A hermeneutic study of integrating psychotherapist competence in postnatal Child Health Care: Parents’ perspectives

A child's emotional and social development depends on the parents’ provision of optimal support. Many parents with perinatal distress experience difficulties in mastering parenthood and seek help from professionals within primary healthcare. A clinical project was launched in Stockholm, where psychodynamic psychotherapists provided short-term consultations at Child Health Centers. This study qualitatively explored parents’ experiences of perinatal distress and of receiving help by nurses and therapists in the project. Thirteen parents were interviewed, and their responses were analyzed with a hermeneutical method. Three main themes crystallized; accessibility of psychological help and detection of emotional problems; experiences of therapy at the Child Health Center; and the therapists’ technique. Parents were also clustered into three so-called ideal types: the insecure; parents in crisis; and parents with lifelong psychological problems. Parents experienced obstacles in accessing psychological care within primary healthcare. Psychotherapists with a holistic family perspective and who managed to oscillate between insight-promoting and supportive interventions were especially appreciated. Patient categories who benefitted from insight promotion and support, respectively, were identified.     

Maternal psychosocial predictors of pacifier use in a mother-infant interaction task: An observational study from the MPEWS pregnancy cohort

The prevalence of pacifier use is high but when it occurs outside of the recommended sleep context, it becomes more controversial. Using 211 mother-infant dyads recorded as part of the Mercy Pregnancy and Emotional Wellbeing Study, we examined the maternal psychosocial predictors of pacifier use within an interaction task (i.e., ten minutes face-to-face followed by 30-minutes unstructured play). Predictors included maternal emotional availability measured with the Emotional Availability Scales; depression measured by the Structured Clinical Interview for the DSM-IV-TR Clinician Version; and maternal history of childhood trauma measured by the Childhood Trauma Questionnaire. An unadjusted odds ratio demonstrated that women classified as non-emotionally available to their infants were three-and-a-half-times more likely to use a pacifier. Multivariate logistic regression including all maternal psychosocial predictors demonstrated that even when adjusting for cessation of breastfeeding, maternal emotional availability remained the only significant predictor of pacifier use. This is the first time that predictors of pacifier use have been examined with a sample of clinically depressed women, as well as women with childhood trauma history. The results provide preliminary evidence that women who are not emotionally available might be more likely to rely on a pacifier during mother-infant interaction.     

Antenatal caregiving representations and perinatal behavior in mothers with severe lifetime psychopathology

Psychopathology poses a risk for optimal parenting. The current study explored antenatal caregiving representations as markers for later risk of nonoptimal maternal behavior among mothers with severe mental illness. Sixty-five mothers diagnosed with psychosis, bipolar disorder, depression (psychopathology group), and nonclinical controls participated in a longitudinal study from pregnancy to 16 weeks after birth. Mental health diagnoses and caregiving representations were assessed during pregnancy. Maternal behavior was assessed during the 5-min recovery phase of the still-face paradigm at 16 weeks. Mothers with psychopathology reported significantly higher levels of “heightened” caregiving representations (i.e., separation anxiety from the child) than did controls. The only significant diagnostic group difference in perinatal maternal behavior was that mothers diagnosed with depression exhibited more overriding-intrusive behavior than did nonclinical control mothers. Regression modeling results showed that antenatal caregiving representations of “role reversal” predicted significantly lower levels of sensitivity and higher levels of overriding-intrusive behavior independent of the effect of psychopathology. The findings can be interpreted in the context of representational transformation to motherhood during pregnancy. The results provide preliminary evidence for the potential of a new questionnaire measure of caregiving representations as a screening instrument for antenatal representational risk.     

Identification of driving simulator sessions of depressed drivers: A comparison between aggregated and time-series classification

Depression has been found to significantly increase the probability of risky driving and involvement in traffic collisions. The majority of studies correlating depressive symptoms with driving, pursue to predict the differences in driving behavior if the driver has already been diagnosed. Little evidence can be found, however, on how mental and psychological disorders can be identified from driving data, and usually analyses utilize simple models and aggregated data. This study aims at utilizing microscopic data from a driving simulator to detect sessions belonging to “depressed” drivers by utilizing powerful machine learning classifiers. Driving simulator sessions from 11 older drivers with symptoms of depression and 65 healthy drivers were utilized towards that aim. Random Forests, an ensemble classifier, with proven efficiency among transportation applications, are then trained on highly disaggregated data describing the mean and standard deviation of speed and lateral or longitudinal acceleration of drivers in the simulator. The kinematic data were aggregated in 30-seconds, 1-minute and 5-minute intervals, but the corresponding time-series of the measurements were also taken into account. Furthermore, classifiers were treated with imbalanced learning techniques to address the scarcity of depressed drivers among the healthy. Time-series of mean speed and the standard deviation of longitudinal acceleration even with a duration of 30-seconds have proven to be the best predictors of driving sessions belonging to depressed drivers with a very low rate of false alarms. The results outperform previous approaches, and indicate that naturalistic driving data or deep learning could prove even more efficient in detecting depression.     

Obsessive-compulsive disorder and the five-factor model of personality: distinction and overlap with major depressive disorder

Research on individual differences in obsessive-compulsive disorder (OCD) has focused largely on analogue models with participants experiencing sub-clinical obsessions and/or compulsions. Few studies have examined the association between normal, dimensional personality traits and obsessive-compulsive symptomatology in a clinical sample. The purpose of this study was to examine personality differences in patients with a primary diagnosis of OCD (n = 98) or major depression (n = 98) using the domains and facets of the five-factor model of personality (FFM). Patients completed the self-report version of the Revised NEO Personality Inventory (NEO PI-R). When contrasted with community controls (Revised NEO Personality Inventory (NEO-PI-R) and NEO Five-Factor Inventory (NEO-FFI) professional manual, Psychological Assessment Resources, Odessa, FL, 1992), participants with OCD were found to differ across the domains (and facets) of neuroticism, extraversion, and conscientiousness and the facets of openness and agreeableness. Further, when compared to depressed participants, those with OCD were found to be more extraverted, agreeable, conscientious and less neurotic. With the exception of the conscientiousness domain (and facets), these significant differences were maintained even after controlling for depression severity. These results highlight the unique associations between trait domains and facets of the FFM and OCD.     

Psychometric properties of the Revised Child Anxiety and Depression Scale in a clinical sample

This study examined the psychometric properties of the Revised Child Anxiety and Depression Scale (RCADS) in a clinical sample of 513 youth referred for mental health assessment at a university clinic. Internal consistency and factor analysis provided support for the factorial validity of the RCADS. Convergent and discriminant validity tests against both clinical interview and self-report criteria also suggested favorable properties of the RCADS. In comparative tests with traditional measures of anxiety and depression, the RCADS generally showed greater correspondence to specific diagnostic syndromes. Clinical cutoffs are reported for the purposes of future clinical and research applications.     

Avoidance and depression: the construction of the cognitive-behavioral avoidance scale

Previous research has demonstrated a relationship between avoidance and depression, although the nature of this relationship has been confused by inconsistent definitions of avoidance. Following a review of the construct of avoidance and an examination of past research, a new multidimensional measure of avoidance was developed and validated using an undergraduate student sample (245 females and 146 males). Four reliable factors reflecting combinations of cognitive/behavioral and social/nonsocial dimensions of avoidance were obtained from the factor analysis of the new scale, entitled the "Cognitive-Behavioral Avoidance Scale" (CBAS). The scale showed the predicted relationships with convergent and divergent measures used for construct validation. As predicted, subscales of the CBAS, as well as the overall scale score, were significantly related to the depression and anxiety criterion measures. The findings from this study suggest that avoidance may be an important construct in the psychosocial conceptualization of depression. In addition, this integrated measure of avoidance has potential utility for depression researchers. Suggestions for further scale development and research are provided.     

Higher levels of state depression in masculine than in feminine nations

Studies using identical measures have identified different levels of depression in different countries or cultures. Until now, however, explanations for such differences, other than methodological ones, have not been empirically addressed. It was hypothesized and found that soft or feminine nations in which both women and men are offered equal opportunities for the fulfillment of multiple social roles that are associated with good self-rated health would score significantly lower on national depression levels than tough or masculine societies in which such opportunities exist to a clearly lesser extent. Analyses of data collected in 14 nations in Europe (total N>5000) demonstrated that higher scores on Hofstede's national masculinity index and lower ones on national wealth were independent predictors of higher national depression levels. National trait neuroticism did not mediate the relationship between national masculinity and national depression levels.