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Frankel LA, Sampige R, Pfeffer K, Zopatti KL. Depression During the Postpartum Period and Impacts on Parent-Child Relationships: A Narrative Review. J Genet Psychol 2024; 185:146-154. [PMID: 37978907 DOI: 10.1080/00221325.2023.2276264] [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: 05/25/2023] [Accepted: 10/24/2023] [Indexed: 11/19/2023]
Abstract
Although controversy exists around labels for postpartum depression (PPD), focusing efforts on terms distracts the research community from better understanding the impact of depression on parent-infant relationships. The purpose of this article is to provide a narrative review of research related to how depression experienced in the postpartum period impacts parent-infant relationships. Our review indicates that PPD is pervasive, symptoms often appear during pregnancy, and it has the potential to negatively impact parent-infant relationships. Based on the recent review of literature, intervention efforts should focus on identification and treatment of PPD as early as possible to mitigate detrimental long-term impacts on parent-child relationships.
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Affiliation(s)
- Leslie Ann Frankel
- Department of Psychological, Health and Learning Sciences, University of Houston, Houston, TX, USA
| | - Ritu Sampige
- School of Medicine, Baylor College of Medicine, Houston, TX, USA
| | | | - Katherine L Zopatti
- Department of Psychological, Health and Learning Sciences, University of Houston, Houston, TX, USA
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2
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Gregersen M, Ellersgaard D, Søndergaard A, Christiani C, Hemager N, Spang KS, Burton BK, Uddin MJ, Ohland J, Gantriis D, Greve A, Hjorthøj C, Mors O, Plessen KJ, Nordentoft M, Clemmensen L, Jepsen JRM, Thorup AAE. Attachment representations in 7-year-old children at familial high risk of schizophrenia or bipolar disorder: Associations with mental disorders and daily functioning: The Danish High Risk and Resilience Study, VIA 7-A population-based cohort study. Scand J Psychol 2023; 64:776-783. [PMID: 37309265 DOI: 10.1111/sjop.12941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 05/23/2023] [Accepted: 05/24/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND Attachment quality may affect psychological functioning. However, evidence on attachment representations and their correlates in children born to parents with schizophrenia and bipolar disorder is sparse. METHODS We compared attachment representations in a Danish sample of 482 children aged 7 years at familial high risk of schizophrenia, bipolar disorder, and population-based controls and examined associations between attachment and mental disorders and daily functioning. Attachment representations were examined with the Story Stem Assessment Profile (SSAP). Mental disorders were ascertained in diagnostic interviews. Daily functioning was assessed with the Children's Global Assessment Scale. RESULTS We found no between-group differences in attachment. Higher levels of secure attachment were associated with decreased risk of concurrent mental disorders in the schizophrenia high-risk group. Higher levels of insecure and disorganized attachment were associated with increased risk of mental disorders across the cohort. Higher levels of secure and insecure attachment were associated with better and poorer daily functioning, respectively. In the current study, results regarding defensive avoidance could not be reported due to methodological limitations. CONCLUSION Familial high risk of schizophrenia (FHR-SZ) or bipolar disorder is not associated with less secure or more insecure attachment at age 7. Insecure and disorganized attachment representations index risk of mental disorders and poorer functioning. Secure attachment may be a protective factor against mental disorders in children at FHR-SZ. Validation of the SSAP is needed.
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Affiliation(s)
- Maja Gregersen
- CORE - Copenhagen Research Centre for Mental Health, Mental Health Services in the Capital Region of Denmark, Mental Health Centre Copenhagen, Copenhagen, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark
| | - Ditte Ellersgaard
- CORE - Copenhagen Research Centre for Mental Health, Mental Health Services in the Capital Region of Denmark, Mental Health Centre Copenhagen, Copenhagen, Denmark
| | - Anne Søndergaard
- CORE - Copenhagen Research Centre for Mental Health, Mental Health Services in the Capital Region of Denmark, Mental Health Centre Copenhagen, Copenhagen, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark
| | - Camilla Christiani
- CORE - Copenhagen Research Centre for Mental Health, Mental Health Services in the Capital Region of Denmark, Mental Health Centre Copenhagen, Copenhagen, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark
| | - Nicoline Hemager
- CORE - Copenhagen Research Centre for Mental Health, Mental Health Services in the Capital Region of Denmark, Mental Health Centre Copenhagen, Copenhagen, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark
- Mental Health Services in the Capital Region of Denmark, Child and Adolescent Mental Health Centre, Copenhagen, Denmark
| | - Katrine Søborg Spang
- Mental Health Services in the Capital Region of Denmark, Child and Adolescent Mental Health Centre, Copenhagen, Denmark
| | - Birgitte Klee Burton
- Mental Health Services in the Capital Region of Denmark, Child and Adolescent Mental Health Centre, Copenhagen, Denmark
- University of Copenhagen - Faculty of Health and Medical Sciences, Copenhagen, Denmark
- Department of Child and Adolescent Psychiatry, Copenhagen University Hospital, Psychiatry Region Zealand, Roskilde, Denmark
| | - Md Jamal Uddin
- CORE - Copenhagen Research Centre for Mental Health, Mental Health Services in the Capital Region of Denmark, Mental Health Centre Copenhagen, Copenhagen, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark
| | - Jessica Ohland
- CORE - Copenhagen Research Centre for Mental Health, Mental Health Services in the Capital Region of Denmark, Mental Health Centre Copenhagen, Copenhagen, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark
| | - Ditte Gantriis
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark
- Psychosis Research Unit, Aarhus University Hospital, Aarhus, Denmark
| | - Aja Greve
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark
- Psychosis Research Unit, Aarhus University Hospital, Aarhus, Denmark
| | - Carsten Hjorthøj
- CORE - Copenhagen Research Centre for Mental Health, Mental Health Services in the Capital Region of Denmark, Mental Health Centre Copenhagen, Copenhagen, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark
- Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark
| | - Ole Mors
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark
- Psychosis Research Unit, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Aarhus University, Aarhus, Denmark
| | - Kerstin Jessica Plessen
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, University Hospital, Lausanne, Switzerland
| | - Merete Nordentoft
- CORE - Copenhagen Research Centre for Mental Health, Mental Health Services in the Capital Region of Denmark, Mental Health Centre Copenhagen, Copenhagen, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark
- University of Copenhagen - Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Lars Clemmensen
- CORE - Copenhagen Research Centre for Mental Health, Mental Health Services in the Capital Region of Denmark, Mental Health Centre Copenhagen, Copenhagen, Denmark
| | - Jens Richardt Møllegaard Jepsen
- CORE - Copenhagen Research Centre for Mental Health, Mental Health Services in the Capital Region of Denmark, Mental Health Centre Copenhagen, Copenhagen, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark
- Mental Health Services in the Capital Region of Denmark, Child and Adolescent Mental Health Centre, Copenhagen, Denmark
- Center for Neuropsychiatric Schizophrenia Research and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
| | - Anne Amalie Elgaard Thorup
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark
- Mental Health Services in the Capital Region of Denmark, Child and Adolescent Mental Health Centre, Copenhagen, Denmark
- University of Copenhagen - Faculty of Health and Medical Sciences, Copenhagen, Denmark
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3
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Kossakowska K, Śliwerski A. Factors affecting mother-infant bonding in a Polish group of mothers. SEXUAL & REPRODUCTIVE HEALTHCARE 2023; 37:100880. [PMID: 37392584 DOI: 10.1016/j.srhc.2023.100880] [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: 07/21/2022] [Revised: 05/23/2023] [Accepted: 06/21/2023] [Indexed: 07/03/2023]
Abstract
AIM The study aimed to identify the factors affecting the mother-infant bond. METHODS This cross-sectional study included 117 mothers of infants up to 12 months of age. The participants completed online versions of the Postpartum Depression Screening Scale - Short Form, the Postpartum Bonding Questionnaire, the Parenting Sense of Competence Scale, the Perception of Stress Questionnaire, and the Prenatal Expectations Scale, which included expectations toward the child, social functioning, and the partner. The results were analyzed using independent t-tests, one-way ANOVA, and multivariate linear regression. RESULTS Mothers who experienced symptoms of postpartum depression reported lower satisfaction with motherhood, higher stress levels, and greater discrepancies between prenatal expectations and postpartum reality. Regression analysis revealed that postpartum depression symptoms did not significantly influence the three dimensions of bonding difficulties. However, stress, discrepancies between expectations toward the partner and child, and maternal sense of competence were found to potentially intensify bonding disorders. The study also found that greater disappointment with the partner was generally associated with a weaker bond with the child. However, in cases where caring for a child was more challenging than expected during pregnancy, high emotional tension was present, or the mother had lower parental competencies, having a partner who functioned better than expected may exacerbate the disruption of the bond between the mother and child. CONCLUSIONS Prenatal expectations, perceived stress levels, and maternal sense of competence are significant factors in bonding difficulties, with postpartum depression symptoms being an important as single variable. However, the role of postpartum depression symptoms in shaping the mother-infant bond diminishes when the overall functioning of the mother is considered.
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Affiliation(s)
- Karolina Kossakowska
- Department of Clinical Psychology and Psychopathology, Institute of Psychology, Faculty of Educational Sciences, University of Lodz, Lodz, Poland.
| | - Andrzej Śliwerski
- Department of Clinical Psychology and Psychopathology, Institute of Psychology, Faculty of Educational Sciences, University of Lodz, Lodz, Poland
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Galbally M, Watson SJ, van IJzendoorn MH, Tharner A, Luijk M, de Kloet ER, van Rossum EFC, Lewis AJ. Prenatal predictors of childhood anxiety disorders: An exploratory study of the role of attachment organization. Dev Psychopathol 2023; 35:1296-1307. [PMID: 34911592 DOI: 10.1017/s0954579421001206] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Childhood anxiety disorders (CAD) are a common childhood mental disorder and understanding early developmental pathways is key to prevention and early intervention. What is not understood is whether early life stress predictors of CAD might be both mediated by infant cortisol reactivity and moderated by infant attachment status. To address this question, this exploratory study draws on 190 women recruited in early pregnancy and followed together with their children until 4 years of age. Early life stress is operationalized as maternal depression measured using the Structured Clinical Interview for the DSM, Childhood Trauma Questionnaire, Parenting Stress Index, and antenatal maternal hair cortisol concentrations. Infant cortisol reactivity was measured at 12 months together with the Strange Situation Procedure and CAD assessed at 4 years of age using the Preschool Age Psychiatric Assessment. There was no direct association between attachment classification and CAD. Furthermore, infant cortisol reactivity neither mediated nor attachment moderated the association of early life stress predictors and CAD. However, only for infants with organized attachment classifications, higher maternal antenatal depression, and hair cortisol were associated with a higher risk of CAD.
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Affiliation(s)
- Megan Galbally
- Psychology, Murdoch University, Murdoch, Australia
- School of Medicine, University of Notre Dame, Australia
- King Edward Memorial Hospital, Subiaco, Perth, WA, Australia
| | - Stuart J Watson
- Psychology, Murdoch University, Murdoch, Australia
- School of Medicine, University of Notre Dame, Australia
| | - Marinus H van IJzendoorn
- Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Department of Clinical, Educational and Health Psychology, Faculty of Brain Sciences, UCL, UK
| | - Anne Tharner
- Department of Educational and Family Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Maartje Luijk
- Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - E Ron de Kloet
- Department of Internal Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands
| | - Elisabeth F C van Rossum
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Galbally M, Watson S, Lewis AJ, Power J, Buus N, van IJzendoorn M. Maternal attachment state of mind and perinatal emotional wellbeing: Findings from a pregnancy cohort study. J Affect Disord 2023; 333:297-304. [PMID: 37062497 DOI: 10.1016/j.jad.2023.04.016] [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: 01/27/2023] [Revised: 04/02/2023] [Accepted: 04/10/2023] [Indexed: 04/18/2023]
Abstract
OBJECTIVES Maternal attachment state of mind is an important potential predictor of risk and resilience to perinatal emotional wellbeing and early parenting. To explore maternal attachment in relation to perinatal depression and emotional wellbeing. METHODS This study drew on data collected within an ongoing cohort from 170 women recruited in early pregnancy, including 67 who met criteria for Major Depression. Maternal attachment state of mind was assessed with the Adult Attachment Interview (AAI) in pregnancy. Additional measures included the Structured Clinical Interview for the DSM (SCID), at 12 months the Strange Situation Procedure (SSP), Child Trauma Questionnaire (CTQ), Parenting Stress Index, and antenatal maternal hair cortisol concentrations (HCC). LIMITATIONS Sample size to be able to undertake all analyses using the 4 way classifications, cortisol measurement is limited to hair only and there is no prospectively collected measure of childhood trauma in mothers. CONCLUSIONS This study found that maternal attachment, specifically the Non-Autonomous states of mind, adjusted for clinical depression, was associated with higher cortisol in pregnancy and higher depressive symptoms across pregnancy and the postpartum. Furthermore, separately those with depression and Non-Autonomous states of mind also had higher postpartum parenting stress. There was no significant intergenerational concordance between AAI and SSP attachment classifications. Our findings support future research exploring the role of maternal attachment state of mind in understanding perinatal depression and emotional wellbeing.
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Affiliation(s)
- Megan Galbally
- School of Health Sciences, Monash University, Australia; Health Futures Institute, Murdoch University, Australia; Research Department of Clinical, Education and Health Psychology, Faculty of Brain Sciences, UCL, UK.
| | - Stuart Watson
- School of Health Sciences, Monash University, Australia; Health Futures Institute, Murdoch University, Australia
| | - Andrew J Lewis
- Institute of Health and Wellbeing, Federation University, Australia
| | | | - Niels Buus
- School of Nursing and Midwifery, Monash University, Australia; Department of Regional Health Research, University of Southern Denmark, Denmark
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Yücesoy H, Erbi L N. Relationship of premenstrual syndrome with postpartum depression and mother-infant bonding. Perspect Psychiatr Care 2022; 58:1112-1120. [PMID: 34231233 DOI: 10.1111/ppc.12909] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/08/2021] [Accepted: 06/19/2021] [Indexed: 11/29/2022] Open
Abstract
PURPOSE This study was conducted to investigate the relationship between pre-pregnancy premenstrual syndrome (PMS) history with postpartum depression and mother-infant bonding. DESIGN AND METHODS The sample of this descriptive and cross-sectional study included 322 mothers. Data were collected using the Premenstrual Syndrome Scale (PMSS), Edinburgh Postnatal Depression Scale (EPDS), and Brockington Postpartum Bonding Questionnaire (BPBQ). FINDINGS There were positive statistically significant correlations between PMSS total and subscale scores and EPDS scores and BPBQ. In addition, there were statistically significant positive correlations between EPDS score scores and BPBQ. IMPLICATIONS FOR NURSING PRACTICE Especially by achieving success in PMS management in the pre-pregnancy period, the risk of postpartum depression development can be prevented, and healthy development of mother-infant bonding can be achieved.
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Affiliation(s)
- Hüsne Yücesoy
- Department of Nursing, Institute of Health Sciences, Ordu University, Ordu, Turkey
| | - Nülüfer Erbi L
- Department of Gynecologic and Obstetrics Nursing, Faculty of Health Sciences, Ordu University, Ordu, Turkey
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Thomas S, Thomas T, Kurpad A, Duggan CP, Srinivasan K. Antenatal depressive symptoms and behavioral outcomes in children at 78 months: A study from South India. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2022; 9:100350. [PMID: 35811630 PMCID: PMC9261908 DOI: 10.1016/j.jadr.2022.100350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Low and middle income countries report a higher prevalence of antenatal depression. The association between antenatal depressive symptoms and behavioral outcomes in children at 78 months in motherchild dyads who participated in a randomized control trial of maternal B12 supplementation during pregnancy was examined in this study. Methods Children of 140 women, out of 366 who had participated in the placebo-controlled, randomized trial of vitamin B12 supplementation during pregnancy and 6 weeks post-partum, on whom serial assessments of depressive symptoms in each of the trimesters were done using the Kessler's 10 Psychological Distress Scale (K10), were assessed using the Strength and Difficulties Questionnaire (SDQ) at 78 months. Results Thirty seven women (26.4%) reported depressive symptoms at one trimester (intermittent group) and 28 women (20%) had depressive symptoms in at least 2 trimesters (persistent group). On adjusted bivariate regression analysis, children of women with intermittent antenatal depressive symptoms scored lower on the prosocial behavior subscale of SDQ compared to children of mothers with no depressive symptoms ( B=;-0.91, 95% CI: -1.65,-0.18; p=0.016). Limitations The use of a screening measure to assess maternal depression, the assessment of the children's behavior based only on the mothers' reports and the small number of women with persistent depressive symptoms in our sample is important limitations. Conclusions The possible association between antenatal depressive symptoms and prosocial behavior in children point to the need for routine assessment and intervention for emotional disorders during pregnancy.
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Affiliation(s)
- Susan Thomas
- Division of Mental Health and Neurosciences, St. John’s Research Institute, St John’s National Academy of Health Sciences, Bengaluru, Karnataka 560034, India
| | - Tinku Thomas
- Department of Biostatistics, St. John’s Medical College, Bengaluru, Karnataka, India
| | - Anura Kurpad
- Department of Physiology, St. John’s Medical College, Bengaluru, Karnataka, India
| | - Christopher P. Duggan
- Center for Nutrition, Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston MA, USA
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Krishnamachari Srinivasan
- Division of Mental Health and Neurosciences, St. John’s Research Institute, St John’s National Academy of Health Sciences, Bengaluru, Karnataka 560034, India
- Department of Psychiatry, St John’s Medical College, Bengaluru, Karnataka, India
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van den Heuvel MI, Vacaru SV, Boekhorst MGBM, Cloin M, van Bakel H, Riem MME, de Weerth C, Beijers R. Parents of young infants report poor mental health and more insensitive parenting during the first Covid-19 lockdown. BMC Pregnancy Childbirth 2022; 22:302. [PMID: 35397538 PMCID: PMC8994419 DOI: 10.1186/s12884-022-04618-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 03/16/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The Covid-19 pandemic has put an unprecedented pressure on families with children. How parents were affected by the first Covid-19 lockdown during the early postpartum period, an already challenging period for many, is unknown. AIM To investigate the associations between Covid-19 related stress, mental health, and insensitive parenting practices in mothers and fathers with young infants during the first Dutch Covid-19 lockdown. METHODS The Dutch Covid-19 and Perinatal Experiences (COPE-NL) study included 681 parents of infants between 0 and 6 months (572 mothers and 109 fathers). Parents filled out online questionnaires about Covid-19 related stress, mental health (i.e. anxiety and depressive symptoms), and insensitive parenting. Hierarchical regression models were used to analyze the data. RESULTS Parents of a young infant reported high rates of Covid-19 related stress, with higher reported stress in mothers compared to fathers. Additionally, the percentages of mothers and fathers experiencing clinically meaningful mental health symptoms during the pandemic were relatively high (mothers: 39.7% anxiety, 14.5% depression; fathers: 37.6% anxiety, 6.4% depression). More Covid-19 related stress was associated with more mental health symptoms in parents and increased insensitive parenting practices in mothers. CONCLUSIONS The results emphasize the strain of the pandemic on young fathers' and mothers' mental health and its potential negative consequences for parenting. As poor parental mental health and insensitive parenting practices carry risk for worse child outcomes across the lifespan, the mental health burden of the Covid-19 pandemic might not only have affected the parents, but also the next generation.
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Affiliation(s)
| | - Stefania V Vacaru
- Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Myrthe G B M Boekhorst
- Department of Cognitive Neuropsychology, Tilburg University, Tilburg, The Netherlands
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | | | | | - Madelon M E Riem
- Behavioral Science Institute, Radboud University, Nijmegen, The Netherlands
- Clinical Child & Family Studies, Faculty of Behavioral and Movement Sciences, Vrije Universiteit, Amsterdam, The Netherlands
| | - Carolina de Weerth
- Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
- Behavioral Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Roseriet Beijers
- Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands.
- Behavioral Science Institute, Radboud University, Nijmegen, The Netherlands.
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Maternal trauma but not perinatal depression predicts infant-parent attachment. Arch Womens Ment Health 2022; 25:215-225. [PMID: 34734355 DOI: 10.1007/s00737-021-01192-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 10/20/2021] [Indexed: 10/19/2022]
Abstract
Understanding if maternal depression is a predictor of infant-parent attachment classification is important to furthering knowledge about the early pathways and predictors of socio-emotional development. Yet few studies that have utilised the Strange Situation Procedure, the gold standard for measurement of infant-parent attachment, have examined antenatal depression as a predictor of attachment, and none has also included a measure of maternal trauma. This study uses data on 224 women recruited in early pregnancy and followed up until 12 months postpartum. Maternal depression was measured in pregnancy using the Structured Clinical Interview for the DSM and repeat Edinburgh Postnatal Depression Scale as well as Stressful Life Events scale across pregnancy and postpartum including items on domestic violence. A past history of trauma was measured using the Childhood Trauma Questionnaire. Attachment was measured using the Strange Situation Procedure (SSP) at 12 months postpartum. We found that maternal depression was not associated with insecure or disorganized attachment. However, a maternal history of childhood trauma and current domestic violence both predicted insecure-avoidant attachment at 12 months, whereas increased number of stressful life events prior to conception and in pregnancy was associated with insecure-resistant attachment. Neither trauma, past or current, nor depression predicted disorganized attachment. In the first study to have included measures of antenatal depression, maternal childhood trauma, and current stressful events as predictors of infant attachment measured using the SSP, we found maternal experiences of past and current trauma but not depression were significant predictors of infant-parent attachment security.
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Stolper H, van Doesum K, Steketee M. How to Support Parents of Infants and Young Children in Mental Health Care: A Narrative Review. Front Psychol 2021; 12:745800. [PMID: 34867627 PMCID: PMC8634941 DOI: 10.3389/fpsyg.2021.745800] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 10/15/2021] [Indexed: 01/30/2023] Open
Abstract
Objective: The aim of this narrative review is to gain insight into the appropriate intervention targets when parents of infants and young children suffer from psychopathology. Background: Psychopathology in parents is a risk factor for maladaptive parenting and is strongly related to negative cascade effects on parent-child interactions and relations in the short and long term. Children in their first years of life are especially at risk. However, in adult mental health care, this knowledge is rarely translated into practice, which is a missed opportunity for prevention. Methods: Electronic databases were searched for reviews and meta-analysis. In addition, sources were obtained via manual search, reference mining, expert opinion, and communications from conferences. In total, 56 papers, whereof 23 reviews and 12 meta-analyses were included. Results: Findings regarding targets of intervention were identified in different interacting domains, namely the parental, family, child, and environmental domains as well as the developing parent-child relationship. A "one size fits all" intervention is not appropriate. A flexible, tailored, resource-oriented intervention program, multi-faceted in addressing all modifiable risk factors and using different methods (individual, dyadic, group), seems to provide the best results. Conclusion: To address the risk factors in different domains, adult and child mental health care providers should work together in close collaboration to treat the whole family including mental disorders, relational, and contextual problems. A multi-agency approach that includes social services is needed.
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Affiliation(s)
- Hanna Stolper
- Department of Psychology Education and Child Studies, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Karin van Doesum
- Department of Clinical Psychology, Radboud University, Nijmegen, Netherlands
| | - Majone Steketee
- Department of Psychology Education and Child Studies, Erasmus University Rotterdam, Rotterdam, Netherlands
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11
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Carlone C, Milan S. Maternal Depression and Child Externalizing Behaviors: The Role of Attachment Across Development in Low-income Families. Res Child Adolesc Psychopathol 2021; 49:603-614. [PMID: 33512615 DOI: 10.1007/s10802-020-00747-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2020] [Indexed: 11/25/2022]
Abstract
Early attachment quality may be a lasting source of vulnerability or protection in children's development. In this study, we examine whether attachment quality at age three moderates the impact of subsequent exposure to maternal depression (at age five or nine) on children's externalizing symptoms at age nine. The sample included 1,917 low-income families (mean child age = 9.28; 55.9% African-American, 20.6% White, 20.0% Latina, 3.5% Other) from the Fragile Families and Child Well Being Study. At age three, 23.9% of children were categorized as insecurely attached based on maternal report of their child's attachment behaviors. At age nine, mothers, teachers, and children reported on the child's externalizing behaviors. Mothers also completed measures of maternal depression at child age three, five, and nine. Controlling for age three externalizing (by maternal report) and age three maternal depression as well as various demographic factors, attachment quality interacted with exposure to subsequent maternal depression in predicting externalizing behaviors at age nine. Interaction effects were evident in mother, teacher, and child report of externalizing. Across all three reporters, exposure to maternal depression was associated with greater externalizing behaviors in children who exhibited insecure attachment behaviors at age three. These findings highlight the potential benefit of interventions to improve early parent-child relationships for families at elevated risk because of maternal mental health.
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Affiliation(s)
- Christina Carlone
- Department of Psychological Sciences, University of Connecticut, 406 Babbidge Road U1020, Storrs, 06269, CT, USA.
| | - Stephanie Milan
- Department of Psychological Sciences, University of Connecticut, 406 Babbidge Road U1020, Storrs, 06269, CT, USA
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12
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Flowers AGD, Mcgillivray JA, Galbally M, Lewis AJ. Perinatal maternal mental health and disorganised attachment: A critical systematic review. CLIN PSYCHOL-UK 2020. [DOI: 10.1111/cp.12145] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
| | - Jane A. Mcgillivray
- School of Psychology, Faculty of Health, Deakin University, Melbourne, Victoria, Australia,
| | - Megan Galbally
- School of Psychology and Exercise Science, Murdoch University, Perth, Western Australia, Australia,
- School of Medicine, University of Notre Dame, Fremantle, Western Australia, Australia,
- Fiona Stanley Hospital, Murdoch, Perth, Western Australia, Australia,
- Harry Perkins Institute of Medical Research, Fiona Stanley Hospital, Perth, Western Australia, Australia,
| | - Andrew J. Lewis
- School of Psychology and Exercise Science, Murdoch University, Perth, Western Australia, Australia,
- Harry Perkins Institute of Medical Research, Fiona Stanley Hospital, Perth, Western Australia, Australia,
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13
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Moss KM, Dobson AJ, Mishra GD. Testing the role of the timing and chronicity of maternal depressive symptoms in the associations with child behaviour and development. Paediatr Perinat Epidemiol 2020; 34:678-686. [PMID: 32535995 DOI: 10.1111/ppe.12681] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 03/04/2020] [Accepted: 03/08/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND There is debate regarding whether the association between maternal depressive symptoms (MDS) and child outcomes is due to the timing or chronicity of symptoms. OBJECTIVES To investigate whether critical periods, sensitive periods, or accumulation models provided the best explanation for the association between MDS and children's behaviour and development. METHODS Data on mothers (N = 892) were collected from 1996 to 2015 as part of the Australian Longitudinal Study on Women's Health, a prospective longitudinal epidemiological study. Data on children (N = 978, 2-12 years) were collected in 2016/17 as part of the Mothers and their Children's Health study. Mothers were categorised according to whether they reported MDS (scored ≥ 10 on the CESD-10) before pregnancy, during pregnancy, or in early childhood. Child outcomes were maternal-rated behaviour problems (Strengths and Difficulties Questionnaire; SDQ) and teacher-rated development (Australian Early Development Census; AEDC). We used a structured life course approach to rigorously test critical period, sensitive period, and accumulation (ie chronicity) theories by comparing the fit of a series of models. RESULTS Most mothers did not report MDS at any time (69.2%), 16.9% reported MDS before pregnancy, 13.2% during pregnancy, and 16.5% in early childhood. High/very high total behaviour problems were reported for 7.0% of children, and developmental vulnerability/risk was reported for 15.9% for social competence and 15.7% for emotional maturity. An accumulation model was the best fit, with each period of MDS associated with an increase of 1.71 points (95% CI 1.26, 2.17) on the SDQ and decreases of 0.31 (95% CI -0.50, -0.12) and 0.29 points (95% CI -0.49, -0.08) on AEDC social competence and emotional maturity, respectively. CONCLUSIONS Chronic MDS were associated with poorer child outcomes than MDS at any single time. Sensitive and critical period models were not supported. This suggests chronicity of symptoms may be more important than timing.
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Affiliation(s)
- Katrina M Moss
- School of Public Health, Centre for Longitudinal and Life Course Research, The University of Queensland, Brisbane, QLD, Australia
| | - Annette J Dobson
- School of Public Health, Centre for Longitudinal and Life Course Research, The University of Queensland, Brisbane, QLD, Australia
| | - Gita D Mishra
- School of Public Health, Centre for Longitudinal and Life Course Research, The University of Queensland, Brisbane, QLD, Australia
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14
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Astor K, Lindskog M, Forssman L, Kenward B, Fransson M, Skalkidou A, Tharner A, Cassé J, Gredebäck G. Social and emotional contexts predict the development of gaze following in early infancy. ROYAL SOCIETY OPEN SCIENCE 2020; 7:201178. [PMID: 33047063 PMCID: PMC7540771 DOI: 10.1098/rsos.201178] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 08/12/2020] [Indexed: 06/11/2023]
Abstract
The development of gaze following begins in early infancy and its developmental foundation has been under heavy debate. Using a longitudinal design (N = 118), we demonstrate that attachment quality predicts individual differences in the onset of gaze following, at six months of age, and that maternal postpartum depression predicts later gaze following, at 10 months. In addition, we report longitudinal stability in gaze following from 6 to 10 months. A full path model (using attachment, maternal depression and gaze following at six months) accounted for 21% of variance in gaze following at 10 months. These results suggest an experience-dependent development of gaze following, driven by the infant's own motivation to interact and engage with others (the social-first perspective).
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Affiliation(s)
- Kim Astor
- Uppsala Child and Baby Lab, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Marcus Lindskog
- Uppsala Child and Baby Lab, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Linda Forssman
- Uppsala Child and Baby Lab, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Ben Kenward
- Department of Psychology, Oxford Brookes University, Oxford, UK
| | - Mari Fransson
- Uppsala Child and Baby Lab, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Alkistis Skalkidou
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Anne Tharner
- Department of Clinical Child and Family Studies, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Gustaf Gredebäck
- Uppsala Child and Baby Lab, Department of Psychology, Uppsala University, Uppsala, Sweden
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15
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Preconception and perinatal predictors of offspring attachment disorganization: Advancing the replicated evidence. Dev Psychopathol 2020; 33:240-251. [PMID: 32299518 DOI: 10.1017/s095457941900172x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Attachment disorganization in early childhood is an influential yet modifiable risk factor for later mental health problems. Beyond established transmission through parents' unresolved attachment representations and caregiving sensitivity, little replicated evidence exists for wider determinants of offspring attachment disorganization. This study examined the replicated evidence for psychosocial risk factors in the preconception, prenatal, and postnatal periods. We identified all relevant longitudinal studies, and examined all risk relationships for which evidence existed in two or more cohorts (48 effects, 17 studies, N = 6,099). Study-specific and pooled risk associations were estimated and a range of moderators evaluated. Mothers' low socioeconomic status (r = .28, k = 2), perinatal loss of a child (r = .26, k = 2), caregiving intrusiveness (r = .31, k = 2), and infant male sex (r = .26, k = 4) predicted offspring attachment disorganization. Maternal sensitivity (r = -.25, k = 6) and higher metacognition during pregnancy (r = -.23, k = 3) predicted lower risk of offspring attachment disorganization. Findings suggest the origins of offspring disorganized attachment include but extend beyond maternal unresolved attachment representations and caregiving. We discuss implications for theory and for identification of modifiable risk pathways in the perinatal window.
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16
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Śliwerski A, Kossakowska K, Jarecka K, Świtalska J, Bielawska-Batorowicz E. The Effect of Maternal Depression on Infant Attachment: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E2675. [PMID: 32295106 PMCID: PMC7216154 DOI: 10.3390/ijerph17082675] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 04/07/2020] [Accepted: 04/08/2020] [Indexed: 12/12/2022]
Abstract
Aims and objectives: The aim of this systematic review was to summarize the key findings of empirical studies assessing the influence of maternal depression on child attachment security measured before 24 months after birth. Method: The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines. A literature search was conducted on the EBSCO (Academic Search Complete; Health Source: Nursing/Academic Edition; MEDLINE; PsycARTICLES) and PubMed databases, with infant attachment AND depression as search terms with Boolean operators. Study design or sample size did not affect inclusion. After screening, 29 of the 1510 unique publications originally identified were included in the review. Results: The studies reveal an equivocal association between maternal depression and child attachment security. Our findings indicate that depression had a significant influence on the attachment style almost only when diagnosed by structured interview: Depression measured by self-descriptive questionnaires was unrelated to attachment style. Furthermore, postpartum depression was found to be significant only when measured up to six months after childbirth. Conclusion: The relationship between maternal depression and infant attachment is both complex and dynamic, and the possible negative effects of depression might be compensated by maternal involvement in childcare. Therefore, further studies in this area should employ a reliable methodology for diagnosing depression and a suitable time point for measuring it; they should also adopt a multifactorial and prospective approach. It is important to note that breastfeeding/formula feeding was omitted as a factor in the majority of studies.
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Affiliation(s)
- Andrzej Śliwerski
- Institute of Psychology, University of Lodz, 91-433 Lodz, Poland; (K.K.); (K.J.); (J.Ś.); (E.B.-B.)
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17
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Slomian J, Honvo G, Emonts P, Reginster JY, Bruyère O. Consequences of maternal postpartum depression: A systematic review of maternal and infant outcomes. ACTA ACUST UNITED AC 2020; 15:1745506519844044. [PMID: 31035856 PMCID: PMC6492376 DOI: 10.1177/1745506519844044] [Citation(s) in RCA: 425] [Impact Index Per Article: 106.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Introduction: The postpartum period represents the time of risk for the emergence of
maternal postpartum depression. There are no systematic reviews of the
overall maternal outcomes of maternal postpartum depression. The aim of this
study was to evaluate both the infant and the maternal consequences of
untreated maternal postpartum depression. Methods: We searched for studies published between 1 January 2005 and 17 August 2016,
using the following databases: MEDLINE via Ovid, PsycINFO, and the Cochrane
Pregnancy and Childbirth Group trials registry. Results: A total of 122 studies (out of 3712 references retrieved from bibliographic
databases) were included in this systematic review. The results of the
studies were synthetized into three categories: (a) the maternal
consequences of postpartum depression, including physical health,
psychological health, relationship, and risky behaviors; (b) the infant
consequences of postpartum depression, including anthropometry, physical
health, sleep, and motor, cognitive, language, emotional, social, and
behavioral development; and (c) mother–child interactions, including
bonding, breastfeeding, and the maternal role. Discussion: The results suggest that postpartum depression creates an environment that is
not conducive to the personal development of mothers or the optimal
development of a child. It therefore seems important to detect and treat
depression during the postnatal period as early as possible to avoid harmful
consequences.
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Affiliation(s)
- Justine Slomian
- 1 Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - Germain Honvo
- 1 Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - Patrick Emonts
- 2 Department of Obstetrics and Gynaecology, CHU Liège, Liège, Belgium
| | - Jean-Yves Reginster
- 1 Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - Olivier Bruyère
- 1 Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium.,3 Department of Sport Science, University of Liège, Liège, Belgium
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18
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Cortes Hidalgo AP, Muetzel R, Luijk MPCM, Bakermans-Kranenburg MJ, El Marroun H, Vernooij MW, van IJzendoorn MH, White T, Tiemeier H. Observed infant-parent attachment and brain morphology in middle childhood- A population-based study. Dev Cogn Neurosci 2019; 40:100724. [PMID: 31726318 PMCID: PMC6974894 DOI: 10.1016/j.dcn.2019.100724] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 10/14/2019] [Accepted: 10/23/2019] [Indexed: 11/24/2022] Open
Abstract
Poor quality of the early infant-parent bond predicts later child problems. Infant-parent attachment has been suggested to influence brain development, but this association has hardly been examined. In adults, larger amygdala volumes have been described in relation to early attachment disorganization; neuroimaging studies of attachment in children, however, are lacking. We examined the association between infant-parent attachment and brain morphology in 551 children from a population-based cohort in the Netherlands. Infant-parent attachment was observed with the Strange-Situation Procedure at age 14 months and different brain measures were collected with magnetic resonance imaging at mean age 10 years. Children with disorganized infant attachment had larger hippocampal volumes than those with organized attachment patterns. This finding was robust to the adjustment for confounders and consistent across hemispheres. The association was not explained by cognitive or emotional and behavioral problems. Disorganized attachment did not predict any other difference in brain morphology. Moreover, children with insecure organized infant attachment patterns did not differ from those who were securely attached in any brain outcome. Causality cannot be inferred, but our findings in this large population-based study provide novel evidence for a long-term association between the quality of infant-parent attachment and specific brain differences in childhood.
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Affiliation(s)
- Andrea P Cortes Hidalgo
- Department of Child and Adolescent Psychiatry, Erasmus Medical Center, PO-Box 2040, 3000 CA Rotterdam, the Netherlands; The Generation R Study Group, Erasmus Medical Center, PO-Box 2040, 3000 CA Rotterdam, the Netherlands
| | - Ryan Muetzel
- Department of Child and Adolescent Psychiatry, Erasmus Medical Center, PO-Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Epidemiology, Erasmus Medical Center, PO-Box 2040, 3000 CA Rotterdam, the Netherlands
| | - Maartje P C M Luijk
- Department of Child and Adolescent Psychiatry, Erasmus Medical Center, PO-Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, PO-Box 1738 3000 DR Rotterdam, the Netherlands
| | | | - Hanan El Marroun
- Department of Child and Adolescent Psychiatry, Erasmus Medical Center, PO-Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, PO-Box 1738 3000 DR Rotterdam, the Netherlands; Department of Paediatrics, Erasmus Medical Center, PO-Box 2040, 3000 CA Rotterdam, the Netherlands
| | - Meike W Vernooij
- Department of Epidemiology, Erasmus Medical Center, PO-Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Radiology and nuclear medicine, Erasmus Medical Center, PO-Box 2040, 3000 CA Rotterdam, the Netherlands
| | - Marinus H van IJzendoorn
- Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, PO-Box 1738 3000 DR Rotterdam, the Netherlands; Primary Care Unit, School of Clinical Medicine, University of Cambridge, CB2 0SP Cambridge, UK
| | - Tonya White
- Department of Child and Adolescent Psychiatry, Erasmus Medical Center, PO-Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Radiology and nuclear medicine, Erasmus Medical Center, PO-Box 2040, 3000 CA Rotterdam, the Netherlands
| | - Henning Tiemeier
- Department of Child and Adolescent Psychiatry, Erasmus Medical Center, PO-Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, MA 02115 Boston, USA.
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19
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Hazell Raine K, Nath S, Howard LM, Cockshaw W, Boyce P, Sawyer E, Thorpe K. Associations between prenatal maternal mental health indices and mother-infant relationship quality 6 to 18 months' postpartum: A systematic review. Infant Ment Health J 2019; 41:24-39. [PMID: 31524300 DOI: 10.1002/imhj.21825] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
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.
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Affiliation(s)
- Karen Hazell Raine
- Discipline of Psychiatry, Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Selina Nath
- Section of Women's Mental Health, King's College, London, United Kingdom
| | - Louise M Howard
- Section of Women's Mental Health, King's College, London, United Kingdom
| | - Wendell Cockshaw
- School of Health and Biomedical Sciences, Royal Melbourne Institute of Technology, Melbourne, Australia
| | - Philip Boyce
- Discipline of Psychiatry, Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Emily Sawyer
- Faculty of Medicine and Dentistry, James Cook University, Townsville, Australia
| | - Karen Thorpe
- Institute for Social Science Research, University of Queensland, Queensland, Australia
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20
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Barnes J, Theule J. Maternal depression and infant attachment security: A meta-analysis. Infant Ment Health J 2019; 40:817-834. [PMID: 31415711 DOI: 10.1002/imhj.21812] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The purpose of this study is to clarify the magnitude of the association between maternal depression and infant attachment nonsecurity, and to identify possible moderators of this relationship. An extensive literature search was conducted using multiple databases of both published and unpublished studies. A meta-analysis was conducted to determine the relationship between maternal depression and infant attachment security and to establish the effect size. The main findings from this meta-analysis, which included 42 studies, indicate that there is a small, yet significant, relationship between maternal depression and infant attachment nonsecurity. The rate of nonsecurity in infants of mothers with depression was approximately 20% higher than expected rates in a nonclinical population, and the association between depressive symptoms and nonsecurity was small, but significant. Infants of mothers with depression were nearly twice as likely to have a nonsecure attachment than were infants of healthy mothers. Depression measure and maternal sample source were identified as significant moderators of the odds ratio effect size. Results of this study demonstrate that there is a significant relationship between maternal depression and infant attachment nonsecurity, and suggest that interventions that focus on both maternal mental health and the attachment relationship are warranted.
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Affiliation(s)
- Jennifer Barnes
- Department of Psychology, University of Manitoba, Winnipeg, Canada
| | - Jennifer Theule
- Department of Psychology, University of Manitoba, Winnipeg, Canada
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21
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Sawyer KM, Zunszain PA, Dazzan P, Pariante CM. Intergenerational transmission of depression: clinical observations and molecular mechanisms. Mol Psychiatry 2019; 24:1157-1177. [PMID: 30283036 DOI: 10.1038/s41380-018-0265-4] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 08/16/2018] [Accepted: 08/20/2018] [Indexed: 02/06/2023]
Abstract
Maternal mental illness can have a devastating effect during the perinatal period, and has a profound impact on the care that the baby receives and on the relationships that the baby forms. This review summarises clinical evidence showing the effects of perinatal depression on offspring physical and behavioural development, and on the transmission of psychopathology between generations. We then evaluate a number of factors which influence this relationship, such as genetic factors, the use of psychotropic medications during pregnancy, the timing within the perinatal period, the sex of the foetus, and exposure to maltreatment in childhood. Finally, we examine recent findings regarding the molecular mechanisms underpinning these clinical observations, and identify relevant epigenetic and biomarker changes in the glucocorticoid, oxytocin, oestrogen and immune systems, as key biological mediators of these clinical findings. By understanding these molecular mechanisms in more detail, we will be able to improve outcomes for both mothers and their offspring for generations.
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Affiliation(s)
- Kristi M Sawyer
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Patricia A Zunszain
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Paola Dazzan
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Carmine M Pariante
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
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22
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Erickson N, Julian M, Muzik M. Perinatal depression, PTSD, and trauma: Impact on mother-infant attachment and interventions to mitigate the transmission of risk. Int Rev Psychiatry 2019; 31:245-263. [PMID: 30810410 DOI: 10.1080/09540261.2018.1563529] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Early interactions between infants and their caregivers are fundamental to child development, and the parent-infant relationship is believed to provide the foundation for healthy and secure attachment relationships and for infant mental health. Over time, these secure attachment relationships become the backbone for positive child outcomes across development. Abundant research to date confirms that parental mental illness, including depression and PTSD following trauma exposure, may have a detrimental impact on parenting quality and subsequent early child relationship formations. This review paper summarizes the literature on the role of sensitive parenting and a healthy mother-infant relationship in establishing a secure mother-infant attachment bond, which in turn is critical for the child's healthy socioemotional and cognitive development. The review also highlights the roles of maternal perinatal depression, PTSD, and/or exposure to interpersonal violence or childhood maltreatment onto parenting, bonding, and child attachment style towards the caregiver. The final section discusses existing therapeutic interventions and approaches that bolster early parenting practices and early maternal-child relationships. Specific emphasis is placed on relational interventions that address bonding and attachment disturbances in the context of maternal perinatal mental health risk and trauma.
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Affiliation(s)
- Nora Erickson
- a Women and Infants Mental Health Program & Zero To Thrive Program, Department of Psychiatry , University of Michigan, Psychiatry , Ann Arbor , MI , USA
| | - Megan Julian
- a Women and Infants Mental Health Program & Zero To Thrive Program, Department of Psychiatry , University of Michigan, Psychiatry , Ann Arbor , MI , USA
| | - Maria Muzik
- a Women and Infants Mental Health Program & Zero To Thrive Program, Department of Psychiatry , University of Michigan, Psychiatry , Ann Arbor , MI , USA
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23
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Smith A, Twynstra J, Seabrook JA. Antenatal depression and offspring health outcomes. Obstet Med 2019; 13:55-61. [PMID: 32714436 DOI: 10.1177/1753495x19843015] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 03/18/2019] [Indexed: 12/11/2022] Open
Abstract
Background Depression is the most common mental disorder during pregnancy, with prevalence rates between 4% and 20%. The objective of this review was to synthesize the literature on the association between antenatal depression and offspring birth outcomes, as well as developmental, behavioral, and psychiatric outcomes. Methods A search of PubMed, Cochrane, and Medline databases was conducted for articles published until December 2017. Articles focusing on the effects of antenatal depression on the offspring were selected to be reviewed. Reference lists of all studies were examined for any missed articles. A total of 32 articles were included in this review. Results Antenatal depression is associated with preterm birth, excessive infant crying, and offspring mental health problems. Untreated antenatal depression is strongly associated with adverse effects on the infant nervous system. Conclusion Antenatal depression increases the likelihood of poor offspring health outcomes. Research should investigate whether medication use confounds this relationship.
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Affiliation(s)
- Alexandra Smith
- School of Food and Nutritional Sciences, Brescia University College, London, Ontario, Canada
| | - Jasna Twynstra
- School of Food and Nutritional Sciences, Brescia University College, London, Ontario, Canada.,Department of Medical Biophysics, Western University, London, Ontario, Canada
| | - Jamie A Seabrook
- School of Food and Nutritional Sciences, Brescia University College, London, Ontario, Canada.,Department of Paediatrics, Western University, London, Ontario, Canada.,Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada.,Children's Health Research Institute, London, Ontario, Canada.,Lawson Health Research Institute, London, Ontario, Canada.,Human Environments Analysis Laboratory, Western University, London, Ontario, Canada
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24
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Smith-Nielsen J, Matthey S, Lange T, Væver MS. Validation of the Edinburgh Postnatal Depression Scale against both DSM-5 and ICD-10 diagnostic criteria for depression. BMC Psychiatry 2018; 18:393. [PMID: 30572867 PMCID: PMC6302501 DOI: 10.1186/s12888-018-1965-7] [Citation(s) in RCA: 114] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 11/28/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The Edinburgh Postnatal Depression Scale (EPDS) is widely used in many countries to screen women for depression in the perinatal period. However, across studies the psychometric properties and cutoff scores of the EPDS have varied considerably; potentially due to different depression criteria and diagnostic systems being used. Therefore, we validated the Danish EPDS against a depression diagnosis according to both DSM-5 and ICD-10. Furthermore, we examined whether the Danish EPDS is multidimensional, as it has previously been suggested. METHODS Women (N = 324) were recruited after routine screenings with the EPDS between 2 and 10 months postpartum (T1). At a subsequent home visit (T2), the EPDS and the Structured Clinical Interview for DSM-5 were administered. Diagnostic interviews were audio recorded to enable subsequent coding for ICD-10 diagnoses and inter-rater reliability analysis. A two-phase stratified sampling strategy with three sampling categories (EPDS-score at T1) was used. Using the distribution of 4931 T1 EPDS-scores from the same population from which we sampled the participants, we used sampling weighing to reweight the sample. The calculation of weights was based upon the mother's sampling category at T1 (i.e. the probability of being sampled) and the weights were applied when assessing the receiver operation characteristics (ROCs) of the EPDS. Sensitivity, specificity, positive predictive value, negative predictive value and area under the ROC curve were computed from the reweighted data for all relevant cutoff values. CIs were computed by embedding the calculations in a weighted logistic regression. Exploratory factor analysis was done using oblique rotation. Parallel analysis was used to assess the number of factors. RESULTS A score of 11 or more was found to be the optimal cutoff for depression according to both DSM-5 and ICD-10 criteria. Factor analysis suggested that the Danish EPDS consists of three factors, including an 'anxiety factor'. CONCLUSIONS The Danish EPDS has reasonable sensitivity and specificity at a cutoff score of 11 or more. There are no notable differences with respect to using ICD-10 or DSM-5 criteria for depression in terms of optimal cutoff. The variation in cutoff scores is likely to be due to cultural variations in the expression of depressive symptoms.
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Affiliation(s)
- Johanne Smith-Nielsen
- Centre for Early Intervention and Family Studies, Department of Psychology, University of Copenhagen, Oester Farimagsgade 2A, DK-1353 Copenhagen, Denmark
| | - Stephen Matthey
- South West Sydney Local Health District, Liverpool Hospital, University of Sydney, Sydney, Australia
| | - Theis Lange
- Department of Public Health, Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Mette Skovgaard Væver
- Centre for Early Intervention and Family Studies, Department of Psychology, University of Copenhagen, Oester Farimagsgade 2A, DK-1353 Copenhagen, Denmark
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26
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Morais AODDS, Simões VMF, Rodrigues LDS, Batista RFL, Lamy ZC, Carvalho CAD, Silva AAMD, Ribeiro MRC. [Maternal depressive symptoms and anxiety and interference in the mother/child relationship based on a prenatal cohort: an approach with structural equations modeling]. CAD SAUDE PUBLICA 2017; 33:e00032016. [PMID: 28724023 DOI: 10.1590/0102-311x00032016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 08/24/2016] [Indexed: 11/22/2022] Open
Abstract
This study aimed to investigate the association between maternal depressive symptoms and anxiety and interference in the mother/child relationship, using structural equations modeling. Data were used from a prospective cohort study initiated during the prenatal period with 1,140 mothers in São Luís, Maranhão State, Brazil. Data were collected during prenatal care and when the children reached two years of age. Interference in the mother/child relationship was measured with the Postpartum Bonding Questionnaire - PBQ (N = 1,140). In the initial theoretical model, socioeconomic status determined the maternal demographic, psychosocial, and social support factors, which determined the outcome, i.e., the mother/child relationship. Adjustments were performed by structural equations modeling, using Mplus 7.0. The final model showed good fit (RMSEA = 0.047; CFI = 0.984; TLI = 0.981). Depressive symptoms in pregnancy and the postpartum were associated with higher PBQ scores, indicating interference in the mother/child relationship. The greatest effect was from depressive symptoms in pregnancy. Other factors associated with higher PBQ scores were lower social support, unfavorable socioeconomic status, and living without a partner, by indirect association. Anxiety symptoms and maternal age were not associated with the mother/child relationship. The results suggest that identifying and treating depression in pregnancy and postpartum can improve mother/child bonding in childhood.
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Zohsel K, Holz NE, Hohm E, Schmidt MH, Esser G, Brandeis D, Banaschewski T, Laucht M. Fewer self-reported depressive symptoms in young adults exposed to maternal depressed mood during pregnancy. J Affect Disord 2017; 209:155-162. [PMID: 27914249 DOI: 10.1016/j.jad.2016.08.059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 06/29/2016] [Accepted: 08/27/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND Depressed mood is prevalent during pregnancy, with accumulating evidence suggesting an impact on developmental outcome in the offspring. However, the long-term effects of prenatal maternal depression regarding internalizing psychopathology in the offspring are as yet unclear. METHODS As part of an ongoing epidemiological cohort study, prenatal maternal depressed mood was assessed at the child's age of 3 months. In a sample of n=307 offspring, depressive symptoms were obtained via questionnaire at the ages of 19, 22, 23 and 25 years. At age 25 years, diagnoses of depressive disorder were obtained using a diagnostic interview. In a subsample of currently healthy participants, voxel-based morphometry was conducted and amygdala volume was assessed. RESULTS In n=85 young adults exposed to prenatal maternal depressed mood, no significantly higher risk for a diagnosis of depressive disorder was observed. However, they reported significantly lower levels of depressive symptoms. This association was especially pronounced when prenatal maternal depressed mood was present during the first trimester of pregnancy and when maternal mood was depressed pre- as well as postnatally. At an uncorrected level only, prenatal maternal depressed mood was associated with decreased amygdala volume. LIMITATIONS Prenatal maternal depressed mood was not assessed during pregnancy, but shortly after childbirth. No diagnoses of maternal clinical depression during pregnancy were available. CONCLUSIONS Self-reported depressive symptoms do not imply increased, but rather decreased symptom levels in young adults who were exposed to prenatal maternal depressed mood. A long-term perspective may be important when considering consequences of prenatal risk factors.
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Affiliation(s)
- Katrin Zohsel
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim / Heidelberg University, J 5, 68159 Mannheim, Germany
| | - Nathalie E Holz
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim / Heidelberg University, J 5, 68159 Mannheim, Germany
| | - Erika Hohm
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim / Heidelberg University, J 5, 68159 Mannheim, Germany
| | - Martin H Schmidt
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim / Heidelberg University, J 5, 68159 Mannheim, Germany
| | - Günter Esser
- Department of Psychology, University of Potsdam, Potsdam, Germany
| | - Daniel Brandeis
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim / Heidelberg University, J 5, 68159 Mannheim, Germany; Department of Child and Adolescent Psychiatry, University of Zürich, Zürich, Switzerland; Zurich Center for Integrative Human Physiology, University of Zürich, Zürich, Switzerland; Neuroscience Center Zurich, University and ETH Zürich, Switzerland
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim / Heidelberg University, J 5, 68159 Mannheim, Germany
| | - Manfred Laucht
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim / Heidelberg University, J 5, 68159 Mannheim, Germany; Department of Psychology, University of Potsdam, Potsdam, Germany.
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Væver MS, Smith-Nielsen J, Lange T. Copenhagen infant mental health project: study protocol for a randomized controlled trial comparing circle of security -parenting and care as usual as interventions targeting infant mental health risks. BMC Psychol 2016; 4:57. [PMID: 27876079 PMCID: PMC5120549 DOI: 10.1186/s40359-016-0166-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 11/10/2016] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Infant mental health is a significant public health issue as early adversity and exposure to early childhood stress are significant risk factors that may have detrimental long-term developmental consequences for the affected children. Negative outcomes are seen on a range of areas such as physical and mental health, educational and labor market success, social network and establishing of family. Secure attachment is associated with optimal outcomes in all developmental domains in childhood, and both insecure and disorganized attachment are associated with a range of later problems and psychopathologies. In disadvantaged populations insecure and disorganized attachment are common, which points to the need of identifying early risk and effective methods of addressing such problems. This protocol describes an experimental evaluation of an indicated group-based parental educational program, Circle of Security-Parenting (COS-P), currently being conducted in Denmark. METHODS/DESIGN In a parallel randomized controlled trial of two intervention groups this study tests the efficacy of COS-P compared to Care as Usual (CAU) in enhancing maternal sensitivity and child attachment in a community sample in the City of Copenhagen, Denmark. During the project a general population of an estimated 17.600 families with an infant aged 2-12 months are screened for two known infant mental health risks, maternal postnatal depression and infant social withdrawal. Eligible families (N = 314), who agree to participate, will be randomly allocated with a ratio of 2:1 into the COS-P intervention arm and into CAU. Data will be obtained at inclusion (baseline) and at follow-up when the child is 12-16 months. The primary outcome is maternal sensitivity. Secondary outcomes include quality of infant attachment, language, cognitive and socioemotional development, family functioning, parental stress, parental mentalizing and maternal mental wellbeing. DISCUSSION The potential implications of the experimental evaluation of an indicated brief group-based parenting educational program to enhance parental sensitivity and attachment are discussed. TRIAL REGISTRATION ClinicalTrials.govID: NCT02497677 . Registered July 15 2015.
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Affiliation(s)
- Mette Skovgaard Væver
- Department of Psychology, University of Copenhagen, Øster Farimagsgade 2A, 1353 Copenhagen K, Denmark
| | - Johanne Smith-Nielsen
- Department of Psychology, University of Copenhagen, Øster Farimagsgade 2A, 1353 Copenhagen K, Denmark
| | - Theis Lange
- Section of Biostatistics, University of Copenhagen, Øster Farimagsgade 5, 1014 Copenhagen K, Denmark
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Smith-Nielsen J, Tharner A, Steele H, Cordes K, Mehlhase H, Vaever MS. Postpartum depression and infant-mother attachment security at one year: The impact of co-morbid maternal personality disorders. Infant Behav Dev 2016; 44:148-58. [DOI: 10.1016/j.infbeh.2016.06.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 05/22/2016] [Accepted: 06/03/2016] [Indexed: 10/21/2022]
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Brummelte S, Galea LAM. Postpartum depression: Etiology, treatment and consequences for maternal care. Horm Behav 2016; 77:153-66. [PMID: 26319224 DOI: 10.1016/j.yhbeh.2015.08.008] [Citation(s) in RCA: 276] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 08/18/2015] [Accepted: 08/21/2015] [Indexed: 01/20/2023]
Abstract
This article is part of a Special Issue "Parental Care". Pregnancy and postpartum are associated with dramatic alterations in steroid and peptide hormones which alter the mothers' hypothalamic pituitary adrenal (HPA) and hypothalamic pituitary gonadal (HPG) axes. Dysregulations in these endocrine axes are related to mood disorders and as such it should not come as a major surprise that pregnancy and the postpartum period can have profound effects on maternal mood. Indeed, pregnancy and postpartum are associated with an increased risk for developing depressive symptoms in women. Postpartum depression affects approximately 10-15% of women and impairs mother-infant interactions that in turn are important for child development. Maternal attachment, sensitivity and parenting style are essential for a healthy maturation of an infant's social, cognitive and behavioral skills and depressed mothers often display less attachment, sensitivity and more harsh or disrupted parenting behaviors, which may contribute to reports of adverse child outcomes in children of depressed mothers. Here we review, in honor of the "father of motherhood", Jay Rosenblatt, the literature on postnatal depression in the mother and its effect on mother-infant interactions. We will cover clinical and pre-clinical findings highlighting putative neurobiological mechanisms underlying postpartum depression and how they relate to maternal behaviors and infant outcome. We also review animal models that investigate the neurobiology of maternal mood and disrupted maternal care. In particular, we discuss the implications of endogenous and exogenous manipulations of glucocorticoids on maternal care and mood. Lastly we discuss interventions during gestation and postpartum that may improve maternal symptoms and behavior and thus may alter developmental outcome of the offspring.
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Affiliation(s)
| | - Liisa A M Galea
- Dept. of Psychology, Graduate Program in Neuroscience, Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
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Smith-Nielsen J, Steele H, Mehlhase H, Cordes K, Steele M, Harder S, Væver MS. Links Among High EPDS Scores, State of Mind Regarding Attachment, and Symptoms of Personality Disorder. J Pers Disord 2015; 29:771-93. [PMID: 25562537 DOI: 10.1521/pedi_2014_28_173] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Underlying persistent psychological difficulties have been found to moderate potential adverse effects of maternal postpartum depression (PPD) on parenting and infant development. The authors examined whether mothers presenting postpartum depressive symptoms showed higher levels of personality pathology and more insecure state of mind regarding attachment compared to nondepressed mothers. Participants (N = 85) were assessed with the Edinburgh Postnatal Depression Scale (EPDS), the Present State Examination, the Adult Attachment Interview, and the Structured Clinical Interview for DSM-IV Axis II. Mothers with high EPDS scores were more likely to have a preoccupied insecure state of mind and to have personality disorder compared with mothers scoring below clinical cutoff. Furthermore, multiple regression analysis showed that personality disorder and AAI classification were independently related to EPDS score, and that these two factors together accounted for 48% of the variance in EPDS score. Findings are discussed in terms of heterogeneity in PPD populations and underline the importance of examining potential coexisting psychological difficulties when studying PPD.
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Untreated depression during pregnancy: Short- and long-term effects in offspring. A systematic review. Neuroscience 2015; 342:154-166. [PMID: 26343292 DOI: 10.1016/j.neuroscience.2015.09.001] [Citation(s) in RCA: 255] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 08/28/2015] [Accepted: 09/01/2015] [Indexed: 01/22/2023]
Abstract
Aim of this systematic review is to assess short- and long-lasting effects of antenatal exposure to untreated maternal depressive symptoms. Pertinent articles were identified through combined searches of Science.gov, Cochrane library, and PubMed databases (through August 2015). Forty-three, selected articles revealed that untreated gestational depression and even depressive symptoms during pregnancy may have untoward effects on the developing fetus (hyperactivity, irregular fetal heart rate), newborns (increased cortisol and norepinephrine levels, decreased dopamine levels, altered EEG patterns, reduced vagal tone, stress/depressive-like behaviors, and increased rates of premature deaths and neonatal intensive care unit admission), and children (increased salivary cortisol levels, internalizing and externalizing problems, and central adiposity). During adolescence, an independent association exists between maternal antenatal mood symptoms and a slight increase in criminal behaviors. In contrast, the relationship between gestational depression and increased risks of prematurity and low birth weight remains controversial. Given this background, when making clinical decisions, clinicians should weigh the growing evidences suggesting the detrimental and prolonged effects in offspring of untreated antenatal depression and depressive symptoms during pregnancy against the known and emerging concerns associated with in utero exposure to antidepressants.
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Pinto P, Costa-Santos C, Ayres-de-Campos D, Bernardes J. Computer analysis of maternal-fetal heart rate recordings during labor in relation with maternal-fetal attachment and prediction of newborn acidemia. J Matern Fetal Neonatal Med 2015; 29:1440-4. [PMID: 26177054 DOI: 10.3109/14767058.2015.1051019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To assess combined maternal (MHR) and fetal heart rate (FHR) recordings during labor, in relation with maternal-fetal attachment and prediction of newborn acidemia. STUDY DESIGN Fifty-nine simultaneous MHR and FHR recordings were acquired in the final minutes of labor. Computer analysis followed the FIGO guidelines with estimation of MHR and FHR baselines, accelerations, decelerations, short- (STV) and long-term variabilities. MHR and FHR characteristics, their differences and correlations were assessed in relation to labor progression and to newborn umbilical artery blood (UAB) pH lower than 7.15 and 7.20. To assess prediction of acidemia, areas under ROC curves (auROC) were calculated. RESULTS Progression of labor was associated with a significant increase in MHR accelerations and FHR decelerations both in the non-acidemic and acidemic fetuses (p < 0.01). At the same time there was an increase in MHR-FHR correlations and differences in accelerations and decelerations in acidemic fetuses. The auROC ranged between 0.50 for FHR accelerations and 0.77 for MHR baseline plus FHR STV. CONCLUSIONS MHR and FHR respond differently during labor with signs of increased maternal-fetal attachment during labor progression in acidemic fetuses. Combined MHR-FHR analysis may help to improve prediction of newborn acidemia compared with FHR analysis alone.
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Affiliation(s)
- Paula Pinto
- a Serviço de Ginecologia e Obstetrícia, Hospital Nélio Mendonça , Funchal , Portugal .,b Departamento de Obstetrícia e Ginecologia , Faculdade de Medicina da Universidade do Porto , Porto , Portugal
| | - Cristina Costa-Santos
- c CINTESIS -- Centre for Research in Health Technologies and Information Systems, Faculdade de Medicina da Universidade do Porto , Porto , Portugal
| | - Diogo Ayres-de-Campos
- b Departamento de Obstetrícia e Ginecologia , Faculdade de Medicina da Universidade do Porto , Porto , Portugal .,d Serviço de Ginecologia e Obstetrícia, Centro Hospitalar São João , Porto , Portugal .,e INEB -- Institute of Biomedical Engineering , Porto , Portugal , and
| | - João Bernardes
- b Departamento de Obstetrícia e Ginecologia , Faculdade de Medicina da Universidade do Porto , Porto , Portugal .,c CINTESIS -- Centre for Research in Health Technologies and Information Systems, Faculdade de Medicina da Universidade do Porto , Porto , Portugal .,d Serviço de Ginecologia e Obstetrícia, Centro Hospitalar São João , Porto , Portugal .,f Departamento da Mulher, do Jovem e da Criança , Hospital Pedro Hispano, Unidade Local de Saude de Matosinhos , Matosinhos , Portugal
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Optimistic outlook regarding maternity protects against depressive symptoms postpartum. Arch Womens Ment Health 2015; 18:197-208. [PMID: 25088532 PMCID: PMC4869708 DOI: 10.1007/s00737-014-0446-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 07/20/2014] [Indexed: 10/24/2022]
Abstract
The transition to motherhood is a time of elevated risk for clinical depression. Dispositional optimism may be protective against depressive symptoms; however, the arrival of a newborn presents numerous challenges that may be at odds with initially positive expectations, and which may contribute to depressed mood. We have explored the relative contributions of antenatal and postnatal optimism regarding maternity to depressive symptoms in the postnatal period. Ninety-eight pregnant women underwent clinician interview in the third trimester to record psychiatric history, antenatal depressive symptoms, and administer a novel measure of optimism towards maternity. Measures of depressive symptoms, attitudes to maternity, and mother-to-infant bonding were obtained from 97 study completers at monthly intervals through 3 months postpartum. We found a positive effect of antenatal optimism, and a negative effect of postnatal disconfirmation of expectations, on depressive mood postnatally. Postnatal disconfirmation, but not antenatal optimism, was associated with more negative attitudes toward maternity postnatally. Antenatal optimism, but not postnatal disconfirmation, was associated with reduced scores on a mother-to-infant bonding measure. The relationships between antenatal optimism, postnatal disconfirmation of expectations, and postnatal depression held true among primigravidas and multigravidas, as well as among women with prior histories of mood disorders, although antenatal optimism tended to be lower among women with mental health histories. We conclude that cautious antenatal optimism, rather than immoderate optimism or frank pessimism, is the approach that is most protective against postnatal depressive symptoms, and that this is true irrespective of either mood disorder history or parity. Factors predisposing to negative cognitive assessments and impaired mother-to-infant bonding may be substantially different than those associated with depressive symptoms, a finding that merits further study.
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Ringoot AP, Tiemeier H, Jaddoe VWV, So P, Hofman A, Verhulst FC, Jansen PW. Parental depression and child well-being: young children's self-reports helped addressing biases in parent reports. J Clin Epidemiol 2015; 68:928-38. [PMID: 25900418 DOI: 10.1016/j.jclinepi.2015.03.009] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 03/13/2015] [Accepted: 03/18/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Effects of maternal and paternal depression on child development are typically evaluated using parental reports of child problems. Yet, parental reports may be biased. METHODS In a population-based cohort, parents reported lifetime depression (N = 3,178) and depressive symptoms (N = 3,131). Child emotional and behavioral problems were assessed at age 6 years by child self-report using the Berkeley Puppet Interview, by mother report using the Child Behavior Checklist (CBCL), and at age 3 years by father and mother reported CBCLs. RESULTS Both maternal and paternal depression was associated with more child problems. Associations were of similar strength if child problems were obtained by self-reports. However, if parents reported about their own depression or depressive symptoms and about their child's problems, estimates were generally stronger for associations with the reporting parent's depression as the determinant. For instance, if mothers reported child emotional problems, associations were stronger for maternal (B = 0.27; 95% confidence interval (CI) = 0.19, 0.35) than for paternal lifetime depression (B = 0.12; 95% CI = 0.02, 0.21; P-value for difference = 0.02). CONCLUSION Depression of mothers and fathers affects young children's well-being. However, if parents reported about their own depression and about child problems, associations were inflated. To accurately estimate effects of parental depression, multiple-source data including young children's perspectives must be considered.
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Affiliation(s)
- Ank P Ringoot
- The Generation R Study Group, Erasmus University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands; Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, PO Box 2060, room KP-2822, 3000 CB Rotterdam, The Netherlands
| | - Henning Tiemeier
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, PO Box 2060, room KP-2822, 3000 CB Rotterdam, The Netherlands; Department of Psychiatry, Erasmus University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands; Department of Epidemiology, Erasmus University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
| | - Vincent W V Jaddoe
- The Generation R Study Group, Erasmus University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands; Department of Psychiatry, Erasmus University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands; Department of Pediatrics, Erasmus University Medical Center, PO Box 2060, 3000 CB Rotterdam, The Netherlands
| | - Pety So
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, PO Box 2060, room KP-2822, 3000 CB Rotterdam, The Netherlands; Department of Child and Adolescent Psychiatry, Riagg Rijnmond, PO Box 711, 3000 AS Rotterdam, The Netherlands
| | - Albert Hofman
- Department of Epidemiology, Erasmus University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Frank C Verhulst
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, PO Box 2060, room KP-2822, 3000 CB Rotterdam, The Netherlands
| | - Pauline W Jansen
- The Generation R Study Group, Erasmus University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands; Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center, PO Box 2060, room KP-2822, 3000 CB Rotterdam, The Netherlands; Institute of Psychology, Faculty of Social Sciences, Erasmus University Rotterdam, Woudestein, T13-01, PO Box 1738, 3000 DR Rotterdam, The Netherlands
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Rubertsson C, Pallant JF, Sydsjö G, Haines HM, Hildingsson I. Maternal depressive symptoms have a negative impact on prenatal attachment – findings from a Swedish community sample. J Reprod Infant Psychol 2014. [DOI: 10.1080/02646838.2014.992009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Stein A, Pearson RM, Goodman SH, Rapa E, Rahman A, McCallum M, Howard LM, Pariante CM. Effects of perinatal mental disorders on the fetus and child. Lancet 2014; 384:1800-19. [PMID: 25455250 DOI: 10.1016/s0140-6736(14)61277-0] [Citation(s) in RCA: 1282] [Impact Index Per Article: 128.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Perinatal mental disorders are associated with increased risk of psychological and developmental disturbances in children. However, these disturbances are not inevitable. In this Series paper, we summarise evidence for associations between parental disorders and offspring outcomes from fetal development to adolescence in high-income, middle-income, and low-income countries. We assess evidence for mechanisms underlying transmission of disturbance, the role of mediating variables (underlying links between parent psychopathology and offspring outcomes) and possible moderators (which change the strength of any association), and focus on factors that are potentially modifiable, including parenting quality, social (including partner) and material support, and duration of the parental disorder. We review research of interventions, which are mostly about maternal depression, and emphasise the need to both treat the parent's disorder and help with associated caregiving difficulties. We conclude with policy implications and underline the need for early identification of those parents at high risk and for more early interventions and prevention research, especially in socioeconomically disadvantaged populations and low-income countries.
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Affiliation(s)
- Alan Stein
- Section of Child and Adolescent Psychiatry, Department of Psychiatry, University of Oxford, Oxford, UK; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
| | - Rebecca M Pearson
- Section of Child and Adolescent Psychiatry, Department of Psychiatry, University of Oxford, Oxford, UK; Elizabeth Blackwell Institute for Health Research, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | | | - Elizabeth Rapa
- Section of Child and Adolescent Psychiatry, Department of Psychiatry, University of Oxford, Oxford, UK
| | - Atif Rahman
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | | | - Louise M Howard
- Health Service and Population Research Department, Institute of Psychiatry, King's College London, UK
| | - Carmine M Pariante
- Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, UK
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Lefkovics E, Baji I, Rigó J. IMPACT OF MATERNAL DEPRESSION ON PREGNANCIES AND ON EARLY ATTACHMENT. Infant Ment Health J 2014; 35:354-65. [DOI: 10.1002/imhj.21450] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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O'Mahen HA, Richards DA, Woodford J, Wilkinson E, McGinley J, Taylor RS, Warren FC. Netmums: a phase II randomized controlled trial of a guided Internet behavioural activation treatment for postpartum depression. Psychol Med 2014; 44:1675-1689. [PMID: 24148703 PMCID: PMC4005035 DOI: 10.1017/s0033291713002092] [Citation(s) in RCA: 137] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Revised: 07/09/2013] [Accepted: 07/21/2013] [Indexed: 12/30/2022]
Abstract
BACKGROUND Despite the high prevalence of postnatal depression (PND), few women seek help. Internet interventions may overcome many of the barriers to PND treatment use. We report a phase II evaluation of a 12-session, modular, guided Internet behavioural activation (BA) treatment modified to address postnatal-specific concerns [Netmums Helping With Depression (NetmumsHWD)]. METHOD To assess feasibility, we measured recruitment and attrition to the trial and examined telephone session support and treatment adherence. We investigated sociodemographic and psychological predictors of treatment adherence. Effectiveness outcomes were estimated with the Edinburgh Postnatal Depression Scale (EPDS), Generalized Anxiety Disorder-7, Work and Social Adjustment Scale, Postnatal Bonding Questionnaire, and Social Provisions Scale. RESULTS A total of 249 women were recruited via a UK parenting site, Netmums.com. A total of 83 women meeting DSM-IV criteria for major depressive disorder were randomized to NetmumsHWD (n = 41) or treatment-as-usual (TAU; n = 42). Of the 83 women, 71 (86%) completed the EPDS at post-treatment, and 71% (59/83) at the 6-month follow-up. Women completed an average of eight out of 12 telephone support sessions and five out of 12 modules. Working women and those with less support completed fewer modules. There was a large effect size favouring women who received NetmumsHWD on depression, work and social impairment, and anxiety scores at post-treatment compared with women in the TAU group, and a large effect size on depression at 6 months post-treatment. There were small effect sizes for postnatal bonding and perceived social support. CONCLUSIONS A supported, modular, Internet BA programme can be feasibly delivered to postpartum women, offering promise to improve depression, anxiety and functioning.
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Affiliation(s)
- H. A. O'Mahen
- Mood Disorders Centre, University of Exeter, Washington Singer Building, Exeter, UK
| | - D. A. Richards
- University of Exeter Medical School, Washington Singer Building, Exeter, UK
| | - J. Woodford
- Mood Disorders Centre, University of Exeter, Washington Singer Building, Exeter, UK
| | - E. Wilkinson
- Academic Unit of Child and Adolescent Psychiatry, Imperial College, St Mary's Campus, Norfolk Place, LondonUK
| | - J. McGinley
- Netmums.com, Marylebone Business Centre, London, UK
| | - R. S. Taylor
- University of Exeter Medical School, Veysey Building, Exeter, UK
| | - F. C. Warren
- University of Exeter Medical School, Veysey Building, Exeter, UK
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Enlow MB, Egeland B, Carlson E, Blood E, Wright RJ. Mother-infant attachment and the intergenerational transmission of posttraumatic stress disorder. Dev Psychopathol 2014; 26:41-65. [PMID: 24059819 PMCID: PMC4145695 DOI: 10.1017/s0954579413000515] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Evidence for the intergenerational transmission of posttraumatic stress disorder (PTSD) is documented in the literature, although the underlying mechanisms are poorly understood. Attachment theory provides a framework for elucidating the ways in which maternal PTSD may increase offspring PTSD vulnerability. The current study utilized two independent prospective data sets to test the hypotheses that (a) maternal PTSD increases the probability of developing an insecure mother-infant attachment relationship and (b) an insecure mother-infant attachment relationship increases the risk of developing PTSD following trauma exposure in later life. In the first study of urban, primarily low-income ethnic/racial minority mothers and infants (N = 45 dyads), elevated maternal PTSD symptoms at 6 months were associated with increased risk for an insecure, particularly disorganized, mother-infant attachment relationship at 13 months. In the second birth cohort of urban, low-income mothers and children (N = 96 dyads), insecure (avoidant or resistant) attachment in infancy was associated in a dose-response manner with increased lifetime risk for a diagnosis of PTSD by adolescence. A history of disorganized attachment in infancy predicted severity of PTSD symptoms, including reexperiencing, avoidance, hyperarousal, and total symptoms, at 17.5 years. In both studies, associations between attachment and PTSD were not attributable to numerous co-occurring risk factors. The findings suggest that promoting positive mother-child relationships in early development, particularly in populations at high risk for trauma exposure, may reduce the incidence of PTSD.
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Affiliation(s)
- Michelle Bosquet Enlow
- Department of Psychiatry, Boston Children’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Byron Egeland
- Institute of Child Development, University of Minnesota, Minneapolis, MN
| | - Elizabeth Carlson
- Institute of Child Development, University of Minnesota, Minneapolis, MN
| | - Emily Blood
- Harvard Medical School, Boston, MA
- Clinical Research Center, Boston Children’s Hospital, Boston, MA
| | - Rosalind J. Wright
- Harvard Medical School, Boston, MA
- Channing Laboratory, Department of Medicine, Brigham & Women’s Hospital
- Department of Environmental Health, Harvard School of Public Health, Boston, MA
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Maternal sensitivity and internalizing problems: evidence from two longitudinal studies in early childhood. Child Psychiatry Hum Dev 2013; 44:751-65. [PMID: 23408268 DOI: 10.1007/s10578-013-0369-7] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The goal of this study is to clarify the relation between maternal sensitivity and internalizing problems during the preschool period. For this purpose, a longitudinal, bidirectional model was tested in two large prospective, population-based cohorts, the Generation R Study and the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development (NICHD SECCYD), including over 1,800 mother-child dyads in total. Maternal sensitivity was repeatedly observed in mother-child interaction tasks and information on child internalizing problems was obtained from maternal reports. Modest but consistent associations between maternal sensitivity and internalizing problems were found in both cohorts, confirming the importance of sensitive parenting for positive development in the preschool years. Pathways from maternal sensitivity to child internalizing problems were consistently observed but child-to-mother pathways were only found in the NICHD SECCYD sample.
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O'Higgins M, Roberts ISJ, Glover V, Taylor A. Mother-child bonding at 1 year; associations with symptoms of postnatal depression and bonding in the first few weeks. Arch Womens Ment Health 2013; 16:381-9. [PMID: 23604546 DOI: 10.1007/s00737-013-0354-y] [Citation(s) in RCA: 111] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Accepted: 04/06/2013] [Indexed: 11/25/2022]
Abstract
Some mothers experience neutral or negative feelings toward their new infant. This study examined the association between symptoms of postnatal depression and mother-infant bonding and the persistence of these feelings over the first year. Bonding was assessed using the Mother-Infant Bonding Scale (MIBQ), at four times postnatal, "early weeks" (1-4 weeks), 9 weeks, 16 weeks and 1 year, in 50 depressed, Edinburgh Postnatal Depression scale (EPDS) ≥13 at 4 weeks post natal, and 29 non-depressed mothers. A significant association between the EPDS score at 4 weeks and bonding score at 1-4 weeks, 9 weeks, and at 1 year postnatal, χ(2)(1) = 9.85, p < 0.01, 5.44, p < 0.05 and 5.21, p < 0.05, respectively, was found, with a trend at 16 weeks. There was a strong association between bonding in the early weeks and all later time points χ(2)(1) = 17.26, p < 0.001, 7.89, p < 0.01 and 13.69, p < 0.001, respectively. Regression showed early bonding rather than early depression was the major predictor of bonding at 1 year. Women who are depressed postnatally can fail to bond well with their baby and this can persist for a year. Early identification and intervention for poor bonding is indicated.
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Affiliation(s)
- Madeleine O'Higgins
- Krembil Neuroscience Centre, Toronto Western Hospital, 399 Bathurst Street, Toronto, ON, Canada, M5T 2S8
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Redshaw M, Henderson J. From antenatal to postnatal depression: associated factors and mitigating influences. J Womens Health (Larchmt) 2013; 22:518-25. [PMID: 23751165 DOI: 10.1089/jwh.2012.4152] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Postnatal depression has a serious impact on new mothers and their children and families. Risk factors identified include a history of depression, multiparity, and young age. The study aimed to investigate factors associated with experiencing antenatal depression and developing subsequent postnatal depression. METHODS The study utilized survey data from 5332 women about their experience and well-being during pregnancy, in labor, and postnatally up to 3 months. Prespecified sociodemographic and clinical variables were tabulated against the incidence of antenatal depression and postnatal depression. Binary logistic regression was used to estimate the effects of the principal underlying variables. RESULTS Risk factors for antenatal depression were multiparity, black and minority ethnic (BME) status, physical or mental health problems, living in a deprived area, and unplanned pregnancy. Different factors for postnatal depression were evident among women who had experienced antenatal depression: multiparity and BME status were protective, whereas being left alone in labor and experiencing poor postnatal health increased the risk of postnatal depression. CONCLUSION This study confirms previous research on risk factors for antenatal depression and stresses the importance of continuous support in labor and vigilance in the postnatal period regarding the potential ill effects of continuing postnatal health problems.
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Affiliation(s)
- Maggie Redshaw
- Policy Research Unit for Maternal Health and Care, National Perinatal Epidemiology Unit, University of Oxford, Oxford OX3 7LF, United Kingdom.
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Guedeney A, Guedeney N, Wendland J, Burtchen N. Treatment - mother-infant relationship psychotherapy. Best Pract Res Clin Obstet Gynaecol 2013; 28:135-45. [PMID: 24045134 DOI: 10.1016/j.bpobgyn.2013.08.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 06/28/2013] [Accepted: 08/22/2013] [Indexed: 11/28/2022]
Abstract
In this chapter, we briefly describe several modes of parent-infant-psychotherapy, an efficient way of treating parent-infant relationship disorders. We then focus on treatment for postnatally depressed mothers. Perinatal depression defines an episode of major or minor depression occurring during pregnancy or the first 12 months after birth. Attachment-based parent-infant interventions are particularly helpful in the context of maternal perinatal depression, as postpartum depression has a special link with unresolved trauma and losses in the mother's childhood. The goal of treatment is to improve the mother's mood but also to prevent or reduce the effects of postpartum depression on the child. Infants of perinatally depressed mothers are at risk for a large array of negative outcomes, including attachment insecurity (particularly disorganised attachment), social-skills deficits, cognitive difficulties, behaviour problems, and later psychopathology. The 'ghosts in the nursery' concept refers to the painful or disturbed early childhood experiences coming from the mother's past, which haunt the present mother-infant relationship. By addressing the mother's unresolved attachment conflicts (in her relationship to her own parents), it is believed that the development of a more adaptive parenting and a more secure and less disorganised attachment between the mother and her infant is facilitated. Changes in parent- infant interaction are not dependent on the port of entry (e.g. child's behaviour, parent's representation or parent-infant relationship). The perspective of attachment is key to install a therapeutic alliance with parents.
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Affiliation(s)
- Antoine Guedeney
- Hospital Bichat Claude Bernard APHP, University Denis Diderot Paris 7, Policlinique Ney, 124 blvd Ney, Paris 75018, France.
| | | | - Jaqueline Wendland
- University Paris Descartes, Psychopathology and Health Processes Laboratory, France; Department of Child and Adolescent Psychiatry, Pitié-Salpêtrière Hospital, Institute of Psychology, Paris, France
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Hopkins J, Gouze KR, Lavigne JV. Direct and indirect effects of contextual factors, caregiver depression, and parenting on attachment security in preschoolers. Attach Hum Dev 2013; 15:155-73. [DOI: 10.1080/14616734.2013.750702] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Tharner A, Dierckx B, Luijk MPCM, van Ijzendoorn MH, Bakermans-Kranenburg MJ, van Ginkel JR, Moll HA, Jaddoe VWV, Hofman A, Hudziak JJ, Verhulst FC, Tiemeier H. Attachment disorganization moderates the effect of maternal postnatal depressive symptoms on infant autonomic functioning. Psychophysiology 2012; 50:195-203. [PMID: 23252764 DOI: 10.1111/psyp.12003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Accepted: 09/27/2012] [Indexed: 11/29/2022]
Abstract
We examined associations of disorganized attachment and maternal depressive symptoms with infant autonomic functioning in 450 infant-mother dyads enrolled in the Generation R study. Maternal depressive symptoms were measured 2 months postpartum with the Brief Symptom Inventory. At 14 months, we assessed infant attachment with a slightly shortened Strange Situation and measured infant resting heart rate. Respiratory sinus arrhythmia (RSA) was calculated using spectral analysis. Higher levels of maternal postnatal depressive symptoms predicted lower resting RSA in disorganized infants (B = -0.31, SE = 0.15, p = .04, R(2) = .05) but not in nondisorganized infants (B = 0.05, SE = 0.06, p = .36). This effect was buffered in disorganized infants with a secondary secure attachment classification. Disorganized infants were more vulnerable to the effect of maternal postnatal depressive symptoms on the physiological stress systems.
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Affiliation(s)
- Anne Tharner
- Generation R Study Group, Erasmus University Medical Center, Rotterdam, The Netherlands
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Hayes LJ, Goodman SH, Carlson E. Maternal antenatal depression and infant disorganized attachment at 12 months. Attach Hum Dev 2012; 15:133-53. [PMID: 23216358 DOI: 10.1080/14616734.2013.743256] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Although high rates of attachment disorganization have been observed in infants of depressed mothers, little is known about the role of antenatal depression as a precursor to infant attachment disorganization. The primary aim of this study was to examine associations between maternal antenatal depression and infant disorganization at 12 months in a sample of women (N = 79) at risk for perinatal depression. A secondary aim was to test the roles of maternal postpartum depression and maternal parenting quality as potential moderators of this predicted association. Among women with histories of major depressive episodes, maternal depressive symptoms were assessed at multiple times during pregnancy and the first year postpartum, maternal parenting quality was measured at three months postpartum, and attachment disorganization was assessed at 12 months postpartum. Results revealed that infants classified as disorganized had mothers with higher levels of depressive symptoms during pregnancy compared to infants classified as organized. Maternal parenting quality moderated this association, as exposure to higher levels of maternal depressive symptoms during pregnancy was only associated with higher rates of infant disorganized attachment when maternal parenting at three months was less optimal. These findings suggest that enhancing maternal parenting behaviors during this early period in development has the potential to alter pathways to disorganized attachment among infants exposed to antenatal maternal depressive symptoms, which could have enduring consequences for child wellbeing.
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Affiliation(s)
- Lisa J Hayes
- Department of Psychology, Emory University, Atlanta, GA, USA
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