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

Interactions of perinatal depression versus anxiety and infants' early temperament trajectories

This study examines the interplay between maternal depression/anxiety and infant temperament's developmental trajectory in 1687 Swedish-speaking mother-infant dyads from Uppsala County (2009-2019), Sweden. The sample includes a high proportion of university-educated individuals and a low share of foreign-born participants. Maternal depressive and anxiety symptoms were assessed using the Edinburgh Postnatal Depression Scale during gestational weeks 17 and 32 and postpartum at week 6. Multinomial regression explored associations between maternal variables and infant temperament trajectories at 6 weeks, 12 months, and 18 months. Prenatal anxiety is associated with the high-rising infant difficult temperament trajectory, while prenatal depression/anhedonia is associated with the stable-medium trajectory, attenuated postpartum. Associations between infant temperament and maternal mood depended on timing (pre/postpartum) and symptom type (depression/anhedonia vs. anxiety).

A dynamic perspective on depressive symptoms during the first year postpartum

The current study used novel methodology to characterize intraindividual variability in the experience of dynamic, within-person changes in postpartum depressive (PPD) symptoms across the first year postpartum and evaluated maternal and infant characteristics as predictors of between-person differences in intraindividual variability in PPD symptoms over time. With a sample of 322 low-income Mexican-origin mothers (Mage = 27.79; SD = 6.48), PPD symptoms were assessed at 11 time points from 3 weeks to 1 year postpartum (Edinburgh Perinatal Depression Scale; Cox & Holden, 2003). A prenatal cumulative risk index was calculated from individual psychosocial risk factors. Infant temperamental negativity was assessed via a maternal report at the infant age of 6 weeks (Infant Behavior Questionnaire; Putnam et al., 2014). Multilevel location scale analyses in a dynamic structural equation modeling (Asparouhov et al., 2018) framework were conducted. Covariates included prenatal depressive symptoms. On average, within-mother change in depressive symptoms at one time point was found to carry over to the next time point. Nonnull within-mother volatility in PPD symptoms reflected substantial ebbs and flows in PPD symptoms over the first year postpartum. Results of the between-level model demonstrated that mothers differed in their equilibriums, carryover, and volatility of their PPD symptoms. Mothers with more negative infants and those with higher prenatal cumulative risk exhibited higher equilibriums of PPD symptoms and more volatility in symptoms but did not differ in their carryover of PPD symptoms. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Effect of Postpartum Depression on Infant Safety Practices in Korea

OBJECTIVE

To describe the prevalence of postpartum depression in a sample of Korean women and to examine the effect of postpartum depression on their adoption of safety practices for their infants.

DESIGN

Secondary, cross-sectional.

SETTING

South Korea.

PARTICIPANTS

A total of 3,127 women who gave birth in 2020.

METHODS

We applied a complex sample design analysis using the national survey data on postpartum care in South Korea. We analyzed the data using weighted multivariate logistic regression to determine the association between postpartum depression and the adoption of five safety practices for infants.

RESULTS

A total 42.7% (n = 1,319) of our participants had symptoms of postpartum depression during the initial 7 days after birth. Participants who had postpartum depression were less likely to engage in certain safety practices for infants.

CONCLUSION

We propose a proactive approach to promote an improved policy for postpartum depression screening alongside a comprehensive program that offers guidance and education to mothers suffering with postpartum depression. The primary objective is to empower these mothers with essential skills that can effectively ensure the safety of their infants.

Maternal Self-Efficacy as a Mediator in the Relationship Between Postpartum Depression and Maternal Role Competence: A Cross-Sectional Survey

INTRODUCTION

This study aimed to (1) examine the relationships among postpartum depression, maternal self-efficacy, and maternal role competence, and to (2) test whether maternal self-efficacy mediates the relationship between postpartum depression and maternal role competence.

METHODS

Using a cross-sectional design, we conveniently sampled 343 postpartum mothers from 3 primary health care facilities in Eswatini. Data were collected using the Edinburgh Postnatal Depression Scale, Maternal Self-Efficacy Questionnaire, and Perceived Competence Scale. Multiple linear regression models and structural equation modeling were performed in IBM SPSS and SPSS Amos to examine the studied associations and to test the mediation effect.

RESULTS

The participants were aged 18 to 44 (mean, 26.4; SD, 5.86) years, and the majority were unemployed (67.1%), had an unintended pregnancy (61.2%), received education during antenatal classes (82.5%), and fulfilled the cultural norm of the maiden home visit (58%). Adjusting for covariates, postpartum depression was negatively associated with maternal self-efficacy (β = -.24, P < .001) and maternal role competence (β = -.18, P = .001), whereas maternal self-efficacy was positively associated with maternal role competence (β = .41, P < .001). In the path analysis, postpartum depression only related to maternal role competence indirectly through maternal self-efficacy (β = -.10, P = .003).

DISCUSSION

High maternal self-efficacy was associated with high maternal role competence and fewer postpartum depression symptoms, suggesting that improving maternal self-efficacy may help reduce postpartum depression and may improve maternal role competence.

Birth-related posttraumatic stress disorder and negative childbirth experience related to maternal functioning among adolescent mothers: a cross-sectional study

BACKGROUND

Adolescent pregnancy is an important issue in terms of reproductive health. Adolescent mothers have to overcome two crises at the same time: motherhood and maturity. Childbirth experience and posttraumatic stress disorder may influence the mother's perception of her infant and postpartum care behaviors.

METHODS

This cross-sectional study was conducted on 202 adolescent mothers referring to health centers in Tabriz and its suburbs between May and December, 2022. Data were collected by PTSD Symptom Scale, Childbirth Experience Questionnaire 2.0, and Barkin Index of Maternal Functioning. The association between childbirth experience, posttraumatic stress disorder and maternal functioning was assessed by multivariate analysis.

RESULTS

After adjusting the effect of socio-demographic and obstetric characteristics, the score of maternal functioning among mothers without posttraumatic stress disorder was statistically significantly higher than mothers with posttraumatic stress disorder diagnosis [β (95% CI) = 2.30 (0.39 to 4.20); p = 0.031]. The score of maternal functioning increased with the increase in the childbirth experience score [β (95% CI) = 7.34 (3.87 to 10.81); p < 0.001]. The score of maternal functioning among mothers with wanted sex of baby was statistically significantly higher than unwanted sex of baby [β (95% CI) = 2.70 (0.37 to 5.02); p = 0.023].

CONCLUSION

Healthcare professionals should pay special attention to improving maternal functioning among adolescent mothers. One of the important actions can be to create a positive experience of childbirth for avoiding of posttraumatic stress disorder following birth and counseling with mothers who stated sex of fetus is undesired.

Maternal psychological functioning mediates the association between infant behavior and subsequent child psychological functioning

Symptoms of psychopathology that onset during childhood are often more severe, chronic, and difficult to treat than symptoms that first appear later in life. Maternal psychological symptoms are associated with the development of psychological symptoms in children. However, less research focuses on whether children's behaviors may presage maternal psychological difficulties that, in turn, contribute to the child's own psychological functioning. Identifying psychological difficulties in families and intervening in early life may lower risk for intergenerational transmission of subsequent psychological symptoms. Even at non-clinical or normative levels, exploring transactional models of parent-child behavior and psychological functioning may provide insight into the development of later psychological difficulties or symptoms within families. Thus, the current study examined whether difficult infant behavior (e.g., fussiness, unpredictability) is associated with future maternal psychological difficulties and subsequently, the child's own psychological functioning in early childhood. The current sample includes 847 dyads from a multi-wave birth cohort in England ('Born in Bradford'), who identified as predominantly non-White (62.2%) and socioeconomically diverse. Mothers reported on their child's behaviors at 6 months, their own psychological functioning during pregnancy and at 18 months postpartum, and their child's psychological functioning at age 3. Results of a mediation model revealed that the association between infant behavior at 6 months and child psychological functioning at 3 years is partially explained by maternal psychological functioning at 18 months, even after accounting for psychological difficulties during pregnancy, maternal age at birth, child sex, family income, and ethnicity. Post-hoc exploratory analyses revealed that the association between infant behavior, maternal psychological functioning, and subsequent child psychological functioning was significant for Pakistani British families but not White British families. These findings provide preliminary evidence that infant behaviors (e.g., temperament) may presage future maternal psychological difficulties and subsequent child psychological functioning, above and beyond previous maternal psychological functioning. Importantly, these results highlight infant behavior as a potential catalyst for later psychological difficulties within families.

Mothers' Emotion Regulation and Negative Affect in Infants: The Role of Self-Efficacy and Knowledge of Parenting Practices

Early in development, children rely heavily on caregivers for assistance with the regulation of negative emotion. As such, it is important to understand parent characteristics that influence caregiver ability to attenuate infant negative affect and mediating factors by which this process may unfold. This study examined the relationship between parental emotional regulation strategies (ERs) and infants' negative affect and tested the mediating effects of parenting self-efficacy and knowledge of this association. Results indicated that higher maternal reappraisal was related to higher maternal self-efficacy whereas higher maternal suppression was related to lower knowledge of parenting practices. Maternal suppression was negatively related to infant frustration; maternal self-efficacy was positively related to infant falling reactivity and negatively related to sadness. There was a significant indirect effect between maternal reappraisal and infant falling reactivity through maternal self-efficacy. The mediation result suggests that mothers with higher use of reappraisal show higher self-efficacy and have infants with higher falling reactivity. Maternal knowledge about parenting practices was related to lower infant fear. Maternal knowledge of parenting practices did not mediate any associations between maternal emotion regulation strategies and infant negative affect. These findings contribute to the understanding early protective parenting mechanisms for supporting the external regulation of negative affect in infants and also in designing and implementing preventive parenting programs focused on the emotional needs of parents and children.

Parenting self-efficacy instruments for parents of infants and toddlers: A review

Background

Parenting Self-Efficacy, a concept first described in Bandura's Social Cognitive Theory, is a parent's belief in their ability to successfully parent their child. The concept of parenting self-efficacy is used by researchers to increase our understanding of parenting abilities and influences on child health and developmental outcomes. Numerous instruments exist for measuring parental self-efficacy; but little is known about the specific topics included in the measures and consistency across instruments. Therefore, this scoping review sought to compare parenting self-efficacy instruments for parents of infants and toddlers, focusing on comparison of parenting topics, scale format, and administration with the goal of providing guidance and recommendations for measurement selection.

Methods

Our sample included 25 instruments and items from every instrument was evaluated and coded using NVIVO Qualitative Software. We reviewed the instruments' target population, subscales, number of items, response options, scoring range and instructions, theoretical background, and parenting topics across each instrument.

Results

This review found three common factors across all instruments: parent, social and family, and child factors. Parent personal factors were addressed most frequently to evaluate self-efficacy and included topics such as, perception of parenting abilities, emotional reactions, and perceived successes. From our synthesis, we also offer recommendations for instrument selection and provide a conceptual model of parenting self-efficacy.

Conclusions

The findings from this scoping review highlight the presence of key factors (parent, social & family, and child) necessary for the evaluation of parenting self-efficacy in parents of infants and toddlers. Given our results, a meta-analysis is needed to compare parenting self-efficacy scores across studies to better understand the associations between self-efficacy and parent and child outcomes.

Maternal self-efficacy development from pregnancy to 3 months after birth

The present study uses a prospective longitudinal study design to investigate the development of maternal self-efficacy in the transition phase to parenthood, drawing on a large sample of socially and/or culturally disadvantaged families (N = 292). Parity, maternal education, migration, informal and formal social support are considered as potential predictors. Results indicate that previous birth experience, being born abroad, and higher levels of formal and informal social support during pregnancy jointly predict higher levels of maternal self-efficacy three months after birth. First-time mothers and mothers born in Germany (where the study was conducted) benefit more from formal support than mothers with previous experience and mothers born outside of Germany. Overall, maternal self-efficacy increases significantly. Implications for prenatal maternal care are discussed.

Maternal depressive symptoms and early childhood temperament before and during the COVID-19 pandemic in the United Kingdom

The COVID-19 pandemic is an unexpected and major global event, with the potential to have many and varied impacts on child development. However, the implications of the pandemic for maternal depressive symptoms, early childhood temperament dimensions, and their associations, remain largely unknown. To investigate this, questionnaires were completed by mothers (N = 175) before and during the pandemic when their child was 10- and 16-months old (Study 1), and by an extended group of mothers with young children (6-48 months; 66 additional mothers) during the first and second national lockdowns in the United Kingdom in 2020 (Study 2). Results indicated that while maternal pandemic-related stress decreased over the first 6 months of the pandemic, there was an increase in mothers who reported feeling some level of pandemic-specific depression. Despite this, we did not observe an increase in the severity of global maternal depressive symptoms, or any negative impact of the pandemic on the development of temperament in infancy and early childhood.

Testing Models of Associations Between Depression and Parenting Self-efficacy in Mothers: A Meta-analytic Review

Numerous cross-sectional studies confirm the long-theorized association between mothers' depression and lower parenting self-efficacy (PSE) beliefs. However, cross-sectional studies leave unanswered the direction of this association: Does depression predict PSE? Does PSE predict depression? Are both true? Does the strength of the association between depression and PSE, regardless of the direction, generalize across participant characteristics and study design features? How stable is PSE over time? And how effective are interventions at enhancing PSE? To answer these questions, we conducted a meta-analytic review of longitudinal studies. With 35 eligible studies (22,698 participants), we found support for both models: there was a significant pooled effect of both depression on PSE and of PSE on depression, with nearly identical effect sizes (d =   - 0.21 and - 0.22, respectively). The association was stronger in samples with mothers' younger average age and studies that measured PSE among mothers relative to during pregnancy. We found a medium degree of stability in the index of PSE, d = 0.60. Finally, the estimated pooled effect size between being in an intervention group versus control group and PSE was 0.505. Overall, we found support for (1) bidirectional associations between depression and PSE in mothers, (2) the stability of PSE over time, and (3) the strength of the relationship between PSE and depression with intervention. These results suggest the importance of continuing to develop, test, and disseminate interventions to enhance PSE. We interpret these findings in the context of both depression and low PSE having serious consequences for child outcomes and maladaptive parenting.

[Maternal depression and child development: A prospective analysis of consequences, risk and protective factors]

Maternal depression and child development: A prospective analysis of consequences, risk and protective factors Abstract. Objective: Maternal stress, specifically maternal mental health problems, are considered risk factors for child development. The literature suggests that prenatal depressive symptoms as well as depressive symptoms are a widespread phenomenon during the further development of the child and have repeatedly been shown to have adverse effects on child mental health outcomes. The present study examined the longitudinal relationships between maternal depression (prenatal, postnatal, during childhood and adolescence) and child mental health from childhood to adolescence. Possible risk and protective factors were also considered. Method: N = 112 mothers were assessed for depressive symptoms via a questionnaire at four different timepoints (prenatal, T1; postnatal, T2; during childhood, T3; during adolescence, T4). Children's externalizing and internalizing symptoms (50.9 % girls) were assessed by their mothers both during childhood (M = 7.68, SD = 0.76 years) and during adolescence (M = 13.23, SD = 0.27 years). We evaluated the relationships between maternal depressive symptoms and children's externalizing/internalizing symptoms using multiple regression models and analyzed possible risk and protective factors using moderation analysis. Results: Externalizing/Internalizing symptoms were not directly associated with maternal depressive symptoms, while associations between such symptoms and maladaptive behavior were found in adolescents. The socioeconomic status of families showed a different risk profile for prenatal and postnatal depressive symptoms. The IQ of the children proved to be a risk factor for internalizing symptoms. Conclusions: Maternal depressive symptoms at any time during child development - in combination with further risk factors - have an impact on child mental health. The early identification of maternal symptoms followed by interventions to differentiate between prenatal and postnatal depression - especially in the context of socioeconomic status - are highly relevant for child development.

Body Appreciation, Depressive Symptoms, and Self-Esteem in Pregnant and Postpartum Brazilian Women

Background

During pregnancy and the postpartum period, women experience tremendous biopsychosocial changes in a short period of time. Poor body appreciation, depressive symptoms, and low self-esteem during the perinatal period may cause negative consequences for both the mother and the infant's physiological and psychological health. The aim of this study was to analyze the differences in body appreciation, depressive symptoms, and self-esteem between the three gestational trimesters and the postpartum period.

Methods

Participants (N = 1,423 pregnant and postpartum Brazilian women), aged between 18 and 42 years old (M = 29.22; SD = ±5.72), answered questionnaires on body appreciation, depressive symptoms, and self-esteem. BMI was self-reported. Descriptive and nonparametric covariance analysis were performed, comparing women who were in the first, second, and third trimesters and the postpartum period.

Results

Body appreciation was significantly higher among women in the third trimester compared to those in the first and second trimester. However, it was lower for women in all three gestational trimesters than for those in the postpartum. There was no difference in self-esteem during pregnancy, but it was significantly lower in the postpartum group. Similarly, depressive symptoms did not vary through pregnant groups but it was significantly higher in the postpartum group.

Conclusions

The results showed that the postpartum period can be a difficult experience for women. They presented poor body appreciation and lower self-esteem and higher depressive symptoms compared to the pregnancy period. Therefore, it is necessary for public health policies to support women in this period, preserving their mental health and making this experience more positive.

Infant sleep and temperament characteristics in association with maternal postpartum depression

OBJECTIVE

Aim of this study was to examine the association between infant temperament and sleep characteristics and postpartum depressive symptoms among mothers.

STUDY DESIGN

Research data were collected at the baseline (2nd -4th days postpartum) and the follow-up (6-8 weeks postpartum), Slovak version of the (EPDS) was used, along with questions focused on perceived sleeping problems of an infant, and temperament Linear regression models were employed.

SETTING

Two public hospital sites in Slovakia.

PARTICIPANTS

204 women participated in both time points (mean age 30.9 ± 4.8, age range: 20-44; 78.9% vaginal births; 56.9% primiparas).

RESULTS

Significant differences in the EPDS scores were found according to infant sleeping problems (p ≤ 0.05) and duration of infant night sleep (p ≤ 0.01). Both night sleep and day sleep duration were significant predictors for the level of postpartum depression symptoms at the 6-8 weeks follow-up in the linear regression model after adjusting for confounding variables (β= -0.13; 95%CI: -3.04;-0.01; β= -0.15; 95%CI: -3.02;-0.28, total explained variance 39.0%). Infant temperament characteristics have not been found significant predictors of postpartum depression symptoms in this study.

KEY CONCLUSIONS

Significant differences in depression levels were found among postpartum women according to perceived sleeping problems of infant, and the duration of infant night sleep. It is important to focus more attention on the role of infant sleeping problems as a possible risk factor for the increased occurrence of postpartum depressive symptoms.

The Effects of Intrapartum Administration of Synthetic Oxytocin on Breastfeeding in the First 9 Months Postpartum: A Longitudinal Prospective Study

Background and Objective: Synthetic oxytocin (synOT) is a widely used drug to induce or accelerate labor and to prevent postpartum hemorrhage. Although some studies indicate there are associations between intrapartum synOT and impaired breastfeeding initiation or earlier cessation, the long-term effects of synOT on breastfeeding are largely understudied. The aim of this study was to examine the effects of synOT on breastfeeding status during the first 9 months postpartum. Materials and Methods: The women were recruited from five maternity hospitals during prenatal medical checkups or postpartum hospital stay. They reported their breastfeeding status on discharge from maternity hospital (mean 4.54 days postpartum) (N = 439), at 6 weeks (N = 439), and at 9 months postpartum (N = 274). The data related to synOT administration were extracted from the medical records. Results: In the analysis adjusted for maternal age, parity, educational level, marital status, child's sex, delivery mode, and labor analgesia/anesthesia, intrapartum administration of synOT predicted a lower probability of exclusive breastfeeding on discharge from maternity hospital (odds ratio = 0.37; p = 0.006), but we observed no effect on breastfeeding status at 6 weeks or 9 months postpartum. Conclusion: Our results suggest that adverse effects of synOT on breastfeeding do not persist beyond the first postpartum days.

Prevalence and factors associated with depression among the mothers of school-going children in Dhaka city, Bangladesh: A multi stage sampling-based study

Background

Motherhood is associated with extra stress, and mothers of young children are particularly prone to developing depression and mental health problems.

Methodology

This analytical cross-sectional study was conducted in Dhaka city, Bangladesh, from June to December 2019. Mothers of school-going children were recruited through a multistage sampling technique. Dhaka city was divided into two divisions and then further subdivided into public and private sectors. Six schools were selected from each sector by using a simple random sampling technique. A list of class five to eight students were collected from each school by systematic random sampling. Data were collected through face-to-face interviews using semi-structured questionnaires. The rate of depressive symptoms was measured by the validated Zung Self-Rating Depression Scale (SDS).

Result

A total of 324 women participated in this study; the majority of the women (85.5%) were Muslim, 67.0% were housewives, and 53.1% had a girl child. Among the women, 15.4% had mild, 22.2% had moderate, and 20.1% had severe depression. Most of the child's behavioral and lifestyle factors were associated with the mother's depression. Adjusted analyses indicate that if a child is often unhappy, depressed, or tearful [(OR (95%CI = 22.27 (8.39-59.11)], gets nervous in new situations or easily loses confidence [(OR (95%CI) = 5.45 (2.96-10.00)], often lies or cheats [(OR (95%CI) = 8.93 (3.76-21.22)], gets afraid easily [(OR (95%CI) = 7.09 (3.79-13.24)], watches television for 3 h or more [(OR (95%CI) = 23.77 (6.46-87.48)] browses the internet for 3 h or more [(OR (95%CI = 7.37 (2.76-19.67)] were associated with mother's depression.

Conclusion

The study concludes that depression among the mothers of school-going children in Dhaka city of Bangladesh is high. Several lifestyles and behavioral factors of school-going children are significantly associated with the mothers' depression.

Postpartum Depression and Early Predictors of Lower Maternal Confidence at 12 to 15 Months after Delivery

The objective of the present study is to assess the association of early postpartum depression and maternal confidence with low maternal confidence at 12-15 months after delivery. Prospective study performed from 2013 to 2015 with 358 postpartum women who had participated in a cluster trial to treat their depression during pregnancy. At 6-8 months after birth, we reviewed socio-demographics, obstetric data and Postpartum Depression (PPD) with the Patient Health Questionnaire-9. Maternal Confidence (MC) was assessed at 6-8 and 12-15 months after birth with the Maternal Confidence Questionnaire. Low and High MC was defined using 50% percentile. The crude and adjusted Odds Ratios (OR) with the 95% Confidence Interval (CI) were calculated using Poisson regression with robust variance. Multivariate models estimated the ORs between postpartum depression and LMC at 12-15 months adjusted for socio-demographic variables, maternal characteristics and previous LMC. Statistical analysis was performed with STATA12 and the significance level was considered equal or lower than 5%. Among a sample of women who were depressed during pregnancy, 19% had probably moderate to severe depression, at the beginning of the child' second year of life. Low maternal confidence was associated with previous low maternal confidence (OR = 1.71; 95% CI 1.33:2.20, p = <0.001) and vaginal delivery but not with previous PPD. Based on our findings, detection and treatment of women presenting confidence problems at the first months after delivery may prevent later mother self-efficacy problems.

Social support buffers the effects of maternal prenatal stress on infants' unpredictability

OBJECTIVE

Exposure to stress in pregnancy has been shown to affect fetal development with short- and long-term physiological and behavioral consequences for the offspring. Although social support is known to lower perceived stress, no prior study has investigated the buffering role of social support in the context of prenatal stress effects on infant temperament. The aim of this study was to examine interactive effects of prenatal stress and social support on several dimensions of infant temperament at 9 months postpartum.

STUDY DESIGN

A total of 272 mothers completed the Perceived Stress Scale and the Perceived Social Support Scale in the 3rd trimester of pregnancy. Infant temperament was assessed by mothers at 9 months postpartum using the Infant Characteristics Questionnaire. Linear regression models were performed to assess the effects of perceived stress, social support, and their interaction on infant temperament.

RESULTS

Prenatal stress interacted with social support, such that prenatal stress increased infant unpredictability when social support was below -0.5 SD.

CONCLUSIONS

Prenatal stress was found to be a risk factor for infant temperamental unpredictability when combined with low social support perceived by the mother during pregnancy. Support of others, not previously examined in this context, can reduce the impact of prenatal stress.

Promoting sensitive parenting in 'at-risk' mothers and fathers: A UK outcome study of Mellow Babies, a group-based early intervention program for parents and their babies

BACKGROUND

The objective of this study was to evaluate the effectiveness of Mellow Babies (MB) in the UK. MB is a 14-week early parenting intervention program that is delivered in groups and is targeted at 'at-risk' parents (both mothers and fathers) and their babies up to 18 months old.

METHOD

The study used a pragmatic pre-post intervention design. Outcomes were parental mental health, parenting confidence, quality of life, socio-emotional development of children, and perceived parent-child relationship. Fifteen groups representing n = 91 parent-baby dyads were recruited across the UK between 2017-2018. The sample consisted of 10 Mellow Mums groups (70 mother-baby dyads) and 5 Mellow Dads groups (21 father-baby dyads). Intention-to-treat and 'completer' analyses were performed.

RESULTS

Findings suggest short-term positive outcomes for parents attending MB. Completion of the program was associated with significant improvements in anxiety and overall wellbeing, parenting confidence, and perceived closeness of the parent-child relationship. The significance of these improvements, except for parenting confidence, was maintained in the intention-to-treat analysis. MB engaged and retained a high proportion of parents who could be considered 'at-risk' and benefitted fathers and mothers attending the intervention equally.

CONCLUSIONS

This is the first prospective study to explore MB participation for both mothers and fathers and to indicate engagement and potential benefits specifically for 'at-risk' parents. Findings further demonstrate the effectiveness of MB as an early intervention program for parents experiencing psychosocial difficulties. Replication by studies using a contrast or control group also incorporating follow-up data would further improve the evidence base for MB.

Associations Between Mode of Birth and Neuropsychological Development in Children Aged 4 Years: Results from a Birth Cohort Study

The aim of this prospective longitudinal study was to examine the association between Cesarean section (CS) and child development and behavior. The sample consisted of 256 children who were born at term without serious perinatal pathologies. Their development and behavior was assessed at the age of four using Ages and Stages Questionnaire (ASQ-3), Children's Behavior Questionnaire and Strength and Difficulties Questionnaire. Multivariate linear regression analyses were conducted to assess the association between CS and child outcomes. CS was associated with better scores in the Problem Solving domain of the ASQ in the whole sample. After stratifying by child sex, the positive association between CS and the Problem Solving domain was significant in boys, while no association was found in girls. Girls were rated less optimally in the Gross Motor domain of the ASQ when born via CS. Mode of birth was not associated with behavioral outcomes.

Effectiveness and acceptability of cognitive-behavioural therapy based interventions for maternal peripartum depression: a systematic review, meta-analysis and thematic synthesis protocol

INTRODUCTION

Peripartum depression is a common mental health difficulty associated with a range of negative impacts for the mother, infant and wider family. This review will examine the effectiveness of cognitive-behavioural therapy (CBT) based interventions for peripartum depression. Secondary aims are to explore the effect of CBT-based interventions targeted at peripartum depression on novel secondary outcomes and moderators potentially associated with effectiveness. To date, there has been little examination of effect on important secondary outcomes (eg, anxiety, stress and parenting), nor clinical and methodological moderators. Further, this review aims to explore the acceptability of CBT-based interventions for women with peripartum depression and examine important adaptations for this population.

METHODS AND ANALYSIS

Electronic databases (e.g., MEDLINE; ISI Web of Science; CINAHL; CENTRAL; Prospero; EMBASE; ASSIA; PsychINFO; SCOPUS; And Swemed+) will be systematically searched. Database searches will be supplemented by expert contact, reference and citation checking, and grey literature. Primary outcomes of interest will be validated measures of symptoms of depression. A proposed meta-analysis will examine: (1) the overall effectiveness of psychological interventions in improving symptoms of depression (both self-reported and diagnosed major depression) in the peripartum period; (2) the impact of interventions on secondary outcomes (eg, anxiety, stress and parenting); (3) clinical and methodological moderators associated with effectiveness. A thematic synthesis will be conducted on qualitative data exploring the acceptability of CBT-based intervention for postpartum depression including participants' experience and perspectives of the interventions, satisfaction, barriers and facilitators to intervention use, intervention relevance to mothers' situations and suggestions for improvements to tailor interventions to the peripartum client group.

ETHICS AND DISSEMINATION

Formal ethical approval is not required by the National Ethical Review Board in Sweden as primary data will not be collected. The results will be disseminated through a peer-reviewed publication and inform the development of a new psychological intervention for peripartum depression. This study including protocol development will run from March 2019 to March 2020.