Kathleen Kendall-Tackett

The use of antidepressants in pregnant and breastfeeding women: a review of recent studies.

Antidepressants are one of the most commonly prescribed medications for pregnant and lactating women. However, there have been some recent concerns about their safety. This article summarizes recent research on the impact of untreated depression on the baby, the effects of antidepressants on the baby when prescribed during pregnancy, the short- and longer-term effects of prenatal exposure on infants and children, and the passage of medications into breast milk. Recommendations are made on providing mothers and their health care providers with information so they can make accurate risk/benefit analyses about using these medications while pregnant or breastfeeding.

Mother–Infant Sleep Locations and Nighttime Feeding Behavior: U.S. Data from the Survey of Mothers' Sleep and Fatigue

The controversy around mother–infant bedsharing continues to grow. In order to make sound policy recommendations, policy makers need current data on where infants sleep and how families handle nighttime feedings. The present study is a survey of 4,789 mothers of infants 0–12 months of age in the U.S. The findings indicate that almost 60% of mothers bedshare and that this occurs throughout the first year. These findings also indicate that 25% of mothers are falling asleep with their infants in dangerous sleep locations, such as chairs, sofas or recliners. Recommendations for promoting safe infant sleep are made.

The long-term impact of childhood abuse on internalizing disorders among older adults: The moderating role of self-esteem

Objectives: First, to determine if childhood experiences of abuse have an impact on internalizing disorders (e.g., anxiety and depressive disorders) among older adults. Second, we wish to determine if self-esteem plays a role in explaining the relationship between abuse and internalizing disorders. Method: First, we conducted an analysis on a population sample of participants aged 50 years or older (mean age = 67 years; SD = 10.3) assessed at two time points, three years apart (Wave 1, N = 1460; Wave 2, N = 1090). We examined the relationship between reports of childhood abuse (physical, emotional, and sexual) and internalizing disorders. Second, we determined the role self-esteem played in explaining the relationship. Results: We found that childhood experiences of abuse assessed at Wave 1 predicted the number of DSM-IV internalizing disorders occurring three years later. Demonstrating the specificity of self-esteem; we found self-esteem, but not emotional reliance, to moderate the relationship between abuse and internalizing disorders such that childhood abuse had more negative effects on those with low self-esteem compared to those with higher self-esteem. Contrary to prediction, self-esteem did not mediate the relationship between abuse and internalizing disorders. Conclusion: The negative effects of childhood abuse persist for many years, even into older adulthood. However, contrary to the findings in younger adults, self-esteem was not correlated with childhood abuse in older adults. Moreover, childhood abuse only had a negative effect on those who had low self-esteem. It may be through the process of lifespan development that some abused individuals come to separate out the effects of abuse from their self-concept.

The Effect of Feeding Method on Sleep Duration, Maternal Well-being, and Postpartum Depression

When a breastfeeding mother is depressed--or even at risk for depression--she is often advised to supplement with formula so that she can get more sleep. Results of recent studies suggest, however, that exclusively breastfeeding mothers actually get more sleep than their mixed- or formula-feeding counterparts. The present study examines the relationship between feeding method, maternal well-being, and postpartum depression in a sample of 6,410 mothers of infants 0-12 months of age. Our findings revealed that women who were breastfeeding reported significantly more hours of sleep, better physical health, more energy, and lower rates of depression than mixed- or formula-feeding mothers. Further, there were no significant differences on any measure between mixed- and formula-feeding mothers, suggesting that breastfeeding is a qualitatively different experience than even mixed feeding.

Causal Mechanisms and Multidirectional Pathways Between Trauma, Dissociation, and Health

Do traumatic events increase the risk of health problems? Over the past decade, researchers in a number of fields—health psychology, medicine, nursing, epidemiology, and public health—have found that they do. In the early stages of this work, researchers worked independently and did not communicate with one another, which limited the application of their findings. For example, researchers in nursing and several fields of medicine— gynecology, gastroenterology, rheumatology—began to notice, quite independently, that patients with pain often had a history of child or domestic abuse (Kendall-Tackett, Marshall & Ness, 2003; Sachs-Ericsson, Cromer, Hernandez, & Kendall-Tackett, this issue). Unfortunately, for many years these findings were discounted because the pain syndromes were usually so-called functional conditions (such as irritable bowel syndrome or fibromyalgia), meaning that lab or radiologic findings rarely matched a patient’s level of pain or impairment from that pain. Because these findings were not placed in a broader context, symptoms were viewed as idiosyncratic, written off as primarily psychological in origin, and were generally not of interest to health care providers.

Childbirth-Related Posttraumatic Stress Disorder: Symptoms and Impact on Breastfeeding

Birth is a significant life event and generally a happy one. Although labor is often challenging, it can also be empowering, with mothers experiencing elation and strength. Unfortunately, for other women, birth can be difficult, can be overwhelming, and can lead to psychological trauma. Some women may experience depression and posttraumatic stress disorder (PTSD) following their births. These effects can last for years and can cause difficulties in women’s relationships with their partners and their babies. Difficult births can also negatively affect breastfeeding. This article describes the prevalence of PTSD after childbirth and summarizes the symptoms so that International Board Certified Lactation Consultants (IBCLCs) can help recognize it and refer mothers to appropriate resources.

The influence of prior rape on the psychological and physical health functioning of older adults

Objectives: Older adults who have experienced traumatic events earlier in life may be especially vulnerable to additional challenges associated with aging. In a cross-sectional study of older females, the present study examines whether a history of rape is associated with current psychological and health problems. Method: This study used existing data from the female respondents (N = 1228) in the National Social Life, Health, and Aging Project (NSHAP), a national probability sample of adults between the ages of 57 and 85 interviewed in their homes. It was determined whether or not the participant experienced forced sexual contact since the age of 18. Measures of psychological health (e.g., scales of depression, anxiety, and loneliness), the presence or absence of a number of serious health problems, and a one-item measure of self-esteem were obtained. Results: Adult rape occurred in 7% of the sample. On average, 36 years had elapsed since the rape had occurred. Using structural equation modeling (SEM), rape was associated with lower self-esteem, psychological, and physical health functioning. Self-esteem partially mediated the association between rape and psychological functioning, but not health functioning. These associations were significant even after controlling for participant characteristics and risky health behaviors. Conclusions: Mechanisms linking prior rape to psychological and health problems in older age are discussed, as well as treatment recommendations for symptomatic older adults.

Intervention for Mothers Who Have Experienced Childbirth-Related Trauma and Posttraumatic Stress Disorder

Lactation consultants may be one of the first healthcare providers who see mothers following a difficult birth. As such, they can be key sources of support and information for mothers at this critical time. Several aspects of the International Board Certified Lactation Consultant’s (IBCLC) scope of practice can fit within trauma-informed care, including helping mothers identify possible trauma symptoms and posttraumatic stress disorder (PTSD), and addressing breastfeeding issues that may be sequelae of a traumatic birth. IBCLCs can inform mothers about their treatment options and refer them to additional sources of support. This article describes breastfeeding issues that might arise in the wake of a traumatic birth and summarizes evidence-based treatment options for PTSD so that IBCLCs can share this information with mothers.

Birth Interventions Related to Lower Rates of Exclusive Breastfeeding and Increased Risk of Postpartum Depression in a Large Sample

Overview: This study examines the impact of birth interventions, such as epidurals, inductions, pain medications, and cesarean sections, on breastfeeding and postpartum depression with a large sample of mothers. Method: Data for the present analyses were from the Survey of Mothers’ Sleep and Fatigue, a 253-item online survey of 6,410 mothers 0–12 months postpartum. Findings: Mothers were significantly more likely to be breastfeeding if they had unassisted vaginal births, or did not have epidurals or other pain medication during labor. Mothers had higher depressive symptoms if they perceived that their labors were difficult and they experienced high levels of pain. They also had higher depressive symptoms if they had planned or emergency cesareans, but unplanned (nonemergent) cesareans were associated with lower levels. When multivariate analysis was conducted, only epidural, postpartum hemorrhage, and postpartum surgery were significantly related to depressive symptoms. Conclusions: The type of birth a woman experiences influences breastfeeding and her emotional health. Contrary to previous findings, epidurals are associated with lower breastfeeding rates and higher rates of postpartum depression. Other birth interventions and complications, such as postpartum hemorrhage or surgery, have a negative impact as well.

Respectful Care During Birth = Better Breastfeeding Rates Remarkable New Statement From WHO Calls for the End of Disrespect and Abuse During Childbirth

The groups WHO identified as most likely to experience disrespectful or abusive treatment are adolescents, Many women experience disrespectful and abusive treatment during childbirth in facilities worldwide. Such treatment not only violates the rights of women to respectful care, but can also threaten their rights to life, health, bodily integrity, and freedom from discrimination. (World Health Organization, 2014)