Identifying embodied risk and protective factors in mothers with postpartum depression and comorbidities using Parental Embodied Mentalizing Assessment™

Background: Clinically, postpartum depression (PPD) is frequently diagnosed with maternal comorbid mental disorders (postpartum anxiety, PPA; personality disorders, PDs) in mothers. Its association with impaired Parental Embodied Mentalizing (PEM) remains unclear. This study aims to investigate embodied risk and protective factors of parental mentalizing in PPD-mothers. More risk factors and fewer protective factors were hypothesized as a function of comorbidities. Method: Sixty-eight mothers with infants aged 3–10 months were examined using the Parental Embodied Mentalizing Assessment™ (PEMA™) on a 5-minute videotaped free-play interaction. Six subgroups were compared according to DSM-IV diagnoses: PPD; PPD and PPA; PPD and Borderline PD (BPD); PPD, PPA, and BPD; PPD and other PDs; and PPD, PPA, and other PDs. Results: Overall, variable subgroup differences were observed (d = 0.9–1.09): PPD-mothers demonstrated the highest and PPD-mothers with BPD the lowest protective factors, in particular Sustained Presence. PPD-mothers with PPA and other PDs showed the lowest interactive Repair, and PPD-mothers with other PDs the highest Connectivity. There were no substantial group differences in risk factors. However, PPD-mothers with BPD displayed the highest Teasing and Objectification, i.e., treating the infant as an inanimate object. Conclusion: In the case of PPD, comorbidities must be taken into account, as they primarily impact the protective character of the mother's embodied communication during infancy. Comorbid BPD is associated with fewer protective and more risk factors, whereas comorbid PPA and/or other PDs are associated with increased over-control. Further research is needed to validate the PEMA™ factors, including a non-clinical control group.