Article

Previous prenatal as a predictor of perinatal depression and anxiety

Department of Psychiatry, University of Rochester Medical Center, New York, NY 14642-8409, USA.
The British journal of psychiatry: the journal of mental science (Impact Factor: 7.34). 03/2011; 198(5):373-8. DOI: 10.1192/bjp.bp.110.083105
Source: PubMed

ABSTRACT Prenatal loss, the death of a fetus/child through miscarriage or stillbirth, is associated with significant depression and anxiety, particularly in a subsequent pregnancy.
This study examined the degree to which symptoms of depression and anxiety associated with a previous loss persisted following a subsequent successful pregnancy.
Data were derived from the Avon Longitudinal Study of Parents and Children cohort, a longitudinal cohort study in the west of England that has followed mothers from pregnancy into the postnatal period. A total of 13,133 mothers reported on the number and conditions of previous perinatal losses and provided self-report measures of depression and anxiety at 18 and 32 weeks' gestation and at 8 weeks and 8, 21 and 33 months postnatally. Controls for pregnancy outcome and obstetric and psychosocial factors were included.
Generalised estimating equations indicated that the number of previous miscarriages/stillbirths significantly predicted symptoms of depression (β = 0.18, s.e. = 0.07, P<0.01) and anxiety (β = 0.14, s.e. = 0.05, P<0.01) in a subsequent pregnancy, independent of key psychosocial and obstetric factors. This association remained constant across the pre- and postnatal period, indicating that the impact of a previous prenatal loss did not diminish significantly following the birth of a healthy child.
Depression and anxiety associated with a previous prenatal loss shows a persisting pattern that continues after the birth of a subsequent (healthy) child. Interventions targeting women with previous prenatal loss may improve the health outcomes of women and their children.

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    • "However, studies which have examined prenatal, perinatal, and post-natal losses have generally found no differences in symptomatology across types of loss (Dyregrov, 1990), although one study has reported more symptomatology following post-natal compared to prenatal loss (Gaudet, Séjourné, Camborieux, Rogers, & Chabrol, 2010). There is significant psychological/psychiatric morbidity associated with infant loss (Blackmore et al., 2011); however , only a few studies have investigated attachment styles and psychological trauma in response to both peri-and post-natal mortality. The primary aim of the current study was to identify attachment styles, or ''classes,'' based on individuals' relationship with their family members, romantic partners, and close friends. "
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    ABSTRACT: Background: Based on Bowlbys (1973) attachment theory, Bartholomew (1990) proposed a four category attachment typology by which individuals judged themselves and adult relationships. This explanatory model has since been utilised to help explain risk of psychiatric comorbidity. Objective: The current study aimed to identify attachment typologies based on Bartholomew’s (1990) attachment styles in a sample of bereaved parents on dimensions of closeness/dependency and anxiety. Additionally, it sought to assess the relationship between the resultant attachment typology with a range of psychological trauma variables. Method: The current study was based on a sample of 445 bereaved parents who had experienced, either peri or post natal death of an infant. Adult attachment was assessed using the Revised Adult Attachment Scale (RAAS) while reaction to trauma was assessed using The Trauma Symptom Checklist (TSC). A latent profile analysis was conducted on scores from the RAAS closeness/dependency and anxiety subscales to ascertain if there were underlying homogeneous attachment classes. Emergent classes were used to determine if these were significantly different in terms of mean scores on TSC scales. Results: A four class solution was considered the optimal based on fit statistics and interpretability of the results. Classes were labelled ‘Fearful’, ‘Preoccupied’ ‘Dismissing’ and ‘Secure’. Females were almost eight times more likely than males to be members of the fearful attachment class. This class evidenced the highest scores across all TSC scales while the secure class showed the lowest scores. Conclusions: The results are consistent with Bartholomew’s four category attachment styles with classes representing secure, fearful, preoccupied and dismissing types. While the loss of an infant is devastating experience for any parent, securely attached individuals showed the lowest levels of psychopathology compared to fearful, preoccupied or dismissing attachment styles. This may suggest that a secure attachment style is protective against trauma related psychological distress.
    European Journal of Psychotraumatology 04/2014; DOI:10.3402/ejpt.v5.23295 · 2.40 Impact Factor
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    • "The labor, birth, and postpartum periods of women who experience stillbirth are physically similar to those of women who give birth to live, healthy babies; however, the negative effects are significantly greater [4]. Consequently, stillbirth presents a threefold increased risk of postpartum depression when compared with live, healthy births [5,6], and symptoms (e.g., perceived stress, anxiety, and sleep quality) may last for years or decades [1,4,6]. Depression may contribute to health problems, including weight retention or gain, increased risk of chronic disease (e.g., heart disease, diabetes), premature mortality, and poor quality of life [7,8]. "
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    BMC Pregnancy and Childbirth 01/2014; 14(1):26. DOI:10.1186/1471-2393-14-26 · 2.15 Impact Factor
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    • "However, studies which have examined prenatal, perinatal, and post-natal losses have generally found no differences in symptomatology across types of loss (Dyregrov, 1990), although one study has reported more symptomatology following post-natal compared to prenatal loss (Gaudet, Séjourné, Camborieux, Rogers, & Chabrol, 2010). There is significant psychological/psychiatric morbidity associated with infant loss (Blackmore et al., 2011); however , only a few studies have investigated attachment styles and psychological trauma in response to both peri-and post-natal mortality. The primary aim of the current study was to identify attachment styles, or ''classes,'' based on individuals' relationship with their family members, romantic partners, and close friends. "
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    ABSTRACT: Background: The loss of a child can be devastating and traumatizing for parents constituting a risk factor for symptoms of posttraumatic stress disorder (PTSD) and other psychiatric disorders. Methods: 600 bereaved parents completed measures of the Revised Adult Attachment Scale and Trauma Symptom Checklist. A 3-step latent profile analysis was conducted to assess the relationship between demographic, attachment style and trauma symptomology. Findings: The four class solution (fearful, dismissing, secure and preoccupied) was considered optimal. The secure class demonstrated significantly lower means scores in terms of PTSD symptoms. The fearful class displayed significantly higher means compared to the other classes. Discussion: Secure attachment may serve as a protective factor whereas fearful attachment style may pose as a risk factor for psychiatric symptoms and a need for care.
    European Health Psychology Society, Bordeux; 07/2013
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