Mothers with and without bipolar disorder and their infants: group differences in mother-infant interaction patterns at three months postpartum

Abstract

Background Women with bipolar disorder (BD) have a high risk of illness relapse postpartum. The risk coincides with the period when mother-infant interactions are evolving. We compared mother-infant interactions in dyads where the mothers have BD with dyads where the mothers have no mental disorder. The association between concurrent affective symptoms of BD mothers and interaction quality was investigated. Methods Twenty-six women with BD and 30 comparison women with infants were included. The Parent-Child Early Relational Assessment (PCERA) was used to assess maternal behaviour, infant behaviour and dyadic coordination in interactions at 3 months postpartum. The Inventory of Depressive Symptomatology and Young Mania Rating Scale were used to assess affective symptoms of BD mothers at the time of interaction. Results There were significant group differences with medium to large effect sizes (0.73–1.32) on five of six subscales within the three interactional domains. Most interactional concerns were identified in dyadic coordination. No significant associations were found between maternal symptom load and interaction quality within the BD sample. Forty-six percent of the BD mothers experienced a mood episode within 0–3 months postpartum. Conclusions The present study identified challenges for mothers with BD and their infants in “finding” each other in interaction at 3 months postpartum. If sustained, this interaction pattern may have a long-term impact on children’s development. We suggest interventions specifically focusing on sensitising and supporting mothers to read infants’ cues on a micro-level. This may help them to respond contingently and improve dyadic coordination and synchronicity.

Bipolar offspring and mothers: interactional challenges at infant age 3 and 12 months—a developmental pathway to enhanced risk?

“…This study is a prospective follow-up study of BD mothers and their infants compared with historical data from non-clinical mothers and their infants. The study is part of a larger Norwegian investigation of infant families in which the mother has BD (Anke et al 2019a , b ).…”

“…The validated 12-month scale is not suitable for investigating how interactions develop from 3 to 12 months because it contains variables that are unrateable at age 3 months. Additionally, the validated scale that was used in our previous study at 3 months (Anke et al 2019a ), does not contain all variables that are of interest at 12 months. Thus, for exploration of patterns of change in the interactions, PCERA variables that are rateable at both 3 and 12 months were clustered into subscales equivalent to behavioural, affective and communicative categories in the manual (Clark 1985 , 2006 , 2009 , 2010 ).…”

“…The mothers with BD were generally positive and friendly in the interactions, but displayed more difficulties in sensitivity, involvement and contingent responsiveness than the comparison mothers, and more infants showed subdued positive affect and communication. However, the most concerning interaction behaviours were observed in mother–infant dyadic coordination (Anke et al 2019a ).…”

“…Interactions are complex and comprise dynamic and interplaying processes between (1) parental behaviour, (2) infant behaviour, and (3) dyadic coordination (Beebe et al 2010 ; Tronick 2007 ), implying that a comprehensive investigation ought to include all three domains. To our knowledge, we are the first to have done this in the context of BD (Anke et al 2019a ). Furthermore, to assess the gravity of interactional challenges, and the possible impact this may have on the developmental risk of bipolar offspring, it is important to get a better sense of how mother–infant interactions develop over time.…”

“…Within this main aim, our first aim was to assess mother–infant interaction patterns at infant age 12 months. Our second aim, and building on our previous findings at infant age 3 months (Anke et al 2019a ), was to investigate patterns of change in the interactions within and between the groups from infant ages 3 to 12 months. The timing of the assessments was selected to reflect important milestones in infants’ social maturation (Zeanah et al 1997 ), and our decision to utilise validated, age-dependent assessment-scales when coding the mother–infant interactions.…”