Recognizing and Screening for Postpartum Depression in Mothers of NICU Infants

Adv Neonatal Care. 2003;3(1) 

In This Article

The Effect of PPD on Infants and Children

While women are "going to the gates of hell and back,"[20] how does PPD affect interactions with their infants? During the first year of life, mothers constitute a large portion of their infants' social environment. They are a critical source of cognitive, emotional, and social stimulation. It is postulated that depressed mothers may be unable to respond to their infants' cues, thus having a negative impact on development.

Mounting evidence supports the adverse effects of PPD on mother-infant relationships during the first year of life. Beck conducted a meta-analysis of 19 studies and found that PPD has a moderate to large effect size in relation to how mothers and their infants interact during the first 12 months after delivery.[26] When compared with nondepressed mothers, those with PPD exhibited the following symptoms:

  • Less affectionate behavior

  • Less responsive to infant cues

  • Withdrawn with a flat affect and/or were hostile and intrusive with their infants

The infants of mothers with PPD tended to be fussier and more discontent and avoidant and made less positive facial expressions and vocalizations than infants whose mothers were not depressed. Depressed mother-infant dyads matched negative behavior states more frequently and positive behavior states less frequently than nondepressed mother-infant dyads.[26]

A significant relationship between PPD and infant sleep problems has been identified.[27,28] In a longitudinal study of 151 Australian mothers followed from the postpartum period to 7 months, elevated PPD symptoms in the early postpartum period were a significant risk indicator of heightened child physical abuse potential at 7 months (P = 0.001).[29]

The adverse effects of living with and being socialized by a mother with PPD on a child's development is highlighted by a meta-analysis of 9 studies examining the effect of PPD on the cognitive and emotional development of children over the age of 1 year.[30] Children whose mothers had PPD displayed small but significant differences with more behavior problems, insecure attachment, and cognitive deficiencies (mean effect size d = 0.45) when compared with infants not exposed to PPD mothers.

Some evidence suggests that the impact of PPD persists beyond infancy. Murray et al investigated the socioemotional development of 5-year-old children whose mothers had been depressed in the first few months after delivery.[31] Even after controlling for current maternal depression and adverse circumstances, children's behavior problems at home and social patterns of play at school were significantly associated with PPD. Children whose mothers had experienced PPD displayed less physical and creative play than the control children. Maternal reports of their child's behavior at home indicated a significant effect of PPD. Children of PPD mothers scored significantly higher on the neurotic (z = -3.67; P < 0.001) and antisocial (z = -2.15; P < 0.001) subscales of the Rutter A2 Questionnaire than children whose mothers did not have PPD.

The effects of PPD may extend beyond early childhood and into the second decade of life. One study reported significantly lower IQ scores in 11-year-old children whose mothers had been depressed at 3 months postpartum.[33] The boys were hyperactive and showed distractible behavior when compared with boys whose mothers had not been depressed during their postpartum period. In summary, accumulating evidence supports both the immediate effects of PPD on maternal-infant interaction and provides evidence for potential long-term sequelae on the cognitive and emotional development of children.

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