A Collaborative, Network-Based Approach to Advance Women's Depression Research in the United States: Preliminary Findings

OBJECTIVE

Translation of women's mental health research has yet to impact overall prevalence and burden of Mood Disorders in the United States. The lack of standard measures and methodological coordination across studies has contributed to the slow impact of research on outcomes. The primary aims of this project were to demonstrate the process by which multiple investigators, sites, and settings administered a standard women's mental health questionnaire within a new Women's Depression Network. Information on the prevalence of mental health and service use across sites is provided.

METHODS

A standard women's mental health questionnaire was developed and administered across seven different women's health sites in the United States. Validated measures of depression and anxiety were included (Patient Health Questionnaire Depression Scale [PHQ-9] and Generalized Anxiety Disorder Scale [GAD-7]). Administration of the questionnaire was embedded into existing clinical or research activities at each site.

RESULTS

Data from 1,316 women were collected from seven sites over 12 months. A total of 14% and 15% of the women scored at or above the cutoff on the PHQ-9 and GAD-7 respectively. Just over half of the women screening positive for either depression or anxiety reported current treatment use.

CONCLUSIONS

Findings suggest that coordination and administration of a standard women's mental health questionnaire is feasible across multiple settings and sites. Results highlight a low percentage of treatment use across various settings. The infrastructure developed for this study sets the stage for hypothesis-driven studies that can facilitate coordinated, network-based research that has the potential to accelerate advances in the field.

STRONG MILITARY FAMILIES INTERVENTION ENHANCES PARENTING REFLECTIVITY AND REPRESENTATIONS IN FAMILIES WITH YOUNG CHILDREN

Military families face many challenges due to deployment and parental separation, and this can be especially difficult for families with young children. The Strong Military Families (SMF) intervention is for military families with young children, and consists of two versions: the Multifamily Group, and a Home-based psychoeducational written materials program. The Multifamily Group was designed to enhance positive parenting through both educational components and in vivo feedback and support during separations and reunions between parents and children (n = 78 parents). In the present study, we examine parenting reflectivity and mental representations in mothers versus fathers in military families, service members versus civilian spouses/parenting partners, and before versus after participation in the SMF Multifamily Group and Home-based interventions. Parenting reflectivity and mental representations were coded from the Working Model of the Child Interview (WMCI; C.H. Zeanah & D. Benoit, 1995). Results suggest that neither parenting reflectivity nor WMCI typology differs between mothers and fathers in military families, or between service members and civilian parenting partners. Furthermore, there was substantial stability in parenting reflectivity and WMCI typology from baseline to posttest, but participation in the Multifamily Group, relative to Home-based, was associated with improvements in both parenting reflectivity and WMCI ratings from baseline to postintervention.

Movements Indicate Threat Response Phases in Children at Risk for Anxiety

Temporal phases of threat response, including potential threat (anxiety), acute threat (startle, fear), and post-threat response modulation, have been identified as the underlying markers of anxiety disorders. Objective measures of response during these phases may help identify children at risk for anxiety; however, the complexity of current assessment techniques prevent their adoption in many research and clinical contexts. We propose an alternative technology, an inertial measurement unit (IMU), that enables noninvasive measurement of the movements associated with threat response, and test its ability to detect threat response phases in young children at a heightened risk for developing anxiety. We quantified the motion of 18 children (3-7 years old) during an anxiety-/fear-provoking behavioral task using an IMU. Specifically, measurements from a single IMU secured to the child's waist were used to extract root-mean-square acceleration and angular velocity in the horizontal and vertical directions, and tilt and yaw range of motion during each threat response phase. IMU measurements detected expected differences in child motion by threat phase. Additionally, potential threat motion was positively correlated to familial anxiety risk, startle range of motion was positively correlated with child internalizing symptoms, and response modulation motion was negatively correlated to familial anxiety risk. Results suggest differential theory-driven threat response phases and support previous literature connecting maternal child risk to anxiety with behavioral measures using more feasible objective methods. This is the first study demonstrating the utility of an IMU for characterizing the motion of young children to mark the phases of threat response modulation. The technique provides a novel and objective measure of threat response for mental health researchers.

Partnerships with Primary Care for the Treatment of Preschoolers

This article reviews mental health access issues relevant to preschool children and data on this population obtained through the Michigan Child Collaborative Care Program (MC3). The MC3 program provides telephonic consultation to primary care physicians (PCPs) in 40 counties in Michigan and video telepsychiatric consultation to patients and families. Attention-deficit/hyperactivity disorder and disruptive behavioral disorders are frequent initial presenting diagnoses, but autism spectrum disorders, parent-child relational issues, trauma, and posttraumatic stress disorder should also be considered. Collaborative care programs provide promising ways to promote access to child psychiatric services when these services are distant to local PCP offices.

Feeding and Mealtime Correlates of Maternal Concern About Children's Weight

OBJECTIVE

To examine associations between maternal concern regarding their children becoming overweight and two domains of weight-related parenting; child feeding practices and family meal characteristics.

DESIGN

Cross-sectional study.

PARTICIPANTS

Low-income mothers (n = 264; 67% non-Hispanic white) and their children (51.5% male, aged 4.02-8.06 years).

VARIABLES MEASURED

Maternal concern and feeding practices, using the Child Feeding Questionnaire. Meal characteristics were assessed using video-recorded meals and meal information collected from mothers.

ANALYSIS

The authors used MANOVA and logistic regression to identify differences in maternal feeding practices and family meal characteristics across levels of maternal concern (none, some, and high).

RESULTS

Approximately half of mothers were not concerned about their child becoming overweight, 28.4% reported some concern, and 19.0% had high concern. Mothers reporting no concern described lower restrictive feeding compared with mothers who reported some or high concern (mean [SE], none = 3.1 [0.1]; some = 3.5 [0.1]; and high = 3.6 [0.1]; P = .004). No differences in other feeding practices or family meal characteristics were observed by level of concern.

CONCLUSIONS AND IMPLICATIONS

Concern regarding children becoming overweight was common. However, concern rarely translated into healthier feeding practices or family meal characteristics. Maternal concern alone may not be sufficient to motivate action to reduce children's risk of obesity.

A Collaborative Process for Evaluating Infant Mental Health Home Visiting in Michigan

This column describes an innovative collaboration in Michigan that could serve as a model for meaningful community-university-state partnerships. Recent legislation in Michigan threatened the infant mental health home visiting program, a service for Medicaid-eligible infants, toddlers, and families affected by mental illness. The University of Michigan is overseeing two major studies in collaboration with the Michigan Department of Health and Human Services, the Michigan Association for Infant Mental Health, the Michigan Infant Toddler Research Exchange faculty network, and community health service providers to determine the evidence base for the program and ensure its future success.

Low-income mothers' feeding goals predict observed home mealtime and child feeding practices

BACKGROUND

Mothers' goals are important for health behavior change, and engagement in child obesity interventions. It is unknown if maternal feeding goals are associated with observed home mealtime or feeding practices. The objective of this study was to examine the association of four common feeding goals (restrict junk food, promote fruit or vegetable intake, promote autonomy in eating and prevent obesity) with mothers' observed home mealtime and feeding practices.

METHODS

Low-income mothers (N = 265) of children (mean child age 70.8 months) participated in a semi-structured interview about child feeding. A coding scheme was developed and reliably applied to identify mothers' feeding goals from transcripts. Mothers' observed home mealtime and feeding practices were reliably coded from home mealtimes and a laboratory eating protocol. Mothers completed a questionnaire and reported demographics. Participant weights and heights were obtained. Regression models were used to test the association of each feeding goal with observed maternal practices, controlling for covariates.

RESULTS

The goal of restricting junk food was associated with the child always eating at a table (OR 2.87, 95% CI (1.39-5.96) p = 0.005), but not with the mother restricting junk food. The goal of promoting fruit or vegetable intake was associated with observationally promoting vegetables (OR 1.41, 95% CI (1.09-1.84), p = 0.01). The goals of promoting autonomy and preventing obesity were not associated with any observed maternal home mealtime or feeding practices.

CONCLUSIONS

While mothers' goals to restrict junk food and promote fruit or vegetable intake were associated with observed home mealtime and feeding practices, promoting autonomy and preventing obesity were not. Increased understanding of why low-income mothers may not translate certain feeding goals into practices may inform childhood obesity interventions.

Observed self-regulation is associated with weight in low-income toddlers

Obesity emerges in early childhood and tracks across development. Self-regulation develops rapidly during the toddler years, yet few studies have examined toddlers' self-regulation in relation to concurrent child weight. Further, few studies compare child responses in food and non-food-related tasks. Our goal was to examine toddlers' observed behavioral and emotional self-regulation in food and non-food tasks in relation to their body mass index z-score (BMIz) and weight status (overweight/obese vs. not). Observational measures were used to assess self-regulation (SR) in four standardized tasks in 133 low-income children (M age = 33.1 months; SD = 0.6). Behavioral SR was measured by assessing how well the child could delay gratification for a snack (food-related task) and a gift (non-food-related task). Emotional SR was measured by assessing child intensity of negative affect in two tasks designed to elicit frustration: being shown, then denied a cookie (food-related) or a toy (non-food-related). Task order was counterbalanced. BMIz was measured. Bivariate correlations and regression analyses adjusting for child sex, child race/ethnicity, and maternal education were conducted to examine associations of SR with weight. Results were that better behavioral SR in the snack delay task associated with lower BMIz (β = -0.27, p < 0.05) and lower odds of overweight/obesity (OR = 0.66, 95% CI 0.45, 0.96), but behavioral SR in the gift task did not associate with BMIz or weight status. Better emotional SR in the non-food task associated with lower BMIz (β = -0.27, p < 0.05), and better emotional SR in food and non-food tasks associated with lower odds of overweight/obesity (OR = 0.65, 95% CI 0.45, 0.96 and OR = 0.56, 95% CI 0.37, 0.87, respectively). Results are discussed regarding how behavioral SR for food and overall emotional SR relate to weight during toddlerhood, and regarding early childhood obesity prevention implications.

Dopamine Receptor Gene DRD4 7-Repeat Allele X Maternal Sensitivity Interaction on Child Externalizing Behavior Problems: Independent Replication of Effects at 18 Months

The DRD4 VNTR has been associated with child behavior problems in interaction with maternal insensitivity in European and American cohorts of preschoolers, with the 7-repeat (7R) allele associated with greater problems. We sought to replicate and expand these findings by examining effects on reports of child behavior problems at 18 months. A 63 family sample with data for observed maternal sensitivity ratings, DRD4 VNTR genotype, and maternal report of child behavior problems at 18-months was used in this preliminary analysis. Maternal sensitivity was measured at 6-months of age using laboratory observational measures (free-play and a teaching task). Maternal report of toddler behavior was obtained at 18-months via the standard Child Behavior Checklist, and infant genotype on the DRD4 VNTR was obtained using PCR. Infants carrying the DRD4 7R allele showed greater effects of maternal insensitivity than non-carriers for behavioral problems at 18-months. We replicated previous findings of association of infant DRD4 x maternal sensitivity interactions with child Externalizing problems in the European-ancestry sample (N = 42) in a median split of maternal sensitivity (p = .00011, eta2 = .329) and in regression analyses controlling for maternal age, maternal depression, and child gender in European ancestry (B = -3.4, SE 1.33, p = .01) and the total sample (B = -2.2, SE 1.02, p = .02). Exploratory analyses also found evidence of DRD4 x maternal sensitivity interaction with the CBCL ADHD scale. These findings replicate in an independent cohort DRD4 x maternal insensitivity interaction effect on child externalizing behavior problems at 18 months, further supporting the role of the DRD4 genotype in differential sensitivity to parenting.

The Evolution of Mothers' Beliefs About Overweight and Obesity in Their Early School-Age Children

OBJECTIVE

To identify changes in maternal beliefs, concerns, and perspectives about overweight and obesity in their children over a 2-year period.

METHODS

A total of 37 low-income English-speaking mothers of overweight or obese children participated in 2 semistructured interviews, separated by about 2 years. Mean child age was 5.9 years at baseline and 8.2 years at follow-up. Mother and child anthropometric data were obtained, and mothers completed demographic questionnaires at both time points. Mothers' interviews were analyzed using the constant comparative method for longitudinal patterns of change in their perspectives on childhood obesity across the 2 time points.

RESULTS

Six longitudinal patterns of change in mothers' perspectives and beliefs were identified: 1) mothers' identification of a weight problem in their child emerges gradually, 2) mothers' level of concern about their child overeating increases, 3) mothers' concerns about consequences of obesity intensify and change over time, 4) mothers feel less control over their child's eating and weight, 5) mothers' efforts to manage eating and weight become more intentional, and 6) mothers are more likely to initiate conversations about weight as their child gets older.

CONCLUSIONS

Mothers' concerns about children's weight and eating habits increased, and reported weight management strategies became more intentional over a 2-year period. Further research should consider attending to maternal perspectives on child weight and eating and their evolution in the development of family-based interventions for childhood obesity.

Perceptions of general and parenting-specific posttraumatic change among postpartum mothers with histories of childhood maltreatment

Although adaptive meanings of childhood maltreatment (CM) are critical to posttraumatic adaptation, little is known about perceptions of posttraumatic change (PTC) during the vulnerable postpartum period. PTC may be positive or negative as well as global or situational. This study examined general and parenting-specific PTC among 100 postpartum women with CM histories (Mage=29.5 years). All reported general and 83% reported parenting PTC. General PTC were more likely to include negative and positive changes; parenting PTC were more likely to be exclusively positive. Indicators of more severe CM (parent perpetrator, more CM experiences) were related to parenting but not general PTC. Concurrent demographic risk moderated associations between number of CM experiences and positive parenting PTC such that among mothers with more CM experiences, demographic risk was associated with stronger positive parenting PTC. Results highlight the significance of valence and specificity of PTC for understanding meanings made of CM experiences.

Affective tone of mothers' statements to restrict their children's eating

Maternal restrictive feeding behaviors have been associated with child weight status. The affective tone of mothers' statements intended to restrict their children's eating has not been examined. The objectives of this study were to describe the affective tone of mothers' restrictive feeding behaviors (positive or negative), and to test the association of child and mother characteristics with rates of Restriction with Positive Affect, Restriction with Negative Affect and Total Restriction. A total of 237 low-income child-mother dyads (mean child age 5.9 years) participated in a videotaped standardized laboratory eating protocol, during which mothers and children were both presented with large servings of cupcakes. A coding scheme was developed to count each restrictive statement with a positive affective tone and each restrictive statement with a negative affective tone. To establish reliability, 20% of videos were double-coded. Demographics and anthropometrics were obtained. Poisson regression models were used to test the association between characteristics of the child and mother with counts of Restriction with Positive Affect, Restriction with Negative Affect, and Total Restriction. Higher rates of Restriction with Positive Affect and Total Restriction were predicted by child obese weight status, and mother non-Hispanic white race/ethnicity. Higher rates of Restriction with Negative Affect were predicted by older child age, child obese weight status, mother non-Hispanic white race/ethnicity, and lower mother education level. In conclusion, in this study mothers of obese (vs. non-obese) children had higher rates of restriction in general, but particularly higher rates of Restriction with Negative Affect. Rather than being told not to restrict, mothers may need guidance on how to sensitively restrict their child's intake. Future studies should consider the contributions of maternal affect to children's responses to maternal restriction.

Maternal concerns about children overeating among low-income children

Addressing overeating is essential to obesity treatment and prevention. The objectives of this study were to investigate maternal concern for child overeating, to identify associated participant characteristics and to determine if concern for child overeating is associated with maternal feeding practices. Low-income mothers (N=289) of children (mean age 70.8months) participated in a semi-structured interview. Themes of maternal concern for child overeating were identified and a coding scheme was reliably applied. Maternal feeding practices were measured by questionnaire and videotaped eating interactions. Logistic regressions were used to test the associations of participant characteristics with the presence of each theme, and bivariate analyses were used to test the associations of the presence of each theme with feeding practices. Three themes were identified: 1) mothers worry that their child does overeat, 2) mothers acknowledge that their child may overeat but indicate that it is not problematic because they manage their child's eating behavior, and 3) mothers acknowledge that their child may overeat but indicate that it is not problematic because of characteristics inherent to the child. Child obesity predicted the themes; mothers of obese and overweight children are more likely to be concerned about overeating. Themes were associated with lower levels of observed pressure to eat. Only Theme 2 was associated with greater restrictive feeding practices. Interventions that provide parents' practical, healthy ways to prevent child overeating may be helpful.

"You've got to settle down!": Mothers' perceptions of physical activity in their young children

Background

Mothers are important mediators of children’s physical activity (PA) level and risk of obesity, however previous studies of maternal perceptions of child PA have been limited. Furthermore, it is unknown if maternal perceptions of child PA are predicted by family, mother and child characteristics. Therefore objectives of this study were to 1) evaluate maternal perceptions of PA in their children and 2) test associations of family, mother and child characteristics with these perceptions.

Methods

278 low-income mothers of children (mean age 70.9 months) participated in an audio-taped semi-structured interview. Transcripts were systematically analyzed using the constant comparative method and themes were generated. A coding scheme to classify the themes appearing in each transcript was developed and reliably applied. Anthropometrics were measured. Demographics and questionnaires (the Confusion, Hubbub and Order Scale, The Parenting Scale, and the Child Behavior Questionnaire (CBQ)) were collected. Logistic regression models were used to test the associations of family, mother and child characteristics with each theme.

Results

In this sample of low-income United States mothers, two themes emerged: 1) Mothers perceive their children as already very active (87.8 %, n = 244), predicted by the child being younger, the child not being overweight, and higher child CBQ Activity Level; and 2) Mothers view their children’s high activity level as problematic (27.0 %, n = 75), predicted by lower Parenting Laxness, the child being male and lower child CBQ Inhibitory Control.

Conclusions

Low-income United States mothers have unique perceptions of PA in their children; these beliefs are associated with characteristics of the child and mother but not characteristics of the family. Further understanding of contributors to maternal perceptions of child PA may inform future childhood obesity interventions. The influence of these perceptions on physical activity outcomes in low-income children should be pursued in future research.

Maternal representations of their children in relation to feeding beliefs and practices among low-income mothers of young children

Identifying maternal characteristics in relation to child feeding is important for addressing the current childhood obesity epidemic. The present study examines whether maternal representations of their children are associated with feeding beliefs and practices. Maternal representations refer to mothers' affective and cognitive perspectives regarding their children and their subjective experiences of their relationships with their children. This key maternal characteristic has not been examined in association with maternal feeding. Thus the purpose of the current study was to examine whether maternal representations of their children, reflected by Working Model of the Child Interview typologies (Balanced, Disengaged, or Distorted), were associated with maternal feeding beliefs (Authority, Confidence, and Investment) and practices (Pressure to Eat, Restriction, and Monitoring) among low-income mothers of young children, with maternal education examined as a covariate. Results showed that Balanced mothers were most likely to demonstrate high authority, Distorted mothers were least likely to demonstrate confidence, and Disengaged mothers were least likely to demonstrate investment in child feeding. Moreover, Balanced mothers were least likely to pressure their children to eat. Findings are discussed with regard to implications for the study of childhood obesity and for applied preventions.

Maternal Feeding Goals Described by Low-Income Mothers

OBJECTIVE

To identify maternal feeding goals and examine associations of number and type of goals with mother and child characteristics.

DESIGN

Qualitative interviews about child feeding and quantitative assessment of goal prevalence and associations with mother and child characteristics.

SETTING

Southeastern Michigan.

PARTICIPANTS

A total of 287 low-income mothers (31% Hispanic or non-white) and their children ages 4 to 8 years.

MAIN OUTCOME MEASURE

Maternal feeding goals.

ANALYSIS

Themes were generated using the constant comparative method, individual interviews were coded, and the prevalence of feeding goals was determined. Regression analyses examined associations of mother and child characteristics with the number and type of feeding goals.

RESULTS

Thirteen maternal feeding goals were identified. The most prevalent were to restrict less nutrient-dense food (60%), promote autonomy around eating (54%), prevent obesity (53%), and promote fruits or vegetables (52%). A child who was female and heavier with an older, non-Hispanic white, more educated mother with less chaos in the home predicted more maternal feeding goals (all P < .05). Specific maternal and child characteristics were associated with individual feeding goals.

CONCLUSIONS AND IMPLICATIONS

Depending on their current goals for child feeding, some mothers may benefit from interventions focused on goal development, whereas other mothers may benefit from interventions designed to facilitate goal implementation.

Mom Power: preliminary outcomes of a group intervention to improve mental health and parenting among high-risk mothers

Maternal psychopathology and traumatic life experiences may adversely impact family functioning, the quality of the parent-child relationship and the attachment bond, placing the child's early social-emotional development at risk. Attachment-based parenting interventions may be particularly useful in decreasing negative outcomes for children exposed to risk contexts, yet high risk families frequently do not engage in programs to address mental health and/or parenting needs. This study evaluated the effects of Mom Power (MP), a 13-session parenting and self-care skills group program for high-risk mothers and their young children (age <6 years old), focused on enhancing mothers' mental health, parenting competence, and engagement in treatment. Mothers were referred from community health providers for a phase 1 trial to assess feasibility, acceptability, and pilot outcomes. At baseline, many reported several identified risk factors, including trauma exposure, psychopathology, poverty, and single parenthood. Ninety-nine mother-child pairs were initially recruited into the MP program with 68 women completing and providing pre- and post-self-report measures assessing demographics and trauma history (pre-assessment only), maternal mental health (depression and post-traumatic stress disorder (PTSD)), parenting, and intervention satisfaction. Results indicate that MP participation was associated with reduction in depression, PTSD, and caregiving helplessness. A dose response relationship was evident in that, despite baseline equivalence, women who attended ≥70 % of the 10 groups (completers; N = 68) improved on parenting and mental health outcomes, in contrast to non-completers (N = 12). Effects were most pronounced for women with a mental health diagnosis at baseline. The intervention was perceived as helpful and user-friendly. Results indicate that MP is feasible, acceptable, and holds promise for improving maternal mental health and parenting competence among high-risk dyads. Further research is warranted to evaluate the efficacy of MP using randomized controlled designs.

Longitudinal examination of infant baseline and reactivity cortisol from ages 7 to 16 months

This study characterized the longitudinal evolution of HPA axis functioning from 7 to 16 months of age and identified individual and environmental factors that shape changes in HPA axis functioning over time. Participants were 167 mother-infant dyads drawn from a larger longitudinal study, recruited based on maternal history of being maltreated during childhood. Salivary cortisol levels were assessed before and after age-appropriate psychosocial stressors when infants were 7 and 16 months old. Maternal observed parenting and maternal reports of infant and environmental characteristics were obtained at 7 months and evaluated as predictors of changes in infant baseline cortisol and reactivity from 7 to 16 months. Results revealed that infants did not show a cortisol response at 7 months, but reactivity to psychosocial stress emerged by 16 months. Individual differences in cortisol baseline and reactivity levels over time were related to infant sex and maternal overcontrolling behaviors, underscoring the malleable and socially informed nature of early HPA axis functioning. Findings can inform prevention and intervention efforts to promote healthy stress regulation during infancy.

The roles of resilience and childhood trauma history: main and moderating effects on postpartum maternal mental health and functioning

OBJECTIVE

Recently postpartum women participated to investigate main and moderating influences of resilience and childhood history of maltreatment on posttraumatic stress disorder (PTSD), major depressive disorder (MDD), parental sense of mastery, and family functioning.

METHOD

At 4-months postpartum, 214 mothers (145 with a history of childhood abuse or neglect) completed interviews assessing mental health symptoms, positive functioning, resilience and trauma history. Multiple and moderated linear regression with the Connor-Davidson Resilience Scale (CD-RISC) and Childhood Trauma Questionnaires (CTQ) were conducted to assess for main and moderating effects.

RESULTS

Resilience, childhood trauma severity, and their interaction predicted postpartum PTSD and MDD. In mothers without childhood maltreatment, PTSD was absent irrespective of CD-RISC scores. However, for those with the highest quartile of CTQ severity, 8% of those with highest resilience in contrast with 58% of those with lowest CD-RISC scores met PTSD diagnostic criteria. Similar, in those with highest resilience, no mothers met criteria for postpartum MDD, irrespective of childhood trauma, while for those with lowest quartile of resilience, 25% with lowest CTQ severity and 68% of those with highest CTQ severity were depressed. The CD-RISC, but not the CTQ, was predictive of postpartum sense of competence. The CD-RISC and the CTQ were predictive of postpartum family functioning, though no moderating influence of resilience on childhood trauma was found.

CONCLUSIONS

Resilience is associated with reduced psychopathology and improved wellbeing in all mothers. It further serves as a buffer against psychiatric symptoms following childhood trauma. Such findings may assist in identification of those at greatest risk of adverse functioning postpartum, utilization of resilience-enhancing intervention may benefit perinatal wellness, and reduce intergenerational transmission of risk.

Maternal mobile device use during a structured parent-child interaction task

OBJECTIVE

To examine associations of maternal mobile device use with the frequency of mother-child interactions during a structured laboratory task.

METHODS

Participants included 225 low-income mother-child pairs. When children were ∼6 years old, dyads were videotaped during a standardized protocol in order to characterize how mothers and children interacted when asked to try familiar and unfamiliar foods. From videotapes, we dichotomized mothers on the basis of whether or not they spontaneously used a mobile device, and we counted maternal verbal and nonverbal prompts toward the child. We used multivariate Poisson regression to study associations of device use with eating prompt frequency for different foods.

RESULTS

Mothers were an average of 31.3 (SD 7.1) years old, and 28.0% were of Hispanic/nonwhite race/ethnicity. During the protocol, 23.1% of mothers spontaneously used a mobile device. Device use was not associated with any maternal characteristics, including age, race/ethnicity, education, depressive symptoms, or parenting style. Mothers with device use initiated fewer verbal (relative rate 0.80; 95% confidence interval 0.63, 1.03) and nonverbal (0.61; 0.39, 0.96) interactions with their children than mothers who did not use a device, when averaged across all foods. This association was strongest during introduction of halva, the most unfamiliar food (0.67; 0.48, 0.93 for verbal and 0.42; 0.20, 0.89 for nonverbal interactions).

CONCLUSIONS

Mobile device use was common and associated with fewer interactions with children during a structured interaction task, particularly nonverbal interactions and during introduction of an unfamiliar food. More research is needed to understand how device use affects parent-child engagement in naturalistic contexts.

The role of social relationships in bipolar disorder: a review

Social relationships and attachment are core developmental elements of human existence and survival that evolve over the lifetime of an individual. The internal and external factors that influence them include the presence of illness in the individual or in their immediate environment. The developmental aspects of attachment and social relationships have become increasingly of interest and relevance in light of early developmental epigenetic modification of gene expression patterns that may influence subsequent behavioral patterns and outcomes. This review examines extant literature on attachment and social relationships in bipolar cohorts. Despite many methodological challenges, the findings indicate that social relationships and capacity for attachment are significantly compromised in individuals with bipolar disorder compared to other mood disorders and normal controls. Though extant research is limited, research clearly points toward the importance of social relationships on the etiology, course, and consequences of bipolar disorder. We highlight a number of key considerations for future research.

Maternal reflective functioning among mothers with childhood maltreatment histories: links to sensitive parenting and infant attachment security

This study examined relationships among maternal reflective functioning, parenting, infant attachment, and demographic risk in a relatively large (N = 83) socioeconomically diverse sample of women with and without a history of childhood maltreatment and their infants. Most prior research on parental reflective functioning has utilized small homogenous samples. Reflective functioning was assessed with the Parent Development Interview, parenting was coded from videotaped mother-child interactions, and infant attachment was evaluated in Ainsworth's Strange Situation by independent teams of reliable coders masked to maternal history. Reflective functioning was associated with parenting sensitivity and secure attachment, and inversely associated with demographic risk and parenting negativity; however, it was not associated with maternal maltreatment history or PTSD. Parenting sensitivity mediated the relationship between reflective functioning and infant attachment, controlling for demographic risk. Findings are discussed in the context of prior research on reflective functioning and the importance of targeting reflective functioning in interventions.

Associations between maternal depressive symptoms and child feeding practices in a cross-sectional study of low-income mothers and their young children

Background

Maternal depression may influence feeding practices important in determining child eating behaviors and weight. However, the association between maternal depressive symptoms and feeding practices has been inconsistent, and most prior studies used self-report questionnaires alone to characterize feeding. The purpose of this study was to identify feeding practices associated with maternal depressive symptoms using multiple methodologies, and to test the hypothesis that maternal depressive symptoms are associated with less responsive feeding practices.

Methods

In this cross-sectional, observational study, participants (n = 295) included low-income mothers and their 4- to 8-year-old children. Maternal feeding practices were assessed via interviewer-administered questionnaires, semi-structured narrative interviews, and videotaped observations in home and laboratory settings. Maternal depressive symptoms were measured using the Center for Epidemiologic Studies-Depression scale (CES-D). Regression analyses examined associations between elevated depressive symptoms (CES-D score ≥16) and measures of maternal feeding practices, adjusting for: child sex, food fussiness, number of older siblings; and maternal age, body mass index (BMI), education, race/ethnicity, single parent status, perceived child weight, and concern about child weight.

Results

Thirty-one percent of mothers reported depressive symptoms above the screening cutoff. Mothers with elevated depressive symptoms reported more pressuring of children to eat (β = 0.29; 95% Confidence Interval (CI): 0.03, 0.54) and more overall demandingness (β = 0.16; 95% CI: 0.03, 0.29), and expressed lower authority in child feeding during semi-structured narrative interview (Odds Ratio (OR) for low authority: 2.82; 95% CI: 1.55, 5.12). In homes of mothers with elevated depressive symptoms, the television was more likely audible during meals (OR: 1.91; 95% CI: 1.05, 3.48) and mothers were less likely to eat with children (OR: 0.48; 95% CI: 0.27, 0.85). There were no associations between maternal depressive symptoms and encouragement or discouragement of food in laboratory eating interactions.

Conclusions

Mothers with elevated depressive symptoms demonstrated less responsive feeding practices than mothers with lower levels of depressive symptoms. These results suggest that screening for maternal depressive symptoms may be useful when counseling on healthy child feeding practices. Given inconsistencies across methodologies, future research should include multiple methods of characterizing feeding practices and direct comparisons of different methodologies.

Fathering after military deployment: parenting challenges and goals of fathers of young children

Although often eagerly anticipated, reunification after deployment poses challenges for families, including adjusting to the parent-soldier's return, re-establishing roles and routines, and the potentially necessary accommodation to combat-related injuries or psychological effects. Fourteen male service members, previously deployed to a combat zone, parent to at least one child under seven years of age, were interviewed about their relationships with their young children. Principles of grounded theory guided data analysis to identify key themes related to parenting young children after deployment. Participants reported significant levels of parenting stress and identified specific challenges, including difficulty reconnecting with children, adapting expectations from military to family life, and coparenting. Fathers acknowledged regret about missing an important period in their child's development and indicated a strong desire to improve their parenting skills. They described a need for support in expressing emotions, nurturing, and managing their tempers. Results affirm the need for support to military families during reintegration and demonstrate that military fathers are receptive to opportunities to engage in parenting interventions. Helping fathers understand their children's behavior in the context of age-typical responses to separation and reunion may help them to renew parent-child relationships and reengage in optimal parenting of their young children.

Mother-infant bonding impairment across the first 6 months postpartum: the primacy of psychopathology in women with childhood abuse and neglect histories

Our goal was to examine the trajectory of bonding impairment across the first 6 months postpartum in the context of maternal risk, including maternal history of childhood abuse and neglect and postpartum psychopathology, and to test the association between self-reported bonding impairment and observed positive parenting behaviors. In a sample of women with childhood abuse and neglect histories (CA+, n = 97) and a healthy control comparison group (CA-, n = 53), participants completed questionnaires related to bonding with their infants at 6 weeks, 4 months, and 6 months postpartum and psychopathology at 6 months postpartum. In addition, during a 6-month postpartum home visit, mothers and infants participated in a dyadic play interaction subsequently coded for positive parenting behaviors by blinded coders. We found that all women, independent of risk status, increased in bonding with their infant over the first 6 months postpartum; however, women with postpartum psychopathology (depression and posttraumatic stress disorder [PTSD]) showed consistently greater bonding impairment scores at all timepoints. Moreover, we found that, at the 6-month assessment, bonding impairment and observed parenting behaviors were significantly associated. These results highlight the adverse effects of maternal postpartum depression and PTSD on mother-infant bonding in early postpartum in women with child abuse and neglect histories. These findings also shed light on the critical need for early detection and effective treatment of postpartum mental illness in order to prevent problematic parenting and the development of disturbed mother-infant relationships. Results support the use of the Postpartum Bonding Questionnaire as a tool to assess parenting quality by its demonstrated association with observed parenting behaviors.

Maternal styles of talking about child feeding across sociodemographic groups

This study sought to identify maternal styles of talking about child feeding from a semistructured interview and to evaluate associated maternal and child characteristics. Mothers of preschool-aged children (n=133) of diverse race/ethnicity and socioeconomic status (SES) (45 lower SES black, 29 lower SES white, 32 lower SES Hispanic, 15 middle to upper SES white, and 12 middle to upper SES Asian) participated in a semistructured interview about feeding. Interviews were audiotaped and transcribed. Themes were identified, and individual interviews were coded within these themes: authority (high/low), confidence (confident/conflicted/unopinionated), and investment (deep/mild/removed). Demographic characteristics were collected and a subset of children had measured weights and heights. Cluster analysis was used to identify narrative styles. Participant characteristics were compared across clusters using Fisher's exact test and analysis of variance. Six narrative styles were identified: Easy-Going, Practical No-Nonsense, Disengaged, Effortful No-Nonsense, Indulgent Worry, and Conflicted Control. Cluster membership differed significantly based on maternal demographic group (P<0.001) and child weight status (P<0.05). More than half (60%) of children of mothers in the Conflicted Control cluster were obese. Maternal styles of talking about feeding are associated with maternal and child characteristics.

The role of infant sleep in intergenerational transmission of trauma

INTRODUCTION

Children of parents who experienced trauma often present emotional and behavioral problems, a phenomenon named inter-generational transmission of trauma (IGTT). Combined with antenatal factors, parenting and the home environment contribute to the development and maintenance of sleep problems in children. In turn, infant sleep difficulty predicts behavioral and emotional problems later in life. The aim of this study was to investigate whether infant sleep problems predict early behavioral problems indicative of IGTT.

METHODS

184 first-time mothers (ages 18-47) participated. N=83 had a history of childhood abuse and posttraumatic stress disorder (PTSD+); 38 women reported childhood abuse but did not meet diagnostic criteria for PTSD (PTSD-); and the control group (N=63) had neither a history of abuse nor psychopathology (CON). Depression, anxiety, and sleep difficulty were assessed in the mothers at 4 months postpartum. Infant sleep was assessed using the Child Behavior Sleep Questionnaire (CSHQ). Outcome measures included the Parent Bonding Questionnaire (PBQ) at 4 months and the Child Behavior Check List (CBCL) at 18 months.

RESULTS

Infants of PTSD+ mothers scored higher on the CSHQ and had more separation anxiety around bedtime than PTSD- and CON, and the severity of their symptoms was correlated with the degree of sleep disturbance. Maternal postpartum depression symptoms mediated impaired mother-infant bonding, while infant sleep disturbance contributed independently to impaired bonding. Mother-infant bonding at 4 months predicted more behavioral problems at 18 months.

CONCLUSIONS

Infant sleep difficulties and maternal mood play independent roles in infant-mother bonding disturbance, which in turn predicts behavioral problems at 18 months.

Optimizing the early parent-child relationship: windows of opportunity for parents and pediatricians

This article explores child and parent risk factors that can affect the early parent-child relationship and highlights how a relational approach can be used in pediatric primary care to optimize early social-emotional development in the context of family-centered care. Risk factors, such as prematurity, parental mental illness, and a history of adverse care-giving experiences, can affect the parent-child relationship and influence later infant social-emotional development. The pediatrician, because of the ongoing relationship with the family, is in an optimal position to identify concerns, initiate interventions, and provide support and services to support the development of the early parent-child relationship.

Reflection in thought and action: Maternal parenting reflectivity predicts mind-minded comments and interactive behavior

Recent research has identified mothers' mental reflective functioning and verbal mind-minded comments as important predictors of subsequent infant attachment security. In the present study, we examine associations between mothers' (N = 95) parenting reflectivity expressed in an interview and observed parenting behavior, including verbal mind-minded comments and interactive behavior during interaction with their 7-month-old infants. Parenting reflectivity was coded from the Working Model of the Child Interview. Maternal behavior was assessed via observations of mother-infant interaction during free play and structured teaching tasks. Both maternal appropriate mind-minded comments as well as other indicators of maternal interactive behavior were coded. Parenting reflectivity was positively correlated with mind-minded comments and behavioral sensitivity. Hierarchical multiple regression analyses indicated that parenting reflectivity contributed to maternal behavior beyond the contributions of mothers' educational status and depression symptoms. Discussion emphasizes the importance of individual differences in parental capacity to accurately perceive and mentalize their infants' experience, and the consequences of these differences for caregiving behavior.

A multirisk approach to predicting chronicity of postpartum depression symptoms

BACKGROUND

Persistence of postpartum depression (PPD) carries potential adverse implications for the emerging mother-child relationship and for child development.

METHODS

This study was designed to investigate factors related to the onset and persistence of PPD; in particular, we examined the cumulative effect of a range of psychosocial risk factors in predicting chronic PPD symptoms. One hundred and five women were interviewed at three assessment periods: within the first days after childbirth, at 6 months, and at 18 months postpartum.

RESULTS

Depressive symptoms at 6 months predicted 18 months depressive symptoms, even when controlling for the contribution of maternal depression at birth. Psychosocial risk had a moderating influence on the stability of depressive symptomatology. Women with two or more risk factors at birth were more likely to have stable depressive symptomatology across the infants' first 18 months of life.

CONCLUSION

To prevent a chronic course of PPD it may be necessary to identify both depressive symptoms and relevant psychosocial risk factors.

Psychosocial Constraints on the Development of Resilience

Although resilience is usually thought to reside in individuals, developmental research is increasingly demonstrating that characteristics of the social context may be better predictors of resilience. When the relative contribution of early resilience and environmental challenges to later child mental health and academic achievement were compared in a longitudinal study from birth to adolescence, indicators of child resilience, such as the behavioral and emotional self-regulation characteristic of good mental health, and the cognitive self-regulation characteristic of high intelligence contributed to later competence. However, the effects of such individual resilience did not overcome the effects of high environmental challenge, such as poor parenting, antisocial peers, low-resource communities, and economic hardship. The effects of single environmental challenges become very large when accumulated into multiple risk scores even affecting the development of offspring in the next generation.

Maternal representations of the infant: associations with infant response to the still face

Mothers' representations of their infants may influence early development of emotional self-regulation. This study examined the associations between characteristics of mothers' (N = 100) narratives about their 7-month-old infants, maternal depression, and their infants' affect regulation during the Still Face procedure. Findings showed that (1) mothers' representations were linked with individual differences in their infants' behavior across the Still Face procedure, (2) the association between mothers' representations and their infants' behavior was mediated by parenting behavior, and (3) mothers' representations explained unique variance in their infants' affect regulation beyond the contribution of maternal depression. Although infants' displays of positive affect diminished while mothers held a still face, only infants of mothers in the balanced representation category returned to high levels of positive affect upon resuming interaction. These findings highlight the role of maternal representations in the process by which dyads repair temporary disruptions in interaction, as well as individual differences in infants' and mothers' responses to the Still Face.

Interpersonal psychotherapy adapted for the group setting in the treatment of postpartum depression

Interpersonal psychotherapy (IPT) has demonstrated efficacy in the individual treatment of antepartum and postpartum depression. The current investigation extends prior work by examining the efficacy of a group IPT approach for the treatment of postpartum depression. Depression scores of 17 women diagnosed with postpartum depressive disorder (DSM-IV criteria) decreased significantly from pre- to post-treatment. Follow-up assessments at 6 months revealed continuation of the treatment effect. Results indicate that IPT adapted for a group model has positive implications for the treatment of postpartum depression, demonstrating both short-term and longer-term effects in the reduction of depressive symptomatology. Study limitations include the small sample size, absence of control group, possible bias in therapist's assessments, and lack of monitoring adherence, which may have jeopardized the accuracy of the results.

Are commonly used self-report inventories suitable for screening postpartum depression and anxiety disorders?

OBJECTIVE

The utility of several self-report symptom inventories were examined for detecting postpartum depression (MDD) and anxiety disorders (AD).

METHOD

Fifty women (3 or 6 months postpartum), at heightened risk for MDD, completed several depression and anxiety symptom checklists. Psychiatric diagnoses were obtained via SCID interview.

RESULTS

Rates of MDD (n=9) and AD (n=9) were equivalent in this sample, with minimal diagnostic overlap. While all the self-report depression inventories screened accurately for MDD, none discriminated AD sensitively and reliably.

CONCLUSION

The frequent occurrence of AD emphasizes the need to identify appropriate screening instruments for postpartum anxiety disorders.

Assessment of peer neglect in the preschool years: a short-term longitudinal study

Examined concurrent and longitudinal relations between different measures of peer neglect in the preschool years. Measures of social competence included peer sociometrics, teacher ratings, and behavioral observations of peer interactions. Participants were sixty 4- to 5-year-old Caucasian boys from low-income family backgrounds. Results indicated that the stability of indicators of peer neglect and social isolation depended on the measure employed. Correlations between different measures suggested heterogeneity in patterns of social adaptation among neglected or isolated preschool children. Results are discussed emphasizing the need to rely on multiple indicators for the assessment of preschool children's social competence.