Post Partum Depression

Transcription

1 Post Partum Depression A chronic reiterated perturbation leading to blind selection with Consequences for Infant Development and the Mother- Infant Relationship As registrant to the workshop, you may print or download to a local hard disk part or all of the content of this presentation for your personal and non-commercial use only. Any transmission, storage, redistribution or reproduction of part or all of the content in any form for any other purpose is a breach of copyright and is strictly prohibited.

2 Rate of Postpartum Depression Approximately 8-15% of postpartum women in community samples report clinically significant levels of depressive symptoms 1990).

3 Over the First Postpartum Year Maternal Depressive Symptoms Are Constant and Stable

4 Simplified Model of Post Partum Blues Depression Resolution

5 Correlations of Maternal CES-D Scores Across Visits In The First Year Postpartum Intake (2 Mos) Intake 3 Mos 6 Mos 3 Months Months Months Note: Pearson product-moment correlations, N = 104; Average Correlation =.51 All p s <.0001

6 Maternal Depressive Symptoms at Two to Twelve Months Postpartum High (N=47) Normative (N=57) 0 2 Months 3 Months 6 Months 12 Months Postpartum Visits

7 Maternal Depression is associated with compromised Maternal Psychosocial Functioning

8 High Levels of Depressive Symptoms Alone Affect Maternal Functioning Much the Same as A Diagnosed Depression

9 Maternal Self-Esteem Mean Scores Diagnosis Hi Symptoms Control Diagnosis Hi Symptoms Control

10 Total Psychiatric Symptoms (SCL-90) Mean Scores Diagnosis Hi Symptoms Control Diagnosis Hi Symptoms Control

11 Negative Emotions Diagnosis Hi Symptoms Control Mean Scores Diagnosis Hi Symptoms Control

12 Over the First 18 months of Life Infants of Depressed Mothers are Exposed to Chronically Compromised Maternal Emotions and Psychosocial Functioning Compared to Controls

13 Parenting Characteristics of Mothers with High Levels of Depressive Symptoms Unavailable Unresponsive Uncommunicative Overreative Overcautious Overindulgent Overcontrolling Anxious Angry Intrusive Withdrawn

14 Disruptive Features of Parenting of Women with High Levels of Symptoms regulation Disrupt infants positive states of joy and interest and curiosity social and physical environment Disrupt meaning making processes

15 High Levels of Maternal Depressive Symptoms Alone (with or without a Diagnosis) are Associated with Compromised Social Emotional Development in Infants and Children

16 Behavioral and Developmental Effects Associated with Maternal Depression on Newborns Higher Levels of Obstetric Risk Poorer Neurobehavioral Performance Poorer motor tone Poorer self-quieting More irritability

17 Behavioral and Developmental Effects Associated with Maternal Depression in Young Infants Less active More crying More anger expressions Less joy expressions Less object engagement Less social engagement More insecure attachments

18 Behavioral and Developmental Effects Associated with Maternal Depression on Preschool Age Children Poorer modulation of affect More unstained Poorer selective attention Less tolerance for frustration Less prosocial behavior

19 Behavioral and Developmental Effects Associated with Maternal Depression on School Age Children More conflict with peers and siblings Increased acting out behavior Poorer cognitive functioning Problems sleeping Enuresis

20 Behavioral and Developmental Effects Associated with Maternal Depression on Adolescents Increased a-social behavior More conflict with parents, siblings and peers Increased school problems truancy drop out poor grades More psychiatric symptomology psychosomatic complaints anhedonia depression

21 What Does the Mutual Regulation of Depressed Mother and Infant Look Like?

22 Simulated Depression

23 PLAY PLAY BRIEF BRIEF MONITOR MONITOR WARY WARY LOOK AWAY BRIEF LOOK AWAY PROTEST BRIEF PROTEST NORMAL INTERACTION SIMULATED DEPRESSION

24 Simulated Depression

25 Studied a Low Risk Sample to Avoid Confounding Effects of High Risk Factors (e.g., poverty) and Depression

26 Proportion of Time INFANTS of Depressed and Non-Depressed Mothers Engage in Affective-Social Behaviors Proportio n of time * 10 0 * Protest Look Away O bject Attend Play * * NonDepressed Depressed * p < 0.05

27 Proportion of Time Depressed and Non-Depressed Mothers Engage in Affective-Social Behaviors Proportio25 n of time * Anger/Poke Disengage Positive/Play * * NonDepressed Depressed * p < 0.05

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29 Different Types of Depressive Caretaking Intrusive Withdrawn

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37 Depressed Intrusive

38 Infant Behavior of Depressed Intrusive Mother Mean Proportion Of Time Protest Look Away Object Attend Play Infant Behaviors Normal Depressed

39 Depressed Intrusive Mother Behavior Mean Proportion Of Time %.0+% Anger/Poke Disengage Elciit Play Mother Behaviors Normal Depressed

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44 Depression Withdrawn VIDEO OF WITHDRAWN MOTHER

45 Depressed Disengaged Mother Behavior Mean Proportion Of Time %.0+% Anger/Poke Disengage Elciit Play Mother Behaviors Normal Depressed

46 Infant Behavior of Depressed Disengaged Mother Mean Proportion Of Time Protest Look Away Object Attend Play Infant Behaiviors Normal Depressed

47 For Good or Ill Specific and Different Moods Emerge from the Chronic Patterns of Affect Reparation

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51 Are there gender differences in the social interactions of sons and daughters and if there are there differential effects associated with depression?

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55 Mean Synchrony Scores For Mother-Daughter and Mother-Son age Dyads at 6 Months Mother- Mother-Son Daughter Mean SD Mean SD 6 months Mean synchrony score = proportion of shared variance at Lag - 0 as indexed by the square of the crosscorrelation between mothers

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62 Dynamic Systems Model of Normal Development and Depression (Any Chronic Perturbation)

63 MATURATIONAL MODEL (Genes &Temperatment & Behavioral Learning) FUNCTIONAL AND CNS MATURATION DEVELOPMENTAL STATUS TIME MONTHS

64 Spurts of Growth and Practice Piaget Motor Skills Language Babbling Language Walking Crawling

65 Dynamic Systems and Change All body, brain, and menatal systems move through periods of disorganization to develop from simpler and less integrated systems to more complex and integrated Systems Greater Complexity And Coherence

66 Development is Not Smooth But is Characterized by Spurts and Disorganization Functional and Developmental Status Crawl Walk Time

67 Normal Disorganization is Regulated by a Dyadic System Functional and Developmental Status PARENT Walking Mood INFANT Sleep Time Interaction

68 Unregulated Disorganization Leads to Loss of Integration and Loss of Complexity Functional and Developmental Status Old Capacity Time Entropy

69 Disorganization in One System Can Disorganize Others and Developmental Status Sleeping Feeding Walking Caused by Depression Attention Time Maternal Anxiety

70 Inability to Regulate Disorganization Can Lead to Developmental Derailment and Developmental Status Parent/Adult Normal Development Time 2 Normal Development Time 1 INFANT Developmental Derailment Cognition Emotions Interaction Time

71 CLINICAN WORKS TO SCAFFOLD REGULATION BUT NOT TO DO AWAY WITH DISORGANIZATION Work PARENT NORMAL PARENTING and DEVELOPMENT and Developmental Status INFANT DEVELOPMENTAL PSYCHOPATHOLOGY Time

72 Perturbation in Infant, Mother, or Environment Disrupts Regulation Depression PARENT ANXIETY ANGER Functional and Developmental Status INFANT DERAILMENT ANXIETY FEARS DYSREGULATION Time

73 Intervention for Postpartum Depression based on Dynamic System Disorganization Model of Development

74 Non-Depressed Mother **** Infant Normal Development Disorganization >>>> Normal Maternal Sense of Failure and Fault

75 of Normal Infant Development Disorganization for Depressed Mother **Normal Maternal Sense of Failure and Fault **KNOWS that Her Depression has Caused the Disorganization

76 of Normal Infant Development Disorganization for the Infant ** Normal Level of Disorganization ** Greater Vulnerability and Intensity to Disorganization

77 DSC Tx for Depressed Mother 1. Depression on Development from Normal Disorganizing Effects in Development >>See Disorganization as Normal and positive 2. Recognizing Effects of Depression Development >> > Worked with own therapist on Separation and Feeding in her own History

78 Case Intervention for Depressed Mother Sleep Issue at 12 months *Infant is Starting To Walk and Sleep and Eating are Disorganized >> Saw as Related to Her Depression

79 DSC Tx for Depressed Mother Sleep Issue at 12 months Mother is Unable to Let the Infant Go to Sleep Unless Fully Fed >> Saw as Related to Her Depression >Woke infant at night * Treat the

80 DSC Tx for Depressed Mother Split the Perception of Disorganization into Two Pieces Normal Piece Depression Related Piece * Treat the Mother-Infant Issues in the Normal Framework Own Depression Centered Therapy

81 Maternal Depression is a Chronic Communicable Disease that is Vertically Transmitted to Infants and Children

82 Focusing our Mental Health Resources Only on Mothers with Diagnoses FAILS to Help the Greater Number of Levels of Symptoms and Their Children