While we have observed in multiple studies that about 15% of women suffer from depression during pregnancy and the postpartum period, we know much less about the course of depressive illness in this patient population. Clinically we observe that many women recover relatively quickly, while others have a much more persistent course of illness.
The EDEN study is a French cohort study of the prenatal and early postpartum determinants of child health and development. In a recent report, researchers followed a group of 1807 mothers participating in the EDEN study from 24-28 weeks of pregnancy to their child’s fifth birthday in order to learn more about the course of depressive illness in the mothers of younger children.
The researchers identified five trajectories of maternal depressive symptoms from pregnancy onward:
- No depressive symptoms (60.2%);
- Persistent moderate levels of depressive symptoms (25.2%);
- Persistent high levels of depressive symptoms (5.0%);
- High levels of depressive symptoms only during pregnancy (4.7%);
- High levels of depressive symptoms only during the child’s preschool period (4.9%).
Persistent depression in the mothers of young children was associated with several risk factors present prior to or during pregnancy, specifically mental health issues prior to pregnancy and high anxiety during pregnancy. Other factors associated with persistent depressive symptoms included being an immigrant, history of childhood adversity and stressful life events during pregnancy.
The most concerning finding here is that about a third of the women have depressive symptoms that persist throughout the first five years of their child’s life. Other studies have shown similarly high rates of depression in mothers.
In a similar study from Australia, 1507 women were recruited during pregnancy and were assessed at 3, 6, 12 and 18 months postpartum, and 4 years postpartum. About a third of the women (31.4%) reported depressive symptoms at least once between early pregnancy and 4 years postpartum. The prevalence of maternal depression was high at all time-points, around 10%. The prevalence of depressive symptoms at 4 years postpartum was 14.5%; this was higher than at any time-point in the first 18 months postpartum.
Another study analyzed data from 2910 mothers with children between the ages of 4 and 14 participating in Canada’s National Longitudinal Survey of Children and Youth. Half of the mothers experienced depressive symptoms during this time period, mostly milder (but persistent) levels of depression. About 18% of the mothers experienced more severe levels of depression at some point.
These studies have been done in different countries using slightly different methodologies; however, they all indicate that a substantial proportion of mothers experience persistent depressive symptoms. Because maternal depression, especially when severe or long-standing, can have a deleterious effect on the child’s development and vulnerability to psychopathology, we need not only to focus on depression that emerges during pregnancy and the postpartum period, but we must follow and care for these women for a much longer duration of time, as they remain at high risk for depression for many years after childbirth.
In an editorial accompanying the Australian study, Meltzer-Brody and Brandon urge a broader approach to how we take care of the mental health needs of mothers:
One of the most important ways in which we can address the neglect of maternal mental health is by examining the delivery of our healthcare services to children and families and finding ways to incorporate psychosocial and mental health assessment and intervention across mother–child units. It is extremely naive to believe that mothers can provide optimal care for their children without having adequate support and treatment for the widely prevalent societal and mental health concerns that challenge women during their reproductive years. Second, if we are to mitigate the intergenerational consequences of violence against women, we must take an active stance against intimate partner violence. Across healthcare settings, we can only optimize mother and child outcomes through tireless advocacy, careful assessment and immediate intervention.
Ruta Nonacs, MD PhD
van der Waerden J, Galéra C, Larroque B, Saurel-Cubizolles MJ, Sutter-Dallay AL, Melchior M; EDEN Mother–Child Cohort Study Group. Maternal Depression Trajectories and Children’s Behavior at Age 5 Years. J Pediatr. 2015 Apr 9.
Wickham ME, Senthilselvan A, Wild TC, Hoglund WL, Colman I. Maternal depressive symptoms during childhood and risky adolescent health behaviors. Pediatrics. 2015 Jan;135(1):59-67.
Woolhouse H, Gartland D, Mensah F, Brown S. Maternal depression from early pregnancy to 4 years postpartum in a prospective pregnancy cohort study: implications for primary health care. BJOG. 2014 May 21.