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Pingeton BC, Nieser KJ, Cochran A, Goodman SH, Laurent H, Sbrilli MD, Knight B, Newport DJ, Stowe ZN. Childhood maltreatment exposure is differentially associated with transdiagnostic perinatal depression symptoms. J Affect Disord 2024; 358:183-191. [PMID: 38705531 PMCID: PMC11194995 DOI: 10.1016/j.jad.2024.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 04/25/2024] [Accepted: 05/02/2024] [Indexed: 05/07/2024]
Abstract
History of childhood maltreatment (CM) is common and robustly associated with prenatal and postpartum (perinatal) depression. Given perinatal depression symptom heterogeneity, a transdiagnostic approach to measurement could enhance understanding of patterns between CM and perinatal depression. METHODS In two independently collected samples of women receiving care at perinatal psychiatry clinics (n = 523 and n = 134), we categorized longitudinal symptoms of perinatal depression, anxiety, stress, and sleep into transdiagnostic factors derived from the Research Domain Criteria and depression literatures. We split the perinatal period into four time points. We conducted a latent profile analysis of transdiagnostic factors in each period. We then used self-reported history of CM (total exposure and subtypes of abuse and neglect) to predict class membership. RESULTS A three-class solution best fit our data. In relation to positive adaptive functioning, one class had relatively more positive symptoms (high adaptive), one class had average values (middle adaptive), and one class had fewer adaptive symptoms (low adaptive). More total CM and specific subtypes associated with threat/abuse increased an individual's likelihood of being in the Low Adaptive class in both samples (ORs: 0.90-0.97, p < .05). LIMITATIONS Generalizability of our results was curtailed by 1) limited racial/ethnic diversity and 2) missing data. CONCLUSIONS Our results support taking a person-centered approach to characterize the relationship between perinatal depression and childhood maltreatment. Given evidence that increased exposure to childhood maltreatment is associated with worse overall symptoms, providers should consider incorporating preventative, transdiagnostic interventions for perinatal distress in individuals with a history of childhood maltreatment.
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Affiliation(s)
- Blaire C Pingeton
- Institute for Innovations in Developmental Sciences, Northwestern University Feinberg School of Medicine, United States of America.
| | - Kenneth J Nieser
- Department of Population Health Sciences, University of Wisconsin, United States of America
| | - Amy Cochran
- Department of Population Health Sciences, University of Wisconsin, United States of America; Department of Mathematics, University of Wisconsin, United States of America
| | - Sherryl H Goodman
- Department of Psychology, Emory University, United States of America
| | - Heidemarie Laurent
- Department of Psychology, University of Illinois at Urbana-Champaign, United States of America
| | - Marissa D Sbrilli
- Department of Psychology, University of Illinois at Urbana-Champaign, United States of America
| | - Bettina Knight
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, United States of America
| | - D Jeffrey Newport
- Departments of Psychiatry and Behavioral Sciences and Women's Health, University of Texas at Austin Dell Medical School, United States of America
| | - Zachary N Stowe
- Department of Psychiatry, University of Wisconsin at Madison, United States of America
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Bérubé A, Pétrin R, Blais C. Parental depression moderates the relationship between childhood maltreatment and the recognition of children expressions of emotions. Front Psychiatry 2024; 15:1374872. [PMID: 38903632 PMCID: PMC11188386 DOI: 10.3389/fpsyt.2024.1374872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 03/05/2024] [Indexed: 06/22/2024] Open
Abstract
Background Sensitivity plays a crucial role in parenting as it involves the ability to perceive and respond appropriately to children's signals. Childhood maltreatment and depression can negatively impact adults' ability to recognize emotions, but it is unclear which of these factors has a greater impact or how they interact. This knowledge is central to developing efficient, targeted interventions. This paper examines the interaction between parents' depressive symptoms and childhood maltreatment and its influence on their ability to recognize the five basic emotions (happiness, anger, sadness, fear, and disgust) in children's faces. Method The sample consisted of 52 parents. Depressive symptoms were measured by the depression subscale of the Brief Symptom Inventory-18 (BSI-18), and maltreatment history was assessed by the Childhood Trauma Questionnaire (CTQ). Children's emotional stimuli were morphed images created using The Child Affective Facial Expression (CAFE) database. Results Our findings indicate that depressive symptoms moderate the relationship between parents' history of childhood maltreatment and emotion recognition skills. Parents with higher depressive symptoms had lower emotion recognition accuracy when they had not experienced maltreatment. When childhood maltreatment was severe, emotion recognition skills were more consistent across all levels of depression. The relationship between depression and emotion recognition was primarily linked to recognizing sadness in children's faces. Conclusion These findings highlight how different experiences can affect parental abilities in emotion recognition and emphasize the need for interventions tailored to individual profiles to improve their effectiveness.
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Affiliation(s)
- Annie Bérubé
- Ricochet, Department of Psychoeducation and Psychology, University of Quebec in Outaouais, Gatineau, QC, Canada
- Centre de Recherche Universitaire sur les Jeunes et les Familles (CRUJeF), Trois-Rivières, QC, Canada
| | - Rachel Pétrin
- Ricochet, Department of Psychoeducation and Psychology, University of Quebec in Outaouais, Gatineau, QC, Canada
| | - Caroline Blais
- Social and Visual Perception Laboratory, Department of Psychoeducation and Psychology, University of Quebec in Outaouais, Gatineau, QC, Canada
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3
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Isobel S. Trauma in the lives of parents experiencing severe perinatal mental illness. Front Psychiatry 2024; 15:1380146. [PMID: 38628255 PMCID: PMC11018874 DOI: 10.3389/fpsyt.2024.1380146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 03/18/2024] [Indexed: 04/19/2024] Open
Abstract
Background The perinatal period is a time of 'high risk' for new and recurrent episodes of mental illness with 0.1-0.2% of birthing parents requiring admission to specialist mental health units in the months after birth. The prevalence and role of trauma in the lives of birthing parents (most commonly mothers) experiencing severe perinatal mental illness is not well known. Method In a new perinatal mental health unit in Sydney Australia, a retrospective audit of trauma prevalence was undertaken using patient completed questionnaires and electronic medical record data. Descriptive analysis was undertaken. Results Prevalence of trauma in the lives of mothers with severe mental illness was found to be higher than that reported in general or community mental health settings, with 76% of mothers reporting lifetime trauma exposure and 24% meeting criteria for complex PTSD. The majority reported trauma experiences likely to impact attachment and also reported difficulties in responding to their infants' cues and needs. Discussion The findings suggest a need for more research, awareness, and consideration of the role of trauma in experiences of perinatal mental illness, with implications for developing trauma informed models for responding to parental mental illness.
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Affiliation(s)
- Sophie Isobel
- Naamuru Parent and Baby Unit, Sydney Local Health District, Sydney, NSW, Australia
- University of Sydney, Faculty of Medicine and Health, Sydney, NSW, Australia
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4
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Beeghly M. Toward a multi-level approach to the study of the intergenerational transmission of trauma: Current findings and future directions. Dev Psychopathol 2024:1-6. [PMID: 38516836 DOI: 10.1017/s0954579424000555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
A central goal in the field of developmental psychopathology is to evaluate the complex, dynamic transactions occurring among biological, psychological, and broader social-cultural contexts that predict adaptive and maladaptive outcomes across ontogeny. Here, I briefly review research on the effects of a history of childhood maltreatment on parental, child, and dyadic functioning, along with more recent studies on the intergenerational transmission of trauma. Because the experience and sequelae of child maltreatment and the intergenerational transmission of trauma are embedded in complex biopsychosocial contexts, this research is best conceptualized in a developmental psychopathology framework. Moreover, there is a pressing need for investigators in this area of study to adopt dynamic, multi-level perspectives as well as using developmentally guided, sophisticated research methods. Other directions for research in this field are suggested, including the implementation of collaborative interdisciplinary team science approaches, as well as community-based participatory research, to increase representation, inclusion, and equity of community stakeholders. A greater focus on cultural and global perspectives is also recommended.
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Affiliation(s)
- Marjorie Beeghly
- Department of Psychology, Wayne State University, Detroit, MI, USA
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5
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Grant C, Powell C, Philip G, Blackburn R, Lacey R, Woodman J. 'On paper, you're normal': narratives of unseen health needs among women who have had children removed from their care. J Public Health (Oxf) 2023; 45:863-869. [PMID: 37525519 PMCID: PMC10687599 DOI: 10.1093/pubmed/fdad137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/30/2023] [Accepted: 07/07/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Mothers who have children removed from their care often have complex needs. These women have poor health outcomes and are dying earlier than their peers from preventable and amenable causes. Yet there is little known about how health care services might mitigate these risks. This study aimed to listen to the voices of women who had children removed from their care to understand their experiences of health and healthcare. METHODS We used a narrative approach to collect and analyse interview data with six mothers who had experienced child removal in England. Each participant was asked to reflect on their life and main health challenges. RESULTS Three narrative subplots were developed to consolidate experiences of unmet health need: (i) 'on paper you're normal': narratives of complex need, (ii) 'in my family, everyone had issues': narratives of whole family need and (iii) 'I'm still mummy, no matter where they are': narratives of maternal identity and health. CONCLUSIONS Findings highlight limitations within current systems of support, including a culture of distrust and women falling between the gaps of services. Women's narratives illustrate opportunities for health intervention, especially immediately following child removal.
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Affiliation(s)
- Claire Grant
- Department of Epidemiology and Public Health, University College London, London, WC1E 7HB, UK
| | - Claire Powell
- Great Ormond Street Institute of Child Health, University College London, London, WC1N 1EH, UK
| | - Georgia Philip
- Centre for Research on Children & Families, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Ruth Blackburn
- Great Ormond Street Institute of Child Health, University College London, London, WC1N 1EH, UK
| | - Rebecca Lacey
- Department of Epidemiology and Public Health, University College London, London, WC1E 7HB, UK
| | - Jenny Woodman
- Thomas Coram Research Unit, Social Research Institute, University College London, London, WC1H 0AA, UK
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Granner JR, Lee SJ, Burns J, Herrenkohl TI, Miller AL, Seng JS. Childhood maltreatment history and trauma-specific predictors of parenting stress in new fathers. Infant Ment Health J 2023; 44:767-780. [PMID: 37660258 DOI: 10.1002/imhj.22084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 03/30/2023] [Accepted: 07/27/2023] [Indexed: 09/04/2023]
Abstract
For new fathers, parenting stress is a risk factor for impaired early parenting and child maltreatment perpetration. Predictors of parenting stress, including fathers' own experiences of trauma, could be useful intervention targets to support new fathers. We aim to examine associations between new fathers' own histories of child maltreatment, and their perinatal mental health, relationships, and parenting stress. We recruited 298 first-time fathers for a survey that measured child maltreatment history, trauma sequelae including posttraumatic stress disorder (PTSD), major depressive disorder (MDD), interpersonal reactivity, substance use, anger expression, coparenting quality, and parenting stress. On the Parenting Stress Index (PSI) (from 36 to 180), bivariate analysis demonstrated that new fathers who experienced child maltreatment (n = 94) had significantly higher parenting stress (x̅ = 85.3, σ = 18.7) than those who did not (n = 204; x̅ = 76.0, σ = 16.6; P < .000). Hierarchical linear regression modeling indicated that a child maltreatment history, PTSD, and MDD were significantly associated with parenting stress. The strongest predictors of parenting stress were coparenting quality and complex trauma sequelae-interpersonal reactivity and anger expression. Interventions to reduce fathers' parenting stress by targeting known mental health and relationship sequelae of maltreatment are promising avenues to breaking intergenerational transmission of child maltreatment and psychiatric vulnerability.
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Affiliation(s)
| | - Shawna J Lee
- University of Michigan School of Social Work, Ann Arbor, Michigan, USA
| | - Jade Burns
- University of Michigan School of Nursing, Ann Arbor, Michigan, USA
| | - Todd I Herrenkohl
- University of Michigan School of Social Work, Ann Arbor, Michigan, USA
| | - Allison L Miller
- University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Julia S Seng
- University of Michigan School of Nursing, Ann Arbor, Michigan, USA
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Rzeszutek M, Dragan M, Lis-Turlejska M, Schier K, Holas P, Pięta M, Van Hoy A, Drabarek K, Poncyliusz C, Michałowska M, Wdowczyk G, Borowska N, Szumiał S. Long-lasting effects of World War II trauma on PTSD symptoms and embodiment levels in a national sample of Poles. Sci Rep 2023; 13:17222. [PMID: 37821535 PMCID: PMC10567698 DOI: 10.1038/s41598-023-44300-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 10/06/2023] [Indexed: 10/13/2023] Open
Abstract
The main aim of this study was to investigate the long-lasting influences of World War II (WWII) trauma in a national sample of Poles, based on Danieli's (1998) survivors' post-trauma adaptational styles (fighter, numb, victim) and their link with current post-traumatic stress disorder (PTSD) symptoms and embodiment level among participants. We also sought to investigate whether the level of knowledge about WWII trauma among ancestors could moderate that association. The study was conducted among a representative sample of 1598 adult Poles obtained from an external company. Participants filled out the Danieli Inventory of Multigenerational Legacies of Trauma, the knowledge about traumatic World War II experiences in the family questionnaire, the Posttraumatic Diagnostic Scale-5, and the Experience of Embodiment Scale. We observed a positive relationship between all survivors' post-trauma adaptational styles and current levels of PTSD symptoms among participants. In addition, PTSD level mediated the relationships between those adaptational styles and embodiment intensity; that mediation was additionally moderated by a lack of knowledge about WWII trauma among ancestors in our participants. Our study adds to the literature on intergenerational trauma by highlighting the importance of evaluating embodiment in understanding the mechanisms of trauma transmission. Furthermore, it highlights the moderating effect of knowledge of family history in this mechanism and the need to share family histories with subsequent generations.
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Affiliation(s)
- Marcin Rzeszutek
- Faculty of Psychology, University of Warsaw, Stawki 5/7, 00-183, Warsaw, Poland.
| | - Małgorzata Dragan
- Faculty of Psychology, University of Warsaw, Stawki 5/7, 00-183, Warsaw, Poland
| | - Maja Lis-Turlejska
- Faculty of Psychology, SWPS University of Social Sciences and Humanities, Chodakowska Street 19/31, 03-815, Warsaw, Poland
| | - Katarzyna Schier
- Faculty of Psychology, University of Warsaw, Stawki 5/7, 00-183, Warsaw, Poland
| | - Paweł Holas
- Faculty of Psychology, University of Warsaw, Stawki 5/7, 00-183, Warsaw, Poland
| | - Małgorzata Pięta
- Faculty of Psychology, University of Warsaw, Stawki 5/7, 00-183, Warsaw, Poland
| | - Angelika Van Hoy
- Faculty of Psychology, University of Warsaw, Stawki 5/7, 00-183, Warsaw, Poland
| | - Katarzyna Drabarek
- Faculty of Psychology, University of Warsaw, Stawki 5/7, 00-183, Warsaw, Poland
| | - Cecylia Poncyliusz
- Faculty of Psychology, University of Warsaw, Stawki 5/7, 00-183, Warsaw, Poland
| | | | - Gabriela Wdowczyk
- Faculty of Psychology, University of Warsaw, Stawki 5/7, 00-183, Warsaw, Poland
| | - Natalia Borowska
- Faculty of Psychology, University of Warsaw, Stawki 5/7, 00-183, Warsaw, Poland
| | - Szymon Szumiał
- Faculty of Psychology, University of Warsaw, Stawki 5/7, 00-183, Warsaw, Poland
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Edwards KM, Waterman EA, Mullet N, Herrington R, Cornelius S, Hopfauf S, Trujillo P, Wheeler LA, Deusch AR. Indigenous Cultural Identity Protects Against Intergenerational Transmission of ACEs Among Indigenous Caregivers and Their Children. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01795-z. [PMID: 37697145 DOI: 10.1007/s40615-023-01795-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 09/01/2023] [Accepted: 09/05/2023] [Indexed: 09/13/2023]
Abstract
A large body of empirical research has demonstrated that caregiver adverse childhood experiences (ACEs) predict ACEs in one's child, a phenomenon known as the intergenerational transmission of ACEs. Little of this empirical research, however, has focused specifically on Indigenous peoples despite a growing body of theoretical literature and the wisdom of Elders and Traditional Knowledge Keepers that speaks to the presence of this phenomenon within Indigenous communities as well as the protective role of Indigenous cultural identity in preventing the intergenerational transmission of ACEs. The purpose of the current study was to conduct an empirical evaluation of this hypothesis, specifically that Indigenous cultural identity and social support protects against the intergenerational transmission of ACEs among Indigenous peoples and their children in the USA. Participants were 106 Indigenous women caregivers of children ages 10 to 14 in South Dakota who completed surveys. Results showed that Indigenous cultural identity moderated the association between caregiver ACEs and child ACEs. At high levels of cultural identity, there was no association between caregiver ACEs and child ACEs. At low levels of Indigenous cultural identity, however, there was a strong and positive relationship between caregiver ACEs and child ACEs. Social support did not moderate the association between caregiver ACEs and child ACEs. These findings underscore the need for initiatives that enhance Indigenous cultural identity and social support among Indigenous caregivers to prevent the intergenerational transmission of ACEs.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Arielle R Deusch
- Avera Research Institute, Sioux Falls, USA
- University of South Dakota, Vermillion, USA
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Weiss SJ, Goodman SH, Kidd SA, Owen MT, Simeonova DI, Kim CY, Cooper B, Rosenblum KL, Muzik M. Unique Characteristics of Women and Infants Moderate the Association between Depression and Mother-Infant Interaction. J Clin Med 2023; 12:5503. [PMID: 37685568 PMCID: PMC10487744 DOI: 10.3390/jcm12175503] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/15/2023] [Accepted: 08/21/2023] [Indexed: 09/10/2023] Open
Abstract
Research has shown mixed results regarding the association between women's postpartum depression and mother-infant interactions, suggesting that a woman's unique experience and context may moderate how depression shapes these interactions. We examined the extent to which a woman's comorbid anxiety, her exposure to adversity, and infant characteristics moderate the relationship between depressive symptoms of women and interactions with their infants at 6 (n = 647) and 12 months (n = 346) postpartum. The methods included standardized coding of mother-infant interactions and structural regression modeling. The results at 6 months of infant age indicated that infant male sex and infant negative affectivity were risk factors for mothers' depression being associated with less optimal interactions. At 12 months of infant age, two moderators appeared to buffer the influence of depression: a woman's history of trauma and infant preterm birth (≤37 weeks gestation). The results reinforce the salience of infant characteristics in the relationship between maternal depression and mother-infant interactions. The findings also suggest that experiences of trauma may offer opportunities for psychological growth that foster constructive management of depression's potential effect on mother-infant interactions. Further research is needed to clarify the underlying processes and mechanisms that explain the influence of these moderators. The ultimate goals are to reduce the risk of suboptimal interactions and reinforce healthy dyadic relations.
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Affiliation(s)
- Sandra J. Weiss
- Department of Community Health Systems, University of California, San Francisco, CA 94143, USA;
| | | | - Sharon A. Kidd
- Department of Pediatrics, University of California, San Francisco, CA 94143, USA;
| | - Margaret Tresch Owen
- Department of Psychology, University of Texas at Dallas, Richardson, TX 75080, USA;
| | - Diana I. Simeonova
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA 30322, USA;
| | - Christine Youngwon Kim
- Department of Human Development and Family Studies, Pennsylvania State University, Hershey, PA 17033, USA;
| | - Bruce Cooper
- Department of Community Health Systems, University of California, San Francisco, CA 94143, USA;
| | - Katherine L. Rosenblum
- Departments of Psychiatry and Obstetrics & Gynecology, University of Michigan, Ann Arbor, MI 48109, USA; (K.L.R.); (M.M.)
| | - Maria Muzik
- Departments of Psychiatry and Obstetrics & Gynecology, University of Michigan, Ann Arbor, MI 48109, USA; (K.L.R.); (M.M.)
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Horino M, Abu-Rmeileh NME, Yang W, Albaik S, Al-Khatib L, Seita A. Exploring the link between adverse childhood experiences and mental and physical health conditions in pregnant Palestine refugee women in Jordan. Public Health 2023; 220:179-186. [PMID: 37331220 DOI: 10.1016/j.puhe.2023.05.005] [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: 11/25/2022] [Revised: 03/14/2023] [Accepted: 05/06/2023] [Indexed: 06/20/2023]
Abstract
OBJECTIVES Adverse childhood experiences (ACEs) are linked to negative pregnancy outcomes. However, little is known about the prevalence of ACEs and their relationship to mental and health outcomes among pregnant Palestine refugee women. STUDY DESIGN This was a cross-sectional study. METHODS Data were collected from 772 pregnant Palestine refugee women with a median (interquartile range) age of 27 (23, 32) years, attending five antenatal clinics in Jordan between February and June 2021. The modified 33-item ACE International Questionnaire was used to assess eight domains of ACEs: (1) marriage and family, (2) relationship with parents, (3) neglect, (4) household dysfunction/domestic violence, (5) abuse, (6) peer violence, (7) community violence, and (8) collective violence. Multivariate logistic regression was used to examine the association between ACEs and mental and health outcomes. The ethical approval was obtained from United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) Research Review Board in May 2020. RESULTS Eighty-eight percent of women experienced at least one type of ACE, and 26% of women experienced ≥4 types of ACEs. Compared with women with 0-3 types of ACE exposure, those with ≥4 types of ACEs had 1.58 (95% confidence interval [CI] 1.10-2.28) times higher prevalence of obesity before pregnancy, 3.28 (95% CI 1.79-6.03) times higher prevalence of depression during pregnancy, and 2.01 (95% CI 1.39-2.91) times higher prevalence of ever been smoking cigarettes or hookah. CONCLUSIONS Exposure to ACEs is prevalent among pregnant Palestine refugee women. Exposure to multiple types of ACEs was associated with obesity, mental health conditions, and smoking.
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Affiliation(s)
- M Horino
- United Nations Relief and Works Agency for Palestine Refugees in the Near East, Department of Health, Headquarters Amman, Jordan; Center for Human Nutrition, Department of International Health and Sight and Life Global Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - N M E Abu-Rmeileh
- Institute of Community and Public Health, Birzeit University, Birzeit, Palestine
| | - W Yang
- School of Public Health, University of Nevada, Reno, USA
| | - S Albaik
- United Nations Relief and Works Agency for Palestine Refugees in the Near East, Department of Health, Headquarters Amman, Jordan
| | - L Al-Khatib
- United Nations Relief and Works Agency for Palestine Refugees in the Near East, Department of Health, Headquarters Amman, Jordan
| | - A Seita
- United Nations Relief and Works Agency for Palestine Refugees in the Near East, Department of Health, Headquarters Amman, Jordan
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11
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Rinne GR, Mahrer NE, Guardino CM, Shalowitz MU, Ramey SL, Dunkel Schetter C. Childhood family stress modifies the association between perinatal stressful life events and depressive symptoms. JOURNAL OF FAMILY PSYCHOLOGY : JFP : JOURNAL OF THE DIVISION OF FAMILY PSYCHOLOGY OF THE AMERICAN PSYCHOLOGICAL ASSOCIATION (DIVISION 43) 2023; 37:432-442. [PMID: 36996242 PMCID: PMC10238650 DOI: 10.1037/fam0001076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The childhood family environment can influence long-term well-being in part by modifying how individuals' respond to and cope with stress across the life span. Theoretical models propose that childhood stress will either exacerbate (stress sensitization) or attenuate (steeling effect) the effects of adult stress on mental health. This study tests whether childhood family stress modifies the association between stressful life events and depressive symptoms in pregnancy and consecutive postpartum periods. A sample of 127 women reported on depressive symptoms after one birth, during a subsequent pregnancy, and postpartum following that birth. Childhood family stress was assessed with the Risky Families Questionnaire. Stressful life events were measured at all three timepoints to capture the number of life events during both pregnancies and between pregnancies. Associations between stressful life events and depressive symptoms varied as a function of childhood family stress. At the between-persons level, more stressful life events were associated with greater depressive symptoms among women who reported infrequent exposure to childhood family stress in this sample, but not among women who reported more frequent exposure to childhood family stress. Results provide novel evidence that moderate exposure to childhood family stress may attenuate the association between stressful life events and depressive symptoms in the perinatal period, consistent with a steeling effect. That is, some degree of childhood family stress may promote resilience to perinatal stress. Findings underscore the utility of examining the interaction of risk factors across the life span in predicting perinatal mental health. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Gabrielle R. Rinne
- Department of Psychology, University of California, Los Angeles. Los Angeles, CA
| | | | | | | | - Sharon L. Ramey
- Fralin Biomedical Research Institute, Department of Psychology, Department of Psychiatry, Virginia Polytechnic Institute and State University. Blacksburg, VA
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Jones KA, Freijah I, Brennan SE, McKenzie JE, Bright TM, Fiolet R, Kamitsis I, Reid C, Davis E, Andrews S, Muzik M, Segal L, Herrman H, Chamberlain C. Interventions from pregnancy to two years after birth for parents experiencing complex post-traumatic stress disorder and/or with childhood experience of maltreatment. Cochrane Database Syst Rev 2023; 5:CD014874. [PMID: 37146219 PMCID: PMC10162699 DOI: 10.1002/14651858.cd014874.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
BACKGROUND Acceptable, effective and feasible support strategies (interventions) for parents experiencing complex post-traumatic stress disorder (CPTSD) symptoms or with a history of childhood maltreatment may offer an opportunity to support parental recovery, reduce the risk of intergenerational transmission of trauma and improve life-course trajectories for children and future generations. However, evidence relating to the effect of interventions has not been synthesised to provide a comprehensive review of available support strategies. This evidence synthesis is critical to inform further research, practice and policy approaches in this emerging area. OBJECTIVES To assess the effects of interventions provided to support parents who were experiencing CPTSD symptoms or who had experienced childhood maltreatment (or both), on parenting capacity and parental psychological or socio-emotional wellbeing. SEARCH METHODS In October 2021 we searched CENTRAL, MEDLINE, Embase, six other databases and two trials registers, together with checking references and contacting experts to identify additional studies. SELECTION CRITERIA All variants of randomised controlled trials (RCTs) comparing any intervention delivered in the perinatal period designed to support parents experiencing CPTSD symptoms or with a history of childhood maltreatment (or both), to any active or inactive control. Primary outcomes were parental psychological or socio-emotional wellbeing and parenting capacity between pregnancy and up to two years postpartum. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the eligibility of trials for inclusion, extracted data using a pre-designed data extraction form, and assessed risk of bias and certainty of evidence. We contacted study authors for additional information as required. We analysed continuous data using mean difference (MD) for outcomes using a single measure, and standardised mean difference (SMD) for outcomes using multiple measures, and risk ratios (RR) for dichotomous data. All data are presented with 95% confidence intervals (CIs). We undertook meta-analyses using random-effects models. MAIN RESULTS We included evidence from 1925 participants in 15 RCTs that investigated the effect of 17 interventions. All included studies were published after 2005. Interventions included seven parenting interventions, eight psychological interventions and two service system approaches. The studies were funded by major research councils, government departments and philanthropic/charitable organisations. All evidence was of low or very low certainty. Parenting interventions Evidence was very uncertain from a study (33 participants) assessing the effects of a parenting intervention compared to attention control on trauma-related symptoms, and psychological wellbeing symptoms (postpartum depression), in mothers who had experienced childhood maltreatment and were experiencing current parenting risk factors. Evidence suggested that parenting interventions may improve parent-child relationships slightly compared to usual service provision (SMD 0.45, 95% CI -0.06 to 0.96; I2 = 60%; 2 studies, 153 participants; low-certainty evidence). There may be little or no difference between parenting interventions and usual perinatal service in parenting skills including nurturance, supportive presence and reciprocity (SMD 0.25, 95% CI -0.07 to 0.58; I2 = 0%; 4 studies, 149 participants; low-certainty evidence). No studies assessed the effects of parenting interventions on parents' substance use, relationship quality or self-harm. Psychological interventions Psychological interventions may result in little or no difference in trauma-related symptoms compared to usual care (SMD -0.05, 95% CI -0.40 to 0.31; I2 = 39%; 4 studies, 247 participants; low-certainty evidence). Psychological interventions may make little or no difference compared to usual care to depression symptom severity (8 studies, 507 participants, low-certainty evidence, SMD -0.34, 95% CI -0.66 to -0.03; I2 = 63%). An interpersonally focused cognitive behavioural analysis system of psychotherapy may slightly increase the number of pregnant women who quit smoking compared to usual smoking cessation therapy and prenatal care (189 participants, low-certainty evidence). A psychological intervention may slightly improve parents' relationship quality compared to usual care (1 study, 67 participants, low-certainty evidence). Benefits for parent-child relationships were very uncertain (26 participants, very low-certainty evidence), while there may be a slight improvement in parenting skills compared to usual care (66 participants, low-certainty evidence). No studies assessed the effects of psychological interventions on parents' self-harm. Service system approaches One service system approach assessed the effect of a financial empowerment education programme, with and without trauma-informed peer support, compared to usual care for parents with low incomes. The interventions increased depression slightly (52 participants, low-certainty evidence). No studies assessed the effects of service system interventions on parents' trauma-related symptoms, substance use, relationship quality, self-harm, parent-child relationships or parenting skills. AUTHORS' CONCLUSIONS There is currently a lack of high-quality evidence regarding the effectiveness of interventions to improve parenting capacity or parental psychological or socio-emotional wellbeing in parents experiencing CPTSD symptoms or who have experienced childhood maltreatment (or both). This lack of methodological rigour and high risk of bias made it difficult to interpret the findings of this review. Overall, results suggest that parenting interventions may slightly improve parent-child relationships but have a small, unimportant effect on parenting skills. Psychological interventions may help some women stop smoking in pregnancy, and may have small benefits on parents' relationships and parenting skills. A financial empowerment programme may slightly worsen depression symptoms. While potential beneficial effects were small, the importance of a positive effect in a small number of parents must be considered when making treatment and care decisions. There is a need for further high-quality research into effective strategies for this population.
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Affiliation(s)
- Kimberley A Jones
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Isabella Freijah
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Sue E Brennan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Joanne E McKenzie
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Tess M Bright
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Renee Fiolet
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Ilias Kamitsis
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Carol Reid
- Judith Lumley Centre, La Trobe University, Bundoora, Australia
| | - Elise Davis
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Shawana Andrews
- Poche Centre for Indigenous Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Carlton, Australia
| | - Maria Muzik
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Leonie Segal
- Health Economics and Social Policy, Australian Centre for Precision Health, University of South Australia, North Terrace, Australia
| | - Helen Herrman
- Orygen, National Centre of Excellenece in Youth Mental Health, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Catherine Chamberlain
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
- Judith Lumley Centre, La Trobe University, Bundoora, Australia
- NGANGK YIRA Murdoch University Research Centre for Aboriginal Health and Social Equity, Murdoch University, Perth, Australia
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Johnson S, Kasparian NA, Cullum AS, Flanagan T, Ponting C, Kowalewski L, Main EK. Addressing Adverse Childhood and Adult Experiences During Prenatal Care. Obstet Gynecol 2023:00006250-990000000-00759. [PMID: 37141600 PMCID: PMC10184824 DOI: 10.1097/aog.0000000000005199] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 12/08/2022] [Indexed: 05/06/2023]
Abstract
Adverse childhood and adult experiences can affect health outcomes throughout life and across generations. The perinatal period offers a critical opportunity for obstetric clinicians to partner with patients to provide support and improve outcomes. This article draws on stakeholder input, expert opinion, and available evidence to provide recommendations for obstetric clinicians' inquiry about and response to pregnant patients' past and present adversity and trauma during prenatal care encounters. Trauma-informed care is a universal intervention that can proactively address adversity and trauma and support healing, even if a patient does not explicitly disclose past or present adversity. Inquiry about past and present adversity and trauma provides an avenue to offer support and to create individualized care plans. Preparatory steps to adopting a trauma-informed approach to prenatal care include initiating education and training for practice staff, prioritizing addressing racism and health disparities, and establishing patient safety and trust. Inquiry about adversity and trauma, as well as resilience factors, can be implemented gradually over time through open-ended questions, structured survey measures, or a combination of both techniques. A range of evidence-based educational resources, prevention and intervention programs, and community-based initiatives can be included within individualized care plans to improve perinatal health outcomes. These practices will be further developed and improved by increased clinical training and research, as well as through broad adoption of a trauma-informed approach and collaboration across specialty areas.
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Affiliation(s)
- Sara Johnson
- La Clinica de La Raza, Oakland, the California Maternal Quality Care Collaborative and the Departments of Pediatrics and Obstetrics and Gynecology, School of Medicine, Stanford University, Palo Alto, and the Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California; and the Department of Pediatrics, University of Cincinnati College of Medicine, Center for Heart Disease and Mental Health, Heart Institute, and Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Janse van Rensburg E, Woolard A, Hill NTM, Reid C, Milroy H, Ohan JL, Lin A, Chamberlain C. The effect of childhood maltreatment on adult survivors' parental reflective function, and attachment of their children: A systematic review. Dev Psychopathol 2023:1-15. [PMID: 37052290 DOI: 10.1017/s0954579423000391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
BACKGROUND Parental reflective function (PRF) is a candidate mechanism in the transmission of intergenerational trauma. This systematic review examined (1) the association between parental history of childhood maltreatment and PRF, (2) how PRF relates to attachment in children of parent survivors, and (3) whether PRF moderates the association between parental maltreatment history and child attachment. METHODS Ten databases were searched (from inception to 10th November 2021). Inclusion criteria were primary study, quantitative, parent participants, measures of childhood maltreatment, and postnatal PRF. Exclusion criteria were qualitative, intervention follow-up, gray literature, or a review study. Risk of bias was assessed using recommended tools. Data were narratively synthesized. RESULTS One-thousand-and-two articles were retrieved, of which eleven met inclusion criteria (N = 974 participants). Four studies found a significant association between parental childhood maltreatment and disrupted PRF, six did not, one found mixed results. One study reported the association between childhood maltreatment and attachment (nonsignificant results). DISCUSSION There is no clear evidence PRF is routinely disrupted in parent survivors, though there is high heterogeneity in studies. Future research should standardize design to better understand whether PRF is a candidate mechanism in intergenerational trauma. OTHER PROSPERO CRD42020223594.
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Affiliation(s)
- Elmie Janse van Rensburg
- Embrace, Telethon Kids Institute, WA, Australia
- School of Psychological Science, The University of Western Australia, WA, Australia
- Youth Mental Health Team, Telethon Kids Institute, WA, Australia
| | - Alix Woolard
- Embrace, Telethon Kids Institute, WA, Australia
- Youth Mental Health Team, Telethon Kids Institute, WA, Australia
- Medical School, University of Western Australia, WA, Australia
| | - Nicole T M Hill
- Youth Mental Health Team, Telethon Kids Institute, WA, Australia
- Centre for Child Health Research, University of Western Australia, WA, Australia
| | - Carol Reid
- Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Helen Milroy
- Embrace, Telethon Kids Institute, WA, Australia
- Youth Mental Health Team, Telethon Kids Institute, WA, Australia
- Medical School, University of Western Australia, WA, Australia
| | - Jeneva L Ohan
- School of Psychological Science, The University of Western Australia, WA, Australia
| | - Ashleigh Lin
- Youth Mental Health Team, Telethon Kids Institute, WA, Australia
- Centre for Child Health Research, University of Western Australia, WA, Australia
| | - Catherine Chamberlain
- Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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Suomi A, Bolton A, Pasalich D. The Prevalence of Post-Traumatic Stress Disorder in Birth Parents in Child Protection Services: Systematic Review and Meta-analysis. TRAUMA, VIOLENCE & ABUSE 2023; 24:1032-1046. [PMID: 34736361 DOI: 10.1177/15248380211048444] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
BACKGROUND Birth parents of children in the statutory child protection system have disproportionally high rates of trauma exposure and mental health problems, however, little is known about the extent to which this population display symptoms of Post-Traumatic Stress Disorder (PTSD) or Complex PTSD. This study provides a systematic review and meta-analysis of the PTSD rates in parent samples involved in the child protection services. METHOD Articles were identified by searching PSYCINFO, Medline, CINAHL, and PILOTS. The search included terminology pertaining to parents, trauma, and child protective services and we included all peer-reviewed articles that reported a valid measure of PTSD and child protection service involvement. RESULTS Fifteen studies were included in the review with a combined prevalence estimate for PTSD based on 11 studies (n = 4871) was 26.0% (95% CI 20.0-32.0%) for mothers, and estimate based on three studies (n = 2606) was 13.0% (95% CI 7.0%-18.0%) for fathers and 23.0% (95% CI 17.0-29.0) for all parents based on 7848 responses. Four studies that did not report prevalence rates, reported sample mean scores for PTSD that were consistently higher than in general population. Factors associated with parents' PTSD symptoms included mental health co-morbidities, victimization of physical and sexual violence, and perpetration of child abuse. CONCLUSION There are high rates of PTSD in parents involved in the protective system, thus more targeted efforts are needed to identify and adequately address trauma symptoms of parents as part of child protection interventions.
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Affiliation(s)
- Aino Suomi
- Institute of Child Protection Studies, 95359Australian Catholic University, Canberra, VIC, Australia
- Research School of Population Health, 2219Australian National University, Canberra, ACT, Australia
| | - Annalese Bolton
- Matilda Centre, University of Sydney, Sydney, NSW, Australia
- Forensic Psychology Clinic, 7800University of New South Wales, Sydney, NSW, Australia
| | - Dave Pasalich
- Research School of Psychology, 2219Australian National University, Canberra, ACT, Australia
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Shin SH, Tomlinson CA, Nelson-Hence D, Ksinan Jiskrova G. Understanding the Intergenerational Cycle of Trauma and Violence: Maternal Adverse Childhood Experiences and Parent-to-Child Aggression Risk. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:4998-5018. [PMID: 36062736 DOI: 10.1177/08862605221120884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Adverse childhood experiences (ACEs), such as exposure to maltreatment and household dysfunction, are major risk factors for physical and mental health problems across the lifespan. While the relationship between ACEs and health outcomes is well established, what effects ACEs might have on parent-to-child aggression are less known. The negative consequences of ACEs on parental aggression can be even more pronounced with multiple exposures to different patterns of ACEs. This study examined the association between patterns of maternal ACEs and subsequent parent-child aggression risk. A diverse sample of young women (N = 329; mean age = 26.3 years) was recruited at a large, urban university medical center. Participants completed self-report measures of the ACEs Questionnaire and the Adult-Adolescent Parenting Inventory-2. Latent class analysis was used to identify classes of women with similar patterns of exposure to ACEs and to examine the associations between ACEs classes and parent-to-child aggression risk. Three latent classes, characterized by distinct patterns of maternal ACEs, were identified: Low ACEs (63% of the sample), High Parental Separation/Divorce (20%), and High/Multiple ACEs classes (17%). Women in the High/Multiple ACEs class were more likely to report higher levels of parent-to-child aggression risk (i.e., inappropriate expectations, belief in corporal punishment, lack of empathy) than those in the other classes (Wald(2) = 8.63, p = .013). Preventive interventions targeting parental attitudes and behaviors among young women exposed to ACEs may decrease the risk for further perpetuation of aggression in the next generations.
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Levey EJ, Chang AR, Sanchez MLJ, Harrison AM, Rodriguez AEM, Gelaye B, Rondon MB. Manifestations of Intergenerational Trauma During the Perinatal Period Among Adolescent Mothers in Lima, Peru: A Qualitative Analysis. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2023; 16:21-30. [PMID: 36776635 PMCID: PMC9908777 DOI: 10.1007/s40653-022-00477-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/04/2022] [Indexed: 06/18/2023]
Abstract
Adverse childhood experiences have a lasting impact on health across the life course. The perinatal period offers a unique opportunity to rework problematic dynamics in families experiencing intergenerational trauma. This study explores the family dynamics that are activated during the perinatal period and considers the potential for intervention with adolescent parents and their families in Lima, Peru. This narrative analysis was part of a broader study that included focus groups and in-depth interviews. Of the ten adolescent mothers interviewed, four narratives were selected for presentation in this manuscript. These particular narratives were selected to illustrate the diversity of the experiences among this group and for the exceptional level of detail provided about their life experiences and family relationships. Narrative excerpts were analyzed in the context of the entire interview and the aggregate content of other interviews in order to explore both explicit and implicit meanings. This study identified critical relational shifts among adolescent parents and their families during the perinatal period. In one instance, adolescent parenthood created an opportunity for the family to come together. In the other cases, conflict escalated, relations grew distant, or both. These narrative data demonstrate that intergenerational trauma can interfere with family relationships in the context of adolescent pregnancy and prevent adolescent parents from accessing needed support from their families. Intervention with families could address the impact of trauma and improve communication and collaboration.
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Affiliation(s)
- Elizabeth J. Levey
- The Chester M. Pierce, Division of Global Psychiatry, Massachusetts General Hospital, Boston, 02114 USA
- Department of Psychiatry, Harvard Medical School, Boston, MA 02115 USA
| | - Andrew R. Chang
- Department of Psychiatry, Harvard Medical School, Boston, MA 02115 USA
| | | | - Alexandra M. Harrison
- Department of Psychiatry, Harvard Medical School, Boston, MA 02115 USA
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA 02139 USA
| | | | - Bizu Gelaye
- The Chester M. Pierce, Division of Global Psychiatry, Massachusetts General Hospital, Boston, 02114 USA
- Department of Psychiatry, Harvard Medical School, Boston, MA 02115 USA
- Department of Epidemiology, Harvard University T. H. Chan School of Public Health, Boston, MA 02115 USA
| | - Marta B. Rondon
- Asociación Civil Proyectos en Salud, Lima, Peru
- Instituto Nacional Materno Perinatal, Lima, Peru
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Reid C, Bennetts SK, Nicholson JM, Amir LH, Chamberlain C. Rural primary care workforce views on trauma-informed care for parents experiencing complex trauma: A descriptive study. Aust J Rural Health 2023; 31:98-113. [PMID: 36083418 PMCID: PMC10947110 DOI: 10.1111/ajr.12922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 08/15/2022] [Accepted: 08/21/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND An important service system for rural parents experiencing complex trauma is primary health care. AIM To investigate workforce knowledge, attitudes and practices, and barriers and enablers to trauma-informed care in rural primary health care. MATERIAL & METHODS This study used a descriptive, cross-sectional design. It involved an on-line survey conducted in 2021 in rural Victoria, Australia. Participants were the primary health care workforce. The main outcome measures were study-developed and included, a 21-item Knowledge, Attitudes and Practices tool, a 16-item Barriers and Enablers to Trauma-Informed Care Implementation tool, and three open-ended questions. RESULTS The 63 respondents were from community health (n = 40, 63%) and child and family services (n = 23, 37%). Many (n = 43, 78%) reported undertaking trauma-informed care training at some point in their career; with 32% (n = 20) during higher education. Respondents self-rated their knowledge, attitudes and practices positively. Perceived enablers were mainly positioned within the service (e.g. workforce motivation and organisational supports) and perceived barriers were largely external structural factors (e.g. availability of universal referral pathways, therapeutic-specific services). Open-ended comments were grouped into four themes: (1) Recognition and understanding; (2) Access factors; (3) Multidisciplinary and collaborative approaches; and (4) Strengths-based and outcome-focused approaches. DISCUSSION & CONCLUSION Primary health care is an important driver of population health and well-being and critical in rural contexts. Our findings suggest this sector needs a rural trauma-informed care implementation strategy to address structural barriers. This also requires policy and system development. Long-term investment in the rural workforce and primary care service settings is essential to integrate trauma-informed care.
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Affiliation(s)
- Carol Reid
- Judith Lumley Centre, School of Nursing and MidwiferyLa Trobe UniversityBundooraVictoriaAustralia
| | - Shannon K. Bennetts
- Judith Lumley Centre, School of Nursing and MidwiferyLa Trobe UniversityBundooraVictoriaAustralia
- Intergenerational Health Group, Murdoch Children's Research InstituteParkvilleVictoriaAustralia
| | - Jan M. Nicholson
- Judith Lumley Centre, School of Nursing and MidwiferyLa Trobe UniversityBundooraVictoriaAustralia
| | - Lisa H. Amir
- Judith Lumley Centre, School of Nursing and MidwiferyLa Trobe UniversityBundooraVictoriaAustralia
| | - Catherine Chamberlain
- Judith Lumley Centre, School of Nursing and MidwiferyLa Trobe UniversityBundooraVictoriaAustralia
- NGANGK YIRA: Murdoch University Research Centre for Aboriginal Health and Social EquityMurdoch UniversityPerthWestern AustraliaAustralia
- Centre for Health EquityThe University of MelbourneMelbourneVictoriaAustralia
- The Lowitja InstituteMelbourneVictoriaAustralia
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Strobel NA, Chamberlain C, Campbell SK, Shields L, Bainbridge RG, Adams C, Edmond KM, Marriott R, McCalman J. Family-centred interventions for Indigenous early childhood well-being by primary healthcare services. Cochrane Database Syst Rev 2022; 12:CD012463. [PMID: 36511823 PMCID: PMC9746601 DOI: 10.1002/14651858.cd012463.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Primary healthcare, particularly Indigenous-led services, are well placed to deliver services that reflect the needs of Indigenous children and their families. Important characteristics identified by families for primary health care include services that support families, accommodate sociocultural needs, recognise extended family child-rearing practices, and Indigenous ways of knowing and doing business. Indigenous family-centred care interventions have been developed and implemented within primary healthcare services to plan, implement, and support the care of children, immediate and extended family and the home environment. The delivery of family-centred interventions can be through environmental, communication, educational, counselling, and family support approaches. OBJECTIVES To evaluate the benefits and harms of family-centred interventions delivered by primary healthcare services in Canada, Australia, New Zealand, and the USA on a range of physical, psychosocial, and behavioural outcomes of Indigenous children (aged from conception to less than five years), parents, and families. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search date was 22 September 2021. SELECTION CRITERIA We included randomised controlled trials (RCTs), cluster RCTs, quasi-RCTs, controlled before-after studies, and interrupted time series of family-centred care interventions that included Indigenous children aged less than five years from Canada, Australia, New Zealand, and the USA. Interventions were included if they met the assessment criteria for family-centred interventions and were delivered in primary health care. Comparison interventions could include usual maternal and child health care or one form of family-centred intervention versus another. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were 1. overall health and well-being, 2. psychological health and emotional behaviour of children, 3. physical health and developmental health outcomes of children, 4. family health-enhancing lifestyle or behaviour outcomes, 5. psychological health of parent/carer. 6. adverse events or harms. Our secondary outcomes were 7. parenting knowledge and awareness, 8. family evaluation of care, 9. service access and utilisation, 10. family-centredness of consultation processes, and 11. economic costs and outcomes associated with the interventions. We used GRADE to assess the certainty of the evidence for our primary outcomes. MAIN RESULTS We included nine RCTs and two cluster-RCTs that investigated the effect of family-centred care interventions delivered by primary healthcare services for Indigenous early child well-being. There were 1270 mother-child dyads and 1924 children aged less than five years recruited. Seven studies were from the USA, two from New Zealand, one from Canada, and one delivered in both Australia and New Zealand. The focus of interventions varied and included three studies focused on early childhood caries; three on childhood obesity; two on child behavioural problems; and one each on negative parenting patterns, child acute respiratory illness, and sudden unexpected death in infancy. Family-centred education was the most common type of intervention delivered. Three studies compared family-centred care to usual care and seven studies provided some 'minimal' intervention to families such as education in the form of pamphlets or newsletters. One study provided a minimal intervention during the child's first 24 months and then the family-centred care intervention for one year. No studies had low or unclear risk of bias across all domains. All studies had a high risk of bias for the blinding of participants and personnel domain. Family-centred care may improve overall health and well-being of Indigenous children and their families, but the evidence was very uncertain. The pooled effect estimate from 11 studies suggests that family-centred care improved the overall health and well-being of Indigenous children and their families compared no family-centred care (standardised mean difference (SMD) 0.14, 95% confidence interval (CI) 0.03 to 0.24; 2386 participants). We are very uncertain whether family-centred care compared to no family-centred care improves the psychological health and emotional behaviour of children as measured by the Infant Toddler Social Emotional Assessment (ITSEA) (Competence domain) (mean difference (MD) 0.04, 95% CI -0.03 to 0.11; 2 studies, 384 participants). We assessed the evidence as being very uncertain about the effect of family-centred care on physical health and developmental health outcomes of children. Pooled data from eight trials on physical health and developmental outcomes found there was little to no difference between the intervention and the control groups (SMD 0.13, 95% CI -0.00 to 0.26; 1961 participants). The evidence is also very unclear whether family-centred care improved family-enhancing lifestyle and behaviours outcomes. Nine studies measured family health-enhancing lifestyle and behaviours and pooled analysis found there was little to no difference between groups (SMD 0.16, 95% CI -0.06 to 0.39; 1969 participants; very low-certainty evidence). There was very low-certainty evidence of little to no difference for the psychological health of parents and carers when they participated in family-centred care compared to any control group (SMD 0.10, 95% CI -0.03 to 0.22; 5 studies, 975 parents/carers). Two studies stated that there were no adverse events as a result of the intervention. No additional data were provided. No studies reported from the health service providers perspective or on outcomes for family's evaluation of care or family-centredness of consultation processes. AUTHORS' CONCLUSIONS There is some evidence to suggest that family-centred care delivered by primary healthcare services improves the overall health and well-being of Indigenous children, parents, and families. However, due to lack of data, there was not enough evidence to determine whether specific outcomes such as child health and development improved as a result of family-centred interventions. Seven of the 11 studies delivered family-centred education interventions. Seven studies were from the USA and centred on two particular trials, the 'Healthy Children, Strong Families' and 'Family Spirit' trials. As the evidence is very low certainty for all outcomes, further high-quality trials are needed to provide robust evidence for the use of family-centred care interventions for Indigenous children aged less than five years.
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Affiliation(s)
- Natalie A Strobel
- Kurongkurl Katitjin, Edith Cowan University, Mount Lawley, Australia
- Medical School, The University of Western Australia, Perth, Australia
| | - Catherine Chamberlain
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Sandra K Campbell
- College of Nursing & Midwifery, Charles Darwin University, Darwin, Australia
| | - Linda Shields
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Sunshine Coast, Australia
| | - Roxanne G Bainbridge
- School of Human Health and Social Sciences, Central Queensland University, Cairns, Australia
| | - Claire Adams
- Kurongkurl Katitjin, Edith Cowan University, Mount Lawley, Australia
| | - Karen M Edmond
- Department of Women and Children's Health, King's College London, London, UK
| | - Rhonda Marriott
- Ngangk Yira Research Centre for Aboriginal Health and Social Equity, Murdoch University, Murdoch, Australia
| | - Janya McCalman
- School of Human Health and Social Sciences, Central Queensland University, Cairns, Australia
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Stanhope KK, Suglia SF, Boulet SL, Powers A, Michopoulos V. Childhood trauma and postpartum care use, estimating mediation by posttraumatic stress disorder and depressive symptoms. Ann Epidemiol 2022; 76:1-6. [DOI: 10.1016/j.annepidem.2022.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 09/14/2022] [Accepted: 09/28/2022] [Indexed: 11/01/2022]
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Heris CL, Kennedy M, Graham S, Bennetts SK, Atkinson C, Mohamed J, Woods C, Chennall R, Chamberlain C. Key features of a trauma-informed public health emergency approach: A rapid review. Front Public Health 2022; 10:1006513. [PMID: 36568798 PMCID: PMC9771594 DOI: 10.3389/fpubh.2022.1006513] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 10/17/2022] [Indexed: 11/29/2022] Open
Abstract
COVID-19 is a major threat to public safety, and emergency public health measures to protect lives (e.g., lockdown, social distancing) have caused widespread disruption. While these measures are necessary to prevent catastrophic trauma and grief, many people are experiencing heightened stress and fear. Public health measures, risks of COVID-19 and stress responses compound existing inequities in our community. First Nations communities are particularly at risk due to historical trauma, ongoing socio-economic deprivation, and lack of trust in government authorities as a result of colonization. The objective of this study was to review evidence for trauma-informed public health emergency responses to inform development of a culturally-responsive trauma-informed public health emergency framework for First Nations communities. We searched relevant databases from 1/1/2000 to 13/11/2020 inclusive, which identified 40 primary studies (and eight associated references) for inclusion in this review. Extracted data were subjected to framework and thematic synthesis. No studies reported evaluations of a trauma-informed public health emergency response. However, included studies highlighted key elements of a "trauma-informed lens," which may help to consider implications, reduce risks and foster a sense of security, wellbeing, self- and collective-efficacy, hope and resilience for First Nations communities during COVID-19. We identified key elements for minimizing the impact of compounding trauma on First Nations communities, including: a commitment to equity and human rights, cultural responsiveness, good communication, and positive leadership. The six principles guiding trauma-informed culturally-responsive public health emergency frameworks included: (i) safety, (ii) empowerment, (iii) holistic support, (iv) connectedness and collaboration, (v) compassion and caring, and (vi) trust and transparency in multi-level responses, well-functioning social systems, and provision of basic services. These findings will be discussed with First Nations public health experts, together with data on the experiences of First Nations families and communities during COVID-19, to develop a trauma-integrated public health emergency response framework or "lens" to minimize compounding trauma for First Nations communities.
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Affiliation(s)
- Christina L. Heris
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, VIC, Australia,National Centre for Aboriginal and Torres Strait Islander Wellbeing Research, National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
| | - Michelle Kennedy
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Simon Graham
- Department of Infectious Diseases, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC, Australia
| | - Shannon K. Bennetts
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, VIC, Australia,Murdoch Children's Research Institute, Parkville, VIC, Australia
| | | | | | - Cindy Woods
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, VIC, Australia,Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Richard Chennall
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Catherine Chamberlain
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, VIC, Australia,Lowitja Institute, Collingwood, VIC, Australia,Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia,Ngangk Yira: Murdoch University Research Centre for Aboriginal Health and Social Equity, Murdoch University, Perth, WA, Australia,*Correspondence: Catherine Chamberlain
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22
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Ingemann C, Jensen E, Olesen I, Tjørnhøj-Thomsen T, Kvernmo S, Larsen CVL. Parents' perspectives on preparing for parenthood: a qualitative study on Greenland's universal parenting programme MANU 0-1 year. BMC Pregnancy Childbirth 2022; 22:859. [PMID: 36404321 PMCID: PMC9675961 DOI: 10.1186/s12884-022-05170-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 10/31/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The transition to parenthood has received increasing attention in research, partly due to evidence pointing out the crucial developmental period of a child's first thousand days. Parenting programmes aim to prepare and support families in their transition and distress. For a programme to be implemented successfully it is important to consider parents' needs and resources. Bringing parents' perspectives and experiences to the forefront of the implementation of the Greenlandic parenting programme MANU 0-1 Year (MANU) is important for determining if the programme can meet its aim of contributing to thriving families. This study aims to investigate how parents' notions and experiences of parenthood are reflected and challenged in MANU. METHOD Data were collected in three of Greenland's five municipalities. Qualitative interviews were held with 38 mothers and 12 fathers either individually or as couples: a total of 40 interviews. Additionally, a Sharing Circle with three fathers was held. Interviews were in Greenlandic or Danish. A thematic, inductive analysis was applied. RESULTS In their transition to parenthood, participants experienced a reprioritisation of their life and changes in their network. It is important to parents that their child experiences security and care, and participants describe this in contrast to their own childhood. Community is the most important value in child-rearing. Conversations and advice from family members and friends are mentioned as a means to prepare for birth and parenthood. Additionally, conversations with midwives and MANU sessions were also used for preparation. Parents appreciated learning from and listening to other parents in MANU sessions. However, accessing MANU depends on the individual parent's interest and ability to attend sessions. CONCLUSIONS Parents' notions and experiences of parenthood are addressed in the programme, but the use of MANU depends on the parents' attendance and how it is organised and locally offered. The study suggests that MANU has the possibility to create a space for parents to reflect and prepare. However, for MANU to be universal as intended and to reach both mother and father the facilitation of sessions could be revisited.
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Affiliation(s)
- Christine Ingemann
- grid.10825.3e0000 0001 0728 0170Centre for Public Health in Greenland, National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455 Copenhagen, Denmark ,grid.449721.dGreenland Center for Health Research, Institute of Health and Nature, Ilisimatusarfik – University of Greenland, Nuuk, Greenland
| | - Else Jensen
- grid.10825.3e0000 0001 0728 0170Centre for Public Health in Greenland, National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455 Copenhagen, Denmark
| | - Ingelise Olesen
- grid.10825.3e0000 0001 0728 0170Centre for Public Health in Greenland, National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455 Copenhagen, Denmark ,grid.449721.dGreenland Center for Health Research, Institute of Health and Nature, Ilisimatusarfik – University of Greenland, Nuuk, Greenland
| | - Tine Tjørnhøj-Thomsen
- grid.10825.3e0000 0001 0728 0170Department of Health and Social Context, National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455 Copenhagen, Denmark
| | - Siv Kvernmo
- grid.10919.300000000122595234IKM, Faculty of Health Sciences, UiT – The Arctic University of Norway, Tromsø, Norway
| | - Christina Viskum Lytken Larsen
- grid.10825.3e0000 0001 0728 0170Centre for Public Health in Greenland, National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455 Copenhagen, Denmark ,grid.449721.dGreenland Center for Health Research, Institute of Health and Nature, Ilisimatusarfik – University of Greenland, Nuuk, Greenland
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23
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Sabola S, Kim J, Sheppard CC. Perinatal Care for Individuals With a History of Sexual Trauma. Nurs Womens Health 2022; 26:371-378. [PMID: 36087641 DOI: 10.1016/j.nwh.2022.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 04/18/2022] [Accepted: 07/28/2022] [Indexed: 06/15/2023]
Abstract
Many women and individuals assigned female at birth experience sexual assault or abuse in their lives leading to sexual trauma. In this article, we review the effects of sexual trauma and resulting chronic stress on the body and during the perinatal period. Maternal, fetal, and neonatal health implications are discussed. Routine screening for sexual assault and violence can assist with early identification and intervention. A variety of modalities and methods for managing the effects of sexual trauma have been identified, including pharmacologic treatment, psychotherapy, complementary and alternative medicine, and shared decision-making. Further research regarding different treatments is essential to find additional tools to aid clinicians providing care to this vulnerable population. When nurses care for individuals with a history of sexual trauma, incorporating trauma-informed care can help prevent retraumatization and promote a healthy perinatal experience.
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24
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Rantanen H, Nieminen I, Kaunonen M, Jouet E, Zabłocka-Żytka L, Viganò G, Crocamo C, Schecke H, Zlatkute G, Paavilainen E. Family Needs Checklist: Development of a Mobile Application for Parents with Children to Assess the Risk for Child Maltreatment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19169810. [PMID: 36011439 PMCID: PMC9408053 DOI: 10.3390/ijerph19169810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/26/2022] [Accepted: 08/02/2022] [Indexed: 05/12/2023]
Abstract
Child maltreatment (CM) has been enormously studied. However, a preventive practice still requires comprehensive and effective instruments to assess the risks for CM in a family context. The aim of this study is to describe the development process of an evidence-based CM risk assessment instrument (Family Needs Checklist, FNC) for primary prevention online utilization. This article reports the development process of the checklist and its mobile application, consisting of a systematic literature review, identification of known risk factors using the content analysis method, and generation of the checklist, including a multidisciplinary group in the design and feedback. As a result, a comprehensive and compact checklist was developed to be used by parents or caregivers as a self-referral instrument with an option to be used with professionals as a basis for joint conversations. The FNC consists of parental, family-, and child-related risk factors. Based on the international evidence, the online application consists of knowledge about different CM types, information about risk factors and protective factors as well as recommendations and guidance to support services. The FNC is based on robust evidence on known risk factors causing CM in families. It can be used for primary prevention utilization in the general population.
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Affiliation(s)
- Heidi Rantanen
- Health Sciences Unit, Faculty of Social Sciences, Tampere University, Arvo Ylpön katu 34, 33520 Tampere, Finland
- Pirkanmaa Hospital District, Tampere University Hospital, Elämänaukio 2, 33520 Tampere, Finland
- Correspondence: (H.R.); (E.P.)
| | - Irja Nieminen
- Health Sciences Unit, Faculty of Social Sciences, Tampere University, Arvo Ylpön katu 34, 33520 Tampere, Finland
- School of Health Sciences, Tampere University of Applied Sciences, Kuntokatu 3, 33520 Tampere, Finland
| | - Marja Kaunonen
- Health Sciences Unit, Faculty of Social Sciences, Tampere University, Arvo Ylpön katu 34, 33520 Tampere, Finland
- Pirkanmaa Hospital District, Tampere University Hospital, Elämänaukio 2, 33520 Tampere, Finland
| | - Emmanuelle Jouet
- Mental Health and Social Sciences Research Laboratory, Groupement Hospitalier Universitaire, Psychiatrie & Neurosciences (GHU-PARIS), 258 Rue Marcaret, Bât N, 2ème étage, 75018 Paris, France
| | - Lidia Zabłocka-Żytka
- Institute of Psychology, The Maria Grzegorzewska University, Szczęśliwicka 40, 02-353 Warszawa, Poland
| | - Giovanni Viganò
- Synergia s.r.l., Via Molino delle Armi 19, 20123 Milan, Italy
| | - Cristina Crocamo
- Department of Medicine and Surgery, University of Milano-Biocca, Via Cadore 48, 20900 Monza, Italy
| | - Henrike Schecke
- Department of Addictive Behaviour and Addictive Medicine, LVR-Hospital Essen, University of Duisburg-Essen, Virchocstrasse 174, 45147 Essen, Germany
| | - Giedre Zlatkute
- School of Medicine, University of St Andrews, N Haugh, St Andrews KY16 9TF, UK
| | - Eija Paavilainen
- Health Sciences Unit, Faculty of Social Sciences, Tampere University, Arvo Ylpön katu 34, 33520 Tampere, Finland
- Etelä-Pohjanmaa Hospital District, 60220 Seinäjoki, Finland
- Correspondence: (H.R.); (E.P.)
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25
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Khoury JE, Dimitrov L, Enlow MB, Haltigan JD, Bronfman E, Lyons-Ruth K. Patterns of Maternal Childhood Maltreatment and Disrupted Interaction Between Mothers and Their 4-Month-Old Infants. CHILD MALTREATMENT 2022; 27:366-377. [PMID: 33853345 PMCID: PMC8591699 DOI: 10.1177/10775595211007567] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Maternal childhood maltreatment (MCM) is associated with parenting disruptions which may contribute to the intergenerational transmission of negative health and social outcomes. Most prior work has used variable-centered approaches to assess MCM. Complementary person-centered approaches can identify groups of participants characterized by similar patterns of maltreatment. The current study assessed both types and patterns of MCM in relation to disrupted parenting among 179 mothers and their 4-month-olds. In variable-centered analyses, physical abuse was related to negative-intrusive maternal behavior and physical neglect to role-confused behavior. Person-centered analyses derived three classes of MCM, which differed in disrupted parenting. For example, mothers who experienced multiple types of maltreatment displayed more withdrawal than mothers in both other classes. Results document the differential effects of particular types and patterns of MCM on aspects of parenting and reveal that mother's history of maltreatment can affect the quality of mother-child interaction as early as 4 months of age.
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Affiliation(s)
- Jennifer E Khoury
- 22199Cambridge Hospital, Cambridge, MA, USA
- 1811Harvard Medical School, Boston, MA, USA
| | | | - Michelle Bosquet Enlow
- 1811Harvard Medical School, Boston, MA, USA
- 1862Boston Children's Hospital, Boston, MA, USA
| | | | - Elisa Bronfman
- 1811Harvard Medical School, Boston, MA, USA
- 1862Boston Children's Hospital, Boston, MA, USA
| | - Karlen Lyons-Ruth
- 22199Cambridge Hospital, Cambridge, MA, USA
- 1811Harvard Medical School, Boston, MA, USA
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26
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Cordeiro K, Wyers C, Oliver M, Foroughe M, Muller RT. Caregiver maltreatment history and treatment response following an intensive Emotion Focused Family Therapy workshop. Clin Psychol Psychother 2022; 29:1728-1741. [PMID: 35373406 DOI: 10.1002/cpp.2739] [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: 11/14/2021] [Revised: 03/24/2022] [Accepted: 03/28/2022] [Indexed: 11/10/2022]
Abstract
This single-arm, repeated measures study investigated the impact caregiver trauma history may have on treatment response following an intensive, 2-day Emotion Focused Family Therapy (EFFT) caregiver workshop. Caregivers (n = 243) completed questionnaires regarding their child's emotion regulation and clinical symptoms, as well as their own childhood trauma history (i.e., exposure to various forms of child maltreatment), caregiver self-efficacy and caregiver blocks (e.g., fears) to support their child's treatment and recovery. Questionnaires were administered prior to and immediately following the workshop and again 4, 8 and 12 months later. At baseline, caregivers who reported experiences of childhood maltreatment demonstrated more blocks compared with caregivers who did not (B = 6.35, SE = 2.62, p < 0.05). Results indicated that caregivers with and without maltreatment histories reported similar, significant gains in their child's total difficulties (B = 0.64, SE = 0.41, p = 0.12) and emotional negativity and lability (B = 0.51, SE = 0.48, p = 0.29) at 12-month post-workshop. Caregivers with maltreatment histories reported greater improvements in caregiver blocks (B = 5.15, SE = 1.34, p < 0.001) and child emotion regulation (B = 0.90, SE = 0.18, p < 0.001) than caregivers without maltreatment histories. They also report less, but still significant, improvement in parental self-efficacy (B = -0.68, SE = 0.26, p < 0.01) when compared with caregivers without maltreatment histories. Findings suggest that EFFT workshops may be an acceptable and effective trans-diagnostic intervention for families presenting with complex histories, including caregiver exposure to childhood maltreatment.
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Affiliation(s)
- Kristina Cordeiro
- Department of Psychology, Faculty of Health, York University, Toronto, Ontario, Canada
| | - Cassandra Wyers
- Department of Psychology, Faculty of Health, York University, Toronto, Ontario, Canada
| | - Meghan Oliver
- Department of Psychology, Faculty of Health, York University, Toronto, Ontario, Canada
| | | | - Robert T Muller
- Department of Psychology, Faculty of Health, York University, Toronto, Ontario, Canada
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27
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Garon-Bissonnette J, Bolduc MÈG, Lemieux R, Berthelot N. Cumulative childhood trauma and complex psychiatric symptoms in pregnant women and expecting men. BMC Pregnancy Childbirth 2022; 22:10. [PMID: 34983417 PMCID: PMC8725451 DOI: 10.1186/s12884-021-04327-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 12/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Women and men having been exposed to childhood trauma would be at high risk of various mental health symptoms while awaiting a child. This study aimed to evaluate the association between cumulative childhood trauma and the accumulation of symptoms belonging to different psychiatric problems in pregnant women and expecting men. METHODS We first examined prevalence rates of childhood trauma across our samples of 2853 pregnant women and 561 expecting men from the community. Second, we evaluated the association between cumulative childhood trauma and symptom complexity (i.e., the simultaneous presentation of symptoms belonging to multiple psychiatric problems) using subsamples of 1779 pregnant women and 118 expecting men. Participants completed self-reported measures of trauma (Childhood Trauma Questionnaire) and psychiatric symptoms (PTSD Checklist for DSM-5; Kessler Psychological Distress Scale; State-Trait Anger Expression Inventory-2; Self and Interpersonal Functioning Scale). RESULTS Trauma was more frequent in pregnant women than in expecting men and in participants reporting sociodemographic risk factors than in those not reporting any. A dose-response relationship was observed between the number of different traumas reported by pregnant women and expecting men and the complexity of their psychiatric symptoms, even when controlling for the variance explained by other risk factors. Women having been exposed to cumulative childhood trauma were 4.95 times more at risk of presenting comorbid psychiatric problems during pregnancy than non-exposed women. CONCLUSIONS Childhood trauma is frequent in the general population of pregnant women and expecting men and is associated with symptom complexity during the antenatal period. These findings call for delivering and evaluating innovative trauma-informed antenatal programs to support mental health and adaptation to parenthood in adults having been exposed to childhood trauma.
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Affiliation(s)
- Julia Garon-Bissonnette
- Department of Psychology, Université du Québec à Trois-Rivières, Québec, Canada.,Centre d'études interdisciplinaires sur le développement de l'enfant et la famille, Québec, Canada.,CERVO Brain Research Center, Québec, Canada.,Interdisciplinary Research Center on Intimate Relationship Problems and Sexual Abuse, Québec, Canada.,Groupe de recherche et d'intervention auprès de l'enfant vulnérable et négligé, Québec, Canada
| | - Marie-Ève Grisé Bolduc
- Department of Psychology, Université du Québec à Trois-Rivières, Québec, Canada.,Centre d'études interdisciplinaires sur le développement de l'enfant et la famille, Québec, Canada.,Groupe de recherche et d'intervention auprès de l'enfant vulnérable et négligé, Québec, Canada
| | - Roxanne Lemieux
- Centre d'études interdisciplinaires sur le développement de l'enfant et la famille, Québec, Canada.,Groupe de recherche et d'intervention auprès de l'enfant vulnérable et négligé, Québec, Canada.,Department of Nursing Sciences, Université du Québec à Trois-Rivières, Trois-Rivières, PO Box 500, Québec, Canada
| | - Nicolas Berthelot
- Centre d'études interdisciplinaires sur le développement de l'enfant et la famille, Québec, Canada. .,CERVO Brain Research Center, Québec, Canada. .,Interdisciplinary Research Center on Intimate Relationship Problems and Sexual Abuse, Québec, Canada. .,Groupe de recherche et d'intervention auprès de l'enfant vulnérable et négligé, Québec, Canada. .,Department of Nursing Sciences, Université du Québec à Trois-Rivières, Trois-Rivières, PO Box 500, Québec, Canada.
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28
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Pointet Perizzolo VC, Glaus J, Stein CR, Willheim E, Vital M, Arnautovic E, Kaleka K, Rusconi Serpa S, Pons F, Moser DA, Schechter DS. Impact of mothers' IPV-PTSD on their capacity to predict their child's emotional comprehension and its relationship to their child's psychopathology. Eur J Psychotraumatol 2022; 13:2008152. [PMID: 35111283 PMCID: PMC8803052 DOI: 10.1080/20008198.2021.2008152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Previous studies demonstrated that when the violence-exposed child becomes a mother and interacts with her own child during early sensitive periods for social-emotional development, she may have difficulties providing sensitive responsiveness to the child's emotional communication. Such difficulties place the child's development of emotional comprehension (EC) and related self-regulation at risk. The aim of this study was to examine how mothers' interpersonal violence-related posttraumatic disorder (IPV-PTSD) would affect their children's EC and their own ability to predict their children's EC. We also investigated how mothers' predictive ability would correlate with child psychopathology. METHODS Sixty-one mother-child dyads (36 with IPV-PTSD) participated in this study. Children's (mean age = 7.0 years, SD = 1.1) EC was assessed with the Test of Emotion Comprehension (child TEC) and their psychopathology as reported by the mother was assessed with the Child Behaviour Checklist (CBCL) and as evaluated by a clinician using selected modules of the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS). Mothers were measured for IPV-PTSD with the Clinician Administered PTSD Scale (CAPS) and for their capacity to predict their child's emotional comprehension (mother-responding-as-child TEC; mTEC). RESULTS We found no significant between-group differences in children's level of EC. Maternal PTSD was associated with lower scores on the mTEC, however. Reduced maternal scores on the mTEC were significantly associated with maternal report of increased aggressive child behaviour and with depression symptoms on the K-SADS. Further, scores on the mTEC interacted with maternal report of child aggression on child oppositional defiant disorder (ODD) symptoms on the K-SADS. CONCLUSION These findings support that improving maternal emotional comprehension may help reduce child risk for psychiatric morbidity in this population.
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Affiliation(s)
- V C Pointet Perizzolo
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - J Glaus
- Department of Psychiatry, University Service of Child and Adolescent Psychiatry, Lausanne University Medical Center, Lausanne, Switzerland
| | - C R Stein
- Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
| | - E Willheim
- Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
| | - M Vital
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Department of Child and Adolescent Psychiatry, University of Geneva Hospitals, Geneva, Switzerland
| | - E Arnautovic
- Department of Child and Adolescent Psychiatry, University of Geneva Hospitals, Geneva, Switzerland
| | - K Kaleka
- College of Medicine, Central Michigan University, Mount Pleasant, Michigan, USA
| | - S Rusconi Serpa
- Faculty of Psychology, University of Geneva, Geneva, Switzerland
| | - F Pons
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Dominik A Moser
- Department of Psychiatry, University Service of Child and Adolescent Psychiatry, Lausanne University Medical Center, Lausanne, Switzerland.,Institute of Psychology, University of Bern, Bern, Switzerland
| | - D S Schechter
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Department of Psychiatry, University Service of Child and Adolescent Psychiatry, Lausanne University Medical Center, Lausanne, Switzerland.,Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, New York, NY, USA.,Department of Psychiatry, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
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29
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Klawetter S, Cetin N, Ilea P, McEvoy C, Dukhovny D, Saxton SN, Rincon M, Rodriguez-JenKins J, Nicolaidis C. "All these people saved her life, but she needs me too": Understanding and responding to parental mental health in the NICU. J Perinatol 2022; 42:1496-1503. [PMID: 35705639 PMCID: PMC9199311 DOI: 10.1038/s41372-022-01426-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 05/20/2022] [Accepted: 06/07/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To explore the mental health needs of parents of infants in a neonatal intensive care unit (NICU), as well as barriers and solutions to meeting these needs. DESIGN Qualitative interviews conducted with parents and staff (n = 15) from a level IV NICU in the Northwestern United States. Thematic analysis completed using an inductive approach, at a semantic level. RESULTS (1) Information and mental health needs change over time, (2) Staff-parent relationships buffer trauma and distress, (3) Lack of continuity of care impacts response to mental health concerns, (4) NICU has a critical role in addressing parental mental health. CONCLUSION Mental health support should be embedded and tailored to the NICU trajectory, with special attention to the discharge transition, parents living in rural areas, and non-English-speaking parents. Research should address structural factors that may impact mental health such as integration of wholistic services, language barriers, and staff capacity.
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Affiliation(s)
- Susanne Klawetter
- School of Social Work, Portland State University, Portland, OR, USA.
| | - Nazan Cetin
- grid.262075.40000 0001 1087 1481School of Social Work, Portland State University, Portland, OR USA
| | - Passion Ilea
- grid.262075.40000 0001 1087 1481School of Social Work, Portland State University, Portland, OR USA
| | - Cindy McEvoy
- grid.5288.70000 0000 9758 5690Department of Pediatrics, Oregon Health & Science University, Portland, OR USA
| | - Dmitry Dukhovny
- grid.5288.70000 0000 9758 5690Department of Pediatrics, Oregon Health & Science University, Portland, OR USA
| | - Sage N. Saxton
- grid.5288.70000 0000 9758 5690Department of Pediatrics, Oregon Health & Science University, Portland, OR USA
| | - Monica Rincon
- grid.5288.70000 0000 9758 5690Department of OBGYN—Maternal Fetal Medicine Division, Oregon Health & Science University, Portland, OR USA
| | | | - Christina Nicolaidis
- grid.262075.40000 0001 1087 1481School of Social Work, Portland State University, Portland, OR USA ,grid.5288.70000 0000 9758 5690Department of Medicine, Oregon Health & Science University, Portland, OR USA
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30
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Using participatory action research to co-design perinatal support strategies for Aboriginal and Torres Strait Islander parents experiencing complex trauma. Women Birth 2021; 35:e494-e501. [PMID: 34961730 DOI: 10.1016/j.wombi.2021.12.005] [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: 09/07/2021] [Revised: 12/07/2021] [Accepted: 12/17/2021] [Indexed: 11/20/2022]
Abstract
PROBLEM & BACKGROUND Support is important for all parents but critical for those experiencing complex trauma. The The Healing the Past by Nurturing the Future project uses participatory action research to co-design effective perinatal support for Aboriginal and Torres Strait Islander parents. AIM This research aims to identify and refine culturally appropriate support strategies for Aboriginal and Torres Strait Islander parents experiencing complex trauma. DESIGN We presented our synthesised eight parent support goals and 60 strategies, collated from Elder and parent focus groups, previous participatory workshops, and evidence reviews, for discussion at a stakeholder workshop. Stakeholder perspectives were captured using a three-point agreement activity and, self- and scribe-recorded comments. Aboriginal and non-Aboriginal researchers analysised the qualitative data, to identify core factors which might facilitate or help enact the parenting related goals. FINDINGS Overall, stakeholders (n = 37) strongly endorsed all eight goals. Workshop attendees (57% Aboriginal) represented multiple stakeholder roles including Elder, parent and service provider. Four core factors were identified as crucial for supporting parents to heal from complex trauma: Culture (cultural traditions, practices and strengths), Relationality (family, individual, community and services), Safety (frameworks, choice and control) and Timing (the right time socio-emotionally and stage of parenting). DISCUSSION Context-specific support tailored to the Culture, Relationality, Safety, and Timing needs of parents is essential. These four factors are important elements to help enact or facilitate parenting support strategies. CONCLUSION Further work is now required to develop practical resources for parents, and to implement and evaluate these strategies in perinatal care to address cumulative and compounding cycles of intergenerational trauma.
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Berthelot N, Drouin-Maziade C, Garon-Bissonnette J, Lemieux R, Sériès T, Lacharité C. Evaluation of the Acceptability of a Prenatal Program for Women With Histories of Childhood Trauma: The Program STEP. Front Psychiatry 2021; 12:772706. [PMID: 34803778 PMCID: PMC8600135 DOI: 10.3389/fpsyt.2021.772706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 10/08/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Childhood trauma would negatively affect pregnant women's mental health and would have intergenerational repercussions. However, there is a paucity of prenatal interventions specifically designed for women exposed to childhood trauma. The study aims to evaluate the acceptability of STEP, a manualized group intervention designed for pregnant women having experienced early life adversity. Methods: The acceptability of STEP was assessed in four phases. In Phase 1, six experts evaluated whether the program activities were pertinent and trauma sensitive. In Phase 2, three parents read the intervention manuals and evaluated whether they considered each session relevant, interesting, and clear. In Phase 3, the program was briefly presented by phone to 309 pregnant women from the community. Women were inquired about their interest in the program, and the reasons for their lack of interest were assessed. In Phase 4, 30 pregnant women exposed to childhood trauma participated in the program and completed anonymous satisfaction questionnaires after each session. Psychological distress was also measured before and after the program. Results: All activities were rated by independent experts as highly pertinent, adequate, and sufficiently safe to be offered to pregnant women. Parents who read through the intervention manuals also considered that the sessions were relevant, clear, and interesting. About half of the pregnant women from the community showed interest in the program. Participants reported very high levels of satisfaction and a significant decrease in psychological distress during the program. Conclusions: Our findings show a high level of convergence among various indicators of program acceptability.
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Affiliation(s)
- Nicolas Berthelot
- Department of Nursing Sciences, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
- Centre d'études interdisciplinaires sur le développement de l'enfant et la famille, Trois-Rivières, QC, Canada
- CERVO Brain Research Center, Quebec City, QC, Canada
- Interdisciplinary Research Center on Intimate Relationship Problems and Sexual Abuse, Montréal, QC, Canada
- Groupe de recherche et d'intervention auprès de l'enfant vulnérable et négligé, Trois-Rivières, QC, Canada
| | - Christine Drouin-Maziade
- Department of Nursing Sciences, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
- Centre d'études interdisciplinaires sur le développement de l'enfant et la famille, Trois-Rivières, QC, Canada
- Groupe de recherche et d'intervention auprès de l'enfant vulnérable et négligé, Trois-Rivières, QC, Canada
| | - Julia Garon-Bissonnette
- Centre d'études interdisciplinaires sur le développement de l'enfant et la famille, Trois-Rivières, QC, Canada
- CERVO Brain Research Center, Quebec City, QC, Canada
- Interdisciplinary Research Center on Intimate Relationship Problems and Sexual Abuse, Montréal, QC, Canada
- Groupe de recherche et d'intervention auprès de l'enfant vulnérable et négligé, Trois-Rivières, QC, Canada
- Department of Psychology, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Roxanne Lemieux
- Department of Nursing Sciences, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
- Centre d'études interdisciplinaires sur le développement de l'enfant et la famille, Trois-Rivières, QC, Canada
- Groupe de recherche et d'intervention auprès de l'enfant vulnérable et négligé, Trois-Rivières, QC, Canada
| | - Thibaut Sériès
- Centre d'études interdisciplinaires sur le développement de l'enfant et la famille, Trois-Rivières, QC, Canada
- Groupe de recherche et d'intervention auprès de l'enfant vulnérable et négligé, Trois-Rivières, QC, Canada
- Department of Psychology, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Carl Lacharité
- Centre d'études interdisciplinaires sur le développement de l'enfant et la famille, Trois-Rivières, QC, Canada
- Groupe de recherche et d'intervention auprès de l'enfant vulnérable et négligé, Trois-Rivières, QC, Canada
- Department of Psychology, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
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Healing the Past by Nurturing the Future: Aboriginal parents' views of what helps support recovery from complex trauma. Prim Health Care Res Dev 2021; 22:e47. [PMID: 34588088 PMCID: PMC8506449 DOI: 10.1017/s1463423621000463] [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] [Indexed: 12/04/2022] Open
Abstract
We aimed to understand support needs for Aboriginal and Torres Strait Islander parents experiencing complex trauma.Becoming a parent is an exciting yet challenging transition, particularly for parents who have experienced past hurt in their own childhood which can have long lasting effects, including complex trauma. Complex trauma-related distress can make it harder to care for a baby, but the parenting transition offers unique opportunities for recovery. This formative research is part of a community-based participatory action research project which aims to co-design perinatal awareness, recognition, assessment and support strategies for Aboriginal and Torres Strait Islander parents experiencing complex trauma. We used an Indigenist approach and grounded theory methods. Aboriginal and Torres Strait Islander parents who were pregnant and/or have children up to two years old were recruited through perinatal care services and community networks in three Australian sites (Alice Springs, Adelaide and Melbourne). Parents were offered a group discussion or individual interview, facilitated by Aboriginal researchers. Third-person scenarios and visual tools were used to facilitate reflections about the impact of past experiences, what keeps parents strong, hopes and dreams, and what is needed to achieve those dreams. Parents were also shown themes from a previous systematic review of parents’ experiences as a prompt to identify any additional key issues. Seventeen Aboriginal and Torres Strait Islander parents participated in August to September 2019. Most were mothers (n = 15). The study’s grounded theory methods provided the foundation of a theoretical supposition that positions the transformation of the compounding cycle of trauma, to a reinforcing cycle of nurturing at the intersection of: 1) parents’ connectedness; 2) social and emotional wellbeing; and 3) the transition to parenting. Unique opportunities and challenges situated at the interface are bound to the compounding or reinforcing nature of the intersecting factors. Findings reveal complexity, differing experiences by gender and age, as well as within and between communities.
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Reid C, McKenzie JE, Brennan SE, Bennetts SK, Clark Y, Mensah F, Hokke S, Ralph N, Brown SJ, Gee G, Nicholson JM, Chamberlain C. Interventions during pregnancy or up to two years after birth for parents who are experiencing complex trauma or have experienced maltreatment in their childhood (or both) to improve parenting capacity or socio-emotional well-being. Hippokratia 2021. [DOI: 10.1002/14651858.cd014874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Carol Reid
- Judith Lumley Centre; La Trobe University; Bundoora Australia
| | - Joanne E McKenzie
- School of Public Health and Preventive Medicine; Monash University; Melbourne Australia
| | - Sue E Brennan
- School of Public Health and Preventive Medicine; Monash University; Melbourne Australia
| | - Shannon K Bennetts
- Judith Lumley Centre; La Trobe University; Bundoora Australia
- Murdoch Children's Research Institute; Parkville Australia
| | - Yvonne Clark
- South Australian Health and Medical Research Institute; Adelaide Australia
| | - Fiona Mensah
- Murdoch Children's Research Institute; Parkville Australia
- Department of Paediatrics; University of Melbourne; Parkville Australia
| | - Stacey Hokke
- Judith Lumley Centre; La Trobe University; Bundoora Australia
| | - Naomi Ralph
- Judith Lumley Centre; La Trobe University; Bundoora Australia
- Central Queensland University; Townsville Australia
| | - Stephanie J Brown
- Murdoch Children's Research Institute; Parkville Australia
- Department of Paediatrics; University of Melbourne; Parkville Australia
- South Australian Health and Medical Research Council; Adelaide Australia
| | - Graham Gee
- Murdoch Children's Research Institute; Parkville Australia
- Melbourne School of Psychological Sciences; University of Melbourne; Melbourne Australia
| | - Jan M Nicholson
- Judith Lumley Centre; La Trobe University; Bundoora Australia
| | - Catherine Chamberlain
- Judith Lumley Centre; La Trobe University; Bundoora Australia
- NGANGK YIRA Murdoch University Research Centre for Aboriginal Health and Social Equity; Murdoch University; Perth Australia
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Marti Castaner M, Fowler R, Landers C, Cohen L, Orjuela M. How trauma related to sex trafficking challenges parenting: Insights from Mexican and Central American survivors in the US. PLoS One 2021; 16:e0252606. [PMID: 34133449 PMCID: PMC8208566 DOI: 10.1371/journal.pone.0252606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 05/18/2021] [Indexed: 11/19/2022] Open
Abstract
Sex trafficking, a form of human trafficking for the purpose of commercial sexual exploitation, with a global prevalence of 4.5 million, has pervasive effects in the mental and physical health of survivors. However, little is known about the experiences and needs of Latinx migrants (the majority of sex trafficking victims in the US) after trafficking, particularly regarding parenting. This QUAL-quant study examines how 14 survivors of sex trafficking (mean age = 30) from Mexico and Central America encounter and respond to parenting experiences after escaping sexual exploitation. Combining a bio-ecological model of parenting with Zimmerman's framework on human trafficking we identified how trauma related to sex trafficking can challenge parenting and how relational and contextual pre and post trafficking factors (dis)enable women to respond to such challenges. Psychological consequences of daily victimization primarily manifested in three ways: overprotective parenting in a world perceived to be unsafe, emotional withdraw when struggling with stress and mental health symptoms, and challenges building confidence as mothers. These experiences were accentuated by pre-trafficking experiences of neglect and abuse, forced separation from their older children, poverty post-trafficking, and migration-related stressors. Yet, finding meaning in the birth of their child, having social support, and faith, also enable mothers to cope with such challenges. We conclude that motherhood after surviving sex trafficking presents new challenges and opportunities in the path to recovery from trauma. Interventions at the policy, community and individual level are needed to support survivors of sex trafficking as they enter motherhood.
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Affiliation(s)
- Marti Marti Castaner
- Department of Public Health, Section of Health Research Services, Copenhagen University, Copenhagen, Denmark
| | - Rachel Fowler
- The Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York City, New York, United States of America
| | - Cassie Landers
- The Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York City, New York, United States of America
| | - Lori Cohen
- ECPAT-USA (End Child Prostitution and Trafficking-USA), New York City, New York, United States of America
| | - Manuela Orjuela
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, New York, United States of America
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van den Heuvel MI. Intergenerational Transmission of Childhood Adversity-Related Risk: Fetal Brain Programming as Potential Mechanism. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2021; 6:385-386. [PMID: 33832693 DOI: 10.1016/j.bpsc.2021.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 01/25/2021] [Indexed: 11/18/2022]
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Olsson CA, Spry EA, Alway Y, Moreno-Betancur M, Youssef G, Greenwood C, Letcher P, Macdonald JA, McIntosh J, Hutchinson D, Patton GC. Preconception depression and anxiety symptoms and maternal-infant bonding: a 20-year intergenerational cohort study. Arch Womens Ment Health 2021; 24:513-523. [PMID: 33111170 DOI: 10.1007/s00737-020-01081-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 10/13/2020] [Indexed: 11/28/2022]
Abstract
Early maternal-infant bonding problems are often forerunners of later emotional and behavioural difficulties. Interventions typically target the perinatal period but many risks may be established well before pregnancy. Here we examine the extent to which adolescent and young adult depression and anxiety symptoms predict perinatal maternal-infant bonding difficulties. The Victorian Intergenerational Health Cohort Study (VIHCS, est. 2006) is following offspring born to the Victorian Adolescent Health Cohort Study (VAHCS; est. 1992). VAHCS participants were assessed for depression and anxiety symptoms nine times during adolescence and young adulthood (age 14-29 years), and then contacted bi-annually (from age 29-35 years) to identify pregnancies. The Postpartum Bonding Questionnaire (PBQ) was administered to mothers at 2 and 12 months postpartum. A total of 395 women (606 infants) completed the 2-month and/or 12-month postpartum interviews. For most infants (64%), mothers had experienced depression and/or anxiety before pregnancy. Preconception depression and anxiety symptoms that persisted from adolescence into young adulthood predicted maternal-infant bonding problems at 2 months (β = 0.30, 95% CI 0.04, 0.55) and 12 months postpartum (β = 0.40, 95% CI 0.16, 0.63). Depression and anxiety symptoms occurring in young adulthood only, also predicted bonding problems at 12 months postpartum (β = 0.37, 95% CI 0.02, 0.71). Associations between preconception depression and anxiety symptoms and anxiety-related maternal-infant bonding problems at 12 months postpartum remained after adjustment for antenatal and concurrent postpartum depressive symptoms. This study puts forward a case for extending preconception health care beyond contraception and nutrition to a broader engagement in supporting the mental health of young women from adolescence.
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Affiliation(s)
- Craig A Olsson
- Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Deakin University, Victoria, Geelong, Australia. .,Murdoch Children's Research Institute, Victoria, Parkville, Australia. .,Department of Paediatrics, Royal Children's Hospital Campus, The University of Melbourne, Victoria, Parkville, Australia.
| | - Elizabeth A Spry
- Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Deakin University, Victoria, Geelong, Australia.,Murdoch Children's Research Institute, Victoria, Parkville, Australia
| | - Yvette Alway
- Murdoch Children's Research Institute, Victoria, Parkville, Australia
| | - Margarita Moreno-Betancur
- Murdoch Children's Research Institute, Victoria, Parkville, Australia.,Department of Paediatrics, Royal Children's Hospital Campus, The University of Melbourne, Victoria, Parkville, Australia
| | - George Youssef
- Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Deakin University, Victoria, Geelong, Australia
| | - Christopher Greenwood
- Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Deakin University, Victoria, Geelong, Australia.,Murdoch Children's Research Institute, Victoria, Parkville, Australia
| | - Primrose Letcher
- Department of Paediatrics, Royal Children's Hospital Campus, The University of Melbourne, Victoria, Parkville, Australia
| | - Jacqui A Macdonald
- Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Deakin University, Victoria, Geelong, Australia.,Murdoch Children's Research Institute, Victoria, Parkville, Australia.,Department of Paediatrics, Royal Children's Hospital Campus, The University of Melbourne, Victoria, Parkville, Australia
| | - Jennifer McIntosh
- Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Deakin University, Victoria, Geelong, Australia.,Murdoch Children's Research Institute, Victoria, Parkville, Australia.,Department of Paediatrics, Royal Children's Hospital Campus, The University of Melbourne, Victoria, Parkville, Australia.,School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Delyse Hutchinson
- Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Deakin University, Victoria, Geelong, Australia.,Murdoch Children's Research Institute, Victoria, Parkville, Australia.,Department of Paediatrics, Royal Children's Hospital Campus, The University of Melbourne, Victoria, Parkville, Australia.,National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - George C Patton
- Murdoch Children's Research Institute, Victoria, Parkville, Australia.,Department of Paediatrics, Royal Children's Hospital Campus, The University of Melbourne, Victoria, Parkville, Australia
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Armfield JM, Gnanamanickam ES, Johnston DW, Preen DB, Brown DS, Nguyen H, Segal L. Intergenerational transmission of child maltreatment in South Australia, 1986-2017: a retrospective cohort study. LANCET PUBLIC HEALTH 2021; 6:e450-e461. [PMID: 33939966 DOI: 10.1016/s2468-2667(21)00024-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 01/06/2021] [Accepted: 01/26/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND The extent of intergenerational transmission of child maltreatment is unclear due to methodological limitations in previous studies. In this study, we aimed to examine factors associated with intergenerational transmission of child maltreatment and quantify its extent in a population sample over a 30-year period in South Australia. METHODS In this retrospective cohort study, we used linked administrative data from the South Australian Birth Registry to identify dyads of mothers and their children both born in South Australia between July 1, 1986, and June 30, 2017. Three child protection system (CPS) outcomes (any CPS involvement, substantiated maltreatment, and time spent in out-of-home care) were computed from data obtained from the South Australian Department for Child Protection. Multivariable Cox regression models were used to estimate hazard ratios (HRs) for child CPS outcomes according to their mother's CPS exposure. FINDINGS 38 556 unique mother-child dyads were included. 458 (2·0%) of 23 437 children whose mothers had no CPS involvement in childhood had a substantiated report of maltreatment and 127 (0·5%) spent time in out-of-home care. By comparison, 970 (22·1%) of 4382 children whose mothers experienced substantiated maltreatment in childhood had substantiated maltreatment and 469 (10·7%) spent time in out-of-home care. After adjusting for potential confounders, children of mothers with any CPS involvement in childhood had an increased risk of CPS contact compared with children whose mothers had no CPS involvement; this risk was greatest for children of mothers who had both substantiated maltreatment and spent time in out-of-home care (HR 6·25 [95% CI 5·59-6·98] for any CPS involvement, 13·69 [10·08-16·92] for substantiated maltreatment, and 25·78 [18·23-36·45] for any time in out-of-home care). Risks of child CPS outcomes were substantially increased for children of mothers who had a first CPS notification under the age of 1 year or who had any CPS notification at age 13-17 years. INTERPRETATION Children are at high risk of maltreatment if their mother experienced maltreatment as a child. Assisting survivors of childhood maltreatment, particularly female survivors, provides a crucial intervention opportunity to help prevent further child abuse and neglect. FUNDING Australian National Health and Medical Research Council; Channel 7 Children's Research Foundation.
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Affiliation(s)
- Jason M Armfield
- Australian Centre for Precision Health, Cancer Research Institute, University of South Australia, Adelaide, SA, Australia; South Australian Health and Medical Research Institute, Adelaide, SA, Australia.
| | - Emmanuel S Gnanamanickam
- Australian Centre for Precision Health, Cancer Research Institute, University of South Australia, Adelaide, SA, Australia; South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - David W Johnston
- Centre for Health Economics, Monash University, Melbourne, VIC, Australia
| | - David B Preen
- School of Population and Global Health, University of Western Australia, Perth, WA, Australia
| | - Derek S Brown
- Brown School, Washington University in St Louis, St Louis, MO, USA
| | - Ha Nguyen
- Australian Centre for Precision Health, Cancer Research Institute, University of South Australia, Adelaide, SA, Australia
| | - Leonie Segal
- Australian Centre for Precision Health, Cancer Research Institute, University of South Australia, Adelaide, SA, Australia; South Australian Health and Medical Research Institute, Adelaide, SA, Australia
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Antonucci LA, Raio A, Pergola G, Gelao B, Papalino M, Rampino A, Andriola I, Blasi G, Bertolino A. Machine learning-based ability to classify psychosis and early stages of disease through parenting and attachment-related variables is associated with social cognition. BMC Psychol 2021; 9:47. [PMID: 33757595 PMCID: PMC7989088 DOI: 10.1186/s40359-021-00552-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 03/16/2021] [Indexed: 12/21/2022] Open
Abstract
Background Recent views posited that negative parenting and attachment insecurity can be considered as general environmental factors of vulnerability for psychosis, specifically for individuals diagnosed with psychosis (PSY). Furthermore, evidence highlighted a tight relationship between attachment style and social cognition abilities, a key PSY behavioral phenotype. The aim of this study is to generate a machine learning algorithm based on the perceived quality of parenting and attachment style-related features to discriminate between PSY and healthy controls (HC) and to investigate its ability to track PSY early stages and risk conditions, as well as its association with social cognition performance. Methods Perceived maternal and paternal parenting, as well as attachment anxiety and avoidance scores, were trained to separate 71 HC from 34 PSY (20 individuals diagnosed with schizophrenia + 14 diagnosed with bipolar disorder with psychotic manifestations) using support vector classification and repeated nested cross-validation. We then validated this model on independent datasets including individuals at the early stages of disease (ESD, i.e. first episode of psychosis or depression, or at-risk mental state for psychosis) and with familial high risk for PSY (FHR, i.e. having a first-degree relative suffering from psychosis). Then, we performed factorial analyses to test the group x classification rate interaction on emotion perception, social inference and managing of emotions abilities. Results The perceived parenting and attachment-based machine learning model discriminated PSY from HC with a Balanced Accuracy (BAC) of 72.2%. Slightly lower classification performance was measured in the ESD sample (HC-ESD BAC = 63.5%), while the model could not discriminate between FHR and HC (BAC = 44.2%). We observed a significant group x classification interaction in PSY and HC from the discovery sample on emotion perception and on the ability to manage emotions (both p = 0.02). The interaction on managing of emotion abilities was replicated in the ESD and HC validation sample (p = 0.03). Conclusion Our results suggest that parenting and attachment-related variables bear significant classification power when applied to both PSY and its early stages and are associated with variability in emotion processing. These variables could therefore be useful in psychosis early recognition programs aimed at softening the psychosis-associated disability. Supplementary Information The online version contains supplementary material available at 10.1186/s40359-021-00552-3.
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Affiliation(s)
- Linda A Antonucci
- Department of Education, Psychology, Communication, University of Bari Aldo Moro, Via Scipione Crisanzio 42, 70122, Bari, Italy. .,Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy.
| | - Alessandra Raio
- Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Giulio Pergola
- Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy.,Lieber Institute for Brain Development, Johns Hopkins Medical Campus, Baltimore, MD, USA
| | - Barbara Gelao
- Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Marco Papalino
- Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Antonio Rampino
- Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | | | - Giuseppe Blasi
- Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Alessandro Bertolino
- Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
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Thomas-Giyer J, Keesler JM. Exploring maternal adversity and childhood outcomes among low-income rural families. CHILD ABUSE & NEGLECT 2021; 111:104817. [PMID: 33250276 DOI: 10.1016/j.chiabu.2020.104817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 10/31/2020] [Accepted: 11/09/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Research has linked adversity among mothers to poorer outcomes among their offspring. However, additional inquiry is warranted particularly in rural communities where risk factors for adversity are prevalent. OBJECTIVE This study had two objectives: (1) to describe and compare relationships between individual and cumulative maternal adversity with childhood outcomes; and, (2) to determine if mother-child attachment mediated the relationship between maternal adversity and childhood outcomes. PARTICIPANTS AND SETTING A convenient sample of 140 women with low socio-economic status (SES) were recruited through Head Start programs in the rural Midwest. METHODS Data was gathered using a survey comprised of multiple measures to assess maternal adversity and childhood outcomes (i.e. behavior and attachment). Data were analyzed in SPSS using bivariate and multivariate analyses, including stepwise regression. RESULTS Nearly 80 % of respondents experienced at least one adverse childhood experience (ACE) and 48 % reported having one or more traumatic experiences. Higher levels of adversity were associated with increased attention problems, increased emotional reactivity, and decreased harmonious attachment (p < .05, d = 0.37-0.38). Maternal experiences of childhood physical abuse and sexual abuse, as well as witnessing trauma, significantly predicted childhood outcomes, however, the variance accounted for by each type of adversity was small (4%-6%). Maternal adversity was unrelated to mother-child attachment. CONCLUSIONS Low-SES mothers in rural communities have significant histories of adversity. It is important to consider individual and cumulative adverse experiences, as well as the mother's perception of events as traumatic. Factors associated with rural communities and Head Start programming, as well as implications for research and practice surrounding maternal adversity and childhood outcomes, are discussed.
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Affiliation(s)
- Jennifer Thomas-Giyer
- Indiana University Bloomington, School of Social Work, 1105 E. Atwater, Bloomington, IN, 47421, United States
| | - John M Keesler
- Indiana University Bloomington, School of Social Work, 1105 E. Atwater, Bloomington, IN, 47421, United States.
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Hashemi L, Fanslow J, Gulliver P, McIntosh T. Intergenerational Impact of Violence Exposure: Emotional-Behavioural and School Difficulties in Children Aged 5-17. Front Psychiatry 2021; 12:771834. [PMID: 35058819 PMCID: PMC8764379 DOI: 10.3389/fpsyt.2021.771834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 12/13/2021] [Indexed: 11/24/2022] Open
Abstract
Background and Objectives: The intergenerational impacts of parental exposure to violence during childhood and adulthood have largely been investigated separately. This limits our understanding of how cumulative violence exposure over a lifespan elevates the risk of subsequent generation's maladjustment. To address this, we examined if parental exposure to violence during childhood and during adulthood was associated with increased emotional-behavioural and school difficulties among the children of these parents. Further, we examined if parental exposure to cumulative violence increased the odds of their children experiencing difficulties. Participants and Setting: 705 participants (354 mothers and 351 fathers) from the 2019 New Zealand Family Violence Survey, a population-based study conducted in New Zealand between March 2017 and March 2019. Methods: Multivariable logistic regressions were conducted to ascertain the impact of parental exposure to violence on children's outcomes after adjustment for sociodemographic characteristics. The impact of parental cumulative violence exposure on children's outcomes was also explored. Results: Findings indicated that children of parents who had histories of exposure to violence during childhood were at increased risk for experiencing emotional-behavioural or school difficulties. However, where parents reported a history of childhood abuse but not adult experience of violence, their children had similar odds of experiencing difficulties as the children of parents who had not been exposed to any violence in their lifetime. Children of parents who had been exposed to violence only during adulthood were at higher risk of experiencing emotional-behavioural difficulties compared with children of parents with no violence exposure. Children of parents with histories of exposure to violence during both childhood and adulthood had the highest prevalence of experiencing emotional/behavioural and school difficulties. Conclusion: These findings highlight the intergenerational impacts of violence exposure and the complex intersections between parents' and children's life experiences. Our findings suggest the need for violence prevention initiatives to foster the development of safe, stable and nurturing relationships and to expand services for parents already exposed to violence to build resilience and to break the inter-generational cycle of disadvantage.
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Affiliation(s)
- Ladan Hashemi
- Department of Social and Community Health, Faculty of Medical and Health Sciences, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Janet Fanslow
- Department of Social and Community Health, Faculty of Medical and Health Sciences, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Pauline Gulliver
- Department of Social and Community Health, Faculty of Medical and Health Sciences, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Tracey McIntosh
- Māori Studies and Pacific Studies, Faculty of Arts, University of Auckland, Auckland, New Zealand
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Risk and resilience: a mixed methods investigation of Aboriginal Australian women's perinatal mental health screening assessments. Soc Psychiatry Psychiatr Epidemiol 2021; 56:547-557. [PMID: 33226453 PMCID: PMC8053144 DOI: 10.1007/s00127-020-01986-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 11/10/2020] [Indexed: 11/21/2022]
Abstract
PURPOSE To describe the psychosocial protective and risk factors for perinatal mental health identified in a sample of Aboriginal women's Kimberley Mum's Mood Scale (KMMS) assessments and explore the role of these factors in their screening assessment and diagnostic outcome. METHODS We used a mixed methods approach to retrospectively analyse a cross-sectional study dataset of 91 completed KMMS assessments. This included: categorising the clinical notes from the KMMS psychosocial yarn into 'risk' and 'protective' factors and describing these categories, describing the number and type of risk and protective factors associated with different KMMS risk assessment categories (no, low, medium, high), and exploring relationships between these risk and protective factors and diagnosis of perinatal depression and/or anxiety. RESULTS Protective factors were recorded for the vast majority of the women; the most prominent was positive family relationships. When protective and risk factors were stratified by KMMS risk category, women in the higher risk group less commonly had specific protective factors (11-33% high vs 61-100% no risk) and more commonly had risk factors (22-67% high vs 6-28% no risk) than women with lower KMMS assessed risk. The average number of protective factors decreased with increasing KMMS risk category (4.9 ± 1.1 to 1.6 ± 1.3), with the inverse pattern for risk factors (1.1 ± 1.1 to 3.8 ± 1.0). Having protective factors also appeared to reduce the risk of developing clinical depression or anxiety. CONCLUSION Assessing protective factors in mental health screening for perinatal Aboriginal women increases the effectiveness of screening and provides a foundation for the delivery of local structured psychosocial care.
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Parental Non-Engagement within Child Protection Services—How Can Understandings of Complex Trauma and Epistemic Trust Help? SOCIETIES 2020. [DOI: 10.3390/soc10040093] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Building on the findings from the national study of mothers in recurrent care proceedings in England, this paper proposes that the concepts of complex trauma and epistemic trust may help explain parents’ difficulties in engaging with child protection services. With the aim of advancing theoretical knowledge, qualitative data drawn from interviews with 72 women who have experienced repeat care proceedings are revisited, with a focus on women’s developmental histories and accounts of engagement with professionals, to probe the issue of service engagement. The article starts with a succinct review of the literature on parental non-engagement in child protection, highlighting strengths and potential limitations of current knowledge. This is followed by an introduction to the theoretical concepts of complex trauma and epistemic trust, outlining how these concepts provide an alternative framing of the reasons why parents may resist, or are reluctant to engage with, professionals. Drawing on women’s first-person accounts, we argue that high levels of maltreatment and adversity in women’s own childhoods shape adult relationships, particularly in relation to vulnerability to harm in adult lives but also mistrust of professional help. Extracts from women’s first-person accounts, chosen for their typicality against the core themes derived from the data, indicate that acts of resistance or rejection of professional help can be seen as adaptive—given women’s childhoods and relationship histories. The authors conclude that parents’ social histories need to be afforded far closer attention in child protection practice, if preventative services are to reach those with histories of developmental trauma.
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Abstract
Perinatal mental health has become a significant focus of interest in recent years, with investment in new specialist mental health services in some high-income countries, and inpatient psychiatric mother and baby units in diverse settings. In this paper, we summarize and critically examine the epidemiology and impact of perinatal mental disorders, including emerging evidence of an increase of their prevalence in young pregnant women. Perinatal mental disorders are among the commonest morbidities of pregnancy, and make an important contribution to maternal mortality, as well as to adverse neonatal, infant and child outcomes. We then review the current evidence base on interventions, including individual level and public health ones, as well as service delivery models. Randomized controlled trials provide evidence on the effectiveness of psychological and psychosocial interventions at the individual level, though it is not yet clear which women with perinatal mental disorders also need additional support for parenting. The evidence base on psychotropic use in pregnancy is almost exclusively observational. There is little research on the full range of perinatal mental disorders, on how to improve access to treatment for women with psychosocial difficulties, and on the effectiveness of different service delivery models. We conclude with research and clinical implications, which, we argue, highlight the need for an extension of generic psychiatric services to include preconception care, and further investment into public health interventions, in addition to perinatal mental health services, potentially for women and men, to reduce maternal and child morbidity and mortality.
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Affiliation(s)
- Louise M. Howard
- Section of Women's Mental Health, Health Service and Population Research DepartmentInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
| | - Hind Khalifeh
- Section of Women's Mental Health, Health Service and Population Research DepartmentInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
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Chamberlain C, Gee G, Gartland D, Mensah FK, Mares S, Clark Y, Ralph N, Atkinson C, Hirvonen T, McLachlan H, Edwards T, Herrman H, Brown SJ, Nicholson AJM. Community Perspectives of Complex Trauma Assessment for Aboriginal Parents: 'Its Important, but How These Discussions Are Held Is Critical'. Front Psychol 2020; 11:2014. [PMID: 33041880 PMCID: PMC7522325 DOI: 10.3389/fpsyg.2020.02014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 07/20/2020] [Indexed: 11/30/2022] Open
Abstract
Background and Purpose Becoming a parent can be an exciting and also challenging transition, particularly for parents who have experienced significant hurt in their own childhoods, and may be experiencing ‘complex trauma.’ Aboriginal and Torres Strait Islander (Aboriginal) people also experience historical trauma. While the parenting transition is an important time to offer support for parents, it is essential to ensure that the benefits of identifying parents experiencing complex trauma outweigh any risks (e.g., stigmatization). This paper describes views of predominantly Aboriginal stakeholders regarding (1) the relative importance of domains proposed for complex trauma assessment, and (2) how to conduct these sensitive discussions with Aboriginal parents. Setting and Methods A co-design workshop was held in Alice Springs (Central Australia) as part of an Aboriginal-led community-based participatory action research project. Workshop participants were 57 predominantly Aboriginal stakeholders with expertise in community, clinical, policy and academic settings. Twelve domains of complex trauma-related distress had been identified in existing assessment tools and through community consultation. Using story-telling and strategies to create safety for discussing complex and sensitive issues, and delphi-style methods, stakeholders rated the level of importance of the 12 domains; and discussed why, by whom, where and how experiences of complex trauma should be explored. Main Findings The majority of stakeholders supported the importance of assessing each of the proposed complex trauma domains with Aboriginal parents. However, strong concerns were expressed regarding where, by whom and how this should occur. There was greater emphasis and consistency regarding ‘qualities’ (e.g., caring), rather than specific ‘attributes’ (e.g., clinician). Six critical overarching themes emerged: ensuring emotional and cultural safety; establishing relationships and trust; having capacity to respond appropriately and access support; incorporating less direct cultural communication methods (e.g., yarning, dadirri); using strengths-based approaches and offering choices to empower parents; and showing respect, caring and compassion. Conclusion Assessments to identify Aboriginal parents experiencing complex trauma should only be considered when the prerequisites of safety, trusting relationships, respect, compassion, adequate care, and capacity to respond are assured. Offering choices and cultural and strengths-based approaches are also critical. Without this assurance, there are serious concerns that harms may outweigh any benefits for Aboriginal parents.
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Affiliation(s)
- Catherine Chamberlain
- Judith Lumley Centre, La Trobe University, Melbourne, VIC, Australia.,NGANGK YIRA: Murdoch University Research Centre for Aboriginal Health and Social Equity, Perth, WA, Australia
| | - Graham Gee
- Intergenerational Health Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,School of Psychology, The University of Melbourne, Melbourne, VIC, Australia
| | - Deirdre Gartland
- Intergenerational Health Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Pediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Fiona K Mensah
- Department of Pediatrics, The University of Melbourne, Melbourne, VIC, Australia.,Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Royal Children's Hospital, Melbourne, VIC, Australia
| | - Sarah Mares
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.,College of Medicine and Public Health, Flinders University, Darwin, NT, Australia
| | - Yvonne Clark
- Judith Lumley Centre, La Trobe University, Melbourne, VIC, Australia.,SAHMRI Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia.,School of Psychology, University of Adelaide, Adelaide, SA, Australia
| | - Naomi Ralph
- Judith Lumley Centre, La Trobe University, Melbourne, VIC, Australia
| | | | - Tanja Hirvonen
- College of Medicine and Public Health, Flinders University, Darwin, NT, Australia
| | - Helen McLachlan
- Judith Lumley Centre, La Trobe University, Melbourne, VIC, Australia
| | - Tahnia Edwards
- Central Australian Aboriginal Congress, Alice Springs, NT, Australia
| | - Helen Herrman
- Orygen, National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Stephanie J Brown
- Intergenerational Health Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Pediatrics, The University of Melbourne, Melbourne, VIC, Australia.,SAHMRI Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - And Jan M Nicholson
- Judith Lumley Centre, La Trobe University, Melbourne, VIC, Australia.,Population Health, Murdoch Children's Research Institute, Melbourne, VIC, Australia
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Russotti J, Handley ED, Rogosch FA, Toth SL, Cicchetti D. The Interactive Effects of Child Maltreatment and Adolescent Pregnancy on Late-Adolescent Depressive Symptoms. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2020; 48:1223-1237. [PMID: 32594294 PMCID: PMC7395875 DOI: 10.1007/s10802-020-00669-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Adolescent females are disproportionately at risk for depression, which is expected to represent the leading cause of disability in 2030 (National Institute of Mental Health [NIMH] 2019). Although prior research has suggested that both child maltreatment and adolescent pregnancy increase the risk for depressive symptoms, less is known about how these two interact to influence depression in late adolescence. The present study tested the unique and interactive effects of adolescent pregnancy and child maltreatment on late-adolescent depressive symptomatology (N = 186) with a prospective, longitudinal design that utilized documented records of maltreatment and included demographically comparable (i.e., economically disadvantaged), nonmaltreated and non-pregnant comparisons. Participants were assessed at ages 10-12 and 18-21. Structural equation modeling was used to test whether adolescent pregnancy amplified the effect of child maltreatment on late-adolescent depressive symptoms. In the context of economic disadvantage, results indicated that the effect of child maltreatment on late-adolescent depressive symptoms was significantly enhanced for those who experienced an adolescent pregnancy. This effect remained after controlling for prior depressive symptoms, peer and maternal relationship quality, and romantic relationship violence. The findings are translated to preliminary guidance for practitioners regarding precision depression screening and tailored preventive interventions..
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Affiliation(s)
- Justin Russotti
- Mt. Hope Family Center, University of Rochester, 187 Edinburgh Street, Rochester, NY, 14608, USA.
| | - Elizabeth D Handley
- Mt. Hope Family Center, University of Rochester, 187 Edinburgh Street, Rochester, NY, 14608, USA
| | - Fred A Rogosch
- Mt. Hope Family Center, University of Rochester, 187 Edinburgh Street, Rochester, NY, 14608, USA
| | - Sheree L Toth
- Mt. Hope Family Center, University of Rochester, 187 Edinburgh Street, Rochester, NY, 14608, USA
| | - Dante Cicchetti
- Mt. Hope Family Center, University of Rochester, 187 Edinburgh Street, Rochester, NY, 14608, USA
- Institute of Child Development, University of Minnesota, Minneapolis, MN, USA
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Rzeszutek M, Lis-Turlejska M, Pięta M, Karlsen M, Backus H, Florek W, Lisowska K, Pankowski D, Szumiał S. Knowledge about traumatic World War II experiences among ancestors and subjective well-being of young adults: A person-centred perspective. PLoS One 2020; 15:e0237859. [PMID: 32833986 PMCID: PMC7446788 DOI: 10.1371/journal.pone.0237859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 08/04/2020] [Indexed: 11/18/2022] Open
Abstract
Objectives The aim of our study is to examine the association between knowledge about the World War II (WWII)-related traumatic experiences of their ancestors and subjective well-being (SWB) of young adults, i.e., descendants of Polish survivors of WWII. Specifically, we focus on the life satisfaction and the mental, physical, and psychosocial well-being of our participants in relation to their knowledge about WWII trauma in their family histories. Method The sample comprised 500 Polish young adults recruited from a nonclinical general population. Participants first filled out a questionnaire assessing their knowledge about traumatic events that their ancestors could have experienced during WWII (see grandparents/mothers, great-grandparents/mothers). After that, subjects were given inventories to assess their SWB, i.e., the Satisfaction with Life Scale (SWLS) and the General Health Questionnaire (GHQ-28). Results Latent profile analysis was applied to extract profiles of participants differing with regard to the scope of knowledge about WWII-related traumatic experiences among ancestors. Specifically, six profiles were observed, and a general lack of knowledge about this kind of trauma in the family was characteristic of the sample. We also found differences in SWB across profiles of participants, with worse SWB in the profiles with the highest lack of knowledge about WWII-related traumatic experiences in the family. Conclusion Our study adds to the literature on intergenerational trauma by applying a person-centred perspective, a methodological approach almost invisible in research on that topic. In addition, our findings can serve as a stimulus for more comprehensive debate on WWII trauma in Polish society.
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Affiliation(s)
- Marcin Rzeszutek
- Faculty of Psychology, University of Warsaw, Warsaw, Poland
- * E-mail:
| | - Maja Lis-Turlejska
- Faculty of Psychology, SWPS University of Social Sciences and Humanities, Warsaw, Poland
| | | | - Monika Karlsen
- Faculty of Psychology, University of Warsaw, Warsaw, Poland
| | - Holly Backus
- Faculty of Psychology, University of Warsaw, Warsaw, Poland
| | | | | | - Daniel Pankowski
- Faculty of Psychology, University of Economics and Human Sciences in Warsaw, Warsaw, Poland
| | - Szymon Szumiał
- Faculty of Psychology, SWPS University of Social Sciences and Humanities, Warsaw, Poland
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Racine N, Zumwalt K, McDonald S, Tough S, Madigan S. Perinatal depression: The role of maternal adverse childhood experiences and social support. J Affect Disord 2020; 263:576-581. [PMID: 31759669 DOI: 10.1016/j.jad.2019.11.030] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 10/21/2019] [Accepted: 11/09/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND A strong association between the number of adverse childhood experiences (ACEs) and the risk of maternal depression has been demonstrated; however, this association has not been examined with regards to changes in depression across the perinatal period. The objectives of this longitudinal study were to: (1) determine whether ACEs predict depressive symptomology in pregnancy and the postpartum period; (2) test the relative contribution of ACEs, with other established risks of depression, including social support, and (3) examine whether the association between ACEs and depression across the perinatal period vary as a function of social support. METHODS Data from 1994 women were collected from a prospective pregnancy cohort. Women completed questionnaires related to ACEs prior to the age of 18. In pregnancy and at 4 months postpartum, social support was measured using the Medical Outcomes Study Social Support Survey and clinical cut-off scores for depression were assessed using the Edinburgh Postnatal Depression Scale. RESULTS Logistic regression demonstrated that after accounting for sociodemographic factors and social support, ACEs predicted depressive symptoms in pregnancy (AOR = =1.26, CI = =1.12-1.43), the postpartum period (AOR = =1.34, CI = =1.17-1.52), and across the perinatal period (AOR = =1.31, CI = =1.12-1.54). Social support did not moderate the association between maternal ACEs and depression for any time point. LIMITATIONS retrospective and self-report nature of the data. CONCLUSION ACEs and low social support are both risk factors for depression, however low social support predicted the highest odds of depression, indicating the importance of asking about social support in pregnant and postpartum women.
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Affiliation(s)
- Nicole Racine
- Department of Psychology, Faculty of Arts, University of Calgary, 2500 University Dr. NW, Calgary T2N 1N4, AB, Canada.
| | - Katarina Zumwalt
- Department of Psychology, Faculty of Arts, University of Calgary, 2500 University Dr. NW, Calgary T2N 1N4, AB, Canada.
| | - Sheila McDonald
- Department of Community Health Sciences, University of Calgary, 2500 University Dr. NW, Calgary T2N 1N4, AB, Canada.
| | - Suzanne Tough
- Department of Community Health Sciences, University of Calgary, Department of Pediatrics, University of Calgary, 2500 University Dr. NW, Calgary T2N 1N4, AB, Canada.
| | - Sheri Madigan
- Department of Psychology, Faculty of Arts, University of Calgary, Alberta Children's Hospital Research Institute, 2500 University Dr. NW, Calgary T2N 1N4, AB, Canada.
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Ginn C, Mughal MK, Pruett MK, Pruett K, Perry RL, Benzies K. Engaging From Both Sides: Facilitating a Canadian Two-Generation Prenatal-to-Three Program for Families Experiencing Vulnerability. Can J Nurs Res 2020; 52:117-128. [PMID: 32046505 DOI: 10.1177/0844562120905710] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Young children living in families experiencing social vulnerability, including low income, mental illness, addictions, social isolation, and/or homelessness, are at risk of developmental delay. Two-generation programs can improve outcomes for preschool children, but underlying mechanisms and outcomes for younger children remain unclear. PURPOSE We explored program facilitation and identified developmental benefits of a two-generation program beginning prenatally. METHODS In our convergent, concurrent mixed methods study, we interviewed agency staff (n = 10) and held focus groups with parents (n = 14). We compared child (N = 100) development between program intake and exit as measured by the Ages and Stages Questionnaires 3rd edition. RESULTS Our core category, Engaging From Both Sides, included (a) Mitigating Adversity (focused codes Developing Trust, Letting Go of Fear, and Putting in the Effort); (b) Continual Learning (focused codes Staying Connected, and Taking it to the Community); (c) Fostering Families (focused codes Cultivating Optimism, and Happiness and Love); (d) Unravelling Cycles of Crisis (focused codes Advocating, and Helping Parents' Parent); and (e) Becoming Mainstream (focused codes Knowing Someone Has Your Back, and Managing Stress, Anxiety, and Anger). We found significant improvements in child Fine Motor, Problem-Solving, and Personal-Social domains between program intake and exit. CONCLUSIONS Our study adds to existing literature regarding mechanisms of two-generation programs beginning prenatally. Mitigating effects of intergenerational adversity was the primary motivation for interaction and engagement of staff and parents in two-generation programming, which improved child development.
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Affiliation(s)
- Carla Ginn
- Faculty of Nursing, University of Calgary, AB, Canada
| | | | | | | | | | - Karen Benzies
- Faculty of Nursing, University of Calgary, AB, Canada
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Steele KR, Townsend ML, Grenyer BFS. Parenting stress and competence in borderline personality disorder is associated with mental health, trauma history, attachment and reflective capacity. Borderline Personal Disord Emot Dysregul 2020; 7:8. [PMID: 32426137 PMCID: PMC7212608 DOI: 10.1186/s40479-020-00124-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 04/17/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Individuals with borderline personality disorder (BPD) may experience additional challenges in their parenting role, including increased stress and lower self-efficacy and satisfaction. These difficulties have been shown to impact their children, and may be implicated in the potential intergenerational transmission of personality vulnerabilities. METHODS Parental stress and competence variables were examined in a cross-sectional study of 284 parents (94.72% female, M = 37.37, SD = 8.04 years), of which 69 (24.30%) met caseness for BPD criteria. We completed a multivariate analysis of variance to test how parents with 'high BPD features' (meeting caseness for BPD) compared to those with 'low BPD features' on a range of parenting and mental health variables. Multivariate linear regression modelling was then utilised to explore whether these parenting variables were associated with personality and psychological wellbeing, recalled trauma history, orientation to attachment relationships and reflective capacity. RESULTS Individuals high in BPD features experienced more stress and lower competence in their parenting role than those low in BPD features. These parents also reported more personality vulnerabilities, poorer psychological wellbeing, recalled more traumatic experiences in their childhood, were more likely to endorse insecure attachment styles and had poorer reflective capacity. In the regression model, parenting stress and competence was associated with personality traits, general psychological wellbeing, recalled trauma history, attachment style and reflective capacity variables. Parental reflective capacity had the strongest association with parenting stress, satisfaction, efficacy, the perception of having a difficult child and a difficult parent-child relationship, and psychological wellbeing had the greatest association with parenting distress. CONCLUSIONS Parents who were able to imaginatively enter the subjective world of the child and hold the child's mind in mind with less certainty, reported reduced parenting stress and greater parenting satisfaction and efficacy. Helping to improve personality and mental health functioning, increasing parental reflective capacity and strengthening parent-child attachment relationships, may reduce parenting stress and increase parenting competence in individuals with BPD.
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Affiliation(s)
- Kayla R Steele
- School of Psychology, Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales Australia
| | - Michelle L Townsend
- School of Psychology, Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales Australia
| | - Brin F S Grenyer
- School of Psychology, Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales Australia
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50
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Dozio E, Feldman M, Bizouerne C, Drain E, Laroche Joubert M, Mansouri M, Moro MR, Ouss L. The Transgenerational Transmission of Trauma: The Effects of Maternal PTSD in Mother-Infant Interactions. Front Psychiatry 2020; 11:480690. [PMID: 33329072 PMCID: PMC7733963 DOI: 10.3389/fpsyt.2020.480690] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 11/04/2020] [Indexed: 11/25/2022] Open
Abstract
The objective of the study was to examine the process of mother to infant trauma transmission among traumatized mothers in humanitarian contexts. We investigated the impact of mothers' post-traumatic stress disorder symptoms on the quality of the dyadic interaction by conducting a microanalysis of mother-infant interactions at specific moments when trauma was recalled, compared to more neutral moments. Twenty-four mother-infant dyadic interactions of traumatized mothers and children aged from 1.5 to 30 months Central Africa, Chad, and Cameroon were videotaped during three sequences: a neutral initial session (baseline) exploring mothers' representations of the infant and of their bonding; a second sequence, "the traumatic narration," in which mothers were asked to talk about the difficult events they had experienced; and a third sequence focusing on a neutral subject. Three minutes of each sequence were coded through a specific grid for microanalysis [based on the scales developed at Bobigny Faculty of Medicine and the work of (1)], according to different communication modalities (touch, visual, and vocal), for both the mother and the child. Impact of traumatic event (IES-R), the level of depression and anxiety (HAD) were investigated in order to have a holistic understanding of the trauma transmission mechanism. The data analysis highlighted significant differences in mothers, children and their interaction during the "traumatic narration": mothers touched and looked at the infant less, looked more absent and smiled less, and looked less at the interviewer; infants looked less at the interviewer, and sucked the breast more. The mother-child interaction "infant self-stimulation-mother looks absent" and "Infant sucks the breast-mother looks absent" occurred more often during the mothers' traumatic narrations. The "absence" of the mother during trauma recall seems to have repercussions on infants' behavior and interaction; infants show coping strategies that are discussed. We found no significant associations between interaction and infant gender and age, the severity of traumatic experience, mothers' depression and anxiety symptoms, and the country of residence. The results of the microanalysis of interaction can shed light on the fundamental role of intermodal exchanges between mother and infant in trauma transmission during mothers' trauma reactivation.
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Affiliation(s)
| | | | | | | | | | | | | | - Lisa Ouss
- Hôpital Necker-Enfants Malades, Assistance Publique Hopitaux De Paris, Paris, France
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