Postpartal depression: Possible effects on early mother-child interaction and psychotherapeutical treatment approach

Die Mutter-Kind-Interaktion nimmt im Rahmen der ambulanten und stationären Behandlung postpartal depressiver Mütter eine zentrale Stellung ein. Es ist bekannt, dass Säuglinge äußerst sensibel auf den emotionalen Zustand ihrer Mutter und anderer Bezugspersonen reagieren. Diese Sensitivität in den ersten Lebensmonaten ist grundlegend für das Verständnis des Einflusses mütterlicher psychiatrischer Erkrankungen auf die kindliche Entwicklung. Der postpartalen Depression kommt als der häufigsten psychischen Störung junger Mütter dabei eine zentrale Bedeutung zu. Die besondere Lebenssituation der jungen Mütter erfordert eine Anpassung des therapeutischen Angebotes an die Bedürfnisse der Patientinnen. Ansätze zur Behandlung der postpartalen Depression unter Berücksichtigung der Mutter-Kind-Beziehung werden vorgestellt. (DIPF/Orig.)The interaction between mother and child helds a central position in in- and outpatient treatment of postpartal depressive mothers. Infants are highly sensitive towards the emotional state of their mothers and other attachment figures. This sensivity is essential for the comprehension of the influence of a psychiatric illness of the mother on child development. Postpartal depression as the most common psychiatric illness in young mothers takes a central part. The specific situation of young depressive mothers demands an adaptation of the therapeutic treatment. Different approaches towards the treatment of postpartal depression with respect to the mother-child interaction are elucidated. (DIPF/Orig.

Intergenerational Transmission of Internalizing Behavior: The Role of Maternal Psychopathology, Child Responsiveness and Maternal Attachment Style Insecurity

Background: Maternal depression and anxiety disorders are risk factors for the development of internalizing disorders in offspring. Maternal attachment has been discussed as one factor accounting for transmission. The aim of this study was to investigate child internalizing behavior at preschool age on a symptomatic and behavioral level and possible links to maternal mental health over time and maternal attachment style insecurity in a sample of postpartum depressed and anxious mothers. Sampling and Methods: Child internalizing behavior at preschool age was rated by the Child Behavior Checklist (CBCL), the Caregiver-Teacher Report Form (C-TRF), and during a mother-child free-play situation. We focused on child responsiveness as it has been linked to child internalizing behavior. Maternal attachment style insecurity was tested to mediate the link between maternal mental health (assessed postpartum and at preschool age with the Structured Clinical Interview for DSM-IV Axis-I Disorders, SCID-I) and child internalizing behavior/child responsiveness. Of the overall sample (n = 58), 28 women were diagnosed with postpartum depression and/or anxiety disorders according to DSM-IV, and 30 were healthy controls. Data were collected 3-9 months after delivery and at preschool age (mean = 4.6 years). Results: At preschool age, children of postpartum depressed and anxious mothers were rated significantly higher on child internalizing behavior by mothers, fathers, and additional caregivers compared to the control group. Child internalizing behavior rated by mothers was influenced by current psychiatric symptoms;maternal attachment style insecurity did not mediate this link. During interaction, children in the clinical group displayed significantly less child responsiveness compared to the control group. Maternal attachment style insecurity mediated the relationship between maternal mental health over time and child responsiveness. Conclusions: The results emphasize the need for interventions focusing on mother-child interaction and maternal attachment. (C) 2016 S. Karger AG, Basel

Rethinking Intrusiveness: Exploring the Sequential Organization in Interactions Between Infants and Mothers

To date, studies investigating maternal postpartum depression (PPD) have mainly focused on identifying failures in interactions of postpartum depressed mothers and their infants, often attributed to single dysfunctional maternal behaviors. Intrusiveness has been identified as a dysfunctional behavior characterizing mothers suffering from PPD. However, this research does not consider the co-constructed and sequential nature of social interactions, in which single behaviors cannot be conceived as isolated or disconnected units. The aim of the work presented in this paper was to explore the interactional dynamics underlying maternal behaviors previously identified as intrusive by mainstream literature on postpartum depression. Through a conversation analytical approach, we analyzed filmed interactions between mothers with and without postpartum depression and their 3-months-old infants. The analyses of 4 selected episodes illustrate similar dyadic activities, yet presenting different levels of mutuality and affective attunement. Results showed two normative features of social interactions that contributed to the different quality in the mutual adjustment of the partners: interactional rhythm and preliminaries. Interactional rhythm refers to the structuring of infants' spontaneous activity into a turn sequence, whereas preliminaries consist of verbal or nonverbal moves that anticipate following action. As evident from our analytical observations, what seems to be hindering the mutual coordination (previously labeled as "intrusive") is not based on specific individual behaviors but on the absence or violation of such interactional norms. Adopting an interactive and dynamical framework, we shifted the focus from maternal behaviors considered as dysfunctional to observing the unfolding of interactional aspects contributing to better or poorer sequential structuring. We argue that these aspects shape the possibilities for the infant's participation. Finally, we discuss the theoretical and methodological implications of adopting a conversation analytical approach for a better understanding of the relational dynamics related to clinical and non-clinical interactions

Rethinking Intrusiveness: Exploring the Sequential Organization in Interactions Between Infants and Mothers

To date, studies investigating maternal postpartum depression (PPD) have mainly focused on identifying failures in interactions of postpartum depressed mothers and their infants, often attributed to single dysfunctional maternal behaviors. Intrusiveness has been identified as a dysfunctional behavior characterizing mothers suffering from PPD. However, this research does not consider the co-constructed and sequential nature of social interactions, in which single behaviors cannot be conceived as isolated or disconnected units. The aim of the work presented in this paper was to explore the interactional dynamics underlying maternal behaviors previously identified as intrusive by mainstream literature on postpartum depression. Through a conversation analytical approach, we analyzed filmed interactions between mothers with and without postpartum depression and their 3-months-old infants. The analyses of 4 selected episodes illustrate similar dyadic activities, yet presenting different levels of mutuality and affective attunement. Results showed two normative features of social interactions that contributed to the different quality in the mutual adjustment of the partners: interactional rhythm and preliminaries. Interactional rhythm refers to the structuring of infants' spontaneous activity into a turn sequence, whereas preliminaries consist of verbal or nonverbal moves that anticipate following action. As evident from our analytical observations, what seems to be hindering the mutual coordination (previously labeled as "intrusive") is not based on specific individual behaviors but on the absence or violation of such interactional norms. Adopting an interactive and dynamical framework, we shifted the focus from maternal behaviors considered as dysfunctional to observing the unfolding of interactional aspects contributing to better or poorer sequential structuring. We argue that these aspects shape the possibilities for the infant's participation. Finally, we discuss the theoretical and methodological implications of adopting a conversation analytical approach for a better understanding of the relational dynamics related to clinical and non-clinical interactions

Rethinking Intrusiveness: Exploring the Sequential Organization in Interactions Between Infants and Mothers

To date, studies investigating maternal postpartum depression (PPD) have mainly focused on identifying failures in interactions of postpartum depressed mothers and their infants, often attributed to single dysfunctional maternal behaviors. Intrusiveness has been identified as a dysfunctional behavior characterizing mothers suffering from PPD. However, this research does not consider the co-constructed and sequential nature of social interactions, in which single behaviors cannot be conceived as isolated or disconnected units. The aim of the work presented in this paper was to explore the interactional dynamics underlying maternal behaviors previously identified as intrusive by mainstream literature on postpartum depression. Through a conversation analytical approach, we analyzed filmed interactions between mothers with and without postpartum depression and their 3-months-old infants. The analyses of 4 selected episodes illustrate similar dyadic activities, yet presenting different levels of mutuality and affective attunement. Results showed two normative features of social interactions that contributed to the different quality in the mutual adjustment of the partners: interactional rhythm and preliminaries. Interactional rhythm refers to the structuring of infants' spontaneous activity into a turn sequence, whereas preliminaries consist of verbal or nonverbal moves that anticipate following action. As evident from our analytical observations, what seems to be hindering the mutual coordination (previously labeled as "intrusive") is not based on specific individual behaviors but on the absence or violation of such interactional norms. Adopting an interactive and dynamical framework, we shifted the focus from maternal behaviors considered as dysfunctional to observing the unfolding of interactional aspects contributing to better or poorer sequential structuring. We argue that these aspects shape the possibilities for the infant's participation. Finally, we discuss the theoretical and methodological implications of adopting a conversation analytical approach for a better understanding of the relational dynamics related to clinical and non-clinical interactions

Rethinking Intrusiveness: Exploring the Sequential Organization in Interactions Between Infants and Mothers

To date, studies investigating maternal postpartum depression (PPD) have mainly focused on identifying failures in interactions of postpartum depressed mothers and their infants, often attributed to single dysfunctional maternal behaviors. Intrusiveness has been identified as a dysfunctional behavior characterizing mothers suffering from PPD. However, this research does not consider the co-constructed and sequential nature of social interactions, in which single behaviors cannot be conceived as isolated or disconnected units. The aim of the work presented in this paper was to explore the interactional dynamics underlying maternal behaviors previously identified as intrusive by mainstream literature on postpartum depression. Through a conversation analytical approach, we analyzed filmed interactions between mothers with and without postpartum depression and their 3-months-old infants. The analyses of 4 selected episodes illustrate similar dyadic activities, yet presenting different levels of mutuality and affective attunement. Results showed two normative features of social interactions that contributed to the different quality in the mutual adjustment of the partners: interactional rhythm and preliminaries. Interactional rhythm refers to the structuring of infants' spontaneous activity into a turn sequence, whereas preliminaries consist of verbal or nonverbal moves that anticipate following action. As evident from our analytical observations, what seems to be hindering the mutual coordination (previously labeled as "intrusive") is not based on specific individual behaviors but on the absence or violation of such interactional norms. Adopting an interactive and dynamical framework, we shifted the focus from maternal behaviors considered as dysfunctional to observing the unfolding of interactional aspects contributing to better or poorer sequential structuring. We argue that these aspects shape the possibilities for the infant's participation. Finally, we discuss the theoretical and methodological implications of adopting a conversation analytical approach for a better understanding of the relational dynamics related to clinical and non-clinical interactions

What Dyadic Reparation Is Meant to Do: An Association with Infant Cortisol Reactivity

BACKGROUND The latency to reparation of interactive mismatches (interactive repair) is argued to regulate infant distress on a psychobiological level, and maternal anxiety disorders might impair infant regulation. SAMPLING AND METHODS A total of 46 dyads (19 mothers with an anxiety disorder, 27 controls) were analyzed for associations between interactive repair and infant cortisol reactivity during the Face-to-Face-Still-Face paradigm 3-4 months postpartum. Missing cortisol values (n = 16) were imputed. Analyses were conducted on both the original and the pooled imputed data. RESULTS Interactive repair during the reunion episode was associated with infant cortisol reactivity (original data: p 0.23). Additional stepwise regression analyses found that latency to repair during play (p < 0.01), an interaction between distress during the first trimester of pregnancy and latency to repair during reunion (p < 0.01) and infant self-comforting behaviors during the reunion episode (p = 0.04) made independent contributions to cortisol reactivity in the final regression model. CONCLUSIONS This is the first study demonstrating that interactive repair is related to infant psychobiological stress reactivity. The lack of a relation to maternal anxiety disorder may be due to the small sample size. However, this result emphasizes that infants respond to what they experience and not to the maternal diagnostic category

The Early Mother-to-Child Bond and Its Unique Prospective Contribution to Child Behavior Evaluated by Mothers and Teachers

Maternal bonding has been described as the quality of the affective tie from a mother to her infant. This early bond's mental components and its longitudinal impact on child outcome have been markedly understudied. Although most researchers assume impaired maternal bonding to have a negative impact on child development, there is a lack of prospective studies evaluating this hypothesis. Since maternal mental health problems may negatively affect both bonding quality and child development, it is still to be determined whether there is a unique contribution of bonding quality to child behavior problems over and above maternal psychopathology. We examined a community sample of 101 mother-child dyads at the child's age of 2 weeks (t1) and 6 weeks (t2), 4 months (t3), 14 months (t4), and 5.5 years (t5). Maternal bonding and psychopathology were assessed at time points t1-t4 using the Postpartum Bonding Questionnaire (PBQ-16) and the Symptom Checklist Revised (SCL 90-R). Child behavior problems were rated in a multi-informant design by mothers and teachers at t5 using the Strengths and Difficulties Questionnaire (SDQ). In the case of maternal judgment of child behavior problems, bonding at 14 months (t4) proved to be a significant predictor ((beta = 0.30;p = 0.011). Teacher-rated child behavior problems were significantly predicted by maternal bonding at 2 weeks (t1;beta = 0.48;p = 0.025). Our results indicate a prospective influence of the early mother-infant bond on child development and underline the unique contribution of bonding quality to child behavior problems over and above the impact of maternal psychopathology in a community sample. (C) 2016 S. Karger AG, Base

Linking maternal psychopathology to children's excessive crying and sleeping problems in a large representative German sample—The mediating role of social isolation and bonding difficulties

Attaining self-regulation is a major developmental task in infancy, in which many children show transient difficulties. Persistent, clinically relevant difficulties in self-regulation include excessive crying or sleeping disorders. Many families with affected children are burdened with multiple psychosocial risk. This suggests that regulatory problems are best conceptualized as the maladaptive interplay of overly burdened parents and a dysfunctional parent–child interaction. The current study examines whether social isolation and bonding difficulties function as mediating mechanisms linking maternal psychopathology to (1) children's excessive crying and (2) sleeping problems. The sample comprised N = 6598 mothers (M = 31.51 years) of children between zero to three years of age (M = 14.08 months, 50.1% girls). In addition to socio demographic data, the written questionnaire included information on maternal depression/anxiety, isolation, bonding, and children's regulatory problems. Hypotheses were tested with a mediation model controlling for psychosocial risk and child characteristics. As expected, maternal symptoms of depression/anxiety were linked to infants‘ excessive crying and sleeping problems. Social isolation and bonding difficulties mediated this association for excessive crying as well as for sleeping problems, but social isolation was a single mediator for sleeping problems only. The findings provide important insights in the mediating pathways linking maternal psychopathology to children's regulatory problems