Maternal response to child affect: Role of maternal depression and relationship quality
Introduction
Maternal depression is associated with negative outcomes for offspring, including higher rates of child psychiatric illness (Goodman et al., 2011). Conceptual models (Hammen et al., 2004) and empirical findings from behavioral studies (Lovejoy et al., 2000) suggest that one putative mechanism for disease transmission across generations is maladaptive parent–child relationships in dyads with a depressed parent. Altered responses to child affect and maladaptive relationship patterns may be especially apparent in depressed mothers with psychiatrically ill children (Zalewski et al., 2013). Specifically, maternal neural function in emotional processing circuits is altered in depression (Barrett and Fleming, 2011) and may be associated with disruptions in parent–child relationships previously observed in depressed mother–child dyads.
In particular, anomalies in neural processing of reward and threat have been associated with depression (Zhang et al., 2013), suggesting that these biologic processes may constitute key elements in depression transmission across generations. Parental capacity to enjoy the rewarding aspects and manage the difficult aspects of parenting may be attenuated by parental depression (Zalewski et al., 2013). Depressed individuals show blunted ventral striatal (VS) activation in response to positive stimuli (Zhang et al., 2013), suggesting diminished pleasure in response to reward, and heightened response in the amygdala and insula to negative stimuli (Hamilton et al., 2012), indicating heightened negative affect in response to threatening stimuli. These findings demonstrate that depressed individuals engage these neural reward and threat systems differently than healthy individuals, and that such neural disruptions may be involved in the clinical course of the disorder.
Disruptions in affect regulation may also explain why depressed individuals respond differently to rewarding and threatening stimuli. Depressed adults show altered activation in regions implicated in affect regulation, such as the dorsolateral and ventrolateral and dorsomedial and ventromedial prefrontal cortex (dlPFC, vlPFC, dmPFC, vmPFC) to both positive and negative stimuli (Phillips et al., 2008). Specifically, depressed adults show heightened mPFC response to monetary rewards (Zhang et al., 2013), suggesting over-engagement of regulatory regions to dampen positive affect. Other work has demonstrated that depression is also associated with heightened dorsal anterior cingulate cortex (ACC) and diminished dlPFC response to threatening stimuli (Hamilton et al., 2012), suggesting that depressed adults not only place greater salience on threatening stimuli, but they also may have difficulty regulating negative affect elicited by these stimuli.
Because social function is clearly disrupted in depressed individuals as evidenced by maladaptive emotional behavior when interacting with family members (Hammen et al., 2004) and impaired interpersonal functioning in general (Petty et al., 2004), depression may be associated with differential response to their own offspring in brain regions associated with social processing. Also, there is some evidence to suggest that individuals with depression attribute their experience of negative events to personal failings more frequently than do healthy individuals (Grimm et al., 2011). Because children are kin, it is possible that depressed parents may identify closely with their children's experiences, viewing their own child's negative emotions as highly related to self. Thus, evaluating neural response to personally relevant positive and negative stimuli in depressed parents of psychiatrically ill children could give us important information in self-related and social processing circuitry, including regions such as the dmPFC, vmPFC, posterior cingulate (PCC), thalamus, and precuneus (Northoff et al., 2006). Function in this network of regions has been shown to be altered in depression (Grimm et al., 2009).
Given the aforementioned interpersonal disruptions, affective displays by close family members could be particularly effective in eliciting differences in affective processing. Measurement of parental neural response to their offspring's affect (rather than responses to more general stimuli) may be a more meaningful way to evaluate the neural systems involved in depression, especially because disrupted parent–child interactions are present for many depressed parents and because children's affect can be a potent stimulus for affect regulation in parents (Lovejoy et al., 2000). However, investigations of depression-related disruptions in neural functioning have largely focused on non-personally relevant paradigms that measure general reward and threat processing (i.e., using money and/or unfamiliar faces as stimuli). In contrast, there is a dearth of personally relevant neuroimaging paradigms that incorporate family context. Some work has evaluated adolescent neural response to maternal stimuli using video clips of maternal affect (Whittle et al., 2012) or audio clips of maternal criticism (Lee et al., 2015), and found that altered adolescent response to maternal stimuli is associated with greater depressive symptoms (Whittle et al., 2012). Other work has evaluated maternal response to infant stimuli, using images of one's own baby or audio clips of infant cry, and provided evidence for maternal response circuits (Barrett and Fleming, 2011), that include the thalamus, striatum, and ACC, and that are altered in depressed mothers of infants. However, to our knowledge, no study has evaluated mothers' response to their own children during middle childhood and adolescence, when the parent–child relationship has changed substantially from infancy (Laursen et al., 1998) and when youth may have their own affective problems (Paus et al., 2008). Altered neural responses to child affect could explain the lower levels of parental warmth and higher parental hostility reported by child offspring of depressed mothers (Lovejoy et al., 2000).
Aberrant responding may be even more likely in dyads in which both parent and child suffer from emotional problems. These families face even greater difficulties relative to dyads in which only one member is psychiatrically ill (Weissman et al., 2015a, Weissman et al., 2015b). In particular, because of the increased burden of caring for a psychiatrically ill child, in addition to coping with one's own depression, it is possible that parents within these very high risk dyads may respond to their offspring's affective displays in different ways than other parents. This altered responding could contribute to a cycle of dysfunction in the parent–child relationship, including greater levels of hostility and lower levels of warmth.
The goal of the current project was to evaluate how the association between parental response to child affect and maternal depression course and mother–child relationship quality in very high risk dyads, defined as mothers and children both diagnosed with syndromal psychiatric disorders. The study objective was to utilize video-recordings of “real” parent–child interactions to develop ecologically valid probes for social reward and threat, similar to methods used by Whittle et al. (2012). We hypothesized that this task, the Positive and Negative Social Interaction Task- Mother-Child (PANSIT-MC), would activate regions previously implicated in reward (VS), threat (amygdala, insula), self-related and social processing (thalamus, precuneus), and affect regulation (dlPFC, vlPFC, mPFC). We further hypothesized that these neural differences in responding to their own child's positive and negative affect would be associated with important clinical correlates of depression, namely chronicity of depression and comorbid anxiety, and with depression-related parenting difficulties, specifically lower child-rated maternal warmth and higher child-rated maternal hostility.
Section snippets
Participants
The participants were 32 mothers with a recent history of depression recruited from a clinical trial (N=168) conducted at the University of Pittsburgh for depressed mothers of children diagnosed with internalizing disorders (Grant R01 MH083647). Mothers were recruited from the larger study at any point during their treatment, during the 12-month follow-up phase, or after completing the trial.
The final sample included 19 participants; 11 of the original 32 did not complete the fMRI scan due to
Results
Maternal warmth and hostility were negatively correlated with one another (r=−.78, p<.001). Number of depressive episodes was not significantly related to either maternal warmth (r=−.38, p=.11) or maternal hostility (r=.28, p=.34).
Discussion
We demonstrated that mothers respond to images of their own child, relative to an unfamiliar child, in key regions associated with reward processing (VS) and threat processing (insula) for positive and negative clips, respectively. Both types of stimuli also elicited activation in regions associated with affect regulation (vlPFC, ACC) and self-related processing (temporal lobe, thalamus). These findings mirror maternal neural networks (VS, thalamus, ACC, insula) previously identified in work
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