Anke Teija M S, Slinning Kari, Moe Vibeke, Brunborg Cathrine, Siqveland Torill S, Skjelstad Dag Vegard
Division of Mental Health and Addiction, Vestre Viken Hospital Trust, 3004, Drammen, Norway.
The Center for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway.
Int J Bipolar Disord. 2020 Aug 31;8(1):27. doi: 10.1186/s40345-020-00192-3.
Bipolar offspring are considered a high-risk group for developing mental disorders. Developmental outcomes result from additive and interactive effects of biological vulnerability and environmental influences. Mother-infant interactions represent important early environmental influences that may modify infants' risk of mental disorders. The aim of the current prospective study was to investigate the patterns and development of mother-infant interactions in the first year of life in dyads in which the mothers have bipolar disorder (BD).
Twenty-six dyads in which the mothers had BD and 28 dyads in which the mothers had no mental disorder were video-taped in a free play interaction. The Parent-Child Early Relational Assessment (PCERA) was used to assess the quality of the interactions on three domains (maternal behaviour, infant behaviour and dyadic coordination) at 3 and 12 months of infant age. First, we compared the mother-infant interaction patterns between the two groups at 12 months. Second, we investigated how the patterns developed within and between the groups from infant ages 3 to 12 months.
BD dyads demonstrated significantly more challenges in all three interaction domains at infant age 12 months compared to the healthy dyads. This observation was in line with the findings at infant age 3 months. Subdued expression of positive affect and mutual underinvolvement represented core challenges in maternal and infant behaviours in the BD dyads. Continuous difficulties with dyadic coordination and reciprocity were the most concerning interaction behaviours at 3 and 12 months. On the positive side, there was little expression of negative affect or tension in maternal, infant and dyadic behaviour, and some positive changes in infant behaviour from 3 to 12 months.
The current results suggest that challenges in mother-infant interaction patterns in the first year of life may enhance the developmental risk for bipolar offspring. Clinical interventions should address both the BD mothers' needs in relation to postpartum mood deviations and mother-infant interactions. We suggest interaction interventions to promote dyadic coordination and reciprocity, such as helping mothers being more sensitive to their infant's cues and to provide attuned contingent responses.
双相情感障碍患者的后代被视为患精神障碍的高危人群。发育结果源于生物易感性和环境影响的累加及交互作用。母婴互动是重要的早期环境影响因素，可能改变婴儿患精神障碍的风险。本前瞻性研究的目的是调查母亲患有双相情感障碍（BD）的二元组在婴儿出生后第一年母婴互动的模式及发展情况。
对26个母亲患有BD的二元组和28个母亲无精神障碍的二元组进行自由玩耍互动的录像。采用亲子早期关系评估（PCERA）在婴儿3个月和12个月时评估三个领域（母亲行为、婴儿行为和二元协调性）的互动质量。首先，我们比较了两组在12个月时的母婴互动模式。其次，我们调查了从婴儿3个月到12个月期间两组内及两组间模式的发展情况。
与健康二元组相比，BD二元组在婴儿12个月时在所有三个互动领域均表现出明显更多的挑战。这一观察结果与3个月大婴儿时的发现一致。积极情感表达抑制和相互参与不足是BD二元组中母婴行为的核心挑战。二元协调和互惠方面的持续困难是3个月和12个月时最令人担忧的互动行为。从积极方面来看，母婴及二元行为中几乎没有消极情感或紧张情绪表达，并且婴儿行为从3个月到12个月有一些积极变化。
目前的结果表明，生命第一年母婴互动模式中的挑战可能会增加双相情感障碍患者后代的发育风险。临床干预应同时关注BD母亲产后情绪偏差及母婴互动方面的需求。我们建议进行互动干预以促进二元协调和互惠，比如帮助母亲对婴儿的线索更敏感并提供协调一致的适时反应。
