To assess the current and lifetime prevalence of psychiatric disorders among children of currently depressed mothers and to assess the association of clinical features of maternal depression (i.e., severity, chronicity, and clinical features) with child psychopathology. Mothers were participants in the STAR*D (Sequenced Treatment Alternatives to Relieve Depression) multisite trial, designed to compare effectiveness and acceptability of different treatment options for outpatients with non-psychotic major depressive disorder (MDD).
Treatment-seeking mothers with a current DSM-IV diagnosis of MDD and with at least 1 child 7 to 17 years old were assessed during a major depressive episode (MDE). For each mother, 1 child was assessed (if a mother had more than 1 child, 1 was randomly selected). Maternal features assessed for this study were history of MDEs, severity of current MDE, comorbid conditions, depressive symptom features, and social functioning. Children were assessed for selected psychiatric diagnoses (Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version [K-SADS-PL]), psychopathologic symptoms and social functioning (Child Behavior Checklist), and global functioning (Children's Global Assessment Scale). Data were gathered from December 2001 to April 2004.
A large proportion (72%) of mothers were severely depressed (17-item Hamilton Rating Scale for Depression score >/= 22). About a third (34%) of children had a current psychiatric disorder, including disruptive behavior (22%), anxiety (16%), and depressive (10%) disorders. Nearly half (45%) had a lifetime psychiatric disorder, including disruptive behavior (29%), anxiety (20%), and depressive (19%) disorders. Atypical depressive features in the mother were associated with a 3-fold increase in the odds of having a child with depressive (OR = 3.3 [95% CI = 1.2 to 9.5]; p = .02) or anxiety (OR = 2.6 [95% CI = 1.1 to 6.9]; p = .03) disorders. A history of maternal suicide attempts and the presence of comorbid panic disorder with agoraphobia were associated with a 3-fold increase and an 8-fold increase in the odds of depressive disorders in the offspring, respectively. The final model showed significant associations (p </= .05) between the following characteristics of maternal depression and offspring disorders: maternal comorbid panic disorder with agoraphobia and offspring depressive and anxiety disorders, maternal irritable depression and offspring disruptive behavior disorders and any disorder, and maternal substance use disorders and any disorder.
Children of mothers in the midst of a current MDE are at high risk for disruptive behavior and anxiety disorders. The elevated risk of psychopathology among children of depressed mothers may recommend assessment of these children when clinically suggested. Children of depressed mothers with comorbid panic disorder with agoraphobia are at high risk for depressive and anxiety disorders and deserve special attention from clinicians.
"Children exposed to untreated antenatal depression are at higher risk for developmental delay, impaired language development, and lower intelligence quotient (IQ) scores,41–43 and poor socioemotional development, including worse emotional regulation and higher rates of depressive and anxiety symptoms.44–46 Others have shown that approximately a third of school-age children experience depressive, anxiety, or disruptive disorders while their mother is depressed.47 "
[Show abstract][Hide abstract] ABSTRACT: In pregnant women with major depression, the overarching goal of treatment is to achieve or maintain maternal euthymia, thus limiting both maternal and fetal exposure to the harmful effects of untreated or incompletely treated depression. However, the absence of uniformly effective therapies with guaranteed obstetric and fetal safety makes the treatment of major depression during pregnancy among the most formidable of clinical challenges. Clinicians and patients are still faced with conflicting data and expert opinion regarding the reproductive safety of antidepressants in pregnancy, as well as large gaps in our understanding of the effectiveness of most antidepressants and nonpharmacological alternatives for treating antenatal depression. In this paper, we provide a clinically focused review of the available information on potential maternal and fetal risks of untreated maternal depression during pregnancy, the effectiveness of interventions for maternal depression during pregnancy, and potential obstetric, fetal, and neonatal risks associated with antenatal antidepressant use.
Drug, Healthcare and Patient Safety 09/2014; 6:109-29. DOI:10.2147/DHPS.S43308
"A history of maternal depression is also associated with characteristics of youth depression that reflect poorer prognosis, including earlier onset (Hammen et al., 2008), higher rates of recurrence (Lieb et al., 2002), and increased risk of comorbid conditions (Hammen and Brennan, 2001). However, despite the enhanced risk conferred by maternal depression, half of all youth with a depressed mother remain free of psychopathology (Pilowsky et al., 2006). "
[Show abstract][Hide abstract] ABSTRACT: Maternal depression serves as a potent source of stress among offspring, greatly enhancing the risk of numerous adverse outcomes including youth depression. Several factors moderate the transmission of depression from mothers to offspring. However, the role of genetic characteristics in this process merits further exploration. Consistent with an interpersonal perspective on depression, the present study focused on a genetic polymorphism that has been shown to be relevant to social functioning, the rs53576 polymorphism of the oxytocin receptor gene (OXTR). In a community sample of 441 youth, OXTR genotype moderated the association between maternal depression in early childhood and youth depressive symptoms in adolescence, such that youth possessing at least one A allele of OXTR who also had a history of maternal depression exhibited the highest levels of depressive symptoms at age 15. In order to explore possible interpersonal mediators of this effect, conditional process analyses examined the role of youth social functioning in adolescence. Results suggest that OXTR genotype may partially account for the transmission of maternal depression to youth and support the role of dysfunctional social processes as a mechanism through which OXTR influences the development of depressive symptoms.
"Children exposed to the stress induced by depressed mothers are also at increased risk of developmental delay, impaired language development, and even low IQ scores (Figure 1) (Deave et al., 2008; Paulson et al., 2009). The impact of maternal depression on newborns has effects that last beyond infancy, as onethird of school-aged children of depressed mothers suffer from depression and anxiety disorders (Pilowsky et al., 2006). Beyond childhood, animal studies have shown that neonatal SSRI exposure suppresses adult serotonergic signaling and elicits depressiveand anxiety-like behaviors in adulthood (Ansorge et al., 2008; Shanahan et al., 2009). "
[Show abstract][Hide abstract] ABSTRACT: In addition to its role in the pathophysiology of numerous psychiatric disorders, increasing evidence points to serotonin (5-HT) as a crucial molecule for the modulation of neurodevelopmental processes. Recent evidence indicates that the placenta is involved in the synthesis of 5-HT from maternally derived tryptophan (TRP). This gives rise to the possibility that genetic and environmental perturbations directly affecting placental TRP metabolism may lead to abnormal brain circuit wiring in the developing embryo, and therefore contribute to the developmental origin of psychiatric disorders. In this review, we discuss how perturbations of the placental TRP metabolic pathway may lead to abnormal brain development and function throughout life. Of particular interest is prenatal exposure to maternal depression and antidepressants, both known to alter fetal development. We review existing evidence on how antidepressants can alter placental physiology in its key function of maintaining fetal homeostasis and have long-term effects on fetal forebrain development.
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