School of Public Health, Centre for Longitudinal and Life Course Research, The University of Queensland, Brisbane, QLD, Australia.
Paediatr Perinat Epidemiol. 2020 Nov;34(6):678-686. doi: 10.1111/ppe.12681. Epub 2020 Jun 14.
There is debate regarding whether the association between maternal depressive symptoms (MDS) and child outcomes is due to the timing or chronicity of symptoms.
To investigate whether critical periods, sensitive periods, or accumulation models provided the best explanation for the association between MDS and children's behaviour and development.
Data on mothers (N = 892) were collected from 1996 to 2015 as part of the Australian Longitudinal Study on Women's Health, a prospective longitudinal epidemiological study. Data on children (N = 978, 2-12 years) were collected in 2016/17 as part of the Mothers and their Children's Health study. Mothers were categorised according to whether they reported MDS (scored ≥ 10 on the CESD-10) before pregnancy, during pregnancy, or in early childhood. Child outcomes were maternal-rated behaviour problems (Strengths and Difficulties Questionnaire; SDQ) and teacher-rated development (Australian Early Development Census; AEDC). We used a structured life course approach to rigorously test critical period, sensitive period, and accumulation (ie chronicity) theories by comparing the fit of a series of models.
Most mothers did not report MDS at any time (69.2%), 16.9% reported MDS before pregnancy, 13.2% during pregnancy, and 16.5% in early childhood. High/very high total behaviour problems were reported for 7.0% of children, and developmental vulnerability/risk was reported for 15.9% for social competence and 15.7% for emotional maturity. An accumulation model was the best fit, with each period of MDS associated with an increase of 1.71 points (95% CI 1.26, 2.17) on the SDQ and decreases of 0.31 (95% CI -0.50, -0.12) and 0.29 points (95% CI -0.49, -0.08) on AEDC social competence and emotional maturity, respectively.
Chronic MDS were associated with poorer child outcomes than MDS at any single time. Sensitive and critical period models were not supported. This suggests chronicity of symptoms may be more important than timing.
关于母亲抑郁症状（MDS）与儿童结局之间的关联是由于症状的时间或持续性，存在争议。
探讨关键期、敏感期或累积模型是否为 MDS 与儿童行为和发育之间关联提供了最佳解释。
1996 年至 2015 年期间，作为澳大利亚妇女健康纵向研究的一部分，收集了母亲（N=892）的数据，这是一项前瞻性纵向流行病学研究。2016/17 年期间，作为母亲及其子女健康研究的一部分，收集了儿童（N=978，2-12 岁）的数据。根据母亲在怀孕前、怀孕期间或幼儿期是否报告 MDS（CESD-10 得分≥10），将母亲分类。儿童结局为母亲评定的行为问题（长处和困难问卷；SDQ）和教师评定的发育（澳大利亚早期发展普查；AEDC）。我们使用结构化的生活历程方法，通过比较一系列模型的拟合度，严格检验关键期、敏感期和累积（即持续性）理论。
大多数母亲在任何时候都没有报告 MDS（69.2%），16.9%在怀孕前报告 MDS，13.2%在怀孕期间报告 MDS，16.5%在幼儿期报告 MDS。报告有 7.0%的儿童存在高/极高总分行为问题，15.9%的儿童社会能力存在发育脆弱/风险，15.7%的儿童情绪成熟度存在发育脆弱/风险。累积模型是最佳拟合模型，MDS 的每个时期都与 SDQ 增加 1.71 分（95%CI 1.26，2.17）相关，与 AEDC 社会能力和情绪成熟度分别降低 0.31 分（95%CI -0.50，-0.12）和 0.29 分（95%CI -0.49，-0.08）。
与单次 MDS 相比，慢性 MDS 与儿童结局较差相关。敏感和关键期模型不支持。这表明症状的持续性可能比时间更重要。
