High Levels of Early Maternal Affection May Lower Emotional Distress in Adult Offspring

Early nurturing and warmth from mothers can have long-lasting positive effects on the long-term mental health of their offspring into adulthood, according to a new cohort study that evaluated the children at 8 months and at a mean age of 34 years.

"It is striking that a brief observation of level of maternal warmth in infancy is associated with distress in adult offspring 30 years later," write lead study author Joanna Maselko, PhD, assistant professor in the Department of Psychiatry and Behavioral Sciences at Duke University in Durham, North Carolina, and colleagues.

"These provocative findings add to the growing evidence that early childhood helps sets the stage for later life experiences and provide support for the notion that biological ‘memories’ laid down early may alter psychological and physiological systems and produce latent vulnerabilities or resilience to problems emerging later in adulthood," the investigators add.

"I think it’s important to note that this study is about affection and only affection," Dr. Maselko told Medscape Medical News. "We don’t say anything about levels of parental involvement, etc. I would not want clinicians to put any more pressure on moms than there already is."

The study was published online July 27 in the Journal of Epidemiology and Community Health.

The Influence of Early Life Experiences

Although past studies have suggested that "the quality of the mother’s interaction with a child is a key determinant" of the child’s subsequent vulnerability and has implications for their health in adulthood, "there is a dearth of longitudinal data with both objective assessments of nurturing behavior during infancy and sustained follow-up ascertaining the quality of adult functioning," the study authors write.

"We are starting to understand that a significant part of our mental health trajectory in life is influenced by early life experiences, but we don’t really understand which experiences are important and how exactly they leave their mark," said Dr. Maselko. "This study is part of the larger area of research trying to decipher what’s going on in this regard."

For the study, the investigators evaluated a cohort of 482 participants in the National Collaborative Perinatal Project.

When the children were 8 months of age, the quality of the mother-child interaction was "objectively" observed and rated by a psychologist at the test site and parental socioeconomic status (SES) was recorded.

During follow-up interviews conducted when the children were adults, the Symptom Checklist 90 was used to assess emotional functioning, including the following 4 subscales: distress due to somatization, interpersonal sensitivity, anxiety, and hostility/anger.

More Warmth Equals Less Distress

Results at the 8-month assessment showed that 9.5% of the participants had a low level of mother’s affection, 85% had a normal level, and almost 6% had a high level.

Although the strongest association between maternal affection at 8 months and distress as adults was seen with the anxiety subscale, with significant differences found between the low/normal and high affection groups (53.86 vs. 46.70 scores; P < .001), significant differences were also found between the groups for general distress scores (55.38 vs. 50.39; P < .001). The smallest difference was found for hostility (55.70 vs. 52.40; P = .07).

"Across all the symptom subscales, the direction of association was highly consistent; more warmth was associated with less distress," report the study authors.

"We initially expected those with both the low and the very high levels of affection to do worse than those in the middle, consistent with the idea that a super affectionate mom could be a smothering mom, which could, in turn, be associated with worse outcomes once the child grows up," said Dr. Maselko, "But this is not what we saw."

The investigators also did not find "evidence that mother’s affection lies on the path between parental SES and higher offspring distress scores."

Overall, these findings "provide strong support to the assertion that even very early life experiences can influence adult health and emphasize the importance of having a strong nurturing relationship," the study authors write. Therefore, "a combination of strategies which empower families, improve access to high-quality childcare, and provide targeted interventions may improve overall population mental health."

When asked what she’d like to see next in regard to research in this area, Dr. Maselko said an important element would be a focus on understanding "whether there is something special about affection per se that is protective or whether affection is simply a marker for other positive parenting strategies.

"Testing the hypothesis that affection makes children and adults less reactive to stress through an oxytocin pathway is a great next step," she added.

Important Clinical Implications

"I think this study generally confirms the tenants of the attachment theory — that early relationship with a primary caregiver can shape the individual in their personal relationships from cradle to the grave," Mohammadreza Hojat, PhD, research professor of psychiatry and human behavior in the Center for Research in Medical Education and Health Care at Jefferson Medical College in Philadelphia, Pennsylvania, told Medscape Medical News.

"Now why this is the case? According to attachment theory, a lovingly responsive mother can serve as a secure base for a child to confidently explore the universe," said Dr. Hojat, who was not involved with this study. "This can contribute to a positive personality profile, including higher self-esteem and better skill at coping with stressful life events."

He said that 1 advantage of this study is its longitudinal nature. "There are currently very few longitudinal studies to test this hypothesis."

Although Dr. Hojat noted that the study also had some shortcomings, including the way in which maternal affection was measured, he found it to be "an important study overall, and its outcomes could have important implications for clinicians.

"It reinforces this attention to the biopsychosocial model of health and illness rather than a biomedical model or paradigm — that there are some other factors that are important to take into consideration for the sake of public health," he concluded.

This study was partially funded by a grant from the National Institutes of Mental Health. The study authors and Dr. Hojat have disclosed reported no relevant financial relationships.

Pediatrics. Published online July 19, 2010.

By: Deborah Brauser

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