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Wendelboe KI, Stuart AC, Smith-Nielsen J, Linkhorst TB, Væver MS. Offline and online parental mentalizing in mothers with symptoms of postpartum depression: Examining the association between self-reported parental reflective functioning and interactional mind-mindedness. Infant Ment Health J 2024; 45:301-317. [PMID: 38446014 DOI: 10.1002/imhj.22109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 10/10/2023] [Accepted: 02/14/2024] [Indexed: 03/07/2024]
Abstract
Mentalizing is, to a certain extent, considered context specific. However, research on the association between parents' abilities to reflect upon their infant's mental states outside social interaction (offline) versus during ongoing parent-infant interaction (online) is currently limited. This study investigated the association between self-reported offline and online mentalizing in a sample of primarily ethnically Danish mothers (N = 142), with symptoms of postpartum depression, and their 1-11-month-old infants. Offline mentalizing was assessed with the Parental Reflective Functioning Questionnaire-Infant Version (PRFQ-I) and online mentalizing was assessed with interactional mind-mindedness. Ordinal logistic regressions showed that a higher score on the PRFQ-I prementalizing subscale was negatively related to number of overall mind-related comments and appropriate mind-related comments produced by mothers during interaction with their infant. Our results indicate partial overlaps between self-reported parental reflective functioning and mind-mindedness, that is, that particularly offline maladaptive mentalizing is associated with lower levels of mentalizing during interaction in mothers with symptoms of depression. Post-hoc examination of the interaction effect of postpartum depression showed that this association was only evident in mothers with medium to high levels of depression. Findings and implications are discussed.
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Affiliation(s)
- Katrine I Wendelboe
- Department of Psychology, Center for Early Intervention and Family Studies, University of Copenhagen, Copenhagen, Denmark
| | - Anne C Stuart
- Department of Psychology, Center for Early Intervention and Family Studies, University of Copenhagen, Copenhagen, Denmark
| | - Johanne Smith-Nielsen
- Department of Psychology, Center for Early Intervention and Family Studies, University of Copenhagen, Copenhagen, Denmark
| | - Thea B Linkhorst
- Department of Psychology, Center for Early Intervention and Family Studies, University of Copenhagen, Copenhagen, Denmark
| | - Mette Skovgaard Væver
- Department of Psychology, Center for Early Intervention and Family Studies, University of Copenhagen, Copenhagen, Denmark
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2
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de Jesús Ossa Henao Y, Trejos Herrera AM, Gutierrez Carvajal OI, Molina Machado DC, Ocampo Dávila J. Intervention in Maternal Sensitivity and Child Attachment in Dyads with Psychosocial Risk: A Pilot Study. TRENDS IN PSYCHOLOGY 2023. [DOI: 10.1007/s43076-023-00279-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
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Burtchen N, Alvarez-Segura M, Urben S, Giovanelli C, Mendelsohn AL, Guedeney A, Schechter DS. Effects of maternal trauma and associated psychopathology on atypical maternal behavior and infant social withdrawal six months postpartum. Attach Hum Dev 2022; 24:1-27. [PMID: 36371796 DOI: 10.1080/14616734.2022.2142894] [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: 08/05/2022] [Accepted: 10/29/2022] [Indexed: 11/15/2022]
Abstract
Maternal psychopathology given a history of maltreatment and domestic violence exposure increases the risk for child psychopathology. Infant social withdrawal is one warning sign of adverse developmental outcomes including child anxiety and depression. It remains unclear how maternal trauma-related psychopathology might affect infant social withdrawal six-months postpartum. METHODS One-hundred ninety-five women and their six-month-old infants were studied in an at-risk community sample. Maternal trauma history, posttraumatic stress (PTSD) and major depressive (MDD) disorders were assessed. Maternal and infant behaviors were coded from videotaped interactions. RESULTS Maternal trauma was correlated with atypical maternal behavior (AMB) and infant social withdrawal (p ≤ .001). PTSD and MDD, and comorbid PTSD/MDD predicted increased AMB (p ≤ .001) but only maternal MDD was predictive of infant social withdrawal (p ≤ .001). Effects of maternal MDD on infant withdrawal were mediated by AMB. CONCLUSIONS At six-months postpartum, maternal MDD was associated with infant withdrawal. AMB is an important target for early intervention.
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Affiliation(s)
- Nina Burtchen
- Clinic for Psychosomatic Medicine and Psychotherapy, Freiburg University Medical Center, Freiburg, Germany
- Department of Pediatrics, New York University, New York University Grossman School of Medicine, New York, NY, USA
| | - Mar Alvarez-Segura
- Child and Adolescent Psychiatry Service, Department of Psychiatry, Abat Oliba CEU University, Barcelona, Spain
- Department of Child & Adolescent Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
| | - Sébastien Urben
- Child & Adolescent Psychiatry Service, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Alan L Mendelsohn
- Department of Pediatrics, New York University, New York University Grossman School of Medicine, New York, NY, USA
| | - Antoine Guedeney
- Child & Adolescent Psychiatry Service, Hôpital Bichat-Claude
- Bernard Faculty of Medicine, University of Paris Diderot, Paris, France
| | - Daniel S Schechter
- Department of Child & Adolescent Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
- Child & Adolescent Psychiatry Service, Department of Psychiatry, Lausanne University Hospital and Faculty of Biology and Medicine, Lausanne, Switzerland
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Madsen EB, Smith-Nielsen J, Egmose I, Lange T, Vaever MS. The impact of childhood adversity on parenting stress is mediated by adult attachment and depressive symptoms. Scand J Psychol 2021; 63:47-54. [PMID: 34743339 DOI: 10.1111/sjop.12788] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 09/21/2021] [Indexed: 11/29/2022]
Abstract
Adverse childhood experiences can have far-reaching implications for later mental health, including in parenthood. Research suggests that childhood adversity is a risk factor for later parenting stress, yet the underlying mechanisms are only just being uncovered. Uncovering these mechanisms is important to diminish heightened levels of parenting stress and thereby reduce adverse effects of elevated parenting stress on child and parent outcomes. In a cross-sectional study using a sample of mothers of 2-10 month-old infants (N = 367) we first examined depressive symptoms as a mediator, and then, the indirect effect of adult attachment through depressive symptoms between childhood adversity and parenting stress. Results showed that the effect of childhood adversity on parenting stress was mediated by an indirect pathway through depressive symptoms alone, and an indirect pathway of adult attachment through depressive symptoms. The indirect effect of adult attachment through depressive symptoms was found to be stronger than the indirect effect of depressive symptoms alone, supporting the hypothesis that adult attachment insecurity together with depressive symptoms are particularly important risk factors to be considered in this relationship. Results suggest that childhood adversity is a risk factor for parenting stress, and not a determinant of later parenting stress per se. Instead, mediators in this association, adult attachment, and depressive symptoms, were identified as potential targets of intervention to prevent negative effects of childhood adversity on parenting stress. A limitation of the study lies in its cross-sectional design. Future studies should examine these associations longitudinally to allow for interpretation of causality.
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Affiliation(s)
- Eva Back Madsen
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | | | - Ida Egmose
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Theis Lange
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Neukel C, Bermpohl F, Kaess M, Taubner S, Boedeker K, Williams K, Dempfle A, Herpertz SC. Understanding and breaking the intergenerational cycle of abuse in families enrolled in routine mental health services: study protocol for a randomized controlled trial and two non-interventional trials investigating mechanisms of change within the UBICA II consortium. Trials 2021; 22:749. [PMID: 34711261 PMCID: PMC8555002 DOI: 10.1186/s13063-021-05653-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 09/24/2021] [Indexed: 11/10/2022] Open
Abstract
Background Parents’ mental illness (MI) and parental history of early life maltreatment (ELM) are known to be significant risk factors for poor parenting while poor parenting is a crucial mediator of the intergenerational continuity of child maltreatment. Hence, maltreatment prevention programs for families with an MI parent, which pay particular attention to experiences of ELM in the parent, are urgently needed. Parental mentalizing was previously found to mediate successful parenting. Interventions aimed at improving the parental mentalizing capacity reduced maltreatment risk in parents. The aim of the present study is to investigate the effectiveness of a mentalization-based parenting-counseling in acutely mentally ill parents currently treated at a psychiatric hospital. Methods Mentalization-based parenting-counseling (MB-PC) vs. enhanced standard clinical care (SCC+) will be administered in a cluster-randomized-controlled trial (RCT). Patients treated at psychiatric hospitals with children between 1.5 and 15 years will be included in the trial. MB-PC will be administered as a 12-h combined individual and group program enriched by social counseling (over a course of 5 weeks) as add-on to standard clinical care, while the control condition will be standard clinical care plus a 90-min psychoeducation workshop on positive parenting. Primary efficacy endpoint is self-reported parenting practices at follow-up. Embedded within the RCT will be two sub-studies investigating social cognition and dyadic synchrony as biobehavioral mechanisms of change. Discussion The main goal of the present study is to investigate ways to break the intergenerational continuity of maltreatment by assessing the benefits of a prevention program which aims at improving parenting in vulnerable mothers and fathers. MB-PC is a short, low-cost intervention which can be delivered by nurses and social workers and is applicable to MI patients with children with a broad range of diagnoses. If it is shown to be effective, it can be directly implemented into standard psychiatric hospital care thereby providing help to prevent child maltreatment. Trial registration German Clinical Trials Register DRKS00017398. Registered on 5 July 2019
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Affiliation(s)
- C Neukel
- Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany.
| | - F Bermpohl
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Campus Charité Mitte, Berlin, Germany, Berlin, Germany
| | - M Kaess
- Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany.,University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - S Taubner
- Department of Psychosocial Prevention, University Hospital of Heidelberg, Heidelberg, Germany
| | - K Boedeker
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Campus Virchow-Klinikum, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Berlin, Germany
| | - K Williams
- Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany
| | - A Dempfle
- Institute of Medical Informatics and Statistics, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - S C Herpertz
- Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany
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Smith-Nielsen J, Egmose I, Wendelboe KI, Steinmejer P, Lange T, Vaever MS. Can the Edinburgh Postnatal Depression Scale-3A be used to screen for anxiety? BMC Psychol 2021; 9:118. [PMID: 34364392 PMCID: PMC8349495 DOI: 10.1186/s40359-021-00623-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 07/18/2021] [Indexed: 12/02/2022] Open
Abstract
Background Anxiety in the ante- and postnatal period is prevalent, often co-occurs with depression, and can have adverse consequences for the infant. Therefore, perinatal mental health screening programs should not only focus on depression but also on detecting anxiety. However, in many already implemented perinatal screening programs, adding extra screening instruments is not feasible. We examine the utility of a subscale of the Edinburgh Postnatal Depression Scale (EPDS) consisting of items 3, 4, and 5 (EPDS-3A) for detecting anxiety in new mothers. Methods We used confirmatory factor analysis (CFA) to confirm the presence of the EPDS-3A found in a previous study (n = 320) where exploratory factor analysis (EFA) was used. For the CFA we used a sample of new mothers (n = 442) with children aged 2–11 months recruited from the same population from which mothers for the previous study was recruited. Three models were tested and compared. Receiver operating characteristics of the EPDS-3A were investigated in relation to anxiety caseness status on the combined sample (N = 762). Sample weighing was used to match the dataset to the target population. Cross tabulation was used to investigate the proportion of anxiety cases identified by the EPDS-3A above those identified with the total EPDS. Results The presence of the EPDS-3A was confirmed. An EFA-driven, two-dimensional 7-item model showed the best data fit with one factor representing the anxiety subscale consisting of items 3, 4, and 5. An EPDS-3A score of ≥ 5 was the most optimal for identifying cases of anxiety (sensitivity: 70.9; specificity: 92.2; AUC: 0.926). Further, we found that the EPDS-3A identifies an additional 2.5% of anxiety cases that would not have been identified with the total EPDS. Conclusions The EPDS-3A can be used as a time-efficient screening for possible anxiety in ante- and postnatal mothers. However, adding the EPDS-3A to routine screening with the total EPDS does not lead to a substantial increase in the number of women identified. In line with previous studies, this study confirms that the EPDS identifies anxiety in addition to depression. Therefore, assessment and treatment adjusted to the specific emotional difficulties is imperative. Supplementary Information The online version contains supplementary material available at 10.1186/s40359-021-00623-5.
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Affiliation(s)
| | - Ida Egmose
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Theis Lange
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Wendelboe KI, Smith-Nielsen J, Stuart AC, Luyten P, Skovgaard Væver M. Factor structure of the parental reflective functioning questionnaire and association with maternal postpartum depression and comorbid symptoms of psychopathology. PLoS One 2021; 16:e0254792. [PMID: 34339422 PMCID: PMC8328297 DOI: 10.1371/journal.pone.0254792] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 07/04/2021] [Indexed: 02/06/2023] Open
Abstract
Parental reflective functioning (PRF) refers to the parent’s capacity to envision mental states in the infant and in themselves as a parent, and to link such underlying mental process with behavior, which is important for parenting sensitivity and child socio-emotional development. Current findings have linked maternal postpartum depression to impaired reflective skills, imposing a risk on the developing mother–infant relationship, but findings are mixed, and studies have generally used extensive methods for investigating PRF. The present study examined the factor structure and measurement invariance of the Danish version of the 18-item self-report Parental Reflective Functioning Questionnaire (PRFQ) in a sample of mothers with and without diagnosed postpartum depression. Moreover, the association between PRF and maternal postpartum depression in mothers with and without comorbid symptoms of personality disorder and/or clinical levels of psychological distress was investigated. Participants included 423 mothers of infants aged 1–11 months. Confirmatory factor analysis supported a three-factor structure of the PRFQ; however, item loadings suggested that a 15-item version was a more accurate measure of PRF in mothers of infants. Multi-group factor analysis of the 15-item PRFQ infant version indicated measurement invariance among mothers with and without diagnosed postpartum depression. Multinomial logistic regression showed that impaired PRF was associated with maternal psychopathology, although only for mothers with postpartum depression combined with other symptoms of psychopathology. These results provide new evidence for the assessment of maternal self-reported reflective skills as measured by a modified infant version of the PRFQ, as well as a more nuanced understanding of how variance in symptomatology is associated with impaired PRF in mothers in the postpartum period in differing ways.
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Affiliation(s)
- Katrine I. Wendelboe
- Department of Psychology, Center for Early Intervention and Family Studies, University of Copenhagen, Copenhagen, Denmark
- * E-mail:
| | - Johanne Smith-Nielsen
- Department of Psychology, Center for Early Intervention and Family Studies, University of Copenhagen, Copenhagen, Denmark
| | - Anne C. Stuart
- Department of Psychology, Center for Early Intervention and Family Studies, University of Copenhagen, Copenhagen, Denmark
| | - Patrick Luyten
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
- Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
- Yale Child Study Center, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Mette Skovgaard Væver
- Department of Psychology, Center for Early Intervention and Family Studies, University of Copenhagen, Copenhagen, Denmark
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Kubo N, Kitagawa M, Iwamoto S, Kishimoto T. Effects of an attachment-based parent intervention on mothers of children with autism spectrum disorder: preliminary findings from a non-randomized controlled trial. Child Adolesc Psychiatry Ment Health 2021; 15:37. [PMID: 34273976 PMCID: PMC8286615 DOI: 10.1186/s13034-021-00389-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 07/08/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Caregivers of children with autism spectrum disorders (ASD) often experience difficulties in responding appropriately to the needs of those children, who typically express attachment in distinct and nonconventional ways. This highlights the need for an attachment-based approach targeted at caregivers of children with ASD. Circle of Security Parenting (COSP), an attachment-based parenting program, is designed to increase caregivers' sensitivity to children's attachment needs. The aim of this study was to provide verification of the effectiveness of COSP in mothers of children with ASD. METHODS This study was a non-randomized controlled trial. Sixty mothers of children with ASD aged 4-12 were recruited. Twenty mothers received the COSP intervention, while 40 did not. The characteristics of children in the control group were matched with those of the intervention group. To evaluate the outcomes of the intervention, changes in parental self-efficacy and mental health were assessed using the Tool to Measure Parenting Self-Efficacy (TOPSE) and the General Health Questionnaire-30 (GHQ-30). The children's improvement in emotional and behavioral problems was assessed from the mothers' perspective using the Child Behavior Checklist (CBCL). Both groups completed the assessments in parallel. Evaluations were compared between baseline (T1) and 6-month follow-up (T2). RESULTS Scores for self-efficacy and mental health of mothers and behavior of children were significantly improved from T1 to T2 in the intervention group, but not in the control group. Participants' mental health was markedly worsened in the control group. CONCLUSION This study demonstrated that the COSP program for mothers of children with ASD improved their parental self-efficacy and mental health, and reduced their subjective sense of difficulties related to their children's behaviors. Our findings support the effectiveness of the attachment-based program for mothers of children with ASD, providing the groundwork for further studies of the attachment-based intervention for children with ASD and their families. Future studies with larger samples and randomization are also needed for direct evaluation of the improvement of children's attachment security, and for exploration of the synergistic relationship between various family support strategies and COSP. Trial Registration This trial was registered with the University Hospital Medical Information Network Clinical Trial Registry (No. UMIN000039574).
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Affiliation(s)
- Nobuyo Kubo
- School of Psychological Science, Kansai University of Welfare Sciences, 3-11-1 Asahigaoka, Kashiwara, Osaka, 582-0026, Japan.
- Department of Psychiatry, Nara Medical University, Nara, Japan.
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Juruena MF, Gadelrab R, Cleare AJ, Young AH. Epigenetics: A missing link between early life stress and depression. Prog Neuropsychopharmacol Biol Psychiatry 2021; 109:110231. [PMID: 33383101 DOI: 10.1016/j.pnpbp.2020.110231] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 12/06/2020] [Accepted: 12/21/2020] [Indexed: 02/08/2023]
Abstract
Research has suggested a relationship between early life stress, and depression in particular longer episodes of depression with treatment resistant outcomes. However, the underlying mechanisms for this association remain poorly understood. Molecular studies indicate that, in general, the hereditary character of psychiatric disorders are polygenic, multifactorial and highly complex, with innumerable low-effect genetic variants interacting with each other. In addition, the importance of the environment and its interaction with genes has pointed to a fundamental role of epigenetic mechanisms in psychiatric disorders, such as methylation of deoxyribonucleic acid (DNA), alterations, histone actions and regulation of gene expression by non-coding ribonucleic acids (RNAs). This article provides an overview of the interplay of epigenetics, the HPA axis, early life stress and the development of depression. Advances in our knowledge of epigenetics in the context of early life stress and depression provide a new understanding of the genetic influence on psychopathology and could lead to the identification of new targets for clinical intervention.
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Affiliation(s)
- Mario F Juruena
- Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Denmark Hill, London SE5 8AF, UK; South London and Maudsley NHS Foundation Trust (SLaM), UK.
| | | | - Anthony J Cleare
- Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Denmark Hill, London SE5 8AF, UK; South London and Maudsley NHS Foundation Trust (SLaM), UK
| | - Allan H Young
- Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Denmark Hill, London SE5 8AF, UK; South London and Maudsley NHS Foundation Trust (SLaM), UK
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Prasetyo YB, Nursalam N, Widyawati IY, Hargono R, Ahsan A, Kumboyono K. A belief-based parenting behavior model for promoting family's ability to care for children with avoidant restrictive food intake disorder (ARFID) in Indonesia. J Public Health Res 2021; 10:1964. [PMID: 33623776 PMCID: PMC7893318 DOI: 10.4081/jphr.2021.1964] [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] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 01/12/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Family's ability to care for children with avoidant restrictive food intake disorder (ARFID) is a central indicator in preventing the children from worse nutritional disorders. Environmental factor, child factor, caregiving behavioral systems, and beliefs can improve the family's ability to care for children. The aim of this research was to analyze the effect of environmental factor, child factor, caregiving behavioral systems, and beliefs on the family's ability to care for children with ARFID. Design and Methods: This cross-sectional research was carried out on 245 families with children suffering from ARFID in Malang Regency, in the working area of the Health Office of Malang Regency. The population of this research was families with children suffering from ARFID within the working area of the Health Office of Malang Regency. The research sample size was computed using the rule of thumb in structural equation modeling (SEM), the sample size used was 245. Results: Results showed that the family's ability to care for children with ARFID was highly influenced by the caregiver's belief (t = 21.796; β = 0.713). Caregiver's belief became a dominant factor in the promotion of the family's ability to care for children with ARFID. A caregiver's belief was influenced by his/her behavior. Conclusions: It was concluded that the caregiver's belief serves as a primary factor in the promotion of the family's ability to care for children with ARFID. A caregiver's behavior holds a prominent role in influencing his/her belief in providing care for children suffering from ARFID.
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Affiliation(s)
- Yoyok Bekti Prasetyo
- Community Department, Department of Nursing, Faculty of Health Sciences, University of Muhammadiyah Malang, Kota Malang, Jawa Timur
| | - Nursalam Nursalam
- Department of Health Sciences, Faculty of Public Health, Airlangga University, Surabaya
| | - Ika Yuni Widyawati
- Department of Health Sciences, Faculty of Public Health, Airlangga University, Surabaya
| | - Rahmat Hargono
- Department of Health Education and Behavioural Sciences, Faculty of Public Health, Airlangga University, Surabaya
| | - Ahsan Ahsan
- Department of Nursing, Faculty of Medicine, Brawijaya University, Kota Malang, Jawa Timur, Indonesia
| | - Kumboyono Kumboyono
- Department of Nursing, Faculty of Medicine, Brawijaya University, Kota Malang, Jawa Timur, Indonesia
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Aarestrup AK, Skovgaard Væver M, Petersen J, Røhder K, Schiøtz M. An early intervention to promote maternal sensitivity in the perinatal period for women with psychosocial vulnerabilities: study protocol of a randomized controlled trial. BMC Psychol 2020; 8:41. [PMID: 32345375 PMCID: PMC7189589 DOI: 10.1186/s40359-020-00407-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 04/12/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Maternal mental well-being and social circumstances during pregnancy and early childhood impact the child's well-being and development. Supportive and sensitive parenting is one of the strongest predictors of positive emotional, social and behavioral outcomes for the child. Knowledge is needed about how to detect and support vulnerable families already during pregnancy and in the postnatal period. The aim of this study is to assemble and evaluate an interdisciplinary cross-sectoral intervention to promote maternal sensitivity among women with psychological or social vulnerabilities. METHODS/DESIGN This randomized controlled trial tests the efficacy of an intervention program in the perinatal period compared to care as usual in enhancing maternal sensitivity in a group of psychologically or socially vulnerable women in the Capital Region of Denmark. The intervention consists of four components: 1) detecting symptoms of mental illness in vulnerable pregnant women and initiating treatment if indicated, 2) strengthening parenting skills using the Circle of Security Parenting program, 3) supporting breastfeeding, and 4) sharing knowledge and organizing treatment pathways for families across sectors. Seventy-six families will be randomly assigned to the intervention or care-as-usual. Data will be obtained at study inclusion at 3-5 months of pregnancy, eight weeks after childbirth, and nine months after childbirth. The primary outcome is maternal sensitivity. Secondary outcomes include infant's socio-emotional development, parents' mentalization, parental stress, depressive symptoms, and parental wellbeing. Qualitative data will provide insight into the implementation process. DISCUSSION This paper presents the rational and background for developing the intervention. Furthermore, the design and protocol of the randomized controlled trial. It is hypothesized that the intervention will be associated with positive changes in primary and secondary outcomes. If effective, the intervention will provide insights into prenatal risk profiles among an identified group of psychosocial vulnerable women important for early screening and point to effective preventive interventions that can support women in the perinatal period, increase maternal sensitivity and promote positive child development -starting before the child is born. TRIAL REGISTRATION ClinicalTrials.gov: ID: NCT03190707. Registered June 16, 2017.
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Affiliation(s)
- Anne Kristine Aarestrup
- Center for Clinical Research and Prevention, Frederiksberg Hospital, Nordre Fasanvej 57, Vej 8, Indgang 1, 1.sal, 2000 Frederiksberg, Denmark
| | - Mette Skovgaard Væver
- Centre for Early Intervention and Family Studies, Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Janne Petersen
- Center for Clinical Research and Prevention, Frederiksberg Hospital, Nordre Fasanvej 57, Vej 8, Indgang 1, 1.sal, 2000 Frederiksberg, Denmark
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Katrine Røhder
- Center for Clinical Research and Prevention, Frederiksberg Hospital, Nordre Fasanvej 57, Vej 8, Indgang 1, 1.sal, 2000 Frederiksberg, Denmark
| | - Michaela Schiøtz
- Center for Clinical Research and Prevention, Frederiksberg Hospital, Nordre Fasanvej 57, Vej 8, Indgang 1, 1.sal, 2000 Frederiksberg, Denmark
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12
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Rayce SB, Rasmussen IS, Væver MS, Pontoppidan M. Effects of parenting interventions for mothers with depressive symptoms and an infant: systematic review and meta-analysis. BJPsych Open 2020; 6:e9. [PMID: 31928569 PMCID: PMC7001473 DOI: 10.1192/bjo.2019.89] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 10/11/2019] [Accepted: 11/10/2019] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Postpartum depression is common in the perinatal period and poses a risk for the development of the infant and the mother-infant relationship. Infancy is a critical developmental period of life and supportive parenting is crucial for healthy development, however, the effects of interventions aimed at improving parenting among mothers with depression are uncertain. AIMS To assess the effects of parenting interventions on parent-child relationship and child development among mothers with depressive symptoms with 0-12-month-old infants. METHOD We conducted a systematic review with the inclusion criteria: (a) randomised controlled trials of structured psychosocial parenting interventions for women with depressive symptoms and a child aged 0-12 months in Western Organisation for Economic Co-operation and Development countries, (b) minimum three sessions with at least half of these delivered postnatally and (c) outcomes relating to the parent-child-relationship and/or child development. Publications were extracted from 10 databases in September 2018 and supplemented with grey search and hand search. We assessed risk of bias, calculated effect sizes and conducted meta-analysis. RESULTS Eight papers representing seven trials were included. We conducted meta-analysis on the post-intervention parent-child relationship. The analysis included six studies and showed no significant effect. For individual study outcomes, no significant effects on the majority of both the parent-child relationship and child development outcomes were reported. CONCLUSIONS No evidence of the effect of parenting interventions for mothers with depressive symptoms was found on the parent-child relationship and child development. Larger studies with follow-up assessments are needed, and future reviews should examine the effects in non-Western countries.
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Affiliation(s)
- Signe B. Rayce
- Senior Researcher, VIVE – The Danish Center for Social Science Research, Denmark
| | - Ida S. Rasmussen
- Research Assistant, VIVE – The Danish Center for Social Science Research, Denmark
| | | | - Maiken Pontoppidan
- Senior Researcher, VIVE – The Danish Center for Social Science Research, Denmark
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Investigation of Relationship Between Maternal Religious Attitude and Mental Health of Infant at Birth. WOMEN’S HEALTH BULLETIN 2019. [DOI: 10.5812/whb.93292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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[Strengthening Attachment Competencies in Parents with Mental Illness: Adaptation and Pilot Testing of the Mentalization-Based Lighthouse Parenting Program]. Prax Kinderpsychol Kinderpsychiatr 2019; 68:27-42. [PMID: 30628875 DOI: 10.13109/prkk.2019.68.1.27] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Strengthening Attachment Competencies in Parents with Mental Illness: Adaptation and Pilot Testing of the Mentalization-Based Lighthouse Parenting Program Mentalizing describes the imaginative ability to understand human behaviour in terms of mental states. Parents with mental illnesses and experiences of early maltreatment frequently show impairments in mentalizing, which negatively impact their caregiving competences for the child. A number of mentalization-based programs to strengthen parental competences have been developed and most of them have been positively evaluated with regard to their efficacy. However, approaches which specifically aim to reach highly impaired families with children from different age groups and which can be implemented in psychiatric settings are currently lacking. The newly adapted mentalization-based Lighthouse-Parenting Program aims to fill this gap and strengthen competences of parents with a mental illness. The specific MBT-based stance, the structure and content of this new program are outlined and first results of a pilot test are presented. The program is a promising approach, which can easily be trained and implemented in existing mental health care systems. The Lighthouse-Parenting Program aims to improve the relationship between parent and child, to reduce parental stress and in the long-term to promote the child's development. A randomized controlled trial to evaluate the program's effectiveness is currently being planned.
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Prasetyo YB, Nursalam N, Hargono R, Ahsan A. Socio-demographic Determinants and the Family Ability to Care for Children with Avoidant Restrictive Food Intake Disorder (ARFID). JURNAL NERS 2019. [DOI: 10.20473/jn.v14i1.12735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: The ability of families to care for avoidant restrictive food intake disorder children is still low. There is only few studies that examined relationship between family factor to ability to care children with avoidant restrictive food intake disorder. The purpose of this study was to identify the influence of socio-demographic factors on the ability of families to represent children with avoidant restrictive food intake disorder.Method: The study design was cross-sectional, and the majority of samples were gathered using the rule of the thumb, totaling 245 participants. The sampling technique used a type of multistage sampling. Data were collected by questionnaire. We then conducted an analysis of the univariate data using frequency distribution, while for the bivariate data, we used the chi-square technique. All of the data was processed using IBM SPSS 23.0 statistics.Results: The results showed that the ability of care from the families (health promotion behavior) of children with avoidant restrictive food intake disorder was influenced by the socio-demographic factors, namely maternal age (p= 0.010), the number of children (p= 0.047) and education (p= 0.036).Conclusion: Young mothers need appropriate guidance and direction through good health education. Good health education in young mothers can reduce the pressure faced by the mothers when caring for their children with avoidant restrictive food intake disorder. Health promotion behavior is influenced by maternal education and maternal age. Through good mother's education, the mother will be able to provide a good pattern of care to children who experience avoidant restrictive food intake disorder.
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Smith-Nielsen J, Matthey S, Lange T, Væver MS. Validation of the Edinburgh Postnatal Depression Scale against both DSM-5 and ICD-10 diagnostic criteria for depression. BMC Psychiatry 2018; 18:393. [PMID: 30572867 PMCID: PMC6302501 DOI: 10.1186/s12888-018-1965-7] [Citation(s) in RCA: 108] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 11/28/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The Edinburgh Postnatal Depression Scale (EPDS) is widely used in many countries to screen women for depression in the perinatal period. However, across studies the psychometric properties and cutoff scores of the EPDS have varied considerably; potentially due to different depression criteria and diagnostic systems being used. Therefore, we validated the Danish EPDS against a depression diagnosis according to both DSM-5 and ICD-10. Furthermore, we examined whether the Danish EPDS is multidimensional, as it has previously been suggested. METHODS Women (N = 324) were recruited after routine screenings with the EPDS between 2 and 10 months postpartum (T1). At a subsequent home visit (T2), the EPDS and the Structured Clinical Interview for DSM-5 were administered. Diagnostic interviews were audio recorded to enable subsequent coding for ICD-10 diagnoses and inter-rater reliability analysis. A two-phase stratified sampling strategy with three sampling categories (EPDS-score at T1) was used. Using the distribution of 4931 T1 EPDS-scores from the same population from which we sampled the participants, we used sampling weighing to reweight the sample. The calculation of weights was based upon the mother's sampling category at T1 (i.e. the probability of being sampled) and the weights were applied when assessing the receiver operation characteristics (ROCs) of the EPDS. Sensitivity, specificity, positive predictive value, negative predictive value and area under the ROC curve were computed from the reweighted data for all relevant cutoff values. CIs were computed by embedding the calculations in a weighted logistic regression. Exploratory factor analysis was done using oblique rotation. Parallel analysis was used to assess the number of factors. RESULTS A score of 11 or more was found to be the optimal cutoff for depression according to both DSM-5 and ICD-10 criteria. Factor analysis suggested that the Danish EPDS consists of three factors, including an 'anxiety factor'. CONCLUSIONS The Danish EPDS has reasonable sensitivity and specificity at a cutoff score of 11 or more. There are no notable differences with respect to using ICD-10 or DSM-5 criteria for depression in terms of optimal cutoff. The variation in cutoff scores is likely to be due to cultural variations in the expression of depressive symptoms.
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Affiliation(s)
- Johanne Smith-Nielsen
- Centre for Early Intervention and Family Studies, Department of Psychology, University of Copenhagen, Oester Farimagsgade 2A, DK-1353 Copenhagen, Denmark
| | - Stephen Matthey
- South West Sydney Local Health District, Liverpool Hospital, University of Sydney, Sydney, Australia
| | - Theis Lange
- Department of Public Health, Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Mette Skovgaard Væver
- Centre for Early Intervention and Family Studies, Department of Psychology, University of Copenhagen, Oester Farimagsgade 2A, DK-1353 Copenhagen, Denmark
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Smith-Nielsen J, Lønfeldt N, Guedeney A, Væver MS. Implementation of the Alarm Distress Baby Scale as a universal screening instrument in primary care: feasibility, acceptability, and predictors of professionals' adherence to guidelines. Int J Nurs Stud 2017; 79:104-113. [PMID: 29223624 DOI: 10.1016/j.ijnurstu.2017.11.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 11/12/2017] [Accepted: 11/14/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Infant socioemotional development is often held under informal surveillance, but a formal screening program is needed to ensure systematic identification of developmental risk. Even when screening programs exist, they are often ineffective because health care professionals do not adhere to screening guidelines, resulting in low screening prevalence rates. OBJECTIVES To examine feasibility and acceptability of implementing universal screening for infant socioemotional problems with the Alarm Distress Baby Scale in primary care. The following questions were addressed: Is it possible to obtain acceptable screening prevalence rates within a 1-year period? How do the primary care workers (in this case, health visitors) experience using the instrument? Are attitudes toward using the instrument related to screening prevalence rates? DESIGN A longitudinal mixed-method study (surveys, data from the health visitors' digital filing system, and qualitative coding of answers to open-ended questions) was undertaken. SETTING AND PARTICIPANTS Health visitors in three of five districts of the City of Copenhagen, Denmark (N=79). METHODS We describe and evaluate the implementation process from the date the health visitors started the training on how to use the Alarm Distress Baby Scale to one year after they began using the instrument in practice. To monitor screening prevalence rates and adherence to guidelines, we used three data extractions (6, 9, and 12 months post-implementation) from the electronic filing system. Surveys including both quantitative and open-ended questions (pre- and post-implementation) were used to examine experiences with and attitudes towards the instrument. Descriptive and inferential statistical and qualitative content analyses were used. RESULTS Screening prevalence rates increased during the first year: Six months after implementation 47% (n=405) of the children had been screened; 12 months after implementation 79% (n=789) of the children were screened (the same child was not counted more than once). Most (92%) of the health visitors reported that the instrument made a positive contribution to their work. The majority (81%) also reported that it posed a challenge in their daily work at least to some degree. The health visitors' attitudes (positive and negative) toward the Alarm Distress Baby Scale, measured 7 months post-implementation, significantly predicted screening prevalence rates 12 months post-implementation. CONCLUSIONS Adding the Alarm Distress Baby Scale to an established surveillance program is feasible and accepTable Screening prevalence rates may be related to the primary care worker's attitude toward the instrument, i.e. successful implementation relies on an instrument that adds value to the work of the screener.
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Affiliation(s)
| | - Nicole Lønfeldt
- Child and Adolescent Mental Health Center, Mental Health Services, Denmark
| | - Antoine Guedeney
- Hospital Bichat Claude Bernard APHP, University Denis Diderot Paris, INSERM U 1178 CERP, France
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