Testing Parent-Infant Mental Health Interventions
Parents suffering from mental illness, addictions to substances of abuse, or domestic violence are less able to respond sensitively to meet their infants’ needs. For this reason, these factors have been called “toxic stressors” to children’s development (Harvard Centre on the Developing Child, 2010). Toxic stress places infants at risk due to unpredictable, neglectful or abusive parenting. In extreme cases, this has been described as “being incubated in terror” (Perry, 1995). At a lesser extreme, infants may be chronically stressed by the lack of emotional and physical safety and security. Toxic stress activates infants’ hypothalamic-pituitary adrenal axis and floods their rapidly developing brains with cortisol. In large persistent doses, cortisol impairs neuronal growth and connectivity with harmful consequences for children’s social-emotional and cognitive development (Gunnar, Herrera, & Hostinar, 2009). Children exposed to early severe stress are also prone to increased sympathetic nervous system arousal, with higher resting heart rate and blood pressure (Saltzman et al., 2005). Qualities of caregiving associated with maternal distress may also interact with the immune system and increase children’s susceptibility to asthma and inflammatory disorders (Kozyrskyj et al., 2007).
Toxic stress associated with alterations in early caregiving leaves a lasting biological fingerprint of damage on children’s brain structure and function, sympathetic nervous system function, immunity, and mental health (Shonkoff, 2004). In 2012, the American Academy of Pediatrics called for interventions to address the effects of toxic stress. That is exactly what Dr. Letourneau’s research program intends to do. To our knowledge, Dr. Letourneau’s research program is unique in the world in its focus on parenting and attachment interventions to promote parent-infant mental health in the face of toxic stressors.
Foundational Leadership and Future Focus
Having completed a series of studies examining parenting support needs of families affected by mental illness (postpartum depression), family violence, and addictions, the next stage of my research program will focus on testing parent-support interventions for these groups. Moreover, this research builds on the work of the Alberta Pregnancy Outcomes and Nutrition (APrON) cohort study of over 2000 mothers and 1000 fathers from Alberta. It is possibly the most comprehensive mental health and nutrition database in the world, capturing extensive family mental status and biological data (e.g. blood and saliva from which nutrition, hormone, inflammatory and (epi) genetic data can be derived). Dr. Letourneau has become part of this team, led by Dr. Bonnie Kaplan and Dr. Katherine Field and has been asked to lead the renewal application to AIHS. Determining the interactive influence of nutrition and mental illness on maternal and infant health puts APrON on the centre stage in the world.
Based on this prior and ongoing work, Interventions will be designed to improve parental mental health, parent-infant interaction and attachment security, and child developmental outcomes. To do this, a team of co-investigators, collaborators, support staff and students have been assembled to take part in competitive team grant proposals to CIHR and to AIHS. This community-based research involves important stakeholders such as service providers (e.g. nurses, physicians, social workers, and psychologists), policy influencers and affected parents.
In addition to supporting families at risk (i.e. those affected by mental illness, domestic violence, addictions and nutritional deficiencies), this research will focus on cause and effect relationships between early environments and a variety of outcomes in parent and infant health including, but not limited to:
- mental health and behaviour;
- hypothalamic pituitary adrenal axis function;
- sympathetic nervous system (e.g. heart rate, blood pressure, vagal reactivity, alpha amylase);
- immunity and inflammation (e.g. allergic disease and asthma);
- brain structure and function (e.g. hippocampus and prefrontal cortex);
- gene-environment interactions;
The preponderance of evidence demonstrating the effect of caregiving on “offspring” health outcomes (like those above) has been performed on animal models (e.g. Kaffman & Meaney, 2007). While compelling, animal studies are incapable of guiding health and social policy affecting human infants in real families affected by toxic stress. We need real-world studies of stressed parents and their babies to tell us how to intervene to promote optimal health and development. We need first to define innovative interventions that successfully and consistently promote optimal parental mental health, caregiving and healthy child development. We need then to test these interventions via experimental, cause and effect, studies with real families. This will provide the evidence necessary to support policy and programs for vulnerable families with the scarce resources of the public purse and put University of Calgary at the forefront of this work internationally.