Couples' relationship affects mothers' and fathers' anxiety and depression trajectories over the transition to parenthood

Karitane Parenting Confidence Scale: measuring parenting self-efficacy in Portuguese mothers during the first year postpartum

BACKGROUND

The Karitane Parenting Confidence Scale (KPCS) was designed to assess parenting self-efficacy in parents of infants during the first year.

OBJECTIVE

The aim of this study was to analyse the psychometric characteristics of the KPCS in Portuguese mothers during the first-year postpartum.

METHODS

A sample of 383 mothers were recruited at two public outpatient units in Northern Portugal. Mothers completed the KPCS, a sociodemographic questionnaire, and measures of depressive and anxiety symptoms at least one time between two weeks, three, six and 12 months postpartum.

RESULTS

Good fit was found for a factor model with three subscales: parenting, support and child development. The KPCS presented good internal consistency. Regarding the criterion validity of the KPCS, significant effects of mother's age were found on the development subscale and significant associations were found between mother's depressive and anxiety symptoms and the KPCS total scale and subscales. Optimal clinical cut-offs were suggested.

CONCLUSION

Findings provided evidence on the psychometric characteristics of the KPCS which can be used to assess parenting self-efficacy in Portuguese mothers during the first-year postpartum, possibly identifying mothers with low parenting self-efficacy.

Exploring the first-time transition to parenthood in mainland China: a qualitative study on the experiences of fathers and mothers using the transition shock model

Background

The transition to parenthood, which is influenced a lot by local parenting culture, is a dramatic stress for both men and women. Chinese social and cultural contexts form specific parental culture, shaping the unique experience of transition to parenthood. However, the understanding of the transition to parenthood in mainland China is limited. Additionally, few qualitative studies explored the transition to parenthood from both dyadic perspectives.

Aim

To explore the first-time transition to parenthood experience among mothers and fathers in mainland China during pregnancy, and compare the similarities and differences between their experiences in this transition period.

Methods

A descriptive qualitative study was conducted with 36 parents, including 18 primiparous women and their husbands. Data were analyzed by directed content analysis guided by the Transition Shock Model. The interview texts were first analyzed at individual levels and subsequently at the couple level to identify dyadic themes.

Results

Five themes and thirteen sub-themes emerged from the data analysis, including role integration, health risk, dilemma of preparation, protective isolation, and multi-dimensional expectation. Unexpectedly, the experiences and perspectives of mothers and fathers regarding the transition to parenthood were found to be similar, with the exception of the sub-theme extra-care requirement.

Conclusion

The findings shed light on the complex emotional journey and expectations of parents, as well as the challenges they face in terms of physical well-being, limited coping resources, and restricted social connections. Notably, fathers in China often shared the stress of the whole process during the transition period alongside mothers but often lacked accessible avenues for seeking and receiving support. These findings underscore the importance of actively involving fathers as a key support population in perinatal care, as well as the need for comprehensive support systems and tailored interventions to enhance the well-being and adaptation of parents.

Perinatal Mental Health: Father Inclusion At The Local, State, And National Levels

Fathers occupy a dual role in the realm of perinatal mental health: partner and parent. In fathers' role as partners, their support for mothers during pregnancy and postpartum is associated with improved maternal mental health. In their role as parents, fathers themselves are vulnerable to perinatal mood and anxiety disorder. This article aims to advance awareness of paternal perinatal mental health issues and impacts on families. We first review the evidence on paternal perinatal mental health. This evidence includes the critical role played by fathers in maternal perinatal mental health, the prevalence of paternal perinatal mood and anxiety disorder, the impact of paternal mental health on child and family well-being, and screening and treatment approaches. Next, we offer recommendations for more inclusive approaches at the local, state, and national levels aimed at improving parental mental health and health outcomes for fathers, mothers, and babies.

Relationship between gender roles, motherhood beliefs and mental health

Gender roles, as social constructs, play a significant role in shaping individuals' beliefs and attitudes, influencing various aspects of life, including perceptions and expectations surrounding motherhood. These beliefs, acquired through culture and society, can have an impact on our mental well-being. This research consists of three independent studies conducted in the Mexican population. In the first and second studies, we extended the Attitudes Towards Gender Roles Scale and Motherhood Beliefs Scale and performed psychometric validation through exploratory and confirmatory factor analysis. The aim of including additional items in both scales was to update these attitudes and beliefs in Mexican culture to avoid the traditionalist bias in both instruments. Finally, the third study examined the relationship between the new versions of both scales and symptoms of depression, anxiety, and Positive Psychological Functioning as indicators of mental health in women and men with and without children. Our findings revealed a significant association between higher levels of traditional attitudes towards gender roles and traditional motherhood beliefs, as well as between non-traditional attitudes towards gender roles and non-traditional beliefs about motherhood. Interestingly, we observed that traditional attitudes toward gender roles were associated with lower anxiety and depression scores, while non-traditional attitudes were associated with higher levels of depression. Furthermore, individuals who embraced non-traditional attitudes towards both gender roles and motherhood beliefs tended to exhibit better psychological well-being in all subsamples. Additionally, women generally showed lesser alignment with traditional attitudes towards both gender roles and motherhood beliefs compared to men. However, women reported higher rates of depression and anxiety, along with lower psychological well-being scores, than their male counterparts. This highlights the significant influence that traditional cultural norms about gender roles and motherhood have on women's mental health, underscoring the need for a deeper understanding and reevaluation of these traditional constructs in society.

Going through it together: Dyadic associations between parents' birth experience, relationship satisfaction, and mental health

BACKGROUND

Previous research suggests that a negative birth experience is associated with symptoms of postpartum depression and anxiety in mothers and partners. However, this has mostly been investigated within the first year postpartum and research on the long-term effects is lacking. Additionally, the role of relationship satisfaction and the interdependence between parents have not been considered so far.

METHODS

Couples (N = 1992) completed questionnaires on their birth experience, relationship satisfaction, and symptoms of depression and anxiety at two months, 14 months, and two years after birth, respectively.

RESULTS

Actor-Partner Interdependence Mediation Models indicated no partner effects, but several significant actor and indirect effects. A more positive birth experience was associated with higher relationship satisfaction and less depression and anxiety symptoms for both parents. Higher relationship satisfaction was in turn associated with less depression (mothers and partners) and anxiety symptoms (mothers). The association between birth experience and depression symptoms was partially mediated by relationship satisfaction for mothers and partners, while the association between birth experience and anxiety symptoms was partially mediated by relationship satisfaction only for mothers.

LIMITATIONS

Due to the highly educated, very healthy sample with low levels of depression and anxiety as well as high relationship satisfaction, results cannot be generalized to less privileged parents. Moreover, all effects were very small.

CONCLUSIONS

Results highlight the importance of a positive birth experience for parents' relationship satisfaction and mental health. Negative birth experiences need to be avoided to prevent a negative impact on the whole family.

Fathers' mental health and coping strategies: a qualitative study in Mwanza, Tanzania

OBJECTIVES

To investigate the nature of paternal mental health problems, their causes and the coping strategies used by fathers of young children under the age of 2 years.

DESIGN AND SETTING

We conducted in-depth interviews with fathers, mothers, community leaders and community health workers as well as focus group discussions with fathers-only, mothers-only and mixed groups of fathers and mothers. Respondents provided their perspectives on the psychosocial challenges affecting fathers and how fathers responded to their mental health problems. Data were triangulated across stakeholders and analysed using thematic content analysis.

SETTING

The study was conducted in four communities in Mwanza, Tanzania.

PARTICIPANTS

The total sample included 56 fathers, 56 mothers and 8 community stakeholders that were equally distributed across the four communities.

RESULTS

Respondents highlighted a spectrum of mental health concerns affecting fathers, including elevated parenting stress, depressive symptoms, and anxiety. Causes of paternal mental health problems included poverty, child-related concerns, marital problems and family illness. When asked about paternal coping strategies, both fathers and mothers shared that fathers mostly turned to negative coping strategies to manage their distress, such as paternal alcohol use and poor conflict resolution strategies. However, respondents also shared how some fathers used positive coping strategies, such as seeking out social support from their family and friends, engaging in exercise and leisure activities and relying on their faith.

CONCLUSIONS

Overall, this study highlights the importance of supporting positive mental health among fathers. Our findings can inform the design of psychosocial programme components that can be integrated within parenting interventions to promote the well-being of specifically fathers and ultimately improve the family caregiving environment.

The role of perceived social support on pregnant women's mental health during the COVID-19 pandemic

PURPOSE

The present study aimed at investigating which sources of social support best account for pregnant women's levels of psychological distress and mental well-being during the COVID-19 pandemic.

METHODS

274 Italian and Canadian expectant mothers completed an online-based survey including measures of perceived social support (from family, significant other and friends), state anxiety, depressive symptoms, and satisfaction with life. Correlation analyses and amultivariate analysis of covariance were performed to explore how social support from different sources was related to depressive symptoms, state anxiety and satisfaction with life.

RESULTS

Different sources of social support contributed to explaining women's psychological distress and mental well-being. Social support both from family and friends was significantly related to women's state anxiety and depressive symptoms. Social support from friends was specifically related to women's satisfaction with life.

CONCLUSION

Our findings endorse the crucial role of perceived social support as a protective factor for pregnant women's mental health. In the context of the COVID-19 pandemic, our results suggest that support from family seems important in preventing psychological distress, whereas support from friends is also associated with mental well-being. These results may help designing future interventions aimed at improving women's perinatal mental health in life-threatening conditions.

Marital adjustment and depressive symptoms among Chinese perinatal women: a prospective, longitudinal cross-lagged study

OBJECTIVES

The objective was to assess the prevalence of perinatal depressive symptoms and determine the trajectories of marital adjustment and depressive symptoms and their reciprocal relationships among Chinese perinatal women.

DESIGN

This was a prospective, longitudinal cross-lagged study.

SETTING

The study was conducted at the outpatient department of the largest women's and children's hospital in China, which is located in Chengdu, Sichuan Province.

PARTICIPANTS

Four hundred and sixty-three mothers were conveniently sampled.

MAIN OUTCOME MEASURES

The Dyadic Adjustment Scale and the Chinese version of the Edinburgh Postnatal Depression Scale were used to evaluate marital adjustment and depressive symptoms, respectively, at three time points: the first trimester of pregnancy (T1), the third trimester of pregnancy (T2) and 6 weeks after childbirth (T3). Descriptive statistics were used to assess the prevalence of perinatal depressive symptoms, and repeated-measures analysis of variance (ANOVA) was used to determine the trajectories of marital adjustment and depressive symptoms among the participants. A cross-lagged model was used to explore the reciprocal relationship between marital adjustment and depressive symptoms.

RESULTS

The prevalence of perinatal depressive symptoms among our participants ranged from 21.2% to 24.0%. Repeated-measures ANOVA showed that during the perinatal period there was a significant tendency towards worse marital adjustment (F=33.031, p=0.000) and a slight but not significant reduction in depressive symptoms (F=1.883, p=0.153) among the participants. The cross-lagged model showed that maternal marital adjustment at T1 significantly and negatively predicted depressive symptoms at T2 (β=-0.165, p<0.001), and that depressive symptoms at T2 significantly and negatively predicted marital adjustment at T3 (β=-0.135, p<0.001). However, the predictive effects of depressive symptoms at T1 on marital adjustment at T2 and that of marital adjustment at T2 on depressive symptoms at T3 were not significant.

CONCLUSION

The prevalence of perinatal depressive symptoms ranged from 21.2% to 24.0% among the participants. During the perinatal period, the marital adjustment of women tended to be worse; however, there was no significant change in depressive symptoms. This study showed that better marital adjustment at T1 was a protective factor against maternal depressive symptoms at T2, and a higher level of depressive symptoms at T2 was a risk factor for worse marital adjustment at T3.

Screening fathers for postpartum depression in a maternal-child health clinic: a program evaluation in a midwest urban academic medical center

BACKGROUND

Postpartum depression (PPD) impacts fathers as well as mothers, and is estimated to affect between 8 and 13% of fathers. Paternal PPD is a risk factor for worsened quality of life, poor physical and mental health, and developmental and relational harms in the father-mother-child triad. There are no current recommendations for PPD screening among fathers. Paternal PPD screening was piloted in an intergenerational postpartum primary care clinic.

METHODS

The pilot was carried out in an intergenerational postpartum primary care clinic located at a Midwest urban academic safety net health system from October 2021 to July 2022. Fathers actively involved in relationships with mothers or infants receiving primary care in the clinic were approached with mothers' permission. A novel survey instrument was used to collect demographic/social data, as well as mental health history and current stress levels; an Edinburgh Postnatal Depression Scale (EPDS) was also administered. Screenings were completed by social workers; data were collected in REDCap and descriptive statistics were calculated in SAS.

RESULTS

29 fathers were contacted and 24 completed screening (83%). Mean age was 31 years (range 19-48). Most (87%) identified as belonging to a racial or ethnic minority group. Fathers self-reported low rates of stress and preexisting mental health conditions, but 30% screened positive for PPD on EPDS (score of ≥ 8, or suicidal ideation). Gaps in health care were found, as one-quarter (26%) of fathers were uninsured and half (54%) did not have a primary care provider. After screening, two requested mental health services, and three established new primary care with a physician.

CONCLUSIONS

Participation was high in a PPD screening pilot for fathers in a primary care setting. This small sample of fathers demonstrated significant peripartum mental health challenges unlikely to have been identified otherwise. For some participants, engaging in PPD screening was an effective tool to prompt their subsequent engagement with general health care. This pilot is a step toward incorporating the health of fathers into models for supporting the health of families. Expanding screening for paternal PPD into routine primary care is necessary to reach more affected fathers.

Fetal heart rate variability and infant self-regulation: the impact of mother's prenatal depressive symptoms

BACKGROUND

Foetal heart rate (FHR) variability is considered a marker of foetal neurobehavioral development associated with infant self-regulation and thus may be an early precursor of the adverse impact of mother's prenatal depressive symptoms on infant self-regulation.

OBJECTIVE

This study analysed the mediator role of FHR variability in the association between mother's prenatal depressive symptoms and infant self-regulation at three months.

METHODS

The sample comprised 86 first-born infants and their mothers. Mothers reported on depressive symptoms at the first trimester of pregnancy and on depressive symptoms and infant self-regulation at three months postpartum. FHR variability was recorded during routine cardiotocography at the third trimester of pregnancy. A mediation model was tested, adjusting for mother's postnatal depressive symptoms.

RESULTS

Higher levels of mother's prenatal depressive symptoms were associated with both lower FHR variability and lower infant self-regulation at three months. FHR variability was associated with infant self-regulation and mediated the association between mother's prenatal depressive symptoms and infant self-regulation at three months.

CONCLUSION

Findings suggested FHR variability as an early precursor of infant self-regulation that underlies the association between mother's prenatal depressive symptoms and infant self-regulation. Infants of mothers with higher levels of prenatal depressive symptoms could be at risk of self-regulation problems, partially due to their lower FHR variability.

Women's perinatal depression: Anhedonia-related symptoms have increased in the COVID-19 pandemic

BACKGROUND

The prevalence of perinatal depression increased during the COVID-19 pandemic, which may be due to changes in the profile of specific depressive symptoms.

AIMS

To analyze the impact of the COVID-19 pandemic on the (1) prevalence and severity of specific depressive symptoms; and on the (2) prevalence of clinically significant symptoms of depression during pregnancy and postpartum.

METHODS

Pregnant and postpartum women recruited before (n = 2395) and during the COVID-19 pandemic (n = 1396) completed a sociodemographic and obstetric questionnaire and the Edinburgh Postnatal Depression Scale (EPDS). For each item, scores ≥1 and ≥ 2 were used to calculate the prevalence and severity of depressive symptoms, respectively.

RESULTS

The prevalence and severity of symptoms of depression were significantly higher during the COVID-19 pandemic. The prevalence of specific symptoms increased by >30%, namely "being able to laugh and see the funny side of things" (pregnancy 32.6%, postpartum 40.6%), "looking forward with enjoyment to things" (pregnancy 37.2%, postpartum 47.2%); and "feelings of sadness/miserable" or "unhappiness leading to crying" during postpartum (34.2% and 30.2%, respectively). A substantial increase was observed in the severity of specific symptoms related to feelings that "things have been getting on top of me" during pregnancy and the postpartum period (19.4% and 31.6%, respectively); "feeling sad or miserable" during pregnancy (10.8%); and "feeling scared/panicky" during postpartum (21.4%).

CONCLUSION

Special attention should be paid to anhedonia-related symptoms of perinatal depression to ensure that they are adequately managed in present and future situations of crisis.

Changes in relationship satisfaction in the transition to parenthood among fathers

To date, research on the transition to parenthood and associated changes in relationship satisfaction (RS) has focused predominantly on mothers with their firstborn. This study targeted fathers to investigate their trajectories of RS with a particular focus on emerging differences between first- and second-time fathers. It furthermore considered various predictors such as the role of age, education, income, duration of relationship, marital status, child's biological sex, and child temperament. Data from a total of 606 fathers from the prospective longitudinal cohort study DREAM were analyzed. The analyses included assessments of four measurement time points (T1: prepartum; T2-T4: postpartum) over a period of more than 2 years. Latent growth curve modeling was applied with RS as the dependent variable and number of children as one of eight predictors of growth over time. First-time fathers showed higher initial RS, however experienced a steeper decline in the transition to parenthood than second-time fathers. At 8 weeks postpartum, first-time fathers still reported higher RS than second-time fathers. While RS continued to decline for first-time fathers up until 14 months postpartum, second-time fathers experienced an increase in RS. At 14 months and 2 years postpartum, second-time fathers showed higher RS scores than first-time fathers. Similar to first-time mothers, first-time fathers seem to experience a stronger RS decline during the transition to parenthood than second-time fathers, suggesting that especially couples becoming parents for the first time should be prepared for expected changes in their relationship.

Long-Term Maternal and Child Outcomes Following Postnatal SSRI Treatment

Importance

Although selective serotonin reuptake inhibitors (SSRIs) are recommended for postnatal depression treatment, there is a lack of evidence regarding long-term maternal and child outcomes following postnatal SSRI treatment.

Objective

To examine whether postnatal SSRI treatment moderated postnatal depression-associated maternal and child outcomes across early childhood years.

Design, Setting, and Participants

This cohort study used longitudinal data from the Norwegian Mother, Father and Child Cohort Study. Participating women were recruited in weeks 17 to 18 of pregnancy from 1999 to 2008 and were prospectively followed up after childbirth. Data analysis was performed between December 2021 to October 2022.

Exposure

Postnatal depression diagnosis (a binary indicator of eligibility for treatment) was defined as a score of 7 or greater on the 6-item version of the Edinburgh Postnatal Depression Scale. The Hopkins Symptom Checklist was used as a continuous indicator of and postnatal depressive symptomology at postpartum month 6. Postnatal SSRI treatment was identified using self-reported data at postpartum month 6.

Main Outcomes and Measures

Maternal outcomes included self-reported depression symptomology and relationship satisfaction from childbirth to postpartum year 5. Child outcomes included maternal-report internalizing and externalizing problems, attention-deficit/hyperactivity disorder symptoms, and motor and language development at ages 1.5, 3, and 5 years. A propensity score adjustment method was used to control for prenatal factors associated with postnatal SSRI exposure probability.

Results

Among a total of 61 081 mother-child dyads, 8671 (14.2%) (mean [SD] age, 29.93 [4.76] years) met the criteria for postnatal depression diagnosis, 177 (2.0%) (mean [SD] age, 30.20 [5.01] years) of whom received postnatal SSRI treatment. More severe postnatal depression symptomology was associated with a range of adverse maternal and child outcomes. Focusing analyses only on the postnatal depression dyads indicated that postnatal SSRI treatment attenuated negative associations between postnatal depression and maternal relationship satisfaction at postpartum month 6 (moderation β, 0.13; 95% CI, 0.07-0.19), years 1.5 (moderation β, 0.11; 95% CI, 0.05-0.18) and 3 (moderation β, 0.12; 95% CI, 0.04-0.19), and for child ADHD at age 5 years (moderation β, -0.15; 95% CI, -0.24 to -0.05). Postnatal SSRI treatment mitigated the negative associations between postnatal depression and maternal depression, partner relationship satisfaction, child externalizing problems, and attention-deficit/hyperactivity disorder up to 5 years after childbirth.

Conclusions and Relevance

The results of this large prospective cohort study suggest that postnatal SSRI treatment was associated with a reduced risk of postnatal depression-associated maternal mental health problems and child externalizing behaviors across early childhood years. These findings suggest that postnatal SSRI treatment may bring benefits in the long term to women with postnatal depression and their offspring. This study potentially provides valuable information for clinicians and women with postnatal depression to make informed treatment decisions.

Bidirectional associations between paternal postpartum depression symptoms and coparenting: A cross-lagged panel model of fathers of infants and toddlers

BACKGROUND

Finding modifiable predictors of paternal depression symptoms is helpful for developing interventions. The aim is to assess the unidirectional and/or bidirectional associations between paternal postpartum depression symptoms and coparenting among fathers of infants and toddlers.

METHODS

Longitudinal data were collected prospectively from 429 fathers of infants aged 0-24 months (median = 8 months) in Sweden, with 6- and 18-month follow-ups. All fathers participated in at least two of three waves of data collection, and multiple imputation was used for missing values. The Edinburgh Postnatal Depression Scale was used to detect depression symptoms (≥10 points), while the Brief Coparenting Relationship Scale measured the coparenting relationship. A cross-lagged panel model was used to estimate the associations between paternal depression symptoms and coparenting relationship quality over time, controlling for several known covariates and COVID-19 exposure.

RESULTS

Fathers with higher coparenting scores at Time 1 and 2 had less depression symptoms at Time 3, and fathers with more depression symptoms at Time 2 had lower coparenting scores at Time 3. Plotted probabilities of having at least mild depression symptoms revealed a multifold increase in the probability of depression symptoms at Time 3 for fathers with minimal coparenting scores at Times 1 and 2, respectively, compared to fathers with mean coparenting scores at Times 1 and 2, respectively.

LIMITATIONS

Causal links cannot be determined using the current non-experimental study design. Using the EPDS alone may have missed some fathers with depression symptoms.

CONCLUSIONS

Clinicians seeking to reduce paternal depression symptoms should help strengthen the coparenting relationship.

Family treatment for postpartum depression: acceptability, feasibility, and preliminary clinical outcomes

The level of support from family members-and degree of family dysfunction-can shape the onset and course of maternal postpartum depression (PPD). In spite of this, family members are typically not included in treatments for PPD. Developing and disseminating intervention approaches that involve partners or other family members may lead to more effective treatment for perinatal women and potentially promote improved family functioning and wellbeing of multiple members of the family. To evaluate the feasibility and acceptability of a family-based treatment for PPD, we conducted an open pilot trial with 16 postpartum mother-father couples (N = 32 participants) and measured session attendance, patient satisfaction, and changes in key symptoms and functional outcomes. At the time of enrollment, mothers were 1-7 months postpartum, met criteria for major depressive disorder, and had moderate-severe symptoms of depression. Treatment involved 10-12 sessions attended by the mother along with an identified family member (all fathers) at each session. Findings provide strong support for the acceptability and feasibility of the intervention: session attendance rates were high, and participants evaluated the treatment as highly acceptable. Improvements in depression were observed among both mothers and fathers, and family functioning improved by the endpoint across several domains. Symptomatic and functional gains were sustained at follow-up. The current findings provide support for a larger randomized trial of family-based treatment for PPD.

Couple's Relationship during the Transition to Parenthood and Toddler's Emotional and Behavioral Problems

The literature has mainly focused on the impact of the negative aspects of the couple's relationship on the toddler's internalizing and externalizing problems. This study explored the impact of the positive and negative dimensions of the couple's relationship during the transition to parenthood on toddlers' psychological adjustment, considering the concurrent impact of the couple's relationship at 30 months postpartum. The sample comprised 115 mothers and fathers (N = 230) recruited during the 1st trimester of pregnancy. The mothers and fathers individually completed a measure of the couple's relationship (Relationship Questionnaire) during the first trimester of pregnancy, at 3 and 30 months postpartum, and the Child Behavior Checklist 1.5-5 at 30 months postpartum. Multiple linear regressions, cluster analyses, and univariate and multivariate analyses of variance were conducted. The positive dimension at the 1st trimester of pregnancy and the negative dimension of the couple's relationship at 3 months postpartum were the strongest predictors of the toddler's internalizing problems, while the negative dimension at 3 months postpartum and the positive dimension of the couple's relationship at 30 months postpartum were the strongest predictors of the toddler's externalizing problems. Two patterns of the couple's relationship (adjusted vs. non-adjusted) during the transition to parenthood were identified. Higher levels of internalizing and externalizing problems were found in toddlers from couples with a non-adjusted couple's relationship. Findings suggested the impact of both positive and negative dimensions of the couple's relationship during the transition to parenthood on the toddler's emotional and behavioral problems. Promoting the couple's relationship adjustment during the transition to parenthood can help to prevent toddlers' emotional and behavioral problems.

Relações entre a saúde mental e a conjugalidade de gestantes primíparas

Este estudo avaliou as relações entre variáveis sociodemográficas, saúde mental da mulher e conjugalidade durante a gestação. Participaram desta pesquisa correlacional 50 mulheres primíparas, que coabitavam com o genitor do bebê e que estavam no segundo ou terceiro trimestre de gestação do primeiro filho. Os sintomas de transtornos mentais comuns foram avaliados pelo Self-Reporting Questionnaire (SRQ-20) e os sintomas depressivos pelo Inventário Beck de Depressão (BDI-I). A conjugalidade foi avaliada com a Escala de Ajustamento Diádico. Os resultados de testes de correlação e de comparação de grupos mostraram que a presença de sintomas de transtornos mentais comuns e de depressão esteve associada a menor nível de ajustamento diádico. Discute-se a importância de identificar problemas na saúde mental da mulher e no ajustamento diádico durante a gestação, para favorecer o bem-estar da tríade mãe-pai-bebê na transição para a parentalidade.

The Effectiveness of Interventions for the Prevention or Treatment of Paternal Perinatal Anxiety: A Systematic Review

Background: The worldwide prevalence of paternal perinatal anxiety (PPA) ranges between 3.4% and 25.0% antenatally, and 2.4% and 51.0% postnatally. Experiencing PPA can adversely impact the individual, partners, and infants. Research concerning PPA is lagging and fragmented compared to research for new mothers. Objectives: To establish the effectiveness of prevention or treatment interventions for PPA in adults identifying as male. Data sources: We completed searches of Medline, EMBASE, PsycINFO and Web of Science from inception to 2 December 2021, as well as hand searches of references from relevant papers. Search selection and data extraction: Randomised controlled trials delivering prevention or treatment interventions and reporting anxiety outcomes for new/expectant fathers in the perinatal mental health period were included. Our review follows the PRISMA reporting guidelines. One reviewer independently screened 5170 titles/abstracts; second reviewers screened 50%. Two reviewers independently screened full text, extracted data, and conducted risk of bias assessments. Synthesis: Cochrane's collaboration tool 2 was used to assess quality. Primarily results are synthesised narratively, a post-hoc sub-group analysis was completed on four studies using the same outcome measure. Main results: Twelve of the 5170 studies fulfilled the inclusion criteria. Studies used psychoeducational or practical skills interventions. Interventions mostly involved couple-dyads and three studies assessed PPA as a primary outcome. Included interventions were prevention-based; no treatment interventions were found. Father-only interventions consistently reported a significant reduction of PPA. Conclusions: Systematic searching yielded no treatment interventions, highlighting a substantial gap in the evidence base. Within a limited and heterogenous sample, no studies targeted diagnosed PPA. Evidence suggested father-focused interventions may be effective in preventing PPA, regardless of the intervention delivery mode or intervention content. However, consistency between study design and options within the field are lacking compared to interventions available for mothers.

Relationships between parent-infant bonding, dyadic adjustment and quality of life, in an intra-partner sample

The transition to parenthood represents a moment of change and adaptation in which the dyadic marital relationship becomes a triadic relationship. Facilitating a positive transition requires a thorough understanding of the explanatory model of the relationship between parental-infant bonding, dyadic adjustment and quality of life (QoL) from an integrative perspective of the family unit. The aim of this work was to analyse the relationships between parent-infant bonding, dyadic adjustment and QoL from an intra-partner perspective, 6-12 months after the birth of a child. A cross-sectional observational study was performed in a convenience sample of 222 couples 6-12 months postpartum, enrolled from October 2013 to March 2016. The mean age of the mothers was 34.07 years (SD = 3.67), and for the fathers, it was 35.75 years (SD = 4.02). Mothers perceived better QoL and greater mother-infant bonding compared to fathers. The perception of an adequate dyadic adjustment, together with positive parent-infant bonding, had positively influenced the individual QoL of both members of the couple 6-12 months after birth. From an intra-partner perspective, the positive transition was influenced by the relationship between parent-infant bonding, dyadic adjustment and QoL. Positive parent-infant bonding in mothers and fathers, as well as promotion of the quality of the relationships between couples, can help promote a better QoL. Positive health results can be achieved in terms of individual and family well-being by designing healthcare interventions that encourage the presence and participation of the family unit.

Care in the time of COVID: An interpretative phenomenological analysis of the impact of COVID-19 control measures on post-partum mothers’ experiences of pregnancy, birth and the health system

Background

Findings suggest pandemic control measures have modified maternal health practices, compromising the quality of care provided to new and expectant mothers and interfering with their birthing experiences. For this reason, this study explored the lived experiences of post-partum Victorian mothers during the pandemic as well as the potential influence of control measures over their perceptions regarding the health system.

Methods

This study used a qualitative approach. Recruitment was conducted between May and June 2021, using both the Australian Breastfeeding Association’s social media pages and snowball recruitment. Interviews were semi-structured using open-ended questions relating to key themes. Seven Victorian post-partum mothers were identified and their transcripts analysed using Interpretative Phenomenological Analysis.

Results

Mothers described how unexpected changes to maternal care exacerbated feelings of uncertainty regarding pregnancy and birth. Mothers also differentiated between impacts by the health system and the role healthcare professionals played in moderating these effects. Whilst visitor restrictions provided some benefit, restrictions to familial and social support left many of the mothers feeling alone during their pregnancy and interfered with their immediate post-partum experience.

Conclusion

This study illustrates the importance of evidence-based practice in maternal care and provides insights for both health professionals and policy analysts in developing new or modifying existing guidelines that better balance the needs of expectant and post-partum mothers with pandemic control measures.

Fathers' anxiety levels during early postpartum: A comparison study between first-time and multi-child fathers

BACKGROUND

The postnatal period is considered the most challenging period in the adjustment to fatherhood. This study aimed to assess anxiety levels among fathers during this period.

METHODS

A comparative study assessing the anxiety levels of first-time and multi-child fathers before the mother and child returned home (0-7 days after birth) was conducted. We used the French validation of the State-Trait Anxiety Inventory (STAI).

RESULTS

Among 235 fathers who were met at the maternity ward, 182 (77 %) responded to the questionnaire. For most fathers in both groups, anxiety levels were low or very low for trait anxiety (166/182, 91.21 %) and state anxiety (177/182, 97.25 %). Levels of state anxiety were statistically higher for first-time fathers compared to multi-child fathers but were mainly at a low or very low level (70/83 [84 %] versus 71/99 [71 %], respectively, p = 0.029). The multiple linear regression showed that "feeling prepared at birth time" was the only significantly (p < 0.001) associated factor with state anxiety among first-time fathers only.

LIMITATIONS

The validity and reliability of the STAI have been widely proven for the general population but not specifically for men during the postpartum period.

CONCLUSIONS

Most fathers had low to very low anxiety levels during the early postpartum period, suggesting that developing new specific support interventions is not needed during early postnatal care. Further research focusing on when the family is back home is warranted.

Transition to Parenthood and Marital Satisfaction: A Meta-Analysis

The transition to parenthood is a major life event characterized by profound changes for a considerable number of people. Previous meta-analyses summarized the results obtained by various researchers in the first year and, respectively, in the first 2 years postpartum, globally. The current studyadds to the literature by testing the changes from 12 to 24 months, the cross-partner associations and the analysis of different moderators. The aims of thispresent meta-analysis are to investigate the decrease in marital satisfaction during the first and second year postpartum, to examine cross-partner associations of the decline in postpartum marital satisfaction, and to investigate the potential moderating variables of this decrease. Forty-nine studies (97 samples of parents and 9 samples of non-parents) that fit our criteria are included in the meta-analysis. The data analysis was performed using meta-analytic techniques. Marital satisfaction has a medium decrease between pregnancy and 12 months postpartum, and a small decline between 12 and 24 months postpartum for both genders. In a similar period with first year postpartum, non-parents present a small decline in marital satisfaction. Moreover, the analysis of the dyadic studies data shows cross-partner associations, confirming that one partner's satisfaction has a steeper decline when the other partner's satisfaction presents a steep decrease. The decrease in marital satisfaction does not stop after the first postpartum year, and the coss-partners associations are present. Theoretical and therapeutic implications are also discussed.

Momentary social interactions and affect in later life varied across the early stages of the COVID-19 pandemic

The COVID-19 pandemic has impacted many different facets of life. The infectious nature of the disease has led to significant changes in social interactions in everyday life. The present study examined how older adults’ patterns of everyday momentary social interactions (i.e., with no one, partner, family, and friends) and their affect varied across the early stages of the pandemic and whether the magnitude of affective benefits associated with social interactions changed across time. A total of 188 adults aged 50 or above (M_age = 62.05) completed momentary assessments in early March, late March, May, and July 2020. Overall, older adults spent more time in solitude and less time interacting with their friends after the declaration of the pandemic. Further, negative affect (NA) spiked after the pandemic declaration and then returned to pre-pandemic level. Finally, momentary interactions with close social ties were consistently associated with higher positive affect (PA) and lower NA whereas momentary solitude was associated with lower PA, but not related to NA. The magnitude of associations between specific social interactions (or solitude) and affect varied across time, and the onset of the pandemic appeared associated with this variation. During the presumably most stressful period, solitude was not associated with lower PA and family interaction was not associated with higher PA as they were at other times. Further, interactions with friends seemed to have diminished affective benefits following the onset of the pandemic.

Couple's Relationship and Depressive Symptoms during the Transition to Parenthood and Toddler's Emotional and Behavioral Problems

The couple’s relationship and mother and father’s depressive symptoms during the transition to parenthood were associated with the toddler’s emotional and behavioral problems. This study aimed to analyze how the couple’s positive and negative interactions and mother and father’s depressive symptoms during the transition to parenthood impact toddlers’ emotional and behavioral problems. A sample of 95 mothers and fathers (N = 190) were recruited and individually completed questionnaires to assess couples’ positive and negative interactions and depressive symptoms during the first trimester of pregnancy and at 3 and 30 months postpartum, and they completed the Child Behavior Checklist 1.5–5 at 30 months postpartum. The path analyses revealed that the couple’s postnatal negative interaction partially mediates the impact of the mother’s prenatal depressive symptoms on the toddler’s internalizing problems at 30 months postpartum. The father’s postnatal depressive symptoms and the couple’s concurrent positive interaction mediated the impact of the couple’s prenatal positive interaction on the toddler’s externalizing problems at 30 months postpartum. The screening of the couple’s negative interaction and depressive symptoms during pregnancy and the postnatal period can help to identify mothers, fathers, and toddlers at risk for mental health problems.

Differential Trajectories of Fathers' Postpartum Depressed Mood: A Latent Class Growth Analysis Approach

Parental psychological well-being is essential to the wellness of the family. However, longitudinal investigations into fathers’ postpartum depressed mood are limited. This study aimed to identify the typologies of depressed mood trajectories over the first year postpartum among Taiwanese fathers and to examine the factors associated with such typologies. We retrieved data from a nationwide longitudinal study on child development and care in Taiwan. A total of 396 fathers, who completed at least one of the three interviews when their children were 3, 6, and 12 months old between 2016 and 2017, were included in this analysis. Conditional latent class growth analysis was conducted to identify the classifications of the fathers’ depressed mood trajectories in the first year postpartum and to estimate the effects of covariates on individuals’ membership of a trajectory class. Three classes of depressed mood trajectories were identified. The high increasing group consisted of 11% of the participants; the moderate increasing and the low decreasing groups consisted of 28% and 61% of the participants, respectively. Financial stress was associated with the fathers’ likelihood of being in the high increasing group compared with their likelihood of being in the low decreasing group (OR = 2.28, CI = 1.16–4.47). The result may be related to the difference in gender roles and social expectations.

Pilot Testing a Brief Partner-Inclusive Hybrid Intervention for Perinatal Mood and Anxiety Disorders

The necessity of hybrid and more accessible options for perinatal mood and anxiety disorders (PMADs) has taken on increased urgency in the wake of the COVID-19 pandemic and its lasting impacts. In the New Family Wellness Project (NFWP), participants engage in a hybrid in-person and teletherapy six-session intervention for new parents early in their postpartum period. This small, phase 1 clinical research examined early outcomes of the NFWP's cognitive behavioral intervention on adverse mental health outcomes (i.e., perinatal depression and anxiety, overall mental illness symptoms) and adaptive outcomes and protective factors (i.e., relational health, social support, flourishing, self-efficacy). Despite a small sample size (N = 12), paired t-tests yielded significant effects for improvements in mental health symptoms at posttest, as well as marginally significant improvements in postpartum anxiety and self-efficacy. Findings suggest the brief, partner-inclusive, hybrid intervention shows promise for further study. Lessons learned from this small phase 1 clinical study and recommendations for revising the intervention prior to future trials are discussed.

Prenatal intervention program for Japanese first-time fathers to adapt to the paternal role: a mixed methods study

This study aimed to develop a prenatal intervention program focused on the formation of paternal identity for adapting to paternal role. The intervention program allowed participants to create a postpartum schedule using a uniquely developed paternity portfolio. Pre and post-intervention effects were evaluated using a convergent design of mixed methods. This intervention effect was quantitatively evaluated between the two groups. To qualitatively examine the intervention's effects, participants were interviewed for effective prenatal education, and their paternal role behaviors were identified by the intervention. Details of actual postpartum paternal role behavior and effective prenatal education were collected. Obtained data were inductively analyzed and compared with those in the proposed prenatal intervention program. There were 10 pairs in the intervention group and 31 pairs in the control group. Intergroup comparison of evaluation data showed no significant difference. However, qualitative results clarified the effective nursing intervention, confirming the achievement of intervention goals by all participants. Intervention expressions were adjusted based on the results, and a revised prenatal intervention program was developed. This article is protected by copyright. All rights reserved.

Measuring and Predicting Maturity to Parenthood: What Has Personality Got to Do with It?

Maturity to parenthood is essential for taking on parental roles but remains an understudied issue. Still, close relations between maturity and personality dimensions are commonly emphasized. Thus, conducting research on maturity in context of personality seems a valuable research direction. The present research consists of two studies, focusing on the development and validation of Maturity to Parenthood Scale (MPS), in relation to personality, emotional regulation, coping with challenges, and intimate relationship satisfaction. In both studies, childless adults aged 20-35 years took part: (1) 718 participants (Mage = 25.49; SD = 2.89; 479 women), (2) 150 participants (Mage = 23.69; SD = 3.15; 104 women). All the participants had been in an intimate relationship for at least six months at the time of the study, the majority declared their willingness to have children in the future, had higher education, and were professionally active. The results showed that MPS is a reliable, valid measure comprising the following three subscales: valence, behavioral, and cognitive-emotional maturity to parenthood. The findings also confirmed the importance of broad- and narrow-band individual differences and contextual factors for maturity. MPS may be used in psychoeducation, supporting the transition to biological or adoptive/foster parenthood, as well as in medical and psychological care.

Father's Perspectives on Family Relationships and Mental Health Treatment Participation in the Context of Maternal Postpartum Depression

Objective: To understand the perspectives of fathers whose partners experienced postpartum depression, particularly (1) views on how fathers and family relationships were impacted by maternal PPD, and (2) attitudes regarding inclusion of fathers within the treatment process. Methods: We conducted qualitative interviews with 8 postpartum couples using a semi-structured protocol, and administered questionnaires assessing demographics, depression, and family functioning. We abstracted data from hospital records regarding the mother's depressive episode. We summarized quantitative data using descriptive statistics, and analyzed interview transcripts using qualitative analysis techniques, focusing specifically on fathers' input on postpartum relationships and treatment involvement. Results: Over one-third of fathers had elevated symptoms of depression, and family functioning scores suggested that most couples were experiencing dysfunction in their relationships. Qualitative analysis identified three major categories of themes, and subthemes in each category. Major themes included: (1) fathers' experiences during the postpartum period, including not understanding postpartum mental health conditions and desiring more information, experiencing a range of emotions, and difficulty of balancing work with family; (2) fathers' views on postpartum relationships, such as communication problems, empathy for partner, and relationship issues with other family members; (3) fathers' attitudes toward postpartum treatment, including openness to be involved, perceived benefits, and barriers and facilitators to the inclusion of partners in treatment. Conclusion: Though barriers exist, many fathers are motivated to be included in the treatment process. In addition to supporting maternal wellbeing, fathers view treatment as a means to improve issues in the couple or family system, such as communication difficulties.

Depressed mood trajectories in the first year postpartum among Taiwanese mothers: Associations with perceived support, financial stress, and marital satisfaction

This study examined the typology of depressed mood trajectories and the associated factors over the first year postpartum among Taiwanese mothers. Data of 4332 mothers from a nationwide longitudinal study on child development and care were analyzed. Three classes of depressed mood trajectories were identified, two with lower initial scores and a decreasing trajectory and one with a higher initial score and an increasing trajectory. Subjective financial stress, perceived support, and marital satisfaction were significant in predicting mothers' membership of the depressed mood trajectory classes. The results highlighted the individual susceptibility to the postpartum depressed mood among Taiwanese mothers.

Relaxation interventions for improving sleep outcomes in perinatal women: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Sleep problem is common amongst perinatal women, and stress may trigger and intensify sleep problems in a vicious cycle. Relaxation interventions are gradually being adopted to improve sleep quality in various populations, but little is known about their effectiveness in perinatal women.

OBJECTIVE

To evaluate the effects of relaxation interventions on sleep outcomes amongst all perinatal women aged 18 and above, and identify the essential type, regime and approach in designing relaxation intervention.

DESIGN

Systematic review and meta-analysis of 11 studies among 1046 perinatal women.

DATA SOURCES

We searched Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, Excerpta Medica dataBASE, PsycINFO, ProQuest Dissertations and Theses, PubMed and Web of Science from their inception until December 15, 2019.

REVIEW METHODS

Studies were assessed for clinical and statistical heterogeneity and considered for meta-analysis. Comprehensive Meta-analysis and The Cochrane Risk of Bias tool were used for meta-analyses and assessing of risk of bias, respectively.

RESULTS

A total of 6346 records were identified, and 11 randomised control trials were selected. Significantly large effects were found in relaxation interventions in improving sleep quality (Cohen's d = 2.55), disturbance (Cohen's d = 1.52), latency (Cohen's d = 1.82) and duration (Cohen's d = 1.14) when compared with those in the control groups. Subgroup analyses showed that antenatal women who performed progressive muscle relaxation (PMR) by themselves for preventive function and long-term practice showed improved sleep quality compared with their counterparts.

CONCLUSION

PMR is preferable as a supplementary intervention to current existing antenatal care. The grade of the overall evidence of the outcomes ranged from very low to low.

IMPLICATIONS FOR PRACTICE

The meta-analysis addressed the effect of relaxation interventions on sleep outcomes amongst perinatal women. Relaxation interventions may effectively improve sleep quality, disturbance, latency and duration amongst perinatal women early in antenatal period. However, further well-designed trials in large samples are required.

Expanding the international conversation with fathers' mental health: toward an era of inclusion in perinatal research and practice

Paternal mental health is beginning to be recognized as an essential part of perinatal health. Historically, fathers were not recognized as being at risk for perinatal mental illnesses or relevant to maternal and infant health outcomes. The purpose of this paper is to provide an overview of paternal perinatal mental health, leading tools to assess paternal depression and anxiety, the impact of paternal mental health on mother and child health, and future directions for the field. An international team of paternal perinatal mental health experts summarized the key findings of the field. Fathers have an elevated risk of depression and anxiety disorders during the perinatal period that is associated with maternal depression and can impact their ability to support mothers. Paternal mental health is uniquely associated with child mental health and developmental outcomes starting from infancy and continuing through the child lifespan. Tailored screening approaches for paternal mental health are essential to support fathers early in the perinatal period, which would offset health risks for the family. Recommendations on paternal mental health are provided on four key areas to support father perinatal mental health: (1) intervention research, (2) clinical training, (3) national policy, and (4) the inclusion of fathers in the focus of the International Marcé Society for Perinatal Mental Health.

Factors associated with postpartum depression among women in Vientiane Capital, Lao People's Democratic Republic: A cross-sectional study

Postpartum depression is a worldwide public health concern. The prevalence of postpartum depression is reported to be greater in developing countries than in developed countries. However, to the best of our knowledge, no papers on postpartum depression in the Lao People’s Democratic Republic have been published. In order to strengthen maternal and child health, the current situation of postpartum depression should be understood. This study aims to determine the prevalence of postpartum depression and identify factors associated with postpartum depression in Vientiane Capital, Lao People’s Democratic Republic. Study participants were 428 women 6–8 weeks postpartum who visited four central hospitals in Vientiane Capital for postnatal care from July to August 2019. Structured questionnaires were used to collect socio-demographic, obstetrical and infant, and psychiatric data about the women and their partners. The Edinburgh Postnatal Depression Scale (EPDS) was used to identify suspected cases of postpartum depression with the cut-off score of 9/10. Multivariable logistic regression was used to examine independent factors that were associated with suspected postpartum depression (EPDS ≥10). The mean age of the 428 women was 28.1 years, and the prevalence of suspected postpartum depression was 31.8%. Multivariable logistic regression using variables that were statistically significant on bivariate analyses indicated that three variables were associated with suspected postpartum depression: unintended pregnancy (AOR = 1.66, 95% CI 1.00–2.73, P = 0.049), low birth satisfaction (AOR = 1.85, 95% CI 1.00–3.43, P = 0.049), and depression during pregnancy (AOR = 3.99, 95% CI 2.35–6.77, P <0.001). In this study, unintended pregnancy, low birth satisfaction, and depression during pregnancy were independent risk factors for postpartum depression. These results suggest that the mental health of pregnant women should be monitored, and that health care services, especially family planning and supportive birth care, should be strengthened to prevent postpartum depression.

Cross-lagged Models of Marital Relationships and Intergenerational Conflicts during Transition to Parenthood: Effect of Patrilineal Coresidence

The transition to parenthood is one of the most stressful intra- and interpersonal adjustment periods for new parents. Bidirectional associations among intergenerational relationships during the transition to parenthood have received limited attention, and the complexity of reciprocal relationships varies in accordance with living arrangements. The objectives of this study were to explore (1) the bidirectional associations between marital relationships and conflicts with in-laws during the transition to parenthood and (2) the moderation of patrilineal coresidence on the aforementioned relationships. A three-wave prospective longitudinal design was adopted for 359 married mothers. The Dyadic Adjustment Scale and Stryker Adjustment Checklist were used to assess marital relationships and conflicts with parents-in-law. Cross-lagged panel analysis was applied to examine reciprocal relationships, and multigroup analyses were employed to determine whether these relationships exhibited different patterns in accordance with the individuals' living arrangements. The two cross-lagged models revealed the presence of a bidirectional relationship between marital distress and conflicts with parents-in-law during the mid- to late pregnancy stages. Meanwhile, the multigroup analyses suggested that conflicts with parents-in-law triggered marital distress during pregnancy in the coresidence group, whereas conflicts with fathers-in-law could intensify marital distress during late pregnancy to the postpartum period in the noncoresidence group. These findings shed light on cross-lagged associations with intergenerational conflicts. Healthcare professionals need to ensure that intergenerational relationships are positive during the transition to parenthood. This study enriches our understanding of the effect of patrilineal coresidence and can guide the future development of interventions based on culturally specific multidimensional approaches.

Profiles of Depressive Symptoms and Anger in Men: Associations With Postpartum Family Functioning

Background: Evidence suggests that men commonly experience depression as feelings of anger; yet, research has not investigated what this means for the manifestation of depressive symptoms in the early years of fatherhood and for key indicators of family functioning. Methods: Using data from a longitudinal cohort study of men at the normative age for entering fatherhood (28-32 years), we conducted latent class analyses to identify patterns of depressive symptoms and 3 sub-types of state anger (feeling; verbal; physical). We then assessed whether class membership was associated with paternity status (n = 535). In a subsample of fathers of infants aged up to 18 months (n = 162), we prospectively assessed associations with paternal-infant bonding, co-parenting, perceived social support, paternal involvement in childcare and alcohol use up to 2 years later. Results: Five classes emerged that differentiated men by anger and depressive symptom severity and by the degree to which men endorsed the feeling of wanting to express anger physically. Compared to the reference class with minimal symptoms, fathers had a higher probability of being in either the mild or most severe symptom classes. Men in symptomatic classes were at higher risk of lower levels of social support, co-parenting problems, and paternal-infant bonds. Class membership was not associated with alcohol use or paternal involvement in childcare. Conclusions: Our results reveal patterns of co-existing symptoms of depression and anger in fathers of infants that will be relevant to men's own need for support, their family safety, partner mental health and child developmental outcomes.

Motherhood in the Time of Coronavirus: The Impact of the Pandemic Emergency on Expectant and Postpartum Women's Psychological Well-Being

The birth of a child is a critical and potentially stressful experience for women, entailing several changes both at the individual and interpersonal level. This event can lead to different forms of distress, ranging in intensity and duration. Many studies highlighted medical, psychological, and social variables as risk factors potentially influencing the onset or aggravation of perinatal maternal conditions. The current pandemic emergency and the restrictive measures adopted by local governments to prevent the spread of the coronavirus infection may negatively affect mothers-to-be and new mothers potentially increasing the likelihood of anxiety, depressive or post-traumatic symptoms to develop. Moreover, the forced quarantine combined with the limited access to professional or family support may increase feelings of fatigue and isolation. The present study aims to investigate women's psychological well-being during pregnancy and in the first months after childbirth, integrating the evaluation of some traditionally studied variables with the specificities of the current situation. 575 Italian women have been administered an online self-report questionnaire assessing the presence of anxiety disorders, depressive and post-traumatic symptoms as well as the expectations toward childbirth (for mothers-to-be) or the subjective experience of childbirth (for postpartum women). Findings revealed a higher percentage of women than that reported in the literature scored above the clinical cut-off both during pregnancy and postpartum on a series of measures of psychological well-being, thus demonstrating that this period was perceived as particularly challenging and stressful and had significant impact on the women's well-being. Moreover, some socio-demographic, medical, and pandemic-related variables, especially the lack of presence and support from one's partner during labor and delivery as well as in the first days postpartum was found to predict women's mental health. These findings suggest the need for developing specific interventions targeted at women who cannot benefit from the support of their partners or family.

Longitudinal Study of Dyadic Adjustment in a Sample of Spanish Fathers

The objectives of this study were to examine the evolution of fathers’ long-term dyadic adjustment after the birth of a child and to analyze their evolution considering related factors. A total of 113 Spanish fathers with a mean age of 35.72 years (SD = 3.84 years) participated. In general, there was a decline in the dyadic adjustment of the fathers until 6–12 months after childbirth, after which their level of adjustment remained stable until 13–24 months. We observed different patterns when analyzing the evolution by subgroups formed based on these different variables, previous experience of paternity, and anxiety. The intrinsic differences between fathers should also be considered because these differences can influence the way in which men face the parental process as well as the evolution of the quality of their relationship with their partner.

The link between parental psychological control, depressive symptoms and epigenetic changes in the glucocorticoid receptor gene (NR3C1)

AIMS

This paper examines the relationship between parental Psychological Control (PC) and depressive symptoms in adolescents and assesses whether this relationship was mediated by DNA methylation, focusing on the glucocorticoid receptor gene (NR3C1), which plays a crucial role in HPA-axis functioning and is linked to environmental stress and depression. This is among the very few studies that looked at the relation between DNA methylation, environmental stress and depression in family trios.

METHODS

The study cohort consisted of 250 families: father, mother and a biologically related adolescent (adolescents (48.9% boys), mean age: 15.14, SD= 1.9; mean age mothers: 45.83, SD= 4.2; mean age fathers: 47.77, SD= 4.7). Depressive symptoms and PC were measured in adolescents and in both parents. DNA methylation levels in NR3C1 were examined in all participants.

RESULTS

Depressive symptoms in adolescents were predicted by PC of both mothers and fathers. Moreover, maternal depressive symptoms were associated with maternal PC, and fathers' depressive symptoms and PC. In fathers, only the level of their self-reported PC was associated with their depressive symptoms. There was no relation between adolescents' DNA methylation and depressive symptoms or the level of parental PC. Yet, there was a significant association between maternal depressive symptoms and maternal epigenetic patterns in NR3C1.

CONCLUSIONS

These findings highlight the need for more research in order to better understand the biological and contextual mechanisms through which parenting and parental emotional well-being is related to the development of psychopathology.

Health related quality of life in Chinese pregnant women at advanced maternal age: a cross-sectional study

OBJECTIVE

This study aims to explore the relationship between advanced maternal age (AMA) and health-related quality of life in Chinese pregnant women.

METHODS

A cross-sectional study was conducted in Guangzhou, China between September 2018 and June 2019. Four hundred and twenty-seven AMA women and the equal number of their younger counterparts completed the 36-Item Short-Form Health Survey (SF-36).

RESULTS

Compared with younger women, the AMA women were more likely to be employed; have a higher monthly household income and insurance covered; have a satisfied relationship with their husband and mother-in-law; and had a significantly lower level of physical (SF36-PCS) health-related quality of life and a higher level of mental (SF36-MCS) health-related quality of life during the pregnancy. The association of maternal age with health-related quality of life varies according with the trimester of pregnancy. Maternal age was a significant predictor of SF36-PCS and SF36-MCS. The third trimester was the significant predictor of SF36-PCS while the relationship with the mother-in-law was the significant predictor of SF36-MCS.

CONCLUSIONS

The SF36-PCS in the AMA women decreased with advancing age. However, their SF36-MCS was better over their younger counterparts. Age-related biological disadvantages may be offset by social/psychological advantages in AMA women.

Health-care practitioners' assessment and observations of birth trauma in mothers and partners

BACKGROUND

Evidence shows that traumatic childbirth can cause ongoing distress, often referred to as birth trauma. This can have an impact on parents and the couple relationship, and consequently identifying and supporting parents with birth trauma is important to practice.

AIM

To investigate the experiences of health-care practitioners from the United Kingdom (UK) in assessment for birth trauma, perceived occurrence of birth trauma and observed impact on parents and the couple relationship.

METHODS

An online survey of UK health-care practitioners working with parents in the first postnatal year.

RESULTS

A sample of 202 practitioners reported identifying birth trauma in 34.4% of mothers and 25.0% of partners. Assessment for birth trauma was only conducted for 50.3% of mothers and 25.9% of partners. The most observed symptoms were re-experiencing among mothers (87.1%) and avoidance among partners (50.9%). Birth trauma was perceived as impacting on the couple relationship for 29.8% of mothers and 26.9% of partners. Written responses provided more detailed observations of the impact of birth trauma.

CONCLUSION

Understanding how birth trauma may present differently in mothers and partners could support effective assessment. Once birth trauma is identified, parents require personalised support to help them cope with the impact.

Associations Between Fear of COVID-19, Mental Health, and Preventive Behaviours Across Pregnant Women and Husbands: An Actor-Partner Interdependence Modelling

The present cross-sectional study examined the actor-partner interdependence effect of fear of COVID-19 among Iranian pregnant women and their husbands and its association with their mental health and preventive behaviours during the first wave of the COVID-19 pandemic in 2020. A total of 290 pregnant women and their husbands (N = 580) were randomly selected from a list of pregnant women in the Iranian Integrated Health System and were invited to respond to psychometric scales assessing fear of COVID-19, depression, anxiety, suicidal intention, mental quality of life, and COVID-19 preventive behaviours. The findings demonstrated significant dyadic relationships between husbands and their pregnant wives' fear of COVID-19, mental health, and preventive behaviours. Pregnant wives’ actor effect of fear of COVID-19 was significantly associated with depression, suicidal intention, mental quality of life, and COVID-19 preventive behaviours but not anxiety. Moreover, a husband actor effect of fear of COVID-19 was significantly associated with depression, anxiety, suicidal intention, mental quality of life, and COVID-19 preventive behaviours. Additionally, there were significant partner effects observed for both the pregnant wives and their husbands concerning all outcomes. The present study used a cross-sectional design and so is unable to determine the mechanism or causal ordering of the effects. Also, the data are mainly based on self-reported measures which have some limitations due to its potential for social desirability and recall biases. Based on the findings, couples may benefit from psychoeducation that focuses on the effect of mental health problems on pregnant women and the foetus.

Experiences, views and needs of first-time fathers in pregnancy-related care: a qualitative study in south-East Nigeria

Background

Given the relevance of paternal involvement in maternal care, there is a need to prepare first-time fathers to participate in pregnancy and childbirth actively. This study explores the experiences and needs of first-time fathers; and how these influences their involvement during pregnancy and childbirth in Nigeria.

Methods

A descriptive qualitative study was conducted. Semi-structured interviews with 50 men recruited from rural and urban workplaces, hospitals, and markets, generated data used to explore the experiences, views and needs of first-time fathers’ in pregnancy-related care in south-east Nigeria. All data were transcribed and analysed using thematic analysis.

Results

Six major themes were identified: gender roles, antenatal involvement, care costs and delivery choices, need to be informed, dealing with emotions, and dealing with the delivery day. The key finding reveals that inexperience and perceptions of gender roles greatly influenced the support provided by first-time fathers to their spouses and the support they received from their social support networks. Two primary needs were identified: need to be informed and the need to know about the cost of care in health settings. First-time fathers acknowledged the role of information on their decision making and final choices.

Conclusion

Findings reveal the influence of gender norms, beliefs, and social support on first-time fathers’ involvement in pregnancy and childbirth. This study also highlights the urgent need to provide informational support for first-time fathers and presents insights into what hospitals can do to achieve this need.

Couple relationship quality and the infant home language environment: Gender-specific findings

Couple relationship quality is known to drop significantly across the transition to parenthood (Ahlborg & Strandmark, 2001; Doss, Rhoades, Stanley, & Markman, 2009), yet individual differences in the amount of parent-to-infant talk have rarely been studied in relation to variation in couple relationship quality. Addressing this gap, the current study of 93 first-time parents with 4-month-old infants included multimeasure reports of couple relationship quality from both mothers and fathers and examined associations between couple relationship quality and the home language environment, assessed via the Language Environment Analysis (LENA), when infants were approximately 7 months old. LENA consists of a wearable talk pedometer that records a full day of naturalistic parent-infant talk and is coupled to software that provides automated analysis. Given the covariation between depression and both couple relationship quality and parental infant-directed talk, both maternal and paternal depression were controlled for in all analyses. Results showed that, for mothers of sons, frequency of infant-directed talk was inversely related to couple relationship quality. Consistent with family systems theory, this finding provides partial support for the compensation hypothesis. However, variation in couple relationship quality was unrelated to infant-directed speech in fathers or in mothers of daughters. Together, these findings demonstrate that the gender composition of the parent-infant dyads plays a moderating role on the association between couple relationship quality and parent-infant talk. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Psychological distress profiles in expectant mothers: What is the association with pregnancy-related and relational variables?

INTRODUCTION

Research has progressively focused on antenatal psychological disease of expectant mothers, showing that anxiety and depression as well as fear of childbirth occur frequently during pregnancy. Some studies have investigated the connection between anxiety, depression, and fear of childbirth with contrasting results. Several authors have analyzed the association between psychological disease of pregnant women and numerous medical-obstetric and relational variables, still reporting inconclusive findings. The present study had three aims: 1) to investigate the psychological well-being of pregnant women based on their levels of anxiety, depression, and fear of childbirth, by identifying psychological profiles; (2) to analyze the association between the emergent psychological profiles and some medical-obstetric variables related to pregnancy; and (3) to examine the association between these profiles and couple's adjustment and social support.

METHODS

410 Italian primiparous pregnant women in the 7th-8th month of pregnancy completed a questionnaire packet on site that included the following scales: Wijma Delivery Expectancy Questionnaire, Edinburgh Postnatal Depression Scale, State-Trait Anxiety Inventory, Dyadic Adjustment Scale, Multidimensional Scale of Perceived Social Support.

RESULTS

Findings revealed the presence of three different clusters: "psychologically healthy women" (34.9%), comprised of women characterized by low levels of symptoms on all the scales; "women experiencing pregnancy- and childbirth-related anxiety" (47.3%), which groups women with an average state anxiety over the clinical value; and "psychologically distressed women" (17.8%), comprised of women who reported high levels of symptoms on all the scales, some above the clinical cut-offs. These profiles were not related to the medical-obstetric variables. On the other hand, findings revealed a significant association between marital adjustment as well as social support and cluster membership.

DISCUSSION

These results support the importance of early and multilevel psychological screening in order to understand the experience of pregnant women and to develop targeted and increasingly personalized interventions.

Increase of depressive symptomatology during pregnancy over 25 years' time in four population based cohorts

BACKGROUND

The use of psychotropic drugs for depression during pregnancy has increased over the past decades, but it is unclear whether women are becoming more depressed over time.

METHODS

We investigated the occurrence of depressive symptoms during pregnancy in four cohorts (N 300-2000) in the same area in the Netherlands over a period of 25 years using a similar study design. Depressive symptoms were assessed using the Edinburgh Depression Scale (EDS) at various time points during pregnancy. Demographics, lifestyle factors, obstetric characteristics and EDS scores were compared between the four cohorts.

RESULTS

From 1988 to 2014, Mean EDS scores during the first and third trimester of pregnancy increased significantly (P < 0.001). The number of women with elevated EDS scores doubled from 7% in 1988-1989 to 14% in 2012-2014 (P = 0.001). The number of highly educated women increased from 23% to 66% and those with paid employment from 75% to 95%, while smoking and alcohol use decreased significantly (all Ps < 0.001). These trends were similar to those of the National Statistics. A previous history of depression, multi-parity and paid employment were associated with higher EDS scores.

LIMITATIONS

Women were highly educated, predominantly Caucasian and had a partner.

CONCLUSIONS

Paradoxically, there was a significant increase in depressive symptomatology during pregnancy over a period of 25 years, while protective factors for depression during pregnancy improved. Potential explanations could be greater awareness, high societal expectations, use of social media or the stressful combination of paid work and children at home.

Effects of psychoeducation on the mental health and relationships of pregnant couples: A systemic review and meta-analysis

BACKGROUND

Previous studies suggest that psychoeducational interventions for pregnant and postpartum couples can improve perinatal mental health outcomes and promote couples' relationships. However, most studies conducted to date have focused only on maternal depression, with few studies addressing the needs of fathers, or the effects of paternal participation on the mental health/relationship of both partners.

OBJECTIVES

This study aimed to systematically examine the effects of perinatal couples' psychoeducation on parental mental health and their relationship.

DESIGN

A systematic review and meta-analysis were conducted.

DATA SOURCES

Six electronic databases were searched, including Embase, MEDLINE, Web of Science, the Cochrane Library, CINAHL, and PubMed.

REVIEW METHODS

The authors independently extracted data from journals written in English or Korean, published between January 2000 and August 2017. Randomized controlled trials (RCTs) that reported psycho-emotional symptoms and couples' relationship outcomes were screened. Of the 11 studies that systematically reviewed couples' mental health and relationship problems, seven RCTs, with data available to pool for quantitative analysis, were reviewed. The total number of participants from all studies was 7119, and the number of participant couples ranged from 15 to 869.

RESULTS

Psychoeducational interventions had a small effect size in promoting maternal mental health (SMD = -0.307; 95% CI: -0.47 to -0.14). However, there was evidence of heterogeneity for the overall outcome, with I² of 16% and p = .27. Paternal mental health also improved, but with a small effect size (SMD = -0.296; 95% CI: -0.53 to -0.05). The pooled results of four studies showed that interventions had very small effect sizes for improving maternal perception of the couple's relationship (SMD = 0.125; 95% CI: -0.05 to 0.30). There was evidence of heterogeneity for the overall outcome, with I² of 7% and p = .36. Psychoeducational interventions with fathers showed a medium effect size for improving paternal perception of the couple's relationship (SMD = 0.348; 95% CI: 0.16 to 0.52); heterogeneity was I² of 0% and p = .68.

CONCLUSION

This study was meaningful as it revealed evidence from published trials regarding the effectiveness of psychoeducational programs that target both pregnant women and their partners. Results indicate that psychoeducational interventions can reduce maternal postpartum depression and ameliorate paternal negative affect, as well as provide overall improvement in the couples' relationship satisfaction. However, further studies on physiological indicators and/or clinical symptoms of postpartum depression are needed to better understand the practical significance of psychoeducational intervention.

Depression and paternal adjustment and attitudes during the transition to parenthood

BACKGROUND

Depression symptoms may negatively affect the achievement of developmental tasks within the transition to parenthood, increasing the risk of paternal adjustment problems and negative paternal attitudes.

OBJECTIVE

This study analysed the effect of men's depression symptoms on paternal adjustment and paternal attitudes trajectories from the second trimester of pregnancy to six months postpartum.

METHODS

A sample of 127 men completed measures of depression symptoms and paternal adjustment and paternal attitudes at the second trimester of pregnancy and at six months postpartum.

RESULTS

From the second trimester of pregnancy to six months postpartum, men with more depression symptoms revealed a decrease on positive attitudes towards sex (while men with fewer depression symptoms revealed an increase), a steeper decrease in the satisfaction with marital relationship (than men with fewer depression symptoms), and a decrease in positive attitudes towards pregnancy and the baby (while men with fewer depression symptoms revealed an increase).

CONCLUSION

Depression symptoms early in pregnancy may represent a risk factor to increased paternal adjustment problems and negative paternal attitudes during the transition to parenthood.