Baylor

Postpartum depression (PPD) has attracted considerable attention from several highly publicized cases. The adverse consequences that may occur if PPD remains untreated affect not only the mother and her infant/child, but also her family and society over the long term, both in terms of health concerns as well as financial burden. PPD occurs in 8- 15% of the general population, but it is more prevalent in mothers of preterm infants. We recently observed that 34% of mothers who delivered infants < 30 weeks gestation were depressed over the duration of their infant�s birthstay hospitalization. This likely resulted from the added concern over their infant�s fragility and health. Insofar as PPD has detrimental effect on mother and child, PPD following the birth of a preterm infant may be a greater threat to the welfare of the preterm dyad than that of a healthy fullterm dyad. Due to the increased survival of preterm infants, there is a growing medical concern over the detrimental effect of PPD on these infants/children�s growth/development and the preterm mother-infant dyad. Maternal characteristics may play a role in the degree of PPD experienced by mothers. Indeed, the magnitude of one�s emotions, be they positive or negative, is dependent upon a person�s particular affect intensity. This trait determines the magnitude of one�s responsiveness to an experienced emotion, e.g., a mother�s depression. In other word, based on their own affect intensity, individuals will demonstrate different levels of responsiveness when encountering the same situation. Such response has been shown to correlate negatively with coping ability and aggravation of depression.

The aim of our application is to gain a better understanding of the psychological make-up of mothers who deliver prematurely; more specifically how affect intensity may affect their psychological status, care of their infant/child, and mother-child interaction. We hypothesize that affect intensity of mothers of premature infants born < 30 weeks gestation is negatively correlated with a mother�s psychological well-being, her caregiving, her child�s growth and development, and their mutual relationship. Our specific aims are:

I. to demonstrate that, during the infant�s birthstay hospitalization, the affect intensity of mothers of medically stable preterm infants (born <30 weeks gestation) is correlated positively with depression, anxiety and stress in the NICU and negatively with coping capabilities and perceived social support. These maternal characteristics will be monitored at 2 weeks postpartum and at the following infant milestones, attainment of full enteral feeding, introduction to oral feeding, when the infant is taking 4 and 8 (full)oral feedings per day, and at time of hospital discharge.

II. to demonstrate that, after discharge home, maternal affect intensity remains correlated positively with depression, anxiety and stress at home and negatively with coping capabilities/parenting quality, perceived social support, her child�s growth, motor and mental development, and their mutual interaction. These measures will be monitored at 1 month post-discharge, 6, 12, and 24 months corrected age when specific child�s milestones are expected to be attained.

This project is aimed to "piggy back" onto our infant project "Oral feeding in infants" (H-10029) which just received a 5-year NIH funding. This is most appropriate insofar as we will obtain the mother-infant dyad data necessary for the proposed study.

Questionnaire/survey/interview

We estimate that physical, psychological, social and legal risks in this proposal are minimal. Mothers who demonstrate significant psychological distress will be referred to their obstetrician during the Specific Aim I phase and to their primary physician during the Specific Aim II phase. Mothers can also be referred to the Pediatric Psychiatry Department of Texas Children's Hospital staffed by a psychiatrist and clinical psychologists. The Bayley Mental and Motor Scale for Infant Development is a routinely used as a developmental tool.

Our subjects may not benefit from this research. But information obtained from this study may help in the development of interventions to assist mothers of preterm infants. The risks are minimal and the potential benefits are of high significance and for the long-term. With a better understanding of PPD, maternal and infant/child health, the integrity of the mother-child dyad, and family function can all improve. In addition, economic burdens will be reduced, as visits to healthcare professionals for both mother and child will decrease.