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      Effects of parenting interventions for mothers with depressive symptoms and an infant: systematic review and meta-analysis

      review-article
      , PhD, , MSc, , PhD, , PhD
      BJPsych Open
      Cambridge University Press
      Depressive disorders, child development, parent–child relationship, systematic review, parenting interventions

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          Abstract

          Background

          Postpartum depression is common in the perinatal period and poses a risk for the development of the infant and the mother–infant relationship. Infancy is a critical developmental period of life and supportive parenting is crucial for healthy development, however, the effects of interventions aimed at improving parenting among mothers with depression are uncertain.

          Aims

          To assess the effects of parenting interventions on parent–child relationship and child development among mothers with depressive symptoms with 0–12-month-old infants.

          Method

          We conducted a systematic review with the inclusion criteria: (a) randomised controlled trials of structured psychosocial parenting interventions for women with depressive symptoms and a child aged 0–12 months in Western Organisation for Economic Co-operation and Development countries, (b) minimum three sessions with at least half of these delivered postnatally and (c) outcomes relating to the parent–child-relationship and/or child development. Publications were extracted from 10 databases in September 2018 and supplemented with grey search and hand search. We assessed risk of bias, calculated effect sizes and conducted meta-analysis.

          Results

          Eight papers representing seven trials were included. We conducted meta-analysis on the post-intervention parent–child relationship. The analysis included six studies and showed no significant effect. For individual study outcomes, no significant effects on the majority of both the parent–child relationship and child development outcomes were reported.

          Conclusions

          No evidence of the effect of parenting interventions for mothers with depressive symptoms was found on the parent–child relationship and child development. Larger studies with follow-up assessments are needed, and future reviews should examine the effects in non-Western countries.

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          Most cited references42

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          Resilience in the face of adversity. Protective factors and resistance to psychiatric disorder.

          M. Rutter (1985)
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            Association of Persistent and Severe Postnatal Depression With Child Outcomes

            Key Points Question What is the association of differing levels of persistence and severity of postnatal depression with long-term child outcomes? Findings This observational study of 9848 women with varying levels of postnatal depression and 8287 children found that, compared with children of women with postnatal depression that did not persist, of either moderate or severe intensity, children of women with persistent and severe depression are at an increased risk for behavioral problems by age 3.5 years as well as lower mathematics grades and depression during adolescence. Furthermore, women with persistent postnatal depression are likely to experience significant depressive symptoms until at least 11 years after childbirth. Meaning Women with persistent and severe postnatal depression should be prioritized for treatment because they are likely to continue to experience high levels of depressive symptoms and because of the high risk of adverse child development.
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              The impact of maternal depression in pregnancy on early child development.

              Postpartum depression in mothers is associated with developmental problems in their children. Many women who are depressed following childbirth are also depressed during pregnancy. The aim of this study was to examine the associations between maternal depressive symptoms during pregnancy and child development at 18 months of age. A prospective cohort study, Avon Longitudinal Study of Parents and Children. The former county of Avon, southwest England. All pregnant women in the defined area with delivery dates between April 1991 and December 1992, 9244 women and their children. Data were collected antenatally, at 18 and 32 weeks of gestation and at 8 weeks and 8 months postnatally, through postal questionnaires, including a self-report measure of depression (Edinburgh Postnatal Depression Scale [EPDS]). By the time their child was 18 months old, women completed five further questionnaires about their children's health and development. Child development at 18 months using a modified Denver Developmental Screening Test (modified DDST). Applying the standard 12/13 cutoff, 1565 (14%) women were depressed antenatally but not at either time-points postnatally. Employing the modified DDST, 893 (9%) children were developmentally delayed at 18 months of age. Persistent depression (EPDS > or = 10 at both time-points) is associated with developmental delay (adjusted OR 1.34, 95% CI 1.11-1.62). Applying the 12/13 and 14/15 cutoffs gave similar results. After further adjustment for postnatal depression, the effect sizes were slightly attenuated. These findings highlight the importance of depression in pregnancy. Some effects on child development attributed to postpartum depression are caused in part by depressive symptoms during pregnancy.
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                Author and article information

                Journal
                BJPsych Open
                BJPsych Open
                BJO
                BJPsych Open
                Cambridge University Press (Cambridge, UK )
                2056-4724
                January 2020
                13 January 2020
                : 6
                : 1
                : e9
                Affiliations
                [1]Senior Researcher, VIVE – The Danish Center for Social Science Research , Denmark
                [2]Research Assistant, VIVE – The Danish Center for Social Science Research , Denmark
                [3]Associate Professor, Department of Psychology, University of Copenhagen , Denmark
                [4]Senior Researcher, VIVE – The Danish Center for Social Science Research , Denmark
                Author notes

                Declaration of interest: None.

                Correspondence: Signe B. Rayce. Email: sbo@ 123456vive.dk
                Author information
                https://orcid.org/0000-0002-1732-113X
                Article
                S2056472419000899
                10.1192/bjo.2019.89
                7001473
                31928569
                c748ff10-eab5-44e7-8bb7-358a2ef9f5b4
                © The Authors 2020

                This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 07 May 2019
                : 11 October 2019
                : 10 November 2019
                Page count
                Figures: 2, Tables: 2, References: 82, Pages: 10
                Categories
                Review

                depressive disorders,child development,parent–child relationship,systematic review,parenting interventions

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