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Beeinträchtigter Start ins Leben

Langfristige Auswirkungen der postpartalen Depression und der Einfluss des mütterlichen Interaktionsverhaltens

Published Online:August 31, 2017https://doi.org/10.1026/0942-5403/a000234

Abstract

Zusammenfassung. Postpartale Depressionen sind häufige und schwerwiegende psychische Erkrankungen mit ungünstigem Einfluss auf die kindliche Entwicklung. Als Haupttransmissionsweg gilt die frühe Mutter-Kind-Interaktion. Über die langfristigen Auswirkungen auf die Kinder im Erwachsenenalter und die Rolle der Interaktion liegen kaum Ergebnisse vor. Im Rahmen der Mannheimer Risikokinderstudie wurden postpartale Depressionen bis zwei Jahre nach der Geburt erfasst. Die kindliche Entwicklung wurde fortlaufend und die Mutter-Kind-Interaktion im Alter von 3 Monaten standardisiert erhoben. 28 Kinder postpartal depressiver und 107 Kinder gesunder Mütter konnten mit 25 Jahren untersucht werden. Beeinträchtigungen der kognitiven und psychischen Entwicklung bei Kindern postpartal depressiver Mütter waren bis ins Erwachsenenalter nachweisbar. Responsives bzw. sensitives mütterliches Verhalten wirkte der negativen Entwicklung entgegen. Dies betont die Bedeutung einer hohen Qualität der Mutter-Kind-Interaktion für die Entwicklung von Risikokindern.


Impaired Start into Life: Long-Term Effects of Postpartum Depression and the Role of Maternal Interactional Behavior

Abstract. Postpartum depression (PPD) is a common and serious mental health problem with prevalence rates ranging from 13 % to 19 %, and is associated with an increased risk of adverse child development. PPD is characterized by symptoms common of depression, particularly by impairments of maternity, parenting, and mother–infant interactions. Several reviews suggest an impact on attachment, cognitive, behavioral, and health-related outcome in the offspring. However, the long-term effects of PPD regarding cognitive and mental development into adulthood and the underlying mechanisms, especially the role of maternal interactional behavior, are not yet well understood. In the Mannheim Study of Children at Risk, maternal depression was assessed when the child was 3 months and 2 years old. Development from infancy to young adulthood (25 years) was assessed at regular intervals in 28 children of postnatally depressed mothers and 107 children born to mentally healthy mothers. Cognitive outcome up to age 11 was measured using standardized instruments; in adulthood, school outcome was used approximately. Psychiatric diagnosis as well as symptom scores served as psychological outcome. At age 3 months, mothers and infants were videotaped during a nursing and a playing situation. Videotapes of the 10-min session were recorded and evaluated by trained raters (κ > .83) using the Category System for Microanalysis of Early Mother Child Interaction (Esser, Scheven, et al., 1989). The cognitive as well as social–emotional outcome of children of mothers suffering from PPD was significantly poorer than in the children of mentally healthy mothers. The adverse effects were more pronounced during childhood. The offspring of postnatally depressed mothers who interacted in a responsive manner with their infant exhibited a better prognosis in contrast to those with mothers interacting less sensitively. This effect was observed with regard to cognitive development and symptoms of externalizing behavior at age 19 years. Regarding internalizing behavior, no impact of maternal behavior was detected. These findings emphasize the importance of high-quality early mother–child interaction in the development of children at risk. Furthermore, convincing arguments are given for very early specialized treatment of impaired mother–child interactions in mothers suffering from PPD. The PPD treatment should always comprise treatment of depression as well as treatment of the disturbed mother–child interaction.

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