Maternal mental health and child problem behaviours: disentangling the role of depression and borderline personality dysfunction

The Moderating Role of Maternal Praise and Positivity in the Association Between Callous-Unemotional (CU) Traits and Later Aggression: A Prospective Study in Preschool Children in Colombia

Our previous findings in the UK and Colombia show that CU traits predict later aggression specifically among children who are already aggressive. We hypothesised that this effect would be reduced in the presence of maternal praise and positivity. In a sample of 220 mothers and children from Colombia, mother-child interactions were coded for maternal praise and positivity, and mothers reported on children's CU traits at age 3.5 and aggression at ages 3.5 and 5 years. The results show three-way interactions between CU traits, child aggression and observed parenting at age 3.5 years in the prediction of later child aggression, and two-way interactions indicating a protective effect of positive parenting in the high aggressive children. Based on our finding, it is plausible that positive parenting may modify the effect of CU traits in the highly vulnerable group of children who are already aggressive in early childhood.

Synergy between callous-unemotional traits and aggression in preschool children: Cross-informant and cross-cultural replication in the UK Wirral Child Health and Development Study, and the Colombian La Sabana Parent-Child Study

Incremental prediction of aggression from callous-unemotional (CU) traits is well established, but cross-cultural replication and studies of young children are needed. Little is understood about the contribution of CU traits in children who are already aggressive. We addressed these issues in prospective studies in the United Kingdom and Colombia. In a UK epidemiological cohort, CU traits and aggression were assessed at age 3.5 years, and aggression at 5.0 years by mothers (N = 687) and partners (N = 397). In a Colombian general population sample, CU traits were assessed at age 3.5 years and aggression at 3.5 and 5.0 years by mother report (N = 220). Analyses consistently showed prediction of age-5.0 aggression by age-3.5 CU traits controlling for age-3.5 aggression. Associations between age-3.5 CU traits and age-5.0 aggression were moderated by aggression at 3.5 years, with UK interaction terms, same informant, β = .07 p = .014 cross-informant, β = .14 p = .002, and in Colombia, β = .09 p = .128. The interactions arose from stronger associations between CU traits and later aggression in those already aggressive. Our findings with preschoolers replicated across culturally diverse settings imply a major role for CU traits in the maintenance and amplification of already established aggression, and cast doubt on their contribution to its origins.

Comorbid borderline personality disorders in women with post-partum depression admitted to mother-baby units

Borderline personality disorder (BPD) is associated with perinatal depression and parenting difficulties. However, little is known about the characteristics and specific effects of BPD in women with postpartum depression. This study aimed to explore 1) the sociodemographic, mental health characteristics, and motherhood difficulties in women with a major depressive postpartum episode (MDPE) and a comorbid diagnosis of BPD, compared to those with other personality disorders (other PD) or no PD and 2) whether BPD itself may be an independent risk factor for infant neglect in women with a MDPE. 412 women admitted to a Mother and Baby Unit (2001-2010) with a MDPE were involved in this study. Our study showed that women with MDPE-BPD (n = 64) more frequently reported a history of childhood maltreatment, single status, low social support, a history of depression, smoking during pregnancy and suicide attempt during the perinatal period compared to women with other PDs (n = 88) or no PD (n = 260). Women with comorbid BPD had a greater length of stay. Regarding infant care, neglect, abuse, and separation at discharge were more frequent in women with comorbid BPD. Logistic regression was performed to specifically examine whether BPD in women with a MDPE was an independent risk factor for infant neglect during the postpartum period. Comorbid BPD was independently associated with infant neglect (OR = 2.21; CI95% [1.02-4.81]). Our results underline the importance of screening for BPD in women with perinatal depression. Further studies are needed to explore the links between MDPE, BPD, and infant development.

Hair cortisol moderates the association between obstetric complications and child wellbeing

Obstetric complications (OC) may have implications for later health outcomes. However, there is a lack of research examining the association between OC and behavior problems or quality of life (HRQoL). We aimed to close this gap and further investigate functioning of the hypothalamus-pituitary-adrenal (HPA)-axis as a potential physiological vulnerability moderating the association between OC and behavior problems and HRQoL. We investigated 232 mothers and their five to 12-year-old children. Presence of OC during the pre-, peri-, and postnatal phases was determined by interviewing mothers. Children's behavior problems (CBCL, TRF) and HRQoL (Kidscreen rated by mothers and children) were assessed. Children gave 3 cm strands of hair for analysis of hair cortisol (HC). Structural equation modeling analyses with a latent variable of child outcome ("distress"), OC as predictor and HC as a potential moderator were conducted. OC significantly predicted distress (β = .33, p < .01). The model showed a good fit to the data: χ2(14)=15.66, p < .33, CFI=.99, TLI=.99, RMSEA=.02, 90 %CI [.00, .06], SRMR=.04. In addition, HC moderated the association between OC and distress (β=-.32, p < .01). The moderation model also showed a good fit: χ2(14) =7.13, p = .93, CFI=1.00, TLI=1.06, RMSEA=.00, 90 %CI [.00, .02], SRMR=.03. Results indicated that the association between OC and distress was significant only when children had low HC-levels. This was also the case for both externalizing and internalizing behavior problems. Our results underline the notion of OC as a risk factor for child behavior problems and wellbeing and point to an important role of the children's physiological set-up such as HPA-functioning.

The Parenting Experience of Those With Borderline Personality Disorder Traits: Practitioner and Parent Perspectives

Background

Borderline Personality Disorder (BPD) is associated with challenges around emotional intensity and interpersonal difficulties. The children of parents with BPD are at risk of poorer outcomes in terms of their own mental health, educational outcomes and wellbeing. The challenges of being a parent can also exacerbate the symptoms of those with BPD traits. There is a pressing need to understand the experience of these parents and to determine what support would be appropriate and useful.

Aim

To explore and compare the experiences and support needs of parents with BPD traits with the experiences and understanding of practitioners who work with them.

Methods

Interviews with 12 parents with BPD traits and 21 practitioners with experience of working with individuals with BPD. The two strands of interviews were analyzed independently using a thematic framework approach, after which the superordinate and subordinate themes were subject to comparison.

Results

Parents with BPD traits represent themselves as experiencing considerable challenges in their role as a parent. These included the impact of emotional intensity, social isolation and lack of a positive parenting models to draw upon. Practitioners demonstrated a strong degree of shared understanding into these difficulties. Both groups highlighted a lack of appropriate support for these parents.

Conclusion

This research highlights the clinical need for parenting-focused support for individuals with BPD traits. Preliminary suggestions for format and content are given.

Maternal personality traits, antenatal depressive symptoms and the postpartum mother-infant relationship: a prospective observational study

PURPOSE

Maternal depression has been associated with bonding difficulties and lower maternal sensitivity in observed mother-infant interactions. However, little research has examined the impact of disordered personality traits in mothers on these outcomes. We investigated the association between disordered personality traits in mothers measured during pregnancy and postnatal (a) self-reported bonding with infant; (b) observational mother-infant interactions.

METHODS

Five hundred fifty-six women were recruited during early pregnancy and subsequently followed up at mid-pregnancy (approximately 28 weeks' gestation) and when infants were aged approximately 3 months (n = 459). During early pregnancy, data were collected on disordered personality traits (using the Standardised Assessment of Personality Abbreviated Scale) and depressive symptoms (using the Edinburgh Postnatal Depression Scale). At 3 months postpartum, self-reported perceived bonding (using the Postpartum Bonding Questionnaire) were collected. A sub-sample of women additionally provided observational mother-infant interaction data (n = 206) (coded using the Child-Adult Relationship Experimental Index).

RESULTS

Higher disordered personality traits was not associated with maternal perceptions of bonding impairment, but was associated with reduced maternal sensitivity during observational mother-infant interactions [adjusted for age, education, having older children, substance misuse prior to pregnancy, infant sex and gestational age: coefficient = - 0.28, 95% CI = - 0.56 to - 0.00, p < 0.05]. After adjusting for depressive symptoms, the association was attenuated [coefficient = - 0.19, 95% CI = - 0.48 to 0.11, p = 0.217].

CONCLUSIONS

Mothers with disordered personality traits did not perceive themselves as having bonding impairments with their infants but were less sensitive during observed interactions, though depressive symptoms attenuated this relationship. Both depression and disordered personality traits need to be addressed to optimize mother-infant interactions.

Randomized controlled trial of the Circle of Security-Intensive intervention for mothers with postpartum depression: maternal unresolved attachment moderates changes in sensitivity

Postpartum depression is related to inadequately sensitive caregiving, putting infants at risk for insecure attachment. Therefore, promoting sensitive maternal caregiving and secure child attachment is particularly important in postpartum depressed mothers and their infants. In this randomized-controlled-trial, we evaluated the efficacy of the Circle of Security-Intensive (COS-I)-intervention in supporting maternal sensitivity and mother-infant-attachment compared to treatment-as-usual (TAU) with unresolved-maternal attachment as a moderator of treatment effect. Eligible mothers with infants (N=72) 4-9 months-old were randomly assigned to treatment (n=36 dyads). Infant attachment was rated at follow-up (child age 16-18 months) (Strange-Situation-procedure). Maternal sensitivity was measured at baseline and follow-up (Mini-Maternal-Behavior-Q-sort). Maternal-unresolved-attachment was assessed at baseline (Adult-Attachment-Interview). We found no significant differences between treatments in infant attachment nor changes in mothers' sensitivity. However, in COS-I, unresolved-mothers exhibited significantly more change in sensitivity than non-unresolved-mothers, whereas in TAU, the opposite was true. These findings may help to optimize clinical use of COS-I.

Management of perinatal depression with non-drug interventions

Perinatal depression is a common disorder that has been associated with serious risks to mother and child. Recently, screening for depression in pregnant and postpartum women has increased, as has the development of new psychotherapy and non-drug treatment modalities. Matching patients to treatments can be challenging, and although research into personalized treatment of major depression in the general population has increased, no published guidelines focus on personalized treatment approaches to perinatal depression. In particular, guidelines on non-drug treatments are lacking. This review summarizes the evidence on personalized non-drug treatment of perinatal depression, how to incorporate patients' preferences, novel treatments under investigation, and the potential role of biomarkers in matching patients to treatment. The review provides recommendations for future research in personalized care of perinatal depression.

Parenting in Patients with Borderline Personality Disorder, Sequelae for the Offspring and Approaches to Treatment and Prevention

PURPOSE OF REVIEW

We review recent findings concerning the implications of borderline personality disorder (BPD) on parenting behaviors, the parent-child relationships, and parental and child outcomes. We focus on self-report and interview data characterizing parents with BPD and their children as well as on observational paradigms investigating parent-child relationships and the quality of dyadic interactions. Novel treatment approaches are discussed.

RECENT FINDINGS

Parents with BPD suffer from increased parenting stress and display characteristic behavioral patterns towards their children, impeding the formation of a healthy parent-child relationship and disrupting offspring emotional development. Offspring are at greater risk of maltreatment and developing BPD themselves, with parental affective instability playing a substantial mediating role. Mothers with BPD face a meaningful burden in their parenting role. Mechanisms of the transmission of BPD pathology onto the following generation are beginning to be understood. Targeted interventions have been devised recently, with preliminary testing producing encouraging results.