Maternal Depression and Anxiety Across the Postpartum Year and Infant Social Engagement, Fear Regulation, and Stress Reactivity

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Abstract

Objective

To examine the effects of maternal depression on infant social engagement, fear regulation, and cortisol reactivity as compared with maternal anxiety disorders and controls and to assess the role of maternal sensitivity in moderating the relations between maternal depression and infant outcome.

Methods

Using an extreme-case design, 971 women reported symptoms of anxiety and depression after childbirth and 215 of those at the high and low ends were reevaluated at 6 months. At 9 months, mothers diagnosed with a major depressive disorder (n = 22) and anxiety disorders (n = 19) and matched controls reporting no symptoms across the postpartum year (n = 59) were visited at home. Infant social engagement was observed during mother–infant interaction, emotion regulation was microcoded from a fear paradigm, and mother's and infant's cortisol were sampled at baseline, reactivity, and recovery.

Results

The infants of depressed mothers scored the poorest on all three outcomes at 9 months—lowest social engagement, less mature regulatory behaviors and more negative emotionality, and highest cortisol reactivity—with anxious dyads scoring less optimally than the controls on maternal sensitivity and infant social engagement. Fear regulation among the children of anxious mothers was similar to that of the controls and their stress reactivity to infants of depressed mothers. Effect of major depressive disorder on social engagement was moderated by maternal sensitivity, whereas two separate effects of maternal disorder and mother sensitivity emerged for stress reactivity.

Conclusions

Pathways leading from maternal depression to infant outcome are specific to developmental achievement. Better understanding of such task-specific mechanisms may help devise more specifically targeted interventions.

Section snippets

Participants

The initial sample included 971 mothers who completed measures of anxiety and depressive symptoms on the 2nd post-birth day. Assistants visited the maternity wards of two tertiary care hospitals in a large metropolitan area and invited women who were physically healthy by their own account, delivered a healthy term singleton infant (excluding genetic disorders and infants requiring specialized medical care or NICU hospitalization), completed at least 12 years of education, and were cohabitating

Postpartum Anxiety and Depressive Symptoms in a Large Community Cohort

Overall, in this large community cohort on the second postbirth day, 25.2% of the women reported subclinical depressive symptoms (BDI > 9), and 3.6% reported severe depressive symptoms (BDI > 15). High symptoms of anxiety (State-Trait Anxiety Inventory > 43) were reported by 12.2% of parturient women.

At 6 months, maternal depressive and anxiety symptoms were related to less optimal measures of parenting, in terms of higher stress, lower sense of competence, and less social support (Table 2).

Discussion

Results of this study are the first to examine the effects of maternal depression in the postpartum year on three infant outcomes central for social-emotional growth— social engagement, fear regulation, and physiological stress reactivity—in comparison with both maternal anxiety disorders and controls. By recruiting a large community sample, separating maternal depression from typically occurring conditions, comparing cases of MDD with those of postpartum anxiety disorders, and assessing the

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    The study was supported by the Israel Science Foundation (Grant 1318/08), the US-Israel Bi-National Science Foundation (Grant 2005–273), and the NARSAD Foundation (Independent Investigator Award to R.F.).

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