Murray, L., Cooper, P.J., Wilson,

¶ … Murray, L., Cooper, P.J., Wilson, A., and Romaniuk, H. (2003).

Controlled trial of the short- and long-term effect of psychological treatment of post-partum depression: Impact on the mother-child relationship and child outcome. The British Journal Retrieved

from http://bjp.rcpsych.org/cgi/content/full/182/5/420.html

In the British Journal of Psychiatry, Lynne Murray, PhD, Peter J. Cooper, DPhil, Anji Wilson, PhD, and Helena Romanijik, PhD., explore the effects of psychological treatment of mothers with postpartum depression upon the quality of the mother-child relationship and the overall child outcome. Their specific goal focused upon completing an evaluation of the effect of three different psychological treatments which were given to the infant's mother: primary care, non-directive counseling, and cognitive-behavioral or psychodynamic theory. Researchers assessed the parental relationship and the child outcome upon the focus group at ages 4.5, 18, and 60 months post-partum.

Prior to this particular study which was published in 2003, several longitudinal studies revealed evidence of an adverse impact of post-partum depression upon the quality of the mother-infant relationship in the early stages and on the overall course of the child's socio-emotional development. In some studies, researchers found that children's cognitive development was negatively affected (Cogill et al., 1986; Hay et al., 2001); however, it is unclear whether the negative effect applies to low-risk samples and whether or not the negative effect endures in the long-term (Murray & Cooper, 2003). In several past studies, a mother was found to have a significant positive benefit with regard to her overall mood fluctuations (Holden, 1989), yet as of the time of this study, it had not been established whether or not an early elevation of the mother's mood actually brought about an improvement in the actual mother-infant relationship or whether or not it improved the child's overall child developmental process. In order to determine whether a mother's treatment for post-partum depression affects the mother-parent relationship as well as the child's developmental progress, the authors embarked upon this particular research project.

Since developmental psychologists generally agree that there are critical periods in infancy and childhood during when infants and children develop perceptual, sensorimotor, social, and language systems depending critically upon his/her environmental stimulation. During a baby's development, intelligence may be shown through the usage of symbols, language is maturing, and memory as well as imagination are both developing. As a baby moves into becoming a toddler, he/she attempts to become independent as they begin to walk, talk, obtain food, and use the toilet for themselves while also developing self-control while simultaneously experimenting in order to hopefully become independent children. In the field of developmental psychology, it is generally accepted that a child's development will be fostered by an encouraging caregiver while a child's development will be hindered and he/she will be less prepared to negotiate his/her environment and will also feel more feelings of self-doubt and shame should the caregiver be overprotective and/or disapproving at this developmental stage. In this particular study, the researchers created a controlled treatment study in order to determine whether or not early elevation of maternal mood also lead to an improvement in the mother-infant relationship and an improvement in the child's developmental progression.

This particular controlled treatment study utilized a group of women with major depressive disorder. On a random basis, the women were assigned to either regular primary care or to one of three psychological interventions: non-directive supportive counseling, cognitive-behavioral therapy (CBT), or a brief psychodynamic psychotherapy. Assessors independent from and unaware of the study itself assessed the overall outcomes of the treatment at several post-partum stages namely at four months, eighteen months, and five years. At this time, assessment was also conducted regarding the quality of the mother-child relationship and the child's developmental progress.

In order to gauge the mother's early maternal management and the mother-infant relationship at the four-month point, mothers filled out a checklist regarding the management of infant behavior in critical areas such as feeding, sleeping, and crying and problems with the infant that may have arisen such as infant demands for attention, separation anxiety, and difficulties playing and relating to the infant. Mothers used a four-point scale to do this ranging from "not at all" to "a great deal" before and after her treatment. To assess the mother-infant interactions at the eight and eighteen week post-partum stages, five-minute videotapes were taken of the mother and infant interacting in a play session in their own home. This interaction was rated by an independent assessor whom looked for evidence of maternal warmth, acceptance, and responsiveness. At the eighteen month stage, the women were interviewed using the Behavior Screening Questionnaire which measured infant difficulties regarding sleep, feeding, separation, and temper. Infant attachment and cognitive development were also measured by using the Ainsworth Strange Situation Procedure and the Mental Development Index of the Bayley Scales of Infant Development. After five years, mothers filled out a self-report using the Rutter A2 Scale, which is known to be a reliable and well-validated questionnaire identifying clinically significant child behavioral problems. Additionally, teachers of the five-year-olds completed the Pre-school Behavior Checklist which has also been widely used to identify behavior problems in the educational context.

Analysis of the data collected reveals that in all the stages, indications of a positive benefit were limited and the results themselves were not able to be broken down such that individual population groups could be identified. Perhaps, this is the function of the broad nature of the researcher's hypothesis. Indeed, the researchers merely believed that there may be a positive relationship between maternal treatment and relationships and cognition of their children. Given the broad and ambiguous nature of the hypothesis itself, it is therefore not surprising that the findings, conclusion and implications failed to specifically identify the efficacy of particular psychological therapies amongst the women. Additionally, the researchers provide no real data regarding how the sample group was selected or the demographics of the sample group. By doing so, they deny the socioeconomic factors which may be at play and therefore reduce the clinical implications of the findings greatly.

There was subjective evidence that the three types of psychological/behavioral treatments did have a benefit on maternal reports of early difficulties in relationships with the infants: counseling gave better infant emotional and behavior ratings at 18 months and more sensitive early mother-infant interactions were discovered. Yet, it must be noted that this evidence of a positive impact is derived primarily from the subjective accounts of the mothers. Indeed, despite the subjective reports of the mothers at the early stages, the treatments had no lasting effect in that there was no significant impact on maternal management of early infant behavior problems, security of infant-mother attachment, infant cognitive development, or any child outcome at 5 years of age. Based upon the foregoing analysis of the various data gathered at various developmental stages, the researchers concluded that early maternal intervention to treat post-partum depression had short-term benefits to the mother-infant relationship and infant behavior issues. However, a majority of the remaining findings failed to show any benefit. In fact, even after five years of treatment, at the end of the study, there was no significant benefit with regard to infant and child cognitive development or the child's emotional and behavioral adjustment. As a result of the finding that only limited and short-term benefits occurred in the mother-infant relationships and the children's cognitive development, it appears that despite symptoms of depression decreasing and initial gains in maternal caregiving that maternal vulnerabilities still persist. The research somewhat suggests that to prevent longer term difficulties with the children's functioning that prolonged visitation should occur.