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Offspring psychopathology following preconception, prenatal and postnatal maternal bereavement stress

Published online by Cambridge University Press:  17 April 2013

Q. A. Class ,
K. M. Abel ,
A. S. Khashan ,
M. E. Rickert ,
C. Dalman ,
H. Larsson ,
C. M. Hultman ,
N. Långström ,
P. Lichtenstein  and
B. M. D‘Onofrio
Q. A. Class*
Affiliation:
Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA
K. M. Abel
Affiliation:
Centre for Women's Mental Health, Manchester Academic Health Sciences, University of Manchester, UK
A. S. Khashan
Affiliation:
Anu Research Centre, Department of Obstetrics and Gynaecology, University College Cork, Ireland
M. E. Rickert
Affiliation:
Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA
C. Dalman
Affiliation:
Department of Public Health Sciences, Division of Public Health Epidemiology, Karolinska Institutet, Stockholm, Sweden
H. Larsson
Affiliation:
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
C. M. Hultman
Affiliation:
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
N. Långström
Affiliation:
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
P. Lichtenstein
Affiliation:
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
B. M. D‘Onofrio
Affiliation:
Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA
*
* Address for correspondence: Q. A. Class, B.S., Department of Psychological and Brain Sciences, Indiana University, 1101 East 10th St, Bloomington, IN 47405, USA. (Email: [email protected])
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Abstract

Background

Preconception, prenatal and postnatal maternal stress is associated with increased offspring psychopathology, but findings are inconsistent and need replication. We estimated associations between maternal bereavement stress and offspring autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), bipolar disorder, schizophrenia, suicide attempt and completed suicide.

Method

Using Swedish registers, we conducted the largest population-based study to date examining associations between stress exposure in 738 144 offspring born 1992–2000 for childhood outcomes and 2 155 221 offspring born 1973–1997 for adult outcomes with follow-up to 2009. Maternal stress was defined as death of a first-degree relative during (a) the 6 months before conception, (b) pregnancy or (c) the first two postnatal years. Cox proportional survival analyses were used to obtain hazard ratios (HRs) in unadjusted and adjusted analyses.

Results

Marginal increased risk of bipolar disorder and schizophrenia following preconception bereavement stress was not significant. Third-trimester prenatal stress increased the risk of ASD [adjusted HR (aHR) 1.58, 95% confidence interval (CI) 1.15–2.17] and ADHD (aHR 1.31, 95% CI 1.04–1.66). First postnatal year stress increased the risk of offspring suicide attempt (aHR 1.13, 95% CI 1.02–1.25) and completed suicide (aHR 1.51, 95% CI 1.08–2.11). Bereavement stress during the second postnatal year increased the risk of ASD (aHR 1.30, 95% CI 1.09–1.55).

Conclusions

Further research is needed regarding associations between preconception stress and psychopathological outcomes. Prenatal bereavement stress increases the risk of offspring ASD and ADHD. Postnatal bereavement stress moderately increases the risk of offspring suicide attempt, completed suicide and ASD. Smaller previous studies may have overestimated associations between early stress and psychopathological outcomes.

Keywords

Attention deficit hyperactivity disorderautismpostnatalpreconceptionprenatalpsychiatricpsychopathologyschizophreniastresssuicide
Type
Original Articles
Information
Psychological Medicine , Volume 44 , Issue 1 , January 2014 , pp. 71 - 84
Copyright
Copyright © Cambridge University Press 2013 

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