Postnatal depression Consequences for mother and child

1. Postnatal depressionConsequences for mother and child Dr Andrew Mayers amayers@bournemouth.ac.uk

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

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

4. 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

5. 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.

6. 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

7. PNP and the child • Observation of interaction with baby • Undertaken with video • From behind mother (to see baby’s face) • But in front of mirror (to see mum’s face)

8. 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

9. 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

10. 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

11. 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)?

12. PNP and the child • This interaction was warm, affectionate and rewarding for both mum and baby

13. PNP and the child • This interaction was not so good • Mum appeared disinterested: blank face… • Baby was unsure and uncomfortable

14. PNP and the child • Results • Significant differences found for several measures • Mothers with serious mental illness (SMI) vs. controls • Poorer mother–infant interaction • Poorer perceived maternal competence • Poorer cognitive function • Mother–infant 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

15. 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 • Mum’s slower processing reduces her response to her child

16. PND and the child • Other evidence • PND associated with several negative outcomes • Increased marital stress • Disturbances in child’s 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 mum’s ability to cope with care of baby

17. 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

18. 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