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Almeida IF, Rinne GR, Coussons-Read M, Dunkel Schetter C. Placental corticotrophin-releasing hormone trajectories in pregnancy: Associations with postpartum depressive symptoms. Psychoneuroendocrinology 2024; 164:107030. [PMID: 38537413 DOI: 10.1016/j.psyneuen.2024.107030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 02/07/2024] [Accepted: 03/17/2024] [Indexed: 04/21/2024]
Abstract
OBJECTIVE Depressive symptoms following birth are common and can have adverse effects for mothers, children, and families. Changes in hypothalamic-pituitary-adrenal (HPA) axis regulation during pregnancy may be implicated in the development of postpartum depressive symptoms, particularly changes in placental corticotropinreleasing hormone (pCRH). However, few studies have tested how dynamic pCRH changes over pregnancy relate to postpartum depressive symptoms. This preregistered investigation tests associations of both pCRH levels and changes from early to late pregnancy with postpartum depressive symptoms. METHODS The sample consists of 173 women studied in early, mid, and late pregnancy who later reported on depressive symptoms with the Edinburgh Postpartum Depression Scale during interviews at 1, 6 and 12 months postpartum. Blood samples were collected at each prenatal timepoint and assayed for pCRH using radioimmunoassay. Latent growth curve analysis was employed to identify distinct trajectories of pCRH during pregnancy. RESULTS We identified three prenatal pCRH trajectories labeled as typical, flat, and accelerated. Each trajectory showed exponential increases in pCRH levels over the course of gestation but differed in overall levels and rates of change. pCRH levels were not associated with postpartum depressive symptoms. However, women with accelerated pCRH trajectories reported marginally higher depressive symptoms one month postpartum. Primary analysis models adjusted for marital status, income, prepregnancy BMI, parity, prenatal depressive symptoms, and gestational age. CONCLUSIONS These findings add to our understanding of dynamic changes to maternal HPA axis regulation during pregnancy and contribute to growing evidence on how pCRH changes relate to the development of postpartum depressive symptoms.
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Kaliush PR, Butner JE, Williams PG, Conradt E, Crowell SE. Dynamic Associations Among Sleep, Emotion Dysregulation, and Desire to Live in a Perinatal Sample. Psychosom Med 2024; 86:272-282. [PMID: 38451838 PMCID: PMC11081831 DOI: 10.1097/psy.0000000000001297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
OBJECTIVE The present study prospectively examined dynamic associations among sleep, emotion dysregulation, and desire to live during the perinatal transition, as it was theorized that these factors may contribute to the emergence of postpartum suicide risk. METHOD Ninety-four women ( Mage = 29.2 years; 23.4% Latina) wore wrist actigraphs and completed twice daily surveys for 7 days during the third trimester of pregnancy, 6 weeks postpartum, and 4 months postpartum. Multilevel, change-as-outcome models were built to examine changes in attractor dynamics among sleep, emotion dysregulation, and desire to live, as well as if sleep-emotion dysregulation dynamics differed based on participants' desires to live. RESULTS From pregnancy to 6 weeks postpartum, emotion dysregulation ( B = -0.09, p = .032) and desire to live ( B = -0.16, p < .001) exhibited more stable temporal patterns around higher emotion dysregulation and lower desire to live. Compared to women who reported consistently high desires to live, those who experienced fluctuations in their desires to live exhibited lower, more stable sleep efficiency during pregnancy ( B = -0.90, p < .001). At 4 months postpartum, those with fluctuating desires to live exhibited a coupling dynamic whereby low sleep efficiency predicted increases in emotion dysregulation ( B = -0.16, p = .020). CONCLUSIONS This study was the first to examine nonlinear dynamics among risk factors for postpartum suicide, which may be evident as early as pregnancy and 6 weeks postpartum. Sleep health, in particular, warrants further exploration as a key susceptibility factor in the emergence of postpartum suicide risk. PREREGISTRATION Open Science Framework ( https://osf.io/qxb75/?view_only=799ffe5c048842dfb89d3ddfebaa420d ).
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Bailey NA, Davis EP, Sandman CA, Glynn LM. DHEA: a neglected biological signal that may affect fetal and child development. J Child Psychol Psychiatry 2024. [PMID: 38426566 DOI: 10.1111/jcpp.13952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/05/2023] [Indexed: 03/02/2024]
Abstract
BACKGROUND The stress-sensitive maternal hypothalamic-pituitary-adrenal (HPA) axis through the end-product cortisol, represents a primary pathway through which maternal experience shapes fetal development with long-term consequences for child neurodevelopment. However, there is another HPA axis end-product that has been widely ignored in the study of human pregnancy. The synthesis and release of dehydroepiandosterone (DHEA) is similar to cortisol, so it is a plausible, but neglected, biological signal that may influence fetal neurodevelopment. DHEA also may interact with cortisol to determine developmental outcomes. Surprisingly, there is virtually nothing known about human fetal exposure to prenatal maternal DHEA and offspring neurodevelopment. The current study examined, for the first time, the joint impact of fetal exposure to prenatal maternal DHEA and cortisol on infant emotional reactivity. METHODS Participants were 124 mother-infant dyads. DHEA and cortisol were measured from maternal hair at 15 weeks (early gestation) and 35 weeks (late gestation). Observational assessments of positive and negative emotional reactivity were obtained in the laboratory when the infants were 6 months old. Pearson correlations were used to examine the associations between prenatal maternal cortisol, prenatal maternal DHEA, and infant positive and negative emotional reactivity. Moderation analyses were conducted to investigate whether DHEA might modify the association between cortisol and emotional reactivity. RESULTS Higher levels of both early and late gestation maternal DHEA were linked to greater infant positive emotional reactivity. Elevated late gestation maternal cortisol was associated with greater negative emotional reactivity. Finally, the association between fetal cortisol exposure and infant emotional reactivity was only observed when DHEA was low. CONCLUSIONS These new observations indicate that DHEA is a potential maternal biological signal involved in prenatal programming. It appears to act both independently and jointly with cortisol to determine a child's emotional reactivity. Its role as a primary end-product of the HPA axis, coupled with the newly documented associations with prenatal development shown here, strongly calls for the inclusion of DHEA in future investigations of fetal programming.
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Affiliation(s)
- Natasha A Bailey
- Department of Psychology, University of Virginia, Charlottesville, VA, USA
| | - Elysia Poggi Davis
- Department of Psychology, University of Denver, Denver, CO, USA
- Department of Pediatrics, University of California, Irvine, CA, USA
| | - Curt A Sandman
- Department of Psychiatry and Human Behavior, University of California, Irvine, CA, USA
| | - Laura M Glynn
- Department of Psychology, Chapman University, Orange, CA, USA
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Howland MA. Recalibration of the stress response system over adult development: Is there a perinatal recalibration period? Dev Psychopathol 2023; 35:2315-2337. [PMID: 37641984 PMCID: PMC10901284 DOI: 10.1017/s0954579423000998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
During early life-sensitive periods (i.e., fetal, infancy), the developing stress response system adaptively calibrates to match environmental conditions, whether harsh or supportive. Recent evidence suggests that puberty is another window when the stress system is open to recalibration if environmental conditions have shifted significantly. Whether additional periods of recalibration exist in adulthood remains to be established. The present paper draws parallels between childhood (re)calibration periods and the perinatal period to hypothesize that this phase may be an additional window of stress recalibration in adult life. Specifically, the perinatal period (defined here to include pregnancy, lactation, and early parenthood) is also a developmental switch point characterized by heightened neural plasticity and marked changes in stress system function. After discussing these similarities, lines of empirical evidence needed to substantiate the perinatal stress recalibration hypothesis are proposed, and existing research support is reviewed. Complexities and challenges related to delineating the boundaries of perinatal stress recalibration and empirically testing this hypothesis are discussed, as well as possibilities for future multidisciplinary research. In the theme of this special issue, perinatal stress recalibration may be a mechanism of multilevel, multisystem risk, and resilience, both intra-individually and intergenerationally, with implications for optimizing interventions.
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Affiliation(s)
- Mariann A Howland
- Institute of Child Development, University of Minnesota, Minneapolis, MN, USA
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Lozowchuk A, Carroll JE, Hobel C, Coussons-Read M, Dunkel Schetter C, Ross KM. Partner relationship quality and IL-6:IL-10 trajectories from pregnancy to a year after-birth. Brain Behav Immun 2023; 114:407-413. [PMID: 37704011 DOI: 10.1016/j.bbi.2023.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 09/05/2023] [Accepted: 09/09/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND Inflammatory activity during pregnancy and the postpartum period shifts systematically due to pregnancy progression, delivery, and postpartum recovery. Factors that deregulate inflammatory activity increase the risk for adverse pregnancy outcomes and slower postpartum recovery. The IL-6:IL-10 or TNF-α:IL-10 ratio is potentially one way to capture peripheral inflammatory regulation; higher values indicate that anti-inflammatory IL-10 is less effective at regulating pro-inflammatory TNF-α or IL-6, skewing towards maladaptive pro-inflammatory profiles. Associations between partner relationship quality and IL-6:IL-10 or TNF-α:IL-10 trajectories during pregnancy and the postpartum period have not been assessed. The purpose of this study was to test whether partner relationship quality (support, conflict) is associated with attenuated IL-6, IL-10, TNF-α, TNF-α:IL-10 or IL-6:IL-10 trajectories from the third trimester to the postpartum period. METHODS A sample of 162 women from the Healthy Babies Before Birth study reported on partner relationship quality (support and conflict) using the Social Support Effectiveness Questionnaire during the third trimester. Plasma samples were collected in the third trimester and at 1-, 6- and 12-months postpartum, and assayed for TNF-α, IL-6 and IL-10. Associations between both indicators of relationship quality (support and conflict) and TNF-α, IL-6, IL-10, IL-6:IL-10, TNF-α:IL-10 trajectories were tested using multi-level modelling, controlling for sociodemographic, pregnancy and health variables. RESULTS Partner support interacted with time to predict IL-6:IL-10 trajectories, linear: b = -0.176, SE = 0.067, p =.010, quadratic: b = 0.012, SE = 0.005, p =.009. Lower partner support was associated with steeper increases in IL-6:IL-10 from the third trimester to 6 months postpartum, followed by steeper decreases in IL-6:IL-10 from 6 months postpartum to a year after birth. Partner conflict was not associated with IL-6:IL-10 levels at study entry, b = 0.233, SE = 0.219, p =.290, or over time, p's > 0.782. Neither indicator of partner relationship quality was associated with TNF-α, IL-6, IL-10, or TNF-α:IL-10 trajectories, p's > 0.205. CONCLUSION Lower partner support may be associated with reduced moderation of IL-6 by IL-10 between pregnancy and a year postpartum, with possible consequences for maternal health and well-being.
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Affiliation(s)
| | - Judith E Carroll
- Cousins Center for Psychoneuroimmunology, Department of Psychiatry & Biobehavioral Sciences, Jane & Terry Semel Institute for Neuroscience and Human Behavior, University of California - Los Angeles, Los Angeles, CA, United States
| | - Calvin Hobel
- Cedar-Sinai Medical Center, Los Angeles, CA, United States
| | - Mary Coussons-Read
- Department of Psychology, University of Colorado-Colorado Springs, Colorado Springs, CO, United States
| | | | - Kharah M Ross
- Psychology Department, University of Calgary, Calgary, AB, Canada; Department of Psychology, Athabasca University, Athabasca, AB, Canada.
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Rinne GR, Somers JA, Ramos IF, Ross KM, Coussons-Read M, Schetter CD. Increases in maternal depressive symptoms during pregnancy and infant cortisol reactivity: Mediation by placental corticotropin-releasing hormone. Dev Psychopathol 2023; 35:1997-2010. [PMID: 35983792 PMCID: PMC9938842 DOI: 10.1017/s0954579422000621] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Maternal depressive symptoms in pregnancy may affect offspring health through prenatal programming of the hypothalamic-pituitary-adrenal (HPA) axis. The biological mechanisms that explain the associations between maternal prenatal depressive symptoms and offspring HPA axis regulation are not yet clear. This pre-registered investigation examines whether patterns of maternal depressive symptoms in pregnancy are associated with infant cortisol reactivity and whether this association is mediated by changes in placental corticotropin-releasing hormone (pCRH). METHOD A sample of 174 pregnant women completed assessments in early, mid, and late pregnancy that included standardized measures of depressive symptoms and blood samples for pCRH. Infant cortisol reactivity was assessed at 1 and 6 months of age. RESULTS Greater increases in maternal depressive symptoms in pregnancy were associated with higher cortisol infant cortisol reactivity at 1 and 6 months. Greater increases in maternal depressive symptoms in pregnancy were associated with greater increases in pCRH from early to late pregnancy which in turn were associated with higher infant cortisol reactivity. CONCLUSIONS Increases in maternal depressive symptoms and pCRH over pregnancy may contribute to higher infant cortisol reactivity. These findings help to elucidate the prenatal biopsychosocial processes contributing to offspring HPA axis regulation early in development.
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Affiliation(s)
| | | | - Isabel F. Ramos
- Department of Chicano/Latino Studies. University of California, Irvine
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Chang CY, Liu SR, Glynn LM. One size doesn't fit all: Attitudes towards work modify the relation between parental leave length and postpartum depression. Arch Womens Ment Health 2023:10.1007/s00737-023-01374-5. [PMID: 37737880 DOI: 10.1007/s00737-023-01374-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 09/12/2023] [Indexed: 09/23/2023]
Abstract
The present study aimed to investigate the relationship between parental leave length and maternal depressive symptoms at six- and twelve-months postpartum and whether this relation was influenced by women's attitudes towards leave, whether leave was paid or unpaid, and the reason they returned to work. The sample included 115 working women recruited during pregnancy as part of a larger longitudinal study. Analyses revealed that maternal attitudes toward leave influenced the association between leave length and depressive symptoms. Specifically, longer leaves were associated with increased depressive symptoms for women who missed their previous activities at work. Furthermore, women who missed work and had leave for 16 weeks or more, exhibited higher depressive symptoms at six- and twelve-months. Last, results also indicated that women who returned to work solely for monetary reasons exhibited more depressive symptoms at six-months postpartum than those who returned to work for other reasons. This study is among the first to show that women's attitudes towards parental leave and their individual reasons for returning to work are important factors to consider that may have potential implications for parental leave policies.
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Affiliation(s)
| | - Sabrina R Liu
- Department of Human Development, California State University, San Marcos, San Marcos, CA, USA
| | - Laura M Glynn
- Department of Psychology, Chapman University, Orange, CA, USA
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Fleck L, Fuchs A, Sele S, Moehler E, Koenig J, Resch F, Kaess M. Prenatal stress and child externalizing behavior: effects of maternal perceived stress and cortisol are moderated by child sex. Child Adolesc Psychiatry Ment Health 2023; 17:94. [PMID: 37550728 PMCID: PMC10408175 DOI: 10.1186/s13034-023-00639-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 07/04/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Externalizing behavior problems are related to social maladjustment. Evidence indicates associations between prenatal stress and child behavioral outcomes. It remains unclear how psychological distress vs. biological correlates of stress (cortisol) differentially predict externalizing behavior, and how their effects might differ as a function of child sex. METHOD 108 pregnant women from the community collected salivary cortisol and reported their perceived stress during each trimester of pregnancy. At child age 9 years (M = 9.01, SD = 0.55), 70 mothers and children reported on child behavior. Structural equation modelling was used to analyze how cortisol levels and perceived stress during pregnancy predicted current child externalizing behavior, considering the moderating effect of child sex. RESULTS Perceived stress predicted higher externalizing behavior in boys (β = 0.42, p = 0.009) and lower externalizing behavior in girls (β = - 0.56, p = 0.014). Cortisol predicted lower externalizing behavior in boys (β = - 0.81, p < .001) and was not related to girls' externalizing behavior (β = 0.37, p = 0.200). DISCUSSION/CONCLUSION Prenatal stress affected externalizing behavior differently in girls vs. boys. These response patters in turn differed for indicators of psychological vs. biological maternal stress, encouraging an integrated approach. Findings indicate that perceived stress and cortisol may affect child development via different trajectories.
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Affiliation(s)
- Leonie Fleck
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Anna Fuchs
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Silvano Sele
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Eva Moehler
- Department of Child and Adolescent Psychiatry, Saarland University Medical Center, Homburg, Germany
| | - Julian Koenig
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Franz Resch
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Michael Kaess
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany.
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
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Ross KM, Mander H, Rinne G, Okun M, Hobel C, Coussons-Read M, Dunkel Schetter C. Pregnancy-specific anxiety and gestational length: The mediating role of diurnal cortisol indices. Psychoneuroendocrinology 2023; 153:106114. [PMID: 37084672 PMCID: PMC10952551 DOI: 10.1016/j.psyneuen.2023.106114] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 04/12/2023] [Accepted: 04/16/2023] [Indexed: 04/23/2023]
Abstract
BACKGROUND Preterm birth or shorter gestation is a common adverse pregnancy outcome. Pregnancy-specific anxiety is robustly associated with risk for shorter gestation. Hypothalamic-pituitary-adrenal (HPA) dysregulation, indicated by diurnal cortisol index variability [slope, area-under-the-curve (AUC) or cortisol awakening response (CAR)], could mediate associations between pregnancy-specific anxiety and shorter gestation. The purpose of this study was to explore whether diurnal cortisol index variability mediates associations between pregnancy-specific anxiety and gestational length. METHODS A sample of 149 women from the Healthy Babies Before Birth study reported pregnancy-specific anxiety in early pregnancy. Saliva samples were taken at three times during pregnancy, for two days each, at wake, 30 min post wake, noon, and evening. Diurnal cortisol indices were calculated using standard approaches. Pregnancy cortisol index variability was calculated across pregnancy timepoints. Gestational length was derived from medical charts. Covariates were sociodemographics, parity and obstetric risk. Mediation models were tested using SPSS PROCESS. RESULTS There was a significant indirect effect of pregnancy-specific anxiety on gestational length via CAR variability, b(SE)= -0.102(0.057), .95CI [- 0.227,- 0.008]. Higher pregnancy-specific anxiety was associated with lower CAR variability, b(SE)= -0.019(0.008), p = .022, and lower CAR variability was associated with shorter gestation, b(SE)= 5.29(2.64), p = .047. Neither AUC or slope variability mediated associations between pregnancy-specific anxiety and gestational length. CONCLUSION Lower CAR variability during pregnancy mediated the association between higher pregnancy-specific anxiety and shorter gestational length. Pregnancy-specific anxiety could dysregulate HPA axis activity, as indicated by lower CAR variability, demonstrating the importance of the HPA axis system in regulating pregnancy outcomes.
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Affiliation(s)
- Kharah M Ross
- Psychology Department, Athabasca University, Athabasca, AB, Canada; Psychology Department, University of Calgary, Calgary, AB, Canada.
| | - Harmeen Mander
- Psychology Department, University of Calgary, Calgary, AB, Canada.
| | - Gabrielle Rinne
- Psychology Department, University of California - Los Angeles, Los Angeles, CA, United States
| | - Michele Okun
- Psychology Department, University of Colorado - Colorado Springs, Colorado Springs, CO, United States
| | - Calvin Hobel
- Cedars-Sinai Medical Centre, Los Angeles, CA, United States
| | - Mary Coussons-Read
- Psychology Department, University of Colorado - Colorado Springs, Colorado Springs, CO, United States
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Rinne GR, Hartstein J, Guardino CM, Dunkel Schetter C. Stress before conception and during pregnancy and maternal cortisol during pregnancy: A scoping review. Psychoneuroendocrinology 2023; 153:106115. [PMID: 37119659 DOI: 10.1016/j.psyneuen.2023.106115] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 04/10/2023] [Accepted: 04/16/2023] [Indexed: 05/01/2023]
Abstract
BACKGROUND Stress before conception and during pregnancy is associated with less favorable maternal and child health. Alterations in prenatal cortisol levels may serve as a central biological pathway linking stress to adverse maternal and child health. Research examining associations between maternal stress from childhood through pregnancy and prenatal cortisol has not been comprehensively reviewed. METHOD The current scoping review of 48 papers synthesizes studies reporting on associations between stress before conception and during pregnancy with maternal cortisol in pregnancy. Eligible studies measured childhood, the proximal preconception period, pregnancy, or lifetime stress based on stress exposures or appraisals and measured cortisol in saliva or hair during pregnancy. RESULTS Higher maternal childhood stress was associated with higher cortisol awakening responses and alterations in typical pregnancy-specific changes in diurnal cortisol patterns across studies. In contrast, most studies of preconception and prenatal stress reported null associations with cortisol and those reporting significant effects were inconsistent in direction. A few studies found that the associations between stress and cortisol during pregnancy varied as a function of several moderators including social support and environmental pollution. CONCLUSIONS Although many studies have evaluated effects of maternal stress on prenatal cortisol, this scoping review is the first to synthesize existing literature on this topic. The association between stress before conception and during pregnancy and prenatal cortisol may depend on the developmental timing of stress and several moderators. Maternal childhood stress was more consistently associated with prenatal cortisol than proximal preconception or pregnancy stress. We discuss methodological and analytic factors that may contribute to mixed findings.
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Affiliation(s)
- Gabrielle R Rinne
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA.
| | - Jenna Hartstein
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
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Rinne GR, Mahrer NE, Guardino CM, Shalowitz MU, Ramey SL, Dunkel Schetter C. Childhood family stress modifies the association between perinatal stressful life events and depressive symptoms. J Fam Psychol 2023; 37:432-442. [PMID: 36996242 PMCID: PMC10238650 DOI: 10.1037/fam0001076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The childhood family environment can influence long-term well-being in part by modifying how individuals' respond to and cope with stress across the life span. Theoretical models propose that childhood stress will either exacerbate (stress sensitization) or attenuate (steeling effect) the effects of adult stress on mental health. This study tests whether childhood family stress modifies the association between stressful life events and depressive symptoms in pregnancy and consecutive postpartum periods. A sample of 127 women reported on depressive symptoms after one birth, during a subsequent pregnancy, and postpartum following that birth. Childhood family stress was assessed with the Risky Families Questionnaire. Stressful life events were measured at all three timepoints to capture the number of life events during both pregnancies and between pregnancies. Associations between stressful life events and depressive symptoms varied as a function of childhood family stress. At the between-persons level, more stressful life events were associated with greater depressive symptoms among women who reported infrequent exposure to childhood family stress in this sample, but not among women who reported more frequent exposure to childhood family stress. Results provide novel evidence that moderate exposure to childhood family stress may attenuate the association between stressful life events and depressive symptoms in the perinatal period, consistent with a steeling effect. That is, some degree of childhood family stress may promote resilience to perinatal stress. Findings underscore the utility of examining the interaction of risk factors across the life span in predicting perinatal mental health. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Gabrielle R. Rinne
- Department of Psychology, University of California, Los Angeles. Los Angeles, CA
| | | | | | | | - Sharon L. Ramey
- Fralin Biomedical Research Institute, Department of Psychology, Department of Psychiatry, Virginia Polytechnic Institute and State University. Blacksburg, VA
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Millwood SN, Manczak EM. Maternal psychological functioning mediates the association between infant behavior and subsequent child psychological functioning. Infant Behav Dev 2023; 71:101837. [PMID: 37027947 DOI: 10.1016/j.infbeh.2023.101837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 03/11/2023] [Accepted: 03/16/2023] [Indexed: 04/09/2023]
Abstract
Symptoms of psychopathology that onset during childhood are often more severe, chronic, and difficult to treat than symptoms that first appear later in life. Maternal psychological symptoms are associated with the development of psychological symptoms in children. However, less research focuses on whether children's behaviors may presage maternal psychological difficulties that, in turn, contribute to the child's own psychological functioning. Identifying psychological difficulties in families and intervening in early life may lower risk for intergenerational transmission of subsequent psychological symptoms. Even at non-clinical or normative levels, exploring transactional models of parent-child behavior and psychological functioning may provide insight into the development of later psychological difficulties or symptoms within families. Thus, the current study examined whether difficult infant behavior (e.g., fussiness, unpredictability) is associated with future maternal psychological difficulties and subsequently, the child's own psychological functioning in early childhood. The current sample includes 847 dyads from a multi-wave birth cohort in England ('Born in Bradford'), who identified as predominantly non-White (62.2%) and socioeconomically diverse. Mothers reported on their child's behaviors at 6 months, their own psychological functioning during pregnancy and at 18 months postpartum, and their child's psychological functioning at age 3. Results of a mediation model revealed that the association between infant behavior at 6 months and child psychological functioning at 3 years is partially explained by maternal psychological functioning at 18 months, even after accounting for psychological difficulties during pregnancy, maternal age at birth, child sex, family income, and ethnicity. Post-hoc exploratory analyses revealed that the association between infant behavior, maternal psychological functioning, and subsequent child psychological functioning was significant for Pakistani British families but not White British families. These findings provide preliminary evidence that infant behaviors (e.g., temperament) may presage future maternal psychological difficulties and subsequent child psychological functioning, above and beyond previous maternal psychological functioning. Importantly, these results highlight infant behavior as a potential catalyst for later psychological difficulties within families.
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Affiliation(s)
| | - Erika M Manczak
- Department of Psychology, University of Denver, Denver, CO, USA
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Méndez Leal AS, Silvers JA, Carroll JE, Cole SW, Ross KM, Ramey SL, Shalowitz MU, Dunkel Schetter C. Maternal early life stress is associated with pro-inflammatory processes during pregnancy. Brain Behav Immun 2023; 109:285-291. [PMID: 36280180 PMCID: PMC10035632 DOI: 10.1016/j.bbi.2022.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 10/12/2022] [Accepted: 10/15/2022] [Indexed: 11/07/2022] Open
Abstract
Early life stress (ELS) is common in the United States and worldwide, and contributes to the development of psychopathology in individuals with these experiences and their offspring. A growing body of research suggests that early life stress may contribute to adverse health partly through modulation of immune (and particularly inflammatory) responses. Therefore, increased maternal prenatal inflammation has been proposed as a mechanistic pathway by which the observed cross-generational effects of parental early life stress on child neuropsychiatric outcomes may be exerted. We examined associations between early life stress and molecular markers of inflammation (specifically pro-inflammatory gene expression and receptor-mediated transcription factor activity) and a commonly studied circulating marker of inflammation (C-Reactive Protein) in a diverse group of women in or near their third trimester of pregnancy, covarying for age, race/ethnicity, BMI, concurrent infection, concurrent perceived stress, and per capita household income. Mothers who experienced higher levels of early life stress had significantly increased pro-inflammatory (NF-κB) and decreased anti-viral (IRF) transcription factor activity. Transcripts that were up or down regulated in mothers with high ELS were preferentially derived from both CD16+ and CD16- monocytes. Early life stress was not associated with elevated CRP. Taken together, these findings provide preliminary evidence for an association between ELS and a pro-inflammatory transcriptional phenotype during pregnancy that may serve as a mechanistic pathway for cross-generational transmission of the effects of early life stress on mental and physical health.
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Affiliation(s)
| | - Jennifer A Silvers
- Department of Psychology, University of California, Los Angeles, CA, USA
| | - Judith E Carroll
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA; Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA; David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Steve W Cole
- Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA; David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Kharah M Ross
- Centre for Social Sciences, Athabasca University, Athabasca, AB, Canada
| | - Sharon L Ramey
- Fralin Biomedical Research Institute, Virginia Tech, Roanoke, VA
| | - Madeleine U Shalowitz
- Department of Pediatrics, NorthShore University HealthSystem Research Institute, Evanston, IL, USA; Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL; Department of Pediatrics, Rush University Medical Center, Chicago, IL
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Kaliush PR, Conradt E, Kerig PK, Williams PG, Crowell SE. A multilevel developmental psychopathology model of childbirth and the perinatal transition. Dev Psychopathol 2023:1-12. [PMID: 36700362 PMCID: PMC10368796 DOI: 10.1017/s0954579422001389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Despite recent applications of a developmental psychopathology perspective to the perinatal period, these conceptualizations have largely ignored the role that childbirth plays in the perinatal transition. Thus, we present a conceptual model of childbirth as a bridge between prenatal and postnatal health. We argue that biopsychosocial factors during pregnancy influence postnatal health trajectories both directly and indirectly through childbirth experiences, and we focus our review on those indirect effects. In order to frame our model within a developmental psychopathology lens, we first describe "typical" biopsychosocial aspects of pregnancy and childbirth. Then, we explore ways in which these processes may deviate from the norm to result in adverse or traumatic childbirth experiences. We briefly describe early postnatal health trajectories that may follow from these birth experiences, including those which are adaptive despite traumatic childbirth, and we conclude with implications for research and clinical practice. We intend for our model to illuminate the importance of including childbirth in multilevel perinatal research. This advancement is critical for reducing perinatal health disparities and promoting health and well-being among birthing parents and their children.
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Affiliation(s)
- Parisa R. Kaliush
- Department of Psychology, University of Utah, 380 South 1530 East, BEH S 502, Salt Lake City, UT 84112, USA
| | - Elisabeth Conradt
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC 27701, USA
| | - Patricia K. Kerig
- Department of Psychology, University of Utah, 380 South 1530 East, BEH S 502, Salt Lake City, UT 84112, USA
| | - Paula G. Williams
- Department of Psychology, University of Utah, 380 South 1530 East, BEH S 502, Salt Lake City, UT 84112, USA
| | - Sheila E. Crowell
- Department of Psychology, University of Utah, 380 South 1530 East, BEH S 502, Salt Lake City, UT 84112, USA
- Department of Psychiatry, University of Utah, Salt Lake City, UT 84108, USA
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT 84132, USA
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15
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Olhaberry M, Sieverson C. Desarrollo socio-emocional temprano y regulación emocional. Revista Médica Clínica Las Condes 2022. [DOI: 10.1016/j.rmclc.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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16
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Voegtline KM, Dhaurali S, Wainger J, Lauzon S. Ontogeny of the Dyad: the Relationship Between Maternal and Offspring Neuroendocrine Function. Curr Psychiatry Rep 2022; 24:297-306. [PMID: 35451797 PMCID: PMC9648681 DOI: 10.1007/s11920-022-01337-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/24/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE OF REVIEW We review ontogeny of the maternal-offspring neuroendocrine relationship in human pregnancy. We present bidirectional genetic, physiological, and behavioral influences that enhance or disrupt HPA activity and its end product cortisol at the individual level and within the dyad. RECENT FINDINGS Consistent evidence supports that maternal mood and caregiving behavior are associated with maternal and offspring cortisol levels. Select studies support the buffering effects of antidepressant use and maternal positive affect on offspring cortisol. Growing research highlights evocative effects of fetal neuroendocrine activity, antenatal gene transfer, and infant behavioral distress and risk characteristics on maternal cortisol levels and dyadic attunement. There is potential to advance our understanding of the mother-offspring neuroendocrine relationship by consideration of other neuroactive steroids in addition to cortisol, and to consider developmental timing and measurement source in study design. Future study should emphasize in what context or for whom neuroendocrine attunement is adaptive versus maladaptive for mother and child.
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Affiliation(s)
- Kristin M. Voegtline
- Johns Hopkins School of Medicine, Department of Pediatrics,Johns Hopkins Bloomberg School of Public Health, Department of Population, Family and Reproductive Health
| | | | - Julia Wainger
- Johns Hopkins School of Medicine, Department of Gynecology and Obstetrics
| | - Sylvie Lauzon
- Johns Hopkins Bloomberg School of Public Health, Department of Population, Family and Reproductive Health
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17
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Ahmad SI, Shih EW, LeWinn KZ, Rivera L, Graff JC, Mason WA, Karr CJ, Sathyanarayana S, Tylavsky FA, Bush NR. Intergenerational Transmission of Effects of Women's Stressors During Pregnancy: Child Psychopathology and the Protective Role of Parenting. Front Psychiatry 2022; 13:838535. [PMID: 35546925 PMCID: PMC9085155 DOI: 10.3389/fpsyt.2022.838535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 03/23/2022] [Indexed: 12/22/2022] Open
Abstract
Objective Experiences of stress and adversity, such as intimate partner violence, confer risk for psychiatric problems across the life span. The effects of these risks are disproportionately borne by women and their offspring-particularly those from communities of color. The prenatal period is an especially vulnerable period of fetal development, during which time women's experiences of stress can have long-lasting implications for offspring mental health. Importantly, there is a lack of focus on women's capacity for resilience and potential postnatal protective factors that might mitigate these intergenerational risks and inform intervention efforts. The present study examined intergenerational associations between women's prenatal stressors and child executive functioning and externalizing problems, testing maternal parenting quality and child sex as moderators, using a large, prospective, sociodemographically diverse cohort. Methods We used data from 1,034 mother-child dyads (64% Black, 30% White) from the Conditions Affecting Neurocognitive Development and Learning in Early Childhood (CANDLE) pregnancy cohort within the ECHO PATHWAYS consortium. Women's prenatal stressors included stressful life events (pSLE) and intimate partner violence (pIPV). Measures of child psychopathology at age 4-6 included executive functioning and externalizing problems. Parenting behaviors were assessed by trained observers, averaged across two sessions of mother-child interactions. Linear regression models were used to estimate associations between women's prenatal stressors and child psychopathology, adjusting for confounders and assessing moderation effects by maternal parenting quality and child sex. Results Women's exposures to pSLE and pIPV were independently associated with child executive functioning problems and externalizing problems in fully-adjusted models. Maternal parenting quality moderated associations between pSLE and both outcomes, such that higher parenting quality was protective for the associations between women's pSLE and child executive functioning and externalizing problems. No moderation by child sex was found. Discussion Findings from this large, sociodemographically diverse cohort suggest women's exposures to interpersonal violence and major stressful events-common for women during pregnancy-may prenatally program her child's executive functioning and externalizing problems. Women's capacity to provide high quality parenting can buffer this intergenerational risk. Implications for universal and targeted prevention and early intervention efforts to support women's and children's wellbeing are discussed.
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Affiliation(s)
- Shaikh I. Ahmad
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Emily W. Shih
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Kaja Z. LeWinn
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Luisa Rivera
- Department of Anthropology, Emory University, Atlanta, GA, United States
| | - J. Carolyn Graff
- College of Nursing, The University of Tennessee Health Science Center, Memphis, TN, United States
- Center on Developmental Disabilities, The University of Tennessee Health Science Center, Memphis, TN, United States
| | - W. Alex Mason
- Department of Preventative Medicine, The University of Tennessee Health Science Center, Memphis, TN, United States
| | - Catherine J. Karr
- Department of Pediatrics, University of Washington, Seattle, WA, United States
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, United States
| | - Sheela Sathyanarayana
- Department of Pediatrics, University of Washington, Seattle, WA, United States
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, United States
| | - Frances A. Tylavsky
- Department of Preventative Medicine, The University of Tennessee Health Science Center, Memphis, TN, United States
| | - Nicole R. Bush
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, United States
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18
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Mclean MA, Scoten OC, Yu W, Ye XY, Petrie J, Church PT, Soraisham AS, Mirea LS, Weinberg J, Synnes AR, O'Brien K, Grunau RE. Lower Maternal Chronic Physiological Stress and Better Child Behavior at 18 Months: Follow-Up of a Cluster Randomized Trial of Neonatal Intensive Care Unit Family Integrated Care. J Pediatr 2022; 243:107-115.e4. [PMID: 34971651 DOI: 10.1016/j.jpeds.2021.12.055] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 12/15/2021] [Accepted: 12/22/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess whether Family Integrated Care (FICare) in the neonatal intensive care unit improves maternal chronic physiological stress and child behavior at 18 months of corrected age for infants born preterm. STUDY DESIGN Follow-up of a multicenter, prospective cluster-randomized controlled trial comparing FICare and standard care of children born at <33 weeks of gestation and parents, stratified by tertiary neonatal intensive care units, across Canada. Primary outcomes at 18 months of corrected age were maternal stress hormones (cortisol, ie, hair cumulative cortisol [HCC], dehydroepiandrosterone [DHEA]) assayed from hair samples. Secondary outcomes included maternal reports of parenting stress, child behaviors (Internalizing, Externalizing, Dysregulation), and observer-rated caregiving behaviors. Outcomes were analyzed using multilevel modeling. RESULTS We included 126 mother-child dyads from 12 sites (6 FICare sites, n = 83; 6 standard care sites, n = 43). FICare intervention significantly lowered maternal physiological stress as indicated by HCC (B = -0.22 [-0.41, -0.04]) and cortisol/DHEA ratio (B = -0.25 [-0.48, -0.02]), but not DHEA (B = 0.01 [-0.11, 0.14]). Enrollment in FICare led to lower child Internalizing (B = -0.93 [-2.33, 0.02]) and Externalizing behavior T scores (B = -0.91 [-2.25, -0.01]) via improvements to maternal HCC (mediation). FICare buffered the negative effects of high maternal HCC on child Dysregulation T scores (B = -11.40 [-23.01, 0.21]; moderation). For mothers reporting high parenting stress at 18 months, FICare was related to lower Dysregulation T scores via maternal HCC; moderated mediation = -0.17 (-0.41, -0.01). CONCLUSIONS FICare has long-term beneficial effects for mother and child, attenuating maternal chronic physiological stress, and improving child behavior in toddlerhood. CLINICAL TRIAL REGISTRATION NCT01852695.
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Affiliation(s)
- Mia A Mclean
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada; BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Olivia C Scoten
- BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Wayne Yu
- Department of Cellular & Physiological Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Xiang Y Ye
- Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Julie Petrie
- BC Women's Hospital, Vancouver, British Columbia, Canada
| | - Paige T Church
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Joanne Weinberg
- Department of Cellular & Physiological Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anne R Synnes
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada; BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada; BC Women's Hospital, Vancouver, British Columbia, Canada
| | - Karel O'Brien
- Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Ruth E Grunau
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada; BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada; BC Women's Hospital, Vancouver, British Columbia, Canada.
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19
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20
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Gunnar MR, Howland MA. Calibration and recalibration of stress response systems across development: Implications for mental and physical health. Advances in Child Development and Behavior 2022. [DOI: 10.1016/bs.acdb.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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21
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Salmon C, Hehman J. Evolutionary Perspectives on Infant-Mother Conflict. Evolutionary Psychology 2022. [DOI: 10.1007/978-3-030-76000-7_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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22
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Dipietro JA, Kivlighan KT, Voegtline KM, Costigan KA, Moore GA. It takes two: An antenatal to postnatal RDoC framework for investigating the origins of maternal attachment and mother–infant social communication. Dev Psychopathol 2021; 33:1539-1553. [DOI: 10.1017/s0954579421000997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractTransformation of the maternal–fetal relationship into the mother–infant relationship remains an enigmatic process. This progression is considered using a Research Domain Criteria (RDoC) informed approach centered on domains of Arousal/Regulation, Positive/Negative Valence, and Social Processes. One hundred and fifty-eight maternal–fetal dyads began participation during pregnancy, maternal–infant dyads were followed at 6 months postpartum. Women exhibited stability in feelings of attachment to the fetus and infant, and in positive/negative appraisal of pregnancy and motherhood. Elicited maternal physiological arousal to emotionally evocative videos generated fetal heart rate variability and motor activity responses. Parasympathetic (i.e., heart rate variability) suppression in the fetus was associated with more positive and regulated infant social communication in the Face-to-Face Still Face protocol; suppression of maternal respiratory sinus arrhythmia was related to infant affect but in the opposite direction. Maternal ratings of infant temperament aligned with maternal antenatal affective valence. Attachment trajectories characterized by stability from antenatal to postnatal periods were most associated with maternal affective appraisal of pregnancy; shifts were influenced by infant characteristics and maternal sympathetic responsivity. Results illustrate how variation in arousal and regulatory systems of the pregnant woman and fetus operate within the context of maternal positive and negative valence systems to separately and jointly shape affiliation and temperament in early infancy.
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23
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Demers CH, Bagonis MM, Al-Ali K, Garcia SE, Styner MA, Gilmore JH, Hoffman MC, Hankin BL, Davis EP. Exposure to prenatal maternal distress and infant white matter neurodevelopment. Dev Psychopathol 2021; 33:1526-1538. [PMID: 35586027 PMCID: PMC9109943 DOI: 10.1017/s0954579421000742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The prenatal period represents a critical time for brain growth and development. These rapid neurological advances render the fetus susceptible to various influences with life-long implications for mental health. Maternal distress signals are a dominant early life influence, contributing to birth outcomes and risk for offspring psychopathology. This prospective longitudinal study evaluated the association between prenatal maternal distress and infant white matter microstructure. Participants included a racially and socioeconomically diverse sample of 85 mother-infant dyads. Prenatal distress was assessed at 17 and 29 weeks' gestational age (GA). Infant structural data were collected via diffusion tensor imaging at 42-45 weeks' postconceptional age. Findings demonstrated that higher prenatal maternal distress at 29 weeks' GA was associated with increased fractional anisotropy (b = .283, t(64) = 2.319, p = .024) and with increased axial diffusivity (b = .254, t(64) = 2.067, p = .043) within the right anterior cingulate white matter tract. No other significant associations were found with prenatal distress exposure and tract fractional anisotropy or axial diffusivity at 29 weeks' GA, nor earlier in gestation.
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Affiliation(s)
- Catherine H. Demers
- Department of Psychology University of Denver, Denver CO,
USA
- Department of Psychiatry, University of Colorado Anschutz
Medical Campus, Aurora CO, USA
| | - Maria M. Bagonis
- Department of Psychiatry, University of North Carolina at
Chapel Hill, Chapel Hill NC, USA
| | - Khalid Al-Ali
- Department of Psychiatry, University of North Carolina at
Chapel Hill, Chapel Hill NC, USA
| | - Sarah E. Garcia
- Department of Psychology University of Denver, Denver CO,
USA
| | - Martin A. Styner
- Department of Psychiatry, University of North Carolina at
Chapel Hill, Chapel Hill NC, USA
- Department of Computer Science, University of North
Carolina at Chapel Hill, Chapel Hill NC, USA
| | - John H. Gilmore
- Department of Psychiatry, University of North Carolina at
Chapel Hill, Chapel Hill NC, USA
| | - M. Camille Hoffman
- Department of Psychiatry, University of Colorado Anschutz
Medical Campus, Aurora CO, USA
- Department of Obstetrics and Gynecology, Division of
Maternal and Fetal Medicine, University of Colorado Denver School of Medicine,
Aurora, Colorado, USA
| | - Benjamin L. Hankin
- Department of Psychology, University of Illinois at
Urbana-Champaign, Champaign IL, USA
| | - Elysia Poggi Davis
- Department of Psychology University of Denver, Denver CO,
USA
- Department of Psychiatry and Human Behavior, University of
California, Irvine, CA, USA
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Fox M. Discrimination as a Moderator of the Effects of Acculturation and Cultural Values on Mental Health Among Pregnant and Postpartum Latina Women. Am Anthropol 2021; 123:780-804. [PMID: 36776224 PMCID: PMC9909989 DOI: 10.1111/aman.13665] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
It is important to consider how identity, culture, and social adversity influence maternal mental health among Latina women both because this community faces unique cultural stressors and also because factors that undermine women's mental health during pregnancy and postpartum could have injurious consequences that cascade across generations. This study uses data from a questionnaire administered to Latina pregnant and postpartum women in Southern California, examining cultural orientation, discrimination, and mental health. Results demonstrate mental health benefits for both American and Latino cultural orientations, but the latter's benefit of lower anxiety was only apparent with high discrimination. American and Latino cultural values systems had opposite relationships with depression, with the latter protective and also positively associated with happiness. More traditional gender roles values were associated with greater perceived stress and lower happiness. Different aspects of familism had opposite effects as obligation was associated with less anxiety and referent (defining oneself communally with kin) with more. Results suggest that social adversity and cultural identity and values influence maternal psychology. This study makes a unique contribution by integrating anthropological and biopsychosocial methods and theories towards addressing an issue of public-health importance.
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Affiliation(s)
- Molly Fox
- Departments of Anthropology and Psychiatry & Biobehavioral Sciences, UCLA, Los Angeles, CA 90095, USA
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Braren SH, Perry RE, Ribner A, Brandes-Aitken A, Brito N, Blair C. Prenatal mother-father cortisol linkage predicts infant executive functions at 24 months. Dev Psychobiol 2021; 63:e22151. [PMID: 34674244 DOI: 10.1002/dev.22151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 05/14/2021] [Accepted: 05/17/2021] [Indexed: 01/19/2023]
Abstract
The present study investigated associations between prenatal mother-father cortisol linkage and infant executive functions. Data come from an international sample (N = 358) of predominantly white and middle- to upper-class first-time parents. During late pregnancy, parents collected diurnal salivary cortisol samples and reported on levels of psychological stress. At 24 months, children completed a battery of executive function tasks. Parent cortisol linkage was operationalized as the time-dependent, within-dyad association between maternal and paternal diurnal cortisol. Results indicated that prenatal linkage was positively related to infant executive functions, suggesting that stronger mother-father cortisol linkage was associated with higher executive function scores. Additionally, this relation was moderated by paternal average cortisol levels such that executive function scores were lower when fathers had higher average cortisol levels and linkage was weak. This association suggests that elevated paternal cortisol amplifies the negative relation between lower cortisol linkage and lower infant executive function scores. Importantly, these findings were observed while controlling for observational measures of caregiving and self-report measures of psychosocial functioning and infant social-emotional behavior. These results suggest that prenatal linkage of mother's and father's stress physiology plays a potentially important part in programming and regulating infant neurocognitive development.
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Affiliation(s)
| | | | - Andrew Ribner
- Department of Applied Psychology, New York University, USA
| | | | - Natalie Brito
- Department of Applied Psychology, New York University, USA
| | - Clancy Blair
- Department of Applied Psychology, New York University, USA
| | -
- Department of Applied Psychology, New York University, USA.,Centre for Family Research, University of Cambridge, UK.,Faculty of Social Sciences, University of Leiden, The Netherlands
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Ali AM, Alkhamees AA, Hori H, Kim Y, Kunugi H. The Depression Anxiety Stress Scale 21: Development and Validation of the Depression Anxiety Stress Scale 8-Item in Psychiatric Patients and the General Public for Easier Mental Health Measurement in a Post COVID-19 World. Int J Environ Res Public Health 2021; 18:10142. [PMID: 34639443 PMCID: PMC8507889 DOI: 10.3390/ijerph181910142] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/22/2021] [Accepted: 09/23/2021] [Indexed: 01/15/2023]
Abstract
Despite extensive investigations of the Depression Anxiety Stress Scales-21 (DASS-21) since its development in 1995, its factor structure and other psychometric properties still need to be firmly established, with several calls for revising its item structure. Employing confirmatory factor analysis (CFA), this study examined the factor structure of the DASS-21 and five shortened versions of the DASS-21 among psychiatric patients (N = 168) and the general public (N = 992) during the COVID-19 confinement period in Saudi Arabia. Multigroup CFA, Mann Whitney W test, Spearman's correlation, and coefficient alpha were used to examine the shortened versions of the DASS-21 (DASS-13, DASS-12, DASS-9 (two versions), and DASS-8) for invariance across age and gender groups, discriminant validity, predictive validity, item coverage, and internal consistency, respectively. Compared with the DASS-21, all three-factor structures of the shortened versions expressed good fit, with the DASS-8 demonstrating the best fit and highest item loadings on the corresponding factors in both samples (χ2(16, 15) = 16.5, 67.0; p = 0.420, 0.001; CFI = 1.000, 0.998; TLI = 0.999, 0.997; RMSEA = 0.013, 0.059, SRMR = 0.0186, 0.0203). The DASS-8 expressed configural, metric, and scalar invariance across age and gender groups. Its internal consistency was comparable to other versions (α = 0.94). Strong positive correlations of the DASS-8 and its subscales with the DASS-21 and its subscales (r = 0.97 to 0.81) suggest adequate item coverage and good predictive validity of this version. The DASS-8 and its subscales distinguished the clinical sample from the general public at the same level of significance expressed by the DASS-21 and other shortened versions, supporting its discriminant validity. Neither the DASS-21 nor the shortened versions distinguished patients diagnosed with depression and anxiety from each other or from other psychiatric conditions. The DASS-8 represents a valid short version of the DASS-21, which may be useful in research and clinical practice for quick identification of individuals with potential psychopathologies. Diagnosing depression/anxiety disorders may be further confirmed in a next step by clinician-facilitated examinations. Brevity of the DASS-21 would save time and effort used for filling the questionnaire and support comprehensive assessments by allowing the inclusion of more measures on test batteries.
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Affiliation(s)
- Amira Mohammed Ali
- Department of Behavioral Medicine, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo 187-8553, Japan; (H.H.); (Y.K.)
- Department of Psychiatric Nursing and Mental Health, Faculty of Nursing, Alexandria University, Alexandria 21527, Egypt
| | - Abdulmajeed A. Alkhamees
- Department of Medicine, College of Medicine and Medical Sciences, Qassim University, Buraydah 52571, Al Qassim, Saudi Arabia;
| | - Hiroaki Hori
- Department of Behavioral Medicine, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo 187-8553, Japan; (H.H.); (Y.K.)
| | - Yoshiharu Kim
- Department of Behavioral Medicine, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo 187-8553, Japan; (H.H.); (Y.K.)
| | - Hiroshi Kunugi
- Department of Psychiatry, Teikyo University School of Medicine, Tokyo 173-8605, Japan;
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo 187-8502, Japan
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27
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Kaliush PR, Terrell S, Vlisides-Henry RD, Lin B, Neff D, Shakiba N, Conradt E, Crowell SE. Influences of adversity across the lifespan on respiratory sinus arrhythmia during pregnancy. Dev Psychobiol 2021; 63:e22132. [PMID: 34053065 DOI: 10.1002/dev.22132] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 03/26/2021] [Accepted: 04/28/2021] [Indexed: 12/27/2022]
Abstract
There is limited understanding of factors across the lifespan that influence pregnant women's respiratory sinus arrhythmia (RSA), which could have implications for their health and offspring development. We examined associations among 162 English- and Spanish-speaking pregnant women's childhood maltreatment history, emotion dysregulation, recent life stress, and resting RSA during the third trimester. Moderated mediation analyses indicated that more severe childhood maltreatment history (95% confidence interval (CI) [0.26, 0.63]) and higher emotion dysregulation (95% CI [0.001, 0.006]) predicted more stress during pregnancy, and childhood maltreatment history interacted with emotion dysregulation to predict resting RSA (95% CI [-0.04, -0.0003]). Exploratory analyses revealed that women's health-related stress during pregnancy mediated the relation between emotion dysregulation and RSA regardless of childhood maltreatment severity (95% CI [-0.007, -0.002]). These findings suggest that women's resting RSA during pregnancy may reflect physical and emotional stress accumulation across the lifespan and that relations between early life adversity and prenatal psychophysiology may be buffered by protective factors, such as emotion regulation. In addition, these findings underscore the importance of distinguishing between types of prenatal stress. Given the implications for women's health and offspring development, we urge researchers to continue exploring factors associated with pregnant women's psychophysiology.
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Affiliation(s)
| | - Sarah Terrell
- Department of Human Development and Family Studies, Pennsylvania State University, Pennsylvania, USA
| | | | - Betty Lin
- Department of Psychology, University at Albany, State University of New York, New York, USA
| | - Dylan Neff
- Department of Psychology, University of Utah, Utah, USA
| | - Nila Shakiba
- Department of Psychology, University of Utah, Utah, USA
| | - Elisabeth Conradt
- Department of Psychology, University of Utah, Utah, USA.,Department of Pediatrics, University of Utah, Utah, USA.,Department of Obstetrics and Gynecology, University of Utah, Utah, USA
| | - Sheila E Crowell
- Department of Psychology, University of Utah, Utah, USA.,Department of Obstetrics and Gynecology, University of Utah, Utah, USA.,Department of Psychiatry, University of Utah, Utah, USA
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28
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Xie S, Hu Y, Fang L, Chen S, Botchway BOA, Tan X, Fang M, Hu Z. The association of oxytocin with major depressive disorder: role of confounding effects of antidepressants. Rev Neurosci 2021; 33:59-77. [PMID: 33989469 DOI: 10.1515/revneuro-2020-0128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 04/18/2021] [Indexed: 01/15/2023]
Abstract
Major depressive disorder is a genetic susceptible disease, and a psychiatric syndrome with a high rate of incidence and recurrence. Because of its complexity concerning etiology and pathogenesis, the cure rate of first-line antidepressants is low. In recent years, accumulative evidences revealed that oxytocin act as a physiological or pathological participant in a variety of complex neuropsychological activities, including major depressive disorder. Six electronic databases (Web of Science, PubMed, Scopus, Google Scholar, CNKI, and Wanfang) were employed for researching relevant publications. At last, 226 articles were extracted. The current review addresses the correlation of the oxytocin system and major depressive disorder. Besides, we summarize the mechanisms by which the oxytocin system exerts potential antidepressant effects, including regulating neuronal activity, influencing neuroplasticity and regeneration, altering neurotransmitter release, down regulating hypothalamic-pituitary-adrenal axis, anti-inflammatory, antioxidation, and genetic effects. Increasing evidence shows that oxytocin and its receptor gene may play a potential role in major depressive disorder. Future research should focus on the predictive ability of the oxytocin system as a biomarker, as well as its role in targeted prevention and early intervention of major depressive disorder.
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Affiliation(s)
- Shiyi Xie
- Obstetrics & Gynecology Department, Integrated Chinese and West Medicine Hospital Affiliated to Zhejiang Chinese Medicine University, 208 Huanchendong Road, 310003Hangzhou, China.,Clinical Medical College, Zhejiang Chinese Medical University, 310053Hangzhou, China
| | - Yan Hu
- Clinical Medical College, Zhejiang Chinese Medical University, 310053Hangzhou, China
| | - Li Fang
- Obstetrics & Gynecology Department, Integrated Chinese and West Medicine Hospital Affiliated to Zhejiang Chinese Medicine University, 208 Huanchendong Road, 310003Hangzhou, China
| | - Shijia Chen
- Institute of Neuroscience, Zhejiang University School of Medicine, 310058Hangzhou, China
| | - Benson O A Botchway
- Institute of Neuroscience, Zhejiang University School of Medicine, 310058Hangzhou, China
| | - Xiaoning Tan
- Institute of Neuroscience, Zhejiang University School of Medicine, 310058Hangzhou, China
| | - Marong Fang
- Institute of Neuroscience, Zhejiang University School of Medicine, 310058Hangzhou, China
| | - Zhiying Hu
- Obstetrics & Gynecology Department, Integrated Chinese and West Medicine Hospital Affiliated to Zhejiang Chinese Medicine University, 208 Huanchendong Road, 310003Hangzhou, China
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29
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Papousek I, Weiss EM, Moertl MG, Schmid-Zalaudek K, Krenn E, Lessiak V, Lackner HK. Unaffected Memory and Inhibitory Functioning Several Weeks Postpartum in Women with Pregnancy Complicated by Preeclampsia. Behav Sci (Basel) 2021; 11:bs11040055. [PMID: 33919495 PMCID: PMC8072974 DOI: 10.3390/bs11040055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/10/2021] [Accepted: 04/16/2021] [Indexed: 01/12/2023] Open
Abstract
Several studies reported impaired cognitive functioning after pregnancy complicated by preeclampsia. The present study examined cognitive and executive functioning in women with preeclampsia at a time at which immediate effects of gestation have resolved, brain damage due to other risk factors have not yet manifested, and impairments may thus primarily occur as a result of the huge stress induced by the potentially life threatening condition. Verbal learning/memory (California Verbal Learning Test) and inhibitory functioning (Mittenecker Pointing Test) of 35 women with preeclampsia and 38 women with uncomplicated pregnancy were followed over five measurement time points during the period from 16 to 48 weeks postpartum. A further control group comprised 40 women with no history of recent pregnancy. The groups did not differ in their verbal learning/memory performance. Higher levels of currently experienced everyday-life stress were associated with poorer inhibitory control/greater stereotypy in responding, but this effect was not directly connected with pregnancy complications. Taken together, the findings do not indicate rapid-onset cognitive impairment after preeclampsia, brought about by its extremely stressful nature or other factors that take effect during gestation. Deficits observed in later life may develop on a long-term basis through late-diagnosed hypertension and unfavorable lifestyle factors. The large time window in which exaggerated cognitive decline can be prevented or mitigated should be utilized for the control of risk factors and interventions to improve lifestyle where appropriate.
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Affiliation(s)
- Ilona Papousek
- Biological Psychology Unit, Department of Psychology, University of Graz, 8010 Graz, Austria; (I.P.); (E.K.)
| | - Elisabeth M. Weiss
- Clinical Psychology Unit, Department of Psychology, University of Innsbruck, 6020 Innsbruck, Austria;
| | - Manfred G. Moertl
- Clinical Center, Department of Obstetrics and Gynecology, 9020 Klagenfurt, Austria; (M.G.M.); (V.L.)
| | - Karin Schmid-Zalaudek
- Biological Psychology Unit, Department of Psychology, University of Graz, 8010 Graz, Austria; (I.P.); (E.K.)
| | - Edina Krenn
- Biological Psychology Unit, Department of Psychology, University of Graz, 8010 Graz, Austria; (I.P.); (E.K.)
| | - Verena Lessiak
- Clinical Center, Department of Obstetrics and Gynecology, 9020 Klagenfurt, Austria; (M.G.M.); (V.L.)
| | - Helmut K. Lackner
- Otto Loewi Research Center, Division of Physiology, Medical University of Graz, 8010 Graz, Austria;
- Correspondence: ; Tel.: +43-316-385-73863
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30
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Perzow SED, Hennessey EMP, Hoffman MC, Grote NK, Davis EP, Hankin BL. Mental health of pregnant and postpartum women in response to the COVID-19 pandemic. J Affect Disord Rep 2021; 4:100123. [PMID: 33649750 PMCID: PMC7904453 DOI: 10.1016/j.jadr.2021.100123] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/19/2021] [Accepted: 02/20/2021] [Indexed: 12/21/2022] Open
Abstract
Background The COVID-19 pandemic has been uniquely challenging for pregnant and postpartum women. Uncontrollable stress amplifies risk for maternal depression and anxiety, which are linked to adverse mother and child outcomes. This study examined change in internalizing symptoms from before to during the COVID-19 pandemic among pregnant and postpartum women longitudinally, and investigated moderation by loneliness and other contextual risk factors. Methods 135 women (Mage = 31.81; 26% Latina, 55% non-Hispanic White, 11% Black; 39% low-income) enrolled in an existing prospective study completed self-report questionnaires including the EPDS and STAI-short form during early pregnancy, prior to COVID-19, and during COVID-19. Results Depressive symptoms were higher during COVID-19 compared to pre-COVID-19 and just as high as during early pregnancy. Anxiety symptoms were higher during COVID-19 compared to both pre-COVID-19 and early pregnancy. Higher loneliness was associated with increased depressive symptoms during COVID-19. Greater COVID-19 specific adversity was linked to greater increases in internalizing symptoms during COVID-19. Lower income-to-needs-ratio most strongly predicted symptoms during early pregnancy. Limitations The present study is longitudinal, but the correlational nature of the data precludes causal conclusions regarding the effect of the pandemic on mental health. Conclusion Longitudinal analyses suggest the COVID-19 pandemic resulted in increased internalizing symptoms among diverse pregnant and postpartum women. Interpersonal and contextual factors exacerbate risk and the impact of the pandemic on women's mental health. Identifying mothers at-risk for depression and anxiety may increase treatment utilization, mitigate fetal and infant exposure to maternal depression and anxiety, and help prevent adverse child outcomes.
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Affiliation(s)
| | | | - M Camille Hoffman
- University of Colorado School of Medicine, Department of Obstetrics and Gynecology, USA
| | - Nancy K Grote
- University of Washington, School of Social Work, USA
| | - Elysia Poggi Davis
- University of Denver, Department of Psychology, USA.,University of California, Irvine Department of Psychiatry and Human Behavior, USA
| | - Benjamin L Hankin
- The University of Illinois at Urbana-Champaign, Department of Psychology, USA
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Racine N, McDonald S, Chaput K, Tough S, Madigan S. Pathways from Maternal Adverse Childhood Experiences to Substance Use in Pregnancy: Findings from the All Our Families Cohort. J Womens Health (Larchmt) 2021; 30:1795-1803. [PMID: 33524303 DOI: 10.1089/jwh.2020.8632] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background: Exposure to adverse childhood experiences (ACEs) is a risk factor for maternal substance use in pregnancy, however, mechanisms by which maternal ACEs may influence substance use in pregnancy have not been fully explored. The current study examines the association between maternal ACEs and substance use in pregnancy (i.e., alcohol, smoking, and drug use) and explores mediating pathways. Methods: A community sample of 1,994 women as part of the All Our Families Cohort were recruited in pregnancy in Calgary, Canada, between 2008 and 2011. Women provided retrospective reports of ACE exposure before age 18 as well as reports of demographic information, substance use (i.e., moderate-to-high alcohol use, any smoking, or any drug use), a previous history of substance use difficulties, and depressive symptoms during pregnancy. Path analyses were used to examine maternal income, education, depression, and previous substance use as mediating variables. Results: There were significant indirect associations between maternal ACEs and maternal substance use in pregnancy via maternal education (β = 0.05, p < 0.001), previous substance use (β = 0.01, p = 0.001), and depression (β = 0.02, p = 0.02). The direct effect of maternal ACEs on maternal substance in pregnancy remained significant after accounting for the indirect effects (β = 0.22, 95% CI = 0.15-0.29, p < 0.001). Conclusions: Exposure to adversity in childhood can lead to socioeconomic and mental health difficulties that increase risk for substance use in pregnancy. Addressing these difficulties before pregnancy may help to reduce the potential for substance use in pregnancy.
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Affiliation(s)
- Nicole Racine
- Department of Psychology, Faculty of Arts, University of Calgary, Calgary, Canada
| | - Sheila McDonald
- Department of Community Health Sciences, University of Calgary, Calgary, Canada.,Department of Pediatrics, University of Calgary, Calgary, Canada
| | - Kathleen Chaput
- Department of Community Health Sciences, University of Calgary, Calgary, Canada.,Department of Obstetrics and Gynecology, University of Calgary, Calgary, Canada.,Alberta Children's Hospital Research Institute, Calgary, Canada
| | - Suzanne Tough
- Department of Community Health Sciences, University of Calgary, Calgary, Canada.,Department of Obstetrics and Gynecology, University of Calgary, Calgary, Canada.,Alberta Children's Hospital Research Institute, Calgary, Canada
| | - Sheri Madigan
- Department of Psychology, Faculty of Arts, University of Calgary, Calgary, Canada.,Alberta Children's Hospital Research Institute, Calgary, Canada
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Vlisides-Henry RD, Deboeck PR, Grill-Velasquez W, Mackey S, Ramadurai DKA, Urry JO, Neff D, Terrell S, Gao MM, Thomas LR, Conradt E, Crowell SE. Behavioral and physiological stress responses: Within-person concordance during pregnancy. Biol Psychol 2021; 159:108027. [PMID: 33476701 DOI: 10.1016/j.biopsycho.2021.108027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 01/12/2021] [Accepted: 01/13/2021] [Indexed: 12/17/2022]
Abstract
During pregnancy, a woman's emotions can have longstanding implications for both her own and her child's health. Within-person emotional concordance refers to the simultaneous measurement of emotional responses across multiple levels of analysis. This method may provide insight into how pregnant women experience emotions in response to stress. We enrolled 162 pregnant women and assessed concordance through autonomic physiology (electrodermal activity [EDA], respiratory sinus arrhythmia [RSA]), and coded behavior (Prosocial, Flight, Displacement) during the Trier Social Stress Test-Speech. We used multilevel models to examine behavioral-physiological concordance and whether self-reported emotion dysregulation moderated these effects. Participants exhibited EDA-Prosocial concordance, suggesting that prosocial behavior may be a marker of stress. Emotion dysregulation did not moderate concordance. These findings provide novel information about behavioral coping to stress in pregnancy. Given the importance of observed behavior in the maintenance and treatment of psychopathology, these findings may provide a launchpad for future perinatal intervention research.
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Affiliation(s)
- Robert D Vlisides-Henry
- 380 S 1530 E, Room 502, Dept. of Psychology, University of Utah, Salt Lake City, UT 84112, USA.
| | - Pascal R Deboeck
- 380 S 1530 E, Room 502, Dept. of Psychology, University of Utah, Salt Lake City, UT 84112, USA
| | - Wendy Grill-Velasquez
- 380 S 1530 E, Room 502, Dept. of Psychology, University of Utah, Salt Lake City, UT 84112, USA
| | - Shantavia Mackey
- 380 S 1530 E, Room 502, Dept. of Psychology, University of Utah, Salt Lake City, UT 84112, USA
| | - Dinesh K A Ramadurai
- 380 S 1530 E, Room 502, Dept. of Psychology, University of Utah, Salt Lake City, UT 84112, USA
| | - Joshua O Urry
- 380 S 1530 E, Room 502, Dept. of Psychology, University of Utah, Salt Lake City, UT 84112, USA
| | - Dylan Neff
- 380 S 1530 E, Room 502, Dept. of Psychology, University of Utah, Salt Lake City, UT 84112, USA
| | - Sarah Terrell
- 115 Health and Human Development Building, Dept. of Human Development and Family Studies, Pennsylvania State University, State College, PA 16802, USA
| | - Mengyu Miranda Gao
- 380 S 1530 E, Room 502, Dept. of Psychology, University of Utah, Salt Lake City, UT 84112, USA
| | - Leah R Thomas
- 380 S 1530 E, Room 502, Dept. of Psychology, University of Utah, Salt Lake City, UT 84112, USA
| | - Elisabeth Conradt
- 380 S 1530 E, Room 502, Dept. of Psychology, University of Utah, Salt Lake City, UT 84112, USA; 30 N 1900 E, Dept. of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT 84132, USA; 295 Chipeta Way, Dept. of Pediatrics, University of Utah, Salt Lake City, UT 84108, USA
| | - Sheila E Crowell
- 380 S 1530 E, Room 502, Dept. of Psychology, University of Utah, Salt Lake City, UT 84112, USA; 501 Chipeta Way, Dept. of Psychiatry, University of Utah, Salt Lake City, UT 84108, USA; 30 N 1900 E, Dept. of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT 84132, USA.
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33
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Ertmann RK, Bang CW, Kriegbaum M, Væver MS, Kragstrup J, Siersma V, Wilson P, Lutterodt MC, Smith-Nielsen J. What factors are most important for the development of the maternal-fetal relationship? A prospective study among pregnant women in Danish general practice. BMC Psychol 2021; 9:2. [PMID: 33397501 PMCID: PMC7784374 DOI: 10.1186/s40359-020-00499-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 12/02/2020] [Indexed: 12/13/2022] Open
Abstract
Background Development of the maternal antenatal attachment (MAA) constitutes an important aspect of the transition into motherhood. Early identification of women at risk of developing a poor MAA provides possibilities for preventive interventions targeting maternal mental health and the emerging mother-infant relationship. In this study, we investigate the relative importance of an extensive set of psychosocial, pregnancy-related, and physiological factors measured in the first trimester of pregnancy for MAA measured in third trimester. Methods A prospective study was conducted among pregnant women in Danish general practice (GP). Data were obtained in the first and the third trimester from pregnancy health records and electronic questionnaires associated with routine GP antenatal care visits. The Maternal Antenatal Attachment Scale (MAAS) was used to assess maternal antenatal attachment. The relative importance of potential determinants of maternal antenatal attachment was assessed by the relative contribution of each factor to the fit (R2) calculated from multivariable regression models. Results The sample consisted of 1328 women. Low antenatal attachment (Total MAAS ≤ 75) was observed for 513 (38.6%) women. Perceived social support (having someone to talk to and having access to practical help when needed) emerged as the most important determinant. Furthermore, scores on the MAAS decreased with worse self-rated health, poor physical fitness, depression, increasing age, having given birth previously, and higher education. Conclusion Pregnant women reporting lack of social support and general low physical and mental well-being early in pregnancy may be at risk for developing a poor MAA. An approach targeting both psychosocial and physiological well-being may positively influence expectant mothers’ successful adaptation to motherhood.
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Affiliation(s)
- Ruth K Ertmann
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Christine W Bang
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Margit Kriegbaum
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Mette S Væver
- Departmant of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Jakob Kragstrup
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Volkert Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Philip Wilson
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Centre for Rural Health, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK
| | - Melissa C Lutterodt
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Abstract
Research shows that a woman's brain and body undergo drastic changes to support her transition to parenthood during the perinatal period. The presence of this plasticity suggests that mothers' brains may be changed by their experiences. Exposure to severe stress may disrupt adaptive changes in the maternal brain and further impact the neural circuits of stress regulation and maternal motivation. Emerging literature of human mothers provides evidence that stressful experience, whether from the past or present environment, is associated with altered responses to infant cues in brain circuits that support maternal motivation, emotion regulation, and empathy. Interventions that reduce stress levels in mothers may reverse the negative impact of stress exposure on the maternal brain. Finally, outstanding questions regarding the timing, chronicity, types, and severity of stress exposure, as well as study design to identify the causal impact of stress, and the role of race/ethnicity are discussed.
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Affiliation(s)
- Pilyoung Kim
- Department of Psychology, University of Denver, Denver, CO, United States.
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35
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Vlisides-Henry RD, Gao M, Thomas L, Kaliush PR, Conradt E, Crowell SE. Digital Phenotyping of Emotion Dysregulation Across Lifespan Transitions to Better Understand Psychopathology Risk. Front Psychiatry 2021; 12:618442. [PMID: 34108893 PMCID: PMC8183608 DOI: 10.3389/fpsyt.2021.618442] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 04/26/2021] [Indexed: 11/13/2022] Open
Abstract
Ethical and consensual digital phenotyping through smartphone activity (i. e., passive behavior monitoring) permits measurement of temporal risk trajectories unlike ever before. This data collection modality may be particularly well-suited for capturing emotion dysregulation, a transdiagnostic risk factor for psychopathology, across lifespan transitions. Adolescence, emerging adulthood, and perinatal transitions are particularly sensitive developmental periods, often marked by increased distress. These participant groups are typically assessed with laboratory-based methods that can be costly and burdensome. Passive monitoring presents a relatively cost-effective and unobtrusive way to gather rich and objective information about emotion dysregulation and risk behaviors. We first discuss key theoretically-driven concepts pertaining to emotion dysregulation and passive monitoring. We then identify variables that can be measured passively and hold promise for better understanding emotion dysregulation. For example, two strong markers of emotion dysregulation are sleep disturbance and problematic use of Internet/social media (i.e., use that prompts negative emotions/outcomes). Variables related to mobility are also potentially useful markers, though these variables should be tailored to fit unique features of each developmental stage. Finally, we offer our perspective on candidate digital variables that may prove useful for each developmental transition. Smartphone-based passive monitoring is a rigorous method that can elucidate psychopathology risk across human development. Nonetheless, its use requires researchers to weigh unique ethical considerations, examine relevant theory, and consider developmentally-specific lifespan features that may affect implementation.
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Affiliation(s)
| | - Mengyu Gao
- Department of Psychology, University of Utah, Salt Lake City, UT, United States
| | - Leah Thomas
- Department of Psychology, University of Utah, Salt Lake City, UT, United States
| | - Parisa R Kaliush
- Department of Psychology, University of Utah, Salt Lake City, UT, United States
| | - Elisabeth Conradt
- Department of Psychology, University of Utah, Salt Lake City, UT, United States.,Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, United States.,Department of Pediatrics, University of Utah, Salt Lake City, UT, United States
| | - Sheila E Crowell
- Department of Psychology, University of Utah, Salt Lake City, UT, United States.,Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, United States.,Department of Psychiatry, University of Utah, Salt Lake City, UT, United States
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36
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Holmberg E, Teppola T, Pajulo M, Davis EP, Nolvi S, Kataja EL, Sinervä E, Karlsson L, Karlsson H, Korja R. Maternal Anxiety Symptoms and Self-Regulation Capacity Are Associated With the Unpredictability of Maternal Sensory Signals in Caregiving Behavior. Front Psychol 2020; 11:564158. [PMID: 33414740 PMCID: PMC7782240 DOI: 10.3389/fpsyg.2020.564158] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 11/24/2020] [Indexed: 11/16/2022] Open
Abstract
The unpredictability of maternal sensory signals in caregiving behavior has been recently found to be linked with infant neurodevelopment. The research area is new, and very little is yet known, how maternal anxiety and depressive symptoms and specific parental characteristics relate to the unpredictable maternal care. The aims of the current study were to explore how pre- and postnatal maternal anxiety and depressive symptoms and self-regulation capacity associate with the unpredictability of maternal sensory signals. The study population consisted of 177 mother-infant dyads. The unpredictability of the maternal sensory signals was explored from the video-recorded mother-infant free play situation when the infant was 8 months of age. Pre- and postnatal anxiety and depressive symptoms were measured by questionnaires prenatally at gwks 14, 24, 34, and 3 and 6 months postpartum. Maternal self-regulation capacity, a trait considered to be stable in adulthood, was assessed using adult temperament questionnaire when the infant was 12 months of age. We found that elevated prenatal maternal anxiety symptoms associated with higher unpredictability in the maternal care while depressive symptoms were unrelated to the unpredictability of maternal care. Moreover, the association was moderated by maternal self-regulation capacity, as higher anxiety symptoms during pre-and postnatal period were associated more unpredictability among the mothers with low self-regulation capacity. The combination of higher amount of maternal anxiety symptoms and lower self-regulation capacity seems to constitute specific risk for the unpredictable maternal care.
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Affiliation(s)
- Eeva Holmberg
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Institute of Clinical Medicine, University of Turku, Turku, Finland.,Department of Psychology, University of Turku, Turku, Finland
| | - Taija Teppola
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Institute of Clinical Medicine, University of Turku, Turku, Finland.,Department of Psychology, University of Turku, Turku, Finland
| | - Marjukka Pajulo
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Institute of Clinical Medicine, University of Turku, Turku, Finland.,Department of Child Psychiatry, Turku University Hospital and University of Turku, Turku, Finland
| | - Elysia Poggi Davis
- Department of Psychology, University of Denver, Denver, CO, United States.,Department of Psychiatry and Human Behavior, University of California, Irvine, Irvine, CA, United States
| | - Saara Nolvi
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Institute of Clinical Medicine, University of Turku, Turku, Finland.,Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Turku, Finland.,Department of Psychology and Speech-Language Pathology, Turku Institute for Advanced Studies, University of Turku, Turku, Finland.,Charité Universitätsmedizin Berlin, a Corporate Member of Freie Universität Berlin, Humboldt - Univeristät zu Berlin, Berlin, Germany
| | - Eeva-Leena Kataja
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Institute of Clinical Medicine, University of Turku, Turku, Finland.,Department of Psychology, University of Turku, Turku, Finland
| | - Eija Sinervä
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Institute of Clinical Medicine, University of Turku, Turku, Finland
| | - Linnea Karlsson
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Institute of Clinical Medicine, University of Turku, Turku, Finland.,Department of Child Psychiatry, Turku University Hospital and University of Turku, Turku, Finland.,Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Turku, Finland
| | - Hasse Karlsson
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Institute of Clinical Medicine, University of Turku, Turku, Finland.,Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Turku, Finland.,Department of Psychiatry, University of Turku and Hospital District of Southwest Finland, Turku, Finland
| | - Riikka Korja
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Institute of Clinical Medicine, University of Turku, Turku, Finland.,Department of Psychology, University of Turku, Turku, Finland
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Kaliush PR, Gao MM, Vlisides-Henry RD, Thomas LR, Butner JE, Conradt E, Crowell SE. Perinatal foundations of personality pathology from a dynamical systems perspective. Curr Opin Psychol 2021; 37:121-8. [PMID: 33444894 DOI: 10.1016/j.copsyc.2020.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 11/17/2020] [Accepted: 12/07/2020] [Indexed: 11/21/2022]
Abstract
The development of personality pathology is an interactive process between biologically based susceptibilities, interpersonal patterns, and contextual factors across the lifespan. In this paper, we argue that these interactions begin before birth. We describe the perinatal period (i.e. pregnancy and up to one year postpartum) as a sensitive developmental window during which regulatory and stress response systems that confer risk for personality pathology begin forming. In addition, we present converging evidence for significant associations between perinatal factors and later life personality disorders. Finally, we present this perinatal perspective through the lens of dynamical systems theory and emphasize the promise of this framework for guiding future personality disorder research, prevention, and intervention.
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Abstract
OBJECTIVE It is widely assumed that glucocorticoids represent a primary mechanism through which exposure to adversity and maternal psychological distress shape prenatal developmental trajectories of both mother and fetus. However, despite repeated investigations and the fact that prenatal cortisol has been reliably linked to developmental outcomes, the empirical evidence supporting an association between prenatal cortisol and maternal distress is scarce. In this study, a novel approach to assessing links between maternal prenatal psychological distress and gestational cortisol profiles, general growth mixture modeling (GGMM), was applied. METHOD Measures of pregnancy anxiety, perceived stress, and state anxiety and depressive symptoms as well as plasma samples (for determination of cortisol) were collected from 250 women 4 times during pregnancy. RESULTS Using GGMM, 3 cortisol trajectory groups were identified, including a typical group (n = 199) that exhibited the expected steady increase in cortisol throughout gestation, a steep group (n = 31) displaying an accelerated increase in cortisol over the course of pregnancy relative to the typical group, and a flat group (n = 20) with relatively higher cortisol levels early in pregnancy that plateaued in midgestation. Women reporting the highest distress scores exhibited trajectories expected to be associated with the least optimal developmental outcomes (flatter trajectories characterized by relatively higher levels early in gestation and lower levels late in gestation). CONCLUSIONS These findings suggest that psychological distress during pregnancy is associated with unique prenatal cortisol profiles and support further examination of this link, to enable continued evaluation of a plausible biological pathway by which maternal psychological distress programs fetal development. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Braren SH, Brandes-Aitken A, Ribner A, Perry RE, Blair C. Maternal psychological stress moderates diurnal cortisol linkage in expectant fathers and mothers during late pregnancy. Psychoneuroendocrinology 2020; 111:104474. [PMID: 31731137 DOI: 10.1016/j.psyneuen.2019.104474] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 09/10/2019] [Accepted: 10/08/2019] [Indexed: 12/20/2022]
Abstract
Using data from a large international sample (N = 385) of first-time expectant parents, the current analysis investigated whether parents demonstrated diurnal cortisol linkage in late pregnancy and whether self-reported psychological stress moderated this linkage. At approximately 36 weeks gestation, mothers and fathers collected saliva samples in their home at three times on two consecutive days and reported on their psychological stress. Results from multilevel models indicated that there was significant positive within-couple diurnal cortisol linkage on average for the whole sample. However, this linkage was moderated by maternal self-reported psychological stress. Specifically, for couples with higher maternal psychological stress, cortisol linkage was strong. Conversely, for couples with lower maternal psychological stress, maternal and paternal cortisol were unrelated. These findings suggest that among higher-maternal-stress couples, lower paternal cortisol may buffer maternal cortisol, whereas higher paternal cortisol may amplify maternal cortisol. Our results support the idea that interpersonal psychological and physiological stress in close relationships is interdependent and mutually influenced. Further, our findings contribute to the field's understanding of interpersonal processes during pregnancy, which may have health-related implications in the prenatal and postnatal periods for both parents and the developing child.
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Affiliation(s)
- Stephen H Braren
- Department of Applied Psychology, 246 Greene Street, Kimball Hall, 8th Floor, New York University, New York, NY, 10012, United States.
| | - Annie Brandes-Aitken
- Department of Applied Psychology, 246 Greene Street, Kimball Hall, 8th Floor, New York University, New York, NY, 10012, United States
| | - Andrew Ribner
- Department of Applied Psychology, 246 Greene Street, Kimball Hall, 8th Floor, New York University, New York, NY, 10012, United States
| | - Rosemarie E Perry
- Department of Applied Psychology, 246 Greene Street, Kimball Hall, 8th Floor, New York University, New York, NY, 10012, United States
| | - Clancy Blair
- Department of Applied Psychology, 246 Greene Street, Kimball Hall, 8th Floor, New York University, New York, NY, 10012, United States.
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- Department of Applied Psychology, 246 Greene Street, Kimball Hall, 8th Floor, New York University, New York, NY, 10012, United States; Leiden University, Leiden, Netherlands; University of Cambridge, Cambridge, United Kingdom
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Asherin RM, Everhart KD, Stophaeros SL, Vogeli JM, Fowler J, Phiel CJ, Kaplan PS. Associations between maternal depression and mother and infant oxytocin receptor gene (OXTR_rs53576) polymorphisms. Dev Psychobiol 2019; 62:496-504. [DOI: 10.1002/dev.21938] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 10/02/2019] [Accepted: 10/20/2019] [Indexed: 12/25/2022]
Affiliation(s)
- Ryan M. Asherin
- Department of Psychology University of Colorado Denver Denver CO USA
| | - Kevin D. Everhart
- Department of Psychology University of Colorado Denver Denver CO USA
| | | | - Jo M. Vogeli
- Department of Anesthesiology Anschutz Medical Campus School of Medicine University of Colorado Denver Denver CO USA
| | - Joshua Fowler
- Department of Psychology University of Colorado Denver Denver CO USA
| | | | - Peter S. Kaplan
- Department of Psychology University of Colorado Denver Denver CO USA
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