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Br J Psychiatry. 2019 May 14:1-7. doi: 10.1192/bjp.2019.89. [Epub ahead of print]

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

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PhD candidate in Education,Laboratory for Innovation in Autism,University of Strathclyde,UK.
Research Associate in Psychiatric Epidemiology,Division of Psychiatry,University College London,UK.
Senior Postdoctoral Research Fellow,Centre for Implementation Science,Institute of Psychiatry, Psychology and Neuroscience, King's College London,UK.
Professor of Epidemiological Psychiatry,Division of Psychiatry,University College London,UK.
Sir Henry Wellcome Post-doctoral Fellow,Division of Psychiatry,University College LondonUK.



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


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.


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.


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 interestNone.


ALSPAC; depression; eating disorders; parental mental health; perinatal mental health


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