SECTION 4. EMOTIONAL CARE OF THE AT-RISK INFANT Emotional Characteristics of Infants Associated With Maternal Depression and Anxiety

Infants as young as 3 months are able to detect depression in their mothers. Depressed mothers are sufficiently different from nondepressed mothers in affect and interaction that the social, emotional, and cognitive functioning of their infants are compromised. This article reviews current findings on the effects of maternal depression and psychiatric illness on infants. Pediatrics 1998;102:1298–1304; maternal depression, anxiety, infants, development, emotion, panic disorder, psychiatric illness. ABBREVIATIONS. PD, panic disorder; CES–D, Center for Epidemiologic Studies–Depression Scale. Tronick1 has argued that even very young infants are exquisitely sensitive to the emotions of their caregivers. This emotional sensitivity is critical to our understanding of normal and abnormal emotional development in children and how maternal depression and anxiety disorders affect children’s development. In a paradigmatic study, Cohn and Tronick2 asked nondepressed mothers to simulate a depressed interaction with their 3-monthold infants. With only minimal instruction, mothers had little difficulty in acting depressed. They spoke in a monotone, expressed little or no facial affect, hardly touched their infants, and interacted at a greater than usual distance from their infants. The infants reacted dramatically when exposed to just 3 minutes of simulated depression. The infants looked away from the mothers and became distressed and wary. Their affect cycled among states of wariness and disengagement. They made brief solicitations to the mother to resume her normal affective state. Importantly, the infants continued to be distressed and disengaged from the mother even after the mother resumed normal interactive behavior. Clearly, infants as young as 3 months are able to detect maternal affective states. They react with well-organized emotional displays that are related to the affect expressed by their mothers. These experimental findings led us to hypothesize that the affective and interactive states of infants would be disturbed by maternal depression and anxiety. EFFECTS OF MATERNAL DEPRESSION AND ANXIETY ON INFANT FUNCTIONING Research on the effects of maternal depression on infant outcome, reviewed by Weinberg and Tronick3 and other investigators,4,5 indicates that in each communicative domain—face, voice, and touch—the quantity, quality, and timing of depressed mothers’ social and affective behavior is distorted in ways that contrast sharply with the behavior of nondepressed mothers and that these affective characteristics compromise infant social, emotional, and cognitive functioning.6,7