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Maternal Self-confidence Postpartum and at Pre-school Age: The Role of Depression, Anxiety Disorders, Maternal Attachment Insecurity

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Abstract

The aim of this study was to analyze the impact of maternal postpartum depression and/or anxiety disorders according to DMS-IV on maternal self-confidence throughout infancy and early childhood. Exploratively, associations between maternal attachment insecurity and maternal self-confidence at pre-school age were examined. The sample (N = 54) of this prospective longitudinal study was comprised of n = 27 women with postpartum depression and/or anxiety disorders according to DSM-IV criteria and n = 27 healthy women without present or history of mental health disorders or psychotherapy. Data was collected in the postpartum period (M = 60.08 days) and at pre-school age (M = 4.7 years). Subjects were recruited between 2004 and 2011 in South Germany. Data revealed a significant difference in maternal self-confidence between clinical and control group at child's pre-school age: Women with postpartum depression and/or anxiety disorder scored lower on maternal self-confidence than healthy controls, but only if they had current SCID-diagnoses or partly remitted symptoms. According to explorative analyses maternal attachment insecurity turned out to be the strongest predictor of maternal self-confidence at pre-school age besides maternal mental health status. The results emphasize the impact of attachment insecurity and maternal mental health regarding maternal self-confidence leading to potential adverse long-term consequences for the mother-child relationship. Attachment based interventions taking maternal self-confidence into account are needed.

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... Maternal mental health problems can be linked to adverse perinatal outcomes for both the mother and the child [21,31,45,64] as well as to problems in the mother-infant relationship [3,41]. Previous research has associated maternal anxiety in particular with adverse perinatal outcomes, such as hyperemesis gravidarum [31,64], preterm labor, low birth weight [21], disturbed mother-child interaction, regulatory disorders in the offspring [31], psychomotor retardation [64], and low maternal self-confidence [45]. ...
... Maternal mental health problems can be linked to adverse perinatal outcomes for both the mother and the child [21,31,45,64] as well as to problems in the mother-infant relationship [3,41]. Previous research has associated maternal anxiety in particular with adverse perinatal outcomes, such as hyperemesis gravidarum [31,64], preterm labor, low birth weight [21], disturbed mother-child interaction, regulatory disorders in the offspring [31], psychomotor retardation [64], and low maternal self-confidence [45]. ...
... Maternal mental health problems can be linked to adverse perinatal outcomes for both the mother and the child [21,31,45,64] as well as to problems in the mother-infant relationship [3,41]. Previous research has associated maternal anxiety in particular with adverse perinatal outcomes, such as hyperemesis gravidarum [31,64], preterm labor, low birth weight [21], disturbed mother-child interaction, regulatory disorders in the offspring [31], psychomotor retardation [64], and low maternal self-confidence [45]. ...
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Purpose Maternal mental disorders develop frequently during the perinatal period, and can have detrimental effects on the developing bond between a mother and her child. While depression has already been widely associated with bonding disorders, the link between anxiety disorders and maternal–fetal attachment has received only limited attention. This study aimed to explore the link between maternal–fetal attachment in the third trimester and postpartum anxiety, as previous research has suggested a potentially protective association. Additionally, we hypothesized a mediating influence of postpartum bonding and partnership satisfaction as additional measurements of attachment capacity. Methods Self-report questionnaires assessing maternal–fetal attachment, postpartum bonding, anxiety, depression, and partnership quality were completed at three time points: third trimester (T1, N = 324), first week postpartum (T2, N = 249), and 4 months postpartum (T3, N = 166). Conditional process analyses were used to test for mediation. Results A statistically significant negative correlation of maternal–fetal attachment was found with maternal anxiety postpartum. Overall, the analyses supported the mediation hypothesis. There was a significant, indirect effect of maternal–fetal attachment during pregnancy on state anxiety in the first week postpartum, mediated through postpartum bonding quality and partnership satisfaction. All three variables together accounted for 18.25% (state anxiety) or 30.35% (trait anxiety) of the variance in postpartum anxiety. Conclusions Our results showed that a close maternal–fetal attachment buffers postpartum symptoms of anxiety, partially mediated through postpartum bonding and partnership satisfaction. Therefore, strengthening the maternal–fetal attachment and the partnership during pregnancy has the potential to reduce maternal postpartum symptoms of anxiety.
... Pervasive depressive symptoms and behavioral deficits have clear implications for parenting, particularly in terms of maternal confidence (O'Hara and McCabe 2013;Reck et al. 2012;Zietlow et al. 2014). Maternal confidence is defined as the mother's perceptions, expectations and selfassessment of the ability to care for, understand and respond to their infant's needs (Gross et al. 1989;Teti and Gelfand 1991;Zahr 1993). ...
... Specifically, Fowles (1998) found that women with depressive symptoms have more negative perceptions about their infant and feel less confident in their ability to feed and care for the infant and about themselves as mothers. Similarly, higher levels of depressive symptoms have been associated with lower levels of maternal confidence in other studies (Reck et al. 2012;Russell 2006;Zheng et al. 2018;Zietlow et al. 2014). Furthermore, although no prior studies have directly explored the association between the occurrence of postpartum negative automatic thoughts and maternal confidence, two reasons seem to support this relationship. ...
... Furthermore, attachment representations may play a role in other dimensions of adjustment to motherhood, particularly maternal confidence. Zietlow et al. (2014) found that, in addition to psychopathology, mothers' insecure attachment representations were found to be the best predictor of maternal confidence, suggesting that women with more insecure attachment representations feel less confident in their maternal role. Similarly, other studies have found that maternal confidence is lower when mothers have more insecure attachment representations of the self (Rholes et al. 1997;Spielman and Taubman-Ben-Ari 2009). ...
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Attachment security can act as an inner resource to promote women’s adjustment to motherhood. However, the mechanisms explaining the relationship between attachment representations and maternal adaptation outcomes are not well understood. This study aimed to examine the direct and indirect effects of attachment representations on maternal confidence, through postpartum negative automatic thoughts and depressive symptoms. The sample consisted of 387 postpartum women who completed a cross-sectional online survey including measures of attachment representations, depressive symptoms, postpartum negative automatic thoughts and maternal confidence. Our results showed a significant relationship between more insecure attachment representations and higher depressive symptoms (p < .001), but also with more frequent postpartum negative automatic thoughts (p < .001); depressive symptoms and postpartum negative automatic thoughts were also inversely associated with women’s maternal confidence (p < .001). Moreover, indirect effects of attachment representations on maternal confidence were found, but only through postpartum negative thoughts [attachment-related anxiety: 95% CI = −0.03/−0.01; attachment-related avoidance: 95% CI = −0.05/−0.01]. The results of the present study emphasize the important role of the cognitive component of depressive symptomatology (postpartum negative automatic thoughts) in the relationship between attachment representations and maternal confidence, allowing to draw specific implications. We highlight the implications for clinical practice during the perinatal period to address both negative thoughts and women’s maternal confidence. © 2018 Springer Science+Business Media, LLC, part of Springer Nature
... First of all, time itself seems to play an important role. As women established routine in everyday life with their child and got a sense for their specific needs, several authors registered an increase in maternal self-confidence during the first months postpartum (Porter & Hsu, 2003;Zietlow et al., 2014). Interestingly, this development failed to appear in women in whom current or remitted postpartum depression was diagnosed (Howell, Mora, DiBonaventura, & Leventhal, 2009;Logsdon, Wisner, & Hanusa, 2009). ...
... Reck et al. demonstrated that a currently existing anxiety or depressive disorder had a significant, negative impact on the development of maternal self-confidence, whereas a "remitted anxiety disorder" proved to be the strongest predictor of low maternal self-confidence two weeks postpartum (Reck et al., 2012). Zietlow et al. showed in a sample of women with postpartum depressive and/or anxiety disorders according to DSM-IV criteria that affective mental illnesses had a long-term negative impact on maternal self-confidence even up to 3-6 years later (Zietlow et al., 2014). This might be traced back to avoidance behavior, often accompanying anxiety disorders (Otto et al., 2016;Raymond, Steele, & Series, 2017). ...
... 17% of participants scored below and 13% above one standard deviation. Our results are comparable to other studies conducted at similar time points (Reck et al., 2012;Zietlow et al., 2014). ...
... Existing studies indicate an association between perinatal depressive symptoms and lower parental role satisfaction (Dix & Meunier, 2009;Ngai et al., 2010). Parental role satisfaction was also found to be related to parental self-confidence (Bornstein et al., 2003), which in turn is associated with maternal depressive symptoms (Zietlow et al., 2014). Higher parental role satisfaction can be associated with a more autonomous parenting motivation and positive parenting behaviors such as more maternal responsiveness and autonomy support (Brenning & Soenens, 2017;Jungert et al., 2015). ...
... This could be especially important when mothers suffer from symptoms of PD, as dysfunctional cognitions are a core aspect of depression that lead to a negatively biased perception and information processing (Ahern et al., 2019). The infant's social signals are often interpreted more negatively resulting in poorer interaction quality (Webb & Ayers, 2015) that is potentially associated with lower maternal self-efficacy (Zietlow et al., 2014) and parental role satisfaction. As other studies have suggested, low parental role satisfaction is associated with more negative parenting behaviors and may lead to a poorer relationship quality of the dyad with possible adverse long-term effects on the child (Brenning & Soenens, 2017;Provenzi et al., 2018). ...
Article
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Maternal prenatal depressive symptoms (PD symptoms) pose a risk factor for child adjustment difficulties (CAD), defined as internalizing and externalizing symptoms. This study examined the underlying mechanisms of the link between PD symptoms and CAD in a longitudinal study. Longitudinal data from pregnancy to age 3, encompassing four assessment points, were analyzed for N = 582 mothers participating in the German family panel pairfam. We tested a serial mediation model considering infant temperament during the first year and mothers’ parental role satisfaction 2–3 years postpartum as mediators between PD symptoms and CAD at age 3. PD symptoms significantly predicted CAD. We could not find that infant temperament or parental role satisfaction mediated between PD symptoms and CAD, though all variables were significantly associated on a correlational level. Furthermore, infant temperament partially mediated between PD symptoms and parental role satisfaction. Our findings emphasize the importance of the infant’s temperament in the scope of PD symptoms for the mother’s perception of her parental role, with possible adverse long-term effects for the mother–child relationship and the child. This study provides evidence for a complex bidirectionality between maternal and child-driven effects in the transmission of adverse effects of maternal PD symptoms. Depressive symptoms, even on subclinical levels, should already be targeted prenatally to prevent negative long-term effects for mothers and children.
... The MSE is essential for mothers' satisfaction with parenting and results in a protective factor against postpartum depression, stress, and anxiety [13,17,41,[43][44][45]. Indeed, maternal stress, anxiety, and depression are negatively associated with a high level of MSE [13,45,46]. However, MSE at one month was also associated with marital positivity (love and maintenance), which supports Bandura's theory that social-marital support influences self-efficacy through processes involving social persuasion and verbal encouragement [34,36]. ...
... The most surprising result of this model is that the relationship between avoidance and maternal efficacy is not statistically significant. Zietlow [46] found that attachment insecurity turned out to be the strongest predictor of maternal self-confidence at preschool age, and also other research reported negative associations between attachment insecurity and self-confidence [25]. However, these studies were not focused on the early postpartum, and research has highlighted that maternal self-efficacy evolves and changes over time [13,39,40]. ...
Article
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A mother’s responses to her newborn and her confidence in the child’s caretaking depend on her attachment security, general parental stress, and perceived self-efficacy. However, few studies have analyzed maternal confidence in caretaking and how it is influenced by some mothers’ characteristics. We aimed to examine the association between maternal adult attachment and confidence in a child’s caretaking and to understand whether this relationship was mediated by parenting stress and maternal self-efficacy. The sample consisted of 96 mothers with a mean age of 33 years with newborn children aged between 3 and 30 days. The instruments used were the Experiences in Close Relationships-Revised (ECR-R), the Mother and Baby Scale (MABS), the Parenting Stress Index Short Form (PSI-SF), and the Maternal Self-Efficacy Questionnaire (MEQ). The results showed a positive association between attachment avoidance and lack of confidence in caretaking, and this association was mediated by parenting stress. Conversely, attachment anxiety appeared not to influence confidence in caretaking, and maternal self-efficacy did not appear to mediate the relationship between attachment and confidence in the caretaking of infants. Our results could guide new research in studying confidence in caretaking and enable healthcare professionals to recognize at-risk situations early from the first month after childbirth.
... Furthermore, levels of anxiety are decreasing gradually in pre-school children with age (19). Several other family-based factors have also been associated with risk for pre-school anxiety disorders that may operate through a combination of genetic and environmental influences. ...
... However, there were few studies on family structure and anxiety in pre-schoolers in China, although there have been many studies on family education style (33), educational level of parents (34), and parent-child dependency status (19). The present study explores the current situation of anxiety among pre-schoolers and investigates the impact of different family structures on the anxiety level of pre-schoolers in Chongqing, China. ...
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Objective: This study explores the current situation of anxiety disorder of pre-schoolers and assesses the association between family structure and anxiety disorder (AD) among pre-schoolers in Chongqing, China. Methods: This is a cross-sectional study of 499 main fosterers of children aged 3–6 years who completed the 28-item Chinese version of the Spence Pre-school Anxiety Scale (PAS). Multinomial logistic regression with three models was used to assess the association of the family structure with the different AD. Results: The prevalence of AD was 31.46%, whose score of PAS were more than 48. Among the five different PAS sub-scales, the prevalence of obsessive-compulsive disorder (OCD) was the highest (50.10%), followed by separation anxiety disorder (SAD, 39.28%), fear of physical harm (FPH, 37.68%), generalized anxiety disorder (GAD, 33.47%), and social phobia (SP, 25.85%). Pre-schoolers from inter-generational families were more probably have AD than those from nuclear families (OR = 3.73, p < 0.05). The participants from inter-generational families were more likely to have SAD (OR = 3.39, p < 0.05), FPM (OR = 2.80, p < 0.05), or OCD (OR = 2.40, p < 0.05), in comparison with participants from other family structures. Conclusion: Anxiety disorder among pre-schoolers aged 3–6 in Chongqing is widespread. Pre-schoolers from inter-generational families were more probably have AD, SAD, FPM, and OR and pre-schoolers from stem families may be less likely to have SAD compared with those from nuclear families. Relieving the anxiety of pre-schoolers may be possible with additional interventional efforts in inter-generational families.
... Maternal psychological distress has been linked to adverse peripartum health outcomes for both mother and child, such as preterm delivery, low birth weight, maternal substance abuse in pregnancy, impaired mother-child interaction, childhood regulatory dysfunction, and impaired cognitive and psychomotor development [3,6,7]. ...
... 5 Institute for Women's Health Tübingen, Tübingen, Germany. 6 Universitätsklinikum Tübingen Medizinische Universitätsklinik, Tübingen, Germany. 7 Universität Bielefeld, Bielefeld, Germany. ...
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Background Mental disorders are common during the peripartum period and may have far-reaching consequences for both mother and child. Unfortunately, most antenatal care systems do not provide any structured screening for maternal mental health. As a consequence, mental illnesses are often overlooked and not treated adequately. If correctly diagnosed, cognitive behavioral therapy is currently the treatment of choice for mental illnesses. In addition, mindfulness-based interventions (MBIs) seem to represent a promising treatment option for anxiety and depression during the peripartum period. Considering the internet’s increasing omnipresence, MBIs can also be offered electronically via a (tablet) computer or smartphone (electronically based MBI = eMBI). Objective The current study aims to examine the clinical effectiveness and cost-effectiveness of an eMBI (the mindmom application) developed by an interdisciplinary team of gynecologists, psychologists, and midwives, teaching pregnant women how to deal with stress, pregnancy-related anxiety, and depressive symptoms. The study sample consists of pregnant women in their third trimester who screened positive for emotional distress. The mindmom study is a bicentric prospective randomized controlled trial (RCT), which is currently conducted at the University women’s hospitals of Heidelberg and Tübingen, Germany. Methods Within the scope of the routine prenatal care, pregnant women attending routine pregnancy care in Baden-Wuerttemberg, Germany, are invited to participate in a screening for mental distress based on the Edinburgh Postnatal Depression Scale (EPDS). Women with an EPDS screening result > 9 will be referred to one of the mindmom coordinating study centers and are offered counseling either face-to-face or via videotelephony. After an initial psychological counseling, women are invited to participate in an eMBI in their last pregnancy trimester. The study will enroll N = 280 study participants (N = 140 per group), who are randomized 1:1 into the intervention (IG) or control group (treatment as usual = TAU). All participants are requested to complete a total of 7 digital assessments (5 visits pre- and 2 follow-up visits postpartum), involving self-report questionnaires, sociodemographic and medical data, physiological measures, and morning cortisol profiles. The primary outcome will be depressive and anxiety symptoms, measured by the Edinburgh Postnatal Depression Scale, the State Trait Anxiety Questionnaire, and the Pregnancy-Related Anxiety Questionnaire. Secondary outcomes include mindfulness, satisfaction with birth, quality of life, fetal attachment, bonding, mode of delivery, and cost-effectiveness. Discussion This is the first German RCT to examine the (cost-)effectiveness of an eMBI on maternal mental health during pregnancy. If successful, the mindmom app represents a low-threshold and cost-effective help for psychologically distressed women during pregnancy, thereby reducing the negative impact on perinatal health outcome. Trial registration Deutsches Register Klinischer Studien, German Clinical Trials Register DRKS00017210. Registered on 13 January 2020. Retrospectively registered.
... Research studies on the development of and changes in parental confidence during the postpartum period indicate increased maternal self-confidence increases during the first week postpartum. In contrast, studies with women who had received a PPD diagnosis did not show an increase in maternal self-confidence during the same period [21][22][23]. Reck and colleagues demonstrated a negative impact of depressive episodes after the postpartum period on maternal confidence [24]. The worse the emotional state of postpartum women, the greater the chances of developing low maternal confidence (LMC) [23,25]. ...
... Psychiatric Quarterly (2020) 91:[21][22][23][24][25][26][27][28][29][30] ...
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The objective of the present study is to evaluate the association of postpartum depression and low maternal confidence in a sample of women who had depression during pregnancy. Cross-sectional study performed from 2013 to 2015 with 346 postpartum women who had participated in an intervention to treat their depression during pregnancy. This study used the Maternal Confidence Questionnaire and the Patient Health Questionnaire 9-item scale. The prevalence ratio, adjusted and non-adjusted, and the 95% CI were calculated using Poisson regression with robust variance. Multivariate models estimated the Prevalence Ratios between postpartum depression and low maternal confidence adjusted for socio-demographic variables and maternal characteristics. Statistical analysis was performed with the STATA12. Among a sample of women who were depressed during pregnancy, only 19% had probably moderate to severe depression and nearly half, 48%, reported high maternal confidence in the postpartum period. In the fully adjusted model, women with moderate/severe probable depression showed increased risk of lower maternal confidence in comparison to women without probable depression Prevalence Ratio = 1.37 (95% CI 1.10–1.71). The results reinforce the importance of the evaluation of maternal confidence feelings in primary care particularly for women with more severe forms of depression.
... Hence, they may be able to see their bond with their child as unaffected by less successful breastfeeding. The relationship between self-confidence, self-care and bonding has been well investigated [95][96][97] and may be of important explanatory value for our findings. Third, thinking that the child is not gaining enough weight or might be hungry could lead to feelings of guilt and cause stress. ...
Article
Full-text available
Associations between depressive symptoms and breastfeeding are well documented. However, evidence is lacking for subdivisions of feeding styles, namely exclusive breastfeeding, exclusive formula feeding and a mixed feeding style (breastfeeding and formula feeding). In addition, studies examining associations between mother-child-bonding and breastfeeding have yielded mixed results. The aim of this study is to provide a more profound understanding of the different feeding styles and their associations with maternal mental health and mother-child-bonding. Data from 307 women were collected longitudinally in person (prenatally) and by telephone (3 months postnatally) using validated self-report measures, and analyzed using correlational analyses, unpaired group comparisons and regression analyses. Our results from a multinomial regression analysis revealed that impaired mother-child-bonding was positively associated with mixed feeding style (p = .003) and depressive symptoms prenatal were positively associated with exclusive formula feeding (p = .013). Further studies could investigate whether information about the underlying reasons we found for mixed feeding, such as insufficient weight gain of the child or the feeling that the child is unsatiated, could help prevent impaired mother-child-bonding. Overall, the results of this study have promising new implications for research and practice, regarding at-risk populations and implications for preventive measures regarding postpartum depression and an impaired mother-child-bonding.
... Tetapi, uji lebih lanjut tidak membuktikan pengaruh kepercayaan diri maternal terhadap depresi pascabersalin pada ibu (p=0,319). Temuan penelitian ini berbanding terbalik dengan penelitian Zietlow et al. (2014) yang menemukan bahwa perempuan dengan depresi pascabersalin cenderung memiliki kepercayaan diri maternal yang rendah. Penelitian lain juga menyebutkan bahwa ibu primipara (yang baru pertama kali melahirkan) memiliki kepercayaan diri maternal yang rendah dan kecemasan pascabersalin lebih tinggi (Dol et al., 2021). ...
Article
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Persalinan membawa berbagai perubahan yang dapat menyebabkan perempuan rentan mengalami depresi pascabersalin. Hal ini tidak hanya berdampak pada ibu tetapi juga pada individu lainnya seperti anak yang baru saja dilahirkan, anak lainnya, pasangan, bahkan anggota keluarga lainnya. Tujuan penelitian ini adalah untuk mengetahui faktor risiko psikologis depresi pascabersalin. Pengumpulan data dilakukan melalui survei sejak April-September 2022 pada ibu pascabersalin yang dipilih dengan teknik convenience sampling. Instrumen pengumpulan data berupa Alat Asesmen Ibu Postpartum (ASIP), Multidimensional of Perceived Social Support (MPSS), dan Edinburgh Postnatal Depression Scale (EPDS) yang diberikan kepada 359 sampel penelitian dengan kriteria perempuan berusia 18-40 tahun, pascamelahirkan dengan rentang waktu 4 minggu hingga 1 tahun, dan tidak pernah didiagnosis mengalami gangguan mental oleh profesional. Hasil analisis menunjukkan bahwa regulasi emosi, kepuasan pernikahan, dan dukungan sosial menjadi faktor risiko depresi pascabersalin dalam penelitian ini. Sementara itu, lebih dari sepertiga ibu pascabersalin mengalami depresi kategori ringan (34,2%), sedangkan yang lainnya mengalami depresi kategori sedang (19,8%), bahkan depresi berat (5,6%). Implikasi penelitian terhadap faktor risiko depresi dibahas lebih lanjut dalam artikel ini
... Becoming a mother for the first time is a particularly vulnerable time. Research indicates that first-time mothers have lower self-confidence than multiparous mothers (Kristensen et al., 2018), and low self-confidence is associated with symptoms of postpartum depression and anxiety (Howell et al., 2009;Matthies et al., 2017;O'Neil et al., 2009;Zietlow et al., 2014). The current study, therefore, adopted a qualitative methodology to explore how ambivalence affects first-time mothers, with the aim of identifying factors that both enable and impede the management of ambivalent feelings. ...
Article
Objective: The aim of this qualitative study was to examine experiences and meanings of maternal ambivalence in first-time mothers with young children. Background: In contrast with normative expectations surrounding contemporary motherhood, there is growing recognition that becoming and being a mother involves ambivalent feelings, and that these feelings are normal and have positive psychological consequences. Yet, little attention has been paid to women's subjective experiences of maternal ambivalence, and capacity to acknowledge and manage ambivalent feelings. Methods: Eleven semi-structured online interviews, with first-time mothers, were conducted and analysed using Interpretative Phenomenological Analysis (IPA) methodology. Results: Two group experiential themes were identified: Crossing boundaries of acceptable mothering feelings and Mothering from a place of 'enough'. Ambivalent mothering feelings challenged participants' expectations about motherhood and themselves as mothers, producing anxiety, self-doubt and feelings of failure. Distress accompanying maternal ambivalence was especially acute when participants perceived their feelings to be unacceptable. Viewing conflicting feelings with compassion, however, helped participants to cope with their diverse and fluctuating emotional mothering experiences, allowing them to mother with a greater sense of equanimity, agency and competence. Conclusion: The study's findings indicate the potential benefits of providing information about the emotional turbulence of early motherhood as part of routine maternity care, as well as the potential value of offering parenting interventions that promote self-compassion to mothers struggling to manage feelings of ambivalence.
... Regarding the effects of maternal depression, a negative impact has been reported on the quality of motherinfant interactions, showing lower synchronic interaction and greater avoidance, crying, and negative affect in the child. Also, maternal depression has been associated with reduced confidence in mothers' parental role (O'Higgins et al., 2013;Zietlow et al., 2014). Consistently, a recent meta-analysis showed that mothers with higher levels of depression show less sensitivity toward their children than those with lower levels of depressive symptoms (Bernard et al., 2018). ...
Article
Quality of early family interactions has been associated with child development, bonding, and mental health. Childhood adversity, stress, and depression impact parenting, affecting the quality of the interaction within the mother‐father‐child triad. The aim of the present study was to analyze the influence of parents’ adverse childhood experiences, depressive symptoms, and parental stress, on their sensitive response toward their tooddler and quality of traidic interactions. A correlational cross‐sectional method was used. The sample included 80 mother–father–child triads, of toddlers with social–emotional difficulties. Parents early adverse experiences, parental stress, and depressive symptoms were assessed through self‐report measures. Observational measures on parental sensitivity and triadic interaction were used. For mothers and fathers, adverse childhood experiences were associated with depressive symptoms in adulthood. Sensitivity toward their child and stress were positively associated among both parents. Symptoms of depression in mothers were associated with lower sensitivity toward their child, but in fathers, their sensitive response was influenced by the level of parental stress in the mother. In both parents, greater sensitivity in the dyadic interaction with the child was associated with a higher quality of the triadic interactions, in the triad as a whole, and in the regulation and involvement of the child.
... A final component of preventive interventions is to provide parenting training. Depressive episodes have been shown to negatively impact parent-child interaction and strongly impair parenting [39,62,70]. By improving parenting consistency, preventive interventions may buffer against the effects of parental negative affect [11,49]. ...
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Objective Parental depression is one of the biggest risk factors for youth depression. This parallel randomized controlled trial evaluates the effectiveness of the German version of the family-group-cognitive-behavioral (FGCB) preventive intervention for children of depressed parents. Methods Families with (i) a parent who has experienced depression and (ii) a healthy child aged 8–17 years (mean = 11.63; 53% female) were randomly allocated (blockwise; stratified by child age and parental depression) to the 12-session intervention (EG; n = 50) or no intervention (CG; usual care; n = 50). Self-reported (unblinded) outcomes were assessed immediately after the intervention (6 months). We hypothesized that CG children would show a greater increase in self-reported symptoms of depression (DIKJ) and internalising/externalising disorder (YSR/CBCL) over time compared to the EG. Intervention effects on secondary outcome variables emotion regulation (FEEL-KJ), attributional style (ASF-KJ), knowledge of depression and parenting style (ESI) were also expected. Study protocol (Belinda Platt, Pietsch, Krick, Oort, & Schulte-Körne, 2014) and trial registration (NCT02115880) reported elsewhere. Results We found significant intervention effects on self-reported internalising ( ηp2\eta_{p}^{2} η p 2 = 0.05) and externalising ( ηp2\eta_{p}^{2} η p 2 = 0.08) symptoms but did not detect depressive symptoms or parent-reported psychopathology. Parental depression severity did not modify these effects. Both groups showed equally improved knowledge of depression ( ηp2\eta_{p}^{2} η p 2 = 0.06). There were no intervention effects on emotion regulation, attributional style or parenting style. Conclusion The German version of the FGCB intervention is effective in reducing symptoms of general psychopathology. There was no evidence that the mechanisms targeted in the intervention changed within the intervention period.
... Although there are many studies (e.g. CorinnaReck, Nonnenmacher, & Zietlow, 2016;Zietlow, Schlüter, Nonnenmacher, Müller, & Reck, 2014) on mothers suffering from post-natal depression and emotion-related factors in children, those mostly refer to the resulting attachment style, but not to emotion regulation strategies. One study focused on n = 45 children aged four to seven of mothers suffering from depression and n = 33 children of never depressed mothers and identified emotion regulation strategies as moderating factor of maternal depression and children's internalizing symptoms and discuss positive emotion regulation strategies as protective factor ...
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According to the World Health Organisation, depression is one of the most common psychiatric disorders - affecting around 350 million people across all age groups worldwide. Suffering from major depression not only causes great personal burden for the affected person, but also for their family, society and economy. The later the disease is recognized, the worse is the prognosis, going along with higher treatment costs. Consequently, an early identification of risk factors for depression is necessary to prevent these high personal and economic costs. One of the groups at greatest risk of developing depression is the offspring of parents suffering from depression. Their risk of developing depression is estimated to be three to four times higher during childhood and adolescence alone, and do even persist into adulthood. Since the transmission of depression from parent to child may result from numerous risk and protective factors and their interaction, the high risk for developing a depression is not understood well yet. Furthermore, although evidence-based treatment interventions for depression have been developed and implemented into practice, few prevention programs for the children of depressed parents have been developed, with heterogeneous findings. In the first part of the thesis, I provide a theoretical framework for the trans-generational transmission of depression based on the existing literature. In addition, prevention approaches and their efficiency in reducing the risk for depression are discussed. In the second and empirical part two studies referring to the transmission and prevention of depression in the offspring of depressed parents are reported. In study I, a high-risk group (HR, n = 74) children of parents with depression is compared to a low-risk group (LR, n = 38) consisting of the offspring of parents without depression. The goal of the study was to i) replicate findings of the increased risk in youth that is associated with parental depression and ii) identify most prevalent risk factors in order to explore possible mechanisms of the trans-generational transmission of depression. Therefore, the HR and LR were compared in general psychopathology (self-rated depressive and psychopathology symptoms; parent-rated psychopathology) and the mediators (emotion regulation, attributional style) and moderators (life events). In addition, the role of parental depression and its impact and association on the children’s depressive symptoms is investigated. The data supported earlier findings of increased risk for depression for the HR, since the HR showed significantly increased psychopathology and depressive symptoms with a big effect size (d = 1.75). Thereby, the parental depression was associated significantly with children’s depression severity. In addition, the data provided strong evidence for group differences in adaptive emotion regulation strategies, positive and negative attributional style and the number of positive life events. Against expectations, groups did not differ in maladaptive emotion regulation strategies and the number of negative life events. Maladaptive emotion regulation strategies, negative life events and parental depression were the strongest predictors of children’s depressive symptoms, together accounting for 30.8 % of the variance. These results suggest practical implications for prevention interventions for depression like increasing emotional and cognitive coping strategies and positive life events. Longitudinal highly-powered studies are necessary in future research. In study II, preliminary results of an ongoing randomized controlled trial of one of the most promising prevention programs for the offspring of depressed parents (replicated here for the first time outside of the research group) are presented. Data from n = 61 families who reached post-assessment are provided. It was hypothesized that children in the experimental group (EG) would show decreased symptoms of psychopathology and depression compared to the control group (CG) over time. In addition, mediating factors such as emotion regulation strategies and attributional style were expected to improve within the EG over time. Rating of treatment fidelity was very high, indicating good reliability of the intervention. The acceptance of families of the program was excellent; children and parents gave a very positive feedback about the intervention and their personal benefit of participating. Results indicate significant reduction of self-reported psychopathological symptoms between groups over time favouring a positive intervention effect. In addition, parent-rated psychopathology symptoms also showed significant decreases from baseline to post-assessment. Against expectations, both groups showed significant lower depression. There was a significant interaction effect of time and group indicating less maladaptive emotion regulation strategies and a more positive internal attributional style in the intervention group compared to the control group over time. Both groups showed improved adaptive emotion regulation strategies but a more negative attributional style over the study period. In contrast to predictions, there was a significant interaction effect of time and group in the negative internal attributional style scale, indicating a more negative attributional style of children in the EG over time. The benefits of the CG are interpreted as general activation for this high risk group for seeking information help. Together these findings are promising, although the results are preliminary and a bigger sample is necessary for more confident interpretations. There is a lack of evidence and number of prevention programs for this high-risk group, especially in Germany. Since effect sizes of prevention interventions were found to be small and diminish over time, further research is needed to identify relevant mediators and moderators in order to increase efficacy. In sum, this thesis supports previous findings about the increased risk of depression for the offspring of parents suffering from depression and the association of parental and youth depression. In addition, it provides novel information about particular risk factors for children of depressed parents. Moreover, results of the first replication of a promising prevention intervention in Germany suggest that it is possible to modify some of these risk factors (maladaptive emotion regulation strategies and positive internal attributional style) and that doing so has positive effects on reducing self-reported psychopathology in children at risk.
... 37 Therefore, maternal self-confidence gives the mother the chance to successfully raise her baby, to cope with parenting responsibilities in daily life, and to create an environment that positively affects the development of the baby, thanks to her ability to correctly understand the messages conveyed by the baby. 37,38 On the other hand, loss of self-confidence, which is one of the symptoms of PPD, may also negatively affect the mother's ...
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Purpose This study evaluated the effect of the maternal risk of depression on the outcomes of infant care. Design and Methods This study was conducted as a cross‐sectional and analytical study with 229 mothers who had 6‐month‐old infants and who were enrolled in a family health center. Findings The results show that mothers at risk of depression have a negative impact on the care and growth of their infants. Practice Implications Providing support to the mothers is suggested for preventive infant health behaviors and monitoring their infants.
... Maternal confidence increases after the birth, suggesting that mothers feel more secure and attached to their babies with more frequent contact [9]. This increase in mother's confidence may not happen among depressed postpartum women [10,11]. As a matter of fact, there is a parallel between maternal mood and maternal confidence: a more depressed mother has a greater risk of developing low maternal confidence [11,12]. ...
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The objective of the present study is to assess the association of early postpartum depression and maternal confidence with low maternal confidence at 12–15 months after delivery. Prospective study performed from 2013 to 2015 with 358 postpartum women who had participated in a cluster trial to treat their depression during pregnancy. At 6–8 months after birth, we reviewed socio-demographics, obstetric data and Postpartum Depression (PPD) with the Patient Health Questionnaire-9. Maternal Confidence (MC) was assessed at 6–8 and 12–15 months after birth with the Maternal Confidence Questionnaire. Low and High MC was defined using 50% percentile. The crude and adjusted Odds Ratios (OR) with the 95% Confidence Interval (CI) were calculated using Poisson regression with robust variance. Multivariate models estimated the ORs between postpartum depression and LMC at 12–15 months adjusted for socio-demographic variables, maternal characteristics and previous LMC. Statistical analysis was performed with STATA12 and the significance level was considered equal or lower than 5%. Among a sample of women who were depressed during pregnancy, 19% had probably moderate to severe depression, at the beginning of the child’ second year of life. Low maternal confidence was associated with previous low maternal confidence (OR = 1.71; 95% CI 1.33:2.20, p = <0.001) and vaginal delivery but not with previous PPD. Based on our findings, detection and treatment of women presenting confidence problems at the first months after delivery may prevent later mother self-efficacy problems.
... Parenting style [36] and parent-child interaction are typically negatively affected by depression (see Lovejoy et al. [37] for a meta-analysis), being characterised by adverse parenting skills (being inconsistent, intrusive) and negative child outcomes (emotional maltreatment, irritability) [38,39]. Parent-child interactions not only affect attachment style and resulting emotion regulation in children in the short-term [16,17,40], but have also been shown to have an impact on the child's continuing psychological development [41,42]. Inconsistent parenting can lead to unpredictable situations and feelings of confusion and insecurity in children of depressed parents, especially since offspring are mostly uninformed about their parent's depression [43]. ...
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Children of depressed parents are at heightened risk for developing depression, yet relatively little is known about the speciic mechanisms responsible. Since preventive interventions for this risk group show small efects which diminish overtime, it is crucial to uncover the key risk factors for depression. This study compared various potential mechanisms in children of depressed (high-risk; n = 74) versus non-depressed (low-risk; n = 37) parents and explored mediators of parental depression and risk in ofspring. A German sample of N = 111 boys and girls aged 8 to 17 years were compared regarding children’s (i) symptoms of depression and general psychopathology, (ii) emotion regulation strategies, (iii) attributional style, (iv) perceived parenting style and (v) life events. Children in the high-risk group showed signiicantly more symptoms of depres- sion and general psychopathology, less adaptive emotion regulation strategies, fewer positive life events and fewer positive parenting strategies in comparison with the low-risk group. Group diferences in positive and negative attributional style were small and not statistically signiicant in a MANOVA test. Maladaptive emotion regulation strategies and negative life events were identiied as partial mediators of the association between parental depression and children’s risk of depression. The study highlights the elevated risk of depression in children of depressed parents and provides empirical support for existing models of the mechanisms underlying transmission. Interestingly, the high-risk group was characterised by a lack of protective rather than increased vulnerability factors. These results are crucial for developing more efective preventive interventions for this high-risk population.
... Given the high frequency of postpartum anxiety disorders and their potential impact on mother-infant interaction, research in this area is clearly indicated. Therefore, after having conducted a variety of studies dealing with postpartum depression [39,67,68,20], our research group shifted their focus from depressive disorder to anxiety disorders in the postpartum period [69,70]. With regard to the mother-infant relationship, attention was first paid to the question if maternal bonding is impacted by maternal anxiety disorder in the postpartum period [71]. ...
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Background This study investigated whether postpartum anxiety disorder is associated to altered patterns of infant as well as maternal engagement in a Face-to-Face-Still-Face interaction (FFSF). Sampling and methods n = 39 women with postpartum DSM-IV anxiety disorder and n = 48 healthy mothers were videotaped during a FFSF with their infant (M = 4.1 months). Results Infants of the clinical group showed significantly less positive engagement during the play episode than infants of controls. This result depended on infant sex: male controls demonstrated more positive interaction than males of anxious mothers. There was no such effect for female infants who engaged significantly less positively during the play episode than males and did not change their positive engagement during the FFSF. These findings imply pronounced interactive positivity and early vulnerability to maternal anxiety symptoms in male infants. Only the infants of the controls showed the still-face effect. They also protested significantly more during the still-face, while the clinical infants’ protest increased significantly during the reunion. Women of both groups did not differ in their interaction. Maternal intrusiveness was associated to infant protest in the course of the FFSF. Conclusions Results suggest that mother-infant intervention should consider affect regulation and infant sex-specific characteristics in anxious mother-infant dyads.
... Data were collected from 2004 to 2011 in two middle-sized towns in Southern Germany. Participants took part in a longitudinal study dealing with the impact of maternal postpartum depression and anxiety disorders on the mother-infant interaction and child development [17,[33][34][35] . Subjects were recruited in local maternity hospitals and at the mother-infant unit of the University Hospital Heidelberg. ...
Article
Background/aims: High maternal emotional availability (EA) positively affects various domains of child development. However, the question of which factors promote or hinder maternal EA has not been investigated systematically. The present study investigated several maternal characteristics, namely maternal psychopathology, maternal attachment style insecurity, and theory of mind (ToM) as possible factors that influence maternal EA. Methods: The sample was comprised of 56 mothers and their preschool-aged children. Half of the mothers were diagnosed with postpartum depression and or anxiety disorders according to DSM-IV, and the other half were healthy controls. Results: The results showed that both low maternal attachment style insecurity and high ToM skills significantly predicted maternal EA sensitivity, independently from maternal postpartum and concurrent psychopathology and education. Moreover, maternal attachment style insecurity fully mediated the link between maternal postpartum psychopathology and sensitivity. Conclusion: The findings suggest that maternal attachment style security can buffer negative effects of maternal psychopathology on maternal sensitivity in the mother-child interaction.
... The results of this study are consistent with previous research where the prevalence of comorbid postpartum depressive symptomatology and anxiety in the first year postpartum ranged between 3% and 10% (Adewuya and Afolabi, 2005; Giakoumaki et al., 2009; Miller et al., 2015) and that of clinically defined comorbidity ranged between 2% and 13% (Austin et al., 2010; Reck et al., 2008; Tavares et al., 2012a). Women with postpartum depressive symptomatology are also more likely to experience anxiety postnatally than women without any depressive symptomatology (Reck et al., 2008; Zietlow et al., 2014). Further, a prospective study Fig. 1 . ...
... With respect to the mother-baby relationship, a number of flaws have been described in the parenting abilities of mothers with PPD, such as low sensitivity, lack of enjoyment, intrusive behaviors, negative emotions, and punitive behaviors during the interaction, as well as high stress and negative perceptions of their babies' behavior (Wan & Green 2009). Likewise, depressed mothers have been observed to have low confidence in themselves and in their role (Zietlow, Schlüter, Nonnenmacher, Müller, & Reck, 2014). Based on the difficulties of depressive mothers to display sensitive behaviors and positive and synchronic affects with their babies, perinatal maternal depression has also been associated with insecure child attachment (Hayes, Goodman, & Carlson, 2013) and with greater negative effects on the bond depending on the severity and chronicity of the mother's depression (McMahon, Barnett, Kowalenko, & Tennant, 2006). ...
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Post-partum depression (PPD) is one of the most common complications associated to maternal suffering, negative effects for the baby, and difficulties in the relationship. Video-feedback is a particularly effective technique used in dyadic early interventions. A brief intervention for mother-infant dyads with maternal depressive symptomatology was implemented using this technique, and was assessed in a longitudinal, quasi-experimental and quantitative study. 61 mother-baby dyads participated, with ages ranged from 18 to 41 years in mothers, and 8,4 to 18,8 months in their babies. The results show an improvement in the quality of the interaction, with a significant increase of maternal sensitivity, and a significant decrease in control. A significant reduction of depressive symptomatology was not found, although the frequency of major depression episodes and bonding risk decreased.
... Untreated AnxD increase the risk of postpartum depression (Prenoveau et al., 2013) and have been associated with maternal low self-confidence (Zietlow et al., 2014); early complications in the offspring (e.g. behavioural inhibition, mother-infant interaction problems, insecure attachment), and later adverse child development (Glasheen et al., 2010). ...
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The high prevalence of depression in developed and developing countries requires a relevant intervention to suppress its incidence. Mindfulness-based intervention is given online as a new complementary intervention that can help reduce symptoms of depression. This study aimed to determine the effectiveness of online mindfulness-based interventions in reducing depressive symptoms in pregnancy. This research method used a randomized control trial, with 66 participants consisting of the mindfulness-based Intervention (MBI) group of 33 participants and the control group of 33 participants. The MBI intervention was provided for eight weeks online. The study uses simple random sampling. Depression was assessed using DASS 42. Data were tested using the Mann-Whitney U Test and t-test and processed with SPSS version 23. The results showed that there was a significant decrease in depression levels in the online MBI group after being given intervention compared to the control group (7.55 ± 2.181 vs 11.00 ± 2.345) p=0.000. Mindfulness-based intervention online can reduce depressive symptoms in pregnant women, so that the intervention becomes a feasible, cheap and easy intervention for pregnant women in improving mental health. In the future, this research can develop other types of complementary interventions to improve maternal and fetal health.
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Gebelik bireyin yaşam döngüsünde fizyolojik, psikolojik ve sosyal değişimlerin yaşandığı, birey için annelik kimliğinin kazanıldığı özel bir deneyimdir. Kadın hamilelik başlangıcından itibaren gebeliğin kendisi, günlük yaşam aktivitelerinin değişen yönleri ve bebeğe bakmanın sorumlulukları ile psikolojik sorunlara karşı artan duyarlılık dönemi yaşamaktadır. Psikolojik sorunlar stresli yaşam koşullarına verilen olumsuz bir psikolojik tepkidir ve küresel sağlık sorunlarından biri olarak tanımlamaktadır. Psikolojik sorunlar olarak adlandırılan depresyon, stres ve anksiyete gebelik ve doğum sonu dönemde yaygın olarak görülmektedir. Gebelik ve yaşanan psikolojik sorunlarla ilişkili faktörler arasında yaşanmış psikiyatrik hastalık öyküsü, yetersiz sosyal destek, eş ve aile ile yaşanılan sorunlar, planlanmamış veya istenmeyen gebelik, primipar olma, riskli gebelik, sosyodemografik ve/veya ekonomik faktörler olarak belirtilmiştir. Kadınların en az %20'si prenatal dönemde depresif semptomlar yaşamaktadır. Anksiyete, doğum öncesi ve doğum sonrası dönemlerde daha az çalışılmış olmasına rağmen, doğum öncesi dönemde %13-21 oranında yaşandığı belirtilmektedir. Gebelik döneminde yaşanan psikolojik sorunların her birinin, düşük doğum ağırlığı ve erken doğum dahil olumsuz doğum sonuçları ve ilerleyen dönemde duygusal, davranışsal ve bilişsel sorunlar dahil olumsuz sonuçları ile ilişkileri olduğu belirtilmektedir. Bu nedenle, bu yaygın durumların tanımlanması ve tedavi edilmesi anne ve bebek sağlığı için son derece önemlidir. Bu çalışma prenatal dönemde en çok görülen ruhsal bozukluklar içerisinde yer alan stres, anksiyete ve depresyonu incelemek amacıyla yapılmıştır.
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Objective Mother's confidence is defined as the understanding of the mother of her ability to take care of the child and knowing his/her needs. The Maternal Confidence Questionnaire (MCQ) is designed to measure a mother's confidence in a neonatal intensive care unit (NICU). The aim of this study was to validate a Persian version of the MCQ for Iranian mothers. Design The MCQ was translated into Persian using a forward–backward method. Validity was assessed using face, content, and construct validity measures. Results Based on the result of face validity, all items of the scale are appropriate, clear and relevant for using. Bartlett's test (KMO = 0.92, PV<0.001) demonstrates the appropriateness of using factor analysis for our data set. Also, 53% of total variance has been explained by one-factor CFA model that confirmed by goodness of fit indices; GFI = 0.96, CFI = 0.93, RMSEA = 0.07 (0.05, 0.09) as well as p-close = 0.040 and the CMIN = 2.2, p<0.001. The scale has excellent internal consistency (Cronbach's alpha = 0.93). Conclusion The Persian version of MCQ showed adequate reliability and validity for measuring maternal confidence in Iranian mothers. This instrument can be used in future studies to assess confidence in mothers with preterm neonates in Iran. Also, this instrument will help neonatal nurses and medical staff to measure confidence in mothers with preterm neonates and accordingly provide supportive interventions.
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Background Maternal mental illness is a major growing global concern which can affect parenting with serious negative implications for offspring. Group-based parenting programs for mothers which both enhance the parent-child relationship and address mental health symptoms in a supportive social setting may optimise better outcomes for mothers and children. The Acorn program in South Australia draws on attachment theory to integrate dance play, reflective diary keeping and therapeutic letters in a holistic program for a diversity of vulnerable mothers and children aged 1–36 months. The program seeks to nurture and enhance parental wellbeing and the quality of the parent-child relationship for mothers experiencing identified mental health illnesses that impinge upon their parenting. This study presents the evaluation of the program and its effectiveness. Methods Action research approach for continuous monitoring and program improvement engaging Acorn program staff in evaluation data collection and interpretation of pre and post self-completion measures and standardized observations. Additional data was collected through a telephone interview of attending mothers 6–8 months after program completion to address sustainable impacts on parenting and wellbeing. Results The program engaged 353 diverse vulnerable mothers with their children. Many had profound overlapping mental health issues including borderline personality disorder (BPD) and depression. The quality of the parent-child interaction, parental confidence, competence and enjoyment were enhanced; mothers' wellbeing, ability to cope and lasting social supports were augmented. This occurred for a number of “most vulnerable” subgroups including single mothers, mothers with BPD, mothers from non-English speaking households and those with lower levels of education or household income. Mothers reported sustained improvements in their wellbeing, parenting, social and family lives, and feeling closer to their child as a result of participating in the program. Conclusions Given the high prevalence of maternal mental health issues and substantial potential negative consequences for mothers and offspring, the Acorn parenting program offers an effective means of addressing this pressing public health issue potentially helping large numbers of vulnerable mothers and their children. This has additional gravitas in the shadow of COVID-19 due to expanded numbers of those experiencing greater parental stress, isolation and mental illness.
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Background Mothers with postpartum depression (PPD) show impaired affects and behaviour patterns in the mother-child interaction, which affects an infant's emotional and cognitive development and the maternal course of disease. However, impairment of the mother-child relationship does not occur in every case of PPD. Aim The aim of this exploratory-descriptive video-based study was to investigate the possible associations between mother-child interactions and aspects of maternal biography and clinical history, with a focus on pre-existing mental disorder. Methods Sixty-two mother-child dyads (31 mothers with PPD and pre-existing mental disorders and 31 mothers with PPD but no further mental disorder) hospitalized at the mother and baby unit (MBU) of the LWL-Hospital Herten were included in this study. The Marcé Clinical Checklist and the “Mannheimer Beurteilungsskala zur Erfassung der Mutter-Kind-Interaktion im Säuglingsalter” (MBS-MKI-S) were used to explore sociodemographic and clinical parameters, and video-based interaction behaviour was examined. Results Mother-infant interaction behaviour showed a significant group difference on the MBS-MKI-S-Vm subscale (variability in maternal behaviour) before psychiatric treatment (exact Mann-Whitney U test: U = 555, p = 0.023), with higher scores in mothers with a pre-existing mental disorder. Furthermore, significant differences were shown on the MBS-MKI-S-RSm (maternal reactivity/sensitivity) (U = 259, p = 0.019) and MBS-MKI-S-Rc (child's reactivity) subscales at discharge (U = 251, p = 0.021). Among mothers with a pre-existing diagnosis, the MBS-MKI-S-Tm (maternal tenderness) and MBS-MKI-S-Rc (child's reactivity) subscales were significantly correlated after treatment. Conclusions Mothers with PPD and a pre-existing mental disorder displayed significantly more behavioural variability than mothers with only PPD. Maternal behaviour seems to influence the child's responsive behaviour; thus, mothers and their children can benefit from inpatient treatment at an MBU. Further investigations with larger samples should be conducted.
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Postpartum Depression (PPD) is a mental health problem in mothers that has a serious impact on mothers, children and families. Late detection and treatment can endanger the lives of mothers and their babies. Unfortunately, in Indonesia, research on developing an early detection instruments of PPD based on potential factors or the risk of PPD has not been widely implemented. This study aims to develop a more comprehensive assessment tool for postpartum mothers based on psychological variables that are theoretically correlated with PPD (emotional regulation, maternal confidence, and marital satisfaction) using Rasch model to obtain information regarding psychometric properties of Alat Asesmen Ibu Postpartum (ASIPP). The subjects of this study were 90 women with characteristics that had just given birth between the last 2-24 weeks. Based on the analysis using the Winsteps program, the results of the reliability coefficient of the maternal self-confidence scale and emotion regulation scale were the same which was 0,82 and the reliability coefficient of the marriage satisfaction scale was 0,91. All of the scales were able to reveal psychological constructs according to the objectives of measurement (unidimensional). The maternal self-confidence scale consists of 15 items that fit model. The emotion regulation scale consists of 12 items that fit model and the marriage satisfaction scale consists of 27 items that fit model. Overall, it can be concluded that Alat Asesmen Ibu Postpartum (ASIPP) which contains a maternal self-confidence scale, emotion regulation scale, and marriage satisfaction scale has good psychometric properties so that it can be used to measure maternal self-confidence, emotion regulation, and marriage satisfaction of postpartum women.
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Introduction Most mothers feel an immediate, strong emotional bond with their newborn. On a neurobiological level, this is accompanied with the activation of the brain reward systems, including the striatum. However, approximately 10% of all mothers report difficulties to bond emotionally with their infant and display impaired reward responses to the interaction with their infant which might have long-term negative effects for the child’s development. As previous studies suggest that activation of the striatal reward system can be regulated through functional MRI (fMRI)-based neurofeedback (NFB), we have designed and investigate fMRI-NFB training to treat maternal bonding difficulties. Methods and analysis In the planned trial, mothers will be presented pictures of their infant and real-time fMRI (rtfMRI), peripheral measures, neural, endocrine, psychophysiological and behavioural measures will be assessed. Mothers with bonding difficulties (n=68) will be randomised to one of two double-blind intervention groups at 4–6 months postpartum. They will participate in three repeated NFB training sessions with rtfMRI-NFB training to increase activation of (a) the ventral striatum or (b) the anterior cingulate. Interview data and real-time mother–infant interaction behaviour pre-intervention, post-intervention and at follow-up will serve as clinical outcome measures. Ethics and dissemination Study procedures are in line with the recommendations of the World Medical Association (revised Declaration of Helsinki) and were approved by the Ethics Committee of the Medical Faculty, s-450/2017, Heidelberg University. All participants will provide written informed consent after receiving a detailed oral and written explanation of all procedures and can withdraw their consent at any time without negative consequence. Results will be internationally published and disseminated, to further the discussion on non-pharmacological treatment options in complex mental disorders. Trial registration number DRKS00014570; Pre-results.
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Maternal self-confidence has become an essential concept in understanding early disturbances in the mother-child relationship. Recent research suggests that maternal self-confidence may be associated with maternal mental health and infant development. The current study investigated the dynamics of maternal self-confidence during the first four months postpartum and the predictive ability of maternal symptoms of depression, anxiety, and early regulatory problems in infants. Questionnaires assessing symptoms of depression (Edinburgh Postnatal Depression Scale), anxiety (State-Trait Anxiety Inventory), and early regulatory problems (Questionnaire for crying, sleeping and feeding) were completed in a sample of 130 women at three different time points (third trimester (T1), first week postpartum (T2), and 4 months postpartum (T3). Maternal self-confidence increased significantly over time. High maternal trait anxiety and early infant regulatory problems negatively contributed to the prediction of maternal self-confidence, explaining 31.8% of the variance (R = .583, F3,96 = 15.950, p < .001). Our results emphasize the transactional association between maternal self-confidence, regulatory problems in infants, and maternal mental distress. There is an urgent need for appropriate programs to reduce maternal anxiety and to promote maternal self-confidence in order to prevent early regulatory problems in infants.
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IntroductionFor new mothers returning to work, the role of the workplace psychosocial environment on maternal mental health has not been fully described. Objectives The purpose of this study was to identify the relationship between psychosocial employment characteristics and mothers' postpartum depression, anxiety, and stress symptoms. Methods Ninety-seven women answered survey questions regarding employment, job demand, control, and support, and postpartum depression, anxiety, and stress symptoms soon after live birth and 6 months later. ResultsWorking and nonworking mothers reported similar mental health symptoms. Psychological characteristics of employment were not associated with increased odds of mental health symptoms. Increased social support provided by coworkers, supervisors, and the organization was associated with reduced odds of anxiety symptoms. Conclusion Our findings identified lack of workplace social support as a modifiable risk factor for postpartum anxiety. Future evaluations of workplace social support interventions may be explored to improve postpartum mental health symptoms. Am. J. Ind. Med. 60:109-120, 2017. (c) 2016 Wiley Periodicals, Inc.
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Background: Maternal depression and anxiety disorders are risk factors for the development of internalizing disorders in offspring. Maternal attachment has been discussed as one factor accounting for transmission. The aim of this study was to investigate child internalizing behavior at preschool age on a symptomatic and behavioral level and possible links to maternal mental health over time and maternal attachment style insecurity in a sample of postpartum depressed and anxious mothers. Sampling and methods: Child internalizing behavior at preschool age was rated by the Child Behavior Checklist (CBCL), the Caregiver-Teacher Report Form (C-TRF), and during a mother-child free-play situation. We focused on child responsiveness as it has been linked to child internalizing behavior. Maternal attachment style insecurity was tested to mediate the link between maternal mental health (assessed postpartum and at preschool age with the Structured Clinical Interview for DSM-IV Axis-I Disorders, SCID-I) and child internalizing behavior/child responsiveness. Of the overall sample (n = 58), 28 women were diagnosed with postpartum depression and/or anxiety disorders according to DSM-IV, and 30 were healthy controls. Data were collected 3-9 months after delivery and at preschool age (mean = 4.6 years). Results: At preschool age, children of postpartum depressed and anxious mothers were rated significantly higher on child internalizing behavior by mothers, fathers, and additional caregivers compared to the control group. Child internalizing behavior rated by mothers was influenced by current psychiatric symptoms; maternal attachment style insecurity did not mediate this link. During interaction, children in the clinical group displayed significantly less child responsiveness compared to the control group. Maternal attachment style insecurity mediated the relationship between maternal mental health over time and child responsiveness. Conclusions: The results emphasize the need for interventions focusing on mother-child interaction and maternal attachment.
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Three studies investigated the relation between adult attachment security and symptoms of depression. Study 1 examined the overall magnitude of the association between adult attachment and depression, and Studies 2 and 3 tested whether this relation was mediated by dysfunctional attitudes and low self-esteem. Results from the three studies were consistent with a mediation model. This model suggests that insecure adult attachment styles are associated with dysfunctional attitudes, which in turn predispose to lower levels of self-esteem. Such depletions in self-esteem are directly associated with increases in depressive symptoms over time. Insecure attachment appears to lead to depressive symptoms in adulthood through its impact on self-worth contingencies and self-esteem.
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The articles included in the special series in this issue of Developmental Psychology demonstrate that perceived self-efficacy for memory functioning is an important facet of metamemory. Self-beliefs of efficacy can enhance or impair performance through their effects on cognitive, affective, or motivational intervening processes. This commentary addresses a number of issues concerning the extension of self-efficacy theory to memory functioning. These include the following: the multidimensionality and measurement of perceived memory capabilities; the veridicality of memory self-appraisal; the efficacious exercise of personal control over memory functioning; the psychosocial processes by which people preserve a favorable sense of memory self-efficacy over the life span; and strategies for generalizing the impact of training in memory skills. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Relationships among parenting self-efficacy, general self-efficacy, child and maternal characteristics, and parenting satisfaction in 145 mothers of school-aged children were examined. Higher parenting self-efficacy was observed in mothers of less emotional and more sociable children, and among mothers who were better educated, had higher family incomes, and reported more previous experience with children. Higher parenting self-efficacy and several mother and child variables predicted greater satisfaction with parenting. Influences of mothers' experience with children other than their own and maternal education on parenting satisfaction were mediated by parenting self-efficacy. Suggestions concerning the conceptualization and measurement of parenting self-efficacy are provided.
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We examined the relationship between parental efficacy and depressive symptoms in a diverse sample of low income mothers. The sample consisted of 607 European American, African American, and Hispanic mothers who participated in The Early Steps Project, a multi-site, longitudinal, preventative intervention study. Parental efficacy was found to be significantly associated with depressive symptoms in the entire sample of low income mothers. Ethnicity moderated results, however, such that parental efficacy was significantly associated with depressive symptoms for European American mothers but was not for the African American and Hispanic mothers. Ethnic differences in the various categories of depressive symptoms (i.e., total, somatic, and psychological) were also explored, with the results showing that African American mothers reported higher levels of depressive symptoms than both European American and Hispanic mothers in each of the categories. The theoretical and clinical implications of these results are discussed.
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The present study examined the role of adult attachment styles in differentiating ‘depressed’ and ‘non-depressed’ college students, and the association between attachment styles and the depressive personality vulnerabilities, sociotropy and autonomy. High scores on the fearful and, to a lesser extent, preoccupied attachment scales were associated with higher levels of depression, highlighting negative self-representation as a key factor in depression. While the sociotropy vulnerability construct correlated exclusively with the preoccupied attachment scale, correlations for the autonomy construct were more complex: as predicted, fearful attachment correlated with all three autonomy subscales while dismissive attachment correlated with the defensive-separation and control subscales, but not with the self-criticism subscale. With an emphasis on negative self-representation, preoccupied attachment also correlated with the self-criticism subscale. The results suggest that fearful attachment is consistent with autonomous vulnerability and preoccupied attachment with sociotropic vulnerability. Self-criticism, a component of both fearful and preoccupied attachment, is highlighted as a strong depressive vulnerability. Dismissive attachment, not involving the self-critical component, does not appear to be associated with depressive predisposition, despite involving self-reliance and avoidance of intimacy.
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Specific patterns of interaction emerging in the first months of life are related to processes regulating mutual affects in the mother-child dyad. Particularly important for the dyad are the matching and interactive repair processes. The interaction between postpartum depressed mothers and their children is characterized by a lack of responsiveness, by passivity or intrusiveness, withdrawal and avoidance, as well as a low level of positive expression of affect. Thus, an impaired capability to regulate the child's affect has been demonstrated in depressed mothers. Maternal aggression, neglect toward infants, infanticidal thoughts, as well as infanticidal behavior are mainly linked to severe postpartum depression, especially with psychotic symptoms. The findings on mother-child interaction reported in this paper are based on mothers with mild to moderate depressive disorders without psychotic symptoms. Considering the stability of interaction patterns in the course of depressive illness as well as the long-term consequences of these interactions, it seems surprising that there are still few systematic studies of depressed mothers interacting with their infants. In connection with an overview on these issues, treatment models for parent-infant psychotherapy are discussed.
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Although the association between maternal depression and adverse child outcomes is well established, the strength of the association, the breadth or specificity of the outcomes, and the role of moderators are not known. This information is essential to inform not only models of risk but also the design of preventive interventions by helping to identify subgroups at greater risk than others and to elucidate potential mechanisms as targets of interventions. A meta-analysis of 193 studies was conducted to examine the strength of the association between mothers' depression and children's behavioral problems or emotional functioning. Maternal depression was significantly related to higher levels of internalizing, externalizing, and general psychopathology and negative affect/behavior and to lower levels of positive affect/behavior, with all associations small in magnitude. These associations were significantly moderated by theoretically and methodologically relevant variables, with patterns of moderation found to vary somewhat with each child outcome. Results are interpreted in terms of implications for theoretical models that move beyond main effects models in order to more accurately identify which children of depressed mothers are more or less at risk for specific outcomes.
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Research shows that social support and maternal self-efficacy are inversely related to postpartum depression; however, little is known about the mechanisms by which these variables impact on depressive symptomatology. This study uses path analysis to examine the proposal that maternal self-efficacy mediates the effects of social support on postpartum depressive symptomatology. Primiparous women (n=247) completed questionnaires during their last trimester and then again at 4 weeks' postpartum (n=192). It was hypothesized that higher levels of parental support, partner support, and maternal self-efficacy would be associated with lower levels of depressive symptomatology postpartum and that the relationship between social support and depressive symptomatology would be mediated by maternal self-efficacy. Results indicated that as expected, higher parental support and maternal self-efficacy were associated with lower levels of depressive symptomatology postpartum. Partner support was found to be unrelated to both depressive symptomatology and maternal self-efficacy. Results from the path analysis supported the mediation model. Findings suggest that parental support lowers depressive symptomatology by the enhancement of maternal self-efficacy.
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The study presents data on the 3-month prevalences of postpartum anxiety disorders (PAD) and postpartum depressive disorders (PDD) and their comorbidity in a German community sample. Associations with sociodemographic variables and previous history of psychopathology were analysed. Data were gathered in a longitudinal study over the first 3 months postpartum. In a two-stage screening procedure, a population-based representative sample of 1024 postpartum women was assessed for symptoms of anxiety and depression using DSM-IV-based screening instruments. The estimated rates of DSM-IV disorders were 11.1% for PAD and 6.1% for PDD. Comorbidity was found in 2.1%. The rate for PAD with postpartum onset was 2.2% and for PDD 4.6%. Young mothers and mothers with a low education level had a heightened risk of developing depression following delivery. Because of the clinical relevance of PAD, controlled studies and specialized programmes for prevention and treatment are urgently required.
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This study examined infant-related stressors as well as life event stress and social support as predictors of postpartum depression. A sample of 25 depressed and 24 nondepressed, married, middle-class primiparous women was selected according to Research Diagnostic Criteria at between 6 and 8 weeks postpartum. These subjects were assessed on measures of life event stress, neonatal risk status, infant temperament, and social support. Contrary to expectation, life event stress and social support were not related to postpartum depression. Infant-related stressors (medical complications and maternal perceptions of infant temperament) discriminated between the two groups and accounted for roughly 17% of the variance in severity of depression. These data underscore the importance of infant-related stressors in postpartum depression and may have clinical implications for the developing mother-infant relationship.
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The explosion of adult attachment research in the last decade has been limited by its reliance on college student and distressed samples. Using a large nationally representative sample of American adults, the authors examined the relation of sociodemographics, childhood adversity, parental representations, adult psychopathology, and personality traits to adult attachment in an effort to replicate previous findings and extend the theory. Distribution of adult attachment styles was similar to that in prior studies: 59% secure, 25% avoidant, and 11% anxious. Adult attachment was associated with several sociodemographic variables (e.g., income, age, race) not previously studied. Childhood adversities of an interpersonal nature were strongly related to insecure adult attachment. Various types of adult psychopathologies and personality traits were also strongly related to adult attachment. Implications for adult attachment theory and future research are discussed.
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This study used a sample of 304 adults to examine mean differences in family climate and personality variables on the basis of individuals' attachment styles. Also examined was whether mean differences varied by age group. Findings showed significant main effects of attachment style, but no Attachment Style x Age Group interactions. Compared with adults with an insecure attachment style, persons with a secure attachment style described their family of origin and their current family more positively and scored higher on personality variables indicative of self-confidence, psychological well-being, and functioning in the social world. When the family climate and personality variables were included in a discriminant function analysis, 2 significant functions were obtained. The 1st function discriminated adults with a positive self-model from those with a negative self-model. The 2nd function contrasted participants with a positive other-model from those with a negative other-model. Thus, this study provided evidence in support of the self- and other-models as the fundamental dimensions of adults' attachment system.
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Why does the burden of mental disorders persist in established market economies? There are four possibilities: the burden estimates are wrong; there are no effective treatments; people do not receive treatment; or people do not receive effective treatments. Data from the Australian National Survey of Mental Health and Wellbeing about the two commonest mental disorders, generalized anxiety disorder and depression, have been used in examining these issues. The burden of mental disorders in Australia is third in importance after heart disease and cancer, and anxiety and depressive disorders account for more than half of that burden. The efficacy of treatments for both disorders has been established. However, of those surveyed, 40% with current disorders did not seek treatment in the previous year and only 45% were offered a treatment that could have been beneficial. Treatment was not predictive of disorders that remitted during the year. The burden therefore persists for two reasons: too many people do not seek treatment and, when they do, efficacious treatments are not always used effectively.
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Although there are an increasing number of studies showing an association of adult attachment style to depressive disorder, such studies have rarely utilised epidemiological approaches with large community-based series and have relied heavily on brief self-report measurement of both attachment style and symptoms. The result is a wide inconsistency in the type of insecure style shown to relate to disorder. The present study examined adult attachment style in a high-risk community sample of women in relation to clinical depression. It utilised an interview measure of adult attachment which allowed for an assessment of both type of attachment style and the degree of insecurity of attachment. A companion paper examines its relationship with other depressive-vulnerability (Bifulco et al. 2002). Two hundred and twenty-two high-risk and 80 comparison women were selected from questionnaire screenings of London GP patient lists and intensively interviewed. A global scale of attachment style based on supportive relationships (with partner and very close others) together with attitudes to support-seeking, derived the four styles paralleling those from self-report attachment assessments (Secure, Enmeshed, Fearful, Avoidant). In order to additionally reflect hostility in the scheme, the Avoidant category was subdivided into 'Angry-dismissive' and 'Withdrawn'. The degree to which attitudes and behaviour within such styles were dysfunctional ('non-standard') was also assessed. Attachment style was examined in relation to clinical depression in a 12-month period. For a third of the series this was examined prospectively to new onset of disorder. The presence of any insecure style was significantly related to 12-month depression. However, when controls were made for depressive symptomatology at interview, only the 'non-standard' levels of Enmeshed, Fearful or Angry-dismissive styles related to disorder. Withdrawn-avoidance was not significantly related to disorder. The relationship of attachment style to clinical depression is increased by differentiating the degree of insecurity of style and differentiating hostile and non-hostile avoidance.
Conference Paper
Maternal depression and anxiety are associated with compromises in infant and maternal social and emotional functioning. In this paper, we briefly review the literature on this topic and present some preliminary findings on a group of mothers in treatment for major depressive disorder, panic disorder, or obsessive-compulsive disorder. The findings suggest that the symptom reports of treated mothers with established DSM diagnoses were similar overall to those of control mothers. However, the mothers' psychiatric illness had a compromising effect on their interactions with their infants and on their infants' social and emotional functioning. The implications of these results are discussed.
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Predictors of prenatal and postnatal parenting efficacy were examined in a sample of 115 primiparous mothers and 73 fathers in an effort to examine the association between preexisting parental characteristics and prenatal efficacy and the association between prenatal characteristics and postnatal efficacy when aspects of the current parenting context are taken into account. The most robust predictors of maternal postnatal efficacy included both prenatal efficacy, which significantly predicted postnatal efficacy independent of all other predictors including the current parenting context, and perceived infant temperamental reactivity as both a main effect and as buffered by social support. This was not the case for fathers, whose postnatal efficacy was primarily a function of their amount of involvement in parenting tasks and social support. The differential predictors of mother and father efficacy as well as their implications for future research are discussed.
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Welche Auffalligkeiten zeigen sich in der Erziehung emotional belasteter Mutter sowie im Verhalten ihrer vier bis sieben Jahre alten Kinder im Vergleich zu einer unausgelesenen Kindergartenstichprobe? Gibt es Zusammenhange zwischen mutterlicher Depressivitat, verschiedenen Aspekten der Erziehung und kindlichen Erlebens- und Verhaltensproblemen? Welche Aspekte der Erziehung vermitteln diese Zusammenhange? Um diese Fragen zu untersuchen, wurden subklinisch depressive Mutter (N = 380) zu kindlichem Verhalten, Erziehungspraktiken, elterlichem Stress sowie zu elterlichem Kompetenzerleben befragt. Die Daten wurden mit einer Kindergartenstichprobe (Losel et al., 2005) verglichen. Die depressiv gestimmten Mutter zeigten im Vergleich zu den unausgelesenen Muttern ein ungunstigeres Erziehungsverhalten, erlebten sich weniger kompetent in der Erziehung und sie berichteten uber hoheren elterlichen Stress. Ihre Kinder wiesen mehr Storungen des Erlebens und Verhaltens auf. Die Merkmale Elterlicher Stress und Kompetenzer...
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This study was designed to examine parenting self-efficacy beliefs as correlates of mothers' competence in parenting toddlers and as predictors of toddlers' behavior and development. Sixty-eight predominantly middle-class mother–toddler pairs participated in this study. Mothers completed questionnaires, toddlers were administered the Bayley Scales of Infant Development (BSID-II), and each dyad participated in the Crowell Procedure, which is designed to observe parent and toddler behaviors in a semistructured laboratory context. Although domain-general and domain-specific parenting self-efficacy beliefs were not associated with parenting competence, domain-specific beliefs were significantly related to toddlers' scores on the Mental Scale of the BSID-II and several behaviors observed during the Crowell Procedure (Affection Towards Mother, Avoidance of Mother, Compliance, Enthusiasm, and Negativity). Implications of the findings are discussed. ©2003 Michigan Association for Infant Mental Health.
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This study tests the idea that mothers' self-efficacy beliefs mediate the effects on parenting behavior of variables such as depression, perceptions of infant temperamental difficulty, and social-marital supports. Subjects were 48 clinically depressed and 38 nondepressed mothers observed in interaction with their 3–13-month-old infants (M= 7.35 months). As predicted, maternal self-efficacy beliefs related significantly to maternal behavioral competence independent of the effects of other variables. When the effects of self-efficacy were controlled, parenting competence no longer related significantly to social-marital supports or maternal depression. In addition, maternal self-efficacy correlated signficantly with perceptions of infant difficulty after controlling for family demographic variables. These results suggest that maternal self-efficacy mediates relations between maternal competence and other psychosocial variables and may play a crucial role in determining parenting behavior and infant psychosocial risk.
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Maternal emotional and physical unavailability have differential effects on infant interaction behavior as noted in a study by Field, Vega-Lahr, Scafidi, and Goldstein (1986). In that study, four-month-old infants experienced their mother's still face and a brief separation from the mother. Spontaneous interactions preceded and followed these to serve as baseline and reunion episodes. Although the infants became more negative and agitated during both conditions, the still face elicited more stressful behaviors. The present study replicated the Field et al. (1986) study but also compared infants of depressed and infants of nondepressed mothers. The infants of depressed versus those of nondepressed mothers were less interactive during the spontaneous interactions, as were their mothers, and they showed less distress behaviors during the still-face condition. During the “return to spontaneous interaction” following the still-face condition, they were also less interactive, as evidenced by fewer positive as well as fewer negative behaviors. Their mothers were also less active. The nondepressed mothers and infants were extremely active, as if trying to reinstate the initial spontaneous interaction. Minimal change occurred during the separation condition except that both groups of infants vocalized less than they had during the spontaneous interaction. During the reunion following the separation period, the infants of depressed versus nondepressed mothers were paradoxically more active, although their mothers continued to be less interactive.
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Low maternal self-confidence may damage the early mother-infant relationship and negatively influence infant development. The goal of this study was to test whether a current and previous history of DSM-IV anxiety and depressive disorders is associated with maternal self-confidence two weeks after delivery. Postpartum anxiety disorder and depression was diagnosed according to DSM-IV criteria in a community sample of 798 women. The data showed a significant link between current postpartum anxiety and depressive disorders and maternal self-confidence. Furthermore, women with a depression or anxiety disorder in their previous psychiatric history scored lower in maternal self-confidence. There is a need for appropriate preventive programmes to promote maternal self-confidence. With such programmes it is possible to prevent infant developmental disorders which might result from reduced feelings of maternal self-confidence and associated maternal interaction behaviour.
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The early course and antecedents of postpartum anxiety are unknown. This study sought to determine the course and antecedents of maternal anxiety during the first month postpartum and to develop a model to predict 1-month anxiety using information obtainable before perinatal hospital discharge. Two hundred and ninety-six mothers were screened before discharge with the State (SS) and Trait (TS) Scales of the State Trait Anxiety Inventory (STAI). Demographic characteristics were assessed by questionnaire and medical record review, and psychiatric history, measures of perinatal stress, and resilient factors were determined by focused questions and formal instruments. At 1-month postpartum, the SS was repeated. Scores on the SS were significantly higher at 1 month than immediately postpartum (35.30+/-0.68 versus 33.38+/-0.60, mean+/-standard error, P=.004), but only 58.6% of mothers with high pre-discharge anxiety had high anxiety at 1 month. One-month anxiety correlated with pre-discharge SS and TS scores, a history of psychiatric problems including depressed mood, medical and negative social life events, lack of pregnancy planning and prenatal class attendance, perceived peripartum stress, and duration of postpartum hospital stay. Inverse correlations were observed with education, household income, and resiliency factors. In multivariate modeling, anxiety trait, education, history >or=2 years of depression, and perception of peripartum stress accounted for 50% of the variance in the 1-month SS score. Maternal anxiety increases during the first postpartum month. Women with high trait anxiety, low education, a history of depressed mood, and a perception of high peripartum stress are at risk for experiencing anxiety at this time.
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Thesis (Ph. D.)--University of Illinois at Chicago, 1990. Includes bibliographical references (leaves 139-144).
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Thesis (Ph. D.)--Michigan State University. Dept. of Family and Child Ecology, 2003. Includes bibliographical references (leaves 86-91). Microfiche. s
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Researchers interested in child developmental outcomes have highlighted the role that parenting self-efficacy (PSE) plays in psychosocial child adjustment. PSE is a cognitive construct that can be broadly defined as an individual's appraisal of his or her competence in the parental role. PSE has emerged in the literature as an important variable when exploring variance in parenting skills. Despite this, much remains to be learned about PSE. Little is known about the predictors of PSE, with much of the existing research conducted in a piecemeal fashion that lacks a solid theoretical framework. In addition, PSE in fathers has been understudied and relatively little is known about PSE in families with toddler age children. Informed by Belsky's process model of parenting, this study explored similarities and differences in PSE and the predictors of PSE for mothers and fathers of toddlers. A total of 62 cohabiting couples whose first-born child was 18-36 months old completed self-report measures of PSE, general self-efficacy, depression, marital satisfaction, parenting stress, child difficultness and family functioning. For fathers, parenting stress and their relational functioning (i.e. marital satisfaction and family functioning) with their spouse predicted PSE scores. For mothers, general self-efficacy and relational functioning were predictive of PSE. CONCLUSIONS AND LIMITATIONS: The results of this study support the use of Belsky's process model of parenting to study the predictors of PSE. Important differences were found in the prediction models for mothers and fathers. Future studies need to clarify the nature of parental self-efficacy beliefs in fathers and continue to use comprehensive theoretical models to identify potentially relevant covariates of PSE. Limitations of the current investigation include reliance on self-report measures and the homogeneity of the sample.
Article
To examine the effects of maternal depression on infant social engagement, fear regulation, and cortisol reactivity as compared with maternal anxiety disorders and controls and to assess the role of maternal sensitivity in moderating the relations between maternal depression and infant outcome. Using an extreme-case design, 971 women reported symptoms of anxiety and depression after childbirth and 215 of those at the high and low ends were reevaluated at 6 months. At 9 months, mothers diagnosed with a major depressive disorder (n = 22) and anxiety disorders (n = 19) and matched controls reporting no symptoms across the postpartum year (n = 59) were visited at home. Infant social engagement was observed during mother-infant interaction, emotion regulation was microcoded from a fear paradigm, and mother's and infant's cortisol were sampled at baseline, reactivity, and recovery. The infants of depressed mothers scored the poorest on all three outcomes at 9 months-lowest social engagement, less mature regulatory behaviors and more negative emotionality, and highest cortisol reactivity-with anxious dyads scoring less optimally than the controls on maternal sensitivity and infant social engagement. Fear regulation among the children of anxious mothers was similar to that of the controls and their stress reactivity to infants of depressed mothers. Effect of major depressive disorder on social engagement was moderated by maternal sensitivity, whereas two separate effects of maternal disorder and mother sensitivity emerged for stress reactivity. Pathways leading from maternal depression to infant outcome are specific to developmental achievement. Better understanding of such task-specific mechanisms may help devise more specifically targeted interventions.
Article
Depression is the most frequent psychiatric disorder and has long-term, compromising effects on the mother-infant relationship and the child's development. The infant continuously faces a climate of negative affect that disrupts the interactive experience of the infant and the mother. This article presents findings on the impact of maternal depression on the infant affective state and the specific interactive patterns associated with infant affect regulation. Mother-infant interactions were studied using microanalytic, second-by-second methods in the laboratory and also by using naturalistic home observations. The empirical findings highlight the impact of maternal depression on the infant affective state and on the capacity for repairing states of miscoordination. The impact is seen not only in severely and acutely depressed mothers, but in mothers who have only high levels of depressive symptoms. These infants develop negative affective states that bias their interactions with others and exacerbate their affective problems. Further findings with regard to gender-specific effects show that male infants are more vulnerable than female infants to maternal depression. The findings point out the need for therapeutic interventions that focus on the mother-infant dyad and infant affective state in the treatment of maternal depression.
Article
Up to 50% of mothers report postpartum depressive symptoms yet providers do a poor job predicting and preventing their occurrence. Our goal was to identify modifiable factors (situational triggers and buffers) associated with postpartum depressive symptoms. Observational prospective cohort telephone study of 563 mothers interviewed at 2 weeks and 6 months postpartum. Mothers reported on demographic factors, physical and emotional symptoms, daily function, infant behaviors, social support, and skills in managing infant and household. Mothers were categorized into four groups based on the presence of depressive symptoms at 2 weeks and at 6 months postpartum: never, always, late onset, and remission groups. Fifty-two percent did not have depressive symptoms at 2 weeks or at 6 months (never group), 14% had symptoms at both time points (always group), 10% had late onset, and 24% had early onset of symptoms with remission. As compared with women in the never group, women in the always and late onset groups had high-risk characteristics (e.g., past history of depression), more situational triggers (e.g., physical symptoms), and less robust social and personal buffers (i.e., social support and self-efficacy). As compared with the never group, mothers in the remission group had more situational triggers and fewer buffers initially. Changes in situational triggers and buffers were different for the four groups and were correlated with group membership. Situational triggers such as physical symptoms and infant colic, and low levels of social support and self-efficacy in managing situational demands are associated with postpartum depressive symptoms. Further research is needed to investigate whether providing education about the physical consequences of childbirth, providing social support, and teaching skills to enhance self-efficacy will reduce the incidence of postpartum symptoms of depression.
Article
The ability to mother her infant is reduced in a woman with postpartum depression (PPD). Although antidepressant treatment effectively improves depressive symptoms, various domains of functioning, for example, work and relationships, do not universally improve with treatment. In this pilot study, we investigated whether maternal role functioning improved with antidepressant treatment in women with PPD. The pilot study was an exploratory analysis of a larger study. A subset of women (n = 27) from a randomized clinical trial (double-blind, 8-week trial of nortriptyline compared with sertraline) completed three outcome measures of maternal role functioning: gratification in the maternal role, the Infant Care Survey (ICS), and videotapes of maternal-infant interaction. The tapes were analyzed using the Child and Caregiver Mutual Regulation Coding Scale and Noldus Behavioral Coding Software. The two antidepressants were equally efficacious in decreasing depressive symptoms and improving overall functioning and gratification in the maternal role. Differences between times 1 and 2 in the mother-infant interactions were related to time (increasing age of the infant) and not assignment of antidepressant or remission of depression. Effective treatment with two antidepressants improves gratification in the maternal role but not self-efficacy or maternal-infant interaction in women with PPD. Results of the study can help women and their healthcare providers to weigh the benefits of short-term antidepressant treatment in the postpartum period. Future studies should consider outcomes related to a longer duration of treatment.
Article
The present article presents an integrative theoretical framework to explain and to predict psychological changes achieved by different modes of treatment. This theory states that psychological procedures, whatever their form, alter the level and strength of self-efficacy. It is hypothesized that expectations of per- sonal efficacy determine whether coping behavior will be initiated, how much effort will be expended, and how long it will be sustained in the face of ob- stacles and aversive experiences. Persistence in activities that are subjectively threatening but in fact relatively safe produces, through experiences of mastery, further enhancement of self-efficacy and corresponding reductions in defensive behavior. In the proposed model, expectations of personal efficacy are derived from four principal sources of information: performance accomplishments, vicarious experience, verbal persuasion, and physiological states. The more de- pendable the experiential sources, the greater are the changes in perceived self- efficacy. A number of factors are identified as influencing the cognitive processing of efficacy information arising from enactive, vicarious, exhortative, and emotive sources. The differential power of diverse therapeutic procedures is analyzed in terms of the postulated cognitive mechanism of operation. Findings are reported from microanalyses of enactive, vicarious, and emotive modes of treatment that support the hypothesized relationship between perceived self-efficacy and be- havioral changes. Possible directions for further research are discussed.
Article
New mothers' confidence in their infant care skills are important concerns for maternity nurses. In this study, correlates of mothers' self-efficacy ratings on 52 infant care behaviors included in the Infant Care Scale were identified. Data on demographic variables and nurses' ratings of mothers' skill on five selected tasks were collected from 200 mothers and their nurses. Results from bivariate and multivariate analyses pointed to predictors of maternal feelings of efficacy and to discrepancies between mothers' and nurses' ratings. Maternal age, number of children, and nurses' ratings of mothers' skills were the strongest predictors of self-efficacy for infant care. Mothers of male infants showed slightly lower efficacy perceptions than did mothers of females. Implications for assessing mothers' educational needs before discharge and focusing teaching efforts are discussed.
Article
Three studies investigated the relation between adult attachment security and symptoms of depression. Study l examined the overall magnitude of the association between adult attachment and depression, and Studies 2 and 3 tested whether this relation was mediated by dysfunctional attitudes and low self-esteem. Results from the three studies were consistent with a mediation model. This model suggests that insecure adult attachment styles are associated with dysfunctional attitudes, which in turn predispose to lower levels of self-esteem. Such depletions in self-esteem are directly associated with increases in depressive symptoms over time. Insecure attachment appears to lead to depressive symptoms in adulthood through its impact on self-worth contingencies and self-esteem.
Article
Maternal depression and anxiety are associated with compromises in infant and maternal social and emotional functioning. In this paper, we briefly review the literature on this topic and present some preliminary findings on a group of mothers in treatment for major depressive disorder, panic disorder, or obsessive-compulsive disorder. The findings suggest that the symptom reports of treated mothers with established DSM diagnoses were similar overall to those of control mothers. However, the mothers' psychiatric illness had a compromising effect on their interactions with their infants and on their infants' social and emotional functioning. The implications of these results are discussed.
Article
To investigate the relationship between maternal physical and emotional health problems six to nine months after childbirth. Statewide postal survey, incorporating the Edinburgh Postnatal Depression Scale, distributed to women six to seven months after childbirth, with telephone interview follow up of a sub-sample of participants at seven to nine months postpartum. The postal survey was distributed to all women who gave birth in a two-week period in Victoria, Australia in September 1993, except those who had a stillbirth or known neonatal death. Follow up interviews were conducted with respondents to the postal survey who provided contact details and expressed interest in participating in further research selected to recruit three groups of equivalent size according to scores on the Edinburgh Postnatal Depression Scale: a low scoring group (< 9); a borderline group (9-12); and a group with scores indicating probable depression (> or = 13). The response rate to the postal survey was 62.5% (n = 1,336). Respondents were representative of the total sample in terms of mode of delivery, parity and infant birthweight; young women, single women and women of non-English speaking background were under-represented. The participation rate in telephone follow up interviews was: 89.1% (n = 204), comprising 66 women with an Edinburgh Postnatal Depression Scale score of < 9; 72 women scoring 9-12; and 66 scoring > or =13. The point prevalence of depression at six to seven months postpartum was 16.9% (225/1,331, 95% CI 14.9-18.9%). Physical and related health problems associated with significantly increased odds of depression at six to seven months were: tiredness (OR 3.42 [2.2-5.3]); urinary incontinence (OR 2.23 [1.5-3.4]); back pain (OR 2.20 [1.6-3.0]); sexual problems (OR 2.16 [1.6-3.0]); more coughs, colds and minor illnesses than usual (OR 2.78 [1.9-4.1]); bowel problems (OR 1.93 [1.3-2.9]) and relationship difficulties (OR 3.88 [2.8-5.4]). At follow up, three physical health factors were associated with statistically significant linear trends with poorer levels of emotional wellbeing. These were: tiredness (chi2 for linear trend = 12.38, P < 0.001); urinary incontinence (chi2 for linear trend = 5.63, P = 0.02); and more minor illnesses than usual (chi2 for linear trend = 7.94, P = 0.005). The study confirms a link between maternal emotional wellbeing and physical health and recovery in the postnatal period and has important implications for clinical practice. Strategies for encouraging greater disclosure of physical and emotional health problems, assessment of the physical health of recent mothers presenting with depression, and emotional health of recent mothers presenting with other morbidity should be high priorities for all health professionals in contact with mothers in the year following childbirth.
Article
Studies of cognitive vulnerability to depression in young children have, in the main, relied on self-report questionnaires (e.g. of self-esteem, attributional style). They have failed to produce convincing evidence of a cognitive vulnerability to depression in children under 8 years. In the current study latent depressive cognitions were investigated in the 5-year-old children (N = 94) of depressed and well mothers in a situation of mild stress, that is, the threat of losing a card deal in a modified version of the competitive children's card game "Snap"'. In the context of "losing", but not "winning", deals, children who had been exposed to maternal depression, either in the previous 12 months or at any other time during their lifetime, were more likely than nonexposed children to express depressive cognitions (hopelessness, pessimism, and low self-worth). The association between depressive cognitions and recent exposure to maternal depression was in part accounted for by current maternal hostility to the child. The results of this study stand in contrast to those of studies which have used questionnaire methods to assess vulnerability to depressive cognitions in this age group. They suggest that it might be important to employ ecologically realistic situations to access latent self-cognitions in young children; and they underscore the importance. increasingly evident in research with adults and older children, of employing methods that involve the induction of low mood in order to elicit cognitions relevant to depression.
Article
To investigate whether prenatal, postnatal, and/or current maternal depressive symptoms are associated with low level of psychosocial functioning or high level of emotional/behavioral problems in school-age children. As part of a prospective longitudinal study, maternal depressive symptoms were screened with the Edinburgh Postnatal Depression Scale prenatally, postnatally, and when the children were 8 to 9 years old. The original sample of 349 mothers was collected in 1989-1990 in Tampere, Finland. Of the 270 mother-child pairs at the latest stage of the study in 1997-1998, 188 mother-child pairs participated and 147 were included. The associations between maternal depressive symptoms at different points in time and the level of children's psychosocial functioning and problems reported on the Child Behavior Checklist and Teacher's Report Form were examined. Children's low social competence and low adaptive functioning were associated with concurrent maternal depressive symptoms. Maternal postnatal depressive symptoms predicted low social competence. The presence of prenatal depressive symptoms in the mother was a strong predictor of child's high externalizing and total problem levels (odds ratio 3.1, 95% confidence interval 1.1-8.9 and odds ratio 8.5, 95% confidence interval 2.7-26.5). Prenatal as well as recurrent maternal depressive symptoms were associated with the least favorable child outcome. Maternal depressive symptomatology at any time, especially prenatally, is a risk factor for the child's well-being. This should be noted already in prenatal care. The timing and the recurrence of maternal depressive symptoms affect the outcome for the child.
Article
Examined the behavior of anxious parents in interactions with their children (ages 6 to 12 years) to test hypotheses about possible psychosocial mechanisms of transmission of anxiety from parent to child. Fifty-one parent-child dyads completed the study. Parents and children were assessed with structured interviews and participated in 2 tasks that were videotaped and coded. Twenty-five dyads had an anxious parent. Primary diagnoses of the anxious group were mostly panic disorder (PD), with or without agoraphobia (AG), social phobia (SP), and generalized anxiety disorder. Anxious participants were excluded if they presented a secondary diagnosis other than another anxiety disorder. Control parents had no present or past diagnosis. Observational data revealed that anxious parents were significantly less productively engaged and more withdrawn and disengaged during the interactions but did not differ from nonanxious parents in terms of overall levels of control. Sequential analyses indicated that there was a trend for both parent group and child sex to effect efforts to control the interaction in response to child expression of negative affect. Implications of these results for a mediational role of parental behavior in the development and maintenance of child anxiety are discussed.