Dr Andrew Mayers

Research: Cognition and mother-infant interaction in serious mental illness

This work was undertaken at the Perinatal Mental Health unit in Calmore, Hampshire, in collaboration with the University of Southampton.

Background: Poor mental health in the postnatal period is related to a number of problems for mothers and their infant. Typically a mother with serious mental illness has been diagnosed with a psychotic disorder (such as schizophrenia), but might also be represented by a severe mood disorder, such as extreme mania in bipolar disorder or severe depression. The risk of harm to mother and/or baby is a serious concern. Furthermore, the relationship between mother and her baby is severely compromised. The infant’s need for a strong attachment bond at this time is crucial, and may contribute to the child’s emotional, cognitive, and social development. One important feature of psychotic disorders is the disruption to cognitive function. This is illustrated by the way in which patients interpret and act on perceptions. Another problem is the speed of cognition, whereby psychotic patients often process executive functions much more slowly. These cognitive impairments represent a potential problem for the mother, whose attention should be more focused on childcare at this time. Some research has shown the extent of poor quality of mother-infant interaction in maternal mental illness, but few have focused on the mechanisms involved; we sought to address that. Potential contributors to these mechanisms include severity of symptoms, medication, life stressors, and cognitive impairment. We chose to focus on cognition, especially the quality and speed of cognition. We explored these factors, whilst examining the quality of mother-infant interaction and perceived maternal competence.

What we did: We explored several aspects of severe maternal mental illness, focusing on mother-infant interaction, cognitive function, and perceived parental competence. We recruited 6 mothers with psychotic disorder or severe depression, and 12 (healthy control) mothers with no illness. We focused on the first 8 weeks after birth. Cognitive functioning was measured via computerised tasks that included tests of memory (verbal and numeric), speed of functioning, special awareness, and attention. We examined perceptions of parenting skills and stress through a series of questionnaires. We observed mother-infant interaction through video recordings. The camera was placed behind the mother, to capture the infant’s facial expressions and reactions, and put a mirror behind the infant to show the mother’s face (see picture). The interactions within the video were assessed for quality, sensitivity, and appropriateness, using the Crittenden Care Index (CARE; Crittenden, 2004).

We found significant differences found for several measures. Mothers with serious mental illness (SMI) showed poorer mother–infant interaction, poorer perceived maternal competence, and poorer cognitive function than controls. SMI mums were significantly less sensitive, and their infants were significantly less cooperative. SMI mums were significantly slower on speed of memory processing. The relationship between mother–infant interaction and cognitive function was illustrated by significant moderate negative correlations: poorer maternal sensitivity vs. presence of SMI; poorer sensitivity vs. poorer speed of memory scores; presence of SMI vs. poorer speed of memory scores. It would appear that serious maternal mental illness is related to poor cognition, specifically slower speed of memory; this may mediate the illness. These factors are implicated in maternal sensitivity, which reduces her response to her child. For more details, see our paper Steadman, Pawlby, Mayers, Bucks, Gregoire, et al., 2007.