|
Depression’s influence on mother-infant interactions
at 3 months postpartum was studied among 50 mother-infant dyads
in which the mothers had at least one past episode of major depression.
Current depression was measured using the BDI-II. Aims were to test
one of the hypothesized behavioral consequences of maternal depression
on infants that greater exposure to maternal depression during fetal
development is associated with infants’ expression of more
negative and less positive affect. The timing duration and course
of depression as well as cortisol levels throughout pregnancy characterized
exposure to maternal depression. Three face-to-face interactions
were videotaped and later coded using behavioral descriptors. Results
support the hypothesis that earlier fetal exposure to depression
is correlated with fewer infant expressions of positive affective
behavior; however a significant correlation between depression and
greater displays of negative affect was not supported. Future studies
may consider refining the measure of affective behavior or using
multiple measures in classifying depression.
Implications for Infant Development (Pregnancy Postpartum
and Newborn Development Analysis [PANDA] Project) is a longitudinal
research study of infants whose mothers suffered from major depression
prior to or during pregnancy. These infants are at a higher risk
of exposure to postpartum depression because a history of depression
is one of the strongest predictors of postpartum depression (O’Hara
& Swain 1996). Depression in mothers has been associated with
adverse experiences not only for infants but also for older children
as well (Goodman & Gotlib 1999). Belsky et al. (2001) found
that high levels of negative emotionality in infants were related
with low levels of social competence later in life. During face-to-face
interactions among mother/infant dyads infants of depressed mothers
showed less positive interaction behavior than infants of nondepressed
mothers (Cohn et al. 1990; Field 2002; Field et al. 1988). Infants
of depressed mothers also showed more negative expressions during
mother-infant interactions (Cohn & Tronick 1983; Field 2002).
Furthermore during pregnancy depression and stress are associated
with elevated cortisol levels which may play a mediating role in
infant development and vulnerability to depression. By focusing
on certain observational situations we expected to show an association
between mothers’ depression and infants’ affective behavior.
We predicted that greater exposure to maternal depression during
fetal development would predict infants’ expression of more
negative and less positive affect.
Recruitment and Participants recruited from the Emory
Healthcare System, Emory Clinics, and private obstetrics practices.
Primiparous women with a personal history of at least one episode
of major depression prior to pregnancy
- N = 50 mother/infant dyads
- Mean age = 30.3 years
- 67.1% Caucasian, 27.6% African American
- Mean Yearly Family Income = $66 000 – 70 000
- 71.1% married families and 23.7% cohabitating families
- 67.1% of mothers have at least an undergraduate college degree
- Mean number of past major depressive episodes = 2.19
- Mean age of onset of first major depressive episode = 21.7
Procedure
Participants partake in a lab visit during each month
of pregnancy through six months postpartum and then again at 12
months postpartum. A collection of measures geared to assess a more
accurate range of depression are completed during each visit. Cortisol
was also measured from 4 hour urine samples collected first thing
in the morning once each month during pregnancy. The Beck Depression
Inventory – II (BDI-II; Beck 1996) was the primary measure
used to evaluate depression. Maternal depression was characterized
as the timing duration and course of depression (as indicated by
exceeding the BDI-II clinical cut-off for depression) as well as
baseline cortisol levels throughout pregnancy. Specifically the
first pregnancy month with depression the total number of pregnancy
months with depression and the average BDI-II pregnancy score were
assessed as well as average cortisol levels during pregnancy. Infant
measures are taken at postpartum 3- 6- and 12-month lab visits of
which the 3-month lab visit is the primary focus of this study for
infant affective behavior. Mother and child were observed during
three conditions: Baseline Feeding and Freeplay. Each observation
was video-recorded to aid in rating affective behavior. The observations
were rated continuously by taking note of the rating as the observation
began the tape was rewound and toggled in slow motion until the
second at which an affect change was determined and changes were
noted throughout the condition. Some conditions were also coded
by another rater to establish inter-rater reliability. The codes
for affective behavior include Approach Withdrawal Neutral Sleep
Uncodeable and Unratable. Table 1 identifies certain emotional expressions
facial indicators vocal cues and body gestures that help define
each affect code (Goodman 2002).
- Analyses of the observational data was conducted using the Generalized
Sequential Querier (GSEQ; Bakeman and Quera 1995)
- Figure 1 and Table 1 display the distribution and statistics
of the indices of maternal depression
- Figure 2 displays the proportion of time infants express each
emotion
- A correlation was conducted using SPSS between relative duration
of time infants express positive and negative affect and the following
indices of maternal depression
- 1st pregnancy month with depression
- Total # of pregnancy months with depression
- Mean BDI-II pregnancy score
- Mean cortisol levels during pregnancy
- Interobserver reliability of coding infant affect kappa coefficient
= 0.79 agreement = 85.95%
- The earlier in pregnancy that depression first occurred the
more relative time duration infants display Approach during feeding
and freeplay (r = 0.35 r = 0.30)
- The higher the BDI-II mean pregnancy score the more relative
time duration infants are in Approach during feeding (r = 0.34)
- No significant correlations were found between the total number
of pregnancy months with depression or mean cortisol levels during
pregnancy with the proportion of time infants express Approach
- No significant correlations were found among the maternal depression
predictors and infant displays of Withdrawal
These findings are very preliminary and will require further testing
to understand the implications. Data collection is ongoing and thus
the sample size will be considerably larger. Additional measures
of depression that are being collected will be considered for their
relationship with infant outcome. Measures of mothers’ affect
expressions during these same interactions may reveal important
contingencies between mothers’ and infants’ affect expression.
Re-evaluation of the proportions of time spent in each affect state
focusing primarily on Approach Withdrawal and Neutral may display
a more accurate depiction of infant emotional behavior.
This material is based upon work supported by the Howard Hughes
Medical Institute under Grant No. 52003727 and by the Emory University
Conte Center for Neuroscience of Mental Disorders under NIMH Grant
No. MH58922. We would also like to thank Dr. Roger Bakeman for consulting
in observational data analyses, Erin Tully for assistance in data
analyses, Charmayne Dunlop-Thomas for project guidance, and Lauren
Gonsalves for affect coding.
Mothers who have a history of depression are more
likely to have postpartum depression. Mothers with depression during
pregnancy or have postpartum depression run the risk of exposing
their infant to depression as well. Several studies have found that
exposure to depression has adverse effects on infants. This research
goes one step further in trying to determine some of the general
trends of depression that might influence the emotions these infants
express more frequently. We observed mothers and infants interact
in certain situations and determined how often the infants displayed
a positive negative or neutral emotion. We then related the infants
emotional states with their mothers' depression.
|
