Methodological considerations for measuring the intergenerational spillover effects related to maternal postpartum depression screening

Abstract:
Purpose: Interventions to promote parental health during the perinatal period and in the child’s earliest years of life affect lifelong child development and economic potential. Yet, the intergenerational spillover effects associated with interventions during this sensitive period in human development are not commonly measured nor reported in economic evaluation. Findings would equip decision-makers with information on potential trade-offs being made between the health of parents versus their children. The purpose of this study was to investigate the intergenerational spillover effects associated with an opportunistic public health screening pathway for maternal postpartum depression (PPD) in Alberta, Canada. 

Methods: Longitudinal data from the All Our Families prospective cohort was linked to public health, inpatient, outpatient, and physician claims administrative databases. Bivariate and multivariable regression models explored the association between maternal PPD screening category and odds of children being at risk versus not at risk of delay across five developmental domains: communication, gross motor, fine motor, personal social, and problem solving.

Results: Relative to mothers not screened, children whose mothers screened either low/moderate- or high-risk for PPD had increased odds of being at risk of delay across all developmental domains at ages 3 and/or 5 years. Despite significant results, however, we were unable to arrive at definitive causal conclusions or associations due to a high potential for residual confounding. 

Conclusions: This study highlights the practical and methodological challenges with measuring intergenerational spillover effects using longitudinal observational research designs. Future research requires careful attention to methodological considerations and the risk of bias. 

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