Postnatal depression
Consequences for mother and child
Dr Andrew Mayers
amayers@bournemouth.ac.uk
PND - consequences
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Overview
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Importance of attachment
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When bonding goes wrong with PND
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What does this mean for mother and baby
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Short and long term
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The importance of attachment
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Why is attachment important between mother and infant?
 Early mother–infant bond may have sig. impact on developing
infant
Infant’s internal working model (IWM) is very important
 Expectations about themselves in relation to others
 Model of self and of other
If infant’s carer attends positively and responds to needs
  Infant has positive IWM:
 High self-worth, availability of others, resolution of crises
Infant’s carer inconsistent response and attention
  Infant’s has negative IWM:
 Low or ambivalent self-worth, unavailable others, crises not
resolved
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Bonding and attachment
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So how is bonding compromised in PND?
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Also applies to other mental health problems in perinatal period
Mum is distracted for whole manner of reasons
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Low mood
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Lack of motivation
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Fear and guilt
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Poor concentration
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Lack of self-worth
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Low self-esteem
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Effect of medication
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PNP and the child
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Some research that we have done
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We explored serious mental illness in mothers (vs. controls)
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Including severe depression
Sample
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6 ill mums; 12 healthy controls
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First 8 weeks after birth
We measured a number of key aspects
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Cognitive functioning (computerised tests)
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Memory, speed of functioning, attention
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Perceptions of parenting skills and stress (questionnaire)
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Observation of interaction with baby (video)
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Quality, sensitivity, appropriateness, etc.
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PNP and the child
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Cognitive functioning
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Computerised program from Cognitive Drug Research (CDR)
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Word and picture recall and recognition
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Reaction time
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Rapid visual information processing
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Spatial and numeric working memory
Focus on cognitive function
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Power and continuity of attention
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Episodic memory
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Working memory
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Speed of memory
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PNP and the child
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Observation of interaction with baby
 Undertaken with video
 From behind mother (to see baby’s face)
 But in front of mirror (to see mum’s face)
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PNP and the child
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Observation of interaction with baby
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Quality and appropriateness of interaction
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Assessed using highly validated method:
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Crittenden CARE Index
Pat Crittenden was a student of Mary Ainsworth
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Ainsworth pioneered attachment styles
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And was herself student of Bowlby
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PNP and the child
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Aims of CARE Index
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Mothers and infants rated on 7 aspects
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Facial expression
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Verbal expression
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Position and body contact
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Affection and sensitivity
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Turn-taking and co-operation
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Control
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Choice of activity
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PNP and the child
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Look at these two videos…
Note that these videos are only available in the lecture. They will
be not be available in post-training materials. This is to protect
confidentiality
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Exercise
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What were the key differences in the ‘bonding’ seen in videos?
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What impact might that have for developing child?
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What does bonding teach the child?
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How does PND affect bonding?
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How might we improve bonding?
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How is breastfeeding relevant here (again)?
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PNP and the child
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This interaction was warm, affectionate and rewarding for both
mum and baby
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PNP and the child
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This interaction was not so good
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Mum appeared disinterested: blank face…
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Baby was unsure and uncomfortable
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PNP and the child
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Results
 Significant differences found for several measures
 Mothers with serious mental illness (SMI) vs. controls
 Poorer mother–infant interaction
 Poorer perceived maternal competence
 Poorer cognitive function
 Mother–infant interaction and perceived maternal competence
 SMI mums significantly less sensitive
 Their infants were significantly less cooperative
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Cognitive function
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SMI mums sig poorer on speed of memory processing
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PNP and the child
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So what does this all mean?
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It would appear that SMI in mums is related to slow cognition
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Specifically slower speed of memory
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This may mediate the illness
SMI and slower speed of memory implicated in maternal
sensitivity
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Mum’s slower processing reduces her response to her child
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PND and the child
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Other evidence
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PND associated with several negative outcomes
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Increased marital stress
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Disturbances in child’s emotional and cognitive development
Children of dep mums more likely to be associated with:
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Insecure attachment
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Eating difficulties
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Sleep disturbance
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Being overly clinging
PND affects mum’s ability to cope with care of baby
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Longer term consequences
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Observations from evidence and my own professional practice…
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Specialist schools for ‘excluded’ children
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Care farm project for ‘troubled’ youngsters
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These young people ALL have attachment problems
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Perhaps mum had PND?
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May be one of many reasons
Young people with conduct disorders
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Many have ‘bonding’ issues
Personality disorders
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Key ‘cause’ relates to poor attachment in childhood
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Future work?
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So how could we extend this?
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We could examine the effect of SMI on other factors
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Attachment and bonding
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Long term affect on child development
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Social, emotional, educational, language, forensic
Studies are now at planning stage
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