Postpartum Depression and Its Impact on Infants

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Table of Contents

Introduction
Research Studies
PPD and Breastfeeding
PPD and Infant Development in the Second Postnatal Year
PPD and Infant Development at 18 Months
Psychological Treatment of PPD
Conclusion
References

Introduction

Motherhood can be hard for many women, and physical or psychological issues can make it even more difficult. Depression is common among new mothers, and the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) specifies a diagnosis of major depressive disorder with peripartum onset (American Psychiatric Association, 2013). A major depressive disorder is a type of depressive disorder that manifests in diminished interest or pleasure, low mood, weight loss, sleep problems, psychomotor changes, fatigue, reduced concentration, and negative thoughts and feelings (APA, 2013). New mothers face the risk of depression because of biological and lifestyle changes occurring at childbirth. Mothers who have depressive symptoms often find it challenging to take care of themselves and the infant. This could damage maternal and child health outcomes.

The negative influence of postpartum depression (PPD) on mothers and infants causes scholars to be interested in this issue. Many research studies aimed to evaluate the progress of PPD and its treatment methods. Academic studies have helped to identify various therapy options. However, because PPD often goes unnoticed by mothers and their families, studying its effect on children is also important. PPD can affect children because it reduces mothers’ caregiving capacity and damages the relationship between the mother and her infant. The present paper will summarize research articles on the effect of PPD on children. Each study will be evaluated in terms of its significance to clinical practice, and major takeaways from each research will be considered.

Research Studies

PPD Prevalence and Impact on Infant Health, Weight, and Sleep

The study by Gress-Smith, Luecken, Lemery-Chalfant, and Howe (2012) focused on infant outcomes specifically. The goal of this research was “to investigate the prevalence of maternal depressive symptoms at 5 and 9 months postpartum in a low-income and predominantly Hispanic sample, and evaluate the impact on infant weight gain, physical health, and sleep at 9 months” (Gress-Smith et al., 2012, p. 887). The sample included 132 mother-infant pairs found through a larger investigation of prenatal care in low-income communities. Thus, all women had low socioeconomic status with a limited household income. The study was carried out in the United States, where Hispanic populations face various social and financial issues. All mothers participating in the study had to be at least 18 years old, and the mean age was 26.5 with a standard deviation of 5.59 (Gress-Smith et al., 2012). The researchers do not provide information on the gender of infants and mothers’ age.

The researchers used different tools in their study. They assessed postpartum depression using the 20-item Center for Epidemiologic Studies Depression scale (Gress-Smith et al., 2012). The authors also developed a specific questionnaire to assess infant outcomes, such as infant weight, health, and nighttime awakenings (Gress-Smith et al., 2012). Data were collected through interviews with mothers. The tests used in the study included pairwise correlations, DFFITS and DFBETAS tests, and regression modeling conducted in SPSS (Gress-Smith et al., 2012). The authors provided no other details about the tools and tests applied in the study.

The results of the study were rather significant. Firstly, the study indicated a very high incidence of postpartum depressive symptoms in low-income mothers. Gress-Smith et al. (2012) state that “33% of the women reported clinically significant levels of depressive symptoms (CESD C 16), and 38% reported clinically significant symptoms at 9 months” (p. 890). Severe cases formed 12% and 18% of these cases (Gress-Smith et al., 2012). Second, the study showed PPD influences infant weight, health, and sleep, all with moderate effect sizes.

Overall, the study shows that depression is a common problem among low-income mothers. It also confirms the effect of PPD on infant outcomes. These data could support the practice by educating mothers and care providers on the importance of PPD. However, the study is limited by its sample size. With a small sample, it is not possible to say if the results can be extended to other low-income populations in America.

PPD and Breastfeeding

Breastfeeding practices can impact infant health and development. Therefore, the study by Hamdan and Tamim (2012) aimed to “investigate the possible correlation or predictive relationship between breastfeeding and Postpartum Depression” (p. 243). The study was conducted in Sharjah, UAE. The sample included 137 Arab women, who were followed during their pregnancy and after birth. The authors do not provide any other information about the women’s backgrounds, including their age, nationality, and socioeconomic status.

In this study, the authors considered many variables, including socio-demographics, depression, anxiety, stress, spirituality, employment, postpartum depression, and infant feeding practices. Four different tools and an original survey were used to collect information. The authors assessed women using the Beck Depression Inventory-II, Beck Anxiety Inventory, Stressful Life Events Inventory, Edinburg Postnatal Depression Scale, and the Mini International Neuro-psychiatric Interview tool (Hamdan & Tamim, 2012). For data analysis, the authors utilized Statistical Analysis Software 9.1. Descriptive statistics were used to represent the results, and the chi-square, Fisher’s Exact, Pearson, t-test, or Wilcoxon-Mann Whitney tests were applied depending on the variable type (Hamdan & Tamim, 2012). No other information about tools, surveys, or tests was provided in the article.

The results of the study were not very significant. Researchers found that breastfeeding at 2 and 4 months was negatively correlated with PPD in some women (Hamdan & Tamim, 2012). They also pointed out the opposite relationship, where breastfeeding reduced the incidence of PPD among mothers. Additionally, the study highlighted possible predictors of feeding practices. Employment had a negative impact on breastfeeding, and Muslim religion influenced breastfeeding practices positively in some women (Hamdan & Tamim, 2012). Other variables reviewed in the study did not affect feeding practices, or their effect was insignificant. The results could be used to inform further research into breastfeeding, but they are not convincing enough to support postpartum care practitioners in their work.

On the whole, the study’s main finding was the two-sided relationship between postpartum depression and breastfeeding. PPD was found to reduce mothers’ breastfeeding rate, and breastfeeding had a negative impact on PPD development (Hamdan & Tamim, 2012). This finding could support the practice by providing education on the importance of breastfeeding, but the study has limitations. The main limitation is the size of the sample because it prevents generalizing the data to other populations. As a result, it is unclear whether the same relationship would affect other women, and the study is not very significant.

PPD and Infant Development in the Second Postnatal Year

The influence of PPD on infant development is also an important topic of study. Research by Cornish et al. (2005) aimed to examine the impact of brief and chronic PPD on mothers and their infants. The initial sample included 127 mother-infant couples, but only 114 provided complete data. The socioeconomic status of mothers was medium to high, and families living in poverty were excluded. According to the authors, most mothers had tertiary education and were white (Cornish et al., 2005). The study was conducted in Australia, and some of the mothers were also bilingual. Of the infants, 58 were boys, and 56 were girls, which provided a good balance of genders. Mothers were aged between 22 and 44, with a mean age of 31.4 years and a standard deviation of 4.2. The authors provided complete information about the sample.

The authors used some popular tools and surveys to measure results. The Composite International Diagnostic Interview and the Center for Epidemiological Studies Depression Scale were used to establish depression in mothers (Cornish et al., 2005). Infant development was assessed using the Bayley Scale and the Receptive-Expressive Emergent Language Test (Cornish et al., 2005). The researchers evaluated the inter-rater reliability and validity of surveys before collecting all data. This helped to increase the quality of the results and study procedures. Data analysis included descriptive statistics, analysis of variance, and logistic regression modeling.

The results of the research are significant and indicate the need to address PPD in clinical settings. The main finding was that “chronic maternal depression, lasting throughout the first 12 months postpartum and beyond, was associated with lower motor and cognitive performance in infants assessed at 15 months of age” (Cornish et al., 2005, p. 413). The effects were similar for boys and girls and were not influenced by infant attention or emotion regulation, as these were controlled (Cornish et al., 2005). Brief maternal depression did not influence infants negatively.

Overall, the study suggests that care providers should focus on early identification and treatment of PPD to avoid damage to infant development. This could help to prevent mothers from developing chronic depression, which leads to poor outcomes in infant development. Again, this study is limited by the small sample size. However, the authors used a strong methodology and controlled most extraneous variables, meaning that the conclusions drawn by them are likely correct.

PPD and Infant Development at 18 Months

Another study into the influence of maternal PPD on children focused on infants aged 18 months. The aim of the study by Conroy et al. (2012) was “to examine whether maternal PD and depression assessed at 2 months postpartum would be independently associated with adverse developmental outcomes at 18 months of age” (p. 51). This means that the study assessed both maternal personality disorder and postpartum depression. The study sample included 200 mothers recruited from a neonatal teaching hospital in the United Kingdom. The distribution of male and female gender among infants was equal. Most of the women were white, and a significant share was in professional occupations (Conroy et al., 2012). The authors did not study socioeconomic status, but from occupational data, it appears that most women were from a medium-income background. Information about their age or education level was not provided.

The authors applied various tools and surveys to screen mothers and infants. They used the Structured Clinical Interview for DSM-IV to diagnose PPD and personality disorder in women. Infant development was assessed using the Infant-Toddler Social and Emotional Assessment and the Bayley Scale of mental development (Conroy et al., 2012). The researchers used t-tests and x2 tests to analyze univariate associations. Correlation analysis, linear regression, and logistic regression analyses were also used for data analysis. These tests helped to analyze the relationship between maternal mental condition and different aspects of infant development.

The results of the study are significant. First, it showed that maternal depression was associated with cognitive development among infants and with their internalizing behavior (Conroy et al., 2012). The research also found that together, maternal personality disorder and PPD were associated with dysregulated infant behavior (Conroy et al., 2012). The study adds to the topic by considering the co-occurrence of these psychological conditions.

The main takeaway from this study is that care providers have to screen mothers for a variety of psychological conditions. This can help to identify co-occurring diagnoses that threaten infant development and treat them adequately. The study also supported the link between maternal depression and the cognitive and emotional development of infants. Timely treatment of PPD can help to avoid negative infant outcomes. The study had an adequate sample size, but it was limited because there was no control group. Comparing the results of healthy mothers with those who have PPD and personality disorder would have helped to make stronger conclusions on the topic.

Psychological Treatment of PPD

Research into the psychological treatment of PPD is a popular field. A study by Murray, Cooper, Wilson, and Romaniuk (2003) aimed to assess the impact of three psychological treatments of PPD on mother-child relationships and child outcomes. The authors included 193 women diagnosed with depression shortly after childbirth. The study was carried out at Cambridge University, and most women were British citizens or residents. The authors do not indicate the socioeconomic status or age of the women included in the sample.

There were four interventions tested in this study: routine care, non-directive counseling, cognitive-behavioral therapy, and psychodynamic therapy (Murray et al., 2003). Each woman completed a Behavioral Screening Questionnaire and Rutter A2 Scale, and children were assessed using the Bayley Scale Questionnaire, Pre-school Behaviour Checklist, and McCarthy Scale (Murray et al., 2003). To test changes after interventions, the researchers used a generalized linear model and descriptive statistics. These tests allowed us to identify the correlation between interventions and maternal or child outcomes. Descriptive statistics were also useful in establishing the significance of the changes and evaluating each treatment objectively.

The results of the study were mixed. On the one hand, the study observed a significant positive impact of psychological interventions on mother-infant relationships, and counseling improved infants’ behavioral and emotional outcomes at 18 months. However, other outcomes did not show any significant change. At five years of age, none of the child outcomes were affected by treatments. The results of the study are not very significant for the field of maternal and child care, and they cannot be used to support mental health practice.

The study fulfilled its purpose by researching the relationship between psychological interventions for PPD and outcomes in mothers and infants. The primary message of the study is that the differences between routine care and psychological interventions do not impact maternal and child outcomes in the long term. Psychological treatments, including directive counseling, can help to improve mother-infant relationships and promote infants’ emotional and behavioral development. The study has many limitations, and the main one is the small sample size. With 193 women enrolled, each intervention group had less than 50 participants. This could have affected the reliability of the results and conclusions. For this reason, using the study to support practice change would not be possible. Repeating the study with a larger sample could help to verify the conclusions and achieve consensus on the psychological treatment of PDD.

Conclusion

In general, postpartum depression is an important problem for young mothers that could affect them and their children alike. Maternal depression is characterized by many symptoms, including fatigue, low mood, and the loss of concentration (APA, 2013). Thus, it can affect mothers’ ability to take adequate care of their children. PPD can also damage the formation of mother-infant relationships. If mothers are withdrawn and are not capable of responding to their children’s needs, they are less likely to build trusting and loving relationships. This can result in developmental delays and impede children’s cognitive and emotional development. Research studies on the topic can help care providers to understand the importance of PPD and provide information about its impacts.

Each of the studies considered in this review focused on different aspects of PPD. The first study highlighted the high prevalence of PPD among poor mothers and its negative influence on infant weight, health, and sleep (Gress-Smith et al., 2012). The second study from the UAE showed that PPD and breastfeeding are interrelated (Hamdan & Tamim, 2012). This means that mothers who are encouraged to breastfeed are less likely to develop PPD, and mothers with PPD are less likely to breastfeed. Two studies into PPD and infant development showed a link between the two (Conroy et al., 2012; Cornish et al., 2005). In particular, chronic depression and depression with personality disorder led to worse outcomes. Finally, one study also described the positive influence of psychological treatment on mother-infant relationships (Murray et al., 2003). These findings can help care providers to make better decisions in their practice and inform future research into PPD.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Publishing.

Conroy, S., Pariante, C. M., Marks, M. N., Davies, H. A., Farrelly, S., Schacht, R., & Moran, P. (2012). Maternal psychopathology and infant development at 18 months: The impact of maternal personality disorder and depression. Journal of the American Academy of Child & Adolescent Psychiatry, 51(1), 51-61.

Cornish, A. M., McMahon, C. A., Ungerer, J. A., Barnett, B., Kowalenko, N., & Tennant, C. (2005). Postnatal depression and infant cognitive and motor development in the second postnatal year: The impact of depression chronicity and infant gender. Infant Behavior and Development, 28(4), 407-417.

Gress-Smith, J. L., Luecken, L. J., Lemery-Chalfant, K., & Howe, R. (2012). Postpartum depression prevalence and impact on infant health, weight, and sleep in low-income and ethnic minority women and infants. Maternal and Child Health Journal, 16(4), 887-893.

Hamdan, A., & Tamim, H. (2012). The relationship between postpartum depression and breastfeeding. The International Journal of Psychiatry in Medicine, 43(3), 243-259.

Murray, L., Cooper, P. J., Wilson, A., & Romaniuk, H. (2003). Controlled trial of the short-and long-term effect of psychological treatment of post-partum depression: I. Impact on maternal mood. The British Journal of Psychiatry, 182(5), 412-419.

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