Title: Maternal depression and anxiety disorders and child mental health outcomes
Funder: Economic and Social Research Council

Abstract: The main objectives of this project are: 1.To make a significant academic contribution on how maternal depression and anxiety disorders (MDAD) affect child mental health outcomes in adolescence. There is evidence that healthy children tend to be healthy and wealthy adolescents and adults. The transmission of depression and anxiety disorders from mothers to children can be explained by three channels: (i) a direct intergenerational transmission of genetic traits, (ii) mothers and children sharing a similar family background, (iii) MDAD potentially leading to changes in the child home environment (e.g. worse parenting and lower parental time investments). We are interested in identifying the role of the third channel to inform policymakers and health practitioners on whether there is a need for interventions designed to improve the home environment when mothers suffer MDAD. We will improve on previous efforts to identify the negative effect of MDAD through the third channel - i.e. those that manifest through changes in child home environment caused by MDAD - by estimating the effect of MDAD on child mental health in adolescence while controlling for family background and genetic characteristics shared by siblings. 2. To identify children who are most vulnerable to the consequences of MDAD by assessing whether the negative effect of MDAD is larger for girls than boys, children with adverse birth outcomes, and children living in deprived areas or in areas with low-quality health care. 3. To inform policymakers on whether school policies and health practices may have a role in attenuating the negative effect of maternal depression by answering the following two questions: (i) does starting school early damage or benefit children of mothers who are experiencing MDAD? (ii) does the timing of diagnosis of postpartum depression (PPD), caused by differences in health practices across areas, exacerbate the consequences of PPD for children? Previous studies have found that early childhood education programs and starting school earlier have a beneficial effect on children from disadvantaged backgrounds. In this project, we assess whether starting school earlier by up to one year has beneficial long-term effects for children with mothers suffering from PPD. Furthermore, we will assess whether an early PPD diagnosis can reduce the long-term effect on child outcomes, in particular, child depression and anxiety disorders during adolescence, and whether differences in health care across areas can explain the timing of post-partum diagnosis. 4. To produce a unique linkage of data from primary and secondary care (QResearch and Hospital Episode Statistics) to construct a longitudinal household data set containing medical and health details on children, their mothers and, for the first time, their siblings. This longitudinal household dataset will allow for the first time the use of statistical methods based on sibling differences in UK administrative health data.

Lay abstract: 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.

Research activity codes: 2.1 BIOLOGICAL AND ENDOGENOUS FACTORS;2.3 PSYCHOLOGICAL, SOCIAL AND ECONOMIC FACTORS
Health categories: MENTAL HEALTH