Trajectories of illness perceptions in paediatric cancer patients and their parents and associations with health-related quality of life: Results of a prospective-longitudinal study

OBJECTIVE

In paediatric oncology, little is known about trajectories of illness perceptions and their longitudinal associations with health-related quality of life (HRQoL). Therefore, the aim of this study was to investigate changes in illness perceptions in children and parents over a one-year-period and to investigate predictive value of child's and parent's illness perceptions during acute treatment for child's HRQoL 1 year later.

METHODS

N = 65 child-parent-dyads participated in a longitudinal study (retention rate: 80.2%). Children were 4-18 years of age and underwent acute cancer treatment at baseline. Children and parents reported on their own illness perceptions (Illness-Perception-Questionnaire-Revised), as well as on the child's HRQoL (KINDL-R) at baseline and one-year-follow-up. Paired-samples t-tests were calculated to investigate changes over time. A hierarchical multiple regression analysis was performed to investigate predictive value of child's and parent's illness perceptions for child's HRQoL.

RESULTS

Child's HRQoL t(63) = -6.73, p < 0.001, their perceptions of coherence (i.e. understanding; t(54) = -2.36, p = 0.022) and consequences of their illness (t(54) = 2.86, p = 0.006), and parent's perception of cyclical trajectory (t(61) = 2.06, p = 0.044) improved from baseline to 1-year-follow-up. All other illness perceptions remained stable. Exploratory post-hoc analyses showed differences in the pattern of change in age-, gender-, and diagnosis-specific subgroups. After controlling for baseline levels of HRQoL, child's perceptions of symptoms and consequences were independent predictors of their HRQoL 1 year later (R2 = 0.396, F(2,52) = 10.782, p < 0.001), whereas no parent's illness perceptions added predictive value.

CONCLUSION

In paediatrics, child's and parent's illness perceptions should be assessed. Our findings highlight the importance of illness perceptions as potential modifiable variables in interventions to improve child's HRQoL.

The puppet interview to measure illness perceptions in paediatric oncology: development and psychometric properties in acute treatment and follow-up care

BACKGROUND

Illness perceptions comprise assumptions about symptoms, timeline, consequences, controllability, and emotional responses to an illness. Recent evidence shows that illness perceptions are associated with coping and well-being. So far, assessment in paediatric care was based on parental report only, since no instrument for the direct assessment of young children was available. We aim to describe the development (incl. indication and contraindication) of an innovative puppet interview to assess illness perceptions in children with cancer from the age of four years. Moreover, we investigate longitudinal trajectories and examine psychometric properties.

METHODS

The puppet interview was developed based on the Illness-Perception-Questionnaire-Revised and the Berkeley-Puppet-Interview. Longitudinal trajectories and psychometric properties were examined in a sample of patient-parent dyads (N = 75) in a prospective longitudinal study in acute treatment with a 1-year follow-up (study 1: nT1 = 41, nT2 = 27) and in a cross-sectional study in follow-up care (study 2, n = 34).

RESULTS

The puppet interview is comprehensible and well-received by children in acute treatment and follow-up care. There were significant differences in perceptions of a chronic timeline (U = 301.00, p = .008), consequences (U = 251.00, p = .008), and emotional representations (U = 244.50, p = .020) between children in acute treatment and children in follow-up care. Over the course of one year, children in acute treatment perceived more symptoms as part of their illness (MT1 = 3.6, SDT1 = 2.9, MT2 = 4.5, SDT2 = 3.1, n = 27, Z = -2.603, p = .009). We found expected intercorrelations between illness perception dimensions, e.g. between perception of consequences and emotional representations (rτ = .27, p = .033), and between perception of a chronic timeline and consequences (rτ = .38, p = .001). Moreover, we found confirming results regarding construct validity, as child's perceptions of symptoms correlated with their self-rated HRQoL (rτ = -.32, padj. = .014). Also parent-rated subscale on illness-specific aspects of child's HRQoL correlated with child's perception of symptoms (rτ = -.26, padj. = .016), cyclicity (rτ = -.28, padj. = .016), and consequences (rτ = -.34, padj. = .014). Acceptable internal consistency was shown for the dimensions timeline-acute/chronic and personal control.

CONCLUSIONS

Parental report can now be complemented by a self-report of illness perceptions in children aged four years and older. This will allow for the further adaptation of medical and psychosocial care during and after acute cancer treatment.

TRIAL REGISTRATION

The study has been pre-registered at the German Clinical Trials Register (registered 30/06/2020; DRK-S00022034) and at the Open Science Foundation ( https://osf.io/7xr6z ).

Young people at risk for developing bipolar disorder: Two-year findings from the multicenter prospective, naturalistic Early-BipoLife study

Early identification and intervention of individuals with an increased risk for bipolar disorder (BD) may improve the course of illness and prevent long‑term consequences. Early-BipoLife, a multicenter, prospective, naturalistic study, examined risk factors of BD beyond family history in participants aged 15-35 years. At baseline, positively screened help-seeking participants (screenBD at-risk) were recruited at Early Detection Centers and in- and outpatient depression and attention-deficit/hyperactivity disorder (ADHD) settings, references (Ref) drawn from a representative cohort. Participants reported sociodemographics and medical history and were repeatedly examined regarding psychopathology and the course of risk factors. N = 1,083 screenBD at-risk and n = 172 Ref were eligible for baseline assessment. Within the first two years, n = 31 screenBD at-risk (2.9 %) and none of Ref developed a manifest BD. The cumulative transition risk was 0.0028 at the end of multistep assessment, 0.0169 at 12 and 0.0317 at 24 months (p = 0.021). The transition rate with a BD family history was 6.0 %, 4.7 % in the Early Phase Inventory for bipolar disorders (EPIbipolar), 6.6 % in the Bipolar Prodrome Interview and Symptom Scale-Prospective (BPSS-FP) and 3.2 % with extended Bipolar At-Risk - BARS criteria). In comparison to help-seeking young patients from psychosis detection services, transition rates in screenBD at-risk participants were lower. The findings of Early-BipoLife underscore the importance of considering risk factors beyond family history in order to improved early detection and interventions to prevent/ameliorate related impairment in the course of BD. Large long-term cohort studies are crucial to understand the developmental pathways and long-term course of BD, especially in people at- risk.

Prediction of estimated risk for bipolar disorder using machine learning and structural MRI features

BACKGROUND

Individuals with bipolar disorder are commonly correctly diagnosed a decade after symptom onset. Machine learning techniques may aid in early recognition and reduce the disease burden. As both individuals at risk and those with a manifest disease display structural brain markers, structural magnetic resonance imaging may provide relevant classification features.

METHODS

Following a pre-registered protocol, we trained linear support vector machine (SVM) to classify individuals according to their estimated risk for bipolar disorder using regional cortical thickness of help-seeking individuals from seven study sites (N = 276). We estimated the risk using three state-of-the-art assessment instruments (BPSS-P, BARS, EPIbipolar).

RESULTS

For BPSS-P, SVM achieved a fair performance of Cohen's κ of 0.235 (95% CI 0.11-0.361) and a balanced accuracy of 63.1% (95% CI 55.9-70.3) in the 10-fold cross-validation. In the leave-one-site-out cross-validation, the model performed with a Cohen's κ of 0.128 (95% CI -0.069 to 0.325) and a balanced accuracy of 56.2% (95% CI 44.6-67.8). BARS and EPIbipolar could not be predicted. In post hoc analyses, regional surface area, subcortical volumes as well as hyperparameter optimization did not improve the performance.

CONCLUSIONS

Individuals at risk for bipolar disorder, as assessed by BPSS-P, display brain structural alterations that can be detected using machine learning. The achieved performance is comparable to previous studies which attempted to classify patients with manifest disease and healthy controls. Unlike previous studies of bipolar risk, our multicenter design permitted a leave-one-site-out cross-validation. Whole-brain cortical thickness seems to be superior to other structural brain features.

Exploratory study of ultraviolet B (UVB) radiation and age of onset of bipolar disorder

BACKGROUND

Sunlight contains ultraviolet B (UVB) radiation that triggers the production of vitamin D by skin. Vitamin D has widespread effects on brain function in both developing and adult brains. However, many people live at latitudes (about > 40 N or S) that do not receive enough UVB in winter to produce vitamin D. This exploratory study investigated the association between the age of onset of bipolar I disorder and the threshold for UVB sufficient for vitamin D production in a large global sample.

METHODS

Data for 6972 patients with bipolar I disorder were obtained at 75 collection sites in 41 countries in both hemispheres. The best model to assess the relation between the threshold for UVB sufficient for vitamin D production and age of onset included 1 or more months below the threshold, family history of mood disorders, and birth cohort. All coefficients estimated at P ≤ 0.001.

RESULTS

The 6972 patients had an onset in 582 locations in 70 countries, with a mean age of onset of 25.6 years. Of the onset locations, 34.0% had at least 1 month below the threshold for UVB sufficient for vitamin D production. The age of onset at locations with 1 or more months of less than or equal to the threshold for UVB was 1.66 years younger.

CONCLUSION

UVB and vitamin D may have an important influence on the development of bipolar disorder. Study limitations included a lack of data on patient vitamin D levels, lifestyles, or supplement use. More study of the impacts of UVB and vitamin D in bipolar disorder is needed to evaluate this supposition.

Machine Learning Prediction of Estimated Risk for Bipolar Disorders Using Hippocampal Subfield and Amygdala Nuclei Volumes

The pathophysiology of bipolar disorder (BD) remains mostly unclear. Yet, a valid biomarker is necessary to improve upon the early detection of this serious disorder. Patients with manifest BD display reduced volumes of the hippocampal subfields and amygdala nuclei. In this pre-registered analysis, we used structural MRI (n = 271, 7 sites) to compare volumes of hippocampus, amygdala and their subfields/nuclei between help-seeking subjects divided into risk groups for BD as estimated by BPSS-P, BARS and EPIbipolar. We performed between-group comparisons using linear mixed effects models for all three risk assessment tools. Additionally, we aimed to differentiate the risk groups using a linear support vector machine. We found no significant volume differences between the risk groups for all limbic structures during the main analysis. However, the SVM could still classify subjects at risk according to BPSS-P criteria with a balanced accuracy of 66.90% (95% CI 59.2-74.6) for 10-fold cross-validation and 61.9% (95% CI 52.0-71.9) for leave-one-site-out. Structural alterations of the hippocampus and amygdala may not be as pronounced in young people at risk; nonetheless, machine learning can predict the estimated risk for BD above chance. This suggests that neural changes may not merely be a consequence of BD and may have prognostic clinical value.

Telepsychiatry in an Era of Digital Mental Health Startups

PURPOSE OF REVIEW

Telepsychiatry practiced by psychiatrists is evidence-based, regulated, private, and effective in diverse settings. The use of telemedicine has grown since the COVID-19 pandemic as people routinely obtain more healthcare services online. At the same time, there has been a rapid increase in the number of digital mental health startups that offer various services including online therapy and access to prescription medications. These digital mental health firms advertise directly to the consumer primarily through digital advertising. The purpose of this narrative review is to contrast traditional telepsychiatry and the digital mental health market related to online therapy.

RECENT FINDINGS

In contrast to standard telepsychiatry, most of the digital mental health startups are unregulated, have unproven efficacy, and raise concerns related to self-diagnosis, self-medicating, and inappropriate prescribing. The role of digital mental health firms for people with serious mental illness has not been determined. There are inadequate privacy controls for the digital mental health firms, including for online therapy. We live in an age where there is widespread admiration for technology entrepreneurs and increasing emphasis on the role of the patient as a consumer. Yet, the business practices of digital mental health startups may compromise patient safety for profits. There is a need to address issues with the digital mental health startups and to educate patients about the differences between standard medical care and digital mental health products.

[Screening to Assess Psychosocial Follow-up Needs in Pediatric Oncology (NPO-11) for Self- and Parent-Report]

BACKGROUND

Children diagnosed with cancer are at increased risk for the development of psychosocial problems. Currently, no qualitative and quantitative tests are available to measure their need for psychosocial follow-up care. The NPO-11 screening was developed to tackle this issue.

PATIENTS AND METHODS

11 dichotomous items were generated to measure self- and parent-reported fear of progression, sadness, avolition, self-esteem problems, school and vocational problems, somatic complaints, emotional withdrawal, social disintegration, pseudo-maturity, parent-child conflicts, and parental conflicts. Data from N=101 parent-child dyads were obtained to validate the NPO-11.

RESULTS

Self- and parent-reported items showed few missing values and response frequencies without floor or ceiling effects. Inter-rater reliability was fair to moderate. Factor analysis confirmed a single-factor model and therefore an overall NPO-11 sum score. Self- and parent-reported sum scores had sufficient to good reliability and large correlations with health-related quality of life.

CONCLUSION

The NPO-11 is a screening for psychosocial needs in pediatric follow-up care with good psychometric properties. It may help to plan diagnostics and interventions for patients transitioning from in-patient to out-patient treatment.

The impact of mode of delivery on parent-infant-bonding and the mediating role of birth experience: a comparison of mothers and fathers within the longitudinal cohort study DREAM

BACKGROUND

The association between mode of delivery (MOD) and parent-infant-bonding has only been studied in mothers and findings have been inconclusive. The aim of this study was to prospectively investigate how MOD relates to postpartum parent-infant-bonding in both mothers and fathers and whether these associations are mediated by birth experience.

METHODS

This study is part of the prospective cohort study "Dresden Study on Parenting, Work, and Mental Health" (DREAM). Our sample comprised N = 1,780 participants who completed quantitative questionnaires during pregnancy as well as 8 weeks and 14 months postpartum. MOD was dummy coded, contrasting spontaneous vaginal delivery against vaginal delivery induced by drugs, operative vaginal delivery, planned, and unplanned cesarean section. Parent-infant bonding and birth experience were assessed using validated scales. A moderated mediation analysis based on ordinary least square (OLS) regression and bootstrapped estimates was conducted, considering relevant confounding variables.

RESULTS

Compared to spontaneous vaginal delivery, all categories of MOD predicted more negative birth experiences in both parents. A more positive birth experience predicted stronger parent-infant-bonding at 8 weeks, but not at 14 months postpartum. Mothers who delivered via cesarean section (planned or unplanned) reported stronger parent-infant-bonding at 8 weeks and 14 months postpartum. In fathers, only unplanned cesarean section was associated with stronger parent-infant-bonding at 8 weeks postpartum. At 8 weeks postpartum, birth experience mediated the association between a vaginal delivery induced by drugs and a planned cesarean section and mother-infant-bonding and between a vaginal delivery induced by drugs, an operative vaginal delivery, and planned cesarean section and father-infant-bonding. At 14 months postpartum, birth experience mediated the association between a vaginal delivery induced by drugs, operative vaginal delivery, and planned cesarean section and parent-infant-bonding in both parents.

CONCLUSIONS

The results emphasize the importance of the birth experience for parent-infant-bonding in both mothers and fathers. Further research should address the mechanisms by which parents with an unplanned cesarean section establish stronger parent-infant-bonding compared to parents whose baby was delivered via spontaneous vaginal delivery, despite their overall more negative birth experiences.

Illness perceptions, fear of progression and health-related quality of life during acute treatment and follow-up care in paediatric cancer patients and their parents: a cross-sectional study

BACKGROUND

This study examines the role of illness perceptions and fear of progression (FoP) in paediatric cancer patients and their parents for patient's health-related quality of life (HRQoL), controlling for sociodemographic and medical variables. 4-18-year-old patients in acute treatment or follow-up care and one parent were examined.

METHODS

N = 46 patient-parent dyads in acute treatment and n = 84 dyads in follow-up care completed measures on illness perceptions (Illness-Perceptions-Questionnaire for 12-18-year-old patients and parents or as age-adapted puppet interview for 4-11-year-old patients) and FoP (Fear-of-Progression-Questionnaire for 7-18-year-old patients and parents). Patients also completed the KINDL-R to measure HRQoL. Hierarchical multiple regression analyses were calculated.

RESULTS

In acute treatment, patient's perceptions of symptoms and cyclicity of their illness explained variation in their HRQoL in addition to sociodemographic and medical variables. In follow-up care, patient's FoP and parent's perception of consequences explained additional variation in patient's HRQoL. Overall, sociodemographic and medical variables explained less variation in HRQoL in follow-up care than in acute treatment.

CONCLUSIONS

Our results stress the importance of psychological factors for the well-being of paediatric cancer patients, particularly in follow-up care, where sociodemographic and medical variables play a lesser role. We recommend screening for illness perceptions and FoP during and after acute treatment to support patients and parents. Furthermore, standardized interventions focussed on changing maladaptive illness perceptions should be developed and evaluated. As parents' perceptions, thoughts, and feelings may also play an important role for the well-being of the patients, interventions should be family-focussed and include parents. Trial registration The study has been pre-registered at the German Clinical Trials Register (registered 30/06/2020; DRKS00022034) and at the Open Science Framework ( https://osf.io/3uwrx ).

Die Bedeutung peripartaler mütterlicher Angst- und depressiver Störungen für die frühkindliche Entwicklung

Zusammenfassung. Theoretischer Hintergrund: Aktuelle Studien zeigen spezifische Zusammenhänge von peripartalen psychischen Störungen und kindlichen Entwicklungsauffälligkeiten. Fragestellung: Haben Kinder von Müttern mit einer peripartalen Angst- oder depressiven Störung ein erhöhtes Risiko für (visuo–)‌motorische, sprachliche und kognitive Entwicklungsauffälligkeiten? Methode: In der prospektiven MARI-Studie ( N = 306) wurden peripartale psychische Störungen mit dem CIDI-V in jedem Schwangerschaftstrimester sowie 2, 4 und 16 Monate nach der Geburt erhoben. Die kindliche Entwicklung wurde mit dem Neuropsychologischen Entwicklungs-Screening im Alter von 4 ( N = 263) und 16 Monaten ( N = 241) erfasst. Ergebnisse: Maternale depressive Störungen vor der Schwangerschaft waren negativ mit der visuellen Entwicklung (4 Monate; OR = 3.3) und der Haltungs- und Bewegungssteuerung (16 Monate; OR = 4.4) des Kindes assoziiert. Diskussion: Entwicklungsauffälligkeiten könnten u. a. durch ein verändertes Interaktionsverhalten (z. B. weniger Blickkontakt/Ermutigung) betroffener Mütter begründet sein.

Physical health profile and associated behaviour during the COVID-19 pandemic in patients with bipolar disorder

Introduction

The COVID-19 pandemic has led to an increased psychological strain on public mental health and may impact behavioural, mental, and physical health, presumably with effects on patients with severe mental disorders.

Objectives

This study examines pandemic-related physical and mental health and (compensatory) behavioural changes, in patients with BD as compared to healthy control individuals.

Methods

Physical and mental health and self-reported changes in daily structure and behaviour due to pandemic were assessed using a self-constructed questionnaire and the brief symptom inventory (BSI) from outpatient clinics in Germany, Austria, and Denmark in individuals with BD and a healthy control group.

Results

The present study included 118 individuals with BD and 215 healthy controls. Individuals with BD reported statistically significant higher physical risk burden, increased weight gain, more physical comorbidities, and a decrease in physical activity and they further reported higher rate of COVID-19 testing, had more worries concerning health and experienced more anxiety but less social distancing.

Conclusions

The COVID-19 pandemic seems to have a greater impact on physical health in individuals with BD than in healthy controls. Individuals with BD appear to be having more difficulties compensating their behaviour due to the pandemic which could amplify the effect of risk factors associated with poorer physical health. This highlights the necessity for optimising and targeting the overall treatment of both mental and physical health in patients with BD during periods with far-reaching changes such as COVID-19 pandemic.

Disclosure

No significant relationships.

Annual prevalence estimation of lymphatic malformation with a cutaneous component: observational study of a national representative sample of physicians

Background

Lymphatic malformations (LMs) represent a potentially life-threatening, rare disease of the lymphatic system characterized by development of abnormal vessels, outpouchings, or cysts filled with lymphatic fluid. There are three morphologic types of LMs based on the size of the individual cysts: macrocystic (typically > 2 cm), microcystic (generally < 2 cm), and mixed (includes aspects of both). Macrocystic LMs typically exist beneath the skin and often can involve vascular components and/or organs. Microcystic LMs often have a cutaneous component and clinically present with lymphorrhea, bleeding, pain, itching, malodor, and functional deficits. There are no treatments approved by the US Food and Drug Administration (FDA) for either macrocystic or microcystic lymphatic malformations. The totality of the epidemiologic literature for LM is limited to the incidence of the disease among various birth cohorts. This is the first nationally representative study to estimate the national managed prevalence for patients with microcystic LM or combined LM with a cutaneous component annually across physician specialties likely to manage this condition. We conducted a retrospective observational survey of a nationally representative sample of patient-care physicians in the United States most likely to manage lymphatic malformations with a cutaneous component (LMC). Once recruited, target physicians participated via an electronic questionnaire. We weighted study physician self-estimates of the number of LMC patients treated in the past 12 months to reflect the specialists’ corresponding proportion in the national universe. All patient information was anonymous; no personally identifiable information was collected.

Results

Of the 420 physicians who visited the study website, 316 agreed to be screened and to participate (75.2% participation rate). Our survey results indicated the estimated number of unique annually managed LMC patients by target specialists is 79,920 (CI 66,600–93,250). This number corresponds to managed prevalence of 24.1 LMC patients per 100,000 population (CI 19.6/100,000–28.4/100,000).

Conclusions

The study indicates that while rare, LMC affects a substantial number of people in the US (79,920) who are being managed by one or more specialists. By better understanding the prevalence of people living with LMC who require treatment, efforts to both increase disease awareness and to identify underserved populations in need of potential new treatments can be better focused.

Subjective Birth Experience Predicts Mother–Infant Bonding Difficulties in Women With Mental Disorders

Background

The subjective experience of giving birth to a child varies considerably depending on psychological, medical, situational, relational, and other individual characteristics. In turn, it may have an impact on postpartum maternal mental health and family relationships, such as mother–infant bonding. The objective of the study was to evaluate the relevance of the subjective birth experience (SBE) for mother–infant bonding difficulties (BD) in women with mental disorders.

Methods

This study used data from N = 141 mothers who were treated for postpartum mental disorders in the mother–baby day unit of the Psychosomatic University Clinic in Dresden, Germany. Patients' mental status at admission and discharge was routinely examined using a diagnostic interview (SCID I) and standard psychometric questionnaires (e.g., EPDS, BSI, PBQ). Both, the SBE (assessed by Salmon's Item List, SIL) as well as medical complications (MC) were assessed retrospectively by self-report. The predictive value of SBE, MC, as well as psychopathological symptoms for mother–infant BD were evaluated using logistic regression analyses.

Results

About half of this clinical sample (47.2%) reported a negative SBE; 56.8% of all mothers presented with severe mother–infant BD toward the baby. Mothers with BD showed not only significantly more depressiveness (EPDS: M = 16.6 ± 5.6 vs. 14.4 ± 6.2^*), anxiety (STAI: M = 57.2 ± 10.6 vs. 51.4 ± 10.6^***), and general psychopathology (BSI-GSI: M = 1.4 ± 0.7 vs. 1.1 ± 0.6^**) compared to women without BD, but also a significantly more negative SBE (SIL: M = 79.3 ± 16.2 vs. 61.3 ± 22.9^***). Moreover, the SBE was the most powerful predictor for BD in univariate and multiple logistic regression analyses [OR = 0.96^*** (95% CI 0.94–0.98) vs. OR = 0.96^** (95% CI 0.93–0.98)], even when univariate significant predictors (e.g., current psychopathology and MC during birth) were controlled.

Conclusions

A negative SBE is strongly associated with mother–infant bonding in patients with postpartum mental disorders. It needs to get targeted within postpartum treatment, preferably in settings including both mother and child, to improve distorted mother–infant bonding processes and prevent long-term risks for the newborn. Furthermore, the results highlight the importance of focusing on the specific needs of vulnerable women prior to and during birth (e.g., emotional safety, good communication, and support) as well as individual factors that might be predictive for a negative SBE.

Psychological and behavioral response on the COVID-19 pandemic in individuals with bipolar disorder: A multicenter study

The COVID-19 pandemic affects both mentally healthy and ill individuals. Individuals with bipolar disorder (BD) constitute an especially vulnerable group. A multicentric online study was conducted in Austria, Denmark, and Germany after the first lockdown phase in 2020. In total, 117 healthy controls (HC) were matched according to age and sex to 117 individuals with BD. The survey included the Brief Symptom Inventory-18, Beck Depression Inventory-2, Pittsburgh Sleep Quality Index, and a self-constructed questionnaire assessing COVID-19 fears, emotional distress due to social distancing, lifestyle, and compliance to governmental measures. In individuals with BD, increased symptoms of depression, somatization, anxiety, distress due to social distancing, and poorer sleep quality were related to emotional distress due to social distancing. The correlation between emotional distress due to social distancing and anxiety showed 26% of shared variance in BD and 11% in HC. Negative lifestyle changes and lower compliance with COVID-19 regulatory measures were more likely to be observed in individuals with BD than in HC. These findings underscore the need for ongoing mental health support during the pandemic. Individuals with BD should be continuously supported during periods of social distancing to maintain a stable lifestyle and employ strategies to cope with COVID-19 fears.

Physical and mental health changes in the five years before and five years after childbirth: A population-based panel study in first-time mothers and fathers from Germany

BACKGROUND

The transition to parenthood is characterized by far-reaching changes in life. However, little prospective-longitudinal evidence from general population samples exists on changes of general physical and mental health in the years around the birth of a child among mothers and fathers.

METHODS

Using data from the German Socio-Economic Panel Study (SOEP), this study examined continuous and discontinuous short- and long-term changes of general physical and mental health from five years before until five years after the birth of the first child in women (N = 1,912) and men (N = 1,742). Whether a child was born was assessed annually throughout the study. Physical and mental health was assessed biannually from 2002 to 2018 with the SF-12v2.

RESULTS

Multilevel analyses revealed that women experienced a considerable decrease of physical health during pregnancy, which remitted after delivery. On average, women's mental health increased in the last year before and first year after delivery. These mental health improvements were stronger in older vs. younger mothers and remained largely stable in the years after childbirth. In contrast, little evidence for changes of general physical or mental health in (expectant) fathers was found.

LIMITATIONS

Physical and mental health was assessed with a short questionnaire only (SF-12v2).

CONCLUSIONS

On average, women's mental health tends to improve before and after the birth of the first child. Men seem to be much less affected by the birth of a child than many previous studies suggest.

Progression of externalizing disorders into anxiety disorders: Longitudinal transitions in the first three decades of life

BACKGROUND

There is a notable comorbidity between externalizing disorders and anxiety disorders, which may be explained by the co-occurrence of two prevalent early-onset disorders, by shared vulnerability and risk factors, or as evidence that one disorder group might be causally related to the other.

AIM

To investigate the longitudinal trajectories of externalizing disorders, their interplay with anxiety disorders, and putative predictors for symptom progression in youth.

METHODS

1053 adolescents (14-17 years) from the general population were assessed at baseline and prospectively at 2, 4, and 10-year follow-up using a standardized interview of mental disorders (DIA-X/M-CIDI) to assess "early" (oppositional-defiant disorder, conduct disorder, ADHD) and "late" (antisocial behavior, substance use disorders) externalizing disorders as well as anxiety disorders. Longitudinal associations and predictors for symptom progression were examined using Kaplan-Meier-analyses.

RESULTS

Lifetime prevalence of early externalizing disorders were 9.1% and 6.4% among those with and without any anxiety disorder. A late externalizing disorder was reported by 50.3% of those with an early externalizing disorder and in 26.6% of those with any anxiety disorder. Both early (HR: 1.5, 95%CI: 1.0-2.3) and late externalizing disorders (HR: 2.1, 95%CI: 1.7-2.6) were associated with incident anxiety disorders. Higher parental rejection, lower volitional inhibition, and higher volitional avoidance predicted incident anxiety disorders among those with early externalizing disorders.

DISCUSSION

Early externalizing disorders likely follow a homotypic continuity (to late externalizing disorders) and/or a heterotypic continuity to anxiety disorders, and thus appear as a useful target for prevention and early intervention.

The impact of postpartum obsessive-compulsive symptoms on child development and the mediating role of the parent-child relationship: A prospective longitudinal study

BACKGROUND

The first 2 years of life are a particularly sensitive period for the parent-child relationship as well as a healthy, age-appropriate child development. Both have been shown to be linked to postpartum depressive and anxiety symptoms, while the role of obsessive-compulsive symptoms, which are also common, is still largely understudied. In addition, fathers have been neglected in this area of research. This study, which includes both mothers and fathers, aims to investigate the longitudinal associations between postpartum obsessive-compulsive symptoms and different domains of child development, as well as the mediating role of the parent-child relationship.

METHODS

Data were drawn from the prospective longitudinal study DREAM, with 674 mothers and 442 fathers from the general population completing self-report questionnaires at four measurement points. Longitudinal associations between parental postpartum obsessive-compulsive symptoms 8 weeks postpartum, the parent-child relationship 14 months postpartum, and child development 24 months postpartum were investigated using regression and mediation analyses. A number of potential confounding variables were considered, i.e., age, academic degree, postpartum depressive and anxiety symptoms of the parents, preterm birth and temperament of the child, as well as COVID-19 pandemic-driven adversities.

RESULTS

When adjusting for confounders, neither maternal nor paternal postpartum obsessive-compulsive symptoms had adverse effects on the respective parent-child relationship and child development. Further, no mediating role of the parent-child relationship between parental postpartum obsessive-compulsive symptoms and child development could be confirmed. Instead, we found that the mother- and father-child relationship were differentially related to specific child developmental domains. For mothers, a poorer mother-child relationship was prospectively related to poorer fine motor development. For fathers, a poorer father-child relationship prospectively predicted a poorer overall development as well as poorer gross motor, fine motor, problem-solving, and personal-social development.

CONCLUSION

Our results suggest that negative effects on the parent-child relationship and child development may only become apparent in full-blown postpartum obsessive-compulsive disorder. Given the differential impact on specific developmental domains, our findings also suggest that it is crucial to consider both parents in clinical practice as well as in future research, rather than focusing only on the mother-child dyad.

Prospective Associations of Lifetime Post-traumatic Stress Disorder and Birth-Related Traumatization With Maternal and Infant Outcomes

OBJECTIVE

Many women experience traumatic events already prior to or during pregnancy, and delivery of a child may also be perceived as a traumatic event, especially in women with prior post-traumatic stress disorder (PTSD). Birth-related PTSD might be unique in several ways, and it seems important to distinguish between lifetime PTSD and birth-related traumatization in order to examine specific consequences for mother and child. This post-hoc analysis aims to prospectively examine the relation of both, lifetime PTSD (with/without interpersonal trauma) and birth-related traumatization (with/without postpartum depression) with specific maternal and infant outcomes.

METHODS

In the prospective-longitudinal Maternal in Relation to Infants' Development (MARI) study, N = 306 women were repeatedly assessed across the peripartum period. Maternal lifetime PTSD and birth-related traumatization were assessed with the Composite International Diagnostic Interview for women. Maternal health during the peripartum period (incl. birth experience, breastfeeding, anxiety, and depression) and infant outcomes (e.g., gestational age, birth weight, neuropsychological development, and regulatory disorders) were assessed via standardized diagnostic interviews, questionnaires, medical records, and standardized observations.

RESULTS

A history of lifetime PTSD prior to or during pregnancy was reported by 25 women who indicated a less favorable psycho-social situation (lower educational level, less social support, a higher rate of nicotine consumption during pregnancy). Lifetime PTSD was associated with pregnancy-related anxieties, traumatic birth experience, and anxiety and depressive disorders after delivery (and in case of interpersonal trauma additionally associated with infant feeding disorder). Compared to the reference group, women with birth-related traumatization (N = 35) indicated numerous adverse maternal and infant outcomes (e.g., child-related fears, sexual problems, impaired bonding). Birth-related traumatization and postpartum depression was additionally associated with infant feeding and sleeping problems.

CONCLUSION

Findings suggest that both lifetime PTSD and birth-related traumatization are important for maternal and infant health outcomes across the peripartum period. Larger prospective studies are warranted.

IMPLICATIONS

Women with lifetime PTSD and/or birth related traumatization should be closely monitored and supported. They may benefit from early targeted interventions to prevent traumatic birth experience, an escalation of psychopathology during the peripartum period, and adverse infant outcomes, which in turn may prevent transgenerational transmission of trauma in the long term.

WISC-IV performance of children with Chronic Tic Disorder, Obsessive-Compulsive Disorder and Attention-Deficit/Hyperactivity Disorder: results from a German clinical study

BACKGROUND

Chronic Tic Disorder (CTD), Obsessive-Compulsive Disorder (OCD) and Attention-Deficit/Hyperactivity Disorder (ADHD) are complex neuropsychiatric disorders that frequently co-occur. The aim of this study was to examine WISC-IV performance of a clinical cohort of children with CTD, OCD and/or ADHD.

METHODS

N = 185 children aged 6 to 17 years from Germany with CTD, OCD and/or ADHD were examined with the WISC-IV that comprises four index scores (VCI: Verbal Comprehension Index, PRI: Perceptual Reasoning Index, WMI: Working Memory Index, PSI: Processing Speed Index) and a Full Scale Intelligence Quotient (FSIQ). WISC-IV profiles of children with CTD-only, OCD-only, ADHD-only, CTD+ADHD, CTD+OCD and CTD+OCD+ADHD were compared with the WISC-IV norm (N = 1650, M = 100 and SD = 15) and among each other.

RESULTS

Unpaired t-tests revealed that children with ADHD-only showed significant lower PSI scores, whereas children with CTD-only and OCD-only had significant higher VCI scores as compared to the German WISC-IV norm. One-way ANOVA revealed that children with ADHD-only showed significant lower WMI scores as compared to children with CTD+OCD.

CONCLUSIONS

We were able to confirm previous evidence on WISC-IV profiles in ADHD in a German clinical sample and contribute new findings on cognitive performance in children with (non-)comorbid CTD and OCD that have to be seen in light of the study's limitations.

Early detection of bipolar disorders and treatment recommendations for help-seeking adolescents and young adults: Findings of the Early Detection and Intervention Center Dresden

Background

Early identification and intervention of individuals with risk factors for or subtle prodromal symptoms of bipolar disorders (BD) may improve the illness course and prevent adverse long-term consequences.

Methods

We examined sociodemographic, clinical and psychopathological characteristics of help-seeking adolescents and young adults who consulted the Early Detection and Intervention Center Dresden at the University of Dresden (Germany) and presented with or without pre-defined at-risk criteria for BD. The standardized diagnostic procedure for all help-seeking youth included a comprehensive psychiatric history and a structured clinical interview. When BD at-risk state was suspected, early detection instruments (EPIbipolar, BPSS-FP) were applied. Treatment recommendations were formulated in multi-professional case conferences.

Results

Out of 890 help-seeking persons between 05/2009 and 04/2018, 582 (65%) completed the diagnostic process. Of these, 24 (4%) had manifest BD and 125 (21%) fulfilled at-risk BD criteria (age = 23.9 ± 0.6 years, female = 62%). Of the pre-defined main risk factors, family history for BD was reported in 22% of the at-risk persons, (hypo-)mania risk state in 44%, and increasing cyclothymic mood swings with increased activity in 48%. The most common secondary risk factors were decreased psychosocial functioning (78%), lifetime diagnosis of depressive disorder (67%) and specific sleep/circadian rhythm disturbances (59%). Substance use was very common in subjects at-risk for BD (cannabis = 50%, alcohol = 33%) and highest in patients with BD (cannabis = 75%, alcohol = 40%). Psychiatric treatment history, including psychopharmacological therapy, was similar between the groups, while treatment recommendations differed, with more advice for psychotherapy and antidepressants in the at-risk group with a lifetime diagnosis of depression and more advice for specialized BD treatment including mood stabilizers in patients with BD.

Conclusion

This analysis on the phenomenology of different BD at-risk stages suggests that early detection of individuals presenting with suggested risk factors for the development of BD is feasible in help-seeking young people. Future research should further develop/test stage-specific prevention and early targeted intervention approaches that were described in a naturalistic setting.

Associations of Partnership Quality and Father-to-Child Attachment During the Peripartum Period. A Prospective-Longitudinal Study in Expectant Fathers

Background: During the transition to parenthood, a complex network of relationships unfolds between father, mother and the child. Expectant parents begin bonding with their unborn child, with this antenatal process supposedly being predictive for later postnatal attachment and child mental health. At the same time, couples may experience a change in partnership quality. While the majority of previous studies focused on associations between psychopathology, partnership quality and attachment from the perspective of mothers, the changes in partnership quality and attachment from the perspective of fathers has gained far less attention. Methods: Data were derived from the Maternal Anxiety and it's Relation to Infants' Development (MARI) study. N = 109 expectant fathers were recruited during mid-pregnancy (22 to 26 week of gestation). Lifetime anxiety and depressive disorders (DSM-IV) were assessed with a standardized diagnostic interview (CIDI). Paternal partnership characteristics and father-to-child attachments were assessed using standardized questionnaires at the second trimester, 10 days after delivery and 4 months after delivery in N = 76 fathers. Analyses were based on bivariate, robust and multivariate regression analyses. Results: Fathers did not report an overall decrease in partnership quality during the peripartum period. However, fathers with comorbid anxiety and depressive disorders reported lower partnership satisfaction at postpartum, as compared to unaffected fathers. Fathers with pure depressive disorders reported lower intensity of antenatal attachment. Paternal antenatal partnership quality was positively associated with antenatal father-to-child attachment. Furthermore, antenatal father-to-child attachment, as well as ante- and postnatal partnership quality in fathers, were positively related to postnatal father-to-child attachment. Conclusions: Antenatal father-to-child-attachment and paternal partnership quality appear to be promising targets for the prevention of postnatal attachment problems in fathers. The associations between partnership quality and attachment to the child further support an interpersonal approach in perinatal research, treatment and intervention, and may also feed into awareness programs that encourage expectant fathers to actively engage in relationships as early as during pregnancy-both with the mother and the unborn child.

Corrigendum: Associations of Partnership Quality and Father-to-Child Attachment During the Peripartum Period. A Prospective-Longitudinal Study in Expectant Fathers

[This corrects the article DOI: 10.3389/fpsyt.2021.572755.].

Physical Health Profile and Associated Behavior During the COVID-19 Pandemic in Patients With Bipolar Disorder

Background: The COVID-19 pandemic has led to an increased psychological strain on public mental health and may impact behavioral, mental, and physical health, presumably with effects on patients with severe mental disorders. This study examines pandemic-related physical and mental health and (compensatory) behavioral changes, in patients with BD as compared to healthy control individuals. Method: Physical and mental health and self-reported changes in daily structure and behavior due to the pandemic were assessed using a self-constructed questionnaire and the brief symptom inventory (BSI) in Germany, Austria, and Denmark in individuals with BD and a healthy control group. Results: The present study included 118 individuals with BD and 215 healthy controls. Individuals with BD reported statistically significant higher physical risk burden, increased weight gain, more physical comorbidities, and a decrease in physical activity and they further reported higher rates of COVID-19 testing, had more worries concerning health, and experienced more anxiety but less social distancing. Conclusion: The COVID-19 pandemic seems to have a greater impact on physical health in individuals with BD than in healthy controls. Individuals with BD appear to be having more difficulties compensating their behavior due to the pandemic which could amplify the effect of risk factors associated with poorer physical health. This highlights the necessity for optimizing and targeting the overall treatment of both mental and physical health in patients with BD during periods with far-reaching changes such as the COVID-19 pandemic. Limitations: Sampling issues and self-report forms, selectivity (missing elderly, and those lacking access or knowledge of technology).

Siblings and Birth Order-Are They Important for the Occurrence of ADHD?

Objective: The associations of birth order, number of siblings, and ADHD was examined. Method: The analysis based on representative, epidemiological data from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) study (N = 13,488). Results: An increased risk for ADHD in firstborn versus youngest born children (odds ratio [OR] = 1.31, 95% confidence interval [CI] [1.09, 1.58]) and also versus children with no sibling (OR = 1.31, 95% CI [1.03, 1.68]) was revealed, while number of siblings was not associated with ADHD. Results remained stable after controlling for confounders. Conclusion: Firstborn children may receive simultaneously less parental resources and more responsibilities if younger siblings are born. This happens during the vulnerable developmental period of ADHD. In addition, due to higher levels of insecurity, parents are assumed to focus more on potential physical or psychological abnormities in their firstborn children. This may result in a diagnostic bias in firstborn children.

Personality and Peripartum Changes in Perceived Social Support: Findings From Two Prospective-Longitudinal Studies in (Expectant) Mothers and Fathers

OBJECTIVE

The aim of this study was to examine changes in perceived social support from early pregnancy to 2 years postpartum and to test whether these changes (a) differ between mothers and fathers or (b) vary as a function of the Big Five personality traits.

BACKGROUND

Higher peripartum social support in (expectant) mothers and fathers has been associated with fewer complications during pregnancy and delivery as well as better parental and offspring health.

METHODS

Prospective-longitudinal data from two regional-epidemiological samples from Germany were used: MARI (N = 396, including n = 293 mothers and n = 103 fathers) and DREAM (N = 2,819, including n = 1,689 mothers and n = 1,130 fathers). The Big Five personality traits were assessed during pregnancy in MARI as well as 8 weeks after the anticipated birth date in DREAM with short forms of the Big Five Inventory. Perceived social support was assessed during pregnancy, 4 months postpartum, and 16 months postpartum in MARI as well as during pregnancy, 14 months postpartum, and 2 years postpartum in DREAM using the short version of the Social Support Questionnaire.

RESULTS

Multilevel analyses revealed that perceived social support decreased across the peripartum period, and this decrease did not differ between mothers and fathers. More extraverted, emotionally stable, agreeable, conscientious, and open parents perceived higher levels of social support across the peripartum period. The peripartum decrease of perceived social support was smaller in parents who were more extraverted.

CONCLUSION

Our findings suggest that especially extraversion plays an important role for high and stable levels of perceived social support across the peripartum period.

IMPLICATIONS

Particularly highly introverted parents might profit from targeted social support interventions.

Precarious working conditions and psychosocial work stress act as a risk factor for symptoms of postpartum depression during maternity leave: results from a longitudinal cohort study

BACKGROUND

The majority of Western women work during their reproductive years, but past research has often neglected the influence of work-related factors on postpartum mental health. Especially postpartum depression (PPD) is an enormous psychological burden for mothers. Therefore, this study aims to investigate the prospective impact of precarious working conditions and psychosocial work stress during pregnancy (such as work-privacy conflict and effort-reward imbalance at the job) on symptoms of maternal PPD.

METHODS

In the prospective-longitudinal cohort study DREAM (DResdner Studie zu Elternschaft, Arbeit und Mentaler Gesundheit), N = 587 employed women were questioned about their work during pregnancy and their mental health 8 weeks after delivery.

RESULTS

Multiple regression analyses revealed that work-privacy conflict, low reward at work, and precarious working conditions significantly predicted symptoms of PPD, even when controlling for lifetime depression, anxiety, education, parity, and age.

CONCLUSION

Our results indicate that psychosocial work stress and precarious working conditions have important implications for maternal peripartum mental health. They might act as prospective risk factors for PPD during the period of maternal leave. Hence, future research should focus on preventative measures targeting work life.

Individual and Dyadic Coping and Fear of Progression in Mothers and Fathers of Children with Hematologic Cancer

This study investigated the association of individual and dyadic coping strategies with fear of progression (FoP) in mothers and fathers of children with hematologic cancer. Parental couples (N = 44) whose children had been diagnosed with hematologic cancer were recruited at a university hospital and a rehabilitation clinic in Germany between 03/2017 and 08/2017. Data included parents' self-report on FoP (Fear of Progression Questionnaire-parent version, FoP-Q-SF/PR), individual coping (Coping Health Inventory for Parents, CHIP-D), and dyadic coping (Dyadic Coping Inventory, DCI). Statistical analyses were carried out for mothers and fathers individually as well as for parental couples using dyadic data analyses (e.g., actor-partner interdependence model, APIM). Individual and dyadic coping strategies were significantly correlated with FoP in mothers, but not in fathers. Fathers' evaluation of the couple's dyadic coping significantly predicted mothers' FoP. The more frequent use of familial integration (CHIP-D FAM) and maintaining social support (CHIP-D SUP) as well as a better evaluation of their partners' dyadic coping was significantly associated with lower FoP in mothers. Differences in individual and dyadic coping in parental couples were not associated with FoP. Individual and dyadic coping strategies should be addressed in the psychosocial care of mothers and fathers of children with hematologic cancer. Study results support the benefits of involving fathers in psychosocial interventions, for example, in couple-based interventions that acknowledge interpersonal effects of coping on FoP. Future research should further explore coping strategies applied by fathers of children with hematologic cancer for the regulation of FoP.

Maternal personality, social support, and changes in depressive, anxiety, and stress symptoms during pregnancy and after delivery: A prospective-longitudinal study

Background

The role of maternal personality and perceived social support for peripartum changes in psychopathological symptoms remains unresolved.

Methods

In a regional-epidemiological sample of 306 women, depressive, anxiety, and stress symptoms were assessed three times during pregnancy and three times after delivery with the 21-item version of the Depression Anxiety Stress Scale. In pregnancy, the Big Five personality traits and perceived social support were assessed with the short version of the Big Five Inventory and the Social Support Questionnaire.

Results

Multilevel analyses revealed that depressive (b = -0.055) and stress (b = -0.047) symptoms decreased from early to late pregnancy. After delivery, anxiety symptoms were lower (two months postpartum: b = -0.193; four/ 16 months postpartum: b = -0.274), but stress symptoms were higher (two months postpartum: b = 0.468; four/ 16 months postpartum: b = 0.320) than during pregnancy. Across the peripartum period, more conscientious and more extraverted women experienced lower depressive and stress symptoms (b = -0.147 to -0.177), and more emotionally stable women experienced lower depressive, anxiety, and stress symptoms (b = -0.294 to -0.415). More emotionally stable women more strongly increased in anxiety during pregnancy (b = 0.019), and more extraverted women less strongly increased in depression after delivery (b = -0.010). Moreover, peripartum depressive, anxiety, and stress symptoms were lower in women with higher perceived social support (b = -0.225 to -0.308).

Conclusions

Less emotionally stable, less conscientious, and less extraverted women and women with lower perceived social support seem to be at increased risk for peripartum psychopathological symptoms and might thus particularly profit from targeted prevention.

My job, my child, my house: the predictive value of job- and housework-related factors on depressive symptoms during the postpartum period

BACKGROUND

Many mothers combine two sides of their life: They are both educated employees and family organizers. The aim of this study is to investigate risk and protective factors of depressive symptoms during the postpartum period (PPD symptoms) on both those sides of mothers' life, including education, job-, and housework-related factors.

METHODS

Data (n = 689) were drawn from the prospective-longitudinal cohort study "Dresden Study on Parenting, Work, and Mental Health" (DREAM). Education, job satisfaction, job burden, and the housework-related factor ministering to family needs (MTFN) were measured during pregnancy. Depressive symptoms were measured 8 weeks postpartum. Multiple linear regression analyses were conducted.

RESULTS

While education was not significantly associated with PPD symptoms, low job satisfaction, high job burden, and low MTFN levels were significant risk factors for PPD symptoms. When controlling for further potential confounders, job satisfaction and job burden remained significant predictors.

LIMITATIONS

Generalization of findings might be limited due to participation bias and some systematic dropout.

CONCLUSIONS

Job characteristics should be considered in future research on postpartum mental health. For the prevention of PPD symptoms, it seems important to ensure satisfying and less burdensome working conditions during pregnancy. Additionally, the results indicate that further research on the effects of housework-related factors on PPD symptoms is worthwhile.

Improving early recognition and intervention in people at increased risk for the development of bipolar disorder: study protocol of a prospective-longitudinal, naturalistic cohort study (Early-BipoLife)

Background

Bipolar disorders (BD) belong to the most severe mental disorders, characterized by an early onset and recurrent, severe episodes or a chronic course with poor psychosocial functioning in a proportion of patients. Many patients with BD experience substantial symptomatology months or even years before full BD manifestation. Adequate diagnosis and treatment is often delayed, which is associated with a worse outcome. This study aims to prospectively evaluate and improve early recognition and intervention strategies for persons at-risk for BD.

Methods

Early-BipoLife is a prospective-longitudinal cohort study of 1419 participants (aged 15–35 years) with at least five waves of assessment over a period of at least 2 years (baseline, 6, 12, 18 and 24 months). A research consortium of ten university and teaching hospitals across Germany conducts this study. The following risk groups (RGs) were recruited: RG I: help-seeking youth and young adults consulting early recognition centres/facilities presenting ≥ 1 of the proposed risk factors for BD, RG II: in-/outpatients with unipolar depressive syndrome, and RG III: in-/outpatients with attention-deficit/hyperactivity disorder (ADHD). The reference cohort was selected from the German representative IMAGEN cohort. Over the study period, the natural course of risk and resilience factors, early symptoms of BD and changes of symptom severity (including conversion to manifest BD) are observed. Psychometric properties of recently developed, structured instruments on potential risk factors for conversion to BD and subsyndromal symptomatology (Bipolar Prodrome Symptom Scale, Bipolar at-risk criteria, EPIbipolar) and biomarkers that potentially improve prediction are investigated. Moreover, actual treatment recommendations are monitored in the participating specialized services and compared to recently postulated clinical categorization and treatment guidance in the field of early BD.

Discussion

Findings from this study will contribute to an improved knowledge about the natural course of BD, from the onset of first noticeable symptoms (precursors) to fully developed BD, and about mechanisms of conversion from subthreshold to manifest BD. Moreover, these generated data will provide information for the development of evidence-based guidelines for early-targeted detection and preventive intervention for people at risk for BD.

Do lifetime anxiety disorders (anxiety liability) and pregnancy-related anxiety predict complications during pregnancy and delivery?

BACKGROUND

Evidence suggests that maternal anxiety is associated with adverse pregnancy and delivery outcomes, such as preterm birth, vaginal bleedings and low birth weight.

AIMS

To examine the association of lifetime anxiety disorders and pregnancy-related anxiety and complications during pregnancy and delivery.

STUDY DESIGN

Prospective-longitudinal study (MARI).

SUBJECTS

N = 306 pregnant women who were investigated repeatedly during the peripartum period.

OUTCOME MEASURES

Information on lifetime anxiety disorders was assessed using a dimensional score (lifetime anxiety liability index) based on the standardized Composite International Diagnostic Interview for Women (CIDI-V). Pregnancy-related anxiety was surveyed with the Pregnancy and Childbirth Related Fears (PCF) questionnaire. Common pregnancy (e.g. vaginal bleedings) and delivery complications (e.g. labor induction) were assessed via medical records, interviews and questionnaires.

RESULTS

The global tests on the association between lifetime anxiety liability and pregnancy complications and on the association between pregnancy-related anxiety and pregnancy/delivery complications revealed significant associations. Further analyses revealed associations of lifetime anxiety liability with preterm labor (OR = 1.6, 95% CI = 1.2-2.0) as well as pregnancy-related anxiety with vaginal bleedings (OR = 1.4, 95% CI = 1.0-1.8), preterm labor (OR = 1.3, 95% CI = 1.0-1.7), gestational diabetes (OR 0.5, 95% CI = 0.2-0.9), labor induction (OR = 1.5, 95% CI = 1.1-1.9) and use of labor medication (OR = 1.6, 95% CI = 1.2-2.0). After adjustment for maternal age, maternal body mass index, maternal smoking, socioeconomic status (occupation, household income) and social support (cohabitation), the associations between pregnancy-related anxiety and labor induction as well as use of labor medication remained significant.

CONCLUSIONS

Pregnancy-related anxiety should be regularly assessed and, if necessary, treated during (early) pregnancy to minimize risks for complications during delivery.

The course of panic disorder during the peripartum period and the risk for adverse child development: A prospective-longitudinal study

BACKGROUND

Panic disorders during pregnancy and after delivery may have detrimental effects for mother and child, but no firm conclusions regarding the course and outcomes of peripartum panic disorders can be drawn from previous studies.

METHODS

N = 306 women were repeatedly interviewed with the Composite International Diagnostic Interview for Women. Social support and partnership quality, gestational outcomes, duration of breastfeeding, regulatory disorders, maternal bonding and parenting style were assessed via medical and maternal reports. Standardized observations of neuropsychological development, infant temperament and attachment were conducted 4 and 16 months after delivery.

RESULTS

Women reported heterogenous courses of panic disorders, and panic disorders/panic attacks were commonly observed during the early stages of pregnancy. Women with peripartum panic disorders presented with a worse psychosocial situation (e.g., lower social support). Clear behavioral differences (temperament, attachment) in infants of women with panic disorders as compared to women with no anxiety and depressive disorder could not be detected in this study, but differences concerning gestational outcomes, duration of breastfeeding, maternal parenting, and bonding as well as regulatory problems in infants were identified.

LIMITATIONS

This prospective-longitudinal multi-wave study is restricted by the relative small sizes of the particular groups that limit the power to detect group differences.

CONCLUSIONS

Heterogenous courses and outcomes of perinatal panic disorders require intensive monitoring of affected mother-infant-dyads who may benefit from early targeted interventions to prevent an escalation of dyadic problems.

Psychometric Properties of the Fear of Progression Questionnaire for Children (FoP-Q-SF/C)

BACKGROUND

Recent research shows that parents of children suffer from fear of progression (FoP), the fear of further disease progression. It is most possible that children also develop FoP, which could impair treatment and psychological health. The aim of this study is to adapt the adult's version of the Fear of Progression Questionnaire - Short Form (FoP-Q-SF) for children and to examine the psychometric properties in pediatric cancer patients.

PATIENTS

32 pediatric cancer patients between 10 and 18 years with different diagnoses and in different treatment states participated in this study.

METHOD

In the cross-sectional study participants completed the adapted Fear of Progression Questionnaire - Short Form for Children (FoP-Q-SF/C) and self-report measures assessing quality of life, depression, fear and coping satisfaction.

RESULTS

The questionnaire (FoP-Q-SF/C) showed adequate psychometric properties (Cronbachs α=0.86) and good results for construct validity. Significant medium to large correlations of children's FoP was observed with quality of life (r=- 0.37), depression (r=0.52), fear (r=0.33 - 0.76), and satisfaction with coping (r=- 0.44). One-fifth of the sample was classified as having high FoP with values over 37.

CONCLUSIONS

The FoP-Q-SF/C is a short, economic questionnaire that is applicable in children with cancer. Clinicians can use the questionnaire to explore specific fear and the need for psychosocial support. Further research for specific treatment approaches for FoP in pediatric cancer patients are warranted.

HINTERGRUND

Aktuelle Forschungsergebnisse zeigen, dass Eltern krebskranker Kinder unter Progredienzangst (PA), der Angst vor dem Fortschreiten einer Erkrankung leiden. Es scheint naheliegend, dass auch Kinder diese Ängste entwickeln, was die Behandlung und die psychologische Gesundheit beeinflussen kann. Ziel der Studie ist die Adaption des Progredienzangst-Fragebogens (FoP-Q-SF) für Kinder und die Ermittlung der psychometrischen Eigenschaften für pädiatrische Onkologiepatienten.

PATIENTEN

32 pädiatrische Krebspatienten zwischen 10 und 18 Jahren mit unterschiedlichen Krebsdiagnosen und in unterschiedlichen Behandlungsstadien nahmen an der Studie teil.

METHODE

In der Querschnittsstudie beantworteten die Teilnehmenden den adaptierten Progredienzangst-Fragebogen-Kurzversion für Kinder (FoP-Q-SF/C) und Selbstbeantwortungsfragebögen zu Lebensqualität, Depression, Angst und Copingzufriedenheit.

ERGEBNISSE

Der Fragebogen (FoP-Q-SF/C) zeigte adäquate psychometrische Eigenschaften (Cronbachs α=0,86) und Konstrukvalidität. Signifikante Korrelationen wurden zwischen Progredienzangst und Lebensqualität (r=- 0,37), Depression (r=0,52), Angst (r=0,33-0,76), und Copingzufriedenheit (r=- 0,44) gefunden. Ein Fünftel der Stichprobe zeigte hohe Progredienzangstwerte mit Werten über 37.

SCHLUSSFOLGERUNG

Der FoP-Q-SF/C ist ein kurzer, ökonomischer Fragebogen, der für krebskranke Kinder passend ist. Kliniker können den Fragebogen einsetzen, um PA und die Notwendigkeit von psychosozialer Unterstützung zu erfassen. Weitere Forschungsarbeiten für spezifische Behandlungsansätze von PA in der pädiatrischen Onkologie sind wünschenswert.

Changes in psychopathological symptoms during pregnancy and after delivery: A prospective-longitudinal study in women with and without anxiety and depressive disorders prior to pregnancy

BACKGROUND

The role of anxiety and depressive disorders prior to pregnancy for changes in peripartum psychopathological symptoms has not been resolved yet.

METHODS

A regional-epidemiological sample of 306 women was prospectively followed in seven waves from early pregnancy until 16 months postpartum. Lifetime DSM-IV anxiety and depressive disorders were assessed at baseline with the CIDI-V. Psychopathological symptoms (somatization, obsession-compulsion, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, and psychoticism) were measured with the BSI three times during pregnancy and three times after delivery.

RESULTS

Multilevel analyses revealed that women with versus without lifetime anxiety (β=0.22 to β=0.32) and depressive (β=0.24 to β=0.34) disorders prior to pregnancy experienced higher peripartum psychopathological symptoms. All symptoms linearly decreased during pregnancy (β=-0.02 to β=-0.07 per month). Somatization (β=-0.46) was lower, whereas paranoid ideation (β=0.26) and obsession-compulsion (β=0.21) were higher after delivery than during pregnancy. Though, obsession-compulsion linearly decreased after delivery (β=-0.02). Lifetime anxiety disorders prior to pregnancy interacted with linear changes in anxiety (β=-0.04) and phobic anxiety (β=-0.05) during pregnancy. That is, only women with, but not without anxiety disorders prior to pregnancy experienced a linear decline in anxiety and phobic anxiety during pregnancy.

LIMITATIONS

Lifetime anxiety and depressive disorders were assessed in early pregnancy and might be biased.

CONCLUSIONS

Peripartum psychopathological symptoms are higher in women with versus without lifetime anxiety and depressive disorders prior to pregnancy, but symptom changes only slightly vary by lifetime diagnostic status.

Parental Cognitions About Sleep Problems in Infants: A Systematic Review

Introduction: Parental cognitions may directly and indirectly contribute to infant sleep outcomes. This review provides a systematic up-to-date overview of the associations between parental cognitions and infant sleep problems with special emphasis on temporal relationships and the content of parental cognitions. Methods: A systematic literature research in PubMed and Web of Science Core Collection sensu Liberati and PRISMA guidelines was carried out in March 2020 using the search terms (parent^* AND infant^* AND sleep^* problem^*), including studies with correlational or control group designs investigating associations between parental cognitions and sleep problems in children aged 1-6 years. Results: Twenty-three studies (published from 1985 to 2016) met inclusion criteria, of which 14 reported group differences or associations between parental sleep-related cognitions and child sleep outcomes. Nine papers additionally reported on the role of general parental child-related cognitions not directly pertaining to sleep. Findings from longitudinal studies suggest that parental cognitions often preceded child sleep problems. Cognitions pertaining to difficulties with limit-setting were especially prevalent in parents of poor sleepers and were positively associated with both subjective and objective measures of child sleep outcomes. Conclusions: Parental cognitions appear to play a pivotal role for the development and maintenance of sleep problems in young children, arguing that parents' attitudes and beliefs regarding child sleep inadvertently prompts parental behavior toward adverse sleep in offspring. Associations are however based on maternal reports and small to moderate effect sizes. Thus, additional parental factors such as mental health or self-efficacy, as well as additional offspring factors including temperamental dispositions and regulatory abilities, require consideration in further studies.

Predictors and outcomes of suicidal ideation during peripartum period

INTRODUCTION

Suicide belongs to the leading causes of maternal perinatal mortality and suicidal ideation is one of the strongest predictors for suicide attempt and completion and thus represents an opportunity for early intervention prior to self and infant harm. This post-hoc analysis aims to investigate predictors of peripartum suicidality (PS) and potential maternal and infant outcomes of PS.

METHODS

In the prospective-longitudinal Maternal Anxiety in Relation to Infant Development (MARI) study, n = 306 women were repeatedly examined from early pregnancy until 16 months postpartum using interviews (Composite International Diagnostic Interview for Women) and questionnaires (Edinburgh Postnatal Depression Scale, Brief Symptom Inventory) to obtain sociodemographic, gynecological and offspring characteristics as well as information about PS (thoughts of death/self-harm, suicide plans, suicide attempt).

RESULTS

PS was indicated by n = 15 women. A stepwise multivariate logistic regression revealed a history of suicide attempt (OR = 17.84, 95%CI: 4.61-69.05), living together with the partner (OR = 0.14, 95%CI: 0.03-0.63), and social support (OR = 0.35, 95%CI: 0.13-0.91) as significant predictors for PS (model fit: AUC = 0.7926). As compared to women with no PS, infants of women with PS presented lower scores in neuropsychological development (p = 0.020).

LIMITATIONS

This post-hoc analysis was conducted with the aim of generating hypotheses for future research. The small number of women who indicated PS limits the statistical power.

CONCLUSION

PS is an important perinatal complication that requires clinical attention. Larger prospective studies are warranted to verify the findings. This will lead to improved preventive and therapeutic approaches and a better understanding of the motives behind maternal suicide and infanticide.

The prospective relationship between postpartum PTSD and child sleep: A 2-year follow-up study

BACKGROUND

The main aim of this study was to examine the prospective impact of maternal postpartum PTSD on several standardized child sleep variables two years postpartum in a large, population-based cohort of mothers. Moreover, we investigated the influence of numerous potential confounding maternal and child factors. Finally, we tested potential reverse temporal associations between child sleep eight weeks postpartum and maternal PTSD symptoms two years postpartum.

METHODS

This study is part of the population-based Akershus Birth Cohort, a prospective cohort study at Akershus University Hospital, Norway. Data from the hospital's birth record, from questionnaires at 17 weeks gestation, eight weeks and two years postpartum were used. At two years postpartum, 39% of the original participants could be retained, resulting in a study population of n = 1480. All child sleep variables significantly correlated with postpartum PTSD symptoms were entered into multiple linear regression analyses, adjusting for confounding factors.

RESULTS

Postpartum PTSD symptoms were related to all child sleep variables, except daytime sleep duration. When all significant confounding factors were included into multivariate regression analyses, postpartum PTSD symptoms remained a significant predictor for number and duration of night wakings (β = 0.10 and β = 0.08, respectively), duration of settling time (β = 0.10), and maternal rating of their child's sleep problems (β = 0.12, all p<.01. Child sleep at eight weeks postpartum was not significantly related to maternal sleep two years postpartum when controlling for postpartum PTSD at eight weeks.

LIMITATIONS

Child outcomes were based on maternal reporting and might be influenced by maternal mental health.

CONCLUSIONS

Our results showed for the first time that maternal postpartum PTSD symptoms were prospectively associated with less favorable child sleep, thus increasing the risk of developmental or behavioral problems through an indirect, but treatable pathway. Early detection and treatment of maternal postpartum PTSD may prevent or improve sleep problems and long-term child development.