Women's perceptions of partner support and conflict in the development of postpartum depressive symptoms

Psychometric evaluation of the Indonesian version of paternal breastfeeding self-efficacy scale- short form: A confirmatory factor analysis

BACKGROUND

Fathers play a significant role in supporting sustaining exclusive breastfeeding. It is crucial to assess paternal confidence in assisting mothers during breastfeeding.

RESEARCH AIM

This study evaluated the psychometric properties of the Paternal Breastfeeding Self-Efficacy Scale- Short Form among Indonesian fathers.

METHODS

A cross-sectional study was conducted among 462 fathers whose wives gave birth to the baby in public hospitals in Indonesia. The internal consistency and test-retest reliability were examined using Cronbach's alpha and intraclass correlation coefficient. We evaluated the convergent, divergent, predictive, and construct validity.

RESULTS

Confirmatory factor analysis demonstrated a one-factor structure model with satisfactory fit indices. The Cronbach's alpha (0.96), McDonald's Omega coefficient (0.97), and intraclass correlation coefficient (0.99) indicated an excellent reliability of the scale. The father's breastfeeding self-efficacy was positively correlated with the mother's breastfeeding self-efficacy (r= 0.251, p < .001), and negatively associated with symptoms of depression (r = -0.150, p < .01) and anxiety (r = -0.314, p < .001). We also found a positive correlation between BSES-SF and exclusive breastfeeding at two weeks postpartum (r = 0.538, p < .001). Fathers who were employed and their partner was multipara, had a vaginal birth, practiced skin-to-skin contact and rooming-in, and exclusive breastfeeding were more confident to support their partner's breastfeeding.

CONCLUSIONS

The Indonesian version of the paternal Breastfeeding Self-Efficacy Scale- Short Form is a reliable and valid tool for screening and assessing fathers' confidence in assisting mothers in breastfeeding.

Partner support for women's antidepressant treatment and its association with depressive symptoms in pregnant women, mothers, and women planning pregnancy

PURPOSE

To examine the association between partner support for women's antidepressant treatment and depressive symptoms in pregnant women, those planning pregnancy, and mothers who ever used antidepressants.

METHODS

We included 334 women (n=44 planners, n=182 pregnant, n=108 mothers) ever treated with antidepressants within the HEALTHx2 study, a web-based cross-sectional study conducted across Norway in June 2020 to June 2021. The Edinburgh Postnatal Depression Scale and two questions of the Patient Health Questionnaire measured depressive symptoms, by degree of severity and for depressed mood, anxiety, and anhedonia sub-dimensions. Partner support was measured using one item from the Antidepressant Compliance Questionnaire. Association was estimated via unadjusted and adjusted linear and logistic regression models.

RESULTS

Being unsupported by the partner was associated with increased odds of reporting moderate-to-very-severe depressive symptoms in mothers (adjusted odds ratio (aOR), 3.57; 95% confidence interval (CI), 1.04-12.19) and pregnant women (aOR, 3.26; 95% CI, 0.95-11.14), relative to being supported. Pregnant women (adjusted mean difference (β), 0.76; 95% CI, 0.14-1.38) and mothers (β, 0.93; 95% CI, 0.23-1.64) with no support for their antidepressant treatment presented greater symptoms of anhedonia; for women planning pregnancy, this association emerged in relation to anxiety symptoms (β among non-users of antidepressant, 2.58; 95% CI, 1.04-4.13).

CONCLUSIONS

Partner support for women's antidepressant treatment may play a key role in depressive symptoms severity and the subtypes of anhedonia and anxiety, among women planning pregnancy, pregnant women, and mothers. This highlights the importance of partner inclusion in the complex decision-making process for antidepressant treatment around the time of pregnancy.

Attachment expectations moderate links between social support and maternal adjustment from 6 to 18 months postpartum

Significant links exist between one's perception of available social support and mental health outcomes, including during the transition to motherhood. Yet, attachment theory posits that individuals do not benefit equally from social support. As such, we examined the influence of attachment representations (i.e., secure base script knowledge) as they potentially moderate links between social support and psychological distress in a 1-year longitudinal study of an ethnically diverse (56% White) sample of infant-mother dyads. We hypothesized that higher social support would predict lower maternal psychological distress and this relation would be strongest in those with higher secure base script knowledge. Results indicated that maternal perceptions of social support were significantly negatively correlated with psychological distress. Analyses revealed that secure base script scores significantly moderated these associations. Interestingly, for those high in script knowledge, low social support predicted greater psychological distress. For those low in script knowledge, social support was unrelated to psychological distress. This pattern suggested that those who expect care (i.e., high secure base script knowledge) but receive minimal support (i.e., low perceived social support) find motherhood uniquely dysregulating. Practitioners may do well to examine individuals' attachment expectations in relation to their current social support.

Association between nonbirthing parent's perinatal education and mental health support desires and perinatal anxiety among either parent

BACKGROUND

Although perinatal anxiety is common in birthing and nonbirthing parents, little is known about the mental health or educational needs of nonbirthing parents during the perinatal period and whether perinatal anxiety in the birthing parent is associated with nonbirthing parent educational preferences.

OBJECTIVE

This study aimed to examine the desired digital perinatal educational preferences of nonbirthing parents and whether these preferences differed by (1) endorsement of high parenthood-related anxiety in the nonbirthing partner and (2) mental health of the birthing parent (including both identified mental health conditions and presence of pregnancy-related anxiety).

STUDY DESIGN

In this cross-sectional study, nonbirthing and birthing parents using Maven, a digital perinatal health platform, selected the areas in which they wanted education or support from a list of options. In addition, the participants reported their experience of parenthood or pregnancy-related anxiety through a 5-item Likert scale in response to the prompt, "On a scale of 1 (not at all) to 5 (extremely), how anxious are you feeling about parenthood or pregnancy?" High parenthood or pregnancy-related anxiety was defined as being very (scale: 4) or extremely (scale: 5) anxious. Furthermore, birthing parents reported whether they had a current or previous mood disorder, but this information was not reported by nonbirthing parents. Survey responses for birthing and nonbirthing parents were linked through the digital platform. Descriptive analyses were used to assess nonbirthing parent demographics and perinatal support interests, stratified by high parenthood-related anxiety, high pregnancy-related anxiety in their partner, and perinatal mood disorders or high pregnancy-related anxiety in their partner.

RESULTS

Among 382 nonbirthing parents, most (85.6%) desired to receive digital support during their partner's pregnancy: the most commonly endorsed support interests were infant care (327 [85.6%]) and understanding their partner's emotional (313 [81.9%]) or physical (294 [77.0%]) experience during pregnancy. Overall, 355 nonbirthing parents (93.9%) endorsed any parenthood-related anxiety, and 63 nonbirthing parents (16.5%) were categorized as having high parenthood-related anxiety. Those with high parenthood-related anxiety were more likely to desire digital support for each topic. Among birthing parents, 124 (32.4%) had a mental health condition, and 45 (11.8%) had high pregnancy-related anxiety. When nonbirthing parents were stratified by the presence of their partner having a mental health condition or high pregnancy-related anxiety alone, no difference in desired perinatal education was identified. Although nonbirthing parents had higher rates of high parenthood-related anxiety if the birthing parent reported high pregnancy anxiety (17 [27.0%] vs 28 [8.8%]; P<.001), no difference was found with other conditions within the mental health composite.

CONCLUSION

In this cross-sectional study, many nonbirthing parents who engaged with a perinatal digital platform desired education on their or their partner's emotional health during the perinatal period, and most endorsed parenthood-related anxiety. Our findings suggest that perinatal mental health support is needed for nearly all parents and that nonbirthing parents who use digital health platforms are amenable to receiving comprehensive perinatal education via these platforms.

Psychosocial predictors of early postpartum depressive and anxious symptoms in primiparous women and their partners

BACKGROUND

While the majority of research on postpartum depressive and anxious symptoms has focused on mothers, a growing body of research suggests a need to understand the role of the partner's health and relationship quality as predictors of postpartum maternal depression, while also better understanding correlates of partner or paternal depression in the postpartum period. The purpose of the current study is to evaluate mother and partner stress, anxiety, mood, infant care support, and relationship quality as predictors of perinatal depressive and anxious symptoms in first time mothers and partners during the postpartum hospital stay.

METHODS

First time parent couples (n = 116) completed a survey during the two-day postpartum stay in a Midwest hospital. Depressive (EPDS) and anxiety symptoms (DASS-21-Anxiety) were assessed in both mothers and partners. Hierarchical linear regression was used to evaluate relationship satisfaction, partner infant care support, stress, and co-parent mood as predictors of mood in mothers and partners separately.

RESULTS

Stress was a predictor of anxiety and depression symptoms in both mothers and partners. Additionally, co-parent anxiety significantly predicted anxiety in both mothers and partners. Maternal relationship satisfaction was a predictor of the partner's depressive symptoms, and maternal perceptions of partner infant support predicted maternal depressive symptoms.

CONCLUSIONS

Together, these results suggest that stress, relationship satisfaction, and co-parent mood are related to depressive and anxious symptoms in mothers and partner, underscoring the need to continue exploring mother and partner mental health in a dyadic framework.

The Relationship Between a Lifetime History of Sexual Victimization and Perinatal Depression: A Systematic Review and Meta-Analysis

BACKGROUND

The association between a lifetime history of sexual victimization and the well-being of women during the perinatal period has received increasing attention. However, research investigating this relationship has yet to be systematically reviewed or quantitatively synthesized.

AIM

This systematic review and meta-analysis aims to calculate the pooled effect size estimate of the statistical association between a lifetime history of sexual victimization and perinatal depression (PND).

METHOD

Four bibliographic databases were systematically searched, and reference harvesting was conducted to identify peer-reviewed articles that empirically examined associations between a lifetime history of sexual victimization and PND. A random effects model was used to ascertain an overall pooled effect size estimate in the form of an odds ratio and corresponding 95% confidence intervals (CIs). Subgroup analyses were also conducted to assess whether particular study features and sample characteristic (e.g., race and ethnicity) influenced the magnitude of effect size estimates.

RESULTS

This review included 36 studies, with 45 effect size estimates available for meta-analysis. Women with a lifetime history of sexual victimization had 51% greater odds of experiencing PND relative to women with no history of sexual victimization (OR = 1.51, 95% CI [1.35, 1.67]). Effect size estimates varied considerably according to the PND instrument used in each study and the racial/ethnic composition of each sample.

CONCLUSION

Findings provide compelling evidence for an association between a lifetime history of sexual victimization and PND. Future research should focus on screening practices and interventions that identify and support survivors of sexual victimization perinatally.

Perinatal Mental Health Disorders: A Review of Lessons Learned from Obstetric Care Settings

Perinatal mental health has garnered significant attention within obstetrics over the last couple of decades as the long- and short-term morbidities of untreated perinatal mental health disorders on both the mother and fetus/neonate have become increasingly apparent. There have been major strides in increasing screening for perinatal mental health disorders, clinician comfort with prescribing common psychiatric medications, and integrating mental health professionals into prenatal care via health services approaches such as the collaborative care model. Despite these advances, however, gaps still remain in the tools used for screening and diagnosis, obstetric clinician training in diagnosis and management of perinatal mood and anxiety disorders, as well as patient access to mental health care during pregnancy and especially postpartum. Herein we review the state of perinatal mental health from the perspective of the obstetric provider and identify areas of ongoing innovation.

Depressive Symptoms and Conflict Behaviors: A Test of the Stress Generation Hypothesis in Romantic Couples During the COVID-19 Pandemic

Introduction: In early 2020, North American jurisdictions required households (e.g., romantic couples) to isolate together to help mitigate the spread of COVID-19. This study provides a first look at the interplay of depressive symptoms and conflict behaviors among isolating couples, including tests of predictions of the stress generation hypothesis. Methods: Mixed-gender couples residing in Canada (N = 711) completed online measures across two waves. We used the actor-partner interdependence mediation model, with Wave 1 depressive symptoms as the predictor, Wave 1 conflict enactment as the mediator, and Wave 2 depressive symptoms as the outcome. Results: Depressive symptoms showed stability across Wave 1 and 2. Wave 1 depressive symptoms showed associations with Wave 1 conflict enactment. For men (but not women), Wave 1 conflict enactment was associated with their own and their partner's Wave 2 depressive symptoms. For both partners, Wave 1 conflict enacted by men mediated the association between Wave 1 depressive symptoms and Wave 2 depressive symptoms. Discussion: Our study confirms and extends the stress generation hypothesis to the pandemic context, showing that depressive symptoms may partially contribute to conflict for isolating couples and that conflict behaviors enacted by men toward their partner can exacerbate depressive symptoms in both partners.

Partner relationship quality, social support and maternal stress during pregnancy and the first COVID-19 lockdown

Introduction: Pregnancy has been associated with diminished maternal mental health and a deterioration in partner relationship quality. The recent COVID-19 quarantine measures have created additional stressors for pregnant women due to isolation and a surge in partner conflict.Objective: The purpose of this study was to assess how partner relationship conflict and social support may mediate mental health outcomes during the COVID-19 lockdown.Methods: A cross-sectional study with a sample of 152 pregnant women using psychological measures, (i.e. Prenatal Distress Questionnaire, Symptom Checklist-90-R, Duke-UNC-11 Functional Social Support Questionnaire, Perceived Stress Scale). Demographic characteristics, obstetrics history, and partner relationship conflict were assessed using questionnaires.Results: While there were few reports of physical violence in this sample, between 18% and 59% of women reported partner relationship conflict on the psychological subscale (e.g. afraid of one's partner or screamed at by one's partner). Further, the psychological subscale was significantly associated with symptoms of psychopathology. There was a significant negative association between social support and pregnancy-specific stress (p = .005), and perceived stress (p= .038).Conclusions: These findings suggest that partner relationship conflict and social support may act as important buffers for prenatal mental health in childbearing women during vulnerable situations, such as the COVID-19 pandemic.

Sources of social support for postpartum women with a history of childhood maltreatment: Consequences for perceived stress and general mental health in the first year after birth

BACKGROUND

Women with a history of childhood maltreatment (CM) experience the postpartum period as particularly stressful and may benefit less from social support, implicating a higher risk for mental health problems and higher stress levels in mothers with CM.

OBJECTIVE

Thus, we investigated the complex relationship of CM and social support provided by different sources (intimate partner, parents, parents-in-law, friends) in predicting stress perception and mental health over the course of the first year postpartum.

PARTICIPANTS

In N = 295 postpartum women we assessed CM experiences, stress perception, perceived social support and general mental health 3 and 12 months postpartum.

METHOD

Linear mixed effect models were used to examine the course of social support over the first year postpartum and path analyses were used to investigate mediation and moderation effects.

RESULTS

We found that CM was linked to lower levels of perceived social support, accounted for more mental health problems, and amplified the negative association between perceived stress and maternal mental health. Most importantly, we showed that only partner support was beneficial for maternal mental health, and this association was mediated by reductions in perceived stress.

CONCLUSION

CM as a major risk factor for mental health impairs the stress resilience of affected postpartum women. Extending previous research, our results reveal that the source of postpartum social support determines its benefits for maternal health. Our findings emphasize the need of at-risk mothers to be provided with additional sources of support to cope with daily practical, organizational and emotional challenges.

Father involvement, couple relationship quality, and maternal Postpartum Depression: the role of ethnicity among low-income families

OBJECTIVES

Maternal postpartum depression (PPD) has been recognized as a serious and wide-spread mental health disorder that has long-term negative impacts on children's cognitive, social, and emotional development. This study extends prior research by examining the associations among predictors of PPD, including two different facets of father involvement and couple relationship quality, with a focus on testing these pathways across ethnic groups.

METHOD

This study analyzed data from the Fragile Families and Child Wellbeing Study (FFCWS) including mothers' baseline interviews and one-year follow-up data sets (n = 2,794). Several models were tested using bootstrapping in structural equation modeling to explore the mediating paths and ethnic differences.

RESULTS

This study found that father involvement in sharing childcare responsibility had direct effects on reducing mothers' parenting stress and promoted maternal psychological adjustment, which was consistent across the three ethnic groups. The mediation pathways through couple relationship quality between father involvement (both father involvement in direct infant care and shared responsibilities) and PPD were detected significant for Black and white mothers.

CONCLUSIONS FOR PRACTICE

This study provided empirical evidence that father involvement in infant care is critical for mothers' perceived relationship quality. Maternal postpartum mental health may benefit from interventions and policies that encourage positive father engagement in infant care.

The postpartum period during the COVID-19 pandemic: investigating Turkish women's postpartum support and postpartum-specific anxiety

OBJECTIVES

This study aimed to examine how Turkish women were affected by the COVID-19 pandemic in the postpartum period in terms of postpartum support and anxiety variables.

METHODS

The study was conducted with 130 women who gave birth during the COVID-19 period. Data were collected online using a personal information form, Postpartum Support Scale and Postpartum Specific Anxiety Scale. Descriptive statistics were used, with Kruskal-Wallis and regression analysis performed.

RESULTS

All postpartum women stated that they were affected negatively by COVID-19. The most common issues described were feeling alone (25.51%), having economic difficulties (15.5%) and experiencing difficulties accessing health services (21.7%). The mean Postpartum Support Scale score was 102.43 ± 27.67, while the mean Postpartum Specific Anxiety Scale score was 188.07 ± 96.71. COVID-19 exposure level had a significant effect on postpartum-specific anxiety (p=0.00). The variables of having a problem during pregnancy (p=0.006), having a baby willingly (p=0.007), and partner's educational status significantly predicted the degree of being affected by COVID-19 (p=0.025). The degree to which COVID-19 affected the women was determined by having problems during pregnancy, having a baby willingly, and a highly educated partner.

CONCLUSIONS

These variables may inform a resource to empower postpartum women during COVID-19. Healthcare systems need to be organised considering pandemic conditions to provide increased postpartum support, evaluate psychological health, deliver healthcare services, and consider pregnancy periods.

Causal model of the association of social support during pregnancy with a perinatal and postpartum depressive state: A nationwide birth cohort - the Japan Environment and Children's Study

BACKGROUND

Despite many epidemiological studies on the relationship between social support during pregnancy and perinatal/postpartum depression, its impact remains unclear. Therefore, this study examined this association using a causal model of risk based on various levels of social support.

METHODS

Participants were 88,711 mothers in an ongoing nationwide birth cohort study in Japan. Social support during pregnancy was set at four treatment levels. Depressive state was identified twice, with the Kessler Psychological Distress Scale (K6; score ≥ 5) and the Edinburgh Postnatal Depression Scale (EPDS; score ≥ 9). With the highest level of social support set as reference, marginal structural models were fitted to derive counterfactual risk ratios (cRRs).

RESULTS

cRRs (95% CIs) for EPDS cases increased as the level of social support decreased, with values of 1.06 (0.99-1.13) for upper-middle, 1.30 (1.23-1.39) for lower-middle, and 1.61 (1.52-1.71) for low. Also, cRRs (95% CIs) at the second measurement (interaction) tended to increase as social support decreased, with values of 1.05 (0.97-1.13) for upper-middle, 1.05 (0.98-1.13) for lower-middle, and 1.10 (1.03-1.18) for low. The same tendency was observed in K6 cases.

LIMITATION

Depressive state was identified by self-administered questionnaire.

CONCLUSIONS

Lower social support during pregnancy is associated with increased counterfactual risk of perinatal/postpartum depressive state and worsened counterfactual spontaneous recovery over time. These findings highlight the importance of sufficient social support for preventing perinatal/postpartum depression and promoting recovery.

TRIAL REGISTRATION

UMIN000030786.

Emergency cesarean section is a risk factor for depressive symptoms when breastfeeding is limited

OBJECTIVE

Previous studies indicated associations between cesarean section (CS), breastfeeding, and depressive symptoms. There is, however, little research integrating these variables into one model to analyze their interrelations. The aim of this observational prospective longitudinal study is to examine whether the effect of CS on postpartum depressive symptoms is mediated by difficulties with breastfeeding.

METHODS

The participants were recruited in 5 maternity hospitals during their prenatal medical check-ups. Breastfeeding status was self-reported by the mothers six weeks postpartum. Screening for depressive symptoms was performed at six weeks (N = 404) and nine months (N = 234) postpartum using the Edinburgh Postnatal Depression Scale. Path analysis was used to model the relations between CS, breastfeeding, and depressive symptoms.

RESULTS

No direct effects of CS on depressive symptoms at six weeks or nine months postpartum were found. CS was associated with a lower probability of exclusive breastfeeding, which was, in turn, associated with higher levels of depressive symptoms six weeks postpartum. The analysis stratified by type of CS revealed that the effect on breastfeeding only occurred with emergency, not planned, CS. The effect of CS on breastfeeding was noticeably stronger in women without versus with a history of depression.

CONCLUSION

Emergency CS predicts breastfeeding difficulties, which are, in turn, associated with higher levels of depressive symptoms. Support should be provided to mothers with emergency CS and breastfeeding problems to reduce the risk of postpartum depressive symptoms in the early postpartum period.

Pilot Testing a Brief Partner-Inclusive Hybrid Intervention for Perinatal Mood and Anxiety Disorders

The necessity of hybrid and more accessible options for perinatal mood and anxiety disorders (PMADs) has taken on increased urgency in the wake of the COVID-19 pandemic and its lasting impacts. In the New Family Wellness Project (NFWP), participants engage in a hybrid in-person and teletherapy six-session intervention for new parents early in their postpartum period. This small, phase 1 clinical research examined early outcomes of the NFWP's cognitive behavioral intervention on adverse mental health outcomes (i.e., perinatal depression and anxiety, overall mental illness symptoms) and adaptive outcomes and protective factors (i.e., relational health, social support, flourishing, self-efficacy). Despite a small sample size (N = 12), paired t-tests yielded significant effects for improvements in mental health symptoms at posttest, as well as marginally significant improvements in postpartum anxiety and self-efficacy. Findings suggest the brief, partner-inclusive, hybrid intervention shows promise for further study. Lessons learned from this small phase 1 clinical study and recommendations for revising the intervention prior to future trials are discussed.

Associations between postpartum depression and assistance with household tasks and childcare during the COVID-19 pandemic: evidence from American mothers

BACKGROUND

The early postpartum period is recognized cross-culturally as being important for recovery, with new parents receiving increased levels of community support. However, COVID-19-related lockdown measures may have disrupted these support systems, with possible implications for mental health. Here, we use a cross-sectional analysis among individuals who gave birth at different stages of the pandemic to test (i) if instrumental support access in the form of help with household tasks, newborn care, and care for older children has varied temporally across the pandemic, and (ii) whether access to these forms of instrumental support is associated with lower postpartum depression scores.

METHODS

This study used data from the COVID-19 And Reproductive Effects (CARE) study, an online survey of pregnant persons in the United States. Participants completed postnatal surveys between April 30 - November 18, 2020 (n = 971). Logistic regression analysis tested whether birth timing during the pandemic was associated with odds of reported sustained instrumental support. Linear regression analyses assessed whether instrumental support was associated with lower depression scores as measured via the Edinburgh Postnatal Depression survey.

RESULTS

Participants who gave birth later in the pandemic were more likely to report that the pandemic had not affected the help they received with household work and newborn care (p < 0.001), while access to childcare for older children appeared to vary non-linearly throughout the pandemic. Additionally, respondents who reported that the pandemic had not impacted their childcare access or help received around the house displayed significantly lower depression scores compared to participants who reported pandemic-related disruptions to these support types (p < 0.05).

CONCLUSIONS

The maintenance of postpartum instrumental support during the pandemic appears to be associated with better maternal mental health. Healthcare providers should therefore consider disrupted support systems as a risk factor for postpartum depression and ask patients how the pandemic has affected support access. Policymakers seeking to improve parental wellbeing should design strategies that reduce disease transmission, while facilitating safe interactions within immediate social networks (e.g., through investment in COVID-19 testing and contact tracing). Cumulatively, postpartum instrumental support represents a potential tool to protect against depression, both during and after the COVID-19 pandemic.

Einbezug der Väter in die stationäre Mutter-Kind-Therapie: „Mit Papa geht es besser“

Hintergrund

Obwohl Forschungsbefunde auf einen großen väterlichen Einfluss hinweisen, gibt es bislang kaum Interventionsprogramme und wissenschaftliche Studien, die den systematischen Einbezug von Vätern in die stationäre Mutter-Kind-Behandlung zum Gegenstand haben.

Ziel der Arbeit

Die Studie untersucht, wie sich der Einbezug von Vätern auf das Outcome stationärer Mutter-Kind-Behandlungen bei postpartalen psychischen Störungen auswirkt. In dieser Pilotstudie wird das Programm „Mit Papa geht es besser“ vorgestellt.

Methodik

Fünfzehn Partner/Kindsväter von behandelten Mutter-Kind-Dyaden durchliefen ein strukturiertes Begleitprogramm parallel zur Mutter-Kind-Behandlung („Mit Papa geht es besser“). Die Mütter in Behandlung wurden in einem Prä-post-Design zu ihrer Symptomatik (Symptom-Checklist 90, SCL-90), Mutter-Kind-Bindung (Parental Bonding Questionnaire, PBQ) und Partnerschaftszufriedenheit (Kurzversion des Partnerschaftsfragebogens, PFB-K) befragt. Diese Gruppe wurden mit einer historischen Kontrollgruppe von 30 behandelten Müttern verglichen, die die Behandlung wie bisher („treatment as usual“, TAU) durchliefen. Die Gruppen wurden post hoc mithilfe einer „Inverse-probability-of-treatment-weighting“(IPTW)-Schätzung von Propensity Scores (PS) balanciert.

Ergebnisse

Mütter in allen Versuchsbedingungen profitierten von der stationären Behandlung. Mütter in der Interventionsgruppe wiesen im Hinblick auf die Zielvariablen ein tendenziell verbessertes Outcome auf, insbesondere für die Veränderung der Partnerschaftszufriedenheit, die Unterschiede erreichten aber keine statistische Signifikanz.

Schlussfolgerung

Die Befunde weisen darauf hin, dass Mütter in stationärer Mutter-Kind-Behandlung vom Einbezug der Väter profitieren könnten. Die Intervention soll nun im Rahmen eines randomisierten kontrollierten Studiendesigns an einer größeren Stichprobe auf ihre Wirksamkeit überprüft werden.

Maternal Mental Health Disorders Following Very Preterm Birth at 5 Years Post-Birth

OBJECTIVE

Mothers of children born very preterm (VP) are at increased risk of developing postnatal depression, anxiety, and post-traumatic stress symptoms. However, mental health disorder rates are rarely assessed in this population compared with full-term peers, and it is unclear if postnatal distress symptoms precede higher rates of maternal mental health disorders at 5 years post-birth in both birth groups.

METHODS

Mothers of children born VP (n = 65; mean [SD] age at birth, 33.9 [5.0]; 72.1% tertiary educated) and full-term (n = 90; mean [SD] age at birth, 33.4 [4.0]; 88.2% tertiary educated) completed questionnaires assessing symptoms of depression, anxiety, and trauma within 4 weeks of birth. At 5 years post-birth, they participated in a structured diagnostic interview assessing mood, anxiety, and trauma-related mental health disorders, both current and over the lifetime.

RESULTS

There was little evidence for differences between mothers in the VP and full-term groups in rates of any mental health disorder at 5 years (VP = 14%, full-term = 14%) or lifetime (VP = 41%, full-term = 37%). In mothers of children born VP, elevated postnatal post-traumatic stress symptoms were associated with higher rates of mental health disorders at 5 years (odds ratio = 21.5, 95% confidence interval = 1.35-342).

CONCLUSIONS

Findings suggest that preterm birth may not lead to increased odds of later developing maternal mental health disorders, despite known risks of elevated postnatal distress following a VP birth. However, those with post-traumatic stress symptoms following a VP birth could be more vulnerable, and assessment and monitoring is recommended.

The role of adverse childhood experience and social support type in postpartum depression in Turkey

BACKGROUND

Improved knowledge of causal and protective factors is crucial for Postpartum depression (PPD) prevention and management.

AIMS

To investigate the relationship between adverse childhood experience (ACE), perceived social support and PPD in a middle-income non-Western country, and to investigate which type of ACE and which sources of social support were associated with PPD.

METHODS

The study was cross-sectional study and conducted in a one center from Turkey during March-June 2019. Women up to 1-week postpartum were included in the study. The Edinburgh Postpartum Depression Scale (EPDS), a validated ACE questionnaire, and the Multidimensional Scale of Perceived Social Support were completed.

RESULTS

Nine hundred women took part in the study. The proportion identified with PPD and ACE were 10% and 8.8%, respectively. In bivariate analysis, having previous PPD, unwanted pregnancy, insufficient antenatal care, low family income, history of ACE, and perception of low social support were associated with PPD (p < 0.05). Family support was perceived as beneficial, in both women with no history or ≥2 instances of ACE. However, perceived support from friends and/or a special person was lowest in the ≥2 ACE group (p < 0.05). In logistic regression, unwanted pregnancy, emotional abuse, and neglect, incarceration of a household member, and poor special person support were factors significantly associated with developing PPD (p = 0.005).

CONCLUSIONS

Emotional abuse, neglect, household dysfunction, and perceived poor support from a special person were risk factors for PPD. A history of maternal childhood trauma and poor social support might indicate the need for early PPD interventions.

The Before Baby Relationship Checkup: A Couples-Based Intervention to Reduce Relationship Risk Factors for Perinatal Mood and Anxiety Disorders

Relationship conflict and lack of partner support are risk factors for perinatal mood and anxiety disorders. An intervention to strengthen couples' relationships before birth may reduce relationship risk factors for perinatal mood and anxiety disorders, though no research has explored this to date. The aims of this Stage 1 open-series non-experimental proof of concept study were to adapt the 'Marriage Checkup', an evidence-based intervention for relationship distress, as a preventative intervention for perinatal mood and anxiety disorders and to assess its feasibility and acceptability. Pregnant women receiving care at a university-based obstetric practice, and their partners, were recruited. Ten couples participated in the Before Baby Relationship Checkup, a personalized relationship health service offered in the obstetric clinic. Quantitative and qualitative data gathered suggests the intervention is feasible to implement in an obstetric setting, and acceptable to perinatal couples. Specific adaptations to the Marriage Checkup for perinatal couples are warranted and further testing is needed to evaluate efficacy.

Prenatal predictors of postpartum depression trajectories from birth to 24 months amongst smoking women

AIMS AND OBJECTIVES

We aimed to identify postpartum depression (PPD) trajectories and examine relevant predictors amongst smoking women.

BACKGROUND

PPD can adversely affect families. Predictors of PPD trajectories amongst smoking women are understudied.

DESIGN

Longitudinal cohort study.

METHODS

A cohort of 49 U.S. women (current or ex-smoking) completed the Edinburgh Postnatal Depression Scale from birth to 24 months postpartum. Latent class growth modelling was used to identify PPD trajectories. Predictors of PPD trajectories were identified, adjusting for confounders. Effect modification by prenatal Patient Health Questionnaire (PHQ) depression score was also assessed. STROBE guidelines were followed in reporting results.

RESULTS

Three PPD trajectories were identified: non-PPD, transient PPD and chronic PPD. In multinomial logistic regression, social support was associated with lower odds of membership in the chronic PPD trajectory compared to non-PPD trajectory: being married or having a partner sharing resources (odds ratio OR = .14 [.02, .85], p-value = .03), greater partner support (OR = .87 [.77, .98], p-value = .02) and greater family/friends support (OR = .53 [.34, .82], p-value = .004). Transient PPD showed no differences with non-PPD on any predictors. In ordinal logistic regression models, social support was associated with lower odds of membership in a more severe PPD depression trajectory when prenatal PHQ depression score was in the low range (being married or having a partner sharing resources: p for effect modification = .06; partner support: p for effect modification = .05; and family/friends support: p for effect modification = .005).

RELEVANCE TO CLINICAL PRACTICE

Compared to the general population, chronic PPD trajectories were more common amongst smoking women. Social support was an important predictor of more severe PPD trajectories, especially when prenatal depression is low.

CONCLUSION

Our findings indicated that social support might decrease likelihood of severe PPD trajectories, especially when prenatal depression was low. Relevant predictors of transient PPD remained elusive.

Expanding the international conversation with fathers' mental health: toward an era of inclusion in perinatal research and practice

Paternal mental health is beginning to be recognized as an essential part of perinatal health. Historically, fathers were not recognized as being at risk for perinatal mental illnesses or relevant to maternal and infant health outcomes. The purpose of this paper is to provide an overview of paternal perinatal mental health, leading tools to assess paternal depression and anxiety, the impact of paternal mental health on mother and child health, and future directions for the field. An international team of paternal perinatal mental health experts summarized the key findings of the field. Fathers have an elevated risk of depression and anxiety disorders during the perinatal period that is associated with maternal depression and can impact their ability to support mothers. Paternal mental health is uniquely associated with child mental health and developmental outcomes starting from infancy and continuing through the child lifespan. Tailored screening approaches for paternal mental health are essential to support fathers early in the perinatal period, which would offset health risks for the family. Recommendations on paternal mental health are provided on four key areas to support father perinatal mental health: (1) intervention research, (2) clinical training, (3) national policy, and (4) the inclusion of fathers in the focus of the International Marcé Society for Perinatal Mental Health.

Impact of a Face-To-Face Versus Smartphone App Versus Combined Breastfeeding Intervention Targeting Fathers: Randomized Controlled Trial

BACKGROUND

Despite the recognized health and economic benefits of exclusive breastfeeding, few Australian infants are exclusively breastfed beyond 5 months of age. Social support for breastfeeding, in particular the support of an infant's father, has been identified as a crucial element for successful breastfeeding.

OBJECTIVE

The objective of this study was to determine the effectiveness of various father-focused breastfeeding interventions in terms of key infant feeding outcomes.

METHODS

The study was a 4-arm, factorial, randomized controlled trial conducted in Perth, Australia. The trial arms included a control group and 3 interventions, consisting of a face-to-face father-focused antenatal breastfeeding class facilitated by a male peer facilitator; Milk Man, a breastfeeding smartphone app designed specifically for fathers; and a combination of both interventions. Expecting couples were recruited from hospital-based antenatal classes and block randomized to 1 of the 4 arms. Each partner completed surveys at recruitment and at 6 weeks and 26 weeks postpartum. Primary outcomes were duration of exclusive and any breastfeeding. Secondary outcomes included age of introduction of formula and complementary foods, maternal breastfeeding self-efficacy, and partner postpartum support.

RESULTS

A total of 1426 couples were recruited from public (443/1426, 31.1%) and private (983/1426, 68.9%) hospitals. Of these, 76.6% (1092/1426) of fathers completed the baseline questionnaire, 58.6% (836/1426) completed the 6-week follow-up questionnaire, and 49.2% (702/1426) completed the 26-week follow-up questionnaire. The average age of fathers who completed the baseline questionnaire was 33.6 (SD 5.2) years; the majority were born in Australia (76.4%) and had attended university (61.8%). There were no significant differences between the control and any of the intervention groups in any of the infant feeding outcomes or level of breastfeeding self-efficacy and postpartum partner support reported by mothers.

CONCLUSIONS

This study did not demonstrate that any intervention was superior to another or that any intervention was inferior to the standard care delivered in routine antenatal classes. Further studies are needed to test the effectiveness of these interventions in more socioeconomically diverse populations that are likely to benefit most from additional partner supports.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN12614000605695; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12614000605695.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1186/s12884-015-0601-5.

Peripartum depression: Does risk versus diagnostic status impact mother-infant bonding and perceived social support?

BACKGROUND

Peripartum depression (PND) impairs mother-infant boding and perceived social support, yet limited research has examined if women at-risk for PND (AR-PND) also experience impairment. We examined if pregnant women AR-PND, women with PND, and healthy comparison women (HCW) differed in their mother-infant bonding and social support. As PND is highly comorbid with anxiety, we also examined if peripartum anxiety impacted postpartum diagnosis of PND.

METHODS

A total of 144 pregnant women AR-PND or euthymic were assessed twice antepartum and twice postpartum. We utilized regression models to examine the impact of PND risk group status and diagnostic status on mother-infant bonding and perceived social support postpartum. We conducted a sensitivity analysis using a generalized estimating equations model to determine if anxiety (Hamilton Anxiety Rating Scale, HAM-A) across all four time points was associated with the postpartum diagnosis of PND.

RESULTS

Women AR-PND experienced significantly worse mother-infant bonding compared to HCW (p = .03). Women diagnosed with PND experienced significantly worse mother-infant bonding and social support compared to HCW (p = .001, p = .002, respectively) and to those who were at-risk for but did not develop PND (p = .02, p = .008, respectively). HAM-A severity at each visit was associated with PND diagnosis status, where each increase in HAM-A was associated with 15% increased odds of being diagnosed with PND postpartum.

CONCLUSIONS

Both women AR-PND and those with PND experience worse mother-infant bonding. Peripartum anxiety should also be assessed as it represents a marker for later PND.

[The Role of Partnership Status and Relationship Satisfaction in Inpatient Mother-Child Treatment in Postpartum Mental Disorders]

The Role of Partnership Status and Relationship Satisfaction in Inpatient Mother-Child Treatment in Postpartum Mental Disorders The study examines the partnership status and satisfaction in connection with symptoms of postpartum mental disorders, mother-child attachment and outcome of inpatient mother-child treatment. Two sub-studies were carried out. In the first study, N = 126 mothers with postpartum mental disorders who went to a preliminary consultation for inpatient mother-child treatment stated their symptom burden (SCL-90), mother-child attachment (PBQ) and satisfaction with their partner relationship (PFB-K). Mothers with stressed relationships showed the highest level of symptom burden and impaired attachment. Mothers without a partner reported the least amount of impairment in mother-child attachment. In the second study, N = 41 mothers were examined over the course of inpatient treatment (within-subject design with a waiting-list). The initial relationship satisfaction was not predictive of symptom reduction or improvement in mother-child attachment. An increase in satisfaction during the treatment was though correlated with an improvement in mother-child attachment.

The etiology of maternal postpartum depressive symptoms: Childhood emotional maltreatment, couple relationship satisfaction, and genes

There is a call for integrative studies examining the roles of biological and psychosocial factors and their interrelations in shaping maternal postpartum psychopathology. Using longitudinal data from 198 primiparous mothers, we tested a biopsychosocial model for the etiology of maternal postpartum depressive symptoms that integrated childhood emotional maltreatment, couple relationship satisfaction, and oxytocin and dopamine D4 receptor genes (i.e., OXTR rs53576 and DRD4). Results indicate (a) two indirect effects from childhood emotional maltreatment and DRD4 to depressive symptoms at 1 year postpartum through couple relationship satisfaction at 6 months postpartum; (b) an interactive effect between DRD4 and couple relationship satisfaction at 6 months postpartum in predicting depressive symptoms at 1 year postpartum, which is in concert with the differential susceptibility hypotheses; and (c) no mediating effects or moderating effects (after adjusting for multiple testing with Bonferroni correction) involving OXTR rs53576. Notably, all associations were identified after controlling for several key covariates (e.g., maternal prenatal depressive symptoms). Last, robustness of the currently identified interactive effect involving DRD4 was demonstrated by an extensive set of additional analyses considering the effects of rGE, G × Covariates, and/or E × Covariates. Taken altogether, this study represents one of the initial efforts for a more sophisticated portrayal of how nature and nurture forces may work in conjunction with each other to shape new mothers' psychopathology. Yet given the current modest sample size and candidate gene approach, our findings are preliminary, should be cautiously interpreted, and need to be replicated with more rigorous designs. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Perceived social support and prenatal wellbeing; The mediating effects of loneliness and repetitive negative thinking on anxiety and depression during the COVID-19 pandemic

Problem

Prenatal depression and anxiety are linked to poor maternal and infant outcomes. We need to understand predictors of poor mental health to identify at-risk women, and targets for support.

Background

Previous research has demonstrated a relationship between low levels of perceived social support, and depression and anxiety in pregnant women. However, there is a lack of research into the factors that may mediate this relationship.

Aim

As social distancing measures (e.g., lockdown) are likely to negatively affect women’s perceived support in the prenatal period, we investigated the relationship between perceived social support and both anxiety and depression in UK-based pregnant women during the COVID-19 pandemic. Further, we examined two potential mediators that may contribute to psychological symptoms: repetitive negative thinking and loneliness.

Methods

We administered a battery of online measures to a sample of pregnant women (N = 205) between May-June 2020, during the first peak of the pandemic in the UK, when perceived social support was likely to be low.

Results

Consistent with predictions, perceived social support was significantly negatively related to depression, anxiety, loneliness and repetitive negative thinking. Furthermore, repetitive negative thinking and loneliness mediated the relationship between perceived social support and both depression and anxiety. Moreover, perceived social support and loneliness were associated with specific types of online behaviours.

Conclusions

Taken together, the findings shed light on the processes through which social support may exert its effects on depression and anxiety and highlight potential therapeutic targets for interventions which aim to prevent and treat mood disorders in perinatal cohorts.

Respiratory sinus arrhythmia as a dyadic protective factor in the transition to parenthood

Considerable heterogeneity has been observed in couples' adjustment to the transition to parenthood (TTP). One potential yet understudied predictor of emotional adjustment to the TTP is the new parents' capacity for regulation. A widely accepted biological marker of this capacity is respiratory sinus arrhythmia (RSA), which is closely tied to parasympathetic activation. In the present work, we sought to examine the role of tonic RSA and RSA reactivity as possible protective dyadic factors in the TTP. As part of a larger study, we recruited a sample (N = 100) of TTP couples. At 15 weeks postpartum, the couples took part in a lab session during which their RSA was assessed both at rest (tonic RSA) and during four affiliative dyadic interactions (RSA reactivity). Following this session, couples completed daily diaries over a period of 3 weeks, reporting their daily levels of negative affect and stress. A Multivariate Actor Partner Interdependence Model was used to examine the extent to which each partner's RSA predicted their own and their partner's negative affect (NA) level, as well as NA stress-reactivity (i.e., the strength of the within-person stress-affect association). New mothers' tonic RSA predicted their own lower NA level and NA stress-reactivity; both their tonic RSA and RSA reactivity predicted their (male) partners' lower NA level; and finally, new fathers' tonic RSA and RSA reactivity predicted their (female) partners' lower NA stress-reactivity. These results suggest that RSA may serve as a personal and dyadic protective factor.

Short-term psychodynamic infant-parent interventions at Child health centers: Outcomes on parental depression and infant social-emotional functioning

Randomized controlled trials (RCTs) demonstrate efficacy of parent-infant psychotherapy, but its applicability and effectiveness in public health care are less known. The method followed is Naturalistic study evaluating Short-term Psychodynamic Infant-Parent Interventions at Child Health Centers (SPIPIC) in Stockholm, Sweden. One hundred distressed mothers with infants were recruited by supervised nurses. Six therapists provided 4.3 therapy sessions on average (SD = 3.3). Sessions typically included the mothers, often with the baby present, while fathers rarely attended sessions. The Edinburgh Postnatal Depression Scale (EPDS) and the Ages and Stages Questionnaire: Social-Emotional (ASQ: SE) were distributed at baseline and at 3 and 9 months later. Data from a nonclinical group were collected simultaneously to provide norm data. Multilevel growth models on the mothers' questionnaire scores showed significant decreases over time on both measures. Nine months after baseline, 50% achieved a reliable change on the EPDS and 14% on the ASQ: SE. Prepost effect-sizes (d) were 0.70 and 0.40 for EPDS and ASQ: SE, figures that are comparable to results of other controlled studies. Psychotherapists integrated with public health care seem to achieve good results when supporting distressed mothers with brief interventions in the postnatal period. SPIPIC needs to be compared with other modalities and organizational frameworks.

Trajectories of perinatal depressive symptoms from early pregnancy to six weeks postpartum and their risk factors-a longitudinal study

BACKGROUND

Few studies explored trajectories of depressive symptoms from early pregnancy and covered the whole perinatal period. This study aimed to explore the trajectories of perinatal depressive symptoms, their heterogeneity of onsets and peaks, and relations to demographic and psychological factors.

METHOD

A longitudinal study was conducted at two hospitals in China amongst 1,126 participants. Perinatal depression was measured using the Edinburgh Postnatal Depression Scale. Demographic and psychological factors were collected by self-developed questionnaire and Generalized Anxiety Disorder-7. Women completing at least three depression screens (n = 879) were included. Latent Growth Curve Model and Growth Mixture Model were performed to identify the depression trajectories and logistic regression was used to analyse factors of trajectories.

RESULTS

Three trajectories were identified: 90.0% of women never presented with depressive symptoms ("Low-throughout"); 5.1% presented with depressive symptoms mainly during the antenatal period ("Antenatal-high"); 4.9% presented with depressive symptoms mainly during the postpartum period ("Postpartum-high"). 52.4% of women experienced their first depressive symptoms during early pregnancy. Suffering from anxiety and being unsatisfied with their marriage were associated with the "Antenatal-high" and "Postpartum-high" trajectories, respectively.

LIMITATIONS

Response rate was not high. We also do not have information on clinical diagnoses or changes in some variables over time.

CONCLUSIONS

We identified three trajectories and heterogeneity existed concerning the timing of their peaks. Women should be considered for depression screening and intervention in early pregnancy. Factors associated with each trajectory were different, raising the potential of individualized intervention to reduce the occurrence of depression.

Association between Lack of Social Support from Partner or Others and Postpartum Depression among Japanese Mothers: A Population-Based Cross-Sectional Study

Lack of social support is a known risk factor for postpartum depression (PPD). However, the association between lack of social support from a partner or others and PPD remains unknown. We examined this association among Japanese mothers. We distributed an original questionnaire to mothers participating in a three- or four-month health check-up program over October to November 2012 in Aichi Prefecture, Japan. Of the 9707 eligible mothers, 6590 responded to the questionnaire (response rate: 68%). Social support from a partner or others was assessed based on whether the mother can consult with her partner or others (i.e., parents, relatives, and friends who are close by or far) on childcare. PPD was assessed with the Edinburgh Postnatal Depression Scale. The data were analyzed using multiple logistic regression analysis for four categories: no social support from either a partner/others, social support from a partner only, social support from others only, and social support from both, adjusted for possible covariates. Mothers who have no social support from either a partner/others, have social support from a partner only, and have social support from others only were 7.22 (95% confidence interval [CI], 1.76–29.6), 2.34 (95% CI, 1.37–3.98), and 3.13 (95% CI, 2.11–4.63) times more likely to show PPD, respectively, in comparison with mothers who have social support from both, after adjustment of possible covariates. Mothers with no social support from a partner, but have social support from others, showed significant risk for PPD, which may be invisible. Further prevention effort is needed to detect PPD cases, with a focus on mothers without support from their partner.

Correlation between postpartum depression and spousal support and factors affecting postpartum depression

This study was conducted to investigate the relationship between postpartum depression (PPD) and women's perceived spousal support during the early postpartum period and the prevalence of PPD and affecting factors. Data were collected using a Personal Information Form, the Edinburgh Postpartum Depression Scale (EPDS) and the Perceived Spousal Support among Women in Early Postpartum Period Scale (PSSAWEPP). The study was completed with 181 women. The prevalence of PPD was found as 28.2%. A significant negative correlation was found between the total EPDS score and total PSSAWEPP score and subscale scores of emotional support, social support and physical support (p < 0.01). It was also found that as spousal support perceived by women increased, PPD risk decreased. In our study, it was observed that spousal violence (aOR = 5.69, 95% CI: 1.65-19.55) and having an unintended pregnancy (aOR = 0.24, CI: 0.11-0.54) were two factors that significantly affected PPD.

Telephone-based nurse-delivered interpersonal psychotherapy for postpartum depression: nationwide randomised controlled trial

BACKGROUND

Postpartum depression and anxiety are under-addressed public health problems with numerous treatment access barriers, including insufficiently available mental health specialist providers.

AIMS

To examine the effectiveness of nurse-delivered telephone interpersonal psychotherapy (IPT) for postpartum depression. Trial registration ISRCTN88987377.

METHOD

Postpartum women (n = 241) with major depression (on the Structured Clinical Interview for DSM-IV (SCID-I)) from 36 Canadian public health regions in rural and urban settings were randomly assigned to 12 weekly 60 min nurse-delivered telephone-IPT sessions or standard locally available care. The primary outcome was the proportion of women clinically depressed at 12 weeks post-randomisation, with masked intention-to-treat analysis. Secondary outcomes examined included comorbid anxiety, self-reported attachment and partner relationship quality.

RESULTS

At 12 weeks, 10.6% of women in the IPT group (11/104) and 35% in the control group (35/100) remained depressed (OR = 0.22, 95% CI 0.10-0.46), with the IPT group 4.5 times less likely to be clinically depressed (SCID); 21.2% in the IPT group and 51% in the control group had an Edinburgh Postnatal Depression Scale (EPDS) score >12 (OR = 0.26, 95% CI 0.14-0.48), and attachment avoidance decreased more in the IPT group than in the control group (P = 0.02). Significant differences favoured the IPT group for comorbid anxiety and partner relationship quality at all time points, with no differences in health service or antidepressant use. None of the IPT responders relapsed by 36 weeks. Between-group SCID differences were sustained at 24 weeks, but not at 36 weeks.

CONCLUSIONS

Nurse-delivered telephone IPT is an effective treatment for diverse urban and rural women with postpartum depression and anxiety that can improve treatment access disparities.

Care-seeking behavior and disclosure on self-reported mental health among young women in urban Shanghai, China

Mental health is a major public health concern in China. Help-seeking behavior typically does not involve professionals. Aim of the study was to assess Shanghai women’s care-seeking behavior for common mental health disorders. Using an online survey, fielding questions regarding perinatal mental health status and help-seeking behavior. A total of 487 women participated. One fifth of participants reporting badwell-being did not seek help for mental distress. A total of 82.2 percent seek online support. A majority entrusted in family and avoided professional contact. Mother-in-laws were the least trusted source of support. Shanghai women avoid seeking professional help for mental health issues. Friends, spouses, and online resources are preferred venues.

A scoping review to determine themes that represent perceptions of self as mother ('ideal mother' vs 'real mother')

Background: Postnatal depression (PND) is a key cause of maternal morbidity, with current systems of initial recognition in the UK detecting only 50% of cases. In attempts to predict those potentially at risk, this review suggests a novel approach. Aim: Implementing the concept of 'ideal mother' versus 'real mother', and asking the woman to compare their 'ideal self' against 'existent self', the aim of this instrument development review was to determine themes from the literature that relate to women's perceptions of self as a mother, and from this identification develop questions for inclusion within a proposed new measure entitled the Self-Image as Mother Scale (SIMS). Method: A scoping review of the literature was carried out to identify themes considered to affect perception of self as mother, and from this identification, evidence-based questions for inclusion in the SIMS were developed. Findings: Themes identified included (1) marital dissatisfaction, (2) inadequate partner support, (3) lack of family support, (4) socioeconomic status and associated poverty, (5) concern about infant, (6) antenatal/postnatal complications, (7) acceptance of infant gender, (8) history of mental health problems, (9) unplanned pregnancy. Conclusions: From this scoping review 18 questions were developed for inclusion in the SIMS, which will then be evaluated for psychometric properties, scale refinement and validation.

Women's experiences of positive postnatal partner support

OBJECTIVE

To explore women's experiences of support from their partners in the first year and a half post-baby and identify the particular attitudes and behaviours they considered helpful.

BACKGROUND

Becoming a mother brings major life changes that impact on maternal mental health. Partner support can have a protective effect during this transition period, although there is currently a gap in the research regarding specific examples of partner support that women find helpful.

METHODS

Six mothers who self-identified as receiving positive partner support took part in semi-structured interviews. Data were analysed using Interpretative Phenomenological Analysis.

RESULTS

Three superordinate themes emerged: role navigation, emotional support and teamwork. Role navigation included an attitude of respect and appreciation of the mother role, as well as a shift in the father's priorities to include the whole family. Specific behaviours such as communicating with the mother in an empathic way, offering praise and demonstrating reliability and a willingness to help were seen as emotionally supportive. Teamwork included notions of fairness and equality.

CONCLUSION

The present study extends upon previous research by providing clear examples of what women consider helpful from their partners, including an attitude of respect, placing family first, contributing fairly to household responsibilities, flexibility during the changing stages of child development, and facilitating personal time for mothers. These findings may assist to support new parents through the often difficult transition to parenthood.

Partner relationship satisfaction, partner conflict, and maternal cardio-metabolic health in the year following the birth of a child

Intimate partner relationship quality during the child-bearing years has implications for maternal health. The purpose of this study was to test whether partner satisfaction, partner conflict, and their interaction predicted maternal cardio-metabolic health at 12-months postpartum. Women were recruited in 5 U.S. sites. Partner conflict and satisfaction were measured at 6-months postpartum, and cardio-metabolic indicators (blood pressure, waist-hip ratio, glycosylated hemoglobin, total cholesterol:HDL ratio) were assessed at 6- and 12-months. Cardio-metabolic indices were scored continuously (CM risk) and using clinical risk cutoffs (CM scores). A significant conflict-by-satisfaction interaction emerged for the CM risk, b(SE) = .043 (.016), p = .006, and CM scores, b(SE)= .089 (.028), p = .002, such that when partner satisfaction was low, low partner conflict was associated with poorer postpartum cardio-metabolic health. This is the first study to examine close relationships and cardio-metabolic health during the child-bearing years, an issue warranting further attention.

Clinical effectiveness of family therapeutic interventions in the prevention and treatment of perinatal depression: A systematic review and meta-analysis

BACKGROUND

Family therapy is a potential strategy to increase family support for those suffering from perinatal depression. Family therapeutic interventions for this population typically target depressed women and their adult family members to improve family functioning and reduce depressive symptoms.

OBJECTIVE

This systematic review and meta-analysis is a synthesis of the current evidence on the usefulness of family therapy interventions in the prevention and treatment of perinatal depression and impacts on maternal depressive symptoms and family functioning.

METHODS

This study used the Cochrane Collaboration guidelines for systematic reviews and meta-analyses. Six electronic databases were searched for randomized controlled trials and cluster randomized trials. The primary outcomes included maternal depressive symptoms and family functioning.

RESULTS

Seven studies were included in the qualitative and quantitative analyses. Fixed effects models showed statistically significant reductions in depressive symptoms at post-intervention in intervention group mothers. Intervention intensity and level of family involvement moderated intervention impacts on maternal depression. A fixed effects model showed a trend in improving family functioning at post-intervention in intervention group couples.

CONCLUSION

Although a limited number of controlled trials on family therapeutic interventions for this population exist, the findings show that these types of interventions are effective in both the prevention and treatment of perinatal depression. Recommendations for future research are addressed.

SYSTEMATIC REVIEW AND META-ANALYSIS PROTOCOL REGISTRATION

PROSPERO, CRD42017075150.

Husband's involvement with mother's awareness and knowledge of newborn danger signs in facility-based childbirth settings: a cross-sectional study from rural Bangladesh

Objective

The aim of this study was to examine the association between husband involvement and maternal awareness and knowledge of newborn danger signs. This cross-sectional study was conducted in three rural hospitals of Bangladesh among the recently delivered women (RDW).

Results

RDW were interviewed to determine their knowledge and understanding of seven key neonatal danger signs. About 51.4% of the respondents were able to identify at least one danger sign. ‘Fever’ was the most correctly identified (43.7%), and hypothermia was the least (26.1%) identified danger sign. The factors associated with RDW possessing knowledge of at least one neonatal danger sign were: secondary education (COR: 1.3, 95% CI 1.1–1.6), increased ANC visits (COR: 1.2, 95% CI 1.1–1.3), previous history of facility delivery (COR: 1.3, 95% CI 1.1–1.4), and husband involvement in the mother’s facility delivery (COR: 1.3, 95% CI 1.1–1.5). RDW were more likely to recall at least one newborn danger sign (AOR: 1.2, 95% CI 1.1–1.4) when the husband was actively involved in his wife’s antenatal, delivery and postnatal care. In conclusion, this study found that husband involvement was significantly associated with the maternal knowledge related to identification of neonatal danger signs.

Electronic supplementary material

The online version of this article (10.1186/s13104-018-3386-6) contains supplementary material, which is available to authorized users.

Spouses' prenatal autonomous motivation to have a child and postpartum depression symptoms

OBJECTIVES

Maternal postpartum depression symptoms (PDS) are linked with negative personal, family, and child developmental outcomes. However, paternal PDS, let alone dyadic process, are understudied. Grounded in the Self-Determination Theory of motivation, this longitudinal study examined whether mothers' and fathers' type of prenatal motivation to have a child predicted depression symptoms 3-6 months after birth.

METHOD

The data (N = 90 heterosexual couples) were analyzed using the Actor-Partner Interdependence Model.

RESULTS

Dyadic analyses showed that a person's prenatal autonomous motivation to have a child significantly predicted own PDS and partner's PDS. Importantly, these finding were equivalent across genders.

CONCLUSIONS

The findings highlight the importance of dyadic prenatal motivational processes as antecedents of PDS.

Antenatal depressive symptoms in Jamaica associated with limited perceived partner and other social support: A cross-sectional study

Background

Antenatal depression is associated with adverse maternal and infant well-being. However, compared to postpartum depression, it has been less frequently explored globally or in Jamaica. This study aimed to determine the prevalence of, and factors associated with, antenatal depressive symptoms among Jamaican women in order to inform policy and build interventions that could improve their management and reduce their negative consequences.

Methods

This secondary analysis of data from the second Jamaican Birth Cohort Study (JA-Kids Birth Cohort) included 3,517 women enrolled during pregnancy. Information was extracted from interviewer-administered questionnaires which recorded social, demographic, medical and obstetric information during pregnancy. The Edinburgh Postnatal Depression scale (EPDS) was used to screen for depression, with scores ≥13 considered indicative of a high likelihood of depression. Bivariate analysis examined associations between depressive symptoms and: age, income, financial difficulties, perceived social support, perceived partner infidelity, previous child-bearing unions and children with the current partner. Obstetric factors were also explored and included gravidity, prior adverse pregnancy outcome and complications from previous pregnancies. Variables that predicted the likelihood of depression based on an EPDS cut score of 13 were evaluated using logistic regression.

Results

One in five participants (19.6%; 95% CI 18.3–20.9%) had a high likelihood of antenatal depression (EPDS ≥13). Significant predictors of high depressive symptom severity included four indicators of poor perceived social and partner support [ORs (95% CI) ranged from: 1.61 (1.07–2.43); p = 0.024 to 3.14(1.69–5.84); p< 0.001], perceived partner infidelity [1.86 (1.36, 2.54); p<0.001], exposure to violence [2.36 (1.66–3.38); p<0.001] and financial difficulties [1.39 (1.07, 1.80); p = 0.013].

Conclusions

Women’s perceived social and partner support were strongly associated with depressive symptom severity. Within the Jamaican cultural context of unstable reproductive unions, efforts are needed to involve fathers in the antenatal care process to strategically improve the psychological well-being of new mothers which may positively influence long term developmental outcomes for their babies.

Text-Based Program Addressing the Mental Health of Soon-to-be and New Fathers (SMS4dads): Protocol for a Randomized Controlled Trial

Background

Recent estimates indicating that approximately 10% of fathers experience Paternal Perinatal Depression (PPND) and the increasing evidence of the impact of PPND on child development suggest that identifying and assisting distressed fathers is justified on public health grounds. However, addressing new fathers’ mental health needs requires overcoming men’s infrequent contact with perinatal health services and their reluctance to seek help. Text-based interventions delivering information and support have the potential to reach such groups in order to reduce the impact of paternal perinatal distress and to improve the wellbeing of their children. While programs utilising mobile phone technology have been developed for mothers, fathers have not been targeted. Since text messages can be delivered to individual mobile phones to be accessed at a time that is convenient, it may provide a novel channel for engaging with “hard-to-reach” fathers in a critical period of their parenting.

Objective

The study will test the efficacy of SMS4dads, a text messaging program designed specifically for fathers including embedded links to online information and regular invitations (Mood Tracker) to monitor their mood, in order to reduce self-reported depression, anxiety and stress over the perinatal period.

Methods

A total of 800 fathers-to-be or new fathers from within Australia will be recruited via the SMS4dads website and randomized to the intervention or control arm. The intervention arm will receive 14 texts per month addressing fathers’ physical and mental health, their relationship with their child, and coparenting with their partner. The control, SMS4health, delivers generic health promotion messages twice per month. Messages are timed according to the babies’ expected or actual date of birth and fathers can enroll from 16 weeks into the pregnancy until their infant is 12 weeks of age. Participants complete questionnaires assessing depression, anxiety, stress, and alcohol at baseline and 24 weeks postenrolment. Measures of coparenting and parenting confidence are also completed at baseline and 24 weeks for postbirth enrolments.

Results

Participant were recruited between October 2016 and September 2017. Follow-up data collection has commenced and will be completed in March 2018 with results expected in June 2018.

Conclusions

This study’s findings will assess the efficacy of a novel text-based program specifically targeting fathers in the perinatal period to improve their depression, anxiety and distress symptoms, coparenting quality, and parenting self-confidence.

Trial Registration

Australian New Zealand Clinical Trials Registry ACTRN12616000261415; https://www.anzctr.org.au/ Trial/Registration/TrialReview.aspx?id=370085 (Archived by WebCite at http://www.webcitation.org/6wav55wII).