Maternal Schizotypal Symptoms during Pregnancy: Links with Postpartum Depressive Symptoms and Mother-Infant Behavior

• In Event: Beyond Depression and Anxiety: New Insights into Perinatal Maternal Mental Health

Abstract

Introduction: Consistent with contemporary dimensional models of psychopathology (Krueger & Markon, 2014), accumulating evidence indicates that schizotypal/psychotic symptoms exist on a continuum in the general population, with schizophrenia at the extreme end (Nelson et al., 2013). Little is known about schizotypal symptoms among pregnant and postpartum women. A few studies have characterized maternal delusions and hallucinations during the perinatal period in community samples (Holt et al., 2018; MacKinnon et al., 2017; Solomonova et al., 2020), but, to our knowledge, no existing research has assessed the full spectrum of schizotypal symptoms (cognitive-perceptual, interpersonal, disorganized) in this population. Additionally, there is a dearth of research examining links between maternal schizotypal symptoms and postpartum maternal and infant outcomes.
Aims: The current study characterized maternal schizotypal symptoms during pregnancy in a community sample. We also examined whether maternal schizotypal symptoms were associated with postpartum depressive symptoms and with observer-rated maternal and infant behavior.
Study population: Women were recruited from university-affiliated prenatal clinics in Southern California into a longitudinal study during their early pregnancy. Women were between 18-44 years of age (M = 30.1) and primarily identified as White (46%) or Hispanic/Latina (29%).
Methods: At approximately 20 weeks’ gestation, 122 women completed the Schizotypal Personality Questionnaire (Raine, 1991), a 74-item yes/no questionnaire designed to assess individual differences in schizotypal personality symptoms in the general population. Women completed the Edinburgh Postnatal Depression Scale (Cox et al., 1987) at 3 months postpartum. At 6 and 12 months postpartum, mother-infant dyads completed a semi-structured play episode in the lab. Maternal and infant behaviors were coded using an NICHD Study of Early Child Care and Youth Development protocol (NICHD ECCRN, 1999). A maternal sensitivity composite was created by summing ratings of sensitivity to nondistress, positive regard, and intrusiveness. Infant behaviors assessed were negative mood, sustained attention, and positive engagement.
Results: Maternal schizotypal symptoms were present on a continuum in this sample (see Figure 1). Of the 122 women, 5 reported symptom levels above the established clinical cut-off. Higher levels of maternal schizotypal symptoms were associated with elevated postpartum depressive symptoms (r = .45, p < .001). Maternal schizotypal symptoms also were associated with lower levels of maternal sensitivity at 12 months postpartum (r = -.45, p < .001) and with lower infant sustained attention at 6 (r = -.31, p = .003) and 12 (r = -.34, p = .001) months. These associations persisted after adjusting for maternal pregnancy and postpartum depressive and anxiety symptoms, as well as relevant covariates (maternal age, gravida, income, cohabitation with infant’s father).
Conclusions: The current investigation suggests that maternal schizotypal symptoms during pregnancy may represent a risk factor for postpartum depression and for compromised maternal and infant behavior. Our findings indicate that perinatal schizotypal symptoms may be important to consider in both clinical and research settings and more broadly highlight the utility of dimensional assessment of perinatal maternal mental health across the full spectrum of psychopathology.

Authors

• Mariann Howland, University of Minnesota - Twin Cities
  Presenting Author

• Curt Sandman, University of California, Irvine
  Non-Presenting Author

• Elysia Davis, University of Denver
  Non-Presenting Author

• Laura Glynn, Chapman University
  Non-Presenting Author