Links Among High EPDS Scores, State of Mind Regarding Attachment, and Symptoms of Personality Disorder

Parental reflective functioning in mothers and fathers of preschoolers: Associations with adult attachment and parenting behavior

Parental reflective functioning (PRF) is considered a key parental competence. Since most research on PRF has focused on infancy or the first years of life, there is a gap in our understanding of PRF among parents of older children. Therefore, we investigated PRF in mothers and fathers with preschool-aged children, examining associations between PRF, parent's romantic attachment, and observed parenting behavior. The sample comprised 50 mothers, 40 fathers, and their 5-year-old children. PRF was assessed using the parental reflective functioning questionnaire (PRFQ), parental romantic attachment was assessed using the experiences in close relationships scale-revised (ECR-R), and parenting behavior was assessed during a parent-child free-play interaction with the coding interactive behavior (CIB) coding system. Results showed that mothers scored higher on the interest and curiosity scale than fathers, indicating that mothers show a more active interest and curiosity in their child's mental states. Further, higher levels of attachment anxiety in fathers were associated with higher levels of pre-mentalizing modes. In mothers, higher levels of attachment avoidance were associated with lower levels of interest and curiosity. Finally, and unexpectedly, higher levels of interest and curiosity in mothers were associated with less sensitivity during free play. In summary, the study found meaningful associations between mothers' and fathers' romantic attachment and their PRF indicating a spill-over of their attachment strategies into their relationship with their child. Further, the study results suggest that very high levels of interest and curiosity in mothers reflect hypermentalizing.

Maternal Attachment Networks and Mother-Infant Bonding Disturbances among Mothers with Postpartum Major Depression

The literature suggests that maternal insecure attachment is a risk factor for postpartum depression which, in turn, affects motherinfant bonding. However, recent research in attachment suggests that the investigation of attachment networks provides further insight in the understanding of psychological outcomes. This study aims to test a model according to which mothers' attachment towards each of their parents contributes to explain attachment towards their romantic partners, which itself is associated with maternal postpartum depression and, in turn, with motherinfant bonding. The Attachment Multiple Model Interview, the Edinburgh Postnatal Depression Scale, and the Postpartum Bonding Questionnaire were administered to 90 mothers of infants under 6 months of age (32 with postpartum major depression). Results showed that attachment towards the partner (1) is best explained by attachment to the father and (2) mediates the link between attachment to the father and depression severity. Also, depression severity mediates the link between attachment to the partner and motherinfant bonding. These results highlight the role of attachment models towards the romantic partner and the father in the perinatal period and the relevance of attachment-focused therapeutic programs in treating postpartum maternal depression.

Internalizing and externalizing problems in preschool children: The role of mothers' and fathers' observed parenting behavior in a well-resourced sample

Empirical evidence links sensitive parenting behavior to positive developmental trajectories in children, whereas parental intrusiveness, in contrast, has been found to increase the risk of socio-emotional problems in children of various ages. However, most studies investigating the effect of parenting behavior have been conducted with mothers. Thus, little is yet known about fathers' role in child development and if mothers' and fathers' parenting behaviors are linked to child socio-emotional outcomes in similar or different ways. To date, findings are ambiguous, and this is why more studies are needed. The present study examined associations between mothers' and fathers' observed sensitivity and intrusiveness and children's internalizing and externalizing problems as reported by parents and by children themselves. The sample compromised 52 mothers, 41 fathers and their preschool children. Results from hierarchical regression analyses showed a negative association between fathers' intrusiveness, at low levels, and children's internalizing problems. This result was unexpected. However, in line with this finding, a number of recent studies suggest that when fathers challenge and push their children's limits, it buffers against emotional problems such as anxiety. The present study highlights the importance of a continuous investigation into fathers' potentially unique contribution to children's socio-emotional development. No other associations were identified between mothers' and fathers' parenting behaviors and children's internalizing and externalizing problems. Most likely, because this study was conducted with a low-risk sample, where children were in general well-functioning.

Associations of maternal sensitivity and embodied mentalizing with infant-mother attachment security at one year in depressed and non-depressed dyads

Parental Embodied Mentalizing (PEM) captures the parent's capacity to extrapolate the child's mental states from movement and respond on a nonverbal level. Little is known about PEM's relation to other established measures of parent-child interactive behavior, such as maternal sensitivity and attachment. This is investigated in a sample of four months old infants and mothers with (n = 27) and without a diagnosis of postpartum depression (n = 44). Video-recorded infant-mother interactions were coded independently using PEM and Coding Interactive Behavior. Attachment was assessed at 13 months using the Strange Situation Procedure. Sensitivity and PEM was positively associated, but only sensitivity predicted attachment security and only the nonclinical group. This indicates that PEM and sensitivity are moderately related as well as capturing different aspects of infant-mother interactions. The study confirms previous findings of sensitivity predicting attachment in nonclinical groups. More research is required to further understand predictors of attachment in clinical samples.

The mother, the infant and the mother-infant relationship: What is the impact of antidepressant medication in pregnancy

BACKGROUND

Both antidepressant use and depression in pregnancy have the potential to impact on outcomes for the women, their mother-infant relationship and their infants.

METHODS

Data were obtained from 485 pregnant women within Mercy Pregnancy and Emotional Wellbeing Study, a pregnancy cohort study. The sampling frame was in three groups: those depressed women taking antidepressants in pregnancy, women with diagnosed depression not taking an antidepressant and control women. Depression was measured using the Structured Clinical Interview for DSM-IV and repeat Edinburgh Postnatal Depression Scale and antidepressant use by repeat self-report, hospital records and blood levels. In addition, data on key maternal, parenting and infant outcomes were collected.

RESULTS

This study found, for women taking SNRI antidepressant medication there was an elevated rate of pregnancy hypertension. Infants exposed to antidepressants had lower Apgar scores and higher birth weight and this was not associated with dose or class of antidepressant. In contrast, women with higher depressive symptoms had lower maternal antenatal attachment and higher postpartum parenting stress. Both women with depression and those taking antidepressants were less likely to initiate breastfeeding. On the Ages and Stages Questionnaire, there was a significant difference in communication skills in SSRI antidepressant exposed infants at 12 months.

LIMITATIONS

Individual antidepressants could not be examined and development was only measured to 12 months CONCLUSIONS: Overall, the study identified that antidepressant treatment in pregnancy was significantly associated with only a limited number of poorer maternal and infant outcomes and was not associated with poorer parenting outcomes.

Insecure Attachment and Other Help-Seeking Barriers among Women Depressed Postpartum

When untreated, postpartum depression (PPD) can severely, negatively affect maternal health, child development, and the wellbeing and functioning of the entire family. Yet, despite screening and treatment programs for PPD, many women who experience depression with onset in the postpartum year do not communicate their symptoms. Negative relational experiences early in life, such as not receiving sensitive help and support when needed, often result in so-called insecure attachment styles, and there is evidence that these may contribute to the development and maintenance of PPD. However, the role of insecure attachment styles in non-help-seeking is unknown for this group. Using mixed quantitative and qualitative methodology, we identified help-seeking barriers of women who experienced depression with onset in the postpartum year but who had not sought help for their depression (N = 37), and explored links to their attachment orientations as assessed through both self-reported attachment style and narrative based attachment script assessment. The sample was non-normative regarding attachment, with an over-representation of avoidant attachment styles. Help-seeking barriers varied systematically with the mother's adult attachment style. Specifically, convictions of a strong self and lack of trust in healthcare professionals constituted a common barrier among women with avoidant attachment styles, while unrealistic expectations about motherhood constituted a barrier for women with secure attachment styles. This new knowledge on how barriers to communicating symptoms and seeking help when suffering from PPD vary systematically with attachment orientation can help formulate individualized, and therefore more efficient, approaches to addressing non-help-seeking behavior in women who suffer in silence.

Maternal postpartum depression is a risk factor for infant emotional variability at 4 months

Maternal postpartum depression (PPD) is a risk for disruption of mother-infant interaction. Infants of depressed mothers have been found to display less positive, more negative, and neutral affect. Other studies have found that infants of mothers with PPD inhibit both positive and negative affect. In a sample of 28 infants of mothers with PPD and 52 infants of nonclinical mothers, we examined the role of PPD diagnosis and symptoms for infants' emotional variability, measured as facial expressions, vocal protest, and gaze using microanalysis, during a mother-infant face-to-face interaction. PPD symptoms and diagnosis were associated with (a) infants displaying fewer high negative, but more neutral/interest facial affect events, and (b) fewer gaze off events.  PPD diagnosis, but not symptoms, was associated with less infant vocal protest. Total duration of seconds of infant facial affective displays and gaze off was not related to PPD diagnosis or symptoms, suggesting that when infants of depressed mothers display high negative facial affect or gaze off, these expressions are more sustained, indicating lower infant ability to calm down and re-engage, interpreted as a disturbance in self-regulation. The findings highlight the importance of not only examining durations, but also frequencies, as the latter may inform infant emotional variability.

Prenatal maternal personality as an early predictor of vulnerable parenting style

Perinatal mental health problems, particularly depression, are prevalent and have been a central focus of prevention initiatives. The greater proportion of ongoing annual perinatal mental health economic cost burdens relate to children. A key linking mechanism is mother-infant relationship quality. Perinatal depression symptoms are typically transient. However, personality style, including interpersonal sensitivity, is a more stable construct and predicts proneness to depression and common mental disorders. Building on our previous work, the objective of the present study is to examine the association between specific dimensions of prenatal interpersonal sensitivity and postpartum mother-infant relationship quality in the context of prenatal depression symptoms. We analysed data from the Avon Longitudinal Study of Parents and Children (ALSPAC). Interpersonal sensitivity and depression symptoms were measured at 18 weeks gestation. In a randomly selected 10% subsample of the ALSPAC cohort, mother-infant interaction was measured through standard observation at 12 months postpartum. For the subsample that had complete data at all time points (n = 812), multiple regression models examined prenatal interpersonal sensitivity dimensions predicting postpartum mother-infant relationship quality, accounting for depression symptoms. Two dimensions of maternal interpersonal sensitivity modestly predicted mother-infant relationship quality at 12 months postpartum and remained robust when we controlled for depression symptoms. The interpersonal sensitivity subscales were significantly associated with prenatal depression symptoms but more consistently and robustly predicted postnatal mother-infant interaction quality. The inclusion of personality measures may strengthen prenatal mental health assessment to identify vulnerability to suboptimal mother-infant relationship quality.

Associations between prenatal maternal mental health indices and mother-infant relationship quality 6 to 18 months' postpartum: A systematic review

Maternal mental disorders can significantly impact on children's psychosocial and psychological development, incurring substantial ongoing economic and personal costs. A key mediating mechanism is mother-infant relationship quality (MIRQ). Research studies and perinatal mental health screening initiatives have predominantly focused on depressive symptoms and perinatal depression as predictors of MIRQ. While maternal depression is associated with suboptimal MIRQ, the findings have not been consistent. Personality characteristics are associated with parenting and proneness to depression, presenting a potential addition to prenatal mental health assessment. We conducted a systematic review of studies that have examined the link between prenatal depressive symptoms and/or personality characteristics with postnatal MIRQ. Our findings suggest that both maternal personality traits and depressive symptoms measured in early pregnancy are associated with postnatal MIRQ. A measure of personality characteristics may enhance prenatal mental health assessment, affording opportunities for targeted intervention commencing in pregnancy to improve MIRQ, parenting, maternal mental health outcomes, and infant psychosocial and psychological development, and thereby contributing to the reduction of human and economic cost burdens.

Mothers' and fathers' observed interaction with preschoolers: Similarities and differences in parenting behavior in a well-resourced sample

Parenting behavior is a key factor in children's socio-emotional development. However, little is known about similarities and differences in maternal and paternal parenting behavior, as most studies have focused on mothers. The present study investigated similarities and differences in mothers' and fathers' parenting behavior during observed free play with their preschool children, in a Danish well-resourced sample. We examined differences in mean scores and associations between mothers' and fathers' sensitivity, intrusiveness and limit-setting assessed with the Coding Interactive Behavior instrument. Additionally, we conducted confirmatory factor analysis to test the model-fit between the measurement model and parental data. Exploratory factor analysis was conducted to investigate if maternal and paternal factor structures replicated the three parenting constructs, and to explore if certain parenting behaviors seemed specifically related to either mothering or fathering. Participants included 52 mothers, 41 fathers and their 5-year old children. Similar mean scores were found for mothers and fathers on all parenting constructs. Maternal and paternal parenting behavior were not correlated. Confirmatory factor analysis revealed a poor model-fit. For both mothers and fathers, latent factors related to sensitivity, intrusiveness and limit-setting emerged, which indicated that the Coding Interactive Behavior instrument was suitable for assessment of both maternal and paternal sensitivity, intrusiveness and limit-setting. However, item loadings suggested that the instrument assessed maternal sensitivity more accurately than paternal sensitivity in our sample. Two additional factors were retrieved for fathers, i.e. paternal performance and challenging behavior, and paternal teaching behavior. This finding may suggest that additional parenting constructs need to be developed for researchers to be able to thoroughly investigate similarities and differences in mothers' and fathers' parenting behavior. Despite difference in factor structure, we did not identify behaviors solely related to mothering or to fathering.

Adult attachment representations and depressive symptoms: A meta-analysis

BACKGROUND

Attachment theory has long argued that insecure and disorganized attachment representations are associated with vulnerability to psychopathology in general, and depressive symptoms in particular. However, studies assessing the link between insecure and disorganized attachment and depressive symptoms report inconsistent results. The primary aim of this meta-analysis was to examine the extent to which adult attachment representations are associated with depressive symptoms.

METHODS

We conducted a literature search for published studies using PsycINFO, MEDLINE, and ProQuest in March 2017, identifying 55 samples (N = 4,386). Eligible studies assessed depression using a well-validated self-report or clinical diagnostic measure of depression and attachment using the Adult Attachment Interview.

RESULTS

Results demonstrated that insecure individuals had higher levels of depression than secure-autonomous individuals (d = 0.21, 95% CI [0.08-0.33]). Specifically, insecure-preoccupied individuals (d = 0.48, 95% CI [0.30-0.65]), but not insecure-dismissing individuals (d = 0.09, 95% CI [-0.03-0.22]), exhibited significantly more depressive symptoms than the secure-autonomous individuals. Additionally, unresolved adults had higher levels of depression than adults with organized attachment classifications (d = 0.29, 95% CI [0.13-0.44]).

LIMITATIONS

Due to the nature of the studies reviewed, causal inferences regarding the links found between adult attachment representations and depressive symptoms may not be drawn. Further, the aggregate effect sizes do not solely reflect the magnitude of the association between attachment representations and clinically-diagnosed major depressive disorder.

CONCLUSIONS

The results of this meta-analysis have important conceptual and practical implications for attachment-based prevention and intervention efforts, as they suggest that attachment representations, specifically insecure-preoccupied and unresolved, are associated with depressive symptoms in adulthood. Future research using longitudinal and intervention-based designs should examine the extent to which insecure-preoccupied and unresolved attachment lead to increased depressive symptoms, as well as the mechanisms by which these attachment patterns across the life span may increase vulnerability to depressive symptoms in adulthood.

Stolen motherhood-case study of postpartum depression

Aim: The objective was to analyze the case of postpartum depression complicated with extended suicide attempt.

Method: The analysis of clinical case and medical history.

Results: In 25-year-old patient, two weeks after childbirth, postpartum depression episode occurred. In the further course of illness psychotic symptoms (delusions, mood disorders), suicidal and infanticide thoughts emerged. Four weeks after childbirth, the patient killed her baby and took an unsuccessful suicidal attempt. Based on medical records, several risk factors of postpartum depression were identified: 1. obstetric and child-related risk factors: Caesarean section, premature birth, obstetric complications during pregnancy, infant’s difficult temper, difficulties related to breastfeeding; 2. psychological risk factors: baby blues, high anxiety level during pregnancy, high level of stress related to child care.

Conclusions: Psychoeducation of women during pregnancy, including their families, is an extremely crucial element of postpartum depression prevention. It is also necessary to raise awareness among healthcare professionals who have frequent contact with mothers after childbirth: midwives, gynaecologists and paediatricians.