Attempting to prevent postnatal depression by targeting the mother–infant relationship: a randomised controlled trial

Cooper, Peter; Pascalis, Leonardo De; Woolgar, Matt; Romaniuk, Helena; Murray, Lynne

doi:10.1017/s1463423614000401

Cited by 34 publications

(55 citation statements)

References 43 publications

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“…Most of the studies have relied on self-report, especially the large sample longitudinal studies for which that might be expected [81–83]. Although the majority of the longitudinal studies exploring the effects of prenatal depression on developmental outcomes have used the EPDS, the intervention studies have more often used the CES-D.…”

Section: Limitations Of This Recent Literaturementioning

confidence: 99%

Prenatal Depression Risk Factors, Developmental Effects and Interventions: A Review

Field¹

2017

J Preg Child Health

108

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This narrative review based on a literature search in PubMed and PsycInfo on the two terms prenatal and antenatal depression includes empirical studies, reviews and meta-analyses that have been published during the last 5 years on risk factors, developmental effects and interventions for prenatal depression. Risk factor studies that met criteria feature demographic measures (lower socioeconomic status, less education, non-marital status, non-employment, less social support and health locus of control, unintended pregnancy, partner violence and history of child abuse) and physiological variables (cortisol, amylase, and pro-inflammatory cytokines and intrauterine artery resistance). The negative effects include postpartum depression, paternal depression, and prematurity and low birth weight. Negative effects on infants include greater right frontal EEG, amygdala connectivity, cortical thinning and more difficult temperament. In childhood, externalizing and internalizing problems have been reported. The data on prenatal antidepressants (specifically SSRIs) reveal negative effects including internalizing problems as well as a greater risk for autism spectrum disorder. Prenatal interventions that have been effective include interpersonal psychotherapy, peer support, massage therapy, yoga, tai chi, and aerobic exercise. Potential underlying mechanisms are discussed as well as methodological limitations including homogeneity of samples and lack of randomization to intervention groups. Despite these limitations, the literature highlights the need for prenatal depression screening and intervention.

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Section: Limitations Of This Recent Literaturementioning

confidence: 99%

Prenatal Depression Risk Factors, Developmental Effects and Interventions: A Review

Field¹

2017

J Preg Child Health

108

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“…All the studies were conducted by authors affiliated with Western universities; five from USA [28 & 31–34], two from Canada [35, 36], four from UK [37–40], one from the Netherlands [41], one from France [42] and one from Australia [43]. Five studies had a majority white or Caucasian ethnicity [34, 35, 38, 39, 41].…”

Section: Resultsmentioning

confidence: 99%

“…The remainder had reported majority ethnicity of 61% African American [31], 43% African American [32], 45% Latino [33], 74% minority race [28] and 48.6% 1 st generation immigrants to France [42]. Two studies did not specify ethnicity [40, 43]. One intervention was delivered in South African shanty towns [37].…”

Section: Resultsmentioning

confidence: 99%

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Decreasing rates of disorganised attachment in infants and young children, who are at risk of developing, or who already have disorganised attachment. A systematic review and meta-analysis of early parenting interventions

et al. 2017

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BackgroundDisorganised attachment patterns in infants have been linked to later psychopathology. Services have variable practices for identifying and providing interventions for families of children with disorganised attachment patterns, which is the attachment pattern leading to most future psychopathology. Several recent government reports have highlighted the need for better parenting interventions in at risk groups.ObjectivesThe objective of this review and meta-analysis was to evaluate the clinical effectiveness of available parenting interventions for families of children at high risk of developing, or already showing, a disorganised pattern of attachment.MethodsPopulation: Studies were included if they involved parents or caregivers of young children with a mean age under 13 years who had a disorganised classification of attachment or were identified as at high risk of developing such problems.Included interventions were aimed at parents or caregivers (e.g. foster carers) seeking to improve attachment.Comparators included an alternative intervention, an attention control, treatment as usual or no intervention.The primary outcome was a disorganised pattern in childhood measured using a validated attachment instrument.Studies that did not use a true Randomised Controlled Trial (RCT) design were excluded from the review. Both published and unpublished papers were included, there were no restrictions on years since publication and foreign language papers were included where translation services could be accessed within necessary timescales.ResultsA comprehensive search of relevant databases yielded 15,298 papers. This paper reports a systematic review as part of an NIHR HTA study identifying studies pre-2012, updated to include all papers to October 2016. Two independent reviewers undertook two stage screening and data extraction of the included studies at all stages. A Cochrane quality assessment was carried out to assess the risk of bias. In total, fourteen studies were included in the review. In a meta-analysis of these fourteen studies the interventions saw less disorganised attachment at outcome compared to the control (OR = 0.50, (0.32, 0.77), p = 0.008). The majority of the interventions targeted maternal sensitivity. We carried out exploratory analyses to examine factors that may influence treatment outcome but these should be treated with caution given that we were limited by small numbers of studies.ConclusionsParenting interventions that target parental sensitivity show promise in reducing disorganised attachment. This is limited by few high quality studies and the fact that most studies are with mothers. More high quality randomised controlled trials are required to elucidate this further.

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“…There was no long-term follow-up, and other studies of different therapies with long-term follow-up have not shown sustained child outcomes (Poobalan et al). Two recent randomised controlled trials of home-visiting programs focussed on both PND and attachment were unsuccessful at either preventing/reducing PND, or improving child outcomes (Cooper, De Pascalis, Woolgar, Romaniuk, & Murray, 2015;Guedeney et al, 2013). Current PND treatments therefore remain adjunct treatments to the mother-child relationship, but show some promise in their ability to address this relationship.…”

Section: Addressing Maternal Sensitivity Deficits To Improve Infant Omentioning

confidence: 99%

Addressing the mother–baby relationship in interpersonal psychotherapy for depression: an overview and case study

Deans

Reay

Buist

2016

Journal of Reproductive and Infant Psychology

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Objective: This article describes the development of an interpersonal psychotherapy group which has been adapted to address the mother-child relationship in the context of postnatal depression (PND).Background: When PND develops, the child of the sufferer is also at risk for deleterious outcomes. It is thought that this is because the mother-baby bonding process is interrupted, affected, or reduced in quality by the existence of depression in addition to genetics and biological effects of exposure to illness in utero. Past approaches to mitigating this risk have focussed on treating the depression as the primary issue and the mother-baby relationship as secondary. This article makes the argument that interpersonal psychotherapy has neglected this relationship despite the evidence that this is a key precipitating/perpetuating factor in postnatal depression, and that targeting this relationship has benefits for both mother and baby. Method: An interpersonal psychotherapy protocol was developed, modified to incorporate psychoeducation and practice of maternally sensitive interactions. A case study from a version of this group intervention is provided. Results: The case study outcomes on selfreport scales of depression suggest the modified protocol is as effective in treating PND as the original protocol. Self-report of maternal attachment and videotape measures of maternal sensitivity also improved, suggesting that the modified protocol can address the mother-baby relationship. Conclusion:The suitability of adapting interpersonal psychotherapy to address the mother-baby relationship appears promising. Further rigorous trials using this therapy are warranted to determine its effectiveness.Keywords: postnatal depression; interpersonal therapy; maternal sensitivity; mother-baby relationship; group therapy Word count: 4,098 words 3 Motherhood is a time of transformation across the spectrum of functioning for women. For most, motherhood is associated with greater wellbeing and satisfaction (Holton, Fisher, & Rowe, 2010). However, it can also be associated with challenges, one of the biggest being that of postnatal depression (PND). For some 7-16% of women (O'Hara & Swain, 1996), new motherhood is associated with the onset of PND. Whilst PND is not a distinct disorder from Major Depressive Episode, there are some clinical differences. The psychosocial stressors surrounding new motherhood, including sleep disturbance and breastfeeding pain, have been shown to increase inflammatory hormones associated with depression (Kendall-Tackett, 2007). There is a higher risk for PND in women with poor marital relationships, and those who develop PND report greater symptoms for a greater duration, and are more susceptible to later recurrence of depression relative to women with supportive relationships (Campbell, Cohn, Flanagan, Popper, & Meyers, 1992). Mothers can find it difficult to engage in depression treatments due to the demands of motherhood, reluctance to disclose their feelings, (Conners-Burrow et. al., 2015). A combination...

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Attempting to prevent postnatal depression by targeting the mother–infant relationship: a randomised controlled trial

Cited by 34 publications

References 43 publications

Prenatal Depression Risk Factors, Developmental Effects and Interventions: A Review

Prenatal Depression Risk Factors, Developmental Effects and Interventions: A Review

Decreasing rates of disorganised attachment in infants and young children, who are at risk of developing, or who already have disorganised attachment. A systematic review and meta-analysis of early parenting interventions

Addressing the mother–baby relationship in interpersonal psychotherapy for depression: an overview and case study

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