Video-Feedback Interaction Guidance for Improving Interactions Between Depressed Mothers and their Infants


Postpartum depression (PPD) is a major public health issue. Known as “the thief that steals motherhood” since symptoms obstruct a mother’s capacity for understanding and enjoying her baby, PPD affects approximately 1 in 5 moms. Built via “serve and return” interactions (e.g. baby smiles, mom smiles back), sensitive and responsive exchanges are the foundation for healthy child development but are diminished by PPD, resulting in interactions that place children at risk for behavioural and cognitive problems. Infants perceive PPD as stressful; stressors stimulate the brain’s hypothalamic pituitary adrenal axis (HPA) and trigger stress hormone (cortisol) release, which, in turn, negatively affects developing infant brains by decreasing brain volume. Infants’ critical periods of brain development are vulnerable to long-term effects of cortisol, explaining some of the problematic developmental outcomes observed in children of depressed mothers.

How can we support depressed mothers and their infants? Successfully treating PPD does not always benefit mother-child relationships; however, this research builds on a successful pilot that demonstrated that nurse-guided video feedback improved mother-infant interactions in the context of PPD. By improving interaction quality, depressed mothers may be motivated to engage in more play and, in turn, infants who appear interested and ready to interact are more likely to elicit positive, enjoyable experiences from mothers. Building on the pilot, we will trial the effectiveness of VID-KIDS (Video-Feedback Interaction Guidance for Improving Interactions Between Depressed Mothers and their Infants) on maternal-infant interaction and infant cortisol patterns as well as infant development, maternal symptoms of depression and anxiety, and parenting self-efficacy. If successful, future aims are to 1) integrate VID-KIDS into existing services of Calgary Public Health; and 2) commercialize VID-KIDS for dissemination.

Furthermore, the COVID-19 pandemic has placed unprecedented strain on families already negatively impacted by toxic stressors, known to undermine children’s mental, emotional and behavioural (MEB) health and development. Families require support more than ever, but traditional clinic and home visit models are inadequate for the challenge, placing many more children at risk for MEB problems over their lifetimes. While these families require this support, parents are reluctant to see health-service providers in home or clinic due to infection fears for themselves, their child and family. However, we have heard from both AHS and our enrolled participants that mothers are more desperate than ever to obtain safe support for their depressive symptoms and to assist them with parenting needs. The expectation that the COVID-19 pandemic has caused a parallel mental health crisis underlines the immediacy of the need to provide mental health supports for vulnerable parents and their children. Adapting VID-KIDs to online delivery will not only fulfill these needs but also to expand its intervention reach to rural communities and reduce costs associated with face-to-face services. Building upon the VID-KIDS study, a new collaboration was forged with a new team focused on the user-informed design of a tailored web-based intervention for VID-KIDS. Using integrated knowledge transfer (iKT) and co-design approaches, we will further develop and pilot test the virtual delivery program for real world implementation, by evaluating the impact of the beta prototypes on children’s MEB health and development. This project will expand our research into user-engaged technology-enabled delivery of urgently needed community mental health interventions and allow us to rapidly scale up these parent training programs to reach a greater number of vulnerable Canadian families.

Goals and Objectives

Specific aims are to evaluate the effect of the VID-KIDS intervention among depressed mothers on: 1) M-I interaction quality (primary outcome); 2) infant cortisol patterns, infant development, maternal PPD and anxiety, and parenting stress (secondary outcomes). If successful, future aims are to 1) conduct rigorous cost-benefit analyses; 2) commercialize VID-KIDS for dissemination by NCAST (Nursing Child Assessment Satellite Training) Programs; and 3) examine integration of VID-KIDS into existing health services.

Expected results promote health research and advance knowledge in three ways: 1) VID-KIDS shows considerable promise as an effective methods for enhancing M-I relationships of depressed mothers. 2) Through Co-Investigators Oxford and Findlay of NCAST Programs, we have means to commercialize and disseminate VID-KIDS alongside a world leader in evidence-based interventions that promote nurturing environments for young children. 3) Through Co-Investigator McNeil and Collaborator Philley and our integrated knowledge translation methods, we have exceptional levels of community engagement with Calgary Public Health and the opportunity to examine integrating VID-KIDS into existing services.

The aim of developing and testing the virtual delivery program of VID-KIDS is to build on the success of the in-person intervention program by transitioning to virtual delivery and to: 1) improve health outcomes for vulnerable people; 2) improve children’s mental, emotional and behavioural outcomes; 3) improve parents or caregivers skills, attitudes and behaviours during uncertain times such as the COVID-19 pandemic. Additionally, the aim of creating a virtual delivery of VID-KIDS will assuredly make it more attractive and likely to be adopted by our community partners under real and emerging economic and budgetary constraints.

Members of the team

Principal InvestigatorsDr. Nicole Letourneau
Faculty of Nursing
University of Calgary

Dr. Panagiota Tryphonopoulos
Faculty of Nursing
Brandon University
Co-InvestigatorsGillian Currie, PhD 
Professor, Cumming School of Medicine
University of Calgary

Cindy-Lee Dennis, PhD
Department of Nursing
University of Toronto

Linda Duffett-Leger, PhD
University of Calgary

Denise Findlay, RN
Director of Education Nursing Child Assessment Satellite Training

Dawn Kingston, PhD
University of Calgary

Deborah McNeil, PhD
Alberta Health Services

Monica Oxford, PhD
University of Washington

Mohammad Moshirpour, PhD
University of Calgary

Shelly Philley, MSA
Alberta Health Services