Inside the 'Baby Blues'
Understanding the part that maternal postpartum depression plays in infant development
Postpartum depression has long been known to interfere with a mother's capacity to care for her newborn. Just what this maternal depression does to compromise infant development has now been clarified a little thanks to a new study published in the August 2009 issue of the "Journal of the American Academy of Child and Adolescent Psychiatry."
Comparing groups of depressed mothers with those experiencing maternal anxiety disorders, as well as controls, Dr. Ruth Feldman and colleagues at the Bar-Ilan University and Sheba Medical Center in Tel-Hashomer, Israel, studied three infant outcomes, including social engagement, fear regulation and physiological stress reactivity.
The researchers found that infants of depressed mothers scored the poorest on all three outcomes measured at nine months: they showed the lowest levels of social engagement, were unable to self-regulate during situations that introduced novelty, fussed and cried more often and their physiological stress response showed both higher baseline levels and a more pronounced stress reactivity.
Not that new mothers-to-be need one more potential worry to add to their list, but in speaking with Feldman about the results of the study, she outlined two longer-term implications. "First, we know from previous longitudinal studies - both ours and others - that disruptions to social engagement and self-regulation at this age (nine to12 months, a key period in infant social and emotional development ) bear long-term consequences for later social adaptation and mental health." Animal studies also have shown that when the physiological stress management system (cortisol) is disrupted in infancy, it is often not fully reversible.
Second, researchers are now seeing that when these children of depressed mothers reach age five or six, the problems can continue and often get worse. "There are more children with a clinical diagnosis (anxiety, conduct problems, attention problems, etc.), their social skills are less mature, they are less able to self-regulate and their physiology continues to be less adaptive," Feldman says. In fact, evidence points to continuity from maternal to child depression and from early-onset to adolescent and adult depression.
These findings are especially important in light of the number of new mothers who experience some degree of postpartum depression. According to Michael O'Hara, professor of psychology at the University of Iowa, Iowa City, a recent comprehensive review of the literature suggests that about seven percent of women will experience a major depression in the first three months after delivery, and the prevalence rate rises to about 19 percent when including minor depression. In relation to her recent study, Feldman notes that researchers were surprised by the proportion of women in the initial sample who reported high symptoms of depression in the second day after birth (about 20 percent), despite the fact that the sample was of women typically considered to be low-risk (educated, physically healthy, middle class, not a teenager, in a stable relationship and delivered a healthy full-term infant).
"It is critical that public opinion changes about post-partum depression," Feldman says. "We should have better systems of public support for mothers and available treatment programs focusing specifically on postpartum depression."
In the meantime, prevention is key. O'Hara recommends that expectant mothers who have a history of depression inform their OB/GYN and perhaps contact their mental health provider so that they can be followed closely. But all women can take steps aimed at reducing the likelihood of exhausting their emotional and physical reserves, such as planning in advance for the baby's needs (nursery, pediatrician, etc.), establishing a social support network of relatives and friends and limiting simultaneous major life transitions like moving or changing jobs.
Once the baby has arrived, new mothers should arrange for help with housework and the care of older children, if necessary, as well as focus on getting adequate sleep. New mothers should take care of themselves, O'Hara says. "This means taking opportunities to exercise, visit friends and engage in other activities that are pleasurable." Sometimes these activities can involve the infant, but other times they should be done without.
If a new mother feels she is experiencing postpartum depression, she should consult with her physician as soon as possible, as symptoms of depression and anxiety are occasionally due to medical problems associated with thyroid dysfunction or other health problems. She may also benefit from consulting with a mental health professional, in addition. "Some parents need training or guidance in how to respond to their infant," O'Hara says. "Depressed mothers can learn to sensitively respond to their infant even when they are distracted by their own worries."
The study by Feldman and colleagues found that sensitive mothering was related to the infant's social engagement and protected against the effects of maternal depression on the development of the child's social skills. Maternal sensitivity also had a positive impact on the infant's physiological stress response.
Regardless, keep in mind that this work and its implications are quite complicated, O'Hara says. "It cannot be said that the parenting behavior of a depressed mother inevitably leads to poor outcomes for the offspring."
But it's clear that simply telling depressed mothers to "snap out of it" is never the answer.
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