The efficacy of group delivered mentalization-based parenting interventions: A systematic review of the literature.

Mentalization refers to the capacity to understand and interpret one's own and others mental states. There is good evidence for individualised treatments aimed at increasing this capacity with children and adolescents. However, there has been no focused synthesis of the literature concerning specifically group delivered mentalization-based parenting interventions. The current study aimed to systematically review the literature in relation to group delivered mentalization-based parenting interventions. Three databases were searched to identify N=515 studies that were screened and reported according to PRISMA guidelines. Inclusion criteria were met by N=10 studies. Interventions varied in terms of content, but often included psychoeducation, experiential group exercises and homework tasks. The length and setting of interventions did not appear to influence outcomes. Significant improvements in parental reflective functioning were found in eight of the ten studies. There was mixed evidence for the efficacy in terms of other parental and child outcomes. This may be due to the lack of high quality studies and the absence of longer-term follow-ups. There is a need for future research to conduct high quality studies with greater diversity in participating parents and long-term follow-up.

The impact of a specialist home-visiting intervention on the language outcomes of young mothers and their children: a pragmatic randomised controlled trial.

BACKGROUND: Young mothers are more likely to provide a suboptimal early language environment for their children who in turn show impairments in their language development, yet few studies have used observational methods to assess the effectiveness of home-visiting programmes in improving the language outcomes of young mothers and their children. The Family Nurse Partnership (FNP) is a licensed home-visiting intervention developed in the USA and introduced into practice in England. The intervention involves up to 64 structured home visits from early pregnancy until the child's second birthday by specially recruited and trained Family Nurses. We assessed the effectiveness of FNP in improving the language outcomes of first-time teenage mothers and their infants. METHOD: We conducted a pragmatic, non-blinded, randomised controlled trial to test whether the FNP programme improved mothers' and children's language production at 24 months postpartum. Eligible participants were nulliparous, aged 19 years or younger, and were recruited at less than 25 weeks' gestation from community midwifery settings (Country). Pregnant young mothers were randomly assigned to FNP plus usual care (n = 243) or usual care alone (n = 233). At 24 months postpartum, mother-child dyads were observed during a standardised free-play task with their first-born child and features of their language production was coded. Data was analysed using multi-level modelling; linear or poisson/negative binomial regression models were used as appropriate. RESULTS: A small effect of FNP on mothers' productive language was detected, where mothers in the FNP group demonstrated higher mean length of utterances than mothers who received usual care alone, mean difference (adjusted by minimisation variables and by site, linear regression) = 0.10, p < .05, 95% CI (0.004-0.20), d = .18. No differences were detected between groups regarding other characteristics of maternal language or children's language outcomes. CONCLUSION: This observational study conducted within the context of a randomised-controlled trial suggests that the FNP home-visiting programme may have a small, but potentially important impact on young mothers' speech to their toddlers. Exploratory analyses identified family environment, maternal, and child related predictors of the language outcomes of young mothers and their offspring. Trial registration This trial is registered with ISRCTN, number ISRCTN23019866, 20/04/2009.

Maternal childhood maltreatment and perinatal outcomes: A systematic review.

BACKGROUND: Maternal childhood maltreatment (MCM) is linked to poor perinatal outcomes but the evidence base lacks cohesion. We explore the impact of MCM on four perinatal outcome domains: pregnancy and obstetric; maternal mental health; infant; and the quality of the care-giving environment. Mechanisms identified in the included studies are discussed in relation to the maternal programming hypothesis and directions for future research. METHOD: We completed a comprehensive literature search of eight electronic databases. Independent quality assessments were conducted and PRISMA protocols applied to data extraction. RESULTS: Inclusion criteria was met by N = 49 studies. MCM was consistently associated with difficulties in maternal and infant emotional regulation and with disturbances in the mother-infant relationship. Directly observed and maternal-reported difficulties in the mother-infant relationship were often mediated by mothers' current symptoms of psychopathology. Direct and mediated associations between MCM and adverse pregnancy and obstetric outcomes were suggested by a limited number of studies. Emotional and sexual abuse were the most consistent MCM subtype significantly associated with adverse perinatal outcomes. LIMITATIONS: A meta-analysis was not possible due to inconsistent reporting and the generally small number of studies for most perinatal outcomes. CONCLUSIONS: MCM is associated with adverse perinatal outcomes for mothers' and infants. Evidence suggests these associations are mediated by disruptions to maternal emotional functioning. Future research should explore biological and psychosocial mechanisms underpinning observed associations between specific subtypes of MCM and adverse perinatal outcomes. Services have a unique opportunity to screen for MCM and detect women and infants at risk of adverse outcomes during the perinatal period.

Longitudinal studies examining the impact of prenatal and subsequent episodes of maternal depression on offspring antisocial behaviour.

Maternal depression is associated with adverse child outcomes including antisocial behaviour (ASB). Prospective longitudinal studies have focused on the timing and cumulative exposure to maternal depression to further delineate the association and mechanisms of effect. The objective of this systematic review was to synthesise and evaluate the findings of longitudinal studies of maternal depression and offspring antisocial behaviour. Three databases were searched (Psychinfo, Web of Science, and Medline). Twenty of 5936 studies met inclusion criteria. Study quality was assessed using the Critical Appraisal Skills Programme criteria [Critical Appraisal Skills Programme (2017) CASP (cohort observation checklist). https://casp-uk.net/wpcontent/uploads/2018/01/CASP-Cohort-Study-Checklist.pdf ]. Results of individual studies were highly varied, using diverse analytical approaches and not all studies explored the independent effects of different episodes. Only three studies examined hypothesised mechanisms. Prenatal, postnatal, and later episodes of depression were all predictive of antisocial outcomes. One particular time period of depression exposure did not emerge as more predictive of offspring ASB than another. However, measures of maternal depression after the perinatal period were limited and typically included a one-off assessment of mothers' depressive symptoms that was concurrent to the assessment of offspring ASB. When cumulative exposure to maternal depression and specific timing effects were measured within the same study it was cumulative exposure that conferred the greatest risk for offspring ASB-particularly when this exposure began during the perinatal period. Findings are discussed in terms of limitations in the literature and highlight the need for future research to examine the biological and environmental mechanisms that underpin associations between maternal depression and offspring antisocial behaviour during different stages of development.

Acceptance and Commitment Therapy for perinatal mood and anxiety disorders: A feasibility and proof of concept study.

OBJECTIVES: The aim of the current study was to assess the feasibility, safety, and effectiveness of a newly developed Acceptance and Commitment Therapy (ACT) intervention developed specifically to address the unique context of pregnancy and parenthood. The intervention was delivered to women accessing a specialist Perinatal Community Mental Health Service (PCMHS). DESIGN: An open-label pilot study was conducted of an 8-week, group-delivered ACT intervention targeting women with moderate-to-severe mood and/or anxiety disorders during pregnancy and/or postpartum. METHODS: Outcomes included session attendance rates, dropout rates, crisis/inpatient service use, and standardized symptom scales. Participant's responses to open-ended questions contained in an end of therapy questionnaire were analysed using thematic analysis. RESULTS: Seventy-four women were referred to the intervention with 65 (88%) completing treatment. The median number of sessions attended was 7. No women required input from crisis/inpatient services. All reported finding the intervention helpful. The implementation of ACT in daily life, therapist support, and group processes were cited as helpful aspects of the intervention. At post-treatment, there was a significant reduction in global distress (d = 0.99) and depressive symptoms (d = 1.05), and an increase in psychological flexibility (d = 0.93). On the secondary outcome of global distress, 38% of women were classified as recovered, 31% had reliably improved, 27% remained the same, and 4% had reliably deteriorated. CONCLUSIONS: The delivery of ACT in a routine practice setting is feasible, safe, and effective. A randomized control trial (RCT) is needed to establish the efficacy and cost-effectiveness of this group-delivered ACT intervention. PRACTITIONER POINTS: Group-delivered Acceptance and Commitment Therapy (ACT) is acceptable for women with moderate-to-severe perinatal mood and/or anxiety disorders and can be feasibly delivered in a routine practice setting. The trans-diagnostic nature of ACT enables the concurrent treatment of depressive and anxiety symptoms within the same intervention which is particularly helpful in the perinatal context given the comorbidity of mood and anxiety disorders. With training and supervision, mental health practitioners without extensive education in the delivery of psychological therapies can facilitate the ACT group programme. As this was a feasibility study, there was no control group, adherence to the manual was not assessed, and the absence of a follow-up period limits our knowledge of the longer-term benefits of the ACT group programme.

Do home visiting programmes improve children's language development? A systematic review.

OBJECTIVES: This review examines home visiting programmes that specifically provide home based support to vulnerable, socially disadvantaged women who are either pregnant or have recently become a new parent. Home visiting programmes often report multiple outcomes. The purpose of this review is to systematically summarise how effective home visiting programmes are at improving young children's language development. DATA SOURCES: A comprehensive search of four online databases (Embase, Emcare, Psycinfo and Medline) between 1990 and 2020 was conducted, as well as a hand search of the references of relevant studies. REVIEW METHOD: Studies were screened with N = 11 meeting the inclusion/exclusion criteria. The risk of bias of each study was assessed. To enable comparisons between home visiting programmes, relevant data was extracted using an adapted version of the Cochrane Public Health Group Data Extraction and Assessment Template. RESULTS: Most of the home visiting programmes had been established in America. Six of the eleven studies reported positive language outcomes for children. Where statistical data was reported, the magnitude of the difference between the intervention and control groups represented small effect sizes. Nine different language measures were used, reporting on varying domains of language development rendering comparisons across programmes difficult. Most studies failed to report the duration of home visits, though studies which started prenatally showed the most promise in improving children's language development. CONCLUSION: Home visiting programmes targeted at socially disadvantaged women and their children have the potential to positively influence the language development of the child. This review highlights that not all home visiting programmes measure the impact that the programme has on children's language development, and not all home visiting programmes achieve positive language outcomes. Initiating visits prenatally may help towards the improvement of children's language development. Future evaluations of home visiting programmes should explore this finding further, consider the language assessment tools selected, and improve on the reporting of their language results.

Assessing the impact of a family nurse-led intervention on young mothers' references to internal states.

A mother's propensity to refer to internal states during mother-child interactions is important for her child's developing social understanding. However, adolescent mothers are less likely to reference internal states when interacting with their children. We investigated whether young mothers' references to internal states are promoted by the Family Nurse Partnership (FNP) intervention, an intensive home-visiting programme designed to support adolescent mothers in England. We also investigated family, maternal, and child factors associated with young mothers' references to inner states during interactions with their children. Adolescent mothers (n = 483, aged ≤ 19 years when recruited in pregnancy) and their children participated in an observational substudy of a randomized controlled trial investigating the impact of FNP compared to usual care. Mother-child dyads were video-recorded during free play, and mothers' speech was coded for use of internal state language (references to cognitions, desires, emotions, intentions, preferences, physiology, and perception). We found no differences in mothers' use of internal state language between the FNP and usual care groups. A sample-wide investigation identified that other features of mothers' language and relationship status with the child's father were associated with internal state language use. Findings are discussed with reference to targeted interventions and implications for future research.

La tendencia de la madre a referirse a los estados internos durante las interacciones madre-niño es importante para el desarrollo social cognitivo de su niño. Sin embargo, las madres adolescentes están menos propensas a referirse a los estados internos cuando interactúan con sus niños. Investigamos si la tendencia de las madres jóvenes a referirse a estados internos es promovida por la intervención de Asociación entre Familia y Enfermera (FNP), un programa intensivo de visitas a casa diseñado para apoyar a madres adolescentes en el Reino Unido. También investigamos factores de familia, maternos y del niño asociados con las interacciones de las jóvenes madres con sus niños. Las madres adolescentes (n = 483, edad ≤ 19 años) y sus niños participaron en un sub-estudio de observación, un ensayo controlado al azar que investigaba el impacto de FNP comparado con el cuidado usual. Las díadas madre-niño fueron grabadas en video durante el juego libre, y se codificó el habla de las madres en cuanto al uso del lenguaje de estados internos (referencias a cogniciones, deseos, emociones, intenciones, preferencias, fisiología y percepción). No encontramos diferencias en cuanto al uso del lenguaje de estados internos en las madres entre la FNP y los grupos de cuidado usual. Una muestra de investigación amplia identificó que otras características del lenguaje de las madres y condiciones de la relación con el padre del niño estaban asociadas con el uso del lenguaje de estados internos. Los resultados se discuten con referencia a intervenciones elegidas como objetivo e implicaciones para la futura investigación.

La propension d'une mère à faire référence à ses états internes durant les interactions mère-enfant est importante pour le développement social et cognitif de son enfant. Cependant, les mères adolescentes sont moins à même de faire référence à leurs états internes dans leur interaction avec leurs enfants. Notre étude a porté sur si la propension des jeunes mères à faire référence à leurs états internes est promue par l'intervention Partenariat Famille Infirmières (en anglais Family Nurse Partnership, soit FNP), un programme intensif de visite à domicile conçu afin de soutenir les mères adolescentes au Royaume Uni. Nous avons également étudié les facteurs familiaux, maternels, et liés aux enfants, liés aux interactions des jeunes mères avec leurs enfants. Les mères adolescentes (n = 483, âgés ≤ 19 ans) et leurs enfants ont participé à une sous-étude observationnelle d'un essai contrôlé randomisé portant sur l'impact de la FNP comparé aux soins normaux. Les dyades mères-enfant ont été filmées durant un jeu libre et les paroles des mères ont été codées pour son utilisation de langage d'état interne (références aux cognitions, désirs, émotions, intentions, préférences, physiologie et perception). Nous n'avons trouvé aucune différence dans l'utilisation des mères du langage d'état interne entre le groupe FNP et les groupes de contrôle. Une étude de l'échantillon a révélé que d'autres traits du langage des mères et du statut de la relation avec le père de l'enfant étaient liés à l'utilisation de langage de l'état interne. Les résultats sont discutés par rapport aux interventions ciblées et aux implications pour les recherches futures.

The impact of maternal prenatal and postnatal anxiety on children's emotional problems: a systematic review.

Maternal mental health problems during pregnancy and the postnatal period are a major public health issue. Despite evidence that symptoms of both depression and anxiety are common during pregnancy and the postpartum, the impact of maternal anxiety on the child has received relatively less attention than the impact of maternal depression. Furthermore, the evidence base for the direct impact of maternal anxiety during pregnancy and the postpartum on children's emotional outcomes lacks cohesion. The aim of this systematic review is to summarise the empirical evidence regarding the impact of maternal prenatal and postnatal anxiety on children's emotional outcomes. Overall, both maternal prenatal and postnatal anxiety have a small adverse effect on child emotional outcomes. However, the evidence appears stronger for the negative impact of prenatal anxiety. Several methodological weaknesses make conclusions problematic and replication of findings is required to improve the identification of at-risk parents and children with appropriate opportunities for intervention and prevention.

Acceptance and commitment therapy (ACT) for clinically distressed health care workers: Waitlist-controlled evaluation of an ACT workshop in a routine practice setting.

OBJECTIVES: To examine the effects of a 1-day acceptance and commitment therapy (ACT) workshop on the mental health of clinically distressed health care employees, and to explore ACT's processes of change in a routine practice setting. DESIGN: A quasi-controlled design, with participants block allocated to an ACT intervention or waiting list control group based on self-referral date. METHODS: Participants were 35 health care workers who had self-referred for the ACT workshop via a clinical support service for staff. Measures were completed by ACT and control group participants at pre-intervention and 3 months post-intervention. Participants allocated to the waitlist condition went on to receive the ACT intervention and were also assessed 3 months later. RESULTS: At 3 months post-intervention, participants in the ACT group reported a significantly lower level of psychological distress compared to the control group (d = 1.41). Across the 3-month evaluation period, clinically significant change was exhibited by 50% of ACT participants, compared to 0% in the control group. When the control group received the same ACT intervention, 69% went on to exhibit clinically significant change. The ACT intervention also resulted in significant improvements in psychological flexibility, defusion, and mindfulness skills, but did not significantly reduce the frequency of negative cognitions. Bootstrapped mediation analyses indicated that the reduction in distress in the ACT condition was primarily associated with an increase in mindfulness skills, especially observing and non-reactivity. CONCLUSIONS: These findings provide preliminary support for providing brief ACT interventions as part of routine clinical support services for distressed workers. PRACTITIONER POINTS: A 1-day ACT workshop delivered in the context of a routine staff support service was effective for reducing psychological distress among health care workers. The brief nature of this group intervention means it may be particularly suitable for staff support and primary care mental health service settings. The findings indicate that the beneficial effects of an ACT workshop on distressed employees' mental health were linked to improvements in specific mindfulness skills. Study limitations include non-random allocation of participants to the ACT and control groups, and measurement of mediators and outcome at the same time point (3 months post-intervention).

Antenatal depression and children's developmental outcomes: potential mechanisms and treatment options.

During the last decade there has been increased recognition of the prevalence of antenatal depression as well as an expansion in research examining the impact of maternal mood during pregnancy on offspring development. The aim of this review was to summarise the theoretical underpinnings and empirical evidence regarding the impact of antenatal depression on children's developmental outcomes. Biological mechanisms hypothesised to account for an association between antenatal depression and adverse offspring outcomes are first identified including the functioning of the prenatal Hypothalamic Pituitary Adrenal (HPA) axis and epigenetic processes. A systematic literature search is then conducted of studies examining the impact of antenatal depression on child development. In general, studies examining associations between antenatal depression and offspring temperament, cognitive and emotional outcomes reveal either no effect of the prenatal environment or small effects that often attenuate following adjustment for other antenatal and postnatal risk factors. In contrast, an independent effect of antenatal depression on children's conduct problems and antisocial behaviour is a well-replicated finding. There is emerging evidence that exposure to depression during pregnancy impacts negatively on offspring biology, although the findings are complex and require replication. Psychological and pharmacological treatments of antenatal depression are then reviewed, considering whether antidepressant medication exerts harmful effects on the foetus. We close by proposing that antenatal depression is an early marker of a developmental cascade to future mental health problems for both mothers and offspring.

Precursors to aggression are evident by 6 months of age.

We tested the hypothesis that developmental precursors to aggression are apparent in infancy. Up to three informants rated 301 firstborn infants for early signs of anger, hitting and biting; 279 (93%) were assessed again as toddlers. Informants' ratings were validated by direct observation at both ages. The precursor behaviours were significantly associated with known risk factors for high levels of aggressiveness. Individual differences were stable from early infancy to the third year and predicted broader conduct problems. These findings suggest that some individuals set forth on the trajectory to high levels of aggression by 6 months of age. The findings have implications for developmental studies of aggression, clinical prevention and intervention strategies, and theoretical considerations regarding the detection of precursors in different domains of development.

Infants at familial risk for depression show a distinct pattern of cortisol response to experimental challenge.

BACKGROUND: The aim of the study was to examine the link between maternal depression and the infant's HPA axis functioning in relation to a sequence of emotional challenges at 12 months postpartum, while controlling for maternal anxiety disorder and general sociodemographic risk. METHOD: Two hundred and fifty-seven infants whose mothers had been interviewed in pregnancy, as part of a prospective longitudinal study of a nationally representative sample of U.K. families, were individually tested in the laboratory and then observed during a simulated birthday party scenario. Three cortisol samples were taken over the course of 1½ h of afternoon testing. RESULTS: The cortisol levels of infants whose mothers had no history of depression decreased significantly after individual testing, and rose again significantly in response to the birthday party challenge. In contrast, infants whose mothers had been diagnosed with depression before conception, during pregnancy or in the first 6 months postpartum showed no decrease from the initially elevated levels at entry to the laboratory and a less marked increase in response to the party. LIMITATIONS: The study does not employ a traditional stress paradigm; instead it introduces a novel design to assess HPA axis functioning in relation to everyday emotional challenges. CONCLUSIONS: The findings suggest that altered responses to mildly challenging events in infancy may be a marker for infants' familial risk for depressive illness.

Known risk factors for violence predict 12-month-old infants' aggressiveness with peers.

This study tested the hypothesis that 12-month-old infants' use of force against peers is associated with known risk factors for violence. We conducted a prospective longitudinal study, which included laboratory observations of firstborn British infants (N = 271) during simulated birthday parties. No gender differences in aggressiveness were observed. The infants' observed aggressiveness was significantly correlated with mothers' mood disorder during pregnancy and with mothers' history of conduct problems. Infants' observed aggressiveness was correlated with parents' ratings of infants' anger and aggression, which were also predicted by mothers' mood disorder and history of conduct problems. Our findings indicate that infants at risk for serious aggression can already be identified when the motor ability to use physical force first enters the human repertoire.

Antenatal depression and offspring psychopathology: the influence of childhood maltreatment.

BACKGROUND: Antenatal depression and childhood maltreatment have each been associated with offspring psychopathology, but have never been examined in the same sample. AIMS: To determine whether childhood maltreatment influences the association between antenatal depression and offspring psychopathology. METHOD: Prospectively collected data on antenatal depression, offspring maltreatment (age 11) and offspring psychopathology (age 11 and 16) were analysed in 120 mother-offspring dyads from the community-based South London Child Development Study. RESULTS: Antenatal depression increased the risk of maltreatment in the offspring by almost four times. Children exposed only to antenatal depression or only to childhood maltreatment were no more at risk of developing psychopathology; however, children exposed to both antenatal depression and childhood maltreatment were at almost 12 times greater risk of developing psychopathology than offspring not so exposed. CONCLUSIONS: Research investigating exposure to adverse events in utero and offspring psychopathology should take account of postnatal adverse events such as maltreatment.

Insufficient evidence of benefit: a systematic review of home telemonitoring for COPD.

RATIONALE, AIMS AND OBJECTIVES: The evidence to support the effectiveness of home telemonitoring interventions for patients with chronic obstructive pulmonary disease (COPD) is limited, yet there are many efforts made to implement these technologies across health care services. METHODS: A comprehensive search strategy was designed and implemented across 9 electronic databases and 11 European, Australasian and North American telemedicine websites. Included studies had to examine the effectiveness of telemonitoring interventions, clearly defined for the study purposes, for adult patients with COPD. Two researchers independently screened each study prior to inclusion. RESULTS: Two randomized trials and four other evaluations of telemonitoring were included. The studies are typically underpowered, had heterogeneous patient populations and had a lack of detailed intervention descriptions and of the care processes that accompanied telemonitoring. In addition, there were diverse outcome measures and no economic evaluations. The telemonitoring interventions in each study differed widely. Some had an educational element that could itself account for the differences between groups. CONCLUSIONS: Despite these caveats, the study reports are themselves positive about their results. However, given the risk of bias in the design and scale of the evaluations we conclude that the benefit of telemonitoring for COPD is not yet proven and that further work is required before wide-scale implementation be supported.

Infants' Use of Force to Defend Toys: The Origins of Instrumental Aggression.

The two aims of the study were (a) to determine when infants begin to use force intentionally to defend objects to which they might have a claim and (b) to examine the relationship between toddlers' instrumental use of force and their tendencies to make possession claims. Infants' and toddlers' reactions to peers' attempts to take their toys were assessed in three independent data sets in which the same observational coding system had been used (N = 200). To ensure that infants' use of force was goal-directed and not a simple physical reaction, we recorded infants' reactions when peers picked up toys that the focal infants had just put down, or were nearby or in the focal infants' mothers' laps. The use of force in response to peers' taking over toys was evident before the first birthday, but more common thereafter, although only a minority of children in each sample used force. Analysis of a combined data set revealed that force was deployed more often by 2-year-olds than younger infants, and was significantly associated with verbal references to people's possession of objects. These observations show that toddlers do deploy force intentionally to defend their possessions.

Identifying early signs of aggression: psychometric properties of the Cardiff infant contentiousness scale.

Our aim was to develop an age-appropriate measure of early manifestations of aggression. We constructed a questionnaire about normative developmental milestones into which a set of items measuring infants' use of physical force against people and expressed anger were included. These items comprise the Cardiff Infant Contentiousness Scale (CICS). Evidence for the reliability and validity of the CICS is provided from analyses of a sample of N=310 British infants, assessed at a mean age of 6 months as part of a larger longitudinal study of the development of aggression. The informants' CICS ratings demonstrated reasonable levels of internal consistency and interrater agreement. Informants' ratings were validated by observations of infants' distress in response to restraint in a car seat. Longitudinal analyses revealed that contentiousness was stable over time and that contentiousness at 6 months predicted infants' later use of force with peers. When used in the company of other methods, the simple four-item CICS scale could serve as a useful screen for early manifestations of aggressiveness in human infants.

Mothers' antenatal depression and their children's antisocial outcomes.

Interviews of 120 British adolescents and their parents (80% of a random sample of antenatal patients drawn from a representative urban population and followed longitudinally) revealed that 40 (33%) had been arrested and/or had a diagnosis of DSM-IV conduct disorder by 16 years of age; of those, 18 (45%) had committed violent acts. Depression in pregnancy significantly predicted violence in adolescence, even after controlling for the family environment, the child's later exposure to maternal depression, the mother's smoking and drinking during pregnancy, and parents' antisocial behavior. Mothers with a history of conduct problems were at elevated risk to become depressed in pregnancy, and the offspring of depressed women had a greater chance of becoming violent by age 16.

Antenatal depression predicts depression in adolescent offspring: prospective longitudinal community-based study.

BACKGROUND: Depression is familial. Evidence shows that untreated postnatal depression is associated with adverse outcomes for the child. Few studies have traced prospectively the course of maternal depression through pregnancy, the postnatal period and the following 16 years in relation to adolescent offspring depression. METHOD: The sample was recruited from two general practice antenatal clinics. Of 151 mother-child dyads followed from pregnancy to 16 years, information on the course of maternal depression and on depression in adolescent offspring was available for 127 (84%). RESULTS: Two-thirds (82/125) of the women had been depressed during the 17-year time period, with the majority (54/82) experiencing more than one episode. A third of the women were depressed in pregnancy (41/124). Over half of these women (23/41) had consulted a doctor about their mental health prior to being pregnant and almost 90% (35/39) had further episodes during the child's lifetime. 14% (18/127) of the adolescent offspring were diagnosed with a depressive disorder at 16 years. Every depressed adolescent had been exposed to maternal depression. The risk of depression for the 16-year-olds exposed to antenatal depression was 4.7 times greater than for offspring not so exposed. The effect of antenatal depression was mediated by repeated exposure. LIMITATIONS: The number of study participants is small and limited to an inner-city population. Only depression spectrum diagnoses in the adolescent offspring have been considered. CONCLUSIONS: Detection of depression in pregnancy identifies mothers at risk of further depressive episodes and a group of children who are at risk of depression in adolescence.

Antepartum and postpartum exposure to maternal depression: different effects on different adolescent outcomes.

BACKGROUND: Postpartum depression (PPD) is considered a major public health problem that conveys risk to mothers and offspring. Yet PPD typically occurs in the context of a lifelong episodic illness, and its putative effects might derive from the child's exposure to other episodes, in pregnancy or later childhood. The aim of the study is to test two hypotheses: (1) that the effects of PPD on adolescent outcomes are partly explained by antepartum depression (APD) and (2) that the effects of APD and PPD are both explained by later exposure to the mother's depression. METHOD: A random sample of 178 antenatal patients was drawn from two general medical practices in South London; 171 gave birth to live infants, and 150 (88%) were assessed at 3 months post partum, with 121 of their offspring (81%) assessed for emotional disorders (ED), disruptive behaviour disorders (DBD) and IQ, at 11 and 16 years of age. RESULTS: When APD and subsequent episodes of depression were taken into account, PPD had a significant effect on adolescent IQ, especially for boys, but did not predict psychopathology. ED and DBD in adolescence were predicted by the extent of exposure to maternal depression after 3 months post partum; a significant effect of APD on ED in girls was accounted for by later exposure to the mother's illness. Mothers' symptoms of anxiety, smoking and alcohol use in pregnancy did not predict adolescent outcomes, once maternal depression was taken into account. CONCLUSIONS: Some effects attributed to mothers' mental health problems in pregnancy or post partum may be mediated by cumulative exposure to maternal illness, probably reflecting genetic influence and gene-environment correlation. However, PPD has a direct effect on cognition. Clinicians should endeavour to identify women with depression in pregnancy (31% of this sample) and help them to manage their lifelong illness.