What About Mom’s Mental Health?
Despite Increases in Screening, Study Finds Only 44 Percent of Pediatricians Inquire about Maternal Depression
Maternal depression affects up to 40 percent of mothers with young children and can have many negative effects on the infant and developing child including feeding issues, the inability to thrive in relationships and delayed cognitive development. However, despite increases in screening among pregnant women and new mothers, few pediatricians ask these women about their mental health.
In a study published in the Journal of Developmental & Behavioral Pediatrics, researchers from the Children’s Hospital at Montefiore (CHAM), NYU Langone Medical Center and the Nathan Kline Institute for Psychiatric Research determined that fewer than half of pediatricians routinely screen for this condition. This represents a missed opportunity to identify depression and provide women with appropriate treatment. The authors say that better educating physicians about the impact of family health can have on a child’s well-being would benefit both children and their families.
According to Marian E. Williams, PhD and Marie Kanne Poulsen, PhD, from the Stein Tikun Olam Infant-Family Mental Health Initiative at Children’s Hospital Los Angeles, the cornerstone of infant mental health is responsive, sensitive mother-infant interactions, resulting in an intimate attachment. Nurturing care provides the neurological and emotional foundations for later relationships, as well as the self-regulation of emotions and behavior. Newborns of depressed mothers show a biochemical profile that mimics their mother’s and the baby may be more irritable, harder to console or exhibit less attentiveness.
Williams and Poulsen talk about the impacts of maternal depression on infant health and what parents can do to insure the best mental health development for their infants.
Can maternal depression affect how a mother interacts with her baby?
Mothers who are struggling with depression are less initiating, responsive and emotionally animated than non-depressed mothers. While feeding, a mom who is depressed may hold her infant in a lethargic manner, giving the infant a feeling of being untethered. Mom may not initiate intimate interactions like cuddling, stroking, singing or skin-on-skin touch. She may not notice her baby’s emotional cues or respond to her baby’s gaze, smiles, cooing or attempts to clutch her finger. If the infant’s social attempts go unnoticed, over time the infant will stop trying to connect. Mother may not realize that her facial expressions and ways of handling her infant are wrapped in a tension that is felt by her baby.
What are the potential impacts of maternal depression on the mental health of an infant?
As early as three months, babies begin to mimic their mothers’ depressed affect. They may vocalize less, avert their gaze from eye contact more often and cry more frequently. Infants at most risk are those whose mothers are not only depressed, but who are isolated without social supports. Differences in early social responsiveness can have profound repercussions when they remain untreated. Children of depressed mother may have long-term problems including developmental delays in walking and talking, social withdrawal, emotional dysregulation, as well as later problems with focused attention and learning.
What are some of the unique approaches to infant mental health being implemented at CHLA?
As a result of a leadership project completed by a CHLA pediatrician who participated in our Leadership Education in Neurodevelopmental Disabilities (CA-LEND) training program, CHLA has instituted routine maternal depression screening during outpatient well-child visits.
When pediatricians at CHLA identify a problem through this screening, a team of infant-family mental health specialists are available, who are trained to recognize and address depression and stress in mothers and fathers as part of caring for the infant’s mental health. Many referrals to our program are babies involved in the foster care system. Other families are referred because their infant has a medical condition or a developmental delay that makes it more difficult for parents to read the child’s cues, creating additional stresses for the family. Our interventions include addressing the parents’ own experience of depression, stress or past trauma, so that they can be present for their baby, stay calm during difficult moments, provide nurturing when their child is upset and recognize when stressful experiences may make it hard for the baby to stay regulated or calm.
An exciting new program at CHLA, made possible by support from the Atlas Family Foundation, places infant-family mental health specialists within the Institute for Maternal Fetal Health. Through this program, CHLA provides medical specialty care to pregnant women who learn that their unborn baby has a genetic or medical condition that is expected to require specialized medical care after birth. Parents in the clinic are often experiencing shock, worry and feelings of depression related to their high-risk pregnancy. Our team is now providing crisis intervention and screening for depression and other mental health needs. The team and supports parents on the journey – through a difficult pregnancy to delivery of a baby with special needs, their stay in the CHLA neonatal intensive care unit and, finally, home-based support following discharge. This continuum of care from pregnancy through the early months at home helps us to quickly respond to the parents’ needs and identify depression and stress, to link them with mental health service if needed, and it helps to form a strong attachment bond between mom and dad and their baby.
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