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Kvestad I, Ulak M, Ranjitkar S, Shrestha M, Chandyo RK, Guedeney A, Braarud HC, Hysing M, Strand TA. Social withdrawal behaviour in Nepalese infants and the relationship with future neurodevelopment; a longitudinal cohort study. BMC Pediatr 2024; 24:195. [PMID: 38500052 PMCID: PMC10946118 DOI: 10.1186/s12887-024-04658-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 02/21/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Social withdrawal in infants may be a signal of distress and a precursor for non-optimal development. OBJECTIVE To examine the relationship between infant social withdrawal and neurodevelopment up to 4 years in Nepalese children. METHODS A total of 597 Nepalese infants 6-11 months old were assessed with the modified Alarm Distress Baby Scale (m-ADBB), and of these, 527 with the Bayley Scales of Infant and Toddler Development 3rd edition (Bayley-III) during early childhood, and the Wechsler Preschool and Primary Scale of Intelligence (WPPSI-IV) and NEPSY-II subtests at 4 years. We examined whether social withdrawal defined by the m-ADBB was associated with neurodevelopmental scores in regression models. RESULTS Children socially withdrawn in infancy had lower Bayley-III language scores (-2.6 (95% CI -4.5, -0.7)) in early childhood. This association seems to be driven by the expressive communication subscale (-0.7 (95% CI -1.0, -0.3)), but not the receptive communication subscale (-0.2 (95% CI -0.6, 0.1)). There were no differences in the other Bayley-III scores or the WPPSI-IV and NEPSY-II scores at 4 years in children who were socially withdrawn or not. CONCLUSION Social withdrawal in infancy was reflected in early language development but not cognitive functioning at 4 years.
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Affiliation(s)
- Ingrid Kvestad
- Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre, Bergen, Norway
- Department of Research, Innlandet Hospital Trust, Lillehammer, Norway
| | - Manjeswori Ulak
- Centre for International Health, University of Bergen, Bergen, Norway
- Department of Pediatrics, Institute of Medicine, Child Health Research Project, Tribhuvan University, Kathmandu, Nepal
| | - Suman Ranjitkar
- Department of Pediatrics, Institute of Medicine, Child Health Research Project, Tribhuvan University, Kathmandu, Nepal
| | - Merina Shrestha
- Department of Pediatrics, Institute of Medicine, Child Health Research Project, Tribhuvan University, Kathmandu, Nepal
| | - Ram K Chandyo
- Department of Community Medicine, Kathmandu Medical College, Kathmandu, Nepal
| | | | - Hanne C Braarud
- Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre, Bergen, Norway
| | - Mari Hysing
- Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Tor A Strand
- Department of Research, Innlandet Hospital Trust, Lillehammer, Norway.
- Centre for International Health, University of Bergen, Bergen, Norway.
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Okitundu-Luwa D, Imbula Essam B, Sombo Ayanne MT, Ndjukendi Omba A, Otete Djamba F, Kayembe Kalula T, Kamanga Mbuyi T, Guedeney A, Kashala-Abotnes E. Sustained social withdrawal behavior and 'difficult' temperament among infants, in relation to maternal affectivity in a low-income area of Kinshasa, Democratic Republic of Congo. Eur Child Adolesc Psychiatry 2023; 32:427-437. [PMID: 34536147 DOI: 10.1007/s00787-021-01873-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 09/08/2021] [Indexed: 10/20/2022]
Abstract
Little is known about the relationship between maternal affectivity, social withdrawal and temperament in infants in low-income countries. The goal of the study was to assess the prevalence of social withdrawal behavior in infants aged 8 ± 2.3 months and to explore associations between maternal affectivity during pregnancy and postpartum, infant social withdrawal (as a sign of stress) and 'difficult' temperament as assessed by the mothers. 458 mother-infant dyads were recruited in the city's public mother and child health-care centers. The eight items of the Alarm Distress Baby scale (8-ADBB) and the five-item M (modified) ADBB (M-ADBB) were used to assess sustained withdrawal behavior (ISSWB). The Goldberg Depression and Anxiety Scales were used to assess maternal affectivity and mental well-being. A specially designed questionnaire was used to identify stressful events faced by the mother during pregnancy. The ELDEQ-QCB was used to assess the degree of difficulty in managing the baby. Using the M-ADBB, we found a striking figure of 69.2% for ISSWB with 8-ABB (range 0-29) and 72.7% with the M-ADBB (range 0-10). ISSWB was linked to negative maternal affectivity and to high incidence of stressful events for the mothers, and to the child being viewed as 'difficult' by the mother. Positive prenatal affectivity was a protective factor of ISSWB (OR 0.46). Results are compared with previous studies in Africa. Early screening for ISSWB and identification of factors affecting maternal mental well-being could help in early intervention and increase the chances of better child development.
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Affiliation(s)
- Daniel Okitundu-Luwa
- Unités de Neurologie Pédiatrique et de Neuropsychologie, Département de Neurologie, Centre Neuro Psycho Pathologique du Mont-Amba, Faculté de Médecine, Université de Kinshasa, B.P.825, Kinshasa, Democratic Republic of the Congo.
| | - Brigitte Imbula Essam
- Service de Psychiatrie Femme et Enfants, Département de psychiatrie, Centre Neuro Psycho Pathologique du Mont-Amba, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Marie-Thérèse Sombo Ayanne
- Unité de Neuropsychologie, Département de Neurologie, Centre Neuro Psycho Pathologique du Mont-Amba, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Ally Ndjukendi Omba
- Service de Psychiatrie Femme et Enfants, Département de psychiatrie, Centre Neuro Psycho Pathologique du Mont-Amba, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Franck Otete Djamba
- Médecin Chargé de la Recherche et la Documentation Scientifique à la Fondation pour la Promotion et la Protection de la sante mentale de l'enfant «FOPPROSAME Asbl», Kinshasa, Democratic Republic of the Congo
| | - Tharcisse Kayembe Kalula
- Service de Neurodiagnostic, Département de Neurologie, Centre Neuro Psycho Pathologique du Mont-Amba, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Timothée Kamanga Mbuyi
- Département de Psychologie Clinique, Faculté de Psychologie et Sciences de l'Education Département et, Consultant au Département de Neurologie, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Antoine Guedeney
- Service de Psychiatrie de l'enfant et de l'adolescent, Hôpital Bichat, APHP, Paris et Université de Paris, Paris, France
| | - Espérance Kashala-Abotnes
- Department of Global Public Health and Primary Care, Centre for International Health, University of Bergen, Bergen, Norway
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Prevalence of and factors associated with postnatal depression and anxiety among parents of preterm infants: A systematic review and meta-analysis. J Affect Disord 2023; 322:235-248. [PMID: 36400151 DOI: 10.1016/j.jad.2022.11.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 09/24/2022] [Accepted: 11/06/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND This study aimed to determine the prevalence of and factors associated with postpartum depression and anxiety among mothers and fathers of preterm infants and to examine the relationships between maternal and paternal symptoms. METHODS Six electronic databases were searched to identify eligible studies reporting parental depression and anxiety within 1 year postpartum. Data were extracted for a random-effects meta-analysis to estimate the prevalence with 95 % confidence intervals (CIs). Subgroup and meta-regression analyses were conducted to analyze associations between study characteristics and prevalence estimates. RESULTS In total, 79 studies were included. The meta-analysis of studies on mothers generated estimates of prevalence for depression (29.2 %, 95 % CI, 21.8 %-37.9 %) and anxiety (37.7 %, 95 % CI, 24.1 %-53.6 %). The meta-analysis of fathers indicated a pooled depression prevalence of 17.4 % (95 % CI, 12.5 %-23.8 %) and an anxiety estimate of 18.3 % (95 % CI, 8.1 %-36.3 %). Assessment time points and methods as well as the geographic continent in which the study was conducted were significant moderators of depression and anxiety. Significant inter-correlations were found between mothers' and fathers' depression and anxiety symptoms (p < 0.05). LIMITATIONS Limited data from specific geographic continents, including Africa and Asia. CONCLUSIONS Prevalence of depression and anxiety among preterm infants' parents was high, highlighting the need for early psychological screening and assessment. Further research is required to improve services that focus on parents' postpartum psychological needs in the family context.
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Stuart AC, Stougård M, Smith‐Nielsen J, Egmose I, Guedeney A, Væver MS. Associations between symptoms of maternal postpartum depression, gestational age and infant social withdrawal: A longitudinal study in a community cohort. BRITISH JOURNAL OF DEVELOPMENTAL PSYCHOLOGY 2022; 40:371-383. [PMID: 35485876 PMCID: PMC9545777 DOI: 10.1111/bjdp.12414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 04/01/2022] [Accepted: 04/04/2022] [Indexed: 11/29/2022]
Abstract
Infant social withdrawal is a risk factor for non-optimal child development; thus, it is important to identify risk factors associated with withdrawal. In a large community sample (N = 19,017), we investigate whether symptoms of maternal and partner postpartum depression (PPD; measured with the Edinburgh Postnatal Depression Scale) and prematurity are predictors of infant social withdrawal (measured with the Alarm Distress Baby Scale). Withdrawal was assessed at 2-3, 4-7 and 8-12 months postpartum. Linear regressions showed that prematurity predicted higher infant social withdrawal at all time points, and maternal symptoms of PPD were positively associated with withdrawal at 2-3 months. Logistic regressions showed that odds for elevated social withdrawal were increased with elevated levels of maternal symptoms of PPD at 2-3 and 8-12 months. Partner's symptoms of PPD were not associated with withdrawal. Future studies should investigate how PPD symptoms and prematurity may impact the individual development of social withdrawal.
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Affiliation(s)
| | - Maria Stougård
- Department of PsychologyUniversity of CopenhagenCopenhagenDenmark
| | | | - Ida Egmose
- Department of PsychologyUniversity of CopenhagenCopenhagenDenmark
| | - Antoine Guedeney
- Université de Paris et Hôpital Bichat Claude Bernard APHPParisFrance
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Assal-Zrike S, Marks K, Atzaba-Poria N. Maternal Postpartum Emotional Distress and Preterm Social Withdrawal in the Bedouin Culture. Res Child Adolesc Psychopathol 2022; 50:907-918. [PMID: 35098419 DOI: 10.1007/s10802-021-00894-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2021] [Indexed: 10/19/2022]
Abstract
This study aimed to test a serial mediation model proposing that prematurity would be related to changes in maternal emotional distress, which in turn would be related to the mother-child (M-C) interaction, which would ultimately be related to infant social withdrawal. Bedouin mothers and their preterm (n = 48) and full-term (n = 57) infants participated in this study. Mothers' mean age was 27.67 years. In addition, 39.4% of the mothers were primiparas and 60.6% were multiparas. Infants and their mothers were recruited shortly after birth (T1) in the maternity ward or Neonatal Intensive Care Unit (NICU) at Soroka Medical Center and were followed up at ages 6 months (T2) and 12 months (T3). Findings indicated that HIGHER levels of maternal emotional distress during the second half of the first year postpartum and LOWER levels of mother-child interaction, were associated with HIGHER levels of infant social withdrawal at T3. Furthermore, the overall indirect effect suggested that HIGHER levels of maternal nonhostility was a main variable mediating the link between prematurity and LOW levels of infant social withdrawal. Our findings provide evidence that changes in maternal emotional distress during the first year are related to lower infant social withdrawal. Moreover, mothers of premature infants showed higher levels of nonhostility when interacting with their premature infants. These findings highlight the importance of gaining a better understanding of maternal behaviors. Specifically, our study provides important information for researchers and clinicians on a possible mechanism leading to early socioemotional difficulties of premature infants.
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Affiliation(s)
- Shuaa Assal-Zrike
- DUET Center and Department of Psychology, Ben-Gurion University of the Negev, Beer Sheva, Israel.
| | - Kyla Marks
- The Faculty of Health Sciences, Soroka University Medical Center, Beer Sheva, Israel
| | - Naama Atzaba-Poria
- DUET Center and Department of Psychology, Ben-Gurion University of the Negev, Beer Sheva, Israel
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6
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Pérez Martínez C, Grollemund B, Gavelle P, Viaux-Savelon S, Guedeney A. The Prevalence of Social Withdrawal in Infants With Cleft Lip and Palate: The Feasibility of the Full and the Modified Versions of the Alarm Distress Baby Scale. Front Pediatr 2022; 10:804802. [PMID: 35874558 PMCID: PMC9301039 DOI: 10.3389/fped.2022.804802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 06/09/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Social withdrawal is a risk indicator for infant development with both organic and non-organic causes. Cleft lip and palate (CLP) impose a higher risk of physical and emotional distress in infants and alters parent-infant relationships. The ADBB scale is a screening tool to identify social withdrawal as a sign of distress in infants. The aim of this study is to evaluate the prevalence of social withdrawal behavior in infants with CLP using the full 8-item ADBB scale and the modified 5-item ADBB scale, and to examine the feasibility of both scales. METHODS 145 infants with Cleft Lip and Palate were enrolled and video recorded during a pediatric consultation. All infants were scored by two expert raters trained in ADBB scale, and subsequently scored with the m-ADBB by an independent expert. We measured the interrater agreement for the full ADBB scale and psychometric properties of both scales. RESULTS The full ADBB scale identified 15.9% of infants as having social withdrawal behavior (score above cutoff ≥5). Among the infants evaluated with the m-ADBB scale, 44.9% had a score above the suggested cutoff (≥2). For both scales, the item "vocalization" showed the higher scores. We found a good internal consistency for the full ADBB (Cronbach's alpha = 0.82) and an acceptable internal consistency for the modified ADBB (Cronbach's alpha = 0.71). The interrater agreement for the full ADBB scale was excellent (kappa = 0.837). The Spearman correlation coefficient between the total scores of the two versions was 0.88 (P < 0.001). CONCLUSION Our results indicate a relatively high prevalence of social withdrawal in infants with Cleft Lip and Palate, especially evaluated with the modified 5-item ADBB scale. We found that the full ADBB and the modified ADBB scales are feasible to use as screening tools of social withdrawal in this population. CLINICAL TRIAL REGISTRATION This trial is registered on ClinicalTrials.gov, identifier: NCT00993993. The data is the property of Assistance Publique, Hôpitaux de Paris.
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Affiliation(s)
| | - Bruno Grollemund
- Department of Dental-Facial Orthopedia, Pole of Bucco Dentaries' Medicine and Surgery, Cleft Competence Center, Strasbourg University Hospital, Strasbourg, France
| | - Pascale Gavelle
- Department of Maxillofacial Surgery and Plastic Hôpital Necker Enfants Malades, Paris, France
| | - Sylvie Viaux-Savelon
- Department of Neonatology an Obstetric, University Lyon 1 and University Hospital Croix Rousse, Hospices Civils de Lyon (HCL), Lyon, France
| | - Antoine Guedeney
- Department of Child and Adolescent Psychiatry, Université de Paris and Bichat Claude Bernard Assistance Publique - Hôpitaux de Paris (APHP) Hôpital, Paris, France
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7
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Bustamante Loyola J, Pérez Retamal M, Mendiburo-Seguel A, Guedeney AC, Salinas González R, Muñoz L, Cox Melane H, González Mas JM, Simó Teufel S, Morgues Nudman M. The Impact of an Interactive Guidance Intervention on Sustained Social Withdrawal in Preterm Infants in Chile: Randomized Controlled Trial. Front Pediatr 2022; 10:803932. [PMID: 35433551 PMCID: PMC9008748 DOI: 10.3389/fped.2022.803932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 02/23/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Sustained social withdrawal is a key indicator of child emotional distress and a risk factor for psychological development. Preterm infants have a higher probability of developing sustained social withdrawal than infants born full-term during their first year. OBJECTIVE To compare the effect of a behavioral guidance intervention to that of routine pediatric care on sustained social withdrawal behavior in preterm infants. DESIGN Multicenter randomized clinical trial. PARTICIPANTS Ninety nine moderate and late preterm newborns and their parents were recruited and randomized into two groups, i.e., Intervention (n = 49) and Control (n = 50). Both groups attended medical check-ups at 2, 6 and 12 months and were assessed with the Alarm Distress Baby Scale. The intervention group received a standardized behavioral intervention if the neonatologist detected sustained social withdrawal. Also, parents filled out the Edinburgh Postnatal Depression Scale, the modified-Perinatal Posttraumatic Stress Disorder Questionnaire, and the Impact of Event Scale-revised. RESULTS At baseline, the prevalence of withdrawal was 4.0% (95% CI: 0.03-14.2) for the control group and 22.4% (95% CI: 13.0-35.9) for the intervention group [OR = 0.22, p = 0.028 (95% CI =0.06-0.84)]. At 6 months, the prevalence was 10.0% (95% CI: 3.9-21.8) for the control group and 6.1% (95% CI: 2.1-16.5) for the intervention group [OR = 2.09, p = 0.318 (95% CI = 0.49-8.88)]. At 12 months, the prevalence was 22.0% (95% CI: 12.8-35.2) for the control group and 4.1% (95% CI: 1.1-13.7) for the intervention group [OR = 6.63, p = 0.018 (95% CI = 1.39-31.71)]. Logistic generalized estimating equation models were performed. The pooled crude OR (considering diagnosis at 6 and 12 months) was 3.54 [p = 0.022 (95% CI = 1.20-10.44); Cohen's d= 0.70]. In the case of pooled adjusted OR, the model considered diagnosis (0 = Withdrawal, 1 = Normal) as the dependent variable, time of evaluation (1= 6 months, 2 = 12 months) and group (0 = Control, 1 = Experimental) as factors. In this case, the pooled adjusted OR was 3.57 [p = 0.022 (95% CI = 1.20-10.65); Cohen's d = 0.70]. CONCLUSION Assessment and intervention of sustained social withdrawal in preterm infants via standardized instruments benefits families by reducing its prevalence, and possible associated negative outcomes. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov; https://clinicaltrials.gov/ct2/show/NCT03212547, identifier: NCT03212547.
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Affiliation(s)
- Jorge Bustamante Loyola
- Clínica Alemana, Universidad del Desarrollo, Santiago, Chile.,Doctoral Programme in Clinical and Health Psychology, University of Valencia, Valencia, Spain.,Association for Infant Mental Health From Pregnancy (ASMI-WAIMH), Valencia, Spain
| | | | | | - Antoine Claude Guedeney
- Paris 7, Université Paris Diderot, Paris, France.,Hospital Bichat Claude Bernard, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | | | | | | | - Sandra Simó Teufel
- Doctoral Programme in Clinical and Health Psychology, University of Valencia, Valencia, Spain
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8
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Egmose I, Smith-Nielsen J, Lange T, Stougaard M, Stuart AC, Guedeney A, Væver MS. How to screen for social withdrawal in primary care: An evaluation of the alarm distress baby scale using item response theory. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2021. [DOI: 10.1016/j.ijnsa.2021.100038] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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9
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Ulak M, Ranjitkar S, Shrestha M, Braarud HC, Chandyo RK, Shrestha L, Guedeney A, Strand TA, Kvestad I. The Feasibility of the Full and Modified Versions of the Alarm Distress Baby Scale (ADBB) and the Prevalence of Social Withdrawal in Infants in Nepal. Front Psychol 2020; 11:2025. [PMID: 32982842 PMCID: PMC7479187 DOI: 10.3389/fpsyg.2020.02025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 07/21/2020] [Indexed: 02/06/2023] Open
Abstract
Background Sustained social withdrawal in infancy may have organic and nonorganic causes and could hinder normal development. The Alarm Distress Baby (ADBB) scale is a widely validated screening tool of social withdrawal in children 2–24 months. The aim of the current study was to evaluate the full and modified ADBB in Nepalese infants in a community-based study. Methods We enrolled 600 infants who were video recorded during a pediatric examination. The 36 infants first enrolled were scored by an expert rater, and the subsequent 64 infants were scored by two trained staff with the full ADBB scale. Of the 600 enrolled infants, 597 videos (including the 100 infants scored with the full ADBB) were scored with the modified ADBB (m-ADBB) scale by the trained staff, with 7% double scoring. We measured the interrater agreement and psychometric properties of both scales. Results In the 64 infants scored with the full ADBB by two raters, the concordance correlation coefficients (CCCs) indicated poor interrater agreement. For the m-ADBB, the CCCs were better indicating acceptable agreement between raters. The greatest lower bound (GLB) for reliability coefficient for the full ADBB scored by an expert rater indicated good internal consistency, whereas the GLB coefficient for the m-ADBB indicated poorer internal consistency. The Spearman correlation coefficient between the total scores of the two versions was 0.82 (P < 0.001). Among the infants scored with the full ADBB, 25% had a score above cutoff (≥5). Scored with the m-ADBB in the full sample, 11.4% of the infants had a score above the suggested cutoff (≥2). In both versions, children achieved high scores on vocalization. Conclusion Our findings suggest that the m-ADBB is an acceptable approach to achieve adequate interrater agreement in a large community-based study in Nepal. Results indicate high prevalence of social withdrawal in this population. There are, however, uncertainties on the internal consistency of the scales in this setting, and the validity of the scales needs to be investigated further. More effective training strategies for administration and additional cultural-specific instructions could be important measures to explore before implementing the scale further in this setting.
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Affiliation(s)
- Manjeswori Ulak
- Child Health Research Project, Department of Pediatrics, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Suman Ranjitkar
- Child Health Research Project, Department of Pediatrics, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Merina Shrestha
- Child Health Research Project, Department of Pediatrics, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Hanne C Braarud
- Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre, Bergen, Norway
| | - Ram K Chandyo
- Department of Community Medicine, Kathmandu Medical College, Kathmandu, Nepal
| | - Laxman Shrestha
- Child Health Research Project, Department of Pediatrics, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Antoine Guedeney
- Department of Child and Adolescent Psychiatry, Hospital Bichat-Claude Bernard, Université de Paris, Paris, France
| | - Tor A Strand
- Centre for International Health, University of Bergen, Bergen, Norway.,Department of Research, Innlandet Hospital Trust, Lillehammer, Norway
| | - Ingrid Kvestad
- Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre, Bergen, Norway
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10
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Bustamante Loyola J, Perez Retamal M, Morgues Nudman MI, Maturana A, Salinas Gonzalez R, Cox H, González Mas JM, Muñoz L, Lopez L, Mendiburo-Seguel A, Simó S, Palau Subiela P, Guedeney A. Interactive Guidance Intervention to Address Sustained Social Withdrawal in Preterm Infants in Chile: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2020; 9:e17943. [PMID: 32589156 PMCID: PMC7394375 DOI: 10.2196/17943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 05/21/2020] [Accepted: 05/27/2020] [Indexed: 11/29/2022] Open
Abstract
Background Preterm newborns can be exposed early to significant perinatal stress, and this stress can increase the risk of altered socioemotional development. Sustained social withdrawal in infants is an early indicator of emotional distress which is expressed by low reactivity to the environment, and if persistent, is frequently associated with altered psychological development. Infants born prematurely have a higher probability of developing sustained social withdrawal (adjusted odds ratio 1.84, 95% CI 1.04-3.26) than infants born full term, and there is a correlation between weight at birth and sustained social withdrawal at 12 months of age. Objective The aims of this study are to compare the effect of the interactive guidance intervention to that of routine pediatric care on sustained social withdrawal in infants born moderately or late preterm and to explore the relationship between sustained social withdrawal in these infants and factors such as neonatal intensive care unit hospitalization variables, parental depression, and posttraumatic stress symptoms. Methods This study is designed as a multicenter randomized controlled trial. Moderate and late preterm newborns and their parents were recruited and randomized (1:1 allocation ratio) to control and experimental groups. During neonatal intensive care unit hospitalization, daily duration of skin-to-skin contact, breastfeeding, and parental visits were recorded. Also, a daily score for neonatal pain and painful invasive procedures were recorded. After discharge from neonatal intensive care, for the duration of the study, both groups will attend follow-up consultations with neonatologists at 2, 6, and 12 months of age (corrected for gestational age) and will receive routine pediatric care. Every consultation will be recorded and assessed with the Alarm Distress Baby Scale to detect sustained social withdrawal (indicated by a score of 5 or higher). The neonatologists will perform an interactive guidance intervention if an infant in the intervention group exhibits sustained social withdrawal. In each follow-up consultation, parents will fill out the Edinburgh Postnatal Depression Scale, the modified Perinatal Posttraumatic Stress Disorder Questionnaire, and the Impact of Event Scale–revised. Results Recruitment for this trial started in September 2017. As of May 2020, we have completed enrollment (N=110 infants born moderately or late preterm). We aim to publish the results by mid-2021. Conclusions This is the first randomized controlled trial with a sample of infants born moderately or late preterm infants who will attend pediatric follow-up consultations during their first year (corrected for gestational age at birth) with neonatologists trained in the Alarm Distress Baby Scale and who will receive this interactive guidance intervention. If successful, this early intervention will show significant potential to be implemented in both public and private health care, given its low cost of training staff and that the intervention takes place during routine pediatric follow-up. Trial Registration ClinicalTrials.gov NCT03212547; https://clinicaltrials.gov/ct2/show/NCT03212547. International Registered Report Identifier (IRRID) DERR1-10.2196/17943
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Affiliation(s)
- Jorge Bustamante Loyola
- Neonatology Unit, Clinica Alemana de Santiago, Santiago, Chile.,Doctoral Programme in Clinical and Health Psychology, Universitat de Valencia, Valencia, Spain.,Spain Association for Infant Mental Health Since Gestation, Valencia, Spain.,Neonatology Unit, Hospital San Jose, Santiago, Chile
| | | | | | - Andres Maturana
- Neonatology Unit, Clinica Alemana de Santiago, Santiago, Chile.,Faculty Development Office, Universidad del Desarrollo, Santiago, Chile
| | | | - Horacio Cox
- Neonatology Unit, Clinica Alemana de Santiago, Santiago, Chile
| | | | - Lucia Muñoz
- Neonatology Unit, Hospital San Jose, Santiago, Chile
| | - Lilian Lopez
- Neonatology Unit, Hospital San Jose, Santiago, Chile
| | | | - Sandra Simó
- Faculty of Psychology, Universitat de Valencia, Valencia, Spain
| | | | - Antoine Guedeney
- Hospital Bichat Claude Bernard, Assistance Publique-Hôpitaux de Paris, Paris, France.,Université Paris Diderot, Paris 7, Paris, France
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A Randomized Trial of Continuous Versus Intermittent Skin-to-Skin Contact After Premature Birth and the Effects on Mother-Infant Interaction. Adv Neonatal Care 2020; 20:E48-E56. [PMID: 31764209 DOI: 10.1097/anc.0000000000000675] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Premature birth affects opportunities for interaction between infants and mothers. Skin-to-skin contact (SSC) is standard care in neonatal care but has not been sufficiently studied regarding the effects on interaction between preterm infant and mothers. PURPOSE The purpose of this study was to compare interaction between preterm infants and their mothers after continuous versus intermittent SSC from birth to discharge. A secondary aim was to study a potential dose-response effect between time in SSC and quality of interaction. METHODS Families were randomly assigned to either continuous (n = 17) or intermittent (n = 14) SSC before delivery. Interaction was measured from videotapes of a Still-Face Paradigm collected at 4 months' corrected age. Face-to-face interaction was coded according to Ainsworth's Maternal Sensitivity Scales and the Maternal Sensitivity and Responsivity Scales-R. Dose-response correlations were calculated between mean time spent in SSC and each of the interaction scales. RESULTS There were no statistically significant differences between groups in maternal interactive behavior toward their infants regarding sensitivity, interference, availability, acceptance, withdrawal, or intrusivity. There was no correlation between mean time in SSC and quality of interaction. IMPLICATIONS FOR PRACTICE Continuous SSC from birth to discharge was not superior to intermittent SSC concerning mother-infant interaction between preterm infants and their mothers at 4 months' corrected age. However, compared with other studies, mean time in SSC was also high in the intermittent group. IMPLICATIONS FOR RESEARCH Further studies are needed to find out how interaction between parents and preterm infants can be improved, supported, and facilitated in the neonatal intensive care unit (NICU) and whether there is an optimal dose for SSC.
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Vaever MS, Pedersen IE, Smith-Nielsen J, Tharner A. Maternal postpartum depression is a risk factor for infant emotional variability at 4 months. Infant Ment Health J 2020; 41:477-494. [PMID: 32057136 DOI: 10.1002/imhj.21846] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Maternal postpartum depression (PPD) is a risk for disruption of mother-infant interaction. Infants of depressed mothers have been found to display less positive, more negative, and neutral affect. Other studies have found that infants of mothers with PPD inhibit both positive and negative affect. In a sample of 28 infants of mothers with PPD and 52 infants of nonclinical mothers, we examined the role of PPD diagnosis and symptoms for infants' emotional variability, measured as facial expressions, vocal protest, and gaze using microanalysis, during a mother-infant face-to-face interaction. PPD symptoms and diagnosis were associated with (a) infants displaying fewer high negative, but more neutral/interest facial affect events, and (b) fewer gaze off events. PPD diagnosis, but not symptoms, was associated with less infant vocal protest. Total duration of seconds of infant facial affective displays and gaze off was not related to PPD diagnosis or symptoms, suggesting that when infants of depressed mothers display high negative facial affect or gaze off, these expressions are more sustained, indicating lower infant ability to calm down and re-engage, interpreted as a disturbance in self-regulation. The findings highlight the importance of not only examining durations, but also frequencies, as the latter may inform infant emotional variability.
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Affiliation(s)
- Mette Skovgaard Vaever
- Center for Early Intervention and Family Studies, Department of Psychology, University of Copenhagen, Copenhagen K, Denmark
| | - Ida Egmose Pedersen
- Center for Early Intervention and Family Studies, Department of Psychology, University of Copenhagen, Copenhagen K, Denmark
| | - Johanne Smith-Nielsen
- Center for Early Intervention and Family Studies, Department of Psychology, University of Copenhagen, Copenhagen K, Denmark
| | - Anne Tharner
- Clinical Child and Family Studies, Faculty of Behavioural and Movement Sciences, Vrije Universitet Amsterdam, Amsterdam, the Netherlands
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de Paula Eduardo JAF, de Rezende MG, Menezes PR, Del-Ben CM. Preterm birth as a risk factor for postpartum depression: A systematic review and meta-analysis. J Affect Disord 2019; 259:392-403. [PMID: 31470184 DOI: 10.1016/j.jad.2019.08.069] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 08/15/2019] [Accepted: 08/19/2019] [Indexed: 01/26/2023]
Abstract
BACKGROUND This systematic review aimed to critically analyze the studies that explored preterm birth as risk factor for postpartum depression in the last 10 years. METHODS Two independent researchers performed a systematic review of indexed studies in PubMed/Medline, Web of Science and PsycInfo database. The PRISMA for reporting systematic review model was used to conduct data extraction. A meta-analysis was performed including a sub-group of studies. RESULTS The final sample consisted of 26 studies and 12 were included in the meta-analysis. Most of the studies supported the association between preterm birth (PTB) and postpartum depression (PPD). However, 8 studies did not find such association and, even among studies with positive findings, results were heterogeneous, given the methodological discrepancies among the studies. The meta-analysis provided evidence of higher risk for PPD among mothers of preterm infants in assessments performed up to 24 weeks after childbirth. LIMITATIONS Most of the studies did not consider the role of important confounding variables, such as previous history of depression. Heterogeneity of assessment tools and cut-off scores were also considered a limitation. CONCLUSIONS Further prospective population-based studies with an integrative approach of PPD are needed to provide consistent evidence of such association. Important confounding variables and biological measures implicated in PPD should be considered. Our findings highlight the importance of maternal mental health care in this target population, as preterm birth experience seem to affect both babies and mothers. We encourage PPD assessment for mothers of preterm infants, especially in the early postpartum period.
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Affiliation(s)
| | | | - Paulo Rossi Menezes
- Department of Preventive Medicine, Faculdade de Medicina, University of São Paulo, Brazil
| | - Cristina Marta Del-Ben
- Department of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, Brazil
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Mateus V, Osório A, Martins C. Effects of prematurity on infants' joint attention abilities: A meta‐analytic study. INFANT AND CHILD DEVELOPMENT 2019. [DOI: 10.1002/icd.2145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Vera Mateus
- School of Psychology, CIPsiUniversity of Minho Braga Portugal
| | - Ana Osório
- Social and Cognitive Neuroscience Lab, Developmental Disorders ProgramMackenzie Presbyterian University São Paulo Brazil
| | - Carla Martins
- School of Psychology, CIPsiUniversity of Minho Braga Portugal
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Re JM, Dean S, Mullaert J, Guedeney A, Menahem S. Maternal Distress and Infant Social Withdrawal (ADBB) Following Infant Cardiac Surgery for Congenital Heart Disease. World J Pediatr Congenit Heart Surg 2018; 9:624-637. [DOI: 10.1177/2150135118788788] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Mothers and infants are exposed to multiple stresses when cardiac surgery is required for the infant. This study reviewed infant responsiveness using a standardized objective observational measure of social withdrawal and explored its association with measures of maternal distress. Methods: Mother–infant pairs involving infants surviving early cardiac surgery were assessed when the infant was aged two months. Infant social withdrawal was measured using the Alarm Distress Baby Scale. Maternal distress was assessed using self-report measures for maternal depression (Edinburgh Postnatal Depression Scale), anxiety (Spielberger State-Trait Anxiety Scale), and parenting stress (Parenting Stress Index–Short Form). Potential associations between infant social withdrawal and maternal distress were evaluated. Results: High levels of maternal distress and infant social withdrawal were identified relative to community norms with a positive association. Such an association was not found between infant social withdrawal and the cardiac abnormality and surgery performed. Conclusion: The vulnerability of infants requiring cardiac surgery may be better understood when factors beyond their medical condition are considered. The findings suggested an association between maternal distress and infant social withdrawal, which may be consistent with mothers’ distress placing infants subjected to cardiac surgery at substantially increased risk of social withdrawal. However, it is unclear to what extent infant withdrawal may trigger maternal distress and what the interactive effects are. Further research is warranted. Trialing a mother–infant support program may be helpful in alleviating distress and improving the well-being and outcomes for these families.
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Affiliation(s)
- Jennifer M. Re
- Psychiatry Department, Monash University, Melbourne, Victoria, Australia
- Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
| | - Suzanne Dean
- Psychiatry Department, Monash University, Melbourne, Victoria, Australia
| | - Jimmy Mullaert
- Denis Diderot University, Paris, France
- Biostatistics, Epidemiology and Clinical Research Department, APHP, Paris, France
| | - Antoine Guedeney
- Denis Diderot University, Paris, France
- Department of Child and Adolescent Psychiatry, APHP, Paris, France
| | - Samuel Menahem
- Psychiatry Department, Monash University, Melbourne, Victoria, Australia
- Paediatric Cardiology Unit, Monash Medical Centre, Melbourne, Victoria, Australia
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Smith-Nielsen J, Lønfeldt N, Guedeney A, Væver MS. Implementation of the Alarm Distress Baby Scale as a universal screening instrument in primary care: feasibility, acceptability, and predictors of professionals' adherence to guidelines. Int J Nurs Stud 2017; 79:104-113. [PMID: 29223624 DOI: 10.1016/j.ijnurstu.2017.11.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 11/12/2017] [Accepted: 11/14/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Infant socioemotional development is often held under informal surveillance, but a formal screening program is needed to ensure systematic identification of developmental risk. Even when screening programs exist, they are often ineffective because health care professionals do not adhere to screening guidelines, resulting in low screening prevalence rates. OBJECTIVES To examine feasibility and acceptability of implementing universal screening for infant socioemotional problems with the Alarm Distress Baby Scale in primary care. The following questions were addressed: Is it possible to obtain acceptable screening prevalence rates within a 1-year period? How do the primary care workers (in this case, health visitors) experience using the instrument? Are attitudes toward using the instrument related to screening prevalence rates? DESIGN A longitudinal mixed-method study (surveys, data from the health visitors' digital filing system, and qualitative coding of answers to open-ended questions) was undertaken. SETTING AND PARTICIPANTS Health visitors in three of five districts of the City of Copenhagen, Denmark (N=79). METHODS We describe and evaluate the implementation process from the date the health visitors started the training on how to use the Alarm Distress Baby Scale to one year after they began using the instrument in practice. To monitor screening prevalence rates and adherence to guidelines, we used three data extractions (6, 9, and 12 months post-implementation) from the electronic filing system. Surveys including both quantitative and open-ended questions (pre- and post-implementation) were used to examine experiences with and attitudes towards the instrument. Descriptive and inferential statistical and qualitative content analyses were used. RESULTS Screening prevalence rates increased during the first year: Six months after implementation 47% (n=405) of the children had been screened; 12 months after implementation 79% (n=789) of the children were screened (the same child was not counted more than once). Most (92%) of the health visitors reported that the instrument made a positive contribution to their work. The majority (81%) also reported that it posed a challenge in their daily work at least to some degree. The health visitors' attitudes (positive and negative) toward the Alarm Distress Baby Scale, measured 7 months post-implementation, significantly predicted screening prevalence rates 12 months post-implementation. CONCLUSIONS Adding the Alarm Distress Baby Scale to an established surveillance program is feasible and accepTable Screening prevalence rates may be related to the primary care worker's attitude toward the instrument, i.e. successful implementation relies on an instrument that adds value to the work of the screener.
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Affiliation(s)
| | - Nicole Lønfeldt
- Child and Adolescent Mental Health Center, Mental Health Services, Denmark
| | - Antoine Guedeney
- Hospital Bichat Claude Bernard APHP, University Denis Diderot Paris, INSERM U 1178 CERP, France
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Væver MS, Smith-Nielsen J, Lange T. Copenhagen infant mental health project: study protocol for a randomized controlled trial comparing circle of security -parenting and care as usual as interventions targeting infant mental health risks. BMC Psychol 2016; 4:57. [PMID: 27876079 PMCID: PMC5120549 DOI: 10.1186/s40359-016-0166-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 11/10/2016] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Infant mental health is a significant public health issue as early adversity and exposure to early childhood stress are significant risk factors that may have detrimental long-term developmental consequences for the affected children. Negative outcomes are seen on a range of areas such as physical and mental health, educational and labor market success, social network and establishing of family. Secure attachment is associated with optimal outcomes in all developmental domains in childhood, and both insecure and disorganized attachment are associated with a range of later problems and psychopathologies. In disadvantaged populations insecure and disorganized attachment are common, which points to the need of identifying early risk and effective methods of addressing such problems. This protocol describes an experimental evaluation of an indicated group-based parental educational program, Circle of Security-Parenting (COS-P), currently being conducted in Denmark. METHODS/DESIGN In a parallel randomized controlled trial of two intervention groups this study tests the efficacy of COS-P compared to Care as Usual (CAU) in enhancing maternal sensitivity and child attachment in a community sample in the City of Copenhagen, Denmark. During the project a general population of an estimated 17.600 families with an infant aged 2-12 months are screened for two known infant mental health risks, maternal postnatal depression and infant social withdrawal. Eligible families (N = 314), who agree to participate, will be randomly allocated with a ratio of 2:1 into the COS-P intervention arm and into CAU. Data will be obtained at inclusion (baseline) and at follow-up when the child is 12-16 months. The primary outcome is maternal sensitivity. Secondary outcomes include quality of infant attachment, language, cognitive and socioemotional development, family functioning, parental stress, parental mentalizing and maternal mental wellbeing. DISCUSSION The potential implications of the experimental evaluation of an indicated brief group-based parenting educational program to enhance parental sensitivity and attachment are discussed. TRIAL REGISTRATION ClinicalTrials.govID: NCT02497677 . Registered July 15 2015.
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Affiliation(s)
- Mette Skovgaard Væver
- Department of Psychology, University of Copenhagen, Øster Farimagsgade 2A, 1353 Copenhagen K, Denmark
| | - Johanne Smith-Nielsen
- Department of Psychology, University of Copenhagen, Øster Farimagsgade 2A, 1353 Copenhagen K, Denmark
| | - Theis Lange
- Section of Biostatistics, University of Copenhagen, Øster Farimagsgade 5, 1014 Copenhagen K, Denmark
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Valla L, Wentzel-Larsen T, Smith L, Birkeland MS, Slinning K. Association between maternal postnatal depressive symptoms and infants' communication skills: A longitudinal study. Infant Behav Dev 2016; 45:83-90. [PMID: 27744111 DOI: 10.1016/j.infbeh.2016.10.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 10/03/2016] [Accepted: 10/05/2016] [Indexed: 01/01/2023]
Abstract
Postnatal depression (PND) is associated with adverse effects on a broad range of child outcomes, including language problems. The current study aimed to investigate if the time of exposure to maternal PND symptoms measured with the Edinburgh Postnatal Depression Scale (EPDS) at 6 weeks, 4 months and 6 months postpartum were related to the infants' communication skills measured with the Ages and Stages Questionnaires (ASQ) at 12 and 24 months. Secondly, to study to what extent the number of exposures to high level of PND symptoms (i.e., EPDS score≥10) might be associated with level of communication skills later (at 12 and 24 months), and last, to determine to what extent maternal PND symptoms at 6 weeks were related to changes in the developmental course of communication skills from 4 to 24 months. 1555 children and their mothers participate in the study. Regression analyses indicated that PND at 4 months were associated with lower levels of communicative skills at 12 (coefficient -0.37, 95% CI -0.63 to -0.12, p=0.004) and 24 months (coefficient -0.34, CI -0.56 to -0.13, p=0.002). Infants of mothers with an EPDS sum score≥10 obtained at a minimum of two time points, had significantly worse communicative skills at 12 months than infants of mothers with no indication of PND (difference -6.12, CI -11.14 to -1.09, p=0.017). No such significant relations were found at 24 months. However, linear mixed effects analysis showed that mothers' depressive symptoms at 6 weeks were not significantly related to changes in infant communication scores from age 4 to 24 months. These findings suggest that symptoms of maternal PND symptoms should be taken into account for communication development in infancy.
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Affiliation(s)
- Lisbeth Valla
- National Network for Infant Mental Health, Center for Child and Adolescent Mental Health, Oslo, Norway.
| | - Tore Wentzel-Larsen
- The Center for Child and Adolescent Mental Health, Oslo, Norway; Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
| | - Lars Smith
- Department of Psychology, University of Oslo, Oslo, Norway
| | | | - Kari Slinning
- National Network for Infant Mental Health, Center for Child and Adolescent Mental Health, Oslo, Norway; Department of Psychology, University of Oslo, Oslo, Norway
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Precursors of social emotional functioning among full-term and preterm infants at 12 months: Early infant withdrawal behavior and symptoms of maternal depression. Infant Behav Dev 2016; 44:159-68. [DOI: 10.1016/j.infbeh.2016.06.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 06/28/2016] [Accepted: 06/30/2016] [Indexed: 01/14/2023]
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Guedeney A, Forhan A, Larroque B, de Agostini M, Pingault JB, Heude B. Social Withdrawal Behaviour at One Year of Age Is Associated with Delays in Reaching Language Milestones in the EDEN Mother-Child Cohort Study. PLoS One 2016; 11:e0158426. [PMID: 27391482 PMCID: PMC4938506 DOI: 10.1371/journal.pone.0158426] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 06/15/2016] [Indexed: 11/18/2022] Open
Abstract
Objective The aim of the study was to examine the relationship between social withdrawal behaviour at one year and motor and language milestones. Materials and Methods One-year old children from the EDEN French population-based birth cohort study (Study on the pre- and postnatal determinants of the child’s development and prospective health Birth Cohort Study) were included. Social withdrawal at one year was assessed by trained midwives using the Alarm Distress BaBy (ADBB) scale. Midwives concurrently examined infants’ motor and language milestones. Parents reported on child’s psychomotor and language milestones, during the interview with the midwife. Results After adjusting for potential confounding factors, social withdrawal behaviour was significantly associated with concurrent delays in motor and language milestones assessed by the midwife or the parents. Discussion Higher scores on social withdrawal behaviour as assessed with the ADBB were associated with delays in reaching language milestones, and to a lesser extent with lower motor ability scores. Taking the contribution of social withdrawal behaviour into account may help understand the unfolding of developmental difficulties in children.
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Affiliation(s)
- Antoine Guedeney
- Univ Denis Diderot Paris - Cité & INSERM UMRS 1178, 94807, Villejuif, France
- * E-mail:
| | - Anne Forhan
- INSERM, UMR1153 Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), Early ORigin of the Child's Health and Development Team (ORCHAD), Paris Descartes University, Paris, F-75014, France
| | - Beatrice Larroque
- Epidemiology and Clinical Research Unit, Beaujon Hospital, Clichy, 92110, France
- Division of Psychology and Language Sciences, University College London, WC1E6BT, London, United Kingdom
| | - Maria de Agostini
- INSERM, UMR1153 Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), Early ORigin of the Child's Health and Development Team (ORCHAD), Paris Descartes University, Paris, F-75014, France
| | - Jean-Baptiste Pingault
- Division of Psychology and Language Sciences, University College London, WC1E6BT, London, United Kingdom
- King’s College London, MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, WC1E6BT, London, United Kingdom
| | - Barbara Heude
- INSERM, UMR1153 Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), Early ORigin of the Child's Health and Development Team (ORCHAD), Paris Descartes University, Paris, F-75014, France
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Family nurture intervention improves the quality of maternal caregiving in the neonatal intensive care unit: evidence from a randomized controlled trial. J Dev Behav Pediatr 2015; 36:188-96. [PMID: 25757070 DOI: 10.1097/dbp.0000000000000148] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE This study assessed the impact of Family Nurture Intervention (FNI) on the quality of maternal caregiving behavior (MCB) while in the neonatal intensive care unit (NICU). FNI is a randomized controlled trial conducted in a high-acuity NICU to facilitate an emotional connection between mothers and their premature infants. FNI begins shortly after birth, continues until discharge, and involves mother/infant calming sessions that include scent cloth exchange, vocal soothing and emotion expression, eye contact, skin-to-skin and clothed holding, and family-based support sessions. METHODS Maternal caregiving behavior was coded during a single holding and feeding session (∼30 min) in the NICU before discharge at approximately 36 weeks gestational age (GA). Sixty-five mothers and their premature infants (34 male, 31 female; 26-34 wk GA) were included in these analyses (FNI, n = 35; standard care [SC], n = 30). RESULTS Relative to mothers in the SC condition, those in the FNI group showed significantly higher quality MCB, which remained significant when controlling for birth order, twin status, maternal depression, and maternal anxiety. CONCLUSION This is the first study to demonstrate that in-unit MCB can be enhanced by a hospital-based intervention. FNI provides a new rationale for integrating nurture-based interventions into standard NICU care.
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Risk factors for postpartum depressive symptoms in low-income women with very low-birth-weight infants. Adv Neonatal Care 2015; 15:E3-8. [PMID: 25626986 DOI: 10.1097/anc.0000000000000131] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE This study examined factors associated with postpartum depressive symptoms in mothers with premature infants in the neonatal intensive care unit (NICU). SUBJECTS A total of 113 new mothers with very low-birth-weight infants in their initial NICU admission were recruited from 2 urban hospitals servicing low-income minority communities. DESIGN This study employed a cross-sectional design. METHODS Data were collected during the infants' postpartum NICU admission and included maternal demographic information (eg, age, education, race, living with the baby's father), infant illness severity (Neurobiologic Risk Score from infant's medical record), and maternal psychological measures (the Center for Epidemiologic Studies Depression Scale, the Perinatal Posttraumatic Stress Questionnaire, and the State-Trait Anxiety Inventory). RESULTS The findings indicated that 47 (42%) women had elevated postpartum depressive symptoms and 33 (30%) women had elevated postpartum posttraumatic stress symptoms (PTSs). Factors associated with postpartum depressive symptoms included PTS, anxiety, maternal age, and whether the mother lived with the baby's father (F₄, ₁₀₄ = 52.27, P < .001). The severity of the infants' illness, parental stress, and maternal education were not associated with depressive symptoms among low-income mothers of NICU infants. CONCLUSIONS On the basis of our findings, we recommend that low-income women should be screened for symptoms of anxiety, posttraumatic stress, and postpartum depression on their infants' admission to the NICU. When this is not feasible, we advise NICU healthcare providers to assess women for familial support, maternal age, posttraumatic stress related to their infants birth, and anxiety to determine which mothers are at the greatest risk for postpartum depressive symptoms. Screening for postpartum depression in the NICU can aid in early identification and treatment, thereby decreasing negative consequences for mothers and their infants.
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