The association between maternal depression and sensitivity: Child-directed effects on parenting during infancy

Maternal contingent responses to distress facilitate infant soothing but not in mothers with depression or infants high in negative affect

Depression in mothers is consistently associated with reduced caregiving sensitivity and greater infant negative affect expression. The current article examined the real-time behavioral mechanisms underlying these associations using Granger causality time series analyses in a sample of mothers (N = 194; 86.60% White) at elevated risk for depression and their 3-month-old infants (46.40% female) living in a major metropolitan area in the United States. Overall, mothers contingently responded to infant distress, and mothers' responses to infant distress increased the likelihood of infant soothing in real time. However, there was no evidence for maternal contingent responding or facilitation of infant soothing in subsamples of mothers who were currently experiencing elevated depression symptoms or in mothers of highly negative infants. These findings suggest real-time behavioral mechanisms by which risks for maladaptive self-regulation may develop. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Unique Characteristics of Women and Infants Moderate the Association between Depression and Mother-Infant Interaction

Research has shown mixed results regarding the association between women's postpartum depression and mother-infant interactions, suggesting that a woman's unique experience and context may moderate how depression shapes these interactions. We examined the extent to which a woman's comorbid anxiety, her exposure to adversity, and infant characteristics moderate the relationship between depressive symptoms of women and interactions with their infants at 6 (n = 647) and 12 months (n = 346) postpartum. The methods included standardized coding of mother-infant interactions and structural regression modeling. The results at 6 months of infant age indicated that infant male sex and infant negative affectivity were risk factors for mothers' depression being associated with less optimal interactions. At 12 months of infant age, two moderators appeared to buffer the influence of depression: a woman's history of trauma and infant preterm birth (≤37 weeks gestation). The results reinforce the salience of infant characteristics in the relationship between maternal depression and mother-infant interactions. The findings also suggest that experiences of trauma may offer opportunities for psychological growth that foster constructive management of depression's potential effect on mother-infant interactions. Further research is needed to clarify the underlying processes and mechanisms that explain the influence of these moderators. The ultimate goals are to reduce the risk of suboptimal interactions and reinforce healthy dyadic relations.

Sleep disturbance has the largest impact on children's behavior and emotions

OBJECTIVE

Children's behavior and emotions are affected by sleep disturbances, the parent-child relationship, media viewing time, and the social status of parents and caregivers. We conducted a questionnaire survey to identify the factors that have the greatest impact on children's behavior and emotions and how these factors relate to each other.

METHODS

A parental questionnaire survey was performed at a public elementary school. The questionnaire comprised questions on the family environment (e.g., family structure, media and game exposure, after-school lessons, and caregiver's work schedule) and physical information, the Strengths and Difficulties Questionnaire (SDQ), the Children's Sleep Habits Questionnaire (CSHQ), and the Pittsburgh Sleep Quality Index (PSQI) for parents' sleep condition. A path diagram was drawn to hypothesize the complex interrelationships among factors, and structural equation modeling was used to estimate the path coefficients.

RESULT

We identified several factors that significantly affected the SDQ score. The CSHQ total score had the largest impact, followed by after-school lessons, single-mother families, and children's sex. In addition, several indirect pathways that led to the CSHQ score (i.e., a pathway from time spent watching television to CSHQ score via children's bedtime and a pathway from single-mother family to CSHQ score via PSQI total score) significantly affected the SDQ score.

CONCLUSION

Children's sleep habits that were influenced by several environmental factors had the greatest impact on children's behavior and emotions, which suggested that children's behavioral problems can be improved by interventions focused on sleep habits, such as sleep hygiene instructions.

Examining reciprocal associations between parent depressive symptoms and child internalizing symptoms on subsequent psychiatric disorders: An adoption study

INTRODUCTION

The dynamic interplay between parent depressive symptoms and child internalizing behavior over time is not well understood.

METHODS

We used data from a prospective parent-offspring adoption design (N = 561) to examine associations between adoptive parent depressive symptoms and child internalizing behavior when children were ages 18 months, 27 months, 4.5 years, and 6 years, and subsequent child psychiatric disorder symptoms when children were between the ages of 6-8 years. Models also accounted for the contributions of birth parent psychopathology, birth mother depressive symptoms during pregnancy, and infant negative emotionality. Bidirectional associations between adoptive parent depressive symptoms and child internalizing behavior were examined using a random-intercept cross-lagged panel model.

RESULTS

There was evidence for associations between child internalizing behavior and adoptive parent depressive symptoms over time, with mothers' depressive symptoms being a more salient risk factor for child internalizing behavior than fathers'. We found one significant cross-lagged association from adoptive mother depressive symptoms at child age 18 months to child internalizing behavior at age 27 months. Infant negative emotionality (i.e., emotional liability) at age 9 months predicted both child internalizing behavior and adoptive parent depressive symptoms.

CONCLUSION

Results suggest that postnatal maternal depressive symptoms confer specific risks for child internalizing behaviors in toddlerhood and childhood and depressive symptoms in childhood.

Maternal social support, depression and emotional availability in early mother-infant interaction: Findings from a pregnancy cohort

BACKGROUND

Social support theory suggests that parental social support may influence the nature of early parenting behaviours and specifically the mother-infant relationship. This study examines whether support from a partner, friends or family is associated with differences in quality of mother-infant interactions in the context of maternal depression.

METHODS

210 women were followed from early pregnancy to six months postpartum within Australian pregnancy cohort, the Mercy Pregnancy and Emotional Wellbeing Study (MPEWS). Mother-infant interactions within a standardised observation at six months postpartum were measured by the Emotional Availability (EA) Scales using total scores of the parental scales. In early and late pregnancy and at six months postpartum, mothers rated perceived maternal social support from a partner, family and friends using subscales of the Multidimensional Scale of Perceived Social Support. Depression was measured in early pregnancy and at six months postpartum using the Structured Clinical Interview for the DSM-IV-TR, with repeated measurement of depressive symptoms by the Edinburgh Postnatal Depression Scale (EPDS). Data was analysed using structural equation models.

RESULTS

There were significant interactions between depressive symptoms in early pregnancy and perceived maternal support from a partner (B = .18, 95% CI = 03, .31) and separately from family (B = .12, 95% CI = .03, .32) in predicting maternal emotional availability. No such interaction was found for support from friends. While partner and family support moderated the association between early depressive symptoms and emotional availability, there were no direct associations between maternal depressive disorder in early pregnancy and perceived support, and further, maternal depression was not a significant predictor of emotional availability.

LIMITATIONS

Future studies should consider extending measurement of the mother-infant relationship beyond the EA Scales, inclusion of a measure of maternal childhood trauma, and replicating our findings.

CONCLUSION

Maternal perception of partner and family support in the postpartum is a predictor of the association between early pregnancy depressive symptoms and maternal emotional availability.

The "EA brief": A single session of parent feedback and coaching to improve emotional attachment and emotional availability (EA)

The goal of this study was to determine the extent to which a brief parenting intervention provided the context for helping families to support positive mother-child interactions as well as more optimal mother and child outcomes. Participants in this study were middle income mothers and their children were between 0-3 years of age (N = 25 dyads). Participants were filmed via Skype during a 20-minute mother-child free play and completed questionnaires (Time 1) before attending the brief intervention (involving: a single session of one-on-one parent feedback and coaching, and information via group meeting, texts, and reading) followed by a repeat of the 20-minute Skype interaction and the completion of the same questionnaires (Time 2). Paired samples t-tests were performed, revealing that mothers reported improvements in their personal well-being (using the Flourishing Scale), reports about the mother-child relationship (using the Emotional Availability Self Report), and observed interactions, particularly the child's side of the relationship (using the Emotional Availability System), from pretest to posttest. Results are discussed in terms of a single session of parent feedback and coaching (in conjunction with an informational group session and texts) potentially having a role in "planting a seed" for observed and self-reported parenting enhancement and child development.

Maternal mental health and infant emotional reactivity: a 20-year two-cohort study of preconception and perinatal exposures

BACKGROUND

Maternal mental health during pregnancy and postpartum predicts later emotional and behavioural problems in children. Even though most perinatal mental health problems begin before pregnancy, the consequences of preconception maternal mental health for children's early emotional development have not been prospectively studied.

METHODS

We used data from two prospective Australian intergenerational cohorts, with 756 women assessed repeatedly for mental health problems before pregnancy between age 13 and 29 years, and during pregnancy and at 1 year postpartum for 1231 subsequent pregnancies. Offspring infant emotional reactivity, an early indicator of differential sensitivity denoting increased risk of emotional problems under adversity, was assessed at 1 year postpartum.

RESULTS

Thirty-seven percent of infants born to mothers with persistent preconception mental health problems were categorised as high in emotional reactivity, compared to 23% born to mothers without preconception history (adjusted OR 2.1, 95% CI 1.4-3.1). Ante- and postnatal maternal depressive symptoms were similarly associated with infant emotional reactivity, but these perinatal associations reduced somewhat after adjustment for prior exposure. Causal mediation analysis further showed that 88% of the preconception risk was a direct effect, not mediated by perinatal exposure.

CONCLUSIONS

Maternal preconception mental health problems predict infant emotional reactivity, independently of maternal perinatal mental health; while associations between perinatal depressive symptoms and infant reactivity are partially explained by prior exposure. Findings suggest that processes shaping early vulnerability for later mental disorders arise well before conception. There is an emerging case for expanding developmental theories and trialling preventive interventions in the years before pregnancy.

Maternal depression and the emotional availability of mothers at six months postpartum: Findings from the Mercy Pregnancy and Emotional Wellbeing Study (MPEWS) pregnancy cohort

BACKGROUND

Existing research suggests maternal depression may reduce the quality of early mother-infant interaction and this might increase our understanding of how maternal mental health impacts on child development outcomes. However, most studies recruit from community samples and few include both a diagnostic measure of maternal depression together with an observational measure of the quality of the mother-infant relationship.

METHODS

Data was drawn from 210 women recruited in early pregnancy until 6 months postpartum within an Australian pregnancy cohort, the Mercy Pregnancy and Emotional Wellbeing Study. Those women who at six months postpartum were video recorded interacting with their infant for at least 40-minutes were included in this study, with the quality of those interactions assessed using the Emotional Availability Scales coding system. Depression was measured using the Structured Clinical Interview for the DSM-IV-TR Clinician Version and the Edinburgh Postnatal Depression Scale, and covariates included maternal age and education.

RESULTS

Whilst results showed a small negative association between antenatal depressive symptoms in trimester one of pregnancy and maternal EA, there was no effect of maternal depression diagnosis or of maternal depressive symptoms in later pregnancy or postpartum.

LIMITATIONS

This study focuses exclusively on mothers and does not account for the role of partners.

CONCLUSIONS

Maternal depression might have a smaller effect on maternal EA then some existing research implies, with that effect most prevalent in early pregnancy. Clinical intervention might not be necessary for all mother-infant dyads experiencing depressive symptomology, but instead be directed to those with additional risk factors.

Home Visiting and Antenatal Depression Affect the Quality of Mother and Child Interactions in South Africa

OBJECTIVE

To examine whether maternal depressed mood at birth moderated the protective effect of a home-visiting intervention on the quality of caregiving for children growing up in a low- and middle-income country.

METHOD

Almost all pregnant mothers in 24 Cape Town neighborhoods were recruited into a cluster randomized controlled trial matched by neighborhoods to the Philani home-visiting condition (HVC) or the standard care condition (SC). At 3 years after birth, the quality of mother-child interactions between HVC and SC mothers with and without antenatal depressed mood was assessed in a representative subset by rating videotaped observations of mother-child interactions on 10 dimensions of caregiving.

RESULTS

As predicted, maternal depressed mood at birth moderated the effect of the HVC on the quality of mother-child interactions. Among nondepressed mothers, mothers and their children in the HVC scored significantly higher on 5 of the 10 dimensions of the maternal-child interaction scale than mothers in the SC: mothers exhibited more maternal sensitivity, talked more, had more harmonious interactions, and had children who paid more attention and exhibited more positive affect. However, being in the HVC did not significantly affect the mother-child interaction scores among mothers with depressed mood. Among HVC children, those with mothers with depressed mood showed significantly less positive affect and talked less with their mothers than children with nondepressed mothers. SC children with mothers with depressed mood were more responsive and paid attention to their mothers than children with nondepressed mothers.

CONCLUSION

Home visiting resulted in a better quality of caregiving for mothers without depressive symptoms. Future interventions need to specifically target maternal depression and positive mother-child interactions.

CLINICAL TRIAL REGISTRATION INFORMATION

Mentor Mothers: A Sustainable Family Intervention in South African Townships; https://clinicaltrials.gov; NCT00972699; Philani Home-based Nutrition Intervention Program; https://clinicaltrials.gov; NCT00995592.

Maternal depression alters stress and immune biomarkers in mother and child

BACKGROUND

Exposure to maternal depression bears long-term negative consequences for children's well-being. Yet, no study has tested the joint contribution of maternal and child's hypothalamic pituitary axis and immune systems in mediating the effects of maternal depression on child psychopathology.

METHODS

We followed a birth cohort over-represented for maternal depression from birth to 10 years (N = 125). At 10 years, mother and child's cortisol (CT) and secretory immunoglobulin A (s-IgA), biomarkers of the stress and immune systems, were assayed, mother-child interaction observed, mothers and children underwent psychiatric diagnosis, and children's externalizing and internalizing symptoms reported.

RESULTS

Depressed mothers had higher CT and s-IgA levels and displayed more negative parenting, characterized by negative affect, intrusion, and criticism. Children of depressed mothers exhibited more Axis-I disorders, higher s-IgA levels, and greater social withdrawal. Structural equation modeling charted four paths by which maternal depression impacted child externalizing and internalizing symptoms: (a) increasing maternal CT, which linked with higher child CT and behavior problems; (b) augmenting maternal and child's immune response, which were associated with child symptoms; (c) enhancing negative parenting that predicted child social withdrawal and symptoms; and (d), via a combined endocrine-immune pathway suppressing symptom formation.

CONCLUSIONS

Our findings, the first to test stress and immune biomarkers in depressed mothers and their children in relation to social behavior, describe mechanisms of endocrine synchrony in shaping children's stress response and immunity, advocate the need to follow the long-term effects of maternal depression on children's health throughout life, and highlight maternal depression as an important public health concern.