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Ionio C, Ciuffo G, Christiansen P, Della Vedova AM, Fallon V, Figlino MF, Landoni M, Silverio SA, Smorti M, Bramante A. Postpartum-Specific Anxiety and Maternal-Infant Bonding: A Predictive Validity Study amongst Italian Women. Eur J Investig Health Psychol Educ 2024; 14:1614-1626. [PMID: 38921073 PMCID: PMC11202692 DOI: 10.3390/ejihpe14060107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 05/31/2024] [Accepted: 05/31/2024] [Indexed: 06/27/2024] Open
Abstract
The role of anxiety is unknown in relation to postpartum bonding, unlike the well-known detrimental effect that postpartum depression has on the relationship between a mother and child. This study investigates how anxiety affects mother-infant bonding after childbirth, comparing the Italian version of the Postpartum Specific Anxiety Scale (PSAS-IT) with generalized measures of anxiety. Examining 324 non-randomly-selected participants responding to various scales, including the Edinburgh postnatal depression scale (EPDS), generalized anxiety disorder (GAD), postpartum-specific anxiety scale (PSAS-IT), postpartum bonding questionnaire (PBQ), and baby care questionnaire (BCQ-2), initial results suggest a link between certain postpartum anxiety symptoms and attachment problems. Surprisingly, anxiety measured with the PSAS has no direct influence on attachment; however, it is a strong predictor of bonding, even when maternal age, general anxiety, and depression are taken into account, explaining 3% of the variance in scores (β = 0.26, p < 0.001). This emphasizes the importance of early identification and intervention of postpartum anxiety in promoting bonding between mother and child.
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Affiliation(s)
- Chiara Ionio
- CRIdee, Unità di Ricerca sul Trauma, Dipartimento di Psicologia, Facoltà di Psicologia, Università Cattolica del Sacro Cuore, 20123 Milan, Italy;
| | - Giulia Ciuffo
- CRIdee, Unità di Ricerca sul Trauma, Dipartimento di Psicologia, Facoltà di Psicologia, Università Cattolica del Sacro Cuore, 20123 Milan, Italy;
| | - Paul Christiansen
- Department of Psychology, Institute of Population Health, Faculty of Health and Life Sciences, University of Liverpool, Liverpool L69 3GF, UK; (P.C.); (V.F.); (S.A.S.)
| | - Anna Maria Della Vedova
- Dipartimento di Scienze Cliniche e Sperimentali, Facoltà di Medicina e Chirurgia, Università Degli Studi di Brescia, 25123 Brescia, Italy;
| | - Victoria Fallon
- Department of Psychology, Institute of Population Health, Faculty of Health and Life Sciences, University of Liverpool, Liverpool L69 3GF, UK; (P.C.); (V.F.); (S.A.S.)
| | - Maria Francesca Figlino
- Dipartimento di Psicologia, Facoltà di Psicologia, Università Cattolica del Sacro Cuore, 20123 Milan, Italy;
| | - Marta Landoni
- CRIdee, Dipartimento di Psicologia, Facoltà di Psicologia, Università Cattolica del Sacro Cuore, 20123 Milan, Italy;
| | - Sergio A. Silverio
- Department of Psychology, Institute of Population Health, Faculty of Health and Life Sciences, University of Liverpool, Liverpool L69 3GF, UK; (P.C.); (V.F.); (S.A.S.)
- Department of Women & Children’s Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King’s College London, London WC2R 2LS, UK
| | - Martina Smorti
- Dipartimento di Patologia Chirurgica, Medica, Molecolare e dell’Area Critica, Università di Pisa, 56126 Pisa, Italy;
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Wriedt SC, Müller M, Reck C, Nonnenmacher N, Zietlow AL, Woll CFJ. The effect of antepartum depressive and anxiety symptoms on mother-infant interaction: The mediating role of antepartum maternal emotional stress. Infant Behav Dev 2024; 75:101942. [PMID: 38522348 DOI: 10.1016/j.infbeh.2024.101942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 02/13/2024] [Accepted: 03/12/2024] [Indexed: 03/26/2024]
Abstract
Anxiety disorders, depression, and emotional stress during the antepartum period are interlinked with adverse child development. The quality of the dyadic interaction seems to play a crucial role in the transmission of these effects. In this study, we explored the mediating effect of antepartum maternal emotional stress (assessed via the Prenatal Emotional Stress Index) regarding the relationship of antepartum maternal depressive (assessed via the Edinburgh Postpartum Depression Scale), anxiety symptoms (assessed via the Stat-Trait-Anxiety-Inventory), and depressive and anxiety disorders (assessed according to the DSM-IV-TR) in the antepartum period on postpartum interactive quality in a longitudinal design. The Face-to-Face-Still-Face Paradigm (FFSF) and the Infant and Caregiver Engagement Phases (ICEP-R) coding system were used to assess the postpartum interactive qualities of the mother-infant dyads. The sample consisted of 59 women, 38 in the clinical and 21 in the control group. We found significant indirect effects of antepartum depressive symptoms and maternal diagnostic status on the mother's neutral engagement and on the latency to the first social positive interactive match during the interaction - effects that were mediated by antepartum stress. Moreover, there was an indirect effect of state anxiety on neutral engagement - mediated by antepartum stress. Therapeutic intervention studies focusing on maternal antepartum regulation of emotional stress and postpartum interactive patterns might be crucial to encounter maladaptive developmental trajectories.
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Affiliation(s)
- Sophia Cécile Wriedt
- Department of Psychology, Clinical Psychology of Childhood and Adolescence and Counselling Psychology, LMU Munich, Leopoldstraße 13, 80802 Munich, Germany
| | - Mitho Müller
- Department of Psychology, Clinical Psychology of Childhood and Adolescence and Counselling Psychology, LMU Munich, Leopoldstraße 13, 80802 Munich, Germany.
| | - Corinna Reck
- Department of Psychology, Clinical Psychology of Childhood and Adolescence and Counselling Psychology, LMU Munich, Leopoldstraße 13, 80802 Munich, Germany
| | - Nora Nonnenmacher
- Department of Psychology, Clinical Psychology of Childhood and Adolescence and Counselling Psychology, LMU Munich, Leopoldstraße 13, 80802 Munich, Germany; Department of Medical Psychology, Heidelberg University Hospital, Bergheimer Straße 20, 69115 Heidelberg, Germany
| | - Anna-Lena Zietlow
- Department of Psychology, Clinical Psychology of Childhood and Adolescence, Technical University Dresden, Chemnitzer Straße 46a, 01187 Dresden, Germany
| | - Christian Franz Josef Woll
- Department of Psychology, Clinical Psychology of Childhood and Adolescence and Counselling Psychology, LMU Munich, Leopoldstraße 13, 80802 Munich, Germany
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Klauser N, Müller M, Zietlow AL, Nonnenmacher N, Woll C, Becker-Stoll F, Rec C. Maternal postpartum anxiety and the development of infant attachment: The effect of body sensations on infant attachment. J Affect Disord 2023; 331:259-268. [PMID: 36958486 DOI: 10.1016/j.jad.2023.03.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 03/04/2023] [Accepted: 03/16/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND Knowledge about the influences of maternal postpartum anxiety disorders (PAD) on infant development is limited. Aim of this present study is to evaluate the influence of PAD on infant attachment. METHODS In a longitudinal study, self-reported anxiety symptoms of N = 70 mothers (N = 28 with PAD diagnosed according to the DSM-IV, N = 42 controls) were examined in the postpartum period and one year later. Infants' attachment was observed in the Strange Situation Test (SST) at the age of 12-24 months. RESULTS Results indicate a strong relationship between PAD and infant attachment: infants of mothers with PAD were significantly more likely to be classified as insecure or disorganized than infants of control mothers. Logistic regression analysis led to a significant model with 76.8 % correct classification of infant attachment dependent on the maternal fear of anxiety associated body sensations (OR = 4.848) in the postpartum period. Including maternal sensitivity and interaction behavior, only maternal intrusiveness was additionally associated with infant attachment (ρ = 0.273, p < .05; OR = 45.021, p = .153). LIMITATIONS Participants were highly educated. Different anxiety disorders included led to a heterogenous sample. Generalization is diminished. Maternal sensitivity was measured on a global scale, and body tension was self-reported. CONCLUSIONS PAD plays a crucial role in the development of infant attachment. Interaction-focused interventions, helping mothers to decrease intrusiveness, and body-focused interventions, helping mothers to deal with their fear of anxiety symptoms, might be promising pathways to buffer the influence of PAD on infant attachment.
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Affiliation(s)
- Nathania Klauser
- Ludwig-Maximilians University, Department of Psychology, Munich, Germany.
| | - Mitho Müller
- Ludwig-Maximilians University, Department of Psychology, Munich, Germany
| | - Anna-Lena Zietlow
- Technical University Dresden, Department of Psychology, Dresden, Germany
| | - Nora Nonnenmacher
- Heidelberg University Hospital, General Psychiatry, Heidelberg, Germany
| | - Christian Woll
- Ludwig-Maximilians University, Department of Psychology, Munich, Germany
| | - Fabienne Becker-Stoll
- Ludwig-Maximilians University, Department of Psychology, Munich, Germany; Staatsinstitut für Frühpädagogik Bayern, Munich, Germany
| | - Corinna Rec
- Ludwig-Maximilians University, Department of Psychology, Munich, Germany
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Burtchen N, Alvarez-Segura M, Urben S, Giovanelli C, Mendelsohn AL, Guedeney A, Schechter DS. Effects of maternal trauma and associated psychopathology on atypical maternal behavior and infant social withdrawal six months postpartum. Attach Hum Dev 2022; 24:1-27. [PMID: 36371796 DOI: 10.1080/14616734.2022.2142894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 10/29/2022] [Indexed: 11/15/2022]
Abstract
Maternal psychopathology given a history of maltreatment and domestic violence exposure increases the risk for child psychopathology. Infant social withdrawal is one warning sign of adverse developmental outcomes including child anxiety and depression. It remains unclear how maternal trauma-related psychopathology might affect infant social withdrawal six-months postpartum. METHODS One-hundred ninety-five women and their six-month-old infants were studied in an at-risk community sample. Maternal trauma history, posttraumatic stress (PTSD) and major depressive (MDD) disorders were assessed. Maternal and infant behaviors were coded from videotaped interactions. RESULTS Maternal trauma was correlated with atypical maternal behavior (AMB) and infant social withdrawal (p ≤ .001). PTSD and MDD, and comorbid PTSD/MDD predicted increased AMB (p ≤ .001) but only maternal MDD was predictive of infant social withdrawal (p ≤ .001). Effects of maternal MDD on infant withdrawal were mediated by AMB. CONCLUSIONS At six-months postpartum, maternal MDD was associated with infant withdrawal. AMB is an important target for early intervention.
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Affiliation(s)
- Nina Burtchen
- Clinic for Psychosomatic Medicine and Psychotherapy, Freiburg University Medical Center, Freiburg, Germany
- Department of Pediatrics, New York University, New York University Grossman School of Medicine, New York, NY, USA
| | - Mar Alvarez-Segura
- Child and Adolescent Psychiatry Service, Department of Psychiatry, Abat Oliba CEU University, Barcelona, Spain
- Department of Child & Adolescent Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
| | - Sébastien Urben
- Child & Adolescent Psychiatry Service, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Alan L Mendelsohn
- Department of Pediatrics, New York University, New York University Grossman School of Medicine, New York, NY, USA
| | - Antoine Guedeney
- Child & Adolescent Psychiatry Service, Hôpital Bichat-Claude
- Bernard Faculty of Medicine, University of Paris Diderot, Paris, France
| | - Daniel S Schechter
- Department of Child & Adolescent Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
- Child & Adolescent Psychiatry Service, Department of Psychiatry, Lausanne University Hospital and Faculty of Biology and Medicine, Lausanne, Switzerland
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Golds L, Gillespie‐Smith K, Nimbley E, MacBeth A. What factors influence dyadic synchrony? A systematic review of the literature on predictors of mother-infant dyadic processes of shared behavior and affect. Infant Ment Health J 2022; 43:808-830. [PMID: 35913364 PMCID: PMC9540815 DOI: 10.1002/imhj.22011] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 06/01/2022] [Indexed: 11/05/2022]
Abstract
Dyadic behavioral synchrony is a complex interactional process that takes place between the mother and her infant. In the first year of life, when the infant is prelinguistic, processes such as synchrony enable the dyad to communicate through shared behavior and affect. To date, no systematic review has been carried out to understand the risk and protective factors that influence behavioral synchrony in the mother-infant dyad. The aim of this review was to identify and evaluate the factors that influence behavioral synchrony in the mother-infant dyad, when the infant is between 3 and 9 months old. Key electronic databases were searched between 1970 and April 2021, and 28 eligible studies were identified for review. As the results were largely heterogeneous, four subgroups of factors were identified: (i) infant demographics, (ii) physiological factors, (iii) maternal mental health, and (iv) miscellaneous factors. Identified risk factors and covariates suggest that social determinants of health, underpinned by biological factors, play a large role in influencing behavioral synchrony within the dyad. Implications for the need to identify additional risk and protective factors, as well as design support for at-risk families are discussed.
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Affiliation(s)
- Lisa Golds
- School of Health in Social ScienceUniversity of EdinburghEdinburghUK
| | | | - Emy Nimbley
- School of Health in Social ScienceUniversity of EdinburghEdinburghUK
| | - Angus MacBeth
- School of Health in Social ScienceUniversity of EdinburghEdinburghUK
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Turk E, Endevelt-Shapira Y, Feldman R, van den Heuvel MI, Levy J. Brains in Sync: Practical Guideline for Parent-Infant EEG During Natural Interaction. Front Psychol 2022; 13:833112. [PMID: 35572249 PMCID: PMC9093685 DOI: 10.3389/fpsyg.2022.833112] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 04/05/2022] [Indexed: 12/14/2022] Open
Abstract
Parent-infant EEG is a novel hyperscanning paradigm to measure social interaction simultaneously in the brains of parents and infants. The number of studies using parent-infant dual-EEG as a theoretical framework to measure brain-to-brain synchrony during interaction is rapidly growing, while the methodology for measuring synchrony is not yet uniform. While adult dual-EEG methodology is quickly improving, open databases, tutorials, and methodological validations for dual-EEG with infants are largely missing. In this practical guide, we provide a step-by-step manual on how to implement and run parent-infant EEG paradigms in a neurodevelopmental laboratory in naturalistic settings (e.g., free interactions). Next, we highlight insights on the variety of choices that can be made during (pre)processing dual-EEG data, including recommendations on interpersonal neural coupling metrics and interpretations of the results. Moreover, we provide an exemplar dataset of two mother-infant dyads during free interactions ("free play") that may serve as practice material. Instead of providing a critical note, we would like to move the field of parent-infant EEG forward and be transparent about the challenges that come along with the exciting opportunity to study the development of our social brain within the naturalistic context of dual-EEG.
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Affiliation(s)
- Elise Turk
- Department of Cognitive Neuropsychology, Tilburg University, Tilburg, Netherlands
| | - Yaara Endevelt-Shapira
- Baruch Ivcher School of Psychology, Interdisciplinary Center Herzliya, Reichman University, Herzliya, Israel
| | - Ruth Feldman
- Baruch Ivcher School of Psychology, Interdisciplinary Center Herzliya, Reichman University, Herzliya, Israel
| | | | - Jonathan Levy
- Baruch Ivcher School of Psychology, Interdisciplinary Center Herzliya, Reichman University, Herzliya, Israel.,Department of Neuroscience and Biomedical Engineering, Aalto University, Espoo, Finland
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Menin D, Aureli T, Dondi M. Two forms of yawning modulation in three months old infants during the Face to Face Still Face paradigm. PLoS One 2022; 17:e0263510. [PMID: 35120177 PMCID: PMC8815912 DOI: 10.1371/journal.pone.0263510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 01/21/2022] [Indexed: 11/19/2022] Open
Abstract
The last decades have seen an increasing interest in the phenomenon of yawning and the dynamics of its modulation, yet no widespread consensus exists on its origins and potential functions. Although most scholars have focused on its potential physiological functions, e.g., related to thermoregulation, arousal modulation or cortisol levels and distress, an emerging line of research has been also investigating the social implications of yawning, including its hypothesized relationship with empathy. In order to explore the dynamics of yawning modulation in infants, we investigated whether a social perturbation–like the one induced by the Face to Face Still Face paradigm, a procedure designed to assess socio-emotional regulation in infants–affects yawning and self-touch hand movements behavior in three-months old infants. As the Still Face episode represents a source of mild distress, we hypothesized that during this phase yawns would be more frequent. Moreover, through the use of path analysis, we investigated potential dynamics of facilitation, inhibition or covariance between the frequencies of these behavioral patterns. Our results showed a sharp increase in self-touch hand movements as well as in the likelihood of yawning during the stressful phase of the procedure (still-face) compared with the two minutes of face-to-face interaction and the reunion episode. Regressions also showed a higher incidence of yawns among girls, consistently with the hypothesis that the analysis of yawning behavior might capture subtle differences in regulatory strategies of infants, possibly related to the transient sex-specific activation of the hypothalamic-pituitary-gonadal axis known as mini-puberty. The path analysis showed a greater consistency between the frequencies of self-touch hand movements during the three episodes of the procedure, compared with yawning. This finding could be a result of distinct yawning-regulating mechanisms being at play in different conditions, e.g., a modulation related to stress and one to social interaction. Taken together, these results suggest that human yawning regulation is an irreducibly complex and multifaceted phenomenon since early age. Moreover, the gender differences highlighted might suggest an early diversification in yawning modulation.
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Affiliation(s)
- Damiano Menin
- Dipartimento di Studi Umanistici, Università degli Studi di Ferrara, Ferrara, Italy
| | - Tiziana Aureli
- Dipartimento di Neuroscienze, Imaging e Scienze cliniche, Università di Chieti-Pescara G. d’Annunzio, Chieti, Italy
| | - Marco Dondi
- Dipartimento di Studi Umanistici, Università degli Studi di Ferrara, Ferrara, Italy
- * E-mail:
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Mundorf A, Bölükbas I, Freund N. Maternal separation: Does it hold the potential to model consequences of postpartum depression? Dev Psychobiol 2022; 64:e22219. [PMID: 35050513 DOI: 10.1002/dev.22219] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 09/30/2021] [Accepted: 11/01/2021] [Indexed: 12/12/2022]
Abstract
The postpartum period is a sensitive time where women are especially vulnerable to develop postpartum depression (PPD), with 10%-15% of women affected. This review investigates whether the maternal separation (MS) paradigm in rodents holds the potential to help to understand mothers suffering from PPD. MS is a well-established stress model to investigate effects on infants, whereas effects on the dam are often overlooked. The database PubMed was searched for studies investigating effects of daily MS within the first weeks after parturition on dams in rats and mice and compared to findings in PPD mothers. MS was categorized as brief MS (5-45 min) with or without handling of pups and long MS (3-4 h and longer). MS alters maternal care, depressive-like behavior, anxiety, and aggression; leads to alterations in neuronal gene expression; and affects hormone and neurotransmitter levels similar to observations in PPD patients. Even though there are disparities between human and rodent mothers, with some results differing in directionality, as well as the reason for separation (self-induced in PPD, externally induced in MS), the overall effects found on neurobiological, hormonal, and behavioral levels mostly coincide. Thus, the MS paradigm can add relevant knowledge to existing PPD animal models, further advancing the study of PPD.
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Affiliation(s)
- Annakarina Mundorf
- Division of Experimental and Molecular Psychiatry, Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr-University Bochum, Bochum, Germany.,Institute for Systems Medicine and Department of Human Medicine, MSH Medical School Hamburg, Hamburg, Germany
| | - Ibrahim Bölükbas
- Division of Experimental and Molecular Psychiatry, Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Nadja Freund
- Division of Experimental and Molecular Psychiatry, Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr-University Bochum, Bochum, Germany
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Müller M, Zietlow AL, Klauser N, Woll C, Nonnenmacher N, Tronick E, Reck C. From Early Micro-Temporal Interaction Patterns to Child Cortisol Levels: Toward the Role of Interactive Reparation and Infant Attachment in a Longitudinal Study. Front Psychol 2022; 12:807157. [PMID: 35126257 PMCID: PMC8810635 DOI: 10.3389/fpsyg.2021.807157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/20/2021] [Indexed: 11/13/2022] Open
Abstract
Parental mental disorders increase the risk for insecure attachment in children. However, the quality of caregiver–infant interaction plays a key role in the development of infant attachment. Dyadic interaction is frequently investigated via global scales which are too rough to uncover micro-temporal mechanisms. Prior research found that the latency to reparation of uncoordinated dyadic states is associated with infant behavioral and neuroendocrine regulation. We investigated the hypothesis that this interactive mechanism is critical in predicting secure vs. insecure attachment quality in infancy. We also assessed the predictive quality of infant attachment regarding neuroendocrine reactivity later in childhood. A subsample of N = 58 dyads (n = 22 mothers with anxiety disorders, n = 36 controls) from a larger study were analyzed. At 3–8 months postpartum, maternal anxiety disorders were diagnosed via a structured clinical interview as well as dyadic interaction during the Face-to-Face-Still-Face (FFSF) was observed and coded on a micro-temporal scale. Infant attachment quality was assessed with the strange situation paradigm at 12–24 months of age. In an overlapping subsample of N = 39 (n = 13 mothers with anxiety disorder; n = 26 controls), we assessed child cortisol reactivity at 5 to 6 years of age. Generalized linear modeling revealed that longer latencies to interactive reparation during the reunion episode of the FFSF as well as maternal diagnosis at 3–8 months of age predict insecure attachment in children aged 12–24 months. Cox regressions demonstrated that dyads with infants who developed insecure attachment at 12–24 months of age were 48% less likely to achieve an interactive reparation at 3–8 months of age. Mixed models revealed that compared to securely attached children, children who had developed an insecure attachment at 12–24 months of age had an increased cortisol reactivity at 5 to 6 years of age during free play. The results confirm the hypothesis that the development of attachment is affected by experienced micro-temporal interactive patterns besides diagnostic categories. They also showed that infants of mothers with postpartum anxiety disorders have a more than fivefold increased risk of developing an insecure attachment than the infants of the control group. Moreover, results imply that these patterns may influence neurohormonal regulation even in preschool aged children.
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Affiliation(s)
- Mitho Müller
- EEKIP-Lab, Clinical Psychology in Childhood and Adolescence, Department Psychology, Ludwig Maximilian University of Munich, Munich, Germany
- *Correspondence: Mitho Müller,
| | - Anna-Lena Zietlow
- Department of Psychology, School of Social Sciences, University of Mannheim, Mannheim, Germany
| | - Nathania Klauser
- EEKIP-Lab, Clinical Psychology in Childhood and Adolescence, Department Psychology, Ludwig Maximilian University of Munich, Munich, Germany
| | - Christian Woll
- EEKIP-Lab, Clinical Psychology in Childhood and Adolescence, Department Psychology, Ludwig Maximilian University of Munich, Munich, Germany
| | - Nora Nonnenmacher
- Institute of Medical Psychology, Center for Psychosocial Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Edward Tronick
- Child Development Unit, Developmental Brain Sciences Program, Department of Psychology, University of Massachusetts Boston – Harvard Medical School, Boston, MA, United States
| | - Corinna Reck
- EEKIP-Lab, Clinical Psychology in Childhood and Adolescence, Department Psychology, Ludwig Maximilian University of Munich, Munich, Germany
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Zietlow AL, Woll CFJ, Nonnenmacher N, Müller M, Labonte V, Ditzen B, Paulus M, Sodian B, Nater UM, Herpertz SC, Reck C. Study protocol of the COMPARE-Interaction study: the impact of maternal comorbid depression and anxiety disorders in the peripartum period on child development. BMJ Open 2022; 12:e050437. [PMID: 35058257 PMCID: PMC8783832 DOI: 10.1136/bmjopen-2021-050437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION To date, there are only few studies that compare the consequences of peripartum maternal depressive disorders (PD) versus depressive with comorbid anxiety disorders (PDCA) for infant and child development. As comorbidity is associated with greater impairment and symptom severity related to the primary diagnosis, comorbidity in mothers might raise their offspring's risk of developing internalising or externalising disorders even more than has been noted in conjunction with PD alone. METHODS AND ANALYSIS This study aims to analyse the impact of parental psychopathology, particularly peripartum depression in mothers with and without comorbid anxiety disorders according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) on child cognitive and socioemotional development. Maternal/paternal psychopathology, mother-infant/father-infant interaction and child development are assessed at four measurement points over the first 2 years (T1: 3-4 months postpartum, T2: 12 months postpartum, T3: 18 months postpartum and T4: 24 months postpartum). The mediating role of mother-infant/father-infant interaction and infant stress reactivity in the relationship between PD/PDCA and infant cognitive and socioemotional development will be analysed. In the ongoing study, 174 families (n=58 mothers with PD, n=58 mothers with PDCA and n=58 healthy controls) will be recruited in inpatient and outpatient centres as well as maternity hospitals in Munich and Heidelberg. ETHICS AND DISSEMINATION This study is implemented in accordance with the current guidelines of the World Medical Association (revised Declaration of Helsinki) and the General Data Protection Regulation of the European Union. The study procedures were approved by the independent ethics committees of the Department of Psychology, Ludwig-Maximilians-University Munich (74_Reck_b) and of the Medical Faculty, University Heidelberg (S-446/2017). Participation is voluntary. A signed written informed consent form must be obtained from each study subject prior to any study-specific procedure. Participants can withdraw from the study at any point in time without giving a reason or being subjected to any future disadvantages. In case of withdrawal from the study, the subject's data and material will be kept unless the participant asks for data removal. Results will be published and disseminated to further the discussion on the effects of maternal PD and PDCA on parent-infant interaction, infant stress reactivity and child development. Furthermore, study results will be presented at international congresses and expert conferences.
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Affiliation(s)
- Anna-Lena Zietlow
- Department of Psychology, School of Social Sciences, University of Mannheim, Mannheim, Germany
| | - Christian Franz Josef Woll
- Department of Psychology, Clinical Psychology of Children and Adolescents, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Nora Nonnenmacher
- Institute of Medical Psychology, Centre of Psychosocial Medicine, Heidelberg University, Heidelberg, Germany
| | - Mitho Müller
- Department of Psychology, Clinical Psychology of Children and Adolescents, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Verena Labonte
- Department of Psychology, Clinical Psychology of Children and Adolescents, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Beate Ditzen
- Institute of Medical Psychology, Centre of Psychosocial Medicine, Heidelberg University, Heidelberg, Germany
| | - Markus Paulus
- Department of Psychology, Developmental and Educational Psychology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Beate Sodian
- Department of Psychology, Developmental and Educational Psychology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Urs M Nater
- Department of Psychology, University of Vienna, Vienna, Austria
| | - Sabine C Herpertz
- Department of General Psychiatry, Centre of Psychosocial Medicine, Heidelberg University, Heidelberg, Germany
| | - Corinna Reck
- Department of Psychology, Clinical Psychology of Children and Adolescents, Ludwig-Maximilians-University Munich, Munich, Germany
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Nonnenmacher N, Müller M, Taczkowski J, Zietlow AL, Sodian B, Reck C. Theory of Mind in Pre-school Aged Children: Influence of Maternal Depression and Infants' Self-Comforting Behavior. Front Psychol 2021; 12:741786. [PMID: 34899482 PMCID: PMC8651535 DOI: 10.3389/fpsyg.2021.741786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 10/29/2021] [Indexed: 11/13/2022] Open
Abstract
A milestone of child development is theory of mind (ToM): the ability to attribute mental states, especially beliefs and desires, to other persons and to understand that their behavior is guided by mental states. The learning process about the mental world also takes place in social communication and interaction, beginning in infancy. Infancy is assumed to be a sensitive period for the development of social skills through interaction. Due to limited self-regulatory skills, infants depend on sensitive behavior of their caregivers to regulate affective states and physiological arousal, and in turn, mutually regulated affects allow the infant to gradually acquire the capability to self-regulate negative affective states. Effective and adequate affect regulation is an important prerequisite for environmental interaction and thus for the development of socio-emotional skills. The present study investigated the relation of self-regulatory abilities in infancy and later ToM in pre-school aged children of clinically depressed mothers and healthy controls. The sample comprised of N = 55 mother-child dyads, n = 22 diagnosed with postpartum or lifetime depression according to DSM-IV and n = 33 healthy controls. Mother-infant-interaction was videotaped during the Face-to-Face Still-Face paradigm. At 3 and 42 months postpartum mothers were interviewed with the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) to evaluate maternal psychopathological status according to DSM-IV. At the age of M = 4.0 years, children's ToM abilities were assessed using content-false-belief and location-false-belief tasks. The results of this study show that contrary to our hypotheses, maternal depression did not impair the development of children's ToM-abilities per se. Rather, an interaction effect highlights the role of infant's self-comforting behavior during mother-infant interaction in infancy (3 months postpartum) for ToM-development at pre-school age assessed with the Maxi-task; this association was distinct for female in comparison to male children. The results of this longitudinal study shed light on the discussion, how maternal depression influences child development and point in the direction that self-comforting behaviors in infancy can also be seen as a resource.
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Affiliation(s)
- Nora Nonnenmacher
- Center for Psychosocial Medicine, Heidelberg University Hospital, Institute of Medical Psychology, Heidelberg, Germany
| | - Mitho Müller
- Department of Psychology, Ludwig Maximilians University Munich, Munich, Germany
| | - Joana Taczkowski
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anna-Lena Zietlow
- Center for Psychosocial Medicine, Heidelberg University Hospital, Institute of Medical Psychology, Heidelberg, Germany.,School of Social Sciences, University of Mannheim, Mannheim, Germany
| | - Beate Sodian
- Department of Psychology, Ludwig Maximilians University Munich, Munich, Germany
| | - Corinna Reck
- Department of Psychology, Ludwig Maximilians University Munich, Munich, Germany
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12
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Korja R, McMahon C. Maternal prenatal mood problems and lower maternal emotional availability associated with lower quality of child's emotional availability and higher negative affect during still-face procedure. INFANCY 2021; 26:901-919. [PMID: 34370394 DOI: 10.1111/infa.12428] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 07/09/2021] [Accepted: 07/15/2021] [Indexed: 01/20/2023]
Abstract
Our aim was to study the effects of maternal perinatal mood and maternal emotional availability on child emotional availability and negative affect during the still-face procedure (SFP). The sample included 214 women who participated in a prospective study. We assessed maternal mood problems using the Mini International Neuropsychiatric Interview and PRAQ questionnaire during pregnancy and using STAI and EPDS questionnaires during pregnancy and at 6 months after delivery. Maternal and child emotional availability were studied using the Emotional Availability Scales during the SFP at 6 months. We observed and quantified child's negative affect during SFP episodes. We found that mothers with maternal mood problems (anxiety and/or depression) during pregnancy, but not postnatally, showed less optimal maternal structuring during the SFP, and the children showed lower involvement and responsiveness during interactions with their mothers. Furthermore, lower maternal emotional availability was related to the child's higher negative affect during the SFP. Our findings underline the independent roles of both prenatal stress exposure and maternal caregiving behavior in a child's socioemotional development.
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Affiliation(s)
- Riikka Korja
- Department of Psychology, University of Turku, Turku, Finland.,The Centre for Emotional Health, Macquarie University, Sydney, NSW, Australia
| | - Catherine McMahon
- The Centre for Emotional Health, Macquarie University, Sydney, NSW, Australia
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13
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Zou ML, Jiang CB, Chen YH, Wu CD, Candice Lung SC, Chien LC, Kallawicha K, Yang YT, Lo YC, Chao HJ. Effects of air pollution, land-use type, and maternal mental health on child development in the first two years of life in the Greater Taipei area. ENVIRONMENTAL RESEARCH 2021; 197:111168. [PMID: 33857463 DOI: 10.1016/j.envres.2021.111168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 04/05/2021] [Accepted: 04/09/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Few studies have investigated the associations of child development with air pollution, land-use type, and maternal mental health simultaneously. Therefore, we evaluated the effect of exposure to air pollutants during several critical periods of life, with adjustment for land-use type and maternal mental status, on child development at 6, 12, and 24 months of age in the Greater Taipei area. METHODS Participants were selected from an ongoing Taiwanese birth cohort study. We analyzed the data of the participants who had been recruited from January 2011 to April 2014. Self-administered standardized questionnaires were used to collect information on sociodemographic factors, infant development and health, maternal mental status, etc. Air pollution levels in pre- and postnatal periods were estimated using a spatial interpolation technique (ordinary kriging) at children's residential addresses. Land-use types around participants' homes were evaluated using buffer analysis. We used multiple logistic regression analysis to examine the relationships between child development delay and environmental factors. RESULTS In total, 228, 361, and 441 families completed child development forms at 6, 12, and 24 months of age, respectively. Our results indicated that prenatal exposure to particulate matter with aerodynamic diameter ≤10 μm and O3 and postnatal exposure to NO2 were negatively associated with child development. Traffic-related land-use types, gas stations, and power generation areas around participants' homes were also adversely correlated with child development. Moreover, poor maternal mental health was associated with child development delay. CONCLUSION Prenatal exposure and postnatal exposure to air pollution were associated with development delay in children under 2 years of age, specifically those under 1 year of age, even after adjustment for land-use type and maternal mental status. Living environment is critical for the development of children under 2 years of age.
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Affiliation(s)
- Ming-Lun Zou
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Chuen-Bin Jiang
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, MacKay Children's Hospital, Taipei, Taiwan; Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Yi-Hua Chen
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan; Neuroscience Research Center, Taipei Medical University, Taipei, Taiwan
| | - Chih-Da Wu
- Department of Geomatics, National Cheng Kung University, Tainan, Taiwan; National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | | | - Ling-Chu Chien
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan; Neuroscience Research Center, Taipei Medical University, Taipei, Taiwan
| | - Kraiwuth Kallawicha
- College of Public Health Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Yu-Ting Yang
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan; Hsinchu County Environmental Protection Bureau, Hsinchu, Taiwan
| | - Yu-Chun Lo
- Neuroscience Research Center, Taipei Medical University, Taipei, Taiwan; Ph.D. Program for Neural Regenerative Medicine, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
| | - Hsing Jasmine Chao
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan; Neuroscience Research Center, Taipei Medical University, Taipei, Taiwan.
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14
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Porto JA, Bick J, Perdue KL, Richards JE, Nunes ML, Nelson CA. The influence of maternal anxiety and depression symptoms on fNIRS brain responses to emotional faces in 5- and 7-month-old infants. Infant Behav Dev 2020; 59:101447. [PMID: 32305734 PMCID: PMC7255941 DOI: 10.1016/j.infbeh.2020.101447] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 03/27/2020] [Accepted: 03/27/2020] [Indexed: 11/24/2022]
Abstract
Greater relative right (versus left) frontal cortical activation to emotional faces as measured with alpha power in the electroencephalogram (EEG), has been considered a promising neural marker of increased vulnerability to psychopathology and emotional disorders. We set out to explore multichannel fNIRS as a tool to investigate infants' frontal asymmetry responses (hypothesizing greater right versus left frontal cortex activation) to emotional faces as influenced by maternal anxiety and depression symptoms during the postnatal period. We also explored activation differences in fronto-temporal regions associated with facial emotion processing. Ninety-one typically developing 5- and 7-month-old infants were shown photographs of women portraying happy, fearful and angry expressions. Hemodynamic brain responses were analyzed over two frontopolar and seven bilateral cortical regions subdivided into frontal, temporal and parietal areas, defined by age-appropriate MRI templates. Infants of mothers reporting higher negative affect had greater oxyhemoglobin (oxyHb) activation across all emotions over the left inferior frontal gyrus, a region implicated in emotional communication. Follow-up analyses indicated that associations were driven by maternal depression, but not anxiety symptoms. Overall, we found no support for greater right versus left frontal cortex activation in association with maternal negative affect. Findings point to the potential utility of fNIRS as a method for identifying altered neural substrates associated with exposure to maternal depression in infancy.
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Affiliation(s)
- Juliana A Porto
- Laboratories of Cognitive Neuroscience, Division of Developmental Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Neurosciences, School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Johanna Bick
- Department of Psychology, University of Houston, College of Liberal Arts and Social Sciences, Houston, TX, USA
| | - Katherine L Perdue
- Laboratories of Cognitive Neuroscience, Division of Developmental Medicine, Boston Children's Hospital, Boston, MA, USA
| | - John E Richards
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Magda L Nunes
- Department of Neurosciences, School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil; Brain Institute of Rio Grande do Sul (BraIns), Porto Alegre, RS, Brazil
| | - Charles A Nelson
- Laboratories of Cognitive Neuroscience, Division of Developmental Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA; Harvard Graduate School of Education, Cambridge, MA, USA.
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15
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Williams LR. The impact of infant carrying on adolescent mother–infant interactions during the still‐face task. INFANT AND CHILD DEVELOPMENT 2020. [DOI: 10.1002/icd.2169] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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16
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The association between prenatal maternal anxiety disorders and postpartum perceived and observed mother-infant relationship quality. J Anxiety Disord 2019; 68:102148. [PMID: 31604204 DOI: 10.1016/j.janxdis.2019.102148] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 07/29/2019] [Accepted: 09/18/2019] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Prenatal maternal anxiety disorders have been associated with adverse outcomes in offspring including emotional, behavioral and cognitive problems. There is limited understanding of the mechanisms underpinning these associations, although one possible candidate is an impaired mother-infant relationship. The authors investigated whether prenatal anxiety disorders were associated with poorer postpartum mother-infant relationship quality, measured by maternal self-reported bonding and observed mother-infant interactions. METHODS A cohort of 454 pregnant women recruited from an inner-city maternity service in London (UK) were assessed for mental disorders using the Structured Clinical Interview for DSM-IV and followed up at mid-pregnancy and 3-months postpartum. Depressive symptoms were assessed at baseline and mid-pregnancy (using the Edinburgh Postnatal Depression Scale). At three months postpartum, women were assessed for self-reported bonding difficulties (using the Postpartum Bonding Questionnaire) and a subsample (n = 204) participated in video-recorded mother-infant interaction, coded using the Child-Adult Relationship Experimental Index by an independent rater. RESULTS Prenatal anxiety disorders were associated with higher perceived bonding impairment, but not associated with observed poor mother-infant interaction quality. Higher levels of depressive symptoms were associated with lower maternal sensitivity. CONCLUSIONS Interventions for anxiety disorders in the perinatal period could be tailored to address anxieties about mother-infant relationship and co-morbid depressive symptoms.
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17
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Zietlow AL, Nonnenmacher N, Reck C, Ditzen B, Müller M. Emotional Stress During Pregnancy - Associations With Maternal Anxiety Disorders, Infant Cortisol Reactivity, and Mother-Child Interaction at Pre-school Age. Front Psychol 2019; 10:2179. [PMID: 31607996 PMCID: PMC6773887 DOI: 10.3389/fpsyg.2019.02179] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 09/10/2019] [Indexed: 12/15/2022] Open
Abstract
There is growing evidence that even milder forms of maternal stress or anxiety during pregnancy affect the fetus causing possible long-term consequences for infant and child development. The mechanisms through which prenatal maternal stress may affect the unborn are not yet entirely clarified. Due to limited self-regulatory skills after birth, infants depend on sensitive behavior of their parents to regulate affective states and physiological arousal. Dyadic affect regulation has been linked to various developmental patterns up to adolescence and thereby represents a key element of early social relationships. Aim of the study was to evaluate possible long-term consequences of emotional stress during pregnancy and postpartum anxiety disorders, as well as infant postpartum cortisol reactivity on mother–child-interaction at pre-school age. The sample comprised of N = 63 mother–infant dyads at study entry, n = 28 diagnosed with postpartum anxiety disorders according to the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV), n = 35 were healthy controls. Mothers were interviewed with the Structured Clinical Interview for DSM-IV Disorders at an average infant age of M = 4.1 months and filled out a questionnaire regarding emotional stress during pregnancy. Further, they were videotaped during the Face-to-Face-Still-Face paradigm (FFSF), a widely used mild socio-emotional stressor for infants. To determine infant stress-reactivity, infant salivary cortisol was collected before, immediately after and 20 min after the FFSF. Missing values were estimated by multiple imputations. At the age of M = 5.3 years, mother-child-interaction was re-assessed in a follow-up sample of n = 30 dyads via a free-play situation. Moreover, dimensional measures for anxiety were assessed. Mothers in the clinical group reported significantly higher stress scores than the control group. Infant stress reactivity in the early postpartum period and maternal anxiety symptoms at the 5-year follow-up assessment were significantly associated with dyadic interaction quality at pre-school age. Even though maternal stress during pregnancy did not directly predict mother–child interaction quality at pre-school age, it was significantly correlated with infant cortisol reactivity during postpartum period. Nevertheless, caution should be taken when interpreting the results considering the small sample size.
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Affiliation(s)
- Anna-Lena Zietlow
- Institute of Medical Psychology, Center for Psychosocial Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Nora Nonnenmacher
- General Psychiatry, Center for Psychosocial Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Corinna Reck
- Department of Psychology, Ludwig Maximilian University of Munich, Munich, Germany
| | - Beate Ditzen
- Institute of Medical Psychology, Center for Psychosocial Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Mitho Müller
- Department of Psychology, Ludwig Maximilian University of Munich, Munich, Germany
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18
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Kokkinaki T, Vasdekis V, Devouche E. Maternal and paternal infant-directed speech to girls and boys: An exploratory study. EUROPEAN JOURNAL OF DEVELOPMENTAL PSYCHOLOGY 2019. [DOI: 10.1080/17405629.2019.1646123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Theano Kokkinaki
- Laboratory of Applied Psychology, Department of Psychology, University of Crete, Rethymno, Greece
| | | | - Emmanuel Devouche
- Laboratoire de Psychopathologie et Processus de Santé, Paris Descartes University, Paris, France
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19
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Heinisch C, Galeris MG, Gabler S, Simen S, Junge-Hoffmeister J, Fößel J, Spangler G. Mothers With Postpartum Psychiatric Disorders: Proposal for an Adapted Method to Assess Maternal Sensitivity in Interaction With the Child. Front Psychiatry 2019; 10:471. [PMID: 31396110 PMCID: PMC6661973 DOI: 10.3389/fpsyt.2019.00471] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 06/13/2019] [Indexed: 01/14/2023] Open
Abstract
About 15% of mothers suffer from postpartum psychiatric disorders, such as depression, anxiety, or psychosis. Numerous studies have shown maternal caregiving behavior to be negatively affected under these circumstances. The current study sets out to shed light on specific caregiving behaviors of affected mothers in the context of parental mental illness at an early stage. There are several methods to assess maternal caregiving behavior in terms of sensitivity. However, all of them have limitations regarding the peculiarities of mothers with postpartum disorders, that is, changes in affect regulation, and the early onset of the disorder postpartum. With the current study, we provide an adapted method to assess maternal sensitivity based on methods recently approved in attachment research. Two groups of mothers, who were either healthy or had different postpartum disorders, were recorded on video during interactions with their infants. Behaviors were rated regarding responsiveness, promptness, appropriateness, intrusiveness, and positive and negative affect. A first analysis revealed an increased number of deficits on all subscales in mothers with postpartum psychiatric disorders as compared to healthy mothers. Depressive mothers with a single diagnosis had lower scores in responsiveness, promptness, and appropriateness and higher scores on intrusiveness as compared to those in healthy mothers. Here, maternal behavior appears more parent-centered, whereas affect seemed to be relatively unharmed. Moreover, as compared to healthy mothers, mothers with comorbid depression and anxiety symptomatology achieved lower scores on responsiveness, appropriateness, and positive affect and higher scores on intrusiveness and negative affect. It is suggested, that increased deficits are related to the severity of illness in mothers with comorbidities. Results on promptness indicate that these mothers are still capable of maintaining higher vigilance to infant cues. Variance in maternal behavior was relatively high in clinical mothers, showing that some of them are well capable of behaving in a sensitive manner toward their child. One strength of our adapted method is that particular aspects of sensitive parent-child interactions are assessed separately. This may shed light on specific behavior patterns of different postpartum psychiatric disorders, which may in turn relate to specific child outcomes. The manual is open for usage, while reliability testing is required.
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Affiliation(s)
- Christine Heinisch
- Developmental and Educational Psychology, Institute of Psychology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Mirijam-Griseldis Galeris
- Developmental and Educational Psychology, Institute of Psychology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany.,Department of Paediatric Psychiatry, Psychotherapy and Psychosomatics, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Sandra Gabler
- Developmental and Educational Psychology, Institute of Psychology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Susanne Simen
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinik der Paracelsus Medizinischen Privatuniversität, Klinikum Nürnberg Süd, Nürnberg, Germany
| | - Juliane Junge-Hoffmeister
- Klinik für Psychotherapie und Psychosomatik des Universitätsklinikums Carl Gustav Carus der Technischen Universität Dresden, Dresden, Germany
| | - Judith Fößel
- Developmental and Educational Psychology, Institute of Psychology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Gottfried Spangler
- Developmental and Educational Psychology, Institute of Psychology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
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20
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Reck C, Tietz A, Müller M, Seibold K, Tronick E. The impact of maternal anxiety disorder on mother-infant interaction in the postpartum period. PLoS One 2018; 13:e0194763. [PMID: 29799842 PMCID: PMC5969737 DOI: 10.1371/journal.pone.0194763] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Accepted: 03/11/2018] [Indexed: 11/26/2022] Open
Abstract
Background This study investigated whether postpartum anxiety disorder is associated to altered patterns of infant as well as maternal engagement in a Face-to-Face-Still-Face interaction (FFSF). Sampling and methods n = 39 women with postpartum DSM-IV anxiety disorder and n = 48 healthy mothers were videotaped during a FFSF with their infant (M = 4.1 months). Results Infants of the clinical group showed significantly less positive engagement during the play episode than infants of controls. This result depended on infant sex: male controls demonstrated more positive interaction than males of anxious mothers. There was no such effect for female infants who engaged significantly less positively during the play episode than males and did not change their positive engagement during the FFSF. These findings imply pronounced interactive positivity and early vulnerability to maternal anxiety symptoms in male infants. Only the infants of the controls showed the still-face effect. They also protested significantly more during the still-face, while the clinical infants’ protest increased significantly during the reunion. Women of both groups did not differ in their interaction. Maternal intrusiveness was associated to infant protest in the course of the FFSF. Conclusions Results suggest that mother-infant intervention should consider affect regulation and infant sex-specific characteristics in anxious mother-infant dyads.
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Affiliation(s)
- Corinna Reck
- Ludwig-Maximilians University, Department of Psychology, Munich, Germany
| | - Alexandra Tietz
- Heidelberg University Hospital, General Psychiatry, Heidelberg, Germany
| | - Mitho Müller
- Ludwig-Maximilians University, Department of Psychology, Munich, Germany
| | - Kirsten Seibold
- Heidelberg University Hospital, General Psychiatry, Heidelberg, Germany
| | - Edward Tronick
- University of Massachusetts, Boston, United States of America.,Harvard Medical School, Boston, United States of America
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21
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Systematic review on maternal depression versus anxiety in relation to excessive infant crying: it is all about the timing. Arch Womens Ment Health 2018; 21:15-30. [PMID: 28900745 DOI: 10.1007/s00737-017-0771-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 08/14/2017] [Indexed: 10/24/2022]
Abstract
Different types of studies suggest a link between maternal depression/anxiety and excessive infant crying (EC). However, comparability is hampered due to different designs, definitions and measurements. This systematic review investigates the specific role of maternal depression and anxiety considering them as preceding, concurrent and subsequent conditions of EC. A computerised literature search was conducted in January 2017 using Medline, PubMed, PsycINFO and Web of Science. After screening n = 399 records for inclusion/exclusion criteria, n = 33 records based on n = 30 projects were eligible for systematic qualitative data synthesis. All studies on maternal depression/anxiety and EC within the first 3 years of life were included. Included studies investigated predominantly maternal depression (25/30) and secondly maternal anxiety (17/30). Significant positive results were found in the majority of studies for maternal depression (21/25) as well as for maternal anxiety (12/17) in relation to EC. In-depth analyses further revealed that concurrent and subsequent maternal depression was robustly related with EC, whilst preceding maternal depression was not. In contrast, preceding and concurrent (but not subsequent) maternal anxiety was consistently related to subsequent EC. Maternal depression is more likely a correlate or even a consequence of EC, whereas anxiety is rather a temporally preceding condition and thus a potential risk factor or risk marker for both subsequent EC and associated maternal depression. Interventions for EC should address concurrent maternal depression, whilst preventive approaches might target preceding maternal anxiety as early as prior to or during pregnancy.
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22
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Graham KA, Blissett J, Antoniou EE, Zeegers MP, McCleery JP. Effects of maternal depression in the Still-Face Paradigm: A meta-analysis. Infant Behav Dev 2018; 50:154-164. [PMID: 29304347 DOI: 10.1016/j.infbeh.2017.12.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 12/06/2017] [Accepted: 12/08/2017] [Indexed: 10/18/2022]
Abstract
The Still-Face Paradigm (SFP) enables researchers to examine the quality of mother-infant interactions. In typical infants, a classic still-face effect (SFE) has been confirmed whereby infants demonstrate reduced positive affect (PA), reduced gaze (GA), and increased negative affect (NA). Recently, the SFP has been used to examine the effect of maternal depression upon infant behaviour. However, the nature and consistency of the behavioural responses of infants of depressed mothers during the SFP remains unclear. In the current meta-analysis, we examined whether or not infants of depressed mothers demonstrate the classic SFE, as well as whether or not these infants display the same levels of PA, NA, and GA as their counterparts with non-depressed mothers. Results revealed that infants of depressed mothers display the classic SFE like infants of their non-depressed counterparts. However, infants of depressed mothers also demonstrated significantly higher levels of PA during the still-face episode. One potential interpretation of this finding is that infants prior experience of similar, depressed interactions with their mothers, encourages them to amplify their positive attachment signals in order to engage maternal attention and response. Alternatively, or additionally, infants of depressed mothers could be using PA in order to regulate their own NA.
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Affiliation(s)
- Katharine A Graham
- School of Psychology, University of Birmingham, UK; Department of Health and Behavioural Sciences, Newman University, UK; Department of Psychology, University of Johannesburg, South Africa.
| | | | - Evangelia E Antoniou
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Maurice P Zeegers
- Department of Complex Genetics, Cluster of Genetics and Cell Biology, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Joseph P McCleery
- School of Psychology, University of Birmingham, UK; Center for Autism Research, Children's Hospital of Philadelphia, USA
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23
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Aktar E, Bögels SM. Exposure to Parents' Negative Emotions as a Developmental Pathway to the Family Aggregation of Depression and Anxiety in the First Year of Life. Clin Child Fam Psychol Rev 2017; 20:369-390. [PMID: 28528457 PMCID: PMC5656709 DOI: 10.1007/s10567-017-0240-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Depression and anxiety load in families. In the present study, we focus on exposure to parental negative emotions in first postnatal year as a developmental pathway to early parent-to-child transmission of depression and anxiety. We provide an overview of the little research available on the links between infants' exposure to negative emotion and infants' emotional development in this developmentally sensitive period, and highlight priorities for future research. To address continuity between normative and maladaptive development, we discuss exposure to parental negative emotions in infants of parents with as well as without depression and/or anxiety diagnoses. We focus on infants' emotional expressions in everyday parent-infant interactions, and on infants' attention to negative facial expressions as early indices of emotional development. Available evidence suggests that infants' emotional expressions echo parents' expressions and reactions in everyday interactions. In turn, infants exposed more to negative emotions from the parent seem to attend less to negative emotions in others' facial expressions. The links between exposure to parental negative emotion and development hold similarly in infants of parents with and without depression and/or anxiety diagnoses. Given its potential links to infants' emotional development, and to later psychological outcomes in children of parents with depression and anxiety, we conclude that early exposure to parental negative emotions is an important developmental mechanism that awaits further research. Longitudinal designs that incorporate the study of early exposure to parents' negative emotion, socio-emotional development in infancy, and later psychological functioning while considering other genetic and biological vulnerabilities should be prioritized in future research.
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Affiliation(s)
- Evin Aktar
- Clinical Psychology Unit, Leiden University, Wassenaarseweg 52, 2333 AK, Leiden, The Netherlands.
- Research Institute of Child Development and Education, University of Amsterdam, Nieuwe Achtergracht 127, 1001 NG, Amsterdam, The Netherlands.
| | - Susan M Bögels
- Research Institute of Child Development and Education, University of Amsterdam, Nieuwe Achtergracht 127, 1001 NG, Amsterdam, The Netherlands
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Oxytocin in the postnatal period: Associations with attachment and maternal caregiving. Compr Psychiatry 2017; 76:56-68. [PMID: 28431269 DOI: 10.1016/j.comppsych.2017.03.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 03/03/2017] [Accepted: 03/22/2017] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND This study investigated the associations of maternal oxytocin, self-reported attachment insecurity and depressive symptoms with maternal caregiving sensitivity at 3-4months postpartum, observed during the 'free play' and 'reunion' episodes of the Still Face Procedure. METHODS 112 mothers completed questionnaires and gave blood samples to determine oxytocin plasma levels before (time 1) and after participating in the Still Face Procedure with their infant (time 2). RESULTS Sensitive maternal caregiving during the free play episode was predicted by 'good' infant behavior; during the reunion episode it was predicted by 'good' infant behavior, higher baseline levels of maternal oxytocin and a greater maternal oxytocin response, or in other words, a larger increase in maternal oxytocin level from time 1 to time 2. With other variables free to vary, baseline maternal oxytocin levels mediated an inverse relation between maternal adult attachment avoidance and sensitive maternal caregiving during the reunion episode. CONCLUSION Results highlight the association between oxytocin and sensitive maternal caregiving and suggest that oxytocin is a biological mechanism through which maternal attachment insecurity affects early parenting quality.
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Individual differences in non-clinical maternal depression impact infant affect and behavior during the still-face paradigm across the first year. Infant Behav Dev 2017; 47:13-21. [DOI: 10.1016/j.infbeh.2017.02.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 02/25/2017] [Accepted: 02/25/2017] [Indexed: 11/17/2022]
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Hipwell AE, Stepp SD, Moses-Kolko EL, Xiong S, Paul E, Merrick N, McClelland S, Verble D, Keenan K. Predicting adolescent postpartum caregiving from trajectories of depression and anxiety prior to childbirth: a 5-year prospective study. Arch Womens Ment Health 2016; 19:871-82. [PMID: 26971266 PMCID: PMC5018913 DOI: 10.1007/s00737-016-0627-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 02/29/2016] [Indexed: 12/18/2022]
Abstract
Symptoms of depression and anxiety in pregnancy have been linked to later impaired caregiving. However, mood symptoms are often elevated in pregnancy and may reflect motherhood-specific concerns. In contrast, little is known about the effects of prepregnancy depression and anxiety on postpartum caregiving. Understanding these developmental risk factors is especially important when childbearing also occurs during adolescence. The sample comprised 188 adolescent mothers (ages 12-19 years) who had participated in a longitudinal study since childhood. Mothers were observed in face-to-face interaction with the infant at 4 months postpartum, and caregiving behaviors (sensitivity, hostile-intrusive behavior, and mental state talk) were coded independently. Data on self-reported depression and anxiety gathered in the 5 years prior to childbirth were drawn from the large-scale longitudinal study. Parallel process latent growth curve models revealed unique effects of distal anxiety and slow decline in anxiety over time on lower levels of maternal mental state talk after accounting for the overlap with depression development. Depressive symptoms showed significant stability from distal measurement to the postpartum period, but only concurrent postpartum mood was associated with poorer quality of maternal speech. The results highlight specific targets for well-timed preventive interventions with vulnerable dyads.
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Affiliation(s)
| | | | | | | | - Elena Paul
- Department of Psychiatry, University of Pittsburgh Medical Center, USA
| | - Natalie Merrick
- Department of Psychiatry, University of Pittsburgh Medical Center, USA
| | | | - Danielle Verble
- Department of Psychiatry, University of Pittsburgh Medical Center, USA
| | - Kate Keenan
- Department of Psychiatry, University of Pittsburgh Medical Center, USA
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How do parents' depression and anxiety, and infants' negative temperament relate to parent-infant face-to-face interactions? Dev Psychopathol 2016; 29:697-710. [PMID: 27580868 DOI: 10.1017/s0954579416000390] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The present study investigated the associations of mothers' and fathers' lifetime depression and anxiety symptoms, and of infants' negative temperament with parents' and infants' gaze, facial expressions of emotion, and synchrony. We observed infants' (age between 3.5 and 5.5 months, N = 101) and parents' gaze and facial expressions during 4-min naturalistic face-to-face interactions. Parents' lifetime symptoms of depression and anxiety were assessed with clinical interviews, and infants' negative temperament was measured with standardized observations. Parents with more depressive symptoms and their infants expressed less positive and more neutral affect. Parents' lifetime anxiety symptoms were not significantly related to parents' expressions of affect, while they were linked to longer durations of gaze to parent, and to more positive and negative affect in infants. Parents' lifetime depression or anxiety was not related to synchrony. Infants' temperament did not predict infants' or parents' interactive behavior. The study reveals that more depression symptoms in parents are linked to more neutral affect from parents and from infants during face-to-face interactions, while parents' anxiety symptoms are related to more attention to parent and less neutral affect from infants (but not from parents).
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Tryphonopoulos PD, Letourneau N, DiTommaso E. Caregiver-Infant Interaction Quality: A Review of Observational Assessment Tools. Compr Child Adolesc Nurs 2016. [DOI: 10.3109/01460862.2015.1134720] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
| | - Nicole Letourneau
- Department of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Enrico DiTommaso
- Department of Psychology, University of New Brunswick, Saint John Campus, Saint John, New Brunswick, Canada
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Abstract
OBJECTIVE To carry out a systematic review exploring the interconnections between oxytocin, postnatal depression (PND), and parenting. Questions include: (1) How does PND affect parenting? (2) How does oxytocin affect parenting? (3) How does oxytocin affect PND? METHODOLOGY To review English articles in major medical databases. RESULTS Compared to nondepressed controls, mothers with PND interact with their infants less sensitively, report feeling less competent, and less often choose recommended practical-parenting strategies. Psychological interventions for mothers with PND generally have positive effects on mother-infant interactions. The administration of oxytocin in community samples tends to improve parental behaviors. Findings exploring the association between oxytocin and PND were inconsistent, with some evidence that oxytocin has a negative impact on mood. CONCLUSIONS Oxytocin is potentially useful in improving parental behaviors of mothers with PND, but more research is needed to establish its safety because of the uncertain impact of OT on maternal mood.
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Lotzin A, Romer G, Schiborr J, Noga B, Schulte-Markwort M, Ramsauer B. Gaze Synchrony between Mothers with Mood Disorders and Their Infants: Maternal Emotion Dysregulation Matters. PLoS One 2015; 10:e0144417. [PMID: 26657941 PMCID: PMC4681006 DOI: 10.1371/journal.pone.0144417] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Accepted: 11/18/2015] [Indexed: 12/31/2022] Open
Abstract
A lowered and heightened synchrony between the mother's and infant's nonverbal behavior predicts adverse infant development. We know that maternal depressive symptoms predict lowered and heightened mother-infant gaze synchrony, but it is unclear whether maternal emotion dysregulation is related to mother-infant gaze synchrony. This cross-sectional study examined whether maternal emotion dysregulation in mothers with mood disorders is significantly related to mother-infant gaze synchrony. We also tested whether maternal emotion dysregulation is relatively more important than maternal depressive symptoms in predicting mother-infant gaze synchrony, and whether maternal emotion dysregulation mediates the relation between maternal depressive symptoms and mother-infant gaze synchrony. We observed 68 mothers and their 4- to 9-month-old infants in the Still-Face paradigm during two play interactions, before and after social stress was induced. The mothers' and infants' gaze behaviors were coded using microanalysis with the Maternal Regulatory Scoring System and Infant Regulatory Scoring System, respectively. The degree of mother-infant gaze synchrony was computed using time-series analysis. Maternal emotion dysregulation was measured by the Difficulties in Emotion Regulation Scale; depressive symptoms were assessed using the Beck Depression Inventory. Greater maternal emotion dysregulation was significantly related to heightened mother-infant gaze synchrony. The overall effect of maternal emotion dysregulation on mother-infant gaze synchrony was relatively more important than the effect of maternal depressive symptoms in the five tested models. Maternal emotion dysregulation fully mediated the relation between maternal depressive symptoms and mother-infant gaze synchrony. Our findings suggest that the effect of the mother's depressive symptoms on the mother-infant gaze synchrony may be mediated by the mother's emotion dysregulation.
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Affiliation(s)
- Annett Lotzin
- University Medical Center Hamburg-Eppendorf, Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Hamburg, Germany
| | - Georg Romer
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Muenster, Muenster, Germany
| | - Julia Schiborr
- University Medical Center Hamburg-Eppendorf, Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Hamburg, Germany
| | - Berit Noga
- University Medical Center Hamburg-Eppendorf, Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Hamburg, Germany
| | - Michael Schulte-Markwort
- University Medical Center Hamburg-Eppendorf, Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Hamburg, Germany
| | - Brigitte Ramsauer
- University Medical Center Hamburg-Eppendorf, Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Hamburg, Germany
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Noe D, Schluckwerder S, Reck C. Influence of dyadic matching of affect on infant self-regulation. Psychopathology 2015; 48:173-83. [PMID: 25833227 DOI: 10.1159/000376586] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 01/23/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Affective behavioural matching during face-to-face interaction fosters the transition from mutual regulation to infant self-regulation. Optimum midrange models of mother-infant interaction hold that moderate degrees of dyadic matching facilitate infant socio-emotional development. The aim of this study was to examine which degree of dyadic matching is most beneficial for infant self-regulation. METHODS To evaluate this model, 3 groups of highly, midrange and poorly matched dyads were created from a mixed sample of 68 dyads with healthy and post-partum depressed mothers and their infants (age range = 1-8 months, mean age = 3.9 months). Mother-infant interactions were videotaped in the face-to-face still-face paradigm (FFSF) and micro-analytically coded. Specifically, the relation between affective behavioural matching in FFSF play and infant positive and negative affect in FFSF still face and FFSF reunion was explored. RESULTS Contrary to our expectation, we found a monotonous trend for all groups: the more matching in FFSF play, the more positive and less negative affect the infant showed in FFSF still face and FFSF reunion, respectively. CONCLUSION The present findings further illuminate the association between different degrees of dyadic matching in early mother-infant interaction and infant self-regulation. Further research should focus on the integration and replication of findings and conceptual approaches to further evaluate and refine the concept of midrange matching and make it applicable to therapeutic work with mothers and their infants.
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Affiliation(s)
- Daniela Noe
- General Psychiatry, Centre for Psychosocial Medicine, Heidelberg University Hospital, Heidelberg, Germany
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Mörelius E, Örtenstrand A, Theodorsson E, Frostell A. A randomised trial of continuous skin-to-skin contact after preterm birth and the effects on salivary cortisol, parental stress, depression, and breastfeeding. Early Hum Dev 2015; 91:63-70. [PMID: 25545453 DOI: 10.1016/j.earlhumdev.2014.12.005] [Citation(s) in RCA: 132] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Revised: 07/25/2014] [Accepted: 12/09/2014] [Indexed: 12/01/2022]
Abstract
AIM To evaluate the effects of almost continuous skin-to-skin contact (SSC) on salivary cortisol, parental stress, parental depression, and breastfeeding. STUDY DESIGN This is a randomised study engaging families of late preterm infants (32-35 weeks gestation). Salivary cortisol reactivity was measured in infants during a nappy change at one month corrected age, and in infants and mothers during still-face at four month corrected age. Both parents completed the Swedish Parenthood Stress Questionnaire (SPSQ) at one month and the Edinburgh Postnatal Depression Scale (EPDS) at one and four months. Ainsworth's sensitivity scale was used to control for parental sensitivity. SUBJECTS Thirty-seven families from two different neonatal care units in Sweden, randomised to either almost continuous SSC or standard care (SC). RESULTS Infants randomised to SSC had a lower salivary cortisol reactivity at one month (p=0.01). There was a correlation between the mothers' and the preterm infants' salivary cortisol levels at four months in the SSC group (ρ=0.65, p=0.005), but not in the SC group (ρ=0.14, p=0.63). Fathers in SSC scored lower on the SPSQ sub-scale spouse relationship problems compared to fathers in SC (p<0.05). CONCLUSIONS Almost continuous SSC decreases infants' cortisol reactivity in response to handling, improves the concordance between mothers' and infants' salivary cortisol levels, and decreases fathers' experiences of spouse relationship problems.
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Affiliation(s)
- Evalotte Mörelius
- Department of Social and Welfare Studies, Division of Health, Activity and Care, Linköping University, Norrköping, Sweden; Department of Pediatrics, County Council of Östergötland, Linköping, Sweden.
| | - Annika Örtenstrand
- Department of Woman and Child Health, Division of Neonatology, Karolinska Institutet, Stockholm, Sweden
| | - Elvar Theodorsson
- Department of Clinical and Experimental Medicine, Division of Clinical Chemistry, Linköping University, Linköping, Sweden
| | - Anneli Frostell
- Department of Behavioural Sciences and Learning, Division of Psychology, Linköping University, Linköping, Sweden
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Ionio C, Di Blasio P. Post-traumatic stress symptoms after childbirth and early mother–child interactions: an exploratory study. J Reprod Infant Psychol 2013. [DOI: 10.1080/02646838.2013.841880] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Bolten M, Nast I, Skrundz M, Stadler C, Hellhammer DH, Meinlschmidt G. Prenatal programming of emotion regulation: neonatal reactivity as a differential susceptibility factor moderating the outcome of prenatal cortisol levels. J Psychosom Res 2013; 75:351-7. [PMID: 24119942 DOI: 10.1016/j.jpsychores.2013.04.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Revised: 04/23/2013] [Accepted: 04/29/2013] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Hypothalamic-pituitary-adrenal (HPA) activation during pregnancy is linked to dysfunctional behavioral outcomes in the offspring. According to Belsky's differential susceptibility hypothesis, individuals vary regarding their developmental plasticity. Translating the differential susceptibility hypothesis to the field of fetal programming, we hypothesize that infants' temperament, as the constitutionally based reactivity to stimulation, moderates prenatal environmental effects on postnatal emotion regulation. METHODS Maternal HPA axis activity and stress-reactivity during pregnancy was estimated, by measuring cortisol concentrations in saliva, collected at 0, 30, 45 and 60 min after awakening and in blood, collected during a laboratory stress test (Trier Social Stress Test), respectively. Newborns reactivity to stimulation was evaluated between postnatal day 10 and 14 using the Neonatal Intensive Care Unit Network Neurobehavioral Scale. Infant's self-quieting-activities, as an indicator of emotion regulation, were evaluated at the age of six months during the still face paradigm. RESULTS Maternal cortisol reactivity to stress during pregnancy was associated with infant's emotion regulation at the age of six months. Whereas cortisol levels after awakening in mid and late pregnancy were not associated with emotion regulation. Furthermore, regression analyses revealed that in interaction with neonatal reactivity, both, prenatal maternal HPA activity as well as prenatal maternal HPA reactivity to stress predicted emotion regulation. CONCLUSION The findings indicate that newborns' reactivity to stimulation is moderating the association between prenatal exposure to maternal glucocorticoids and emotion regulation in infancy. Data suggests that temperamental characteristics of the newborn are a relevant differential susceptibility factor with regard to prenatal effects on emotion regulation.
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Affiliation(s)
- Margarete Bolten
- Psychiatric University Clinics of Basel, Department of Child and Adolescent Psychiatry, Switzerland; sesam - Swiss Etiological Study of Adjustment Mental Health, National Centre of Competence in Research, Faculty of Psychology, University of Basel, Switzerland.
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Abstract
Emotion expression is an important feature of healthy child development that has been found to show gender differences. However, there has been no empirical review of the literature on gender and facial, vocal, and behavioral expressions of different types of emotions in children. The present study constitutes a comprehensive meta-analytic review of gender differences and moderators of differences in emotion expression from infancy through adolescence. We analyzed 555 effect sizes from 166 studies with a total of 21,709 participants. Significant but very small gender differences were found overall, with girls showing more positive emotions (g = -.08) and internalizing emotions (e.g., sadness, anxiety, sympathy; g = -.10) than boys, and boys showing more externalizing emotions (e.g., anger; g = .09) than girls. Notably, gender differences were moderated by age, interpersonal context, and task valence, underscoring the importance of contextual factors in gender differences. Gender differences in positive emotions were more pronounced with increasing age, with girls showing more positive emotions than boys in middle childhood (g = -.20) and adolescence (g = -.28). Boys showed more externalizing emotions than girls at toddler/preschool age (g = .17) and middle childhood (g = .13) and fewer externalizing emotions than girls in adolescence (g = -.27). Gender differences were less pronounced with parents and were more pronounced with unfamiliar adults (for positive emotions) and with peers/when alone (for externalizing emotions). Our findings of gender differences in emotion expression in specific contexts have important implications for gender differences in children's healthy and maladaptive development.
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Affiliation(s)
- Tara M Chaplin
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06519, USA.
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Lunkenheimer ES, Albrecht EC, Kemp CJ. Dyadic Flexibility in Early Parent-Child Interactions: Relations with Maternal Depressive Symptoms and Child Negativity and Behaviour Problems. INFANT AND CHILD DEVELOPMENT 2012; 22:250-269. [PMID: 24027424 DOI: 10.1002/icd.1783] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Lower levels of parent-child affective flexibility indicate risk for children's problem outcomes. This short-term longitudinal study examined whether maternal depressive symptoms were related to lower levels of dyadic affective flexibility and positive affective content in mother-child problem-solving interactions at age 3.5 years (N=100) and whether these maternal and dyadic factors predicted child emotional negativity and behaviour problems at a 4-month follow-up. Dyadic flexibility and positive affect were measured using dynamic systems-based modelling of second-by-second affective patterns during a mother-child problem-solving task. Results showed that higher levels of maternal depressive symptoms were related to lower levels of dyadic affective flexibility, which predicted children's higher levels of negativity and behaviour problems as rated by teachers. Mothers' ratings of child negativity and behaviour problems were predicted by their own depressive symptoms and individual child factors, but not by dyadic flexibility. There were no effects of dyadic positive affect. Findings highlight the importance of studying patterns in real-time dyadic parent-child interactions as potential mechanisms of risk in developmental psychopathology.
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Reebye PN, Ng TWC, Misri S, Stikarovska I. Affect Expression and Self-Regulation Capacities of Infants Exposed in utero to Psychotropics. Front Psychiatry 2012; 3:11. [PMID: 22403552 PMCID: PMC3289044 DOI: 10.3389/fpsyt.2012.00011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Accepted: 02/03/2012] [Indexed: 11/13/2022] Open
Abstract
This study explored the affect expression and self-regulation capacities of 8-month-old infants exposed in utero to psychotropic medications. This was a continuation of our previous study conducted on the same cohort when the infants were 3 months old. Psychotropics implicated included selective serotonin reuptake inhibitors (SSRIs), and a benzodiazepine derivative anxiolytic (clonazepam). The three comparison groups were: control (n = 23; infants not exposed to psychotropics in utero), SSRI-alone (n = 22; infants exposed to SSRIs only and having mothers who had a primary diagnosis of depressive disorder without having comorbid anxiety disorder), and SSRI+ group (n = 15; infants gestationally exposed to SSRIs and clonazepam and having mothers that had both clinical depression and anxiety disorder). Using the Parent-Child Early Relational Assessment Scale, infants were assessed in a dyadic context during free play and a structured task. There were significant differences in psychotropic exposed and non-exposed dyads regarding infant negative affect management. There were significant associations between the SSRI+ group of mothers and infant negative affect. This group of mothers also showed significant associations with infants' averting and avoiding behaviors in both play situations. The SSRI-alone group was similar to the control group and showed variable associations with infant's positive, negative, and sober moods unlike the SSRI+ group. There were no differences in infants' capacity for self-regulation in psychotropic exposed and non-exposed groups. Increased awareness of these vulnerable subgroups (SSRI-alone and SSRI+) is needed, in order to safeguard these dyads through better support systems and improved management.
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Affiliation(s)
- Pratibha N. Reebye
- Infant Psychiatry Clinic, Department of Psychiatry, University of British ColumbiaVancouver, BC, Canada
| | | | - Shaila Misri
- Reproductive Psychiatry Clinic, Department of Psychiatry, University of British ColumbiaVancouver, BC, Canada
| | - Irena Stikarovska
- Infant Psychiatry Clinic, Department of Psychiatry, University of British ColumbiaVancouver, BC, Canada
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Vilela FC, Melo CM, Giusti-Paiva A. Glucocorticoids impair maternal anxiolysis during lactation. Neurosci Lett 2012; 509:121-4. [DOI: 10.1016/j.neulet.2011.12.056] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Revised: 12/16/2011] [Accepted: 12/27/2011] [Indexed: 10/14/2022]
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A developmental psychopathology perspective on emotional availability research: Current trends and challenges. Dev Psychopathol 2012; 24:107-11. [DOI: 10.1017/s0954579411000691] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractStudies using the Emotional Availability Scales have burgeoned in the past decade. The collection of papers included in this Special Section represents the latest innovations in research with this paradigm. Consistent with a developmental psychopathology perspective, these papers evaluate emotional availability in a variety of typical, at-risk, international, and intergenerational samples of children and caregivers, with many utilizing longitudinal designs or employing measures from multiple levels of analysis. One study begins to translate findings from this body of research into a promising intervention program. Although further growth and refinement in research with this paradigm is needed, the results to date begin to place the construct of emotional availability into a complex, dynamic biopsychosocial context, and promise to inspire a new generation of studies. In this commentary, some of the key contributions and challenges of this collection of studies are highlighted using a developmental psychopathology framework.
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Beebe B, Steele M, Jaffe J, Buck KA, Chen H, Cohen P, Kaitz M, Markese S, Andrews H, Margolis A, Feldstein S. MATERNAL ANXIETY SYMPTOMS AND MOTHER-INFANT SELF- AND INTERACTIVE CONTINGENCY. Infant Ment Health J 2011; 32:174-206. [PMID: 25983359 PMCID: PMC4431701 DOI: 10.1002/imhj.20274] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Associations of maternal self-report anxiety-related symptoms with mother-infant 4-month face-to-face play were investigated in 119 pairs. Attention, affect, spatial orientation, and touch were coded from split-screen videotape on a 1-s time base. Self- and interactive contingency were assessed by time-series methods. Because anxiety symptoms signal emotional dysregulation, we expected to find atypical patterns of mother-infant interactive contingencies, and of degree of stability/lability within an individual's own rhythms of behavior (self-contingencies). Consistent with our optimum midrange model, maternal anxiety-related symptoms biased the interaction toward interactive contingencies that were both heightened (vigilant) in some modalities and lowered (withdrawn) in others; both may be efforts to adapt to stress. Infant self-contingency was lowered ("destabilized") with maternal anxiety symptoms; however, maternal self-contingency was both lowered in some modalities and heightened (overly stable) in others. Interactive contingency patterns were characterized by intermodal discrepancies, confusing forms of communication. For example, mothers vigilantly monitored infants visually, but withdrew from contingently coordinating with infants emotionally, as if mothers were "looking through" them. This picture fits descriptions of mothers with anxiety symptoms as overaroused/fearful, leading to vigilance, but dealing with their fear through emotional distancing. Infants heightened facial affect coordination (vigilance), but dampened vocal affect coordination (withdrawal), with mother's face-a pattern of conflict. The maternal and infant patterns together generated a mutual ambivalence.
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Tissot H, Frascarolo F, Despland JN, Favez N. Dépression post-partum maternelle et développement de l'enfant : revue de littérature et arguments en faveur d'une approche familiale. PSYCHIATRIE DE L ENFANT 2011. [DOI: 10.3917/psye.542.0611] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Maternal anxiety, mother–infant interactions, and infants’ response to challenge. Infant Behav Dev 2010; 33:136-48. [DOI: 10.1016/j.infbeh.2009.12.003] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2009] [Revised: 12/04/2009] [Accepted: 12/28/2009] [Indexed: 11/20/2022]
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Manian N, Bornstein MH. Dynamics of emotion regulation in infants of clinically depressed and nondepressed mothers. J Child Psychol Psychiatry 2009; 50:1410-8. [PMID: 19788549 PMCID: PMC2844731 DOI: 10.1111/j.1469-7610.2009.02166.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Emotion regulation (ER) has been conceptualized as an ongoing process of the individual's emotion patterns in relation to moment-to-moment contextual demands. In contrast to traditional approaches of descriptively quantizing ER, we employed a dynamic approach to ER by examining key transitions in infants of clinically depressed and nondepressed mothers in the context of maternal still-face (SF). METHODS Mothers with (n = 48) and without a clinical diagnosis of depression (n = 68) were seen in a modified SF paradigm with their 5-month-olds. Infant states and self-soothing behaviors were coded in 1-sec time intervals. RESULTS Infants of nondepressed mothers used attentional regulatory strategies, whereas infants of depressed mothers used internally directed strategies of self-soothing to reduce negativity and maintain engagement with mother. CONCLUSIONS This study advances our understanding of processes underlying infant ER and points to possible mechanisms for the development of long-term maladaptive ER strategies in infants of depressed mothers.
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Affiliation(s)
- Nanmathi Manian
- Child and Family Research, Program in Developmental Neuroscience, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Suite 8030, 6705 Rockledge Drive, Bethesda, MD 20892-7971, USA.
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