Childhood obesity puts children at risk for chronic metabolic diseases. Identification of weight-related risk factors in childhood is important to prevent adult cardiovascular disease (CVD). This dissertation evaluates risk factors for adolescent obesity and dyslipidemia. Multivariable regression analyses of data from black and white girls in the National Growth and Health Study (n=2,379) were used to identify predictors of these cardiometabolic risks (CMR). The first aim was to compare the impact of different measures of early adolescent adiposity (body mass index, BMI; waist circumference, WC; waist-to-hip ratio, WHR; percent body fat from bioelectrical impedance, %BF) as predictors of later adolescent lipid levels. Black girls had significantly lower pre-adolescent %BF (23.6% vs. 26.4%) than whites, but gained fat more rapidly (34.7% vs. 14.0% increases), exceeding whites in %BF by late adolescence. WC was a stronger predictor of subsequent low-density lipoprotein (LDL) levels than other measures of body composition (LDL difference between WC of highest and lowest quintiles: 29.5 mg/dL, whites; 17.9 mg/dL, blacks). Regardless of race, BMI was associated with lower levels of high-density lipoprotein (HDL), and higher levels of LDL, TG, and TG/HDL (triglyceride to HDL ratio). The second aim compared pre- and post-menarche measures of early adolescent body fat as determinants of later LDL, HDL, TG, and TG/HDL. BMI measures post-menarche were generally better predictors of later lipids in white girls compared with pre-menarche measures, while pre- and post-menarche BMI measures were equally good as predictors of later lipid levels in black girls. The third aim examined the role of maternal depressive symptoms as a risk factor for increased BMI among daughters. Daughters of mothers with higher depression scores had greater BMI increases throughout adolescence (p<0.0001), and a late adolescent BMI that was 0.88 kg/m2 higher than those of mothers with lower depression scores. These findings underline the importance of monitoring early physical and psychosocial CMR factors during adolescence to prevent CVD risk.

Depression during the perinatal time period is the most common medical condition related to pregnancy and childbirth. Based on previous research, this condition can have negative sequelae for mothers, their offspring, families and the community. Therefore, studies are needed to better understand risk factors and health outcomes among women with depression and the health outcomes among children born to mothers with depression. We examined rurality as a risk factor for depression during the perinatal time period using data from the 2016 Pregnancy Risk Assessment Monitoring Survey (aim one). We found women who resided in rural communities, as defined by their individual states, had an increase in the odds of depression during the perinatal period by 21% (OR: 1.21; 95% CI 1.05,1.41) when compared to women who resided in urban communities. Based on the results from this study, future studies are warranted to examine mediators of this relationship to develop effective public health and clinical interventions. Next, we examined the association between perinatal mental health conditions and postpartum prescription opioid use using private insurance claims data of women who delivered a baby in the state of Iowa 2005 to 2016 (aim two). Overall 38.63% of the women in our study filled at least one opioid prescription and 5.88% filled at least two prescriptions in the first 90 days postpartum. A significant interaction of having a perinatal mental health condition and delivery mode was observed for at least one (p=.04) and at least two opioid fills (<.0001). The presence of a mental health condition among women who delivered vaginally increased their odds of filling at least one opioid fill by nearly 50% (OR: 1.48 95% CI 1.35, 1.63) and by almost 20% (OR: 1.19 95% CI: 1.00, 1.43) among women with a cesarean delivery. A mental health condition significantly increased the odds of filling at least two opioid prescriptions among women with a vaginal or cesarean delivery by 2.78 (95% CI: 2.32-3.33) and 1.66 (95% CI: 1.40,1.98). Based on findings from this study, more research is needed to improve our understanding of the relationship between perinatal mental health and prescription opioid use. Finally, the association between perinatal depression and attention deficit hyperactivity disorder (ADHD) use was examined using private insurance claims data from mother-child pairs from the state of Iowa (aim three). Children were born during years 2004 through 2015. In our study children born to mothers with perinatal depression were at an increased odds of ADHD diagnosis by 170% (OR: 2.70; 95% CI 2.06, 3.55). We also evaluated how timing of depression (during pregnancy vs. postpartum) influenced the odds of ADHD diagnosis. While we found children born to mothers with depression during pregnancy and postpartum had an increased risk of ADHD diagnosis, we observed children exposed to depression during fetal development had the greatest risk overall. Research is needed to better understand the mechanisms of risk between perinatal depression and ADHD risk in offspring. Additionally, due to low power we were not able to evaluate how treatment of depression during pregnancy or postpartum may influence childhood outcomes, therefore more studies are needed in this area. Overall, findings from each study illustrate the importance of maternal mental health and how a mental health condition during the perinatal period can influence maternal and child health outcomes. Future prospective population-based studies are needed to better understand the etiologies of perinatal mental health conditions and how such conditions can influence outcomes for maternal and child health. Results from future studies have the potential to shift clinical practice to improve prevention and intervention in turn improving overall maternal and child health outcomes.

Although there is evidence that children of depressed parents are far more likely to suffer from depression than other children (Hammen & Brennan, 2003), the majority of research examining links between parents’ depression and adolescent depression has focused on maternal depression, minimizing or ignoring the potential influence of paternal depression. Thus, the goals of the proposed study were 1) to examine both maternal and paternal depressive symptoms in relation to adolescents’ depressive symptoms over time, 2) to explore possible gender differences in how teens are affected by maternal versus paternal depressive symptoms, and 3) to investigate the role of parent-teen relationship quality. This study used data from the NICHD Study of Early Child Care and Youth Development, which includes measures of each parents’ depressive symptoms, taken when children were in 3rd, 5th, 6th, and 10th grades, and adolescent depressive symptoms measured at grades 5, 6, and 10. Results of path analyses using a cross-lagged panel design revealed that paternal depressive symptoms significantly predicted changes in adolescent depressive symptoms from grade 5 to 6 and 6 to grade 10. Although maternal depressive symptoms were not significantly associated with female adolescents’ depressive symptoms, mothers’ depressive symptoms predicted male adolescents’ depressive symptoms at grade 5. Models revealed a reciprocal influence of female adolescents’ depressive symptoms and paternal depressive symptoms. Furthermore, models of indirect effects suggest that the relationship of maternal depressive symptoms at grade 3 and male teens’ depressive symptoms had an enduring effect on males’ depressive symptoms through grades 6 and 10. This was also found for the association of paternal depressive symptoms and subsequent female teens’ symptoms. Finally, moderation analyses revealed a significant interaction of maternal depressive symptoms and mother-teen relationship quality predicting female teens’ subsequent depressive symptoms such that females who had high-quality relationships with highly depressed mothers were more likely to be depressed themselves, whereas female teens’ depressive symptoms were lowest if they had high quality relationships with mothers who reported low levels of depressive symptoms. The present study highlights the need for systems-based approaches to working with families in which one or more family members experience depressive symptoms. / text

abstract: It is well-established that maternal depression is significantly related to internalizing and externalizing behavioral problems and psychopathology in general. However, research suggests maternal depression does not account for all the variance of these outcomes and that other family contextual factors should be investigated. The role of fathers beyond their simple presence or absence is one factor that needs to be further investigated in the context of maternal depression. The proposed study used prospective and cross-sectional analyses to examine father effects (i.e., paternal depression, alcohol use, involvement, and familism) on youth internalizing and externalizing symptoms within the context of maternal depression. The sample consisted of 405 Mexican-American families who had a student in middle school. Data were collected when the students were in 7th and 10th grade. Results from path analyses revealed that maternal depression significantly predicted concurrent youth internalizing symptoms in 7th and 10th grade and externalizing symptoms in 10th grade. In contrast, paternal depression was not related to adolescent symptomatology at either time point, nor was paternal alcoholism, and analyses failed to support moderating effects for any of the paternal variables. However, paternal involvement (father-report) uniquely predicted youth internalizing and externalizing symptoms over and above maternal depression in 7th grade. Youth report of paternal involvement uniquely predicted both internalizing and externalizing in 7th and 10th grade. Paternal familism uniquely predicted youth externalizing symptoms in 7th grade. The present findings support that maternal depression, but not paternal depression, is associated with concurrent levels of youth symptomatology in adolescence. The study did not support that fathers adjustment moderated (exacerbate or buffer) maternal depression effects. However, paternal involvement and paternal familism showed compensatory effects on youth symptomatology in concurrent analyses. / Dissertation/Thesis / M.A. Psychology 2013

Importance: Polymorphic expression of drug metabolizing enzymes affects the metabolism of antidepressants, and thus can contribute to drug response and/or adverse events. Pregnancy itself can affect CYP2D6 activity with profound variations determined by CYP2D6 genotype. Objective: To investigate the association between CYP2D6 genotype and the risk of antidepressant discontinuation, dosage modification, and the occurrence of maternal CYP2D6, Antidepressants, Depression during pregnancy. Setting: Data from the Organization of Teratology Information Specialists (OTIS) Antidepressants in Pregnancy Cohort, 2006-2010, were used. Women were eligible if they were within 14 completed weeks of pregnancy at recruitment and exposed to an antidepressant or having any exposures considered non-teratogenic. Main Outcomes and Measures: Gestational antidepressant usage was self-reported and defined as continuous/discontinued use, and non-use; dosage modification was further documented. Maternal depression and anxiety were measured every trimester using the telephone interviewer-administered Edinburgh Postnatal Depression Scale and the Beck Anxiety Inventory, respectively. Saliva samples were collected and used for CYP2D6 genotype analyses. Logistic regression models were used to calculate crude and adjusted odds ratios (OR) with 95% confidence intervals. Results: A total of 246 pregnant women were included in the study. The majority were normal metabolizers (NM, n = 204, 83%); 3.3% (n = 8) were ultrarapid metabolizers (UM), 5.7%(n = 14) poor metabolizers (PM), and 8.1%(n= 20) intermediate metabolizers (IM). Among study subjects, 139 women were treated with antidepressants at the beginning of pregnancy, and 21 antidepressant users (15%) discontinued therapy during pregnancy. Adjusting for depressive symptoms, and other potential confounders, the risk of discontinuing antidepressants during pregnancy was nearly four times higher in slow metabolizers (poor or intermediate metabolizers) compared to those with a faster metabolism rate (normal or ultrarapid metabolizers), aOR = 3.57 (95% CI: 1.15-11.11). Predicted CYP2D6 metabolizer status did not impact dosage modifications. Compared with slow metabolizers, significantly higher proportion of women in the fast metabolizer group had depressive symptomin the first trimester (19.81 vs. 5.88%, P = 0.049). Almost 21% of treated women remained depressed during pregnancy (14.4% NM-UM; 6.1% PM-IM). Conclusions and Relevance: Prior knowledge of CYP2D6 genotype may help to identify pregnant women at greater risk of antidepressant discontinuation. Twenty percent of women exposed to antidepressants during pregnancy remained depressed, indicating an urgent need for personalized treatment of depression during pregnancy.

The purpose of the current dissertation was to develop a measure of mother’s reward responsivity in parenting. I proposed that deficits in reward responsivity may contribute to maladaptive parenting behaviors, especially among depressed mothers. Reward responsivity is conceptualized as an individual difference in reactivity to pleasurable stimuli and represents a key motivational component that could contribute to the frequency and quality of mothers’ interactions with their infants. To empirically evaluate the link between mother reward responsivity, behaviors towards their infant, and infant behavior outcomes, a measure of reward responsivity in relation to parenting behavior was needed. The current dissertation addressed this need and developed a self-report measure of reward responsivity in parenting named the Mother Inventory of Reward Experience (MIRE). The MIRE was evaluated in two studies: the first study was among 31 adolescent mothers (M = 16.97, SD = 1.22) and the second was among 200 adult mothers (M = 28.45, SD = 5.50). Following guidelines on scale development, the development of MIRE started with an initial item pool of 105 items that were examined for psychometric performance of item mean, item kurtosis and item-total correlations. Seventy-two items were deleted because the mean of the item was at the top or bottom of its range, the kurtosis was above or below the absolute value of three, or the item remainder coefficient was less than 0.3. The remaining 33 items displayed high internal consistency reliability and test re-test reliability over two weeks. Convergent validity was established via a statistically significant correlation with a self-report measure of general reward responsivity. Concurrent validity was established via statistically significant correlations with depressive symptoms, parenting stress, and child behavior. Incremental validity of the MIRE over measures of general reward responsivity was supported via significant predictions of parenting stress, infant positive affectivity, and infant regulatory capacity. These results support the reliability and initial validation of the MIRE. Future directions are presented with a focus on understanding the role of maternal reward responsivity, maternal depression, and parenting behaviors.

京都大学 / 0048 / 新制・課程博士 / 博士(社会健康医学) / 甲第22009号 / 社医博第95号 / 新制||社医||10(附属図書館) / 京都大学大学院医学研究科社会健康医学系専攻 / (主査)教授 中山 健夫, 教授 村井 俊哉, 教授 川村 孝 / 学位規則第4条第1項該当 / Doctor of Public Health / Kyoto University / DFAM

Do Maternal Psychosocial Factors Predict Adolescent Weight? Sandra Jody MarksDepartment of Exercise Sciences, BYUMaster of SciencePurpose: This study investigated the possible relationship between maternal psychosocial factors, mainly maternal stress and maternal depression, and adolescent weight status. Also, this study examined the predictive effect of these maternal psychosocial factors on adolescent weight loss during a health education intervention as well as the months following the health education. Methods: Study design was a longitudinal pretest posttest with a health education intervention. We assessed 40 adolescents and their mothers on four occasions over a 1-year period. At each occasion, the Stress Index for Parents of Adolescents (SIPA) was used to measure maternal stress and the Beck Depression Inventory (BDI-II) was used to measure maternal depression. Also, at the four occasions, adolescent anthropometric data were obtained by research assistants using a digital scale for weight and a portable stadiometer for measuring height. Body Mass Index scores (BMI = [weight (kg)]/[height (m)]2) were calculated and converted into a percentile score (zBMI), adjusting for age and gender, using the standard Center for Disease Control and Prevention calculator. At the onset of the study, the adolescent participants and their mothers all received 12 weeks of health education, which included group behavioral therapy, family-based intervention, motivational interviewing and electronic intervention. Results: Hierarchical regression analysis revealed that no significant relationships existed between maternal stress and adolescent zBMI or between maternal depression and adolescent zBMI at baseline (Time 1). Nor did the study find that maternal stress and/or depression scores at Time 1 significantly predicted a greater amount of adolescent weight loss. Lower stress and/or depression also did not significantly predict adolescent weight maintenance after the 12-week intervention (Time 2). However, results did indicate that the adolescent component of the maternal stress domain (AD) from Time 1 to Time 2 was a significant predictor of adolescent zBMI from Time 1 to Time 2, (R2 = 0.238, F (1,21) = 6.571, p = 0.018). This means that 23.8% of the variability in overall zBMI change from Time 1 to Time 2 is being accounted for by change in the maternal AD stress domain from Time 1 to Time 2. Conclusion: Adolescent zBMI decreased concurrently with maternal stress during the health education intervention stage. Although the correlational nature of this study prevents causal claims, this result suggests that decreasing maternal stress may strengthen the ability of obese adolescents to effectively lose weight. This study encourages further research to examine the effects that maternal psychosocial factors may have on adolescent weight status, weight loss, and weight maintenance.

Maternal depression is a robust risk factor for heightened internalizing symptoms in offspring. Studies also suggest that maternal depression is associated with greater maternal emotion regulation (ER) difficulties. However, emotion regulation has been conceptualized as a multidimensional construct, and few studies have identified specific components of ER related to maternal depression and the role these components may play in the relationship between maternal depression and child internalizing symptoms. Mothers (n = 73) of young children (ages 4–9; 42 females), recruited from both clinical and community settings, reported their depression symptoms and emotion regulation difficulties. Children’s internalizing symptoms were assessed using both parental report and a semi-structured clinical interview. Regression analyses revealed that maternal depression symptoms were positively related to maternal ER, specifically, limited access to emotion regulation strategies and non-acceptance of emotional responses. Structural equation models revealed that the relation between maternal depression and child internalizing problems was mediated only through mother’s limited access to emotion regulation strategies. Our findings offer new insight for targeting mothers’ limited access to emotion strategies as a novel early intervention method to help break the intergenerational transmission of internalizing symptoms from mother to child.

No description available.