1. Maternal postpartum depression - precursors and patterns of symptomatology.
2. Persistence of maternal depression, mother-child attachment and infant outcomes in the second postnatal year
3. "I am not depressed!" Why Bother to Comply With Intervention?

Maternal postpartum depression - precursors and patterns of symptomatology.

Bryanne Barnett, Professor of Perinatal and Infant Psychiatry, UNSW.
Park House, 13, Elizabeth Street, Liverpool, NSW 2170
Bryanne.Barnett@swsahs.nsw.gov.au

Many women with infants less than a year old presenting to primary care services with a variety of complaints concerning themselves or, more often, their infants, are told they have "Postnatal Depression". Sometimes they are relieved to receive this diagnosis, sometimes they refuse it, most are ambivalent. Sometimes the diagnosis is wrong; often it is grossly inadequate, as hierarchical, operational diagnostic systems have a limited, though valuable, place in the real world of human existence.

Although this may be the first time many of these women have been formally described (or treated) as depressed, careful interviewing reveals that more than a third have been depressed in the past, and follow-up will show that a similar proportion continue to be, or have recurrence of, their depression. Many are highly, probably chronically, anxious. What is actually happening in the lives of these women and who among them are going to have ongoing difficulties that affect not only themselves but also the rest of the family? What is the natural history of "postnatal depression"?

Material will be offered from a prospective study of 120 mothers admitted to a residential family care centre in Sydney. The women completed the Edinburgh Postnatal Depression Scale (Cox et al, 1987) on admission to the Centre, the Spielberger State-Trait Anxiety Scale (Spielberger et al, 1987), a modified CIDI (WHO, 1997), the Dyadic Adjustment Scale (Spanier, 1976) and the CES-D (Radloff, 1977) when their infant was four months old. Sociodemographic data and a history of the delivery and subsequent experience were collected. Measures were repeated at one year, while infant development and attachment pattern were assessed at 15 months. Cases will be presented to illustrate several commonly found patterns of signs and symptoms among women receiving a diagnosis of postnatal depression.

The precursors and prognoses of these patterns will be discussed.

Persistence of maternal depression, mother-child attachment and infant outcomes in the second postnatal year

Dr Catherine McMahon, Department of Psychological Medicine, Royal North Shore Hospital, University of Sydney
cmcmahon@blackburn.med.usyd.edu.au

Maternal depression in the first postnatal year has been linked to adverse child outcomes with respect to cognitive development, toddler behaviour problems and insecure attachment. However findings from research studies are mixed and most have concluded that the attachment relationship and the child's development are likely to be impaired only when maternal depression is chronic and/or severe.

This paper reports findings from a prospective study of 120 mothers and infants and will examine relations among depression in the first postnatal year, infant temperament, parent-child attachment and infant developmental outcomes at 15 months. Parents were interviewed and completed self-report measures of infant temperament and behaviour at 4, 12 and 15 months. At fifteen months infant development was assessed using the Bayley Scales of Infant Development and the Strange Situation was used to measure security of mother-child attachment.

30% of mothers continued to have elevated symptoms of depression and anxiety throughout the first postnatal year and 25% reported their toddlers were behaviourally difficult. Overall 50% of mothers and infants were classified as securely attached. However there was a significant relationship between maternal depression and security of attachment with 75% of infants whose mothers were not depressed, 45% of infants whose mothers were transiently depressed and 33% of infants whose mothers were depressed throughout the year classified as securely attached (p=.045). Relations between persistence of depression, infant temperament, mother-child attachment and toddler development and behaviour will be discussed.

"I am not depressed!" Why Bother to Comply With Intervention?

Dr Nick Kowalenko, Department of Child and Adolescent Psychiatry, Royal North Shore Hospital, Sydney. evalle@doh.health.nsw.gov.au

This paper will describe treatment uptake in a sample of 78 mothers who met diagnostic criteria for an episode of major depression in the first four months after birth.

Sample and Method: Mothers in this study were admitted to a parentcraft centre for assistance with unsettled infant behaviour and subsequently visited at home when their infants were four months old. At this visit they received a diagnostic interview to establish a diagnosis of depression (CIDI) and were asked questions regarding suicidal ideation, feelings of frustration with the baby and details of any mental health treatment they had received (including counselling and antidepressant medication).

Results: Suicidal ideation was reported in 27% of the depressed mothers and 38% described being at "the end of their tether" at times in caring for their infants. 13% reported occasional "rough handling" (eg. throwing baby down roughly on the bed). At four months, 40% of mothers who had been depressed had sought counselling for mental health or relationship problems at least once since giving birth and 21% of depressed mothers had been prescribed antidepressant medication.

However, this paper will demonstrate that in those mothers receiving routine care, after PND has been identified, access to ongoing treatment, compliance with interventions offered and who best provides services in the primary care network still remains a vexed question. Other factors that may influence maternal engagement with interventions will also be explored.

Recommendations for practice that may enhance engagement in effective interventions will be considered in light of the evidence presented.