Associations between symptoms of maternal postpartum depression,gestational age and infant social withdrawal: A longitudinal study in a community cohort

Infant social withdrawal is a risk factor for non-optimal child development; thus, it is important to identify risk factors associated with withdrawal. In a large community sample (N = 19,017), we investigate whether symptoms of maternal and partner postpartum depression (PPD; measured with the Edinburgh Postnatal Depression Scale) and prematurity are predictors of infant social withdrawal (measured with the Alarm Distress Baby Scale). Withdrawal was assessed at 2–3, 4–7 and 8–12 months postpartum. Linear regressions showed that prematurity predicted higher infant social withdrawal at all time points, and maternal symptoms of PPD were positively associated with withdrawal at 2–3 months. Logistic regressions showed that odds for elevated social withdrawal were increased with elevated levels of maternal symptoms of PPD at 2–3 and 8–12 months. Partner's symptoms of PPD were not associated with withdrawal. Future studies should investigate how PPD symptoms and prematurity may impact the individual development of social withdrawal.     

Unplanned pregnancies and abortion counselling: Some thoughts on unconscious motivations

Abstract

My experience of abortion counselling¹ over ten years has shown me the importance of understanding the unconscious dynamics behind an unplanned and unwanted pregnancy. Unless these dynamics are made conscious and understood, the experience of abortion may have to be repeated again and again. Both becoming pregnant and having an abortion often involve unconscious conflicts and fantasies originating in a woman's early development and reflecting her relationship with her mother. These may be acted out via an unplanned pregnancy and decision to have an abortion. The central task of abortion counselling is to address and make links with the unconscious processes, and in particular help the pregnant woman recognize and acknowledge her ambivalent feelings. In this way the counselling makes use of the opportunity to reflect provided by the crisis situation of the pregnancy.     

Perinatal maternal mental health and infant socio-emotional development: A growth curve analysis using the MPEWS cohort

Pregnancy and the early post partum period are widely understood as a critical period for the infant’s emotional development and the earliest influence shaping social interaction. The present study aims to understand the potential influence of both antenatal and postnatal maternal anxiety and depressive symptoms on socio-emotional outcomes in offspring aged 12 months. The study used longitudinal data from a prospective cohort study on Australian pregnant women and their children. Data were available for 282 mothers and their children. Maternal depressive and anxiety symptoms were measured in early pregnancy, trimester three of pregnancy, six and 12 months postpartum. Social and emotional development in children was measured using the Brief Infant and Toddler Social Emotional Assessment (BITSEA) at 12 months. Using growth curve analysis of 4 waves of repeated measurement to examine intercept and slope, we found that both initial maternal depression and anxiety symptom levels, and the growth of these symptoms over time, predicted more problems with children’s social and emotional development. In the final model anxiety accounted for 19% of the variance in child socio-emotional problems and depression 23% of variance. The results emphasise the importance of perinatal maternal mental health as a potential risk factor for child development. This carries important implications for policy development, such as the need to build early identification and early intervention models in to the current clinical practice for perinatal care, specifically, to develop targeted screening, assessment and interventions to address maternal mental health issues for at-risk parents during pregnancy, and continuing monitoring of young children whose mothers have experienced perinatal mental health difficulties.     

Chronicity and severity of maternal postpartum depression and infant sleep disorders: a population-based cohort study in southern Brazil

A cohort study was conducted with 397 women randomly selected from the Brazilian National System of Public Health, to describe the prevalence rates of infant sleep problems at 12-month of life, and its association with chronicity and severity of maternal depressive symptoms. Mothers were assessed, first, from the 9th to the 12th week postpartum and then at 12 months after delivery, with EPDS and a self-rating questionnaire regarding babies’ sleep behavior. After controlling for possible confounders, babies whose mothers had severe chronic depressive symptoms were at higher risk for sleep disorder at 12 months of birth.     

Efficacy of brief guided self-help cognitive behavioral treatment for perfectionism in reducing perinatal depression and anxiety: a randomized controlled trial

Perfectionism has been proposed as a transdiagnostic process that maintains depression and anxiety through shared cognitive and behavioral processes. The purpose of this study was to investigate the efficacy of a brief, guided cognitive behavioral treatment (CBT) for perfectionism delivered via a self-help booklet in reducing perfectionism and symptoms of depression and anxiety during the antenatal period. Pregnant women in their third trimester were randomly allocated to self-help (n = 30) or waitlist control (n = 30). There were significant reductions in perfectionism and symptoms for participants who received CBT for perfectionism from pre- to post-treatment, which were maintained at 3-month follow-up, while the waitlist control group demonstrated no significant changes. Path analysis demonstrated a significant indirect effect of treatment condition on post-treatment depression and anxiety scores via perfectionism, controlling for pre-treatment scores, suggesting changes in perfectionism were associated with decreases in symptoms. The findings suggest that it would be useful for future research with larger samples to further investigate the efficacy of CBT for perfectionism for perinatal depression and anxiety.     

催产素对产后抑郁症患者母性行为的调节作用

产后抑郁症是指女性分娩后一段时间内出现的严重抑郁发作现象。研究表明, 催产素不仅参与分娩过程和正常的母性行为表达, 也在调节产后抑郁的发病及患者的母性行为中起到了重要的作用。产后抑郁症患者的情绪和认知功能受损, 这可能导致了母性行为表达质量的下降; 催产素可以通过中脑边缘多巴胺系统来调控母性行为, 作用于内侧视前区(MPOA)来激活中脑腹侧被盖区(VTA)-伏隔核(NAc)环路从而影响伏隔核内多巴胺的分泌; 催产素对产后抑郁症中母性行为的调节机制可能是通过调节五羟色胺系统的功能来发挥抗焦虑作用, 也可能是通过与其它激素的交互作用来加速母性行为的表达。未来研究进一步明确催产素在中枢神经环路中的功能差异, 以及社会支持对产后抑郁症患者催产素的使用带来的影响。     

Peritraumatic dissociation and posttraumatic stress after pregnancy loss: a prospective study

This study examined (1). predictors for peritraumatic dissociation, (2). its relations with acute and chronic symptoms of posttraumatic stress disorder (PTSD), and (3). pathways regarding these relations in response to pregnancy loss. In early pregnancy, about 1370 women volunteers completed questionnaires for neuroticism, control over emotions, dissociative tendencies, absorption, and prior life events. Of these, 126 subsequently experienced pregnancy loss and most of them completed measures 1 month (N = 118) and 4 months (N = 104) later. At 1 month, peritraumatic dissociation, memory of pregnancy loss (degree of fragmentation, sensory impressions, and emotional intensity), thought suppression, and PTSD symptoms were assessed, and at 4 months, PTSD symptoms were re-assessed. Peritraumatic dissociation was predicted by prior low control over emotions, dissociative tendencies, and lower education. It was not predicted by neuroticism, absorption, and prior life events. Peritraumatic dissociation was related to acute PTSD symptoms and LISREL analyses indicated that self-reported memory fragmentation and thought suppression of pregnancy loss mediated this relation. It also predicted chronic PTSD symptoms, and this relation was mediated by acute PTSD symptoms.     

Self-schemas and risk for depression: a prospective study

The role of depressive self-schemas in vulnerability to depression was explored in a longitudinal design. Five groups of subjects hypothesized to be at differential risk for depression according to a schema model were identified: depressed schematic, depressed nonschematic, nondepressed schematic, nondepressed nonschematic, and a psychopathology control. They were followed regularly for 4 months with self-report and clinical interview measures of depression. There was no evidence of risk for depression associated with schema status apart from initial mood and no interaction of life stress events and schemas. In a second experiment with the same subjects, it was shown that depressive self-schemas do not exert an ongoing, active influence on everyday information processing; instead current mood affected information processing. Remitted depressed persons resembled nondepressed rather than depressed ones. The results support Kuiper and colleagues' distinction between concomitant and vulnerability schemas, and help to clarify differences between cognitions that are symptoms or correlates of depression and those that may play a causal role under certain conditions.     

Effects of maternal postpartum depression in a well‐resourced sample: Early concurrent and long‐term effects on infant cognitive,language, and motor development

This study examined early and long‐term effects of maternal postpartum depression on cognitive, language, and motor development in infants of clinically depressed mothers. Participants were 83 mothers and their full‐term born children from the urban region of Copenhagen, Denmark. Of this group, 28 mothers were diagnosed with postnatal depression three to four months postpartum in a diagnostic interview. Cognitive, language, and motor development was assessed with the Bayley Scales of Infant and Toddler Development third edition, when the infants were 4 and 13 months of age. We found that maternal postpartum depression was associated with poorer cognitive development at infant age four months, the effect size being large (Cohen's d = 0.8) and with similar effects for boys and girls. At 13 months of age infants of clinical mothers did not differ from infants of non‐clinical mothers. At this time most (79%) of the clinical mothers were no longer, or not again, depressed. These results may indicate that maternal depression can have an acute, concurrent effect on infant cognitive development as early as at four months postpartum. At the same time, in the absence of other risk factors, this effect may not be enduring. The main weaknesses of the study include the relatively small sample size and that depression scores were only available for 35 of the non‐clinical mothers at 13 months.     

Maternal depression and dyadic interaction: the role of maternal attachment style

Maternal mental health and the contents of her representational world are important determinants of early parent–child relationship. We examined, first, the role of prenatal and postnatal depressive symptoms and maternal attachment style in predicting the quality of mother–child interaction. Second, we analysed whether the secure‐autonomous attachment style can protect the dyadic interaction from the negative effects of maternal depression. The participants were 59 mother–infant pairs examined during pregnancy (T1), 4–5 months postpartum (T2) and when the children were approximately 14 months old (T3). Maternal attachment style was assessed with a modified Adult Attachment Interview ‐procedure, depressive symptoms with Edinburgh Postnatal Depression Scale, and observed mother–child interaction with Care Index. The results show that autonomous mothers were more sensitive and responsive and their children more co‐operative than dyads with dismissing maternal attachment style. As hypothesized, mothers with the combination of both prenatal and postpartum depressive symptoms were highly unresponsive in their dyadic interaction. Further, prenatal depressive symptoms had a stronger impact on maternal unresponsiveness than postnatal symptoms. As hypothesized, mother's autonomous attachment style protected the mother–child interaction from the negative impact of maternal postnatal depressive symptoms, whereas dyads with preoccupied mothers were especially at risk for interaction problems when mothers had postpartum depressive symptoms. Copyright © 2010 John Wiley & Sons, Ltd.     

The impact of maternal postnatal depression on men and their ways of fathering: an interpretative phenomenological analysis

Objectives: Postnatal depression affects approximately 15% of women in Western countries. There are conflicting findings about the effects on fathers as well as the extent to which fathers buffer against the negative effects of depression on children. This study sought to understand the ways in which maternal postnatal depression affects men and their ways of fathering.

Design: Narrative interviews were conducted with 14 British fathers (mean age?=?33.9?years) whose (ex)partners had experienced at least one episode of postnatal depression. Interviews explored how their partner’s depression affected them, the partner relationship, their children and their ways of fathering. Data were analysed with interpretative phenomenological analysis.

Results and Conclusions: Men felt that their partner’s depression led to significant physical and/or psychological maternal absence as well as a fracturing of the family unit, which had been an important ideological foundation for men’s fathering. Unequal divisions of labour, unfulfilled expectations, a thwarting of preferred ways of fathering and preoccupation with their partner’s depression took some men away from fathering. Others reported adaptation by accepting the loss of shared parenting and investing in an exclusive father–child relationship. Fathering appears to be particularly affected by the loss of a close adult relationship.     

Goodness of fit between prenatal maternal sleep and infant sleep: Associations with maternal depression and attachment security

The current study prospectively examined the ways in which goodness of fit between maternal and infant sleep contributes to maternal depressive symptoms and the mother-child relationship across the first years of life. In a sample of 173 mother-child dyads, maternal prenatal sleep, infant sleep, maternal depressive symptoms, and mother-child attachment security were assessed via self-report, actigraphy, and observational measures. Results suggested that a poor fit between mothers’ prenatal sleep and infants’ sleep at 8 months (measured by sleep diary and actigraphy) was associated with maternal depressive symptoms at 15 months. Additionally, maternal depression mediated the association between the interplay of mother and infant sleep (measured by sleep diary) and mother-child attachment security at 30 months. Findings emphasize the importance of the match between mother and infant sleep on maternal wellbeing and mother-child relationships and highlight the role of mothers’ perceptions of infant sleep.     

Symptoms of depression in Swedish fathers in the postnatal period and development of a screening tool

Methods for detecting depression in fathers after the birth of their child are scarce. The Edinburgh Postnatal Depression Scale (EPDS), used to screen mothers for postpartum depression (PPD), lacks somatization and externalizing items. This potentially decreases its sensitivity in detecting depression in fathers, as many men actually express depression with somatization or externalizing symptoms. The present study assessed depressive symptoms in fathers of children 0–18 months old, and evaluated whether addressing both typical depression and externalizing, so‐called “depressive equivalent” symptoms, might be more suitable for such assessment. The Beck Depression Inventory‐II (BDI‐II), EPDS, and Gotland Male Depression Scale (GMDS) were responded to by 447 Swedish fathers online. Among participants, 27% reported depressive symptoms above the BDI‐II cut‐off suggestive of depression. Most fathers reported both traditional and depressive equivalent symptoms and a subgroup expressed exclusively depressive equivalent symptoms. Consistently, a scale combining items from the EPDS and GMDS showed higher sensitivity than the EPDS alone in identifying fathers with elevated depressive symptoms, at equal levels of specificity. Our findings suggest that a combination of EPDS and depressive equivalent symptom items results in a more suitable instrument for screening for depression in fathers during the postnatal period.     

Intention stability assessed using residual change scores moderates the intention-behaviour association: a prospective cohort study

Intention stability is considered to be one of the key pre-requisites for a strong association between intention and behaviour. It has been claimed, however, that studies examining the moderating impact of intention stability may be invalid, as they have relied on statistically inferior methods. Residual change scores have been suggested as a more appropriate method of measuring change (or lack thereof) in constructs. The aim of the current study, therefore, is to test whether intention stability, calculated using residual change scores, moderates the intention-physical activity behaviour association. A total of 163 participants (124 women, 39 men) completed questionnaires online at three time points separated by 14 day intervals. The moderating impact of intention stability was assessed using multiple linear regression followed up using simple slope analyses to identify the direction of any effect. The interaction of intention and intention stability was found to significantly improve the overall model fit. Intentions had a stronger positive association with behaviour when intentions were more stable than when they were more unstable. However, sensitivity analyses revealed that the association was not robust and reduced to non-significant with the removal of potential multivariate outliers. Future research should use residual change scores as the preferred method of assessing intention stability.     

Mediated pathways from maternal depression and early parenting to children's executive function and externalizing behaviour problems

Structural equation models were used to examine pathways from maternal depression and early parenting to children's executive function (EF) and externalizing behaviours in the first nationally representative study to obtain direct assessments of children's kindergarten EF skills (i.e., the Early Childhood Longitudinal Study Kindergarten Class of 2010–2011). Preliminary analyses revealed that maternal depression was negatively related to children's EF and positively related to children's externalizing behaviour problems. However, the negative association between maternal depression and children's EF was completely mediated by maternal parenting practices (i.e., warmth and home learning stimulation). Furthermore, there was an indirect effect from maternal parenting practices to children's externalizing behaviour problems through EF, such that children with stronger EF skills had fewer externalizing behaviour problems. Findings provide support for a family process model in which warm, cognitively stimulating parenting supports children's EF, which in turn decreases externalizing behaviours.

Highlights

• This study examined pathways from parent mental health to children's executive function (EF) and behaviour problems.
• Maternal depression was negatively related to children's EF and positively related to children's behaviour problems.
• The negative association between maternal depression and children's EF was completely mediated by maternal parenting. There was an indirect effect from maternal parenting to children's behaviour problems through EF.

     

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。     

Social capital,migration stress,depression and sexual risk behaviors among rural-to-urban migrants in China: a moderated mediation modeling analysis

Background: Few studies have examined the complex relationship of migration stress and depression with sexual risk behaviors among migrants. The relationship between migration stress and sexual risk behaviors may be mediated by depression, and the mediation process may be modified by social capital. The study aims to investigate this moderated mediation mechanism among rural-to-urban migrants.

Methods: Data were collected from rural-to-urban migrants in China. Migration stress, depression, and social capital were measured with validated scales and used as predictor, mediator and moderator, respectively, to predict the likelihood of having sex with risk partners. Mediation and moderated mediation models were used to analyze the data.

Results: Depression significantly mediated the migration stress–sex with risk partner relationship for males (the indirect effect [95%CI]?=?0.36 [0.08, 0.66]); the mediation effect was not significant for females (0.31 [?0.82, 0.16]). Among males, social capital significantly moderated the depression-sex with risk partner relation with moderation effect ?0.12 [?0.21, ?0.04], ?0.21 [?0.41, ?0.01] and ?0.17 [?0.30, ?0.05] for total, bonding and bridging capital respectively.

Conclusion: Social capital may weaken the association between migration stress and sexual risk behavior by buffering the depression-sexual risk behaviors association for males. Additional research is needed to examine this issue among females.     

Preterm birth and maternal sensitivity: Findings from a non-western country

IntroductionAlthough there are several studies on maternal sensitivity of preterm-born children conducted in Western countries, the factors affecting the sensitivity of mothers of preterm infants have not been investigated outside the Western context.ObjectivesThis study aimed to compare maternal sensitivity of preterm children at 18 months of corrected age with their healthy term-born peers and explore the factors associated with maternal sensitivity in a middle-income non-Western country. Moreover, the associations of maternal sensitivity with socio-demographic factors, maternal depression, and social-emotional competency and behavior problems of infants were investigated.MethodsIn total, 70 (40 preterm-born and 30 term-born) mother-child dyads participated in this study. An observation-based measurement tool, Maternal Sensitivity Scale, was used to assess maternal sensitivity. Social-emotional competency and behavior problems of infants were evaluated via The Turkish version of the Brief Infant-Toddler Social Emotional Assessment. Maternal depressive symptoms were assessed via the Beck Depression Inventory. In addition, a demographic information form was filled out by the mothers.ResultsMaternal sensitivity scores of preterm infants were significantly lower compared to term infants. Depressive symptoms scores and employment status of mothers, socio-economic status (SES), gestational age, breastfeeding duration, and behavior problems of children were the factors related to maternal sensitivity scores. In hierarchical regression analysis, SES and gestational age were the strongest predictors of maternal sensitivity. After controlling SES and gestational age, maternal depressive symptoms scores negatively predicted maternal sensitivity scores.ConclusionThis study pointed out the factors associated with the maternal sensitivity of preterm infants outside the Western context. Interventions to improve sensitive parenting behaviors of preterm infants are needed, especially in socio-economically disadvantaged groups.     

The relationship between personality, social functioning, and depression: a structural equation modeling analysis

The relationship between personality, social functioning, and depression remains unclear. The present study employs structural equation modeling to examine the mediating role of social functioning between harm avoidance (HA), self-directedness (SD), and depression. A sample of 902 individuals completed a self-report questionnaire consisting of the following scales: HA and SD subscales of the Temperament and Character Inventory (TCI), Beck Depression Inventory (BDI), and Social Adaptation Self-Evaluation Scale (SASS). Structural equation modeling via analysis of moment structure was used to estimate the fit of nine related models. Results indicated that social functioning is a mediator between harm avoidance or self-directness and depression. Self-directedness was also shown to have direct effects on depression. The results support the social reinforcement theory of depression and provide a theoretical account of how the variables are related based on correlation methods. Suggestions are offered for future experimental and longitudinal research.