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Psychiatry Research 186 (2011) 281–286
Contents lists available at ScienceDirect
Psychiatry Research
j o u r n a l h o m e p a g e : w w w. e l s ev i e r. c o m / l o c a t e / p s yc h r e s
The evaluation of emotional facial expressions in early postpartum depression mood:
A difference between adult and baby faces?
Sandrine Gil a,⁎, Frédérique Teissèdre b, Patrick Chambres b, Sylvie Droit-Volet b
a
b
Centre de Recherches sur la Cognition et l'Apprentissage (CeRCA), CNRS, UMR 6234, Université de Poitiers, 99 avenue du Recteur Pineau, F-86000 Poitiers Cedex, France
Laboratoire de Psychologie Sociale et Cognitive (LAPSCO), CNRS, UMR 6024, Université Blaise Pascal, 34 avenue Carnot, 63037 Clermont-Ferrand, France
a r t i c l e
i n f o
Article history:
Received 4 May 2009
Received in revised form 14 June 2010
Accepted 21 June 2010
Keywords:
Early postpartum depressive mood
Emotion
Face
Anxiety
Affective disorders
a b s t r a c t
Research suggests that depressive individuals exhibit disturbances in the evaluation of emotional facial
expressions. Owing to the specific character of postnatal depressive mood, the purpose of the present study
was to examine whether postpartum depressive mood intensity in the mothers would involve the same
disturbances as depression or a specific distortion in the emotional evaluation of baby faces as compared to
adult faces. Three days after birth, the participants (N = 79) completed the Edinburgh Postnatal Depression
Scale, the State-Trait Anxiety Inventory and the Toronto Alexithymia Scale. They also evaluated the facial
expressions of adults and babies displaying anger, happiness, sadness and neutrality in terms of the intensity
of five emotions: Anger, disgust, sadness, happiness and neutrality. Our findings suggest that judgements of
emotional facial expressions depend to a great extent on anxiety, which specifically increased negative
perception of babies' emotions. Moreover, the only difference between mothers with and without
postpartum depressive mood lays in their assessment of the babies' faces, neutral baby faces being judged
to be less neutral, thus demonstrating the specificity of postpartum affective disorders.
© 2010 Elsevier Ireland Ltd. All rights reserved.
1. Introduction
The quality of early mother–infant interactions is a determining
factor for children's abilities to communicate, for their emotional
development and well-being (Murray, 1992; Weinberg and Tronick,
1994; Papousek and Papousek, 1997; Tronick and Weinberg, 1997;
Field, 2002; Feldman, 2007). Evidence suggests that “linkages
detected between maternal emotional disposition and infant face
processing reflect, at least in part, the role of experience in shaping
face processing” (de Haan et al., 2004, p. 1214). However, after
childbirth, some mothers suffer from a specific form of depressive
mood that can modify these early relationships.
There are three forms of affective disorders which differ in both
their severity and timing: (1) postpartum blues (also known as baby
or maternity blues), (2) postpartum depression, and (3) puerperal
psychosis which includes heterogeneous entities that incorporate all
the major psychiatric disorders which occur during the period
following childbirth. The former is the most frequent affective
disorder and is experienced by 25% to 85% of mothers. Postpartum
depression affects between 10 and 20% of mothers, while puerperal
⁎ Corresponding author.
E-mail address: [email protected] (S. Gil).
0165-1781/$ – see front matter © 2010 Elsevier Ireland Ltd. All rights reserved.
doi:10.1016/j.psychres.2010.06.015
psychosis affects less than 2 per 1000 (Beck, 2002). The symptoms of
postpartum blues consist of common emotional disturbances such as
crying, anxiety and a depressed and unstable mood. These symptoms
appear in the first week after childbirth and are limited in time. When
they persist beyond two weeks, or if they are very intense, the
diagnosis is one of postpartum depression. Moreover, the link
between early postpartum depressive mood and postpartum depression has been extensively reported on the basis of the Edinburgh
Postnatal Depression Scale (EPDS), which makes it possible to
evaluate the depressive component of the former and to predict the
clinical diagnosis of the latter (e.g., Teissèdre and Chabrol, 2004;
Gonidakis et al., 2008). Since the way a mother processes the
emotional facial information expressed by her child may help her
respond correctly to her infant's physical and social needs, the
purpose of our original work was to examine how mothers suffering
from depression symptomatology in the first days after childbirth
evaluate emotional facial expressions. To date, no research has
attempted to examine this topic. Indeed, the few experimental studies
on emotion and postpartum depressive mood have focused on
disturbances in the emotional expressiveness of the mothers and/or
their children (e.g., Cohn et al., 1990; Lundy et al., 1996; Field, 1997;
Lundy et al., 1997; Striano et al., 2002; Nadel et al., 2005).
As far as depression in general is concerned, two types of
disruption to the perception of emotional facial expressions have
been reported on many occasions. Firstly, a number of studies have
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S. Gil et al. / Psychiatry Research 186 (2011) 281–286
shown that the recognition of emotional expressions is less accurate
in depressive individuals than in controls (Gur et al., 1992; Rubinow
and Post, 1992; George et al., 1998; Suslow et al., 2001; Leppänen
et al., 2004; Mendlewicz et al., 2005). Secondly, other studies have
reported a negative bias in emotional evaluations, namely in that
depressed individuals attribute negative emotions to neutral or
positive facial expressions, or judge negative facial expressions to be
more intense (Gur et al., 1992; Hale, 1998; Gollan et al., 2008). This
keeps with the mood congruence effect (Niedenthal et al., 2000):
While someone in love sees life through rose-tinted spectacles, a
sad or depressed person sees it through grey spectacles. However,
compared to depression, postpartum depressive symptoms have to be
considered as being related to a specific context, because they appear
in reaction to childbirth. We may thus suppose that the depressionbased disturbances in the evaluation of the emotions expressed by
faces might be specific to baby faces or more important for baby than
for adult faces. Furthermore, there is some evidence that interindividual variations in the external context (e.g. having low mother
esteem) might exacerbate the depressive symptoms and their effects
(Kendell et al., 1984; O'Hara et al., 1991; Tamaki et al., 1997;
Robertson et al., 2004; Séjourné et al., 2008). Certain external
variables might therefore modulate the effect of depressive mood
on the evaluation of emotional faces. Consequently, in our study, we
have also taken into account many external variables of sociobiographical, psychosocial and obstetrical nature.
Furthermore, with regard to postnatal symptoms, an increasing
number of studies have provided empirical evidence that childbirth is
associated not only with depression but also with other affective
styles, especially anxiety disorders (Heron et al., 2004; Gonidakis
et al., 2008; Mota et al., 2008; Skouteris et al., 2009) and alexithymia
(Le et al., 2007; Gonidakis et al., 2008), the later often being found to
be related to depression (Taylor et al., 2000; Kojima et al., 2003). In
the present study, we thus investigated whether, as has been shown
for depressive mood, early postpartum depressive mood is associated
with disturbances in the evaluation of emotional facial expressions,
and whether these disturbances are observed at a higher rate in
response to baby faces. In this framework, we examined also whether
affective styles (anxiety and alexithymia), as external variables
associated with postnatal depressive mood intensity explain, at least
partly, the distortions in emotional expression evaluation.
2. Method
2.1. Study design
The study was conducted in two hospitals near Clermont-Ferrand. Seventy-nine
female volunteers were seen individually in their rooms on the third day after delivery.
The inclusion criteria consisted of an adequate knowledge of French language and the
delivery of a healthy baby.
2.2. Clinical symptoms questionnaires
The French version (Guedeney and Fermanian, 1998) of the Edinburgh Postnatal
Depression Scale (EPDS) (Cox et al., 1987) was used to assess postpartum depression
symptomatology on the third day after childbirth. This questionnaire consists of 10-item
self-report statements which investigate the mother's mood, the level of anxiety, the
feeling of guilt, the feeling of lacking ability, sleep problems and the desire to end one's
own life. The score range is between 0 and 30. This questionnaire is acknowledged as
making it possible to screen for postnatal depressive mood at an early stage and identify
mothers at risk (Beck, 2001; Chabrol and Teissèdre, 2004).
The intensity and the frequency of anxiety were measured with the State-Trait
Anxiety Inventory (STAI) (Spielberger et al., 1983; French version by Schweitzer
and Paulhan, 1990). This commonly employed self-report instrument, which consists of
4-point Likert scales, allowed us to assess state anxiety and trait anxiety independently on
two different 20-item subscales. The anxiety score on each subscale provides information
about the general probability of experiencing anxiety symptoms and ranges from 20 to 80.
The French version (Loas et al., 1996) of the 20-item Toronto Alexithymia Scale
(TAS-20) (Bagby et al., 1994) was also administered. In this extensively validated scale,
subjects were asked to indicate the degree to which they agree with each of the 20
statements on a 5-point Likert scale. The scores range from 20 to 100, with higher
scores indicating a higher level of alexithymia.
2.3. The emotional facial expression task
Because there are no pictures of the facial expressions of adults and babies taken
under the same conditions, we had developed our own stimuli.1 Adults and babies
exhibiting facial expressions of basic emotions that are widely recognized in adults—
anger, happiness, sadness and neutrality—were therefore photographed from the
shoulders up. To standardize the photographs, all wore a grey pullover, and were
photographed against a light-blue background. We consequently selected 452
photographs that were judged to represent recognizable facial expressions. Each
photograph was then evaluated by 25 undergraduate students who, in each case, had to
judge the intensity of 8 emotions (anger, happiness, sadness, neutrality, disgust, fear,
surprise, and shame) on a 7-point scale ranging from 0 “The face in no way expresses
this emotion” to 6 “The face fully expresses this emotion”. This larger panel of emotions
was used in order to exclude ambiguous facial expressions. The order of presentation of
both the photographs and the emotion scale was randomised across the participants.
These evaluations allowed us to identify the best photographs2 that expressed a specific
emotion3 at a high level of intensity (N3.5). The final set of stimuli consisted of 48
colour photographs displaying 4 different kinds of emotional facial expressions—anger,
happiness, sadness, and neutrality (see Fig. 1 for an example). There were 12
photographs for each emotion tested. Six photographs represented an adult's
emotional facial expression (3 males and 3 females) and six photographs represented
a baby's emotional facial expression (two babies). Each target expressed the 4 emotion
expressions once.
2.4. Procedure
All the women, who volunteered to take part in the study, gave their informed
consent and were asked to complete a questionnaire relating to their demographic,
obstetric and psychosocial details4 (see Table 1).
The women then completed the emotional facial expression task. They were told
that they would see faces of different individuals, and that they had to indicate the
intensity of a given emotion on a 7-point scale from 0 “The face in no way expresses this
emotion” to 6 “The face fully expresses this emotion”. For each photograph, they had to
judge the intensity of 5 emotions: the four actually expressed emotion (anger,
happiness, sadness and neutrality) and, in order to avoid overloading the experiment,
only one additional emotion, namely disgust, because literature highlights that this
emotion plays an critical role in some affective styles, particularly anxiety (Marzillier
and Davey, 2005). The order of the emotions was counterbalanced between each
photograph. The 48 emotional facial expressions were therefore presented one by one
centered on the computer screen. After judging a photograph, the participant had to
press a key on the computer keyboard to see the next photograph. The order of the
photographs was counterbalanced for each participant. Finally, the participants
completed the three self-report scales for postnatal depression symptoms, anxiety,
and alexithymia. The entire session lasted about 1 h.
1
To produce the facial expressions of anger, happiness and sadness, we asked the
adults to think of an event which induces a specific emotion, (e.g., for happiness,
thinking of a party with friends). In addition, we presented them with examples of
pilot-tested emotional facial expressions from Beaupré and Hess's (2005) study. In the
case of the babies, the photos were taken as a function of the baby's spontaneous
mood. In others words, the experimenter waited for the baby to laugh (e.g., when he
was happy to play with his mother), or cry (e.g., when he was hungry).
2
The photographs were tested by an additional sample of participants and selected
and assessed following 3 phases: (1) a preliminary selection of photographs
considered by the participants as representing a given emotion at a high level of
intensity (i.e., mean N 3.5 on a 7-point scale) was run; (2) A series of analyses of
variance (ANOVAs) and T-tests were performed to examine whether the selected
photographs differed as a function of the category of expressed emotion, and were
similar in each emotional category; (3) A principal component analyses for each
emotion and for all selected photographs was also run in order to confirm that the
sample of photographs expressing a particular emotion was homogeneous.
3
Regarding the evaluations of babies' facial expressions, the data revealed that baby
photographs evaluated as strongly expressing anger were also systematically
evaluated as expressing sadness. Consequently, in our experiment, the “angry baby
faces” category actually corresponded to an “angry/sad baby faces” category. This
blending of anger and sadness is usually observed in emotional baby faces (e.g., Matias
and Cohen, 1993; Sullivan and Lewis, 2003). The other categories (i.e., happy, sad,
neutral) corresponded to a specific emotion.
4
Since 11% of women reported to have already used antidepressants, we carried out
an independent-sample T-test in order to control that these women did not obtain an
EPDS score significantly higher than the other women. The results showed no
difference between women who have already used antidepressants (M = 9.11; S.D. =
4.45) and the others (M = 8.76; S.D. = 5.57, t(73) = −.18, P N 0.10). Because the
question was not precise, we can supposed that these women took antidepressants at
a more or less remote point in time, with this former antidepressant intake having no
impact on the results obtained in our study.
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283
Fig. 1. Examples of adults' and babies' facial expression for each emotion: happiness, neutrality, sadness and anger.
2.5. Data analysis
3. Results
Analyses of data were performed using SPSS version 16. Analyses included all
participants. Concerning the stimuli, because previous statistical analyses showed no
effect of the sex of adult faces (P b 0.05), we thus considered adult faces independently
of sex.
First (point 3.1), we examined the relationship between the clinical measures
(EPDS, STAI state, STAI trait) and the evaluations of facial expressions. In this vain, we
used Spearman correlations and, then, when emotional evaluations were correlated
with more than one clinical measure, we conducted Stepwise linear regression analyses
in order to determine which was the predictor. As multiple regression analysis can
inflate the familywise error rate, the regression analyses were interpreted after
applying the Bonferroni correction (α = 0.05/2).
Second (point 3.2), we investigated whether emotional distortions observed due to
clinical dimensions should be also related to external variables (demographic, obstetric
and psychosocial variables). Consequently, we used Spearman correlations, and then
Stepwise linear regression analyses (conducted with a Bonferroni correction, α = 0.05/6)
for the emotional evaluations which were significantly correlated with a clinical score, by
entering both clinical variables and external variables as predictors.
3.1. Clinical variables and emotional evaluations
Table 1
Sample characteristics.
Parity
Delivery
Difficulties during pregnancy
History of psychological illness
Pregnancy satisfaction (0–10)
Self-confidence as a mother (0–10)
Category
Percentage
1
2
3
4
5
6
Natural
Caesarean
Forceps
Yes
No
No
Psychotherapy
Antidepressant
Mood stabilizers
Mean = 7.21, S.D. = 2.79
Mean = 7.52, S.D. = 2.14
44.30
36.71
11.39
3.80
2.53
1.27
72.16
22.78
5.06
36.71
63.29
83.55
5.06
11.39
0
In line with the values reported in the literature, 30.38% of the
women in our sample corresponded to the criteria defined for the
Edinburgh Postnatal Depression Scale. As stated in the Introduction,
our aim was to investigate whether there was any relationship
between postpartum depressive mood intensity in the mothers and
its related affective styles (i.e., anxiety and alexithymia) on the one
hand, and the evaluations of facial expressions, on the other hand. To
this end, we began by calculating Spearman correlations between
depressive mood intensity, anxiety and alexithymia (Table 2). In line
with the results of previous studies (Heron et al., 2004; Skouteris
et al., 2009), postpartum depressive mood appeared to be strongly
positively correlated with both state anxiety (r = 0.67, P b 0.001) and
trait anxiety (r = 0.51, P b 0.001), these latter being themselves
correlated (r = 0.42, P b 0.001). However, depressive mood intensity
was not correlated with alexithymia (r = 0.21, P N 0.05). Consequently,
alexithymia was excluded from the subsequent analyses. Our findings
thus indicated that the higher the level of anxiety the higher the level
of depressive mood.
Table 2
Correlations between early postpartum depressive mood intensity (EPDS score),
anxiety (STAI state and trait scores) and alexithymia (TAS score) measures.
1.
2.
3.
4.
EPDS
STAI state
STAI trait
TAS
1
2
3
4
–
–
–
–
0.67⁎⁎⁎
–
–
–
0.51⁎⁎⁎
0.42⁎⁎⁎
–
–
0.21
0.18
0.36
–
EPDS = Edinburg Postnatal Depression Scale (score range: 0–30); STAI state = StateTrait Anxiety Inventory state subscale (score range: 20–80); STAI trait = State-Trait
Anxiety Inventory trait subscale (score range: 20–80); TAS = Toronto Alexithymia
Scale (score range: 20–100).
⁎⁎⁎ P b 0.001 (α = 0.05/18).
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Next, since there were significant correlations between postpartum
depressive mood intensity and anxiety (state and trait), we calculated
Spearman correlations between these three clinical measures and the
five averaged emotional evaluations of the pictures of adults and babies
expressing anger, happiness, sadness and neutrality. The emotional
evaluations, which were significantly correlated with clinical measures,
are presented in Table 3. The evaluation of positive expressions
(happiness) was not affected by these clinical variables, thus explaining
that this evaluation was not on Table 3. Only the evaluation of neutral
and negative emotions—sadness, disgust, anger—changed with the
depressive mood intensity or the anxiety. More precisely, Table 3 shows
that the evaluation of the emotional expressions of the adult faces was
not affected by depressive mood intensity. Only state anxiety was
related to the evaluation of the emotions expressed by adults in terms of
an increased disgust rating, with the neutral and the angry adult faces
being considered to express a greater level of disgust. Finally, there was a
linkage between early postpartum depressive mood and emotional
expressions only in the case of the babies' faces. As the level of early
postpartum depressive mood increased, the neutral baby faces were
evaluated as less neutral and sadder. Moreover, with increasing STAI
state, babies' faces expressing anger were also judged to be more
disgusted, while with increasing STAI trait those expressing sadness
were judged sadder.
However, Table 3 shows that the early postpartum depression score
was correlated with the evaluations of the neutrality and sadness of the
neutral baby faces, which were also systematically correlated with state
anxiety. Stepwise linear regression analyses were therefore conducted
in order to identify which clinical score (EPDS or state anxiety)
predicted the evaluation of the neutrality and sadness of the neutral
baby faces. The findings indicated that postpartum depressive mood
intensity was the only predictor of the neutral evaluation of a neutral
baby face, accounting for 6% of the variance, while state anxiety was no
longer a reliable factor. Thus, the greater the depressive mood
experienced by a woman, the less neutral she evaluated the neutral
face of a baby (β = −0.27, P = 0.01). In contrast, the only factor
predicting that neutral baby faces would be perceived as being sadder
was state anxiety, which accounts for 8% of the variance (β = 0.30,
P = 0.007).
3.2. External variables and emotional evaluations
Our results showed that the evaluation of most emotional baby
and adult faces was affected by state anxiety (STAI state), while
depressive mood intensity (EPDS) only explained the evaluation of
neutral baby faces as less neutral. The aim of the second part of the
study was to investigate whether these emotional distortions might
also have been predicted by external variables. Table 4 indicates that
there were significant Spearman correlations between the clinical
variables (EPDS, STAI state and STAI trait) and the demographic,
obstetric and psychosocial variables.5 EPDS, STAI state and STAI trait
were positively correlated with pregnancy difficulties. Consequently,
the greater the problems women experience during pregnancy, the
higher the level of depressive mood and anxiety symptoms that they
exhibit. This finding is consistent with published studies (O'Hara and
Swain, 1996; Verdoux et al., 2002). However, the anxiety state
intensity was significantly reduced in women who have already had
children. In addition, anxiety trait was negatively related to pregnancy
satisfaction, and depressive mood intensity with mother's confidence.
To test the degree to which the external variables were involved in
the clinical variable-related emotional distortions, we conducted
stepwise linear regression analyses for the emotional evaluations,
which were significantly correlated with a clinical score (see Section 3.1
and Table 3), by entering both the clinical variables (EPDS, STAI state and
5
As some of these variables were nominal, these variables were transformed on
dichotomic ones.
Table 3
Significant correlations between clinical measures and emotional evaluations.
Expressed
emotion
Status of the
photo
Evaluated
emotion
EPDS
Neutral
Babies
Babies
Adults
Babies
Adults
Babies
Neutral
Sadness
Disgust
Disgust
Disgust
Sadness
− 0.29⁎ − 0.22⁎ − 0.19
0.18⁎
0.25⁎⁎
0.21
0.10
0.30⁎
0.15
⁎
0.14
0.21
0.19
⁎⁎
0.09
0.36
0.15
− 0.03 − 0.05
0.24⁎
Anger
Sadness
STAI
state
STAI
trait
⁎ P b 0.05.
⁎⁎ P b 0.01.
trait) and the external variables as predictor variables. Those external
variables that were not significantly correlated with the clinical scores
were not considered in these analyses. The analyses revealed that none
of the external variables was a reliable predictor of emotion distortion in
the evaluation of emotional expressions (all P N 0.05).
4. Discussion
Studies of emotions have shown that depressive individuals
attribute negative emotions to neutral and positive faces, and judge
negative facial expressions to be more negative (Gur et al., 1992; Hale,
1998; Gollan et al., 2008). Our results suggest that depressive
mothers' mood intensity has not the same effect on the perception
of emotional expressions. Indeed, postpartum depressive mood did
not change the perception of facial expressions, all mothers (i.e., both
those exhibiting and those who did not exhibit these symptoms)
having similar perception of the positive and negative expressions. In
contrast, and as expected, our main result demonstrated that the
intensity of depressive mood in the mothers has a specific impact on
baby faces perception (i.e., the neutral baby faces were judged to be
less neutral and sadder). This specific emotional distortion with
regard to baby faces may be related to the role of women in the
upbringing of children. Although widely speculative at this point, it
seems possible that distress feelings of women suffering from mood
disorders may involve negative perception of neutrality (i.e., mood
congruence effect), but that this distortion may be primarily directed
towards infants because women's crucial responsibility towards their
children is salient. Whatever the case, this early postpartum
depression mood-related distortion in the perception of neutral
baby faces might represent an indicator of a potential risk of
developing disturbances within the mother–children interaction. It
would be interesting to investigate if this emotional distortion is
maintained only in the few number of mothers who develop
postpartum depression or if it is also maintained in the other mothers,
those who do not develop depression but remain anxious.
Indeed, our results revealed that, at an early stage of the postpartum,
the depressive mood intensity was strongly correlated with state
anxiety, and that it was this anxiety in the mothers that produced larger
distortion in the perception of other people's emotion, especially the
perception of emotion in babies. This finding is entirely consistent with
the growing body of evidence indicating that state anxiety is more or
less related to depressive symptoms through both pregnancy and the
initial period after childbirth (Heron et al., 2004; Gonidakis et al., 2008;
Mota et al., 2008; Skouteris et al., 2009). For example, studies have
shown that anxiety level may predict the risk of developing major
postpartum depression 6 weeks after childbirth (Stuart et al., 1998;
Teissèdre and Chabrol, 2003). Moreover, Brown (1993) has highlighted
that 84% of mothers suffering from postpartum depression have
experienced a recent episode of intense stress. Consistent with this
idea, our results showed that postpartum depressive mood and anxiety
were positively correlated with pregnancy difficulties. In our study, the
pregnancy difficulties were the only reliable external variable systematically associated with our clinical measures. Experiencing a difficult
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S. Gil et al. / Psychiatry Research 186 (2011) 281–286
285
Table 4
Correlations between clinical variables and external variables.
1.
2.
3.
4.
5.
6.
Parity
Delivery
Pregnancy difficulties
History of psychological illness
Pregnancy satisfaction
Mother's self-confidence
1
2
3
4
5
6
EPDS
STAI state
STAI trait
–
–
–
–
–
–
− 0.18
–
–
–
–
–
− 0.17
0.05
–
–
–
–
0.05
− 0.05
0.23
–
–
–
0.05
− 0.05
− 0.29
− 0.05
–
–
0.39⁎⁎⁎
0.00
− 0.24
0.01
0.42
–
− 0.29
0.27
0.58⁎⁎⁎
0.03
− 0.28
− 0.39⁎⁎⁎
− 0.35⁎⁎
0.32
0.38⁎⁎⁎
0.03
− 0.25
− 0.29
− 0.06
0.09
0.46⁎⁎⁎
0.30
− 0.37⁎⁎⁎
− 0.27
⁎⁎⁎ P b 0.001.
⁎⁎ P b 0.003 (α = 0.05/18).
pregnancy could therefore be an important source involved in the
emergence of postpartum depression. However, our study was not
concerned with postpartum depression, but depressive mood just after
childbirth day. It nevertheless revealed that, at this early stage, state
anxiety was already associated to distortions in the judgment of
emotional expressions. With adult faces as targets, when state anxiety
increased, mothers perceived more disgust in the adult faces expressing
anger or neutrality. However, more specifically, with baby faces as
targets, mothers not only perceived more disgust in the babies when
they expressed anger, but also more sadness for neutral baby faces.
Mothers with anxious personalities (trait anxiety) also perceived more
sadness in sad baby faces. Mothers' anxiety after childbirth therefore
increased the negative perception of babies' emotions. It would be now
interesting to investigate the evolution of this negative emotional
perception at different points in time during the first year after
childbirth in order to better understand its eventual impact on the
mother–infant relationship. It might be possible that these anxious
mothers would experience more difficulties to adapt to their infants'
need and to communicate with him. In this case, an early and systematic
diagnostic of anxiety in the mothers would be important for an early
care.
Moreover, it is interesting to note that, in the present study,
anxiety was related to the evaluation of disgust, with the higher the
level anxiety the more disgust perceived, be it with an adult or a baby
as target. This is consistent with numerous studies indicating the
relationship between the emotion of disgust and anxious psychopathologies (e.g., phobias or eating disorders) (Davey et al., 1998;
Phillips et al., 1998; Woody and Tolin, 2002). Recently, Schofield et al.
(2007) showed that anxiety may induce interaction difficulties (i.e., a
high interaction cost as evaluated by the individuals themselves, in
the presence of a facial expression of disgust). More interestingly,
recent findings revealed that inducing anxiety in participants led to an
increase in self-reported disgust (Marzillier and Davey, 2005), or,
conversely, inducing disgust led to an increase in self-reported
anxiety (Davey et al., 2008). The question is why anxious individuals
perceive more disgust in other people's faces. It is likely that anxious
mothers attribute their own feeling of disgust to others. An alternative
explanation is that perceiving disgust in another person is a means of
protecting one's child against that person. Within an evolutionist
perspective, disgust is conceived as a powerful adaptive emotion
allowing us to reduce the risk of contact with a contaminating object
(Lazarus, 1991; Rozin and Fallon, 1987). Following the observation of
selective attention to threats in anxious states (Öhman et al., 2001;
Surcinelli et al., 2006; Rossignol et al., 2007), it is conceivable that a
mother's anxiety after childbirth could produce emotional distortions
which allow her to protect her children against a potential danger: all
other people could be a potential source of contamination.
To summarize, although further research testing mothers at different
times after childbirth and with different level of depression needs to be
performed to examine the evolution of emotional evaluation performance, the observed pattern of results raises the question of the need
to screen mothers who have recently given birth for both depression
and anxiety symptomatology.
Acknowledgements
The authors would like to thank Pierre-Jean Marescaux for
advising on the statistical analyses in the revised version of the
manuscript, Anaïs Beaudoux and Noémie Christol for their assistance
during data collection, and Serban C. Musca for English proofreading
the revised version of the manuscript. We extend our thanks to the
women who participated to this research. This research was
supported by the French National Research Agency (ANR Blan06-2145908 FaceExpress).
References
Bagby, R.M., Parker, J.D.A., Taylor, G.J., 1994. The Twenty-Item Toronto Alexithymia
Scale. I. Item selection and cross-validation of the factor structure. Journal of
Psychosomatic Research 38, 23–32.
Beaupré, M.G., Hess, U., 2005. Cross-cultural emotion recognition among Canadian
ethnic groups. Journal of Cross-Cultural Psychology 26, 355–370.
Beck, C.T., 2001. Predictors of postpartum depression: an update. Nursing Research 50,
275–285.
Beck, C.T., 2002. Postpartum depression: a metasynthesis. Qualitative Health Research
12, 453–472.
Brown, G.W., 1993. The role of life events in the aetology of depressive and anxiety
disorders. In: Stanford, S.C., Salmon, P. (Eds.), Stress: From Synapse to Syndrome.
Academic Press, London, pp. 23–50.
Chabrol, H., Teissèdre, F., 2004. Relation between Edinburgh Postnatal Depression Scale
scores at 2–3 days and 4–6 weeks postpartum. Journal of Reproductive and Infant
Psychology 22, 33–39.
Cohn, J.F., Campbell, S.B., Matias, R., Hopkins, J., 1990. Face-to-face interactions of
postpartum depressed and nondepressed mother–infant pairs at 2 months.
Developmental Psychology 26, 15–23.
Cox, J.L., Holden, J.M., Sagovsky, R., 1987. Detection of postnatal depression:
development of the 10-item Edinburgh Postnatal Depression Scale. The British
Journal of Psychiatry 150, 782–786.
Davey, G.C.L., Buckland, G., Tantow, B., Dallos, R., 1998. The effect of disgust on anxiety
ratings to fear-relevant, disgust-relevant and fear-irrelevant stimuli. Journal of
Anxiety Disorders 6, 201–211.
Davey, G.C.L., MacDonald, B.A., Brierley, L., 2008. The effect of disgust on anxiety ratings
to fear-relevant, disgust-relevant and fear-irrelevant stimuli. Journal of Anxiety
Disorders 22, 1347–1354.
de Haan, J., Belsky, J., Reid, V., Volein, A., Johnson, M., 2004. Maternal personality and
infant's neural and visual responsivity to facial expressions of emotion. Journal of
Child Psychology and Psychiatry 45, 1209–1218.
Feldman, R., 2007. Parent–infant synchrony and the construction of shared timing;
physiological precursors, developmental outcomes, and risk conditions. Journal of
Child Psychology and Psychiatry 48, 329–354.
Field, T., 1997. The treatment of depressed mothers and their infants. In: Murray, L.,
Cooper, P.J. (Eds.), Postpartum Depression and Child Development. The Guilford
Press, NY, pp. 221–236.
Field, T., 2002. Early interactions between infants and their postpartum depressed
mothers. Infant Behavior & Development 7, 527–532.
George, M.S., Huggins, T., Mcdermut, W., Parekh, P.I., Rubinow, D., Post, R.M., 1998.
Abnormal facial emotion recognition in depression: serial testing in an Ultra-RapidCycling Patient. Behavior Modification 22, 192–204.
Gollan, J.K., Pane, H.T., McCloskey, M.S., Coccaro, E.F., 2008. Identifying differences in biased
affective information processing in major depression. Psychiatry Research 159, 18–24.
Gonidakis, F., Rabavilas, A.D., Varsou, E., Kreatsas, G., Christodoulou, G.N., 2008. A 6month study of postpartum depression and related factors in Athens Greece.
Comprehensive Psychiatry 49, 275–282.
Guedeney, A., Fermanian, J., 1998. Validation study of the French version of the
Edinburgh Postnatal Depression Scale (EPDS): new results about use and
psychometric properties. European Psychiatry 13, 83–89.
Gur, R.C., Erwin, R.J., Gur, R.E., Zwil, A.S., Heimberg, C., Kraemer, H.C., 1992. Facial
emotion discrimination: II. Behavioral findings in depression. Psychiatry Research
42, 241–251.
Author's personal copy
286
S. Gil et al. / Psychiatry Research 186 (2011) 281–286
Hale, W.W., 1998. Judgement of facial expressions and depression persistence.
Psychiatry Research 80, 265–274.
Heron, J., O'Connor, T., Evans, J., Golding, J., Glover, J., 2004. The course of anxiety and
depression through pregnancy and the postpartum in a community sample. Journal
of Affective Disorders 80, 65–73.
Kendell, R.E., Mackenzie, W.E., West, C., McGuire, R.J., Cox, J.L., 1984. Day-to-day mood
changes after childbirth: further data. The British Journal of Psychiatry 145,
620–625.
Kojima, M., Senda, Y., Nagaya, T., Tokudome, S., Furukawa, T., 2003. Alexithymia,
depression and social support among Japanese workers. Psychotherapy and
Psychosomatics 72, 307–314.
Lazarus, R.S., 1991. Emotion and Adaptation. Oxford University Press, NY.
Le, H.N., Ramos, M.A., Munoz, R.F., 2007. The relationship between alexithymia and
perinatal depressive symptomatology. Journal of Psychosomatic Research 62,
215–222.
Leppänen, J.M., Milders, M., Bell, J.S., Terriere, E., Hietanen, J.K., 2004. Depression biases
the recognition of emotionally neutral faces. Psychiatry Research 128, 123–133.
Loas, G., Otmani, O., Verrier, A., Fremaux, D., Marchand, M.P., 1996. Factor analysis of the
French version of the 20-item Toronto Alexithymia Scale (TAS-20). Psychopathology 29, 139–144.
Lundy, B., Field, T., Pickens, J., 1996. Newborns of mothers with depressive symptoms
are less expressive. Infant Behavior & Development 19, 419–424.
Lundy, B., Field, T., Cigales, M., Cuadra, A., 1997. Vocal and facial expression matching in
infants of mothers with depressive symptoms. Infant Mental Health Journal 18,
265–273.
Marzillier, S., Davey, G.C.L., 2005. Anxiety and disgust: evidence for a unidirectional
relationship. Cognition and Emotion 19, 729–750.
Matias, R., Cohen, J.F., 1993. Are Max-specified infant facial expressions during face-to-face
interaction consistent with differential emotions theory? Developmental Psychology
29, 524–531.
Mendlewicz, L., Linkowski, P., Bazelmans, C., Philippot, P., 2005. Decoding emotional
facial expressions in depressed and anorexic patients. Journal of Affective Disorders
89, 195–199.
Mota, N., Cox, B., Enns, M.W., Calhoun, L., Sareen, J., 2008. The relationship between mental
disorders, quality of life, and pregnancy: findings from a nationally representative
sample. Journal of Affective Disorders 109, 300–304.
Murray, L., 1992. The impact of postnatal depression on infant development. Journal of
Child Psychology and Psychiatry 33, 543–561.
Nadel, J., Soussignan, R., Canet, P., Libert, G., Gérardin, P., 2005. Two-month-old infants
of depressed mothers show mild, delayed and persistent change in emotional state
non-contingent interaction. Infant Behavior & Development 28, 418–425.
Niedenthal, P.M., Halberstadt, J.B., Margolin, J., Innes-Ker, A.H., 2000. Emotional state
and the detection of change in facial expression of emotion. European Journal of
Social Psychology 30, 211–222.
O'Hara, M.W., Swain, A.M., 1996. Rates and risk of postpartum depression: a metaanalysis. International Review of Psychiatry 8, 37–54.
O'Hara, M.W., Schlechte, J.A., Lewis, D.A., Wright, E.J., 1991. Prospective study of
postpartum blues: biologic and psychosocial factors. Archives of General Psychiatry
48, 801–806.
Öhman, A., Flykt, A., Esteves, F., 2001. Emotion drives attention: detecting the snake in
the grass. Journal of Experimental Psychology: General 130, 466–478.
Papousek, H., Papousek, M., 1997. Fragile aspects of early social integration. In: Murray,
L., Cooper, P. (Eds.), Post Partum Depression and Child Development. The Guilford
Press, New York, pp. 35–53.
Phillips, M.L., Senior, C., Fahy, T., David, A.S., 1998. Disgust: the forgotten emotion in
psychiatry. The British Journal of Psychiatry 172, 373–375.
Robertson, E., Grace, S., Wallington, T., Stewart, E., 2004. Antenatal risk factors for
postpartum depression: a synthesis of recent literature. General Hospital Psychiatry
26, 289–295.
Rossignol, M., Anselme, C., Vermeulen, N., Philippot, P., Campanella, S., 2007.
Categorical perception of anger and disgust facial expression is affected by nonclinical social anxiety: an ERP study. Brain Research 1132, 166–176.
Rozin, P., Fallon, A.E., 1987. A perspective on disgust. Psychological Review 94, 23–41.
Rubinow, D.R., Post, R.M., 1992. Impaired recognition of affect in facial expression in
depressed patients. Biological Psychiatry 31, 947–953.
Schofield, C.A., Coles, M.E., Gibb, B.E., 2007. Social anxiety and interpretation biases for
facial displays of emotion: emotion detection and ratings of social cost. Behaviour
Research and Therapy 45, 2950–2963.
Schweitzer, M.B., Paulhan, I., 1990. Manuel pour l'Inventaire d'Anxiété Trait - Etat
(forme Y). Editions du Centre de Psychologie Appliquée, Paris.
Séjourné, N., Denis, A., Theux, G., Chabrol, H., 2008. The role of some psychological,
psychosocial and obstetrical factors in the intensity of postpartum blues. L'Encéphale
34, 179–182.
Skouteris, H., Wertheim, E.H., Rallis, S., Milgrom, J., Paxton, S.J., 2009. Depression and
anxiety through pregnancy and the early postpartum: an examination of
prospective relationships. Journal of Affective Disorders. 113, 303–308.
Spielberger, C.D., Gorsuch, R.L., Lusthene, R.E., 1983. Manual for the State-Trait Anxiety
Inventory. Consulting Psychologist Press, Palo Alto.
Striano, T., Brennan, P.A., Vanman, E.J., 2002. Maternal depressive symptoms and 6-monthold infants' sensitivity to facial expressions. Infancy 3, 115–126.
Stuart, S., Couser, G., Schilder, K., O'Hara, M., Gorman, L., 1998. Post-partum anxiety and
depression: onset and comorbidity in a community Sample. The Journal of Nervous
and Mental Disease 186, 420–424.
Sullivan, M.W., Lewis, M., 2003. Contextual determinants of anger and other negative
expressions in young infants. Developmental Psychology 39, 693–705.
Surcinelli, P., Codispoti, M., Montebarocci, O., Rossi, N., Baldaro, B., 2006. Facial emotion
recognition in trait anxiety. Journal of Anxiety Disorders 20, 110–117.
Suslow, T., Junghanns, K., Arolt, V., 2001. Detection of facial expressions of emotions in
depression. Perceptual and Motor Skills 92, 857–868.
Tamaki, R., Murata, M., Okano, T., 1997. Risk factors for postpartum depression in Japan.
Psychiatry and Clinical Neurosciences 51, 93–98.
Taylor, G.J., Bagby, R.M., Luminet, O., 2000. Assessment of alexithymia: self-report and
observer-rated measures. In: Bar-On, R., Parker, J.D.A. (Eds.), The Handbook of
Emotional Intelligence: Theory, Development, Assessment, and Application at
Home, School, and in the Workplace. Jossey-Bass, San Francisco, pp. 301–319.
Teissèdre, F., Chabrol, H., 2003. Postnatal depression: a study of the predictive effects of
postnatal anxiety. Irish Journal of Psychological Medecine 20, 111–114.
Teissèdre, F., Chabrol, H., 2004. Detecting women at risk of postnatal depression using
the EPDS at 2 to 3 days postpartum. Canadian Journal of Psychiatry 49, 51–54.
Tronick, E.Z., Weinberg, M.K., 1997. Depressed mothers and infants: failure to form dyadic
states of consciousness. In: Cooper, P., Murray, L. (Eds.), Post Partum Depression and
Child Development. The Guilford Press, New York, pp. 54–81.
Verdoux, H., Sutter, A.L., Glatigny-Dallay, E., Minisini, A., 2002. Obstetrical complications and the development of postpartum depressive symptoms: a prospective
survey of the MATQUID cohort. Acta Psychiatrica Scandinavica 106, 212–219.
Weinberg, M.K., Tronick, E.Z., 1994. Beyond the face: an empirical study of infant
affective configurations of facial, vocal, gestural, and regulatory behaviours. Child
Development 65, 1495–1507.
Woody, S.R., Tolin, D.F., 2002. The relationship between disgust sensitivity and avoidant
behavior: studies of clinical and nonclinical samples. Journal of Anxiety Disorders
16, 543–559.