Michael T. Hynan

A measurement model of perinatal stressors: Identifying risk for postnatal emotional distress in mothers of high-risk infants

A measurement model of perinatal stressors was first evaluated for reliability and then used to identify risk factors for postnatal emotional distress in high-risk mothers. In Study 1, six measures (gestational age of the baby, birthweight, length of the babys hospitalization, a postnatal complications rating for the infant, and Apgar scores at 1 and 5 min) were obtained from chart reviews of preterm births at two different hospitals. Confirmatory factor analyses revealed that the six measures could be accounted for by three factors: (a) Infant Maturity, (b) Apgar Ratings, and (c) Complications. In Study 2, a modified measurement model indicated that Infant Maturity and Complications were significant predictors of postnatal emotional distress in an additional sample of mothers. This measurement model may also be useful in predicting (a) other measures of psychological distress in parents, and (b) measures of cognitive and motor development in infants.

Convergent and discriminant validity of the perinatal PTSD questionnaire (PPQ): a preliminary study.

We evaluated the validity of the Perinatal Posttraumatic Stress Disorder Questionnaire (PPQ) as a measure of posttraumatic stress symptomatology. Mothers of high-risk infants (N = 91) and healthy, full-term infants (N = 51) answered the PPQ and two other convergent measures of posttraumatic stress disorder symptoms, the Impact of Event Scale (IES) and the Penn Inventory (PI). The Need for Cognition Scale (NCS) was used as a divergent measure. Correlations among the convergent measures were significantly greater than the correlation between the PPQ and NCS. High-risk mothers also scored higher than normal mothers on the PPQ and IES. The results support the validity of the PPQ.

Modification of the Perinatal PTSD Questionnaire to enhance clinical utility

Objective:To enhance the clinical utility of the Perinatal Post-Traumatic Stress Disorder (PTSD) Questionnaire (PPQ), the current study sought to refine the measure by changing the item response options from dichotomous choices to a likert scale format.Study Design:Using a convergent/divergent validity design and two data sources (traditional survey and World Wide Web), 58 high-risk and 86 low-risk mothers answered four questionnaires.Results:Principal components analysis of items on the modified PPQ revealed three components conceptually similar to the diagnostic criterion associated with PTSD. In addition, convergent and divergent validity of the modified measure was supported. The clinical utility of the modified PPQ was established with a strong positive likelihood ratio.Conclusion:The modified PPQ is a useful clinical tool for identifying mothers experiencing significant emotional distress during the postnatal period so they may be referred for mental health services.

Identifying Mothers at Risk for Postnatal Emotional Distress: Further Evidence for the Validity of the Perinatal Posttraumatic Stress Disorder Questionnaire

OBJECTIVE: We evaluated the construct validity of the Perinatal Posttraumatic Stress Disorder Questionnaire.STUDY DESIGN: Using a convergent/divergent validity design and two data sources (traditional survey and World Wide Web), 121 high-risk and 52 low-risk mothers answered four questionnaires.RESULTS: High-risk mothers scored higher than low-risk mothers on all measures of emotional distress. There were significant positive correlations among the convergent measures of emotional distress, which were significantly larger than any correlation of the divergent measure with a convergent measure. Scores on the Perinatal Posttraumatic Stress Disorder Questionnaire were positively related to mothers seeking formal psychotherapy for their childbirth experiences. Questionnaire responses were not related to data source.CONCLUSION: The Perinatal Posttraumatic Stress Disorder Questionnaire is a useful tool for identifying significant emotional distress in mothers during the postnatal period.

Screening parents of high-risk infants for emotional distress: rationale and recommendations.

Having a baby hospitalized in a neonatal intensive care unit (NICU) is a potentially traumatic event for parents. This article summarizes research documenting heightened symptoms of depression and post-traumatic stress in these parents and reviews studies of the relationship of parental distress with impaired infant and child development. We describe an array of validated screening devices for depression and post-traumatic stress, along with research on risk factors for elevated scores. In making recommendations for screening both mothers and fathers for emotional distress in the NICU, we (a) present commentary on the pros and cons of screening, (b) propose a timetable for screening and (c) describe both supportive interventions for parents in the NICU and a variety of referral possibilities for parents most at risk.

Models of Psychotherapy Outcome: Are They Applicable in Training Clinics?

To explore whether psychotherapy models are applicable in the training clinic setting, the dose-effect model of psychotherapy outcome was tested in the outpatient clinic of an American Psychological Association-approved doctoral training program in clinical psychology. Outcome data, using the Outcome Questionnaire 45.2, were gathered immediately prior to each psychotherapy session during the course of treatment (mean total number of sessions: 14.81). Sixty-one clients, treated by 21 trainee clinicians, participated. Although a similar pattern emerged, response to treatment was not as rapid as the dose-effect model would predict. Ideas for future research are proposed. The dose-effect model of psychotherapy outcome (Howard, Kopta, Krause, & Orlinsky, 1986) emerged from meta-analytic findings spanning 30 years and has spawned renewed interest and research into psychotherapy research. However, those analyses did not examine possible site differences (e.g., whether the site was a training clinic) in the dose-effect response.

Test of the Phase Model of Psychotherapy in a Training Clinic

Recent publications suggest that psychotherapy models generated in outpatient settings do not fully generalize to the training clinic. A possible explanation for these findings is that the nature in which change occurs during psychotherapy may actually differ according to setting. To examine this possibility, the phase model of psychotherapy was tested in an outpatient training clinic. Results partially support the phase model, suggesting that the nature of change during effective psychotherapy within the training clinic setting does not differ from that in other outpatient settings. That is, clients who completed effective courses of treatment in the training clinic environment generally experience an improvement in subjective well-being before evidencing a reduction in symptom distress. Obtaining success in role performances (i.e., work or school) appears to emerge last. Practitioners may enhance treatment outcomes by targeting interventions that are congruent with the phase of the individual client presenting for treatment.

Recommendations for mental health professionals in the NICU

This article describes recommended activities of social workers, psychologists and psychiatric staff within the neonatal intensive care unit (NICU). NICU mental health professionals (NMHPs) should interact with all NICU parents in providing emotional support, screening, education, psychotherapy and teleservices for families. NMHPs should also offer educational and emotional support for the NICU health-care staff. NMHPs should function at all levels of layered care delivered to NICU parents. Methods of screening for emotional distress are described, as well as evidence for the benefits of peer-to-peer support and psychotherapy delivered in the NICU. In the ideal NICU, care for the emotional and educational needs of NICU parents are outcomes equal in importance to the health and development of their babies. Whenever possible, NMHPs should be involved with parents from the antepartum period through after discharge.

Psychosocial program standards for NICU parents.

This article provides a rationale for and brief description of the process of developing recommendations for program standards for psychosocial support of parents with babies in the neonatal intensive care unit (NICU). A multidisciplinary workgroup of professional organizations and NICU parents was convened by the National Perinatal Association. Six interdisciplinary committees (family-centered developmental care, peer-to-peer support, mental health professionals in the NICU, palliative and bereavement care, follow-up support and staff education and support) worked to produce the recommendations found in this supplemental issue. NICU parents contributed to the work of each committee.

Aggression in a Competitive Task

This paper describes the construction and validation of a competitive task which uses a new apparatus designed for the study of aggression. A variety of personality measures were answered by 144 male and female university students before they participated in the task. During the task three independent variables (instrumentality of aggression, sex of aggressor, and sex of target) were manipulated to determine the comparability of the results with past research. Instrumental shocking occurred more frequently than non-instrumental (hostile) shocking, and males shocked more than females. A factor analysis of the personality measures produced a factor, Repression vs Expression, which represented a dimension of aggressiveness and accounted for 18% of the variance in hostile shocking. The competition paradigm was shown to provide a valid index of hostile aggression while minimizing deception and risk to subjects.