Maternal depression and anxiety disorders and child mental health outcomes

Problems relating to Maternal Depression and Anxiety Disorders (MDAD) are common and are known to affect child health and development. In the UK, the cost of perinatal mental health problems has been estimated at £8.1 billion for each birth cohort of children, and 72 percent of this cost is related to the direct impact on the children.

The overarching aim of our proposed research is to examine the effect of MDAD on child health outcomes, with a special focus on the role that MDAD plays in the development of child depression and anxiety disorders (CDAD) in adolescence. In particular, this research will provide robust empirical evidence to understand how depression and anxiety disorders are transmitted from one generation to the next and to help design interventions aimed at reducing the negative consequences of poor maternal mental health for children.

To achieve this aim, we will address the following research questions:

1) Are the negative effects of MDAD on children exclusively explained by genetic transmission and family background characteristics? Or are these negative effects also explained by changes in the child's home environment?
If the transmission of mental and anxiety disorders is explained exclusively by genetic traits and family background characteristics, then interventions targeted at reducing the negative effect of MDAD on maternal behaviour, e.g. through cognitive behavioural therapy, would be ineffective. On the contrary, evidence on significant effects of MDAD after controlling for genetic and family background characteristics would suggest that MDAD can lead to changes in the child home environment, e.g. changes in maternal behaviour, harsher parenting style and lower time investments in the child, with negative consequences on children.

2) Do school policies and health practices have a role in attenuating the negative effect of maternal depression on children?
We will answer this research question by focusing on whether starting school earlier harms or protects children who are exposed to MDAD, and on whether an early diagnosis of maternal depression can attenuate the negative effects suffered by children.

We will develop and use state-of-the-art estimation methods in combination with a novel administrative dataset covering general practices and hospitals created by merging two population-based health databases from England - namely QResearch and Hospital Episode Statistics. Using this merged database, we will create a longitudinal household dataset that will allow us to study the mental health of mothers and their children at different stages of the children's lives up to adolescence.

We are a multi-disciplinary team from the Universities of Oxford and York, consisting of experts in applied econometric methods, child and maternal mental health, psychology, general practice, and on the data that we plan to utilise.

We will translate our research findings into advice for policy-makers to help them design new interventions aimed at achieving better outcomes for patients suffering from maternal mental health issues and their children. Our research will also have an impact on health practitioners, psychologists, academics and charities working with mothers and children. We will produce papers aimed at academics as well as non-technical outputs to engage with policy-makers and a non-academic audience. Furthermore, by sharing and explaining our data and estimation methods to academics, we will build capacity for further research based on large health datasets.

The final central element of the project will be to build the capacity of early career researchers to undertake and lead large interdisciplinary projects.

The analysis of health administrative data and the outputs generated by this project will provide new evidence on the relationship between maternal mental health and child mental health in adolescence. The findings of this project will impact on a wide range of beneficiaries, namely:

1) Policymakers
Mental health is a topic of considerable interest to UK policymakers and politicians. The Joint Strategic Needs Assessment (JSNA) toolkit (2017) on mental health developed by the UK Government suggests that the mental health of the mother, and the family environment during pregnancy, infancy and childhood is of fundamental importance to child development. Furthermore, NHS England implemented the NHS Five Year Forward View for Mental Health in 2016 that marked the start of a ten-year journey for the transformation of mental health services. This was associated with a UK Government task force that will look at how to improve children's mental health services and improve access for young people. All of these organisations, plus local mental health services, can benefit from our research as it will help, for example, to more appropriately and efficiently target resources by identifying the children most at risk of suffering ill effects from poor maternal mental health; and to better understand the role of schools and health practices in reducing the negative consequences of poor maternal mental health. We will use networks developed in previous collaborations with these organisations to engage them, share policy briefs, and invite them to study events.

2) Charities
A number of charities working with mothers will be interested in our research, as our work will provide new evidence on the harmful effects on children of mental health problems suffered by their mothers. This will include mental health charities such as Mind, the Samaritans, Mental Health UK etc. We will collaborate in particular with OXPIP and Motherkind Café. Both charities focus on maternal mental health. Their main objectives are to deliver high-quality parent-infant mental health training, to influence policy and to improve practice. Motherkind Café is a wellbeing and emotional support group for mothers. They provide a non-structured drop-in group for women with young children where they can talk to other mothers about their mental health or any challenges they are facing with parenting. Our research work will provide new insights on the relationship between maternal depression, home environment and child mental health, and therefore will increase the knowledge that the charities can use to influence policy and improve practices, e.g. by introducing new material that can be used in the parent-infant mental health training organized by OXPIP or in focus groups in Motherkind Cafe.

3) Academics
The project will be useful for academic researchers who plan to extend health research by using sibling methodology similar to that proposed in the project. We will produce a specific report about the data linkage and the list of clinical codes used to define mental health. Our research will have also an impact on economists, sociologists and psychologists interested in child development, academics who work with big data, and those interested in policy design. More details are provided in the academic beneficiaries' section.

4) User community
The focus of our research is on child and mother mental health, a topic of great interest to the media and the general public. Our results will help mothers with potential mental depression and anxiety disorders to better understand the relevance of positive and sensitive parenting, of a non-stressful home environment for child development and the potential importance of seeking an early diagnosis. Our results will also be useful for health practitioners and policymakers who hope to better design interventions able to attenuate the effect of maternal depression on children.