Lecture by Prof. A Stein

Today I attended a lecture by Professor A Stein (Child and Adolescent Psychiatry, University of Oxford) at an event organized by Manchester Medical Society. The title was 'The influence of parental depression on mother-infant interaction and child development in the context of adversity'.
The event was well attended by a mixture of academics, students and practitioners. These were his main points.
He stressed the need to know what the normal processes of infant/parent bonding were and commented that at six weeks of age the infant is highly sensitive to the qualities of adult communication. At nine months of age an infant uses his parent for social referencing, i.e. how to react, as parents normally convey pre-verbal information, e.g. by expression. Infants learn from their mothers.
However, postnatal depression affects thoughts, emotions and behaviour in a negative way which often leads to a narrow focus of attention. A study by Sarason(1986) showed this had a profound impact on attention and activity which affects attention and responses. This compromises parenting and diminishes responsiveness.
Other studies have been done which show the risk of adverse effects, e.g. mother/father interaction (Murray); behavioural development (Sinclair); social development (Halligan) and cognitive (Hay). Also a study by Lovejoy showed that cognitive development is affected more where the family is more disadvantaged, especially by poor language.
In the developing world PND also can be affected by poorer growth, digestive problems, e.g. diarrhea, insensitive parenting and insecure attachment. Nyleen (2006) said that treating depression alone does not migrate the effects on children - we need to deal with the mother/infant interaction too. They trained lay workers to enhance maternal responsiveness which lead to increased attachment.
Postnatal depression can affect 3 - 4% of fathers. Ramchandani (1995) reported that this was associated with behavioural problems, especially in boys, when the infant was 3 years old. Also at 8 years there were increased psychiatric diagnosis. The main conditions were of OCD and conduct disorder. At this age there was no gender difference.
HIV/Aids and depression was highlighted. 25 million have died from it and 38.6 million are living with HIV. 4.1 million were infected in 2005. In sub-Sahara Africa half of new cases are in 15 - 24 year olds. More women are infected earlier than men. There are high rates of HIV in pregnancy which can be reduced by doses of relevant drugs if given within hours of birth, which lowers vertical transmission. This is better for the infant but parents are still HIV. Often mothers are given news of suffering of HIV during pregnancy. This creates mixed feelings. Sufferers have to take medication for ever - this is better with ARV's - anti-retro viral treatment but it is not available for everyone and some will not or do not take it. The feelings of being told you are HIV positive still have a stigma, there are issues of fidelity and many negative thoughts. All these are likely to be worse if you have a new baby. Babies and their siblings show that their mental and motor development is affected. There are some non-medical treatment trials in Uganda at the moment regarding PND and HIV.
Therefore we can clearly see that parental depression has influence on mother-infant interaction and child development in the context of adversity.
Thank you Professor Stein for an interesting lecture and to the Manchester Medical Society for hosting the event.

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