Article

The impact of paternal feelings and stress on mother–child interactions and on the development of the preterm newborn

Taylor & Francis
Early Child Development and Care
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Abstract

This study aims to evaluate the influence of fathers’ negative feelings, parenting stress and post-traumatic symptomatology experienced after the premature birth of their infant onmother–child interaction and on infant’s development in the perinatal period. Forty-five fathers and 45 mothersof preterm infants (GA = 30.25 ± 2.95; birth weight = 1288.02 ± 488.76) filled out:Impact of Event Scale Revised, Profile of Mood States and Parenting Stress Index Short Form. At 3 months of infants’ corrected age, mother–child interactions were assessed by Global Rating Scales (GRS) and the development of the preterms was tested by Bayley Scales of Infant Development. Higher scores in paternal feelings, stress and post-traumatic symptomatology predicted lower scores in Global Rating Scales dimensions and in the Bayley Scales of Infant Development scales. Feelings and stress experienced by fathers of preterms should be considered risk factors for the building of mother-child interaction and for the early language development of preterms.

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... Le père, comme la mère, traverse une période riche en remaniements psychiques et identitaires pouvant entraîner de profonds bouleversements sur le plan individuel et au sein du couple [6]. Par ailleurs, les effets de la santé mentale du père sur le développement du bébé [7,8], sur la relation mère-bébé [9] ou sur la relation de couple [10] sont de plus en plus documentés et révèlent l'importance d'un accompagnement précoce adapté aux spécificités paternelles. Il semble dès lors essentiel de repenser l'accueil et l'accompagnement des pères en période périnatale, de prendre en considération les remaniements psychologiques qu'ils vivent en devenant pères, de les informer et de les soutenir en considérant leurs attentes et leurs spécificités. ...
... L'accompagnement de cette détresse paternelle repose en premier lieu sur l'identification de la symptomatologie de celle-ci. En Australie, un modèle multiniveau pour l'évaluation et la prise en charge de la dépression paternelle postnatale a été proposé [9]. Remarquons que ce modèle convoque les ressources précédemment décrites, à l'exception des ressources connectées, et propose de les hiérarchiser et de donner des points de repère pour leur utilisation. ...
... L'évaluation plus approfondie par le praticien va ensuite statuer sur l'intensité de la symptomatologie dépressive. Les pères seront alors orientés vers une psychothérapie et/ou une psychoéducation s'ils présentent une symptomatologie légère à modérée, ou vers des traitements pharmacologiques s'ils présentent une symptomatologie sévère [9]. Notons qu'à l'heure actuelle, il n'existe pas d'outils francophones validés spécifiques à la détresse paternelle en période périnatale [21], alors que de tels outils se développent à l'étranger. ...
Article
La littérature s’accorde sur l’idée que l’accompagnement du père en période périnatale doit être repensé en fonction de ses attentes et de ses besoins spécifiques. Les enjeux étant considérables au regard du risque de développement de vulnérabilités paternelles et de leurs effets délétères sur le développement de l’enfant, nous proposons dans cette synthèse des pistes de réflexion pour impliquer, informer et soutenir les pères durant cette période. - Literature review reveals that the father’s support during the perinatal period must rethink according to his expectations and specific needs. The stakes being high regarding the risk of developing paternal vulnerabilities and their negative impact on child development, we therefore bring, in this synthesis, ideas and thoughts to involve, inform and support fathers during this period.
... Ειδικότερα, ο πατέρας συχνότερα αισθάνεται: Φόβο σχετικά με το ιατροτεχνολογικό εξοπλισμό, το περιβάλλον αλλά και το πρόωρο βρέφος καθαυτό, το οποίο είναι πιθανό να παρουσιάσει σοβαρές επιπλοκές, αναπηρίες ή και να μην επιβιώσει (Rio et al 2022). Θυμό για τις μη πραγματοποιημένες προσδοκίες που υπήρχαν σχετικά με τον τοκετό και τη γενικότερη απώλεια ελέγχου των γεγονότων (Ionio et al 2018). Ενοχή προς τον εαυτό του και στις επιλογές που έχει κάνει ή τις πιθανές επιλογές που δεν έκανε (Alexopoulou et al 2018). ...
... Παράλληλα, ο πατέρας τείνει να δείχνει τη συναισθηματική επιβάρυνση συχνότερα με εξωτερικευμένες συμπεριφορικές εκδηλώσεις και σε ορισμένες περιπτώσεις αναφέρονται ταυτόχρονα και άλλες ψυχοσυναισθηματικές διαταραχές (αγχώδεις διαταραχές, συμπεριφορικές εκδραματίσεις και εθισμοί), οι οποίες δυσχεραίνουν ακόμη περισσότερο την ανιχνευτική διαδικασία των ειδικών. Τα αρνητικά συναισθήματα, σε συνδυασμό με τα υψηλά επίπεδα άγχους μπορούν να επηρεάσουν αρνητικά την προστατευτική λειτουργία που έχει ο ρόλος του πατέρα προς τη μητέρα, το βρέφος, την αλληλεπίδραση και το δεσμό μητέρας-βρέφους καθώς και την ψυχοκινητική και συναισθηματική ανάπτυξη του βρέφους (Ionio et al 2018). ...
Article
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Fathers’ inclusion in the Neonatal Intensive Care Unit (NICU) is a key element for family-centered care, in case their preterm infant needs to be hospitalized for a prolonged period of time. Nevertheless, the extent of their involvement is not yet fully recognized by hospital policies and medical practitioners. This comprehensive literature review investigates the father’s role in the NICU, in respect to infant care and maternal support. Mental health issues that may arise by fathers’ emotional state and stressful events were also taken into consideration. Data collection included articles published from 2013 to 2023, derived from scientific databases such as PUBMED, Science Direct, Medline and Google Scholar. Including fathers in NICU seems to be beneficial for both mothers’ and infants’ emotional and practical needs. The stressful conditions in the NICU, however, may raise emotional reactions, such as anxiety and paternal depression symptoms, that affect the father’s mental health. The nursing and medical staff should provide support to help fathers embrace their paternal role and develop a father-infant bond. Fathers who receive support take on a crucial role in infant care, implementing practices acquired from the medical staff to support their infants, leading to a faster recovery and discharge from the NICU.
... While the majority of previous studies on parental stress have focused on mothers, there is limited evidence to suggest that fathers exhibit lower levels of stress than mothers [7,8]. However, the stress experienced by fathers of preterm infants may negatively impact the mother-child interaction and the language development of the preterm infants [9]. In addition to affecting the children's neurodevelopment, parental stress also negatively impacts the well-being of parents themselves. ...
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Background This study aims to evaluate the impact of a home-based, post-discharge early intervention (EI) program on reducing parental stress levels in families with preterm infants born between 28+ 0 and 31+ 6 weeks gestational age. Methods A randomized controlled trial was conducted, with families randomly allocated to either the EI or standard care (SC) group. A term reference group was also recruited for comparison. The Parental Stress Index-Short Form was used to assess parental stress levels, yielding a total stress score and three subdomain scores. Assessment was performed at baseline, at the 60-day mark of the study, and when the infants reached six corrected months of age. Parents in the reference group were assessed only at six months of corrected age for infants. The intervention comprised three sections: intellectual, physical, and social training, which was administered to the infants in the EI group immediately after discharge and to those in the SC group after 60 days of enrollment. Results Seventy-three families were enrolled in this study, with 37 allocated to the EI group, and 36 to the SC group. Prior to intervention, higher stress levels were reported by mothers in both groups than fathers, with no difference observed between the EI and SC groups. Re-assessment performed at 60 days of the study showed that mothers and fathers in the EI group had significantly lower total stress score than those in the SC group (82.00 ± 5.64 vs. 94.26 ± 7.99, p < 0.001; 80.74 ± 7.14 vs. 89.94 ± 9.17, p < 0.001, respectively), which was predominantly due to the lower scores in parental distress and parental-child dysfunction interaction subdomains in the EI group (both had p < 0.001). Mothers in the EI group exhibited a more pronounced reduction in total stress score after intervention when compared to fathers (13.15 ± 4.68 vs. 8.26 ± 4.03, p < 0.001). At six months of infant age, the total stress score and subdomain scores of parents in the EI and SC groups were similar, but significantly higher than those of the reference group. Conclusion The home-based, post-discharge EI program demonstrated significant effectiveness in reducing parental stress levels among the parents of very preterm infants. Trial registration This study was registered in the Chinese Clinical Trial Registry (registration number: CTR1900028330). Registration date: December 19, 2019.
... Indeed, many longitudinal studies have found parental mental health problems can further influence premature children's development (de Jong et al., 2015;Ionio et al., 2016) due to their influence on the parent-infant relationship (Treyvaud et al., 2019). Thus, some scholars (DeMier et al., 2000;Ionio et al., 2019a) highlight how having more information on how parents perceive neonatal care and monitoring their stress level during and after the infant hospitalization may allow healthcare staff to identify psychosocial risks, plan early interventions to meet parents' needs and generally promote family functioning. ...
Article
Purpose Introduction: The birth of a preterm child requires hospitalization in a neonatal intensive care unit (NICU), which is a very stressful experience for parents. Aim: To determine the stress level of parents of preterm babies admitted to intensive and sub-intensive units in two hospitals in Northern Italy and its association with their sociodemographic variables and the clinical conditions of their newborns. Design/methodology/approach The sampling was non-probabilistic and included parents of preterm babies admitted to intensive and/or sub-intensive care for at least 10 days. Instruments: (1) information deduced from the clinical record of preterm newborns; (2) sociodemographic determinants of parents' well-being deduced from a questionnaire; (3) parental stress scale: neonatal intensive care unit (PSS:NICU), which measures the perception of parents about stressors from the physical and psychological environment of the NICU. Findings Results: A total of 104 parents of 59 hospitalized preterm babies participated in the study. The average parental stress level was 1.87 ± 0.837. The subscale score that got higher was parent-infant relationship subscale. Concerning the infant characteristics, the birth weight of the babies and the length of their hospitalization affected the parents' stress level. Looking at parents' sociodemographic characteristics instead, the greater predictors were gender, age and occupational social class. Originality/value The parental role alteration caused by infant premature birth and consequent hospitalization is a major stressor for parents and in particular for mothers. The variables that resulted positively associated with higher stress in parents of preterm infants hospitalized are specific parental characteristics, including not adequately or previously studied ones, and infant characteristics.
... Early language experiences via mother-infant interactions are foundational for children's social and cognitive growth, as well as their future academic success. Unaddressed maternal psychological distress within the first year postpartum is known to have numerous negative consequences on the child's developmental outcomes, including language acquisition [1][2][3][4][5]. A very preterm (VPT; ≤32 weeks gestational age) birth creates high levels of psychological distress for mothers, and approximately 40% of VPT infants develop speech and language disorders [6][7][8][9][10][11]. ...
Article
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Unaddressed maternal psychological distress within the first year postpartum is known to have numerous negative consequences on the child’s developmental outcomes, including language acquisition. This study examined the relationship between early maternal psychosocial factors and the language outcomes of children born very preterm (VPT; ≤32 weeks gestational age). It used data from the Cincinnati Infant Neurodevelopment Early Prediction Study, an ongoing National-Institutes-of-Health-funded prospective, multicenter cohort investigation of VPT infants. A total of 243 (125 boys; 118 girls) children born VPT (M = 29.03 weeks of gestation; SD = 2.47) and their corresponding 207 mothers (34 with multiple infants) were included in this study. We did not find an association between maternal depression or anxiety and Bayley-III (M = 92.3, SD = 18.9) language scores. Additionally, maternal grit and self-efficacy did not modify the relationship between depression and anxiety and language scores. A higher level of maternal education and infant female sex were significantly associated with higher language scores. While preterm birth typically results in higher rates of depression and anxiety for parents, the findings suggest that maternal depression, anxiety, and grit and the self-efficacy of the mothers in this sample did not relate to the language development of their children, independent of maternal education and infant female sex.
... Different national and cross-national studies confirmed that fathers are nowadays spending more time caring for, and interacting with, their children than in the past (Haas & Hwang, 2019;Shwalb et al.,2013;McFadden and Tamis-Lemonda, 2013;Steenhoff et al., 2019). In the early months of their infant's life, fathers do not only play a key role in supporting mothers during the post-partum period providing them with protection (Ionio et al., 2018;Candelori et al., 2015;Baldoni, 2005) but they are also crucial for positive child outcomes (Parfitt et al., 2013;Allport et al., 2018;Jeong et al., 2016;Maselko et al., 2019). This has spurred a growing body of research comparing maternal and paternal parenting behaviour but these studies still provide conflicting results (Fuertes et al., 2016;Hallers-Haalboom et al., 2014). ...
Article
Infancy is characterized by intensive parenting which may affect later child development. However, little is known about similarities and differences in maternal and paternal parenting behaviour, as the majority of the studies have mainly focused on mothers. The present study investigated similarities and differences in mothers' and fathers' parenting behaviour during parent-infant interaction in 56 mothers and 56 fathers of 3-months-old infants in a good-resourced sample. Parent-child interactions were videotaped and coded by the Global Rating Scales. Results suggested similar parenting behaviour in terms of maternal and paternal sensitivity, intrusiveness and remoteness. Moreover, regardless of sex infant's behaviour was similar during interactions with mothers and fathers. The low-risk and non-clinical nature of our sample may have had a positive influence on mother-child and father-child dyadic exchanges. These findings suggest including family system models in research and clinical practice.
... [9] At discharge, they express their fears about the baby's condition and express their lack of self-confidence by saying, "My baby is very weak, he goes home with medical equipment, medicines and needs specialist's visit." [10] The mothers' anxiety and concerns gradually increase and finally lead to unpreparedness to care for their infant after being discharged, decreased quality of caring, the infant's growth disorder, disordered mother-infant relationship, negative mutual effects on parents, the mother's continuous stress, long-term effects on the infant's behavior, [11] and eventually rehospitalization. [12] In fact, mothers with an infant discharged from NICU face a lot of unanswered questions about caring for their infant at home. ...
Article
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Context After being discharged from hospital, most preterm infants need to receive treatments such as gastric gavage, oxygen therapy, apnea control, and medication. Mother's unpreparedness to care for their infants causes anxiety for them. Aims The purpose of the present study was to investigate the effect of home visit on anxiety of mothers having preterm infant discharged from neonatal intensive care unit (NICU). Settings and Design This was a experimental control group study on 50 mothers with preterm infant discharged from NICU of Shahid Sadoughi Hospital, an educational hospital with 30 beds in a city in the west of Iran in 2019. Subjects and Methods Participants with a convenience sampling were randomly assigned in the experimental and control groups. In the experimental group, home visit was done on the 3 rd and 5 th days after discharging the infants, and the mothers received necessary instructions proportional to their needs. Data collection tools included demographic information and Spielberger State-Trait Anxiety Inventory. Statistical Analysis Used The findings were analyzed by SPSS 20 software using Kolmogorov–Smirnov, independent t -test, and Chi-square. Results The mean ages of the participants in the intervention and control groups were 30.59 ± 6.38 and 28.67 ± 5.05 years, respectively. There was no significant difference between the mean obvious and hidden anxiety in the two groups ( P > 0.05) before the intervention. However, after the intervention, the mean obvious and hidden anxiety in the experimental group was lower than the mean of the control group, and this difference was significant ( P < 0.001). Conclusions Home visit is effective in decreasing anxiety in mothers of preterm infant who have been discharged from NICU.
... Women seem to be particularly concerned about the impact of cancer and oncological treatment on the children they are expecting, and this can impact on the perception of their health-related quality of life [15]. Drawing from these studies on oncological populations, together with literature investigating the possible factors that can interfere with the development of the mother-child relationship in other populations of pregnant women [18,19], it is possible to sustain that cancer survivors might face some challenges that could affect their parental role [20,21]. ...
Article
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Young cancer survivors often wish to bear a child after oncological treatments, as they might not have started or completed their families. As young cancer survivors have a higher risk of developing psychological difficulties, this study investigated whether there were significant differences in psychological aspects between pregnant women who received a cancer diagnosis in the past and pregnant women without a history of cancer. A total of 123 pregnant women, of which 36 were cancer survivors and 87 women without a history of cancer, were recruited during their last trimester at different hospitals in Northern Italy. Patients were asked to complete a socio-demographic profile and questionnaires measuring mood states, post-traumatic symptoms, centrality of the pregnancy and cancer event, quality of life, and prenatal attachment. Cancer survivors had significantly higher levels of PTSD symptoms, perceived pregnancy as more central to their identity and life story, perceived lower quality of life and had lower intensity of prenatal attachment compared with the control group. Centrality of the cancer event did not correlate with any psychological variables. Preliminary results suggest that a past cancer diagnosis can influence the mother’s psychological functioning and the development of the relationship with their child.
... Starting from these conflicting results, for this study, we wanted to better clarify which risk factors play important roles in predicting maternal and paternal reactions and feelings immediately after preterm births. As researchers have pointed out (Ionio et al., 2016a;Ionio et al., 2018), it is important to consider the characteristics and points of view of both mothers and fathers, as both parents are at risk after premature births. Moreover, in most of the past studies, researchers have focussed on experiences over the longer period of the infants' hospitalizations; the analysed situations have already become normal for many of the parents. ...
Article
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Aims: The aims of this study were to explore parents' stress levels and negative feelings after premature births and to identify the risk factors related to parents' stress and negative feelings during their children's neonatal intensive care unit (NICU) stay. Background: Preterm birth is a multi-problematic event that may put the babies in danger for both their medical and neurophysiological conditions and could have a negative impact on both the mother-father relationship and the parent-child interactions. Methods: The study involved 43 mothers and 38 fathers of preterm infants. All participants filled out the Parental Stressor Scale: Neonatal Intensive Care Unit and the Profile of Mood States. Findings: The results revealed significant differences between mothers' and fathers' responses to preterm births in terms of both stress and negative feelings. We found that, for mothers, their own young age and the baby's need for respiratory support were significant predictors of stress; for fathers, their own young age and the baby's lower gestational age and worse condition at birth were significant predictors of stress and negative feelings. The NICU may be a stressful place both for mothers and fathers. Identifying which mothers and fathers are at risk immediately after their children are born could help to direct specific interventions that can reduce these parents' stress and prevent them from negative feelings.
Article
Long focused on maternal roles in infancy, research is now exploring fathers' contributions to child development. Current public policy emphasizes early prevention and intervention for child and parent well‐being, especially for at‐risk infants such as those born prematurely. A literature review was conducted following the approach of a narrative review, to examine fatherhood in the context of preterm birth, highlighting the stress and emotional vulnerability experienced by fathers of preterm infants. Promoting early paternal presence and involvement in infant care helps fathers cope with this emotionally challenging experience. Despite limited data on premature fatherhood, fathers are active partners in dyadic interactions and play a significant role in their infant's neonatal intensive care unit journey and family dynamics. The discussion underscores the importance of father‐focused interventions and the paternal contribution to child development, framed within the authors' proposed integrative and developmental model of the family triad.
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Este trabalho objetivou investigar a percepção de pais (mãe e pai) de bebês prematuros internados em uma Unidade de Terapia Intensiva neonatal acerca da hospitalização e assistência psicológica recebida na unidade. A amostra foi composta por 12 pais de bebês internados e os dados foram coletados entre os meses de janeiro e maio de 2021 através de entrevista semiestruturada e analisados por meio da técnica da análise de conteúdo. Enquanto o sofrimento que marca a hospitalização do bebê ficou evidenciado através dos relatos de medo e angústia, sobretudo nos momentos iniciais de internação, também foram descritas sensações de alívio e felicidade emergentes da consciência de que o paciente estava recebendo os cuidados necessários disponibilizados pelo serviço. A melhora clínica do bebê e a percepção positiva acerca do cuidado ofertado pela equipe de saúde contribuíram para a estabilidade emocional dos pais ao longo da internação. Por fim, a assistência psicológica recebida foi descrita como promotora de apoio e acolhimento e mostrou-se relevante no auxílio ao enfrentamento da situação vivenciada.
Article
Infants who experience sensitive caregiving are at lower risk for numerous adverse outcomes. This is especially true for infants born preterm, leading them to be more susceptible to risks associated with poorer quality caregiving. Some research suggests that preterm and full-term infants differ on temperament, which may contribute to these findings. This study aimed to investigate associations between infant temperament (negative emotionality, positive affectivity/surgency, and orienting/regulatory capacity) and maternal sensitivity among infants born preterm (M = 30.2 weeks) and full term. It was hypothesized that mothers of infants born preterm and mothers of infants with more difficult temperaments would display lower sensitivity, indicated by lower responsiveness to nondistress, lower positive regard, and higher intrusiveness. Videotaped play interactions and a measure of temperament (Infant Behavior Questionnaire) were coded for 18 preterm and 44 full-term infants at 9 months (corrected) age. Results suggest that mothers of preterm and full-term infants differed significantly in responding to their infants, but these results cannot be explained by infant temperament. Preterm status and sociodemographic risk emerged as correlates of maternal behavior, such that mothers of infants born preterm and mothers with greater sociodemographic risk displayed lower levels of maternal sensitivity.
Article
Objective: This study examined the association of personality traits and paternal/infant background characteristics with subjective well-being (SWB) among fathers of preterm infants. Background: While studies of parental care of preterm infants have focused on mothers or both parents, studies focusing specifically on fathers are relatively rare. In this study, we provide new information on the personality traits and paternal/infant background characteristics and their association with SWB among fathers of preterm infants. Methods: This study used a cross-sectional design. Participants included fathers of preterm infants hospitalised in the neonatal intensive care unit, neonatal intermediate care nursery, or postpartum ward of a medical centre in northern Taiwan within 5 days of birth. The Personality Inventory Scale and Subjective Well-being Scale were administered and background characteristics of fathers and preterm infants were measured. Results: A total of 104 fathers participated, of whom 73.1% showed a moderate level of SWB. Fathers with higher extraversion and openness exhibited higher SWB, while fathers with higher neuroticism exhibited lower SWB. SWB was also predicted by age, infant weight, family structure, and paternal education level. These factors cumulatively accounted for 48% of the variance in SWB. Conclusion: Fathers’ SWB was associated with extraversion, openness, neuroticism, age, education, family structure, and infant weight. The personality traits of fathers should be considered when developing plans for family support after following preterm infant birth. In addition to focusing on maternal well-being, programmes to increase paternal well-being would benefit the families of preterm infants.
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Rarely have researchers elucidated early childhood precursors of externalizing behaviors for boys and girls from a normative sample. Toddlers (N = 104; 52 girls) were observed interacting with a same-sex peer and their mothers, and indices of conflict-aggression, emotion and behavior dysregulation, parenting, and child externalizing problems were obtained. Results indicated that boys initiated more conflictual-aggressive interactions as toddlers and had more externalizing difficulties 2 years later, yet girls' (not boys') conflict-aggressive initiations at age 2 were related to subsequent externalizing problems. When such initiations were controlled for, emotional-behavioral undercontrol at age 2 also independently predicted externalizing problems at age 4. Moreover, the relation between conflict-aggressive initiations at age 2 and externalizing problems at age 4 was strongest for dysregulated toddlers. Finally, the relation between age 2 conflict-aggressive initiations and age 4 externalizing problems was strongest for those toddlers who incurred high levels of maternal negativity. These findings illustrate temperament by parenting connections in the development of externalizing problems.
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Preterm birth is a stressful event for families. In particular, the unexpectedly early delivery may cause negative feelings in mothers and fathers. The aim of this study was to examine the relationship between preterm birth, parental stress and negative feelings, and the environmental setting of NICU. 21 mothers (age = 36.00 ± 6.85) and 19 fathers (age = 34.92 ± 4.58) of preterm infants (GA = 30.96 ± 2.97) and 20 mothers (age = 40.08 ± 4.76) and 20 fathers (age = 40.32 ± 6.77) of full-term infants (GA = 39.19 ± 1.42) were involved. All parents filled out the Parental Stressor Scale: Neonatal Intensive Care Unit, the Impact of Event Scale Revised, Profile of Mood States, the Multidimensional Scale of Perceived Social Support and the Post-Partum Bonding Questionnaire. Our data showed differences in emotional reactions between preterm and full-term parents. Results also revealed significant differences between mothers and fathers' responses to preterm birth in terms of stress, negative feelings, and perceptions of social support. A correlation between negative conditions at birth (e.g., birth weight and Neonatal Intensive Care Unit stay) and higher scores in some scales of Impact of Event Scale Revised, Profile of Mood States and Post-Partum Bonding Questionnaire were found. Neonatal Intensive Care Unit may be a stressful place both for mothers and fathers. It might be useful to plan, as soon as possible, interventions to help parents through the experience of the premature birth of their child and to begin an immediately adaptive mode of care.
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The goal of the present study was to evaluate the psychometric properties of the English and Spanish versions of the Parenting Stress Index-Short Form (PSI-SF) with mothers of 12- to 15-month-old infants with elevated levels of behavior problems and from predominately Hispanic, low-income backgrounds. Mothers of 58 infants were assessed as part of a larger study examining a brief home-based intervention for infants with elevated behavior problems. Internal consistency was good for all 3 subscales (i.e., Parental Distress, Parent-Child Dysfunctional Interaction, and Difficult Child) and the Total Stress scale. Convergent validity of subscales was supported by correlations with measures of theoretically related constructs, including maternal depressive symptoms, maternal parenting practices, and infant behavior. Furthermore, examination of the optimal clinical cutoff by examining sensitivity and specificity suggested that for this high-risk sample lower percentile scores (73rd-77th), relative to the published 85th percentile cutoff, were sufficient for identifying mothers with clinically elevated depressive symptoms and infants with clinically elevated behavioral and emotional difficulties. The current results provide psychometric support for the PSI-SF as an effective and appropriate measure for use with high-risk families that have been underrepresented in previous research, including mothers of very young children with behavior problems, Hispanic and Spanish-speaking populations, and low-income families. (PsycINFO Database Record
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Aim: The study explored fathers’ experience of premature birth during the hospitalization of their infants, analyzing levels of depressive and anxiety symptoms as compared with mothers. Moreover the Italian version of the Clinical Interview for Parents of High-Risk Infant (CLIP) was tested through confirmatory factor analysis. Methods: Couples of parents (N = 64) of preterm infants (gestational age < 37 weeks) were administered a socio-demographic questionnaire, the Edinburgh Postnatal Depression Scale, the State-Trait Anxiety Inventory and the CLIP after the admission to the Neonatal Intensive Care Unit (NICU). Results: Significant levels of anxiety and depressive symptoms and high percentages of subjects above the corresponding risk thresholds were found among fathers and mothers with higher scores among the latters. Confirmatory factor analysis of the CLIP showed an adequate structure, with better fit for mothers than for fathers. Conclusion: Results highlighted the importance for nurses and clinicians working in the NICU to consider not only the maternal difficulties but also the paternal ones, even if these are often more hidden and silent. In addition the CLIP may be considered an useful interview for research and clinical purposes to be used with parents of high-risk infants.
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The aims of the current study were to examine the effect of fathers' and mothers' pre and postnatal mental health on mother-infant and father-infant interactions. Mental health was broadly defined to include anxiety, depression and PTSD. A community sample of 44 mothers and 40 fathers from 45 families completed questionnaire measures of mental health in late pregnancy and three months postpartum. Mother-infant and father-infant interactions were observed and videoed three months postpartum and analysed using the CARE-index. Results showed that prenatal mental health, in particular anxiety, was associated with parent-infant interactions to a greater extent than postnatal mental health. Fathers' prenatal symptoms were associated with higher paternal unresponsiveness and infant passivity whilst fathers' postnatal symptoms were associated with higher levels of infant difficulty in the father-baby interaction. The results also indicated that mothers and fathers interaction with their babies were similar, both on average and within the couples, with 34% being inept or at risk. These findings highlight the need for early detection and prevention of both mental health and parent-infant relationship problems in fathers as well as mothers. However, further prospective and longitudinal studies are needed to understand the influences of parental mental health on the parent-infant interactions further. Also it should be noted that the mental health scores were low in this sample, which may reflect the sample characteristics. Future studies therefore would benefit from focusing on more vulnerable groups of parents.
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Aim: To assess the associations between cognitive development of very low birth weight (VLBW) infants and measures of parental psychological well-being. Methods: In this prospective cohort study, 182 VLBW infants born 1/2001-12/2006 at the Turku University Hospital, Finland, were followed up. At 2 years corrected age, cognitive development of the child was assessed using the Mental Development Index of Bayley Scales, and both parents filled in validated questionnaires defining parental psychological well-being (Beck Depression Inventory, Parenting Stress Index and Sense of Coherence Scale). Results: The cognitive delay of the infant was associated with paternal symptoms of depression (p = 0.007) and parenting stress (p = 0.03). Mothers of the infants with cognitive delay reported increased parenting stress related to the difficulty to accept the child (p = 0.001). Weak sense of coherence predicted depressive symptoms in both parents (p < 0.0001). Conclusion: Even if the fathers of VLBW infants experienced depressive symptoms less often than the mothers, the ability of the fathers to cope was significantly associated with the cognitive development of the infant. In addition, the fathers reported more parenting stress if the infant had a cognitive delay. The mothers reported more parenting stress related to accepting the VLBW infant with cognitive delay.
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Background Factors related to parents and parenting capacities are important predictors of the development of behavioural problems in children. Recently, there has been an increasing research focus in this field on the earliest years of life, however, relatively few studies have addressed the role of fathers, despite this appearing to be particularly pertinent to child behavioural development. This study aimed to examine whether father–infant interactions at age 3 months independently predicted child behavioural problems at 1 year of age. Method A sample of 192 families was recruited from two maternity units in the United Kingdom. Father–infant interactions were assessed in the family home and coded using the Global Rating Scales. Child behaviour problems were assessed by maternal report. Hierarchical and logistic regression analyses were used to examine associations between father–infant interaction and the development of behavioural problems. Results Disengaged and remote interactions between fathers and their infants were found to predict externalising behavioural problems at the age of 1 year. The children of the most disengaged fathers had an increased risk of developing early externalising behavioural problems [disengaged (nonintrusive) interactions – adjusted Odds Ratio 5.33 (95% Confidence Interval; 1.39, 20.40): remote interactions adj. OR 3.32 (0.92, 12.05)] Conclusions Disengaged interactions of fathers with their infants, as early as the third month of life, predict early behavioural problems in children. These interactions may be critical factors to address, from a very early age in the child’s life, and offer a potential opportunity for preventive intervention.
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The purpose was to explore whether poor parental psychological well-being is associated with behavioral problems of very low birth weight (VLBW, ≤1500 g) infants at 3 years of age. In this prospective cohort study, 189 VLBW preterm infants born between January 2001 and December 2006 at the Turku University Hospital, Finland, were followed. Validated questionnaires (Beck Depression Inventory, Parenting Stress Index, and Sense of Coherence Scale) were mailed to the parents when their children were 2 years corrected age. A total of 140 parents evaluated the behavior of the child at 3 years by filling out the Child Behavior Checklist. There were significant associations between most of the measures of parental symptoms of depression, parenting stress, and sense of coherence and the behavioral outcome of the VLBW infants. The concomitant symptoms of both parents were associated with more problematic child behavior. Parents report more behavioral and emotional problems in VLBW children at age 3 if they themselves have had symptoms of depression, parenting stress, or weak sense of coherence 1 year earlier. The new finding of this study was to show the significance of the father's psychological well-being on the behavioral development of a preterm child.
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There is a dearth of knowledge about the effects of early interaction-based interventions on parenting and infant communication skills in moderately and late preterm infants. Assess in a RCT the effects of the Mother-Infant Transaction program (MITP) on maternal depression and stress, breastfeeding and mothers' perception of infant temperament; and MITP's impact on preterm infant communication skills at 12 months. Mothers/preterm infants (30-36 weeks) were randomly assigned to MITP (intervention group) or standard care (control group). Mean gestational age in the intervention group was 33.3±1.5 (n=56) and in the control group (n=50) 33.0±1.6. Outcomes were assessed by CES-D, Parenting Stress Index; WHO breast-feeding categories, Infant Behavior Questionnaire and The Pictorial Infant Communication Scales. Intervention mothers reported significantly less postpartum depression one month after discharge (p=.04) and more breastfeeding at 9 months (p=.02). No significant group differences in favour of the intervention group were found on total parenting stress at 6 (p=.08) and 12 months (p=.46) or on perceived infant communication skills at 12 months (p=.86). The intervention mothers reported significantly less infant smile and laughter at 6 (p=.02) and 12 (p=.006) months and less motor activity at 12 months (p=.04). The results suggest that MITP reduced postpartum depression and extended the period of breastfeeding, but did not support any positive effects of the intervention on self-reported maternal stress and perceived infant communication.
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To study the social-emotional development of triplets, 23 sets of triplets, 23 sets of twins, and 23 singleton infants (N=138) were followed from birth to 2 years. Maternal depression and social support were assessed in the postpartum period, mother-infant and father-infant interaction and the home environment were observed at 3 months, a separation-reunion episode and a maternal interview were conducted at 12 months, and infant behavior problems were evaluated at 24 months. Lower parent-infant synchrony was observed for triplets. Triplets showed less distress during maternal separation and less approach at reunion. Mothers reported lower adjustment and differentiation among siblings for triplets than for twins. Higher internalizing problems were reported for triplets, and the triplet with intrauterine growth retardation showed the poorest outcomes. Behavior problems were predicted by medical risk, maternal depression, parent-infant synchrony, infant approach, and mother adjustment. Discussion focuses on developmental risk when the exclusivity of the parent-infant relationship is compromised.
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La teoria dell’attaccamento attribuisce alle relazioni umane una funzione importante per la protezione dai pericoli e lo sviluppo di un senso di sicurezza. In tale prospettiva le relazioni familiari, le esperienze amorose, la vita di coppia e le funzioni genitoriali vengono considerate in una prospettiva nuova e complementare a quella delineata dalla psicoanalisi. In questo lavoro la funzione svolta dal padre viene descritta tenendo conto dei dati di ricerca sull'attaccamento.
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Aim: This paper aims to investigate if the dyadic interactive behaviours were influenced by parental stress and feelings both in preterm and full-term mother-child dyads. Methods: 45 mothers (age = 35.29 ± 5.38) and fathers (age = 36.77 ± 6.89) of preterm infants (GA = 30.25 ± 2.95; BW = 1288.02 ± 488.76), and 36 mothers (age = 32.60 ± 4.56) and fathers (age = 35.54 ± 5.16) of full-term (GA = 39.88 ± 1.38; BW = 3156.39 ± 493.81) were involved. Parents filled out the Impact of Event Scale Revised (IES-R), Profile of Mood States (POMS) and Parenting Stress Index Short Form (PSI-SF) and interactive behaviours (Global Rating Scale) was videotaped after 3 months. Results: Mothers of preterm children showed higher level of Intrusiveness (Mpreterm = 4.07 ± .74, Mfullterm = 4.39 ± .51, t = 2.22, p = .029) and Remoteness (Mpreterm = 4.45 ± .83, Mfullterm = 4.79 ± .34, t = 2.51, p = .015) than mothers of term children. In preterm mothers' lower levels of Sensitivity, higher levels of Intrusiveness, Remoteness and Depression are associated with the presence of negative feelings and parental stress in both parents. Moreover, higher children Distress is associated to parental negative feelings, paternal stress and post-traumatic symptoms. A higher score of parental negative feelings and parental stress predicted lower scores in Global RatingScale dimensions. Conclusions: Our results underline that preterm birth could be a risk factor for the co-construction of interactive exchanges between mother and premature baby. This study could help practitioners to better consider parental roles and to carry out specific supportive interventions for both parents and children.
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The current study examines the association between early father involvement and infant neurodevelopment, and whether neonatal medical risk moderates this association. Data from approximately 6000 fathers and their children were obtained from the Early Childhood Longitudinal Study: Birth Cohort (ECLS-B). Hierarchical regression was employed to analyze the data. The findings reveal that the association between early father involvement and infant neurodevelopment is contingent on both the timing of involvement (i.e., prenatal/perinatal or infancy) and offspring medical status at birth. The neurodevelopment of medically at-risk neonates was enhanced when fathers were involved during the gestational period and at the time of their birth. This relationship was not detected, however, in the case of infants who did not experience medical risks as neonates. Neonatal medical risk appears to be an important moderating factor in the link between father involvement during pregnancy and childbirth and infant neurodevelopment. Practitioners should continue to make efforts to involve fathers during gestation and childbirth. The findings of the present study suggest that doing so may protect against neurodevelopmental delays in neonates with medical risks.
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Objective: Despite the presence of many studies on difficulties related to premature birth, findings on developmental outcomes are heterogeneous. This could be explained from a biological and environmental point of view, but also from a methodological one. The aims of this study were as follows: assess cognitive and linguistic performance using the BSID-III in a population of healthy preterm infants at 24 and 36 months (corrected age); analyze whether the correction for prematurity should be applied, decide when to stop using corrected age and evaluate possible improvements between 24 and 36 months. Methods: Developmental outcome was assessed at 24 and 36 months (corrected age) with the BSID-III in 75 healthy preterm (GA=32.5±1.97; BW=1631.55±453.92) and 69 term-born children (GA=39.77±1.00; BW=3298.95±457.27). Results: Preterm infants had significantly lower scores than those of term infants in Cognitive (COG) and Language (LANG REC, LANG EC) scales of the BSID-III at both 24 and 36 months, considering both corrected (CA) and chronological (UCA) age. At 24 months, significant differences between corrected and chronological scores were found for each BSID-III scale, while at 36 months, significant differences between corrected and chronological scores were found for LANG scales. Only the scores in the COG scale were statistically different between 24 and 36 months (F=4.894, P=0.009, η(2)=0.075). Considering only the preterm sample at 24 months, the differences between CA and UCA scores in the COG scale were significantly correlated to GA (p=0.000) and days in hospital (p=0.002;), while differences between CA and UCA scores in the LANG ESP scale were significantly correlated to GA (p=0.010), days in hospital (p=0.001), and birth weight (p=0.007). At 36 months, no significant correlations were found. Conclusions: Preterm birth is followed by poorer cognitive and language outcomes during infancy than full-term birth. Age correction of prematurity is useful if the child is under 2 years of age; however, our findings raise concerns about the need for age correction, considering that at later ages, healthy preterm children have a higher rate of developmental delay compared with term infants. With regard to cognitive development, preterm children seem to recover from their initial disadvantage; however, with regard to linguistic development, data confirm that preterm infants are at risk for language difficulties.
Article
Objective: To reveal mothers' experiences of providing kangaroo care for their preterm newborns while still in the hospital. Design: Transcendental phenomenology was used to analyze the experiences of mothers providing kangaroo care for their preterm newborns. Tape recorded, semistructured interviews were conducted 1 to 4 weeks postpartum. Mothers were asked one grand tour question, "What was it like for you to provide kangaroo care for your preterm infant while in the hospital?" This study was the qualitative component of a randomized clinical trial. Participants: Ten women who provided kangaroo care for their preterm newborns, 32-36 completed weeks, weighing 1500-3000 grams, with APGAR scores 6 or greater at 1 minute, 7 or greater at 5 minutes. Results: Four dominant themes emerged. The themes were reduced to one essential structure of knowing. The two essential elements of the structure of knowing were mothers kept from knowing their preterm newborn and mothers getting to know their preterm newborn. Conclusions: Kangaroo care facilitates bonding and enhances maternal-infant acquaintance, even in the neonatal intensive care unit (NICU) environment. Mothers found that kangaroo care calmed them and their newborns.
Article
Parents experience a lot of positive and negative feelings and emotions after birth. The main purpose of this study was to compare perceptions and experiences of mothers and fathers with term, moderately and very preterm infants. We included 202 infants with both parents, divided into three groups: 1) term infants (≥ 37 weeks' gestation), 2) moderately preterm infants (≥32-<37 weeks' gestation) and 3) very preterm infants (< 32 weeks' gestation). The Clinical Interview for Parents of High-risk Infants (CLIP) was used to examine parental perceptions and experiences in eight areas: 1) Infant's current condition, 2) Course of the pregnancy, 3) Labor and delivery, 4) Relationship with infant and feelings as a parent, 5) Reactions to hospital and staff, 6) Support system, 7) Discharge and beyond, and 8) Quality of narratives during the interview. The lower the gestational age of the infant, the more negative parental experiences and perceptions were on the following five areas: infant's current condition, pregnancy course, labor and delivery, relationship with the infant, and discharge and beyond. No differences were found between maternal and paternal perceptions on any of the eight CLIP areas. Negative parental perceptions and experiences were mainly associated with the gestational age of the infant and not at all with the gender of the parent. These findings resulted in several recommendations to optimize care for parents after preterm birth.
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The study evaluated the quality of preterm infant-mother interactions, considering severity of birth weight (ELBW and VLBW) and maternal depression, compared to full term babies. 69 preterm infants (29 ELBW and 40 VLBW) and 80 full-term (FT) infants and their mothers were recruited. At 3 months of corrected age, the quality of mother-infant interaction was evaluated through Global Rating Scales; moreover, infant level of development and maternal depression were assessed through Griffith Development Mental Scales and Edinburgh Postnatal Depression Scale. Results showed adequate sensitivity in preterm infants' mothers and higher involvement with their infants, compared to full term mothers, but ELBW ones exhibited an intrusive interactive pattern and a higher prevalence of depressive symptoms. The study underlined the relevance of paying special attention to both ELBW infants and their mothers, in order to support the parenting role and the co-construction of early interactions.
Article
Objective To explore the experiences of fathers shortly after the birth of their preterm infants. Design/MethodA focused ethnography conducted over 33 months (2003–2006) in the neonatal intensive care unit (NICU) of a large U.K. National Health Trust (NHS) teaching hospital. Data were collected through participant observation, in-depth interviews with fathers (n = 10), and an ethnographic survey distributed to NICU staff (n = 87). Practices and relationships with fathers were concurrently analyzed thematically through the conceptual perspective of emotion work. FindingsFathers’ emotional reactions to their experiences were described in three themes: emotional withdrawal and control, stereotyping, and mixed feelings. Fathers’ emotional behaviors were governed by complex, culturally determined conventions and expectations. Conclusions Fathers engaged in considerable effort to manage their emotions as they attempted to reconcile the tension between what they wanted to feel and what they thought others expected them to feel. The results of this study support the view that focusing on emotional externalities alone tends to underplay the amount of emotion work carried out by less expressive individuals; this “silent emotion work” was characteristic of the fathers in this study.
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Background: It is well known that mother–child relationships may be affected by maternal psychological disorders, but, at present, few experimental studies have investigated the negative impact of postpartum post-traumatic stress disorder (PTSD) symptoms on child behaviour using the Still Face paradigm. Objective: The aim of this exploratory work is to investigate whether postpartum stress symptoms may affect mother–child relationships. The underlying hypothesis is that the persistence of postpartum stress symptoms may have a negative outcome on the mother’s tuning with the child. Methods: A sample of 19 pregnant women (mean age = 31.31; SD = 4.50) attended the four phases of the research, from the seventh month of pregnancy. Maternal personality characteristics were assessed by MMPI-2. The Perinatal PTSD Questionnaire was used to assess PTSD symptoms two days and two months after delivery. Three months after childbirth the dyads attended the Still Face paradigm. Results: Data have shown that the persistence of PTSD symptoms has a different effect on early mother–child interactions than those of mothers who have not had postpartum stress symptoms. Conclusion: These data allow us to hypothesise that there are some baseline difficulties in women with PTSD symptoms in producing a positive interactive engagement, not only in relation to the break of interaction caused by the Still episode.
Article
ABSTRACT The study compared a group of 62 new Israeli fathers of pre-term infants with a comparison group of 58 new fathers of full-term infants with respect to parental stress, depression symptoms, mastery, self-esteem and involvement with the child. Findings indicated that fathers of pre-term infants had significantly greater stress and depression scores and lower involvement rate with the child compared with fathers of the matching group. No differences were found with respect to the fathers' mastery and self-esteem. New fathers of full-term infants, aged 30 years and more, had significantly higher self-esteem compared with fathers aged less than 30 years. Findings are discussed with respect to practice in neonatal units.
Article
Objective: To validate an Italian version of the Impact of Event Scale (IES) in patients addressing the emotional impact of a recent road accident. Methods: Seventy-nine subjects were examined within 1–34 weeks after an accident by means of (1) an Italian version of the IES, (2) a free description of the accident, and (3) a questionnaire assessing subjects' behaviour and feelings. Results: IES data were analysed by means of the principal component analysis (PCA) method, followed by a quartimax rotation, obtaining a two-factor solution interpreted as intrusion (Factor 1) and avoidance (Factor 2). Furthermore, the scores to the two subscales were considered in order to assess their predictive value on some variables linked to the traumatic event. Intrusion significantly discriminated the emotional intensity and fear level of subjects as a consequence of the accident. Conclusions: The IES is a two-dimensional test capable of evaluating posttraumatic stress. The intrusion and avoidance factors explained 40% of the total variance. The two-factor solution has a psychological counterpart and is similar to the findings of earlier studies conducted on a larger number of subjects in other countries.
Article
Background: Postnatal psychological symptoms have been studied less often in fathers than in mothers. However, recent research shows that fathers' psychopathology may have long-term effects on their children's emotional and behavioural development independently of maternal psychopathology. More research is needed on factors associated with paternal symptoms at the early stage of child development. Aims: The aim of the study was to examine the paternal, maternal, infant and family factors associated with the occurrence of depressive and anxiety symptoms in fathers of infants. Methods: As part of a study conducted in Tampere, Finland, on infants' social withdrawal symptoms, both parents of 4-, 8- and 18-month-old infants (n = 194) completed the Edinburgh Postnatal Depression Scale (EPDS) and general information questionnaires during routine check-ups of the infants in well-baby clinics. Parental depressive and anxiety symptoms were screened using the recommended cut-off points for this purpose (5/6 for fathers and 7/8 for mothers on the EPDS). The associations between the fathers' symptoms and paternal, maternal, infant and family factors were explored. Results: Twenty-one per cent of the fathers and 24% of the mothers scored above the cut-off points for depressive and anxiety symptoms on the EPDS. Both paternal and maternal factors predicted high paternal symptom level in regression models. Infant factors were not statistically significantly associated with paternal symptoms. Conclusions: Father's psychological symptoms were associated with many facets of both parents' impaired well-being. The whole family system should be considered whenever there are concerns about either parent's psychological well-being.
Article
The book provides information on emotional care for both parent and infant; expresses theoretical constructs from many professionals; and is rich in clinical material. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Aims: The study examined the effects of a parental intervention to reduce parents' stress levels during the hospitalization of their very preterm infants in a NICU, taking into account possible differences between mothers and fathers. Methods: Parents of infants born ≤ 32 weeks gestational age (GA) were randomly assigned to a standard support group (N = 21) or intervention group (N = 21). The intervention was based both on a joint observation method and infant massage provided by both parents. Parents' stress was assessed by the Parental Stressor Scale: Neonatal Intensive Care Unit, after the first week of admission and at the infant's discharge. Results: At discharge, intervention group parents showed significantly lower levels of stress related to infants' appearance/behaviour and to parental role alteration (PRA) than those of the standard support group (p = 0.000). Overall, mothers reported more stress compared with fathers (p ≤ 0.05). The intervention was effective in reducing the stress-role alteration in mothers (p < 0.05), but not in fathers. Conclusions: Mothers reported more stress compared with fathers, above all for PRA. A parental intervention was effective in reducing stress-role alteration in mothers, but not fathers. Parental interventions should take into account that help for fathers could be different from help for mothers.
Article
Literature is reviewed demonstrating the impact of maternal depression on early infant interactions and development. Infants of depressed mothers (a) develop a depressed mood style as early as 3 months; (b) this mood generalizes to interactions with nondepressed women; (c) it persists over the first year if the mother's depression persists; and (d) it affects growth and Bayley developmental scores by the end of the first year. Other data are reviewed on individual differences including maternal depression styles of withdrawal and intrusion, negative behavior matching, and distorted perceptions of behavior. Finally, genetic, intrauterine, and extrauterine environment effects are discussed and interventions are suggested for altering the mother's depressed behavior and distorted perceptions. The review concludes that a developmental psychopathology perspective is needed to better understand the development of early depression.
Article
Background. The birth of a preterm infant has a long-term impact on both parents. Mothers report more stress and poor adjustment compared with fathers. Influencing factors, such as family situation and health status of the child, can support or weaken the coping ability of the parents. Studies on experiences of fathers are sparse. Aim. The aim of this research was to study how mothers and fathers of preterm infants describe their experiences of parenthood during the infant's first 18 months of life. Methods. Seven consecutively selected sets of parents of preterm infants born at ≤34 weeks of gestation with no serious congenital defects were interviewed 1–2 weeks after the infant's birth and at 2, 6 and 18 months of age, and the findings were analysed using a phenomenological method. Findings. Internalization of parenthood was described as a time-dependent process, with four syntheses of experiences – alienation, responsibility, confidence and familiarity. Within the syntheses, similarities in how mothers and fathers described their parental roles involved concern for the child, insecurity, adjustment and relationship with the child. Regarding differences, mothers experienced having more responsibility and control of the care and a need to be confirmed as a mother, while fathers described confidence in leaving the care to the staff and wanted to find a balance between work and family life. Important turning points in parenthood experiences often occurred when the infant could be removed from the incubator, discharged from the ward, and when the infant looked normal compared to full-term infants. Conclusions. The structure of the phenomenon of parenthood was formed by the integration of the syntheses of alienation, responsibility, confidence and familiarity. The structure seems to be based on the parents’ expectations of the parental role, the infant's health condition and the health care environment. These interacting factors are influenced by cultural beliefs.
Article
Attachment has generally been examined from the infant's perspective. We focused on mothers' post-partum thoughts and behaviors. Guided by an ethological approach, maternal bonding was examined under conditions of proximity, separation, and potential loss. Ninety-one mothers were interviewed: mothers of full-term infants who maintained continuous proximity to the infant, mothers of healthy premature infants who were separated from the infant, and mothers of very low birthweight infants who experienced potential loss and prolonged separation. Mothers of term infants reported medium-to-high levels of preoccupations with thoughts of infant safety and well-being. Preoccupations increased with separation (Group 2) and significantly decreased with impending loss (Group 3). Attachment behaviors and representations were the highest among mothers of term infants and declined linearly with the duration of mother-infant separation. Maternal trait anxiety and depression were related respectively to higher levels of preoccupations and reduced attachment behaviors and representations, independent of the infant medical condition and mother-child separation. Discussion focused on the comparability of maternal and infant attachment in relation to the neurobiological system underlying bond formation.
Article
A large group of infants of primiparous women who were at high risk for postnatal depression (N=188) and a smaller group of those at low risk (N=43) were assessed in the neonatal period using the Neonatal Behavioural Assessment Scale. Poor motor scores and high irritability were strongly predictive of the onset of maternal depression by eight wéeks postpartum. These effects obtained after taking account of both maternal mood in the neonatal period and maternal perceptions of infant temperament. Poor motor scores and high levels of infant irritability in the neonatal period also predicted less optimal infant behaviour in face‐to‐face interactions with the mother at two months postpartum. Neonatal behaviour did not predict the persistence of depression, nor did it predict the quality of maternal behaviour in interaction with the infant. RÉSUMÉ Le rôle des facteurs infantiles dans la dépression post‐ natale et les interactions mère‐enfant. Un groupe important de nourrissons de mères primipares à haut risque de dépression du postpartum (N=188) et un plus petit groupc de mères à faible risque (N=43) ont été examinées durant la période néonatale à l'aide de la Neonatal Behavioural Assessement Scale. Des scores moteurs médiocres et un degréélevé d'irritabilité ont été fortement prédictifs d'un début de dépression maternelle à huit semaines de post‐partum. Ces effets étaient obtenus en tenant compte à la fois de l'humeur maternelle dans la période néonatale et la perception maternelle du comportement de leur enfant. Des scores moteurs médiocres et un niveau élevé de l'irritabilité chez lc nourrisson durant la période néonatale prédisait également un comportcment infantile moins optimal dans l'interaction de face à face avec la mère deux mois après la naissance. Le comportement à la naissance ne prédisait pas la persistance de la dépression, ni la qualité du comportement maternel dans l'interaction avec son nourrisson. ZUSAMMENFASSUNG Der Einfluβ kindlicher Faktoren auf postnatale Depressionen und Mutter‐Kind Interaktionen Eine große Gruppe von Säuglingen erstgebärender Mütter, die ein hohes Risiko für eine postnatale Depression hatten (N=188) und eine kleinere Gruppe solcher mit niedrigem Risiko (N=43) wurden in der Neugeborenenperiode mit Hilfe der Neonatal Behavioural Assessment Scale untersucht. Schlechte motorische Scores und hochgradige Empfindlichkeit waren wichtige Parameter für den Beginn einer mütterlichen Depression bis fünf Wochen postpartum. Diese Einfüsse blieben auch bestehen, nachdem man sowohl die Stimmung der Mutter in der Nconatalpcriode als auch ihre Einschätzungen des kindlichen Temperaments berücksichtigt hattc. Schlechte motorische Scores und hochgradige Empfindlichkeit des Kindes in der Neonatalperiode waren kein optimaler Parameter für das kindliche Verhalten bei Blickkontakt‐Interaktionen mit der Mutter im Alter von zwei Monaten post partum. Das Verhalten in der Neonatalperiode besagte nichts über das Fortbestehen der Depression, noch besagte es etwas über die Art des mütterlichen Verhaltens bei Interaktionen mit dem Kind. RESUMEN Papel de los factores del recién nacido en la depresión postnatal y en las interacciones madre‐lactante ; Un gran grupo de lactantes de mujeres primíparas de alto riesgo para la depresión postnatal (N=188) y un grupo más pequcño con bajo riesgo (N=43) fueron evaluados en el período neonatal utilizando la Neonatal Behavioural Assessment Scale. Los puntajes motores pobres y la alta irritabilidad fueron fuertemenie predictivos del inicio de una depresión materna a las ocho semanas postpartum. Estos efectos se obtuvieron después de tener en cuenta la manera de ser de la madre (su estado de ánimo) en el período neonatal y las percepciones maternas del temperamento del lactante. Los puntajes motores pobres y los altos niveles de irritabilidad el lactante en el período neonatal tambíen predijeron un comportamiento del lactante menos óptimo en su interacción con la madre a los dos meses del postparto. El comportamiento neonatal no predijo la persistencia de la depresión, ni la cualidad del comportamiento materno en su interacción con el lactante.
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
AimThe aim of this study was to describe the experiences from the birth of premature infants in the fathers’ perspective.MethodsEight fathers participated; their infants were born prematurely and thereby needed care in a neonatal intensive care unit. Narrative interviews were conducted and a thematic content analysis was used to analyze the interviews.Results and conclusionFathers described their experiences of having a preterm infant, as getting into the midst of something never previously reflected on. It was important to have information and to know what was going on, but it was difficult to understand what was happening. The fathers were protective over the mother and infant. They wanted to be with both the mother and the infant as much as possible and wished to be seen as a natural part in the care. However, fathers had their own needs and, therefore, needed to be cared for as well.
Article
The aim of this study was to explore the early experiences of parents who have a very preterm infant. Very preterm infants are physiologically ill-prepared for extra-uterine life, but a greater number now survive birth and the postnatal period. The complex needs of the very preterm infant are met in the technological environment of the neonatal intensive care area, separating parents, physically and psychologically from their very preterm infant. Studies exploring the parental experience have identified parental stress; lowly parental status and attachment issues as areas of concern. However, there is little understanding about the early parental experience. This study used a phenomenological interpretive design. Ethical approval to conduct this study using two study centres was obtained. An interpretive interactionist approach guided this study. Data were collected from three sources: 20 parents of very preterm infants, five senior neonatal nurses and seven neonatal intensive care nurses. Purposive sampling was used for the first and second sources, and data were collected through semi-structured interviews. The third source of data occurred opportunistically through one focus group. Analysis involved constant comparative analysis. Crisis, uncertainty and powerlessness, properties of liminality framed this early complex parental transition. It is argued that the overarching theme of parental liminality best framed the parental physical, psychological and social experiences. This qualitative interpretive study identified that parents of very preterm infants experienced many crises, uncertainty and powerlessness in their transition to parenthood, making them liminal people. Parental liminality provides a means of conceptualising the early experiences of parents of very preterm infants, providing practitioners, at strategic and operational levels, with the means of developing supporting interventions in the early stages of transition for parents of very preterm infants. Such support could mediate parent-infant relationships.
Article
Premature birth is a stressful experience for parents. This study explores the links between maternal posttraumatic stress, maternal attachment representations of the infant and mother-infant dyadic interactions. The study enrols 47 preterm (GA<34 weeks) and 25 full-term infants. The Perinatal Posttraumatic Stress Disorder Questionnaire was administered to evaluate maternal posttraumatic stress symptoms. At 6 months of corrected age, maternal attachment representations of the infant were explored and coded with the Working Model of the Child Interview. Interactive characteristics were explored in a videotaped play session and coded with the Care Index. Full-term mothers were more likely to follow a "Cooperative" dyadic pattern of interaction with the infant and demonstrate Balanced representations of the infant. Preterm mothers with high posttraumatic stress symptoms were more likely to follow a "Controlling" dyadic pattern of interaction, with more Distorted representations. In contrast, preterm mothers with low posttraumatic stress symptoms were more likely to fall into a "Heterogeneous" group of patterns of dyadic interaction, with Disengaged representations. Interestingly, in Cooperative preterm dyads, only 23% of the mothers demonstrated Balanced representations, despite rates of 69% in full-term Cooperative dyads. Premature birth affects both mother-infant interaction characteristics and maternal representations of attachment with the infant. In particular, a "Controlling" dyadic pattern was associated with high maternal posttraumatic stress symptoms and Distorted maternal representations. It is important to examine the impact of maternal posttraumatic stress on the parent-infant relationship in order to plan supportive, preventive interventions in the neonatal period.
Article
To describe and understand how mothers utilize the opportunity to actively participate in their preterm infants' pain care using facilitated tucking by parents (FTP). Descriptive and exploratory study with postintervention interview. Finnish level III Neonatal Intensive Care Unit (NICU). Twenty-three mothers who had preterm infants born at gestational ages of 32 to 34 weeks. The parents (N=45) of 29 preterm infants were taught to use FTP. In addition, all nurses in the NICU (N=76) received the same education to support the parents' use of FTP. After 2 to 4 weeks of FTP use, the mothers (n=23) were interviewed using the Clinical Interview for Parents of High-Risk Infants with additional questions related to the infants' pain care. The interviews were analyzed inductively with cross-case analysis and deductively with a previously developed coding scheme. Facilitated tucking by parents was perceived positively and was used by all participating mothers. Three different styles of involvement in preterm infants' pain care with FTP were identified. They formed a continuum from external to random and finally to internalized involvement. In external involvement, the pain care with FTP was triggered by outside factors such as nurses, whereas in random and internalized involvement the motivation emerged from a parent. Mothers with external involvement thought that any person could apply the FTP. In random involvement, mothers were mainly absent during painful procedures, although they saw themselves as the best caregivers. In internalized involvement, the responsibility for infant pain care was shared within the family. Mothers' NICU-related stress and maternal attachment were associated with this variation. This study showed that mothers' are willing to actively participate in their preterm infants' pain care. However, the participation is unique according to mother and her experiences before and during NICU admission. Nurses need to consider these differences in mothers when involving them in preterm infants' pain care.
Article
Although much is known about the risk factors for postpartum depression (PPD), the role of giving birth to a preterm or low-birth-weight infant has not been reviewed systematically. To review systematically the prevalence and risk factors for PPD among women with preterm infants. Medline, CINAHL, EMBASE, PsycINFO and the Cochrane Library were searched from their start dates to August 2008 using keywords relevant to depression and prematurity. Peer-reviewed articles were eligible for inclusion if a standardised assessment of depression was administered between delivery and 52 weeks postpartum to mothers of preterm infants. Data on either the prevalence of PPD or mean depression score in the target population and available comparison groups were extracted from the 26 articles included in the review. Risk factors for PPD were also extracted where reported. The rates of PPD were as high as 40% in the early postpartum period among women with premature infants. Sustained depression was associated with earlier gestational age, lower birth weight, ongoing infant illness/disability and perceived lack of social support. The main limitation was that most studies failed to consider depression in pregnancy as a confounding variable. Mothers of preterm infants are at higher risk of depression than mothers of term infants in the immediate postpartum period, with continued risk throughout the first postpartum year for mothers of very-low-birth-weight infants. Targeted clinical interventions to identify and prevent PPD in this vulnerable obstetric population are warranted.
Article
A large group of infants of primiparous women who were at high risk fo r postnatal depression (N=188) and a smaller group of those at low risk (N=43) were assessed in the neonatal period using the Neonatal Behavioural Assessment Scale. Poor motor scores and high irritability were strongly predictive of the onset of maternal depression by eight weeks postpartum. These effects obtained after taking account of both maternal mood in the neonatal period and maternal perceptions of infant temperament. Poor motor scores and high levels of infant irritability in the neonatal period also predicted less optimal infant behaviour in face-to-face interactions with the mother at two months postpartum. Neonatal behaviour did not predict the persistence of depression, nor did it predict the quality of maternal behaviour in interaction with the infant.
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
To examine the effects of infant negative emotionality and of mothering and fathering during the toddler years on 3-year-old boys' externalizing problems and inhibition, as well as explore the proposition that children vary in their susceptibility to rearing influence, 125 first-born, Caucasian boys from maritally intact families were studied. Results revealed that when infant negativity is measured with objective, replicable, and discriminantly valid procedures, no relation obtains between it and externalizing problems (nor inhibition). Moreover, as hypothesized on the basis of prior work, parenting was a stronger predictor of externalizing problems and inhibition in the case of children who were highly negative as infants. Mothering proved a stronger predictor of externalizing problems and fathering of inhibition, with more negative mothering in the 2nd and 3rd year forecasting higher CBCL-externalizing scores and less negative fathering in the 2nd and 3rd year and more positive fathering in the 2nd year forecasting more inhibition at age 3 Implications of these findings for studies of parental influence are considered.
Article
Attachment has generally been examined from the infant's perspective. We focused on mothers' post-partum thoughts and behaviors. Guided by an ethological approach, maternal bonding was examined under conditions of proximity, separation, and potential loss. Ninety-one mothers were interviewed: mothers of full-term infants who maintained continuous proximity to the infant, mothers of healthy premature infants who were separated from the infant, and mothers of very low birthweight infants who experienced potential loss and prolonged separation. Mothers of term infants reported medium-to-high levels of preoccupations with thoughts of infant safety and well-being. Preoccupations increased with separation (Group 2) and significantly decreased with impending loss (Group 3). Attachment behaviors and representations were the highest among mothers of term infants and declined linearly with the duration of mother-infant separation. Maternal trait anxiety and depression were related respectively to higher levels of preoccupations and reduced attachment behaviors and representations, independent of the infant medical condition and mother-child separation. Discussion focused on the comparability of maternal and infant attachment in relation to the neurobiological system underlying bond formation.
Article
Despite being developed before the formal introduction of posttraumatic stress disorder (PTSD) within the diagnostic literature, the Impact of Event Scale (Horowitz, Wilner, & Alvarez, 1979) remains one of the most widely used self-report measures of posttraumatic stress. This paper presents an overview of research using the IES in an attempt to assess its psychometric status. It is concluded that the psychometric properties of the IES are satisfactory (although not as a PTSD diagnostic measure) and that continued use of the IES as a measure of intrusive and avoidant processes is warranted.
Article
The birth of a very premature infant is a critical event in the life of a family and studies have shown that mothers of these infants are at greater risk of psychological distress than mothers of full-term infants. A total population study of mothers of preterm infants born at less than 32-week gestation at a tertiary referral hospital. Sixty-two mothers of very preterm infants (<32 weeks) participated in the present study which examines correlates of maternal depressive symptomatology at 1 month following very premature birth. Information was obtained from structured questionnaires completed by mothers at 1 month after infant admission to neonatal intensive care. Forty percent of the mothers reported significant depressive symptoms on the Edinburgh Postpartum Depression Scale (EPDS). Logistic regression analysis indicated that high maternal stress resulted in an increased likelihood of depressive symptoms (OR 1.15, CI 1.04-1.26, p<0.01). Higher levels of maternal education (p<0.05), and increased perception of support from nursing staff (OR 1.06, CI 0.88-1.00, p<0.05) resulted in decreased likelihood of depressive symptoms. The birth and subsequent hospitalisation of a very premature infant evokes considerable psychological distress in mothers. These results have implications for policy development in order to enhance family centred care in the neonatal intensive care.
Article
To describe Swedish men's experiences of becoming fathers to their preterm infants. A cross-sectional descriptive study. Eight men participated in semistructured interviews with open-ended questions. The interviews were analyzed using manifest and latent content analysis. The concepts of control and noncontrol. The manifest analysis of the interview text produced six categories: concern, stress, helplessness, security, support, and happiness. The latent content interpretation indicated that the concepts of control and noncontrol were relevant to the fathers' experiences. The men's experiences of early fatherhood were influenced by their ability to experience control. When concern, stress, and helplessness dominated the fathers' experiences and coincided with low levels of happiness, support, and security, they experienced noncontrol. Conversely, when they experienced support, security, and happiness, they felt that they were in control and able to handle the situation.
Article
Previous studies have shown that premature birth and the immaturity of the child can affect the quality of the parent-child relationship. The present study examines the relationship between maternal and infant interactional behavior over time and infant perinatal risk factors as well as maternal perinatal recollected traumatic experience. Few studies have explored the relationship between maternal stress and the quality of parent-infant interaction. Mother-child interaction was recorded at 6 and 18 months of infant's age, in a population of 47 preterm infants (GA<34 weeks) and 25 full-term infants, born in 1998, during a play interaction. According to the Care Index, sensitivity, control and unresponsiveness have been used to code maternal interactional characteristics, and cooperation, compliance-compulsiveness, difficulty and passivity have been used to code the infant's interactional characteristics. The level of maternal stress was evaluated with the Perinatal Posttraumatic Stress Disorder Questionnaire (PPQ), and the infant's perinatal risk factors were assessed with the Perinatal Risk Inventory (PERI). Mothers of high-risk infants, as well as mothers that had experienced traumatic stress in the perinatal period, were less sensitive and more controlling at 6 months. The interactional behavior of the preterm infant was different from that of the full-term infant at 18 months of age, and was correlated with maternal traumatic stress but not with perinatal risk factors. These results underline the importance of maternal traumatic experience related to premature birth and its potential long lasting influence on mother-child interactional behavior.