Evaluating a home‐based dyadic intervention: Changes in postpartum depression,maternal perceptions,and mother–infant interactions

Psychotherapeutic treatments that focus on improving the relational processes between mothers with postpartum depression (PPD) and their infants, as well as the mother's individual therapeutic needs, have a great potential to positively impact the mother, her infant, and their relationship (K.J. Nylen, T.E. Moran, C.L. Franklin, & M. O'Hara, 2006 ). Utilizing pilot data from an evaluation of a home‐based dyadic therapy for mothers with PPD and their infants, this article reports on a recent academic–community partnership study. The effectiveness of the intervention was examined, specifically regarding changes in mother's mood, parenting experience, and relationship with her infant. In addition, associations were examined among maternal self‐report variables measuring change from pre‐ to posttreatment in PPD, psychological distress, and maternal perceptions of parenting and those variables measuring change in observer ratings of maternal–infant interactions. Results showed improvements in mothers' depression, distress, and perceptions of parenting as well as many ratings of mothers' interactions with their infants. However, only improvements in maternal perceptions of parenting, such as maternal self‐esteem and parenting stress, were associated with better mother–‐infant interactions. Importance of this research for the field of infant mental health as well as clinical implications are discussed.     

Effects of male postpartum depression on father–infant interaction: The mediating role of face processing

It is estimated that postpartum depression affects up to 25% of men. Despite such high prevalence, the majority of studies on postpartum depression are focused on mothers, and the role of paternal depression and its effects on infant development have been overlooked by researchers and clinicians. The present study aimed to fill this gap by investigating the effect of paternal postpartum depression on father–infant interactions. In addition, we examined whether differences in face recognition mediated the effects of paternal postpartum depression on father–infant interactions. A total of 61 father–infant dyads (17 postpartum depression, 44 controls) took part in the study. Results revealed that compared to controls, fathers with postpartum depression had a worse pattern of interaction with their infants on measures of responsiveness, mood, and sensitivity; they also had greater difficulty in recognizing happy adult faces, but greater facility in recognizing sad adult faces. Depressed fathers attributed greater intensities to sad adult and infant faces. The tendency to attribute greater intensity to sad adult faces was confirmed as a partial mediator of the effect of paternal postpartum depression on measures of father responsiveness and as a full mediator of the effects of paternal depression on father sensitivity. Clinical implications and suggestions for further studies are discussed.     

Maternal postpartum depression is a risk factor for infant emotional variability at 4 months

Maternal postpartum depression (PPD) is a risk for disruption of mother–infant interaction. Infants of depressed mothers have been found to display less positive, more negative, and neutral affect. Other studies have found that infants of mothers with PPD inhibit both positive and negative affect. In a sample of 28 infants of mothers with PPD and 52 infants of nonclinical mothers, we examined the role of PPD diagnosis and symptoms for infants’ emotional variability, measured as facial expressions, vocal protest, and gaze using microanalysis, during a mother–infant face-to-face interaction. PPD symptoms and diagnosis were associated with (a) infants displaying fewer high negative, but more neutral/interest facial affect events, and (b) fewer gaze off events.  PPD diagnosis, but not symptoms, was associated with less infant vocal protest. Total duration of seconds of infant facial affective displays and gaze off was not related to PPD diagnosis or symptoms, suggesting that when infants of depressed mothers display high negative facial affect or gaze off, these expressions are more sustained, indicating lower infant ability to calm down and re-engage, interpreted as a disturbance in self-regulation. The findings highlight the importance of not only examining durations, but also frequencies, as the latter may inform infant emotional variability.     

Comparing emotional coordination in early spontaneous mother–infant and father–infant interactions

We compare matching of facial expressions and attunement of emotional intensity in spontaneous communication of mothers with infants and of fathers with infants, in families in Crete. Eleven infant–mother and 11 infant–father dyads were video-recorded at home in familiar interactions from the 2nd to the 6th month. Microanalysis of infant, maternal and paternal facial expressions of emotion provided evidence of quantitative differences that favour father–infant interaction as more playful, but the infants' behaviours with mothers and fathers show similar developmental curves. These results are discussed in the frame of the theory of innate intersubjectivity and of the emotional support parents give to developing motives of infants.     

Adult attachment as a predictor of maternal gatekeeping among new parents

This study examined the associations between expectant couples' adult attachment styles and new mothers' gatekeeping (i.e., maternal behaviors that may inhibit or encourage father involvement in parenting) at the transition to parenthood. Data were drawn from a study of 182 different-gender dual-earner couples followed from the third trimester of pregnancy through 3 months postpartum. In the third trimester, expectant parents reported their attachment anxiety and avoidance. At 3 months postpartum, mothers and fathers reported on mothers' gate opening and gate closing behaviors. Also, at 3 months postpartum, maternal gate opening and gate closing were coded during mother–father–infant interactions in play and caregiving. Actor–Partner Interdependence Models were conducted in IBM SPSS AMOS 21.0. Findings indicated that higher maternal anxiety predicted higher mother-reported maternal gate closing, whereas higher paternal avoidance and higher paternal anxiety predicted lower father-reported maternal gate opening. During caregiving, higher paternal anxiety predicted higher observed maternal gate closing, and higher maternal anxiety predicted lower observed maternal gate opening. Findings reveal the importance of attachment in coparenting relationships among new parents, as attachment anxiety and avoidance may shape maternal behaviors encouraging or hindering father involvement in parenting.     

Mother and father interaction with their 3-month-old infants: Similarities and differences in parenting behaviour in well-resourced parents

Infancy is characterized by intensive parenting which may affect later child development. However, little is known about similarities and differences in maternal and paternal parenting behaviour, as the majority of the studies have mainly focused on mothers. The present study investigated similarities and differences in mothers’ and fathers’ parenting behaviour during parent-infant interaction in 56 mothers and 56 fathers of 3-months-old infants in a good-resourced sample. Parent-child interactions were videotaped and coded by the Global Rating Scales. Results suggested similar parenting behaviour in terms of maternal and paternal sensitivity, intrusiveness and remoteness. Moreover, regardless of sex infant’s behaviour was similar during interactions with mothers and fathers. The low-risk and non-clinical nature of our sample may have had a positive influence on mother-child and father-child dyadic exchanges. These findings suggest including family system models in research and clinical practice.     

Promoting infant well‐being in the context of maternal depression by supporting the father

Maternal depression is recognized as posing a significant risk to the healthy development of infants. Guided by attachment theory, interventions have focused on the distressed mother's relationship with her infant. While interventions which include fathers are reported in the literature, the processes involved in the fathers' support of a distressed mother and in his interactions with his infant in the context of maternal depression remain unexplored. In the case study described here, home‐visiting support was directed to the father in a couple in which the mother had been treated for depression after the birth. The observed effects of the intervention on father–infant interaction and the “knock‐on” effects on the mothers' parenting suggest that targeting support to fathers in distressed families should be considered. Points for a service protocol are provided to incorporate fathers into the identification and treatment of maternal distress.     

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.     

Concordance Between the Quality of Maternal and Paternal Parenting Behavior Within Couples

There is compelling evidence that the quality of maternal and paternal parenting behavior bears critical importance for child development. Yet, less is known of the degree of similarity between maternal and paternal parenting behavior in families, and especially little is known about the factors that may explain variation in degrees of similarity. This article aims to examine (a) the concordance (similarity) between the quality of mothers’ and fathers’ interactive behavior with their child and (b) the sociodemographic determinants of this concordance. The sample included 74 families (mother, father, and their child). The quality of maternal and paternal interactive behavior was assessed independently, and rated with the Maternal Behavior Q-Sort (mother–infant, 12 months; D. R. Pederson et al., 1990) or the Mutually Responsive Orientation scale (father–toddler, 18 months; N. Aksan et al., 2006). The results indicated that the overall correlation between the quality of mothers’ and fathers’ behavior was moderate. The concordance was greater among higher socioeconomic status families or when interacting with a boy, but did not differ according to the presence or absence of siblings in the family.     

Infants of “depressed” mothers interact better with their nondepressed fathers

To determine whether infants of “depressed” mothers interact better with their nondepressed fathers, twenty-six 3- to 6-month-old infants were videotaped during face-to-face interactions with their parents. The “depressed” mother group consisted of twelve 3- to 6-month-old infants and their “depressed” mothers and nondepressed fathers. The control group was composed of 14 nondepressed mothers and nondepressed fathers and their 3- to 6-month-old infants. In the “depressed” mother group, the nondepressed fathers received better interaction ratings than the “depressed” mothers. In turn, the infants received better interaction ratings when they interacted with their nondepressed fathers than with their “depressed” mothers. In contrast, nondepressed fathers and mothers and their infants in the control group did not differ on any of their interaction ratings. These findings suggest that infants' difficult interaction behaviors noted during interactions with their “depressed” mothers may not extend to their nondepressed fathers. The data are discussed with respect to the notion that nondepressed fathers may “buffer” the effects of maternal depression on infant interaction behavior.     

Interactions between depressed and nondepressed Latina mothers and their premature infants

The impact of depression upon mother–infant interaction was studied longitudinally in a sample of very low income, immigrant Latina mothers with premature, very low birth weight infants. Both maternal characteristics and infant characteristics were examined using a rating scale which measured feeding interactions. Results indicate that mothers who were depressed at one month did not interact differently with their premature infants than nondepressed mothers. In addition, infants of mothers who were depressed at one month did not interact differently with their mothers than infants of nondepressed mothers. There were no differences between groups of mothers who remained depressed across the one-year period and groups whose scores reflected no depression or changes in depression levels. These findings challenge previous assumptions about interactions between depressed mother–infant dyads. Results indicate the need to broaden study attention to include socioeconomic, cultural, and life circumstances of families that may have greater impact on child outcomes than single assessments of maternal depression. Such studies may lead to changes in the way services are delivered and the types of interventions provided to non-mainstream families. © 1997 Michigan Association for Infant Mental Health     

Impact of fathers' alcoholism and associated risk factors on parent–infant attachment stability from 12 to 18 months

This study examined short‐term attachment stability and sought to identify predictors of stability and change within a sample characterized by fathers' alcoholism. Results suggest moderate stability of attachment classifications (60% for mothers, 53% for fathers) from 12 to 18 months. Higher paternal and maternal alcohol symptoms, maternal depression, and maternal antisocial behavior were found in families with stable insecure mother–infant attachment compared to those who were stable secure. Mother–infant stable insecurity was associated with higher levels of maternal negative affect expression during play. Father–infant stable insecurity was associated with lower levels of paternal positive affect expression and decreased sensitivity during play. Stable insecure children also had higher levels of negative affect during parent–infant interactions and higher negative emotionality during other episodes compared to stable secure children. Results indicate that infants who were insecure at both time points had the highest constellation of family risk characteristics.     

Caregiving behavior and interactions of prenatally depressed mothers (antidepressant‐treated and non‐antidepressant‐treated) during newborn acute pain

This exploratory study aimed to examine time‐based measures of the behaviors and interactions of prenatally depressed serotonin reuptake inhibitors (SRI)‐medicated mothers to their infant's pain (n = 10) by comparing them with similar measures obtained from prenatally depressed nonmedicated mothers and their infants (n = 10), and nondepressed mothers and their infants (n = 10). During the second trimester of their pregnancy, the 30 study mothers were assessed for depression and anxiety, with no further measures of maternal mood taken. Maternal and infant interactions were continuously videorecorded while the infant underwent a scheduled heel lance for routine blood screening that occurred when study infants were between the ages of 24 and 60 hr. Maternal behavior and infant cry, for all 30 cases, were coded second‐by‐second for the full duration of each infant's heel lance using a reliable coding system and analyzed using odds ratio and regression analyses. Infants exposed to prenatal SRIs and depressed maternal mood were more likely to have lower Apgar scores and to exhibit weak and absent cry. Even when duration of the heel lance was controlled for, women with depression during the second trimester were more likely to exhibit depressed behavior at 2 days' postpartum despite sustained SRI antidepressant treatment. Both groups of prenatally depressed mothers were more likely to exhibit diminished response to their infants' pain cue although nonmedicated mothers' expressions of depressed behavior were more similar to healthy controls. Comprehensive understanding is essential to optimize the clinical care of mothers and their infants in this complex setting. This study contributes preliminary new findings that warrant prospective and longitudinal studies to clarify further the impacts of prenatal SRI and maternal mental mood (e.g., chronic depression and anxiety) effects on the mother–infant interaction and infant pain and stress reactivity.     

The 1990s: Gender differences in parenting roles

Seventy European American families with 6-month-old infants participated in this investigation of current parenting roles. Parental reports and observations revealed that mothers were more involved with the infants and fathers were employed outside the home more hours per week than mothers. Both parents rated the mother as a better caretaker of the infant than the father. The mother rated the father's caretaking abilities higher than he rated himself. In concordance with previous research, maternal concerns about separations related to employment were found to be influenced by maternal employment factors. Paternal concerns about separations related to employment were also influenced by maternal employment factors. Changes in parenting roles were discussed.     

Postpartum depression and infant-mother attachment security at one year: The impact of co-morbid maternal personality disorders

Previous studies on effects of postpartum depression (PPD) on infant-mother attachment have been divergent. This may be due to not taking into account the effects of stable difficulties not specific for depression, such as maternal personality disorder (PD).Mothers (N = 80) were recruited for a longitudinal study either during pregnancy (comparison group) or eight weeks postpartum (clinical group). Infants of mothers with depressive symptoms only or in combination with a PD diagnosis were compared with infants of mothers with no psychopathology. Depression and PD were assessed using self-report and clinical interviews. Infant-mother attachment was assessed when infants were 13 months using Strange Situation Procedure (SSP). Attachment (in)security was calculated as a continuous score based on the four interactive behavioral scales of the SSP, and the conventional scale for attachment disorganization was used.PPD was associated with attachment insecurity only if the mother also had a PD diagnosis. Infants of PPD mothers without co-morbid PD did not differ from infants of mothers with no psychopathology. These results suggest that co-existing PD may be crucial in understanding how PPD impacts on parenting and infant social-emotional development. Stable underlying factors may magnify or buffer effects of PPD on parenting and child outcomes.     

Fathers' versus mothers' social referencing signals in relation to infant anxiety and avoidance: a visual cliff experiment

Infants use signals from others to guide their behavior when confronted with novel situations, a process called ‘social referencing’ (SR). Via SR, signs of parental anxiety can lead to infant anxiety. Little is known about differences in the effect of paternal and maternal SR signals on child anxiety. Using a visual cliff paradigm, we studied whether SR processes between fathers and their infants differed from mothers and their infants. Eighty‐one infants aged 10–15 months were randomly assigned to conduct the visual cliff task with their father (n = 41) or mother (n = 40). The infant was placed on the shallow side of the cliff and the parent, standing at the deep side, was instructed to encourage the infant to cross. Results showed that although mothers showed more intense facial expressions of encouragement than fathers, no differences occurred in how fast, and with how much anxiety, infants crossed the cliff with fathers and mothers. However, path analyses showed that paternal, but not maternal, expressed anxiety was positively associated with infant expressed anxiety and avoidance. For infants who participated with their mother, infants' anxious temperament was negatively associated with infant avoidance of the cliff. Infant anxious temperament moderated the link between paternal expressed anxiety and infant avoidance: the higher the level of infant anxious temperament the stronger the positive association between paternal expressed anxiety and infant's avoidance of the cliff. Lastly, parental encouragement was unrelated to infant expressed anxiety and avoidance. Our results suggest that SR processes between fathers and their infants differ from those between mothers and their infants.     

Interaction between maternal and paternal parenting styles with infant temperament in emerging behavior problems

This study examined the interaction effects of infant temperament (negative affect, orienting/regulatory capacity, surgency) on the relationship between maternal and paternal parenting styles (authoritative, authoritarian, permissive) and externalizing and internalizing behaviors simultaneously. A diverse sample of mothers (N = 186) and fathers (N = 142) reported on infant temperament of their 6-month-olds and their children’s internalizing and externalizing behaviors one year later. Significant interactions revealed: (a) surgency moderated maternal authoritative and paternal permissive parenting style and externalizing behaviors; and (b) surgency moderated maternal authoritarian and paternal authoritative parenting style and internalizing behaviors. No significant interactions were found between maternal and paternal parenting styles and their report of their infants’ orienting/regulatory capacity and negative affect. Findings suggest interaction effects may appear beginning in infancy.     

母亲抑郁情绪对幼儿内化问题的影响：有调节的中介模型

采用问卷法对298名6个月婴儿的母亲进行为期8个月的追踪,通过交叉滞后回归以及多层回归分析探究母亲抑郁情绪与母亲教养压力的准因果关系,母亲抑郁情绪与幼儿内化问题间的有调节的中介效应。结果表明：（1）母亲抑郁情绪与母亲教养压力存在准因果关系,母亲抑郁情绪可显著正向预测母亲的教养压力。（2）母亲感受到的教养压力对母亲抑郁情绪与幼儿内化问题的关系具有部分中介效应。母亲抑郁情绪不仅对幼儿内化问题产生直接影响,也可通过母亲的教养压力对幼儿内化问题产生间接影响。不过这一中介模型受母亲受教育程度的调节。只有在母亲受教育程度低时,教养压力对母亲抑郁情绪与幼儿内化问题的中介作用才成立,母亲较高的受教育程度可以明显减弱由于母亲抑郁情绪对幼儿内化问题的影响。这在一定程度上揭示了母亲抑郁情绪对幼儿内化问题的影响机制,对缓解母亲抑郁水平高的幼儿的内化问题提供理论和参考价值。     

Is the Effect of Postpartum Depression on Mother-Infant Bonding Universal?

PurposeAlthough the negative consequences of maternal depression on infants has been documented in several Western societies, similar studies have not been conducted in Middle-Eastern countries where cultural norms and traditions may differ. The main objective of this study was to determine the risk factors for postpartum depression (PPD) and its relationship to mother −infant bonding in a Lebanese population.MethodsOne hundred and fifty participants were administered the Edinburgh Postpartum Depression Scale (EPDS), and the social support scale at 2–3 days postpartum. At 10–12 weeks mother–infant bonding using the Postpartum Bonding Questionnaire (PBQ) and depression using the Beck Inventory (BDI-II) were assessed during a telephone interview.ResultsThe prevalence of depression was 19% with an average score of 10.9 ± 6.02 on the EPDS. At 10–12 weeks 2.7% of the whole sample was depressed with an average score of 18.60 ± 16.87 on the BDI-II. Risk factors of PPD on the EPDS were; history of alcohol use, complications during pregnancy, not a good marital relationship, baby admitted to an intensive care unit, history of depression and low social support. Risk factors for impaired bonding were age, history of depression, BDI-II scores above 20 and low social support. The multiple regression analysis found that impaired bonding was associated with older age, history of depression and low social support, which explained 39% of the variance, F = 7.12, p = 0.02.ConclusionThe prevalence of PPD was higher than previously reported at day 2–3 post-delivery, but lower at 10–12 weeks postpartum. Impaired mother- infant bonding was associated older mothers, history of depression, low social support and BDI-II scores above 20 which should alert practitioner to assessing these factors in post-partum mothers.     

Interactive coordination of currently depressed inpatient mothers and their infants during the postpartum period

In healthy mother–infant dyads, interactions are characterized by a pattern of matching and mismatching interactive states with quick reparation of mismatches into matches. In contrast, dyads in which mothers have postpartum depression show impaired mother–infant interaction patterns over the first few months of the infant's life. The majority of studies that have examined such interaction patterns have drawn on community samples rather than on depressed inpatient samples of mothers who were in a state of current depression at the time of assessment. To date, no study has investigated specific microanalytic patterns of interactive coordination between depressed German mothers and their infants using the Face‐to‐Face Still‐Face paradigm (FFSF). The primary goal of this study was to evaluate specific patterns of dyadic coordination and the capacity for repairing states of miscoordination in an inpatient sample of postpartum currently depressed mothers and their infants as compared with a healthy control group. A sample of 28 depressed inpatient German mothers and their infants (age range = 1–8 months, M age = 4.06 months) and 34 healthy dyads (range = 1–8 months, M age = 3.89 months) were videotaped while engaging in the FFSF. A focus was placed on the play and reunion episodes. Compared with healthy dyads, dyads with depressed mothers showed less coordination of positive matched states and longer latencies when repairing interactive mismatching states into positive matched states. Clinical implications are discussed.