Does Treating Maternal Depression Affect Maternal and Child Hypothalamic Pituitary Adrenal Axis Activity? Six‐Year Follow‐Up of a Cluster Randomized Trial in Rural Pakistan
Allison Frost, Kaitlin Shartle, John A. Gallis, Michelle Escobar Carias, Wan‐Chen Lin, Amanda Collins, Divya Aikat, Ashley Hagaman, Sonia Bhalotra, Victoria Baranov, Elizabeth L. Turner, Rosalind J. Wright, Atif Rahman, Joanna MaselkoABSTRACT
Perinatal depression is a risk factor for adverse long‐term outcomes in both mothers and children, including stress system dysregulation. Yet, it is unclear whether treating perinatal depression has lasting intergenerational effects on biological stress regulation. This study evaluated the effects of a psychosocial intervention programme initiated during the perinatal period and sustained throughout the child's early childhood (up to 5 years of age) on hair‐derived measures of hypothalamic pituitary adrenal (HPA) axis activity in mothers and their children. Mothers with prenatal depression were recruited during their third trimester of pregnancy and randomly assigned to a peer‐delivered psychosocial depression intervention ( n = 283) or control ( n = 287). At six years postpartum (one year after the conclusion of the intervention), hair samples were collected from mothers ( n = 392) and children ( n = 366) and analysed for cortisol, cortisone, and dehydroepiandosterone (DHEA). Additionally, 584 mothers without prenatal depression were recruited during pregnancy, of which 426 mothers and 389 children provided hair samples at six years. Mixed models showed no evidence of intervention effects on maternal HPA axis activity or child cortisone and DHEA. In contrast, children whose mothers received the intervention exhibited higher cortisol levels relative to children in the control group, bringing them closer to cortisol levels observed in the non‐depressed group. There was also an interaction between the intervention and baseline maternal depression severity, with stronger intervention effects on cortisol among children whose mothers experienced more severe depressive symptoms during pregnancy. Results suggest that treating prenatal depression can lead to durable improvements in stress system regulation in children, especially among those whose mothers had the highest symptom burden prenatally.