母亲围生期抑郁与4岁儿童行为问题关联队列研究

Association of perinatal depression with behavioral problems of children at 4 years of age:a cohort study

目的探讨母亲围生期不同时点抑郁状况与4岁儿童行为问题的关联。方法基于2012年在上海建立的闵行出生队列,本研究纳入653对母子对。采用流调用抑郁自评量表评估母亲孕中期、孕晚期、产后6个月和产后12个月时的抑郁状况,采用儿童行为量表评估4岁儿童行为问题的发生情况,运用log-binomial回归模型分析母亲抑郁与儿童行为问题的关联。结果母亲孕中期、孕晚期、产后6个月和产后12个月可疑抑郁症状检出率分别为19.71%(121/614)、10.45%(56/536)、8.65%(45/520)和4.65%(23/495)。调整协变量后,4个时点母亲抑郁均可增加儿童行为问题的发生风险,其中孕中期和产后12个月母亲抑郁效应更强。孕中期母亲抑郁与儿童情感反应、躯体主诉、攻击行为和内向性行为异常风险增加有关,RR(95%CI)分别为2.01(1.04~3.89)、2.29(1.20~4.34)、1.97(1.11~3.50)和1.67(1.09~2.55);产后12个月母亲抑郁与儿童焦虑/抑郁、注意问题、退缩、攻击行为、内向性行为和外向性行为异常风险增加有关,RR(95%CI)分别为3.27(1.36~7.89)、2.76(1.19~6.40)、2.77(1.30~5.90)、2.65(1.24~5.66)、2.64(1.48~4.71)和2.76(1.42~5.34)。母亲仅在孕期发生抑郁或仅在产后发生抑郁的结果与主分析中孕期抑郁和产后抑郁的结果类似。结论围生期不同时点母亲抑郁与4岁儿童行为问题发生风险增加有关,其中母亲孕中期和产后12个月抑郁与儿童行为异常的关联更强,且母亲孕期抑郁和产后抑郁在儿童神经行为发育的负面影响中均可发挥独立效应。

Objective To evaluate the association between perinatal depression at multiple time points and behavioral problems of children at 4 years old.Methods A total of 653 mother-child pairs were included in the study from the Shanghai-Minhang Birth Cohort Study established in 2012.Follow-up interviews were conducted among the mothers at third trimester,childbirth in hospitals and at 6 and 12 months postpartum,4 years of age of child at homes.Center for Epidemiological Studies-Depression scale was used to assess the depression of the mothers.Behavioral problems of children at 4 years were assessed with the Child Behavior Checklist scale.Log-binomial regression model was adopted to examine the association between perinatal depression and children′s behavioral problems.Results The detection rates of depressive symptoms among the mothers were 19.71%(121/614),10.45%(56/536),8.65%(45/520),and 4.65%(23/495)at the second and third trimester,6 and 12 months postpartum,respectively.After adjusting for covariates,maternal depression symptoms at the four time points were associated with an increased risk of children′s behavioral problems,and the effects of maternal depression symptom in the second trimester and 12 months postpartum were stronger.Maternal depression in the second trimester was associated with children′s emotional reaction,somatic,aggressive behavior,and internal behavior abnormalities,with the relative risk(RR)(95%confidence interval[95%CI])of 2.01(1.04-3.89),2.29(1.20-4.34),1.97(1.11-3.50),and 1.67(1.09-2.55),respectively.Besides,maternal depression at 12 months postpartum increased the risk of children′s anxiety/depression(RR,95%CI:3.27,1.36-7.89),attention problems(2.76,1.19-6.40),withdrawn(2.77,1.30-5.90),aggressive behavior(2.65,1.24-5.66),internal behavior disorders(2.64,1.48-4.71),and external behavior disorders(2.76,1.42-5.34).Similar to the results mentioned above,the maternal depression occurring only during pregnancy or only after childbirth was also associated with behavioral problems of the children.Conclusion Perinatal depression at multiple time points is associated with the increased risk of behavioral problems of children at 4 years of age and the effects of maternal depression in the second trimester and 12 months postpartum are stronger.In addition,maternal depression during pregnancy and postpartum both play independent adverse role on children′s neurobehavioral development.