Extending Models of Sensitive Parenting of Infants to Women at Risk for Perinatal Depression

Objective. Recognizing that not all mothers at risk for depression engage in insensitive parenting, this study examined predictors of individual differences in sensitive parenting of infants by mothers with histories of depression, who are at elevated risk for depression during the perinatal period. Design. We examined maternal personal characteristics, context, and early infant temperament as predictors of sensitive parenting. Seventy-six women with a history of major depression were followed through pregnancy and postpartum and observed during play and feeding interactions with their 12-month-old infants. Results. Maternal personal characteristics (recurrence of clinically significant depression symptom levels during pregnancy or postpartum and higher trait anxiety), context (lower social context and lower income), and early infant temperament (higher negative affectivity, surgency/extraversion, and orienting/regulation) are often associated with less sensitive parenting, with stronger and clearer associations for play than feeding and with some differences based on whether sensitivity was defined as affective matching or rated sensitivity. Conclusions. The findings extend support for multi-determination of sensitive parenting of infants to women with histories of depression, albeit with small to medium effect sizes, and suggest ways to identify those who may be most at risk for insensitive parenting and the potential value of intervening in pregnancy to enhance subsequent sensitivity of parenting.     

Course of depression and anxiety symptoms during the transition to parenthood for female adolescents with histories of victimization

The aim of the current study was to increase understanding of how victimization history impacts the longitudinal course of depression and anxiety in a sample of 55 adolescents emerging into parenthood. Adolescents were interviewed about their victimization experiences during their second trimester of pregnancy, and interviews were subsequently classified according the Maltreatment Classification Scale (Barnett, Manly, & Cicchetti, 1993). Adolescents reported on their symptoms of depression and anxiety prenatally and 6 and 12 months postpartum. Growth curve modeling revealed that, on average, there was a steady linear decline in depression and anxiety symptoms across the transition to parenthood, with a rate of change of 25% and 20%, respectively, from the prenatal assessment to 12 months postpartum. Sexual abuse history attenuated the likelihood of a decrease in depressive symptoms over time. Neglect history was associated with higher prenatal levels of anxiety, as well as a steeper decline in anxiety symptoms over time. Future research is needed to determine the role of poly-victimization in predicting the onset and change of depression and anxiety symptoms. Findings from the current study have the potential to aid in the design of preventative and intervention efforts to reduce risks of mental health difficulties in adolescent parents.     

Maternal Perinatal and Concurrent Anxiety and Mental Health Problems in Early Childhood: A Sibling-Comparison Study

Do associations between maternal anxiety symptoms and offspring mental health remain after comparing differentially exposed siblings? Participants were 17,724 offspring siblings and 11,553 mothers from the Norwegian Mother and Child Cohort study. Mothers reported anxiety and depressive symptoms at 30 weeks’ gestation, and 0.5, 1.5, 3, and 5 years postpartum. Child internalizing and externalizing problems were assessed at ages 1.5, 3, and 5, and modeled using multilevel analyses with repeated measures nested within siblings, nested within mothers. Maternal pre- and postnatal anxiety were no longer associated with child internalizing or externalizing problems after adjusting for maternal depression and familial confounding. Maternal anxiety when the children were in preschool age, however, remained significantly associated with child internalizing but not externalizing problems.     

Effects of a prenatal care intervention for adolescent mothers on birth weight, repeat pregnancy, and educational outcomes at one year postpartum

About one-third of adolescent mothers receive inadequate prenatal care, and babies born to young mothers are more likely to be of low birth weight. The objective of this study is to evaluate a peer-centered prenatal care program for adolescent mothers. Pregnant adolescents were randomly assigned to an experimental or control group in a mastery modeling peer-support intervention designed to improve long- and short-term perinatal outcomes. A sample of 282 urban pregnant adolescents (94% African American, 4% Caucasian, 2% other) participated in the study. Participants were recruited from five clinics located mainly in Detroit, Michigan. Participants in the experimental group received care in a small group setting and learned to perform critical measurements with a peer partner during prenatal visits. Participants in the control group received individual prenatal care in the same clinics. Outcome measures included birth weight, years of schooling completed at one year postpartum, planned and unplanned pregnancy at one year postpartum, and employment and school attendance at one year postpartum. Mothers in the experimental group had a lower rate of low birth weight (6.6% vs. 12.5%, p=0.08). The rate of unplanned pregnancy was also lower for adolescents in the experimental group (13.4% vs. 15.9%), although this difference was not statistically significant. Adolescents who participated in the intervention were more likely to have continued their education during the pregnancy and the postpartum year. The mastery modeling, peer-centered, prenatal care program produced some positive pregnancy outcomes for adolescent mothers.     

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

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

Postpartum depression, marital dysfunction, and infant outcome: a longitudinal study

This longitudinal study explores the relationship of postpartum depression (PPD) and marital dysfunction on infant outcomes from birth to 2 1/2 years of age among middle-class, postpartum women. Participants were recruited during the prenatal period. Twelve mothers completed the study throughout a 2 1/2-year period. Questionnaires, semistructured interviews, and observations were used to collect data. Content analysis of the interviews (Morse & Field, 1995) was conducted and thematic patterns were identified. Clinical PPD and marital dysfunction (defined as little or no support or closeness, or verbal, emotional or physical abuse) characterized nearly one in three mothers. Four themes describing the women's postpartum progression were identified: stress, isolation, resentment, and eventual adjustment by creating a new normal. No major developmental delays or behavioral problems were found among the infants. Eight of the 12 mothers who were initially identified as breastfeeding nursed their infants for 6-18 months. Regardless of financial and educational advantages, mothers in the study experienced depression and marital dysfunction. These findings support other studies that confirm the lack of association of PPD with social class or marital status. Childbirth educators and other health care professionals are encouraged to continue providing expectant families with anticipatory education and community resources in order to increase awareness of mental health and marital risks during the postpartum transition.     

High antenatal maternal anxiety is related to ADHD symptoms, externalizing problems, and anxiety in 8- and 9-year-olds

Associations between antenatal maternal anxiety, measured with the State Trait Anxiety Inventory, and disorders in 8- and 9-year-olds were studied prospectively in 71 normal mothers and their 72 firstborns. Clinical scales were completed by the mother, the child, the teacher, and an external observer. Hierarchical multiple regression analyses showed that maternal state anxiety during pregnancy explained 22%, 15%, and 9% of the variance in cross-situational attention deficit hyperactivity disorder symptoms, externalizing problems, and self-report anxiety, respectively, even after controlling for child's gender, parents' educational level, smoking during pregnancy, birth weight, and postnatal maternal anxiety. Anxiety at 12 to 22 weeks postmenstrual age turned out to be a significant independent predictor whereas anxiety at 32 to 40 weeks was not. Results are consistent with a fetal programming hypothesis.     

Childhood history of abuse and child abuse potential in adolescent mothers: a longitudinal study

OBJECTIVES: The purpose of this research was to determine whether adolescent mothers of newborns are at higher risk for child abuse than adult mothers of newborns and to examine whether adolescent mothers with memories of child maltreatment have a higher risk for child abuse. METHOD: Two groups (adolescents and adults) of pregnant mothers were followed for 20 months beginning between the 5th and the 7th month of pregnancy until the child was 18 months old. Adolescent (N = 24) and adult (N = 24) mothers were matched on sociodemographic variables. During pregnancy, memories of child maltreatment were evaluated. When child was 1, 6, 12, and 18 months old, risk for child abuse was evaluated. RESULTS: Adolescent and adult mothers showed no differences in memories of childhood physical or emotional abuse. Nevertheless, adolescent mothers showed higher child abuse potential and depression scores than adult mothers. Mothers with memories of severe physical punishment showed higher child abuse potential scores and mothers with memories of physical punishment producing physical damage showed higher child abuse potential and depression scores. A statistically significant age of the mother by physical punishment producing physical damage interaction was found for depression. CONCLUSIONS: The results of this longitudinal study indicated that the potential for abuse was significantly greater in adolescent mothers than in adult mothers, and in mothers who had been victims of physical abuse than in those who had not. It also appeared that, among adolescent mothers, those who had been victims of childhood physical abuse constitute a higher risk group for child physical abuse.     

“Neglected moms” - The implications of emotional neglect in childhood for the transition to motherhood

BackgroundThe transition to motherhood involves many challenges that require adjustment; included among them are adapting to body changes, forging a maternal identity, and attaching to the baby. Although these tasks may not be easy for any women, those who experienced emotional neglect during childhood may find them especially difficult.ObjectiveThe aim of the current study was to examine a model illuminating the mechanism underlying the association between childhood emotional neglect and women’s adjustment during pregnancy and the postpartum period.Participants and settingThree hundred and ninety four Israeli women participated in the study, during their pregnancy (Time 1) and two months postpartum (Time 2).MethodsParticipants filled out a battery of questionnaires assessing their history of childhood emotional neglect, body experience, maternal self-efficacy, attachment to the fetus/baby, and depression.ResultsResults from structural equation modeling (SEM) indicated that childhood emotional neglect was associated with depression at both Time 1 and Time 2. These associations were mediated by the body experience during pregnancy (Time 1) and motherhood (Time 2) as well as by anticipated maternal self-efficacy (Time 1) and maternal self-efficacy (Time 2). The model explained 56% of the variance of postpartum depression (Time 2).ConclusionsThese findings point to the long-term implications of childhood emotional neglect for women’s adjustment to the transition to motherhood. The underlying mechanism suggested by the research model is discussed.     

Self-Efficacy and Postpartum Depression Teaching Behaviors of Hospital-Based Perinatal Nurses

Based upon the Self-Efficacy Theory, this study examined the relationship between self-efficacy, self-efficacy-related variables, and postpartum depression teaching behaviors of hospital-based perinatal nurses. Findings revealed that teaching new mothers about postpartum depression is related to a perinatal nurse's self-efficacy in postpartum-depression teaching, self-esteem, and the following self-efficacy-related variables: social persuasion (supervisor's expectations for teaching); mastery (postpartum depression continuing education and teaching experience); and vicarious experience (observing other nurses teach new mothers about postpartum depression). Teaching new mothers about postpartum depression can assist mothers in overcoming barriers to depression treatment. Nurse educators and managers play an important role in encouraging postpartum depression education for perinatal nurses.     

Antecedents and behavior-problem outcomes of parental monitoring and psychological control in early adolescence

The early childhood antecedents and behavior-problem correlates of monitoring and psychological control were examined in this prospective, longitudinal, multi-informant study. Parenting data were collected during home visit interviews with 440 mothers and their 13-year-old children. Behavior problems (anxiety/depression and delinquent behavior) were assessed via mother, teacher, and/or adolescent reports at ages 8 through 10 years and again at ages 13 through 14. Home-interview data collected at age 5 years were used to measure antecedent parenting (harsh/reactive, positive/proactive), family background (e.g., socioeconomic status), and mother-rated child behavior problems. Consistent with expectation, monitoring was anteceded by a proactive parenting style and by advantageous family-ecological characteristics, and psychological control was anteceded by harsh parenting and by mothers' earlier reports of child externalizing problems. Consistent with prior research, monitoring was associated with fewer delinquent behavior problems. Links between psychological control and adjustment were more complex: High levels of psychological control were associated with more delinquent problems for girls and for teens who were low in preadolescent delinquent problems, and with more anxiety/depression for girls and for teens who were high in preadolescent anxiety/depression.     

Perspectives on trauma-informed care from mothers with a history of childhood maltreatment: A qualitative study

Women who experienced abuse or neglect as children are more likely to have health problems during pregnancy and postpartum, but can be reluctant to seek help due to a lack of trauma-informed services. As part of a larger mixed method study, this component aimed to obtain qualitative data from trauma-exposed new mothers about their health care preferences during the perinatal period with the ultimate goal to design personalized, supportive interventions. Fifty-two trauma-exposed mothers completed a semi-structured interview at seven months postpartum about health care preferences including ideas for programs that promote wellness, thoughts about the influences of being a new mother and possible names for a program serving trauma-exposed mothers. Interviews were transcribed and coded using N-Vivo. Participants described ambivalence about seeking help but also a sincere desire for healing, coupled with hope for the future. This tension was apparent in the discussions highlighting the importance of access to experienced, nonjudgmental, and knowledgeable health and social care staff and volunteers, the wish for both formal, integrated physical and mental health services, and for informal opportunities to meet other trauma-exposed mothers in a non-stigmatizing, child-friendly setting. Finally, positive relationship-building, respect, and safety were identified as key elements of services critical to counteract trauma-related shame and mistrust in others. Services for trauma-exposed mothers should acknowledge the normal ambivalence surrounding seeking help, but promote hope-affirming practices in a family-centered, safe, non-clinical setting that involves children, builds social support, and provides peer interaction. Program names should reflect optimism and healing rather than trauma.     

Predictors of Behavior Problems in Preschool Children of Inner-City Afro-American and Puerto Rican Adolescent Mothers

Maternal reports on the Child Behavior Checklist/2-3 (CBCL/2-3) were used to evaluate child, maternal, and environmental predictors of behavior problems in 83 preschool children of disadvantaged adolescent mothers. CBCL/2-3 scores correlated modestly with independent ratings of child difficult behaviors observed in videotaped mother-child play interactions. 13% of children had scores in the clinical range. Significant correlations were consistently found between CBCL/2-3 ratings and maternal depressive symptoms, social supports, and life stress—assessed 3 times during the first year postpartum. In hierarchical regression analyses, maternal depressive symptoms, residence with the adolescent's mother, and perceived emotional support from friends contributed most to the explained variance. A significant ethnicity and child gender interaction term also suggested that African American mothers of male children reported more behavioral problems. Findings evidence the heterogeneity of outcomes for children of disadvantaged adolescent mothers but also demonstrate how correlates of poverty negatively affect their socioemotional development.     

Measurement of infant difficultness.

The Infant Characteristics Questionnaire (ICQ) was developed as a short, factor-analytic screening device for difficultness. Responses of 322 mothers of 4-6-month-old infants suggested that they regard the fussy, hard-to-soothe, labile infant as difficult. Mother report on the ICQ, particularly on the main fussy-difficult factor was found to have adequate reliability over time and convergence with the Carey Survey of Temperamental Characteristics, with father report on the ICQ, and, to a lower degree, with home data collected by independent observers. It was also found that mother characteristics may affect perceptions of infant difficultness: multiparous, extraverted mothers tended to rate their infants as easy.     

A life course perspective of victimization,child welfare involvement,cumulative stress and mental health for mothers on probation and parole

Women involved in the criminal justice system experience multiple forms of adversity over their lifetimes. These events may include childhood abuse, involvement in the child welfare system as children, intimate partner violence victimization during adulthood, and punitive interactions with the child welfare system as mothers. Community supervision (e.g. probation or parole) entails particular stressors, such as obtaining basic needs and employment. A majority of women under community supervision also experience depression and anxiety. The current study used the Stress Process Model to investigate associations between childhood and adulthood stressors (including childhood abuse, intimate partner violence and child welfare system involvement), recent stressful life events, and symptoms of depression and anxiety for mothers (n = 348) on probation and parole. All of the mothers had experienced some form of childhood and/or adulthood victimization. Structural equation modeling was conducted to examine how childhood abuse, adulthood victimization, and child welfare system involvement as a child and a mother were associated with recent stressful life events and symptoms of depression and anxiety. Results indicated multiple direct and indirect relationships from childhood and adulthood stressors to mental health symptoms as women navigated probation and parole. For example, adverse childhood experiences were associated with elevated anxiety and depression symptoms via higher levels of recent stressful life events and adverse adulthood experiences. These findings highlight relationships between childhood abuse and adulthood factors and the mental health of mothers involved in the criminal justice system, with implications for theory, practice, and research.     

The role of parental stress in physically abusive families

This study examines the role of several components of parental stress in physically abusive and nonabusive families with conduct-disordered children. The 123 families studied were seen in a parenting clinic aimed at improving parent-child interactions in families with a highly oppositional child. Data were collected over a several-week period and included both mother and father self-report measures and independent observations by trained researchers. Parental stress was found to play an important role in abusive families. Physically abusive families were significantly more often low income, had younger mothers with less education, more frequently reported a family history of child abuse, and were more likely to be abusing alcohol or drugs. Abusive mothers reported more stress due to frequent life events, and had a more negative perception of these events. Further, these mothers had higher rates of both depression and state anxiety. Abusive fathers spanked their children significantly more often than the nonabusive fathers, and abusive mothers had the highest frequency of critical statements directed at their children. Children from abusive households had significantly more behavior problems. Finally, abusive mothers reported more marital dissatisfaction and social isolation than their nonabusive counterparts.     

Social support, infant temperament, and parenting self-efficacy: a mediational model of postpartum depression

A model of maternal postpartum depression was tested in which difficult infant temperament was construed as a stressor and supportive interpersonal relationships were construed as a protective resource. It was hypothesized that both infant temperamental difficulty and level of social support would affect maternal depression through the cognitive mediation of perceived self-efficacy in the parenting role. Participants were 55 married women who were assessed during pregnancy and again 3 months postpartum. Infant temperament was assessed through observation, maternal crying records, and the Revised Infant Temperament Questionnaire. Results of a path analysis indicated that infant temperamental difficulty was strongly related to the mothers' level of postpartum depression, both directly and through the mediation of parenting self-efficacy. Consistent with predictions, social support appeared to exert its protective function against depression primarily through the mediation of self-efficacy. Both practical implications for identifying women at risk for postpartum depression and theoretical implications for understanding the mechanisms through which stressful events and social support affect adjustment are discussed.     

Psychological health of doctoral candidates,study-related challenges and perceived performance

Psychological distress is prevalent in doctoral degree training and affects students' completion time. It is crucial to monitor the amount of distress experienced and understand the causes for it to inform the type of support most needed. This mixed method study explored challenges related to candidature, self-reported progress and measures of perceived and actual psychological distress with a convenience sample of 81 doctoral candidates in an Australian university. Using validated survey instruments, participants reported higher levels of depression, anxiety and stress than age-matched general population normative data. Additionally, those who self-reported being behind or exceeding their study schedule had significantly higher scores for depression, anxiety and stress than those who reported they were meeting schedule. Conversely, stage of candidature did not affect any of these attribute scores. The responses to open-ended questions about challenges associated with doctoral study were coded and explored with an existing typology. The most frequent challenge reported in doctoral study is related to the development of generic skills, followed by management of self, including motivation. Given that not all challenges could be included in the existing typology, we recommend expansion to the typology.     

Antenatal prediction of mother-infant difficulties

A prospective study of 143 "low risk" pregnant women expecting their first baby was conducted in Newcastle, Australia. The study was designed to examine the contribution of a woman's perception of her own childhood experiences, her trait anxiety level, socioeconomic status, and social support network to difficulties in her relationship with her baby during the baby's first year. The women were initially interviewed during pregnancy and followed up 3 and 12 months postpartum. Follow-up measures included the Dimensions of Perinatal Adjustment, the Neonatal Perception Inventory, the Ainsworth Strange Situation, and information from hospital records, family doctors, and baby health centre sisters. Women who perceived their social network as less supportive during pregnancy were likely to see their one-year-old babies (p less than .05) as more difficult. The other antenatal measures were not significantly predictive of outcome.     

母子依恋与幼儿焦虑的关系

本研究以194名3～6岁幼儿及其母亲为被试,采用报告法测查幼儿的焦虑状况及其与母子依恋的关系.结果表明:在各焦虑症状中,女孩的躯体伤害恐惧得分显著高于男孩,低社会经济地位组幼儿的焦虑总分、分离焦虑、强迫一冲动障碍和广泛性焦虑得分显著高于中等和/或高社会经济地位组儿童,而中、高社会经济地位组儿童之间无显著差异;母子依恋与幼儿的焦虑总分及各焦虑症状(除强迫一冲动障碍)得分之间均呈显著负相关.