression affects almost half of the mothers at Head Start. A recent study by Silverstein et al. (2017) examines the efficacy of embedding a depression prevention strategy in the Head Start program.
Postnatal depression affects around 1 in 10 women and not only impacts on the wellbeing of the mother, but can also have long term impacts on the mental and physical health of the infant.
The authors of this Lancet paper are from the Postpartum Depression: Action Towards Causes and Treatment (PACT) consortium. This is an international group who aim to gather information about PND to explore a number of questions, including whether there are distinguishable subtypes of PND which might be relevant for treatment and prognosis, in particular taking into account comorbid anxiety.
In this post via The Mental Elf, Jill Domoney looks at the methods and results of this paper, the authors of which believe has created “an important hypothesis-generating foundation for future work”.
Dhillon, A. et al. Mindfulness | Published online 17 April 2017
This systematic review aims to assess the effect of mindfulness-based interventions carried out during pregnancy exploring mindfulness and mental health outcomes.
Pooled results of the non-RCTs reporting anxiety, depression and perceived stress showed a significant benefit for the mindfulness group. Mindfulness as an outcome was assessed in four RCTs for which the pooled results show a significant difference in favour of the mindfulness intervention when compared to a control group. The pooled results of the four non-RCTs also indicate a significant difference following mindfulness intervention.
Results suggest that mindfulness-based interventions can be beneficial for outcomes such as anxiety, depression, perceived stress and levels of mindfulness during the perinatal period. Further research would be useful to explore if such benefits are sustained during the post-natal period.
This year’s World Health Day (7 April 2017) focuses on the World Health Organisation’s one-year global campaign on depression.
Depression is the leading cause of ill health and disability worldwide. According to the latest estimates from WHO, more than 300 million people are now living with depression, an increase of more than 18% between 2005 and 2015. Lack of support for people with mental disorders, coupled with a fear of stigma, prevent many from accessing the treatment they need to live healthy, productive lives.
Despite being very common, depression is still under-recognized and undertreated and there is a need to open up dialogue and tackle the stigma associated with it. The campaign provides information regarding the consequences and management of depression, and how to provide support to people living with depression. Resources include videos, handouts and posters.