Professional interaction guidance to improve maternal-infant interaction quality of depressed mothers: a feasibility pilot randomized controlled trial

Abstract

Mothers and infants in stressful environments, such as those affected by Postpartum Depression (PPD), are known to have both (1) reduced quality maternal-infant interactions and (2) elevated cortisol (neuroendocrine stress hormone) levels. Both elevated cortisol levels and poor quality maternal-infant interactions associated with PPD negatively affect developmental outcomes in children and may lead to decreased resiliency to stressors later in life (Essex, Klien, Cho, & Kalin, 2002; Gunnar & Donzella, 2002). Maternal depression calls for immediate intervention for a mother-infant dyad. Maternal depressive symptoms may be improved via parental training interventions that promote sensitive and responsive maternal-infant interactions. This study seeks to (1) explore the relationships between PPD, maternal-infant interaction quality and cortisol levels as well as (2) test the efficacy of a professional interaction guidance intervention designed to improve the interaction quality of these dyads. To date, no studies have been conducted which attempt to concurrently explore the relationship between PPD maternal and infant cortisol levels and the quality of maternal-infant interaction. The dissertation is presented in five manuscripts. The first manuscript describes the patterns of cortisol secretion in infancy and compares the most commonly used approaches for collecting and analyzing salivary cortisol samples in infants 12 months or younger. The second manuscript is a review comparing observational measures of attachment quality. The third manuscript reviews the most commonly utilized observational measures of caregiver-child attachment quality. The fourth manuscript describes the challenges associated with recruiting depressed mothers into research and highlights promising recruitment strategies uncovered via a realist review of literature and lessons learned during the recruitment activities of three exemplar studies of women with postpartum depression. The fifth and final manuscript presents the main findings of a randomized controlled trail testing the efficacy of a video-feedback interaction guidance intervention with depressed mothers. The dissertation concludes with a summary of the five manuscripts and recommendations for research and practice.