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Biaggi A, Hazelgrove K, Waites F, Bind RH, Lawrence AJ, Fuste M, Conroy S, Howard LM, Mehta MA, Miele M, Seneviratne G, Pawlby S, Pariante CM, Dazzan P. Mother-infant interaction and infant development in women at risk of postpartum psychosis with and without a postpartum relapse. Psychol Med 2024; 54:823-834. [PMID: 37706314 DOI: 10.1017/s0033291723002568] [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: 09/15/2023]
Abstract
BACKGROUND This study aimed to investigate mother-infant interaction and infant development in women at-risk of postpartum psychosis (PP), with and without a postpartum relapse. METHODS 103 women (and their offspring) were included, 43 at-risk-of-PP because of a diagnosis of bipolar disorder, schizoaffective disorder or previous PP, and 60 with no current/previous mental illness or family history of PP. Of the at-risk women, 18 developed a psychiatric relapse within 4 weeks after delivery (AR-unwell), while 25 remained symptom-free (AR-well). Mother-infant interaction was assessed using the CARE-Index at 8 weeks' and 12 months' postpartum and infant development using the Bayley-III at 12 months' postpartum. RESULTS Women at-risk-of-PP as a group, regardless of whether they developed a psychiatric relapse within 4 weeks after delivery, had less synchronous mother-infant interactions and had infants with less optimal cognitive, language, motor and socio-emotional development than healthy controls. In particular, boys of at-risk women had the lowest scores in cognitive, language and motor development and in mother-infant interaction, while girls of the at-risk women had the lowest scores in socio-emotional development. The synchrony in the dyad predicted infant cognitive and language development. There was no evidence for a difference in mother-infant interaction nor in infant development between the AR-unwell and AR-well groups. CONCLUSIONS These results suggest that, while there is a lack of evidence that an early postpartum relapse in women at-risk-of-PP could represent a risk for the infant per se, maternal risk for PP may be associated with less optimal mother-infant interaction and infant development.
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Affiliation(s)
- Alessandra Biaggi
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 9RX, UK
| | - Katie Hazelgrove
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 9RX, UK
| | - Freddie Waites
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 9RX, UK
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK
| | - Rebecca H Bind
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 9RX, UK
| | - Andrew J Lawrence
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 9RX, UK
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | - Montserrat Fuste
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK
- Perinatal Parent-Infant Mental Health Service, Goodmayes Hospital, North East London Foundation Trust, London, IG3 8XD, UK
| | - Susan Conroy
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 9RX, UK
| | - Louise M Howard
- Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK
| | - Mitul A Mehta
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neurosciences, King's College London, London, SE5 8AF, UK
| | - Maddalena Miele
- Perinatal Mental Health Service, St Mary's Hospital, Imperial College London and Central North West London NHS Foundation Trust, London, W2 1PF, UK
| | - Gertrude Seneviratne
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 9RX, UK
| | - Susan Pawlby
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 9RX, UK
| | - Carmine M Pariante
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 9RX, UK
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | - Paola Dazzan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 9RX, UK
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
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Rebecchini L, Bind RH, Allegri B, Zamparelli A, Biaggi A, Hazelgrove K, Osborne S, Conroy S, Pawlby S, Sethna V, Pariante CM. Women with depression in pregnancy or a history of depression have decreased quality of mentalization in the speech to their infants. Acta Psychiatr Scand 2023. [PMID: 37931907 DOI: 10.1111/acps.13624] [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: 02/20/2023] [Revised: 09/20/2023] [Accepted: 10/09/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Our study aims to understand whether depression, either in pregnancy or lifetime, affects cognitive biases (comprising the attentional focus and affective state) and mentalizing features (ability to understand children's internal mental states, thereby detecting and comprehending their behavior and intention), in maternal speech during mother-infant interaction in the first postnatal year. METHODS We recruited 115 pregnant women (44 healthy, 46 with major depressive disorder [MDD] in pregnancy, and 25 with a history of MDD but healthy pregnancy) at 25 weeks' gestation. Three-minute videos were recorded at 8 weeks and 12 months postnatally for each dyad. Maternal speech was transcribed verbatim and coded for cognitive biases and mentalizing comments using the Parental Cognitive Attributions and Mentalization Scale (PCAMs). RESULTS Women suffering from antenatal depression showed a decreased proportion of mentalizing comments compared with healthy women, at both 8 weeks (0.03 ± 0.01 vs. 0.07 ± 0.01, P = 0.002) and 12 months (0.02 ± 0.01 vs. 0.04 ± 0.01, P = 0.043). Moreover, compared with healthy women, both those with antenatal depression and those with a history of depression showed decreased positive affection in speech (0.13 ± 0.01 vs. 0.07 ± 0.01 and 0.08 ± 0.02, respectively P = 0.003 and P = 0.043), and made significantly fewer comments focused on their infants' experience at 8 weeks (0.67 ± 0.03 vs. 0.53 ± 0.04 and 0.49 ± 0.05, respectively P = 0.015 and P = 0.005). In linear regression models women's socioeconomic difficulties and anxiety in pregnancy contribute to these associations, while postnatal depression did not. CONCLUSIONS Both antenatal depression and a lifetime history of depression are associated with a decreased quality of women's speech to their infants, as shown by less focus on their infant's experience, decreased positive affection, and less able to mentalize. Examining maternal speech to their infants in the early postnatal months may be particularly relevant to identify women who could benefit from strategies addressing these aspects of the interactive behavior and thus improve infant outcome in the context of depression.
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Affiliation(s)
- Lavinia Rebecchini
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Rebecca H Bind
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Beatrice Allegri
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Arianna Zamparelli
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Alessandra Biaggi
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Katie Hazelgrove
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Sarah Osborne
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Susan Conroy
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Susan Pawlby
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Vaheshta Sethna
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
- Department of Forensic & Neurodevelopmental Sciences, Sackler Institute for Translational Neurodevelopment, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, UK
| | - Carmine M Pariante
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
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Benton M, Bird J, Pawlby S, Ismail K. The impact of gestational diabetes mellitus on perceived mother-infant bonding: a qualitative study. J Reprod Infant Psychol 2023:1-14. [PMID: 37493446 DOI: 10.1080/02646838.2023.2239834] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
BACKGROUND The prevalence of gestational diabetes mellitus (GDM) is rapidly increasing. It is associated with adverse physical and mental health outcomes for women and their babies. Mother-infant bonding is important for maternal health and infant development, but the effect of GDM on mother-infant bonding has not been examined. OBJECTIVE To explore and describe the impact of GDM on perceived mother infant-bonding in the antenatal and postnatal period. METHODS Qualitative, individual, semi-structured interviews were conducted with 33 women from diverse backgrounds with current or previous GDM. Data were analysed using reflexive inductive thematic analysis. RESULTS Three main themes were generated from the analysis: 1) Concern for baby's health and its impact on bonding; 2) GDM management, the pregnancy experience, and bonding; 3) Continuity and discontinuity of the impact on bonding between the antenatal and postnatal periods. CONCLUSION It was found that GDM can have both positive and negative impacts on perceived mother-infant bonding, which appear to change over the course of the perinatal period. Further observational research is needed to assist in understanding the impact of GDM on mother-infant bonding and the potential mediating effect of mental disorders, including depression.
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Affiliation(s)
- Madeleine Benton
- Department of Psychological Medicine, King's College London, London, UK
| | - Jessica Bird
- Department of Psychological Medicine, King's College London, London, UK
| | - Susan Pawlby
- Department of Psychological Medicine, King's College London, London, UK
| | - Khalida Ismail
- Department of Psychological Medicine, King's College London, London, UK
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Howard LM, Trevillion K, Potts L, Heslin M, Pickles A, Byford S, Carson LE, Dolman C, Jennings S, Johnson S, Jones I, McDonald R, Pawlby S, Powell C, Seneviratne G, Shallcross R, Stanley N, Wieck A, Abel KM. Effectiveness and cost-effectiveness of psychiatric mother and baby units: quasi-experimental study. Br J Psychiatry 2022; 221:628-636. [PMID: 35505514 DOI: 10.1192/bjp.2022.48] [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] [Indexed: 12/20/2022]
Abstract
BACKGROUND Psychiatric mother and baby units (MBUs) are recommended for severe perinatal mental illness, but effectiveness compared with other forms of acute care remains unknown. AIMS We hypothesised that women admitted to MBUs would be less likely to be readmitted to acute care in the 12 months following discharge, compared with women admitted to non-MBU acute care (generic psychiatric wards or crisis resolution teams (CRTs)). METHOD Quasi-experimental cohort study of women accessing acute psychiatric care up to 1 year postpartum in 42 healthcare organisations across England and Wales. Primary outcome was readmission within 12 months post-discharge. Propensity scores were used to account for systematic differences between MBU and non-MBU participants. Secondary outcomes included assessment of cost-effectiveness, experience of services, unmet needs, perceived bonding, observed mother-infant interaction quality and safeguarding outcome. RESULTS Of 279 women, 108 (39%) received MBU care, 62 (22%) generic ward care and 109 (39%) CRT care only. The MBU group (n = 105) had similar readmission rates to the non-MBU group (n = 158) (aOR = 0.95, 95% CI 0.86-1.04, P = 0.29; an absolute difference of -5%, 95% CI -14 to 4%). Service satisfaction was significantly higher among women accessing MBUs compared with non-MBUs; no significant differences were observed for any other secondary outcomes. CONCLUSIONS We found no significant differences in rates of readmission, but MBU advantage might have been masked by residual confounders; readmission will also depend on quality of care after discharge and type of illness. Future studies should attempt to identify the effective ingredients of specialist perinatal in-patient and community care to improve outcomes.
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Affiliation(s)
- Louise M Howard
- Section of Women's Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Kylee Trevillion
- Section of Women's Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Laura Potts
- Biostatistics and Health Informatics, King's College London, UK
| | - Margaret Heslin
- King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Andrew Pickles
- Biostatistics and Health Informatics, King's College London, UK
| | - Sarah Byford
- King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Lauren E Carson
- Section of Women's Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Clare Dolman
- Section of Women's Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Stacey Jennings
- Section of Women's Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | | | - Ian Jones
- National Centre for Mental Health, Division of Psychiatry and Clinical Neuroscience, Cardiff University, UK
| | - Rebecca McDonald
- Section of Women's Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Susan Pawlby
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Claire Powell
- Section of Women's Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | | | - Rebekah Shallcross
- Section of Women's Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Nicky Stanley
- School of Social Work, Care and Community, University of Central Lancashire, Preston, UK
| | - Angelika Wieck
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Kathryn M Abel
- Centre for Women's Mental Health, University of Manchester, UK
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Howard LM, Trevillion K, Potts L, Heslin M, Pickles A, Byford S, Carson LE, Dolman C, Jennings S, Johnson S, Jones I, McDonald R, Pawlby S, Powell C, Seneviratne G, Shallcross R, Stanley N, Wieck A, Abel KM. Effectiveness and cost-effectiveness of psychiatric mother and baby units: quasi-experimental study - CORRIGENDUM. Br J Psychiatry 2022; 221:1. [PMID: 35920025 DOI: 10.1192/bjp.2022.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Howard LM, Abel KM, Atmore KH, Bick D, Bye A, Byford S, Carson LE, Dolman C, Heslin M, Hunter M, Jennings S, Johnson S, Jones I, Taylor BL, McDonald R, Milgrom J, Morant N, Nath S, Pawlby S, Potts L, Powell C, Rose D, Ryan E, Seneviratne G, Shallcross R, Stanley N, Trevillion K, Wieck A, Pickles A. Perinatal mental health services in pregnancy and the year after birth: the ESMI research programme including RCT. Programme Grants Appl Res 2022. [DOI: 10.3310/ccht9881] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background
It is unclear how best to identify and treat women with mental disorders in pregnancy and the year after birth (i.e. the perinatal period).
Objectives
(1) To investigate how best to identify depression at antenatal booking [work package (WP) 1]. (2) To estimate the prevalence of mental disorders in early pregnancy (WP1). (3) To develop and examine the efficacy of a guided self-help intervention for mild to moderate antenatal depression delivered by psychological well-being practitioners (WP1). (4) To examine the psychometric properties of the perinatal VOICE (Views On Inpatient CarE) measure of service satisfaction (WP3). (5) To examine the clinical effectiveness and cost-effectiveness of services for women with acute severe postnatal mental disorders (WPs 1–3). (6) To investigate women’s and partners’/significant others’ experiences of different types of care (WP2).
Design
Objectives 1 and 2 – a cross-sectional survey stratified by response to Whooley depression screening questions. Objective 3 – an exploratory randomised controlled trial. Objective 4 – an exploratory factor analysis, including test–retest reliability and validity assessed by association with the Client Satisfaction Questionnaire contemporaneous satisfaction scores. Objective 5 – an observational cohort study using propensity scores for the main analysis and instrumental variable analysis using geographical distance to mother and baby unit. Objective 6 – a qualitative study.
Setting
English maternity services and generic and specialist mental health services for pregnant and postnatal women.
Participants
Staff and users of mental health and maternity services.
Interventions
Guided self-help, mother and baby units and generic care.
Main outcome measures
The following measures were evaluated in WP1(i) – specificity, sensitivity, positive predictive value, likelihood ratio, acceptability and population prevalence estimates. The following measures were evaluated in WP1(ii) – participant recruitment rate, attrition and adverse events. The following measure was evaluated in WP2 – experiences of care. The following measures were evaluated in WP3 – psychometric indices for perinatal VOICE and the proportion of participants readmitted to acute care in the year after discharge.
Results
WP1(i) – the population prevalence estimate was 11% (95% confidence interval 8% to 14%) for depression and 27% (95% confidence interval 22% to 32%) for any mental disorder in early pregnancy. The diagnostic accuracy of two depression screening questions was as follows: a weighted sensitivity of 0.41, a specificity of 0.95, a positive predictive value of 0.45, a negative predictive value of 0.93 and a likelihood ratio (positive) of 8.2. For the Edinburgh Postnatal Depression Scale, the diagnostic accuracy was as follows: a weighted sensitivity of 0.59, a specificity of 0.94, a positive predictive value of 0.52, a negative predictive value of 0.95 and a likelihood ratio (positive) of 9.8. Most women reported that asking about depression at the antenatal booking appointment was acceptable, although this was reported as being less acceptable for women with mental disorders and/or experiences of abuse. Cost-effectiveness analysis suggested that both the Whooley depression screening questions and the Edinburgh Postnatal Depression Scale were more cost-effective than with the Whooley depression screening questions followed by the Edinburgh Postnatal Depression Scale or no-screen option. WP1(ii) – 53 women with depression in pregnancy were randomised. Twenty-six women received modified guided self-help [with 18 (69%) women attending four or more sessions] and 27 women received usual care. Three women were lost to follow-up (follow-up for primary outcome: 92%). At 14 weeks post randomisation, women receiving guided self-help reported fewer depressive symptoms than women receiving usual care (adjusted effect size −0.64, 95% confidence interval −1.30 to 0.06). Costs and quality-adjusted life-years were similar, resulting in a 50% probability of guided self-help being cost-effective compared with usual care at National Institute for Health and Care Excellence cost per quality-adjusted life-year thresholds. The slow recruitment rate means that a future definitive larger trial is not feasible. WP2 – qualitative findings indicate that women valued clinicians with specialist perinatal expertise across all services, but for some women generic services were able to provide better continuity of care. Involvement of family members and care post discharge from acute services were perceived as poor across services, but there was also ambivalence among some women about increasing family involvement because of a complex range of factors. WP3(i) – for the perinatal VOICE, measures from exploratory factor analysis suggested that two factors gave an adequate fit (comparative fit index = 0.97). Items loading on these two dimensions were (1) those concerning aspects of the service relating to the care of the mother and (2) those relating to care of the baby. The factors were positively correlated (0.49; p < 0.0001). Total scores were strongly associated with service (with higher satisfaction for mother and baby units, 2 degrees of freedom; p < 0.0001) and with the ‘gold standard’ Client Service Questionnaire total score (test–retest intraclass correlation coefficient 0.784, 95% confidence interval 0.643 to 0.924; p < 0.0001). WP3(ii) – 263 of 279 women could be included in the primary analysis, which shows that the odds of being readmitted to acute care was 0.95 times higher for women who were admitted to a mother and baby unit than for those not admitted to a mother and baby unit (0.95, 95% confidence interval 0.86 to 1.04; p = 0.29). Sensitivity analysis using an instrumental variable found a markedly more significant effect of admission to mother and baby units (p < 0.001) than the primary analysis. Mother and baby units were not found to be cost-effective at 1 month post discharge because of the costs of care in a mother and baby unit. Cost-effectiveness advantages may exist if the cost of mother and baby units is offset by savings from reduced readmissions in the longer term.
Limitations
Policy and service changes had an impact on recruitment. In observational studies, residual confounding is likely.
Conclusions
Services adapted for the perinatal period are highly valued by women and may be more effective than generic services. Mother and baby units have a low probability of being cost-effective in the short term, although this may vary in the longer term.
Future work
Future work should include examination of how to reduce relapses, including in after-care following discharge, and how better to involve family members.
Trial registration
This trial is registered as ISRCTN83768230 and as study registration UKCRN ID 16403.
Funding
This project was funded by the National Institute for Health and Care Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 10, No. 5. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Louise M Howard
- Section of Women’s Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Kathryn M Abel
- Centre for Women’s Mental Health, The University of Manchester, Manchester, UK
| | - Katie H Atmore
- Section of Women’s Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Debra Bick
- Division of Women and Children’s Health, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, UK
| | - Amanda Bye
- Section of Women’s Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Sarah Byford
- King’s Health Economics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Lauren E Carson
- Section of Women’s Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Clare Dolman
- Section of Women’s Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Margaret Heslin
- King’s Health Economics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Myra Hunter
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Stacey Jennings
- Section of Women’s Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Sonia Johnson
- Division of Psychiatry, University College London, London, UK
| | - Ian Jones
- Institute of Psychological Medicine and Clinical Neuroscience, Cardiff University, Cardiff, UK
| | | | - Rebecca McDonald
- Section of Women’s Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Jeannette Milgrom
- Department of Clinical and Health Psychology, Parent–Infant Research Institute, University of Melbourne, Melbourne, VIC, Australia
| | - Nicola Morant
- Division of Psychiatry, University College London, London, UK
| | - Selina Nath
- Section of Women’s Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Susan Pawlby
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Laura Potts
- Biostatistics and Health Informatics, King’s College London, London, UK
| | - Claire Powell
- Section of Women’s Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Diana Rose
- Service User Research Enterprise, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Elizabeth Ryan
- Biostatistics and Health Informatics, King’s College London, London, UK
| | | | - Rebekah Shallcross
- Section of Women’s Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Nicky Stanley
- School of Social Work, Care and Community, University of Central Lancashire, Harrington, UK
| | - Kylee Trevillion
- Section of Women’s Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Angelika Wieck
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Andrew Pickles
- Biostatistics and Health Informatics, King’s College London, London, UK
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Osborne S, Biaggi A, Hazelgrove K, Preez AD, Nikkheslat N, Sethna V, Zunszain PA, Conroy S, Pawlby S, Pariante CM. Increased maternal inflammation and poorer infant neurobehavioural competencies in women with a history of major depressive disorder from the psychiatry research and motherhood - Depression (PRAM-D) study. Brain Behav Immun 2022; 99:223-230. [PMID: 34644586 DOI: 10.1016/j.bbi.2021.09.020] [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: 07/26/2020] [Revised: 09/21/2021] [Accepted: 09/26/2021] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION Stress in pregnancy is associated with adverse outcomes in offspring, and developmental programming is a potential mechanism. We have previously shown that depression in pregnancy is a valid and clearly defined stress paradigm, and both maternal antenatal and offspring stress-related biology is affected. This study aims to clarify whether maternal biology in pregnancy and offspring outcomes can also be influenced by a history of a prior depression, in the absence of depression in pregnancy. Our primary hypothesis is that, similarly to women with depression in pregnancy, women with a history of depression but who are not depressed in pregnancy will have increased cortisol secretion and markers of immune system function, and that their offspring will have poorer neuro-developmental competencies and increased cortisol stress response. METHODS A prospective longitudinal design was used in 59 healthy controls and 25 women with a past history of depression who were not depressed in pregnancy, named as 'history-only', and their offspring. Maternal antenatal stress-related biology (cortisol and markers of immune system function) and offspring outcomes (gestational age at birth, neonatal neurobehaviour (Neonatal Behavioural Assessment Scale, NBAS), cortisol stress response and basal cortisol at 2 and 12 months) and cognitive, language and motor development (Bayley Scales of Infant and Toddler Development (BSID)) were measured. RESULTS Compared with healthy pregnant women, those with a history of depression who remain free of depression in pregnancy exhibit increased markers of immune system function in pregnancy: IL-8 (d = 0.63, p = 0.030), VEGF (d = 0.40, p = 0.008) and MCP-1 (d = 0.61, p = 0.002) and have neonates with lower neurobehavioural scores in most areas, reaching statistical significance in thesocial-interactive (d = 1.26, p = 0.015) cluster. However, there were no differences in maternal or offspring HPA axis function or in infant development at 12 months. CONCLUSION Our study indicates that pregnant women with a history of depression have increased markers of immune system function, and their offspring show behavioural alterations that may be the effects of in utero programming, epigenetic factors or genetic predisposition.
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Affiliation(s)
- Sarah Osborne
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, London SE5 9RT, UK
| | - Alessandra Biaggi
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, London SE5 9RT, UK
| | - Katie Hazelgrove
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, London SE5 9RT, UK
| | - Andrea Du Preez
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, London SE5 9RT, UK; King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Basic and Clinical Neuroscience, The Maurice Wohl Clinical Neuroscience Institute, Cutcombe Road, London SE5 9RX, UK
| | - Naghmeh Nikkheslat
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, London SE5 9RT, UK
| | - Vaheshta Sethna
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, London SE5 9RT, UK; Sackler Institute for Translational Neurodevelopment, Department of Forensic & Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Patricia A Zunszain
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, London SE5 9RT, UK
| | - Susan Conroy
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, London SE5 9RT, UK
| | - Susan Pawlby
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, London SE5 9RT, UK
| | - Carmine M Pariante
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, London SE5 9RT, UK.
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8
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Kolk TA, Nath S, Howard LM, Pawlby S, Lockwood-Estrin G, Trevillion K. The association between maternal lifetime interpersonal trauma experience and perceived mother-infant bonding. J Affect Disord 2021; 294:117-127. [PMID: 34280788 PMCID: PMC8424749 DOI: 10.1016/j.jad.2021.06.069] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 06/19/2021] [Accepted: 06/27/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND Interpersonal traumas are common among expectant and new mothers and are found to have considerable impacts on women's mental health. These experiences may disrupt maternal perceptions of the mother-infant relationship, which is essential for healthy infant development, but findings are inconsistent. This study aims to explore associations between lifetime interpersonal traumas and their impact on self-reported mother-infant bonding. METHODS Secondary data analysis of a representative cohort of 453 women attending at a South London maternity service. Lifetime interpersonal trauma experience and its association with self-reported mother-infant bonding (Postpartum Bonding Questionnaire) was assessed in uni- and multivariable linear regressions, the latter adjusted to account for antenatal depressive and posttraumatic symptoms, measured using the Edinburgh Postnatal Depression Scale and Posttraumatic Stress Disorder Scale, and key sociodemographic risk factors. RESULTS Maternal lifetime trauma was not associated with perceived difficulties in mother-infant bonding at three months postnatal; however antenatal depressive symptoms, both with continuous EPDS score (0.33, 95% CI 0.17-0.50, p<0.001) and clinical cut-off ≥13 (4.26, 95% CI 2.02-6.49, p<0.001) were associated with self-reported bonding difficulties. LIMITATIONS The composite trauma measurement did not allow for a comprehensive assessment of individual trauma types. CONCLUSIONS There was no evidence for a link between maternal lifetime trauma experiences and self-reported bonding difficulties. However, an association between antenatal depressive symptoms and perceived postpartum bonding impairment was found. This highlights the importance of identification and treatment of depressive symptoms during pregnancy and offering women support in facilitating a positive mother-infant relationship.
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Affiliation(s)
- Tessel Annejo Kolk
- Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, UK..
| | - Selina Nath
- Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, UK
| | - Louise Michele Howard
- Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, UK
| | - Susan Pawlby
- Division of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, UK
| | - Georgia Lockwood-Estrin
- Henry Wellcome Building, Centre for Brain and Cognitive Development, Birkbeck College, 32 Torrington Square, London WC1E 7JL, UK
| | - Kylee Trevillion
- Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, UK
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9
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Biaggi A, Hazelgrove K, Waites F, Fuste M, Conroy S, Howard LM, Mehta MA, Miele M, Seneviratne G, Pawlby S, Pariante CM, Dazzan P. Maternal perceived bonding towards the infant and parenting stress in women at risk of postpartum psychosis with and without a postpartum relapse. J Affect Disord 2021; 294:210-219. [PMID: 34303299 DOI: 10.1016/j.jad.2021.05.076] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 04/19/2021] [Accepted: 05/30/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Postpartum psychosis (PP) is the most severe psychiatric disorder associated with childbirth. However, there is little research on maternal bonding towards the infant and parenting stress in this clinical population. METHODS We investigated maternal bonding during pregnancy and post-partum in 75 women: 46 at risk of PP (AR), because of a DSM-IV diagnosis of bipolar disorder, schizoaffective disorder or previous PP, and 29 healthy controls. Of the AR women, 19 developed a psychiatric relapse within 4 weeks' post-partum (AR-unwell), while 27 remained symptom-free (AR-well). We investigated childhood maltreatment, parenting stress and psychiatric symptoms as potential predictors of maternal bonding. RESULTS In pregnancy, AR-unwell women reported a more negative affective experience towards their infants than AR-well women (d = 0.87, p = .001), while postnatally there was no significant difference in bonding. In contrast, AR women as a group reported a more negative affective experience than HC postnatally (d = 0.69, p = .002; d = 0.70, p = .010), but not antenatally. Parenting stress and psychiatric symptoms significantly predicted less optimal postnatal bonding (b = -0.10, t = -4.29, p < .001; b = -0.37, t = -4.85, p < .001) but only psychiatric symptoms explained the difference in bonding between AR and HC (b = -1.18, 95% BCa CI [-2.70,-0.04]). LIMITATIONS A relatively small sample size precluded a more in-depth investigation of underlying pathways. CONCLUSION This study provides new information on maternal bonding in women at risk of PP, and particularly in those that do and do not develop a postpartum relapse. The results suggest that improving maternal symptoms and parenting stress in the perinatal period in women at risk of PP could also have positive effects on bonding.
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Affiliation(s)
- Alessandra Biaggi
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 9RX, UK.
| | - Katie Hazelgrove
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 9RX, UK
| | - Freddie Waites
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 9RX, UK; Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK
| | - Montserrat Fuste
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, SE5 8AF, UK; Perinatal Parent-Infant Mental Health Service, Goodmayes Hospital, North East London Foundation Trust, London, IG3 8XD, UK
| | - Susan Conroy
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 9RX, UK
| | - Louise M Howard
- Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK
| | - Mitul A Mehta
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neurosciences, King's College London, London, SE5 8AF, UK; National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | - Maddalena Miele
- Perinatal Mental Health Service, St Mary's Hospital, Imperial College London and Central North West London NHS Foundation Trust, London, W2 1PF, UK
| | - Gertrude Seneviratne
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 9RX, UK
| | - Susan Pawlby
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 9RX, UK
| | - Carmine M Pariante
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 9RX, UK; National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | - Paola Dazzan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 9RX, UK; National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
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10
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Paul E, Kwong A, Moran P, Pawlby S, Howard LM, Pearson RM. Maternal thoughts of self-harm and their association with future offspring mental health problems. J Affect Disord 2021; 293:422-428. [PMID: 34246951 PMCID: PMC8370273 DOI: 10.1016/j.jad.2021.06.058] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 06/21/2021] [Accepted: 06/27/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Depression and self-harm are leading causes of disability in young people, but prospective data on how maternal depression and self-harm thoughts contribute to these outcomes, and how they may interact is lacking. METHODS The study sample consisted of 8,425 mothers and offspring from the Avon Longitudinal Study of Parents and Children, an ongoing birth cohort study. Exposures were maternal self-harm ideation and depression measured using the Edinburgh Postnatal Depression Scale, collected at eleven time points over the period 18 weeks' gestation to 18 years post-partum. Outcomes were offspring past-year major depressive disorder and lifetime self-harm assessed at age 24. RESULTS Nearly one-fifth (16.7%) of mothers reported thoughts of self-harm on at least one of the eleven assessment points. The frequency of maternal self-harm ideation was related to both outcomes in a dose-response manner. Young adults whose mothers had self-harm ideation on 5-11 occasions were over three times more likely (Odds ratio (OR), 3.32; 95% CI, 1.63-6.76) to be depressed and over 1.5 times as likely (OR, 1.55; 95% CI, 0.73, 3.29) to have self-harmed than their peers whose mothers had never reported self-harm thoughts. Maternal self-harm thoughts remained associated with both offspring outcomes independent of maternal depression, and no evidence was found for an interaction between the two exposures. DISCUSSION Clinicians collecting data on maternal depression may consider paying attention to questions about self-harm ideation in assessments. Examining accumulated maternal self-harm ideation over time may provide insights into which children are most at risk for later self-harm and depression.
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Affiliation(s)
- Elise Paul
- Department of Behavioural Science and Health at University College, London, United Kingdom.
| | - Alex Kwong
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Bristol, United Kingdom
| | - Paul Moran
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Bristol, United Kingdom.
| | - Susan Pawlby
- Faculty of Life Sciences & Medicine, School of Life Course Sciences, King's College London, London, United Kingdom.
| | - Louise M Howard
- Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Rebecca M Pearson
- Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
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11
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Challacombe FL, Nath S, Trevillion K, Pawlby S, Howard LM. Fear of childbirth during pregnancy: associations with observed mother-infant interactions and perceived bonding. Arch Womens Ment Health 2021; 24:483-492. [PMID: 33336315 PMCID: PMC8116271 DOI: 10.1007/s00737-020-01098-w] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 12/02/2020] [Indexed: 01/18/2023]
Abstract
Fear of childbirth (FOC) is a common phenomenon that can impair functioning in pregnancy but potential longer term implications for the mother-infant relationship are little understood. This study was aimed at investigating postpartum implications of FOC on the mother-infant relationship. A UK sample of 341 women in a community setting provided data on anxiety, mood and FOC in mid-pregnancy and subsequently completed self-report measures of postnatal bonding in a longitudinal cohort study. Postnatal observations of mother-infant interactions were collected and rated for a subset of 141 women. FOC was associated with maternal perception of impaired bonding, even after controlling for sociodemographic factors, concurrent depression and the presence of anxiety disorders (Coef = 0.10, 95% CI 0.07-0.14, p < 0.001). Observed mother-infant interactions were not associated with FOC (Coef = -0.01-0.03 CI - 0.02 to 0.02, p = 0.46), weakly with concurrent depression (Coef = - 0.10, CI - 0.19 to 0.00, p = 0.06) and not associated with anxiety disorders. The self-efficacy component of FOC was most strongly associated with lower reported bonding (Coef 0.37, 95% CI 0.25-0.49, p < 0.001) FOC makes a distinct contribution to perceived postpartum bonding difficulties but observed mother-infant interaction quality was not affected. This may be due to low self-efficacy impacting psychological adjustment during pregnancy. Targeted interventions during pregnancy focusing both on treatment of key childbirth fears and bonding could help women adjust earlier.
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Affiliation(s)
- Fiona L Challacombe
- Section of Women's Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, SE5 8AF, London, UK.
| | - Selina Nath
- Section of Women's Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, SE5 8AF, London, UK
| | - Kylee Trevillion
- Section of Women's Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, SE5 8AF, London, UK
| | - Susan Pawlby
- Division of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Louise M Howard
- Section of Women's Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, SE5 8AF, London, UK
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12
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Hazelgrove K, Biaggi A, Waites F, Fuste M, Osborne S, Conroy S, Howard LM, Mehta MA, Miele M, Nikkheslat N, Seneviratne G, Zunszain PA, Pawlby S, Pariante CM, Dazzan P. Risk factors for postpartum relapse in women at risk of postpartum psychosis: The role of psychosocial stress and the biological stress system. Psychoneuroendocrinology 2021; 128:105218. [PMID: 33892376 DOI: 10.1016/j.psyneuen.2021.105218] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 08/17/2020] [Revised: 02/24/2021] [Accepted: 03/30/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Postpartum psychosis is the most severe psychiatric disorder associated with childbirth, and the risk is particularly high for women with a history of bipolar disorder, schizoaffective disorder or those who have suffered a previous episode of postpartum psychosis. Whilst there is a lot of evidence linking stress to psychosis unrelated to childbirth, the role of stress in the onset of postpartum psychosis has not been fully investigated. METHODS A prospective longitudinal study of 112 pregnant women, 51 at risk of postpartum psychosis because of a DSM-IV diagnosis of bipolar disorder (n = 41), schizoaffective disorder (n = 6) or a previous postpartum psychosis (n = 4) and 61 healthy women with no past or current DSM-IV diagnosis and no family history of postpartum psychosis. Women were followed up from the third trimester of pregnancy to 4 weeks' post partum. Women at risk who had a psychiatric relapse in the first 4 weeks' post partum (AR-unwell) (n = 22), were compared with those at risk who remained well (AR-well) (n = 29) on measures of psychosocial stress (severe childhood maltreatment and stressful life events) and biological stress (cortisol and inflammatory biomarkers). RESULTS Logistic regression analyses revealed that severe childhood maltreatment (OR = 4.9, 95% CI 0.5-49.2) and higher daily cortisol in the third trimester of pregnancy (OR=3.7, 95% CI 1.2-11.6) predicted psychiatric relapse in the first 4 weeks' post partum in women at risk of postpartum psychosis after adjusting for clinical and sociodemographic covariates. CONCLUSION The current study provides evidence for the role of psychosocial stress and the biological stress system in the risk of postpartum relapse in women at risk of postpartum psychosis.
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Affiliation(s)
- Katie Hazelgrove
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK.
| | - Alessandra Biaggi
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK.
| | - Freddie Waites
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK.
| | - Montserrat Fuste
- Perinatal Parent-Infant Mental Health Service, Goodmayes Hospital, North East London Foundation Trust, London IG3 8XD, UK.
| | - Sarah Osborne
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK.
| | - Susan Conroy
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK.
| | - Louise M Howard
- Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK.
| | - Mitul A Mehta
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK.
| | - Maddalena Miele
- Perinatal Mental Health Service, St Mary's Hospital, Imperial College London and Central North West London NHS Foundation Trust, London W2 1PF, UK.
| | - Naghmeh Nikkheslat
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK.
| | - Gertrude Seneviratne
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK.
| | - Patricia A Zunszain
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK.
| | - Susan Pawlby
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK.
| | - Carmine M Pariante
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK.
| | - Paola Dazzan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK.
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13
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Bind RH, Biaggi A, Bairead A, Du Preez A, Hazelgrove K, Waites F, Conroy S, Dazzan P, Osborne S, Pawlby S, Sethna V, Pariante CM. Mother-infant interaction in women with depression in pregnancy and in women with a history of depression: the Psychiatry Research and Motherhood - Depression (PRAM-D) study. BJPsych Open 2021; 7:e100. [PMID: 34030765 PMCID: PMC8167851 DOI: 10.1192/bjo.2021.52] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Little is known about the effects of depression before birth on the quality of the mother-infant interaction. AIMS To understand whether depression, either in pregnancy or in lifetime before pregnancy, disrupts postnatal mother-infant interactions. METHOD We recruited 131 pregnant women (51 healthy, 52 with major depressive disorder (MDD) in pregnancy, 28 with a history of MDD but healthy pregnancy), at 25 weeks' gestation. MDD was confirmed with the Structured Clinical Interview for DSM-IV Disorders. Neonatal behaviour was assessed at 6 days with the Neonatal Behavioural Assessment Scale, and mother-infant interaction was assessed at 8 weeks and 12 months with the Crittenden CARE-Index. RESULTS At 8 weeks and 12 months, dyads in the depression and history-only groups displayed a reduced quality of interaction compared with healthy dyads. Specifically, at 8 weeks, 62% in the depression group and 56% in the history-only group scored in the lowest category of dyadic synchrony (suggesting therapeutic interventions are needed), compared with 37% in the healthy group (P = 0.041); 48% and 32%, respectively, scored the same at 12 months, compared with 14% in the healthy group (P = 0.003). At 6 days, neonates in the depression and history-only groups exhibited decreased social-interactive behaviour, which, together with maternal socioeconomic difficulties, was also predictive of interaction quality, whereas postnatal depression was not. CONCLUSIONS Both antenatal depression and a lifetime history of depression are associated with a decreased quality of mother-infant interaction, irrespective of postnatal depression. Clinicians should be aware of this, as pregnancy provides an opportunity for identification and intervention to support the developing relationship.
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Affiliation(s)
- Rebecca H Bind
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Alessandra Biaggi
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | | | - Andrea Du Preez
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; and The Maurice Wohl Clinical Neuroscience Institute, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Katie Hazelgrove
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Freddie Waites
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Susan Conroy
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Paola Dazzan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Sarah Osborne
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Susan Pawlby
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Vaheshta Sethna
- Sackler Institute for Translational Neurodevelopment, Department of Forensic & Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Carmine M Pariante
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
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14
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Sambataro F, Cattarinussi G, Lawrence A, Biaggi A, Fusté M, Hazelgrove K, Mehta MA, Pawlby S, Conroy S, Seneviratne G, Craig MC, Pariante CM, Miele M, Dazzan P. Altered dynamics of the prefrontal networks are associated with the risk for postpartum psychosis: a functional magnetic resonance imaging study. Transl Psychiatry 2021; 11:238. [PMID: 33976106 PMCID: PMC8113224 DOI: 10.1038/s41398-021-01351-5] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 02/15/2021] [Accepted: 03/02/2021] [Indexed: 11/23/2022] Open
Abstract
Postpartum psychosis (PP) is a severe mental disorder that affects women in the first few weeks after delivery. To date there are no biomarkers that distinguish which women at risk (AR) develop a significant psychiatric relapse postpartum. While altered brain connectivity may contribute to the risk for psychoses unrelated to the puerperium, this remains unexplored in PP. We followed up 32 AR and 27 healthy (HC) women from pregnancy to 8-week postpartum. At this point, we classified women as AR-unwell (n = 15) if they had developed a psychiatric relapse meeting DSM-IV diagnostic criteria, or impacting on daily functioning and requiring treatment, or AR-well (n = 17) if they remained asymptomatic. Women also underwent an fMRI scan at rest and during an emotional-processing task, to study within- and between-networks functional connectivity. Women AR, and specifically those in the AR-well group, showed increased resting connectivity within an executive network compared to HC. During the execution of the emotional task, women AR also showed decreased connectivity in the executive network, and altered emotional load-dependent connectivity between executive, salience, and default-mode networks. AR-unwell women particularly showed increased salience network-dependent modulation of the default-mode and executive network relative to AR-well, who showed greater executive network-dependent modulation of the salience network. Our finding that the executive network and its interplay with other brain networks implicated in goal-directed behavior are intrinsically altered suggest that they could be considered neural phenotypes for postpartum psychosis and help advance our understanding of the pathophysiology of this disorder.
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Affiliation(s)
- Fabio Sambataro
- Department of Neuroscience (DNS), Padua Neuroscience Center, University of Padova, Padua, Italy.
| | - Giulia Cattarinussi
- Department of Neuroscience (DNS), Padua Neuroscience Center, University of Padova, Padua, Italy
| | - Andrew Lawrence
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | - Alessandra Biaggi
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
| | - Montserrat Fusté
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
| | - Katie Hazelgrove
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
| | - Mitul A Mehta
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
- Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Susan Pawlby
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
| | - Susan Conroy
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
| | - Gertrude Seneviratne
- South London and Maudsley NHS Foundation Trust Channi Kumar Mother and Baby Unit, Bethlem Royal Hospital, London, UK
| | - Michael C Craig
- National Female Hormone Clinic, Maudsley Hospital, SLaM NHS Foundation Trust, and Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, De Crespigny Park, London, UK
| | - Carmine M Pariante
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | - Maddalena Miele
- Perinatal Mental Health Service, St Mary's Hospital, Imperial College London and Central North West London NHS Foundation Trust, London, UK
| | - Paola Dazzan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
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15
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Abstract
Agnostic analyses of unique video material from a Mother and Baby Unit were carried out to investigate the usefulness of such analyses to the unit. The goal was to improve outcomes: the health of mothers and their babies. The method was to implement a learning machine that becomes more useful over time and over task. A feasible set-up is here described, with the purpose of producing intelligible and useful results to healthcare professionals at the unit by means of a vision processing pipeline, grouped together with multi-modal capabilities of handling annotations and audio. Algorithmic bias turned out to be an obstacle that could only partly be handled by modern pipelines for automated feature analysis. The professional use of complex quantitative scoring for various mental health-related assessments further complicated the automation of laborious tasks. Activities during the MBU stay had previously been shown to decrease psychiatric symptoms across diagnostic groups. The implementation and first set of experiments on a learning machine for the unit produced the first steps toward explaining why this is so, in turn enabling decision support to staff about what to do more and what to do less of.
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Affiliation(s)
- Magnus Boman
- Department of Software and Computer Systems, School of Electrical Engineering and Computer Science, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Johnny Downs
- Child & Adolescent Psychiatry, Psychological Medicine and Integrated Care, Clinical Academic Group, The National Institute for Health Research Maudsley Biomedical Research Centre, King's College London, London, United Kingdom
| | - Abubakrelsedik Karali
- Department of Software and Computer Systems, School of Electrical Engineering and Computer Science, KTH Royal Institute of Technology, Stockholm, Sweden
- NVIDIA Corporation, London, United Kingdom
| | - Susan Pawlby
- Channi Kumar Mother and Baby Unit, Bethlem Royal Hospital, South London and Maudsley National Health Service Trust, London, United Kingdom
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16
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Nath S, Pearson RM, Moran P, Pawlby S, Molyneaux E, Howard LM. Maternal personality traits, antenatal depressive symptoms and the postpartum mother-infant relationship: a prospective observational study. Soc Psychiatry Psychiatr Epidemiol 2020; 55:621-634. [PMID: 31642966 DOI: 10.1007/s00127-019-01790-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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] [Received: 05/22/2019] [Accepted: 10/09/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE Maternal depression has been associated with bonding difficulties and lower maternal sensitivity in observed mother-infant interactions. However, little research has examined the impact of disordered personality traits in mothers on these outcomes. We investigated the association between disordered personality traits in mothers measured during pregnancy and postnatal (a) self-reported bonding with infant; (b) observational mother-infant interactions. METHODS Five hundred fifty-six women were recruited during early pregnancy and subsequently followed up at mid-pregnancy (approximately 28 weeks' gestation) and when infants were aged approximately 3 months (n = 459). During early pregnancy, data were collected on disordered personality traits (using the Standardised Assessment of Personality Abbreviated Scale) and depressive symptoms (using the Edinburgh Postnatal Depression Scale). At 3 months postpartum, self-reported perceived bonding (using the Postpartum Bonding Questionnaire) were collected. A sub-sample of women additionally provided observational mother-infant interaction data (n = 206) (coded using the Child-Adult Relationship Experimental Index). RESULTS Higher disordered personality traits was not associated with maternal perceptions of bonding impairment, but was associated with reduced maternal sensitivity during observational mother-infant interactions [adjusted for age, education, having older children, substance misuse prior to pregnancy, infant sex and gestational age: coefficient = - 0.28, 95% CI = - 0.56 to - 0.00, p < 0.05]. After adjusting for depressive symptoms, the association was attenuated [coefficient = - 0.19, 95% CI = - 0.48 to 0.11, p = 0.217]. CONCLUSIONS Mothers with disordered personality traits did not perceive themselves as having bonding impairments with their infants but were less sensitive during observed interactions, though depressive symptoms attenuated this relationship. Both depression and disordered personality traits need to be addressed to optimize mother-infant interactions.
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Affiliation(s)
- Selina Nath
- Section of Women's Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK.
| | - Rebecca M Pearson
- Centre for Academic Mental Health, Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2BN, UK
| | - Paul Moran
- Centre for Academic Mental Health, Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2BN, UK
| | - Susan Pawlby
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Emma Molyneaux
- Section of Women's Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Louise M Howard
- Section of Women's Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
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17
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Gordon H, Nath S, Trevillion K, Moran P, Pawlby S, Newman L, Howard LM, Molyneaux E. Self-Harm, Self-Harm Ideation, and Mother-Infant Interactions: A Prospective Cohort Study. J Clin Psychiatry 2019; 80. [PMID: 31509361 DOI: 10.4088/jcp.18m12708] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 04/23/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To investigate the association between maternal self-harm (lifetime history of self-harm and self-harm ideation during pregnancy) and mother-infant interactions in a representative cohort from southeast London. METHODS Data were drawn from a prospective cohort of 545 women attending antenatal appointments between 2014 and 2016. Women were asked about history of self-harm and current self-harm ideation during a research interview following first antenatal visit. Follow-up data on depressive symptoms using the Edinburgh Postnatal Depression Scale (EPDS) were collected at 28 weeks' gestation and 3 months postpartum, and data on mother-infant relationship using the CARE-Index and Postpartum Bonding Questionnaire were collected at 3 months postpartum. Linear regression analyses were conducted to investigate the associations between history of self-harm and (a) depressive symptoms and (b) the mother-infant relationship. Analyses were repeated with current self-harm ideation as the exposure. RESULTS The population prevalence of history of self-harm was 7.9% (95% CI 5.5%-11.2%) and of current self-harm ideation was 2.3% (95% CI, 1.2%-4.2%). History of self-harm was associated with baseline depressive symptoms (adjusted regression coefficient = 2.23 [95% CI, 0.16-4.29], P = .035), and self-harm ideation was associated with depressive symptoms at all time points (adjusted regression coefficients = 11.53 [95% CI, 10.13-12.94], P < .001 at baseline; 8.16 [95% CI, 5.43-10.89], P < .001 at midpregnancy; and 6.73 [95% CI, 4.48-8.99], P < .001 postpartum). Self-harm ideation, but not history of self-harm, was associated with maternal controlling behaviors (adjusted regression coefficient = 2.34 [95% CI, 0.40-4.48], P = .019) and infant compulsive behaviors (adjusted regression coefficient = 2.37 [95% CI, 0.36-4.38], P = .021). CONCLUSIONS Self-harm ideation during pregnancy is associated with elevated depressive symptoms in the perinatal period and with poorer quality mother-infant interactions. These women require effective psychological help that targets their distress, risk, and interactions with their infants.
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Affiliation(s)
- Hannah Gordon
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Bldg 181 University of Melbourne, Grattan St, Melbourne VIC 3010, Australia. .,Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Australia
| | - Selina Nath
- Section of Women's Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Kylee Trevillion
- Section of Women's Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Paul Moran
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Susan Pawlby
- Department of Psychological Medicine, King's College London, London, United Kingdom
| | - Louise Newman
- Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Australia.,Royal Women's Hospital, Melbourne, Australia
| | - Louise M Howard
- Section of Women's Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Emma Molyneaux
- Section of Women's Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
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18
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Trevillion K, Shallcross R, Ryan E, Heslin M, Pickles A, Byford S, Jones I, Johnson S, Pawlby S, Stanley N, Rose D, Seneviratne G, Wieck A, Jennings S, Potts L, Abel KM, Howard LM. Protocol for a quasi-experimental study of the effectiveness and cost-effectiveness of mother and baby units compared with general psychiatric inpatient wards and crisis resolution team services (The ESMI study) in the provision of care for women in the postpartum period. BMJ Open 2019; 9:e025906. [PMID: 30904867 PMCID: PMC6475160 DOI: 10.1136/bmjopen-2018-025906] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION Research into what constitutes the best and most effective care for women with an acute severe postpartum mental disorder is lacking. The effectiveness and cost-effectiveness of psychiatric mother and baby units (MBUs) has not been investigated systematically and there has been no direct comparison of the outcomes of mothers and infants admitted to these units, compared with those accessing generic acute psychiatric wards or crisis resolution teams (CRTs). Our primary hypothesis is that women with an acute psychiatric disorder, in the first year after giving birth, admitted to MBUs are significantly less likely to be readmitted to acute care (an MBU, CRTs or generic acute ward) in the year following discharge than women admitted to generic acute wards or cared for by CRTs. METHODS AND ANALYSIS Quasi-experimental study of women accessing different types of acute psychiatric services in the first year after childbirth. Analysis of the primary outcome will be compared across the three service types, at 1-year postdischarge. Cost-effectiveness will be compared across the three service types, at 1-month and 1-year postdischarge; explored in terms of quality-adjusted life years. Secondary outcomes include unmet needs, service satisfaction, maternal adjustment, quality of mother-infant interaction. Outcomes will be analysed using propensity scoring to account for systematic differences between MBU and non-MBU participants. Analyses will take place separately within strata, defined by the propensity score, and estimates pooled to produce an average treatment effect with weights to account for cohort attrition. ETHICS AND DISSEMINATION The study has National Health Service (NHS) Ethics Approval and NHS Trust Research and Development approvals. The study has produced protocols on safeguarding maternal/child welfare. With input from our lived experience group, we have developed a dissemination strategy for academics/policy-makers/public.
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Affiliation(s)
- Kylee Trevillion
- Section of Women's Mental Health, Institute of Psychiatry, Psychology & Neuroscience at King's College London, London, UK
| | - Rebekah Shallcross
- Centre for Academic Primary Care, University of Bristol Medical School, Bristol, UK
| | - Elizabeth Ryan
- Biostatistics Department, Institute of Psychiatry, Psychology & Neuroscience at King's College London, London, UK
| | - Margaret Heslin
- King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience at King's College London, London, UK
| | - Andrew Pickles
- Biostatistics Department, Institute of Psychiatry, Psychology & Neuroscience at King's College London, London, UK
| | - Sarah Byford
- King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience at King's College London, London, UK
| | - Ian Jones
- National Centre for Mental Health, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, London, UK
| | - Sonia Johnson
- Division of Psychiatry, University College London, London, UK
| | - Susan Pawlby
- Institute of Psychiatry, Psychology & Neuroscience at King's College London, London, UK
| | - Nicky Stanley
- School of Social Work, Care and Community, University of Central Lancashire, Preston, UK
| | - Diana Rose
- Service User Research Enterprise, Institute of Psychiatry, Psychology & Neuroscience at King's College London, London, UK
| | - Gertrude Seneviratne
- Psychological Medicine and Integrated Care Clinical Academic Group, South London and Maudsley NHS Foundation Trust, London, UK
| | - Angelika Wieck
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Stacey Jennings
- Addictions, Institute of Psychiatry, Psychology & Neuroscience at King's College London, London, UK
| | - Laura Potts
- Biostatistics Department, Institute of Psychiatry, Psychology & Neuroscience at King's College London, London, UK
| | - Kathryn M Abel
- Medical and Human Sciences, Institute of Brain Behaviour and Mental Health, Manchester, UK
- Manchester Mental Health & Social Care Trust, Manchester, UK
| | - Louise M Howard
- Section of Women's Mental Health, Institute of Psychiatry, Psychology & Neuroscience at King's College London, London, UK
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19
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Affiliation(s)
- Susan Pawlby
- Developmental Psychologist,Division of Psychological Medicine,King's College London,UK
| | - Deborah Sharp
- Professor of Primary Health Care,Centre for Academic Primary Care,University of Bristol,UK
| | - Dale F Hay
- Professor of Psychology,School of Psychology,Cardiff University,UK
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20
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Plant DT, Pawlby S, Pariante CM, Jones FW. When one childhood meets another - maternal childhood trauma and offspring child psychopathology: A systematic review. Clin Child Psychol Psychiatry 2018; 23:483-500. [PMID: 29171287 DOI: 10.1177/1359104517742186] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND Child maltreatment can have a long-term impact on mental health. Less is known about the consequences of child maltreatment on the next generation's psychological wellbeing. AIM This systematic review aimed to synthesise the existing empirical literature on the association between a mother's history of maltreatment in her own childhood and her children's experiences of psychopathology, and to characterise potential mediating pathways. METHOD Electronic database and hand searches yielded 12 studies, with a combined sample size of 45,723 mother-child dyads, which met criteria for inclusion in the review. RESULTS There was evidence of an overall positive association between a mother's history of child maltreatment and her child's experience of emotional and behavioural difficulties across childhood and adolescence. Maternal psychological distress and poorer parenting practices were found to be key mediating pathways of this association. CONCLUSION Children of mothers who were exposed to maltreatment in childhood appear to be at an increased risk for psychopathology. Mothers with traumatic childhood experiences should be offered improved access to psychological therapies and parenting programmes to help mitigate the potential impact of child maltreatment on future generations.
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Affiliation(s)
- Dominic T Plant
- 1 Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK.,2 Salomons Centre for Applied Psychology, Canterbury Christ Church University, UK
| | - Susan Pawlby
- 1 Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Carmine M Pariante
- 1 Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Fergal W Jones
- 2 Salomons Centre for Applied Psychology, Canterbury Christ Church University, UK
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21
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Stephenson LA, Beck K, Busuulwa P, Rosan C, Pariante CM, Pawlby S, Sethna V. Perinatal interventions for mothers and fathers who are survivors of childhood sexual abuse. Child Abuse Negl 2018; 80:9-31. [PMID: 29558671 DOI: 10.1016/j.chiabu.2018.03.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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] [Received: 10/25/2017] [Revised: 03/04/2018] [Accepted: 03/12/2018] [Indexed: 06/08/2023]
Abstract
Childhood sexual abuse (CSA) is a worldwide problem with severe long-term consequences. A history of CSA can impact the childbearing experience of mothers and fathers; affecting their mental health, parenting skills and compromising infant development. Nonetheless, the perinatal period offers huge opportunity for intervention and hope. This literature review collates evidence for perinatal psychosocial interventions targeting both mothers and fathers who are survivors of CSA. Publications dating from 1970 to June 2016 were searched using Medline, Maternity and Infant Health, PsychINFO, PsychArticles, PubMed and the International Bibliography of the Social Sciences (IBSS). There were no perinatal interventions that considered the needs of survivor fathers. Sixteen publications on 9 psychosocial perinatal interventions for CSA survivors were identified. However, no sub-analyses specific to CSA survivors were reported. Trauma-specific perinatal interventions drew from a range of theoretical models and varied widely in format. Generally interventions were associated with improvements in maternal mental health, parenting competence, infant attachment security and positive public health outcomes. They were safe and feasible to implement, acceptable to parents and therapist, and therapists were able to implement protocols with adequate fidelity. Yet current data is hampered by small sample size, inconsistent reporting of CSA rates and outcome measures, scarcity of observational data and longer-term follow-up. Intervention modifications are proposed for CSA survivors in view of their unique childbearing experiences.
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Affiliation(s)
- Lucy A Stephenson
- South London and the Maudsley NHS Foundation Trust/Institute Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Katherine Beck
- Department of Psychosis Studies, Institute Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Paula Busuulwa
- GKT School of Medical Education, King's College London, UK
| | - Camilla Rosan
- National Society for the Prevention of Cruelty to Children, UK
| | - Carmine M Pariante
- Stress, Psychiatry and Immunology Lab. & Perinatal Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Susan Pawlby
- Stress, Psychiatry and Immunology Lab. & Perinatal Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Vaheshta Sethna
- Stress, Psychiatry and Immunology Lab. & Perinatal Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Sackler Institute for Translational Neurodevelopment, Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK.
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22
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Stephenson LA, Macdonald AJD, Seneviratne G, Waites F, Pawlby S. Mother and Baby Units matter: improved outcomes for both. BJPsych Open 2018; 4:119-125. [PMID: 29971155 PMCID: PMC6020269 DOI: 10.1192/bjo.2018.7] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [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: 12/08/2017] [Revised: 12/08/2017] [Accepted: 01/08/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Mother and Baby Units (MBUs) are usually preferred by patients and clinicians. Current provision is limited, although expansion is in progress. To ensure successful investment in services, outcome measurement is vital. AIMS To describe maternal outcomes, mother-infant outcomes and their relationship in one MBU. METHOD Paired maternal Brief Psychiatric Rating Scale (BPRS) scores, Health of the Nation Outcome Scales (HoNOS) scores and Crittenden CARE-Index (CCI) mother-infant interaction data were collected at admission and discharge. RESULTS There were significant improvements in BPRS (n = 152), HoNOS (n = 141) and CCI (n = 62) scores across diagnostic groups. Maternal BPRS scores and mother-infant interaction scores were unrelated. Improvement in maternal HoNOS scores was associated with improved maternal sensitivity and reduction in maternal unresponsiveness and infant passiveness. CONCLUSIONS Positive outcomes were achieved for mothers and babies across all diagnostic groups. Reduction in maternal symptoms, as measured by BPRS, does not necessarily confer improvement in mother-infant interaction. MBU treatment should focus on both maternal symptoms and mother-infant interaction. DECLARATION OF INTEREST None.
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Affiliation(s)
- Lucy A Stephenson
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Alastair J D Macdonald
- Chair, Trust Outcomes Group, South London and Maudsley NHS Foundation Trust, and NIHR Maudsley Biomedical Research Centre, The Maudsley Hospital, London, UK
| | - Gertrude Seneviratne
- Associate Clinical Director and Consultant Perinatal Psychiatrist, Perinatal Mental Health Services, South London & Maudsley NHS Foundation, London, UK
| | - Freddie Waites
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Susan Pawlby
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
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Fusté M, Pauls A, Worker A, Reinders AATS, Simmons A, Williams SCR, Haro JM, Hazelgrove K, Pawlby S, Conroy S, Vecchio C, Seneviratne G, Pariante CM, Mehta MA, Dazzan P. Brain structure in women at risk of postpartum psychosis: an MRI study. Transl Psychiatry 2017; 7:1286. [PMID: 29249808 PMCID: PMC5802701 DOI: 10.1038/s41398-017-0003-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 08/11/2017] [Accepted: 08/20/2017] [Indexed: 12/12/2022] Open
Abstract
Postpartum psychosis (PP) is the most severe psychiatric disorder associated with childbirth. The risk of PP is very high in women with a history of bipolar affective disorder or schizoaffective disorder. However, the neurobiological basis of PP remains poorly understood and no study has evaluated brain structure in women at risk of, or with, PP. We performed a cross-sectional study of 256 women at risk of PP and 21 healthy controls (HC) in the same postpartum period. Among women at risk, 11 who developed a recent episode of PP (PPE) (n = 2 with lifetime bipolar disorder; n = 9 psychotic disorder not otherwise specified) and 15 at risk women who did not develop an episode of PP (NPPE) (n = 10 with lifetime bipolar disorder; n = 1 with schizoaffective disorder; n = 1 with a history of PP in first-degree family member; n = 3 with previous PP). We obtained T1-weighted MRI scans at 3T and examined regional gray matter volumes with voxel-based morphometry and cortical thickness and surface area with Freesurfer. Women with PPE showed smaller anterior cingulate gyrus, superior temporal gyrus and parahippocampal gyrus compared to NPPE women. These regions also showed decreased surface area. Moreover, the NPPE group showed a larger superior and inferior frontal gyrus volume than the HC. These results should be interpreted with caution, as there were between-group differences in terms of duration of illness and interval between delivery and MRI acquisition. Nevertheless, these are the first findings to suggest that MRI can provide information on brain morphology that characterize those women at risk of PP more likely to develop an episode after childbirth.
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Affiliation(s)
- Montserrat Fusté
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neurosciences, King's College London, De Crespigny Park, London, UK, SE5 8AF. .,CIBERSAM, Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain.
| | - Astrid Pauls
- 0000 0001 2322 6764grid.13097.3cDepartment of Psychosis Studies, Institute of Psychiatry, Psychology & Neurosciences, King’s College London, De Crespigny Park, London, UK SE5 8AF
| | - Amanda Worker
- 0000 0001 2322 6764grid.13097.3cDepartment of Neuroimaging, Institute of Psychiatry, Psychology & Neurosciences, King’s College of London, De Crespigny Park, London, UK
| | - Antje A. T. S Reinders
- 0000 0001 2322 6764grid.13097.3cDepartment of Psychosis Studies, Institute of Psychiatry, Psychology & Neurosciences, King’s College London, De Crespigny Park, London, UK SE5 8AF
| | - Andrew Simmons
- 0000 0001 2322 6764grid.13097.3cDepartment of Neuroimaging, Institute of Psychiatry, Psychology & Neurosciences, King’s College of London, De Crespigny Park, London, UK ,0000 0001 2116 3923grid.451056.3National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London, London, UK
| | - Steven C. R. Williams
- 0000 0001 2322 6764grid.13097.3cDepartment of Neuroimaging, Institute of Psychiatry, Psychology & Neurosciences, King’s College of London, De Crespigny Park, London, UK ,0000 0001 2116 3923grid.451056.3National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London, London, UK
| | - Josep M. Haro
- CIBERSAM, Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain
| | - Kate Hazelgrove
- 0000 0001 2322 6764grid.13097.3cDepartment of Psychosis Studies, Institute of Psychiatry, Psychology & Neurosciences, King’s College London, De Crespigny Park, London, UK SE5 8AF
| | - Susan Pawlby
- 0000 0001 2322 6764grid.13097.3cSection of Stress, Psychiatry and Immunology and Perinatal Psychiatry, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neurosciences, King’s College London, London, UK
| | - Susan Conroy
- 0000 0001 2322 6764grid.13097.3cSection of Stress, Psychiatry and Immunology and Perinatal Psychiatry, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neurosciences, King’s College London, London, UK
| | - Costanza Vecchio
- 0000 0001 2322 6764grid.13097.3cSection of Stress, Psychiatry and Immunology and Perinatal Psychiatry, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neurosciences, King’s College London, London, UK
| | - Gertrude Seneviratne
- 0000 0001 2322 6764grid.13097.3cSection of Stress, Psychiatry and Immunology and Perinatal Psychiatry, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neurosciences, King’s College London, London, UK
| | - Carmine M. Pariante
- 0000 0001 2116 3923grid.451056.3National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London, London, UK ,0000 0001 2322 6764grid.13097.3cSection of Stress, Psychiatry and Immunology and Perinatal Psychiatry, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neurosciences, King’s College London, London, UK
| | - Mitul A. Mehta
- 0000 0001 2322 6764grid.13097.3cDepartment of Neuroimaging, Institute of Psychiatry, Psychology & Neurosciences, King’s College of London, De Crespigny Park, London, UK
| | - Paola Dazzan
- 0000 0001 2322 6764grid.13097.3cDepartment of Psychosis Studies, Institute of Psychiatry, Psychology & Neurosciences, King’s College London, De Crespigny Park, London, UK SE5 8AF ,0000 0001 2116 3923grid.451056.3National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London, London, UK
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24
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Plant DT, Jones FW, Pariante CM, Pawlby S. Association between maternal childhood trauma and offspring childhood psychopathology: mediation analysis from the ALSPAC cohort. Br J Psychiatry 2017; 211:144-150. [PMID: 28729357 PMCID: PMC5579325 DOI: 10.1192/bjp.bp.117.198721] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 05/11/2017] [Accepted: 05/12/2017] [Indexed: 02/04/2023]
Abstract
BackgroundStudies have shown that a mother's history of childhood maltreatment is associated with her child's experience of internalising and externalising difficulties.AimsTo characterise the mediating pathways that underpin this association.MethodData on a mother's history of childhood maltreatment, depression during pregnancy, postnatal depression, maladaptive parenting practices and her child's experience of maltreatment and internalising and externalising difficulties were analysed in an Avon Longitudinal Study of Parents and Children (ALSPAC) sample of 9397 mother-child dyads followed prospectively from pregnancy to age 13.ResultsMaternal history of childhood maltreatment was significantly associated with offspring internalising and externalising difficulties. Maternal antenatal depression, postnatal depression and offspring child maltreatment were observed to significantly mediate this association independently.ConclusionsPsychological and psychosocial interventions focused around treating maternal depression, particularly during pregnancy, and safeguarding against adverse childhood experiences could be offered to mothers with traumatic childhood histories to help protect against psychopathology in the next generation.
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Affiliation(s)
| | | | | | - Susan Pawlby
- D. T. Plant, PhD, DClinPsy, Institute of Psychiatry, Psychology & Neuroscience, King's College London, and Salomons Centre for Applied Psychology, Canterbury Christ Church University, Tunbridge Wells; F. W. Jones, PhD, PsychD, Salomons Centre for Applied Psychology, Canterbury Christ Church University, Tunbridge Wells; C. M. Pariante, MD, FRCPsych, PhD, S. Pawlby, MA, PhD, CPsychol, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
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Barona M, Taborelli E, Corfield F, Pawlby S, Easter A, Schmidt U, Treasure J, Micali N. Neurobehavioural and cognitive development in infants born to mothers with eating disorders. J Child Psychol Psychiatry 2017; 58:931-938. [PMID: 28452420 DOI: 10.1111/jcpp.12736] [Citation(s) in RCA: 12] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/01/2017] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Although recent research has focused on the effects of maternal eating disorders (EDs) on children, little is known about the effect of maternal EDs on neurobiological outcomes in newborns and infants. This study is the first to investigate neurobehavioural regulation and cognitive development in newborns and infants of mothers with EDs. METHODS Women with an active and past ED and healthy controls were recruited to a prospective longitudinal study during their first trimester or second trimester of pregnancy. Newborns and infants of mothers with ED were compared with newborns and infants of healthy controls on (a) neurobehavioural dysregulation using the Brazelton Neonatal Behavioural Assessment Scale at 8 days postpartum (active ED, n = 15; past ED, n = 20; healthy controls, n = 28); and (b) cognitive development using the Bayley Scales of Infant and Toddler Development at 1-year postpartum (active ED, n = 18; past ED, n = 19; healthy controls, n = 28). In order to maintain the largest possible sample at each time point, sample size varied across time points. RESULTS Newborns of mothers with an active ED had worse autonomic stability when compared with newborns of healthy controls [B = -0.34 (-1.81, -0.26)]. Infants of mothers with a past ED had poorer language [B = -0.33 (-13.6, -1.9)] and motor development [B = -0.32 (-18.4, -1.3)] compared with healthy controls. CONCLUSIONS Children of mothers with ED display neurobehavioural dysregulation early after birth and poorer language and motor development at 1 year. These characteristics suggest evidence of early neurobiological markers in children at risk. Differential outcomes in children of women with active versus past ED suggest that active symptomatology during pregnancy might have an effect on physiological reactivity while cognitive characteristics might be more stable markers of risk for ED.
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Affiliation(s)
| | | | - Freya Corfield
- Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, KCL, London, UK
| | - Susan Pawlby
- Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, KCL, London, UK
| | - Abigail Easter
- Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, KCL, London, UK
| | - Ulrike Schmidt
- Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, KCL, London, UK
| | - Janet Treasure
- Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, KCL, London, UK
| | - Nadia Micali
- Institute of Child Health, UCL, London, UK.,Department of Psychiatry, Icahn Medical School at Mount Sinai, New York, NY, USA.,Mindich Child Health and Development Institute, Icahn Medical School at Mount Sinai, New York, NY, USA
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Vaillancourt K, Pawlby S, Fearon RMP. HISTORY OF CHILDHOOD ABUSE AND MOTHER-INFANT INTERACTION: A SYSTEMATIC REVIEW OF OBSERVATIONAL STUDIES. Infant Ment Health J 2017; 38:226-248. [PMID: 28236319 DOI: 10.1002/imhj.21634] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Literature that has examined maternal self-reported history of abuse and an observational assessment of infant-mother interaction were reviewed. Electronic databases were searched, and studies that met predefined criteria were included. Fourteen (12 independent samples) studies were included and assessed for quality using the Effective Public Health Practice Project tool (National Collaborating Centre for Methods and Tools, 2008). Ten of the 14 studies found a direct or an indirect relationship between self-reported abuse and observed caregiving. The small number of studies and variation in sample characteristics and measurement limit conclusions. Of the studies that were rated of the highest quality, there is some consistency showing that the effect of maternal abuse history on caregiving may be via a third variable (i.e., stress reactivity or depressive symptoms). The current review discusses strengths and limitations of the existing literature and offers suggestions for future research.
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Affiliation(s)
- Kyla Vaillancourt
- Institute of Psychiatry, Psychology & Neuroscience, King's College London
| | - Susan Pawlby
- Institute of Psychiatry, Psychology & Neuroscience, King's College London
| | - R M Pasco Fearon
- Department of Clinical, Educational and Health Psychology, University College London
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Plant DT, Pawlby S, Sharp D, Zunszain PA, Pariante CM. Prenatal maternal depression is associated with offspring inflammation at 25 years: a prospective longitudinal cohort study. Transl Psychiatry 2016; 6:e936. [PMID: 27801895 PMCID: PMC5314108 DOI: 10.1038/tp.2015.155] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 08/19/2015] [Accepted: 09/06/2015] [Indexed: 12/23/2022] Open
Abstract
Animal studies and a handful of prospective human studies have demonstrated that young offspring exposed to maternal prenatal stress show abnormalities in immune parameters and hypothalamic-pituitary-adrenal (HPA) axis function. No study has examined the effect of maternal prenatal depression on offspring inflammation and HPA axis activity in adulthood, nor the putative role of child maltreatment in inducing these abnormalities. High-sensitivity C-reactive protein (hs-CRP) and awakening cortisol were measured at age 25 in 103 young-adult offspring of the South London Child Development Study (SLCDS), a prospective longitudinal birth cohort of mother-offspring dyads recruited in pregnancy in 1986. Maternal prenatal depression was assessed in pregnancy at 20 and 36 weeks; offspring child maltreatment (birth 17 years) was assessed at offspring ages 11, 16 and 25; and offspring adulthood depression (18-25 years) was assessed at age 25. Exposure to maternal prenatal depression predicted significantly elevated offspring hs-CRP at age 25 (odds ratio=11.8, 95% confidence interval (CI) (1.1, 127.0), P=0.041), independently of child maltreatment and adulthood depression, known risk factors for adulthood inflammation. In contrast, maternal prenatal depression did not predict changes in offspring adulthood cortisol; however, offspring exposure to child maltreatment did, and was associated with elevated awakening cortisol levels (B=161.9, 95% CI (45.4, 278.4), P=0.007). Fetal exposure to maternal depression during pregnancy has effects on immune function that persist for up to a quarter of a century after birth. Findings are consistent with the developmental origins of health and disease (DOHaD) hypothesis for the biological embedding of gestational psychosocial adversity into vulnerability for future physical and mental illness.
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Affiliation(s)
- D T Plant
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK,Stress, Psychiatry and Immunology Laboratory, Section of Perinatal Psychiatry, G.30 Maurice Wohl Clinical Neuroscience Institute, 5 Cutcombe Road, London SE5 9RT, UK. E-mail:
| | - S Pawlby
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - D Sharp
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - P A Zunszain
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - C M Pariante
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Abstract
BACKGROUND Research has shown that maternal mental illness can affect mother-infant interactions with implications for infant outcomes. Severe and chronic mental illness (SMI), particularly schizophrenia, is associated with the greatest risk. Schizophrenia is also associated with impairments in attribution of mental states, 'theory of mind' (ToM). Recent attachment research has suggested that maternal mentalizing skills are strongly associated with attachment outcome in infants. To date, no research has explored the relationship between ToM and maternal sensitivity in mothers with SMI using standard tests of ToM. The present study was designed as an exploratory study in order to investigate this. METHOD A total of 40 women with SMI in the postpartum period were administered a battery of ToM tasks and general neuropsychological tasks. The women were also filmed in an unstructured play session with their infants, which was coded for maternal sensitivity using the Crittenden CARE-Index. RESULTS One ToM task, the Frith-Happé Animations, predicted maternal sensitivity across all diagnoses. There was also an effect of diagnosis, with lower sensitivity observed in women with schizophrenia. ToM impairments did not fully explain the effect of diagnosis on sensitivity. Mothers of girls were rated as being more sensitive than mothers of boys. CONCLUSIONS The results suggest that ToM is a significant predictor of maternal sensitivity across all mental health diagnoses, extending the results of studies focusing on healthy populations. Clinical interventions emphasizing the importance of understanding the perspective of the infant may enhance maternal sensitivity.
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Affiliation(s)
- J Rigby
- South London and Maudsley NHS Foundation Trust,London,UK
| | - S Conroy
- King's College London, Institute of Psychiatry,Psychology and Neuroscience,London,UK
| | | | - S Pawlby
- King's College London, Institute of Psychiatry,Psychology and Neuroscience,London,UK
| | - F Happé
- King's College London, Institute of Psychiatry, Psychology and Neuroscience,MRC Social, Genetic and Developmental Psychiatry Centre,London,UK
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Du Preez A, Conroy S, Pawlby S, Moran P, Pariante CM. Authors' reply. Br J Psychiatry 2016; 208:499. [PMID: 27143012 DOI: 10.1192/bjp.208.5.499a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Andrea Du Preez
- Andrea Du Preez, Susan Conroy, Susan Pawlby, Paul Moran, Carmine M. Pariante, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
| | - Susan Conroy
- Andrea Du Preez, Susan Conroy, Susan Pawlby, Paul Moran, Carmine M. Pariante, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
| | - Susan Pawlby
- Andrea Du Preez, Susan Conroy, Susan Pawlby, Paul Moran, Carmine M. Pariante, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
| | - Paul Moran
- Andrea Du Preez, Susan Conroy, Susan Pawlby, Paul Moran, Carmine M. Pariante, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
| | - Carmine M Pariante
- Andrea Du Preez, Susan Conroy, Susan Pawlby, Paul Moran, Carmine M. Pariante, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
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Biaggi A, Conroy S, Pawlby S, Pariante CM. Identifying the women at risk of antenatal anxiety and depression: A systematic review. J Affect Disord 2016; 191:62-77. [PMID: 26650969 PMCID: PMC4879174 DOI: 10.1016/j.jad.2015.11.014] [Citation(s) in RCA: 792] [Impact Index Per Article: 99.0] [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: 05/14/2015] [Revised: 10/19/2015] [Accepted: 11/11/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Pregnancy is a time of increased vulnerability for the development of anxiety and depression. This systematic review aims to identify the main risk factors involved in the onset of antenatal anxiety and depression. METHODS A systematic literature analysis was conducted, using PubMed, PsychINFO, and the Cochrane Library. Original papers were included if they were written in English and published between 1st January 2003 and 31st August 2015, while literature reviews and meta-analyses were consulted regardless of publication date. A final number of 97 papers were selected. RESULTS The most relevant factors associated with antenatal depression or anxiety were: lack of partner or of social support; history of abuse or of domestic violence; personal history of mental illness; unplanned or unwanted pregnancy; adverse events in life and high perceived stress; present/past pregnancy complications; and pregnancy loss. LIMITATIONS The review does not include a meta-analysis, which may have added additional information about the differential impact of each risk factor. Moreover, it does not specifically examine factors that may influence different types of anxiety disorders, or the recurrence or persistence of depression or anxiety from pregnancy to the postpartum period. CONCLUSIONS The results show the complex aetiology of antenatal depression and anxiety. The administration of a screening tool to identify women at risk of anxiety and depression during pregnancy should be universal practice in order to promote the long-term wellbeing of mothers and babies, and the knowledge of specific risk factors may help creating such screening tool targeting women at higher risk.
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Affiliation(s)
- Alessandra Biaggi
- PO63 Section of Perinatal Psychiatry, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, United Kingdom.
| | - Susan Conroy
- Section of Perinatal Psychiatry, Department of Psychological Medicine, Institute of Psychiatry Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Susan Pawlby
- Section of Perinatal Psychiatry, Department of Psychological Medicine, Institute of Psychiatry Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Carmine M Pariante
- Section of Perinatal Psychiatry, Department of Psychological Medicine, Institute of Psychiatry Psychology & Neuroscience, King's College London, London, United Kingdom
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Plant DT, Pawlby S, Pariante CM, Sharp D. Authors' reply. Br J Psychiatry 2016; 208:198-9. [PMID: 26834174 DOI: 10.1192/bjp.208.2.198a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Dominic T Plant
- Dominic T. Plant, Stress, Psychiatry and Immunology Laboratory & Perinatal Psychiatry, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 2-059 James Black Centre, 125 Coldharbour Lane, London SE5 9NU, UK. ; Susan Pawlby, Carmine M. Pariante, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; Deborah Sharp, School of Social and Community Medicine, University of Bristol, UK
| | - Susan Pawlby
- Dominic T. Plant, Stress, Psychiatry and Immunology Laboratory & Perinatal Psychiatry, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 2-059 James Black Centre, 125 Coldharbour Lane, London SE5 9NU, UK. ; Susan Pawlby, Carmine M. Pariante, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; Deborah Sharp, School of Social and Community Medicine, University of Bristol, UK
| | - Carmine M Pariante
- Dominic T. Plant, Stress, Psychiatry and Immunology Laboratory & Perinatal Psychiatry, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 2-059 James Black Centre, 125 Coldharbour Lane, London SE5 9NU, UK. ; Susan Pawlby, Carmine M. Pariante, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; Deborah Sharp, School of Social and Community Medicine, University of Bristol, UK
| | - Deborah Sharp
- Dominic T. Plant, Stress, Psychiatry and Immunology Laboratory & Perinatal Psychiatry, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 2-059 James Black Centre, 125 Coldharbour Lane, London SE5 9NU, UK. ; Susan Pawlby, Carmine M. Pariante, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; Deborah Sharp, School of Social and Community Medicine, University of Bristol, UK
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Du Preez A, Conroy S, Pawlby S, Moran P, Pariante CM. Differential effects of ethnic density on the risk of postnatal depression and personality dysfunction. Br J Psychiatry 2016; 208:49-55. [PMID: 26494869 DOI: 10.1192/bjp.bp.114.148874] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 02/13/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND The relationship between ethnic density and psychiatric disorder in postnatal women in the UK is unclear. AIMS To examine the effect of own and overall ethnic density on postnatal depression (PND) and personality dysfunction. METHOD Multilevel analysis of ethnically mixed community-level data gathered from a sample of 2262 mothers screened at 6 weeks postpartum for PND and personality dysfunction. RESULTS Living in areas of higher own ethnic density was protective against screening positive for PND in White women (z = -3.18, P = 0.001), even after adjusting for area level deprivation, maternal age, relationship status, screening positive for personality dysfunction, parity and geographical clustering (odds ratio (OR) 0.98 (95% CI 0.96-0.99); P = 0.002), whereas the effect on personality dysfunction (z = -2.42, P = 0.016) was no longer present once the effect of PND was taken into account (OR = 0.99 (95% CI 0.90-1.0); P = 0.13). No overall ethnic density effect was found for women screening positive for PND or personality dysfunction. CONCLUSIONS In White women, living in areas of higher own ethnic density was protective against developing PND.
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Affiliation(s)
- Andrea Du Preez
- Andrea Du Preez, MSc, Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London; Susan Conroy, MSc, Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London; Susan Pawlby, MA, PhD, CPsychol, Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London; Paul Moran, MD, MSc, MRCPsych, Institute of Psychiatry, Psychology and Neuroscience, King's College London; Carmine M. Pariante, MD, FRCPsych, PhD, Psychological Medicine, The James Black Centre, King's College London, UK
| | - Susan Conroy
- Andrea Du Preez, MSc, Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London; Susan Conroy, MSc, Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London; Susan Pawlby, MA, PhD, CPsychol, Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London; Paul Moran, MD, MSc, MRCPsych, Institute of Psychiatry, Psychology and Neuroscience, King's College London; Carmine M. Pariante, MD, FRCPsych, PhD, Psychological Medicine, The James Black Centre, King's College London, UK
| | - Susan Pawlby
- Andrea Du Preez, MSc, Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London; Susan Conroy, MSc, Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London; Susan Pawlby, MA, PhD, CPsychol, Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London; Paul Moran, MD, MSc, MRCPsych, Institute of Psychiatry, Psychology and Neuroscience, King's College London; Carmine M. Pariante, MD, FRCPsych, PhD, Psychological Medicine, The James Black Centre, King's College London, UK
| | - Paul Moran
- Andrea Du Preez, MSc, Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London; Susan Conroy, MSc, Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London; Susan Pawlby, MA, PhD, CPsychol, Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London; Paul Moran, MD, MSc, MRCPsych, Institute of Psychiatry, Psychology and Neuroscience, King's College London; Carmine M. Pariante, MD, FRCPsych, PhD, Psychological Medicine, The James Black Centre, King's College London, UK
| | - Carmine M Pariante
- Andrea Du Preez, MSc, Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London; Susan Conroy, MSc, Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London; Susan Pawlby, MA, PhD, CPsychol, Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London; Paul Moran, MD, MSc, MRCPsych, Institute of Psychiatry, Psychology and Neuroscience, King's College London; Carmine M. Pariante, MD, FRCPsych, PhD, Psychological Medicine, The James Black Centre, King's College London, UK
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Plant DT, Pariante CM, Sharp D, Pawlby S. Maternal depression during pregnancy and offspring depression in adulthood: role of child maltreatment. Br J Psychiatry 2015; 207:213-20. [PMID: 26045352 PMCID: PMC4555443 DOI: 10.1192/bjp.bp.114.156620] [Citation(s) in RCA: 120] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Revised: 12/04/2014] [Accepted: 12/09/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND Studies have shown that maternal depression during pregnancy predicts offspring depression in adolescence. Child maltreatment is also a risk factor for depression. AIMS To investigate (a) whether there is an association between offspring exposure to maternal depression in pregnancy and depression in early adulthood, and (b) whether offspring child maltreatment mediates this association. METHOD Prospectively collected data on maternal clinical depression in pregnancy, offspring child maltreatment and offspring adulthood (18-25 years) DSM-IV depression were analysed in 103 mother-offspring dyads of the South London Child Development Study. RESULTS Adult offspring exposed to maternal depression in pregnancy were 3.4 times more likely to have a DSM-IV depressive disorder, and 2.4 times more likely to have experienced child maltreatment, compared with non-exposed offspring. Path analysis revealed that offspring experience of child maltreatment mediated the association between exposure to maternal depression in pregnancy and depression in adulthood. CONCLUSIONS Maternal depression in pregnancy is a key vulnerability factor for offspring depression in early adulthood.
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Affiliation(s)
- Dominic T Plant
- Dominic T. Plant, PhD, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; Carmine M. Pariante, MD, FRCPsych, PhD, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; Deborah Sharp, MA, FRCGP, PhD, School of Social and Community Medicine, University of Bristol, UK; Susan Pawlby, MA, PhD, CPsychol, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Carmine M Pariante
- Dominic T. Plant, PhD, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; Carmine M. Pariante, MD, FRCPsych, PhD, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; Deborah Sharp, MA, FRCGP, PhD, School of Social and Community Medicine, University of Bristol, UK; Susan Pawlby, MA, PhD, CPsychol, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Deborah Sharp
- Dominic T. Plant, PhD, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; Carmine M. Pariante, MD, FRCPsych, PhD, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; Deborah Sharp, MA, FRCGP, PhD, School of Social and Community Medicine, University of Bristol, UK; Susan Pawlby, MA, PhD, CPsychol, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Susan Pawlby
- Dominic T. Plant, PhD, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; Carmine M. Pariante, MD, FRCPsych, PhD, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; Deborah Sharp, MA, FRCGP, PhD, School of Social and Community Medicine, University of Bristol, UK; Susan Pawlby, MA, PhD, CPsychol, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
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Previti G, Pawlby S, Chowdhury S, Aguglia E, Pariante CM. Neurodevelopmental outcome for offspring of women treated for antenatal depression: a systematic review. Arch Womens Ment Health 2014; 17:471-83. [PMID: 25212663 PMCID: PMC4237905 DOI: 10.1007/s00737-014-0457-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 09/01/2014] [Indexed: 12/01/2022]
Abstract
The aim of this systematic review is to appraise existing literature on the effects of treatments for antenatal depression on the neurodevelopment outcomes of the offspring. We conducted a systematic review of the literature to identify studies on different kinds of treatments for antenatal depression (antidepressants and alternative therapies) and their effects on infants' neurodevelopment. After reading the title, abstract, or full text and applying exclusion criteria, a total of 22 papers were selected. Nineteen papers studied the effects of antidepressant drugs, one on docosahexanoic acid (DHA) (fish oil capsules) and two on massage therapy; however, no studies used a randomized controlled design, and in most studies, the control group comprise healthy women not exposed to depression. Comparisons between newborns exposed to antidepressants in utero with those not exposed showed significant differences in a wide range of neurobehavioral outcomes, although in many cases, these symptoms were transient. Two studies found a slight delay in psychomotor development, and one study found a delay in mental development. Alternative therapies may have some benefits on neurodevelopmental outcomes. Our review suggests that antidepressant treatment may be associated with some neurodevelopmental changes, but we cannot exclude that some of these effects may be due to depression per se.
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Affiliation(s)
- Giovanni Previti
- Department of Psychological Medicine, Institute of Psychiatry, King’s College London, Room 2-055, The James Black Centre, 125 Coldharbour Lane, London, SE5 9NU UK
- Department of Clinical and Molecular Biomedicine, Section of Psychiatry, University of Catania, School of Medicine, Catania, Italy
| | - Susan Pawlby
- Department of Psychological Medicine, Institute of Psychiatry, King’s College London, Room 2-055, The James Black Centre, 125 Coldharbour Lane, London, SE5 9NU UK
| | - Sahmina Chowdhury
- Department of Psychological Medicine, Institute of Psychiatry, King’s College London, Room 2-055, The James Black Centre, 125 Coldharbour Lane, London, SE5 9NU UK
| | - Eugenio Aguglia
- Department of Clinical and Molecular Biomedicine, Section of Psychiatry, University of Catania, School of Medicine, Catania, Italy
| | - Carmine M. Pariante
- Department of Psychological Medicine, Institute of Psychiatry, King’s College London, Room 2-055, The James Black Centre, 125 Coldharbour Lane, London, SE5 9NU UK
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Kenny M, Conroy S, Pariante CM, Seneviratne G, Pawlby S. Mother-infant interaction in mother and baby unit patients: before and after treatment. J Psychiatr Res 2013; 47:1192-8. [PMID: 23786913 DOI: 10.1016/j.jpsychires.2013.05.012] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [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: 12/17/2012] [Revised: 04/22/2013] [Accepted: 05/15/2013] [Indexed: 11/30/2022]
Abstract
Maternal severe mental illness (SMI) disrupts mother-infant interaction in the immediate postpartum and is associated with less than optimal offspring development. In-patient mother and baby units (MBUs) provide the opportunity of supporting mothers with SMI in developing their relationships with their infants in order to minimise this disruption. One way is through an individualised video feedback intervention, delivered as part of a multidisciplinary inpatient treatment package. The present study prospectively measured changes in mother-infant interaction following video feedback intervention, during admission to an MBU (N = 49). Comparisons were made with mother-infant interactions of (1) a community-based ill group of mothers (N = 67) with a mental health diagnosis of similar severity, living at home and without the intervention and (2) a group of healthy mothers (N = 22). Maternal sensitivity and unresponsiveness, and infant cooperativeness and passiveness, were measured from a 3-min videotaped play session, using the CARE-Index. Following admission and the video feedback intervention, the MBU mothers (irrespective of diagnosis) and their infants showed improvements in their interactions. Moreover, on discharge the MBU dyads were significantly more sensitive, cooperative and responsive than the community ill group, and as attuned as the healthy group. While the design of the study does not allow us to conclude unequivocally that the video feedback intervention has effects on the outcome for the mothers and babies independent from the whole inpatient therapeutic package, the results do show that the dyadic interaction of mothers with SMI and their infants improves following the focussed treatment package in a specialised MBU.
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Affiliation(s)
- Maeve Kenny
- PO 71, Section of Perinatal Psychiatry, King's College London, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, United Kingdom
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Plant DT, Barker ED, Waters CS, Pawlby S, Pariante CM. Intergenerational transmission of maltreatment and psychopathology: the role of antenatal depression. Psychol Med 2013; 43:519-528. [PMID: 22694795 PMCID: PMC3558981 DOI: 10.1017/s0033291712001298] [Citation(s) in RCA: 117] [Impact Index Per Article: 10.6] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2011] [Revised: 05/02/2012] [Accepted: 05/17/2012] [Indexed: 12/13/2022]
Abstract
BACKGROUND Maternal experience of childhood maltreatment and maternal antenatal depression are both associated with offspring childhood maltreatment and offspring adjustment problems. We have investigated the relative impact of maternal childhood maltreatment and exposure to depression in utero on offspring maltreatment and psychopathology. METHOD The sample included 125 families from the South London Child Development Study. A prospective longitudinal design was used. Data on maternal childhood maltreatment, maternal antenatal depression (36 weeks of pregnancy), offspring childhood maltreatment (age 11 years) and offspring adolescent antisocial behaviour and depression (ages 11 and 16 years) were obtained from parents and offspring through clinical interview. RESULTS Mothers who experienced childhood maltreatment were significantly more likely to be depressed during pregnancy [odds ratio (OR) 10.00]. Offspring of mothers who experienced only childhood maltreatment or only antenatal depression were no more at risk of being maltreated or having psychopathology; however, offspring of mothers who experienced both maternal childhood maltreatment and antenatal depression were exposed to significantly greater levels of childhood maltreatment and exhibited significantly higher levels of adolescent antisocial behaviour compared with offspring not so exposed. Furthermore, maternal childhood maltreatment accounted for a significant proportion of the variance in offspring childhood maltreatment in only those offspring exposed to depression in utero. CONCLUSIONS Maternal childhood maltreatment and maternal antenatal depression are highly associated. The co-occurrence of both insults significantly increases the risk of offspring adversity. The antenatal period is an optimum period to identify vulnerable women and to provide interventions.
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Affiliation(s)
- D T Plant
- Department of Psychological Medicine, Institute of Psychiatry, King's College London, UK.
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O'Keane V, Lightman S, Patrick K, Marsh M, Papadopoulos AS, Pawlby S, Seneviratne G, Taylor A, Moore R. Changes in the maternal hypothalamic-pituitary-adrenal axis during the early puerperium may be related to the postpartum 'blues'. J Neuroendocrinol 2011; 23:1149-55. [PMID: 22004568 DOI: 10.1111/j.1365-2826.2011.02139.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [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] [Indexed: 11/29/2022]
Abstract
Most women experience time-limited and specific mood changes in the days after birth known as the maternity blues (Blues). The maternal hypothalamic-pituitary-adrenal (HPA) axis undergoes gradual changes during pregnancy because of an increasing production of placental corticotrophin-releasing hormone (CRH). The abrupt withdrawal of placental CRH at birth results in a re-equilibration of the maternal HPA axis in the days post-delivery. These changes may be involved in the aetiology of the Blues given the central role of the HPA axis in the aetiology of mood disorders in general, and in perinatal depression in particular. We aimed to test the novel hypothesis that the experience of the Blues may be related to increased secretion of hypothalamic adrenocorticotrophic hormone (ACTH) secretagogue peptides, after the reduction in negative-feedback inhibition on the maternal hypothalamus caused by withdrawal of placental CRH. We therefore examined hormonal changes in the HPA axis in the days after delivery in relation to daily mood changes: our specific prediction was that mood changes would parallel ACTH levels, reflecting increased hypothalamic peptide secretion. Blood concentrations of CRH, ACTH, cortisol, progesterone and oestriol were measured in 70 healthy women during the third trimester of pregnancy, and on days 1-6 post-delivery. Blues scores were evaluated during the postpartum days. Oestriol, progesterone and CRH levels fell rapidly from pregnancy up to day 6, whereas cortisol levels fell modestly. ACTH concentrations declined from pregnancy to day 3 post-delivery and thereafter increased up to day 6. Blues scores increased, peaking on day 5, and were positively correlated with ACTH; and negatively correlated with oestriol levels during the postpartum days, and with the reduction in CRH concentrations from pregnancy. These findings give indirect support to the hypothesis that the 'reactivation' of hypothalamic ACTH secretagogue peptides may be involved in the aetiology of the Blues.
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Affiliation(s)
- V O'Keane
- Trinity Health Sciences Building, Tallaght Hospital (AMNCH), Dublin, Ireland.
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Abstract
BACKGROUND Antenatal depression and childhood maltreatment have each been associated with offspring psychopathology, but have never been examined in the same sample. AIMS To determine whether childhood maltreatment influences the association between antenatal depression and offspring psychopathology. METHOD Prospectively collected data on antenatal depression, offspring maltreatment (age 11) and offspring psychopathology (age 11 and 16) were analysed in 120 mother-offspring dyads from the community-based South London Child Development Study. RESULTS Antenatal depression increased the risk of maltreatment in the offspring by almost four times. Children exposed only to antenatal depression or only to childhood maltreatment were no more at risk of developing psychopathology; however, children exposed to both antenatal depression and childhood maltreatment were at almost 12 times greater risk of developing psychopathology than offspring not so exposed. CONCLUSIONS Research investigating exposure to adverse events in utero and offspring psychopathology should take account of postnatal adverse events such as maltreatment.
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Affiliation(s)
- Susan Pawlby
- Section of Perinatal Psychiatry, PO Box 71, Institute of Psychiatry, Kings College London, De Crespigny Park, London SE5 8AF, UK.
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O'Keane V, Lightman S, Marsh M, Pawlby S, Papadopoulos AS, Taylor A, Moore R, Patrick K. Increased pituitary-adrenal activation and shortened gestation in a sample of depressed pregnant women: a pilot study. J Affect Disord 2011; 130:300-5. [PMID: 21093926 DOI: 10.1016/j.jad.2010.10.004] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2010] [Revised: 10/07/2010] [Accepted: 10/07/2010] [Indexed: 11/19/2022]
Abstract
BACKGROUND Major depression (MD) is frequently accompanied by a relatively increased production of the stress hormone cortisol. During pregnancy corticotrophin releasing hormone (CRH) is secreted from the placenta and critically high levels of CRH are one of the key triggers for parturition. Maternal cortisol promotes the secretion of placental CRH. In this study, we examined the hypothesis that women suffering with MD in pregnancy would have relatively increased cortisol secretion, a time-advanced rise in placental CRH production and an earlier delivery of the baby. METHODS A group of medication-free pregnant women, free of know obstetric and medical complications, with (n=27) and without (n=38) MD were recruited. Blood concentrations of CRH, adrenocorticotrophic hormone (ACTH) and diurnal salivary cortisol concentrations were measured at fixed time points. RESULTS Maternal cortisol concentrations were highly correlated with placental CRH secretion for the entire group. Second trimester CRH concentrations and mean evening salivary cortisol concentrations were significantly higher in the depressed women. Although pregnancy length was shorter in the depressed women there were no statistical relationships between the stress hormone measures and pregnancy length. LIMITATIONS The sample size was small and highly selected. CONCLUSIONS These findings suggest that depressed pregnant women hypersecrete cortisol in a diurnal pattern similar to that typical of MD, and that this leads to a time-advanced rise in placental CRH secretion. Factors other than this stress-delivery mechanism may be contributing to the shortened pregnancy length in depressed women.
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Affiliation(s)
- V O'Keane
- Trinity Science Building, Tallaght Hospital (AMNCH), Dublin 24, Ireland.
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Pawlby S, Fernyhough C, Meins E, Pariante CM, Seneviratne G, Bentall RP. Mind-mindedness and maternal responsiveness in infant-mother interactions in mothers with severe mental illness. Psychol Med 2010; 40:1861-1869. [PMID: 20102664 DOI: 10.1017/s0033291709992340] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Previous cross-diagnosis studies of interaction between mothers with severe mental illness and their babies have concluded that mothers with schizophrenia have deficits in interaction, but these studies have not included healthy controls. METHOD In-patients on a mother and baby unit, with diagnoses of schizophrenia (n=15), depressive mood disorders with or without psychosis (n=23), or mood disorders where mania was the predominant feature, with or without psychosis (n=12), were observed interacting with their infants on admission and discharge. Mothers' mind-mindedness and other measures of the quality of maternal and infant behaviour were coded. Findings from this sample were compared with those from healthy mothers and their infants (n=49). RESULTS Compared with healthy controls, on admission depressed mothers were marginally less likely to comment appropriately on their infants' mental states. Both the depressed and mania groups were more likely to touch their babies and engage in attention-seeking behaviours. Interactional behaviours of mothers in the schizophrenia group were not markedly different from healthy controls. On discharge there were fewer differences between the clinical and healthy groups, although the depressed group continued to engage in more attention-seeking and touching behaviour and the mania group continued to touch their infants more. Only mothers in the schizophrenia group showed changes in interactional behaviours between admission and discharge, talking more to their infants. CONCLUSIONS The findings challenge previous conclusions that mothers with schizophrenia have deficits in their interactions with their babies, and demonstrate that mothers with severe mental illness are able to respond appropriately to their infants' cues.
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Affiliation(s)
- S Pawlby
- Section of Perinatal Psychiatry and Stress, Psychiatry and Immunology, Institute of Psychiatry, King's College London, London, UK.
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Turton P, Badenhorst W, Pawlby S, White S, Hughes P. Psychological vulnerability in children next-born after stillbirth: a case-control follow-up study. J Child Psychol Psychiatry 2009; 50:1451-8. [PMID: 19594837 DOI: 10.1111/j.1469-7610.2009.02111.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Case studies and anecdotal accounts suggest that perinatal loss may impact upon other children in the family, including those born subsequent to loss. However, there is a dearth of systematically collected quantitative data on this potentially vulnerable group. METHODS Case-controlled follow-up of 52 mothers with history of stillbirth with their next-born children aged 6-8 years, and 51 control mother-child dyads. Previously reported baseline data included maternal antenatal and postnatal psychological assessment, and infant security of attachment at 12 months. Follow-up assessments included maternal psychiatric and socio-demographic data, mother and teacher-rated scales of the child's strengths and difficulties, child IQ, observer-rated mother-child interaction and maternal reports of child health. RESULTS There were no significant between-group differences in child cognitive or health assessments, or in teacher-rated child difficulties. However, mothers with history of stillbirth (the index group) reported increased child difficulties, in particular peer problems, and more adverse interaction was observed in respect of higher levels of maternal criticism of the child's actions, more overall controlling behaviour by the mother, a less harmonious emotional atmosphere and a lower level of maternal engagement with the child. Some of these effects appeared to be mediated by maternal perinatal psychological symptoms and family breakdown. CONCLUSIONS This study provides no evidence to suggest that siblings born after stillbirth are clinically at risk but does lend empirical support to clinical reports that such children are seen by their mothers as having problems and that they are exposed to less optimal interaction with their mothers. Possible interpretations of these findings are discussed in the context of theoretical accounts of 'replacement child' and 'vulnerable child' syndromes.
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Abstract
BACKGROUND Postpartum depression (PPD) is considered a major public health problem that conveys risk to mothers and offspring. Yet PPD typically occurs in the context of a lifelong episodic illness, and its putative effects might derive from the child's exposure to other episodes, in pregnancy or later childhood. The aim of the study is to test two hypotheses: (1) that the effects of PPD on adolescent outcomes are partly explained by antepartum depression (APD) and (2) that the effects of APD and PPD are both explained by later exposure to the mother's depression. METHOD A random sample of 178 antenatal patients was drawn from two general medical practices in South London; 171 gave birth to live infants, and 150 (88%) were assessed at 3 months post partum, with 121 of their offspring (81%) assessed for emotional disorders (ED), disruptive behaviour disorders (DBD) and IQ, at 11 and 16 years of age. RESULTS When APD and subsequent episodes of depression were taken into account, PPD had a significant effect on adolescent IQ, especially for boys, but did not predict psychopathology. ED and DBD in adolescence were predicted by the extent of exposure to maternal depression after 3 months post partum; a significant effect of APD on ED in girls was accounted for by later exposure to the mother's illness. Mothers' symptoms of anxiety, smoking and alcohol use in pregnancy did not predict adolescent outcomes, once maternal depression was taken into account. CONCLUSIONS Some effects attributed to mothers' mental health problems in pregnancy or post partum may be mediated by cumulative exposure to maternal illness, probably reflecting genetic influence and gene-environment correlation. However, PPD has a direct effect on cognition. Clinicians should endeavour to identify women with depression in pregnancy (31% of this sample) and help them to manage their lifelong illness.
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Affiliation(s)
- Dale F Hay
- School of Psychology, Cardiff University, Cardiff, UK.
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Pawlby S, Sharp D, Hay D, O'Keane V. Postnatal depression and child outcome at 11 years: the importance of accurate diagnosis. J Affect Disord 2008; 107:241-5. [PMID: 17854906 DOI: 10.1016/j.jad.2007.08.002] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2007] [Revised: 08/04/2007] [Accepted: 08/06/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND One in ten women suffers from postnatal depression (PND) and their children have elevated rates of psychopathology. We compared caseness of PND using the Edinburgh Postnatal Depression Scale (EPDS), the most commonly used research tool for the detection of PND, and the Clinical Interview Schedule (CIS) in terms of their relative abilities to identify infants at risk of psychopathology in middle childhood. METHOD In a prospective longitudinal primary care study, 147 randomly selected women were administered both the CIS and the EPDS at three months postpartum. Childhood psychopathology was identified by face-to-face interview at 11 years. RESULTS The risk for psychiatric disorder at 11 years was four times greater among children whose mothers were cases of PND on the CIS, compared to children whose mothers were not depressed. Using the EPDS to identify PND, there was no significant difference in the risk for children whose mothers scored above and below a conventional cut-off score. LIMITATIONS This study was retrospectively designed and was not part of the original study plan. CONCLUSIONS These data support the evidence that accurate detection of PND is better achieved by face-to-face clinical interview than through the use of the EPDS. They provide novel evidence that a simple diagnostic clinical interview for PND, in contrast to the EPDS, can identify mothers whose children will be at an increased risk of developing psychiatric disorder in later childhood.
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Affiliation(s)
- Susan Pawlby
- Institute of Psychiatry, King's College, London, UK.
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Steadman J, Pawlby S, Mayers A, Bucks RS, Gregoire A, Miele‐Norton M, Hogan AM. An exploratory study of the relationship between mother–infant interaction and maternal cognitive function in mothers with mental illness. J Reprod Infant Psychol 2007. [DOI: 10.1080/02646830701691343] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Burt KB, Hay DF, Pawlby S, Harold G, Sharp D. The prediction of disruptive behaviour disorders in an urban community sample: the contribution of person-centred analyses. J Child Psychol Psychiatry 2004; 45:1159-70. [PMID: 15257672 DOI: 10.1111/j.1469-7610.2004.00308.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [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] [Indexed: 11/28/2022]
Abstract
BACKGROUND Variable- and person-centred analyses were used to examine prediction of middle childhood behaviour problems from earlier child and family measures. METHOD A community sample of 164 families, initially recruited at antenatal clinics at two South London practices, was assessed for children's behaviour problems and cognitive ability, maternal mental health, and the family environment when the children were 4 years old. At age 11, children, mothers, and teachers reported the child's disruptive behaviour, and mothers and children were interviewed to identify cases of disruptive behaviour disorders (DBD). RESULTS Neither social class nor ethnicity predicted the child's disruptive behaviour at age 11. Rather, path analyses and logistic regression analyses drew attention to early behavioural problems, maternal mental health and the child's cognitive ability at 4 as predictors of disruptive behaviour at age 11. Cluster analysis extended these findings by identifying two distinct pathways to disruptive symptoms and disorder. In one subgroup children who showed intellectual difficulties at 4 had become disruptive by 11. In a second subgroup mothers and children both showed psychological problems when the child was 4, and the children were disruptive at age 11. The person-centred approach also revealed a high-functioning group of cognitively able 4-year-olds in supportive environments, at especially low risk for DBD. CONCLUSIONS Combining variable- and person-centred analytic approaches can aid prediction of children's problems, draw attention to pertinent developmental pathways, and help integrate data from multiple informants.
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Affiliation(s)
- Keith B Burt
- Institute of Child Development, University of Minnesota, Minneapolis 55455-0345, USA.
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Abstract
The study tested whether children's prosocial behavior was negatively or positively related to children's and mothers' psychological problems. Participants were 149 London families when mothers were pregnant and followed up in infancy and at ages 4 and 11. Children's cooperation at 4 and general prosocial tendencies at 11 were negatively associated with externalizing problems but unrelated to internalizing problems. A subgroup of children who were more prosocial than average expressed clinically significant worries about family members. Maternal depression decreased prosocial behavior in the eyes of adults, but children of depressed mothers saw themselves to be prosocial. Early cooperation protected children against later risk for externalizing problems, even when their early behavioral problems were taken into account.
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Affiliation(s)
- Dale F Hay
- School of Psychology, Cardiff University, Wales, United Kingdom.
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Abstract
The impact of postnatal depression on a child's risk for violent behavior was evaluated in an urban British community sample (N=122 families). Mothers were interviewed during pregnancy, at 3 months postpartum, and when the child was 1, 4, and 11 years of age. Mothers, teachers, and children reported on violent symptoms at age 11. Structural equation modeling revealed that the child's violence was predicted by the mother's postnatal depression even when her depression during pregnancy, her later history of depression, and family characteristics were taken into account. Violence was associated with symptoms of attention-deficit/hyperactivity disorder and problems with anger management. Children were most violent if mothers had been depressed at 3 months and at least once thereafter.
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Affiliation(s)
- Dale F Hay
- School of Psychology, Cardiff University, Cardiff, United Kingdom.
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Abstract
The aim of the study was to examine long-term sequelae in the children of mothers who were depressed at 3 months postpartum. In a community sample from two general practices in South London. 149 women were given psychiatric interviews at 3 months postpartum and 132 of their children (89 %) were tested at 11 years of age. The children of women who were depressed at 3 months postpartum had significantly lower IQ scores. They also had attentional problems and difficulties in mathematical reasoning. and were more likely than other children to have special educational needs. Boys were more severely affected than girls, with the sex difference most pronounced on Performance IQ. The links between postnatal depression and the children's intellectual problems were not mediated by parental IQ and were not accounted for by measures of social disadvantage nor by the mother's later mental health problems. Breastfeeding did not remove the effect of the mother's illness on Full Scale IQ, but exerted its own influence on Verbal IQ and appeared to mediate the link with mathematical ability. The findings show that adverse experiences in infancy predict cognitive ability and academic performance a decade later.
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Affiliation(s)
- D F Hay
- School of Psychology, Cardiff University, Wales, UK.
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Hay DF, Pawlby S, Sharp D, Schmücker G, Mills A, Allen H, Kumar R. Parents' judgements about young children's problems: why mothers and fathers might disagree yet still predict later outcomes. J Child Psychol Psychiatry 1999; 40:1249-58. [PMID: 10604403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
Correlates of parents' ratings of behavioural problems were explored in a sample of 93 British families, in which mothers and fathers rated their children at the time of the fourth birthday on the Achenbach Child Behavior Checklist. As in other samples, there was moderate convergence in mothers' and fathers' total problem scores, but also signs that they were reporting different sorts of problems linked to different influences. The father's rating was primarily associated with the child's cognitive ability. The mother's rating was primarily affected by her own mental state and view of her marriage. The father's but not the mother's rating provided unique information that predicted teachers' reports of the children's problems 7 years later. In general, parents' ratings of preschool children's problems reflect particular informants' perspectives on family life.
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Affiliation(s)
- D F Hay
- Faculty of Social and Political Sciences, University of Cambridge, UK
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