Postnatal depression Consequences for mother and child

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Postnatal depressionConsequences for
mother and child

• Dr Andrew Mayers
• amayers_at_bournemouth.ac.uk

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PND - consequences

• Overview
• Importance of attachment
• When bonding goes wrong with PND
• What does this mean for mother and baby
• Short and long term

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The importance of attachment

• Why is attachment important between mother and
  infant?
• Early motherinfant bond may have sig. impact on
  developing infant
• Infants internal working model (IWM) is very
  important
• Expectations about themselves in relation to
  others
• Model of self and of other
• If infants carer attends positively and responds
  to needs
• ? Infant has positive IWM
• High self-worth, availability of others,
  resolution of crises
• Infants carer inconsistent response and
  attention
• ? Infants has negative IWM
• Low or ambivalent self-worth, unavailable others,
  crises not resolved

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Bonding and attachment

• So how is bonding compromised in PND?
• Also applies to other mental health problems in
  perinatal period
• Mum is distracted for whole manner of reasons
• Low mood
• Lack of motivation
• Fear and guilt
• Poor concentration
• Lack of self-worth
• Low self-esteem
• Effect of medication

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PNP and the child

• Some research that we have done
• We explored serious mental illness in mothers
  (vs. controls)
• Including severe depression
• Sample
• 6 ill mums 12 healthy controls
• First 8 weeks after birth
• We measured a number of key aspects
• Cognitive functioning (computerised tests)
• Memory, speed of functioning, attention
• Perceptions of parenting skills and stress
  (questionnaire)
• Observation of interaction with baby (video)
• Quality, sensitivity, appropriateness, etc.

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PNP and the child

• Cognitive functioning
• Computerised program from Cognitive Drug Research
  (CDR)
• Word and picture recall and recognition
• Reaction time
• Rapid visual information processing
• Spatial and numeric working memory
• Focus on cognitive function
• Power and continuity of attention
• Episodic memory
• Working memory
• Speed of memory

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PNP and the child

• Observation of interaction with baby
• Undertaken with video
• From behind mother (to see babys face)
• But in front of mirror (to see mums face)

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PNP and the child

• Observation of interaction with baby
• Quality and appropriateness of interaction
• Assessed using highly validated method
• Crittenden CARE Index
• Pat Crittenden was a student of Mary Ainsworth
• Ainsworth pioneered attachment styles
• And was herself student of Bowlby

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PNP and the child

• Aims of CARE Index
• Mothers and infants rated on 7 aspects
• Facial expression
• Verbal expression
• Position and body contact
• Affection and sensitivity
• Turn-taking and co-operation
• Control
• Choice of activity

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PNP and the child

• Look at these two videos
• Note that these videos are only available in the
  lecture. They will be not be available in
  post-training materials. This is to protect
  confidentiality

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Exercise

• What were the key differences in the bonding
  seen in videos?
• What impact might that have for developing child?
• What does bonding teach the child?
• How does PND affect bonding?
• How might we improve bonding?
• How is breastfeeding relevant here (again)?

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PNP and the child

• This interaction was warm, affectionate and
  rewarding for both mum and baby

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PNP and the child

• This interaction was not so good
• Mum appeared disinterested blank face
• Baby was unsure and uncomfortable

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PNP and the child

• Results
• Significant differences found for several
  measures
• Mothers with serious mental illness (SMI) vs.
  controls
• Poorer motherinfant interaction
• Poorer perceived maternal competence
• Poorer cognitive function
• Motherinfant interaction and perceived maternal
  competence
• SMI mums significantly less sensitive
• Their infants were significantly less cooperative
• Cognitive function
• SMI mums sig poorer on speed of memory processing

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PNP and the child

• So what does this all mean?
• It would appear that SMI in mums is related to
  slow cognition
• Specifically slower speed of memory
• This may mediate the illness
• SMI and slower speed of memory implicated in
  maternal sensitivity
• Mums slower processing reduces her response to
  her child

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PND and the child

• Other evidence
• PND associated with several negative outcomes
• Increased marital stress
• Disturbances in childs emotional and cognitive
  development
• Children of dep mums more likely to be associated
  with
• Insecure attachment
• Eating difficulties
• Sleep disturbance
• Being overly clinging
• PND affects mums ability to cope with care of
  baby

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Longer term consequences

• Observations from evidence and my own
  professional practice
• Specialist schools for excluded children
• Care farm project for troubled youngsters
• These young people ALL have attachment problems
• Perhaps mum had PND?
• May be one of many reasons
• Young people with conduct disorders
• Many have bonding issues
• Personality disorders
• Key cause relates to poor attachment in
  childhood

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Future work?

• So how could we extend this?
• We could examine the effect of SMI on other
  factors
• Attachment and bonding
• Long term affect on child development
• Social, emotional, educational, language,
  forensic
• Studies are now at planning stage