Mothers' Perceptions of Infants Labelled ‘Depressed’

Early Development and Parenting, Vol. 5 (l), 15-22 (1996) -~

Mothers’ Perceptions of Infants Labelled ’Depressed ’

-

Alexandra Martinez Tiffany Field Jeffrey N. Pickens Tarja Raag Touch Research Institute, University o f Miami School o f Medicine, Miami, Florida, U S A

Regina Yando Hatvard Medical School, U S A

Debra Bendell Fremont Kaiser Permanente, U S A

Paul Blaney University of Miami, U S A

Forty-four depressed and non-depressed mothers participated in a videotaped interaction with their own infant and then rated the videotape using the Infant Stereotyping Scale and the Interaction Rating Scale. In addition, one half of the mothers rated a videotape of an unfamiliar infant who was labelled psychologically ’depressed’ and the other half rated a videotape of the same infant with no label given. Both the depressed and non-depressed mothers rated the ’depressed’ labelled infant more negatively than the non-labelled infant on the attributes of physical potency, cognitive competence, sociability and difficult behaviour. Physical appearance was the only rating that was not biased by the ‘depressed’ label. Mothers‘ ratings of their own infants were more positive than their ratings of the non-labelled stimulus infant. Depressed mothers did not see their infants more negatively except on one rating. They rated the physical appearance of their own infant more negatively than non-depressed mothers.

I Key words: depressed mothers; depressed infants; perceptions

Adults use stereotypes to guide and establish their perceptions of infants (Pharis and Manosevitz, 1984; Stem and Hildebrandt, 1984). Psychologically depressed mothers, in particular, view their infants more negatively than mothers who are not depressed (Field et al., 1993). The present investigation examined whether mothers generally perceive normal infants negatively when they are labelled

Address for repMts: Tiffany Field, Touch Research Institute, University of Miami School of Medicine, Po Box 016820 (D- 820), Miami, FL. 33101, USA. Tel305-243-6781

psychologically ‘depressed’. Further, psychologically depressed and nondepressed mothers were compared on their perceptions of their own versus an unfamiliar infant. Psychologically depressed mothers, who generally have a negative attribution style, were expected to rate their own infants more negatively than nondepressed mothers.

Stereotyped perceptions have been documented for a number of infant qualities. For example, attributions about infants are affected by precon- ceived expectations related to gender (Bell and Carver, 1980; Condry and Condry, 1976; Leone and

CCC 10!57-3593/96/010015-08 91996 by John Wiley h Sons, Ltd.

Received 17 Nmember 1993 Accepted 17 Iuly 1995

16 A. Martinez, T. Field, 1. N. Pickers et al.

Robertson, 1989) as well as physical attractiveness (Hildebrandt-Karraker and Stem, 1990; Maier ef al., 1984; Stephan and Langlois, 1984). Negative stereotyping has also been noted for premature infants.

In a study which served as the model for the present investigation, Stem and Hildebrandt (1984) tested the prematurity stereotype by showing videotapes of full-term infants to college students and mothers of full-term infants. The videotaped full-term infants were either correctly labelled 'full- term' or incorrectly labelled 'pre-term'. Subjects were asked to rate the infants on a bipolar adjective scale assessing perceptions of infants' physical appearance, physical potency, cognitive capability, behavioural characteristics and sociability. Both college students and mothers rated the 'pre-term' labelled infants more negatively. College students rated the 'pre-term' labelled infants as weaker, more shy, sad, passive, less fun to play with, less attentive, slower, quieter, more sleepy and less liked than 'full- term' labelled infants. Mothers rated 'pre-term' labelled infants as smaller, finer featured, less attentive, slower, less smart, quieter, more sleepy and less liked than the 'full-term' labelled infants.

In another study, Stem and Hildebrandt- Karraker (1988) tested the prematurity stereotype with mothers of pre-term infants rather than mothers of full-term infants. Subjects were told, however, that the'purpose of the study was to assess differences between full-term and pre-term infants that might be noticed by caregivers'. Mothers of pre- term infants were also influenced by the pre-term infant stereotype. However, the stereotype of mothers of pre-term infants (versus mothers of term infants and college students) was more specific and confined to physical characteristics of pre-term infants and not the infants' cognitive competence, sociability or behaviour (Stem and Hildebrandt- Karraker, 1988). Thus, mothers of pre-term infants seemed to exhibit a more selective stereotyping that was specific to physical characteristics.

NEGATIVE ATTRIBUTIONS ABOUT PSYCHOLOGICALLY DEPRESSED INDIVIDUALS

Despite the large body of research on stereotyping of 'normal' infants and physically impaired infants, there has been no research on stereotyping of 'depressed' labelled infants. The possibility for stereotyping based on labelling adults as psychologically 'depressed' is suggested by negative attributions towards adults who are, in fact,

depressed. Coyne (1976) reported that subjects who conversed with depressed individuals on the telephone rejected and devalued them more than subjects who spoke to non-depressed individuals. In addition, non-depressed subjects reported feel- ing depressed immediately following the telephone conversation with their depressed partner. Subse- quent studies have confirmed that adults display negative attributions towards depressed individuals indicating devaluation of depressed persons (Boswell and Murray, 1981; Howes and Hokanson, 1979; Weiner et al., 1981).

INFANT DEPRESSION

Depressed affect has been reported for infants of depressed mothers (Cohn et al., 1990; Field et al., 1988). Interactions between psychologically depressed mothers and their infants suggest that the infants seem to 'mirror' the behaviour of their mothers (Field, 1984). Thm, affective and behavioural disturbances occur in infants whose mothers display symptoms of depression, suggesting that a form of infant depression exists for infants of depressed mothers. Although the term 'infant depression' has not yet been recognized by DSM-III nomenclature, the literature on depressed infants is growing. Although traditionally the term 'depressed infant' has been used primarily by neurologists and neonatologists for compromised infants, reports on psychologically depressed infants are becoming known among the lay population (i.e. caregivers, teachers, health care workers). They, in turn, may begin to view these infants negatively.

Psychologically depressed mothers, in particular, have negative perceptions of their children's behaviour (Affleck et al., 1983; Brody and Forehand, 1986; Griest et al., 1979) and code their infants more negatively than independent raters (Field et af., 1993). In the Field et al. (1993) study, both the independent coders and the mothers rated the depressed infants more negatively, suggesting that the depressed infants did, in fact, appear more negative. How- ever, the depressed mothers rated their infants even more negatively than did the independent coders. Thus, depressed mothers seem to perceive their infants' behaviours more negatively.

The present study investigated whether a 'depression' stereotype occurs when normal infants are labelled 'depressed' and whether depressed and non-depressed mothers stereotype these infants differently. Qualities that might be affected by this

Infants Labelled ’Depressed’ 17

stereotype were assessed, including: physical potency, physical appearance, sociability, cognitive capability, difficult behaviour and interaction behaviours. Since depressed mothers often perceive their infants more negatively, depressed and non- depressed mothers’ ratings of their own infants were compared. Finally, depressed versus nondepressed mothers’ ratings of their own infants were compared to their ratings of an unfamiliar infant.

METHODS

Sample Forty-four (23 depressed, 21 non-depressed) mother-infant dyads were recruited from a long- itudinal study of psychologcally depressed teenage mothers. Infants ranged in age from 3 to 6 months (M=4.5 months) at the time of the study. The mothers were typically single (87%) ranging in age from 14 to 21 years (M=18.4), were either African American (57%) or Hispanic (43%) and were of lower socioeconomic status (Hollingshead M4.1).

Procedure

First, mothers were given the Beck Depression Inventory. They were then videotaped interacting with their own infant for 3 minutes. Mothers then viewed the videotape of their own infant and an unfamiliar (labelled or non-labelled) infant with order (own infant/other infant) counterbalanced across subjects in each group.

Beck Depression Inventory The Beck Depression Inventory (BDI; Beck et al., 1961) has 21 items scored on a four-point scale indicating the presence/absence and severity of depressed feelings/behaviours/symptoms. How- ever, even though the BDI is an instrument that is widely used to detect depression, it is not equiva- lent to a clinical diagnosis. Mothers who received a score of less than 10 were classified as non- depressed and those receiving a score of greater than 12 were classified as depressed, in agreement with other researchers’ use of this scale. Data for two dyads were excluded from analyses because these mothers obtained out of range Beck Depres- sion scores (between 10 and 12) and could not be classified.

Videotaped Mother-lnfant Interaction

Following these questionnaires, the mothers participated in a 3-minute, face-to-face play interaction with their infants. They were simply instructed ’to pretend you are playing with your infant as you would at home‘. The infants were placed in an infant seat on a table approximately 15 inches from the mother, who was seated across the table. Two video cameras and a split screen generator enabled simultaneous recording of the mother’s face and torso and the infant’s face.

Interaction Rating Procedures

Following the interaction, mothers were seated in front of a television screen. Mothers were shown the videotape of their own infant and a videotape of a normal (nondepressed) infant interacting with his/her mother. The videotapes were presented in a counterbalanced order so that half viewed their own infant first and vice versa. The mothers (depressed/non-depressed) were randomly assigned to one of two unfamiliar infant conditions, receiving one of the following two instructions: (1) ’The baby you are about to watch in this videotape is psychologically depressed’; (2) ’The baby you are about to watch on this videotape came in last week‘. Mothers were asked to complete the rating forms following each videotape presentation. The unfamiliar videotaped infant was matched for the age and ethnicity of the subject’s own infant. The tapes were selected from a pool of 200 filmed mother-infant interactions on the basis of specific criteria: (a) non-depressed mother (BDI score of less than 10); (b) male infant to control for potential gender stereotyping; and (c ) a neutral interaction rating of 2.0k0.3 on the Interaction Rating Scale (Field, 1980). To ensure that subjects watched only the infant, the mother’s side of the video screen was covered.

Mothers completed two rating scales, the Infant Stereotyping Scale and the Interaction Rating Scale. The Infant Stereotyping Scale was adapted from a bipolar adjective scale by Stem and Hildebrandt- Karraker (1988) that was divided into five clusters. These clusters and their kappa coefficients given in parentheses included. (a) physical potency (0.78) (passive/assertive; weak/strong; slow/fast); (b) physical appearance (0.75) (unattractive/attradve; not cute/cute; little/big); (c) cognitive competency (0.72) (doesn‘t pay attentiodpays attention; not smart/smart); (d) sociability (0.84) (sad/happy; not fun to play with/fun to play with; shy/friendly);

18 A. Martinez, T. Field, I. N. Pickers et al.

Table 1. Background characteristics of mothers presented with ‘depressed’ label and no label conditions

‘Depressed’ label No label M SD M SD P

Mother’s age (yr) Infant age (months) Hollingshead SES stress total BDI

~

18.4 (2.5) 18.4 (1.9) NS 4.5 (1.4) 4.5 (1.6) NS 4.2 (1.2) 4.3 (0.7) NS 19.3 (4.2) 20.7 (4.6) NS 13.8 (10.5) 15.3 (12.0) NS

and (e) difficult behaviour (0.62) (quiet/loud; difficult/easy; not cuddly/cuddly) (Stem and Hildebrandt-Karraker, 1988). The scale was mod- ified in the present study by reducing the number of items from 17 to 14 and by reducing the range of the Likert continuum from seven to four. The reason the Likert continuum was reduced to four was because less educated mothers have more difficulty making a selection from a broader continuum, and having an even number of ratings forces them to make a rating at the positive or negative end of the continuum rather than an average rating (in the middle of the continuum). The mothers then completed the Interaction Rating Scale (Field, 1980), which utilizes a threepoint scale (high ratings being optimal) on the following infant behaviours: (a) awake/drowsy (0.91); (b) physical activity (0.82); (c) head position (0.96); (d) gaze behaviour (0.85); (e) faaal expressions (0.84); ( f ) fussiness (0.96); (g) vocalizations (0.82). This scale was used because depressed infants were previously noted to receive lower ratings on at least the state, faaal expression and vocalization items (Field et d., 1988).

RESULTS Analyses of Demographic Variables

Analyses of variance were performed to ensure comparability of the mothers presented with

‘depressed‘ label versus mothers in the no-label condition. As shown in Table 1, no differences were observed across the two conditions for the infant‘s age or the mother‘s age, education, socioeconomic status or Beck Depression Inventory scores. Ana- lyses of variance comparing the depressed and non-depressed groups on matemal demographic and infant physical characteristics revealed only the expected difference that the depressed group had higher inventory scores (Table 2).

lnfunt Stereotyping Scale (ZSS) The ISS single summary score, and a 2x2

ANOVA was performed with label (depressed/ non-depressed) as factors. A significant main effect of label was observed for the Iss summary score (F(1,40)=17.98, p<O.OOl). As shown in Table 3, mothers rated the ’depressed‘ labelled infant sigruficantly lower than the non-labelled infant on a combined summary score that included all items of the ISS.

The five individual clusters were then submitted to a 2 x 2 multivariate analysis of variance (MAN- OVA) with label (‘depressed‘ label/no label) and matemal depression (depressed/non-depressed) as main factors. This analysis revealed a significant main effect for label (F(5,34)=5.21, p<O.OOl). Post- hoc univariate F tests revealed signhcant label

Table 2. Background characteristics of depressed and nondepressed mothers and physical characteristics of their infants

Nondepressed M SD M SD P

Age of mother Infant age

Hollingshead SES Stress total BDI

weight (g) Length (cm)

18.0 (2.2) 18.7 4.1 (1.1) 4.8 7057 (1346) 7034 63.4 (4.7) 62.4 4.3 (1.0) 4.0 19.7 (3.4) 20.5 23.7 (8.4) 4.9

Infants Labelled ’Depressed’ 19

Table 3. Infant Stereotyping Scale cluster scores of ’depressed’ labelled versus non-labelled stimulus infants

Summary score Physical potency Physical appearance Cognitive capability Sociability Difficult behaviour

’Depressed’ label M SD

2.2 (0.50) _______~_.. .

2.1 (0.83) 2.8 (0.57) 2.2 (0.6) 1.9 (0.68) 2.1 (0.70)

No label M SD

2.9 (0.50) 2.7 (0.60) 3.1 (0.59) 3.0 (0.62) 3.1 (0.73) 2.7 (0.67)

P

0.001 0.05 NS

0.001 0.001 0.01

Note: Higher scores are more positive/optimal.

effects for each of the following clusters: physical potency (F(1,38)=5.67, p<0.05), cognitive capability (F(1,38)=13.04, p<O.OOl), sociability (F(1,38)=27.79, p<O.OOl) and difficult behaviour (F(1,38)=9.06, p<O.Ol). The mothers rated infants labelled as ‘depressed‘ more negatively on these clusters (Table 3). No group differences were noted for the physical appearance factor.

Interaction Rating Scale (IRS) A MANOVA performed on the seven items of

the Interaction Rating Scale, with label and group as main factors, revealed a significant main effect for label (F(7,32)=2.29, p<0.05). Post- hoc univariate F tests revealed sigruficant effects of label for infant facial expressions and infant vocalizations ( ~ ~ 0 . 0 5 , both tests). This suggests that mothers perceived ‘depressed‘ labelled infants as showing more negative facial expressions and producing fewer vocalizations, respec- tively (Table 4).

Mothers’ Perception of Own Infant

lnfant Stereotyping Scale An ANOVA was performed on the summary

score for mothers’ ratings of their own infant on the Infant Stereotyping Scale with maternal depression (depressed/non-depressed) as the between-subjects factopr. No sigruhcant main effects were observed for this analysis. A multivariate analysis of variance was then performed using the five cluster scores as dependent variables, with group (depressed/non-depressed) as a main factor. This revealed a sigruficant main effect of group (F(5,36)=2.62, p<0.05). Follow-up univariate F-tests showed a significant effect of group only for the physical appearance cluster (F(1,40)=7.40 p<O.Ol), suggesting that depressed mothers rated their own infant‘s physical attributes less optimally than non-depressed mothers (Table 5).

Table 4. Mothers’ Interaction Rating Scale scores of ‘depressed’ labelled versus non-labelled stimulus infants

IRS summary score State Physical activity Head orientation Gaze behaviour Facial expression FusSiness Vocalization

’Depressed’ label M SD

2.1 (0.34) 1.9 (0.87) 2.5 (0.75) 2.1 (0.75)

2.5 ( O W

2.1 (0.71) 2.0 (0.72)

1.8 (0.59)

~~

No label M SD P

2.3 (0.455) NS 2.3 ( O W NS 2.4 (0.79) NS 2.1 (0.75) NS 2.0 (0.69) NS 2.5 (0.67) 0.05 2.6 (0.66) NS 2.3 (0.66) 0.05


20 A. Martinez, 7’. Field, 1. N. Pickers et al.

Table 5. Depressed versus nondepressed mothers’ Infant Stereotyping Scale duster ratings of their own infants

Depressed Non-depressed M SD M SD P

summary score 3.3 (0.47) 3.4 (0.39) NS Physical potency 3.3 (0.63) 3.5 (0.39) NS

Cognitive capability 3.2 (0.56) 3.5 (0.61) NS Sociability 3.3 (0.79) 3.5 (0.70) NS Behaviour 3.2 (0.46) 3.1 (0.54) NS


Physical appearance 3.2 (0.49) 3.6 (0.41) 0.01

Table 6. Mothers’ Infant Stereotyping Scale ratings of their own infant versus a non-labelled stimulus infant

Own infant Stimulus infant M SD M SD P

summary score 3.4 (0.45) 2.9 (0.50) 0.001 Physical potency 3.3 (0.51) 2.7 (0.59) 0.001 Physical appearance 3.5 (0.42) 3.1 (0.58) 0.001 Cognitive capability 3.3 (0.6) 3.0 (0.60) 0.05 Sociability 3.5 (0.68) 3.1 (0.72) 0.05 Difficult behaviour 3.2 (0.54) 2.8 (0.67) 0.05

Note: Higher scores are more positve/optimal.

Interaction Rating Scale A MANOVA on the seven Interaction Rating Scale items with maternal depression (depressed/non- depressed) as the between-subjects factor yielded no effects.

Mothers‘ Ratings of Own vs Other lnfant

Infant Stereotyping Scale Depressed and nondepressed mothers’ ratings

of their own infants were compared with their ratings of the non-labelled infants. A repeated measures ANOVA was performed on the ISS summary score with maternal depression as the between-subjects factor and with ratings of own versus other infant as the within-subjects factor. A within-subjects effect of own versus other infant was observed for the ISS summary Score (F(1,19)=14.19, p<O.OOl), suggesting that mothers rated their own infant more positively than an unfamiliar non-labelled infant. Repeated measures ANOVAs on the cluster scores revealed significant within-subjects effects for physical potency

(F(1,20)=21.29, p<O.OOl), physical appearance (F(1,20)=14.51, p<O.OOl), cognitive capability (F(1,20)=4.84, p<0.05), sociability (F(1,20)=4.32, p<0.05) and difficult behaviour (F(1,20)=6.73, p<0.05), suggesting that mothers rated their own infant more positively than the other non-labelled infant (Table 6).

DISCUSSION

Mothers rated infants labelled ’depressed‘ as less physically potent, cognitively competent and soci- able as well as more difficult than non-labelled infants. In addition, mothers rated infants labelled ’depressed‘ as showing more bland or unhappy facial expressions and fewer vocalizations. Since the infants they viewed were not depressed but simply labelled ‘depressed’, the mothers’ negative rating may have resulted from stereotypes they had about psychologically depressed infants.

Because depressed infants are not widely known, data on mothers’ notions about depressed infants

Infants Labelled 'Depressed' 21

may stem from their knowledge about depressed adults. Negative attributions and negative behaviours towards adults suffering from depression have previously been reported. For example, depressed individuals are noted to be rejected and devalued by their peers more often than controls (Coyne, 1976; Howes and Hokanson, 1979; Weiner et al. 1981). The findings of the present study suggest that these stereotypes may extend to infancy. Further, these results extend the infant stereotyping literature (e.g. prematurity, physical attractiveness and gender stereotyping) to another infant condition (depressed). Of note is the fact that the mothers, both depressed and non- depressed, made more negative judgements about the labelled infant on somewhat 'hidden' characteristics. For example, cognitive capability could not have been obvious from the videotape they saw. But they were unaffected by labelling on the observable characteristics, for example fussiness. This suggests that parents may be relatively reality based when given specific characteristics to rate, but are more readily influenced by stereotypes when less information is available.

Other infant stereotyping studies have concen- trated on manipulating variables that were primarily physical, such as gender, attractiveness and prematurity (Stephan and Langlois, 1984; Stem and Hildebrandt-Karraker, 1988). Some of these studies revealed negative stereotypes that involved physical attributes, for example physical appearance and physical potency (Stem and Hildebrandt-Karraker, 1988). In contrast, the 'depressed' label did not yield negative physical appearance in the present study. The items that were negatively rated were cognitive competency, sociability, difficult behaviour and physical potency. Taken together, these studies suggest that specific negative attributes may be tailored to specific infant conditions rather than mothers perceiving all atypical infants in a universally negative way. This suggests that they are relatively knowledgeable about risk conditions in general, including prematurity and maternal depression effects.

Both depressed and non-depressed mothers demonstrated a negative stereotype for infants labelled 'depressed'. This suggests a pervasive negative view of depressed infants that generalized across mothers regardless of whether they were depressed themselves. Researchers have observed that perceived similarity to a person being judged will cause an attenuation of negative attributions. In contrast, perceived dissimilarity motivates the perceiver to rely on societal conventions that result

in a more global negative attribution style (Leone and Robertson, 1989). The absence of differences between the ratings of depressed versus non- depressed mothers suggests that they may not have been aware of their own depression and/or did not respond to the 'depressed' label on the basis of similarity or dissimilarity to themselves. Further research should examine the interaction between mothers' awareness of their own mood states and their attribution styles.

Since the 'depression' stereotype in this study included a broad range of negative infant qualities, it is potentially a very detrimental stereotype. Infants perceived by adults as having negative traits at an early age may later develop negative behaviour, as in a self-fulfilling prophecy.

In addition to exploring infant depression stereotypes, the present study investigated depressed and non-depressed mothers' perceptions of their own infants. All mothers rated their own infant more positively than an unfamiliar non-labelled infant on all of the adjective clusters. Despite this, the depressed mothers rated their own infants as less optimal on physical appearance (i.e. smaller, less cute and less attractive) than nondepressed mothers rated their infants. In previous studies, depressed mothers were more negative towards their infant/child's behavioural characteristics rather than physical traits (Cundall, 1987; Field et al., 1993). The results from the present study were especially surprising since the infants of depressed mothers were no smaller than the infants of non- depressed mothers on body weight or length. The absence of size differences suggests that the depressed mothers were not experiencing a physical reality but rather a flawed negative perception of their own infant's physical attributes. However, this was the only way depressed mothers viewed their own infants more negatively. Depressed and nondepressed mothers showed similar ratings of their own infants on all other variables.

The present investigation suggests that mothers attribute a wide range of negative qualities to infants labelled 'depressed'. Future research should attempt to examine the separate influences of mothers' behaviours and their negative attributions on the developing infant.

ACKNOWLEDGEMENTS

We would like to thank Thomas Nawrocki and Diane Soutullo for their help with data collection and the mothers and infants who participated in

22 A. Martinez, T. Field, J. N. Pickers et al.

this project. This research was completed in partial fulfilment of the Master’s degree by Alexandra Martinez and was supported by NIMH Research scientist Award #MHOO331 and NIMH Basic Research Grant #MH46596 awarded to Tiffany Field.

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Documents

Mothers' Perceptions of Infants Labelled ‘Depressed’