IPMH lectures by Lynne Murray: Postnatal Depression

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The IPMH group had a wonderful weekend with Lynne Murray. Lynne talked about the effects of postnatal depression in the mother on the developing child, and the effects of maternal anxiety on the developing child. I will discuss postpartum depression in this blog and anxiety in a subsequent posting.

Postpartum depression (or postnatal depression – PND):

Depression can be defined as a pervasive low mood, loss of interest, and feelings of guilt or even the wish to die, and usually includes neuro-biological features such as sleep or appetite disturbance, loss of concentration, retardation or agitation, and excessive fatigue. The point prevalence of depression in childbearing years (the proportion of women in child-bearing years that has depression at a specific point in time) is more than 8%. The prevalence of women with depression 3 months postpartum ranges from 13% in high-income countries (Gavin et al, 2005, Pearlstein et al, 2009) to 20% in low-income countries (Fisher, 2012, Pearlstein et al, 2009). Most women with postpartum depression recover within 6 months, but a significant proportion (30%) continue to be depressed after one year (Goodman et al, 2004). The impact of a mother’s postpartum depression on her developing infant derives from the fact that this condition occurs at a time of an infant’s maximum dependency on his mother (I will refer to the infant using the masculine pronoun to distinguish the infant from pronouns indicating the mother.) and at a time when the infant is most sensitive to his mother’s cues and will be most strongly influenced by them.

Nature has encouraged the process of mutual communication between babies and adults by giving baby faces features that adults find irresistible and by making babies prefer human faces to other visual images. In fact, an adult has specific brain responses to gazing at a baby (especially a mother to her own baby) that are similar to those when gazing at her romantic partner. There is also a rise in the “love hormone”, oxytocin. Gazing at a baby sets off specific behaviors such as a stereotyped greeting (raised eyebrows, open mouth, smile) and changes in the voice (high pitch, simple phrases, melodic pitch). Correspondingly, the infant will gaze longer at an image with the configuration of a human face (schematic eyes, nose, mouth) than at a blank face shape or one with scrambled internal features. Newborns also prefer faces with eyes open and with a gaze directed at them than eyes closed or averted gaze (A Batki et al, 2000, Farroni et al, 2002). The famous studies of Meltzoff and Moore showing that newborns can imitate an adult sticking out his tongue or opening his mouth wide demonstrate the amazing capacity the infant has for “cross-modal” responsibility. In other words, the infant can perceive the visual image of the adult making these movements and respond by making a facial action that mirrors that of the adult through an “active intermodal mapping” ( Meltzoff & Moore, 1989, p. 961). You can imagine that this ability in the newborn prepares the infant to be able to connect with the adult caregiver in a remarkable way. Not only that, but newborns also prefer their mother’s face, voice, and smell, rather than someone else’s. All these preferences prepare the infant to make a connection to his particular caregiver.

However, postpartum can intrude into the caregiving relationship just at this sensitive time when the infant is ready for a special connection and needs it for his healthy development. Colwyn Trevarthen calls the back and forth gaze, gestural, and vocal exchange of the caregiver and infant in the first few months as “proto-conversation” (Trevarthen, 1978). This important communication between mother and infant can be interfered with when the mother is depressed. Mothers with postnatal depression tend to show general insensitivity to their infants’ cues with two main patterns of response – either remote and disengaged or hostile and intrusive. In both cases the infants are likely to avoid contact with their mothers and become distressed. In low risk samples, the PND mothers are less sensitive but the disturbance is subtler, with problems occurring more often with boy babies than with girls.

In fact, after the mother’s recovery from depression, there tend to be persistent difficulties in the interaction between mother and infant (Martins & Gaffan, 2000, Murray et al, 1996). It is important to recognize that different parenting practices are associated with different patterns of child development; weaknesses in one area do not always predict weaknesses in another. Murray has documented different parenting practices associated with cognitive development and achievements (IQ), behavioral regulation problems in childhood, and depressive disorder in adolescence. I will discuss these three areas of child development and the effects of PND in several subsequent blog postings. I will emphasize the potential for mothers with PND to modify their behavior towards their infants in order to possibly mediate these effects.

References:

Batki A, Baron-Cohen S, Wheelwright S, Connellan J, Ahluwalia J (2000). Is there an innate gaze module? Evidence from human neonates, Infant Behavior & Development, 23:223-229.

Farroni T, Csibra G, Simion F, Johnson M, Eye contact detection in humans from birth, Proceedings of the National Academy of Sciences, 99:9602-9605.

Fisher J, Mello M, Patel V, Rahman A, Tran T, Holton S, Holmes W (2012). Prevalence and determinants of common perinatal mental disorders in women in low-and lower-middle-income countries: A systematic review. Bulletin of the World Health Organization, 90:139-149.

Gavin N, Gaynes B, Lohr K, Meltzer-Brody S, Gartlehner G, Swinson T (2005). Perinatal depression: A systematic review of prevalence and incidence, Obstetrics & Gynecology, 106:1071-1083.

Goodman J (2004). Postpartum depression beyond the early postpartum period, Journal of Obstetric, Gynecologic & Neonatal Nursing, 33:410-420.

Martins C, Gaffan EA (2000). Effects of early maternal depression on patterns of infant-mother attachment: a meta-analytic investigation, J Child Psychol Psychiatry 41(6):737-746.

Murray L, Fiori-Cowley A, Hooper R, Cooper C (1996). The impact of postnatal depression and associated adversity on early mother-infant interactions and later infant outcome, Child Development 67(5):2512-2526.

Pearlstein T, Howard M, Salisbury A, Zlotnik C (2009). Postpartum depression, American Journal of Obstetrics & Gynecology, 4:357-364.

Trevarthen C & Hubley P (1978). Secondary intersubjectivity: confidence, confiding and acts of meaning in the first year. In A. Lock (Ed.) Action, gesture and symbol: The emergence of language, London: Academic Press (pp. 183-229).

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