Linda Duffett-Leger

Postpartum Depression is a Family Affair: Addressing the Impact on Mothers, Fathers, and Children

The purpose of this paper is to present research on the effects of postpartum depression (PPD) on mothers, fathers, and children that point to a re-conceptualization of PPD as a mental health condition that affects the whole family. As such, the objectives of this paper are to discuss: (1) the incidence and effects of PPD on mothers and fathers; (2) common predictors of PPD in mothers and fathers, and (3) the effects of PPD on parenting and parent-child relationships, and (4) the effects of PPD on childrens health, and their cognitive and social-emotional development. Finally, the implications for screening and intervention if depression is re-conceptualized as a condition of the family are discussed.

Socioeconomic Status and Child Development A Meta-Analysis

Lower socioeconomic status (SES) is widely accepted to have deleterious effects on the well-being and development of children and adolescents. However, rigorous meta-analytic methods have not been applied to determine the degree to which SES supports or limits children’s and adolescents behavioural, cognitive and language development. While SES is largely determined by combinations of variables such as parental education level, marital status, and income, SES may also interact with other variables mediating or moderating the influence of SES on children’s behavior and cognitive development. Thus, the objective of this study was to conduct a meta-analysis of research on the relationship between composite measures of SES and developmental outcomes for children and adolescents between the ages of birth to 19 years of age. The results revealed very small to small, but significant effects of SES on aspects of the three outcome variables of literacy and language, aggression, and internalizing behaviours including depression. Many other factors come in to play that may better explain the small, but significant relationship between SES and development. Given the small observed associations, policy makers and programmers may focus interventions on family and community factors that contribute to child and adolescent developmental outcomes across the socioeconomic spectrum.

Maternal depressive symptoms and parenting of children from birth to 12 years.

Maternal depression, especially in the early years of child development, affects parenting behaviors that have been repeatedly linked to poor outcomes in children. However, recurrent maternal depression may be a more potent predictor of parenting than depression that only occurs in the early years. Longitudinal population data were used to examine the influence of depression in the first 2 years postpartum alone or in combination with recurrent episodes of depression on self-reported parenting behaviors known to influence children’s development. Growth curve hierarchical linear modeling was used to examine the relationships among depression in the early years, recurrent depression, and parenting during children’s first 12 years of life. Findings revealed that 63% of the depressed mothers reported recurrent episodes of depression. Self-reported parenting behaviors characterized by positive forms of discipline, firmness, and consistency were related to recurrent episodes of depression, whereas warmth and nurturant parenting behaviors were unaffected by recurrent episodes.

Cervical Cancer Screening Practices among University Women

OBJECTIVE To assess predictors of young womens intentions to be screened for cervical cancer. DESIGN A descriptive, correlational, cross-sectional study using the Theory of Planned Behavior (TPB). PARTICIPANTS A total of 904 young women (mean age=20.7 years; SD=1.77) participated in an online cervical cancer screening survey. METHOD A web-based survey (WebCT) was used to survey young women, 25 years of age or less, attending a university in eastern Canada. Descriptive, correlational, and logistic regression statistics were calculated. RESULTS Findings indicated that social norms (perceptions about whether or not people close to them think Pap screening is important) and perceived behavioral control (perceptions about personal resources or barriers to receiving a Pap test) were significantly related to young womens intentions to be screened. CONCLUSION Strategies to promote cervical cancer screening among young university women need to recognize the impact of social norms and perceived barriers on Pap screening intentions in this population.

Cortisol patterns of depressed mothers and their infants are related to maternal–infant interactive behaviours

Background: Postpartum depression (PPD) reduces maternal–infant interaction quality, stresses infants and mothers, and is linked to adverse child social–emotional and cognitive developmental outcomes. Objectives: A hypothesised mechanism for these observed relationships is the stress-related over-activation of the hypothalamic–pituitary–adrenal (HPA) axis and resultant altered cortisol patterns. While cortisol levels of mothers and infants are strongly correlated, environmental, maternal, infant and maternal–infant interactive factors may also contribute to altered cortisol patterns. Thus, the objective of this study is to use Barnard’s Child Health Assessment Model to explore the influences on maternal and infant diurnal cortisol patterns for matched pairs of mothers and infants affected by postpartum depression. Method: Secondary analyses were conducted on data collected from mothers and their infants affected by symptoms of PPD (n = 53). Multiple regression models were undertaken to study mothers’ and infants’ diurnal cortisol patterns using area under the curve analysis. Results: Having a preterm child predicted both an increase in overall cortisol levels (p = .01) and a reduction in the daily decline (p = .02) in cortisol patterns for mothers. Difficult life circumstances (p = .04) also predicted a reduction in mothers’ expected daily decline in cortisol. For infants, maternal–infant interaction qualities including cognitive growth-fostering (p = .03) and socioemotional growth fostering (p = .02) reduced overall cortisol levels and increased the daily decline in cortisol, respectively. Conclusion: For mothers, preterm birth was the most robust predictor of elevated cortisol levels. For infants, more optimal maternal–infant interactions predicted lower levels of infant cortisol. Future research should examine interactions among infant temperament, maternal responsiveness and infant cortisol patterns.

Mothers Affected by Domestic Violence: Intersections and Opportunities with the Justice System

Secondary analysis from two qualitative studies was used to explore the interactions of mothers exposed to intimate partner violence (IPV) with the justice system. Results were categorized according to three key themes: (a) negative interactions within the justice system, (b) positive interactions within the justice system, and (c) recommendations for an improved justice system response to domestic violence. Overall, findings suggested that mothers affected by domestic violence are confronted with negative attitudes and ineffectual practices within convoluted bureaucratic criminal justice systems, leaving many feeling revictimized. Despite the negative aspects of the legal system, women in both studies cited positive examples of feeling comforted, validated, and even empowered by the actions of the specific service providers. The findings of both studies underscore the need for greater efficiencies within the justice system and mandatory training for service providers, making it easier for women who have left their abusers to access appropriate support services, as well as the importance of affirmational support particularly when it can be provided by a peer with shared experiences. Future research is needed to guide the development of interventions that will limit the impacts of IPV exposure on child developmental outcomes.

Interactive online health promotion interventions: A “health check”

As an increasingly popular medium by which to access health promotion information, the Internet offers significant potential to promote (often individualized) health-related behavioral change across broad populations. Interactive online health promotion interventions are a key means, therefore, by which to empower individuals to make important well being and treatment decisions. But how ldquohealthyrdquo are interactive online health promotion interventions? This paper discusses a literature review (or ldquohealth checkrdquo) of interactive online health interventions. It highlights the types of interactive interventions currently available and identifies areas in which research attention is needed in order to take full advantage for the Internet for effective health promotion.

Using Play to Improve Infant Sleep: A Mixed Methods Protocol to Evaluate the Effectiveness of the Play2Sleep Intervention

Background One in four Canadian families struggle with infant sleep disturbances. The aim of this study is to evaluate Play2Sleep in families of infants with sleep disturbances. In addition to parental education on infant sleep, Play2Sleep uses examples from a video-recorded, structured play session with mothers and fathers separately to provide feedback on parent–infant interactions and their infant’s sleep-related social cues. The quantitative phase will answer the research question: Does one dose of Play2Sleep delivered during a home visit with mothers and fathers of infants aged 5 months reduce night wakings at age 7 months? The qualitative phase will answer the research question: What are parental perceptions of family experiences, processes, and contexts related to Play2Sleep and infant sleep? The overarching mixed methods research question is as follows: How do parental perceptions of family experiences, processes, and contexts related to infant sleep explain the effectiveness of Play2Sleep? Method and analysis An explanatory sequential mixed methods design will be used. In the quantitative phase, a randomized controlled trial and RM-ANOVA will compare night wakings in infants whose parents receive Play2Sleep versus standard public health nursing information. Sixty English-speaking families (mothers and fathers) of full-term, healthy, singleton, 5-month-old infants who perceive that their infant has sleep disturbances will be recruited. The primary outcome measure will be change in the number of night wakings reported by parents. The qualitative component will use thematic analysis of family interviews to describe parental perceptions and experiences of infant sleep. Mixed methods integration will use qualitative findings to explain quantitative results. Discussion Play2Sleep is a novel approach that combines information about infant sleep with personalized feedback on parent–infant interactions and infant cues. Including fathers and mixed methods should capture complex family experiences of infant sleep disturbances and Play2Sleep. If effective, Play2Sleep has possible application for preventing infant sleep disturbance and tailoring for other populations. Clinical Trial Registration www.ClinicalTrials.gov, identifier: NCT02742155. Registered on 2016 April 23.