Maternal prenatal psychological distress and temperament in 1–4 month old infants – A study in a non-western population

In this longitudinal study, conducted in women attending antenatal visits at the obstetrics and gynecology clinic of a general hospital in Bangalore, India, we aimed to assess the relationship between prenatal distress in mothers, and maternal report of infant temperament at four months. 100 mothers with normal full term deliveries completed the General Health Questionnaire-28 item version (GHQ) in the third trimester and postnatally. Salivary cortisol and temperament (using the Early Infancy Temperament Questionnaire – EITQ) were assessed in their infants aged 1–4 months. In this study, maternal prenatal psychological distress was not significantly associated with maternal report of difficult temperament in infants. Infants of mothers who were a negative screen for psychological distress (GHQ < 7), n = 85 had higher scores on the adaptability and approach dimensions of temperament. Infant salivary cortisol was significantly higher in infants with higher intensity scores. These results introduce the possibility of cultural differences in the relationship between prenatal distress in the mother and infant temperament. These could be factors linked to child rearing practices or to the measures employed to study infant temperament. These findings derive from a small sample with few mothers with psychological distress, and need replication in a larger sample.     

Maternal postnatal psychiatric symptoms and infant temperament affect early mother-infant bonding

Postnatal mother-infant bonding refers to the early emotional bond between mothers and infants. Although some factors, such as maternal mental health, especially postnatal depression, have been considered in relation to mother-infant bonding, few studies have investigated the role of infant temperament traits in early bonding. In this study, the effects of maternal postnatal depressive and anxiety symptoms and infant temperament traits on mother-infant bonding were examined using both mother and father reports of infant temperament. Data for this study came from the first phase of the FinnBrain Birth Cohort Study (n = 102, father reports n = 62). After controlling for maternal symptoms of depression and anxiety, mother-reported infant positive emotionality, measured by infant smiling was related to better mother-infant bonding. In contrast, infant negative emotionality, measured by infant distress to limitations was related to lower quality of bonding. In regards to father-report infant temperament, only infant distress to limitations (i.e., frustration/anger) was associated with lower quality of mother-infant bonding. These findings underline the importance of infant temperament as one factor contributing to early parent-infant relationships, and counseling parents in understanding and caring for infants with different temperament traits.     

Perinatal depression influences on infant negative affectivity: Timing,severity, and co-morbid anxiety

Accumulating evidence suggests that antenatal depression predicts infants’ negative affectivity, albeit with variable effect sizes. With a prospective longitudinal design, we sought to explain that variability by addressing questions about timing of the depression across pregnancy and the early postpartum, the role of high symptom levels relative to diagnosed depression, comorbidity with anxiety, and the potential mediating role of neuroendocrine functioning. Primiparous women (n = 77) with histories of depression prior to pregnancy were assessed for cortisol levels monthly beginning by mid-pregnancy. Depression symptom levels and diagnostic status were similarly assessed monthly in pregnancy and also until infants reached three months of age, when mothers completed the Infant Behavior Questionnaire-Revised to measure infant negative affectivity. Antenatal depression symptoms and infant negative affectivity were positively associated (r = .39). Controlling for depression symptom levels in other trimesters, only second trimester depression symptoms predicted higher infant negative affectivity (β = .44). With postpartum depression symptom levels in the model, only antenatal depression symptoms predicted infant negative affectivity (β = .45). In the context of depression, neither antenatal anxiety symptoms nor anxiety disorder diagnosis were associated with infant NA scores. The hypothesized role of elevated maternal cortisol as a mechanism for the association between antenatal depression and infant NA was not supported. Our findings contribute to efforts to more precisely identify infants of perinatally depressed mothers who are at greater risk for elevated negative affectivity, suggesting a window of vulnerability in mid pregnancy and the need for further study of potential mechanisms.     

Exploring relations among mindfulness facets and various meditation practices: Do they work in different ways?

Several meditation practices are associated with mindfulness-based interventions but little is known about their specific effects on the development of different mindfulness facets. This study aimed to assess the relations among different practice variables, types of meditation, and mindfulness facets. The final sample was composed of 185 participants who completed an on-line survey, including information on the frequency and duration of each meditation practice, lifetime practice, and the Five Facet Mindfulness Questionnaire. A Multiple Indicators Multiple Causes structural model was specified, estimated, and tested. Results showed that the Model’s overall fit was adequate: χ² (1045) = 1542.800 (p < 0.001), CFI = 0.902, RMSEA = 0.042. Results revealed that mindfulness facets were uniquely related to the different variables and types of meditation. Our findings showed the importance of specific practices in promoting mindfulness, compared to compassion and informal practices, and they pointed out which one fits each mindfulness facet better.     

Approach-avoidance responses to infant facial expressions in nulliparous women: Associations with early experience and mood induction

Infant expressions are important signals for eliciting caregiving behaviors in parents. The present study sought to test if infant expressions affect adults’ behavioral response, taking into account the role of a mood induction and childhood caregiving experiences. A modified version of the Approach Avoidance Task (AAT) was employed to study nulliparous female university students’ implicit responses to infant faces with different expressions. Study 1 showed that sad, neutral and sleepy expressions elicit a tendency for avoidance, while no tendency for approach or avoidance was found for happy faces. Notably, differences between approach and avoidance response latencies for sad faces and participants’ negative caregiving experiences were positively correlated (r = 0.30, p = 0.04, Bonferroni corrected), indicating that individuals who experienced insensitive parental care show more bias toward sad infant faces. In Study 2, we manipulated participants' current mood (inducing sad and happy mood by asking to recall a happy or sad event of their recent life) before the AAT. Results showed that sad mood enhanced the bias toward sad faces that is buffered by positive mood induction. In conclusion, these findings indicate that implicit approach avoidance behaviors in females depend on the emotional expression of infant faces and are associated with childhood caregiving experiences and current mood.     

Exploring the Effectiveness of a Mixed-Diagnosis Group Cognitive Behavioral Therapy Intervention Across Diverse Populations

Depression and anxiety are the most common mental health disorders seen in clinical practice and they are highly comorbid. Cognitive behavioral therapy (CBT) has been demonstrated as an effective treatment for both depression and anxiety but is often not available to all individuals who could benefit from it. This paper investigates the effectiveness of a mixed-diagnosis group CBT intervention that incorporates mindfulness meditation for individuals presenting with depression and/or anxiety: CBT Basics II. This intervention was evaluated across two distinct mental health programs to determine both if it can demonstrate positive results and if it is feasible to implement in these types of programs. Sample 1 (n = 42 completers) consisted of higher-functioning individuals in a general mental health program. Sample 2 (n = 53 completers) consisted of individuals with more chronic and severe mental health diagnoses. Overall, intent-to-treat analyses revealed improvements in psychiatric symptoms, and increases in CBT knowledge and mindfulness skill across both programs. This indicates that CBT Basics II is effective across diverse mental health populations and shows promise for improving access to CBT.     

An experimental study on mother-infant skin-to-skin contact in full-terms

In premature infants, daily skin-to-skin contact (SSC) has various beneficial effects on the health of the infant and the mother. These beneficial effects might extend to full-term infants. This experimental within-subject study examines the immediate effects of SSC on full-terms’ cortisol physiology during SSC and subsequent physiological and behavioral reactions to a mild stressor (a bathing session). Additionally, the effects of SSC on the quality of maternal behavior are examined.Between 5 and 7 weeks postpartum, 17 full-term infant-mother dyads were visited at home twice. During one home visit, a bathing session was proceeded by 50 min of mother-infant SSC, while during the other visit the bathing session was proceeded by 50 min of the infant resting alone. The order of the home visits was counterbalanced. Infant salivary cortisol measures were taken to measure the cortisol response to the experimental condition (SSC versus solitary resting) and the bathing session. Furthermore, infant behavioral distress and the quality of maternal behavior during the bathing session were scored from videotapes.Two-way within-subject repeated measures ANOVA’s showed that, when compared to solitary resting, full-terms’ cortisol concentrations significantly decreased during SSC, followed by higher cortisol reactivity in response to the subsequent bathing session. No effects of SSC on infant behavioral distress and maternal caregiving behavior were found. Apparently, a single session of mother-infant SSC can affect infant cortisol physiology in full-term infants. Future SSC research is needed to investigate the neurobiological mechanisms and dose-response relations in full-term infants.     

CROSS-CULTURAL STUDIES OF TEMPERAMENT: TEMPERAMENT IN GREEK INFANTS

Three infant cohorts from Greek cultural backgrounds were compared with an Anglo-Australian infant cohort across 9 dimensions of temperament using Australian and Greek versions of the revised Infant Temperament Questionnaire (Carey and McDevitt 1978). Infants from a Greek cultural background were generally considered to be more ‘difficult’ than the Anglo-Australian infants on the temperament dimensions of Approach, Adaptability, Mood and Distractibility even after the effects of social class were controlled statistically. The reported cross-cultural differences were discussed with regard to the potential influence on temperament ratings of ethnicity and culture, social status, psychobiological factors, migrant status, social assimilation, and questionnaire characteristics.     

Maternal postpartum depressive symptoms and infant externalizing and internalizing behaviors

Maternal postpartum depression has been shown to be one of the main predictors of externalizing and internalizing behaviors in toddlers and adolescents. Research suggests that presence of such behaviors can be observed as early as infancy. The current study uses longitudinal data from 247 mothers to examine the relationship between postpartum depressive symptoms at 8 weeks and the infant's externalizing and internalizing behaviors at 12 months. In unadjusted linear regression models, there were associations between postpartum depressive symptoms and infant externalizing behaviors (β = 0.082, SE = 0.032, p = 0.012) and internalizing behaviors (β = 0.111, SE = 0.037, p = 0.003). After controlling for potential confounding factors, including maternal age, race, education, home ownership, smoking status in the postpartum period, marital status, parenting stress, and happiness from becoming a parent, the associations between postpartum depressive symptoms and infant externalizing (β = 0.051, SE = 0.034, p = 0.138) and internalizing behaviors (β = 0.077, SE = 0.040, p = 0.057) were reduced and became non-significant. Furthermore, in these models the total amount of variance explained was 17.2% (p < 0.0001) for externalizing behaviors and 10.5% (p < 0.01) for internalizing behaviors; the only significant predictor of externalizing behaviors was maternal age (β = −0.074, SE = 0.030, p = 0.014), and of internalizing behaviors was white non-Hispanic ethnicity (β = −1.33, SE = 0.378, p = 0.0005). A combined effect of the confounding factors seems to explain the finding of no significant independent association between postpartum depressive symptoms and infant externalizing and internalizing behaviors.     

Cognition and the development of temperament from late childhood to early adolescence

Temperament is related to cognition, but it is unclear whether reciprocal associations exist with early developmental trajectories. Children from the Longitudinal Study of Australian Children (N = 8,677) were assessed over four waves on verbal ability at ages 8/9, nonverbal ability at ages 8/9 and 10/11, and parent-rated temperament every two years from ages 8/9 to 14/15. Latent difference score analyses indicated correlated changes between ages 8/9 and 10/11. Increased nonverbal ability over the first two years was associated with declined reactivity and increased persistence. Latent growth curve models further indicated that nonverbal and verbal ability at baseline were associated with declined reactivity and increased persistence over the six years. These findings suggest bidirectional associations between childhood cognitive ability and temperament development.     

Correlation between maternal and infant cortisol varies by breastfeeding status

ObjectiveThe objective of this study was to examine associations of mother and infant salivary cortisol, measured three times over the course of a day, and assess whether these varied by breastfeeding status.MethodsWe conducted a cross-sectional study of 54 mothers and their infants aged 4–11 months. Mothers collected their own saliva and that of their infants upon awakening, 30 min after waking and at bedtime. Breastfeeding status was reported by mothers and cortisol level was measured in saliva in μg/dl using standard techniques. We used generalized linear models to evaluate relationships between maternal and infant cortisol levels, and assessed whether the relationship differed by breastfeeding status: formula only compared to partial and full breastfeeding, adjusting for infant sex, race, age, maternal education, and family income.ResultsThirty-four infants received formula only and 20 were either partially or fully breastfed. Breastfeeding was associated with higher household income, higher maternal education, and white race. Cortisol levels were higher among breastfed infants at all three time points. After adjustment, maternal cortisol levels were related with infant cortisol at bedtime only (regression estimate 0.06; 95% CI: 0.10, 1.1; p = 0.02). The adjusted association between bedtime maternal and infant cortisol was stronger among breastfeeding dyads than among formula-feeding dyads (regression estimate 1.0; 95% CI: 0.1, 2.0; p = 0.04 vs. 0.6; CI: −0.1, 1.3; p = 0.10). In addition, we assessed the influence of maternal education and household income in our adjusted model; income strengthened the observed association, whereas maternal education did not change the estimate.ConclusionsBreastfeeding mothers and infants had significant correlations for cortisol at bedtime, while formula-feeding dyads did not. These data suggest that several factors may contribute to cortisol synchrony observed in mother/infant dyads, including the transfer of cortisol in human milk, physical interaction such as skin-to-skin contact, and shared environment. In addition, our findings support household income as a possible contributor.     

Stress-sensitivity and reciprocal associations between stressful events and adolescent temperament

This study aimed to elucidate the longitudinal, bidirectional associations between stressful life events (SLEs) and adolescent temperament. Subsequently, the study investigated whether the effects of SLEs on future temperament were moderated by (a) a cumulative sensitivity gene index (b) the 5-HTTLPR (the polymorphism most consistently indicated as a sensitivity genotype) and (c) pre/perinatal risk. Data were used from TRAILS, a large population cohort of Dutch adolescents (n = 1475). Temperament was assessed at 11, 16 and 19 years. Data of SLEs that occurred between age 0–11, 11–16, and 16–19 were captured using interviews. The results indicated that SLEs and temperament traits are associated from childhood to adolescence and that the direction of the effects differed between temperament traits. Whereas SLEs were found to predict subsequent fear, SLEs were predicted by, but not predictive of, shyness and affiliation. For effortful control and frustration a fully reciprocal model was found. The cumulative sensitivity gene index, 5-HTTLPR and the pre/perinatal risk did not moderate the effects of SLEs on future temperament.     

Does the Animal Fun program improve social-emotional and behavioural outcomes in children aged 4–6 years?

Animal Fun was designed to enhance motor and social development in young children. Its efficacy in improving motor skills was presented previously using a randomised controlled trial and a multivariate nested cohort design. Based on the Environmental Stress Hypothesis, it was argued that the program would also result in positive mental health outcomes, investigated in the current study. Pre-intervention scores were recorded for 511 children aged 4.83–6.17 years (M = 5.42, SD = .30). Intervention and control groups were compared 6 months following intervention, and again in their first school year. Changes in teacher-rated prosocial behaviour and total difficulties were assessed using the Strengths and Difficulties Questionnaire, and data analysed using Generalised Linear Mixed Models. There was a significant improvement in prosocial behaviour of children in the intervention group six months after initial testing, which remained at 18-month follow-up. Total difficulties decreased at 6 months for the intervention group, with no change at 18 months. This effect was present only for the hyperactivity/inattention subscale. The only significant change for the control group was an increase in hyperactivity/inattention scores from pre-intervention to 18-month follow-up. The Animal Fun program appears to be effective in improving social and behavioural outcomes.     

Maternal alexithymic traits,prenatal stress,and infant temperament

We aimed at investigating, whether maternal alexithymia or prenatal anxiety influences infant temperament (Infant Temperament Questionnaire, IBQ) at six months. Maternal alexithymic trait of “Difficulty in Identifying Feelings” predicted higher infant “Duration of Orienting”. “Fear of Bearing a Handicapped Child” predicted lower infant “Activity Level”.     

Foetal programming and cortisol secretion in early childhood: A meta-analysis of different programming variables

It is widely recognized that different events may take place in the intrauterine environment that may influence later developmental outcome. Scholars have long postulated that maternal prenatal stress, alcohol or drug use, and cigarette smoking may impact foetal formation of the hypothalamus–pituitary–adrenal (HPA) axis, which may later influence different aspects of early childhood socioemotional and cognitive development. However, results linking each of these factors with child cortisol secretion have been mixed. The current meta-analysis examined the relation between each of these programming variables and child cortisol secretion in studies conducted up to December 31st, 2012. Studies were included if they were conducted prior to child age 60 months, and if they reported an index of effect size linking either maternal prenatal stress, alcohol or drug use, or cigarette smoking with an index of child cortisol secretion. In total, 19 studies (N = 2260) revealed an average effect size of d = .36 (p < .001). Moderator analyses revealed that greater effect sizes could be traced to maternal alcohol use, to the use of retrospective research methodology, where mothers are questioned after childbirth regarding programming variables, and to the use of baseline measures of cortisol secretion, as opposed to recovery measures. Discussion focuses on processes that link the environment to foetal development and how both are linked to later adaptation.     

Is sensory processing an issue for infants with colic?

ObjectivesTo determine the association between sensory functioning, sleep, cry/fuss, and feeding behaviors of infants with colic younger than 4 months of age.MethodsDunn’s Infant/Toddler Sensory Profile™ and a modified Barr Baby Day Diary^© were used to assess 44 breastfed infants with colic under four months of age. Colic was defined according to Wessel’s criteria.ResultsThirty-four of the 44 infants with colic (77%) scored as atypical for sensory processing. Of these, 56% scored atypical for sensory processing on quadrant one (Q1) (Low Registration), with 24%, 65%, and 18% scoring as atypical for sensory processing on Q2 (Sensory seeking), Q3 (Sensory sensitivity), and Q4 (Sensation avoiding), respectively. All infants demonstrating sensation avoiding also scored as Low Threshold. A moderate statistically significant correlation was found between sensation seeking and time spent sleeping (r = 0.31; p = 0.04). No other statistically significant associations between infant behaviors and their sensory functioning were demonstrated. Overall, infants demonstrating atypical sensory responses (in any quadrant) slept significantly more than infants demonstrating typical sensory responses (mean difference = −67.8 min/day; 95% CI = −133.6 to −2.1; p = 0.04).ConclusionVery limited associations between infant behaviors and sensory functioning were demonstrated, suggesting that sensory functioning may not be a significant factor in the multifactorial nature of infant colic. Further well-designed studies using validated tools for infants with colic are required to determine whether associations between infant behaviors and sensory functioning exist.     

Québécois,Haitian, and Vietnamese Mothers' Report of Infant Temperament

Research has shown different temperamental attributes in infants of various cultural origins. Some authors have suggested that these temperamental attributes might be related to biological and genetic differences. In the present study, mothers' reports of infant temperament, using the Revised Infant Temperament Questionnaire (Carey & McDevitt, 1978), were compared among Québécois, Haitian, and Vietnamese groups living in Montréal. Results indicated patterns of differences across groups that essentially distinguished the Québécois from the other two groups. These two groups reported more difficult temperamental characteristics in their infants. The values and caretaking practices related to the specific cultural contexts, contrasted with the values expressed through a North-American validated questionnaire, may explain the variations in infant temperament reports. Further studies should examine more thoroughly the relation between observed infant behaviours and maternal reports.     

Randomized Controlled Trial of an Internet-Based Cognitive-Behavioral Treatment Program for Binge-Eating Disorder

Binge-eating disorder (BED) is a prevalent health condition associated with obesity. Few people with BED receive appropriate treatment. Personal barriers include shame, fear of stigma, geographic distance to mental health services, and long wait-lists. The aims of this study were to examine the efficacy of an Internet-based cognitive-behavioral intervention for adults with threshold BED (DSM-IV) and to examine the stability of treatment effects over 12 months. Participants were randomly assigned to a 16-week Internet-based cognitive-behavioral intervention (n = 69) or a wait-list condition (n = 70). Binge-eating frequency and eating disorder psychopathology were measured with the Eating Disorder Examination–Questionnaire and the Eating Disorder Examination administered over the telephone. Additionally, body weight and body mass index, depression, and anxiety were assessed before and immediately after treatment. Three-, 6-, and 12-month follow-up data were recorded in the treatment group. Immediately after the treatment the number of binge-eating episodes showed significant improvement (d = 1.02, between group) in the treatment group relative to the wait-list condition. The treatment group had also significantly reduced symptoms of all eating psychopathology outcomes relative to the wait-list condition (0.82 ≤ d ≤ 1.11). In the treatment group significant improvement was still observed for all measures 1 year after the intervention relative to pretreatment levels. The Internet-based intervention proved to be efficacious, significantly reducing the number of binge-eating episodes and eating disorder pathology long term. Low-threshold e-health interventions should be further evaluated to improve treatment access for patients suffering from BED.     

Maternal reflective functioning as a multidimensional construct: Differential associations with children’s temperament and externalizing behavior

Maternal reflective functioning (RF) has been associated with children’s behavioral development. This study examined maternal prenatal and postnatal RF, as measured by the Pregnancy Interview and Parent Development Interview, as multidimensional constructs. It was also examined whether the RF-dimensions were associated with children’s temperament and externalizing behavior, as assessed by several questionnaires. The sample consisted of 123 first-time mothers (M age = 22.85 years, SD = 2.21) and their children (M age = 19.97 months, SD = 0.85, 56% male). Two related but distinct dimensions were found for prenatal RF, termed self-focused and child-focused mentalization. Three dimensions were observed for postnatal RF, termed self-focused, child-focused, and relation-focused mentalization. Results showed that prenatal RF negatively related to reported child physical aggression. Postnatal self-focused RF was positively linked to externalizing behavior and negative emotionality in offspring, while relation-focused RF scores were negatively associated with child physical aggression. Findings show that it is important to also look at the specific RF-dimensions when examining the effects of maternal RF on children’s behavioral development, as differential associations with behavioral outcomes exist. Discussion further focuses on the importance of these findings in prevention and clinical practice, and suggestions are being made to further improve the measurement of maternal RF-dimensions.     

Bidirectional pathways between relational aggression and temperament from late childhood to adolescence

Relational aggression is linked to numerous adverse consequences. However, we know little about how temperament leads individuals to become perpetrators/victims of relational aggression, or how being a perpetrator/victim influences the development of temperament. We used longitudinal data from 674 Mexican-origin youth to examine relations between relational aggression and mother- and child-reported temperament from 5th grade (M_age = 10.8; SD = 0.60) through 11th grade (M_age = 16.8; SD = 0.50). Results show that: (a) high Negative Emotionality and low Effortful Control predicted increases in victimization; (b) low Effortful Control predicted increases in perpetration; (c) victims increased in Negative Emotionality and decreased in Effortful Control; and (d) perpetrators increased in Negative Emotionality and Surgency. Thus, temperament serves as both an antecedent to and a consequence of relational aggression.