Catherine McMahon

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.

Psychosocial adjustment and the quality of the mother-child relationship at four months postpartum after conception by in vitro fertilization

OBJECTIVE To examine psychological adjustment to early motherhood at 4 months postpartum in mothers who conceived by IVF-ET. DESIGN Controlled clinical study. SETTING Healthy human volunteers in an academic research environment. PATIENT(S) Sixty-five primiparous women undergoing IVF-ET and 62 age-matched primiparous women with no history of infertility. INTERVENTION(S) Completion of questionnaires, interviews, and videotaped interaction. MAIN OUTCOME MEASURE(S) Maternal self-reports of psychosocial adjustment and behavioral ratings of quality of mother-infant interaction based on a videotaped observation scored blind to IVF-ET status. RESULT(S) Mothers who conceived by IVF-ET did not differ from control mothers on measures of anxiety, postnatal depression, marital satisfaction, or use of support services. However, they reported lower self-esteem and lower maternal self-efficacy, and they rated their infants as more temperamentally difficult. (Ratings of temperament difficulty for the infants of mothers who conceived by IVF-ET are within the normal range when compared with Australian normative data for this age group.) The videotapes revealed no group differences in maternal behaviors, but the infants of mothers who conceived by IVF-ET displayed more negative behaviors in response to an interactive stress. Group differences were accounted for largely by those mothers who underwent more than one treatment cycle and by their infants. CONCLUSION(S) Overall, the results are reassuring for parents who conceive by IVF-ET. However, specific adjustment measures reveal some minor difficulties and suggest that mothers who conceive by IVF-ET may benefit from increased support in the early postpartum months.

Mood state and psychological adjustment to pregnancy

SummaryThe aim of this study was to investigate whether there is an association between antenatal mood state (depression and anxiety) and psychological adjustment to pregnancy. Participants were first-time, low obstetric risk mothers at a Sydney teaching hospital who completed self-report questionnaires measuring depression, anxiety, thoughts about motherhood and self as mother and relationship with the fetus. Higher symptom levels of antenatal anxiety were related to less optimal maternal-fetal quality of attachment, more negative attitudes towards motherhood and the self as mother. Similar trends were found for symptoms of depression, however depression was not significantly related to psychological adjustment to pregnancy variables. The significance of anxiety in the current study highlights the importance of considering anxiety in the psychological adjustment to pregnancy, as well as the in the context of perinatal mental health more generally. Implications of these findings for intervention are also briefly discussed.

Stress in pregnancy and infant HPA axis function: Conceptual and methodological issues relating to the use of salivary cortisol as an outcome measure

Problems regulating behaviour and emotions in infancy may be a risk factor for the development of psychopathology later in life. Compelling evidence from animal models suggests that one potential pathway to early dysregulation is fetal programming of the hypothalamic-pituitary-adrenal (HPA) axis. According to this model, prenatal maternal stress and anxiety during sensitive periods of development can lead to enduring changes in fetal and offspring neurodevelopment and behaviour. While there is emerging evidence from human studies to suggest a link between maternal negative mood states in pregnancy and various cognitive, behavioural, and emotional disturbances in offspring, it is not yet clear whether the programming mechanism demonstrated in animal studies also applies to humans. Few studies have directly assessed HPA axis function in the infants of prenatally stressed women. Research in this area has been constrained by a number of measurement challenges unique to the assessment of cortisol in infants. This paper discusses these challenges with a view to stimulating further research in the area.

The impact of postnatal and concurrent maternal depression on child behaviour during the early school years

BACKGROUND This prospective study explores the ongoing impact of early and subsequent maternal depression on offspring behaviour in the early school years. METHODS Seventy five mothers recruited into a longitudinal study were assessed for symptoms of depression when their children were 4, 12 and 15 months, 4 years and later when the children were 6-8 years of age. Mothers, fathers, and school teachers were asked to report on childrens internalising and externalising behaviour problems. RESULTS Exposure to maternal depression during the first postpartum year was related to mother reports of child internalising and externalising problems in the early school years. Although depression in the first year predicted later internalising problems, effects for externalising behaviour problems were mediated by concurrent depression. Relations between concurrent maternal depression and externalising problems were confirmed by teacher ratings. Interestingly, the severity of symptoms at four months was significantly correlated with behaviour problems seven years later. LIMITATIONS Attrition over successive study contacts and therefore limited statistical power is acknowledged. Findings may be a conservative estimate of associations between maternal depression and later child behaviour problems. Also, the high prevalence of depressive symptomatology in the population from which the sample was drawn may limit the generalisability of results. CONCLUSIONS Findings confirm the importance of early identification and treatment for mothers with postnatal depression, given the likelihood of ongoing depression and relations with later child behaviour problems. From a practical point, severity of early symptoms may be a reliable index of those mothers and children at greatest risk.

The mother-child relationship following in vitro fertilisation (IVF): infant attachment, responsivity, and maternal sensitivity.

Infant attachment and mother-child interaction were evaluated for 65 primiparous women and their singleton infants conceived through in vitro fertilisation (IVF) and a control group of 61 women and their infants conceived naturally. The sample was enrolled during pregnancy as part of a longitudinal study. At 12 months postpartum, security of infant attachment was assessed using the Strange Situation procedure, and mother-child interaction was assessed in a free play context using the Emotional Availability Scales. IVF children demonstrated predominantly secure attachment relationships with their mothers (64.6% IVF, 55.9% controls), and there were no significant between-group differences in the proportion of IVF compared to control group children classified in any of the secure or insecure attachment groups. Furthermore, there were no significant group differences on maternal (sensitivity, structuring, hostility) or child (responsivity, involving) dimensions of interaction during play. The majority of IVF mothers (86%) were sensitive and their infants responsive (91%). Contrary to expectation, mothers ratings of greater anticipated infant difficultness assessed during pregnancy and higher ratings of infant temperament and behaviour difficulty assessed at 4 and 12 months postpartum were associated with secure attachment relationships and more optimal mother-child interaction in both the IVF and control groups.

Preschoolers' sleep behaviour: associations with parental hardiness, sleep-related cognitions and bedtime interactions

BACKGROUND Childhood sleep problems which are prevalent in Western societies are associated with a wide range of emotional, cognitive and behavioural disturbances. Growing evidence suggests that parents play a pivotal role in childrens sleep behaviour and that a parenting style which promotes self-regulation is beneficial. This study tested a unique model that included parental hardiness, sleep-related cognitions, bedtime interactions and child sleep behaviour. METHODS Parents (N = 110) with a child attending preschool (mean age = 3.81 years, SD = .84) responded to a survey assessing their level of hardiness, sleep-related cognitions, bedtime interactions and their childs sleep behaviour and temperament. Secondary caregivers completed a survey assessing child sleep and temperament, and teachers/childcare workers also reported on child temperament. RESULTS In line with previous research, 37% of children in this community sample met criteria for a sleep problem. Regression analyses and structural equation modelling confirmed that low parental hardiness, problematic sleep-related cognitions and a greater number of parental interactions at bedtime significantly predicted child sleep problems, after considering child temperament. CONCLUSIONS This studys theoretically driven model not only offers an explanation for what contributes to and maintains sleep problems in childhood but also suggests new areas for research. Importantly, the model can also be readily translated into clinical interventions to develop and enhance effective authoritative parenting.

Age at first birth, mode of conception and psychological wellbeing in pregnancy: findings from the parental age and transition to parenthood Australia (PATPA) study

BACKGROUND It is increasingly common for women in high-income countries to delay childbearing. We aimed to describe the context of pregnancy for first-time mothers of different ages and examine relationships among maternal age at first birth, mode of conception and psychosocial wellbeing in pregnancy. METHODS Using stratified sampling, we recruited similar numbers of women conceiving through assisted reproductive technology (ART; n = 297) or spontaneously (n = 295) across three age groups: younger, ≤ 20-30 years; middle, 31-36 years; older, ≥ 37 years. Women participated in a structured interview and completed validated questionnaires assessing socio-economic status, personality, quality of partner relationship, state and trait anxiety, pregnancy-focused (P-F) anxiety and maternal-fetal attachment. RESULTS Older maternal age was associated with lower depression and anxiety symptoms, lower maternal-fetal attachment (P< 0.05), greater psychological hardiness (resilience) (P< 0.001) and lower ratings of control in the partner relationship (P< 0.05) at a univariate level. ART conception, but not older maternal age, was associated with more P-F anxiety. Although most main effects of age and mode of conception became non-significant after controlling for contextual/reproductive history variables, a significant association between ART conception and more intense fetal attachment emerged (P< 0.05). CONCLUSIONS Women having their first baby when older appear to have some psychological advantages over their younger counterparts; they are more resilient, report their partners as less controlling and report lower symptoms of depression and anxiety during pregnancy. However, women conceiving through ART have a more complex experience of pregnancy, simultaneously experiencing more P-F anxiety and more intense emotional attachment to the fetus.

‘Don't count your chickens’: A comparative study of the experience of pregnancy after IVF conception

Abstract The aim of this paper was to describe the personal experience of pregnancy for IVF mothers. Seventy in vitro fertilization (IVF) mothers were compared to a control group of 63 older first-time mothers using both questionnaire and interview measures of adjustment at 30 weeks of pregnancy. The IVF group was subdivided into women who had conceived on their first treatment cycle and repeat cycle mothers. Results showed that while there were no differences between the IVF and control group mothers on self-report measures of maternal role acquisition, the experience of pregnancy was different for the IVF mothers. Despite their higher levels of anxiety about the well-being of the baby, the repeat cycle IVF mothers were more likely to report positive, idealized attitudes to pregnancy than were the controls. The repeat cycle IVF mothers also differed from control group mothers in reporting expectations of a more difficult baby, and both 1 cycle and repeat cycle IVF mothers reported fewer conversations wit...

Acceptance and Experience of Treatment for Postnatal Depression in a Community Mental Health Setting

Our objective in this qualitative study was to investigate the acceptance and experience of treatment for postnatal depression (PND). Fifteen women who had received treatment and support from the community mental health service for PND were interviewed. Interviews were transcribed verbatim and then analyzed using the modified analytic induction method. The majority of women interviewed had reached “crisis point” before they sought and received treatment. The stigma attached to an inability to cope and being a “bad mother” emerged as the main barrier to seeking help earlier. In addition, women were unable to differentiate between “normal” levels of postpartum distress and depressive symptoms that might require intervention. Talking about their distress and experiences, both with health professionals and other mothers, was regarded as of primary importance in the recovery process.