Maladaptive personality styles in a clinical sample of women with postpartum depression

A systematic review of research examining mothers, infants, family and staff in psychiatric mother-baby units

OBJECTIVE

This systematic review aimed to summarise and synthesise research conducted in psychiatric mother-baby units (MBUs) in relation to patients, their families, or staff, published from 1st January 2016 to 1st May 2024.

METHOD

Quantitative, qualitative, and mixed-method studies were included for review if they were published in peer-review journals in English and reported research on MBUs between January 2016 and May 2024. From the initial yield of 10,007 unique studies, 53 studies were included for review.

RESULTS

MBU research was found to more frequently investigate maternal characteristics rather than the benefits of MBU treatment compared to studies conducted prior to 2016. Most studies that did investigate impact of admission showed favourable results, however few follow-up studies and studies comparing MBU outcomes to other clinical settings were undertaken. Little research has been conducted to investigate the differential impacts of MBU admission on different diagnoses and long-term (>1 year) patient outcomes. There was a dearth of research investigating partners of women in MBUs and few studies conducted on infant outcomes.

CONCLUSIONS

MBUs were consistently found to improve mental health systems and mother-infant attachment in patients after admission. More research investigating patient support networks and child health, impact of diagnosis on outcomes, and studies with adequate follow-up are required.

The interplay of personality pathology and treatment outcome in psychosomatic psychotherapy: A longitudinal analysis using latent change score modelling

INTRODUCTION

While ample data demonstrate the effectiveness of inpatient psychosomatic treatment, clinical observation and empirical evidence demonstrate that not all patients benefit equally from established therapeutic methods. Especially patients with a comorbid personality disorder often show reduced therapeutic success compared to other patient groups. Due to the heterogeneous and categorical personality assessment, previous studies indicated no uniform direction of this influence. This complicates the derivation of therapeutic recommendations for mental disorders with comorbid personality pathology.

METHODS

Analyzing n = 2094 patients from German university hospitals enrolled in the prospective "MEPP" study, we tested the dynamic interaction between dimensionally assessed personality functioning and psychopathology of anxiety and depression.

RESULTS

Longitudinal structural equation modelling replicated the finding that the severity of symptoms at admission predicts symptom improvement within the same symptom domain. In addition, we here report a significant coupling parameter between the baseline level of personality function and the change in general psychopathology - and vice versa.

DISCUSSION AND CONCLUSION

These results imply that personality pathology at admission hinders the therapeutic improvement in anxiety and depression, and that improvement of personality pathology is hindered by general psychopathology. Furthermore, the covariance between both domains supports the assumption that personality functioning and general psychopathology cannot be clearly distinguished and adversely influence each other. A dimensional assessment of the personality pathology is therefore recommendable for psychotherapy research and targeted therapeutic treatment.

The Management of Perinatal Borderline Personality Disorder

Borderline personality disorder (BPD) is highly prevalent in clinical perinatal mental health settings, although there are few systematic programmes to identify BPD at this time. Retrospective studies show compromised birth outcomes for women with this condition, and several authors have highlighted a significant range of problem outcomes for offspring identifiable from early infancy through the adult years, including the intergenerational transfer of mental health problems from mother to child. A literature review identifies the varying prevalence rates found in non-clinical and clinical settings and the paucity of published studies on the management of perinatal BPD, in particular focused both on the mother and mother-infant relationships. A case study is presented to show both the potential benefits of inpatient mother-baby unit protocols and of specialised longer-term group therapy. Many knowledge gaps can be identified for further clinical research that could potentially benefit families with perinatal BPD, including systematic identification of perinatal BPD and intensive programmes that not only could perhaps improve birth outcomes but also provide skills to mothers to help with their emotional regulation and potentially improve mother-infant relationships and longer-term offspring developmental pathways.

Reflective functioning and mother-infant relationships among mothers with Borderline Personality Disorder post-therapy

The stressful nature of parenting infants exacerbates the characteristics of Borderline Personality Disorder (BPD). Consequently, mothers with BPD tend to be emotionally dysregulated, respond impulsively to their infants, and have poorer mother-infant relationships. Few parenting interventions target the specific skill deficits observed in mothers with BPD. This study explored the differences in parental reflective functioning (PRF) and mother-infant relationship quality at baseline and following a 24-week, group parenting intervention for mothers with BPD. PRF and mother-infant relationship quality were assessed from quantitative (N = 23) and qualitative (N = 32) perspectives. Quantitative data (Parental Reflective Functioning Questionnaire) showed a significant improvement in one of the three subscales, Interest and Curiosity, between baseline and post-intervention, and a significant moderate positive association between the subscale Certainty of Mental States and maternal-infant interaction quality post-intervention. Improvements in mother-infant relationship quality were not evident from the observational measure, Nursing Child Assessment Satellite Teaching scale. In contrast, semi-structured interview qualitative data found maternal improvements in parental reflection, coping strategies implemented post-intervention, and quality of mother-infant relationships. Overwhelmingly positive intervention feedback suggested perceived maternal benefits of group format and skills taught. Future studies with larger sample sizes would allow further clarification of such parenting interventions for mothers with BPD.

Parenting styles and obsessive-compulsive symptoms in college students: the mediating role of perfectionism

Introduction

Obsessive-compulsive symptoms is a common psychological phenomenon among early adulthood college students, which are closely related to their parents' parenting styles. Theoretical and some empirical studies have suggested the mediating role of perfectionism in this process, but this has not been confirmed, and the binary perspective of positive-negative perfectionism has not been addressed in this issue.

Methods

This study aimed to investigate the mediating role of perfectionism in the relationship between parenting styles and obsessive-compulsive symptoms among college students. A total of 661 college students participated in this study.

Results

Negative perfectionism mediated the relationship between negative parenting style and obsessive-compulsive symptoms among college students. Negative parenting style predicted obsessive-compulsive symptoms through its positive predictive effect on negative perfectionism. However, the mediating effect of positive perfectionism was not significant in this process.

Discussion

This study provides further evidence of the mechanisms underlying the occurrence of obsessive-compulsive symptoms, and offers new ideas for interventions for OCD.

A Conceptual Analysis of Mental Health Maladaptation in Postpartum

Aim: This concept analysis aims to explore how the concept of maladaptation applies to mental health changes among postpartum women. Background: The concept of maladaptation is utilized throughout various disciplines but minimally in women's health, including a limited focus on maladaptive body dissatisfaction and perfectionistic beliefs of women in the postpartum period. Methods: The Walker and Avant eight-phase model was used to guide this analysis. Data Source: A search for maladaptation articles through Cumulative Index to Nursing and Allied Health Literature (CINAHL) Complete, ProQuest, and PubMed databases, as well as Google Scholar, was conducted. Results: A review of the literature concerning maladaptation in postpartum mental health resulted in defining two key attributes, including conforming to cultural norms of body image and pressure of perfection. In understanding maladaptation and its attributes, childbirth educators and health-care professionals will be able to better determine more contributing factors for postpartum depression (PPD) and formulate a plan that includes early intervention and support. Conclusion: This concept analysis is intended to improve maternal and neonatal health outcomes by understanding mental health maladaptations related to PPD.

Comorbid borderline personality disorders in women with post-partum depression admitted to mother-baby units

Borderline personality disorder (BPD) is associated with perinatal depression and parenting difficulties. However, little is known about the characteristics and specific effects of BPD in women with postpartum depression. This study aimed to explore 1) the sociodemographic, mental health characteristics, and motherhood difficulties in women with a major depressive postpartum episode (MDPE) and a comorbid diagnosis of BPD, compared to those with other personality disorders (other PD) or no PD and 2) whether BPD itself may be an independent risk factor for infant neglect in women with a MDPE. 412 women admitted to a Mother and Baby Unit (2001-2010) with a MDPE were involved in this study. Our study showed that women with MDPE-BPD (n = 64) more frequently reported a history of childhood maltreatment, single status, low social support, a history of depression, smoking during pregnancy and suicide attempt during the perinatal period compared to women with other PDs (n = 88) or no PD (n = 260). Women with comorbid BPD had a greater length of stay. Regarding infant care, neglect, abuse, and separation at discharge were more frequent in women with comorbid BPD. Logistic regression was performed to specifically examine whether BPD in women with a MDPE was an independent risk factor for infant neglect during the postpartum period. Comorbid BPD was independently associated with infant neglect (OR = 2.21; CI95% [1.02-4.81]). Our results underline the importance of screening for BPD in women with perinatal depression. Further studies are needed to explore the links between MDPE, BPD, and infant development.

Early Abusive Relationships-Influence of Different Maltreatment Types on Postpartum Psychopathology and Mother-Infant Bonding in a Clinical Sample

Postpartum psychopathology is a well-documented risk factor for impaired mother-infant bonding and thus child development. Increasingly, the focus of research in this area lies on maternal adverse childhood experiences that mothers bring into the relationship with their own baby, especially regarding the possible intergenerational transmission of traumatic experiences. Several studies showed that there is no direct link between child maltreatment and mother-infant bonding as one part of mother-child relationship, but that this link is mediated by postpartum psychopathology. To date, few studies examined differential effects between sexual, physical, and emotional abuse, and physical and emotional neglect, especially in a clinical sample. The aim of this study is to investigate whether the relationship between child maltreatment, psychopathology, and mother-infant bonding can be found for different forms of child maltreatment in patients of a mother-baby unit. Our sample consisted of 330 mothers of a mother-baby-unit in a psychosomatic clinic, who filled out self-report measures at time of admission. Mothers reported on maternal child maltreatment history with the Childhood Trauma Questionnaire, on current psychopathology with the Brief Symptom Inventory, and on mother-infant bonding with the Postpartum Bonding Questionnaire. Mediation analyses were performed with psychopathology as mediator, child maltreatment history as independent, and mother-infant bonding as dependent variable. There was no total effect of child maltreatment on mother-infant bonding. However, there were significant indirect effects of child maltreatment in general (ab = 0.09) and of the various forms of child maltreatment on mother-infant bonding via psychopathology (0.16 ≤ ab ≤ 0.34). The strongest effect was found for emotional abuse. After controlling for psychopathology, the direct effect of physical abuse on mother-infant bonding presented as a negative significant effect. This indicates that the more severe the physical abuse experienced, the better the self-reported bonding. A similar, but non-significant trend was found for sexual abuse. Our findings highlight the importance of assessing neglect forms of child maltreatment as well as abuse in women during the perinatal period. It further supports initial findings that different forms of child maltreatment can have differential effects on mother-infant bonding as one aspect of the mother-child relationship. Further research should include observational data to compare with self-report measures.

Mapping the Field in Stress, Anxiety, and Postpartum Depression in Mothers of Preterm Infants in Neonatal Intensive Care

Objective: The main aim of this study was to describe and conduct a bibliometric analysis of the state of research on stress, anxiety, and postpartum depression in mothers of preterm infants in the Neonatal Intensive Care Unit. Background: Women affected by premature births are particularly exposed to mental health difficulties in the postpartum period. The desire to comprehend and the growing interest in research on stress, anxiety, and postpartum depression in mothers of preterm infants in neonatal intensive care have led to a substantial rise in the number of documents in this field over the last years. Thus, it makes it vital to regularly review the state of knowledge on this phenomenon in order to identify progress and constraints, to stimulate reflection, and to encourage progress in future research. Method: This study examined 366 articles published in the Scopus database (1976–2020). Keyword analysis was also used to identify hot research trends to be developed in future studies. This study complies with the PRISMA-Scr guidelines for quality improvement research in the EQUATOR network. Results: Our results reveal that research in this field is in a period of high production and allows this flourishing body of work to be organized into different periods, highlighting the most important themes. In such a way, our research enriches the lively field by presenting a comprehensive understanding of the field. Discussion: The key contribution of this study is the development of a conceptual map of research on stress, anxiety, and postpartum depression in mothers of preterm infants in neonatal intensive care units.

[Improvement of Mental Health and Bonding in Women with Mental Disorders in the Postpartum Period - Evaluation of an Interaction-Centered Treatment of a Mother-Baby Day Clinic]

OBJECTIVE

Women with postpartum mental disorders often have a delayed bonding to their child with negative consequences for the child's development. In several countries it has been demonstrated that a specific mother-child treatment has positive effects on maternal psychopathology and mother-child bonding. Data for German-speaking countries are rare, partly due to the lack of adequately financed mother-baby units. The objectives of this study were to characterize the patients and to evaluate the treatment in a psychosomatic-psychotherapeutic mother-child day clinic.

METHODS

A total of 270 patients were examined at admission and discharge from the mother-child day clinic. The evaluation included main and secondary diagnoses according to ICD-10, duration of treatment, medication, information on the child, and psychometric questionnaires on maternal psychopathology, mother-child bonding, and parental sense of competence.

RESULTS

Of the women examined, 75% had more than one, on average 2.3 mental diagnoses. The most frequent main diagnoses were affective disorders (38.5%), neurotic, stress and somatoform disorders (30.7%) and personality and behavioral disorders (20.4%). About 56% reported impaired mother-child bonding. The average duration of therapy was 32 treatment days. Between admission and discharge, a highly significant improvement in symptoms was observed with a high effect size [F=288.557 (df=1), p<0.001, Eta²=0.549]. At discharge, 86.6% of patients showed no signs of mother-child bonding disorder.

DISCUSSION

The results indicate high potential effects of an interaction-centered treatment on maternal mental health and mother-child bonding.

CONCLUSIONS

The joint treatment of mother and child should be a fixed and financed component of the mental health system in order to prevent chronification and negative developmental consequences for the child.

Personality structure and attachment models of women who kill their children. A systematic review on maternal filicide

BACKGROUND

A mother's ability to attune with her child is crucial in structuring one's attachment style and personality. Both dimensions shape mother-child interactions, and they are therefore likely to impact on the risk of filicide. Numerous risk factors for filicide have been identified, but personality and attachment look relatively understudied.

OBJECTIVE

We focused on filicide mothers' personality and states of mind regarding attachment to shed new light on this phenomenon, for the purpose of an improved and earlier identification of at-risk maternities.

METHODS

A systematic review of five electronic databases was performed. All studies on filicide, infanticide or neonaticide were included in the search, regardless of the study design or the socio-demographic characteristics of the offenders.

RESULTS

Twelve original articles were found to be eligible for the systematic review. The data were categorized in personality and attachment related, and then by study design. Only two studies performed comparisons with control groups, and only three reported data about psychodiagnostic/neuropsychiatric tests or questionnaires. Personality diagnoses were strongly heterogeneous (mostly pertaining to cluster B and C), and not supported by statistically significant evidence. Attachment was examined by only one study, which showed that the most frequent states of mind regarding attachment were unresolved/unclassifiable (U/CC).

CONCLUSIONS

Despite their pivotal importance in determining relational patterns in an individual, both personality and attachment are almost unacknowledged across the literature about maternal filicide. It is thus advisable to further focus on them, carrying out structured and validated assessments, to better define the causes of this dramatic event.