Antenatal and postnatal depressive symptoms: Association with quality of mother–infant interaction

Antenatal and postnatal depression are independently associated with an increased risk of adverse infant development. A key linking mechanism is the quality of mother–infant interaction.ObjectivesThis study assesses the association between postnatal depressive symptoms (PDS) and their severity, with the quality of mother–infant interaction and compare the quality of mother–infant interaction and severity of the symptoms depending on the presence or absence of antenatal depressive symptoms (ADS).Methodsobservational study in 177 psychosocial risk mother–infant dyads from Chile (infant aged 2–12 months).ResultsMothers with PDS had lower maternal sensitivity and a more intrusive/controlling style than mothers without PDS, although the severity of the symptoms was not associated with lower maternal sensitivity. Maternal sensitivity did not differ in the postnatal depressed mothers depending on the presence of ADS, although the mothers differed in interaction style and the severity of symptoms. Mothers with ADS and PDS presented with a predominant intrusive/controlling interaction style and more severe depressive symptoms, whereas those with only PDS presented with a predominant nonresponsive/passive interaction style and reduced severity of symptoms.ConclusionsThe results corroborate the need to offer treatment and dyadic interventions to antenatal and postnatal depressive mothers and postulate that the presence of antenatal depressive symptoms may influence the subsequent mother–infant interaction style and greater severity of symptoms.     

Timing of Early Maternal Mental Health and Child Cortisol Regulation

Maternal mental health problems can negatively impact children's physiological stress regulation. Yet, little is known of their long‐term effects, especially related to the timing of maternal symptoms. We examined how maternal mental health problems during pregnancy versus in the early postpartum period predict children's cortisol levels and diurnal patterns at 10–12 years. Participants were a selection (N = 102) of an original sample of 805 Finnish families, who were followed from the second trimester of pregnancy (T1) to child's age of 2 months (T2) and 12 months (T3), and again at child's age of 10–12 years (T4). Based on the timing of psychological distress and depressive symptoms (T1–T3), the mothers could be assigned to three distinct mental health trajectory groups: mothers with prenatal mental health problems (n = 15), mothers with early postpartum mental health problems (n = 15) and mothers without mental health problems (n = 72). Children's cortisol (T4) was measured by saliva samples through five within‐1‐day assessments. The results show that maternal prenatal mental health problems predicted a relatively steep increase of child cortisol from awakening to 1 h later, indicating an intensified cortisol awakening response (CAR). Mothers' early postpartum mental health problems instead predicted a reduced CAR. Both maternal prenatal and postnatal mental health problems thus predicted children's later stress regulation, but in unique ways. We discuss the specific roles of direct biochemical effects during pregnancy and postpartum mother–infant interaction quality as modifiers of the hypothalamic–pituitary–adrenal system. Copyright © 2015 John Wiley & Sons, Ltd.     

Maternal representations and emotional availability among drug‐abusing and nonusing mothers and their infants

Both negative and idealized maternal prenatal representations may constitute a risk for mother–infant interaction. This study analyzed the role of maternal prenatal representations and pre‐ to postnatal representational change in predicting mother–infant emotional availability (EA) among 51 drug‐abusing mothers and their infants who participated in either psychodynamic group therapy (PGT) or received psychosocial support (PSS) and among 50 nonusing comparison dyads. Maternal representations of her child, the child's father, her own mother, self‐as‐mother, and self‐as‐woman were measured during pregnancy and at 4 and 12 months' postpartum with the Interview of Maternal Representations (M. Ammaniti et al., 1992 ; M. Ammaniti, R. Tambelli, & P. Perucchini, 1998). EA was measured with the Emotional Availability Scales, fourth edition (Z. Biringen, 2008 ) at 4 and 12 months. The results showed that drug‐abusing mothers had more negative prenatal representations of the self‐as‐woman and of the child's father. Postnatally, PSS mothers tended to first idealize their child, but later to experience disillusionment of idealization. Both negative and idealized prenatal representations of the self‐as‐mother predicted mother–infant EA problems, but only among the PGT mothers. For all mothers, negative representational change was detrimental for the mother–infant EA whereas for drug‐abusing mothers, also increasing idealization from the prenatal period to the postnatal period was harmful. Clinicians working with drug‐abusing mothers should aim at supporting the development of a realistically positive view of motherhood.     

Psychotherapy groups and individual support to enhance mental health and early dyadic interaction among drug‐abusing mothers

The purpose of this controlled study was to examine the outcome of psychodynamic mother–infant group psychotherapy (PGT) outpatient intervention for drug‐abusing perinatal mother–infant dyads. PGT comprised 20 to 24 weekly 3‐hr sessions with 3 to 5 months of follow‐up. A comparison intervention group was formed of mothers participating in individually tailored psychosocial support (PSS) lasting, on average, 12 months and providing mother–infant support and practical counseling. We hypothesized that positive changes would occur in maternal drug abuse, mental health, and mother–infant interaction, especially in the PGT group due to its more intensive therapeutic focus. Participants were 26 drug‐abusing dyads in PGT, 25 in PSS, and 50 dyads in a non‐drug‐abusing comparison group. Assessments were pre‐intervention and at 4 and 12 months' follow‐up, including maternal depressive symptoms and mother–child interaction assessed by the Emotional Availability Scales (EA). As hypothesized, in dyadic interaction maternal hostility decreased significantly in the PGT group, and intrusiveness decreased in both intervention groups, but especially in the PTG group. However, both interventions showed a general improvement in the quality of mother–infant interaction. They also succeeded in sustaining high maternal abstinence, treatment retention, and alleviating depressive symptoms. The findings are discussed in relation to preventing negative transgenerational interaction patterns in the high‐risk dyads.     

Goodness of fit between prenatal maternal sleep and infant sleep: Associations with maternal depression and attachment security

The current study prospectively examined the ways in which goodness of fit between maternal and infant sleep contributes to maternal depressive symptoms and the mother-child relationship across the first years of life. In a sample of 173 mother-child dyads, maternal prenatal sleep, infant sleep, maternal depressive symptoms, and mother-child attachment security were assessed via self-report, actigraphy, and observational measures. Results suggested that a poor fit between mothers’ prenatal sleep and infants’ sleep at 8 months (measured by sleep diary and actigraphy) was associated with maternal depressive symptoms at 15 months. Additionally, maternal depression mediated the association between the interplay of mother and infant sleep (measured by sleep diary) and mother-child attachment security at 30 months. Findings emphasize the importance of the match between mother and infant sleep on maternal wellbeing and mother-child relationships and highlight the role of mothers’ perceptions of infant sleep.     

Maternal romantic attachment,and antenatal and postnatal mother–infant attachment in a sample of Polish women

In this exploratory study, we evaluated the relationship between a woman's self-reported romantic attachment style (as measured with The Attachment Styles Questionnaire), her experience of pregnancy, antenatal (The Maternal–Fetal Attachment Scale) and postnatal (Postpartum Bonding Questionnaire) attachment with her baby, and depressive symptomatology (The Edinburgh Postnatal Depression Scale). In the first stage of the study 162 pregnant females participated; of these, 64 were followed up in the second stage. The maternal romantic attachment style predicted attachment with the baby in the antenatal, but not in the postpartum period. The anxious-ambivalent romantic attachment style predicted more interaction with and attributing more characteristics to the foetus, secure attachment style was positively correlated with role taking, and avoidant—with attributing more characteristics to the foetus. In the postpartum period, the correlation between antenatal and postnatal attachment was only moderate; role taking during pregnancy correlated with anxiety about care for an infant. However, our study shows the association of the profile of anxious-ambivalent romantic attachment with postpartum depression, which heightens the risk of postnatal mother–infant bonding impairments.     

Dyadic synchrony in parent–child interactions: A link with maternal representations of attachment relationships

The study examined the relation between maternal representations of attachment relationships from childhood and current parent–child interactions with their own preschool aged children. Thirty-six mother–child dyads were recruited from a community sample. The Adult Attachment Interview was converted into a questionnaire (AAIQ) and used to classify mothers as either “secure” or “insecure.” The mother–child dyads then engaged in a 20-min, videotaped play interaction task. The quality of maternal representations of attachment relationships was related to the degree of dyadic synchrony, as well as maternal affect and style of relating. Secure mothers and their children engaged in a more fluid, synchronous process of give-and-take than insecure mothers and their children. In addition, secure mothers expressed more warmth and affection, and their style of relating was less intrusive and more encouraging of child autonomy than insecure mothers. Children of secure mothers sought closer contact and were more compliant than children of insecure mothers. These interaction patterns were uniquely related to maternal representations of attachment, independent of maternal age, education and SES. There were no differences in these patterns of relating between mothers who had experienced loving relationships in childhood (continuous secure) and mothers who had come to terms with unloving and painful childhood relationships (earned secure). Therefore, rather than the quality of childhood histories, it was the manner in which these early experiences were mentally organized and integrated in adulthood that was significantly related to current parent–child interaction patterns. Finally, these differences in parent–child interaction patterns that were apparent on the observational measure were in contrast to information obtained from a maternal self-report measure. © 1997 Michigan Association for Infant Mental Health     

Maternal Depressive Symptoms and Child Externalizing Problems: Moderating Effects of Emotionally Maltreating Parenting Behaviors

While prior research has examined the relationship between maternal depressive symptoms and child externalizing behaviors, little research has focused specifically on the moderating effects of observed parenting behaviors on this relationship. This study was conducted to investigate the role of emotionally maltreating parenting behaviors, which were hypothesized to exacerbate the strength of the relationship between maternal depressive symptoms and child behavior problems. Maternal depressive symptoms, child externalizing problems, and emotionally maltreating parenting behaviors were assessed in a community sample of 62 mother–child dyads (with children age 8–11 years). Results indicated the overall model was significant, after controlling for maternal race, as was the interaction between maternal depressive symptoms and emotionally maltreating parenting behaviors. Based on these findings, future research is needed to identify potential protective factors that may prevent depressive symptoms from negatively affecting parenting behaviors, with the attendant goal of decreasing risk for emotional maltreatment.     

Postnatal trajectories of maternal depressive symptoms: Postpartum antecedents and differences in toddler adjustment

Infants are uniquely vulnerable to maternal depression's noxious effects, but few longitudinal studies have tried to identify discrete postnatal trajectories of maternal depressive symptoms (MDS) beginning in infancy. This study extends evidence of heterogeneous change in postnatal MDS by examining their cross-contextual antecedents in infancy and their consequences for children's early behavior problems and language skills in late toddlerhood. A community sample of mother–child dyads (N = 235, 72% Caucasian) was assessed when children were 7, 15, and 33 months old. Mothers reported their socioeconomic status (SES), social support, marital relationship quality, family dysfunction, parenting stress, and infants’ functional regulatory problems at 7 months postpartum, and children's internalizing and externalizing symptoms at 33 months. Children completed a receptive vocabulary assessment at 33 months in the lab. Latent class growth analysis identified three postnatal MDS trajectory classes that fit the data best: low-decreasing, moderate, and increasing. Psychosocial measures at seven months postpartum primarily predicted membership to these postnatal trajectory classes, which subsequently differed in children's internalizing, externalizing, and receptive vocabulary in late toddlerhood, controlling for family SES and functional regulatory problems in infancy. We discuss salient antecedents and consequences of postnatal depression for mothers and their offspring.     

Family and Contextual Predictors of Depressive Symptoms in Inner-City African American Youth

Family and contextual predictors of depression in inner-city, African American youth have rarely been examined. In this study we explore the contribution of current and historical life events, family conflict, perceived social support from mother, maternal depression, and maternal explanatory style to the depressive symptoms of inner-city African American school-age (M = 10.7 years) children. Home interviews were conducted with 89 mother and child dyads living in moderate- to high-violent areas of a southeastern city. Regression analyses revealed that the children in this sample with higher levels of depressive symptoms had higher levels of child-reported everyday stress, were more likely to have been abused at some point in their past, came from homes with mothers who were less well educated, and had mothers who reported higher levels of depression, a past history of domestic abuse, as well as a less pessimistic explanatory style. Implications for interventions with inner-city African American families are discussed.     

A Longitudinal Study of Parental Depressive Symptoms and Coparenting in the First 18 Months

Although the negative impact of postpartum depression on parenting behaviors has been well established—albeit separately—for mothers and fathers, the respective and joint impact of both parents' mood on family‐group interactive behaviors, such as coparenting support and conflict behaviors between the parents, have not yet been investigated. The aim of this study was to examine the association between parental depressive symptoms and coparenting behaviors in a low‐risk sample of families with infants, exploring reciprocity between the variables, as well as gender differences between mothers and fathers regarding these links. At 3 (T1), 9 (T2), and 18 months postpartum (T3), we assessed both parents' depressive symptoms with a self‐report questionnaire and observed coparenting support and conflict during triadic mother–father–child interactions. The results revealed that higher maternal depressive symptoms at T1 were associated with lower support at T1 and T2. Conflict at T3 was associated with higher maternal depressive symptoms at T3 and, more surprisingly, with less depressive symptoms in mothers at T2 and fathers at T3. Cross‐lagged associations suggested that parental depressive symptoms were more likely to influence coparenting than the reverse. Moreover, maternal depressive symptoms were more likely to be linked to coparenting behaviors than were paternal depressive symptoms. These results confirm that parental—mostly maternal—depressive symptoms, even of mild intensity, may jeopardize the development of healthy family‐level relations, which previous research has shown to be crucial for child development.     

Prenatal depression predicts postpartum maternal attachment in low-income Latina mothers with infants

Although maternal attachment is an important predictor of infant attachment security and other developmental outcomes, little is known about the formation of maternal attachment in the first few months of the infant's life, particularly among ethnic minority mothers. The current study examined the predictors of postpartum maternal attachment in a sample of 217 Latina women enrolled in a perinatal depression prevention trial. Mothers’ attachment to their infants was measured at 6-8 weeks postpartum using the Maternal Postnatal Attachment Scale. A variety of predictors of early attachment were explored including: depressive symptoms during pregnancy, pregnancy intention, feelings about the pregnancy, and the quality of the partner relationship. The strongest predictor of lower maternal attachment was depressive symptoms late in pregnancy; pregnancy intention was marginally predictive of attachment, with lower scores being associated with unwanted pregnancies. The study fills a critical gap in our understanding of the role of depressive symptoms during pregnancy in shaping mothers’ early attachment to their infants.     

Examining Maternal Elaborative Reminiscing as a Protective Factor in the Intergenerational Transmission of Psychopathology

Most research examining the impact of early parental depression on the developing child has focused on the nature of parenting practices observed in depressed adults. Maternal elaborative reminiscing, or the extent to which mothers elaboratively discuss past shared experiences with their children, has a considerable influence on children’s emotional and social development and is understudied within the context of maternal depression. The current study is the first to examine whether maternal elaborative reminiscing in middle childhood mediates the association between exposure to maternal depressive symptoms in infancy and later internalizing and externalizing problems. The study included 206 mother–child dyads recruited from the community who participated in a prospective longitudinal study. Maternal depressive symptoms were assessed when offspring were 6-months old. At 5-years old, dyads were observed during a free play task to measure sensitive and harsh-intrusive parenting and during a reminiscing task to measure maternal elaboration. Teacher-reported internalizing and externalizing problems were collected at age 7. A saturated path model revealed that maternal elaborative reminiscing, but not sensitive or harsh-intrusive parenting, fully mediated the association between maternal depression in infancy and externalizing, but not internalizing, problems. Reduced maternal elaboration during parent–child reminiscing constitutes one way in which risk from early maternal depression is associated with later externalizing problems.

     

The Associations between Mothers’ and Grandmothers’ Depressive Symptoms,Parenting Stress,and Relationship with Children: An Actor–Partner Interdependence Mediation Model

Three-generation households that include parents and grandparents raising children together have become increasingly common in China. This study examined the relations among depressive symptoms, parenting stress, and caregiver–child relationships in the mother–grandmother dyadic context. Participants were mothers and grandmothers from 136 three-generation households. Results from Actor–Partner Interdependence Mediation Modeling indicated that mothers’ depressive symptoms were indirectly related to mother–child conflict/closeness through own parenting stress; grandmothers’ depressive symptoms were indirectly related to grandmother–child conflict through own parenting stress. Mothers’ depressive symptoms were indirectly related to grandmothers’ conflict with children through grandmothers’ parenting stress, and grandmothers’ depressive symptoms were indirectly related to mothers’ conflict/closeness with children through mothers’ parenting stress. The relation between mothers’ parenting stress and mother–child closeness was stronger than the relation between grandmothers’ parenting stress and grandmother–child closeness. Findings highlight the implications of using a family system perspective and the dyadic approach in understanding and improving family functioning in Chinese three-generation households.     

Like mother,like child? Maternal determinants of children's early social-emotional development

Social-Emotional competencies evolve early in life. For example, early emotion regulation is learned primarily in the context of mother–child interaction, which may allow for maternal influences to shape children's social-emotional development. The aim of the current study was to longitudinally examine maternal determinants of children's early social-emotional development in a community-based sample of first-time mothers (N = 61, aged 22–39 years). Specifically, we used structural equation modeling to examine how maternal emotion regulation difficulties and subclinical depression directly and indirectly, through sensitivity and postnatal bonding, assessed at 6 to 8 months predicted child outcomes at 12 to 16 months. We found that mothers’ sensitivity predicted fewer social-emotional and behavioral problems and that stronger bonding predicted fewer problems and more social-emotional competencies. Emotion regulation difficulties were significantly associated with depressive symptoms; yet, when accounting for shared variances, both factors differentially predicted less positive child outcomes such that more difficulties indirectly, through poorer bonding, predicted greater delay in competencies, and more symptoms indirectly, through less sensitivity, predicted more problems. Current findings underline the significance of maternal factors impacting the quality of mother–child interaction for children's positive development. Potential implications for early prevention programs to support children who are otherwise at risk for negative emotional outcomes due to mothers’ emotional state postpartum are discussed.     

PRENATAL AND POSTNATAL MATERNAL REPRESENTATIONS IN NONRISK AND AT‐RISK PARENTING: EXPLORING THE INFLUENCES ON MOTHER–INFANT FEEDING INTERACTIONS

The aim of this study was to investigate the mother–infant relationship in depressive, psychosocial, and cumulative‐risk parenting by assessing prenatal and postnatal maternal representations and mother–infant interactions during feeding at 4 months of age. The sample consisted of 167 mother–infant pairs: 41 nonrisk women, 40 depressive‐risk women, 40 psychosocial‐risk women, and 46 cumulative‐risk women. During pregnancy, the women were interviewed about psychosocial‐risk variables. Maternal representations and depressive symptoms were evaluated during pregnancy and again when the infants were 3 and 4 months old, respectively. All mother–infant pairs were observed in 20‐min video recordings during breast‐feeding. Maternal Integrated/balanced representations were more frequent in the nonrisk group whereas the maternal Nonintegrated/ambivalent category was more represented in the cumulative‐risk group during pregnancy and after the infant's birth. At 4 months, the cumulative‐risk group of mothers and infants showed a lack of reciprocity, conflictual communicative exchanges, and higher food refusal behavior. Moreover, at 4 months, differences between the quality of mother–infant feeding interactions and the quality of prenatal and postnatal maternal representations emerged, showing less adequate maternal scaffolding in the Nonintegrated/ambivalent and Restricted/disengaged women. This study has rich implications for intervention to support the affective and communicative caregiving system and to prevent infant feeding problems and mother–infant relational disturbances in childhood.     

Maternal touch in caregiving behavior of mothers with and without postpartum depression

The way a mother touches her infant plays a central role in maternal caregiving behavior. Thus, the purpose of the present study was to examine associations between touch and positive and negative caregiving behavior and whether this association differed in mothers with and without postpartum depression, an episode of depressive disorder following childbirth. Positive caregiving behavior was operationalized as sensitive behavior, i.e. the mother’s ability to notice the child’s signals, interpret these signals correctly and respond to them promptly and appropriately. Negative caregiving behavior was operationalized as overriding behavior, i.e. behavior which disturbs the child’s behavior or redirects the child’s attention to follow the parent’s agenda. Seventy mother-infant dyads (44 in the nonclinical group and 26 in the clinical group) participated in a 10 minutes long mother-infant interaction at four months postpartum. The sample is part of an archival dataset of a longitudinal study investigating the parent-child relationship and child development. Three minutes of the interaction were coded a) microanalytically for touch, using a modified version of the Maternal Touch Scale (Beebe et al., 2010), and b) macroanalytically for sensitive and overriding behavior, using the Coding Interactive Behavior measure (Feldman, 1998). Hierarchical regression analyses with bootstrapping showed that caregiving touch, but not affectionate and static touch, was associated with sensitive behavior across the whole sample. Moreover, playful, but not rough-intrusive touch, was associated with overriding behavior across the whole sample. Associations did not differ between mothers with and without postpartum depression.     

MATERNAL INTERACTION QUALITY MODERATES EFFECTS OF PRENATAL MATERNAL EMOTIONAL SYMPTOMS ON GIRLS’ INTERNALIZING PROBLEMS

The role of mother–infant interaction quality is studied in the relation between prenatal maternal emotional symptoms and child behavioral problems. Healthy pregnant, Dutch women (N = 96, M = 31.6, SD = 3.3) were allocated to the “exposed group” (n = 46), consisting of mothers with high levels of prenatal feelings of anxiety and depression, or the “low‐exposed group” (n = 50), consisting of mothers with normal levels of depressive or anxious symptoms during pregnancy. When the children (49 girls, 47 boys) were 23 to 60 months of age (M = 39.0, SD = 9.6), parents completed the Child Behavior Checklist (T.M. Achenbach & L.A. Rescorla, 2000 ), and mother–child interaction quality during a home visit was rated using the Emotional Availability Scales. There were no differences in mother–child interaction quality between the prenatally exposed and low‐exposed groups. Girls exposed to high prenatal emotional symptoms showed more internalizing problems, if maternal interaction quality was less optimal. No significant effects were found for boys.     

Influences of maternal postpartum depression on fathers and on father–infant interaction

Maternal postpartum depression (PPD) has been shown to negatively influence mother–infant interaction; however, little research has explored how fathers and father–infant interaction are affected when a mother is depressed. This study examined the influence of maternal PPD on fathers and identified maternal and paternal factors associated with father–infant interaction in families with depressed as compared with nondepressed mothers. A convenience sample of 128 mother–father–infant triads, approximately half of which included women with significant symptoms of PPD at screening, were recruited from a screening sample of 790 postpartum women. Mothers and fathers completed measures of depression, marital satisfaction, and parenting stress at 2 to 3 months' postpartum and were each videotaped interacting with their infants. Results indicate that maternal PPD is associated with increased paternal depression and higher paternal parenting stress. Partners of depressed women demonstrated less optimal interaction with their infants, indicating that fathers do not compensate for the negative effects of maternal depression on the child. Although mother–infant interaction did not influence father–infant interaction, how the mother felt about her relationship with the infant did, even more so than maternal depression. The links between maternal PPD, fathers, and father–infant interaction indicate a need for further understanding of the reciprocal influences between mothers, fathers, and infants.     

Adverse Effects of Childhood Emotional Maltreatment on Child Behavioral Outcomes

This study used a diverse community sample to test a moderated mediation model, investigating maternal depressive symptoms as a mediator of the relations between maternal emotional maltreatment and child behavior problems; we further tested the moderating effects of observed maternal hostility on these relations. Participants included 64 mother–child dyads (8–11 years old; 59.4% female), in which mothers completed self- and child-report measures and dyads completed a conflict resolution task. Results of a moderated mediation analysis (PROCESS; Hayes, 2013) indicated that the maternal history of emotional maltreatment was associated with increased maternal depressive symptoms, and subsequently with higher child externalizing problems. In addition, these relations were strongest at high levels of observed maternal hostility in the conflict task.