Section of Child and Adolescent Psychiatry, Department of Psychiatry, University of Oxford, Oxford, UK; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
Section of Child and Adolescent Psychiatry, Department of Psychiatry, University of Oxford, Oxford, UK; Elizabeth Blackwell Institute for Health Research, School of Social and Community Medicine, University of Bristol, Bristol, UK.
Lancet. 2014 Nov 15;384(9956):1800-19. doi: 10.1016/S0140-6736(14)61277-0. Epub 2014 Nov 14.
Perinatal mental disorders are associated with increased risk of psychological and developmental disturbances in children. However, these disturbances are not inevitable. In this Series paper, we summarise evidence for associations between parental disorders and offspring outcomes from fetal development to adolescence in high-income, middle-income, and low-income countries. We assess evidence for mechanisms underlying transmission of disturbance, the role of mediating variables (underlying links between parent psychopathology and offspring outcomes) and possible moderators (which change the strength of any association), and focus on factors that are potentially modifiable, including parenting quality, social (including partner) and material support, and duration of the parental disorder. We review research of interventions, which are mostly about maternal depression, and emphasise the need to both treat the parent's disorder and help with associated caregiving difficulties. We conclude with policy implications and underline the need for early identification of those parents at high risk and for more early interventions and prevention research, especially in socioeconomically disadvantaged populations and low-income countries.
围产期精神障碍与儿童心理和发育障碍的风险增加有关。然而,这些障碍并非不可避免。在本综述论文中,我们总结了高收入、中等收入和低收入国家中从胎儿发育到青春期的父母障碍与后代结局之间关联的证据。我们评估了障碍传播的潜在机制、中介变量(父母精神病理学与后代结局之间的潜在联系)和可能的调节因素(改变任何关联的强度)的证据,并重点关注潜在可改变的因素,包括育儿质量、社会(包括伴侣)和物质支持,以及父母障碍的持续时间。我们回顾了干预措施的研究,这些研究主要针对母亲的抑郁,并强调需要治疗父母的障碍,并帮助解决相关的育儿困难。最后,我们提出了政策影响,并强调需要早期识别那些处于高风险的父母,并进行更多的早期干预和预防研究,特别是在社会经济处于不利地位的人群和低收入国家。