Maternal Depression: A Risk Factor for Infant Mental Health

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Maternal Depression A Risk Factor for Infant
Mental Health

• Presented by
• Dr. Deborah Perry
• Georgetown University Child Development Center

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Outline for Presentation

• Epidemiology of depression
• Symptoms and assessments
• Influence on child development
• Implications for practice

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Prevalence of Major Depression
Kessler et al. (1994)
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Prevalence of Post-Partum Depression

• Estimated 50-80 of all mothers experience
  post-partum blues in 10 days following birth
• 8-15 mothers experience post-partum depression
  within first year

• 1 in 1,000 women experience post-partum psychosis
  during first year, most occur before third month

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Syndromes and Symptoms

• Post-partum Blues tearfulness, fatigue,
  insomnia, feelings of loss or being overwhelmed
• Post-partum Depression Low mood, irritability,
  sleep/appetite disturbance, guilt, despair,
  worthlessness, etc. lasting at least 2 weeks

• Post-partum Psychosis hallucinations, paranoia,
  inability to care for self or baby, thoughts of
  suicide or infanticide

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Assessment

• Self Report
• Observational techniques
• Formal screening measures (e.g., CES-D, BDI)
• Clinical interview

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Consequences for Children

• Children of depressed mothers have higher rates
  of depression, attention deficits, behavior
  problems, separation anxiety, and conduct
  disorder compared to control samples

• Findings are consistent across different types of
  raters (parent report, child and teacher reports)
• Also poorer social skills and peer relations
• Insecure attachments

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How depression affects development

• Changes in hormones during fetal period
• Specific aspects of parenting behavior
• Maternal responsivity
• Maternal sensitivity
• Emotional availability
• Negative mood (intrusive/hostile)
• Inconsistency in discipline
• Modeling negative affect
• Inability to assist with emotional regulation

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Maternal Depression Affects Most Children

• 50 - 80 of offspring have significant problems
• Exposure in early life appears to confer more
  risk
• Duration and severity of mothers depression
  affects childrens severity
• Even mild depression associated with child
  problems

Goodman Gotlib, 1999 Timko et al., 2002
Anderson Hammen, 1993
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Maternal Depression Major Negative Effects on
Children

• Significantly worse school outcomes
• Lower cognitive functioning
• Significantly poorer reading achievement
• Significantly worse grades
• Significantly more behavior problems
• 50 of adolescents have a psychiatric disorder
• 2x the rate of physical problems

Riley, et al, 2002 Goodman Gotlib, 1999
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• Other Influences
• Other parent
• Other adults
• School
• Out of home
• activities

• Childs Biological/
• Individual Factors
• Temperament
• Cognitive ability
• Automatic responses
• Pubertal development
• Medical conditions

Services Use
Social Relations
Maternal Depression
Family Environment

• Child Outcomes
• Well-Being
• Somatic health
• Social functioning
• Academic functioning
• Behavior problems
• Psychiatric sx/dx
• Service utilization

• Child Cognitions/
• Perceptions
• Self-concept
• Problem solving skills
• World view

Life Stressors
Parenting
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Best Practices

• Address needs within the community context
• Develop program in the real-world setting
• Link with primary care providers, especially
  pediatricians

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Implications for Practice

• Early identification and intervention
• Treatment of mothers symptoms and provide
  parenting support
• Model appropriate interactions
• Strengthen social support
• Reflective supervision for staff