van der Waerden J, Galéra C, Saurel-Cubizolles M-J, Sutter-Dallay A-L, Melchior M
Department of Social Epidemiology,INSERM UMR-S 1136,Pierre Louis Institute of Epidemiology and Public Health,F-75013 Paris,France.
Department of Child and Adolescent Psychiatry,Charles Perrens Hospital,F-33000 Bordeaux,France.
Psychol Med. 2015 Jul;45(9):1999-2012. doi: 10.1017/S003329171500015X. Epub 2015 Feb 13.
Maternal depression in the pre- and postpartum period may set women on a course of chronic depressive symptoms. Little is known about predictors of persistently elevated depressive symptoms in mothers from pregnancy onwards. The aims of this study are to determine maternal depression trajectories from pregnancy to the child's fifth birthday and identify associated risk factors.
Mothers (N = 1807) from the EDEN mother-child birth cohort study based in France (2003-2011) were followed from 24-28 weeks of pregnancy to their child's fifth birthday. Maternal depression trajectories were determined with a semi-parametric group-based modelling strategy. Sociodemographic, psychosocial and psychiatric predictors were explored for their association with trajectory class membership.
Five trajectories of maternal symptoms of depression from pregnancy onwards were identified: no symptoms (60.2%); persistent intermediate-level depressive symptoms (25.2%); persistent high depressive symptoms (5.0%); high symptoms in pregnancy only (4.7%); high symptoms in the child's preschool period only (4.9%). Socio-demographic predictors associated with persistent depression were non-French origin; psychosocial predictors were childhood adversities, life events during pregnancy and work overinvestment; psychiatric predictors were previous mental health problems, psychological help, and high anxiety during pregnancy.
Persistent depression in mothers of young children is associated to several risk factors present prior to or during pregnancy, notably anxiety. These characteristics precede depression trajectories and offer a possible entry point to enhance mother's mental health and reduce its burden on children.
产前和产后的母亲抑郁可能使女性走上慢性抑郁症状的病程。从怀孕开始，对于母亲持续出现的抑郁症状的预测因素知之甚少。本研究的目的是确定从怀孕到孩子五岁时母亲的抑郁轨迹，并识别相关风险因素。
对法国EDEN母婴出生队列研究（2003 - 2011年）中的1807名母亲进行随访，从怀孕24至28周一直到孩子五岁生日。采用基于半参数分组的建模策略确定母亲的抑郁轨迹。探讨社会人口学、心理社会和精神方面的预测因素与轨迹类别成员之间的关联。
确定了从怀孕开始母亲抑郁症状的五种轨迹：无症状（60.2%）；持续中度抑郁症状（25.2%）；持续高度抑郁症状（5.0%）；仅在孕期有高度症状（4.7%）；仅在孩子学龄前有高度症状（4.9%）。与持续抑郁相关的社会人口学预测因素是非法国裔；心理社会预测因素是童年逆境、孕期生活事件和工作过度投入；精神方面的预测因素是既往心理健康问题、心理帮助以及孕期高焦虑。
幼儿母亲的持续抑郁与怀孕前或孕期存在的多种风险因素相关，尤其是焦虑。这些特征先于抑郁轨迹出现，为改善母亲心理健康并减轻其对孩子的负担提供了一个可能的切入点。
