Impact of Maternal Depression on Mother-Infant Interactions: A Qualitative Study

Purpose: Postpartum depression (PPD) affects approximately 12-25% of child-bearing women, and is manifested in symptoms such as sadness, hopelessness, irritability, poor concentration, decreased motivation, and sleep disturbances. Mothers may have low maternal self-esteem, a limited sense of self-efficacy with respect to parenting, and shame surrounding their experience (Kendall-Tackett, 2005). Affectively, mothers' responses to their infants can include rejection, anger, hatred, disengagement, and/or withdrawal – responses which strain attachment processes, and impair infant social-relational learning and self-regulation capacities (Brockington, 2004). Although studies have demonstrated the negative impact of PPD on mothers' interactions with their infants (Tronick & Weinberg, 1997), little is known about mothers' perceptions of the process. This study seeks to expand upon existing research by examining how mothers experience PPD and its impact on their parenting and the maternal-infant relationship.

Methods: As part of a larger evaluation study of a home-based intervention for women with PPD and their infants, post-treatment interviews were conducted with 22 mothers, focusing on experiences of postpartum depression, relationships with infants, partners, family and friends, and specifics of the intervention. More than two-thirds of participants were first time mothers with a mean age of 32, 63% were Caucasian and all were severely depressed at the start of treatment. Mean age of infants at intake was 14 weeks. All interviews were audio-taped and transcribed. For this study, analyses focused on the transcript section detailing mothers' experiences of PPD and interactions with their infants (Lieblich, Tuval-Maschiach, & Zilber, 1998). Two researchers worked inductively with data using grounded theory techniques (Charmaz, 2006), first coding line-by-line, then organizing codes into larger categories, and ultimately into a framework to explain how mothers' PPD manifested in the maternal-infant relationship. The QDA program ATLAS.ti was used to manage the data and facilitate coding.

Findings: Analyses yielded descriptive information about the mothers' perceptions of their PPD and the particular paths their feelings took in compromising relationships with their infants. Consonant with prior research, mothers described feeling sad, depressed, angry, guilty, ashamed and overwhelmed, painful feelings that were further augmented by the conflict between expectations of perfect motherhood and the reality of the experience. Mothers felt isolated and unable to share feelings of despair due to shame, misunderstanding and false reassurances. They also felt unable to care for their infants, didn't want to hold them, often feeling little connection. Some perceived that their infants would be better off without them, and experienced a desire to harm themselves or their infants in order to escape an unbearable situation. Depression caused mothers to be self-focused, making it difficult to attune to their infants' needs.

Conclusion: Findings from this qualitative study showed that mothers perceived their experiences of depression as disabling, which made caring for newborn infants almost impossible. Isolation, shame, and guilt regarding PPD added to their distress and were detrimental to self-esteem and confidence regarding the maternal-infant relationship. With this knowledge social work clinicians can address the stigma attached to PPD, as well as the challenges mothers experience in interactions with their infants.