The protective role of maternal posttraumatic growth and cognitive trauma processing among Palestinian mothers and infants

Maternal mental health mediates the effect of prenatal stress on infant temperament: The Harvey Mom Study

Prenatal maternal stress and mental health problems are known to increase risk for developmental psychopathology in offspring, yet pathways leading to risk or resiliency are poorly understood. In a quasi-experimental design, we prospectively examined associations between disaster-related prenatal stress, maternal mental health symptoms, and infant temperament outcomes. Mothers who were pregnant during Hurricane Harvey (N = 527) reported on objective hardships (e.g., loss of belongings or income, evacuation, home flooding) related to the storm and subsequent mental health symptoms (anxiety/depression, posttraumatic stress) across time. At a postpartum assessment, mothers reported on their infant's temperament (negative affect, positive affect, orienting/regulatory capacity). Greater objective hardship indirectly predicted higher levels of infant orienting/regulatory capacity through its association with increased maternal posttraumatic stress symptoms. Greater objective hardship also indirectly predicted higher levels of infant negative affect through its association with increased maternal anxiety/depression symptoms across time. Our findings suggest a psychological mechanism linking prenatal stress with specific temperamental characteristics via maternal mental health symptoms. Findings point to the importance of high-quality assessment and mental health services for vulnerable women and young children.

Maternal postnatal depressive symptoms and early achievement of developmental milestones in infants and young children: A meta-analysis

Screening for social determinants of health, including maternal depression, is a recommended pediatric practice. However, the magnitude of association between maternal and child screening tools remains to be determined. The current study evaluated the association between maternal postnatal depressive symptoms and child developmental milestones, as well as moderators of these associations. A comprehensive search strategy was carried out in four databases (MEDLINE, EMBASE, APA PsycINFO, and Cochrane Central Register of Controlled Trials) from database inception to September 2022. Studies that examine postnatal depressive symptoms and associations with infant and early child (<6 years) achievement of developmental milestones were included. Data were extracted by two independent coders and a random-effects meta-analysis was used to estimate pooled effect sizes and test for moderators. A total of 38 non-overlapping studies (95,897 participants), all focused on maternal postnatal depression, met inclusion criteria. The pooled effect size for the association between postnatal depressive symptoms and early achievement of infant and child developmental milestones (N = 38; r = -.12; 95% CI = -.18, -.06) was small in magnitude. Child age at maternal depression measurement was a moderator, whereby effect sizes became greater for older children. Despite small effects, maternal postnatal depressive symptoms should be included in screening during routine well-child visits to enhance child development outcomes.

The effects of midwifery care provided to primiparous mothers during the postpartum period on maternal attachment and post-traumatic growth

AIM

This study was conducted to determine the effects of midwifery care provided to primiparous mothers during the postpartum period on maternal attachment and post-traumatic growth.

METHOD

The study was conducted based on a quasi-experimental model with a pre-test/post-test control group. The population of the study was composed of primiparous mothers who gave birth in a public hospital located in eastern Turkey, and the sample consisted of 128 postpartum women (64 women in the control group and 64 women in the experimental group); the sample size was determined via power analysis. Midwifery care was provided to the mothers in the experimental group throughout their hospitalisation in accordance with the Postpartum Care Management Guidelines (PCMG) published by the Republic of Turkey's Ministry of Health. In addition, 3 home visits were carried out between the postpartum 2^nd and 5^th days, 13^th and 17^th days and 36^th and 42^nd days. The mothers in the control group were not subjected to any intervention. The data were collected using a personal information form, the Maternal Attachment Inventory (MAI) and the Post-traumatic Growth Inventory (PTGI). Statistical analyses were conducted using percentage distribution, arithmetic mean, standard deviation, chi-square testing, independent samples t-testing and dependent samples t-testing.

RESULTS

Based on the mean MAI and PTGI pre-test scores, it was determined that the mothers in the experimental and control groups were similar in terms of maternal attachment and post-traumatic growth characteristics (p>0.05). The mean MAI post-test score was 101.85±2.85 in the experimental group and 98.68±5.91 in the control group, and the difference between the groups was statistically significant (p<0.001). The mean PTGI post-test score was 86.21±20.39 in the experimental group and 79.54±22.32 in the control group, and the difference between the groups' mean scores was statistically significant (p<0.05). The mean post-test score of the PTGI Change in Philosophy of Life subscale was 19.37±6.04 in the experimental group and 16.17±6.83 in the control group, and the difference between the mean scores was statistically significant (p<0.05).

CONCLUSION

It was determined that the midwifery care provided to primiparous mothers during the postpartum period had a positive effect on levels of post-traumatic growth and maternal attachment.

Measuring mental health burden in humanitarian settings: a critical review of assessment tools

Background

The effects of disasters and conflicts are widespread and heavily studied. While attention to disasters’ impacts on mental health is growing, mental health effects are not well understood due to inconsistencies in measurement.

Objective

The purpose of this study is to review mental health assessment tools and their use in populations affected by disasters and conflicts.

Method

Tools that assess posttraumatic stress disorder, depression, substance use disorder, and general mental health were examined. This review began with a search for assessment tools in PubMed, PsycINFO, and Google Scholar. Next, validation studies for the tools were obtained through snowball sampling. A final search was conducted for scientific studies using the selected tools in humanitarian settings to collect the data for analysis. The benefits and limitations described for each tool were compiled into a complete table.

Results

Twelve assessment tools were included, with 88 studies using them. The primary findings indicate that half of the studies used the Impact of Events Scale-Revised. The most common limitation discussed is that self-report tools inaccurately estimate the prevalence of mental health problems. This inaccuracy is further exacerbated by a lack of cultural appropriateness of the tools, as many are developed for Western contexts.

Conclusion

It is recommended that researchers and humanitarian workers reflect on the effectiveness of the mental health assessment tool they use to accurately represent the populations under study in emergency settings. In addition, mental health assessment should be coupled with action.

Contextualizing Cognitions: the Relation Between Negative Post-traumatic Cognitions and Post-traumatic Stress Among Palestinian Refugees

Negative post-traumatic cognitions (PTC) are a relevant factor in the development, persistence, and treatment of post-traumatic stress disorder (PTSD). Palestinian refugees live under challenging circumstances and have negative future prospects, so negative cognitions might be expected to prevail. It is uncertain whether findings on the relation between PTC and PTSD in other (non-refugee) populations can be generalized to the Palestinian refugee context. The first objective was to examine the degree to which endorsement of PTC in this sample differed from the endorsement observed in other samples. The second objective was to investigate whether PTC explain variance in PTSD symptomatology and are predictive of PTSD diagnostic status. In Palestinian refugees (N = 85, 51.8% female), PTSD symptoms and negative cognitions were assessed. One sample t tests and multiple logistic regression analyses were performed. Total PTC scores were significantly higher in the Palestinian sample than in reference samples. Negative cognitions explained significant variance in PTSD symptoms and probable diagnostic status. Findings support the relevance of PTC for PTSD symptoms and diagnosis in a Palestinian refugee sample, in line with the cognitive model for PTSD. This is especially relevant for researchers and clinicians working with refugees in conflict areas.

Trauma reactivation under propranolol among traumatized Syrian refugee children: preliminary evidence regarding efficacy

Background: There is a dearth of therapeutic solutions for traumatized young patients. Trauma reactivation conducted under the influence of the reconsolidation blocker propranolol (Reconsolidation Therapy) is a simple, cost-effective treatment option that has some promising initial results in adults suffering from posttraumatic stress disorder (PTSD). Objective: To explore the usefulness of this novel treatment in children. The primary outcome was the reduction of PTSD symptoms at the end of treatment, while secondary outcomes included reduction in anxiety and in depressive symptoms. Method: An open-label clinical trial was conducted in a refugee camp in Syria, investigating the safety and efficacy of this therapeutic strategy in 117 children suffering from enduring PTSD symptoms. Participants received propranolol 90 minutes before briefly recalling (i.e. reactivating) a single personal traumatic memory, for 5 consecutive days. Self-reported anxiety, depressive, and PTSD symptoms were assessed at baseline, as well as 4 and 13 weeks after treatment. Results: A significant, clinically meaningful symptom reduction was observed at all post-treatment measurement times vs. baseline. More specifically, between baseline and the 13-week follow-up we observed a 64% PTSD symptoms reduction (d = 2.71). In a similar vein, we obtained a 39% symptoms reduction for depressive symptoms (d = 1.01). The general anxiety symptoms improved, but eventually returned to prior level, probably because of the deteriorating living conditions in the camp. Conclusions: This therapy appeared as a potentially safe and useful treatment strategy for children suffering from PTSD symptoms, warranting replication studies using stronger study designs. The social acceptability and ease of implementation of the treatment should also be noted.

Agency via Life Satisfaction as a Protective Factor From Cumulative Trauma and Emotional Distress Among Bedouin Children in Palestine

Adopting an ecological perspective on children's functioning and psychological well-being, we investigated the association between agency and life satisfaction, and its bearing on trauma symptoms and negative emotions in a group of Bedouin children living in the occupied Palestinian territories. Specifically, we hypothesized that the more children were agentic, the more they would be satisfied with their lives; and that greater life satisfaction would be associated with better affect balance, and reduced trauma symptoms. A sample of 286 Bedouin children attending primary schools in four different villages in the Jordan Valley completed the multidimensional students' life satisfaction scale (MSLSS), positive affect and negative affect scale for children (PANAS-C), Children's Impact of Event Scale (CRIES-13), and the children's hope scale (CHS). Structural equation modeling was performed to evaluate the cumulative network of direct and indirect effects between children's agency, life satisfaction, and trauma symptoms. The findings confirmed the key role of life satisfaction in mitigating traumatic reactions. Higher levels of life satisfaction were associated with reduced negative emotions and trauma symptoms, suggesting that agency may be viewed as a pre-determining factor with the potential to protect children from trauma symptoms. We discuss the implications for research and clinical practice.