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Fourment K, Espinoza C, Ribeiro ACL, Mesman J. Latin American Attachment studies: A narrative review. Infant Ment Health J 2022; 43:653-676. [PMID: 35661377 PMCID: PMC9546405 DOI: 10.1002/imhj.21995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 02/02/2022] [Indexed: 11/10/2022]
Abstract
Attachment theory´s core hypotheses (universality, normativity, sensitivity, and competence) are assumed to be applicable worldwide. However, the majority of studies on attachment theory have been conducted in Western countries, and the extent to which these core hypotheses are supported by research conducted in Latin America has never been systematically addressed. The purpose of this systematic narrative literature review is to provide an integrative discussion of the current body of empirical studies concerning attachment theory conducted in Latin American countries. For that purpose, a search was conducted in four electronic databases (Web of Science, PsycInfo, SciELO, and Redalyc) and 82 publications on attachment and/or sensitivity met inclusion criteria. None of the studies reported cases in which an attachment relationship was absent, and a predominance of secure attachment patterns was found, mainly for non-risk samples (NRS). Sensitivity levels were generally deemed adequate in NRS, and related to attachment quality. Attachment security and caregivers' sensitivity were positively associated with child outcomes. Attachment-based intervention studies mostly showed efficacy. In conclusion, Latin American research supports the key theoretical assumptions of attachment theory, mainly in samples of urban middle-class NRS. However, the field of attachment-related research would be enriched by also investing in Latin American studies on caregiving rooted in local concepts and theories.
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Affiliation(s)
- Katherine Fourment
- Institute of Education and Child StudiesLeiden UniversityLeidenthe Netherlands
- Department of PsychologyPontifical Catholic University of PeruLimaPeru
| | - Camila Espinoza
- Institute of Education and Child StudiesLeiden UniversityLeidenthe Netherlands
| | - Ana Carla Lima Ribeiro
- Graduate School of Social PsychologyUniversityof State of Rio de JaneiroRio de JaneiroBrazil
| | - Judi Mesman
- Institute of Education and Child StudiesLeiden UniversityLeidenthe Netherlands
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Jeong J, Franchett EE, Ramos de Oliveira CV, Rehmani K, Yousafzai AK. Parenting interventions to promote early child development in the first three years of life: A global systematic review and meta-analysis. PLoS Med 2021; 18:e1003602. [PMID: 33970913 PMCID: PMC8109838 DOI: 10.1371/journal.pmed.1003602] [Citation(s) in RCA: 218] [Impact Index Per Article: 72.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 04/01/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Parents are the primary caregivers of young children. Responsive parent-child relationships and parental support for learning during the earliest years of life are crucial for promoting early child development (ECD). We conducted a global systematic review and meta-analysis to evaluate the effectiveness of parenting interventions on ECD and parenting outcomes. METHODS AND FINDINGS We searched MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, and Global Health Library for peer-reviewed, published articles from database inception until November 15, 2020. We included randomized controlled trials (RCTs) of parenting interventions delivered during the first 3 years of life that evaluated at least 1 ECD outcome. At least 2 reviewers independently screened, extracted data, and assessed study quality from eligible studies. ECD outcomes included cognitive, language, motor, and socioemotional development, behavior problems, and attachment. Parenting outcomes included parenting knowledge, parenting practices, parent-child interactions, and parental depressive symptoms. We calculated intervention effect sizes as the standardized mean difference (SMD) and estimated pooled effect sizes for each outcome separately using robust variance estimation meta-analytic approaches. We used random-effects meta-regression models to assess potential effect modification by country-income level, child age, intervention content, duration, delivery, setting, and study quality. This review was registered with PROSPERO (CRD42018092458 and CRD42018092461). Of the 11,920 articles identified, we included 111 articles representing 102 unique RCTs. Pooled effect sizes indicated positive benefits of parenting interventions on child cognitive development (SMD = 0.32, 95% CI [confidence interval]: 0.23, 0.40, P < 0.001), language development (SMD = 0.28, 95% CI: 0.18 to 0.37, P < 0.001), motor development (SMD = 0.24, 95% CI: 0.15 to 0.32, P < 0.001), socioemotional development (SMD = 0.19, 95% CI: 0.10 to 0.28, P < 0.001), and attachment (SMD = 0.29, 95% CI: 0.18 to 0.40, P < 0.001) and reductions in behavior problems (SMD = -0.13, 95% CI: -0.18 to -0.08, P < 0.001). Positive benefits were also found on parenting knowledge (SMD = 0.56, 95% CI: 0.33 to 0.79, P < 0.001), parenting practices (SMD = 0.33, 95% CI: 0.22 to 0.44, P < 0.001), and parent-child interactions (SMD = 0.39, 95% CI: 0.24 to 0.53, P < 0.001). However, there was no significant reduction in parental depressive symptoms (SMD = -0.07, 95% CI: -0.16 to 0.02, P = 0.08). Subgroup analyses revealed significantly greater effects on child cognitive, language, and motor development, and parenting practices in low- and middle-income countries compared to high-income countries; and significantly greater effects on child cognitive development, parenting knowledge, parenting practices, and parent-child interactions for programs that focused on responsive caregiving compared to those that did not. On the other hand, there was no clear evidence of effect modification by child age, intervention duration, delivery, setting, or study risk of bias. Study limitations include considerable unexplained heterogeneity, inadequate reporting of intervention content and implementation, and varying quality of evidence in terms of the conduct of trials and robustness of outcome measures used across studies. CONCLUSIONS Parenting interventions for children during the first 3 years of life are effective for improving ECD outcomes and enhancing parenting outcomes across low-, middle-, and high-income countries. Increasing implementation of effective and high-quality parenting interventions is needed globally and at scale in order to support parents and enable young children to achieve their full developmental potential.
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Affiliation(s)
- Joshua Jeong
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Emily E. Franchett
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Clariana V. Ramos de Oliveira
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Karima Rehmani
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Aisha K. Yousafzai
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
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Silva DID, Mello DFD, Mazza VDA, Toriyama ATM, Veríssimo MDLÓR. DYSFUNCTIONS IN THE SOCIO EMOTIONAL DEVELOPMENT OF INFANTS AND ITS RELATED FACTORS: AN INTEGRATIVE REVIEW. TEXTO & CONTEXTO ENFERMAGEM 2019. [DOI: 10.1590/1980-265x-tce-2017-0370] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: to synthesize factors related to dysfunctions in the socioemotional development of infants. Method: integrative review carried out between April and August 2016 with defined criteria for inclusion and exclusion of studies, search strategies, extraction and synthesis of data. The exposure factors underwent categorical thematic analysis and systematization according to the levels of the context (Microsystem, Mesosystem, Exosystem and Macrosystem) of the Bioecological Model of Human Development. Results: in the context of the Microsystem and Mesosystem, the factors found were: limitations in care; adversities in family relationships and in the social support and illness situation of the caregivers that influence the proximal processes. In the Exosystem and the Macrosystem, they were: social vulnerabilities of caregivers and fragilities of public policies that determine the material and social conditions of the family. Conclusion: the synthesis of evidence on exposure factors favors the construction of measurement scales of the contextual elements related to the social emotional development of young children. Beyond the milestones, present or not, in the evaluation of a child, these technologies can be predictive, with great potential of anticipation of the factors of exposure and prevention of developmental dysfunctions.
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Hurt L, Paranjothy S, Lucas PJ, Watson D, Mann M, Griffiths LJ, Ginja S, Paljarvi T, Williams J, Bellis MA, Lingam R. Interventions that enhance health services for parents and infants to improve child development and social and emotional well-being in high-income countries: a systematic review. BMJ Open 2018; 8:e014899. [PMID: 29439064 PMCID: PMC5829600 DOI: 10.1136/bmjopen-2016-014899] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 07/14/2017] [Accepted: 08/22/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Experiences in the first 1000 days of life have a critical influence on child development and health. Health services that provide support for families need evidence about how best to improve their provision. METHODS We systematically reviewed the evidence for interventions in high-income countries to improve child development by enhancing health service contact with parents from the antenatal period to 24 months postpartum. We searched 15 databases and trial registers for studies published in any language between 01 January 1996 and 01 April 2016. We also searched 58 programme or organisation websites and the electronic table of contents of eight journals. RESULTS Primary outcomes were motor, cognitive and language development, and social-emotional well-being measured to 39 months of age (to allow the interventions time to produce demonstrable effects). Results were reported using narrative synthesis due to the variation in study populations, intervention design and outcome measurement. 22 of the 12 986 studies identified met eligibility criteria. Using Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group criteria, the quality of evidence overall was moderate to low. There was limited evidence for intervention effectiveness: positive effects were seen in 1/6 studies for motor development, 4/11 for language development, 4/8 for cognitive development and 3/19 for social-emotional well-being. However, most studies showing positive effects were at high/unclear risk of bias, within-study effects were inconsistent and negative effects were also seen. Intervention content and intensity varied greatly, but this was not associated with effectiveness. CONCLUSIONS There is insufficient evidence that interventions currently available to enhance health service contacts up to 24 months postpartum are effective for improving child development. There is an urgent need for robust evaluation of existing interventions and to develop and evaluate novel interventions to enhance the offer to all families. PROSPERO REGISTRATION NUMBER CRD42015015468.
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Affiliation(s)
- Lisa Hurt
- Division of Population Medicine, Cardiff University School of Medicine, Cardiff, UK
| | - Shantini Paranjothy
- Division of Population Medicine, Cardiff University School of Medicine, Cardiff, UK
| | | | - Debbie Watson
- School for Policy Studies, University of Bristol, Bristol, UK
| | - Mala Mann
- Specialist Unit for Review Evidence, Cardiff University, Cardiff, UK
| | - Lucy J Griffiths
- Population, Policy and Practice Programme, Institute of Child Health, London, UK
| | - Samuel Ginja
- Institute of Health and Society, Newcastle University, Newcastle, UK
| | - Tapio Paljarvi
- Division of Population Medicine, Cardiff University School of Medicine, Cardiff, UK
| | | | | | - Raghu Lingam
- Institute of Health and Society, Newcastle University, Newcastle, UK
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Winberg Salomonsson M, Barimani M. THERAPISTS' EXPERIENCES OF MOTHER-INFANT PSYCHOANALYTIC TREATMENT: A QUALITATIVE STUDY. Infant Ment Health J 2017; 39:55-69. [PMID: 29281749 DOI: 10.1002/imhj.21683] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
As part of a larger research project in Sweden, a qualitative study investigated psychotherapists' experiences of mother-infant psychoanalysis (MIP). A randomized controlled trial compared two groups of mother-infant dyads with psychological problems. One had received Child Health Center care, and the other received MIP. Previous articles on long-term effects have found that mothers who had received MIP were less depressed throughout a posttreatment period of 3½ years, and their children showed better global functioning and psychological well-being. The present study's objectives were to describe the therapist's experiences of MIP and deepen the understanding of the MIP process. Six months after treatment began, all therapists were interviewed. Transcribed interviews with therapists from 10 (of 33 total) MIP treatments were randomly selected and analyzed in detail by thematic analysis. Therapists worked successfully with mother and infant together and found different ways of cooperation during MIP sessions. Therapists reported overall positive experiences; however, in cases where mothers needed more personal attention, it would be important to adapt the method to them.
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Winberg Salomonsson M, Barimani M. MOTHERS’ EXPERIENCES OF MOTHER-INFANT PSYCHOANALYTIC TREATMENT-A QUALITATIVE STUDY. Infant Ment Health J 2017; 38:486-498. [DOI: 10.1002/imhj.21649] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Pontoppidan M, Klest SK, Sandoy TM. The Incredible Years Parents and Babies Program: A Pilot Randomized Controlled Trial. PLoS One 2016; 11:e0167592. [PMID: 27974857 PMCID: PMC5156553 DOI: 10.1371/journal.pone.0167592] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 11/14/2016] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Infancy is an important period of life; adverse experiences during this stage can have both immediate and lifelong impacts on the child's mental health and well-being. This study evaluates the effects of offering the Incredible Years Parents and Babies (IYPB) program as a universal intervention. METHOD We conducted a pragmatic, two-arm, parallel pilot randomized controlled trial; 112 families with newborns were randomized to the IYPB program (76) or usual care (36) with a 2:1 allocation ratio. The primary outcome was parenting confidence at 20 weeks(Karitane Parenting Confidence Scale and Parental Stress Scale). Secondary outcomes include measures of parent health, parent-child relationship, infant development, parent-child activities, and network. Interviewers and data analysts were blind to allocation status. Multiple linear-regression analyses were used for evaluating the effects of the intervention. RESULTS There were no intervention effects on the primary outcomes. Only one effect was detected for secondary outcomes, intervention mothers reported a significantly smaller network than control mothers (β = -0.15 [-1.85,-0.28]). When examining the lowest-functioning mothers in moderator analyses, we found that intervention mothers reported significantly higher parent stress (β = 5.33 [0.27,10.38]), lower parenting confidence (β = -2.37 [-4.45,-0.29]), and worse mental health than control mothers (β = -18.62 [-32.40,-4.84]). In contrast, the highest functioning intervention mothers reported significantly lower parent stress post-intervention (β = -6.11 [-11.07,-1.14]). CONCLUSION Overall, we found no effects of the IYPB as a universal intervention for parents with infants. The intervention was developed to be used with groups of low functioning families and may need to be adapted to be effective with universal parent groups. The differential outcomes for the lowest and highest functioning families suggest that future research should evaluate the effects of delivering the IYPB intervention to groups of parents who have similar experiences with parenting and mental health. TRIAL REGISTRATION ClinicalTrials.gov NCT01931917.
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Affiliation(s)
- Maiken Pontoppidan
- SFI–The Danish National Centre for Social Research, Department for Child and Family, Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Sihu K. Klest
- Health Sciences Faculty, University of Tromsø, Arctic University of Norway, Tromsø, Norway
| | - Tróndur Møller Sandoy
- SFI–The Danish National Centre for Social Research, Department for Child and Family, Copenhagen, Denmark
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Brahm P, Cortázar A, Fillol MP, Mingo MV, Vielma C, Aránguiz MC. Maternal sensitivity and mental health: does an early childhood intervention programme have an impact? Fam Pract 2016; 33:226-32. [PMID: 26370623 DOI: 10.1093/fampra/cmv071] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Maternal sensitivity (MS) and mental health influence mother-child attachment and the child's mental health. Early interventions may promote resilience and facilitate healthy development of the children through an impact on mothers' outcomes such as their sensitivity and mental health. Play with Our Children (POC) is an early intervention programme aiming to promote a positive mother-child interaction for children who attend three family health centres of deprived areas of Santiago de Chile. OBJECTIVE To estimate the effect of the programme POC on MS and mental health. METHODS A quasi-experimental design with propensity score matching estimations was employed. MS was measured with the Q-Sort of Maternal Sensitivity, and maternal mental health was assessed with the Patient Health Questionnaire and the Parenting Stress Index. Mean-difference comparison and difference-in-difference method were used as statistical strategies. The sample included 102 children from 2 to 23 months of age, 54 of them participated in the intervention and 48 children were the comparison group. RESULTS Estimates showed that participation in POC was positively associated with less stress in mothers of children younger than 12 months (P < 0.05) and positively associated with MS for mothers of children from 12 to 23 months (P < 0.05). There were no significant differences in maternal depression scores. CONCLUSION The dyadic early intervention POC may influence mother's mental health and indirectly impact children's well-being during critical stages of their development by strengthening their mother's sensitivity towards them.
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Affiliation(s)
- Paulina Brahm
- Department of Family Medicine, Pontificia Universidad Católica de Chile, Santiago 7820436, Chile,
| | - Alejandra Cortázar
- Centre for Comparative Politics of Education, Universidad Diego Portales, Santiago 8370056, Chile
| | | | - María Verónica Mingo
- Fundación Infancia Primero, Santiago 7500776, Chile, Department of Child Study and Human Development, Tufts University, Medford, MA 02155, USA and
| | - Constanza Vielma
- Centre for Comparative Politics of Education, Universidad Diego Portales, Santiago 8370056, Chile
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Wright B, Barry M, Hughes E, Trépel D, Ali S, Allgar V, Cottrill L, Duffy S, Fell J, Glanville J, Glaser D, Hackney L, Manea L, McMillan D, Palmer S, Prior V, Whitton C, Perry A, Gilbody S. Clinical effectiveness and cost-effectiveness of parenting interventions for children with severe attachment problems: a systematic review and meta-analysis. Health Technol Assess 2016; 19:vii-xxviii, 1-347. [PMID: 26177494 DOI: 10.3310/hta19520] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Services have variable practices for identifying and providing interventions for 'severe attachment problems' (disorganised attachment patterns and attachment disorders). Several government reports have highlighted the need for better parenting interventions in at-risk groups. This report was commissioned to evaluate the clinical effectiveness and cost-effectiveness of parenting interventions for children with severe attachment problems (the main review). One supplementary review explored the evaluation of assessment tools and a second reviewed 10-year outcome data to better inform health economic aspects of the main review. DATA SOURCES A total of 29 electronic databases were searched with additional mechanisms for identifying a wide pool of references using the Cochrane methodology. Examples of databases searched include PsycINFO (1806 to January week 1, 2012), MEDLINE and MEDLINE In-Process & Other Non-Indexed Citations (1946 to December week 4, 2011) and EMBASE (1974 to week 1, 2012). Searches were carried out between 6 and 12 January 2012. REVIEW METHODS Papers identified were screened and data were extracted by two independent reviewers, with disagreements arbitrated by a third independent reviewer. Quality assessment tools were used, including quality assessment of diagnostic accuracy studies - version 2 and the Cochrane risk of bias tool. Meta-analysis of randomised controlled trials (RCTs) of parenting interventions was undertaken. A health economics analysis was conducted. RESULTS The initial search returned 10,167 citations. This yielded 29 RCTs in the main review of parenting interventions to improve attachment patterns, and one involving children with reactive attachment disorder. A meta-analysis of eight studies seeking to improve outcome in at-risk populations showed statistically significant improvement in disorganised attachment. The interventions saw less disorganised attachment at outcome than the control (odds ratio 0.47, 95% confidence interval 0.34 to 0.65; p < 0.00001). Much of this focused around interventions improving maternal sensitivity, with or without video feedback. In our first supplementary review, 35 papers evaluated an attachment assessment tool demonstrating validity or psychometric data. Only five reported test-retest data. Twenty-six studies reported inter-rater reliability, with 24 reporting a level of 0.7 or above. Cronbach's alphas were reported in 12 studies for the comparative tests (11 with α > 0.7) and four studies for the reference tests (four with α > 0.7). Three carried out concurrent validity comparing the Strange Situation Procedure (SSP) with another assessment tool. These had good sensitivity but poor specificity. The Disturbances of Attachment Interview had good sensitivity and specificity with the research diagnostic criteria (RDC) for attachment disorders. In our supplementary review of 10-year outcomes in cohorts using a baseline reference standard, two studies were found with disorganised attachment at baseline, with one finding raised psychopathology in adolescence. Budget impact analysis of costs was estimated because a decision model could not be justifiably populated. This, alongside other findings, informed research priorities. LIMITATIONS There are relatively few UK-based clinical trials. A 10-year follow-up, while necessary for our health economists for long-term sequelae, yielded a limited number of papers. CONCLUSIONS Maternal sensitivity interventions show good outcomes in at-risk populations, but require further research with complex children. The SSP and RDC for attachment disorders remain the reference standards for identification until more concurrent and predictive validity research is conducted. A birth cohort with sequential attachment measures and outcomes across different domains is recommended with further, methodologically sound randomised controlled intervention trials. The main area identified for future work was a need for good-quality RCTs in at-risk groups such as those entering foster care or adoption. STUDY REGISTRATION This study is registered as PROSPERO CRD42011001395. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Barry Wright
- Hull York Medical School, University of York, York, UK.,Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Melissa Barry
- Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Ellen Hughes
- Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Dominic Trépel
- Department of Health Sciences, University of York, York, UK
| | - Shehzad Ali
- Department of Health Sciences, University of York, York, UK
| | | | - Lucy Cottrill
- Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | | | - Jenny Fell
- Leeds and York Partnership NHS Foundation Trust, Leeds, UK.,Department of Health Sciences, University of York, York, UK
| | | | - Danya Glaser
- Great Ormond Street Hospital, London, UK.,Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Lisa Hackney
- Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Laura Manea
- Hull York Medical School, University of York, York, UK
| | - Dean McMillan
- Hull York Medical School, University of York, York, UK.,Department of Health Sciences, University of York, York, UK
| | - Stephen Palmer
- Centre for Health Economics, University of York, York, UK
| | - Vivien Prior
- Faculty of Population Health Sciences, Institute of Child Health, University College London, London, UK
| | - Clare Whitton
- Tees, Esk and Wear Valleys NHS Foundation Trust, Middlesbrough, UK
| | - Amanda Perry
- Department of Health Sciences, University of York, York, UK
| | - Simon Gilbody
- Hull York Medical School, University of York, York, UK.,Department of Health Sciences, University of York, York, UK
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Salomonsson MW, Sorjonen K, Salomonsson B. A LONG-TERM FOLLOW-UP STUDY OF A RANDOMIZED CONTROLLED TRIAL OF MOTHER-INFANT PSYCHOANALYTIC TREATMENT: OUTCOMES ON MOTHERS AND INTERACTIONS. Infant Ment Health J 2015; 36:542-55. [DOI: 10.1002/imhj.21536] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Pontoppidan M. The effectiveness of the Incredible Years™ Parents and Babies Program as a universal prevention intervention for parents of infants in Denmark: study protocol for a pilot randomized controlled trial. Trials 2015; 16:386. [PMID: 26329163 PMCID: PMC4557844 DOI: 10.1186/s13063-015-0859-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 07/10/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Infancy is an important period in a child's life, with rapid growth and development. Early experiences shape the developing brain, and adverse experiences can have both an immediate and lifelong impact on health and wellbeing. Parenting interventions offered to parents of newborns can support parents in providing sensitive and responsive care, and reinforce healthy development for their infants. This study aims to evaluate the impact of the Incredible Years™ Parents and Babies Program in a universal setting for parents with infants. METHODS/DESIGN This is a pragmatic, two-arm, parallel, pilot, randomized controlled trial (RCT) where 128 families with newborn infants up to four-months-old are recruited in two municipalities in Denmark. Families are randomized to the Incredible Years Parents and Babies Program or usual care with a 2:1 allocation ratio. The primary outcome is parenting confidence measured after 20 weeks by the Karitane Parenting Confidence Scale and Parental Stress Scale. Secondary outcomes include measures of parent health, reflective functioning, relationship with the infant, and infant development. Interviewers and data analysts are blind to allocation status. DISCUSSION This is the first RCT of the Incredible Years Parents and Babies Program, and one of the first rigorous evaluations of a universally offered preventive intervention for parents with infants. The trial will provide important information on the effectiveness of a relatively brief, universally offered parenting intervention for parents of infants, and will also provide information on infant measures, parent recruitment and participation, and implementation of the program, which could inform future trials. TRIAL REGISTRATION This trial was registered with Clinicaltrials.gov (identifier: NCT01931917) on 27 August 2013.
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Affiliation(s)
- Maiken Pontoppidan
- SFI - The Danish National Centre for Social Research, Department for Children and Family, Herluf Trolles Gade 11, 1052, Copenhagen, Denmark. .,University of Copenhagen, Department of Public Health, Øster Farimagsgade 5, 1014, Copenhagen K, Denmark.
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Intervención grupal para reducir la sintomatología depresiva y promover la sensibilidad materna en embarazadas chilenas. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.sumpsi.2015.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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13
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Letourneau N, Tryphonopoulos P, Giesbrecht G, Dennis CL, Bhogal S, Watson B. NARRATIVE AND META-ANALYTIC REVIEW OF INTERVENTIONS AIMING TO IMPROVE MATERNAL-CHILD ATTACHMENT SECURITY. Infant Ment Health J 2015; 36:366-87. [DOI: 10.1002/imhj.21525] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Nicole Letourneau
- Alberta Children's Hospital Research Institute for Child and Maternal Health; University of Calgary
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Barlow J, Bennett C, Midgley N, Larkin SK, Wei Y. Parent-infant psychotherapy for improving parental and infant mental health. Cochrane Database Syst Rev 2015; 1:CD010534. [PMID: 25569177 PMCID: PMC8685508 DOI: 10.1002/14651858.cd010534.pub2] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Parent-infant psychotherapy (PIP) is a dyadic intervention that works with parent and infant together, with the aim of improving the parent-infant relationship and promoting infant attachment and optimal infant development. PIP aims to achieve this by targeting the mother's view of her infant, which may be affected by her own experiences, and linking them to her current relationship to her child, in order to improve the parent-infant relationship directly. OBJECTIVES 1. To assess the effectiveness of PIP in improving parental and infant mental health and the parent-infant relationship.2. To identify the programme components that appear to be associated with more effective outcomes and factors that modify intervention effectiveness (e.g. programme duration, programme focus). SEARCH METHODS We searched the following electronic databases on 13 January 2014: Cochrane Central Register of Controlled Trials (CENTRAL, 2014, Issue 1), Ovid MEDLINE, EMBASE, CINAHL, PsycINFO, BIOSIS Citation Index, Science Citation Index, ERIC, and Sociological Abstracts. We also searched the metaRegister of Controlled Trials, checked reference lists, and contacted study authors and other experts. SELECTION CRITERIA Two review authors assessed study eligibility independently. We included randomised controlled trials (RCT) and quasi-randomised controlled trials (quasi-RCT) that compared a PIP programme directed at parents with infants aged 24 months or less at study entry, with a control condition (i.e. waiting-list, no treatment or treatment-as-usual), and used at least one standardised measure of parental or infant functioning. We also included studies that only used a second treatment group. DATA COLLECTION AND ANALYSIS We adhered to the standard methodological procedures of The Cochrane Collaboration. We standardised the treatment effect for each outcome in each study by dividing the mean difference (MD) in post-intervention scores between the intervention and control groups by the pooled standard deviation. We presented standardised mean differences (SMDs) and 95% confidence intervals (CI) for continuous data, and risk ratios (RR) for dichotomous data. We undertook meta-analysis using a random-effects model. MAIN RESULTS We included eight studies comprising 846 randomised participants, of which four studies involved comparisons of PIP with control groups only. Four studies involved comparisons with another treatment group (i.e. another PIP, video-interaction guidance, psychoeducation, counselling or cognitive behavioural therapy (CBT)), two of these studies included a control group in addition to an alternative treatment group. Samples included women with postpartum depression, anxious or insecure attachment, maltreated, and prison populations. We assessed potential bias (random sequence generation, allocation concealment, incomplete outcome data, selective reporting, blinding of participants and personnel, blinding of outcome assessment, and other bias). Four studies were at low risk of bias in four or more domains. Four studies were at high risk of bias for allocation concealment, and no study blinded participants or personnel to the intervention. Five studies did not provide adequate information for assessment of risk of bias in at least one domain (rated as unclear).Six studies contributed data to the PIP versus control comparisons producing 19 meta-analyses of outcomes measured at post-intervention or follow-up, or both, for the primary outcomes of parental depression (both dichotomous and continuous data); measures of parent-child interaction (i.e. maternal sensitivity, child involvement and parent engagement; infant attachment category (secure, avoidant, disorganised, resistant); attachment change (insecure to secure, stable secure, secure to insecure, stable insecure); infant behaviour and secondary outcomes (e.g. infant cognitive development). The results favoured neither PIP nor control for incidence of parental depression (RR 0.74, 95% CI 0.52 to 1.04, 3 studies, 278 participants, low quality evidence) or parent-reported levels of depression (SMD -0.22, 95% CI -0.46 to 0.02, 4 studies, 356 participants, low quality evidence). There were improvements favouring PIP in the proportion of infants securely attached at post-intervention (RR 8.93, 95% CI 1.25 to 63.70, 2 studies, 168 participants, very low quality evidence); a reduction in the number of infants with an avoidant attachment style at post-intervention (RR 0.48, 95% CI 0.24 to 0.95, 2 studies, 168 participants, low quality evidence); fewer infants with disorganised attachment at post-intervention (RR 0.32, 95% CI 0.17 to 0.58, 2 studies, 168 participants, low quality evidence); and an increase in the proportion of infants moving from insecure to secure attachment at post-intervention (RR 11.45, 95% CI 3.11 to 42.08, 2 studies, 168 participants, low quality evidence). There were no differences between PIP and control in any of the meta-analyses for the remaining primary outcomes (i.e. adverse effects), or secondary outcomes.Four studies contributed data at post-intervention or follow-up to the PIP versus alternative treatment analyses producing 15 meta-analyses measuring parent mental health (depression); parent-infant interaction (maternal sensitivity); infant attachment category (secure, avoidant, resistant, disorganised) and attachment change (insecure to secure, stable secure, secure to insecure, stable insecure); infant behaviour and infant cognitive development. None of the remaining meta-analyses of PIP versus alternative treatment for primary outcomes (i.e. adverse effects), or secondary outcomes showed differences in outcome or any adverse changes.We used the Grades of Recommendation, Assessment, Development and Evaluation Working Group (GRADE) approach to rate the overall quality of the evidence. For all comparisons, we rated the evidence as low or very low quality for parental depression and secure or disorganised infant attachment. Where we downgraded the evidence, it was because there was risk of bias in the study design or execution of the trial. The included studies also involved relatively few participants and wide CI values (imprecision), and, in some cases, we detected clinical and statistical heterogeneity (inconsistency). Lower quality evidence resulted in lower confidence in the estimate of effect for those outcomes. AUTHORS' CONCLUSIONS Although the findings of the current review suggest that PIP is a promising model in terms of improving infant attachment security in high-risk families, there were no significant differences compared with no treatment or treatment-as-usual for other parent-based or relationship-based outcomes, and no evidence that PIP is more effective than other methods of working with parents and infants. Further rigorous research is needed to establish the impact of PIP on potentially important mediating factors such as parental mental health, reflective functioning, and parent-infant interaction.
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Affiliation(s)
- Jane Barlow
- Warwick Medical SchoolDivision of Mental Health and WellbeingUniversity of WarwickGibbett Hill RoadCoventryUKCV4 7LF
| | - Cathy Bennett
- Coventry UniversityCentre for Technology Enabled Health Research (CTEHR)Priory StreetCoventryUKCV1 5FB
| | - Nick Midgley
- University College LondonResearch Department of Clinical, Educational and Health PsychologyGower StreetLondonUKWC1E 6BT
| | - Soili K Larkin
- University of WarwickDivision of Health SciencesGibbets Hill RoadCoventryUKCV4 7AL
| | - Yinghui Wei
- University of PlymouthSchool of Computing and MathematicsPlymouthUK
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Salomonsson MW, Sorjonen K, Salomonsson B. A LONG-TERM FOLLOW-UP OF A RANDOMIZED CONTROLLED TRIAL OF MOTHER-INFANT PSYCHOANALYTIC TREATMENT: OUTCOMES ON THE CHILDREN. Infant Ment Health J 2014; 36:12-29. [DOI: 10.1002/imhj.21478] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Rodrigo A, van der Veer R, Vermeer HJ, van IJzendoorn MH. From foundling homes to day care: a historical review of childcare in Chile. CAD SAUDE PUBLICA 2014; 30:461-72. [DOI: 10.1590/0102-311x00060613] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 01/13/2014] [Indexed: 11/22/2022] Open
Abstract
This article discusses significant changes in childcare policy and practice in Chile. We distinguish four specific periods of childcare history: child abandonment and the creation of foundling homes in the 19th century; efforts to reduce infant mortality and the creation of the health care system in the first half of the 20th century; an increasing focus on inequality and poverty and the consequences for child development in the second half of the 20th century; and, finally, the current focus on children’s social and emotional development. It is concluded that, although Chile has achieved infant mortality and malnutrition rates comparable to those of developed countries, the country bears the mark of a history of inequality and is still unable to fully guarantee the health of children from the poorest sectors of society. Recent initiatives seek to improve this situation and put a strong emphasis on the psychosocial condition of children and their families.
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Affiliation(s)
- A Rodrigo
- Leiden University, The Netherlands; Universidad de Magallanes, Chile
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17
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Baker-Henningham H. The role of early childhood education programmes in the promotion of child and adolescent mental health in low- and middle-income countries. Int J Epidemiol 2013; 43:407-33. [DOI: 10.1093/ije/dyt226] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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18
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Bryanton J, Beck CT, Montelpare W. Postnatal parental education for optimizing infant general health and parent-infant relationships. Cochrane Database Syst Rev 2013:CD004068. [PMID: 24284872 DOI: 10.1002/14651858.cd004068.pub4] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Many learning needs arise in the early postpartum period, and it is important to examine interventions used to educate new parents about caring for their newborns during this time. OBJECTIVES The primary objective was to assess the effects of structured postnatal education delivered to an individual or group related to infant general health or care and parent-infant relationships. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 March 2013). SELECTION CRITERIA We included randomized controlled trials of any structured postnatal education provided to individual parents or groups of parents within the first two months post-birth related to the health or care of an infant or parent-infant relationships. DATA COLLECTION AND ANALYSIS Two review authors (JB, CTB) assessed trial quality and extracted data from published reports. MAIN RESULTS Of the 27 trials (3949 mothers and 579 fathers) that met the inclusion criteria, only 15 (2922 mothers and 388 fathers) reported useable data. Educational interventions included: five on infant sleep enhancement, 12 on infant behaviour, three on general post-birth health, three on general infant care, and four on infant safety. Details of the randomization procedures, allocation concealment, blinding, and participant loss were often not reported. Of the outcomes analyzed, only 13 were measured similarly enough by more than one study to be combined in meta-analyses. Of these 13 meta-analyses, only four were found to have a low enough level of heterogeneity to provide an overall estimate of effect. Education about sleep enhancement resulted in a mean difference of 29 more night-time minutes of infant sleep in 24 hours at six weeks of age (95% confidence interval (CI) 18.53 to 39.73) than usual care. However, it had no significant effect on the mean difference in minutes of crying time in 24 hours at six weeks and 12 weeks of age. Education related to infant behaviour increased maternal knowledge of infant behaviour by a mean difference of 2.85 points (95% CI 1.78 to 3.91). AUTHORS' CONCLUSIONS The benefits of educational programs to participants and their newborns remain unclear. Education related to sleep enhancement appears to increase infant sleep but appears to have no effect on infant crying time. Education about infant behaviour potentially enhances mothers' knowledge; however more and larger, well-designed studies are needed to confirm these findings.
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Affiliation(s)
- Janet Bryanton
- School of Nursing, University of Prince Edward Island, 550 University Avenue, Charlottetown, Canada, C1A 4P3
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Abstract
BACKGROUND Structured antenatal education programs for childbirth or parenthood, or both, are commonly recommended for pregnant women and their partners by healthcare professionals in many parts of the world. Such programs are usually offered to groups but may be offered to individuals. OBJECTIVES To assess the effects of this education on knowledge acquisition, anxiety, sense of control, pain, labour and birth support, breastfeeding, infant-care abilities, and psychological and social adjustment. SEARCH STRATEGY We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (April 2006), CINAHL (1982 to April 2006), ERIC (1984 to April 2006), EMBASE (1980 to April 2006) and PsycINFO (1988 to April 2006). We handsearched the Journal of Psychosomatic Research from 1956 to April 2006 and reviewed the reference lists of retrieved studies. SELECTION CRITERIA Randomized controlled trials of any structured educational program provided during pregnancy by an educator to either parent that included information related to pregnancy, birth or parenthood. The educational interventions could have been provided on an individual or group basis. Educational interventions directed exclusively to either increasing breastfeeding success, knowledge of and coping skills concerning postpartum depression, improving maternal psycho-social health including anxiety, depression and self-esteem or reducing smoking were excluded. DATA COLLECTION AND ANALYSIS Both authors assessed trial quality and extracted data from published reports. MAIN RESULTS Nine trials, involving 2284 women, were included. Thirty-seven studies were excluded. Educational interventions were the focus of eight of the studies (combined n = 1009). Details of the randomization procedure, allocation concealment, and/or participant accrual or loss for these trials were not reported. No consistent results were found. Sample sizes were very small to moderate, ranging from 10 to 318. No data were reported concerning anxiety, breastfeeding success, or general social support. Knowledge acquisition, sense of control, factors related to infant-care competencies, and some labour and birth outcomes were measured. The largest of the included studies (n = 1275) examined an educational and social support intervention to increase vaginal birth after caesarean section. This high-quality study showed similar rates of vaginal birth after caesarean section in 'verbal' and 'document' groups (relative risk 1.08, 95% confidence interval 0.97 to 1.21). AUTHORS' CONCLUSIONS The effects of general antenatal education for childbirth or parenthood, or both, remain largely unknown. Individualized prenatal education directed toward avoidance of a repeat caesarean birth does not increase the rate of vaginal birth after caesarean section.
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Affiliation(s)
- A J Gagnon
- McGill University/McGill University Health Center, School of Nursing and Department of Obstetrics and Gynaecology, 3506 University Street, Montreal, Quebec, Canada, H3A 2A7.
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