Jane Kohlhoff

Parenting self-efficacy: Links with maternal depression, infant behaviour and adult attachment

BACKGROUND This study examined predictors of parenting self-efficacy (PSE) in a sample of first-time mothers during the first year after childbirth and evaluated the effect of a brief, intensive, mother-infant residential intervention on PSE and infant behaviour. METHODS 83 primiparous women with infants aged 0-12 months admitted to a residential parent-infant program participated in a structured clinical interview for DSM-IV diagnosis of depressive and anxiety disorders and completed questionnaires assessing psychological distress, adult attachment and childhood parenting experiences. During their residential stay, nurses recorded infant behaviour using 24-hour charts. RESULTS Results showed PSE to be inversely correlated with maternal depression, maternal anxiety and attachment insecurity. Low levels of parental abuse during childhood, avoidant attachment, male infant gender and depressive symptom severity were found to predict low PSE. Major depression mediated the relation between attachment insecurity and PSE, but there were no links between PSE and infant behaviour. After the intervention, there was a significant improvement in PSE, with abusive parenting during childhood and depressive symptom severity being predictive of change. CONCLUSIONS This study highlights the links between maternal psychopathology and maternal background factors such as childhood parenting experiences and attachment style in the development of postnatal PSE. Directions for future research are discussed.

Pregnancy anxiety: A systematic review of current scales

BACKGROUND Depression in pregnancy is a serious health issue; however, anxiety in pregnancy, with a reported higher prevalence, may also be a serious issue. Anxiety symptoms in pregnancy can relate to several anxiety types, such as general anxiety, anxiety disorders, and pregnancy-related anxiety (PrA), anxiety characterised by pregnancy specific fears and worries. Awareness of these distinctions however, is not always widespread. Both general anxiety and PrA are associated with maternal negative outcomes (e.g. increased nausea) however; PrA is more often associated with negative outcomes for the child (e.g. preterm birth). Furthermore, PrA is potentially a risk factor for postnatal depression with assessment of PrA potentially affording important intervention opportunities. Currently several different instruments are used for PrA however their psychometric properties are unclear. To our knowledge a review of current instruments and their psychometric properties is lacking, this paper aims to fill that gap. METHODS Studies, which assessed PrA, published between 1983 and 2013 in peer-reviewed journals, were identified. RESULTS Sixty studies were identified after applying inclusion/exclusion criteria, and classified as: pregnancy-related anxiety specific, scales for other constructs, sub scales of another instrument and general anxiety scales. Each scales strengths and limitations were discussed. LIMITATIONS Our findings may be limited by restricting our review to peer-reviewed journals. This was done however as we sought to identify scales with good psychometric properties. CONCLUSIONS Currently no scales are available for pregnancy-related anxiety with sound theoretical and psychometric properties. Clinically the need for such a scale is highlighted by the potential intervention opportunities this may afford. Future research should be directed towards the development of such a scale.

Separation Anxiety, Attachment and Inter-Personal Representations: Disentangling the Role of Oxytocin in the Perinatal Period

In this paper, we aimed to assess cross-sectionally and longitudinally associations between disturbances in maternal early attachment experiences, symptoms of separation anxiety and depression and oxytocin plasma levels. We examined a mediational model that tested the hypothesis that anxious attachment style arising from the mothers’ early bonding experiences with her own parents was associated with high levels of separation anxiety which, via its impact on depression, was associated with reduced levels of oxytocin in the postnatal period. Data is reported on a structured sample of 127 women recruited during pregnancy from a general hospital antenatal clinic and an initial follow up cohort of 57 women who were re-assessed at 3-months post-partum. We found an association between lower oxytocin level in the post partum period and symptoms of separation anxiety and depression during pregnancy, as well as maternal negative interpersonal representations, upbringing attributes and anxious attachment style. Further meditational analysis revealed that the unique association between anxious attachment and depression is mediated by separation anxiety and that depressed mood mediated the relationship between separation anxiety and oxytocin. In conjunction with evidence from the literature suggesting that lower oxytocin level is associated with bonding difficulties, our findings have significant implications for understanding the biological processes underpinning adverse attachment experiences, negative affect state, and mother-to-infant bonding difficulties.

Antenatal psychosocial assessment and depression screening in a private hospital

It has been recommended that psychosocial assessment (including depression screening) be integrated into routine antenatal care across Australia, but implementation in the private sector has lagged.

Parent-Child Interaction Therapy for Toddlers: A Pilot Study

Parent-Child Interaction Therapy (PCIT) is an evidence-based program used to treat behavioral disorders in early childhood (2–7 years; Eyberg, 1988). This article describes a modified version of PCIT for young toddlers (PCIT-T) adapted to meet the developmental needs of children aged 12–24 months. A pilot study was conducted to evaluate the effectiveness of PCIT-T with 29 parent-toddler dyads (children aged <2 years) presenting with significant behavior problems, assessed pretreatment and posttreatment. Outcomes for two groups of older children who participated in PCIT (Group 1: 2–3 years, n = 29; Group 2: 3–4 years, n = 29) were also assessed. Results showed PCIT-T to be associated with a range of positive child and parental outcomes including decreased intensity of disruptive child behaviors, increased parental utilization of PCIT parenting skills, decreased parental depressive symptoms, and high levels of consumer satisfaction with the program. This study provides early evidence that a modified version of PCIT can be successfully used to treat behavior disorders in children aged less than 2 years.

Emotion Regulation Strategies and Parenting Practices among Parents of Children With Clinic-Referred Conduct Problems

SYNOPSIS Objective. This study examined the cognitive-affective strategies used by parents of young children with conduct problems to regulate emotions. Key questions concerned the extent to which these emotion regulation strategies are associated with positive and negative parenting practices and predict quality of parenting through interplay with parental depression. Design. Participants were families of toddlers (n = 84) referred to a tertiary-level health service for the treatment of disruptive behavior problems. Parenting practices were indexed through observational coding of parent–child interactions and self-report data on multiple dimensions of positive and negative parenting. Parents self-reported their use of cognitive reappraisal and expressive suppression—the two emotion regulation strategies that are most robustly associated with psychosocial functioning in adults. Results. Associations between emotion regulation strategy and quality of parenting were moderated by parental depressive symptom severity, with distinct effects seen for positive and negative parenting practices. In terms of positive parenting, more frequent use of cognitive reappraisal was associated with increased use of labeled praise among parents with lower levels of depressive symptoms, whereas parents who had higher levels of depressive symptoms engaged in less such praise regardless of how frequently they used reappraisal. In terms of negative parenting, frequent use of cognitive reappraisal and expression suppression were associated with reduced levels of negative parenting, but only among parents with high levels of depression. Conclusions. These findings add to growing support for the integration of emotion regulation strategies into family process models of early-onset conduct problems and related clinical interventions.

Adult separation anxiety and unsettled infant behavior: Associations with adverse parenting during childhood and insecure adult attachment

OBJECTIVE This study examined the prevalence and correlates of Adult Separation Anxiety Disorder (ASAD) and Adult Separation Anxiety (ASA) symptoms in a sample of first-time mothers with an unsettled infant during the first postpartum year. METHODS Eighty-three primiparous women admitted to a residential parent-infant program participated in a structured clinical interview for DSM-IV diagnosis and questionnaires assessing ASA symptoms, adult attachment and childhood parenting experiences. Nurses recorded infant behavior using 24-hour charts. RESULTS The prevalence of ASAD in this sample was 19.3% and women with ASAD were, on average, more likely to be diagnosed with depression and anxiety disorders, report aversive parenting experiences during childhood and show adult attachment style insecurity. Both ASAD and ASA symptoms were predicted by adult attachment anxiety, and ASAD was associated with unsettled infant behavior. Attachment anxiety and attachment avoidance mediated relations between parental over-control and ASAD diagnosis, and between parental abuse and ASAD diagnosis. Attachment anxiety mediated the relation between parental over-control and ASA symptoms, and attachment avoidance mediated the relations of parental over-control and parental abuse with ASA symptoms. CONCLUSIONS This study highlights the prevalence of ASAD among first time mothers experiencing early parenting difficulties and the roles of childhood parenting experiences and adult attachment style in the development of the disorder. This points to the importance of introducing universal screening for ASAD in postnatal settings, and for the development of targeted interventions.

Re-examining pregnancy-related anxiety: A replication study

BACKGROUND Recognition of pregnancy-related anxiety as a distinct anxiety is supported by evidence differentiating it from general anxiety and depression. Adverse associations with pregnancy-related anxiety further support this distinction. An influential study by Huizink et al. (2004), demonstrated that anxiety and depression contribute little to the variance of pregnancy-related anxiety, yet this study has not been replicated. Further, addressing limitations of the original study will provide further clarity to the findings. METHODS Participants (N=1209), were recruited online and completed three scales: pregnancy-related anxiety, general anxiety and depression. Multiple regression assessed the unique contribution of general anxiety and depression (predictors) to pregnancy-related anxiety scores (criterion) for each trimester. RESULTS Across pregnancy, general anxiety and depression explained only 2-23% of the variance in the pregnancy-related anxiety scores. Anxiety and depression showed small unique contributions for some trimesters and specific areas of concern, ranging from 2 to 11%. Comparisons to the original Huizink study showed most results were comparable. CONCLUSIONS The methodology and more detailed analyses employed addressed noted limitations of the Huizink study. Findings that the contribution of general anxiety and depression to the variance in pregnancy-related anxiety scores was low, supports previous conclusions that pregnancy-related anxiety is a discrete anxiety type. Recognition of this unique anxiety (associated with many deleterious outcomes) may provide opportunity for prenatal screening/early intervention, potentially resulting in improved pregnancy outcomes. Limitations include no exclusion of women deemed as high-risk pregnancy and the pregnancy-related anxiety scale limited in its ability to fully assess this anxiety type.

The pregnancy-related anxiety scale: A validity examination using Rasch analysis

BACKGROUND Pregnancy-related anxiety is increasingly recognised as a common condition that is associated with many deleterious outcomes for both the mother and infant (e.g., preterm birth, postnatal depression). Limitations in the psychometric properties and/or breadth of existing scales for pregnancy-related anxiety highlight the need for a psychometrically sound measure to facilitate effective screening and possible early interventions. The recently developed Pregnancy-related Anxiety Scale (PrAS) was evaluated using Rasch analysis to explore how the scales psychometric properties could be fine-tuned. METHOD A sample of 497 pregnant women completed the PrAS. Data were subjected to Rasch analysis, and the resulting scale structure examined using Confirmatory Factor Analysis. RESULTS After minor modifications, the Rasch model with 33-items and 8-factors demonstrated good fit, unidimensionality and excellent targeting and internal consistency. Confirmatory Factor Analysis confirmed the final structure, and Cronbachs alpha demonstrated excellent reliability. LIMITATIONS The use of the same sample for all analyses was a potential limitation due to the possibility of sample-specific influences. CONCLUSIONS The Rasch analysis further supports the internal construct validity of the PrAS. Ordinal to interval score conversions provide added precision to the analysis of the PrAS scores. The Rasch results, together with previous validation evidence, point to the PrAS as a comprehensive and psychometrically sound screening scale for pregnancy-related anxiety. The PrAS offers clinicians the ability to screen for pregnancy-related anxiety. The subscales provide additional insights into a womans pregnancy-related anxiety and her specific areas of concern, enabling more targeted interventions.

Partner involvement: negotiating the presence of partners in psychosocial assessment as conducted by midwives and child and family health nurses

Universal screening for maternal depression and assessment of psychosocial risks has been integrated into the routine perinatal care provided in many Australian hospitals, but to date, partners/fathers have been largely excluded from the process. This study explored the ways in which clinicians in health service settings include partners who attend antenatal and postnatal visits with women. Qualitative data were collected using observations (n = 54), interviews (n = 60), and discussion groups (n = 7) with midwives and child and family health nurses who conducted the appointments. Transcripts from observations, interviews, and discussion groups underwent qualitative analysis, and key themes were identified. Results showed partners to have little or no involvement in psychosocial assessment and depression screening. Thematic analysis revealed four key themes: negotiating partner exclusion, partial inclusion, womens business or a couple concern? and they know anyway. Partner involvement appeared to be challenged particularly by mandatory interpersonal violence screening, which, according to health service policy, is to be conducted confidentially. Overall, results highlighted partner involvement in perinatal depression screening and psychosocial assessment processes and identified some of the benefits such as partner disclosure, but also the challenges and complexities of inclusion of partners. Clinical implications and directions for further education and research are discussed.