Why Should We Worry About Maternal Depression?

It seems as if I’ve had a lot of discussions of maternal depression lately-- both the perinatal mood disorders of birth mothers and post-adoption depression. When these topics come up, there are a lot of different responses. Some deny that there could be post-adoption depression, because they’re convinced that the hormones of pregnancy cause perinatal mood disorders (although if this were the case, it’s not too clear why all women don’t have the same problems). Others feel that the women are just suffering from “buyer’s remorse” and could do perfectly well if they just pulled their socks up. Still others feel that such mood disorders are excuses given by people who don’t like the hard work of early motherhood.

In most cases, people focus on the mother as the significant person, the one who’s influenced by depression. They forget the fact that the impact of maternal depression on a baby’s development can be quite negative. They also forget that this is an issue that has significance not just for mothers but for all major caregivers. Depression in nannies, day care providers, or grandmothers who “watch” the child while the mother works all have the potential for interfering with optimum development. (You notice I don’t say “normal development”. Things have to get pretty bad before development gets below the bottom of the normal range-- but long before that there may be a deviation from a baby’s best developmental trajectory, the one that will result in the best developmental outcome.)

So, what do depressed mothers and caregivers do that’s so different from what better-functioning people manage?

Imagine your own experiences with depression-- whether they involved an afternoon of low interest in life, or a long, serious problem with thoughts of suicide. Think how you feel when you’re depressed, what you feel like doing, and how you respond to other people. You’ll probably realize that you feel not only sad, but slow, tired, unresponsive, hard to please, pessimistic, and perhaps guilty or even worthless. You’d like people either to leave you alone completely or to nurture you without thought of themselves. You don’t want to talk or listen to others, you don’t want to make eye contact, you don’t smile or show expression in your posture or gestures.

Then, imagine how you feel when you’re with someone else who is depressed (and you aren’t). You may feel and act sympathetic at first, but that might not last long in the face of their negative mood. You interpret the other person’s mood as anger or hostility or rejection, and soon you respond to that perceived mood by being angry yourself. You don’t want to be with that person, and if you have to be (you live together, for instance), you may end up picking a fight just to get some acknowledgement of your existence.

Now, I don’t want to act as if I think babies have the same interpretations of other people’s behavior as adults do. I’m positive they do not. But when you consider how you feel when you’re depressed, and how you react to other depressed people, I think you can catch something of the flavor of a baby’s reaction to a depressed caregiver. In addition to that “flavor”, though, it might be good to consider some things depressed caregivers do or don’t do, and how those things relate to a baby’s needs.

1.Depressed caregivers don’t talk much.

Babies need to hear speech from the earliest months. Initially, hearing speech helps babies learn which noises adults make as part of speech, and which are not part of speech. To understand a language, you have to learn that particular sounds determine the meaning of speech, and others, like humming, coughing, or saying “ummm” do not. Different languages have different proportions of certain speech sounds and sometimes don’t use a particular sound at all. Babies who hear little speech are delayed in their understanding of the way their native language works and which sounds they need to pay attention to in order to understand.

2.Depressed caregivers make the “still face” often.

By a few months of age, certainly by 4-6 months, babies have normally learned to expect adult facial expressions to change in response to baby communications. When an adult makes the “still face”-- gazing blankly and unresponsively as if he or she can’t see the baby-- it’s very disturbing to the baby, who will begin to cry quite soon, will avert his or her gaze and become disorganized, sometimes hiccupping or spitting up. Adults can make still faces under perfectly normal situations like trying to remember where the car keys are or trying to talk to the plumber on the phone while the baby makes a bid for attention. Ordinarily, though, the non-depressed adult quickly comes back and re-engages with the baby, repairing their temporarily troubled communication. Depressed caregivers, on the contrary, may not only do the still face more often, but may lack the energy or interest to help the baby later understand that everything is okay and resolve the disorganization and anxiety the baby feels.

3.Depressed caregivers do only the basics.

Fatigue and slowing of responses are part of depression and interfere with normal infant care routines. Ordinarily, caregivers do a lot more than just the physical jobs of caring for a baby. The non-depressed caregiver who is changing a diaper talks to the baby in an interesting, voice that catches the baby’s attention. She plays with the baby at the same time, making eye contact, smiling, tickling or blowing on the tummy, perhaps giving the baby a toy to hold (not entirely play, of course, this is a good strategy for keeping the little hands out of the dirty diaper). When feeding the baby, she talks and jokes, perhaps pretending to eat some of the food herself (for some reason, this is a wow with the high-chair set), or helping the baby pick up some finger food. The depressed caregiver goes through these routines without any of the usual grace notes, doing the minimum and missing out the actions that pique the baby’s interest and foster communication, as well as those that encourage learning.

4.Depressed caregivers may not be very careful or attentive.

When babies can roll over, or pull to stand in their cribs, or later on crawl and so on, caregivers need “eyes in the back of their heads” to ensure safety. Even so, most babies experience a few scary tumbles as their caregivers fail to anticipate their doing something for the first time. The depressed caregiver moves slowly and has trouble paying attention to more than the troubles in her own thoughts and feelings. She may be so preoccupied that the baby might as well be at the top of the stairs or in the bathtub alone. Paradoxically, the depressed caregiver’s sense of guilt or worthlessness may concern her so much that she fails to prevent accidents and thus really does become guilty.

These are only a few of the caregiving problems that can be associated with depression. It may well be that the best thing we could do to foster good early development would be to attend to and treat the depression of mothers and other infant caregivers, so they can do the optimum job of bringing up young children.