Targeting Adolescent Mothers with Depressive Symptoms for Early Intervention
Field, Tiffany, Pickens, Jeffrey, Prodromidis, Margarita, Malphurs, Julie, Fox, Nathan, Bendell, Debra, Yando, Regina, Schanberg, Saul, Kuhn, Cynthia, Adolescence
Infants of mothers with depressive symptoms show developmental delays if symptoms persist over the first 6 months of the infant's life, thus highlighting the importance of identifying those mothers for early intervention. In Study 1, mothers with depressive symptoms (n = 160) and mothers without depressive symptoms (n = 100) and their infants were monitored to identify variables from the first 3 months that predict which mothers would still be symptomatic at 6 months. A "dysregulation" profile was noted for the infants of depressed mothers, including lower Brazelton scores, more indeterminate sleep, and elevated norepinepbrine, epinephrine, and dopamine levels at the neonatal period, and greater right frontal EEG activation, lower vagal tone, and negative interactions at the 3- and 6-month periods. A group of maternal variables from the neonatal and 3-month assessments accounted for 51% of the variance in the mothers' continuing depressive symptoms. These variables included greater right frontal EEG activatio n, lower vagal tone, and less positive interactions at 3 months, and elevated norepinephrine, serotonin, and cortisol levels at the neonatal stage. In Study 2, a similar sample of mothers with depressive symptoms (n = 160) and without depressive symptoms (n = 100) was recruited and followed to 3 months. Those symptomatic mothers who had values above (or below) the median (depending on the negative direction) on the predictor variables identified in Study 1 (taken from the first 3 months) were then randomly assigned to an intervention or a control group at 3 months. These groups were then compared with each other, as well as with the group without depressive symptoms, at 6 and 12 months. The intervention, conducted from 3 to 6 months, consisted of free day care for the infants and a rehab program (social, educational, and vocational) plus several mood induction interventions for the mothers, including relaxation therapy, music mood induction, massage therapy, and mother-infant interaction coaching. Although th e mothers who received the intervention continued to have more depressive symptoms than did the nondepressed mothers, their interactions significantly improved and their biochemical values and vagal tone normalized. Their infants also showed more positive interations, better growth, fewer pediatric complications, and normalized biochemical values, and by 12 months their mental and motor scores were better than those of the infants in the control group.
Longitudinal studies on mothers with depressive symptoms have examined various kinds of depression, such as postpartum depression, dysthymia, and major depressive disorder, and various degrees of chronicity (Campbell, Cohn, & Meyers, 1995; Field, Healy, Goldstein, & Guthertz, 1990; Lyons-Ruth, Zoll, Connell, & Grunebaum, 1986; Murray, 1992). Irrespective of the type of depression, mothers' depressive mood states appear to affect infants' development negatively (Beardslee, Bemporad, Keller, & Klerman, 1983; Field, 1984; Orvaschel, 1983; Zuckerman & Beardslee, 1987). Findings indicate that infants and children of depressed mothers are more likely to have problems, including sleep disorders, accidents, growth failure, and psychosomatic complaints. For example, in a prospective study, Radke-Yarrow, Cummings, Kuzynski, and Chapman (1985) noted that clinically depressed mothers displayed very little affection, and their toddlers showed greater sadness, talked less often, and engaged in less exploratory behavior.
The typical paradigm has been to study the face-to-face interactions of depressed mothers and their infants. In this context, depressed mothers have been described as having flat affect or depressed mood, and as being less vocal and less responsive to their infants (Cohn, Campbell, Matias, & Hopkins, 1990; Field, Healy, Goldstein, & Guthertz, 1990). This, in turn, may affect their infants' language development, problem-solving ability, mastery motivation, and social competence. …