Associations between symptoms of maternal postpartum depression,gestational age and infant social withdrawal: A longitudinal study in a community cohort

Infant social withdrawal is a risk factor for non-optimal child development; thus, it is important to identify risk factors associated with withdrawal. In a large community sample (N = 19,017), we investigate whether symptoms of maternal and partner postpartum depression (PPD; measured with the Edinburgh Postnatal Depression Scale) and prematurity are predictors of infant social withdrawal (measured with the Alarm Distress Baby Scale). Withdrawal was assessed at 2–3, 4–7 and 8–12 months postpartum. Linear regressions showed that prematurity predicted higher infant social withdrawal at all time points, and maternal symptoms of PPD were positively associated with withdrawal at 2–3 months. Logistic regressions showed that odds for elevated social withdrawal were increased with elevated levels of maternal symptoms of PPD at 2–3 and 8–12 months. Partner's symptoms of PPD were not associated with withdrawal. Future studies should investigate how PPD symptoms and prematurity may impact the individual development of social withdrawal.     

Effects of maternal postpartum depression in a well‐resourced sample: Early concurrent and long‐term effects on infant cognitive,language, and motor development

This study examined early and long‐term effects of maternal postpartum depression on cognitive, language, and motor development in infants of clinically depressed mothers. Participants were 83 mothers and their full‐term born children from the urban region of Copenhagen, Denmark. Of this group, 28 mothers were diagnosed with postnatal depression three to four months postpartum in a diagnostic interview. Cognitive, language, and motor development was assessed with the Bayley Scales of Infant and Toddler Development third edition, when the infants were 4 and 13 months of age. We found that maternal postpartum depression was associated with poorer cognitive development at infant age four months, the effect size being large (Cohen's d = 0.8) and with similar effects for boys and girls. At 13 months of age infants of clinical mothers did not differ from infants of non‐clinical mothers. At this time most (79%) of the clinical mothers were no longer, or not again, depressed. These results may indicate that maternal depression can have an acute, concurrent effect on infant cognitive development as early as at four months postpartum. At the same time, in the absence of other risk factors, this effect may not be enduring. The main weaknesses of the study include the relatively small sample size and that depression scores were only available for 35 of the non‐clinical mothers at 13 months.     

Maternal substance use and mother–infant feeding interactions

The purpose of this study was to examine the impact of maternal polydrug cocaine use during pregnancy and associated risk factors such as maternal psychopathology and negative infant temperament on the quality of mother–infant feeding interactions at 2 months of infant age. Participants were 45 mother–infant dyads (19 cocaine‐exposed and 26 nonexposed) who were recruited at birth and assessed again 2 months of infant age. Mother–infant interactions during feeding were videotaped and coded with regard to dyadic reciprocity, maternal noncontingency, and dyadic conflict. Results indicated that maternal cocaine use was associated with higher dyadic conflict. Moreover, cocaine‐using mothers were also more likely to use marijuana and alcohol, and use of such substances was associated with lower dyadic reciprocity and higher maternal noncontingency during interactions. Results also suggested that one pathway to higher dyadic conflict during interactions among cocaine‐using mothers was through the impact of cocaine on infant risk conditions like lower gestational age and negative temperament (e.g., higher distress to novelty). Interventions focusing on promoting the quality of mother–infant interactions in combination with substance abuse treatment may be especially promising for this population. ©2001 Michigan Association for Infant Mental Health.     

Early manifestations of childhood depression: influences of infant temperament and parental depressive symptoms

In this longitudinal study, 83 parents of infants between 3 and 12 months completed questionnaires assessing demographic information, infant temperament, and maternal depression. When these children were at least 18 months of age, parents completed follow‐up questionnaires assessing toddler temperament and depression‐like symptoms. We were primarily interested in the contributions of infant temperament and maternal depression to toddler depressive problems, and the analytic strategy involved controlling for toddler temperament in order to isolate the influence of infancy characteristics. The findings indicated that lower levels of infant regulatory capacity and greater severity of maternal depression were predictive of toddler depression‐like symptoms. Moderator effects of infant temperament were also examined, with the negative affectivity * maternal depression interaction emerging as significant. Follow‐up analyses indicated that the risk for early manifestations of depression was attenuated for children with lower negative affectivity in infancy and parents who reported lower levels of their own depressive symptoms; conversely, children exhibiting higher infant negative emotionality had higher levels of depression‐like symptoms as toddlers, regardless of their parents' level of depression. The present findings further suggest that parental depressive symptoms need not be ‘clinically significant’ to predict toddler affective problems. Copyright © 2008 John Wiley & Sons, Ltd.     

Perinatal maternal mental health and infant socio-emotional development: A growth curve analysis using the MPEWS cohort

Pregnancy and the early post partum period are widely understood as a critical period for the infant’s emotional development and the earliest influence shaping social interaction. The present study aims to understand the potential influence of both antenatal and postnatal maternal anxiety and depressive symptoms on socio-emotional outcomes in offspring aged 12 months. The study used longitudinal data from a prospective cohort study on Australian pregnant women and their children. Data were available for 282 mothers and their children. Maternal depressive and anxiety symptoms were measured in early pregnancy, trimester three of pregnancy, six and 12 months postpartum. Social and emotional development in children was measured using the Brief Infant and Toddler Social Emotional Assessment (BITSEA) at 12 months. Using growth curve analysis of 4 waves of repeated measurement to examine intercept and slope, we found that both initial maternal depression and anxiety symptom levels, and the growth of these symptoms over time, predicted more problems with children’s social and emotional development. In the final model anxiety accounted for 19% of the variance in child socio-emotional problems and depression 23% of variance. The results emphasise the importance of perinatal maternal mental health as a potential risk factor for child development. This carries important implications for policy development, such as the need to build early identification and early intervention models in to the current clinical practice for perinatal care, specifically, to develop targeted screening, assessment and interventions to address maternal mental health issues for at-risk parents during pregnancy, and continuing monitoring of young children whose mothers have experienced perinatal mental health difficulties.     

The mediating role of maternal responsiveness in some longer term effects of postnatal depression on infant development

We hypothesized a mediating role for low maternal responsiveness in certain child developmental deficits found previously to be associated with postnatal depression. Forty depressed inpatients and 48 control (non-depressed) mothers and their infants were followed until 42 months postpartum. Mother–infant interactions were impaired at 6 months postpartum in the depressed group. Subsequent cognitive deficits were found in children's Full Scale IQ on the Wechsler Preschool Primary Scale of Intelligence (Revised) at 42 months of age. Statistical modeling of the mediation hypothesis confirmed that these effects were overwhelmingly explained by lowered maternal responsiveness at 6 months. Similarly, increased temperamental difficulties were apparent in children of depressed mothers but were not correlated with maternal responsiveness. Male infants of depressed mothers were disproportionately vulnerable (compared to females) to impaired cognitive abilities associated with maternal depression. The data concur with previous work and provide empirical support for the theoretical prediction that early disturbances of the mother–infant interaction will mediate some developmental deficits in the children of depressed mothers.     

Influence of in utero exposure to maternal depression and natural disaster-related stress on infant temperament at 6 months: The children of Superstorm Sandy

This study examined the effects of in utero exposure to maternal depression and Superstorm Sandy, a hurricane that hit metropolitan New York in 2012, on infant temperament at 6 months. Temperament was assessed using the Infant Behavior Questionnaire-Revised. Maternal depression was measured by the Edinburgh Postnatal Depression Scale. The main effects and the interaction of maternal depression and Sandy exposure on infant temperament were examined using a multivariable generalized linear model. Results show that prenatal maternal depression was associated with lower emotion regulation and greater distress. Stratification and interaction analyses suggested that the adverse effects of prenatal maternal depression on problematic temperament were amplified by in utero Sandy exposure. This study underscores the importance of providing prenatal screening and treatment for maternal depression during pregnancy while also identifying high-risk families who may have suffered from disaster-related traumas to provide necessary services. As the frequency of natural disasters may increase due to climate change, it is important to understand the consequences of in utero stress on child development and to formulate plans for early identification.     

Maternal pre‐ and postnatal anxiety and infant temperament. The generation R study

The aim of this study was to investigate whether maternal anxiety that is temporary or chronic during the pre‐ and postnatal period predicts infant temperament. Mothers of 2997 infants in a population‐based birth cohort reported levels of pregnancy‐specific anxiety (Pregnancy Outcome Questionnaire) and general anxiety symptoms (Brief Symptom Inventory) prenatal and at 6 months postnatal. Temperament characteristics were assessed by maternal report using the Infant Behavior Questionnaire—Revised when the infants were 6 months of age. Maternal pregnancy‐specific and general anxiety during the pre‐ and postnatal period were all independently associated with perceived infant temperamental difficulties. Chronically high maternal anxiety predicted the highest perceived infant activity level and negative affectivity. These findings show that different forms of maternal anxiety during both the pre‐ and postnatal period are independently related to perceived temperamental problems in infancy. They also emphasize the significance of chronic maternal anxiety for infant mental health. Copyright © 2009 John Wiley & Sons, Ltd.     

Stability of maternal postnatal bonding between 3 and 6 months: Associations with maternal mental health and infant temperament

Maternal bonding is key for infant development and well-being. Research to date focused on prenatal bonding experience, with fewer studies looking at the postnatal period. Moreover, evidence suggests significant associations among maternal bonding, maternal mental health, and infant temperament. The joint impact of maternal mental health and infant temperament on maternal postnatal bonding remains unclear, with limited research reporting longitudinal data. Hence, the present study aims (1) to explore the impact of maternal mental health and infant temperament on postnatal bonding at both 3 and 6 months of age, (2) to explore postnatal bonding stability from 3 to 6 months, and (3) to determine which factors are linked with 3-to-6-month changes in bonding. At the infants' 3 months (n = 261) and 6 months of age (n = 217), mothers provided measures of bonding, depressive and anxious symptoms, and infant temperament via validated questionnaires. At 3 months, higher levels of maternal bonding were predicted by lower levels of anxiety and depression in the mothers and by higher infants' regulation scores. At 6 months, lower levels of anxiety and depression predicted higher levels of bonding. Moreover, mothers showing decreases in bonding were characterized by 3-to-6-month increases in depression and anxiety, as well as increased reported difficulties in regulation dimensions of infant temperament. This study highlights the impact of both maternal mental health and infant temperament on maternal postnatal bonding in a longitudinal sample and could offer useful information for early childhood prevention and care.     

Postnatal maternal symptoms of depression and child emotion dysregulation: The mediation role of infant EEG alpha asymmetry

In a community-based sample of 104 infants and their mothers, we hypothesized a pathway from postnatal maternal symptoms of depression to child emotion dysregulation, and tested at 6 months of age the mediation role of alpha asymmetry at frontal and parietal sites. We recorded infant resting-state EEG at 6 months of age. Child emotion dysregulation was measured at 24 months by the Child Behavior Checklist Dysregulation Profile derived from the CBCL 1½-5. Maternal depression symptoms were scored 6 months after the delivery by the Anxious/Depressed scale of the Adult Self-Report. We used structural equation modeling to test the mediation model from maternal depression symptoms to child emotion dysregulation mediated by frontal and parietal alpha asymmetry. The mediation model provided an excellent fit to the data [χ2(3) = 3.088, p = .378; RMSEA = .017, CFI = .1.00; SRMR = 0.040] and explained 23.3% of the variance in child emotion dysregulation. The indirect path via parietal alpha asymmetry was significant (β = .065; SE = .033; 95% CI = .001–.139; p = .048), i.e. greater levels of maternal depression symptoms predicted left parietal alpha asymmetry, which predicted higher levels of child emotion dysregulation. The direct effect, i.e. the pathway linking maternal depression symptoms and child emotion dysregulation above and beyond the indirect effects, was also significant. We found evidence for a partial mediation role of left parietal alpha asymmetry in a longitudinal pathway from postnatal maternal symptoms of depression to child emotion dysregulation, providing support for left parietal asymmetry as an index of biological vulnerability to emotion dysregulation in the first years of life.     

Maternal postnatal psychiatric symptoms and infant temperament affect early mother-infant bonding

Postnatal mother-infant bonding refers to the early emotional bond between mothers and infants. Although some factors, such as maternal mental health, especially postnatal depression, have been considered in relation to mother-infant bonding, few studies have investigated the role of infant temperament traits in early bonding. In this study, the effects of maternal postnatal depressive and anxiety symptoms and infant temperament traits on mother-infant bonding were examined using both mother and father reports of infant temperament. Data for this study came from the first phase of the FinnBrain Birth Cohort Study (n = 102, father reports n = 62). After controlling for maternal symptoms of depression and anxiety, mother-reported infant positive emotionality, measured by infant smiling was related to better mother-infant bonding. In contrast, infant negative emotionality, measured by infant distress to limitations was related to lower quality of bonding. In regards to father-report infant temperament, only infant distress to limitations (i.e., frustration/anger) was associated with lower quality of mother-infant bonding. These findings underline the importance of infant temperament as one factor contributing to early parent-infant relationships, and counseling parents in understanding and caring for infants with different temperament traits.     

Affect expression in prenatally psychotropic exposed and nonexposed mother–infant dyads

This prospective study examined infant, maternal, and dyadic affective profiles at three months postpartum in infant–mother dyads that were exposed to psychotropic medications in utero compared with nonexposed control dyads. Control dyads of nondepressed mothers and their infants showed many similarities in affect expression with mother–infant dyads who were exposed to selective serotonin reuptake inhibitors (SSRIs) alone for treatment of maternal depression. In contrast, mothers who received SSRIs and Rivotril (Benzodiazepine derivative) for treatment of depression and anxiety expressed both positive and negative affect towards their infants. Clinical implications regarding use of psychotropic medications such as SSRIs alone or in combination with other drugs for treatment of maternal anxiety and depression during pregnancy are discussed. Clinicians should be aware of the possible differential response in maternal–infant interaction in a mixed diagnosis group (i.e., depression and anxiety) regarding infant temperament, possibly suggesting latent behavioral teratogenicity with psychotropics. ©2002 Michigan Association for Infant Mental Health.     

Perceived mother‐infant relationship difficulties in postnatal depression

Postnatal depression has been associated with mother–infant relationship difficulties, but there has been less research in clinical populations. This study aims to identify characteristics of reported mother–infant relationship difficulties in mothers with postnatal depression who had been referred to a tertiary Mother and Baby Service. Forty‐one mothers with postnatal depression completed self‐report and interview measures with regards to their mental state, social adversity, and perceptions on their relationship with their infants. Almost one‐third of mothers (31.7%) reported severe difficulties, including rejection of the infant and maternal pathological anger. A low birth weight and maternal dissatisfaction towards their social role were found to be significantly related to perceived mother–infant interaction difficulties. Self‐reports correlated satisfactorily with interview schedules. A significant proportion of mothers reported difficulties in relating to their infants which can be reliably identified by means of the self‐report measures used. Copyright © 2004 John Wiley & Sons, Ltd.     

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.     

Infant sleep moderates the effect of infant temperament on maternal depressive symptoms,maternal sensitivity,and family functioning

Observed infant temperamental difficulty and infant sleep efficiency and sleep variability were examined as predictors of maternal depressive symptoms, maternal sensitivity, and family functioning. Eight observations at 8-months postpartum were used to assess infant temperament, and actigraphy was used to measure infant sleep for 1-week at the time of the 8-month assessment. Structured clinical interviews were used to assess maternal depressive symptoms between 5 and 12 months postpartum and at 15 months postpartum, and observational assessments were used to assess maternal sensitivity and family functioning at 15 months postpartum. Variability in infant sleep moderated the effect of infant temperament on maternal depressive symptoms, maternal sensitivity, and family functioning. Infant temperament was positively associated with maternal depressive symptoms when variability in infant sleep efficiency was high, but not when variability in infant sleep efficiency was low. Likewise, infant temperament was negatively associated with maternal sensitivity and family functioning when variability in infant sleep efficiency was high, but not when variability in infant sleep efficiency was low. Results underscore the importance of infant sleep for maternal and family health.     

Maternal depression and dyadic interaction: the role of maternal attachment style

Maternal mental health and the contents of her representational world are important determinants of early parent–child relationship. We examined, first, the role of prenatal and postnatal depressive symptoms and maternal attachment style in predicting the quality of mother–child interaction. Second, we analysed whether the secure‐autonomous attachment style can protect the dyadic interaction from the negative effects of maternal depression. The participants were 59 mother–infant pairs examined during pregnancy (T1), 4–5 months postpartum (T2) and when the children were approximately 14 months old (T3). Maternal attachment style was assessed with a modified Adult Attachment Interview ‐procedure, depressive symptoms with Edinburgh Postnatal Depression Scale, and observed mother–child interaction with Care Index. The results show that autonomous mothers were more sensitive and responsive and their children more co‐operative than dyads with dismissing maternal attachment style. As hypothesized, mothers with the combination of both prenatal and postpartum depressive symptoms were highly unresponsive in their dyadic interaction. Further, prenatal depressive symptoms had a stronger impact on maternal unresponsiveness than postnatal symptoms. As hypothesized, mother's autonomous attachment style protected the mother–child interaction from the negative impact of maternal postnatal depressive symptoms, whereas dyads with preoccupied mothers were especially at risk for interaction problems when mothers had postpartum depressive symptoms. Copyright © 2010 John Wiley & Sons, Ltd.     

Chronicity and severity of maternal postpartum depression and infant sleep disorders: a population-based cohort study in southern Brazil

A cohort study was conducted with 397 women randomly selected from the Brazilian National System of Public Health, to describe the prevalence rates of infant sleep problems at 12-month of life, and its association with chronicity and severity of maternal depressive symptoms. Mothers were assessed, first, from the 9th to the 12th week postpartum and then at 12 months after delivery, with EPDS and a self-rating questionnaire regarding babies’ sleep behavior. After controlling for possible confounders, babies whose mothers had severe chronic depressive symptoms were at higher risk for sleep disorder at 12 months of birth.     

Predicting maternal reactivity/sensitivity: The role of infant emotionality,maternal depressiveness/anxiety,and social support

It was hypothesized that an accumulation of unfavorable conditions, i.e., high negative emotionality and low positive emotionality of the infant, maternal depression and anxiety, and lacking social and emotional support can attenuate mothers' reactivity/sensitivity. Maternal reactivity/sensitivity was observed during home visits and in the laboratory. Infant negative and positive emotionality was assessed by mother reports and behavioral observations. Maternal depressiveness/anxiety as well as social support were assessed via questionnaires. All mothers were primiparous and had healthy infants. Data collection was conducted at the infants' ages of four months (37 dyads) and eight months (33 dyads). The sample consisted of 19 male and 18 female infants (four‐months' measurement). Whereas the presence of a single risk factor was not related to maternal reactivity/sensitivity, the combination was. A decrease in maternal reactivity/sensitivity over the course of time was demonstrated for mothers who had to deal with high negative emotionality of the infant in combination with either high depressiveness/anxiety or low social support at the infants' age of four months. No significant main or interaction effects could be shown for infant positive emotionality. ©2004 Michigan Association for Infant Mental Health.     

The association of paternal mood and infant temperament: A pilot study

Maternal depression is associated with adverse child development, but little is known about the effects of paternal depression. This pilot study estimated the prevalence of paternal depression and mood state, and assessed the relationship between paternal mood and infant temperament. The participants in the study were 98 fathers of newborn babies. Fathers were initially screened for depressed mood (Hospital anxiety and depression scale, and Edinburgh postnatal depression scale), and at 6 months parental mood, infant temperament, couple relationship quality, alcohol use, adverse life events, parenting, and demographics were recorded. Infant fussiness was analysed in relation to paternal mood and other contextual factors using multiple regression. Of the 98 fathers, 48 (49%) completed depression-screening measures. Of these 48 fathers, 4 (8%) reported depressive symptoms above the cut-off for case definition. A total of 48% (N=19) completed measures at follow-up. In the adjusted model, higher paternal depression scores, more traditional attitudes towards fathering, and increased recent life events were related to higher infant fussiness scores; and better couple relationship quality was related to lower fussiness scores. This study showed that 1 in 12 fathers had depressed mood, and lower mood was associated with negative infant temperament. Since the findings of this feasibility study were based on a small sample size the association of paternal mood and child development merits further study using a larger sample of fathers.