Bipolar offspring and mothers: interactional challenges at infant age 3 and 12 months—a developmental pathway to enhanced risk?

Abstract

Background: Bipolar offspring are considered a high-risk group for developing mental disorders. Developmental outcomes result from additive and interactive effects of biological vulnerability and environmental influences. Mother-infant interactions represent important early environmental influences that may modify infants' risk of mental disorders. The aim of the current prospective study was to investigate the patterns and development of motherinfant interactions in the first year of life in dyads in which the mothers have bipolar disorder (BD). Methods: Twenty-six dyads in which the mothers had BD and 28 dyads in which the mothers had no mental disorder were video-taped in a free play interaction. The Parent-Child Early Relational Assessment (PCERA) was used to assess the quality of the interactions on three domains (maternal behaviour, infant behaviour and dyadic coordination) at 3 and 12 months of infant age. First, we compared the mother-infant interaction patterns between the two groups at 12 months. Second, we investigated how the patterns developed within and between the groups from infant ages 3 to 12 months. Results: BD dyads demonstrated significantly more challenges in all three interaction domains at infant age 12 months compared to the healthy dyads. This observation was in line with the findings at infant age 3 months. Subdued expression of positive affect and mutual underinvolvement represented core challenges in maternal and infant behaviours in the BD dyads. Continuous difficulties with dyadic coordination and reciprocity were the most concerning interaction behaviours at 3 and 12 months. On the positive side, there was little expression of negative affect or tension in maternal, infant and dyadic behaviour, and some positive changes in infant behaviour from 3 to 12 months. Conclusions: The current results suggest that challenges in mother-infant interaction patterns in the first year of life may enhance the developmental risk for bipolar offspring. Clinical interventions should address both the BD mothers' needs in relation to postpartum mood deviations and mother-infant interactions. We suggest interaction interventions to promote dyadic coordination and reciprocity, such as helping mothers being more sensitive to their infant's cues and to provide attuned contingent responses.

Emotional availability in women with bipolar disorder and major depression: A longitudinal pregnancy cohort study

“…For infants, mother’s perinatal disorder had large effects on their EA, accounting for 33% of the variance in their responsiveness towards their mothers (Cohen’s d = 2.67, p < 0.001) and 38% of the variance in their involvement towards her (Cohen’s d = 2.95, p < 0.001). These interaction patterns resemble observations made by Anke et al (2019, 2020) at 3 and 12 months postpartum, who described mothers with BD in their cohort as having subdued expressions of positive affect and less sensitivity, and their infants as quiet and under-involving, with similar subdued affect as opposed to irritable and easily dysregulated. The EA quality with the least deficits among our cohort was maternal non-hostility, suggesting women in our cohort were not predominantly characterised by negative affect and covertly or overtly hostile language and behaviour.…”

“…The first cohort comprised mothers with postpartum BD (n = 40), unipolar depression (n = 50) and no disorder (n = 40) and their infants, and found that dyads in the BD group displayed less maternal sensitivity and dyadic synchrony at 12 months postpartum; however, the differences did not reach significance (Logsdon et al, 2015). The second cohort comprised women with perinatal BD (n = 26) and women with no disorder (n = 30) and their infants and, in contrast to Logsdon et al, identified significant difficulties in maternal behaviour, infant behaviour and dyadic coordination at 3 months (Anke et al, 2019) and 12 months (Anke et al, 2020) postpartum among women with BD and their infants.…”

“…BD, previously known as manic depression, is characterised by at least one episode of major depression and one episode of mania (Bipolar 1) or hypomania (Bipolar 2). While the effects of perinatal BD on various child developmental outcomes have been examined (Jones et al, 2014;Santucci et al, 2017), we identified only three peer-review studies that included observations of mother-infant interactions among women with diagnosed BD, and two of the three involved the same cohort (Anke et al, 2019(Anke et al, , 2020.…”

“…However, Anke et al’s cohort involved fewer women with BD and fewer constructs measuring relationship quality, as well as similar observation duration. Although either did not remark on the duration, they were brief: 3 minutes (Logsdon et al, 2015) and 5 minutes (Anke et al, 2019, 2020).…”

Lithium Medication in Pregnancy and Breastfeeding—A Case Series

“…In one retrospective study, only 24% of bipolar women who continued lithium relapsed compared with 70% who discontinued lithium [ 13 ]. A severe mood episode in early infancy can negatively impact mother-to-child bonding, mother–child interaction and the development of the child, accordingly it is very important to reduce the relapse risk as best as possible [ 14 , 15 ]. However, lithium is excreted in the breastmilk and can be found in varying degrees between 0 and 50% of the mother’s serum levels [ 16 ].…”