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Augustin M, Wenzel AS, Licata-Dandel M, Breeman LD, Bilgin A, Wolke D, Ziegler M, Mall V, Friedmann A. App-based intervention for parents of children with crying, sleeping, and feeding problems: Usability, usefulness and implications for improvement. Internet Interv 2024; 35:100700. [PMID: 38221943 PMCID: PMC10784306 DOI: 10.1016/j.invent.2023.100700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 11/29/2023] [Accepted: 12/11/2023] [Indexed: 01/16/2024] Open
Abstract
Background There is a lack of evidence-based app guidance for parents of children with crying, sleeping, and feeding problems who are often highly burdened and not likely to seek professional help. A new psychoeducational app for parents providing scientifically sound information via text and videos, a diary function, selfcare strategies, a chat forum and a regional directory of specialized counseling centers may serve as a low-threshold intervention for this target group. Objective We investigated how parents perceived the app in terms of the following: (1) overall impression and usability, (2) feedback on specific app functions regarding usefulness and (3) possible future improvements. Methods Our clinical sample of N = 137 parents of children aged from 0 to 24 months was recruited from a cry baby outpatient clinic in Southern Germany between 2019 and 2022. A convergent parallel mixed methods design was used to collect and analyse cross-sectional data on app evaluation. After app use within the framework of a clinical trial, parents filled in an app evaluation questionnaire. Results Most participants used the app at least once a week (86, 62.8 %) over an average period of 19.06 days (SD = 15.00). Participants rated overall impression and usability as good, and the informational texts, expert videos and regional register of counseling centers as appealing and useful. The diary function and chat forum were found to be helpful in theory, but improvements in implementation were requested, such as a timer function for the diary entry. Regarding future functionality, parents posed several suggestions such as the option to contact counseling centers directly via app, and the inclusion of the profile of their partners. Conclusions Positive ratings of overall impression, usability, and specific app functions are important prerequisites for the app to be effective. App-based guidance for this target group should include easy-to-use information. The app is intended to serve as a secondary preventive low-threshold offer and to complement professional counseling.
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Affiliation(s)
- Michaela Augustin
- Social Pediatrics, TUM School of Medicine, Technical University of Munich, Heiglhofstr. 65, 81377 Munich, Germany
| | - Anne Sophie Wenzel
- Social Pediatrics, TUM School of Medicine, Technical University of Munich, Heiglhofstr. 65, 81377 Munich, Germany
| | - Maria Licata-Dandel
- Social Pediatrics, TUM School of Medicine, Technical University of Munich, Heiglhofstr. 65, 81377 Munich, Germany
- kbo-Kinderzentrum Munich, Heiglhofstr. 65, 81377 Munich, Germany
- Department of Psychology, Charlotte-Fresenius-University, Infanteriestr.11a, 80797 Munich, Germany
| | - Linda D. Breeman
- Health, Medical, and Neuropsychology Unit, Leiden University, Wassenaarseweg 52, 2333 AK Leiden, Netherlands
| | - Ayten Bilgin
- Department of Psychology, University of Essex, Colchester CO4 3SQ, United Kingdom
| | - Dieter Wolke
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry CV4 7AL, United Kingdom
- Department of Psychology, University of Warwick, Coventry CV4 7HL, United Kingdom
| | - Margret Ziegler
- kbo-Kinderzentrum Munich, Heiglhofstr. 65, 81377 Munich, Germany
| | - Volker Mall
- Social Pediatrics, TUM School of Medicine, Technical University of Munich, Heiglhofstr. 65, 81377 Munich, Germany
- kbo-Kinderzentrum Munich, Heiglhofstr. 65, 81377 Munich, Germany
| | - Anna Friedmann
- Social Pediatrics, TUM School of Medicine, Technical University of Munich, Heiglhofstr. 65, 81377 Munich, Germany
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Schwarze CE, von der Heiden S, Wallwiener S, Pauen S. The role of perinatal maternal symptoms of depression, anxiety and pregnancy-specific anxiety for infant's self-regulation: A prospective longitudinal study. J Affect Disord 2024; 346:144-153. [PMID: 37832733 DOI: 10.1016/j.jad.2023.10.035] [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: 03/20/2023] [Revised: 09/10/2023] [Accepted: 10/08/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND Maternal symptoms of anxiety and depression are highly prevalent during pregnancy and postpartum and have the potential to impact fetal development and offspring behavior. However, research on the effects of fetal exposure to maternal subclinical affective symptoms on infant self-regulation is still lacking. Self-regulation provides a fundamental precondition for healthy development and overall life success whereas dysfunctional self-regulation can lead to behavioral problems, poor academic achievement, social rejection, and physical/mental disorders. During pregnancy and infancy, children largely depend upon their mothers in order to successfully regulate their internal states. Given the high prevalence of mothers suffering from anxiety and depressive symptoms during pregnancy and after childbirth, the aim of the present study is to explore how maternal affective symptoms change during the pre- and postnatal period, and how measures obtained in pregnancy and beyond impact self-regulation in infants, as indicated by crying-, sleeping-, and/or feeding problems. METHODS This prospective longitudinal study investigates the effects of maternal symptoms of depression, anxiety, and pregnancy-specific anxiety on infant's self-regulation in N = 225 mother-infant dyads. Maternal affective symptoms were examined at five prenatal and three postnatal time-points using the Edinburgh Postnatal Depression Scale (EPDS), the State-Trait Anxiety Inventory (STAI) and the Pregnancy Related Anxiety Questionnaire Revised (PRAQ-R2). Infant's self-regulation was assessed twice - at the age of three and six months - using the Crying Feeding Sleeping Scale (SFS). RESULTS Maternal pregnancy-specific anxiety was the most significant predictor for infant self-regulatory problems. It predicted crying-, sleeping, and feeding problems and explained up to 18 % of the variance. Even when controlling for maternal postpartum affective symptoms, pregnancy-specific anxiety remained a significant predictor for infant self-regulation problems. LIMITATIONS Rather homogenous sample (high socioeconomic status). Data based on maternal reports of infant behavior. CONCLUSIONS Our results suggest that fetal exposure to maternal affective symptoms - specifically pregnancy-related anxiety - plays a substantial role in the development of infant self-regulation problems, potentially mediated by epigenetic modifications. Importantly, even though maternal symptoms of depression and anxiety only reached subclinical levels, they were predictive for infant crying-, sleeping-, and feeding problems. Our findings underline the importance of early prevention and clearly tailored interventions during pregnancy and postpartum to prevent adverse outcome for mother, child and family.
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Affiliation(s)
- Cornelia E Schwarze
- Heidelberg University, Department of Psychology, Developmental and Biological Psychology Unit, Heidelberg, Germany.
| | - Sina von der Heiden
- Heidelberg University, Department of Psychology, Developmental and Biological Psychology Unit, Heidelberg, Germany
| | - Stephanie Wallwiener
- University Hospital Heidelberg, Department of Gynecology and Obstetrics, Heidelberg, Germany; University of Halle-Wittenberg, Department of Obstetrics and Prenatal Medicine, Halle, Germany
| | - Sabina Pauen
- Heidelberg University, Department of Psychology, Developmental and Biological Psychology Unit, Heidelberg, Germany
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Klauser N, Müller M, Zietlow AL, Nonnenmacher N, Woll C, Becker-Stoll F, Rec C. Maternal postpartum anxiety and the development of infant attachment: The effect of body sensations on infant attachment. J Affect Disord 2023; 331:259-268. [PMID: 36958486 DOI: 10.1016/j.jad.2023.03.048] [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: 05/20/2022] [Revised: 03/04/2023] [Accepted: 03/16/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND Knowledge about the influences of maternal postpartum anxiety disorders (PAD) on infant development is limited. Aim of this present study is to evaluate the influence of PAD on infant attachment. METHODS In a longitudinal study, self-reported anxiety symptoms of N = 70 mothers (N = 28 with PAD diagnosed according to the DSM-IV, N = 42 controls) were examined in the postpartum period and one year later. Infants' attachment was observed in the Strange Situation Test (SST) at the age of 12-24 months. RESULTS Results indicate a strong relationship between PAD and infant attachment: infants of mothers with PAD were significantly more likely to be classified as insecure or disorganized than infants of control mothers. Logistic regression analysis led to a significant model with 76.8 % correct classification of infant attachment dependent on the maternal fear of anxiety associated body sensations (OR = 4.848) in the postpartum period. Including maternal sensitivity and interaction behavior, only maternal intrusiveness was additionally associated with infant attachment (ρ = 0.273, p < .05; OR = 45.021, p = .153). LIMITATIONS Participants were highly educated. Different anxiety disorders included led to a heterogenous sample. Generalization is diminished. Maternal sensitivity was measured on a global scale, and body tension was self-reported. CONCLUSIONS PAD plays a crucial role in the development of infant attachment. Interaction-focused interventions, helping mothers to decrease intrusiveness, and body-focused interventions, helping mothers to deal with their fear of anxiety symptoms, might be promising pathways to buffer the influence of PAD on infant attachment.
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Affiliation(s)
- Nathania Klauser
- Ludwig-Maximilians University, Department of Psychology, Munich, Germany.
| | - Mitho Müller
- Ludwig-Maximilians University, Department of Psychology, Munich, Germany
| | - Anna-Lena Zietlow
- Technical University Dresden, Department of Psychology, Dresden, Germany
| | - Nora Nonnenmacher
- Heidelberg University Hospital, General Psychiatry, Heidelberg, Germany
| | - Christian Woll
- Ludwig-Maximilians University, Department of Psychology, Munich, Germany
| | - Fabienne Becker-Stoll
- Ludwig-Maximilians University, Department of Psychology, Munich, Germany; Staatsinstitut für Frühpädagogik Bayern, Munich, Germany
| | - Corinna Rec
- Ludwig-Maximilians University, Department of Psychology, Munich, Germany
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Augustin M, Licata-Dandel M, Breeman LD, Harrer M, Bilgin A, Wolke D, Mall V, Ziegler M, Ebert DD, Friedmann A. Effects of a Mobile-Based Intervention for Parents of Children With Crying, Sleeping, and Feeding Problems: Randomized Controlled Trial. JMIR Mhealth Uhealth 2023; 11:e41804. [PMID: 36897641 PMCID: PMC10039405 DOI: 10.2196/41804] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 12/16/2022] [Accepted: 01/13/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Excessive crying, sleeping, and feeding problems in early childhood are major stressors that can result in parents feeling socially isolated and having low self-efficacy. Affected children are a risk group for being maltreated and developing emotional and behavioral problems. Thus, the development of an innovative and interactive psychoeducational app for parents of children with crying, sleeping, and feeding problems may provide low-threshold access to scientifically based information and reduce negative outcomes in parents and children. OBJECTIVE We aimed to investigate whether following the use of a newly developed psychoeducational app, the parents of children with crying, sleeping, or feeding problems experienced less parenting stress; gained more knowledge about crying, sleeping, and feeding problems; and perceived themselves as more self-effective and as better socially supported and whether their children's symptoms decreased more than those of the parents who did not use the app. METHODS Our clinical sample consisted of 136 parents of children (aged 0-24 months) who contacted a cry baby outpatient clinic in Bavaria (Southern Germany) for an initial consultation. Using a randomized controlled design, families were randomly allocated to either an intervention group (IG; 73/136, 53.7%) or a waitlist control group (WCG; 63/136, 46.3%) during the usual waiting time until consultation. The IG was given a psychoeducational app that included evidence-based information via text and videos, a child behavior diary function, a parent chat forum and experience report, tips on relaxation, an emergency plan, and a regional directory of specialized counseling centers. Outcome variables were assessed using validated questionnaires at baseline test and posttest. Both groups were compared at posttest regarding changes in parenting stress (primary outcome) and secondary outcomes, namely knowledge about crying, sleeping, and feeding problems; perceived self-efficacy; perceived social support; and child symptoms. RESULTS The mean individual study duration was 23.41 (SD 10.42) days. The IG reported significantly lower levels of parenting stress (mean 83.18, SD 19.94) after app use compared with the WCG (mean 87.46, SD 16.67; P=.03; Cohen d=0.23). Furthermore, parents in the IG reported a higher level of knowledge about crying, sleeping, and feeding (mean 62.91, SD 4.30) than those in the WCG (mean 61.15, SD 4.46; P<.001; Cohen d=0.38). No differences at posttest were found between groups in terms of parental efficacy (P=.34; Cohen d=0.05), perceived social support (P=.66; Cohen d=0.04), and child symptoms (P=.35; Cohen d=0.10). CONCLUSIONS This study provides initial evidence of the efficacy of a psychoeducational app for parents with child crying, sleeping, and feeding problems. By reducing parental stress and increasing knowledge of children's symptoms, the app has the potential to serve as an effective secondary preventive measure. Additional large-scale studies are needed to investigate long-term benefits. TRIAL REGISTRATION German Clinical Trials Register DRKS00019001; https://drks.de/search/en/trial/DRKS00019001.
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Affiliation(s)
- Michaela Augustin
- Social Pediatrics, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Maria Licata-Dandel
- Social Pediatrics, TUM School of Medicine, Technical University of Munich, Munich, Germany
- kbo-Kinderzentrum Munich, Munich, Germany
| | - Linda D Breeman
- Health, Medical, and Neuropsychology Unit, Leiden University, Leiden, Netherlands
| | - Mathias Harrer
- Psychology & Digital Mental Health Care, Department of Sports and Health Sciences, Technical University of Munich, Munich, Germany
- Clinical Psychology and Psychotherapy, Institute for Psychology, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Ayten Bilgin
- School of Psychology, University of Kent, Canterbury, United Kingdom
| | - Dieter Wolke
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
- Department of Psychology, University of Warwick, Coventry, United Kingdom
| | - Volker Mall
- Social Pediatrics, TUM School of Medicine, Technical University of Munich, Munich, Germany
- kbo-Kinderzentrum Munich, Munich, Germany
| | | | - David Daniel Ebert
- Psychology & Digital Mental Health Care, Department of Sports and Health Sciences, Technical University of Munich, Munich, Germany
| | - Anna Friedmann
- Social Pediatrics, TUM School of Medicine, Technical University of Munich, Munich, Germany
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Lux U, Müller M, Reck C, Liel C, Walper S. Linking maternal psychopathology to children's excessive crying and sleeping problems in a large representative German sample-The mediating role of social isolation and bonding difficulties. INFANCY 2023; 28:435-453. [PMID: 36397657 DOI: 10.1111/infa.12514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 10/07/2022] [Accepted: 10/25/2022] [Indexed: 11/21/2022]
Abstract
Attaining self-regulation is a major developmental task in infancy, in which many children show transient difficulties. Persistent, clinically relevant difficulties in self-regulation include excessive crying or sleeping disorders. Many families with affected children are burdened with multiple psychosocial risk. This suggests that regulatory problems are best conceptualized as the maladaptive interplay of overly burdened parents and a dysfunctional parent-child interaction. The current study examines whether social isolation and bonding difficulties function as mediating mechanisms linking maternal psychopathology to (1) children's excessive crying and (2) sleeping problems. The sample comprised N = 6598 mothers (M = 31.51 years) of children between zero to three years of age (M = 14.08 months, 50.1% girls). In addition to socio demographic data, the written questionnaire included information on maternal depression/anxiety, isolation, bonding, and children's regulatory problems. Hypotheses were tested with a mediation model controlling for psychosocial risk and child characteristics. As expected, maternal symptoms of depression/anxiety were linked to infants' excessive crying and sleeping problems. Social isolation and bonding difficulties mediated this association for excessive crying as well as for sleeping problems, but social isolation was a single mediator for sleeping problems only. The findings provide important insights in the mediating pathways linking maternal psychopathology to children's regulatory problems.
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Affiliation(s)
- Ulrike Lux
- National Centre for Early Prevention, German Youth Institute, Munich, Germany.,Ludwig-Maximilians-University Munich, Munich, Germany
| | - Mitho Müller
- Ludwig-Maximilians-University Munich, Munich, Germany
| | - Corinna Reck
- Ludwig-Maximilians-University Munich, Munich, Germany
| | - Christoph Liel
- National Centre for Early Prevention, German Youth Institute, Munich, Germany
| | - Sabine Walper
- National Centre for Early Prevention, German Youth Institute, Munich, Germany.,Ludwig-Maximilians-University Munich, Munich, Germany
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Shakiba N, Doron G, Gordon‐Hacker A, Egotubov A, Wagner NJ, Gueron‐Sela N. Mother-infant emotional availability through the COVID-19 pandemic: Examining continuity, stability, and bidirectional associations. INFANCY 2023; 28:34-55. [PMID: 36468187 PMCID: PMC9877570 DOI: 10.1111/infa.12517] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 08/15/2022] [Accepted: 10/31/2022] [Indexed: 12/07/2022]
Abstract
The COVID-19 pandemic may impact the development of infants' social communication patterns with their caregivers. The current study examined continuity, stability, and bidirectional associations in maternal and infant dyadic Emotional Availability (EA) before and during the COVID-19 pandemic. Participants were 110 Israeli mother-infant dyads (51% girls) that were assessed prior to (Mage = 3.5 months) and during (Mage = 12.4 months) the pandemic. At both time points, mother-infant interactions were observed during play (nonstressful context) and tasks designed to elicit infant frustration (stressful context). Maternal and child EA were coded offline. Maternal EA demonstrated no significant mean-level changes from before to during the COVID-19 pandemic, whereas infant responsiveness and involvement increased over time. Stability and bidirectional associations in EA differed by context and were evident only in the stressful context. Mothers' perceived levels of social support further moderated these associations. Specifically, infants' pre-pandemic responsiveness and involvement predicted maternal EA during the pandemic only when mothers reported low levels of social support. Our findings suggest that maternal and child EA were not adversely impacted by the COVID-19 pandemic. However, patterns of EA demonstrated moderate-to-no stability over time, suggesting considerable individual differences in trajectories of EA.
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Affiliation(s)
- Nila Shakiba
- Department of Psychological and Brain SciencesBoston UniversityBostonMassachusettsUSA
| | - Gal Doron
- Department of PsychologyBen‐Gurion University of the NegevBeer‐ShevaIsrael
| | | | - Alisa Egotubov
- Department of PsychologyBen‐Gurion University of the NegevBeer‐ShevaIsrael
| | - Nicholas J. Wagner
- Department of Psychological and Brain SciencesBoston UniversityBostonMassachusettsUSA
| | - Noa Gueron‐Sela
- Department of PsychologyBen‐Gurion University of the NegevBeer‐ShevaIsrael
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Perez A, Göbel A, Stuhrmann LY, Schepanski S, Singer D, Bindt C, Mudra S. Born Under COVID-19 Pandemic Conditions: Infant Regulatory Problems and Maternal Mental Health at 7 Months Postpartum. Front Psychol 2022; 12:805543. [PMID: 35153928 PMCID: PMC8826543 DOI: 10.3389/fpsyg.2021.805543] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 12/09/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The SARS-COVID-19 pandemic and its associated disease control restrictions have in multiple ways affected families with young children, who may be especially vulnerable to mental health problems. Studies report an increase in perinatal parental distress as well as symptoms of anxiety or depression in children during the pandemic. Currently, little is known about the impact of the pandemic on infants and their development. Infant regulatory problems (RPs) have been identified as early indicators of child socio-emotional development, strongly associated with maternal mental health and the early parent-infant interaction. Our study investigates whether early parenthood under COVID-19 is associated with more maternal depressive symptoms and with a perception of their infants as having more RPs regarding crying/fussing, sleeping, or eating, compared to mothers assessed before the pandemic. METHODS As part of a longitudinal study, 65 women who had given birth during the first nationwide disease control restrictions in Northern Germany, were surveyed at 7 months postpartum and compared to 97 women assessed before the pandemic. RPs and on maternal depressive symptoms were assessed by maternal report. Number of previous children, infant negative emotionality, and perceived social support were assessed as control variables. RESULTS Compared to the control cohort, infants born during the COVID-19 pandemic and those of mothers with higher depressive symptoms were perceived as having more sleeping and crying, but not more eating problems. Regression-based analyses showed no additional moderating effect of parenthood under COVID-19 on the association of depressive symptoms with RPs. Infant negative emotionality was positively, and number of previous children was negatively associated with RPs. LIMITATIONS Due to the small sample size and cross-sectional assessment, the possibility for more complex multivariate analysis was limited. The use of parent-report questionnaires to assess infant RPs can support but not replace clinical diagnosis. CONCLUSIONS The pandemic conditions affecting everyday life may have a long-term influence on impaired infant self- and maternal co-regulation and on maternal mental health. This should be addressed in peripartum and pediatric care. Qualitative and longitudinal studies focusing on long-term parental and infant outcomes under ongoing pandemic conditions are encouraged.
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Affiliation(s)
- Anna Perez
- Division of Neonatology and Pediatric Intensive Care, Center for Obstetrics and Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ariane Göbel
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lydia Yao Stuhrmann
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Steven Schepanski
- Division of Experimental Feto-Maternal Medicine, Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Institute of Developmental Neurophysiology, Center for Molecular Neurobiology Hamburg (ZMNH), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Dominique Singer
- Division of Neonatology and Pediatric Intensive Care, Center for Obstetrics and Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Carola Bindt
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Susanne Mudra
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Müller M, Zietlow AL, Klauser N, Woll C, Nonnenmacher N, Tronick E, Reck C. From Early Micro-Temporal Interaction Patterns to Child Cortisol Levels: Toward the Role of Interactive Reparation and Infant Attachment in a Longitudinal Study. Front Psychol 2022; 12:807157. [PMID: 35126257 PMCID: PMC8810635 DOI: 10.3389/fpsyg.2021.807157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/20/2021] [Indexed: 11/13/2022] Open
Abstract
Parental mental disorders increase the risk for insecure attachment in children. However, the quality of caregiver–infant interaction plays a key role in the development of infant attachment. Dyadic interaction is frequently investigated via global scales which are too rough to uncover micro-temporal mechanisms. Prior research found that the latency to reparation of uncoordinated dyadic states is associated with infant behavioral and neuroendocrine regulation. We investigated the hypothesis that this interactive mechanism is critical in predicting secure vs. insecure attachment quality in infancy. We also assessed the predictive quality of infant attachment regarding neuroendocrine reactivity later in childhood. A subsample of N = 58 dyads (n = 22 mothers with anxiety disorders, n = 36 controls) from a larger study were analyzed. At 3–8 months postpartum, maternal anxiety disorders were diagnosed via a structured clinical interview as well as dyadic interaction during the Face-to-Face-Still-Face (FFSF) was observed and coded on a micro-temporal scale. Infant attachment quality was assessed with the strange situation paradigm at 12–24 months of age. In an overlapping subsample of N = 39 (n = 13 mothers with anxiety disorder; n = 26 controls), we assessed child cortisol reactivity at 5 to 6 years of age. Generalized linear modeling revealed that longer latencies to interactive reparation during the reunion episode of the FFSF as well as maternal diagnosis at 3–8 months of age predict insecure attachment in children aged 12–24 months. Cox regressions demonstrated that dyads with infants who developed insecure attachment at 12–24 months of age were 48% less likely to achieve an interactive reparation at 3–8 months of age. Mixed models revealed that compared to securely attached children, children who had developed an insecure attachment at 12–24 months of age had an increased cortisol reactivity at 5 to 6 years of age during free play. The results confirm the hypothesis that the development of attachment is affected by experienced micro-temporal interactive patterns besides diagnostic categories. They also showed that infants of mothers with postpartum anxiety disorders have a more than fivefold increased risk of developing an insecure attachment than the infants of the control group. Moreover, results imply that these patterns may influence neurohormonal regulation even in preschool aged children.
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Affiliation(s)
- Mitho Müller
- EEKIP-Lab, Clinical Psychology in Childhood and Adolescence, Department Psychology, Ludwig Maximilian University of Munich, Munich, Germany
- *Correspondence: Mitho Müller,
| | - Anna-Lena Zietlow
- Department of Psychology, School of Social Sciences, University of Mannheim, Mannheim, Germany
| | - Nathania Klauser
- EEKIP-Lab, Clinical Psychology in Childhood and Adolescence, Department Psychology, Ludwig Maximilian University of Munich, Munich, Germany
| | - Christian Woll
- EEKIP-Lab, Clinical Psychology in Childhood and Adolescence, Department Psychology, Ludwig Maximilian University of Munich, Munich, Germany
| | - Nora Nonnenmacher
- Institute of Medical Psychology, Center for Psychosocial Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Edward Tronick
- Child Development Unit, Developmental Brain Sciences Program, Department of Psychology, University of Massachusetts Boston – Harvard Medical School, Boston, MA, United States
| | - Corinna Reck
- EEKIP-Lab, Clinical Psychology in Childhood and Adolescence, Department Psychology, Ludwig Maximilian University of Munich, Munich, Germany
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Gerlach J, Fößel JM, Vierhaus M, Sann A, Eickhorst A, Zimmermann P, Spangler G. Family risk and early attachment development: The differential role of parental sensitivity. Infant Ment Health J 2022; 43:340-356. [PMID: 35020951 DOI: 10.1002/imhj.21964] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 12/01/2021] [Indexed: 11/11/2022]
Abstract
Family risks are known to be detrimental to children's attachment development. This study investigated whether parental sensitivity plays different roles in early attachment development in the context of risk: Sensitivity was hypothesized to mediate risk effects on attachment, as well as a moderator that shapes the relation between risk and attachment. Multiple family risks, parental sensitivity (defined as responsivity and supportive presence), and children's attachment security of 197 infants and toddlers (Mage = 15.25 months) and their caregivers were assessed in a prospective study with a cohort-sequential-design in Germany. Caregivers' sensitivity served as a mediator of risk effects on attachment as well as a moderator that buffers adverse consequences of risk. Early sensitivity might be relevant in setting the stage for attachment development supporting resilience.
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Affiliation(s)
- Jennifer Gerlach
- Department of Psychology, University of Erlangen-Nuremberg, Erlangen, Germany
| | | | - Marc Vierhaus
- Education and School Counselling District Gütersloh, Gütersloh, Germany
| | | | - Andreas Eickhorst
- Department of Social Work, University of Applied Sciences and Arts Hanover, Hanover, Germany
| | - Peter Zimmermann
- Department of Developmental Psychology, University of Wuppertal, Wuppertal, Germany
| | - Gottfried Spangler
- Department of Psychology, University of Erlangen-Nuremberg, Erlangen, Germany
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10
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Syam A, Musni M, Amin AN, Iskandar I. Potential Loss among Infant Feeding Options. JURNAL NERS 2021. [DOI: 10.20473/jn.v16i1.23285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction: The conceptual relationship between economics and breastfeeding is still mathematically invaluable, while the family's economic burden increases along with babies born. Indicating potential loss when a family chooses other than breastmilk is a progressive way to manage campaign messages about exclusive breastmilk and prolonged breastfeeding. Descriptive studies are needed to magnify all of these indicators and transform them into measuring instruments generalized to assess family expenditures related to infant feeding.Methods: This study uses a quantitative descriptive design, questionnaire draft upon qualitative open questions containing all micro indicators impacted financially during the baby’s first year. Data collection was carried out in Makassar based on telephone surveys with 330 preliminary samples. After structural analysis and data reduction, the expenditure indicators were divided into medical and non-medical expenses.Results: The study show there is a difference in the average amount of family expenses of those who provide formula milk compared to breastmilk. This outcome is 21.1 times higher in non-medical components and 2.5 times higher in the medical component. One of the highest contributions in medical expenses is the cost of a recurrent visit to a pediatrician due to a history of illness such as allergies, respiratory infections, and diarrhea.Conclusion: This empirical fact stated the strong affirmation of how families should consider wisely to choose the best feeding pattern for babies aged 0-12 months.
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Fricke J, Bolster M, Ludwig-Körner C, Kuchinke L, Schlensog-Schuster F, Vienhues P, Reinhold T, Berghöfer A, Roll S, Keil T. Occurrence and determinants of parental psychosocial stress and mental health disorders in parents and their children in early childhood: rationale, objectives, and design of the population-based SKKIPPI cohort study. Soc Psychiatry Psychiatr Epidemiol 2021; 56:1103-1112. [PMID: 33337512 PMCID: PMC8192328 DOI: 10.1007/s00127-020-02004-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 11/25/2020] [Indexed: 01/09/2023]
Abstract
PURPOSE The postnatal period is a vulnerable time for parents and children but epidemiological and health care utilisation data for Germany on parental mental health during early childhood is scarce. This protocol describes the rationale, aim and study design of a population-based cohort study to assess the occurrence and determinants of psychosocial stress and mental health disorders, as well as the use and cost of health care and social services in early childhood. METHODS As part of the collaborative SKKIPPI project, we will contact a random sample of 30,000 infants listed in the residents' registration offices of three German towns and we expect to include 6,000 mother-child pairs. Both parents are invited to fill out an online screening questionnaire. Mothers with indications of psychosocial stress will be interviewed to assess mental health disorders, regulatory problems of their children, as well as health care and social services utilisation, with a follow-up assessment after 6 months. RESULTS After description of sociodemographic and health data, we will analyse occurrences, patterns, and potential determinants (maternal age, social status, household factors, migration status etc.) of psychosocial stress and mental health disorders in the mothers and their children in early childhood. CONCLUSIONS Our study will identify potential risk and protective factors for postnatal mental health and health care utilization of psychosocially burdened families. This will help to improve prevention and treatment strategies to strengthen the parent-child relationship, to reduce persisting vulnerability of children, and to improve health care and social services. TRIAL REGISTRATION The study has been registered in the German Clinical Trial Registry on February 8th 2019 (DRKS-ID: DRKS00016653).
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Affiliation(s)
- J. Fricke
- grid.6363.00000 0001 2218 4662Institute for Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Luisenstr. 57, 10117 Berlin, Germany
| | - M. Bolster
- grid.6363.00000 0001 2218 4662Institute for Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Luisenstr. 57, 10117 Berlin, Germany
| | - C. Ludwig-Körner
- grid.461709.d0000 0004 0431 1180International Psychoanalytic University, Berlin, Germany
| | - L. Kuchinke
- grid.461709.d0000 0004 0431 1180International Psychoanalytic University, Berlin, Germany
| | - F. Schlensog-Schuster
- grid.9647.c0000 0004 7669 9786Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University of Leipzig, Leipzig, Germany
| | - P. Vienhues
- Department of Psychiatry, Psychosomatics and Psychotherapy, Diakonissenkrankenhaus Flensburg, Flensburg, Germany
| | - T. Reinhold
- grid.6363.00000 0001 2218 4662Institute for Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Luisenstr. 57, 10117 Berlin, Germany
| | - A. Berghöfer
- grid.6363.00000 0001 2218 4662Institute for Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Luisenstr. 57, 10117 Berlin, Germany
| | - S. Roll
- grid.6363.00000 0001 2218 4662Institute for Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Luisenstr. 57, 10117 Berlin, Germany
| | - T. Keil
- grid.6363.00000 0001 2218 4662Institute for Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Luisenstr. 57, 10117 Berlin, Germany ,grid.8379.50000 0001 1958 8658Institute of Clinical Epidemiology and Biometry, University of Wuerzburg, Wuerzburg, Germany ,State Institute of Health, Bavarian Health and Food Safety Authority, Bad Kissingen, Germany
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12
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Creation and validation of the Postpartum Specific Anxiety Scale Research Short-Form (PSAS-RSF). Arch Womens Ment Health 2021; 24:957-969. [PMID: 33900462 PMCID: PMC8585799 DOI: 10.1007/s00737-021-01114-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 02/10/2021] [Indexed: 11/22/2022]
Abstract
The Postpartum Specific Anxiety Scale (PSAS) is a valid, reliable measure of postpartum anxiety (PPA). However, it contains 51 items, so is limited by its length. This study aimed to reduce the number of items in the PSAS, produce a small number of high-performing short-form tools, and confirm the factor structure of the most statistically and theoretically meaningful model. A pooled sample of English-speaking mothers (N = 2033) with infants up to 12 months were randomly split into three samples. (1) A principal component analysis (PCA) was conducted to initially reduce the items (n = 672). (2) Four short-form versions of varying length (informed by statistical, theoretical, lay-person, and expert-guided feedback) were developed and their factor structure examined (n = 673). (3) A final confirmatory factor analysis (CFA) was performed to confirm the factor structure of the PSAS Research Short-Form (PSAS-RSF) (n = 688). PCA and theoretical review reduced the items from 51 to 34 (version 1). Statistical review retained 22 items (version 2). Quantitative expert panel data retained 17 items (version 3). Qualitative expert panel data retained 16 items (version 4). The 16-item version was deemed the most theoretically and psychometrically robust. The resulting 16-item PSAS-RSF demonstrated good psychometric properties and reliability. The PSAS-RSF is the first brief research tool which has been validated to measure PPA. Our findings demonstrate it is theoretically meaningful, statistically robust, reliable, and valid. This study extends the use of the measure up to 12 months postpartum, offering broader opportunity for measurement while further enhancing accessibility through brevity.
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13
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The relationship between parental behavior and infant regulation: A systematic review. DEVELOPMENTAL REVIEW 2020. [DOI: 10.1016/j.dr.2020.100923] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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14
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Olsen AL, Ammitzbøll J, Olsen EM, Skovgaard AM. Problems of feeding, sleeping and excessive crying in infancy: a general population study. Arch Dis Child 2019; 104:1034-1041. [PMID: 31270094 DOI: 10.1136/archdischild-2019-316851] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 04/26/2019] [Accepted: 05/20/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To study regulatory problems (RPs) of feeding, sleeping and excessive crying in infancy, and explore the influence of maternal mental health problems and parent-child relationship problems. DESIGN AND SETTING Data were collected in the general child health surveillance delivered to infant families by community health nurses (CHNs). Information on CHNs' assessments and conclusions were obtained on 2598 infants and merged with data from national registers. Descriptive statistics and logistic regression models were used to study RPs in early and late infancy, and the influences due to child, family and parent-child relationship problems. RESULTS Combined RPs (C-RPs), defined as two or more simultaneous problems of feeding, sleeping or excessive crying, was identified in 2.9% and 8.6% of the population between age 2-6 and 8-11 months, respectively. Low maternal schooling and immigrant parents were associated with an increased risk of late C-RPs, but RPs in early infancy stand out as the main predictor of late C-RPs OR 3.4 (95% CI 1.8 to 6.6), and the effect of early maternal mental health problems and parent-child relationship problems seem to be mediated by early C-RPs. CONCLUSIONS Combined problems of feeding, sleeping or excessive crying may exist throughout infancy independently of exposures to maternal mental health problems and parent-child relationship problems. The results indicate that infants with RPs exceeding age 2 months need special attention, in clinical as well as community settings. Suggested intervention includes specific guidance to the parents to help them understand and regulate their infant's sensitivity and reactions.
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Affiliation(s)
- Anne Lise Olsen
- Infant and Toddler Psychiatric Department, Child and Adolescent Centre, University Hospital of Copenhagen, Glostrup, Denmark
| | - Janni Ammitzbøll
- Faculty of Health Sciences, National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Else Marie Olsen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Medicine, Research Centre for Prevention and Health, Healthcare Services, Capital Region, Copenhagen, Denmark
| | - Anne Mette Skovgaard
- Faculty of Health Sciences, National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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15
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Mohr C, Gross-Hemmi MH, Meyer AH, Wilhelm FH, Schneider S. Temporal Patterns of Infant Regulatory Behaviors in Relation to Maternal Mood and Soothing Strategies. Child Psychiatry Hum Dev 2019; 50:566-579. [PMID: 30710313 DOI: 10.1007/s10578-018-00862-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This study investigates the temporal patterning of infant self-regulatory behaviors (crying/fussing, sleeping) in relation to both infant (age, sex, regulatory problems) and maternal variables (soothing behaviors, mood). Self-regulatory and soothing behaviors were assessed in 121 mother-infant dyads (4-44 weeks) by the Baby's Day Diary at 5 min intervals over 3 days. Further infant characteristics and maternal mood were assessed by questionnaires (DASS, CES-D, STAI) and the Diagnostic Interview for the Assessment of Regulatory Problems in Infancy and Toddlerhood. Data were analyzed using generalized additive mixed models. Negative maternal mood was associated with a deviant course of crying/fussing during the day. Body contact was associated with reduced variability in the 24 h course of sleep. Mother-infant transactional processes-above and beyond known relationships with overall levels of crying/fussing and sleeping-might play out on the temporal dimension of infant regulatory behaviors.
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Affiliation(s)
- Cornelia Mohr
- Clinical Child and Adolescent Psychology, Ruhr-Universität Bochum, Massenbergstraße 9 -11, 44787, Bochum, Germany.
| | - Mirja H Gross-Hemmi
- Swiss Etiological Study of Adjustment and Mental Health, Institute of Psychology, University of Basel, Basel, Switzerland
| | - Andrea Hans Meyer
- Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland
| | - Frank H Wilhelm
- Division of Clinical Psychology, Psychotherapy, and Health Psychology, Department of Psychology, University of Salzburg, Salzburg, Austria
| | - Silvia Schneider
- Clinical Child and Adolescent Psychology, Ruhr-Universität Bochum, Massenbergstraße 9 -11, 44787, Bochum, Germany
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16
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Zhang H, Shao S, Su Q, Yao D, Sun H, Ding D, Dang S, Wang S, Zhu Z, Li H. Involvement of prolactin in newborn infant irritability following maternal perinatal anxiety symptoms. J Affect Disord 2018; 238:526-533. [PMID: 29936391 DOI: 10.1016/j.jad.2018.05.080] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 05/01/2018] [Accepted: 05/28/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Newborn irritability could be an unique and special status and/or adverse neurobehavioral outcomes which was independent of serious disease. To determine whether maternal perinatal anxiety symptoms was associated with newborn irritability, and whether the alteration of serum prolactin in newborns were involved in newborn irritability. METHODS 205 pregnant women were recruited: normal group (n = 100), and anxiety group (n = 105), which was randomly divided to Newborn Behavioral Observations (NBO)+anxiety group(n = 65) and control+anxiety group(n = 40). Newborn Irritability was assessed by Neonatal Behavioral Assessment Scale(NBAS). Serum prolactin, cortisol and 5-HT in mothers and infants were measured. RESULTS 1. The scores of irritability items in the newborns of anxiety group were higher than that of the normal group (p < 0.05). 2. Lower serum PRL, 5-HT and higher serum cortisol were found in the newborns of anxiety group compared with that of the control group both postpartum 2d and 15 (p < 0.05). 3. The level of serum PRL in newborn infants were significantly and negatively correlated to the scores of irritability items (p < 0.05). 4. After 7 rounds of NBO interventions, the anxiety scores of mothers and the scores of irritability items of newborns in the NBO intervention group were all lower than those of the control group (p < 0.05) . LIMITATIONS In future experiments, we should explore the effect of PRL in the breast milk on newborn infant serum PRL. CONCLUSIONS Prolactin could be a potential mediator in newborn irritability following maternal perinatal anxiety symptoms.
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Affiliation(s)
- Huiping Zhang
- Department of Neonatology, First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, Shaanxi 710061, China
| | - Shuya Shao
- Department of Neonatology, First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, Shaanxi 710061, China
| | - Qian Su
- Department of Neonatology, First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, Shaanxi 710061, China
| | - Dan Yao
- Department of Neonatology, First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, Shaanxi 710061, China
| | - Hongli Sun
- Shaanxi Institute of Pediatric Diseases, The Affiliated Children Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710003, China
| | - Ding Ding
- Department of Neonatology, First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, Shaanxi 710061, China
| | - Shaokang Dang
- Department of Neonatology, First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, Shaanxi 710061, China
| | - Shan Wang
- Department of Neonatology, First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, Shaanxi 710061, China
| | - Zhongliang Zhu
- Shaanxi Province Biomedicine Key Laboratory, College of Life Sciences, Northwest University, 229 Taibai North Road, Xi'an, Shaanxi 710069, China.
| | - Hui Li
- Department of Neonatology, First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, Shaanxi 710061, China.
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17
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Resignation/Dissoziation des Säuglings statt gelungener Selbstregulation. Monatsschr Kinderheilkd 2018. [DOI: 10.1007/s00112-018-0570-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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18
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Reck C, Tietz A, Müller M, Seibold K, Tronick E. The impact of maternal anxiety disorder on mother-infant interaction in the postpartum period. PLoS One 2018; 13:e0194763. [PMID: 29799842 PMCID: PMC5969737 DOI: 10.1371/journal.pone.0194763] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Accepted: 03/11/2018] [Indexed: 11/26/2022] Open
Abstract
Background This study investigated whether postpartum anxiety disorder is associated to altered patterns of infant as well as maternal engagement in a Face-to-Face-Still-Face interaction (FFSF). Sampling and methods n = 39 women with postpartum DSM-IV anxiety disorder and n = 48 healthy mothers were videotaped during a FFSF with their infant (M = 4.1 months). Results Infants of the clinical group showed significantly less positive engagement during the play episode than infants of controls. This result depended on infant sex: male controls demonstrated more positive interaction than males of anxious mothers. There was no such effect for female infants who engaged significantly less positively during the play episode than males and did not change their positive engagement during the FFSF. These findings imply pronounced interactive positivity and early vulnerability to maternal anxiety symptoms in male infants. Only the infants of the controls showed the still-face effect. They also protested significantly more during the still-face, while the clinical infants’ protest increased significantly during the reunion. Women of both groups did not differ in their interaction. Maternal intrusiveness was associated to infant protest in the course of the FFSF. Conclusions Results suggest that mother-infant intervention should consider affect regulation and infant sex-specific characteristics in anxious mother-infant dyads.
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Affiliation(s)
- Corinna Reck
- Ludwig-Maximilians University, Department of Psychology, Munich, Germany
| | - Alexandra Tietz
- Heidelberg University Hospital, General Psychiatry, Heidelberg, Germany
| | - Mitho Müller
- Ludwig-Maximilians University, Department of Psychology, Munich, Germany
| | - Kirsten Seibold
- Heidelberg University Hospital, General Psychiatry, Heidelberg, Germany
| | - Edward Tronick
- University of Massachusetts, Boston, United States of America.,Harvard Medical School, Boston, United States of America
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19
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Fallon V, Halford JCG, Bennett KM, Harrold JA. Postpartum-specific anxiety as a predictor of infant-feeding outcomes and perceptions of infant-feeding behaviours: new evidence for childbearing specific measures of mood. Arch Womens Ment Health 2018; 21:181-191. [PMID: 28936752 PMCID: PMC5856861 DOI: 10.1007/s00737-017-0775-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 09/04/2017] [Indexed: 11/29/2022]
Abstract
Studies of pregnancy-specific anxiety suggest that it is a distinct construct which predicts perinatal outcomes more effectively than other general measures of anxiety. In response, a novel measure of postpartum-specific anxiety (PSAS) has been developed and validated, but it is not yet clear whether it possesses the same predictive power as its pregnancy-specific counterparts. The aim of this short-term prospective study was to (a) test the predictive validity of the PSAS in the context of one specific perinatal outcome, infant-feeding, and (b) examine whether the PSAS may be more efficacious at predicting infant-feeding outcomes and behaviours than the more commonly used general measures. Eight hundred mothers of infants aged between 0 and 6 months completed the PSAS alongside general measures of anxiety and depression at baseline. A subsample (n = 261) returned to complete a follow-up questionnaire examining infant-feeding outcomes and behaviours two weeks later. Hierarchical regression models revealed that the PSAS was associated with lower odds of breastfeeding exclusively, and breastfeeding in any quantity in the first 6 months postpartum. PSAS scores were also significantly associated with infant-feeding behaviours including a lower perceived enjoyment of food, and greater perceived food responsiveness and satiety responsiveness in the infant. As hypothesised, the PSAS was a stronger predictor of infant-feeding outcomes and behaviours than general anxiety and depression. The findings provide evidence for the predictive validity of the PSAS and call for the use of childbearing specific measures of mood when attempting to predict perinatal outcomes. Replication of these findings across other indices of maternal and infant health is now necessary.
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Affiliation(s)
- Victoria Fallon
- Institute of Psychology, Health and Society, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA, UK.
| | - Jason Christian Grovenor Halford
- Institute of Psychology, Health and Society, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA, UK
| | - Kate Mary Bennett
- Institute of Psychology, Health and Society, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA, UK
| | - Joanne Allison Harrold
- Institute of Psychology, Health and Society, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA, UK
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20
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Coo S, Somerville S, Matacz R, Byrne S. Development and preliminary evaluation of a group intervention targeting maternal mental health and mother-infant interactions: a combined qualitative and case series report. J Reprod Infant Psychol 2018. [PMID: 29517336 DOI: 10.1080/02646838.2018.1443435] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE AND BACKGROUND The purpose of this study was to investigate the outcomes of an Emotional Wellbeing Group intervention developed to treat maternal depression and anxiety while concurrently supporting positive development of the mother-infant relationship. METHOD Five women diagnosed with depressive and/or anxiety disorders and their infants completed the Emotional Wellbeing Group. The participants completed pre- and post- intervention assessments which included self-report measures of mood and the motherhood experience, and a video-taped, unstructured play session between mothers and their infants. RESULTS Four of the participants reported a clinically significant decrease in their symptoms of anxiety. All mothers reported more positive perceptions of their infants and their experience of motherhood, and showed enhanced maternal sensitivity and responsiveness towards their infants. Depression levels were not shown to improve consistently. CONCLUSION This study provides initial positive evidence to support future research directions and clinical efforts to develop interventions that target both the treatment of perinatal depression and anxiety and the quality of mother-infant interactions. Clinical insights for mental health professionals working with mothers and infants are presented.
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Affiliation(s)
- Soledad Coo
- a Department of Psychological Medicine , King Edward Memorial Hospital , Perth , WA , Australia.,b Centro de Apego y Regulación Emocional CARE, School of Psychology , Universidad del Desarrollo , Santiago , Chile
| | - Susanne Somerville
- a Department of Psychological Medicine , King Edward Memorial Hospital , Perth , WA , Australia
| | - Rochelle Matacz
- a Department of Psychological Medicine , King Edward Memorial Hospital , Perth , WA , Australia.,c School of Psychology , Edith Cowan University , Perth , WA , Australia
| | - Shannon Byrne
- a Department of Psychological Medicine , King Edward Memorial Hospital , Perth , WA , Australia.,d The University of Western Australia , School of Psychology , Perth , WA , Australia
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21
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Systematic review on maternal depression versus anxiety in relation to excessive infant crying: it is all about the timing. Arch Womens Ment Health 2018; 21:15-30. [PMID: 28900745 DOI: 10.1007/s00737-017-0771-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 08/14/2017] [Indexed: 10/24/2022]
Abstract
Different types of studies suggest a link between maternal depression/anxiety and excessive infant crying (EC). However, comparability is hampered due to different designs, definitions and measurements. This systematic review investigates the specific role of maternal depression and anxiety considering them as preceding, concurrent and subsequent conditions of EC. A computerised literature search was conducted in January 2017 using Medline, PubMed, PsycINFO and Web of Science. After screening n = 399 records for inclusion/exclusion criteria, n = 33 records based on n = 30 projects were eligible for systematic qualitative data synthesis. All studies on maternal depression/anxiety and EC within the first 3 years of life were included. Included studies investigated predominantly maternal depression (25/30) and secondly maternal anxiety (17/30). Significant positive results were found in the majority of studies for maternal depression (21/25) as well as for maternal anxiety (12/17) in relation to EC. In-depth analyses further revealed that concurrent and subsequent maternal depression was robustly related with EC, whilst preceding maternal depression was not. In contrast, preceding and concurrent (but not subsequent) maternal anxiety was consistently related to subsequent EC. Maternal depression is more likely a correlate or even a consequence of EC, whereas anxiety is rather a temporally preceding condition and thus a potential risk factor or risk marker for both subsequent EC and associated maternal depression. Interventions for EC should address concurrent maternal depression, whilst preventive approaches might target preceding maternal anxiety as early as prior to or during pregnancy.
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22
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Neu M, Pan Z, Haight A, Fehringer K, Maluf K. Hormonal and Neuromuscular Responses to Breastfeeding: A Pilot Study. Biol Res Nurs 2017. [PMID: 28627308 DOI: 10.1177/1099800417697380] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Difficult breastfeeding in the first weeks after birth may result in muscle tension in infants and activation of the maternal hypothalamic-pituitary-adrenal (HPA) axis and sympathetic nervous system (SNS). Our primary objective was to examine the feasibility of collecting neuroendocrine markers of maternal HPA axis and SNS activation (salivary cortisol and α-amylase [sAA]) and electromyographic (EMG) markers of infant distress during feeding in the first 2 weeks after birth. We also examined the relationships of these indices to each other and to mother-infant interactive behaviors during feeding. METHODS We recruited mothers in the postpartum unit of a teaching hospital and observed a feeding in the dyad's home. Cortisol and sAA were sampled before feeding, 10 min into feeding, at feeding end, and 20 min after feeding. Infant muscle activity was recorded continuously with an EMG data logger. We used the Nursing Child Assessment Feeding Scale to measure mother-infant interaction. RESULTS The 20 mothers reported no disruption to breastfeeding and no change in infant behavior due to collection measures. Mean cortisol levels decreased significantly; there was no significant change in sAA levels. Relationships were found between interactive behavior and trends in neuroendocrine biomarkers. Longer bursts of infant muscle activity were associated with higher levels of maternal cortisol during feeding but not mother-infant interactive behaviors. CONCLUSIONS Maternal salivary biomarkers and their association with feeding behaviors can be a useful tool for clinical longitudinal research beginning soon after birth. Infant EMG data may be useful for assessing maternal arousal.
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Affiliation(s)
- Madalynn Neu
- 1 College of Nursing, University of Colorado Anschutz Medical Campus, CO, USA
| | - Zhaoxing Pan
- 2 Department of Pediatrics, University of Colorado Anschutz Medical Campus, CO, USA
| | - Ashley Haight
- 3 School of Physical Therapy, University of Colorado, CO, USA
| | - Karen Fehringer
- 4 Colorado School of Public Health, University of Colorado Anschutz Medical Campus, CO, USA
| | - Katrina Maluf
- 5 School of Exercise and Nutritional Sciences, San Diego State University, CA, USA
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Fotiou C, Vlastarakos PV, Bakoula C, Papagaroufalis K, Bakoyannis G, Darviri C, Chrousos G. Parental stress management using relaxation techniques in a neonatal intensive care unit: A randomised controlled trial. Intensive Crit Care Nurs 2017; 32:20-8. [PMID: 26520208 DOI: 10.1016/j.iccn.2015.08.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 08/19/2015] [Accepted: 08/22/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The objective of this study was to investigate the effect of relaxation techniques on the stress/anxiety of parents with hospitalised premature infants, three months following discharge from the neonatal intensive care unit. STUDY DESIGN A randomised controlled trial was conducted in the neonatal intensive care unit of a tertiary maternity hospital including 59 parents, who were randomised into two groups: 31 in the intervention group and 28 in the control group. Parents in the intervention group practiced three different relaxation techniques, in addition to undergoing the same information-based training courses as did the parents of the control group. DATA COLLECTION Data were collected 10-15 days post delivery and three months post discharge. The assessment measures included the Perceived Stress Scale, the State and Trait Anxiety Inventory 1 and 2 and salivary cortisol levels. RESULTS The psychometric assessment at baseline was comparable between the two groups. The intervention group showed a significant reduction in trait anxiety (p=0.02) compared with the control group three months post discharge. The perceived stress decreased in both groups (p=0.699). No difference in salivary cortisol levels was detected. The multivariate analysis revealed that higher initial stress levels (p<0.001) and university/college education (p=0.003) were associated with higher parental stress, whereas moderate-to-high income satisfaction was associated with lower parental stress (p=0.003). CONCLUSION Further long-term follow-up of families with a neonatal intensive care unit experience could assess more delayed effects of stress management by relaxation techniques.
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Affiliation(s)
- Catherine Fotiou
- Postgraduate Program in Stress Management and Health Promotion, University of Athens, Athens, Greece
| | | | - Chrysa Bakoula
- Second Department of Pediatrics, University of Athens, "P. & A. Kyriakou" Children's Hospital, Athens, Greece
| | | | - George Bakoyannis
- Department of Biostatistics, "Richard M. Fairbanks" School of Public Health, University of Indiana, Indianapolis, IN, USA
| | - Christine Darviri
- Postgraduate Program in Stress Management and Health Promotion, University of Athens, Athens, Greece
| | - George Chrousos
- First Department of Pediatrics, University of Athens, "Aghia Sophia" Children's Hospital, Athens, Greece
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Abstract
There is increasing evidence for the effect of postpartum anxiety (PPA) on maternal and infant health outcomes. Despite evidence linking suboptimal infant-feeding outcomes with other indices of maternal mental health, the relationship between PPA and infant feeding has not yet been reviewed. A systematic review with narrative synthesis was conducted to examine the relationship between PPA and infant-feeding outcomes. Electronic searches were performed using specific keywords (eg, "postnatal anxiet*"; "breastfeed*"). A hand search of selected journals and reference lists of included articles was then conducted. All studies were considered that provided information related to PPA and infant-feeding outcomes. One hundred and two studies were identified, of which 33 were eligible. Two authors independently extracted data including study design, participants, and results. Results indicated that women with symptoms of PPA are less likely to breastfeed exclusively and more likely to terminate breastfeeding earlier. Some evidence also suggests that those experiencing PPA are less likely to initiate breastfeeding and more likely to supplement with formula in the hospital. In those who do breastfeed, PPA reduces self-efficacy, increases breastfeeding difficulties, and may negatively affect breastfeeding behaviors and breast milk composition. Heterogeneous outcomes and methodological limitations somewhat limit the comparability of findings. However, in combination with a review linking depression with similar negative infant-feeding sequelae, the findings provide evidence for the effect of negative postpartum mood on breastfeeding. Additional support for breastfeeding mothers with PPA is warranted.
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Popp L, Fuths S, Seehagen S, Bolten M, Gross-Hemmi M, Wolke D, Schneider S. Inter-rater reliability and acceptance of the structured diagnostic interview for regulatory problems in infancy. Child Adolesc Psychiatry Ment Health 2016; 10:21. [PMID: 27382412 PMCID: PMC4932761 DOI: 10.1186/s13034-016-0107-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 06/10/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Regulatory problems such as excessive crying, sleeping-and feeding difficulties in infancy are some of the earliest precursors of later mental health difficulties emerging throughout the lifespan. In the present study, the inter-rater reliability and acceptance of a structured computer-assisted diagnostic interview for regulatory problems (Baby-DIPS) was investigated. METHODS Using a community sample, 132 mothers of infants aged between 3 and 18 months (mean age = 10 months) were interviewed with the Baby-DIPS regarding current and former (combined = lifetime) regulatory problems. Severity of the symptoms was also rated. The interviews were conducted face-to-face at a psychology department at the university (51.5 %), the mother's home (23.5 %), or via telephone (25.0 %). Inter-rater reliability was assessed with Cohen's kappa (k). A sample of 48 mothers and their interviewers filled in acceptance questionnaires after the interview. RESULTS Good to excellent inter-rater reliability on the levels of current and lifetime regulatory problems (k = 0.77-0.98) were found. High inter-rater agreement was also found for ratings of severity (ICC = 0.86-0.97). Participants and interviewers' overall acceptance ratings of the computer-assisted interview were favourable. Acceptance scores did not differ between interviews that revealed one or more clinically relevant regulatory problem(s) compared to those that revealed no regulatory problems. CONCLUSIONS The Baby-DIPS was found to be a reliable instrument for the assessment of current and lifetime problems in crying and sleeping behaviours. The computer-assisted version of the Baby-DIPS was well accepted by interviewers and mothers. The Baby-DIPS appears to be well-suited for research and clinical use to identify infant regulatory problems.
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Affiliation(s)
- Lukka Popp
- Clinical Child and Adolescent Psychology, Ruhr-Universität Bochum, Massenbergstraße 9-13, 44787 Bochum, Germany
| | - Sabrina Fuths
- Clinical Child and Adolescent Psychology, Ruhr-Universität Bochum, Massenbergstraße 9-13, 44787 Bochum, Germany
| | - Sabine Seehagen
- School of Psychology, University of Waikato, Private Bag 3105, Hamilton, 3240 New Zealand
| | - Margarete Bolten
- Department of Developmental Psychopathology, Child and Adolescents Psychiatric Clinic, University Basel, Schanzenstrasse 13, 4056 Basel, Switzerland
| | - Mirja Gross-Hemmi
- Department of Developmental Psychopathology, Child and Adolescents Psychiatric Clinic, University Basel, Schanzenstrasse 13, 4056 Basel, Switzerland
| | - Dieter Wolke
- Department of Psychology and Health Sciences Research Institute, Warwick Medical School, University of Warwick, Coventry, CV47AL UK
| | - Silvia Schneider
- Clinical Child and Adolescent Psychology, Ruhr-Universität Bochum, Massenbergstraße 9-13, 44787 Bochum, Germany
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Petzoldt J, Wittchen HU, Einsle F, Martini J. Maternal anxiety versus depressive disorders: specific relations to infants' crying, feeding and sleeping problems. Child Care Health Dev 2016; 42:231-45. [PMID: 26490836 DOI: 10.1111/cch.12292] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 08/11/2015] [Accepted: 08/30/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Maternal depression has been associated with excessive infant crying, feeding and sleeping problems, but the specificity of maternal depression, as compared with maternal anxiety remains unclear and manifest disorders prior to pregnancy have been widely neglected. In this prospective longitudinal study, the specific associations of maternal anxiety and depressive disorders prior to, during and after pregnancy and infants' crying, feeding and sleeping problems were investigated in the context of maternal parity. METHODS In the Maternal Anxiety in Relation to Infant Development (MARI) Study, n = 306 primiparous and multiparous women were repeatedly interviewed from early pregnancy until 16 months post partum with the Composite International Diagnostic Interview for Women (CIDI-V) to assess DSM-IV anxiety and depressive disorders. Information on excessive infant crying, feeding and sleeping problems was obtained from n = 286 mothers during postpartum period via questionnaire and interview (Baby-DIPS). RESULTS Findings from this study revealed syndrome-specific risk constellations for maternal anxiety and depressive disorders as early as prior to pregnancy: Excessive infant crying (10.1%) was specifically associated with maternal anxiety disorders, especially in infants of younger and lower educated first-time mothers. Feeding problems (36.4%) were predicted by maternal anxiety (and comorbid depressive) disorders in primiparous mothers and infants with lower birth weight. Infant sleeping problems (12.2%) were related to maternal depressive (and comorbid anxiety) disorders irrespective of maternal parity. CONCLUSIONS Primiparous mothers with anxiety disorders may be more prone to anxious misinterpretations of crying and feeding situations leading to an escalation of mother-infant interactions. The relation between maternal depressive and infant sleeping problems may be better explained by a transmission of unsettled maternal sleep to the fetus during pregnancy or a lack of daily structure and bedtime routine with the infant. Maternal disorders prior to pregnancy require more attention in research and clinical practice.
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Affiliation(s)
- J Petzoldt
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - H-U Wittchen
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - F Einsle
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.,Professorship Clinical Psychology and Psychotherapy, SRH Fachhochschule für Gesundheit Gera, Gera, Germany
| | - J Martini
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.,Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
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Abstract
BACKGROUND Neonates cared for in neonatal intensive care units are exposed to many painful and stressful procedures that, cumulatively, could impact later neurodevelopmental outcomes. However, a systematic analysis of these effects is yet to be reported. OBJECTIVES The aim of this research was to review empirical studies examining the association between early neonatal pain experiences of preterm infants and the subsequent developmental outcomes of these children across different ages. METHODS The literature search was performed using the PubMed, PsycINFO, Lilacs, and SciELO databases and included the following key words: "pain," "preterm," and "development." In addition, a complementary search was performed in online journals that published pain and developmental studies to ensure all of the target studies had been found. The data were extracted according to predefined inclusion and exclusion criteria. RESULTS Thirteen studies were analyzed. In infants born extremely preterm (gestational age ≤29 wk) greater numbers of painful procedures were associated with delayed postnatal growth, with poor early neurodevelopment, high cortical activation, and with altered brain development. In toddlers born very preterm (gestational age ≤32 wk) biobehavioral pain reactivity-recovery scores were associated with negative affectivity temperament. Furthermore, greater numbers of neonatal painful experiences were associated with a poor quality of cognitive and motor development at 1 year of age and changes in cortical rhythmicity and cortical thickness in children at 7 years of age. CONCLUSIONS For infants born preterm, neonatal pain-related stress was associated with alterations in both early and in later developmental outcomes. Few longitudinal studies examined the impact of neonatal pain in the long-term development of children born preterm.
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Anding J, Röhrle B, Grieshop M, Schücking B, Christiansen H. Early Detection of Postpartum Depressive Symptoms in Mothers and Fathers and Its Relation to Midwives' Evaluation and Service Provision: A Community-Based Study. Front Pediatr 2015; 3:62. [PMID: 26217649 PMCID: PMC4495314 DOI: 10.3389/fped.2015.00062] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 06/22/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Postpartum parental mental health problems pose a serious risk for child development and often remain undetected in postpartum primary care. Within the framework of the German Midwifes Prevention Study, the aim of this study was to investigate the presence of postpartum emotional distress in mothers and fathers, and the detection of distressed parents by midwives in a primary care setting. We also examined whether a temporal extension of the postpartum midwife care period is associated with greater use of midwife contacts and higher rates of referral to further professional support if needed. METHODS Mothers, fathers, and midwives filled out questionnaires at 2 weeks (t 1) and 6 months (t 2) postpartum. Compared to standard care in the control group (CG), midwives in an intervention group (IG) offered extended postpartum care of 6 months postpartum. Parental psychological distress was assessed using the Edinburgh postnatal depression scale (EPDS). Midwives reported on parental psychological distress as well as the number of postpartum contacts and referrals to additional social- and health-care providers. RESULTS Based on their ratings, midwives identified half of mothers and around one-quarter of fathers with elevated depressive symptoms according to the EPDS at t 1 and t 2. IG mothers used significantly more midwife contacts than CG mothers. IG mothers with high-postnatal psychological distress at t 2 used significantly more contacts than mothers with lower levels of distress. IG mothers with high-psychological distress at t 2 were referred to additional support services more often than mothers with lower levels of distress.
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Affiliation(s)
- Jana Anding
- Department of Psychology, Child and Adolescent Psychology, Philipps-University Marburg, Marburg, Germany
| | - Bernd Röhrle
- Department of Psychology, Child and Adolescent Psychology, Philipps-University Marburg, Marburg, Germany
| | | | | | - Hanna Christiansen
- Department of Psychology, Child and Adolescent Psychology, Philipps-University Marburg, Marburg, Germany
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Capponi I. L’anxiété paternelle et maternelle postnatale et ses liens avec les dimensions relationnelles. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.neurenf.2014.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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30
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Cosentino-Rocha L, Klein VC, Linhares MBM. Effects of preterm birth and gender on temperament and behavior in children. Infant Behav Dev 2014; 37:446-56. [DOI: 10.1016/j.infbeh.2014.04.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 01/09/2014] [Accepted: 04/08/2014] [Indexed: 11/29/2022]
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