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Windhorst DA, Klein Velderman M, van der Pal S, de Weerth C. The effects and process of the intervention "Individual Shantala Infant Massage" in preventive child healthcare to improve parent-child interaction: study protocol for a quasi-experimental study. BMC Complement Med Ther 2023; 23:231. [PMID: 37434181 DOI: 10.1186/s12906-023-04039-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 06/14/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND Individual Shantala Infant Massage is an intervention that is offered by several Dutch Preventive Child Healthcare (PCH) organizations as optional preventive support, in addition to basic care as offered to all children. It targets vulnerable families and aims to enhance sensitive parenting and to reduce (effects of) parental stress. The intervention is carried out by a certified nurse. It consists of three structured home visits. Parents learn to massage their infant and receive parenting support. This study aims to investigate the effectiveness and the process of the intervention. The main hypothesis is that Individual Shantala Infant Massage leads to increased parental sensitive responsiveness, lower perceived and physiological parental stress, and improved child growth and development in the intervention group, compared to a control group where this intervention is not offered by PCH. Secondary research questions address effects on parenting confidence and parental concerns regarding the infant, the influence of background characteristics and the intervention process. METHODS The study is a quasi-experimental non-randomized trial. The aim is to include 150 infant-parent dyads in both the intervention and the control group. This takes into account possible attrition and missing data as 105 dyads with complete data per group are sufficient for analysis. All participants complete questionnaires at T0 (pre-test, child age between six-sixteen weeks), T1 (post-intervention, or ± four weeks after T0), and T2 (follow-up at five months). At T2, a hair tuft is cut from the parents' head to measure hair cortisol levels. Data on infant growth and development is obtained from PCH files. In the intervention group, additional data is collected to evaluate the intervention process: parents complete an evaluation questionnaire at T1, nurses keep semi-structured logbooks of intervention sessions and interviews are conducted with parents and professionals. DISCUSSION Study results can contribute to the evidence base of infant massage as applied in Dutch PCH, and can inform parents, PCH practitioners, policy makers and researchers both inside and outside the Netherlands on feasibility and effectiveness of the infant massage intervention as applied in this format and setting. TRIAL REGISTRATION ISRCTN registry: ISRCTN16929184. Date (retrospectively) registered: 29/03/2022.
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Affiliation(s)
- Dafna A Windhorst
- Department of Child Health, Netherlands Organization for Applied Scientific Research TNO, Leiden, the Netherlands.
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands.
| | - Mariska Klein Velderman
- Department of Child Health, Netherlands Organization for Applied Scientific Research TNO, Leiden, the Netherlands
| | - Sylvia van der Pal
- Department of Child Health, Netherlands Organization for Applied Scientific Research TNO, Leiden, the Netherlands
| | - Carolina de Weerth
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
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Klauser N, Müller M, Zietlow AL, Nonnenmacher N, Woll C, Becker-Stoll F, Rec C. Maternal postpartum anxiety and the development of infant attachment: The effect of body sensations on infant attachment. J Affect Disord 2023; 331:259-268. [PMID: 36958486 DOI: 10.1016/j.jad.2023.03.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 03/04/2023] [Accepted: 03/16/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND Knowledge about the influences of maternal postpartum anxiety disorders (PAD) on infant development is limited. Aim of this present study is to evaluate the influence of PAD on infant attachment. METHODS In a longitudinal study, self-reported anxiety symptoms of N = 70 mothers (N = 28 with PAD diagnosed according to the DSM-IV, N = 42 controls) were examined in the postpartum period and one year later. Infants' attachment was observed in the Strange Situation Test (SST) at the age of 12-24 months. RESULTS Results indicate a strong relationship between PAD and infant attachment: infants of mothers with PAD were significantly more likely to be classified as insecure or disorganized than infants of control mothers. Logistic regression analysis led to a significant model with 76.8 % correct classification of infant attachment dependent on the maternal fear of anxiety associated body sensations (OR = 4.848) in the postpartum period. Including maternal sensitivity and interaction behavior, only maternal intrusiveness was additionally associated with infant attachment (ρ = 0.273, p < .05; OR = 45.021, p = .153). LIMITATIONS Participants were highly educated. Different anxiety disorders included led to a heterogenous sample. Generalization is diminished. Maternal sensitivity was measured on a global scale, and body tension was self-reported. CONCLUSIONS PAD plays a crucial role in the development of infant attachment. Interaction-focused interventions, helping mothers to decrease intrusiveness, and body-focused interventions, helping mothers to deal with their fear of anxiety symptoms, might be promising pathways to buffer the influence of PAD on infant attachment.
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Affiliation(s)
- Nathania Klauser
- Ludwig-Maximilians University, Department of Psychology, Munich, Germany.
| | - Mitho Müller
- Ludwig-Maximilians University, Department of Psychology, Munich, Germany
| | - Anna-Lena Zietlow
- Technical University Dresden, Department of Psychology, Dresden, Germany
| | - Nora Nonnenmacher
- Heidelberg University Hospital, General Psychiatry, Heidelberg, Germany
| | - Christian Woll
- Ludwig-Maximilians University, Department of Psychology, Munich, Germany
| | - Fabienne Becker-Stoll
- Ludwig-Maximilians University, Department of Psychology, Munich, Germany; Staatsinstitut für Frühpädagogik Bayern, Munich, Germany
| | - Corinna Rec
- Ludwig-Maximilians University, Department of Psychology, Munich, Germany
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Do Improvements in Maternal Mental Health Predict Improvements in Parenting? Mechanisms of the Mindful with Your Baby Training. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137571. [PMID: 35805226 PMCID: PMC9265470 DOI: 10.3390/ijerph19137571] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/16/2022] [Accepted: 06/18/2022] [Indexed: 02/01/2023]
Abstract
Postpartum mental health symptoms are associated with parenting difficulties, which have negative consequences for child development. Interventions for young mothers should target their mental health problems and parenting difficulties. Mindful with Your Baby (MwyB) is an intervention for parents, with a baby, who experience (mental) health problems and/or stress or insecurity in parenting. This study seeks to replicate previous effects of MwyB regarding mindfulness, mindful parenting, maternal (mental) health (psychological distress, depressive mood, physical health complaints) and parenting outcomes (parenting stress, parental self-efficacy, bonding), and gain insight into the working mechanisms of the training. Mothers with babies aged 1–18 months (n = 61) completed questionnaires at waitlist, pretest, posttest, and 8-week follow-up. No significant differences were seen between the waitlist and pretest. Significant improvements in all outcomes were shown in the posttest (except for physical health complaints) and follow-up, compared to the pretest. Improvements in depressive symptoms and physical health complaints were dependent on improvements in mindfulness. Improvements in parental self-efficacy were dependent on improvements in mindful parenting. Improvements in some (mental) health and parenting outcomes seemed to be bidirectional. The results suggest that both mindfulness and mindful parenting are important for mothers who experience psychological distress and/or stress or insecurity in parenting their babies.
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Potharst ES, Schaeffer MA, Gunning C, de Lara MC, Boekhorst MGBM, Hulsbosch LP, Pop VJM, Duijff SN. Implementing "Online Communities" for pregnant women in times of COVID-19 for the promotion of maternal well-being and mother-to-infant bonding: a pretest-posttest study. BMC Pregnancy Childbirth 2022; 22:415. [PMID: 35585565 PMCID: PMC9116067 DOI: 10.1186/s12884-022-04729-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 04/26/2022] [Indexed: 12/17/2022] Open
Abstract
Background The Coronavirus Disease 2019 (COVID-19) pandemic elevated the risk for mental health problems in pregnant women, thereby increasing the risk for long-term negative consequences for mother and child well-being. There was an immediate need for easily accessible interventions for pregnant women experiencing elevated levels of pandemic related stress. Methods A three-session intervention “Online Communities” (OC) was developed at the beginning of the Dutch lockdown, and implemented by a team of midwives and psychologists specialized in Infant Mental Health. Pretest (N = 34) and posttest (N = 17) measurements of depressive symptoms, worries about COVID-19 and worries in general, and mother-to-infant bonding were administered, as well as a posttest evaluation. Results At pretest, the OC group was compared to two reference groups of pregnant women from an ongoing pregnancy cohort study: a COVID-19 (N = 209) and pre-COVID-19 reference group (N = 297). OC participants had significantly more depressive symptoms than both reference groups, and less positive feelings of bonding than the COVID-19 but not the pre-COVID-19 reference group. Compared to pretest, significant decreases in depressive symptoms (with significantly less participants scoring above cut-off) and worries about COVID-19 (large effect sizes) and worries in general (moderate to large effect size) were found at posttest for the OC participants. No significant improvement was found in bonding. Participants rated the intervention positively. Conclusions The current study provides initial evidence supporting the idea that OC is a promising and readily accessible intervention for pregnant women experiencing stress due to the COVID-19 pandemic, and possibly also applicable to other stressors. Trial registration This intervention was registered in the Netherlands Trial Registration (registration number Trial NL8842, registration date 18/08/2020).
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Affiliation(s)
- Eva S Potharst
- Research Institute of Child Development and Education, University of Amsterdam, Gebouw D, Roeterseilandcomplex, Nieuwe Achtergracht 127, 1018 WS, Amsterdam, the Netherlands. .,UvA Minds, Academic Outpatient (child and adolescent) Treatment Center of the University of Amsterdam, Banstraat 29, 1071 JW, Amsterdam, the Netherlands.
| | - Mirla A Schaeffer
- UvA Minds, Academic Outpatient (child and adolescent) Treatment Center of the University of Amsterdam, Banstraat 29, 1071 JW, Amsterdam, the Netherlands.,Amsterdam Law and Behaviour Institute (A-LAB), Vrije Universiteit Amsterdam, De Boelelaan 1077a, 1081 HV, Amsterdam, the Netherlands.,Netherlands Institute for the Study of Crime and Law Enforcement, De Boelelaan 1077, 1081 HV, Amsterdam, the Netherlands
| | - Cecile Gunning
- Infant Mental Health Expertise Centre OuderKindLijn, Javastraat 155, 1095 CC, Amsterdam, The Netherlands
| | - Merith Cohen de Lara
- Outpatient Maternal Mental Health Practice Psyche en Zwangerschap, Cornelis Anthoniszstraat 28, 1071 VV, Amsterdam, The Netherlands
| | - Myrthe G B M Boekhorst
- Department of Medical and Clinical Psychology, Center of Research On Psychological and Somatic Disorders (CoRPS), Tilburg University, Gebouw TIAS, Warandelaan 2, 5037 AB, Tilburg, the Netherlands
| | - Lianne P Hulsbosch
- Department of Medical and Clinical Psychology, Center of Research On Psychological and Somatic Disorders (CoRPS), Tilburg University, Gebouw TIAS, Warandelaan 2, 5037 AB, Tilburg, the Netherlands
| | - Victor J M Pop
- Department of Medical and Clinical Psychology, Center of Research On Psychological and Somatic Disorders (CoRPS), Tilburg University, Gebouw TIAS, Warandelaan 2, 5037 AB, Tilburg, the Netherlands
| | - Sasja N Duijff
- Infant Mental Health Expertise Centre OuderKindLijn, Javastraat 155, 1095 CC, Amsterdam, The Netherlands.,Clinical Child, Family and Education Studies, University of Utrecht, Heidelberglaan 1, Postbus 80140, 3508 TC, Utrecht, The Netherlands
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Stolper H, van Doesum K, Steketee M. How to Support Parents of Infants and Young Children in Mental Health Care: A Narrative Review. Front Psychol 2021; 12:745800. [PMID: 34867627 PMCID: PMC8634941 DOI: 10.3389/fpsyg.2021.745800] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 10/15/2021] [Indexed: 01/30/2023] Open
Abstract
Objective: The aim of this narrative review is to gain insight into the appropriate intervention targets when parents of infants and young children suffer from psychopathology. Background: Psychopathology in parents is a risk factor for maladaptive parenting and is strongly related to negative cascade effects on parent-child interactions and relations in the short and long term. Children in their first years of life are especially at risk. However, in adult mental health care, this knowledge is rarely translated into practice, which is a missed opportunity for prevention. Methods: Electronic databases were searched for reviews and meta-analysis. In addition, sources were obtained via manual search, reference mining, expert opinion, and communications from conferences. In total, 56 papers, whereof 23 reviews and 12 meta-analyses were included. Results: Findings regarding targets of intervention were identified in different interacting domains, namely the parental, family, child, and environmental domains as well as the developing parent-child relationship. A "one size fits all" intervention is not appropriate. A flexible, tailored, resource-oriented intervention program, multi-faceted in addressing all modifiable risk factors and using different methods (individual, dyadic, group), seems to provide the best results. Conclusion: To address the risk factors in different domains, adult and child mental health care providers should work together in close collaboration to treat the whole family including mental disorders, relational, and contextual problems. A multi-agency approach that includes social services is needed.
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Affiliation(s)
- Hanna Stolper
- Department of Psychology Education and Child Studies, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Karin van Doesum
- Department of Clinical Psychology, Radboud University, Nijmegen, Netherlands
| | - Majone Steketee
- Department of Psychology Education and Child Studies, Erasmus University Rotterdam, Rotterdam, Netherlands
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Burke K, Dittman CK, Forbes EJ, Eggins E. PROTOCOL: A systematic review and meta-analysis of randomised controlled trials evaluating the impact of parenting programmes for parents of adolescents (10-18 years) on adolescent mental health outcomes, positive development and the parent-adolescent relationship. CAMPBELL SYSTEMATIC REVIEWS 2021; 17:e1146. [PMID: 37050970 PMCID: PMC8356282 DOI: 10.1002/cl2.1146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Affiliation(s)
- Kylie Burke
- Parenting and Family Support Centre, School of PsychologyThe University of QueenslandBrisbaneQueenslandAustralia
| | - Cassandra K. Dittman
- School of Health, Medical and Applied SciencesCentral Queensland UniversityBundabergQueenslandAustralia
| | - Elana J. Forbes
- Parenting and Family Support Centre, School of PsychologyThe University of QueenslandBrisbaneQueenslandAustralia
| | - Elizabeth Eggins
- School of Social Science, The University of QueenslandBrisbaneQueenslandAustralia
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Raouna A, Malcolm R, Ibrahim R, MacBeth A. Promoting sensitive parenting in 'at-risk' mothers and fathers: A UK outcome study of Mellow Babies, a group-based early intervention program for parents and their babies. PLoS One 2021; 16:e0245226. [PMID: 33534841 PMCID: PMC7857589 DOI: 10.1371/journal.pone.0245226] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 12/26/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The objective of this study was to evaluate the effectiveness of Mellow Babies (MB) in the UK. MB is a 14-week early parenting intervention program that is delivered in groups and is targeted at 'at-risk' parents (both mothers and fathers) and their babies up to 18 months old. METHOD The study used a pragmatic pre-post intervention design. Outcomes were parental mental health, parenting confidence, quality of life, socio-emotional development of children, and perceived parent-child relationship. Fifteen groups representing n = 91 parent-baby dyads were recruited across the UK between 2017-2018. The sample consisted of 10 Mellow Mums groups (70 mother-baby dyads) and 5 Mellow Dads groups (21 father-baby dyads). Intention-to-treat and 'completer' analyses were performed. RESULTS Findings suggest short-term positive outcomes for parents attending MB. Completion of the program was associated with significant improvements in anxiety and overall wellbeing, parenting confidence, and perceived closeness of the parent-child relationship. The significance of these improvements, except for parenting confidence, was maintained in the intention-to-treat analysis. MB engaged and retained a high proportion of parents who could be considered 'at-risk' and benefitted fathers and mothers attending the intervention equally. CONCLUSIONS This is the first prospective study to explore MB participation for both mothers and fathers and to indicate engagement and potential benefits specifically for 'at-risk' parents. Findings further demonstrate the effectiveness of MB as an early intervention program for parents experiencing psychosocial difficulties. Replication by studies using a contrast or control group also incorporating follow-up data would further improve the evidence base for MB.
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Affiliation(s)
- Aigli Raouna
- Mellow Parenting, Glasgow, United Kingdom
- Department of Clinical Psychology, School of Health in Social Science, The University of Edinburgh, Edinburgh, United Kingdom
| | | | | | - Angus MacBeth
- Department of Clinical Psychology, School of Health in Social Science, The University of Edinburgh, Edinburgh, United Kingdom
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Döhnert M, Wiegand-Grefe S. [Preventive and therapeutic interventions for children of mentally ill parents]. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2020; 49:51-61. [PMID: 33269950 DOI: 10.1024/1422-4917/a000771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Preventive and therapeutic interventions for children of mentally ill parents Abstract. The risk of developing mental disorders increases markedly in children of mentally ill parents. Several risk factors have been identified and become possible targets of preventive and therapeutic interventions. Numerous studies investigated the efficacy of these interventions, which are very heterogeneous regarding content and methodology. One part of these studies focuses on infants of depressed and substance-addicted mothers; the other part focuses on children and adolescents of parents suffering from various mental disorders. Today, we have several meta-analyses at our disposal which yielded small effect sizes concerning the development of psychological symptoms or disorders in these affected children. The current review reveals a lack of high-quality studies, and analyses on cost-effectiveness are also needed. The preventive and therapeutic interventions now available show inadequate efficacy to effectively improve the situation of these children and adolescents. Future research is needed to develop and implement cost-effective interventions as well as high-quality studies to investigate the efficacy of these interventions.
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Affiliation(s)
- Mirko Döhnert
- Universitätsklinikum Leipzig AöR, Klinik und Poliklinik für Psychiatrie, Psychotherapie und Psychosomatik des Kindes- und Jugendalters, Leipzig
| | - Silke Wiegand-Grefe
- Universitätsklinikum Hamburg-Eppendorf (UKE), Zentrum für psychosoziale Medizin, Klinik für Kinder- und Jugendpsychiatrie, -psychotherapie und -psychosomatik, Hamburg
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[Supporting Children of Parents With a Mental Illness: State of Research and Two Practice Approaches and Claims for the Government]. Prax Kinderpsychol Kinderpsychiatr 2020; 69:443-462. [PMID: 32886045 DOI: 10.13109/prkk.2020.69.5.443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Supporting Children of Parents With a Mental Illness: State of Research and Two Practice Approaches and Claims for the Government Children of parents with a mental illness (COPMI) are at an increased risk to develop (severe) mental disorders (SMI) themselves. Estimates for Germany result in about 25 % of COPMI. This is thus a large and high risk group. On the other hand, prevention programs for COPMI are still scarce, especially in Germany, and central features of the transgenerational transmission of mental disorders have not been studied in conjunction to shed light on potential transmission mechanisms. The current article presents two current research projects on COPMI focusing on preventive approaches. The BMBF funded project "Children of Parents with a Mental Illness At Risk Evaluation" (COMPARE) targets parents of children aged 1.5 to 16 years of age. Parents need to fulfil a current DSM-5 based diagnosis of a mental disorder and then receive either 25-45 sessions gold standard cognitive behavioural therapy (CBT) or CBT plus 10 sessions Positive Parenting Program (PPP) to test the effects of parental therapy on the children and whether an additional parent training results in incremental effects above and beyond CBT alone. The project "The Village" is a model project in the region Tyrol, Austria, targeting the improved identification and collaborative care of COPMI.
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Changing parental depression and sensitivity: Randomized clinical trial of ABC's effectiveness in the community. Dev Psychopathol 2020; 33:1026-1040. [DOI: 10.1017/s0954579420000310] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
AbstractAttachment and Biobehavioral Catch-up (ABC) demonstrates efficacy in improving parent and child outcomes, with preliminary evidence for effectiveness in community settings. The objective of this study was to assess the effectiveness of a community-based ABC implementation in improving parent outcomes as well as to examine potential mediators and moderators of intervention effectiveness. Two hundred parents and their 5- to 21-month-old infants recruited from an urban community were randomly assigned to receive ABC or be placed on a waitlist. The majority of participants had a minority racial or ethnic background. Before intervention, parents completed questionnaires about sociodemographic risk and adverse childhood experiences. At both baseline and follow-up, parents reported depression symptoms and were video-recorded interacting with their infant, which was coded for sensitivity. The ABC intervention predicted significant increases in parental sensitivity and, among parents who completed the intervention, significant decreases in depression symptoms. Changes in parental depression symptoms did not significantly mediate the intervention effects on sensitivity. Risk variables did not moderate the intervention effects. The results indicate that ABC shows promise for improving parent outcomes in community settings, supporting dissemination.
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Farkas C, Álvarez C, Cuellar MDP, Avello E, Gómez DM, Pereira P. Mothers' competence profiles and their relation to language and socioemotional development in Chilean children at 12 and 30 months. Infant Behav Dev 2020; 59:101443. [PMID: 32276086 DOI: 10.1016/j.infbeh.2020.101443] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 02/27/2020] [Accepted: 03/19/2020] [Indexed: 11/19/2022]
Abstract
The study of early parental competences is relevant because such competences are related to children's development; however, most studies have considered competences using a variable-centered approach in which each parental competence is examined in isolation. This paper approaches these competences using a person-centered approach, generating profiles that combine different competences in Chilean mothers assessed when their children were aged 12 months and again at 30 months. The aim of this study was to generate and compare these profiles and to analyze the associations of these profiles with children's language and socioemotional skills. Mother-child interactions in the contexts of storytelling and free play were videotaped at two different times. Ninety mother-child dyads were assessed using the Adult Sensitivity Scale (E.S.A.), the Evaluation of the Mentalization of Significant Caregivers, the Checklist of Observations Linked to Outcomes (PICCOLO), Bayley's language scale and the Functional Emotional Assessment Scale (FEAS). Profiles of mothers' behaviors were identified through person-centered within-group analyses of six aspects: sensitivity, mentalization, affection, responsiveness, encouragement, and teaching. Cluster analyses yielded three similar profiles for mothers at both ages: highly competent, average competent, and poorly competent. The mothers' profiles were related to maternal age, socioeconomic status (SES) and educational level, and the mothers improved their profiles at the 30-month assessment. The mothers' profiles were related to children's language and socioemotional outcomes at both ages. These results and their applicability to promotion and intervention programs are discussed.
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Rayce SB, Rasmussen IS, Væver MS, Pontoppidan M. Effects of parenting interventions for mothers with depressive symptoms and an infant: systematic review and meta-analysis. BJPsych Open 2020; 6:e9. [PMID: 31928569 PMCID: PMC7001473 DOI: 10.1192/bjo.2019.89] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 10/11/2019] [Accepted: 11/10/2019] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Postpartum depression is common in the perinatal period and poses a risk for the development of the infant and the mother-infant relationship. Infancy is a critical developmental period of life and supportive parenting is crucial for healthy development, however, the effects of interventions aimed at improving parenting among mothers with depression are uncertain. AIMS To assess the effects of parenting interventions on parent-child relationship and child development among mothers with depressive symptoms with 0-12-month-old infants. METHOD We conducted a systematic review with the inclusion criteria: (a) randomised controlled trials of structured psychosocial parenting interventions for women with depressive symptoms and a child aged 0-12 months in Western Organisation for Economic Co-operation and Development countries, (b) minimum three sessions with at least half of these delivered postnatally and (c) outcomes relating to the parent-child-relationship and/or child development. Publications were extracted from 10 databases in September 2018 and supplemented with grey search and hand search. We assessed risk of bias, calculated effect sizes and conducted meta-analysis. RESULTS Eight papers representing seven trials were included. We conducted meta-analysis on the post-intervention parent-child relationship. The analysis included six studies and showed no significant effect. For individual study outcomes, no significant effects on the majority of both the parent-child relationship and child development outcomes were reported. CONCLUSIONS No evidence of the effect of parenting interventions for mothers with depressive symptoms was found on the parent-child relationship and child development. Larger studies with follow-up assessments are needed, and future reviews should examine the effects in non-Western countries.
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Affiliation(s)
- Signe B. Rayce
- Senior Researcher, VIVE – The Danish Center for Social Science Research, Denmark
| | - Ida S. Rasmussen
- Research Assistant, VIVE – The Danish Center for Social Science Research, Denmark
| | | | - Maiken Pontoppidan
- Senior Researcher, VIVE – The Danish Center for Social Science Research, Denmark
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Binda V, Figueroa-Leigh F, Olhaberry M. Antenatal and postnatal depressive symptoms: Association with quality of mother-infant interaction. Infant Behav Dev 2019; 57:101386. [PMID: 31706199 DOI: 10.1016/j.infbeh.2019.101386] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 09/23/2019] [Accepted: 10/02/2019] [Indexed: 11/30/2022]
Abstract
Antenatal and postnatal depression are independently associated with an increased risk of adverse infant development. A key linking mechanism is the quality of mother-infant interaction. OBJECTIVES This study assesses the association between postnatal depressive symptoms (PDS) and their severity, with the quality of mother-infant interaction and compare the quality of mother-infant interaction and severity of the symptoms depending on the presence or absence of antenatal depressive symptoms (ADS). METHODS observational study in 177 psychosocial risk mother-infant dyads from Chile (infant aged 2-12 months). RESULTS Mothers with PDS had lower maternal sensitivity and a more intrusive/controlling style than mothers without PDS, although the severity of the symptoms was not associated with lower maternal sensitivity. Maternal sensitivity did not differ in the postnatal depressed mothers depending on the presence of ADS, although the mothers differed in interaction style and the severity of symptoms. Mothers with ADS and PDS presented with a predominant intrusive/controlling interaction style and more severe depressive symptoms, whereas those with only PDS presented with a predominant nonresponsive/passive interaction style and reduced severity of symptoms. CONCLUSIONS The results corroborate the need to offer treatment and dyadic interventions to antenatal and postnatal depressive mothers and postulate that the presence of antenatal depressive symptoms may influence the subsequent mother-infant interaction style and greater severity of symptoms.
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Affiliation(s)
- Victoria Binda
- Department of Family Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
| | | | - Marcia Olhaberry
- Department of Psychology, Pontificia Universidad Católica de Chile, Santiago, Chile
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Potharst ES, Boekhorst MGBM, Cuijlits I, van Broekhoven KEM, Jacobs A, Spek V, Nyklíček I, Bögels SM, Pop VJM. A Randomized Control Trial Evaluating an Online Mindful Parenting Training for Mothers With Elevated Parental Stress. Front Psychol 2019; 10:1550. [PMID: 31379646 PMCID: PMC6650592 DOI: 10.3389/fpsyg.2019.01550] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 06/19/2019] [Indexed: 01/02/2023] Open
Abstract
Objectives The prevalence of maternal stress in early years of parenting can negatively impact child development. Therefore, there is a need for an early intervention that is easily accessible and low in costs. The current study examined the effectiveness of an 8-session online mindful parenting training for mothers with elevated levels of parental stress. Methods A total of 76 mothers were randomized into an intervention (n = 43) or a waitlist control group (n = 33). The intervention group completed pretest assessment prior to the online intervention. Participants completed a post intervention assessment after the 10 weeks intervention and a follow-up assessment 10 weeks later. The waitlist group completed waitlist assessment, followed by a 10-week waitlist period. After these 10 weeks, a pretest assessment took place, after which the waitlist group participants also started the intervention, followed by the posttest assessment. Participating mothers completed questionnaires on parental stress (parent-child interaction problems, parenting problems, parental role restriction) and other maternal (over-reactive parenting discipline, self-compassion, symptoms of depression and anxiety) and child outcomes (aggressive behavior and emotional reactivity) while the non-participating parents (father or another mother) were asked to also report on child outcomes. Results The online mindful parenting intervention was shown to be significantly more effective at a 95% level than a waitlist period with regard to over-reactive parenting discipline and symptoms of depression and anxiety (small and medium effect sizes), and significantly more effective at a 90% level with regard to self-compassion, and mother-rated child aggressive behavior and child emotional reactivity (small effect sizes). The primary outcome, parental stress, was found to have a 95% significant within-group effect only for the subscale parental role restriction (delayed small effect size improvement at follow-up). No significant improvements on child outcomes were found for the non-participating parent. Conclusion To conclude, the results provide first evidence that an online mindful parenting training may be an easily accessible and valuable intervention for mothers with elevated levels of parental stress.
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Affiliation(s)
- Eva S Potharst
- UvA Minds, Academic Outpatient (Child and Adolescent) Treatment Center, University of Amsterdam, Amsterdam, Netherlands.,Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, Netherlands
| | - Myrthe G B M Boekhorst
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, Netherlands.,Department of Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, Netherlands.,Department of Psychiatry, Erasmus MC, University Medical Centre, Rotterdam, Netherlands
| | - Ivon Cuijlits
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, Netherlands.,Department of Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, Netherlands
| | - Kiki E M van Broekhoven
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, Netherlands.,Department of Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, Netherlands
| | - Anne Jacobs
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, Netherlands
| | - Viola Spek
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, Netherlands.,Department of Psychology, Fontys University of Applied Sciences, Eindhoven, Netherlands
| | - Ivan Nyklíček
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, Netherlands
| | - Susan M Bögels
- Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, Netherlands.,Developmental Psychology, University of Amsterdam, Amsterdam, Netherlands
| | - Victor J M Pop
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, Netherlands
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15
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Goodman JH. Perinatal depression and infant mental health. Arch Psychiatr Nurs 2019; 33:217-224. [PMID: 31227073 DOI: 10.1016/j.apnu.2019.01.010] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 01/24/2019] [Indexed: 12/19/2022]
Abstract
A mother's mental health during pregnancy and the first year postpartum is of the utmost importance to the cognitive, social, and emotional development of her child. Perinatal depression is associated with increased risk for wide-ranging adverse child development effects that can affect infant and early childhood mental health. Although effective treatments for perinatal depression exist, it is currently unclear if treatment of maternal depression alone is sufficient to ameliorate the negative effects of maternal depression on child outcomes. Interventions focused on the mother-infant relationship and dyadic interaction may be required to address the potential effect of maternal depression on the child. This paper provides an overview of maternal perinatal depression, the risk it poses for infant/early-childhood mental health, strategies for intervention that include mitigating depression and decreasing risk to the child, and implications for psychiatric nurses who work with perinatal women. Early identification and treatment of perinatal depression are critical to ensure optimal infant development and the child's future mental health.
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Affiliation(s)
- Janice H Goodman
- MGH Institute of Health Professions, School of Nursing, 36 1st Avenue, Boston, MA 02129, United States of America.
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16
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Zeegers MA, Potharst ES, Veringa-Skiba IK, Aktar E, Goris M, Bögels SM, Colonnesi C. Evaluating Mindful With Your Baby/Toddler: Observational Changes in Maternal Sensitivity, Acceptance, Mind-Mindedness, and Dyadic Synchrony. Front Psychol 2019; 10:753. [PMID: 31068848 PMCID: PMC6491830 DOI: 10.3389/fpsyg.2019.00753] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 03/19/2019] [Indexed: 01/11/2023] Open
Abstract
Studies on the effectiveness of mindful parenting interventions predominantly focused on self-report measures of parenting, whereas observational assessments of change are lacking. The present study examined whether the Mindful with your baby/toddler training leads to observed changes in maternal behavior and mother-child interaction quality. Mindful with your baby/toddler is a 8- or 9-week mindful parenting training for clinically referred mothers of young children (aged 0-48 months), who experience parental stress, mother-child interaction problems, and/or whose children experience regulation problems. The study involved a quasi-experimental non-random design including a sample of 50 mothers who were diagnosed with a mood disorder (n = 21, 42%), an anxiety disorder (n = 7, 14%), post-traumatic stress disorder (n = 6, 12%), or other disorder (n = 7, 14%). Mothers completed a parental stress questionnaire and participated in home observations with their babies (n = 36) or toddlers (n = 14) during a waitlist, pretest, and posttest assessment. Maternal sensitivity, acceptance, and mind-mindedness were coded from free-play interactions and dyadic synchrony was coded from face-to-face interactions. Sensitivity and acceptance were coded with the Ainsworth's maternal sensitivity scales. Mind-mindedness was assessed by calculating frequency and proportions of appropriate and nonattuned mind-related comments. Dyadic synchrony was operationalized by co-occurrences of gazes and positive facial expressions and maternal and child responsiveness in vocal interaction within the dyad. Coders were blind to the measurement moment. From waitlist to pretest, no significant improvements were observed. At posttest, mothers reported less parenting stress, and were observed to show more accepting behavior and make less nonattuned comments than at pretest, and children showed higher levels of responsiveness. The outcomes suggest that the Mindful with your baby/toddler training affects not only maternal stress, but also maternal behavior, particularly (over)reactive parenting behaviors, which resulted in more acceptance, better attunement to child's mental world, and more "space" for children to respond to their mothers during interactions. Mindful with your baby/toddler may be a suitable intervention for mothers of young children with (a combination of) maternal psychopathology, parental stress, and problems in the parent-child interaction and child regulation problems.
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Affiliation(s)
- Moniek A.J. Zeegers
- Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, Netherlands
| | - Eva S. Potharst
- UvA Minds, Academic Outpatient (Child and Adolescent) Treatment Center, University of Amsterdam, Amsterdam, Netherlands
| | - Irena K. Veringa-Skiba
- Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, Netherlands
| | - Evin Aktar
- Department of Clinical Psychology, Leiden University, Leiden, Netherlands
| | - Melissa Goris
- Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, Netherlands
| | - Susan M. Bögels
- Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, Netherlands
- Department of Developmental Psychology, University of Amsterdam, Amsterdam, Netherlands
| | - Cristina Colonnesi
- Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, Netherlands
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17
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Mindell JA, Williamson AA. Benefits of a bedtime routine in young children: Sleep, development, and beyond. Sleep Med Rev 2018; 40:93-108. [PMID: 29195725 PMCID: PMC6587181 DOI: 10.1016/j.smrv.2017.10.007] [Citation(s) in RCA: 155] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 09/03/2017] [Accepted: 10/30/2017] [Indexed: 12/11/2022]
Abstract
This paper presents a conceptual model and reviews the empirical evidence to support a nightly bedtime routine as a key factor in the promotion of not only healthy sleep, but also of broad development and wellbeing in early childhood. A bedtime routine embodies the characteristics of nurturing care and early child stimulation, which are deemed to be essential for positive outcomes, especially for at-risk children. Furthermore, common, adaptive components of a bedtime routine can contribute to an array of positive developmental outcomes beyond improved sleep, inclusive of language development, literacy, child emotional and behavioral regulation, parent-child attachment, and family functioning, among other outcomes. These bedtime routine components include activities in the broad domains of nutrition (e.g., feeding, healthy snack), hygiene (e.g., bathing, oral care), communication (e.g., reading, singing/lullabies) and physical contact (e.g., massage, cuddling/rocking). A bedtime routine can provide multiple benefits to child and family functioning at a time of day that many parents are present with their children. Although additional research on hypothesized routine-related child outcomes and mechanisms of action are needed, promoting a bedtime routine may be a feasible and cost-effective method to promote positive early childhood development worldwide, particularly for socioeconomically disadvantaged and other at-risk young children.
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Affiliation(s)
- Jodi A Mindell
- Department of Psychology, Saint Joseph's University, Philadelphia, PA, USA; Sleep Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Ariel A Williamson
- Sleep Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Center for Sleep and Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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18
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Bernard K, Nissim G, Vaccaro S, Harris JL, Lindhiem O. Association between maternal depression and maternal sensitivity from birth to 12 months: a meta-analysis. Attach Hum Dev 2018; 20:578-599. [PMID: 29374991 DOI: 10.1080/14616734.2018.1430839] [Citation(s) in RCA: 112] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Maternal sensitivity plays a central role in shaping children's development across a number of domains, and may be disrupted by depression. The current meta-analysis quantified the magnitude of the association between depression and maternal sensitivity, defined broadly as timely, contingent, and appropriate responding to infants' cues, from birth to 12 months. Across k = 48 studies and n = 4,934 mother-infant dyads, the aggregate effect size between depression and maternal sensitivity was r = -.16, p < .0001, indicating that mothers with higher depression levels were less sensitive than mothers with lower depression levels. Studies that compared a depressed group with a nondepressed/control group had larger effect sizes (r = -.35, p < .0001) than studies that examined depression within a single sample of either unselected cases or clinical-only cases (r = -.11, p < .001), suggesting that clinical levels of depression may pose a particular threat to sensitive parenting. Clinical implications (e.g. screening, prevention) are discussed.
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Affiliation(s)
- Kristin Bernard
- a Department of Psychology , Stony Brook University , Stony Brook , NY, USA
| | - Galia Nissim
- a Department of Psychology , Stony Brook University , Stony Brook , NY, USA
| | - Suzanne Vaccaro
- a Department of Psychology , Stony Brook University , Stony Brook , NY, USA
| | - Jordan L Harris
- b Western Psychiatric Institute and Clinic , University of Pittsburgh Medical Center, PA, USA
| | - Oliver Lindhiem
- c Department of Psychiatry , University of Pittsburgh School of Medicine , PA , USA
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19
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Rayce SB, Rasmussen IS, Klest SK, Patras J, Pontoppidan M. Effects of parenting interventions for at-risk parents with infants: a systematic review and meta-analyses. BMJ Open 2017; 7:e015707. [PMID: 29284713 PMCID: PMC5770968 DOI: 10.1136/bmjopen-2016-015707] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Infancy is a critical stage of life, and a secure relationship with caring and responsive caregivers is crucial for healthy infant development. Early parenting interventions aim to support families in which infants are at risk of developmental harm. Our objective is to systematically review the effects of parenting interventions on child development and on parent-child relationship for at-risk families with infants aged 0-12 months. DESIGN This is a systematic review and meta-analyses. We extracted publications from 10 databases in June 2013, January 2015 and June 2016, and supplemented with grey literature and hand search. We assessed risk of bias, calculated effect sizes and conducted meta-analyses. INCLUSION CRITERIA (1) Randomised controlled trials of structured psychosocial interventions offered to at-risk families with infants aged 0-12 months in Western Organisation for Economic Co-operation and Development (OECD) countries, (2) interventions with a minimum of three sessions and at least half of these delivered postnatally and (3) outcomes reported for child development or parent-child relationship. RESULTS Sixteen studies were included. Meta-analyses were conducted on seven outcomes represented in 13 studies. Parenting interventions significantly improved child behaviour (d=0.14; 95% CI 0.03 to 0.26), parent-child relationship (d=0.44; 95% CI 0.09 to 0.80) and maternal sensitivity (d=0.46; 95% CI 0.26 to 0.65) postintervention. There were no significant effects on cognitive development (d=0.13; 95% CI -0.08 to 0.41), internalising behaviour (d=0.16; 95% CI -0.03 to 0.33) or externalising behaviour (d=0.16; 95% CI -0.01 to 0.30) post-intervention. At long-term follow-up we found no significant effect on child behaviour (d=0.15; 95% CI -0.03 to 0.31). CONCLUSIONS Interventions offered to at-risk families in the first year of the child's life appear to improve child behaviour, parent-child relationship and maternal sensitivity post-intervention, but not child cognitive development and internalising or externalising behaviour. Future studies should incorporate follow-up assessments to examine long-term effects of early interventions.
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Affiliation(s)
- Signe B Rayce
- Department for Child and Family, VIVE – The Danish Centre of Applied Social Science, Copenhagen, Denmark
| | - Ida S Rasmussen
- Department for Child and Family, VIVE – The Danish Centre of Applied Social Science, Copenhagen, Denmark
| | - Sihu K Klest
- Faculty of Health Sciences, University of Tromsø, Arctic University of Norway, Tromsø, Norway
| | - Joshua Patras
- Faculty of Health Sciences, University of Tromsø, Arctic University of Norway, Tromsø, Norway
| | - Maiken Pontoppidan
- Department for Child and Family, VIVE – The Danish Centre of Applied Social Science, Copenhagen, Denmark
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20
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Spieker SJ, Oxford ML, Fleming CB, Lohr MJ. PARENTAL CHILDHOOD ADVERSITY, DEPRESSIVE SYMPTOMS, AND PARENTING QUALITY: EFFECTS ON TODDLER SELF-REGULATION IN CHILD WELFARE SERVICES INVOLVED FAMILIES. Infant Ment Health J 2017; 39:5-16. [PMID: 29266280 DOI: 10.1002/imhj.21685] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Parents who are involved with child welfare services (CWSI) often have a history of childhood adversity and depressive symptoms. Both affect parenting quality, which in turn influences child adaptive functioning. We tested a model of the relations between parental depression and child regulatory outcomes first proposed by K. Lyons-Ruth, R. Wolfe, A. Lyubchik, and R. Steingard (2002). We hypothesized that both parental depression and parenting quality mediate the effects of parental early adversity on offspring regulatory outcomes. Participants were 123 CWSI parents and their toddlers assessed three times over a period of 6 months. At Time 1, parents reported on their childhood adversity and current depressive symptoms. At Time 2, parents' sensitivity to their child's distress and nondistress cues was rated from a videotaped teaching task. At Time 3, observers rated children's emotional regulation, orientation/engagement, and secure base behavior. The results of a path model partly supported the hypotheses. Parent childhood adversity was associated with current depressive symptoms, which in turn related to parent sensitivity to child distress, but not nondistress. Sensitivity to distress also predicted secure base behavior. Depression directly predicted orientation/engagement, also predicted by sensitivity to nondistress. Sensitivity to distress predicted emotion regulation and orientation/engagement. Results are discussed in terms of intervention approaches for CWSI families.
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21
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Farkas C, Vallotton CD, Strasser K, Santelices MP, Himmel E. Socioemotional skills between 12 and 30 months of age on Chilean children: When do the competences of adults matter? Infant Behav Dev 2017; 49:192-203. [PMID: 28950222 DOI: 10.1016/j.infbeh.2017.09.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 04/07/2017] [Accepted: 09/18/2017] [Indexed: 11/28/2022]
Abstract
Due to the rapid growth in early socioemotional skills during the first three years of life, significant variations in socioemotional development begin early and increase with time. Family competences as sensitivity and mentalization, contribute to differences among children of the same age. This study examines whether the level of socioemotional skills is stable or changes between 12 and 30 months of age, and whether primary caregiver sensitivity and mentalization, as well as educational level, are associated with changes in the level of socioemotional skills. One hundred and three Chilean children were evaluated. The results showed a significant change in socioemotional level between 12 and 30 months. Primary caregivers' sensitivity was associated with socioemotional skills at 12 months of age, and caregivers' educational levels was the strongest predictor. At 30 months, caregivers' sensitivity and educational level did not contribute additional influence, and only child socioemotional skills reported at 12 months acted as a predictor. Results indicate that family competences contribute to infants' socioemotional development in the first year of life, which subsequently influences their later skills.
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Affiliation(s)
- Chamarrita Farkas
- Chamarrita Farkas, Escuela de Psicología, Pontificia Universidad Católica de Chile, Avenida Vicuña Mackenna 4860, Macul, Santiago, Chile.
| | - Claire D Vallotton
- Department of Human Development and Family Studies, Michigan State University, 552 W. Circle Drive, 5A Human Ecology, East Lansing, MI 48824-1030, USA.
| | - Katherine Strasser
- Escuela de Psicología, Pontificia Universidad Católica de Chile, Avenida Vicuña Mackenna 4860, Macul, Santiago, Chile.
| | - María Pía Santelices
- Escuela de Psicología, Pontificia Universidad Católica de Chile, Avenida Vicuña Mackenna 4860, Macul, Santiago, Chile.
| | - Erika Himmel
- Escuela de Psicología, Pontificia Universidad Católica de Chile, Avenida Vicuña Mackenna 4860, Macul, Santiago, Chile.
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22
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Do preventive interventions for children of mentally ill parents work? Results of a systematic review and meta-analysis. Curr Opin Psychiatry 2017; 30:283-299. [PMID: 28505032 DOI: 10.1097/yco.0000000000000342] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW The transgenerational transmission of mental disorders is one of the most significant causes of psychiatric morbidity. Several risk factors for children of parents with mental illness (COPMI) have been identified in numerous studies and meta-analyses. RECENT FINDINGS Many interventions have been developed for this high-risk group, but data about their efficacy are heterogeneous. SUMMARY The current meta-analysis reports on 96 articles including 50 independent samples from randomized controlled trials quantifying effects of preventive interventions for COPMI. Random effect models resulted in small, though significant Effect Sizes (ES) for programs enhancing the mother-infant interaction (ES = 0.26) as well as mothers' (ES = 0.33) and children's (ES = 0.31) behavior that proved to be stable over the 12-month follow-up, except for infants' behavior. Interventions for children/adolescents resulted in significant small effects for global psychopathology (ES = 0.13), as well as internalizing symptoms (ES = 0.17), and increased significantly over time, with externalizing symptoms reaching significance in the follow-up assessments as well (ES = 0.17). Interventions addressing parents and children jointly produced overall larger effects. Higher study quality was associated with smaller effects. There is a dearth of high quality studies that effectively reduce the high risk of COPMI for the development of mental disorders.
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Abstract
This article looks at both nutrition and early childhood stimulation interventions as part of an integrated life cycle approach to development. We build on recent systematic reviews of child development, which are comprehensive in regard to what is currently known about outcomes reported in key studies. We then focus particularly on implementation, scaling, and economic returns, drawing mainly on experience in low- and middle-income countries where undernutrition and poor child development remain significant public health challenges with implications across the life course.
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Affiliation(s)
- Harold Alderman
- International Food Policy Research Institute, Washington, DC 20006;
| | - Lia Fernald
- Community Health Sciences, School of Public Health, University of California, Berkeley, California 94720;
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24
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Potharst ES, Aktar E, Rexwinkel M, Rigterink M, Bögels SM. Mindful with Your Baby: Feasibility, Acceptability, and Effects of a Mindful Parenting Group Training for Mothers and Their Babies in a Mental Health Context. Mindfulness (N Y) 2017; 8:1236-1250. [PMID: 28989548 PMCID: PMC5605590 DOI: 10.1007/s12671-017-0699-9] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Many mothers experience difficulties after the birth of a baby. Mindful parenting may have benefits for mothers and babies, because it can help mothers regulate stress, and be more attentive towards themselves and their babies, which may have positive effects on their responsivity. This study examined the effectiveness of Mindful with your baby, an 8-week mindful parenting group training for mothers with their babies. The presence of the babies provides on-the-spot practicing opportunities and facilitates generalization of what is learned. Forty-four mothers with their babies (0-18 months), who were referred to a mental health clinic because of elevated stress or mental health problems of the mother, infant (regulation) problems, or mother-infant interaction problems, participated in 10 groups, each comprising of three to six mother-baby dyads. Questionnaires were administered at pretest, posttest, 8-week follow-up, and 1-year follow-up. Dropout rate was 7%. At posttest, 8-week follow-up, and 1-year follow-up, a significant improvement was seen in mindfulness, self-compassion, mindful parenting, (medium to large effects), as well as in well-being, psychopathology, parental confidence, responsivity, and hostility (small to large effects). Parental stress and parental affection only improved at the first and second follow-ups, respectively (small to medium effects), and maternal attention and rejection did not change. The infants improved in their positive affectivity (medium effect) but not in other aspects of their temperament. Mindful with your baby is a promising intervention for mothers with babies who are referred to mental health care because of elevated stress or mental health problems, infant (regulation) problems, or mother-infant interaction problems.
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Affiliation(s)
- Eva S. Potharst
- UvA Minds, Academic Outpatient (Child and Adolescent) Treatment Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Evin Aktar
- Research Institute of Child Development and Education, University of Amsterdam, Nieuwe Achtergracht 127, WS 1018 Amsterdam, The Netherlands
- Clinical Psychology Unit, Leiden University, Leiden, The Netherlands
| | - Marja Rexwinkel
- Infant Mental Health Center OuderKindLijn, Amsterdam, The Netherlands
- Medical Pedagogical Center ‘t Kabouterhuis, Amsterdam, The Netherlands
| | - Margo Rigterink
- Infant Mental Health Center OuderKindLijn, Amsterdam, The Netherlands
- Medical Pedagogical Center ‘t Kabouterhuis, Amsterdam, The Netherlands
| | - Susan M. Bögels
- UvA Minds, Academic Outpatient (Child and Adolescent) Treatment Center, University of Amsterdam, Amsterdam, The Netherlands
- Research Institute of Child Development and Education, University of Amsterdam, Nieuwe Achtergracht 127, WS 1018 Amsterdam, The Netherlands
- Research Priority Area Yield, University of Amsterdam, Amsterdam, The Netherlands
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25
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Edwards RC, Hans SL. Prenatal Depressive Symptoms and Toddler Behavior Problems: The Role of Maternal Sensitivity and Child Sex. Child Psychiatry Hum Dev 2016; 47:696-707. [PMID: 26521260 DOI: 10.1007/s10578-015-0603-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Increasing evidence suggests that maternal depression during pregnancy is associated with child behavioral outcomes even after accounting for later maternal depression. The purpose of this study was to examine various mechanisms, including maternal sensitivity, neonatal problems, and concurrent maternal depression, that might explain the association between prenatal maternal depressive symptoms and toddler behavior problems. Young, low income, African American mothers (n = 196) were interviewed during pregnancy and at 24-months postpartum, medical records were collected at the birth, and mother-child interactions were video-recorded at 24 months. Path analyses revealed that the association between prenatal depression and toddler behavior problems was mediated by maternal sensitivity and maternal depressive symptoms at 24 months. No evidence was found for a mediating effect of neonatal problems. Path models examining sex differences suggested that different mediating factors may be important for boys and girls, with boys being particularly susceptible to the effects of maternal sensitivity.
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Affiliation(s)
- Renee C Edwards
- School of Social Service Administration, The University of Chicago, 969 E. 60th Street, Chicago, IL, 60637, USA.
| | - Sydney L Hans
- School of Social Service Administration, The University of Chicago, 969 E. 60th Street, Chicago, IL, 60637, USA
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26
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Barlow J, Schrader-McMillan A, Axford N, Wrigley Z, Sonthalia S, Wilkinson T, Rawsthorn M, Toft A, Coad J. Review: Attachment and attachment-related outcomes in preschool children - a review of recent evidence. Child Adolesc Ment Health 2016; 21:11-20. [PMID: 32680362 DOI: 10.1111/camh.12138] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/30/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Secure attachment is associated with optimal outcomes across all domains in childhood, and both insecure and disorganised attachment are associated with a range of later psychopathologies. Insecure and disorganised attachment are common, particularly in disadvantaged populations, pointing to the need to identify effective methods of addressing such problems. AIMS This paper presents the findings of a review of secondary and primary studies evaluating the effectiveness of interventions aimed at improving attachment and attachment-related outcomes on a universal, targeted or indicated basis, which was undertaken as part of an update of the evidence base for a UK-based national programme targeting children aged 0-5 years (Healthy Child Programme). METHOD A systematic search of key electronic databases was undertaken to identify secondary and primary sources of data that addressed the research question and that had been published between 2008 and 2014; search sources included Cochrane Collaboration, NICE, EPPI Centre, Campbell Collaboration and PubMed, PsychInfo, CINAHL databases. FINDINGS Six systematic reviews and 11 randomised controlled trials were identified that had evaluated the effectiveness of universal, selective or indicated interventions aimed at improving attachment and attachment-related outcomes in children aged 0-5 years. Potentially effective methods of improving infant attachment include parent-infant psychotherapy, video feedback and mentalisation-based programmes. Methods that appear to be effective in improving attachment-related outcomes include home visiting and parenting programmes. CONCLUSIONS A number of methods of working to promote attachment and attachment-related outcomes in preschool children are now being recommended as part of the Healthy Child Programme. The implications in terms of the role and contribution of practitioners working in child and adolescent mental health service are discussed.
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Affiliation(s)
- Jane Barlow
- Health Services Research Unit, Warwick Medical School, University of Warwick, Medical School Building, Gibbet Hill Road, Coventry, CV4 7AL, UK
| | - Anita Schrader-McMillan
- Health Services Research Unit, Warwick Medical School, University of Warwick, Medical School Building, Gibbet Hill Road, Coventry, CV4 7AL, UK
| | | | | | | | | | | | - Alex Toft
- Centre for Children and Families Applied Research (CCFAR), Coventry University, Coventry, UK
| | - Jane Coad
- Centre for Children and Families Applied Research (CCFAR), Coventry University, Coventry, UK
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Brockington I. Emotional Rejection of the Infant: Status of the Concept. Psychopathology 2016; 49:247-260. [PMID: 27583348 DOI: 10.1159/000448334] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 07/11/2016] [Indexed: 11/19/2022]
Abstract
Emotional rejection of the infant is a morbid, clinical phenomenon, central to mother-infant psychiatry. It occurs in about 1% of births in the general population, but much more often in mothers referred to specialist services. It has severe consequences for children, but responds well to treatment. It is now better recognized, but research is required, especially cohort studies and neuroscientific investigations.
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Affiliation(s)
- Ian Brockington
- Professor Emeritus, University of Birmingham, Birmingham, UK
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Christiansen H, Anding J, Schrott B, Röhrle B. Children of mentally ill parents-a pilot study of a group intervention program. Front Psychol 2015; 6:1494. [PMID: 26539129 PMCID: PMC4611090 DOI: 10.3389/fpsyg.2015.01494] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 09/16/2015] [Indexed: 11/30/2022] Open
Abstract
Objective: The transgenerational transmission of mental disorders is one of the most prominent risk factors for the development of psychological disorders. Children of mentally ill parents are a vulnerable high risk group with overall impaired development and high rates of psychological disorders. To date there are only a few evidence based intervention programs for this group overall and hardly any in Germany. We translated the evidence based Family Talk Intervention by Beardslee (2009) and adapted it for groups. First results of this pilot study are presented. Method: This investigation evaluates a preventive group intervention for children of mentally ill parents. In a quasi-experimental design three groups are compared: an intervention group (Family Talk Intervention group: n = 28), a Wait Control group (n = 9), and a control group of healthy children (n = 40). Mean age of children was 10.41 years and parental disorders were mostly depressive/affective disorders (n = 30), but a small number also presented with Attention-Deficit/Hyperactivity Disorder (n = 7). Results: Children of mentally ill parents showed higher rates of internalizing/externalizing disorders before and after the intervention compared to children of parents with no disorders. Post intervention children's knowledge on mental disorders was significantly enhanced in the Family Talk Intervention group compared to the Wait Control group and the healthy control group. Parental ratings of externalizing symptoms in the children were reduced to normal levels after the intervention in the Family Talk Intervention group, but not in the Wait Control group. Discussion: This pilot study of a group intervention for children of mentally ill parents highlights the importance of psycho-education on parental mental disorders for children. Long-term effects of children's enhanced knowledge about parental psychopathology need to be explored in future studies.
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Affiliation(s)
- Hanna Christiansen
- Department of Psychology, Clinical Child and Adolescent Psychology, Philipps-University Marburg Marburg, Germany
| | - Jana Anding
- Department of Psychology, Clinical Child and Adolescent Psychology, Philipps-University Marburg Marburg, Germany
| | - Bastian Schrott
- Department of Child and Adolescent Psychiatry and Psychotherapy, Philipps-University Marburg Marburg, Germany
| | - Bernd Röhrle
- Department of Psychology, Clinical Child and Adolescent Psychology, Philipps-University Marburg Marburg, Germany
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Goodman JH, Prager J, Goldstein R, Freeman M. Perinatal Dyadic Psychotherapy for postpartum depression: a randomized controlled pilot trial. Arch Womens Ment Health 2015; 18:493-506. [PMID: 25522664 PMCID: PMC4439372 DOI: 10.1007/s00737-014-0483-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 12/03/2014] [Indexed: 01/16/2023]
Abstract
An integrated approach addressing maternal depression and associated mother-infant relationship dysfunction may improve outcomes. This study tested Perinatal Dyadic Psychotherapy (PDP), a dual-focused mother-infant intervention to prevent/decrease maternal postpartum depression and improve aspects of the mother-infant relationship related to child development. Women recruited from hospital postpartum units were screened using a three-stage process. Forty-two depressed first-time mothers and their 6-week-old infants were enrolled and randomized to receive the PDP intervention or usual care plus depression monitoring by phone. The intervention consisted of eight home-based, nurse-delivered mother-infant sessions consisting of (a) supportive, relationship-based, mother-infant psychotherapy, and (b) a developmentally based infant-oriented component focused on promoting positive mother-infant interactions. Data collected at baseline, post-intervention, and three-month follow-up included measures of maternal depression, anxiety, maternal self-esteem, parenting stress, and mother-infant interaction. Depression and anxiety symptoms and diagnoses decreased significantly, and maternal self-esteem increased significantly across the study time frame with no between-group differences. There were no significant differences between groups on parenting stress or mother-infant interaction at post-intervention and follow-up. No participants developed onset of postpartum depression during the course of the study. PDP holds potential for treating depression in the context of the mother-infant relationship; however, usual care plus depression monitoring showed equal benefit. Further research is needed to explore using low-intensity interventions as a first step in a stepped care approach and to determine what subset of at-risk or depressed postpartum mothers might benefit most from the PDP intervention.
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Affiliation(s)
- Janice H. Goodman
- MGH Institute of Health Professions, School of Nursing, 36 1 Ave, Boston, MA 02129, Phone: 617-726-0862, Fax: 617-724-6321
| | - Joanna Prager
- MGH Institute of Health Professions, School of Nursing, Boston, MA
| | - Richard Goldstein
- Spaulding Rehabilitation Hospital, Department of Physical Medicine and Rehabilitation, Boston, MA
| | - Marlene Freeman
- Massachusetts General Hospital Harvard Medical School Boston, MA
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Dimidjian S, Goodman SH, Felder JN, Gallop R, Brown AP, Beck A. An open trial of mindfulness-based cognitive therapy for the prevention of perinatal depressive relapse/recurrence. Arch Womens Ment Health 2015; 18:85-94. [PMID: 25298253 DOI: 10.1007/s00737-014-0468-x] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Accepted: 09/23/2014] [Indexed: 10/24/2022]
Abstract
Pregnant women with histories of depression are at high risk of depressive relapse/recurrence during the perinatal period, and options for relapse/recurrence prevention are limited. Mindfulness-based cognitive therapy (MBCT) has strong evidence among general populations but has not been studied among at-risk pregnant women to prevent depression. We examined the feasibility, acceptability, and clinical outcomes of depression symptom severity and relapse/recurrence associated with MBCT adapted for perinatal women (MBCT-PD). Pregnant women with depression histories were recruited from obstetrics clinics in a large health maintenance organization at two sites and enrolled in MBCT-PD (N = 49). Self-reported depressive symptoms and interview-based assessments of depression relapse/recurrence status were measured at baseline, during MBCT-PD, and through 6-months postpartum. Pregnant women reported interest, engagement, and satisfaction with the program. Retention rates were high, as were rates of completion of daily homework practices. Intent to treat analyses indicated a significant improvement in depression symptom levels and an 18 % rate of relapse/recurrence through 6 months postpartum. MBCT-PD shows promise as an acceptable, feasible, and clinically beneficial brief psychosocial prevention option for pregnant women with histories of depression. Randomized controlled trials are needed to examine the efficacy of MBCT-PD for the prevention of depressive relapse/recurrence during pregnancy and postpartum.
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Affiliation(s)
- Sona Dimidjian
- Department of Psychology and Neuroscience, University of Colorado Boulder, 345 UCB Muenzinger, Boulder, CO, 80309-0345, USA,
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Stein A, Pearson RM, Goodman SH, Rapa E, Rahman A, McCallum M, Howard LM, Pariante CM. Effects of perinatal mental disorders on the fetus and child. Lancet 2014; 384:1800-19. [PMID: 25455250 DOI: 10.1016/s0140-6736(14)61277-0] [Citation(s) in RCA: 1275] [Impact Index Per Article: 127.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Perinatal mental disorders are associated with increased risk of psychological and developmental disturbances in children. However, these disturbances are not inevitable. In this Series paper, we summarise evidence for associations between parental disorders and offspring outcomes from fetal development to adolescence in high-income, middle-income, and low-income countries. We assess evidence for mechanisms underlying transmission of disturbance, the role of mediating variables (underlying links between parent psychopathology and offspring outcomes) and possible moderators (which change the strength of any association), and focus on factors that are potentially modifiable, including parenting quality, social (including partner) and material support, and duration of the parental disorder. We review research of interventions, which are mostly about maternal depression, and emphasise the need to both treat the parent's disorder and help with associated caregiving difficulties. We conclude with policy implications and underline the need for early identification of those parents at high risk and for more early interventions and prevention research, especially in socioeconomically disadvantaged populations and low-income countries.
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Affiliation(s)
- Alan Stein
- Section of Child and Adolescent Psychiatry, Department of Psychiatry, University of Oxford, Oxford, UK; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
| | - Rebecca M Pearson
- Section of Child and Adolescent Psychiatry, Department of Psychiatry, University of Oxford, Oxford, UK; Elizabeth Blackwell Institute for Health Research, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | | | - Elizabeth Rapa
- Section of Child and Adolescent Psychiatry, Department of Psychiatry, University of Oxford, Oxford, UK
| | - Atif Rahman
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | | | - Louise M Howard
- Health Service and Population Research Department, Institute of Psychiatry, King's College London, UK
| | - Carmine M Pariante
- Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, UK
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Mortensen JA, Mastergeorge AM. A META-ANALYTIC REVIEW OF RELATIONSHIP-BASED INTERVENTIONS FOR LOW-INCOME FAMILIES WITH INFANTS AND TODDLERS: FACILITATING SUPPORTIVE PARENT-CHILD INTERACTIONS. Infant Ment Health J 2014; 35:336-53. [DOI: 10.1002/imhj.21451] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Horowitz JA, Murphy CA, Gregory K, Wojcik J, Pulcini J, Solon L. Nurse home visits improve maternal/infant interaction and decrease severity of postpartum depression. J Obstet Gynecol Neonatal Nurs 2014; 42:287-300. [PMID: 23682696 DOI: 10.1111/1552-6909.12038] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To test the efficacy of the relationship-focused behavioral coaching intervention Communicating and Relating Effectively (CARE) in increasing maternal/infant relational effectiveness between depressed mothers and their infants during the first 9 months postpartum. DESIGN Randomized clinical trial (RCT) with three phases. METHODS In this three-phase study, women were screened for postpartum depression (PPD) in Phase I at 6 weeks postpartum. In Phase II, women were randomly assigned to treatment or control conditions and maternal/infant interaction was video recorded at four intervals postpartum: 6 weeks, 3 months, 6 months, and 9 months. Phase III involved focus group and individual interviews with study participants. SETTING Phase I mothers were recruited from obstetric units of two major medical centers. Phase II involved the RCT, a series of nurse-led home visits beginning at 6 weeks and ending at 9 months postpartum. Phase III focus groups were conducted at the university and personal interviews were conducted by telephone or in participants' homes. PARTICIPANTS Postpartum mother/infant dyads (134) representative of southeastern New England, United States participated in the RCT. One hundred and twenty-five mother/infant dyads were fully retained in the 9-month protocol. RESULTS Treatment and control groups had significant increases in quality of mother/infant interaction and decreases in depression severity. Qualitative findings indicated presence of the nurse, empathic listening, focused attention and self-reflection during data collection, directions for video-recorded interaction, and assistance with referrals likely contributed to improvements for both groups. CONCLUSIONS Efficacy of the CARE intervention was only partially supported. Nurse attention given to the control group and the data collection process likely confounded results and constituted an unintentional treatment. Results suggest that nurse-led home visits had a positive effect on outcomes for all participants.
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Affiliation(s)
- June Andrews Horowitz
- Boston College, W. F. Connell School of Nursing, 140 Commonwealth Avenue, Chestnut Hill, MA 02467, USA.
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Bennett C, Underdown A, Barlow J. Massage for promoting mental and physical health in typically developing infants under the age of six months. Cochrane Database Syst Rev 2013; 2013:CD005038. [PMID: 23633323 PMCID: PMC8078453 DOI: 10.1002/14651858.cd005038.pub3] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Infant massage is increasingly being used in the community with babies and their primary caregivers. Anecdotal reports suggest benefits for sleep, respiration and elimination, the reduction of colic and wind, and improved growth. Infant massage is also thought to reduce infant stress and promote positive parent-infant interaction. OBJECTIVES The aim of this review was to assess whether infant massage is effective in promoting infant physical and mental health in low-risk, population samples. SEARCH METHODS Relevant studies were identified by searching the following electronic databases up to June 2011: CENTRAL; MEDLINE; EMBASE; CINAHL; PsycINFO; Maternity and Infant Care; LILACS; WorldCat (dissertations); ClinicalTrials.gov; China Masters' Theses; China Academic Journals; China Doctoral Dissertations; China Proceedings of Conference. We also searched the reference lists of relevant studies and reviews. SELECTION CRITERIA We included studies that randomised healthy parent-infant dyads (where the infant was under the age of six months) to an infant massage group or a 'no-treatment' control group. Studies had to have used a standardised outcome measure of infant mental or physical development. DATA COLLECTION AND ANALYSIS Mean differences (MD) and standardised mean differences (SMD) and 95% confidence intervals (CIs) are presented. Where appropriate, the results have been combined in a meta-analysis using a random-effects model. MAIN RESULTS We included 34 studies, which includes one that was a follow-up study and 20 that were rated as being at high risk of bias.We conducted 14 meta-analyses assessing physical outcomes post-intervention. Nine meta-analyses showed significant findings favouring the intervention group for weight (MD -965.25 g; 95% CI -1360.52 to -569.98), length (MD -1.30 cm; 95% CI -1.60 to -1.00), head circumference (MD -0.81 cm; 95% CI -1.18 to -0.45), arm circumference (MD -0.47 cm; 95% CI -0.80 to -0.13), leg circumference (MD -0.31 cm; 95% CI -0.49 to -0.13), 24-hour sleep duration (MD -0.91 hr; 95% CI -1.51 to -0.30), time spent crying/fussing (MD -0.36; 95% CI -0.52 to -0.19), deceased levels of blood bilirubin (MD -38.11 mmol/L; 95% CI -50.61 to -25.61), and there were fewer cases of diarrhoea, RR 0.39; 95% CI 0.20 to 0.76). Non-significant results were obtained for cortisol levels, mean increase in duration of night sleep, mean increase in 24-hour sleep and for number of cases of upper respiratory tract disease and anaemia.Sensitivity analyses were conducted for weight, length and head circumference, and only the finding for length remained significant following removal of studies judged to be at high risk of bias. These three outcomes were the only ones that could also be meta-analysed at follow-up; although both weight and head circumference continued to be significant at 6-month follow-up, these findings were obtained from studies conducted in Eastern countries only. No sensitivity analyses were possible.We conducted 18 meta-analyses measuring aspects of mental health and development. A significant effect favouring the intervention group was found for gross motor skills (SMD -0.44; 95% CI -0.70 to -0.18), fine motor skills (SMD -0.61; 95% CI -0.87 to -0.35), personal and social behaviour (SMD -0.90; 95% CI -1.61 to -0.18) and psychomotor development (SMD -0.35; 95% CI -0.54 to -0.15); although the first three findings were obtained from only two studies, one of which was rated as being at high risk of bias, and the finding for psychomotor development was not maintained following following removal of studies judged to be at high risk of bias in a sensitivity analysis. No significant differences were found for a range of aspects of infant temperament, parent-infant interaction and mental development. Only parent-infant interaction could be meta-analysed at follow-up, and the result was again not significant. AUTHORS' CONCLUSIONS These findings do not currently support the use of infant massage with low-risk groups of parents and infants. Available evidence is of poor quality, and many studies do not address the biological plausibility of the outcomes being measured, or the mechanisms by which change might be achieved. Future research should focus on the impact of infant massage in higher-risk groups (for example, demographically and socially deprived parent-infant dyads), where there may be more potential for change.
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Affiliation(s)
- Cathy Bennett
- Plymouth University Peninsula Schools of Medicine and DentistryThe John Bull Building, Tamar Science Park, Research WayPlymouthUKPL6 8BU
| | - Angela Underdown
- Warwick Medical SchoolDivision of Mental Health and WellbeingUniversity of WarwickGibbett Hill RoadCoventryUKCV4 7AL
| | - Jane Barlow
- Warwick Medical SchoolDivision of Mental Health and WellbeingUniversity of WarwickGibbett Hill RoadCoventryUKCV4 7AL
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Brown LF, Pickler R. A guided feeding intervention for mothers of preterm infants: two case studies. J SPEC PEDIATR NURS 2013; 18:98-108. [PMID: 23560581 DOI: 10.1111/jspn.12020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Accepted: 12/09/2012] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of this study was to determine how mothers of preterm infants perceive the feasibility and acceptability of a guided feeding intervention. DESIGN AND METHODS In this multiple case study design, feasibility was assessed by retention of participants through all intervention sessions. Acceptability was assessed with a semi-structured interview. RESULTS Participants found the intervention useful for demonstrating and explaining behaviors that facilitate feeding, and helpful in dispelling previous, erroneous understandings about infant behaviors. PRACTICE IMPLICATIONS The results are encouraging. The intervention was found to be both feasible and acceptable. The effectiveness of this intervention needs to be assessed in a randomized controlled trial.
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Affiliation(s)
- Lisa F Brown
- School of Nursing, Virginia Commonwealth University, Richmond, VA, USA.
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Pearson RM, Melotti R, Heron J, Joinson C, Stein A, Ramchandani PG, Evans J. Disruption to the development of maternal responsiveness? The impact of prenatal depression on mother-infant interactions. Infant Behav Dev 2012; 35:613-26. [PMID: 22982260 DOI: 10.1016/j.infbeh.2012.07.020] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Revised: 06/11/2012] [Accepted: 07/31/2012] [Indexed: 10/27/2022]
Abstract
Both prenatal and postnatal maternal depression are independently associated with an increased risk of adverse infant development. The impact of postnatal depression on infants may be mediated through the effect of depression in reducing maternal responsiveness. However, the mechanisms underlying the effect of prenatal depression are unclear. Using longitudinal data from over 900 mother-infant pairs in a UK birth cohort (ALSPAC), we found that women with high depressive symptom scores during mid pregnancy, but NOT when their infants were 8 months, had a 30% increased risk of low maternal responsiveness when the infant was 12 months compared to women with consistently low depression. This may provide a mechanism to explain the independent association between prenatal depression and poorer infant development.
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Affiliation(s)
- R M Pearson
- School of Social & Community Medicine, University of Bristol, Oakfield House, Oakfield Grove, Clifton, Bristol BS8 2BN, United Kingdom.
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Rishel CW. Pathways to prevention for children of depressed mothers: a review of the literature and recommendations for practice. DEPRESSION RESEARCH AND TREATMENT 2012; 2012:313689. [PMID: 22454768 PMCID: PMC3290810 DOI: 10.1155/2012/313689] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Revised: 10/07/2011] [Accepted: 10/24/2011] [Indexed: 11/18/2022]
Abstract
Maternal depression is one of the most well-documented risk factors for child and adolescent depression, but little work has focused on how to reduce this risk. Although a few interventions have been developed and tested, implementing targeted prevention efforts with depressed mothers and their children is not common practice. The increased risk of depression for children of depressed mothers is so clear, however, professionals can no longer "sit on the sidelines" without initiating specific prevention efforts with this population. To do so requires a paradigm shift-moving from a focus on individual treatment to a prevention approach that engages the entire family as the unit of care. The purpose of this paper is to draw on existing literature to highlight potential "pathways to prevention" for children of depressed mothers. Recommendations for initiating these pathways based on family lifecycle stage, point of contact, and service setting are presented and discussed.
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Affiliation(s)
- Carrie W. Rishel
- Division of Social Work, West Virginia University, P.O. Box 6830, Morgantown, WV 26506, USA
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