Prenatal Depression and Maternal Sensitivity in Toddlerhood

Background and Purpose Although there is substantial evidence to suggest that maternal depression is related to poorer quality parenting and problems in children's development, it is still unclear how the timing of maternal depression matters for these outcomes. Recent studies indicate that prenatal and postpartum depression can have negative long term effects on children, even after controlling for later exposure to maternal depression (Hay et al, 2010; Bureau et al, 2009). Parenting behavior remains an important theoretical frame for understanding the link between perinatal maternal mood and child outcomes. Using a population considered high-risk for depression, our study tested the extent to which different patterns of maternal depressive symptoms between the third trimester and early toddlerhood were associated with maternal sensitivity in early toddlerhood.

Methods A sample of 196 young, African-American mothers, aged 14 to 21 (mean age at birth= 18.2, SD = 1.7), was interviewed prenatally and at 4, 12, and 24 months postpartum. Depressive symptoms were assessed at all interviews (CES-D) and mothers were videorecorded interacting with their child at 24 months. Blinded coders used the Parent Child Observation Guide to code maternal sensitivity.

Results Maternal sensitivity at 24 months postpartum was significantly correlated with depression measures from all four time points: Prenatal (r = -.27), 4 month (r = -.18), 12 month (r = -.16), 24 month (r = -.18). Four groups were created using the clinical cutoff for the CES-D (≥ 16): "prenatal depression only" (n=38, 19.3%), "prenatal + at least once postpartum" (n=51, 25.9%), "postpartum depression only" (n=24, 12.2%), and "no depression" (n=84, 42.6%). An ANOVA with an LSD post hoc test indicated that mothers who had clinical levels of depressive symptoms "prenatal only" displayed significantly less sensitivity (m=6.84, sd=2.22) towards their toddlers than "never depressed" mothers (m=7.89, sd=1.69). Moreover, the "prenatal only" mothers were not more sensitive towards their toddlers than mothers who experienced "prenatal and postpartum" depression (m=6.53, sd=2.28). Mothers who only experienced elevated depressive symptoms postpartum were more similar to the never depressed mothers in their mean levels of sensitivity (m=7.67, sd=2.16) than mothers who were depressed prenatally.

Conclusions and Implications Our findings suggest that mothers who experience prenatal depressive symptoms, regardless of whether these symptoms continue after the birth, may be at greater risk for displaying poor sensitivity towards their toddlers than mothers who experience an onset of depressive symptoms postpartum. Therefore, young mothers who are depressed prenatally are an especially important group to target. Moreover, interventions targeting this population may be insufficient if efforts are limited to treating the mothers' depressive symptoms and do not address their needs as parents. There is evidence that interventions aimed to treat mothers' depression during the postpartum period do not necessarily have positive carry over effects on the mothers' responsiveness or child outcomes (Forman et al, 2007). Future intervention targeting prenatal depression should also focus on the developing relationship between the mother and her unborn infant and may need to continue after the child is born.