Elina Savonlahti

Antenatal depression, substance dependency and social support

BACKGROUND The purpose of this study was to explore the prevalence of depression and factors associated with depressive mood among pregnant women. METHOD 391 women who were 14-37 weeks pregnant were evaluated with the Edinburgh Postnatal Depression Screen (EPDS), which has also been validated for prenatal use. Four questionnaires were used in order to explore associated factors: a questionnaire on background and pregnancy data, the Substance Abuse Subtle Screening Inventory (SASSI) and two Social Support Questionnaires (SSQ1 and 2). RESULTS 7.7% of the total sample screened positive on the EPDS with a cut-off point of 12/13 recommended. Substance dependency and experienced difficulties in social environment had an independently significant association with maternal depression. LIMITATION The caseness was defined with a self-report instrument. CONCLUSION Substance dependency and experienced difficulties, especially in relation to friends, partner and own mother, are associated with antenatal depression. It is important to be aware of this when developing interventions in maternity care primary units.

Maternal depression is associated with mother-infant interaction in preterm infants.

Aim: The purpose of this study was to assess the prevalence and the background factors of maternal depressive symptoms and their relation to the quality of mother–infant interaction in a group of preterm infants and their mothers.

Relations between maternal attachment representations and the quality of mother-infant interaction in preterm and full-term infants

The aim of the study was to assess the relationship between maternal representations and the quality of mother-infant interaction in a group of preterm and full-term infants. The study groups consisted of 38 mothers and their preterm infants (</=1500g or<32 gestational weeks) and 45 mothers and their full-term infants. Maternal representations were assessed using the Working Model of Child Interview (WMCI) at 12 months of the infants corrected age. The quality of mother-infant interaction was studied using the Parent-Child Early Relational Assessment (PCERA) method at 6 and 12 months of the infants corrected age. The results showed that maternal representations are related to the quality of mother-infant interaction in a parallel manner in preterm and full-term infants and their mothers. Furthermore, distorted representations were more strongly related to a higher number of areas of concern in mother-infant interaction than other representation classifications. Our results underline the importance of combined assessment of the subjective experiences of the mother and the quality of mother-infant interaction in clinical follow-up. This is the first study to describe the relation between maternal attachment representations and the quality of mother-infant interaction involving preterm infants.

Children of Parents with Cancer: A Collaborative Project Between a Child Psychiatry Clinic and an Adult Oncology Clinic

This article describes the development of a collaborative relationship between a child psychiatry clinic and an adult oncology clinic within a university hospital. The interest of the child psychiatry clinic was to pay attention to children of parents with cancer, and to propose an intervention to support them. A child-centred family counselling model was designed for this purpose. The preparation, implementation, and results of this project are described. Positive results, as well as mistakes and failures are discussed, and recommendations are made regarding this kind of collaboration.

Interactive skills of infants with their high-risk mothers

In this pilot study, the interactive skills of infants with their high-risk, substance-dependent mothers were explored in residential treatment from pregnancy until the infant was 6 months of age. Fourteen mother–infant pairs were videotaped in feeding and free play situations at 6 months after birth. A comparison, low-risk group consisted of 12 ordinary Finnish mother–infant pairs with minimal clinical risks. The findings show significantly higher levels of dyadic interactive deficiencies among the high-risk mother–infant pairs compared to the low-risk pairs, displayed especially in the feeding situation as lack of mutuality and flat, empty, constricted affective tone of interaction. Also, more interactive deficiencies were found among the high-risk infants compared to the low-risk infants, but the differences were not significant. In this study, this finding might reflect the reduced amount of somatic complications and the benefits of treatment, the impacts of which were not explored. The differences between the high- and low-risk infants were displayed as more withdrawal, depressed mood and avoiding behavior and as less alertness and attentional abilities, robustness and focus on parents emotional state among the high-risk group.

Maternal representations, depression and interactive behaviour in the postnatal period: a brief report

The association between pre/postnatal change in the content of maternal representations and maternal interactive capacity/number of depressive symptoms at 6 months postpartum was investigated among 12 substance‐addicted mothers in residential treatment. The measures used were semantic differentials of the Interview of Maternal Representations (IRMAG), maternal variables of the Parent‐Child Early Relational Assessment (ERA) and the Edinburgh Postnatal Depression Scale (EPDS). Change towards a more negative view of the child was associated with having more problem areas in maternal interaction, and more depressive symptoms at 6 months postpartum. Change towards a more negative view of the childs father and own mother‐as‐mother was associated with having more interaction problems, and towards a more negative view of self was related to depression postnatally.

Children younger than 4 years and their substance-dependent mothers in the child welfare clinic.

Aim: To explore the prevalence of substance dependency among mothers of small children and to evaluate the value of a routine‐style maternal report on social support, childs somatic health history and child caregiving experiences to differentiate the substance‐dependent group from the non‐dependent group. Methods: Mothers (n= 413) of children less than 4 y in the child welfare clinics filled in the Substance Abuse Subtle Screening Inventory (SASSI, Miller 1985) and questionnaires concerning social support, somatic history of the child, difficulties in social environment and in caring for the child. Results: The prevalence of substance dependency was 5.8%. The maternal perceptions of the childs somatic history could not differentiate the dependent from the non‐dependent group, while the child caregiving difficulties were more often present in the group of substance‐dependent mothers. The combined group of substance dependency and substance use was significantly associated with low social support and difficulties in social environment.

Maternal Substance Abuse: Infant Psychiatric Interest: A Review and a Hypothetical Model of Interaction

Substance abuse problems have strongly increased among Finnish women during the last decade. The negative effects that maternal substance abuse is thought to have on the quality of early mother-baby interaction are an area of interest and concern to specialists in infant mental health. During pregnancy and the newborn period of the infant, substance-abusing women have been shown to be especially willing and able to reduce use once the problem is identified. The desire to stop abusing substances appears to be predicated on a strong desire to be a good mother to the child. Interventions that focus on abstaining during pregnancy and on the early mother-child relationship have shown promise in helping these mothers improve the developmental prognosis of the child and become better parents through sobriety.