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Fiorentino F, Lo Buglio G, Morelli M, Chirumbolo A, Di Giuseppe M, Lingiardi V, Tanzilli A. Defensive functioning in individuals with depressive disorders: A systematic review and meta-analysis. J Affect Disord 2024; 357:42-50. [PMID: 38663554 DOI: 10.1016/j.jad.2024.04.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 04/15/2024] [Accepted: 04/21/2024] [Indexed: 05/04/2024]
Abstract
BACKGROUND This systematic review and meta-analysis aimed to address the limited generalizability of studies on defense mechanisms in depression by comparing depressive individuals with non-clinical controls (aim a) and examining changes throughout psychological interventions (aim b) (PROSPERO CRD42023442620). METHODS We followed PRISMA 2020 guidelines, searching PubMed/Web of Science/(EBSCO)PsycINFO until 13/04/2023 for studies evaluating defense mechanisms with measures based on the hierarchical model in depressive patients versus non-clinical controls or throughout psychological intervention. We conducted random-effect meta-analyses for mature defenses/non-mature (neurotic/immature) defenses/overall defensive functioning (ODF), with standardized mean difference (SMD) as outcome measure metric. Meta-regression/sub-group/sensitivity analyses were conducted. Study quality was appraised using the Newcastle-Ottawa Scale (NOS), and certainty of evidence for aim b outcomes was evaluated using GRADE (Grading of Recommendations, Assessment, Development and Evaluations). RESULTS 18 studies were included (mean NOS score = 5.56). Depressive patients used significantly more non-mature defenses than non-clinical controls (SMD = 0.74; k = 13). Non-clinical controls did not significantly differ in use of mature defenses compared to depressive patients (SMD = 0.33; k = 14). Significant moderators were publication year/NOS score/geographical distribution/mean age for non-mature defenses and NOS score/geographical distribution for mature defenses. Throughout psychological interventions, only ODF significantly increased (SMD = 0.55; k = 2) (GRADE = very low). LIMITATIONS Quality of many studies was medium/sub-optimal, and longitudinal studies were scarce. CONCLUSION Individuals with depressive disorders show a high use of non-mature defenses that could be assessed and targeted in psychological interventions, especially in younger patients.
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Affiliation(s)
- Flavia Fiorentino
- Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy.
| | - Gabriele Lo Buglio
- Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Mara Morelli
- Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | | | | | - Vittorio Lingiardi
- Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Annalisa Tanzilli
- Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy.
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Orkaby N, Kalfon-Hakhmigari M, Levy S, Krissi H, Peled Y, Handelzalts JE. COVID-19-Related worries mediate the association between attachment orientation and elevated depression levels at 21-month postpartum. J Reprod Infant Psychol 2024; 42:550-562. [PMID: 36210511 DOI: 10.1080/02646838.2022.2132382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 09/28/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND The study's aims were to examine whether the COVID-19 pandemic was associated with increases in depression levels of 21 months postpartum women who were initially sampled before the pandemic and whether COVID-19-related worries mediated the association between women's attachment orientations and this hypothesized increase. METHODS Participants comprised 185 postpartum women sampled in the maternity ward of a tertiary healthcare center in Israel followed from childbirth to 21 months postpartum in four-time points. . We analyzed demographic and obstetric information and the Experiences in Close Relationships (ECR) scale at T1; changes in the Edinburgh Postnatal Depression Scale (EPDS) levels at all timepoints (T1-4); and COVID-19-related worries at T4. RESULTS Results showed a significant increase in depression levels at T4 compared to T2 and T3, and an increase in the prevalence of women at the lower clinical EPDS threshold. COVID-19-related worries mediated the association between anxious attachment and depression (indirect effect: B = .21, p < .05, 95% CI = (.015, .47), R2=0.12). DISCUSSION The evident effect of COVID-19 on postpartum depression is associated with variability between people. Thus, early assessment of women's attachment orientations might provide a strategy for identifying and treating women at risk.
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Affiliation(s)
- Naomi Orkaby
- School of Behavioral Sciences, Academic College of Tel-Aviv-Yafo, Tel-Aviv, Israel
| | | | - Sigal Levy
- School of Behavioral Sciences, Academic College of Tel-Aviv-Yafo, Tel-Aviv, Israel
| | - Haim Krissi
- The Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yoav Peled
- The Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Jonathan E Handelzalts
- School of Behavioral Sciences, Academic College of Tel-Aviv-Yafo, Tel-Aviv, Israel
- Department of Psychiatry, University of Michigan, Ann Arbor, Michiga, USA
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3
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Shakib Haji Agha R, Kachooei M. The mediating role of body image concern in the relationship between immature defense mechanisms and postpartum depression in Iranian women. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2023; 12:344. [PMID: 38144036 PMCID: PMC10743989 DOI: 10.4103/jehp.jehp_1038_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 11/30/2022] [Indexed: 12/26/2023]
Abstract
BACKGROUND Postpartum depression leaves irredeemable impacts on a mother's mental health and her child. Little is known about the relationship between immature defense mechanisms and body image concerns or postpartum depression. The present study examines the mediating role of body image concerns in the relationship between immature defense mechanisms and postpartum depression. MATERIALS AND METHODS In a correlational study, 227 women were selected through a convenience sampling method from all women in the postpartum period in medical centers in 2021 in Tehran, Iran. The participants were asked to fill out the Edinburgh Postnatal Depression Scale (EPDS), the Defense Style Questionnaire-40 (DSQ-40) by Andrews et al., and the Body Image Concern Inventory (BICI). The collected data was analyzed using the IBM SPSS Amos 24 and SPSS 21 software. RESULTS There was a positive correlation between body image concern, immature defense mechanisms, and postpartum depression. Furthermore, body image concern was a mediator in the relationship between immature defense mechanisms and postpartum depression. The immature defense mechanisms had an indirect positive impact on depression due to the concerns over one's body image after giving birth (P > 0.05). CONCLUSION Immature defense mechanisms and body image concerns can increase the risk of postpartum depression. Therefore, providing mental health and psychiatric services to expecting mothers is an effective tool to decrease the activation of immature defense mechanisms, which would reduce their body image concerns and prevent them from falling into postpartum depression.
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Affiliation(s)
- Rana Shakib Haji Agha
- Department of Psychology, Humanities Faculty, University of Science and Culture, Tehran, Iran
| | - Mohsen Kachooei
- Department of Psychology, Humanities Faculty, University of Science and Culture, Tehran, Iran
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Allahvirdie Rezaieh S, Ghorbani N, Farahani H. Mediating role of splitting in relation to attachment styles and shopping addiction. Front Psychol 2023; 14:1249591. [PMID: 37854143 PMCID: PMC10581345 DOI: 10.3389/fpsyg.2023.1249591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 09/07/2023] [Indexed: 10/20/2023] Open
Abstract
Introduction Shopping can provide a sense of satisfaction and pleasure; however, if a person's excessive involvement in this behavior starts to negatively impact other aspects of their life, similar to other addictive behaviors like excessive internet use, gaming, and gambling, it may be classified as pathological. Given the lack of agreement regarding the classification of excessive shopping tendencies as a separate mental health condition or addictive behavior, taking a socio-emotional approach to explore the psychological factors that precede this behavior, may offer a better comprehension of it. Methods The purpose of this study was to examine the relationship between attachment styles and excessive shopping behavior, as well as to investigate the potential mediating effect of defense mechanisms like splitting on this relationship. Using convenience sampling, a group of 457 stock market employees (116 female, 341 male) between the ages of 24 and 60 were recruited. The researchers utilized a set of validated psychological questionnaires to assess the employees attachment styles, shopping addiction, and splitting tendencies. Results The results obtained from both the mediation model and path analysis suggest that attachment styles do not have a direct relationship with shopping addiction. Nonetheless, the study supports the impact of insecure anxious and avoidan attachment styles on splitting. Furthermore, the findings confirm that splitting has a mediating effect on the relationship between attachment styles and splitting. Discussion The present study enhanced our comprehension of the subconscious mechanisms underlying shopping tendencies. Specifically, the findings suggest that excessive tendencies towards shopping can be considered a maladaptive response resulting from insecure attachment styles and the unconscious utilization of the splitting defense mechanism.
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Affiliation(s)
| | - Nima Ghorbani
- Department of Clinical Psychology, University of Tehran, Tehran, Iran
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5
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Vanwalleghem S, Miljkovitch R, Sirparanta A, Toléon C, Leclercq S, Deborde AS. Maternal Attachment Networks and Mother-Infant Bonding Disturbances among Mothers with Postpartum Major Depression. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6155. [PMID: 37372742 DOI: 10.3390/ijerph20126155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 06/09/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023]
Abstract
The literature suggests that maternal insecure attachment is a risk factor for postpartum depression which, in turn, affects motherinfant bonding. However, recent research in attachment suggests that the investigation of attachment networks provides further insight in the understanding of psychological outcomes. This study aims to test a model according to which mothers' attachment towards each of their parents contributes to explain attachment towards their romantic partners, which itself is associated with maternal postpartum depression and, in turn, with motherinfant bonding. The Attachment Multiple Model Interview, the Edinburgh Postnatal Depression Scale, and the Postpartum Bonding Questionnaire were administered to 90 mothers of infants under 6 months of age (32 with postpartum major depression). Results showed that attachment towards the partner (1) is best explained by attachment to the father and (2) mediates the link between attachment to the father and depression severity. Also, depression severity mediates the link between attachment to the partner and motherinfant bonding. These results highlight the role of attachment models towards the romantic partner and the father in the perinatal period and the relevance of attachment-focused therapeutic programs in treating postpartum maternal depression.
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Affiliation(s)
- Stéphanie Vanwalleghem
- Unité de Recherche CLIPSYD, Paris Nanterre University, 200 Avenue de la République, 92000 Nanterre, France
| | - Raphaële Miljkovitch
- Laboratoire Paragraphe, Paris 8 University, 2 Rue de la Liberté, 93200 Saint-Denis, France
| | - Aino Sirparanta
- Laboratoire Paragraphe, Paris 8 University, 2 Rue de la Liberté, 93200 Saint-Denis, France
| | - Camille Toléon
- Laboratoire Paragraphe, Paris 8 University, 2 Rue de la Liberté, 93200 Saint-Denis, France
| | - Stéphanie Leclercq
- Centre Hospitalier la Chartreuse, Unité Père-Mère-Bébé, 1 Boulevard Chanoine Kir, 21000 Dijon, France
| | - Anne-Sophie Deborde
- Laboratoire Paragraphe, Paris 8 University, 2 Rue de la Liberté, 93200 Saint-Denis, France
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Arikan G, Ustundag-Budak AM, Toz N, Senturk G. Do Turkish mothers' emotion regulation, psychological symptoms and caregiving helplessness vary based on attachment states of mind? Attach Hum Dev 2023; 25:417-436. [PMID: 37265061 DOI: 10.1080/14616734.2023.2219657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 05/26/2023] [Indexed: 06/03/2023]
Abstract
Mothers' emotion regulation, mental health, and feeling of helplessness in caring for their child may vary based on maternal attachment classifications. Particularly, insecure attachment and unresolved state of mind can act as risk factors. Therefore, we examined how emotion regulation strategies of suppression and cognitive reappraisal, maternal symptoms of depression and anxiety, and caregiving helplessness differ based on maternal attachment classifications in the Adult Attachment Interview (AAI). Fifty mothers of children in the early childhood (AgeRange = 12-56 months) completed a pack of questionnaires, including Emotion Regulation Questionnaire, Brief Symptom Inventory, and Caregiving Helplessness Questionnaire. Then AAI interview protocol was administered and coded. Mothers did not vary in emotion regulation strategies, indicating emotion regulation balance. However, mothers with secure/autonomous AAIs reported less anxiety than mothers whose AAIs were judged to show unresolved loss or unresolved trauma. The mothers who provided AAIs judged to be secure/autonomous scored lower in depression and caregiving helplessness than mothers whose AAIs were judged to show unresolved loss or unresolved trauma. To our knowledge, this is one of the first studies conducting AAI in Turkish mothers. We revealed the critical role of secure attachment for mental health and caregiving helplessness that can facilitate interventions targeting maternal attachment mind state.
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Affiliation(s)
- Gizem Arikan
- Department of Psychology, Ozyegin University, Istanbul, Turkey
| | | | - Naz Toz
- Counseling Services, Bilgi University, Istanbul, Turkey
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7
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Validation of Self-Reported Attachment Classification Among Racially and Ethnically Diverse Parents of Young Children. Nurs Res 2023; 72:150-157. [PMID: 36729697 DOI: 10.1097/nnr.0000000000000634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The Attachment Style Questionnaire (ASQ) was developed to measure individual differences in insecure adult attachment and was suitable for populations that may have minimal or no experience in romantic relationships. The measure was previously validated on homogenous populations. OBJECTIVES The purpose of this study was to verify construct validity and internal consistency of the ASQ among an ethnically and racially diverse sample of caregivers of young children ages birth to 3 years. METHODS Using a cross-sectional design, we examined the psychometric properties of the ASQ. A racially and ethnically diverse sample of caregivers of young children (birth to 3 years old) completed the 40-item measure. Factor analyses and internal consistency analyses were conducted. RESULTS Confirmatory factor analyses showed that the previously published factor structures were not a good fit for this diverse sample. Exploratory factor analysis with promax rotation revealed a four-factor solution among 16 items, including relationship anxiety, relationships as secondary, discomfort with closeness, and relationship distrust. Adequate internal consistency was noted for the factors, and structural invariance was confirmed across Hispanic and non-Hispanic ethnicities. DISCUSSION Nurse scientists and practitioners should take caution when using or developing indices based on previous research. There should be consideration of structural stability and replication across the intended population.
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Gioia MC, Cerasa A, Muggeo VMR, Tonin P, Cajiao J, Aloi A, Martino I, Tenuta F, Costabile A, Craig F. The relationship between maternal-fetus attachment and perceived parental bonds in pregnant women: Considering a possible mediating role of psychological distress. Front Psychol 2023; 13:1095030. [PMID: 36726507 PMCID: PMC9885764 DOI: 10.3389/fpsyg.2022.1095030] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 12/19/2022] [Indexed: 01/19/2023] Open
Abstract
Maternal-Fetal Attachment (MFA) delineates the emotional, cognitive, and behavioral aspects that mothers develop toward the unborn baby during pregnancy. The literature indicates that optimal attachment in pregnancy represents a protective factor for the mother-child attachment bond after birth and child development outcomes. To date, there are few studies that have investigated associated factors of MFA. This study sets out to explore the association between perceived parental bonds and maternal-fetal bonding in pregnant women, accounting for factors such as psychological distress, socio-demographic and obstetric characteristics. Methods In this cross-sectional study, 1,177 pregnant women answered the Parental Bonding Instrument, the Maternal-Fetal Attachment Scale, State-Trait Anxiety Inventory (STAI-Y), and Beck-Depression Inventory (BDI-II). Results We found out that perceived maternal and paternal care had significant direct effects on maternal-infant bonding during the pregnancy period when controlling for some confounders, including gestational age and mother age among others. Such maternal and paternal perceived care effects were not mediated by levels of psychological distress, which in turn resulted to be a "borderline" significant predictor of prenatal attachment. Interestingly, the gestational age and the mother age emerged to have a significant and synergic nonlinear effect, suggesting the influence on the MFAS of the gestational age depends on the values of the mother age, and likewise, the effect of mother age on MFAS depends on the gestational week. Conclusion This study expands our knowledge of the intergenerational transmission of attachment pointing out the effects of a woman's perceived bond in relation to her parental figures during the development of the prenatal attachment process. Findings also suggests that parenting support interventions may have benefits that are realized across generations.
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Affiliation(s)
- Maria C. Gioia
- iGreco Ospedali Riuniti, Cosenza, Italy,Associazione di Volontariato Mammachemamme, Cosenza, Italy
| | - Antonio Cerasa
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy (CNR), Messina, Italy,Pharmacotechnology Documentation and Transfer Unit, Preclinical and Translational Pharmacology, Department of Pharmacy, Health Science and Nutrition, University of Calabria, Rende, Italy,S’Anna Institute, Crotone, Italy,*Correspondence: Antonio Cerasa,
| | - Vito M. R. Muggeo
- Department of Economics, Business and Statistics, University of Palermo, Palermo, Italy
| | | | - Juanita Cajiao
- Faculty of Medicine Universitat de Barcelona, Barcelona, Spain
| | - Alessia Aloi
- Associazione di Volontariato Mammachemamme, Cosenza, Italy
| | - Iolanda Martino
- Department of Medical and Surgical Sciences, Institutes of Neurology, Magna Græcia University of Catanzaro, Catanzaro, Italy
| | - Flaviana Tenuta
- Department of Cultures, Education and Society, University of Calabria, Cosenza, Italy
| | - Angela Costabile
- Department of Cultures, Education and Society, University of Calabria, Cosenza, Italy
| | - Francesco Craig
- Department of Cultures, Education and Society, University of Calabria, Cosenza, Italy,Scientific Institute, IRCCS E. Medea—Unit for Severe Disabilities in Developmental Age and Young Adults, Brindisi, Italy
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BİLGE Y, KARAMUSTAFALIOĞLU N, KANLISU N, ÖZDEMİR A. Examination of the Role of Defense Mechanisms and Attachment Styles in Personality Disorder Beliefs among Nonclinical and Clinical Samples. PSIKIYATRIDE GUNCEL YAKLASIMLAR - CURRENT APPROACHES IN PSYCHIATRY 2022. [DOI: 10.18863/pgy.1052998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Attachment styles, defense mechanisms, and the underlying personality disorders’ personality beliefs are considered to be closely related to psychopathology. The aim of this study is to compare the scores of attachment styles, defense mechanisms, and personality beliefs variables in a non-clinical group and a clinical group diagnosed with depression, obsessive-compulsive, and anxiety disorder and to examine the relationships between these variables. A total of 178 participated in the study, 59 of which were in the clinical group and 119 in the nonclinical group. The Personality Belief Questionnaire-Short Form (PBQ-SF), The Defense Style Questionnaire-40 (DSQ-40), and Relationship Scales Questionnaire (RSQ) were applied to the participants. Avoidant, dependent, passive-aggressive, obsessive-compulsive (OC), antisocial, schizoid, paranoid, and borderline personality belief scores were found to be higher in the clinical group, while mature defense scores were significantly higher in the nonclinical group. On the other hand, there was no difference between the two groups in terms of attachment styles. According to multiple linear regression analysis results, attachment styles and defense mechanisms predicted personality disorder beliefs in the range of 19.5% to 33.5% for the clinical group and 22.7% to 46.9% for the nonclinical group. In conclusion, the findings suggest that attachment styles and defense mechanisms may contribute to the understanding of the etiological causes of personality disorders and may be helpful in the treatment of personality disorders.
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Affiliation(s)
| | - Nesrin KARAMUSTAFALIOĞLU
- SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, İSTANBUL BAKIRKÖY PROF.DR. MAZHAR OSMAN RUH SAĞLIĞI VE SİNİR HASTALIKLARI SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ
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10
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Factor structure of the parental bonding instrument for pregnant Japanese women. Sci Rep 2022; 12:19071. [PMID: 36351967 PMCID: PMC9646826 DOI: 10.1038/s41598-022-22017-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 10/07/2022] [Indexed: 11/11/2022] Open
Abstract
The parental bonding instrument (PBI) is often used to examine the perceptions of children and adolescents regarding parenting practices. Previous studies have investigated the factor structure of the PBI. However, although it is important to examine the relationships between the perceived parenting practices and perinatal mental health, few studies have included perinatal women. We aimed to accurately clarify which PBI factor structure was useful in assessing perinatal women (n = 4633). Furthermore, we evaluated the measurement invariance between primipara and multipara groups, and between the paternal and maternal PBI forms. Our exploratory and confirmatory factor analyses revealed that a three-factor PBI structure was most plausible for perinatal women. Moreover, we found complete invariance (residual invariance) of the PBI ratings across primipara and multipara women for the paternal and maternal forms. In contrast, we found weak invariance (metric invariance) of the PBI ratings across the paternal and maternal forms. Our participants tended to rate fathers as less caring and less overprotective than mothers. This three-factor structure shows measurement invariance in perinatal women and can be used to accurately determine how the perceived parenting style before adolescence influences women's mental health in the perinatal period.
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Goecke TW, Schöberl GI, Beckmann MW, Beetz AM. Der Bindungsstil der Mutter und ihr perinatales Wohlbefinden
beeinflussen die frühkindliche Entwicklung. Z Geburtshilfe Neonatol 2022; 226:325-332. [DOI: 10.1055/a-1872-1046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
ZusammenfassungImmer mehr Kinder zeigen bereits in der frühen Kindheit Anzeichen von
Verhaltensauffälligkeiten und Dysregulationen. Es wird ein Einfluss der
pränatalen Bindung der Schwangeren zu ihrem ungeborenen Kind sowie ihres
peripartalen Wohlbefindens angenommen. In einer prospektiven Studie an 161
Erstgebärenden wurde über standardisierte Fragebögen im
dritten Trimenon und 3 Wochen, 6 Monate und 18 Monate postpartum die
pränatale Bindung der Mutter zum Kind, den maternalen Bindungsstil, die
Bindung in der Paarbeziehung und die prä- und postpartale
Depressivität, sowie Entwicklungsauffälligkeiten des Kindes im
Alter von 18 Monaten erfasst. Im allgemeinen linearen Modell (ALM) waren eine
länger vorliegende prä- und postpartale Depressivität
der Mutter sowie Anzeichen einer unsicheren pränatalen Bindung zum Kind
mit einer höheren Rate an kindlichen Verhaltensauffälligkeiten
assoziiert. Die Befunde untermauern die Bedeutung der frühzeitigen
Wahrnehmung von Depressivität bei Frauen während und nach der
Schwangerschaft durch medizinische Fachkräfte und der Einleitung von
entsprechenden Hilfen, um die Häufigkeit kindlicher
Verhaltensauffälligkeiten zu reduzieren.
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Affiliation(s)
- Tamme W. Goecke
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen,
Germany
- Klinik für Gynäkologie und Geburtshilfe, RoMed Klinikum
Rosenheim, Rosenheim, Germany
| | | | | | - Andrea M. Beetz
- Professur für Heilpädagogik und
Inklusionspädagogik, IU Internationale Hochschule, Erfurt,
Germany
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12
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Kidd KN, Prasad D, Cunningham JEA, de Azevedo Cardoso T, Frey BN. The relationship between parental bonding and mood, anxiety and related disorders in adulthood: A systematic review and meta-analysis. J Affect Disord 2022; 307:221-236. [PMID: 35378151 DOI: 10.1016/j.jad.2022.03.069] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 03/05/2022] [Accepted: 03/29/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND A strong bond between parents and their children is essential in promoting healthy psychological development. Poor quality parent-child relationships can render children vulnerable to various adverse outcomes. Although extensive research has highlighted the association between abnormal parent-child bonding and mood and anxiety-related psychopathology in offspring, no systematic review or meta-analysis has assessed this relationship in adults. METHODS A literature search was conducted in five databases (MEDLINE, Embase, PsycINFO, CINAHL, Web of Science) on January 4th, 2021. Studies that assessed the relationship between parental bonding and the presence of a mood or anxiety disorder in adults were eligible for inclusion. RESULTS Fifty-seven studies were included in the systematic review (n = 44 in the meta-analysis). Quantitative results indicated that individuals with major depression, panic disorder, or persistent depressive disorder reported lower parental care and higher overprotection compared to individuals without psychiatric diagnoses. Qualitative results indicated that individuals with diagnoses of mood or anxiety disorders tended to report higher parental abuse than controls. LIMITATIONS The measures of parental bonding used by the included studies are retrospective and subject to biases. All studies had a case-control design and thus, causal-relationships cannot be drawn from the results. CONCLUSIONS Our findings suggest that poor-quality parental bonding early in life may place offspring at greater risk for mood and anxiety disorders during adulthood. Future research should extend these results by confirming the relationship between parental bonding and other psychiatric disorders, as well as identifying which factors mediate the relationship between abnormal parental bonding and psychiatric disorders.
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Affiliation(s)
- Katrina N Kidd
- Neuroscience Graduate Program, McMaster University, Hamilton, Canada
| | - Divya Prasad
- Neuroscience Graduate Program, McMaster University, Hamilton, Canada; Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, Canada
| | | | - Taiane de Azevedo Cardoso
- Mood Disorders Program, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
| | - Benicio N Frey
- Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, Canada; Mood Disorders Program, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada.
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Lenzo V, Sardella A, Barberis N, Isgrò C, Torrisi R, Giunta S, Petralia MC, Verrastro V, Quattropani MC. The Interplay of Attachment Styles and Defense Mechanisms on Eating Disorders Risk: Cross-Sectional Observation in the Community Population. CLINICAL NEUROPSYCHIATRY 2022; 18:296-303. [PMID: 35126531 PMCID: PMC8808290 DOI: 10.36131/cnfioritieditore20210603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Eating Disorders (Eds) are considered a broad group of pathological conditions characterized by dysregulated eating-related behaviors and habits. Attachment styles and defense mechanisms appear to be linked to the development of EDs-related unhealthy behaviors; however, these factors have been seldom investigated jointly. This study aimed at exploring the shared association between attachment styles, defense mechanisms, and EDs-related behaviors; additionally, we aimed at investigating whether defense mechanisms might be potential mediators of the association between attachment and Eds behaviors. METHOD A community-based sample was recruited (88% females, mean age= 22.33 ± 4.81 years) and underwent a comprehensive evaluation protocol assessing attachment styles, defense mechanisms, and risk of eating disorders. RESULTS Several shared associations between attachment styles, defense mechanisms, and eating disorders scores were found. Additionally, a maladaptive defense style appeared to be a significant mediator of the association between attachment styles and EDs-related symptoms. CONCLUSIONS The integrated evaluation of attachment and defense mechanisms could generate a more comprehensive framework of the psychological antecedents related to Eating Disorders, and it could be a beneficial factor involved in therapies.
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Affiliation(s)
- Vittorio Lenzo
- Department of Social and Educational Sciences of the Mediterranean Area, University for Foreigners "Dante Alighieri" of Reggio Calabria, Reggio Calabria, Italy
| | - Alberto Sardella
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Nadia Barberis
- Department of Surgical and Medical Sciences, "Magna Graecia" University of Catanzaro, Catanzaro, Italy
| | - Carmen Isgrò
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Roberta Torrisi
- Department of Surgical and Medical Sciences, "Magna Graecia" University of Catanzaro, Catanzaro, Italy
| | | | | | - Valeria Verrastro
- Department of Surgical and Medical Sciences, "Magna Graecia" University of Catanzaro, Catanzaro, Italy
| | - Maria C Quattropani
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
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Mothers at-risk for postpartum depression: Mental health and emotion regulation throughout the postpartum period. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-021-02435-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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15
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Sechi C, Prino LE, Rollé L, Lucarelli L, Vismara L. Maternal Attachment Representations during Pregnancy, Perinatal Maternal Depression, and Parenting Stress: Relations to Child's Attachment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:69. [PMID: 35010329 PMCID: PMC8751134 DOI: 10.3390/ijerph19010069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/09/2021] [Accepted: 12/20/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND This paper aimed to explore the associations between maternal representations of attachment evaluated during pregnancy, pre and postnatal maternal depression, parenting stress and child's attachment at 15 months after childbirth. METHODS Mothers (n = 71), and their infants participated in a longitudinal study of maternal attachment, pre and postnatal depression, parenting stress and child attachment. Adult Attachment Interview (AAI) was conducted between 24 and 26 weeks of pregnancy (Time 1), depression was assessed using the Edinburgh Perinatal Depression Scale (EPDS) (at Time 1 and 6 months after childbirth, i.e., Time 2), parenting stress was assessed using the Parenting Stress Index-Short Form (PS-SF) (at Time 2) and the Strange Situation Procedure (SSP) at child's 15 months of age (Time 3). RESULTS Free-autonomous maternal classification of attachment increases the likelihood of secure child classification in her offspring, while decreases that of avoidance and ambivalence. Insecure maternal representation of attachment evaluated during pregnancy and higher levels of parenting stress at six months after childbirth was associated with higher rates of infant insecure attachment at 15 months. CONCLUSIONS Our study validates the importance of considering maternal representations of attachment crucial in determining the quality of the caregiving environment, thereby the healthy development of children, despite the presence of other contextual risk.
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Affiliation(s)
- Cristina Sechi
- Department of Education, Psychology, Philosophy, University of Cagliari, 09123 Cagliari, Italy; (C.S.); (L.L.)
| | - Laura Elvira Prino
- Department of Philosophy and Education Sciences, University of Torino, 10124 Torino, Italy;
| | - Luca Rollé
- Department of Psychology, University of Torino, 10124 Torino, Italy;
| | - Loredana Lucarelli
- Department of Education, Psychology, Philosophy, University of Cagliari, 09123 Cagliari, Italy; (C.S.); (L.L.)
| | - Laura Vismara
- Department of Education, Psychology, Philosophy, University of Cagliari, 09123 Cagliari, Italy; (C.S.); (L.L.)
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Waikamp V, Serralta FB, Ramos-Lima LF, Zatti C, Freitas LHM. Relationship between childhood trauma, parental bonding, and defensive styles and psychiatric symptoms in adult life. TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2021; 43:225-234. [PMID: 34855314 PMCID: PMC8638712 DOI: 10.47626/2237-6089-2020-0086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 12/24/2020] [Indexed: 12/04/2022]
Abstract
Introduction A relationship between different types of childhood trauma, parental care, and defensive styles and development of psychiatric symptoms in adulthood is proposed in this study. Understanding the nature of this association is essential to assist psychotherapists who treat patients with a history of past trauma. This study aims to examine the associations between childhood trauma, parental bonding, and defensive styles and current symptoms in adult patients who sought care at an analytical psychotherapy clinic. Methods The sample comprised 197 patients from an analytically oriented psychotherapy clinic. Participants responded to four self-report instruments that assessed, respectively, presence and frequency of several types of early trauma, type of parental attachment, styles of defenses, and current symptoms encompassing a wide variety of psychopathological syndromes. Results Only 5% of patients reported not having experienced any traumatic experience in childhood. Several traumas such as emotional and physical abuse, emotional neglect, and physical neglect showed positive and significant associations with several dimensions of current symptoms, and also with parental bonding and defensive styles. When analyzed together with the other variables, defensive styles explained the level of psychological suffering caused by the symptoms. Conclusions This study offers additional support for understanding the associations between childhood trauma, parental bonding styles, and defense styles and the psychiatric symptoms of patients in analytically oriented psychotherapy.
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Affiliation(s)
- Vitória Waikamp
- Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Fernanda Barcellos Serralta
- Programa de Pós-Graduação em Psicologia, Universidade do Vale do Rio dos Sinos (UNISINOS), São Leopoldo, RS, Brazil
| | - Luis Francisco Ramos-Lima
- Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Cleonice Zatti
- Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Lucia Helena Machado Freitas
- Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
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Psouni E, Frisk C, Brocki K. Anxiety among fathers in the postnatal period: Links to depression, attachment insecurity and emotion regulation. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021. [DOI: 10.1016/j.jadr.2021.100276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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18
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Fukui N, Motegi T, Watanabe Y, Hashijiri K, Tsuboya R, Ogawa M, Sugai T, Egawa J, Enomoto T, Someya T. Perceived parenting before adolescence and parity have direct and indirect effects via depression and anxiety on maternal-infant bonding in the perinatal period. Psychiatry Clin Neurosci 2021; 75:312-317. [PMID: 34314089 DOI: 10.1111/pcn.13289] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 07/12/2021] [Accepted: 07/19/2021] [Indexed: 11/28/2022]
Abstract
AIM This study was aimed towards detecting how perceived parenting practices before adolescence affect maternal-infant bonding in the perinatal period, considering factors such as depression, anxiety, and parity. METHODS We used the Parental Bonding Instrument (PBI) to examine perceived parenting practices. Participants included 1301 pregnant women who completed the Hospital Anxiety and Depression Scale (HADS) and Mother-to-Infant Bonding Scale (MIBS) at three time points: early pregnancy (approximately 12-15 weeks), late pregnancy (approximately 30-34 weeks) and postpartum (4 weeks after childbirth). We performed a path analysis with factors including parity, PBI subscales (paternal care, paternal overprotection, maternal care and maternal overprotection), HADS and MIBS. RESULTS Perceived paternal or maternal low care parenting predicted higher HADS and MIBS scores in early pregnancy. Moreover, perceived maternal low care parenting predicted higher HADS scores at postpartum and higher MIBS scores in late pregnancy. Perceived paternal or maternal overprotective parenting predicted higher HADS scores in the pregnancy period. Furthermore, perceived maternal overprotective parenting predicted higher MIBS scores in late pregnancy. Being primipara predicted higher HADS scores at postpartum and higher MIBS scores in early pregnancy and at postpartum. Being multipara predicted higher MIBS scores in late pregnancy. CONCLUSION This study suggests that perceived negative parenting before adolescence has indirect effects (via anxiety and depression) and direct effects on maternal-infant bonding in the perinatal period.
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Affiliation(s)
- Naoki Fukui
- Department of Psychiatry, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Takaharu Motegi
- Department of Psychiatry, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yuichiro Watanabe
- Department of Psychiatry, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Koyo Hashijiri
- Department of Psychiatry, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Ryusuke Tsuboya
- Department of Psychiatry, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Maki Ogawa
- Department of Psychiatry, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Takuro Sugai
- Department of Psychiatry, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Jun Egawa
- Department of Psychiatry, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Takayuki Enomoto
- Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Toshiyuki Someya
- Department of Psychiatry, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Sakowicz A, Allen EC, Nugooru A, Grobman WA, Miller ES. Timing of perinatal mental health needs: data to inform policy. Am J Obstet Gynecol MFM 2021; 4:100482. [PMID: 34517144 DOI: 10.1016/j.ajogmf.2021.100482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 08/29/2021] [Accepted: 09/03/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND The policies pertaining to perinatal healthcare should be informed by medical needs. The windows of standard obstetrical care and mandated Medicaid coverage eligibility typically end approximately 8 weeks postpartum, even though women may have perinatal health concerns, including suicidal ideation, which are identified beyond this period. OBJECTIVE To evaluate the timing of mental health needs across the perinatal period with a focus on how frequently the initial referral and suicidal ideation occur outside of standard obstetrical care windows. STUDY DESIGN This retrospective cohort study included all women during pregnancy or up to one year postpartum referred to a perinatal mental health collaborative care program (COMPASS) between September 2017 and September 2019. The timing of initial referral to COMPASS was identified, with women referred postpartum categorized by whether the referral was made after 8 weeks postpartum. The characteristics of the women were compared according to the timing of the initial mental health referral with receiver operating characteristic curves to identify whether patient characteristics could accurately classify women whose initial mental health needs were not recognized until after 8 weeks postpartum. Similarly, the assessment of suicidal ideation, either at or after referral, was ascertained, with the evaluation of the timing at which suicidal ideation was first expressed. RESULTS Of 1421 women referred for mental healthcare during the study period, 774 (54%) were initially referred antenatally and 647 (46%) were initially referred postpartum. The women who were referred antenatally exhibited no clustering in the timing of referral. Of the women referred postpartum, 203 (31%) were referred after 8 weeks postpartum. Sociodemographic and medical characteristics were unable to accurately classify which women were referred for mental health care after 8 weeks postpartum (area under the curve, 0.64; 95% confidence interval, 0.58-0.68). A total of 215 (16%) women reported suicidal ideation at or after the time of initial referral: 129 (17%) antenatally and 86 (14%) postpartum. The incidence of suicidal ideation was not significantly different before vs 8 weeks postpartum. CONCLUSION Perinatal mental health needs, including suicidal ideation, are often first recognized beyond 8 weeks postpartum. These data should be taken into consideration in policymaking discussions pertaining to the approach to medical care continuity and postpartum healthcare coverage.
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Affiliation(s)
- Allie Sakowicz
- Northwestern University Feinberg School of Medicine, Chicago, IL (Mses Sakowicz, Allen, and Nugooru).
| | - Emma C Allen
- Northwestern University Feinberg School of Medicine, Chicago, IL (Mses Sakowicz, Allen, and Nugooru)
| | - Aishwarya Nugooru
- Northwestern University Feinberg School of Medicine, Chicago, IL (Mses Sakowicz, Allen, and Nugooru)
| | - William A Grobman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL (Drs Grobman and Miller)
| | - Emily S Miller
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL (Drs Grobman and Miller)
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Peng J, Zhang J, Zhao K, Wang X, Wu Y, Fang P, Lv J. The Impact of Attachment on Depression in Married Seniors: Chain Mediating Effects of Self-Esteem and Rumination. Front Psychol 2021; 12:677015. [PMID: 34456792 PMCID: PMC8387878 DOI: 10.3389/fpsyg.2021.677015] [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: 03/07/2021] [Accepted: 07/20/2021] [Indexed: 11/23/2022] Open
Abstract
In this study, we discuss the effects of attachment on depression and the mediating roles of self-esteem and rumination in Chinese seniors. We assessed 431 using the Experiences in Close Relationships Inventory, the Rosenberg Self-Esteem Scale, the Ruminative Responses Scale, and the Short Form of Center for Epidemiologic Studies Depression Scale. Both attachment anxiety and attachment avoidance significantly predicted depression in seniors. Attachment anxiety and attachment avoidance positively predicted rumination but negatively predicted self-esteem. Structural equation models showed that rumination and self-esteem fully mediated the effects of attachment anxiety and attachment avoidance on depression. The attachment of seniors is related to depression, and self-esteem and rumination have chain mediating effects between attachment and depression.
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Affiliation(s)
- Jiaxi Peng
- College of Teachers, Chengdu University, Chengdu, China
| | - Jiaxi Zhang
- Department of Political Theory, Xi'an Research Institute of High Technology, Xi'an, China
| | - Kangwei Zhao
- College of Teachers, Chengdu University, Chengdu, China
| | - Xin Wang
- College of Teachers, Chengdu University, Chengdu, China
| | - Yi Wu
- College of Teachers, Chengdu University, Chengdu, China
| | - Peng Fang
- Department of Military Medical Psychology, Air Force Medical University, Xi'an, China
| | - Jing Lv
- The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
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21
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Validation and factor analysis of the parental bonding instrument in Japanese pregnant women. Sci Rep 2021; 11:13759. [PMID: 34215793 PMCID: PMC8253841 DOI: 10.1038/s41598-021-93146-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 06/14/2021] [Indexed: 11/18/2022] Open
Abstract
The Parental Bonding Instrument (PBI) evaluates parental attitudes derived from an individual’s childhood experiences with their parents. The factor structure of the PBI differs depending on variables such as psychosocial factors including culture, race, sex, and psychological and social conditions of participants. Although previous studies of the relationships between perinatal depression and parenting experiences have used the factor structures of the PBI from the general population, it is unclear whether the same factor structures are appropriate in the highly variable perinatal period. In this study, complete responses to the PBI and the Edinburgh Postnatal Depression Scale (EPDS) were received from 932 primiparas at 25 weeks of gestation and at 1 month postpartum. An exploratory factor analysis was performed on half of the responses, and it was confirmed that the three factors were care, interference, and autonomy. Confirmatory factor analysis of the remaining half of the answers showed comprehensible fitness. Each factor showed a high degree of internal consistency, and each factor of the PBI correlated with the EPDS, indicating construct validity. The reliability and validity of the PBI in perinatal Japanese women were confirmed, and it was found that the PBI had a three-factor structure.
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22
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Tanzilli A, Di Giuseppe M, Giovanardi G, Boldrini T, Caviglia G, Conversano C, Lingiardi V. Mentalization, attachment, and defense mechanisms: a Psychodynamic Diagnostic Manual-2-oriented empirical investigation. ACTA ACUST UNITED AC 2021; 24:531. [PMID: 33937117 PMCID: PMC8082535 DOI: 10.4081/ripppo.2021.531] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 03/17/2021] [Indexed: 12/19/2022]
Abstract
Mentalizing capacities depends on the quality of primary attachment interactions with caregivers who thinks of the child as a subject with mental states. Operationalized as reflective functioning, mentalization is crucial for regulating emotions and developing of a coherent sense of identity, for interacting with individuals making sense to own and others mental states, and for distinguishing internal and external realities without distortions. Although the clinical literature on interplay between mentalization, attachment, and emotional regulation is rich, the empirical research is limited. This study sought to explore connections between reflective functioning, attachment styles, and implicit emotion regulation, operationalized as defense mechanisms, in a group of depressive patients. Twenty-eight patients were interviewed using the adult attachment interview (AAI) and diagnosed using the Psychodynamic Chart-2 of the Psychodynamic Diagnostic Manual, Second Edition. The reflective functioning scale and the defense mechanisms rating scale Qsort were applied to AAI transcriptions to assess reflective functioning and defensive profile. Patients with secure attachment showed significantly higher levels in reflective functioning and overall defensive functioning as compared to those with insecure attachment. Good reflective functioning and secure attachment correlated with mature defenses and specific defensive mechanisms that serve in better regulating affective states. Overall, the relationship between mentalization, attachment and emotion regulation lay the foundations for the delineation of defensive profiles associated with attachment patterns and reflective functioning in depressive patients. The systematic assessment of these psychological dimensions with gold-standard tools may help in tailoring personalized therapeutic interventions and promoting more effective treatments.
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Affiliation(s)
- Annalisa Tanzilli
- Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, La Sapienza University of Rome, Rome
| | - Mariagrazia Di Giuseppe
- Department of Surgical, Medical and Molecular Pathology, Critical and Care Medicine, University of Pisa, Pisa
| | - Guido Giovanardi
- Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, La Sapienza University of Rome, Rome
| | - Tommaso Boldrini
- Department of Developmental Psychology and Socialization, University of Padua, Padua
| | - Giorgio Caviglia
- Department of Psychology, University of Campania Luigi Vanvitelli, Caserta, Italy
| | - Ciro Conversano
- Department of Surgical, Medical and Molecular Pathology, Critical and Care Medicine, University of Pisa, Pisa
| | - Vittorio Lingiardi
- Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, La Sapienza University of Rome, Rome
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Brake E, Berle D, Reilly NM, Austin M. The relationship between emotion dysregulation and postnatal attachment in women admitted to a mother baby unit. AUSTRALIAN JOURNAL OF PSYCHOLOGY 2021. [DOI: 10.1111/ajpy.12289] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Elloise Brake
- Discipline of Clinical Psychology, University of Technology Sydney, Sydney, New South Wales, Australia,
| | - David Berle
- Discipline of Clinical Psychology, University of Technology Sydney, Sydney, New South Wales, Australia,
- School of Psychiatry, UNSW Sydney, Sydney, New South Wales, Australia,
| | - Nicole M. Reilly
- Research Centre for Generational Health and Ageing, University of Newcastle, Callaghan, New South Wales, Australia,
- School of Nursing and Midwifery, University of Newcastle, Callaghan, New South Wales, Australia,
| | - Marie‐paule Austin
- School of Psychiatry, UNSW Sydney, Sydney, New South Wales, Australia,
- Perinatal and Women's Mental Health Unit, St John of God Health Care, Burwood Hospital, Sydney, New South Wales, Australia,
- Royal Hospital for Women, Sydney, New South Wales, Australia,
- Black Dog Institute, Sydney, New South Wales, Australia,
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Molmen Lichter M, Peled Y, Levy S, Wiznitzer A, Krissi H, Handelzalts JE. The associations between insecure attachment, rooming-in, and postpartum depression: A 2 months' longitudinal study. Infant Ment Health J 2020; 42:74-86. [PMID: 33161595 DOI: 10.1002/imhj.21895] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Postpartum depression (PPD) is the most common complication of childbearing, and recent studies have attempted to examine risk factors associated with it. The main study hypothesis was that a protective situational factor at a sensitive time period (full rooming-in postpartum) would moderate the associations between insecure attachment dimensions and PPD. Three hundred twelve women, in either full or partial rooming-in, participated in a longitudinal study at the maternity ward of a tertiary healthcare center. A Demographic questionnaire and the Experiences in Close Relationships Scale were administered at 1-4 days postpartum, and the Edinburgh Postnatal Depression scale at 2 months postpartum. PPD was significantly associated with both anxious and avoidant attachment dimensions, but not with rooming-in conditions. In addition, women in partial rooming-in showed a positive correlation between insecure attachment dimensions and PPD, whereas no such correlation was found for full rooming-in women. A situational factor such as full rooming-in, which occurs at a critical time point for the mother-infant relationship, can moderate the association between maternal avoidant or anxious attachment dimensions and the mother's PPD levels. Postpartum practices, such as rooming-in, can be personalized and thus beneficial in moderating personal risk factors for PPD.
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Affiliation(s)
- Maayan Molmen Lichter
- School of behavioral Sciences, The Academic College of Tel-Aviv Yaffo, Tel-Aviv, Israel
| | - Yoav Peled
- The Helen Schneider Hospital for Women, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sigal Levy
- Statistics Education Unit, The Academic College of Tel-Aviv Yaffo, Tel-Aviv, Israel
| | - Arnon Wiznitzer
- The Helen Schneider Hospital for Women, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Haim Krissi
- The Helen Schneider Hospital for Women, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jonathan E Handelzalts
- Department of Psychiatry, University of Michigan - Michigan Medicine, Ann Arbor, Michigan
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Ciocca G, Rossi R, Collazzoni A, Gorea F, Vallaj B, Stratta P, Longo L, Limoncin E, Mollaioli D, Gibertoni D, Santarnecchi E, Pacitti F, Niolu C, Siracusano A, Jannini EA, Di Lorenzo G. The impact of attachment styles and defense mechanisms on psychological distress in a non-clinical young adult sample: A path analysis. J Affect Disord 2020; 273:384-390. [PMID: 32560933 DOI: 10.1016/j.jad.2020.05.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 04/21/2020] [Accepted: 05/10/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Insecure attachment styles and immature or neurotic defense mechanisms are related to psychological distress. However, their mutual interaction in influencing psychological distress deserves further investigation. METHODS One-thousand-one-hundred-twenty-nine University students were evaluated using the Global Severity Index of Symptoms Check List 90-Revised for psychological distress, Relationship Questionnaire for attachment styles and Defense Style Questionnaire for defense mechanisms. Following exploratory analyses, a Path Analysis was performed with psychological distress as outcome. RESULTS Fearful and preoccupied attachment styles had a substantial impact on psychological distress. About 30% of their effect was mediated by Immature and Neurotic defenses, with the former having the major effect. Dismissing attachment showed no substantial effect on psychological distress. Secure Attachment and Mature Defenses had a small protective effect on psychological distress, but their inclusion in the path model did not improve overall goodness-of-fit. Attachment style and defense mechanisms accounted for nearly 25% of the variance in psychological distress. CONCLUSIONS The results showed that attachment styles and defense mechanisms have a substantial impact on psychological distress. The effect of attachment style is mediated by defense mechanisms. Individual differences in attachment style and defense mechanisms represent risk factors for psychological distress in young adults.
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Affiliation(s)
- Giacomo Ciocca
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Rome, Italy
| | - Rodolfo Rossi
- Department of Systems Medicine, University of Rome Tor Vergata, Italy
| | - Alberto Collazzoni
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Italy
| | - Fiorela Gorea
- Catholic University of "Our Lady of Good Council", Tirana, Albania
| | - Blerina Vallaj
- Catholic University of "Our Lady of Good Council", Tirana, Albania
| | - Paolo Stratta
- Department of Mental Health, ASL 01 Avezzano-Sulmona-L'Aquila, Italy
| | - Lucia Longo
- Department of Systems Medicine, University of Rome Tor Vergata, Italy; Psychiatry and Clinical Psychology Unit, Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Erika Limoncin
- Department of Systems Medicine, University of Rome Tor Vergata, Italy
| | - Daniele Mollaioli
- Department of Systems Medicine, University of Rome Tor Vergata, Italy
| | - Dino Gibertoni
- DIBINEM Department of Biomedical And Neuromotor Sciences, Unit of Hygiene, Public Health And Biostatistics, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Emiliano Santarnecchi
- Department of Medicine, Surgery and Neuroscience, University of Siena, Italy; Berenson-Allen Center for Non-Invasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Francesca Pacitti
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Italy; Catholic University of "Our Lady of Good Council", Tirana, Albania
| | - Cinzia Niolu
- Department of Systems Medicine, University of Rome Tor Vergata, Italy; Psychiatry and Clinical Psychology Unit, Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Alberto Siracusano
- Department of Systems Medicine, University of Rome Tor Vergata, Italy; Psychiatry and Clinical Psychology Unit, Fondazione Policlinico Tor Vergata, Rome, Italy
| | | | - Giorgio Di Lorenzo
- Department of Systems Medicine, University of Rome Tor Vergata, Italy; Psychiatry and Clinical Psychology Unit, Fondazione Policlinico Tor Vergata, Rome, Italy; IRCCS Fondazione Santa Lucia, Rome, Italy.
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Cacciola E, Psouni E. Insecure Attachment and Other Help-Seeking Barriers among Women Depressed Postpartum. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E3887. [PMID: 32486285 PMCID: PMC7313466 DOI: 10.3390/ijerph17113887] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/23/2020] [Accepted: 05/27/2020] [Indexed: 11/16/2022]
Abstract
When untreated, postpartum depression (PPD) can severely, negatively affect maternal health, child development, and the wellbeing and functioning of the entire family. Yet, despite screening and treatment programs for PPD, many women who experience depression with onset in the postpartum year do not communicate their symptoms. Negative relational experiences early in life, such as not receiving sensitive help and support when needed, often result in so-called insecure attachment styles, and there is evidence that these may contribute to the development and maintenance of PPD. However, the role of insecure attachment styles in non-help-seeking is unknown for this group. Using mixed quantitative and qualitative methodology, we identified help-seeking barriers of women who experienced depression with onset in the postpartum year but who had not sought help for their depression (N = 37), and explored links to their attachment orientations as assessed through both self-reported attachment style and narrative based attachment script assessment. The sample was non-normative regarding attachment, with an over-representation of avoidant attachment styles. Help-seeking barriers varied systematically with the mother's adult attachment style. Specifically, convictions of a strong self and lack of trust in healthcare professionals constituted a common barrier among women with avoidant attachment styles, while unrealistic expectations about motherhood constituted a barrier for women with secure attachment styles. This new knowledge on how barriers to communicating symptoms and seeking help when suffering from PPD vary systematically with attachment orientation can help formulate individualized, and therefore more efficient, approaches to addressing non-help-seeking behavior in women who suffer in silence.
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Affiliation(s)
| | - Elia Psouni
- Department of Psychology, Lund University, P.O. Box 213, SE221-00 Lund, Sweden;
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Robakis TK, Zhang S, Rasgon NL, Li T, Wang T, Roth MC, Humphreys KL, Gotlib IH, Ho M, Khechaduri A, Watson K, Roat-Shumway S, Budhan VV, Davis KN, Crowe SD, Ellie Williams K, Urban AE. Epigenetic signatures of attachment insecurity and childhood adversity provide evidence for role transition in the pathogenesis of perinatal depression. Transl Psychiatry 2020; 10:48. [PMID: 32066670 PMCID: PMC7026105 DOI: 10.1038/s41398-020-0703-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 11/05/2019] [Accepted: 12/08/2019] [Indexed: 11/16/2022] Open
Abstract
Early life adversity and insecure attachment style are known risk factors for perinatal depression. The biological pathways linking these experiences, however, have not yet been elucidated. We hypothesized that overlap in patterns of DNA methylation in association with each of these phenomena could identify genes and pathways of importance. Specifically, we wished to distinguish between allostatic-load and role-transition hypotheses of perinatal depression. We conducted a large-scale analysis of methylation patterns across 5 × 106 individual CG dinucleotides in 54 women participating in a longitudinal prospective study of perinatal depression, using clustering-based criteria for significance to control for multiple comparisons. We identified 1580 regions in which methylation density was associated with childhood adversity, 3 in which methylation density was associated with insecure attachment style, and 6 in which methylation density was associated with perinatal depression. Shorter telomeres were observed in association with childhood trauma but not with perinatal depression or attachment insecurity. A detailed analysis of methylation density in the oxytocin receptor gene revealed similar patterns of DNA methylation in association with perinatal depression and with insecure attachment style, while childhood trauma was associated with a distinct methylation pattern in this gene. Clinically, attachment style was strongly associated with depression only in pregnancy and the early postpartum, whereas the association of childhood adversity with depression was time-invariant. We concluded that the broad DNA methylation signature and reduced telomere length associated with childhood adversity could indicate increased allostatic load across multiple body systems, whereas perinatal depression and attachment insecurity may be narrower phenotypes with more limited DNA methylation signatures outside the CNS, and no apparent association with telomere length or, by extension, allostatic load. In contrast, the finding of matching DNA methylation patterns within the oxytocin receptor gene for perinatal depression and attachment insecurity is consistent with the theory that the perinatal period is a time of activation of existing attachment schemas for the purpose of structuring the mother-child relationship, and that such activation may occur in part through specific patterns of methylation of the oxytocin receptor gene.
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Affiliation(s)
- Thalia K Robakis
- Stanford University Department of Psychiatry and Behavioral Sciences, Stanford, CA, USA.
| | - Siming Zhang
- Stanford University Department of Psychiatry and Behavioral Sciences, Stanford, CA, USA
- Stanford University Department of Genetics, Stanford, CA, USA
| | - Natalie L Rasgon
- Stanford University Department of Psychiatry and Behavioral Sciences, Stanford, CA, USA
| | | | - Tao Wang
- AccuraScience, LLC, Johnston, IN, USA
| | - Marissa C Roth
- Vanderbilt University Department of Psychology, Nashville, TN, USA
| | | | - Ian H Gotlib
- Stanford University Department of Psychology, Stanford, CA, USA
| | - Marcus Ho
- Stanford University Department of Psychiatry and Behavioral Sciences, Stanford, CA, USA
| | | | - Katherine Watson
- Stanford University Department of Psychiatry and Behavioral Sciences, Stanford, CA, USA
| | - Siena Roat-Shumway
- Stanford University Department of Psychiatry and Behavioral Sciences, Stanford, CA, USA
| | - Vena V Budhan
- Palo Alto University Graduate School of Psychology, Palo Alto, CA, USA
| | - Kasey N Davis
- Stanford University Department of Psychiatry and Behavioral Sciences, Stanford, CA, USA
| | - Susan D Crowe
- Stanford University Department of Obstetrics & Gynecology, Stanford, CA, USA
| | | | - Alexander E Urban
- Stanford University Department of Psychiatry and Behavioral Sciences, Stanford, CA, USA.
- Stanford University Department of Genetics, Stanford, CA, USA.
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deMontigny F, Gervais C, Pierce T, Lavigne G. Perceived Paternal Involvement, Relationship Satisfaction, Mothers' Mental Health and Parenting Stress: A Multi-Sample Path Analysis. Front Psychiatry 2020; 11:578682. [PMID: 33240130 PMCID: PMC7667046 DOI: 10.3389/fpsyt.2020.578682] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 09/28/2020] [Indexed: 12/21/2022] Open
Abstract
Research has demonstrated the short- and long-term impacts of maternal mental health and well-being on children's emotional and behavioral outcomes. It is thus important to better understand the antecedents of maternal depression and stress. The aim of this study was to determine whether the contribution of perceived paternal involvement to account for mothers' depression and parental stress was mediated by relationship factors such as parenting alliance and dyadic adjustment. A second aim was to determine whether these relationships hold equally true in mothers of infants and young toddlers (0-24 months) and mothers of older children (25 months and older). Cross-sectional data were collected from 447 mothers. Mothers reported on their perceptions of paternal involvement with childcare responsibilities, dyadic adjustment, parenting alliance, parenting stress, and depression. Multi-sample path modeling analyses were conducted. Results revealed that perceived paternal involvement was positively related to both dyadic adjustment and parental alliance, that parenting alliance was negatively related to all three subscales of parenting stress and mothers' depression but that dyadic adjustment was negatively related to parenting distress (one subscale of parenting stress) and mothers' depression. Results from the multi-sample analyses indicated that the pattern of relationships was the same in the two groups, but that the model was not invariant. The most notable difference was that parenting alliance did not significantly account for depression in the mothers of younger children. Correlates of maternal mental health and well-being identified in this study could be useful when designing psychological interventions for mothers and fathers.
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Affiliation(s)
- Francine deMontigny
- Laboratory at the Heart of Families, Department of Nursing Science, Center of Research and Studies in Family Intervention, Université du Québec en Outaouais, Gatineau, QC, Canada
| | - Christine Gervais
- Laboratory at the Heart of Families, Department of Nursing Science, Center of Research and Studies in Family Intervention, Université du Québec en Outaouais, Gatineau, QC, Canada
| | - Tamarha Pierce
- Department of Psychology, Université Laval, Québec City, QC, Canada
| | - Geneviève Lavigne
- Center of Research and Studies in Family Intervention, Université du Québec en Outaouais, Gatineau, QC, Canada
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Mangialavori S, Terrone G, Cantiano A, Chiara Franquillo A, Di Scalea GL, Ducci G, Cacioppo M. Dyadic Adjustment and Prenatal Parental Depression: A Study with Expectant Mothers and Fathers. JOURNAL OF SOCIAL AND CLINICAL PSYCHOLOGY 2019. [DOI: 10.1521/jscp.2019.38.10.860] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Introduction: This paper evaluated the relationships between the dyadic adjustment of expectant parents and prenatal maternal and paternal depression. Method: Participants were 98 couples who were expectant parents in the third trimester of pregnancy. Most couples (97%) were primiparous. Participants' prenatal depression, psychiatric symptomatology, perinatal affectivity, and dyadic adjustment were evaluated. Results: Hierarchical regression and relative weight analyses showed the importance of various marital adjustment dimensions in predicting prenatal maternal and paternal depression. In particular, the marital relationship variables of dyadic consensus and affective expression of both partners was related to prenatal depression in expectant mothers, with the relationship even stronger in expectant fathers. The results suggested that for both partners, perception of marital relationship quality contributes to the development of depressive symptoms in new mothers and fathers to a greater degree than the single perception of one partner. Discussion: Clinically, the results suggest that clinicians should focus on partner relationships in the perinatal period. The provision of psychological interventions to improve a couple's functioning may help to protect new parents against depressive symptomatology.
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Khademi M, Hajiahmadi M, Faramarzi M. The role of long-term psychodynamic psychotherapy in improving attachment patterns, defense styles, and alexithymia in patients with depressive/anxiety disorders. TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2019; 41:43-50. [PMID: 30994785 DOI: 10.1590/2237-6089-2017-0144] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 07/04/2018] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Long-term psychodynamic psychotherapy (LTPP) emphasizes the centrality of intrapsychic and unconscious conflicts and their relation to development. Although there is evidence supporting the efficacy of LTPP in mental disorders, little research has been published on the efficacy of LTPP for depressive and anxiety disorders. OBJECTIVE To examine whether patients with anxiety and depressive disorders demonstrate improvement in their attachment styles, defense styles, psychiatric symptoms, anxiety/depressive symptoms, and alexithymia with LTPP. METHODS In this retrospective, descriptive study, the psychological outcomes of patients who were treated at the psychoanalytic clinic of Babol University of Medical Sciences were assessed. Fourteen patients diagnosed with depressive or anxiety disorder participated in the study of LTPP using the self-psychology approach. The Beck Depression Inventory II, Beck Anxiety Inventory, Adult Attachment Scale, 40-item Defense Style Questionnaire, and the 20-item Toronto Alexithymia Scale were administered at pre-treatment, post-treatment, and 6-month follow-up. Generalized estimating equations were used to analyze changes in psychological outcomes after each of the three assessments. RESULTS The mean scores of depression and anxiety and secure attachment improved significantly after LTPP with self-psychology approach from baseline to post-treatment and follow-up. Also, the mean scores of neurotic and immature defenses, difficulty in identifying feelings, difficulty in describing feelings, externally oriented thinking, and total alexithymia scores decreased significantly from baseline to post-treatment and follow-up. CONCLUSION Symptoms of anxiety disorders, depressive disorders, insecure attachment styles, alexithymia, and neurotic/immature defense styles improved after the LTPP with self-psychology approach. Moreover, the improvements persisted at the 6-month follow-up.
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Affiliation(s)
| | - Mahmoud Hajiahmadi
- Non-Communicable Pediatric Diseases Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Mahbobeh Faramarzi
- Social Determinants of Health Research Center, Babol University of Medical Sciences, Babol, Iran
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Ohara M, Nakatochi M, Okada T, Aleksic B, Nakamura Y, Shiino T, Yamauchi A, Kubota C, Morikawa M, Murase S, Goto S, Kanai A, Kato R, Ando M, Ozaki N. Impact of perceived rearing and social support on bonding failure and depression among mothers: A longitudinal study of pregnant women. J Psychiatr Res 2018; 105:71-77. [PMID: 30205250 DOI: 10.1016/j.jpsychires.2018.09.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 09/02/2018] [Accepted: 09/03/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Although previous studies have reported associations between bonding failure, depression, social support among mothers, and perceived rearing, the causal relationships remain unclear. METHODS A total of 855 women (mean age, 32.4 ± 4.4 years) completed the Mother-Infant Bonding Questionnaire (MIBQ), the Edinburgh Postnatal Depression Scale (EPDS), the Japanese version of the Social Support Questionnaire, and the Parental Bonding Instrument in early pregnancy before week 25 (T1) and at 1 month after delivery (T2). We created a path model to clarify the causal relationships between perinatal bonding failure, depression, social support, and perceived rearing during pregnancy and at 1 month after delivery. The model was tested using structural equation modeling. RESULTS Our recursive model showed acceptable fit (chi-squared statistic/degree of freedom = 2.1, comparative fit index = 0.98, root mean square error of approximation = 0.04). It was revealed that: (1) at T1, higher overprotection significantly predicted MIBQ scores; (2) at T1, poorer social support significantly predicted both MIBQ and EPDS scores; and (3) at T1, both MIBQ and EPDS scores significantly predicted respective scores at T2. CONCLUSIONS These results showed that bonding failure in the postpartum period was significantly influenced by mothers' own perceived rearing and social support during pregnancy. In addition, depression in the postpartum period was strongly influenced by social support during pregnancy. These findings suggest that psychosocial interventions that focus on both mothers' recollections of their own upbringing and social support during pregnancy are effective for preventing bonding failure and depression in the postpartum period.
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Affiliation(s)
- Masako Ohara
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masahiro Nakatochi
- Division of Data Science, Data Coordinating Center, Department of Advanced Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Takashi Okada
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Branko Aleksic
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yukako Nakamura
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomoko Shiino
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan; National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Aya Yamauchi
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Chika Kubota
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan; National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Mako Morikawa
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | | | | | - Atsuko Kanai
- Graduate School of Education and Human Development, Nagoya University, Nagoya, Japan
| | - Ryuji Kato
- Department of Basic Medical Sciences, Graduate School of Pharmaceutical Sciences, Nagoya University, Nagoya, Japan
| | - Masahiko Ando
- Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya, Japan
| | - Norio Ozaki
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Shorey S, Chee CYI, Ng ED, Chan YH, Tam WWS, Chong YS. Prevalence and incidence of postpartum depression among healthy mothers: A systematic review and meta-analysis. J Psychiatr Res 2018; 104:235-248. [PMID: 30114665 DOI: 10.1016/j.jpsychires.2018.08.001] [Citation(s) in RCA: 436] [Impact Index Per Article: 72.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 07/23/2018] [Accepted: 08/01/2018] [Indexed: 01/17/2023]
Abstract
This review aims to examine the prevalence and incidence of postpartum depression among healthy mothers without prior history of depression including postpartum depression and who gave birth to healthy full-term infants. A systematic search of ClinicalTrials.gov, CINAHL, EMBASE, PsycINFO, and PubMed was performed for English articles from the inception of the database to November 2017, as well as a manual search of the reference lists of the included articles, and an expert panel was consulted. Across 15,895 articles, 58 articles (N = 37,294 women) were included in the review. The incidence of postpartum depression was 12% [95% CI 0.04-0.20] while the overall prevalence of depression was 17% [95% CI 0.15-0.20] among healthy mothers without a prior history of depression. Prevalence was similar regardless of the type of diagnostic tool used; however, there were statistical differences in the prevalence between different geographical regions, with the Middle-East having the highest prevalence (26%, 95% CI 0.13-0.39) and Europe having the lowest (8%, 95% CI 0.05-0.11). There was no statistical difference in prevalence between different screening time points, but an increasing prevalence was observed beyond six months postpartum. Intervention studies often neglect healthy mothers. This review reports a similar prevalence rate of postpartum depression among mothers without history of depression when compared to mothers with history of depression. Thus, future studies should place equal emphasis on this neglected group of mothers so that targeted interventions and follow-ups can be introduced at appropriate time points.
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Affiliation(s)
- Shefaly Shorey
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive, 117597, Singapore.
| | - Cornelia Yin Ing Chee
- Department of Psychological Medicine, 5 Lower Kent Ridge Road, National University Hospital, 119074, Singapore
| | - Esperanza Debby Ng
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive, 117597, Singapore
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, Block MD 1, 12 Science Drive 2, National University of Singapore, 117549, Singapore
| | - Wilson Wai San Tam
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive, 117597, Singapore
| | - Yap Seng Chong
- Women's Centre, 5 Lower Kent Ridge Road, National University Hospital, 119074, Singapore
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Khalifa DS, Glavin K, Bjertness E, Lien L. Course of depression symptoms between 3 and 8 months after delivery using two screening tools (EPDS and HSCL-10) on a sample of Sudanese women in Khartoum state. BMC Pregnancy Childbirth 2018; 18:324. [PMID: 30089466 PMCID: PMC6083586 DOI: 10.1186/s12884-018-1948-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Accepted: 07/24/2018] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Effects of depression on parenting and on cognitive development of newborns are augmented when symptoms continue throughout the first postnatal year. Current classification systems recognize maternal depression as postnatal if symptoms commence within four to six weeks. Traditional cultural rituals in Sudan offer new mothers adequate family support in the first 6-8 weeks postpartum. The course of postnatal depression symptoms beyond that period is not explored in such settings. We therefore aim to investigate the change in screening status and in severity of depression and distress symptoms between three and eight months postpartum among a sample of Sudanese women using the Edinburgh Postnatal Depression Scale (EPDS) and a locally used tool: the 10-items Hopkins Symptoms Checklist (HSCL-10). METHODS Three hundred pregnant women in their 2nd or 3rd trimester were recruited from two clinics in Khartoum state. They were followed up and screened for depression symptoms eight months after delivery by EPDS at ≥12, and by HSCL-10 at ≥1.85. The same sample was previously screened for depression at three months after birth. RESULTS Prevalence of postnatal depression symptoms by EPDS was lower at eight months compared to three months after birth (3.6% at eight months (8/223) compared to 9.2% at three months (22/238), p < 0.001). Eight Mothers exhibited depression symptoms eight months after birth. Depressed mothers at three months had a 56% reduction in EPDS mean scores by eight months and 96.4% of participants either remained in the same EPDS category, or improved eight months after birth. Four participants with major depression symptoms at eight months were also depressed three months after birth and four participants had new onset depression symptoms. The HSCL-10 measured higher distress than EPDS across the two screening points (19.3% at three months, 9.1% at eight months postpartum, p < 0.001). Nonetheless, the two tests correlated positively at both points. CONCLUSIONS Repeated screenings by EPDS (depression surveillance) is recommended during the first postnatal year because a subset of mothers can have symptoms beyond the early postnatal period. Existing depression screening instruments can be assessed for their validity to detect PND.
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Affiliation(s)
- Dina Sami Khalifa
- Department of Community Medicine, Institute of Health and Society, Faculty of Medicine, University of Oslo, Postboks 1130 Blindern, 0318 Oslo, Norway
- Faculty of Health Sciences, Ahfad University for Women, Khartoum, Sudan
| | | | - Espen Bjertness
- Department of Community Medicine, Institute of Health and Society, Faculty of Medicine, University of Oslo, Postboks 1130 Blindern, 0318 Oslo, Norway
| | - Lars Lien
- National Advisory Board on Dual Diagnosis, Innlandet Hospital Trust, Hamar, Norway
- Department of Public Health, Hedmark University College, Elverum, Norway
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Affiliation(s)
- Sameer P. Sarkar
- Ministry of Defence, UK
- DCMH Aldershot, Aldershot Center for Health, Aldershot, UK
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35
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Defense mechanism is predicted by attachment and mediates the maladaptive influence of insecure attachment on adolescent mental health. CURRENT PSYCHOLOGY 2018. [DOI: 10.1007/s12144-018-9839-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Duman B, Senturk Cankorur V, Taylor C, Stewart R. Prospective associations between recalled parental bonding and perinatal depression: a cohort study in urban and rural Turkey. Soc Psychiatry Psychiatr Epidemiol 2018; 53:385-392. [PMID: 29322200 PMCID: PMC5916992 DOI: 10.1007/s00127-018-1484-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 01/02/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE Recalled experiences of parental bonding may be important in the aetiology of perinatal depression. We hypothesized that lower recalled parental bonding would be associated with perinatal depression. METHOD In a cohort study of perinatal depression in Turkey, 677 women were recruited in their third trimester. Parental Bonding Inventory (PBI) scores at baseline were investigated as predictors of depression on the Edinburgh Postnatal Depression Scale (EPDS) at 4, 14 and 21 months after childbirth in mothers without depression at baseline. RESULTS Poor parental bonding scores, apart from paternal control and overprotection, were independently associated with antenatal depression. Incident postnatal depression at 4 months was predicted by parental overprotection, at 14 months by parental care and overprotection, and at 21 months by paternal control and overprotection. CONCLUSIONS Less satisfactory parenting recalled in the antenatal period was an independent predictor of postnatal depression; however, the different bonding subscales varied as predictors according to the timing of the depression assessment after childbirth.
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Affiliation(s)
- Berker Duman
- Department of Psychiatry, Ankara University Faculty of Medicine, Dikimevi, Ankara, 06100 Turkey
| | - Vesile Senturk Cankorur
- Department of Psychiatry, Ankara University Faculty of Medicine, Dikimevi, Ankara, 06100 Turkey
| | - Clare Taylor
- King’s College London (Institute of Psychiatry, Psychology and Neuroscience), London, UK
| | - Robert Stewart
- King’s College London (Institute of Psychiatry, Psychology and Neuroscience), London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
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Antenatal depressive symptoms in Jamaica associated with limited perceived partner and other social support: A cross-sectional study. PLoS One 2018; 13:e0194338. [PMID: 29554107 PMCID: PMC5858785 DOI: 10.1371/journal.pone.0194338] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 03/01/2018] [Indexed: 11/30/2022] Open
Abstract
Background Antenatal depression is associated with adverse maternal and infant well-being. However, compared to postpartum depression, it has been less frequently explored globally or in Jamaica. This study aimed to determine the prevalence of, and factors associated with, antenatal depressive symptoms among Jamaican women in order to inform policy and build interventions that could improve their management and reduce their negative consequences. Methods This secondary analysis of data from the second Jamaican Birth Cohort Study (JA-Kids Birth Cohort) included 3,517 women enrolled during pregnancy. Information was extracted from interviewer-administered questionnaires which recorded social, demographic, medical and obstetric information during pregnancy. The Edinburgh Postnatal Depression scale (EPDS) was used to screen for depression, with scores ≥13 considered indicative of a high likelihood of depression. Bivariate analysis examined associations between depressive symptoms and: age, income, financial difficulties, perceived social support, perceived partner infidelity, previous child-bearing unions and children with the current partner. Obstetric factors were also explored and included gravidity, prior adverse pregnancy outcome and complications from previous pregnancies. Variables that predicted the likelihood of depression based on an EPDS cut score of 13 were evaluated using logistic regression. Results One in five participants (19.6%; 95% CI 18.3–20.9%) had a high likelihood of antenatal depression (EPDS ≥13). Significant predictors of high depressive symptom severity included four indicators of poor perceived social and partner support [ORs (95% CI) ranged from: 1.61 (1.07–2.43); p = 0.024 to 3.14(1.69–5.84); p< 0.001], perceived partner infidelity [1.86 (1.36, 2.54); p<0.001], exposure to violence [2.36 (1.66–3.38); p<0.001] and financial difficulties [1.39 (1.07, 1.80); p = 0.013]. Conclusions Women’s perceived social and partner support were strongly associated with depressive symptom severity. Within the Jamaican cultural context of unstable reproductive unions, efforts are needed to involve fathers in the antenatal care process to strategically improve the psychological well-being of new mothers which may positively influence long term developmental outcomes for their babies.
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38
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Iliadis SI, Skalkidou A, Ranstrand H, Georgakis MK, Axfors C, Papadopoulos FC. Self-Harm Thoughts Postpartum as a Marker for Long-Term Morbidity. Front Public Health 2018. [PMID: 29515990 PMCID: PMC5825918 DOI: 10.3389/fpubh.2018.00034] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction Postpartum depression predisposes to maternal affective and somatic disorders. It is important to identify which women are at an increased risk of subsequent morbidity and would benefit from an intensified follow-up. Self-harm thoughts (SHTs), with or without other depressive symptomatology, might have prognostic value for maternal health beyond the postpartum period. Aim This study is to investigate the somatic and psychiatric morbidity of postpartum women with SHTs, with or without other depressive symptoms, over a 7-year follow-up period. Materials and methods The subjects for this study are derived from a population-based Swedish cohort of women who gave birth at Uppsala University Hospital (May 2006–June 2007) and who answered the Edinburgh Postnatal Depression Scale (EPDS) at 5 days, 6 weeks, and 6 months postpartum. Three groups were included: women reporting SHTs (SHT group, n = 107) on item 10 of the EPDS; women reporting depressive symptoms, i.e., EPDS ≥ 12 at 6 weeks and/or 6 months postpartum, without SHTs (DEP group, n = 94); and randomly selected controls screening negatively for postpartum depression (CTL group, n = 104). The number of diagnostic codes for somatic and psychiatric morbidity according to the International Statistical Classification of Diseases and Related Health Problems system, and the number of medical interventions were retrieved from medical records over 7 years following childbirth and were used as the outcome measures, together with any prescription of antidepressants and sick leave during the follow-up. Results The SHT group had the highest psychiatric morbidity of all groups and more somatic morbidity than controls. Affective disorders were more common in the SHT and the DEP groups compared with controls, as well as antidepressant prescriptions and sick leave. One-fifth of women with SHTs did not screen positive for depressive symptoms; nevertheless, they had more somatic and psychiatric morbidity than the control group. Conclusion Women reporting thoughts of self-harm in the postpartum period are at an increased risk of somatic and psychiatric morbidity during a follow-up of 7 years after delivery, and this increased risk may not be fully attributed to depressive symptoms. Results underline the importance of screening for self-harm symptoms postpartum and point to a need for individualized follow-up.
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Affiliation(s)
- Stavros I Iliadis
- Department for Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Alkistis Skalkidou
- Department for Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Hanna Ranstrand
- Department for Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Marios K Georgakis
- Department for Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Cathrine Axfors
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
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Treatment of maternal depression in urban slums of Karachi, Pakistan: A randomized controlled trial (RCT) of an integrated maternal psychological and early child development intervention. Asian J Psychiatr 2017; 29:63-70. [PMID: 29061430 DOI: 10.1016/j.ajp.2017.03.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 11/24/2016] [Accepted: 03/07/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Maternal depression is a major public health problem. This may affect a mother's ability to provide adequate care for the child. The objective of this study was to evaluate the effectiveness of the Learning through Play Plus program (LTP Plus) - a parenting program integrated with Cognitive Behaviour Therapy (CBT). METHODS A total of 247 women with symptoms of depression in Karachi, Pakistan were assigned randomly to either LTP Plus or routine care (Clinical Trials Identifier: NCT00835016). Symptoms of maternal depression were measured using the Edinburgh Postnatal Depression Scale (EPDS) at 3 and 6 months after baseline. RESULTS At 3 months, there was a significant reduction in the EPDS scores in the intervention group compared to the routine group (adjusted mean difference [AMD] -3.65, 95% CI -6.14 to -1.15, p <0.004). This effect was sustained at 6 months (AMD -2.62, 95% CI -4.43 to -0.81, p<0.005). These women also reported less parental distress and disability. There was also a significant improvement in maternal knowledge about child development at 6 months. CONCLUSION There was a significant reduction in depression among women who received the group parenting program LTP Plus. This intervention has the potential to be scaled up and integrated with mother and child health programs.
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Afolabi O, Bunce L, Lusher J, Banbury S. Postnatal depression, maternal–infant bonding and social support: a cross-cultural comparison of Nigerian and British mothers. J Ment Health 2017; 29:424-430. [DOI: 10.1080/09638237.2017.1340595] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Oladayo Afolabi
- Department of Psychology, London Metropolitan University, London, UK,
- Department of Nursing Science, University of Maiduguri, Maiduguri, Nigeria, and
| | - Louise Bunce
- Department of Psychology, London Metropolitan University, London, UK,
- Department of Psychology, Social Work and Public Health, Oxford Brookes University, Oxford, UK
| | - Joanne Lusher
- Department of Psychology, London Metropolitan University, London, UK,
| | - Samantha Banbury
- Department of Psychology, London Metropolitan University, London, UK,
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Axfors C, Sylvén S, Skalkidou A, Ramklint M. Psychometric properties of the attachment style questionnaire in Swedish pregnant women: short and full versions. J Reprod Infant Psychol 2017. [PMID: 29517387 DOI: 10.1080/02646838.2017.1342786] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES (i) To evaluate the reliability and factor structure of the Attachment Style Questionnaire - Short Form (ASQ-SF) for use in pregnant women and (ii) to compare the reliability and factor structure of the short- and full version-ASQ among pregnant women. BACKGROUND Adult attachment insecurity is currently included as a major risk factor in studies of perinatal health. None of the self-report measures with a Swedish translation have been psychometrically evaluated in a pregnant cohort. METHODS A population-based cohort of 1631 pregnant women answered the ASQ in late pregnancy. Internal consistency (item-subscale correlations, Cronbach's α, and α if item deleted) was evaluated for the seven available subscales. Confirmatory factor analysis (CFA) was run to examine the factor structure of the short form compared with the full-version. Test-retest correlations were assessed in a subgroup (n = 48). RESULTS All mean item-subscale correlations for the ASQ-SF were > 0.30. Cronbach's α's for ASQ-SF dimensions were as follows: Avoidance (0.87); Anxiety (0.89); Discomfort with Closeness (0.85); Relationships as Secondary (0.54); Confidence (0.83); Need for Approval (0.76); and Preoccupation with Relationships (0.77). No item removal substantively increased subscale α's. The CFA demonstrated better model fit for the ASQ-SF than for the full-version ASQ, while other reliability measures were similar. Test-retest correlations ranged from 0.65 to 0.84. CONCLUSION The ASQ-SF showed similar psychometric properties in pregnant women as in the general population and had good reliability, but the optimal factor structure needs to be studied further. Results support the usage of the ASQ-SF in pregnant cohorts.
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Affiliation(s)
- Cathrine Axfors
- a Department of Neuroscience, Psychiatry , Uppsala University , Uppsala , Sweden
| | - Sara Sylvén
- a Department of Neuroscience, Psychiatry , Uppsala University , Uppsala , Sweden
| | - Alkistis Skalkidou
- b Department for Women's and Children's Health , Uppsala University , Uppsala , Sweden
| | - Mia Ramklint
- a Department of Neuroscience, Psychiatry , Uppsala University , Uppsala , Sweden
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Lenze SN, Potts MA. Brief Interpersonal Psychotherapy for depression during pregnancy in a low-income population: A randomized controlled trial. J Affect Disord 2017; 210:151-157. [PMID: 28038377 PMCID: PMC5292056 DOI: 10.1016/j.jad.2016.12.029] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 11/24/2016] [Accepted: 12/17/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Depression is common in low-income pregnant women, and treatments need to be fitted to meet their needs. We conducted a randomized controlled trial comparing brief Interpersonal Psychotherapy (brief-IPT) to enhanced treatment as usual (ETAU) for perinatal depression in low-income women. The brief-IPT model is designed to better engage low-income women by utilizing an engagement session, providing flexible delivery of sessions, and pragmatic case management. METHODS Pregnant women, aged ≥18, between 12 and 30 weeks gestation were recruited from an urban prenatal clinic. Women scoring ≥10 on the Edinburgh Depression Scale and meeting depressive disorder criteria were randomized to either brief-IPT (n=21) or ETAU (n=21). We assessed treatment outcomes, acceptability, and feasibility of the intervention (measured by session attendance). RESULTS Depression scores significantly decreased in both brief-IPT and ETAU. Brief-IPT participants reported significant improvements in social support satisfaction as compared to ETAU participants, even after controlling for concurrent depressive symptoms. Brief-IPT participants reported high satisfaction with the program. However, many participants did not participate in the full 9-session course of treatment (average sessions attended =6, range 0-17). LIMITATIONS Small sample size, use of self-report measures, and lack of an active psychotherapy control group limits interpretation of study results. CONCLUSIONS Brief-IPT for perinatal depression is acceptable to low-income women and is helpful for improving depressive symptoms and social support. However, feasibility of the treatment was limited by relatively low session attendance in spite of efforts to maximize treatment engagement. Additional modifications to meet the needs of low-income women are discussed.
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Affiliation(s)
- Shannon N. Lenze
- Corresponding author: Shannon Lenze, PhD, Department of Psychiatry, Campus Box 8504, 660 S. Euclid, St. Louis, MO 63110. Tel.: 314-362-2752.
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Milan S, Kershaw TS, Lewis J, Westdahl C, Rising SS, Patrikios M, Ickovics JR. Caregiving History and Prenatal Depressive Symptoms in Low-Income Adolescent and Young Adult Women: Moderating and Mediating Effects. PSYCHOLOGY OF WOMEN QUARTERLY 2016. [DOI: 10.1111/j.1471-6402.2007.00367.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Prenatal depressive symptoms have been linked to negative outcomes for mothers and children. Using attachment theory as a framework, this study examined developmental differences in the interpersonal context of prenatal depressive symptoms among adolescents (age 14 to 19 years; n = 352) and young adults (age 20 to 24 years; n = 348). Participants included low-income, single, predominantly African American and Latina women. Moderating and mediating factors were found in the relation between caregiving history (perceived unavailability and inconsistency of maternal and paternal figures during childhood) and depressive symptoms. For pregnant adolescents, maternal unavailability predicted depressive symptoms whereas maternal inconsistency did not. In contrast, for pregnant young women, only maternal inconsistency predicted depressive symptoms; and this association was mediated by perceptions of prenatal support. For both groups, paternal caregiving history had a small yet independent association with depressive symptoms. Results highlight the need to consider developmental differences in the interpersonal context of prenatal depressive symptoms in delivering mental health interventions to young women of color.
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Affiliation(s)
- Stephanie Milan
- Stephanie Milan, Department of Psychology, University of Connecticut
| | - Trace S. Kershaw
- Trace S. Kershaw, Jessica Lewis, Mary Patrikios, and Jeannette R. Ickovics, Yale School of Public Health, Yale University
| | - Jessica Lewis
- Trace S. Kershaw, Jessica Lewis, Mary Patrikios, and Jeannette R. Ickovics, Yale School of Public Health, Yale University
| | - Claire Westdahl
- Claire Westdahl, Department of Gynecology and Obstetrics, Emory University
| | | | - Mary Patrikios
- Trace S. Kershaw, Jessica Lewis, Mary Patrikios, and Jeannette R. Ickovics, Yale School of Public Health, Yale University
| | - Jeannette R. Ickovics
- Trace S. Kershaw, Jessica Lewis, Mary Patrikios, and Jeannette R. Ickovics, Yale School of Public Health, Yale University
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Chi X, Zhang P, Wu H, Wang J. Screening for Postpartum Depression and Associated Factors Among Women in China: A Cross-Sectional Study. Front Psychol 2016; 7:1668. [PMID: 27847483 PMCID: PMC5088192 DOI: 10.3389/fpsyg.2016.01668] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 10/11/2016] [Indexed: 11/13/2022] Open
Abstract
Objectives: This study examined what percentage of Chinese mothers during a three-year postpartum period were screened for postpartum depression and explored the correlation between postpartum depression and various socio-demographic, psychological, and cultural factors. Study design: Cross-sectional survey. Methods: A total of 506 mothers 23 years of age and older who were within three years postpartum completed the online survey. The survey collected information such as family economic status, a history of depression, preparation for pregnancy, relationships with husbands, and family members, adult attachment types (Adult Attachment Scale, AAS), and depression (The Center for Epidemiologic Studies Depression Scale, CESD). Results: Approximately 30% of mothers 1-3 years postpartum reported symptoms above the CESD cut-off score (≥16 scores) associated with the risk for depression (28.0% in the first year, 30.8% in the second year, and 31.8% in the third year). Factors significantly associated with depression in participants in the correlation analysis were education level; family income; preparation for pregnancy; a history of depression; amount of time spent with their husbands; relationships with husbands, parents, and parents-in-law; and a close, dependent, and/or anxious attachment style. Multiple regression analyses revealed that a history of depression; less preparation for pregnancy; poorer relationships with husbands, parents, and parents-in-law; and a more anxious attachment style were strongly related to a higher risk of postpartum depression. Conclusion: The overall percentage of mothers after delivery who were vulnerable to depression in China remains high. Various factors were significant predictors of postpartum depression. The research findings have several valuable implications for intervention practices. For example, attachment styles and depression history in the assessments of perinatal depression could improve screenings and the design of interventions. Additionally, improving the family relationships and family environments of women post-delivery may be promising approach for postpartum depression prevention or intervention.
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Affiliation(s)
- Xinli Chi
- College of Psychology and Sociology, Shenzhen University, Shenzhen China
| | - Peichao Zhang
- Research Center of Modern Psychology, Wuhan University, Wuhan China
| | - Haiyan Wu
- State Grid Anhui Maintenance Company, Hefei China
| | - Jian Wang
- College of politics and law, Anhui Jianzhu University, Hefei China
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Raine K, Cockshaw W, Boyce P, Thorpe K. Antenatal interpersonal sensitivity is more strongly associated than perinatal depressive symptoms with postnatal mother-infant interaction quality. Arch Womens Ment Health 2016; 19:917-25. [PMID: 27168153 DOI: 10.1007/s00737-016-0640-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 04/30/2016] [Indexed: 01/11/2023]
Abstract
Maternal mental health has enduring effects on children's life chances and is a substantial cost driver for child health, education and social services. A key linking mechanism is the quality of mother-infant interaction. A body of work associates maternal depressive symptoms across the antenatal and postnatal (perinatal) period with less-than-optimal mother-infant interaction. Our study aims to build on previous research in the field through exploring the association of a maternal personality trait, interpersonal sensitivity, measured in early pregnancy, with subsequent mother-infant interaction quality. We analysed data from the Avon Longitudinal Study of Parents and Children (ALSPAC) to examine the association between antenatal interpersonal sensitivity and postnatal mother-infant interaction quality in the context of perinatal depressive symptoms. Interpersonal sensitivity was measured during early pregnancy and depressive symptoms in the antenatal year and across the first 21 months of the postnatal period. In a subsample of the ALSPAC, mother-infant interaction was measured at 12 months postnatal through a standard observation. For the subsample that had complete data at all time points (n = 706), hierarchical regression examined the contribution of interpersonal sensitivity to variance in mother-infant interaction quality. Perinatal depressive symptoms predicted little variance in mother-infant interaction. Antenatal interpersonal sensitivity explained a greater proportion of variance in mother-infant interaction quality. The personality trait, interpersonal sensitivity, measured in early pregnancy, is a more robust indicator of subsequent mother-infant-interaction quality than perinatal depressive symptoms, thus affording enhanced opportunity to identify vulnerable mother-infant relationships for targeted early intervention.
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Affiliation(s)
- Karen Raine
- Sydney Medical School, The University of Sydney, Department of Psychiatry, Westmead Hospital, Wentworthville, NSW, Australia.
| | | | - Philip Boyce
- Sydney Medical School, The University of Sydney, Department of Psychiatry, Westmead Hospital, Wentworthville, NSW, Australia
| | - Karen Thorpe
- Queensland University of Technology, Brisbane, Australia
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Fowler C, Schmied V, Dickinson M, Dahlen HG. Working with complexity: experiences of caring for mothers seeking residential parenting services in New South Wales, Australia. J Clin Nurs 2016; 26:524-534. [PMID: 27461911 DOI: 10.1111/jocn.13478] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2016] [Indexed: 11/29/2022]
Abstract
AIM AND OBJECTIVES To investigate staff perception of the changing complexity of mothers and infants admitted to two residential parenting services in New South Wales in the decade from 2005-2015. BACKGROUND For many mothers with a young child, parenting is difficult and stressful. If parenting occurs within the context of anxiety, mental illness or abuse it often becomes a high-risk situation for the primary caregiver. Residential parenting services provide early nursing intervention before parenting problems escalate and require physical or mental health focused care. DESIGN A qualitative descriptive design using semi-structured interview questions was used as phase three of a larger study. Data were gathered from 35 child and family health nurses and ten physicians during eight focus groups. RESULTS Three main themes emerged: (1) dealing with complexity; (2) changing practice; and (3) appropriate knowledge and skills to handle greater complexity. CONCLUSIONS There was a mix of participant opinions about the increasing complexity of the mothers presenting at residential parenting services during the past decade. Some of the nurses and physicians confirmed an increase in complexity of the mothers while several participants proposed that it was linked to their increased psychosocial assessment knowledge and skill. All participants recognised their work had grown in complexity regardless of their perception about the increased complexity of the mothers. RELEVANCE TO CLINICAL PRACTICE Australian residential parenting services have a significant role in supporting mothers and their families who are experiencing parenting difficulties. It frequently provides early intervention that helps minimise later emotional and physical problems. Nurses are well placed to work with and support mothers with complex histories. Acknowledgement is required that this work is stressful and nurses need to be adequately supported and educated to manage the complex presentations of many families.
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Affiliation(s)
- Cathrine Fowler
- Centre for Midwifery, Child & Family Health, University of Technology Sydney, Broadway, NSW, Australia
| | - Virginia Schmied
- School of Nursing and Midwifery, Western Sydney University, Penrith, NSW, Australia
| | | | - Hannah Grace Dahlen
- School of Nursing and Midwifery, Western Sydney University, Penrith, NSW, Australia.,Ingham Institute, Liverpool, NSW, Australia
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Fletcher R, May C, Wroe J, Hall P, Cooke D, Rawlinson C, Redfern J, Kelly B. Development of a set of mobile phone text messages designed for new fathers. J Reprod Infant Psychol 2016. [DOI: 10.1080/02646838.2016.1214250] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Falah-Hassani K, Shiri R, Dennis CL. Prevalence and risk factors for comorbid postpartum depressive symptomatology and anxiety. J Affect Disord 2016; 198:142-7. [PMID: 27016657 DOI: 10.1016/j.jad.2016.03.010] [Citation(s) in RCA: 122] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Revised: 02/19/2016] [Accepted: 03/07/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND To date, little is known about the prevalence and risk factors for comorbid postpartum depression and anxiety. The aims of this study were to estimate the prevalence of comorbid depressive symptomatology and anxiety during the first 8 weeks postpartum and to identify risk factors. METHODS As part of a longitudinal study conducted in a health region near Vancouver, British Columbia, a sample of 522 women completed mailed questionnaires at 1, 4, and 8 weeks postpartum. The presence of comorbid postpartum depressive symptomatology and anxiety was defined as having an Edinburgh Postnatal Depression Scale (EPDS) score of ≥10 and a State Trait Anxiety Inventory (STAI)-state anxiety score of ≥40 at the same time point. Risk factors associated with comorbidity were examined using generalized estimating equations (GEE). RESULTS The prevalence of comorbid depressive symptomatology and anxiety was 13.1% during the first 8 weeks postpartum. In multivariable analysis, immigration within past 5 years (adjusted odds ratio (AOR)=8.03, 95% CI 3.43-18.77), maternal vulnerable personality (AOR=1.42, 95% CI 1.02-1.97 for 1 SD increase), child care stress (AOR=1.66, 95% CI 1.18-2.35 for 1 SD increase) and perceived stress (AOR=3.00, 95% CI 2.01-4.47 for 1 SD increase) predicted a higher risk of comorbidity. Conversely, high breastfeeding self-efficacy (AOR=0.66, 95% CI 0.49-0.88 for 1 SD increase), maternal self-esteem (AOR=0.66, 95% CI 0.45-0.97 for 1 SD increase), and partner support (AOR=0.73, 95% CI 0.55-0.98 for 1 SD increase) were associated with a lower risk of developing comorbidity. LIMITATION In this study, women who were single or from non-Caucasian ethnic groups were underrepresented. CONCLUSIONS Comorbid postpartum depressive symptomatology and anxiety is a common condition with little known about risk factors. Additional research is warranted to develop strategies to reliably identify women with this comorbid condition and to determine effective treatment options.
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Affiliation(s)
- Kobra Falah-Hassani
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada.
| | - Rahman Shiri
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Cindy-Lee Dennis
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
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Clout D, Brown R. Marital Relationship and Attachment Predictors of Postpartum Stress, Anxiety, and Depression Symptoms. JOURNAL OF SOCIAL AND CLINICAL PSYCHOLOGY 2016. [DOI: 10.1521/jscp.2016.35.4.322] [Citation(s) in RCA: 22] [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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