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. Author manuscript; available in PMC: 2026 Sep 29.
Published in final edited form as: J Affect Disord. 2025 Nov 3;394(Pt B):120590. doi: 10.1016/j.jad.2025.120590

Infant Emotionality and Maternal Depression at 6 Months Postpartum

Karley Mariano 1, Sandra J Weiss 2
PMCID: PMC13618973  NIHMSID: NIHMS2202799  PMID: 41192733

Abstract

Background

Postpartum depression is a global concern associated with multiple complications, including the risk of suicide. Beyond the suffering experienced by women with postpartum depression, research provides evidence of its negative impact on mother-infant relationships. However, little attention has been given to the potential impact of infant characteristics on development or severity of postpartum depression.

Objective

The purpose of this study was to determine if greater infant emotionality is associated with symptoms of maternal depression at 6 months postpartum. Emotionality was defined as infant negative affectivity and emotional reactivity in response to a stressor.

Methods

At 6 months postpartum, women completed questionnaires to assess their history of depression, current depressive symptoms, and infant’s negative affectivity. Mother and infant also participated in a video-recorded, stressor protocol (the Still Face Paradigm) that was later coded for infant emotional reactivity, using a standardized measure.

Results

Postpartum depression ranged from asymptomatic to severe, with 10% of women meeting criteria for Major Depressive Disorder. Linear regression indicated that infant negative affectivity (β=0.93, p=0.002), but not emotional reactivity, was associated with mother’s depressive symptoms at 6 months postpartum. Neither a woman’s previous diagnosis of depression nor her prenatal depression predicted infant negativity, supporting the directional effect of infant negativity on postpartum depression.

Conclusions

Findings indicate the need for early assessment of infant temperament and mother-infant interactions, especially among women with a history of depression. Early intervention to assist mothers in caring for infants with more challenging affective behaviors may prevent development or worsening of postpartum depression.

Keywords: Women’s depression, infant temperament, negative affectivity, mother-infant interaction

1. Introduction

Postpartum depression (PPD) occurs in approximately 17% of all women worldwide and is associated with a range of complications, from social isolation and difficulty returning to the workforce, to suicide in severe cases (Slomian et al., 2019; Wang et al., 2021). Many predisposing factors have been identified that put a woman at risk for PPD, such as a history of depression prior to or during pregnancy, negative birth experience, preterm birth, and suboptimal partner support (van der Zee-van den Berg et al., 2021).

In contrast to other types of depression, PPD occurs in the context of the mother-infant relationship. This relationship typically involves an emotional bond between mother and child that is one of the most significant psychological processes for a mother during the postpartum period (Hill & Flanagan, 2020; Kinsey & Hupcey, 2023). Despite the significance of the mother-infant relationship for the mother’s psychological well-being, research has focused primarily on how a woman’s depression may impact her relationship with the infant or the infant’s well-being. For instance, there is evidence of PPD’s negative impact on the mother-infant relationship, including effects on perceived parenting ability and poor infant attachment (Makeen et al., 2022). However, negative infant temperament has been found to moderate the relationship between PPD and the mother-infant relationship, suggesting that infant characteristics do indeed influence a mother’s depression (Weiss et al., 2023). It has been proposed that temperamentally “difficult,” more emotional babies may elicit feelings of depression and inadequacy in the mother (Rigato et al., 2020).

1.1. Purpose

While studies have previously explored how PPD affects infant behavior, research has not evaluated how infant negative temperament or a propensity to emotional reactivity when encountering a stressor may be associated with maternal depression, especially beyond 3 months postpartum (Troutman et al., 2012). We examined these relationships and hypothesized that greater infant emotionality (negative affectivity and greater emotional reactivity when experiencing a stressor) would be associated with greater severity of maternal depression at 6 months postpartum.

2. Methods

2.1. Participants and Sampling

This research was a secondary, cross-sectional data analysis at 6 months postpartum of 70 women/infant dyads who were part of a larger 15-month longitudinal study. The larger parent study examined the effect of prenatal and postpartum risk factors associated with infant stress regulation during the first year of life in women who were at risk for preterm labor and delivery. Women were recruited from 2 obstetric clinics affiliated with a major academic health center. Inclusion criteria included English or Spanish-speaking women in their 3rd trimester (between 24 and 34 weeks of gestation), who were at high risk for preterm delivery. Women who used antenatal steroids or had a history of endocrine disorders, smoked, or had serious medical or cognitive problems were excluded. Infants who had major congenital disease, chronic lung disease, or major neonatal illness were excluded. These exclusion criteria were established as part of the parent study which examined effects of antenatal corticosteroids and maternal depression on cortisol regulation and other stress-related responses of mothers and infants. Approval was obtained through the University Institutional Review Board for Human Research Protection. Women provided informed consent with proxy consent for the infant.

Data were extracted from the electronic health records of mothers and infants to determine possible covariates and verify inclusion/exclusion criteria. Women completed a demographic questionnaire and depression assessment using the Patient Health Questionnaire (PHQ-9) during their 3rd trimester of pregnancy. At 6 months postpartum, the mother completed the Major Depressive Disorder (MDD) Subscale of the Psychiatric Diagnostic Screening Questionnaire (PDSQ) and the Infant Behavior Questionnaire to assess infant temperament. At this timepoint, mother and infant also participated in a standardized stressor protocol (the Still Face Paradigm) to evaluate the infant’s emotional reactivity in response to a stressor.

2.2. Primary Outcome: Postpartum Depression

The MDD subscale of the Psychiatric Diagnostic Screening Questionnaire was used to evaluate depression at 6 months postpartum (Zimmerman & Mattia, 2001). This is a 22-item subscale that evaluates criteria of MDD identified by the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV). The measure is distinguished from most self-report depression questionnaires by the precision of its items and their close alignment with the criteria for a Major Depressive Disorder defined in the DSM (Rogers et al., 2025). Its reliability and validity have been established with clinical and community samples, including women (Kramer et al., 2008; Perkey et al., 2018). The sum score for all items was used as our measure of depression severity.

If women endorsed a suicidal ideation item or received a score that indicated a moderate or greater level of depression (>10), we implemented a safety protocol that first involved the National Institute of Mental Health’s Suicide Screen. If the screen was positive, we immediately referred the woman to either her ongoing psychiatric clinician, a psychiatric clinician on our team, or dialed 911 if she was in imminent danger.

2.3. Predictor 1: Infant Temperament (Negative Affectivity)

Temperament was measured using the 37-item Infant Behavior Questionnaire – Revised. This is a well-established caregiver report measure for infants 3 to 12 months of age, which measures negative affectivity, positive affectivity, and regulatory capacity. For this study, we focused on the negative affectivity subscale which includes 12 items assessing behaviors such as sadness, distress to limitations, and fear. This scale has demonstrated appropriate internal consistency across varied samples (including income and racial/ethnic variability) and has good interparent agreement, retest reliability, and validity (Leerkes et al., 2017; Putnam et al., 2014).

2.4. Predictor 2: Emotional Reactivity in Response to a Stressor

To measure emotional reactivity, a validated observational protocol was used to code infant behaviors that were video-recorded during a mother-infant interaction at home when the infant was 6 months of age. This interaction involved the Repeated Still Face Paradigm (SFP) as a stressor to elicit emotional reactivity of the infant in response to unexpected emotional disengagement of the mother during the interaction (Mesman et al., 2009; Tronick, 2003). The SFP is a well-established, reliable, ethical stressor protocol to evaluate an infant’s response to stressors by exposing the infant to 3 distinct phases of interaction with the mother: initial spontaneous play, still face, and a reunion phase. During the still face (the stressor phase), the mother is asked to look at the infant but show no emotion toward the infant (i.e., “poker face”). The total time from the initial play to the reunion was 20 minutes. Infant emotional reactivity was measured during the stressor using a validated and reliable standardized coding system that identified infant distress behaviors during all three phases (Weiss et al., 2024). These included: 1) crying/fussing, 2) attention/approach to the mother to be comforted, 3) wiggling, kicking, flailing, or banging, 4) grimacing, and 5) withdrawal/disengagement from the mother. A score was assigned to the infant for the change in total number of distress behaviors from prior to the stressor until the post-stressor period.

Two research assistants (RAs) coded the emotional distress of the infant during the stressor. They were given didactic training in the coding system, watched video exemplars of the distress behaviors, practiced coding with other training videos, and reviewed their codes with an expert coder. RAs were then assessed for coding reliability on 3 evaluation videos, achieving a Cohen’s kappa of 0.82 for interrater reliability.

2.5. Covariates

Three covariates were examined. Covariates were determined a priori based on previous research and included the woman’s history of receiving a depression diagnosis at some point in their life, their depressive symptoms during pregnancy, and neonatal morbidity (Batt et al., 2020; Luciano et al., 2022; Zemtsov et al., 2022). History of a depression diagnosis was assessed via self-report (yes/no) on a clinical survey that was part of the larger parent study. Depressive symptoms during pregnancy were determined using the Patient Health Questionnaire-9 (PHQ-9) during the 3rd trimester. The PHQ-9 is a well-established measure of depression with good validity and reliability among women, including during pregnancy and the postpartum (Kroenke et al., 2001; Weiss et al., 2021). Women reported the frequency of their depressive symptoms during the past two weeks from “not at all” to “nearly every day.” The sum of symptom scores was used in our analysis. We also used the PHQ-9 to assess women’s depression at 1 month postpartum for follow-up analyses regarding potential associations between prior maternal depression and later infant emotionality. Neonatal morbidity was assessed with the Morbidity Assessment Index for Newborns (Verma et al., 2005). This index includes 47 binary items that identify complications during delivery and health problems experienced by the infant during the first month of life. It has shown good validity and reliability over time (Fu et al., 2023). The presence of infant complications and health problems was determined through review of the electronic health record. The total number of problems an infant experienced was used as their morbidity score.

2.6. Statistical Analyses

Demographics of the mother and infant were identified using simple descriptive statistics. Multiple linear regression was used to determine the relationships of both infant negative affectivity and emotional reactivity to maternal depressive symptoms at 6 months postpartum. The three covariates described earlier were included in the regression model. Variables in the model were assessed for linearity, normality, collinearity, and homoscedasticity (constant error variance). To overcome violations, bootstrapping and robust standard errors were leveraged. To better understand the directionality of the relationship between infant emotionality (negative affectivity and emotional reactivity) and maternal depression, scores for maternal depressive symptoms during pregnancy and one month postpartum (both measured with the PHQ-9) were correlated with scores for infant emotionality at 6-month postpartum. We used Pearson correlations for these analyses. Differences in infant emotionality at 6 months of age were also examined with analysis of variance for women who had a previous diagnosis of depression and those who did not. These analyses provided data on the degree to which maternal depression may have preceded infant emotionality, potentially influencing the development of the infant’s negative affectivity or emotional reactivity at 6 months of age.

Statistical significance was defined as a two-sided p-value of <0.05. STATA (version 17.0, College Station, TX) was used for all analyses.

3. Results

3.1. Sample Characteristics

Data for seventy women and their infants were included in the final model. On average, women were 35 (± 6.0) years of age, with 83% in a committed relationship. 27% had a prior depression diagnosis. Postpartum depression ranged from asymptomatic to severe, with 10% meeting the cutoff for MDD at 6 months. Although the sample included women who were at risk of preterm delivery during pregnancy, as expected, not all women actually delivered preterm infants. Infants had an average gestational age of 37 weeks, and 55% were full term. 44% were female. 30% of mothers and infants were African or Asian American, and 17% were Hispanic. Additional characteristics are described in Table 1.

Table 1.

Maternal and Infant Characteristics.

Characteristic Mean or N
Maternal Characteristics
Age (mean, SD) 34.61 (5.50)
Relationship Status (n, %)
 Committed Partner 58 (82.8)
 Single/Separated/Divorced 12 (17.2)
Employment (n, %)
 Unemployed 20 (28.6)
 Part- or Full-Time 50 (71.4)
Race (n, %)
 White/European American 49 (70.00)
 Black/African American 13 (18.57)
 Asian American/Pacific Islander 8 (11.43)
Hispanic Ethnicity (n, %) 12 (17.14)
Reliance on Government Assistance (n, %) 40 (57.14)
Depression during Pregnancy (mean, SD)+ 5.1 (4.50)
Depression Score at 6 months (mean, SD)* 2.84 (3.99)
Prior Diagnosis of Depression during lifetime (n, %) 19 (27.14)
Infant Characteristics
Female Sex (n, %) 31 (44.29)
Gestational Age in weeks (mean, SD) 37.06 (2.88)
Birthweight in grams (mean, SD) 2841 (768.50)
Neonatal Morbidity Index (mean, SD) 163.56 (319.96)
Negative Affectivity (mean, SD)^ 3.54 (1.03)
Emotional Reactivity in Response to a Stressor (mean, SD) 0.96 (1.97)
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+

Using the PHQ-9 (range: 0–27)

*

Using the Major Depression Disorder Scale Score on the Psychiatric Diagnostic Screening Questionnaire (range: 0–21)

^

Using the Negative Affectivity Subscale on the Infant Behavior Questionnaire-Revised (range: 1–7)

Note: Abbreviations: SD = Standard Deviation; the Neonatal Morbidity Index and Emotional Reactivity Measure have individualized scoring, with no set ranges for their scores.

3.2. Infant Emotionality and Postpartum Depression

As shown in the preliminary model of Table 2, neonatal morbidity was not a significant predictor; thus, this covariate was not included in the final model. The other two covariates (prior diagnosis of depression and prenatal depression) showed significant relationships to maternal depression at 6 months postpartum, so they were left in the model.

Table 2.

Multiple Regression Models for the Relationships of Infant Negative Affectivity and Emotional Reactivity to Severity of Maternal Depression at Six Months Postpartum, Controlling for Covariates.

Variable Preliminary Model Final Model
β 95% CI p-value β SE+ 95% CI^ p-value
Negative Affectivity 1.08 0.33, 1.83 0.005 0.93 0.31 0.35, 1.50 0.002
Emotional Reactivity in Response to a Stressor 0.30 −0.01, 0.62 0.059 0.00 0.12 −0.31, 0.31 0.98
History of Depression Diagnosis 2.72 1.10, 4.35 0.001 1.97 0.77 0.71, 3.23 0.01
Depression during 3rd Trimester 0.43 0.28, 0.58 <0.001 0.30 0.10 0.10, 0.50 0.005
Neonatal Morbidity 0.00 −0.00, 0.00 0.76 N/A N/A N/A N/A
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+

Robust Standard Error

^

Bootstrap Confidence Interval

Table 2 presents the results for the final regression model. Infant negative affectivity was associated with severity of maternal depression at 6 months postpartum (β=0.93, p=0.002, 95% CI 0.35, 1.50). However, the infant’s emotional reactivity in response to a stressor was not related to maternal depression. Both covariates showed significant associations with the severity of postpartum depression, including a previous diagnosis of depression and 3rd trimester depression. Variables in this model accounted for 49% of the variability in maternal depression (F(4, 64) = 6.45, p<0.001).

3.3. Prior Maternal Depression and Later Infant Emotionality

Neither maternal depression during pregnancy nor maternal depression at one-month postpartum predicted infant emotional reactivity to a stressor at 6 months postpartum (r=0.02, p=0.83; r=0.12, p=0.22, respectively). Similarly, prenatal depression and depression at one month postpartum did not predict infant negative affectivity (temperament) at 6 months postpartum (r=.06, p=.55; r=.09, p=.45) In addition, infants of women with a prior diagnosis of depression did not differ from infants of women without a diagnosis in either their negative affectivity (F=.004 (df=1), p=.94) or their emotional reactivity to a stressor (F=.002 (df=1), p=.96). Figure 1 shows the correlations between infant negative affectivity and maternal depression at these various timepoints.

Figure 1. Associations of Maternal Depression at Various Timepoints to Infant Negative Affectivity .

Figure 1.

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4. Discussion

4.1. Key Findings

Infant negative affectivity was associated with more severe depressive symptoms for women at 6 months postpartum, suggesting that infant negative temperament may contribute to a mother’s feelings of sadness and other depressive symptoms. These findings were supported by our examination of data prior to the 6-month postpartum timepoint to better understand the potential direction of the relationship between infant negative affectivity and maternal depression. As shown in Figure 1, these analyses indicated that neither a prior diagnosis of depression, maternal depression during pregnancy, nor depression at one-month postpartum predicted infant negative temperament at 6 months postpartum. In contrast to negative affectivity, infant emotional reactivity to a stressor was not significantly related to maternal depression at 6 months postpartum.

In addition to results related to our aims, findings regarding the covariates suggest that women with a history of depression appear to have a predisposition to more severe symptoms of depression at 6 months postpartum. Both a previous diagnosis of depression and prenatal depression were significant predictors of more severe depression at 6 months postpartum.

4.2. Infant Negative Affectivity and PPD

Our findings are consistent with previous literature, which has shown that infant temperament may result in increased risk of PPD (Skodova et al., 2022). Other research indicates that babies with high negative emotionality or irritability appear to reduce feelings of parenting efficacy in the postpartum (Troutman et al., 2012). Since maternal self-efficacy has been associated with fewer postpartum depression symptoms, this factor may potentially mediate the relationship between infant negative affectivity and maternal depression (Dlamini et al., 2023). Weiss et al. (2023) found that a mother’s depression was related to less positive engagement with their infant when the infant had greater negative affectivity, which may further intensify negative mother-infant interactions.

While many studies offer findings that support a relationship between PPD and negative affectivity, there is a paucity of studies that evaluate the directionality of this relationship (Rouse & Goodman, 2014; Sacchi et al., 2018; Swales et al., 2023). Our study offers unique findings that allow for better prediction of infant emotionality on PPD instead of the reverse. An infant who is calmer, less fussy, and sleeps well is less likely to result in additional stressors and less sleep for the mother compared to one who does not sleep well, is fussier, and more difficult to console. However, it is likely that there is a cyclical relationship between these two variables that results in amplification of both depression and negative affectivity by the other.

It is important to note one caveat to the association we found: our measure of infant negative affectivity was based on maternal report. It is possible that mothers who were more depressed perceived their infants’ affectivity in more negative ways than mothers who were not depressed. Some research suggests that persons who are depressed are more likely to have a ‘negative interpretation bias,’ whereby they attribute more negative meaning to situations, including others’ behavior (Espejo et al., 2012; Nejati, 2018). Indeed, this bias has been reported in depressed mothers’ perceptions of infant crying and temperament (Karreman et al., 2023; Rigato et al., 2020). Future studies could acquire assessments of infant negative affectivity from the infant’s father or other close caregivers (as well as the mother) to determine their varied associations with maternal depression and create a more robust assessment of the infant’s affectivity.

4.3. Infant Emotional Reactivity and PPD

Although not congruent with our hypothesis, the lack of association between infant emotional reactivity and PPD is supported by other findings in the literature. Gordon-Hacker et al. (2024) showed no association between infant emotional reactivity and maternal depressive symptoms at 3 months postpartum, despite an opposite hypothesis. Results of another study indicated that infant emotional reactivity was not associated with improvements in PPD that occurred because of a cognitive-behavioral intervention during the first year postpartum, further supporting the perspective that emotional reactivity may not be a key influence on PPD (Amani et al., 2023). An infant’s emotional reactivity in response to observable stressors may be easier for a mother to understand and cope with, considering the clear source of the child’s distress and its transitory, short-term nature. As a result, emotional reactivity in response to stressors may have less impact on a mother’s perceived parenting efficacy or overall mood. In contrast, infant negative affectivity is a more stable temperament trait that pervades interactions with the child and is often not linked to clear reasons for distress (Planalp & Goldsmith, 2020). Such persistent negativity may engender chronic stress and a sense of parenting failure for the mother that contributes more significantly to feeling despondent and hopeless about life.

4.4. Strengths and Limitations

There are several limitations to this study inherent in secondary analysis. Our research aims would benefit from a study specifically addressing the relationship between infant emotionality and PPD longitudinally. The parent study from which our data were derived excluded infants and mothers with major illness or disability; factors they experience may contribute to the risk of PPD, and results could be even more striking in this population. Additionally, women in this study were at high risk for preterm labor, which is a risk factor for PPD. In a population that is not high-risk, results may have differed. Another potential limitation was that infant negative affectivity was measured by maternal reports, as were her symptoms of depression. It is possible that a mother’s depressive symptoms at the time she completed the measures negatively biased her views of her infant’s behavior. However, a major strength of this study is that we were able to evaluate data points across time to assess the direction of the potential effects. Additionally, the population being studied was diverse, including self-reported racial and ethnic background, income and resource needs, and employment, and representative of the broader population. Lastly, two measures of infant emotionality were available, including maternal report and behavioral observation.

5. Implications

Findings emphasize the importance of early detection of negative affectivity and its impact on maternal mental health so that there can be therapeutic and parenting support provided to mothers. Early interventions can provide support to mothers in caring for infants with more challenging affective behaviors and help mothers more accurately assess the meaning of their infant’s affect and vocalizations if they are interpreting them as negative when not actually warranted. However, future longitudinal research is sorely needed to determine causal pathways and better understand the complex relationship between a mother’s postpartum depression and her child’s negative temperament. Examining how an infant’s affect may influence a mother’s sense of self or parenting efficacy is essential. In addition, it will be important to determine whether any specific symptoms of depression are associated with infant negativity, such as worthlessness or hopelessness. Such research can yield more precise targets of intervention to assist mothers in caring for infants with more challenging affective behaviors that may contribute to the development or worsening of their PPD symptoms. Interventions that focus on self-efficacy in the context of infant negativity may be particularly useful.

It is also important to consider the effects of infant negative affectivity on the child’s development and mental health. Research provides evidence that infant negative emotionality predicts later psychopathology across the life course (Frenkel et al., 2015; Kostyrka-Allchorne et al., 2020). Therefore, early interventions to support optimal affective development for the child are also critical.

Highlights.

  • Scant research has examined how infant behavior impacts a woman’s postpartum depression

  • This study found that infant negative affectivity predicts more severe depressive symptoms

  • Infant negativity may engender stress or perceived parenting failure that augments depression

  • Identification of high-risk mother-infant dyads enables early therapeutic support

Acknowledgements

The authors are grateful to Sandra Niemann, PhD for her coordination of data collection and data curation, to Katherine Reeves, PhD and Midori Nakajima, PhD for their coding of infant emotion regulation, and to Nina Ahlers, MPH and Genesis Vasconez, MS, PMHNP for their contributions to data collection.

Funding

This project was a secondary analysis of data from a larger study funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NIH, R01 HD081188, S.J. Weiss, Principal Investigator)

Footnotes

Ethical Approval and Informed Consent

The Institutional Review Board at University of California, San Francisco approved this research (IRB 14–13516, # 087016). All participants provided written informed consent prior to participating.

Author Statement

Ms. Mariano was involved in the conceptualization, formal analysis, methodology, and writing of the original draft of this manuscript.

Dr. Weiss was involved in the conceptualization, data curation, formal analysis, original investigation, supervision of the first author, and review and editing of the manuscript.

Conflicts of Interest

The authors declare that there are no relevant financial or non-financial conflicts of interest to report.

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Contributor Information

Karley Mariano, Department of Community Health Systems, School of Nursing, University of California, San Francisco, 490 Illinois Street, San Francisco, CA, USA 94143.

Sandra J. Weiss, Department of Community Health Systems, School of Nursing, University of California, San Francisco, San Francisco, CA, USA.

Data Availability

The data supporting the findings of this study are available upon reasonable request from the parent study’s Principal Investigator (sandra.weiss@ucsf.edu).

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

The data supporting the findings of this study are available upon reasonable request from the parent study’s Principal Investigator (sandra.weiss@ucsf.edu).

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