Postpartum depression, parentings and child outcomes Flashcards
Discuss the key to good parenting being the quality of the relationship
- emotional availability
- be sensitive/attuned
- provide appropriate structure (stimulation, activities)
- don’t be intrusive
- don’t be hostile
What is optimal structuring?
- provides appropriate guidance and suggestions
- emotional and cognitive scaffolding
- sets limits and boundaries appropriate to context
- remains firm in the face of pressure
- adult is clearly “older and wiser”
what are Belsky’s 1984 determinants of individual differences in parenting
- child characteristics
- parent characteristics: personality, developmental history, mood, own attachment to parents
- context: culture/support
Discuss the importance of attachment theory re parenting characteristics in how people parent
- the quality of caregiving in early childhood/through childhood of parent is important to their own parenting
e. g. how the parent mentally represents this/state of mind regarding attachment - compelling evidence for this determining child’s attachment
Discuss the important of mood re parenting characteristics in how people parent
- anxiety/depression
- lots of evidence saying that parental loss/harsh parenting in childhood predisposes adults to mood disorders, especially chronic depression
What is postnatal depression ?
-depressed mood meeting DSM-V criteria for mood disorder during first year after birth
what percentage of people with PND can be persistent
30%
discuss the difficulty in identifying PND
- there is a difficulty in disentangling “normal” adjustment difficulties to a clinical mood disorder
- also confounded my stigma associated with PND: should be happiest time of life etc.
What percentage of women experience postnatal depression
13%
what is the plan in Australia associated with PND and what does it do
National Perinatal Depression Plan - identifies, refers and supports women with perinatal mood disorders and train health professionals
when does PND usually show itself
-symptoms usually appear between 6 weeks and 6 months after birth
how does PND meet the DSM-IV criteria
when symptoms last most of the day everyday for at least 2 weeks, to the extent that function is compromised
what are the symptoms of PND
-symptoms are the same as symptoms of depression at any other time in life
what are the shared symptoms between exhaustion and PND
- teariness
- sleep disturbance
- loss of concentration
- feeling you can’t cope
what are the distinguishing symptoms between exhaustion and PND
- inability to sleep even when baby is sleeping
- loss of pleasure
- morbid/suicidal thoughts
- low self-esteem
- loss of interest in eating
discuss the problems with denial/minimising/normalising PND
- rates of treatment uptake and acceptance of the “label” are very low despite public health education campaigns
- many people confused PND with postpartum psychosis, therefore distance themselves from it
- many woman have to reach crisis point before seeking help
who is vulnerable to PND
-everybody but some more than others
what are teh risk factors of PND
- past history/family history of mental illness
- unsupportive critical relationship
- stressful life events
- social factors - low income, migrant families
- personality factors
- a difficult/unsettled infant
discuss the difference between a transient “adjustment disorder” to a life transition & PND (percentages)
- many recover (70%) by the time baby is 6 mths old
- some (30%) have ongoing and severe depression
who is vulnerable to persistent or late onset depression
- depends on severity of symptoms
- depression/anxiety in pregnancy
- low ses
- migrant background
- low marital satisfaction 4 mths
- infant health problems/temperament in first 4 mths
What are the mechanisms through which PND may impact on the infant: four pathways
- genetic predisposition: effects on babies serotonin transporter gene
- in utero environment effects: impact of maternal stress hormones
- postnatal caretaking effects: mothers negative perception of infant behaviour, mother’s behaviour towards child
- the stressful social/ecologial context of the children’s lives
Discuss the impact of depression symptoms on the baby in regards to affect, cognitions and behaviour
affect - low mood, anxiety, irritability - baby can imitate mother’s mood
cognitions - negative/distorted thinking of baby behaviours
behaviour - hostile, irritable, unresponsive
Discuss the caretaking: mutual regulation model
Mother fails to respond sensitively to infant’s signals. Infant then becomes inattentive and/or rejecting of mother’s stimulation as a way of coping. Infant gives fewer cues to mother - mother has less chance to practice responsive caregiving.
Discuss Field’s 2010 caregiving/interaction style problems associated with depression
Interaction style:
irritability and hostility during interaction, less engagement, less warmth, less turntaking/gameplaying, less attunement to infant responses, different vocalisations, less stimulation
What are two common profiles of depressed mothers and what is their main element
withdrawn - affectively restricted behaviours
intrusive - high affectivity and irritability
Discuss the findings of the Tresillian Family Adjustment Study 2000-2009 in regards to PND impact on infants
Why does PND effect cognitive development? (Hay, 1997)
- early social experiences that interfere with the infant’s capacity to attend to the environment result in decreased capacity for learning
- process of learning by following mother & observing her interactions with the world may be compromised
- if mother fails to provide support for regulation of emotion, this may compromise information processing
Why does PND effect relationship/attachment in children?
mutual regulation model- impaired pattern of day to day interaction between mother and infant
Why does PND cause behaviour problems in children
- genetic predisposition to internalising/externalising problems
- parent fails to provide optimal support for child’s developing emotional regulation
- disciplinary/parenting styles related to concurrent mood e.g. hostility
Discuss the finding that not all children of depressed mothers
- it is the nature of caregiving not depression per se that contributes to adverse outcomes for children
- research shows that in cases where depressed mothers behave sensitively with their infants, the infants are not securely attached
- intervention studies have shown that treatment of depression ‘on its own’ has little or no impact on the quality of the parent-child relationship
What are other moderators of the effect of maternal depression, other than caregiving style
- father’s/alternative carers health and involvement with the child
- course, severity and timing of mother’s depression
- characteristics of the child - gender, temperament
- characteristics of the mother
- characteristics of the environment
Discuss the sample in the Tresillian Family Adjustment Study 2000-2009 in regards to PND impact on infants
-sample: mothers who presented to a parent-craft hospital with unsettled infants. Recruited child at 4 mths. 70% tertiary education, 20% from migrant families migrant
In the Tresillian Family Adjustment study 2000-2009 how was depression assesed in mothers, and how was the impact assessed in the babies
- mothers: both diagnostic and symptom measures when baby was 4 mths, 12 mths, 4 yrs, 7 yrs
- babies: Bayley scales 15 mths, WPPSI 4 yrs, Peabody Picture Vocabulary Test 7 yrs
In the Tresillian study, at 4 mths what percentage of mothers met the DSM-IV criterion for an episode of depression since childbirth. What percentage continued to experience depression at a diff time-point?
62% & 30%
Discuss the findings in the Tresillians study for cognitive development
- cognitive: chronic depression related to lower cognitive performance at 15 mths
- no significant associated between depression and cognitive outcomes at 4 or 7 years
Discuss the findings for the Tresillian study for internalising and externalising behaviour problems at 4 yrs
- children exposed to chronic maternal depression were rated by their parents as significantly more problematic
- at 15mths, this finding was not supported by an independent rater but it was at 4 yrs (e.g. teacher)
Discuss the correlation between parenting styles and being never depressed, brief depression & chronic depression (McMahon et al. 2006)
-never depressed: secure/autonomous most high
-brief depression: secure/autonomous most high, but closely followed by dismissing
chronic depression: pre-occupied most high closely followed by dismissing
Discuss the correlation between the attachment between the child and mother and mother’s depression for never depressed, brief depression, chronic depression (McMahon 2006)
- never depressed: most highly secure
- brief depression: most high secure
- chronic depression: most high avoidant & secure, some ambivalent
Discuss the finding that a secure attachment state of mind in the mother is protective
- non depressed mothers with a secure state of mind of attachment, 60% of children securely attached
- briefly depressed mothers with a secure state of mind of attachment, about 65% children securely attached
BUT when you combine brief or chronic depression with an insecure state of mind, the probability of your child being securely attached is much less
What did Trapolini 2008 find using the depression & maternal emotional availability scale at 4 yrs
-chronically depressed mothers are less sensitive
What did Trapolini 2008 find using the depression & maternal caregiving representations scale at 4 yrs
chronically depressed mothers have lower perspective taking and lower pleasure in child
In summary, what is chronic maternal depression associated with at 15 mths & 4 yrs
15 mths: more likelihood of insecure attachment with child (moderated by mother’s state of mind about attachment)
4 years: less optimal maternal caretaking representations, lower maternal sensitivity during interactions
What conclusions can be drawn from the relatively low-risk sample on maternal impacts of depression
- chronic, but not brief depression was associated with ongoing social and emotional problems with children
- mothers with an insecure state of mind about attachment 7 times more likely to have chronic depression
- relationship effects moderated by state of mind
- effects on cognitive development minimal
Adverse child outcomes for kids with mothers with PND is higher in….
high SES risk samples: cumulative risk
What are the clinical implications for all of this
- universal screening important
- evidence that treating only depression does not influence parenting
- need to address maternal state of mind about attachment
- need to support mothers in providing positive parenting
