Depression prevalence based on the Edinburgh Postnatal Depression Scale compared to Structured Clinical Interview for DSM DIsorders classification: Systematic review and individual participant data meta-analysis.

OBJECTIVES: Estimates of depression prevalence in pregnancy and postpartum are based on the Edinburgh Postnatal Depression Scale (EPDS) more than on any other method. We aimed to determine if any EPDS cutoff can accurately and consistently estimate depression prevalence in individual studies. METHODS: We analyzed datasets that compared EPDS scores to Structured Clinical Interview for DSM (SCID) major depression status. Random-effects meta-analysis was used to compare prevalence with EPDS cutoffs versus the SCID. RESULTS: Seven thousand three hundred and fifteen participants (1017 SCID major depression) from 29 primary studies were included. For EPDS cutoffs used to estimate prevalence in recent studies (≥9 to ≥14), pooled prevalence estimates ranged from 27.8% (95% CI: 22.0%-34.5%) for EPDS ≥ 9 to 9.0% (95% CI: 6.8%-11.9%) for EPDS ≥ 14; pooled SCID major depression prevalence was 9.0% (95% CI: 6.5%-12.3%). EPDS ≥14 provided pooled prevalence closest to SCID-based prevalence but differed from SCID prevalence in individual studies by a mean absolute difference of 5.1% (95% prediction interval: -13.7%, 12.3%). CONCLUSION: EPDS ≥14 approximated SCID-based prevalence overall, but considerable heterogeneity in individual studies is a barrier to using it for prevalence estimation.

Foetal brain development in offspring of women with psychosis.

Cerebral ventricular enlargement and reduced cortical volume are correlates of chronic schizophrenia. We investigated whether genetic risk for psychosis related to differences in foetal brain development as measured by prenatal ultrasonography. Routine foetal cerebral measures at 19-23 weeks of gestation were compared between the offspring of 35 women with a history of psychosis and 105 control women matched for gestational age. Overall, no significant differences were found between the high-risk and control groups. There was a non-significant trend in the adjusted analysis towards increased lateral ventricular width in the offspring of mothers with psychosis.

Maternal depression and children's antisocial behavior: nature and nurture effects.

BACKGROUND: Children of depressed mothers have elevated conduct problems, presumably because maternal depression disrupts the caregiving environment. Alternatively, the association between maternal depression and children's antisocial behavior (ASB) may come about because (1) depressed women are likely to have comorbid antisocial personality traits, (2) depressed women are likely to mate and bear children with antisocial men, or (3) children of depressed mothers inherit a genetic liability for psychopathology. METHOD: We used data from the E-Risk Study, a representative British cohort of 1116 twin pairs assessed at 5 and 7 years of age. We tested for environmental mediation of the association between maternal depression during the children's first 5 years of life and children's ASB at age 7 years, free from familial liability for ASB. RESULTS: Maternal depression occurring after, but not before, the twins' birth was associated with child ASB and showed a significant dose-response relationship with child ASB at 7 years of age. Parental history of ASPD symptoms accounted for approximately one third of the observed association between maternal depression and children's ASB, but maternal depression continued to significantly predict children's ASB. Intraindividual change analyses indicated that children exposed to their mother's depression between ages 5 and 7 years showed a subsequent increase in ASB by age 7 years. The combination of depression and ASPD symptoms in mothers posed the greatest risk for children's ASB. CONCLUSIONS: Studies ignoring genetic transmission overestimate social transmission effects because both genetic and environmental processes are involved in creating risk for ASB in children of depressed mothers. Interventions for depressed mothers aiming to reduce conduct problems in their children should address parents' antisocial personality, as well as mothers' depression.