Longitudinal study of the impact of postpartum depression on children's behavior to 8 years of age

N. Letourneau and J. D. Willms

Canadian Research Institute for Social Policy

Acknowledgements:

Cindy-Lee Dennis Cara Fedick Kathleen Hegadoren Miriam Stewart Social Sciences and Humanities

Research Council, Initiative on the New Economy

Depressed mothers often:

have impaired maternal-infant interactions and negative perceptions of normal infant behavior

less likely to pick up on their infants’ cues resulting in less positive feedback and a decreased likelihood of meeting their infants’ needs

Depressed mothers often:

less sensitive and appropriate in their interactions with their children, and more negative in their play

speak more slowly and less often less emotionally expressive and

responsive less affectionate and more anxious

Disturbances in mother-child interactions are observed at one year postpartum, even when mothers are no longer depressed.

Infants more often:

abused or neglected

diagnosed with ‘failure to thrive’

hospitalized for poor health

Two meta-analyses suggest that PPD has a significant effect on infants’ cognitive and social development.

3 to 7 month old infants:

are more tense, less content show fewer positive facial expressions,

more negative expressions and protest behavior

more drowsy, fussy, withdrawn, disruptive, avoidant, and disengaged in maternal-infant interactions and in toy play.

19 month old infants:

show less sharing, concentration, and sociability to strangers, and a lower overall rate of interaction

less responsive and interactive and show decreased positive affect

show more insecure (avoidant) attachment.

3- 5 year old children:

are more “difficult” respond in negative

manner to friendly approaches by other children

boys most likely to show behaviour problems

Long-term effects

Parental mental health problems can compromise 12 year-old children’s behavioral adjustment.

Children of mothers who experienced PPD are two to five times more likely to develop long-term behavioral problems.

Boys and girls

Boys of depressed mothers tend to display more externalizing behaviors including aggression and hyperactivity characterized by antisocial, active, and distractible behaviors

Girls of depressed mothers tend to display more internalizing behaviors such as anxiety and withdrawal

Theory

PPD disrupts maternal behavior and infant interactions and engagements with the mother, and as a consequence, impairs infant health and developmental outcomes.

Theory

SocioeconomicStatus

MaternalDepression

FamilyFunctioning

ParentingStyle

Engagement

Children’sOutcomes

Research Question

Compared to mothers who are not depressed after childbirth, what is the impact of maternal depression on children’s anxiety, hyperactivity, aggression and prosocial behaviors over time?

Do factors such as parenting, social support, SES, and child gender affect this impact?

Where did we get our data?

National Longitudinal Survey of Children and Youth (NLSCY)

Launched in 1994 by Statistics Canada to track the development, health, and well-being of a nationally-representative sample of children in Canada over time.

Four cycles of NLSCY data were used:

Cycle 1 (1994-95), Cycle 2 (1996-97), Cycle 3 (1998-99) and Cycle 4 (2000-01).

How many families?

Four cycles of NLSCY data were used:

Cycle 1 (1994-95), Cycle 2 (1996-97), Cycle 3 (1998-99) & Cycle 4 (2000-01).

3533 mothers and children were in our sample

691 mothers were depressed when their infants were less than 2 years of age.

Behaviour Measures

Anxiety Hyperactivity Aggression Prosocial 1 = Never or not true, 2 = Somewhat or

sometimes true, and 3 = often or very true

Higher scores show increased presence of behavior in the child.

Method

Hierarchical linear modelling

Allows analysis of growth trajectories

Outcome variable

Cycle 2Age 2 to 4 years

Depressed Non-depressed

Anxiety 1.28 (0.275) 1.20 (0.238)

Hyperactivity 1.74 (0.448) 1.62 (0.400)

Aggression 1.49 (0.478) 1.40 (0.428)

Prosocial Behavior 2.12 (0.544) 2.13 (0.524)

Outcome variable

Cycle 3Age 4 to 6 years

Depressed Non-depressed

Anxiety 1.32 (0.293) 1.25 (0.259)

Hyperactivity 1.74 (0.442) 1.58 (0.399)

Aggression 1.35 (0.390) 1.26 (0.311)

Prosocial Behavior 2.22 (0.407) 2.22 (0.385)

Outcome variable

Cycle 4Age 6 to 8 years

Depressed Non-depressed

Anxiety 1.38 (0.344) 1.31 (0.301)

Hyperactivity 1.72 (0.480) 1.58 (0.416)

Aggression 1.29 (0.380) 1.23 (0.308)

Prosocial Behavior 2.38 (0.406) 2.41 (0.363)

Findings

1.00

1.25

1.50

1.75

2.00

2.25

2.50

2 3 4 5 6 7 8Age (in years)

Be

ha

vio

ur

Sc

ore

Non-Depressed: Hyperactivity

Non-Depressed: Aggression

Depressed: AggressionNon-Depressed: Anxiety

Depressed: Anxiety

Depressed: Hyperactivity

Non-Depressed and Depressed: Prosocial Behaviour

Then we added the other variables: Parenting

Positive discipline Warm and nurturing Consistent

Social Support SES Single Parent Gender

What happened?

The effects of postpartum depression were diminished

Anxiety

Positive discipline and consistent parenting lowered the level of anxiety at 2 years of age.

Being in a single parent household raised the initial level of anxiety in 2-year-old children.

Hyperactivity

Positive discipline, warm and nurturing parenting and SES all decrease initial levels of hyperactivity in two year olds.

Female children have lower levels of hyperactivity than males at age two.

Aggression

Initial Aggression scores are lower for 2 year old children who experience positive discipline and warm and nurturing parenting

Discussion

Exposure to maternal depression in infancy appears to affect children’s behavior at two years of age and these effects may persist to eight years of age and beyond.

However, parenting characteristics may have a greater impact on children’s anxiety, hyperactivity, aggression, and prosocial behaviours.

Intervention:

Needs to start early Should target parenting behaviours Should be offered to all parents,

regardless of depression

Thank you