Psychological and sleep-related functioning among women with unsettled infants in Victoria, Australia: a cross-sectional study

Supporting families with complex early parenting needs through a virtual residential parenting service: An investigation of outcomes, facilitators and barriers

AIM

To investigate clients' perspectives about outcomes of a telehealth residential unit (RU) program for families experiencing complex early parenting issues, and to explore facilitators and barriers to positive client outcomes.

DESIGN

Qualitative study using semi-structured interviews.

METHODS

Semi-structured interviews were conducted with mothers (n = 18) admitted to a telehealth RU program. Interview transcripts were analysed using thematic analysis.

RESULTS

Mothers reported short-term improvements in their child's presenting issues (e.g. feeding to sleep, night-time waking, co-sleeping), increased confidence and increased partner involvement. According to participants, program outcomes were facilitated by a positive parent-clinician relationship, the accessibility of clinicians and being able to take part in the program from their own home. Barriers included difficulties with technical equipment and connecting with the clinician overnight, and challenges with implementing strategies in the longer term.

CONCLUSION

This nurse-led telehealth program was viewed positively by parents and the study identified a number of areas for improvement.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Telehealth early parenting programs provide an important way for parents to receive support with early child sleep, settling and feeding issues. Clinicians working in this area should focus on the development of positive parent-nurse relationships, enhancing communication and availability for parents during overnight periods and supporting parents to develop early parenting skills that will be applicable across the early childhood period.

IMPACT

The study is the first to address client experiences of a telehealth RU program. Facilitators and barriers identified will inform service improvements to the program going forward, and similar telehealth programs for families; to ensure benefits and service outcomes are maximised for parents for such a crucial service.

REPORTING METHOD

The Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines for qualitative research were followed.

Prospective evaluation of parent and child outcomes following admission to a 'virtual' early parenting residential programme

OBJECTIVES

Australian early parenting residential services provide interventions for families experiencing complex early parenting issues. Many services have recently shifted to virtual care models but the clinical effectiveness of such programmes is currently unknown. This study sought to test outcomes of a 'virtual' early parenting residential programme and to compare these with those of an in-person programme.

DESIGN

Prospective cohort study; self-report questionnaires on admission, at discharge and 6-week follow-up.

SETTING

An early parenting residential unit in Sydney, Australia.

PARTICIPANTS

Consecutive series of parent-child dyads admitted to the unit virtually (n=56) or in person (n=44) between August 2021 and January 2022.

INTERVENTIONS

Participants in both groups received a 4-night/5-day intervention programme involving access to 24-hour support from a multidisciplinary team of health professionals. The in-person programme was delivered at a residential unit; the virtual programme involved provision of support via video calls, phone calls, SMS and emails.

PRIMARY AND SECONDARY OUTCOME MEASURES

Infant sleep, parenting self-efficacy (primary outcomes); parenting empathy, emotion, hostility, helplessness, mentalisation and stress (secondary outcomes).

RESULTS

Parents who received the virtual programme reported improvements from admission to discharge, and from admission to 6-week follow-up, in a range of areas including parenting self-efficacy, empathy, mentalisation, hostility, helplessness, stress and infant sleep resistance (ps<0.05). At 6 weeks, they also reported improvements in emotion and understanding related to their child (p<0.05). In contrast to expectation, outcomes at discharge and 6 weeks were not superior in the in-person group. In fact, at 6 weeks, parents who attended the virtual residential group reported significantly lower levels of parenting hostility and parenting stress, and greater levels of parenting confidence compared with those in the in-person group (ps<0.05).

CONCLUSIONS

Virtual early parenting residential interventions may be effective in bringing positive changes for families, and there is no evidence to suggest that outcomes are inferior to those of in-person programmes.

Residential parenting services: An integrative literature review of characteristics, service usage and parent and staff perspectives

AIMS

The primary aim of the review was to provide an overall assessment of residential parenting services in Australia, by describing the characteristics of infants and parents using residential parenting services, their prior service use and reasons for admission, referral pathways for access and parenting and infant outcomes. The secondary aims were to explore parent and staff perception of the programmes.

DESIGN

An integrative literature review.

METHODS

A systematic and comprehensive search of health and social sciences databases was conducted for studies related to residential parenting services (published between 1st January 1990-31st December 2019). Six hundred and eleven peer-reviewed papers were identified, after which 301 duplicates were removed and an additional 256 papers excluded after titles/abstracts were read. Of the remaining 54 abstracts/papers, a further 14 were omitted as not relevant. Forty papers were independently reviewed by four authors. ENTREQ and MOOSE checklists were applied.

RESULTS

Thirty studies were quantitative, nine were qualitative, and one was mixed methods. All studies originated from in Australia. Women and babies admitted to residential parenting services were found more likely to be: older, Australian born, from higher socio-economic groups, and first-time mothers, and having labour and birth interventions and a history of mental health disorders. The babies were more likely to be twins, male and admitted with sleep disorders and dysregulated behaviour. Studies reporting postintervention outcomes demonstrated improvements to maternal mental health, breastfeeding, parenting confidence and sleep quality, and infant sleeping and behaviour.

919 syrup inhibits ROS-mediated leptin-induced anorexia by activating PPARγ and improves gut flora abnormalities

BACKGROUND

Women with postpartum psychiatric disorders are prone to severe anorexia. Clinical studies have revealed the efficacy of 919 syrup, a traditional Chinese medicine mixture against postpartum illnesses, such as in regulating maternal mood and improving postpartum anorexia.

AIM

This study investigated the mechanisms through which 919 syrup improved anorexia induced by postpartum stress, focussing on the combined peroxisome proliferator-activated receptor gamma (PPARγ) and leptin signalling pathway, and its effects on the structure of the gut flora.

METHODS

Mice were randomly divided into five groups-control group, immobilisation stressed (IS) group (normal saline), pioglitazone (Piog; western medicine control) group, 919 syrup low-dose (TJD; 13.5 g/kg) group, and 919 syrup high-dose (TJG; 27.0 g/kg) group. The control group was housed normally. The other groups received IS for 3 h daily for 21 days. The treatments were initiated following the first postnatal day and were administered by gastric gavage. All mice were sacrificed under anaesthesia on postnatal day 22. Blood, hypothalamus, stomach, and faecal specimens were collected. Gene and protein expression levels of components of the PPARγ-leptin signalling pathway in the serum, hypothalamus, and stomach were determined. Immunofluorescence staining for proopiomelanocortin (POMC), phosphorylated signal transducer and activator of transcription 3 (pSTAT3), and leptin was performed to observe their spatial distributions in the hypothalamus and stomach. 16s rRNA gene sequencing and bioinformatics analysis of fecal specimens were performed.

RESULTS

After IS, postpartum mice showed significantly reduced appetite and body weight, accompanied by abnormalities in the structure of the gut flora. Treatment with 919 syrup (27.0 g/kg) downregulated malondialdehyde and upregulated catalase, glutathione peroxidase, and superoxide dismutase by activating PPARγ, thereby affecting the expression of leptin signalling pathway components (leptin, leptin receptor, pSTAT3, POMC, and cocaine and amphetamine-related transcript and neuropeptide Y), and modulated the gut flora in stressed mice.

CONCLUSION

919 syrup improved appetite in mice with postnatal stress by activating PPARγ to induce crosstalk with the leptin signalling pathway, this mechanism was similar to that of PPARγ agonists. 919 syrup also improved gut flora structure, and the changes in the relative abundances of the gut flora strongly correlated with the expression levels of PPARγ and leptin pathway components.

More than depression: a multi-dimensional assessment of postpartum distress symptoms before and after a residential early parenting program

INTRODUCTION

Parents are vulnerable to psychological distress symptoms in the postpartum period. It is routine to screen for depressive symptoms, but anxiety, stress, fatigue, irritability and insomnia symptoms are less often assessed despite their prevalence. This study aimed to assess multiple dimensions of psychological distress, and their reliable change and clinically significant change among women admitted to a residential program for assistance with unsettled infant behaviors (UIB).

METHOD

Women admitted to a five-night residential early parenting program completed self-report measures: the Depression Anxiety Stress Scale, Irritability Depression Anxiety Scale, Fatigue Severity Scale, and Insomnia Severity Index. A sub-group completed a computerized emotional Go-NoGo (EGNG) task as a measure of emotional impulsivity.

RESULTS

Seventy-eight women were recruited (Mage = 34.46, SDage = 4.16). On admission, 48% of women reported clinically elevated depressive symptoms and 97.5% of women not reporting elevated depressive symptoms reported clinical elevations in at least one other form of distress. Upon discharge, all self-report distress symptoms were significantly reduced (all p-values <.001), but reliable and clinically significant change only occurred in a subgroup of women. There were no significant changes in indicators of impulsivity based on the EGNG.

CONCLUSIONS

In addition to, and often in the absence of, depressive symptoms, women attending an early parenting program experienced a wide range of psychological distress, including fatigue, insomnia, anxiety and stress. Different forms of distress improved in different magnitudes to the treatment provided. These findings highlight the need for a multi-dimensional approach in the assessment and treatment of postpartum distress.