The following article is a part of conference coverage from the American Psychiatric Nurses Association (APNA) 34th Annual Conference, held online from September 30 to October 4, 2020. The team at the Clinical Advisor will be reporting on the latest news and research conducted by leading nurses in psychiatry. Check back for more from APNA 2020.


Children born prematurely to mothers who had depression and who meet the threshold for poverty have a greater odds of having affective and anxiety disorders compared with children of non-depressed mothers and families not in poverty, according to research presented at the American Psychiatric Nurses Association (APNA) 34th Annual Conference, held online from September 30th to October 4th, 2020. 

Premature birth make up about 8% of births in the United States and 23% of children born prematurely experience mental health disorders between ages 2 to 17 years, as compared with 15.5% of children born at term, noted Cherry Leung, PhD, PMHNP-BC, CPNP, RN, from the School of Nursing at the University of California, San Francisco. “There is an ongoing need for early assessment of risk factors, such as poverty, maternal depression, and adolescent parenting,” to allow for effective intervention of early mental health conditions, Dr Leung added.

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Working with Sandra Weiss, PhD, RN, FAAN, the researchers studied maternal risk factors of early affective and anxiety disorders for children born prematurely. They recruited mothers from 2 neonatal intensive care units (NICUs) at 2 hospitals to complete a mental health questionnaire; mothers aged 16 years and older were recruited before 37 weeks’ gestation. Exclusion criteria included mothers who could not complete the questionnaire and infants born later than 37 weeks’ gestation; infants who had major neonatal illnesses, and mothers were too psychologically or physically fragile to participate.

Mothers and infants were followed from the first 2 weeks after birth until 2 years of age. Mothers completed a sociodemographic questionnaire at the start of the study and at 2 years of infant age; a home visit was made where mothers completed the Patient Health Questionnaire-9 (PHQ-9), Family Satisfaction Scale (FSS), and Child Behavior Checklist (CBCL).

The primary outcome measure was to identify the prevalence of potential affective and anxiety disorders at 2 years of age among the sample; secondary analysis included the extent to which poverty, maternal depression, or teen motherhood increased the likelihood that the child might develop an internalizing disorder in early life.

A total of 105 mothers and their children were included in the study; 45% of mothers had a European (White) heritage, 22.4% were African-American/Black, 26.6% were Hispanic, 4% were Asian, and the remaining 2% were of mixed background.

“In our study, about 25% of children met criteria for either anxiety or affective disorder or both,” Dr Leung said. The study found that while teen motherhood, family poverty, and maternal depression were all associated with childhood anxiety, only family poverty and maternal depression were significant predictors of having an affective disorder.

“Our results indicate that need for early and ongoing assessment of children and their mothers to allow for effective intervention. Clinicians should prevent, identify, and treat maternal depression for the benefit of both the mother and child,” the study authors concluded, “Similarly, resources for families in poverty and adolescent mothers need to be considered.”

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Leung C, Weiss S. Maternal risk factors of early affective and anxiety disorders for children born prematurely. Presented at: APNA 34th Annual Conference; September 30-October 4, 2020. Poster 148.