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Maternal Mental Illness
Overview Maternal mental illness
Post-natal depression Post-natal psychosis
Effect on relationship between them
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The importance of attachment
Why is attachment important between mother and infant? Early mother–infant bond may have sig. impact on
developing infant (e.g. Bowlby, 1953; Ainsworth, 1993) Infant’s internal working model (IWM) is very important
Expectations about themselves in relation to others Model of self and of other
If infant’s carer attends positively and responds to needs Infant has positive IWM:
High self-worth, availability of others, resolution of crises
Infant’s carer inconsistent response and attention Infant’s has negative IWM:
Low or ambivalent self-worth, unavailable others, crises not resolved
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Post-natal depression (PND)
Baby blues Two to four days after birth (quite normal – but not PND)
Emotional/liable to burst into tears, for no apparent reason
Difficult sleeping (even when baby permits) Loss of appetite Feeling anxious, sad, or guilty Questioning maternal skills
Effects up to 75% of mums May relate to changes in post-birth hormone levels
Or could be related to being in hospital Key is that this doesn't last long – usually only a few days
If it persists it may develop into PND
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PND: Features
PND needs same DSM-5 diagnosis as major depressive disorder But relates specifically to the peripartum period
Pregnancy and/or within 4 weeks of birth Additional features may also indicate presence
Sense of inadequacy, inability to cope Feeling guilty Being unusually irritable
Which makes the guilt worse Being hostile/indifferent to husband/partner/baby Panic attacks Excessive unwarranted anxiety
Such as being alone in the house Obsessive fears about the baby's health or wellbeing
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PND: Prevalence
PND affects about 10% of new mums Compare to baby blues
Although DSM-5 states ‘must be within 4 weeks of birth’ Quite clear that symptoms last MUCH longer
Vulnerable mums usually referred in ‘perinatal’ period During pregnancy up until baby is 1 year
Can come on gradually or all of a sudden Can range from being relatively mild to very hard-hitting At LEAST 50% PND women afraid to tell health profs about
it Scared it will lead to social services taking child away Or that they would be seen as bad mothers
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Post-natal psychosis (PNP)
PNP needs same DSM-5 diagnosis as any psychotic disorder Schizophrenia Schizoaffective disorder Brief psychotic disorder Can also include manic stages of Bipolar disorder
But PNP is not specifically mentioned in DSM-5 Other than ‘postpartum mood (MDD or manic) with
psychotic features’ Not particularly helpful
Symptoms usually immediately within few weeks of birth
But psychotic episodes can also occur during pregnancy
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PNP - features
Prevalence 1 in 1000 mums may get post-natal psychosis (0.1%)
Contrast with baby blues and PND
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Attachment and bonding
Research with Clinical Doctorate student (see Steadman, et al 2007) We explored serious mental illness in mothers (vs. controls)
Bipolar disorder, schizophrenia, schizoaffective disorder, severe depression
Sample 6 ill mums; 12 healthy controls First 8 weeks after birth
We measured a number of key aspects Cognitive functioning (computerised tests)
Memory, speed of functioning, attention Perceptions of parenting skills and stress
(questionnaire) Observation of interaction with baby (video)
Quality, sensitivity, appropriateness, etc.
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Attachment and bonding
Observation of interaction with baby Undertaken with video
From behind mother (to see baby’s face) But in front of mirror (to see mum’s face)
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Attachment and bonding
Observation of interaction with baby Quality and appropriateness of interaction
Assessed via Crittenden CARE Index (Crittenden, 2004)
Aims of CARE Index Mothers and infants rated on 7 aspects
Facial expression Verbal expression Position and body contact Affection and sensitivity Turn-taking and co-operation Control Choice of activity
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Attachment and bonding
Look at these two videos…
Note that these videos are only available in the lecture. They will be not be posted on myBU. This is to protect confidentiality
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Attachment and bonding
This interaction was warm, affectionate and rewarding for both mum and baby
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Attachment and bonding
This interaction was not so good Mum appeared disinterested: blank face… Baby was unsure and uncomfortable
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PNP and the child
Results Significant differences found for several measures
Mothers with serious mental illness (SMI) vs. controls
Poorer mother–infant interaction Poorer perceived maternal competence Poorer cognitive function
But how could we extend this? We could examine the effect of SMI on other factors
Attachment and bonding Long term affect on child development
Social, emotional, educational, language, forensic Studies are now at planning stage
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Attachment and bonding
What should we do? How can we improve bonding? Encourage breastfeeding?
Or is there already too much pressure? Implications with medication? Alternatives?
Bonding classes Mindfulness, relaxation and positive therapy?
