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.     

Well-being in major depression and social phobia with and without comorbidity

Background/Objective: Lower levels in well-being have been observed in individuals with Major Depression (MDD) and Social Phobia (SP), but well-planned direct comparisons with control individuals, not suffering from a mental disorder, are lacking. Furthermore, MDD is highly comorbid with anxiety disorders, and SP with depressive disorders. This study is among the first to examine differences in well-being in individuals with a clinical diagnosis of MDD or SP compared to individuals with no such diagnosis and to test differences in well-being within the combined diagnostic categories respective with and without anxiety-depressive comorbidity. Method: Participants were 119 individuals with a diagnosis of MDD, 47 SP and 118 controls. Results: Results revealed that overall well-being as well as emotional, psychological, and social well-being were lower in the MDD and SP group compared to the control group. Individuals with comorbidity reported lower well-being than individuals without comorbidity. Conclusions: These findings have clinical implications as presence of comorbidity may require a different therapeutic approach than with no comorbidity.     

Suicide Attempts in Major Depressed Patients with Personality Disorder

Suicide attempters who met criteria for borderline personality disorder (BPD) comorbid with major depressive disorder (MDD) were compared to both suicide attempters suffering from MDD alone and to attempters with comorbid MDD and other personality disorders (PD). Participants were 239 (158 patients with comorbid PD and 81 patients with MDD without comorbidity) inpatients consecutively admitted after a suicide attempt made in the last 24 hours. Suicide attempters with comorbid MDD and BPD had more frequent previous suicide attempts and were more likely to have a history of aggressive behaviors and alcohol and drug use disorders compared with patients suffering from MDD without Axis II comorbidity.     

Comorbidity of unipolar depression: I. Major depression with dysthymia

The degree of current and lifetime comorbidity between major depressive disorder (MDD) and dysthymia (DY) was examined in large community samples of older adolescents (n = 1,710) and adults (n = 2,060). DY was highly comorbid with MDD (lifetime odds ratio of 3.4 for adolescents and 1.6 for adults) and was more likely to precede than to follow MDD, especially in persons who became depressed early in life. MDD was by far the more frequent form of depression: Approximately 80% of the depressed persons experienced only MDD, 10% experienced only DY, and 10% experienced both MDD and DY. The large number of persons who had became depressed twice experienced MDD in the 2nd episode, regardless of the nature of the 1st depression. History of depression was associated with a greater probability for other mental disorders in both adolescents and adults; however, the rates of comorbidity for MDD did not differ from rates for DY or for both MDD and DY.     

Confounding of Big Five Personality Assessments in Emotional Disorders by Comorbidity and Current Disorder

Foremost cross‐sectional studies of personality in common mental disorders show similar Big Five trait profiles [i.e. high neuroticism (N), low conscientiousness (C) and low extraversion (E)]. It remains undecided whether this lack of distinct personality profiles is partly due to comorbidity among disorders or contamination by current state. Using data from the Netherlands Study of Depression and Anxiety, we investigated 1046 participants with panic disorder (PD), social anxiety disorder (SAD) and/or major depressive disorder (MDD) and 474 healthy controls. Personality traits at baseline and two‐year follow‐up were assessed with the NEO‐Five Factor Inventory. The Composite International Diagnostic Interview was used to determine the presence of emotional disorders at baseline and at two‐year follow‐up; the Life Chart Interview determined symptom severity in the month prior to baseline and during follow‐up. By analysing pure cases and investigating the effects in remitted cases, PD participants were found to be higher in N, but not lower in E and C than controls. Pure PD participants were also lower in N and higher in E than SAD and MDD participants. Both SAD and MDD participants were characterized by high levels of N and low levels of E, irrespective of comorbidity or current disorder state. Future studies should be more attentive to confounding of personality profiles by comorbidity and state effects. Copyright © 2012 John Wiley & Sons, Ltd.     

The impact of parental borderline personality disorder on vulnerability to depression in children of affectively ill parents

Children of parents with major depressive disorder (MDD) are four to six times more likely than other children to develop MDD. Little research has examined whether comorbid parental diagnoses further increase children's risk. This study examines whether children of parents with comorbid MDD and Borderline Personality Disorder (BPD) (1) are at greater risk for experiencing depressive symptoms and/or episodes and (2) whether such increased risk may be due, in part, to their exhibiting higher levels of cognitive/interpersonal vulnerability factors. Children (n = 140; ages 6-14) of parents with MDD completed measures assessing cognitive/interpersonal vulnerability factors. Parents completed semi-structured clinical interviews assessing severity of current depressive symptoms and BPD. Both children and parents completed a semi-structured clinical interview assessing the child's current and past history of MDD. Children of parents with comorbid MDD and BPD exhibited higher levels of current depressive symptoms and higher levels of cognitive/interpersonal vulnerability factors than children of parents with MDD but no BPD, even after controlling for parents' current levels of depressive symptoms. The relationship between parental BPD and chil-dren's current levels of depressive symptoms was partially mediated by children's cognitive/interpersonal vulnerability factors. Last, children of parents with comorbid BPD and MDD were 6.84 times more likely to exhibit a current or past diagnosis of MDD.     

What lies behind postnatal depression: is it only a mood disorder?

Postnatal depression (PND) is a common condition that has been extensively researched specifically because of its negative impact on the mother-infant relationship. Psychiatric research has looked at comorbidity of major depressive disorder and found it to be strongly associated with Axis II disorders. This study's principal aim was to investigate whether there is a greater incidence of personality disorder (PD) among a PND population than among a non-PND population at 3 months postpartum. A secondary aim was to define the different types of PD. Depression was assessed with the Montgomery and Asberg Depression Rating Scale (MADRS), and PD was assessed with the Structured Interview for DSM-IV Personality Disorders (SIDP-IV) in 109 women with their 12-week-old infants. Twice as many depressed mothers had PD. The PND group presented a greater number of severe clinical symptoms than the nondepressed group (p < .002). Further research is necessary to reexamine the heterogeneity of PND and reassess its impact on infant development.     

Happy faces are habituated more slowly by infants of depressed mothers

Three-month-old infants of depressed (n=16) and non-depressed mothers (n=16) were habituated to video clips of a female model reciting phrases while posing happy or sad facial/vocal expressions and dishabituated to the alternate expressions. Overall, infants of depressed mothers took longer to habituate the video clips compared to infants of non-depressed mothers, and those assigned to habituate the sad video clips displayed a novelty response or dishabituated to the happy expressions. These findings suggest that 3-month-old infants of depressed mothers discriminate sad from happy expressions, however, they do not appear to perceive sad expressions as novel.     

Examining Safety Behavior Subtypes Across Distinct Social Contexts in Social Anxiety Disorder and Major Depression

People with social anxiety disorder (SAD) use different types of safety behaviors that have been classified as avoidance vs. impression management. The current study investigated differences in safety behavior subtype use in 132 individuals with principal diagnoses of social anxiety disorder (SAD, n = 69), major depressive disorder (MDD, n = 30), and nonpatient controls (n = 33) across two social contexts: an interpersonal relationship-building task (social affiliation) and a speech task (social performance). We examined whether diagnostic groups differed in safety behavior subtype use and whether group differences varied by social context. We also explored relationships between avoidance and impression management safety behaviors, respectively, and positive and negative valence affective and behavioral outcomes within the social affiliation and social performance contexts. Safety behavior use varied by diagnosis (SAD > MDD > nonpatient controls). The effect of diagnosis on impression management safety behavior use depended on social context: use was comparable for the principal SAD and MDD groups in the social performance context, whereas the SAD group used more impression management safety behaviors than the MDD group in the social affiliation context. Greater use of avoidance safety behaviors related to higher negative affect and anxious behaviors, and lower positive affect and approach behaviors across contexts. Impression management safety behaviors were most strongly associated with higher positive affect and approach behaviors within the social performance context. These findings underscore the potential value of assessing safety behavior subtypes across different contexts and within major depression, in addition to SAD.     

Influence of maternal depression on children's brooding rumination: Moderation by CRHR1 TAT haplotype

There is growing evidence that brooding rumination plays a key role in the intergenerational transmission of major depressive disorder (MDD) and may be an endophenotype for depression risk. However, less is known about the mechanisms underlying this role. Therefore, the goal of the current study was to examine levels of brooding in children of mothers with a history of MDD (n = 129) compared to children of never depressed mothers (n = 126) and to determine whether the variation in a gene known to influence hypothalamic-pituitary-adrenal axis functioning—corticotropin-releasing hormone receptor 1 (CRHR1) —would moderate the link between maternal MDD and children's levels of brooding. We predicted children of mothers with a history of MDD would exhibit higher levels of brooding than children of mothers with no lifetime depression history but that this link would be stronger among children carrying no copies of the protective CRHR1 TAT haplotype. Our results supported these hypotheses and suggest that the development of brooding among children of depressed mothers, particularly children without the protective CRHR1 haplotype, may serve as an important mechanism of risk for the intergenerational transmission of depression.     

Perseverative thought: a robust predictor of response to emotional challenge in generalized anxiety disorder and major depressive disorder

Generalized anxiety disorder (GAD) and major depressive disorder (MDD) frequently co-occur, yet the reasons for their comorbidity remain poorly understood. In the present experiment, we tested whether a tendency to engage in negative, repetitive thinking constitutes a common risk process for the two disorders. A mixed sample of adults with comorbid GAD–MDD (n = 50), GAD only (n = 35), MDD only (n = 34), or no lifetime psychopathology (n = 35) was administered noncontingent failure and success feedback on consecutive performance tasks. Perseverative thought (PT), measured by negative thought intrusions during a baseline period of focused breathing, emerged as a powerful prospective predictor of responses to this experimental challenge. Participants reporting more frequent negative thought intrusions at baseline, irrespective of thought content or diagnostic status, exhibited a stronger negative response to failure that persisted even after subsequent success. Higher PT over the course of the experiment was associated with later behavioral avoidance, with negative affect and other traits closely linked to anxiety and depression, and with the presence and severity of GAD and MDD. These findings provide evidence for a broadly-defined PT trait that is shared by GAD and MDD and contributes to adverse outcomes in these disorders.     

Axis I and axis II disorders as predictors of prospective suicide attempts: findings from the collaborative longitudinal personality disorders study

This study examined diagnostic predictors of prospectively observed suicide attempts in a personality disorder (PD) sample. During 2 years of follow-up, 58 participants (9%) reported at least 1 definitive suicide attempt. Predictors that were examined include 4 PD diagnoses and selected Axis I diagnoses (baseline and course). Multivariate logistic regression analyses indicated that baseline borderline personality disorder (BPD) and drug use disorders significantly predicted prospective suicide attempts. Controlling for baseline BPD diagnosis, proportional hazards analyses showed that worsening in the course of major depressive disorder (MDD) and of substance use disorders in the month preceding the attempt were also significant predictors. Therefore, among individuals diagnosed with PDs. exacerbation of Axis I conditions, particularly MDD and substance use, heightens risk for a suicide attempt.     

Heightened subjective experience of depression in borderline personality disorder

Despite the frequent comorbidity of major depression and borderline personality disorder (BPD), limited research has examined what effect this comorbidity has on the severity, course, and presentation of depression. The purpose of this study was to examine whether the severity of major depressive disorder (MDD) in the context of comorbid borderline personality disorder (BPD) differs from MDD when comorbid BPD is not present and to determine whether different measures of depression yield convergent findings. Sixty patients diagnosed with DSM-IV MDD participated in this study. Twenty-nine were diagnosed with DSM-IV BPD, while the remaining 31 had no Axis II diagnosis. Depression was evaluated with both clinician (Hamilton Rating Scale for Depression) and self-report (Beck Depression Inventory) ratings. While the two groups were rated as similarly depressed by clinicians on the overall rating and the factor scores, the MDD/BPD group reported more severe depressive symptoms on the self-report measure. This difference was significant even after controlling for clinician-rated severity. Gender interacted with diagnosis, males in the BPD group showed the largest discrepancies between clinician ratings and self-reports. Posthoc analyses of HDRS factors with the BDI showed that the clinicianrated cognitive disturbance and retardation factors were correlated with self-rated severity overall. Within subgroups, only the retardation factor was correlated with the BDI. Our results suggest that while depressed individuals with and without BPD may be rated as similarly depressed when assessed with objective rating methods, the subjective experience of the depression may be rated as more intense or severe by patients with comorbid BPD. The mechanism underlying this effect remains unknown, and requires further research.     

The beginning of conversation: Early patterns of mother-infant vocal responsiveness

Microanalytic techniques were used to characterize the structure of the prespeech communication of 4-month-old infants and their mothers. Two observers continuously recorded the interactive behavior of mothers and their infants during hour-long observations in the homes of 25 families. Loglinear models were used to examine the extent to which the vocal behavior of one person was conditional upon the vocal behavior of the partner. Within the limits of this microanalytic approach, analyses indicated that patterns of mother-infant vocal exchange were structurally similar to patterns of adult conversation. Initial vocal responses were followed by suppression of vocalization, allowing the partner to join the conversation. The comparative effectiveness of vocal behavior as an elicitor of vocalization and as a response to vocalization was shown for mothers and infants relative to the other behaviors observed. Vocalization served as a modulator of visual attentiveness: When the partner was not visually attentive, vocalization elicited visual attention.     

Does personality disorder co-morbidity impact treatment outcome for patients with major depression? A multi-level analysis

In literature, there exists disagreement regarding the impact of comorbid personality disorder(s) (PD[s]) on treatment outcome for patients with major depressive disorder (MDD). The aim of this paper was to investigate whether statistical heterogeneity and inter-dependency are potential moderators of the effect of co-morbid PDs on outcome for patients with MDD. Clinician-rated MADRS scores and DSM-IV Axis II personality disorder diagnoses were obtained from 562 outpatients with MDD who received 6 months of combined psycho- and pharmacotherapy. Single-level regression showed significantly worse treatment outcome among patients with co-morbid PD, as compared to patients with no PD. After controlling for statistical heterogeneity and interdependency, treatment outcome was no longer significantly worse for patients with co-morbid PD. In conclusion, heteroscedasticity and inter-dependency should be considered as potentially compelling explanations for inconsistencies in findings on treatment outcome for depressed patients with co-morbid PDs.     

First onset versus recurrence of depression: differential processes of psychosocial risk.

Differential risk factors for the onset of depression were prospectively examined in a community-based sample of adolescents (N = 1,709), some of whom had a history of major depressive disorder (MDD; n = 286) and some of whom did not (n = 1,423). From the theories of J. Teasdale (1983, 1988) and R. Post (1992) concerning the etiology of initial versus recurrent episodes of depression, the authors hypothesized that (a) dysphoric mood and dysfunctional thinking styles would be correlated more highly among those with a previous history of MDD than among those without a history of MDD; (b) dysphoric mood or symptoms and dysfunctional thinking would be a stronger predictor of onset of recurrent episodes (n = 43) than of first onsets (n = 70); and (c) major life stress would be a stronger predictor of first onsets of MDD than of recurrent episodes. The results provide support for the 3 hypotheses and suggest that distinct processes are involved in the onset of first and recurrent episodes of MDD.     

The disturbed caregiving system: Relations among childhood trauma,maternal caregiving,and infant affect and attachment

The interrelations among maternal childhood experiences of physical or sexual abuse, adult trauma-related symptoms, adult caregiving behavior, and infant affect and attachment were investigated among 45 low-income mothers and their 18-month-old infants. A history of physical abuse was associated with increased hostile-intrusive behavior toward the infant, increased infant negative affect, and a decreased tendency to report trauma-related symptoms. A history of sexual abuse was associated with decreased involvement with the infant, more restricted maternal affect, and more active reporting of trauma-related symptoms. Infants of mothers who had experienced childhood violence or abuse were not more likely to display insecure attachment strategies than infants of mothers who had not experienced trauma. However, the form of insecure behavior was significantly different. Insecure infants of violence-exposed mothers displayed predominantly disorganized strategies, whereas insecure infants of mothers with benign childhoods or neglect only displayed predominantly avoidant strategies. Results are discussed in relation to Main and Hesse's (1990) concept of frightened or frightening behavior and to current literature on psychological sequelae of trauma.     

Maternal soothing and infant stress responses: soothing, crying and adrenocortical activity during inoculation

The relation between maternal soothing and infant stress response during inoculation was examined in a sample of 37 mothers and their 3-month-old infants. The mothers' soothing and the infants' cry vocalizations and the mothers' and the infants' salivary cortisol level pre- and post-injection were analysed. There was a positive relation between infants' cry vocalization post-injection and maternal soothing pre- and post-injection. The sample was divided in two sub-groups depending on whether the mothers evidenced most soothing of the infants in the period before (Preparatory group; n=20) or after (Contingent group; n=17) the syringe injection. In the Preparatory group, the duration of infant cry vocalizations was related to amount of maternal soothing before and after the injection, while cry vocalizations in the Contingent group was related to amount of maternal soothing after the injection. The Contingent infants responded to the injection with a significant increase in cortisol, while there was no increase in the Preparatory infants. The Preparatory infants evidenced significantly longer duration of looking at the target stimuli in a visual marking task, suggesting greater difficulties in disengaging attention. These findings indicate that 3-month-olds' stress responses and their mothers' situational behaviour are mutually regulated.