Postpartum depression and mother-infant relationship at 3 months old

Background: This paper is part of a prospective, epidemiologic study concerning postpartum depression (PPD). The women were first examined during pregnancy; after delivery they were seen with their infants at 3 and 18 months. The present study focuses on the 3-months-postpartum results. Methods: A sample of 570 women and their infants were examined 3 months after delivery. Using the EPDS (Edinburgh Postnatal Depression Scale; Cox et al., 1987. Br. J. Psychiatry 150:782–786), 10.2% of these new mothers presented PPD. The focus of the study concerned the effects of this neurotic disorder on the mother, the infant and on the mother–infant relationship. Results: The deleterious effects concerning the infant were functional disorders such as eating or sleeping difficulties. The ‘depressed’ dyads presented less vocal and visual communications, less corporal interactions and less smiling. Conditions surrounding delivery and tiredness at 3 months are linked to difficulties in mother–infant relationship for the non-depressed mothers. Logistic models showed that primiparous PPD mothers have difficulties bathing their infants, whereas multiparous PPD mothers are more tired. Limitation: This study did not take into account either protective factors or the effects of the infant himself. Clinical relevance: Knowledge of the mothers’ and infants’ difficulties may help caregivers to detect these at-risk dyads and initiate therapeutic measures.     

PREPP: postpartum depression prevention through the mother–infant dyad

Most interventions to prevent postpartum depression (PPD) focus on the mother rather than the mother–infant dyad. As strong relationships between infant sleep and cry behavior and maternal postpartum mood have been demonstrated by previous research, interventions targeted at the dyad may reduce symptoms of PPD. The goal of the current study was to examine the effectiveness of Practical Resources for Effective Postpartum Parenting (PREPP). PREPP is a new PPD prevention protocol that aims to treat women at risk for PPD by promoting maternally mediated behavioral changes in their infants, while also including mother-focused skills. Results of this randomized control trial (RCT) (n?=?54) indicate that this novel, brief intervention was well tolerated and effective in reducing maternal symptoms of anxiety and depression, particularly at 6 weeks postpartum. Additionally, this study found that infants of mothers enrolled in PREPP had fewer bouts of fussing and crying at 6 weeks postpartum than those infants whose mothers were in the Enhanced TAU group. These preliminary results indicate that PREPP has the potential to reduce the incidence of PPD in women at risk and to directly impact the developing mother–child relationship, the mother’s view of her child, and child outcomes.     

Postnatal depression and mother and infant outcomes after infant massage

BACKGROUND: Postnatal depression can be a long lasting condition which affects both the mother and her baby. A pilot study indicated that attending baby massage improved maternal depression and mother-infant interactions. The current study further investigates any benefits of baby massage for mothers with postnatal depression and their infants. METHODS: Mothers scoring (3)13 on the Edinburgh Postnatal Depression Scale (EPDS) at 4 weeks postpartum were randomly assigned to attend baby massage classes (n=31) or a support group (n=31). They completed depression, anxiety and Infant Characteristics Questionnaires and were filmed interacting with their infants before and after 6 intervention sessions, and at one year. Thirty four non-depressed mothers also completed the study. RESULTS: More of the massage than support group mothers showed a clinical reduction in EPDS scores between four weeks and outcome (p<0.05). At one year, massage-group mothers had non-depressed levels of sensitivity of interaction with their babies, whereas the support group did not. There were no other differences in either mother or child between the two intervention groups. Depressed mothers did not achieve control depression or anxiety scores at one year. LIMITATIONS: For ethical reasons, the study did not include a control group of depressed mothers who did not receive an intervention. CONCLUSIONS: Both intervention groups showed reductions in depression scores across the study period, but the massage group did better on some indices. They also had somewhat better interactions with their infants at one year, but these effects were limited.     

Emotional reactivity in infants with congenital heart defects and maternal symptoms of postnatal depression

The object of this study was to examine the role of emotional reactivity in infants with congenital heart defects (CHD) in relation to their mothers' symptoms of postnatal depression. The study population was drawn from the Norwegian country-wide CHD registry from the Department of Pediatric Cardiology at Oslo University Hospital and the Norwegian Mother and Child Cohort Study. Mother–infant dyads with mild/moderate or severe CHD (n = 242) were assessed with a 6-item short version (EPDS-6) of the Edinburgh Postnatal Depression Scale and the Infant Characteristic Questionnaire's fussy/difficult subscale (ICQ-D/F-7) at 6 months postpartum. When adjusting for infant emotional reactivity, mothers of infants with severe CHD showed significantly elevated symptoms of postnatal depression 6 months postpartum (odds ratio = 2.22) compared to the mothers of infants with mild/moderate CHD. The results identify severe CHD in infants as a predictor of heightened symptoms of postnatal depression in mothers, independent of the infant's emotional reactivity. Although a causal direction underlying the association could not be determined, the possible, negative reciprocal relationships between severe CHD in infants, high levels of emotional reactivity in infants, and symptoms of maternal postnatal depression are considered.     

Interventions for the prevention of postpartum depression in adolescent mothers: a systematic review

Postpartum depression (PPD) is a major public health problem affecting 10–57% of adolescent mothers which can affect not only adolescent mothers but also their infants. Thus, there is a need for interventions to prevent PPD in adolescent mothers. However, recent systematic reviews have been focused on effective interventions to prevent PPD in adult mothers. These interventions may not necessarily be applicable for adolescent mothers. Therefore, the purpose of this review was to examine the effectiveness of the existing interventions to prevent PPD in adolescent mothers. A systematic search was performed in MEDLINE, CINAHL, and SCOPUS databases between January 2000 and March 2017 with English language and studies involving human subjects. Studies reporting on the outcomes of intervention to prevent PPD particularly in adolescent mothers were selected. Non-comparative studies were excluded. From 2002 identified records, 13 studies were included, reporting on 2236 adolescent pregnant women. The evidence from this systematic review suggests that 6 of 13 studies from both psychological and psychosocial interventions including (1) home-visiting intervention, (2) prenatal antenatal and postnatal educational program, (3) CBT psycho-educational, (4) the REACH program based on interpersonal therapy, and (5) infant massage training is successful in reducing rates of PPD symptoms in adolescent mothers in the intervention group than those mothers in the control group. These interventions might be considered for incorporation in antenatal care interventions for adolescent pregnant women. However, this review did not find evidence identifying the most effective intervention for preventing postpartum depression symptoms in adolescent mothers.

     

Personal relatedness and attachment in infants of mothers with borderline personality disorder

The principal aim of this study was to assess personal relatedness and attachment patterns in 12-month-old infants of mothers with borderline personality disorder (BPD). We also evaluated maternal intrusive insensitivity toward the infants in semistructured play. We videotaped 10 mother-infant dyads with borderline mothers and 22 dyads where the mothers were free from psychopathology, in three different settings: a modification of Winnicott's Set Situation in which infants faced an initially unresponsive ("still-face") stranger, who subsequently tried to engage the infant in a game of give and take; the Strange Situation of Ainsworth and Wittig; and a situation in which mothers were requested to teach their infants to play with miniature figures and a toy train. In relation to a set of a priori predictions, the results revealed significant group differences as follows: (a) compared with control infants, toward the stranger the infants of mothers with BPD showed lower levels of "availability for positive engagement," lower ratings of "behavior organization and mood state," and a lower proportion of interpersonally directed looks that were positive; (b) in the Strange Situation, a higher proportion (8 out of 10) of infants of borderline mothers were categorized as Disorganized; and (c) in play, mothers with BPD were rated as more "intrusively insensitive" toward their infants. The results are discussed in relation to hypotheses concerning the interpersonal relations of women with BPD, and possible implications for their infants' development.     

Attachment quality is related to the synchrony of mother and infant monitoring patterns

We investigated whether attachment quality is related to infant–mother dyadic patterns in monitoring animated social situations. Sixty 12-month-old infants and their mothers participated in an eye-tracking study in which they watched abstractly depicted distress interactions involving the separation of a “baby” and a “parent” character followed by reunion or further separation of the two characters. We measured infants’ and their mothers’ relative fixation duration to the two characters in the animations. We found that infant attachment disorganization moderated the correspondence between the monitoring patterns of infant–mother dyads during the final part of the animations resulting in reunion or separation. Organized infants and their mothers showed complementary monitoring patterns: the more the mothers focused their attention on the “baby” character, the more the infants focused their attention on the “parent” character, and vice versa. Disorganized infant–mother dyads showed the opposite pattern although the correlation was nonsignificant: mothers and their infants focused on the same character. The attachment-related differences in the nature of the synchrony in the attentional processes of infants and their mothers suggest that by 12 months the dyads’ representations of social situations reflect their shared social–emotional experiences.     

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.     

Patient choice of treatment for postpartum depression: a pilot study

Summary Objective: The lack of systematic efficacy research makes the selection of optimal treatment for postpartum depression (PPD) difficult. Moreover, the treatment decisions for women with PPD who are breastfeeding are heavily influenced by their concerns about infant exposure to antidepressant medication. The objective of this pilot trial was to examine the clinical characteristics of women with PPD associated with treatment selection. Method: This open pilot trial offered 23 women with PPD one of 3 treatment options: sertraline, interpersonal psychotherapy (IPT), or their combination administered in an outpatient mental health setting over 12 weeks. Baseline and treatment outcome measures included the Hamilton Rating Scale for Depression (HRSD), the Beck Depression Inventory (BDI) and the Edinburgh Postnatal Depression Scale (EPDS). Results: Completers across all 3 treatment groups (n = 18) experienced significant clinical improvement with each of the 3 treatment modalities on the HRSD (p < 0.001), BDI (p < 0.001) and EPDS (p < 0.001). There were trends for women with a prior depression to more frequently choose sertraline as a treatment (alone or with IPT, p = 0.07), and for women who were breastfeeding to choose sertraline (alone or with IPT, p = 0.10) less frequently. Conclusion: In this small sample of women with PPD, most women chose IPT with or without sertraline. A larger randomized study could further confirm the suggested predictors of treatment selection identified in this study: previous depression and breastfeeding status.     

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.     

An experimental study on developmental changes of maternal discrimination of infants in crab-eating monkeys (Macaca fascicularis)

Individually reared mother-infant dyads of crab-eating monkeys (Macaca fascicularis) were observed cross-sectionally in their mother-infant relationship. In infants aged from 0 to 5.0 months, rather drastic changes were found both at 0.5-1.0 and 2.0-3.0 months of age. For an explanation of these changes, developmental processes of discrimination between mother and infant were analyzed cross-sectionally by exchanging mother-infant combinations. The results indicated that the first 0.5 months postpartum was characterized as a behaviorally nondiscriminating stage where nipple discrimination by infants was the only exception. The latter half of the first month was the beginning of a nonaggressive discrimination stage by mothers, indicated by lipsmacking and sniffing and in infants by clinging. When infants reached the age of 2.0-3.0 months, the mothers' nonaggressive discrimination with lipsmacking decreased, and her aggressive discrimination of alien infants increased. In addition to maternal visual discrimination of infants' physical appearances, differences in infants' odor and/or their method of nipple contact were suggested to affect the mothers' differential behaviors.     

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.     

Maternal touch and maternal child-directed speech: effects of depressed mood in the postnatal period

BACKGROUND: Postnatal depression affects the emotional state of mothers and the quality of mother-infant interaction. METHOD: Touch behaviour and content of child-directed speech were analysed for 72 mothers and their infants during pleasurable play. Infants (18) of mothers with depressed mood and 18 controls were seen when they were 6 months old; and 18 infants of mothers with depressed mood and 18 controls were seen when they were 10 months old. RESULTS: Depressed mothers in comparison with non-depressed mothers lifted their infants more, restraining their behaviours. Infants of depressed mothers in contrast to infants of non-depressed mothers spent greater periods of time in touching self rather than mother or toy, compensating for the lack of positive touch from their mothers. Mothers with depressed mood of 6-month-old infants included fewer affective and informative features in their speech than their controls. Non-depressed mothers of younger babies showed a higher use of affective features when compared with non-depressed mothers of older infants. In contrast, depressed mothers of 6- and 10-month-old babies showed similar frequencies of affect-salient speech during interactions in spite of their infants' changing developmental demands. LIMITATIONS: Mothers in this study were only mildly depressed, as assessed by the Edinburgh Postnatal Depression Scale (EPDS). Nevertheless, the findings indicate that mothers with depressive symptoms differ from non-depressed mothers in relation to touch and content of speech when interacting with their infants. CONCLUSIONS: These results suggest that postnatal depression may influence touch behaviour as well as the affective and informative content of maternal speech. The effect is that mothers with depressed mood in comparison with non-depressed mothers touch their infants more negatively and their speech is less well adjusted concerning the amount of emotional vs. information-related content thereby preventing depressed mothers from responding effectively to their infants' developmental needs.     

Physiological measures of mother–infant interactional synchrony

Mother–infant interactional synchrony has been hypothesized to be crucial for the development of many key neurodevelopmental behaviors in infants, including speech and language. Assessing synchrony is challenging because many interactive behaviors may be subtlety, if at all, observable in overt behaviors. Physiological measures, therefore, may provide valuable physiological/biological markers of mother–infant synchrony. We have developed a multilevel measurement platform to assess physiological synchrony, attention, and vocal congruency during dynamic face-to-face mother–infant interactions. The present investigation was designed to provide preliminary data on its application in a group of 10 mother–infant dyads (20 subjects) ranging in age from 7 to 8.5 months at the time of the experimentation. Respiratory kinematics, heart rate, and vocalization were recorded simultaneously from mothers and infants during nonstructured, face-to-face interactions. Novel statistical methods were used to identify reliable moments of synchrony from cross-correlated, mother–infant respiration and to tag infant attention from heart rate deceleration. Results revealed that attention, vocal contingency, and respiratory synchrony are temporally clustered within the dyad interaction. This temporal alignment is consistent with the notion that biological synchrony provides a supportive platform for infant attention and mother–infant contingent vocalization.     

Face-to-Face Interaction Between Infants with Orofacial Clefts and Their Mother

Compared mother-infant face-to-face (en face) interaction among3-month-old infants with cleft lip and palate (CLP), infantswith isolated cleft palate (CP), or nonimpaired infants (NI).The Monadic Phase system (Tronick, Als, & Brazelton, 1980)was used to describe patterns of laboratory en face interactionin 116 mother-infant dyads. Diagnostic group comparisons ofpercentages of monadic phases and infant-mother monadic phasesequences revealed more similarities than differences. However,CP group mothers appeared less involved in en face interactionthan mothers in the CLP group. Low maternal involvement in thecombined cleft groups was predicted by concurrent measures ofinfant characteristics including infant negative reactivity,whereas low maternal involvement in the comparison group waspredicted by maternal characteristics including low psychologicaldistress. There was little evidence to suggest that anomalousfacial appearance is a significant factor influencing the qualityof early mother-infant interaction. Assessing other characteristicsof the infant and the broader social context is also important.     

Antenatal cognitive-behavioral therapy for prevention of postpartum depression: a pilot study

PURPOSE: To examine the efficacy of cognitive-behavioral therapy (CBT) for the prevention of postpartum depression (PPD) in "at risk" women. MATERIALS AND METHODS: We recruited 927 pregnant women in 6 obstetric and gynecology clinics and screened them using Beck Depression Inventory (BDI). Ninety-nine of the screened women who had significantly high scores in BDI (a score above 16) were selected for the study. They were contacted through by telephone, and 27 who had consented to participate in the study were interviewed via SCID-IV-I. Twenty-seven eligible women were randomly assigned to the CBT intervention (n = 15) and control condition (n = 12). All participants were required to complete written questionnaires, assessing demographic characteristics, depressive symptoms, negative thoughts, dyadic communication satisfaction, and global marital satisfaction prior to treatment and approximately 1 month postpartum. The 15 women in the CBT condition received 9 bi-weekly 1-hour individual CBT sessions, targeting and modifying negative patterns of thinking and behaviors occurring in the context of the dyadic relationship. RESULTS: The analysis of covariance (ANCOVA) showed that there were significant differences in all postpartum measures between the 2 groups, indicating that our antenatal intervention with CBT was effective in reducing depressive symptoms and improving marital satisfaction, which lasted until the postpartum period. CONCLUSION: Our pilot study has provided preliminary empirical evidence that antenatal CBT intervention can be an effective preventive treatment for PPD. Further study in this direction was suggested.     

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.     

Attachment,depression, and cortisol: Deviant patterns in insecure‐resistant and disorganized infants

Both attachment insecurity and maternal depression are thought to affect infants' emotional and physiological regulation. In the current study, Strange Situation Procedure (SSP) attachment classifications, and cortisol stress reactivity and diurnal rhythm were assessed at 14 months in a prospective cohort study of 369 mother–infant dyads. Maternal lifetime depression was diagnosed prenatally using the Composite International Diagnostic Interview (CIDI). Insecure‐resistant infants showed the largest increase in cortisol levels from pre‐ to post‐SSP; the effect was even stronger when they had depressive mothers. Disorganized children showed a more flattened diurnal cortisol pattern compared to nondisorganized children. Findings are discussed from the perspective of a cumulative risk model. © 2010 Wiley Periodicals, Inc. Dev Psychobiol 52: 441–452, 2010.     

A behavioral-educational intervention to promote maternal and infant sleep: a pilot randomized, controlled trial

STUDY OBJECTIVES: Maternal and infant sleep are significant health concerns for postpartum families. The results of previously published studies have indicated that behavioral-educational strategies promote infant sleep, but these reports relied on parental report and did not include maternal sleep. This pilot study of a maternal-infant sleep intervention evaluated feasibility, acceptability, and effects on sleep and other outcomes in the early postpartum period. DESIGN: Randomized controlled trial with concealed-group allocation. SETTING: Hospital postpartum unit with home follow-up. PARTICIPANTS: First-time mothers and their infants randomly assigned to sleep intervention (n = 15) or control group (n = 15). INTERVENTIONS: The sleep intervention included a 45-minute meeting with a nurse to discuss sleep information and strategies, an 11-page booklet, and weekly phone contact to reinforce information and problem solve. The control group received a 10-minute meeting during which only maternal sleep hygiene and basic information about infant sleep were discussed, a 1-page pamphlet, and calls at weeks 3 and 5 to maintain contact without provision of advice. MEASUREMENT AND RESULTS: Questionnaires were completed at baseline and 6 weeks; sleep diaries and mother and infant actigraphy were completed at 6 weeks. The mothers in the sleep intervention group averaged 57 minutes more nighttime sleep, and fewer rated their sleep as a problem, as compared with the mothers in the control group. Infants in the sleep intervention group had fewer nighttime awakenings and had maximum lengths of nighttime sleep that were, on average, 46 minutes longer than those in the control group. CONCLUSIONS: A behavioral-educational intervention with first-time mothers in the early postpartum period promotes maternal and infant sleep. Further evaluation of the intervention in a larger, more diverse sample is needed.