Eva Moehler

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.

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.

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.

Infant predictors of behavioural inhibition

Behavioural inhibition in the second year of life is a hypothesized predictor for shyness, social anxiety and depression in later childhood, adolescence and even adulthood. To search for the earliest indicators of this fundamental temperamental trait, this study examined whether behavioural characteristics in early infancy can predict behavioural inhibition, as previously postulated. The results show that infant crying to unfamiliar stimuli at 4 months of age is a significant predictor (p = .002) of behavioural inhibition in the second year of life. These data implicate the possibility of measuring a temperamental anxiety disposition at a very young age simply by assessing crying in the face of novel stimuli.

Prenatal stress: course and interrelation of emotional and physiological stress measures.

Background: Prenatal stress is known to be a potential risk factor for cognitive, behavioural and motor development that even last until adolescence. A consensus of how ‘prenatal stress’ can be measured, in which trimester of pregnancy women should be studied and whether subjective feelings of being stressed are associated with a hormonal response is still lacking. To close this gap, a prospective longitudinal study was conducted in pregnant women. Sampling and Methods: 108 subjects were asked to fill out questionnaires concerning pregnancy-related anxiety, perceived stress, marital satisfaction, critical life events and to collect salivary cortisol in each trimester of pregnancy. Results: Fear of giving birth increases until the end of pregnancy, and marital satisfaction is highest at the end of pregnancy. Perceived stress is related to a hormonal response in cortisol only in the first (r = 0.18, p < 0.10) and second (r = 0.18, p < 0.10) trimesters of pregnancy. Critical life events are linked to raised cortisol levels in early pregnancy only (r = 0.28, p < 0.01). Conclusion: Prenatal stress can be operationalized by using different subjective as well as physiological stress measures. Only in the first half of pregnancy self-report and physiological stress measures seem to be associated.

Association of behavioral inhibition with hair pigmentation in a European sample.

Behavioral inhibition, a temperamental trait signalling a predisposition to childhood and adolescent anxiety disorders, is slightly more frequent in America among Caucasian children having blue irises. This paper examines a community sample of 101 German toddlers assessed for behavioral inhibition in a standardized laboratory procedure. Hair pigmentation was found to be significantly associated with behavioral inhibition in the sense that blond children exhibited higher fear scores. As in American samples, blue-eyed children had a higher fear score than did other children, but this difference was not statistically significant.

History of Childhood Abuse Is Accompanied by Increased Dissociation in Young Mothers Five Months Postnatally

Background: Dissociation has been recognized as a relevant factor within the context of traumatization. Since childhood maltreatment as well as child birth can be regarded as a potential trauma, this study examined dissociation in a sample of 58 young mothers with a history of abuse in comparison to a control group. Methods: All women with newborn children were contacted by mail and presented with the Childhood Trauma Questionnaire. Women who reached a cutoff for moderate or severe sexual and/or physical abuse and whose children were term babies with Apgar scores >7 were included in the study to form the index group (n = 58); the control group was formed by matching mothers with no reported experiences of physical and/or sexual abuse (n = 61). Dissociative experiences were assessed by the Scale of Dissociative Experiences (German version of the Dissociative Experiences Scale). Results: The results show that mothers with a history of physical or sexual abuse – matched for infant gender, maternal education, marital status, number of infants and birth weight – had significantly more dissociative experiences. Conclusions: Maternal history of abuse significantly increases maternal dissociative experiences, which has frequently been postulated but never empirically shown in a prospective design in a sample of young mothers. As maternal psychopathology has been found to have a profound impact on child development, specifically in the first year of life, these data are of immediate relevance for preventive efforts when targeting at-risk mother-infant dyads.

The maternal brain in women with a history of early-life maltreatment: an imagination-based fMRI study of conflictual versus pleasant interactions with children

BACKGROUND Early-life maltreatment has severe consequences for the affected individual, and it has an impact on the next generation. To improve understanding of the intergenerational effects of abuse, we investigated the consequences of early-life maltreatment on maternal sensitivity and associated brain mechanisms during mother-child interactions. METHODS In total, 47 mothers (22 with a history of physical and/or sexual childhood abuse and 25 without, all without current mental disorders) took part in a standardized real-life interaction with their 7- to 11-year-old child (not abused) and a subsequent functional imaging script-driven imagery task. RESULTS Mothers with early-life maltreatment were less sensitive in real-life mother-child interactions, but while imagining conflictual interactions with their child, they showed increased activation in regions of the salience and emotion-processing network, such as the amygdala, insula and hippocampus. This activation pattern was in contrast to that of mothers without early-life maltreatment, who showed higher activations in those regions in response to pleasant mother-child interactions. Mothers with early-life maltreatment also showed reduced functional connectivity between regions of the salience and the mentalizing networks. LIMITATIONS Region-of-interest analyses, which were performed in addition to whole-brain analyses, were exploratory in nature, because they were not further controlled for multiple comparisons. CONCLUSIONS Results suggest that for mothers with early-life maltreatment, conflictual interactions with their child may be more salient and behaviourally relevant than pleasant interactions, and that their salience network is poorly modulated by the brain regions involved in mentalizing processes. This activation pattern offers new insights into the mechanisms behind the intergenerational effects of maltreatment and into options for reducing these effects.

Neural processing of the own child’s facial emotions in mothers with a history of early life maltreatment

Early life maltreatment (ELM) has long-lasting effects on social interaction. When interacting with their own child, women with ELM often report difficulties in parenting and show reduced maternal sensitivity. Sensitive maternal behavior requires the recognition of the child’s emotional state depicted in its facial emotions. Based on previous studies, it can be expected that ELM affects the neural processing of facial emotions by altering activation patterns in parts of the brain’s empathy and mentalizing networks. However, so far studies have focused on the processing of standardized, adult facial emotions. Therefore, the current study investigated the impact of ELM on the processing of one’s own child’s facial emotions using functional magnetic resonance imaging. To achieve this, 27 mothers with and 26 mothers without a history of ELM (all without current mental disorders and psychopharmacological treatment) took part in an emotional face recognition paradigm with happy, sad, and neutral faces of their own and an unknown primary school-aged child of the same age and sex. We found elevated activations in regions of the mentalizing (superior temporal sulcus, precuneus) and mirror neuron (inferior parietal lobule) networks as well as in the visual face processing network (cuneus, middle temporal gyrus) in mothers with ELM compared to the non-maltreated mothers in response to happy faces of their own child. This suggests a more effortful processing and cognitive empathic mentalizing of the own child’s facial happiness in mothers with ELM. Future research should address whether this might indicate a compensatory recruitment of mentalizing capacities to maintain maternal sensitivity.

Vacuum extraction and autonomic balance in human infants

Abstract The impact of delivery mode on the cardiac autonomic balance was studied in a sample of 101 full term appropriate for gestational age (AGA) human infants. Cardiac autonomic balance was measured by assessing basic heart rate, and two indicators of vagal tone, the Root Mean Square of Successive Differences (RMSSD) and Standard Deviation of NN-intervals (SDNN) as two different measures of short-term heart rate variability at 2, 6, and 16 weeks postnatal age. Sixty-seven infants were delivered spontaneously, 29 by cesarean section and five by vacuum extraction. Children delivered by vacuum extraction had a significantly lower basic heart rate (P=0.01), higher RMSSD (P=0.0003) and higher SDNN (P=0.0001) at two, but not at six and sixteen weeks, indicating a temporary elevation of cardiac vagal tone in these infants. These data indicate a potential transitory impact of vacuum extraction on autonomic balance persisting until at least two weeks postnatal age.