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The prevalence of postpartum depression worldwide varies from 0.5% to 60.8% in the first 12 months postpartum using self-reported questionnaire. This review aims to update the current magnitude of postpartum depression based on self-reported questionnaire and clinical interview and explore its associated factors in developed and developing countries. A literature search conducted between 2005 and 2014 identified 203 studies, of which 191 used self-reported questionnaire in 42 countries and 21 used structured clinical interview in 15 countries. Nine studies used a combination of self-reported questionnaire and clinical interview. The prevalence of postpartum depression varies from 1.9% to 82.1% in developing countries and from 5.2% to 74.0% in developed countries using self-reported questionnaire. Structured clinical interview shows a much lower prevalence range from 0.1% in Finland to 26.3% in India. Antenatal depression and anxiety, previous psychiatric illness, poor marital relationship, stressful life events, negative attitude towards pregnancy, and lack of social support are significant contributors to postpartum depression. All studies are included irrespective of the methodological quality, such as small sample size and their inclusion could affect the generalizability of the results. The current prevalence of postpartum depression is much higher than that previously reported, and similar risk factors are documented. A culturally sensitive cut-off score with adequate psychometric properties of the screening instruments should be available. In future studies, examining the physical, biological, and cultural factors in qualitative studies and in those with adequate methodological qualities is recommended. Copyright © 2015 The Authors. Published by Elsevier B.V. All rights reserved.
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Few studies have addressed the course and severity of maternal depression and its effects on child psychiatric disorders from a longitudinal perspective. This study aimed to identify longitudinal patterns of maternal depression and to evaluate whether distinct depression trajectories predict particular psychiatric disorders in offspring. Cohort of 4231 births followed-up in the city of Pelotas, Brazil. Maternal depressive symptoms were assessed with the Edinburgh Postnatal Depression Scale (EPDS) at 3, 12, 24 and 48 months and 6 years after delivery. Psychiatric disorders in 6-year-old children were evaluated through the development and well-being assessment (DAWBA) instrument. Trajectories of maternal depression were calculated using a group-based modelling approach. We identified five trajectories of maternal depressive symptoms: a "low" trajectory (34.8%), a "moderate low" (40.9%), a "increasing" (9.0%), a "decreasing" (9.9%), and a "high-chronic" trajectory (5.4%). The probability of children having any psychiatric disorder, as well as both internalizing and externalizing problems, increased as we moved from the "low" to the "high-chronic" trajectory. These differences were not explained by maternal and child characteristics examined in multivariate analyses. Data on maternal depression at 3-months was available on only a sub-sample. In addition, we had to rely on maternal report of child's behavior alone. The study revealed an additive effect on child outcome of maternal depression over time. We identified a group of mothers with chronic and severe symptoms of depression throughout the first six years of the child life and for this group child psychiatric outcome was particularly compromised. Copyright © 2014 The Authors. Published by Elsevier B.V. All rights reserved.
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Postnatal depression (PND) affects approximately 10-20 % of new mothers in developed countries, with accumulating research documenting its adverse impact on not only the mother but also the wider family. Longitudinal studies assessing potential effects of maternal PND on offspring are mounting, and it is therefore timely to investigate the long-term psychological outcomes for adolescent offspring who were exposed to PND in infancy. PsycINFO, Medline, and Embase databases were searched with key terms for English language abstracts. Papers of 16 were identified that examined associations between PND and internalising problems, externalising problems, psychopathology, psychosocial, and cognitive outcomes of adolescent offspring. Impaired offspring cognitive outcomes reflected some of the most consistent findings. Conflicting evidence was found for an effect of PND on adolescent offspring internalising and externalising problems and overall psychopathology. Psychosocial outcomes in offspring adolescents indicated a specific adverse effect, although based on only two studies. Significant gender differences across outcomes were found. It was concluded that PND possibly increases risk vulnerability in the presence of recurrent, concurrent, and antenatal maternal depression but that these latter factors alone may be the stronger specific predictors. Limitations of the review are discussed as well as implications for future research and clinical practice.
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Although an increasing number of studies show an association between adult attachment style and mood disorders, the relationship between adult attachment style and depression associated with childbirth is largely unknown. This study investigated the association between women's attachment style, postpartum depression (PPD), and other risk factors. During the 32nd week of pregnancy, 84 women were interviewed using the Attachment Style Interview. Participants also completed self-report questionnaires about reaction to pregnancy, family relationships, current life stresses, and symptoms of depression and anxiety. At one-month postpartum, they were evaluated for postpartum depressive symptoms using the Mini-International Neuropsychiatric Interview. Eighty-two women completed the second self-report questionnaires and were evaluated for PPD. The data of 76 women were eligible for analysis. PPD was present in 21%. An insecure attachment style was significantly related to depression. A multiple logistic regression analysis showed significant effects for insecure attachment, social economic status, and antenatal depression on PPD. Adding the insecure attachment style factor to the logistic model that predicted PPD increased the area under the curve to 0.87 (95% CI .77-.98; p < .05). The inclusion of attachment styles in assessments of perinatal depressive disorders could improve screening and the design of interventions.
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Purpose: A growing body of evidence links poor maternal mental health with negative outcomes on early child development. We examined the effect of antenatal and postnatal maternal mental health on infant neurodevelopment at age 18 months in a population-based mother-child cohort (Rhea Study) in Crete, Greece. Methods: Self-reported measures of maternal depression (EPDS), trait anxiety (STAI-Trait) and personality traits (EPQ-R) were assessed in a sample of women during pregnancy and at 8 weeks postpartum (n = 223). An additional sample of 247 mothers also completed the EPDS scale at 8 weeks postpartum (n = 470). Neurodevelopment at 18 months was assessed with the use of Bayley Scales of Infant and Toddler Development (3rd edition). Results: Multivariable linear regression models adjusted for confounders revealed that antenatal depressive symptoms (EPDS ≥ 13) were associated with decrease in cognitive development independently of postnatal depression. High trait anxiety and extraversion were associated with decrease and increase, respectively, in social-emotional development. Also, high trait anxiety and neuroticism had a positive effect on infants' expressive communication. Finally, postpartum depressive symptoms (EPDS ≥ 13) were associated with decrease in cognitive and fine motor development independently of antenatal depression. Conclusions: These findings suggest that antenatal and postnatal maternal psychological well-being has important consequences on early child neurodevelopment.
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Although the association between maternal depression and adverse child outcomes is well established, the strength of the association, the breadth or specificity of the outcomes, and the role of moderators are not known. This information is essential to inform not only models of risk but also the design of preventive interventions by helping to identify subgroups at greater risk than others and to elucidate potential mechanisms as targets of interventions. A meta-analysis of 193 studies was conducted to examine the strength of the association between mothers' depression and children's behavioral problems or emotional functioning. Maternal depression was significantly related to higher levels of internalizing, externalizing, and general psychopathology and negative affect/behavior and to lower levels of positive affect/behavior, with all associations small in magnitude. These associations were significantly moderated by theoretically and methodologically relevant variables, with patterns of moderation found to vary somewhat with each child outcome. Results are interpreted in terms of implications for theoretical models that move beyond main effects models in order to more accurately identify which children of depressed mothers are more or less at risk for specific outcomes.
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The study presents data on the 3-month prevalences of postpartum anxiety disorders (PAD) and postpartum depressive disorders (PDD) and their comorbidity in a German community sample. Associations with sociodemographic variables and previous history of psychopathology were analysed. Data were gathered in a longitudinal study over the first 3 months postpartum. In a two-stage screening procedure, a population-based representative sample of 1024 postpartum women was assessed for symptoms of anxiety and depression using DSM-IV-based screening instruments. The estimated rates of DSM-IV disorders were 11.1% for PAD and 6.1% for PDD. Comorbidity was found in 2.1%. The rate for PAD with postpartum onset was 2.2% and for PDD 4.6%. Young mothers and mothers with a low education level had a heightened risk of developing depression following delivery. Because of the clinical relevance of PAD, controlled studies and specialized programmes for prevention and treatment are urgently required.
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This investigation examined associations between pre- and postnatal reports of 1st-time mothers' depression, anxiety, and marital quality and postnatal reports of infant temperament and changes in feelings of efficacy. Maternal efficacy measured prenatally was associated with concurrent measures of depression, anxiety, marital conflict, and levels of previous child-care experience. Mothers' perception of infant temperament postnatally accounted for a significant proportion of variance in postnatal reports of maternal efficacy. Although individual differences in women's feelings of efficacy were fairly stable, significant increases in maternal efficacy were also observed over time. Findings suggest that 1st-time mothers' beliefs about their ability to perform nurturing routines may changes from a global sense of self-competence to more differentiated perceptions of nurturing efficacy.
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Insecure attachment style relates to major depression in women, but its relationship to depression associated with childbirth is largely unknown. A new UK-designed measure, the Attachment Style Interview (ASI), has potential for cross-cultural use as a risk marker for maternal disorder. To establish there liability of the ASI across centres, its stability over a 9-month period, and its associations with social context and major or minor depression. The ASI was used by nine centres antenatally on 204 women, with 174 followed up 6 months postnatally. Interrater reliability was tested and the ASI was repeated on a subset of 96 women. Affective disorder was assessed by means of the Structured Clinical Interview for DSM-IV. Satisfactory interrater reliability was achieved with relatively high stability rates at follow-up. Insecure attachment related to lower social class position and more negative social context. Specific associations of avoidant attachment style (angry-dismissive or withdrawn) with antenatal disorder, and anxious style (enmeshed or fearful) with postnatal disorder were found. The ASI can be used reliably in European and US centres as a measure for risk associated with childbirth. Its use will contribute to theoretically under pinned preventive action for disorders associated with childbirth.
In non-human mammals mothering is hormone-dependent, with crucial roles for oxytocin and prolactin. While human parenting is not hormone-dependent, hormonal changes in oxytocin, vasopressin, prolactin, testosterone, and cortisol prime and accompany the expression of parenting. In the following we focus on oxytocin (OT) as a key hormone in human parenting. OT is a nine-amino-acid neuropeptide hormones which evolved from the ancient vasotocin molecule approximately 650 MYO. OT is implicated in sociality across vertebrate evolution and substantial research has pinpointed its role in birth, lactation, and maternal care in mammals. Over the last decade, studies have begun to examine peripheral levels of OT – in plasma, saliva, urine, and to lesser extend CSF – in humans as well as OT administration to parents. Correlational and experimental studies indicate that OT is associated with increased parent-child synchrony, sensitive parenting, and parental contact; interacts with other hormones, such as vasopressin, cortisol, or testosterone to create parent-specific effects; is associated with activation of key nodes in the parental brain, and is altered in conditions of high risk or parental psychopathology. We conclude by discussing the potential role of OT in interventions for high-risk parenting.
Maternal postpartum depression (PPD) exerts long-term negative effects on infants; yet the mechanisms by which PPD disrupts emotional development are not fully clear. Utilizing an extreme-case design, 971 women reported symptoms of depression and anxiety following childbirth and 215 high and low on depressive symptomatology reported again at 6 months. Of these, mothers diagnosed with major depressive disorder (n = 22), anxiety disorders (n = 19), and controls (n = 59) were visited at 9 months. Mother-infant interaction was microcoded for maternal and infant's social behavior and synchrony. Infant negative and positive emotional expression and self-regulation were tested in 4 emotion-eliciting paradigms: anger with mother, anger with stranger, joy with mother, and joy with stranger. Infants of depressed mothers displayed less social gaze and more gaze aversion. Gaze and touch synchrony were lowest for depressed mothers, highest for anxious mothers, and midlevel among controls. Infants of control and anxious mothers expressed less negative affect with mother compared with stranger; however, maternal presence failed to buffer negative affect in the depressed group. Maternal depression chronicity predicted increased self-regulatory behavior during joy episodes, and touch synchrony moderated the effects of PPD on infant self-regulation. Findings describe subtle microlevel processes by which maternal depression across the postpartum year disrupts the development of infant emotion regulation and suggest that diminished social synchrony, low differentiation of attachment and nonattachment contexts, and increased self-regulation during positive moments may chart pathways for the cross-generational transfer of emotional maladjustment from depressed mothers to their infants. (PsycINFO Database Record
Background: There has been increasing interest in the relative effects of mothers' and fathers' interactions with their infants on later development. However to date there has been little work on children's cognitive outcomes. Methods: We examined the relative influence of fathers' and mothers' sensitivity during interactions with their children at the end of the child's first year (10-12 months, n = 97), on child general cognitive development at 18 months and language at 36 months. Results: Both parents' sensitivity was associated with cognitive and language outcomes in univariate analyses. Mothers' sensitivity, however, appeared to be associated with family socio-demographic factors to a greater extent that fathers' sensitivity. Using path modelling the effect of paternal sensitivity on general cognitive development at 18 months and language at 36 months was significantly greater than the effect of maternal sensitivity, when controlling for socio-demographic background. In relation to language at 36 months, there was some evidence that sensitivity of one parent buffered the effect of lower sensitivity of the other parent. Conclusions: These findings suggest that parental sensitivity can play an important role in children's cognitive and language development, and that higher sensitivity of one parent can compensate for the lower sensitivity of the other parent. Replication of these findings, however, is required in larger samples.
This study leveraged data from the Minnesota Longitudinal Study of Risk and Adaptation (N = 243) to investigate the predictive significance of maternal sensitivity during the first 3 years of life for social and academic competence through age 32 years. Structural model comparisons replicated previous findings that early maternal sensitivity predicts social skills and academic achievement through midadolescence in a manner consistent with an enduring effects model of development and extended these findings using heterotypic indicators of social competence (effectiveness of romantic engagement) and academic competence (educational attainment) during adulthood. Although early socioeconomic factors and child gender accounted for the predictive significance of maternal sensitivity for social competence, covariates did not fully account for associations between early sensitivity and academic outcomes. © 2014 The Authors. Child Development © 2014 Society for Research in Child Development, Inc.
The aim of this study was to analyze the impact of maternal postpartum depression and/or anxiety disorders according to DMS-IV on maternal self-confidence throughout infancy and early childhood. Exploratively, associations between maternal attachment insecurity and maternal self-confidence at pre-school age were examined. The sample (N = 54) of this prospective longitudinal study was comprised of n = 27 women with postpartum depression and/or anxiety disorders according to DSM-IV criteria and n = 27 healthy women without present or history of mental health disorders or psychotherapy. Data was collected in the postpartum period (M = 60.08 days) and at pre-school age (M = 4.7 years). Subjects were recruited between 2004 and 2011 in South Germany. Data revealed a significant difference in maternal self-confidence between clinical and control group at child's pre-school age: Women with postpartum depression and/or anxiety disorder scored lower on maternal self-confidence than healthy controls, but only if they had current SCID-diagnoses or partly remitted symptoms. According to explorative analyses maternal attachment insecurity turned out to be the strongest predictor of maternal self-confidence at pre-school age besides maternal mental health status. The results emphasize the impact of attachment insecurity and maternal mental health regarding maternal self-confidence leading to potential adverse long-term consequences for the mother-child relationship. Attachment based interventions taking maternal self-confidence into account are needed.
In recent years, there has been growing interest in investigating the processes affecting caregiving behavior. Recent studies of human and nonhuman primates have suggested that hormones can account, at least in part, for changes in caregiving motivation during pregnancy and the postpartum period and for variability in caregiving motivation and behavior among individuals. Although hormones may not be the primary determinants of caregiving, future research cannot afford to overlook the contribution that biological processes can make to normative and pathological attachment and parenting.
Ninety-four mothers and their 18- or 24-month-old children participated in four laboratory episodes designed to elicit fear or anger. Mothers’ behavior was constrained for the first part of each episode; mothers were then instructed to help their children. Toddlers’ behavioral strategies differed as a function of maternal involvement and as a function of the emotion-eliciting context. Only some of the behavioral strategies assumed to minimize expressions of distress truly did so; other behaviors showed maintenance effects on fear and anger expressions. The different pattern of results for the fear and frustration episodes highlights the importance of examining behavioral strategies across contexts designed to elicit different emotions.
The goal of this study is to clarify the relation between maternal sensitivity and internalizing problems during the preschool period. For this purpose, a longitudinal, bidirectional model was tested in two large prospective, population-based cohorts, the Generation R Study and the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development (NICHD SECCYD), including over 1,800 mother-child dyads in total. Maternal sensitivity was repeatedly observed in mother-child interaction tasks and information on child internalizing problems was obtained from maternal reports. Modest but consistent associations between maternal sensitivity and internalizing problems were found in both cohorts, confirming the importance of sensitive parenting for positive development in the preschool years. Pathways from maternal sensitivity to child internalizing problems were consistently observed but child-to-mother pathways were only found in the NICHD SECCYD sample.
Mothers' perceptions of their infants and their own levels of self-efficacy contribute to developing maternal-infant attunement. The purpose of this investigation was to examine the associations between maternal perceptions of their own infants relative to other infants and maternal self-efficacy in a group of ethnically diverse, low-income, first-time mothers during the first six weeks postpartum. By employing a structural equation model approach, we explored relationships between the predictor (maternal neonatal perceptions) and dependent variable (maternal self-efficacy). Changes in maternal perceptions of their own infants significantly contributed to self-reported levels of self-efficacy while controlling for concurrent self-esteem. Maternal perceptions of her infant as less difficult than the average infant at six weeks postpartum predicted increased levels of maternal self-reported self-efficacy. The present study supports further exploration of the first six weeks postpartum as a sensitive period for targeting intervention and support, particularly for mothers and infants at highest risk.
Objective. This study investigates observed and self-reported emotional availability in clinically depressed and nondepressed mother–infant pairs. Design. Observations of mother–infant interaction were made during 30-min free-play interaction during the first year of life in clinically postpartum depressed (n = 49) and nondepressed mothers (n = 35) in Flanders (Belgium). Results. Postpartum depressed mothers had significantly lower scores on most emotional availability dimensions, both as observed by clinicians and on the self-report measure of emotional availability, except for observed hostility and self-reported intrusiveness and hostility, and appeared to have difficulty in being engaged in play interaction with their infants. Both dyadic dimensions of the self-report questionnaire, mutual attunement and affect quality, are related to all six observed dimensions; children seen by their mothers as able to involve them in play are scored as responsive and involving by external observers; mothers of involving infants were observed as more sensitive; self-reported hostility is associated with observed nonhostility and nonintrusiveness; and, as expected, self-reported maternal intrusiveness is not related to observed nonintrusiveness or with other aspects of observed emotional availability. Conclusion. The current study underlines the differences in most aspects of observed and self-reported emotional availability between postpartum depressed and nondepressed mothers, as well the potential divergences between observed and self-perceived aspects of this construct.
present a system for describing the infant's capacities for coping with stressful interactions, and we summarize data on the developmental changes and stability of these capacities Mutual Regulation Model of social engagement infant coping in response to the still-face, simulated depression, clinical depression, and the strange situation interconnections among self and mutual regulation, object exploration, coping, and defense (PsycINFO Database Record (c) 2012 APA, all rights reserved)
A developmental model of the origins of maternal self-efficacy and its impact on maternal sensitivity was tested. Participants were 92 primiparous mothers and their 6-month-old infants. Mothers completed questionnaires about remembered care from their own parents and self-esteem prenatally, satisfaction with support, infant temperament, and maternal self-efficacy postnatally, and they participated in a laboratory observation with their infants. Maternal self-efficacy was predicted by remembered maternal care as mediated by global self-esteem. Infant soothability predicted maternal self-efficacy independently and in conjunction with distress to novelty and in conjunction with both distress to limits and satisfaction with support. Maternal self-efficacy interacted with distress to limits to predict maternal sensitivity during emotionally arousing activities. High infant distress was associated with less sensitive maternal behavior when maternal self-efficacy was moderately low and extremely high, but was positively associated with sensitive maternal behavior when self-efficacy was moderately high. Implications for future research are discussed.
Background The effectiveness of preventive approaches in the field of child protection depends, amongst other things, upon identifying typical risk constellations of infanticide. Postpartum bonding disorder, a disorder affecting a mother’s emotional relationship with her child, is one of those risk constellations alongside other negative consequences to child development. It frequently accompanies postpartum depression, which is determined by other emotional qualities. The therapeutic response is a determinant factor for the success of preventive measures. Method 42 mothers with postpartum disorders (25 depressive, 17 schizophrenic) undergoing treatment at a mother-baby-unit were examined for bonding disorders and the therapeutic response, primarily regarding the mother-child relationship. Perception of bonding, maternal self-efficacy and objectively measured parameters of mother-child interaction were the most important parameters assessed. Results. Nearly 60% of the mothers suffered from a bonding disorder. Overall, the results indicated a clear improvement in psychiatric disorder as well as in the assessed parameters for the mother-child relationship and the experience of motherhood. Conclusions. Maternal bonding disorders are strongly associated with postpartum depression and low maternal self-efficacy, which can lead to a risk constellation for infanticide. The data confirm the therapeutic response, thus demonstrating that early diagnosis and treatment of postpartum depression can represent a timely and effective preventive approach in the field of child protection.
Low maternal self-confidence may damage the early mother-infant relationship and negatively influence infant development. The goal of this study was to test whether a current and previous history of DSM-IV anxiety and depressive disorders is associated with maternal self-confidence two weeks after delivery. Postpartum anxiety disorder and depression was diagnosed according to DSM-IV criteria in a community sample of 798 women. The data showed a significant link between current postpartum anxiety and depressive disorders and maternal self-confidence. Furthermore, women with a depression or anxiety disorder in their previous psychiatric history scored lower in maternal self-confidence. There is a need for appropriate preventive programmes to promote maternal self-confidence. With such programmes it is possible to prevent infant developmental disorders which might result from reduced feelings of maternal self-confidence and associated maternal interaction behaviour.
Whether course trajectories of depressive and anxiety disorders are different, remains an important question for clinical practice and informs future psychiatric nosology. This longitudinal study compares depressive and anxiety disorders in terms of diagnostic and symptom course trajectories, and examines clinical prognostic factors. Data are from 1209 depressive and/or anxiety patients residing in primary and specialized care settings, participating in the Netherlands Study of Depression and Anxiety. Diagnostic and Life Chart Interviews provided 2-year course information. Course was more favorable for pure depression (n=267, median episode duration = 6 months, 24.5% chronic) than for pure anxiety (n=487, median duration = 16 months, 41.9% chronic). Worst course was observed in the comorbid depression-anxiety group (n=455, median duration > 24 months, 56.8% chronic). Independent predictors of poor diagnostic and symptom trajectory outcomes were severity and duration of index episode, comorbid depression-anxiety, earlier onset age and older age. With only these factors a reasonable discriminative ability (C-statistic 0.72-0.77) was reached in predicting 2-year prognosis. Depression and anxiety cases concern prevalent - not incident - cases. This, however, reflects the actual patient population in primary and specialized care settings. Their differential course trajectory justifies separate consideration of pure depression, pure anxiety and comorbid anxiety-depression in clinical practice and psychiatric nosology.
Language is one of the most important acquisitions made during childhood. Before verbal language, a child develops a range of skills and behaviours that allow the child to acquire all communication skills. Factors such as environmental factors, socio-economic status and interaction with parents can affect the acquisition of vocabulary in children. Post-partum depression can negatively affect the first interactions with the child and, consequently, the emotional, social and cognitive development of the child. To analyse the effect of the duration of the mother's depression on the language development of children at 12 months old. This was a longitudinal study. The participants of this study were mothers who had received prenatal care from the Brazilian National System of Public Health in Pelotas city, State of Rio Grande do Sul, Brazil. The mothers were interviewed at two different time points: from 30 to 90 days after delivery and at 12 months after delivery; the children were also evaluated at this later time point. To diagnose maternal depression, we used the Mini International Neuropsychiatric Interview, and to assess child development, we used the language scale of the Bayley Scales of Infant Development III. We followed 296 dyads. Maternal depression at both time points (post partum and at 12 months) was significantly associated with the language development of infants at 12 months of age. This impact was accentuated when related to the duration of the disorder. Older women and women with more than two children were more likely to have children with poorer language development, while women who were the primary caregiver had children with higher scores on the language test. The findings indicate that maternal age, parity, primary caregiver status and duration of post-partum depression are associated with the language development of the child.
Depression is the most frequent psychiatric disorder and has long-term, compromising effects on the mother-infant relationship and the child's development. The infant continuously faces a climate of negative affect that disrupts the interactive experience of the infant and the mother. This article presents findings on the impact of maternal depression on the infant affective state and the specific interactive patterns associated with infant affect regulation. Mother-infant interactions were studied using microanalytic, second-by-second methods in the laboratory and also by using naturalistic home observations. The empirical findings highlight the impact of maternal depression on the infant affective state and on the capacity for repairing states of miscoordination. The impact is seen not only in severely and acutely depressed mothers, but in mothers who have only high levels of depressive symptoms. These infants develop negative affective states that bias their interactions with others and exacerbate their affective problems. Further findings with regard to gender-specific effects show that male infants are more vulnerable than female infants to maternal depression. The findings point out the need for therapeutic interventions that focus on the mother-infant dyad and infant affective state in the treatment of maternal depression.
Up to 50% of mothers report postpartum depressive symptoms yet providers do a poor job predicting and preventing their occurrence. Our goal was to identify modifiable factors (situational triggers and buffers) associated with postpartum depressive symptoms. Observational prospective cohort telephone study of 563 mothers interviewed at 2 weeks and 6 months postpartum. Mothers reported on demographic factors, physical and emotional symptoms, daily function, infant behaviors, social support, and skills in managing infant and household. Mothers were categorized into four groups based on the presence of depressive symptoms at 2 weeks and at 6 months postpartum: never, always, late onset, and remission groups. Fifty-two percent did not have depressive symptoms at 2 weeks or at 6 months (never group), 14% had symptoms at both time points (always group), 10% had late onset, and 24% had early onset of symptoms with remission. As compared with women in the never group, women in the always and late onset groups had high-risk characteristics (e.g., past history of depression), more situational triggers (e.g., physical symptoms), and less robust social and personal buffers (i.e., social support and self-efficacy). As compared with the never group, mothers in the remission group had more situational triggers and fewer buffers initially. Changes in situational triggers and buffers were different for the four groups and were correlated with group membership. Situational triggers such as physical symptoms and infant colic, and low levels of social support and self-efficacy in managing situational demands are associated with postpartum depressive symptoms. Further research is needed to investigate whether providing education about the physical consequences of childbirth, providing social support, and teaching skills to enhance self-efficacy will reduce the incidence of postpartum symptoms of depression.
The ability to mother her infant is reduced in a woman with postpartum depression (PPD). Although antidepressant treatment effectively improves depressive symptoms, various domains of functioning, for example, work and relationships, do not universally improve with treatment. In this pilot study, we investigated whether maternal role functioning improved with antidepressant treatment in women with PPD. The pilot study was an exploratory analysis of a larger study. A subset of women (n = 27) from a randomized clinical trial (double-blind, 8-week trial of nortriptyline compared with sertraline) completed three outcome measures of maternal role functioning: gratification in the maternal role, the Infant Care Survey (ICS), and videotapes of maternal-infant interaction. The tapes were analyzed using the Child and Caregiver Mutual Regulation Coding Scale and Noldus Behavioral Coding Software. The two antidepressants were equally efficacious in decreasing depressive symptoms and improving overall functioning and gratification in the maternal role. Differences between times 1 and 2 in the mother-infant interactions were related to time (increasing age of the infant) and not assignment of antidepressant or remission of depression. Effective treatment with two antidepressants improves gratification in the maternal role but not self-efficacy or maternal-infant interaction in women with PPD. Results of the study can help women and their healthcare providers to weigh the benefits of short-term antidepressant treatment in the postpartum period. Future studies should consider outcomes related to a longer duration of treatment.
This review examines the potential roles of parental self-efficacy (PSE) in parent and child adjustment and the role of parental cognitions in understanding behaviors and emotions within families. The areas in this review include parental competence and psychological functioning, as well as child behaviors, socio-emotional adjustment, school achievement, and maltreatment. There is strong evidence linking PSE to parental competence, and more modest linkage to parental psychological functioning. Some findings suggest that PSE impacts child adjustment directly but also indirectly via parenting practices and behaviors. Although the role of PSE likely varies across parents, children, and cultural-contextual factors, its influence cannot be overlooked as a possible predictor of parental competence and child functioning, or perhaps an indicator of risk. PSE may also be an appropriate target for prevention and intervention efforts. Limitations in the literature include measurement problems, variability in conceptualizations and definitions of the construct, and the lack of research exploring causality. Future research should focus on clarifying the measurement of PSE, studying potential bias in self-report of PSE, and utilizing experimental and longitudinal designs to untangle the issues of causal direction and potential transactional processes.
To date there has been no study investigating mother-infant bonding impairment and its link to pospartum depressive symptoms in a representative German population sample. The present study therefore aimed to carry out initial analyses of the psychometric properties of the German version of the Postpartum Bonding Questionnaire (PBQ). Eight hundred and sixty two mothers provided the data for a principal component analysis of the original 25 item PBQ. This analysis was used to assess the validity of the four scale structure of the questionnaire. Correlations between postpartum depression, sociodemographic variables and bonding impairment were additionally calculated. On the basis of our data, the original 4 factor structure of the PBQ scale was not confirmed. Nine items did not meaningfully load onto the single factor accounting for the most variance. Mother-infant bonding impairment and postpartum depression were shown to be significantly positively correlated. According to the factor solution of Brockington we found a 7.1% rate of mothers with bonding impairment two weeks postpartum (with 95% confidence ranging from 5.5 to 9%). An abridged 16 item German version of the PBQ can be implemented as a reliable screening instrument for bonding impairment.
Maternity blues have been described as a relevant risk factor for postpartum depression. Information regarding the influence of maternity blues on the onset and course of clinical postpartum anxiety disorders is scarce. The goal of this study was to determine whether maternity blues significantly predict postpartum depression and anxiety disorders in the first 3 months after delivery in a German sample. Demographic, psychiatric, and obstetric correlates of maternity blues were also investigated. Maternity blues were assessed 2 weeks after delivery in a community sample of 853 women using a telephone interview and the Patient Health Questionnaire-Depression. Depression and anxiety disorders were diagnosed according to DSM-IV criteria over the first 3 months following delivery. A two-stage screening procedure was applied. In a first stage, the Patient Health Questionnaire-Depression, the Edinburgh Depression Scale, and two anxiety-screening instruments were employed. In the case of clinically relevant scores, the Structured Clinical Interview for DSM-IV was administered in a second stage. The estimated prevalence rate of maternity blues among German women was 55.2%. We found a significant association between maternity blues and postpartum depression (odds ratio: 3.8) and between maternity blues and anxiety disorders (odds ratio=3.9). Based on our predominantly middle class low-risk sample, maternity blues prevalence may be underestimated. Retrospective assessment of maternity blues 2 weeks postpartum might lead to biased results. Women with maternity blues should be carefully observed in the first weeks postpartum with the aim of identifying those at risk of developing postpartum depression/anxiety disorders and providing treatment at an early stage of the disorder.
Ob sessional thoughts and compulsive behaviors in a sample of women with postpartum mood symptoms
  • J S Abramowitz
  • S Meltzer-Brody
  • J Leserman
  • S Killenberg
  • K Rinaldi
  • B L Mahaffey
  • C Pedersen
Abramowitz, J. S., Meltzer-Brody, S., Leserman, J., Killenberg, S., Rinaldi, K., Mahaffey, B. L., & Pedersen, C. (2010). Ob sessional thoughts and compulsive behaviors in a sample of women with postpartum mood symptoms. Archives of Women's Mental Health, 13, 523 - 530. DOI 10.1007/s00737-010-0172-4.
Socio-economic determinants and self-reported depressive symptoms during postpartum period
  • P Barbadoro
  • G Cotichelli
  • C Chiatti
  • M L Simonetti
  • A Marigliano
  • F Di Stanislao
  • E Prospero
Barbadoro, P., Cotichelli, G., Chiatti, C., Simonetti, M. L., Marigliano, A., Di Stanislao, F., & Prospero, E. (2012). Socio-economic determinants and self-reported depressive symptoms during postpartum period. Women & Health, 52, 352 - 368. DOI 10.1080/03630242.2012.674090.
Maternal-fetal attachment and its correlates in a sample of Italian women: A study using the Prenatal Attachment Inventory
  • L Barone
  • F Lionetti
  • A Dellagiulia
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