Multiple regression analyses provide further information regarding the strength of each relationship within the process model. Our results suggest that infant temperament has the strongest effect on maternal role with additional significant effects of postpartum depression. Postpartum depression had a smaller, significant direct effect on maternal role. However, within a process context, postpartum depression had a strong effect on infant temperament, suggesting indirect effects on maternal role via infant temperament. Postpartum depression, therefore,contributedtomaternalroleviatwopathways.First, it indirectly affected maternal role through infant temperament. Mothers who are depressed have fewer emotional resourcesandtendtoavoidemotionalinteraction,whichmaybe influencing the development of difficult infant temperament (Field et al. 2005). Alternatively, mothers with high levels of postpartum depression may perceive their infants to be more difficult, whether or not they objectively are (Edhborg et al. 2000). Given that postpartum depression and infant temperament were assessed concurrently, the current study cannot conclude causality in this relation, so future studies should empirically evaluate this interpretation. Second, postpartum depression contributed directly to maternal role. Depressed mood can color a mother’s perspective, leading to negative evaluation of her mothering skills and effectiveness. These differentpathways ofinfluence suggest that maternal postpartum depression may be a particularly salient target for intervention. Again, these variables were measured concurrently, limiting interpretation of causality. Interventions aimed at mothers at risk for postpartum depression may seek to provide mothers with tangible tools to improveinteractionexperiencesforbothmotherandbaby.For example, interventions could include training which emphasizesdirecteyecontact andpurposefulsmilingwithbaby,and cues to better understand and prioritize baby’s needs. These skillsmay directlyaffectinfanttemperamentand alsoprovide depressed mothers with skills to improve her parenting and subsequent progression in her maternal role (Mercer and Walker 2006). Although our study contributes to a more comprehensive understanding of depression and maternal role, it was not without its limitations. Our study was limited by a small, heterogeneous sample. Further, in using a web-based survey, we lacked diagnostic measures of depression and included only maternal perceptions of infant temperament. While the Infant Characteristics Questionnaire is a well-validated measure, we implemented a shortened version without previous evidence of validity. Additional research examining these relationships will benefit from using larger samples, with the inclusion of physiological variables and objective measures of maternal
depressionandinfanttemperament.Finally,althoughourdata provided longitudinal assessment of depression, infant temperament and maternal role were assessed concurrently with postpartum depression. A more stringent test of the influence of these constructs on each other would include additional time points and repeated assessments to confirm the developmental processes implied in our model. Overall, this study highlights the contribution of both maternal depression and infant temperament in mothers’ evaluationsoftheirmaternalrole.Considerationofbothprenataland postpartum depression demonstrated how risk for negative effects onmaternalroledevelopment may evolveacrosstime. Inclusion of infant temperament acknowledged the dynamic nature ofthe mother-infant relationship and the importance of both partners in maternal role development. These results reveal specific points of intervention for pregnant and postpartum women exhibiting higher levels of depressive symptoms to help achieve optimal development for both them and their infants.
Acknowledgments This research was supported in part by a research award from the American Psychiatric Nurses Foundation.