OPUS Spring 2017
Letter from the Editor
Staff Articles
- Managing Mental Health in the Primary Care Sector
- An Interview with Dr. Joshua Aronson
- An Interview with Dr. Elise Cappella
- Childhood Emotional Abuse and Borderline Personality Disorder
- Split: A Review and Its Unexpected Merit
- The Influence of Leadership Style on Individuals’ Satisfaction on Small Teams
- The Impact of Postpartum Depression on the Mother-Child Relationship
- Don’t Worry, But Don’t Just Be Happy
- Teachers’ Use of Positive and Negative Feedback: Implications for Student Behavior
Hannah Ephraim
Postpartum depression (PPD), defined as post- birth feelings that include extreme sadness, anxiety, fatigue, and excessive worry (or lack thereof) about one’s infant (Closa-Monasterolo et al., 2017; NIMH, 2016), affects 10-15% of new mothers (Grace, Evindar, & Stewart, 2003; Mirhosseini et al., 2015). Postpartum depression compromises mothers’ abilities to complete everyday tasks, such as attending to their child’s needs (Closa-Monasterolo et al., 2017; NIMH, 2016). Mothers with PPD also tend to experience reduced overall happiness, triggering suicidal thoughts and issues with sleep, appetite, concentration, and mood (Closa- Monasterolo et al., 2017; Murray, Halligan, & Cooper, 2010). Given that the beginning of an infant’s life is a critical time for the development of mother-infant attachment and bonding (Bowlby, 1977; Closa- Monasterolo et al., 2017; Grace et al., 2003; O’Higgins, Roberts, Glover, & Taylor, 2013), children of mothers with PPD may be at risk for both short- and long-term attachment problems (Bowlby, 1977; Nonnenmacher, Noe, Ehrenthal, & Reck, 2016; Murray et al., 1996; Shorey, Chan, Chong, & He, 2015; Werner, Miller, Osborne, Kuzava, & Monk, 2015). As a result, this paper addresses the following research question: how does PPD impact the mother-child relationship?
PPD and Mother-Child Interactions in the Early Years
Postpartum depression is known to influence mother-child interactions from as early as the first year of life (Bernard-Bonnin, 2004; Ferber, Feldman, & Makhoul, 2008; Herrera, Reissland, & Shepherd, 2004; Smith-Nielsen, Tharner, Krogh, & Vaever, 2016). Mother-child interactions during the early years—and in particular interactions during the first three months— are especially important for the development of a healthy mother-child relationship (Bernard-Bonnin, 2004; Closa-Monasterolo et al., 2017; Murray et al., 1996; O’Higgins et al, 2013; Smith-Nielsen et al., 2016). Mothers with postpartum depression, however, tend to exhibit fewer instances of maternal-child touch and positive engagement as compared to non-depressed mothers (Ferber et al., 2008; Herrera et al., 2004), as evidenced by detached mother-child interactions in
activities such as reading books, singing songs, sharing stories, and playing games (Paulson et al., 2006). Mothers with PPD also display less sensitive behaviors toward their children, and tend to respond to their children’s needs in a less responsive, attentive, and nurturing manner (McLearn, Minkovitz, Strobino, Marks, & Hou, 2006; Murray et al., 1996; Smith-Nielsen et al., 2016). These withdrawn behaviors, in turn, are associated with an overall reduction in maternal involvement in children’s activities and a lack of communication between mother and child (Weissman, Paykel, & Klerman, 1972). These detached interactions limit instances of positive engagement and inhibit the formation of a caring and attentive mother-child relationship (Bernard-Bonnin, 2004; Closa-Monasterolo et al., 2017; Ferber et al., 2008).
The mother-child relationship also suffers from a lack of physical touch (Bernard-Bonnin, 2004; Ferber et al., 2008). Physical touch during the early years are crucial to the development of children’s regulatory skills and the ability to cope with stress (Bernard-Bonnin, 2004; Ferber et al., 2008; Feldman, Singer, & Zagoory, 2009). An infant’s self-regulation skills, in turn, are developed through warm and nurturing interactions with their mothers (Bernard-Bonnin, 2004). Conversely, mothers with PPD are more inclined to affectionately care for their infant if the infant is able to self-soothe (Bernard-Bonnin, 2004; Malphurs, Raag, Field, Pickens, & Pelaez-Nogueras, 1996; Tronick & Reck, 2009), thereby establishing a cycle that perpetuates the development of an avoidant and detached mother-child relationship (Bernard-Bonnin, 2004; Murray, 1996; Nonnenmacher, et al., 2016; Tronick & Reck, 2009). As a result, mothers with PPD may face greater impediments in their ability to actively engage with their children, preventing the development of children’s self-regulation, and, ultimately, a loving relationship overall (Bernard- Bonnin, 2004; Ferber, et al., 2008; Murray, 1996; Nonnenmacher, et al., 2016; Tronick & Reck, 2009).
Long-term Effects of PPD on Parenting Style
Furthermore, the longevity of these less-than- optimal mother-child interactions introduces long-term effects of PPD on parenting style (Bernard- Bonnie, 2004; Tronick et al., 2009). In other words, the negative impact of PPD on maternal-child bonding likewise increases with the mother’s continued inability to care for her child (Closa-Monasterolo et al., 2017; O’Higgins et al., 2013; Verkuijl et al., 2014). In particular, children up to 10 years old whose mothers had PPD six months postpartum are twice as likely to have significant psychological issues (Verkuijl et al., 2014). Postpartum depression, and more specifically mothers’ non-caring dispositions, is also significantly associated with children’s anxiety and depression up to eight years of age (Closa-Monasterolo et al., 2017). These dispositions, in turn, are dependent on the type of behavior exhibited by the mother with PPD (Bernard- Bonnin, 2004; Malphurs et al., 1996; Murray et al., 2010; Tronick et al., 2009), and more specifically mothers’ long-term intrusive and disengaged parenting behaviors (Bernard-Bonnin, 2004; Malphurs et al., 1996; Murray et al., 2010; Tronick et al., 2009).
Although both intrusive and disengaged parenting styles contribute to children’s poor self-regulation, these two types of parenting styles affect the mother-child relationship differently (Bernard-Bonnin, 2004; Malphurs et al., 1996; Murray et al., 2010; Tronick et al., 2009). The intrusive mother is more aggressive and irritating toward her child, interacting in a disruptive, bothersome, and unwanted manner that discourages a child’s willingness to spend time with his or her mother (Bernard-Bonnin, 2004; Malphurs et al., 1996). The disengaged mother, on the other hand, is withdrawn and less attentive in tending to her child’s needs, thereby increasing the infant’s irritability (Bernard-Bonnin, 2004; Tronick et al., 2009). This disengaged relationship creates an emotional disconnect and vicious cycle between a child and his or her mother, with the mother in turn becoming frustrated by the child’s irritability (Tronick et al., 2009). As a result, both intrusive and disengaged caregiving styles may impede in the child’s development of self-regulation skills, leading the child to depend physically and emotionally on their mother, despite her uncaring affect and lack of desire to care for her child (Bernard-Bonnin, 2004). Both the flat, unemotional caretaking, as well as the aggressive, intrusive caretaking, foster a relationship between the mother and child based on irritability and anger as opposed to love and care (Bernard-Bonnin, 2004; Tronick et al., 2009). With the progression of age, PPD continues to impede in the development of an attentive mother-child relationship (Closa-Monasterolo et al., 2017; O’Higgins et al., 2013; Verkuijl et al., 2014).
CONCLUSION
In sum, PPD is associated with detached and neglectful mother-child relationships that inhibit maternal bonding and the provision of warm and attentive care (McLearn, 2006; Nonnenmacher et al., 2016; Smith-Nielsen et al., 2016; Song et al., 2017; Tronick et al., 2009). In light of the high prevalence of women affected by postpartum depression, it is important to recognize PPD’s negative impact on maternal-infant bonding and attachment (Closa- Monasterolo et al., 2017; Murray, 1996; NIMH, 2016; Nonnenmacher, et al., 2016; Smith-Nielsen et al., 2016). Nonetheless, recent research suggests that prioritizing PPD screening (Werner et al., 2015) and intervention could improve maternal-infant relationships. When combined with prenatal psychoeducation on PPD (Shorey et al., 2015; Werner et al., 2015), as well as video-based interventions showing and analyzing the interactions on camera (Nonnenmacher et al., 2016), these early interventions have been shown to be effective tools for decreasing rates of PPD and improving the mother-child relationship (Shorey et al., 2015; Werner et al., 2015). Including PPD screening and psychoeducation in prenatal and postnatal appointments, as well as offering resources for women experiencing PPD, may thus decrease the prevalence of PPD and increase maternal-infant bonding (Closa- Monasterolo et al., 2017; Nonnemacher et al., 2016; Shorey et al., 2015; Werner et al., 2015).
Current research on the implications of PPD and the impact on the mother-child relationship, however, does not take into account variability within cultures and SES with regards to specific effects of PPD. While it is clear that depression has a more severe effect on women of low SES compared to women coming from high-SES backgrounds (Freeman et al., 2016), research on PPD has yet to consider or differentiate between the varying impacts PPD may have on women from varying SES. In addition, the research on PPD assumes the importance of a loving and caring mother regardless of sociocultural background and degree of social support. As such, future research should explore the varying effects of PPD on women from multiple cultures with different notions of an engaged mother-child relationship. Lastly, there is a heavy emphasis on the work of Lynne Murray, whose major findings on PPD and its effects were completed in the 1990’s. Researchers should therefore explore the different possible treatments for postpartum depression and how they impact the mother-child relationship, as well as how various forms of treatment may decrease rates of postpartum depression toward improving the mother-child relationship to offer more recent contributions to the literature.