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Sved Williams A, Hill R. The Management of Perinatal Borderline Personality Disorder. J Clin Med 2023; 12:6850. [PMID: 37959315 PMCID: PMC10650510 DOI: 10.3390/jcm12216850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/19/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023] Open
Abstract
Borderline personality disorder (BPD) is highly prevalent in clinical perinatal mental health settings, although there are few systematic programmes to identify BPD at this time. Retrospective studies show compromised birth outcomes for women with this condition, and several authors have highlighted a significant range of problem outcomes for offspring identifiable from early infancy through the adult years, including the intergenerational transfer of mental health problems from mother to child. A literature review identifies the varying prevalence rates found in non-clinical and clinical settings and the paucity of published studies on the management of perinatal BPD, in particular focused both on the mother and mother-infant relationships. A case study is presented to show both the potential benefits of inpatient mother-baby unit protocols and of specialised longer-term group therapy. Many knowledge gaps can be identified for further clinical research that could potentially benefit families with perinatal BPD, including systematic identification of perinatal BPD and intensive programmes that not only could perhaps improve birth outcomes but also provide skills to mothers to help with their emotional regulation and potentially improve mother-infant relationships and longer-term offspring developmental pathways.
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Affiliation(s)
- Anne Sved Williams
- Women’s and Children’s Health Network, North Adelaide 5006, Australia;
- Faculty of Psychiatry, University of Adelaide, Adelaide 5005, Australia
- School of Medicine and Psychology, Australian National University, Canberra 2601, Australia
| | - Rebecca Hill
- Women’s and Children’s Health Network, North Adelaide 5006, Australia;
- Faculty of Psychiatry, University of Adelaide, Adelaide 5005, Australia
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2
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Mokwena K, Modjadji P. A comparative study of postnatal depression and associated factors in Gauteng and Free State provinces, South Africa. Afr J Prim Health Care Fam Med 2022; 14:e1-e11. [PMID: 36226935 PMCID: PMC9575337 DOI: 10.4102/phcfm.v14i1.3031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 05/04/2022] [Accepted: 05/08/2022] [Indexed: 11/06/2022] Open
Abstract
Background The factors contributing to probable postnatal depression (PND), a type of clinical depression that can affect woman after childbirth, are socially derived. Therefore, variations among groups of women necessitate studies in different communities. Aim This study compared the prevalence of PND and associated factors among women attending postnatal services facilities. Setting The study setting included Tshwane Municipal district in Gauteng province (GP) and Fezile Dabi District (FS) in Free State province (FSP), South Africa. Methods A total of 477 mothers within 12 weeks of giving birth were recruited by convenient sampling in health facilities. A self-developed questionnaire was used to obtain information on socio-demographics, obstetric history, and children’s characteristics. The Edinburgh Postnatal Depression Scale (EPDS) was used to collect data on depression symptoms, with a score of ≥ 13 used as a cut-off for probable PND. Data were analysed using STATA 14. Multivariate logistic regression was used to determine association between probable PND and various covariates. Results The overall mean age of women was 28 ± 6 years. The overall prevalence rate of PND was 22%, slightly higher in FS (23%) than in GP (21%). Most participants living in GP were married, had tertiary education, were employed and from the households with income of more than R8000.00. A chi-square test showed that planned pregnancy was significantly higher in GP compared with FS (p ≤ 0.001). Multivariate logistic regression showed that support from a partner or husband decreased the odds of a probable PND in GP (adjusted odd ratio [AOR] 0.37; 95% confidence interval [CI] [95%CI: 0.14–0.96; p = 0.041] and in the FS [AOR = 0.14, 95%CI: 0.05–0.40; p ≤ 0.001]). Significant associations of probable PND with several factors – planned pregnancy, baby age, support in difficult times, partner or husband drinking alcohol and stressful events – were more common in the FSP than in the GP. Conclusion The prevalence of probable PND and its associated risk factors in the GP and the FS indicates the need for routine screening and targeted interventions in both urban and rural settings. Contribution The results confirm that the prevalence of PND is similar in both rural and urban areas, and that pregnancy planning remains a challenge in the FS, which calls for increased efforts to revive family planning programmes in primary health care facilities.
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Affiliation(s)
- Kebogile Mokwena
- Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, Pretoria.
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3
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Gressier F, Glangeaud-Freudenthal NM, Falissard B, Sutter-Dallay AL. Comorbid borderline personality disorders in women with post-partum depression admitted to mother-baby units. J Psychiatr Res 2022; 146:149-155. [PMID: 34982970 DOI: 10.1016/j.jpsychires.2021.12.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 12/05/2021] [Accepted: 12/20/2021] [Indexed: 10/19/2022]
Abstract
Borderline personality disorder (BPD) is associated with perinatal depression and parenting difficulties. However, little is known about the characteristics and specific effects of BPD in women with postpartum depression. This study aimed to explore 1) the sociodemographic, mental health characteristics, and motherhood difficulties in women with a major depressive postpartum episode (MDPE) and a comorbid diagnosis of BPD, compared to those with other personality disorders (other PD) or no PD and 2) whether BPD itself may be an independent risk factor for infant neglect in women with a MDPE. 412 women admitted to a Mother and Baby Unit (2001-2010) with a MDPE were involved in this study. Our study showed that women with MDPE-BPD (n = 64) more frequently reported a history of childhood maltreatment, single status, low social support, a history of depression, smoking during pregnancy and suicide attempt during the perinatal period compared to women with other PDs (n = 88) or no PD (n = 260). Women with comorbid BPD had a greater length of stay. Regarding infant care, neglect, abuse, and separation at discharge were more frequent in women with comorbid BPD. Logistic regression was performed to specifically examine whether BPD in women with a MDPE was an independent risk factor for infant neglect during the postpartum period. Comorbid BPD was independently associated with infant neglect (OR = 2.21; CI95% [1.02-4.81]). Our results underline the importance of screening for BPD in women with perinatal depression. Further studies are needed to explore the links between MDPE, BPD, and infant development.
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Affiliation(s)
- Florence Gressier
- CESP, Inserm U1018, University Paris-Saclay, Faculté de Médecine Paris Saclay, Department of Psychiatry, Bicêtre University Hospital, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Saclay, 78 rue du Général Leclerc, 94275, Le Kremlin Bicêtre, France.
| | - Nine Mc Glangeaud-Freudenthal
- INSERM Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Epidemiology and Biostatistics (U1153), Paris Descartes University, Paris, France
| | - Bruno Falissard
- Department of Biostatistics, Maison de Solenn, Université Paris Saclay, UVSQ, CESP, Inserm U1018, 97 Bld de Port-Royal, 75679, Paris, Cedex 14, France
| | - Anne-Laure Sutter-Dallay
- Charles Perrens Hospital, Perinatal Psychiatry Network, University Department of Child and Adolescent Psychiatry, Univ. Bordeaux, INSERM, BPH, U1219, F-33000, Bordeaux, France
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4
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Nagel K, Thomson R, Lorimer S, Judd F. Prevalence and characteristics of women with borderline personality pathology referred to a perinatal consultation liaison service. Aust N Z J Psychiatry 2021; 55:911-918. [PMID: 33636989 DOI: 10.1177/0004867421998770] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To examine the prevalence and characteristics of pregnant women with borderline personality pathology (defined as borderline personality disorder and borderline personality traits) referred to a perinatal consultation-liaison psychiatry service. METHOD Socio-demographic and clinical data, and diagnoses made according to Diagnostic and Statistical Manual of Mental Disorders (5th ed.) criteria were recorded for all women referred to and seen by the perinatal consultation-liaison psychiatry service over an 18-month period. Data were analysed using descriptive statistics and logistic regression analysis. RESULTS A total of 318 women were seen. The most common diagnoses found were depressive disorder (25.5%) and anxiety disorder (15.1%). Borderline personality disorder was found in 10.1% of women and almost one in five women had two or more borderline personality traits (19.5%). When compared to women with other diagnoses, women with borderline personality pathology had higher rates of unplanned pregnancy, being unpartnered, substance use during pregnancy and higher rates of child safety services involvement as a child or in a previous pregnancy. Over 40% of women with borderline personality pathology were referred to child safety services in the current pregnancy and a diagnosis of borderline personality pathology increased the risk of child safety services involvement by almost sixfold (odds ratio: 5.5; 95% confidence interval = [1.50, 20.17]). CONCLUSION The prevalence of borderline personality pathology in antenatal women identified at antenatal screening and the recognition that women with borderline personality pathology are 'high-risk' caregivers argue for borderline personality pathology to be recognised as a high priority for investment in service development.
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Affiliation(s)
- Katharina Nagel
- Tasmanian Health Service, Perinatal and Infant Mental Health Team, Child and Adolescent Mental Health Services-South, Hobart, TAS, Australia
| | | | - Stephanie Lorimer
- Tasmanian Health Service, Perinatal and Infant Mental Health Team, Child and Adolescent Mental Health Services-South, Hobart, TAS, Australia
| | - Fiona Judd
- Tasmanian Health Service, Perinatal and Infant Mental Health Team, Child and Adolescent Mental Health Services-South, Hobart, TAS, Australia.,Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
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5
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Sved Williams A, Osborn A, Yelland C, Hollamby S. Changing intergenerational patterns of emotional dysregulation in families with perinatal borderline personality disorder. Arch Womens Ment Health 2021; 24:641-648. [PMID: 33742283 DOI: 10.1007/s00737-021-01119-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 03/03/2021] [Indexed: 11/24/2022]
Abstract
A pilot study with women with borderline personality disorder (BPD) and their infants showed promising results. This clinical research program sought to discover whether ongoing implementation confirmed preliminary results in relation to maternal mental health and, in addition, whether parenting and the mother-infant relationship showed sufficient improvement. Women with BPD and their infants were referred to a 25-week group program of Mother-Infant Dialectical Behavior Therapy (MI-DBT). During groups, infants were provided care by childcare workers while mothers took part in a skills training session. Mothers and infants then reunited and took part in an activity together that incorporated skills taught in the teaching session. Sixty-nine of 98 women commencing MI-DBT completed the program, demonstrating a 71% completion rate. Women showed improvement on all measures of mental health including depression, anxiety, and BPD symptoms. While women reported improvement in parenting confidence, an objective measure of the mother-infant relationship showed continuation of concerning relationships in a significant percentage. MI-DBT was found to be effective at improving mothers' mental health, both at the initial site and in community settings, with different clinicians and with different childcare options. While there were some improvements found in measures of the mother's perception of the infant-parent relationship, there were no significant improvements in currently used observational measures of the interaction or the infant's social-emotional development, suggesting that additional intervention such as infant-parent therapy may be needed to augment the benefits of MI-DBT to improve outcomes in these areas.
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Affiliation(s)
- Anne Sved Williams
- Perinatal and Infant Mental Health Services, Women's and Children's Hospital, North Adelaide, South Australia. .,The University of Adelaide, Adelaide, South Australia.
| | - Amanda Osborn
- Perinatal and Infant Mental Health Services, Women's and Children's Hospital, North Adelaide, South Australia.,The University of Adelaide, Adelaide, South Australia
| | - Chris Yelland
- Perinatal and Infant Mental Health Services, Women's and Children's Hospital, North Adelaide, South Australia
| | - Sharron Hollamby
- Perinatal and Infant Mental Health Services, Women's and Children's Hospital, North Adelaide, South Australia
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6
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Mao Q, Tian T, Chen J, Guo X, Zhang X, Zou T. Serum Metabolic Profiling of Late-Pregnant Women With Antenatal Depressive Symptoms. Front Psychiatry 2021; 12:679451. [PMID: 34305679 PMCID: PMC8295540 DOI: 10.3389/fpsyt.2021.679451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 05/24/2021] [Indexed: 12/27/2022] Open
Abstract
Background: Antenatal depression (AD) is a major public health issue worldwide and lacks objective laboratory-based tests to support its diagnosis. Recently, small metabolic molecules have been found to play a vital role in interpreting the pathogenesis of AD. Thus, non-target metabolomics was conducted in serum. Methods: Liquid chromatography-tandem mass spectrometry-based metabolomics platforms were used to conduct serum metabolic profiling of AD and non-antenatal depression (NAD). Orthogonal partial least squares discriminant analysis, the non-parametric Mann-Whitney U test, and Benjamini-Hochberg correction were used to identify the differential metabolites between AD and NAD groups; Spearman's correlation between the key differential metabolites and Edinburgh Postnatal Depression Scale (EPDS) and the stepwise logistic regression analysis was used to identify potential biomarkers. Results: In total, 79 significant differential metabolites between AD and NAD were identified. These metabolites mainly influence amino acid metabolism and glycerophospholipid metabolism. Then, PC (16:0/16:0) and betaine were significantly positively correlated with EPDS. The simplified biomarker panel consisting of these three metabolites [betaine, PC (16:0/16:0) and succinic acid] has excellent diagnostic performance (95% confidence interval = 0.911-1.000, specificity = 95%, sensitivity = 85%) in discriminating AD and NAD. Conclusion: The results suggested that betaine, PC (16:0/16:0), and succinic acid were potential biomarker panels, which significantly correlated with depression; and it could make for developing an objective method in future to diagnose AD.
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Affiliation(s)
- Qiang Mao
- Department of Pharmacology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Tian Tian
- Department of Neurology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Jing Chen
- Department of Psychiatry, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Xunyi Guo
- Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - Xueli Zhang
- Department of Psychiatry, Linyi Mental Health Center, Linyi, China
| | - Tao Zou
- Shanghai Key Laboratory of Forensic Medicine (Academy of Forensic Science), Shanghai, China
- Department of Psychiatry, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
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Hazell Raine K, Thorpe K, Boyce P. Perinatal depression screening in Australia: A position paper. Nurs Health Sci 2020; 23:279-287. [PMID: 33241903 DOI: 10.1111/nhs.12793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 11/08/2020] [Accepted: 11/10/2020] [Indexed: 01/24/2023]
Abstract
Perinatal depression can have enduring adverse effects on women and their children and families, incurring substantial ongoing economic and personal costs. A significant proportion of the cost of perinatal depression relates to adverse impacts on the child, most likely mediated through impairment to the mother-infant relationship. In recognition of this problem, Australia has invested in routine perinatal depression screening. Our previous research produced convergent findings suggesting that expected benefits for children have not yet been realised through perinatal depression screening. We question the potential of including a measure of personality in current perinatal depression screening for identifying maternal mental health problems and suboptimal mother-infant relationships. This paper reviews our previous research findings within the broader context of perinatal depression screening. We propose a position, that perinatal depression screening in Australia should be redesigned to more precisely detect vulnerable mother-infant relationships, parenting, maternal mental health, and infant psychosocial and psychological development. Practice change to appropriately target antenatal interventions may more efficiently improve both maternal and child outcomes, thereby contributing to greater efficiency and cost savings for the health system.
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Affiliation(s)
- Karen Hazell Raine
- Nursing, School of Health, Faculty of Medicine and Health, University of New England; School of Nursing, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Karen Thorpe
- Institute for Social Science Research (ISSR), The University of Queensland, Brisbane, Queensland, Australia
| | - Philip Boyce
- Discipline of Psychiatry, Sydney Medical School, Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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The Need for Universal Screening for Postnatal Depression in South Africa: Confirmation from a Sub-District in Pretoria, South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17196980. [PMID: 32987674 PMCID: PMC7579387 DOI: 10.3390/ijerph17196980] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 09/15/2020] [Accepted: 09/19/2020] [Indexed: 12/16/2022]
Abstract
Although postnatal depression (PND) is a worldwide public health problem, it is relatively higher in developing countries, including countries in Sub-Saharan Africa. Postnatal depression is not routinely screened for in primary healthcare facilities in South Africa, despite its reported compromise on mother and child health. The purpose of this study was to determine the prevalence of, as well as factors associated with, postnatal depression in a sample of clinic attendees in a sub district in Tshwane, South Africa. A quantitative and cross-sectional survey was conducted in a sample of 406 women in three healthcare facilities. The Edinburgh Postnatal Depression Scale (EPDS) was used to collect data from women who had infants between the ages of 0 and 12 months. The cut-off point for the EPDS for the depressed category was a score of 13 out of a maximum of 30. The majority of the women (57.14%, n = 232) had scores of 13 and above, which is indicative of postnatal depressive symptoms. On logistic regression, postnatal depressive symptoms were significantly associated with lack of support in difficult times (p < 0.001, 95% CI 10.57–546.51), not having the preferred sex of the baby (p = 0.001, 95% CI 0.37–0.58), low household income (p < 0.001, 95% CI 1.23–1.67), and an older baby (p = 0.005, 95% CI 1.21–1.49). The results show the high proportion of women who have postnatal depression but remain undiagnosed and untreated, and therefore confirm the need for routine screening for postnatal depressive symptoms in primary healthcare facilities, which are used by the majority of women in South Africa.
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9
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Anderson G. Pathoetiology and pathophysiology of borderline personality: Role of prenatal factors, gut microbiome, mu- and kappa-opioid receptors in amygdala-PFC interactions. Prog Neuropsychopharmacol Biol Psychiatry 2020; 98:109782. [PMID: 31689444 DOI: 10.1016/j.pnpbp.2019.109782] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 10/05/2019] [Accepted: 10/06/2019] [Indexed: 02/07/2023]
Abstract
The pathoetiology and pathophysiology of borderline personality disorder (BPD) have been relatively under-explored. Consequently, no targetted pharmaceutical treatments or preventative interventions are available. The current article reviews the available data on the biological underpinnings of BPD, highlighting a role for early developmental processes, including prenatal stress and maternal dysbiosis, in BPD pathoetiology. Such factors are proposed to drive alterations in the infant's gut microbiome, in turn modulating amygdala development and the amygdala's two-way interactions with other brain regions. Alterations in opioidergic activity, including variations in the ratio of the mu-and kappa-opioid receptors seem a significant aspect of BPD pathophysiology, contributing to its comorbidities with depression, anxiety, impulsivity and addiction. Stress and dysphoria are commonly experienced in people classed with BPD. A growing body of data, across a host of medical conditions, indicate that stress and mood dysregulation may be intimately associated with gut dysbiosis and increased gut permeability, coupled to heightened levels of oxidative stress and immune-inflammatory activity. It urgently requires investigation as to the relevance of such gut changes in the course of BPD symptomatology. Accumulating data indicates that BPD symptom exacerbations may be linked to cyclical variations in estrogen, in turn decreasing serotonin and local melatonin synthesis, and thereby overlapping with the pathophysiology of migraine and endometriosis, which also have a heightened association with BPD. Future research directions and treatment implications are indicated.
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10
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di Giacomo E, Colmegna F, Dakanalis A, Pessina R, Placenti V, Pescatore F, Clerici M. Screening for postpartum depression and borderline personality disorder: Food for thought. Aust N Z J Psychiatry 2020; 54:319-320. [PMID: 31813237 DOI: 10.1177/0004867419893425] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ester di Giacomo
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,Psychiatric Department, ASST Monza, Monza, Italy
| | | | - Antonios Dakanalis
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | | | | | | | - Massimo Clerici
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,Psychiatric Department, ASST Monza, Monza, Italy
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11
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Hazell Raine K, Cockshaw W, Boyce P, Thorpe K. Prenatal maternal personality as an early predictor of vulnerable parenting style. Arch Womens Ment Health 2019; 22:799-807. [PMID: 31016471 DOI: 10.1007/s00737-019-00963-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 03/21/2019] [Indexed: 02/07/2023]
Abstract
Perinatal mental health problems, particularly depression, are prevalent and have been a central focus of prevention initiatives. The greater proportion of ongoing annual perinatal mental health economic cost burdens relate to children. A key linking mechanism is mother-infant relationship quality. Perinatal depression symptoms are typically transient. However, personality style, including interpersonal sensitivity, is a more stable construct and predicts proneness to depression and common mental disorders. Building on our previous work, the objective of the present study is to examine the association between specific dimensions of prenatal interpersonal sensitivity and postpartum mother-infant relationship quality in the context of prenatal depression symptoms. We analysed data from the Avon Longitudinal Study of Parents and Children (ALSPAC). Interpersonal sensitivity and depression symptoms were measured at 18 weeks gestation. In a randomly selected 10% subsample of the ALSPAC cohort, mother-infant interaction was measured through standard observation at 12 months postpartum. For the subsample that had complete data at all time points (n = 812), multiple regression models examined prenatal interpersonal sensitivity dimensions predicting postpartum mother-infant relationship quality, accounting for depression symptoms. Two dimensions of maternal interpersonal sensitivity modestly predicted mother-infant relationship quality at 12 months postpartum and remained robust when we controlled for depression symptoms. The interpersonal sensitivity subscales were significantly associated with prenatal depression symptoms but more consistently and robustly predicted postnatal mother-infant interaction quality. The inclusion of personality measures may strengthen prenatal mental health assessment to identify vulnerability to suboptimal mother-infant relationship quality.
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Affiliation(s)
- Karen Hazell Raine
- Discipline of Psychiatry, Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
| | - Wendell Cockshaw
- School of Health and Biomedical Sciences, Royal Melbourne Institute of Technology, Melbourne, Australia
| | - Philip Boyce
- Discipline of Psychiatry, Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Karen Thorpe
- Institute for Social Science Research, The University of Queensland, Brisbane, Australia
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12
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Hazell Raine K, Nath S, Howard LM, Cockshaw W, Boyce P, Sawyer E, Thorpe K. Associations between prenatal maternal mental health indices and mother-infant relationship quality 6 to 18 months' postpartum: A systematic review. Infant Ment Health J 2019; 41:24-39. [PMID: 31524300 DOI: 10.1002/imhj.21825] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Maternal mental disorders can significantly impact on children's psychosocial and psychological development, incurring substantial ongoing economic and personal costs. A key mediating mechanism is mother-infant relationship quality (MIRQ). Research studies and perinatal mental health screening initiatives have predominantly focused on depressive symptoms and perinatal depression as predictors of MIRQ. While maternal depression is associated with suboptimal MIRQ, the findings have not been consistent. Personality characteristics are associated with parenting and proneness to depression, presenting a potential addition to prenatal mental health assessment. We conducted a systematic review of studies that have examined the link between prenatal depressive symptoms and/or personality characteristics with postnatal MIRQ. Our findings suggest that both maternal personality traits and depressive symptoms measured in early pregnancy are associated with postnatal MIRQ. A measure of personality characteristics may enhance prenatal mental health assessment, affording opportunities for targeted intervention commencing in pregnancy to improve MIRQ, parenting, maternal mental health outcomes, and infant psychosocial and psychological development, and thereby contributing to the reduction of human and economic cost burdens.
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Affiliation(s)
- Karen Hazell Raine
- Discipline of Psychiatry, Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Selina Nath
- Section of Women's Mental Health, King's College, London, United Kingdom
| | - Louise M Howard
- Section of Women's Mental Health, King's College, London, United Kingdom
| | - Wendell Cockshaw
- School of Health and Biomedical Sciences, Royal Melbourne Institute of Technology, Melbourne, Australia
| | - Philip Boyce
- Discipline of Psychiatry, Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Emily Sawyer
- Faculty of Medicine and Dentistry, James Cook University, Townsville, Australia
| | - Karen Thorpe
- Institute for Social Science Research, University of Queensland, Queensland, Australia
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13
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Ogbo FA, Kingsley Ezeh O, Dhami MV, Naz S, Khanlari S, McKenzie A, Agho K, Page A, Ussher J, Perz J, Eastwood J. Perinatal Distress and Depression in Culturally and Linguistically Diverse (CALD) Australian Women: The Role of Psychosocial and Obstetric Factors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E2945. [PMID: 31426304 PMCID: PMC6720521 DOI: 10.3390/ijerph16162945] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 08/12/2019] [Accepted: 08/13/2019] [Indexed: 01/24/2023]
Abstract
Perinatal distress and depression can have significant impacts on both the mother and baby. The present study investigated psychosocial and obstetric factors associated with perinatal distress and depressive symptoms among culturally and linguistically diverse (CALD) Australian women in Sydney, New South Wales. The study used retrospectively linked maternal and child health data from two Local Health Districts in Australia (N = 25,407). Perinatal distress was measured using the Edinburgh Postnatal Depression Scale (EPDS, scores of 10-12) and depressive symptoms, with EPDS scores of 13 or more. Multivariate multinomial logistic regression models were used to investigate the association between psychosocial and obstetric factors with perinatal distress and depressive symptoms. The prevalence of perinatal distress and depressive symptoms among CALD Australian women was 10.1% for antenatal distress; 7.3% for antenatal depressive symptoms; 6.2% for postnatal distress and 3.7% for postnatal depressive symptoms. Antenatal distress and depressive symptoms were associated with a lack of partner support, intimate partner violence, maternal history of childhood abuse and being known to child protection services. Antenatal distress and depressive symptoms were strongly associated with postnatal distress and depressive symptoms. Higher socioeconomic status had a protective effect on antenatal and postnatal depressive symptoms. Our study suggests that current perinatal mental health screening and referral for clinical assessment is essential, and also supports a re-examination of perinatal mental health policy to ensure access to culturally responsive mental health care that meets patients' needs.
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Affiliation(s)
- Felix Akpojene Ogbo
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2571, Australia.
- General Practice Unit, Prescot Specialist Medical Centre, Welfare Quarters, Makurdi, Benue State 972261, Nigeria.
| | - Osita Kingsley Ezeh
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2571, Australia
| | - Mansi Vijaybhai Dhami
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2571, Australia
| | - Sabrina Naz
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2571, Australia
| | - Sarah Khanlari
- Department of Community Paediatrics, Sydney Local Health District, Croydon Community Health Centre, 24 Liverpool Street, Croydon, NSW 2132, Australia
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
| | - Anne McKenzie
- Primary & Community Health, Child and Family, South Western Sydney Local Health District, Narellan CHC, NSW 2567, Australia
| | - Kingsley Agho
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2571, Australia
| | - Andrew Page
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2571, Australia
| | - Jane Ussher
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2571, Australia
| | - Janette Perz
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2571, Australia
| | - John Eastwood
- Department of Community Paediatrics, Sydney Local Health District, Croydon Community Health Centre, 24 Liverpool Street, Croydon, NSW 2132, Australia
- Ingham Institute for Applied Medical Research, 1 Campbell Street, Liverpool, NSW 2170, Australia
- School of Women's and Children's Health, The University of New South Wales, Kensington, Sydney, NSW 2052, Australia
- Menzies Centre for Health Policy, Charles Perkins Centre, School of Public Health, Sydney University, Sydney, NSW 2006, Australia
- Sydney Institute for Women, Children and their Families, Sydney Local Health District, Camperdown, NSW 2050, Australia
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Khanlari S, Barnett AM B, Ogbo FA, Eastwood J. Re-examination of perinatal mental health policy frameworks for women signalling distress on the Edinburgh Postnatal Depression Scale (EPDS) completed during their antenatal booking-in consultation: a call for population health intervention. BMC Pregnancy Childbirth 2019; 19:221. [PMID: 31266468 PMCID: PMC6604146 DOI: 10.1186/s12884-019-2378-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 06/24/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Globally, anxiety and depression are the most common complications of the perinatal period (conception to 1 year postpartum). It is now recognised that anxiety and depression are more commonly found antenatally than postnatally and represent the greatest risk factor for developing postnatal depression. Research in this space has focused on treatment of postnatal depression, with limited attention paid to preventative strategies for women signalling distress, who are subthreshold for diagnosable illness. MAIN TEXT The Edinburgh Postnatal Depression Scale (EPDS) was introduced in 1987 and has since been validated as a depression screening tool in the Australian and international setting. The EPDS has been embedded as a depression screening tool within a broader psychosocial assessment for women who receive their maternity care in the public system in Australia. Owing to perceived service restrictions, an EPDS score must reach a threshold of 13 or more to warrant specific assessment or intervention. Current policy frameworks focus on tertiary prevention models, and those women scoring 10 to 12, who could reasonably be considered as signalling distress or early signs of illness, are not currently offered intervention. The consequences of undetected or untreated perinatal mood or anxiety disorder (often co-morbid) include maternal psychological, social, occupational and physical dysfunction, and extend to deleterious infant and child life-course effects. This provides a strong justification to explore the role of preventative programs for women who are distressed. A range of low-resource, population-based interventions are available and effective. We explore the evidence for a selection of these programs. Further research is needed to decipher their effectiveness as a secondary prevention approach in women who are currently signalling distress during antenatal assessment. CONCLUSION The burden of perinatal mood disorders, and their potential for prolonged impact, justify the exploration of preventatively-focused programs in women who signal distress during antenatal care.
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Affiliation(s)
- Sarah Khanlari
- Department of Community Paediatrics, Sydney Local Health District, Croydon Community Health Centre, 24 Liverpool Street, Croydon, NSW 2132 Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan Campus, University Drive, Callaghan, NSW 2308 Australia
- Sydney Institute for Women Children and their Families, Sydney Local Health District, Camperdown, NSW 2050 Australia
| | - Bryanne Barnett AM
- Sydney Institute for Women Children and their Families, Sydney Local Health District, Camperdown, NSW 2050 Australia
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Kensington Campus, Kensington, NSW 2052 Australia
| | - Felix Akpojene Ogbo
- Translational Health Research Institute, School of Medicine, University of Western Sydney, Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2571 Australia
| | - John Eastwood
- Department of Community Paediatrics, Sydney Local Health District, Croydon Community Health Centre, 24 Liverpool Street, Croydon, NSW 2132 Australia
- Sydney Institute for Women Children and their Families, Sydney Local Health District, Camperdown, NSW 2050 Australia
- Ingham Institute for Applied Medical Research, 1 Campbell Street, Liverpool, NSW 2170 Australia
- School of Women’s and Children’s Health, Faculty of Medicine, The University of New South Wales, Kensington, Sydney, NSW 2052 Australia
- Menzies Centre for Health Policy, Charles Perkins Centre, School of Public Health, Sydney University, Sydney, NSW 2006 Australia
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