Effective treatment for postpartum depression is not sufficient to improve the developing mother–child relationship

Abstract

Maternal depression is prevalent, and puts children at risk. Little evidence addresses whether treatment for maternal depression is sufficient to improve child outcomes. An experiment was conducted testing whether psychotherapeutic treatment for mothers, suffering from major depression in the postpartum period, would result in improved parenting and child outcomes. Participants included depressed women randomly assigned to interpersonal psychotherapy (n = 60) or to a waitlist (n = 60), and a nondepressed comparison group (n = 56). At 6 months, depressed mothers were less responsive to their infants, experienced more parenting stress, and viewed their infants more negatively than did nondepressed mothers. Treatment affected only parenting stress, which improved significantly but was still higher than that for nondepressed mothers. Eighteen months later, treated depressed mothers still rated their children lower in attachment security, higher in behavior problems, and more negative in temperament than nondepressed mothers. Initial response to treatment did not predict reduced risk for poor child outcomes. Early maternal negative perceptions of the child predicted negative temperament and behavior problems 18 months after treatment. Treatment for depression in the postpartum period should target the mother-infant relationship in addition to the mothers' depressive symptoms.

Oxytocin pathways in the intergenerational transmission of maternal early life stress

“…Depressed mothers are more likely to withdraw from interactions with their child, show lower amounts of sensitive parenting (Feldman et al, 2009), and perceive infant cues as more negative than non-depressed mothers (Forman et al, 2007). In addition, maternal postpartum depression (PPD) increases the likelihood of offspring internalizing and externalizing problems (Goodman et al, 2011), insecure attachment (Carter et al, 2001), increased stress reactivity (Halligan et al, 2004), and lower social engagement and empathy (Apter-Levy et al, 2014).…”

Alteración del desarrollo psicomotor en hijos de mujeres con depresión posparto de la ciudad de Valdivia-Chile

“…Por ejemplo, en los recién nacidos de madres deprimidas existiría mayor reactividad fisiológica (aumento de frecuencia cardiaca y niveles de cortisol), lo que se traduce en mayor irritabilidad y menor tolerancia al estrés 11,[15][16][17] . Asimismo, en lactantes se ha reportado menor actividad general, afecto plano, y cambios electroencefalográficos similares a los que ocurren en adultos con depresión crónica 11,18 ; además, a los 18 meses estos niños presentan peor desempeño en la escala de evaluación de desarrollo psicomotor de Bayley 19 .…”

Addressing the mother–baby relationship in interpersonal psychotherapy for depression: an overview and case study

“…IPT is therefore a PND treatment which has the potential to directly address maternal sensitivity in a similar manner to the attachment-based therapies. However, IPT so far has not been shown to make significant changes to the mother-baby relationship or the outcomes for the child (Forman et al, 2007). …”

“…The second possibility is that the IPT simply did not target the mother-child relationship. When IPT targets different relationships, such as the marital relationship (Forman et al, 2007) or the adolescent-parent relationship (Mufson et al, 2004), these relationships improve. Clark, Tluczek, and Wenzel (2008) found that a standard IPT treatment for depression could increase maternal positive affective involvement and verbalisation.…”

“…IPT is therefore a PND treatment which has the potential to directly address maternal sensitivity in a similar manner to the attachment-based therapies. However, IPT so far has not been shown to make significant changes to the mother-baby relationship or the outcomes for the child (Forman et al, 2007).Forman and colleagues (2007) suggest two possible causes for why IPT fails to change the course of the mother-baby relationship. One possibility is that when the mother's relationship with the child is formed under negative circumstances (such as during a depressive episode), then it remains stable and resistant to treatment.…”