06 October 2009

Depressed mom, child abuse linked

In families with a history of child abuse, a mother's depression may increase the risk that she will act aggressively toward her child, a new study suggests.


In families with a history of child abuse, a mother's depression may increase the risk that she will act aggressively toward her child, a new study suggests.

The study, which followed 5 500 US families investigated by child- welfare agencies, found that when a mother developed depression, the odds of her child suffering "psychologically aggressive acts" -- including threats or name-calling -- increased.

The findings do not prove that mothers' depression, per se, led to the children's abuse, the researchers report in the Archives of Paediatrics and Adolescent Medicine.

However, they write, the study does support general recommendations that adults be screened by their doctors for both depression and spousal or partner abuse -- which is also linked to increased odds of child abuse.

How the study was done
For the study, Dr Kerith J. Conron and colleagues at the Harvard School of Public Health used data from a national survey of 5 500 families who had been involved in child abuse investigations.

Mothers completed a standard measure of depression symptoms at the outset, and again 18 months and three years later. They were also asked about any instances in which their child was abused over the past year -- including physical abuse, neglect and psychological aggression.

The researchers found that when mothers developed depression over the course of the study, incidents of threats, name-calling and other forms of psychological aggression against their children also increased -- by an average of two extra incidents per year.

Roughly one-quarter of the mothers were deemed to have major depression at each of the three surveys. One-third of the women overall either a remission or onset of depression during the study period.

Supportive partner, less child abuse risk
In other findings, mothers who reported an increase in abuse from a partner were also more likely to report an increase in physical abuse and neglect of their children.

In contrast, mothers who moved in with a non-abusive partner during the study generally reported a decrease in psychologically aggressive behaviour toward their children.

It's possible, according to Conron's team, that having a supportive partner lessened some mothers' strain and, in turn, lowered the likelihood of child abuse.

It is not clear from the study data whether mothers' depression typically preceded the increases in aggressive behaviour toward their children.

However, the researchers write, the findings still support recommendations from several medical groups that doctors routinely screen adults for both depression and intimate-partner violence.

Right now, the researchers note, there are no screening tests for parents that reliably catch cases of child abuse.

Antidepressants lead to preterm delivery
And if depressed mothers weren’t feeling bad enough, another study has shown that women who take antidepressants during pregnancy risk preterm birth.

The study showed that women who took antidepressants during pregnancy has shown that they had twice the risk of pre-term delivery as other women, and their babies were more likely to be admitted to an intensive care unit than those of women who did not take the drugs, researchers reported.

They said antidepressants, known as selective serotonin reuptake inhibitors or SSRIs, which affect a message-carrying brain chemical called serotonin, may raise the risk of pre-term delivery and affect a baby's health at birth.

Some prior studies have found that drugs in this class can cross the placenta and appear in the umbilical cord blood of babies whose mothers have taken them.

"The study justifies increased awareness to the possible effects of intrauterine exposure to antidepressants," Dr Najaaraq Lund of the Bandim Health Project in Guinea-Bissau, and colleagues wrote in the Archives of Paediatrics and Adolescent Medicine.

About one in 10 pregnant women experience depression during pregnancy. Because depression can jeopardise a pregnant woman's health, doctors often prescribe antidepressants, but it is not yet clear how these drugs affect a baby's health.

How the study was done
To study this, Lund and colleagues analysed data on 57 000 pregnancies and deliveries at Aarhus University Hospital in Skejby, Denmark, between 1989 to 2006.

They identified 329 pregnancies in which the mothers took an SSRI medication, another 4 902 with a history of psychiatric illness not treated with an antidepressant, and 51 700 with no history of psychiatric illness.

Women who took antidepressants while pregnant delivered their babies five days earlier than other women in the study, and had twice the risk of pre-term delivery than women with no history of psychiatric illness.

Babies exposed to antidepressants during pregnancy were far more likely than those in the other two groups to have a five-minute Apgar score -- a measure of a newborn's health -- of seven or below. Seven is typically an indicator of a healthy baby.

They were also more likely to be admitted to the neonatal intensive care unit, and some of these babies showed signs of withdrawal, such as jitters, seizures, respiratory problems, infections and jaundice.

The team found no differences in the babies' head size or birth weight among the three groups.

Antidepressants used by women in the study included Pfizer Inc's Zoloft, known generically as sertraline; Forest Laboratories Inc's Celexa, or citalopram, and Lexapro, or escitalopram; Eli Lilly and Co's Prozac or fluoxetine; and GlaxoSmithKline's Paxil or paroxetine.

Although treating depression might be warranted, the team said more studies are needed to see if some drugs in the class pose less risk than others.

Babies born to abused moms more likely to get sick
Another study has shown that infants born to mothers who report family violence suffer more bouts of diarrhea and infections of the airways such as pneumonia, which are the two leading causes of death and illness among children in the developing world.

Studies have already linked violence against women to a higher risk of death among their children, Dr Kajsa Asling-Monemi of Uppsala University in Sweden and her colleagues note in the Archives of Paediatrics and Adolescent Medicine, but less is known about how family violence might affect children's risk of getting sick.

The findings are more evidence that violence against women can have an effect on their children, particularly in poverty-stricken areas where infant mortality is already high, the authors conclude based on their new study from Bangladesh.

To investigate, the researchers followed 3 132 babies whose mothers were participating in a study of nutrition during pregnancy. Half of the women said they had experienced family violence in their lifetimes, and just 11% percent of the babies remained free of diarrheal or lung infections during 12 months of follow-up.

Overall, the babies whose mothers reported family violence were 20% more likely to develop diarrhea, and 31% more likely to develop infections of their lungs and lower airways. Any sort of family violence against mothers-from controlling behavior to emotional violence to physical or sexual violence-independently boosted the risk that babies would get sick with either condition.

Female babies affected more
The relationship between violence and illness was stronger for female babies, and in situations where the violence was more severe.

The babies of abused mothers weighed less at birth, and might have been more likely to be undernourished as well, but these factors would only explain part of the association between family violence and infant illness, the researchers say. – (Reuters Health, October 2009)

Read more:
Drug, alcohol in crimes against children
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