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Fisher SD, Walsh T, Wongwai C. The importance of perinatal non-birthing parents' mental health and involvement for family health. Semin Perinatol 2024; 48:151950. [PMID: 39069440 DOI: 10.1016/j.semperi.2024.151950] [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] [Indexed: 07/30/2024]
Abstract
Perinatal mental health research typically focuses on the birthing parent's experiences and their influence on birth/child outcomes, while not considering non-birthing parents in similar depth. Non-birthing parents are also at increased risk for mental illness during the perinatal period, and non-birthing parents' health and involvement affect the health of birthing people, fetuses, and newborns, necessitating greater understanding of non-birthing parents' contributions to family functioning. This review examines perinatal mental health disorders in non-birthing parents, their relationship quality with the birthing parent, and how the non-birthing parent's mental health and involvement affects the health outcomes of the birthing parent and the child. Recommendations are provided for healthcare professionals who work with perinatal patients and their families to engage non-birthing parents, learn about non-birthing parent health, and facilitate connections to care. By doing so, professionals working with perinatal patients can optimize health outcomes for their patients and the family as a whole.
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Affiliation(s)
- Sheehan D Fisher
- Department of Psychiatry & Behavioral Sciences, Northwestern University, 676 North Saint Clair Street Arkes Pavilion, Chicago, IL 60611, USA.
| | - Tova Walsh
- Sandra Rosenbaum School of Social Work, University of Wisconsin-Madison, 1350 University Ave, Madison, WI 53706 USA
| | - Clare Wongwai
- Department of Psychiatry & Behavioral Sciences, Northwestern University, 676 North Saint Clair Street Arkes Pavilion, Chicago, IL 60611, USA
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Cheung PS, McCaffrey T, Tighe SM, Lowther T, Mohamad MM. Developing Music Therapy in Maternity Care in Ireland: A Qualitative Study. J Music Ther 2024:thae019. [PMID: 39293022 DOI: 10.1093/jmt/thae019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 04/23/2024] [Accepted: 08/22/2024] [Indexed: 09/20/2024]
Abstract
Music therapy can be a form of preventive or early intervention. It strengthens and utilizes women's own resources to build resilience, aids relaxation, reduces symptoms of anxiety and depression, promotes parent-infant attachment, and adapts to physical and psychological challenges during the perinatal period. The inclusion of music therapy in Irish maternity services has the potential to improve the quality of healthcare delivery provided to parents and infants. Recent studies demonstrate that the prospect of music therapy is welcomed by parents and perinatal healthcare professionals in Ireland, but such services are yet to be formally embedded in maternity care. Building on a cross-sectional survey, this qualitative study employed 6 semi-structured interviews with women and perinatal healthcare professionals in Ireland to understand their perspectives on developing music therapy in Irish maternity care services. Four themes were identified from the thematic analysis of these interviews: (1) music has multiple functions during the perinatal period; (2) music programs contribute to holistic perspectives and approachability in perinatal care; (3) music therapy provides specialist support; and (4) further development of music therapy services is challenging. The findings offer important insights and practical considerations on the key components of the music therapy programs and strategies in developing music therapy in Irish maternity settings. This information can directly inform music therapy researchers and practitioners in designing music therapy programs and developing relevant services in collaboration with maternity care professionals and policymakers.
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Affiliation(s)
- Pui Sze Cheung
- Irish World Academy of Music and Dance, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Ireland
- Specialist Perinatal Mental Health Team, University Maternity Hospital Limerick, Limerick, Ireland
| | - Triona McCaffrey
- Irish World Academy of Music and Dance, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Ireland
| | - Sylvia Murphy Tighe
- Health Research Institute, University of Limerick, Ireland
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Timothy Lowther
- Irish World Academy of Music and Dance, University of Limerick, Limerick, Ireland
| | - Mas Mahady Mohamad
- Specialist Perinatal Mental Health Team, University Maternity Hospital Limerick, Limerick, Ireland
- School of Medicine, University of Limerick, Limerick, Ireland
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3
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Golsäter M, Randell E, Engström M, Lucas S. Parents' perceptions of the safe environment for every kid (SEEK) model in the Swedish child health services. BMC Pediatr 2024; 24:581. [PMID: 39272002 PMCID: PMC11401304 DOI: 10.1186/s12887-024-05064-8] [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: 12/05/2023] [Accepted: 09/06/2024] [Indexed: 09/15/2024] Open
Abstract
BACKGROUND The Safe Environment for Every Kid (SEEK) model was developed to address psychosocial risk factors (financial worries, depressive symptoms, major parental stress, alcohol misuse and intimate partner violence) in the pediatric primary care setting but has not been evaluated from the parents' perspective. To further investigate the usefulness of SEEK, it is important to explore how parents perceive the model. OBJECTIVE The aim of the present study was to explore parents' perceptions of the SEEK model as a part of regular health visits in the Child Health Services in Sweden. PARTICIPANTS AND SETTING Eighteen parents (13 women and five men) in two Swedish counties participated in the study. METHODS Semi-structured telephone interviews were conducted, and the resulting data were analyzed using reflective thematic analysis. RESULTS Three themes were identified: Acceptance and understanding of the SEEK model in the child health services, The questionnaire as a bridge to a dialogue, and Feeling trust in the system and the child health nurse's professional competence. Further, an overarching theme was created that encompassed a core meaning of all three themes; SEEK provides a process-oriented framework to receive support in parenting with a focus on child health. CONCLUSIONS The study showed that parents express both acceptance and understanding of the SEEK model and they perceive that the model provides an avenue for repeated dialogues about the family's situation during the child's upbringing and an opportunity to access support if needed.
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Affiliation(s)
- Marie Golsäter
- Child Research Group, School of Health and Welfare, Jönköping University, Child Health Service and Futurum - Academy for Health and Care, Region Jönköping County, Jönköping, Jönköping, Sweden
| | - Eva Randell
- Department of Social work, Uppsala University, Uppsala, Sweden.
| | - Maria Engström
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Steven Lucas
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Attia Hussein Mahmoud H, Lakkimsetti M, Barroso Alverde MJ, Shukla PS, Nazeer AT, Shah S, Chougule Y, Nimawat A, Pradhan S. Impact of Paternal Postpartum Depression on Maternal and Infant Health: A Narrative Review of the Literature. Cureus 2024; 16:e66478. [PMID: 39246890 PMCID: PMC11380704 DOI: 10.7759/cureus.66478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2024] [Indexed: 09/10/2024] Open
Abstract
Postpartum depression (PPD) has been widely studied, assessed, and promptly intervened in new mothers. However, paternal postpartum depression gained attention not long ago. Postpartum depression in men could present over one year following the birth of the child, frequently presenting with symptoms like irritability, low mood, sleep disturbances, changes in appetite, fatigue, and loss of interest in everyday activities; amongst other symptoms of Major Depressive Disorder which may hinder them from taking care of themselves and the baby. Paternal PPD significantly impacts partner relationships causing maternal PPD, poor infant bonding, and therefore, affecting overall child development. The following narrative review is based on a literature search of articles published on paternal postnatal depression. The primary emphasis of this review has been to provide an overview of the current comprehension of paternal postpartum depression regarding prevalence, global incidence, and risk factors and to explore potential diagnostic tools for assessment and interventional strategies to treat this condition. Interestingly, pandemic-related stressors have been positively attributed to an increase in PPD prevalence post-pandemic. While more research is being conducted on this subject, research on the measurement characteristics of the diagnostic tools is highly recommended to implement well-defined criteria for early diagnosis of paternal PPD. The significant adverse consequences of PPD for not just the new mother, but also the infants, necessitate proper and timely diagnosis of PPD. Despite its severity, there have been no specific treatment modalities.
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Affiliation(s)
| | | | | | - Pranav S Shukla
- Medical School, Grant Medical College and Sir J.J. Group of Hospitals, Mumbai, IND
| | - Alviya T Nazeer
- Obstetrics and Gynaecology, Government Medical College and Hospital, Pudukkottai, IND
| | - Sukesh Shah
- Medical School, American University of Integrative Sciences, Bridgetown, BRB
| | | | - Amisha Nimawat
- Internal Medicine, Interfaith Medical Center, New York, USA
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Schöch P, Hölzle L, Lampe A, Hörtnagl C, Zechmeister-Koss I, Buchheim A, Paul JL. Towards effective screening for paternal perinatal mental illness: a meta-review of instruments and research gaps. Front Public Health 2024; 12:1393729. [PMID: 38983254 PMCID: PMC11231099 DOI: 10.3389/fpubh.2024.1393729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 06/04/2024] [Indexed: 07/11/2024] Open
Abstract
Background Paternal perinatal mental illness (PPMI), which affects around one in 10 fathers, is under-recognised despite increasing awareness of men's mental health in the perinatal period. Social stigma and men's reluctance to seek help exacerbate this gap. Neglecting the mental health needs of new fathers not only puts them at increased risk for mental illness themselves, but also has a profound and long-lasting impact on their families, children and their own self-esteem as they navigate their new role in the family dynamic. Objective This meta-review systematically identifies instruments assessing PPMI symptoms, evaluates their psychometric properties and applicability, presents key findings from studies using these tools, and identifies gaps and limitations in the literature on PPMI symptom assessment. Methods A systematic literature review was conducted using search strategies applied to PubMed, PsycNet APA, Cochrane, and Web of Science, supplemented by hand searches. Relevant information was extracted from each included study. Extracted data were analysed narratively to address the research questions. Results Findings identified limitations and gaps in current screening practices. While the Edinburgh Postnatal Depression Scale (EPDS) is the most widely used screening tool for both fathers and mothers, it inadequately captures atypical depressive symptoms in men. Cutoff scores lack consensus, and instrument sensitivity varies significantly due to cultural and sociodemographic factors. A number of other screening tools have been identified, most of which are more general and not specifically designed for perinatal mental health. Conclusion This meta-review broadens perspectives on PPMI screening instruments, highlighting key themes, patterns, and differences across the included reviews. While a variety of screening tools are used, the review underscores the necessity for tools specifically tailored to fathers during the perinatal period.
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Affiliation(s)
- Philipp Schöch
- Department of Psychiatry, Psychotherapy, Psychosomatics, and Medical Psychology, Division of Psychiatry I, Medical University Innsbruck, Innsbruck, Austria
- Department of Clinical Psychology II, Institute of Psychology, University Innsbruck, Innsbruck, Austria
| | - Laura Hölzle
- Department of Psychiatry, Psychotherapy, Psychosomatics, and Medical Psychology, Division of Psychiatry I, Medical University Innsbruck, Innsbruck, Austria
- Department of Clinical Psychology II, Institute of Psychology, University Innsbruck, Innsbruck, Austria
| | - Astrid Lampe
- Ludwig Boltzmann Institute for Rehabilitation Research, Vienna, Austria
| | - Christine Hörtnagl
- Department of Psychiatry, Psychotherapy, Psychosomatics, and Medical Psychology, Division of Psychiatry I, Medical University Innsbruck, Innsbruck, Austria
| | | | - Anna Buchheim
- Department of Clinical Psychology II, Institute of Psychology, University Innsbruck, Innsbruck, Austria
| | - Jean Lillian Paul
- Department of Psychiatry, Psychotherapy, Psychosomatics, and Medical Psychology, Division of Psychiatry I, Medical University Innsbruck, Innsbruck, Austria
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Ståhl A, Salonen M, Hakanen E, Mikkola S, Sulkama S, Lahti J, Lohi H. Development and validation of the puppy blues scale measuring temporary affective disturbance resembling baby blues. NPJ MENTAL HEALTH RESEARCH 2024; 3:27. [PMID: 38849543 PMCID: PMC11161525 DOI: 10.1038/s44184-024-00072-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 04/30/2024] [Indexed: 06/09/2024]
Abstract
It has been described that many puppy owners experience a state called puppy blues involving stress, worry, anxiety, strain, frustration, or regret. While puppy blues is a commonly used term among dog owners, the term is nearly nonexistent in scientific literature. In turn, analogous phenomenon, postpartum affective disturbance of infant caregivers, is well described in the literature. This study aimed to develop and validate the first questionnaire to evaluate puppy blues. The methodology involved generating scale items based on a qualitative review of 135 pilot survey responses from people who had experienced distress during the puppy period, conducting exploratory factor analysis for the final scale items from a dataset of 1801 answers from Finnish dog owners (92% women), and collecting test-retest data from 265 individuals to assess the consistency of the measurement of items and factor structure across time. In addition, we collected an independent sample of 326 owners of 1-2-year-old dogs who answered the survey both regarding puppy period and current moment. The results indicate that the scale is a valid and reliable tool for measuring dog owners' negative experiences and feelings related to puppyhood. We discovered three factors that describe different aspects of puppy blues: Frustration, Anxiety, and Weariness, which accounted for a significant proportion of the variance in puppy blues. The study demonstrated good internal consistency and consistency across two independent samples for the three identified factors. The test-retest reliability of the factors was good. Responses for the current timeframe compared to puppyhood experiences revealed significantly lower current scores across all factors for the current period, validating that the scale captures distress during puppyhood that diminishes over time. Interestingly, we found a fading affect bias where recollections of the experiences in the puppy period became more positive with time. Our findings shed light on the characteristics of puppy blues and provide a useful retrospective tool for measuring it.
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Affiliation(s)
- Aada Ståhl
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland.
- Department of Veterinary Biosciences, University of Helsinki, Helsinki, Finland.
- Department of Medical and Clinical Genetics, University of Helsinki, Helsinki, Finland.
- Folkhälsan Research Center, Helsinki, Finland.
| | - Milla Salonen
- Department of Veterinary Biosciences, University of Helsinki, Helsinki, Finland
- Department of Medical and Clinical Genetics, University of Helsinki, Helsinki, Finland
- Folkhälsan Research Center, Helsinki, Finland
- Department of Biology, University of Turku, Turku, Finland
| | - Emma Hakanen
- Department of Veterinary Biosciences, University of Helsinki, Helsinki, Finland
- Department of Medical and Clinical Genetics, University of Helsinki, Helsinki, Finland
- Folkhälsan Research Center, Helsinki, Finland
| | - Salla Mikkola
- Department of Veterinary Biosciences, University of Helsinki, Helsinki, Finland
- Department of Medical and Clinical Genetics, University of Helsinki, Helsinki, Finland
- Folkhälsan Research Center, Helsinki, Finland
| | - Sini Sulkama
- Department of Veterinary Biosciences, University of Helsinki, Helsinki, Finland
- Department of Medical and Clinical Genetics, University of Helsinki, Helsinki, Finland
- Folkhälsan Research Center, Helsinki, Finland
| | - Jari Lahti
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
- Folkhälsan Research Center, Helsinki, Finland
| | - Hannes Lohi
- Department of Veterinary Biosciences, University of Helsinki, Helsinki, Finland.
- Department of Medical and Clinical Genetics, University of Helsinki, Helsinki, Finland.
- Folkhälsan Research Center, Helsinki, Finland.
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Murray Cunningham S, McHugh Power J, Hyland P, Casey AM. Support for the Supporter: Paternal Postpartum Loneliness and Social Support During the COVID-19 Pandemic. Am J Mens Health 2024; 18:15579883241249921. [PMID: 38767285 PMCID: PMC11107328 DOI: 10.1177/15579883241249921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 04/05/2024] [Accepted: 04/09/2024] [Indexed: 05/22/2024] Open
Abstract
During the postpartum period, fathers may be at risk of increased stress and loneliness, which may be offset or buffered by the provision of social support. This study aimed to explore fathers' postpartum experiences of loneliness, perceived stress, and social support. A constructivist grounded theory approach was used to inform study design and analysis. Semistructured interviews were conducted to collect data from 12 fathers, living in the Republic of Ireland, who had an infant aged 6 months or younger. A grounded theory entitled "support for the supporter," describing fathers' experiences with social support, and loneliness during the postpartum period, was derived. Participants described experiencing increased financial pressure and having difficulty balancing the role of "breadwinner" with fatherhood. Participants described feeling excluded from maternity care and lacked avenues for information within the Irish health care system. Participants linked their experiences of loneliness to the lack of social support in the postpartum period. This study offers a novel insight into Irish fathers' experiences with maternity care during the COVID-19 pandemic. This study is the first to qualitatively explore paternal postpartum loneliness and provides a good foundation for future research and intervention in this area. Findings suggest that it would be wise to promote social support from other experienced fathers, friends, family, and from partners to reduce paternal postpartum loneliness.
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Jean-Dit-Pannel R, Belot RA, Mellier D, Robert L, Petersen C, Dinet B, Bréhat C, Koliouli F. Becoming a first-time father during the COVID-19 pandemic in France. Front Psychiatry 2024; 15:1376934. [PMID: 38690200 PMCID: PMC11060328 DOI: 10.3389/fpsyt.2024.1376934] [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: 01/26/2024] [Accepted: 03/28/2024] [Indexed: 05/02/2024] Open
Abstract
The role of fathers in Western societies has undergone significant change over time. However, their psychopathology remains largely misunderstood and difficult to identify. This study aims to explore the lived experiences of first-time fathers during the COVID-19 pandemic. Twenty-seven first-time French fathers were recruited for the study, which involved a narrative interview, the Rorschach projective test, the Edinburgh Postnatal Depression Scale (EPDS), and a semi-structured interview. Narrative interviews revealed several challenges faced by these fathers, including the pressure of paternal responsibility, the need to be actively involved in the prenatal activities and caregiving (haptonomy, skin-to-skin contact), and concerns about the future of their couple and family as a triad. The Rorschach tests showed numerous perinatal responses and difficulties in identifying phallic representations among the fathers. Additionally, the EPDS scores indicated that 15% of fathers showed signs of depression, while 52% exhibited signs of anxiety. This study also examines the impact of the COVID-19 pandemic and its associated health context on creating the initial triad. Lastly, the case of one father is presented to illustrate the need for diagnostic tools to address the psychopathology of fathers, as narrative or semi-structured interviews have often fallen short of addressing this issue.
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Affiliation(s)
- Romuald Jean-Dit-Pannel
- Psychology Department, Laboratory of Psychology, Faculty of Languages and Human Sciences, University of Strasbourg, Besançon, France
| | - Rose-Angélique Belot
- Psychology Department, Laboratory of Psychology, Faculty of Languages and Human Sciences, University of Strasbourg, Besançon, France
| | - Denis Mellier
- Psychology Department, Laboratory of Psychology, Faculty of Languages and Human Sciences, University of Strasbourg, Besançon, France
| | - Laura Robert
- Psychology Department, Laboratory of Psychology, Faculty of Languages and Human Sciences, University of Strasbourg, Besançon, France
| | - Célia Petersen
- Psychology Department, Laboratory of Psychology, Faculty of Languages and Human Sciences, University of Strasbourg, Besançon, France
| | - Benoît Dinet
- Department of Family Medicine, Laboratory of Psychology, Faculty of Health, University of Franche-Comté, Besançon, France
| | - Cécile Bréhat
- Psychology Department, Laboratory of Psychology, Faculty of Languages and Human Sciences, University of Strasbourg, Besançon, France
| | - Flora Koliouli
- School of Early Childhood Education, Faculty of Education, Laboratory Psyché, University of Thessaloniki, Thessaloniki, Greece
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Alvarez D, Adynski H, Harris R, Zou B, Taylor JY, Santos HP. Social Support Is Protective Against the Effects of Discrimination on Parental Mental Health Outcomes. J Am Psychiatr Nurses Assoc 2024:10783903241243092. [PMID: 38600825 DOI: 10.1177/10783903241243092] [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] [Indexed: 04/12/2024]
Abstract
BACKGROUND Discrimination, or unfair treatment based on individual characteristics such as gender, race, skin color, and or sexual orientation, is a pervasive social stressor that perpetuates health disparities by limiting social and economic opportunity and is associated with poor mental and physical health outcomes. AIMS The purpose of the present study is to (1) examine the association between maternal experiences of discrimination and paternal experiences of discrimination; (2) explore how discrimination relates to parental (maternal and paternal) stress and depressive symptoms; and (3) examine whether social support exerts protective effects. METHODS The sample was 2,510 mothers and 1,249 fathers from the Child Community Health Network study. Linear regression models were conducted to explore associations between maternal and paternal discrimination. In addition, mediation analyses were conducted to explore if social support functioned as a mediator between discrimination on parental stress and depressive symptoms. RESULTS Most mothers (40.3%) and fathers (50.7%) identified race as the predominant reason for discrimination. Experiencing discrimination was significantly related to stress and depressive symptoms for both parents, and all forms of social support mediated these relationships. Our findings suggest that social support can act as a protective factor against the negative association between discrimination and both stress and depressive symptoms. CONCLUSIONS These findings highlight the need to integrate social support into existing interventions and include fathers in mental health screenings in primary-care settings. Finally, we briefly describe the role of nurses and other allied health professionals in addressing discrimination in health care and health policy implications.
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Affiliation(s)
- Dallis Alvarez
- Dallis Alvarez, BSN, RN, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Harry Adynski
- Harry Adynski, PhD, RN, PMH-BC, University of California San Francisco, San Francisco, CA, USA
| | - Rebeca Harris
- Rebeca Harris BSN, RN, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Baiming Zou
- Baiming Zou, PhD, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jacquelyn Y Taylor
- Jacquelyn Y. Taylor, PhD, RN, FAHA, FAAN, Columbia University, New York, NY, USA
| | - Hudson P Santos
- Hudson P. Santos Jr, PhD, RN, FAAN, University of Miami, Coral Gables, FL, USA
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Walsh TB, Garfield CF. Perinatal Mental Health: Father Inclusion At The Local, State, And National Levels. Health Aff (Millwood) 2024; 43:590-596. [PMID: 38560802 DOI: 10.1377/hlthaff.2023.01459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Fathers occupy a dual role in the realm of perinatal mental health: partner and parent. In fathers' role as partners, their support for mothers during pregnancy and postpartum is associated with improved maternal mental health. In their role as parents, fathers themselves are vulnerable to perinatal mood and anxiety disorder. This article aims to advance awareness of paternal perinatal mental health issues and impacts on families. We first review the evidence on paternal perinatal mental health. This evidence includes the critical role played by fathers in maternal perinatal mental health, the prevalence of paternal perinatal mood and anxiety disorder, the impact of paternal mental health on child and family well-being, and screening and treatment approaches. Next, we offer recommendations for more inclusive approaches at the local, state, and national levels aimed at improving parental mental health and health outcomes for fathers, mothers, and babies.
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Affiliation(s)
- Tova B Walsh
- Tova B. Walsh , University of Wisconsin-Madison, Madison, Wisconsin
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Harris SA, Eapen V, Kohlhoff J. Implementing a National Navigation Service for Perinatal and Infant Mental Health: Early Learnings from the ForWhen Model. Community Ment Health J 2024; 60:581-588. [PMID: 37991577 DOI: 10.1007/s10597-023-01211-0] [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: 06/04/2023] [Accepted: 11/08/2023] [Indexed: 11/23/2023]
Abstract
ForWhen is an Australia-based national navigation service aimed at helping parents and carers navigate the perinatal mental health service landscape and connect them with appropriate support and clinical services. The current study forms part of a mixed-methods evaluation of the ForWhen program. Semi-structured interviews were conducted with ForWhen navigators during the early design and implementation phases of the service. Results were used to characterise the ForWhen navigator activities and responsibilities, identify navigator core competencies, and examine facilitators and barriers to successful implementation of a large-scale navigation program for perinatal and infant mental health. Further research will be crucial for evidencing the utility and potential of navigation models in addressing identified issues with access to treatment for perinatal and infant mental health issues.
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Affiliation(s)
- Sophia A Harris
- Discipline of Psychiatry & Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia
| | - Valsamma Eapen
- Discipline of Psychiatry & Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia
- Academic Unit of Infant, Child & Adolescent Psychiatry Services (AUCS), South Western Sydney Local Health District and Ingham Institute, Sydney, Australia
| | - Jane Kohlhoff
- Discipline of Psychiatry & Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia.
- , Karitane, Sydney, Australia.
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12
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Wynter K, Mansour KA, Forbes F, Macdonald JA. Barriers and opportunities for health service access among fathers: A review of empirical evidence. Health Promot J Austr 2024. [PMID: 38494641 DOI: 10.1002/hpja.846] [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: 12/07/2023] [Revised: 01/26/2024] [Accepted: 01/30/2024] [Indexed: 03/19/2024] Open
Abstract
ISSUE ADDRESSED Engagement with health supports benefits the whole family, yet few health services report successful engagement of fathers. Our aim was to describe available evidence on barriers and opportunities relevant to health system access for fathers. METHODS Scoping reviews were conducted seeking empirical evidence from (1) Australian studies and (2) international literature reviews. RESULTS A total of 52 Australian studies and 44 international reviews were included. The most commonly reported barriers were at the health service level, related to an exclusionary health service focus on mothers. These included both 'surface' factors (e.g., appointment times limited to traditional employment hours) and 'deep' factors, in which health service policies perpetuate traditional gender norms of mothers as 'caregivers' and fathers as 'supporters' or 'providers'. Such barriers were reported consistently, including but not limited to fathers from First Nations or culturally diverse backgrounds, those at risk of poor mental health, experiencing perinatal loss or other adverse pregnancy and birth events, and caring for children with illness, neurodevelopmental or behavioural problems. Opportunities for father engagement include offering father-specific resources and support, facilitating health professionals' confidence and training in working with fathers, and 'gateway consultations', including engaging fathers via appointments for mothers or infants. Ideally, top-down policies should support fathers as infant caregivers in a family-based approach. CONCLUSIONS Although barriers and opportunities exist at individual and cultural levels, health services hold the key to improved engagement of fathers. SO WHAT?: Evidence-based, innovative strategies, informed by fathers' needs and healthy masculinities, are needed to engage fathers in health services.
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Affiliation(s)
- Karen Wynter
- Department of Psychiatry, School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia
- School of Nursing and Midwifery, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Kayla A Mansour
- Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Faye Forbes
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jacqui A Macdonald
- Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Deakin University, Geelong, Victoria, Australia
- Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia
- Department of Paediatrics, Royal Children's Hospital, University of Melbourne, Melbourne, Victoria, Australia
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Gressier F, Glangeaud-Freudenthal NMC, Essadek A, Falissard B, Corruble E, Sutter-Dallay AL. Impact of paternal psychiatric disorders on parents-baby separation after mother-baby unit care. CHILD ABUSE & NEGLECT 2024; 149:106652. [PMID: 38277874 DOI: 10.1016/j.chiabu.2024.106652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 12/13/2023] [Accepted: 01/10/2024] [Indexed: 01/28/2024]
Abstract
BACKGROUND Paternal mental health may have an impact on parenthood especially in case of maternal postpartum severe psychiatric illness. OBJECTIVE The aim of this study was to search for an association between paternal psychiatric disorder and parents-baby separation after a maternal joint hospitalization for a severe postpartum psychiatric episode. PARTICIPANTS AND SETTINGS In an observational, naturalist and multicentric study, 787 fathers whose partner was hospitalized in a mother-baby unit were included. METHODS Fathers were assessed for psychiatric diagnoses associated with parents-baby separation. RESULTS 25 % of the fathers had a psychiatric disorder. 69 babies (8.77 %) were separated from their parents at the end of the joint hospitalization. In multivariate analysis, parents-baby separation was associated with a paternal diagnosis of addictive disorder (OR = 8.35, 95 % CI [3.45-30.30]) and psychotic disorder (OR = 5.76, 95 % CI [1.97-16.78]), independently from potential confounding variables including maternal psychiatric diagnosis. CONCLUSIONS This study shows the major impact of a paternal psychiatric disorder in the outcome of a joint hospitalization. A paternal mental illness should be systematically looked for in case of a severe maternal postpartum psychiatric episode, considering it is predictive of parenthood difficulties.
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Affiliation(s)
- Florence Gressier
- Department of Psychiatry, Bicêtre University Hospital, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Saclay, Le Kremlin Bicêtre, France; MOODS Team, CESP, U1018, Faculté de Médecine Paris-Saclay, Université Paris-Saclay, Le Kremlin-Bicêtre, France.
| | - Nine M C Glangeaud-Freudenthal
- INSERM Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Epidemiology and Biostatistics (U1153), Paris Descartes University, Paris, France
| | - Aziz Essadek
- Laboratoire INTERPSY, Université Lorraine, Nancy, France
| | - Bruno Falissard
- Department of Biostatistics, Maison de Solenn, Université Paris Saclay, UVSQ, CESP, Inserm U1018, Paris, France
| | - Emmanuelle Corruble
- Department of Psychiatry, Bicêtre University Hospital, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Saclay, Le Kremlin Bicêtre, France; MOODS Team, CESP, U1018, Faculté de Médecine Paris-Saclay, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Anne-Laure Sutter-Dallay
- University Department of Child and Adolescent Psychiatry, Charles-Perrens Hospital, Bordeaux, France; INSERM, Bordeaux Population Health Research Center, U 1219, Bordeaux University, Bordeaux, France
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Reay M, Mayers A, Knowles-Bevis R, Knight MTD. Understanding the Barriers Fathers Face to Seeking Help for Paternal Perinatal Depression: Comparing Fathers to Men Outside the Perinatal Period. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 21:16. [PMID: 38276804 PMCID: PMC10815257 DOI: 10.3390/ijerph21010016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/14/2023] [Accepted: 12/18/2023] [Indexed: 01/27/2024]
Abstract
Research has shown that men are less likely than women to seek help for depression at any time of life due to barriers, including stereotypical masculine norms and stigma. The evidence suggests that approximately 10% of fathers experience postnatal depression, yet new and expectant fathers are not routinely offered screening or support in the same way as mothers. Therefore, this research explored the barriers fathers face to seeking help for paternal perinatal depression (PPD). Data were collected using an online survey. Initially, fathers with postnatal depression were compared to men experiencing depression at another time of their life in terms of their attitudes to seeking psychological help, conformity to masculine norms, self-stigma, and awareness of services. Secondly, a proposed model of help-seeking amongst fathers with postnatal depression was evaluated. Finally, additional barriers to help-seeking for paternal postnatal depression were explored qualitatively. A total of 125 participants took part in the quantitative comparison, and 50 of the fathers also provided qualitative data. No between-group differences were found, suggesting that the existing literature on barriers to seeking help for male depression is applicable to fathers with postnatal depression. The qualitative results also highlighted the need for better awareness of paternal postnatal depression and better access to services for fathers. Limitations, implications for policy, and directions for future research are discussed.
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Affiliation(s)
- Megan Reay
- Oxford Health NHS Foundation Trust, The University of Oxford, Oxford OX4 4XN, UK; (R.K.-B.); (M.T.D.K.)
| | - Andrew Mayers
- Department of Psychology, Bournemouth University, Poole BH12 5BB, UK;
| | - Rebecca Knowles-Bevis
- Oxford Health NHS Foundation Trust, The University of Oxford, Oxford OX4 4XN, UK; (R.K.-B.); (M.T.D.K.)
| | - Matthew T. D. Knight
- Oxford Health NHS Foundation Trust, The University of Oxford, Oxford OX4 4XN, UK; (R.K.-B.); (M.T.D.K.)
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15
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Mattera JA, Campagna AX, Goodman SH, Gartstein MA, Hancock GR, Stowe ZN, Newport DJ, Knight BT. Associations between mothers' and fathers' depression and anxiety prior to birth and infant temperament trajectories over the first year of life: Evidence from diagnoses and symptom severity. J Affect Disord 2023; 343:31-41. [PMID: 37741466 PMCID: PMC10672733 DOI: 10.1016/j.jad.2023.09.023] [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: 04/22/2023] [Revised: 09/11/2023] [Accepted: 09/17/2023] [Indexed: 09/25/2023]
Abstract
BACKGROUND Developmental shifts in infant temperament predict distal outcomes including emerging symptoms of psychopathology in childhood. Thus, it is critical to gain insight into factors that shape these developmental shifts. Although parental depression and anxiety represent strong predictors of infant temperament in cross-sectional research, few studies have examined how these factors influence temperament trajectories across infancy. METHODS We used latent growth curve modeling to examine whether mothers' and fathers' anxiety and depression, measured in two ways - as diagnostic status and symptom severity - serve as unique predictors of developmental shifts in infant temperament from 3 to 12 months. Participants included mothers (N = 234) and a subset of fathers (N = 142). Prior to or during pregnancy, both parents were assessed for lifetime diagnoses of depression and anxiety as well as current severity levels. Mothers rated their infants' temperament at 3, 6, and 12 months of age. RESULTS Mothers' depression and anxiety primarily predicted initial levels of temperament at 3 months. Controlling for mothers' symptoms, fathers' depression and anxiety largely related to temperament trajectories across infancy. Lifetime diagnoses and symptom severities were associated with distinct patterns. LIMITATIONS Infant temperament was assessed using a parent-report measure. Including an observational measure would provide a more comprehensive picture of the infants' functioning. CONCLUSIONS These results indicate that mothers' and fathers' mental health are uniquely associated with infant temperament development when measured using diagnostic status and/or symptom severity. Future studies should examine whether these temperament trajectories mediate intergenerational transmission of risk for depression and anxiety.
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Affiliation(s)
| | | | | | - Maria A Gartstein
- Department of Psychology, Washington State University, Pullman, WA, USA
| | - Gregory R Hancock
- Department of Human Development and Quantitative Methodology, University of Maryland, College Park, MD, USA
| | - Zachary N Stowe
- Department of Psychiatry and Behavioral Sciences, University of Wisconsin at Madison, Madison, WI, USA
| | - D Jeffrey Newport
- Departments of Psychiatry & Behavioral Sciences and Women's Health, University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Bettina T Knight
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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16
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Lewkowitz AK, Rubin-Miller L, Jahnke HR, Clark MA, Zlotnick C, Miller ES, Henrich N. Demographic and Support Interest Differences Among Nonbirthing Parents Using a Digital Health Platform With Parenthood-Related Anxiety: Cross-Sectional Study. JMIR Pediatr Parent 2023; 6:e46152. [PMID: 37990826 PMCID: PMC10686614 DOI: 10.2196/46152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 10/11/2023] [Accepted: 10/16/2023] [Indexed: 11/23/2023] Open
Abstract
Background The transition to parenthood is a period of major stressors and increased risk of anxiety for all parents. Though rates of perinatal anxiety are similar among women (4%-25%) and men (3%-25%), perinatal anxiety research on nonbirthing partners remains limited. Objective We aimed to examine whether demographic characteristics or digital perinatal support preferences differed among nonbirthing partners with compared to without self-reported high parenthood-related anxiety. Methods In this large cross-sectional study of nonbirthing partners using a digital perinatal health platform during their partner's pregnancy, users reported their parenthood-related anxiety through a 5-item Likert scale in response to the prompt "On a scale of 1=None to 5=Extremely, how anxious are you feeling about parenthood?" High parenthood-related anxiety was defined as reporting being very or extremely anxious about parenthood. During the onboarding survey, in response to the question "Which areas are you most interested in receiving support in?" users selected as many support interests as they desired from a list of options. Chi-square and Fisher exact tests were used to compare demographic characteristics and support interests of nonbirthing partners with low versus high parenthood anxiety. Logistic regression models estimated the odds ratios (ORs), with 95% CIs, of high parenthood-related anxiety with each user characteristic or digital support interest. Results Among 2756 nonbirthing partners enrolled in the digital platform during their partner's pregnancy, 2483 (90.1%) were men, 1668 (71.9%) were first-time parents, 1159 (42.1%) were non-Hispanic White, and 1652 (50.9%) endorsed an annual household income of >US $100,000. Overall, 2505 (91.9%) reported some amount of parenthood-related anxiety, and 437 (15.9%) had high parenthood-related anxiety. High parenthood-related anxiety was more common among non-White nonbirthing partners: compared to those who identified as non-Hispanic White, those who identified as Asian, Black, or Hispanic had 2.39 (95% CI 1.85-3.08), 2.01 (95% CI 1.20-3.23), and 1.68 (95% CI 1.15-2.41) times the odds of high parenthood-related anxiety, respectively. Lower household income was associated with increased odds of reporting high parenthood anxiety, with the greatest effect among those with annual incomes of US $100,000 (OR 2.13, 95% CI 1.32-3.34). In general, nonbirthing partners were interested in receiving digital support during their partner's pregnancy, but those with high parenthood-related anxiety were more likely to desire digital support for all support interests compared to those without high parenthood anxiety. Those with high parenthood-related anxiety had more than 2 times higher odds of requesting digital education about their emotional health compared to those without high parenthood-related anxiety (OR 2.06, 95% CI 1.67-2.55). Conclusions These findings demonstrate the need for perinatal anxiety-related support for all nonbirthing partners and identify nonbirthing partners' demographic characteristics that increase the odds of endorsing high parenthood-related anxiety. Additionally, these findings suggest that most nonbirthing partners using a digital health platform with high parenthood-related anxiety desire to receive perinatal mental health support.
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Affiliation(s)
- Adam K Lewkowitz
- Department of Obstetrics and Gynecology, Warren Alpert Medical School at Brown University, ProvidenceRI, United States
| | | | | | - Melissa A Clark
- Department of Obstetrics and Gynecology, Warren Alpert Medical School at Brown University, ProvidenceRI, United States
- Department of Health Services, Policy, & Practice, Brown School of Public Health, ProvidenceRI, United States
| | - Caron Zlotnick
- Department of Obstetrics and Gynecology, Warren Alpert Medical School at Brown University, ProvidenceRI, United States
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School at Brown University, ProvidenceRI, United States
| | - Emily S Miller
- Department of Obstetrics and Gynecology, Warren Alpert Medical School at Brown University, ProvidenceRI, United States
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17
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Cheung PS, McCaffrey T, Tighe SM, Mohamad MM. Music as a health resource in pregnancy: A cross-sectional survey study of women and partners in Ireland. Midwifery 2023; 126:103811. [PMID: 37708586 DOI: 10.1016/j.midw.2023.103811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/18/2023] [Accepted: 08/30/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Wellbeing in pregnancy can have long term effects for women, infants, and families. Research has shown that music can promote maternal health, infant development, and parent-infant bonding. This study aimed to explore women's and their partners' experiences of using music during pregnancy while also considering their perspectives on the potential role of music in maternity care. METHODS A cross-sectional online survey was conducted from June to October 2020 in Ireland. 265 respondents including 254 women and 11 partners who were pregnant or had given birth in the past 12 months participated. Descriptive statistics and content analysis were used to analyse the results. RESULTS Findings indicated that, during pregnancy, 75% of respondents sang to their unborn baby, 47% created playlists for childbirth, 46% intentionally used music to support their wellbeing, over one-third were not aware of supporting evidence on music for perinatal wellbeing, 88% thought there was not enough guidance, and 70% supported the idea of establishing music therapy in maternity care. Qualitative analysis revealed three themes: 'Positive impacts of music', 'Facilitators and barriers to the use of music during pregnancy', and 'Future visions on implementing music in maternity care'. CONCLUSION This study is the first to explore the experience and perspectives of women and partners in Ireland on using music during pregnancy. The findings highlight the need for more music-based resources and education on this topic and suggests an openness amongst women and partners towards the implementation of music therapy in maternity care to promote perinatal health and wellbeing.
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Affiliation(s)
- Pui Sze Cheung
- Irish World Academy of Music and Dance, University of Limerick, Limerick V94DK18, Ireland.
| | - Triona McCaffrey
- Irish World Academy of Music and Dance, University of Limerick, Limerick V94DK18, Ireland. https://twitter.com/MccaffreyTriona
| | - Sylvia Murphy Tighe
- Department of Nursing and Midwifery, University of Limerick, Limerick V94DK18, Ireland. https://twitter.com/sylviamurphyt
| | - Mas Mahady Mohamad
- Specialist Perinatal Mental Health Team, University Maternity Hospital Limerick, Limerick, V94 C566, Ireland, School of Medicine, University of Limerick, V94DK18, Ireland. https://twitter.com/MahadyMas
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18
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Meijer L, Franz MR, Deković M, van Ee E, Finkenauer C, Kleber RJ, van de Putte EM, Thomaes K. Towards a more comprehensive understanding of PTSD and parenting. Compr Psychiatry 2023; 127:152423. [PMID: 37722204 DOI: 10.1016/j.comppsych.2023.152423] [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: 07/03/2023] [Revised: 09/04/2023] [Accepted: 09/08/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND The impact of post-traumatic stress disorder (PTSD) on parenting and the parent-child relationship has been well-documented in the scientific literature. However, some conceptual and methodological challenges within this research field remain. PROCEDURE We reflect on a number of challenges that we identified while examining the literature in preparation of an individual participant data meta-analysis on the relationships between PTSD and parenting. FINDINGS We address 1) the presence of 'trauma-islands'; 2) the need for transdiagnostic theoretical frameworks for mechanisms between PTSD and parenting; 3) the lack of developmental perspectives; 4) the overuse of self-reported retrospective measures; 5) the need to study more diverse samples and cultural contexts; and 6) the lack of research on resilience and post-traumatic growth in parenting. Based on these reflections, we offer suggestions on strategies for responding to these challenges through: 1) welcoming open science; 2) working towards shared theoretical frameworks; 3) doing more longitudinal research 4) expanding the methodological palette; 5) centering lived experience; and 6) taking systemic inequality into account. CONCLUSION With this commentary, we aim to open a discussion on next steps towards a more comprehensive understanding of the association between PTSD and parenting, and inspire collaborative research.
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Affiliation(s)
- Laurien Meijer
- Sinai Centrum Arkin Mental Health Care, Amstelveen, Laan van de Helende Meesters 2, 1186 AM Amstelveen, the Netherlands; Department of Interdisciplinary Social Science, Utrecht University, Padualaan 14, 3584 CH Utrecht, the Netherlands.
| | - Molly R Franz
- Department of Psychology, University of Maryland Baltimore County, 1000 Hilltop Circle, Baltimore, MD 21250, United States
| | - Maja Deković
- Department of Clinical Child and Family Studies, Utrecht University, Heidelberglaan 1, 3584 CS Utrecht, the Netherlands
| | - Elisa van Ee
- Psychotraumacentrum Zuid Nederland, Den Bosch, Bethaniestraat 10, 5211 LJ 's Hertogenbosch, the Netherlands; Behavioural Science Institute, Radboud University, Thomas Van Aquinostraat 4, 6525 GD Nijmegen, the Netherlands
| | - Catrin Finkenauer
- Department of Interdisciplinary Social Science, Utrecht University, Padualaan 14, 3584 CH Utrecht, the Netherlands
| | - Rolf J Kleber
- Department of Clinical Psychology, Utrecht University, Heidelberglaan 1, 3584 CS Utrecht, the Netherlands; ARQ National Psychotrauma Centre, Diemen, Heidelberglaan 1, 3584 CS Utrecht, the Netherlands
| | - Elise M van de Putte
- Wilhelmina Children's Hospital / University Medical Center Utrecht, Lundlaan 6, 3584 EA Utrecht, the Netherlands
| | - Kathleen Thomaes
- Department of Psychiatry, Amsterdam University Medical Centre/VUmc, Laan van de Helende Meesters 2, 1186 AM Amstelveen, the Netherlands
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19
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Cockshaw WD, Thorpe KJ, Giannotti M, Hazell-Raine K. Factor structure of the Edinburgh Postnatal Depression Scale in a large population-based sample of fathers. J Affect Disord 2023; 340:167-173. [PMID: 37557985 DOI: 10.1016/j.jad.2023.08.025] [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: 02/20/2023] [Revised: 07/03/2023] [Accepted: 08/03/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Paternal perinatal distress is receiving increasing attention. The Edinburgh Postnatal Depression Scale (EPDS) is the predominant screening tool for paternal perinatal distress. Research using the large Avon Longitudinal Study of Parents and Children (ALSPAC) cohort demonstrated that a three-factor EPDS structure is appropriate among mothers, with anhedonia, anxiety and depression factors emerging consistently across perinatal timepoints. METHOD We employed confirmatory factor (CFA; n = 6170 to 9848) analysis to determine if this structure was appropriate for ALSPAC fathers, and the extent of invariance between mother and father groups. RESULTS At 18-weeks gestation, and 8-weeks, 8-months and 21-months postpartum, the three-factor model had consistently superior fit to other proposed models. Consistent with interpretation of a total distress score, factors were highly correlated. The model exhibited configural invariance in both the first (8-months) and second (21-months) post-partum years. Metric and scalar invariance were not supported, however, non-invariance was largely attributable to item 9 canvassing "crying". LIMITATIONS While the study employs a large cohort, the data collection in 1991 to 1992 in the United Kingdom may not account for the diverse gender roles, family structures and societal changes seen since that time. CONCLUSIONS Interpretation of the EPDS as representing perinatal distress, reflecting anhedonia, anxiety and depression aspects, is appropriate for mothers and fathers. The experience of distress has nuanced gender-based differences. Implications for EPDS interpretation and cut-off scores among fathers are discussed.
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Affiliation(s)
- Wendell D Cockshaw
- Wesley Research Institute, Brisbane, Australia; Faculty of Health, Charles Darwin University, Darwin, Australia
| | - Karen J Thorpe
- Queensland Brain Institute, The University of Queensland, St Lucia, Australia; Faculty of Health, Charles Darwin University, Darwin, Australia
| | - Michele Giannotti
- Department of Psychology and Cognitive Science, University of Trento, Trento, Italy
| | - Karen Hazell-Raine
- Faculty of Health, Charles Darwin University, Darwin, Australia; Faculty of Medicine and Health, The University of Sydney, Australia.
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20
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Lewkowitz AK, Guille C, Rubin-Miller L, Jahnke HR, Ayala NK, Miller ES, Henrich N. Association between nonbirthing parent's perinatal education and mental health support desires and perinatal anxiety among either parent. Am J Obstet Gynecol MFM 2023; 5:101177. [PMID: 37806649 PMCID: PMC10842621 DOI: 10.1016/j.ajogmf.2023.101177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/19/2023] [Accepted: 10/03/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Although perinatal anxiety is common in birthing and nonbirthing parents, little is known about the mental health or educational needs of nonbirthing parents during the perinatal period and whether perinatal anxiety in the birthing parent is associated with nonbirthing parent educational preferences. OBJECTIVE This study aimed to examine the desired digital perinatal educational preferences of nonbirthing parents and whether these preferences differed by (1) endorsement of high parenthood-related anxiety in the nonbirthing partner and (2) mental health of the birthing parent (including both identified mental health conditions and presence of pregnancy-related anxiety). STUDY DESIGN In this cross-sectional study, nonbirthing and birthing parents using Maven, a digital perinatal health platform, selected the areas in which they wanted education or support from a list of options. In addition, the participants reported their experience of parenthood or pregnancy-related anxiety through a 5-item Likert scale in response to the prompt, "On a scale of 1 (not at all) to 5 (extremely), how anxious are you feeling about parenthood or pregnancy?" High parenthood or pregnancy-related anxiety was defined as being very (scale: 4) or extremely (scale: 5) anxious. Furthermore, birthing parents reported whether they had a current or previous mood disorder, but this information was not reported by nonbirthing parents. Survey responses for birthing and nonbirthing parents were linked through the digital platform. Descriptive analyses were used to assess nonbirthing parent demographics and perinatal support interests, stratified by high parenthood-related anxiety, high pregnancy-related anxiety in their partner, and perinatal mood disorders or high pregnancy-related anxiety in their partner. RESULTS Among 382 nonbirthing parents, most (85.6%) desired to receive digital support during their partner's pregnancy: the most commonly endorsed support interests were infant care (327 [85.6%]) and understanding their partner's emotional (313 [81.9%]) or physical (294 [77.0%]) experience during pregnancy. Overall, 355 nonbirthing parents (93.9%) endorsed any parenthood-related anxiety, and 63 nonbirthing parents (16.5%) were categorized as having high parenthood-related anxiety. Those with high parenthood-related anxiety were more likely to desire digital support for each topic. Among birthing parents, 124 (32.4%) had a mental health condition, and 45 (11.8%) had high pregnancy-related anxiety. When nonbirthing parents were stratified by the presence of their partner having a mental health condition or high pregnancy-related anxiety alone, no difference in desired perinatal education was identified. Although nonbirthing parents had higher rates of high parenthood-related anxiety if the birthing parent reported high pregnancy anxiety (17 [27.0%] vs 28 [8.8%]; P<.001), no difference was found with other conditions within the mental health composite. CONCLUSION In this cross-sectional study, many nonbirthing parents who engaged with a perinatal digital platform desired education on their or their partner's emotional health during the perinatal period, and most endorsed parenthood-related anxiety. Our findings suggest that perinatal mental health support is needed for nearly all parents and that nonbirthing parents who use digital health platforms are amenable to receiving comprehensive perinatal education via these platforms.
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Affiliation(s)
- Adam K Lewkowitz
- Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Providence, RI (Drs Lewkowitz, Ayala, and Miller); Center for Digital Health, Brown University School of Public Health, Providence, RI (Dr Lewkowitz).
| | - Constance Guille
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC (Dr Guille); Maven Clinic, New York, NY (Dr Guille, Ms Rubin-Miller, and Drs Jahnke and Henrich)
| | - Lily Rubin-Miller
- Maven Clinic, New York, NY (Dr Guille, Ms Rubin-Miller, and Drs Jahnke and Henrich)
| | - Hannah R Jahnke
- Maven Clinic, New York, NY (Dr Guille, Ms Rubin-Miller, and Drs Jahnke and Henrich)
| | - Nina K Ayala
- Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Providence, RI (Drs Lewkowitz, Ayala, and Miller)
| | - Emily S Miller
- Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Providence, RI (Drs Lewkowitz, Ayala, and Miller)
| | - Natalie Henrich
- Maven Clinic, New York, NY (Dr Guille, Ms Rubin-Miller, and Drs Jahnke and Henrich)
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21
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O'Brien J, Gregg L, Wittkowski A. A systematic review of clinical psychological guidance for perinatal mental health. BMC Psychiatry 2023; 23:790. [PMID: 37904101 PMCID: PMC10614401 DOI: 10.1186/s12888-023-05173-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 09/08/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND Guidelines on psychological and/or psychosocial assessment and intervention in the perinatal period can provide beneficial practice guidance for healthcare professions to reduce maternal distress and potential mortality. As little is known about the similarities in recommendations across guidelines, which could impact the quality of therapeutic intervention women receive, this systematic review was conducted to draw out the consistent guidance for perinatal psychological and/or psychosocial therapeutic input. METHOD Eight literature and two guideline databases were searched alongside guideline development institutions, and organisations of maternity or perinatal mental health care. All relevant guidance was searched for and extracted before guideline quality was assessed using the AGREE-II instrument. Included guidelines had a primary or secondary focus on psychological assessment and therapeutic intervention for perinatal mental health difficulties. Using a narrative synthesis approach, recommendation consistencies and inconsistencies were outlined. RESULTS From the 92 records screened, seven guidelines met the inclusion criteria. Only two guidelines were rated high (> 80%) across all assessed domains, with the other guidelines scoring between poor and excellent across domains. Highest rated domains across all seven guidelines were clarity of presentation (75%) and scope and purpose (70%). Recommendations for structured psychological assessment and intervention were most commonly reported in the guidelines; however, the level of detail and depth of information varied across guidelines. Whilst assessment and intervention recommendations for mother-infant dyad and partners were considered, research into working therapeutically with these client groups in perinatal mental health services is only just emerging. Hence, guideline recommendations for working with the mother-infant dyad and partners were based on consensus of expert opinion. CONCLUSION Perinatal mental health guidelines were consistent in scope but showed considerable variability in quality and depth of recommendations, which could have implications for standards of clinical practice. However, there is still a need to improve the evidence underpinning recommendations in perinatal mental health guidelines to advance the implementation of psychological and/or psychosocial interventions. High quality interventions in the perinatal period could improve outcomes for women and their families.
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Affiliation(s)
- Jayne O'Brien
- The University of Manchester, School of Health Sciences, Manchester, M13 9PL, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, M25 3BL, UK
| | - Lynsey Gregg
- The University of Manchester, School of Health Sciences, Manchester, M13 9PL, UK
| | - Anja Wittkowski
- The University of Manchester, School of Health Sciences, Manchester, M13 9PL, UK.
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, M25 3BL, UK.
- The University of Manchester, Manchester Health Alliance Science Centre, Manchester, M13 9PL, UK.
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, 2nd Floor Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK.
- Manchester Academic Health Science Centre, Manchester, M13 9NQ, UK.
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Uriko K, Christoforou A, Motrico E, Moreno-Peral P, Kömürcü Akik B, Žutić M, Lambregtse-van den Berg MP. Paternal peripartum depression: emerging issues and questions on prevention, diagnosis and treatment. A consensus report from the cost action Riseup-PPD. J Reprod Infant Psychol 2023:1-19. [PMID: 37818835 DOI: 10.1080/02646838.2023.2266470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 09/28/2023] [Indexed: 10/13/2023]
Abstract
INTRODUCTION Paternal peripartum depression (P-PPD) is a serious and understudied public health problem associated with impaired family functioning and child development. The lack of recognition of P-PPD may result in limited access to both information and professional help. OBJECTIVE The aim of the study was to review studies on paternal peripartum depression and to identify issues and questions where future research and theory formation are needed. METHODS A literature search for systematic reviews, meta-analyses and primary studies was conducted using PubMed, Web of Science, Embase, Scopus, Medline, PsychInfo and Informit databases. Key results within the retrieved articles were summarised and integrated to address the review objectives. RESULTS Based on the literature, the knowledge related to prevalence, screening, risk factorsunique to fathers, management strategies and outcomes of P-PPD is lacking. Currently, there is no consensual understanding of the definition of P-PPD and recommendations for dealing with P-PPD. Limited data were available regarding the barriers preventing fathers from accessing support systems. CONCLUSION Emerging issues that need to be addressed in future research include: P-PPD definition and pathogenetic pathways; prevention strategies and assessment tools; self-help seeking and engagement with interventions; the cost-effectiveness of P-PPD management; needs of health professionals; effect on child development, and public awareness. Future studies and clinical practice should account the complexities that may arise from the father's perceptions of health care services. Results from this review highlights the critical issues on how to plan, provide and resource health services, to meet the health needs of fathers.
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Affiliation(s)
- Kristiina Uriko
- School of Natural Sciences and Health, Department of Psychology and Behavioural Sciences, Tallinn University, Tallinn, Estonia
| | - Andri Christoforou
- Department of Social and Behavioural Sciences, European University Cyprus, Nicosia, Cyprus
| | - Emma Motrico
- Department of Psychology, University Loyola Andalucia, Seville, Spain
| | - Patricia Moreno-Peral
- Department of Personality, Evaluation and Psychological Treatment, University of Málaga (UMA). Biomedical Research Institute of Malaga (IBIMA plataforma Bionand), Malaga, Spain
| | | | - Maja Žutić
- Department of Psychology, Catholic University of Croatia, Zagreb, Croatia
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23
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Wainwright S, Caskey R, Rodriguez A, Holicky A, Wagner-Schuman M, Glassgow AE. Screening fathers for postpartum depression in a maternal-child health clinic: a program evaluation in a midwest urban academic medical center. BMC Pregnancy Childbirth 2023; 23:675. [PMID: 37726664 PMCID: PMC10508033 DOI: 10.1186/s12884-023-05966-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 08/31/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Postpartum depression (PPD) impacts fathers as well as mothers, and is estimated to affect between 8 and 13% of fathers. Paternal PPD is a risk factor for worsened quality of life, poor physical and mental health, and developmental and relational harms in the father-mother-child triad. There are no current recommendations for PPD screening among fathers. Paternal PPD screening was piloted in an intergenerational postpartum primary care clinic. METHODS The pilot was carried out in an intergenerational postpartum primary care clinic located at a Midwest urban academic safety net health system from October 2021 to July 2022. Fathers actively involved in relationships with mothers or infants receiving primary care in the clinic were approached with mothers' permission. A novel survey instrument was used to collect demographic/social data, as well as mental health history and current stress levels; an Edinburgh Postnatal Depression Scale (EPDS) was also administered. Screenings were completed by social workers; data were collected in REDCap and descriptive statistics were calculated in SAS. RESULTS 29 fathers were contacted and 24 completed screening (83%). Mean age was 31 years (range 19-48). Most (87%) identified as belonging to a racial or ethnic minority group. Fathers self-reported low rates of stress and preexisting mental health conditions, but 30% screened positive for PPD on EPDS (score of ≥ 8, or suicidal ideation). Gaps in health care were found, as one-quarter (26%) of fathers were uninsured and half (54%) did not have a primary care provider. After screening, two requested mental health services, and three established new primary care with a physician. CONCLUSIONS Participation was high in a PPD screening pilot for fathers in a primary care setting. This small sample of fathers demonstrated significant peripartum mental health challenges unlikely to have been identified otherwise. For some participants, engaging in PPD screening was an effective tool to prompt their subsequent engagement with general health care. This pilot is a step toward incorporating the health of fathers into models for supporting the health of families. Expanding screening for paternal PPD into routine primary care is necessary to reach more affected fathers.
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Affiliation(s)
- Sam Wainwright
- Division of Academic Internal Medicine, College of Medicine, University of Illinois at Chicago, 820 S. Wood Street, CSN 440, M/C 718, Chicago, IL, 60612, USA.
- Department of Pediatrics, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA.
| | - Rachel Caskey
- Division of Academic Internal Medicine, College of Medicine, University of Illinois at Chicago, 820 S. Wood Street, CSN 440, M/C 718, Chicago, IL, 60612, USA
- Department of Pediatrics, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Aida Rodriguez
- Division of Academic Internal Medicine, College of Medicine, University of Illinois at Chicago, 820 S. Wood Street, CSN 440, M/C 718, Chicago, IL, 60612, USA
| | - Abigail Holicky
- Division of Academic Internal Medicine, College of Medicine, University of Illinois at Chicago, 820 S. Wood Street, CSN 440, M/C 718, Chicago, IL, 60612, USA
- School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | - Melissa Wagner-Schuman
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, OH, USA
- Department of Psychiatry, University of Illinois Chicago College of Medicine, Chicago, IL, USA
| | - Anne Elizabeth Glassgow
- Division of Academic Internal Medicine, College of Medicine, University of Illinois at Chicago, 820 S. Wood Street, CSN 440, M/C 718, Chicago, IL, 60612, USA
- Department of Pediatrics, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
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24
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de Waal N, van den Heuvel MI, Nyklíček I, Pop VJM, Boekhorst MGBM. Paternal bonding in pregnancy and early parenthood: a qualitative study in first-time fathers. J Reprod Infant Psychol 2023:1-16. [PMID: 37650726 DOI: 10.1080/02646838.2023.2252890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 08/24/2023] [Indexed: 09/01/2023]
Abstract
The birth of an infant marks a period of profound change in first-time parents. Parental love and warmth, however, already begin to develop during pregnancy. Also for fathers, the development of bonding to the infant may be a unique process. The current qualitative study aimed to explore views and experiences of first-time fathers on the origins and development of paternal bonding during pregnancy and early childhood. In total, 30 in-depth semi-structured interviews were conducted with expectant fathers (second or third trimester of pregnancy; n = 10) and fathers of infants (0-6 months postpartum; n = 11) and toddlers (2-3 years of age; n = 9). Two major themes were uncovered from the data: feelings of bonding and facilitators of bonding. The first theme was supported with three subthemes: 1) from abstract to concrete, 2) positive emotions, and 3) uncertainties and worries. The second theme, facilitators of bonding, was supported with four subthemes: 1) experiencing the foetus, 2) meeting the child, 3) interaction, and 4) communication. Similar to previous studies, our results suggested that, in most fathers, paternal bonding originates in pregnancy and that it evolves over time. Seeing or feeling the child, both during pregnancy and postpartum, as well as interacting or communicating with the child, appears to facilitate fathers' feelings of bonding. Involving fathers in pregnancy, childbirth, and parenting may be essential for their bonding process.
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Affiliation(s)
- Noor de Waal
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, Netherlands
| | | | - Ivan Nyklíček
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, Netherlands
| | - Victor J M Pop
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, Netherlands
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25
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Mestermann S, Arndt M, Fasching PA, Beckmann MW, Kratz O, Moll GH, Kornhuber J, Eichler A. The Father's Part: Influences of Paternal Psychopathology and Parenting Behavior on Child and Adolescent Well-Being. Healthcare (Basel) 2023; 11:2119. [PMID: 37570360 PMCID: PMC10418667 DOI: 10.3390/healthcare11152119] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/14/2023] [Accepted: 07/22/2023] [Indexed: 08/13/2023] Open
Abstract
Family influences on child quality of life (QoL) are increasingly understood. Parenting behavior and parent individual psychopathology are among the established predictors of offspring mental health. However, literature often addresses these factors as 'parental', lacking further gender-specific differentiation while predominantly studying maternal aspects. Social and biological fathers are still underrepresented in family research. The aim of this study was to analyze paternal contributions to child well-being. A total of 197 father/mother-dyads gave a standardized self-report on parenting behavior and their own psychopathology at child primary school age (t1; 6-10 y). Ratings were compared mutually and associated with child self-rated QoL at t1 and adolescence (t2; 12-14 y). Fathers and mothers differed in psychopathology and most parenting behavior dimensions (positive parenting, involvement, responsible parenting, poor monitoring, and corporal punishment). Father psychopathology made a relevant predictive contribution to girls' QoL at t2. Boys' t1 QoL was significantly influenced by maternal parenting factors (positivity and corporal punishment). Compared to mothers, fathers are faced with different individual stressors; paternal parenting behavior is different, while fathers' influences are significant, particularly for daughters. Father-addressed pre- and intervention programs in child psychotherapeutic treatment are of high relevance.
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Affiliation(s)
- Stefan Mestermann
- Department of Child and Adolescent Mental Health, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany (A.E.)
| | - Marie Arndt
- Department of Child and Adolescent Mental Health, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany (A.E.)
| | - Peter A. Fasching
- Department of Obstetrics and Gynaecology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
| | - Matthias W. Beckmann
- Department of Obstetrics and Gynaecology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
| | - Oliver Kratz
- Department of Child and Adolescent Mental Health, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany (A.E.)
| | - Gunther H. Moll
- Department of Child and Adolescent Mental Health, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany (A.E.)
| | - Johannes Kornhuber
- Department of Psychiatry and Psychotherapy, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
| | - Anna Eichler
- Department of Child and Adolescent Mental Health, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany (A.E.)
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26
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Goutaudier N, Séjourné N. Post-partum post-traumatic stress disorder in fathers: Issues and prospects. L'ENCEPHALE 2023; 49:314-316. [PMID: 37088576 DOI: 10.1016/j.encep.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/22/2022] [Accepted: 11/25/2022] [Indexed: 04/25/2023]
Affiliation(s)
- Nelly Goutaudier
- Centre de Recherches sur la Cognition et l'Apprentissage, CeRCA-UMR CNRS 7295, Université de Poitiers, Poitiers, France.
| | - Natalène Séjourné
- Centre d'Études et de Recherches en Psychopathologie et Psychologie de la Santé - CERPPS EA 7411, Université de Toulouse Jean-Jaurès, Toulouse, France
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27
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Muzard A, Olhaberry M, Nuñez C, Vaccarezza S, Franco P, Morán J, Sieverson C, León MJ, Apter G. Parental personality traits and emotion regulation: Its relationship with infants' socioemotional development during the perinatal period. Gen Hosp Psychiatry 2023; 83:20-26. [PMID: 37030058 DOI: 10.1016/j.genhosppsych.2023.04.004] [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: 11/23/2022] [Revised: 02/27/2023] [Accepted: 04/02/2023] [Indexed: 04/10/2023]
Abstract
Socioemotional development is central throughout life, and it unfolds in an interpersonal context in which each significant caregiver has an impact, particularly during infancy. However, only a relatively small number of studies have investigated associations between mothers and fathers' personality and emotional characteristics with their infant's socioemotional development during the perinatal period. Therefore, the present article examines the relationship between maternal and paternal personality traits and emotion regulation difficulties during the prenatal period with offspring's socioemotional development. This was a non-experimental and longitudinal study that included a community sample of 55 mother-father-baby triads. Parental assessments were carried out between the second and third trimester of pregnancy, and baby's socio-emotional development was assessed during their 2nd month after birth. Results evidenced differences between maternal and paternal personality traits and emotion regulation difficulties during the perinatal period as well as distinct contributions on infant's socioemotional development.
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Affiliation(s)
- Antonia Muzard
- Psychotherapy, School of Psychology, Pontificia Universidad Católica de Chile, Millennium Institute for Research in Depression and Personality (MIDAP), Chile; School of Psychology, Universidad Finis Terrae, Santiago, Chile.
| | - Marcia Olhaberry
- School of Psychology, Pontificia Universidad Católica de Chile, Millennium Institute for Research in Depression and Personality (MIDAP), Chile.
| | - Catalina Nuñez
- Psychotherapy, School of Psychology, Pontificia Universidad Católica de Chile, Millennium Institute for Research in Depression and Personality (MIDAP), Chile; School of Psychology, Universidad Finis Terrae, Santiago, Chile; School of Psychology, Universidad Adolfo Ibañez, Santiago, Chile.
| | - Stephanie Vaccarezza
- Psychotherapy, School of Psychology, Pontificia Universidad Católica de Chile; School of Psychology, Universidad de Chile; Millennium Institute for Research in Depression and Personality (MIDAP), Chile; School of Psychology, Universidad Finis Terrae, Santiago, Chile.
| | - Pamela Franco
- Doctoral Program in Psychotherapy, School of Psychology, Pontificia Universidad Católica de Chile; Millennium Institute for Research in Depression and Personality (MIDAP), Chile.
| | - Javier Morán
- School of Psychology, Universidad de Valparaiso, Chile; Millennium Institute for Research in Depression and Personality (MIDAP); Fundación Mente en Mente, Chile.
| | - Catalina Sieverson
- School of Psychology, Pontificia Universidad Católica de Chile; Millennium Institute for Research in Depression and Personality (MIDAP), Chile.
| | - María José León
- Millennium Institute for Research in Depression and Personality (MIDAP); Fundación Mente en Mente, Chile.
| | - Gisele Apter
- Doctoral Program in Psychotherapy, Université de Rouen Normandie, Groupe Hospitalier du Havre, France.
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28
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Atmore KH, Taylor BL, Potts LC, Trevillion K, Howard LM. Caregiving and mental health needs in the significant others of women receiving inpatient and home treatment for acute severe postpartum mental illness. Arch Womens Ment Health 2023; 26:49-56. [PMID: 36565312 PMCID: PMC9908709 DOI: 10.1007/s00737-022-01286-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 12/09/2022] [Indexed: 01/01/2023]
Abstract
To examine the mental health and caregiving needs of significant others (including partners, parents, friends) to women who received acute psychiatric care either as inpatients or at home during the perinatal period. Cross-sectional survey of 98 significant others of 279 women who participated in a quasi-experimental cohort study of services for mothers with acute severe postpartum mental health diagnoses. Significant others completed an adapted General Health Questionnaire-12 (GHQ) and Involvement Evaluation Questionnaire (IEQ) to indicate their mental health needs and service use as well as caregiving activities. The mean age of significant others was 38.9 years (range 24-69). 81.6% were male and 81.6% were intimate partners to the women. High levels of unmet mental health needs were detected in significant others, with a majority (51.0%) having a score > 2 on the GHQ-12 indicating caseness for a psychiatric disorder. In those with GHQ-12 caseness indicated, few were receiving help for their difficulties: 22.5% received support from their general practitioner, and 14.3% received help from a social worker, psychologist, psychiatrist or outpatient department. 18.4% received medication for GHQ-12 symptoms. The median sumscore of IEQ surveying caregiving activities in significant others was 18/108. We did not find evidence of differences in GHQ-12 or IEQ scores for significant others to women who received inpatient care versus care at home. Significant others to women with acute severe postpartum psychiatric illness have high levels of unmet mental health needs during the weeks after women are discharged from acute care. Services need to address these needs to optimise outcomes for the whole family.
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Affiliation(s)
- Katie H. Atmore
- Section of Women’s Mental Health, Institute of Psychiatry Psychology and Neuroscience, King’s College London, London, UK
| | - Billie Lever Taylor
- Section of Women’s Mental Health, Institute of Psychiatry Psychology and Neuroscience, King’s College London, London, UK
| | - Laura C. Potts
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Kylee Trevillion
- Section of Women’s Mental Health, Institute of Psychiatry Psychology and Neuroscience, King’s College London, London, UK
| | - Louise M. Howard
- Section of Women’s Mental Health, Institute of Psychiatry Psychology and Neuroscience, King’s College London, London, UK
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29
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Challacombe FL, Pietikäinen JT, Kiviruusu O, Saarenpää-Heikkilä O, Paunio T, Paavonen EJ. Paternal perinatal stress is associated with children's emotional problems at 2 years. J Child Psychol Psychiatry 2023; 64:277-288. [PMID: 36215991 PMCID: PMC10092317 DOI: 10.1111/jcpp.13695] [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] [Accepted: 07/28/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND Paternal mental health in pregnancy and postpartum has been increasingly highlighted as important both in its own right, but also as crucial for the development of children. Rates of help-seeking among fathers is low, possibly due to conceptualising their own difficulties as stress rather than problems with mood. The relationship between paternal stress and child outcomes has not been investigated. METHODS This study used data from the Finnish CHILD-SLEEP birth cohort. Data were available for 901 fathers and 939 mothers who completed questionnaires on demographics, stress, anxiety and depression at 32 weeks gestation, 3 months, 8 months and 24 months postpartum. Parental report of child emotional and behavioural problems was collected at 24 months. RESULTS Around 7% of fathers experienced high stress (over 90% percentile) at each timepoint measured in the perinatal period, rising to 10% at 2 years postpartum. Paternal stress measured antenatally, at 3 and 24 months was associated with child total problems at 24 months, while paternal depression and anxiety were not related to child outcomes when in the same model. After adjusting for concurrent maternal depression, anxiety and stress, an association remained between paternal stress at each timepoint and child total problem scores at 24 months. The strongest association was with paternal stress at 3 months (OR 3.17; 95% CI 1.63-6.16). There were stronger relationships between paternal stress and boys' rather than girls' total problem scores, although the interactions were not statistically significant. CONCLUSIONS Paternal stress is an important manifestation of perinatal distress and is related to child mental health, particularly when present in the early postpartum months. Paternal stress should therefore be assessed in the perinatal period, which presents opportunities for early intervention and prevention of difficulties for both father and child.
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Affiliation(s)
| | - Johanna T Pietikäinen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland.,Department of Psychiatry, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Olli Kiviruusu
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Outi Saarenpää-Heikkilä
- Pediatric Clinics, Tampere University Hospital, Tampere, Finland.,Tampere Centre for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland
| | - Tiina Paunio
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland.,Department of Psychiatry and SleepWell Research Program, Faculty of Medicine, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - E Juulia Paavonen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland.,Pediatric Research Center, Child Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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30
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Delgado L, Cobo J, Giménez C, Fucho-Rius GF, Sammut S, Martí L, Lesmes C, Puig S, Obregón N, Canet Y, Palao DJ. Initial Impact of Perinatal Loss on Mothers and Their Partners. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1304. [PMID: 36674059 PMCID: PMC9858910 DOI: 10.3390/ijerph20021304] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/07/2023] [Accepted: 01/09/2023] [Indexed: 06/17/2023]
Abstract
(1) Background: Perinatal Loss affects one in ten women worldwide. It is known to have a deep impact on the physical and psychological wellbeing of the mother. Moreover, there is a lack of information in regard to gender differences. The role of culture, environment, personal characteristics, and gender is yet to be determined in most reports; (2) Objective and Methods: Our aim is to study the initial impact of perinatal losses in an unselected sample of couples, focusing on gender differences. We conducted a longitudinal prospective study with 29 mothers and 17 fathers. Upon discharge from the hospital, they filled out the Edinburgh Postnatal Depression Scale (EPDS), among others. After one-month post-loss, they performed the EPDS and the Short Version of the Perinatal Grief Scale. We used descriptive statistics for the sample and non-parametric tests for the comparison of gender; (3) Results: We found no gender differences in initial depressive symptoms, nor in depressive symptoms, perinatal grief symptoms, or grief level (total scores or complicated grief) one month after the loss; (4) Conclusions: we need to better understand the psychological evolution of couples in cases of perinatal loss without falling into preconceived ideas about the influence of gender.
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Affiliation(s)
- Laia Delgado
- Mental Health Department, Corporació Sanitària Parc Taulí, Universitat Autònoma de Barcelona, CIBERSAM, 08208 Sabadell, Spain
| | - Jesus Cobo
- Mental Health Department, Corporació Sanitària Parc Taulí, Universitat Autònoma de Barcelona, CIBERSAM, 08208 Sabadell, Spain
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
- Institut d’Investigació i Innovació Parc Taulí (I3PT), CERCA, 08208 Sabadell, Spain
| | - Cristina Giménez
- Mental Health Department, Corporació Sanitària Parc Taulí, Universitat Autònoma de Barcelona, CIBERSAM, 08208 Sabadell, Spain
| | - Genís Felip Fucho-Rius
- Mental Health Department, Corporació Sanitària Parc Taulí, Universitat Autònoma de Barcelona, CIBERSAM, 08208 Sabadell, Spain
| | - Stephanie Sammut
- Perinatal Mental Health Program, Cerdanyola-Ripollet Outpatient Department, Sant Joan de Dèu Serveis de Salut Mental, 08291 Ripollet, Spain
| | - Laia Martí
- Gynaecology and Obstetrics Department, Hospital Universitari Parc Taulí, Corporació Sanitària Parc Taulí, Universitat Autònoma de Barcelona, 08208 Sabadell, Spain
| | - Cristina Lesmes
- Gynaecology and Obstetrics Department, Hospital Universitari Parc Taulí, Corporació Sanitària Parc Taulí, Universitat Autònoma de Barcelona, 08208 Sabadell, Spain
| | - Salut Puig
- Gynaecology and Obstetrics Department, Hospital Universitari Parc Taulí, Corporació Sanitària Parc Taulí, Universitat Autònoma de Barcelona, 08208 Sabadell, Spain
| | - Noemí Obregón
- Gynaecology and Obstetrics Department, Hospital Universitari Parc Taulí, Corporació Sanitària Parc Taulí, Universitat Autònoma de Barcelona, 08208 Sabadell, Spain
| | - Yolanda Canet
- Gynaecology and Obstetrics Department, Hospital Universitari Parc Taulí, Corporació Sanitària Parc Taulí, Universitat Autònoma de Barcelona, 08208 Sabadell, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
| | - Diego J. Palao
- Mental Health Department, Corporació Sanitària Parc Taulí, Universitat Autònoma de Barcelona, CIBERSAM, 08208 Sabadell, Spain
- Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
- Institut d’Investigació i Innovació Parc Taulí (I3PT), CERCA, 08208 Sabadell, Spain
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31
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Ayala NK, Lewkowitz AK, Whelan AR, Miller ES. Perinatal Mental Health Disorders: A Review of Lessons Learned from Obstetric Care Settings. Neuropsychiatr Dis Treat 2023; 19:427-432. [PMID: 36865680 PMCID: PMC9971615 DOI: 10.2147/ndt.s292734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 02/17/2023] [Indexed: 02/25/2023] Open
Abstract
Perinatal mental health has garnered significant attention within obstetrics over the last couple of decades as the long- and short-term morbidities of untreated perinatal mental health disorders on both the mother and fetus/neonate have become increasingly apparent. There have been major strides in increasing screening for perinatal mental health disorders, clinician comfort with prescribing common psychiatric medications, and integrating mental health professionals into prenatal care via health services approaches such as the collaborative care model. Despite these advances, however, gaps still remain in the tools used for screening and diagnosis, obstetric clinician training in diagnosis and management of perinatal mood and anxiety disorders, as well as patient access to mental health care during pregnancy and especially postpartum. Herein we review the state of perinatal mental health from the perspective of the obstetric provider and identify areas of ongoing innovation.
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Affiliation(s)
- Nina K Ayala
- Division of Maternal Fetal Medicine, Women and Infants Hospital of Rhode Island, Providence, RI, USA.,Department of Obstetrics and Gynecology, Alpert Medical School of Brown University, Providence, RI, USA
| | - Adam K Lewkowitz
- Division of Maternal Fetal Medicine, Women and Infants Hospital of Rhode Island, Providence, RI, USA.,Department of Obstetrics and Gynecology, Alpert Medical School of Brown University, Providence, RI, USA
| | - Anna R Whelan
- Division of Maternal Fetal Medicine, Women and Infants Hospital of Rhode Island, Providence, RI, USA.,Department of Obstetrics and Gynecology, Alpert Medical School of Brown University, Providence, RI, USA
| | - Emily S Miller
- Division of Maternal Fetal Medicine, Women and Infants Hospital of Rhode Island, Providence, RI, USA.,Department of Obstetrics and Gynecology, Alpert Medical School of Brown University, Providence, RI, USA
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Attard R, Iles J, Satherley RM. How acceptable do parents experiencing mental health challenges find e-Health interventions for mental health in the postnatal period: a systematic review. BMC Pregnancy Childbirth 2022; 22:763. [PMID: 36224526 PMCID: PMC9554391 DOI: 10.1186/s12884-022-05070-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 09/21/2022] [Indexed: 11/10/2022] Open
Abstract
Poor mental health in the postnatal period is experienced by high numbers of parents, with a high associated cost to society, however accessing therapeutic support during this time is complicated by parenting commitments. This has been further compounded by the covid-19 pandemic, where access to traditional therapy has been impacted. A lack of access to support for poor mental health in this period can have long term impacts on both the parents and their child. E-Health provides a potential solution to parents accessing support during this period by providing a convenient and flexible intervention which overcomes the barriers of traditional face-to-face therapy. However, without investigating the acceptability of such support for parents, it is not possible to predict uptake and consequent effectiveness. The current review synthesizes data available on acceptability of e-Health interventions in the post-natal period, finding that parents valued e-Health interventions however considerations must be made to certain, key areas impacting the acceptability of these interventions for parents. An element of therapist support and individualised content was preferred, along with a smooth user experience. Parents valued that e-Health fit into their routines and provided anonymity in their interactions. Further research needs to be completed into acceptability for minority social and ethnic groups where access and preference may differ.
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Affiliation(s)
- Rosie Attard
- School of Psychology, Department of Psychological Interventions, University of Surrey, GU2 7XH, Guildford, England, UK.
| | - Jane Iles
- School of Psychology, Department of Psychological Interventions, University of Surrey, GU2 7XH, Guildford, England, UK
| | - Rose-Marie Satherley
- School of Psychology, Department of Psychological Interventions, University of Surrey, GU2 7XH, Guildford, England, UK
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A Missed Opportunity? How Prenatal Care, Birth Hospitalization, and Digital Health Could Increase Nonbirthing Partners' Access to Recommended Medical and Mental Healthcare. J Perinat Neonatal Nurs 2022; 36:330-334. [PMID: 36288436 PMCID: PMC9623469 DOI: 10.1097/jpn.0000000000000688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Daire C, de Tejada BM, Guittier MJ. Fathers' anxiety levels during early postpartum: A comparison study between first-time and multi-child fathers. J Affect Disord 2022; 312:303-309. [PMID: 35760186 DOI: 10.1016/j.jad.2022.06.052] [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: 01/20/2022] [Revised: 06/01/2022] [Accepted: 06/20/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND The postnatal period is considered the most challenging period in the adjustment to fatherhood. This study aimed to assess anxiety levels among fathers during this period. METHODS A comparative study assessing the anxiety levels of first-time and multi-child fathers before the mother and child returned home (0-7 days after birth) was conducted. We used the French validation of the State-Trait Anxiety Inventory (STAI). RESULTS Among 235 fathers who were met at the maternity ward, 182 (77 %) responded to the questionnaire. For most fathers in both groups, anxiety levels were low or very low for trait anxiety (166/182, 91.21 %) and state anxiety (177/182, 97.25 %). Levels of state anxiety were statistically higher for first-time fathers compared to multi-child fathers but were mainly at a low or very low level (70/83 [84 %] versus 71/99 [71 %], respectively, p = 0.029). The multiple linear regression showed that "feeling prepared at birth time" was the only significantly (p < 0.001) associated factor with state anxiety among first-time fathers only. LIMITATIONS The validity and reliability of the STAI have been widely proven for the general population but not specifically for men during the postpartum period. CONCLUSIONS Most fathers had low to very low anxiety levels during the early postpartum period, suggesting that developing new specific support interventions is not needed during early postnatal care. Further research focusing on when the family is back home is warranted.
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Affiliation(s)
- C Daire
- University of Applied Sciences and Arts Western Switzerland (HES-SO) and University of Lausanne (UNIL), Switzerland
| | - B Martinez de Tejada
- Department of Pediatrics, Gynecology and Obstetrics, University Hospitals of Geneva, Geneva, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - M J Guittier
- Department of Pediatrics, Gynecology and Obstetrics, University Hospitals of Geneva, Geneva, Switzerland; School of Health Sciences Geneva HES-SO, University of Applied Sciences and Arts Western, Switzerland.
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Garthus-Niegel S, Radoš SN, Horsch A. Perinatal Depression and Beyond-Implications for Research Design and Clinical Management. JAMA Netw Open 2022; 5:e2218978. [PMID: 35749121 DOI: 10.1001/jamanetworkopen.2022.18978] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Susan Garthus-Niegel
- Institute for Systems Medicine and Faculty of Medicine, MSH Medical School Hamburg, Hamburg, Germany
- Institute and Outpatient Clinics of Occupational and Social Medicine, Faculty of Medicine of the Technische Universität Dresden, Dresden, Germany
- Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway
| | - Sandra Nakic Radoš
- Department of Psychology, Catholic University of Croatia, Zagreb, Croatia
| | - Antje Horsch
- Institute of Higher Education and Healthcare Sciences, University of Lausanne, Lausanne, Switzerland
- Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
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Perez GR, Stasik-O’Brien SM, Laifer LM, Brock RL. Psychological and Physical Intimate Partner Aggression Are Associated with Broad and Specific Internalizing Symptoms during Pregnancy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031662. [PMID: 35162685 PMCID: PMC8834854 DOI: 10.3390/ijerph19031662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/21/2022] [Accepted: 01/28/2022] [Indexed: 12/10/2022]
Abstract
Background: Intimate partner violence (IPV) has serious consequences, particularly during high-risk periods such as pregnancy, which poses a significant risk to maternal mental health. However, it is unclear whether IPV presents a broad risk for psychopathology or is specific to distinct diagnoses or symptom dimensions (e.g., panic, social anxiety). Further, the relative impact of physical versus psychological aggression remains unclear. Methods: One hundred and fifty-nine pregnant couples completed surveys assessing psychological and physical intimate partner aggression unfolding in the couple relationship, as well as a range of internalizing symptoms. Results: Psychological and physical aggression were each associated with broad negative affectivity, which underlies mood and anxiety disorders; however, only psychological aggression demonstrated a unique association. Further, for pregnant women, aggression was uniquely associated with several symptom dimensions characteristic of PTSD. In contrast, men demonstrated a relatively heterogeneous symptom presentation in relation to aggression. Conclusion: The present study identifies unique symptom manifestations associated with IPV for couples navigating pregnancy and suggests psychological aggression can be more detrimental to mental health than physical aggression. To promote maternal perinatal mental health, clinicians should screen for covert forms of psychological aggression during pregnancy (e.g., raised voices, insults), trauma-related distress, and symptom elevations in women and their partners.
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Affiliation(s)
- Gabriela R. Perez
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE 68588, USA; (G.R.P.); (L.M.L.)
- Department of Psychology, Idaho State University, Pocatello, ID 83209, USA
| | | | - Lauren M. Laifer
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE 68588, USA; (G.R.P.); (L.M.L.)
| | - Rebecca L. Brock
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE 68588, USA; (G.R.P.); (L.M.L.)
- Correspondence:
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