Posts Tagged ‘ maternal depression ’

That “Cry-It-Out” Study: 5 Important Take-Home Messages You Should Know

Sunday, September 30th, 2012

In response to the publication of the recent study on sleep training methods in Pediatrics, many of the headlines focused on the conclusion that the cry-it-out method does not harm kids. In reality, the implications of this are more nuanced than those headlines would lead you to believe. Here are 5 things you should know: 

1) This paper was important because there are few studies that have evaluated sleep training methods using scientific designs. This one is especially interesting because the research team followed 225 7-month-olds – reported by their parents to have sleep issues – for 5 years. This longitudinal design permitted the researchers to examine short- and long-term effects of sleep training.

2) The study examined 2 types of sleep-training methods – controlled comforting and camping out. Controlled comforting is a variation on what you might think of as cry-it-out (or pure extinction). In contrast to pure extinction (which is let baby cry until they fall asleep – however long that is), controlled comforting involves settling a baby in to sleep, leaving the room, and establishing short intervals of tolerated crying (say, 2 minutes) before going in to soothe the baby. These intervals can be increased slowly with the idea being that baby will stop crying and fall back asleep. Camping out involves starting off in the room with baby – typically next to or near baby – and waiting until baby falls asleep before leaving. After a period of success, the parent then changes the routine by sitting in the room, but not right next to baby, and again staying until baby is asleep. And here the idea is that parent can get to the point of leaving the room before baby falls asleep. In the study, 3 conditions were used. Some parents could choose to be trained (by a nurse) in either controlled comforting or camping out (conditions 1 and 2) – and some parents were offered just general advice but received no sleep training.

3) The results were that either sleep training method was successful in improving the babies sleep and reducing levels of maternal depression – both conditions produced better results than no sleep training. So in the short term sleep training worked.

4) The positive effects on sleep did not extend out for 5 years. This is not surprising, as each developmental period raises new sleep challenges. In terms of kids’ outcomes – behavioral and emotional – there were also no differences across all 3 groups. Sleep training (either method) had no positive or negative effects. The headlines here were that “cry-it-out” didn’t harm kids. Well, not exactly. Controlled comforting did not have negative consequences 5 years later – and neither did camping out. The camping out part of this was typically left out of many news stories.

5) The key takeaway is that when parents are trained in reputable methods, they work to reduce sleep problems and indirectly help parents sleep better and feel better. Parents can feel comfortable choosing either controlled comforting or camping out, based on the results of this study. What didn’t work so well was not receiving instruction in sleep training – in the short term, these families continued to experience all the negative stuff that happens when baby won’t sleep at night. Keep in mind the point made above – the sleep training will certainly take for awhile, but sleep problems could happen again during different developmental periods (e.g., age 2, age 5). The inference to be made, however, is that sleep training will work again, but it will of course be somewhat different and tailored to the age of the child.

This study is a welcome addition to the scientific literature and also to the endless debates about sleep training that we all have. Modern sleep training methods work – especially if parents are trained to use them properly and stick with them. And you can feel comfortable picking a method that suits your style. Just remember to talk to your pediatrician (or other experts) when you are ready to start – and also remember that these kinds of sleep training methods are typically recommended for infants at least 6 months of age.

Image of adults sleeping – via Shutterstock – as a reminder that when baby sleeps, parents sleep too! 

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When Depressed Parents Are Treated Successfully Their Kids Improve Too

Tuesday, July 17th, 2012

As a follow-up to my blog post on DNA, destiny, and depression, I wanted to remind readers that there is good evidence that when parents get treated for depression, their kids improve as well. 

One study published last year (which I flagged in my year end review of influential studies of 2011) provides a great example and bears repeating. Researchers studied parents (dads as well as moms) who sought out treatment for depression (whether it was drug therapy, psychotherapy, or a combination) and their kids (most of whom were in middle childhood) 6 times over a 2-year period. When parents were depressed, their kids tended to have high levels of symptoms as well. When parents got better, their kids depressive symptoms were reduced as well. And the big thing is that this happened in parallel – with the good news being that kids’ symptoms improved pretty quickly in concert with parental improvement. Keep in mind that it didn’t matter what treatment was used – just that it was effective.

Another project has looked at kids’ functioning for a 1-year period after a mother started treatment for depression. Over this period, kids’ symptoms decreased and their overall behavior improved when the treatment for depression was successful – particularly if the mom responded quickly to treatment. In contrast, if the mom did not respond to treatment, kids’ behavior not only didn’t improve, but in fact became more problematic.

So the big take-home message is that treating parental depression successfully makes a big difference for their kids as well. The more subtle point is that parents need to find a treatment that really works well for them. For some, it’s drug therapy; for others, psychotherapy works best; and for others a combination is optimal. I know it’s hard (by definition) to maintain hope, energy and motivation when you are depressed – but if you are, please know that once you find the right treatment it will benefit you and your kids.

Image of happy mom and daughter via Shutterstock.com

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The Downside Of Parental Negativity

Friday, June 29th, 2012

I’ve come across a number of new studies that have examined how consistent exposure to negative emotions can have a very strong impact on kids, particularly in terms of their risk for depression. I’m not talking about the occasional frustration that all parents have – rather I’m referring to negative interaction styles that can seem innocuous but in fact become insidious. Every parent expresses some anger, hostility, a sharp tone, or annoyance now and then – but what happens if it starts to become habit? 

The short answer is that there are two things to consider.

First, it is very clear that emotions are contagious. Recent studies show that parental negativity can bring an infant down – even if the baby is not especially prone (via temperament) to negativity. Parents can start “behavior chains” early in life – if you are often cranky with your baby, chances are your baby will respond the same way. Studies with older kids have confirmed (for a long time now) that negativity in the home leads to early emerging symptoms of depression in the school years (not full blown depressive episodes, but the first signs of depressed mood). Of course, the opposite is true – for example, when parents are treated successfully for depression, their kids shown rapid improvements with respect to their own depressive symptoms.

Second – and this is the big piece for me – new research is suggesting that this cumulative exposure to parental negativity can lead kids to develop the cognitive risks for later, full blown, depressive episodes. Researchers typically assess what they call “attributional style” – sort of how kids see themselves and the world. It’s very clear that certain attributional styles (think kids with low self-image and a lot of defeatist attitude) are a strong risk factor for later depression. What’s emerging is the idea that the chain goes like this: parental negativity -> child negativity -> negative attributional style -> later depression. In particular, the middle childhood years – and the entry into adolescence – are key developmental periods when attributional style comes together. So the thinking is that kids’ developmental history of emotional experiences in the home help shape their emerging attributional style.

I bring all this up because, to my mind, it’s become somewhat fashionable to talk about the downside of parenting. Much of this is healthy venting – sure, parenting is stressful, it changes your life, there are lots of not great moments that occur, and sometimes it can be overwhelming. But the thing is, if negativity starts to become the overriding experience of being a parent – and if kids get exposed to habitual (rather than occasional) negativity – their chances of becoming depressed later in life go way up.

So I have two take-home messages:

If you think you may be depressed, seeking out treatment (behavioral, pharmaceutical, a combination) could have a very positive impact on your life. Treatment works – and when it works, it helps kids too.

If you find yourself slipping into negative interaction styles with your kids, take the lead and change the emotional climate. Keep in mind that positivity – like negativity – can be contagious!

Be Positive Not Negative via Shutterstock.com

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Moms And Depression, Part Three: How Does It Affect Your Kids And How Can Treatment Make Life Better?

Tuesday, December 27th, 2011

My prior two posts have discussed depression in moms, focusing on why it’s so common and who’s at highest risk, and how to recognize the signs of depression. While you should – if necessary – seek out treatment simply for your own health and well-being, as a mom you also want to know how depression affects your kids – and how getting treated may help them as well as you. 

I’ve done a number of blog posts on maternal depression over the last six months, including summaries of recent studies that showed how maternal depression affects kids from infancy onward and that part of the risk is due directly to the rearing environment (rather than via genetic mechanisms). I’ve also discussed a key paper by Dr. Judy Garber and colleagues (selected by me as one of the most influential studies of 2011) that provided unparalleled insight into the tight associations between parent and child depression and how successful treatment of parental depression can have immediate positive effects on their kids. Here I’ll discuss a bit more about what might change with successful treatment (please note that I plan future posts on dads and depression).

All of the things that happen when a mom get depressed – increasing sadness, irritability, sleep problems, guilt, hopelessness, indecisiveness – can severely undermine the ability to parent. You can become less patient, less accepting, more angry, and more critical. Please keep in mind that this is not a case of loving a child less or not wanting to be the best parent you can be. It’s the consequence of having a real disorder with significant biological symptoms that can substantially impair your functioning.

That said, one of the important things that changes with successful treatment – as described in the Garber paper – is that parental acceptance increases as depression symptoms go away. Moms become more affectionate, supportive, and caring as the cloud of depression lifts. And these changes were shown to be the primary mechanism that lead to immediate reductions in kids’ depressive symptoms (as well as improvements in their social behavior and academic performance).

So the bottom line is that understanding your risk for depression and being vigilant about the symptoms of depression can help you understand when you might need to seek out treatment. Since different treatments work for different people, it’s critical to stick with the process and find what works. And since depression is a recurring condition – it unfortunately can happen again and again – you will need to maintain your vigilance even after successful treatment. But the good news is that you can find ways to manage it and you and your kids will reap the benefits of treatment.

Click here to read Part One of this series (focused on how to gauge your risk)

Click here to read Part Two of this series (focused on how to be aware of the symptoms of depression)

Image of happy mom and child via Shutterstock.com

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Moms And Depression, Part Two: What Signs Should You Look For?

Tuesday, December 27th, 2011

In my last post, I provided a brief overview of the many reasons why moms are at risk for depression. It’s thus critical for every mom to be aware of the signs of depression – especially those that may not be as obvious as others. 

A trusted source for information on depression is the National Institute of Mental Health. I recommend having a look at their discussion of women and depression, which includes a list of the basic symptoms, which I quote here:

  • Persistent sad, anxious or “empty” feelings
  • Feelings of hopelessness and/or pessimism
  • Irritability, restlessness, anxiety
  • Feelings of guilt, worthlessness and/or helplessness
  • Loss of interest in activities or hobbies once pleasurable, including sex
  • Fatigue and decreased energy
  • Difficulty concentrating, remembering details and making decisions
  • Insomnia, waking up during the night, or excessive sleeping
  • Overeating, or appetite loss
  • Thoughts of suicide, suicide attempts
  • Persistent aches or pains, headaches, cramps or digestive problems that do not ease even with treatment
This list of symptoms may seem straightforward at first glance, but in my experience, it isn’t. So here are the key points I suggest you keep in mind:
  • The vast majority of women show only some of these symptoms – you don’t need to have all of them to be depressed
  • While sadness may be what first comes to mind when you think about depression, note that most of these symptoms are not about sadness per se – and even in terms of sadness, this doesn’t always get expressed as crying (it can be more “quiet” than that, especially in terms of feeling empty inside). It’s important to think about other feelings that you may be experiencing – like guilt and hopelessness – that go beyond sadness
  • There are a number of physical symptoms – irritability, anxiety, restlessness, fatigue, even aches and pains. While these can be caused by a number of things, it’s important to remember that they can be signs of depression, especially if you have other symptoms as well
  • Some of the symptoms can be expressed very differently – sleep problems can involve insomnia OR excessive sleeping, you can experience overeating OR appetite loss. The reason for this is not clear, but be aware that any problem with sleep or eating can be tied to depression. A loss of energy and lack of interest in things that are important to you are also important signals to be aware of – though for some women increasing anxiety may dominate.
  • There are a number of cognitive symptoms. It can be difficult to focus, concentrate, and make decisions. Especially important are changes in these symptoms in conjunction with some of the other symptoms (e.g., being sad and finding you are becoming more indecisive than usual)

In terms of diagnosing depression, a clinician will be looking for a constellation of these symptoms (which as described above can be very different from one woman to the next), along with the duration (for a major depressive episode, the typical benchmark is two weeks of having a number of symptoms most of the time). That said, depressive symptoms can wax and wane, and it’s important to start to recognize some of the signs – especially if it seems like they are increasing – even if you don’t have a full “episode.” So it’s very important to learn these signs, monitor yourself over time, and be aware if some of these symptoms are coming together at the same time. At that point it would be worth discussing with your primary care physician, who ideally would refer you to a mental health specialist for evaluation if necessary. This last step is very important, as depression is treatable using a number of approaches (both talk therapy as well as drug therapy). Most of all, I am a firm believer in trusting your gut instincts. If you don’t feel like yourself, get yourself checked out. Depression is a serious disorder and seeking treatment when necessary often leads to very positive changes in a woman’s life. And in my next post, I will discuss how it can lead to positive changes in your parenting as well.

Click here to read Part One of this series

Image of depressed woman via Shutterstock.com 

 

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