Skip to main content Accessibility help
×
Home

Eighteen-year trajectories of depressive symptoms in mothers with a lifetime eating disorder: findings from the ALSPAC cohort

  • Yu Wei Chua (a1), Gemma Lewis (a2), Abigail Easter (a3), Glyn Lewis (a4) and Francesca Solmi (a5)...

Abstract

Background

Two longitudinal studies have shown that depressive symptoms in women with eating disorders might improve in the antenatal and early postnatal periods. No study has followed up women beyond 8 months postnatal.

Aims

To investigate long-term trajectories of depressive symptoms in mothers with lifetime self-reported eating disorders.

Method

Using data from the Avon Longitudinal Study of Parents and Children and multilevel growth curves we modelled trajectories of depressive symptoms from the 18th week of pregnancy to 18 years postnatal in women with lifetime self-reported anorexia nervosa, bulimia nervosa or both anorexia and bulimia nervosa. As sensitivity analyses we also investigated these trajectories using quintiles of a continuous measure of body image in pregnancy.

Results

Of the 9276 women in our main sample, 126 (1.4%) reported a lifetime diagnosis of anorexia nervosa, 153 (1.6%) of bulimia nervosa and 60 (0.6%) of both anorexia and bulimia nervosa. Women with lifetime eating disorders had greater depressive symptoms scores than women with no eating disorders, before and after adjustment for confounders (anorexia nervosa: 2.10, 95% CI 1.36–2.83; bulimia nervosa: 2.28, 95% CI: 1.61–2.94, both anorexia and bulimia nervosa: 2.86, 95% CI 1.81–3.90). We also observed a dose–response association between greater body image and eating concerns in pregnancy and more severe trajectories of depressive symptoms, even after adjusting for lifetime eating disorders which also remained independently associated with greater depressive symptoms.

Conclusions

Women with eating disorders experience persistently greater depressive symptoms across the life-course. More training for practitioners and midwives on how to recognise eating disorders in pregnancy could help to identify depressive symptoms and reduce the long-term burden of disease resulting from this comorbidity.

Declaration of interest

None.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Eighteen-year trajectories of depressive symptoms in mothers with a lifetime eating disorder: findings from the ALSPAC cohort
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Eighteen-year trajectories of depressive symptoms in mothers with a lifetime eating disorder: findings from the ALSPAC cohort
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Eighteen-year trajectories of depressive symptoms in mothers with a lifetime eating disorder: findings from the ALSPAC cohort
      Available formats
      ×

Copyright

This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Corresponding author

Correspondence: Francesca Solmi, UCL Division of Psychiatry, 6th Floor, Wing B, Maple House, 149 Tottenham Court Road, London N1T 7NF, UK. Email: francesca.solmi@ucl.ac.uk

References

Hide All
1Franko, DL, Blais, MA, Becker, AE, Delinsky, SS, Greenwood, DN, Flores, AT, et al. Pregnancy complications and neonatal outcomes in women with eating disorders. Am J Psychiatry 2001; 158: 1461–6.
2Morgan, JF, Lacey, JH, Sedgwick, PM. Impact of pregnancy on bulimia nervosa. Br J Psychiatry 1999; 174: 135.
3Morgan, JF, Lacey, JH, Chung, E. Risk of postnatal depression, miscarriage, and preterm birth in bulimia nervosa: retrospective controlled study. Psychosom Med 2006; 68: 487–92.
4Micali, N, Simonoff, E, Stahl, D, Treasure, J. Maternal eating disorders and infant feeding difficulties: maternal and child mediators in a longitudinal general population study. J Child Psychol Psychiatry 2011; 52: 800–7.
5Easter, A, Solmi, F, Bye, A, Taborelli, E, Corfield, F, Schmidt, U, et al. Antenatal and postnatal psychopathology among women with current and past eating disorders: longitudinal patterns. Eur Eat Disord Rev 2014;23: 1927.
6Mazzeo, SE, Landt, M, Jones, I, Mitchell, K, Kendler, KS, Neale, MC, et al. Associations among postpartum depression, eating disorders, and perfectionism in a population-based sample of adult women. Int J Eat Disord 2006; 39: 202–11.
7Howard, LM, Molyneaux, E, Dennis, CL, Rochat, T, Stein, A, Milgrom, J. Non-psychotic mental disorders in the perinatal period. Lancet 2014; 384: 1775–88.
8Micali, N, Simonoff, E, Treasure, J. Pregnancy and post-partum depression and anxiety in a longitudinal general population cohort: the effect of eating disorders and past depression. J Affect Disord 2011; 131: 150–7.
9Boyd, A, Golding, J, Macleod, J, Lawlor, DA, Fraser, A, Henderson, J, et al. Cohort profile: the Avon longitudinal study of parents and children: ALSPAC mothers cohort. Int J Epidemiol 2013; 42: 97110.
10Golding, J, Pembrey, M, Jones, R. ALSPAC–the Avon longitudinal study of parents and children. I. Study methodology. Paediatr Perinat Epidemiol 2001; 15: 7487.
11Kothari, R, Solmi, F, Treasure, J, Micali, N. The neuropsychological profile of children at high risk of developing an eating disorder. Psychol Med 2012: 112.
12Keski-Rahkonen, A, Sihvola, E, Raevuori, A, Kaukoranta, J, Bulik, CM, Hoek, HW, et al. Reliability of self-reported eating disorders: optimizing population screening. Int J Eat Disord 2006; 39: 754–62.
13Pearson, RM, Evans, J, Kounali, D, Lewis, G, Heron, J, Ramchandani, PG, et al. Maternal depression during pregnancy and the postnatal period risks and possible mechanisms for offspring depression at age 18 years. JAMA Psychiatry 2013; 70: 1312–9.
14Cox, JL, Holden, JM, Sagovsky, R. Detection of postnatal depression: development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry 1987; 150: 782–6.
15Royston, P, White, IR. Multiple imputation by chained equations (MICE): implementation in Stata. J Stat Softw 2011; 45.
16Sterne, JAC, White, IR, Carlin, JB, Spratt, M, Royston, P, Kenward, MG, et al. Multiple imputation for missing data in epidemiological and clinical research: potential and pitfalls. BMJ 2009; 338: b2393.
17Nicholls, DE, Viner, RM, Doll, H, Davies, B, O'Connor, M, Sullivan, P. Childhood risk factors for lifetime anorexia nervosa by age 30 years in a national birth cohort. J Am Acad Child Adolesc Psychiatry 2009; 48: 791–9.
18Smink, FRE, Van Hoeken, D, Hoek, HW. Epidemiology of eating disorders: incidence, prevalence and mortality rates. Curr Psychiatry Rep 2012;14: 406–14.
19Keel, PK, Brown, TA. Update on course and outcome in eating disorders. Int J Eat Disord 2010; 43: 195204.
20Bardone-Cone, AM, Harney, MB, Maldonado, CR, Lawson, MA, Robinson, DP, Smith, R, et al. Defining recovery from an eating disorder: conceptualization, validation, and examination of psychosocial functioning and psychiatric comorbidity. Behav Res Ther 2010; 48: 194202.
21Holtkamp, K, Muller, B, Heussen, N, Remschmidt, H, Herpertz-Dahlmann, B. Depression, anxiety, and obsessionality in long-term recovered patients with adolescent-onset anorexia nervosa. Eur Child Adolesc Psychiatry 2005; 14: 106–10.
22Micali, N, Stahl, D, Treasure, J, Simonoff, E. Childhood psychopathology in children of women with eating disorders: understanding risk mechanisms. J Child Psychol Psychiatry 2014;53: 124–34.
23Deave, T, Heron, J, Evans, J, Emond, A. The impact of maternal depression in pregnancy on early child development. BJOG 2008; 115: 1043–51.
24Flouri, E, Ruddy, A, Midouhas, E. Maternal depression and trajectories of child internalizing and externalizing problems: the roles of child decision making and working memory. Psychol Med 2017; 47: 1138–48.
25Lampard, AM, Franckle, RL, Davison, KK. Maternal depression and childhood obesity: a systematic review. Prev Med (Baltim) 2014; 59: 60–7.
26Netsi, E, Pearson, RM, Murray, L, Cooper, P, Craske, MG, Stein, A. Association of persistent and severe postnatal depression with child outcomes. JAMA Psychiatry 2018; 75: 247–53.
27NHS Digital. Mental Health and Wellbeing in England Adult Psychiatric Morbidity Survey 2014. NHS, 2016.
28Freeman, EW, Sammel, MD, Boorman, DW, Zhang, R. Longitudinal pattern of depressive symptoms around natural menopause. JAMA Psychiatry 2014;71: 3643.
29Bye, A, Shaw, J, Bick, D, Easter, A, Kash-McDonald, M, Micali, N. Barriers to identifying eating disorders in pregnancy and in the postnatal period: a qualitative approach. BMC Pregnancy Childbirth 2018; 18: 114.
30Ali, K, Farrer, L, Fassnacht, DB, Gulliver, A, Bauer, S, Griffiths, KM. Perceived barriers and facilitators towards help-seeking for eating disorders: a systematic review. Int J Eat Disord 2017; 50: 921.
31National Institute for Health and Care Excellence. Antenatal and Postnatal Mental Health Guidelines. Clinical Guidelines CG192. NICE, 2014.
32Howard, LM, Ryan, EG, Trevillion, K, Anderson, F, Bick, D, Bye, A, et al. Accuracy of the Whooley questions and the Edinburgh Postnatal Depression Scale in identifying depression and other mental disorders in early pregnancy. Br J Psychiatry 2018; 212: 50–6.
33National Institute for Health and Care Excellence. Eating Disorders: Recognition and Treatment. Appendix P: Health Economic Evidence – Evidence Tables. NICE, 2017.
34Taborelli, E, Easter, A, Keefe, R, Schmidt, U, Treasure, J, Micali, N. Transition to motherhood in women with eating disorders: a qualitative study. Psychol Psychother Theory Res Pract 2016; 89: 308–23.

Keywords

Type Description Title
WORD
Supplementary materials

Chua et al. supplementary material
Chua et al. supplementary material 1

 Word (553 KB)
553 KB

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

Eighteen-year trajectories of depressive symptoms in mothers with a lifetime eating disorder: findings from the ALSPAC cohort

  • Yu Wei Chua (a1), Gemma Lewis (a2), Abigail Easter (a3), Glyn Lewis (a4) and Francesca Solmi (a5)...
Submit a response

eLetters

No eLetters have been published for this article.

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *