INFANT BEHAVIOR AND DEVELOPMENT 19, 149-l 52 (1996)

BRIEF REPORT

Mother-Infant and Father-Infant interactions in Postpartum Depression

HENRI CHABROL, NATHALIE BRON, AND JEAN LE CAMUS Universitt! de Toulouse Le Mirail

Mother-infant, father-infant, and father-mother-infant interactions were studied in two groups of 10 families each, one where the mother was moderately depressed, the other where she was nondepressed. No differences were found between groups. Dyadic and triadic parent-infant interactions were positive in both two groups as evaluated by the total time spent in positive and negative behavior states and by the time spent in joint states.

postpartum depression mother-infant interaction father-infant interaction

Father-infant interaction has not been investi- gated in postpartum depression. However, the importance of father-infant interaction in the early development is now being emphasized. Moreover, father-mother-infant interaction has not yet been studied, even though it would be interesting to evaluate the influence of the father on mother-infant interaction. As fathers are usually as competent as mothers in early interactions (Yogman, 1982), it is possible that a positive father-infant interaction could partly compensate for a negative or insufficiently pos- itive mother-infant interaction. But Field et al. (1988) found that the “depressive” behavior of the infant could generalize with nondepressed partners, and, on the other hand, depressive symptomatology of the fathers has been found to be correlated with that of the mothers (Richman, Raskin, & Gaines, 1991).

We report the study of mother-infant and father-infant interactions in two groups of 10 families each, one where the mother was depressed, the other where she was non- depressed.

Postpartum women were recruited from an obstetrics clinic and a mother and baby health center. One hundred twenty-one consecutively consulting mothers of infants aged 3 to 6 months were given the Edinburgh Postnatal Depression Scale (EPDS; Cox, Holden, & Sagowsky, 1987). Among the 32 mothers who received scores of 9 or above on the EPDS, 12 agreed to participate in the study. Ten of them met DSM-III-R criteria

Correspondence and requests for reprints should be sent to H. Chabrol, 21 rue d’Alsace-Lorraine, 31000 Toulouse, France.

for major depression and received scores of 18 or above on the Montgomery Asberg Depression Rating Scale (MADRS). The mean score, which was 26 f 9.9, indicated low-to-moderate depres- sive symptomatology. The mean Beck Depression Inventory score of fathers was 1.7 f 1.8. Among mothers whose score was under 5 on the EPDS, 30 were randomly selected, and 17 agreed to participate in the study. One mother whose score was 0 was excluded, because Field et al. (1991) showed that “zero Beck mothers” have more perturbed interactions with their infants than depressed mothers. Ten were cho- sen to match age and sex of the infants with those from the depressed group. Their mean EPDS score was 3.5 f 1.7. The mean Beck Depression Inventory score of the husbands of control women was 1.2 f 1.5. The group of non- depressed mothers and the depressed group were matched in age (32.1 f 5.9 vs. 28.8 + 3.0, respectively) and social class (middle class). The infants were well matched in gender and age (M age = 4.5 months f 1 .O in the two groups). There were 6 males and 4 females in the depressed group and 5 males and 5 females in the control group.

All families were videotaped during home visits by the same interviewer (H.C.) on Saturday mid-morning or mid-afternoon at an hour chosen by the parents. During face-to-face interactions, the infants were placed in an infant seat on a table approximately 40 cm from the face of the parent who was seated at the table. A mirror placed to one side of the infant enabled filming of the frontal views of partners with a single camera. Mother-infant dyadic interactions were first videotaped for

149

150 Chabrol, Bran, and t.e Camus

2 min of face-to-face play, then father-infant dyadic interactions were videotaped for another 2 min, and finally father-mother-infant triadic interactions were videotaped for another 2 min. During dyadic interactions, one parent sat in front of the infant and the other sat beside him/her. During triadic interactions, both par- ents sat on chairs put together so that both faces could be filmed in the mirror.

Parents’ and infants’ behavior was coded using behavioral descriptors and a l-s scoring interval. The behavior-state system developed by Cohn, Matias, Tronick, Connell, and Lyons- Ruth (1986) for coding depressed mother- infant interaction was used to code the infants’ and mothers’ behavior in this study in order to

provide data comparable with that of the Cohn et al. (1986) study and with that of the Field, Healy, Goldstein, and Guthertz study (1990) which also used the same system. Coded for the parents were anger/poke, disengage, elicit, and play. Coded for the infant were protest, avert, attend, object, and play. The total time spent in these behavior states was compared between the two groups. Behavior state matching was studied by measuring the time spent in joint state by the parent and the infant as in the Field et al. (1990) study. Because we wanted to have correspond- ing behavior states for the parents and infants for the purposes of assessing matching of states, we added a category called “object” where the par- ent hands an object to his or her infant with a

TABLE 1 Means and Standard Deviations of Infants’, Mothers’, and Fathers’ Total Times,

Expressed in Seconds, Spent in Each Behavioral State

Depressed Group Nondepressed Group

M SD M SD t(r(18) q 2.10)

Infants’ Behavior States in Dyadic Interaction With Mothers Protest/Look Away 35.9 32.9 36.4 Attend 42.6 34.0 57.4 Play 14.0 19.7 11.6 Obiect 27.5 42.9 11.6

Mothers’ Behavior States in Dyadic Interaction $ntter/Poke/Disengage . I . 78.3 5.7 20.7 6.2 63.5 5.8

Play 35.7 22.8 46.7

Infants Behavior States in Dyadic Interaction With Fathers Protest/Look Away 33.8 4.9 41.0 Attend 46.9 32.4 46.7 Play 18.7 19.5 19.8 Obiect 21.4 37.5 12.5

Fathers’ Behavior States in Dyadic Interaction hzer/Poke/Disengage 77.3 8.1 32.0 8.9 71.4 8.8

Play 46.3 24.2

Infants’ Behavior States in Triadic Interaction Protest/Look Attend.

Away 36.1 34.4 I

46.1 29.7 Play 14.2 15.5 Object 32.0 47.0 Mothers’ Behavior States in Triadic Interaction

40.0

32.1 51.4 13.2 23.1

Play 33.0 27.0

Fathers’ Behavior States in Triadic Interaction

$;Ter/Poke/Disengage Plby

35.9 41.2 30.6 33.8 36.7 29.8

Anger/Poke/Disengage 15.2 16.0 12.6 Elicit 68.8 2.2 54.4

46.4

31.6 40.5 43.1

30.0 0.04 ILS

31.4 1.01 “S

12.0 0.32 ns 31.9 0.94 ns

7.6 0.02 ns 28.6 1.30 ns 32.4 0.87 “S

36.4 0.50 ns 27.2 0.02 ns 22.3 0.11 ns 26.4 0.61 ns

17.5 0.11 ns 24.7 0.46 ns 28.0 0.53 ns

29.5 0.27 ns 31.8 0.38 ns 20.5 0.12 ns 37.1 0.46 ns

9.4 0.44 ns 25.9 1.10 ns 24.2 1.16 ns

20.8 0.36 ns 28.0 0.05 ns 20.6 0.56 ns

Interactions in Postpartum Depression 151

neutral affective expression. Four categories were considered to be matching states. The first one was a negative state which assembled anger- poke/protest and disengage/look away, because anger-poke/protest were rare events in our sub- jects. The second and third ones were elicit/attend and play/play. The fourth category, object, refers to the infant looking with neutral expressions at an object handled by the parent with a neutral affective expression.

The videotapes were then rated by a research assistant (N.B.) who was blind to the diagnostic status of the mothers. Videotapes were viewed in real time. Whenever a change in behavior was observed, the videotape was replayed at either full or slow speed to deter- mine its time of occurence. Times read from a digital display recorded on the videotapes were rounded to the nearest 1 s. Behavior states were coded with Kronos computer program (Kerguelen, 1991). Code keys were used to enter the durations of the behavior states which were summarized by the computer. Behavior state matching was studied by analysis of state

curves yielded by behavior state coding soft- ware. To assess observer reliability, videotapes of two families were recoded independently by H.C. Interrater agreement, defined as the two coders observing the same total duration of each behavior state, allowing l-s differences, ranged from 83% to 98% for mothers’ states, from 85% to 94% for fathers’ states, and from 78% to 97% for infants’ states.

Comparisons between the two groups used t tests and showed no statistically significant difference. Depressed mothers and their infants were as positive as nondepressed dyads. Fathers and infants were as positive in the two groups (Table 1). Triadic interactions were equally as positive in the two groups. There was no differ- ence in behavior state matching between the two groups. The two groups spent the same amount of time in joint states (Table 2).

This study shows that some families with a moderately depressed mother may display posi- tive interactions. This result is not surprising as Cohn and Tronick (1989) found that, among 13 depressed mothers with cumulated negative con-

TABLE 2 Means and Standard Deviations of limes, Expressed in Seconds,

Parents’ and Infants’ Shared Behavioral States

Depressed Group Nondepressed Group

M SD M SD

Mother-Infant Dyadic Interaction Anger/Poke/Protest

Disengage/Look Away 3.8 5.2 Elicit/Attend 30.7 27.0

Play/Play 10.3 15.0 Obiect 21.0 34.0

Father-Infant Dyadic Interaction Anger/Poke/Protest

Disengage/Look Away 2.7 4.4 Elicit/Attend 24.4 17.0 Play/Play 12.2 15.6 Object 16.5 30.3

Mother-Infant Interaction in Triadic Situation Anger/Poke/Protest

Disengage/Look Away 6.5 10.3 Elicit/Attend 23.3 19.5 Play/Play 8.6 11.5 Obiect 25.9 38.5

Father-Infant Interaction in Triadic Situation Anger/Poke/Protest

Disengage/Look Away 7.6 16.2 Elicit/Attend 10.7 11.5 Play/Play 7.6 8.0 Object 8.3 30.5

3.1 4.4 31.7 26.2

9.0 9.6 10.7 23.0

5.4 13.0 0.61 ns 29.9 23.6 0.38 ns

8.8 10.3 0.68 “S 8.9 18.8 0.65 ns

A.2 5.5 0.62 “S

18.5 11.2 0.67 “S 10.0 16.6 0.22 ns 15.2 20.7 0.27 IlS

8.0 5.8 0.07 flS

17.5 18.4 0.99 ns 10.1 18.3 0.39 “S

8.9 21.6 0.05 “S

t(t(18) q 2.10)

0.32 “.S

0.06 nS

0.23 flS

0.78 IX

152 Chabrol, Bron, and Le Camus

ditions such as low economic status, prior psychi- atric hospitalization, or single parenthood, a sub- group of depressed mothers showed high rates of positive expression, comparable to that found in laboratory studies of normal development. An influence of social class may be discarded as Cohn, Campbell, Matias, and Hopkins (1990) found reduced positivity of depressed dyads in middle-class families. In our study, the lack of difference between the two groups may be explained by the following three main reasons:

1. The low-to-moderate intensity of the depressive symptomatology may have con- tributed to reducing the differences. A pos- sibility is that the mothers were experienc- ing transient episodes. The low level of depressive symptoms in the fathers may be linked to that. Most of the depression effects have been found to be carried by women with chronic depression (J.F. Cohn, person- al communication, August 11, 1994).

2. Only one third of depressed mothers agreed to participate in the study: The most dysfunctional families may have refused to be videotaped. Families willing to partici- pate may have more positive interactions.

3. Finally, the small number of participants may have led to a lack of statistical power.

REFERENCES

Cohn, J.F., Matias, R., Tronick, E.Z., Connell, D., & Lyons-Ruth, K. (1986). Face-to-face interactions of depressed mothers and their infants. In E.Z. Tronick

& T. Fields (Eds.), Maternal depression and infant disturbance. San Francisco: Jossey-Bass.

Cohn, J.F., & Tronick, E.Z. (1989). Specificity of infant’s response to mothers’ affective behavior. Journal of the American Academy of Child and Adolescent Psychiatry, 28.242-248.

Cohn, J.F., Campbell, S.B., Matias, R., & Hopkins, J. (1990). Face-to-face interactions of postpartum depressed and nondepressed mother-infant pairs at 2 months. Developmental Psychology, 26, 15-23.

Cox, J.L., Holden, J.M., Sagowsky, R. (1987). Detection of postnatal depression: Development of the 10 item Edingburgh Postnatal Depression Scale. British Journal of Psychiatry, 150, 782-786.

Field, T., Healy, B., Goldstein, S., Perry, S., Bendell, D., Schanberg, S., Zimmerman, E.A., & Kuhn, C. (1988). Infants of depressed mothers show “depressed” behavior even with nondepressed adults. Child Development, 59, 1569-1579.

Field, T., Healy, B., Goldstein, S., & Guthertz, M. (1990). Behavior state matching and synchrony in mother-infant interactions of nondepressed versus depressed dyads. Developmental Psychology, 26, 7-14.

Field, T., Morrow, C., Healy, B., Foster, T., Adlestein, D., & Goldstein S. (1991). Mothers with zero Beck depression scores act more depressed with their infants. Development and Psychopatholo,qyv. 3. 253-262.

Kerguelen, A. (1991). Kronos for Macintosh. Montrouge: Agence Nationale pour I’AmClioration des Condi- tions de Travail.

Richman, J.A., Raskin, V.D., & Gaines, V.C. (1991). Gender roles, social support, and postpartum depres- sive symptomatology. The Journal of Nervous and Mental Disease, 179, 139-147.

Yogman, M.W. (1982). Development of the father-infant relationship. Theory and Research in Beha\iorul Pediatrics, I, 221-279.

03 February 1995; Revised 29 June 1995 n