Mother-infant interaction in women with depression in pregnancy and in women with a history of depression: the Psychiatry Research and Motherhood - Depression (PRAM-D) study.

Rebecca H Bind,Carmine M Pariante,Andrea Du Preez,Paola Dazzan,Sarah Osborne,Alessandra Biaggi,Vaheshta Sethna,Aoife Bairead,Freddie Waites,Katie Hazelgrove,Susan Pawlby,Susan Conroy

doi:10.1192/bjo.2021.52

Abstract

Little is known about the effects of depression before birth on the quality of the mother-infant interaction. To understand whether depression, either in pregnancy or in lifetime before pregnancy, disrupts postnatal mother-infant interactions. We recruited 131 pregnant women (51 healthy, 52 with major depressive disorder (MDD) in pregnancy, 28 with a history of MDD but healthy pregnancy), at 25 weeks' gestation. MDD was confirmed with the Structured Clinical Interview for DSM-IV Disorders. Neonatal behaviour was assessed at 6 days with the Neonatal Behavioural Assessment Scale, and mother-infant interaction was assessed at 8 weeks and 12 months with the Crittenden CARE-Index. At 8 weeks and 12 months, dyads in the depression and history-only groups displayed a reduced quality of interaction compared with healthy dyads. Specifically, at 8 weeks, 62% in the depression group and 56% in the history-only group scored in the lowest category of dyadic synchrony (suggesting therapeutic interventions are needed), compared with 37% in the healthy group (P = 0.041); 48% and 32%, respectively, scored the same at 12 months, compared with 14% in the healthy group (P = 0.003). At 6 days, neonates in the depression and history-only groups exhibited decreased social-interactive behaviour, which, together with maternal socioeconomic difficulties, was also predictive of interaction quality, whereas postnatal depression was not. Both antenatal depression and a lifetime history of depression are associated with a decreased quality of mother-infant interaction, irrespective of postnatal depression. Clinicians should be aware of this, as pregnancy provides an opportunity for identification and intervention to support the developing relationship.

Highlights

Little is known about the effects of depression before birth on the quality of the mother–infant interaction
At 6 days, neonates in the depression and history-only groups exhibited decreased social-interactive behaviour, which, together with maternal socioeconomic difficulties, was predictive of interaction quality, whereas postnatal depression was not. Both antenatal depression and a lifetime history of depression are associated with a decreased quality of mother–infant interaction, irrespective of postnatal depression
Studies have shown that the association between postnatal depression (PND) and a less optimal mother–infant interaction may be attributable to a continuation of impaired foetal attachment from pregnancy into the postnatal period,[7] and that antenatal depressive symptoms are associated with poorer bonding and increased maternal unresponsiveness postnatally.[8,9,10]

Summary

Methods

Method We recruited131 pregnant women (51 healthy, 52 with major depressive disorder (MDD) in pregnancy, 28 with a history of MDD but healthy pregnancy), at 25 weeks’ gestation. The sample included 131 women: healthy women, attending their routine antenatal ultrasound scan at King’s College Hospital [healthy group]; women diagnosed with depression, referred to the Maudsley Perinatal Psychiatry Services [depression group]; and 28 ‘history-only’ women, who had a history of MDD but no current diagnosis, recruited from either their regular antenatal scan or the psychiatric clinical service (where they were referred for assessment only, because of the historical vulnerability) [history-only group]. Women and their offspring were assessed from 25 weeks’ gestation (baseline) until 1 year postnatal.

Results

Discussion

Conclusion