Social support helps protect against perinatal bonding failure and depression among mothers: a prospective cohort study

Customization and acceptability of the WHO labor care guide to improve labor monitoring among health workers in Uganda. An iterative development, mixed method study

Cognisant of persistently high maternal and perinatal mortality rates, WHO called for adoption and evaluation of new adaptable and context-specific solutions to improve labor monitoring and health outcomes. We aimed at customizing/refining the new WHO labour care guide (LCG) to suite health care provider needs (HCP) in monitoring labour in Uganda. We used mixed methods to customize/refine and pilot test the new WHO LCG using stakeholder perspectives. Between 1st July 2023 and 30th December 2023, we conducted; 1)30 stakeholder interviews to identify user needs/challenges that informed initial modifications of the WHO LCG; 2)15 HCP in-depth interviews to identify any further needs to modify the LCG; 3) Two focus group discussions and 4) Two exit expert panels to identify any further user needs to further refine proposed modifications into the final prototype. Questionnaires were administered to assess acceptability. We interviewed 125 stakeholders with median age of 36 years (IQR;26-48) exposed to the LCG for at least 12 months with 11.8(SD = 4.6) years of clinical practice. Simple useful modifications/customizations based on format, HCP's perceived function and role in improving decision making during monitoring labour included; 1) Customizing LCG by adding key socio-demographic data; 2) Adjusting observation ordering; 3) Modification of medication dosages and 4) Provision for recording key clinical notes/labour outcome data on reverse side of the same A4 paper. All HCPs found the modified WHO LCG useful, easy to use, appropriate, comprehensive, appealing and would recommend it to others for labour monitoring. It was implementable and majority took less than 2 minutes to completely record/fill observations on the LCG after each labour assessment. Active involvement of end-users improved inclusiveness, ownership, acceptability and uptake. The modified LCG prototype was found to be simple, appropriate and easy-to-use. Further research to evaluate large-scale use, feasibility and effectiveness is warranted.

Unfolding of maternal-infant bonding amidst the COVID-19 pandemic: Social support as a risk and protective factor

BACKGROUND

Social, familial, and physiological stressors may put maternal-infant bonding at risk. Therefore, it is plausible that the stressful conditions brought on by COVID-19 could influence maternal-infant bonding. This study aimed to elucidate the contribution of COVID-19-related experience to variance in maternal-infant bonding, beyond that of established risk factors and as moderated by social support.

METHODS

This longitudinal, multicenter study examined the relationship of demographic and obstetric variables, social support, postpartum depression, as well as COVID-19-related fear, exposure, and subjective difficulty with mother-infant bonding six months following birth. Participants (N = 246) were women who delivered during the pandemics' strict lockdown period and were recruited 10 weeks after a liveborn delivery and followed up six months later.

RESULTS

Relationship between fear of COVID-19 and maternal-infant bonding was moderated by social support: Amongst mothers with high levels of social support, fear of COVID-19 negatively predicted bonding.

DISCUSSION

Results indicate that social support, while overall a protective factor for mother-infant bonding, may lose its buffering effect when fear of COVID-19 is high. This relationship was maintained even when early bonding experiences such as forced separation and the risk incurred by postpartum depression were accounted for. Implications for providers are discussed.

The concept analysis of parent-infant bonding during pregnancy and infancy: a systematic review and meta-synthesis

INTRODUCTION

Despite the emerging body of literature on mother-to-infant bonding and the associated variables, there are various definitions of bonding construct. Also, there is a lack of a comprehensive conceptual framework of antecedents and consequences of bonding that would guide empirical work.

OBJECTIVE

Aim of the study was to provide a systematic review and synthesis of concept analysis studies on maternal-foetal, mother-infant, or father-infant bonding.

METHOD

A systematic search was performed in PubMed, EBSCOHost (including PsycINFO), ProQuest, and CINAHL. In addition, a hand search was conducted. Papers were eligible for inclusion if they conducted concept analyses on mother or father to foetus/infant bonding. A qualitative meta-synthesis was applied to synthesise the findings.

RESULTS

Eight papers on concept analyses were eligible for inclusion. In meta-synthesis, six aspects of parent-to-(unborn) child bonding emerged, including direction, domain, process, timing, endurance, and parental gender. Defining attributes are (i) a close relationship, (ii) filled with positive parental affection, (iii) manifested during pregnancy as monitoring foetal development and behaviour and after childbirth in proximity and interaction. Antecedents, affecting factors, and consequences of the parent-child bonding have been summarised.

CONCLUSION

Parent-infant bonding refers to an emotional, behavioural, cognitive, and neurobiological tie of the parent to the (unborn) child, as a process from intention to have a child throughout infancy. This is a parental-driven process which can continue to evolve throughout child's and parent's life, characterised as enduring, committed, and engaged. Based on meta-synthesis, a conceptual structure of parent-infant bonding has been provided, which needs further empirical testing.

The association between fear of childbirth and social support through the Internet and Social Networking Services in pregnant women: A cross-sectional study

Social support is an important factor in reducing fear of childbirth (FOC). Recently, the Internet and Social Networking Services (SNS) have become new forms of social support. However, it is unclear whether such support can reduce pregnant women's fear. This study aimed to investigate the association between FOC and social support through the Internet and SNS in pregnant women. A cross-sectional study using a web-based questionnaire including questions about FOC, social support, the Internet and SNS usage, psychological variables, and sociodemographic variables was conducted. Data from 111 participants were analyzed. A greater number of social support from people who are often seen during pregnancy, and becoming relieved by interaction with others through the Internet and SNS were negatively associated with FOC. This study showed that face-to-face social support was associated with lower FOC, while social support through the Internet and SNS was not. Further research is needed on how to use Internet and SNS to reduce FOC in pregnant women.

Experience of postpartum depression among Chinese women: A meta-synthesis of qualitative research

Postpartum depression (PPD) is associated with various adverse health outcomes among mothers and babies. Meta-synthesis can improve our understanding of postpartum women's experiences. However, the meta-analysis of PPD among Chinese women is limited. Therefore, a meta-analysis was conducted to evaluate the prevalence of PPD among Chinese women and if and how traditional culture may exacerbate PPD. Qualitative studies on the experiences of Chinese women with PPD were searched from database establishment until May 2022 in ten databases. The meta-ethnography reporting guidelines and framework was applied to the writing and reporting of this review. The protocol for this systematic review was registered with the International Prospective Register of Systematic Reviews (CRD42022323388). 2321 studies were retrieved, and 11 studies qualified for the meta-synthesis. The final five themes extracted and re-conceptualized from these studies were as follows: the gap between expectation and reality, conflicts with family, physical and mental frustrations, critical needs for coping with changes, and measures against PPD. Chinese women with PPD frequently feel vulnerable physically, mentally, or both after childbirth and often have conflicts with their families due to the influence of traditional Chinese culture. Family relationships and social support often are factors preventing women from seeking help.

Protective Effect of Prenatal Social Support on the Intergenerational Transmission of Obesity in Low-Income Hispanic Families

Background: Prepregnancy overweight/obesity (OW/OB) is a strong risk factor for child obesity. Few studies have identified modifiable factors that mitigate this risk. Objective: The objective of this study was to determine if prenatal social support buffers the effect of prepregnancy OW/OB on child birth weight z-score (BWz) and weight-for-age z-score (WFAz) trajectory. Methods: We performed a longitudinal secondary analysis of 524 mother-infant pairs enrolled in a randomized controlled trial of the Starting Early Program, a child obesity prevention program for Hispanic families with low income. Social support was assessed in the third trimester of pregnancy; maternal prepregnancy OW/OB and child WFAz from birth to age 3 years were obtained from medical records. Linear regression and multilevel modeling tested the effects of maternal prepregnancy OW/OB on child weight outcomes, and whether prenatal social support moderated these effects. Results: Prepregnancy OW/OB was associated with significantly higher child BWz (B = 0.23, p = 0.01) and WFAz trajectories (B = 0.19, 0.01). The interaction between social support and prepregnancy OW/OB was negatively related to child BWz (B = -0.26, p = 0.02) and WFAz trajectory (B = -0.40, p = 0.047). Conclusions: Prenatal social support may be protective against the intergenerational transmission of obesity risk. Interventions for the prevention of child obesity should consider incorporating social support into their design. Clinical Trial Registration Number: NCT01541761.

The impact of postpartum social support on postpartum mental health outcomes during the COVID-19 pandemic

Social support is an influential component of postpartum recovery, adjustment, and bonding, which was disrupted by social distancing recommendations related to the COVID-19 pandemic. This study reports on changes in the availability of social support for postpartum women during the pandemic, investigates how those changes may have contributed to postpartum mental health, and probes how specific types of social support buffered against poor postpartum mental health and maternal-infant bonding impairment. Participants were 833 pregnant patients receiving prenatal care in an urban USA setting and using an electronic patient portal to access self-report surveys at two time points, during pregnancy (April-July 2020) and at ~12 weeks postpartum (August 2020-March 2021). Measures included an assessment of COVID-19 pandemic-related change in social support, sources of social support, ratings of emotional and practical support, and postpartum outcomes including depression, anxiety, and maternal-infant bonding. Overall self-reported social support decreased during the pandemic. Decreased social support was associated with an increased risk of postpartum depression, postpartum anxiety, and impaired parent-infant bonding. Among women reporting low practical support, emotional support appeared to protect against clinically significant depressive symptoms and impaired bonding with the infant. Decreases in social support are associated with a risk for poor postpartum mental health outcomes and impaired maternal-infant bonding. Evaluation and promotion of social support are recommended for healthy adjustment and functioning of postpartum women and families.

Social support for postpartum women and associated factors including online support to reduce stress and depression amidst COVID-19: Results of an online survey in Thailand

BACKGROUND

Social support for postpartum women helps mothers to recover from childbirth and fosters healthy infant development. However, the impacts of reduced interpersonal interactions inflicted by the COVID-19 outbreak on available social support for postpartum women have received little attention. Therefore, this study aimed to examine the levels of social support provided to postpartum women and associated factors in Thailand during the COVID-19 pandemic.

METHODS

A cross-sectional study was conducted from July to October 2021 using an anonymous online questionnaire. The responses of 840 eligible women up to six months postpartum in Thailand were obtained. The maternity social support scale was used to measure social support. Multivariate logistic regression was used to analyse the factors associated with social support among postpartum women.

RESULTS

About 57% of women reported to receive high support. Women in the high social support group were more likely to be married (aOR:2.70; 95% CI:1.57-4.66), have a university education or above (1.88; 1.35-2.64), have an intended pregnancy (2.06; 1.34-3.16), good health (2.01; 1.44-2.81), good sleep quality (1.62; 1.14-2.31), receive counsel from peers or family (1.56; 1.13-2.16), and use internet or social media to reduce stress and depression (1.51; 1.08-2.11). Meanwhile, women in the high social support group were significantly less likely to feed complementary foods to infants within 24 hours of completing the survey (0.28; 0.15-0.52).

CONCLUSIONS

The results of this study indicated that more than half of the women reported high support and illustrated the important role played by family, peers, and professionals as well as online and remote channels in providing postpartum informational and emotional support during the pandemic. Online platforms and remote support may be considered to provide social support to postpartum women during a pandemic such as COVID-19.

The Day-in-the-Life method for assessing infant caregiving in rural Pakistan

Objective

This manuscript describes the Day-in-the-Life (DIL) method for assessing child caregiving activities, its implementation, and findings regarding family members' roles and associations with maternal depression symptoms.

Background

Infant caregiving activities are most commonly performed by the mother, although there is increasing acknowledgement of others' contribution. Few methods exist to measure the diverse caregiving activities that mothers and others perform.

Method

Method development occurred within the Bachpan Cohort Study in rural Pakistan (N = 1,154 maternal-child dyads) when the child was 3 months old. The DIL was designed as a semi-structured interview in which the mother describes her child's day from their perspective. Regression analyses were then used to explore the correlation between the DIL and depression symptoms, using the Patient Health Questionnaire-9 (PHQ-9) measure.

Results

The DIL method was easy to administer and displayed excellent interrater agreement. The findings indicated that instrumental caregiving was mostly provided by the mother alone, others in the household tended to contribute more to infant social interactions, and there was more support from others when the mother was less able to provide care (e.g., when ill). Depression symptoms were higher among women who experienced less contribution from family members when the mother was less able to provide care.

Conclusions

The DIL can be deployed to measure infant caregiving activities and associations with maternal mental health.

Implications

This method is promising for researchers interested in disentangling the contribution of multiple family members toward child caregiving and its impacts on maternal and child health.

Trajectories of distress from pregnancy to 15-months post-partum during the COVID-19 pandemic

Background

The COVID-19 pandemic has particularly burdened pregnant and postpartum women. It remains unclear how distress levels of pregnant and postpartum people have changed (or persisted) as the pandemic continues on and which factors may contribute to these trajectories of distress.

Methods

This longitudinal study included 304 pregnant people, who were followed during pregnancy, 6-weeks, 6-months and 15-months postpartum. At each time point, a latent “distress” factor was estimated using self-reported depressive symptoms, anxiety symptoms, and stress. Reported negative impact of COVID-19 and social support were assessed during pregnancy as risk and protective factors related to distress. Second-order latent growth curve modeling with a piecewise growth function was used to estimate initial levels and changes in distress over time.

Results

Mean distress was relatively stable from the pregnancy to 6-weeks postpartum and then declined from 6-weeks to 15-months postpartum. Higher education, greater social support, and lower negative impact of COVID-19 were associated with a lower distress during pregnancy. Unexpectedly, negative impact of COVID-19 was associated with a faster decrease in distress and more social support was associated with a greater increase in distress from pregnancy to 6-weeks postpartum. However, these effects became non-significant after controlling for distress during pregnancy.

Conclusion

Findings indicate high but declining levels of distress from pregnancy to the postpartum period. Changes in distress are related to social support and the negative impact of the pandemic in pregnancy. Findings highlight the continued impact of COVID-19 on perinatal mental health and the need for support to limit the burden of this pandemic on pregnant people and families.

Evaluating the Feasibility, Acceptability, and Preliminary Efficacy of SupportMoms-Uganda, an mHealth-Based Patient-Centered Social Support Intervention to Improve the Use of Maternity Services Among Pregnant Women in Rural Southwestern Uganda: Randomized Controlled Trial

BACKGROUND

SMS text messaging and other mobile health (mHealth) interventions may improve knowledge transfer, strengthen access to social support (SS), and promote positive health behaviors among women in the perinatal period. However, few mHealth apps have been taken to scale in sub-Saharan Africa.

OBJECTIVE

We evaluated the feasibility, acceptability, and preliminary efficacy of a novel, mHealth-based, and patient-centered messaging app designed using behavioral science frameworks to promote maternity service use among pregnant women in Uganda.

METHODS

We performed a pilot randomized controlled trial between August 2020 and May 2021 at a referral hospital in Southwestern Uganda. We included 120 adult pregnant women enrolled in a 1:1:1 ratio to receive routine antenatal care (ANC; control), scheduled SMS text or audio messages from a novel messaging prototype (scheduled messaging [SM]), and SM plus SMS text messaging reminders to 2 participant-identified social supporters (SS). Participants completed face-to-face surveys at enrollment and in the postpartum period. The primary outcomes were feasibility and acceptability of the messaging prototype. Other outcomes included ANC attendance, skilled delivery, and SS. We conducted qualitative exit interviews with 15 women from each intervention arm to explore the intervention mechanisms. Quantitative and qualitative data were analyzed using STATA and NVivo, respectively.

RESULTS

More than 85% and 75% of participants received ≥85% of the intended SMS text messages or voice calls, respectively. More than 85% of the intended messages were received within 1 hour of the expected time; 18% (7/40) of women experienced network issues for both intervention groups. Over 90% (36/40) of the intervention participants found this app useful, easy to use, engaging, and compatible and strongly recommended it to others; 70% (28/40), 78% (31/40), and 98% (39/40; P=.04) of women in the control, SM, and SS arms, respectively, had a skilled delivery. Half (20/40), 83% (33/40), and all (40/40; P=.001) of the women in the control, SM, and SS arms attended ≥4 ANC visits, respectively. Women in the SS arm reported the highest support (median 3.4, IQR 2.8-3.6; P=.02); <20% (8/40; P=.002) missed any scheduled ANC visit owing to lack of transportation. Qualitative data showed that women liked the app; they were able to comprehend ANC and skilled delivery benefits and easily share and discuss tailored information with their significant others, who in turn committed to providing them the needed support to prepare and seek help.

CONCLUSIONS

We demonstrated that developing a novel patient-centered and tailored messaging app that leverages SS networks and relationships is a feasible, acceptable, and useful approach to communicate important targeted health-related information and support pregnant women in rural Southwestern Uganda to use available maternity care services. Further evaluation of maternal-fetal outcomes and integration of this intervention into routine care is needed.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04313348; https://clinicaltrials.gov/ct2/show/NCT04313348.

Maternal-Infant Attachment and its Relationships with Postpartum Depression, Anxiety, Affective Instability, Stress, and Social Support in a Canadian Community Sample

As a crucial component of child development, maternal-infant attachment influences a child's cognitive, psychological, and social development. Maternal depression, anxiety, stress, and social support have been identified as risk factors for poor maternal-infant attachment in some studies, while others did not find such relationships. The aim of this study was to examine the associations of maternal-infant attachment with depression, anxiety, affective instability, stress, social support, and other variables in a community sample of Canadian postpartum women. A total of 108 Canadian postpartum women participated in this cross-sectional study. The Depression, Anxiety, and Stress Scale-21 (DASS-21) assessed depression, anxiety, and stress, and the Affective lability Scale-18 measured affective instability (AI). Multiple linear regression was conducted to examine the association between maternal-infant attachment and other variables. The findings revealed a significant association of maternal-infant attachment with postpartum depression, and infant temperament, while anxiety, AI, stress, and social support were not identified as predictors for maternal-infant attachment. The results implicate the importance of addressing maternal depression and maternal-infant attachment, consequently decreasing the risk for childhood psychopathology.

Prenatal maternal stress during the COVID-19 pandemic and infant regulatory capacity at 3 months: A longitudinal study

The COVID-19 pandemic is a global traumatic experience for citizens, especially during sensitive time windows of heightened plasticity such as pregnancy and neonatal life. Pandemic-related stress experienced by mothers during pregnancy may act as an early risk factor for infants' regulatory capacity development by altering maternal psychosocial well-being (e.g., increased anxiety, reduced social support) and caregiving environment (e.g., greater parenting stress, impaired mother-infant bonding). The aim of the present longitudinal study was to assess the consequences of pandemic-related prenatal stress on infants' regulatory capacity. A sample of 163 mother-infant dyads was enrolled at eight maternity units in northern Italy. They provided complete data about prenatal stress, perceived social support, postnatal anxiety symptoms, parenting stress, mother-infant bonding, and infants' regulatory capacity at 3 months of age. Women who experienced emotional stress and received partial social support during pregnancy reported higher anxious symptoms. Moreover, maternal postnatal anxiety was indirectly linked to the infants' regulatory capacity at 3 months, mediated by parenting stress and mother-infant bonding. Dedicated preventive interventions should be delivered to mothers and should be focused on protecting the mother-infant dyad from the detrimental effects of pandemic-related stress during the COVID-19 healthcare emergency.

Development of Social Life Impact for Mother (SLIM) scale at first trimester to identify mothers who need social support postpartum: a hospital-based prospective study in Japan

OBJECTIVE

To develop and validate the Social Life Impact for Mother (SLIM) scale to identify mothers in Japan who need social support postpartum.

METHODS

Hospital-based prospective study was implemented nationwide in Japan. A total of 7462 pregnant women completed the SLIM scale in their first trimester, and postpartum social problems (postpartum depression and bonding disorders) were assessed at 1 month after delivery (N = 5768, follow-up rate 77.3%). Multivariate logistic regression was applied to investigate the association between SLIM scale and postpartum social problems.

RESULTS

The SLIM scale is made up of nine risk factors for postpartum social problems, including relationship problems, lower financial status, and lack of social support. The SLIM scale predicted postpartum social problems with moderate accuracy (area under the curve 0.63, 95% confidence interval 0.60-0.65). Further stratification by local clinic and tertiary hospital did not affect the estimates.

CONCLUSION

The SLIM scale at prenatal check-up may be useful for obstetricians to detect mothers with postpartum social problems. Further intervention studies using the SLIM score are warranted.

Social isolation and postnatal bonding disorder in Japan: the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study

Although there is substantial information about the effects of social relationships on mental health, their effects on postnatal bonding remain unclear. We aimed to examine the association between social isolation and postnatal bonding disorder. We analyzed data from 17,999 women who participated in the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study. An abbreviated version of the Lubben Social Network Scale was used to assess social isolation in the second trimester of pregnancy, and its subscales were used to assess marginal family ties and marginal friendship ties. Bonding disorder was defined as a Mother-to-Infant Bonding Scale score of ≥ 5 1 month after delivery. Multiple logistic regression analyses were conducted to examine the association between social isolation and postnatal bonding disorder after adjusting for age at delivery, parity, feelings towards pregnancy, psychological distress during pregnancy, and household income. Analyses stratified by postnatal depressive symptoms (PDS) were also conducted. Social isolation was associated with postnatal bonding disorder: the odds ratio (OR) was 1.55 (95% confidence interval [CI], 1.41-1.71). Marginal family ties and friendship ties were associated with postnatal bonding disorder: the ORs were 1.40 (95% CI, 1.23-1.60) and 1.44 (95% CI, 1.32-1.57), respectively. Marginal family ties were associated with postnatal bonding disorder only among women without PDS: the ORs were 1.30 (95% CI, 1.10-1.55) among women without PDS and 1.13 (95% CI, 0.91-1.40) among women with PDS. Social isolation during pregnancy was associated with an increased risk of postnatal bonding disorder.

Social connectedness as a determinant of mental health: A scoping review

Public health and epidemiologic research have established that social connectedness promotes overall health. Yet there have been no recent reviews of findings from research examining social connectedness as a determinant of mental health. The goal of this review was to evaluate recent longitudinal research probing the effects of social connectedness on depression and anxiety symptoms and diagnoses in the general population. A scoping review was performed of PubMed and PsychInfo databases from January 2015 to December 2021 following PRISMA-ScR guidelines using a defined search strategy. The search yielded 66 unique studies. In research with other than pregnant women, 83% (19 of 23) studies reported that social support benefited symptoms of depression with the remaining 17% (5 of 23) reporting minimal or no evidence that lower levels of social support predict depression at follow-up. In research with pregnant women, 83% (24 of 29 studies) found that low social support increased postpartum depressive symptoms. Among 8 of 9 studies that focused on loneliness, feeling lonely at baseline was related to adverse outcomes at follow-up including higher risks of major depressive disorder, depressive symptom severity, generalized anxiety disorder, and lower levels of physical activity. In 5 of 8 reports, smaller social network size predicted depressive symptoms or disorder at follow-up. In summary, most recent relevant longitudinal studies have demonstrated that social connectedness protects adults in the general population from depressive symptoms and disorders. The results, which were largely consistent across settings, exposure measures, and populations, support efforts to improve clinical detection of high-risk patients, including adults with low social support and elevated loneliness.

"Hey child, why were you born when the world is almost over?": An analysis of first-time mothers' postpartum experiences during the early stages of the COVID-19 pandemic in Coatepec, Veracruz, Mexico

INTRODUCTION

In Coatepec, Mexico, the immediate postpartum is considered a special time, called the cuarentena, when postpartum women receive critical social support and observe diet and activity pre- and proscriptions-all intended to enhance maternal-child health. This study examined how public health mandates aimed at containing COVID-19, which instructed people to socially isolate, affected women's postpartum experiences, including observing the cuarentena.

METHODS

We recruited first-time mothers from the local public health clinic and collected qualitative data via a verbally administered survey that covered knowledge/perceived threat of COVID-19 and its effect on the cuarentena and maternal mood. We used content analysis to analyze the data.

RESULTS

We conducted 33 telephonic interviews from March to December 2020. Overall, women were knowledgeable about and receptive to public health messaging regarding COVID-19 risks and safety measures. Despite knowledge and receptivity, most followed their original cuarentena plans to observe culturally prescribed postpartum practices, even when doing so contradicted public health mandates. However, the mandates that limited socialization with friends and extended family during the cuarentena negatively affected maternal mood.

DISCUSSION

Postpartum women, especially in under-studied low- and middle-income countries, merit research attention. Emergent from this study is that public health messaging should speak to its target audience in a way that makes sense within local contexts, which includes consideration of highly valued health practices. Future studies aimed at understanding how to achieve this goal will facilitate development of stronger programs that address public health needs and protect individual well-being.

Maternal Confidence and Parenting Stress of First-Time Mothers in Taiwan: The Impact of Sources and Types of Social Support

The adjustment process to becoming a mother is affected by culture. However, earlier studies have not clarified the relationship between parenting stress, social support, and maternal confidence in non-Western women. This study examined the associations between different types and sources of social support, maternal confidence, and parenting stress experienced by first-time mothers. The sample consisted of first-time mothers with a child under one year of age in northern Taiwan, and a total of 205 valid questionnaires were collected. The results supported the stress-buffering hypothesis, which suggests that social support reduces the adverse effect of stress on maternal confidence. Although previous studies have suggested that spouses and maternal relatives are critical in supporting first-time mothers’ transition into their new roles, each source did not show a mediator effect in our study. The beneficial effect of social support was found only when all social network members collectively participated. Regarding the types of social support, only appraisal support had a significant mediator effect; no effect was found for emotional, instrumental, or informational support. These findings add to our understanding of how different types and sources of social support play a role in helping first-time mothers adapt.

Psychological risks to mother-infant bonding during the COVID-19 pandemic

BACKGROUND

The purpose of this study was to examine the association between mental health symptoms, along with psychological experiences and coronavirus disease 2019 (COVID-19) related concerns, and self-reported maternal-infant bonding experiences of postpartum women.

METHODS

Using data collected from May 19 to August 17, 2020, this cross-sectional online study assessed 429 women to better understand the impact of the COVID-19 pandemic on women during the postpartum period. Enrolled respondents were asked to participate in a 30-45-min online survey about COVID-19-related experiences, pregnancy, stress, and well-being.

RESULTS

Postpartum women's depressive symptoms were related to lower quality maternal-infant bonding, but the anxiety symptoms were not associated with bonding. Maternal self-efficacy, but not social support, was associated with mothers' higher quality of maternal-infant bonding. COVID-19-related grief was significantly associated with lower quality bonding. On the other hand, COVID-19-related health worries were associated with higher quality of maternal-infant bonding.

CONCLUSIONS

We describe potential psychological risk factors to maternal-infant bonding among postpartum women during the pandemic period. To best support the medical and psychological well-being of the mothers and infants, enhanced interdisciplinary partnerships among perinatal healthcare professionals involved in primary and/or specialty care is needed.

IMPACT

Unique COVID-19-related health and grief concerns exist, with implications for maternal-infant bonding. Depression but not anxiety is associated with lower maternal-infant bonding. Caregiving confidence, but not social support, is associated with higher maternal-infant bonding. It is critical to screen for postpartum depression and COVID-19-related grief during maternal follow-up and pediatric visits. Study findings inform and prioritize pediatric interventions toward enhancing maternal-infant bonding during the COVID-19 era.

Association between social support and postpartum depression

Postpartum depression is common; however, little is known about its relationship to social support and postpartum depression. This study examined the association between them among South Korean women within one year of childbirth. This study was based on the 2016 Korean Study of Women’s Health-Related Issues (K-Stori), a cross-sectional survey employing nationally-representative random sampling. Participants were 1,654 postpartum women within a year of giving birth. Chi-square test and logistic regression analysis were conducted to analyze the associations between social support (and other covariates) and postpartum depression. Among participants, 266 (16.1%) had postpartum depression. Depending on the level of social support, 6.0%, 53.9%, and 40.1% of them had low, moderate, and high social support, respectively. Women with moderate or low social support were more likely to have postpartum depression (OR = 1.78, 95% CI = 1.26–2.53; OR = 2.76, 95% CI = 1.56–4.89). This trend was observed in participants with multiparity, pregnancy loss, obese body image, and employed women. Social support was associated with a decreased likelihood of postpartum depression, indicating the importance of social support, especially for women experiencing multiparity, pregnancy loss, negative body image, as well as for employed women.

Exogenous oxytocin used to induce labor has no long-term adverse effect on maternal-infant bonding: Findings from the Japan Environment and Children's Study

BACKGROUND

This study investigated the association between exogenous oxytocin use for labor induction and adverse maternal-infant bonding (MIB).

METHODS

Data on 19 700 mother-infant pairs were collected, in which the infants were live-birth singletons, born in cephalic position and at >37 weeks of gestation; the drug used to induce labor was noted. Between 2011 and 2014, Japanese pregnant women were enrolled in a nationwide prospective birth cohort study, the Japan Environment and Children's Study. The Japanese version of the Mother-to-infant Bonding Scale (MIBS-J) was administered and demographic information was collected through medical record transcripts. MIBS-J scores were obtained at one month, six months, and one year after delivery. We estimated the risk of adverse MIB between use of oxytocin and other methods for labor induction using multiple linear regression analyses; interaction and mediation analyses to assess the relationship among MIBS-J scores also followed.

RESULTS

Exogenous oxytocin was used during labor on 15 252 (77.4%) participants. After adjusting for confounders, there were no significant differences in adverse MIB between groups for which exogenous oxytocin was used and not used for labor induction.

LIMITATION

The MIBS-J scores at one and six months were compiled using five instead of 10 questions. Moreover, detailed information was unavailable; for example, the questionnaire did not ask for the dosage and timing of the drugs used to induce labor.

CONCLUSIONS

Exogenous oxytocin is a safe and vital drug to induce labor, and has been shown in this study to have no significant impact on long-term adverse MIB.

A Pilot Trial of a Health Promotion and Illness Prevention Paradigm in the Perinatal Period

OBJECTIVES

This is a pilot study of the Vermont Family Based Approach, an innovative health promotion program designed to address behavioral health prevention in primary care, adapted for perinatal women. We aimed to determine the acceptability of the intervention across socioeconomic strata, and to identify if participation improves perinatal mental health.

METHODS

Recruitment occurred at a general obstetrics practice. Women 12-25 weeks gestation were paired with a wellness coach who administered a wellness assessment and used motivational interviewing to facilitate individualized plans based on evidence-based domains of health promotion. Participants were offered access to free, co-located wellness activities through the peripartum, and referred to behavioral health services if appropriate.

RESULTS

93 women consented; 16 Medicaid Insured women (MI) and 30 Privately Insured (PI) were randomized to the intervention. Of all activities, yoga and parenting activities were most appealing, with 58% of women attending. PI (M = 12.30, SD = 11.71) attended significantly more activities than MI (M = 3.81, SD = 12.30; p = .001). Trauma exposure was inversely associated with attendance (p = .004). Randomization to the intervention was not associated with improvements in internalizing symptoms or perceived stress at 12 months postpartum, however, attending three or more wellness activities was associated with a decrease in perceived stress between baseline and 12 months postpartum.

CONCLUSION

This program appeared acceptable and engaging to women with private insurance, but less so with Medicaid. The trial failed to demonstrate improvement in internalizing scores, but of those randomized to the intervention, higher engagement was associated with decreased stress one year after giving birth.

Mother-Infant Bonding and Its Associated Factors Among Mothers in the Postpartum Period, Northwest Ethiopia, 2021

BACKGROUND

The emotional bond that a mother senses to her infant is essential to their social, emotional, and cognitive development. Understanding the level of mother-infant bonding plays an imperative role in the excellence of care. However, in Ethiopia, there is a paucity of information about mother-infant bonding in the postpartum period.

OBJECTIVE

This study aimed to assess the level of mother-infant bonding and its associated factors among mothers in the postpartum period, Debre Tabor Town Northwest Ethiopia, 2021.

METHODS

A community-based cross-sectional study was conducted with 422 postpartum mothers. The postpartum Bonding Questionnaire was used to assess mother-infant bonding. The Edinburgh Postnatal Depression Scale was used to assess postnatal depression. The level of marital satisfaction was assessed by using Kansas marital satisfaction scale. Social support was assessed by Oslo social support scale. A simple random sampling technique was applied to select study participants. Simple and multiple linear regression were used to identify potential factors associated with the mother-infant bonding scale. A P-value of <0.05 was considered to declare statistical significance.

RESULTS

In this study, out of 420 postpartum mothers,53 (12.6%) had a risk for the quality of mother-infant bond difficulties between mother and an infant; 8.1% of mothers had a risk for rejection and pathological anger; 3.6% of mothers had a risk for infant-focused anxiety and 1.9% of mothers had risk for incipient abuse of an infant. Maternal depression status [adjusted β coefficient (β) = 2.31, 95% CI: (1.98, 2.64)], non-union marital status [β = 15.58, 95% CI: (9.88, 21.27)], being government employee [β = -5.68, 95% CI: (-9.71, -1.64)], having current pregnancy complication [β = -7.28, 95% CI: (-12.27, -2.29)], being non-breastfeeding mother [β = 7.66, 95% CI: (2.94, 12.38)], substance use history [β = -6.55, 95% CI: (-12.80, -0.30)], and social support [β = -2, 95% CI: (-2.49, -1.50)] were statistically significant factors for mother-infant bonding.

CONCLUSION

Generally, a significant number of mothers had mother-infant bonding difficulties in the postpartum period. Preventing strategies for bonding difficulties focus on social support during pregnancy, screening postpartum mothers for postpartum depression, and special attention to substance users, non-union maternal status, and non-breastfeeding mothers.

Parental Mental Illness, Borderline Personality Disorder, and Parenting Behavior: The Moderating Role of Social Support

PURPOSE OF REVIEW

Parental mental disorders, particularly borderline personality disorder (BPD), impair parenting behavior. Consequently, the children exhibit an elevated risk for psychopathology across their lifespan. Social support for parents is thought to moderate the relationship between parental mental illness and parenting behavior. It may dampen negative effects and serve as starting point for preventive interventions. This paper provides a literature overview regarding the impact of social support on the sequelae of parental mental illness and BPD for parenting behavior.

RECENT FINDINGS

Current literature highlights the increased burden of families with a mentally ill parent and associated changes in parenting behavior like increased hostility and affective dysregulation, especially in the context of parental BPD. Literature further demonstrates the powerful impact of social support in buffering such negative outcomes. The effect of social support seems to be moderated itself by further factors like socioeconomic status, gender, or characteristics of the social network. Social support facilitates positive parenting in mentally ill parents and may be particularly important in parents with BPD. However, social support is embedded within a framework of influencing factors, which need consideration when interpreting scientific results.

Prenatal expectations and other psycho-social factors as risk factors of postnatal bonding disturbance

The mother's bond to her baby starts to develop during pregnancy, and it is related to the baby's attachment. We study how the mother's prenatal expectations of her unborn baby, the mother's adult relationships, and postnatal psycho-social factors (stress, depression, and anxiety) are related to the risk of bonding disturbance. The study comprised 1398 mothers and their unborn babies assessed both during pregnancy and when the babies were 3 months old (47.7% girls). The mother's risk of bonding disturbance was investigated using Brockington's Postpartum Bonding Questionnaire. According to the results, 71 (5.1%) of all the mothers in the study had a risk of a bonding disturbance. In a final adjusted logistic regression model, the most important risk factors were the mother's inability to form positive expectations about relationships with the baby during the third trimester of pregnancy (AOR = 7.78, p ≤ .001), maternal postnatal stress (AOR = 4.95, p ≤ .001) and maternal postnatal depression (AOR = 3.46, p ≤ .01). The results challenge healthcare professionals to screen pregnant mothers to identify at-risk groups for post-partum bonding disturbances. Intervention programs to prevent the development of bonding disturbances, and thus their possible serious consequences for children's development, should be considered.

Paternal childcare at 6 months and risk of maternal psychological distress at 1 year after delivery: The Japan Environment and Children's Study (JECS)

Background

Paternal childcare is reported to benefit maternal mental health, but specific childcare behaviors have not been comprehensively determined. This study sought to identify paternal childcare behaviors associated with maternal mental health by adjusting for other covariates associated with maternal mental health and examining childcare behaviors.

Methods

This study investigated whether seven types of paternal childcare behaviors at 6 months after delivery were associated with maternal psychological distress at 1 year after delivery, which was assessed using the Kessler Psychological Distress Scale (K6). After exclusions from a dataset of 103,062 pregnancies obtained in the Japan Environment and Children’s Study, we evaluated data from 75,607 mothers.

Results

More than 70% of fathers were always or sometimes involved in “playing at home,” “playing outdoors,” “changing diapers,” and “bathing,” 60%–70% in “helping with feeding” and “dressing,” and 45.9% in “putting the child to bed.” All paternal childcare behaviors showed some beneficial association with less maternal psychological distress, both moderate (K6 score 5–12) and severe (K6 score ≥ 13) distress. Playing at home was the most beneficial association identified (adjusted odds ratio [aOR] 0.66, 95% confidence interval [CI] 0.56–0.76 for moderate psychological distress; aOR 0.36, 95% CI 0.28–0.48 for severe psychological distress).

Conclusions

These seven types of paternal childcare behaviors may help lessen maternal psychological distress. Emphasis should be given to building education systems and working environments that promote paternal childcare.

Peripartum depression: Does risk versus diagnostic status impact mother-infant bonding and perceived social support?

BACKGROUND

Peripartum depression (PND) impairs mother-infant boding and perceived social support, yet limited research has examined if women at-risk for PND (AR-PND) also experience impairment. We examined if pregnant women AR-PND, women with PND, and healthy comparison women (HCW) differed in their mother-infant bonding and social support. As PND is highly comorbid with anxiety, we also examined if peripartum anxiety impacted postpartum diagnosis of PND.

METHODS

A total of 144 pregnant women AR-PND or euthymic were assessed twice antepartum and twice postpartum. We utilized regression models to examine the impact of PND risk group status and diagnostic status on mother-infant bonding and perceived social support postpartum. We conducted a sensitivity analysis using a generalized estimating equations model to determine if anxiety (Hamilton Anxiety Rating Scale, HAM-A) across all four time points was associated with the postpartum diagnosis of PND.

RESULTS

Women AR-PND experienced significantly worse mother-infant bonding compared to HCW (p = .03). Women diagnosed with PND experienced significantly worse mother-infant bonding and social support compared to HCW (p = .001, p = .002, respectively) and to those who were at-risk for but did not develop PND (p = .02, p = .008, respectively). HAM-A severity at each visit was associated with PND diagnosis status, where each increase in HAM-A was associated with 15% increased odds of being diagnosed with PND postpartum.

CONCLUSIONS

Both women AR-PND and those with PND experience worse mother-infant bonding. Peripartum anxiety should also be assessed as it represents a marker for later PND.

Neuraxial labour analgesia is associated with a reduced risk of maternal depression at 2 years after childbirth: A multicentre, prospective, longitudinal study

Supplemental Digital Content is available in the text

BACKGROUND

Severe labour pain is an important risk factor of postpartum depression, and early depression is associated with an increased risk of long-term depression; whereas the use of epidural analgesia during labour decreases the risk of postpartum depression.

OBJECTIVE

To investigate whether neuraxial labour analgesia was associated with a decreased risk of 2-year depression.

DESIGN

This was a multicentre, prospective, longitudinal study.

SETTING

The study was performed in Peking University First Hospital, Beijing Obstetrics and Gynecology Hospital and Haidian Maternal and Child Health Hospital in Beijing, China, between 1 August 2014 and 25 April 2017.

PATIENTS

Five hundred ninety-nine nulliparous women with single-term cephalic pregnancy preparing for vaginal delivery were enrolled.

MAIN OUTCOME MEASURE

Depressive symptoms were screened with the Edinburgh Postnatal Depression Scale at delivery-room admission, 6-week postpartum and 2 years after childbirth. A score of 10 or higher was used as the threshold of depression. The primary endpoint was the presence of depression at 2 years after childbirth. The association between the use of neuraxial labour analgesia and the development of 2-year depression was analysed with a multivariable logistic regression model.

RESULTS

Five hundred and eight parturients completed 2-year follow-up. Of these, 368 (72.4%) received neuraxial analgesia during labour and 140 (27.6%) did not. The percentage with 2-year depression was lower in those with neuraxial labour analgesia than in those without (7.3 [27/368] vs. 13.6% [19/140]; P = 0.029). After correction for confounding factors, the use of neuraxial analgesia during labour was associated with a significantly decreased risk of 2-year depression (odds ratio 0.455, 95% confidence interval 0.230 to 0.898; P = 0.023).

CONCLUSION

For nulliparous women with single-term cephalic pregnancy planning for vaginal delivery, the use of neuraxial analgesia during labour was associated with a reduced risk of maternal depression at 2 years after childbirth.

TRIAL REGISTRATION

www.chictr.org.cn: ChiCTR-OCH-14004888 and ClinicalTrials.gov: NCT02823418.

Association between Lack of Social Support from Partner or Others and Postpartum Depression among Japanese Mothers: A Population-Based Cross-Sectional Study

Lack of social support is a known risk factor for postpartum depression (PPD). However, the association between lack of social support from a partner or others and PPD remains unknown. We examined this association among Japanese mothers. We distributed an original questionnaire to mothers participating in a three- or four-month health check-up program over October to November 2012 in Aichi Prefecture, Japan. Of the 9707 eligible mothers, 6590 responded to the questionnaire (response rate: 68%). Social support from a partner or others was assessed based on whether the mother can consult with her partner or others (i.e., parents, relatives, and friends who are close by or far) on childcare. PPD was assessed with the Edinburgh Postnatal Depression Scale. The data were analyzed using multiple logistic regression analysis for four categories: no social support from either a partner/others, social support from a partner only, social support from others only, and social support from both, adjusted for possible covariates. Mothers who have no social support from either a partner/others, have social support from a partner only, and have social support from others only were 7.22 (95% confidence interval [CI], 1.76–29.6), 2.34 (95% CI, 1.37–3.98), and 3.13 (95% CI, 2.11–4.63) times more likely to show PPD, respectively, in comparison with mothers who have social support from both, after adjustment of possible covariates. Mothers with no social support from a partner, but have social support from others, showed significant risk for PPD, which may be invisible. Further prevention effort is needed to detect PPD cases, with a focus on mothers without support from their partner.

Prenatal Attachment and Perinatal Depression: A Systematic Review

Pregnancy is a period of complex bio-psychological changes, during which the development of an attachment bond to the fetus takes on a central role. Depressive symptoms are common during this period. Both symptoms of depression and low levels of prenatal attachment are related to negative outcomes in caregivers and infants. Following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement, this systematic review analyzes and systematizes 41 studies concerning the association between prenatal attachment and perinatal depression. The majority of the studies reported a significant association between the two. Specifically, prenatal depressive symptoms were found to be negatively associated with prenatal attachment. Furthermore, lower levels of prenatal attachment were related to higher postnatal depressive symptoms, although fewer studies assessed this association. While these results were found across different populations, conflicting findings emerged, suggesting they should be interpreted with caution, particularly in male samples and in non-normative pregnancies (e.g., high-risk pregnancies, medically assisted pregnancies, and pregnancies with previous perinatal losses). These results are clinically important for the perinatal screening process and for implementing preventive and treatment programs. However, future studies are needed to further confirm and generalize these results.

Changes in tryptophan metabolism during pregnancy and postpartum periods: Potential involvement in postpartum depressive symptoms

BACKGROUND

Many women experience depressive symptoms during pregnancy and postpartum periods. These depressive symptoms are often accompanied by other inflammatory morbidities present during pregnancy. Tryptophan (TRP) metabolism has attracted considerable attention due to its influence on the onset of depression via induction of inflammation. We examined the changes in plasma levels of TRP metabolites in pregnant women with depressive symptoms during pregnancy and/or the postpartum period.

METHODS

In line with a previous analysis using the Edinburgh Postnatal Depression Scale (EPDS), participants were divided into a non-depressive (ND) group, a postpartum depressive (PD) group, a temporary gestational depressive (TG) group, and a continuous depressive (CD) group. Blood samples were collected before and 1 month after delivery. The concentrations of plasma TRP metabolites were measured using high-performance liquid chromatography (HPLC).

RESULTS

There are differences in plasma levels of TRP metabolites during pregnancy and postpartum periods between the ND group and the PD group, but not the TG or CD group. In the PD group, plasma levels of kynurenine (KYN) and kynurenic acid (KA), and KYN/TRP and KA/KYN ratio during the pregnancy period were higher and 3-hydroxyanthranilic acid (3HAA) during the postpartum period was lower than those in the ND group.

LIMITATIONS

Histories regarding mood disorders before pregnancy were not assessed.

CONCLUSIONS

The higher plasma levels of KYN and KA, and KYN/TRP and KA/KYN ratio during pregnancy period and lower plasma level of 3HAA during the postpartum period could be useful predictive and diagnostic markers of postpartum depressive symptoms.

A systemic review of maternal wellbeing and its relationship with maternal fetal attachment and early postpartum bonding

Background

An emerging body of literature suggests there is a relationship between a pregnant woman’s psychological wellbeing and the development of maternal-fetal attachment (MFA) and early postpartum bonding. The nature of this relationship is not well understood because of the limited theoretical framework surrounding the construct of MFA and variations in study methods and data collection points. In this systematic review, we synthesize the published literature to determine the nature of the relationship from the antenatal to early postnatal period and to provide recommendations for future research and clinical practice.

Method

Using the preferred reporting items for systematic reviews and meta-analyses (PRISMA) approach, four electronic databases were searched for peer-reviewed empirical studies, published in English. Articles were considered for inclusion if data was collected on at least one domain of maternal wellbeing/mental health and MFA during pregnancy or MFA during pregnancy and the mother-infant relationship during the early postpartum period (up to 12 weeks). No date parameters were applied to the search strategy. The review was registered with PROPSERO (registration number: CRD42018096174).

Results

25 studies examining maternal mental health and MFA/postpartum bonding were selected for inclusion in this review. Key findings identified from the review were: a need to validate existing mental health measures or develop new measures specific for use in antenatal populations; inconsistencies in data collection points throughout pregnancy and postpartum; a lack of consensus about the construct of MFA and the way it is assessed; and a continued focus on postpartum outcomes.

Conclusion

Scientific gaps remain in our understanding of the relationship between maternal mental health and both MFA and postpartum bonding which limit our theoretical understanding of the MFA construct. Recommendations for future research are to employ prospective longitudinal designs that span the full pregnancy and postpartum period, and for consistency in the terminology and methodology used when considering MFA. A re-focus of research attention on the theory behind MFA will allow a richer and more holistic account of the emerging relationship between mother and baby.

The Protective Effect of Prenatal Social Support on Infant Adiposity in the First 18 Months of Life

OBJECTIVE

To determine whether prenatal social support was associated with infant adiposity in the first 18 months of life in a low-income, Hispanic sample, known to be at high risk of early child obesity.

STUDY DESIGN

We performed a longitudinal analysis of 262 low-income, Hispanic mother-infant pairs in the control group of the Starting Early child obesity prevention trial. Prenatal social support was measured using an item from the Maternal Social Support Index. We used multilevel modeling to predict weight-for-length z-score trajectories from birth to age 18 months and logistic regression to predict macrosomia and overweight status at ages 6, 12, and 18 months.

RESULTS

High prenatal social support was independently associated with lower infant adiposity trajectories from birth to age 18 months (B = -0.40; 95% CI, -0.63 to -0.16), a lower odds of macrosomia (aOR = 0.35; 95% CI, 0.15-0.80), and a lower odds of overweight at ages 12 (aOR = 0.28; 95% CI, 0.10-0.74) and 18 months (aOR = 0.35; 95% CI, 0.14-0.89). Prenatal social support was not significantly associated with overweight status at age 6 months.

CONCLUSIONS

Prenatal social support may protect against excessive infant adiposity and overweight in low-income, Hispanic families. Further research is needed to elucidate mechanisms underlying these associations and to inform preventive strategies beginning in pregnancy.

Changes in the association between postpartum depression and mother-infant bonding by parity: Longitudinal results from the Japan Environment and Children's Study

The results of several epidemiological studies have shown a moderate association between postpartum depression (PPD) and mother-infant bonding (MIB); however, associations and changes that longitudinally considered parity were not reported. We investigated the possible association between PPD and MIB at one month after birth, in addition, the changes of these indices by parity. From a dataset comprising 103,099 maternal registrations in The Japan Environment and Children's Study, the present study analyzed complete data on questionnaires for 76,363 women who participated once (cross-sectional group) and 3753 women who participated twice (follow-up subgroup). Edinburgh Postnatal Depression Scale (EPDS) scores and the Mother-to-Infant Bonding Scale-Japan (MIBS-J) scores were obtained one month after delivery. We identified the two factors of the MIBS-J, "lack of maternal feeling (LMF)" and "anxiety about caregiving (AC)" through confirmatory factor analysis. Associations between total EPDS and each factor of MIBS-J were evaluated using multiple regression analyses after adjusting for potential confounders. Total EPDS and both factors (LMF and AC) were positively related in the cross-sectional group (fully adjusted β = 0.26 and 0.39 for LMF and AC, respectively), in the follow-up subgroup at first participation (0.24 and 0.40, respectively) and at the second participation (0.25 and 0.39, respectively). Multiple regression analyses revealed a robust, moderate relationship between postpartum depression and mother-infant bonding. PPD and MIB scores were shown to decrease from the first child to the second in the follow-up subgroup. Consequently, interventions which would increase a mother's child care experience and expertise would prevent PPD and improve MIB.

Effectiveness of Kangaroo Care for a Patient with Postpartum Depression and Comorbid Mother-Infant Bonding Disorder

The presently reported patient was a 37-year-old married primipara with peripartum depression comorbid with bonding disorder. Care anxiety and a lack of affection towards her baby first appeared at around the time of delivery, and the patient developed major depression at one month after the birth of her healthy baby. At first, standard treatment for major depression including the use of antidepressants, electroconvulsive therapy, and supportive psychotherapy were provided. However, bonding problems appeared to impede and obstruct the amelioration of depression. Although treatment methods for bonding disorder have not yet been established, Kangaroo Care was introduced to facilitate skin-to-skin contact. We also educated her in better parenting behavior and provided repeated motivational interviews with her family because a lack of partner and social support and personal temperament (low self-directedness and cooperativeness) were thought to be related to her bonding disorder. This case suggests the effectiveness of Kangaroo Care, which promotes a humanizing maturation of both baby and parent alike, for mothers with postpartum depression and comorbid severe bonding disorder.

Impact of perceived rearing and social support on bonding failure and depression among mothers: A longitudinal study of pregnant women

BACKGROUND

Although previous studies have reported associations between bonding failure, depression, social support among mothers, and perceived rearing, the causal relationships remain unclear.

METHODS

A total of 855 women (mean age, 32.4 ± 4.4 years) completed the Mother-Infant Bonding Questionnaire (MIBQ), the Edinburgh Postnatal Depression Scale (EPDS), the Japanese version of the Social Support Questionnaire, and the Parental Bonding Instrument in early pregnancy before week 25 (T1) and at 1 month after delivery (T2). We created a path model to clarify the causal relationships between perinatal bonding failure, depression, social support, and perceived rearing during pregnancy and at 1 month after delivery. The model was tested using structural equation modeling.

RESULTS

Our recursive model showed acceptable fit (chi-squared statistic/degree of freedom = 2.1, comparative fit index = 0.98, root mean square error of approximation = 0.04). It was revealed that: (1) at T1, higher overprotection significantly predicted MIBQ scores; (2) at T1, poorer social support significantly predicted both MIBQ and EPDS scores; and (3) at T1, both MIBQ and EPDS scores significantly predicted respective scores at T2.

CONCLUSIONS

These results showed that bonding failure in the postpartum period was significantly influenced by mothers' own perceived rearing and social support during pregnancy. In addition, depression in the postpartum period was strongly influenced by social support during pregnancy. These findings suggest that psychosocial interventions that focus on both mothers' recollections of their own upbringing and social support during pregnancy are effective for preventing bonding failure and depression in the postpartum period.

Issues on the diagnosis and etiopathogenesis of mood disorders: reconsidering DSM-5

The authors present a narrative review from the diagnostic and nosologic viewpoints of mood disorders (bipolar and depressive ones) by revisiting the revision from the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, Text Revision to DSM-5, including the following: the separation of the bipolar and depressive sections; the addition of increased energy and continuation of symptoms to the hypo/manic criteria; the elimination of mixed episodes; the creation of new categories and specifiers ("other specified bipolar and related disorder", "disruptive mood dysregulation disorder", "with anxious distress", "with mixed features", "with peripartum onset"); the categorization of hypo/manic episodes during antidepressant treatment into bipolar disorder; the elimination of the "bereavement exclusion"; the ambiguous separation between bipolar I and II; the insufficient distinction between "other specified bipolar and related disorders" and major depressive disorder; the differentiation regarding borderline personality disorder; agitation; premenstrual dysphoric disorder; and society and psychiatry. Through this analysis, we point out both the achievements and limitations of DSM-5. In addition, to examine the future direction of psychiatry, we introduce our cohort study regarding maternal depression and an outline of the National Institute of Mental Health's Research Domain Criteria project in the US. Finally, we advocate the importance of elucidating etiopathogeneses by starting from or going beyond the DSM operational diagnostic system, which has shown great efficacy.