Brief report: the risk of posttraumatic stress disorder in mothers of children diagnosed with pediatric cancer and type I diabetes

OBJECTIVE: To evaluate the risk of and predictors of enduring and late-onset posttraumatic stress disorder (PTSD) among mothers of children diagnosed with type I diabetes and cancer. METHOD: Mothers (N = 99) of children diagnosed with cancer or diabetes for at least 12 months completed a structured clinical interview for PTSD and self-report measures of PTSD, depression, anxiety, and stressful life events. RESULTS: There was no significant difference in the rate of PTSD between the two groups. Overall, fewer mothers (7%) met criteria for PTSD on the structured clinical interview than those on a self-report measure of PTSD (17%). Mothers who reported more depressive symptoms, anxiety, and stressful life events tended to report significantly more PTSD symptoms. CONCLUSIONS: The findings extend prior research regarding the prevalence rate and predictors of PTSD and PTSD symptoms in pediatric populations. It is recommended that clinicians exercise caution when interpreting prevalence rates for PTSD that are derived from self-report measures.     

Impact of postpartum depressive and anxiety symptoms on mothers’ emotional tie to their infants 2–3 months postpartum: a population-based study from rural Bangladesh

The purpose of this study was to investigate the impact of depressive and anxiety symptoms on maternal bonding to the infant 2–3 months postpartum and the influence of the mother’s bonding to the infant during pregnancy and to her own caregiver during her childhood on maternal bonding 2–3 months postpartum. This study originated from a community-based cohort study carried out in rural Bangladesh. Trained staff collected data and administrated the questionnaires during the third trimester of pregnancy, at childbirth and 2–3 months postpartum. Maternal depressive and anxiety symptoms were assessed with the Edinburgh Postnatal Depression Scale and the State Anxiety Inventory and the mother’s emotional bonding to the infant with the Postpartum Bonding Questionnaire. The results showed that 11% of the women reported depressive symptoms, 35% anxiety symptoms, 3.4% both depressive and anxiety symptoms and 51% neither depressive nor anxiety symptoms. Mothers with depressive symptoms were older, were poorer, fewer were literate, reported more intimate partner violence and showed lower emotional bonding to their infants 2–3 months postpartum compared to mentally well and anxious mothers. Approximately 11% of the mothers reported mild bonding disturbances and nearly one third of them showed depressive symptoms. Depressive symptoms and giving birth to a girl were negatively associated to a mother’s emotional bonding to her infant, while maternal anxiety symptoms and high bonding to the foetus during pregnancy were positively associated to the mother's emotional bonding to the infant 2–3 months postpartum.     

Depression and anxiety symptoms of mothers of preterm infants are decreased at 4 months corrected age with Family Nurture Intervention in the NICU

Preterm delivery can precipitate maternal psychological morbidities. Family Nurture Intervention (FNI) was designed to minimize these by facilitating the emotional connection between mother and infant, beginning early in the infant’s neonatal intensive care unit (NICU) stay. We examined depression and anxiety symptoms of mothers of preterm infants at 4 months infant corrected age (CA). One hundred fifteen mothers who delivered between 26 and 34 weeks gestational age were randomized to receive standard care (SC) or standard care plus FNI. Mothers’ self-reported depressive symptoms (Center for Epidemiologic Studies Depression Scale: CES-D) and state anxiety (Spielberger State-Trait Anxiety Inventory: STAI) symptoms were assessed at enrollment, near to term age, and 4 months (CA). At 4 months CA, mean CES-D and STAI scores were significantly lower in FNI mothers compared to SC mothers. Effectiveness of FNI can only be evaluated as an integrated intervention strategy as it was not possible to control all aspects of FNI activities. Although there was considerable loss to follow-up, analyses suggest that resulting biases could have masked rather than inflated the measured effect size for depressive symptoms. FNI may be a feasible and practicable way to diminish the impact of premature delivery on maternal depressive and anxiety symptoms.     

Anxiety and depression in mothers of children undergoing bone marrow transplant: symptom prevalence and use of the Beck depression and Beck anxiety inventories as screening instruments.

This study examined anxiety and depressive symptoms among 115 mothers of children undergoing bone marrow transplant and evaluated the ability of the Beck Anxiety Inventory (BAI; A. T. Beck, N. Epstein, et al., 1988) and the Beck Depression Inventory (BDI; A. T. Beck, 1978) to serve as screening tools for assessing generalized anxiety disorder (GAD), panic disorder (PD), and major depressive disorder (MDD). Mothers with BAI or BDI scores greater than or equal to 14 were administered a structured clinical interview. An additional 20% was randomly selected for interview to determine whether the scale cutoff was an accurate screening method. Among the 64 mothers interviewed, 20% received at least I of the 3 diagnoses. Although the BAI did not demonstrate predictive accuracy in assessing GAD and PD, the BDI did in assessing MDD. The results suggest that a subset of mothers may have an anxiety or depressive disorder and that investigators should use caution before using the BAI as a screening instrument for anxiety disorder.     

Maternal bonding in mothers with postpartum anxiety disorder: the crucial role of subclinical depressive symptoms and maternal avoidance behaviour

Hardly any research has examined the link between postpartum anxiety disorder and maternal bonding. This study examined if postpartum anxiety disorder and maternal bonding are related in the postpartum period. Thereby, subclinical depressive symptoms and specific aspects of an anxious symptomatology were also taken into consideration. The German sample of N?=?78 mother–infant dyads is composed of n?=?30 mothers with postpartum anxiety disorders but without major or minor depression according to the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) and n?=?48 healthy mothers. Subjects were interviewed with the Structured Clinical Interview for DSM-IV Disorders at an average infant age of M?=?4.1 months. Moreover, mothers filled out the Postpartum Bonding Questionnaire-16. The Anxiety Cognitions Questionnaire, the Body Sensations Questionnaire and the Mobility Inventory were chosen to assess different aspects of anxious symptomatology. To control for concurrent subclinical depressive symptoms, we used the German Edinburgh-Postnatal-Depression Scale. Mothers with postpartum anxiety disorder reported significantly lower bonding than healthy mothers. However, in a linear regression analysis, concurrent subclinical depressive symptoms and avoidance of anxiety-related situations in company explained 27 % of the overall variance in maternal bonding. The perceived lower bonding of mothers with anxiety disorder could be due to aspects of a concurrent subclinical depressive symptomatology. This notion emphasizes the need to target even mild depressive symptoms in the treatment of postpartum anxiety disorders. The outcomes also underline that the severity of anxious symptomatology, reflected by avoidance behaviour in company, puts the mother–infant bond at risk.     

Stability and individual change in depressive symptoms among mothers raising young children with ASD: maternal and child correlates

Mothers raising children with Autism Spectrum Disorders (ASD) evidence elevated depressive symptoms, but symptom stability has not been examined. Mothers (N=143) of toddlers with ASD (77% boys) were enrolled and assessed when their children were 18 to 33 months old and followed annually for 2 years. Multilevel modeling revealed no significant change in group depressive symptom level, which was in the moderately elevated range (Intercept=13.67; SE=.96). In contrast, there was significant individual variation in change over time. Child problem behaviors and delayed competence, maternal anxiety symptoms and angry/hostile mood, low parenting efficacy and social supports, and coping styles were associated with depression severity. Only maternal anxiety and parenting efficacy predicted individual change. Many mothers do not appear to adapt, supporting the need for early intervention for maternal well-being. © 2009 Wiley Periodicals, Inc. J Clin Psychol 65: 1–11, 2009.     

Type-D personality but not depression predicts severity of anxiety in heart failure patients at 1-year follow-up

BACKGROUND: Chronic heart failure (CHF) is a debilitating condition associated with poor outcome, including increased anxiety. However, anxiety and its determinants have not yet been studied systematically in CHF. We examined whether type-D personality and depressive symptoms would predict clinically significant anxiety at 1-year follow-up. METHODS: Consecutive patients with systolic CHF (n=149; 79% men; mean age 66+/-8.6) completed the type-D Scale (DS14), the Beck Depression Inventory, and the Anxiety Sensitivity Index at baseline. A clinical interview (Hamilton Anxiety Rating Scale) was used to assess clinically significant anxiety at 1-year follow-up. RESULTS: At 12 months follow-up, 26% (9/35) of type-D patients had clinically significant anxiety versus only 6% (7/114) of the non type-Ds (p=0.001). In univariable analyses, type-D personality (OR=5.3; p=0.002) and anxiety sensitivity (OR=4.5; p=0.009), but not depressive symptoms (p=0.27) predicted clinically significant anxiety. Type-D remained an independent predictor of anxiety at 1 year (OR=5.7; p=0.01), controlling for depressive symptoms, anxiety sensitivity, socio-demographic and clinical variables. Adding type-D in a hierarchical logistic regression model, comprising standard and psychological risk factors, enhanced the level of prediction of clinically significant anxiety substantially (-2LL=75.16 chi(2)=26.46; p=0.009). CONCLUSIONS: Type-D personality, but not depressive symptoms predicted 1-year clinically significant anxiety. The type-D scale could be used to identify CHF patients at high risk of anxiety, as these patients may be at an increased risk of adverse prognosis and impaired quality of life.     

Stress and adaptation in mothers of children with cerebral palsy

OBJECTIVE: To assess the importance of disability severity and child functional status as predictors of maternal depressive symptoms and the moderating effects of maternal appraisal, social support, and family income on the relationship between disability factors (severity and functional status) and maternal depressive symptoms. METHOD: Mothers of 270 children with cerebral palsy completed surveys on their appraisal of the child's disability, social support, and family demographics. Physicians assessed the severity of the disability and the child's functional status. RESULTS: Thirty percent of the mothers had depressive symptoms above the cutoff on a depression screening instrument. Disability severity and child's functional status did not predict maternal depression. Perceived social support moderated the relationship between the child's functional status and maternal depressive symptoms. CONCLUSIONS: Mothers of children with cerebral palsy may be at risk for depression. Interventions that take into account the moderating effects of social support may increase maternal adaptation.     

Stability and change in level of maternal depressive symptomatology during the first postpartum year

BACKGROUND: This study evaluated stability and change in the level of maternal depressive symptomatology over the course of the first postpartum year in a community cohort of 106 first-time mothers of full-term, healthy infants. Effects of diagnosed depression and infant gender were also assessed. METHODS: At 2 months postpartum (intake), mothers were classified into one of two symptom groups on the basis of their total score on the Center for Epidemiological Studies-Depression Scale (CES-D): high (CES-D score > or = 16, 46%) or normative (CES-D score = 2-12, 54%). Mothers completed the CES-D again at 3, 6, and 12 months postpartum. At 12 months, maternal diagnostic status for major depression and related disorders was evaluated using the Diagnostic Interview Schedule-III-Revised. RESULTS: Mothers in the High symptom group at intake continued to have significantly higher CES-D scores at 3, 6, and 12 months than mothers in the Normative symptom group at intake, and a third in the High symptom group at intake had a subsequent CES-D score above the clinical cutoff (> or = 16). Maternal CES-D scores were significantly correlated across visits. In regressions controlling for diagnostic status and infant gender, mothers' CES-D score at the most recent prior assessment contributed significant unique variance to mothers' CES-D score at each subsequent assessment. CES-D scores were higher at 3 months if mothers had diagnosed depression and were parenting a son, and higher at 12 months if mothers had both diagnosed depression and a prior, high CES-D score. LIMITATIONS: Findings may not generalize to multipara or high-risk cohorts. CONCLUSIONS: First-time mothers with high levels of depressive symptomatology at 2 months postpartum (especially those with diagnosed depression) are at increased risk of continuing to experience high levels of depressive symptomatology throughout the first postpartum year. Implications for preventative intervention services are discussed.     

Mediators of depressive symptoms in children with type 1 diabetes and their mothers

OBJECTIVE: To examine the relationships among maternal and child depressive symptoms and child and family psychosocial factors. METHOD: Secondary analysis of baseline data for a coping skills intervention for school-age children (ages 8-12) with type 1 diabetes (T1D) and their mothers. Children and mothers completed measures of depressive symptoms, coping, quality of life, and family functioning. RESULTS: There was a strong relationship between maternal and child depressive symptoms (r = .44, p < .001). Maternal depressive symptoms were negatively related to child quality of life, perceptions of coping, and family functioning. Impact of diabetes on quality of life, finding coping with diabetes upsetting, and family warmth mediated the relationship between maternal and child depressive symptoms. CONCLUSIONS: Maternal depression may negatively affect child adjustment through its influence on quality of life, coping, and family functioning. Implications for interventions to improve psychosocial adjustment in children with T1D are discussed.     

The experience of labor, maternal perception of the infant, and the mother’s postpartum mood in a low-risk community cohort

Postpartum negative mood interferes with maternal–infant bonding and carries long-term negative consequences for infant growth. We examined the effects of birth-related risks on mother’s postpartum anxiety and depression. A community cohort of 1,844 low-risk women who delivered a singleton term baby completed measures assessing delivery, emotions during labor, attitudes toward pregnancy and infant, mood regulation, and postpartum anxiety and depression. Under conditions of low risk, 20.5% of parturient women reported high levels of depressive symptoms. Following Cesarean Section Delivery (CSD), 23% reported high depressive symptoms, compared to 19% following Vaginal Delivery (VGD), and 21% after Assisted Vaginal Delivery (AVGD). State anxiety was highest in CSD and lowest in VGD. Mothers undergoing CSD experienced labor as most negative, reported highest somatic symptoms during the last trimester, and were least efficient in regulating negative mood. Postpartum depression was independently associated with higher maternal age, CSD, labor pain, lower negative and higher positive emotions during labor, inefficient mood regulation, somatic symptoms, and more negative and less positive perception of fetus during last trimester. Results demonstrate that elevated depressive symptoms are prevalent in the postpartum even under optimal socioeconomic and health conditions and increase following CSD. Interventions to increase positive infant-related perceptions and emotions may be especially important for promoting bond formation following CSD.     

Impact of a multiple, IVF birth on post-partum mental health: a composite analysis

BACKGROUND: This study explored the impact of a multiple IVF birth on maternal mental health in the early post-partum period. METHODS: A prospective study of 207 women who had conceived following IVF treatment and followed up at 6 weeks post-partum. Mothers rated their mood using the Edinburgh postnatal depression scale (EPDS) and their baby's behaviour using the Unsettled and Irregular Behaviour scale. Mothers' emotional well-being was explored using theme analysis of semi-structured telephone interviews. RESULTS: Of the 175 (84.5%) followed up post-partum, 56 (32%) had a multiple birth (7 triplets, 49 twins). Nearly 16% of mothers in the multiple group scored>12 on the EPDS indicating clinically significant symptoms, which represented a 3-fold increased risk compared to mothers of singletons (Odds ratio=3.4, Confidence Interval=1.011-11.618, P=0.048). Unsettled and irregular infant behaviour was another independent risk factor. Qualitative analysis of interviews identified 12 themes. Mothers of multiples were more likely to express negative themes including 'tiredness' (P<0.01), 'feelings of stress/depression' (P<0.05) and 'questioning parenthood' (P<0.05). Mothers of singletons were more likely to be 'feeling wonderful', reflecting their delight in parenthood (P<0.05). CONCLUSIONS: Mothers of multiples are at increased risk of poorer emotional well-being. Clinicians should focus on the psychological benefits of a singleton birth.     

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     

Modifiable factors associated with changes in postpartum depressive symptoms

Up to 50% of mothers report postpartum depressive symptoms yet providers do a poor job predicting and preventing their occurrence. Our goal was to identify modifiable factors (situational triggers and buffers) associated with postpartum depressive symptoms. Observational prospective cohort telephone study of 563 mothers interviewed at 2 weeks and 6 months postpartum. Mothers reported on demographic factors, physical and emotional symptoms, daily function, infant behaviors, social support, and skills in managing infant and household. Mothers were categorized into four groups based on the presence of depressive symptoms at 2 weeks and at 6 months postpartum: never, always, late onset, and remission groups. Fifty-two percent did not have depressive symptoms at 2 weeks or at 6 months (never group), 14% had symptoms at both time points (always group), 10% had late onset, and 24% had early onset of symptoms with remission. As compared with women in the never group, women in the always and late onset groups had high-risk characteristics (e.g., past history of depression), more situational triggers (e.g., physical symptoms), and less robust social and personal buffers (i.e., social support and self-efficacy). As compared with the never group, mothers in the remission group had more situational triggers and fewer buffers initially. Changes in situational triggers and buffers were different for the four groups and were correlated with group membership. Situational triggers such as physical symptoms and infant colic, and low levels of social support and self-efficacy in managing situational demands are associated with postpartum depressive symptoms. Further research is needed to investigate whether providing education about the physical consequences of childbirth, providing social support, and teaching skills to enhance self-efficacy will reduce the incidence of postpartum symptoms of depression.     

Maternal expressed emotion and metabolic control of children and adolescents with diabetes mellitus

BACKGROUND: The objectives of this study of children and adolescents with diabetes were to: (1) examine whether maternal expressed emotion (EE), in the form of critical comments (CC), hostility and emotional overinvolvement (EOI), is related to metabolic control; (2) determine if CC and EOI are separately related to poor metabolic control, and (3) ascertain whether high EE is related to psychopathology in these children. METHODS: The Present Episode version of the Schedule for Affective Disorders and Schizophrenia for School-Age Children (Kiddie-SADS-P/K-SADS-P) interview was administered to 55 children and adolescents with diabetes and the parental EE instrument, the 5-min speech sample, to 55 mothers. The same instruments were utilized with the 54 controls and their mothers. Glycosylated hemoglobin A1 values were used as a measure of metabolic control. RESULTS: More than half of the children with diabetes (58.2%) had mild to moderate symptoms of anxiety or depression as compared to 9.3% of the controls. High EE was exhibited by 70.9% of the index group mothers in contrast to only 29.6% of the control group mothers. High maternal EE was not related to the psychopathology of children with diabetes. High maternal EE and in particular its EOI component and excessive detail (a subcategory of EOI) were related to poor metabolic control of the index children. CONCLUSIONS: Maternal EE is related to metabolic control in childhood diabetes; maternal EOI in particular is related to poor metabolic control. Mental health professionals should work with mothers of children with diabetes in an effort to modify such attitudes and emotions.     

A follow-up study of DSM-III-R generalized anxiety disorder with syndromal and subsyndromal major depression

OBJECTIVE: The authors examined the long-term outcome of generalized anxiety disorder with depressive symptoms utilizing both categorical and dimensional analyses. METHOD: Thirty-nine out-patients with a DSM-III-R diagnosis of generalized anxiety disorder (GAD) with depressive symptoms, both with (n=23) and without (n=16) syndromal major depression (MD) participated in an 11-week clinical trial. Approximately 18 months after initial screening, these individuals were once again evaluated using a structured diagnostic interview and a battery of rating scales. RESULTS: Three distinct groups were discernible at follow-up. Twenty-three (60%) of the patients remained syndromal for GAD; 10 patients (43%) were in partial remission from GAD; six (15%) were asymptomatic. Of the 23 patients who were syndromal for MD at baseline, 13 (56%) remained syndromal for MD at follow-up. All of the patients who were syndromal for MD at follow-up remained syndromal for GAD as well. CONCLUSIONS: Outcomes in this study were quite divergent, though they support the concept of GAD as a chronic illness in most patients, with or without MD. The presence or absence of MD versus subsyndromal depression at baseline appeared to have relatively little impact upon the outcome. Patients with subsyndromal anxiety and depressive symptoms may be at special risk for syndromal disorders over time.     

Parity mediates the association between infant feeding method and maternal depressive symptoms in the postpartum

Summary Maternal depression is the most common complication of the postpartum, having devastating and long lasting effects on mother and infant. Lactation is associated with attenuated stress responses, especially that of cortisol, and the lactogenic hormones, oxytocin and prolactin, are associated with anti-depressant and anxiolytic effects. These associations suggest that breast-feeding may decrease maternal depressive symptoms, yet empirical results have been conflicting. Recent findings have indicated that parity may mediate the association between breast-feeding and stress response. Because a decreased stress response is associated with a decreased risk for depression, parity may also mediate the association between infant feeding method and depressive symptoms. Specifically, the benefits of breast-feeding may appear in multiparous but not primiparous mothers. In the present study, data drawn from a national sample of primiparous and multiparous mothers were examined for possible associations between infant feeding method and depressive symptoms, as assessed by the Center for Epidemiological Survey-Depression scale (CES-D). After controlling for several possible confounding variables, breast-feeding by multiparas was associated with significantly decreased odds of having depression compared with bottle-feeders (OR = 0.41, CI 0.19–0.87, p = 0.02); however, no risk reduction from breast-feeding was evident among primiparas. The results support a parity-mediated association between lactation and maternal depressive symptoms. The results provide a reason for earlier conflicting findings, present new research avenues, and suggest possible clinical approaches. Correspondence: Elizabeth Sibolboro Mezzacappa, Ph.D., 93 Stony Road, Edison, NJ 08817-3726, U.S.A.     

Fragmented maternal sleep is more strongly correlated with depressive symptoms than infant temperament at three months postpartum

To determine the contribution of infant temperament to the relationship between maternal sleep disturbance and depressive symptoms. Utilizing a repeated measures design, 112 couples recruited from childbirth education classes were assessed in third trimester and postpartum. Instruments included Center for Epidemiologic Studies Depression Scale, General Sleep Disturbance Scale, wrist actigraphy, and an investigator-developed tool to assess infant temperament completed by mothers and fathers. Regardless of infant temperament, mothers who slept < 4 h between midnight and 6 am and mothers who napped < 60 min during the day were at increased risk for depression at three months postpartum. Infant temperament was associated with maternal sleep but was not a significant predictor of depressive symptoms after controlling for other contextual factors. Postpartum clinical visits should include questions about maternal sleep so interventions can be directed toward sufficient sleep to minimize risk of postpartum depression.     

Child and genetic variables associated with maternal adaptation to fragile X syndrome: a multidimensional analysis

One hundred eight carrier mothers (95 premutation, 13 full mutation) of children with the full mutation fragile X syndrome completed seven scales to assess maternal stress, depressive symptoms, anger, anxiety, quality of life, hope, and optimism. A wide range of responses was found on each measure, with most mothers scoring in the non-clinical range on any individual measure. However, nearly half of the mothers scored in the clinically significant range on at least one measure and 25% on two or more measures. High stress and low quality of life were the most common domains of concern. Mothers with the full mutation generally did not differ from mothers with the premutation. CGG repeat length was not associated with responses on any of the measures completed by mothers with the premutation. Severity of the child's delay was not associated with any of the outcome measures, but child behavior problems accounted for significant variance in stress, depressive symptoms, anxiety, anger, and quality of life. Maternal adaptation appears to be a multidimensional phenomenon experienced in unique ways by each mother. Most mothers experienced positive adaptation, but a subset appear to be more vulnerable, especially those with children who have significant behavior problems. Future research needs to identify family, child, and support factors associated with maternal vulnerability and how adaptation changes over time in response to these factors.     

Associations between maternal depression and mother and infant oxytocin receptor gene (OXTR_rs53576) polymorphisms

Polymorphisms in the oxytocin receptor gene, OXTR_rs53576, have been linked to differences in maternal sensitivity and depressive symptoms. Although some studies suggest the A allele confers risk for mood disorders, individuals homozygous for the G allele may exhibit greater sensitivity to both positive and negative social experiences, including in the mother–infant dyad. Given the bi-directional nature of mother–infant influences on maternal mood, we tested the association between both mothers’ and infants’ OXTR_rs53576 genotype and maternal depression, as assessed through a self-report inventory. Although Beck Depression Inventory (BDI-II) scores were significantly higher for GG in comparison to AG/AA mothers, and for mothers of GG in comparison to AG/AA infants, an ANCOVA revealed that after sociodemographic risk factors had been controlled, infants’, but not mothers’, OXTR genotype predicted maternal depression scores, with no significant interaction between the two. The effect of infant OXTR on maternal depression was not explained by maternal reports of difficult infant temperament. We propose that GG infants have an enhanced capacity for processing both positive and negative socially meaningful contextual information, first amplifying and then differentially perpetuating negative affectivity in mothers who exhibit depressive characteristics.