Maternal Depression and Anxiety Across the Postpartum Year and Infant Social Engagement, Fear Regulation, and Stress Reactivity RUTH FELDMAN, PH.D., ADI GRANAT, PH.D., CLARA PARIENTE, M.A., HANNAH KANETY, PH.D., JACOB KUINT, M.D., AND EVA GILBOA-SCHECHTMAN, PH.D. ABSTRACT Objective: To examine the effects of maternal depression on infant social engagement, fear regulation, and cortisol reactivity as compared with maternal anxiety disorders and controls and to assess the role of maternal sensitivity in moderating the relations between maternal depression and infant outcome. Method: Using an extreme-case design, 971 women reported symptoms of anxiety and depression after childbirth and 215 of those at the high and low ends were reevaluated at 6 months. At 9 months, mothers diagnosed with a major depressive disorder (n = 22) and anxiety disorders (n = 19) and matched controls reporting no symptoms across the postpartum year (n = 59) were visited at home. Infant social engagement was observed during motherYinfant interaction, emotion regulation was microcoded from a fear paradigm, and mother’s and infant’s cortisol were sampled at baseline, reactivity, and recovery. Results: The infants of depressed mothers scored the poorest on all three outcomes at 9 monthsVlowest social engagement, less mature regulatory behaviors and more negative emotionality, and highest cortisol reactivityVwith anxious dyads scoring less opti- mally than the controls on maternal sensitivity and infant social engagement. Fear regulation among the children of anxious mothers was similar to that of the controls and their stress reactivity to infants of depressed mothers. Effect of major depressive disorder on social engagement was moderated by maternal sensitivity, whereas two separate effects of maternal disorder and mother sensitivity emerged for stress reactivity. Conclusions: Pathways leading from maternal depression to infant outcome are specific to developmental achievement. Better understanding of such task-specific mechanisms may help devise more specifically targeted interventions. J. Am. Acad. Child Adolesc. Psychiatry, 2009;48(9):919Y927. Key Words: maternal depression, maternal anxiety disorder, social engagement, emotion regulation, cortisol. Maternal depression during the postpartum period has long been known to interfere with the mother’s capacity to care for her infant. 1,2 Longitudinal studies demon- strate that children of depressed mothers exhibit poor cognitive, neuropsychological, social, and emotional skills across childhood and up to adolescence. 3Y7 Maternal depression has similarly been shown to bear long-term negative consequences for the infant’s physiological regulation, particularly the consolidation of the stress response. 8 In searching for mechanisms by which ma- ternal depression affects infant development, researchers have suggested that, in addition to genetic vulnerability, depressed mothers are less competent in constructing a growth-promoting environment for their infants, and their relational behavior is characterized by low sensitivity, restricted range of affective expression, and inconsistent support of the infant’s budding engage- ment. 3,6,7,9 Because sensitive mothering is critical for the infant’s ability to handle social processes, regulate negative emotions, and manage physiological stress, the diminished sensitivity of depressed mothers may serve as an additional risk factor and disrupt the consolidation of early regulatory capacities that support cognitive, Accepted June 9, 2009. Drs. Feldman, Granat, and Gilboa-Schechtman are with Bar-Ilan University; and Drs. Pariente, Kanety, and Kuint are with the Sheba Medical Center. The study was supported by the Israel Science Foundation (Grant 1318/08), the US-Israel Bi-National Science Foundation (Grant 2005-273), and the NARSAD Foundation (Independent Investigator Award to R.F.). Correspondence to Ruth Feldman, Ph.D., Department of Psychology, Bar-Ilan University, Ramat-Gan 52900, Israel; e-mail: Feldman@mail.biu.ac.il. 0890-8567/09/4809-0919Ó2009 by the American Academy of Child and Adolescent Psychiatry. DOI: 10.1097/CHI.0b013e3181b21651 WWW.JAACAP.COM 919 J. AM. ACAD. CHILD ADOLESC. PSYCHIATRY, 48:9, SEPTEMBER 2009