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Murray L, Jaffe NM, Tierney AO, Pidvirny K, Balkind EG, Abbasi BS, Brown M, Webb CA. Brain mechanisms of rumination and negative self-referential processing in adolescent depression. J Affect Disord 2024; 366:83-90. [PMID: 39191310 PMCID: PMC11468901 DOI: 10.1016/j.jad.2024.08.114] [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: 04/01/2024] [Revised: 08/21/2024] [Accepted: 08/22/2024] [Indexed: 08/29/2024]
Abstract
BACKGROUND Depression is linked to cognitive biases towards more negative and less positive self-relevant information. Rumination, perseverative negative thinking about the past and the self, may contribute to these biases. METHODS 159 adolescents (12-18 years), with a range of depression symptoms, completed the SRET during fMRI. Multiple regressions tested associations between conventional self-report and ecological momentary assessment (EMA) measured rumination, and neural and behavioral responses during a self-referent encoding task (SRET). RESULTS Higher rumination (conventional self-report and EMA) was associated with more negative and fewer positive words endorsed and recalled. Higher self-reported (but not EMA) rumination was associated with higher accuracy in recognizing negative words and greater insula and dorsal anterior cingulate activity to negative versus positive words. LIMITATIONS The sample included mostly non-Hispanic White participants with household incomes above the national average, highlighting the need for replication in more diverse samples. Word endorsement discrepancies required fMRI analyses to model neural response to viewing negative versus positive words. CONCLUSIONS Adolescents with higher rumination endorsed and recalled more negative and fewer positive words and recognized more negative words during the SRET. Higher insula reactivity, a key region for modulating externally-oriented attention and internally-oriented self-referential processes, may contribute to links between rumination and negative memory biases. These findings provide insight into neurocognitive mechanisms underlying depression.
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Affiliation(s)
- Laura Murray
- Cognitive and Pharmacological Neuroimaging Unit, National Institute on Drug Abuse, Biomedical Research Center, 251 Bayview Blvd, Baltimore, MD 21224, United States of America; McLean Hospital, 115 Mill Street, Belmont, MA 02478, United States of America.
| | - Nigel M Jaffe
- McLean Hospital, 115 Mill Street, Belmont, MA 02478, United States of America
| | - Anna O Tierney
- McLean Hospital, 115 Mill Street, Belmont, MA 02478, United States of America
| | - Kristina Pidvirny
- McLean Hospital, 115 Mill Street, Belmont, MA 02478, United States of America
| | - Emma G Balkind
- McLean Hospital, 115 Mill Street, Belmont, MA 02478, United States of America
| | - Batool S Abbasi
- McLean Hospital, 115 Mill Street, Belmont, MA 02478, United States of America
| | - Miranda Brown
- McLean Hospital, 115 Mill Street, Belmont, MA 02478, United States of America
| | - Christian A Webb
- McLean Hospital, 115 Mill Street, Belmont, MA 02478, United States of America; Department of Psychiatry, Harvard Medical School, Boston, MA 02215, United States of America
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Vega-Sanz M, Rey-Sáez R, Berástegui A, Sánchez-López Á. Difficulties in Pregnancy Adjustment as Predictors of Perinatal Depression: Indirect Effects through the Role of Brooding Rumination and Maternal-Fetal Bonding. Am J Perinatol 2024; 41:e2870-e2877. [PMID: 37848044 PMCID: PMC11150065 DOI: 10.1055/s-0043-1776062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
OBJECTIVE The aim of this research was to study the ways in which problems of adaptation to pregnancy influence the development of symptoms of perinatal depression via the presence of brooding and low maternal-fetal bonding, in addition to other risk factors previously established in the literature. STUDY DESIGN Representative sample of pregnant women in the third trimester of gestation (N = 594) completed an online survey that included sociodemographic data and measures of perinatal depression, adjustment to pregnancy, bonding, and brooding. Other risk factors were also assessed as covariates, such as previous history of depression, generalized anxiety, perceived social support, and experience of stressful life events. Descriptive and correlational analyses were performed on the scores obtained by the subjects with the different instruments. A path model was formulated to establish the pathways through which adjustment influences perinatal depression symptomatology. On the one hand, the presence of brooding (worst adjustment to pregnancy → high brooding → perinatal depression symptomatology), and on the other hand, the quality of maternal-fetal bonding (worst adjustment to pregnancy → poor quality fetal-maternal bonding → perinatal depression symptomatology) would act as a mediator. RESULTS The factors proposed by the literature were predictive of perinatal depressive symptomatology and the quality of adjustment to pregnancy. Problems adjusting to changes during pregnancy and experiencing it unsatisfactorily may predict individual differences in perinatal depressive symptoms. Significantly, this relationship was mediated by two key factors, the presence of brooding and low quality of the maternal-fetal bond. CONCLUSION Our results provide evidence in favor of the existence of multiple paths through which difficulties in adapting to pregnancy can favor the occurrence of higher levels of perinatal depressive symptoms and identify new avenues for developing research in this area and preventive interventions empirically informed.
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Affiliation(s)
- Maria Vega-Sanz
- University Institute of Family Studies, Comillas Pontifical University, Madrid, Spain
| | - Ricardo Rey-Sáez
- Department of Personality, Evaluation and Psychological Treatments, Complutense University of Madrid, Madrid, Spain
| | - Ana Berástegui
- University Institute of Family Studies, Comillas Pontifical University, Madrid, Spain
| | - Álvaro Sánchez-López
- Department of Personality, Evaluation and Psychological Treatments, Complutense University of Madrid, Madrid, Spain
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Miller ML, Jiang LJ, O'Hara MW. Experiential avoidance as a mediator of risk factors for higher order internalizing psychopathology in the perinatal period. J Clin Psychol 2024; 80:625-645. [PMID: 38265296 DOI: 10.1002/jclp.23644] [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: 04/09/2023] [Revised: 11/09/2023] [Accepted: 01/07/2024] [Indexed: 01/25/2024]
Abstract
OBJECTIVES Perinatal psychopathology can be damaging. This study examined the strength of the associations between risk factors and all perinatal mood and anxiety disorder symptoms while assessing the mediating effect of experiential avoidance. METHOD Participants (N = 246) completed assessments during pregnancy (28-32 weeks) and the postpartum (6-8 weeks). Structural equation modeling (SEM) was used to examine associations between risk factors and latent factors: distress (composed of depression, generalized anxiety, irritability, and panic symptoms); fear (social anxiety, agoraphobia, specific phobia, and obsessive-compulsive); and bipolar (mania and obsessive-compulsive). RESULTS During pregnancy, past psychiatric history, anxiety sensitivity, maladaptive coping, and age were significant risk factors. In the postpartum, negative maternal attitudes and past psychiatric history were only risk factors for symptoms that composed distress. Experiential avoidance mediated the relation between maladaptive coping and symptoms that composed fear. CONCLUSION It is important to assess for psychological risk factors starting in pregnancy. This study identified critical risk factors that are associated with the underlying commonality among perinatal mood and anxiety symptoms. Some of the risk factors as well as the mediator are malleable (negative maternal attitudes, experiential avoidance), creating new possibilities for prevention and treatment of perinatal mood and anxiety disorder symptoms.
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Affiliation(s)
- Michelle L Miller
- University of Iowa, Iowa City, Iowa, USA
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Lily J Jiang
- Indiana University-Bloomington, Bloomington, Indiana, USA
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Nikandish Z, Sajjadian I. The effectiveness of behavioral activation therapy on the symptoms of depression, rumination, and social-occupational functioning impairment among women with postpartum depression. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2024; 13:17. [PMID: 38532913 PMCID: PMC10965035 DOI: 10.4103/jehp.jehp_1783_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 05/06/2023] [Indexed: 03/28/2024]
Abstract
BACKGROUND Postpartum depression is caused by a wide range of factors, and women in their postpartum period are highly vulnerable, either physically or emotionally. The present study aimed to investigate the effects of behavioral activation therapy on the symptoms of depression, rumination, and social-occupational functioning impairment among women with postpartum depression (PPD). MATERIALS AND METHODS This quasi-experimental research included a pre-test, a post-test, and a one-month follow-up, as well as experimental and control groups. The participants were screened using Edinburgh Postnatal Depression Scale (EDPS) in 2019. The research included 32 women who had visited Isfahan Healthcare Centers. They were selected using convenience sampling and then randomly divided into experimental (16 individuals) and control groups (16 individuals). Both groups answered the following questionnaires before, immediately after, and one month after the intervention: Beck Depression Inventory (BDI), Nelon, et al. Ruminative Response Scale, and Mundt et al. Work and Social Adjustment Scale (WSAS). The experimental group received behavioral activation therapy for nine 90-minute sessions once a week. The data were analyzed using the statistical method of multivariance analysis of covariance (MANCOVA). RESULT The results showed that behavioral activation therapy had a significant effect on the symptoms of depression (P = 0.001, F = 79.65), postpartum depression (P = 0.001, F = 220.359), rumination (P = 0.001, F = 121.765), and social-occupational functioning impairment (P = 0.001, F = 368.512) among women with postpartum depression. The effects of behavioral activation therapy also lasted in the follow-up stage of the study. CONCLUSION According to the present research, behavioral activation therapy is an effective method that decreases the symptoms of depression, rumination, and occupational-social functioning impairment among women with postpartum depression. Therefore, behavioral activation therapy could be beneficial to intervention designs and treatment of postpartum depression.
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Affiliation(s)
- Zahra Nikandish
- PHD Student, Psychology Department, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran
| | - Ilnaz Sajjadian
- Department of Clinical Psychology, Community Health Research Center, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran
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Meng F, Cheng C, Xie Y, Ying H, Cui X. Perceived parental warmth attenuates the link between perceived parental rejection and rumination in Chinese early adolescents: two conditional moderation models. Front Psychiatry 2024; 15:1294291. [PMID: 38328760 PMCID: PMC10848273 DOI: 10.3389/fpsyt.2024.1294291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 01/08/2024] [Indexed: 02/09/2024] Open
Abstract
Background Prior studies have explored the association between perceived parental rejection-warmth and adolescents' rumination, but it is unclear whether the interaction between perceived parental rejection and warmth can predict adolescents' rumination in a Chinese context and whether this interaction varies by children's gender during the post-COVID-19 era. Objective This study aimed to address these issues in Chinese early adolescents from a family system perspective. Methods A total of 910 adolescents (M age = 13.63, 48.50% female) from two middle schools in Chongqing and Changsha, China participated in the survey, answering measures for demographics, perceived parental rejection-warmth, and rumination. Results The results show that adolescents' rumination was positively related to perceived paternal rejection (r = 0.326, p <.001) and maternal rejection (r = 0.343, p <.001), and negatively related to perceived paternal warmth (r = -.184, p <.001) and maternal warmth (r = -0.125, p <.001). Moreover, perceived maternal warmth significantly moderated the link between perceived paternal rejection and adolescents' rumination (boot effect = -0.066, 95CI% = [-0.124, -0.010]), but this moderating effect is only presented in boys not in girls (boot effect = -0.063, 95CI% = [-0.015, 0.140]). However, perceived paternal warmth moderated the link between perceived maternal rejection and rumination in adolescents (boot effect = -0.052, 95CI% = [-0.103, -0.001]), and this interaction varied by adolescents' gender (boot effect = 0.103, 95CI% = [0.029, 0.177]). Conclusions Perceived Parental rejection and parental warmth co-exist in the Chinese family system, and they exert an interactive effect on adolescents' rumination depending on their gender. It implies that both parents should be more accepting, caring, considerate, and warm toward their daughters, and it is also in line with the tradition and status quo of parenting in Chinese families. These findings have implications for Chinese parental co-parenting practices in families with adolescents and adolescence mental health counseling work.
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Affiliation(s)
- Fanfei Meng
- School of Education Science, Nanjing Normal University, Nanjing, China
- School of Preschool Education, Changsha Normal University, Changsha, China
| | - Cuiping Cheng
- School of Teacher Development, Chongqing University of Education, Chongqing, China
| | - Yuntian Xie
- School of Preschool Education, Changsha Normal University, Changsha, China
| | - Haihua Ying
- International School, Hohai University, Nanjing, China
| | - Xinling Cui
- School of Education Science, Northwest Normal University, Lanzhou, China
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Tester-Jones M, Moberly NJ, Karl A, O'Mahen H. Daily relationships among maternal rumination, mood and bonding with infant. Behav Res Ther 2023; 165:104309. [PMID: 37037181 DOI: 10.1016/j.brat.2023.104309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 02/23/2023] [Accepted: 03/27/2023] [Indexed: 03/31/2023]
Abstract
There is little research examining the association between maternal maladaptive emotion regulation strategies such as rumination and perceived maternal bonding and mood. This study investigated the concurrent and prospective relationship of both trait and daily rumination with daily perceived maternal bonding and mood. Ninety-three mothers of infants aged between 3 and 14 months completed a ten-day diary study investigating the relationship between daily and trait ruminative self-focus, negative affect and perceived maternal bonding, or her perceived feelings of closeness with her infant. The majority of mothers reported mild to moderate depressive symptoms. The data were analysed using Hierarchical Linear Modelling. Baseline depressive symptoms and trait rumination were each positively associated with mean levels of daily ruminative self-focus and mood over the ten-day sampling period. Bonding with infant at baseline was not associated with mean levels of daily rumination, mood or bonding over the sampling period. Concurrently, daily rumination and daily bonding were negatively correlated, after accounting for daily mood. Prospectively, lower levels of daily bonding predicted increases in daily rumination and depressive mood on the subsequent day. Interestingly, daily rumination did not predict increases in depressive mood or bonding on the subsequent day, suggesting that rumination occurred in response to perceived disruptions in feelings of closeness with the infant, but did not lead to prospective decreases in these feelings of closeness. These findings hold important implications for understanding the relationship between the mother-infant relationship, and maternal rumination and depressive mood, suggesting that disruptions in the way mothers perceive they are bonding to their infants may contribute to depressongenic processes.
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Moulds ML, Black MJ, Newby JM, Hirsch CR. Correlates of repetitive negative thinking in postnatal first time mothers. J Reprod Infant Psychol 2023; 41:53-64. [PMID: 34261384 DOI: 10.1080/02646838.2021.1946023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Despite the well-established role of repetitive negative thinking (RNT) in the prediction and maintenance of depression and anxiety, only minimal research to date has investigated RNT in the context of postnatal psychological adjustment. OBJECTIVE We examined the relationships between RNT, associated maladaptive cognitive processes, infant responsiveness and psychopathology in a sample of first-time mothers (N = 235) with babies under 12 months. METHODS Participants completed an online battery of measures that indexed RNT, dampening of positive affect, metacognitive beliefs about RNT, infant responsiveness, depression and anxiety symptoms. RESULTS As predicted, RNT was correlated with depression. Controlling for depression, RNT was associated with anxiety, dampening positive affect and positive beliefs about RNT. RNT was inversely related to maternal responsiveness, but this relationship was accounted for by depression. CONCLUSIONS Consistent with findings in the broader literature, RNT was associated with depression, anxiety and other unhelpful cognitive processes in the postnatal period, as well as with poor infant responsiveness. Whilst cross-sectional and preliminary, these data suggest there may be potential clinical utility in targeting RNT in first-time mothers.
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Affiliation(s)
- Michelle L Moulds
- School of Psychology, The University of New South Wales, UNSW Sydney, Sydney, Australia
| | - Melissa J Black
- School of Psychology, The University of New South Wales, UNSW Sydney, Sydney, Australia.,Black Dog Institute, The University of New South Wales, UNSW Sydney, Sydney, Australia
| | - Jill M Newby
- School of Psychology, The University of New South Wales, UNSW Sydney, Sydney, Australia.,Black Dog Institute, The University of New South Wales, UNSW Sydney, Sydney, Australia
| | - Colette R Hirsch
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
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Beck S, Whitaker K, Cropley M. Is rumination associated with psychological distress after a cancer diagnosis? A systematic review. J Psychosoc Oncol 2023; 41:584-609. [PMID: 36604965 DOI: 10.1080/07347332.2022.2145925] [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] [Indexed: 01/07/2023]
Abstract
Objective: The aim of this work was to review evidence on the association between psychological rumination and distress in those diagnosed with cancer. Methods: Six databases were searched for studies exploring rumination alongside overall assessments of psychological distress, depression, anxiety, or stress. Results: Sixteen studies were identified. Rumination was associated with distress cross-sectionally and longitudinally. However, once baseline depression was controlled for, the association was no longer seen. The emotional valence of ruminative thoughts and the style in which they were processed, rather than their topic, was associated with distress. Brooding and intrusive rumination were associated with increased distress, deliberate rumination had no association, and reflection/instrumentality had mixed findings. Conclusions: This review highlights that it is not necessarily the topic of content, but the style and valence of rumination that is important when considering its association with distress. The style of rumination should be the target of clinical intervention, including brooding and intrusion.
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Affiliation(s)
- Sarah Beck
- School of Psychology, University of Surrey, Guildford, UK
| | | | - Mark Cropley
- School of Psychology, University of Surrey, Guildford, UK
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Bohne A, Nordahl D, Høifødt RS, Moe V, Landsem IP, Wang CEA, Pfuhl G. Do parental cognitions during pregnancy predict bonding after birth in a low-risk sample? Front Psychol 2022; 13:986757. [PMID: 36452378 PMCID: PMC9704052 DOI: 10.3389/fpsyg.2022.986757] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 10/14/2022] [Indexed: 09/06/2024] Open
Abstract
Parental bonding to their infant is important for healthy parent-infant interaction and infant development. Characteristics in the parents affect how they bond to their newborn. Parental cognitions such as repetitive negative thinking, a thinking style associated with mental health issues, and cognitive dispositions, e.g., mood-congruent attentional bias or negative implicit attitudes to infants, might affect bonding. To assess the influence of cognitive factors on bonding, 350 participants (220 pregnant women and their partners) were recruited over two years by midwives at the hospital and in the communal health care services. Participants were followed throughout the pregnancy and until the infant was seven months old as a part of the Northern Babies Longitudinal Study. Both mothers and fathers took part. First, we measured demographics, repetitive negative thinking, attentional bias, and implicit attitudes to infants during pregnancy, as predictors of bonding two months postnatally. Second, we also measured infant regulatory problems, and depressive symptoms at two months postnatally as predictors of parents' perception of infant temperament at five months. Robust regression analyses were performed to test hypotheses. Results showed that mothers and fathers differed on several variables. Parity was beneficial for bonding in mothers but not for fathers. Higher levels of mothers' repetitive negative thinking during pregnancy predicted weaker bonding, which was a non-significant trend in fathers. For fathers, higher education predicted weaker bonding, but not for mothers. Mothers' perception of their infant temperament at five months was significantly affected by bonding at two months, but for fathers, their depressive symptoms were the only significant predictor of perceived infant temperament. In conclusion, for mothers, their relationship with their infant is essential for how they experience their infant, while for fathers their own wellbeing might be the most important factor. Health care providers should screen parents' thoughts and emotions already during pregnancy to help facilitate optimal bonding.
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Affiliation(s)
- Agnes Bohne
- Department of Psychology, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
- Division of Child and Adolescent Health, University Hospital of Northern Norway, Tromsø, Norway
| | - Dag Nordahl
- Department of Psychology, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Ragnhild Sørensen Høifødt
- Department of Psychology, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Vibeke Moe
- Department of psychology, University of Oslo, Oslo, Norway
| | - Inger Pauline Landsem
- Division of Child and Adolescent Health, University Hospital of Northern Norway, Tromsø, Norway
- Department of Health Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Catharina E. A. Wang
- Department of Psychology, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Gerit Pfuhl
- Department of Psychology, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
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Harrison V, Moulds ML, Jones K. Support from friends moderates the relationship between repetitive negative thinking and postnatal wellbeing during COVID-19. J Reprod Infant Psychol 2022; 40:516-531. [PMID: 33586544 DOI: 10.1080/02646838.2021.1886260] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Increasing evidence has linked repetitive negative thinking (RNT) to postnatal depression and anxiety, yet the factors moderating this relationship have been minimally investigated. During the COVID-19 pandemic of 2020, social restrictions imposed to reduce viral transmission limited access to social support, which is critical to postnatal psychological wellbeing - potentially intensifying RNT. OBJECTIVE We examined whether perceived social support (from friends, family, and a significant other) played a moderating role in the relationship between RNT and maternal postnatal anxiety and depressive symptoms. METHODS A sample of women (N = 251) who had given birth in the preceding 12 months completed an online battery of standardised measures during the COVID-19 'lockdown' of May 2020. RESULTS As predicted, social support moderated the relationship between RNT and depression such that the association between RNT and depression was stronger for women who reported lower levels of social support. Interestingly, this finding emerged for social support from friends only; for support from family and significant other, social support did not play a moderating role. Further, and unexpectedly, overall social support did not moderate the relationship between RNT and postnatal anxiety, however, social support from friends was a significant moderator. CONCLUSIONS High levels of perceived social support from friends (but not family or significant others) buffered the effects of RNT on depression and anxiety during the postpartum period. Strategies to bolster peer social support may be a valuable inclusion in interventions to prevent and treat postnatal depression and anxiety.
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Affiliation(s)
- Virginia Harrison
- School of Psychology and Counselling, The Open University, Milton Keynes, UK
| | - Michelle L Moulds
- School of Psychology and Counselling, The University of New South Wales, Sydney, Australia
| | - Katie Jones
- School of Psychology and Counselling, The Open University, Milton Keynes, UK
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11
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Rumination, automatic thoughts, dysfunctional attitudes, and thought suppression as transdiagnostic factors in depression and anxiety. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-020-01086-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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12
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Petrošanec M, Brekalo M, Nakić Radoš S. The metacognitive model of rumination and depression in postpartum women. Psychol Psychother 2022; 95:838-852. [PMID: 35638223 DOI: 10.1111/papt.12405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 04/11/2022] [Accepted: 05/12/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVES The metacognitive model of rumination and depression (Papageorgiou & Wells, 2003, Cognitive Therapy and Research, 27, 261) postulates that beliefs that perseverative negative thinking, i.e. rumination, will help solve problems contributing to rumination. However, this activates negative beliefs about the uncontrollability and social consequences of ruminations, which exacerbate depression. The metacognitive model has been well-supported but with some inconsistencies in specific pathways. It has also not yet been tested for postpartum depression (PPD). Therefore, this study aimed to examine the relations between the metacognitive model of rumination and depression when applied to PPD symptoms and to compare it with the cognitive model of depression. DESIGN This is a cross-sectional study. METHOD Postpartum mothers (N = 603) participated in an online study in their first postpartum year. They completed the Edinburgh Postnatal Depression Scale (EPDS), Postnatal Negative Thoughts Questionnaire (PNTQ), Ruminative Responses Scale (RRS), Positive Beliefs about Rumination Scale (PBRS) and Negative Beliefs about Rumination Scale (NBRS). RESULTS A path analysis revealed that the model had an excellent fit to the data. Specifically, positive beliefs about rumination predicted engagement in rumination that, in turn, predicted PPD, both directly and indirectly, through negative beliefs about uncontrollability and the social consequences of rumination. A cognitive model with ruminations as a partial mediator between negative postpartum thoughts and PPD symptoms also had a good fit. CONCLUSION The findings of this study contribute to the understanding of the cognitive and metacognitive mechanisms underlying postpartum depression, which might be similar to depression in general and have important implications for treatment strategies.
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Affiliation(s)
- Maja Petrošanec
- Faculty of Education and Rehabilitation Sciences, University of Zagreb, Zagreb, Croatia
| | - Maja Brekalo
- Department of Psychology, Catholic University of Croatia, Zagreb, Croatia
| | - Sandra Nakić Radoš
- Department of Psychology, Catholic University of Croatia, Zagreb, Croatia
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Moulds ML, Bisby MA, Black MJ, Jones K, Harrison V, Hirsch CR, Newby JM. Repetitive negative thinking in the perinatal period and its relationship with anxiety and depression. J Affect Disord 2022; 311:446-462. [PMID: 35597469 DOI: 10.1016/j.jad.2022.05.070] [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: 03/24/2022] [Revised: 05/04/2022] [Accepted: 05/13/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Rumination and worry represent two types of repetitive negative thinking (RNT), and their predictive and maintaining roles are well-established in depression and anxiety, respectively. Furthermore, there is an emerging literature on the link between RNT and psychological wellbeing in the perinatal period. METHODS We conducted a scoping review of studies that have investigated the relationship between RNT and perinatal depression and anxiety. We identified 87 papers eligible for inclusion in the review; they included cross-sectional and longitudinal studies, as well as treatment evaluations (pilot trials and randomised controlled trials). RESULTS Cross-sectional studies provided evidence of an association between RNT (i.e., rumination and worry) and depression and anxiety, in both pregnancy and postpartum. Longitudinal findings were mixed. Whilst antenatal worry consistently predicted subsequent depression and anxiety (both later in pregnancy and postpartum), rumination did not consistently predict depression. However, there was some evidence that rumination interacted with other processes to predict later psychopathology. Three randomised controlled trials evaluated whether psychological treatments reduce RNT in the perinatal period, only one of which included a clinical sample. LIMITATIONS No experimental investigations were eligible for inclusion in the review. CONCLUSIONS Further studies are needed to further our understanding of the nature and role of RNT in pregnancy and postpartum, and its consequences for maternal mental health. These include (but are not limited to) experimental investigations, studies with large clinical samples, and RCTs evaluating the effectiveness of psychological interventions targeting RNT to prevent and treat perinatal depression and anxiety.
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Affiliation(s)
| | - Madelyne A Bisby
- eCentreClinic, School of Psychological Sciences, Macquarie University, Australia
| | - Melissa J Black
- School of Psychology, UNSW Sydney, Australia; Black Dog Institute, UNSW Sydney, Australia
| | - Katie Jones
- School of Health, Wellbeing and Social Care, The Open University, UK
| | | | - Colette R Hirsch
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; South London and Maudsley NHS Foundation Trust, UK
| | - Jill M Newby
- School of Psychology, UNSW Sydney, Australia; Black Dog Institute, UNSW Sydney, Australia
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Guyon-Harris KL, Taraban L, Bogen DL, Wilson MN, Shaw DS. Individual differences in symptoms of maternal depression and associations with parenting behavior. JOURNAL OF FAMILY PSYCHOLOGY : JFP : JOURNAL OF THE DIVISION OF FAMILY PSYCHOLOGY OF THE AMERICAN PSYCHOLOGICAL ASSOCIATION (DIVISION 43) 2022; 36:681-691. [PMID: 35389670 PMCID: PMC9703954 DOI: 10.1037/fam0000988] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Links between global levels of maternal depressive symptoms and parenting behavior in early childhood are well established. However, depression is a heterogeneous disorder and little is known about how individual differences in depression symptoms may be differentially associated with different types of parenting behavior. We aimed to uncover nuance in the relationship between depression and parenting behavior by examining individual differences in symptoms of maternal depression and associations with parenting behavior with 2- and 3-year-old children. Participants included 714 diverse, low-income mothers and their 2-year-old children. Maternal depression symptoms were self-reported at child age 2. Three domains of parenting behavior (harsh, positive, and disengaged) were coded from mother-child interactions at ages 2 and 3. Individual differences in maternal depressive symptoms at child age 2 comprised five profiles: low, interpersonal rejection, moderate, high depressed affect and physical, and severe. Women with the high depressed affect and physical profile demonstrated the greatest risk for parenting challenges with higher levels of harsh parenting at child age 2 compared to all other profiles and higher levels of disengaged parenting at child age 3 compared to the low, moderate, and severe profiles. Unexpectedly, positive parenting did not differ by maternal depression profile at either age. There is wide heterogeneity in symptoms of depression among mothers of 2-year-old children that is clinically relevant for different dimensions of parenting. Physical and depressed affect symptoms in particular may present risk for harsh parenting. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Effectiveness of Existential Therapy Based on Ontological Core Schemas on Rumination and Mindfulness of Depressed Women: A Randomized Clinical Trial Design. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2022. [DOI: 10.1007/s10879-022-09552-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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16
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Kalmbach DA, Cheng P, Roth T, Swanson LM, Cuamatzi-Castelan A, Roth A, Drake CL. Examining Patient Feedback and the Role of Cognitive Arousal in Treatment Non-response to Digital Cognitive-behavioral Therapy for Insomnia during Pregnancy. Behav Sleep Med 2022; 20:143-163. [PMID: 33719795 PMCID: PMC8440671 DOI: 10.1080/15402002.2021.1895793] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Insomnia affects over half of pregnant and postpartum women. Early evidence indicates that cognitive-behavioral therapy for insomnia (CBTI) improves maternal sleep and mood. However, standard CBTI may be less efficacious in perinatal women than the broader insomnia population. This study sought to identify patient characteristics in a perinatal sample associated with poor response to CBTI, and characterize patient feedback to identify areas of insomnia therapy to tailor for the perinatal experience. PARTICIPANTS Secondary analysis of 46 pregnant women with insomnia symptoms who were treated with digital CBTI in a randomized controlled trial. METHODS We assessed insomnia, cognitive arousal, and depression before and after prenatal treatment, then 6 weeks postpartum. Patients provided feedback on digital CBTI. RESULTS Residual cognitive arousal after treatment was the most robust factor associated with treatment non-response. Critically, CBTI responders and non-responders differed on no other sociodemographic or pretreatment metrics. After childbirth, short sleep (<6 hrs/night) was associated with maternal reports of poor infant sleep quality. Patient feedback indicated that most patients preferred online treatment to in-person treatment. Although women described digital CBTI as convenient and helpful, many patients indicated that insomnia therapy would be improved if it addressed sleep challenges unique to pregnancy and postpartum. Patients requested education on maternal and infant sleep, flexibility in behavioral sleep strategies, and guidance to manage infant sleep. CONCLUSIONS Modifying insomnia therapy to better alleviate refractory cognitive arousal and address the changing needs of women as they progress through pregnancy and early parenting may increase efficacy for perinatal insomnia.Name: Insomnia and Rumination in Late Pregnancy and the Risk for Postpartum DepressionURL: clinicaltrials.govRegistration: NCT03596879.
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Affiliation(s)
- David A Kalmbach
- Thomas Roth Sleep Disorders & Research Center, Henry Ford Health System, Detroit, Michigan
| | - Philip Cheng
- Thomas Roth Sleep Disorders & Research Center, Henry Ford Health System, Detroit, Michigan
| | - Thomas Roth
- Thomas Roth Sleep Disorders & Research Center, Henry Ford Health System, Detroit, Michigan
| | - Leslie M Swanson
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | | | - Andrea Roth
- Thriving Minds Behavioral Health, Brighton, Michigan
| | - Christopher L Drake
- Thomas Roth Sleep Disorders & Research Center, Henry Ford Health System, Detroit, Michigan
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Liakea I, K. C. A, Bränn E, Fransson E, Sundström Poromaa I, Papadopoulos FC, Skalkidou A. Working Memory During Late Pregnancy: Associations With Antepartum and Postpartum Depression Symptoms. Front Glob Womens Health 2022; 3:820353. [PMID: 35284907 PMCID: PMC8904422 DOI: 10.3389/fgwh.2022.820353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 01/27/2022] [Indexed: 11/13/2022] Open
Abstract
Background Few studies, with conflicting results, report on the association between memory performance and depressive symptoms during the perinatal period. In this study, we aimed to evaluate whether memory performance during late pregnancy is associated with antepartum (APD) and postpartum depression (PPD) symptoms. Method We conducted a prospective follow-up of 283 pregnant women, nested within a large cohort of women enrolled in the BASIC study in Uppsala University hospital between 2009 and 2019. The Wechsler Digit Span Task (forward-DSF, backward-DSB and total score-DST) was performed to evaluate short-term memory/attention (DSF) and working memory (DSB) around the 38th gestational week; the Edinburgh Postnatal Depression Scale (EPDS), evaluating depressive symptoms, was filled out at 17, 32, 38 gestational weeks, as well as at 6 weeks postpartum. Unadjusted and multivariate logistic regression was used to assess the association between performance on the Digit Span Task and outcome, namely depressive symptoms (using a cut-off of 12 points on the EPDS) at 38 gestational weeks, as well as at 6 weeks postpartum. Results APD symptoms were not significantly associated with DSF (p = 0.769) or DSB (p = 0.360). APD symptoms were significantly associated with PPD symptoms (p < 0.001). Unadjusted regression modeling showed that DSF in pregnancy was a significant predictor of PPD symptoms (OR 1.15; 95% CI, 1.00, 1.33, p = 0.049), and remained a significant predictor when adjusted for confounders (education and feeling rested at assessment; OR 1.21, 95% CI 1.03, 1.42, p = 0.022). DSF was a predictor of PPD symptoms only for women without a pre-pregnancy history of depression (OR 1.32; 95% CI 1.04, 1.67, p = 0.024) and also those without APD (OR 1.20, 95% CI 1.01, 1.43, p = 0.040). Conclusion There was no significant association between working and short-term memory performance and APD symptoms. Among all women, but especially non-depressed earlier in life and/or at antepartum, those scoring high on the forward memory test, i.e., short-term memory, had a higher risk for PPD. Future studies are required to further explore the pathophysiology behind and the predictive value of these associations.
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Affiliation(s)
- Iliana Liakea
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- *Correspondence: Iliana Liakea
| | - Ashish K. C.
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Emma Bränn
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Emma Fransson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | | | | | - Alkistis Skalkidou
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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18
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Bohne A, Høifødt RS, Nordahl D, Landsem IP, Moe V, Wang CEA, Pfuhl G. The role of early adversity and cognitive vulnerability in postnatal stress and depression. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-021-02651-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AbstractThe purpose of the present study was to examine vulnerability factors in expecting parents that might lead to mental illness in the perinatal period. Specifically, we studied how parental early adversity, attentional bias to infant faces, repetitive negative thinking, and demographic factors, were associated with pre- and postnatal depressive symptoms and parenting stress. Participants were expecting parents taking part in the Northern Babies Longitudinal Study, where assessments were made both pre- and postnatally. Assessments included both questionnaires and cognitive tasks. About half of the participants received the Newborn Behavior Observation (NBO)-intervention after birth, between pre- and postnatal assessments. Results show that repetitive negative thinking was a significant predictor of both depressive symptoms and parenting stress, while education, social support, and parity came out as protective factors, especially in mothers. Parental early adversity had an indirect effect on postnatal depressive symptoms and parenting stress, mediated by prenatal and postnatal depressive symptoms, respectively. The NBO intervention did not affect the results, signifying the importance of early childhood adverse events and negative thinking on parents' postnatal adjustment and mood, even when an intervention is provided. In conclusion, repetitive negative thinking is a significant vulnerability factor independent of the presence of depressive symptoms, and health professionals must be aware of parents’ thinking style both during pregnancy and after birth.
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Schoppmann J, Teismann T, Holleck-Weithmann VA, Hundertmark E, Jandewerth K, Obereiner P, Rudolph D, Seehagen S. Infant carrying is associated with reduced maternal repetitive negative thinking and increased maternal mental health. J Reprod Infant Psychol 2021:1-14. [PMID: 34882494 DOI: 10.1080/02646838.2021.2012647] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Mental disorders, such as postnatal depression, are common in mothers. Repetitive negative thinking has been identified as a cognitive factor underlying the resulting difficulties in mother-infant interactions. METHOD The present online survey investigated associations between infant carrying (baby-wearing) and maternal repetitive negative thinking and positive mental health. RESULTS Repetitive negative thinking was significantly lower, and positive mental health was significantly higher while carrying compared to overall levels. There were no relations between maternal mental health and frequency of carrying. Maternal activities during carrying are portrayed. CONCLUSION These results are the first indication that carrying could be a low threshold, easily administered intervention method for maternal mental health problems.
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Affiliation(s)
| | - Tobias Teismann
- Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany
| | | | | | | | | | - Dinah Rudolph
- Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany
| | - Sabine Seehagen
- Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany
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20
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Vertsberger D, Roskam I, Talmon A, van Bakel H, Hall R, Mikolajczak M, Gross JJ. Emotion regulation during the COVID-19 pandemic: risk and resilience factors for parental burnout (IIPB). Cogn Emot 2021; 36:100-105. [PMID: 34821543 DOI: 10.1080/02699931.2021.2005544] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The COVID-19 pandemic has impacted families' lives around the world. The measures used to contain transmission have led to increased stress and put parents at increased risk for parental burnout (PB). The aim of the current study was to examine the association between COVID-related parental stress and PB, and to test whether emotion regulation (ER) moderated this association. We hypothesised that rumination, which is a generally maladaptive ER strategy, would act as a risk factor. In comparison, we hypothesised that reappraisal, which is a generally adaptive ER strategy, would act as a resilience factor. We assessed 8225 parents from 22 countries using an on-line survey, and focused on general stress and parenting stress. These stressors were associated with greater PB. Importantly, parental ER moderated these associations; rumination strengthened the link between stress-related variables and PB, whereas reappraisal weakened it. This study emphasises the negative effect COVID-19 has on parents and highlights key ER risk and resilience factors.
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Affiliation(s)
- Dana Vertsberger
- Department of Psychology, Stanford University, Stanford, CA, USA
| | - Isabelle Roskam
- Faculty of Psychology and Educational Sciences, Psychological Sciences Research Institute, UCLouvain, Louvain-la-Neuve, Belgium
| | - Anat Talmon
- Department of Psychology, Stanford University, Stanford, CA, USA
| | - Hedwig van Bakel
- Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
| | - Ruby Hall
- Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
| | - Moïra Mikolajczak
- Faculty of Psychology and Educational Sciences, Psychological Sciences Research Institute, UCLouvain, Louvain-la-Neuve, Belgium
| | - James J Gross
- Department of Psychology, Stanford University, Stanford, CA, USA
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21
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Kalmbach DA, Cheng P, Drake CL. A pathogenic cycle between insomnia and cognitive arousal fuels perinatal depression: exploring the roles of nocturnal cognitive arousal and perinatal-focused rumination. Sleep 2021; 44:6217388. [PMID: 33830248 DOI: 10.1093/sleep/zsab028] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 01/01/2021] [Indexed: 11/12/2022] Open
Abstract
STUDY OBJECTIVES Depression is among the most prevalent perinatal complications, yet modifiable risk factors remain elusive. Over half of perinatal women endorse clinical insomnia symptoms, which are etiologically implicated in depression in nonperinatal samples. Yet, prospective data on perinatal insomnia and depression are mixed. We sought to clarify temporal associations of insomnia and depression during peripartum, and to investigate cognitive arousal as a potential mechanism facilitating this relationship. METHODS Seventy pregnant women completed sociodemographic information and baseline sleep and mood symptoms between gestational weeks 25 and 30. Beginning at gestational week 30, participants completed 17 weekly online surveys assessing insomnia, depression, and three cognitive arousal indices (nocturnal cognitive arousal, perseverative thinking, and perinatal-focused rumination). Mixed effects models were conducted to test hypotheses. RESULTS Women were at risk for depression when experiencing insomnia (odds ratio [OR] = 2.36, 95% confidence interval [CI] = 1.28 to 4.35), nocturnal cognitive arousal (OR = 3.05, 95% CI = 1.60 to 5.79), perinatal-focused rumination (OR = 2.05, 95% CI = 1.11 to 3.79), and perseverative thinking (OR = 7.48, 95% CI = 3.90 to 14.32). Prospective analyses revealed bidirectional effects between insomnia and cognitive arousal, and both predicted future depression. Nocturnal cognitive arousal mediated 23-43% of the effect of insomnia on depression. Insomnia mediated 12%-18% of the effect of nocturnal cognitive arousal on depression. A similar pattern was observed with perinatal-focused rumination. Depression did not predict insomnia. CONCLUSION Nocturnal cognitive arousal, including ruminating on perinatal concerns while trying to fall asleep, fuels insomnia. In turn, lying awake at night provides an opportunity for nocturnal cognitive arousal. This cycle feeds perinatal depression. Daytime cognitive arousal may indirectly disrupt sleep as perseverating during the day persists into the night.
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Affiliation(s)
- David A Kalmbach
- Thomas Roth Sleep Disorders & Research Center, Henry Ford Health System, Detroit, MI, USA.,Pulmonary & Critical Care and Sleep Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - Philip Cheng
- Thomas Roth Sleep Disorders & Research Center, Henry Ford Health System, Detroit, MI, USA
| | - Christopher L Drake
- Thomas Roth Sleep Disorders & Research Center, Henry Ford Health System, Detroit, MI, USA
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22
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Hirsch CR, Meeten F, Newby JM, O’Halloran S, Gordon C, Krzyzanowski H, Moulds ML. Looking on the Bright Side Reduces Worry in Pregnancy: Training Interpretations in Pregnant Women. CLINICAL PSYCHOLOGY IN EUROPE 2021; 3:e3781. [PMID: 36397954 PMCID: PMC9667128 DOI: 10.32872/cpe.3781] [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: 05/28/2020] [Accepted: 03/22/2021] [Indexed: 11/25/2022] Open
Abstract
Background Recent evidence suggests that anxiety is more common than depression in the perinatal period, however there are few interventions available to treat perinatal anxiety. Targeting specific processes that maintain anxiety, such as worry, may be one potentially promising way to reduce anxiety in this period. Given evidence that negative interpretation bias maintains worry, we tested whether interpretation bias could be modified, and whether this in turn would lead to less negative thought (i.e., worry) intrusions, in pregnant women with high levels of worry. Method Participants (N = 49, at least 16 weeks gestation) were randomly assigned to either an interpretation modification condition (CBM-I) which involved training in accessing positive meanings of emotionally ambiguous scenarios, or an active control condition in which the scenarios remained ambiguous and unresolved. Results Relative to the control condition, participants in the CBM-I condition generated significantly more positive interpretations and experienced significantly less negative thought intrusions. Conclusions Our findings indicate that worry is a modifiable risk factor during pregnancy, and that it is possible to induce a positive interpretation bias in pregnant women experiencing high levels of worry. Although preliminary, our findings speak to exciting clinical possibilities for the treatment of worry and the prevention of perinatal anxiety.
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Affiliation(s)
- Colette R. Hirsch
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Frances Meeten
- School of Psychology, University of Sussex, Brighton, United Kingdom
| | - Jill M. Newby
- School of Psychology, University of New South Wales, Sydney, Australia
- Black Dog Institute, Hospital Road Randwick, New South Wales, Sydney, Australia
| | - Sophie O’Halloran
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Calum Gordon
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Hannah Krzyzanowski
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
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23
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Rzeszutek M, Gruszczyńska E. Inertia, innovation, and cross-lagged effects in negative affect and rumination: daily diary study among people living with HIV. ANXIETY STRESS AND COPING 2021; 34:411-422. [PMID: 33594920 DOI: 10.1080/10615806.2021.1887481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The aim of this study was to examine individual differences in the day-by-day relationship between negative affect (NA) and rumination in terms of their inertia, innovation, and cross-lagged effects among people living with HIV (PLWH). METHODS The participants were 217 PLWH with confirmed diagnoses of HIV and undergoing antiretroviral treatment. They assessed their NA and rumination for five consecutive days each evening via an online survey. RESULTS Results showed that inertia in NA is negatively related to inertia in rumination. Both innovations were unrelated. However, the individuals with relatively higher overall NA were also more reactive to external factors and/or had more variability in their daily lives, to which they respond with NA. Finally, the autoregressive effects were revealed to be important for spillover effects in a direction that is coherent with a given inertia. Thus, the direction of the cascade between daily NA and rumination depends on the area of major regulatory weakness. CONCLUSION The results support the view that intensity, inertia, and innovation are distinct dimensions in spite of the common assumption that higher overall intensity of emotions and coping should be strongly related or even synonymous to their perseveration.
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Affiliation(s)
| | - Ewa Gruszczyńska
- Faculty of Psychology, SWPS University of Social Sciences and Humanities, Warsaw, Poland
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24
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Newby JM, Werner-Seidler A, Black MJ, Hirsch CR, Moulds ML. Content and Themes of Repetitive Thinking in Postnatal First-Time Mothers. Front Psychol 2021; 12:586538. [PMID: 33603697 PMCID: PMC7884627 DOI: 10.3389/fpsyg.2021.586538] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 01/11/2021] [Indexed: 11/13/2022] Open
Abstract
Repetitive thinking (RT) predicts and maintains depression and anxiety, yet the role of RT in the perinatal context has been under-researched. Further, the content and themes that emerge during RT in the perinatal period have been minimally investigated. We recruited an online community sample of women who had their first baby within the past 12 months (n = 236). Participants completed a battery of self-report questionnaires which included four open-ended questions about the content of their RT. Responses to the latter were analyzed using an inductive thematic analysis approach. Participants reported RT about a range of unexpected emotional responses to becoming a new mother, impact on their sleep and cognitive functioning, as well as the impact on their identity, sense of self, lifestyle, achievements, and ability to function. RT was commonly experienced in first-time mothers, and the themes that emerged conveyed an overall sense of discrepancy between expectations and reality, as well as adjustment to profound change. By providing insight into the content of RT in new mothers, the findings of our study have scope to inform the content of interventions that seek to prevent and treat postnatal mental health problems, particularly those which target key psychological processes such as RT.
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Affiliation(s)
- Jill M. Newby
- Black Dog Institute, The University of New South Wales, Sydney, NSW, Australia
| | | | - Melissa J. Black
- Black Dog Institute, The University of New South Wales, Sydney, NSW, Australia
| | - Colette R. Hirsch
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Michelle L. Moulds
- School of Psychology, The University of New South Wales, Sydney, NSW, Australia
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Ruminations and their correlates in depressive episodes: Between-group comparison in patients with unipolar or bipolar depression and healthy controls. J Affect Disord 2021; 280:1-6. [PMID: 33197781 DOI: 10.1016/j.jad.2020.10.064] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 09/09/2020] [Accepted: 10/29/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Rumination is an important feature of affective disorders. Relationships between rumination, cognitive function, emotion regulation, and psychological resilience have been examined in unipolar depression; but few studies have determined whether unipolar and bipolar depressive episodes are distinguishable in terms of these variables. This study examined rumination in relation to clinical and cognitive variables in patients with unipolar depression or bipolar depression, and healthy controls. METHODS In total, 150 participants (50 bipolar, 50 unipolar, 50 controls) were included. Assessments comprised the Ruminative Response Scale-Short Form, Positive Beliefs about Rumination Scale, Negative Beliefs about Rumination Scale, Brief Resilience Scale, Emotion Regulation Questionnaire, Stroop Test, and Trail Making Test A and B. RESULTS The unipolar group had significantly higher scores in ruminative response and performed better in a neuropsychological test (Trail Making Test Part A) than the bipolar group. When duration of illness was controlled, no significant difference was found between depression groups in terms of rumination. There was a negative relationship between rumination and emotion regulation (cognitive reappraisal subscale), and rumination and psychological resilience in both patient groups, but no significant relationship was found in healthy controls. LIMITATIONS Relatively small sample size: future studies in larger clinical samples would increase knowledge of rumination in both unipolar and bipolar depression. CONCLUSIONS Patients experiencing unipolar or bipolar depressive episodes are potentially distinguishable in terms of ruminative response levels and cognitive functions. This differentiation may help in developing targeted interventions for unipolar and bipolar depression.
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Perceived social support and prenatal wellbeing; The mediating effects of loneliness and repetitive negative thinking on anxiety and depression during the COVID-19 pandemic. Women Birth 2021; 35:232-241. [PMID: 33422441 PMCID: PMC9051127 DOI: 10.1016/j.wombi.2020.12.014] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 11/06/2020] [Accepted: 12/25/2020] [Indexed: 01/06/2023]
Abstract
Problem Prenatal depression and anxiety are linked to poor maternal and infant outcomes. We need to understand predictors of poor mental health to identify at-risk women, and targets for support. Background Previous research has demonstrated a relationship between low levels of perceived social support, and depression and anxiety in pregnant women. However, there is a lack of research into the factors that may mediate this relationship. Aim As social distancing measures (e.g., lockdown) are likely to negatively affect women’s perceived support in the prenatal period, we investigated the relationship between perceived social support and both anxiety and depression in UK-based pregnant women during the COVID-19 pandemic. Further, we examined two potential mediators that may contribute to psychological symptoms: repetitive negative thinking and loneliness. Methods We administered a battery of online measures to a sample of pregnant women (N = 205) between May-June 2020, during the first peak of the pandemic in the UK, when perceived social support was likely to be low. Results Consistent with predictions, perceived social support was significantly negatively related to depression, anxiety, loneliness and repetitive negative thinking. Furthermore, repetitive negative thinking and loneliness mediated the relationship between perceived social support and both depression and anxiety. Moreover, perceived social support and loneliness were associated with specific types of online behaviours. Conclusions Taken together, the findings shed light on the processes through which social support may exert its effects on depression and anxiety and highlight potential therapeutic targets for interventions which aim to prevent and treat mood disorders in perinatal cohorts.
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Hirsch CR, Meeten F, Gordon C, Newby JM, Bick D, Moulds ML. Repetitive Negative Thinking and Interpretation Bias in Pregnancy. CLINICAL PSYCHOLOGY IN EUROPE 2020; 2:e3615. [PMID: 36398060 PMCID: PMC9645466 DOI: 10.32872/cpe.v2i4.3615] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 11/01/2020] [Indexed: 11/25/2022] Open
Abstract
Background Repetitive negative thinking (RNT; e.g., worry about the future, rumination about the past) and the tendency to interpret ambiguous information in negative ways (interpretation bias) are cognitive processes that play a maintaining role in anxiety and depression, and recent evidence has demonstrated that interpretation bias maintains RNT. In the context of perinatal mental health, RNT has received minimal research attention (despite the fact that it predicts later anxiety and depression), and interpretation bias remains unstudied (despite evidence that it maintains depression and anxiety which are common in this period). Method We investigated the relationship between RNT, interpretation bias and psychopathology (depression, anxiety) in a pregnant sample (n = 133). We also recruited an age-matched sample of non-pregnant women (n = 104), to examine whether interpretation bias associated with RNT emerges for ambiguous stimuli regardless of its current personal relevance (i.e., pregnancy or non-pregnancy-related). Results As predicted, for pregnant women, negative interpretation bias, RNT, depression and anxiety were all positively associated. Interpretation bias was evident to the same degree for material that was salient (pregnancy-related) and non-salient (general), and pregnant and non-pregnant women did not differ. RNT was associated with interpretation bias for all stimuli and across the full sample. Conclusion Our findings highlight the need to further investigate the impact of interpretation bias in pregnant women, and test the effectiveness of interventions which promote positive interpretations in reducing RNT in the perinatal period.
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Affiliation(s)
- Colette R. Hirsch
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Frances Meeten
- School of Psychology, University of Sussex, Sussex, United Kingdom
| | - Calum Gordon
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Jill M. Newby
- School of Psychology, University of New South Wales, Sydney, Australia
- Black Dog Institute, Hospital Road Randwick, New South Wales, Sydney, Australia
| | - Debra Bick
- Warwick Clinical Trials Unit, University of Warwick, Coventry, United Kingdom
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28
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Reflecting on rumination: Consequences, causes, mechanisms and treatment of rumination. Behav Res Ther 2020; 127:103573. [DOI: 10.1016/j.brat.2020.103573] [Citation(s) in RCA: 129] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 11/23/2019] [Accepted: 01/24/2020] [Indexed: 12/11/2022]
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Kalmbach DA, Roth T, Cheng P, Ong JC, Rosenbaum E, Drake CL. Mindfulness and nocturnal rumination are independently associated with symptoms of insomnia and depression during pregnancy. Sleep Health 2020; 6:185-191. [PMID: 32146168 DOI: 10.1016/j.sleh.2019.11.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 10/21/2019] [Accepted: 11/26/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Insomnia and depression are highly prevalent perinatal complications. Ruminating on stress is etiologically implicated in both disorders, and ruminating while trying to fall asleep has been linked to insomnia and depression during pregnancy. Incompatible with rumination is everyday mindfulness, i.e., living with intentional and nonjudgmental awareness of internal and external experiences in the present moment. Responding to stress mindfully may protect against stress-related perinatal complications such as insomnia and depression. The present study described the association between everyday mindfulness and nocturnal rumination, and examined whether these trait characteristics were independently related to perinatal insomnia and depression. METHODS Cross-sectional and secondary analysis of existing data from 65 pregnant women recruited from a multisite hospital in Metro Detroit, MI, USA. Subjects completed online surveys including the Insomnia Severity Index, Edinburgh Postnatal Depression Scale, Presleep Arousal Scale, and the revised Cognitive and Affective Mindfulness Scale. RESULTS Over half (53.8%) of women screened positive for clinical insomnia and 12.3% screened positive for major depression. Women high in mindfulness, relative to those low in mindfulness, reported less nocturnal rumination (Cohen's d=1.16), insomnia symptoms (Cohen's d=1.24), and depressive symptoms (Cohen's d=1.35). Multivariate linear regression revealed that both mindfulness (β=-.24, p=.03) and rumination (β=.38, p<.01) were independently associated with insomnia. Similarly, a multivariate model showed that mindfulness (β=-.41, p<.001) and rumination (β=.35, p<.01) were independently associated with depression. CONCLUSIONS Ruminating in bed at night is strongly associated with insomnia and depression during pregnancy, whereas mindfulness may potentially protect against these stress-related perinatal complications.
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Affiliation(s)
- David A Kalmbach
- Thomas Roth Sleep Disorders & Research Center, Division of Sleep Medicine, Henry Ford Health System, Detroit, MI 48202 USA.
| | - Thomas Roth
- Thomas Roth Sleep Disorders & Research Center, Division of Sleep Medicine, Henry Ford Health System, Detroit, MI 48202 USA
| | - Philip Cheng
- Thomas Roth Sleep Disorders & Research Center, Division of Sleep Medicine, Henry Ford Health System, Detroit, MI 48202 USA
| | - Jason C Ong
- Departments of Neurology and Psychiatry & Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611 USA
| | - Elana Rosenbaum
- Center for Mindfulness in Medicine, Health Care, and Society, University of Massachusetts Medical School, Shrewsbury, MA 01545 USA
| | - Christopher L Drake
- Thomas Roth Sleep Disorders & Research Center, Division of Sleep Medicine, Henry Ford Health System, Detroit, MI 48202 USA
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Douglas PS. Pre-emptive Intervention for Autism Spectrum Disorder: Theoretical Foundations and Clinical Translation. Front Integr Neurosci 2019; 13:66. [PMID: 31798425 PMCID: PMC6877903 DOI: 10.3389/fnint.2019.00066] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 11/04/2019] [Indexed: 12/28/2022] Open
Abstract
Autism spectrum disorders (ASD) are an emergent public health problem, placing significant burden upon the individual, family and health system. ASD are polygenetic spectrum disorders of neural connectome development, in which one or more feedback loops amplify small genetic, structural, or functional variations in the very early development of motor and sensory-motor pathways. These perturbations trigger a 'butterfly effect' of unpredictable cascades of structural and functional imbalances in the global neuronal workspace, resulting in atypical behaviors, social communication, and cognition long-term. The first 100 days post-term are critically neuroplastic and comprise an injury-sensitive developmental window, characterized by a neural biomarker, the persistence of the cortical subplate, and a behavioral biomarker, the crying diathesis. By the time potential diagnostic signs are identified, from 6 months of age, ASD neuropathy is already entrenched. The International Society for Autism Research Special Interest Group has called for pre-emptive intervention, based upon rigorous theoretical frames, and real world translation and evaluation. This paper responds to that call. It synthesizes heterogenous evidence concerning ASD etiologies from both psychosocial and biological research literatures with complexity science and evolutionary biology, to propose a theoretical framework for pre-emptive intervention. This paper hypothesizes that environmental factors resulting from a mismatch between environment of evolutionary adaptedness and culture initiate or perpetuate early motor and sensory-motor lesions, triggering a butterfly effect of multi-directional cascades of atypical developmental in the complex adaptive system of the parent and ASD-susceptible infant. Chronic sympathetic nervous system/hypothalamic-pituitary-adrenal axis hyperarousal and disrupted parent-infant biobehavioral synchrony are the key biologic and behavioral mechanisms perpetuating these atypical developmental cascades. A clinical translation of this evidence is proposed, for application antenatally and in the first 6 months of life, as pre-emptive intervention for ASD.
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Affiliation(s)
- Pamela S. Douglas
- Transforming Maternity Care Collaborative, Griffith University, Brisbane, QLD, Australia
- Discipline of General Practice, The University of Queensland, Brisbane, QLD, Australia
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Kalmbach DA, Cheng P, Ong JC, Ciesla JA, Kingsberg SA, Sangha R, Swanson LM, O'Brien LM, Roth T, Drake CL. Depression and suicidal ideation in pregnancy: exploring relationships with insomnia, short sleep, and nocturnal rumination. Sleep Med 2019; 65:62-73. [PMID: 31710876 DOI: 10.1016/j.sleep.2019.07.010] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 07/03/2019] [Accepted: 07/09/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Sleep problems and depression are highly prevalent in pregnancy. Nocturnal rumination has been linked to insomnia and depression in non-pregnant samples, but remains poorly characterized in pregnancy. This study explored relationships of depression and suicidal ideation with insomnia, short sleep, and nocturnal rumination in mid-to-late pregnancy. METHODS In this study, 267 pregnant women were recruited from obstetric clinics and completed online surveys on sleep, depression, and nocturnal rumination. RESULTS Over half (58.4%) of the sample reported clinical insomnia on the Insomnia Severity Index, 16.1% screened positive for major depression on the Edinburgh Postnatal Depression Scale (EPDS), and 10.1% endorsed suicidal ideation. Nocturnal rumination was more robustly associated with sleep onset difficulties than with sleep maintenance issues. Depressed women were at greater odds of sleep onset insomnia (OR = 2.80), sleep maintenance insomnia (OR = 6.50), high nocturnal rumination (OR = 6.50), and negative perinatal-focused rumination (OR = 2.70). Suicidal ideation was associated with depression (OR = 3.64) and negative perinatal-focused rumination (OR = 3.50). A four-group comparison based on insomnia status and high/low rumination revealed that pregnant women with insomnia and high rumination endorsed higher rates of depression (35.6%) and suicidal ideation (17.3%) than good-sleeping women with low rumination (1.2% depressed, 4.9% suicidal). Women with insomnia alone (depression: 3.9%, suicidal: 5.9%) or high rumination alone (depression: 10.7%, suicidal: 7.1%) did not differ from good-sleeping women with low rumination. CONCLUSIONS High rumination and insomnia are highly common in mid-to-late pregnancy and both are associated with depression and suicidal ideation. Depression and suicidal ideation are most prevalent in pregnant women with both insomnia and high rumination. CLINICALTRIALS. GOV IDENTIFIER NCT03596879.
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Affiliation(s)
- David A Kalmbach
- Thomas Roth Sleep Disorders & Research Center, Division of Sleep Medicine, Henry Ford Health System, Detroit, MI, 48202, USA.
| | - Philip Cheng
- Thomas Roth Sleep Disorders & Research Center, Division of Sleep Medicine, Henry Ford Health System, Detroit, MI, 48202, USA
| | - Jason C Ong
- Departments of Neurology and Psychiatry & Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Jeffrey A Ciesla
- Department of Psychological Sciences, Kent State University, Kent, OH, 44240, USA
| | - Sheryl A Kingsberg
- Departments of Reproductive Biology and Psychiatry, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Roopina Sangha
- Department of Obstetrics & Gynecology, Henry Ford Health System, Detroit, MI, 48202, USA
| | - Leslie M Swanson
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Louise M O'Brien
- Departments of Obstetrics & Gynecology and Neurology, Ann Arbor, MI, 48105, USA
| | - Thomas Roth
- Thomas Roth Sleep Disorders & Research Center, Division of Sleep Medicine, Henry Ford Health System, Detroit, MI, 48202, USA
| | - Christopher L Drake
- Thomas Roth Sleep Disorders & Research Center, Division of Sleep Medicine, Henry Ford Health System, Detroit, MI, 48202, USA
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Pedro L, Branquinho M, Canavarro MC, Fonseca A. Self-criticism, negative automatic thoughts and postpartum depressive symptoms: the buffering effect of self-compassion. J Reprod Infant Psychol 2019; 37:539-553. [DOI: 10.1080/02646838.2019.1597969] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Liliana Pedro
- Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Mariana Branquinho
- Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Maria Cristina Canavarro
- Research Group “Relationships, Development & Health”, Center for Research in Neuropsychology and Cognitive-Behavioural Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Ana Fonseca
- Research Group “Relationships, Development & Health”, Center for Research in Neuropsychology and Cognitive-Behavioural Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
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Fonseca A, Canavarro MC. Cognitive correlates of women's postpartum depression risk and symptoms: the contribution of dysfunctional beliefs and negative thoughts. J Ment Health 2019; 29:614-622. [PMID: 30924704 DOI: 10.1080/09638237.2019.1581331] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Despite the extensive research on interpersonal and clinical risk factors for postpartum depression (PPD), there is a paucity of research on the potential role of cognitive variables (dysfunctional beliefs and negative thoughts) as correlates of PPD symptoms.Aims: This exploratory study aimed to understand the cognitive processes of women at a higher risk (i.e. presenting well-established interpersonal and clinical risk factors) for PPD by: (a) comparing women's dysfunctional motherhood-related beliefs and frequency of automatic thoughts, as a function of their levels of PPD risk and symptoms; (b) examining the cognitive correlates of PPD symptoms, controlling for the presence of well-established risk factors.Method: A cross-sectional internet survey comprising 441 postpartum women was conducted.Results: Women presenting high-risk for PPD showed more dysfunctional motherhood-related attitudes (p < 0.001), more frequent negative thoughts (p < 0.001) and less frequent positive thoughts (p < 0.001) than low-risk women. More dysfunctional beliefs related to maternal responsibility, more frequent negative thoughts related with personal maladjustment and with the metacognitive appraisal of the thoughts' content, and less frequent positive thoughts were found to be significantly associated with PPD symptoms.Conclusion: The inclusion of cognitive variables in risk assessment and preventive efforts for PPD may hold potential to increase its clinical efficacy.
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Affiliation(s)
- Ana Fonseca
- Center for Research in Neuropsychology and Cognitive-Behavioral Intervention (CINEICC) of the Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Maria Cristina Canavarro
- Center for Research in Neuropsychology and Cognitive-Behavioral Intervention (CINEICC) of the Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
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Monteiro F, Fonseca A, Pereira M, Alves S, Canavarro MC. What protects at-risk postpartum women from developing depressive and anxiety symptoms? The role of acceptance-focused processes and self-compassion. J Affect Disord 2019; 246:522-529. [PMID: 30599377 DOI: 10.1016/j.jad.2018.12.124] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 11/02/2018] [Accepted: 12/24/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND Not all women presenting risk factors for postpartum depression (PPD) develop depressive symptoms. Research has shown that acceptance-focused processes (nonjudgmental appraisal of thought content, psychological flexibility) and self-compassion play an important protective role in the development of psychological symptoms. However, considering the perinatal period, little is known about what variables can modify the negative impact of risk. METHODS The sample consisted of 185 postpartum women at risk of developing PPD (Postpartum Depression Predictors Inventory-Revised > 5.5). Data were collected regarding depressive (Edinburgh Postnatal Depression Scale) and anxiety symptoms (Hospital Anxiety and Depression Scale), psychological flexibility (Acceptance and Action Questionnaire-II), nonjudgmental appraisal of thought content (Postnatal Negative Thoughts Questionnaire) and self-compassion (Self-Compassion Scale-Short Form). RESULTS Women not presenting depressive and anxiety symptoms reported significantly higher levels of psychological flexibility, nonjudgmental appraisal of thought content and self-compassion than women presenting depressive and anxiety symptoms. Hierarchical logistic regression showed that women with higher levels of psychological flexibility (OR = 1.06, CI: 1.01-1.12) and nonjudgmental appraisal of thought content (OR = 1.33, CI: 1.15-1.53) had a significantly higher likelihood of not presenting depressive and anxiety symptoms. LIMITATIONS The limitations of this study were the cross-sectional design, the use of self-report questionnaires and the self-selected bias in recruitment. CONCLUSIONS This study emphasizes the important role of acceptance-based processes, suggesting that at-risk women who are more accepting of their private events may be more protected from developing psychological symptoms. Preventive interventions should consider the promotion of these processes to improve women's adjustment to this period.
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Affiliation(s)
- Fabiana Monteiro
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculdade de Psicologia e de Ciências da Educação da Universidade de Coimbra, 3000-115 Coimbra, Portugal.
| | - Ana Fonseca
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculdade de Psicologia e de Ciências da Educação da Universidade de Coimbra, 3000-115 Coimbra, Portugal
| | - Marco Pereira
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculdade de Psicologia e de Ciências da Educação da Universidade de Coimbra, 3000-115 Coimbra, Portugal
| | - Stephanie Alves
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculdade de Psicologia e de Ciências da Educação da Universidade de Coimbra, 3000-115 Coimbra, Portugal
| | - Maria Cristina Canavarro
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculdade de Psicologia e de Ciências da Educação da Universidade de Coimbra, 3000-115 Coimbra, Portugal
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Kaseke T, January J, Tadyanemhandu C, Chiwaridzo M, Dambi JM. A structural equation modelling of the buffering effect of social support on the report of common mental disorders in Zimbabwean women in the postnatal period. BMC Res Notes 2019; 12:110. [PMID: 30819242 PMCID: PMC6394011 DOI: 10.1186/s13104-019-4151-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 02/22/2019] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Globally, 13-20% of women experience a common mental disorder (CMD) postnatally. Unfortunately, the burden of CMDs is disproportionally substantial in women from low-income countries. Nevertheless, there is a growing recognition of the buffering effect of social support (SS) on psychiatric morbidity and the need for mental well-being support services/interventions. This study evaluated the relationship between psychiatric morbidity and SS levels, and factors influencing the mental health functioning of Zimbabwean women postnatally. Data were collected from 340 mothers and were analysed through structural equation modelling. RESULTS The mothers' mean age was 26.6 (SD 5.6) years. The mean Multidimensional Scale of Perceived Social Support score was 42.7 (SD 10.8), denoting high levels of SS. Additionally, 29.1% of the population reported excessive psychiatric morbidity, the median Shona Symptoms Questionnaire score was 5 (IQR: 2-8). The structural equation model demonstrated the buffering effects of SS on psychiatric morbidity (r = - 0.585, p = 0.01), and accounted for 70% of the variance. Being unmarried, increased maternal age, lower educational and income levels were associated with poorer maternal mental health. There is a need for routine; surveillance and treatment of CMDs in women in the postnatal period, including integration of low-cost, evidenced-based and task-shifting SS interventions.
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Affiliation(s)
- Tanaka Kaseke
- Department of Rehabilitation, University of Zimbabwe, College of Health Sciences, P.O Box A178, Avondale, Harare, Zimbabwe
| | - James January
- Department of Community Medicine, University of Zimbabwe, College of Health Sciences, P.O Box A178, Avondale, Harare, Zimbabwe
| | - Catherine Tadyanemhandu
- Department of Rehabilitation, University of Zimbabwe, College of Health Sciences, P.O Box A178, Avondale, Harare, Zimbabwe
- Department of Physiotherapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Matthew Chiwaridzo
- Department of Rehabilitation, University of Zimbabwe, College of Health Sciences, P.O Box A178, Avondale, Harare, Zimbabwe
- School of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town Observatory, Cape Town, 7700 South Africa
| | - Jermaine M. Dambi
- Department of Rehabilitation, University of Zimbabwe, College of Health Sciences, P.O Box A178, Avondale, Harare, Zimbabwe
- School of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town Observatory, Cape Town, 7700 South Africa
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Moulds ML, Black MJ, Newby JM, Hirsch CR. Repetitive Negative Thinking and Its Role in Perinatal Mental Health. Psychopathology 2018; 51:161-166. [PMID: 29694970 DOI: 10.1159/000488114] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 03/02/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND There is evidence that anxiety is common, perhaps even more prevalent than depression, in the post-partum period. In this review we propose adopting a transdiagnostic approach to perinatal mental health: to delineate psychopathology and identify potential underlying cognitive mechanisms such as repetitive negative thinking (RNT). SAMPLING AND METHODS We provide an overview of key studies of RNT in perinatal mental health and suggest directions for future work. We propose the value of examining post-partum depression and anxiety, and their co-occurrence, and of testing whether the psychological mechanisms that predict and maintain depression and anxiety also play a role in these conditions in the post-partum period. Further, given that psychological distress often first emerges in the antenatal phase, we make a case for investigating RNT across the perinatal period - i.e., in antenatal and postnatal women. RESULTS AND CONCLUSIONS RNT may be a modifiable risk factor which can be targeted in pregnancy to prevent depression and anxiety in new mothers.
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Affiliation(s)
- Michelle L Moulds
- School of Psychology, The University of New South Wales, UNSW Sydney, Sydney, New South Wales, Australia
| | - Melissa J Black
- School of Psychology, The University of New South Wales, UNSW Sydney, Sydney, New South Wales, Australia
| | - Jill M Newby
- School of Psychology, The University of New South Wales, UNSW Sydney, Sydney, New South Wales, Australia
| | - Colette R Hirsch
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
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Flynn EP, Chung EO, Ozer EJ, Fernald LCH. Maternal Depressive Symptoms and Child Behavior among Mexican Women and Their Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14121566. [PMID: 29258221 PMCID: PMC5750984 DOI: 10.3390/ijerph14121566] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 11/27/2017] [Accepted: 11/29/2017] [Indexed: 01/12/2023]
Abstract
Over 50% of mothers in rural Mexico have high depressive symptoms, and their children's health and development are likely to be negatively affected. A critical question is whether children vary in their vulnerability to the effects of high maternal depressive symptoms according to their indigenous ethnicity, maternal education, or household wealth. Our sample included 4442 mothers and 5503 children from an evaluation of Mexico's social welfare program. Maternal depressive symptoms were assessed using the Center for Epidemiologic Studies Depression (CES-D) Scale, and child behavior was measured using an adapted version of the Behavior Problems Index (BPI). Multiple linear regression models were used to explore the associations between maternal depressive symptoms and child behavior problems, and the heterogeneity of associations by indigenous ethnicity, maternal education, and household assets. We found that having greater maternal depressive symptoms was significantly associated with having a child with more behavior problems (β = 0.114, p < 0.0001, [95% CI 0.101, 0.127]), in adjusted models. In tests of heterogeneity, the association between maternal depressive symptoms and child behavior problems was strongest in households with indigenous ethnicity, low maternal education, or in households with fewer assets. These results strengthen the case for effective mental health interventions in low- and middle-income countries, particularly among the most vulnerable families where mothers and children appear to be at the greatest risk.
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Affiliation(s)
- Emily P Flynn
- Country Doctor Community Health Centers and Swedish Cherry Hill Family Medicine Residency, Seattle, WA 98122, USA.
| | - Esther O Chung
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA 94720, USA.
| | - Emily J Ozer
- Division of Community Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, CA 94720, USA.
| | - Lia C H Fernald
- Division of Community Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, CA 94720, USA.
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A longitudinal investigation of perfectionism and repetitive negative thinking in perinatal depression. Behav Res Ther 2017; 97:26-32. [DOI: 10.1016/j.brat.2017.06.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 05/31/2017] [Accepted: 06/26/2017] [Indexed: 11/17/2022]
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Psychogiou L, Moberly NJ, Parry E, Russell AE, Nath S, Kallitsoglou A. Does fathers' and mothers' rumination predict emotional symptoms in their children? BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2017; 56:431-442. [PMID: 28805254 DOI: 10.1111/bjc.12148] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 03/31/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Although rumination can have a negative influence on the family environment and the quality of parent-child interactions, there is little research on the role of parental rumination in predicting adverse child outcomes over time. This longitudinal study examined whether mothers' and fathers' brooding rumination would each uniquely predict emotional symptoms in preschool children. METHODS The initial sample consisted of 160 families (including 50 mothers with past depression, 33 fathers with past depression, and 7 fathers with current depression according to the Structural Clinical Interview for DSM-IV). Families were seen at two times separated by 16 months. Children's mean age at the entry into the study was 3.9 years (SD = 0.8). Each parent independently completed the Ruminative Response Scale, the Child Behavior Checklist, the Patient Health Questionnaire, and the Dyadic Adjustment Scale. RESULTS Fathers' brooding rumination significantly predicted children's emotional symptoms over 16 months when controlling for child emotional symptoms, couple adjustment, parents' depressive symptoms, mothers' brooding and reflective rumination, and fathers' reflective rumination at baseline. Unexpectedly, mothers' brooding rumination did not significantly predict child emotional symptoms over time. Correlational analyses showed significant associations between parents' rumination and lower levels of couple adjustment. CONCLUSIONS Findings suggest that fathers' brooding rumination may play a unique role in their children's emotional outcomes. If these findings are replicated, studies should examine the processes by which these links occur and their implications for clinical interventions. PRACTITIONER POINTS Rumination is prevalent among individuals with depression, but to date no studies have examined the possible role of mothers' and fathers' brooding rumination in predicting children's emotional symptoms. Fathers' brooding rumination was positively associated with children's emotional symptoms over time when controlling for mothers' rumination and other important characteristics. Parental rumination might be a promising target for both prevention and intervention strategies for parents with depression and their children. The findings of this study could inform parenting interventions (e.g., educate parents about the possible effects of rumination on family interactions and children's outcomes, help parents notice when they ruminate, teach them to replace rumination with more adaptive strategies). The findings should be interpreted with caution. The study relied on self-reports, and therefore, the data are subject to shared method variance which may have artificially inflated associations between parent and child outcomes. The sample consisted of well-educated parents, and therefore, the findings should be generalized to other populations with caution.
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Affiliation(s)
- Lamprini Psychogiou
- School of Psychology, College of Life and Environmental Sciences, University of Exeter, UK
| | - Nicholas J Moberly
- School of Psychology, College of Life and Environmental Sciences, University of Exeter, UK
| | - Elizabeth Parry
- School of Psychology, College of Life and Environmental Sciences, University of Exeter, UK
| | | | - Selina Nath
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
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Schmidt D, Seehagen S, Hirschfeld G, Vocks S, Schneider S, Teismann T. Repetitive Negative Thinking and Impaired Mother–Infant Bonding: A Longitudinal Study. COGNITIVE THERAPY AND RESEARCH 2016. [DOI: 10.1007/s10608-016-9823-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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