Long term effects of a perinatal depression intervention on child development outcomes
Ameliorating the impact of maternal depression on child development is a significant public health priority. Short term evidence from trials of perinatal depression treatment suggests that treatment of depression may have beneficial effects on child development. However, longer term studies are lacking and it remains unknown whether the observed improvements in child developmental outcomes immediately post intervention represent a shift in the developmental trajectory or a temporary improvement. We present results from a 7 year follow-up of the Thinking Healthy Programme (THP), one of the first very successful community based perinatal depression Randomized Controlled Trial (RCT) delivered by lay health workers to show meaningful improvements in depression in a low resource setting (Pakistan).
METHODS:
The original clustered RCT began in the third trimester in pregnancy and lasted through 10 months post-partum in 2005-2006. In 2013, the mother-child dyads in the original control and experimental arm clusters were re-enrolled and interviewed (LTFU=15%). We also interviewed a random sample of children whose mothers screened out of the original intervention because they were not depressed. Outcomes of interest include cognitive, socio-emotional and physical development outcomes. An intention-to-treat random effects modelling strategy was used as the main method of analysis.
RESULTS:
Preliminary results (N=738) indicate a lack of meaningful differences in cognitive, socio-emotional or physical developmental outcomes between children born to mothers in the control and intervention arms. Differences between children of non-depressed mothers at the time of screening for the RCT and those of mothers who participated in the RCT were more robust, with children of depressed mothers having consistently worse developmental outcomes.
CONCLUSIONS:
A single intervention in the perinatal period is not sufficient to meaningfully improve the compromised developmental trajectory of children exposed to maternal depression.