The postpartum period after the birth of a new baby can be the most exciting, joyful, and stressful time of life. It is also a period of sleep interruption, hormonal fluctuations, and exhaustion due to the demanding schedule of caring for a newborn baby.

It is a time when many women are more vulnerable to experiencing mental health challenges, such as postpartum depression and postpartum anxiety. Nearly 20% of women experience some form of postpartum depression1, and 4-8% of women experience postpartum anxiety2, providing evidence that women struggling with feelings of depression and anxiety after the delivery of their baby are not alone.

"Children of mother's who experience postpartum depression may be more vulnerable to experiencing problems …. "

It is common to struggle with anxiety and depression, even after the "baby blues" pass, which is typically the first few weeks after birth. For mothers and caregivers reading this, it is important to recognize that these experiences are common, and there are effective treatments to help you transition into your new role as a parent, such as psychotherapy, new parent support groups, and instrumental help from friends and family members (such as babysitting, cooking meals, cleaning, and/or shopping/errands).

Children of mother's who experience postpartum depression may be more vulnerable to experiencing problems with managing their emotions, attention, and behavior3. While there is significantly much less research on postpartum anxiety, the research that is available suggests that postpartum anxiety disorders may also increase the likelihood of difficulties in interactions between mothers and their infants, and are also correlated with mental health struggles in children4.

This is why it is also especially important as family members or friends of women who may be struggling with mental health problems after the birth of their child to help connect them to supportive resources to help with boosting resiliency and enhancing mental health during this vulnerable time. Women are often so exhausted caring for their newborn baby, it may be up to the spouse or family to help recognize a mental health problem, and create a connection to a mental health resource.

Severity v. Chronicity

However, less is known about whether or not it is the severity (how intense the symptoms are) of the maternal depression and anxiety, or the chronicity (how long the symptoms last for) of it, that may impact the children's mental health. This is important to understand, in order to identify mothers and children who may be most at risk of experiencing mental health challenges. This may also help to develop more targeted interventions to help those most at risk recover from anxiety and depression in the postpartum period.

This is what a team of researchers wanted to understand: Is it the severity of the postpartum anxiety and depression, or the chronicity of it, that can impact children's mental health5? This team of researchers recruited a sample of roughly 300 mothers who were diagnosed with either major depression (MDD), generalized anxiety disorder (GAD), both MDD and GAD, or no disorder 3 months after the delivery of their baby. They assessed the mothers' mental health at 3, 6, 10, and 14 months, and then assessed child mental health, including both internalizing (such as anxiety) and externalizing (such as aggression) problems, as well as their attention, frustration, sooth-ability, focusing, and negative emotions, at 24 months of age.

They found that the chronicity of both maternal anxiety and depressive symptoms during the first two years postpartum was related to mother's reports of poorer behavior and emotional negativity in their 24-month-old children. However, when examining the role of chronic maternal anxiety and depression together, researchers found that only chronic depression was predictive of mothers' reports of children's behavior and emotional negativity. In addition, only chronic maternal depression was related to observed emotional problems in children, whereas chronic maternal anxiety was not. Another key finding was that the occasion-specific maternal anxiety and depression was not predictive of child mental health problems at 24-months, indicating that there is no relationship between children's mental health and brief episodes of postpartum anxiety or depression.

The key take-away points from this article are that brief periods of postpartum anxiety or depression are not likely to impact your children's emotional health in their early toddlerhood. However, children of mothers who are experiencing chronic anxiety and depression over most of their child's first year and a half of life, are at higher risk of developing mental health challenges, such as difficulty regulating emotions like anger or fear, problems with self-soothing, focusing and shifting attention, and struggles managing frustration in early toddlerhood.

Family, friends, and caregivers can all play a role

These findings also suggest that the low positive emotional expression in parents to their children, more common in postpartum depression than postpartum anxiety, may be more detrimental to the child's emotional health than just the presence of anxiety or negative emotions in their caregiver. These findings suggest the importance of creating spaces for children to observe and experience a lot of warm, positive emotional expression from their caregivers, to boost their mental health in their infancy and early toddlerhood, especially if a mother or caregiver is struggling with postpartum depression.

These findings also highlight the critical importance of the mother's social network to help her get support to recover from chronic postpartum depression or anxiety. Finally, an important thing to remember is that children are resilient and if a child begins to struggle with managing emotions in early toddlerhood, there are supportive resources available to help them cope as well. It takes a village to raise a child, and no mother needs to be alone.

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Julie Bindeman, Psy.D.

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Sources

1. Gavin, N. I., Gaynes, B. N., Lohr, K. N., Meltzer-Brody, S., Gartlehner, G., & Swinson, T. (2005). Perinatal depression: A systematic review of prevalence and incidence. Obstetrics and Gynecology, 106, 1071–1083. http://dx.doi.org/10.1097/01.AOG.0000183597.31630.db

2. Ross, L. E., & McLean, L. M. (2006). Anxiety disorders during pregnancy and the postpartum period: A systematic review. The Journal of Clinical Psychiatry, 67, 1285–1298. http://dx.doi.org/10.4088/JCP.v67n0818

3. Goodman, S. H., Rouse, M. H., Connell, A. M., Broth, M. R., Hall, C. M., & Heyward, D. (2011). Maternal depression and child psychopathology: A meta-analytic review. Clinical Child and Family Psychology Review, 14, 1–27. http://dx.doi.org/10.1007/s10567-010-0080-1

4. Murray, L., Cooper, P., Creswell, C., Schofield, E., & Sack, C. (2007). The effects of maternal social phobia on mother-infant interactions and infant social responsiveness. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 48, 45–52. http://dx.doi.org/10.1111/j.1469-7610 .2006.01657.x

5. Prenoveau, J. M., Craske, M. G., West, V., Giannakakis, A., Zioga, M., Lehtonen, A., & ... Stein, A. (2017). Maternal postnatal depression and anxiety and their association with child emotional negativity and behavior problems at two years. Developmental Psychology, 53(1), 50-62. doi:10.1037/dev0000221

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