Maternal Emotion Regulation Strategies, Internalizing Problems and Infant Negative Affect

The role of emotion regulation in perinatal depression and anxiety: a systematic review

BACKGROUND

Major depressive disorder and anxiety disorders are highly prevalent and comorbid during the perinatal period. Although research and clinicians agree that emotion regulation (ER) is an important transdiagnostic factor underlying both disorders in the general population, ER during the perinatal period has received less research attention. The aim of this systematic review was to assess the literature regarding the role of ten commonly studied ER strategies in the onset and maintenance of perinatal depression and anxiety in pregnant women and young mothers, using the Process Model of Gross (1998) as a theoretical framework.

METHODS

We searched four electronic databases with variations of the following key words: women; emotion regulation (i.e., behavioral approach, behavioral avoidance, problem solving, support seeking, distraction, rumination, reappraisal, acceptance, expressive suppression, and expressive engagement); perinatal period; and psychopathology. The aim was to identify peer-reviewed, and quantitative studies published between January 1999 and January 2023. Six articles were selected for analysis.

RESULTS

Similar ER strategies emerged as risk and protective factors in perinatal depression and anxiety. Overall, behavioral avoidance, distraction, rumination, and expressive engagement appeared as risk factors, while problem solving, emotional and instrumental support seeking, cognitive reappraisal, and acceptance, emerged as protective factors in the onset and maintenance of perinatal depression and anxiety. These findings align with previous research in perinatal community samples, as well as in non-perinatal clinical samples.

CONCLUSIONS

Our results support the role of ER as a transdiagnostic factor underlying both perinatal depression and anxiety. Clinicians are encouraged to implement ER strategies into the screening, prevention, and treatment of perinatal depression and anxiety. Further research is needed to strengthen these findings and to examine the role of emotion regulation during antenatal depression and anxiety more closely.

Relationship between maternal anxiety and infants' temperament: The mediating role of mindful parenting

Research has indicated that maternal anxiety does have an effect on infant temperament. Therefore, it is important to study the variables that could play a role in this relationship. In this study, we propose that mindful parenting could act as a mediator in this relationship. Thus, the main objective was to evaluate the relationship between maternal anxiety and child temperament (i.e., negative affectivity, surgency, and effortful control) through the mindful parenting of mothers. Mothers (N = 225) self-reported their anxiety, mindful parenting use, and the temperament of their old infants (aged 4-18 months). First, the reliability and validity results showed that the infant version of the Interpersonal Mindful Parenting questionnaire was a good tool for the assessment of mindful parenting among parents with infants. The five-factor structure of the questionnaire was confirmed; it involved self-regulation in the parenting relationship, listening with full attention, emotional awareness of the child, compassion for the child, and non-judgmental acceptance of parenting behavior. Correlational analyses showed that maternal anxiety was related to negative affectivity and effortful control in infants. Furthermore, mediational analyses indicated that the relation between maternal anxiety and infant negative affectivity was mediated by self-regulation in parenting and the emotional awareness of the child. In addition, the relation between maternal anxiety and infant effortful control was mediated by compassion for the child and listening with full attention. These results contribute to knowledge about the relation between maternal anxiety and child temperament, which may increase the risk of psychological symptoms. The results of this study suggest that promoting mindful parenting skills may be beneficial for affectivity and effortful control in infants.

Mothers' Emotion Regulation and Negative Affect in Infants: The Role of Self-Efficacy and Knowledge of Parenting Practices

Early in development, children rely heavily on caregivers for assistance with the regulation of negative emotion. As such, it is important to understand parent characteristics that influence caregiver ability to attenuate infant negative affect and mediating factors by which this process may unfold. This study examined the relationship between parental emotional regulation strategies (ERs) and infants' negative affect and tested the mediating effects of parenting self-efficacy and knowledge of this association. Results indicated that higher maternal reappraisal was related to higher maternal self-efficacy whereas higher maternal suppression was related to lower knowledge of parenting practices. Maternal suppression was negatively related to infant frustration; maternal self-efficacy was positively related to infant falling reactivity and negatively related to sadness. There was a significant indirect effect between maternal reappraisal and infant falling reactivity through maternal self-efficacy. The mediation result suggests that mothers with higher use of reappraisal show higher self-efficacy and have infants with higher falling reactivity. Maternal knowledge about parenting practices was related to lower infant fear. Maternal knowledge of parenting practices did not mediate any associations between maternal emotion regulation strategies and infant negative affect. These findings contribute to the understanding early protective parenting mechanisms for supporting the external regulation of negative affect in infants and also in designing and implementing preventive parenting programs focused on the emotional needs of parents and children.

Self-compassion and complete perinatal mental health in women at high risk for postpartum depression: The mediating role of emotion regulation difficulties

OBJECTIVES

There is evidence suggesting that self-compassion is linked to key mechanisms in emotion regulation models of depression and anxiety. However, the majority of prior research has targeted community samples and overlooked the analysis of such mechanisms in relation to positive mental health. This study sought to examine the direct and indirect effects, via emotion regulation difficulties, of self-compassion on the complete mental health outcomes of women at high risk for postpartum depression (PPD).

DESIGN

Cross-sectional, correlational study.

METHODS

The sample for this study comprised 1053 postpartum women presenting high risk for PPD, as determined by the clinical cut-off score obtained through the Postpartum Depression Predictors Inventory-Revised. The assessment protocol further included self-report measures of self-compassion, depression and anxiety symptoms, flourishing and emotion regulation difficulties. Correlation analyses were conducted to ascertain associations between variables, and path analysis was performed to examine direct and indirect effects.

RESULTS

Difficulties in emotion regulation mediated the links between self-compassion and negative (distress) and positive (flourishing) mental health outcomes. The overall mediation model explained 48% and 39% of variance for psychological distress and flourishing/positive mental health respectively.

CONCLUSIONS

These findings support the applicability of an emotion regulation model of self-compassion to women identified as being at high risk of developing PPD. Self-compassion interventions directed at these women are likely to decrease their levels of emotion dysregulation and to improve their complete mental health outcomes.

Emotional Regulation in Mothers and Fathers and Relations to Aggression in Hong Kong Preschool Children

This study explored the associations among emotional regulation in mothers and fathers and preschool children's physical and relational aggression using a Hong Kong Chinese sample. This study also explored whether child gender would moderate the association between parental emotional regulation strategies and children's physical and relational aggression. Participants were 168 children aged 4-6 years. Parents reported on their own emotional regulation approaches and kindergarten class teachers rated children's aggression 6 months later. Path analyses showed that higher levels of reappraisal and lower levels of suppression by mothers was associated with higher levels of child relational aggression. There were no significant associations among fathers' emotional regulation and children's aggression. Results from multi-group analysis showed that there were no significant moderation of the associations by child gender. Results highlight the importance of mothers' emotional regulation in child aggression and suggest that the maladaptive consequences of emotional suppression are culturally relative.

Parent emotional regulation: A meta-analytic review of its association with parenting and child adjustment

We conducted a meta-analytic review of 53 studies published between 2000 and 2020 to quantify associations of parents’ emotion regulation with parenting behavior and children’s emotion regulation and internalizing and externalizing symptoms. Twelve meta-analyses, which included between 4 to 22 effect sizes ( N from 345 to 3609), were conducted to summarize associations of parent emotion regulation with positive or negative parenting behaviors and child outcomes of emotion regulation, difficulties in emotion regulation, internalizing symptoms, or externalizing behavior. Given the range of behavioral parent emotion regulation measures used across studies, effect sizes for parent emotion regulation strategy use ( skill) were analyzed separately from effect sizes for parents’ difficulties with emotion regulation. Summary effect sizes ranged from |.08| to |.28| for relations of parent emotion regulation skill with parenting behaviors and children’s adjustment. Summary effect sizes ranged from |.03| to |.42| for relations of parent emotion regulation difficulties with parenting behaviors and children’s adjustment. In general, parents with better emotion regulation skill or fewer difficulties are higher in positive parenting behaviors and have children with better emotion regulation and fewer internalizing symptoms. Evidence was less clear-cut for child externalizing behaviors. Significant effect size heterogeneity was observed in most analyses, and study characteristics (measures, child age, parent gender, sampling, and region where the study was conducted) were examined as moderators. Measures used, child age, and participant risk status moderated effect size in some analyses.

Maternal influences on binge eating behaviors in children

Binge eating in childhood has been linked to adverse future health outcomes. Parental factors, such as parents' emotion regulation and executive functioning, are likely to influence children's self-regulatory behaviors, including eating. Executive functioning describes a range of higher-order cognitive functions such as planning, abstraction, inhibitory control and working memory, which involves the ability to learn, update and manipulate new information while managing distractions. No studies have examined associations between maternal emotion regulation and executive functioning and the child's maladaptive eating patterns, which was the goal of the present study. Forty-eight mother and child pairs completed self-report clinical measures of emotion dysregulation and attentional control, and mothers completed a brief neuropsychological battery, which included executive functioning measures. Child's disordered eating was measured with the Child Binge Eating Disorder Scale. Linear regression results indicated that mother's performance on a working memory task and child's emotion dysregulation was significantly associated with child's binge eating symptoms (R ² = 0.34). These data, which reveal that maternal executive functioning is associated with self-regulatory behaviors in children, indicate a possible mechanism through which maladaptive eating behaviors may emerge early in development. This relationship merits further exploration in larger-scale prospective intergenerational studies.

The peripartum human brain: Current understanding and future perspectives

The peripartum period offers a unique opportunity to improve our understanding of how dramatic fluctuations in endogenous ovarian hormones affect the human brain and behavior. This notwithstanding, peripartum depression remains an underdiagnosed and undertreated disorder. Here, we review recent neuroimaging findings with respect to the neuroplastic changes in the maternal brain during pregnancy and the postpartum period. We seek to provide an overview of multimodal neuroimaging designs of current peripartum depression models of hormone withdrawal, changes in monoaminergic signaling, and maladaptive neuroplasticity, which likely lead to the development of a condition that puts the lives of mother and infant at risk. We discuss the need to effectively integrate the available information on psychosocial and neurobiological risk factors contributing to individual vulnerability. Finally, we propose a systematic approach to neuroimaging the peripartum brain that acknowledges important co-morbidities and variation in disease onset.

Friendship Quality Moderates the Relation Between Maternal Anxiety and Trajectories of Adolescent Internalizing Symptoms

The current study examined the moderating role of friendship quality on the relation between maternal anxiety and internalizing symptoms in a 3-year prospective study of adolescent development. Participants included 177 adolescents (M _age = 16.05, SD _age = 0.91) and their mothers. Mothers reported their own levels of anxiety; youth completed self-reports of internalizing symptoms and friendship quality. Positive friendship quality moderated the relation between maternal anxiety and initial levels of internalizing symptoms. Maternal anxiety was associated with steeper increases in internalizing symptoms over time, but only for those with greater negative peer interactions. Findings underscore the important role of both parental and peer relationships in the development of internalizing symptoms and highlight specific avenues for clinical interventions.

Associations Between Emotion Regulation and Parental Reflective Functioning

Emotion regulation encapsulates the capability to successfully manage an ongoing emotional experience, particularly in social interactions, and thus may be especially significant to early parent-child relationships. In particular, the capacity to adjust emotions may support parental mentalization and reflective functioning - how parents think about their own and their child's mental states and how these mental states effect behavior. To examine this issue, we investigated the association between emotion regulation, emotion dysregulation, and parental reflective functioning in a maternal sample (N=97). We found that mothers with higher tendencies to suppress their emotions and who had more difficulties with emotion regulation engaged in greater levels of pre-mentalizing (i.e., a non-mentalizing mode). Mothers with poorer emotional awareness also evidenced less interest and curiosity in their child's mental states. Finally, mothers who reported greater difficulty setting goals also evidenced a reduced capacity to recognize that their infant's mental states are not directly observable. Taken together, our findings support the relationship between different aspects of emotion regulation and maternal reflective functioning, suggesting that emotion regulation should be integrated in empirical and intervention work that targets maternal mentalization.

Be a Mom, a Web-Based Intervention to Prevent Postpartum Depression: The Enhancement of Self-Regulatory Skills and Its Association With Postpartum Depressive Symptoms

Aim: Be a Mom is a self-guided, web-based intervention to prevent persistent postpartum depression symptoms [PPD], targeting both at-risk postpartum women and/or women presenting early-onset postpartum depressive symptoms (selective/indicated preventive intervention). Be a Mom is grounded on the principles of Cognitive-Behavior Therapy and incorporates the recent contributions of acceptance and compassion-based approaches (third-wave approaches) applied to the perinatal context. This study aimed to explore the processes underlying therapeutic change in the Be a Mom intervention, by: (1) exploring whether participation in the Be a Mom promotes the enhancement of self-regulatory skills (emotion regulation abilities, psychological flexibility and self-compassion) in comparison with women who did not participate in the program; and (2) exploring whether changes in self-regulatory skills are associated with changes in depressive symptoms, among women who participated in the Be a Mom program. Methods: A pilot randomized, two-arm controlled trial was conducted. Eligible women (presenting PPD risk-factors and/or early-onset PPD symptoms) were enrolled in the study and were randomly assigned to the intervention group (Be a Mom, n = 98) or to the waiting-list control group (n = 96). Participants in both groups completed baseline (T1) and post-intervention assessments (T2), including measures of depressive symptoms, emotion regulation abilities, psychological flexibility and self-compassion. Results: From baseline to post-intervention assessment, women in the intervention group showed a significantly greater decrease in the levels of emotion regulation difficulties (p < 0.001) and a significant greater increase in the levels of self-compassion (p < 0.001) compared to the control group. No significant differences were found concerning psychological flexibility. Moreover, a greater decrease in difficulties in emotion regulation and greater increase in self-compassion levels were significantly associated with a greater decrease in depressive symptoms, among women in the intervention group. Discussion: Be a Mom promotes the enhancement of women's emotion regulation abilities and self-compassion, and this seems to exert a protective effect in the presence of PPD risk factors (or early-onset symptoms) because it led to a reduction of depressive symptoms. By providing some insights into the processes that underlie treatment response to Be a Mom, this study highlights the important role of the targeted third-wave processes applied to the perinatal context.

Mothers' negative emotional expression and preschoolers' negative emotional regulation strategies in Beijing, China: The moderating effect of maternal educational attainment

The relationship between mothers' negative emotional expression and preschoolers' negative emotional regulation has been a topic of debate. Studies have confirmed the unique effect of maternal education on children's emotional regulation. Further understanding of the role of maternal educational attainment in the relationship between mothers' emotional expression and children's emotional regulation strategies will help us better explain the possible reasons for the differences in children's emotional regulation abilities. In this study, 503 Chinese mother-child dyads were recruited. The Chinese version of the Self-Expressiveness in the Family Questionnaire (SEFQ) was used to measure the mothers' negative emotional expression, and the Emotional Regulatory Strategy Questionnaire (ERQ) was used to measure the children's negative emotional regulation strategies. The results indicated that mothers' negative emotional expression was positively related to children's negative emotional regulation strategies. Moreover, maternal educational attainment moderated this relationship. The findings of the current study demonstrate the importance of mothers' educational background, providing an important supplement to and extension of previous research on family emotions.