Understanding the impact of postpartum psychiatric symptoms in women at risk of postpartum psychosis on the mother-infant relationship and infant development

Student thesis: Doctoral ThesisDoctor of Philosophy


Background: Despite the severity of postpartum psychosis (PP), little research has been done to investigate the potential impact of this illness on mother-infant relationship and infant development. This study aimed to investigate mother-infant relationship in women at risk of PP who developed and did not develop clinical symptoms postnatally and their infants’ development. The study also examined women’s childhood experience of maltreatment, ability to recognise emotions and parenting stress, with the hypothesis that these factors may play a role in the mother-infant relationship. It was also hypothesized that mother-infant relationship would be a crucial factor for infant development.

Methodology: In a prospective longitudinal study, 89 pregnant women, 44 at risk of PP because of a DSM-IV diagnosis of Bipolar Affective Disorder, Schizoaffective Disorder or previous PP (At Risk of PP, AR), and 45 with no history of mental illness or family history of PP (Healthy Controls, HC) and their offspring, were followed up from pregnancy until 12 months’ post partum. Depending on whether they suffered a relapse in the first 4 weeks after delivery, women at risk were classified as experiencing clinically significant symptoms (AR-PS) or not (AR-NPS). The 3 groups were compared on their experience of childhood maltreatment, ability to recognise emotions, parenting stress and on measures of mother-infant relationship and infant development.

Results: Compared to the AR-NPS, the AR-PS had a more negative quality of the affective experience towards the foetus. Women from the AR-PS group also had a more negative quality of the affective experience towards the infant postnatally and this was mediated by their higher levels of parenting stress. Women from the AR group had less synchronous interactions with their infants compared to HC. Maternal ability to recognize fear predicted mother-infant synchronicity during the interaction, while the experience of childhood maltreatment was not associated with worse outcomes for the mother-infant relationship. Male infants born to AR women had lower cognitive scores, while both males and females had lower language and motor scores than infants of HC, although females performed better in both groups. The level of mother-infant synchronicity predicted infant language development, although it was not a mediator between maternal Risk of PP and child development.

Conclusion: Although preliminary, these findings shed light on the mother-infant relationship and infant development in women at risk of PP who develop and do not develop clinical symptoms in the early post partum and have important clinical implications. They highlight the importance of promoting preventive interventions with these women from the pregnancy period, to help them to improve their experience of parenting. 

Date of Award1 Jun 2019
Original languageEnglish
Awarding Institution
  • King's College London
SupervisorPaola Dazzan (Supervisor) & Susan Pawlby (Supervisor)

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