Perinatal Depression Linked to Offspring Psychosis at 18 Years

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Perinatal depression in mothers is associated with a greater risk of their offspring reporting psychotic experiences by 18 years old.

The study, believed to be the first to associate maternal perinatal depressive symptoms and adult offspring psychosis, indicates common development mechanisms might be driving genetic psychiatric risk—and stresses the need for increased mental health monitoring of pregnant and postnatal women.

A team of UK-based investigators, led by Ramya Srinivasan, BMBCh, of the University College London, conducted a longitudinal study of data from the Avon Longitudinal Study of Parents and Children (ASPLAC), a 14,541-participant birth cohort of pregnant women with an estimated delivery date between April 1991 and December 1992.

In the ASPLAC study, investigators had measured depression through the Edinburgh Postnatal Depression Scale (EPDS). Srinivasan and colleagues gauged observed participants’ offspring for psychotic experiences at 18 years with the Psychosis-Like Symptom Interview. They used logistic regression to assess the link between maternal depression—both antenatal and postnatal—and early adult offspring psychotic experiences.

The team’s assessment included 3067 offspring for whom data were available for both themselves and maternal perinatal depression.

Maternal perinatal depression has been previously linked to adverse effect on social, emotional, and cognitive function in children.

Psychotic experiences, investigators noted, are a critical metric because of their representation of the milder end of the psychosis continuum and thereby psychotic disorders. The experiences are also associated with more severe representations of depression and anxiety.

Maternal antenatal depressive symptoms were associated with an unadjusted 38% increased risk of offspring adult psychotic experiences (uOR, 1.38; 95% CI, 1.18-1.61; P = .0001), and a 26% increased risk when adjusted for confounders (OR, 1.26; 95% CI, 1.06-1.49; P = .0074).

Both offspring depression (OR 1.18; 95% CI, 1.03-1.34; P = .016) and psychotic experiences (OR, 1.32; 95% CI, 1.16-1.51; P <.0001) at 18 years were associated with maternal antenatal depressive symptoms, per five-point increase in EPDS scores. That said, investigators found no evidence of differing strength in either’s association with maternal antenatal depression.

Srinivasan and colleagues did not find a significant association between paternal antenatal and postnatal depression and offspring psychotic experiences at 18 years. As they noted, maternal depression during pregnancy has been previously linked to pregnancy and delivery complications—which has been linked to increased psychotic experience risk at 12 years old in this cohort.

“Maternal antenatal depression might also interfere with maternal postnatal bonding with the infant as well as with maternal representations of the unborn child that are associated with mother—infant interactions in the early postnatal period,” they wrote.

Even postnatal depression, investigators noted, could influence offspring environmental factors including parenting and wider social engagement—at a time during the infancy stage where the offspring has extreme dependency on the caregiver while rapidly developing.

The team concluded their continued assessment of the ASPLAC cohort showed mothers who suffer from perinatal-period depression are more likely to have children with adolescent psychotic experiences.

It suggests that common developmental mechanisms might underlie the risk of many psychiatric disorders and adds weight to the importance of identifying and treating maternal mental health problems during pregnancy and the postnatal period, especially in view of evidence that they might be increasing in the current generation of young women,” they wrote.

The study, “Maternal perinatal depressive symptoms and offspring psychotic experiences at 18 years of age: a longitudinal study,” was published online in The Lancet Psychiatry.