Improvements in postpartum depression and mother-infant interactions: Findings from a pilot study of a home-based therapeutic intervention

Postpartum depression and other mood disorders are serious mental health problems affecting approximately 12-25% of childbearing women (Gavin et al., 2005). These disorders, manifested through symptoms such as sadness, withdrawal, preoccupation, and anxiety, disrupt the parent-child bond and subsequently aspects of the infant's learned social, emotional, and cognitive development (Weinberg & Tronick, 1998). Individual treatments to ameliorate the mother's depression have not demonstrated conclusive improvement in 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 mothers with serious postpartum mood disorders and their infants. The short-term intervention focuses on reducing maternal depression and anxiety, and on strengthening maternal competence and the parent-child relationship. This pilot study utilized pre and post-treatment data from a multi-method evaluation to examine changes in self-reported maternal mood, self-esteem, and parenting stress, and observer-rated mother-infant interactions.

Measures included the Postpartum Depression Screening Scale (Beck & Gable, 2000), Maternal Self-Report Inventory (Shea & Tronick, 1988), Brief Symptom Inventory (Derogatis, 1975, 1993), and Parenting Stress Index (Abidin, 1995). Coding Interactive Behavior scales (Feldman, 1998) were used to rate videotaped mother-infant interactions. Parametric and non-parametric tests were utilized in our analyses (e.g. t-tests and Wilcoxon sign-rank tests) given the pilot nature of our data and sample size (n=24 mother-infant dyads). Over the course of treatment, we hypothesized that maternal depression and parenting stress would decrease, self-esteem would increase, and mothers would demonstrate improved mood and greater sensitivity and responsivity in interactions with their infants.

Most subject mothers were married (90%) and had a history of depression (58%). The majority were Caucasian (63%) with the remaining identifying as Asian (21%) or Latino/biracial/other (15%). Infant mean age was 14 weeks. The intervention lasted an average of 12 sessions. At pre-treatment the mothers were profoundly depressed, had poor self-esteem, and were very stressed in parenting. Additionally, their severity of depression and poor self-esteem were significantly correlated with decreased sensitivity and disengagement from their infants. Analyses of pre and post-treatment self-report measures demonstrated significant reductions in depression and stress and an increase in maternal self-esteem. At post-treatment mothers were significantly less anxious and depressed with their infants and displayed more pleasure in interactions with them. They also showed more sensitivity and responsivity through increased ability to acknowledge their baby's needs, demonstrate resourcefulness in interactions with them, and offer a more supportive presence. Overall, the synchrony between the mothers and infants showed substantial improvement.

Initially, these depressed mothers were unable to consistently offer the nurturance their infants needed for optimal development (Weinberg, et al., 2001). Results of our pilot study showed that over the course of this time-limited intervention distressed women who were having difficulties responding to their infants, improved in mood, maternal sense of self, and parenting practices. Our results support the growing literature that addresses the importance of dyadic interventions for treating both a mother's postpartum depression and her relationship with her infant.