The Impact of Postnatal Depression and Associated Adversity on Early Mother-Infant Interactions and Later Infant Outcome

Early infant interest in their mother's face is driven by an experience based face processing system, and is associated with maternal psychological health, even within a non clinical community sample. The present study examined the role of the voice in eliciting infants' interest in mother and stranger faces and in the association between infant face interest and maternal psychological health.Infants aged 3.5-months were shown photographs of their mother's and a stranger's face paired with an audio recording of their mother's and a stranger's voice that was either matched (e.g., mother's face and voice) or mismatched (e.g., mother's face and stranger's voice). Infants spent more time attending to the stranger's matched face and voice than the mother's matched face and voice and the mismatched faces and voices. Thus, infants demonstrated an earlier preference for a stranger's face when given voice information than when the face is presented alone. In the present sample, maternal psychological health varied with 56.7% of mothers reporting mild mood symptoms (depression, anxiety or stress response to childbirth). Infants of mothers with significant mild maternal mood symptoms looked longer at the faces and voices compared to infants of mothers who did not report mild maternal mood symptoms. In sum, infants' experience based face processing system is sensitive to their mothers' maternal psychological health and the multimodal nature of faces. Early infant interest in their mother's face is driven by an experience based face processing system, and is associated with maternal psychological health, even within a non clinical community sample. The present study examined the role of the voice in eliciting infants' interest in mother and stranger faces and in the association between infant face interest and maternal psychological health.Infants aged 3.5-months were shown photographs of their mother's and a stranger's face paired with an audio recording of their mother's and a stranger's voice that was either matched (e.g., mother's face and voice) or mismatched (e.g., mother's face and stranger's voice). Infants spent more time attending to the stranger's matched face and voice than the mother's matched face and voice and the mismatched faces and voices. Thus, infants demonstrated an earlier preference for a stranger's face when given voice information than when the face is presented alone. In the present sample, maternal psychological health varied with 56.7% of mothers reporting mild mood symptoms (depression, anxiety or stress response to childbirth). Infants of mothers with significant mild maternal mood symptoms looked longer at the faces and voices compared to infants of mothers who did not report mild maternal mood symptoms. In sum, infants' experience based face processing system is sensitive to their mothers' maternal psychological health and the multimodal nature of faces.

Objective The goal of this study was to characterize racial-ethnic differences in mental health care utilization associated with postpartum depression in a multiethnic cohort of Medicaid recipients. Methods In a retrospective cohort study, administrative claims data from New Jersey’s Medicaid program were obtained for 29,601 women (13,001 whites, 13,416 blacks, and 3,184 Latinas) who delivered babies between July 2004 and October 2007. Racial-ethnic differences were estimated with logistic regression for initiation of antidepressant medication or outpatient mental health visits within six months of delivery, follow-up (a prescription refill or second visit), and continued mental health care (at least three visits or three filled antidepressant prescriptions within 120 days). Results Nine percent (N=1,120) of white women initiated postpartum mental health care, compared with 4% (N=568) of black women and 5% (N=162) of Latinas. With analyses controlling for clinical factors, the odds of initiating treatment after delivery were significantly (p<.001) lower for blacks (adjusted odds ratio [AOR]=.43) and Latinas (AOR=.59) compared with whites. Among those who initiated treatment, blacks and Latinas were less likely than whites to receive follow-up treatment (blacks, AOR=.66, p<.001; Latinas, AOR=.67, p<.05) or continued care (blacks, AOR=.81, marginal difference at p<.10; Latinas, AOR=.67, p<.05). Among those who initiated antidepressant treatment, black women and Latinas were less likely than whites to refill a prescription. Conclusions There were significant racial-ethnic differences in depression-related mental health care after delivery. Suboptimal treatment was prevalent among all low-income women in the study. However, racial and ethnic disparities in the initiation and continuation of postpartum depression care were particularly troubling and warrant clinical and policy attention.

Elevated MAO-A levels in the early postpartum period can be interpreted as a marker of a monoamine-lowering process that contributes to the mood change of postpartum blues. Rather than a purely psychosocial model, we propose a neurobiological model of estrogen decline, followed by elevated MAO-A binding, low mood, and subsequently a period of high risk for major depressive episodes. Our model has important implications for preventing postpartum depression and for developing therapeutic strategies that target or compensate for elevated MAO-A levels during postpartum blues.