University College London Great Ormond Street Institute of Child Health, London, United Kingdom.
Department of Population Health Sciences, University of Bristol, Bristol, United Kingdom.
JAMA Netw Open. 2023 Mar 1;6(3):e231175. doi: 10.1001/jamanetworkopen.2023.1175.
Parental intimate partner violence (IPV) and maternal depression are associated with increased risk of depression in children at the population level. However, it is not known whether having information about these experiences can accurately identify individual children at higher risk of depression.
To examine the extent to which experiencing parental IPV and/or maternal depression before age 12 years is associated with depression at age 18 years at the population and individual level.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study used data from the Avon Longitudinal Study of Parents and Children, a UK population-based birth cohort, which initially recruited pregnant mothers with estimated due dates in 1991 and 1992. Data used in this study were collected from 1991 to 2009. Data analysis was performed from February to March 2022.
Mother-reported parental IPV was assessed on 8 occasions (child age, 1-11 years). Maternal depression was assessed via the Edinburgh Postnatal Depression Scale or by the mother taking medication for depression, as reported by the mother on 8 occasions (child age, 2-12 years).
Depressive symptoms were measured with the Short Mood and Feelings Questionnaire (SMFQ) and Clinical Interview Schedule-Revised (CIS-R) when the child was aged 18 years. Binary indicators of a case of depression were derived the cutoff point of 11 points or above for the SMFQ and 12 points or above for the CIS-R.
The study included 5029 children (2862 girls [56.9%]; 2167 boys [43.1%]) with a measure of depressive symptoms at age 18 years. IPV only was associated with a 24% (adjusted risk ratio, 1.24; 95% CI, 0.97-1.59) higher risk of depression at age 18 years, exposure to maternal depression only was associated with a 35% (adjusted risk ratio, 1.35; 95% CI, 1.11-1.64) higher risk, and exposure to both IPV and maternal depression was associated with a 68% (adjusted risk ratio, 1.68; 95% CI, 1.34-2.10) higher risk. At the individual level, the area under the receiver operating characteristic curve was 0.58 (95% CI, 0.55-0.60) for depression according to the SMFQ and 0.59 (95% CI, 0.55-0.62) for the CIS-R, indicating a 58% to 59% probability (ie, 8%-9% above chance) that a random participant with depression at age 18 years had been exposed to IPV and/or maternal depression compared with a random participant who did not have depression.
In this cohort study, parental IPV and maternal depression were associated with depression in adolescence at the population level. However, estimation of an individual developing depression in adolescence based only on information about IPV or maternal depression is poor. Screening children for maternal depression and IPV to target interventions to prevent adolescent depression will fail to identify many children who might benefit and may unnecessarily target many others who do not develop depression.
在人群水平上，父母间的亲密伴侣暴力（IPV）和母亲抑郁与儿童抑郁风险增加有关。然而，目前尚不清楚是否有这些经历的信息可以准确识别出患有抑郁症风险较高的个体儿童。
研究在 12 岁之前经历父母间的 IPV 和/或母亲抑郁与 18 岁时抑郁之间的关联在人群和个体水平上的程度。
设计、设置和参与者：这项队列研究使用了英国基于人群的出生队列“雅芳纵向父母与子女研究”的数据，该研究最初招募了预计在 1991 年和 1992 年分娩的孕妇。本研究中使用的数据收集于 1991 年至 2009 年。数据分析于 2022 年 2 月至 3 月进行。
母亲报告的父母间的 IPV 在 8 个时间点（儿童年龄，1-11 岁）进行评估。母亲抑郁通过爱丁堡产后抑郁量表或母亲在 8 个时间点（儿童年龄，2-12 岁）因抑郁而服用药物来评估，由母亲报告。
当孩子 18 岁时，使用短期情绪和感受问卷（SMFQ）和临床访谈量表修订版（CIS-R）来测量抑郁症状。使用 11 分或以上的 SMFQ 和 12 分或以上的 CIS-R 的切点来确定病例的二进制指标。
该研究纳入了 5029 名儿童（2862 名女孩[56.9%]；2167 名男孩[43.1%]），他们在 18 岁时有一项抑郁症状的测量结果。仅 IPV 暴露与 18 岁时抑郁风险增加 24%（调整风险比，1.24；95%置信区间，0.97-1.59）相关，仅母亲抑郁暴露与 35%（调整风险比，1.35；95%置信区间，1.11-1.64）相关，而同时暴露于 IPV 和母亲抑郁与 68%（调整风险比，1.68；95%置信区间，1.34-2.10）相关。在个体水平上，根据 SMFQ，抑郁的受试者工作特征曲线下面积为 0.58（95%置信区间，0.55-0.60），根据 CIS-R，为 0.59（95%置信区间，0.55-0.62），这表明随机参与者在 18 岁时患有抑郁的概率为 58%至 59%（即，比机会高出 8%-9%），与没有抑郁的随机参与者相比，该随机参与者经历了 IPV 和/或母亲抑郁。
在这项队列研究中，父母间的 IPV 和母亲抑郁与青少年时期的抑郁在人群水平上有关。然而，仅根据有关 IPV 或母亲抑郁的信息来估计个体在青少年时期患抑郁症的可能性是很差的。对儿童进行母亲抑郁和 IPV 的筛查，以针对干预措施预防青少年抑郁，这将无法识别许多可能受益的儿童，并且可能不必要地针对许多不会发展为抑郁症的儿童。
