Review
Postpartum depression effects on early interactions, parenting, and safety practices: A review

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Abstract

In this paper studies are reviewed from the last decade on postpartum depression effects on early interactions, parenting, safety practices and on early interventions. The interaction disturbances of depressed mothers and their infants appear to be universal, across different cultures and socioeconomic status groups and, include less sensitivity of the mothers and responsivity of the infants. Several caregiving activities also appear to be compromised by postpartum depression including feeding practices, most especially breastfeeding, sleep routines and well-child visits, vaccinations and safety practices. These data highlight the need for universal screening of maternal and paternal depression during the postpartum period. Early interventions reviewed here include psychotherapy and interaction coaching for the mothers, and infant massage for their infants.

Section snippets

Postpartum depression effects on parenting

The significance of continuing research on postpartum depression is highlighted by the increasing incidence of postpartum depression and some longitudinal studies that have reported long-term negative effects of postpartum depression on children's health and their social, emotional, cognitive and physical development. Statistics from large sample studies have placed postpartum depression at about 20–40% in mothers and a somewhat lower percentage in fathers (Goodman, 2004, McCoy et al., 2006).

Early interactions

As already mentioned, researchers have attributed the long-term effects of maternal depression including behavior problems, cognitive delays and physical health problems to disturbed early interactions (Beardslee, Versage, & Gladstone, 1998). In a meta-analysis of studies on the early interactions of postpartum depressed mothers, the mothers who were depressed across their infants’ first 3 months of life were noted to be more irritable and hostile, to be less engaged, to exhibit less emotion

Inadequate caregiving practices

Several caregiving activities also appear to be compromised by postpartum depression effects on the developing parenting roles including feeding practices, most especially breastfeeding, sleep routines and well-child visits and vaccinations. These would seem to be even more basic functions of parenting, although they have received less attention than the effects of postpartum depression on mother–infant interactions.

Safety practices

Safety practices have also been affected by maternal depression symptoms. In a secondary analysis from the Healthy Steps National Evaluation, interviews given at the end of infancy provided information about safety practices including using an infant car seat, having electric outlet covers, having safety latches on cabinets and having lowered the temperature on the water heater (McLearn et al., 2006a, McLearn et al., 2006b). In this sample, the mothers with depressive symptoms at 2–4 months had

Clinical implications

The findings from these studies on early interaction problems and inadequate caregiving and safety practices have important clinical implications for pediatric healthcare professionals. One of the implications is the need for universal screening of maternal and paternal depression by pediatricians during the postpartum period, inasmuch as pediatric professionals have frequent contact with families at that time. Several pediatric organizations have suggested that pediatric professionals not only

Behavioral interventions

Most intervention programs for postpartum depressed mothers have focused on providing pharmaceuticals or psychotherapy for the mothers. Although the psychotherapy studies have suggested positive effects, the literature on antidepressants is mixed and generally suggests that antidepressants should not be used at least by breastfeeding mothers (see Field, 2008 for a review).

In a review on the different types of psychosocial and psychological interventions for postpartum depression, several

Methodological limitations

Many of these studies have the limitation that they used self-report measures (the CES-D and the Edinburgh Depression Scales) to assess parental depression. Although these self-report measures are not typically used for clinical diagnoses, the self-report depression scales do reflect a range of depressive symptoms that are typically associated with the diagnosis of depression, and they are reliable measures. Further, they are cost-effective measures that could be used for universal screening to

Summary

This paper reviewed studies from the last decade on postpartum depression effects on early interactions, parenting, and safety practices, and on early interventions. The interaction disturbances of depressed mothers and their infants appear to be universal across different cultures and socioeconomic status groups and include less sensitivity of the mothers and responsivity of the infants. Several caregiving activities also appear to be compromised by postpartum depression including feeding

Acknowledgments

We would like to thank the parents and infants who participated in these studies. This research was supported by a Merit Award (MH# 46586) and NIH grant (AT# 00370) and Senior Research Scientist Awards (MH# 0033 I and AT# 001585) and a March of Dimes Grant (# 12-FYO3-48) to Tiffany Field and funding from Johnson and Johnson Pediatric Institute to the Touch Research Institute.

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