Anxiety

• Field, T., Diego, M., Hernandez-Reif, M., Figueiredo, B., Deeds, O., Ascencio., A., Schanberg, S. & Kuhn, C. (2010). Comorbid depression and anxiety effects on pregnancy and neonatal outcome. Infant Behavior and Development, 33, 23-29.

The comorbid group had higher scores than the other groups (depression alone and anxiety alone groups) on self-report measures of depression, anxiety, anger and daily hassles, and they had lower dopamine levels. As compared to the non-depressed group, they also reported more sleep disturbances and relationship problems. Moreover, the comorbid group also experienced a greater incidence of prematurity.


Field, T., Diego,  M., Hernandez-Reif, M., Figueiredo, B., Ezell, S., & Siblalingappa, V. (2010). Depressed mothers and infants are more relaxed during breastfeeding versus bottlefeeding interactions: brief report. Infant Behavior and Development, 33, 241-244.

Depressed and non-depressed mothers and their 3-month-old infants were videotaped during breastfeeding and bottlefeeding interactions. The breastfeeding mothers showed less burping and less intrusive behavior during the nipple-in periods as well as during the nipple-out periods. In addition, the breastfeeding mothers and their infants received better ratings on the Interaction Rating Scales.

 


Anxiety/Anger

• Field, T., Diego, M., Hernandez-Reif, M., Salman, F., Schanberg, S., Kuhn, C., Yando, R. & Bendell, D. (2002). Prenatal Anger Effects on the Fetus and Neonate. Journal of Obstetrics and Gynecology, 22, 260-266.

Women were classified as experiencing high or low anger during the second trimester of pregnancy. The high-anger women also had high scores on depression and anxiety scales. In a follow-up across pregnancy, the fetuses of the high-anger women were noted to be more active and to experience growth delays. The high anger mothers’ high prenatal cortisol and adrenaline and low dopamine and serotonin levels were mimicked by their neonates’ high cortisol and low dopamine levels. The high anger mothers and infants were also similar on their relative right frontal EEG activation and their low vagal tone. Finally, the newborns of high-anger mothers had disorganized sleep patterns (greater indeterminate sleep and more state changes) and less optimal performance on the Brazelton Neonatal Behavior Assessment Scale (orientation, motor maturity and depression).


• Field, T., Hernandez-Reif, M. & Feijo, L. (2002). Breastfeeding in depressed mother-infant dyads. Early Child Development and Care, 172, 539-545.

Depressed versus nondepressed mothers were interviewed on their breastfeeding practices and perceptions of their infants’ feeding behavior when their infants were eight-months-old. The depressed mothers less often breastfed, they stopped breastfeeding their infants significantly earlier in infancy and they scored lower on a breastfeeding confidence scale. Independent of maternal depression, mothers who breastfed rather than bottlefed their infants had higher confidence levels and rated their infants as less alert and less irritable during feedings.


• Field, T., Diego, M., Hernandez-Reif, M., Schanberg, S., Kuhn, C., Yando, R. & Bendell, D. (2003). Pregnancy anxiety and comorbid depression and anger effects on the fetus and neonate. Depression and Anxiety, 17, 140-151.


Women were classified as experiencing high or low anxiety during the second trimester of pregnancy. The high anxiety women also had high scores on depression and anger scales. In a follow-up across pregnancy, the fetuses of the high anxiety women were noted to be more active and to experience growth delays. The high anxiety mothers’ high prenatal norepinephrine and low dopamine levels were followed by their neonates having low dopamine and serotonin levels. The high anxiety mothers’ newborns also had greater relative right frontal EEG activation and lower vagal tone. Finally, the newborns of high anxiety mothers spent more time in deep sleep and less time in quiet and active alert states and showed more state changes and less optimal performance on the Brazelton Neonatal Behavior Assessment Scale (motor maturity, autonomic stability and withdrawal).


• Field, T., Diego, M., Dieter, J., Hernandez-Reif, M, Schanberg, S. Kuhn, C., Yando, R., & Bendell, D. (2004). Prenatal depression effects on the fetus and the newborn. Infant Behavior & Development, 27, 216-229.

Prenatal mood and biochemistry levels were assessed in women with and without depressive symptoms during their second trimester of pregnancy. At the neonatal period maternal and neonatal biochemistry, EEG and vagal tone levels were assessed, neonatal behavioral states were observed and the Brazelton neurobehavioral assessment was conducted. The mothers with depressive symptoms had higher prenatal cortisol levels and lower dopamine and serotonin levels. Mothers with depressive symptoms were also more likely to deliver prematurely and have low birthweight babies. The newborns of mothers with depressive symptoms had higher cortisol levels and lower dopamine and serotonin levels, thus mimicking their mothers’ prenatal levels.


• Field, T., Diego, M., Hernandez-Reif, M., Vera, Y., Gil, K., Schanberg S., Kuhn, C. & Gonzalez-Garcia, A. (2004). Prenatal maternal biochemistry predicts neonatal biochemistry. International Journal of Neuroscience, 114, 981-993.

Depressed and nondepressed mothers were recruited prenatally at an ultrasound clinic. Their urine samples were assayed for cortisol, catecholamines (norepinephrine, epinephrine, dopamine) and serotonin. Their urines were assayed again at the neonatal period, and their newborns’ urines were also assayed at that time. The depressed versus the non-depressed mothers showed significantly higher cortisol and norepinephrine and significantly lower dopamine levels across the pre- and postnatal assessments. At the postnatal assessment all levels had decreased except the serotonin levels for both groups. Regression analyses on the mothers’ postnatal biochemistry with the prenatal biochemistry entered as predictor variables showed highly significant, specific relationships between each of the catecholamines, cortisol, and serotonin. The newborns’ biochemistry (except for epinephrine) was higher than the maternal biochemistry.


• Field, T., Diego, M., Hernandez-Reif, M., Vera, Y., Gil, K., Schanberg S., Kuhn, C. & Gonzalez-Garcia, A. (2004). Prenatal predictors of maternal and newborn EEG. Infant Behavior and Development, 27, 533-536.

Mothers were recruited at a prenatal ultrasound clinic at which time they were given the CES-D for depression and the State-Trait Anxiety inventory, and their urines were assayed for cortisol, norepinephrine, epinephrine, dopamine, and serotonin. At the neonatal period the mothers were assayed on frontal EEG asymmetry. Correlations analyses revealed that the mothers’ frontal asymmetry was negatively related to prenatal depression and the frontal asymmetry of the newborn was positively correlated with the mothers’ frontal asymmetry. The neonates’ EEG frontal asymmetry was also, like the mothers’, negatively related to prenatal maternal norepinephrine and positively related to prenatal maternal serotonin.


• Diego, M., Field, T., & Hernandez-Reif, M. (2005). Prepartum, postpartum and chronic depression effects on neonatal behavior. Infant Behavior & Development, 28, 155-164.

Neonates born to mothers reporting symptoms of depression at any time point exhibited greater indeterminate sleep than neonates of non-depressed mothers. Neonates born to mothers reporting prenatal depression spent more time fussing and crying and exhibited more stress behaviors than neonates born to non-depressed mothers or neonates born to mothers exhibiting symptoms of depression only during the postpartum assessment. Moreover, neonates born to mothers exhibiting symptoms of depression both in the prepartum and postpartum assessments received lower Brazelton Neonatal Behavior Assessment scores than neonates of non-depressed mothers or neonates born to mothers who exhibited symptoms of depression only in the prepartum or postpartum assessments.


•Field, T., Diego, M., Hernandez-Reif, M., Gil, K., & Vera, Y. (2005). Prenatal maternal cortisol, fetal activity and growth. International Journal of Neuroscience, 115, 423-429.

Pregnant women were given the CES-D for depression and the State-Trait Anxiety Inventory and were asked to provide a urine sample to be assayed for cortisol, norepinephrine, epinephrine, dopamine, and serotonin. Ultrasound sessions were conducted and coded for fetal activity and estimated fetal weight. Regression analyses were then conducted with fetal activity and fetal weight as outcome variables. Gestational age entered both analyses as the first variable followed by prenatal cortisol as a predictor of fetal activity and prenatal eortisol as a predictor of estimated fetal weight.


• Field, T., Hernandez-Reif, M., Vera, Y., Gil, K., Diego, M., Bendell, D., & Yando, R. (2005). Anxiety and anger effects on depressed mother-infant spontaneous and imitative interactions. Infant Behavior and Development, 28, 1-9.

Depressed mothers with high and low anxiety were compared and depressed mothers with high and low anger were compared on their spontaneous and imitative interactions with their 3-month-old infants. The high versus low anxiety mothers spent less time smiling, showing exaggerated faces, game playing and imitating, more time moving their infants’ limbs, but equivalent amounts of time vocalizing and touching. The infants of high versus low anxiety mothers spent less time smiling and more time in distress brow and crying, but spent equivalent amounts of time on other behaviors. The high anger versus low anger mothers differed in the same ways that the high anxiety mothers differed from the low anxiety mothers. However, the infants of high versus low anger mothers differed on all behaviors (less time spent smiling, vocalizing, and showing motor activity and imitation and more time spent showing distress brow, gaze aversion and crying). During the imitation versus the spontaneous play sessions the mothers in all groups spent less time smiling, vocalizing, touching and game playing and more time showing imitative behavior. The infants also showed increased time in imitative behavior but also increased time spent crying during the imitation sessions.


• Field, T., Hernandez-Reif, M., Vera, Y., Gil, K., Diego, M., & Sanders, C. (2005). Infants of depressed mothers facing a mirror versus their mother. Infant Behavior and Development, 28, 48-53.

Behavioral responses were assessed in 3–6-month-old infants of depressed mothers placed face-to-face in front of a mirror versus in front of their mother. Infants showed more positive behavior (smiling) with their mothers versus the mirror but also showed more negative behavior (gaze aversion, distress brow and crying) during the mother condition. These differences highlight the infants’ greater affective responses (both positive and negative) to their mother versus the mirror. Equivalent amounts of vocalizing to the mother and mirror suggested that the mirror does elicit social behavior, with the infants perhaps enjoying watching themselves talk. Group differences suggested that the infants of depressed mothers showed less gaze aversion with their mothers, perhaps because their mothers were less interactive. When in front of the mirror, they vocalized more and gaze averted less than the infants of non-depressed mothers, suggesting that the mirror was particularly effective in eliciting vocalizations in infants of depressed mothers.


• Field, T., Nadel, J., Hernandez-Reif, M., Diego, M., Vera, Y., Gil, K. & Sanders, C. (2005). Depressed mothers’ infants show less negative affect during non-contingent interactions. Infant Behavior and Development, 28, 426-30.

Infants of depressed and non-depressed mothers were videotaped interacting with their mothers in the paradigm which consists of three segments including: (1) a free play, contingent interaction, (2) a non-contingent replay of the mothers’ behavior that had been videotaped during the first segment, and (3) a return to a free play, contingent interaction. As compared to infants of non-depressed mothers, infants of depressed mothers showed less negative change (less increase in frowning) in their behavior during the non-contingent replay segment.


• Field, T., Diego, M., Hernandez-Reif, M., Figueiredo, B., Deeds, O., Contogeorgos, J., Ascencio, A. (2006). Prenatal paternal depression. Infant Behavior and Development, 29, 579-583.

Prenatal depressive symptoms, anxiety, anger, and daily hassles were investigated in non-depressed pregnant women and their depressed and non-depressed partners. Depressed versus non-depressed fathers had higher depression, anxiety, and daily hassles scores.


• Field, T., Hernandez-Reif, M., Diego, M. (2006). Risk Factors and stress variables that differentiate depressed from nondepressed pregnant women. Infant Behavior and Development, 29, 169-174.

Pregnant women were recruited at prenatal clinics at around 20 weeks gestational age. They were interviewed on several demographic variables, risk factors and stress questionnaires. On average, the depressed pregnant women were younger, had lower education levels and socioeconomic status and were less often married. Fewer of the depressed women and their partners were happy when they were told they were pregnant, a greater number of the depressed women experienced a stressful situation during pregnancy, more of the depressed women were prescribed antibiotics during pregnancy, the depressed women had less optimal obstetric complications scores, and a greater percentage of them delivered prematurely.


• Field, T., Hernandez-Reif, M., & Diego, M. (2006). Stability of mood states and biochemistry across pregnancy. Infant Behavior and Development, 29, 262-267.

Pregnant women were recruited during their second trimester of pregnancy and were assessed as depressed or non-depressed. They were given a second assessment when they were approximately 32 weeks gestational age. At both assessments they were given self-report measures and provided urine samples for assays of cortisol, catecholamines (norepinephrine, epinephrine and dopamine) and serotonin. They were also given the VITAS scale for lower back pain and leg pain and a sleep disturbance scale. The stability of mood states and biochemistry across pregnancy (20 and 32 weeks) were assessed inasmuch as mood states and biochemistry have been noted to predict prematurity and low birthweight. Significant correlations were noted for all variables except serotonin. Relationships between mood states and biochemistry were also noted but only between cortisol and depression, cortisol and anxiety, and epinephrine and anxiety. Significant stability was noted between the 20-week measures and the 32-week measures including depression, anxiety, anger, and cortisol.


• Field, T., Diego, M., Hernandez-Reif, M., Figueiredo, B., Ascencio, A., Schanberg, S. & Kuhn, C. (2007). Prenatal dysthymia versus major depression effects on maternal cortisol and fetal growth. Depression and Anxiety, 25, 1-6.

The major depression group had more self- reported symptoms, although the dysthymia group had higher prenatal cortisol levels and lower fetal growth measurements as measured on their first ultrasound. Thus, depressed pregnant women with dysthymia and major depression appear to have different prenatal symptoms.


• Field, T., Hernandez-Reif, M., Diego, M., Feijo, L., Gil, K. and Sanders, C. (2007). Responses to animate and inanimate faces by infants of depressed mothers. Early Child Development and Care, 177, 533-539.

Forty infants (mean age 5 months) of depressed mothers and non-depressed mothers were seated in an infant seat and were exposed to four different degrees of animation, including a still-face Raggedy Ann doll (about two-feet tall suspended in front of the infant), the same doll in an animated state talking and head-nodding, an imitative mother and a spontaneously interacting mother (the more animate mother condition). The infants spent more time looking at the doll, but they smiled and laughed more at the mother. The infants of depressed versus non-depressed mothers showed less laughing and more fussing when their mothers were spontaneously interacting, but showed more laughing and less fussing during the mother imitation condition. Paradoxically, the infants of non-depressed mothers were negatively affected by the imitation condition, showing less smiling and laughing and more fussing than they had during the spontaneous interactions.


• Field, T., Hernandez-Reif, M., Diego, M., Feijo, L., Vera, Y., Gil, K. and Sanders, C. (2007). Still-face and separation effects on depressed mother-infant interactions. Infant Mental Health Journal, 28, 314-323.

Maternal emotional and physical unavailability have differential effects on infant interaction behavior as noted in a study by Field, Vega-Lahr, Scafidi, and Goldstein (1986). In that study, four-month-old infants experienced their mother's still face and a brief separation from the mother. Spontaneous interactions preceded and followed these to serve as baseline and reunion episodes. Although the infants became more negative and agitated during both conditions, the still face elicited more stressful behaviors. The present study replicated the Field et al. (1986) study but also compared infants of depressed and infants of non-depressed mothers. The infants of depressed versus those of non-depressed mothers were less interactive during the spontaneous interactions, as were their mothers, and they showed less distress behaviors during the still-face condition. During the return to spontaneous interaction following the still-face condition, they were also less interactive, as evidenced by fewer positive as well as fewer negative behaviors. Their mothers were also less active. The non-depressed mothers and infants were extremely active, as if trying to reinstate the initial spontaneous interaction. Minimal change occurred during the separation condition except that both groups of infants vocalized less than they had during the spontaneous interaction. During the reunion following the separation period, the infants of depressed versus non-depressed mothers were paradoxically more active, although their mothers continued to be less interactive.


• Field, T., Yando, S., Bendell, D., Hernandez-Reif, M., Diego, M., Vera, Y., & Gil, K. (2007). Prenatal depression effects on pregnancy feelings and substance use. Journal of Child & Adolescent Substance Abuse, 17, 111-125.

Depressed and nondepressed mothers were given a set of self-report measures, including the CES-D (depression), the STAI (anxiety), the STAXI (anger), the Perinatal Anxieties and Attitudes Scale, a questionnaire on substance use and the Feelings About Pregnancy and Delivery Scale that includes scales on coping, support, intimacy, common knowledge of depression, and cultural effects on pregnancy. During the neonatal period, the depressed mothers scored higher on the depression, anger, and anxiety scales as well as the Perinatal Anxieties and Attitudes Scale. They also reported using more substances including cigarettes, caffeine, and medications (primarily antibiotics). Their scores on the Feelings About Pregnancy and Delivery Scale were lower including the coping, support, intimacy, and cultural effects scores. In addition, they reported having more stressful situations during pregnancy, being less happy when finding out they were pregnant and their significant other being less happy when finding out about the pregnancy.


Pelaez, M., Field et al. (2007). Disengaged and authoritarian parenting behavior of depressed mothers with their toddlers. Infant Behavior and Development, 31, 145-148.

Mothers with depressive symptoms were classified as authoritarian a greater percentage of the time and disengaged a greater percentage of the time than non-depressed mothers. The non-depressed mothers were classified as permissive a greater percentage of time than the group of mothers with depressive symptoms. The groups did not differ on time spent showing authoritative behaviors. The toddlers of mothers with depressive symptoms followed their mothers’ instructions for a lesser percent of time, and they displayed aggressive play behavior for a greater percentage of time than the toddlers of non-depressed mothers.


• Diego, M., Field, T., Hernandez-Reif, M., Vera, Y., & Gil, K. (2008). Caffeine use affects pregnancy outcome. Journal of Child and Adolescent Substance Abuse, 17, 41-49.

Women were interviewed during pregnancy on their depression and anxiety symptoms, substance use and demographic variables. A subsample was seen again at the neonatal stage, and their infants were observed for sleep-wake behavior. Symptoms of depression and anxiety were related to caffeine use. Women who consumed more caffeine also smoked more, were younger, were less educated, reported less sleep effectiveness and more obstetric complications. Their newborns were lower birthweight, they spent less time in REM sleep, and they showed more stress behaviors including hiccups, tremors and jerkiness.


• Field, T. (2008). Prematurity and Potential Predictors. International Journal of Neuroscience, 118, 277 - 289.

Prematurity continues to be the leading cause of neonatal death and developmental disability, highlighting the importance of identifying potential predictors of prematurity as well as interventions that can be linked to the predictors. This review covers recent research on potential psychological, physiological, and biochemical predictors. Among the psychological stressors are depression, anxiety, difficult relationships, and lack of social support. Biochemical predictors include corticotrophin releasing hormone, cortisol, and fetal fibronectin. A program of research that links an intervention for prematurity with a predictor for prematurity, that is, massage therapy to reduce cortisol and, in turn, reduce prematurity, is then presented.


• Field, T., Diego, M., Hernandez-Reif, M., Deeds, O., Holder, V., Schanberg, S. & Kuhn, C. (2008). Depressed Pregnant Black Women Have a Greater Incidence of Prematurity and Low Birthweight Outcomes. Infant Behavior and Development, 32, 10-16.

Pregnant black depressed women were compared to pregnant black non-depressed women on self-report stress measures and cortisol levels at mid and late pregnancy and on neonatal outcomes. The depressed women had higher anxiety, anger, daily hassles and sleep disturbance scores and a greater increase in cortisol levels across pregnancy. These higher stress levels may have contributed to the greater incidence of prematurity and low birthweight neonatal outcomes noted in the depressed group, and they may partially explain the higher rate of prematurity and low birthweight among black women.


• Field, T., Diego, M., Hernandez-Reif, M., Figueiredo, B., Deeds, O., Ascencio, A., Schanberg, S. and Kuhn, C. (2008). Prenatal dopamine and neonatal behavior and biochemistry. Infant Behavior and Development, 31, 590-593.

Depressed pregnant women (N=126) were divided into high and low prenatal maternal dopamine (HVA) groups based on a tertile split on their dopamine levels at 20 weeks gestation. The high versus the low dopamine group had lower Center for Epidemiological Studies-Depression Scale (CES-D) scores, higher norepinephrine levels at the 20-week gestational age visit and higher dopamine and serotonin levels at both the 20- and the 32-week gestational age visits. The neonates of the mothers with high versus low prenatal dopamine levels also had higher dopamine and serotonin levels as well as lower cortisol levels. Finally, the neonates in the high dopamine group had better autonomic stability and excitability scores on the Brazelton Neonatal Behavior Assessment Scale. Thus, prenatal maternal dopamine levels appear to be negatively related to prenatal depression scores and positively related to neonatal dopamine and behavior regulation, although these effects are confounded by elevated serotonin levels.


• Field, T., Diego, M., Hernandez-Reif, M., Figueiredo, B., Schanberg, S., Kuhn, C., Deeds, O., Contogeorgos, J., Ascencio, A. (2008). Chronic Prenatal Depression and Neonatal Outcome. International Journal of Neuroscience, 118, 95-103.

Pregnant women were recruited at approximately 22 weeks gestation at prenatal clinics. Of these, 20% were diagnosed as depressed. The women were seen again at approximately 32 weeks gestation and after delivery. Chronicity of depression was evidenced by continuing high depression scores in those women diagnosed as depressed. Comorbid problems were chronically high anxiety, anger, sleep disturbance, and pain. Less optimal outcomes for the depressed women included lower gestational age and lower birthweight of their newborns.


• Field, T., Diego, M. and Hernandez-Reif, M. (2008). Prenatal dysthymia versus major depression effects on the neonate. Infant Behavior and Development, 31, 190-193.

Depressed pregnant women were classified as dysthymic or major depression disorder based on the Structured Clinical Interview for Depression and followed to the newborn period. The newborns of dysthymic versus major depression disorder mothers had a significantly shorter gestational age, a lower birthweight, shorter birth length and less optimal obstetric complications scores. The neonates of dysthymic mothers also had lower orientation and motor scores and more depressive symptoms on the Brazelton Neonatal Behavior Assessment Scale. These findings were not surprising given the elevated cortisol levels and the inferior fetal measures including lower fetal weight, fetal length, femur length and abdominal circumference noted in our earlier study on fetuses of dysthymic pregnant women.


• Field, T., Diego, M. A., Hernandez-Reif, M., Figueiredo, B., Ascencio, A., Schanberg, S. and Kuhn, C. (2008). Prenatal dysthymia versus major depression effects on maternal cortisol and fetal growth. Depression and anxiety, 25, 11-16.

To determine differences between pregnant women diagnosed with Dysthymia versus Major Depression, depressed pregnant women (N=102) were divided by their diagnosis into Dysthymic (N=48) and Major Depression (N=54) groups and compared on self-report measures (depression, anxiety, anger, daily hassles and behavioral inhibition), on stress hormone levels (cortisol and norepinephrine), and on fetal measurements. The Major Depression group had more self-reported symptoms. However, the Dysthymic group had higher prenatal cortisol levels and lower fetal growth measurements (estimated weight, femur length, abdominal circumference) as measured at their first ultrasound (M=18 weeks gestation). Thus, depressed pregnant women with Dysthymia and Major Depression appeared to have different prenatal symptoms.


• Diego, M. A., Field, T., Hernandez-Reif, M., Schanberg, S., Kuhn, C. and Gonzalez-Quintero, V. H. (2009). Prenatal depression restricts fetal growth. Early Human Development, 85, 65-70.

Midgestation (18-20 weeks GA) estimated fetal weight and urine cortisol and birthweight and gestational age at birth data were collected on a sample of 40 depressed and 40 non-depressed women. Estimated fetal weight and birthweight data were then used to compute fetal growth rates. Depressed women had a 13% greater incidence of premature delivery and 15% greater incidence of low birthweight than non-depressed women. Depressed women also had elevated prenatal cortisol levels and fetuses who were smaller and who showed slower fetal growth rates and lower birthweights. Mediation analyses further revealed that prenatal maternal cortisol levels were a potential mediator for the relationship between maternal symptoms of depression and both gestational age at birth and the rate of fetal growth. After controlling for maternal demographic variables, prenatal maternal cortisol levels were associated with 30% of the variance in gestational age at birth and 14% of the variance in the rate of fetal growth.


• Field, T., Diego, M. and Hernandez-Reif, M. (2009). Depressed mothers' infants are less responsive to faces and voices. Infant Behavior and Development, 32, 239-244.

A review of our recent research suggests that infants of depressed mothers appeared to be less responsive to faces and voices as early as the neonatal period. At that time they have shown less orienting to the live face/voice stimulus of the Brazelton scale examiner and to their own and other infants' cry sounds. This lesser responsiveness has been attributed to higher arousal, less attentiveness and less "empathy." Their delayed heart rate decelerations to instrumental and vocal music sounds have also been ascribed to their delayed attention and/or slower processing. Later at 3-6 months they showed less negative responding to their mothers' non-contingent and still-face behavior, suggesting that they were more accustomed to this behavior in their mothers. The less responsive behavior of the depressed mothers was further compounded by their comorbid mood states of anger and anxiety and their difficult interaction styles including withdrawn or intrusive interaction styles and their later authoritarian parenting style. Pregnancy massage was effectively used to reduce prenatal depression and facilitate more optimal neonatal behavior. Interaction coaching was used during the postnatal period to help these dyads with their interactions and ultimately facilitate the infants' development.


• Field, T., Diego, M., Hernandez-Reif, M. and Ascencio, A. (2009). Prenatal dysthymia versus major depression effects on early mother-infant interactions: a brief report. Infant Behavior and Development, 32,129-131.

Maternal dysthymia and major depression effects on mother-infant interactions were assessed when the infants were 3-months-old. The dysthymia group mothers spent less time smiling, touching and imitating their infants and more time moving their infants' limbs. The infants of the dysthymia group mothers spent less time smiling and more time showing distress behaviors.


Moszkowski, R. J., Stack, D. M., Girouard, N., Field, T. M., Hernandez-Reif, M. and Diego, M. (2009). Touching behaviors of infants of depressed mothers during normal and perturbed interactions.  Infant Behavior and Development, 32, 183-194.

The present study investigated the touching behaviors of 4-month-old infants of depressed and non-depressed mothers during the still-face (SF; maternal emotional unavailability) and separation (SP; maternal physical unavailability) procedures. Forty-one dyads participated in the present study. Dyads were from low SES backgrounds, and they exhibited poor relationship qualities (e.g. poor maternal sensitivity, low infant responsiveness). Thus, they were considered at-risk. Results indicated that infants exhibited more patting and pulling when mothers were unavailable during the SF and SP procedures. Moreover, depression affected infants' tactile behaviors: infants of depressed mothers used more reactive types of touch (i.e. active touching behaviors, such as grab, pat, pull) than infants of non-depressed mothers during emotional and physical unavailability, suggesting greater activity levels in infants of depressed mothers. Negative relationship indicators, such as maternal intrusiveness and hostility, predicted soothing/regulatory (i.e. nurturing) and reactive/regulatory types of touch, even after controlling for maternal depression. Taken together, these results underscore the importance of touch for infant communication and regulation during early social interactions.


Cortisol

• Field, T., Hernandez-Reif, M., & Diego, M. (2006). Stability of mood states and biochemistry across pregnancy. Infant Behavior and Development, 29, 262-267.

Relationships were noted between cortisol and depression, cortisol and anxiety, and epinephrine and anxiety. Stability was noted between the 20-week and 32-week measures including depression, anxiety, anger, and cortisol. These were, in turn, correlated with each other and with low back pain, leg pain, and sleep disturbance.


• Field, T., Hernandez-Reif, M., Diego, M., Figueiredo, B., Schanberg, S., & Kuhn, C. (2006). Prenatal cortisol, prematurity and low birthweight. Infant Behavior and Development, 29, 268-275.

In comparison to the low cortisol group of depressed pregnant women, the high cortisol group of depressed pregnant women had higher CES-D depression scores and higher inhibition scores prenatally. Their fetuses had smaller head circumference, abdominal circumference, biparietal diameter, and fetal weight. Also, their neonates were shorter in gestational age and lower birthweight and they had lower Brazelton habituation and higher Brazelton reflex scores.


• Field, T. & Diego, M. (2008) Cortisol: The culprit prenatal stress variable. International Journal of Neuroscience, 118, 1181-1205.

Elevated prenatal cortisol has been associated with several negative conditions including aborted fetuses, excessive fetal activity, delayed fetal growth and development, prematurity and low birthweight, attention and temperament problems in infancy, externalizing problems in childhood, and psychopathology and chronic illness in adulthood.


Demographics

• Field, T., Hernandez-Reif, M., Diego, M. (2006). Risk factors and stress variables that differentiate depressed from nondepressed pregnant women. Infant Behavior and Development, 29, 169-174.

On average, the depressed pregnant women were younger, had lower education levels and socioeconomic status and were less often married. Some stress variables and risk factors depressed mothers experienced included a greater number of stressful situations during pregnancy, more prescriptions for antibiotics, less optimal obstetric complication scores, and a greater incidence of premature delivery.


• Field, T., Diego, M., Hernandez-Reif, M., Deeds, O., Holder, V., Schanberg, S. and Kuhn, C. (2009). Depressed pregnant black women have a greater incidence of prematurity and low birthweight outcomes. Infant Behavior and Development, 32, 10-16.

Pregnant black depressed women were compared to pregnant black non-depressed women on self-report stress measures and cortisol levels at mid and late pregnancy and on neonatal outcomes. The depressed women had higher anxiety, anger, daily hassles, sleep disturbance scores and cortisol levels at both prenatal visits. These higher stress levels may have contributed to the greater incidence of prematurity and low birthweight neonatal outcomes noted in the depressed group, and they may partially explain the higher rate of prematurity and low birthweight among black women.


EEG

• Field, T., Fox, N., Pickens, J., & Nawrocki, T. (1995). Relative right frontal EEG activation in 3- to 6-month-old infants of "depressed" mothers. Developmental Psychology, 31, 358-363.

A greater number of depressed mothers and their infants versus nondepressed mothers and their infants displayed right frontal EEG asymmetry. These data indicate that the depressed affect exhibited by infants of depressed mothers is associated with a brain electrical activity pattern similar to that found in inhibited infants and children and in chronically depressed adults.


• Jones, N.A., Field, T., Davalos, M. & Pickens, J. (1997). EEG stability in infants/children of depressed mothers. Child Psychiatry and Human Development, 28, 59-70.

The stability of EEG was examined in infants of depressed and non-depressed mothers from 3 months to 3 years. Of the 32 infants seen at 3 months, 15 were seen again at 3 years of age. Seven of the eight children who had exhibited right frontal EEG asymmetry as infants still showed that EEG asymmetry pattern at the 3 year visit. Children with right frontal EEG asymmetry at 3 years were observed to be more inhibited during an exploratory play task, and children of depressed versus non-depressed mothers were less empathetic during simulated maternal distress.


• Jones, N.A., Field, T., Fox, N.A., Davalos, M., Malphurs, J., Carraway, K., Schanberg, S., & Kuhn, C. (1997). Infants of intrusive and withdrawn mothers. Infant Behavior and Development, 20, 177-189.

Two styles of mother-infant interactions have been observed in depressed mothers, including an intrusive style (overstimulating behavior) and a withdrawn style (understimulating behavior). To examine how these styles affect infants, we assessed infants and their mothers who had been assigned to intrusive or withdrawn profiles based on their face-to-face interaction behaviors with their 3-month-old infants. The results indicated that infants of withdrawn mothers showed less optimal interaction behavior, greater relative right frontal EEG asymmetry (due to decreased left frontal EEG activation and increased right frontal EEG activation), and lower Bayley Mental Scale scores at 1 year. Infants of intrusive mothers had higher catecholamine and dopamine levels, and their EEG patterns showed greater relative left frontal EEG asymmetry (due to increased left frontal EEG activation and decreased right frontal EEG activation).


• Jones, N., Field, T., Fox, N.A., Lundy, B., & Davalos, M. (1997). EEG activation in one-month-old infants of depressed mothers. Development & Psychopathology, 9, 491-505.

In the present study, EEG was recorded in 1-month-old infants of depressed and non-depressed mothers. The infants of depressed mothers exhibited greater relative right frontal EEG asymmetry (due to reduced left frontal activation), and this pattern at 1 month was significantly related to 3-month EEG asymmetry. Right frontal EEG asymmetry was also related to more frequent negative facial expressions (sad and pre-cry faces) during the Brazelton exam. Finally, the infants of depressed mothers showed more indeterminate sleep, were less active and cried less than infants of non-depressed mothers.


• Jones, N.A., Field, T., Fox, N.A., Davalos, M., Lundy, B., & Hart, S. (1998). Newborns of mothers with depressive symptoms are physiologically less developed. Infant Behavior and Development, 21, 537-541.

Infants of mothers with depressive symptoms were compared on physiology and behavior to infants of nonsymptomatic mothers. The newborns of depressed mothers had greater relative right frontal EEG asymmetry (due to reduced left hemisphere activation), lower vagal tone, and less optimal scores on the Brazelton, suggesting that maternal depression symptoms during pregnancy may be contributing to newborn neurobehavioral functioning.


• Jones, N., Field, T., & Davalos, M. (2000). Right frontal EEG asymmetry and lack of empathy in preschool children of depressed mothers. Child Psychiatry and Human Development, 30, 189-204.

EEG activity, empathic reactions to emotion-inducing stimuli, and the ability to complete a teaching task were examined in preschool children of depressed and non-depressed mothers. EEG activity from frontal and parietal regions was recorded. The children of depressed mothers had greater relative right frontal EEG asymmetry, a pattern that typically accompanies greater negative affect, and showed less empathic responses to a crying infant as well as to their own mothers’ simulated distress. Children of depressed mothers were slower in completing the teaching task (involving mutual cooperation with their mother), and they spent more time asking for help than children of non-depressed mothers. Further, the depressed mothers stated their approval less often and spent less time helping their children complete the task.


• Diego, M.A., Field T. & Hernandez-Reif, M. (2001). BIS / BAS scores are correlated with frontal EEG asymmetry in intrusive and withdrawn depressed mothers. Infant Mental Health Journal, 22, 665-675.

Differences between different style-depressed mothers, intrusive and withdrawn, were examined by the use of the Behavioral Inhibition and Activation Scales ( BIS / BAS ) and EEG activity from the mid-frontal and parietal regions. Withdrawn mothers had left frontal EEG hypoactivation, higher Behavior Inhibition ( BIS ), and lower Behavior Activation ( BAS ) scores than the intrusive mothers.


• Diego, M.A., Field T. & Hernandez-Reif, M. (2001). CES-D depression scores are correlated with frontal alpha asymmetry. Depression and Anxiety, 13, 32-37.

In order to evaluate the relationship between frontal EEG asymmetry and depressive symptomology, the Center for Epidemiological Studies Depression scale [CES-D] was given to women, and their EEG was recorded from the mid frontal and parietal regions during a 3 min baseline recording. As expected from previous research on depression, CES-D scores were negatively correlated with frontal EEG alpha asymmetry scores and positively correlated with left frontal EEG alpha power.


• Jones, N.A., Field, T., Fox, N.A., Davalos, M. & Gomez, J. (2001). EEG during different emotions in 10-month-old infants of depressed mothers. Journal of Reproductive and Infant Psychology, 19,, 295-312.

EEG activity of 10-month-old infants of depressed and non-depressed mothers was compared during stimuli designed to produce happy and sad responses. During a baseline recording and during their happy facial expressions, infants of depressed mothers showed greater relative right frontal EEG asymmetry compared to infants of non-depressed mothers.


• Diego, M.A., Field, T., Hart, S., Hernandez-Reif, M., Jones, N., Cullen, C., Schanberg, S., & Kuhn, C. (2002). Facial expressions and EEG in infants of intrusive and withdrawn mothers with depressive symptoms. Depression and Anxiety, 15, 10-17.

When intrusive and withdrawn mothers with depressive symptoms modeled happy, surprised, and sad expressions, their 3-month-old infants did not differentially respond to these expressions or show EEG changes. When a stranger modeled these expressions, the infants of intrusive vs. withdrawn mothers looked more at the surprised and sad expressions and showed greater relative right frontal EEG activity in response to the surprise and sad expressions as compared to the happy expressions. These findings suggest that the infants of intrusive mothers with depressive symptoms showed more differential responding to the facial expressions than the infants of withdrawn mothers. In addition, the infants of intrusive vs. infants of withdrawn mothers showed increased saliva cortisol following the interactions, suggesting that they were more stressed by the interactions.


• Field, T., Diego, M., Hernandez-Reif, M., Schanberg, S. & Kuhn, C. (2002). Relative Right Versus Left Frontal EEG in neonates. Developmental Psychobiology, 41,147-155 .

Although infants have been noted to have greater relative right or left frontal EEG as early as the neonatal period, other ways in which these newborns differ have not been reported. In this study, 48 newborns were divided on the basis of greater relative right versus greater relative left frontal EEG to determine whether these groups differed in other ways at the neonatal period including behavior, physiology, and biochemistry. We also were interested in whether these EEG patterns were related to any prenatal maternal variables including mood states (depression, anxiety, anger) and biochemistry as well as fetal activity. The greater relative right frontal EEG newborns had mothers with lower prenatal and postnatal serotonin and higher postnatal cortisol levels. The mothers of the greater relative right frontal EEG newborns also had greater relative right frontal EEG activation and lower vagal tone. The greater relative right frontal EEG newborns themselves had elevated cortisol levels, showed a greater number of state changes during sleep/ wake behavior observations, and performed less optimally on the Brazelton Neonatal Behavior Assessment including the habituation, motor, range of state, excitability, and depressive symptoms scales. These data suggest that greater relative right frontal EEG newborns may be at greater risk for developmental problems than those with greater relative left frontal EEG activation. In addition, a discriminant function analysis correctly classified 67% of the newborns' EEGs by prenatal maternal variables, suggesting that these might be used to target pregnant women for prenatal intervention.


• Field, T., Diego, M., Hernandez-Reif M., Schanberg, S., & Kuhn, C. (2002). Right Frontal EEG and Pregnancy/Neonatal Outcomes. Psychiatry, 65, 35-47.

Pregnant women that were recruited during their second trimester were given EEGs and divided into greater relative right and left frontal EEG activation groups. The greater relative right frontal EEG women had lower dopamine levels during their second trimester and lower dopamine and higher cortisol levels during the neonatal period. The newborns of the right frontal EEG mothers also showed greater relative right frontal EEG, had lower dopamine and serotonin levels, spent more time in indeterminate sleep and had inferior Brazelton scores.

• Diego, M., Field, T., Jones, N.A., & Hernandez-Reif, M. (2006). Withdrawn and intrusive maternal interaction style and infant frontal EEG symmetry shifts in infants of depressed and non depressed mothers. Infant Behavior and Development, 29, 220-229.

Infants of depressed mothers exhibited greater relative right frontal EEG activation than infants of non-depressed mothers. Infants of depressed withdrawn mothers exhibited greater relative right frontal EEG activation than infants of depressed intrusive mothers.


• Diego, M., Jones, N., Field, T. & Hernandez-Reif, M. (In Review). Frontal EEG Asymmetry Gender Differences in Infants of Depressed and Non-Depressed Mothers. Developmental Psychobiology.

Gender differences in resting frontal EEG asymmetry patterns were examined in infants of depressed and nondepressed mothers. Distinct frontal EEG asymmetry pattern differences were noted in male and female infants as a function of their being born to depressed or nondepressed mothers. Female infants of depressed mothers exhibited greater relative right frontal EEG asymmetry than infants of nondepressed mothers. Male infants of depressed and nondepressed mothers did not exhibit any frontal EEG asymmetry differences.


• Diego, M. A., Jones, N. A. and Field, T. (2010). EEG in 1-week, 1-month and 3-month-old infants of depressed and non-depressed mothers. Biological psychology, 83, 7-14.

EEGs were examined in data collected from 348 1-week, 1-month and 3-month-old infants of depressed and non-depressed mothers across several studies. Both the percentage of infants exhibiting spectral peaks and the frequency in Hz at which those peaks were exhibited increased with age. Consistent with previous studies, infants of depressed mothers exhibited greater left frontal EEG power, suggesting greater relative right frontal EEG activity than infants of non-depressed mothers. This profile was apparent across a narrow frequency range, which shifted from 3-9Hz at 1 week of age to 4-9Hz by 3 months of age.


• Jones, N. A., Field, T. and Almeida, A. (2009). Right frontal EEG asymmetry and behavioral inhibition in infants of depressed mothers. Infant Behavior and Development, 32, 298-304.

Recent studies have shown associations between maternal psychopathology and inhibited behaviors in infants. Moreover, physiological factors have been identified as affecting the continuity of behavioral inhibition across childhood. The purpose of the present study was to examine electroencephalogram (EEG) activity and inhibited behavior in 12-month-old infants of depressed versus non-depressed and mothers. Repeated measures MANOVAs indicated that the infants of mothers with stable psychopathology had greater relative right frontal EEG asymmetry, a pattern that typically accompanies greater negative affect and greater withdrawal behaviors. Infants of affectively ill mothers also showed more proximal behaviors toward a stranger and a novel toy than infants of well mothers, but fewer non-proximal behaviors toward their mothers. These results are discussed within a framework of behavioral inhibition for infants exposed to early psychopathologies in their mothers.


Father-Infant Interactions

• Field, T., Hossain, Z. & Malphurs, J. (1999). Depressed fathers’ interactions with their infants. Infant Mental Health Journal, 20, 322-332.

Four groups of depressed (depressive symptoms) and non-depressed fathers and mothers were compared during interactions with their 3- to 6-month-old infants to determine how depressed versus non-depressed fathers interacted with their infants and how their interactions compared with depressed mothers interacting with their infants. Depressed and non-depressed fathers received similar ratings and depressed fathers received higher interaction ratings than depressed mothers. Although depressed fathers did not seem to behave negatively with their infants, their non-depressed partners showed less optimal interaction behaviors with their infants.


Hossain, Z., Field, T., Gonzalez, J., Malphurs, J.,DelValle, C., & Pickens, J. (1994). Infants of depressed mothers interact better with their non depressed fathers. Infant Mental Health Journal, 15, 348-357.

To determine whether infants of depressed mothers interact better with their non-depressed fathers, twenty-six 3- to 6-month-old infants were videotaped during face-to-face interactions with their parents. The depressed mother group consisted of twelve 3- to 6-month-old infants and their depressed mothers and non-depressed fathers. The control group was composed of 14 non-depressed mothers and non-depressed fathers and their 3- to 6-month-old infants. In the depressed mother group, the non-depressed fathers received better interaction ratings than the depressed mothers. In turn, the infants received better interaction ratings when they interacted with their non-depressed fathers than with their depressed mothers. In contrast, non-depressed fathers and mothers and their infants in the control group did not differ on any of their interaction ratings. These findings suggest that infants' difficult interaction behaviors noted during interactions with their depressed mothers may not extend to their non-depressed fathers. The data are discussed with respect to the notion that non-depressed fathers may buffer the effects of maternal depression on infant interaction behavior.


Pelaez-Nogueras, M., Field, T., Cigales, M., Gonzalez, A., & Clasky, S. (1994). Infants of depressed mothers show less "depressed" behavior with their nursery teachers. Infant Mental Health Journal, 15, 358-367.

The infants’ behavior ratings improved when they interacted with their familiar teachers compared to their interactions with their depressed mothers. The infants’ low activity level and negative affect were specific to their interactions with their depressed mothers.


Prodromidis, M., Abrams, S., Field, T., Scafidi, F., Rahdert, E.R. (1994). Psychosocial stressors among depressed adolescent mothers. Adolescence, 29, 331-343.

The study sought to determine whether depressed adolescent mothers experience more psychosocial stressors than do nondepressed mothers and which stressors best predict maternal depression. Depressed mothers consistently reported more problems in most areas of psychosocial functioning. Data suggest the best predictors for maternal depression were mental health status, family relations, and social skills.


Fathers' Perceptions of their infants’ behavior

• Hart, S., Field, T., Stern, M., & Jones, N. (1997). Depressed fathers’ stereotyping of infants labeled depressed. Infant Mental Health Journal, 18, 436-445.

This study investigated whether depressed and non-depressed fathers stereotyped infants labeled depressed and how they viewed their own infants. Fathers rated depressed versus normal infants lower on sociability and cognitive competence. Depressed versus non-depressed fathers rated depressed infants lower on social behavior, potency, and sociability. Depressed fathers rated their own infants lower on social behavior, potency and cognitive competence as well as being more vulnerable.


Mother Infant Interactions

• Field, T., Healy, B., Goldstein, S., Perry, S., Bendell, D., Schanberg, S., Zimmerman, E. A., & Kuhn, C. (1988). Infants of depressed mothers show "depressed" behavior even with non-depressed adults. Child Development, 59, 1569-1579.

Depressed mothers and their infants received lower ratings on all behaviors than non-depressed mothers and their infants. Although the infants of depressed versus non- depressed mothers also received lower ratings with the stranger adult, very few differences were noted between those infants-ratings when interacting with their mother versus the stranger, suggesting that their depressed style of interacting is not specific to their interactions with depressed mothers but generalizes to their interactions with non- depressed adults as early as 3 months of age.


• Lowenstein, M., & Field, T. (1990). Maternal depression effects on infants. Devenir, 12, 52-65.

This review supports the theory that infants develop different interaction styles depending on their mother's affect. If the mother is affectively unavailable, the infant must find ways to self-regulate which may unsuccessfully result in distress and depressed affect. The literature also suggests that a depressed maternal style is much more distressing to infants than physical unavailability.


• Field, T., Morrow, C., Healy, B., Foster, T., Palestine, D. & Goldstein, S. (1991). Mothers with zero beck depression scores act more "depressed" with their infants. Development and Psychopathology, 3, 253-262.

Mothers who scored zero on the Beck Depression Inventory were compared to depressed mothers and non-depressed mothers during face-to-face interactions with their 5-month-old infants. The zero Beck mothers and their infants received lower ratings and were in less positive behavior states (alone or together) than the high scoring Beck depressed mother/infant dyads even more frequently than the non-depressed mother/infant dyads. The lower activity levels, less expressivity, and less frequent vocalizing were suggestive of depressed behavior in both the mothers and their infants. The infants of the zero Beck mothers had lower vagal tone and lower growth percentiles than the infants of non- depressed mothers.


• Pickens, J.N. & Field, T. (1993). Facial expressivity in infants of "depressed" mothers. Developmental Psychology, 29, 986-988.

Infants of both depressed and low-scoring mothers showed significantly more sadness and anger expressions than infants of non-depressed mothers.


• Field, T. (1994). The effects of mother's physical and emotional unavailability on emotion regulation. Monographs of the Society for Research in Child Development, 59, 208-227.

Emotion dysregulation can develop from brief or more prolonged separations from the mother as well as the more disturbing effects of her emotional unavailability, such as occurs when she is depressed. Emotional unavailability was investigated through two laboratory situations; the still face paradigm and the momentary leave-taking. The still face had more negative effects on the infants-interaction behaviors than the physical separation. The most extreme form of emotional unavailability, mothers’ depression, had the most negative effects. Changes in physiology, play behavior, affect, activity level, sleep organization, and regulating functions, such as eating, persist for the duration of the mothers depression.


Mothers’ perceptions of their infants

• Field, T., Morrow, C. & Adlestein, D. (1993). Depressed mothers' perceptions of infant behavior. Infant Behavior and Development, 16, 99-108.

Black mothers with high and low Beck Depression Inventory scores were videotaped interacting with their infants. To determine whether the mothers with depressive symptoms perceived their infants’ behavior more negatively, both the mothers and trained observers (naive to group assignment) coded the videotapes. Both the mothers and the observers coded the infants of symptomatic mothers more negatively. However, the symptomatic mothers coded their infants; behavior even more negatively than the observers did. In contrast, they coded their own behavior more positively than the observers did. Both groups of mothers underestimated their own negative behavior.


• Field, T., Estroff, D., Yando, R., del Valle, C., Malphurs,J., & Hart, S. (1996). "Depressed" mothers' perceptions of infant vulnerability are related to later development. Child Psychiatry and Human Development, 27, 43-53.

Depressed mothers assigned greater vulnerability scores to their infants, and their infants engaged in less exploratory play and had lower Bayley mental and motor scores. The depressed mothers’ vulnerability scores at 3 months were related to less exploratory play in their infants as well as lower Bayley mental scores at 12 months.


• Martinez, A., Field, T., Pickens, J.N., Raag, T., Yando, R., Bendell, D., & Blaney, P. (1996). Mothers' perceptions of infants labeled depressed. Early Development and Parenting, 5, 15-22.


Depressed and non-depressed mothers participated in a videotaped interaction with their own infant and then rated the videotape using the Infant Stereotyping Scale and the Interaction Rating Scale. In addition, one half of the mothers rated another videotape of an unfamiliar infant who was labeled psychologically depressed, and the other half rated a videotape of the same infant with no label given. Both the depressed and non-depressed mothers rated the depressed labeled infant more negatively than the non-labeled infant on the attributes of physical potency, cognitive competence, sociability, and difficult behavior. Physical appearance was the only rating that wasn’t biased by the depressed label. Mothers’ ratings of their own infants were more positive than the ratings of the non-labeled stimulus infant. Depressed mothers did not see their infants more negatively except on one rating. They rated the physical appearance of their own infant more negatively than non-depressed mothers.


• Jones, N.A., Field, T., Hart, S., Lundy, B., & Davalos, M. (2001). Maternal self-perceptions and reactions to infant crying among intrusive and withdrawn depressed mothers. Infant Mental Health Journal, 22, 576-586.

This study compared intrusive and withdrawn mothers’ ratings of their own interaction styles with their infants and the behaviors of videotaped models of intrusive and withdrawn mothers. Withdrawn mothers rated themselves as less withdrawn than the model withdrawn mother. Intrusive mothers viewed themselves as more intrusive than the model intrusive mother. Both groups viewed their own infants as more outgoing than the infants of the model intrusive and withdrawn mothers. The withdrawn mothers reported feeling more distressed when they observed an infant (of an intrusive or withdrawn mother) crying, suggesting that they felt more empathy than the intrusive mothers.


Neonatal Behavior

• Abrams, S.M., Field, T., Scafidi, F. & Prodromidis, M. (1995). Newborns of depressed mothers. Infant Mental Health Journal, 16, 233-239.

Infants of depressed mothers demonstrated poorer performance on the orientation cluster of the Brazelton Neonatal Assessment scale; revealing inferior orientation to the inanimate stimuli. Infants of depressed mothers also showed less motor tone and activity and more irritability and less robustness and endurance during the examination.


• Hart, S., Field, T., & Roitfarb, M. (1999). Depressed mothers’ assessments of their neonates’ behaviors. Infant Mental Health Journal, 20, 200-210.

Neonates were assessed at delivery and again at 1 month by examiners and by their depressed or non-depressed mothers. Examiners rated neonates of depressed mothers lower than neonates of non-depressed mothers on state organization. At delivery, newborn infants of depressed mothers were given lower state regulation scores by their mothers than by the examiners and, 1 month later, examiners state regulation ratings were as negative as those of the depressed mothers. Conversely, infants of non-depressed mothers were given higher social interaction scores by their mothers than by the examiners, and 1 month later, examiner ratings of social interaction were as positive as those of the non-depressed mothers.


• Field, T., Pickens, J., Prodromidis, M., Malphrus, J., Fox, N., Bendell, D., Yando, R., Schanberg, S. & Kuhn, C. (2000). Targeting adolescent mothers with depressive symptoms for early intervention. Adolescence, 35, 381-414.

Infants of mothers with depressive symptoms show developmental delays if symptoms persist over the first 6 months of the infant's life, thus highlighting the importance of identifying those mothers for early intervention. Mothers with depressive symptoms and mothers without depressive symptoms and their infants were monitored to identify variables from the first 3 months that predict which mothers would still be symptomatic at 6 months. A dysregulation profile was noted for the infants of depressed mothers, including lower Brazelton scores, motor scores indeterminate sleep, and elevated norepinephrine, epinephrine, and dopamine levels at the neonatal period, and greater right frontal EEG activation, lower vagal tone, and negative interactions at the 3-and 6-month periods.


• Field, T., Diego, M., Hernandez-Reif, M., Schanberg, S. Kuhn, C., Yando, R., & Bendell, D. (2002). Prenatal depression effects on the fetus and neonate in different ethnic and socio-economic status groups. Journal of Reproductive and Infant Psychology, 20, 149-157.

Eighty-six depressed pregnant women were compared by ethnic group, (Hispanic and African-American), and by socio-economic status (upper/lower) on prenatal and neonatal outcome variables. The Hispanic mothers were older, had a higher SES and had higher prenatal norepinephrine. Their fetuses were also more active. At the neonatal period they has higher anger scores, but also higher serotonin levels, and their infants had higher dopamine and lower cortisol levels and they spent less time in deep and indeterminate sleep. The comparison by middle/lower socio-economic status revealed that the middle SES group was older, had more social support and showed less depressed affect but higher norepinephrine levels prenatally.


• Field, T., Diego, M. & Hernandez-Reif, M. (2007). Prenatal Dysthymia versus Major Depression Effects on the Neonate. Infant Behavior and Development, 31, 190-193.

The neonates of dysthymic versus major depression disorder mothers had a shorter gestational age, lower birthweight, shorter birth length, less optimal obstetrics complication scores, lower orientation and motor scores, and more depressive symptoms.


• Field, T., Diego, M., Hernandez-Reif, M. & Ascencio, A. (2009). Prenatal Dysthymia versus Major Depression Effects on Early Mother-Infant Interactions: A Brief Report. Infant Behavior and Development, 32, 129-131.

Maternal dysthymia and major depression effects on mother-infant interactions were assessed when the infants were 3-months-old. The dysthymia group mothers spent less time smiling, touching and imitating their infants and more time moving their infants' limbs. The infants of the dysthymia group mothers spent less time smiling and more time showing distress behaviors.


Prenatal Depression Effects

Field, T. (2011). Prenatal depression effects on early development: A review. Infant Behavior and Development, 34, 1-14.

This review of recent research on prenatal depression suggests that it is a strong predictor of postpartum depression and is more common than postpartum depression. Prenatal depression has been associated with excessive activity and growth delays in the fetus as well as prematurity, low birthweight, disorganized sleep and less responsiveness to stimulation in the neonate. Infants of depressed mothers have difficult temperament, and later attentional, emotional and behavioral problems have been noted during childhood and adolescence, as well as chronic illnesses in adulthood. Some studies also suggest the heritability of developmental problems for the children of prenatally depressed mothers, including ADHD and antisocial behavior.

 


 

Field, T., Diego, M., & Hernandez-Reif, M. (2010). Prenatal depression effects and interventions: A review. Infant Behavior and Development, 33, 409-418.

 

  This review covers research on the negative effects of prenatal depression and cortisol on fetal growth, prematurity and low birthweight. Women with Dysthymia ascomparedto Major Depression Disorder had higher cortisol levels, and their newborns had lower gestational age and birthweight. Massage therapy combined with group interpersonal psychotherapy was effective for reducing depression and cortisol levels.

 

 

• Lundy, B.L., Jones, N.A., Field, T., Nearing, G., Davalos, M., Pietro, P., Schanberg, S. & Kuhn, C. (1999). Prenatal depression effects on neonates. Infant Behavior and Development, 22, 121-137.

Pregnant women (36 with depression symptoms) were recruited during their last trimester of pregnancy. The depressed mothers had higher cortisol and norepinephrine levels and lower dopamine levels. Their infants subsequently had higher cortisol and norepinephrine levels and lower dopamine levels at the neonatal stage. The neonates of depressed mothers also showed inferior performance on the orientation, reflex, excitability, and withdrawal clusters of the Brazelton Neonatal Behavioral Assessment. Stepwise regression analyses revealed that the depressed mothers' prenatal norepinephrine and dopamine levels significantly predicted the newborns' norepinephrine and dopamine levels and their Brazelton scores, highlighting an early biochemical influence on neonatal outcome.


• Dieter, J., Field, T., Hernandez-Reif, M., Jones, N.A., Lecanuet, J.P., Salman, F.A., & Redzepi, M. (2001). Maternal depression and increased fetal activity. Journal of Obstetrics and Gynaecology, 21, 468-473.

Pregnant women with and without symptoms of depression were provided ultrasound examinations during the second and third trimesters. An analysis of variance on the cross-sectional data yielded a significant diagnosis by gestational month interaction effect. The fetuses of depressed mothers spent significantly more time being active during the fifth, sixth and seventh gestational months than fetuses of non-depressed mothers.


• Field, T. (2010). Prenatal depression and selective serotonin reuptake inhibitors. International Journal of Neuroscience, 120, 163-167.

Separate studies suggest that both untreated depression and exposure to antidepressants have been associated in some cases with unfavorable outcomes. Studies on long-term neurodevelopmental outcomes for children have also been inconclusive. Another problem for the mother and fetus is the discontinuation of antidepressants. Research on the selective serotonin reuptake inhibitors (SSRIs) suggests that late pregnancy exposure may have worse effects than first and second trimester exposure, leading to the neonatal abstinence syndrome. Still other data suggest a dual syndrome of abstinence/withdrawal and of serotonergic overstimulation, with symptoms of the two syndromes being very similar. Future research would not only need to correct these problems but also further explore the different trimester effects and the withdrawal versus serotonin activity effects on the infant. In addition, alternative therapies need to be explored for their potential antidepression effects on the pregnant woman, the fetus, and the neonate.


Preschool Children of Depressed Mothers

Bendell, D., Field, T., Yando, S., Lang, C., Martinez, A., & Pickens, J. (1994). "Depressed" mothers' perceptions of their preschool children's vulnerability. Child Psychiatry and Human Development, 24, 183-190.

Depressed versus nondepressed mothers rated their preschool children as being more vulnerable (as did an independent observer) as well as having more behavioral problems.


• Field, T., Lang, C., Martinez, A., Yando, R., Pickens, J. & Bendell, D. (1996). Preschool follow-up of infants of dysphoric mothers. Journal of Clinical Child Psychology, 25, 272-279.

The infants of dysphoric mothers had lower interaction ratings and lower heart rate variability. At the preschool age, the dysphoric dyads also had lower interaction ratings, and the dysphoric mothers rated their preschool children as being more vulnerable and having more internalizing (depressed) and externalizing problems (aggressive and destructive). The internalizing and externalizing problems at preschool age were related to infancy stage measures.


• Lang, C., Field, T., Pickens, J., Martinez, A., Bendell, D., Yando, R., & Routh, D. (1996). Preschoolers of dysphoric mothers. Journal of Child Psychology and Psychiatry, 37, 221-224.

Dysphoric mothers rated their children as having more internalizing and externalizing behavior problems than children of nondysphoric mothers. The data suggest that mothers’ chronic dsyphoria has a negative impact on the mothers’ perceptions of their children as well as the mothers’ and children’s interaction behavior.


Reviews

• Field, T. (1992). Infants of depressed mothers. Development and Psychopathology, 4, 49-66.

Literature is reviewed demonstrating the effect of maternal depression on their infants. Some effects during early infancy include the development of a depressed mood style as early as 3 months generalization of that mood to nondepressed women, infant mood persistence if mothers’ depression persists, and the delay of growth and lower Bayley developmental scores within the first year of life. Interventions for their improvement are suggested.


• Field, T. (1995). Infants of depressed mothers. Infant Behavior and Development, 18, 1-13.

In this review, data are first presented demonstrating the negative effects of maternal depression on infant behavior and the ways in which the mothers’ and infants’ interactions vary from the norm. Data are then reviewed suggesting that a mood style may develop that generalizes to other non-depressed adults. If the mothers’ depression continues, by one year of age, the infant begins to show growth and developmental delays. The infants’ and mothers’ contributions to disturbed interactions are then presented and examples of early interventions are given.


• Field, T. (1998). Maternal depression effects on infants and early interventions. Preventive Medicine, 27, 200-203.

Research suggests that: (1) maternal depression negatively affects infants as early as the neonatal period, implicating prenatal effects of maternal depression; (2) 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; (3) these effects are compounded by the disorganized influence of the mothers’ interaction behavior; (4) depressed mothers have two predominant interaction styles, withdrawn or intrusive, which seem to have differential, negative effects on their infants related to inadequate stimulation and arousal modulation; (5) non-depressed caregivers such as fathers may buffer these effects because they provide more optimal stimulation and arousal modulation; and (6) interventions that 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.


• Field, T., Diego, M., Hernandez-Reif, M. (2006). Prenatal depression effects on the fetus and newborn: a review. Infant Behavior and Development, 29, 445-455.

A review of research on prenatal depression effects on the fetus and newborn suggests that they experience prenatal, perinatal and postnatal complications. Fetal activity is elevated, prenatal growth is delayed, and prematurity and low birthweight occur more often. Newborns of depressed mothers then show a biochemical/physiological profile that mimics their mothers’ prenatal biochemical/physiological profile including elevated cortisol, lower levels of dopamine and serotonin, greater relative right frontal EEG activation and lower vagal tone. Elevated prenatal maternal cortisol is the strongest predictor of these neonatal outcomes. Moderate pressure massage can alleviate these effects including reducing prematurity.


• Field, T., Hernandez-Reif, M., & Diego, M. (2006). Intrusive and withdrawn depressed mothers and their infants. Developmental Review, 26, 15-30.

This review of the literature on two different interaction styles of depressed mothers, intrusive and withdrawn, shows that withdrawn versus intrusive mothers typically have an EEG pattern that is associated with negative affect (i.e., greater relative right frontal EEG activation) as well as lower levels of the activating neurotransmitter, dopamine. These profiles also occur in their newborn infants. These prenatal effects together with the less stimulating interaction behavior of their withdrawn mothers might explain why infants of withdrawn mothers are less exploratory and have lower scores than infants of intrusive mothers on the Bayley Mental scale at one year.


• Field, T. (2008). Breastfeeding and Antidepressants. Infant Behavior and Development, 31, 481-487.

Although a large literature supports the benefits of breastfeeding, this review suggests that breastfeeding is less common among postpartum depressed women, even though their infants benefit from the breastfeeding. Depressed mothers, in part, do not breastfeed because of their concern about potentially negative effects of antidepressants on their infants As in the literature on prenatal antidepressant effects, the question still remains whether the antidepressants or the untreated depression itself has more negative effects on the infant. It is possible that the positive effects of breastfeeding may outweigh the positive effects of the antidepressants for both the mother and the infant. In addition, some alternative therapies may substitute or attenuate the effects of antidepressants, such as vagal stimulation or massage therapy, both therapies being noted to reduce depression.


• Field, T. & Diego, M. (2008). Cortisol: The Culprit Prenatal Stress Variable. International Journal of Neuroscience, 118, 1181-1205.

Elevated prenatal cortisol has been associated with several negative conditions including aborted fetuses, excessive fetal activity, delayed fetal growth and development, prematurity and low birthweight, attention and temperament problems in infancy, externalizing problems in childhood, and psychopathology and chronic illness in adulthood. Cortisol would appear to be a mediating variable, resulting from prenatal stress in several forms including depression, anxiety, anger and daily hassles. Cortisol effects are further complicated by its interaction with neurotransmitters such as norepinephrine, which may itself cause premature birth via intrauterine growth deprivation related to uterine artery resistance. Recent research has suggested that cortisol-reducing therapies such as massage therapy can reduce the risk of perinatal complications including prematurity and low birthweight.


• Field, T. and Diego, M. (2008). Maternal depression effects on infant frontal EEG asymmetry. The International journal of neuroscience, 118, 1081-1108.

In the space of two decades, research has moved from documenting the associations between frontal EEG asymmetry profiles and positive/negative affect, to later reinterpreting these as approach/withdrawal behavior patterns, to documenting individual differences in relationships between EEG and temperament and inhibition/uninhibition. The research has associated greater relative right frontal EEG activation with depression in adults and in depressed women and their infants. Stability of these EEG profiles has been noted from the neonatal stage to early infancy to the preschool years. More recent research assessed mood induction and physical intervention effects on these EEG activation patterns as well as their associated biochemistry and behavior.


• Field, T. and Diego, M. (2008). Vagal activity, early growth and emotional development. Infant Behavior and Development, 31, 361-373.

A review of the research on infant vagal tone suggests that vagal activity is associated with both infant growth and infant socioemotional development. Vagal activity has been noted to increase following the stimulation of pressure receptors as in massage therapy. Vagal activity, in turn, stimulates gastric motility which mediates weight gain in infants. Vagal activity has also been notably elevated during synchronous mother-infant interactions and positive affect, providing confirmatory data for the Porges "social engagement system" model. In contrast, low vagal activity has been noted in prenatally depressed mothers (and prenatally angry and anxious mothers) and their infants, as well as in children with autism. These studies highlight the relations between vagal activity and the social behaviors of attentiveness, facial expressions and vocalizations.


• Field, T., Diego, M., Hernandez-Reif, M., Figueiredo, B., Schanberg, S., Kuhn, C., Deeds, O., Contogeorgos, J., Ascencio, A. (2008). Chronic prenatal depression and neonatal outcome. International Journal of Neuroscience, 118, 95-103.

Comorbid problems were chronically high anxiety, anger, sleep disturbance, and pain scores. Less optimal outcomes for the depressed women included lower gestational age and lower birthweight of their newborns.


 

            Field, T. (2010). Postpartum depression effects on early interactions, parenting and safety practices: A review. Infant Behavior and Development, 33, 1-6.

 

In this paper studies are reviewed from the last decade on postpartum depression effects on early interactions, parenting, safety practices and on early interventions. These data highlight the need for universal screening of maternal and paternal depression during the postpartum period. Early interventions reviewed here include psychotherapy and interaction coaching for the mothers, and infant massage for their infants.


Scales

• Wilcox, H., Field, T., Prodromidis, M., & Scafidi, F. (1998).Correlations between the BDI and CES-D in a sample of adolescent mothers. Adolescence, 131, 565-574.

Adolescent mothers were administered the Beck Depression Inventory (BDI), the Center for Epidemiologic Studies Depression Scale (CES-D), and the Diagnostic Interview Schedule for Children (DISC). They also were asked if they preferred the BDI or CES-D. The findings indicated that BDI and CES-D scores were significantly correlated, and that more adolescent mothers preferred the CES-D. Both the BDI and CES-D were correlated with the DISC. However; the BDI was more highly correlated with the Major Depression subscale, and the CES-D with the Dysthymia subscale.


Scafidi, F.A., Field, T., Prodromidis, M. & Abrams, S.M. (1999). Association of fake-good MMPI-2 profiles with low Beck Depression Inventory scores. Adolescence, 34, 61-68.

Adolescent mothers were administered the Beck Depression Inventory and three validity scales of the Minnesota Multiphasic Personality Inventory 2 (MMPI-2). The aim was to determine whether low-BDI mothers were faking good or denying their depression. The adolescent mothers were assigned to a low-BDI group, a non-depressed group, or a depressed group. The depressed group had higher F (Symptom) scale scores than the non-depressed group, which in turn had higher scores than the low-BDI group. The low BDI group, in contrast, had more faking-good profiles than the two other groups.



• Figueiredo, B., Field, T., Diego, M., Hernandez-Reif, M., Vera, Y. & Gil, K. (In Press). Relationship Questionnaire: Validity data from pregnant women and their partners. Journal of Family Psychology.

The Relationship Questionnaire was designed to assess positive and negative dimensions of the partner relationship and was given along with the Center for Epidemiological Studies Depression Scale and the State Anxiety Inventory to women and their partners during the second trimester of pregnancy and again after delivery. Women/men with less positive relationships had higher anxiety scores than women/ men with more positive partner relationships, and those women/men with more negative relationship scores had both higher depression and higher anxiety scores than women/men with less negative relationship scores.


Withdrawn vs. Intrusive

Malphurs, J.E., Raag, T., Field, T., Pickens, J. & Pelaez-Nogueras, M. (1996). Touch by intrusive and withdrawn mothers with depressive symptoms. Early Development and Parenting, 5, 111-115.

Depressed mothers were classified as intrusive, withdrawn, or good by one observer and another observer coded rough tickling, poking, tugging, and pulling as negative touch behaviors and gentle stroking and rubbing as positive touch behaviors. The mothers with depressive symptoms were more likely to touch their infants in a negative way and more likely to be classified as intrusive.


Raag, T., Malphurs, J., Field, T., Pelaez-Nogueras, M., Martinez, A., Pickens, J., Bendell, D. & Yando, R. (1997). Moderately dysphoric mothers behave more positively with their infants after completing the BDI. Infant Mental Health Journal, 18, 394-405.

To determine whether mildly and moderately dysphoric adolescent mothers display infantized facial and vocal behaviors nondysphoric mothers and dysphoric mothers were videotaped during face-to-face interactions with their 4-month-old infants. Mildly dysphoric mothers showed less positive facial expressions and less animated/exaggerated vocal expressions. The moderately/severely dysphoric mothers however did not differ from nondysphoric mothers in their display of facial and vocal behaviors. Moderately/ severely dysphoric mothers who were given the BDI before their interactions showed more positive behavior than mothers given the BDI after their interactions.


• Hart, S., Field, T., Del Valle, C., & Pelaez-Nogueras, M. (1998). Depressed mothers’ interactions with their 1-year-old infants. Infant Behavior and Development, 21, 519-525.

During toy-play interactions, one-year old infants of depressed mothers engaged in less object examination, and daughters of depressed mothers showed less positive and more negative affect. Depressed mothers were more intrusive with sons.


• Hart, S., Field, T., & Nearing, G. (1998). Depressed mothers’ neonates improve following the MABI and a Brazelton demonstration. Journal of Pediatric Psychology, 23, 351-356.

The effectiveness of a short-term intervention was assessed for improving the interaction behaviors of newborn infants with their depressed mothers. One-month Brazelton assessments administered by an examiner revealed that experimental group infants performed more optimally than controls on Interaction and State Organization.


• Hart, S., Jones, N.A. Field, T., & Lundy, B.(1999). One-year-old infants of intrusive and withdrawn depressed mothers. Child Psychiatry and Human Development, 30, 111-120.

This study examined behaviors of intrusive/depressed versus withdrawn/ depressed mothers and their one-year-old infants during a structured teaching interaction. Group comparisons revealed that intrusive/depressed mothers showed more positive responses, more demonstrating toys, and more physical guidance, and their infants demonstrated less toy manipulation. Withdrawn/depressed mothers maintained infant play more frequently and showed more restricted affect, and their infants demonstrated less affective behavior, both positive and negative. These findings suggested that exposure to depressed mothers' non-optimal interaction styles represents different types of risk to infants' cognitive and affective development.


• Field, T., Diego, M., Dieter, J., Hernandez-Reif, M., Schanberg, S., Kuhn, C., Yando, R. & Bendell, D. (2001) Depressed withdrawn and intrusive mothers effects on their fetuses and neonates. Infant Behavior and Development, 24, 27-39.

Depressed mothers who could be classified as withdrawn or intrusive were compared with nondepressed mothers on their prenatal cortisol and catecholamine levels and on fetal activity and neonatal outcome variables. The data suggested that the withdrawn mothers had lower dopamine levels during pregnancy, and their infants had lower Brazelton scale scores. The infants of withdrawn mothers also had the highest cortisol levels and the lowest dopamine and serotonin levels as well as the most asymmetrical EEG patterns.


• Field, T., Diego, M., Hernandez-Reif, M., Schanberg, S. & Kuhn, C. (2003). Depressed mothers who are good interaction partners versus those who are withdrawn or intrusive. Infant Behavior and Development,26, 238-252.

The interactions of 3-month-old infants and their depressed mothers were classified as intrusive, withdrawn or good interactions. Analyses of retrospective data suggested that all depressed groups scored higher on depression (CES-D) and anxiety (STAI) scales and had similarly elevated cortisol, norepinephrine and epinephrine during pregnancy. The depressed mothers and their newborns also had greater relative right frontal EEG activation. Despite these group similarities, the infants of the good interaction mothers did not show high amounts of indeterminate sleep and they received better scores on the Brazelton scale.


• Field, T., Hernandez-Reif, M., & Diego, M. (2010). Depressed mothers’ are less responsive to animate and inanimate stimuli. Infant and Child Development. DOI: 10.1002/icd.687

Data from our research are reviewed showing limited attentiveness and responsivity to animate stimuli in newborns of depressed mothers. Newborns of depressed mothers are also noted to be less attentive and responsive when presented with inanimate stimuli, including different texture nipples, different temperature nipples and different weight tubes. Potential underlying mechanisms are suggested by research showing negative effects of prenatal depression, elevated prenatal cortisol and lower prenatal dopamine and serotonin on the newborns of depressed mothers. Additional risk factors are explored, including sleep disturbances and other prenatal stressors. Early interventions, including pregnancy massage, massage therapy for infants and demonstration of the Brazelton Assessment, have been noted to enhance the neonates’ attentiveness and responsivity to animate and inanimate stimuli.


Vagal tone

• Field, T., Pickens, J., Fox, N., Nawrocki, T., & Gonzalez, J. (1995). Vagal tone in infants of depressed mothers. Development and Psychopathology, 7, 227-231.

Vagal tone did not differ for infants of depressed versus non-depressed mothers at 3 months, but lower vagal tone was noted in infants of depressed versus non-depressed mothers at 6 months. The developmental increase in vagal tone that occurred between 3 and 6 months of non-depressed mothers did not occur for infants of depressed mothers.


• Pickens, J., & Field, T. (1995). Facial expressions and vagal tone of infants of depressed and nondepressed mothers. Early Development and Parenting, 4, 83-89.

Infants of both depressed and low-scoring mothers showed significantly more sad and anger expressions and fewer interest expressions than infants of non-depressed mothers. Cardiac vagal tone was correlated with infants’ joy and interest expressions and with self-comfort behaviors in the non-depressed and low-scoring groups, but not in the depressed groups.


Withdrawn vs. Intrusive Interaction Style

Malphurs, J., Field, T., Larrain, C.M., Pickens, J., Pelaez-Nogueras, M., Yando, R., & Bendell, D. (1996). Altering withdrawn and intrusive interaction behaviors of depressed mothers. Infant Mental Health Journal, 17, 152-160.

The results suggest that the specific type of interaction coaching for the specific type of depressed mother (imitation for the intrusive mothers and attention-getting for the withdrawn mothers) improved their interaction behaviors with their infants.


• Hart, S., Field, T., Jones, N.A. & Yando, R. (1999). Intrusive and withdrawn behaviors of mothers interacting with their infants and boyfriends. Journal of Child Psychology and Psychiatry, 40, 239-246.

Comparisons between mother-infant and mother-boyfriend interactions revealed that mothers who have been withdrawn with their infants were quiet, bored-looking, physically distant, and under involved with their boyfriends. Mothers who had been intrusive with their infants were verbally sharp and controlling with their boyfriends.