Behavioral Intervention Improves Infant Sleep and Maternal Mood

Abstract

Source: Hiscock H, Wake M. Randomised controlled trial of behavioural infant sleep intervention to improve infant sleep and maternal mood. BMJ. 2002;324:1062–1067.The authors performed a randomized controlled trial in suburban Melbourne, Australia, well-child clinics to compare the effect of a behavioral sleep intervention with the effect of providing written information only about normal sleep on infant sleep problems and maternal depression. The participants included 156 mothers who reported severe sleep problems in their 6–12 month-old infants. Mothers in the intervention group attended 3 private meetings separated 2 weeks apart at which a senior pediatric trainee with 1 year of sleep management experience discussed normal sleep behavior and taught a “controlled crying” method of sleep management. Mothers in the control group were mailed a single sheet of paper describing normal sleep patterns in 6–12 month-old infants but were offered no advice. Two and 4 months following the intervention, more sleep problems had resolved in the intervention group than in the controls (at 2 months: 70% versus 47%, P=.005; at 4 months: 64% versus 55%, P=.26). Scores on the Edinburgh postnatal depression scale fell further among the intervention mothers than in controls (mean change −3.7 versus −2.5, P=.06). In the subgroup of mothers with initial depression scores of 10 and greater, more sleep problems had resolved in the intervention group than in the control group (79% versus 39%, P=.001). In this subgroup depression scores also fell further for intervention mothers than control mothers at 2 months (−6.0 versus −3.7, P=.01) and 4 months (−6.5 versus −4.2, P=.04). Four months following the intervention, sleep problems had resolved in more than half of the infants in both groups, and differences in sleep problems and depression scores had disappeared between the 2 groups. The authors conclude that behavioral intervention significantly reduces infant sleep problems at 2 but not 4 months. Maternal report of depression symptoms decreased significantly at 2 months and was sustained at 4 months for mothers with high depression scores.Infant sleep problems and maternal depression are common and have potentially serious implications. Mothers whose infants have sleep problems are more likely to report depressive symptoms.1 This is the first controlled study of the effect of an infant sleep intervention on postnatal depression. Does this study provide convincing evidence of effectiveness? The investigators randomized subjects to intervention and control groups and they demonstrate a modest reduction in maternal depressive symptoms that persists in more depressed mothers. However, it is not clear what aspect of the intervention leads to this effect. It could be that intervention mothers benefited from simply meeting with a supportive professional 3 times and that the content of the session was irrelevant. Further studies in this area should include a control group in which mothers spend equal time with a supportive professional who does not discuss behavioral sleep intervention.