Antenatal interpersonal sensitivity is more strongly associated than perinatal depressive symptoms with postnatal mother-infant interaction quality

Maternal-infant interaction quality is associated with child NR3C1 CpG site methylation at 7 years of age

OBJECTIVE

Infancy is both a critical window for hypothalamic-pituitary-adrenal (HPA) axis development, and a sensitive period for social-emotional influences. We hypothesized that the social-emotional quality of maternal-infant interactions are associated with methylation of HPA-axis gene NR3C1 later in childhood.

METHODS

Using a subsample of 114 mother-infant pairs from the Avon Longitudinal Study of Parents and Children (ALSPAC), linear regression models were created to predict variance in methylation of seven selected CpG sites from NR3C1 in whole blood at age 7 years, including the main predictor variable of the first principal component score of observed maternal-infant interaction quality (derived from the Thorpe Interaction Measure at 12 months of age) and covariates of cell-type proportion, maternal financial difficulties and marital status at 8 months postnatal, child birthweight, and sex.

RESULTS

CpG site cg27122725 methylation was negatively associated with warmer, more positive maternal interaction with her infant (β = 0.19, p = .02, q = 0.13). In sensitivity analyses, the second highest quartile of maternal behavior (neutral, hesitant behavior) was positively associated with cg12466613 methylation. The other five CpG sites were not significantly associated with maternal-infant interaction quality.

CONCLUSIONS

Narrow individual variation of maternal interaction with her infant is associated with childhood methylation of two CpG sites on NR3C1 that may be particularly sensitive to environmental influences. Infancy may be a sensitive period for even small influences from the social-emotional environment on the epigenetic determinants of HPA-axis function.

Parental Sensitivity and Responsiveness as Mediators Between Postpartum Mental Health and Bonding in Mothers and Fathers

Background: There is a lack of studies that examine the complex relationship between parental mental health, parental sensitivity and responsiveness, and parent-infant bonding. This study aimed to test whether parental sensitivity and responsiveness were mediators between postpartum mental health (depression, anxiety, and stress) and parent-infant bonding in mothers and fathers. Method: Mothers (n = 427) and fathers (n = 170) of infants aged up to 1-year-old participated in an online study. The parents completed questionnaires on depression (Edinburgh Postnatal Depression Scale, EPDS), anxiety and stress (Depression, Anxiety, and Stress Scale, DASS-21). Parent-infant bonding was measured by Postpartum Bonding Questionnaire (PBQ) that has three components: Impaired bonding (PBQ1), Anxiety about care and parental distress (PBQ2), and Lack of enjoyment and affection with infant (PB3Q). Parental sensitivity was measured as the number of correct recognitions of infant facial expressions (City Infant Faces Database, CIFD). Responsiveness was measured as a self-report with two subscales of responsiveness and non-responsiveness (Maternal Infant Responsiveness Instrument, MIRI). Results: The path analysis showed that the model had a good fit to the data. Parental sex was a significant moderator, indicating different paths in mothers and fathers. In mothers, responsiveness and non-responsiveness were significant mediators between depression symptoms and three dimensions of bonding. In fathers, only non-responsiveness was a significant mediator between anxiety and PBQ3. Although recognizing infant facial expressions directly affected PBQ3 in mothers (but not in fathers), it was not a significant mediator between mental health and bonding. Conclusion: Higher levels of parental mental health problems (depression and anxiety) were associated with lower levels of parental responsiveness, which is, in turn, related to poor parent-infant bonding. Prevention and intervention programs should be offered for both mothers and fathers, focusing on postpartum mental health promotion and enhancing responsiveness in infant care.

Perinatal depression screening in Australia: A position paper

Perinatal depression can have enduring adverse effects on women and their children and families, incurring substantial ongoing economic and personal costs. A significant proportion of the cost of perinatal depression relates to adverse impacts on the child, most likely mediated through impairment to the mother-infant relationship. In recognition of this problem, Australia has invested in routine perinatal depression screening. Our previous research produced convergent findings suggesting that expected benefits for children have not yet been realised through perinatal depression screening. We question the potential of including a measure of personality in current perinatal depression screening for identifying maternal mental health problems and suboptimal mother-infant relationships. This paper reviews our previous research findings within the broader context of perinatal depression screening. We propose a position, that perinatal depression screening in Australia should be redesigned to more precisely detect vulnerable mother-infant relationships, parenting, maternal mental health, and infant psychosocial and psychological development. Practice change to appropriately target antenatal interventions may more efficiently improve both maternal and child outcomes, thereby contributing to greater efficiency and cost savings for the health system.

Maternal depression and the emotional availability of mothers at six months postpartum: Findings from the Mercy Pregnancy and Emotional Wellbeing Study (MPEWS) pregnancy cohort

BACKGROUND

Existing research suggests maternal depression may reduce the quality of early mother-infant interaction and this might increase our understanding of how maternal mental health impacts on child development outcomes. However, most studies recruit from community samples and few include both a diagnostic measure of maternal depression together with an observational measure of the quality of the mother-infant relationship.

METHODS

Data was drawn from 210 women recruited in early pregnancy until 6 months postpartum within an Australian pregnancy cohort, the Mercy Pregnancy and Emotional Wellbeing Study. Those women who at six months postpartum were video recorded interacting with their infant for at least 40-minutes were included in this study, with the quality of those interactions assessed using the Emotional Availability Scales coding system. Depression was measured using the Structured Clinical Interview for the DSM-IV-TR Clinician Version and the Edinburgh Postnatal Depression Scale, and covariates included maternal age and education.

RESULTS

Whilst results showed a small negative association between antenatal depressive symptoms in trimester one of pregnancy and maternal EA, there was no effect of maternal depression diagnosis or of maternal depressive symptoms in later pregnancy or postpartum.

LIMITATIONS

This study focuses exclusively on mothers and does not account for the role of partners.

CONCLUSIONS

Maternal depression might have a smaller effect on maternal EA then some existing research implies, with that effect most prevalent in early pregnancy. Clinical intervention might not be necessary for all mother-infant dyads experiencing depressive symptomology, but instead be directed to those with additional risk factors.

Prenatal maternal personality as an early predictor of vulnerable parenting style

Perinatal mental health problems, particularly depression, are prevalent and have been a central focus of prevention initiatives. The greater proportion of ongoing annual perinatal mental health economic cost burdens relate to children. A key linking mechanism is mother-infant relationship quality. Perinatal depression symptoms are typically transient. However, personality style, including interpersonal sensitivity, is a more stable construct and predicts proneness to depression and common mental disorders. Building on our previous work, the objective of the present study is to examine the association between specific dimensions of prenatal interpersonal sensitivity and postpartum mother-infant relationship quality in the context of prenatal depression symptoms. We analysed data from the Avon Longitudinal Study of Parents and Children (ALSPAC). Interpersonal sensitivity and depression symptoms were measured at 18 weeks gestation. In a randomly selected 10% subsample of the ALSPAC cohort, mother-infant interaction was measured through standard observation at 12 months postpartum. For the subsample that had complete data at all time points (n = 812), multiple regression models examined prenatal interpersonal sensitivity dimensions predicting postpartum mother-infant relationship quality, accounting for depression symptoms. Two dimensions of maternal interpersonal sensitivity modestly predicted mother-infant relationship quality at 12 months postpartum and remained robust when we controlled for depression symptoms. The interpersonal sensitivity subscales were significantly associated with prenatal depression symptoms but more consistently and robustly predicted postnatal mother-infant interaction quality. The inclusion of personality measures may strengthen prenatal mental health assessment to identify vulnerability to suboptimal mother-infant relationship quality.

Antenatal interpersonal sensitivity as an early predictor of vulnerable mother-infant relationship quality

Maternal mental health problems in the perinatal period incur significant human and economic costs attributable to adverse child outcomes. In response, governments invest in screening for perinatal depressive symptoms. Mother-infant relationship quality (MIRQ) is a key mechanism linking maternal perinatal mental health to child outcomes. Perinatal depressive symptoms are typically transient while personality style, including interpersonal sensitivity, is a more stable construct. We have demonstrated that antenatal interpersonal sensitivity independently predicted MIRQ at 12 months postpartum. Building on our previous work, the objective of this study was to examine the associations of antenatal interpersonal sensitivity and depressive symptoms with MIRQ 1 year postnatal. A sample of 73 women attending routine antenatal care, 61 (84%) from ethnically diverse populations, were studied across the perinatal period. At ⩽26 weeks, gestation interpersonal sensitivity and depressive symptoms were measured. At 12 months, postnatal mental health and MIRQ was assessed in 35 of the mother-infant dyads. We found no significant statistical association between antenatal interpersonal sensitivity and depressive symptoms with postnatal MIRQ. Interpersonal sensitivity (r = -.24) showed weak association with MIRQ. Depressive symptom scores were not associated (r =-.01). Maternal sensitivity assessment (MIRQ) using the CARE-Index identified low mean scores signifying low levels of maternal sensitivity (potential range 0-14; mean score = 6.3). We cautiously suggest that the findings raise questions about the presentation and assessment of perinatal mental health status among ethnically diverse populations and scoping of parenting support needs within this population.

Associations between prenatal maternal mental health indices and mother-infant relationship quality 6 to 18 months' postpartum: A systematic review

Maternal mental disorders can significantly impact on children's psychosocial and psychological development, incurring substantial ongoing economic and personal costs. A key mediating mechanism is mother-infant relationship quality (MIRQ). Research studies and perinatal mental health screening initiatives have predominantly focused on depressive symptoms and perinatal depression as predictors of MIRQ. While maternal depression is associated with suboptimal MIRQ, the findings have not been consistent. Personality characteristics are associated with parenting and proneness to depression, presenting a potential addition to prenatal mental health assessment. We conducted a systematic review of studies that have examined the link between prenatal depressive symptoms and/or personality characteristics with postnatal MIRQ. Our findings suggest that both maternal personality traits and depressive symptoms measured in early pregnancy are associated with postnatal MIRQ. A measure of personality characteristics may enhance prenatal mental health assessment, affording opportunities for targeted intervention commencing in pregnancy to improve MIRQ, parenting, maternal mental health outcomes, and infant psychosocial and psychological development, and thereby contributing to the reduction of human and economic cost burdens.

Cognitive factors and post-partum depression: What is the influence of general personality traits, rumination, maternal self-esteem, and alexithymia?

OBJECTIVES

The objective was to assess the impact of cognitive factors on post-partum depression (PPD) symptoms. Because most of the literature data concern the immediate post-partum period or the first year post-partum, we notably sought to assess the longer term impact of cognitive factors on the symptoms of PPD.

METHODS

Two studies were performed. In a pilot study, 1-month post-partum, 63 women filled out a sociodemographic information sheet and completed the abbreviated, revised Eysenck Personality Questionnaire, the Ruminative Responses Scale, the Maternal Self-Report Inventory, and the Edinburgh Post-Natal Depression Scale. In the main study, 124 women additionally completed the Toronto Alexithymia Scale. The main study population was divided into 2 subgroups: women in the first year post-partum (n = 74) and those in the second year post-partum (n = 50).

RESULTS

In the pilot study performed 1-month post-partum, brooding rumination and low self-esteem were significant predictors of the PPD symptom intensity. Neuroticism, brooding rumination, and low maternal self-esteem were also significant predictors of the PPD symptoms reported in the first year post-partum. Lastly, ruminative thoughts and alexithymia were significant predictors of the PPD symptoms reported in the second year post-partum.

CONCLUSIONS

Our results suggest that alexithymia may be an important predictor of the incidence of this condition. The observation of differences in the PPD models as a function of the post-partum period may open up opportunities for developing novel PPD prevention/treatment programs.

Maternal sensitivity and social support protect against childhood atopic dermatitis

BACKGROUND

Many studies have identified associations between qualities of maternal-child relationships and childhood asthma, but few have examined associations with childhood atopic dermatitis (AD), a common precursor to asthma. Moreover, maternal psychological distress, including prenatal and postnatal depression, anxiety and stress, may increase risk, while social support from partners may reduce risk for childhood AD. We sought to uncover the association between maternal-infant relationship qualities (maternal sensitivity towards infant behavioral signals, controlling behavior, and unresponsiveness) and child AD after accounting for risk (i.e., prenatal and postnatal maternal depression, anxiety and stress) and protective (i.e., social support) factors.

METHODS

We conducted a secondary analysis of data collected on a subsample of 242 women and their infants enrolled during pregnancy in the ongoing Alberta Pregnancy Outcomes and Nutrition cohort study. Inclusion criteria required mothers to be >16 years of age, English speaking and <22 weeks gestational age at enrollment. Data on depression, anxiety and stress in the prenatal and postnatal periods and physician diagnosis of childhood AD at 18 months were gathered via maternal report. Maternal sensitivity, unresponsiveness and controlling behaviours were assessed via videotaped observations using the Child-Adult Relationship Experimental (CARE)-Index at 6 months of infant age.

RESULTS

Higher maternal sensitivity, or the inability of the mother to appropriately understand and respond to infant needs based on behavioral signals, predicted reduced odds of AD independent of and in combination with low prenatal and postnatal anxiety and high paternal support. After adjustment, higher maternal controlling behaviours and unresponsiveness also predicted greater odds of AD.

CONCLUSIONS

Low maternal sensitivity is a risk factor for childhood AD, independently and in combination with perinatal anxiety and low social support. Thus, interventions that improve maternal-infant relationship quality, especially sensitivity, reduce anxiety and improve social support from partners could reduce odds of childhood AD.