This literature review will consider four peer-reviewed research papers concerned with the causality of depression in pregnant women and the effects of maternal depression on the psychological and physical well-being of their infants. The research will differentiatebetween quantitative and qualitative data and consider the appropriate methodology used to gather the data. I will examine how the research was undertaken and completed and whether the methodology was valid and reliable. I will also consider ethical issues and any concerns regarding the safeguarding of patient confidentiality. 1.
‘Doesmothers’ postnatal depression influence the development of imitation?’ In this study, the authors hypothesise that postnatal depression (PND) may interfere with infants’ ‘imitation’, which is an early learningability that features in early mother–infant interaction and is linked tomemory, causal understanding and joint attention. This study demonstrated a mixed methodology as the quantitative data was sufficient to present a nationally representative sample of Britishfirst-time mothers and their infants and to examine whether there is a correlation between PND and a reduction in imitation. The qualitative data involved observation, interviews and questionnairesand allowed the researchers to investigate aspects of sociodemographicadversity and to find out whether there were causal elements of depression during pregnancy or prior to conception. Method 332 first-time mothers represented the entire range of socioeconomic categories in the UK, sothe final sample was nationally representative, equivalent to the most recentUK national cohort study.
301 parents were interviewed and observed with their children. One parentwas interviewed by telephone, eight provided questionnaires. Six families withdrew from the study, four failed tokeep appointments, eight could not be traced within the time frame, and fourcould not be assessed due to ill health or because of family circumstances. 253 infants were presented with two imitation tasks thatvaried in difficulty (manipulating a door knocker, light panel or spring; tapping on the wall of a box; and another, arbitrary task), of which 174 (68.8%) imitated a modelled action at least once.
The children of women who had experienced PND were significantly less likely than others to imitate the modelled actions. Only 10 (48%) of the infantswhose mothers had been depressed postpartum imitated the model at least once,whereas 160 (70%) of other infants imitated at least one modelled action. The researchers only took into consideration completed tasks, which could possibly make this research less reliable but there was a small p-value which would indicate that the study suggested that the likelihood of PND influencing imitation tasks was greater than simple chance.
The ethical considerations in this study are that informed consent would be needed in order to undertake experiments on children and there were issues of confidentiality?with mothers who have PND. That parents were given the right to withdraw from the programme demonstrates that correct ethical considerations were implemented. The potential benefits of being able to associate learning difficulties in children of mothers with PND and thereby supporting those children so that they are treated with justice, respect and equality within society outweigh any other ethical considerations. The study also demonstrates the power of social modelling as children imitate a ‘power’ role model.
Those children who imitated more than once seem to get a positive reinforcement fromtheir role model and if the parent repeats this action their infants understand that what they have done is a good action.? The limitations of this study might be that the cohort size is not large enough to extrapolate into the wider population. Moreover,the imitation exercises were perhaps too brief to be reliable or effective, especially because observation was limited.
Perhaps some of the children showed poor imitationbecause the parents had not had the experiment explained to them clearly enough. The Hawthorne effect could also be taken into account as both parent and childmight have been conscious that they were being observed. However, knowledge of the effects on learning of PND should inform health professionals in postnatalcare, which could lead to further studies and possible intervention strategies.
2. ‘Mechanisms of Resilience in Children of Mothers WhoSelf-Report with Depressive Symptoms in the First Postnatal Year’. The second study suggests that maternal postnatal depression symptoms are associated with an increased possibility of adverse effects on the development of the child. Thisliterature aims to determine the mechanism of resilience in children exposed to PND symptoms.
Method Data was taken from a large-scale prospective cohort study. The methodology of this research is a qualitative review as mothers were given questionnaires during pregnancy and the child’s first two years asking the motherstheir views of parenting and how they judged the development of their child. The Edinburgh Postnatal Depression Scale (EPDS) was completed postnatally at 8 months and theStrengths and Difficulties Questionnaire (SDQ) at 11 years. Children of mothers reporting PND who scored above the median score of childrenof mothers not reporting PND were defined as resilient. The information was subjected to exploratory factor analysis to assistwith statistical data. It has been stated that modelling condition (AlbertBandura) could affect the results: an individual’s belief in their ability and efficacy to exercisecontrol over their own lives and actions could be a contributing factor innon-optimal child development.
There were 14,541 pregnancies along with 13,988 children alive at the age of one. There were 10,923 pregnant mothers with PND. Those mothers excluded were those with multiple births and those whose children had died (4,423). 1,009 children in total were exposed to maternal PND.
Positive parenting behaviours and interactions with their child were associated with betterverbal skills and fewer behavioural difficulties at a younger age in their study of the ALSPAC cohort (age 7 years compared with 11 years inthe current study). This confirms speculations suggesting that positivematernal parenting characteristics may have important protective effects inhigh-risk populations, serving to neutralise some of the effects of the risks encountered. One finding of the study was that children who at 15 months aremore able to communicate in a non-verbal way have a greater likelihood of beingresilient at 11 years. Due to the nature of the data collection in the ALSPAC sample, it is not clear whether the non-verbalcommunication displayed by the children at age 2 elicited warm responses from their mothers.
However, it could bespeculated that such non-verbal forms of communication might lead to positivechains of responses from the mother, which in turn fostered resilience. Within the paper it is stated that ethical approval for the study was obtained from the ALSPA ethics committee and the local researchethics committee. Parents were given the right to withdraw from receiving thequestionnaire through the post. However, again the Hawthorne effect might have made an impact and made data less reliable. There was only one method used to gather data, which might have made the information unreliable, as there may not have been enough evidence. Moreover, a numerical description rather than a detailed narrative generally provides less elaborate accounts of human perception. It has been suggested that there were difficulties within the questionnaires as some were completed at different points in the survey, reflecting differently on thedevelopment of the children. A quantitative approach has shown that findings can give evidence either to support or contradict a hypothesis.
What is clear is that it might contradict the hypothesis as there is a low rate of reliance in children. Nonetheless, the growing knowledge on resilience maybe vital in guiding social policies for the promotion of well-being andpositive adaptation across populations. Early interventions could help improvethe long-term outcomes for children as well as potentially interrupt theintergenerational transmission risk of depression. And by assessing those factors that have contributed to thedevelopment of resilience in children who have been exposed to postnataldepression there is a better understanding of those aspects of a child’s earlyenvironment that may help support them to withstand the effects of the symptomsof postnatal depression.
3. In this third article it is calledinfluence of prenatal maternal stress maternal plasma cortisol and cortisol inatomic fluid on both outcomes and child temperament at three months. Thisliterature review aims to investigate relationships and signs of maternalpaternal stress and the infant birth outcomes and the potential earlytemperament in addition to examining patterns associated between psychologicalsuch as cortisol and plasma concentration in addition to self-reports ofmothers with paternal stress. This is a prospective longitudinalproject into the effects of prenatal hormones on development in children.
Hasbeen suggested that 185 women declared willingness to participate within thestudy only single pregnancies were used however only 158 pregnant women. Thesewomen were given questionnaires to be able to report stress levels. 26.04 whichwas the mean of the perceived score in the sample. Cortisol in the atomic fluidwas determined by the radioanimus variation that was taken fromthe lower limit of the detection to be able to measure the average within thecortisol whin the atomic fluid. But thequestionnaires were taken for the temperament of the infants at three months inregarding the behaviour such as stress to limitation and fear as bait babyfears and crying in convening position during can I take in activities andunable to perform certain actions. Methodology was Quantitive data as yet again they want tosee levels of stress in relation to cortisol in the atomic fluid to see if thereis an increase of stress and to see if it also increases the cortisol in theatomic fluid. As they are interested in numbers as they do want to know themean average within this longitudinal prospective study.
This demonstrate in the result as wellas in the table that the mean of the quarter the event the atomic fluid was4206 but in the range it was 27 to 63, does show thereis an increase of cortisol. Whether this also demonstrates a low p value whichis less by chance there was no sex difference in the atomic fluid and Cortisol contraction. It has been suggested that it was moderate by maternalstate and is IT as there was no difference between stress and low anxiousmothers based on the ST a I test nor high and low mothersas measured by these questionnaires handed handed out in comparisons. In therelation to the independent Variables it has been suggested that maternalplasma and the atomic fluid quarters or contractions were positively associateddue to a small P value questionnaires and says about giving birth within thepregnancy do correlate as stress did not correlate with maternal state anxiety. However they also suggest that they hadthree hypotheses and one positive association between maternal and self-reportof stress and Anxiety and cortisol Contraction Each patient were given a informed consent To theprocedure and the UMCU you medical ethical committee approved of the studythe maturity 96 was referred because of their age 36 or older had the aminothesis because amniocentesis because of their deviate serum screening. Asbecause there is a high risk of maleficence being performed and there is aPossibility mother losing the so the mother has to be aware The procedure they are going throughfor legal document purposes. But can also be considered as benefices The study will open knowledge andways to enhance and understanding towards a fact of stress and to infantbehaviour.
‘Effects of pre-natal depressive symptoms on maternal and infantcortisol reactivity.’ The literature suggests that pre-natal depression is associated with adverse offspring outcomes, and the prevailingtheory to account for mood-associated effects implicates alterations of thematernal and foetal hypothalamic-pituitary adrenal axes. Recent researchsuggests that depression may be associated with a failure to attenuate cortisolreactivity during early pregnancy. This studyinvestigates whether this effect continues into mid and late gestation. Asecond aim is to test whether maternal pre-natal cortisol reactivity directlypredicts infant cortisol reactivity. Method The study investigated 103 pregnant women in the second and thirdtrimesters of their pregnancy. The participants were asked to complete a questionnaire which contained questions about their demographic characteristics and current levelsof mood.
They were then asked to watch a 6-minute film of distressed babies. Saliva samples were collected five times during the test session; two samples were taken before the film; a third sample was taken immediately after thefilm; fourth and fifth samples were taken 10 and 20 minutes after the film. Maternal depressive symptoms were self-reported via the questionnaires. Postnatal mood symptoms were further assessed by visits at theparticipants’ homes and saliva samples were also taken from their infants bythe mothers. The methodology uses quantitative data as the researchers wanted to measure the amount of cortisol in the mothers’ saliva. Qualitative data regarding depressive symptoms was taken via questionnaire. One aspect ofthe study that might render the findings less than universal is that theparticipants were ‘primarily Caucasian ..
. highly educated, had a mean age of31 and all participants were primiparous’. The researchers admit that ‘the participants were drawn from alow-risk community sample and levels of maternal prenatal depression wererelatively low.’ Contrary to theresearchers’ initial hypotheses, symptoms of depression werenot associated with maternal hyper-cortisol secretion in response to the infantdistress stimulus. Further, maternal cortisol reactivity did not directlypredict infant cortisol reactivity. The ethicalconsiderations were not clear in this study. The showing of the ‘short film depicting distressed young infants, allunder the age of 6 months’ might arguably have stimulated and increased cortisol levels and could be in conflict with the non-maleficence principle inthat it might effect levels of distress and anxiety in the participants.
?It is worrying that the researchers reported that’the infant distress video may not have been a sufficiently potent stressor toinduce a cortisol stress response in this group of pregnant women, althoughparticipants did report increases in state anxiety following the film.’ In conclusion, it is clear from these literature reviews that the topic of depression in pregnant women and theeffects of maternal depression on the psychological and physical well-being oftheir infants is a field that demands a great amount of quantitative data and that knowledge of the effects on learning of PND should inform health professionals in postnatalcare, which could lead to further studies and possible intervention strategies.Qualitative data is problematic given that studies are often self-selective.
Moreover, the studies here are arguably not as diverse in terms of sociodemographics as they might be. Ethically, all studies undertaken or proposed were bound by national and localguidelines and there were no declared conflicts of interest. Women withdepression need to be treated perhaps more carefully than participants instudies where mental health well-being is not an issue. Also, infants areunable to give informed consent and their human rights must be taken intoaccount. My one concern was regarding the use of film of distressed infants,first on the well-being of the babies showing distress and second on thepsychological well-being of the women who were shown the film.
It is clear that there is importance in there being more research to monitor and enhance cognitive and motor skills in infants and to support the psychological well-beingof women pre- and postpartum.