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Postnatal depression Consequences for mother and child. Dr Andrew Mayers [email protected]. PND - consequences. Overview Importance of attachment When bonding goes wrong with PND What does this mean for mother and baby Short and long term. The importance of attachment. - PowerPoint PPT Presentation
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PND - consequences
Overview
Importance of attachment
When bonding goes wrong with PND
What does this mean for mother and baby
Short and long term
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The importance of attachment
Why is attachment important between mother and infant? Early mother–infant bond may have sig. impact on
developing infant Infant’s internal working model (IWM) is very important
Expectations about themselves in relation to others Model of self and of other
If infant’s carer attends positively and responds to needs Infant has positive IWM:
High self-worth, availability of others, resolution of crises
Infant’s carer inconsistent response and attention Infant’s has negative IWM:
Low or ambivalent self-worth, unavailable others, crises not resolved
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Bonding and attachment
So how is bonding compromised in PND?
Also applies to other mental health problems in perinatal period
Mum is distracted for whole manner of reasons
Low mood
Lack of motivation
Fear and guilt
Poor concentration
Lack of self-worth
Low self-esteem
Effect of medication
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PNP and the child
Some research that we have done We explored serious mental illness in mothers (vs.
controls) Including severe depression
Sample 6 ill mums; 12 healthy controls First 8 weeks after birth
We measured a number of key aspects Cognitive functioning (computerised tests)
Memory, speed of functioning, attention Perceptions of parenting skills and stress
(questionnaire) Observation of interaction with baby (video)
Quality, sensitivity, appropriateness, etc.
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PNP and the child
Cognitive functioning Computerised program from Cognitive Drug Research
(CDR) Word and picture recall and recognition Reaction time Rapid visual information processing Spatial and numeric working memory
Focus on cognitive function Power and continuity of attention Episodic memory Working memory Speed of memory
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PNP and the child
Observation of interaction with baby Undertaken with video
From behind mother (to see baby’s face) But in front of mirror (to see mum’s face)
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PNP and the child
Observation of interaction with baby Quality and appropriateness of interaction
Assessed using highly validated method: Crittenden CARE Index
Pat Crittenden was a student of Mary Ainsworth Ainsworth pioneered attachment styles And was herself student of Bowlby
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PNP and the child
Aims of CARE Index Mothers and infants rated on 7 aspects
Facial expression Verbal expression Position and body contact Affection and sensitivity Turn-taking and co-operation Control Choice of activity
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PNP and the child
Look at these two videos…
Note that these videos are only available in the lecture. They will be not be available in post-training materials. This is to protect confidentiality
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Exercise
What were the key differences in the ‘bonding’ seen in
videos?
What impact might that have for developing child?
What does bonding teach the child?
How does PND affect bonding?
How might we improve bonding?
How is breastfeeding relevant here (again)?
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PNP and the child
This interaction was warm, affectionate and rewarding for both mum and baby
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PNP and the child
This interaction was not so good Mum appeared disinterested: blank face… Baby was unsure and uncomfortable
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PNP and the child
Results Significant differences found for several measures
Mothers with serious mental illness (SMI) vs. controls
Poorer mother–infant interaction Poorer perceived maternal competence Poorer cognitive function
Mother–infant interaction and perceived maternal competence
SMI mums significantly less sensitive Their infants were significantly less cooperative
Cognitive function SMI mums sig poorer on speed of memory processing
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PNP and the child
So what does this all mean?
It would appear that SMI in mums is related to slow cognition
Specifically slower speed of memory
This may mediate the illness
SMI and slower speed of memory implicated in maternal sensitivity
Mum’s slower processing reduces her response to her child
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PND and the child
Other evidence PND associated with several negative outcomes
Increased marital stress Disturbances in child’s emotional and cognitive
development Children of dep mums more likely to be associated with:
Insecure attachment Eating difficulties Sleep disturbance Being overly clinging
PND affects mum’s ability to cope with care of baby
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Longer term consequences
Observations from evidence and my own professional practice… Specialist schools for ‘excluded’ children Care farm project for ‘troubled’ youngsters
These young people ALL have attachment problems Perhaps mum had PND? May be one of many reasons
Young people with conduct disorders Many have ‘bonding’ issues
Personality disorders Key ‘cause’ relates to poor attachment in childhood
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Future work?
So how could we extend this?
We could examine the effect of SMI on other factors
Attachment and bonding
Long term affect on child development
Social, emotional, educational, language, forensic
Studies are now at planning stage