Comaskey Brenda, Roos Noralou P, Brownell Marni, Enns Murray W, Chateau Dan, Ruth Chelsea A, Ekuma Okechukwu
Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada.
PLoS One. 2017 May 24;12(5):e0177065. doi: 10.1371/journal.pone.0177065. eCollection 2017.
To examine the association between maternal depression and anxiety disorders (MDAD) and child development assessed during the kindergarten year.
Administrative data from several health and social databases in Manitoba, Canada, were used to study 18,331 mother-child pairs. MDAD over the period from one year prior to the child's birth to the kindergarten year was defined using physician diagnoses and filled prescriptions. Child development was assessed during the kindergarten year using the Early Development Instrument (EDI) which measures vulnerability across five domains of development. Structural equation modeling was used to examine associations between timing, recurrence and severity of MDAD and child outcomes. Health at Birth (preterm, low birth weight, neonatal intensive care stay and long birth hospitalization), Family Context (teen mother, lone parent, socio-economic status (SES)), child age and child sex were covariates.
MDAD had a modest negative association with child EDI scores across all models tested, particularly for social, emotional and physical development. Prenatal MDAD had a stronger negative association with outcomes than other time periods; however, recurrent MDAD had a stronger negative association with outcomes than any specific time period or MDAD severity. The influence of MDAD was mediated by Family Context, which had a strong, negative association with outcomes, particularly language and cognitive development.
The number of time periods a child was exposed to MDAD in early childhood was more negatively associated with five areas of child development than timing or severity. Prenatal exposure may be more sensitive to MDAD than other time periods. The familial context (teen mother, lone parenthood and low SES) had a stronger influence on child outcomes than MDAD. Findings can be used to inform interventions which address maternal mental health from the prenatal period onward, and to support disadvantaged families to encourage healthy birth outcomes, early childhood development and school readiness.
研究孕期抑郁与焦虑障碍（MDAD）与幼儿园阶段儿童发育之间的关联。
利用加拿大曼尼托巴省多个健康与社会数据库的管理数据，对18331对母婴进行研究。MDAD定义为从孩子出生前一年到幼儿园阶段，依据医生诊断和已开具的处方确定。在幼儿园阶段，使用早期发育指标（EDI）评估儿童发育情况，该指标衡量五个发育领域的脆弱性。采用结构方程模型研究MDAD的发生时间、复发情况和严重程度与儿童发育结果之间的关联。出生时健康状况（早产、低出生体重、新生儿重症监护病房住院时间和长时间分娩住院）、家庭背景（青少年母亲、单亲家庭、社会经济地位（SES））、儿童年龄和儿童性别作为协变量。
在所有测试模型中，MDAD与儿童EDI得分呈适度负相关，尤其是在社交、情感和身体发育方面。产前MDAD与发育结果的负相关性比其他时间段更强；然而，复发性MDAD与发育结果的负相关性比任何特定时间段或MDAD严重程度都更强。MDAD的影响通过家庭背景介导，家庭背景与发育结果呈强烈负相关，尤其是在语言和认知发育方面。
儿童在幼儿期接触MDAD的时间段数量，比接触时间或严重程度更能对儿童发育的五个领域产生负面影响。产前接触MDAD可能比其他时间段更敏感。家庭背景（青少年母亲、单亲家庭和低SES）对儿童发育结果的影响比MDAD更强。研究结果可用于指导从孕期开始针对孕产妇心理健康的干预措施，并支持处境不利的家庭，以促进健康的出生结局、幼儿发育和入学准备。
