Successful intervention with multi-problem mothers: Effects on the mother-infant relationship

A two-step model of intervention for multi-problem mothers was proposed. In order to improve mother-child interaction and later developmental outcomes, the first step is for the practitioner to help the mother change her external competencies (adult social skills) and internal perceptions (support, depression). These changes make the second step possible—the mother then can learn to foster her own child's development. The model was tested in a study of 95 multi-problem women who participated in a nursing intervention program from mid-pregnancy through the child's first birthday. The results supported the two-step model. Improvements in the mothers' external competencies were related to completion of intervention goals. These external improvements also were related to more optimal patterns of mother-child interaction during teaching and feeding episodes at 1 year. Furthermore, an especially insecure type of attachment relationship was found more frequently among the infants of mothers in the group that did not improve. Changes in internal perceptions were unrelated to intervention or interaction measures. These unexpected results suggest that the mother's internal improvements may have a more delayed or a less direct effect upon the child.     

Early infant temperament shapes the nature of mother-infant bonding in the first postpartum year

ObjectiveThis study examined longitudinal relations between maternal bonding and infant temperament in the first nine months after birth.DesignOur sample consisted of 281 women, enrolled at five maternity hospitals, who completed questionnaires during the first week (T1), at six weeks (T2) and nine months postpartum (T3). Maternal bonding was assessed using the Mother-to-Infant Bonding Scale at T1 and T2 and the Postpartum Bonding Questionnaire at T3. Infant temperament was measured using the Infant Characteristics Questionnaire, completed by the mothers at T2 and T3.ResultsThe results of a path model showed a long-term effect flowing from the child to the mother, with infant temperament at T2 predicting maternal bonding at T3 over and above stability in bonding. At T3, bonding was linked more strongly to child temperament at T2 than to child temperament assessed concurrently at T3. Maternal bonding did predict infant temperament, but this was true only of bonding reported at T1 and infant temperament at T2, that is, not of bonding assessed at T2 and infant temperament at T3.ConclusionOur results indicate that maternal bonding in the first week postpartum may temporarily affect child temperament, but infant’s temperament several weeks after birth – rather than several months postpartum – plays a pervasive role in shaping the long-lasting nature of the mother-child relationship. Our findings thus seem to support the suggestion that the early postpartum weeks represent an important period in the development of maternal bonding.     

Living with depression: Coping strategies used by South Asian women,living in the UK,suffering from depression

This brief study employed a qualitative, grounded theory approach within a constructivist paradigm, to explore the coping strategies used by Asian women suffering from depression. Ten Asian women were interviewed about their choice of coping strategies, factors affecting this and how this relates to treatment. The patients were interviewed individually using a brief semi-structured interview. The data were gathered and analysed according to the grounded-theory approach. Findings revealed that coping strategies included religion and prayer, talking, crying and self harm. The strategies were mediated by the individual's perception of the problem as depression, motivating factors and access to help. A distinction is made between general and culture-specific coping strategies and clinical implications for mental health services are also briefly discussed. Limitations of the study were also presented in line with qualitative research guidelines.     

产后抑郁的预测因素及神经生理机制

产后抑郁是产后时期出现的抑郁症状,对女性及其后代甚至家人都会造成严重的负面影响。产后抑郁稳定的预测因素是遗传基因、依恋风格、童年负性生活经历和激素水平的变化;涉及的脑区和神经网络集中在前额叶皮层、扣带回、杏仁核和海马等脑区及相应神经网络。未来应在探索综合的预测模型、男性伴侣的对照试验和基于大脑可塑性特征的干预模式等方面展开深入研究。     

Parenting and mother-infant interactions in the context of maternal postpartum obsessive-compulsive disorder: Effects of obsessional symptoms and mood

BackgroundMaternal mental illness is associated with negative effects on the infant and child. Increased attention has been paid to the effects of specific perinatal disorders on parenting and interactions as an important mechanism of influence. OCD can be a debilitating disorder for the sufferer and those around them. Although OCD is a common perinatal illness, no previous studies have characterized parenting and mother infant interactions in detail for mothers with OCD.Methods37 mothers with postpartum OCD and a 6 month old infant were compared with 37 community control dyads on a variety of measures of psychological distress and parenting. Observed mother-infant interactions were assessed independently.ResultsObsessions and compulsions were reported in both groups, although they did not cause interference in the control group. Mothers with OCD were troubled by their symptoms for a mean of 9.6 hours/day. Mothers with OCD were less confident, reported more marital distress and less social support than healthy peers and were less likely to be breastfeeding. Infant temperament ratings did not differ. Mothers with OCD were rated as less sensitive in interactions than the comparison group, partly attributable to levels of concurrent depression.ConclusionsMaternal postpartum OCD is a disorder that can affect experiences of parenting and mother-infant interactions although this may not be driven by OCD symptoms. Longitudinal studies are required to assess the trajectory and impact of maternal difficulties as the infant develops.     

Evidence for a neuroendocrinological foundation of human affiliation: plasma oxytocin levels across pregnancy and the postpartum period predict mother-infant bonding

Although research on the neurobiological foundation of social affiliation has implicated the neuropeptide oxytocin in processes of maternal bonding in mammals, there is little evidence to support such links in humans. Plasma oxytocin and cortisol of 62 pregnant women were sampled during the first trimester, last trimester, and first postpartum month. Oxytocin was assayed using enzyme immunoassay, and free cortisol was calculated. After the infants were born, their interactions with their mothers were observed, and the mothers were interviewed regarding their infant-related thoughts and behaviors. Oxytocin was stable across time, and oxytocin levels at early pregnancy and the postpartum period were related to a clearly defined set of maternal bonding behaviors, including gaze, vocalizations, positive affect, and affectionate touch; to attachment-related thoughts; and to frequent checking of the infant. Across pregnancy and the postpartum period, oxytocin may play a role in the emergence of behaviors and mental representations typical of bonding in the human mother.     

Perturbation of Japanese mother-infant habitual interactions in the double video paradigm and relationship to maternal playfulness

Double video paradigm (DVP) studies have found contradictory evidence regarding the young infants' ability to discriminate their mother's 'replay' image from 'live'. This study examined the hypothesis that 4-month-old infants whose mothers showed high-levels-of-playful-behavior are more likely to discriminate social contingency in the DVP. We also examined the relationships between the infants' DVP behaviors and mothers' free-play behaviors at home with their 3-month-old infants. The results supported our hypothesis. Further, when the mothers' behaviors were reduced to playful companion (PC) and sensitive support (SS) by a principal component analysis, the level of PC was closely related to the infants' detection of social contingency, but SS was not. The different functions of mothers' 'playfulness' and 'sensitivity' in communication with their infants are discussed.     

Prevalence and correlates of postpartum depression in first-time mothers.

The prevalence and correlates of postpartum depression were examined in a large (N = 1,033) sample of married, primiparous, middle-class mothers of full-term, healthy infants; 9.3% met modified Research Diagnostic Criteria for depression. However, 39% of the nondepressed women also reported at least 1 somatic symptom. Depressed women whose symptoms were current obtained elevated scores on the Center for Epidemiological Studies-Depression scale, as did some women who did not meet depression criteria. Depressed women different from nondepressed women on several socioeconomic status indicators and the occurrence of obstetric complications, even in this low-risk sample. These data have implications for the assessment of depression in postpartum women.     

Assessing postpartum depression: Evidences for the need of multiple methods

IntroductionDifferent methods and instruments are frequently used to measure postpartum depression (PPD) in research, e.g. PPD-specific scales, DSM-based diagnostic interviews and rating scales assessing general depression. However, it is unsure whether these measures would lead to the same results, e.g. in the identification of “depressed” women or in their relations to third variables.Objective(s)We compared different measures of PPD and their relations with a third variable, namely the mothers’ marital satisfaction.MethodWe recruited 65 mothers to take part in a study about the impact of PPD on the development of early family relations. Maternal PPD was assessed with multiple methods (i) a PPD-specific scale, (ii) a DSM-based diagnostic interviews and (iii) a rating scale designed to assess the severity of depressive symptoms. We assessed mothers’ marital satisfaction with the Marital Adjustment Test (MAT).ResultsResults showed weak overlap between PPD-specific scale and DSM-based diagnosis of PPD, and modest correlations between the PPD-specific scale and the general depression rating scale. Only the score on the PPD-specific scale could predict marital satisfaction.ConclusionAs we found discrepancies between different measures of PPD, we suggest being cautious in the choice of measures and using multiple methods to measure PPD in a comprehensive way.     

Cesarean childbirth in sweden: Effects on the mother and father-infant relationship

The effects of Cesarean delivery on father-infant and mother-infant interaction were studied in a sample of 30 Swedish, two-parent families with a full-term healthy first-born infant. Fifteen infants were delivered vaginally, and 15 infants were delivered under full anesthesia by Cesarean section. The infants and parents were observed at home when the infants were 3 and 8 months old. The findings indicate that mothers of infants delivered by Cesarean section reacted less positively when they saw their infants for the first time and encountered more difficulties breastfeeding than did mothers of vaginally delivered infants. At 3 months post-partum, fathers of infants who were Cesarean-delivered participated in a greater amount of caregiving activities. There were no differences between Cesarean and vaginally delivered mothers at 3 months after delivery. At 8 months, there were no differences between the two groups (Cesarean and vaginal) on either the interview questions or on-any of the behavioral measures. Results from this study do not support reports from the USA of long-lasting effects of Cesarean delivery on parent-infant interaction. The results suggest the need to study cultural variations that surround Cesarean section delivery so as to understand in what way the subsequent parent-infant relationship is influenced by this event.     

Suicide after suicide attempt in severe depression: a long-term follow-up

The temporal relation between completed suicide and first-ever suicide attempt was investigated in 58 future suicides with a primary severe depression/melancholia. The median survival after a first attempted suicide was 6.7 years. Male patients with initial ratings of psychomotor retardation lived significantly longer after their initial attempt than those who were not retarded. They also had more depressive episodes compared to other male suicides and retarded controls. Thus a slow suicidal process in the men with a severe depression and psychomotor retardation is proposed. Severity, repetition, and method of suicide attempt did not decrease the survival time.     

Woman's social status as a reflection of the internal relationship to mother and father in both sexes1

Abstract

Starting with three examples showing different kinds of external barriers which meet a woman in her professional life, the author examines how they are related to internal elements. She points out power as a common factor, and proposes that Freud, as well as many succeeding male and female psychoanalysts, wishfully described women as suffering from deficiencies, while the unconscious image of Mother in children and adults of both sexes is the very opposite of this: a potentially dangerous or ideally good, powerful creature. She argues that both men and women out of fear for this power try to restrict and belittle the capabilities of women. This thesis is further delineated by references to Greek mythology and clinical examples.     

Preliminary study of the relationship between guilt resolution and depression in a gerontological population

An individual interview process was used to investigate the relationship between proneness to depression in a gerontological sample and their evaluation of critical life incidents. High and low depressed individuals were asked to recall prideful and guiltful incidents from their past, and discrepancy scores were obtained between their past and present evaluations of those events. Limited evidence supported the hypothesis that individuals with higher proneness to depression showed a greater negative discrepancy in evaluations of critical life incidents. Subjects did not differ in the content of their recalled incidents as a function of guilt type or guilt referent.     

Bereavement and triangular relationships in a case of a child suffering from anorexia

This paper describes the mother–child assessment of a five-year-old girl suffering from anorexia since weaning, which was carried out in an Italian NHS neuropsychiatric child and adolescent unit. The author aims to show how she was able to link the little girl’s refusal of food to a death in the maternal family, which occurred soon after her birth. As well as this post-traumatic formulation, the author links the child’s anorexia to two related aspects of the family dynamics: avoidance of the awareness of death and the inability to manage triangular relationships, due to important intrusion and exclusion anxieties. Using extracts from the sessions, the author shows how the little girl was able to begin to work through the death phantasy which was previously inaccessible to her and her family. The concept of the death phantasy is defined and explored and possible analogies between this case and what is observed in some anorexic adolescent girls and their families are described.