The document discusses maternal depressive symptoms and their effects. It begins by introducing the author and her research on reducing depressive symptoms in low-income mothers. It then addresses how to identify depressive symptoms in mothers, including specific behaviors to look for. Depressive symptoms can negatively impact mother-child interactions and the child's development through less interaction and responsiveness. The document outlines risk factors for maternal depression and provides recommendations for staff, including continuing program activities, offering social support, and making appropriate referrals.

1. Maternal Depressive Symptoms:
More than the Baby Blues
Linda S. Beeber, PhD, RN
The University of North Carolina at Chapel
Hill School of Nursing
CB # 7460 Chapel Hill, NC 27599-7460
Tel: (919) 843-2386 FAX: (919) 966-0894
beeber@email.unc.edu

2. About Our Research
• “Reducing Depressive Symptoms in Low-Income Mothers”
– National Institute of Mental Health
• “EHS Latina Mothers: Reducing Depressive Symptoms and Improving
Infant/Toddler Mental Health”
– DHHS/Administration for Child and Family/ACYF Early Head Start-
University Partnership Grant
• “Alumbrando el camino/Bright Moments:” A Curriculum for Staff Working
with Early Head Start Parents with Depressive Symptoms
– DHHS/Administration for Child and Family/ACYF Early Head Start-
University Partnership Grant
• Feasibility of Screening and Recruitment of Low-Income, LEP Latina
Mothers Community-Dwelling Mothers”
– National Institute of Mental Health

3. I will address these questions:
• How do I know a mother is depressed?
• How do depressive symptoms interfere
with optimal mothering and affect her
infant or toddler?
• What risk factors should I know about?
• What can I do?

4. How do I know a mother is
depressed?

5. Depression is…
• a persistent sad mood and loss of joy
accompanied by changes in thinking,
feeling, behaving, relationships, and
bodily functions. The symptoms of
depression may be different from one
person to the next, but the sad mood and
loss of joy are almost always present, even
if the person seems outwardly angry or
irritable.

6. Depression
• Does not have to reach clinical levels
to interfere with mothering
• Depressive symptoms are ALWAYS
important in a mother of an infant or
toddler
• Depressive symptoms that last 6
months or longer will negatively
affect the infant or toddler

7. Depressive Symptoms and Mothers:
National Figures
• During pregnancy:
– Trimester 1 --- 7.4%
– Trimester 2 --- 12.8
– Trimester 3 --- 12.0
• 19% women experience depression at
some point including post partum
• “Postpartum” is a milestone – may not be
related to the pregnancy!
• Influenced by samples providing the data

8. Depressive Symptoms
and Mothers
• North Carolina:
– 19% of new mothers indicated they were moderately or
severely depressed after delivery (PRAMS 2001-2003)
– 23% African American/Lumbee Indian sample in
Eastern NC
– 48% National Early Head Start Evaluation
– 51% Latina mothers in 3 Early Head Start (EHS)
programs scored over 16 on the Center for
Epidemiological Studies Depression Scale (CES-D) (97
out of 191)(Alas, 2007)
– 53% African American and Caucasian mothers in 7
EHS programs in NC (6 and NY (461/877 mothers)

9. Baby Blues or Depressive
Symptoms? HANDOUT
Baby Blues Depressive Sxs/Depression
2-3 days after delivery May be there during
pregnancy, appear anytime
after delivery
Last a week or less Persist for more than a week
A few symptoms; come and Many symptoms are present
go (sad, crying,overwhelmed) (see list on “What to Do” handout)
Mother can be “cheered up” Mother cannot be “cheered
up”

10. Three Presentations
• “Blunted mother”
– Sad or emotion-less
– Slowed, fatiqued
• “Angry, irritable mother”
– Emotionally reactive to noise, frustrations
– Unpredictable
• “Good enough mother”
– Adequately nurtures the child
– No energy for other aspects of her life

11. How Do I Know that a Mother is
Depressed During Pregnancy?
• Persistence of symptoms e.g., morning
sickness & vomiting past 3rd month
• Self-endangerment (poor nutrition, lack of
care, excessive exercise, smoking, drugs)
• Disinterest in preparing for the baby
• Dread or negative beliefs about the outcome
or toward the baby

12. How Do I Know that a Mother is
Depressed? (Parenting)
• Short, less frequent interactions
• Little interest or child-centered attention
• Rarely touches
• Rough touch
• Sad, angry face toward the child
• Critical judgments of child
• Negative responses to the child that are not anchored to
her/his behavior

13. How Do I Know that a Mother is
Depressed? (Parenting)
• Intrusive parenting actions that don’t
correspond to the child’s cues
• Talking “at” the child – ordering the child
to do things
• No joy when the child accomplishes
something
• No playfulness with the child (everything
is serious business)
• No pride or in being a parent or openly
angry about being a parent

14. How Do I Know that a Mother is
Depressed? (Program Participation)
• Decreased involvement in • Not following through on
activities they previously parenting activities that
attended are suggested
• Coming late or leaving • Avoiding or confronting
early from activities teachers & staff
• Looking bored with the • Complaining to
activity administration about
• Being loudly critical of teachers or staff behavior
activities

15. How do depressive symptoms
interfere with optimal mothering and
affect her infant or toddler?

16. To An Infant or Toddler,
Mother is “the World”
• Teaches the “Mother Tongue”
• Creates the beginning of “Me”
• Models the very first intimate
relationship
• Makes the first “Social
Introductions”

17. To An Infant or Toddler,
Mother is “the World”
• Teaches the “Mother Tongue”
– “Motherese” builds first language
– Mother talks my language (“Wow! I can
sound like she does!”)
• Depressed mothers talk less or in
consistently low tones

18. To An Infant or Toddler,
Mother is “the World”
• Creates the beginning of “Me”
– Mother smiles at me (“I must be
beautiful”)
– Mother kisses me (“I must be loveable”)
– Mother looks joyfully at me (I must be a
good person!”)
• Depressed mothers struggle to show
joy and positive feelings

19. To An Infant or Toddler,
Mother is “the World”
• Models the very first intimate
relationship
– Mother is there to help me (“Others are
safe and I can rely on them”)
– Mother is gentle (“I can expect others to
be trustworthy”)
• Depressed mothers struggle to stay
connected and consistently responsive

20. To An Infant or Toddler,
Mother is “the World”
• Makes the first “Social Introductions”
– Mother shows me off to kin and
community (“I must be somebody!”)
– Mother tells me how to behave in her
social circle (“I must belong here”)
• Depressed mothers isolate themselves
and are anxious in social settings

21. How Do Mothers’ Depressive
Symptoms Impact Infants &
Toddlers?
• Delayed language & developmental
milestones
• More negative affect
• Severe tantrums
• Less social interest & exploration

22. What Factors Put a Mother at Risk
for Depressive Symptoms?

23. Risks to Mothers?
• Previous depressive symptoms, diagnosed
depressive disorder, or other mood disorder
• Childhood trauma
• Recent “exit” events
• “Shame” or “Entrapment” events
• Current stressors (may be mild but chronic)
• Interpersonal tensions
• Poor social support, especially confidant support

24. What Can I Do?

25. Curriculum Project
• Regular program activities can support a
depressed parent
• Staff need support to work closely with depressed
parents especially around crisis situations

26. What Can I Do? 10 Lessons…
1. Keep the child in the program
2. Reach out
3. Keep trying
4. Be patient. Be consistent. Don’t Take
Over!
5. Stay sensitive to her low energy

27. What Can I Do? 10 Lessons…
6. Keep it simple. Repeat things. Give her
reminders. Emphasize one strength.
7. Break big goals into small ones.
8. Praise them.
9. Expectations low…optimism high.
10. Invest in the mother, not her progress.

28. A Mother is Depressed…What to
Do?
LEVEL ONE: Referral for evaluation; Intensive services
and close contact by phone
• Sad, but can get out of the mood
• Scattered thoughts, but able to focus on tasks for short periods;
child care does not suffer
• Not much pleasure in things; little interest in activities;
• Feels worthless about the self
• Withdraws from others; stays to self
• Sleep, eating, sexual desire, energy level are all down, but not
totally disrupted

29. A Mother is Depressed…What to
Do?
LEVEL TWO: Referral for immediate evaluation;
Frequent Monitoring by staff with Family/Other Support
Continuous
• Sad all the time, can’t get out of the mood
• Can’t focus on other thoughts, concentrate or make decisions
• Continuous crying
• Irritated with others and noise (especially crying or whining by the
child)
• Regular work and care of child is not adequate
• Sleep is poor, but can get some; eating is poor, but is able to eat

30. A Mother is Depressed…What to
Do?
LEVEL THREE: Immediate Protective Containment and
Continuous Monitoring especially when with the child
• Thoughts are mostly about depression or harm (may include
harming the child)
• Suicidal ideas present with a plan and/or a method
• Voices or beliefs that are strange
• Not able to function (remaining in bed all day; inability to care for
the child)
• Not able to sleep or eat for several days
Always talk to your supervisor, team or mental health
resource person

31. Questions????
Linda S. Beeber
beeber@email.unc.edu
The University of North Carolina at Chapel Hill
School of Nursing Tel: (919) 843-2386 FAX: (919) 966-0984
CB #7460, Chapel Hill, NC 27599-7460