Archives of Women's Mental Health

, Volume 15, Issue 4, pp 249–257 | Cite as

Use of video feedback intervention in an inpatient perinatal psychiatric setting to improve maternal parenting

  • Justin L. C. Bilszta
  • Anne E. Buist
  • Fandy Wang
  • Nur Rusydina Zulkefli
Original Article


This study utilizes video feedback to improve maternal parenting behavior in clinically depressed mothers admitted to a perinatal inpatient psychiatric unit. Depressed mothers (n = 74) were randomized to “video” (n = 25), “verbal” (n = 26), or “standard care” (n = 23). “Video” mothers were taped playing with their infant; interaction was reviewed with a mental health specialist. “Verbal” mothers only discussed interaction with their infant. “Standard care” mothers received only routine inpatient care. Mothers were assessed for mental health status, perceptions of baby behavior, and parenting competence. There was significant improvement in mental health status of all participants, regardless of intervention. Neither intervention had an advantage, compared to standard care, in improving parenting confidence or perceptions of infant behavior. Video mothers were more likely to report no change in their parenting confidence the more feedback sessions completed. The number of intervention sessions for each participant was limited by the duration of their inpatient admission. Most participants were on simultaneous pharmacotherapy and psychotherapy, as well as receiving intensive mothercraft assistance; this may have influenced intervention effectiveness. Results suggest that this type of intervention may be beneficial, but in the current format does not add sufficiently to standard care to be detected by the measures used.


Postnatal depression Inpatient Mother–infant Video Intervention 


  1. Agrawal H, Gunderson J, Holmes B, Lyons-Ruth K (2004) Attachment studies with borderline patients: a review. Harv Rev Psychiatry 12:94–104PubMedCrossRefGoogle Scholar
  2. Ainsworth M, Blehar M, Waters E, Wall S (1978) Patterns of attachement: a psychological study of the strange situation. Earlbaum, HIllsideGoogle Scholar
  3. Austin M-P, Priest S (2005) Clinical issues in perinatal mental health: new developments in the detection and treatment of perinatal mood and anxiety disorders. Acta Psychiatr Scand 112:97–104PubMedCrossRefGoogle Scholar
  4. Bakermans-Kranenburg M, Juffer F, van IJzendoorn M (1998) Intervention with video feedback and attachment discussions: deoso type of maternal insecurity make a difference? Infant Ment Health J 19:202–219CrossRefGoogle Scholar
  5. Bakermans-Kranenburg M, van Ijzendoorn M, Juffer F (2003) Less is more: meta-analysis of sensitivity and attachment interventions in early childhood. Psychol Bull 129(2):195–215PubMedCrossRefGoogle Scholar
  6. Beebe B (2005) Mother–infant research informs mother–infant treatment. Psychoanal Study Child 60:7–46PubMedGoogle Scholar
  7. Belsky J (1984) The determinants of parenting: a process model. Child Dev 55:83–96PubMedCrossRefGoogle Scholar
  8. Berling LJ (2007) Interventions to enhance early attachments: the state of the field today. In: Berlin LJ, Ziv Y, Amaya-Jackson L, Greenberg MT (eds) Enhancing early attachments: theory, research, intervention and policy. Part1: theoretical and research bases for interventions to enhance early attachments. Guilford, New York, pp 3–33Google Scholar
  9. Bowlby J (1980) Attachment and Loss: volume III: loss, sadness and depression. The Hogarth Press and the Institute of Psycho-Analysis, LondonGoogle Scholar
  10. Buist A, Minto B, Szego K, Samhuel M, Shawyer L, O’Connor L (2004) Mother-Baby Psychiatric Units in Australia - The Victorian Experience. Arch Womens Ment Health 7(1):81–87Google Scholar
  11. Buist A, Barnett B, Milgrom J, Pope S, Condon J, Ellwood D, Boyce P, Austin M-P, Hayes B (2002) To screen or not to screen—that is the question in perinatal depression. Med J Aust(7/10/02 Issue): S101-S105Google Scholar
  12. Buist A, Austin M, Hayes B, Speelman C, Bilszta J, Gemmill A, Brooks J, Ellwood D, Milgrom J (2008) Postnatal mental health of women giving birth in Australia 2002–2004: findings from the beyondblue National Postnatal Depression Program. Aust N Z J Psychiatry 42:66–73PubMedCrossRefGoogle Scholar
  13. Buultjens M, Robinson P, Liamputtong P (2008) A holistic programme for mothers with postnatal depression: pilot study. J Adv Nurs 63(2):181–188PubMedCrossRefGoogle Scholar
  14. Crockenberg S, Leerkes E (2003) Parental acceptance, postpartum depression and maternal sensitivity: mediating and moderating processes. J Fam Psychol 17(1):80–93PubMedCrossRefGoogle Scholar
  15. De Wolff M, van IJzendoorn M (1997) Senitivity and attachment: a meta-analysis of parental antecedents of infant attachment. Child Dev 68:571–591PubMedCrossRefGoogle Scholar
  16. Dennis C (2004) Treatment of postpartum depression: part 2. A clinical review of nonbiological interventions. J Clin Psychiatry 69(9):1252–1264CrossRefGoogle Scholar
  17. Dennis C, Hodnett E (2007) Psychosocial and psychological interventions for treating postpartum depression. Cochrane Database Syst Rev (4):CD006116Google Scholar
  18. Dennis C, Stewart D (2004) Treatment of postpartum depression: part 1. A critical review of biological interventions. J Clin Psychiatry 65(9):1242–1251PubMedCrossRefGoogle Scholar
  19. Egeland B, Weinfield N, Bosquett M, Cheng V (2000) Remembering, repeating, and working through: lessons from attachment based interventions. In: Osofsky J, Fitzgerald H (eds) WAIMH handbook of infant mental health vol. 4. Infant mental health in groups at high risk. Wiley, New York, pp 35–98Google Scholar
  20. Elgar FJ, Mills RS, McGrath PJ, Washbusch DA, Brownbridge DA (2007) Maternal and paternal depressive symptoms and chidl maladjustment: the mediating role of parental behaviour. J Abnorm Child Psychol 35:943–955PubMedCrossRefGoogle Scholar
  21. Elkin A, Gilburt H, Slade M, Lloyd-Evans B, Gregoire A, Johnson S, Howard L (2009) A national survey of psychiatric mother and baby units in England. Psychiatr Serv 60(5):629–633PubMedCrossRefGoogle Scholar
  22. Field T, Sandberg D, Garcia R, Vaga Lahr N, Goldstein S, Guy L (1985) Prenatal problems, postpartum depression and early mother infant interactions. Dev Psychopathol 12:1152–1156Google Scholar
  23. Forman D, O’Hara M, Stuart S, Gorman L, Larsen K, Coy K (2007) Effective treatment for postpartum depression is not sufficient to improve the developing mother–child relationship. Dev Psychopathol 19:585–602PubMedCrossRefGoogle Scholar
  24. Glangeaud-Freudenthal N, Sutter A, Thieulin A, Dagens-Lafont V, Zimmermann M, Debourg A, Massari B, Cazas O, Cammas R, Rainelli C, Poinso F, Maron M, Nezelof S, Ancel P, Khoshnood B (2011) Inpatient mother-and-child postpartum psychiatric care: factors associated with improvement in maternal mental health. Europ Psychiatry 26(4):215–223CrossRefGoogle Scholar
  25. Goodman S, Gotlib I (1999) Risk for psychpathology in the children of depressed mothers: a developmental model for understanding mechanisms of transmission. Psychol Rev 106:458–490PubMedCrossRefGoogle Scholar
  26. Holmes J (2004) Disorganized attachment and borderline personality disorder: a clinical perspective. Attach Hum Dev 6(2):181–190PubMedCrossRefGoogle Scholar
  27. Juffer F, Bakermans-Kranenburg M, van Ijzendoorn M (2005) The importance of parenting in the development of disorganized attachment: evidence from a preventive intervention study in adoptive families. J Child Psychol Psychiatry 46(3):263–274PubMedCrossRefGoogle Scholar
  28. Juffer F, van Ijzendoorn M, Bakermans-Kranenburg M (2008) Attachment-based interventions in early childhood: an overview. In: Juffer F, Bakermans-Kranenburg M, van Ijzendoorn M (eds) Promoting positive parenting. Taylor and Francis, New York, pp 37–58Google Scholar
  29. Kalinauskiene L, Cekuoliene D, Van IJzendoorn M, Bakermans-Kranenburg M, Juffer F, Kusakovsskaja I (2009) Supporting insensitive mothers: the Vilnius randomized control trial of video-feedback intervention to promote maternal sensitivty and infant attachment security. Child Care Health Dev 35:613–623. doi:10.111/j.1365-2214.2009.00962.x PubMedCrossRefGoogle Scholar
  30. Koren-Karie N, Oppenheim D, Dolev S, Sher E, Etzion-Carasso A (2002) Mothers’ insightfulness regarding their infants’ internal experience: relations with maternal sensitivity and infant attachment. Dev Psychol 38(4):534–542PubMedCrossRefGoogle Scholar
  31. Leahy-Warren P, McCarthy G (2007) Postnatal depression: prevalence, mothers’ perspectives, and treatments. Arch Psychiatr Nurs 21(2):91–100PubMedCrossRefGoogle Scholar
  32. Luoma I, Tamminen T, Kaukonen P, Laippala P, Puura K, Salmelin R, Almqvist F (2001) Longitudinal study of maternal depressive symptoms and child well-being. J Am Acad Child Adolesc Psychiatry 40(12):1367–1374PubMedCrossRefGoogle Scholar
  33. Marvin R, Cooper G, Hoffman K, Powell B (2002) The Circle of Security project: attachment-based intervention with caregiver–pre-school child dyads. Attach Hum Dev 4(1):107–124PubMedCrossRefGoogle Scholar
  34. Meredith P, Noller P (2003) Attachment and infant difficulties in postnatal depression. J Fam Issues 24(5):668–686CrossRefGoogle Scholar
  35. Murray L, Cooper P (1997) Postpartum depression and child development. Psychol Med 27:253–260PubMedCrossRefGoogle Scholar
  36. Nair R, Bilszta J, Sharfira N, Salam N, Buist A (2009) Review of patients admitted to a specialist inpatient parent–infant psychiatric service. Austral Psychiatry 18:567–572CrossRefGoogle Scholar
  37. Nair R, Bilszta J, Salam N, Shafira N, Buist A (2010) Client evaluation of a specialist inpatient parent–infant psychiatric service. Australas Psychiatry 18(6):573–578PubMedCrossRefGoogle Scholar
  38. Neilson-Forman D, Videbech P, Prince M, Kumar R (2000) Postpartum depression: identification of women at risk. Br J Obstet Gynaecol 107:1210–1217CrossRefGoogle Scholar
  39. O’Connor T, Heron J, Golding J, Beveridge M, Glover V, ALSPAC Study Team (2002) Maternal prenatal anxiety and children’s behavioural/emotional problems at 4 years. Br J Psychiatry 180:502–508PubMedCrossRefGoogle Scholar
  40. O’Hara M, Swain A (1996) Rates and risks of postpartum depression—a meta-analysis. Int Rev Psychiatry 8:37–54CrossRefGoogle Scholar
  41. Oppenheim D, Goldsmith D (2007) Attachment theory in clinical work with children: bridging the gap between research and practice. Guildford, New YorkGoogle Scholar
  42. Pilowsky D, Wickramaratne P, Talati A, Tang M, Hughes C, Garber J, Malloy E, King C, Cerda G, Sood A, Alpert J, Trivedi M, Fava M, Rush A, Wisniewski S, Weisman M (2008) Children of depressed mothers one year after the initiation of maternal treatment: findings from the Star*D Child Study. Am J Psychiatry 165:1136–1147PubMedCrossRefGoogle Scholar
  43. Rahman A, Iqbal Z, Bunn J, Lovel H, Harrington R (2004) Impact of maternal depression on infant nutritional status and illness: a cohort study. Arch Gen Psychiatry 61:946–952PubMedCrossRefGoogle Scholar
  44. Riggs S, Jacobvitz D (2002) Expectant parents’ representations of early attachment relationships: associations with mental health and family history. J Consult Clin Psychol 70(1):195–204PubMedCrossRefGoogle Scholar
  45. Robbins Broth M, Goodman S, Hall C, Rynor L (2004) Depressed and well mothers emotion interpretation accuracy and quality of mother–infant interaction. Infancy 6:37–55CrossRefGoogle Scholar
  46. Rusconi-Serpa S, Rossignol A, McDonough S (2009) Video-feedback in parent–infant treatments. Child Adolesc Psychiatr Clin N Am 18:735–751PubMedCrossRefGoogle Scholar
  47. Shaver P, Mikulincer M (2010) New directions in attachment theory and research. J Soc Pers Relat 27(2):163–172CrossRefGoogle Scholar
  48. Simpson J, Rholes S, Campbell L, Tran S, Wilson C (2003) Adult attachment, the transition to parenthood and depressive symptoms. J Pers Soc Psychol 84(6):1172–1187PubMedCrossRefGoogle Scholar
  49. Tronick E, Als H, Adamson L, Wise S, Brazelton T (1978) The infant’s response to entrapment between contradictory messages in face-to-face interaction. J Am Acad Child Psychiatry 17(1):1–13PubMedCrossRefGoogle Scholar
  50. van Ijzendoorn M, Juffer F, Duyvesteyn M (1995) Breaking the intergenerational cycle of insecure attachment: a review of the effects of attachment-based interventions on maternal sensitivity and infant security. J Child Psychol Psychiatry 36(2):225–248PubMedCrossRefGoogle Scholar
  51. van Zeijl J, Mesman J, van IJzendoorn M, Bakermans-Kranenburg M, Juffer F, Stolk M (2006) Attachment-based intervention of enhancing sensitive discipline in mothers of 1-to-3 year-old children at risk of externalizing behaviour problems: a randomized-control trial. J Consult Clin Psychol 74(6):994–1005PubMedCrossRefGoogle Scholar
  52. Velderman M, Bakermans-Kranenburg M, Juffer F, van IJzendoorn M (2006) Effects of attachment-based interventions on maternal sensitivity and infant attachment: differential susceptibility of highly reactive infants. J Fam Psychol 20(2):266–274PubMedCrossRefGoogle Scholar
  53. Wan M, Green J (2009) The impact of maternal psychopathology on child–mother attachment. Arch Womens Ment Health 12:123–134PubMedCrossRefGoogle Scholar
  54. Ward M, Lee S, Polan H (2006) Attachment and psychopathology in a community sample. Attach Hum Dev 8(4):327–340PubMedCrossRefGoogle Scholar
  55. Weissman MM, Wickramaratne P, Nomura Y, Warner V, Pilowsky D, Verdeli H (2006) Offspring of depressed parents: 20 years later. Am J Psychiatry 163:1001–1008PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Justin L. C. Bilszta
    • 1
  • Anne E. Buist
    • 2
  • Fandy Wang
    • 3
  • Nur Rusydina Zulkefli
    • 3
  1. 1.Department of PsychiatryUniversity of Melbourne and Austin HealthWest HeidelbergAustralia
  2. 2.Department of PsychiatryUniversity of Melbourne, Austin Health, and NorthparkWest HeidelbergAustralia
  3. 3.Melbourne Medical SchoolUniversity of MelbourneParkvilleAustralia

Personalised recommendations