Bryanne Barnett

Paternal and maternal depressed mood during the transition to parenthood.

BACKGROUND The course of postnatal depression was examined in first-time mothers and fathers with emphasis on the role of personality and parental relationships as risk factors. METHOD 157 couples were assessed at four points: antenatally and at 6, 12 and 52 weeks postnatally. Various measures of mood and personality were administered at each of these assessment points. RESULTS Examination of the factors associated with depressed mood suggested that a womans relationship with her own mother was important in the early postpartum stage, and also her level of interpersonal sensitivity and neuroticism. For the father, his relationship with either his mother or father and his level of neuroticism were associated with his mood level early on. By the end of the first year couple morbidity increased, with rates of distress being at their highest for both parents, and factors associated with depressed mood being linked to partner relationship variables, at least for mothers. At most time points, antenatal mood and partner relationship were significant predictor variables for the postnatal mood of both mothers and fathers. LIMITATIONS The sample had a relatively high level of education and this should be taken into account when considering the generalisation of findings to less educated populations. At the time of conducting this study, the Edinburgh Postnatal Depression Scale (EPDS) had only been validated for use in the first few months postpartum, and thus we used another scale to measure the mothers mood at the other assessment points (the Beck Depression Inventory). Current research would suggest that the EPDS is valid both antenatally and at other times in the first year postpartum. CONCLUSION Whilst there was some consistency for mothers and fathers in the variables that predict their postpartum adjustment, these being antenatal mood and partner relationship, there is also evidence that adjustment to parenthood was related to different variables at different times. Early adjustment was related to the couples relationship with their own parents, as well as their own personality. Later adjustment was related to the couples functioning and relationship.

Variability in use of cut-off scores and formats on the Edinburgh Postnatal Depression Scale – implications for clinical and research practice

SummaryObjectives: i) To highlight the increasing use in the literature of unvalidated cut-off scores on the Edinburgh Depression Scale (EDS/EPDS), as well as different wording and formatting in the scale; ii) to investigate and discuss the possible impact of using an unvalidated cut-off score; iii) to highlight possible reasons for these ‘errors’; and iv) to make recommendations to clinicians and researchers who use the EDS/EPDS. Method: A convenience sample of studies that have used unvalidated cut-off scores, or different formatting, are cited as evidence that these types of ‘errors’ are occurring fairly frequently. Examination of previous data from one of the authors is undertaken to determine the effect of using an unvalidated cut-off score. Summary: Many studies report rates of high scorers on the EDS/EPDS using different cut-off scores to the validated ones. The effect of doing this on the overall rate can be substantial. The effect of using different formatting is not known, though excluding items from the EDS/EPDS must also make a substantial difference. Recommendations: We recommend that i) the validated score of 13 or more is used when reporting on probable major depression in postnatal English-speaking women, and 15 or more when reporting on antenatal English-speaking women; ii) that the wording used is “13 or more” (or equivalent), and not other terms that may cause confusion (e.g., ‘>12’; ‘more than 12’; ‘13’ etc), iii) if a different cut-off score to the validated one is used, a clear explanation is given as to why this has been done; and iv) that the scale should be worded and formatted as originally described by its authors.

Postnatal Depression, Anxiety and Unsettled Infant Behaviour

Objective: This study compares maternal mood, marital satisfaction and infant temperament in 128 mothers admitted to the residential care unit of a parentcraft hospitaland 58 mothers in a demographically matched group. Method: Mothers were recruited from the residential care unit of a parentcraft hospital (Tresillian Family Care Centres) and a comparison group from a private obstetric practice in the same demographic area. Both groups completed self-report questionnaires on depression, anxiety and marital adjustment, while mothers in the residential care group also received a structured diagnostic interview for depression (CIDI). Results: Sixty-two per cent of mothers in the residential care group met diagnostic criteria for a major depressive episode occurring since childbirth and a further 13% met DSM-IV research criteria for minor depression. The residential care group also scored significantly higher on both state and trait anxiety and rated their infants as significantly more temperamentally difficult than did the comparison group. Conclusions: This study replicates a previous Australian finding of a high incidence of maternal mood disorders in mothers admitted to parentcraft hospitals. Acknowledgement of the close association between maternal mood state and unsettled infant behaviour facilitates an integrated multidisciplinary approach offering appropriate management for both mothers and infants. Residential care units may be ideally suited to provide such early intervention strategies in a non-stigmatizing environment, but provision of adequate staff support, mental health consultation, education and skills in managing mental health problems in these settings is important.

Possible determinants, correlates and consequences of high levels of anxiety in primiparous mothers

Groups of highly anxious, moderately anxious and minimally anxious primiparous mothers (N = 147) were obtained on the basis of Spielberger trait anxiety scores in the postpartum period, and subjects were compared. Allocation to those groups appeared to be more likely to reflect constitutional levels of anxiety, rather than recent or current social stressors. Highly anxious mothers were distinguished on a number of presumed correlates of anxiety measured by clinical questions (e.g. terminating of anxious situations), hospital notes (e.g. mood problems noted by nursing staff) and blind rater assessments (e.g. unassertiveness). While highly anxious mothers were more likely to report more recent life events, less social support, and negative interpretations of the pregnancy, the hospital experience and the hospital staff, such variables were less discriminating when neuroticism levels were effectively controlled. This suggests an intrinsic perceptual bias, rather than that the factors were determinants. Highly anxious mothers had more delivery complications, while their babies were more likely to be dysmature and slow to suckle, features we interpret as consequences of the anxiety levels. In the postpartum period these mothers were more depressed, had more concerns about their baby, themselves and their marriage, and were less confident about coping and their parenting capacities. Such variables may be correlates or consequences of anxiety.

Postnatal depression and post‐traumatic stress after childbirth: Prevalence, course and co‐occurrence

Research relating to the postnatal mental health of women has tended to focus on postnatal depression. There have been increasing calls to consider the issue of post‐partum anxiety disorders, including post‐traumatic stress disorder (PTSD). This study sought to provide further evidence regarding the prevalence and longitudinal course of post‐traumatic stress symptoms resulting from traumatic birth experiences. The study also investigated the extent to which symptoms of trauma and depression occur together in the postnatal period. Four hundred women were recruited from the maternity ward of a public hospital in South West Sydney. Symptoms of birth trauma and postnatal depression were assessed via questionnaires given at birth, 6 weeks, 6 months and 12 months post‐partum. The prevalence of having a PTSD profile at 6 weeks post‐partum was 2%. A further 10.5% of women reported experiencing significant distress related to childbirth and several symptoms of post‐traumatic stress without meeting full diagnostic criteria. The prevalence of a PTSD profile remained relatively stable across the first 12 months post‐partum, with estimates being 2.6% at 6 months and 2.4% at 12 months. The co‐morbidity between post‐traumatic stress and postnatal depression was high at all three time points. The study highlights the potentially chronic nature of PTSD after childbirth and the importance of viewing post‐partum emotional distress in a broader context than simply postnatal depression.

Postnatal depression and social supports in Vietnamese, Arabic and Anglo-Celtic mothers

Abstract The significance of a western womans social supports to postnatal depression is well documented. We examine which deficits in components of their social support network are associated with postnatal depression in women from a non-English-speaking background. The social support network and postnatal mood of 105 Anglo-Celtic, 113 Vietnamese and 98 Arabic women were assessed at 6 weeks postpartum. The role of social supports in determining scores on the Edinburgh Postnatal Depression Scale (EPDS) was analysed using multiple regressions. For Anglo-Celtic women, low postnatal mood was associated with perceived need for more emotional support from partners and mothers. For Vietnamese women, low postnatal mood was associated with poor quality of relationship with the partner and a perceived need for more practical help from him. For Arabic women, low postnatal mood was associated with perceived need for more emotional support from partners. We conclude that cultural factors mediate the relation between social supports and postnatal depression.

Life event scales for obstetric groups.

Although associations have been described between life events and the incidence of perinatal complications, research has been limited by the lack of life event scales appropriate to obstetric groups. We report the development of such scales for primiparous and multiparous women. High ranking items from existing general life event scales as well as items relevant only to pregnant women were included. The degree of resultant distress was rated by visual analogue scales, and the frequency of each life event was assessed. High internal consistency was demonstrated for each of the scales and their general utility is suggested by the similar rank ordering of ratings in the primiparous and multiparous samples. Approximately one-third of the highest rating items on the scales were pregnancy related, supporting the view that scales measuring the stress of life events should include items relevant to the particular group of respondents.

The Parentified Child: Early Competence or Childhood Deprivation?

A review of the psychological, psychiatric, and social science literature revealed that parentification and role-reversal are terms that are used extensively, often without precise definition, although the implication is almost invariably that the process is pathogenic. An organismic rather than mechanistic view of the situation might suggest that, as is so often the case, whether the effects are adverse or not depends on a multitude of other factors. The final outcome for any individual can only be judged at the end of his or her life-span and the judgement will be largely subjective.

Routine psychosocial assessment of women in the antenatal period: frequency of risk factors and implications for clinical services

SummaryRoutine psychosocial assessment was introduced at an Australian public hospital’s antenatal clinic in 2001. After modification, this assessment consists of 12 questions together with the Edinburgh Depression Scale (EDS). Data are reported for responses to these questions from over 2,000 English-speaking women presenting to the clinic in a 12-month period. These 12 questions and the EDS were categorised into seven risk domains, with 12% of the women (n = 260) having three or more of these risk domains. Referral information to one of our two clinical services shows that 6.7% of women assessed in the antenatal clinic become clients having face–face counselling, and a further 7.2% have just telephone contact with this specialist perinatal mental health service. This information should prove useful for services considering implementing routine psychosocial assessments (or “screening”) in the antenatal period.

The early development of empathy: Self-regulation and individual differences in the first year

A longitudinal study of 45 mothers and their first-born infants was conducted to identify developmentally meaningful, individual differences in childrens primitive empathic responding at 12 months of age, and to determine whether differences in self-regulatory skills assessed at 4 months might underlie any differences in empathic responding observed. Personal distress responses analogous to those observed in older children and adults were identified in one-third of the sample at 12 months of age. These distress responses were associated with indices of poorer self-regulatory skills in social contexts at 4 months of age. The results are interpreted within the broader framework of the development of self-regulatory strategies in the early childhood years.