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ABSTRACT: Infant faces elicit early, specific activity in the orbitofrontal cortex (OFC), a key cortical region for reward and affective processing. A test of the causal relationship between infant facial configuration and OFC activity is provided by naturally occurring disruptions to the face structure. One such disruption is cleft lip, a small change to one facial feature, shown to disrupt parenting. Using magnetoencephalography, we investigated neural responses to infant faces with cleft lip compared with typical infant and adult faces. We found activity in the right OFC at 140 ms in response to typical infant faces but diminished activity to infant faces with cleft lip or adult faces. Activity in the right fusiform face area was of similar magnitude for typical adult and infant faces but was significantly lower for infant faces with cleft lip. This is the first evidence that a minor change to the infant face can disrupt neural activity potentially implicated in caregiving.
Social neuroscience 05/2013; · 3.17 Impact Factor
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ABSTRACT: Risk of antenatal depression has been shown to be elevated in Southern Africa and can impact maternal and child outcomes, especially in the context of the Human Immunodeficiency Virus (HIV). Brief screening methods may optimize access to care during pregnancy, particularly where resources are scarce. This research evaluated shorter versions of the Edinburgh Postnatal Depression Scale (EPDS) to detect antenatal depression. This cross-sectional study at a large primary health care (PHC) facility recruited a consecutive series of 109 antenatal attendees in rural South Africa. Women were in the second half of pregnancy and completed the EPDS and Structured Clinical Interview for Depression (SCID). The recommended EPDS cutoff (≥13) was used to determine probable depression. Four versions, including the 10-item scale, seven-item depression, and novel three- and five-item versions developed through regression analysis, were evaluated using receiver operating characteristic (ROC) analysis. High numbers of women 51/109 (47 %) were depressed, most depression was chronic, and nearly half of the women were HIV positive 49/109 (45 %). The novel three-item version had improved positive predictive value (PPV) over the 10-item version and equivalent specificity to the seven-item depression subscale; the novel five-item provided the best overall performance in terms of ROC and Cronbach's reliability statistics and had improved specificity. The brevity, sensitivity, and reliability of the short and ultrashort versions could facilitate widespread community screening. The usefulness of the novel three- and five-item versions are underscored by the fact that sensitivity is important at first screening, while specificity becomes more important at higher levels of care. Replication in larger samples is required.
Archives of Women s Mental Health 04/2013; · 2.06 Impact Factor
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ABSTRACT: BACKGROUND: The objective was to examine the course and longitudinal associations of generalized anxiety disorder (GAD) and major depressive disorder (MDD) in mothers over the postpartum 2 years. METHOD: Using a prospective naturalistic design, 296 mothers recruited from a large community pool were assessed for GAD and MDD at 3, 6, 10, 14, and 24 months postpartum. Structured clinical interviews were used for diagnoses, and symptoms were assessed using self-report questionnaires. Logistic regression analyses were used to examine diagnostic stability and longitudinal relations, and latent variable modeling was employed to examine change in symptoms. RESULTS: MDD without co-occurring GAD, GAD without co-occurring MDD, and co-occurring GAD and MDD, displayed significant stability during the postpartum period. Whereas MDD did not predict subsequent GAD, GAD predicted subsequent MDD (in the form of GAD + MDD). Those with GAD + MDD at 3 months postpartum were significantly less likely to be diagnosis free during the follow-up period than those in other diagnostic categories. At the symptom level, symptoms of GAD were more trait-like than those of depression. CONCLUSIONS: Postpartum GAD and MDD are relatively stable conditions, and GAD is a risk factor for MDD but not vice versa. Given the tendency of MDD and GAD to be persistent, especially when comorbid, and the increased risk for MDD in mothers with GAD, as well as the potential negative effects of cumulative exposure to maternal depression and anxiety on child development, the present findings clearly highlight the need for screening and treatment of GAD in addition to MDD during the postpartum period.
Depression and Anxiety 01/2013; · 4.18 Impact Factor
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ABSTRACT: An infant's cry is one of the most emotionally salient sounds in our environment. Depression is known to disrupt a mother's ability to respond to her infant, but it is not well-understood why such difficulties arise. One reason might be that depression disrupts the perceptual abilities necessary to interpret infant's affective cues. Given that musicians are known to have enhanced auditory perception, we assessed whether depression and previous musical training can impact on the ability to interpret distress in infant cries, as manipulated by changes in pitch. Depressed participants with musical training demonstrated better discriminative acuity of distress in infant cry bursts compared to those without. Non-depressed participants, with and without musical training, had levels comparable to musicians with depression. We suggest that previous musical training may act as a protective factor that maintains auditory perceptual abilities in the context of depression. These findings have potential implications for the development of novel training interventions to maintain sensitivity to infant vocal cues in individuals with postnatal depression. (PsycINFO Database Record (c) 2012 APA, all rights reserved).
Emotion 07/2012; · 3.88 Impact Factor
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ABSTRACT: Food ensures our survival and is a potential source of pleasure and general well-being. In order to survive, the human brain is required to optimize the resource allocation such that rewards are pursued when relevant. This means that food intake follows a similar cyclical time course to other rewards with phases related to expectation, consummation and satiety. Here we develop a multilevel model for the full cycle of eating behavior based on the evidence for the brain networks and mechanisms initiating, sustaining and terminating the various phases of eating. We concentrate on how the underlying reward mechanisms of wanting, liking and learning lead to how human food intake is governed by both hedonic and homeostatic principles. We describe five of the main processing principles controlling food intake: hunger and attentional signal processing; motivation-independent discriminative processing; reward representations; learning-dependent multimodal sensory representations and hedonic experience. Overall, the evidence shows that while human food intake is complex, we are making progress in understanding the underlying mechanisms and that the brain networks supporting the food pleasure cycle are remarkably similar to those underlying the processing of other rewards.
Physiology & Behavior 03/2012; 106(3):307-16. · 2.87 Impact Factor
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ABSTRACT: There has been increasing research interest in parenting by anxious adults; however, little is known about anxiety-subtype effects, or effects of the context in which parenting is assessed.
Two groups of anxious mothers, social phobia (N = 50), generalised anxiety disorder (N = 38), and nonanxious controls (N = 62) were assessed with their 4.9-year-old children in three tasks: two presented threat specifically relevant to each maternal disorder, namely, a social threat task where the child had to give a speech, and a nonsocial threat task where the child had to explore potentially scary objects; the third was a nonthreat task (playing with play dough). Seven parenting dimensions were scored. Effects on parenting of maternal anxiety subgroup and task, and their interactions, were examined, as were effects of earlier child behavioural inhibition and currently manifest anxiety.
There were no parenting differences between maternal groups in the nonthreat play-dough task; parenting difficulties in the two anxious groups were principally evident in the disorder-specific challenge. Parenting differences between nonanxious and anxious mothers occurred independently of child characteristics. There was little evidence for particular forms of parenting difficulty being unique to maternal disorder.
Anxious mothers' parenting difficulties emerge when occurring under challenge, especially when this is disorder-specific. These effects should be considered in research and clinical practice.
Journal of Child Psychology and Psychiatry 02/2012; 53(2):188-96. · 4.28 Impact Factor
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ABSTRACT: Postnatal depression and anxiety have been shown to increase the risk of disturbances in mother-child interaction and child development. Research into mechanisms has focused on genetics and maternal behavior; maternal cognitions have received little attention. Our aim was to experimentally determine if worry and rumination in mothers with generalized anxiety disorder (GAD) and major depressive disorder (MDD), diagnosed in the postnatal 6 months, interfered with maternal responsiveness to their 10-month old infants. Mothers (N = 253: GAD n = 90; MDD n = 57; control n = 106) and their infants were randomized to either a worry/rumination prime (WRP) or a neutral prime (NP); mother-infant interactions were assessed before and after priming. Type of priming was a significant predictor of maternal cognitions, with WRP resulting in more negative thoughts, higher thought recurrence and more self-focus relative to NP across the entire sample. Interaction effects between group and priming were significant for two parenting variables: Compared with controls, WRP had a more negative impact on maternal responsiveness to infant vocalization for GAD, and to a lesser extent for MDD; WRP led to decreased maternal vocalization for GAD. Also, mothers with GAD used stronger control after the NP than WRP, as well as compared with other groups, and overall post-priming, their children exhibited lower emotional tone and more withdrawal. Across the entire sample, WRP was associated with increased child vocalization relative to NP. This study demonstrated that disturbances in maternal cognitions, in the context of postnatal anxiety and to a lesser degree depression, play a significant role in mother-child interaction. (PsycINFO Database Record (c) 2012 APA, all rights reserved).
Journal of Abnormal Psychology 01/2012; · 4.86 Impact Factor
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ABSTRACT: Deep brain stimulation (DBS) has been shown to be clinically effective for some forms of treatment-resistant chronic pain, but the precise mechanisms of action are not well understood. Here, we present an analysis of magnetoencephalography (MEG) data from a patient with whole-body chronic pain, in order to investigate changes in neural activity induced by DBS for pain relief over both short- and long-term. This patient is one of the few cases treated using DBS of the anterior cingulate cortex (ACC). We demonstrate that a novel method, null-beamforming, can be used to localise accurately brain activity despite the artefacts caused by the presence of DBS electrodes and stimulus pulses. The accuracy of our source localisation was verified by correlating the predicted DBS electrode positions with their actual positions. Using this beamforming method, we examined changes in whole-brain activity comparing pain relief achieved with deep brain stimulation (DBS ON) and compared with pain experienced with no stimulation (DBS OFF). We found significant changes in activity in pain-related regions including the pre-supplementary motor area, brainstem (periaqueductal gray) and dissociable parts of caudal and rostral ACC. In particular, when the patient reported experiencing pain, there was increased activity in different regions of ACC compared to when he experienced pain relief. We were also able to demonstrate long-term functional brain changes as a result of continuous DBS over one year, leading to specific changes in the activity in dissociable regions of caudal and rostral ACC. These results broaden our understanding of the underlying mechanisms of DBS in the human brain.
PLoS ONE 01/2012; 7(6):e37993. · 4.09 Impact Factor
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ABSTRACT: Maternal depression is known to be associated with impairments in child cognitive development, although the effect of timing of exposure to maternal depression is unclear.
Data collected for the Avon Longitudinal Study of Parents and Children, a longitudinal study beginning in pregnancy, included self-report measures of maternal depression the Edinburgh Postnatal Depression Scale, completed on 6 occasions up to 3 years of age, and IQ of the index child (WISC) measured at aged 8 years. We used these data to assign women to 8 groups according to whether depression occurred in the antenatal, postnatal, preschool period, any combination of these times, or not at all. We compared a model comprising all patterns of depression (saturated model) with models nested within this to test whether there is a relationship between depression and child cognitive development and, if so, whether there is a sensitive period. We then investigated the relationship with child IQ for each model, following adjustment for confounders.
Six thousand seven hundred and thirty-five of 13,615 children from singleton births (49.5%, of eligible core sample) attended a research clinic at 8 years and completed a WISC with a score ≥ 70. A total of 5,029 mothers of these children had completed mood assessments over the 3 time periods. In unadjusted analyses, all three sensitive period models were as good as the saturated model, as was an accumulation model. Of the sensitive period models, only that for antenatal exposure was a consistently better fit than the accumulation model. After multiple imputation for missing data (to n = 6,735), there was no effect of postnatal depression on child IQ independent of depression at other times [-0.19 IQ points, 95% confidence interval (CI) -1.5 to 1.1 points]. There was an effect of antenatal depression (-3.19 IQ points, 95% CI: -4.33 to -2.06) which attenuated following adjustment (-0.64 IQ points, 95% CI: -1.68 to 0.40).
The postnatal period is not a sensitive one for the effect of maternal depression on child cognitive development.
Journal of Child Psychology and Psychiatry 12/2011; 53(6):632-40. · 4.28 Impact Factor
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Acta Paediatrica 12/2011; 101(4):e189-91. · 2.07 Impact Factor
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ABSTRACT: It is well established that postnatal depression (PND) is prevalent in high-income countries and is associated with negative personal, family and child developmental outcomes.
Here, studies on the prevalence of maternal PND in low- and middle-income countries are reviewed and a geographical prevalence map is presented. The impact of PND upon child outcomes is also reviewed.
The available evidence suggests that rates of PND are substantial, and in many regions, are higher than those reported for high-income countries. An association between PND and adverse child developmental outcomes was identified in many of the countries examined.
Significant heterogeneity in prevalence rates and impact on child outcomes across studies means that the true extent of the disease burden is still unclear.
Nonetheless, there is a compelling case for the implementation of interventions to reduce the impact of PND on the quality of the mother-infant relationship and improve child outcomes.
British Medical Bulletin 12/2011; 101:57-79. · 4.54 Impact Factor
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ABSTRACT: Difficulties in mother-child interaction are commonly observed in the context of postnatal depression. These difficulties may result in part from the negative cognitive bias present in depression, which may in turn lead to biased negative perceptions of the infant: in particular, these biases encompass the negative appraisal of facial expressions. Given the important role of early mother-child interactions in child development it is vital to investigate potential interventions that might be beneficial in ameliorating the negative cognitive bias. This study aimed to examine the effects of two different antidepressants (reboxetine and citalopram) on the appraisal of infant facial expressions of emotion using a faces rating task, and on attention to infant emotion using an attentional probe. Thirty-nine volunteers were randomly assigned to a double-blind 7-day intervention with either placebo, citalopram or reboxetine. There were significant positive effects on the appraisal of facial expressions; participants assigned to the placebo group rated positive faces less positively than those either in the citalopram or in the reboxetine groups. However, there was no evidence that these drugs had an effect on attentional vigilance. If antidepressants are able to help a mother to perceive her infant's facial expressions as more positive, this may lead to more positive interactions, thereby potentially mitigating the negative effects of depression on infant development. These findings should be treated with caution until replicated in larger and clinical samples.
Journal of Psychopharmacology 09/2011; 26(5):670-6. · 3.04 Impact Factor
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ABSTRACT: Although the prevalence of depression is similar in pregnant, postpartum and non-pregnant women, the onset of new depression is higher during the perinatal period. Women of low-income, and those living in low and middle income countries, are known to be at particularly high risk. Early identification and treatment of antenatal depression may improve pregnancy outcomes and could serve as an early indicator of postnatal depression. Culturally sensitive and accurate diagnostic tools are urgently needed.
A consecutive series of 109 pregnant women were recruited in the third trimester at a primary health clinic, in a rural part of South Africa, with a high HIV prevalence. A cross sectional assessment of depression was completed using a structured clinical interview method and DSM-IV diagnostic criteria. Qualitative data on women's descriptions of depressive symptoms was also collected. The aim was to examine the prevalence of depression and to better understand the presentation of depressive symptomatology in this population.
Prevalence of depression was high, 51/109 (47%), with over half of the depressed women 34/51(67%) reporting episode duration greater than two months. 8/51 reported a prior history of depression. Women used psychological language to describe symptoms and, as a result, standardised diagnostic tools were culturally sensitive. Somatic pregnancy symptoms were frequently reported, but did not overestimate depression. Both HIV positive (27/51) and HIV negative (24/51) women were at risk of being depressed.
The study is limited by the small sample size and possible attrition biases.
Antenatal depression is high and clinical presentation is similar to high income countries. Standardised diagnostic tools are culturally sensitive and adequate for early detection.
Journal of affective disorders 08/2011; 135(1-3):362-73. · 3.76 Impact Factor
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ABSTRACT: We undertook a systematic search and review of individual, family, community, and societal risk and protective factors for mental health in children and adolescents who are forcibly displaced to high-income countries. Exposure to violence has been shown to be a key risk factor, whereas stable settlement and social support in the host country have a positive effect on the child's psychological functioning. Further research is needed to identify the relevant processes, contexts, and interplay between the many predictor variables hitherto identified as affecting mental health vulnerability and resilience. Research designs are needed that enable longitudinal investigation of individual, community, and societal contexts, rather than designs restricted to investigation of the associations between adverse exposures and psychological symptoms. We emphasise the need to develop comprehensive policies to ensure a rapid resolution of asylum claims and the effective integration of internally displaced and refugee children.
The Lancet 08/2011; 379(9812):266-82. · 38.28 Impact Factor
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ABSTRACT: Children and adolescents who are forcibly displaced represent almost half the world's internally displaced and refugee populations. We undertook a two-part systematic search and review of the evidence-base for individual, family, community, and societal risk and protective factors for the mental health outcomes of children and adolescents. Here we review data for displacement to low-income and middle-income settings. We draw together the main findings from reports to identify important issues and establish recommendations for future work. We draw attention to exposure to violence as a well established risk factor for poor mental health. We note the paucity of research into predictor variables other than those in the individual domain and the neglect of other variables for the assessment of causal associations, including potential mediators and moderators identifiable in longitudinal work. We conclude with research and policy recommendations to guide the development and assessment of effective interventions.
The Lancet 08/2011; 379(9812):250-65. · 38.28 Impact Factor
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ABSTRACT: Postnatally depressed mothers have difficulties responding appropriately to their infants. The quality of the mother-child relationship depends on a mother's ability to respond to her infant's cues, which are largely non-verbal. Therefore, it is likely that difficulties in a mother's appraisal of her infants' facial expressions will affect the quality of mother-infant interaction. This study aimed to investigate the effects of postnatal depression and anxiety on the processing of infants' facial expressions.
A total of 89 mothers, 34 with Generalised Anxiety Disorder, 21 with Major Depressive Disorder, and 34 controls, completed a 'morphed infants' faces task when their children were between 10 and 18 months.
Overall, mothers were more likely to identify happy faces accurately and at lower intensity than sad faces. Depressed compared to control participants, however, were less likely to accurately identify happy infant faces. Interestingly, mothers with GAD tended to identify happy faces at a lower intensity than controls. There were no differences between the groups in relation to sad faces.
Our sample was relatively small and further research is needed to investigate the links between mothers' perceptions of infant expressions and both maternal responsiveness and later measures of child development.
Our findings have potential clinical implications as the difficulties in the processing of positive facial expressions in depression may lead to less maternal responsiveness to positive affect in the offspring and may diminish the quality of the mother-child interactions. Results for participants with GAD are consistent with the literature demonstrating that persons with GAD are intolerant of uncertainty and seek reassurance due to their worries.
Journal of affective disorders 06/2011; 133(1-2):197-203. · 3.76 Impact Factor
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ABSTRACT: This article provides a summary of emerging psychosocial evidence relevant to the success of comprehensive family-centered approaches to HIV prevention, treatment, care and support programs in poorly resourced settings. This report synthesizes current evidence on maternal, paternal and family experiences of HIV prevention, diagnosis, treatment, adherence and disclosure, with special focus on HIV-infected mothers and HIV-exposed children. Taking a developmental approach, we explore the current challenges and opportunities towards a family-centered approach within the continuum of HIV treatment and care, beginning in pregnancy and following the course of childhood. The discussion is limited to early and middle childhood and excludes discussion of special issues emergent in adolescence, which would warrant discussion outside the scope of this article. Attention is drawn to the complexity of problems arising within the family context and the need for improvements in the integration of aspects of treatment, care and support. While this article focuses on examples from sub-Saharan Africa, the lessons learnt and future challenges outlined are applicable to most low- and middle-income countries, and to poorly resourced contexts in higher-income countries.
Future Virology 06/2011; 6(6):687-696. · 1.21 Impact Factor
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ABSTRACT: This study investigated the effects of different characteristics of early child-care in England on the development of cognition, language, and task-related attention and behaviour (orientation/engagement and emotion regulation during the Bayley assessment) at 18 months. Data were drawn from a prospective longitudinal study of 1,201 infants. As found in previous studies, socio-demographic characteristics and maternal caregiving (especially 'opportunities for stimulation') were significant predictors of all child outcomes. There were also effects of quantity of individual and group care, and quality of non-maternal care. Controlling for demographics and maternal caregiving, more hours of group care (nurseries) were related to higher cognitive scores, while more hours of individual care (e.g., grandparents, nannies etc.) were related to lower orientation/engagement scores. Non-maternal caregiving was observed in a subsample of 345 children, and after controlling for all covariates as well as quantity and stability of care, quality of care was found to be predictive of higher cognitive ability and better orientation/engagement. Although the effect sizes were small in magnitude, in line with other similar studies, such modest effects from a large English sample are important when viewed in light of the widespread use of non-maternal care during infancy and early childhood.
British Journal of Developmental Psychology 03/2011; 29(Pt 1):18-45. · 1.57 Impact Factor
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Kristine Rømer Thomsen,
Hans C Lou,
Morten Joensson,
Jonathan A Hyam,
Peter Holland,
Christine E Parsons,
Katherine S Young,
Arne Møller, Alan Stein,
Alex L Green,
Morten L Kringelbach,
Tipu Z Aziz
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ABSTRACT: Emotion and reward have been proposed to be closely linked to conscious experience, but empirical data are lacking. The anterior cingulate cortex (ACC) plays a central role in the hedonic dimension of conscious experience; thus potentially a key region in interactions between emotion and consciousness. Here we tested the impact of emotion on conscious experience, and directly investigated the role of the ACC. We used a masked paradigm that measures conscious reportability in terms of subjective confidence and objective accuracy in identifying the briefly presented stimulus in a forced-choice test. By manipulating the emotional valence (positive, neutral, negative) and the presentation time (16 ms, 32 ms, 80 ms) we measured the impact of these variables on conscious and subliminal (i.e. below threshold) processing. First, we tested normal participants using face and word stimuli. Results showed that participants were more confident and accurate when consciously seeing happy versus sad/neutral faces and words. When stimuli were presented subliminally, we found no effect of emotion. To investigate the neural basis of this impact of emotion, we recorded local field potentials (LFPs) directly in the ACC in a chronic pain patient. Behavioural findings were replicated: the patient was more confident and accurate when (consciously) seeing happy versus sad faces, while no effect was seen in subliminal trials. Mirroring behavioural findings, we found significant differences in the LFPs after around 500 ms (lasting 30 ms) in conscious trials between happy and sad faces, while no effect was found in subliminal trials. We thus demonstrate a striking impact of emotion on conscious experience, with positive emotional stimuli enhancing conscious reportability. In line with previous studies, the data indicate a key role of the ACC, but goes beyond earlier work by providing the first direct evidence of interaction between emotion and conscious experience in the human ACC.
PLoS ONE 01/2011; 6(4):e18686. · 4.09 Impact Factor
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ABSTRACT: Infant facial features are thought to be powerful elicitors of caregiving behaviour. It has been widely assumed that men and women respond in different ways to those features, such as a large forehead and eyes and round protruding cheeks, colloquially described as 'cute'. We investigated experimentally potential differences using measures of both conscious appraisal ('liking') and behavioural responsivity ('wanting') to real world infant and adult faces in 71 non-parents. Overall, women gave significantly higher 'liking' ratings for infant faces (but not adult faces) compared to men. However, this difference was not seen in the 'wanting' task, where we measured the willingness of men and women to key-press to increase or decrease viewing duration of an infant face. Further analysis of sensitivity to cuteness, categorising infants by degree of infantile features, revealed that both men and women showed a graded significant increase in both positive attractiveness ratings and viewing times to the 'cutest' infants. We suggest that infant faces may have similar motivational salience to men and women, despite gender idiosyncrasies in their conscious appraisal.
PLoS ONE 01/2011; 6(5):e20632. · 4.09 Impact Factor
