Hammerton Gemma, Zammit Stanley, Mahedy Liam, Pearson Rebecca M, Sellers Ruth, Thapar Anita, Collishaw Stephan
Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK.
Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK; Centre for Academic Mental Health, University of Bristol, Bristol, UK.
J Am Acad Child Adolesc Psychiatry. 2015 May;54(5):385-93. doi: 10.1016/j.jaac.2015.02.006. Epub 2015 Feb 17.
Offspring of mothers with depression are a high-risk group for the development of suicide-related behavior. These offspring are therefore a priority for preventive interventions; however, pathways contributing to risk, including specific aspects of offspring psychopathology, remain unclear. The aim of this study was to examine whether offspring symptoms of major depressive disorder (MDD), generalized anxiety disorder (GAD), disruptive behavior disorder (DBD), attention-deficit/hyperactivity disorder (ADHD), and alcohol abuse independently mediate the association between maternal depression and offspring suicide-related behavior.
Data were used from a population-based birth cohort, the Avon Longitudinal Study of Parents and Children (ALSPAC). Three distinct classes of depression symptoms across the mothers' first 11 years of their child's life were identified (minimal, moderate, chronic-severe). Offspring psychopathology was assessed at age 15 years and suicide-related behavior at age 16 years. Data were analyzed using structural equation modeling.
There was evidence for increased risk of suicidal ideation in offspring of mothers with chronic-severe depression symptoms in comparison to offspring of mothers with minimal symptoms (odds ratio = 3.04, 95% CI = 2.19, 4.21). This association was independently mediated by offspring MDD, GAD, and DBD symptoms. The same mechanisms were found for offspring of mothers with moderate depression symptoms over time. Results were similar for offspring suicide attempt except for additional evidence of an indirect effect through offspring ADHD symptoms.
Findings highlight that suicide prevention efforts in offspring of mothers with depression should not only be targeted at offspring with MDD; it is also important to consider offspring with other forms of psychopathology.
患有抑郁症母亲的后代是自杀相关行为发展的高危群体。因此，这些后代是预防性干预的重点对象；然而，导致风险的途径，包括后代精神病理学的具体方面，仍不清楚。本研究的目的是检验重度抑郁症（MDD）、广泛性焦虑症（GAD）、破坏性行为障碍（DBD）、注意力缺陷多动障碍（ADHD）和酒精滥用的后代症状是否独立介导母亲抑郁与后代自杀相关行为之间的关联。
数据来自一项基于人群的出生队列研究——雅芳亲子纵向研究（ALSPAC）。确定了母亲在孩子生命的前11年中三种不同类型的抑郁症状（轻微、中度、慢性重度）。在15岁时评估后代的精神病理学，在16岁时评估自杀相关行为。使用结构方程模型分析数据。
有证据表明，与症状轻微的母亲的后代相比，患有慢性重度抑郁症状的母亲的后代有自杀意念的风险增加（优势比 = 3.04，95%置信区间 = 2.19，4.21）。这种关联由后代的MDD、GAD和DBD症状独立介导。随着时间的推移，中度抑郁症状母亲的后代也发现了相同的机制。除了通过后代ADHD症状产生间接影响的额外证据外，后代自杀未遂的结果相似。
研究结果强调，对患有抑郁症母亲的后代进行自杀预防的努力不仅应针对患有MDD的后代；考虑患有其他形式精神病理学的后代也很重要。
