Trajectories of maternal depressive symptoms from pregnancy to 11 years postpartum: Findings from Avon Longitudinal Study of Parents and Children (ALSPAC) cohort.

Maternal depressive symptoms are common in pregnancy and may extend to the perinatal period and beyond for some women. To date, few longitudinal studies have investigated maternal depressive symptoms from pregnancy to eleven years postpartum. Drawing data from a large population-based study cohort the aims of this study were to 1) identify distinct groups of mothers defined by their trajectories of depressive symptoms spanning from pregnancy to eleven years following the birth of the child, and 2) to identify psychosocial risk factors during pregnancy and in the first few postnatal years that are associated with these trajectories. Data were analyzed from 14,170 mothers who participated in Avon Longitudinal Study of Parents and Children (ALSPAC). The Edinburgh Postnatal Depression Scale (EPDS) was used to capture maternal depressive symptoms across 10 time points including two prenatal (18 and 32 weeks), and eight postnatal (2, 8, 21, 33, 61, 73, 97 and 134 months) time points. The latent growth model was created to describe the course of maternal depressive symptoms across the preceding time points followed by a latent growth mixture modelling (LGMM) to identify distinct trajectories of depressive symptoms over time within the overall sample. The predictors of maternal depressive symptoms trajectories were categorized into sociodemographic, child, and psychosocial factors. The multinomial regression analyses were conducted to explore associations between the risk factors and depressive symptoms trajectories. LGMM identified four distinct trajectories of maternal depressive symptoms over time: minimal symptoms, increasing symptoms, persistent symptoms, and decreasing symptoms. Predictors of all patterns of depression - persistent, increasing and decreasing symptoms include smoking during pregnancy, and partner conflict. The strongest predictors of the persistent symptom trajectory included maternal history of depression and inadequate social support. The use of self-reported maternal mental health symptoms and under representation of ethnic minorities are our study's limitations. The study findings highlight the importance of early identification and treatment for mothers experiencing depressive symptoms from pregnancy to the perinatal period and beyond.

Mughal MK ，Giallo R ，Arshad M ，Arnold PD ，Bright K ，Charrois EM ，Rai B ，Wajid A ，Kingston D ... -  《-》

Trajectories of maternal depressive symptoms during pregnancy and the first 12 months postpartum and child externalizing and internalizing behavior at three years.

Kingston D ，Kehler H ，Austin MP ，Mughal MK ，Wajid A ，Vermeyden L ，Benzies K ，Brown S ，Stuart S ，Giallo R ... -  《PLoS One》

Patterns and predictors of depressive and anxiety symptoms in mothers affected by previous prenatal loss in the ALSPAC birth cohort.

Studies investigating the patterns or predictors of psychological distress in expecting and postpartum mothers affected by previous prenatal loss, are limited. The study objectives were to explore longitudinal trajectory patterns of depressive and anxiety symptoms in mothers affected by previous prenatal loss from early in a subsequent pregnancy up to pre-adolescence, and to identify early factors predictive of elevated symptom trajectory patterns. A total of 2854 mothers from the Avon Longitudinal Study of Parents and Children self-identified as having experienced a previous prenatal loss. A latent class analysis identified trajectory patterns of symptoms across 10 timepoints from 18-weeks' gestation up to 134-months postpartum, multivariate regression analysis identified predictors of elevated symptom trajectories, and hierarchical regression analysis determined predictive accuracy between predictors and elevated trajectory patterns. Three distinct longitudinal trajectory patterns of depressive and anxiety symptoms reflected low (54%), sub-clinical (34%), and clinical symptoms (12%). Key factors that predicted elevated symptom trajectory patterns better than increased symptom scores early in subsequent pregnancy include history of severe depression or other psychiatric problem, experiencing three or more stressful events from mid-pregnancy, inadequate social support, history of induced abortion, and history of abuse. Predictive accuracy of elevated trajectories was 0.542 (depression) and 0.432 (anxiety). Generalizability may be compromised by attrition, under-reporting, and recall bias. Including factors predictive of long-term sub-clinical or clinical depressive and anxiety symptoms in early assessments will improve clinician's ability to identify mothers who may benefit from immediate and/or ongoing monitoring, and psychotherapeutic intervention after prenatal loss.

Charrois EM ，Mughal MK ，Arshad M ，Wajid A ，Bright KS ，Giallo R ，Kingston D ... -  《-》

Perinatal depression among mothers in a South African birth cohort study: Trajectories from pregnancy to 18 months postpartum.

Perinatal depression affects 21-50% of women in South Africa and poses significant health risks to mothers and children. Trajectories of depressive symptoms change over time and have not been well characterized during the perinatal period in low and middle-income countries. Data from women enrolled in a population-based birth cohort study in Paarl, South Africa with at least 3 depression measures from pregnancy through 18 months postpartum (N = 831) were analyzed. Depressive symptoms were measured continuously using the Edinburgh Postnatal Depression Scale (EPDS). Group-based trajectory models were used to estimate trajectories of depressive symptoms during the perinatal period and multinomial multivariable models to identify predictors of trajectory group membership. Five distinct trajectory patterns of depressive symptoms were identified: moderate levels of depressive symptoms during pregnancy but minimal postpartum (3.5%), minimal levels during pregnancy and increasing postpartum (3.7%), unstable levels peaking at 12 months postpartum (6.6%), mild levels with slight decrease postpartum (82.9%), and severe levels during pregnancy and postpartum (3.1%). Membership in the chronic severe symptom group was associated with stressful life events, sexual intimate partner violence and tobacco use. Modeling limitations prevented determining how changes in psychosocial predictors over time may influence depressive symptom trajectories. Mild to severe depressive symptoms during pregnancy/postpartum were common among this South African cohort. Interventions to treat women with severe chronic depressive symptoms with co-occurring psychosocial issues are urgently needed.

Pellowski JA ，Bengtson AM ，Barnett W ，DiClemente K ，Koen N ，Zar HJ ，Stein DJ ... -  《-》

Parental depressive symptoms across the first three years of a child's life and emotional and behavioural problem trajectories in children and adolescents.

The risk associated with parental perinatal depressive symptoms and the continuum of emotional and behavioural problems in offspring is unclear. This study aimed to investigate the association between maternal and paternal perinatal depressive symptoms and behavioural problem trajectories in offspring aged 3-16 years. We used data from the Avon Longitudinal Study of Parents and Children (ALSPAC) in Bristol, Avon, United Kingdom (UK). Parental perinatal depressive symptoms in the first three years of a child's life were measured using the Edinburgh Postnatal Depression Scale (EPDS). Offspring emotional- and behavioural problems were measured using the Strengths and Difficulties Questionnaire (SDQ) when the child was 3.5, 7, 9, 11, and 16 years. A group-based trajectory modelling was used to identify the distinct trajectories of emotional and behavioural problems. Multinomial logistic regression analyses were used to examine associations, and z-scores were calculated to compare maternal and paternal associations. We identified three trajectories of emotional and behavioural problems in offspring between the ages of 3.5 and 16: low, moderate and high symptom trajectories. We found that maternal and paternal antenatal and postnatal depressive symptoms were associated with high levels of emotional and behavioural problem trajectories in offspring. We also found that children exposed to maternal (adjusted RR = 8.11; 95% CI: 5.26-12.48) and paternal (adjusted RR = 2.32; 1.05-5.14) persistent depressive symptoms were more likely to be in high levels of total behavioural problem trajectory group than in the normal trajectory group. The maternal-effect was stronger (p < 0.001). Our findings suggest that exposure to parental depressive symptoms were associated with high levels of emotional and behavioural problem trajectories in offspring, with the maternal effect being stronger than the paternal effect.

Dachew BA ，Heron JE ，Alati R 《-》