Symposium
Chair: Lynne Murray
Discussant: Edward Z. Tronick
Several studies of postpartum depression have found it to have a deleterious impact on the quality of the early mother-infant relationship. Typically, such relationships have been found to be characterised by either a hostile-intrusive maternal style or a withdrawn one. In this context, infants are typically avoidant and disengaged. These studies have found an association between postpartum depression and aspects of infant development. Thus, infants of mothers who have had a postpartum depression show cognitive delays, behavioural problems, and a high rate of insecurity of attachment. These adverse short-term outcomes appear to be mediated by the quality of the early mother-infant relationship.An important question is whether the short-term effects of postpartum depression have long term consequences for child development. There have been very few long term studies. This symposium brings together three of these studies (together with a unique study from the developing world). The findings are not entirely consistent. For example, the Cambridge study found no long term cognitive consequences, but strong continuities in behavioural disturbance (based on both maternal and teacher reports), with disturbances in the later mother-child relationship strongly predicted by infant attachment status. The two London samples, on the other hand, revealed an enduring cognitive deficit, with behavioural disturbance mediated by IQ. In contrast, the German study found few reliable indications of long term adverse sequelae. The extent to which these differences relate to specific features of the samples studied will be discussed. In addition, the evidence for a sensitive period with respect to the relationship between postpartum depression and child development will be examined in relation to the cognitive and the socio-emotional outcomes investigated.
Details of individual items:
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As part of a prospective, longitudinal study of the impact of postnatal depression on child development in a representative community sample of 100 mother-child pairs (58 index, 42 control), 96 were assessed at age eight-nine years. Measures were taken of the child's behavioural adjustment (by means of maternal and teacher reports), the presence of depressive cognitive styles (in response to story stems, and in the face of the threat of competition from a peer), and the quality of current mother-child interactions in a coaching task. Maternal reports of behaviour problems at eight to nine years showed striking continuity with those at five years. Although a deleterious impact of recent maternal depression was apparent, its association with reported behaviour problems was not as strong as that with postnatal depression. Maternal accounts of child behaviour disturbance were not influenced by either social class or child gender, but they were related to maternal negativity towards the child during coaching interactions.Teacher reports also showed substantial continuity between five and eight-nine years; these similarly showed an effect of postnatal rather than recent maternal depression, however, this was modified by child gender, with index boys being rated as showing the most problematic behaviour, whereas index girls' behaviour was rated as optimal. The children's cognitions of relevance to the experience of depression, expressed in the competetive peer game (e.g., pessimism, self blame) were significantly associated with both maternal and teacher reports of behavioural disturbance.
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There are conflicting findings about the long term consequences of growing up with a mother who has suffered maternal depression. While some short-term effects of postnatal depression on cognitive development have been demonstrated, uncertainty remains regarding long term cognitive sequelae. Behavioural problems have been reported more frequently for children of depressed mothers, however most studies have relied on maternal report measures. Perceptions of child behaviour may be influenced by maternal state. There is a general lack of studies of the influence of maternal depression on the children's self-esteem development.The study investigated the effects of severity, onset, number of phases and duration of depression on children's development. Of 1329 mothers screened for the presence of depressive symptoms, 92 mothers were diagnosed as having suffered DSM-IV defined depression (7%). The children of the 92 depressed and 92 control children were studied from birth until 8 and half years. Assessments included repeated DQ/IQ assessments, the Child Behavior Checklist (CBCL) at 6.3 and 8.5 years and child behaviour observations at 4.8, 6.3 and 8.5 years. Child self-esteem was assessed with the Harter Pictorial Scale of Self Competence at both 6.3 and 8.5 years, administered to both the children and the mothers about their child. No significant effects of severity, onset of depression (postnatal or later) or duration of depressive episodes on the child's cognitive development were found. However, mothers suffering chronic depression had children whose IQ fell 0.8 SD below those of the control group. Severity, onset (i.e. postnatal) and frequency of phases were significantly related to maternal ratings of behaviour problems on the CBCL (> 90. percentile). At 4.8 years, the case children were also observed to have more attention problems. At 6.3 and 8.5 years the differences had disappeared. Depressed mothers perceive more behaviour problems, however, few adverse cognitive or behavioural deficits are seen when observed independently. To assess whether this is due to maternal distorted perception, interviews about the child's self-esteem and mother reports about the child's competence (Harter) will be compared and related to the objective assessments of cognitive and motor development. Overall, the effects of SES on cognitive development scores far outstripped the effect sizes for depression. Depression per se may have less severe longterm effects on children's cognitive development than previously hypothesised. It will be discussed whether the maternal reports of high behaviour problems in their children not confirmed by observation are due to depression distortion or specific maladaptive behaviour of the child towards the mother.
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Since the abolition of the 'pass' laws in 1986, South Africa has seen a rapid urbanisation process, leading to a sharp increase in the number of people living in poor, overcrowded conditions in shanty towns on the periphery of established cities. Khayelitsha is one such peri-urban settlement2E It is characterized by endemic socio-economic adversity. An epidemiological study was conducted to determine the prevalence of significant postpartum mood disorder and associated difficulties in the mother-infant relationship and the course of infant developmental progress. Over the course of nine months a series of 147 women who had recently delivered a baby was identified from a defined area of Khayelitsha. These women were assessed at two months and 18 months postpartum. In addition to determining their social circumstances, assessments were made of maternal mood, the mother-infant relationship and infant physical, cognitive and socio-emotional development. Postpartum depression (i.e. DSMIV major depression) was identified in 34.7% of the sample. Maternal depression was found to be associated with an unplanned and an unwanted pregnancy. It was also associated with poor emotional and practical support from the partner. The mother-child interactions were characterised by marked maternal insensitivity and by marked infant disengagement. There was considerable continuity in these features.