Maternal Mental Health Moderates the Relationship Between Oxytocin and Interactive Behavior

Mothers with mood or anxiety disorders exhibit less optimal interactive behavior. The neuropeptide oxytocin (OT) has been linked to more optimal interactive behaviors in mothers without mental illness, and it may play a particularly beneficial role in mothers with mood or anxiety disorders given its antidepressant and anxiolytic functions. We compared the relationship between OT and interactive behavior in mothers with and without mental health problems. Participants included 20 women diagnosed with postpartum mood or anxiety disorders (clinical sample) and 90 women with low levels of depression and anxiety during pregnancy and postpartum (community sample). At 2 months' postpartum, blood was drawn to assess maternal OT levels, and mother–infant interaction was coded for maternal sensitivity, intrusiveness, remoteness, and depressiveness. Clinical mothers exhibited less sensitive, more intrusive, and more depressive interactive behaviors than did community mothers. The groups did not differ in OT levels. Mothers with higher OT levels were less intrusive with their infants. Higher OT levels were associated with less depressive interactive behavior only in clinical mothers. OT was associated with positive interactive behaviors in both groups. In clinical mothers, the calming and soothing effects of OT may promote more relaxed, energetic, and infant-focused interactive behaviors. Propósito: las madres con trastornos de estado anímico o ansiedad exhiben conductas interactivas menos óptimas. La oxitocina (OT) es un neuropéptido que ha sido asociado con conductas interactivas más óptimas en madres sin enfermedad mental, y pudiera tener un papel particularmente beneficioso en madres con trastornos de estado anímico o ansiedad dadas sus funciones antidepresivas y ansiolíticas. Comparamos las relaciones entre OT y la conducta interactiva en madres con y sin problemas de salud mental. Métodos: las participantes fueron 20 mujeres con diagnosis de trastornos de estado anímico o ansiedad con posterioridad al parto (grupo muestra clínico), y 90 mujeres con bajos niveles de depresión y ansiedad durante el embarazo y con posterioridad al parto (grupo muestra comunitario). A los dos meses después del parto, se les sacó sangre para evaluar los niveles maternales de OT, y se codificó la interacción en cuanto a sensibilidad materna, entremetimiento, alejamiento y sentimiento depresivo. Resultados: las madres del grupo clínico mostraron conductas interactivas menos sensibles, más entremetidas, y más depresivas que las madres del grupo comunitario. Los grupos no difirieron en cuanto a los niveles de OT. Las madres con niveles más altos de OT fueron menos entremetidas con sus infantes. Los más altos niveles de OT se asociaron con conductas interactivas menos depresivas sólo en el grupo clínico de madres. Conclusiones: Se asoció la OT con conductas interactivas positivas en ambos grupos. En las madres del grupo clínico, los efectos calmantes y de alivio de OT pudieran promover conductas interactivas más relajantes, energéticas y enfocadas en el infante. But: Les mères ayant des troubles de l’humeur ou de l’anxiété font preuve d’un comportement interactif moins optimal. L’oxytocin neuropeptide (abrégé ici OT) a été lié à des comportements interactifs plus optimaux chez les mères n’ayant pas de maladie mentale, et pourrait jouer un rôle particulièrement bénéfique chez les mères ayant des troubles de l’humour ou de l’anxiété au vu de ses fonctions anti-dépressives et anxiolytiques. Nous avons comparé la relation entre l’OT et le comportement interactif chez des mères avec et sans problèmes de santé mentale. Méthodes: Les participantes ont compris 20 femmes diagnostiquées comme ayant des problèmes postpartum d’humeur ou d’anxiété échantillon Clinique) et 90 femmes ayant des niveaux peu élevés de dépression et d’anxiété durant la grossesse et après la grossesse (échantillon communautaire). A 2 mois après la naissance, une prise de sang a été faite afin d’évaluer les niveaux d’OT maternels, et l’interaction mère-enfant a été codée pour la sensibilité maternelle, l’intrusion, la distance et la propension à la dépression. Résultats: Les mères cliniques ont fait preuve de comportements interactifs moins sensibles, plus intrusifs, et plus dépressifs par rapport aux autres mères. Les groupes n’ont pas différé pour ce qui concerne les niveaux d’OT. Les mères ayant des niveaux d’OT plus élevés étaient moins intrusives avec leurs bébés. Les niveaux plus élevés d’OT étaient liés à un comportement interactif moins dépressif uniquement chez les mères cliniques. Conclusions: L’OT était lié à des comportements interactifs positifs chez les deux groupes. Chez les mères cliniques les effets calmants et relaxants de l’OT peut promouvoir des comportements interactifs plus relax, plus énergique et placés sur le nourrisson. Ziel: Mütter mit Stimmungs- oder Angststörungen weisen weniger optimales Interaktionsverhalten auf. Das Neuropeptid Oxytocin (OT) wurde mit optimalem Interaktionsverhalten bei Müttern ohne psychische Erkrankung in Verbindung gebracht und könnte angesichts seiner antidepressiven und angstlindernden Funktionen eine besonders begünstigende Rolle bei Müttern mit Stimmungs- oder Angststörungen spielen. Wir verglichen den Zusammenhang zwischen OT und Interaktionsverhalten bei Müttern ohne und mit psychischen Problemen. Methoden: Die Teilnehmer umfassen 20 Frauen mit diagnostizierten postpartalen Stimmungs- oder Angststörungen (klinische Stichprobe) und 90 Frauen mit niedrigen Depressions- und Angstniveau während der Schwangerschaft und nach der Geburt (Bevölkerungsstichprobe). 2 Monate nach der Geburt wurde Blut abgenommen, um das mütterliche OT-Level zu bewerten und die Mutter-Kind-Interaktion wurde für mütterliche Sensitivität, Intrusivität, Distanziertheit und Depressivität kodiert. Ergebnisse: Klinische Mütter zeigten weniger sensitives, mehr intrusives und mehr depressives Interaktionsverhalten als Mütter aus der Bevölkerung. Die Gruppen unterschieden sich nicht im OT-Level. Mütter mit höherem OT-Level waren weniger intrusiv mit ihren Säuglingen. Höhere OT-Level wurden nur bei klinischen Müttern mit weniger depressiven Interaktionsverhalten assoziiert. Schlussfolgerungen: OT wurde in beiden Gruppen mit positivem Interaktionsverhalten assoziiert. Bei klinischen Müttern könnte die beruhigende und entspannende Wirkung von OT ein entspannteres, energiegeladeneres und kind-orientierteres Interaktionsverhalten fördern. 目的:気分障害あるいは不安障害の母親は、至適ではない相互交流行動を示す。神経ペプチド、オキシトシン oxytocin (OT) は、精神疾患のない母親におけるより至適な相互交流行動とつながりがあり、その抗うつおよび抗不安機能を考えると、気分障害あるいは不安障害の母親において、特に有益な役割をはたしているだろう。私たちは、精神保健問題のある母親とない母親において、OTと相互交流行動の関係を比較した。方法:参加者には、産後気分障害あるいは不安障害と診断された20人の女性(臨床群)と、妊娠中および出産後の抑うつと不安のレベルが低かった90人の女性(地域群)が含まれた。産後2か月時に、母親のOTレベルを測定するために採血され、母親-乳児相互交流が、母親の感受性、侵入性、よそよそしさ、および抑うつについてコード化された。結果:臨床群の母親は、地域群の母親よりも、感受性が低く、侵入性が高く、より抑うつ的な相互交流行動を示した。両群はOTレベルに差が無かった。OTレベルの高い母親は、乳児に侵入的ではなかった。高いOTレベルは、臨床群の母親にだけ、より抑うつ的な相互交流行動の少なさと関連した。結論:OTは両群でポジティブな相互交流行動と関連した。臨床群の母親では、OTの穏やかにして落ち着かせる効果が、よりリラックスして元気があり乳児に焦点化した相互交流行動を促進するだろう。 目的:有情感或焦慮疾患的母親不能表達最合適的互動行為。在無精神病的母親中,神經肽催産素(OT)已被聯繫到較多的互動行為,而且因為它的抗鬱及抗焦慮作用,可能令它對有情感或焦慮疾患的母親也會有一個特別有益的作用。我們比較在有及無精神健康問題的母親中OT與互動行為的關係。方法:參與者包括二十個被診斷為有產後情感或焦慮疾患的女性(臨床樣本),及九十名在妊娠期和產後衹有低程度憂鬱和焦慮的女性(社區樣本)。在產後兩個月時用抽血去評估產婦的OT水平,同時亦從母嬰互動中為母親的敏感性,侵擾性,漠然性及憂鬱性作了編碼。結果:臨床樣本母親比社區樣本母親表現較少敏感性,較多侵擾性及較多憂鬱性的互動行為。這兩組的OT水平並無不同。有較高OT水平的母親對她們的幼兒有較少的侵擾。高OT水平祇有在臨床樣本中才與低憂鬱互動行為有關。結論:OT在兩組中都與正向的互動行為有關。在臨㡷樣本的母親中,OT的鎮定和撫慰效應可能會促進更多輕鬆的,精力充沛的,及以幼兒為中心的互動行為。 Mothers with postpartum mood or anxiety disorders are at greater risk for exhibiting poor interactive behaviors (McErlean & Eapen, 2012). For instance, depressed mothers have been shown to be less sensitive with their 6- to 30-month-olds (Coyne, Low, Miller, Seifer, & Dickstein, 2007; Crockenberg & Leerkes, 2003). They also exhibit fewer matched states and less synchrony with their children (for a review, see Feldman, 2007). In a meta-analysis of studies with children up to 16 years of age, depressed mothers were found to exhibit less enthusiastic and pleasant behaviors as well as increased negative affect and more coercive, hostile, disengaged, and uninvolved behaviors (Lovejoy, Graczyk, O'Hare, & Neuman, 2000). Similarly, during interactions with their infants, anxious mothers exhibited less sensitivity (Feldman et al., 2009; Nicol-Harper, Harvey, & Stein, 2007), less structuring (Zelkowitz, Papageorgiou, Bardin, & Wang, 2009), and more exaggerated (e.g., excessively frequent) behavior (Kaitz, Maytal, Devor, Bergman, & Mankuta, 2010). Maternal interactive behaviors have important implications in that they predict various child outcomes such as attachment style (Dexter, Wong, Stacks, Beeghly, & Barnett, 2013), internalizing and externalizing symptoms (Laucht, Esser, & Schmidt, 2002; Mäntymaa, Puura, Luoma, Salmelin, & Tamminen, 2004), and linguistic and cognitive development, socioemotional competence, and responsiveness toward their mothers (Wang & Dix, 2013). A consideration of hormonal factors associated with both maternal mood and behavior may be useful in elucidating how maternal mental health impacts the mother–infant relationship. One such factor that has received increased attention in recent decades is oxytocin (OT), a neuropeptide primarily produced in the supraoptic and paraventricular nuclei of the hypothalamus (Brunton & Russell, 2008). OT has been linked to maternal caregiving behaviors in both animal and human studies (for reviews, see Galbally, Lewis, van IJzendoorn, & Permezel, 2011; Rilling & Young, 2014). In animal studies, female rats who were more responsive toward pups and exhibited higher levels of pup licking/grooming had higher OT receptor levels in certain brain regions, including the central nucleus of the amygdala and the bed nucleus of the stria & oxytocin their pups less & Similarly, in human studies, maternal levels of OT during the postpartum have been associated to synchrony with & Feldman, 2011; Feldman, & 2011; & Feldman, positive & 2007; et al., & Feldman, and positive interactive (Feldman et al., OT has been linked to more optimal interactive behaviors in community of mothers without mental may the between OT and maternal behavior. In OT has been shown to in brain to and the and et al., and between brain to and the and in with et al., 2013). the of OT has been found to et al., as well as the to the mental states of the & 2007). with mood or anxiety who to exhibit interactive also have been shown to have levels of OT. In have a negative relationship between OT levels and both anxiety et al., et al., and depression & Feldman, & Feldman, et al., & 2009; et al., 2007; & 2011; & & that OT has been linked to both maternal interactive behavior and mental it may to mothers with mental health exhibit less optimal interactive behaviors with their infants. A studies of OT and interactive behavior in depressed have in recent to mothers and their depressed mothers had OT levels, and their children exhibited during interactions et al., 2013). In depressed mothers who were OT were more intrusive their van IJzendoorn, & and to their relationship with their child more van IJzendoorn, & 2013). the studies a of mothers, it to the that maternal mental health and OT in interactive behavior during no studies to have compared the relationship between OT levels and interactive behaviors during the postpartum in mothers with and without mental health problems. is that OT a particularly beneficial role in mothers with mood or anxiety disorders to its anxiolytic and has that OT may of the amygdala et al., et al., and of the OT also has been found to levels of & also see and et al., 2009; with in & 2003). the anxiolytic effects of OT & et al., & for not in & mothers with higher OT levels be less during interactions with their infants. in of animal studies that have the antidepressant effects of OT & & 2002; for a review, see & mothers with higher OT levels be less and during interactions with their infants. In has that mothers with mood and anxiety disorders in interactive and levels of OT, a neuropeptide has been linked to more optimal caregiving behaviors in community of mothers without mental health problems. OT may play a particularly beneficial role in mothers with mood or anxiety disorders given its antidepressant and anxiolytic the of mental health the between OT levels and interactive behavior. the to the maternal mental health the relationship between OT levels and or interactive behaviors. The a of a maternal OT, mental and the mother–infant relationship. who for mental health at the of a were to in the A a to a diagnosis of mental health in with the and of 2000). the women who were to in the for included of or and not to the to OT and interactive behaviors in mothers with mood or anxiety were a diagnosis of or with depressed anxious as well as in the and of the of the did not the mother–infant interactions not be the mothers to be or their not be the of 20 women mood anxiety mood and anxiety and 2 disorders with depressed anxious For to as the The was a of women during a et al., 2014). They the & a of depressive during the at to to postpartum, and 2 months' They also the & a of anxious at to to and 2 months' have as low as of & & 2004), included women with at They also at or the for anxiety et al., the at a community of women who were depressed anxious during the The of 90 women with low both the and the and who both the interaction and the postpartum blood We to as the are in women were were in their The had a The was the for of the mothers. of the were or in with of the 20 clinical they were the were 2 were and and and a and A of blood the of a was were at for The was and at were to the of at the of was were or to the sensitive of the The were and the was to the of and to were in the and of were The has been et al., 2007; & 2004), and has been Mankuta, & with et al., & Feldman, 2013). The OT in the the in studies of OT in women during the (Feldman et al., 2007). The & are a to assess mother–infant interactive behaviors. have been shown to predict cognitive outcomes in et al., and to with the of the for the of the et al., has been with mothers with mental health such as including & and & 2003). also has been in including et al., The maternal were & for to The maternal sensitivity was the of and and to to than of or and and The maternal was the of not the in a that and not The maternal was the of of and without The maternal was the of in and a coded clinical and community the et al., 2014). were for sensitivity, for for and for is as of were both and of were for both & is in with studies that have (e.g., et al., 2007). was for the of the the was Participants to the At 2 months' postpartum, a and a the mother–infant at The a blood to assess OT levels. with (Feldman et al., 2011; et al., blood was drawn or more to the of OT levels et al., age, and was In mother–infant interaction was for Mothers were to with their as they at without The who was in a both of the a was the and the Maternal interactive behaviors were coded the that OT were We OT levels, as was in studies OT and interactions (e.g., et al., et al., were OT levels than OT levels. In the community 2 OT to of and the of for & We to their in the their did not of the their OT of and have been in studies of OT in and postpartum women (e.g., et al., 2007; Feldman, & 2007). We and to that the clinical and community were in of age, as well as of was as a years of were years for for or 16 for for and for We for OT and the in We also and to OT levels and were to the to the community and clinical interactive behaviors and and OT levels. were to that maternal mental health the relationship between OT levels and interactive behaviors. health was coded as (community sample) or (clinical sample). OT levels were as a the interaction the mental health (community and OT levels were and their was for OT and the in are in Clinical and community did not differ in age, or the clinical had more female than did the community In the clinical OT levels and interactive behaviors were not in who were who were was associated with such that mothers with more children were more during interactions with the OT and were not to In sensitivity were higher in who or in with to who OT levels did not differ in who or in with compared to who The community exhibited more sensitivity than did the clinical for in a The groups also in and They did not differ in their for in a They also did not differ in their levels of OT, in OT levels were with of the maternal in both groups and in the clinical maternal mental OT levels, or their interaction to and behaviors. were to maternal mental health the relationship between OT levels and interactive behavior The was of the in maternal behavior was mental health OT levels, and their interaction was a of mental health community mothers exhibited less intrusive behavior than did clinical mothers. also was a of OT mothers with higher OT levels exhibited less intrusive behavior than did mothers with OT levels. The interaction was not to maternal mental health the relationship between OT levels and interactive behavior The was of the in maternal behavior was mental health OT levels, and their interaction was a of mental health interactive community mothers exhibited less depressive behavior than did clinical mothers. was no of OT interactive behavior. A interaction of mental health and OT interactive behavior was that maternal mental health the relationship between OT levels and depressive interactive behaviors. higher levels of OT were linked to less depressive behavior only in mothers with mood or anxiety disorders The to the between OT and maternal behavior were in mothers with and without mental health problems. maternal mental health the relationship between OT and interactive with and found that the community mothers exhibited more optimal interactive behaviors sensitive, than did clinical mothers. The groups did not differ in the of may have as in a low of In to did not that community mothers had higher levels of OT than did clinical mothers. both groups exhibited a of OT levels. The OT and depression have been & et al., to OT levels in depressed have been found to be & et al., 2009), higher et al., during in et al., or not et al., van et al., Similarly, have been OT and anxiety et al., with negative et al., or no et al., 2008). studies may play a role in The relationship between OT and in or postpartum women et al., et al., 2011; et al., may be the hormonal that during the have the relationship between OT and of (e.g., et al., et al., the of may not to of OT in for a (e.g., et al., et al., In a of levels of OT were shown to predict postpartum mood et al., that may be linked not that the relationship between OT and mental health is not that postpartum women with mood and anxiety disorders exhibit a of OT levels. OT levels have been found to women in the (e.g., et al., 2007; et al., 2007; et al., et al., and have to women have higher levels of OT. in OT levels may be to a of including of the OT receptor et al., 2013), attachment and in et al., 2014). of mothers both had levels of OT have been had the of such factors to in OT. is to factors such as and that may the relationship that is between OT levels and mental health problems. We also did not that OT levels in women who compared to who did is with that levels of OT not differ in the groups OT is or more (Feldman et al., 2011; et al., as was the in Similarly, found that OT levels and interactive behaviors were not in who who were is with a recent of no in OT levels in depressed & 2013). the clinical had more female than did the community the were not in female in both is with that has the et al., did not interaction mothers with more children were found to be more during interactions with the the was and may clinical its with found that mothers with higher levels of OT exhibited more optimal interactive behavior. In they were less intrusive during interactions with their infants. OT may have the of mothers to et al., and mental states et al., in their infants, mothers to their than their the of is in with studies that have linked OT to more interactions et al., 2011; et al., 2011; et al., was found that higher OT levels were associated with less depressive behavior in the clinical not in the community who had low levels of depressive and anxious In mothers with postpartum mood or anxiety higher levels of OT may have anxiolytic and antidepressant & de et al., et al., et al., may have clinical mothers to in a more relaxed, energetic, and infant-focused calming and soothing of OT may have been less less in community mothers with low levels of depressive and anxious is in with recent that OT had greater positive effects or outcomes (e.g., and amygdala in diagnosed to & et al., 2010). The has in human studies of OT and and maternal behavior (e.g., et al., et al., levels of OT. For and human assess central levels of OT in the recent has a positive between levels of OT in and in that OT levels be to central OT levels et al., 2014). has been in the the of We to has shown that a of the OT in & 2013). of clinical is and in is to it is of postpartum women with mood or anxiety OT and interactive behavior during the postpartum was to women community (e.g., et al., 2011; et al., 2011; et al., 2007; et al., et al., or clinical of depressed women et al., et al., 2013). the is the to the relationship between OT levels and interactive behavior in postpartum women with and without mental health problems. found that higher OT levels were associated with more optimal interactive behaviors in both a mothers with mood or anxiety disorders exhibited less optimal interactive did not have levels of OT, than did mothers without mental health problems. clinical mothers had a of OT and with higher OT levels exhibited more optimal relaxed, energetic, and interactive behaviors than did with OT levels. higher levels of maternal OT may the negative effects of mental health caregiving behaviors during interactions with their infants. OT may be useful in elucidating depressed mothers exhibit more optimal interactive behaviors than & 2003). In a toward the of the relationship between maternal mood and is to have important implications for and child

Anxiety · Developmental psychology · Intrusiveness · Mental health · Mood · Oxytocin · Pregnancy · Psychiatry · Child and Adolescent Psychosocial and Emotional Development · Clinical Psychology · Neuroendocrine regulation and behavior · Psychology

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