The importance of the early mother-infant relationship on subsequent child development is supported strongly by research evidence. Recent studies also suggest that postpartum depression interferes with a woman's ability to engage in behavioural and emotional interchanges with her baby that are now recognized as necessary for a successful mother-infant interaction. Evidence from longitudinal studies of the long-term consequences of maternal postpartum depression on the infant's cognitive, social and emotional adjustment indicates negative effects on child development, ongoing parenting difficulties, and that women are likely to feel a sense of failure as parents. Current treatment approaches to post-natal depression generally target maternal mood only. Our results from a recent randomized control trial suggest that intervention programs targeted only at women's mood disorders, without a specific focus on parent-infant difficulties, have a limited impact. This paper will describe our results on an effective screening and cognitive-behavioural treatment (CBT) intervention for improving both maternal depression, as well as a current trial of additional modules targeting parent-infant difficulties. These include a H.U.G.S. (Happiness, Understanding, Giving and Sharing) intervention and an 'Intuitive Mothering' intervention to improve dysfunctional parent-infant interactions.

Methodology

Initial Study

4148 women were screened using Edinburgh Postnatal Depression Scale (EPDS) after childbirth. 240 depressed women were randomly allocated to structured intervention programs targeting maternal mood or routine primary care within the community. Nine maternal and three couple sessions were offered in all interventions. Follow-up study: a comparison cohort of 40 depressed women have been offered the H.U.G.S. program, and a sub-sample the 'Intuitive Mothering' program.

Results

Incidence

13.2% women scored = 12 on the EPDS. Of these 66.4% received a DSM-IV diagnosis of a Major Affective Disorder. A further 17.4% (83.8% in all) received a psychiatric diagnosis which had depression as a feature when assessed with a semi-structured clinical interview.

Treatment effects

CBT group treatment improved depression and anxiety whereas routine primary care within the community resulted in little change. These improvements remained at the 12 month follow up. Whilst maternal depression was successfully treated this intervention did not improve parenting feelings of self-competence, feelings of attachment or positive perceptions of their infant. 67% of depressed mothers reported some interactional difficulties. Video analysis has validated this self-report data and preliminary results demonstrate improvement after treatment with targeted parent-infant interventions.

Conclusion

Strong evidence is provided that treatment targeting maternal mood only does not alter difficult parent-infant relationships. Preliminary results of the H.U.G.S. and 'Intuitive Mothering' interventions indicate that these result in improved mother-infant functioning.