SPECIAL SECTION: ASSESSMENT OF INFANT AND TODDLER MENTAL HEALTH: ADVANCES AND CHALLENGES
Maternal Depression and Comorbidity: Predicting Early Parenting, Attachment Security, and Toddler Social-Emotional Problems and Competencies

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ABSTRACT

Objective

To examine relations between maternal depression (in pure and comorbid forms) and mother–infant interactions, infant attachment, and toddler social-emotional problems and competencies. A second objective was to explore sex differences.

Method

Sixty-nine mother–infant dyads were followed from pregnancy to 30 months postpartum. Depression was measured at multiple times with self-report and interview assessments. Play was assessed at 4 months and attachment status at 14 months postpartum. At 30 months, mothers completed the Child Behavior Checklist and Infant-Toddler Social and Emotional Assessment.

Results

Lifetime maternal depression predicted less optimal mother–infant interactions and insecure infant attachment. However, this “depression effect” was accounted for by mothers with comorbid diagnoses, who had less optimal interactions, and infants with higher rates of insecurity than either mothers with depression only or mothers with no psychopathology. Prenatal and postpartum depressive symptoms were associated with problem behaviors and lower competencies for boys. In contrast, quality of early interactions predicted problem behaviors in girls.

Conclusions

It is important to examine the context of maternal depression with respect to additional psychopathology and environmental risks. Maternal depression in the presence of other psychopathology confers risk to the mother–child dyad. Consistent with previous work, risk pathways appear to differ for boys and girls. Early identification and prevention efforts are warranted.

Section snippets

Participants

Pregnant women were recruited from an obstetrics and gynecology department in a health maintenance organization in a mid-sized city in the northeastern United States. Women who did not understand English and infants born preterm or with serous birth complications were excluded. Approximately 50% of women approached completed a questionnaire packet in the second or third trimester of pregnancy (N = 128). See Baker and colleagues (1999) for a description of the prenatal study sample. This report

RESULTS

Prior to examining the role of maternal depression in the early course of children's social-emotional development, associations between demographic variables (i.e., maternal age, maternal education, household income, number of children, and child sex) and maternal depressive symptoms, maternal diagnostic status, emotional availability at 4 months postpartum, security of infant attachment, and maternal ratings of infant-toddler problems and competencies were examined for consideration as

DISCUSSION

This study highlights the importance of comorbidity in conferring risk for problems in early parent–child interactions and infant attachment status. Women who experienced a depressive illness, as well as an anxiety, substance, or eating disorder had less optimal play interactions with their 4-month-old infants than either mothers who had experienced depression only or mothers who had no history of psychopathology. By 14 months of age, infants in the comorbid group were at very high risk for

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    This study was supported by NIMH grant 49684 to Dr. Carter.

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