Symposium
Chair: Peter Cooper
Discussant: Alan Stein
There have been several studies from around the world which have identified a deleterious impact of maternal postpartum mood disorder on the quality of the mother-infant relationship. Other work has documented similar mother-infant difficulties in conditions of extreme socio-economic adversity. The predictive power of these early difficulties is less clearly established, but there is some evidence from longitudinal research suggesting that the quality of such early relationships constrains child emotional and, possibly, cognitive development. There are certainly sufficient empirical grounds to justify the development and evaluation of preventive interventions for delivery to populations identified to be at high risk of early mother-infant relationship difficulties. This symposium brings together clinical researchers from four continents who have recently been engaged in such preventive work. The British study identified primiparous women late in pregnancy who were at high risk for postpartum depression. Two studies involved women drawn from conditions of extreme socio-economic adversity: a sample of pregnant women in a Khayelithsa, a South African peri-urban settlement; and a sample of young mothers from a peri-urban settlement in Caracas, Venezuela. The fourth sample was a group of single adolscent Portuguese mothers. Although the specific features of the interventions used in these studies differed, they all aimed to enhance the quality of the early mother-infant relationship.In this symposium the interventions used in these varied populations will be described and contrasted. In all of them some benefit of treatment has been found. These will be outlined and the role of culturally specific mediating factors will be discussed. The place of preventive interventions in the routine delivery of services, both in economically developed countries and ones characterised by widespread poverty, will be considered.
Details of individual items:
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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. The rate of maternal depression and associated difficulties in the mother-infant relationship is high.Four mothers drawn from the Khayelitsha community were trained in basic counselling skills and the preventive intervention programme developed by Murray and Cooper (see Cooper and Murray abstract above). They delivered this intervention from the late antenatal period until six months postpartum to a random sample of 40 women recruited late in pregnancy. These women were matched on demographic variables with 40 women drawn from a simultaneously assessed large epidemiological sample of Khayelitsha women who had recently delivered a baby. An assessments was made, blind to treatment, at six months postpartum, covering demographic factors, maternal mood, the quality of the mother-infant relationship, and infant physical, cognitive, and socio-emotional development.The intervention was extremely well received by the mothers who reported gaining considerable support from it. There was a modest benefit in terms of maternal mood. In addition, the children who received the intervention gained weight quicker than those who did not. Notably, ratings of the quality of the mother-infant relationship, both in play and in the feeding situation, revealed a significant benefit of the intervention, as did sensitivity to infant temperamental features.
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In view of the fact that adolescent motherhood is a risk factor for disturbances in thepsychological well being of both mother and infant, and that postpartum depression is common in this group of new mothers, a preventive programme for adolescent mothers was developed and evaluated. The preventive programme was delivered to a group of 18 adolescent mothers and the outcome compared with that of a group of 60 adolescent mothers from the same community who did not receive the preventive intervention.The preventive programme was delivered from the 3rd trimester of pregnancy and during the first three months following childbirth. It comprised several facets and strategies of intervention corresponding to the diversity of adolescent mothers' needs. For example, a group discussion was held during pregnancy concerning preparing for the task of motherhood; specific strategies were included postnatally designed to facilitate optimal mother-infant interaction; and attention was paid to the quality of the mother's childcare, with mothers receiving help in the management of infant difficulties. Differences between the two groups of adolescent mothers were examined at three, six and twelve months postpartum, in terms of maternal mood, infant mental, motor and behavioural development, as well as early signs of psychopathology.One third of the control group mothers were found to experience significant depression in the postpartum period. Although this rate was not significantly reduced by the preventive intervention, the intervention programme was found to be of benefit in terms of the mother-infant relationship as well as a number of indices of disturbed infant development associated with mood disorder in the control group.