Research That Matters (January 17 - 20, 2008)

Purpose: Postpartum mood disorders are potentially devastating conditions that are under-diagnosed, under-treated, and affect approximately 13% of childbearing women (O'Hara & Swain, 1996). Maternal depression, manifested through symptoms such as sadness, withdrawal, anxiety, irritability, or suicidality disrupts the parent-child bond and crucial aspects of social, emotional and cognitive development learned through early interaction with the primary caregiver. Individual treatments to ameliorate the mother's depression have not demonstrated conclusive improvement in the maternal-infant interaction. Based on research evidence showing the importance of dyadic interventions (Nylen, et al., 2006), a community social service agency developed a program providing relationship-based therapeutic home-visits to a broad spectrum of mothers with serious postpartum mood disorders and their infants. The short-term intervention focuses on strengthening maternal competence and the parent-child relationship as early as 2-3 weeks postpartum. This study utilizes baseline data collected at intake from a multi-method evaluation to understand the nature and severity of the mothers' mood disorders and their impact on relationships with their infants.

Methods: Measures used for the study included the Postpartum Depression Screening Scale (Beck & Gable, 2000), the Maternal Self-Report Inventory (Shea & Tronick, 1988), the Brief Symptom Inventory (Derogatis, 1975, 1993), the Dyadic Adjustment Scale (Spanier, 1976), and the Coding Interactive Behavior scales (Feldman, 1998) based on mother-infant videos. Twenty-five mother-infant dyads were enrolled. Infant mean age was 11 weeks. We hypothesized that maternal depression and self-esteem would be negatively associated with engagement and sensitivity towards infants, infants' affective expression, and infants' involvement with the mother.

Results: Baseline data demonstrated that mothers were profoundly depressed, had poor self-esteem, and experienced mental confusion, emotional lability, anxiety, sleep disturbances, guilt, shame, and suicidal thoughts. In bivariate analyses we found that mother's severity of depression and poor self-esteem were significantly correlated with decreased sensitivity and disengagement from infants, and with infants' limited positive affect and initiation of interactions (e.g. gaze, vocalizations, etc). Counter to previous studies, quality of marital relationship was not associated with severity of postpartum depression or feeling inadequate as a mother. By computing a series of hierarchical regression models we found the following: 1) after controlling for baby age, the mothers with less parental confidence and greater depression were less able to acknowledge their infants and be responsive to their needs; 2) mothers with poor self-esteem, difficulties adjusting to parenting, and who were suicidal were more likely to be disengaged from their infants and display flat affect in interactions with them; and 3) regardless of age, infants who had very depressed mothers showed more fatigue, less positive affect, and initiated fewer interactions with their mothers.

Implications: These depressed mothers with extremely low self-esteem were unable to offer the nurturance their infants needed for optimal development (Weinberg, et al., 2001). Without an accessible postpartum depression intervention women are left isolated and shamed by their experiences and their infants suffer the consequences. Our results support the importance of maternal depression screening immediately postpartum and the availability of interventions that focus on maternal-infant relationships as well as the mothers' mood disorders.