Journal Article Annotations
2018, 2nd Quarter
Annotation by Priya Gopalan, MD
Type of study: Observational cohort study
The finding: This is a prospective, longitudinal observational study of women in the UK with postpartum depression, measured across multiple time points (2 months and 8 months postpartum) with evaluation of both depressive symptoms in mother and behavioural symptoms in children until the child was 18 years old. The study found that women’s mean Edinburgh Postnatal Depression Scale (EPDS) scores stayed stable over time. Children of women with persistent PND were at higher risk of behavioural problems at 3.5 years: moderate severity OR, 3.04; 95%CI, 2.10-4.38 and marked severity (OR, 2.84; 95%CI, 1.71-4.71) when compared to children of women with PND that was not persistent at any level of severity. Whether persistent or not, the presence of postpartum depression doubled the risk of child behavior disturbance. Persistent depression had the most significant adverse outcomes for children including at age 16 and 18. Persistent and severe postpartum depression substantially raised the risk for adverse outcome on all child measures used in the study.
Strength and weaknesses: Strengths of the study included the large sample size for postnatal depression overall and the longitudinal, long-term follow-up. A postpartum depression study of this length is unusual. Another big strength of the study is that there was stratification of depression severity and persistence. The primary weakness is the relatively small sample size in the group of women with persistent and severe postpartum depression, owing in part to high attrition rates. Controls were kept to a minimum (maternal education only).
Relevance: C-L psychiatrists seeing pregnant and postpartum patients in either inpatient or outpatient settings should be aware of the elevated risks associated with persistent postpartum depression. As EPDS scores remained stable across time and as severe and persistent depression caused adverse childhood outcomes across childhood and adolescence, these risks should be weighed against risks of medications and presented to pregnant and postpartum patients as a risk of untreated illness. This adds to the growing body of literature that suggests that untreated depression in the perinatal period has significant implications on the wellbeing of the baby, and in this case, has long-term implications.