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Kohlhoff J, Traynor NM. Prospective evaluation of parent and child outcomes following admission to a 'virtual' early parenting residential programme. BMJ Open 2024; 14:e077024. [PMID: 38355170 PMCID: PMC10868264 DOI: 10.1136/bmjopen-2023-077024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 01/22/2024] [Indexed: 02/16/2024] Open
Abstract
OBJECTIVES Australian early parenting residential services provide interventions for families experiencing complex early parenting issues. Many services have recently shifted to virtual care models but the clinical effectiveness of such programmes is currently unknown. This study sought to test outcomes of a 'virtual' early parenting residential programme and to compare these with those of an in-person programme. DESIGN Prospective cohort study; self-report questionnaires on admission, at discharge and 6-week follow-up. SETTING An early parenting residential unit in Sydney, Australia. PARTICIPANTS Consecutive series of parent-child dyads admitted to the unit virtually (n=56) or in person (n=44) between August 2021 and January 2022. INTERVENTIONS Participants in both groups received a 4-night/5-day intervention programme involving access to 24-hour support from a multidisciplinary team of health professionals. The in-person programme was delivered at a residential unit; the virtual programme involved provision of support via video calls, phone calls, SMS and emails. PRIMARY AND SECONDARY OUTCOME MEASURES Infant sleep, parenting self-efficacy (primary outcomes); parenting empathy, emotion, hostility, helplessness, mentalisation and stress (secondary outcomes). RESULTS Parents who received the virtual programme reported improvements from admission to discharge, and from admission to 6-week follow-up, in a range of areas including parenting self-efficacy, empathy, mentalisation, hostility, helplessness, stress and infant sleep resistance (ps<0.05). At 6 weeks, they also reported improvements in emotion and understanding related to their child (p<0.05). In contrast to expectation, outcomes at discharge and 6 weeks were not superior in the in-person group. In fact, at 6 weeks, parents who attended the virtual residential group reported significantly lower levels of parenting hostility and parenting stress, and greater levels of parenting confidence compared with those in the in-person group (ps<0.05). CONCLUSIONS Virtual early parenting residential interventions may be effective in bringing positive changes for families, and there is no evidence to suggest that outcomes are inferior to those of in-person programmes.
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Affiliation(s)
- Jane Kohlhoff
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Kensington, New South Wales, Australia
- Karitane, Carramar, New South Wales, Australia
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Dahlen HG, Ormsby SM, Brownhill S, Fowler C, Schmied V. Residential parenting services: An integrative literature review of characteristics, service usage and parent and staff perspectives. Nurs Open 2022; 10:1180-1216. [PMID: 36317700 PMCID: PMC9912445 DOI: 10.1002/nop2.1415] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 03/03/2022] [Accepted: 10/04/2022] [Indexed: 11/06/2022] Open
Abstract
AIMS The primary aim of the review was to provide an overall assessment of residential parenting services in Australia, by describing the characteristics of infants and parents using residential parenting services, their prior service use and reasons for admission, referral pathways for access and parenting and infant outcomes. The secondary aims were to explore parent and staff perception of the programmes. DESIGN An integrative literature review. METHODS A systematic and comprehensive search of health and social sciences databases was conducted for studies related to residential parenting services (published between 1st January 1990-31st December 2019). Six hundred and eleven peer-reviewed papers were identified, after which 301 duplicates were removed and an additional 256 papers excluded after titles/abstracts were read. Of the remaining 54 abstracts/papers, a further 14 were omitted as not relevant. Forty papers were independently reviewed by four authors. ENTREQ and MOOSE checklists were applied. RESULTS Thirty studies were quantitative, nine were qualitative, and one was mixed methods. All studies originated from in Australia. Women and babies admitted to residential parenting services were found more likely to be: older, Australian born, from higher socio-economic groups, and first-time mothers, and having labour and birth interventions and a history of mental health disorders. The babies were more likely to be twins, male and admitted with sleep disorders and dysregulated behaviour. Studies reporting postintervention outcomes demonstrated improvements to maternal mental health, breastfeeding, parenting confidence and sleep quality, and infant sleeping and behaviour.
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Affiliation(s)
- Hannah Grace Dahlen
- School of Nursing and MidwiferyWestern Sydney UniversityPenrithNew South WalesAustralia
| | - Simone Maree Ormsby
- School of Nursing and MidwiferyWestern Sydney UniversityPenrithNew South WalesAustralia
| | - Suzanne Brownhill
- School of Nursing and MidwiferyWestern Sydney UniversityPenrithNew South WalesAustralia
| | - Cathrine Fowler
- School of Nursing & MidwiferyUniversity of Technology SydneyUltimoNew South WalesAustralia
| | - Virginia Schmied
- School of Nursing and MidwiferyWestern Sydney UniversityPenrithNew South WalesAustralia
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Schnatschmidt M, Lollies F, Schlarb AA. Can a parental sleep intervention in an individual setting improve the maternal and paternal sense of competence and parent-child interaction in parents of young sleep-disturbed children? findings from a single-arm pilot intervention study. BMC Psychol 2022; 10:243. [PMID: 36316716 PMCID: PMC9623967 DOI: 10.1186/s40359-022-00945-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 09/07/2022] [Accepted: 10/07/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND In early childhood sleep and regulatory problems, parental factors are often impaired but essential to overcoming them. This study aims to examine, in parents of young sleep-disturbed children, whether mothers' and fathers' sense of parenting competence were increased and dysfunctional parent-child interactions reduced with a parental sleep intervention, whether these changes were sustained over a 12-month follow-up period and if children's symptomatic parameters could be related factors. METHODS A total of 57 families with sleep-disturbed children aged 6 months to 4 years entered this single-arm pilot study. Each parent pair participated in six weekly individual face-to-face sessions of a multimodal cognitive-behavioral sleep intervention. The Parenting Sense of Competence Scale, Parental Stress Index Short Form, Child's Sleep Diary and Child's Questionnaire on Crying, Eating and Sleeping were obtained pre-, post-, 3, 6 and 12 months after the intervention. RESULTS Maternal sense of competence and dysfunctional mother-child interaction improved significantly up to 6 months after the intervention. Factors related to lower maternal competence were the child's more frequent nightly food intake and more crying due to defiance; factors related to dysfunctional mother-child interaction were more frequent crying episodes, more crying due to defiance and more eating difficulties; factors related to increased maternal competence were less duration of child's night waking, less bed-sharing and lower frequency of crying episodes; factors related to increased paternal competence were less child's nightly food intake and fewer episodes of unexplained and unsoothable crying; and factors related to improved father-child interaction were less frequent child's night waking and fewer unexplained and unsoothable crying episodes. CONCLUSION For parents of sleep-disturbed young children, an intervention that addresses the child's sleep could be promising to increase the parental sense of competence and reduce dysfunctional parent-child interactions, especially for mothers. Child symptomatic parameters may change, together with the parental sense of competence and parent-child interaction of both parents, after the intervention. Mothers with children with more severe symptomatology perceive their parenting competence as lower on average and their mother-child interaction as more dysfunctional. Future research with a larger sample and a randomized controlled design is needed. TRIAL REGISTRATION The study was retrospectively registered at the German Clinical Trials Register (ID: DRKS00028578; registration date: 21.03.2022).
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Affiliation(s)
- Marisa Schnatschmidt
- grid.7491.b0000 0001 0944 9128Faculty of Psychology and Sports Science, Department of Psychology, Clinical Psychology and Psychotherapy of Childhood and Adolescence, Bielefeld University, P.O.P. 10 01 31, DE-33501 Bielefeld, Germany
| | - Friederike Lollies
- grid.7491.b0000 0001 0944 9128Faculty of Psychology and Sports Science, Department of Psychology, Clinical Psychology and Psychotherapy of Childhood and Adolescence, Bielefeld University, P.O.P. 10 01 31, DE-33501 Bielefeld, Germany
| | - Angelika A. Schlarb
- grid.7491.b0000 0001 0944 9128Faculty of Psychology and Sports Science, Department of Psychology, Clinical Psychology and Psychotherapy of Childhood and Adolescence, Bielefeld University, P.O.P. 10 01 31, DE-33501 Bielefeld, Germany
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Dahlen HG, Schmied V, Fowler C, Peters LL, Ormsby S, Thornton C. Characteristics and co-admissions of mothers and babies admitted to residential parenting services in the year following birth in NSW: a linked population data study (2000-2012). BMC Pregnancy Childbirth 2022; 22:428. [PMID: 35597917 PMCID: PMC9123292 DOI: 10.1186/s12884-022-04736-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 04/28/2022] [Indexed: 11/10/2022] Open
Abstract
Background There is a tiered healthcare system in Australia to support maternal and child health, including, non-psychiatric day stay and residential parenting services (RPS) such as Tresillian and Karitane (in New South Wales [NSW]). RPS are unique to Australia, and currently there is limited information regarding the healthcare trajectory of women accessing RPS and if they are more likely to have admissions to other health facilities within the first-year post-birth. This study aimed to examine differences in hospital co-admissions for women and babies admitted to RPS in NSW in the year following birth compared to non-RPS admitted women. Methods A linked population data study of all women giving birth in NSW 2000–2012. Statistical differences were calculated using chi-square and student t-tests. Results Over the 12-year timeframe, 32,071 women and 33,035 babies were admitted to RPS, with 5191 of these women also having one or more hospital admissions (7607 admissions). The comparator group comprised of 99,242 women not admitted to RPS but having hospital admissions over the same timeframe (136,771 admissions). Statistically significant differences between cohorts were observed for the following parameters (p ≤ .001). Based upon calculated percentages, women who were admitted to RPS were more often older, Australian born, socially advantaged, private patients, and having their first baby. RPS admitted women also had more multiple births and labour and birth interventions (induction, instrumental birth, caesarean section, epidural, episiotomy). Their infants were also more often male and admitted to Special Care Nursery/Neonatal Intensive Care. Additionally, RPS admitted women had more admissions for mental health and behavioural disorders, which appeared to increase over time. There was no statistical difference between cohorts regarding the number of women admitted to a psychiatric facility; however, women attending RPS were more likely to have mood affective, or behavioural and personality disorder diagnoses. Conclusion Women accessing RPS in the year post-birth were more socially advantaged, had higher birth intervention and more co-admissions and treatment for mental health disorders than those not accessing RPS. More research is needed into the impact of birth intervention and mental health issues on subsequent parenting difficulties.
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Affiliation(s)
- Hannah Grace Dahlen
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia.
| | - Virginia Schmied
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Cathrine Fowler
- School of Nursing and Midwifery, University of Technology, Broadway, Sydney, NSW, 2007, Australia
| | - Lilian L Peters
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia.,Department of Midwifery Science AVAG, Amsterdam UMC (location Vumc), Vrije Universiteit, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Simone Ormsby
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Charlene Thornton
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
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Keys EM, Benzies KM, Kirk VG, Duffett-Leger L. Effect of Play2Sleep on mother-reported and father-reported infant sleep: a sequential explanatory mixed-methods study of a randomized controlled trial. J Clin Sleep Med 2022; 18:439-452. [PMID: 34409935 PMCID: PMC8805006 DOI: 10.5664/jcsm.9618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 08/09/2021] [Accepted: 08/10/2021] [Indexed: 02/03/2023]
Abstract
STUDY OBJECTIVES This study evaluated the effect on infant sleep of a novel intervention (Play2Sleep) that combined infant sleep information with self-modeled video feedback on parent-infant interactions. METHODS An explanatory sequential mixed-methods design consisting of a randomized controlled trial with 63 mother-father-infant triads randomized to Play2Sleep or comparison home visit interventions was used. We used repeated measures analysis of covariance to detect changes in infant night wakings, nocturnal wakefulness, and sleep durations and Wilcoxon signed rank test to evaluate changes in perception of infant sleep problems. Family interviews (n = 20) were used to explain the quantitative findings and analyzed qualitatively using thematic analysis. RESULTS Play2Sleep was effective in reducing maternal-reported infant wakefulness, F(1,55) = 5.33, P = .03, partial η2 = .09, and the number of paternal-reported naps, F(1,58) = 4.90, P = .03, partial η2 = .08. Parents in the Play2Sleep group reported significant improvements in problematic infant sleep that were not observed in the comparison group; however, Play2Sleep was not effective in reducing the number of parent-reported night wakings. Information overwhelm, learning infant cues, and working together with a subtheme of father involvement were key qualitative themes developed to explain the quantitative results. Unplanned exploratory analyses revealed a significant improvement in maternal depression symptoms in the Play2Sleep group. CONCLUSIONS This study suggests Play2Sleep could improve infant sleep by promoting parental awareness of infant cues and father involvement and improving maternal depression. Additional research is needed to determine the optimal number and timing of sessions. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: Play2Sleep: Using Play to Improve Sleep; URL: https://clinicaltrials.gov/ct2/show/NCT02742155; Identifier: NCT02742155. CITATION Keys EM, Benzies KM, Kirk VG, Duffett-Leger L. Effect of Play2Sleep on mother-reported and father-reported infant sleep: a sequential explanatory mixed-methods study of a randomized controlled trial. J Clin Sleep Med. 2022;18(2):439-452.
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Affiliation(s)
- Elizabeth M. Keys
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
- School of Nursing, Faculty of Health and Social Development, The University of British Columbia, Kelowna, British Columbia, Canada
| | - Karen M. Benzies
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Valerie G. Kirk
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital, Alberta Health Services, Calgary, Alberta, Canada
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Infant sleep and temperament characteristics in association with maternal postpartum depression. Midwifery 2021; 105:103232. [PMID: 34971869 DOI: 10.1016/j.midw.2021.103232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 12/14/2021] [Accepted: 12/18/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Aim of this study was to examine the association between infant temperament and sleep characteristics and postpartum depressive symptoms among mothers. STUDY DESIGN Research data were collected at the baseline (2nd -4th days postpartum) and the follow-up (6-8 weeks postpartum), Slovak version of the (EPDS) was used, along with questions focused on perceived sleeping problems of an infant, and temperament Linear regression models were employed. SETTING Two public hospital sites in Slovakia. PARTICIPANTS 204 women participated in both time points (mean age 30.9 ± 4.8, age range: 20-44; 78.9% vaginal births; 56.9% primiparas). RESULTS Significant differences in the EPDS scores were found according to infant sleeping problems (p ≤ 0.05) and duration of infant night sleep (p ≤ 0.01). Both night sleep and day sleep duration were significant predictors for the level of postpartum depression symptoms at the 6-8 weeks follow-up in the linear regression model after adjusting for confounding variables (β= -0.13; 95%CI: -3.04;-0.01; β= -0.15; 95%CI: -3.02;-0.28, total explained variance 39.0%). Infant temperament characteristics have not been found significant predictors of postpartum depression symptoms in this study. KEY CONCLUSIONS Significant differences in depression levels were found among postpartum women according to perceived sleeping problems of infant, and the duration of infant night sleep. It is important to focus more attention on the role of infant sleeping problems as a possible risk factor for the increased occurrence of postpartum depressive symptoms.
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Brown N, Luckett T, Davidson PM, DiGiacomo M. 'Stretched thin with little children' - smoking perceptions and experiences of families seeking help with parenting. J Child Health Care 2021; 25:549-561. [PMID: 33054352 DOI: 10.1177/1367493520967834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Cigarette smoking is the leading preventable cause of poor pregnancy outcomes. Pregnancy is a trigger for smoking cessation yet, up to 50% of parents will relapse in the early years of their child's life. This study explored the smoking-related perceptions and experiences of 11 parents seeking professional help with the care and parenting of babies and toddlers using semi-structured interviews. Inductive thematic analysis identified three themes: parenting as a change catalyst, smoking as a parenting challenge and smoking as a coping strategy. Becoming a parent is a catalyst to reduce the associated risks and stigma associated with smoking, but maintaining rules and boundaries can be perceived as a further burden for parents who are struggling to care for their infant. When faced with difficulties with parenting, parents may revert to smoking as a coping strategy. Based on these study findings, interventions targeting gender norms may be useful in addressing smoking cessation.
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Affiliation(s)
- Nicola Brown
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), Faculty of Health, 110561University of Technology Sydney, Sydney, Australia
| | - Tim Luckett
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), Faculty of Health, 110561University of Technology Sydney, Sydney, Australia
| | - Patricia M Davidson
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), Faculty of Health, 110561University of Technology Sydney, Sydney, Australia.,School of Nursing, 1466Johns Hopkins University, MD, USA
| | - Michelle DiGiacomo
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), Faculty of Health, 110561University of Technology Sydney, Sydney, Australia
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Woodman J, Simon A, Hauari H, Gilbert R. A scoping review of 'think-family' approaches in healthcare settings. J Public Health (Oxf) 2021; 42:21-37. [PMID: 30668870 DOI: 10.1093/pubmed/fdy210] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 09/27/2018] [Accepted: 11/06/2018] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND 'Think-family' child health approaches treat child and parent/carer health as inter-related. They are promoted within health policy internationally (also called 'family paediatrics' or 'whole-family', 'family-centred' approaches or 'child-centred' approaches within adult services). METHODS We reviewed publications of think-family interventions. We developed a typology of these interventions using thematic analysis of data extracted from the included studies. RESULTS We included 62 studies (60% USA and 18% UK); 45/62 (73%) treated the parent as patient, helping the child by addressing parental mental health, substance and alcohol misuse and/or domestic violence. Our typology details three common mechanisms of change in relevant interventions: screening, health promotion and developing relationships (inter-professional and parent-professional). CONCLUSIONS Policy-makers, practitioners and researchers can use our typology to develop and evaluate think-family approaches within healthcare. Strong relationships between parents and professionals are key in think-family approaches and should be considered in service design. Although helping the child through the parent may be a good place to start for service development, care is needed to ensure parental need does not eclipse child need. Strategies that reach out to the parent behind the child (child as patient) and which work simultaneously with parent and child warrant attention.
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Affiliation(s)
- Jenny Woodman
- UCL-Institute of Education, Thomas Coram Research Unit, 27/8 Woburn Square, London, UK
| | - Antonia Simon
- UCL-Institute of Education, Social Science Research Unit, 27/8 Woburn Square, London, UK
| | - Hanan Hauari
- UCL-Institute of Education, Thomas Coram Research Unit, 27/8 Woburn Square, London, UK
| | - Ruth Gilbert
- UCL-GOS- Institute of Child Health, 30 Guilford Street, London, UK
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Dahlen HG, Thornton C, Fowler C, Mills R, O'Loughlin G, Smit J, Schmied V. Characteristics and changes in characteristics of women and babies admitted to residential parenting services in New South Wales, Australia in the first year following birth: a population-based data linkage study 2000-2012. BMJ Open 2019; 9:e030133. [PMID: 31543503 PMCID: PMC6773315 DOI: 10.1136/bmjopen-2019-030133] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To examine the characteristics of women and babies admitted to the residential parenting services (RPS) of Tresillian and Karitane in the first year following birth. DESIGN A linked population data cohort study was undertaken for the years 2000-2012. SETTING New South Wales (NSW), Australia. PARTICIPANTS All women giving birth and babies born in NSW were compared with those admitted to RPS. RESULTS During the time period there were a total of 1 097 762 births (2000-2012) in NSW and 32 991 admissions to RPS. Women in cohort 1: (those admitted to RPS) were older at the time of birth, more likely to be admitted as a private patient at the time of birth, be born in Australia and be having their first baby compared with women in cohort 2 (those not admitted to an RPS). Women admitted to RPS experienced more birth intervention (induction, instrumental birth, caesarean section), had more multiple births and were more likely to have a male infant. Their babies were also more likely to be resuscitated and have experienced birth trauma to the scalp. Between 2000 and 2012 the average age of women in the RPS increased by nearly 2 years; their infants were older on admission and women were less likely to smoke. Over the time period there was a drop in the numbers of women admitted to RPS having a normal vaginal birth and an increase in women having an instrumental birth. CONCLUSION Women who access RPS in the first year after birth are more socially advantaged and have higher birth intervention than those who do not, due in part to higher numbers birthing in the private sector where intervention rates are high. The rise in women admitted to RPS (2000-2012) who have had instrumental births is intriguing as overall rates did not increase.
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Affiliation(s)
- Hannah G Dahlen
- School of Nursing and Midwifery, Western Sydney University, Penrith South, New South Wales, Australia
| | - Charlene Thornton
- College of Nursing and Health Sciences, Flinders University, Faculty of Medicine Nursing and Health Sciences, Adelaide, South Australia, Australia
| | - Cathrine Fowler
- Tresillian Chair in Child and Family Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Robert Mills
- Tresillian Family Care Centres, Belmore, New South Wales, Australia
| | - Grainne O'Loughlin
- Karitane Residential Family Care Unit, Karitane, Carramar, New South Wales, Australia
| | - Jenny Smit
- Tresillian Family Care Centres, Belmore, New South Wales, Australia
| | - Virginia Schmied
- School of Nursing and Midwifery, Western Sydney University, Penrith South, New South Wales, Australia
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Wilson N, Wynter K, Anderson C, Rajaratnam SM, Fisher J, Bei B. Postpartum fatigue, daytime sleepiness, and psychomotor vigilance are modifiable through a brief residential early parenting program. Sleep Med 2019; 59:33-41. [DOI: 10.1016/j.sleep.2019.01.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 12/21/2018] [Accepted: 01/08/2019] [Indexed: 12/12/2022]
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Wilson N, Wynter K, Anderson C, Rajaratnam SMW, Fisher J, Bei B. More than depression: a multi-dimensional assessment of postpartum distress symptoms before and after a residential early parenting program. BMC Psychiatry 2019; 19:48. [PMID: 30696418 PMCID: PMC6352433 DOI: 10.1186/s12888-019-2024-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 01/11/2019] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Parents are vulnerable to psychological distress symptoms in the postpartum period. It is routine to screen for depressive symptoms, but anxiety, stress, fatigue, irritability and insomnia symptoms are less often assessed despite their prevalence. This study aimed to assess multiple dimensions of psychological distress, and their reliable change and clinically significant change among women admitted to a residential program for assistance with unsettled infant behaviors (UIB). METHOD Women admitted to a five-night residential early parenting program completed self-report measures: the Depression Anxiety Stress Scale, Irritability Depression Anxiety Scale, Fatigue Severity Scale, and Insomnia Severity Index. A sub-group completed a computerized emotional Go-NoGo (EGNG) task as a measure of emotional impulsivity. RESULTS Seventy-eight women were recruited (Mage = 34.46, SDage = 4.16). On admission, 48% of women reported clinically elevated depressive symptoms and 97.5% of women not reporting elevated depressive symptoms reported clinical elevations in at least one other form of distress. Upon discharge, all self-report distress symptoms were significantly reduced (all p-values <.001), but reliable and clinically significant change only occurred in a subgroup of women. There were no significant changes in indicators of impulsivity based on the EGNG. CONCLUSIONS In addition to, and often in the absence of, depressive symptoms, women attending an early parenting program experienced a wide range of psychological distress, including fatigue, insomnia, anxiety and stress. Different forms of distress improved in different magnitudes to the treatment provided. These findings highlight the need for a multi-dimensional approach in the assessment and treatment of postpartum distress.
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Affiliation(s)
- Nathan Wilson
- Faculty of Medicine, Nursing and Health Sciences, Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, 18 Innovation Walk, Clayton Campus, Clayton, VIC, 3800, Australia
| | - Karen Wynter
- Global Public Health Unit, School of Public Health and Preventative Medicine, Monash University, Clayton, VIC, Australia
- Centre for Quality and Patient Safety Research - Western Health Partnership, School of Nursing and Midwifery, Faculty of Health, Deakin University, Burwood, VIC, Australia
| | - Clare Anderson
- Faculty of Medicine, Nursing and Health Sciences, Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, 18 Innovation Walk, Clayton Campus, Clayton, VIC, 3800, Australia
- Cooperative Research Centre for Alertness, Safety and Productivity, Clayton, VIC, Australia
| | - Shanthakumar M W Rajaratnam
- Faculty of Medicine, Nursing and Health Sciences, Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, 18 Innovation Walk, Clayton Campus, Clayton, VIC, 3800, Australia
- Cooperative Research Centre for Alertness, Safety and Productivity, Clayton, VIC, Australia
- NHMRC Centre for Sleep and Circadian Neurobiology, Sydney, NSW, Australia
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
| | - Jane Fisher
- Global Public Health Unit, School of Public Health and Preventative Medicine, Monash University, Clayton, VIC, Australia
- Masada Early Parenting Centre, Masada Private Hospital, East St Kilda, VIC, Australia
| | - Bei Bei
- Faculty of Medicine, Nursing and Health Sciences, Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, 18 Innovation Walk, Clayton Campus, Clayton, VIC, 3800, Australia.
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Bobevski I, McKenzie DP, Rowe H, Kissane DW, Clarke DM, Fisher J. Measuring postnatal demoralisation: adaptation of the Demoralisation Scale-II (DS-II) for postnatal use. J Reprod Infant Psychol 2018; 36:561-577. [PMID: 30252502 DOI: 10.1080/02646838.2018.1519781] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To examine the psychometric properties of the Demoralisation Scale II (DS-II) and adapt it for use with women in the postnatal period. BACKGROUND Demoralisation is a psychological state characterised by a sense of incompetence and feelings of helplessness and hopelessness in response to a stressful situation. The postnatal period is a life stage of many disruptions. Women may lose their confidence and become demoralised if feeling unprepared for the tasks of motherhood. The DS-II is a 16-item scale developed among cancer patients, but with content that is also relevant postnatally, including items on sense of failure, helplessness, hopelessness, isolation, entrapment and loss of purpose. METHODS Rasch analysis was used to investigate the psychometric properties of the DS-II and refine the scale for postnatal use. RESULTS Participants were 209 women admitted with their babies to a residential early parenting programme. A 14-item revised scale was derived, the Postnatal DS-II, showing good psychometric properties, discriminant validity and sensitivity to change, and being well targeted to the sample. CONCLUSION The Postnatal DS-II could have utility as an assessment tool, helping clinicians to understand better women's postnatal experiences, assess the effectiveness of interventions and communicate with women in a meaningful and non-stigmatising way.
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Affiliation(s)
- Irene Bobevski
- a Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University , Melbourne , Australia.,b Department of Psychiatry, School of Clinical Sciences at Monash Health, Faculty of Medicine , Nursing and Health Sciences, Monash University , Melbourne , Australia
| | - Dean P McKenzie
- c Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine , Monash University , Melbourne , Australia.,d Research Development & Governance, Epworth HealthCare , Melbourne , Australia
| | - Heather Rowe
- a Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University , Melbourne , Australia
| | - David W Kissane
- b Department of Psychiatry, School of Clinical Sciences at Monash Health, Faculty of Medicine , Nursing and Health Sciences, Monash University , Melbourne , Australia
| | - David M Clarke
- b Department of Psychiatry, School of Clinical Sciences at Monash Health, Faculty of Medicine , Nursing and Health Sciences, Monash University , Melbourne , Australia
| | - Jane Fisher
- a Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University , Melbourne , Australia
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Priddis H, Thornton C, Fowler C, Schmied V, Tooher J, Dickinson M, Dahlen HG. Characteristics and service needs of women and babies admitted to residential parenting units in New South Wales: A mixed‐methods study. J Clin Nurs 2018; 27:2963-2973. [DOI: 10.1111/jocn.14497] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Holly Priddis
- School of Nursing and Midwifery Western Sydney University Rydalmere NSW Australia
| | - Charlene Thornton
- College of Nursing and Health Sciences Flinders University Adelaide SA Australia
| | - Cathrine Fowler
- Faculty of Health University of Technology, Sydney Sydney NSW Australia
| | - Virginia Schmied
- School of Nursing and Midwifery Western Sydney University Rydalmere NSW Australia
| | - Jane Tooher
- Royal Prince Alfred Hospital Camperdown NSW Australia
| | | | - Hannah G Dahlen
- School of Nursing and Midwifery Western Sydney University Rydalmere NSW Australia
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Keys E, Benzies KM, Kirk V, Duffett-Leger L. Using Play to Improve Infant Sleep: A Mixed Methods Protocol to Evaluate the Effectiveness of the Play2Sleep Intervention. Front Psychiatry 2018; 9:109. [PMID: 29719517 PMCID: PMC5913340 DOI: 10.3389/fpsyt.2018.00109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 03/19/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND One in four Canadian families struggle with infant sleep disturbances. The aim of this study is to evaluate Play2Sleep in families of infants with sleep disturbances. In addition to parental education on infant sleep, Play2Sleep uses examples from a video-recorded, structured play session with mothers and fathers separately to provide feedback on parent-infant interactions and their infant's sleep-related social cues. The quantitative phase will answer the research question: Does one dose of Play2Sleep delivered during a home visit with mothers and fathers of infants aged 5 months reduce night wakings at age 7 months? The qualitative phase will answer the research question: What are parental perceptions of family experiences, processes, and contexts related to Play2Sleep and infant sleep? The overarching mixed methods research question is as follows: How do parental perceptions of family experiences, processes, and contexts related to infant sleep explain the effectiveness of Play2Sleep? METHOD AND ANALYSIS An explanatory sequential mixed methods design will be used. In the quantitative phase, a randomized controlled trial and RM-ANOVA will compare night wakings in infants whose parents receive Play2Sleep versus standard public health nursing information. Sixty English-speaking families (mothers and fathers) of full-term, healthy, singleton, 5-month-old infants who perceive that their infant has sleep disturbances will be recruited. The primary outcome measure will be change in the number of night wakings reported by parents. The qualitative component will use thematic analysis of family interviews to describe parental perceptions and experiences of infant sleep. Mixed methods integration will use qualitative findings to explain quantitative results. DISCUSSION Play2Sleep is a novel approach that combines information about infant sleep with personalized feedback on parent-infant interactions and infant cues. Including fathers and mixed methods should capture complex family experiences of infant sleep disturbances and Play2Sleep. If effective, Play2Sleep has possible application for preventing infant sleep disturbance and tailoring for other populations. CLINICAL TRIAL REGISTRATION www.ClinicalTrials.gov, identifier: NCT02742155. Registered on 2016 April 23.
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Affiliation(s)
- Elizabeth Keys
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
| | | | - Valerie Kirk
- Alberta Children’s Hospital/University of Calgary, Calgary, AB, Canada
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Priddis HS, Keedle H, Dahlen H. The Perfect Storm of Trauma: The experiences of women who have experienced birth trauma and subsequently accessed residential parenting services in Australia. Women Birth 2017; 31:17-24. [PMID: 28666701 DOI: 10.1016/j.wombi.2017.06.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 05/19/2017] [Accepted: 06/06/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND There appears to be a chasm between idealised motherhood and reality, and for women who experience birth trauma this can be more extreme and impact on mental health. Australia is unique in providing residential parenting services to support women with parenting needs such as sleep or feeding difficulties. Women who attend residential parenting services have experienced higher rates of intervention in birth and poor perinatal mental health but it is unknown how birth trauma may impact on early parenting. AIMS AND OBJECTIVES This study aims to explore the early parenting experiences of women who have accessed residential parenting services in Australia and consider their birth was traumatic. METHODS In-depth interviews were conducted with eight women across Australia who had experienced birth trauma and accessed residential parenting services in the early parenting period. These interviews were conducted both face to face and over the telephone. The data was analysed using thematic analysis. FINDINGS One overarching theme was identified: "The Perfect Storm of Trauma" which identified that the participants in this study who accessed residential parenting services were more likely to have entered pregnancy with pre-existing vulnerabilities, and experienced a culmination of traumatic events during labour, birth, and in the early parenting period. Four subthemes were identified: "Bringing Baggage to Birth", "Trauma through a Thousand Cuts", "Thrown into the Pressure Cooker", and "Trying to work it all out". CONCLUSION How women are cared for during their labour, birth and postnatal period impacts on how they manage early parenthood. Support is crucial for women, including practical parenting support, and emotional support by health professionals and peers.
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Affiliation(s)
- Holly S Priddis
- School of Nursing and Midwifery, Western Sydney University, Australia.
| | - Hazel Keedle
- School of Nursing and Midwifery, Western Sydney University, Australia.
| | - Hannah Dahlen
- School of Nursing and Midwifery, Western Sydney University, Australia.
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Brockington I. Emotional Rejection of the Infant: Status of the Concept. Psychopathology 2016; 49:247-260. [PMID: 27583348 DOI: 10.1159/000448334] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 07/11/2016] [Indexed: 11/19/2022]
Abstract
Emotional rejection of the infant is a morbid, clinical phenomenon, central to mother-infant psychiatry. It occurs in about 1% of births in the general population, but much more often in mothers referred to specialist services. It has severe consequences for children, but responds well to treatment. It is now better recognized, but research is required, especially cohort studies and neuroscientific investigations.
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Affiliation(s)
- Ian Brockington
- Professor Emeritus, University of Birmingham, Birmingham, UK
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Bobevski I, Rowe H, Clarke DM, McKenzie DP, Fisher J. Postnatal demoralisation among women admitted to a hospital mother-baby unit: validation of a psychometric measure. Arch Womens Ment Health 2015; 18:817-27. [PMID: 25520260 DOI: 10.1007/s00737-014-0486-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 12/03/2014] [Indexed: 10/24/2022]
Abstract
Demoralisation is a psychological state characterised by experiences of distress and sadness, helplessness, subjective incompetence and hopelessness, in the context of a stressful situation. Experiences of demoralisation may be particularly relevant to women who have recently given birth, who can feel incompetent, isolated and helpless. The psychometric properties of the Demoralisation Scale among women in the postnatal period participating in a clinical program were examined. Women admitted with their infants to a hospital mother-baby unit in Australia for five nights were recruited consecutively (N = 209) and assessed at admission and discharge. The Demoralisation Scale was perceived as relevant and exhibited high reliability, acceptable construct validity and good sensitivity to change. The mean demoralisation score was high (M = 30.9, SD = 15.5) and associated with negative experiences of motherhood and functional impairment, independent of depression and anxiety symptoms. Mean demoralisation decreased significantly after program completion (M = 18.4, SD = 12.4). More participants showed a significant improvement in demoralisation (57.5 %) than in depression (34.8 %) and anxiety (9.8 %) symptoms. Demoralisation can provide a useful framework for understanding and measuring the experiences of women participating in postnatal clinical programs and in directing treatment towards helping women to acquire the necessary caregiving skills and increasing parental efficacy. The Demoralisation Scale is a useful clinical tool for assessing intervention effects.
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Affiliation(s)
- I Bobevski
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, 6th Floor, Alfred Centre, 99 Commercial Road, Prahran, Melbourne, Victoria, 3004, Australia. .,Department of Psychiatry, Southern Clinical School, Monash University, Melbourne, Australia.
| | - H Rowe
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, 6th Floor, Alfred Centre, 99 Commercial Road, Prahran, Melbourne, Victoria, 3004, Australia
| | - D M Clarke
- Department of Psychiatry, Southern Clinical School, Monash University, Melbourne, Australia
| | - D P McKenzie
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - J Fisher
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, 6th Floor, Alfred Centre, 99 Commercial Road, Prahran, Melbourne, Victoria, 3004, Australia
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Bobevski I, Rowe H, Clarke DM, McKenzie DP, Fisher J. Early postnatal demoralisation among primiparous women in the community: measurement, prevalence and associated factors. BMC Pregnancy Childbirth 2015; 15:259. [PMID: 26459266 PMCID: PMC4603773 DOI: 10.1186/s12884-015-0680-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Accepted: 10/04/2015] [Indexed: 11/17/2022] Open
Abstract
Background Demoralisation is a psychological state occurring in stressful life situations where a person feels unable to respond effectively to their circumstances, characterised by feelings of distress, subjective incompetence, helplessness and hopelessness. The period after the birth of a first baby is a time of great changes and disruptions to many aspects of the mother's physical, psychological and social functioning. This can lead to feelings of distress, a sense of incompetence and helplessness. This study aimed to examine: (1) the psychometric properties of the Demoralisation Scale in a community setting; (2) the prevalence of demoralisation symptoms among primiparous women in the community; and (3) factors that are uniquely associated with demoralisation in the early postnatal period. Methods Primiparous women attending community maternal health centres (n = 400) were recruited and administered the study's questionnaires through a telephone interview. Results The Demoralisation Scale was found to be a reliable and valid tool among women in the community who had recently given birth. Higher levels of demoralisation were independently associated with lower confidence on going home from the hospital after birth, lower rating of mother's self-rated global health, more than 3 h of infant crying and fussing in the last 24 h, and a controlling partner, after symptoms of depression and anxiety, and vulnerable personality characteristics were controlled for. Conclusions The relevance of demoralisation to postnatal health practitioners in the community is in helping them to better understand women's experiences and to intervene in a way that is more meaningful and less stigmatising to women.
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Affiliation(s)
- Irene Bobevski
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia. .,Department of Psychiatry, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
| | - Heather Rowe
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - David M Clarke
- Department of Psychiatry, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
| | - Dean P McKenzie
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia. .,Research Development & Governance, Epworth HealthCare, Melbourne, Australia.
| | - Jane Fisher
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
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Bicking Kinsey C, Hupcey JE. State of the science of maternal-infant bonding: a principle-based concept analysis. Midwifery 2013; 29:1314-20. [PMID: 23452661 DOI: 10.1016/j.midw.2012.12.019] [Citation(s) in RCA: 160] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Revised: 12/11/2012] [Accepted: 12/17/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE to provide a principle-based analysis of the concept of maternal-infant bonding. DESIGN principle-based method of concept analysis for which the data set included 44 articles published in the last decade from Pubmed, CINAHL, and PyschINFO/PsychARTICLES. SETTING literature inclusion criteria were English language, articles published in the last decade, peer-reviewed journal articles and commentary on published work, and human populations. MEASUREMENT AND FINDINGS after a brief review of the history of maternal-infant bonding, a principle-based concept analysis was completed to examine the state of the science with regard to this concept. The concept was critically examined according to the clarity of definition (epistemological principle), applicability of the concept (pragmatic principle), consistency in use and meaning (linguistic principle), and differentiation of the concept from related concepts (logical principle). Analysis of the concept revealed: (1) Maternal-infant bonding describes maternal feelings and emotions towards her infant. Evidence that the concept encompasses behavioural or biological components was limited. (2) The concept is clearly operationalised in the affective domain. (3) Maternal-infant bonding is linguistically confused with attachment, although the boundaries between the concepts are clearly delineated. KEY CONCLUSION despite widespread use of the concept, maternal-infant bonding is at times superficially developed and subject to confusion with related concepts. Concept clarification is warranted. A theoretical definition of the concept of maternal-infant bonding was developed to aid in the clarification, but more research is necessary to further clarify and advance the concept. IMPLICATIONS FOR PRACTICE nurse midwives and other practitioners should use the theoretical definition of maternal-infant bonding as a preliminary guide to identification and understanding of the concept in clinical practice.
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Affiliation(s)
- Cara Bicking Kinsey
- School of Nursing, The Pennsylvania State University SON, 600 Centerview Drive, 1300 ASB/A110, Hershey, PA 17033, USA.
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Goldberg WA, Lucas-Thompson RG, Germo GR, Keller MA, Davis EP, Sandman CA. Eye of the beholder? Maternal mental health and the quality of infant sleep. Soc Sci Med 2012; 79:101-8. [PMID: 22858167 DOI: 10.1016/j.socscimed.2012.07.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Revised: 05/11/2012] [Accepted: 07/03/2012] [Indexed: 11/28/2022]
Abstract
Transactional models of parenting and infant sleep call attention to bidirectional associations among parenting, the biosocial environment, and infant sleep behaviors. Although night waking and bedtime fussing are normative during infancy and early childhood, they can be challenging for parents. The current study, conducted in the United States between 2003 and 2009, examined concurrent and longitudinal associations between maternal mental health and infant sleep during the first year. Concurrent associations at 6 and 12 months and longitudinal associations from 6 to 12 months were studied in a non-clinic referred sample of 171 economically and culturally diverse families. Mothers with poorer mental health reported that their infants had more night waking and bedtime distress and were more bothered by these sleep issues. Associations between infant sleep and maternal mental health were moderated by culture (Hispanic/Asian vs. other) and by stressors that included high parenting stress, more stressful life events, and low family income. Individual differences in maternal well-being may color mothers' interpretations of infants' sleep behaviors. It may be prudent to intervene to support maternal mental health when infants are referred for sleep problems.
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Affiliation(s)
- Wendy A Goldberg
- Department of Psychology and Social Behavior, School of Social Ecology, University of California, Irvine, CA 92697, USA.
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Chapman DP, Wheaton AG, Perry GS, Sturgis SL, Strine TW, Croft JB. Household demographics and perceived insufficient sleep among US adults. J Community Health 2012; 37:344-9. [PMID: 21800186 DOI: 10.1007/s10900-011-9451-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
It has become increasingly recognized that insufficient sleep is associated with adverse health outcomes. Studies have observed that sleep duration and daytime sleepiness varies by sex and marital status. Few studies have examined the impact of the number of children on sleep. To evaluate the association of marital status and number of children with insufficient sleep and in a large national sample. We analyzed data from the 2008 Behavioral Risk Factor Surveillance System (BRFSS) survey, a population-based telephone survey of non-institutionalized US adults (N = 395,407), in which respondents were asked, "During the past 30 days, for about how many days have you felt you did not get enough rest or sleep?" We used sex-specific, multivariate logistic regression analyses to assess the associations of marital status (married, previously married, never married) and the number of children in the household with frequent insufficient sleep (≥14 days in past 30 days) after adjusting for age, race/ethnicity, and education. In this study population, 23% were never married, 60% were married, and 17% were previously married. Forty-three percent reported having children aged <18 years in the household. Married men (24.3%) were less likely to report frequent insufficient sleep than never married men (28.0%) or previously married men (28.8%). Never married women (33.4%) were more likely to report frequent insufficient sleep than currently married (29.0%) or previously married women (29.0%). The likelihood of frequent insufficient sleep increased in a linear fashion with the number of children in the household for all subgroups (P < 0.05) except among never married men. These findings suggest that the presence of children in the household often increases the frequency of insufficient rest or sleep among the adults with whom they reside. Thus, health care providers may wish to consider the presence of children under 18 years of age a potential "risk factor" for insufficient sleep when counseling adults in the household about the importance of sleep to overall health.
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Affiliation(s)
- Daniel P Chapman
- Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway NE Mailstop K-67, Atlanta, GA 30041, USA.
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Matthey S, Črnčec R. Comparison of two strategies to improve infant sleep problems, and associated impacts on maternal experience, mood and infant emotional health: a single case replication design study. Early Hum Dev 2012; 88:437-42. [PMID: 22115988 DOI: 10.1016/j.earlhumdev.2011.10.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2011] [Revised: 10/17/2011] [Accepted: 10/26/2011] [Indexed: 10/15/2022]
Abstract
BACKGROUND Infant sleep problems (ISP) are common and have known effects on parental mood. There is debate as to whether treatment strategies may impact on the infant's emotional health. AIMS To compare the effectiveness of two treatment strategies for ISP on the infant's sleep, maternal mood, and the infant's emotional health. The two strategies are 1) systematic ignoring with minimal check ('SI-mc': commonly known as 'controlled crying'), and 2) a new, but similar, method where parents feign sleep inside the infant's room before intervening (parental presence with minimal check: 'PP-mc'). DESIGN Participants were randomised to one of the two conditions. Measures were taken at baseline, then three weeks and four months post-intervention. SUBJECTS Data were collected from 16 families with infants aged 6-18 months who were seeking professional help with their infant's sleep difficulties. OUTCOME MEASURES Measures of infant sleep, maternal experiences and mood, and infant emotional health were collected. RESULTS Both treatments were effective, with a third to a half of families reporting decreased ISP by 3 week post intervention, and nearly all reporting decreased ISP by follow-up. Similarly, most mothers in both treatments reported improvements to their experiences or mood, and there was no discernable disruption to infant emotional health. CONCLUSIONS These findings support previous research into the effectiveness of SI-mc. The study also expands the research into the effectiveness of parental presence by showing that with the inclusion of the minimal check component, which may be preferred by both parents and clinicians over non-responding to the crying infant, the strategy is as effective as SI-mc.
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Affiliation(s)
- Stephen Matthey
- Infant, Child and Adolescent Mental Health Service, South Western Sydney Local Health Network, Australia.
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Matthey S, Reay R, Fletcher R. Service Strategies for Engaging Fathers in the Perinatal Period — What Have we Learned so Far? INTERNATIONAL JOURNAL OF MENTAL HEALTH PROMOTION 2012. [DOI: 10.1080/14623730.2009.9721785] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Thome M, Orlygsdottir B, Elvarsson BT. Evaluation of the clinical effect of an on-line course for community nurses on post-partum emotional distress: a community-based longitudinal time-series quasi-experiment. Scand J Caring Sci 2011; 26:494-504. [PMID: 22122594 DOI: 10.1111/j.1471-6712.2011.00954.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
About 14% of Icelandic women suffer post-partum from frequent depressive symptoms, and of those, 12% also report a high degree of parenting stress. Education of nurses and midwives on post-partum distress is crucial in reducing its degree. The purpose of the study is to evaluate the clinical effect of an on-line course for community nurses on post-partum emotional distress. A community-based, longitudinal, time-series quasi-experiment was conducted in four stages from 2001 to 2005. Mothers attending 16 health centres throughout Iceland and scoring ≥ 12 on the Edinburgh Postnatal Depression Scale (EPDS) at the 9th week post-partum were eligible to participate. Health centres were divided into experimental (EHC) and control centres (CHC), and control centres were crossed over to experimental centres the following year and new control centres recruited. Nurses at EHC attended an on-line course on post-partum emotional distress. Participating mothers answered the EPDS; the Parenting Stress Index/Short form and the Fatigue Scale. Nursing diagnoses and interventions were recorded at all study centres. Of the women who were eligible (n = 163), 57% (n = 93) participated. At baseline, 9 weeks post-partum, there were no significant differences between groups of women in the rate of depressive symptoms, fatigue or parenting stress. Women in all groups improved on all distress indicators over time; however, those from the EHC improved statistically and clinically significantly more on depressive symptoms than those from the CHC. Documentation of particular nursing diagnoses and interventions was significantly more frequent at the EHC, but referrals to specialists were significantly less frequent. On-line education for nurses on post-partum emotional distress is feasible and is related to improvement in post-partum depressive symptoms.
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Affiliation(s)
- Marga Thome
- School of Health Science, Faculty of Nursing, University of Iceland, Reykjavik, Iceland
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25
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Magnusson M, Lagerberg D, Sundelin C. How can we identify vulnerable mothers who do not reach the cut off 12 points in EPDS? J Child Health Care 2011; 15:39-49. [PMID: 21451009 DOI: 10.1177/1367493510397622] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The aim was to investigate the correspondence between 352 mother's self-reports about postpartum distress in a questionnaire including an item about distress 18 months after birth and their earlier scores within, on average, 2.5 months of childbirth from a screening with the Edinburgh Postnatal Depression Scale (EPDS). Mothers who did not reach the EPDS score of 12 points, but reported that they had been sad/depressed after childbirth, were similar in socio-demographic variables to mothers with no outcomes in sadness/depression issues. In items related to negative parenting and perceptions of the child, they presented the same picture as those with high EPDS scores who also reported having been depressed. These results suggest that EPDS does not identify all vulnerable mothers. Complementary methods for detecting mothers at risk of stress and depression need to be developed.
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Affiliation(s)
- Margaretha Magnusson
- Department of Women's and Children's Health, Section for Paediatrics, Uppsala University, Children's Hospital, Uppsala, Sweden.
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Fisher JR, Rowe HJ, Hammarberg K. Admission of women, with their infants, for psychological and psychiatric causes in Victoria, Australia. Aust N Z J Public Health 2011; 35:146-50. [DOI: 10.1111/j.1753-6405.2010.00653.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Brockington I. Maternal rejection of the young child: present status of the clinical syndrome. Psychopathology 2011; 44:329-36. [PMID: 21734436 DOI: 10.1159/000325058] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2010] [Accepted: 01/17/2011] [Indexed: 11/19/2022]
Abstract
This article reviews severe disorders of the mother-infant relationship involving emotional rejection of the infant in the first year of its life. Infants exposed to their mother's hatred and rage may suffer far-ranging and long-term disadvantages, and are at risk of maltreatment. Diagnosis, therapy and research have been hampered by the lack of recognition of this clinical syndrome in the classifications. The imminent revision of these classificatory systems must include them.
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Matthey S, White T, Rice S. Women's responses to postnatal self-report mood and experience measures: does anonymity make a difference? Arch Womens Ment Health 2010; 13:477-84. [PMID: 20386941 DOI: 10.1007/s00737-010-0159-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2009] [Accepted: 03/03/2010] [Indexed: 11/25/2022]
Abstract
This study aimed to investigate whether endorsement of "difficulty coping" questions on two self-report measures would be affected by whether or not women had to put their name on the questionnaires. In addition, a small survey of mental health professionals was conducted to see what they thought the study would find. Women (n= 211) attending maternal and child health clinics completed two self-report measures of mood and experience of motherhood. Women were either asked to write their name on the forms and were told that the project officer would check their forms once completed ("named" condition) or asked not to put their name on the forms and that the forms would not be looked at ("anonymous" condition). Perinatal mental health professionals (n= 44) completed an anonymous survey asking them what they considered the study would find. Most health professionals (77.3%) expected that the anonymous condition would result in more "honest" responding by women-that is, there would be a higher rate of women admitting to not coping in the anonymous condition. To the contrary, however, this was not found. There were no differences between the rates of endorsement of "not currently coping" by women in the two conditions, a finding only expected by 13.6% of the professionals. There was a small, but statistically significant, difference in women reporting whether they had a prior history of difficulty coping, with more women in the named condition endorsing this. Rates of postnatal distress or depression, based upon responses to self-report mood or similar questionnaires, are unlikely to be affected by whether participants are required to put their name on the measures or not or whether they anticipate that their responses will be scrutinized. This is an unexpected finding by a sample of mental health professionals interested in the perinatal mental health field, and thus, the study has "new knowledge" significance.
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Affiliation(s)
- Stephen Matthey
- Infant, Child and Adolescent Mental Health Service-Research Unit, Sydney South West Area Health Service, Liverpool Hospital, Mental Health Centre (L1), Locked Bag 7103, Liverpool BC, NSW 1871, Australia.
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Rowe HJ, Fisher JRW. Development of a universal psycho-educational intervention to prevent common postpartum mental disorders in primiparous women: a multiple method approach. BMC Public Health 2010; 10:499. [PMID: 20718991 PMCID: PMC2931475 DOI: 10.1186/1471-2458-10-499] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2009] [Accepted: 08/18/2010] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Prevention of postnatal mental disorders in women is an important component of comprehensive health service delivery because of the substantial potential benefits for population health. However, diverse approaches to prevention of postnatal depression have had limited success, possibly because anxiety and adjustment disorders are also problematic, mental health problems are multifactorially determined, and because relationships amongst psychosocial risk factors are complex and difficult to modify. The aim of this paper is to describe the development of a novel psycho-educational intervention to prevent postnatal mental disorders in mothers of firstborn infants. METHODS Data from a variety of sources were synthesised: a literature review summarised epidemiological evidence about neglected modifiable risk factors; clinical research evidence identified successful psychosocial treatments for postnatal mental health problems; consultations with clinicians, health professionals, policy makers and consumers informed the proposed program and psychological and health promotion theories underpinned the proposed mechanisms of effect. The intervention was pilot-tested with small groups of mothers and fathers and their first newborn infants. RESULTS What Were We Thinking! is a psycho-educational intervention, designed for universal implementation, that addresses heightened learning needs of parents of first newborns. It re-conceptualises mental health problems in mothers of infants as reflecting unmet needs for adaptations in the intimate partner relationship after the birth of a baby, and skills to promote settled infant behaviour. It addresses these two risk factors in half-day seminars, facilitated by trained maternal and child health nurses using non-psychiatric language, in groups of up to five couples and their four-week old infants in primary care. It is designed to promote confidence and reduce mental disorders by providing skills in sustainable sleep and settling strategies, and the re-negotiation of the unpaid household workload in non-confrontational ways. Materials include a Facilitators' Handbook, creatively designed worksheets for use in seminars, and a book for couples to take home for reference. A website provides an alternative means of access to the intervention. CONCLUSIONS What Were We Thinking! is a postnatal mental health intervention which has the potential to contribute to psychologically-informed routine primary postnatal health care and prevent common mental disorders in women.
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Affiliation(s)
- Heather J Rowe
- Centre for Women's Health Gender and Society, Melbourne School of Population Health, University of Melbourne, Victoria 3010 Australia
| | - Jane RW Fisher
- Centre for Women's Health Gender and Society, Melbourne School of Population Health, University of Melbourne, Victoria 3010 Australia
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Tenenbojm E, Rossini S, Estivill E, Segarra F, Reimão R. Causas de insônia nos primeiros anos de vida e repercussão nas mães: atualização. REVISTA PAULISTA DE PEDIATRIA 2010. [DOI: 10.1590/s0103-05822010000200015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJETIVO: Revisar a literatura sobre insônia de crianças pequenas e seus aspectos relacionados às repercussões familiares, à abordagem pediátrica e ao seu tratamento. FONTES DE DADOS: Levantamento de publicações indexadas no Medline e Lilacs entre os anos de 1998 e 2008, rastreadas com a combinação dos descritores: "sleep", "insomnia", "child", "depression", "mother-child relationship", além de teses e capítulos de livros pertinentes ao assunto. SÍNTESE DOS DADOS: A insônia da criança pequena, definida como dificuldade repetida em iniciar e/ou manter o sono, é queixa frequente na clínica pediátrica e usualmente traz repercussões nos pais relativas à privação de sono. Aos dois a três meses de idade, há condições biológicas para consolidação das horas de sono à noite; estando a conduta parental associada às dificuldades neste processo. Estudos demonstram que há associação entre insônia do bebê e depressão nas mães, e a insônia pode ser manifestação de dificuldades no desenvolvimento psíquico da criança pequena, que acontece na relação com sua mãe. CONCLUSÕES: O ritmo de sono nos bebês pode e deve estabelecer-se precocemente; os hábitos para o sono devem basear-se nas medidas de higiene do sono. A depressão nas mães, que pode contribuir para a insônia do bebê, idealmente poderia ser detectada pelo pediatra, prevenindo esse comprometimento das mães e de seus bebês.
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Rowe HJ, Fisher JRW. The contribution of Australian residential early parenting centres to comprehensive mental health care for mothers of infants: evidence from a prospective study. Int J Ment Health Syst 2010; 4:6. [PMID: 20380739 PMCID: PMC2873569 DOI: 10.1186/1752-4458-4-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2009] [Accepted: 04/11/2010] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Australia's public access residential early parenting services provide programs to assist parents who self-refer, to care for their infants and young children. Treatment programs target infant feeding and sleeping difficulties and maternal mental health. There is limited systematic evidence of maternal and infant mental health, psychosocial circumstances or presenting problems, or the effectiveness of the programs. The aim of this study was to contribute to the evidence base about residential early parenting services. METHODS A prospective cohort design was used. A consecutive sample of mothers with infants under one year old recruited during admission to a public access residential early parenting service for a 4 or 5 night stay in Melbourne, Australia was recruited. They completed structured self-report questionnaires, incorporating standardised measures of infant behaviour and maternal mood, during admission and at one and six months after discharge. Changes in infant behaviour and maternal psychological functioning after discharge were observed. RESULTS 79 women completed the first questionnaire during admission, and 58 provided complete data. Women admitted to the residential program have poor physical and mental health, limited family support, and infants with substantial behaviour difficulties. One month after discharge significant improvements in infant behaviour and maternal psychological functioning were observed (mean (SD) daily crying and fussing during admission = 101.02 (100.8) minutes reduced to 37.7 (55.2) at one month post discharge, p < 0.001; mean (SD) Edinburgh Postnatal Depression Scale at admission = 11.3 (5.7) reduced to 6.78 (4.44), at one month, p < 0.001) which were sustained at six months. Participant satisfaction with the program was high; 58 (88%) found the support of the nurses and 50 (75%) the social support of other mothers very helpful. CONCLUSIONS This psycho-educational approach is an effective and acceptable early intervention for parenting difficulties and maternal mood disturbance, and contributes to a system of comprehensive mental health care for mothers of infants.
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Affiliation(s)
- Heather J Rowe
- Centre for Women's Health Gender and Society, Melbourne School of Population Health, Faculty of Medicine Dentistry and Health Sciences, University of Melbourne, Victoria 3010 Australia
| | - Jane RW Fisher
- Centre for Women's Health Gender and Society, Melbourne School of Population Health, Faculty of Medicine Dentistry and Health Sciences, University of Melbourne, Victoria 3010 Australia
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Phillips J, Sharpe L, Nemeth D. Maternal psychopathology and outcomes of a residential mother-infant intervention for unsettled infant behaviour. Aust N Z J Psychiatry 2010; 44:280-9. [PMID: 20180728 DOI: 10.3109/00048670903487225] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Residential mother-infant intervention programmes for unsettled infant behaviour have been shown to be associated with positive child and maternal outcomes. Despite evidence of elevated rates of maternal psychopathology among residential unit populations, little is known about whether psychological disorders interfere with the effectiveness of such interventions. METHOD Two cohorts (n = 104 and 147, respectively) were recruited from a residential mother-infant intervention programme for unsettled infant behaviour. In study 1, mothers completed self-report questionnaires measuring depression, anxiety and parenting stress at three time points (admission, 1 month after discharge and 3 months after discharge). In study 2, mothers were interviewed using a structured clinical interview for depressive and anxiety disorders. In both studies, nurses recorded infant behaviours over the duration of the 5 day admission using 24 h behaviour charts. RESULTS Study 1 showed the intervention to be associated with significant improvements in child behaviours and in levels of maternal depression, anxiety and parenting stress. These improvements were evident for women who scored above the Edinburgh Postnatal Depression Scale threshold for major depression during the admission, as well as for women in the normal range. Study 2 confirmed that the intervention was associated with significant improvements in infant behaviours. Infants of mothers with a depressive or anxiety disorder were less unsettled on admission, but improvements over the course of the admission were comparable for infants of women who had, or had not, experienced an anxiety or depressive disorder during the admission. CONCLUSIONS These results show positive infant and maternal outcomes associated with a residential mother-infant intervention for unsettled infant behaviour, regardless of the women's psychiatric status on admission. This suggests that women with depression or anxiety disorders who also report unsettled infant behaviour, will benefit from referral to residential programmes.
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Affiliation(s)
- Jane Phillips
- Karitane, PO Box 241, Villawood, NSW 2163, Australia.
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Črnčec R, Matthey S, Nemeth D. Infant sleep problems and emotional health: a review of two behavioural approaches. J Reprod Infant Psychol 2010. [DOI: 10.1080/02646830903294995] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Crncec R, Cooper E, Matthey S. Treating infant sleep disturbance: does maternal mood impact upon effectiveness? J Paediatr Child Health 2010; 46:29-34. [PMID: 19943865 DOI: 10.1111/j.1440-1754.2009.01613.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM To explore whether mild-to-moderate maternal depression affects the effectiveness of a behavioural approach to treating infant sleep disturbance (ISD). METHODS The health records of 90 mothers attending an inpatient parenting service for management of their 5-12-month-old infant's sleep difficulties were examined. These records contained detailed, nurse-completed, 24-hour behaviour charts of infant sleeping and crying. Participants were allocated to the depression group based on Edinburgh Depression Scale score and/or review of mental health assessment notes. RESULTS There were no differences between infants of mothers with (n= 39) or without (n= 51) depression on either (i) the severity of their initial sleeping difficulty, or (ii) their response to behavioural treatment. Both groups showed significant improvements over the 5-day stay on all sleep variables observed, including number of night wakings, time to fall asleep, time spent crying at night and total time slept at night. CONCLUSIONS Mild-to-moderate maternal depression does not appear to attenuate ISD behavioural treatment outcomes. Given ISD treatment has been shown to improve maternal mood, the results of this study argue against recommendations initially to address maternal mood in isolation when managing ISD.
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Affiliation(s)
- Rudi Crncec
- MARCS Auditory Laboratories, Sydney South West Area Health Service, Liverpool Hospital, Mental Health Centre (Level 1: ICAMHS), Locked Bag 7103, Liverpool BC, NSW 1871, Australia.
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Hammarberg K, Rowe H, Fisher J. Early post-partum adjustment and admission to parenting services in Victoria, Australia after assisted conception. Hum Reprod 2009; 24:2801-9. [DOI: 10.1093/humrep/dep282] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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