Considerable attention has been focused on women’s mental health in the perinatal period and the subsequent impacts on children. Comparatively, we know much less about maternal depression at later time points and the potential implications for child mental health. The objective of this paper was to explore the association between maternal depression and child emotional/behavioural difficulties at 4 years postpartum, taking into account earlier episodes of perinatal depression. The Maternal Health Study is a prospective cohort study of 1,507 nulliparous women. Maternal depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS) in early pregnancy and at 3, 6 and 12 months postpartum and again at 4 years postpartum. Maternal depressive symptoms at 4 years postpartum were associated with significantly increased odds of child emotional/behavioural difficulties (odds ratio (OR) = 3.46, 95 % confidence interval (CI) = 2.21–5.43). This remained significant after adjusting for earlier episodes of perinatal depression and socio-demographic characteristics (OR = 2.07, 95 % CI = 1.18–3.63). We also observed a robust association between child difficulties at age 4 and measures of socio-economic disadvantage. Our findings suggest a pressing need to rethink current paradigms of maternal health surveillance and extend mental health surveillance and support to at least 4 years postpartum.
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Aasheim V, Waldenström U, Hjelmstedt A, Rasmussen S, Pettersson H, Schytt E (2012) Associations between advanced maternal age and psychological distress in primiparous women, from early pregnancy to 18 months postpartum. BJOG 119(9):1108–1116
Alpern L, Lyons-Ruth K (1993) Preschool children at social risk: chronicity and timing of maternal depressive symptoms and child behavior problems at school and at home. Dev Psychopathol 5(03):371–387
Australian Health Ministers’ Advisory Council (2012) Clinical practice guidelines: antenatal care—module 1. Australian Government Department of Health and Ageing, Canberra
beyondblue (2010) Clinical practice guidelines for depression and related disorders—anxiety, bipolar disorder, and puerperal psychosis—in the perinatal period. beyondblue, Melbourne
Boyce P, Stubbs R, Todd A (1993) The Edinburgh Postnatal Depression Scale: validation in an Australian sample. Aust NZ J Psychiat 27:472–476
Brennan PA, Hammen C, Andersen MJ, Bor W, Najman JM, Williams GM (2000) Chronicity, severity, and timing of maternal depressive symptoms: relationships with child outcomes at age 5. Dev Psychol 36(6):759–766. doi:10.1037/0012-1622.214.171.1249
Briggs-Gowan MJ, Carter AS, Schwab-Stone M (1996) Discrepancies among mother, child, and teacher reports: examining the contributions of maternal depression and anxiety. J Abnorm Child Psychol 24(6):749–765
Brown SJ, Donath S, MacArthur C, McDonald EA, Krastev AH (2010) Urinary incontinence in nulliparous women before and during pregnancy: prevalence, incidence, and associated risk factors. Int Urogynecol J 21(2):193–202
Brown S, McDonald EA, Krastev AH (2008) Fear of an intimate partner and women’s health in early pregnancy: findings from the Maternal Health Study. Birth 35(4):293–302
Brown SJ, Lumley JM, McDonald EA, Krastev AH (2006) Maternal health study: a prospective cohort study of nulliparous women recruited in early pregnancy. BMC Pregnancy Childbirth 6:12
Cox JL, Holden JM, Sagovsky R (1987) Detection of postnatal depression: development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry 150:782–786
Cox JL, Chapman G, Murray D, Jones P (1996) Validation of the Edinburgh postnatal depression scale (EPDS) in non-postnatal women. J Affect Disord 39:185–189
Department of Education and Early Childhood Development (2009) Maternal and child health service: practice guidelines. Victorian State Government, Melbourne
Gartland D, Brown S, Donath S, Perlen S (2010) Women’s health in early pregnancy: findings from an Australian nulliparous cohort study. Aust N Z J Obstet Gynaecol 50(5):413–418. doi:10.1111/j.1479-828X.2010.01204.x
Gartland D, Hemphill SA, Hegarty K, Brown SJ (2011) Intimate partner violence during pregnancy and the first year postpartum in an Australian pregnancy cohort study. Matern Child Health J 15(5):570–578. doi:10.1007/s10995-010-0638-z
Gartland D, Woolhouse H, Mensah FK, Hegarty K, Hiscock H, Brown SJ (2014) The case for early intervention to reduce the impact of intimate partner abuse on child outcomes: results of an Australian cohort of first‐time mothers. Birth 41(4):374–83
Giallo R, Cooklin A, Nicholson JM (2014a) Risk factors associated with trajectories of mothers’ depressive symptoms across the early parenting period: an Australian population-based longitudinal study. Arch Womens Ment Health 17(2):115–125
Giallo R, Cooklin A, Wade C, D’Esposito F, Nicholson JM (2014b) Maternal postnatal mental health and later emotional–behavioural development of children: the mediating role of parenting behaviour. Child Care Health Dev 40(3):327–336
Glascoe FP (2005) Screening for developmental and behavioral problems. Ment Retard Dev Disabil Res Rev 11(3):173–179
Goodman R (2001) Psychometric properties of the strengths and difficulties questionnaire. J Am Acad Child Adolesc Psychiatry 40(11):1337–1345
Goodman S, Rouse M, Connell A, Broth M, Hall C, Heyward D (2011) Maternal depression and child psychopathology: a meta-analytic review. Clin Child Fam Psychol Rev 14(1):1–27
Goodman SH, Gotlib IH (1999) Risk for psychopathology in the children of depressed mothers: a developmental model for understanding mechanisms of transmission. Psychol Rev 106(3):458
Hawes DJ, Dadds MR (2004) Australian data and psychometric properties of the Strengths and Difficulties Questionnaire. Aust N Z J Psychiatry 38(8):644–651
Kiernan KE, Mensah FK (2009) Poverty, maternal depression, family status and children’s cognitive and behavioural development in early childhood: a longitudinal study. J Soc Policy 38(4):569–588
Kiernan K, Pickett KE (2006) Marital status disparities in maternal smoking during pregnancy, breastfeeding and maternal depression. Soc Sci Med 63:335–346
Kingston D, Tough S (2013) Prenatal and postnatal maternal mental health and school-age child development: a systematic review. Matern Child Health J 18(7):1728–41
Kingston D, Tough S, Whitfield H (2012) Prenatal and postpartum maternal psychological distress and infant development: a systematic review. Child Psychiatry Hum Dev 43(5):683–714
Lansakara N, Brown SJ, Gartland D (2010) Birth outcomes, postpartum health and primary care contacts of immigrant mothers in an Australian nulliparous pregnancy cohort study. Matern Child Health J 14(5):807–816. doi:10.1007/s10995-009-0514-x
LaRosa AC, Glascoe FP, Macias MM (2009) Parental depressive symptoms: relationship to child development, parenting, health, and results on parent-reported screening tools. J Pediatr 155(1):124–128
Leis JA, Heron J, Stuart EA, Mendelson T (2014) Associations between maternal mental health and child emotional and behavioral problems: does prenatal mental health matter? J Abnorm Child Psychol 42(1):161–171
Martikainen P, Laaksonen M, Piha K, Lallukka T (2007) Does survey non-response bias the association between occupational social class and health? Scand J Public Health 35(2):212–215
Mealing NM, Banks E, Jorm LR, Steel DG, Clements MS, Rogers KD (2010) Investigation of relative risk estimates from studies of the same population with contrasting response rates and designs. BMC Med Res Methodol 10:26
Murray D, Cox JL (1990) Screening for depression during pregnancy with the Edinburgh Postnatal Depression Scale (EPDS). J Reprod Infant Psyc 8:99–106
Murray L, Carothers AD (1990) The validation of the Edinburgh Postnatal Depression Scale on a community sample. Brit J Psychiat 157:288–290
Murray L, Stanley C, Hooper R, King F, Fiori‐Cowley A (1996) The role of infant factors in postnatal depression and mother‐infant interactions. Dev Med Child Neurol 38(2):109–119
Najman JM, Andersen MJ, Bor W, O’Callaghan MJ, Williams GM (2000) Postnatal depression—myth and reality: maternal depression before and after the birth of a child. Soc Psychiatry Psychiatr Epidemiol 35(1):19–27
National Institute for Health and Clinical Excellence (2007) NICE Clinical Guideline 45: antenatal and postnatal mental health: clinical management and service guidance. National Institute for Health and Clinical Excellence, London
O’Connor TG, Monk C, Fitelson EM (2014) Practitioner review: maternal mood in pregnancy and child development—implications for child psychology and psychiatry. J Child Psychol Psychiatry 55(2):99–111
O’Hara M, Swain AM (1996) Rates and risk of postpartum depression—meta-analysis. Int Rev Psychiatry 8:37–54
Paschetta E, Berrisford G, Coccia F, Whitmore J, Wood Amanda G, Pretlove S, Ismail Khaled MK (2014) Perinatal psychiatric disorders: an overview. Am J Obstet Gynecol 210(6):501–509, e506
Pearson RM, Evans J, Kounali D, Lewis G, Heron J, Ramchandani PG, Stein A (2013) Maternal depression during pregnancy and the postnatal period: risks and possible mechanisms for offspring depression at age 18 years. JAMA Psychiatry 70(12):1312–1319
Richters JE (1992) Depressed mothers as informants about their children: a critical review of the evidence for distortion. Psychol Bull 112(3):485
Smith M (2004) Parental mental health: disruptions to parenting and outcomes for children. Child Fam Soc Work 9(1):3–11
Spratt M, Carpenter J, Sterne JAC, Carlin JB, Heron J, Henderson J, Tilling K (2010) Strategies for multiple imputation in longitudinal studies. Am J Epidemiol 172(4):478–487
StataCorp (2013) Stata statistical software: release 13. StataCorp LP, College Station
Study, Ontario. Early Years, McCain MN, Mustard JF (1999) Early years study: final report: reversing the real brain drain. Canadian Institute for Advanced Research, Toronto
Winter P (2010) Engaging families in the early childhood development story: neuroscience and early childhood development: summary of selected literature and key messages for parenting. Ministerial Council for Education, Early Childhood Development and Youth Affairs, Carlton South
Woolhouse H, Gartland D, Hegarty K, Donath S, Brown S (2012a) Depressive symptoms and intimate partner violence in the 12 months after childbirth: a prospective pregnancy cohort study. BJOG 119(3):315–323. doi:10.1111/j.1471-0528.2011.03219.x
Woolhouse H, Perlen S, Gartland D, Brown S (2012b) Physical health and recovery in the first 18 months postpartum: does cesearean section reduce longer-term morbidity? Birth 39(3):221–229
Woolhouse H, Brown S, Krastev A, Perlen S, Gunn J (2009) Seeking help for anxiety and depression after childbirth: results of the Maternal Health Study. Arch Womens Ment Health 12:75–83
Woolhouse H, Gartland D, Mensah F, Brown SJ (2014) Maternal depression from early pregnancy to four years postpartum in a prospective pregnancy cohort study: implications for primary health care. BJOG. doi: 10.1111/1471-0528.12837
Woolhouse H, Gartland D, Perlen S, Donath S, Brown SJ (2013) Physical health after childbirth and maternal depression in the first 12 months post partum: results of an Australian nulliparous pregnancy cohort study. Midwifery. Epub ahead of print: doi:10.1016/j.midw.2013.03.006
We are extremely grateful to all of the women taking part in the study, to the members of the Maternal Health Study Collaborative Group (Christine MacArthur, Kelsey Hegarty, Jane Gunn, Shaun Brennecke, Peter Wein and Jane Yelland) who contributed to the design of study instruments, to Creina Mitchell who assisted us in the early stage of planning recruitment methods and to the members of the Maternal Health Study research team who have contributed to data collection and coding (Sue Perlen, Ann Krastev, Ellie McDonald, Marion Tait, Liesje Brice, Maggie Flood, Kay Paton, Renee Paxton and Martine Spaull). This work was supported by grant nos. 199222, 433006 and 491205 from The National Health and Medical Research Council (NHMRC), a VicHealth Research Fellowship (SB), an Australian Research Council (ARC) Future Fellowship (SB), an NHMRC Career Development Fellowship (SB) and an NHMRC Early Career Fellowship no. 1037449 (FM) and a grant from the Medical Research and Technology in Victoria Fund (ANZ Trustees), and Murdoch Childrens Research Institute research is supported by the Victorian Government’s Operational Infrastructure Program. The funding organisations had no involvement in the conduct of the study, and the authors are independent of the funding sources. All authors had access to the study data and were responsible for the decision to submit the paper for publication.
Conflict of interest
The authors declare that they have no competing interests.
Contribution to authorship
All authors have significantly contributed to this article and approved the final version of the manuscript. HW was involved in data collection, conducted literature searches, completed data analyses and interpretation and co-wrote the paper. SB was responsible for the study concept and design, data analysis and interpretation and co-wrote the paper. DG was involved in data collection, analysis and interpretation of the data and critical revisions of the manuscript. FM assisted with data analysis and interpretation and critical revision of the manuscript. RG assisted with data analysis and interpretation and critical revisions of the manuscript.
Details of ethics approval
The study was approved by the relevant ethics committees in all participating hospitals and the ethics committee of La Trobe University (FHEC/HEC number 05/86; 27 April 2002). Written informed consent was obtained from all participants.
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Woolhouse, H., Gartland, D., Mensah, F. et al. Maternal depression from pregnancy to 4 years postpartum and emotional/behavioural difficulties in children: results from a prospective pregnancy cohort study. Arch Womens Ment Health 19, 141–151 (2016). https://doi.org/10.1007/s00737-015-0562-8
- Maternal depression
- Child behaviour
- Child mental health