Medical Technology and Childbirth: Experiences of Expectant Mothers and Fathers

Research and theory on medical technologysuggests that, for many expectant mothers, medicalintervention in pregnancy and childbirth results infeelings of alienation from their bodies and a lack ofcontrol over the childbirth experience. Few studies,however, examine the influence of medical interventionon the expectant father's experience of this significantlife event. In this study, we compare expectant fathers' and mothers' experiences with medicaltechnology during pregnancy and childbirth. In-depthinterviews were conducted with 15 primarily White,middle-class, married couples prior to and after the birth of their first child. Our findings revealdifferences in the impact of medical technology onexpectant mothers' and fathers' perceptions ofinvolvement and control over pregnancy andchildbirth.     

Voluntary Stigmatization and Social Comparison: Single Mothers View Their Lot1

This research examined the impact of voluntary Stigmatization, depression, and self-esteem on downward social comparisons. The stigmatized group was 51 mothers who chose to become parents as single women; 51 demographically similar married mothers were the nonstigmatized group. The women described their stressors and rated these stressors relative to other mothers of the same marital status and relative to mothers who differed in marital status. Consistent with downward comparison theory, Stigmatization increased the likelihood of making downward comparisons. Contrary to the theory, high self-esteem and low levels of depression resulted in self-enhancing comparisons, but only when individuals compared themselves to others who differed in Stigmatization status. The combination of these individual difference variables and Stigmatization increased the tendency to make downward comparisons.     

Children of Prenatally Depressed Mothers: Externalizing and Internalizing Symptoms are Accompanied by Reductions in Specific Social-Emotional Competencies

Studies have shown that child development is negatively affected by prenatal depression. A dysregulated hypothalamic-pituitary-adrenal axis in the pregnant woman, passed to the fetus, is one discussed key mechanism. Studies, investigating primary-school age children, have found effects on antisocial behavior. Effects on internalizing symptoms were not found, but the analysis did not distinguish between anxiety and depression symptoms. Additionally, until now, no objective test data operationalizing social-emotional competencies have been included. The present study examined: 1.Whether the effects on child externalizing symptoms could be replicated; 2. If there are specific effects on child internalizing symptoms, separated for anxiety and depression; and 3. Are child clinical symptoms reflected in reductions in social-emotional competencies. A sample of 61 prenatally depressed and 143 prenatally not-depressed women and their 6–9 year old children were compared, controlling for key confounders in both the perinatal period and in middle childhood. Children of prenatally depressed mothers had more antisocial behavior and depression symptoms reported by their mothers. The prediction of antisocial behavior scores tended to be more significant for boys than for girls. Child anxiety symptoms were primarily explained by current maternal depressive symptoms. Children of prenatally depressed mothers also showed a reduction in social-emotional competencies, specifically regarding the ability to interpret complex social situations. This study showed that, even in a non-clinical sample, there are distinct effects of prenatal depression on child externalizing and internalizing symptoms which are accompanied by reductions in specific social-emotional competencies. These results emphasize that treatment for depressed pregnant women and/or early support for affected families is worthwhile. Additional work is required to identify the underlying biological mechanisms.     

The development and content of an interpersonal psychotherapy group for postnatal depression

Postnatal depression (PND) usually causes distressing symptoms for sufferers and significant impairments in relationships. Group Interpersonal Psychotherapy (IPT-G) provides the experienced therapist with a brief, focused, and manualized approach to helping women recover from the debilitating effects of PND. This paper describes the background and development of IPT-G for PND. The evidence for the effectiveness of individual and group IPT formats with this population is summarized. The triad of theories underpinning IPT are discussed with an emphasis on the important role of attachment styles during the transition to parenthood. Its strengths, which include its unique package of targets, tactics, and techniques, are highlighted. The benefits and challenges of IPT-G are also explored, and the results of a randomized controlled trial are summarized. Finally, a case study illustrates how IPT-G specifically addresses the social role transitions, conflicts, losses, and social isolation that mothers commonly experience.     

Bidirectional Effects of Positive Affect,Warmth, and Interactions Between Mothers With and Without Symptoms of Depression and Their Toddlers

Maternal depression has negative implications for parenting and child outcomes, but it is also important to understand the daily transactional interactions that occur between mothers varying in symptoms of depression and their children. The current study aimed to examine immediate bidirectional effects between maternal warmth and positive affect and toddler affect in a sample of mothers varying in symptoms of depression. Ninety-one mothers and their 24-month-old toddlers completed a laboratory free-play/clean-up task. Mothers rated their symptoms of depression using the CES-D, and maternal warmth and positive affect and toddler positive and negative affect were observationally coded from a free-play and clean-up laboratory task. Sequential analyses indicated that mothers with no or mild symptoms of depression exhibited mutual positive affect with their children, but mothers with more severe symptoms of depression did not. Mothers with higher symptoms of depression displayed a decrease in warmth concurrent with toddlers’ positive affect. Further, unlike dyads in which mothers had higher symptoms of depression, dyads of mothers with lower symptoms appeared to exhibit some covariation in positive affect across the episode. These results provide evidence that even in non-clinical samples, affective manifestations of mothers’ subthreshold levels of depression may have negative immediate effects on toddlers’ emotions, and that mothers without symptoms of depression may have more reciprocal affective exchanges with their toddlers.     

Impact of Depression and Childhood Trauma in Mothers Receiving Home Visitation

Research has documented the deleterious effects of maternal depression and childhood trauma on parenting and child development. There are high rates of both depression and childhood trauma in new mothers participating in home visitation programs, a prevention approach designed to optimize mother and child outcomes. Little is known about the impacts of maternal depression and childhood trauma on parenting in the context of home visitation. This study contrasted depressed and non-depressed mothers enrolled in the first year of a home visitation program on parenting stress, quality of home environment, social network, and psychiatric symptoms. Mothers were young, low income, and predominantly unmarried. Results indicated that depressed mothers displayed impairments in parenting, smaller and less robust social networks, and increased psychiatric symptoms relative to their non-depressed counterparts. Path analyses for the full sample revealed a path linking childhood trauma, depression, and parenting stress. Path analyses by group revealed several differential relationships between dimensions of social network and parenting. Number of embedded networks, namely the number of different domains in which the mother is actively interacting with others, was associated with lowered parenting stress among non-depressed mothers and increased parenting stress in their depressed counterparts with childhood trauma histories. In depressed mothers, social network size was associated with lower levels of parenting stress but decreased quality of the home environment, whereas number of embedded networks was positively related to quality of the home environment. Implications of findings for home visitation programs are discussed.     

Sudden gains in interpersonal psychotherapy for depression

Sudden, precipitous improvements in depressive symptom severity have been identified as occurring among unipolar depressed individuals. These "sudden gains" have been associated with superior acute treatment outcome in several treatment modalities, including cognitive therapy. A better understanding of sudden gains may provide insight into the mechanisms of action in these and other psychotherapies. One efficacious therapy that has been overlooked in sudden gains research is interpersonal psychotherapy (IPT; Weissman, M. M., Markowitz, J. C., & Klerman, G. L. (2000). Comprehensive guide to interpersonal psychotherapy. New York: Basic Books). The present research examined the rates and concomitant features of sudden, precipitous improvements in depressive symptomotology among 185 women receiving IPT for recurrent depression. Sudden gains, defined using extant criteria for the Beck Depression Inventory, were assessed over 12 weeks of acute IPT treatment for depression and occurred for 33.5% of the sample. Sudden gains were not associated with diagnostic and demographic characteristics or with differential likelihood of achieving depression remission with IPT monotherapy during active treatment. Further, those with sudden gains were no more likely to maintain their recovery through maintenance treatment. The lack of impact of sudden gains on eventual outcome is discussed in terms of potentially disparate emphases and mechanisms of change between IPT and cognitive-behavioral therapy (CBT).     

Invisible Household Labor and Ramifications for Adjustment: Mothers as Captains of Households

We address the issue of invisible labor in the home by examining how the distribution of the mental and emotional labor inherent in managing the household between spouses may be linked with women’s well-being, including their satisfaction with life, partner satisfaction, feelings of emptiness, and experiencing role overload. In a sample of 393 U.S. married/partnered mothers, mostly of upper-middle class backgrounds with dependent children at home, results showed that a majority of women reported that they alone assumed responsibility for household routines involving organizing schedules for the family and maintaining order in the home. Some aspects of responsibilities related to child adjustment were primarily handled by mothers, including being vigilant of children’s emotions, whereas other aspects were shared with partners, including instilling values in the children. Responsibility was largely shared for household finances. Regression analyses showed that after controlling for dimensions of emotional and physical intimacy, feeling disproportionately responsible for household management, especially child adjustment, was associated with strains on mothers’ personal well-being as well as lower satisfaction with the relationship. The implications of our work highlight the need to consider the burden of household management on mothers’ well-being and speak to mothers’ own needs for support and care as the primary managers of the household. In future research on division of labor, it will be useful to measure these critical but often neglected dimensions of who coordinates the household, given potential ramifications of this dimension for the quality of marriages and women’s personal well-being.

     

Mothers,daughters, and the socialization of political women

Using biographical data from what we call a focused sample of 36 elite women, the conjugal power structure of their parental families is examined to assess its impact upon the development of political women. The results revealed that the mothers of elite political women scored higher on indices of independence both within the family structure and outside the home than did the mothers of elite nonpolitical women. The fathers of the elite political women tended to show more respect and love for their wives than did the fathers of the elite nonpolitical women. The fathers of elite political women also tended to view their work as interesting and fun rather than as just a job. The elite political women were also less likely to have brothers, particularly older brothers, than the nonpolitical women. This finding suggests that female involvement in politics is not necessarily derived from cross-sex-role preferences. The study suggests that in terms of political socialization, the father's behavior and achievements are not as critical for his daughter as they are for his son. Their importance for the daughter must be filtered through the effect the father and his behavior have on the mother and the sex-role ideology held by the family.     

Pediatric Symptom Checklist Ratings by Mothers with a Recent History of Intimate Partner Violence: A Primary Care Study

Screening for psychosocial problems is an effective way to identify children who need further evaluation, and many brief, psychometrically strong measures exist for this purpose. More research is needed, however, about the performance of these measures in special populations who are familiar to primary care settings. The purpose of this study was to examine and compare maternal ratings on the Pediatric Symptom Checklist (PSC) between low-income, urban mothers who had suffered intimate partner violence (IPV) in the past year (n = 23) and a demographically-matched comparison group of mothers (n = 23). Victims of violence rated their children as having significantly more problems in a number of categories (Total PSC Score, Externalizing, and Internalizing) than did mothers in the comparison group. The PSC shows promise as an adequate screening tool for psychosocial problems in the children of women who have suffered IPV, but more research is needed.     

Attention-Deficit/Hyperactivity Disorder Symptoms in Mothers and Fathers: Family Level Interactions in Relation to Parenting

Previous studies linking parent ADHD symptoms to parenting have typically focused on each parent individually. To provide a broader understanding of family context, in this study, levels of inattention and hyperactivity-impulsivity in mothers and fathers were examined, both individually and in combination, in relation to negative parenting and child-rearing disagreements. Two-parent families of 5 to 13 year old boys (126 with ADHD and 53 typically developing) participated. Parents reported their own ADHD symptoms and their perceptions of child-rearing disagreements. Parenting was measured using self-, partner-, and child-reports as well as observations. Controlling for child ADHD symptoms, inattention symptoms in fathers predicted parenting difficulties. For mothers, inattention symptoms were linked to parenting problems only when fathers also had high levels of inattention. In contrast, parenting was most problematic for both mothers and fathers in families in which fathers had higher and mothers had lower levels hyperactivity-impulsivity symptoms. These results remained essentially unchanged when child externalizing behavior and mother depression and hostility were controlled, but father depression reduced the significance of some interactions. The results highlight the importance of the match between father and mother levels of symptoms, and point to differential relations of parenting to inattention and hyperactivity-impulsivity symptoms in parents.     

What Low-Income,Depressed Mothers Need From Mental Health Care: Overcoming Treatment Barriers From Their Perspective

Maternal depression is a major public health concern, as children of depressed mothers have a substantially increased risk for psychiatric problems into adulthood. Low-income mothers have high rates of depression, yet few receive mental health care. Barriers have been identified, but solutions have been based on what mental health professionals believe is helpful rather than mothers’ own perspectives, or require participation in an existing treatment. The purpose of our study was to learn what low-income, depressed mothers believe they need from mental health care to overcome barriers to mental health care. Twelve mothers with at least one child between the ages of 2 and 17 participated in individual interviews. Using qualitative grounded theory methodology, data were organized into six theoretical constructs. These included: (1) attitudes, expectations, and emotions impact the intention to enter treatment, (2) identifying as self-sufficient inhibits the intention to enter treatment, (3) providing knowledge, skills and environmental resources facilitate treatment entry, (4) habits and life circumstances that make treatment seem unimportant inhibit treatment entry, (5) balancing acceptance, change, and the therapeutic relationship facilitates treatment retention, and (6) sharing similarities with people involved in treatment often, but does not always facilitate treatment retention. A 3-step theory was developed regarding variables that influence mothers’ (a) intentions to enter treatment, (b) treatment entry, and (c) treatment retention. Offering what low-income, depressed mothers believe they need could better engage and retain them in mental health treatment.     

Testing Models of Associations Between Depression and Parenting Self-efficacy in Mothers: A Meta-analytic Review

Numerous cross-sectional studies confirm the long-theorized association between mothers’ depression and lower parenting self-efficacy (PSE) beliefs. However, cross-sectional studies leave unanswered the direction of this association: Does depression predict PSE? Does PSE predict depression? Are both true? Does the strength of the association between depression and PSE, regardless of the direction, generalize across participant characteristics and study design features? How stable is PSE over time? And how effective are interventions at enhancing PSE? To answer these questions, we conducted a meta-analytic review of longitudinal studies. With 35 eligible studies (22,698 participants), we found support for both models: there was a significant pooled effect of both depression on PSE and of PSE on depression, with nearly identical effect sizes (d?=?????0.21 and ??0.22, respectively). The association was stronger in samples with mothers’ younger average age and studies that measured PSE among mothers relative to during pregnancy. We found a medium degree of stability in the index of PSE, d?=?0.60. Finally, the estimated pooled effect size between being in an intervention group versus control group and PSE was 0.505. Overall, we found support for (1) bidirectional associations between depression and PSE in mothers, (2) the stability of PSE over time, and (3) the strength of the relationship between PSE and depression with intervention. These results suggest the importance of continuing to develop, test, and disseminate interventions to enhance PSE. We interpret these findings in the context of both depression and low PSE having serious consequences for child outcomes and maladaptive parenting.

     

Mothers and Daughters as Adults

For most women, their relationship with their mothers, both external and internal, remains important throughout life, although it may be intensely ambivalent. The tension between the ongoing process of differentiation and developing a sense of self, and also maintaining the attachments that have been present during development into adulthood, continue to be present, fluctuating with life events and changes for both daughters and mothers. The body with its similarities to the mother, mutual identification, and competitive aspects is a central area for experiencing this relationship. A patient who illustrates these processes is described.     

Employment Status and Sex Role Attitudes in Middle-class Suburban Mothers

Twenty-one employed and 31 nonemployed suburban mothers of 2nd and 6th grade children were administered the Bern Sex Role Inventory (BSRI), Welledey Role Orientation Scale (WROS), and items from the Traditional Family Inventory (TFI items). Employed mothers agreed with more nontraditional attitudes on the WROS and described themselves in more masculine or androgynous terms than did nonempldyed mothers. These differences were not affected by grade or sex of child. While the directionality of effect could not be established, it was clear that these employed women viewed themselves and their roles as wives and mothers differently than did their nonemployed counterparts. This was true despite differences in conditions of employment, and despite a more traditional overall attitude among these women than has been reported in studies using younger, upper middle-class university women. In this study, mothers employed part time were more traditional in their responses to TFI items concerned with child rearing attitudes than were mothers employed full time. Again, while directionality of effect could not be established, the decision to work part time and thus spend more time with the children is compatible with a more traditional attitude. The usefulness of these easily administered measures in dividing groups of women for further research on sex roles outside university communities is apparent.     

Prenatal maternal representations: Mothers at psychosocial risk

The aim of the study was to explore differences in the content of prenatal mental representations between a risk group (n = 84) and a low‐risk group (n = 296) of pregnant women, enrolled from maternity care centers in southwestern Finland. The method used was semantic differentials of IRMAG (Interview of Maternal Representations During Pregnancy). The risk group was defined by means of questionnaire screens that concerned chemical dependency, depression, difficulties in social environment, and low social support. The ratings on all target subjects, i.e., child, self, partner, self‐as‐mother and own mother‐as‐mother, were significantly more negative in the risk group. The representation profiles of the groups differed: especially the ratings of partner and own mother‐as‐mother were more consistently and strongly negative among the risk mothers. © 2001 Michigan Association for Infant Mental Health.     

Mothers with depressive symptoms: cross-situational consistency and temporal stability of their parenting behavior

In the present study, it has been hypothesized that anxious and depressed mothers may show less typical behavior in a laboratory observational setting because they may be more affected by unfamiliarity and the social evaluative meaning of the situation. They may thus show low consistency across laboratory and home assessments. A sample of 101 mother-infant pairs participated in the longitudinal study. Laboratory and home observations of mother-infant interaction episodes were conducted at the infant ages of 4, 8, and 12 months. Consistent with expectations, at 4 months the association between laboratory- and home-assessed maternal sensitivity was significantly moderated by maternal depression/anxiety: in highly anxious/depressed mothers the association between laboratory- and home-assessed sensitivity was weak, whereas a strong association was found in mothers with low anxiety/depression. At 8 months this interaction was still marginally significant and at 12 months it had disappeared. Thus, mothers with depressive symptoms showed less consistent behavior across the two settings of the first assessment wave, and with increased familiarity with the procedures of the longitudinal study, their behavioral consistency increased and no longer differed from that of well mothers.     

Interpersonal psychotherapy for eating disorders with co-morbid depression: A pilot study

Objective: Patients with eating disorders (ED) often suffer from co-morbid depression, which may complicate the ED treatment. Previous studies have found that ED interventions seem to have limited capacity to reduce depressive symptoms. Several studies of interpersonal psychotherapy (IPT), have found that when patients have been treated for depression, co-morbid symptoms have diminished. As depression and EDs are commonly co-occurring conditions, this pilot study aimed to examine the effect of an IPT treatment for these conditions, with the focus on the depressive symptoms.

Method: In this multi-centre study, 16 patients with EDs and co-occurring major depression received 16 weeks of depression-focused IPT.

Results: Significant improvements with substantial effect sizes were found for both depression (d = 1.48) and ED (d = .93). Symptom reduction in the two syndromes were strongly correlated (r = .625, p = .004). Patients with a restrictive ED did not improve on either depression or ED symptoms.

Conclusion: These findings point to the usefulness of IPT for concurrent depression and ED with a bingeing/purging symptomatology. Working with negative affect and problem-solving related to current interpersonal problems may alleviate general psychological distress among these patients.     

Couples Relationships of AFDC Mothers

SUMMARY

Virtually nothing is known about AFDC mothers and their relationships with their male friends. Yet such men are clearly an influence in their lives. Findings from a sample of 275 Baltimore AFDC mothers provide important exploratory data about the characteristics of these relationships and about how women who have a long-term male friend differ from AFDC mothers who do not. Implications for work with these couples are also presented.