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Menke RA, Swanson L, Erickson NL, Reglan G, Thompson S, Bullard KH, Rosenblum K, Lopez JP, Muzik M. Childhood adversity and sleep are associated with symptom severity in perinatal women presenting for psychiatric care. Arch Womens Ment Health 2019; 22:457-465. [PMID: 30276477 PMCID: PMC6443486 DOI: 10.1007/s00737-018-0914-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 09/17/2018] [Indexed: 01/21/2023]
Abstract
This study leverages psychiatric intake data from treatment-seeking perinatal women aiming to explore the understudied associations between childhood adversity, sleep quality, and severity of perinatal mental illness in this population. The sample is 578 perinatal women presenting for initial evaluation to a university-based perinatal psychiatry clinic. At intake, we collected demographics, adverse childhood experiences (ACEs), sleep quality, and diagnosis and symptom severity of depression, anxiety, and posttraumatic stress disorder (PTSD). Clinician-rated diagnoses showed that 65% of women met criteria for major depression, 23% for generalized anxiety disorder and 4% for PTSD; almost 30% of women had childhood adversity and 98.2% reported poor perinatal sleep quality. Regression analyses revealed differential associations between ACEs and sleep quality and perinatal mood symptoms; ACEs were significantly associated with pregnancy and postpartum PTSD, whereas sleep quality was associated with perinatal depression and generalized anxiety. Screening for ACEs and sleep quality during perinatal intake has high clinical utility, as these two factors significantly contribute to symptom severity across peripartum.
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Affiliation(s)
- Rena A Menke
- Department of Psychiatry, University of Michigan, 4250 Plymouth Rd., Ann Arbor, MI, 48105, USA
| | - Leslie Swanson
- Department of Psychiatry, University of Michigan, 4250 Plymouth Rd., Ann Arbor, MI, 48105, USA
| | - Nora L Erickson
- Department of Psychiatry, University of Michigan, 4250 Plymouth Rd., Ann Arbor, MI, 48105, USA
| | - Greta Reglan
- Department of Psychiatry, University of Michigan, 4250 Plymouth Rd., Ann Arbor, MI, 48105, USA
| | - Stephanie Thompson
- Department of Psychiatry, University of Michigan, 4250 Plymouth Rd., Ann Arbor, MI, 48105, USA
| | | | - Katherine Rosenblum
- Department of Psychiatry, University of Michigan, 4250 Plymouth Rd., Ann Arbor, MI, 48105, USA
- Center for Human Growth & Development, University of Michigan, 300 N. Ingalls St, Ann Arbor, MI, 48104, USA
| | - Juan P Lopez
- Department of Psychiatry, University of Michigan, 4250 Plymouth Rd., Ann Arbor, MI, 48105, USA
| | - Maria Muzik
- Department of Psychiatry, University of Michigan, 4250 Plymouth Rd., Ann Arbor, MI, 48105, USA.
- Center for Human Growth & Development, University of Michigan, 300 N. Ingalls St, Ann Arbor, MI, 48104, USA.
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Swain JE, Ho SS, Fox H, Garry D, Brummelte S. Effects of opioids on the parental brain in health and disease. Front Neuroendocrinol 2019; 54:100766. [PMID: 31128130 PMCID: PMC8318357 DOI: 10.1016/j.yfrne.2019.100766] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 05/20/2019] [Accepted: 05/21/2019] [Indexed: 12/20/2022]
Abstract
The epidemic of opioid use disorder (OUD) directly affects millions of women of child-bearing age. Unfortunately, parenting behaviors - among the most important processes for human survival - are vulnerable to the effects of OUD. The standard of care for pregnant women with OUD is opioid maintenance therapy (OMT), of which the primary objective is to mitigate addiction-related stress. The aim of this review is to synthesize current information specific to pregnancy and parenting that may be affected by OUD. We first summarize a model of the parental brain supported by animal research and human neuroimaging. We then review animal models of exogenous opioid effects on parental brain and behavior. We also present preliminary data for a unifying hypothesis that may link different effects of exogenous opioids on parenting across species and in the context of OMT. Finally, we discuss future directions that may inform research and clinical decision making for peripartum women with OUD.
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Affiliation(s)
- James E Swain
- Department of Psychiatry and Behavioral Health, and Psychology, Stony Brook University, Stony Brook, NY, United States; Department of Psychiatry, Psychology, and Center for Human Growth & Development, University of Michigan, Ann Arbor, MI, United States.
| | - S Shaun Ho
- Department of Psychiatry and Behavioral Health, and Psychology, Stony Brook University, Stony Brook, NY, United States
| | - Helen Fox
- Department of Psychiatry and Behavioral Health, and Psychology, Stony Brook University, Stony Brook, NY, United States
| | - David Garry
- Department of Obstetrics and Gynecology, Stony Brook University, Stony Brook, NY, United States
| | - Susanne Brummelte
- Department of Psychology, Wayne State University, Detroit, MI, United States.
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Doi S, Fujiwara T. Combined effect of adverse childhood experiences and young age on self-harm ideation among postpartum women in Japan. J Affect Disord 2019; 253:410-418. [PMID: 31103806 DOI: 10.1016/j.jad.2019.04.079] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 03/29/2019] [Accepted: 04/17/2019] [Indexed: 01/23/2023]
Abstract
BACKGROUND Suicide among postpartum women is a new and emerging issue in developed countries. However, little is known about the combined effect of risk factors on self-harm ideation, although various risk factors have been found. The aim of this study is to examine the combined effect of maternal adverse childhood experiences and maternal age on self-harm ideation among postpartum women. METHODS The study comprised a cross-sectional study of 8074 mothers participating in a 3-month health checkup between September 2013 and August 2014 in City A, Prefecture A, Japan. Main outcome was self-harm ideation assessed using the Edinburgh Postnatal Depression Scale (EPDS), item 10. Possible risk factors were maternal adverse childhood experiences (ACEs), maternal characteristics, relationship with husband/partner (e.g., feelings when pregnancy was confirmed), household characteristics, child characteristics (e.g., age, sex, birth weight), and postpartum characteristics, and postpartum depression status other than self-harm ideation. RESULTS Postpartum women with 3 or more ACEs and younger age (<25 years old) were 10.3 times more likely than those with no ACEs and older age to have self-harm ideation (95%CI = 5.3-20.2). This combined effect was also found in first-time mothers (OR = 7.6, 95%CI = 3.2-17.9). LIMITATIONS Study limitations are excluding an item on sexual abuse which is one of the ACEs, recall bias and information bias. CONCLUSIONS Postpartum women with 3 or more ACEs and who were younger than 25 years old were at a high risk for self-harm ideation. Providing prevention strategies aimed at mothers with multiple risk factors, especially younger age and ACEs, is warranted.
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Affiliation(s)
- Satomi Doi
- Department of Global Health Promotion, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
| | - Takeo Fujiwara
- Department of Global Health Promotion, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
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Baber M, Gough A, Jamieson J, Milne R, Pham H, Walters E, Izzard S, Ji E. Reducing the risk of mental ill health: the importance of the early years of life. Perspect Public Health 2019; 139:126-127. [DOI: 10.1177/1757913919839003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | | | | | | | | | | | | | - Ellen Ji
- INSERM U955, Translational Psychiatry Team
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Erickson N, Julian M, Muzik M. Perinatal depression, PTSD, and trauma: Impact on mother-infant attachment and interventions to mitigate the transmission of risk. Int Rev Psychiatry 2019; 31:245-263. [PMID: 30810410 DOI: 10.1080/09540261.2018.1563529] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Early interactions between infants and their caregivers are fundamental to child development, and the parent-infant relationship is believed to provide the foundation for healthy and secure attachment relationships and for infant mental health. Over time, these secure attachment relationships become the backbone for positive child outcomes across development. Abundant research to date confirms that parental mental illness, including depression and PTSD following trauma exposure, may have a detrimental impact on parenting quality and subsequent early child relationship formations. This review paper summarizes the literature on the role of sensitive parenting and a healthy mother-infant relationship in establishing a secure mother-infant attachment bond, which in turn is critical for the child's healthy socioemotional and cognitive development. The review also highlights the roles of maternal perinatal depression, PTSD, and/or exposure to interpersonal violence or childhood maltreatment onto parenting, bonding, and child attachment style towards the caregiver. The final section discusses existing therapeutic interventions and approaches that bolster early parenting practices and early maternal-child relationships. Specific emphasis is placed on relational interventions that address bonding and attachment disturbances in the context of maternal perinatal mental health risk and trauma.
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Affiliation(s)
- Nora Erickson
- a Women and Infants Mental Health Program & Zero To Thrive Program, Department of Psychiatry , University of Michigan, Psychiatry , Ann Arbor , MI , USA
| | - Megan Julian
- a Women and Infants Mental Health Program & Zero To Thrive Program, Department of Psychiatry , University of Michigan, Psychiatry , Ann Arbor , MI , USA
| | - Maria Muzik
- a Women and Infants Mental Health Program & Zero To Thrive Program, Department of Psychiatry , University of Michigan, Psychiatry , Ann Arbor , MI , USA
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A feasibility study exploring self-care and parenting for adults recovering from addictive substances. Arch Psychiatr Nurs 2019; 33:155-163. [PMID: 30927985 DOI: 10.1016/j.apnu.2018.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 10/16/2018] [Accepted: 11/17/2018] [Indexed: 11/23/2022]
Abstract
Little information is available on parental self-care while in recovery from addictive substances, and its relationship to parenting and recovery outcomes. We evaluated the feasibility of obtaining self-care and parenting outcomes for adults in long-term recovery from addictive substances, and explored potential contributing factors. Nineteen mothers and fathers who self-reported at least two years of sobriety participated in this study. Feasibility challenges included recruitment and scheduling interviews, given multiple work and personal demands on participants' schedules. Possible associations of self-care to parental efficacy (PE), parenting behaviors, resilience, and total recovery years were examined as indicators to parental functioning. The exploratory analyses showed a significant moderate correlation between PE and parenting behaviors (r = 0.45, p < 0.05) as well as total years in recovery and age (r = 0.43, p < 0.05); total years in recovery differed significantly when compared by race (χ2 (1) = 5.63; p = 0.018) and education (χ2 (1) = 3.94; p = 0.048). There was also a significant inverse relationship between total years in recovery and PE (r = -0.43, p < 0.05) and parental self-care (r = -0.59, p < 0.01). Recruiting parents (especially minorities) in long-term recovery was very challenging indicating that recruitment through community organizations was not feasible without a site champion. Preliminary findings showed statistically significant correlations among self-care, parental efficacy, age, and total years in recovery. As researchers and clinicians, it is necessary to determine the role and impact of self-care for future intervention development, however, recruitment strategies need to be modified to ensure sufficiently large study samples.
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57
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Levi D, Ibrahim R, Malcolm R, MacBeth A. Mellow Babies and Mellow Toddlers: Effects on maternal mental health of a group-based parenting intervention for at-risk families with young children. J Affect Disord 2019; 246:820-827. [PMID: 30795486 DOI: 10.1016/j.jad.2018.12.120] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 11/15/2018] [Accepted: 12/24/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Parental risk factors can have a significant detrimental impact on child development, yet most parenting interventions do not address parental mental health. There is also a dearth of evidence regarding parenting interventions for families with children under two years old. Mellow Parenting (MP) is a suite of parenting interventions targeting at-risk families with complex needs, including those with very young children. Preliminary studies suggest that MP can improve both parent and child outcomes, but no evaluation has been conducted in routine practice. METHODS Using a real-world design we analysed routine data from a UK cohort of n = 183 mother-child dyads, collected over a 21-month period. Data were gathered immediately pre- and post-intervention. Outcomes included maternal mental health, parenting confidence, daily parenting stress, and child behaviour. Intention-to-treat and 'completer' analyses were performed. Associations between attendance, participant demographics, and pre-post change in outcomes were modelled. RESULTS MP participation was associated with improvements in maternal mental health (d = 0.36), parenting confidence (d = 0.42), and a component of child psychosocial behaviour (conduct problems; d = 0.36), but not overall child difficulties, or daily parenting stress. Mothers with a partner experienced larger benefits in mental health and parenting confidence compared to single mothers. Younger mothers, and those with a history of mental health problems, attended more intervention sessions. LIMITATIONS The study used real-world data and was thus uncontrolled, limiting causal interpretations. CONCLUSIONS This is the first study to explore MP participation on a multi-site national level and suggests that group-based parenting interventions may be effective for at-risk families. These results should be expanded upon via controlled studies that incorporate follow-up data.
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Silva DID, Mello DFD, Mazza VDA, Toriyama ATM, Veríssimo MDLÓR. DYSFUNCTIONS IN THE SOCIO EMOTIONAL DEVELOPMENT OF INFANTS AND ITS RELATED FACTORS: AN INTEGRATIVE REVIEW. TEXTO & CONTEXTO ENFERMAGEM 2019. [DOI: 10.1590/1980-265x-tce-2017-0370] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: to synthesize factors related to dysfunctions in the socioemotional development of infants. Method: integrative review carried out between April and August 2016 with defined criteria for inclusion and exclusion of studies, search strategies, extraction and synthesis of data. The exposure factors underwent categorical thematic analysis and systematization according to the levels of the context (Microsystem, Mesosystem, Exosystem and Macrosystem) of the Bioecological Model of Human Development. Results: in the context of the Microsystem and Mesosystem, the factors found were: limitations in care; adversities in family relationships and in the social support and illness situation of the caregivers that influence the proximal processes. In the Exosystem and the Macrosystem, they were: social vulnerabilities of caregivers and fragilities of public policies that determine the material and social conditions of the family. Conclusion: the synthesis of evidence on exposure factors favors the construction of measurement scales of the contextual elements related to the social emotional development of young children. Beyond the milestones, present or not, in the evaluation of a child, these technologies can be predictive, with great potential of anticipation of the factors of exposure and prevention of developmental dysfunctions.
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Postpartum depression and resilience predict parenting sense of competence in women with childhood maltreatment history. Arch Womens Ment Health 2018; 21:777-784. [PMID: 29860623 PMCID: PMC6240379 DOI: 10.1007/s00737-018-0865-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 05/17/2018] [Indexed: 10/14/2022]
Abstract
This study examines the effect of a history of childhood maltreatment (CM) on parenting sense of competence, taking into account the influence of resilience and postpartum depressive symptoms as moderators of this relationship. Participants (N = 131) were a community sample of women recruited into a larger study of maternal childhood maltreatment. Women completed questionnaires over the phone at 4 months postpartum and parenting sense of competence (PSOC) was assessed during a home visit at 6 months postpartum. A three-way interaction emerged; women with low depression and high resilience factors maintained high levels of PSOC, even when they had a CM history. In contrast, among women with one postpartum risk factor (depression or low resilience) CM was associated with decreased PSOC. Results suggest that a mother's well-being postpartum moderates the effect of a childhood maltreatment history on her parenting sense of competence. Reducing postpartum depressive symptoms and enhancing resilience may be important components for interventions that address parenting confidence with maltreated women.
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Radey M. Informal Support among Low-income Mothers Post Welfare Reform: A Systematic Review. JOURNAL OF CHILD AND FAMILY STUDIES 2018; 27:3782-3805. [PMID: 30766015 PMCID: PMC6372123 DOI: 10.1007/s10826-018-1223-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The vulnerability and instability of low-income mothers situated in a context with a weak public safety net make informal social support one of few options many low-income mothers have to meet basic needs. This systematic review examines (a) social support as an empirical construct, (b) the restricted availability of one important aspect of social support-informal perceived support, hereafter informal support-among low-income mothers, (c) the role of informal support in maternal, economic, parenting, and child outcomes, (d) the aspects of informal support that influence its effects, and (e) directions for future research. Traditional systematic review methods resulted in an appraisal of 65 articles published between January 1996 and May 2017. Findings indicated that informal support is least available among mothers most in need. Informal support provides some protection from psychological distress, economic hardship, poor parenting practices, and poor child outcomes. To promote informal support and its benefits among low-income families, future research can advance knowledge by defining the quintessential characteristics of informal support, identifying instruments to capture these characteristics, and providing the circumstances in which support can be most beneficial to maternal and child well-being. Consistent measurement and increased understanding of informal support and its nuances can inform intervention design and delivery to strengthen vulnerable mothers' informal support perceptions thereby improving individual and family outcomes.
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Affiliation(s)
- Melissa Radey
- Florida State University, College of Social Work Tallahassee USA
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61
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Silva DID, Mello DFD, Takahashi RF, Hollist CS, Mazza VDA, Veríssimo MDLÓR. Validation of vulnerability markers of dysfunctions in the socioemotional development of infants. Rev Lat Am Enfermagem 2018; 26:e3087. [PMID: 30517577 PMCID: PMC6280182 DOI: 10.1590/1518-8345.2736.3087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 09/05/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES to validate the vulnerability markers of dysfunctions in the socioemotional development of infants. METHODS study with a sequential exploratory mixed-method design. The vulnerability markers elaborated in the qualitative phase were analyzed by experts in the quantitative phase using the Delphi technique with a minimum consensus of 70%. Seventeen judges answered the questionnaire in the first round of analysis and 11 answered in the second round. RESULTS in the first round, two markers did not reach minimum consensus: the presence of instability in family relationships (66%) and delinquency and/or drug abuse by parents/caregivers (65%). In the second round, all markers were validated, with more than 90% agreement in most of the attributes, and reached the minimum consensus of 73%. CONCLUSION the eight vulnerability markers reached the minimum consensus for validation, and a relevant instrument for infant care can be developed after assessing the reliability and clinically validating these markers.
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Affiliation(s)
| | - Débora Falleiros de Mello
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil
| | | | - Cody Stonewall Hollist
- University of Nebraska-Lincoln, College of Education and Human Sciences, Lincoln, NE, United States of America
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Healthy Mothers Healthy Families Workshop Intervention: A Preliminary Investigation of Healthy Lifestyle Changes for Mothers of a Child with a Disability. J Autism Dev Disord 2018; 49:935-949. [DOI: 10.1007/s10803-018-3789-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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63
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A systematic review of psychological treatments for clinical anxiety during the perinatal period. Arch Womens Ment Health 2018; 21:481-490. [PMID: 29368048 DOI: 10.1007/s00737-018-0812-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 01/14/2018] [Indexed: 01/01/2023]
Abstract
Maternal anxiety is common during the perinatal period, and despite the negative outcomes of anxiety on the mother and infant, its treatment has received limited attention. This paper describes the first review of psychological interventions for clinical anxiety during the perinatal period. A systematic search was carried out of six electronic databases. Five studies which evaluated psychological interventions for clinical anxiety in perinatal women were identified. Of the five studies included, four were open trials and one was a randomised controlled trial. Three studies evaluated group-based interventions; one study evaluated an online-delivered intervention; and one study a combined pharmacologic-psychological intervention. All participants demonstrated significant reductions in anxiety symptom severity from pre- to post-treatment. However, this review was limited to published literature evaluating treatments for clinical anxiety in perinatal women, which may have excluded important intervention studies and prevention programs, and unpublished literature. This review identifies an area of research that needs urgent attention, as very few studies have evaluated psychological treatments for perinatal anxiety. The studies included in this review demonstrate that symptoms of anxiety during the perinatal period appear to improve during treatment. Future research is needed to establish the efficacy of perinatal anxiety interventions in randomised controlled trials, whether reductions persist long term and whether benefits extend to other outcomes for the mother, infant and family.
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Julian MM, Muzik M, Kees M, Valenstein M, Dexter C, Rosenblum KL. Intervention effects on reflectivity explain change in positive parenting in military families with young children. JOURNAL OF FAMILY PSYCHOLOGY : JFP : JOURNAL OF THE DIVISION OF FAMILY PSYCHOLOGY OF THE AMERICAN PSYCHOLOGICAL ASSOCIATION (DIVISION 43) 2018; 32:804-815. [PMID: 29878806 PMCID: PMC6126948 DOI: 10.1037/fam0000431] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Military families with young children often experience stress related to the unique circumstances of military families (e.g., deployment), and there is a need for interventions that are specifically tailored to military families with young children. The Strong Military Families (SMF) intervention responds to this need, and consists of two versions: A Multifamily Group (N = 34), and a Homebased psychoeducational written material program (N = 42; treated as the comparison group in this report). The Multifamily Group utilized an attachment-based parenting education curriculum and in vivo support of separations and reunions, encouraged peer support among parents, and connected families to additional services. In the present nonrandomized trial, we examine intervention effects on observed parenting behavior and affect, and test whether changes in parenting reflectivity account for intervention-related changes in observed parenting. Observed parenting behavior and affect were coded from the Caregiver-Child Structured Interaction Procedure (Crowell & Fleischmann, 1993), and parenting reflectivity was coded from the Working Model of the Child Interview (Zeanah & Benoit, 1995). Results suggest that relative to Homebased participants, Multifamily Group participants showed pre- and post- improvements in aspects of positive parenting (Emotional Responsivity, Positive Affect), but no decreases in negative parenting. The efficacy of the SMF Multifamily Group intervention does not appear to depend on parent risk level or preintervention parent behavior and affect. Further, a mediation model demonstrated that the intervention effects on parents' observed positive affect in an interaction task with their child were partially accounted for by intervention-related changes in their parenting reflectivity. (PsycINFO Database Record
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Affiliation(s)
- Megan M. Julian
- University of Michigan Center for Human Growth & Development
| | - Maria Muzik
- University of Michigan Center for Human Growth & Development
- University of Michigan Department of Psychiatry
| | | | | | - Casey Dexter
- Berry College, School of Education and Human Sciences
| | - Katherine L. Rosenblum
- University of Michigan Center for Human Growth & Development
- University of Michigan Department of Psychiatry
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65
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Stephenson LA, Beck K, Busuulwa P, Rosan C, Pariante CM, Pawlby S, Sethna V. Perinatal interventions for mothers and fathers who are survivors of childhood sexual abuse. CHILD ABUSE & NEGLECT 2018; 80:9-31. [PMID: 29558671 DOI: 10.1016/j.chiabu.2018.03.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 03/04/2018] [Accepted: 03/12/2018] [Indexed: 06/08/2023]
Abstract
Childhood sexual abuse (CSA) is a worldwide problem with severe long-term consequences. A history of CSA can impact the childbearing experience of mothers and fathers; affecting their mental health, parenting skills and compromising infant development. Nonetheless, the perinatal period offers huge opportunity for intervention and hope. This literature review collates evidence for perinatal psychosocial interventions targeting both mothers and fathers who are survivors of CSA. Publications dating from 1970 to June 2016 were searched using Medline, Maternity and Infant Health, PsychINFO, PsychArticles, PubMed and the International Bibliography of the Social Sciences (IBSS). There were no perinatal interventions that considered the needs of survivor fathers. Sixteen publications on 9 psychosocial perinatal interventions for CSA survivors were identified. However, no sub-analyses specific to CSA survivors were reported. Trauma-specific perinatal interventions drew from a range of theoretical models and varied widely in format. Generally interventions were associated with improvements in maternal mental health, parenting competence, infant attachment security and positive public health outcomes. They were safe and feasible to implement, acceptable to parents and therapist, and therapists were able to implement protocols with adequate fidelity. Yet current data is hampered by small sample size, inconsistent reporting of CSA rates and outcome measures, scarcity of observational data and longer-term follow-up. Intervention modifications are proposed for CSA survivors in view of their unique childbearing experiences.
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Affiliation(s)
- Lucy A Stephenson
- South London and the Maudsley NHS Foundation Trust/Institute Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Katherine Beck
- Department of Psychosis Studies, Institute Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Paula Busuulwa
- GKT School of Medical Education, King's College London, UK
| | - Camilla Rosan
- National Society for the Prevention of Cruelty to Children, UK
| | - Carmine M Pariante
- Stress, Psychiatry and Immunology Lab. & Perinatal Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Susan Pawlby
- Stress, Psychiatry and Immunology Lab. & Perinatal Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Vaheshta Sethna
- Stress, Psychiatry and Immunology Lab. & Perinatal Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Sackler Institute for Translational Neurodevelopment, Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK.
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66
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Rosenblum K, Lawler J, Alfafara E, Miller N, Schuster M, Muzik M. Improving Maternal Representations in High-Risk Mothers: A Randomized, Controlled Trial of the Mom Power Parenting Intervention. Child Psychiatry Hum Dev 2018; 49:372-384. [PMID: 28936602 PMCID: PMC5862741 DOI: 10.1007/s10578-017-0757-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A key mechanism of risk transmission between maternal risk and child outcomes are the mother's representations. The current study examined the effects of an attachment-based, trauma-informed parenting intervention, the Mom Power (MP) program, in optimizing maternal representations of high-risk mothers utilizing a randomized, controlled trial design (NCT01554215). High-risk mothers were recruited from low-income community locations and randomized to either the MP Intervention (n = 42) or a control condition (n = 33) in a parallel design. Maternal representations were assessed before and after the intervention using the Working Model of the Child Interview. The proportion of women with balanced (secure) representations increased in the MP group but not in the control group. Parenting Reflectivity for mothers in the treatment group significantly increased, with no change in the control condition. Participation in the MP program was associated with improvements in a key indicator of the security of the parent-child relationship: mothers' representations of their children.
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Affiliation(s)
- Katherine Rosenblum
- University of Michigan, Department of Psychiatry, Ann Arbor, MI,University of Michigan, Center for Human Growth and Development, Ann Arbor, MI,Corresponding author: Dr. Maria Muzik, MD, MS; Department of Psychiatry, University of Michigan, Rachel Upjohn Building, 4250 Plymouth Rd Ann Arbor, MI 48109; Phone: 734-232-0206;
| | - Jamie Lawler
- University of Michigan, Department of Psychiatry, Ann Arbor, MI
| | - Emily Alfafara
- University of Michigan, Department of Psychiatry, Ann Arbor, MI
| | - Nicole Miller
- University of Michigan, Department of Psychiatry, Ann Arbor, MI
| | - Melisa Schuster
- University of Michigan, Department of Social Work, Ann Arbor, MI
| | - Maria Muzik
- Department of Psychiatry, University of Michigan, Rachel Upjohn Building, 4250 Plymouth Rd, Ann Arbor, MI, 48109, USA. .,Center for Human Growth and Development, University of Michigan, Ann Arbor, MI, USA.
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Maternal depression in the intergenerational transmission of childhood maltreatment and its sequelae: Testing postpartum effects in a longitudinal birth cohort. Dev Psychopathol 2018; 31:143-156. [PMID: 29562945 DOI: 10.1017/s0954579418000032] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Mothers who have experienced childhood maltreatment are more likely to have children also exposed to maltreatment, a phenomenon known as intergenerational transmission. Factors in the perinatal period may contribute uniquely to this transmission, but timing effects have not been ascertained. Using structural equation modeling with 1,016 mothers and their 2,032 children in the Environmental Risk Longitudinal Twin Study, we tested the mediating role of postpartum depression between maternal childhood maltreatment and a cascade of negative child outcomes, specifically child exposure to maltreatment, internalizing symptoms, and externalizing symptoms: (a) adjusting for later maternal depression, (b) comparing across sex differences, and (c) examining the relative role of maltreatment subtypes. Mothers who had been maltreated as children, especially those who had experienced emotional or sexual abuse, were at increased risk for postpartum depression. In turn, postpartum depression predicted children's exposure to maltreatment, followed by emotional and behavioral problems. Indirect effects from maternal childhood maltreatment to child outcomes were robust across child sex and supported significant mediation through postpartum depression; however, this appeared to be carried by mothers' depression beyond the postpartum period. Identifying and treating postpartum depression, and preventing its recurrence, may help interrupt the intergenerational transmission of maltreatment and its sequelae.
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Julian MM, Muzik M, Kees M, Valenstein M, Rosenblum KL. STRONG MILITARY FAMILIES INTERVENTION ENHANCES PARENTING REFLECTIVITY AND REPRESENTATIONS IN FAMILIES WITH YOUNG CHILDREN. Infant Ment Health J 2017; 39:106-118. [PMID: 29286541 DOI: 10.1002/imhj.21690] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Military families face many challenges due to deployment and parental separation, and this can be especially difficult for families with young children. The Strong Military Families (SMF) intervention is for military families with young children, and consists of two versions: the Multifamily Group, and a Home-based psychoeducational written materials program. The Multifamily Group was designed to enhance positive parenting through both educational components and in vivo feedback and support during separations and reunions between parents and children (n = 78 parents). In the present study, we examine parenting reflectivity and mental representations in mothers versus fathers in military families, service members versus civilian spouses/parenting partners, and before versus after participation in the SMF Multifamily Group and Home-based interventions. Parenting reflectivity and mental representations were coded from the Working Model of the Child Interview (WMCI; C.H. Zeanah & D. Benoit, 1995). Results suggest that neither parenting reflectivity nor WMCI typology differs between mothers and fathers in military families, or between service members and civilian parenting partners. Furthermore, there was substantial stability in parenting reflectivity and WMCI typology from baseline to posttest, but participation in the Multifamily Group, relative to Home-based, was associated with improvements in both parenting reflectivity and WMCI ratings from baseline to postintervention.
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69
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Garcia ER, Yim IS. A systematic review of concepts related to women's empowerment in the perinatal period and their associations with perinatal depressive symptoms and premature birth. BMC Pregnancy Childbirth 2017; 17:347. [PMID: 29143635 PMCID: PMC5688402 DOI: 10.1186/s12884-017-1495-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The perinatal period, which we here define as pregnancy and the first year postpartum, is a time in women's lives that involves significant physiological and psychosocial change and adjustment, including changes in their social status and decision-making power. Supporting women's empowerment at this particular time in their lives may be an attractive opportunity to create benefits for maternal and infant health outcomes such as reductions in perinatal depressive symptoms and premature birth rates. Thus, we here systematically review and critically discuss the literature that investigates the effects of empowerment, empowerment-related concepts and empowerment interventions on reductions in perinatal depressive symptoms, preterm birth (PTB), and low birthweight (LBW). METHODS For this systematic review, we conducted a literature search in PsychInfo, PubMed, and CINAHL without setting limits for date of publication, language, study design, or maternal age. The search resulted in 27 articles reporting on 25 independent studies including a total of 17,795 women. RESULTS The majority of studies found that, for the most part, measures of empowerment and interventions supporting empowerment are associated with reduced perinatal depressive symptoms and PTB/LBW rates. However, findings are equivocal and a small portion of studies found no significant association between empowerment-related concepts and perinatal depressive symptoms and PTB or LBW. CONCLUSION This small body of work suggests, for the most part, that empowerment-related concepts may be protective for perinatal depressive symptoms and PTB/LBW. We recommend that future theory-driven and integrative work should include an assessment of different facets of empowerment, obtain direct measures of empowerment, and address the relevance of important confounders, including for example, ethnicity and socioeconomic status.
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Affiliation(s)
- Esmeralda R. Garcia
- Department of Psychology and Social Behavior, University of California, 4562 Social and Behavioral Sciences Gateway, Irvine, CA 92697-7085 USA
| | - Ilona S. Yim
- Department of Psychology and Social Behavior, University of California, 4562 Social and Behavioral Sciences Gateway, Irvine, CA 92697-7085 USA
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70
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A community-based randomized controlled trial of Mom Power parenting intervention for mothers with interpersonal trauma histories and their young children. Arch Womens Ment Health 2017; 20. [PMID: 28647759 PMCID: PMC5709180 DOI: 10.1007/s00737-017-0734-9] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
We conducted a study to evaluate the effectiveness of Mom Power, a multifamily parenting intervention to improve mental health and parenting among high-risk mothers with young children in a community-based randomized controlled trial (CB-RCT) design. Participants (N = 122) were high-risk mothers (e.g., interpersonal trauma histories, mental health problems, poverty) and their young children (age <6 years), randomized either to Mom Power, a parenting intervention (treatment condition), or weekly mailings of parenting information (control condition). In this study, the 13-session intervention was delivered by community clinicians trained to fidelity. Pre- and post-trial assessments included mothers' mental health symptoms, parenting stress and helplessness, and connection to care. Mom Power was delivered in the community with fidelity and had good uptake (>65%) despite the risk nature of the sample. Overall, we found improvements in mental health and parenting stress for Mom Power participants but not for controls; in contrast, control mothers increased in parent-child role reversal across the trial period. The benefits of Mom Power treatment (vs. control) were accentuated for mothers with interpersonal trauma histories. Results of this CB-RCT confirm the effectiveness of Mom Power for improving mental health and parenting outcomes for high-risk, trauma-exposed women with young children. ClinicalTrials.gov Identifier: NCT01554215.
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71
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Muzik M, Umarji R, Sexton MB, Davis MT. Family Social Support Modifies the Relationships Between Childhood Maltreatment Severity, Economic Adversity and Postpartum Depressive Symptoms. Matern Child Health J 2017; 21:1018-1025. [PMID: 28028663 DOI: 10.1007/s10995-016-2197-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES This study examines the main and moderating effects of childhood abuse or neglect severity, income, and family social support on the presence of postpartum depressive symptoms (PDS). METHODS Participants included 183 postpartum mothers who endorsed a history of childhood maltreatment (CM) and enrolled in a longitudinal study of mother and child outcomes. Participants completed questionnaires to assess CM severity, associated societal and maternal characteristics, and depressive symptom severity. RESULTS The results confirm previously identified links between CM severity and PDS. Further, hierarchical linear regression analyses indicate the interaction of household income and interpersonal support from the family attenuates the relationship between CM severity and PDS. The final model accounted for 29% of the variance of PDS scores, a large effect size. CONCLUSIONS This study is the first to demonstrate interrelationships between income and social support on resilience to postpartum psychopathology in childhood trauma-surviving women. Social support appeared to protect against PDS for all mothers in this study while income only conferred a protective effect when accompanied by family support. For clinicians, this implies the need to focus on improving family and other relationships, especially for at-risk mothers.
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Affiliation(s)
- Maria Muzik
- Department of Psychiatry, University of Michigan, Rachel Upjohn Building, 4250 Plymouth Rd, Ann Arbor, MI, 48109, USA.
- Center for Human Growth and Development, University of Michigan, Ann Arbor, USA.
| | - Rujuta Umarji
- Institute for Social Research, University of Michigan, 426 Thompson Street, Ann Arbor, MI, 48104, USA
| | - Minden B Sexton
- Department of Psychiatry, University of Michigan, Rachel Upjohn Building, 4250 Plymouth Rd, Ann Arbor, MI, 48109, USA
- Ann Arbor Veterans Healthcare Administration, Mental Health Service, 116C, 2215 Fuller Rd., Ann Arbor, MI, 48105, USA
| | - Margaret T Davis
- Department of Psychiatry, University of Michigan, Rachel Upjohn Building, 4250 Plymouth Rd, Ann Arbor, MI, 48109, USA
- Ann Arbor Veterans Healthcare Administration, Mental Health Service, 116C, 2215 Fuller Rd., Ann Arbor, MI, 48105, USA
- Auburn University, Auburn, AL, USA
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Howell KH, Miller-Graff LE, Schaefer LM, Scrafford KE. Relational resilience as a potential mediator between adverse childhood experiences and prenatal depression. J Health Psychol 2017; 25:545-557. [PMID: 28810501 DOI: 10.1177/1359105317723450] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
This study examined the indirect effects of individual, relational, and contextual resilience in the relationship between adverse childhood experiences and prenatal depression. Participants included 101 pregnant women. Adverse childhood experiences had a direct effect on depression, B = 1.11, standard error = .44, p = .01, and relational resilience, B = -1.15, standard error = .19, p < .001, but not individual or contextual resilience. With resilience as a mediator, the effect of adverse childhood experiences on depression was no longer significant. Specifically, relational resilience had a significant indirect effect (IE) on the association between adverse childhood experiences and depression, IE = 1.04, boot standard error = .28 (95% confidence interval = .58, 1.68). Results emphasize the associated role of relational qualities, such as sense of security and belongingness, with childhood adversity and mental health.
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73
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Parent-child intervention decreases stress and increases maternal brain activity and connectivity during own baby-cry: An exploratory study. Dev Psychopathol 2017; 29:535-553. [PMID: 28401845 DOI: 10.1017/s0954579417000165] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Parental responses to their children are crucially influenced by stress. However, brain-based mechanistic understanding of the adverse effects of parenting stress and benefits of therapeutic interventions is lacking. We studied maternal brain responses to salient child signals as a function of Mom Power (MP), an attachment-based parenting intervention established to decrease maternal distress. Twenty-nine mothers underwent two functional magnetic resonance imaging brain scans during a baby-cry task designed to solicit maternal responses to child's or self's distress signals. Between scans, mothers were pseudorandomly assigned to either MP (n = 14) or control (n = 15) with groups balanced for depression. Compared to control, MP decreased parenting stress and increased child-focused responses in social brain areas highlighted by the precuneus and its functional connectivity with subgenual anterior cingulate cortex, which are key components of reflective self-awareness and decision-making neurocircuitry. Furthermore, over 13 weeks, reduction in parenting stress was related to increasing child- versus self-focused baby-cry responses in amygdala-temporal pole functional connectivity, which may mediate maternal ability to take her child's perspective. Although replication in larger samples is needed, the results of this first parental-brain intervention study demonstrate robust stress-related brain circuits for maternal care that can be modulated by psychotherapy.
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74
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Boris NW, Renk K. Beyond Reactive Attachment Disorder: How Might Attachment Research Inform Child Psychiatry Practice? Child Adolesc Psychiatr Clin N Am 2017; 26:455-476. [PMID: 28577603 DOI: 10.1016/j.chc.2017.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This article provides an updated review of attachment research with a focus on how comprehensive clinical assessment and intervention informs the care of young children. Child psychiatrists can serve as an important part of care coordination teams working with young children who have histories of early maltreatment and/or disruption in caregiving whether or not the children they are seeing meet criteria for an attachment disorder. Child psychiatrists should be familiar with both comprehensive assessment and the recent attachment-based interventions and appreciate how pharmacotherapy can be a useful adjunctive intervention when intensive therapy alone is ineffective.
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Affiliation(s)
- Neil W Boris
- Center for Prevention and Early Intervention Policy, Florida State University, 1339 East Lafayette Street, Tallahassee, FL 32301, USA.
| | - Kimberly Renk
- Department of Psychology, University of Central Florida, 4111 Pictor Lane, Psychology Building (99), Room 353, Orlando, FL 32816, USA
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Mucka LE, Dayton CJ, Lawler J, Kirk R, Alfafara E, Schuster MM, Miller N, Ribaudo J, Rosenblum KL, Muzik M. MIXED-METHODS EVALUATION OF PARTICIPANT RECRUITMENT AND RETENTION IN THE MOM POWER PARENTING INTERVENTION PROGRAM. Infant Ment Health J 2017; 38:536-550. [PMID: 28665536 DOI: 10.1002/imhj.21652] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Parenting group success begins with attendance. Using archival pilot data from 99 mothers who enrolled in the Mom Power (MP) parenting intervention, this study sought to understand the factors that influenced participant engagement and retention. MP is a group-based, early intervention program grounded in attachment theory that utilizes motivational interviewing as a core component to enhance program engagement. Study aims were to qualitatively describe the reasons why mothers were interested in participating in the program, including what they hoped to gain from the experience, and to quantitatively examine the extent to which attendance was associated with demographic, experiential, and psychosocial factors. The qualitative analysis of intake interviews revealed that mothers expected the MP intervention to provide a warm environment for themselves and their children as well as to support and enhance their parenting, and 95% revealed their hopes that the intervention would help them grow and develop as women. Attendance rates were relatively high, with 62% of mothers missing less than one group session. Quantitative analyses using multiple regression to test associations of demographic, experiential, and psychosocial factors with attendance rates were not significant. Results suggest that motivational interviewing may be an important component in promoting participant engagement efforts in parenting interventions.
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76
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Swain JE, Ho SHS. Neuroendocrine mechanisms for parental sensitivity: overview, recent advances and future directions. Curr Opin Psychol 2017; 15:105-110. [PMID: 28813249 PMCID: PMC7195810 DOI: 10.1016/j.copsyc.2017.02.027] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 02/27/2017] [Indexed: 01/22/2023]
Abstract
Early parent-infant relationships play important roles in infants' development. New parents adapt to the developing relationship with their infants to coordinate parenting behaviors in the milieu of infant needs, hormones, moods, and stress. This review highlights research from the past two years, using non-invasive brain-imaging techniques and naturalistic tasks in mothers and fathers in relation to psychological, and endocrine measures. Recent work also connects parental brain physiology with parental sensitive behavior, parent/child outcomes and parent psychotherapy. Understanding neurobiological mechanisms underlying parenting thoughts, behaviors and moods (see Figure 1) will help identify mental health risks and contribute to parental mental health interventions and resilience.
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Affiliation(s)
- James E Swain
- Department of Psychiatry, Stony Brook University Medical Center, Stony Brook, NY, USA; Center of Human Growth and Development, University of Michigan, Ann Arbor, MI, USA; Department of Psychology, University of Michigan, Ann Arbor, MI, USA; Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA; Child Study Center, Yale University, New Haven, CT, USA.
| | - Shao-Hsuan Shaun Ho
- Department of Psychiatry, Stony Brook University Medical Center, Stony Brook, NY, USA
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77
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Julian M, Lawler J, Rosenblum K. Caregiver-Child Relationships in Early Childhood: Interventions to Promote Well-Being and Reduce Risk for Psychopathology. Curr Behav Neurosci Rep 2017. [DOI: 10.1007/s40473-017-0110-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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78
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Taylor ZE, Conger RD. Promoting Strengths and Resilience in Single-Mother Families. Child Dev 2017; 88:350-358. [DOI: 10.1111/cdev.12741] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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79
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Pawluski JL, Lonstein JS, Fleming AS. The Neurobiology of Postpartum Anxiety and Depression. Trends Neurosci 2017; 40:106-120. [PMID: 28129895 DOI: 10.1016/j.tins.2016.11.009] [Citation(s) in RCA: 169] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 11/28/2016] [Accepted: 11/29/2016] [Indexed: 12/27/2022]
Abstract
Ten to twenty percent of postpartum women experience anxiety or depressive disorders, which can have detrimental effects on the mother, child, and family. Little is known about the neural correlates of these affective disorders when they occur in mothers, but they do have unique neural profiles during the postpartum period compared with when they occur at other times in a woman's life. Given that the neural systems affected by postpartum anxiety and depression overlap and interact with the systems involved in maternal caregiving behaviors, mother-infant interactions are highly susceptible to disruption. Thus, there is an intricate interplay among maternal mental health, the mother-infant relationship, and the neurobiological mechanisms mediating them that needs to be the focus of future study.
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Affiliation(s)
- Jodi L Pawluski
- Inserm U1085-IRSET, Université de Rennes 1, Campus Villejean, 35000 Rennes, France.
| | - Joseph S Lonstein
- Neuroscience Program & Department of Psychology, Michigan State University, East Lansing, MI 48824, USA.
| | - Alison S Fleming
- Psychology and Fraser Mustard Institute for Human Development, University of Toronto at Mississauga (UTM), Mississauga, ONT L5L1C6, Canada
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80
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Deep mechanisms of social affect – Plastic parental brain mechanisms for sensitivity versus contempt. Behav Brain Sci 2017; 40:e249. [PMID: 29122035 DOI: 10.1017/s0140525x16000935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
AbstractInsensitive parental thoughts and affect, similar to contempt, may be mapped onto a network of basic emotions moderated by attitudinal representations of social-relational value. Brain mechanisms that reflect emotional valence of baby signals among parents vary according to individual differences and show plasticity over time. Furthermore, mental health problems and treatments for parents may affect these brain systems toward or away from contempt, respectively.
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81
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Muzik M, Morelen D, Hruschak J, Rosenblum KL, Bocknek E, Beeghly M. Psychopathology and parenting: An examination of perceived and observed parenting in mothers with depression and PTSD. J Affect Disord 2017; 207:242-250. [PMID: 27732922 PMCID: PMC5107117 DOI: 10.1016/j.jad.2016.08.035] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 05/20/2016] [Accepted: 08/27/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND The postpartum period represents a major transition in the lives of many women, a time when women are at increased risk for the emergence of psychopathology including depression and PTSD. The current study aimed to better understand the unique contributions of clinically significant postpartum depression, PTSD, and comorbid PTSD/depression on mother-infant bonding and observed maternal parenting behaviors (i.e., behavioral sensitivity, negative affect, positive affect) at 6 months postpartum. METHODS Mothers (n=164; oversampled for history of childhood maltreatment given parent study's focus on perinatal mental health in women with trauma histories) and infants participated in 6-month home visit during which dyads engaged in interactional tasks varying in level of difficulties. Mothers also reported on their childhood abuse histories, current depression/PTSD symptoms, and bonding with the infant using standardized and validated instruments. RESULTS Mothers with clinically significant depression had the most parenting impairment (self-report and observed). Mothers with clinically significant PTSD alone (due to interpersonal trauma that occurred predominately in childhood) showed similar interactive behaviors to those who were healthy controls or trauma-exposed but resilient (i.e., no postpartum psychopathology). Childhood maltreatment in the absence of postpartum psychopathology did not infer parenting risk. LIMITATIONS Findings are limited by (1) small cell sizes per clinical group, limiting power, (2) sample size and sample demographics prohibited examination of third variables that might also impact parenting (e.g., income, education), (3) self-report of symptoms rather than use of psychiatric interviews. CONCLUSIONS Findings show that in the context of child abuse history and/or current PTSD, clinically significant maternal depression was the most salient factor during infancy that was associated with parenting impairment at this level of analysis.
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Affiliation(s)
- Maria Muzik
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.
| | - Diana Morelen
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Jessica Hruschak
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | | | - Erika Bocknek
- College of Education, Wayne State University, Detroit, MI, USA
| | - Marjorie Beeghly
- Department of Psychology, Wayne State University, Detroit, MI, USA; Division of Developmental Medicine, Boston Children's Hospital, Boston, MA, USA
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Kunze J, Wagner K, Fittig E. [Practical implementation of an integrated care model in mother-child treatment]. DER NERVENARZT 2016; 87:974-9. [PMID: 27531206 DOI: 10.1007/s00115-016-0186-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This article summarizes the specific treatment options in the combined mother-child treatment for women with postpartum psychiatric disorders. The incidence of postpartum mental illness is high, especially for postpartum depression that probably occurs in10-15 % of cases. Mental disorders not only have a negative impact on the mental health of the women affected, such as chronification and suicidal tendencies but can also adversely affect the mother-child relationship as well as the emotional and cognitive development of the child. For these reasons it is important, also under the aspects of a primary prevention with respect to the children of mentally ill mothers, to provide a needs-oriented, timely and disorder-specific interactional therapy, which also considers the long-term aspects of treatment. At the Celenus Klinik Carolabad in Chemnitz an integrated treatment model, the "Carola PLUS", could be established that caters for the particularly high demands of combined care and treatment for both mother and child.
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Affiliation(s)
- J Kunze
- Celenus Klinik Carolabad Chemnitz, Medizinisches Rehabilitationszentrum für Psychotherapie, Psychiatrie und Psychosomatik, Riedstraße 32, 09117, Chemnitz, Deutschland.
| | - K Wagner
- Celenus Klinik Carolabad Chemnitz, Medizinisches Rehabilitationszentrum für Psychotherapie, Psychiatrie und Psychosomatik, Riedstraße 32, 09117, Chemnitz, Deutschland
| | - E Fittig
- Celenus Klinik Carolabad Chemnitz, Medizinisches Rehabilitationszentrum für Psychotherapie, Psychiatrie und Psychosomatik, Riedstraße 32, 09117, Chemnitz, Deutschland
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Sidani S, Epstein DR. Toward a Conceptualization and Operationalization of Satisfaction With Nonpharmacological Interventions. Res Theory Nurs Pract 2016; 30:242-257. [PMID: 28304269 DOI: 10.1891/1541-6577.30.3.242] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Although satisfaction is recognized as an essential aspect in the evaluation of interventions' effectiveness, there is lack of clarity on its conceptualization and operationalization. In this article, we present conceptual and operational definitions that specify the domains and attributes of satisfaction with nonpharmacological interventions. METHODS An integrative review of conceptual and empirical literature was conducted to generate the conceptual and operational definitions of satisfaction with interventions. Fifty-six publications were included in the review. The definitions of satisfaction and the content of instruments measuring satisfaction were reviewed, compared, and contrasted to identify the domains and attributes of the concept. RESULTS Satisfaction is defined as the appraisal of the interventions' process and outcome. It is operationalized in 4 domains of process: (a) suitability and utility of the intervention's components, (b) attitude toward and desire to continue with the intervention, (c) competence and interpersonal style of interventionist, and (d) implementation (format and dose) of the intervention. The outcome domain includes improvement in the health problem and in everyday functions, discomfort, and attribution of the outcomes to the intervention. CONCLUSIONS The conceptual and operational definitions can guide the development of instruments to assess satisfaction with nonpharmacological interventions, which can point to aspects of interventions that are viewed favorably or unfavorably.
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Oh W, Muzik M, McGinnis EW, Hamilton L, Menke RA, Rosenblum KL. Comorbid trajectories of postpartum depression and PTSD among mothers with childhood trauma history: Course, predictors, processes and child adjustment. J Affect Disord 2016; 200:133-41. [PMID: 27131504 PMCID: PMC4887316 DOI: 10.1016/j.jad.2016.04.037] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 04/16/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Both postpartum depression and posttraumatic stress disorder (PTSD) have been identified as unique risk factors for poor maternal psychopathology. Little is known, however, regarding the longitudinal processes of co-occurring depression and PTSD among mothers with childhood adversity. The present study addressed this research gap by examining co-occurring postpartum depression and PTSD trajectories among mothers with childhood trauma history. METHODS 177 mothers with childhood trauma history reported depression and PTSD symptoms at 4, 6, 12, 15 and 18 months postpartum, as well as individual (shame, posttraumatic cognitions, dissociation) and contextual (social support, childhood and postpartum trauma experiences) factors. RESULTS Growth mixture modeling (GMM) identified three comorbid change patterns: The Resilient group (64%) showed the lowest levels of depression and PTSD that remained stable over time; the Vulnerable group (23%) displayed moderately high levels of comorbid depression and PTSD; and the Chronic High-Risk group (14%) showed the highest level of comorbid depression and PTSD. Further, a path model revealed that postpartum dissociation, negative posttraumatic cognitions, shame, as well as social support, and childhood and postpartum trauma experiences differentiated membership in the Chronic High-Risk and Vulnerable. Finally, we found that children of mothers in the Vulnerable group were reported as having more externalizing and total problem behaviors. LIMITATIONS Generalizability is limited, given this is a sample of mothers with childhood trauma history and demographic risk. CONCLUSIONS The results highlight the strong comorbidity of postpartum depression and PTSD among mothers with childhood trauma history, and also emphasize its aversive impact on the offspring.
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Affiliation(s)
- Wonjung Oh
- Department of Human Development and Family Studies, Texas Tech University
| | - Maria Muzik
- Department of Psychiatry, University of Michigan, Ann Arbor, United States; Center for Human Growth & Development, University of Michigan, Ann Arbor, United States.
| | | | | | - Rena A. Menke
- Department of Psychiatry, University of Michigan, Ann Arbor
| | - Katherine Lisa Rosenblum
- Department of Psychiatry, University of Michigan, Ann Arbor,Center for Human Growth & Development, University of Michigan, Ann Arbor
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Beach Copeland D, Harbaugh BL. Early Maternal-Efficacy and Competence in First-Time, Low-Income Mothers. Compr Child Adolesc Nurs 2016. [DOI: 10.1080/24694193.2016.1200695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
| | - Bonnie Lee Harbaugh
- College of Nursing, University of Southern Mississippi, Hattiesburg, Mississippi
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86
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Fava NM, Simon VA, Smith E, Khan M, Kovacevic M, Rosenblum KL, Menke R, Muzik M. Perceptions of general and parenting-specific posttraumatic change among postpartum mothers with histories of childhood maltreatment. CHILD ABUSE & NEGLECT 2016; 56:20-9. [PMID: 27131270 PMCID: PMC4884472 DOI: 10.1016/j.chiabu.2016.04.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2015] [Revised: 04/05/2016] [Accepted: 04/14/2016] [Indexed: 05/23/2023]
Abstract
Although adaptive meanings of childhood maltreatment (CM) are critical to posttraumatic adaptation, little is known about perceptions of posttraumatic change (PTC) during the vulnerable postpartum period. PTC may be positive or negative as well as global or situational. This study examined general and parenting-specific PTC among 100 postpartum women with CM histories (Mage=29.5 years). All reported general and 83% reported parenting PTC. General PTC were more likely to include negative and positive changes; parenting PTC were more likely to be exclusively positive. Indicators of more severe CM (parent perpetrator, more CM experiences) were related to parenting but not general PTC. Concurrent demographic risk moderated associations between number of CM experiences and positive parenting PTC such that among mothers with more CM experiences, demographic risk was associated with stronger positive parenting PTC. Results highlight the significance of valence and specificity of PTC for understanding meanings made of CM experiences.
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Affiliation(s)
- Nicole M Fava
- Merrill Palmer Skillman Institute & Department of Psychology, Wayne State University, United States
| | - Valerie A Simon
- Merrill Palmer Skillman Institute & Department of Psychology, Wayne State University, United States
| | - Erin Smith
- Merrill Palmer Skillman Institute & Department of Psychology, Wayne State University, United States
| | - Maria Khan
- Merrill Palmer Skillman Institute & Department of Psychology, Wayne State University, United States
| | - Merdijana Kovacevic
- Merrill Palmer Skillman Institute & Department of Psychology, Wayne State University, United States
| | - Katherine L Rosenblum
- Department of Psychiatry & Center for Human Growth and Development, University of Michigan, United States
| | - Rena Menke
- Department of Psychiatry, University of Michigan, United States
| | - Maria Muzik
- Department of Psychiatry & Center for Human Growth and Development, University of Michigan, United States.
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87
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Kim P, Strathearn L, Swain JE. The maternal brain and its plasticity in humans. Horm Behav 2016; 77:113-23. [PMID: 26268151 PMCID: PMC4724473 DOI: 10.1016/j.yhbeh.2015.08.001] [Citation(s) in RCA: 179] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 08/03/2015] [Accepted: 08/07/2015] [Indexed: 02/01/2023]
Abstract
This article is part of a Special Issue "Parental Care". Early mother-infant relationships play important roles in infants' optimal development. New mothers undergo neurobiological changes that support developing mother-infant relationships regardless of great individual differences in those relationships. In this article, we review the neural plasticity in human mothers' brains based on functional magnetic resonance imaging (fMRI) studies. First, we review the neural circuits that are involved in establishing and maintaining mother-infant relationships. Second, we discuss early postpartum factors (e.g., birth and feeding methods, hormones, and parental sensitivity) that are associated with individual differences in maternal brain neuroplasticity. Third, we discuss abnormal changes in the maternal brain related to psychopathology (i.e., postpartum depression, posttraumatic stress disorder, substance abuse) and potential brain remodeling associated with interventions. Last, we highlight potentially important future research directions to better understand normative changes in the maternal brain and risks for abnormal changes that may disrupt early mother-infant relationships.
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Affiliation(s)
- Pilyoung Kim
- Department of Psychology, University of Denver, 2155 South Race Street, Denver, CO 80208-3500, United States.
| | - Lane Strathearn
- Department of Pediatrics, University of Iowa, Center for Disabilities and Development, 100 Hawkins Drive 213F CDD, Iowa City, IA 52246-1011, United States.
| | - James E Swain
- Department of Psychiatry, Psychology and Center for Human Growth and Development, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI 48109-2700, United States.
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88
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Leung CYY, Miller AL, Lumeng JC, Kaciroti NA, Rosenblum KL. Maternal representations of their children in relation to feeding beliefs and practices among low-income mothers of young children. Appetite 2015; 95:176-81. [PMID: 26145277 DOI: 10.1016/j.appet.2015.06.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 06/15/2015] [Accepted: 06/26/2015] [Indexed: 11/30/2022]
Abstract
Identifying maternal characteristics in relation to child feeding is important for addressing the current childhood obesity epidemic. The present study examines whether maternal representations of their children are associated with feeding beliefs and practices. Maternal representations refer to mothers' affective and cognitive perspectives regarding their children and their subjective experiences of their relationships with their children. This key maternal characteristic has not been examined in association with maternal feeding. Thus the purpose of the current study was to examine whether maternal representations of their children, reflected by Working Model of the Child Interview typologies (Balanced, Disengaged, or Distorted), were associated with maternal feeding beliefs (Authority, Confidence, and Investment) and practices (Pressure to Eat, Restriction, and Monitoring) among low-income mothers of young children, with maternal education examined as a covariate. Results showed that Balanced mothers were most likely to demonstrate high authority, Distorted mothers were least likely to demonstrate confidence, and Disengaged mothers were least likely to demonstrate investment in child feeding. Moreover, Balanced mothers were least likely to pressure their children to eat. Findings are discussed with regard to implications for the study of childhood obesity and for applied preventions.
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Affiliation(s)
- Christy Y Y Leung
- Center for Human Growth and Development, University of Michigan, Ann Arbor, MI, USA
| | - Alison L Miller
- Center for Human Growth and Development, University of Michigan, Ann Arbor, MI, USA; Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Julie C Lumeng
- Center for Human Growth and Development, University of Michigan, Ann Arbor, MI, USA; Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI, USA; Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Niko A Kaciroti
- Center for Human Growth and Development, University of Michigan, Ann Arbor, MI, USA; Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Katherine L Rosenblum
- Center for Human Growth and Development, University of Michigan, Ann Arbor, MI, USA; Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.
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