SEMINAR 1 – DEPRESSION IN MOTHERS AND CHILDREN’S OUTCOMES

INTRO DEPRESSION

Depression -HIGHLY PREVALENT( Lifetime prev 10-20%), HIGHLY RECURRENT (50-60% after 1st episode, 90% after 3rd ) and HIGHLY DISABLING: (World Health Organisation ranked it as number 1 cause of disability worldwide) - Kessler, 2006; Blazer et al., 1994)

-3-6% of men (half of its prevalence in women-30).

INTRO DEPRESSION AFFECTING MOTHERS

adolescent mothers. Women who give birth as teenagers have higher rates of depression symptoms (Deal and Holt 1998), poverty, single motherhood, and other stressors (Prodromidis et al. 1994) relative to older mothers. POSTPARTUM Even women for whom the pregnancy was intentional and who have sufficient support and resources may become overwhelmed emotionally by the physical changes brought on by pregnancy. For instance, women experiencing morning sickness during the first trimester have been found to report greater levels of depressed mood (Abraham, Taylor, & Conti, 2001; Chou, Lin, Cooney, Walker, & Riggs, 2003).

Most mothers assimilate these new responsibilities with the other tasks of daily living. As the assimilation occurs, synchronicity in the mother-infant relationship develops (Coplan O’Neil, & Arbeau, 2005. Synchronicity in this relationship supports optimal growth and development for the child (Jacobson & Melvin, 1995; Rothbart, & Bates, 1998). However, for the mother with postpartum depression, care of a newborn might be overwhelming, leading to increased stress, anxiety, and increasing feelings of isolation.

Psych disorders of parents are associated an increased risk of psychological and developmental difficulties in their children.(Psychogiou, 2009). Mothers- primary caregivers, greater role (but men often underemphasized).

MATERNAL DEPRESSION AFFECTING CHILDREN’S DEVELIPMENT

-Infants of depressed mothers: Show atypical brain activity , Have low vagal activity ,Exhibit high frequency of awakening during sleep, Use internally directed strategies of self-soothing. During interactions infants are less responsive, Look sad, Spend more time looking away, Are more disengaged (Diego, 2010)

Ex: Field(2009)- Depressed mothers’ infants are less responsive to faces and voices-> As early as the neonatal period less orienting to voice of examiner and to own or other infants’ cry sounds.-> attributed to higher arousal, less attentiveness and less empathy. Later at 3-6 months they showed less negative responding to their mothers’ non-contingent and still-face behaviour-> suggesting that they were accustomed to this behaviour in mothers. Because parenting –withdrawn/intrustive/authoritarian. Similar to -> In study on 3-month-old-infants – happy faces habituated more slowly by Inf of D.M. (Hernandez-Reif, 2006c). discriminated sad from happy but did not seem to perceive sad as novel, most likely because they had experienced mothers’ sad facial expression. Another experiment (Field,2007)– mean age 5 months - exposed to a still-face Raggedy Ann Doll , imitative mother and spontaneously interacting mother- more laughing and less fussing during the mother imitation condition- more contingent to what they were used to.

still face experiment- sits down and plays. Give agreement to each other. Engage the child. Coordinate. What the baby is used to. Then ask mother to not respond. Baby quickly picks up on this. Baby tries to get attention back- smiles, points, etc. Then react with negative emotions, feel the stress.- experiment -94 mothers (not depression, just depressive symptoms). -one camera looking at baby, one at mother, one at overall and one at mirror. -behaviour mother – restrictive/low interaction/ ignoring etc -assess child non-compliance, compliance, defying etc -child orientation- got mothers to watch it back, what they feel at different times +what made them change emotions -forbidden toys to see child compliance when being told no.-anger only emotion that wasn’t inhibited. HOW MEASURE?- still showed it even if mothers shifted attention.-limit- no twin studies. (genetics)

· Newborns crying in response to cry of other newborn –empathetic response. Non-D Mothers – infants responsed with reduced sucking and decreased rate-suggesting attentive response. Depressed-M-inf – no change. Precursor to non-empathetic beh noted in preschool children of prenat depressed (Jones, 2000).

Emotion regulation (ER) – ongoing process of the individual’s emotion patterns in relation to moment-to-moment contextual demands. Infants of nondepressed mothers used attentional regulatory strategies whereas infants of depressed mothers used internally directed strategies of self-soothing to reduce negativity and maintain engagement with mother. ER during infancy is partly dyadic because the caregiver is central to providing refulation that the child needs, which in turn facilitates development of autonomous child regulation.During Still Face experiments, infants typically show gaze aversion, self-soothing and lowered positive and heightened negative affect. – interpreted as attempts to regulate their negative arousal (self-directed regulatory beh) and to re-establish reciprocal normal patterns of interaction (other-directed regulatory beh). (Manian, 2009)

Physiological effects-> Prenatal depression has been noted to have physiological and biochemical effects on fetus and neonate (Field, 2006) . Infant perception and beh also affected. Dysregulated physiological (right frontal EEG and low vagal active) and biochemical profile (elevated cortisol and lower levels of serotonin and dopamine). EG asymmetry profiles –associated with positive/negative affect or approach/withdrawal patterns, inhibition/uninhibition (Field & Diego, 2008). . Left frontal electrical activity is generally associated with approach and positive emotionality, whereas activity in the right frontal hemisphere appears related to withdrawal and negative emotionality (Field, Fox, Pickens, & Nawrocki, 1995; Jones, Field, & Davalos, 2000). Typically, infants exhibit greater left than right frontal brain activity (Dawson et al., 1999). Infants and toddlers of depressed mothers have been found to exhibit less left frontal electrical brain activation and more right frontal activation than children of nondepressed mothers (Dawson et al., 2003)

-Children X3 risk of depression, anxiety and substance dependence, Internalising disorders (r=0.18) , Externalising problems (r=0.17) (Goodman et al., 2010)

Evidence is unequivocal – point prevalence rates of psych dis among children of dep parents 2-5 times above normal: 41-77%.

longit studies – increased rates of difficulties in infants and children after exposure to maternal postnatal depression- high rates of emotional and beh problems (25,26), delayed cogn development (27) and increased risk of depression and anxiety disorders in adolescence (29). (Psychogiou, 2009).

Beardslee (1998) – by the age of 20 someone with an affectively ill parent had a 40% chance of experiencing an episode of major depression

Study examined parental beh as mediators in links between depressive in mothers and fathers and child adjustment probl. Pps = 4.184 parents and 6.048 15yo.-Canadian National Longit Survey Self reported symptoms of depression at time 1 and 2 and children assessed nurturance, rejection, monitoring, self-reported internalizing and externalizing problems at time 2. Quality of child’s rearing environment was one mechanism that carries risk to children of depressed parents.

WHY????????????/ MECHANISMS THAT EXPLAIN ASSOCIATION (Goodman, 2002)

1- HERITABILITY (Sullivan,2000)

2- INNATE DISFUNCTIONAL NEUROREGULATORY MECHANISMS (Hellemans, 2010)

§ Neuroendocrine alternations: Depression in women during pregnancy increases their levels of cortisol

§ Poor health behaviours: Smoking or alcohol during pregnancy have negative effects on the fetus

3- ENVIRONMENT (observed interactions- Lovejoy, 2000)

Mothers with depression are more withdrawn and disengaged during interactions with their children compared to mothers without depression . Impaired interactions may explain (fully or partially) the association between maternal depression and child outcomes

Possible causal relationships between maternal depression and child adjustment problems include genetic transmission, observational learning resulting from exposure to depressive symptoms, and impaired parenting (Downey & Coyne, 1990).

Depressed mothers- more negative mood, more critical, rejecting and expressed more negative affect towards children. Diminished sensitivity to child’s needs and impaired disciplinary functioning .

-particularly depression (Oyserman, 2000). (Berg-Nielsen, 2002)- mothers more…. Blabla.these less effective parenting practices have been found to be related to children’s increased vulnerability to affective disturbances and interpersonal struggles. Postpartum depression-women exhibit less positive beh toward inhants who, in turn, exhibit less positive beh in interaction with mothers (Carter, 2001).

Inappropriately use infants as source of comfort.- high self focus and low child-focus.

Expression of depressive symptoms can interfere with parents’ abilities to be nurturing, to show firm and consistent discipline and to avoid “giving in” to child tantrums through negative reinforcement (Loevejoy, 2000).

Review (Lovejoy, 2000) – 46 studies – links between depressive syumptoms and parental beh are stronger for presence of negative parental neh (rejection and hostility ) than for lack of positive parental beh (nurturance and monitoring), And that parenting deficits are not specific to depressive disorder and can also be found among parents who exhibit subclinical levels of distress (Kane, 2040)

3 dimensions especially predictive of adjustment difficulties 1) lack of nurturance and positive involvement 2) parent-child hostility and parental rejection 3) poor monitoring and supervision (Cunningham, 2002).

The disruption to the early mother—infant relationship associated with maternal depression is, at least in part, responsible for the adverse child outcomes (Murray & Cooper, 2003)

COGNITIVE OUTCOMES-> Children of depressed mothers are at risk for poor cognitive development, language problems and academic underachievement (Murray et al., 2010)

Infants typically exhibit an increase in vagal tone between 3 and 6 months, a pattern not observed in infants of depressed mothers (Field, 1995) Relevant to cognitive and language development, vagal regulation has been shown to support infant information processing (Bornstein & Suess, 2000) and to predict toddlers’ language scores (Suess & Bornstein, 2000).

1) INFANTS - Negative maternal affect seems to diminish infants’ motivation and interest in communicating and increase infants’ distress and arousal (Field, 1995; Gauvain, 2001). Moreover, frequent bouts of infant distress seem to interfere with infants’ ability to process information (Bugental, Blue, Cortez, Fleck, & Rodriguez, 1992; Hay, 1997) and increase infants likelihood of forgetting recent information (Fagen, Ohr, Fleckenstein, & Ribner, 1985; Hay, 1997; Singer & Fagen, 1992). Thus, infants of chronically depressed mothers may be more vulnerable to learning difficulties in part because the high levels of negative maternal affect increases infants’ arousal to levels that interfere with infants’ early learning efforts.

Depressed mothers seem to use infant-directed speech less effectively than nondepressed mothers. During interactions with infants, chronically depressed mothers seem to be less facially and vocally expressive, to be more likely to speak with a “flat” tone of voice (Breznitz, 2001) and to use less infant-directed speech (motherese) - iffers from adult-directed speech in that parents use a greatly exaggerated prosody (Kaplan, Bachorowski, Smoski, & Hudenko, 2002). Infant-directed speech is more effective in eliciting infant attention (Cooper & Aslin, 1990). - > less –linked to less associative learning (Kaplan et al.,2002).

Early touch has been shown to exert lasting effects on cognitive development (Caulfield, 2000), possibly because maternal touch stimulates cortical growth and synaptic proliferation (Weiss, Wilson, & Morrison,2004). Animal studies demonstrate that more early tactile stimulation is associated with larger cortical size and more diffused patterns of neural connections (Nudo, 96) /Stimulating touch also may have the immediate consequence of facilitating attention and readiness for environmental engagement (Weiss et al., 2004), potentially pulling infants into a state in which they are particularly primed to learn. D.M touch less

Infants’ cognitive skills are enhanced when mothers use face-to-face exchanges to model the give-and-take of social exchanges (Feldman et al., 2004; mportantly, mothers facilitate cognitive and language advances by adapting and responding to infants’ cues and inputs. . Inconsistent maternal responding, in contrast, fails to provide infants with opportunities to perceive order and predictability in their environment. Uncoordinated, unresponsive, and noncontingent maternal responses to infants’ cues tend to characterize the interactional patterns between depressed mothers and their infants (Hay, 1997)

2) TODLERS- By playing with their toddlers, mothers encourage cognitive and language competency by stretching children’s level of play. That is, children’s play with their mothers tends to involve more complex, varied, and sustained activity than solitary play (Dunn & Wooding,1977; Tamis-LeMonda, Užgiris, & Bornstein, 2002) less able to engage in symbolic play with their young children (Tingley, 1994). In addition, toddlers of chronically depressed mothers exhibit lasting deficits in their own capacity to engage in symbolic play (Tingley, 1994). Chronically depressed mothers may frequently leave their children to play by themselves or only half-heartedly play with them when prompted (symbolic play – abstract, as if …opposed to functional) .

-> early shared book reading encourages joint attention, exposes children to complex language that varies from everyday spoken language, provides opportunities for vocabulary instruction, and/or establishes regular reading habits (Karrass & Braungart-Rieker, 2005) oreover, Bigatti and colleagues (2001) found that when depressed mothers did read to their children, depressed mothers read for shorter periods of time and asked their children fewer questions about the storyDepressed mothers also failed to adjust their speech based on the age of the child, perhaps reflecting a less child-centered approach towards reading (Reissland et al., 2003). Taken together, children of chronically depressed mothers may enter preschool and/or elementary school with less exposure to books and reading and less understanding of language than their same-aged peers.

ATTACHMENT- Study by Brumariu (2010) – Children of depressed mothers show significantly less signs of secure attachment and more of insecure attachment. Insecure attachment has been linked to both internalising and externalising problems in childrenInsecure attachment may interact with other risk factors in predicting poor child outcomes (Brumariu et al., 2010)

Baumrind’s classification (autoritharian or disengaged). Experiment- asked to engage toddlers in a “clean up “ task during which toddler encouraged to help pick up a series of toys and put them in boxes. Depressed Mothers. –more autoritharian and disengaging. Toddlers, in return, followed instructions for a lesser percept of time + aggressive play behaviour. Off-task behaviour.

Negative parenting by depressed mothers also has been characterized by either too much involvement (i.e., intrusive and controlling) or too little involvement with their children (i.e., neglectful or distant) (e.g., Garber et al. 1997; Lovejoy et al. 2000). For example, depressed mothers are less engaging, less vocal, and less skillful at getting and keeping their children’s attention (Sameroff et al. 1982), and they make more off-task, non-productive comments to their children than do nondepressed mothers (Hammen et al. 1987).

-lack of maternal warmth, emotional attachment and poor communication increased the risk of suicidal adolescent behaviour (Adams, 1994).

PARENTING AS A MEDIATOR OF THE LINK BETWEEN MATERNAL DEPRESSION AND CHILD OUTCOMES