Parenting stress and depressive symptoms in postpartum mothers: bidirectional or unidirectional effects?

Maternal ADHD Symptoms and Parenting Stress: The Roles of Parenting Self-Efficacy Beliefs and Neuroticism

OBJECTIVE

ADHD symptoms in adults are consistently related to stress in a variety of domains, although whether the link between ADHD symptoms and stress is direct, or accounted for or moderated by other variables, is little studied. We used a cross-sectional design to examine whether parenting self-efficacy accounts for the relation between maternal ADHD symptoms and parenting stress, and whether levels of maternal neuroticism moderate this relation.

METHOD

A nonclinical sample of mothers of 120, six- to 12-year-old children completed surveys online.

RESULTS

Maternal ADHD symptoms were associated with parenting stress, but this relation was accounted for by parenting self-efficacy beliefs. Neuroticism did not moderate the relations among these variables. Covariate analyses indicated that although parenting self-efficacy beliefs remain a robust predictor of parenting stress, the relation between maternal ADHD symptoms and parenting stress can be better accounted for by other variables.

CONCLUSION

The results highlight the importance of self-efficacy beliefs and demonstrate that ADHD symptoms are not sufficient to understand the experience of parenting.

DOES FATHERS' PRENATAL MENTAL HEALTH BEAR A RELATIONSHIP TO PARENTING STRESS AT 6 MONTHS?

This study aimed to explore fathers' mental health and retrospectively reported adverse childhood experiences during pregnancy, as well as various pathways predicting self-reported stress at 6 months' postpartum as assessed by the Parenting Stress Index (PSI; R.R. Abidin, ). A total of 835 fathers contributed data to the study. Data collection comprised five time points during pregnancy and one at 6 months' postpartum. The main analyses were performed using linear regression and path analyses. First, linear regression analyses showed that paternal anxiety symptoms during pregnancy predicted stress scores in the PSI child domain at 6 months (coefficient = 0.36). Second, path analyses showed that depressive symptoms during pregnancy predicted parenting stress in the child domain, mediated by spousal disharmony at 6 months' postpartum (coefficient = 0.77). Third, adverse childhood experiences scores predicted parenting stress in the child domain by two different pathways: one mediated by anxiety symptoms in pregnancy (coefficient = 0.29) and the other by depressive symptoms in pregnancy and experienced spousal disharmony at 6 months' postpartum (coefficient = 0.77). The findings suggest that fathers' symptoms of anxiety and depression during pregnancy as well as adverse childhood experiences predict paternal stress and a negative perception of their children's behavior at 6 months' postpartum.

Subclinical maternal depressive symptoms modulate right inferior frontal response to inferring affective mental states of adults but not of infants

BACKGROUND

Being a mother of young children increases the risk of depression characterised by deficits in inferring what a person is feeling, i.e., affective theory of mind (aToM). Despite the adverse consequences for mothers, children, families, and society as a whole, little is known of how the brain functions underlying aToM ability are affected by subclinical maternal depressive symptoms, and act as a risk indicator for major depressive disorders (MDD).

METHODS

Thirty healthy mothers with varying levels of depressive symptoms underwent functional magnetic resonance imaging (fMRI) while performing mind-reading tasks based on the emotional expressions of adult eyes and infant faces.

RESULTS

In the adult eyes-based mind-reading task, mothers with more severe depressive symptoms showed less activation in the right inferior frontal gyrus (IFG), a central part of the putative mirror neuron system (pMNS). This was unrelated to behavioural performance decline in the task. However, brain activation involved in the infant face-based mind-reading task was not affected by depressive symptoms.

LIMITATIONS

Although aToM ability, assessed by mind-reading tasks, can be distinguished from empathy, these can be interacting functions of the pMNS, wherein they could mutually affect each other.

CONCLUSION

These findings suggest that functional activation of the right IFG, which underlies aToM ability, has variable vulnerability to maternal depressive symptoms according to the type of social signal. This functional decline of the right IFG may be a risk indicator for clinical maternal depression, which is associated with impaired social functioning and communication conflicts with family members and other social supporters.

I. INTRODUCTION: UNDERSTANDING THE TRANSITION TO SIBLINGHOOD FROM A DEVELOPMENTAL PSYCHOPATHOLOGY AND ECOLOGICAL SYSTEMS PERSPECTIVE

The birth of an infant sibling is a common occurrence in the lives of many toddler and preschool children. Early childhood is also a time for the emergence of disruptive behavior problems that may set the stage for later problem behaviors. The current study examined individual differences in young children’s behavioral and emotional adjustment after the birth of a sibling in an effort to uncover developmental trajectories reflecting sudden and persistent change (maladaptation), adjustment and adaptation (resilience), gradual linear increases, and no change (stability and continuity). Growth mixture modeling (GMM) was conducted with a sample of 241 families expecting their second child using a longitudinal research design across the first year after the sibling’s birth (prenatal, 1, 4 8 and 12 months) on seven syndrome scales of the Child Behavior Checklist (CBCL 1.5–5:(Achenbach & Rescorla, 2000 ): aggression, attention problems, anxiety/depression, emotional reactivity, withdrawal, somatic complaints, and sleep problems. For all scales, multiple classes describing different trajectory patterns emerged that reflected predominantly intercept differences; children high on problem behavior after the birth were those high before the birth. There was no evidence of a sudden, persistent maladaptive response indicating children underwent a developmental crisis for any of the problem behaviors examined. Most children were low on all problem behaviors examined and showed little change or actually declined in problem behaviors over time, although some children did experience more pronounced changes in the borderline clinical or clinical range. Only in the case of aggressive behavior was there evidence of an Adjustment and Adaptation Response showing a sudden change (prenatal to 1 month) that subsided by 4 months, suggesting that some young children react to stressful life events but adapt quickly to these changing circumstances. Further, children’s withdrawal revealed a curvilinear, quadratic path, suggesting children both increased and decreased in their withdrawal over time. Guided by a developmental ecological systems framework, we employed data mining procedures to uncover the child, parent, and family variables that best discriminated the different trajectory classes and found that children’s temperament, coparenting, parental self-efficacy, and parent-child attachment relationships were prominent in predicting children’s adjustment after the birth of an infant sibling. Finally, when trajectory classes were used to predict sibling relationship quality at 12 months, children high on aggression, attention problems, and emotional reactivity in the year after the birth engaged in more conflict and less positive involvement with the infant sibling at the end of the first year.

Moderated Mediation Effect of Self-esteem on the Relationship Between Parenting Stress and Depression According to Employment Status in Married Women: A Longitudinal Study Utilizing Data from Panel Study on Korean Children

PURPOSE

This study was to examined the moderated mediation effect of self-esteem on the relationship between parenting stress and depression among married women with children using longitudinal data from the 3rd to 6th Panel Studies on Korean.

METHODS

The data from the Panel Study of Korean Children (Korea Institute of Child Care and Education) was collected as part of a longitudinal inquiry of babies born in 2008, their parents and their community environments. Only the data collected from the married women over the age of 20 who participated in the maternal survey was used for this study.

RESULTS

The initial level of married women's parenting stress affects the initial level and the rate of change in self-esteem; the initial level of self-esteem, the initial level and rate of change in depression; and the initial level of parenting stress, the initial level of depression. However, the impact of the rate of change in parenting stress on that of self-esteem was significant only in employed women while the impact of the rate of change in self-esteem on that of depression was significant only in unemployed women.

CONCLUSION

It is necessary to manage parenting stress among married women through various programs and education that increase self-esteem in order to reduce their level of depression.

Associations of maternal stress with children's weight-related behaviours: a systematic literature review

Low adherence to guidelines for weight-related behaviours (e.g. dietary intake and physical activity) among US children underscores the need to better understand how parental factors may influence children's obesity risk. In addition to most often acting as primary caregiver to their children, women are also known to experience greater levels of stress than men. This study systematically reviewed associations between maternal stress and children's weight-related behaviours. Our search returned 14 eligible articles, representing 25 unique associations of maternal stress with a distinct child weight-related behaviour (i.e. healthy diet [n = 3], unhealthy diet [n = 6], physical activity [n = 7] and sedentary behaviour [n = 9]). Overall, findings for the relationship between maternal stress and children's weight-related behaviours were mixed, with no evidence for an association with children's healthy or unhealthy dietary intake, but fairly consistent evidence for the association of maternal stress with children's lower physical activity and higher sedentary behaviour. Recommendations for future research include prioritizing prospective designs, identifying moderators, and use of high-resolution, real-time data collection techniques to elucidate potential mechanisms.

Clinical Effectiveness of Family Therapeutic Interventions Embedded in General Pediatric Primary Care Settings for Parental Mental Health: A Systematic Review and Meta-analysis

The aim of this systematic review and meta-analysis was to synthesize the available evidence on embedded family therapy interventions in pediatrics and impacts on parental mental health and family functioning outcomes. The Cochrane Collaboration guidelines for systematic reviews and meta-analysis were used for this study. Six electronic databases were searched for randomized controlled trials and cluster randomized trials. The Cochrane Collaboration's Risk of Bias Tool and GRADE system were used to rate the quality of evidence of the included studies. The primary outcomes included parental distress, parental depressive symptoms, and dysfunctional parent-child interaction. Fixed effects models showed statistically significant reductions in parental distress at 6-month and 12-month post-intervention in favor of the intervention group. Family therapy model, intervention level, delivery modality, and dosage moderated intervention impacts on parental distress. Fixed effects models showed statistically significant reductions in parental depressive symptoms and in dysfunctional parent-child interaction in favor of the intervention group. Family therapy interventions can be successfully embedded in general pediatric primary care, and intended outcomes are achieved in this setting. Recommendations for future research and implications for policy development are discussed.

Paternal involvement and early infant neurodevelopment: the mediation role of maternal parenting stress

Background

Father–child interactions are associated with improved developmental outcomes among infants. However, to the best of our knowledge, no study has addressed the effects of paternal involvement on the neurodevelopment of infants who are less than 6 months of age, and no study has reported how maternal parenting stress mediates the relationship between paternal involvement and infant neurodevelopment during early infancy. This study investigates the direct and indirect relationship between paternal involvement and infant neurodevelopment at 3–4 months of age. The indirect relationship was assessed through the mediating factor of maternal parenting stress.

Methods

The participants were recruited through the Sesalmaul Research Center’s website from April to June 2014. The final data included 255 mothers and their healthy infants, who were aged 3–4 months. The mothers reported paternal involvement and maternal parenting stress by using Korean Parenting Alliance Inventory (K-PAI) and Parenting Stress Index (PSI), respectively. Experts visited the participants’ homes to observe infant neurodevelopment, and completed a developmental examination using Korean version of the Ages and Stages Questionnaire II (K-ASQ II). A hierarchical multiple regression analysis was used for data analysis.

Results

Infants’ mean ages were 106 days and girls accounted for 46.3%. The mean total scores (reference range) of the K-PAI, PSI, and the K-ASQ II were 55.5 (17–68), 45.8 (25–100), and 243.2 (0–300), respectively. Paternal involvement had a positive relationship with K-ASQ II scores (β = 0.29, p < 0.001) at 3–4 months of age, whereas maternal parenting stress was negatively related with K-ASQ II scores (β = −0.32, p < 0.001). Maternal parenting stress mediated the relationship between paternal involvement and early infant neurodevelopment (Z = 3.24, p < 0.001). A hierarchical multiple regression analysis showed that paternal involvement reduced maternal parenting stress (β = −0.25, p < 0.001), which led to positive infant outcomes (β = 0.23, p < 0.001).

Conclusions

Paternal involvement is significantly associated with infant neurodevelopment during early infancy, and maternal parenting stress partially mediates that association. This result emphasizes the importance of fathers’ involvement and mothers’ parenting stress on early infant neurodevelopment.

Associations between intimate partner violence (IPV) during pregnancy, mother-to-infant bonding failure, and postnatal depressive symptoms

This study examined the associations between intimate partner violence (IPV) during pregnancy, mother-to-infant bonding failure, and postnatal depressive symptoms at 1 month postnatal. This study also examined if these relationships would be mediated by antenatal depressive symptoms. This study was a prospective cohort study that investigated effects between the third trimester of pregnancy and 1 month after childbirth. The Japanese version of the Index of Spouse Abuse (ISA), the Japanese version of the Mother-Infant Bonding Scale (MIBS), and the Japanese version of the Hospital Anxiety and Depression Scale (HADS) were used to measure IPV during pregnancy, bonding failure with infants, and depressive symptoms during pregnancy and the postnatal period respectively. Structural equation modeling (SEM) was used to find the associations between those four variables. The final path model of the SEM showed good fit with the data. IPV during pregnancy was associated with mother-to-infant bonding failure at 1 month postnatal, whereas IPV during pregnancy was not significantly associated with postnatal depressive symptoms at 1 month postnatal. In addition, this study demonstrated that the associations between IPV during pregnancy, mother-to-infant bonding failure, and postnatal depressive symptoms at 1 month postnatal were mediated by antenatal depressive symptoms. The results of this study indicated the need for interventions for IPV and psychological health care for abused pregnant women to prevent antenatal depressive symptoms in prenatal health settings. Those interventions by perinatal health professionals would help to prevent bonding failure with infants and postnatal depressive symptoms after childbirth.

The effect of telephone-based cognitive-behavioural therapy on parenting stress: A randomised controlled trial

Objective Stress related to parenting has detrimental effects on the well-being of children, parents and the family system as a whole. There are limited studies about the efficacy of cognitive-behavioural therapy delivered by telephone in reducing parenting stress. The present study investigates the effect of telephone-based cognitive-behavioural therapy on parenting stress at six weeks and six months postpartum.

METHODS

This is a multi-site randomised controlled trial. A total of 397 Chinese mothers at risk of postnatal depression were randomly assigned to receive either telephone-based cognitive-behavioural therapy or routine postpartum care. Parental stress was assessed by the Parenting Stress Index Short Form at six weeks and six months postpartum.

RESULTS

The findings revealed that mothers who had received telephone-based cognitive-behavioural therapy showed significantly lower levels of parenting stress than women only receiving routine postpartum care at six weeks (mean difference=9.42, 95% confidence interval 5.85-12.99, p<0.001, Cohen's d=0.52) and six months postpartum (mean difference=3.58, 95% confidence interval 0.07-7.09, p=0.046, Cohen's d=0.20).

CONCLUSION

Telephone-based cognitive-behavioural therapy is a promising treatment modality for supporting parenting and reducing stress during the transition period. Integration of telephone-based cognitive-behavioural therapy into routine postpartum care might facilitate positive adaptation in particular for mothers at risk of postnatal depression.

Perinatal Parenting Stress, Anxiety, and Depression Outcomes in First-Time Mothers and Fathers: A 3- to 6-Months Postpartum Follow-Up Study

OBJECTIVE

Although there is an established link between parenting stress, postnatal depression, and anxiety, no study has yet investigated this link in first-time parental couples. The specific aims of this study were 1) to investigate whether there were any differences between first-time fathers' and mothers' postnatal parenting stress, anxiety, and depression symptoms and to see their evolution between three and 6 months after their child's birth; and 2) to explore how each parent's parenting stress and anxiety levels and the anxiety levels and depressive symptoms of their partners contributed to parental postnatal depression.

METHOD

The sample included 362 parents (181 couples; mothers' M Age = 35.03, SD = 4.7; fathers' M Age = 37.9, SD = 5.6) of healthy babies. At three (T1) and 6 months (T2) postpartum, both parents filled out, in a counterbalanced order, the Parenting Stress Index-Short Form, the Edinburgh Postnatal Depression Scale, and the State-Trait Anxiety Inventory.

RESULTS

The analyses showed that compared to fathers, mothers reported higher scores on postpartum anxiety, depression, and parenting stress. The scores for all measures for both mothers and fathers decreased from T1 to T2. However, a path analysis suggested that the persistence of both maternal and paternal postnatal depression was directly influenced by the parent's own levels of anxiety and parenting stress and by the presence of depression in his/her partner.

DISCUSSION

This study highlights the relevant impact and effects of both maternal and paternal stress, anxiety, and depression symptoms during the transition to parenthood. Therefore, to provide efficacious, targeted, early interventions, perinatal screening should be directed at both parents.

Perinatal Parenting Stress, Anxiety, and Depression Outcomes in First-Time Mothers and Fathers: A 3- to 6-Months Postpartum Follow-Up Study

OBJECTIVE

Although there is an established link between parenting stress, postnatal depression, and anxiety, no study has yet investigated this link in first-time parental couples. The specific aims of this study were 1) to investigate whether there were any differences between first-time fathers' and mothers' postnatal parenting stress, anxiety, and depression symptoms and to see their evolution between three and 6 months after their child's birth; and 2) to explore how each parent's parenting stress and anxiety levels and the anxiety levels and depressive symptoms of their partners contributed to parental postnatal depression.

METHOD

The sample included 362 parents (181 couples; mothers' M Age = 35.03, SD = 4.7; fathers' M Age = 37.9, SD = 5.6) of healthy babies. At three (T1) and 6 months (T2) postpartum, both parents filled out, in a counterbalanced order, the Parenting Stress Index-Short Form, the Edinburgh Postnatal Depression Scale, and the State-Trait Anxiety Inventory.

RESULTS

The analyses showed that compared to fathers, mothers reported higher scores on postpartum anxiety, depression, and parenting stress. The scores for all measures for both mothers and fathers decreased from T1 to T2. However, a path analysis suggested that the persistence of both maternal and paternal postnatal depression was directly influenced by the parent's own levels of anxiety and parenting stress and by the presence of depression in his/her partner.

DISCUSSION

This study highlights the relevant impact and effects of both maternal and paternal stress, anxiety, and depression symptoms during the transition to parenthood. Therefore, to provide efficacious, targeted, early interventions, perinatal screening should be directed at both parents.

Perceived parenting stress in the course of postpartum depression: the buffering effect of maternal bonding

Research investigating maternal bonding and parenting stress in the course of postpartum depression is lacking. Aim of the study was to investigate the development and potential mediation of both constructs in the course of postpartum depression. n = 31 mothers with postpartum depression according to DSM-IV and n = 32 healthy controls completed the German version of the Postpartum Bonding Questionnaire and the Parenting Stress Index at two measuring times: acute depression (T1) and remission (T2). At T1, the clinical group reported lower bonding and higher parenting stress. Bonding was found to partially mediate the link between maternal diagnosis and parenting stress. Furthermore, the clinical group reported lower bonding and higher parenting stress averaged over both measurement times. However, at T2, the clinical group still differed from the controls even though they improved in bonding and reported less parenting stress. A significant increase of bonding was also observed in the control group. Maternal bonding seems to buffer the negative impact of postpartum depression on parenting stress. The results emphasize the need for interventions focusing on maternal bonding and mother-infant interaction in order to prevent impairment of the mother-child relationship.

Associations of social support and stress with postpartum maternal mental health symptoms: Main effects, moderation, and mediation

Poor maternal mental health during the postpartum period can have significant effects on the health of mothers, infants, and families. The findings from cross-sectional studies suggest that stress and social support are related to maternal mental health. This study contributes to the literature through the use of longitudinal data, and examines moderation and mediation among these factors. In 2012-2013, mothers completed surveys assessing stress, social support, and depressive and anxiety symptoms following birth (n = 125), and 3 months (n = 110) and 6 months (n = 99) after birth. The authors examined temporal associations, moderation, and mediation of social support on the relationship between stress and postpartum depressive and anxiety symptoms using modified Poisson regression models and the counterfactual approach to mediation. Current levels of stress and social support were associated with depressive and anxiety symptoms, both independently and when considered together at multiple time points. Social support did not strongly moderate or mediate the relationships between stress and maternal mental health. Interventions to reduce current perceptions of stress and increase social support for mothers during the postpartum period may help improve maternal mental health symptoms. Efforts are needed to assess the current needs of mothers continuously.

Postnatal Mother-to-Infant Attachment in Subclinically Depressed Mothers: Dyads at Risk?

BACKGROUND

Dyadic interactions between children and depressed mothers have been characterized as less synchronous and with lower maternal sensitivity, fostering an inharmonious, insecure attachment relationship between mother and child. Thus, these children may experience enhanced early life stress and are at higher risk of disturbed socioemotional development. Recently, this association has also been found in women with mild depressive symptoms. However, potential confounding effects of mother's history of own rearing experiences or infant temperament on the link between depressive symptoms and postnatal mother-to-infant attachment have not yet been investigated.

METHODS

Differences in mother-to-infant attachment (e.g. quality of attachment, absence of hostility, and pleasure in interaction) between mothers with and without symptoms of depression 6-8 months postpartum were analyzed in a low-risk community sample (n = 38, 19 per group). Depressive symptomatology was measured with the Beck Depression Inventory (BDI-II) and the Edinburgh Postnatal Depression Scale (EPDS). Depressed mothers indicated mild-to-moderate depressive symptomatology (mean BDI-II 11.26 ± 3.86) but did not fulfill criteria for a major depressive episode and, thus, were referred to as 'subclinically' depressed. Potential confounders, namely maternal history of own rearing experiences and infant temperament, were explored by multivariate AN(C)OVA.

RESULTS

Primiparous mothers with subclinical depression differed significantly from healthy control mothers, i.e. showed poorer mother-to-infant attachment and higher infant-related hostility 6-8 months postpartum. As expected, infant temperament and mother's history of own rearing experiences were both associated with mother-to-infant attachment but did not explain the negative effects of subclinical depression on the mother-infant relationship.

CONCLUSIONS

Given the high prevalence of maternal depression, the current findings give reason for increased concern for the developing mother-child relationship. Therefore, early interventions are needed that focus on the mother-child dyad and target not only clinically but also subclinically depressed mothers.

Association between depressive symptoms and parental stress among mothers and fathers in early parenthood: A Swedish cohort study

Aim To determine whether there is an association between depressive symptoms and parental stress among mothers and fathers during early parenthood in Sweden. Methods In this study, 401 mothers and 396 fathers (393 couples) were included; the Edinburgh Postnatal Depression Scale and the Sense of Coherence Scale were measured 3 months after childbirth, and the Swedish Parenthood Stress Questionnaire and the Sense of Coherence Scale after 18 months. Complete data for multivariable analysis were available for 264 mothers and 252 fathers. Results The mothers estimated greater total depressive symptoms and parental stress than the fathers did. Both the mothers and the fathers had the greatest level of stress in the sub-area 'Role restriction'. The mothers had the lowest level of stress in the sub-area 'Social isolation' and the fathers in the sub-area 'Incompetence'. The mothers perceived greater levels of stress than the fathers did in all sub-areas except for 'Social isolation', where the fathers perceived higher stress. There was an association between the parents' depressive symptoms and parental stress. The parents' own depressive symptoms at 3 months and sense of coherence and the partners' parental stress at 18 months were positively associated with the parental stress at 18 months in univariable and multivariable analyses. Conclusions Understanding the relationship between depressive symptoms and parental stress is important for health professionals so they can offer parents adequate support in early parenthood to optimize the conditions for raising a child. This knowledge should also be communicated to the parents.