Early comorbid parental depression and its effects on child outcomes

Background: Although depression can affect anyone at any time, the first year after the birth of a child appears to be a time when both parents are more likely to experience depression. Research has mainly focussed on maternal perinatal or early depression which has an estimated incidence of 10-15%. Less is known about early paternal depression or early comorbid depression, where both parents experience depression. Methods: I conduct a systematic review on the prevalence of early comorbid parental depression and associated childhood outcomes. Next, I explore adolescent depression recording in UK primary care, and trends over time. Finally, I use structural equation modelling to provide a quantitative analysis of the association between early comorbid parental depression and adolescent outcomes, focussing on the effects of recurrent parental depression and internalizing behaviours in childhood. I examine depression and its intergenerational transmission using data from a large UK primary care database, The Health Improvement Network (THIN). Results: Prevalence of early comorbid depression in parents ranged from 0 to 20%. However, it was not feasible to perform a meta-analysis due to measurement variation and study quality. I identified only two studies assessing child outcomes. Diagnoses of adolescent depression and antidepressant prescribing have increased in recent years despite a temporary drop in 2002-2005. Symptom recording increased steadily between 1995-2009. I did not find evidence for an association between early comorbid parental depression and adolescent depression (OR: 2.02, 95% CI: 0.42-9.67). Early maternal depression does increase the risk of adolescent depression. The effect is mainly indirect, mediated by recurrent parental depression (OR: 1.54, 95% CI: 1.26-1.87), as opposed to direct (OR: 1.06, 95% CI: 0.69-1.63). Childhood internalizing behaviour might be an early indicator of depression risk. Conclusion: Early parental depression increases the risk of adolescent depression, but the effect is strongly mediated by recurrent parental depression

Emergency admissions and long-term conditions during transition from paediatric to adult care: a cross-sectional study using Hospital Episode Statistics data

OBJECTIVE: To determine whether changes in emergency admission rates during transition from paediatric to adult hospital services differed in children and young people (CYP) with and without underlying long-term conditions (LTCs). DESIGN: Cross-sectional study. SETTING: Emergency admissions between 2009 and 2011 recorded in the Hospital Episode Statistics Admitted Patient Care data in England. PARTICIPANTS: 763 199 CYP aged 10-24 years with and without underlying LTCs (LTCs were defined using the International Classification of Diseases, 10th Revision codes recorded in the past 5 years). PRIMARY AND SECONDARY OUTCOME MEASURES: We calculated emergency admission rates before (10-15 years) and after transition (19-24 years), stratified by gender, LTC and primary diagnosis. We used negative binomial regression to estimate adjusted incidence rate ratios (IRRs). RESULTS: We included 1 109 978 emergency admissions, of which 63.2% were in children with LTCs. The emergency admission rate increased across the age of transition for all CYP, more so for those with LTCs (IRRLTC: 1.55, 99% CI 1.47 to 1.63), compared with those without (IRRnoLTC: 1.21, 99% CI 1.18 to 1.23). The rates increased most rapidly for CYP with mental health problems, MEDReG (metabolic, endocrine, digestive, renal, genitourinary) disorders, and multiple LTCs (both genders) and respiratory disorders (female only). Small or no increased rates were found for CYP without LTCs and for those with cancer or cardiovascular disease. Increases in length of stay were driven by long admissions (10+ days) for a minority (1%) of CYP with mental health problems and potentially psychosomatic symptoms. Non-specific symptoms related to abdominal pain (girls only), gastrointestinal and respiratory problems were the most frequent primary diagnoses. CONCLUSIONS: The increased rates and duration of emergency admissions and predominance of non-specific admission diagnoses during transition in CYP with underlying LTCs may reflect unmet physical or mental health needs