Friday, April 4, 2014

Maternal Depression and Infant Sleep

With 14% of postpartum women in the US screening positive for depression, according to a 2013 study, it’s important to understand how depression affects infant sleep and how infant sleep (or lack of maternal sleep) affects depressed mothers and their babies.

We all know that night waking with an infant and nighttime parenting are stressful, both physically and mentally. But for depressed mothers, how is it different?
The authors of a recent study proposed 2 potential explanations for how nighttime infant behaviors and depressed mood of mothers are related.  It’s a question of what comes first. Does the infant’s night waking lead to more maternal involvement at night and thus sleep loss predisposing the mother to depressive symptoms? Or do the mothers’ elevated symptoms of depression predict more involvement with the infant during the nighttime, even without infant distress, and does that cause increased night waking? Let’s take a closer look at the study to see how these questions were answered.

The Study
Depressive symptoms were measured in 45 mothers of infants between 1-24 months of age. The mothers kept diaries about their infant’s sleep (i.e. sleep location, number and duration of night wakings) for 7 days. Also, a video of bedtime/nighttime interactions for 1 night and a survey of maternal thoughts/reactions to infant night waking (such as “It is all right to allow my child to cry at night” and “I am able to resist my child’s demands when he/she wakes at night”) were collected.

Key Findings
  • Depressed mothers had infants with more night waking.
  • Mothers who were more worried about their infants’ nighttime needs had babies that   woke more at night.
  • Depressed mothers reported more thoughts of helplessness around infant night waking.
  • Depressed mothers were more worried about their infants’ physical/emotional needs at night.
  • Mothers’ thoughts of helplessness/loss of control around night waking were not associated with infant night waking.
  • Depressed mothers spent more time with their infants during the night.
  • Mothers who were worried about their infants’ physical/emotional needs at night were also more likely to spend more time with their infants at night.

The authors concluded the following: The more depressed feelings a mother had, the more time she spent with her baby at night, and the more time she spent with her baby at night, the more night waking her baby had. Also, the more a mother worries about her baby at night, the more time she spends near her baby, and the more time she spends near her baby, the more times her baby wakes up. That’s a mouthful! Before we clarify what all this means, let’s take a look at a few other findings of this study.
  • 88% of moms engaged in calming bedtime routines
  • Moms with more depressive symptoms participated in less bedtime routines
  • Moms with more depressive symptoms responded more quickly to infant vocalization, some even woke up the babies to check on them
  • Moms with more depressive symptoms set less limits at bedtime & during the night

That’s a lot of information to process! So, what’s the bottom line? Maternal depressive symptoms and infant night waking are linked. However, because of the type of study, we can’t positively say that the mother’s depressive symptoms caused the infant night waking, or vice versa.  We just know that certain behaviors are associated with another behavior. Maternal worries about the nighttime needs of her infant are also linked to infant night waking. Depressed moms were more likely to be hyper responsive to infant nighttime needs, to the point of waking their sleeping infant and were more likely to have an unstructured bedtime. Now if you’ve been following our blog, you know that following a regular calming bedtime routine can lead to less night waking! So, if depressed mothers are more likely to have infants who wake more and are less likely to use bedtime routines, there could be a connection.

Now here’s another baby behavior connection. The authors recommended parenting education on reasons for nighttime crying to reduce maternal stress about nighttime parenting. It’s possible that information about normal infant sleep patterns would also reduce stress at nighttime. The authors believe mother-driven influences are at work from what they observed in the study. Though it can’t be ruled out that the infant night waking actually predisposed the mothers to spend more time with their infants at night, which in turn caused depressed feelings or excess worry about infant nighttime needs.

It’s important to note that this study was done with a relatively low-risk sample of mothers, not with mothers with severe or clinical depression. If you have depression and are a new mom, or if you know someone in this situation, understanding about normal infant sleep and crying may be helpful to alleviate some of the stress around nighttime parenting. Here are some links to the basics about infant sleep and crying.
Crying Basics
Sleep Basics
Top 5 Sleep Posts

Also, if you or someone you know is depressed, please see a doctor, or encourage them to see one. There are many effective treatments for depression that can help.  For more information about postpartum depression, click here.

Teti DM, Crosby B. Maternal Depressive Symptoms, Dysfunctional Cognitions, and Infant Night Wakin: The Role of Maternal Nighttime Behavior. Child Development. 2012;83(3):939-953.

Wisner et al. Onset timing, thoughts of self-harm, and diagnoses in postpartum women with screen-positive depression findings. JAMA Psychiatry. 2013;70 (5):490-8.

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