Mother–infant interaction in schizophrenia:Transmitting risk or resilience? A systematic review of the literature

Purpose: The parent–infant relationship is an important context for identifying very early risk and resilience factors and targets for the development of preventative interventions. The aim of this study was to systematically review studies investigating the early caregiver–infant relationship and attachment in offspring of parents with schizophrenia. Methods: We searched computerized databases for relevant articles investigating the relationship between early caregiver–infant relationship and outcomes for offspring of a caregiver with a diagnosis of schizophrenia. Studies were assessed for risk of bias. Results: We identified 27 studies derived from 10 cohorts, comprising 208 women diagnosed with schizophrenia, 71 with other psychoses, 203 women with depression, 59 women with mania/bipolar disorder, 40 with personality disorder, 8 with unspecified mental disorders and 119 non-psychiatric controls. There was some evidence to support disturbances in maternal behaviour amongst those with a diagnosis of schizophrenia and there was more limited evidence of disturbances in infant behaviour and mutuality of interaction. Conclusions: Further research should investigate both sources of resilience and risk in the development of offspring of parents with a diagnosis of schizophrenia and psychosis. Given the lack of specificity observed in this review, these studies should also include maternal affective disorders including depressive and bipolar disorders

Individual participant data meta-analysis to compare EPDS accuracy to detect major depression with and without the self-harm item

Item 10 of the Edinburgh Postnatal Depression Scale (EPDS) is intended to assess thoughts of intentional self-harm but may also elicit concerns about accidental self-harm. It does not specifically address suicide ideation but, nonetheless, is sometimes used as an indicator of suicidality. The 9-item version of the EPDS (EPDS-9), which omits item 10, is sometimes used in research due to concern about positive endorsements of item 10 and necessary follow-up. We assessed the equivalence of total score correlations and screening accuracy to detect major depression using the EPDS-9 versus full EPDS among pregnant and postpartum women. We searched Medline, Medline In-Process and Other Non-Indexed Citations, PsycINFO, and Web of Science from database inception to October 3, 2018 for studies that administered the EPDS and conducted diagnostic classification for major depression based on a validated semi-structured or fully structured interview among women aged 18 or older during pregnancy or within 12 months of giving birth. We conducted an individual participant data meta-analysis. We calculated Pearson correlations with 95% prediction interval (PI) between EPDS-9 and full EPDS total scores using a random effects model. Bivariate random-effects models were fitted to assess screening accuracy. Equivalence tests were done by comparing the confidence intervals (CIs) around the pooled sensitivity and specificity differences to the equivalence margin of δ = 0.05. Individual participant data were obtained from 41 eligible studies (10,906 participants, 1407 major depression cases). The correlation between EPDS-9 and full EPDS scores was 0.998 (95% PI 0.991, 0.999). For sensitivity, the EPDS-9 and full EPDS were equivalent for cut-offs 7–12 (difference range − 0.02, 0.01) and the equivalence was indeterminate for cut-offs 13–15 (all differences − 0.04). For specificity, the EPDS-9 and full EPDS were equivalent for all cut-offs (difference range 0.00, 0.01). The EPDS-9 performs similarly to the full EPDS and can be used when there are concerns about the implications of administering EPDS item 10. Trial registration: The original IPDMA was registered in PROSPERO (CRD42015024785)

Perinatal depression in adolescent mothers: for identifying vulnerabilities

Introduction and objectives Due to the high frequency and co-occurrence of vulnerabilities, mothers under 20 years are at higher risk of perinatal depression than adults mothers. We performed a review of the literature investigating the epidemiology of adolescents mothers’ depression, compared these data to adult mothers and listed associated factors, to develop a more preventive approach and specific follow-up. Methods The review is based on Pubmed and Sciencedirect research combining “adolescent” or “teenage” and “depression” as keywords. Results Seventeen international studies were included, evaluating both prenatal (6 studies) and postnatal (14 studies) depression with three different scales (CES-D, BDI, EPDS). Depression rate in adolescents mothers varies from 26 to 63% in the third trimester of pregnancy and from 26 to 61% in the first 3 months postpartum, with differences depending of studies designs, screening instruments and cut-offs. Depression rate declines with time, but still persists with a prevalence ranging from 21 to 32% at 4 to 5 years after delivery. Depression rate in adolescent mothers are globally twice higher than in adult mothers, both in prenatal and postnatal periods. Characteristics associated with adolescent mothers depression include sociodemographic factors (less education, low income), psychosocial factors (confidence, self-esteem), poor or inadequate social support and negative life events (violence exposure, history of abuse). Conclusion Perinatal depression in adolescent mothers is very high and can contribute negatively to child-mother interaction. It should be a priority to screen depression early during pregnancy and to offer appropriate support services during the first years of motherhood. Moreover, it could be of high interest to assess maternofoetal attachment during pregnancy using validated instruments combined with depression scales.Introduction Comparativement aux mères plus âgées, les mères de moins de 20 ans cumulent certains facteurs de vulnérabilité les exposant à un risque accru de dépression. Méthodes À travers une revue de la littérature, cet article fait le point sur la prévalence de la dépression chez les mères adolescentes et compare ces données à celles des mères plus âgées. Résultats La prévalence de la dépression chez les mères adolescentes varie de 26 à 68 % au troisième trimestre de la grossesse et de 26 à 61 % dans les trois mois du post-partum, selon les études, les instruments d’évaluation et les cut-offs associés. Les taux de dépression à quatre et cinq ans varient de 21 à 32 %. Globalement, les taux de dépression chez les mères adolescentes sont deux fois plus élevés que chez les mères plus âgées. Les caractéristiques associées à la dépression des mères adolescentes incluent des facteurs sociodémographiques et psychosociaux, un soutien social faible ou inadéquat et des événements de vie négatifs. Conclusion La dépression périnatale chez les mères adolescentes est très élevée et peut contribuer négativement aux interactions mère-enfant. Il est impératif de pouvoir détecter les situations de vulnérabilité chez les jeunes mères afin d’organiser une réponse préventive et un suivi spécifiques. -------------------------------------------------------------------------------