Complex Mental Health Sequelae of Psychological Trauma Among Women in Prenatal Care

The Basics of Trauma-Informed Care in the NICU

This article will define the basics of trauma, adverse childhood event scoring, and social determinants of health and how they relate to the perinatal and NICU populations. It will then apply that foundation to identify and define a trauma-informed care approach to provide improved care to the families supported in the NICU.

Childhood abuse and perinatal outcomes for mother and child: A systematic review of the literature

Childhood abuse can have long-term adverse outcomes in adulthood. These outcomes may pose a particular threat to the health and well-being of perinatal women; however, to date, this body of knowledge has not been systematically collated and synthesized. This systematic review examined the child abuse literature and a broad range of perinatal outcomes using a comprehensive search strategy. The aim of this review was to provide a clearer understanding of the distinct effect of different abuse types and areas where there may be gaps in our knowledge. Following PRISMA guidelines, EBSCO, PsychInfo, Scopus, Medline, CINAHL, PubMed, and Google Scholar databases and gray literature including preprints, dissertations and theses were searched for literature where childhood abuse was associated with any adverse perinatal outcome between 1969 and 2022. Exclusion criteria included adolescent samples, abuse examined as a composite variable, editorials, letters to the editor, qualitative studies, reviews, meta-analyses, or book chapters. Using an assessment tool, two reviewers extracted and assessed the methodological quality and risk of bias of each study. From an initial 12,384 articles, 95 studies were selected, and the outcomes were categorized as pregnancy, childbirth, postnatal for the mother, and perinatal for mother and child. The prevalence of childhood abuse ranged from 5-25% with wide variability (physical 2-78%, sexual 2-47%, and emotional/psychological 2-69%). Despite some consistent findings relating to psychological outcomes (i.e., depression and PTSD), most evidence was inconclusive, effect sizes were small, or the findings based on a limited number of studies. Inconsistencies in findings stem from small sample sizes and differing methodologies, and their diversity meant studies were not suitable for a meta-analysis. Research implication include the need for more rigorous methodology and research in countries where the prevalence of abuse may be high. Policy implications include the need for trauma-informed care with the Multi-level Determinants of Perinatal Wellbeing for Child Abuse Survivors model a useful framework. This review highlights the possible impacts of childhood abuse on perinatal women and their offspring and areas of further investigation. This review was registered with PROSPERO in 2021 and funded by an internal grant from Charles Sturt University.

Trauma History Questionnaire: validation with novel samples of incarcerated women and perinatal women

Trauma exposure is associated with numerous negative outcomes, many of which are amplified within at-risk populations. Two under-researched and at-risk populations, incarcerated women and perinatal women, both report high rates of trauma, psychopathology, and PTSD compared to the general population. One common measure of trauma exposure in various populations, including incarcerated women and perinatal women, is the Trauma History Questionnaire (THQ). However, no known studies have validated the THQ within these two unique, understudied populations. Using data from two studies of incarcerated women and one study of perinatal women, researchers explored indices of THQ construct, predictive, and convergent validity. The study also included between-sample comparisons, highlighting differences in trauma incidence between the included samples. Analyses supported statistically significant relations between THQ scores and Severity of Violence Against Women Scale (SVAWS), depressive symptoms, PTSD, and psychological distress. Prenatal women's THQ scores were also predictive of later postpartum depressive symptoms. Significantly higher THQ scores were found within the incarcerated samples compared to the perinatal sample. The study results provide further information about trauma within incarcerated and perinatal populations, as well as increase understanding of the utility of trauma assessments within these vulnerable groups.

Women's experiences of trauma, the psychosocial impact and health service needs during the perinatal period

BACKGROUND

Traumatic events are associated with psychological and physical health problems for women in the perinatal period (i.e., pregnancy-12-months after childbirth). Despite the negative impact of trauma on perinatal women, the long-term impact of such diverse trauma and women's experience during the perinatal period remains understudied.

METHODS

This study explored two research questions: 1) What are the psychological experiences of perinatal women who have experienced interpersonal traumatic events? And 2) What are the service needs and gaps expressed by women relating to perinatal medical protocols and psychological services? These questions were addressed via in-depth semi-structured qualitative interviews with nine perinatal women (one pregnant and eight postpartum) residing in central Canada who reported experiencing interpersonal traumatic events occurring from adolescence to the perinatal period. Recruitment and data collection occurred from October 2020 to June 2021. Interviews were audio-recorded, transcribed, and analyzed according to constructivist grounded theory.

RESULTS

The emergent grounded theory model revealed the central theme of the role of prior trauma in shaping women's perinatal experiences, with four related main themes including perinatal experiences during the COVID-19 pandemic, the role of social support in women's perinatal experiences, the barriers that women experienced while seeking psychological and medical services prior to the perinatal period and during the perinatal period, and the specific needs of perinatal women with a history of interpersonal trauma.

CONCLUSIONS

Findings of this research highlight the negative and long-lasting impact of traumatic events experienced on women's psychological health and psychosocial functioning during the perinatal period, as well as perinatal women's unmet psychological and medical service needs. A call to action for perinatal researchers and clinicians is imperative in furthering this important area of research and practicing person-centered and trauma-informed care with this population.

Views from women and maternity care professionals on routine discussion of previous trauma in the perinatal period: A qualitative evidence synthesis

BACKGROUND

Over a third of pregnant women (around 250,000) each year in the United Kingdom have experienced trauma such as domestic abuse, childhood trauma or sexual assault. These experiences can have a long-term impact on women's mental and physical health. This global qualitative evidence synthesis explores the views of women and maternity care professionals on routine discussion of previous trauma in the perinatal period.

METHODS

Systematic database searches (MEDLINE, EMBASE, CINAHL Plus, APA PsycINFO and Global Index Medicus) were conducted in July 2021 and updated in April 2022. The quality of each study was assessed using the Critical Appraisal Skills Programme. We thematically synthesised the data and assessed confidence in findings using GRADE-CERQual.

RESULTS

We included 25 papers, from five countries, published between 2001 and 2022. All the studies were conducted in high-income countries; therefore findings cannot be applied to low- or middle-income countries. Confidence in most of the review findings was moderate or high. The findings are presented in six themes. These themes described how women and clinicians felt trauma discussions were valuable and worthwhile, provided there was adequate time and appropriate referral pathways. However, women often found being asked about previous trauma to be unexpected and intrusive, and women with limited English faced additional challenges. Many pregnant women were unaware of the extent of the trauma they have suffered, or its impact on their lives. Before disclosing trauma, women needed to have a trusting relationship with a clinician; even so, some women chose not to share their histories. Hearing trauma disclosures could be distressing for clinicians.

CONCLUSION

Discussions of previous trauma should be undertaken when women want to have the discussion, when there is time to understand and respond to the needs and concerns of each individual, and when there are effective resources available for follow up if needed. Continuity of carer should be considered a key feature of routine trauma discussion, as many women will not disclose their histories to a stranger. All women should be provided with information about the impact of trauma and how to independently access support in the event of non-disclosures. Care providers need support to carry out these discussions.

Perinatal (Re)experiencing of Post-Traumatic Stress Disorder Symptoms for Survivors of Childhood Sexual Abuse: An Integrative Review

This integrative review aimed to synthesize both qualitative and quantitative research on the (re)experiencing of post-traumatic stress disorder (PTSD) symptoms during the perinatal period for childhood sexual abuse (CSA) survivors. Whittemore and Knafl's framework, which includes problem identification, literature review, data evaluation, data analysis, and results dissemination, was used. A search in four databases (i.e., PsycINFO, MEDLINE, Scopus, and ProQuest Dissertations and Thesis Global) yielded an initial sample of 3420 articles. After screening and deduplication, 16 articles met our inclusion criteria (i.e., history of CSA, minimum 8 weeks pregnant, reported quantitative statistics or qualitative findings, discussed PTSD symptoms) and were retained in the final sample. CSA survivors (re)experienced PTSD symptoms as a result of (1) aspects of their medical care (vaginal examinations, male medical providers, lack of control, and restraint), (2) physical sensations during pregnancy, childbirth, and breastfeeding, and (3) sex of the child (worries over child becoming an abuser/abused, male genitalia). CSA survivor's PTSD symptoms of intrusion, dissociation, avoidance, and hyperarousal were significantly greater throughout the perinatal period compared with individuals without CSA or with other traumas. CSA survivors are at increased risk of (re)experiencing PTSD symptoms throughout the perinatal period, which may be due to several internal and external triggers. Further research is needed to understand external triggers outside of medical care, and how the unique context of pregnancy may differ from other life contexts for survivors of CSA. Findings point to the relevance of adopting trauma-informed practices with CSA survivors during their perinatal period.

Cumulative childhood trauma and complex psychiatric symptoms in pregnant women and expecting men

BACKGROUND

Women and men having been exposed to childhood trauma would be at high risk of various mental health symptoms while awaiting a child. This study aimed to evaluate the association between cumulative childhood trauma and the accumulation of symptoms belonging to different psychiatric problems in pregnant women and expecting men.

METHODS

We first examined prevalence rates of childhood trauma across our samples of 2853 pregnant women and 561 expecting men from the community. Second, we evaluated the association between cumulative childhood trauma and symptom complexity (i.e., the simultaneous presentation of symptoms belonging to multiple psychiatric problems) using subsamples of 1779 pregnant women and 118 expecting men. Participants completed self-reported measures of trauma (Childhood Trauma Questionnaire) and psychiatric symptoms (PTSD Checklist for DSM-5; Kessler Psychological Distress Scale; State-Trait Anger Expression Inventory-2; Self and Interpersonal Functioning Scale).

RESULTS

Trauma was more frequent in pregnant women than in expecting men and in participants reporting sociodemographic risk factors than in those not reporting any. A dose-response relationship was observed between the number of different traumas reported by pregnant women and expecting men and the complexity of their psychiatric symptoms, even when controlling for the variance explained by other risk factors. Women having been exposed to cumulative childhood trauma were 4.95 times more at risk of presenting comorbid psychiatric problems during pregnancy than non-exposed women.

CONCLUSIONS

Childhood trauma is frequent in the general population of pregnant women and expecting men and is associated with symptom complexity during the antenatal period. These findings call for delivering and evaluating innovative trauma-informed antenatal programs to support mental health and adaptation to parenthood in adults having been exposed to childhood trauma.

Prospective Associations of Lifetime Post-traumatic Stress Disorder and Birth-Related Traumatization With Maternal and Infant Outcomes

OBJECTIVE

Many women experience traumatic events already prior to or during pregnancy, and delivery of a child may also be perceived as a traumatic event, especially in women with prior post-traumatic stress disorder (PTSD). Birth-related PTSD might be unique in several ways, and it seems important to distinguish between lifetime PTSD and birth-related traumatization in order to examine specific consequences for mother and child. This post-hoc analysis aims to prospectively examine the relation of both, lifetime PTSD (with/without interpersonal trauma) and birth-related traumatization (with/without postpartum depression) with specific maternal and infant outcomes.

METHODS

In the prospective-longitudinal Maternal in Relation to Infants' Development (MARI) study, N = 306 women were repeatedly assessed across the peripartum period. Maternal lifetime PTSD and birth-related traumatization were assessed with the Composite International Diagnostic Interview for women. Maternal health during the peripartum period (incl. birth experience, breastfeeding, anxiety, and depression) and infant outcomes (e.g., gestational age, birth weight, neuropsychological development, and regulatory disorders) were assessed via standardized diagnostic interviews, questionnaires, medical records, and standardized observations.

RESULTS

A history of lifetime PTSD prior to or during pregnancy was reported by 25 women who indicated a less favorable psycho-social situation (lower educational level, less social support, a higher rate of nicotine consumption during pregnancy). Lifetime PTSD was associated with pregnancy-related anxieties, traumatic birth experience, and anxiety and depressive disorders after delivery (and in case of interpersonal trauma additionally associated with infant feeding disorder). Compared to the reference group, women with birth-related traumatization (N = 35) indicated numerous adverse maternal and infant outcomes (e.g., child-related fears, sexual problems, impaired bonding). Birth-related traumatization and postpartum depression was additionally associated with infant feeding and sleeping problems.

CONCLUSION

Findings suggest that both lifetime PTSD and birth-related traumatization are important for maternal and infant health outcomes across the peripartum period. Larger prospective studies are warranted.

IMPLICATIONS

Women with lifetime PTSD and/or birth related traumatization should be closely monitored and supported. They may benefit from early targeted interventions to prevent traumatic birth experience, an escalation of psychopathology during the peripartum period, and adverse infant outcomes, which in turn may prevent transgenerational transmission of trauma in the long term.

Alcohol and other substance use disorder recovery during pregnancy among patients with posttraumatic stress disorder symptoms: A qualitative study

Background

About 5% of women are pregnant at substance use disorder (SUD) treatment entry, and pregnant women with SUD often belong to marginalized groups experiencing social, economic, and health care barriers associated with stigma from prenatal substance use. Pregnant women in SUD treatment have high rates of trauma and posttraumatic stress disorder (PTSD). This study sought to (1) examine the lived experiences of pregnant individuals with PTSD symptoms in SUD treatment and (2) understand the roles of systematic or contextual barriers to the pursuit of prenatal abstinence.

Methods

We draw upon in-depth semi-structured interviews to examine relationships between SUD, psychological trauma/PTSD experience, social resources, and lived experiences among patients in prenatal SUD treatment with PTSD symptoms. Our sample was pregnant patients (N = 13) with prior DSM-5 Criterion A trauma and current PTSD symptoms enrolled in a comprehensive program integrating prenatal care, substance use counseling, medication for opioid use disorder and case management at three sites affiliated with an urban academic medical center in New Mexico.

Results

Using thematic analysis, four main themes identified structural forces influencing alcohol and drug use: (a) lack of access or ability to obtain resources, (b) substance use to cope with negative affect, (c) social stigma, and (d) interpersonal relationships.

Conclusions

Despite receiving high-quality integrated prenatal and SUD care, these pregnant patients with PTSD symptoms in SUD treatment still experienced substantial social and structural hurdles to achieving abstinence during pregnancy.

'We experienced lack of understanding in the healthcare system'. Experiences of childhood sexual abuse survivors of the childbearing process, health and motherhood

BACKGROUND

Childhood sexual abuse (CSA) has widespread and long-lasting impact on women's lives and health. Increased knowledge and deeper understanding are needed of survivors' experiences of the childbearing process, health and motherhood.

METHODS

In this phenomenological study, 16 in-depth interviews were conducted with nine female CSA survivors. The interviews were recorded, transcribed verbatim and thematically analysed.

RESULTS

The overarching theme of the study is: 'more understanding is needed', which refers to the participants' experience that greater understanding is needed from health professionals of the long-term effects of CSA on childbearing women. Most of the women had suffered from poor health, especially chronic pain associated with fibromyalgia and gynaecological diseases. All of them had suffered mental health consequences particularly anxiety, depression and PTSD. The majority had experienced flashbacks to the violence and disassociation. Many had experienced miscarriages, had deviations from normal pregnancies and births, such as prolonged labour, caesarean sections, induction of labour, vacuum extraction, bleeding and exaggerated pregnancy problems, such as great nausea and pelvic pain. All but one had a negative experience in one of their births. All of them had experienced a lack of understanding in the healthcare system, perceived abuse of power and felt vulnerable in those situations. All of them had a strong need for a sense of control and participation in decision-making in the childbearing process. Most of them had experienced problems in bonding with their children and some have had difficulties touching them. All of them were in dire need of protecting their children from potential violence and many expressed a tendency to overprotect them.

CONCLUSIONS

Healthcare professionals need to have more knowledge and greater understanding of how healthcare services can be improved so that CSA survivors can have a better experience of the childbearing process.

H2S and Oxytocin Systems in Early Life Stress and Cardiovascular Disease

Today it is well established that early life stress leads to cardiovascular programming that manifests in cardiovascular disease, but the mechanisms by which this occurs, are not fully understood. This perspective review examines the relevant literature that implicates the dysregulation of the gasomediator hydrogen sulfide and the neuroendocrine oxytocin systems in heart disease and their putative mechanistic role in the early life stress developmental origins of cardiovascular disease. Furthermore, interesting hints towards the mutual interaction of the hydrogen sulfide and OT systems are identified, especially with regards to the connection between the central nervous and the cardiovascular system, which support the role of the vagus nerve as a communication link between the brain and the heart in stress-mediated cardiovascular disease.

Decreased Plasma Oxytocin Levels in Patients With PTSD

Introduction

Although the pathophysiology of post-traumatic stress disorder (PTSD) is still unclear, growing preclinical evidences suggest that oxytocin (OT), a pleiotropic hormone, is possibly involved. However, direct studies on OT levels or clinical trials with this exogenous hormone in patients with PTSD led to inconsistent findings. Therefore, the aim of the present study was at exploring and comparing the plasma OT levels in a group of patients with PTSD and matched healthy subjects as the control group.

Materials and Methods

Twenty-six outpatients (13 men, 13 women, mean age: 40.3 ± 11.5 years) suffering from PTSD, according to the Diagnostic and Statistical Manual for Mental Disorders, fifth edition (DSM-5), and 26 healthy subjects (13 men, 13 women, mean age: 43.8 ± 12.7 years) were included. The patients were assessed through the structured clinical interview for DSM-5 research version, patient edition (SCID-I/P), and the Impact for Event Scale revised (IES-R). All fasting subjects underwent three venous blood samples for the subsequent oxytocin radioimmunoassay. We used unpaired Student’s t-test to assess OT levels and the intergroup difference of demographic characteristics, while anxiety, avoidance, and hyperarousal scores were compared among groups adjusting for the effect of gender and age by means of analysis of covariance (ANCOVA). The correlations between different variables were investigated by Pearson’s method.

Results

The most common traumatic events of patients with PTSD were the following: severe car accident, physical violence, sexual violence, sudden death of a loved one, and natural disaster. The IES total score was 55 ± 15. Student’s t-test revealed that the patients showed significantly lower OT levels (mean ± SD, pg/ml) than healthy control subjects (4.37 ± 1.61 vs 5.64 ± 2.17, p < 0.001). We detected no correlation between the IES total score, subscales, or single items and OT plasma levels. Again, no difference between men and women was detected in the patients’ group, while healthy control women showed higher OT levels than men.

Discussion

Our study, while reporting the presence of decreased plasma OT levels in outpatients with PTSD of both sexes, as compared with healthy control subjects, would support the possible involvement of OT in the pathophysiology of PTSD. However, given the complexity of the clinical picture, future investigations are necessary to better deepen the role and level of OT in PTSD.

Child Sexual Abuse and Pregnancy: A Systematic Review of the Literature

BACKGROUND

Child sexual abuse is related to many negative outcomes but less known is the effect on pregnancy and childbirth.

OBJECTIVE

This review critically examined the literature on the occurrence of child sexual abuse and outcomes associated with this abuse during pregnancy and childbirth.

METHODS

Five databases were searched over 50 years using an iterative approach and the terms pregnancy, sexual abuse/assault, childbirth/labour, identifying 49 studies.

RESULTS

The prevalence of child sexual abuse in pregnant women ranged from 2.63% to 37.25 with certain characteristics more common with a higher (e.g., specific questions, low income) or lower (broad questions, higher education) prevalence. Compared to women with no history of abuse, child sexual abuse survivors may have more concerns with their care, greater health complaints, fear childbirth and have difficulties with delivery. They also had a higher likelihood of PTSD symptomology and anxiety, consumed more harmful substances (e.g., alcohol, cigarettes, and drugs) and had greater concerns with their appearance, poorer health, sleep and may also have a higher risk of re-victimisation.

CONCLUSIONS

The balance of evidence suggests that compared to non-abused women, women with a child abuse history have more adverse experiences with pregnancy, childbirth, and care, with their abuse history, likely contributes to harmful behaviours and psychopathology. However, variability in operationalisation and measurement of abuse may contribute to these findings so tentative conclusions are drawn. Future research should examine the generalisability of the findings (relating to scale limitations) and recommendations for screening (e.g., sensitive items, scoring). Clinical implications of the findings point to the need for early identification of women with a child abuse history as such women require trauma-sensitive care and consideration. A useful tool is the Pregnancy-related Anxiety Scale which provides insights into specific areas of concern.

Maternal substance use in pregnancy: Differential prediction by childhood adversity subtypes

Substance use in pregnancy, including alcohol use, drug use, or smoking, is associated with poor health outcomes for both the mother and her unborn child. Building on previous research that has examined the cumulative impact of Adverse Childhood Experiences (ACEs) on maternal binge drinking and alcohol use in pregnancy, the current study sought to examine the association between maternal ACEs and substance use in pregnancy more broadly, including alcohol use, binge drinking, smoking, and drug use. Furthermore, we also examined how different adversity subtypes, including sexual abuse, family violence (physical abuse, emotional abuse), and household dysfunction, differentially predict maternal substance use behavior. A sample of 1994 women were recruited between 2008 and 2011 from a community-based pregnancy cohort in Calgary, Canada. Self-reported information on exposure to ACEs prior to the age of 18 years and maternal substance usewere collected. Examining ACE subtypes, medium effects were observed for the role of household-dysfunction on binge drinking, drug use, and smoking in pregnancy, while only small effects were observed for family violence on binge drinking, drug use, and smoking. There were no significant effects for sexual abuse after controlling for covariates. A dose-response association between the number of ACEs and substance use in pregnancy was also demonstrated. Increased support prior to, and in pregnancy, particularly for women with a history of childhood adversity, is needed to reduce substance use behaviors in pregnancy.

Anxiety, Depression, and Trauma Among Immigrant Mexican Women up to Two-Years Post-partum

Anxiety has significant consequences for maternal and infant health, and Mexican immigrant mothers are at significantly high-risk. This study examined whether maternal depressive symptoms and trauma are related to anxiety symptoms in perinatal Mexican immigrants. Data were collected from 103 Mexican women residing in the Midwestern United States who were pregnant or up to two years postpartum. Half were aged 30-34. The majority had two or more children and low socio-economic status. Linear regression analyses predicted current anxiety symptoms from current maternal depression symptoms, trauma history, and socio-demographics. Anxiety symptoms were significantly related to depressive symptoms (B = 0.87, 95% CI   0.73, 1.01) and trauma. Compared to women with no trauma history, women who experienced more than ten traumas had increased anxiety symptoms (B = 7.15, 95% CI 0.34, 13.96). Perinatal Mexican women with higher depression symptoms and trauma have increased anxiety symptoms, increasing the need for more comprehensive screening.

Psychological aspects of gestational cancer: A systematic review

OBJECTIVE

Gestational cancer is defined as any type of cancer diagnosed during pregnancy or within 12 months of delivery. To date, existing studies on the psychological aspects of this type of cancer have not been evaluated for methodological quality. The aim of this systematic review was to identify the psychological aspects of gestational cancer.

METHODS

Five journal databases were searched to identify peer-reviewed articles reporting upon the psychological aspects of women with gestational cancer. Studies published from journal inception to December 2019 were included, and Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. The Mixed-Method Appraisal Bias Tool was used, to assess the methodological quality of the studies. A narrative description was developed for the psychological outcomes reported in quantitative studies. Qualitative data was synthesized using thematic analysis.

RESULTS

Five papers were eligible for inclusion (two qualitative and three quantitative studies). Factors that contributed to women's psychological distress during gestational cancer included disease characteristics, sociodemographic factors, the baby's health, pregnancy-related factors and cognitive emotion regulation. Four main themes emerged from the qualitative studies; concerns about the baby's health, lost opportunities, "not fitting in," and healthcare decision-making.

CONCLUSIONS

These findings suggest that (a) women with gestational cancer experience psychological distress that is associated with concerns about their babies' health, and (b) their healthcare experiences are affected by communication within multidisciplinary care teams.

A mother's bond: An ecological momentary assessment study of posttraumatic stress disorder symptoms and substance craving during pregnancy

Pregnant women with substance use disorder (SUD) comprise an underserved population with complex treatment needs, including complications from trauma histories and comorbid psychological disorders. Using ecological momentary assessment, we examined momentary fluctuations in posttraumatic stress disorder (PTSD) symptoms, prenatal bonding, and substance craving, among pregnant women in SUD treatment who had a history of trauma. We hypothesized that (a) PTSD symptoms and prenatal bonding would each be associated with substance craving and (b) PTSD symptoms would be negatively associated with prenatal bonding, and this would at least partially account for the association between PTSD symptoms and substance craving (i.e., indirect effect). Participants (n = 32) were on average 27.1 weeks pregnant (SD = 5.27), 27.8 years old (SD = 4.54), and predominantly Hispanic/Latina (66%). At the within subjects level, higher momentary ratings of PTSD symptoms were associated with lower quality (but not intensity of preoccupation) of prenatal bonding, which in turn was associated with greater craving. Lower quality of prenatal bonding partially mediated the positive association between PTSD symptoms and craving, which remained strong after accounting for prenatal bonding. Our results provide some preliminary support for considering interventions aimed at stabilizing or decreasing PTSD symptoms and stabilizing or increasing prenatal bonding to reduce substance craving and, thus, the risk of perinatal substance use among women with SUD and trauma histories. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

The effectiveness of Nurture and Play: a mentalisation-based parenting group intervention for prenatally depressed mothers

AIM

This randomised control trial (RCT) study examined the effectiveness of a mentalisation-based perinatal group intervention, Nurture and Play (NaP), in improving mother-infant interaction quality and maternal reflective functioning and in decreasing depressive symptoms.

BACKGROUND

Few preventive prenatal interventions have been developed for primary health care settings for mothers with depressive symptoms. Furthermore, previous prenatal intervention studies have only concentrated on reducing depressive symptoms and have not directly addressed enhancing optimal parenting qualities.

METHODS

The participants were 45 pregnant women with depressive symptoms. Women in the randomly assigned intervention group (n = 24) participated in the manualised, short-term NaP intervention group from pregnancy until the baby's age of seven months, whereas control group women received treatment as usual (TAU). Maternal emotional availability (EA), reflective functioning (RF) and depressive symptoms were measured before the intervention and at the infants' 12 months of age, and changes were evaluated using repeated measure analyses of variances (ANOVAs).

FINDINGS

The results showed that the intervention group displayed higher maternal sensitivity and RF and more reduction in depressive symptoms than the control group when babies were 12 months old. These findings provide preliminary support for the effectiveness of the NaP intervention.

Sluggish cognitive tempo and exposure to interpersonal trauma in children

Background: Childhood adversity has been suggested, but not yet empirically examined, as a factor in sluggish cognitive tempo (SCT) in childhood.Objective: This study was an examination of SCT in relation to childhood adversity, and its association with exposure to non-interpersonal and interpersonal trauma.Method: Caregivers (N = 161) and a sub-sample of children, 8-17 years old, were recruited from mental health and pediatric practices/programs and interviewed.Results: SCT was positively associated with interpersonal trauma but not non-interpersonal trauma. Two hierarchical regression analyses revealed that interpersonal trauma exposure was associated with SCT score over and above symptoms of other psychopathologies.Conclusion: Results suggest that SCT is associated with interpersonal trauma exposure in children. Further research is needed to examine the association between SCT and interpersonal trauma exposure, and trauma-related biopsychosocial impairments.

Trauma, psychiatric disorders, and treatment history among pregnant African American women

OBJECTIVE

Pregnant African American women living in low-income urban communities have high rates of trauma exposure and elevated risk for the development of trauma-related disorders, including posttraumatic stress disorder (PTSD) and depression. Yet, engagement in behavioral health services is lower for African American women than Caucasian women. Limited attention has been given to identifying trauma exposure and PTSD, especially within at-risk communities. The present study examined rates of trauma exposure, PTSD, depression, and behavioral health treatment engagement in an obstetrics/gynecology (OB/GYN) clinic within an urban hospital.

METHOD

The study included 633 pregnant African American women screened within the OB/GYN clinic waiting room; 55 of the women also participated in a subsequent detailed clinical assessment based on eligibility for a separate study of intergenerational risk for trauma and PTSD in African American mother-child dyads.

RESULTS

Overall, 98% reported trauma exposure, approximately one third met criteria for probable current PTSD, and one third endorsed moderate-or-severe depression based on self-report measures. Similar levels were found based on clinical assessments in the subsample. While 18% endorsed depression treatment, only 6% received treatment for PTSD. In a subsample of women with whom chart reviews were conducted (n = 358), 15% endorsed a past psychiatric diagnosis but none shared their PTSD diagnosis with their OB/GYN provider.

CONCLUSION

Results of the current study highlight elevated levels of trauma exposure, PTSD, and depression in low-income, African American pregnant women served by this urban clinic, and demonstrate the need for better identification of trauma-related disorders and appropriate linkage to culturally responsive care especially for PTSD. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Preliminary psychometrics of the Structured Trauma-Related Experiences and Symptoms Screener for Adults (STRESS-A) in an urban prenatal healthcare clinic

OBJECTIVE

The primary objective of the current study was to examine preliminary psychometric characteristics of the Structured Trauma-Related Experiences and Symptoms Screener for Adults (STRESS-A), a novel self-report instrument that inventories childhood and adulthood trauma-related experiences and assesses symptoms of posttraumatic stress disorder (PTSD) according to the Diagnostic and Statistical Manual for Mental Disorders (5th ed.; [DSM-5] American Psychiatric Association, 2013). Designed for efficient administration and interpretation by nonclinically trained professionals, the STRESS-A is a promising tool for use in settings where mental health professionals are lacking.

METHOD

A sample of 170 women in their third trimester of pregnancy and receiving services at an urban prenatal health care clinic completed the STRESS-A and a battery of instruments measuring mental health functioning, perceived stress, and emotion dysregulation. Tests of reliability and validity were conducted, including confirmatory factor analysis to examine the fit of STRESS-A symptom criteria relative to PTSD symptom structures supported in the literature.

RESULTS

Results provide initial support for internal consistency, reliability, and convergent and construct validity in a largely Hispanic pregnancy sample. The STRESS-A symptom structure fit well with several that have been supported in the literature, including the 4-factor model of the DSM-5.

CONCLUSION

The STRESS-A is a promising tool for assessing risk associated with trauma exposure and probable DSM-5-based PTSD. Findings support its utility in a high-risk pregnancy cohort, a population that is underserved, yet shows high rates of trauma exposure and associated symptoms. Addressing maternal trauma-related impairment may have important implications for healthy fetal and child development. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Biological and psychosocial predictors of anxiety worsening in the postpartum period: A longitudinal study

BACKGROUND

As many as 20% of women will experience an anxiety disorder during the perinatal period. Women with pre-existing anxiety disorders are at increased risk of worsening during this time, yet little is known about its predictors.

STUDY AIM

To investigate the psychosocial and biological risk factors for anxiety worsening in the postpartum in women with pre-existing anxiety disorders.

METHODS

Thirty-five (n = 35) pregnant women with pre-existing DSM-5 anxiety disorders were enrolled in this prospective study investigating the psychosocial (e.g., childhood trauma, intolerance of uncertainty, depression) and biological risk factors (e.g. C-reactive protein, interleukin-6, tumor necrosis factor-α) for anxiety worsening in the postpartum period. Anxiety worsening was defined as an increase of ≥50% or greater on Hamilton Anxiety Rating Scale scores from the third trimester of pregnancy (32.94 ± 3.35 weeks) to six weeks postpartum.

RESULTS

Intolerance of uncertainty, depressive symptom severity, and obsessive-compulsive disorder symptoms present in pregnancy were significant predictors of anxiety worsening in the postpartum.

LIMITATIONS

Sample heterogeneity and limited sample size may affect study generalizability.

CONCLUSIONS

To our knowledge, this is the first longitudinal study to investigate psychosocial and biological risk factors for anxiety worsening in the postpartum in women with pre-existing anxiety disorders. Continued research investigating these risk factors is needed to elucidate whether they differ from women experiencing new-onset anxiety disorders in the perinatal period, and those in non-puerperal groups. Identifying these risk factors can guide the development of screening measures for early and accurate symptom detection. This can lead to the implementation of appropriate interventions aimed at decreasing the risk of perinatal anxiety worsening.

An ecological momentary assessment study examining posttraumatic stress disorder symptoms, prenatal bonding, and substance use among pregnant women

BACKGROUND

Substance use disorder (SUD) during pregnancy requires efficacious interventions based on understanding the ebb and flow of risk and protective factors for substance use across time. To assess how these fluctuations are associated temporally with substance use, we used ecological momentary assessment (EMA) to evaluate substance use risk (posttraumatic stress disorder [PTSD] symptoms) and protective (prenatal fetal bonding) factors and their associations with prenatal substance use recorded in real time.

METHODS

Pregnant women in SUD treatment (N = 33) with prior trauma exposure received smartphones with an EMA application that queried them thrice daily for 28 days about PTSD symptoms, prenatal bonding, and substance use.

RESULTS

Nearly all (N = 32) provided EMA data resulting in 2049 EMA reports (74% compliance). Most participants reported tobacco (72%), alcohol (22%), heroin (41%), and/or other illicit drug (6%-31%) use at least once via EMA. There were moderate associations (average β = 0.23) between greater daily peak PTSD symptoms and substance use with significant effects on illicit drug (β = 0.37), cannabis (β = 0.35) and cigarette use (β = 0.24). Prenatal bonding subscales were modestly associated with substance use, with daily intensity of attachment low point associated with lower heroin (β=-0.34), but higher alcohol (β = 0.24) use. Quality of attachment low point was associated with higher cigarette use (β = 0.06).

CONCLUSIONS

Despite the SUD severity and social instability of this sample, we observed high rates of compliance. We found preliminary support suggesting daily PTSD symptoms as a risk factor and less consistent support for prenatal bonding as a protective factor for prenatal substance use.

Correlates of Perinatal Post-Traumatic Stress among Culturally Diverse Women with Depressive Symptomatology

Post-traumatic stress disorder (PTSD) is an important and often neglected comorbidity of pregnancy; left untreated, it can lead to serious health complications for the mother and developing fetus. Structured interviews were conducted to identify risk factors of PTSD among culturally diverse women with depressive symptomatology receiving perinatal services at community obstetric/gynecologic clinics. Women abused as adults, with two or more instances of trauma, greater trauma severity, insomnia, and low social support were more likely to present perinatal PTSD symptoms. Perinatal PTSD is prevalent and has the potential for chronicity. It is imperative healthcare providers recognize salient risk factors and integrate culturally sensitive screening, appropriate referral, and treatment services for perinatal PTSD.

When Nowhere Is Safe: Interpersonal Trauma and Attachment Adversity as Antecedents of Posttraumatic Stress Disorder and Developmental Trauma Disorder

Developmental trauma disorder (DTD) has been proposed as clinical framework for the sequelae of complex trauma exposure in children. In this study, we investigated whether DTD is associated with different traumatic antecedents than posttraumatic stress disorder (PTSD). In a multisite sample of 236 children referred from pediatric or mental health treatment, DTD was assessed using the DTD Structured Interview. Trauma history was assessed using the Traumatic Events Screening Instrument (TESI). On an unadjusted basis, both DTD, odds ratios (ORs) = 2.0-3.8, 95% CI [1.17, 7.19]; and PTSD, ORs = 1.8-3.0, 95% CI [1.04, 6.27], were associated with past physical assault and/or abuse, family violence, emotional abuse, neglect, and impaired caregivers; and DTD was associated community violence, OR = 2.7, 95% CI [1.35, 5.43]. On a multivariate basis after controlling for the effects of PTSD, DTD was associated with family and community violence and impaired caregivers, ORs = 2.0-2.5, 95% CI [1.09, 5.97], whereas PTSD was only associated with physical assault and/or abuse after controlling for the effects of DTD, OR = 2.4, 95% CI [1.07, 4.99]. Exposure to both interpersonal trauma and attachment adversity was associated with the highest DTD symptom count, controlling for the PTSD symptom count. Although childhood PTSD and DTD share several traumatic antecedents, DTD may be uniquely associated with pervasive exposure to violent environments and impaired caregiving. Therefore, DTD warrants further investigation as a framework for the assessment and treatment of children with histories of interpersonal victimization and attachment adversity.

PTSD and dissociation symptoms as mediators of the relationship between polyvictimization and psychosocial and behavioral problems among justice-involved adolescents

Polyvictimization (PV) has been shown to be associated with psychosocial and behavioral impairment in community and high risk populations, including youth involved in juvenile justice. However, the mechanisms accounting for these adverse outcomes have not been empirically delineated. Symptoms of posttraumatic stress disorder (PTSD) and dissociation are documented sequelae of PV and are associated with a wide range of behavioral/emotional problems. This study used a cross-sectional research design and bootstrapped multiple mediation analyses with self-report measures completed by a large sample of justice-involved youth (N = 809, ages 12-19 years old, 27% female, 46.5% youth of color) to test the hypothesis that PTSD and dissociation symptoms mediate the relationship between PV and problems with anger, depression/anxiety, alcohol/drug use, and somatic complaints after controlling for the effects of exposure to violence and adversities related to juvenile justice involvement. As hypothesized, PTSD symptoms mediated the relationship of PV with all outcomes except alcohol/drug use problems (which had an unmediated direct association with PV). Partially supporting study hypotheses, dissociation symptoms mediated the relationship between PV and internalizing problems (i.e., depression anxiety; suicide ideation). Implications are discussed for prospective research demarcating the mechanisms linking PV and adverse outcomes in juvenile justice and other high risk populations.

The Associations Between Oxytocin and Trauma in Humans: A Systematic Review

Studies have shown that traumatic experiences may affect hormonal systems mediated by the hypothalamic-pituitary-adrenal (HPA) axis and the oxytocinergic system. This effect is the result of long-term impairments in hypothalamic structures and negative feedback mechanisms within the HPA axis, structures that mediate the response to stress. This deregulation reduces the production and release of cortisol and oxytocin (OXT), which may alter stress responses and lead to increased vulnerability to impairments from stressful experiences. The presence of gene polymorphisms might also have an impact on the vulnerability to psychopathology. We made a systematic review of articles dealing with the relationship between OXT and traumatic emotional experiences in humans. Thirty-five studies were reviewed and significant associations between experiences of emotional trauma (ET) and OXT were found. The main results showed that the presence of ET and post-traumatic stress disorder (PTSD) is strongly associated with reductions in endogenous OXT, and also that the acute effects of OXT administrations in individuals with ET tend to be anxiolytic only in less severe forms. In victims of recent traumatic experiences (RTE), OXT increased the re-experience of traumas and restored the function of different neural networks associated with fear control/extinction in PTSD patients. The results available also suggest that gene receptor polymorphisms may have a protective function in different outcomes after the experience of traumatic events. We conclude that the relationship between ET and OXT is multifaceted, complex, and mediated by contextual and individual factors. Directions for future studies are suggested considering the gaps in the available literature.

The Dissociative Subtype of Posttraumatic Stress Disorder (PTSD) Among Adolescents: Co-Occurring PTSD, Depersonalization/Derealization, and Other Dissociation Symptoms

OBJECTIVE

The purpose of this study was to examine the co-occurrence of posttraumatic stress disorder (PTSD) and dissociation in a clinical sample of trauma-exposed adolescents by evaluating evidence for the depersonalization/derealization dissociative subtype of PTSD as defined by the DSM-5 and then examining a broader set of dissociation symptoms.

METHOD

A sample of treatment-seeking, trauma-exposed adolescents 12 to 16 years old (N = 3,081) from the National Child Traumatic Stress Network Core Data Set was used to meet the study objectives. Two models of PTSD/dissociation co-occurrence were estimated using latent class analysis, one with 2 dissociation symptoms and the other with 10 dissociation symptoms. After model selection, groups within each model were compared on demographics, trauma characteristics, and psychopathology.

RESULTS

Model A, the depersonalization/derealization model, had 5 classes: dissociative subtype/high PTSD; high PTSD; anxious arousal; dysphoric arousal; and a low symptom/reference class. Model B, the expanded dissociation model, identified an additional class characterized by dissociative amnesia and detached arousal.

CONCLUSION

These 2 models provide new information about the specific ways PTSD and dissociation co-occur and illuminate some differences between adult and adolescent trauma symptom expression. A dissociative subtype of PTSD can be distinguished from PTSD alone in adolescents, but assessing a wider range of dissociative symptoms is needed to fully characterize adolescent traumatic stress responses.

The Symptoms of Trauma Scale (SOTS): Psychometric evaluation and gender differences with adults diagnosed with serious mental illness

A new clinician rating measure, the Symptoms of Trauma Scale (SOTS), was administered to adult psychiatric outpatients (46 men, 47 women) with severe mental illness who reported a history of trauma exposure and had recently been discharged from inpatient psychiatric treatment. SOTS composite severity scores for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, and Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, posttraumatic stress disorder (PTSD), complex PTSD (cPTSD), and total PTSD/cPTSD severity had acceptable internal consistency reliability. SOTS scores' construct and convergent validity was supported by correlations with self-report measures of childhood and adult trauma history and PTSD, dissociation, and anger symptoms. For men, SOTS scores were associated with childhood sexual and emotional abuse and self-reported anger problems, whereas for women SOTS scores were most consistently and strongly associated with childhood family adversity and self-reported PTSD symptoms. Results provide preliminary support for the reliability and validity of the SOTS with adults with severe mental illness and suggest directions for replication, measure refinement, and research on gender differences.

Effect of Previous Posttraumatic Stress in the Perinatal Period

OBJECTIVE

To review the extant literature on the effect of traumatic experiences that pre-date conception, pregnancy, and the postpartum period (perinatal period) and present a thematic overview of current issues in this relatively new area of inquiry.

DATA SOURCES

Electronic databases Cochrane, CINAHL, PsychINFO, and PubMed were searched. Manual searches of reference lists supplemented the electronic search.

STUDY SELECTION

Peer-reviewed articles written in English on the role of posttraumatic stress disorder during the perinatal period were included.

DATA EXTRACTION

Key findings relevant to perinatal posttraumatic stress that were reported in primary sources and meta-analyses were organized according to themes, including The Role of Childbirth, Comorbidity With Depression and Anxiety, Risk Factors for Perinatal PTSD, High-Risk Health Behaviors, and Association With Adverse Health Outcomes.

DATA SYNTHESIS

Across studies, antenatal posttraumatic stress disorder (PTSD) rates were estimated between 2.3% and 24%, and observed prevalence rates during the postnatal period ranged from 1% to 20%; however, many researchers failed to assess PTSD that existed before or during pregnancy, and when preexisting PTSD is a controlled variable, postpartum rates drop to 2% to 4.7%. In addition to prenatal depression and anxiety and pre-pregnancy history of psychiatric disorders, history of sexual trauma, childhood sexual abuse, intimate partner violence, and psychosocial attributes are risk factors for development or exacerbation of perinatal PTSD.

CONCLUSION

Women's health care providers should evaluate for PTSD in routine mental health assessments during and after pregnancy, especially with a reported history of trauma or the presence of a mood or anxiety disorder. Such screening will allow women to receive needed treatment and referrals and mitigate the potentially negative sequelae of PTSD. Future investigators must recognize the importance of subsyndromal posttraumatic stress symptoms and individual differences in responses to trauma.

The prevalence of posttraumatic stress disorder in pregnancy and after birth: A systematic review and meta-analysis

BACKGROUND

Previous reviews have provided preliminary insights into risk factors and possible prevalence of Post-traumatic Stress Disorder (PTSD) postpartum with no attempt to examine prenatal PTSD. This study aimed to assess the prevalence of PTSD during pregnancy and after birth, and the course of PTSD over this time.

METHODS

PsychINFO, PubMed, Scopus and Web of Science were searched using PTSD terms crossed with perinatal terms. Studies were included if they reported the prevalence of PTSD during pregnancy or after birth using a diagnostic measure.

RESULTS

59 studies (N =24267) met inclusion criteria: 35 studies of prenatal PTSD and 28 studies of postpartum PTSD (where 4 studies provided prevalence of PTSD in pregnancy and postpartum). In community samples the mean prevalence of prenatal PTSD was 3.3% (95%, CI 2.44-4.54). The majority of postpartum studies measured PTSD in relation to childbirth with a mean prevalence of 4.0% (95%, CI 2.77-5.71) in community samples. Women in high-risk groups were at more risk of PTSD with a mean prevalence of 18.95% (95%, CI 10.62-31.43) in pregnancy and 18.5% (95%, CI 10.6-30.38) after birth. Using clinical interviews was associated with lower prevalence rates in pregnancy and higher prevalence rates postpartum.

LIMITATIONS

Limitations include use of stringent diagnostic criteria, wide variability of PTSD rates, and inadequacy of studies on prenatal PTSD measured in three trimesters.

CONCLUSIONS

PTSD is prevalent during pregnancy and after birth and may increase postpartum if not identified and treated. Assessment and treatment in maternity services is recommended.

Maternal abuse history and reduced fetal heart rate variability: Abuse-related sleep disturbance is a mediator

The consequences of childhood maltreatment are profound and long lasting. Not only does the victim of abuse suffer as a child, but there is mounting evidence that a history of maltreatment places the next generation at risk for significant psychopathology. Research identifies postnatal factors as affecting this intergenerational transmission of trauma. However, emerging evidence suggests that part of this risk may be transmitted before birth, passed on via abuse-related alterations in the in utero environment that are as yet largely unidentified. To date, no study has directly assessed the influence of pregnant women's abuse history on fetal neurobehavioral development, nor considered trauma-associated poor sleep quality as a mediator reflecting established physiological dysregulation. Using data from 262 pregnant adolescents (ages 14-19), a population at elevated risk for childhood maltreatment, the current study examined maternal emotional abuse history and sleep quality in relation to third-trimester fetal resting heart rate variability, an index of parasympathetic nervous system functioning. The results indicate that maternal emotional abuse history is indirectly associated with lower fetal heart rate variability via abuse-related sleep disturbances. These data demonstrate an association between maternal abuse histories and fetal development, showing that at least part of the intergenerational transmission of risk occurs during pregnancy.

Working together for women’s empowerment: Strategies for interdisciplinary collaboration in perinatal care

Women’s experiences of pregnancy, birth, and postpartum adjustment are often characterized by feelings of disempowerment, trauma, and emotional pain. Psychosocial perinatal care has not kept up with medical advances in perinatal care. Access to psychosocial care appears to be inadequate because of the following: (a) perinatal health care providers are insufficiently prepared to address emotional aspects of maternal care and (b) traditional, compartmentalized psychological services benefit only a subsection of perinatal women, often in an untimely manner. Practical and innovative psychosocial services, integrated into routine perinatal care, can provide widespread access to psychosocial resources for mothers and supports providers in delivering optimal care.

Teen Mothers' Experience of Intimate Partner Violence: A Metasynthesis

Pregnant and parenting teens suffer higher rates of intimate partner violence (IPV) than older mothers. This qualitative metasynthesis explores teen mothers' experience with IPV during pregnancy and postpartum. Organized by the metaphor of a web, findings highlight how pervasive violence during childhood contributes to teen pregnancy and the risk of IPV as violence is normalized. The web constricts through the partner's control as violence emerges or worsens with pregnancy. Young mothers become increasingly isolated, and live with the physical and psychological consequences of IPV. Trauma-informed nursing practice is needed to support teen mothers in violent intimate relationships to spin a new web.

Alexithymia, Coping Styles and Traumatic Stress Symptoms in a Sample of Veterans Who Experienced Military Sexual Trauma

The current study examined the association between alexithymia and coping styles (planning, positive reinterpretation and growth, social-emotion coping, and denial), and trauma symptoms in a clinical sample of 170 male and female veterans who experienced sexual trauma during military service. Denial was the only coping style positively associated with trauma symptoms, and it mediated the relationship between alexithymia and trauma symptoms. Alexithymia was negatively associated with planning. Likewise, alexithymia was negatively associated with social-emotional coping and with positive reinterpretation and growth. The results speak to the significant role that alexithymia has in predicting individual coping styles.

Identifying the women at risk of antenatal anxiety and depression: A systematic review

BACKGROUND

Pregnancy is a time of increased vulnerability for the development of anxiety and depression. This systematic review aims to identify the main risk factors involved in the onset of antenatal anxiety and depression.

METHODS

A systematic literature analysis was conducted, using PubMed, PsychINFO, and the Cochrane Library. Original papers were included if they were written in English and published between 1st January 2003 and 31st August 2015, while literature reviews and meta-analyses were consulted regardless of publication date. A final number of 97 papers were selected.

RESULTS

The most relevant factors associated with antenatal depression or anxiety were: lack of partner or of social support; history of abuse or of domestic violence; personal history of mental illness; unplanned or unwanted pregnancy; adverse events in life and high perceived stress; present/past pregnancy complications; and pregnancy loss.

LIMITATIONS

The review does not include a meta-analysis, which may have added additional information about the differential impact of each risk factor. Moreover, it does not specifically examine factors that may influence different types of anxiety disorders, or the recurrence or persistence of depression or anxiety from pregnancy to the postpartum period.

CONCLUSIONS

The results show the complex aetiology of antenatal depression and anxiety. The administration of a screening tool to identify women at risk of anxiety and depression during pregnancy should be universal practice in order to promote the long-term wellbeing of mothers and babies, and the knowledge of specific risk factors may help creating such screening tool targeting women at higher risk.

Early maternal relational traumatic experiences and psychopathological symptoms: a longitudinal study on mother-infant and father-infant interactions

Early maternal relational traumas and psychopathological risk can have an impact on mother-infant interactions. Research has suggested the study of fathers and of their psychological profiles as protection or risk factors. The aim of the paper is to assess the quality of parental interactions during feeding in families with mothers with early traumatic experiences. One hundred thirty-six (N = 136) families were recruited in gynecological clinics: Group A included families with mothers who experienced early sexual/physical abuse; Group B was composed of families with mothers who experienced early emotional abuse or neglect; and Group C comprised healthy controls. The subjects participated in a 10-month longitudinal protocol [at the fourth month of pregnancy (T₀), 3 months after child birth (T₁), and 6 months after child birth (T₂)] that included an observation of mother-infant and father-infant interactions during feeding (Scala di Valutazione dell’Interazione Alimentare [SVIA]) and a self-reporting 90-item Symptom Checklist-Revised (SCL-90-R). Maternal higher rates of depression and early traumatic experiences of neglect and emotional abuse predicted more maladaptive scores on the affective state of the dyad SVIA subscale. Paternal anxiety predicted more severe levels of food refusal in the child during feeding.

In search of an adult attachment stress provocation to measure effect on the oxytocin system: a pilot validation study

BACKGROUND

Oxytocin is a promising biomarker for psychiatric conditions arising from early relational trauma, childhood maltreatment, and attachment dysregulation, including posttraumatic stress and dissociative disorders.

OBJECTIVE

This exploratory pilot study examined plasma oxytocin as a biomarker for alterations in the attachment system.

DESIGN

We used a single group, repeated-measures design with 15 women. The protocol used a film clip previously validated as a provocation to the hypothalamic-pituitary-adrenal axis.

RESULTS

The repeated-measures ANOVA showed differences in oxytocin across the three time points. Correlations with oxytocin indicated that measures of dissociation and somatization correlated most strongly with higher levels of oxytocin measured during exposure to the film's bonding scene and posttraumatic stress disorder correlated most strongly with lower levels at the film's abandonment scene. Post hoc analyses revealed differences in oxytocin response related to psychopathology.

CONCLUSION

Replication studies should characterize participants on a range of psychiatric conditions associated with attachment dysregulation.