Grief and Loss Across the Lifespan, Second Edition

76 Grief and Loss Across the Lifespan

facial expression. Eddie shows little ability to self-soothe, an inability to sus-

tain focus on play, a worried facial expression, and muted affect and is not

easily calmed or soothed.

Maternal Depression and Risks to the Caregiving Environment

Maternal depression is a broad term that includes depression that occurs pre-

natally or during gestation (Gurian, 2003). Maternal depression may impact the

mother’s ability to utilize prenatal care or to provide self-care during pregnancy,

and can vary in type and degree to include a period of “postpartum blues” as

well as the more serious condition of postpartum depression. Postpartum psy-

chosis, though rare, can also occur. In addition, episodes of maternal depression

can vary with regard to their timing, severity, and duration, and may be either

single episodes or recurring in nature. Factors such as the many physiological

and hormonal changes occurring during and after pregnancy, the severity of

psychosocial stressors experienced, a lack of access to social support, and a pre-

existing history of depression and/or unresolved experiences of loss and grief

as are associated with a higher likelihood of experiencing maternal depression.

Impact of Maternal Depression on Infant and Early Childhood

Development

Prenatally, infants of depressed mothers are exposed to a higher level of stress

chemicals, which alters infants’ immunological systems and prenatal growth

patterns. Infants of depressed mothers are more difficult to soothe, showing

greater levels of distress, and often have deficits in their ability to sustain gaze

and interaction. Toddlers of depressed mothers display more behavioral prob-

lems, less capacity for emotional regulation and delays in language devel-

opment. During childhood and adolescence, children of depressed mothers

show greater difficulty with peer relationships, learning readiness, and both

internalizing and externalizing disorders (Embry & Dawson, 2002).

Maternal depression has been described as a condition of “double jeop-

ardy” in that it simultaneously poses risks to both mother and child. The

symptoms of maternal depression interfere with the parental ability to engage

in contingently responsive, or “serve and return interactions” (Center on the

Developing Child, 2009). These “serve and return” interactions are infused

with an attuned understanding of the needs of the developing infant and the

internal world of the child. Developmental neuroscience research has shown

this type of interaction to be particularly important to the development of

attachment as well as infant brain development; lack of attuned caregiving is

associated with impairment of the stress response system and other indicators

of social and emotional competence (Gunnar, 2000).

Mothers who are depressed are less likely to respond to infant cues in ways

that reflect an accurate appraisal of the infant’s needs. Whether the maternal

behavior is over-stimulating (as in intrusive interactions) or under- stimulating

(as in interaction characterized by withdrawal and neglect), the infant is neg-

atively affected (Embry & Dawson, 2002). Both patterns are associated with

high levels of infant psychophysiological arousal and anxiety that can lead to

negative developmental outcomes even after maternal depression is lessened