Johanne Smith-Nielsen

Postpartum depression and infant-mother attachment security at one year: The impact of co-morbid maternal personality disorders.

Previous studies on effects of postpartum depression (PPD) on infant-mother attachment have been divergent. This may be due to not taking into account the effects of stable difficulties not specific for depression, such as maternal personality disorder (PD). Mothers (N=80) were recruited for a longitudinal study either during pregnancy (comparison group) or eight weeks postpartum (clinical group). Infants of mothers with depressive symptoms only or in combination with a PD diagnosis were compared with infants of mothers with no psychopathology. Depression and PD were assessed using self-report and clinical interviews. Infant-mother attachment was assessed when infants were 13 months using Strange Situation Procedure (SSP). Attachment (in)security was calculated as a continuous score based on the four interactive behavioral scales of the SSP, and the conventional scale for attachment disorganization was used. PPD was associated with attachment insecurity only if the mother also had a PD diagnosis. Infants of PPD mothers without co-morbid PD did not differ from infants of mothers with no psychopathology. These results suggest that co-existing PD may be crucial in understanding how PPD impacts on parenting and infant social-emotional development. Stable underlying factors may magnify or buffer effects of PPD on parenting and child outcomes.

Links Among High EPDS Scores, State of Mind Regarding Attachment, and Symptoms of Personality Disorder

Underlying persistent psychological difficulties have been found to moderate potential adverse effects of maternal postpartum depression (PPD) on parenting and infant development. The authors examined whether mothers presenting postpartum depressive symptoms showed higher levels of personality pathology and more insecure state of mind regarding attachment compared to nondepressed mothers. Participants (N = 85) were assessed with the Edinburgh Postnatal Depression Scale (EPDS), the Present State Examination, the Adult Attachment Interview, and the Structured Clinical Interview for DSM-IV Axis II. Mothers with high EPDS scores were more likely to have a preoccupied insecure state of mind and to have personality disorder compared with mothers scoring below clinical cutoff. Furthermore, multiple regression analysis showed that personality disorder and AAI classification were independently related to EPDS score, and that these two factors together accounted for 48% of the variance in EPDS score. Findings are discussed in terms of heterogeneity in PPD populations and underline the importance of examining potential coexisting psychological difficulties when studying PPD.

Measuring spatial proximity in mother-infant interaction: A kinematic approach for an examination of the effects of maternal postpartum depression

A kinematic approach was used to measure mother-infant spatial proximity at 4 months. Maternal postpartum depression (PPD) impacts on mother-infant spatial interaction. We compared 28 dyads with mothers meeting criteria for PPD and 46 typical dyads. The PPD dyads had less variability in spatial proximity compared to typical dyads.

Effects of maternal postpartum depression in a well-resourced sample: Early concurrent and long-term effects on infant cognitive, language, and motor development

This study examined early and long-term effects of maternal postpartum depression on cognitive, language, and motor development in infants of clinically depressed mothers. Participants were 83 mothers and their full-term born children from the urban region of Copenhagen, Denmark. Of this group, 28 mothers were diagnosed with postnatal depression three to four months postpartum in a diagnostic interview. Cognitive, language, and motor development was assessed with the Bayley Scales of Infant and Toddler Development third edition, when the infants were 4 and 13xa0months of age. We found that maternal postpartum depression was associated with poorer cognitive development at infant age four months, the effect size being large (Cohens dxa0=xa00.8) and with similar effects for boys and girls. At 13xa0months of age infants of clinical mothers did not differ from infants of non-clinical mothers. At this time most (79%) of the clinical mothers were no longer, or not again, depressed. These results may indicate that maternal depression can have an acute, concurrent effect on infant cognitive development as early as at four months postpartum. At the same time, in the absence of other risk factors, this effect may not be enduring. The main weaknesses of the study include the relatively small sample size and that depression scores were only available for 35 of the non-clinical mothers at 13xa0months.

Reflective functioning in postpartum depressed women with and without comorbid personality disorder.

Mentalization or Reflective Functioning (RF), that is, the ability to reflect upon ones’ own and others behavior in terms of underlying mental states, plays an important role in parenting behavior and children’s socioemotional development. RF has been suggested to be impaired in psychopathology, and thus maternal psychopathology after birth, such as postpartum depression (PPD) and Personality Disorder (PD), may not only affect the mother’s socioemotional functioning but also the development of the child. However, little is known about mentalizing abilities of PPD mothers, and mothers with PPD and comorbid PD. Therefore, the aim of this study was to evaluate RF in women presenting symptoms of PPD (n = 13), and women with PPD symptoms and comorbid PD (n = 14) compared with a nonclinical group (n = 52). Women were interviewed with the Adult Attachment Interview (AAI) before birth (nonclinical group), and 9–12 weeks after birth (clinical groups), and RF was assessed with the Reflective Functioning Scale applied to the AAI. ANCOVA results revealed no significant differences in mean RF abilities among the 3 groups. Possible reasons for the lack of differences in RF between the 3 diagnostic groups are discussed.

Implementation of the Alarm Distress Baby Scale as a universal screening instrument in primary care: feasibility, acceptability, and predictors of professionals’ adherence to guidelines

BACKGROUNDnInfant socioemotional development is often held under informal surveillance, but a formal screening program is needed to ensure systematic identification of developmental risk. Even when screening programs exist, they are often ineffective because health care professionals do not adhere to screening guidelines, resulting in low screening prevalence rates.nnnOBJECTIVESnTo examine feasibility and acceptability of implementing universal screening for infant socioemotional problems with the Alarm Distress Baby Scale in primary care. The following questions were addressed: Is it possible to obtain acceptable screening prevalence rates within a 1-year period? How do the primary care workers (in this case, health visitors) experience using the instrument? Are attitudes toward using the instrument related to screening prevalence rates?nnnDESIGNnA longitudinal mixed-method study (surveys, data from the health visitors digital filing system, and qualitative coding of answers to open-ended questions) was undertaken.nnnSETTING AND PARTICIPANTSnHealth visitors in three of five districts of the City of Copenhagen, Denmark (N=79).nnnMETHODSnWe describe and evaluate the implementation process from the date the health visitors started the training on how to use the Alarm Distress Baby Scale to one year after they began using the instrument in practice. To monitor screening prevalence rates and adherence to guidelines, we used three data extractions (6, 9, and 12 months post-implementation) from the electronic filing system. Surveys including both quantitative and open-ended questions (pre- and post-implementation) were used to examine experiences with and attitudes towards the instrument. Descriptive and inferential statistical and qualitative content analyses were used.nnnRESULTSnScreening prevalence rates increased during the first year: Six months after implementation 47% (n=405) of the children had been screened; 12 months after implementation 79% (n=789) of the children were screened (the same child was not counted more than once). Most (92%) of the health visitors reported that the instrument made a positive contribution to their work. The majority (81%) also reported that it posed a challenge in their daily work at least to some degree. The health visitors attitudes (positive and negative) toward the Alarm Distress Baby Scale, measured 7 months post-implementation, significantly predicted screening prevalence rates 12 months post-implementation.nnnCONCLUSIONSnAdding the Alarm Distress Baby Scale to an established surveillance program is feasible and accepTable Screening prevalence rates may be related to the primary care workers attitude toward the instrument, i.e. successful implementation relies on an instrument that adds value to the work of the screener.

Mutual regulation between infant facial affect and maternal touch in depressed and nondepressed dyads

The ability to regulate affect is important for later adaptive child development. In the first months of life, infants have limited resources for regulating their own affects (e.g. by gaze aversion), and for this reason they are dependent on external affect regulation from their parents. Previous research suggests that touch is an important means through which parents regulate their infants affects. Also, previous research has shown that post-partum depressed (PPD) mothers and nonclinical mothers differ in their touching behaviors when interacting with their infants. We examined the affect-regulating function of affectionate, caregiving and playful maternal touch in 24 PPD and 47 nonclinical mother-infant dyads when infants were four months old. In order to investigate the direction of effects and to account for repeated observations, the data were analysed using time-window sequential analysis and Generalized Estimating Equations. The results showed that mothers adapt their touching behaviors according to negative infant facial affect; thus, when the infant displays negative facial affect, the mothers were less likely to initiate playful touch and more likely to initiate caregiving touch. Unexpectedly, only in the PPD dyads, were the mothers more likely to initiate affectionate touch when their infants were displaying negative facial affect. Our results also showed that mothers use specific touch types to regulate infants negative and positive affects; infants are more likely to initiate positive affect during periods with playful touch, and more likely to terminate negative affect during periods with caregiving touch.

Copenhagen infant mental health project: study protocol for a randomized controlled trial comparing circle of security –parenting and care as usual as interventions targeting infant mental health risks

BackgroundInfant mental health is a significant public health issue as early adversity and exposure to early childhood stress are significant risk factors that may have detrimental long-term developmental consequences for the affected children. Negative outcomes are seen on a range of areas such as physical and mental health, educational and labor market success, social network and establishing of family. Secure attachment is associated with optimal outcomes in all developmental domains in childhood, and both insecure and disorganized attachment are associated with a range of later problems and psychopathologies. In disadvantaged populations insecure and disorganized attachment are common, which points to the need of identifying early risk and effective methods of addressing such problems. This protocol describes an experimental evaluation of an indicated group-based parental educational program, Circle of Security–Parenting (COS-P), currently being conducted in Denmark.Methods/designIn a parallel randomized controlled trial of two intervention groups this study tests the efficacy of COS-P compared to Care as Usual (CAU) in enhancing maternal sensitivity and child attachment in a community sample in the City of Copenhagen, Denmark. During the project a general population of an estimated 17.600 families with an infant aged 2–12 months are screened for two known infant mental health risks, maternal postnatal depression and infant social withdrawal. Eligible families (Nu2009=u2009314), who agree to participate, will be randomly allocated with a ratio of 2:1 into the COS-P intervention arm and into CAU. Data will be obtained at inclusion (baseline) and at follow-up when the child is 12–16 months. The primary outcome is maternal sensitivity. Secondary outcomes include quality of infant attachment, language, cognitive and socioemotional development, family functioning, parental stress, parental mentalizing and maternal mental wellbeing.DiscussionThe potential implications of the experimental evaluation of an indicated brief group-based parenting educational program to enhance parental sensitivity and attachment are discussed.Trial registrationClinicalTrials.govID: NCT02497677. Registered July 15 2015

Maternal touch in caregiving behavior of mothers with and without postpartum depression

The way a mother touches her infant plays a central role in maternal caregiving behavior. Thus, the purpose of the present study was to examine associations between touch and positive and negative caregiving behavior and whether this association differed in mothers with and without postpartum depression, an episode of depressive disorder following childbirth. Positive caregiving behavior was operationalized as sensitive behavior, i.e. the mothers ability to notice the childs signals, interpret these signals correctly and respond to them promptly and appropriately. Negative caregiving behavior was operationalized as overriding behavior, i.e. behavior which disturbs the childs behavior or redirects the childs attention to follow the parents agenda. Seventy mother-infant dyads (44 in the nonclinical group and 26 in the clinical group) participated in a 10minutes long mother-infant interaction at four months postpartum. The sample is part of an archival dataset of a longitudinal study investigating the parent-child relationship and child development. Three minutes of the interaction were coded a) microanalytically for touch, using a modified version of the Maternal Touch Scale (Beebe et al., 2010), and b) macroanalytically for sensitive and overriding behavior, using the Coding Interactive Behavior measure (Feldman, 1998). Hierarchical regression analyses with bootstrapping showed that caregiving touch, but not affectionate and static touch, was associated with sensitive behavior across the whole sample. Moreover, playful, but not rough-intrusive touch, was associated with overriding behavior across the whole sample. Associations did not differ between mothers with and without postpartum depression.

Relations between Automatically Extracted Motion Features and the Quality of Mother-Infant Interactions at 4 and 13 Months

Bodily movements are an essential component of social interactions. However, the role of movement in early mother-infant interaction has received little attention in the research literature. The aim of the present study was to investigate the relationship between automatically extracted motion features and interaction quality in mother-infant interactions at 4 and 13 months. The sample consisted of 19 mother-infant dyads at 4 months and 33 mother-infant dyads at 13 months. The coding system Coding Interactive Behavior (CIB) was used for rating the quality of the interactions. Kinetic energy of upper-body, arms and head motion was calculated and used as segmentation in order to extract coarse- and fine-grained motion features. Spearman correlations were conducted between the composites derived from the CIB and the coarse- and fine-grained motion features. At both 4 and 13 months, longer durations of maternal arm motion and infant upper-body motion were associated with more aversive interactions, i.e., more parent-led interactions and more infant negativity. Further, at 4 months, the amount of motion silence was related to more adaptive interactions, i.e., more sensitive and child-led interactions. Analyses of the fine-grained motion features showed that if the mother coordinates her head movements with her infants head movements, the interaction is rated as more adaptive in terms of less infant negativity and less dyadic negative states. We found more and stronger correlations between the motion features and the interaction qualities at 4 compared to 13 months. These results highlight that motion features are related to the quality of mother-infant interactions. Factors such as infant age and interaction set-up are likely to modify the meaning and importance of different motion features.