Corinna Reck

Maternal depressive symptoms in the postnatal period are associated with long-term impairment of mother-child bonding.

SummaryBackground: Postnatal Depression has demonstrated long-term consequences on child cognitive and emotional development, however, the link between maternal and child pathology has not been clearly identified.Objective: This study examined whether maternal bonding to the infant and young child is impaired by maternal depressive symptoms.Methods: 101 mothers of newborn infants were recruited from local obstetric units and examined for psychopathology using Symptom Checklist, the Edinburgh Postnatal Depression Scale (EPDS) and the Postpartum Bonding Questionnaire at two weeks, six weeks, four months and fourteen months postpartum.Results: Maternal depressive symptoms at 2 weeks, 6 weeks and four months postnatally but not at fourteen months of infant’s age were found to be strongly associated with lower quality of maternal bonding to the infant and child from two weeks until fourteen months of postnatal age. Even mild and unrecognized maternal depressive symptoms had a significant impact on maternal bonding, if they occurred during the first four months of life.Conclusions: This gives reason for increased concern for mother–infant dyads in the first few months after birth that could be regarded as a highly sensitive period for the development of the mother–child relationship. The findings warrant further studies and inspire the development of preventive programs focussing on infant and early childhood mental health by emphasizing protection and support during the first critical months.

Prevalence, onset and comorbidity of postpartum anxiety and depressive disorders

Objective:  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.

Interactive Regulation of Affect in Postpartum Depressed Mothers and Their Infants: An Overview

Specific patterns of interaction emerging in the first months of life are related to processes regulating mutual affects in the mother-child dyad. Particularly important for the dyad are the matching and interactive repair processes. The interaction between postpartum depressed mothers and their children is characterized by a lack of responsiveness, by passivity or intrusiveness, withdrawal and avoidance, as well as a low level of positive expression of affect. Thus, an impaired capability to regulate the child’s affect has been demonstrated in depressed mothers. Maternal aggression, neglect toward infants, infanticidal thoughts, as well as infanticidal behavior are mainly linked to severe postpartum depression, especially with psychotic symptoms. The findings on mother-child interaction reported in this paper are based on mothers with mild to moderate depressive disorders without psychotic symptoms. Considering the stability of interaction patterns in the course of depressive illness as well as the long-term consequences of these interactions, it seems surprising that there are still few systematic studies of depressed mothers interacting with their infants.In connection with an overview on these issues, treatment models forparent-infant psychotherapy are discussed.

The German version of the Postpartum Bonding Instrument: Psychometric properties and association with postpartum depression

SummaryBackground: 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). Methods: 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. Findings: 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%). Interpretation: An abridged 16 item German version of the PBQ can be implemented as a reliable screening instrument for bonding impairment.

Maternity blues as a predictor of DSM-IV depression and anxiety disorders in the first three months postpartum

BACKGROUND 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. METHODS 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. RESULTS 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). LIMITATIONS 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. CONCLUSIONS 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.

Reconfirming the role of life events for the timing of depressive episodes: A two-year prospective follow-up study

BACKGROUND Since the 1960s the association of stressful life events and depression seemed to be firmly established. However, a few recent studies did not confirm those earlier findings. One of the reasons discussed for the inconsistencies was the sampling of milder depressed neurotic out-patients in the earlier studies vs. more severely ill endogenous type in-patients in recent studies. METHODS This investigation was carried out with 50 consecutively admitted in-patients with endogenous depression according to ICD 9 and unipolar major depression according to DSM-III-R as ascertained by SCID. The control sample consisted of 26 healthy volunteers. Life events and chronic distressing life conditions were recorded with the Munich Interview for the Assessment of Life Events and Conditions (MEL) every 3 months over a period of 2 years along with psychopathological symptoms and recurrencies. Hence the design was prospective in the sense that life events were recorded for one 3-month cross-section, the depressive reaction for the subsequent one. BDI scores taken at the respective cross section were used to control for depressive bias of the subjective part of the patients life event evaluation. RESULTS Three months prior to the index hospitalization patients were more often affected by life events and conditions than controls. The number of stressful conditions prior to the index hospitalization indicated the time to relapse after discharge. Controls showed more desirable positive conditions than patients. Relapse patients suffered more often stressful life events and conditions than non-relapsers 3 months prior to their relapse. Multivariate analysis indicates that the cumulative number of life events within the 2-year course is the best predictor of the BDI score at the end of the follow-up period. LIMITATIONS Since the subjective component of life event assessment by MEL displayed a higher impact on the course of depression than the objective part of the assessment, confounding of subjective ratings, attributional styles, and depressive symptoms may be a problem although controlled for in this study. CONCLUSION The results support the importance of stressful life events and chronic distressing conditions for the 2-year course and outcome of major depression in an in-patient sample. Since the overall consistency of significant results was more pronounced in the subjective than in the objective part of the MEL the results fit best a circular pathogenetic model of interactions between life events, their individual evaluation by the patient, and depressive symptoms.

Effects of postpartum anxiety disorders and depression on maternal self-confidence

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.

Childhood Behavioral Inhibition and Maternal Symptoms of Depression

Background: The significance of behavioral inhibition in the second year of life for the development of social phobia in later childhood was the incentive to explore whether maternal postnatal psychopathology is a predictor for behavioral inhibition in the offspring. Method: 101 mother-infant pairs were recruited from local obstetric units and examined for maternal psychopathology by the Symptom Checklist and the Edinburgh Postnatal Depression Scale several times during the first postnatal year. Child behavioral inhibition was assessed at 14 months in a laboratory procedure. Results: Postpartum depression at 4 months measured by the Edinburgh Postnatal Depression Scale was found to be strongly associated with toddlers’ fear score/behavioral inhibition at 14 months. Maternal depressive symptoms assessed by the revised 90-item Symptom Checklist at 6 weeks , 4 and 14 months were found to be related to child inhibition as well. Conclusions: Even maternal depression not reaching the level of clinical diagnosis and treatment has an impact on child behavioral development. These data should give rise to further studies on the origins of this relationship, which might be primarily genetic or interactional.

Interactive coordination of currently depressed inpatient mothers and their infants during the postpartum period

In healthy mother-infant dyads, interactions are characterized by a pattern of matching and mismatching interactive states with quick reparation of mismatches into matches. In contrast, dyads in which mothers have postpartum depression show impaired mother-infant interaction patterns over the first few months of the infants life. The majority of studies that have examined such interaction patterns have drawn on community samples rather than on depressed inpatient samples of mothers who were in a state of current depression at the time of assessment. To date, no study has investigated specific microanalytic patterns of interactive coordination between depressed German mothers and their infants using the Face-to-Face Still-Face paradigm (FFSF). The primary goal of this study was to evaluate specific patterns of dyadic coordination and the capacity for repairing states of miscoordination in an inpatient sample of postpartum currently depressed mothers and their infants as compared with a healthy control group. A sample of 28 depressed inpatient German mothers and their infants (age range = 1-8 months, M age = 4.06 months) and 34 healthy dyads (range = 1-8 months, M age = 3.89 months) were videotaped while engaging in the FFSF. A focus was placed on the play and reunion episodes. Compared with healthy dyads, dyads with depressed mothers showed less coordination of positive matched states and longer latencies when repairing interactive mismatching states into positive matched states. Clinical implications are discussed.

The influence of general anxiety and childbirth-specific anxiety on birth outcome

In the present study, we examined a German sample to determine whether anxiety symptoms during pregnancy had an impact on the duration and method of childbirth. Data of N = 88 women recruited at the Heidelberg University Hospital were used in the analyses. Prepartum anxiety symptoms were assessed with the State-Trait Anxiety Inventory (STAI, general anxiety) and the Pregnancy Related Anxiety Questionnaire (PRAQ-R, pregnancy-specific anxiety). Obstetric outcome was taken from birth records and operationalized by two parameters: the total duration of birth (dilation and fetal expulsion) and the incidence of pregnancy or birth-related interventions (ventouse, planned, and unplanned Cesarean section). The data show that childbirth-specific anxiety assessed by the PRAQ-R is an important predictor of total birth duration. In contrast, general anxiety measured by the STAI had no effect. The incidence of birth intervention was explained by parity. Anxiety, however, had no predictive value. In addition to medical factors, childbirth-specific anxiety during pregnancy plays an important role in the process of childbirth. The findings of the present study point to the need of implementing psychological interventions to reduce childbirth-specific anxiety and thereby positively influencing birth outcome.