Advertisement

Journal of Child and Family Studies

, Volume 26, Issue 11, pp 3135–3144 | Cite as

Children of Prenatally Depressed Mothers: Externalizing and Internalizing Symptoms are Accompanied by Reductions in Specific Social-Emotional Competencies

  • Anna Eichler
  • Lisa Walz
  • Juliane Grunitz
  • Jennifer Grimm
  • Jessica Van Doren
  • Eva Raabe
  • Tamme W. Goecke
  • Peter A. Fasching
  • Matthias W. Beckmann
  • Johannes Kornhuber
  • Oliver Kratz
  • Hartmut Heinrich
  • Gunther H. Moll
Original Paper

Abstract

Studies have shown that child development is negatively affected by prenatal depression. A dysregulated hypothalamic-pituitary-adrenal axis in the pregnant woman, passed to the fetus, is one discussed key mechanism. Studies, investigating primary-school age children, have found effects on antisocial behavior. Effects on internalizing symptoms were not found, but the analysis did not distinguish between anxiety and depression symptoms. Additionally, until now, no objective test data operationalizing social-emotional competencies have been included. The present study examined: 1.Whether the effects on child externalizing symptoms could be replicated; 2. If there are specific effects on child internalizing symptoms, separated for anxiety and depression; and 3. Are child clinical symptoms reflected in reductions in social-emotional competencies. A sample of 61 prenatally depressed and 143 prenatally not-depressed women and their 6–9 year old children were compared, controlling for key confounders in both the perinatal period and in middle childhood. Children of prenatally depressed mothers had more antisocial behavior and depression symptoms reported by their mothers. The prediction of antisocial behavior scores tended to be more significant for boys than for girls. Child anxiety symptoms were primarily explained by current maternal depressive symptoms. Children of prenatally depressed mothers also showed a reduction in social-emotional competencies, specifically regarding the ability to interpret complex social situations. This study showed that, even in a non-clinical sample, there are distinct effects of prenatal depression on child externalizing and internalizing symptoms which are accompanied by reductions in specific social-emotional competencies. These results emphasize that treatment for depressed pregnant women and/or early support for affected families is worthwhile. Additional work is required to identify the underlying biological mechanisms.

Keywords

Prenatal exposure Prenatal depression Child development Conduct disorder Social emotional competence 

Notes

Author Contributions

A.E.: Designed and conducted the FRANCES study, supervised the data acquisition, analyzed the data, interpreted the findings and wrote the paper. L.W.: Contributed to the FRANCES data acquisition, analyzed the data, interpreted the findings and wrote the first draft of the paper. J. Gru: Contributed to the FRANCES design and data acquisition. J. Gri: Contributed to the FRANCES design and data acquisition. J.v.D.: Interpreted the findings, collaborated in the writing and editing of the final manuscript. E.R.: Contributed to the FRANCES design and recruitment. T.W.G.: Initiated, designed and conducted the FRAMES study. P.A.F.: Initiated, designed and conducted the FRAMES study. M.W.B.: Initiated, designed and conducted the FRAMES study. J.K.: Initiated, designed and conducted the FRAMES study. O.K.: Initiated and designed the FRANCES study. H.H.: Initiated, designed and conducted the FRANCES study, interpreted the findings, collaborated in the writing of the manuscript. G.H.M.: Initiated and designed the FRANCES study. All authors corrected the manuscript, provided substantial intellectual input, and approved the final version of the manuscript.

Compliance with Ethical Standards

Conflict of Interest

Anna Eichler was supported by the ELAN Fund of the Friedrich-Alexander-University Erlangen-Nuremberg. The remaining authors declare that they have no competing interests.

Ethical Approval

All procedures performed were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

References

  1. Achenbach, T. M. (1991). Manual for the child behavior checklist/4–18. Burlington, VT: University of Vermont.Google Scholar
  2. Apgar, V. (1966). The newborn (Apgar) scoring system: Reflections and advice. Pediatric Clinics of North America, 13(3), 645–650.CrossRefPubMedGoogle Scholar
  3. Baibazarova, E., van de Beek, C., Cohen-Kettenis, P. T., Buitelaar, J., Shelton, K. H., & van Goozen, S. H. (2013). Influence of prenatal maternal stress, maternal plasma cortisol and cortisol in the amniotic fluid on birth outcomes and child temperament at 3 months. Psychoneuroendocrinology, 38(6), 907–915. doi: 10.1016/j.psyneuen.2012.09.015.CrossRefPubMedGoogle Scholar
  4. Bortz, J., & Schuster, C. (2010). Statistik für human- und Sozialwissenschaftler. Berlin: Springer.CrossRefGoogle Scholar
  5. Cohen, J. (1988). Statistical power analysis for the behavioral sciences. Hillsdale, NJ: Erlbaum.Google Scholar
  6. Cox, J. L., Chapman, G., Murray, D., & Jones, P. (1996). Validation of the Edinburgh postnatal depression scale (EPDS) in non-postnatal women. Journal of Affective Disorders, 39(3), 185–189.CrossRefPubMedGoogle Scholar
  7. Cox, J. L., Holden, J. M., & Sagovsky, R. (1987). Detection of postnatal depression: Development of the 10-item Edinburgh postnatal depression scale. The British Journal of Psychiatry, 150, 782–786.CrossRefPubMedGoogle Scholar
  8. Davis, E. P., Glynn, L. M., Waffarn, F., & Sandman, C. A. (2011). Prenatal maternal stress programs infant stress regulation. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 52(2), 119–129. doi: 10.1111/j.1469-7610.2010.02314.x.CrossRefPubMedGoogle Scholar
  9. Deave, T., Heron, J., Evans, J., & Emond, A. (2008). The impact of maternal depression in pregnancy on early child development. An International Journal of Obstetrics and Gynaecology, 115(8), 1043–1051. doi: 10.1111/j.1471-0528.2008.01752.x.CrossRefGoogle Scholar
  10. Döpfner, M., Görtz-Dorten, A., Lehmkuhl, G., Breuer, D., & Goletz, H. (2008). Diagnostik-System für psychische Störungen nach ICD-10 und DSM-IV für Kinder und Jugendliche. Bern: Huber.Google Scholar
  11. Eichler, A., Grunitz, J., Grimm, J., Walz, L., Raabe, E., Goecke, T. W., et al. (2016). Did you drink alcohol during pregnancy? Inaccuracy and discontinuity of women’s self-reports: On the way to establish meconium ethyl glucuronide (EtG) as a biomarker for alcohol consumption during pregnancy. Alcohol, 54, 39–44. doi: 10.1016/j.alcohol.2016.07.002.CrossRefPubMedGoogle Scholar
  12. Field, T. (2010). Postpartum depression effects on early interactions, parenting, and safety practices: A review. Infant Behavior & Development, 33(1), 1–6. doi: 10.1016/j.infbeh.2009.10.005.CrossRefGoogle Scholar
  13. Gentile, S. (2015). Untreated depression during pregnancy: Short- and long-term effects in offspring. A systematic review. Neuroscience. doi: 10.1016/j.neuroscience.2015.09.001.
  14. Glover, V., O’Connor, T. G., & O’Donnell, K. (2010). Prenatal stress and the programming of the HPA axis. Neuroscience & Biobehavioral Reviews, 35(1), 17–22. doi: 10.1016/j.neubiorev.2009.11.008.CrossRefGoogle Scholar
  15. Goecke, T. W., Burger, P., Fasching, P. A., Bakdash, A., Engel, A., Haberle, L., et al. (2014). Meconium indicators of maternal alcohol abuse during pregnancy and association with patient characteristics. BioMed Research International, 2014, 702848 doi: 10.1155/2014/702848.CrossRefPubMedPubMedCentralGoogle Scholar
  16. Grob, A., Meyer, C., & Hagmann-von Arx, P. (2009). Intelligence and development scales (IDS). Bern: Huber.Google Scholar
  17. Halberstadt, A. G., Denham, S. A., & Dunsmore, J. (2001). Affective social competence. Social Development, 10, 79–119.CrossRefGoogle Scholar
  18. Hanson, M. A., & Gluckman, P. D. (2014). Early developmental conditioning of later health and disease: Physiology or pathophysiology? Physiological Reviews, 94(4), 1027–1076. doi: 10.1152/physrev.00029.2013.CrossRefPubMedPubMedCentralGoogle Scholar
  19. Hatzinger, M., Brand, S., Perren, S., von Wyl, A., von Klitzing, K., & Holsboer-Trachsler, E. (2007). Hypothalamic-pituitary-adrenocortical (HPA) activity in kindergarten children: Importance of gender and associations with behavioral/emotional difficulties. Journal of Psychiatric Research, 41(10), 861–870. doi: 10.1016/j.jpsychires.2006.07.012.CrossRefPubMedGoogle Scholar
  20. Hein, A., Rauh, C., Engel, A., Haberle, L., Dammer, U., Voigt, F., et al. (2014). Socioeconomic status and depression during and after pregnancy in the Franconian Maternal Health Evaluation Studies (FRAMES). Archives of Gynecology and Obstetrics, 289(4), 755–763. doi: 10.1007/s00404-013-3046-y.CrossRefPubMedGoogle Scholar
  21. Kessler, R. C., Gruber, M., Hettema, J. M., Hwang, I., Sampson, N., & Yonkers, K. A. (2008). Co-morbid major depression and generalized anxiety disorders in the national comorbidity survey follow-up. Psychological Medicine, 38(3), 365–374. doi: 10.1017/s0033291707002012.CrossRefPubMedGoogle Scholar
  22. Korhonen, M., Luoma, I., Salmelin, R., & Tamminen, T. (2014). Maternal depressive symptoms: Associations with adolescents’ internalizing and externalizing problems and social competence. Nordic Journal of Psychiatry, 68(5), 323–332. doi: 10.3109/08039488.2013.838804.CrossRefPubMedGoogle Scholar
  23. Kroes, G., Veerman, J. W., & De Bruyn, E. E. (2003). Bias in parental reports? Maternal psychopathology and the reporting of problem behavior in clinic-referred children. European Journal of Psychological Assessment, 19, 195.CrossRefGoogle Scholar
  24. Lebowitz, E. R., Leckman, J. F., Silverman, W. K., & Feldman, R. (2016). Cross-generational influences on childhood anxiety disorders: Pathways and mechanisms. Journal of Neural Transmission, 123(9), 1053–1067. doi: 10.1007/s00702-016-1565-y.CrossRefPubMedPubMedCentralGoogle Scholar
  25. Lewis, A. J., Austin, E., Knapp, R., Vaiano, T., & Galbally, M. (2015). Perinatal maternal mental health, fetal programming and child development. Healthcare, 3(4), 1212–1227. doi: 10.3390/healthcare3041212.CrossRefPubMedPubMedCentralGoogle Scholar
  26. Logan, D. E., Claar, R. L., & Scharff, L. (2008). Social desirability response bias and self-report of psychological distress in pediatric chronic pain patients. Pain, 136(3), 366–372. doi: 10.1016/j.pain.2007.07.015.CrossRefPubMedGoogle Scholar
  27. Luoma, I., Kaukonen, P., Mantymaa, M., Puura, K., Tamminen, T., & Salmelin, R. (2004). A longitudinal study of maternal depressive symptoms, negative expectations and perceptions of child problems. Child Psychiatry and Human Development, 35(1), 37–53.CrossRefPubMedGoogle Scholar
  28. Luoma, I., Tamminen, T., Kaukonen, P., Laippala, P., Puura, K., Salmelin, R., & Almqvist, F. (2001). Longitudinal study of maternal depressive symptoms and child well-being. Journal of the American Academy of Child & Adolescent Psychiatry, 40(12), 1367–1374. doi: 10.1097/00004583-200112000-00006.CrossRefGoogle Scholar
  29. Mehta, D., Quast, C., Fasching, P. A., Seifert, A., Voigt, F., Beckmann, M. W., et al. (2012). The 5-HTTLPR polymorphism modulates the influence on environmental stressors on peripartum depression symptoms. Journal of Affective Disorders, 136(3), 1192–1197. doi: 10.1016/j.jad.2011.11.042.CrossRefPubMedGoogle Scholar
  30. Moffitt, T. E., Harrington, H., Caspi, A., Kim-Cohen, J., Goldberg, D., Gregory, A. M., & Poulton, R. (2007). Depression and generalized anxiety disorder: Cumulative and sequential comorbidity in a birth cohort followed prospectively to age 32 years. Archives of General Psychiatry, 64(6), 651–660. doi: 10.1001/archpsyc.64.6.651.CrossRefPubMedGoogle Scholar
  31. O’Connor, T. G., Monk, C., & Fitelson, E. M. (2014). Practitioner review: Maternal mood in pregnancy and child development- implications for child psychology and psychiatry. Journal of Child Psychology and Psychiatry, 55(2), 99–111. doi: 10.1111/jcpp.12153.CrossRefPubMedGoogle Scholar
  32. Pawlby, S., Hay, D. F., Sharp, D., Waters, C. S., & O’Keane, V. (2009). Antenatal depression predicts depression in adolescent offspring: Prospective longitudinal community-based study. Journal of Affective Disorders, 113(3), 236–243. doi: 10.1016/j.jad.2008.05.018.CrossRefPubMedGoogle Scholar
  33. Pearson, R. M., Evans, J., Kounali, D., Lewis, G., Heron, J., Ramchandani, P. G., et al. (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. doi: 10.1001/jamapsychiatry.2013.2163.CrossRefPubMedPubMedCentralGoogle Scholar
  34. Provencal, N., & Binder, E. B. (2015). The effects of early life stress on the epigenome: From the womb to adulthood and even before. Experimental Neurology, 268, 10–20. doi: 10.1016/j.expneurol.2014.09.001.CrossRefPubMedGoogle Scholar
  35. Ravens-Sieberer, U., Wille, N., Erhart, M., Bettge, S., Wittchen, H. U., Rothenberger, A., et al. (2008). Prevalence of mental health problems among children and adolescents in Germany: Results of the BELLA study within the National Health Interview and Examination survey. European Child & Adolescent Psychiatry, 17(Suppl 1), 22–33. doi: 10.1007/s00787-008-1003-2.CrossRefGoogle Scholar
  36. Reulbach, U., Bleich, S., Knorr, J., Burger, P., Fasching, P. A., Kornhuber, J., et al. (2009). Pre-, peri- and postpartal depression. Fortschritte der Neurologie-Psychiatrie, 77(12), 708–713. doi: 10.1055/s-0028-1109822.CrossRefPubMedGoogle Scholar
  37. Rice, F., Harold, G. T., Boivin, J., Hay, D. F., van den Bree, M., & Thapar, A. (2009). Disentangling prenatal and inherited influences in humans with an experimental design. Proceedings of the National Academy of Sciences of the United States of America, 106(7), 2464–2467. doi: 10.1073/pnas.0808798106.CrossRefPubMedPubMedCentralGoogle Scholar
  38. Rice, F., Harold, G. T., Boivin, J., van den Bree, M., Hay, D. F., & Thapar, A. (2010). The links between prenatal stress and offspring development and psychopathology: Disentangling environmental and inherited influences. Psychological Medicine, 40(2), 335–345. doi: 10.1017/s0033291709005911.CrossRefPubMedGoogle Scholar
  39. Ruttle, P. L., Shirtcliff, E. A., Serbin, L. A., Fisher, D. B., Stack, D. M., & Schwartzman, A. E. (2011). Disentangling psychobiological mechanisms underlying internalizing and externalizing behaviors in youth: Longitudinal and concurrent associations with cortisol. Hormones and Behavior, 59(1), 123–132. doi: 10.1016/j.yhbeh.2010.10.015.CrossRefPubMedGoogle Scholar
  40. Schneider, M., Engel, A., Fasching, P. A., Haberle, L., Binder, E. B., Voigt, F., et al. (2014). Genetic variants in the genes of the stress hormone signalling pathway and depressive symptoms during and after pregnancy. BioMed Research International, 2014, 469278 doi: 10.1155/2014/469278.PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Anna Eichler
    • 1
  • Lisa Walz
    • 1
  • Juliane Grunitz
    • 1
  • Jennifer Grimm
    • 1
  • Jessica Van Doren
    • 1
  • Eva Raabe
    • 2
  • Tamme W. Goecke
    • 2
    • 3
  • Peter A. Fasching
    • 2
  • Matthias W. Beckmann
    • 2
  • Johannes Kornhuber
    • 4
  • Oliver Kratz
    • 1
  • Hartmut Heinrich
    • 1
    • 5
  • Gunther H. Moll
    • 1
  1. 1.Division of Child and Adolescent Mental Health, Department of Psychiatry and PsychotherapyUniversity Hospital Erlangen, Friedrich-Alexander University Erlangen-NurembergErlangenGermany
  2. 2.Department of Obstetrics and GynecologyUniversity Hospital Erlangen, Friedrich-Alexander University Erlangen-NurembergErlangenGermany
  3. 3.Department of Obstetrics and GynecologyUniversity Hospital RWTH AachenAachenGermany
  4. 4.Department of Psychiatry and PsychotherapyUniversity Hospital Erlangen, Friedrich-Alexander University Erlangen-NurembergErlangenGermany
  5. 5.kbo-Heckscher-KlinikumMünchenGermany

Personalised recommendations