Parenting Stress Plays a Mediating Role in the Prediction of Early Child Development from Both Parents’ Perinatal Depressive Symptoms

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Abstract

Maternal postnatal depression has been associated with a broad range of developmental risk among children. However, there has been less focus on disentangling the effects of pre- and postnatal depressive symptoms, as well as examining the symptoms of both parents. This study aims to investigate the separate effects of pre- and postnatal depressive symptoms in mothers and fathers, and parents' differential effects on child social-emotional, cognitive, and language development at 18 months of age. Further, we investigate whether effects of depressive symptomatology on child outcomes are particularly strong when both parents evinced high symptom loads and whether parenting stress mediates associations between perinatal depressive symptoms and child developmental outcomes. The study used data from 1036 families participating in a community-based study from mid-pregnancy until 18 months postpartum. Depressive symptoms were assessed at seven time points (four prenatally). Within a structural equation framework, we found that parental perinatal depressive symptoms predicted child social-emotional functioning, specifically externalizing, internalizing, and dysregulation problems, as well as language developmental delay at 18 months. Controlling for postnatal symptoms we found no independent effect of prenatal depressive symptoms on any child outcomes. A differential effect was evident, linking maternal symptoms to social-emotional outcomes, and paternal symptoms to language outcomes. There was no evidence of stronger associations between depressive symptoms and child outcomes when both parents showed high symptom loads. However, parenting stress mediated most relations between parental depressive symptoms and child outcomes. Findings demonstrate the importance of including paternal depressive symptoms in both clinical and research contexts.

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Onset timing, thoughts of self-harm, and diagnoses in postpartum women with screen-positive depression findings.

Katherine L Wisner, Dorothy Sit, Mary McShea … (2013)

The period prevalence of depression among women is 21.9% during the first postpartum year; however, questions remain about the value of screening for depression. To screen for depression in postpartum women and evaluate positive screen findings to determine the timing of episode onset, rate and intensity of self-harm ideation, and primary and secondary DSM-IV disorders to inform treatment and policy decisions. Sequential case series of women who recently gave birth. Urban academic women's hospital. During the maternity hospitalization, women were offered screening at 4 to 6 weeks post partum by telephone. Screen-positive women were invited to undergo psychiatric evaluations in their homes. A positive screen finding was an Edinburgh Postnatal Depression Scale (EPDS) score of 10 or higher. Self-harm ideation was assessed on EPDS item 10: "The thought of harming myself has occurred to me" (yes, quite often; sometimes; hardly ever; never). Screen-positive women underwent evaluation with the Structured Clinical Interview for DSM-IV for Axis I primary and secondary diagnoses. Ten thousand mothers underwent screening, with positive findings in 1396 (14.0%); of these, 826 (59.2%) completed the home visits and 147 (10.5%) completed a telephone diagnostic interview. Screen-positive women were more likely to be younger, African American, publicly insured, single, and less well educated. More episodes began post partum (40.1%), followed by during pregnancy (33.4%) and before pregnancy (26.5%). In this population, 19.3% had self-harm ideation. All mothers with the highest intensity of self-harm ideation were identified with the EPDS score of 10 or higher. The most common primary diagnoses were unipolar depressive disorders (68.5%), and almost two-thirds had comorbid anxiety disorders. A striking 22.6% had bipolar disorders. The most common diagnosis in screen-positive women was major depressive disorder with comorbid generalized anxiety disorder. Strategies to differentiate women with bipolar from unipolar disorders are needed. clinicaltrials.gov Identifier: NCT00282776.

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Declan Murray, John L. Cox (1990)

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Risk factors for antenatal depression, postnatal depression and parenting stress

Bronwyn Leigh, Jeannette Milgrom (2008)

Background Given that the prevalence of antenatal and postnatal depression is high, with estimates around 13%, and the consequences serious, efforts have been made to identify risk factors to assist in prevention, identification and treatment. Most risk factors associated with postnatal depression have been well researched, whereas predictors of antenatal depression have been less researched. Risk factors associated with early parenting stress have not been widely researched, despite the strong link with depression. The aim of this study was to further elucidate which of some previously identified risk factors are most predictive of three outcome measures: antenatal depression, postnatal depression and parenting stress and to examine the relationship between them. Methods Primipara and multiparae women were recruited antenatally from two major hoitals as part of the beyondblue National Postnatal Depression Program [1]. In this subsidiary study, 367 women completed an additional large battery of validated questionnaires to identify risk factors in the antenatal period at 26–32 weeks gestation. A subsample of these women (N = 161) also completed questionnaires at 10–12 weeks postnatally. Depression level was measured by the Beck Depression Inventory (BDI). Results Regression analyses identified significant risk factors for the three outcome measures. (1). Significant predictors for antenatal depression: low self-esteem, antenatal anxiety, low social support, negative cognitive style, major life events, low income and history of abuse. (2). Significant predictors for postnatal depression: antenatal depression and a history of depression while also controlling for concurrent parenting stress, which was a significant variable. Antenatal depression was identified as a mediator between seven of the risk factors and postnatal depression. (3). Postnatal depression was the only significant predictor for parenting stress and also acted as a mediator for other risk factors. Conclusion Risk factor profiles for antenatal depression, postnatal depression and parenting stress differ but are interrelated. Antenatal depression was the strongest predictor of postnatal depression, and in turn postnatal depression was the strongest predictor for parenting stress. These results provide clinical direction suggesting that early identification and treatment of perinatal depression is important.