Stress, Coping and Depression

Sheri L. Johnson, Adele M. Hayes, Tiffany M. Field, Neil Schneiderman, Philip Mccabe

• Publisher: Psychology Press
• Year: 1999
• eBook ISBN: 9781135663261
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

Stress, Coping, and Depression is the latest volume based on the Annual Stress and Coping Conference held at the University of Miami. In this timely collection, leading researchers offer a variety of new perspectives on depression. They review the social, biological, and psychological processes that put adults and their children at risk and discuss innovative treatments grounded in empirical studies. Research findings are integrated across domains to construct more effective models of etiology and intervention. The contributors' thought-provoking ideas will provide inspiration for the ongoing efforts addressing the problems associated with this devastating disorder.

Content highlights include:
* novel information processing approaches to depression;
* an overview of the neural pathways guiding moods;
* empirical approaches for the treatment of bipolar disorders;
* integrated models of biological and environmental influences on the transmission of depression to children; and
* new perspectives on the relationship between personality and stress.

Part I
CHILD DEVELOPMENT

Chapter 1
Infants of Depressed Mothers

Tiffany M.Field
Touch Research Institutes, University of Miami Medical School and Nova Southeastern University

Maternal depression negatively affects infants as early as the neonatal period, implicating prenatal effects of maternal depression. This is discussed in the first section of this chapter. As early as birth, the infants show a profile of dysregulation in their behavior, physiology, and biochemistry, which probably derives from prenatal exposure to a biochemical imbalance in their mothers. These effects are compounded by the disorganizing influence of the mothers’ interaction behavior.

Nondepressed caregivers, such as fathers, may buffer these effects because they provide more optimal stimulation and arousal modulation. The evidence for this and the positive effects of several laboratory interventions are presented in the second section of this chapter. Interventions such as massage and music therapy, which are mood altering for the mothers and arousal reducing for the infants, make the mothers and infants more responsive to interaction coaching and improve their interactions. These interventions may be effective because (a) they induce a better mood state in the mothers (and alter right frontal electroencephalograms, EEGs, a marker of depression) and (b) they reduce sympathetic arousal in the infants. Norepinephrine and cortisol levels, for example, are lower following 1 month of these therapies, and (c) being less sympathetically aroused, both the mothers and infants can be more responsive and more available to interaction coaching; thus, their interactions subsequently improve.

Depressed mothers have two predominant interaction styles, withdrawn or intrusive, which seem to have differential, negative effects on infants related to inadequate stimulation and arousal modulation. The type of interaction coaching that is effective depends on the interaction style of the mother. These data and a model regarding the different types of maternal depression are presented in the final section of this chapter.

INFANTS OF DEPRESSED MOTHERS

Infants of depressed mothers appear to have a profile of dysregulation as early as the neonatal period. This dysregulation profile is characterized by: (a) limited responsivity on the Brazelton, excessive indeterminate sleep, and elevated norepinephrine and cortisol levels at the neonatal period; (b) relative right frontal EEG activation at 1 week, 1 month, and 3 months, and stability in these patterns from 3 months to 3 years; (c) limited responsivity to facial expressions, lower vagal tone, and signs of neurological delay at 6 months; (d) less social referencing at 9 months; and (e) limited play and exploratory behavior, inferior Bayley scores, and delayed growth at 12 months.

Neonatal Period

In our neonatal studies, the newborns of depressed mothers showed inferior performance on the Brazelton orienting items (particularly on the inanimate items), received inferior scores on the depression and robustness factors, and demonstrated more neonatal stress behavior (Abrams, Field, Scafidi, & Prodromidis, 1995; Lundy, Field, & Pickens, 1996). They also showed excessive indeterminate sleep (sleep that is difficult to code), which is disconcerting given that Sigman and Parmelee (1989) found an inverse relation between indeterminate sleep during the neonatal period and IQ scores at 12 years. Newborns were also less attentive and less expressive during a procedure of modeled faces (Lundy et al., 1996). Both the depressed mothers’ and their neonatal infants’ norepinephrine and cortisol levels were significantly elevated (Lundy et al., 1999). Assessments of EEG asymmetry revealed a pattern that is noted in chronically depressed adults, namely, relative right frontal EEG activation in both the mothers and their infants when the infants were 3 months old (Field, Fox, Pickens, Nawrocki, & Soutullo, 1995), when they were 1 month old (Jones, Field, Fox, Lundy, & Davalos, 1997) and even as early as 1 week of age (Jones, Field, & Fox, 1999). Relative right frontal EEG activation at 1 month also was related to indeterminate sleep patterns and negative affect at the neonatal assessment (Jones, Field, Fox, Lundy, & Davalos, 1997). The relative right frontal EEG activation among depressed mothers is not surprising, but the appearance of this pattern as early as 1 week in their infants was very unexpected, given the supposed plasticity of brain development and the relatively undeveloped frontal cortex during the first several months of life.

The Infancy Period

In our laboratory studies on affect perception and production, we learned that depressed mothers exhibited fewer positive and animated facial expressions and less animated vocal expression (Raag et al., 1997) and that infants of depressed mothers produced more sad and angry faces and showed fewer expressions of interest (Pickens & Field, 1993b). They also showed a preference for sad faces and/or voices (greater time looking at videotaped models looking and sounding sad; Lundy, Field, Cigales, Quadra, & Pickens, 1997), which might relate to sad expressions being more familiar to them. They also displayed less accurate matching of happy facial expressions with happy vocal expressions (Lundy et al., 1996). In addition, the absence of a relation between infant facial expressions and vagal tone in infants of depressed mothers suggested biobehavioral uncoupling that might derive from the infants’ excessive vigilance in emotional situations (Pickens & Field, 1993b). Finally, during a mother-holding-doll situation, infants of depressed mothers showed less protest behavior (Hart, Field, Letourneau, & DelValle, 1998).

At 6 months, vagal tone was significantly lower and behavioral responses to facial expressions were slower in the infants of depressed mothers (Field, Pickens, Fox, Nawrocki, & Gonzalez, 1995). Although the significance of lower vagal tone is not entirely understood, higher vagal tone is typically associated with better performance on attention and learning tasks. By 12 months, infants of depressed mothers were more likely to exhibit neurological soft signs, and they showed less exploratory behavior, lower Bayley Mental and Motor Scale (BMMS) scores, and lower weight percentiles (Field et al., 1998).

Preschool Period

In our longitudinal follow up, 75% of the mothers with high scores on the Beck at the neonatal period had elevated Beck scores at the 3-year follow up. Their preschool-age children continued to show interaction problems, and they demonstrated clinical scores on the externalizing and internalizing factors of the Child Behavior Checklist (CBCL; Field, Yando, et al., 1996) and elevated cortisol levels. Additionally, their mothers viewed them as vulnerable (Bendell et al., 1994). Predictors from the 3-month infancy assessment that explained 3-year outcome variance included heart-rate (HR) variability and ratings of the infants’ interactions with a stranger (Bendell et al., 1994). In terms of the stability of EEG patterns, 3-month-old infants with relative right frontal EEG activation continued to demonstrate the same pattern at 3 years (Jones, Field, Fox, Davalos, & Pickens 1997). The 3-year-old children with relative right frontal EEG activation also showed more inhibited behavior in strange object and strange person situations, and they showed nonempathetic behavior during their mothers’ display of distress (crying) behavior. Two styles of nonempathetic behavior were noted, including passive-withdrawn and angry-aggressive behavior.

INTERVENTION STUDIES

Comprehensive Intervention

In a comprehensive intervention study, mothers and their infants were followed over the first 6 months to assess the infants’ development and to identify potential markers from the first 3 months that predicted chronic depression in the mothers (Field, 1999). Of the depressed mothers we sampled, 70% appeared to have chronic depression that persisted across the first 6 months of the infants’ life. The infants of these mothers showed delays in growth and development at 12 months (Field, 1992).

Physiological-biochemical markers that we identified for the mothers’ chronic depression included relative right frontal EEG activation, low vagal tone and serotonin (as indexed by the metabolite 5H1AA), and elevated norepinephrine and cortisol levels (Field, 1999). These variables, measured at 3 months, accounted for 51% of the mothers’ continuing depression at 6 months (with maternal relative right frontal EEG activation alone explaining 31% of the variance). Because infants, whose mothers remained depressed at 6 months, began to show growth and developmental delays at 1 year, it was important to identify those mothers for intervention purposes. In this study, a simple electrocardiogram (EKG), EEG, and urine analysis (for cortisol, norepinephrine, and serotonin) together could explain more than half the variance in the mothers’ continuing depression and could be used to identify those mother-infant dyads needing early intervention. We used these markers to identify a second sample of chronically depressed mothers to receive an intervention. Mothers in the intervention received social, educational, and vocational rehabilitation and mood-induction interventions, including relaxation therapy, music mood induction, massage therapy, and interaction coaching. Additionally, their infants received day care.

Although the intervention mothers continued to have higher depression scores than the nondepressed mothers, their interaction behavior became significantly more positive and their biochemical values and vagal tone normalized or approximated the values of the nondepressed control group. The infants in the intervention group also showed more positive interaction behavior, better growth, fewer pediatric complications, and normalized biochemical values, and by 1 year, they obtained superior BMMS scores. Thus, chronically depressed mothers could be identified and offered a relatively cost-effective intervention. This intervention attenuated the typical delays in growth and development. Finally, although we had limited success modifying depressed mothers’ relatively flat facial and vocal expressions (Raag et al., 1997), we were able to increase their touching behavior. This, in turn, improved the mothers’ mood state and interaction behavior as well as their infants’ interaction behavior, and it was a very effective modulation of negative state during Tronick’s still-face situation (Pelaez-Nogueras, Field, Pickens, et al., 1996).

Other Effective Interventions

Natural Buffers of the Depressed Mothers’ Negative Effects (Fathers and Nursery School Caregivers). Natural buffers in the environment included nondepressed fathers or boyfriends (Hossain, Field, Pickens, & Gonzalez, 1995) and the nursery school teachers of the infants of depressed mothers (Pelaez-Nogueras, Field, Cigales, Gonzalez, & Clasky, 1995). Infants of depressed mothe...

Table of contents

• Contents
• Preface
• Part I CHILD DEVELOPMENT
• Part II BASIC ADULT PSYCHOPATHOLOGY
• Part III TREATMENT
• Author Index
• Subject Index