Abstract
BACKGROUND: Postpartum depression (PPD) may negatively impact a woman’s ability to effectively care for her child, potentially leading to compromised developmental functioning in key areas, including cognitive functioning, sleep and behavior. However, research investigating potential negative behavioral outcomes in infancy (birth through 12 months of age) is limited. Little is currently known regarding whether infants may be at risk for specific types of behavior difficulties. Also unclear is whether the effects of PPD on behavioral adjustment may vary between boys and girls. Using data from a prospective cohort study, the current investigation examined the association between elevated PPD symptomatology and infant behavior problems (total, internalizing and externalizing) at 12 months of age (n=248). We also examined whether the gender of the infant moderates these potential associations. \r \r METHODS: Participants were recruited from a postpartum floor of a university hospital in the northeastern United States and followed up to 12 months. At eight weeks postpartum, women completed a modified version of the Edinburgh Postnatal Depression Scale. Mothers reported on a range of infant behaviors at 12 months of age. \r \r RESULTS: Unadjusted models suggest that elevated PPD symptomatology is significantly related to an increased odds of infant behavior problems at 12 months of age, specifically total and externalizing behavior problems. However, adjusting for confounding factors (and a proxy of maternal mental health measured when outcomes were assessed) led to an attenuation of these associations. Elevated PPD symptomatology was found to be positively, but not statistically significantly, associated with infant behavior problems in the fully adjusted models (total: odds ratio [OR]=1.98, 95% confidence interval [CI]=0.90-4.37; internalizing: OR=1.49, 95% CI= 0.65-3.28; externalizing: OR=1.65, 95% CI=0.76-3.57). Findings further suggest the existence of gender differences in these associations. Girls who had mothers with elevated PPD symptomatology were more prone to internalizing behaviors than boys with this exposure (girls: OR=1.85, 95% CI=0.68-5.04; boys: OR=0.68, 95% CI=0.13-3.66); yet externalizing behavior problems were more common among exposed boys than among exposed girls (boys: OR=3.70, 95% CI=0.98-14.00; girls: OR=1.14, 95% CI=0.43-2.99). \r \r CONCLUSIONS: Results indicate a possible trend association between elevated PPD symptomatology and infant behavior problems at 12 months of age. While much of the reported overall association may be due to residual or unmeasured confounding, findings may suggest that the effect of PPD may differ for boys and girls. Important associations may be missed when analyses are not conducted separately by gender. Additional prospective studies with larger sample sizes are needed to more fully address these research questions, including questions of gender differences in the associations between PPD and infant behavior problems.