Raquel A. Costa

Anxiety and depression during pregnancy in women and men

BACKGROUND High-anxiety and depression rates have been reported in women during pregnancy; however men and parity effects have not been studied as extensively. The purpose of this study was to analyze anxiety and depression in women and their partners during pregnancy, namely differences between the 1st, 2nd and 3rd pregnancy trimesters, between women and men, and between primiparous and multiparous. METHODS A sample of 300 women and their partners (n=560) were recruited during the 1st pregnancy trimester and have completed the STAI-S (State Anxiety Inventory) and the EPDS (Edinburgh Postnatal Depression Scale) in the 1st, 2nd and 3rd pregnancy trimesters. RESULTS Anxiety symptoms follow a U pattern in pregnancy, while depression symptoms decrease throughout pregnancy. Women show higher anxiety and depression values than men, although patterns of time variation are similar. Primiparous women and men display higher anxiety levels in the 1st than in the 3rd trimester, while multiparous register higher values in the 3rd than in the 1st pregnancy trimester. CONCLUSION Different time variation in pregnancy was found for anxiety and depression symptoms; however anxiety and depression symptoms are particularly high during the 1st trimester. Intervention needs will be analyzed according to the results.

Depression during pregnancy and the postpartum period in adolescent and adult Portuguese mothers

SummaryObjective: To study prevalence as well as risk factors for pregnancy and postpartum depression in a sample of adolescent and adult Portuguese mothers.Methods: The Edinburgh Postnatal Depression Scale (EPDS) was administered to 108 (54 adult and 54 adolescent) Portuguese women at 24–36 weeks of pregnancy and at 2–3 months postpartum.Results: Rates for EPDS > 12 are high during the 3rd trimester of pregnancy (18.5%) and at 2–3 months postpartum (17.6%), and not significantly different between these two periods; more than 1/4 of the sample (27.8%) had an EPDS > 12 before or after delivery. Adolescent mothers presented more depressive symptoms as well as more EPDS > 12 than adult mothers, both in pregnancy (25.9% versus 11.1%) and at 2–3 months postpartum (25.9% versus 9.3%); moreover, when considering other socio-demographics, adolescent mothers were still at risk for depressive symptoms during pregnancy as well as for postpartum depression. Women depressed in pregnancy, and ones who are under 18 years old and who live with the partner, were at risk for postpartum EPDS > 12.Conclusion: Adolescent mothers seem particularly at risk for depression during pregnancy and the postpartum period, therefore, just like the women who are depressed during pregnancy, they should be better targeted in preventive and intervention measures.

Teenage pregnancy, attachment style, and depression: A comparison of teenage and adult pregnant women in a Portuguese series

Abstract The aim of this Portuguese study is to compare the experience of pregnancy in teenage years and later adulthood and to examine insecure attachment style as a risk factor for depression during pregnancy. The Attachment Style Interview (ASI; Bifulco, Moran, Ball, & Bernazzani, 2002) and the Edinburgh Postnatal Depression Scale (EPDS; Cox, Holden, & Sagovsky, 1987) were administered to 66 pregnant adolescents and 64 adult women. Pregnant teenagers were found to be nearly three times more likely to have an insecure attachment style of Enmeshed, Angry-Dismissive, or Fearful style than adults, all at high levels of impairment (54% vs.19%, p < .02). Logistic regression showed, when all risk factors were entered, highly Enmeshed style and poor partner support provided the best model for depression with age at pregnancy no longer adding. Insecure attachment style should be addressed in prevention and intervention strategies with teenage mothers.

Mother-to-Infant Emotional Involvement at Birth

Objectives To study mother-to-infant emotional involvement at birth, namely factors (socio-demographics, previous life events, type of delivery, pain at childbirth, support from partner, infant characteristics, early experiences with the newborn, and mother’s mood) that interfere with the mother’s positive, negative and not clear emotions toward the newborn. Methods The Bonding Scale (an extended Portuguese version of the ‘New Mother-to-Infant Bonding Scale’) and the Edinburgh Postnatal Depression Scale were administrated during the first after delivery days to 315 mothers recruited at Júlio Dinis Maternity Hospital (MJD, Porto, Portugal). Results A worse emotional involvement with the newborn was observed when the mother was unemployed, unmarried, had less than grade 9, previous obstetrical/psychological problems or was depressed, as well as when the infant was female, had neonatal problems or was admitted in the intensive care unit. Lower total bonding results were significantly predicted when the mother was depressed and had a lower educational level; being depressed, unemployed and single predicted more negative emotions toward the infant as well. No significant differences in the mother-to-infant emotional involvement were obtained for events related to childbirth, such as type of delivery, pain and partner support, or early experiences with the newborn; these events do not predict mother’s bonding results either. Conclusion The study results support the need for screening and supporting depressed, unemployed and single mothers, in order to prevent bonding difficulties with the newborn at birth.

Screening for depression and anxiety disorders from pregnancy to postpartum with the EPDS and STAI

The Edinburgh Postnatal Depression Scale (EPDS) and the State Anxiety Inventory (STAI-S) are widely used self-report measures that still need to be further validated for the perinatal period. The aim of this study was to examine the screening performance of the EPDS and the STAI-S in detecting depressive and anxiety disorders at pregnancy and postpartum. Women screening positive on EPDS (EPDS ≥ 9) or STAI-S (STAI-S ≥ 45) during pregnancy (n = 90), as well as matched controls (n = 58) were selected from a larger study. At 3 months postpartum, 99 of these women were reassessed. At a second stage, women were administered a clinical interview to establish a DSM-IV-TR diagnosis. Receiver operator characteristics (ROC) analysis yielded areas under the curve higher than .80 and .70 for EPDS and STAI-S, respectively. EPDS and STAI-S optimal cut-offs were found to be lower at postpartum (EDPS = 7; STAI-S = 34) than during pregnancy (EPDS = 9; STAI-S = 40). EPDS and STAI-S are reasonably valid screening tools during pregnancy and the postpartum.

Mother-to-infant and father-to-infant initial emotional involvement

While infant attachment has been largely studied, parental attachment is still relatively unknown, especially when referred to fathers. However, it is mainly recognised that parents’ emotional involvement with the newborn contributes to the quality of the interaction and the care they provide. The aim of this study was to study mother‐to‐infant and father‐to‐infant initial emotional involvement; namely, differences between mothers and fathers and changes in mother’s emotions toward the neonate within the first days after delivery. The Bonding Scale, an extended Portuguese version of the ‘New Mother‐to‐Infant Bonding Scale’, was administered during the first two days after childbirth to a sample of 315 mothers and 141 fathers (n = 456), at the Júlio Dinis Maternity Hospital (Portugal). Most mothers and fathers show positive emotions and only a few of them showed negative emotions toward the infant. Maternal and paternal emotional involvement toward the newborn tend to be similar; nevertheless, fathers show less fear and better emotional involvement with the neonate, while mothers are sadder and show more emotions not related to bonding. During the first days following delivery, emotions not related to bonding, such as fear, seem to decrease in mothers.

Depressive symptoms and mental adjustment in women with breast cancer.

Depression is the most common psychological disorder observed in breast cancer patients. The purposes of this study were: to determine the prevalence of depressive symptoms among women with breast cancer; and examine the association of depressive symptoms and demographic and clinical variables as well as the association between mental adjustment to cancer and level of depressive symptoms.

Brazelton Neonatal Behavioral Assessment Scale: a psychometric study in a Portuguese sample.

BACKGROUND The Neonatal Behavioral Assessment Scale (NBAS, Brazelton & Nugent, 1995) is an instrument conceived to observe the neonatal neurobehavior. Data analysis is usually performed by organizing items into groups. The most widely used data reduction for the NBAS was developed by Lester, Als, and Brazelton (1982). OBJECTIVE Examine the psychometric properties of the NBAS items in a sample of 213 Portuguese infants. METHOD The NBAS was performed in the first week of infant life (3 days±2) and in the seventh week of life (52 days±5). RESULTS Principal component analyses yielded a solution of four components explaining 55.13% of total variance. Construct validity was supported by better neurobehavioral performance of 7-week-old infants compared with 1-week-old infants. CONCLUSION Changes in the NBAS structure for the Portuguese sample are suggested compared to Lester factors in order to reach better internal consistency of the scale.

Infants’ behavioral and physiological profile and mother–infant interaction

This study aims to (a) identify and profile groups of infants according to their behavioral and physiological characteristics, considering their neurobehavioral organization, social withdrawal behavior, and endocrine reactivity to stress, and to (b) analyze group differences in the quality of mother–infant interaction. Ninety-seven 8-week-old infants were examined using the Neonatal Behavioral Assessment Scale and the Alarm Distress Baby Scale. Cortisol levels were measured both before and after routine inoculation between 8 and 12 weeks. At 12 to 16 weeks mother–infant interaction was assessed using the Global Rating Scales of Mother–Infant Interaction. Three groups of infants were identified: (a) “withdrawn”; (b) “extroverted”; (c) “underaroused.” Differences between them were found regarding both infant and mother behaviors in the interaction and the overall quality of mother–infant interaction. The identification of behavioral and physiological profiles in infants is an important step in the study of developmental pathways.

Parental tobacco consumption and child development

OBJECTIVE To analyze the association between parental tobacco consumption and the prevalence of psychomotor development disorders in children between 6 and 22 months of age. METHOD One hundred and nine mothers, fathers, and their babies participated in the study. The sociodemographic and clinical conditions were assessed using questionnaires. Tobacco consumption was assessed using the Fagerström Test for Nicotine Dependence (FTND). Child development was evaluated using the Scale of Psychomotor Development in Early Childhood. RESULTS There was a significant negative correlation between the fathers morning smoking (FTND) and the childs language development quotient; r=-0.41, p=0.005, r(2)=0.15. The children of mothers without nicotine dependence had a higher mean language development quotient than children of mothers with nicotine dependence; F(1, 107)=5.51, p=0.021, ηp(2)=0.05. CONCLUSION Parental smoking appears to have a detrimental effect on child development.