The bond between a mother and child is one of the strongest and most elemental in life. York University psychology Professor Rebecca Pillai Riddell, associate vice-president research, led a research team with members from the universities of Ottawa and Toronto and the Hospital for Sick Children (SickKids) as they examined links between maternal depression symptoms and mother-child attachment early in life. The first author of this work was Shaylea Badovinac, a doctoral student and Ontario Graduate Fellow in York University’s Faculty of Health.
The study concluded that mothers of children with “disorganized” or “controlling” attachment styles consistently report the most depressive symptoms across the child’s first three years of life. These attachment styles are particularly dysfunctional, as they describe children who do not have a coherent strategy for obtaining the comfort and care from their parent that helps them adaptively manage their emotions in distressing situations.
This situation – the mental health of the mother and the dysfunctional behaviour of the child – is a bit of a chicken and egg. Existing research tells us that caregiver/parent behaviour shapes children’s attachment patterns.
“We’ve made good progress in better understanding the ways that maternal psychological challenges may be associated with dysfunctional attachment outcomes,” Pillai Riddell sums up. She emphasizes that these findings reiterate the importance of supporting mothers when treating children for attachment challenges.
This research, the findings of which were published in PLOS ONE in 2018, was funded by the Social Sciences & Humanities Research Council, the Natural Sciences & Engineering Research Council of Canada and the Ontario Graduate Fellowship program.
Research needed as maternal mental health is major public health challenge
The World Health Organization named maternal mental illness a major public health challenge. It also reported that depressive disorders are the most commonly diagnosed psychological disorders for mothers.
Pillai Riddell’s research focuses on the dynamics of the caregiver-child relationship in distressing contexts such as pain. Her research draws on attachment theory, which states that infants are biologically predisposed to forming close bonds with their primary caregivers, usually their parents, and suggests that nurturing a secure attachment is a critical milestone in early childhood.
“Despite what we’ve learned about the importance of learning emotional regulation and its dependence on early caregiving, little work has been done to help integrate this knowledge into pediatric primary care settings,” she explains – again, emphasizing the practical application of this new knowledge.
Researchers suspected they would find significant association between depression and attachment issues
This study was a systematic review, which collects data, critically appraises existing research studies and synthesizes the studies.
Pillai Riddell’s team of researchers set out to review and analyze concurrent and longitudinal associations between maternal depression symptoms and attachment in preschool-aged children – specifically, children two to seven years of age. They also wanted to investigate how these associations varied as a function of the child’s age and how maternal depression symptoms may be linked to specific types of attachment styles – i.e. secure, avoidant, resistant or disorganized and controlling attachments.
“We hypothesized that we would identify significant associations between maternal depressive symptoms and attachment outcomes, particularly with regard to attachment insecurity,” she explains.
Rigorous methodology developed working with SickKids’ librarian
How did the researchers find the best and most suitable studies to assemble and analyze? Working with an academic librarian at SickKids, they developed a strategy for finding appropriate studies and fine-tuned the inclusion and exclusion criteria. They limited their work to related studies published in English and after 1985, for example.
In total, this search strategy resulted in the identification of nearly 8,000 abstracts. After a team of co-authors reviewed the abstracts to identify potential candidates, 363 articles were selected for full-text review and 18 studies were ultimately included in the review.
The key finding, as noted, was that the preschool-age children with disorganized and controlling attachment styles typically had mothers who reported more depressive symptoms relative to mothers of children with more organized and coherent attachment styles.
Pillai Riddell presses for more research
Pillai Riddell would like to see more research in this important area. She suggests that more could be gained by studying the disorganized/controlling group variation.
“Since studies from two large samples found that mothers of behaviourally disorganized children consistently reported the most depressive symptoms, it is possible that distinct patterns of maternal behaviour may place children at elevated risk for this particular attachment outcome,” she explains.
Changes in clinical practices could optimize child development outcomes
This research points the way to priorities in clinical practices, Pillai Riddell emphasizes. Since disorganized attachment has been linked to a variety of negative outcomes in children’s social and emotional development, she asks, “How can we identify and prevent the maladaptive developmental outcomes associated with this pattern of mother-child interactions?”
Pillai Riddell notes that there are opportunities to screen for maternal mental health challenges during the early years of a child’s life – for example, during postnatal visits or even prenatally – that have been implemented with success in some regions of Canada and the United States.
“Given these opportunities, our research supports using maternal mental health screening during pregnancy and the early years as a strategy for optimizing child development outcomes,” she says.
To read the article “Associations between mother-preschooler attachment and maternal depression symptoms: A systematic review and meta-analysis” in PLOS ONE, visit the website. To learn more about Pillai Riddell’s research, visit her faculty profile page or the website for the Opportunities to Understand Childhood Hurt (O.U.C.H.) Laboratory, which Pillai Riddell runs. She is also a scientific staff member at SickKids and an adjunct associate professor at the University of Toronto.
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By Megan Mueller, senior manager, research communications, Office of the Vice-President Research & Innovation, York University, muellerm@yorku.ca