Trajectories of maternal symptoms of depression and anxiety over 13 years: the influence of stress, social support, and maternal temperament

Risk and protective factors for postpartum depressive symptoms among women in postpartum nursing center

OBJECTIVES

In Taiwan, many women receive postpartum care at postpartum nursing centers for one month. However, limited research has examined the postpartum depressive symptoms in women residing in postpartum nursing center. The objectives of this study were to investigate the prevalence of postpartum depressive symptoms and to identify the risk factors and protective factors for postpartum depressive symptoms in postpartum nursing center.

MATERIALS AND METHODS

This was an observational study. Postpartum women who were over 20 years old and able to speak Mandarin Chinese or Taiwanese, and had delivered singleton, live infants at term were recruited between January 2020 and June 2020 from a postpartum nursing center in central Taiwan. A questionnaire including sociodemographic characteristics, the Edinburgh Postnatal Depression Scale, and a pain scale was administered at first week and last week in the postpartum nursing center.

RESULTS

A total of 60 postpartum women participated in the study. The prevalence rates of postpartum depressive symptoms after admission and before discharge from a postpartum nursing center were 13% and 8%, respectively. The postpartum depressive symptoms and postpartum pain intensity (including perineum pain and postoperative pain after caesarean delivery) scores were significantly decreased after staying at the postpartum nursing center. The risk factors for postpartum depressive symptoms were previous abortion experience and postpartum pain, while the protective factors were having child care arrangements after return home and having 8-11 h of sleep per day.

CONCLUSIONS

There is a need for the early detection and management of postpartum depressive symptoms in postpartum nursing center.

Going through it together: Dyadic associations between parents' birth experience, relationship satisfaction, and mental health

BACKGROUND

Previous research suggests that a negative birth experience is associated with symptoms of postpartum depression and anxiety in mothers and partners. However, this has mostly been investigated within the first year postpartum and research on the long-term effects is lacking. Additionally, the role of relationship satisfaction and the interdependence between parents have not been considered so far.

METHODS

Couples (N = 1992) completed questionnaires on their birth experience, relationship satisfaction, and symptoms of depression and anxiety at two months, 14 months, and two years after birth, respectively.

RESULTS

Actor-Partner Interdependence Mediation Models indicated no partner effects, but several significant actor and indirect effects. A more positive birth experience was associated with higher relationship satisfaction and less depression and anxiety symptoms for both parents. Higher relationship satisfaction was in turn associated with less depression (mothers and partners) and anxiety symptoms (mothers). The association between birth experience and depression symptoms was partially mediated by relationship satisfaction for mothers and partners, while the association between birth experience and anxiety symptoms was partially mediated by relationship satisfaction only for mothers.

LIMITATIONS

Due to the highly educated, very healthy sample with low levels of depression and anxiety as well as high relationship satisfaction, results cannot be generalized to less privileged parents. Moreover, all effects were very small.

CONCLUSIONS

Results highlight the importance of a positive birth experience for parents' relationship satisfaction and mental health. Negative birth experiences need to be avoided to prevent a negative impact on the whole family.

Examining transactional associations between maternal internalizing symptoms, infant negative emotionality, and infant respiratory sinus arrhythmia

The current study examined transactional associations between maternal internalizing symptoms, infant negative emotionality, and infant resting respiratory sinus arrhythmia (RSA). We used data from the Longitudinal Attention and Temperament Study (N = 217) to examine the associations between maternal internalizing symptoms, infant negative emotionality, and infant resting RSA from 4-months to 18-months using a random-intercepts cross-lagged panel model. We found that mothers with higher average internalizing symptoms have infants with higher levels of resting RSA. However, there were no stable, between-individual differences in infant negative emotionality across time. Additionally, we found significant negative within-dyad cross-lagged associations from maternal internalizing symptoms to subsequent measures of infant negative emotionality, as well as a significant negative cross-lagged association from maternal internalizing symptoms to child resting RSA after 12-months of age. Lastly, we find evidence for infant-directed effects of negative emotionality and resting RSA to maternal internalizing symptoms. Results highlight the complex, bidirectional associations in maternal-infant dyads during the first two years of life, and the importance of considering the co-development of infant reactivity and regulatory processes in the context of maternal internalizing symptoms.

Co-Developmental Trajectories of Parental Psychological Distress and Child Internalizing and Externalizing Problems in Childhood and Adolescence: Associations with Self-Harm and Suicide Attempts

Growing evidence has suggested that parental mental illness and child internalizing and externalizing problems tend to co-occur and engender risk for adverse child outcomes; however, there is considerable heterogeneity in their joint developmental trajectories. This study aimed to evaluate the joint developmental trajectories of maternal and paternal psychological distress and child internalizing and externalizing problems from early childhood to middle adolescence. Given that suicide and self-harm are major public health issues in adolescence and often occur in the context of other mental health issues, we also examined the association between these joint trajectories and these outcomes in adolescence. Parallel-process latent class growth analysis was applied to 14 years of follow-up data from a large-scale, nationally representative sample of youths participating in the UK's Millennium Cohort Study (MCS; n = 12,520, 50.9% male). Results showed the best-fitting solution had four trajectory classes: (1) low symptoms, 59.0%; (2) moderate symptoms in children, 22.5%; (3) notable symptoms in fathers, 10.7%; and (4) co-occurring maternal and child symptoms, 7.8%. The trajectory groups differed in their self-harm and suicide attempts in adolescence, underscoring the possible importance of the roles of both parental distress and child problem behaviors processes in these outcomes. Future studies will be valuable to rigorously test the directionality and the respective roles of parents and children in this association. Our findings suggest the need for two-generation mental health intervention programs that are tailored based on co-developmental trajectory group membership.

Factors Influencing Parenting Stress in the Mothers of Infants and the Effects of Artwork Production

Background

The importance of support for the mothers of infants to cope with parenting stress due to isolated parenting environments is being emphasized. In order to reduce the parenting stress in parenting mothers while improving the quality of parenting support for them, it is important to identify factors influencing such stress. We investigated the effects of artwork production in different styles, conducted self-evaluation of such production, and identified factors influencing parenting stress in mothers, involving those who participated in a handprint artwork production workshop.

Methods

We included 140 mothers who participated in a handprint artwork production workshop, dividing them into 2 groups: A: 70 with children younger than 3 years of age who engaged in artwork production alone; and B: 70 who engaged in it through collaboration with their children aged 3 years or older. The instructor distributed an anonymous, self-administered questionnaire to all the mothers, and collected their responses. The questionnaire examined the following items: attributes, the number of participations in the workshop, artwork production self-evaluation, and parenting stress.

Results

There were 140 (100%) responses, and the number of valid responses was 65 from Group A and 54 from Group B, a total of 119 (85%). The mean [parenting strain] score was significantly higher in Group B. Multiple regression analysis identified the child's age and presence/absence of his/her siblings overall and in Group A, and <confidence in one's work>, an item for artwork production self-evaluation, in Group B as factors influencing the total [parenting strain] score.

Conclusion

The present results suggest that the child's age and presence/absence of his/her siblings could influence parenting stress in the mothers. Additionally, there was a correlation between the level of parenting stress and score for <confidence in one's work> among the mothers who engaged in artwork production through collaboration with their children.

Development and psychometric properties of the Pandemic-Related Postpartum Stress Scale (PREPS-PP)

PURPOSE

Postpartum experiences have been adversely affected by the burdens of the COVID-19 pandemic. However, there are no well-tested measures of pandemic-specific postpartum stress. We developed a modified, postpartum version of the Pandemic-Related Pregnancy Stress Scale (PREPS) and examined the psychometric properties of this novel measure.

METHODS

Online questionnaires were administered at 3-4 month intervals throughout pregnancy and postpartum to women pregnant at the start of the pandemic. This study reports psychometric properties of the Pandemic-Related Postpartum Stress Scale (PREPS-PP) among women who were administered this instrument at either of two postpartum timepoints.

RESULTS

At both timepoints (n = 1301 and n = 1009), CFAs revealed good model fit of the same three-factor structure identified for the prenatal PREPS (Preparedness Stress, Infection Stress, and Positive Appraisal). All PREPS-PP subscales demonstrated good reliability (α's .78-87). Higher levels of Preparedness Stress and Infection Stress were associated with greater health and financial burdens and psychological distress.

CONCLUSIONS

The PREPS-PP is a reliable and valid measure of postpartum stress related to the COVID-19 pandemic. It is a valuable tool for future research into how pandemic-related postpartum stress may affect families in the short- and long-term.

Compassion protects against vital exhaustion and negative emotionality

We investigated (i) the predictive relationships of compassion with negative emotionality (a marker of susceptibility to stress) and vital exhaustion (a marker of chronic stress response) and (ii) the effect of compassion on the developmental courses of negative emotionality and vital exhaustion over a follow-up from early adulthood to middle age. We used the prospective Young Finns data (n = 1031-1495, aged 20-50). Compassion was evaluated in 1997, 2001, and 2012; and vital exhaustion and negative emotionality in 2001, 2007, and 2012. The predictive paths from compassion to vital exhaustion and negative emotionality were stronger than vice versa: high compassion predicted lower vital exhaustion and lower negative emotionality. The effect of high compassion on lower vital exhaustion and lower negative emotionality was evident from early adulthood to middle age. Overall, high compassion appears to protect against dimensions of stress from early adulthood to middle age, whereas this study found no evidence that dimensions of stress could reduce disposition to feel compassion for others' distress over a long-term follow-up.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s11031-021-09878-2.

Associations between Coparenting Relationships and Maternal Depressive Symptoms and Negative Bonding to Infant

Maternal mental illnesses during early postpartum may be caused by lack of the coparenting relationship parents share and cooperate regarding child-rearing. This study clarifies the association of the coparenting relationship and negative mental health of mothers at one and three months after childbirth. This study conducted a secondary analysis of data from an intervention study wherein 24 mothers rearing their first child with a cohabitant (husband/partner) participated. Maternal mental health was evaluated using the Edinburgh Postnatal Depression Scale to determine postpartum depressive symptoms and the Mother-to-Infant Bonding Scale to assess negative bonding. Mothers’ average age was 31.5 ± 4.2 years old. All mothers were not working during the research period. The prevalence of postpartum depression and bonding disorder were approximately 13% and 21%, respectively. A better coparenting relationship was associated with lower postpartum depressive symptoms at both one month (β = −0.617, p = 0.002) and three months (β = −0.709, p < 0.01) postpartum. In contrast, no association was found between a coparenting relationship and negative bonding. The results indicate that the coparenting relationship may possibly prevent maternal depression during the early postpartum period.

How does the COVID-19 pandemic impact on population mental health? A network analysis of COVID influences on depression, anxiety and traumatic stress in the UK population

BACKGROUND

The coronavirus disease 2019 (COVID-19) emergency has led to numerous attempts to assess the impact of the pandemic on population mental health. The findings indicate an increase in depression and anxiety but have been limited by the lack of specificity about which aspects of the pandemic (e.g. viral exposure or economic threats) have led to adverse mental health outcomes.

METHODS

Network analyses were conducted on data from wave 1 (N = 2025, recruited 23 March-28 March 2020) and wave 2 (N = 1406, recontacts 22 April-1 May 2020) of the COVID-19 Psychological Research Consortium Study, an online longitudinal survey of a representative sample of the UK adult population. Our models included depression (PHQ-9), generalized anxiety (GAD-7) and trauma symptoms (ITQ); and measures of COVID-specific anxiety, exposure to the virus in self and close others, as well as economic loss due to the pandemic.

RESULTS

A mixed graphical model at wave 1 identified a potential pathway from economic adversity to anxiety symptoms via COVID-specific anxiety. There was no association between viral exposure and symptoms. Ising network models using clinical cut-offs for symptom scores at each wave yielded similar findings, with the exception of a modest effect of viral exposure on trauma symptoms at wave 1 only. Anxiety and depression symptoms formed separate clusters at wave 1 but not wave 2.

CONCLUSIONS

The psychological impact of the pandemic evolved in the early phase of lockdown. COVID-related anxiety may represent the mechanism through which economic consequences of the pandemic are associated with psychiatric symptoms.

Intimate partner violence and maternal mental health ten years after a first birth: An Australian prospective cohort study of first-time mothers

BACKGROUND

We aimed to assess the relationship between intimate partner violence (IPV) and maternal mental health ten years after a first birth METHODS: 1507 first-time mothers completed questionnaires at 3, 6, 12 and 18 months postpartum and 4 and ten years post the index birth. Exposure to IPV was assessed using the Composite Abuse Scale at 1, 4 and ten years. Standardised measures of depressive (CES-D), anxiety (BAI) and post-traumatic stress symptoms (PCL-C) were completed at ten-year follow-up.

RESULTS

One in three (34%) women experienced IPV between the birth of their first child and their child turning 10. For the one in six women (18.6%) who experienced IPV in the year prior to ten-year follow-up, the prevalence of depressive symptoms was 38.9% compared with 14.2% for women who never reported IPV (adjusted odds ratio [AdjOR] 2.9, 95% confidence interval [CI] 1.9-4.5). Prevalence of anxiety symptoms was 28.1% compared with 8.5% (AdjOR 3.4, 95% CI 2.0-5.9); and prevalence of post-traumatic stress symptoms was 41.9% compared with 11.3% (AdjOR 4.9, 95% CI 3.0-7.9).

LIMITATIONS

Mental health symptoms and exposure to IPV were assessed by self-report and may be subject to misclassification bias as a result of non-disclosure.

CONCLUSIONS

The high prevalence of mental health symptoms among women exposed to IPV in the ten years after giving birth coupled with the extent of post-traumatic stress symptoms and co-morbid mental health symptoms reinforce the need to provide appropriate care and referral pathways to women in the decade after having a baby. Recognition of the context of IPV and nature of mental health concerns is needed in tailoring responses.

Assessing longitudinal pathways between maternal depressive symptoms, parenting self-esteem and infant temperament

BACKGROUND

Previous studies of relations between parenting self-concepts, parental adjustment and child temperament have been ambiguous regarding the direction of influence; and have rarely followed families from pregnancy through the first year of life. The current study examines change and stability in maternal depressive symptoms, parenting competences and child temperament through the perinatal period until nine months postpartum.

METHODS

Czech mothers (N = 282) participated at three time points: the third trimester of pregnancy (Time 1), six weeks (Time 2) and nine months postpartum (Time 3). Questionnaire data concerned depressive symptoms (T1, T2, T3), maternal parenting self-esteem (T1, T2) and sense of competence (T3), and child temperament (T2, T3). A path model was used to examine concurrent and longitudinal relations between these variables.

RESULTS

The analyses indicated longitudinal stability of all constructs, as well as concurrent relations between them. Longitudinal relations supported child-to-parent, rather than parent-to-child, effects: child difficult temperament predicted decreases in perceived maternal parenting competences, but maternal variables did not predict change in infant temperament. In addition, we observed weak mutual relations between maternal depression levels and parenting competences, such that maternal depression diminished perceived parenting competences that in turn contributed to higher levels of depression.

CONCLUSION

Mothers' confidence in their ability to parent is influenced by their experience with a difficult infant and by their depressive symptoms during the child's first year of life. Depressive symptoms are, in turn, aggravated by mothers' low perceived competences in the parenting role.

Trajectories and determinants of depressive symptoms among Korean employed women with young children

BACKGROUND

This study examined the trajectory groups of maternal depressive symptoms of Korean employed women with young children and the association between trajectory group membership and personal, family, social and sociodemographic factors.

METHOD

This study used Nagin's semi-parametric, group-based modeling to analyze 2008 (Wave 1) to 2012 data (Wave 5) from the Panel Study on Korean Children, a nationally representative sample of children.

RESULTS

Four distinct trajectory groups were identified, namely, a non-depressive symptoms group, increasing subclinical depressive symptoms group, stable moderate depressive symptoms group and severe depressive symptoms group. Results showed that self-esteem, parental stress, child care cooperation of husband, marital satisfaction and social support affected the likelihood of membership in the four depressive symptoms groups.

CONCLUSION

Prevention or intervention toward trajectory groups requires integrative approaches that target various factors across multiple contexts.

Demographic and Parental Factors Associated With Developmental Outcomes in Children With Intellectual Disabilities

The aim of the study was to examine the relation between demographic variables, parental characteristics, and cognitive, language and motor skills development in children with intellectual disabilities (ID). A sample of 89 children with ID, aged 20-47 months, completed the Bayley Scales of Infant Development to measure cognitive, motor, and linguistic development. Parents were administered questionnaires about demographic information and parental anxiety, depression, parental stress, conjugality and familial functioning. Parenting behaviors (affection, responsiveness, encouragement, and teaching) were observed using the Spanish version of PICCOLO (Parenting Interactions with Children: Checklist of Observations Linked to Outcomes). A bivariate analysis showed that cognitive development in infants was significantly related to the mother's and father's responsiveness, and to the father's teaching scores. Infant language development was related to a variety of maternal factors (educational level, anxiety, depression, maternal responsiveness) and to the father's teaching scores. None of the factors were statistically related to child motor development. A multivariate regression analysis indicated that children's cognitive development can be predicted by a linear combination of maternal responsiveness and paternal teaching scores. Language development can be predicted by a linear combination of maternal anxiety and responsiveness, and paternal teaching scores. The present study provides evidence of the importance of paternal involvement for cognitive and language development in children with intellectual disabilities, and contributes to the increasing literature about fathering. Gaining knowledge about parental contributions to children's development is relevant for improving positive parenting in early intervention programs.

Transactional associations of maternal depressive symptoms with child externalizing behaviors are small after age 3

A large and growing body of research suggests that maternal depressive symptoms and child externalizing behaviors are strongly associated. Theoretical arguments supported by these findings led to the question of whether maternal depressive symptoms are transactionally associated with child externalizing behaviors. Using 5-year nationally representative longitudinal data from Turkey (N = 1,052), we estimated a transactional bivariate autoregressive latent trajectory model addressing this question. This model disaggregated the association of the two processes into two components: (a) the association of the interindividual differences in the trajectories; and (b) the intradyad association of the changes in maternal depressive symptoms with the changes in child externalizing behaviors. Although maternal depressive symptoms were robustly associated with child externalizing behaviors at age 3, the transactional associations of the two processes were small prior to age 5 and absent at ages 5 to 7. Furthermore, maternal harsh parenting did not have a mediating role in the limited transactional association of maternal depressive symptoms with child externalizing behaviors.

Explaining the gender gap in sickness absence

Background

In many western countries, women have a much higher rate of sickness absence than men. To what degree the gender differences in sickness absence are caused by gender differences in health is largely unknown.

Aims

To assess to what degree the gender gap in sickness absence can be explained by health factors and work- and family-related stressors.

Methods

Norwegian parents participating in the Tracking Opportunities and Problems (TOPP) study were asked about sickness absence and a range of factors possibly contributing to gender differences in sickness absence, including somatic and mental health, sleep problems, job control/demands, work-home conflicts, parent-child conflicts and stressful life events. Using a cross-sectional design, we did linear regression analyses, to assess the relative contribution from health and stressors.

Results

There were 557 study participants. Adjusting for health factors reduced the gender difference in sickness absence by 24%, while adjusting for stressors in the family and at work reduced the difference by 22%. A simultaneous adjustment for health factors and stressors reduced the difference in sickness absence by about 28%.

Conclusions

Despite adjusting for a large number of factors, including both previously well-studied factors (e.g. health, job control/demands) and lesser-studied factors (parent-child conflict and sexual assault), this study found that most of the gender gap in sickness absence remains unexplained. Gender differences in health and stressors account for only part of the differences in sickness absence. Other factors must, therefore, exist outside the domains of health, work and family stressors.

"To Suffer in Paradise": Feelings Mothers Share on Portuguese Facebook Sites

Background: Motherhood is an emotional rollercoaster. This is overlooked by most literature, which tends to refer mothers’ pathological states of postpartum depression and anxiety, mainly seeking to understand their causes or predicting factors, and consequences on children’s development.

Objective: In this study, we aim to observe the diversity of mothers’ emotional states, and to analyze both positive and negative feelings they disclose on specific public and closed motherhood sites on Facebook. We hypothesize that the intensive motherhood model is prevalent in Portuguese society, thus influencing the type of feelings and circumstances in which mothers disclose them.

Methods: We collected posts and comments from the four most popular Portuguese Facebook motherhood sites during 2015 and, then, conducted a quantitative and content analysis to identify the expressed range of feelings concerning motherhood.

Results: Mothers preferably share their positive feelings on public pages, whereas negative feelings are shared more in closed groups (CGs). Expressed positive and negative feelings were significantly different whether we look at normative or non-normative, public or closed sites.

Discussion: We assume that motherhood sites on Portuguese Facebook reflect an intensive motherhood model that is normative in Portuguese society. Positive feelings toward children are promoted and openly shared in public normative sites, while negative feelings concerning motherhood are dealt with in the privacy of CGs. We propose an extensive motherhood model to overcome this duality and to allow women to pursue several different social roles simultaneously in an equally rewarding way.

Maternal Psychological Distress and Offspring Psychological Adjustment in Emerging Adulthood: Findings from Over 18 Years

OBJECTIVE

To examine the long-term prediction of psychological maladaptive (i.e., symptoms of anxiety and depression) and adaptive adjustment (i.e., self-efficacy) in emerging adult offspring from trajectories of maternal psychological distress from toddlerhood to adolescence.

METHOD

Trajectories of maternal psychological distress (low, moderate, high, and low-rising patterns) from toddlerhood (age 1.5 years) to adolescence (age 14.5 years) were used to predict psychological adjustment in emerging adult offspring (age 18-20 years) (n = 400).

RESULTS

Adverse maternal distress trajectories during childhood were linked to maladaptive and adaptive adjustment in adult offspring. Consistently high maternal distress levels experienced across childhood predicted higher symptoms of anxiety and depression and lower self-efficacy than low maternal distress trajectories. Two other adverse maternal distress trajectories (consistently moderate and low-rising patterns) compared with the low trajectory predicted higher offspring depressive symptoms. The findings persisted when adjusting for potential confounders: offspring gender and maternal education, relationship status, language, and economy.

CONCLUSION

The current study showed longitudinal multi-informant impact from adverse maternal distress trajectories to adult offspring maladjustment over 18 years, emphasizing the importance of early identification and prevention.

Social adversity in pregnancy and trajectories of women's depressive symptoms: A longitudinal study

BACKGROUND

Sound evidence has linked the experience of adversity with depression. Less is known about this association over time.

AIM

The aim of this study is to determine whether or not social adversity experienced by pregnant women is associated with their patterns of depressive symptoms over their reproductive life course.

METHODS

Data were obtained from a cohort of women collected at their first obstetrical clinic visit of an index pregnancy (time-point 1) and at a further six time-points to 27 years following the birth. Latent Class Growth Modelling was used to estimate trajectories of women's depressive symptoms over this time period. Logistic regression modelling determined the prospective association between measures of adversity in pregnancy and 27-year postpartum depression trajectories, controlling for potential confounders.

FINDINGS

Experiencing financial problems, housing problems, serious disagreements with partners and with others, and experiencing serious health problems in pregnancy were associated with membership of high and middle depression trajectories over the 27 years. Having someone close die or have a serious illness was associated with the high depression trajectory only. Younger maternal age and low family-income at first clinic visit were also associated with an increased risk of women's membership of both high and middle depression trajectories.

CONCLUSIONS

Experiencing adversity during pregnancy predicts subsequent patterns of maternal depression over an extended period of women's reproductive life course. It is not clear whether women's experiences of adversity during pregnancy were causally associated with subsequent depression or whether there are other explanations of the observed association.

Fertility history and use of antidepressant medication in late mid-life: a register-based analysis of Norwegian women and men

OBJECTIVES

Life course influences on later life depression may include parenting trajectories. We investigate associations between number and timing of births and use of antidepressant medication in late mid-life using data on the whole Norwegian population.

METHODS

We estimated logistic regression models to analyse variations in the purchase of antidepressants between 2004 and 2008 by timing of births and number of children among women and men aged 45-73, using Norwegian population register data. We controlled for age, education, marital and partnership status, and (in some models) family background shared among siblings.

RESULTS

Mothers and fathers of two or more children were generally less likely to purchase antidepressants than the childless. Mothers who started childbearing before age 22 were an exception, although according to sibling models they were not more likely to purchase antidepressants. All models showed that women who became mothers before age 26 and had only one child had higher odds of medication purchase than the childless. Older age at first birth was generally associated with lower risks of antidepressant purchase.

CONCLUSION

This analysis of high-quality data for a national population indicates that early motherhood, childlessness and low parity are associated with higher usage of antidepressants in late mid-life. Our data did not allow identification of mediating pathways, and we lacked information on early mental and physical health and some other potentially important confounders not shared between siblings. Furthermore purchase of antidepressants is not a perfect indicator of depression. Those concerns aside, the results suggest complex effects of fertility on depression that merit further investigation.

Does having a difficult child lead to poor maternal mental health?

OBJECTIVES

Considerable evidence suggests maternal psychopathology influences that of their offspring. The probability of a reverse causal pathway has been only rarely considered but is a concern, given around 10% of children manifest mental impairment during their early years. This study determines the extent to which child behavior problems at ages 5 and 14 years are associated with mothers' mental health at 21 years post birth.

STUDY DESIGN

Longitudinal study.

METHODS

Data were taken from a sample of 3650 women from Mater and University of Queensland Study of Pregnancy birth cohort. Women's mental health was measured using the Mental Disorder Screening Tool at 21 years post birth. The Child Behavior Check List was used to measure internalizing, combined social/attention/thought disorder, and aggression at the age of 5 and 14 years. Logistic regression was used to derive odds ratios and 95% confidence intervals. A number of confounders were used to test for independence.

RESULTS

Following all adjustments, child internalizing behaviors and combined social/attention/thought disorder at 5 years, and all measures of child behavior problem at 14 years were associated with mothers meeting criteria for mental health impairment at 21 years post birth. Moreover mothers of children with behavior problems at 14 years were approximately 2-3 times more likely to these meet these criteria.

CONCLUSIONS

Mothers of children with behavior problems at 5 and 14 years of age were more likely to have mental health impairment at 21 years post birth. Child health professionals should be cognizant of the mother-child relationship having mutual mental health vulnerability.

Adverse trajectories of mental health problems predict subsequent burnout and work-family conflict - a longitudinal study of employed women with children followed over 18 years

BACKGROUND

The long-term consequence of experiencing mental health problems may lead to several adverse outcomes. The current study aims to validate previous identified trajectories of mental health problems from 1993 to 2006 in women by examining their implications on subsequent work and family-related outcomes in 2011.

METHODS

Employed women (n = 439) with children were drawn from the Tracking Opportunities and Problems-Study (TOPP), a community-based longitudinal study following Norwegian families across 18 years. Previous identified latent profiles of mental health trajectories (i.e., High; Moderate; Low-rising and Low levels of mental health problems over time) measured at six time points between 1993 and 2006 were examined as predictors of burnout (e.g., exhaustion and disengagement from work) and work-family conflict in 2011 in univariate and multivariate analyses of variance adjusted for potential confounders (age, job demands, and negative emotionality).

RESULTS

We found that having consistently High and Moderate symptoms as well as Low-Rising symptoms from 1993 to 2006 predicted higher levels of exhaustion, disengagement from work and work-family conflict in 2011. Findings remained unchanged when adjusting for several potential confounders, but when adjusting for current mental health problems only levels of exhaustion were predicted by the mental health trajectories.

CONCLUSIONS

The study expands upon previous studies on the field by using a longer time span and by focusing on employed women with children who experience different patterns of mental health trajectories. The long-term effect of these trajectories highlight and validate the importance of early identification and prevention in women experiencing adverse patterns of mental health problems with regards to subsequent work and family-related outcomes.

Working with complexity: experiences of caring for mothers seeking residential parenting services in New South Wales, Australia

AIM AND OBJECTIVES

To investigate staff perception of the changing complexity of mothers and infants admitted to two residential parenting services in New South Wales in the decade from 2005-2015.

BACKGROUND

For many mothers with a young child, parenting is difficult and stressful. If parenting occurs within the context of anxiety, mental illness or abuse it often becomes a high-risk situation for the primary caregiver. Residential parenting services provide early nursing intervention before parenting problems escalate and require physical or mental health focused care.

DESIGN

A qualitative descriptive design using semi-structured interview questions was used as phase three of a larger study. Data were gathered from 35 child and family health nurses and ten physicians during eight focus groups.

RESULTS

Three main themes emerged: (1) dealing with complexity; (2) changing practice; and (3) appropriate knowledge and skills to handle greater complexity.

CONCLUSIONS

There was a mix of participant opinions about the increasing complexity of the mothers presenting at residential parenting services during the past decade. Some of the nurses and physicians confirmed an increase in complexity of the mothers while several participants proposed that it was linked to their increased psychosocial assessment knowledge and skill. All participants recognised their work had grown in complexity regardless of their perception about the increased complexity of the mothers.

RELEVANCE TO CLINICAL PRACTICE

Australian residential parenting services have a significant role in supporting mothers and their families who are experiencing parenting difficulties. It frequently provides early intervention that helps minimise later emotional and physical problems. Nurses are well placed to work with and support mothers with complex histories. Acknowledgement is required that this work is stressful and nurses need to be adequately supported and educated to manage the complex presentations of many families.

Low-Income First-Time Mothers: Effects of APN Follow-up Using Mobile Technology on Maternal and Infant Outcomes

Background. Low-income mothers have greater challenges in accessing health care services due changes in the health care system and budget cuts. The purpose of this randomized clinical trial was to test a nurse practitioner (NP) intervention using cell phone and texting on maternal/infant outcomes. Methods. The sample included 129 mother-infant pairs. Intervention group mothers received NP 2-way cell phone follow-up intervention post–hospital discharge for 6 months. Results. Intervention mothers’ perceived social support was significantly higher. Intervention infants received their first newborn follow-up visit significantly earlier (6 vs 9 days); significantly more infants were immunized at recommended times (2, 4, and 6 months of age); and there were fewer infant morbidities compared to controls. The intervention saved between $51 030 and $104 277 in health care costs averted. Conclusion. This easy-to-use, safe intervention is an effective way to reach a wide range of populations and demonstrated improved maternal/infant outcomes and decreased cost.

Fathers of children with or without ID: understanding long-term psychological symptoms

BACKGROUND

Researchers have primarily relied on mother report to understand the parenting contexts of rearing children with intellectual disabilities. Fathers are increasingly being considered as equally important reporters of their child's behaviours, as they have unique and independent relationships with their children. The purpose of this study was to understand how one source of stress - reports of child behaviour problems - along with spousal support related to parenting tasks, associated with fathers' reports of psychological symptoms over time.

METHOD

One hundred eighty-two father participants completed measures of child behaviour problems, spousal support and psychological symptoms. Growth curve modelling was employed to examine paternal psychological symptoms over the child's developmental trajectory.

RESULTS

Fathers' reports of child behaviour problems predicted initial levels of paternal psychological symptoms but did not predict change in paternal psychological symptoms over time. Spousal support further reduced initial levels of paternal psychological symptoms.

CONCLUSIONS

Child behaviour problems are more important than disability status in predicting father's psychological symptoms. Spousal support predicts paternal psychological symptoms and can be viewed as an additional resource for fathers. Implications for research and practice are discussed.

Trajectories and predictors of women's depression following the birth of an infant to 21 years: a longitudinal study

Little is known about the long-term mental health of women following the birth of an infant. This study describes the 21 year trajectory of women's depression following the birth of an infant and identifies early predictors of post-birth maternal depression trajectories. The sample comprises 2,991 women from the Mater and University of Queensland Study of Pregnancy. Using the Delusions-Symptoms-States-Inventory, depression was measured at 6 months, 5, 14 and 21 years after the birth. These measures were clustered and in addition bivariate and multivariate analyses were used to test for significant association between the groups and a range of maternal socio-demographic, psychological and pregnancy-related factors. Two depression trajectories were produced, a no-low depression group (79.0 %) and a high-escalating depression group (21.0 %). The strongest predictors for a high-escalating depression group were conflict in the partner-relationship (p < 0.001), anxiety (p < 0.001) and stress (p < 0.001) in the antenatal period, having many pregnancy symptoms (p < 0.001), being younger (p < 0.001) and having poorer social networks (p < 0.001). To a lesser extent not completing high school (p < 0.05), being unsure about wanting the pregnancy (p < 0.05) and not wanting contact with the infant following the birth (p < 0.05) were also predictors for high-escalating depression trajectory. Our findings suggest a sub-sample of mothers experience persistent depressive symptoms over a 21 year period following the birth of their infant. Partner conflict, inadequate social supports and poor mental health during the pregnancy, rather than factors relating to the birth event, contribute to women's depressive symptoms in the long-term. Given the identification of early markers for persistent depression, there may be opportunities for intervention for at-risk pregnant women.

Predictors of persistent maternal depression trajectories in early childhood: results from the EDEN mother-child cohort study in France

BACKGROUND

Maternal depression in the pre- and postpartum period may set women on a course of chronic depressive symptoms. Little is known about predictors of persistently elevated depressive symptoms in mothers from pregnancy onwards. The aims of this study are to determine maternal depression trajectories from pregnancy to the child's fifth birthday and identify associated risk factors.

METHOD

Mothers (N = 1807) from the EDEN mother-child birth cohort study based in France (2003-2011) were followed from 24-28 weeks of pregnancy to their child's fifth birthday. Maternal depression trajectories were determined with a semi-parametric group-based modelling strategy. Sociodemographic, psychosocial and psychiatric predictors were explored for their association with trajectory class membership.

RESULTS

Five trajectories of maternal symptoms of depression from pregnancy onwards were identified: no symptoms (60.2%); persistent intermediate-level depressive symptoms (25.2%); persistent high depressive symptoms (5.0%); high symptoms in pregnancy only (4.7%); high symptoms in the child's preschool period only (4.9%). Socio-demographic predictors associated with persistent depression were non-French origin; psychosocial predictors were childhood adversities, life events during pregnancy and work overinvestment; psychiatric predictors were previous mental health problems, psychological help, and high anxiety during pregnancy.

CONCLUSIONS

Persistent depression in mothers of young children is associated to several risk factors present prior to or during pregnancy, notably anxiety. These characteristics precede depression trajectories and offer a possible entry point to enhance mother's mental health and reduce its burden on children.