Parental Sensitivity and Responsiveness as Mediators Between Postpartum Mental Health and Bonding in Mothers and Fathers

A family perspective for the mechanism of parent-child conflict on maternal anxiety in Chinese children with autism

BACKGROUND

Mothers of children with autism reported higher levels of anxiety than mothers of typical children. This study revealed the relationship between parent-child conflict, children's problem behavior, parenting stress, and maternal anxiety from the perspective of the relationship within the family.

METHODS

The State-Trait Anxiety Inventory (STAI) and Caregiver Strain Questionnaire (CGSQ) were used to measure maternal anxiety and parenting stress respectively from 102 mothers of children with autism. We also collected information on parent-child relationships and children's problem behaviors by using the Child-Parent Relationship Scale (CPRS) and Conners Parent Symptom Questionnaire (PSQ).

RESULTS

Parent-child conflict positively predicted state and trait anxiety in mothers of children with autism. The severity of children's psychosomatic disorders fully mediated the positive association between parent-child conflict and state-trait anxiety in mothers of children with autism. Parenting stress significantly moderated the impact of parent-child conflict on maternal state anxiety and trait anxiety.

CONCLUSION

In the case of children with autism spectrum disorders, parent-child conflict can directly affect maternal anxiety levels, especially when mothers have low levels of parenting stress. Parent-child conflict can also affect children's problem behaviors and thus indirectly affect maternal anxiety. Therefore, this study is of great significance for the alleviation of anxiety of mothers of autistic children and the family intervention for the early rehabilitation of autistic children.

Development of the Parent-to-Infant Bonding Scale: Validation in Swedish Mothers and Fathers in Community and Clinical Contexts

Valid measurement instruments are needed to investigate the impact of parental bonding on child health development. The aim was to develop and validate a self-report questionnaire, the Parent-to-Infant Bonding Scale (PIBS) to measure bonding in both mothers and fathers. Internal consistency and construct validity were analysed using data from Swedish parents from both clinical (N = 182), and community (N = 122) population samples. Overall, good or acceptable internal consistency of the PIBS appeared. Convergent validity (against the Postpartum Bonding Questionnaire, analysed in the clinical sample) and discriminant validity (against the mental health constructs of depressive symptoms and anxiety) were demonstrated. The results support the PIBS as a measure of maternal and paternal bonding in community and clinical populations. Assessments of criterion validity in these populations are desirable. The similarities in PIBS measurement properties between the parent groups suggest its usefulness for comparisons between mothers and fathers, and for future investigations of unique and interactive impacts of maternal and paternal bonding on child outcomes using community and clinical cohorts.

Assessment of Postpartum Stress Using the Maternal Postpartum Stress Scale (MPSS) in Spanish Women

Although scales that evaluate postpartum stress exist, they lack specificity in maternal postpartum stress. The MPSS was created because there was a need to assess maternal stress during the postpartum stage. The introduction of the MPSS has enriched the evaluation tools for postpartum stress and has helped understand maternal stress at various postpartum time points and identify women at high risk for postpartum stress during this period. The aim was to translate the MPSS into Spanish and study its psychometric properties. Postpartum women (N = 167) with a mean age of 34.26 (SD = 4.71) were involved in this study. In addition to the MPSS, a battery of instruments was administered: a demographic sheet, the Birth Satisfaction Scale-Revised (BSS-R) and the Edinburgh Postnatal Depression Scale (EPDS). The MPSS data were analyzed, checking item communality first. As a result, three items showed unsatisfactory communality values (h2 < 0.40). Confirmatory Factor Analysis was conducted, comparing factor models using the full pool of MPSS items or the version without items with unacceptable communality. As a result, the original three-factor structure was endorsed on the Spanish MPSS, with better fit indices when removing items with low communality (RMSEA = 0.067, CFI = 0.99, TLI = 0.99). The reliability of this version was satisfactory (ω = 0.93). Finally, group comparisons for some perinatal variables were performed, showing no significant differences between groups of interest (p = 0.05 and above). To conclude, the MPSS will contribute to the existing literature, having a wider capacity to assess perinatal mental health difficulties in Spanish-speaking populations.

Maternal stressors and maternal bonding among immigrant and Refugee Arab Americans resettled in the United States

Maternal bonding with the infant and child is essential for the growth and development of the child, and for establishing the relationship between them. The effect of maternal acculturative stress, trauma, and depressive symptoms on maternal bonding has been established in nonimmigrant populations, but not in immigrant and refugee populations. In this study, we aimed to (1) examine the relationships among maternal psychosocial stress (acculturative stress, posttraumatic stress), depressive symptoms, and maternal bonding, and (2) examine whether maternal depression is a mediator of the relationship between maternal psychosocial stress and maternal bonding among a sample of Arab American immigrant and refugee mothers. Using a cross-sectional design, we recruited 78 immigrant and refugee Arab American mothers. Acculturative stress was correlated with posttraumatic stress (ρ = 0.56, p < 0.001), depressive symptoms (ρ = 0.48, p < 0.001), and bonding impairment (ρ = 0.39, p < 0.001). Posttraumatic stress and depressive symptoms were also correlated with maternal bonding impairment (ρ = 0.39, and 0.52, respectively, p < 0.001 for both). The effect of maternal psychosocial stress on maternal bonding was mediated by depressive symptoms. We concluded that higher levels of acculturative stress and posttraumatic stress were associated with higher levels of depressive symptoms and impairment of maternal bonding. Additionally, maternal depressive symptoms mediated the relationship between maternal stress and bonding. Assessing the stressors and depressive symptoms of immigrant and refugee mothers is key to avoiding negative effects on child outcomes.

The concept analysis of parent-infant bonding during pregnancy and infancy: a systematic review and meta-synthesis

INTRODUCTION

Despite the emerging body of literature on mother-to-infant bonding and the associated variables, there are various definitions of bonding construct. Also, there is a lack of a comprehensive conceptual framework of antecedents and consequences of bonding that would guide empirical work.

OBJECTIVE

Aim of the study was to provide a systematic review and synthesis of concept analysis studies on maternal-foetal, mother-infant, or father-infant bonding.

METHOD

A systematic search was performed in PubMed, EBSCOHost (including PsycINFO), ProQuest, and CINAHL. In addition, a hand search was conducted. Papers were eligible for inclusion if they conducted concept analyses on mother or father to foetus/infant bonding. A qualitative meta-synthesis was applied to synthesise the findings.

RESULTS

Eight papers on concept analyses were eligible for inclusion. In meta-synthesis, six aspects of parent-to-(unborn) child bonding emerged, including direction, domain, process, timing, endurance, and parental gender. Defining attributes are (i) a close relationship, (ii) filled with positive parental affection, (iii) manifested during pregnancy as monitoring foetal development and behaviour and after childbirth in proximity and interaction. Antecedents, affecting factors, and consequences of the parent-child bonding have been summarised.

CONCLUSION

Parent-infant bonding refers to an emotional, behavioural, cognitive, and neurobiological tie of the parent to the (unborn) child, as a process from intention to have a child throughout infancy. This is a parental-driven process which can continue to evolve throughout child's and parent's life, characterised as enduring, committed, and engaged. Based on meta-synthesis, a conceptual structure of parent-infant bonding has been provided, which needs further empirical testing.

The first three years: The association of early postpartum depressive symptoms with infant and toddler development

BACKGROUND

The influence of postpartum depression (PPD) on child development has been a source of professional interest and practical relevance.

OBJECTIVE

This study investigated the association of early PPD symptoms with developmental domains.

DESIGN AND METHOD

This historical cohort study included 574,282 children attending Mother Child Healthcare Centers in Israel from January 1, 2014 to July 31, 2020, who underwent at least one developmental screening examination by public health nurses up to age 36 months, and whose mothers completed the Edinburgh Postnatal Depression Scale (EPDS) postnatally. Developmental milestone tasks included four domains: fine and gross motor, language/communication, and social/behavioral.

RESULTS

The rate of failure to complete age-appropriate tasks was higher among children whose mothers had scored ≥ 10 on the EPDS on the majority of tasks in every domain.

DISCUSSION

This large population-based study has demonstrated the association between early maternal postnatal depressive symptoms and failure to meet developmental milestones across domains, until three years. Recommendations for practice focus on the mother, the child, and health policy.

Psychosocial Factors and Parent-Infant Bonding

BACKGROUND

Parent-infant bonding plays a significant role in promoting the psychosocial well-being of the child. This study aimed to examine the relationships between family sense of coherence, marital satisfaction, depressive symptoms, and parent-infant bonding among Chinese parents at 6 weeks postpartum.

METHODS

A secondary data analysis was conducted of an intervention study for postnatal depression. The participants were Chinese parents recruited from public hospitals. Family sense of coherence, marital satisfaction, depressive symptoms, and parent-infant bonding were measured using the Family Sense of Coherence Scale, the Dyadic Adjustment Scale, the Edinburgh Postnatal Depression Scale, and the Postpartum Bonding Questionnaire, respectively. Path analysis was performed on data collected from the control group (n = 211) at 6 weeks postpartum.

RESULTS

Less impairment of mother-infant bonding at 6 weeks postpartum was found among mothers who had a stronger family sense of coherence and lower levels of depressive symptoms. Less impairment of father-infant bonding at 6 weeks postpartum was found among fathers who had greater marital satisfaction and family sense of coherence and fewer depressive symptoms. The mothers' levels of family sense of coherence, marital satisfaction, and parent-infant bonding were closely related to those of their partners.

CONCLUSION

The study highlights the importance of developing culturally appropriate interventions that focus on strengthening family sense of coherence, enhancing marital satisfaction, and reducing depressive symptoms in both parents to promote the quality of parent-infant bonding at early postpartum.

Paternal bonding in pregnancy and early parenthood: a qualitative study in first-time fathers

The birth of an infant marks a period of profound change in first-time parents. Parental love and warmth, however, already begin to develop during pregnancy. Also for fathers, the development of bonding to the infant may be a unique process. The current qualitative study aimed to explore views and experiences of first-time fathers on the origins and development of paternal bonding during pregnancy and early childhood. In total, 30 in-depth semi-structured interviews were conducted with expectant fathers (second or third trimester of pregnancy; n = 10) and fathers of infants (0-6 months postpartum; n = 11) and toddlers (2-3 years of age; n = 9). Two major themes were uncovered from the data: feelings of bonding and facilitators of bonding. The first theme was supported with three subthemes: 1) from abstract to concrete, 2) positive emotions, and 3) uncertainties and worries. The second theme, facilitators of bonding, was supported with four subthemes: 1) experiencing the foetus, 2) meeting the child, 3) interaction, and 4) communication. Similar to previous studies, our results suggested that, in most fathers, paternal bonding originates in pregnancy and that it evolves over time. Seeing or feeling the child, both during pregnancy and postpartum, as well as interacting or communicating with the child, appears to facilitate fathers' feelings of bonding. Involving fathers in pregnancy, childbirth, and parenting may be essential for their bonding process.

Dyadic analyses on the prospective association between birth experience and parent-child-bonding: The role of postpartum depression, anxiety, and childbirth-related posttraumatic stress disorder

OBJECTIVE

Negative birth experiences are associated with postpartum mental health difficulties in parents. However, research considering the long-term impact of a negative birth experience on parent-child-bonding and the interdependence between parents is rare. This study aimed to investigate actor as well as partner effects for the association between parents' birth experience and parent-child-bonding and whether this association is mediated by postpartum psychiatric symptoms.

METHOD

A community sample of couples (N = 743) completed questionnaires during pregnancy, 2, and 14 months after birth.

RESULTS

Applying Actor-Partner Interdependence Mediation Models, structural equation modeling showed that parents' own negative birth experience predicted a poorer bond to their child 14 months postpartum. Compared to mothers, this association was twice as strong for partners and was mediated by symptoms of postpartum depression (mothers and partners), anxiety (partners), and childbirth-related posttraumatic stress disorder (mothers). Negative birth experiences of one parent were not related to the other parent's bonding with the child.

CONCLUSION

Results underline the importance of parents' positive birth experience for their postpartum mental health and secure bond to their child. The other parent's birth experience or postpartum mental health does not seem to affect one's own bond to the child in the long term.

Narrative Review of Use and Continued Relevance of the Maternal Infant Responsiveness Instrument

BACKGROUND

The Maternal Infant Responsiveness Instrument (MIRI) was developed in 2002 to measure a critical aspect of maternal-infant health. The objective of this analysis was to examine use, results, and continued relevance of the MIRI 20 years after its creation.

METHODS

For the completion of this narrative review, 5 electronic databases were accessed using key search terms. Inclusion criteria were English-language, peer-reviewed research using the MIRI. Hand searches of reference lists were conducted. Five authors performed screening, data extraction, appraisal, and summarized findings.

RESULTS

Fifteen studies were included. All studies reported an internal consistency of α > 0.70 for the MIRI. Positive correlations were reported with self-efficacy, infant temperament, and life satisfaction. Inverse relationships were reported with stress, depression, and experiential avoidance. Depressive symptomatology, life satisfaction, self-esteem, self-efficacy, and previous childcare experience were predictors of maternal responsiveness.

DISCUSSION

Maternal well-being (postpartum depression and stress) can affect maternal responsiveness. Given the pervasive disparities in maternal health and well-being, it is important to have reliable measures of the effects of those disparities. The MIRI, a valid and reliable measure, may be useful for assessing the effectiveness of interventions designed to improve infant and maternal well-being.

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.

Predictors of Parent-Infant Bonding Among Postpartum Chinese Mothers and Fathers

INTRODUCTION

The emotional bond that parents feel with their child is a crucial determinant of the child's psychosocial well-being and future development. Few studies have evaluated the predictive roles of depressive symptoms, relationship satisfaction, and family sense of coherence in the quality of parent-infant bonding for both parents during the perinatal period. The aim of this study was to determine the predictive effects of depressive symptoms, relationship satisfaction, and family sense of coherence during pregnancy; changes thereof from pregnancy to 6 weeks postpartum; and the partner's bond with the infant on the quality of parent-infant bonding at 6 weeks postpartum in Chinese mothers and fathers.

METHODS

This was a secondary analysis of data from an intervention study. A convenience sample of 231 Chinese childbearing couples was recruited from the antenatal clinics of public hospitals in Hong Kong. Parent-infant bonding, depressive symptoms, relationship satisfaction, and family sense of coherence were measured using the Postpartum Bonding Questionnaire, Edinburgh Postnatal Depression Scale, Dyadic Adjustment Scale, and Family Sense of Coherence Scale during pregnancy and at 6 weeks postpartum.

RESULTS

The findings indicated that higher depressive symptoms during pregnancy and poor partner bonding with the infant were the major predictors of impaired parent-infant bonding at 6 weeks postpartum for both parents. Prenatal relationship satisfaction was not a significant predictor of parent-infant bonding at 6 weeks postpartum for either parent. Prenatal family sense of coherence was a strong predictor of parent-infant bonding for mothers but not for fathers.

DISCUSSION

The findings highlight the significant effects of depressive symptoms, family sense of coherence, and the partner's bond with the infant on parent-infant bonding during the perinatal period. Comprehensive early prenatal programs that promote parental well-being and strengthen family sense of coherence should be integrated into existing perinatal services to promote the quality of parent-infant bonding for both parents.

Intersubjectivity as an antidote to stress: Using dyadic active inference model of intersubjectivity to predict the efficacy of parenting interventions in reducing stress—through the lens of dependent origination in Buddhist Madhyamaka philosophy

Intersubjectivity refers to one person’s awareness in relation to another person’s awareness. It is key to well-being and human development. From infancy to adulthood, human interactions ceaselessly contribute to the flourishing or impairment of intersubjectivity. In this work, we first describe intersubjectivity as a hallmark of quality dyadic processes. Then, using parent-child relationship as an example, we propose a dyadic active inference model to elucidate an inverse relation between stress and intersubjectivity. We postulate that impaired intersubjectivity is a manifestation of underlying problems of deficient relational benevolence, misattributing another person’s intentions (over-mentalizing), and neglecting the effects of one’s own actions on the other person (under-coupling). These problems can exacerbate stress due to excessive variational free energy in a person’s active inference engine when that person feels threatened and holds on to his/her invalid (mis)beliefs. In support of this dyadic model, we briefly describe relevant neuroimaging literature to elucidate brain networks underlying the effects of an intersubjectivity-oriented parenting intervention on parenting stress. Using the active inference dyadic model, we identified critical interventional strategies necessary to rectify these problems and hereby developed a coding system in reference to these strategies. In a theory-guided quantitative review, we used this coding system to code 35 clinical trials of parenting interventions published between 2016 and 2020, based on PubMed database, to predict their efficacy for reducing parenting stress. The results of this theory-guided analysis corroborated our hypothesis that parenting intervention can effectively reduce parenting stress if the intervention is designed to mitigate the problems of deficient relational benevolence, under-coupling, and over-mentalizing. We integrated our work with several dyadic concepts identified in the literature. Finally, inspired by Arya Nagarjuna’s Buddhist Madhyamaka Philosophy, we described abstract expressions of Dependent Origination as a relational worldview to reflect on the normality, impairment, and rehabilitation of intersubjectivity.