Many studies have observed that postpartum depression may negatively affect the mother-infant relationship and may thus impede bonding and attachment and negatively affect the development of the young child.  A recent study explores the use of Perinatal Dyadic Psychotherapy (PDP), a dual-focused mother-infant intervention designed to prevent and/or decrease depressive symptoms in the mother and to improve aspects of the mother-infant relationship related to child development.

In this pilot study, women were recruited from hospital postpartum units. Forty-two depressed first-time mothers (who scored >9 and <20 on the Edinburgh Postnatal Depression Scale) and their 6-week-old infants were enrolled and randomized to receive the PDP intervention or usual care plus depression monitoring by phone. The intervention consisted of eight home-based, nurse-delivered mother-infant sessions consisting of supportive, relationship-based, mother-infant psychotherapy and a developmentally based infant-oriented component focused on promoting positive mother-infant interactions.

Depression and anxiety symptoms decreased significantly, and maternal self-esteem increased significantly in both groups. There were no significant differences between groups with regard to parenting stress or mother-infant interaction immediately after the intervention and at 3 month follow-up.

While this finding suggests that PDP is no better than “usual care”, one possible explanation for these findings is that the control condition may have provided some beneficial effects. Women in the control group received eight phone calls over 3 months. The authors note, “Although the content of the calls was focused on completing the EPDS, this regular contact from a friendly person inquiring about their emotional health may have provided a helpful level of support and reassurance. Control group mothers also received three home visits from RAs over the course of the study. Self-reflection required them to answer frequent questions about emotions, supports, stresses, and mental health may have promoted increased self-awareness and self-monitoring by the mothers in regards to their emotional well-being, possibly leading to improved self-care, thus constituting an effective intervention.”  If this is the case, the good news is that less intensive interventions may be helpful to women with postpartum depression.

There have been other studies which have demonstrated that interventions focusing on the mother-infant relationship may be helpful in reducing depressive symptoms and improving maternal self-esteem.  For example, the work of Tiffany Field suggests that infant massage and interaction coaching may have beneficial effects for both mother and child.   In contrast to the study described in this report where most of the mothers were married and college-educated, many of the other studies (with positive results) were carried out with younger mothers and mothers in impoverished settings; thus one may speculate that certain mothers – those with fewer resources and/or limited psychosocial supports – may benefit more from these types of interventions.

 

Ruta Nonacs, MD PHD

Goodman JH, Prager J, Goldstein R, Freeman M.  Perinatal Dyadic Psychotherapy for postpartum depression: a randomized controlled pilot trial.  Arch Womens Ment Health. 2014 Dec 20.