Association between maternal depression symptoms across the first eleven years of their child’s life and subsequent offspring suicidal ideation

Depression is common, especially in women of child-bearing age; prevalence estimates for this group range from 8% to 12%, and there is robust evidence that maternal depression is associated with mental health problems in offspring. Suicidal behaviour is a growing concern amongst young people and those exposed to maternal depression are likely to be especially at high risk. The aim of this study was to utilise a large, prospective population cohort to examine the relationship between depression symptom trajectories in mothers over the first eleven years of their child’s life and subsequent adolescent suicidal ideation. An additional aim was to test if associations were explained by maternal suicide attempt and offspring depressive disorder. Data were utilised from a population-based birth cohort: the Avon Longitudinal Study of Parents and Children. Maternal depression symptoms were assessed repeatedly from pregnancy to child age 11 years. Offspring suicidal ideation was assessed at age 16 years. Using multiple imputation, data for 10,559 families were analysed. Using latent class growth analysis, five distinct classes of maternal depression symptoms were identified (minimal, mild, increasing, sub-threshold, chronic-severe). The prevalence of past-year suicidal ideation at age 16 years was 15% (95% CI: 14-17%). Compared to offspring of mothers with minimal symptoms, the greatest risk of suicidal ideation was found for offspring of mothers with chronic-severe symptoms [OR 3.04 (95% CI 2.19,4.21)], with evidence for smaller increases in risk of suicidal ideation in offspring of mothers with sub-threshold, increasing and mild symptoms. These associations were not fully accounted for by maternal suicide attempt or offspring depression diagnosis. Twenty-six percent of non-depressed offspring of mothers with chronic-severe depression symptoms reported suicidal ideation. Risk for suicidal ideation should be considered in young people whose mothers have a history of sustained high levels of depression symptoms, even when the offspring themselves do not have a depression diagnosis

Linear growth trajectories in Zimbabwean infants

Wellcome Trust (108065/Z/15/Z)

Dynamic Treatment Regimes

In recent years, treatment and intervention scientists increasingly realize that individual heterogeneity in disorder severity, background characteristics and co-occurring problems translates into heterogeneity in response to various aspects of any treatment program. Accordingly, research in this area is shifting from the traditional “one-size-fits-all ” treatment to dynamic treatment regimes, which allow greater individualization in programming over time. A dynamic treatment regime is a sequence of decision rules that specify how the dosage and/or type of treatment should be adjusted through time in response to an individual’s changing needs, aiming to optimize the effectiveness of the program. In the chapter we review the Sequential Multiple Assignment Randomized Trials (SMART), which is an experimental design useful for the development of dynamic treatment regimes. We compare the SMART approach with other experimental approaches and discuss data analyses methods for constructing a high quality dynamic treatment regime as well as other secondary analyses. 1