Maternal depression is thought to be a risk factor for children’s socioemotional and cognitive development (1). The current prevalence of depression in Canada is 6%, which is comparable to other Western nations (2). (the female-to-male ratio average is 2:1 ). However, postpartum depression affects roughly 13% of women (4). Women of reproductive age are more vulnerable to depression, and many of them have significant levels of social morbidity and depressive symptoms that go unnoticed and untreated. Mothers who are predisposed to depression are especially vulnerable during the first few months after giving birth. Maternal depression has an impact on the development of the kid. Because doctors who care for newborns and children often meet moms, they must have the knowledge and abilities to diagnose indications of maternal depression.
This statement’s goals are as follows:
The MEDLINE database and the bibliographies of the retrieved papers were used to perform a 15-year literature search. Prospective longitudinal cohort studies, in which mothers were recruited throughout their pregnancy or postpartum period and children were tested at regular intervals, were of special interest.
There are three types of postpartum psychiatric disorders: postpartum blues, postpartum psychosis, and postpartum depression. Postpartum blues is a fairly common emotional disturbance characterized by crying, confusion, mood lability, anxiety, and depression. The symptoms appear during the first week after giving birth, last a few hours to a few days, and have a few negative consequences. Postpartum psychosis, on the other hand, is a severe disorder that begins within four weeks of childbirth and causes delusions, hallucinations, and gross impairment in functioning. Postpartum depression occurs during or after the postpartum period and is distinguished by dysphoric mood, fatigue, anorexia, sleep disturbances, anxiety, excessive guilt, and suicidal thoughts (5). The symptoms must be present for at least one month and cause some impairment in the woman’s functioning for the diagnosis to be made (6). Women who have had postpartum depression are 50% to 62% more likely to suffer another depression (7). A history of mood problems, depressive symptoms during pregnancy, and a family history of mental illnesses are all risk factors for postpartum depression (4). Some studies have shown a link between postpartum depression and stressors such as bad life experiences, poor marital relationships, having a special needs or medically ‘fragile’ baby, a lack of social support, drug misuse, and personal and family psychopathology (6). Postpartum depression is typically milder than other types of depression, with lower levels of anxiety, agitation, insomnia, and somatic symptoms (8). However, the duration of postpartum and nonpostpartum depression appears to be the same, lasting several months (6).
The effects of maternal postpartum depression on the child are not limited to infancy but can extend into toddlerhood, preschool, and even school age. Maternal depression that develops later has an impact on the development of the school-age child and adolescent. From prenatal issues to adolescence, Table 1 summarizes the consequences of maternal depression.
The Effects of Maternal Depression
The relationships between maternal depression, maternal behavior, and child outcomes are complicated, and not all studies have discovered a link between maternal depression and indicators of poor parenting. Variations in the type, severity, chronicity, and timing of maternal depression (9), sampling heterogeneity (community versus high-risk multiproblem samples), and potentiating risk factors such as family adversity, low social support, and financial stress (10), all contribute to differences in outcomes in children. In the absence of maternal depression, stress factors may be responsible for bad child outcomes.
INFANT DEVELOPMENT AND MATERNAL DEPRESSION
Infants engage in interactive routines with their mothers daily. Maternal depression impairs the dyad’s ability to regulate its interaction through one of two interactive patterns: intrusiveness or withdrawal. Intrusive mothers have a hostile demeanor and disrupt the infant’s activities. The infants become angry, turn away from the mother to limit her intrusion, and internalize an angry and protective coping style. Withdrawn women are disengaged, apathetic, and affectively flat, and they contribute nothing to the infant’s activities. Because the newborns are unable to cope or self-regulate in this negative condition, they develop apathy, withdrawal, and self-regulatory behaviors (for example, gazing away or sucking on their thumb) (11,12).
Infants born to postnatally depressed moms have been shown to have dysregulated attention and arousal patterns. Murray (13), for example, found that cognitive performance regarding the independent existence of objects was worse in newborns of 61 postnatally depressed mothers than in infants of 42 non-depressed mothers, even after controlling for contextual adversity. Depressed moms are less likely to provide contingent stimulation to their babies (14), which interferes with their performance on nonsocial learning tasks (15). Another factor that may impede learning is the negative effect displayed by infants of depressed mothers, even when they interact with nondepressed adults (16). It has been established that an infant’s negative affect interferes with learning and information processing (17).
MATERNAL DEPRESSION AND THE DEVELOPMENT OF TODDLER AND PRESCHOOLERS
Depressed mothers are less attentive and responsive to their children’s needs. They are also poor role models for dealing with negative emotions and problem-solving Longitudinal studies have compared the behaviors and outcomes of depressed and nondepressed mothers and their children. They discovered that depressed mothers were less likely to set limits for their children and ttick to them if they did (18). Children of depressed mothers appeared more passively nnon-compliant with less mature expressions of age-appropriate autonomy (19). (19). Their dysphoric mothers rated them as more vulnerable, with more internalizing (depressed) and externalizing (aggressive and destructive) issues, which are associated with lower interaction ratings (20). They were also more likely than control children to react adversely to pleasant advances, to participate in low-level physical play, and to engage in independent creative play (21). Even when unfavorable events such as marital conflict and demographic characteristics such as mmaternalage, ethnicity, socioeconomic level, marital status, child’s age, and na umber of siblings were taken into consideration, these elements of child behavior were connected with postnatal depression.
Large-sample studies all concur that parental postpartum depression has a deleterious influence on a child’s cognitive development. Early exposure to insensitive parental relationships (as in maternal postpartum depression) tends to predict lower cognitive performance later in life (22). Boys may be more susceptible to the impacts of their mother’s sickness than girls. Only boys showed a decrease on standardized tests of intellectual attainment (primarily on indexes of abstract intelligence, reasoning about opposites and analogies) and the “draw-a-child” task in a study by Sharp et al (23). Other aspects of cognitive development, such as cognitive-linguistic functioning (24), were also found to be impaired, as were deficits on the perceptual and performance scales (25). Birth order, maternal education, family income, marital status, and social support did not affect outcome.
MATERNAL DEPRESSION AND THE DEVELOPMENT OF SCHOOL-AGE CHILDREN
Several studies have found that children of depressed mothers have impaired adaptive functioning, including internalizing and externalizing issues. Although the studies reviewed by Beardslee et al (26) were uncontrolled, a more recent review by Downey and Coyne (27) included studies that used control groups (matched for parental age, occupational status, ethnicity, marital status, and number and age of children), standardized diagnostic criteria to identify parental depression, and valid measures of psychological functioning in children. Billings and Moos (28) sshowedthat family stress and insufficient support contributed to the prediction of child disruption in addition to having a depressive parent. However, aesearch by Lee and Gotlib (29) comparing children of depressed psychiatric mothers and nondepressed psychiatric mothers found that the level of maternal psychopathology was more significantly associated twiththe child’s adjustment than to diagnostic status.
Children with sad parents are also more likely to develop psychopathology, such as affective (primarily depression), anxiety, and behavioral problems. Hammen et al (30) compared children from four groups of mothers with no differences in ethnicity, age, socioeconomic status, or educational level (mothers with unipolar disorder, bipolar disorder and chronic medical illness, and normal mothers). They discovered that, even when the effects of chronic stress were statistically controlled, there were still differences in psychosocial outcome variables between groups, with children of unipolar mothers suffering the most (30). Other research (31-34) have demonstrated an elevated risk of psychopathology in offspring of depressive parents despite no demographic differences (age, marital status, or socioeconomic level) between depressed and nondepressed parents. It seems that the development of a severe depressive illness in parents before the age of 30 increases the likelihood of their children having depression throughout childhood (33,34). It is difficult to distinguish between behavioral abnormalities caused by maternal sadness and other environmental circumstances and those caused by genetic predisposition.
According to a cross-sectional study by Lesesne et al., there appears to be a link between attention deficit/hyperactivity disorder (ADHD) in children and maternal mental health (35). Using the 1998 National Health Interview Study, they discovered a link between activity-limiting depression, anxiety, or emotional problems in mothers and ADHD in their children aged four to 17 years, even after controlling for the child’s age, gender, race, household income, and family structure (35).
Lower IQ scores, attentional problems, difficulties with mathematical reasoning, and special educational needs were significantly more common in children whose mothers were depressed at three months postpartum than in controls, according to Hay et al (36). Furthermore, boys were more affected than girls. Academic difficulties in children of depressed mothers, on the other hand, were not mediated by parental intelligence, sociodemographic variables, or the mother’s mental health following the postpartum depressive episode.
ADOLESCENT DEVELOPMENTAL OUTCOME AND MATERNAL DEPRESSION
In general, adolescence is a vulnerable period for affective illness and major depressive disorder, which affect girls twice as much as boys (37). Two cross-sectional studies found that adolescents with a depressed parent had more psychosocial maladjustment and a higher rate of affective disorder than adolescents with nonaffective psychiatric control parents (39).
Longitudinal studies have consistently found that adolescents with an affectively ill parent have higher rates of major depression and other psychopathology (anxiety disorders, conduct disorders, and substance abuse disorders) than control families with similar demographic characteristics (age, ethnicity, socioeconomic status and educational level). Over a three-year period, Hammen et al (40) followed 92 children/adolescents ranging in age from eight to sixteen years. They discovered that children/adolescents with unipolar depression had higher rates of affective disorders, with frequent multiple diagnoses, whereas children/adolescents with bipolar depression had less severe disorders. Over a 10-year period, Weissman et al (31,41,42) studied 91 households with 220 children aged six to 23. They discovered that the kids of depressive parents had greater rates of serious depression, phobias, panic disorder, and alcohol dependency than the non-ill comparison group. When major depression struck, it usually struck between the ages of 15 and 20. Beardslee et al (43) evaluated 81 families from a health maintenance organization’s metropolitan center, with 153 children ranging in age from six to 19 years. At the time of the first evaluation, 30% of children/adolescents with an affectively unwell parent experienced at least one episode of an affective illness, compared to 2% in the control group. After four years, the rates of affective disorders were 26% and 10%, respectively, and children of affectively ill parents had longer episodes, earlier onset, and a higher number of comorbid diagnoses (44).
School-age children’s problems, primarily ADHD and learning disabilities, persist into adolescence (35).
FACTORS OF RISK, VULNERABILITY, AND RESILIENCE
Many studies have found that some children with depressed caregivers do not exhibit behavioral dysfunctions, and that certain factors may exacerbate or moderate the effects of parental depression (45).
Factors in the context
Marital conflict (27), stressful life events (6), limited social support (6), poverty (46), lower social class (13) and lower maternal education (47) are all contextual risk factors that can exacerbate parental depression and maladaptive parenting. Cicchetti et al (48) discovered that contextual risk factors mediated the relationship between maternal depression and child behavior problems in a study of 156 toddlers (104 of whom had mothers with major depressive disorder since the child’s birth).
The role of fathers and paternal distress in child development are understudied, meanwhile, primary emphasis continues to be placed on mothers, possibly because the main caregiver for the young infant is usually the mother. However, in their study of three- to six-month-old infants, Hossain et al (49) showed that infants of depressed mothers interacted better with their nondepressed fathers who could ‘buffer’ the effects of the mother’s depression on infant interaction behaviour. In addition, a cross-sectional study (50) of 96 families with children between the ages of five and 10 years showed that in families in which the mother was depressed, children showed lower social and emotional competence if the father also had a psychiatric disorder. The role of fathers has been studied indirectly in the context of marital discord. According to a review by Downey and Coyne (27), marital distress contributes directly to children externalizing problems, and increases their risk for clinical depression by inducing and maintaining parental depression.