Perinatal stress: a study of factors linked to the risk of parenting problems

Additive effects between prematurity and postnatal risk factors of suicidal behavior

BACKGROUND

Pre- and perinatal insults increase suicide risk. The main objective of the present study is to investigate if prematurity interacts in an additive fashion with postnatal risk factors of suicidal behavior.

METHOD

Sample and procedure: 857 adult suicide attempters consecutively hospitalized for a suicide attempt were included. Studied characteristics of suicide attempts included use of a violent mean, age at first suicide attempt, and number of suicide attempts. Risk factors of suicidal behavior included indexes of pre- and perinatal adversity, childhood maltreatment as measured with the Childhood Trauma Questionnaire, personality traits as measured with the Tridimensional Personality Questionnaire, and family history of suicidal behavior.

STATISTICAL ANALYSES

Comparisons between the different patterns of suicide attempts characteristics were made using logistic regression with crude and adjusted odds ratios and 95% confidence intervals.

RESULTS

The risk of violent suicide attempts increased significantly in patients born prematurely (OR [95%] = 2.38[1.12-5.08]). There were additive effects for very preterm birth and 1) emotional abuse (OR [95% CI] = 4.52 [1.75-11.60]), 2) novelty seeking (OR [95% CI] = 8.92[3.09-25.7]), and 3) harm avoidance (OR [95% CI] = 5.81 [2.43-13.90]) on the age at first suicide attempt, after adjustment for potential confounders.

CONCLUSIONS

Very preterm birth appears to be the first step in a cascade of stressors across lifetime, which affects the risk and the severity of suicidal behavior. Furthermore, very preterm birth, childhood maltreatment and personality traits have additive effects that influence the age at onset of suicide attempt. Our findings may have potential consequences for preventive policies.

Effects of interview on mood status of pregnant women with high-risk delivery

BACKGROUND

Expectant mothers at high risk for preterm labor admitted to the Mother and Child Health Centers (MCH) often have psychological problems and mood disturbances. The purpose of the present study was to evaluate the effects of an interview by health professionals on their mood status.

METHODS

Participants consisted of 52 women admitted to the MCH of Kansai Medical University (KMU) hospital and who had delivered between December 2006 and September 2007. Interview sessions by health professionals consisting of a neonatologist and a clinical psychologist, termed 'KMU baby doctor-team interview', were held once a week. During the interview the neonatologist discussed the physiology of preterm infants and treatment for the possible complications while the clinical psychologist listened to the expectant mothers talk about their anxieties or complaints and responded to their requests as much as possible. To investigate their mood status objectively, the participants were asked to complete the Japanese version of the Profile of Mood States (POMS) before and after the first session.

RESULTS

On admission, more than 20% of participants ranging from 19 to 42 years of age had mood disturbances in Tension-Anxiety, Depression-Dejection, and Vigor categorized by POMS. The average score for Depression-Dejection, however, significantly improved after the first interview sessions.

CONCLUSIONS

Mood disturbances were observed in a considerable number of expectant mothers at high risk for preterm labor. Interviews by health professionals consisting of a neonatologist and a clinical psychologist may alter their mood status.

Effects of family coping and resources on family adjustment and parental stress in the acute phase of the NICU experience

PURPOSE

To determine the relationship between family coping and resources and family adjustment and parental stress in the acute phase of the NICU experience.

DESIGN

Correlational study based on the Resiliency Model of Family Stress, Adjustment, and Adaptation. Main study instruments included the State Anxiety scale of the State-Trait Anxiety Inventory, the Family Inventory of Resources for Management, the Family Crisis Oriented Personal Evaluation Scales, and the General Functioning subscale of the McMaster Family Assessment Device.

SAMPLE

Data collected from 124 mother and father pairs within two to four days of their infant's admission to the NICU.

MAIN OUTCOME VARIABLES

Family adjustment and parental stress.

RESULTS

Adequate resources were more strongly related to positive adjustment and decreased stress than were either coping or being a first-time parent. The relationships among the variables were generally the same for both parents. Mothers utilized more coping strategies than did fathers. PRACTICE RECOMMENDATIONS: Families with limited resources should be identified early to facilitate their adjustment to the NICU.

The relationship between psychosocial factors and developmental outcome for very low and extremely low birthweight infants: a review

Over the last quarter century, the improved survival rate of very low birthweight infants has sharpened questions about their residual disabilities. Longitudinal studies have devoted attention to the cognitive and neurodevelopmental outcome of these infants, but much less is known about their long-term social and emotional development. Psychiatrists consulting to neonatal intensive care units and assessing these infants in their families, will be assisted by a better understanding of the developmental and psychological outcomes of such infants. This paper reviews the state of knowledge in both of these areas. It argues the paramount importance of psychosocial factors to the infants' developmental outcome, and the importance of longitudinal research in further clarifying the predictive value of these factors. In a subsequent paper, we consider the efficacy of interventions with this group.