The attachment-based intervention of child-parent psychotherapy (CPP) for toddlers and their mothers with major depressive disorder (MDD) benefits both individuals’ affective expression and cohesion long-term, according to a study published in Research on Child and Adolescent Psychopathology.

Researchers included 135 dyads of mothers with MDD and toddlers. Mothers were 92.8% White and were aged 21 to 41 years while children were an average of 20.34 months old (standard deviation (SD): 4.68 months). Mothers with bipolar disorder were excluded.

The dyads were assigned to the intervention (DI) of CPP (final n=46) or a depressed control (DC) condition of no intervention (n=47). They were compared with a healthy control group of mothers without depression or other current or past major psychiatric disorder (NC, n=42) at T1 (20 months old); at T2, post-intervention (36 months old); and at T3, follow-up, 9 years old. Between T1 and T2, about 45% of mothers of both DI and DC groups engaged in outside interventions such as individual psychotherapy (34%), marital therapy (11.3%) or group therapy (5.2%).


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CPP interventions involved weekly hour-long sessions for an average of 58.19 weeks (SD=10). The mean number of schedules successfully conducted was 45.24 (SD=11.16).

At T1, 83.3% of DI dyads were insecurely attached, and that level fell to 32.6% after CPP. In the DC group, 78.1% of dyads were insecurely attached at T1, which rose to 83.3% at T2. Among the NC group, a greater portion of dyads were insecure at T2 than T1 (44.1% grew to 52.4%). Maternal depressive symptoms at T3 were significantly associated with less positive maternal affect, increased maternal coercive control, and increased child anger.

The researchers found that toddlers in the DI group were significantly more likely than those in either of the other groups to change to secure attachment at T2 as NC and DC groups showed stability in attachment from T1 to T2.

Maternal depressive symptoms were stable over time and did not significantly impact T2 attachment security. Mothers who participated in other mental health treatments were more likely to have greater depressive symptoms at T2. Greater depression among mothers at T2 predicted significantly less Maternal Warmth, Child Anger/Problem Behavior, and Dyadic Cohesion at T3.

Mediation analyses showed that insecurely attached toddlers of mothers with depression who received CPP were more likely to become securely attached at T2 compared with both the DC and NC groups. These dyads who changed had further success at T3, as the mothers had higher levels of maternal warmth (95% confidence interval (CI) [-.63, -.04]) and the children had lower levels of Child Anger/Problem Behavior (95% CI [.08, .76]).

Limitations of the study include the fact that the sample was restricted to middle-class mothers, of whom most were White and college graduates, and that CPP was compared with a non-intervention control instead of another treatment.

References

Guild DJ, Alto ME, Handley ED, Rogosch F, Cicchetti D, Toth SL. Attachment and affect between mothers with depression and their children: Longitudinal outcomes of child parent psychotherapy. Res Child Adolesc Psychopatho. 49:563–577 (2021). doi:10.1007/s10802-020-00681-0