Interventions with depressed mothers and their infants: modifying interactive behaviours

BACKGROUND: Postpartum depression (PPD) has a prevalence ranging from 3% to 30% and is associated with serious infant growth and developmental problems. Interventions directed at improving maternal mood have been unsuccessful in producing changes in observed face-to-face interactions between mother and infant. The Keys to Caregiving (KTC) is an intervention program that helps parents to understand and respond to infant behaviours, with a goal of increasing positive affective expressions in infants. In this pilot study, KTC was used with mothers suffering from mild to moderate PPD and their infants. METHODS: PPD was confirmed by scores on the Edinburgh Postnatal Depression Scale and the Beck Depression Inventory. Eleven dyads completed the study. KTC was carried out in 5 weekly group sessions, beginning at infant age of 3 months. Dyads were videotaped prior to and after KTC, using the Face-to-Face Still-Face paradigm, which assesses infants' responses during normal play and the effects of the Still-Face perturbation. The tapes were scored for infant facial emotion expressions. RESULTS: After intervention, infants displayed a marked increase in Interest and Joy when interacting face-to-face with their mothers, even though mothers' depression ratings did not change. LIMITATIONS: This pilot study is limited by lack of control dyads, however, it provides the foundation necessary for a full trial. CONCLUSIONS: This study suggests that intervention that focuses on what mothers do with their infants instead of how they feel can be effective in increasing infants' positive responsiveness and improving infant outcomes. Such interventions can be an essential component of treatment when mothers present with postpartum depression.