Article

PREPP: Postpartum Depression Prevention through the Mother-Infant Dyad

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Abstract

Most interventions to prevent postpartum depression (PPD) focus on the mother rather than the mother-infant dyad. As strong relationships between infant sleep and cry behavior and maternal postpartum mood have been demonstrated by previous research, interventions targeted at the dyad may reduce symptoms of PPD. The goal of the current study was to examine the effectiveness of Practical Resources for Effective Postpartum Parenting (PREPP). PREPP is a new PPD prevention protocol that aims to treat women at risk for PPD by promoting maternally mediated behavioral changes in their infants, while also including mother-focused skills. Results of this randomized control trial (RCT) (n = 54) indicate that this novel, brief intervention was well tolerated and effective in reducing maternal symptoms of anxiety and depression, particularly at 6 weeks postpartum. Additionally, this study found that infants of mothers enrolled in PREPP had fewer bouts of fussing and crying at 6 weeks postpartum than those infants whose mothers were in the Enhanced TAU group. These preliminary results indicate that PREPP has the potential to reduce the incidence of PPD in women at risk and to directly impact the developing mother-child relationship, the mother's view of her child, and child outcomes.

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... A review of prevention programs for postnatal depression found that those using interpersonal therapy were the most consistent in delivering effective results (Werner et al., 2016). Mixed results were seen for cognitive behavioral programs, although individual interventions appeared more effective than group-based interventions (Werner et al., 2016). ...
... A review of prevention programs for postnatal depression found that those using interpersonal therapy were the most consistent in delivering effective results (Werner et al., 2016). Mixed results were seen for cognitive behavioral programs, although individual interventions appeared more effective than group-based interventions (Werner et al., 2016). ...
... Practical Resources for Effective Postpartum Parenting (PREPP) is a targeted intervention for women at risk of postnatal depression; it is also focused on optimizing infant behavioral outcomes (Werner et al., 2016). The intervention uses traditional psychotherapy, psychoeducation and mindfulness techniques. ...
Article
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The period of infancy and early childhood is a critical time for interventions to prevent future mental health problems. The first signs of mental health difficulties can be manifest in infancy, emphasizing the importance of understanding and identifying both protective and risk factors in pregnancy and the early postnatal period. Parents are at a higher risk of developing mental health problems during the perinatal period. An understanding of the evidence around prevention and intervention for parental anxiety and depression is vital to the process of prevention of early mental health disorders in infants and young children. Here we review the existing prevention and treatment interventions in the early years focusing on the period from conception to 3 years – the majority targeting parents in order to improve their mental health, and that of their infants. Elements of successful programs for parents include psychoeducation and practical skills training, as well as work on the co-parenting relationship, developing secure attachment, and enhancing parental reflective functioning. While both targeted and universal programs have produced strong effect sizes, universal programs have the added benefit of reaching people who may otherwise not have sought treatment. In synthesizing this information, our goal is to inform the development of integrated models for prevention and novel early intervention programs as early in life as possible.
... Two randomized control trials have demonstrated its efficacy in at-risk populations. Among a sample of 54 pregnant women with sub-threshold symptoms of depression, PREPP was associated with a significant reduction in depression and anxiety symptoms and more than a 50% reduction in the rate of severe postpartum depression at 6 weeks postpartum (Werner et al., 2016). Similarily, among a low SES population, PREPP was associated with improved sub-clinical symptoms of anxiety and depression at six weeks postpartum (Scorza, 2020). ...
... In a randomized controlled trial among 156 mothers of infants aged 6-12 months, a behavioral sleep intervention compared to receiving written information led to decreases in depression scores, though more so in the women with moderate depressive scores (Hiscock and Wake, 2002). Furthermore, Werner et al. demonstrated that infants of mothers enrolled in PREPP versus those who received two-sessions of psycho-education on postpartum depression (PPD) had fewer bouts of fussing and crying at 6 weeks postpartum (Werner et al., 2016). Interventions that focus both on augmenting sensitive parenting as well as improving maternal mental health have a greater potential for positive impact on a broader range of outcomes, including maternal, child, and family system functioning (. (Forman et al., 2007;Nylen et al., 2006;van IJzendoorn, 1995) A dyadic form of intervention capitalizes on the relationship between infant and mother, but a history of childhood maltreatment interferes with this relational bond and also is a risk factor for perinatal depression and anxiety. ...
... This manuscript reports the findings of a secondary analysis of two combined RCTs from the Werner et al. (2016) and Scorza, 2020) data sets. The primary outcomes were depression and anxiety symptoms during the early postnatal period with secondary outcomes evaluating the decrease in infant fuss and cry behavior. ...
Article
BACKGROUND Prevention studies for perinatal depression rarely focus on the mother–infant dyad or consider the impact of maternal childhood maltreatment (CM). METHODS A secondary analysis of two combined randomized controlled trials of Practical Resources for Effective Postpartum Parenting (PREPP) examined the moderating role of CM on the efficacy of preventing perinatal depression and effects on infant behavior at six weeks. RESULTS 32% of 109 pregnant women endorsed CM (CM+). At six weeks postpartum, women who received PREPP compared to enhanced treatment as usual (ETAU) had significant reductions in depression and anxiety based on the observer-rated Hamilton Rating Scale for Depression (HRSD) and Hamilton Rating Scale for Anxiety (HRSA) (mean difference of M=-3.84 (SD= 0.14, p<0.01) and M=- 4.31 (SD= 0.32, p <0.001) respectively). When CM was added to the models, there no longer was a significant PREPP versus ETAU treatment effect on HRSD and HRSA outcomes in CM+ women though effects remained for CM- women. However, CM+ women who received PREPP vs ETAU reported a mean increase in infant daytime sleep of 189.8 minutes (SE= 50.48, p=0.001). LIMITATIONS: Self-report measures of infant behavior were used. CONCLUSIONS CM+ women versus CM- had limited response to an intervention to prevent perinatal depression yet still reported an increase in infant daytime sleep. This study adds to the growing literature that prevention studies may need to incorporate approaches tailored to fit women with childhood trauma histories while also considering infant functioning as both may be treatment targets relevant to maternal mood.
... The standard mean differences for continuous data were computed; variability was assessed using the Cochrane Q statistic, and the random effects model was used to estimate the overall intervention effect size from the heterogeneous data. We only analysed data for maternal depression outcomes since there was insufficient data for infant outcomes; although three studies (Cooper et al., 2009;Letourneau et al., 2011;Werner et al., 2016) reported on infant outcomes they were not related to the infant development variables targeted in the current review. ...
... Rights reserved. Maternal depression reduced significantly in the intervention group relative to the control group at post-intervention Maternal depression reduced significantly in the intervention group relative to the control group at post-intervention There was no significant reduction in maternal depression for either the intervention or control group at post-intervention Werner et al., 2016), the Beck Depression Inventory-BDI-II (Horowitz et al., 2001;Tsivos et al., 2015;Boyd et al., 2019) and the Depression Anxiety Stress Scales-DASS (Ericksen et al., 2018). The reported maternal mean age ranged from 25.9 to 32.8 years. ...
... All 17 studies included baseline and post-intervention assessments and only three studies (O'Mahen et al., 2014;Goodman et al., 2015;Tsivos et al., 2015) explicitly reported later follow-up assessments. Although infant outcomes were part of the focus of this review, only three studies (Cooper et al., 2009;Letourneau et al., 2011;Werner et al., 2016) reported infant outcomes such as fussing and crying, attachment and security, feeding, and cortisol levels. Figure 2 presents a summary of the risk of bias assessment for all included studies. ...
Article
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Considering the significant impact of perinatal depression on both maternal wellbeing and infant development, it is important to examine the effectiveness of interventions designed to prevent or reduce these risks. This systematic review and meta-analysis synthesised evidence on parenting intervention in relation to how such programs affect symptoms of perinatal depression and infant outcomes within 12 months of postpartum. We followed the Cochrane Collaboration guidelines on conducting systematic reviews and meta-analyses. A total of five electronic databases were searched for controlled trials that met pre-determined eligibility criteria. Outcomes of interest were maternal depressive symptoms and infants’ language, motor and socioemotional development. Seventeen studies involving 1665 participants were included in the systematic review. Estimates from a random effects model of 15 studies in the final meta-analysis revealed statistically significant reductions in maternal depressive symptoms at post-intervention for mothers allocated to receive parenting interventions (SMD = − 0.34, 95%CI − 0.44, − 0.24; z = 5.97, p < 0.001; I² = 0%). Data on infant development outcomes from the included studies were scarce, and therefore, infant outcomes were not analysed in this review. For individual study outcomes, the majority of studies reported a general trend for reductions in maternal depressive symptoms from pre- to post-intervention. Although parenting interventions are frequently considered preventive strategies that are designed to offer support to parents and impart skills that promote their physical and psychological wellbeing, our findings suggest that these interventions have a positive effect on perinatal depressive symptoms. Implications and recommendations for future research are addressed. The systematic review protocol was registered with PROSPERO 2020 CRD42020184491.
... A previous randomized control trial of PREPP in a sample of 54 pregnant women with subthreshold symptoms of depression showed that PREPP was associated with a statistically significant reduction in depressive and anxiety symptoms at 6 weeks after delivery. 6 Rates of depression are higher for those living in poverty, with almost 50% of low-income mothers of infants and young children having depression. 7 Women who live in poverty often have a combination of low maternal education, young maternal age at childbirth, single parenthood, minority group status, substance use, increased stressful life situations, and challenges accessing mental healthcare, all leading to a higher risk of MMHDs and poor developmental outcomes in the offspring. ...
... 36,37 Each depression scale has strengths and weaknesses relevant to the study aims and is reliable for prenatal and postpartum research, 38 and the 4 scales have been used together in previous research. 6,39,40 The HRSD provides observer ratings; in some studies, the selfreport EPDS has demonstrated greater reliability than the PHQ-9 for postpartum women, 41e43 whereas the PHQ-9 has robust evidence for use in primary care settings. 42 The following cutoffs were used to test PPD outcomes, which have been used in a previous research as cutoffs for depression diagnosis 38 : EPDS, 9 (a cutoff value found to be optimal among low-income, urban women) 44 ; HRSD, 7 38 ; HRSA, 14 45,46 ; and PHQ-9, 10. 41,43 Analyses Data were analyzed on an intention to treat basis. ...
... Consistent with previous results of PREPP 6 -a novel, dyadic approach to preventing MMHDs delivered within OB clinical care-this study found that PREPP reduced postnatal depressive and anxiety symptoms at 6 weeks after delivery in a sample of women at risk of PPD based on poverty status. Similar to Original Research the previous trial of PREPP, we did not see symptom reductions at later postpartum time points. ...
Article
Background The United States Preventive Services Task Force recommends that clinicians provide or refer pregnant and postpartum women who are at an increased risk of perinatal depression to counseling interventions. However, this prevention goal requires effective interventions that reach women at risk of, but before, the development of a depressive disorder. Objective We describe a pilot efficacy trial of a novel dyadic intervention to prevent common maternal mental health disorders, that is, Practical Resources for Effective Postpartum Parenting, in a sample of women at risk of maternal mental health disorders based on poverty status. We hypothesized that Practical Resources for Effective Postpartum Parenting compared with enhanced treatment as usual would reduce symptoms of maternal mental health disorders after birth. Study Design A total of 60 pregnant women who were recruited from obstetrical practices at Columbia University Irving Medical Center were randomized to the Practical Resources for Effective Postpartum Parenting (n=30) or enhanced treatment as usual (n=30) intervention. The Edinburgh Postnatal Depression Scale, Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, and Patient Health Questionnaire were used to compare maternal mood at 6 weeks, 10 weeks, and 16 weeks after delivery. Results At 6 weeks after delivery, women randomized to Practical Resources for Effective Postpartum Parenting had lower mean Edinburgh Postnatal Depression scores (P=.018), lower mean Hamilton Depression scores (P<.001), and lower mean Hamilton Anxiety scores (P=.041); however, the incidence of postpartum mental disorders did not differ by treatment group. Conclusion The Practical Resources for Effective Postpartum Parenting, which is an intervention integrated within obstetrical care, improves subclinical symptomology for at-risk dyads at a crucial time in the early postpartum period; however, our study did not detect reductions in the incidence of postpartum mental disorders.
... Early screening and intervention can help prevent more serious symptoms and lessen the impact on parent and baby. 24 In the past decade numerous national medical governing bodies and professional organizations have formally recommended screening for perinatal mental health conditions. [25][26][27][28][29][30] In addition, the American College of Obstetricians and Gynecologists recently issued recommendations on comprehensive care in the first three months postpartum and is developing guidance on screening, assessing, and treating perinatal mental health conditions. ...
... Three evidence-based protocols-Mothers and Babies; Reach Out, Stay Strong, Essentials for Mothers of Newborns (ROSE); and Practical Resources for Effective Postpartum Parenting (PREPP)-have proved effective in preventing perinatal mental health conditions by teaching parents how to reduce stress, improve communication, and build social support. 24,32,58 These programs focus primarily on parents with limited resources or support systems and are typically available via community mental health centers, federally qualified health centers, or home visiting programs. ...
Article
In the United States, mental health conditions are the most common complications of pregnancy and childbirth, and suicide and overdose combined are the leading cause of death for new mothers. Although awareness of and action on perinatal mental health is increasing, significant gaps remain. Screening and treatment are widely recommended but unevenly implemented, and policies and funding do not adequately support the mental health of childbearing people. As a result, treatable perinatal mental health conditions can have long-term, multigenerational negative consequences. This article provides an overview of the perinatal mental health landscape in the United States by identifying serious gaps in screening, education, and treatment; describing recent federal and state policy efforts; highlighting successful models of care; and offering recommendations for robust and integrated perinatal mental health care.
... Secondly, this study targeted the mother and her infant. Most PND interventions focus on the mother rather than the mother-infant dyad (Werner et al. 2016). Targeting the mother-infant relationship can reduce PND symptoms (Werner et al. 2016). ...
... Most PND interventions focus on the mother rather than the mother-infant dyad (Werner et al. 2016). Targeting the mother-infant relationship can reduce PND symptoms (Werner et al. 2016). Thirdly, our intervention taught mothers on healthy motherinfant interaction and infant stimulation, thus improving maternal competence. ...
Article
Full-text available
Research has shown that postnatal depression (PND) is higher in low- and middle-income countries as compared to higher-income countries. Despite this, little is known about practical interventions in these poorly resourced countries. This research investigated the effectiveness of a brief, prophylactic and therapeutic psychoeducational intervention in a low-resourced community in Nairobi. Two closely similar Maternal and Child Health (MCH) clinics in urban slums in Nairobi were identified and randomly selected. A total of 567 mothers formed the study population. The experimental group (284) mothers received the intervention, which included psychoeducation on PND, coping skills, healthy way of mother/child interaction and infant stimulation in addition to routine treatment, while the control group (283) mothers received treatment as usual. Data was collected using a social-demographic questionnaire and the English version of Becks Depression Inventory (BDI) at baseline. At 6 months, we reassessed both groups using BDI only. Within group comparison, the percentage reduction of depression was 35.6% among the experimental as compared to 2.3% in the control group. Between group comparison, the mean BDI depression score was significantly low in the experimental arm compared to the control arm at endline (p = 0.025). When all variables were adjusted, using a generalized linear model, BDI depression score reduction among the participants was significantly associated with the intervention (p = 0.040). A brief, psychoeducational intervention that targets the mother and her infant may reduce PND even in poorly resourced environments. Therefore, it can be integrated into existing MCH services.
... PREPP revealed strong effects on reducing depression symptoms at 6 weeks, but the effect was not sustained beyond that period. 140 This suggests a role for pediatric providers in providing ongoing parenting education along with evidence-based strategies for coping with stress. ...
... The recommendation for maternal depression screening is once during pregnancy and then during the infant's well visits at 1, 2, 4, and 6 months of age.15,20 However, despite the efforts of many state and local AAP and AAFP chapters and other advocacy groups, perinatal depression screening remains far from universal in clinical practice or payment.140 As more providers are screening and identifying psychosocial risk factors in diverse clinical settings, more emphasis needs to be put on improving collaboration and transitions of care throughout the perinatal period. ...
Article
Perinatal depression is the most common obstetric complication in the United States, with prevalence rates of 15% to 20% among new mothers. Untreated, it can adversly affect the well-being of children and families throught increasing the risk for costly complications during birth and lead to deterioration of core supports, including partner relationships and social networks. Perinatal depression contributes to long-lasting, and even permanent, consequences for the physical and mental health of parents and children, including poor family functioning, increased risk of child abuse and neglect, delayed infant development, perinatal obstetric complications, challenges with breastfeeding, and costly increases in health care use. Perinatal depression can interfere with early parent-infant interaction and attachment, leading to potentially long-term disturbances in the child's physical, emotional, cognitive, and social development. Fortunately, perinatal depression is identifiable and treatable. The US Preventive Services Task Force, Centers for Medicare and Medicaid Services, and many professional organizations recommend routine universal screening for perinatal depression in women to facilitate early evidence-based treatment and referrals, if necessary. Despite significant gains in screening rates from 2004 to 2013, a minority of pediatricians routinely screen for postpartum depression, and many mothers are still not identified or treated. Pediatric primary care clinicians, with a core mission of promoting child and family health, are in an ideal position to implement routine postpartum depression screens at several well-child visits throughout infancy and to provide mental health support through referrals and/or the interdisciplinary services of a pediatric patient-centered medical home model.
... One can also consider whether the mother's difficulty in getting involved with her baby is not a factor that affects her mood after childbirth. This is emphasized in the studies in which mothers at risk of postnatal depression were subjected to specific actions to improve their ability to care for their child, which resulted in a reduction of anxiety and depression symptoms [17]. ...
... Feedback can occur, in which difficulties in building attachment to the child aggravate the mother's depression and her symptoms have a negative impact on the relationship with the child. Undoubtedly, the therapeutic effects directed at the relationship between the mother and the child allow to break the vicious circle [17]. ...
... Although the majority of participants in the included studies were non-Hispanic white (69% of all participants in trials that reported race/ethnicity), 2 trials were limited to Latina women, 27,28 and 8 had majority black and Latina samples. [16][17][18][36][37][38][39][40] In addition, 13 studies (26%) were primarily or entirely composed of economically disadvantaged women. 16 (52) 42 (84) 42 (84) 12 (24) 23 (46) 20 (40) 11 (22) 13 ( Studies excluded persons with a diagnosis of depressive disorder or who met an a priori threshold for symptoms of depression (eg, exceeded a specified score on a screening test). ...
Article
Importance: Depression during pregnancy and the postpartum period is relatively common and can have adverse effects on both mother and child. Objective: To systematically review benefits and harms of primary care-relevant interventions to prevent perinatal depression, a major or minor depressive episode during pregnancy or up to 1 year after childbirth, to inform the US Preventive Services Task Force. Data sources: MEDLINE, PubMED (for publisher-supplied records only), PsycINFO, and the Cochrane Central Register of Controlled Trials; surveillance through December 5, 2018. Study selection: Randomized clinical trials (RCTs) and nonrandomized controlled intervention studies of interventions (eg, behavior-based, antidepressants, dietary supplements) to prevent perinatal depression in general populations of pregnant and postpartum individuals or in those at increased risk of perinatal depression. Large cohort studies were considered for harms of antidepressant use only. Data extraction and synthesis: Two investigators independently reviewed abstracts and full-text articles and quality rated included studies. Random-effects meta-analysis was used to estimate the benefits of the interventions. Main outcomes and measures: Depression status; depression symptoms; maternal, infant, and child health outcomes. Results: Fifty studies (N = 22 385) that met inclusion criteria were identified. Counseling interventions were the most widely studied interventions. Compared with controls, counseling interventions were associated with a lower likelihood of onset of perinatal depression (pooled risk ratio [RR], 0.61 [95% CI, 0.47-0.78]; 17 RCTs [n = 3094]; I2 = 39.0%). The absolute difference in the risk of perinatal depression ranged from 1.3% greater reduction in the control group to 31.8% greater reduction in the intervention group. Health system interventions showed a benefit in 3 studies (n = 5321) and had a pooled effect size similar to that of the counseling interventions, but the pooled effect was not statistically significant using a method appropriate for pooling a small number of studies (restricted maximum likelihood RR, 0.58 [95% CI, 0.22-1.53]; n = 4738; I2 = 66.3%; absolute risk reduction range, -3.1% to -13.1%). None of the behavior-based interventions reported on harms directly. A smaller percentage of participants prescribed sertraline had a depression recurrence compared with those prescribed placebo (7% vs 50%, P = .04) at 20 weeks postpartum in 1 very small RCT (n = 22 analyzed) but with an increased risk of adverse effects to the mother. Conclusions and relevance: Counseling interventions can be effective in preventing perinatal depression, although most evidence was limited to women at increased risk for perinatal depression. A variety of other intervention approaches provided some evidence of effectiveness but lacked a robust evidence base and need further research.
... 52 Two other trials reported statistically significant or near-significant reductions in symptom severity scores at 1 (but not all) of several time points on at least 1 depression screening instrument (but not all). 53,54 Educational interventions and other supportive interventions, such as telephone-based peer support and nondirective group sessions, dem-onstrated inconsistent findings, with 1 of 6 and 3 of 7 trials, respectively, reporting statistically significant reductions in depression status or depression symptom scores. Yoga classes, debriefing exercises, and expressive writing failed to demonstrate statistically significant reductions in depression symptoms or status. 2 Four trials of chemoprevention of perinatal depression assessed the effects of sertraline (n = 22), 55 nortriptyline (n = 58), 56 and omega-3 fatty acids (n = 219). ...
Article
Importance: Perinatal depression, which is the occurrence of a depressive disorder during pregnancy or following childbirth, affects as many as 1 in 7 women and is one of the most common complications of pregnancy and the postpartum period. It is well established that perinatal depression can result in adverse short- and long-term effects on both the woman and child. Objective: To issue a new US Preventive Services Task Force (USPSTF) recommendation on interventions to prevent perinatal depression. Evidence review: The USPSTF reviewed the evidence on the benefits and harms of preventive interventions for perinatal depression in pregnant or postpartum women or their children. The USPSTF reviewed contextual information on the accuracy of tools used to identify women at increased risk of perinatal depression and the most effective timing for preventive interventions. Interventions reviewed included counseling, health system interventions, physical activity, education, supportive interventions, and other behavioral interventions, such as infant sleep training and expressive writing. Pharmacological approaches included the use of nortriptyline, sertraline, and omega-3 fatty acids. Findings: The USPSTF found convincing evidence that counseling interventions, such as cognitive behavioral therapy and interpersonal therapy, are effective in preventing perinatal depression. Women with a history of depression, current depressive symptoms, or certain socioeconomic risk factors (eg, low income or young or single parenthood) would benefit from counseling interventions and could be considered at increased risk. The USPSTF found adequate evidence to bound the potential harms of counseling interventions as no greater than small, based on the nature of the intervention and the low likelihood of serious harms. The USPSTF found inadequate evidence to assess the benefits and harms of other noncounseling interventions. The USPSTF concludes with moderate certainty that providing or referring pregnant or postpartum women at increased risk to counseling interventions has a moderate net benefit in preventing perinatal depression. Conclusions and recommendation: The USPSTF recommends that clinicians provide or refer pregnant and postpartum persons who are at increased risk of perinatal depression to counseling interventions. (B recommendation).
... Data used in the current study came from a small randomized control trial (RCT) that compared enhanced treatment as usual (ETAU) to Practical Resources for Effective Postpartum Parent- ing (PREPP; NCT02121496), a brief intervention program aimed at preventing postpartum depression. 14 This intervention consists of (1) teaching mothers behavioral techniques to help soothe their crying baby (e.g. swaddling, carrying), (2) providing psychoedu- cation about the postpartum period (e.g. ...
Article
Maternal perinatal depression exerts pervasive effects on the developing brain, as evidenced by electroencephalographic (EEG) patterns that differ between children of women who do and do not meet DSM or ICD diagnostic criteria. However, little research has examined if the same EEG pattern of right-frontal alpha asymmetry exists in newborns and thus originates in utero independent of postnatal influences, and if depressive symptoms are associated with this neural signature. Utilizing 125-lead EEG ( n= 18), this study considered clinician-rated maternal prenatal depressive symptoms in relation to newborn EEG. Maternal depressive symptomatology was associated with greater relative right-frontal alpha asymmetry during quiet sleep. These results suggest that even subclinical levels of maternal depression may influence infant brain development, and further support the role of the prenatal environment in shaping children’s future neurobehavioral trajectories.
... Specifically, interventions that improve pregnant women's well-being and affect regulation may also reach the developing child; improvement in mood during pregnancy is thought to diminish risks for postpartum depression and the associated effects on the child and to foster more positive representations of the child in utero that will carry over into the quality of the mother-child attachment system (Glover & Capron 2017). Increasingly, clinical researchers who study maternal perinatal mood disturbance are calling for a dyadic approach to treatment, one that encompasses both the mother and her child (or future child), given the profound bidirectional psychological and biological influences between them (Weissman 2018, Werner et al. 2016). An innovative, ongoing NIH randomized controlled trial (ClinicalTrials.gov ...
Article
The developmental origins of health and disease hypothesis applied to neurodevelopmental outcomes asserts that the fetal origins of future development are relevant to mental health. There is a third pathway for the familial inheritance of risk for psychiatric illness beyond shared genes and the quality of parental care: the impact of pregnant women's distress—defined broadly to include perceived stress, life events, depression, and anxiety—on fetal and infant brain–behavior development. We discuss epidemiological and observational clinical data demonstrating that maternal distress is associated with children's increased risk for psychopathology: For example, high maternal anxiety is associated with a twofold increase in the risk of probable mental disorder in children. We review several biological systems hypothesized to be mechanisms by which maternal distress affects fetal and child brain and behavior development, as well as the clinical implications of studies of the developmental origins of health and disease that focus on maternal distress. Development and parenting begin before birth. Expected final online publication date for the Annual Review of Clinical Psychology Volume 15 is May 7, 2019. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
... The pregnant and postpartum period includes logistical challenges to attending added health care appointments typically uncoordinated with obstetric and pediatric care. [64][65][66][67] And yet pregnant and postpartum women have dramatically increased contact with primary care providers based on routine prenatal and pediatric visits. Barriers to access of mental health care and success of treatment include lack of accessible treatment. ...
Article
Maternal mortality continues to be a public health priority in national and international communities. Maternal death rates secondary to medical illnesses such as cardiovascular disease, preeclampsia, and postpartum hemorrhage are well documented. The rates of maternal death secondary to self-harm, including suicide and overdose, have been omitted from published rates of maternal mortality, despite growing attention to the prevalence of perinatal mood disorders, estimated at up to 15% of pregnant and postpartum women in the United States. Underlying psychiatric disorder, including depression, is consistently identified as a risk factor in substance abuse and suicide. The rate of opioid-associated morbidity and mortality has recently been deemed a national crisis. Pregnancy does not protect against these risks, and the postpartum period has been identified as a particularly vulnerable time. The lack of consistent and inclusive data on self-harm deaths in the pregnancy-postpartum period is alarming. This review will identify barriers to reporting and ascertainment of maternal suicide and overdose deaths, summarize geographic-specific data available, address potential social and psychological biases that have led to neglect of the topic of maternal self-harm deaths, and suggest recommendations that incorporate the whole woman in prenatal care and thus prevention of this devastating outcome.
... The therapy is grounded in the conceptual frameworks of psychoanalysis, attachment theory, stress and trauma work and developmental psychopathology (Austin and Highet, 2013). Studies have found effect of MIP in improving the mother-infant relationship/interaction and maternal mood as well (Werner et al., 2016). Meschino et al. suggested that MIP showed excellent feasibility, acceptability, and had good preliminary efficacy results (de Camps et al., 2016). ...
Article
Background: It has been suggested that mother-infant psychotherapy may offer an alternative approach to treating postpartum depression, but little is known about its effectiveness. This review presents a summarized effectiveness of mother-infant psychotherapy on postpartum depression. Methods: Multiple electronic databases were searched including Pubmed, Cochrane Library, EMBase, MEDLINE, et al. Hand searching of references was also performed. Randomized controlled trials reporting on mother-infant psychotherapy targeting postpartum depression were included if they used a validated measure of prescribing appropriateness. Evidence quality was assessed using the Cochrane risk of bias tool. Results: A total of 13 randomized controlled trials met inclusion criteria and were included in the final analysis. In the short-term effect analysis, mother-infant psychotherapy reduced standardized mean depressive scores (-0.25, 95% CI -0.40, -0.09) and risk ratio (0.71, 95% CI 0.55, 0.91). In the long-term effect analysis, mother-infant psychotherapy did not improve maternal mood, mother-infant interaction and infant attachment. Limitations: Clinical heterogeneity was observed among included studies in mother-infant psychotherapy intervention, suggesting the existence of potential moderators such as intensity, frequency, trimester of pregnancy or type of mother-infant psychotherapy. Conclusion: Mother-infant psychotherapy appears to be effective for the treatment of maternal depression in the short-term. Future studies with better design/execution and larger sample size are needed to confirm the effect of mother-infant psychotherapy on short-term and to explore its effect on long-term depression.
... These problems have a significant effect and they can have a negative impact on their physical, emotional, and social health, breastfeeding, relationships with the family, community, baby care, and homework (Bahrami et al., 2014;Parker et al., 2015). Postpartum physical and psychological problems can interfere with the ability of the new mothers to care for their babies and this can adversely affect their quality of life (Lovell, Huntsman, & Hedley-Ward, 2015;Werner et al., 2016). ...
Article
Full-text available
Postpartum mothers are vulnerable to several problems during the puerperium, such as fatigue, sleep disorders, anxiety, depression, sexual problems, physical functioning and dissatisfaction with partner support that can affect their quality of life. The aim of this systematic review is to explore the effect of exercise on postpartum women’s quality of life. Comprehensive searches including experimental studies (including RCTs and non-randomized trials) from several databases, namely Scopus, PubMed, and Science-Direct, were used to search for scientific contributions published between 2009 and 2019. The articles are identified using the relevant keywords. This systematic review is guided by PRISMA. Fourteen of the 636 articles met both the inclusion and exclusion criteria. The postpartum exercises found in this study were Yoga, Pelvic Floor Muscle Training (PFMT), Pilates, Postnatal Exercise, Aerobic Exercise and Progressive Muscle Relaxation (PMR). This review cannot provide definitive conclusions about the best form of exercise, the suggested duration or the timing needed to improve the quality of life for postpartum women. However, Yoga and Pilates are proven to effectively improve maternal well-being because this exercise focuses on increasing the physical, psychological and social support during the postpartum period. Further research is needed to provide evidence and to strengthen the results of this systematic review.
... The positive interaction of the mother with the infant can be therapeutic in itself. 9 One could pick apart the methods of all the studies (eg, sample sizes, duration and intensity of treatment, severity of maternal depression, reliability of the outcome measures). But a more fruitful point of the discussion could be the paucity of research and the need for new direction. ...
Article
Just when it seemed that nothing new could be written about the clinical effects of maternal depression on offspring, an article has appeared that deepens our insight and raises new, interesting questions. Using data from the British Avon Longitudinal Study of Parents and Children (ALSPAC), Netsi et al¹ examine the long-term course and impact of persistent, severe postpartum depression on a child. The ALSPAC is an ongoing population-based study examining the overall health of children. It enrolled all pregnant women in a section of southwest England who delivered between April 1991 and December 1992 (n = 9848), with attrition over the years.
... Findings suggested that the intervention was effective and we included them in our analysis (B3.3). Werner et al. (2015; US; RCT; N=54; initiated and started during pregnancy, completed postnatal) evaluated an intervention called Practical Resources for Effective Postpartum Parenting (PREPP); the aim was to determine if a behavioural intervention primarily targeting maternal caregiving could increase infant sleep and reduce fussing or crying, and thereby reduce the incidence or severity of postpartum maternal depression. This was an integrated intervention that incorporated caregiving techniques, traditional psychotherapy approaches, psycho-education, as well as mindfulness meditation training. ...
... Considering the growing evidence pointing to the emergence of a "parental brain" that underlies caregiving behavior and adaptation to motherhood, further investigation into the influence of maternal psychopathology on these neural adaptations likely will underscore the dyadic nature of maternal mental illness as affecting both mother and child (Barrett and Fleming, 2011;Werner et al., 2015). In attempting to understand how psychopathology may emerge or be exacerbated in the peripartum, consideration of the potential negative consequences of these otherwise adaptive changes to the maternal brain, as well as individual differences in the degree of brain change across this period, could reveal neural bases for perinatal mental illness. ...
Chapter
This chapter provides an overview of current research discoveries beginning to uncover the neurobiology of maternal mental illness. Results are described according to standard diagnostic categories (specifically, perinatal depression, perinatal anxiety and OCD, postpartum psychosis and bipolar disorder, and trauma and posttraumatic stress disorder), yet we aim to put this approach in context with the introduction of a classification model for psychiatric research, the research domain criteria, gaining traction in basic and clinical translational fields. We first review a new area of study, the neuroplasticity of the pregnant and postpartum brain, as work here has relevance for understanding the pathophysiology of mental disorders and may provide clues to changes in brain functioning that are related to compromised parenting in the context of postpartum depression. We next provide background information on neuroendocrine and immune changes during pregnancy and, to a lesser extent, the postpartum period, as alterations in these systems are significantly implicated in underlying neurobiology of mental illness for peripartum women. Our discussion of the major mental illnesses for pregnant and postpartum women includes neuroendocrine changes, neuroinflammation, and neurotransmitter alterations, as well as circuit dysfunction. Overall, remarkable progress has been made in identifying variations in neurobiology (and related systems) involved in maternal mental illness; yet, it is clear that, as classified with standard diagnostic systems, these are heterogeneous disorders and there is individual variability in the alterations in neurobiology for the same illness.
... Several important barriers to these interventions have been proposed, including inconsistent measurement of PPD and high rates of attrition, potentially as consequences of stigma, accessibility, and a sole focus on the mother. 93,120 Feasibility of Web-based and smartphone-based interventions for PPD to address accessibility challenges have been piloted and represent innovative future directions. [121][122][123][124][125] Examples of larger selected interventions targeting depression after the first year of life have found that improvement in maternal depression symptoms mediated the effect of family-based treatment on toddlers externalizing and internalizing symptoms; however, this was not specific to PPD. 126 Despite evidence that universal CBT was, for the most part, ineffective in decreasing PPD risk, CBT provided to selected high-risk populations seems to have some efficacy in decreasing depression risk as well as in mood regulation and coping, factors expected to have direct implications for maternal caregiving. ...
Article
The lasting negative impact of postpartum depression (PPD) on offspring is well established. PPD seems to have an impact on neurobiological pathways linked to socioemotional regulation, cognitive and executive function, and physiologic stress response systems. This review focus on examining the current state of research defining the effect of universal, selected, and indicated interventions for PPD on infant neurodevelopment. Given the established lasting, and potentially intergenerational, negative implications of maternal depression, enhanced efforts targeting increased identification and early intervention approaches for PPD that have an impact on health outcomes in both infants and mothers represent a critical public health concern.
... There is preliminary evidence that parenting support and anticipatory parenting guidance can prevent postpartum depression. 23 Obstetricians can play a key role in recognizing women with need for additional parenting support and refer to appropriate resources such as home visiting programs or maternity support services, available in most states. A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either 1) depressed mood or 2) loss of interest or pleasure. ...
Article
Women are at a higher risk for depression than are men, and this risk is especially pronounced at specific reproductive periods of vulnerability: adolescence, pregnancy, postpartum, and the menopausal transition. Obstetrician-gynecologists are often the health care providers who women consult during these vulnerable periods, usually presenting with conditions or complaints other than depression or anxiety. Presenting symptoms are frequently known comorbidities with depression or are risk factors for depression. Thus, by screening for depression and other mood disorders in these critical periods, in addition to screening at routine intervals such as annual examinations, obstetricians and gynecologists can play an important role in early detection, prevention, and treatment of mood disorders and their comorbid conditions. We provide a framework for depression management within busy obstetric gynecology settings using new integrated care models for mental health.
... Our findings suggest that incorporating aspects of bonding in interventions for mothers with a history of a bipolar spectrum disorder could be valuable, irrespective of a relapse. For example, Practical Resources for Effective Postpartum Parenting is an intervention for women at risk for postpartum depression that focuses on the mother-infant dyad, and had positive outcomes for the mother, child and the mother-child relationship (36). Next, findings of a meta-analysis showed that maternal-child interaction guidance could be a promising intervention for mothers with postpartum depression, with regard to parenting and child outcomes (37). ...
Article
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Purpose: Offspring of mothers with a bipolar disorder are at high-risk for impaired developmental outcomes and psychopathology (e. g., mood, anxiety, sleep disorders) later in life. This increased risk of psychopathology is not only because of genetic vulnerability, but environmental factors may play an important role as well. The often long and debilitating mood episodes of mothers with bipolar disorder might hamper their qualities as a caregiver and may impact the child. We examined early mother-to-infant bonding 1 year postpartum in mothers with bipolar spectrum disorder as compared to mothers of the general population. The association between mother-to-infant bonding and the type of bipolar spectrum diagnosis (bipolar I, bipolar II, bipolar Not Otherwise Specified) as well as relapse within 12 months postpartum was also assessed. Methods: In total, 75 pregnant women with a bipolar spectrum disorder participated in the current study. The participants were included in a longitudinal cohort study of women with bipolar spectrum disorder and were prospectively followed from pregnancy until 1 year postpartum. Mother-to-infant bonding was assessed using the Pre- and Postnatal Bonding Scale. A longitudinal population-based cohort of 1,419 pregnant women served as the control group. Multiple linear regression analyses were used to assess the association between bipolar spectrum disorder and mother-to-infant bonding scores, controlling for several confounders. Results: Women with bipolar spectrum disorder perceived the bonding with their child as less positive compared to the control group. The type of bipolar spectrum disorder was not associated with poorer bonding scores. Relapse during the 1st year after delivery also did not affect bonding scores in women with bipolar spectrum disorder. Conclusions: Our findings could imply that women with bipolar spectrum disorder are more vulnerable to impairments in bonding due to the nature of their psychopathology, regardless of the occurrence of postpartum relapse. Careful follow-up including monitoring of mother-to-infant bonding of pregnant women with a history of bipolar spectrum disorder should be a standard to this vulnerable group of women. In addition, regardless of severity and mood episode relapse, an intervention to improve bonding could be beneficial for all mothers with bipolar spectrum disorder and their newborns.
... Importantly, recent work evaluating dyadic therapy designed to prevent postpartum depression and anxiety in high-risk women includes a randomized control trial that found not only fewer symptoms for women in the intervention group at 6 weeks postpartum, but also clear behavioral changes in infants. Infants of women in the intervention group exhibited less fussing and crying than infants of women in the enhanced treatment as usual group [42]. ...
Article
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Purpose of review: This review evaluates the state of the research regarding the effects of postpartum mental illness on the developing infant. It defines the scope of these disorders in the literature, and includes the impact of disorders referred to as perinatal mood and anxiety disorders (PMADs) on infants. Recent findings: New research reveals that PMADs apply to not only mothers, but that fathers can also experience perinatal depression and anxiety. When untreated in a primary caregiver, PMADs adversely affect parental cognitions and beliefs, attachment to the infant, and the growing caregiver-infant relationship. PMADs affect early developmental outcomes of infants including neurosynaptic development, regulatory development, and developmental milestones. Early identification and treatment for PMADs are critical to ensure optimal infant development. Standardized and routine screening for PMADs, especially in the first 6 months postpartum, and cross-disciplinary communication among medical providers afford the best opportunity for early identification and treatment.
... Given that lower resting fetal HRV has been associated with more difficult infant temperament , this study's findings also suggest that children of abused mothers may enter the world more physiologically reactive and more difficult to soothe. Preventive programs that focus on teaching mothers behavioral techniques that can help to settle and soothe reactive infants (e.g., Werner et al., 2016) may be particularly high yield when implemented in this population. Child HRV continues to undergo development throughout childhood (and has been shown to be influenced by contextual factors, including parenting behaviors; e.g., Perry et al., 2014), suggesting that interventions of this nature may help children compensate for lower fetal HRV. ...
Article
The consequences of childhood maltreatment are profound and long lasting. Not only does the victim of abuse suffer as a child, but there is mounting evidence that a history of maltreatment places the next generation at risk for significant psychopathology. Research identifies postnatal factors as affecting this intergenerational transmission of trauma. However, emerging evidence suggests that part of this risk may be transmitted before birth, passed on via abuse-related alterations in the in utero environment that are as yet largely unidentified. To date, no study has directly assessed the influence of pregnant women's abuse history on fetal neurobehavioral development, nor considered trauma-associated poor sleep quality as a mediator reflecting established physiological dysregulation. Using data from 262 pregnant adolescents (ages 14–19), a population at elevated risk for childhood maltreatment, the current study examined maternal emotional abuse history and sleep quality in relation to third-trimester fetal resting heart rate variability, an index of parasympathetic nervous system functioning. The results indicate that maternal emotional abuse history is indirectly associated with lower fetal heart rate variability via abuse-related sleep disturbances. These data demonstrate an association between maternal abuse histories and fetal development, showing that at least part of the intergenerational transmission of risk occurs during pregnancy.
... Fears of teratogenic effects of sleep medications often prevent perinatal women from utilizing this option [83], and the evaluation of behavioral interventions is sorely lacking in perinatal cohorts. There are some reports of interventions including the use of chamomile tea [84], psychoeducation about hormonal and psychosocial changes [85,86], mindfulness meditation [87], cognitive behavioral therapy [88], and maternally mediated behavioral changes in their infants [89]. Barring a handful of interventions (being) conducted on pregnant women [90,91], most of which do not focus on sleep, and almost all studies have been conducted in postpartum women with PPD. ...
Article
Full-text available
The perinatal period introduces a myriad of changes. One important but often overlooked change is an increased reporting of sleep disturbance. Although casually regarded as a consequence of pregnancy or postpartum, there is emerging evidence implicating significant sleep disturbance, characterized by insomnia symptoms and/or poor sleep quality, with adverse outcomes, such as an increase in depressive symptomatology or the development postpartum depression (PPD). Significant consequences may arise as a result including issues with maternal-infant bonding, effective care for the infant, and behavioral or emotional difficulties in the infant. This review discusses the relevant literature as to how disturbed sleep during pregnancy as well as in the postpartum may increase the risk for PPD.
... Practical Resources for Effective Postpartum Parenting is an example of an intervention program that aims to treat at-risk women by promoting maternally-mediated behavioral changes in their infants, while also including mother-focused skills (e.g., mindfulness). Results from a randomized control trial indicate that this novel, brief intervention reduced maternal symptoms of anxiety and depression, particularly at 6 weeks postpartum, although symptomology in the sample was sub-clinical [50]. Such interventions can leverage the unique, dyadic nature of the transition to parenting, addressing mothers' prenatal distress as a way to focus on the health of both mothers and babies. ...
Article
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Background Maternal prenatal stress is associated with worse socio-emotional outcomes in offspring throughout childhood. However, the association between prenatal stress and later caregiving sensitivity is not well understood, despite the significant role that caregiving quality plays in child socio-emotional development. The goal of this study was to examine whether dimensions of pregnancy-specific stress are correlated with observer-based postnatal maternal caregiving sensitivity in pregnant adolescents. Methods Healthy, nulliparous pregnant adolescents (n = 244; 90 % LatinX) reported on their pregnancy-specific stress using the Revised Prenatal Distress Questionnaire (NuPDQ). Of these 244, 71 participated in a follow-up visit at 14 months postpartum. Videotaped observations of mother-child free play interactions at 14 months postpartum were coded for maternal warmth and contingent responsiveness. Confirmatory factor analysis of the NuPDQ supported a three-factor model of pregnancy-specific stress, with factors including stress about the social and economic context, baby’s health, and physical symptoms of pregnancy. Results Greater pregnancy-specific stress about social and economic context and physical symptoms of pregnancy was associated with reduced maternal warmth but not contingent responsiveness. Conclusions Heightened maternal stress about the social and economic context of the perinatal period and physical symptoms of pregnancy may already signal future difficulties in caregiving and provide an optimal opening for early parenting interventions.
... support expectant parents [6], but it also requires identification of the prenatal influences that promote motherfetus bonding during pregnancy and an understanding of how expectant mothers' emotional bonds with the their unborn infants might contribute to later variation in their caregiving practices. ...
Article
Full-text available
Background Maternal–Fetal Attachment (MFA) describes the cognitive-representational, emotional, and behavioral aspects of the mother–fetus relationship that develops during pregnancy. We present two studies conducted on pregnant Italian women. In Study I, we aimed to explore multifaceted associations of MFA with variables important for a healthy pregnancy (e.g., maternal mental health, the couple’s relationship). In Study II, we investigated the predictive role of MFA on observed maternal caregiving during the first months of the infant’s life. Methods In Study I, 113 pregnant Italian women were assessed on MFA (Maternal Antenatal Attachment Scale, MAAS), maternal depression (Beck Depression Inventory-II, BDI-II), maternal anxiety (State Trait Anxiety Inventory – State version, STAI), adjustment of the couple (Dyadic Adjustment Scale, DAS), and perceived parental care (The Parental Bonding Instrument, PBI). In Study II, 29 mother–infant pairs were followed up at 4 months to assess observational variables of maternal caregiving through the Emotional Availability Scale (EAS) and to test for an association with MFA in pregnancy. Results Study I showed a significant association between MFA and the quality of the couple relationship (β = .49, P < .001) and between MFA and the recall of memories of care received in childhood (β = .22, P = .025). Study II showed a predictive effect of MFA on maternal structuring observed during mother–infant interactions at 4 months of age (β = 0.36, P = .046). Conclusion The study points out relevant relationship contexts that might receive care and support throughout pregnancy to protect MFA. The findings also provide thoughtful insights on the role of MFA in early maternal caregiving, suggesting that MFA might be a candidate as one putative antecedent of mother–infant interaction processes.
... However, risk of PPD is often overlooked during the pregnancy follow-up process, which is focused on the physical health of the mother and the well-being of the fetus. It is wellaccepted that intervention by either pharmacological treatment or psychological counseling may reduce the risk of perinatal depression [12] and may improve the outcomes of both mother and child [13], however the safety of exposure to antidepressant medications during pregnancy and breastfeeding is an area of current research [14] . Although the risk factors of PPD are well-known, there are no quantitative risk assessment tools to support the screening and clinical management of women during perinatal period. ...
Article
Full-text available
Background Postpartum depression is a widespread disorder, adversely affecting the well-being of mothers and their newborns. We aim to utilize machine learning for predicting risk of postpartum depression (PPD) using primary care electronic health records (EHR) data, and to evaluate the potential value of EHR-based prediction in improving the accuracy of PPD screening and in early identification of women at risk. Methods We analyzed EHR data of 266,544 women from the UK who gave first live birth between 2000 and 2017. We extracted a multitude of socio-demographic and medical variables and constructed a machine learning model that predicts the risk of PPD during the year following childbirth. We evaluated the model’s performance using multiple validation methodologies and measured its accuracy as a stand-alone tool and as an adjunct to the standard questionnaire-based screening by Edinburgh postnatal depression scale (EPDS). Results The prevalence of PPD in the analyzed cohort was 13.4%. Combing EHR-based prediction with EPDS score increased the area under the receiver operator characteristics curve (AUC) from 0.805 to 0.844 and the sensitivity from 0.72 to 0.76, at specificity of 0.80. The AUC of the EHR-based prediction model alone varied from 0.72 to 0.74 and decreased by only 0.01–0.02 when applied as early as before the beginning of pregnancy. Conclusions PPD risk prediction using EHR data may provide a complementary quantitative and objective tool for PPD screening, allowing earlier (pre-pregnancy) and more accurate identification of women at risk, timely interventions and potentially improved outcomes for the mother and child.
... So konnten z. B. in der PREPP-Studie (Practical Resources for Effective Postpartum Parenting) durchaus positive Effekte auf das Verhalten der Säuglinge gezeigt werden (Werner et al. 2016). Eine Studie zur Behandlung postpartaler Depression fand hingegen keine Effekte einer zusätzlichen interaktionszentrierten Video-Feedback-Therapie auf kindliche Outcomes im Alter von zwei Jahren (kognitive Entwicklung, Sprachentwicklung, Verhaltensprobleme, Bindungssicherheit) (Stein et al. 2018). ...
Article
Early parent-child therapy fostering bonds in the case of psychological disorders in the postpartum period Psychological disorders and traumatization can have a negative influence on parental behavior with negative effects on the parent-child relationship and the child’s attachment development. The goals of early dyadic treatment of mother or father and child are, in addition to reducing maternal symptomatology, to enable a secure bonding to the child by promoting sensitivity and learning about the baby’s needs. An important method for promoting the parent-child relationship is video-based work. Early joint treatment of parents and child takes place in various settings, e. g., as personal or group sessions, in the home environment or in an outpatient facility or clinic. There are preventative interventions for dyads at increased risk of developing problems or disorders, as well as treatment for children and their parents with early trauma or mental disorders. Studies on the effectiveness of such approaches have shown that these interventions can increase parental sensitivity and improve the child’s safe bonding. Additionally, there is evidence that treatment of postpartum depression leads to greater reductions in the depressive symptoms in the mother. In contrast, there are still few and unclear findings regarding the effects on longer-term child development.
... Chronic and elevated stress levels experienced by parents while in the NICU may increase the risks for impaired social and occupational function, marital discord, difficulty in developing secure attachments with the infant, and in severe cases an impaired ability to care for the infant (Dudek-Shriber, 2004). Perinatal mood disorders can consequently lead to poor child health and development outcomes (Werner et al., 2016). However, by addressing and reducing stress through appropriate psychosocial interventions, we may be able to decrease a parent's risk for baby blues, postpartum depression, posttraumatic stress disorder (PTSD), and other mental health challenges during the perinatal period (Dennis & Dowswell, 2013). ...
Article
The perinatal experience contains many stressors that can impact parental mental health. We examined the integration of music therapy (MT), an evidence-based health profession, and its stress reduction role in parents during their inpatient maternity and neonatal intensive care unit (NICU) experience. The Perceived Stress Scale (PSS) and Stress Numeric Rating Scale (SNRS-11) were used to measure stress reduction in 34 maternity and NICU parents (17 maternity patients and 17 NICU parents). Participants included parents on the antepartum unit (expecting parents on bedrest), laboring parents, pre-operation parents before cesarean delivery, parents of full-term healthy infants on the postpartum unit, and parents of premature infants on the NICU. Results were calculated based upon number of sessions rather than total number of participants and indicated that after one MT session, a 50% reduction in the SNRS-11 was measured in NICU and antepartum parents. The PSS score demonstrated a more modest stress reduction in the NICU parents but failed to achieve a statistically significant decrease in the maternity group. Findings were in line with existing literature in MT-associated stress reduction levels and may be integrated as part of an ongoing continuity of care during pregnancy, delivery, and NICU hospitalization. Earlier screening for stress may benefit parents during their perinatal hospital stay. Further research exploring the benefits of MT, as part of continuum of care and stress management for the inpatient perinatal parent population, may encourage the inclusion of MT services and improve quality of care.
... Whether or not frequent carrying might lead to long-term benefits for maternal mental well-being could be investigated in longitudinal studies and in randomised controlled trials with follow-up assessments. One randomised-controlled study which focused on preventing postpartum depression promoted carrying as part of the intervention programme (Werner et al., 2016). Results indicated that the intervention programme successfully reduced maternal anxiety and depression symptoms and also bouts of fussing and crying in infants. ...
Article
Introduction: Mental disorders, such as postnatal depression, are common in mothers. Repetitive negative thinking has been identi- fied as a cognitive factor underlying the resulting difficulties in mother-infant interactions. Method: The present online survey investigated associations between infant carrying (baby-wearing) and maternal repetitive negative thinking and positive mental health. Results: Repetitive negative thinking was significantly lower, and positive mental health was significantly higher while carrying com- pared to overall levels. There were no relations between maternal mental health and frequency of carrying. Maternal activities during carrying are portrayed. Conclusion: These results are the first indication that carrying could be a low threshold, easily administered intervention method for maternal mental health problems.
... Background. Various approaches to PPD prevention have been implemented as follows: (i) interpersonal counselling interventions 33,34 , (ii) cognitive-behavioural therapies 35,36 , (iii) therapies to modify health habits [37][38][39] , and (iv) postpartum support interventions 2,[40][41][42][43][44] . A meta-analysis performed for the US Preventive Services Task Force 45 found that cognitive behavioural therapy and interpersonal therapy are effective interventions for preventing PPD. ...
Article
Full-text available
Postpartum depression (PPD) is the most frequent psychiatric complication during the postnatal period. According to existing evidence, an association exists between the development of PPD and the maintenance of breastfeeding. A brief motivational intervention (bMI), based on the motivational interview, seems effective in promoting breastfeeding. The objective of this study was to analyse the impact of a bMI aiming to promote breastfeeding on the development of PPD and explore the mediating/moderating roles of breastfeeding and breastfeeding self-efficacy in the effect of the intervention on developing PPD. Eighty-eight women who gave birth by vaginal delivery and started breastfeeding during the immediate postpartum period were randomly assigned to the intervention group (bMI) or control group (breastfeeding education). Randomisation by minimisation was carried out. The breastfeeding duration was longer in the intervention group (11.06 (± 2.94) weeks vs 9.02 (± 4.44), p = 0.013). The bMI was associated with a lower score on the Edinburgh Postnatal Depression Scale, with a regression β coefficient of − 2.12 (95% CI − 3.82; − 0.41). A part of this effect was mediated by the effect of the intervention on the duration of breastfeeding (mediation/moderation index β = − 0.57 (95% CI − 1.30; − 0.04)). These findings suggest that a bMI aiming to promote breastfeeding has a positive impact preventing PPD mainly due to its effectiveness in increasing the duration of breastfeeding.
... Fears of teratogenic effects of sleep medications often prevent perinatal women from utilizing this option [83], and the evaluation of behavioral interventions is sorely lacking in perinatal cohorts. There are some reports of interventions including the use of chamomile tea [84], psychoeducation about hormonal and psychosocial changes [85,86], mindfulness meditation [87], cognitive behavioral therapy [88], and maternally mediated behavioral changes in their infants [89]. Barring a handful of interventions (being) conducted on pregnant women [90,91], most of which do not focus on sleep, and almost all studies have been conducted in postpartum women with PPD. ...
Chapter
Full-text available
... Fears of teratogenic effects of sleep medications often prevent perinatal women from utilizing this option [83], and the evaluation of behavioral interventions is sorely lacking in perinatal cohorts. There are some reports of interventions including the use of chamomile tea [84], psychoeducation about hormonal and psychosocial changes [85,86], mindfulness meditation [87], cognitive behavioral therapy [88], and maternally mediated behavioral changes in their infants [89]. Barring a handful of interventions (being) conducted on pregnant women [90,91], most of which do not focus on sleep, and almost all studies have been conducted in postpartum women with PPD. ...
Chapter
Full-text available
Article
Perinatal depression is associated with high risk of morbidity and mortality, and may have a long term consequences on child development. The US Preventive Services Task Force has recently recognized the importance of identifying and treating women with depression in the perinatal period. However, screening and accessing appropriate treatment come with logistical challenges. In many areas, there may not be sufficient access to psychiatric care, and, until these resources develop, the burden may inadvertently fall on obstetricians. As a result, understanding the risks of perinatal depression in comparison to the risks of treatment is important. Many studies of selective serotonin reuptake inhibitors (SSRIs) in pregnancy fail to control for underlying depressive illness, which can lead to misinterpretation of SSRI risk by clinicians. This review discusses the risks and benefits of SSRI treatment in pregnancy within the context of perinatal depression. While SSRIs may be associated with certain risks, the absolute risks are low and may be outweighed by the risks of untreated depression for many women and their offspring.
Article
Background: The progress of labour in the early or latent phase is usually slow and may include painful uterine contractions. Women may feel distressed and lose their confidence during this phase. Support and assessment interventions have been assessed in two previous Cochrane Reviews. This review updates and replaces these two reviews, which have become out of date. Objectives: To investigate the effectiveness of assessment and support interventions for women during early labour.In order to measure the effectiveness of the interventions, we compared the duration of labour, the rate of obstetrical interventions, and the rate of other maternal or neonatal outcomes. Search methods: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register, ClinicalTrials.gov, the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (31 October 2016) and reference lists of retrieved studies. Selection criteria: Randomised controlled trials of any assessment or support intervention in the latent phase of labour. We planned to include cluster-randomised trials if they were eligible. We did not include quasi-randomised trials. Data collection and analysis: Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. We resolved any disagreement by discussion or by involving a third assessor. The quality of the evidence was assessed using the GRADE approach. Main results: We included five trials with a total of 10,421 pregnant women in this review update. The trials were conducted in the UK, Canada and America. The trials compared interventions in early labour versus usual care. We examined three comparisons: early labour assessment versus immediate admission to hospital; home visits by midwives versus usual care (telephone triage); and one-to-one structured midwifery care versus usual care. These trials were at moderate- risk of bias mainly because blinding women and staff to these interventions is not generally feasible. For important outcomes we assessed evidence using GRADE; we downgraded evidence for study design limitations, imprecision, and where we carried out meta-analysis, for inconsistency.One trial with 209 women compared early labour assessment with direct admission to hospital. Duration of labour from the point of hospital admission was reduced for women in the assessment group (mean difference (MD) -5.20 hours, 95% confidence interval (CI) -7.06 to -3.34; 209 women, low-quality evidence). There were no clear differences between groups for the number of women undergoing caesarean section or instrumental vaginal birth (risk ratio (RR) 0.72, 95% CI 0.30 to 1.72, very low quality evidence; and, RR 0.86, 95% CI 0.58 to 1.26, very low quality evidence, respectively). Serious maternal morbidity was not reported. Women in the early assessment group were slightly less likely to have epidural anaesthesia (RR 0.87, 95% CI 0.78 to 0.98, low-quality evidence), and considerably less likely to have oxytocin for labour augmentation (RR 0.57, 95% CI 0.37 to 0.86) and this group also had increased satisfaction with their care compared with women in the immediate admission group (MD 16.00, 95% CI 7.53 to 24.47). No babies were born before admission to hospital and only one infant had a low Apgar score at five minutes after the birth (very low quality evidence). Admission to neonatal special care was not reported.Three studies examined home assessment and midwifery support versus telephone triage. One trial reported the duration of labour; home visits did not appear to have any clear impact compared with usual care (MD 0.29 hours, 95% CI -0.14 to 0.72; 1 trial, 3474 women, low-quality evidence). There was no clear difference for the rate of caesarean section (RR 1.05, 95% CI 0.95 to 1.17; 3 trials, 5170 women; I² = 0%; moderate-quality evidence) or the rate of instrumental vaginal birth (average RR 0.95, 95% CI 0.79 to 1.15; 2 trials, 4933 women; I² = 69%; low-quality evidence). One trial reported birth before arrival at hospital or unplanned home birth; there was no clear difference between the groups (RR 1.33, 95% CI 0.30 to 5.95; 1 trial, 3474 women). No clear differences were identified for serious maternal morbidity (RR 0.93, 95% CI 0.61 to 1.42; 1 trial, 3474 women; low-quality evidence), or use of epidural (average RR 0.95, 95% CI 0.87 to 1.05; 3 trials, 5168 women; I² = 60%; low-quality evidence). There were no clear differences for neonatal admission to special care (average RR 0.84, 95% CI 0.50 to 1.42; 3 trials, 5170 infants; I² = 71%; very low quality evidence), or for Apgar score less than seven at five minutes after birth (RR 1.19, 95% CI 0.71 to 1.99; 3 trials, 5170 infants; I² = 0%; low-quality evidence).One study, with 5002 women, examined one-to-one structured care in early labour versus usual care. Length of labour was not reported. There were no clear differences between groups for the rate of caesarean section (RR 0.93, 95% CI 0.84 to 1.02; 4996 women, high-quality evidence), or for instrumental vaginal birth (RR 0.94, 95% CI 0.82 to 1.08; 4996 women, high-quality evidence). No clear differences between groups were reported for serious maternal morbidity (RR 1.13, 95% CI 0.84 to 1.52; 4996 women, moderate-quality evidence). Use of epidural was similar in the two groups (RR 1.00, 95% CI 0.99 to 1.01; 4996 women, high-quality evidence). For infant outcomes, there were no clear differences between groups (admission to neonatal intensive care unit: RR 0.98, 95% CI 0.80 to 1.21; 4989 infants, high-quality evidence; Apgar score less than seven at five minutes: RR 1.07, 95% CI 0.64 to 1.79; 4989 infants, moderate-quality evidence). Authors' conclusions: Assessment and support in early labour does not have a clear impact on rate of caesarean section or instrumental vaginal birth, or whether the baby was born before arrival at hospital or in an unplanned home birth. However, evidence suggested that interventions may have an impact on reducing the use of epidural anaesthesia, labour augmentation and on increasing maternal satisfaction with giving birth. Evidence about the effectiveness of early labour assessment versus immediate admission was very limited and more research is needed in this area.
Article
Background: Gymnastics is a preferable safe exercise for postnatal women performing regularly. Objective: The aim of this pilot randomized controlled trial was to determine whether the aerobic gymnastic exercise improves stress, fatigue, sleep quality and depression in postpartum women. Design: Single-blinded, randomized controlled trial held from December 2014 until September 2015. Setting: Postnatal clinic of a medical center in southern Taiwan. Participants: 140 eligible postnatal women were systematically assigned, with a random start to experimental (n=70) or a control (n=70) group. Interventions: Engage in aerobic gymnastic exercise at least three times (15min per section) a week for three months using compact disc in the home. Outcome measures: Perceived Stress Scale, Postpartum Fatigue Scale, Postpartum Sleep Quality Scale, and Edinburgh Postnatal Depression Scale. Results: In a two-way ANOVA with repeated measures, the aerobic gymnastic exercise group showed significant decrease in fatigue after practicing exercise 4 weeks and the positive effects extended to the 12-week posttests. Paired t-tests revealed that aerobic gymnastic exercise participants had improved significantly in perceived stress and fatigue after 4 weeks gymnastic exercise; these positive effects extended to the 12-week posttests. In addition, the changes in physical symptoms-related sleep inefficiency after 12 weeks gymnastic exercise were significantly decreased in the experimental group compared with the control group. Relevance to clinical practice: The findings can be used to encourage postnatal women to perform moderate-intensity gymnastic exercise in their daily life to reduce their stress, fatigue and improve sleep quality.
Chapter
The weeks and months following childbirth can be quite stressful for mothers. Although many women experience occasional feelings of sadness and anxiety during the postpartum period, others have longer-lasting and more severe symptoms that may qualify as postpartum depression, defined as the onset of a depressive episode. Biological processes, including major changes in reproductive hormones, contribute to risk of depression during this time. In addition, socioeconomic and psychological factors, such as low income, lack of support, and life stressors, may contribute to increased risk. If untreated, maternal postpartum depression can adversely affect mothers, their partners, new infants, and the whole family. Evidence-based treatments include psychotherapy and medication.
Article
This article provides a review of recent literature, current and ongoing research in the field of prevention of depression. It highlights the efforts employed in targeting vulnerable and susceptible individuals at higher risk of developing depression. Prevention efforts should target both specific and non-specific risk factors, enhance protective factors, use a developmental approach, and target selective and/or indicated samples. In general, our review suggested that employing specific strategies and interventions that are targeted at high-risk individuals or groups may reduce rates of depression, its associated mortality and morbidity. Overall, it appears that there is a reason for hope regarding the role of interventions in preventing depressive disorders in high-risk groups. Several new directions for future research on the prevention of depression in high-risk groups were outlined.
Article
Although animal models and correlational studies support a model of fetal programming as a mechanism in the transmission of risk for psychopathology from parents to children, the experimental studies that are required to empirically test the model with the human prenatal dyad are scarce. With a systematic review and meta-analysis of the literature, we critically examined the evidence regarding the neurobiological and behavioral changes in infants as a function of randomized clinical trials to prevent or reduce maternal depression during pregnancy, treating randomized clinical trials as experiments testing the fetal programming model. Based on 25 articles that met inclusion criteria, we found support for interventions designed to change maternal prenatal mood being associated with changes in offspring functioning, but with a very small effect size. Effect sizes ranged broadly, and were higher for younger children. The findings enhance understanding of putative mechanisms in the transmission of risk from women's prenatal depression to infants’ vulnerabilities to, and early signs of, the development of psychopathology. We note limitations of the literature and suggest solutions to advance understanding of how preventing or treating depression in pregnant women might disrupt the transmission of risk to the infants.
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Introduction: Symptoms of depression during pregnancy and the postpartum period can negatively impact parenting. It is important to understand the parenting experiences of women with depression, and what parenting support they need. Methods: This is a mixed methods analysis of data (demographic data, depression outcomes, patient survey results, and transcripts of patient and care manager focus groups) from an open treatment trial of the feasibility of delivering perinatal depression treatment using collaborative care in a rural obstetric setting. Results: Patients who attended focus groups did not differ significantly from those who did not. Qualitative analysis of focus groups revealed the following themes: Maternal mood and parenting difficulties are interrelated; Access to depression treatment is complicated by expectations for the perinatal period and by factors related to parenting; Women want parenting support in the context of treatment for perinatal depression. Conclusion: Women receiving perinatal depression treatment experience unique parenting challenges and desire parenting support. Healthcare providers caring for these women should be mindful of their patients’ parenting needs. Future research should explore ways to integrate parenting interventions with depression treatments. Mother–infant interaction is a key determinant of optimal infant development and integrating parenting support with perinatal depression treatments can have significant public health impact.
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Postpartum depression (PPD) is a serious public health issue that affects around 13% of women within a year of giving birth. Although depression rates do not appear to be greater in the postpartum period compared to age-matched control women (10-15%), the rates of first onset and severe depression are at least three times higher. Depression at this stage of life has unique implications and hazards for the woman and her family. It is feasible to identify women who have higher risk factors for PPD, however all currently available prenatal screening techniques have very low positive predictive values, making them impossible to suggest for regular care. There are several postpartum screening techniques available, however the best timing for screening and their relevance are unknown.
Article
Differences in the quality of delivery hospital care contribute to persistent, intertwined racial and ethnic disparities in both maternal and infant health. Despite the shared causal pathways and overlapping burden of maternal and infant health disparities, little research on perinatal quality of care has addressed obstetric and neonatal care jointly to improve outcomes and reduce health inequities for the maternal-infant dyad. In this paper, we review the role of hospital quality in shaping perinatal health outcomes, and investigate how a framework that considers the mother-infant dyad can enhance our understanding of the full burden of obstetric and neonatal disparities on health and society. We conclude with a discussion of how integrating a maternal-infant dyad lens into research and clinical intervention to improve quality of care can move the needle on disparity reduction for both women and infants around the time of birth and throughout the life course.
Article
Evidence supporting the use of glucagon-like peptide-1 (GLP-1) analogues to pharmacologically treat disorders beyond type 2 diabetes and obesity is increasing. However, little is known about how activation of the GLP-1 receptor (GLP-1R) during pregnancy affects maternal and offspring outcomes. We treated female C57Bl/6 J mice prior to conception and throughout gestation with a long-lasting GLP-1R agonist, Exendin-4. While GLP-1R activation has significant effects on food and drug reward, depression, locomotor activity, and cognition in adults, we found few changes in these domains in exendin-4-exposed offspring. Repeated injections of Exendin-4 had minimal effects on the dams and may have enhanced maternal care. Offspring exposed to the drug weighed significantly more than their control counterparts during the preweaning period and demonstrated alterations in anxiety-like outcomes, which indicate a developmental role for GLP-1R modulation in the stress response that may be sex-specific.
Chapter
Individual differences in risk for neuropsychiatric disorders are shaped before the individual is born. In this chapter, we summarize existing evidence from animal and human studies describing prenatal programming in the fetus and placenta in response to prenatal maternal stress, and associated outcomes seen in offspring neurobehavioral development and risk for psychopathology. First, we review fetal neurobehavioral development and assessment, including fetal physiological monitoring and fetal neuroimaging. We then highlight extant research on associations between fetal neurobehavior and later outcomes. Emerging research also points to the involvement of the placenta, which regulates the prenatal environment. We continue by describing how maternal stress can disrupt the placenta’s fundamental functions, highlighting the role of nutrient transfer, placental barrier permeability, serotonin signaling, and epigenetic changes to placental genes. We close by discussing the importance of sex differences in fetal and placental programming as well as developmental timing of exposures, and future directions for research.
Article
Maternal symptoms of depression can interfere with the establishment of healthy mother-infant-bonding, which negatively affects developmental trajectories of the child and maternal wellbeing. However, current evidence about the effects of treatment in severely affected women is still lacking and the transdiagnostic prognostic value of depressive symptoms is not fully clear. Therefore, a naturalistic clinical sample of 140 mother-infant-dyads in inpatient treatment at a mother-baby-unit was analyzed with instruments being administered at admission and before dismissal. Linear mixed effects models were calculated in order to assess the longitudinal influence of scores on the Edingburgh Postpartum Depression Scale (EPDS) on post-partum-bonding measured with the postpartum bonding questionnaire (PBQ). Furthermore, interaction-effects with psychiatric diagnosis of the mothers (depression vs. psychosis) and their partners were assessed. Successful treatment of depressive symptoms was paralleled by a significant decrease of impaired bonding, with only 6.4% of the women having PBQ total scores above cut-off at discharge. Overall, higher scores on the EPDS were associated with a significantly poorer outcome on the PBQ (p = < 0.001), irrespective of diagnosis (p = 0.93). Importantly, there was an interaction effect of EPDS and a psychiatric diagnosis of the partner on the PBQ (p = 0.017). Thus, our results further emphasize the significance of postpartum symptoms of depression for mother-child bonding, which can be effectively improved by comprehensive treatment even in severely affected women. Optimizing treatment and diagnostics as early as possible and enabling access for all women must become a priority.
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Postpartum fatigue is an important issue that threatens women’s health. The incidence of postpartum fatigue is high. Failure to intervene in time may lead to adverse outcomes such as postpartum depression, premature termination of breastfeeding, child abuse, and low infant development. This article reviews the concepts, characteristics, related factors, adverse effects, and interventions of postpartum fatigue. The aim is to improve doctors’ and nurses’ awareness of on postpartum fatigue in pregnant women, enrich the research content and methods, stimulate the interest of nurses, and actively carry out targeted intervention research to prevent or reduce the occurrence of adverse outcomes.
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Pregnant women with histories of depression are at high risk of depressive relapse/recurrence during the perinatal period, and options for relapse/recurrence prevention are limited. Mindfulness-based cognitive therapy (MBCT) has strong evidence among general populations but has not been studied among at-risk pregnant women to prevent depression. We examined the feasibility, acceptability, and clinical outcomes of depression symptom severity and relapse/recurrence associated with MBCT adapted for perinatal women (MBCT-PD). Pregnant women with depression histories were recruited from obstetrics clinics in a large health maintenance organization at two sites and enrolled in MBCT-PD (N = 49). Self-reported depressive symptoms and interview-based assessments of depression relapse/recurrence status were measured at baseline, during MBCT-PD, and through 6-months postpartum. Pregnant women reported interest, engagement, and satisfaction with the program. Retention rates were high, as were rates of completion of daily homework practices. Intent to treat analyses indicated a significant improvement in depression symptom levels and an 18 % rate of relapse/recurrence through 6 months postpartum. MBCT-PD shows promise as an acceptable, feasible, and clinically beneficial brief psychosocial prevention option for pregnant women with histories of depression. Randomized controlled trials are needed to examine the efficacy of MBCT-PD for the prevention of depressive relapse/recurrence during pregnancy and postpartum.
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A short and simple questionnaire for the assessment of duration and bouts of fussing and crying behaviour in infants, the Crying Pattern Questionnaire (CPQ), was compared with a 7-day 24 hour systematic diary record. Moderate to good convergence between maternal reports in the CPQ and the diary were found for duration of fuss/cry behaviour. The convergences were lower but highly significant for reports of the number of bouts of crying in 24 hours. Slightly poorer agreement was also found when mothers reported that the infants had large variations in the day to day amounts of fussing and crying. The total amount of fussing and crying was overestimated by the mothers in the CPQ relative to the diary by 13%. The data support that the CPQ may be a useful instrument for large scale community surveys of the prevalence of excessive crying.
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The average prevalence rate of non-psychotic postpartum depression based on the results of a large number of studies is 13%. Prevalence estimates are affected by the nature of the assessment method (larger estimates in studies using self-report measures) and by the length of the postpartum period under evaluation (longer periods predict high prevalences). A meta-analysis was undertaken to determine the sizes of the effects of a number of putative risk factors, measured during pregnancy, for postpartum depression. The strongest predictors of postpartum depression were past history of psychopathology and psychological disturbance during pregnancy, poor marital relationship and low social support, and stressful life events. Finally, indicators of low social status showed a small but significant predictive relation to postpartum depression. In sum, these findings generally mirror the conclusions from earlier qualitative reviews of postpartum depression risk factors.
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This study aims to evaluate the effectiveness of an antenatal psycho-educational intervention to prevent postpartum depression in Mexican women. Pregnant women at high risk for depression were randomized to intervention or a usual care condition. Assessments of depression (SCID, BDI-II) occurred during pregnancy, 6 weeks and 4-6 months postnatally, and subjective impact of the intervention in the postpartum. Of the 6484 women approached, 377 were eligible and consented to randomization (250 intervention, 127 control). Sixty-eight intervention (27.2%) and 68 (53.5%) control participants completed the three assessment periods. The cumulative incidence of major depression over three time periods was significantly lower (p<0.05) in the intervention (10.7%) than the control group (25%). Repeated-measures analysis of variance showed a significant reduction of BDI-II in both groups, but no significant treatment effect. Even when controlling for initial levels of depressive and anxiety symptoms, a treatment effect on depressive symptoms could not be confirmed, although there was a trend demonstrating that intervention participants with high initial symptoms had a larger reduction of BDI-II. Most participants that completed the intervention reported that it had a medium to great influence on their well-being, depression, current problems, role as mothers and their relationship with the baby. Attrition was the most salient methodological problem in this study. This is the first randomized control depression prevention trial in high-risk pregnant Mexican women. Available data are consistent with the possibility that the incidence of depression may have been reduced by the intervention, but differential attrition makes interpretation of the findings difficult.
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Infant crying is an important precipitant for shaken-infant syndrome. OBJECTIVE. To determine if parent education materials (The Period of PURPLE Crying [PURPLE]) change maternal knowledge and behavior relevant to infant shaking. This study was a randomized, controlled trial conducted in prenatal classes, maternity wards, and pediatric practices. There were 1374 mothers of newborns randomly assigned to the PURPLE intervention and 1364 mothers to the control group. Primary outcomes were measured by telephone 2 months after delivery. These included 2 knowledge scales about crying and the dangers of shaking; 3 scales about behavioral responses to crying generally and to unsoothable crying, and caregiver self-talk in response to unsoothable crying; and 3 questions concerning the behaviors of sharing of information with others about crying, walking away if frustrated, and the dangers of shaking. The mean infant crying knowledge score was greater in the intervention group (69.5) compared with controls (63.3). Mean shaking knowledge was greater for intervention subjects (84.8) compared with controls (83.5). For reported maternal behavioral responses to crying generally, responses to unsoothable crying, and for self-talk responses, mean scores for intervention mothers were similar to those for controls. For the behaviors of information sharing, more intervention mothers reported sharing information about walking away if frustrated and the dangers of shaking, but there was little difference in sharing information about infant crying. Intervention mothers also reported increased infant distress. Use of the PURPLE education materials seem to lead to higher scores in knowledge about early infant crying and the dangers of shaking, and in sharing of information behaviors considered to be important for the prevention of shaking.
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Despite their common use parental diaries of infants' cry and fuss behaviour have not been compared with objective methods of recording. To understand what is meant by the descriptions of crying and fussing in the diaries, the diaries of 10 mothers of 6 week old infants were compared with tape recordings of vocalisations made by the babies over a 24 hour period. There were moderately strong correlations between the frequency of episodes (clusters of 'negative vocalisations') on the audiotape and episodes of 'crying and fussing' in the diaries, and between the duration of episodes on the audiotape and episodes of 'crying' in the diaries. To assess the acceptability of the diaries for recording information for clinical and epidemiological research, they were then used in a population study of a wide socioeconomic group. Usable data were obtained from 91% of the sample. The results suggest that despite pronounced differences between recording methods, these diaries may provide valid and useful reports of crying and fussing in the short term.
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The crying pattern of normal infants in industrialized societies is characterized by an overall increase until 6 weeks of age followed by a decline until 4 months of age with a preponderance of evening crying. We hypothesized that this "normal" crying could be reduced by supplemental carrying, that is, increased carrying throughout the day in addition to that which occurs during feeding and in response to crying. In a randomized controlled trial, 99 mother-infant pairs were assigned to an increased carrying or control group. At the time of peak crying (6 weeks of age), infants who received supplemental carrying cried and fussed 43% less (1.23 v 2.16 h/d) overall, and 51% less (0.63 v 1.28 hours) during the evening hours (4 PM to midnight). Similar but smaller decreases occurred at 4, 8, and 12 weeks of age. Decreased crying and fussing were associated with increased contentment and feeding frequency but no change in feeding duration or sleep. We conclude that supplemental carrying modifies "normal" crying by reducing the duration and altering the typical pattern of crying and fussing in the first 3 months of life. The relative lack of carrying in our society may predispose to crying and colic in normal infants.
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This paper reports further data from the Stoke study of postnatal depression and examines whether psychosocial characteristics and symptom profiles differ between postnatal and control depression. Two hundred and thirty-two postnatal and non-postnatal control women were screened with the Edinburgh Postnatal Depression Scale; all high scorers and a sample of low scores were interviewed with the Standardised Psychiatric Interview and modified Social Maladjustment Schedule. Depression was diagnosed using the Research Diagnostic Criteria. Postnatal but not control depression was associated with a poor relationship with the woman's own mother and greater occupational instability. Depression in control women was associated with low income, having three or more children, performing manual work and occupational dissatisfaction, but postnatal depression was not. There were no differences in the symptom profiles of the postnatal and control women nor between early and late onset postnatal depression. Depression is a common and socially disabling disorder affecting mothers of young children. Postnatal depression is more contingent on acute biopsychosocial stresses caused by the arrival of a new family member. Depression in women with older children is more closely related to longer term social adversity.
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To compare two interventions (supplementary carrying, increased parental responsiveness) introduced from birth for their effectiveness in reducing the amounts of crying in general community infants at 2, 6, and 12 weeks age. Mothers and infants in newborn wards of maternity hospitals were assigned to carrying intervention, responsiveness intervention, or control groups. Follow-up measures were used to confirm that the interventions were implemented and to determine their effects on infant crying. SETTING AND MEASUREMENTS: Diary measurements completed in the home were employed to measure the aspects of parental behavior targeted by the interventions. Audio recordings, diaries, and questionnaires assessed the amounts the infants cried and the impact of the crying on their mothers and the health services. Sample sizes at 6 weeks of age were 59 (carrying intervention), 57 (responsiveness intervention), and 94 infants (control group). The carrying intervention successfully increased the amounts the infants were carried, particularly while settled, to the target levels. The responsiveness intervention led to more limited increases in carrying and to a modest increase in feeding frequency, but did not affect measures of parental interactiveness and play. No differences in amounts of crying and fussing were found between the three groups of infants on any of the measures. Subsidiary analyses confirmed that the dependent variable (infant fuss/crying) and main independent variable (carrying while settled) were not significantly correlated. It is not, at present, possible to recommend either supplementary carrying or increased parental responsiveness as primary, preventative interventions to reduce infant crying.
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Parents commonly seek clinicians' help for infant crying that they judge to be excessive. To date there is no independent evidence whether such babies actually cry more than average. To assess this, maternal diary and 24 hour audiotape recordings of the crying periods of 16 infants referred for excessive crying were compared with equivalent measures of a normative sample. The overall amounts of crying measured by the two methods were similar. The referred infants cried substantially more over 24 hours and in the afternoon and evening. The difference approached significance in the morning but was insignificant at night time. Some qualifications to the findings are indicated.
Article
Nearly 20 % of mothers will experience an episode of major or minor depression within the first 3 months postpartum, making it the most common complication of childbearing. Postpartum depression (PPD) is significantly undertreated, and because prospective mothers are especially motivated for self-care, a focus on the prevention of PPD holds promise of clinical efficacy. This study is a qualitative review of existing approaches to prevent PPD. A PubMed search identified studies of methods of PPD prevention. The search was limited to peer-reviewed, published, English-language, randomized controlled trials (RCTs) of biological, psychological, and psychosocial interventions. Eighty articles were initially identified, and 45 were found to meet inclusion criteria. Eight RCTs of biological interventions were identified and 37 RCTs of psychological or psychosocial interventions. Results were mixed, with 20 studies showing clear positive effects of an intervention and 25 showing no effect. Studies differed widely in screening, population, measurement, and intervention. Among biological studies, anti-depressants and nutrients provided the most evidence of successful intervention. Among psychological and psychosocial studies, 13/17 successful trials targeted an at-risk population, and 4/7 trials using interpersonal therapy demonstrated success of the intervention versus control, with a further two small studies showing trends toward statistical significance. Existing approaches to the prevention of PPD vary widely, and given the current literature, it is not possible to identify one approach that is superior to others. Interpersonal therapy trials and trials that targeted an at-risk population appear to hold the most promise for further study.
Article
Objective: While considerable attention has focused on improving the detection of depression, assessment of severity is also important in guiding treatment decisions. Therefore, we examined the validity of a brief, new measure of depression severity. Measurements: The Patient Health Questionnaire (PHQ) is a self-administered version of the PRIME-MD diagnostic instrument for common mental disorders. The PHQ-9 is the depression module, which scores each of the 9 DSM-IV criteria as "0" (not at all) to "3" (nearly every day). The PHQ-9 was completed by 6,000 patients in 8 primary care clinics and 7 obstetrics-gynecology clinics. Construct validity was assessed using the 20-item Short-Form General Health Survey, self-reported sick days and clinic visits, and symptom-related difficulty. Criterion validity was assessed against an independent structured mental health professional (MHP) interview in a sample of 580 patients. Results: As PHQ-9 depression severity increased, there was a substantial decrease in functional status on all 6 SF-20 subscales. Also, symptom-related difficulty, sick days, and health care utilization increased. Using the MHP reinterview as the criterion standard, a PHQ-9 score > or =10 had a sensitivity of 88% and a specificity of 88% for major depression. PHQ-9 scores of 5, 10, 15, and 20 represented mild, moderate, moderately severe, and severe depression, respectively. Results were similar in the primary care and obstetrics-gynecology samples. Conclusion: In addition to making criteria-based diagnoses of depressive disorders, the PHQ-9 is also a reliable and valid measure of depression severity. These characteristics plus its brevity make the PHQ-9 a useful clinical and research tool.
Article
Objective: To evaluate a prevention program for infant sleep and cry problems and postnatal depression. Methods: Randomized controlled trial with 781 infants born at 32 weeks or later in 42 well-child centers, Melbourne, Australia. Follow-up occurred at infant age 4 and 6 months. The intervention including supplying information about normal infant sleep and cry patterns, settling techniques, medical causes of crying and parent self-care, delivered via booklet and DVD (at infant age 4 weeks), telephone consultation (8 weeks), and parent group (13 weeks) versus well-child care. Outcomes included caregiver-reported infant night sleep problem (primary outcome), infant daytime sleep, cry and feeding problems, crying and sleep duration, caregiver depression symptoms, attendance at night wakings, and formula changes. Results: Infant outcomes were similar between groups. Relative to control caregivers, intervention caregivers at 6 months were less likely to score >9 on the Edinburgh Postnatal Depression Scale (7.9%, vs 12.9%, adjusted odds ratio [OR] 0.57, 95% confidence interval [CI] 0.34 to 0.94), spend >20 minutes attending infant wakings (41% vs 51%, adjusted OR 0.66, 95% CI 0.46 to 0.95), or change formula (13% vs 23%, P < .05). Infant frequent feeders (>11 feeds/24 hours) in the intervention group were less likely to have daytime sleep (OR 0.13, 95% CI 0.03 to 0.54) or cry problems (OR 0.27, 95% CI 0.08 to 0.86) at 4 months. Conclusions: An education program reduces postnatal depression symptoms, as well as sleep and cry problems in infants who are frequent feeders. The program may be best targeted to frequent feeders.
Article
The nine-item Patient Health Questionnaire depression scale is a dual-purpose instrument that can establish provisional depressive disorder diagnoses as well as grade depression severity.
Article
Synchrony—a construct used across multiple fields to denote the temporal relationship between events—has been applied to the study of mother–infant interaction and is suggested here as a framework for the study of interpersonal relationships. Defined as the temporal coordination of micro-level social behavior, parent–infant synchrony is charted in its development across infancy from the initial consolidation of biological rhythms during pregnancy to the emergence of symbolic exchange between parent and child. Synchrony is shown to depend on physiological mechanisms supporting bond formation in mammals—particularly physiological oscillators and neuroendocrine systems such as those involving the hormone oxytocin. Developmental outcomes of the synchrony experience are observed in the domains of self-regulation, symbol use, and the capacity for empathy across childhood and adolescence. Specific disruptions to the parameters of synchrony that may be observed in various pathological conditions, such as prematurity or maternal affective disorder, are detailed. A time-based, micro-analytic behavioral approach to the study of human relationship may offer new insights on intersubjectivity across the lifespan.
Article
Objective: To quantify the extent to which maternal report of inconsolable infant crying, rather than colic (defined by Wessel's criteria of daily duration of fussing and crying >3 hours), is associated with maternal postpartum depressive symptoms. Methods: Participants were 587 mothers who were recruited shortly before or after delivery and followed longitudinally. At 5 to 6 weeks postpartum, mothers recorded the duration and mode (fussing, crying, or inconsolable crying) of their infant's distress by using the Baby's Day Diary. The Edinburgh Postnatal Depression Scale (EPDS) was administered at enrollment and at 8 weeks postpartum. Using regression models that included baseline EPDS scores and multiple confounders, we examined associations of colic and inconsolable crying with later maternal EPDS scores at 8 weeks postpartum. Results: Sixty mothers (10%) met the EPDS threshold for "possible depression" (score ≥9) at 8 weeks postpartum. For mothers reporting >20 minutes of inconsolable crying per day, the adjusted odds ratio for an EPDS score ≥9 was 4.0 (95% confidence interval: 2.0-8.1), whereas the adjusted odds ratio for possible depression in mothers whose infants had colic was 2.0 (95% confidence interval: 1.1-3.7). These associations persisted after adjusting for baseline depression symptoms. Conclusions: Maternal report of inconsolable infant crying may have a stronger association with postpartum depressive symptoms than infant colic. Asking a mother about her ability to soothe her infant may be more relevant for potential intervention than questions about crying and fussing duration alone.
Article
OBJECTIVE: While considerable attention has focused on improving the detection of depression, assessment of severity is also important in guiding treatment decisions. Therefore, we examined the validity of a brief, new measure of depression severity. MEASUREMENTS: The Patient Health Questionnaire (PHQ) is a self-administered version of the PRIME-MD diagnostic instrument for common mental disorders. The PHQ-9 is the depression module, which scores each of the 9 DSM-IV criteria as “0” (not at all) to “3” (nearly every day). The PHQ-9 was completed by 6,000 patients in 8 primary care clinics and 7 obstetrics-gynecology clinics. Construct validity was assessed using the 20-item Short-Form General Health Survey, self-reported sick days and clinic visits, and symptom-related difficulty. Criterion validity was assessed against an independent structured mental health professional (MHP) interview in a sample of 580 patients. RESULTS: As PHQ-9 depression severity increased, there was a substantial decrease in functional status on all 6 SF-20 subscales. Also, symptom-related difficulty, sick days, and health care utilization increased. Using the MHP reinterview as the criterion standard, a PHQ-9 score ≥10 had a sensitivity of 88% and a specificity of 88% for major depression. PHQ-9 scores of 5, 10, 15, and 20 represented mild, moderate, moderately severe, and severe depression, respectively. Results were similar in the primary care and obstetrics-gynecology samples. CONCLUSION: In addition to making criteria-based diagnoses of depressive disorders, the PHQ-9 is also a reliable and valid measure of depression severity. These characteristics plus its brevity make the PHQ-9 a useful clinical and research tool.
Chapter
This article provides an overview of generalized linear mixed models (GLMMs), how they are fit to data, and the inferences possible when using them. GLMMs are a class of statistical models that handle a wide variety of distributions for the outcome, accommodate nonlinear models, and model correlated data. As regression methods, they are not only capable of estimation and testing of covariate effects but also can be used to draw inferences about correlation structures in the data and are able to calculate predicted values that take into account not only covariates but also observed outcomes. We briefly describe software available for fitting GLMMs.
Article
Postpartum depression has been the focus of much research in the past 15 years, but little is known about factors associated with depression of longer duration or later onset. The purpose of this longitudinal study was to analyze the relationship between stressful life conditions and postnatal depression in a group of women of low socioeconomic status from the third week to the sixth month postpartum. Nulliparas who met criteria for low socioeconomic status were recruited from the prenatal care clinics of four Montreal hospitals. Questionnaires were verbally administered in the home at 30 weeks' gestation, at 3 and 9 weeks postpartum, and at 6 months postpartum. Blockwise multiple linear regression analyses were performed by entering predictor variables that included sociodemographic characteristics, chronic stressors, life events, and social support network. Sixty-eight women participated in the study. At 6 months postpartum, 38.2 percent of the mothers had a Beck Depression Inventory score of 10 or more. After accounting for previous depression, analyses indicated that chronic stressors (maternal health problems, infant difficulty, lack of money for basic needs, frequent conflicts with network members) and poor social support (informational and emotional) were associated with postnatal depressive symptoms. Health practitioners should recognize that high depressive symptomatology frequently occurs among low socioeconomic status first-time mothers at six months postpartum. Chronic stressors and inadequate social support are the most important factors associated with this problem.
Article
The combined impact of infant colic and maternal depression on infant, parent, and family difficulties was examined. The sample included 93 consecutive patients seen at an outpatient Colic Clinic. Most mothers had private insurance and completed high school. Infants were approximately 2 months of age. Questionnaires completed by the mother prior to treatment onset were used to measure depressive symptoms in the mothers, infant cry, sleep and temperament, characteristics, parenting stress, maternal self-esteem, social support, and family function. Moderate to severe depressive symptoms were reported by 45.2% of the mothers. More severe depressive symptoms in the mothers were related to fussy/difficult infant temperament, more parenting stress, lower parental self-esteem, and more family-functioning problems. Pediatric health care providers need to be aware that the combined effects of colic and maternal depression can be problematic for the family. ©2005 Michigan Association for Infant Mental Health.
Article
Empirical studies of suicide survivors with designs that include control groups are reviewed. Investigations are discussed individually with respect to those in which participating survivors are friends or a combination of many different relationships to the deceased, parents of the deceased child, and spouses. Following the review is a brief discussion of the commonalities of the findings and the most frequent methodological difficulties. Concluding comments suggest methodological improvements as well as issues and groups for which additional investigations are needed.
Article
The impact of maternal depression and adversity on mother-infant face-to-face interactions at 2 months, and on subsequent infant cognitive development and attachment, was examined in a low-risk sample of primiparous women and their infants. The severe disturbances in mother-infant engagement characteristic of depressed groups in disadvantaged populations were not evident in the context of postpartum mood disorder in the present study. However, compared to well women, depressed mothers were less sensitively attuned to their infants, and were less affirming and more negating of infant experience. Similar difficulties in maternal interactions were also evident in the context of social and personal adversity. Disturbances in early mother-infant interactions were found to be predictive of poorer infant cognitive outcome at 18 months. Infant attachment, by contrast, was not related to the quality of 2-month interactions, but was significantly associated with the occurrence of adversity, as well as postpartum depression.
Article
The Hamilton Anxiety Scale (HAM-A) was tested for reliability and validity in two different samples, one sample (n=97) defined by anxiety disorders, the other sample (n=101) defined by depressive disorders. The reliability and the concurrent validity of the HAM-A and its subscales proved to be sufficient. Internal validity tested by latent structure analysis was insufficient. The major problems with the HAM-A are that (1) anxiolytic and antidepressant effects cannot be clearly distinguished; (2) the subscale of somatic anxiety is strongly related to somatic side effects. The applicability of the HAM-A in anxiolytic treatment studies is therefore limited. More specific anxiety scales are needed.
Article
Little is known about the prevalence and comorbidity of Major Depressive Episode (MDE) during pregnancy in the general population. This study presents nationally representative data on the prevalence, correlates, and psychiatric comorbidities of depression in women during pregnancy and postpartum in the United States. Data were drawn from the 2001-2002 National Epidemiological Survey on Alcohol and Related Conditions (NESARC). The NESARC is a survey of 43,093 adults aged 18 years and older residing in households in the United States of whom 14,549 were women 18 to 50 years old with known past-year pregnancy status. Diagnoses of depression and other mood, anxiety, and drug disorders were based on the Alcohol Use Disorder and Associated Disabilities Interview Schedule - DSM-IV version. The overall prevalence of MDE during pregnancy was 12.4%. Among pregnant and postpartum women, depression was associated with younger age, ethnicity other than Latino, being widowed, divorced, separated or never married, traumatic events within the past 12 months and pregnancy complication. Strong associations were found between MDE during pregnancy and postpartum and nearly all 12-month psychiatric disorders. Past-year depressed pregnant and postpartum women were more likely than nondepressed pregnant women to use substances (including alcohol, illicit drugs and cigarettes). Past-year pregnant and postpartum women were significantly less likely to receive past-year treatment for depression than nonpregnant women although not after adjusting for background sociodemographic characteristics. These results indicate that depression during pregnancy and postpartum is associated with a large range of psychiatric disorders. The high frequency of psychiatric comorbidities, the elevated use of any substances and the high rate of unmet needs should be kept in mind when considering the management of depression during pregnancy and postpartum.
Article
This study was undertaken to compare the sleep profiles of healthy infants in swaddling and sleeping bag conditions. Polysomnographs of 85 healthy infants (40 in the study group, 45 in the control group) with a mean age of 7.5 weeks were recorded in the sleeping laboratory. A positive decision from the local Ethics Committee and the written consent of the parents were obtained for the study. Swaddling significantly reduces the rate of spontaneous waking (events/h: 1.39 [0.85-2.77] vs. 2.81 [1.49-4.53], P=0.020) and the number of sleep stage changes (events/h: 3.82 [2.97-5.16] vs. 5.37 [3.58-6.67], P=0.015). Swaddling promotes quiet sleep (36.37% [29%-40.31%] vs. 30.2% [24.45%-36.78%], P=0.032), the time spent awake was decreased (8.98% [4.62%-14.25%] vs. 14.17% [9.2%-18.94%], P=0.001) and sleep efficiency was increased (91.02% [85.75%-95.38%] vs. 85.83% [81.06%-90.8%], P=0.001). Swaddling promotes a more quiet sleep in infants.
Article
To study if infant crying is associated with maternal postnatal depression. Data from 1015 mothers and their children participating in a prospective European multicentre study were analysed. Infantile colic and prolonged crying were defined as excessive crying as reported by the mothers 2 and 6 months after delivery, and at the same time the mothers completed the Edinburgh Postnatal Depression Scale (EPDS). In cross-sectional analyses, infant crying was associated with high EPDS scores both 2 (OR: 4.4; 95% CI: 2.4-8.2) and 6 months postpartum (OR: 10.8; 95% CI: 4.3-26.9). More than one-third of the others of infants with prolonged crying had high EPDS scores 6 months postpartum. Longitudinal analyses showed that mothers of infants with colic had increased odds of having high EPDS scores 6 months after delivery even if crying had resolved (OR: 3.7; 95% CI: 1.4-10.1). Both infantile colic and prolonged crying were associated with high maternal depression scores. Most noteworthy, infantile colic at 2 months of age was associated with high maternal depression scores 4 months later.
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A broad capacity for deliberate self-regulation plays a key role in emotion regulation. This longitudinal investigation from infancy to preschool age examines genotype by environment (G x E) interaction in the development of self-regulation, using molecular measures of children's genotypes and observed measures of the quality of early mother-child relationship, as reflected in attachment organization in infancy. In 89 children, we assessed the polymorphism in the serotonin transporter gene (5-HTTLPR, ss/sl vs. ll allele status), security of attachment to mothers at 15 months in the Strange Situation, and children's ability for self-regulation at 25, 38, and 52 months, using behavioral batteries of tasks that called for deliberately suppressing a dominant response and performing instead a sub-dominant response. There was a robust G x E interaction between genetic risk and the quality of early relationship. Among children who carried a short 5-HTTLPR allele (ss/sl ), those who were insecurely attached developed poor regulatory capacities, but those who were securely attached developed as good regulatory capacities as children who were homozygotic for the long allele (ll ). There was no effect of security for ll homozygotes. Those findings, consistent with diathesis-stress model, bridge research on self-regulation in typically developing children with research on non-human primates and research on psychopathology. They also indicate that a secure attachment relationship can serve as a protective factor in the presence of risk conferred by a genotype.
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The Hamilton Depression Rating Scale (HDRS) is the most widely used scale for patient selection and follow-up in research studies of treatments of depression. Despite extensive study of the reliability and validity of the total scale score, the psychometric characteristics of the individual items have not been well studied. In the only reliability study to report agreement on individual items using a test-retest interview method, most of the items had only fair or poor agreement. Because this is due in part to variability in the way the information is obtained to make the various rating distinctions, the Structured Interview Guide for the HDRS (SIGH-D) was developed to standardize the manner of administration of the scale. A test-retest reliability study conducted on a series of psychiatric inpatients demonstrated that the use of the SIGH-D results in a substantially improved level of agreement for most of the HDRS items.
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This paper investigates the reliability and validity of a Spanish version of the Hamilton Rating Scale for Depression (17-item version) which has good concurrent (r = 0.82) and content (average frequency = 62%) validity. Inter-rater reliability (r = 0.99), split-half reliability (r = 0.89) and alpha reliability (r = 0.72) are acceptable. A Factor Analysis identified five factors accounting for 56% of total variance.
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A model of maternal postpartum depression was tested in which difficult infant temperament was construed as a stressor and supportive interpersonal relationships were construed as a protective resource. It was hypothesized that both infant temperamental difficulty and level of social support would affect maternal depression through the cognitive mediation of perceived self-efficacy in the parenting role. Participants were 55 married women who were assessed during pregnancy and again 3 months postpartum. Infant temperament was assessed through observation, maternal crying records, and the Revised Infant Temperament Questionnaire. Results of a path analysis indicated that infant temperamental difficulty was strongly related to the mothers' level of postpartum depression, both directly and through the mediation of parenting self-efficacy. Consistent with predictions, social support appeared to exert its protective function against depression primarily through the mediation of self-efficacy. Both practical implications for identifying women at risk for postpartum depression and theoretical implications for understanding the mechanisms through which stressful events and social support affect adjustment are discussed.
Article
This randomized, controlled trial tested the hypothesis that women identified as more vulnerable to developing postnatal depression who attended two specific antenatal groups and one postnatal group have a reduced frequency of postnatal depression from 37 to 15 percent at 6 weeks, 12 weeks, and 6 months postpartum. A modified antenatal screening questionnaire was completed, and women identified as more vulnerable to postnatal depression were stratified by parity and randomly allocated to receive extra support groups or to a control group. The Edinburgh Postnatal Depression Scale (EPDS) was used to detect postnatal depression. Attendance at the support groups was low, 31 percent overall. At six weeks, in the intervention group, 8 (13%) of 64 women scored high (> 12) on the EPDS, compared with 11 (17%) controls. Similarly, at 12 weeks 7 (11%) of 63 versus 10 (15%) of 65 women scored higher than 12, and at 6 months, 9 (15%) of 60 versus 6 (10%) of 64 women scored higher than 12, indicating that the intervention did not reduce postnatal depression. It is possible that the method of applying the intervention, using groups separate from the standard antenatal classes, may have affected attendance. More research is required into ways of reaching and supporting women who may become depressed.
Article
To determine whether prepartum and postpartum emotional distress in first-time mothers is associated with crying and fussing behavior and activity level in 6-week-old infants, after eliminating potential biases. Observational study examining predictive and concurrent associations between maternal emotions and infant behaviors. General community. Expectant primiparas attending obstetricians' offices for routine prenatal care were recruited in the third trimester. Mothers and babies were required to be free of medical complications to complete the study. Of 113 mothers who enrolled, complete crying/fussing data were obtained in 88 dyads. Activity data were obtained in a designated subgroup of 50 infants. Mothers completed a self-report scale of emotional distress, the 28-item General Health Questionnaire, at 34 weeks of gestation and at 6 weeks postpartum. Crying/fussing data were obtained using a previously validated parent diary of infant behavior during the sixth week of life. Motor activity was measured objectively in the home setting with actometers. Third-trimester distress was not related to either infant crying/fussing or activity. Postpartum distress was significantly related to crying/fussing duration and bout frequency (r[88] = .45 and .28, respectively; both P < .01). These relations were not diminished after controlling statistically for background and/or potential mediating variables, nor could they be accounted for by different diary-recording styles in the mothers. Postpartum distress was not, however, related to activity level (r[50] = -.09; not significant). Furthermore, the pattern of maternal distress was associated differentially with crying levels. Distress levels increased from prepartum to postpartum among mothers of infants who met predefined clinical criteria for "colic," while decreasing in the others ("colic" status x period interaction: F(1,86) = 8.2; P < .01). Also, infant crying varied among four groups of mothers who differed according to presence and timing of clinically significant emotional disturbance (one-way analysis of variance, F (3,86) = 9.4; P < .001). Infants of mothers who became significantly distressed postpartum ("reactive") cried more than those in the other groups, even mothers who had been distressed both prepartum and postpartum (&