Parental depression and developmental outcomes of their babies

Dear families,


Depression hurts everyone. Parental depression can disrupt not only parents' own well being but also caregiving and nurturing which leads to negative developmental consequences in babies. The following article explains how parental depression impacts developmental and socioemotional outcomes in developing babies. 

- Minnie

          Babies are born with tremendous abilities to develop relationships with their primary caregivers, mainly their parents (Bowlby, 1958, 1969; Campa, 2013; Kaplan, Bachorowski, Smoski, & Hudenko, 2002).  Their tiny body constantly sends and receives non-verbal signals with their parents which allows parents to meet babies’ physiogical and psychological needs (Browne & Talmi, 2015).  Parental observation, interpretation, accommodation, and adaptation in order to meet babies’ current needs are the foundation for developing infants.  However, many studies (e.g., Aktar et al., 2016; Guyon-harris, Huth-bocks, Lauterbach, & Janisse, 2016 ; (Kaplan et al., 2002) have shown that parental mental health can interfere with their ability to respond their babies.  Consequently, babies’ paths for optimal development can be in jeopardy.  In this paper, a literature review will be drawn upon to explain how parental psychopathology, especially depression impacts developmental and socioemotional outcomes in developing babies.

          Developmental psychologists have tried to introduce human development into several progressive orders.  Many of them agreed that basic physiological and psychological needs should be met first within the relationship with parents in order to achieve a more sophisticated and complex development.  For example, Maslow (1943) believed that there are five different layers of needs.  One level should be fulfilled to pursue the next level.   He explained that the first two fundamental needs are physiological needs, such as food and water, and security needs, such as security and shelter.  These are the foundation for the next step, love and belonging.  Greenspan (1997; 2006) introduced six basic developmental capacities for early childhood.  He (1997; 2006) explained that the first step is developing the ability to regulate their own body as well as attention and focus on the world followed by the second step, mutual engagement and forming relationships and the third step, interactive intentionality and reciprocity.  Winnicott (1960; 1986) also argued that satisfaction when babies’ physical and psychological needs are met through parental care, babies start learning about themselves and the world around them.  Therefore, parental ability to provide a safe environment, read their babies’ signals, and adjust their behaviours to meet their babies’ physical and psychological needs are cornerstones for optimal development in babies.


          We often only think about parental influence on their babies, not their fetus.  However, the interactions between expecting mothers and their fetus start earlier than the birth of newborn babies.  For example, Feldman (2007) argued that expecting mothers support their unborn babies’ biological rhythms.  In the third trimester, expecting mothers and their fetus synchronize their states, which supports the fetus to consolidate their sleep-wake cycle and the cardiac rhythm, which controls heart rhythms.  However, when expecting mothers are depressed, the development of the fetus can be compromised.

          Field (2011) argued that the evidence of prenatal depression could be found to be 6-38% in the published literature.  There is no clear explanation of the mechanisms underlying the influence of depressed expecting mothers on the development of their unborn child, however, dysregulated hormones among expecting mothers are considered one of the key influencers of developmental consequences (Lewis et al. 2015).  In a literature review, Field (2011) showed that prenatal depression is associated with excessive activity and growth delays in the fetus.

          Other researchers attempted to unveil prenatal maternal depression and the developmental outcomes after birth.  Field (2011) explained prenatal depression could lead to prematurity, low birthweight, disorganized sleep and less responsiveness to stimulation in the neonate.  In addition, Junge et al. (2017) argued that prenatal depression caused high cortisol exposure prenatally which may cause children to be reactive to stress after birth.

          Developmental oddness can be found in older children.  Eichler et al. (2017) investigated that the relationship between prenatal maternal depression and social outcomes among children at four years of age.  One thing that makes this study unique is that children’s social outcomes were measured by trained phycologists, not a parental report to avoid parental bias.  They found that children whose mothers were depressed prenatally displayed more antisocial behaviour symptoms at this particular age.


          Postpartum depression can be found in 13-20% of new mothers (World Health Organization, n.d.).  Maternal depression interferes with interaction with their babies (Kaplan et al., 2002).  Infant direct speech (ID) is crucial to stimulate babies (Fernald, 1985).  Kaplan et al. (2002) observed the conditioned attention paradigm, ID as a signalling stimulus and smiling as reinforcer among infants whose mothers were depressed and not depressed at four months of age.  Babies of depressed mothers could not attain learning opportunities due to inappropriate maternal support (e.g., withdrawn, negative affect, lower quantity of stimulation, less salient stimulation).  However, the important thing is these children demonstrated attention when other non-depressed females prompted them.  This aligns with the view of capable infants and emphasizes the importance of not only early detection but also support for mothers who are depressed. 

          Synchrony is another key element in the early relationship between mothers and their babies.  Schore and Shore (2008) argued that sensitive parents attune infants’ arousal in order for them to synchronize together to regulate affective states and then, move towards the next emotional state together.  Therefore, in these relationships between mothers and their babies, mothers can support babies’ development of both central (CNS) and autonomic (ANS) nerve systems after birth.  Granat, Gadassi, Gilboa-Schechtman and Feldman (2017) studied the differences of synchrony between three groups of mothers; depressed, anxious and typical, and their babies.  Depressed mothers demonstrated frequent but short gazing to their infants which did not help synchrony between them and their babies.  These babies display social withdrawal (less gaze, aversion) which can lead to an increase in behavioural issues in the near future.  Also, in stressful circumstances, for babies of depressed mothers, the presence of mothers was not effective to reduce negative emotions as an external regulatory agent.  Anxious mothers achieved the highest level of frequency of synchrony.  However, their babies moved to a negative emotional state (anxious) together with their mothers.  Moreover, the intrusiveness of anxious mothers hindered their babies’ opportunity to develop autonomy.  Therefore, a different type of mental illness of mothers requires different strategies to support early relationships with their babies.

          Maternal depression can increase undesirable emotional/behavioural outcomes in older children (Woolhouse, Gartland, Mensah, Giallo, & Brown, 2016).  Woolhouse et al. (2016) measured maternal depression in early pregnancy and at 3, 6 and 12 months postpartum and again at four years postpartum and emotional/behavioural difficulties of children at four years.  Even though any point of maternal depression increased the chance of emotional/behavioural difficulties, children with mothers who were depressed at four years postpartum displayed three times more emotional/behavioural difficulties than children with non-depressed mothers.  This study provides insight into the needs of support for depressed mothers during an extended period.


          There are many studies about the impacts of maternal depression on child developmental outcomes, but there is a lack of studies related to father influences.  In consideration of the social-ecological systems theory (Bronfenbrenner, 1979) and the transactional theory (Sameroff, 2009), it is important to understand the complex bi-directional, non-linear impact on maternal depression and father contribution.  Fathers can impact a child’s development as well as maternal mental health.  Paulson & Bazemore (2010) found that 10% of fathers suffer from prenatal and postpartum depression and it had a moderate positive correlation with maternal depression. Kim and Kim (2017) compared high-income and low-income families to see the relationship between fathers' indirect influence on children's social/emotional outcomes.  In both groups, fathers' involvement mediated maternal depression and parenting stress, and consequently, children demonstrated better social and emotional outcomes.

          Within the dyad, characteristics or conditions of babies can contribute and influence maternal depression.  For example, the negative temperament of babies is more related to maternal depression (Aktar et al., 2016).  Premature birth also contributes not only to maternal depression (Bakalar, 2008), but also paternal depression (States News Service, 2016).  In fact, maternal postpartum depression is found among as high as 40% of mothers who give premature birth (Vigod, Villegas, Dennis, & Ross, 2010).  Moreover, having a child with developmentally delay is another major risk factor for parental mental health (Alvarez, Meltzer-Brody, Mandel, & Beeber, 2015).  Alvarez et al. (2015) illustrated that depression and anxiety symptoms could be found in as high as 68% and 52 % respectively among these parents.  Therefore, more dedicated support is necessary for these parents whose babies are medically fragile in promoting their mental health as well as the early relationship with their babies.

          Babies are capable communicators (Bowlby, 1958, 1969; Campa, 2013; Kaplan et al., 2002) and their non-verbal communication allows parents to help meet babies’ physiological and psychological needs (Browne & Talmi, 2015).  Parental ability to observe, interpret, accommodate, and adapt are cornerstones for developing infants.  Prenatal depression disrupts developmental outcomes not only in the fetus but also in babies after birth.  Moreover, maternal postpartum depression interferes with the maternal ability to communicate and synchronize with their babies, consequently resulting in undesirable developmental and social/emotional outcomes.  Fathers should also be the centre of our attention due to their own suffering from depression and their influences on child development.  Lastly, the characteristics and conditions of babies can be risk factors to parental depression.  Therefore, those parents whose babies are medically fragile requires more dedicated support to promote their mental health as well as the early relationship with their babies.


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