Effective treatment for postpartum depression is not sufficient to improve the developing mother-child relationship

Maternal depression is prevalent, and puts children at risk. Little evidence addresses whether treatment for maternal depression is sufficient to improve child outcomes. An experiment was conducted testing whether psychotherapeutic treatment for mothers, suffering from major depression in the postpartum period, would result in improved parenting and child outcomes. Participants included depressed women randomly assigned to interpersonal psychotherapy (n = 60) or to a waitlist (n = 60), and a nondepressed comparison group (n = 56). At 6 months, depressed mothers were less responsive to their infants, experienced more parenting stress, and viewed their infants more negatively than did nondepressed mothers. Treatment affected only parenting stress, which improved significantly but was still higher than that for nondepressed mothers. Eighteen months later, treated depressed mothers still rated their children lower in attachment security, higher in behavior problems, and more negative in temperament than nondepressed mothers. Initial response to treatment did not predict reduced risk for poor child outcomes. Early maternal negative perceptions of the child predicted negative temperament and behavior problems 18 months after treatment. Treatment for depression in the postpartum period should target the mother-infant relationship in addition to the mothers' depressive symptoms.     

Patterns of brain electrical activity in infants of depressed mothers who breastfeed and bottle feed: the mediating role of infant temperament

Successful breastfeeding involves a dyadic interaction between a mother and her infant. The present study was designed to examine the association between breastfeeding and temperament in infants of depressed mothers. Seventy-eight mothers, 31 who were depressed, and their infants participated. Depressed mothers who had stable breastfeeding patterns were less likely to have infants with highly reactive temperaments. Multivariate analyses of variances (MANOVAs) showed that infants of depressed mothers who breastfed did not show the frontal asymmetry patterns, i.e., left frontal hypoactivity, previously reported. Moreover, breastfeeding stability, even in depressed mothers, was related to more positive dyadic interactions. Finally, a model was supported, in which the effects of maternal depression on infant feeding are mediated by infant frontal EEG asymmetry and infant temperament. These findings could provide a foundation for developing intervention techniques, employing breastfeeding promotion and support, directed toward attenuating the affective and physiological dysregulation already noted in infants of depressed mothers.     

Interactions between maternal characteristics and neonatal behavior in the prediction of parenting stress and perception of infant temperament

BACKGROUND: Prenatal cocaine exposure is a marker of developmental risk. Social environmental risk factors may include maternal stress and maternal perceptions of difficult infant temperament. OBJECTIVES: To examine factors that may predict or moderate maternal ratings of parenting stress and difficult temperament in cocaine-exposed (CE) infants. METHOD: Neonatal behavior, infant temperament, parenting stress, and maternal psychopathology were measured in a large sample of infant-mother dyads with prenatal CE and a nonexposed comparison sample. Participants were drawn from an existing longitudinal data set (Maternal Lifestyle Study). RESULT: Relations between neonatal behavior and infant temperament ratings were moderated by mothers' ratings of parenting stress. Relations between neonatal cry and parenting stress were moderated by maternal psychopathology ratings. Results were unrelated to drug exposure history. CONCLUSIONS: For mothers of at risk infants (with or without prenatal CE), psychological distress affects the degree to which infant behavioral characteristics are experienced as stressful or difficult. Implications for treatment and outcome are discussed.     

Mothers' dopamine receptor polymorphism modulates the relation between infant fussiness and sensitive parenting

We determined whether the combination of the 48‐bp variable number tandem repeat polymorphism of the dopamine (DRD4) gene and infants' (fussy‐difficult) temperament predicted parenting sensitivity. The sample was comprised of 147 mothers and their 6‐month olds. Sensitive parenting was assessed by coding filmed interactions between mothers and infants. Infant temperament was assessed by parents' reports on a standard questionnaire. Moderated regressions models, with maternal education and infants' interactive behavior as controls, were used to test our hypotheses. Results showed no main effects of either temperament or DRD4, though the maternal DRD4 × infant temperament interaction was significant. Probes indicated that parents with a DRD4 7‐repeat allele behaved more sensitively to fussier infants and less sensitively to less fussy infants compared to parents without the 7‐repeat allele. Among those parents, sensitivity did not vary with infant temperament. This pattern of results indicates that mothers are differentially susceptible to infant fussiness, dependent on the presence of the 7‐repeat DRD4 allele. © 2010 Wiley Periodicals, Inc. Dev Psychobiol 52:149–157, 2010     

Frontal brain electrical activity in infants of depressed and nondepressed mothers: relation to variations in infant behavior.

In previous studies, infants of depressed mothers have been found to exhibit reduced left frontal brain electrical activity (EEG). The left frontal region has been hypothesized to mediate social approach behaviors and positive affective expression. These findings raise important questions about the cause and nature of atypical EEG patterns in infants of depressed mothers. The present study begins to address some of these questions by examining whether or not variations in patterns of frontal brain activity in infants of depressed and nondepressed mothers are related to variations in infant behavior as observed in naturalistic situations. If such relations exist, are they specific to certain behaviors hypothesized to be mediated by the frontal region (i.e., positive approach behaviors)? Frontal and parietal brain electrical activity was recorded from 14- to 15-month old infants of depressed versus nondepressed mothers during a baseline condition and during conditions designed to elicit interest and positive affect. Infant behavior was observed in naturalistic play conditions, with and without mother, on a separate day from EEG testing. Mothers provided information on infant temperament. Infants of depressed mothers showed less affection and touching of their mothers. For infants of depressed mothers only, reduced left frontal brain activity was found to be related to lower levels of affection toward mother, but not to infant temperament. Furthermore, increased generalized frontal activation was found to be related to higher levels of negative affect, hostility, and tantrums and aggression. Relations between infant brain activity and behavior were not found for parietal EEG activity. These results suggest that infant frontal electrical brain activity is related to variations in infant behavior, especially those involved in positive affiliative behavior and the expression and regulation of negative affect. The nature and cause of atypical patterns of brain activity and question of whether such atypical patterns of frontal brain activity predispose infants to affective disorders in later life are discussed.     

Perceived social support interacts with prenatal depression to predict birth outcomes

Prenatal depression has been linked to adverse reproductive outcomes including preterm labor and delivery, and low birth weight. Social support also has been linked to birth outcomes, and may buffer infants from the adverse impact of maternal depression. In this prospective study, 235 pregnant women completed questionnaires about depression and social support. Clinical interviews were administered to assess for DSM-IV axis I disorders. Following delivery, birth outcomes were obtained from medical records. Babies of depressed mothers weighed less, were born earlier and had lower Apgar scores than babies of nondepressed mothers. Depressed women had smaller social support networks and were less satisfied with support from social networks. We found no direct associations between perceived social support and birth weight. However, depressed women who rated their partners as less supportive had babies who were born earlier and had lower Apgar scores than depressed mothers with higher perceived partner support. Women’s perception of partner support appears to buffer infants of depressed mothers from potential adverse outcomes. These results are notable in light of the low-risk nature of our sample and point to the need for continued depression screening in pregnant women and a broader view of risk for adverse birth outcomes. The results also suggest a possible means of intervention that may ultimately lead to reductions in adverse birth outcomes.     

The effect of postnatal depression on mother-infant interaction, infant response to the Still-face perturbation, and performance on an Instrumental Learning task

A representative community sample of primiparous depressed women and a nondepressed control group were assessed while in interaction with their infants at 2 months postpartum. At 3 months, infants were assessed on the Still-face perturbation of face to face interaction, and a subsample completed an Instrumental Learning paradigm. Compared to nondepressed women, depressed mothers' interactions were both less contingent and less affectively attuned to infant behavior. Postnatal depression did not adversely affect the infant's performance in either the Still-face perturbation or the Instrumental Learning assessment. Maternal responsiveness in interactions at 2 months predicted the infant's performance in the Instrumental Learning assessment but not in the Still-face perturbation. The implications of these findings for theories of infant cognitive and emotional development are discussed.     

Parenting stress in mothers of very-low-birth-weight (VLBW) and full-term infants: a function of infant behavioral characteristics and child-rearing attitudes

OBJECTIVE: To examine the moderating effects of child-rearing attitudes on the relation between parenting stress and infant behavioral characteristics for mothers of very-low-birth-weight (VLBW) and full-term infants. METHODS: Fifty-six 9-month-old infants (23 VLBW and 33 full-term) and their mothers were the participants. Mothers completed measures of parenting stress, child-rearing attitudes, infant temperament, and infant behavioral problems. RESULTS: The VLBW infants had a higher frequency of behavioral problems, and their mothers reported more child health concerns than the mothers of the full-term infants. Regression analyses showed that the relation between parenting stress and infant distress was moderated at medium and high levels of parental strictness for only the VLBW infants. CONCLUSIONS: The amount of stress the mothers of the VLBW infants experienced was a result of the congruence between their infant's behavioral characteristics and their own child-rearing attitudes.     

The depressed mother as a source of stimulation for her infant

Compared a group of 25 postpartum depressed mothers and 25 control mothers with respect to the level and quality of stimulation they provided for their newborn infants during a feeding session. Observer measures of maternal behavior included visual, auditory and kinesthetic stimulation and levels of unconditional positive regard. Results did not indicate any differences between the two groups in levels of stimulation. However, depressed mothers provided significantly lower levels of unconditional positive regard and exhibited less continuity of rocking behavior with their infants. A post hoc analysis that compared the extremes of the two S groups (N = 22) revealed significant differences in gazing behavior, with more depressed mothers gazing less at their infant's faces. Depressed mothers exhibited significantly lower levels of marital adjustment and had more extensive postpartum concerns. Contrary to expectations, no relationship was demonstrated between level of marital adjustment and maternal behavior toward the infant.     

Emerging self-regulation in toddlers born preterm or low birth weight: differential susceptibility to parenting?

The differential susceptibility to parenting model was examined in relation to toddler self-regulation in a prospective longitudinal study of infants born preterm or low birth weight. We followed 153 mother-infant dyads across five time points between the infant's Neonatal Intensive Care Unit stay and 24 months postterm. Assessments of infant temperament, quality of early parenting interactions, contextual variables, and toddler effortful control and behavior problems were conducted. Results supported differential susceptibility and dual risk models in addition to documenting main effects of early parenting on children's emerging self-regulation. Our data suggested that preterm or low birth weight infants who were prone to distress or rated by mothers as more difficult were particularly susceptible to the effects of early negative parenting.     

Thoughts of harming infants in depressed and nondepressed mothers.

BACKGROUND: Thoughts of harming the infant and other disturbing cognitions are frequently described in anecdotal reports on postpartum depression. These cognitions have not been examined empirically. METHODS: 100 clinically depressed mothers with a child under 3 years were evaluated and compared to a control group of 46 nondepressed mothers. RESULTS: 41% of depressed mothers compared to 7% of control mothers admitted to thoughts of harming their infant. Fear of being alone with the infant and inability to care for the infant were assessed only in depressed mothers and occurred less frequently. More than half of depressed mothers had problems in one of these three areas. CONCLUSIONS: Thoughts of harming the infant are common in depressed mothers. Demographic variables, psychosocial stressors and psychiatric variables do not help predict which mothers are likely to experience thoughts of harm or fear of being alone with the infant. These cognitive and affective disturbances may be one pathway by which maternal depression affects infants. LIMITATIONS: The control group was not given the full diagnostic interview. Consequently, the groups were not selected by identical procedures. Also fear of being alone with the infant and difficulty caring for the infant were not assessed in the control group.     

Infant and maternal behavior moderate reactivity to novelty to predict anxious behavior at 2.5 years

The degree to which infant regulatory behaviors, together with infant reactivity to novelty, predicted anxious behavior at 2.5 years, and the moderating effect of maternal behavior were tested. Sixty-four low-risk mothers and infants participated. Mothers rated infant negative reactivity and anxious behavior; infant and maternal behaviors were observed at 6 months postpartum. Based on results of hierarchical, multiple regressions, infant regulatory behaviors (i.e., attention control, withdrawal) moderated associations between reactivity to novelty and later anxious behavior, but predictions depended also on maternal behavior. High reactivity to novelty, in conjunction with withdrawal and with poor attention control, predicted anxious behavior only when mothers were less engaged or less sensitive, suggesting that maternal behavior alters developmental trajectories associated with infant temperament.     

Predicting aggressive behavior in the third year from infant reactivity and regulation as moderated by maternal behavior

The degree to which infant attention behaviors, together with infant reactivity to frustrating events, predict aggressive behavior at 2.5 years, and the moderating effect of maternal behavior were tested with 64 low-risk mothers and infants. Mothers rated infant negative reactivity at 5 months and aggressive behavior and maternal trait anger at 2.5 years; infant and maternal behaviors were observed at 6 months. Based on hierarchical multiple regressions, infant attention to frustrating events at 6 months positively predicted aggressive behavior, whereas looking away from frustrating events was associated with less aggressive behavior for girls only. High reactivity to limits predicted aggressive behavior only when mothers encouraged infant attention to the frustrating event, suggesting that maternal behavior amplifies developmental pathways associated with infant temperament.     

Development, behaviour and temperament: a prospective study of infants conceived through in-vitro fertilization

The development, behaviour and temperament of 65 singleton infants conceived through in-vitro fertilization (IVF) and 63 matched controls were compared at 1 year postpartum. Primiparous women were recruited during pregnancy and their infants' development was assessed at 1 year. In addition, test-taking behaviour was evaluated by an examiner using the Bayley behaviour rating scale and mothers completed a behaviour problem checklist and temperament scale. Mental, motor, speech and social development were appropriate for age, with no significant group differences. While receptive language development was in the normal range, IVF infants scored lower than control infants. Across both groups, mothers reported low levels of behaviour difficulty and mean temperament ratings were in the general population range. There were no group differences in observed test-taking behaviour. However, IVF mothers rated their children at a higher level of behaviour difficulty and more reactive than the ratings given by control mothers. Overall, singleton children conceived through IVF demonstrate appropriate general development at 1 year of age. The higher reported behaviour difficulty experienced by IVF mothers may reflect their concerns about the well-being and adjustment of their child during the first year.      

Modifying the Prematurity Stereotype in Mothers of Premature and Ill Full-Term Infants

Tested the efficacy of an information-based intervention in reducing prematurity stereotyping in 43 mothers of premature infants and in 32 mothers of ill full-term infants. Mothers either read a paragraph that stressed the similarities between premature and full-term infant development or were given no information about infant development. The mothers then viewed two videotapes of 9-month-old fullterm infants, one described as full term and one described as premature. Mothers who received no prior information about infant development rated the infants labeled premature as littler, less sociable, less cognitively competent, less behaviorally appealing, and less physically potent than infants labeled full term. Stressing similarities in premature and full-term infant development largely eliminated the prematurity stereotype. The application of these findings to hospital-based intervention with mothers of high-risk newborns is discussed.     

Depressed Mothers' Neonates Improve Following the MABI and a Brazelton Demonstration

Objective: To assess the effectiveness of a short-term interventionfor improving interaction behaviors of newborn infants withtheir depressed mothers. Method: Depressed mothers assigned to the experimental groupfirst observed an administration of the Neonatal BehavioralAssessment Scale (NBAS) at delivery. Mothers then used a similarinstrument, the Mother's Assessment of the Behavior of her Infant(MABI), to independently conduct NBAS-like infant assessmentsperiodically at home. Depressed mothers in the control groupwere not present when the NBAS was administered at delivery,and they periodically completed written assessments at homeof their parenting attitudes and infants' development. Results: One month NBAS assessments administered by an examinerrevealed that experimental group infants performed more optimallythan controls on Social Interaction and State Organization. Conclusions: Findings suggested that an intervention consistingof mothers taking part in NBAS/MABI assessments may be a simpleand cost effective technique for benefiting infants of depressedmothers during the early postpartum period.     

Maternal depression and infant daytime cortisol

The effect of maternal depressive disorder on infant daytime cortisol production was studied in three groups of infants; one group with mothers with comorbid depression and anxiety (n = 19), a second group with mothers with depression only (n = 7), and a third group with non‐depressed mothers (n = 24). The infants' cortisol production pattern was measured when they were 6, 12, and 18 months old in combination with repeated measures of parenting stress and depression symptoms. Multilevel modeling analyses showed that infants of mothers with comorbid depression and anxiety had relatively higher cortisol production from morning to bedtime and higher bedtime values as compared to infants of non‐depressed mothers and infants of depressed only mothers when they were 6 and 12 months old, but not when 18 months old. The results were interpreted in light of possible changes in the infants' stress regulatory capacities or changes in maternal coping strategies at infant age 18 months. © 2012 Wiley Periodicals, Inc. Dev Psychobiol 55: 334–351, 2013     

Depressed adolescents of depressed and nondepressed mothers: tests of an interpersonal impairment hypothesis

Two groups of depressed youngsters were compared. From an interpersonal perspective, it was hypothesized that depressed adolescents of depressed mothers would have significantly more interpersonal dysfunction than depressed youngsters of nondepressed mothers. In a large community sample of youth and their families, 65 depressed offspring of women with histories of a major depressive episode or dysthymia were compared with 45 depressed offspring of never-depressed women. As predicted, after controlling for current symptoms and family social status variables, depressed offspring of depressed mothers displayed significantly more negative interpersonal behaviors and cognitions compared with depressed offspring of nondepressed mothers, but they did not differ on academic performance. Implications concerning mechanisms, course, and consequences of different forms of adolescent depression are presented.     

Trajectories of mothers’ emotional availability: relations with infant temperament in predicting attachment security

The present study examined observations of parenting quality (mothers’ emotional availability – EA) during infant bedtimes at 4 points across the infants’ first year, assessing relations between levels and trajectories of EA and infant attachment at 12 months and the role of infant temperament in moderating these associations. The sample (N = 128) was predominantly Euro-American (82.5%) and at low socioeconomic risk. Latent growth curve modeling with latent basis coefficients indicated substantial individual differences in initial levels and slopes in EA trajectories across the first year. Both levels of maternal EA and EA trajectories across the first year predicted 12-month infant attachment security. Although maternal EA tended to decrease across the first year in the full sample, EA trajectories that showed a “bounce-back” between 6 and 12 months, suggesting more successful maternal adaptation to an expanding infant developmental repertoire, predicted greater infant security at 12 months. In addition, linkages between latent EA trajectories and 12-month attachment were moderated by 3-month infant temperamental reactivity and regulation. These findings indicate that infant attachment security is sensitive to both static and dynamic aspects of parenting quality across the first year, and that infant temperament can interact with both in predicting infant attachment.     

Social skills deficits and self-evaluation among depressed and nondepressed psychiatric inpatients

Depressed psychiatric inpatients, nondepressed psychiatric inpatients, and nonpsychiatric controls role-played responses to 28 standardized interpersonal situations. Judges blindly rated these responses on overall social skill and component measures, and subjects rated their own social skills. Judges rated depressed and nondepressed psychiatric patients as having significant problems in social skills compared to normals. No differences were found between the two patient groups in judges' ratings of social skill. Depressed patients rated their own recent interpersonal behavior and optimal social skills significantly lower than did subjects in the other groups. Results suggest that social skills deficits are not specific to depression and that depressives and other psychiatric groups may differ primarily in their self-appraisals of social competence.