Postpartum bonding and association with depressive symptoms and prenatal attachment in women with fear of birth

Maternal stressors and maternal bonding among immigrant and Refugee Arab Americans resettled in the United States

Maternal bonding with the infant and child is essential for the growth and development of the child, and for establishing the relationship between them. The effect of maternal acculturative stress, trauma, and depressive symptoms on maternal bonding has been established in nonimmigrant populations, but not in immigrant and refugee populations. In this study, we aimed to (1) examine the relationships among maternal psychosocial stress (acculturative stress, posttraumatic stress), depressive symptoms, and maternal bonding, and (2) examine whether maternal depression is a mediator of the relationship between maternal psychosocial stress and maternal bonding among a sample of Arab American immigrant and refugee mothers. Using a cross-sectional design, we recruited 78 immigrant and refugee Arab American mothers. Acculturative stress was correlated with posttraumatic stress (ρ = 0.56, p < 0.001), depressive symptoms (ρ = 0.48, p < 0.001), and bonding impairment (ρ = 0.39, p < 0.001). Posttraumatic stress and depressive symptoms were also correlated with maternal bonding impairment (ρ = 0.39, and 0.52, respectively, p < 0.001 for both). The effect of maternal psychosocial stress on maternal bonding was mediated by depressive symptoms. We concluded that higher levels of acculturative stress and posttraumatic stress were associated with higher levels of depressive symptoms and impairment of maternal bonding. Additionally, maternal depressive symptoms mediated the relationship between maternal stress and bonding. Assessing the stressors and depressive symptoms of immigrant and refugee mothers is key to avoiding negative effects on child outcomes.

The Impact of Postpartum Depression on the Early Mother-Infant Relationship during the COVID-19 Pandemic: Perception versus Reality

Postpartum depression (PPD) can interfere with the establishment of affective bonds between infant and mother, which is important for the cognitive, social-emotional, and physical development of the child. Rates of PPD have increased during the COVID-19 pandemic, likely due to the added stress and limited support available to new parents. The present study examined whether parenting-related stress, perceived bonding impairments, the quality of observed mother-infant interactions, and salivary oxytocin levels differ between depressed and non-depressed mothers, along with differential impacts of COVID-19 on depressed mothers. Participants included 70 mothers (45 depressed, 25 controls) with infants aged 2-6 months. All data were collected remotely to ease participant burden during the pandemic. Depression was associated with experiences of heightened parenting-related stress and bonding difficulties. These differences were not observed during mother-infant interactions or in salivary oxytocin levels. Differences in COVID-19-related experiences were minimal, though depressed mothers rated slightly higher stress associated with returning to work and financial impacts of the pandemic. Findings highlight the importance of early intervention for PPD to mitigate long-term effects on mothers, children, and families. Additionally, they underscore the need for early intervention to support the developing mother-infant dyad relationship during this crucial time.

Traversing mental health disorders during pregnancy: Lebanese women's experiences of antepartum depression and anxiety

INTRODUCTION

Over the past few years, Lebanon-a developing country-has faced a plethora of economic and political challenges, with more than half of the general population presenting depressive and anxiety symptoms. However, when it comes to maternal mental health during pregnancy, the last examination in Lebanon dates far back to 2005. Our study's aim was to help delineate the factors associated with Lebanese women's mental health disorders during pregnancy, namely antepartum depression and anxiety.

METHODS

We launched a cross-sectional study among Lebanese pregnant women (age ≥ 18 years) between June and July 2021, during the COVID-19 lockdown (N = 433).

RESULTS

In total, 87.8% of the participants experienced depression (mild to severe), where severe depression was observed in 7.9%. In addition, 70.3% had a significant level of anxiety. Increased pregnancy-specific hassles (beta = 0.93), being Muslim compared to Christians (beta = 3.19), being afraid of an existing aggressor (beta = 8.75), urinary tract infections (beta = 2.02), and higher gestational age (beta = 0.07) were significantly associated with higher depression, whereas higher physical activity index (beta =  - 0.09) and increased disordered eating attitudes during pregnancy (beta =  - 0.27) were significantly associated with less depression, all accounting for 60.4% of the model's variance. Additionally, increased pregnancy-specific hassles (beta = 0.54), being Muslim compared to Christians (beta = 2.42), urinary tract infections (beta = 1.72), and having been emotionally or physically abused (beta = 1.19) were significantly associated with higher levels of anxiety and could predict 49% of the total variance.

CONCLUSION

Our study has suggested the existence of factors that have additive effects in potentiating the risk for depression and anxiety among Lebanese pregnant women, namely cultural beliefs, pregnancy-related distress, medical complications during pregnancy, and a history of abuse. Therefore, it would be judicious to implement screening programs targeting pregnant women at risk for antepartum depression and anxiety. In addition, high rates of prenatal depression and anxiety were detected among our sample, supporting that recognizing and treating maternal mental health disorders should be prioritized during antenatal care in Lebanon.

Association of inpatient postpartum quality of recovery with postpartum depression: A prospective observational study

STUDY OBJECTIVE

To explore the relationship between Obstetric Quality of Recovery survey (ObsQoR-10-Heb) and Edinburgh postnatal depression scale (EPDS) measured 6 weeks after delivery, adjusted for potential confounding factors.

DESIGN

Prospective, longitudinal cohort study.

SETTING

Large postpartum department, 13,000 annual deliveries, quaternary medical center in Israel.

PATIENTS

Women ≥18 years old, gestational age ≥ 37 weeks after term delivery (spontaneous vaginal, operative vaginal, planned, and unplanned cesarean delivery), with non-anomalous neonates not requiring special support after delivery or at the time of recruitment. Written informed consent was provided. Women unable to read or understand Hebrew were excluded.

INTERVENTIONS

No interventions were done.

MEASUREMENTS

We investigated the relationship between inpatient postpartum recovery and positive postpartum depression (PPD) screening at 6 weeks postpartum. Enrolled women completed the validated Hebrew version of ObsQoR-10 survey (ObsQoR-10-Heb; scored between 0 and 100 with 0 and 100 representing worst and best possible recovery) from 24 to 48 h after delivery, and the Edinburgh Postnatal Depression Scale (EPDS) at 6- and 12 weeks postpartum. We assessed the univariate association between ObsQoR-10-Heb; patient factors; obstetric factors; and positive PPD screening at 6 weeks postpartum. Potential confounders were adjusted in a multiple logistic regression model.

MAIN RESULTS

Inpatient ObsQoR-10-Heb has been completed by 325 postpartum women; 270 (83.1%) and 253 (77.9%) completed the 6- and 12 weeks EPDS respectively. Lower ObsQoR-10-Heb (aOR 0.95 (95% CI 0.92, 0.98); p = 0.001); depression or anxiety before delivery (aOR 4.53 (95% CI 1.88, 10.90); p = 0.001); and hospital readmission (aOR 9.08 (95% CI 1.23, 67.14); p = 0.031) were associated with positive screening for postpartum depression at 6 weeks.

CONCLUSIONS

Our study demonstrates that worse inpatient postpartum recovery is an independent risk factor for positive PPD screening at 6 weeks postpartum. Other risk factors found in our study were maternal hospital readmission and a previous history of anxiety or depression.

Development and evaluation of the psychometric properties of a digital questionnaire for the evaluation of perinatal psychosocial needs

BACKGROUND

If the purpose of maternal education is for women to take control of their own health and that of their family in the process, it is essential to have a simple instrument that allows them to self-assess, globally, how prepared they are to face future childbirth and maternity. As there is nothing similar in our area, the objective of this study was to design a complete, specific measurement questionnaire, with good metric quality and in digital format, for the assessment of perinatal psychosocial needs.

METHODS

A cross-sectional study was carried out, to evaluate the psychometric properties of a digital measurement questionnaire. The questionnaire was developed in 4 steps following the recommendations of the International Test Commission. The participants were 263 pregnant women who were recruited in primary health care appointments in the Basque Healthcare Service (Osakidetza); they completed the newly created questionnaire and all the test selected as gold standard. Their mean age was 33.55 (SD = 4.73). The analysis of the psychometric characteristics was based on mixed expert judgment procedures (focus group of healthcare professionals, item assessment questionnaire and interviews with users) and quantitative procedures (EFA, CFA, association with the gold standard and classification agreement index, ordinal alpha and McDonald's omega).

RESULTS

The final version of the questionnaire was made up of 55 items that evaluate 8 aspects related to perinatal psychosocial well-being (anxious-depressive symptoms, pregnancy acceptance, partner support, coping, internal locus of control, childbirth self-efficacy, perception of childbirth as a medicalized event, and fear of childbirth). Various tests were made of the validity and reliability of the scores, providing metric guarantees for their use in our context.

CONCLUSIONS

The use of this complete, quick-to-use tool with good psychometric properties will allow pregnant women to take stock of their situation, assess whether they have the necessary resources in the psychological and social sphere, and work together with midwives and other health professionals in the areas that are lacking.

Perceived Birth Trauma in Macedonian Women

Although the childbearing is perceived as a normal and happy event, new research shows that psychological birth trauma is, however, a universal and not so rare phenomenon. Traumatic birth experiences can cause postnatal mental health disturbances, fear of childbirth in subsequent pregnancies and disruption to mother-infant bonding, leading to possible impaired child development. The purpose of this research was to evaluate collected data from several obstetric clinics, as well as from primary paediatric settings related to 'Birth Trauma' in order to review women with symptoms of post-traumatic stress disorder (PTSD) following childbirth. The study is prospective, starting from January 2021 and ending in December 2022. The psychological instrument used in this research is the Intersect Questionnaire, composed of 59 questions grouped in 8 parts. The obtained results from our study confirmed that birth trauma is not a rare phenomenon in our country. Symptoms correlated with PTSD were present as follows: unpleasant memories (2.7%), anxiety (38.54%), panic (6.47%), trying not to remember the delivery (4.04%), self-accusation (2.16%), negative emotions (1.89%), alienation (4.31%), irritation/aggression (1.89%), self-destruction (1.89%), impulsiveness (4.31%), problems with concentration (3.23%), and sleeping problems (21.88%). These results are alarming. It is imperative to better understand this vulnerable period in a woman's life. As a general conclusion, we must highlight the importance of perceived birth trauma in women, phenomena which has been confirmed worldwide and which must be overcome as quickly and as successfully as possible.

Depression and Anxiety in Adolescents and their Caregivers: A Cross-Sectional Study from North Macedonia

Introduction: Mental health problems have increased internationally during the COVID-19 pandemic. Adolescents and their caregivers form a vulnerable group for the development of mental health problems. However, most data stems from high-income countries, and there is a clear lack of prevalence rates and potential risk factors from Balkan countries. No data is available on the impact of the COVID-19 pandemic on mental health in adolescents and their caregivers in North Macedonia. Materials and methods: A cross-sectional study was conducted on adolescents and their caregivers in a school setting in rural and urban areas of North Macedonia. Survey items assessed symptoms of depression, anxiety, and respondents' fear of COVID-19, as well as a number of risk factors, such as gender and living environment. Results: 506 adolescents and 492 caregivers completed the survey. Symptoms of depression and anxiety were mild to moderate in adolescents and their caregivers. Women and girls generally scored higher than men and boys, and adolescents in high school scored higher than those in elementary school. Prevalence rates for depression were 29.2% for adolescents and 10.4% for caregivers, while rates of anxiety were 23.7% for adolescents and 6.1% for caregivers. Conclusion: This study provides a first insight into the mental health of adolescents and their caregivers after the COVID-19 pandemic in North Macedonia. Further research is required to investigate the relatively low rates of caregivers' mental health problems compared to data from other countries.