Maternal anxiety, risk factors and parenting in the first post-natal year

Risk factors associated with postpartum anxiety in Australia, Europe, and North America: A systematic review and narrative synthesis

BACKGROUND

Reducing the prevalence and consequences of anxiety following childbirth (postpartum anxiety) is a strategic priority in the UK and many similar nations; a comprehensive review of risk factors can support the development of interventions and guide further research.

METHODS

This registered systematic review was guided by 'Preferred Reporting Items for Systematic Reviews and Meta-Analyses' (PRISMA) and analysed using 'Synthesis Without Meta-analysis' (SWiM) to answer the question; 'What factors have been reported to increase the risk of maternal postpartum anxiety (PPA) in Australia, Europe, and North America?'. MEDLINE and PsycINFO were searched for relevant research from Australia, Europe, and North America, published up to July 2021.

RESULTS

Screening yielded 39 reports (total N = 40,238). Seven risk categories were identified (Psychopathology and personality, Social, Socio-demographic, Health, Cognitive, Pregnancy and birth, and Infant characteristics and postpartum experiences). Historic and concurrent depression, historic anxiety, and low social support were the most frequently evidenced risk factors.

LIMITATIONS

The review was limited to three geographical regions with comparable health, political, and cultural contexts, and research pertaining only to special populations was excluded.

CONCLUSIONS

Findings synthesise new evidence of the risk factors associated with PPA, whilst the discussion highlights potentially modifiable factors as targets for intervention. Monitoring for risk factors during routine pregnancy and postpartum care would allow for additional surveillance and earlier intervention with those most at risk. Peer support should be offered to people with heightened vulnerability to PPA. Developing support strategies that address cognitive vulnerabilities (e.g., parenting-related confidence) could prove particularly beneficial.

Depression in High-Risk Offspring: The Mediating Role of Sleep Problems

Parental depression is associated with offspring depression and sleep problems are prospectively associated with the development of depression. However, little work has examined sleep problems in the offspring of depressed parents and whether these problems partially account for the association between parent and offspring depression. This longitudinal study examined the indirect effect of sleep problems on the association between parent psychopathology and offspring depression in a sample of 10,953 10 to 12-year-old children participating in the Adolescent Brain and Cognitive Development (ABCD) study. Controlling for age, sex, and other forms of parent psychopathology, we found significant indirect effects of parent to offspring depression through parent and youth reports of youth insomnia and hypersomnia. We also found indirect effects of parent history of anxiety and drug use problems to offspring depression through insomnia, and indirect effects of parent history of anxiety, drug use problems, and alcohol use problems to offspring depression through hypersomnia. Our findings show that sleep may be a mechanism of the transmission of parent depression, anxiety, drug use problems, and alcohol use problems to offspring depression. Mitigating sleep problems represents a potential avenue for preventative interventions in youth with a heightened susceptibility to depression.

Economic hardships during COVID-19 and maternal mental health: Combining samples with low incomes across three cities

The COVID-19 pandemic increased maternal depression and anxiety, imperiling both mothers' own wellbeing and that of their children. To date, however, little is known about the extent to which these increases are attributable to economic hardships commonly experienced during the pandemic: income loss, job loss, and loss of health insurance. Few studies have examined the individual impacts of these hardships, and none have lasted beyond the first year of the pandemic. This study harmonizes data from six evaluations of pediatric-based parenting programs for women with young children and low incomes across three U.S. cities (N = 1,254). Low-income mothers are of special interest because their families have been disproportionately affected by economic shocks due to COVID-19, and mothers of young children have been more distressed than other mothers by COVID-19. The studies' combined window of observation lasted from the onset of the pandemic to over three years later. Results indicate that income loss, job loss, and health insurance loss were all significantly associated with depression and anxiety. When each hardship was assessed net of the others, lost income was associated with more than a two-fold increase in the odds of anxiety, and a lost job and lost health insurance were associated with 50% and 90% greater odds of depression, respectively. Associations between hardships and maternal mental health did not diminish over time during the window of observation. These associations are likely to have been even greater in the absence of generous social policies enacted during the pandemic.

Preliminary findings on the association between maternal salivary and hair cortisol and the mother-infant-interaction during the early postpartum period

Maternal capabilities to engage in sensitive caregiving are important for infant development and mother-infant-interaction, however, can be negatively affected by cortisol due to a stress response. Previous research suggested that cortisol possibly impairs cognitive functions important for caregiving behavior, which potentially leads to less maternal sensitivity. However, studies investigating the influence of cortisol using endocrine parameters on the mother-infant-interaction during the early postpartum are lacking. In the current study, fifty-nine mother-infant-dyads participated in a laboratory face-to-face still-face (FFSF) observation when infants were 4 months of age. Maternal and infant positive, negative and matched behavior during the FFSF was microanalytically coded. Cortisol concentrations were obtained using hair and saliva samples. For salivary cortisol, the area under the curve with respect to ground (AUCG) was calculated using two saliva samples obtained after arrival and after the FFSF. Multiple block-wise hierarchical linear regression models were conducted to incorporate potential confounding factors (maternal age, parity, infant gestational age, infant sex) in a first step and, then, test for the association of hair and salivary cortisol with maternal and infant positive, negative and dyadic behavior in a second step. For both it was hypothesized that cortisol assessed in hair and saliva is negatively associated with positive and matched mother-infant-interaction, and positively associated with negative mother-infant-interaction. It could be shown that salivary but not hair cortisol as well as infant gestational age and infant sex related significantly to infant positive and negative affect as well as matched behavior during the reunion phase of the FFSF. Maternal positive affect was unrelated to any of the variables. The results are discussed in regard to the importance of maternal cortisol levels over a longer period of time and more acute situational levels for the mother-infant-interaction as well as the relevance of included confounding factors.

Resilience in maternal, newborn, and child health in low- and middle-income countries: findings from a scoping review

OBJECTIVES

The research objectives were to identify and synthesise prevailing definitions and indices of resilience in maternal, newborn, and child health (MNCH) and propose a harmonised definition of resilience in MNCH research and health programmes in low- and middle-income countries (LMICs).

DESIGN

Scoping review using Arksey and O'Malley's framework and a Delphi survey for consensus building.

PARTICIPANTS

Mothers, new-borns, and children living in low- and middle-income countries were selected as participants.

OUTCOMES

Resilience as defined by the authors was deduced from the studies.

RESULTS

Twenty-two out of 76,566 cited studies published between 2006 and 2010 were included in the review. Thirteen (59.1%) examined maternal resilience, and nine (40.9%) examined newborn and child health resilience; most of the included studies were quantitative (n = 17; 81%). Seven studies defined 'resilience' in the context of maternal health, most of which described the term at the individual level. 'Maternal resilience' was measured using validated scales in five studies; another five defined newborn and child resilience. Only one reviewed study used maternal characteristics to identify newborn and child resilience. The synthesised consensus definition of 'maternal, newborn, and child resilience' is 'A woman's ability to prevent or adapt to significant and challenging circumstances including threats, tragedy, and trauma to herself during pregnancy, childbirth, and puerperium and to her neonates or children five years or younger'.

CONCLUSION

The information identified was limited but included a few definitions of resilience in MNCH and an index of child resilience in LMICs. The proposed definition is useful for MNCH programme implementation and interventions in LMICs. Scoping review registration: The protocol for this review was registered in the open science framework at the registered address ( https://osf.io/jt6nr ).

The prevalence and related factors of post-partum anxiety and depression among mothers during COVID-19 pandemic in 2021

BACKGROUND

There are many factors effective on occurrence of post-partum anxiety and depression. COVID-19 pandemic, as a major health crisis, affected many countries and had undesirable mental health outcomes, especially for the vulnerable population. The aim of this study was to evaluate the prevalence of post-partum anxiety and depression and their related factors during COVID-19 pandemic.

METHODS

The present descriptive cross-sectional study was conducted on 360 mothers who delivered their child during COVID-19 pandemic and had referred to the comprehensive urban health canter of Lenjan city two months after their delivery (from November 10th, 2021, until March 19th, 2022). Data were gathered using 3 questionnaires including demographic characteristics, Edinburgh Postnatal Depression Scale (EPDS), and Beck Anxiety Inventory (BAI). Data were analyzed using SPSS software version 24 and the level of significance was set at p < 0.05.

RESULTS

The prevalence of anxiety and post-partum depression was 27% and 20%, respectively. None of the demographic characteristics had a significant relationship with anxiety and depression. Related factors to post-partum anxiety included desired pregnancy, premenstrual syndrome, marital conflicts, history of mother's hospitalization due to COVID-19, compliance rate with preventive health measures for COVID-19, stressful events, and social support.

CONCLUSION

It is suggested to screen mothers to detect significant related factors of post-partum anxiety and depression in other future pandemics or epidemics to support them.

Relationship between maternal anxiety and infants' temperament: The mediating role of mindful parenting

Research has indicated that maternal anxiety does have an effect on infant temperament. Therefore, it is important to study the variables that could play a role in this relationship. In this study, we propose that mindful parenting could act as a mediator in this relationship. Thus, the main objective was to evaluate the relationship between maternal anxiety and child temperament (i.e., negative affectivity, surgency, and effortful control) through the mindful parenting of mothers. Mothers (N = 225) self-reported their anxiety, mindful parenting use, and the temperament of their old infants (aged 4-18 months). First, the reliability and validity results showed that the infant version of the Interpersonal Mindful Parenting questionnaire was a good tool for the assessment of mindful parenting among parents with infants. The five-factor structure of the questionnaire was confirmed; it involved self-regulation in the parenting relationship, listening with full attention, emotional awareness of the child, compassion for the child, and non-judgmental acceptance of parenting behavior. Correlational analyses showed that maternal anxiety was related to negative affectivity and effortful control in infants. Furthermore, mediational analyses indicated that the relation between maternal anxiety and infant negative affectivity was mediated by self-regulation in parenting and the emotional awareness of the child. In addition, the relation between maternal anxiety and infant effortful control was mediated by compassion for the child and listening with full attention. These results contribute to knowledge about the relation between maternal anxiety and child temperament, which may increase the risk of psychological symptoms. The results of this study suggest that promoting mindful parenting skills may be beneficial for affectivity and effortful control in infants.

Lower maternal emotional availability is related to increased attention toward fearful faces during infancy

It has been suggested that infants' age-typical attention biases for faces and facial expressions have an inherent connection with the parent-infant interaction. However, only a few previous studies have addressed this topic. To investigate the association between maternal caregiving behaviors and an infant's attention for emotional faces, 149 mother-infant dyads were assessed when the infants were 8 months. Caregiving behaviors were observed during free-play interactions and coded using the Emotional Availability Scales. The composite score of four parental dimensions, that are sensitivity, structuring, non-intrusiveness, and non-hostility, was used in the analyses. Attention disengagement from faces was measured using eye tracking and face-distractor paradigm with neutral, happy, and fearful faces and scrambled-face control pictures as stimuli. The main finding was that lower maternal emotional availability was related to an infant's higher attention to fearful faces (p = .042), when infant sex and maternal age, education, and concurrent depressive and anxiety symptoms were controlled. This finding indicates that low maternal emotional availability may sensitize infants' emotion processing system for the signals of fear at least during this specific age around 8 months. The significance of the increased attention toward fearful faces during infancy is an important topic for future research.

Breast milk oxytocin and s-IgA modulate infant biomarkers and social engagement; The role of maternal anxiety

Breastfeeding has long been known to improve infants' health and mental development and to enhance the mother-infant bond, but much less research focused on the biological composition of breast milk and its associations with the infant's biomarkers and social development. In this exploratory study, we measured oxytocin (OT) and secretory immunoglobulin-A (s-IgA), the most abundant antibody in breast milk, and evaluated their associations with the same biomarkers in infant saliva and, consequently, with infant social engagement behavior. Fifty-five mother-infant dyads were home-visit and OT and s-IgA were assessed from breast milk and from infant saliva before and after a free-play interaction. Infant social behavior was coded offline using the Coding Interactive Behavior (CIB) and maternal anxiety self-reported. A path model revealed that mother's breast milk s-IgA impacted child social engagement via its links with child OT. In parallel, maternal breast milk OT was linked with infant social behavior through its association with the infant's immunity. This path was moderated by maternal anxiety; only in cases of high anxiety breast milk OT was positively connected to infant s-IgA. Our study, the first to measure OT and s-IgA in both breast milk and infant saliva in relation to observed social behavior, underscores the need for much further research on the dynamic interplay between breast milk composition, infant biomarkers, maternal mental health, and infant social outcomes. Results may suggest that biological systems in breast milk integrate to prepare infants to function in their social ecology through bio-behavioral feedback loops that signal the degree of stress in the environment.

Maternal psychological risk and the neural correlates of infant face processing: A latent profile analysis

Maternal psychological factors, including anxiety, depression, and substance use, may negatively affect parenting. Previous works with mothers have often assessed each of these factors in isolation despite their frequent co-occurrence. Psychological factors have also been associated with neural processing of facial stimuli, specifically the amplitude (i.e., size) and latency (i.e., timing) of the face-specific N170 event-related potential. In the current study, 106 mothers completed measures assessing maternal psychological factors-anxiety, depression, and substance use. A latent profile analysis was used to identify profiles of psychological factors and assess profile associations with the N170 elicited by infant faces and with parental reflective functioning (PRF) as a measure related to caregiving. Two profiles (termed high and low psychological risk) were identified, with the higher risk profile associated with delayed N170 latency responses to infant faces. An exploratory analysis evidenced an indirect effect between the higher psychological risk profile and lower PRF through delayed N170 latency responses to infant faces. Taken together, maternal psychological risk across multiple indicators may together shape neural processing of infant faces, which may have downstream consequences for caregiving.

Meta-Analyses of the Relationships between Family Systems Practices, Parents' Psychological Health, and Parenting Quality

(1) Background: Family systems theories include assertations that both personal and environmental factors are determinants of parents' psychological health, well-being, and parenting quality. Applied family systems theories focus on determinants that can be operationalized as intervention practices. The analyses described in this paper focused on the direct and indirect effects of four family systems practices (family needs, resources, supports, and strengths), parents' psychological health (depression, well-being, etc.), and parenting quality (parenting beliefs, involvement, and practices) in families of children with identified disabilities, medical conditions, or at-risk conditions for poor outcomes; (2) Methods: Data from previously completed meta-analyses of the relationships between family systems practices and parents' psychological health outcomes and parenting quality outcomes were reanalyzed. Next, a meta-analysis of the relationships between parents' psychological health and parenting quality was completed to identify which predictors were related to which parenting quality outcomes. Both main effects and mediated effects were examined; (3) Results: The four family systems practices were each related to six different psychological health measures and three parenting quality measures. The six different parental psychological health measures were also related to the three parenting quality measures. The relationships between family systems practices and parenting quality were partially mediated by parents' psychological health; (4) Conclusions: The effects of family systems practices and parents' psychological health on parenting quality were primarily direct and independent. The relationships between family systems practices and parenting quality were partially mediated by parents' psychological health. Future research should focus on the identification of other mediator variables found to be important for explaining the indirect effects of family systems practices measures on parenting beliefs, behavior, and practices.

Unique Characteristics of Women and Infants Moderate the Association between Depression and Mother-Infant Interaction

Research has shown mixed results regarding the association between women's postpartum depression and mother-infant interactions, suggesting that a woman's unique experience and context may moderate how depression shapes these interactions. We examined the extent to which a woman's comorbid anxiety, her exposure to adversity, and infant characteristics moderate the relationship between depressive symptoms of women and interactions with their infants at 6 (n = 647) and 12 months (n = 346) postpartum. The methods included standardized coding of mother-infant interactions and structural regression modeling. The results at 6 months of infant age indicated that infant male sex and infant negative affectivity were risk factors for mothers' depression being associated with less optimal interactions. At 12 months of infant age, two moderators appeared to buffer the influence of depression: a woman's history of trauma and infant preterm birth (≤37 weeks gestation). The results reinforce the salience of infant characteristics in the relationship between maternal depression and mother-infant interactions. The findings also suggest that experiences of trauma may offer opportunities for psychological growth that foster constructive management of depression's potential effect on mother-infant interactions. Further research is needed to clarify the underlying processes and mechanisms that explain the influence of these moderators. The ultimate goals are to reduce the risk of suboptimal interactions and reinforce healthy dyadic relations.

Developmental trajectories of behavioral inhibition from infancy to age seven: The role of genetic and environmental risk for psychopathology

The present study leveraged data from a longitudinal adoption study of 361 families recruited between 2003 and 2010 in the United States. We investigated how psychopathology symptoms in birth parents (BP; Mage  = 24.1 years; 50.5-62.9% completed high school) and adoptive parents (AP; Mage  = 37.8 years; 80.9% completed college; 94% mother-father couples) influenced children's behavioral inhibition (BI) trajectories. We used latent growth models of observed BI at 18 and 27 months, and 4.5 and 7 years in a sample of adopted children (Female = 42%, White = 57%, Black = 11%, Multi-racial = 21%, Latinx = 9%). BI generally decreased over time, yet there was substantial variability in these trajectories. Neither BP nor AP psychopathology symptoms independently predicted systematic differences in BI trajectories. Instead, we found that AP internalizing symptoms moderated the effects of BP psychopathology on trajectories of BI, indicating a gene by environment interaction.

Parental-Led Sexual Abuse Education Amongst At-Risk Parents: Associations with Parenting Practices, and Parent and Child Symptomology

Considering the emphasis on parent-led sexual abuse education (PLSAE) in child sexual abuse (CSA) prevention, and the imperative of prevention in families living with demonstrated risk factors, it is important to understand the extent to which this group delivers PLSAE to their children, whether this is associated with any barriers or facilitators, whether parents are engaging in other protective behaviors (such as monitoring and involvement) and the relationship between these variables and other risk factors such as parent and child symptomology. We surveyed 117 parents, with children ranging in age from 25-89 months (67% boys), attending a parenting program for assistance with a range of parenting difficulties and child behavior problems from 2020-22. A large majority of parents reported not giving their children comprehensive prevention messages, discussing body integrity and abduction dangers to a greater extent. PLSAE was significantly positively associated with child internalizing and externalizing symptoms; parent and child age; and discussion of body integrity and abduction. However, PLSAE was not associated with any other measured variables (protective parenting; CSA knowledge; parenting self-efficacy; general and own-child risk appraisal; parent burnout, stress, depression or anxiety; child diagnosis; parental education level; employment or marital status; or income). The current findings suggest that investing resources into increasing parental knowledge, risk perception and confidence may be misguided. Future endeavors should consider helping parents be protective in other ways, for example, through the creation of safe environments and reducing the risks of CSA.

Psychometric evaluation and validation of the Postpartum Specific Anxiety Scale for the Spanish-speaking population: PSAS-ES

OBJECTIVE

The transition to motherhood is a period of risk for the development of mood disorders. Postpartum anxiety has not been as thoroughly studied as other emotional disorders despite its impact on mothers and their babies. The absence of standardized programmes for early detection and specific tools for its diagnosis means postpartum anxiety is often underestimated or overshadowed. This study aimed to translate and validate the Postpartum Specific Anxiety Scale [PSAS] for the Spanish population and to analyse its reliability as an exploratory tool for specific anxiety in mothers.

METHOD

Four stages were followed in this research: translation and back-translation to obtain the Spanish version [PSAS-ES]; preliminary pilot study to explore the comprehensibility and ease of responding the items (n = 53); convergent validity analyses (n = 644); and test-retest reliability (n = 234).

RESULTS

The PSAS-ES has shown to have good acceptability, convergent validity and high internal consistency with a Cronbach's α coefficient of 0.93 for the overall scale of PSAS. The four factors had good reliability. The results of test-retest was 0.86, indicating excellent stability over time in the first 16 weeks.

CONCLUSION

The psychometric results show that the PSAS-ES is a valid tool to explore and detect anxiety in Spanish mothers between 0 and 16 weeks postpartum.

Linking maternal psychopathology to children's excessive crying and sleeping problems in a large representative German sample-The mediating role of social isolation and bonding difficulties

Attaining self-regulation is a major developmental task in infancy, in which many children show transient difficulties. Persistent, clinically relevant difficulties in self-regulation include excessive crying or sleeping disorders. Many families with affected children are burdened with multiple psychosocial risk. This suggests that regulatory problems are best conceptualized as the maladaptive interplay of overly burdened parents and a dysfunctional parent-child interaction. The current study examines whether social isolation and bonding difficulties function as mediating mechanisms linking maternal psychopathology to (1) children's excessive crying and (2) sleeping problems. The sample comprised N = 6598 mothers (M = 31.51 years) of children between zero to three years of age (M = 14.08 months, 50.1% girls). In addition to socio demographic data, the written questionnaire included information on maternal depression/anxiety, isolation, bonding, and children's regulatory problems. Hypotheses were tested with a mediation model controlling for psychosocial risk and child characteristics. As expected, maternal symptoms of depression/anxiety were linked to infants' excessive crying and sleeping problems. Social isolation and bonding difficulties mediated this association for excessive crying as well as for sleeping problems, but social isolation was a single mediator for sleeping problems only. The findings provide important insights in the mediating pathways linking maternal psychopathology to children's regulatory problems.

Association between newborn hypoglycemia screening and breastfeeding success in an Ottawa, Ontario, hospital: a retrospective cohort study

BACKGROUND

There has been limited investigation of the unintended effects of routine screening for asymptomatic hypoglycemia in at-risk newborns. This study aimed to explore whether rates of exclusive breastfeeding were lower in screened babies than in unscreened babies.

METHODS

This retrospective cohort study conducted in Ottawa, Canada, used data from Hôpital Montfort's electronic health information system. Healthy singleton newborns discharged between Feb. 1, 2014, and June 30, 2018, were included. We excluded babies and mothers with conditions expected to interfere with breastfeeding (e.g., twins). We investigated the association between postnatal screening for hypoglycemia and initial exclusive breastfeeding (in the first 24 hours of life).

RESULTS

We included 10 965 newborns; of these, 1952 (17.8%) were fully screened for hypoglycemia. Of screened newborns, 30.6% exclusively breastfed and 64.6% took both formula and breastmilk in the first 24 hours of life. Of unscreened newborns, 45.4% exclusively breastfed and 49.8% received both formula and breastmilk. The adjusted odds ratio for exclusive breastfeeding in the first 24 hours of life among newborns screened for hypoglycemia was 0.57 (95% confidence interval 0.51-0.64).

INTERPRETATION

The association of routine newborn hypoglycemia screening with a lower initial rate of exclusive breastfeeding suggests a potential effect of screening on early breastfeeding success. Confirmation of these findings might warrant a re-evaluation of the net benefit of asymptomatic postnatal hypoglycemia screening for different newborn populations at risk of hypoglycemia.

A Qualitative Exploration of Maternal Anxiety: Implications for Helping Professionals

OBJECTIVES

To gain insight into the nature of maternal anxiety among mothers from diverse cultures through exploring the components of maternal anxiety and ways mothers cope with it in order to assist helping professionals in providing psychoeducation and counseling to mothers who experience intense anxiety regarding their children.

METHODS

In this qualitative study, 17 mothers participated in cognitive interviews conducted as a part of the maternal anxiety scale development. Data from semi-structured interviews was explored using thematic analysis.

RESULTS

Four themes related to mothers' experiences of anxiety emerged from the data: (1) maternal insecurities and social comparison, (2) coping with anxiety, (3) dependence versus autonomy, (4) cultural considerations.

CONCLUSIONS FOR PRACTICE

The results of this study can be used by helping professionals working with mothers by implementing emotion regulation skills for maternal anxiety that are described in the implications section of the paper.

Latina mothers' mental health: An examination of its relation to parenting and material resources

The demands and stressors associated with motherhood can increase a mother's risk for mental health concerns. Latina mothers are particularly vulnerable to the relation between motherhood-related stressors and maternal mental health given that they are at an increased risk for mental health concerns, that they are likely to have their mental health needs go unmet, and that traditional Latinx cultural values/gender roles emphasize women assuming the role of primary caregiver of the family's children. In an attempt to better understand how motherhood impacts Latina mother's mental health, this study explored the relations among parental self-efficacy, parenting stress, and maternal mental health. This study also explored how a mother's perception of her material resources influenced these relations. One hundred and thirty-two Latina mothers completed questionnaires to assess parenting stress, parental self-efficacy, and maternal mental health risk. The moderating effect of maternal perception of material resources in the aforementioned relations was assessed through the creation of a composite variable derived from items in the demographic questionnaires. Multiple linear regression analyses were used. Higher levels of parenting stress, but not parental self-efficacy, were related to increased maternal mental health risk. Furthermore, mothers who perceived themselves to have lower material resources were at increased risk for diminished mental health in the context of low parental self-efficacy. Results of this study yielded important information that is necessary for informing healthcare best practices, identifying targets for future interventions, and ultimately improving the health outcomes of Latinx mothers and their families.

The effect of behavioral therapy based counseling with anxious mothers on their infants' colic: a randomized controlled clinical trial

Background

Given the possible effect of maternal anxiety on the severity of colic pain in infants, this study aimed to investigate the effects of behavioral therapy counseling on infantile colic (primary outcome), maternal anxiety, and mother-infant attachment (secondary outcomes) in anxious mothers with colicky infants.

Method

This randomized controlled clinical trial was conducted on 46 anxious mothers of 2–6-weeks-old exclusively breastfed colicky infants who had a score of 112 and above according to the Postpartum Specific Anxiety Scale (PSAS), reffered to the pediatric clinics of Al-Zahra, Taleghani and Children Hospitals of Tabriz, Iran. The participants were randomly assigned to the intervention (n = 23) and control (n = 23) groups using randomized block design. Mothers in the intervention group attended 8 systematic desensitization counseling sessions (2–3 sessions per week). Those in the control group received routine care. The researcher completed the Postpartum Specific Anxiety Scale (PSAS), Mother-Infant Attachment Questionnaire (MIAQ), and Infant Colic Scale (ICS) by interviewing the participants before and two weeks after the intervention.

Results

There was no significant difference between the intervention and control groups in the socio-demographic profile of participants. After the intervention, the mean postpartum anxiety score of women in the intervention group was significantly lower than that of those in the control group (Mean Difference (MD) = 22.5, 95% Confidence Interval (CI) = 2.3 to 42.7; p = 0.029). The mean infant colic score of the infants of mothers in the intervention group was insignificantly lower than that of those in the control group (MD = -2.9, 95% CI = -8.3 to 2.4; p = 0.271). In addition, no significant difference was observed between the two groups in terms of their mean mother-infant attachment scores (MD = -0.04, 95% CI = -3.1 to 0.3; p = 0.976).

Conclusion

Behavioral therapy counseling effectively reduced postpartum anxiety in women with colicky infants; however, this reduction did not lead to a significant decrease in the infants’ colic pain. Therefore, health care providers are recommended to use this counseling method in combination with other effective counseling approaches to promote mental health of these mothers.

Trial Registration

IRCT Registration Number: IRCT20111219008459N14, registered on 08/10/2020. https://irct.ir/user/trial/45949/view

Support from friends moderates the relationship between repetitive negative thinking and postnatal wellbeing during COVID-19

BACKGROUND

Increasing evidence has linked repetitive negative thinking (RNT) to postnatal depression and anxiety, yet the factors moderating this relationship have been minimally investigated. During the COVID-19 pandemic of 2020, social restrictions imposed to reduce viral transmission limited access to social support, which is critical to postnatal psychological wellbeing - potentially intensifying RNT.

OBJECTIVE

We examined whether perceived social support (from friends, family, and a significant other) played a moderating role in the relationship between RNT and maternal postnatal anxiety and depressive symptoms.

METHODS

A sample of women (N = 251) who had given birth in the preceding 12 months completed an online battery of standardised measures during the COVID-19 'lockdown' of May 2020.

RESULTS

As predicted, social support moderated the relationship between RNT and depression such that the association between RNT and depression was stronger for women who reported lower levels of social support. Interestingly, this finding emerged for social support from friends only; for support from family and significant other, social support did not play a moderating role. Further, and unexpectedly, overall social support did not moderate the relationship between RNT and postnatal anxiety, however, social support from friends was a significant moderator.

CONCLUSIONS

High levels of perceived social support from friends (but not family or significant others) buffered the effects of RNT on depression and anxiety during the postpartum period. Strategies to bolster peer social support may be a valuable inclusion in interventions to prevent and treat postnatal depression and anxiety.

Maternal self-efficacy and emotional well-being in Chilean adolescent mothers: the relationship with their children's social-emotional development

Background

Low maternal self-efficacy and high levels of anxiety, depression, and stress can be triggered in adolescent mothers due to an incomplete development process that makes them physically or psychologically unprepared for the responsibilities of motherhood and parenting. These factors may be linked to difficulties with their children's social-emotional development. The present study aims to: (a) analyze the relationship between maternal self-efficacy and stress, depression, and anxiety levels in low-income adolescent mothers; (b) examine the relationship between maternal self-efficacy and well-being with children's social-emotional development; and (c) describe the effects of maternal self-efficacy on children's social-emotional development, mediated by maternal well-being.

Methods

A sample of 79 dyads comprising low-income Chilean adolescent mothers aged from 15 to 21 years old (M = 19.1, SD = 1.66) and their children aged 10 to 24 months (M = 15.5, SD = 4.2) participated in this research. A set of psychometric scales was used to measure maternal self-efficacy (Parental Evaluation Scale, EEP), the mothers' anxiety and depression (Hospital Anxiety and Depression Scale, HADS), maternal stress (Parental Stress Scale, PSS), and the children's social-emotional development (Ages and Stages Questionnaire Socio-emotional, ASQ-SE). Bivariate analyses and mediation models were employed to estimate and test the relevant relationships.

Results

A bivariate analysis showed that maternal self-efficacy was negatively related to the mother's anxiety, depression, and stress. Moreover, there was a significant relationship between maternal self-efficacy and maternal stress, and children's self-regulation and social-emotional development. Maternal self-efficacy, mediated by maternal anxiety, depression, and stress scores, had a significant effect on the development of children's self-regulation.

Conclusions

The results confirm the importance of adolescent mothers' emotional well-being and maternal self- efficacy with respect to their children's social-emotional development. This makes it necessary to have detailed information about how emotional and self-perception status influences a mother's role in the development of her children.

Family Stressors and Resources as Social Determinants of Health among Caregivers and Young Children

Life course-informed theories of development suggest it is important to integrate information about positive and negative aspects of the social environment into studies of child and parental wellbeing, including both stressors that compromise health and resources that promote well-being. We recruited a sample of 169 pairs of caregivers and young children (birth to 5 years) from a community health clinic and administered survey questions to assess stressors and resources. We constructed inventories of stressors and resources and examined the relationships between these inventories and caregivers' depressive symptoms, anxiety symptoms, and sleep problems, and young children's medical diagnoses derived from electronic health records. Cumulative stressors and resources displayed bivariate and adjusted associations with caregivers' depressive symptoms, anxiety symptoms, and sleep problems. For depressive and anxiety symptoms, these associations were evident in models that included stressors and resources together. Caregivers with high stressors and low resources displayed the highest levels of depressive and anxiety symptoms and sleep problems. In terms of children's health outcomes, only modest trends were evident for developmental/mental health outcomes, but not other diagnostic categories. Future studies are needed to examine stressors and resources together in larger samples and in relation to prospectively assessed measures of child well-being.

Scoping review of evidence for managing postnatal hypoglycaemia

OBJECTIVES

To identify what is known empirically about the screening, treatment and harm of exposure to neonatal hypoglycaemia.

DESIGN

Scoping review that applied a preregistered protocol based on established frameworks.

DATA SOURCES

Medline and Embase, up to 12 May 2020.

STUDY SELECTION

Comparative and case-series studies, as well as guidelines, published in English or French, on the topic of immediate inpatient postnatal glucose screening in newborns.

DATA GATHERING

Article selection and characterisation were performed in duplicate using predefined data extraction forms specific to primary studies and guidelines.

RESULTS

12 guidelines and 74 primary studies were included. A neurodevelopmental outcome was primary in 32 studies: 30 observational studies followed up posthypoglycaemic, and the 2 intervention studies included 1 randomised controlled trial (RCT) about treatment thresholds. Three other RCTs assessed dextrose gel (two) and oral sucrose (one). 12 of 30 studies that evaluated non-neurodevelopmental primary outcomes were intervention studies. Only one cohort study compared outcomes in screened vs unscreened newborns. The guidelines did not arrive at a consensus definition of postnatal hypoglycaemic, and addressed potential harms of screening more often than primary studies.

CONCLUSIONS

The primary literature that informs hypoglycaemia screening is a series of studies that relate neurodevelopmental outcomes to postnatal hypoglycaemia. Further research is needed to better define an optimal threshold for hypoglycaemia that warrants intervention, based on long-term neurodevelopmental outcomes and a better delineation of potential screening harms.

Maternal mental health and early childhood development: Exploring critical periods and unique sources of support

BACKGROUND

The objective of this study was to explore associations between maternal depression and anxiety during early sensitive periods, child social-emotional and behavioral problems and the moderating roles of financial, instrumental, and partner emotional support.

METHODS

Analyses was conducted using data from the Fragile Families and Child Wellbeing Study. Hierarchical linear regression modeling was used to explore associations between maternal depression and anxiety at 1- and 3-years postpartum, three unique types of social support, and childhood behavioral problems at 5-years of age (n = 2,827).

RESULTS

Mothers who were depressed at one or both timepoints, compared to nondepressed mothers, reported higher externalizing behavioral problems scores of 1.96 and 2.90, and internalizing behavioral problems scores of 1.16 and 2.20, respectively, at 5-years of age (both p < .01), after controlling for covariates. Financial, instrumental, and partner emotional support were independently and inversely associated with behavioral problems (p < .05); however, none of these types of support moderated the relationship between maternal depression and behavioral problems, after controlling for covariates.

IMPLICATIONS

Promoting maternal mental health as well as different sources of support throughout the first five years of life, instead of one critical period, may help to reduce the burden of chronic disease in the next generation.

Positive cognitive appraisal "buffers" the long-term effect of peritraumatic distress on maternal anxiety: The Queensland Flood Study

BACKGROUND

Limited research has evaluated distinct aspects of disaster experience as predictors of affective symptoms. In this study, we examined the extent to which maternal depression and anxiety over time were predicted by (1) objective hardship from a flood during pregnancy, (2) peritraumatic distress and (3) cognitive appraisal of the flood's consequences.

METHODS

Data were drawn from the 2011 Queensland Flood Study, a prospective, longitudinal study of pregnancy (n = 183). Mothers' disaster experience was measured within 1 year after the flood. Their levels of depression, anxiety and stress were measured at 16 months, 30 months, 4 years and 6 years after childbirth. Linear mixed models were employed to evaluate symptom trajectories.

RESULTS

There were no time-dependent effects of disaster-related variables. Objective hardship did not predict outcomes. Peritraumatic distress significantly predicted depression and anxiety symptoms when cognitive appraisal was negative. Conversely, when cognitive appraisal was neutral or positive, the effect of peritraumatic distress was "buffered". For anxiety, but not depression, this interaction survived Bonferroni correction. Neutral/positive cognitive appraisal similarly moderated the effect of peritraumatic dissociation.

LIMITATIONS

The generalizability of our findings is limited by overall low levels of depression and anxiety, along with a predominantly Caucasian, higher socioeconomic status sample. Potential confounders such as pre-disaster anxiety were not controlled for.

CONCLUSION

In line with previous evidence, this study supports the predictive validity of peritraumatic distress for post-disaster depression and anxiety. Our findings suggest that cognitive appraisal could be a relevant target for interventions aimed at fostering maternal resilience.

Perinatal anxiety and depressive symptoms and perception of child behavior and temperament in early motherhood

The perinatal period is a vulnerable time for the development of psychopathology, particularly mood and anxiety disorders. In the study of maternal anxiety, important questions remain regarding the association between maternal anxiety symptoms and subsequent child outcomes. This study examined the association between depressive and anxiety symptoms, namely social anxiety, panic, and agoraphobia disorder symptoms during the perinatal period and maternal perception of child behavior, specifically different facets of development and temperament. Participants (N = 104) were recruited during pregnancy from a community sample. Participants completed clinician-administered and self-report measures of depressive and anxiety symptoms during the third trimester of pregnancy and at 16 months postpartum; child behavior and temperament outcomes were assessed at 16 months postpartum. Child development areas included gross and fine motor skills, language and problem-solving abilities, and personal/social skills. Child temperament domains included surgency, negative affectivity, and effortful control. Hierarchical multiple regression analyses demonstrated that elevated prenatal social anxiety symptoms significantly predicted more negative maternal report of child behavior across most measured domains. Elevated prenatal social anxiety and panic symptoms predicted more negative maternal report of child effortful control. Depressive and agoraphobia symptoms were not significant predictors of child outcomes. Elevated anxiety symptoms appear to have a distinct association with maternal report of child development and temperament. Considering the relative influence of anxiety symptoms, particularly social anxiety, on maternal report of child behavior and temperament can help to identify potential difficulties early on in mother-child interactions as well as inform interventions for women and their families.

Maternal sleep patterns and parenting quality during infants' first 6 months

The present study examined both between- and within-person effects of maternal sleep patterns on quality of mothering at bedtime during infants' first 6 months. Participants included 142 mothers who reported on their daily fall asleep and wake times across seven consecutive days with a daily sleep diary when infants were 1, 3, and 6 months old. At each age point, maternal emotional availability during one night of infant bedtime was observed and scored by trained observers who were blind to maternal sleep patterns. Multilevel modeling revealed that mothers with irregular sleep patterns, especially later average fall asleep times and greater average variability in sleep period across three age points, showed poorer parenting quality with infants at bedtime than other mothers. In addition, both between- and within-person effects of maternal sleep on bedtime parenting quality changed with infant age. Compared to mothers' individual averages across 1, 3, and 6 months, maternal short average sleep period, increased variability in sleep period, and later fall asleep times predicted poorer bedtime parenting quality at 6 months, but not at 1 or 3 months. Results emphasize the importance of maternal sleep regulation and sleep hygiene for maternal parenting quality, especially as infants get older. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Maternal anxiety and diet quality among mothers and toddlers from low-income households

We evaluated the association between maternal anxiety score and diet quality over time among mothers and toddlers in low‐income families. Longitudinal data were collected from 267 mother–toddler dyads in an obesity prevention trial. Participants were recruited from the Special Supplemental Nutrition Program for Women, Infants and Children and paediatric clinics between 2007 and 2010. Dyads were assessed at study enrolment (Time 1), 6‐month (Time 2), and 12‐month follow‐up (Time 3). On the basis of a 1‐day 24‐hr dietary recall, we estimated maternal and toddler diet quality using the Healthy Eating Index 2015. Anxiety, a time‐varying variable, was assessed via the State–Trait Anxiety Inventory. Associations between maternal anxiety score and maternal and toddler diet quality over time were assessed in adjusted mixed models. Maternal and toddler diet quality were positively correlated (r = .48, p < .001). Higher maternal anxiety scores were related to lower toddler Healthy Eating Index scores (b = −0.51, 95% confidence interval, CI [−0.87, −0.15]) with no significant variation over time. The relation between maternal diet quality and anxiety score varied over time (b = 0.28, p = .03, for time–anxiety interaction). Higher maternal anxiety scores were associated with lower maternal diet quality at Time 1 (b = −0.71, 95% CI [−1.09, 0.34]) and at Time 2 (b = −0.51, 95% CI [−0.97, −0.05]), but not at Time 3 (b = −0.14, 95% CI [−0.54, 0.26]). Findings suggest that mothers and toddlers exhibited similar low‐quality dietary patterns and that lower diet quality was associated with higher maternal anxiety scores. Approaches to enhance diet quality may consider incorporating anxiety‐reducing strategies into maternal and toddler care and feeding behaviour guidelines.

Men's Intentions to Recommend Professional Help-Seeking to Their Partners in the Postpartum Period: the Direct and Indirect Effects of Gender-Role Conflict

Women's partners may act as facilitators of professional help-seeking for mental health problems in the postpartum period. This study aimed to examine the sociodemographic and clinical correlates of men's intentions to recommend professional help-seeking to their partners if they display postpartum mood and anxiety disorders and to explore the relationship between gender-role conflict and the intention to recommend help-seeking. A cross-sectional study included 214 adult men in a heterosexual relationship with a partner within the reproductive age. Men presented a high intention to recommend professional help to their partners. All dimensions of gender-role conflict were directly associated with the intention to recommend professional help-seeking (p < 0.05). High levels of gender-role conflict (dimensions success, power and competition, and restricted emotionality) were found to lead to increased levels of stigma and lower levels of intention to seek professional help, which, in turn, translated into lower intention to recommend help-seeking. These results emphasize the importance of developing universal awareness-raising and education campaigns directed at men aiming to reduce levels of gender-role conflict and stigma, and normalize the use of mental health services, to increase men's intentions to recommend professional help-seeking to their partners.

Evaluation of Mothers' Perceptions of a Technology-Based Supportive Educational Parenting Program (Part 2): Qualitative Study

Background

Transitioning into parenthood can be stressful as parents struggle to cope with new parenting responsibilities. Although perinatal care in hospitals aims to improve parental outcomes, there is a general consensus that it is suboptimal and insufficient. Therefore, many studies have designed intervention methods to supplement support for parents during this stressful period. However, studies often focus on parental outcomes as indicators of their interventions’ success and effectiveness. Studies evaluating participants’ experiences and feedback are limited.

Objective

This study aimed to examine the experiences and perceptions of participants who participated in a supportive education parenting program intervention study.

Methods

A qualitative semistructured interview was conducted with 16 mothers (6 control and 10 intervention) from a randomized controlled trial. The supportive education parenting program received by the intervention group included 2 phone-based perinatal educational sessions, a phone-based educational session after childbirth, and a 1-month postpartum access to a mobile health app. The interviews were approximately 30- to 60-min long, audiotaped and transcribed verbatim, and analyzed using thematic analysis. Study findings were reported according to the Consolidated Criteria for Reporting Qualitative Research checklist.

Results

The 3 main themes evaluating mothers’ experiences and perceptions were generated: (1) changed perspective toward parenthood, (2) journey from pregnancy to after birth, and (3) a way forward. Mothers from the intervention group mostly had good perinatal experiences with sufficient support received, which elevated their emotional well-being and increased parenting involvement. Mothers in the control group, although satisfied with the hospital care received, were more stressed and shared a need for professional advice and extra support. Apart from technical enhancements, mothers also requested extended social support during early pregnancy up to 1 year postpartum, taking into consideration Asian cultural practices.

Conclusions

Mothers who received the intervention were overall satisfied with the support provided by the technology-based supportive educational parenting program. The success of the educational program in this study highlights the need to supplement standard care in hospitals with technology-based educational programs. Future research should include fathers’ perceptions to attain an in-depth understanding of overall participants’ experiences and needs in the future development of supportive and educational programs.

Effectiveness of a Technology-Based Supportive Educational Parenting Program on Parental Outcomes (Part 1): Randomized Controlled Trial

Background

Transitioning into parenthood can be stressful for new parents, especially with the lack of continuity of care from health care professionals during the postpartum period. Short hospital stays limit the availability of support and time parents need to be well equipped with parenting and infant care skills. Poor parental adjustment may, in turn, lead to negative parental outcomes and adversely affect the child’s development. For the family’s future well-being, and to facilitate a smoother transition into parenthood, there is a need for easily accessible, technology-based educational programs to support parents during the crucial perinatal period.

Objective

This study aimed to examine the effectiveness of a technology-based supportive educational parenting program (SEPP) on parenting outcomes during the perinatal period in couples.

Methods

A randomized, single-blinded, parallel-armed, controlled trial was conducted. The study recruited 236 parents (118 couples) from an antenatal clinic of a tertiary hospital in Singapore. Eligible parents were randomly assigned to the intervention group (n=118) or the control group (n=118). The SEPP is based on Bandura’s self-efficacy theory and Bowlby’s theory of attachment. Components of the intervention include 2 telephone-based educational sessions (1 antenatal and 1 immediately postnatal) and a mobile health app follow-up for 1 month. The control group only received routine perinatal care provided by the hospital. Outcome measures including parenting self-efficacy (PSE), parental bonding, perceived social support, parenting satisfaction, postnatal depression (PND), and anxiety were measured using reliable and valid instruments. Data were collected over 6 months at 4 time points: during pregnancy (third trimester), 2 days postpartum, 1 month postpartum, and 3 months postpartum. Outcomes were standardized using baseline means and SDs. Linear mixed models were used to compare the groups for postpartum changes in the outcome variables.

Results

The intervention group showed significantly better outcome scores than the control group from baseline to 3 months postpartum for PSE (mean difference, MD, 0.37; 95% CI 0.06 to 0.68; P=.02), parental bonding (MD −1.32; 95% CI −1.89 to −0.75; P<.001), self-perceived social support (MD 0.69; 95% CI 0.18 to 1.19; P=.01), parenting satisfaction (MD 1.40; 95% CI 0.86 to 1.93; P<.001), and PND (MD −0.91; 95% CI −1.34 to −0.49; P<.001). Postnatal anxiety (PNA) scores of the intervention group were only significantly better after adjusting for covariates (MD −0.82; 95% CI −1.15 to −0.49; P<.001).

Conclusions

The technology-based SEPP is effective in enhancing parental bonding, PSE, perceived social support and parental satisfaction, and in reducing PND and PNA. Health care professionals could incorporate it with existing hands-on infant care classes and routine care to better meet parents’ needs and create positive childbirth experiences, which may in turn encourage parents to have more children.

Trial Registration

ISRCTN Registry ISRCTN48536064; http://www.isrctn.com/ISRCTN48536064 (Archived by WebCite at http://www.webcitation.org/6wMuEysiO).

Mediating effects of parental psychological distress and individual-level social capital on the association between child poverty and maltreatment in Japan

Child poverty is well known as a major risk factor for child maltreatment. However, it is not known whether parental psychological distress and individual-level social capital mediate the association. We examined the mediation effect of these two factors on the association between child poverty and maltreatment. In the Adachi Child Health Impact of Living Difficulty (A-CHILD) Study, a questionnaire was administered to all caregivers of first-grade children in every public elementary school in Adachi City between July and November 2015, and valid responses were used for analysis (N = 3944). Logistic and Poisson regression analyses were employed to examine the association between child poverty and maltreatment. Child poverty was defined in this study as meeting one of these criteria: 1) household income less than 3 million yen; 2) deprivation of specific material items that children or the household requires, or 3) experience of being unable to pay for lifeline utilities. Child maltreatment (physical abuse, neglect, and psychological abuse) was answered by parents. We confirmed a robust association between child poverty and maltreatment. Mediation analysis indicated that parental psychological distress mediated more than 60% of the association between child poverty on physical abuse and psychological abuse, while individual-level social capital mediated only 10% of the association with any type of maltreatment. In addition, structural equation modeling analysis revealed that the association was mediated by both parental psychological distress and social capital simultaneously. The findings suggest that supporting parental psychological distress may be an effective intervention to remedy the negative impact of child poverty on maltreatment.

Comparative Social Media Use and the Mental Health of Mothers With High Levels of Perfectionism

Social media is thought to communicate idealized images and discourses of motherhood. As such, it may present as a risk factor for poor mental health in mothers who strive for perfection and compare themselves to the ideals presented on social media. The present study examined the influence of Facebook and In-stagram on the relationship between perfectionism in mothers and their mental health. A sample of 201 mothers completed an online survey. Two dimensions of perfectionism were assessed: Self-Orientated Parenting Perfectionism (SOPP) and Societal-Prescribed Parenting Perfectionism (SPPP). Mediation models were conducted to examine social media frequency and social comparison respectively on the relationship between perfectionism and maternal mental health. Results revealed that for mothers with SOPP, the process of social comparison with other mothers on social media contributed to symptoms of anxiety and depression. The amount of time engaging in social media however, had no impact. In contrast, for mothers with SPPP, the amount of time spent on Facebook contributed to symptoms of depression and anxiety, while the process of social comparison led to anxiety symptoms alone. Social comparison appears to be important for perfectionistic mothers who use social media, as this may contribute to negative mental health outcomes.

Screening for postpartum anxiety: A quality improvement project to promote the screening of women suffering in silence

BACKGROUND

Postpartum anxiety is a mental health problem that has largely been ignored by maternity care providers despite an estimated incidence as high as 28.9%. Though postpartum anxiety may or may not be accompanied by depression, and while screening for postpartum depression has become more common place, postpartum anxiety is often not assessed or addressed.

PURPOSE

The purpose of this pilot quality improvement project was to implement a screening, treatment and referral program for postpartum anxiety in the birth centre environment.

PROCEDURES

Midwives from 10 geographically diverse birth centres, and all members of the American Association of Birth Centres, were recruited to participate in the project. An online video was developed which detailed postpartum anxiety, screening through use of the anxiety subscale of the Edinburgh Postnatal Depression Scale and a toolkit for treatment and/or referral for screen positive patients. Participants entered patient scores into the Perinatal Data Registry of the American Association of Birth Centres. Individual interviews of midwives were conducted following the 10-week pilot period.

MAIN FINDINGS

There were a total of 387 participants across 9 participating sites. Among all screened participants with follow-up data, (n = 382), 9.69% (n = 37) were lost to follow-up. Among all participants screened with the Edinburgh Postpartum Depression Scale -3A and Edinburgh Postpartum Depression Scale (n = 318), 12.58% (n = 40) had a positive Edinburgh Postpartum Depression Scale -3A score of greater than six. Of all screened participants with an Edinburgh Postpartum Depression Scale score, 15 (6.98%) had a Edinburgh Postpartum Depression Scale score of less than 12 and an Edinburgh Postpartum Depression Scale -3A score greater than six, and would have not received follow up care if only screened for postpartum depression. Midwife participants expressed heightened awareness of the need to screen and felt screening was easy to integrate into clinical practice.

CONCLUSIONS

The Edinburgh Postpartum Depression Scale -3A is a valid, easy-to-use tool which should be considered for use in clinical practice. Modification of the electronic health record can serve as an important impetus triggering screening and treatment. It is important that clinicians are educated on the prevalence of postpartum anxiety, its risk factors, symptoms and implications.

Maternal burn-out: an exploratory study

INTRODUCTION

Maternal burn-out is a psychological, emotional and physiological condition resulting from the accumulation of various stressors characterised by a moderate but also a chronic and repetitive dimension. Little research has focused on this syndrome.

OBJECTIVE

The current study aims to assess maternal burn-out rate and to identify factors associated with this state of exhaustion.

METHOD

263 French mothers aged between 20 and 49 years answered five scales quantifying maternal burn-out, perceived social support, parental stress, depression and anxiety symptoms and history of postnatal depression.

RESULTS

About 20% of mothers were affected by maternal burn-out. The main factors related to maternal burn-out were having a child perceived as difficult, history of postnatal depression, anxiety, satisfaction of a balance between professional and personal life and parental stress.

CONCLUSION

This research shows the need for further work on maternal burn-out to better understand and prevent this syndrome.

Newborn biliary atresia screening with the stool colour card: a questionnaire survey of parents

PURPOSE

Biliary atresia can easily be screened using a stool colour card (SCC) and has shown to significantly reduce time to diagnosis, improving children's outcome. Despite the general approval of the clinical usefulness of the SCC, physicians remain reluctant: it might unnecessarily worry parents. This study aimed to analyse the parental reaction to this screening method and if it evokes parental stress.

METHODS

A semistructured questionnaire was sent to parents with one or more healthy child to inquire about reactions on receipt and use of the SCC.

RESULTS

109/256 questionnaires were returned and evaluated (43%). 107/107 parents considered the SCC as helpful, a simple screening method and easy to use (100%). 26/43 were reassured when receiving the SCC (60%), 2 were worried (5%) and 9 had no particular feelings (21%). In 41/49, emotions experienced during its use were positive or neutral (84%), and 3 were worried (6%). In 41/50, the discussion with the paediatrician about stool colour-linked pathologies was neutral (82%), and 9 felt uneasy (18%).

CONCLUSION

A vast majority of parents appreciate the SCC. It creates uneasiness in a minority of parents. Our results are encouraging and argue in favour of implementing the regular distribution of the SCC in antenatal, postnatal and newborn infant clinics.

[Consultation liaison during the peripartum: Network care between liaison and mobile unit]

OBJECTIVES

The pregnancy periods of peripartum and immediate postpartum represent moments of opportunity to access care. Both prevention and therapeutic management can be offered with a better chance of success during these periods. Our specific Consultation Liaison (CL) team PPUMMA was created in order to respond to the need for early detection of psychopathology and rapid implementation of therapeutic management and preventive measure for mother and child. The importance of urgently intervening "on site" seemed a necessity since duration of hospitalization in maternity wards is very short. Women might not know or understand their symptoms or be ready to ask for a referral for themselves but could be ready to respond positively to a team approach where the psychiatrist is part of the Ob-Gyn department. Working with an interdisciplinary approach tends to lower stress linked to the psychiatric side of the consultation and stigma related to psychological or psychiatric issues; therefore, PPUMMA intervenes within 48 to 72hours of birth. It deals with assessment and diagnosis during the peripartum period and orientation and referral for both mother and infant when necessary after birth. The Perinatal Psychiatry emergency mobile unit PPUMMA was created in order to address these issues.

METHODS

From 2008 to 2015, 1907 patients were assessed but data were missing for 90 patients. We therefore analyzed 1817 patient files looking at age, diagnosis origin of referral, time of referral (pre or postpartum) and delay from referral to assessment.

RESULTS

Most patients were between 20 and 40 (81.5 %). One hundred and eighteen patients were under 20 years of age, of whom 64 were minors (3.5 %), and 218 were 40 or more (12 %). These two groups were over-represented close to threefold when comparing with national birth data records. A psychologist had first seen three out of four women. Midwives and Ob-Gyn referred 9 % and 8 % of patients while Social workers sent in 4 %. Two thirds of the women were seen during pregnancy, 50 % were seen the same day and 80 % received a consultation within 72hours. Three out of five of women had an assessment that concluded in a "Neurotic, stress-related and somatoform disorders" type code disorder linked to stress and somatoform disorder in ICD 10 (F40-F49). This is due to a high number (47.2 %) of F43 "Reaction to severe stress, and adjustment disorders". Twentynine present of women had a mood disorder (F30-39), and close to one third (31.6 %) had a personality disorder diagnosis attached. Schizophrenia, schizotypal and delusional disorders (F20-F29) represented 4.4 % of diagnoses. One third of the population had comorbid disorders: meeting either two (28.5 %) or three (3.7 %) diagnostic criteria for a psychiatric disorder. Most co-morbidity is due to personality disorder (82 % F60-F69).

CONCLUSION

The number of referrals and diagnostic criteria met show how essential a psychiatric CL team assessing and orienting women during pregnancy and immediate postpartum is. Opportunity for adaptation of treatment during the peripartum period and more long-term tailored management of disorders can be organized during this period in a multidisciplinary approach. Knowing how essential maternal mental health is for women, for infant development and for mother-infant interactions, this is a unique window for access to care and intervention. Maternal mental health is a public health issue. Access to psychiatric assessment and care during the peripartum period offers unique possibilities for prevention and care.

Stress and distress in parents of neonates admitted to the neonatal intensive care unit for cardiac surgery

BACKGROUND

Parents of infants admitted to the Neonatal Intensive Care Unit (NICU) are at risk of psychological distress and NICU-related stress. However, parents of infants admitted to NICU for cardiac surgery are an under-researched population.

AIMS

Identify levels of NICU-related stress, and levels of psychological distress, reported by parents of infants admitted to the NICU for cardiac surgery.

STUDY DESIGN

Observational study.

SUBJECTS

69 parents of infants admitted to the NICU for cardiac surgery (cardiac group) and 142 parents of healthy infants (control group).

OUTCOME MEASURES

Questionnaire packs provided to parents prior to discharge (time-point 1), and at six and 12months corrected age included: Hospital Anxiety and Depression Scale, Coping Inventory for Stressful Situations, and Family Support Scale. The Parental Stressor Scale:NICU was administered to the cardiac group at time-point 1.

RESULTS

The cardiac group reported (i) that parental role alteration was the most stressful aspect of the NICU and (ii) higher scores for anxiety and depression than the control group at all three time-points, with the highest levels reported during the NICU stay. Correlation analyses indicated (i) stress associated with the sights and sounds of the NICU, and the appearance and behaviour of the infant in the NICU, had a significant positive association with anxiety and depression, and (ii) a significant negative relationship between anxiety and task-focused coping.

CONCLUSIONS

An individualised parent-targeted intervention aimed at reducing stress associated with the NICU and enhancing task-focused coping style may help to reduce levels of anxiety and depression within this group of parents.

Early origins of mental disorder - risk factors in the perinatal and infant period

BACKGROUND

There is increasing understanding of the significance of early neurodevelopment in establishing risk for the range of mental disorders. Models of the early aetiology of mental disorders are complex with a range of potential factors from genetic and epigenetic to environmental influencing neurological and psychological development. Whilst the mechanisms are not fully understood, this paper provides an overview of potential biological and neurobiological factors that might be involved.

METHOD

An aetiological model is presented and discussed. The discussion includes a range of risk factors for mental disorder. Maternal anxiety disorder is presented and reviewed as an example of the interaction of placental, epigenetic and early parenting factors elevating risk of poor neonatal outcome.

RESULTS

Available evidence points to the importance of in-utero influences as well as the role of early attachment and emotional care. Transgenerational mechanisms such as the impact of maternal mental disorder on foetal development are important models for examination of early risk. Maternal anxiety, as an example, is a significant risk factor for compromised mental health.

CONCLUSIONS

Development of models for understanding the early origins of mental disorder is an important step in elaborating risk reduction strategies. Comprehensive early identification of risk raises the possibility of preventive interventions.

Enhancing reciprocal partner support to prevent perinatal depression and anxiety: a Delphi consensus study

BACKGROUND

Systematic reviews have established that partner support protects against perinatal mood problems. It is therefore a key target for interventions designed to prevent maternal and paternal depression and anxiety. Nonetheless, the extant literature is yet to be translated into specific actions that parents can implement. Prevention efforts aiming to facilitate reciprocal partner support within the couple dyad need to provide specific guidance on how partners can support one another to reduce their vulnerability to perinatal depression and anxiety.

METHOD

Two panels of experts in perinatal mental health (21 consumer advocates and 39 professionals) participated in a Delphi consensus study to establish how partners can support one another to reduce their risk of developing depression and anxiety during pregnancy and the postpartum period.

RESULTS

A total of 214 recommendations on how partners can support each other were endorsed by at least 80 % of both panels as important or essential in reducing the risk of perinatal depression and anxiety. The recommendations were grouped under the following categories: becoming a parent, supporting each other through pregnancy and childbirth, communication, conflict, division of labor, practical support, emotional support, emotional closeness, sexual satisfaction, using alcohol and drugs, encouraging self-care, developing acceptance, and help-seeking.

CONCLUSION

This study established consensus between consumers and professionals in order to produce a set of guidelines on how partners can support each other to prevent depression and anxiety during pregnancy and following childbirth. It is hoped that these guidelines will inform the development of perinatal depression and anxiety prevention efforts.

Mother-preterm infant interactions at 3 months of corrected age: influence of maternal depression, anxiety and neonatal birth weight

Maternal depression and anxiety represent risk factors for the quality of early mother-preterm infant interactions, especially in the case of preterm birth. Despite the presence of many studies on this topic, the comorbidity of depressive and anxious symptoms has not been sufficiently investigated, as well as their relationship with the severity of prematurity and the quality of early interactions. The Aim of this study was to evaluate the quality of early mother-infant interactions and the prevalence of maternal depression and anxiety comparing dyads of extremely low birth weight (ELBW) and very low birth weight (VLBW) preterm infants with full-term ones. Seventy seven preterm infants (32 ELBW; 45 VLBW) and 120 full term (FT) infants and their mothers were recruited. At 3 months of corrected age, 5 min of mother-infant interactions were recorded and later coded through the Global Ratings Scales. Mothers completed the Edinburgh Postnatal Depression Scale and Penn State Worry Questionnaire. Infant levels of development were assessed through the Griffiths Mental Development Scales. A relation emerged among the severity of prematurity, depression, anxiety, and the quality of interactions. When compared with the FT group, the ELBW interactions were characterized by high maternal intrusiveness and low remoteness, while the VLBW dyads showed high levels of maternal sensitivity and infant communication. Depression was related to maternal remoteness and negative affective state, anxiety to low sensitivity, while infant interactive behaviors were impaired only in case of comorbidity. ELBW's mothers showed the highest prevalence of depressive and anxious symptoms; moreover, only in FT dyads, low maternal sensitivity, negative affective state and minor infant communication were associated to the presence of anxious symptoms. The results confirmed the impact of prematurity on mother-infant interactions and on maternal affective state. Early diagnosis can help to plan supportive interventions.