Mothers’ Stress Early in Life Found to Negatively Impact Their Children

A study in AJP in Advance provides further evidence that the detrimental effects of adverse life experiences can carry across generations. Researchers found that children of mothers who experienced stressful events during childhood had greater biological signs of stress and were more likely to have behavioral problems at 18 months.

“[O]ur data, when combined with findings from other studies, confirm maternal life-course experiences as a potent predictor of offspring mental and physical well-being,” wrote Kyle Esteves, M.P.H., of Tulane University School of Medicine and colleagues. “Our results suggest that screening for maternal ACEs [adverse childhood events] in obstetric, pediatric, and child mental health settings may provide an important indicator of risk for both the mother and the child, especially during infancy.”

Esteves and colleagues recruited 237 pregnant women for the study. During a prenatal assessment, study participants were asked to indicate the presence or absence of 10 types of childhood adversity, including abuse, parental mental illness, and divorce on the Adverse Childhood Experiences questionnaire. The women also completed anxiety, depression, and stress assessments during the prenatal assessment.

The mothers and their children returned for follow-up assessments when the children were 4, 12, and 18 months. At these visits, the researchers screened the mothers for postnatal depression and collected cheek swabs from the children for telomere analysis. Telomeres are the protective caps on the ends of chromosomes, and their length is considered a biomarker of biological stress and aging (shorter telomeres are associated with a broad range of age-related diseases). Child behavior was also assessed at the 18-month visit.

The final analysis included 155 mother-child pairs who completed at least two of the three assessments (103 pairs completed all three assessments). The results showed that higher scores on the Adverse Childhood Experiences questionnaire in mothers correlated with shorter telomeres in the children at all time points. Higher scores also correlated with more externalizing problems (for example, temper tantrums) in the children at 18 months, but not internalizing problems (for example, being quiet and withdrawn). Maternal depression also increased the risk of externalizing problems and internalizing problems; however, higher Adverse Childhood Experiences scores remained associated with shorter telomeres and more externalizing problems, even when accounting for maternal postnatal depression.

“Encouraging the widespread utilization of practical screening tools that have clinical utility and capture stressors across the life course and the broader environment in which children develop may enhance our ability to understand the origins of early mental illness and the effectiveness, rather than the efficacy, of current intervention and prevention efforts,” Esteves and colleagues noted. Additionally, such efforts could help identify ways to buffer the negative effects of maternal early adversity, they added.

For related information, see the Psychiatric News article “Researchers Tackle Complexity of Intergenerational Stress Transmission.”

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App Improves Mental Health Service Delivery to Pregnant Women With Symptoms of Depression

A smartphone application that tracks mood changes and alerts providers if symptoms worsen appears to improve service delivery and patient engagement among pregnant women with perinatal depression symptoms, according to a report in Psychiatric Services in Advance.  

The findings suggest such an app “is a feasible option to improve mental health service delivery via monitoring at-risk patients between visits,” wrote Liisa Hantsoo, Ph.D., and colleagues at the University of Pennsylvania Perleman School of Medicine. “[T]his app also facilitated patient-provider contact when needed rather than relying on the patient to decide to send an electronic message to her provider through a [patient portal].”

Hantsoo and colleagues recruited pregnant women (aged 18 and older; 32 weeks gestation or less) with depressive symptoms (≥5 on the Patient Health Questionnaire-9 [PHQ-9]) during a routine prenatal appointment at a clinic within an academic medical center serving a predominantly low-income and racial-ethnic minority population. To be included in this trial, the women had to own a smartphone with an iOS or Android operating system and speak English.

Seventy-two participants were randomly assigned to either a mobile app allowing access to a standard patient portal used for all patients at the health center that enabled email-like communication with providers (n=24) or to the patient portal with the addition of a mood tracking and alert (MTA) app (n=48). The MTA app alerted providers when participant mood symptoms worsened, prompting the provider to contact the participant. 

The researchers assisted the study participants with downloading the app(s), provided written materials explaining the apps, and administered a baseline interview, where care engagement and satisfaction were assessed. After eight weeks, care engagement and satisfaction were reassessed, and service delivery data on patient-provider contacts during the eight-week period were extracted from the electronic health record of each participant. Within the MTA group, depressive and anxiety symptoms were assessed after eight weeks.

Compared with the patient portal group, the MTA group had significantly more telephone encounters with providers that mentioned mental health. Within the MTA group, 17 women (41%) received a phone call from a provider that was triggered by an alert from the app. These women had a significantly higher rate of referral to a mental health provider compared with women who did not receive an MTA app–triggered contact. As gestational age increased, MTA users rated their ability to manage their own health significantly better than women in the control group.

The mean daily mood score was significantly positively correlated with the number of calls that a participant in the MTA group received in weeks 1 to 4. Participants who received an MTA-triggered call had consistently higher PHQ-9 and Generalized Anxiety Disorder (GAD-7) scores across the eight weeks compared with those who did not receive an MTA-triggered call. Among MTA users, PHQ-9, GAD-7, and self-reported daily mood scores significantly improved over eight weeks.

For related information, see the Psychiatric News PsychoPharm article, “FDA Clears First Prescription-Based ‘Digital Therapeutic’.”

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