Research report
Infant massage improves mother–infant interaction for mothers with postnatal depression

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Abstract

Background: Postnatal depression can have long term adverse consequences for the mother–infant relationship and the infant’s development. Improving a mother’s depression per se has been found to have little impact on mother–infant interaction. The aims of this study were to determine whether attending regular massage classes could reduce maternal depression and also improve the quality of mother–infant interaction. Method: Thirty-four primiparous depressed mothers, median 9 weeks postpartum, identified as being depressed following completion of the Edinburgh Postnatal Depression Scale (EPDS) at 4 weeks postpartum, were randomly allocated either to an infant massage class and a support group (massage group) or to a support group (control group). Each group attended for five weekly sessions. Changes in maternal depression and mother–infant interaction were assessed at the beginning and the end of the study by comparing EPDS scores and ratings of videotaped mother–infant interaction. Results: The EPDS scores fell in both groups. Significant improvement of mother–infant interaction was seen only in the massage group. Limitation: The sample size was small and had relatively high dropout. It was not possible to distinguish which aspects of the infant massage class contributed to the benefit. Conclusion: This study suggests that learning the practice of infant massage by mothers is an effective treatment for facilitating mother–infant interaction in mothers with postnatal depression.

Introduction

Postnatal depression affects 10–15% of mothers (O’Hara and Swain, 1996) and there is evidence that it is linked with impaired mother–infant interaction and with adverse psychological developmental outcome for the child (Cogill et al., 1986, Murray, 1992, Sharp et al., 1995, Murray and Cooper, 1997). The early postpartum months may be especially important for the establishment of a satisfactory relationship between mother and infant and also for infant development (Hay and Kumar, 1995). It is clearly of potential clinical benefit if the interaction in depressed mothers can be enhanced by a positive intervention in the early postpartum period.

Improving maternal depression does not, in itself, necessarily improve mother–infant interaction (Cooper and Murray, 1997). Direct attempts to improve the quality of mother–infant interactions, independently of improving their depression, have been reported to have had more success. ‘Brief mother–baby psychotherapy’ has been proposed by Cramer et al. (1990). A second therapeutic approach is that of McDonnough (1993) which uses cognitive-behavioural strategies to improve the mother’s parenting capacities. Field (1977) has recommended teaching mothers both about infants’ cues and also about massage. In one study with the infants of depressed adolescent mothers, she showed that massage of the infants by a trained nurse had several beneficial effects such as improved growth, as well as improved interaction between the mother and her infant (Field et al., 1996b). In another study she coached overintrusive mothers to imitate their infants and withdrawn mothers to keep their infants’ attention (Malphurs et al., 1996).

One possible strategy for improving mother–infant interaction when mothers are depressed is for them to learn to massage their infants. The aim of the present study was to determine whether attending an infant massage class, which also emphasized understanding the infant’s behavioural cues, could help mother–infant interaction in mothers with postnatal depression. The effects on maternal depression were also monitored.

Section snippets

Subjects

Primiparous mothers who delivered at Queen Charlotte’s and Chelsea Hospital who were aged 18 to 45 years with a singleton born from 37 to 42 weeks gestation, with no gross congenital abnormality and not requiring admission to a special care baby unit, were eligible for the study. Eight hundred and thirty such women were sent the Edinburgh Postnatal Depression Scale (EPDS) (Cox et al., 1987) at 4 weeks postpartum and 581 (70.0%) completed it. Ninety one (15.7%) scored ≥13 (the screening cut-off

Results

Table 1 shows the characteristics of the two groups that completed the study together with the dropouts. There was no difference in baseline depression score or other demographic variables in the two groups, or in those that started but did not complete the study. One mother in the massage group was taking anti-depressants and one in the control group had been depressed during pregnancy.

Table 2 shows the results for the EPDS scores. There was an improvement in mood in both groups over the few

Discussion

This study has found a clear benefit for mothers with postnatal depression from attending 5 weeks of a massage class.

First, there was a greater improvement in depression scores in the massage group than in the control group. It must be noted that much of the effect was before the class started and may reflect expectation (Appleby et al., 1997). However, the benefit was maintained. Several previous studies have shown improvements in depression following non-directive counselling (Holden et al.,

Acknowledgements

We thank all the mothers and infants who participated in this study; our thanks also to Cherry Bond, Alison Hodgkinson and Lowell Herbert for the massage class, Melanie Gunning for videotape rating, to Professor Lynne Murray for helpful comments, and Caroline Doré for statistical advice.

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Dr. Kumar sadly died last September.

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