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Peer-reviewedCC BY-NC-ND 4.0Stress and Health

Does Treating Maternal Depression Affect Maternal and Child Hypothalamic Pituitary Adrenal Axis Activity? Six‐Year Follow‐Up of a Cluster Randomized Trial in Rural Pakistan

  • Allison Frost1
  • Kaitlin Shartle2
  • John A. Gallis3,4
  • Michelle Escobar Carias5
  • Wan‐Chen Lin6
  • Amanda Collins7
  • Divya Aikat7
  • Ashley Hagaman8,9
  • Sonia Bhalotra10
  • Victoria Baranov5
  • Elizabeth L. Turner3,4
  • Rosalind J. Wright11
2 more authors
  • Atif Rahman12
  • Joanna Maselko1,7
12 affiliations
  1. 1Carolina Population Center University of North Carolina at Chapel Hill Chapel Hill North Carolina USA
  2. 2Sanford School of Public Policy Duke University Durham North Carolina USA
  3. 3Duke Global Health Institute Duke University Durham North Carolina USA
  4. 4Department of Biostatistics and Bioinformatics Duke University Durham North Carolina USA
  5. 5Department of Economics University of Melbourne Melbourne Australia
  6. 6Department of Health Behavior Gillings School of Global Public Health University of North Carolina at Chapel Hill Chapel Hill North Carolina USA
  7. 7Department of Epidemiology Gillings School of Global Public Health University of North Carolina at Chapel Hill Chapel Hill North Carolina USA
  8. 8Department of Social and Behavioral Sciences Yale School of Public Health New Haven Connecticut USA
  9. 9Center for Methods in Implementation and Prevention Science Yale School of Public Health New Haven Connecticut USA
  10. 10Department of Economics University of Warwick Coventry UK
  11. 11Department of Public Health Icahn School of Medicine at Mount Sinai New York New York USA
  12. 12Department of Primary Care & Mental Health University of Liverpool Liverpool UK
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Abstract

Perinatal depression is a risk factor for adverse long‐term outcomes in both mothers and children, including stress system dysregulation. Yet, it is unclear whether treating perinatal depression has lasting intergenerational effects on biological stress regulation. This study evaluated the effects of a psychosocial intervention programme initiated during the perinatal period and sustained throughout the child's early childhood (up to 5 years of age) on hair‐derived measures of hypothalamic pituitary adrenal (HPA) axis activity in mothers and their children. Mothers with prenatal depression were recruited during their third trimester of pregnancy and randomly assigned to a peer‐delivered psychosocial depression intervention (n = 283) or control (n = 287). At six years postpartum (one year after the conclusion of the intervention), hair samples were collected from mothers (n = 392) and children (n = 366) and analysed for cortisol, cortisone, and dehydroepiandosterone (DHEA). Additionally, 584 mothers without prenatal depression were recruited during pregnancy, of which 426 mothers and 389 children provided hair samples at six years. Mixed models showed no evidence of intervention effects on maternal HPA axis activity or child cortisone and DHEA. In contrast, children whose mothers received the intervention exhibited higher cortisol levels relative to children in the control group, bringing them closer to cortisol levels observed in the non‐depressed group. There was also an interaction between the intervention and baseline maternal depression severity, with stronger intervention effects on cortisol among children whose mothers experienced more severe depressive symptoms during pregnancy. Results suggest that treating prenatal depression can lead to durable improvements in stress system regulation in children, especially among those whose mothers had the highest symptom burden prenatally.

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Cite

BibTeXRIS
BibTeX
@article{frost2026does,
  title = {{Does Treating Maternal Depression Affect Maternal and Child Hypothalamic Pituitary Adrenal Axis Activity? Six‐Year Follow‐Up of a Cluster Randomized Trial in Rural Pakistan}},
  author = {Allison Frost and Kaitlin Shartle and John A. Gallis and Michelle Escobar Carias and Wan‐Chen Lin and Amanda Collins and Divya Aikat and Ashley Hagaman and Sonia Bhalotra and Victoria Baranov and Elizabeth L. Turner and Rosalind J. Wright and Atif Rahman and Joanna Maselko},
  journal = {Stress and Health},
  year = {2026},
  month = oct,
  doi = {10.1002/smi.70239},
  url = {https://doi.org/10.1002/smi.70239},
  note = {CC BY-NC-ND 4.0},
}
RIS
TY  - JOUR
TI  - Does Treating Maternal Depression Affect Maternal and Child Hypothalamic Pituitary Adrenal Axis Activity? Six‐Year Follow‐Up of a Cluster Randomized Trial in Rural Pakistan
AU  - Allison Frost
AU  - Kaitlin Shartle
AU  - John A. Gallis
AU  - Michelle Escobar Carias
AU  - Wan‐Chen Lin
AU  - Amanda Collins
AU  - Divya Aikat
AU  - Ashley Hagaman
AU  - Sonia Bhalotra
AU  - Victoria Baranov
AU  - Elizabeth L. Turner
AU  - Rosalind J. Wright
AU  - Atif Rahman
AU  - Joanna Maselko
PY  - 2026
DA  - 2026/10/27
JO  - Stress and Health
DO  - 10.1002/smi.70239
UR  - https://doi.org/10.1002/smi.70239
AB  - Perinatal depression is a risk factor for adverse long‐term outcomes in both mothers and children, including stress system dysregulation. Yet, it is unclear whether treating perinatal depression has lasting intergenerational effects on biological stress regulation. This study evaluated the effects of a psychosocial intervention programme initiated during the perinatal period and sustained throughout the child's early childhood (up to 5 years of age) on hair‐derived measures of hypothalamic pituitary adrenal (HPA) axis activity in mothers and their children. Mothers with prenatal depression were recruited during their third trimester of pregnancy and randomly assigned to a peer‐delivered psychosocial depression intervention (n = 283) or control (n = 287). At six years postpartum (one year after the conclusion of the intervention), hair samples were collected from mothers (n = 392) and children (n = 366) and analysed for cortisol, cortisone, and dehydroepiandosterone (DHEA). Additionally, 584 mothers without prenatal depression were recruited during pregnancy, of which 426 mothers and 389 children provided hair samples at six years. Mixed models showed no evidence of intervention effects on maternal HPA axis activity or child cortisone and DHEA. In contrast, children whose mothers received the intervention exhibited higher cortisol levels relative to children in the control group, bringing them closer to cortisol levels observed in the non‐depressed group. There was also an interaction between the intervention and baseline maternal depression severity, with stronger intervention effects on cortisol among children whose mothers experienced more severe depressive symptoms during pregnancy. Results suggest that treating prenatal depression can lead to durable improvements in stress system regulation in children, especially among those whose mothers had the highest symptom burden prenatally.
SN  - 1532-3005
SN  - 1532-2998
ER  -