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Maternal depression during pregnancy and offspring depression in adulthood: Role of child maltreatment

  • Dominic T. Plant (a1), Carmine M. Pariante (a1), Deborah Sharp (a2) and Susan Pawlby (a1)

Abstract

Background

Studies have shown that maternal depression during pregnancy predicts offspring depression in adolescence. Child maltreatment is also a risk factor for depression.

Aims

To investigate (a) whether there is an association between offspring exposure to maternal depression in pregnancy and depression in early adulthood, and (b) whether offspring child maltreatment mediates this association.

Method

Prospectively collected data on maternal clinical depression in pregnancy, offspring child maltreatment and offspring adulthood (18–25 years) DSM-IV depression were analysed in 103 mother–offspring dyads of the South London Child Development Study.

Results

Adult offspring exposed to maternal depression in pregnancy were 3.4 times more likely to have a DSM-IV depressive disorder, and 2.4 times more likely to have experienced child maltreatment, compared with non-exposed offspring. Path analysis revealed that offspring experience of child maltreatment mediated the association between exposure to maternal depression in pregnancy and depression in adulthood.

Conclusions

Maternal depression in pregnancy is a key vulnerability factor for offspring depression in early adulthood.

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Copyright

This is an open access article distributed under the terms of the Creative Commons Attribution (CC BY) licence.

Corresponding author

Dominic Plant, Stress, Psychiatry and Immunology Laboratory & Perinatal Psychiatry, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 2-059 James Black Centre, 125 Coldharbour Lane, London SE5 9NU, UK. Email: dominic.plant@kcl.ac.uk

Footnotes

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The study was supported by the Psychiatry Research Trust, the National Institute for Health Research (NIHR)/Wellcome Trust King's Clinical Research Facility, the NIHR Biomedical Research Centre at South London and Maudsley National Health Service Foundation Trust and the Institute of Psychiatry, Psychology & Neuroscience, King's College London and the Medical Research Council United Kingdom.

Declaration of interest

None.

Footnotes

References

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Maternal depression during pregnancy and offspring depression in adulthood: Role of child maltreatment

  • Dominic T. Plant (a1), Carmine M. Pariante (a1), Deborah Sharp (a2) and Susan Pawlby (a1)
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eLetters

Childhood environment (parental behaviour and maternal depression) seems to be a key causal factor on intergenerational transmission of depression

Alexander Moreira-Almeida, Associate Professor of Psychiatry, University Hospital and School of Medicine, Federal University of Juiz de Fora (UFJF), Brazil
Mauro J Souza, Psychiatry resident, University Hospital, Federal University of Juiz de Fora (UFJF), Brazil
25 September 2015

Plant and colleagues, in a very interesting and elegant study (1), found that maternal depression during pregnancy was associated with: offspring depression in adulthood (OR 3.4), maternal depression during offspring’s childhood (OR 4.8), and with offspring exposure to child maltreatment (OR 2.4). However, as authors said, "when childhood factors (i.e. child maltreatment, maternal depression 1 to 16 years) were entered at the second steps, prenatal maternal depression no longer predicted significantly offspring depression". In our view, these findings are suggestive that the key causal factor is not maternal depression during pregnancy, but maternal depression during offspring childhood and child maltreatment (probably the former promoting the later). Since maternal depression during pregnancy probably does not cause directly child maltreatment or later maternal depression, these two should not be viewed as mediators or mechanisms of the association found between maternal depression during pregnancy with offspring depression in adulthood. Since after adding the childhood factors there is no statistical correlation of maternal depression during pregnancy with offspring depression in adulthood anymore, this seems suggestive that maternal depression during pregnancy is more probably a marker of mothers with higher risk of developing depression during offspring childhood and of offering/allowing maladaptive parental behaviour. This is in line with previous studies showing that environmental factors, especially maladaptive parental behaviour, were total or partial mediators of the association between parental and offspring depressive symptoms (2,3,4). Despite maternal depression during pregnancy being a marker of an at risk mother-child dyad, the actual causal factors seem to be the factors happening during childhood: maternal depression and parental behaviour. So, preventive measures should focus on screening depressive mothers (during pregnancy, but especially during offspring childhood), providing treatment and support for adequate parental behaviour.

However, authors' conclusions go in the opposite direction. At paper's discussion, it is stated "we did not find that exposure to maternal depression after birth contributes to this association (maternal depression during pregnancy with offspring depression in adulthood). This suggests that exposure to maternal depression specifically during pregnancy represents a unique setting for the intergenerational transmission of risk for depression". However, the results' section states "offspring exposure to maternal depression during childhood (1–16 years) was associated significantly with offspring adulthood depression (OR = 4.2)" They see their study "in line with the theoretical premise of foetal programming", related to elevated levels of maternal glucocorticoids at the intrauterine environment. Finally, for preventive measures, they emphasize screening and treating depressive expectant mothers, supporting the use of antidepressants during pregnancy. These are valuable measures, but not supported by this study results.

In summary, in our perspective, this extremely well done study supports the view that childhood factors (parental behaviour and maternal depression) have key causal implication on intergenerational transmission of depression. Preventive measures should focus mainly on childhood period, providing treatment and support for adequate parental behaviour.

References

1 Plant DT, Pariante CM, Sharp D, Pawlby S. Maternal depression during pregnancy and offspring depression in adulthood: role of child maltreatment. Br J Psychiatry 2015; 207 (suppl 3): 213-20.

2 Johnson JG, Cohen P, Kasen S, Smailes E, Brook JS. Association of maladaptive parental behavior with psychiatric disorder among parents and their offspring. Arch Gen Psychiatry 2001; 58 (suppl 5): 453-60.

3 Tully EC, Iacono WG, McGue M. An adoption study of parental depression as an environmental liability for adolescent depression and childhood disruptive disorders. Am J Psychiatry 2008; 165 (suppl 9): 1148-54.

4 Elgar FJ, Mills RS, McGrath PJ, Waschbusch DA, Brownridge DA. Maternal and paternal depressive symptoms and child maladjustment: the mediating role of parental behavior. J Abnorm Child Psychol 2007; 35 (suppl 6): 943-55.

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Conflict of interest: None Declared

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