The early predictors of depression and anxiety disorders: Factors that influence and are influenced by the early life environment

Background: Pregnancy and the first year of life is recognized as an important developmental period for lifelong health and well-being, including for mental disorders such as depression and anxiety. Understanding important exposures and environmental influences during the perinatal period from conception to 12 months that may act as risk or protective factors is an area of increasing focus. Objectives: To explore the key risk and protective factors across pregnancy and the first year of life for later child depression and anxiety disorders. To examine whether treatment of maternal depression in pregnancy with antidepressant medication increases, decreases or has no impact on the risk of a child developing depression and anxiety. To discuss future clinical and research directions for maternal depression and child emotional disorders. Methods: The Mercy Pregnancy Emotional Wellbeing Studies is a prospective, pregnancy longitudinal study that recruits women in early pregnancy and follows-up to 4 years of age. Mental health is assessed using both diagnostic measures as well as self-report and antidepressant use is assessed by self-report, hospital records and maternal and cord blood levels. Child mental health is assessed using the diagnostic measure Preschool Age Psychiatric Assessment at 4 years of age together with neuropsychological assessment. Findings: Pathways from maternal depression in pregnancy to child depression and anxiety disorders at 4 years of age are complex and multifactorial with evidence to suggest the importance of biological as well as psychological and social factors operating together and independently to increase risk. These provide important insights into the development of new interventions. Conclusions: Understanding the early life pathways to childhood depression and anxiety and the relationship to maternal depression in pregnancy is important to progress the aims of prevention and early intervention and to improve outcomes for women and chi