PRENATAL AND POSTNATAL MATERNAL REPRESENTATIONS IN NONRISK AND AT‐RISK PARENTING: EXPLORING THE INFLUENCES ON MOTHER–INFANT FEEDING INTERACTIONS

The aim of this study was to investigate the mother–infant relationship in depressive, psychosocial, and cumulative‐risk parenting by assessing prenatal and postnatal maternal representations and mother–infant interactions during feeding at 4 months of age. The sample consisted of 167 mother–infant pairs: 41 nonrisk women, 40 depressive‐risk women, 40 psychosocial‐risk women, and 46 cumulative‐risk women. During pregnancy, the women were interviewed about psychosocial‐risk variables. Maternal representations and depressive symptoms were evaluated during pregnancy and again when the infants were 3 and 4 months old, respectively. All mother–infant pairs were observed in 20‐min video recordings during breast‐feeding. Maternal Integrated/balanced representations were more frequent in the nonrisk group whereas the maternal Nonintegrated/ambivalent category was more represented in the cumulative‐risk group during pregnancy and after the infant's birth. At 4 months, the cumulative‐risk group of mothers and infants showed a lack of reciprocity, conflictual communicative exchanges, and higher food refusal behavior. Moreover, at 4 months, differences between the quality of mother–infant feeding interactions and the quality of prenatal and postnatal maternal representations emerged, showing less adequate maternal scaffolding in the Nonintegrated/ambivalent and Restricted/disengaged women. This study has rich implications for intervention to support the affective and communicative caregiving system and to prevent infant feeding problems and mother–infant relational disturbances in childhood.     

Associations between prenatal maternal mental health indices and mother–infant relationship quality 6 to 18 months’ postpartum: A systematic review

Maternal mental disorders can significantly impact on children's psychosocial and psychological development, incurring substantial ongoing economic and personal costs. A key mediating mechanism is mother–infant relationship quality (MIRQ). Research studies and perinatal mental health screening initiatives have predominantly focused on depressive symptoms and perinatal depression as predictors of MIRQ. While maternal depression is associated with suboptimal MIRQ, the findings have not been consistent. Personality characteristics are associated with parenting and proneness to depression, presenting a potential addition to prenatal mental health assessment. We conducted a systematic review of studies that have examined the link between prenatal depressive symptoms and/or personality characteristics with postnatal MIRQ. Our findings suggest that both maternal personality traits and depressive symptoms measured in early pregnancy are associated with postnatal MIRQ. A measure of personality characteristics may enhance prenatal mental health assessment, affording opportunities for targeted intervention commencing in pregnancy to improve MIRQ, parenting, maternal mental health outcomes, and infant psychosocial and psychological development, and thereby contributing to the reduction of human and economic cost burdens.     

CAREGIVING HISTORY AND PRENATAL DEPRESSIVE SYMPTOMS IN LOW-INCOME ADOLESCENT AND YOUNG ADULT WOMEN: MODERATING AND MEDIATING EFFECTS

Prenatal depressive symptoms have been linked to negative outcomes for mothers and children. Using attachment theory as a framework, this study examined developmental differences in the interpersonal context of prenatal depressive symptoms among adolescents (age 14 to 19 years; n = 352) and young adults (age 20 to 24 years; n = 348). Participants included low-income, single, predominantly African American and Latina women. Moderating and mediating factors were found in the relation between caregiving history (perceived unavailability and inconsistency of maternal and paternal figures during childhood) and depressive symptoms. For pregnant adolescents, maternal unavailability predicted depressive symptoms whereas maternal inconsistency did not. In contrast, for pregnant young women, only maternal inconsistency predicted depressive symptoms; and this association was mediated by perceptions of prenatal support. For both groups, paternal caregiving history had a small yet independent association with depressive symptoms. Results highlight the need to consider developmental differences in the interpersonal context of prenatal depressive symptoms in delivering mental health interventions to young women of color.     

Postnatal Depression and Infant Health Practices Among High-Risk Women

Women’s postnatal depressive symptoms have been associated with many adverse outcomes for children. The current study examined the frequency association with relative risk between postnatal depressive symptoms and mothers’ use of preventative infant health practices. The study used the Edinburgh Postnatal Depression Scale (EPDS) and Parental Health and Depression Questionnaire (PHDQ) to identify women’s depressive symptoms in a prospective longitudinal sample of 134 high-risk non-white mothers receiving well-baby health services. Unadjusted frequency comparisons examined the effect of women’s postnatal depressive symptoms on infant outcomes. Results found that compared to 60 women without postnatal depressive symptoms, 74 women with symptoms engaged in significantly fewer well-child health-visits, were less likely to use home safety devices or place their infants in the preferred back-to-sleep position, and did not complete immunizations. Depressed women were also more likely to lack knowledge of nurturing and sensitive parenting, use corporal punishment and inappropriate foods, and to show poor parenting practices. These findings provide additional supportive evidence that more efforts are needed to identify and assess women’s depressive symptoms to promote health and safety of young children. Methodological limitations and recommendations for future research are addressed.     

Maternal sensitivity moderates the impact of prenatal anxiety disorder on infant responses to the still-face procedure

Animal studies have demonstrated the interactive effects of prenatal stress exposure and postnatal rearing style on offspring capacity to manage stress. However, little is known about how parenting quality impacts the association between maternal prenatal anxiety and stress reactivity in human infants. This prospective study examined the impact of prenatal anxiety disorder and maternal caregiving sensitivity on infants’ responses to a standardised interactive stressor (still-face procedure). Eighty-four women completed a clinical interview during pregnancy to assess anxiety symptoms meeting DSM-IV diagnostic criteria. At infant age 7 months, maternal sensitivity to infant distress and infant negative affect were observed and coded during the still-face procedure. Maternal postnatal (concurrent) anxiety and depression were also assessed at this time. Results indicated a negative association between maternal sensitivity to infant distress and infant negative affect responses to the still-face procedure. An unexpected finding was a positive association between parity and infant reactivity. The main effect for sensitivity was qualified by a significant interaction, p < .05, suggesting that the impact of sensitivity was particularly marked among infants of women who experienced an anxiety disorder during pregnancy. This finding is consistent with a cumulative risk model suggesting that maternal prenatal anxiety and quality of maternal care act in concert to shape infant outcomes.     

Sexual assault history and suicidal behavior in a national sample of women

This study examined demographic and psychosocial correlates of suicidal ideation and suicide attempts in women with histories of sexual assault in childhood and/or adulthood identified from a national sample of women. Multivariate analyses showed that women with histories of sexual assault in both childhood and adulthood reported significantly greater odds of lifetime suicide attempts, controlling for demographic factors and other psychosocial characteristics. As predicted, younger age (marginal), stressful life events (marginal), depression, PTSD, and alcohol dependence symptoms were also significantly associated with suicidal ideation. Furthermore, number of lifetime traumatic events and depression were each associated with lifetime odds of suicide attempts. Implications for studying the role of sexual trauma and other psychosocial factors in relation to women's suicidal behavior are discussed.     

Caregiving representations in war conditions: Associations with maternal trauma,mental health,and mother–infant interaction

Risk features in mothers’ caregiving representations remain understudied in dangerous environments where infants most urgently need protective parenting. This pilot study examines the feasibility of a novel coding system for the Parent Development Interview (PDI) interview (ARR, Assessment of Representational Risk) in assessing 50 war-exposed Palestinian mothers’ caregiving representations. First, we explored the content and structure of risks in the representations. Second, we examined associations between the high-risk representations, mothers’ pre- and postnatal exposure to traumatic war events (TWE), depressive and post-traumatic stress disorder (PTSD) symptoms, and self-rated emotional availability (EA) with their 1-year-old infants. Following three dimensions of high-risk caregiving representations were identified: self/dyadic dysregulation, unavailable, and fearful. Mothers’ prenatal depressive symptoms were associated with dysregulating and fearful representations, and their postnatal PTSD with fearful representations. TWE were not associated with the high-risk representations. Moreover, mothers of boys reported more fearful representations, and mothers with financial difficulties reported more unavailable representations. TWE and high-risk representations were not associated with EA. However, qualitative analysis of the representations indicated risks in the mother–infant relationship. Further, older mothers and mothers with postnatal PTSD reported lower EA. Cultural variance in caregiving representations and the use of self-report measures among traumatized mothers are discussed.     

Adult attachment style and stress as risk factors for early maternal sensitivity and negativity

The current study examined the individual and joint effects of self‐reported adult attachment style, psychological distress, and parenting stress on maternal caregiving behaviors at 6 and 12 months of child age. We proposed a diathesis‐stress model to examine the potential deleterious effects of stress for mothers with insecure adult attachment styles. Data from 137 mothers were gathered by the longitudinal Durham Child Health and Development Study. Mothers provided self‐reports using C. Hazan and P. Shaver's ( 1987 ) Adult Attachment Style measure, the Brief Symptom Inventory (L.R. Derogatis & P.M. Spencer, 1982 ), and the Parent Stress Inventory (R.R. Abidin, 1995 ); observations of parenting data were made from 10‐min free‐play interactions. Consistently avoidant mothers were less sensitive with their infants than were consistently secure mothers; however, this effect was limited to avoidant mothers who experienced elevated levels of psychological distress. Results suggest that the association between insecure adult attachment style and insensitive parenting behavior is moderated by concurrent psychosocial stress. Clinical implications for these findings are discussed.     

Influences of Biological and Adoptive Mothers’ Depression and Antisocial Behavior on Adoptees’ Early Behavior Trajectories

Research clearly demonstrates that parents pass risk for depression and antisocial behavior on to their children. However, most research confounds genetic and environmental mechanisms by studying genetically related individuals. Furthermore, most studies focus on either depression or antisocial behavior in parents or children, despite evidence of co-occurrence and shared etiology, and few consider the early origins of these problems in childhood. We estimated the influence of biological and adoptive mothers’ depression and antisocial behavior on growth in child externalizing and internalizing behaviors across early childhood using data from a prospective adoption study. Participants were 346 matched triads of physically healthy children (196 boys; 150 girls), biological mothers (BM), and adoptive mothers (AM). Latent growth curve models were estimated using AM reports of child internalizing and externalizing behaviors at ages 18, 27, and 54 months. Predictors of intercept (18 months) but not slope were identified. BM lifetime histories of major depressive disorder predicted child externalizing behaviors and BM antisocial behavior predicted child internalizing behavior. AM depressive symptoms and antisocial behavior were associated with both child outcomes. AM paths, but not BM paths were partially replicated using adopted fathers’ reports of child outcomes. BM obstetric complications, prenatal depressive symptoms, and postnatal adoptive family contact with BM did not account for BM paths. This adoption study distinguished risks conferred by biological mothers’ depression and antisocial behavior to children’s behaviors from those associated with adoptive mothers’ related symptoms. Future studies should examine gene-environment interplay to explain the emergence of serious problem trajectories in later childhood.     

The relationship of childhood trauma to nicotine dependence in pregnant smokers

Pregnant women with high levels of nicotine dependence are the least likely to quit smoking spontaneously during pregnancy or to benefit from smoking cessation interventions. In the general population, there is increasing evidence of a relationship between smoking, nicotine dependence, and exposure to childhood trauma. We examined the relationship of childhood trauma to several measures of nicotine dependence and evaluated whether this relationship was mediated by major depressive disorder or depressive symptom severity in pregnant smokers. Moderate to extreme levels of childhood trauma were significantly related to smoking within 5 minutes or less of waking, and to the Behavioral Choice-Melioration, Negative Reinforcement, and Tolerance subscales of the Wisconsin Inventory of Smoking Dependence Motives (WISDM-68) scale. The relationships between childhood emotional abuse and the WISDM-68 Total and Negative Reinforcement subscale were partially mediated by depressive symptoms. Results suggest that childhood trauma may be a risk factor underlying nicotine dependence in pregnant smokers. Increased understanding of the relationship of affect regulation to smoking in individuals with childhood trauma histories may aid in the development of more effective treatments of nicotine dependence for this population of smokers.     

Effects of maternal depressive symptoms on sensitivity to infant distress and non-distress: Role of SES and race

The goals of the present study were to examine the extent to which (a) maternal depressive symptoms (prenatal vs. postnatal depressive symptoms) undermine maternal sensitivity toward both infant distress and non-distress; (b) such effects are stronger in the context of socioeconomic risk. SES risk and depressive symptoms interacted such that depressive symptoms, both pre and postnatal, only predicted lower sensitivity among mothers at heightened SES risk. The effects were comparable for sensitivity to distress and non-distress and did not vary by maternal race.     

PARENTAL CHILDHOOD ADVERSITY,DEPRESSIVE SYMPTOMS,AND PARENTING QUALITY: EFFECTS ON TODDLER SELF‐REGULATION IN CHILD WELFARE SERVICES INVOLVED FAMILIES

Parents who are involved with child welfare services (CWSI) often have a history of childhood adversity and depressive symptoms. Both affect parenting quality, which in turn influences child adaptive functioning. We tested a model of the relations between parental depression and child regulatory outcomes first proposed by K. Lyons‐Ruth, R. Wolfe, A. Lyubchik, and R. Steingard (2002). We hypothesized that both parental depression and parenting quality mediate the effects of parental early adversity on offspring regulatory outcomes. Participants were 123 CWSI parents and their toddlers assessed three times over a period of 6 months. At Time 1, parents reported on their childhood adversity and current depressive symptoms. At Time 2, parents’ sensitivity to their child's distress and nondistress cues was rated from a videotaped teaching task. At Time 3, observers rated children's emotional regulation, orientation/engagement, and secure base behavior. The results of a path model partly supported the hypotheses. Parent childhood adversity was associated with current depressive symptoms, which in turn related to parent sensitivity to child distress, but not nondistress. Sensitivity to distress also predicted secure base behavior. Depression directly predicted orientation/engagement, also predicted by sensitivity to nondistress. Sensitivity to distress predicted emotion regulation and orientation/engagement. Results are discussed in terms of intervention approaches for CWSI families.     

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.     

The child as held in the mind of the mother: The influence of prenatal maternal representations on parenting behaviors

Using a longitudinal design, this study examined the relationship of a mother's prenatal representation of her child and her parenting behavior with that child at 1 year of age in a sample of women who were either exposed or not exposed to intimate partner violence (IPV) (N = 164; M child age = 1.1 years, SD = .11 years; 52% male). Controlling for prenatal IPV, a MANCOVA analysis revealed that prenatal representational typology was significantly related to parenting behavior 1 year postpartum. Mothers whose representations were affectively deactivated (disengaged) were more behaviorally controlling with their children. Mothers whose representations were affectively overactivated (distorted) were more hostile with their children. Mothers with balanced representations demonstrated more positive parenting. Exposure to IPV did not moderate this relationship. There was no direct association between prenatal or postnatal IPV and parenting behavior. These findings suggest that prenatal representations influence postnatal parenting behavior in significant and theoretically consistent ways and that this relationship functions similarly for both abused and nonabused women. Results add to the growing literature that internal representations serve to guide behavior throughout development and suggest that maternal working models may be one important link in the intergenerational transmission of attachment relationships.     

Treating Adults With Complex Trauma: An Evidence‐Based Case Study

This article presents an overview of complex trauma and a case study describing the evidence‐informed treatment of a 25‐year‐old woman with chronic complex trauma symptoms resulting from childhood sexual, physical, and psychological abuse from a caregiver. Treatment followed a relationship‐based, cognitive behavior therapy model across 3 treatment phases. Significant reductions in trauma and general distress symptoms occurred from pre‐ to posttreatment, although firm conclusions about cause cannot be drawn from case studies. Verbatim vignettes illustrate specific interactions.     

The Prenatal Lausanne Trilogue Play: A New Observational Assessment Tool of the Prenatal Co‐Parenting Alliance

The goal of this study is to present a new observational assessment tool, the prenatal Lausanne Trilogue Play situation (LTP). Expectant parents were asked to role play their first meeting with their baby using a doll, and the videotaped interaction was subsequently coded. Scores were correlated with measures of the couples' marital satisfaction as well as the postnatal family alliance 3 months after the baby's birth. Results showed that the prenatal co‐parenting alliance was positively linked to both fathers' marital satisfaction as well as to the postnatal family alliance at 3 months. Thus, the prenatal LTP allows for assessment of the prenatal co‐parenting alliance at the interactional level. It predicts the place the parents will afford their baby after birth and can contribute to methods of clinical assessment and prevention.     

Parenting stress and depressive symptoms in postpartum mothers: Bidirectional or unidirectional effects?

Despite the consistent link between parenting stress and postpartum depressive symptoms, few studies have explored the relationships longitudinally. The purpose of this study was to test bidirectional and unidirectional models of depressive symptoms and parenting stress. Uniquely, three specific domains of parenting stress were examined: parental distress, difficult child stress, and parent–child dysfunctional interaction (PCDI). One hundred and five women completed the Beck Depression Inventory and the Parenting Stress Index – Short Form at 3, 7, and 14 months after giving birth. Structural equation modeling revealed that total parenting stress predicted later depressive symptoms, however, there were different patterns between postpartum depressive symptoms and different types of parenting stress. A unidirectional model of parental distress predicting depressive symptoms best fit the data, with significant stability paths but non-significant cross-lagged paths. A unidirectional model of depressive symptoms predicted significant later difficult child stress. No model fit well with PCDI. Future research should continue to explore the specific nature of the associations of postpartum depression and different types of parenting stress on infant development and the infant–mother relationship.     

Envisioning motherhood: Mental-state language in caregiving narratives across the perinatal period

Nancy Suchman's work highlighted the fundamental role of maternal mentalization in maternal addiction, mental health, and caregiving challenges. In this study, we aimed to examine the role of mental-state language (MSL) as a measure of mentalization in prenatal and postnatal narratives and their sentiment in a sample of 91 primarily White mothers from the western United States, followed from the second trimester of pregnancy, through the third trimester, to 4 months postpartum. Specifically, we investigated the use of affective and cognitive MSL in prenatal narratives when mothers visualized caring for their baby and postnatal narratives when mothers compared their prenatal visualization to the current caregiving reality. Results indicated moderate consistency in MSL between the second and third trimesters, but prenatal and postnatal MSL was not significantly correlated. Across all time points, higher use of MSL was related to more positive sentiment, indicating an association between mentalization and positive caregiving representations across the perinatal period. Women used more affective than cognitive MSL in prenatal imagination of caregiving, but this pattern was reversed in their postpartum reflection. Implications on assessing parental mentalization prenatally and considering the relative dominance of affective and cognitive mentalizing are discussed while considering study limitations.     

Transgenerational patterns of abusive parenting: Analog and clinical tests

Two studies were conducted to determine whether there was an association between punitive childhood histories and abusive parenting. In the first experiment, undergraduate students who reported more punitive childhood histories and undergraduates who reported mild or nonpunishing childhoods were tested with an Analog Parenting Task. The task used photographic stimuli to depict child behaviors and to elicit disciplinary choices in response to children's transgressions. Persons from the more punitive backgrounds were significantly more likely to endorse potentially injurious disciplinary responses. Additionally, in a post-hoc analysis, women with mild punishment backgrounds were more likely to indicate they were annoyed by the depicted child behaviors than women with the severe punishment backgrounds and men with both punishment histories. In the second experiment, childhood histories of parents of children seen at a psychiatric clinic were assessed. The data indicated an association between severely punitive backgrounds of parents and the probability that the referred child had been physically abused. Also, the punishment histories of the parents were associated with the presence of antisocial and aggressive presenting problems displayed by the referred child. The two experiments together were considered to provide support for a modified version of the trans-generational hypothesis of abuse.     

MATERNAL TRAUMA AFFECTS PRENATAL MENTAL HEALTH AND INFANT STRESS REGULATION AMONG PALESTINIAN DYADS

We examined how diverse and cumulated traumatic experiences predicted maternal prenatal mental health and infant stress regulation in war conditions and whether maternal mental health mediated the association between trauma and infant stress regulation. Participants were 511 Palestinian mothers from the Gaza Strip who reported exposure to current war trauma (WT), past childhood emotional (CEA) and physical abuse, socioeconomic status (SES), prenatal mental health problems (posttraumatic stress disorder and depression symptoms), and perceived stress during their secondtrimester of pregnancy as well as infant stress regulation at 4 months. While all trauma types were associated with high levels of prenatal symptoms, CEA had the most wide‐ranging effects and was uniquely associated with depression symptoms. Concerning infant stress regulation, mothers’ CEA predicted negative affectivity, but only among mothers with low WT. Against hypothesis, the effects of maternal trauma on infant stress regulation were not mediated by mental health symptoms. Mothers’ higher SES was associated with better infant stress regulation whereas infant prematurity and male sex predisposed for difficulties. Our findings suggest that maternal childhood abuse, especially CEA, should be a central treatment target among war‐exposed families. Cumulated psychosocial stressors might increase the risk for transgenerational problems.