Postpartum Depression and Child Development
A compilation of research from distinguished contributors in the United States, the United Kingdom, and Germany is presented in Postpartum Depression and Child Development. The editors, Lynne Murray and Peter J. Cooper, founded the Winnicott research unit in the department of psychiatry at the University of Cambridge and later at the University of Reading. The book is divided into five sections, with a foreword by Eugene Paykel and an afterword by Michael Rutter. Individually and together, the sections succeed in the goal of illuminating the darkness of postpartum depression and its complex sequelae in infancy and early childhood.
The introduction and section 2 probe the etiology and treatment of postpartum mood disorders, followed by examination of the structure of the mother-infant relationship. Michael O'Hara points out that women of childbearing age are at high risk for depression. However, several controlled studies suggest that no increased risk for nonpsychotic depression is associated with childbearing. In contrast, women in the first 30 days after delivery are at higher risk for both "blues" symptoms and psychotic depression. Although standard treatments seem to be effective for postpartum depression, more outcome studies are needed.
The chapter by Hanus and Mechthild Papousek delves into the mother-infant system and vicious circles of communication failures in maternal depression. E. Z. Tronick and M. Katherine Weinberg review the fascinating processes of a model of mutual regulation and how maternal depression derails establishment of a dyadic mother-infant system.
The seven chapters of sections 3 and 4 explore the impact of depression in the puerperium on the infant and treatment for both mother and child. The authors discuss the intellectual and emotional development of infants, dysregulated arousal and attention, and the role of gender. They methodically explore the possible links between postpartum depression and the cognitive problems of children. Discussion of a theory of intergenerational transmission of psychopathology from a depressed parent to the child is of particular interest to clinicians.
The fifth and final section investigates postpartum psychosis, emphasizing its effects on the infant. The authors thoughtfully examine the adverse consequences for the child of a mother's severe mental illness, and they raise questions about the risks and benefits of hospitalizing both mother and child. This chapter, like most in the book, also addresses social and familial factors in detail. The authors note that in England and Wales the Infanticide Act of 1938 recognizes that the mother's mental state may have been influenced "by reason of childbirth or lactation."
The book meets its objective of exploring the impact of postpartum depression through well-written chapters that capture international perspectives on research. The chapters flow together well, avoiding redundancy. The research data are presented clearly and with good graphics. Intended for psychiatrists, psychologists, and all professionals in the field of human development, this book belongs on the shelf of any student of postpartum depression.
Dr. Tully is a child and adolescent psychiatrist with Sutter Medical Group in Sacramento, California, and assistant clinical professor on the voluntary faculty at the University of California, Davis.
