Postnatal depression

Consequences for mother and child

Dr Andrew Mayers

amayers@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 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

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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 baby’s face) But in front of mirror (to see mum’s 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 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

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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

Mum’s 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 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

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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