Ilona Luoma

Longitudinal study of maternal depressive symptoms and child well-being

OBJECTIVE To investigate whether prenatal, postnatal, and/or current maternal depressive symptoms are associated with low level of psychosocial functioning or high level of emotional/behavioral problems in school-age children. METHOD As part of a prospective longitudinal study, maternal depressive symptoms were screened with the Edinburgh Postnatal Depression Scale prenatally, postnatally, and when the children were 8 to 9 years old. The original sample of 349 mothers was collected in 1989-1990 in Tampere, Finland. Of the 270 mother-child pairs at the latest stage of the study in 1997-1998, 188 mother-child pairs participated and 147 were included. The associations between maternal depressive symptoms at different points in time and the level of childrens psychosocial functioning and problems reported on the Child Behavior Checklist and Teachers Report Form were examined. RESULTS Childrens low social competence and low adaptive functioning were associated with concurrent maternal depressive symptoms. Maternal postnatal depressive symptoms predicted low social competence. The presence of prenatal depressive symptoms in the mother was a strong predictor of childs high externalizing and total problem levels (odds ratio 3.1, 95% confidence interval 1.1-8.9 and odds ratio 8.5, 95% confidence interval 2.7-26.5). Prenatal as well as recurrent maternal depressive symptoms were associated with the least favorable child outcome. CONCLUSIONS Maternal depressive symptomatology at any time, especially prenatally, is a risk factor for the childs well-being. This should be noted already in prenatal care. The timing and the recurrence of maternal depressive symptoms affect the outcome for the child.

Mother's early perception of her infant's difficult temperament, parenting stress and early mother–infant interaction

The current study investigated factors contributing to mothers early perception of her infants difficult temperament. One hundred and twenty-four mother–infant dyads participated in the study. Mothers perception of the infants temperament was assessed with the Infant Characteristics Questionnaire (ICQ). The influence of mother–infant interaction, mothers mental health and parenting stress were investigated. Mother–infant interaction was videotaped during a face-to-face interaction and analysed using the Global Rating Scale. Mothers mental health was assessed through a structured interview (Structured Clinical Interview for DSM-IV, SCID) and parenting stress was examined by a questionnaire (Parenting Stress Index). First, the difficultness scale of the ICQ was used as a continuous variable and factors contributing to mothers perception of her infants temperament as more or less difficult were examined. Secondly, infants were categorized into difficult and non-difficult, and factors increasing the infants risk of being perceived as difficult were examined. The model including mothers mental health and parental distress accounted for 24% of the variance in perceived infant difficultness, with parental distress in particular being an influential contributor. When infants categorized as difficult were examined, mothers intrusiveness and infants poor interactive behaviour in early mother–infant interaction as well as parental distress significantly increased the infants risk of being perceived as difficult.

A Longitudinal Study of Maternal Depressive Symptoms, Negative Expectations and Perceptions of Child Problems

The aim of this longitudinal study was to examine the associations between maternal depressive symptoms and perceptions of children’s problems. One hundred and nineteen mother–child dyads were followed from the third trimester of pregnancy for almost 10 years. Depressive symptoms and background factors of the mothers and the anticipated/perceived problems of their firstborn were assessed prenatally, postnatally, and when the child was 4–5 years and 8–9 years old. The simultaneous and long-term associations between maternal depressive symptoms and childs problems were examined. Maternal prenatal depressive symptoms, the continuity of negative expectations to postnatal problem perceptions, and high problem level at 4–5 years of childs age predicted high problem level in 8–9-year-olds.

Emotional and behavioural symptoms in 8–9-year-old children in relation to family structure

The association between family structure and behavioural and emotional symptoms in prepubertal children was studied in an epidemiological survey conducted in Finland. Five thousand eight hundred thirteen children aged 8 and 9 years were screened using the Rutter Parent Questionnaire (RA2) for parents and the Rutter Teacher Questionnaire (RB2) for teachers. Information concerning family type, birth order and sibship size were obtained from the parents. The majority of the children (84%) in the sample lived with both their biological parents, 10% with a single parent, and around 5% with a biological parent and a stepparent. Around 1% of the children lived outside their original home. The prevalence of behavioural and emotional symptoms was lowest in children living with both their biological parents and highest among children living outside their original home according to both parents’ and teachers’ reports. Children living with a parent and a stepparent had problems more often at home, but less often at school than children living with a single parent. Living with a single father was associated with having more externalising, school-related problems, while living with a stepfather was associated with having more internalising, home related problems. Having younger siblings seemed to be associated with fewer problems at school, and being the youngest child with having less problems both at home and at school.

Maternal depressive symptoms: Associations with adolescents’ internalizing and externalizing problems and social competence

Abstract Background: The negative effect of maternal depressive symptoms on child wellbeing has been quite extensively studied. There is, however, debate as to whether it is the timing, the recurrence or the chronicity of maternal depressive symptoms that puts the childs wellbeing at risk. Aims: This study explores the associations between the timing, recurrence and the patterns of maternal depressive symptoms and adolescent psychosocial functioning. Methods: One hundred and ninety-one mothers and 192 adolescents were followed up from the mothers pregnancy to the childs adolescence. Maternal depressive symptoms were screened with the Edinburgh Postnatal Depression Scale prenatally, postnatally, in early and middle childhood, and at adolescence. The adolescents’ outcomes were screened using Child Behavior Checklists and Youth Self Reports. Results: The results indicate that the initial exposure to maternal depressive symptoms at pregnancy is associated with more externalizing problems in adolescence, 2 months postnatally with more internalizing problems, in early childhood with poorer social competence and concurrently with more externalizing problems. Combined analyses indicate that recurrent maternal depressive symptoms best explain adolescents’ internalizing problems and the chronic pattern of maternal depressive symptoms externalizing problems. The chronic and intermittent patterns of maternal depressive symptoms best explained adolescents’ poorer social competence. Conclusions: Recurrent or chronic maternal depressive symptoms rather than the timing predict adolescents’ psychosocial problems better. The timing, however, may explain the different kinds of problems in adolescence depending on the developmental task at the time of the exposure. The findings should be noted when treating both mothers and children in psychiatric clinics and other health services.

Long-term trajectories of maternal depressive symptoms and their antenatal predictors.

BACKGROUND Depressive symptoms, often long-term or recurrent, are common among mothers of young children and a well-known risk for child well-being. We aimed to explore the antecedents of the long-term trajectories of maternal depressive symptoms and to define the antenatal factors predicting the high-symptom trajectories. METHODS The sample comprised 329 mothers from maternity centers. Maternal depressive symptoms were assessed with the Edinburgh Postnatal Depression Scale (EPDS) antenatally and at two months, six months, 4-5 years, 8-9 years and 16-17 years after delivery. Maternal expectations concerning the baby were assessed with the Neonatal Perception Inventory (NPI). Background information was gathered with questionnaires. RESULTS A model including four symptom trajectories (very low, low-stable, high-stable and intermittent) was selected to describe the symptom patterns over time. The high-stable and the intermittent trajectory were both predicted pairwise by a high antenatal EPDS sum score as well as high EPDS anxiety and depression subscores but the other predictors were specific for each trajectory. In multivariate analyses, the high-stable trajectory was predicted by a high antenatal EPDS sum score, a high EPDS anxiety subscore, diminished life satisfaction, loneliness and more negative expectations of babies on average. The intermittent trajectory was predicted by a high antenatal EPDS sum score, a poor relationship with own mother and urgent desire to conceive. LIMITATIONS Only self-report questionnaires were used. The sample size was rather small. CONCLUSIONS The results suggest a heterogeneous course and background of maternal depressive symptoms. This should be considered in intervention planning.

Fathers’ postnatal depressive and anxiety symptoms: An exploration of links with paternal, maternal, infant and family factors

Abstract Background: Postnatal psychological symptoms have been studied less often in fathers than in mothers. However, recent research shows that fathers’ psychopathology may have long-term effects on their childrens emotional and behavioural development independently of maternal psychopathology. More research is needed on factors associated with paternal symptoms at the early stage of child development. Aims: The aim of the study was to examine the paternal, maternal, infant and family factors associated with the occurrence of depressive and anxiety symptoms in fathers of infants. Methods: As part of a study conducted in Tampere, Finland, on infants’ social withdrawal symptoms, both parents of 4-, 8- and 18-month-old infants (n = 194) completed the Edinburgh Postnatal Depression Scale (EPDS) and general information questionnaires during routine check-ups of the infants in well-baby clinics. Parental depressive and anxiety symptoms were screened using the recommended cut-off points for this purpose (5/6 for fathers and 7/8 for mothers on the EPDS). The associations between the fathers’ symptoms and paternal, maternal, infant and family factors were explored. Results: Twenty-one per cent of the fathers and 24% of the mothers scored above the cut-off points for depressive and anxiety symptoms on the EPDS. Both paternal and maternal factors predicted high paternal symptom level in regression models. Infant factors were not statistically significantly associated with paternal symptoms. Conclusions: Fathers psychological symptoms were associated with many facets of both parents’ impaired well-being. The whole family system should be considered whenever there are concerns about either parents psychological well-being.

Early mother–infant interaction: associations with the close relationships and mental health of the mother

The present study examined the association between a womans close relationships and mental health and the quality of her maternal behaviour in early mother–infant interaction. A total of 131 mothers and their infants participated in the study. The quality of the mothers childhood relationship with her own mother and her marital relationship were investigated in a semi‐structured interview and, as a part of the interview, the Structured Clinical Interview for DSM‐IV (SCID) was used to assess her mental health. Mother–infant interaction was videotaped at 8–11 weeks of the infants age, and scored using the Global Rating Scale for Mother–Infant Interaction. The mothers childhood relationship with her mother was significantly related to her own interactive and affective behaviour with her infant. A poor, disengaged marital relationship was also associated with poorer interactive behaviour but only among mothers with mental health problems. Thus the mothers close relationships had an effect on maternal behaviour; however, maternal perinatal psychopathology per se was not related to maternal behaviour at 2 months of the infants age.

The trajectories of child’s internalizing and externalizing problems, social competence and adolescent self-reported problems in a Finnish normal population sample

Group-based modeling techniques are increasingly used in developmental studies to explore the patterns and co-occurrence of internalizing and externalizing problems. Social competence has been found to reciprocally influence internalizing and externalizing problems, but studies on its associations with different patterns of these problems are scarce. Using data from a Finnish longitudinal normal population sample, trajectories of internalizing and externalizing problems were formed using the Child Behavior Checklist completed by the mother at the child’s age of 4- to 5-years-old, 8- to 9-years-old, and 16- to 17-years-old (N = 261). The results indicate that adolescent’s self-reported internalizing and externalizing problems based on the Youth Self Report were associated with the trajectories of internalizing and externalizing problems. Social competence both in early childhood and in adolescence was poorer among children with chronic internalizing problems and among those with adolescent-onset externalizing problems. One-third of the children who had a chronically high level of internalizing problems had an initially high but decreasing level of externalizing problems, while 33% of the adolescents with adolescent-onset externalizing problems had a chronically high level of internalizing problems. School psychologists are encouraged to screen for internalizing problems from children with behavioral, academic or social problems.

Child psychiatry in the Finnish health care reform: National criteria for treatment access

OBJECTIVES As a part of the Finnish National Health Care Project, to develop and validate nationwide standardised criteria for assessing the need for non-urgent child psychiatric specialised medical care (SMC). METHODS The Finnish criteria tool, a cutpoint measure indicating access to SMC, was developed on the basis of the Western Canada Waiting List Criteria Tool. The Finnish criteria were widely discussed at national level and finally confirmed by a national child psychiatric consensus meeting. The testing data included 949 new cases, aged 5-18 years, from SMC, family guidance clinics, primary health care and child protection. RESULTS The Finnish Child Psychiatric Criteria Tool covers the entire case-mix of child psychiatric disorders. Danger to self or others and psychotic symptoms have been combined into a threshold item. This alone suffices to indicate access to SMC. Sensitivity of the tool was 82% and specificity 74% with cutoff point 16/75. CONCLUSIONS Child psychiatric non-urgent SMC is provided in accordance with national criteria, publicly accessible in the Internet. The criteria development process evoked multisectoral discussion on organising child mental health services and, by determining the need of treatment requiring SMC, defined health policy.