Maternal Mental Illness Impairs Recognition of Child Emotions

Liam Davenport

October 10, 2018

BARCELONA, Spain — Pregnant women who have a history of affective disorders have difficulty recognizing infant facial expressions and vocal signals, investigators report. The preliminary findings may flag the need for additional help with mother-infant interactions in this patient population.

"In this study, we found that pregnant women with unipolar depression (UD) or bipolar disorder (BD) process infants' facial and vocal signals of emotion differently even when they are not currently experiencing a depressive or manic episode.

"These differences may impair these women's ability to recognize, interpret and respond appropriately to their future infants' emotional signals," lead investigator Anne Bjertrup, BSc, the Copenhagen Affective Disorder Research Center, Rigshospitalet, said in a release.

The findings were presented here at the 31st European College of Neuropsychopharmacology (ECNP) Congress.

Altered Emotional Processing

Previous studies suggest that individuals with UD have a negative bias in the cognitive processing of emotional information that is linked to depression severity and relapse risk.

On the other hand, BD patients have difficulty recognizing emotional expressions and have a positive cognitive bias.

Some evidence suggests that pregnant women with UD have negative bias; no such studies have been conducted in pregnant women with BD. The team set out to determine whether the processing of emotional information is altered in pregnant women who have a history of affective disorders.

The study included 57 pregnant women from obstetric departments and mental health centers around Copenhagen. Participants included 22 women with a history of UD, seven with a history of BD, and 28 healthy control individuals.

The investigators also recruited 18 nonpregnant healthy women, matched for age and education, to act as additional control participants.

Importantly, all of the women with affective disorders were in remission.

Between weeks 27 and 39 of their pregnancy, the women completed the Facial Emotion Recognition and Baby Paradigm emotion processing tasks.

Consistent with previous findings, pregnant women with a history of BD had significantly poorer accuracy on adult facial expression recognition than other women (P = .01).

They also were significantly better at recognizing positive faces than both healthy pregnant women (P = .01) and nonpregnant women (P < .001).

In contrast, for pregnant women with a history of UD, recognition of negative faces was increased compared with other women (P = .049).

When it came to infant emotional expressions, the team found that pregnant women with a history of BD rated smiling infant faces more positively than healthy pregnant women (P = .02), but showed no positive bias on infant sounds.

On the other hand, pregnant women with a history of UD rated infant crying more negatively than pregnant women (P = .020), albeit without showing any negative bias on infant faces.

Impact on Children?

Bjertrup told Medscape Medical News that the emotional biases they identified in the study "are risk factors for new episodes and maintaining factors for the illness overall."

Although the results don't speak to the potential impact on their offspring, she noted that in theory, if such women have emotional biases even when they're not currently in a manic or depressive state, they would tend to misinterpret other people's expressions.

"If they do that with their own child's expressions, that will have an impact on the daily mother-infant interactions, and these daily interactions are the foundation on which the attachment bond builds," she said.

She suggested, therefore, that the attachment bond "might be negatively affected by the mother responding in a certain way, and if the attachment quality is worse, then this is risk factor and a vulnerability factor for the child as it grows."

This could be one way in which mental disorders are transmitted through generations. It is well known that the offspring of mothers with UD and BD have an increased risk not only for these conditions but also for attention-deficit/hyperactivity disorder, anxiety, and other psychological problems.

"Children are not born with the ability to know their own emotions and be able to regulate them. They need a caregiver to teach them how to do that, and this is what happens in the very early mother-infant interactions," said Bjertrup.

"The mother is containing all the infant's confusing affective states, and if the mother herself has some difficulties regulating her own emotional states, it's really difficult to teach that to her child," she said.

Consequently, Bjertrup believes that for mothers with affective disorders, interventions should be targeted toward the mother-infant interaction, not just toward the mother and her symptoms.

However, she added, it is very important to understand that "this is not about being good or bad mothers. It's about difficulties that make you process and interpret your environment in a different way, and that affects your environment.

"These mothers are not to blame, and they certainly shouldn't blame themselves, because these illnesses are already associated with much self-blame and guilt," she siad.

On the basis of these findings, further studies are required to determine whether the cognitive biases the researchers identified "influence the risk of postpartum mood episodes and early mother-infant interactions," Bjertrup said.

Intervention Opportunity?

Commenting on the findings, Eduard Vieta, MD, PhD, chair of the Department of Psychiatry and Psychology at the University of Barcelona Hospital Clinic, Spain, who was not involved in the study, welcomed the research.

He noted that the findings add to the growing scientific literature that shows emotional bias in people with mood disorders, even when their conditions are in remission. These results show for the first time the difficulties mothers have in identifying emotions in their own newborns, he said.

"The results, however, do not imply at all that women with such conditions would not be able to raise a child properly, and it does not prove any risk for their children, since longitudinal data are lacking. This work may help us identify targets for pharmacological and psychological treatments, which in turn may help people with depression and bipolar disorder," Dr Vieta said in a release.

No funding for the study has been reported. The investigators and Dr Vieta have disclosed no relevant financial relationships.

31st European College of Neuropsychopharmacology (ECNP) Congress. Abstract P.569, presented October 8, 2018.

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