Susan Conroy

Prenatal depression, prenatal anxiety, and spontaneous preterm birth: a prospective cohort study among women with early and regular care.

Objective: This article investigates the effects of antenatal depression and anxiety on spontaneous preterm birth resulting either from preterm labor or preterm premature rupture of membranes. Methods: We conducted a prospective cohort study of 681 women with singleton pregnancies consecutively recruited between 20 and 28 weeks of gestation in the Obstetrics Department of the French University Hospital of Caen. Most were of European ethnic origin and received early and regular antenatal care. The assessment of gestational age was based on ultrasound examination (occurring before 13 weeks of gestation for 94.9% of the women). Depression and anxiety were assessed using self-administered questionnaires: the Edinburgh Postnatal Depression Scale and the Spielberger State-Trait Anxiety Inventory. Logistic regression analysis, controlling for sociodemographic factors (e.g., maternal age, occupation) and obstetric factors (e.g., previous preterm birth, cervical or vaginal infection), provided adjusted odds ratios (ORs) and 95% confidence intervals (CIs). Results: Spontaneous preterm birth occurred in 31 women (4.8%). The rate of spontaneous preterm birth was significantly higher among women with high depression scores (9.7%) as opposed to other women (4.0%) even after adjustment for potential confounding factors (adjusted OR = 3.3, 95% CI = 1.2–9.2, p = .020). Anxiety was not significantly associated with the outcome. There were no significant interaction effects between psychological and biomedical factors. Conclusions: These findings provide evidence that antenatal depression is significantly associated with spontaneous preterm birth in a population of European women receiving early and regular care. CRH = corticotropin-releasing hormone; EPDS = Edinburgh Postnatal Depression Scale; STAI-Y = State-Trait Anxiety Inventory; BMI = body mass index; HPA = hypothalamic–pituitary–adrenocortical; ACTH = adrenocorticotropin hormone.

Identifying the women at risk of antenatal anxiety and depression: A systematic review

Background Pregnancy is a time of increased vulnerability for the development of anxiety and depression. This systematic review aims to identify the main risk factors involved in the onset of antenatal anxiety and depression. Methods A systematic literature analysis was conducted, using PubMed, PsychINFO, and the Cochrane Library. Original papers were included if they were written in English and published between 1st January 2003 and 31st August 2015, while literature reviews and meta-analyses were consulted regardless of publication date. A final number of 97 papers were selected. Results The most relevant factors associated with antenatal depression or anxiety were: lack of partner or of social support; history of abuse or of domestic violence; personal history of mental illness; unplanned or unwanted pregnancy; adverse events in life and high perceived stress; present/past pregnancy complications; and pregnancy loss. Limitations The review does not include a meta-analysis, which may have added additional information about the differential impact of each risk factor. Moreover, it does not specifically examine factors that may influence different types of anxiety disorders, or the recurrence or persistence of depression or anxiety from pregnancy to the postpartum period. Conclusions The results show the complex aetiology of antenatal depression and anxiety. The administration of a screening tool to identify women at risk of anxiety and depression during pregnancy should be universal practice in order to promote the long-term wellbeing of mothers and babies, and the knowledge of specific risk factors may help creating such screening tool targeting women at higher risk.

Review articleIdentifying the women at risk of antenatal anxiety and depression: A systematic review

Background Pregnancy is a time of increased vulnerability for the development of anxiety and depression. This systematic review aims to identify the main risk factors involved in the onset of antenatal anxiety and depression. Methods A systematic literature analysis was conducted, using PubMed, PsychINFO, and the Cochrane Library. Original papers were included if they were written in English and published between 1st January 2003 and 31st August 2015, while literature reviews and meta-analyses were consulted regardless of publication date. A final number of 97 papers were selected. Results The most relevant factors associated with antenatal depression or anxiety were: lack of partner or of social support; history of abuse or of domestic violence; personal history of mental illness; unplanned or unwanted pregnancy; adverse events in life and high perceived stress; present/past pregnancy complications; and pregnancy loss. Limitations The review does not include a meta-analysis, which may have added additional information about the differential impact of each risk factor. Moreover, it does not specifically examine factors that may influence different types of anxiety disorders, or the recurrence or persistence of depression or anxiety from pregnancy to the postpartum period. Conclusions The results show the complex aetiology of antenatal depression and anxiety. The administration of a screening tool to identify women at risk of anxiety and depression during pregnancy should be universal practice in order to promote the long-term wellbeing of mothers and babies, and the knowledge of specific risk factors may help creating such screening tool targeting women at higher risk.

Maternal Psychopathology and Infant Development at 18 Months: The Impact of Maternal Personality Disorder and Depression

OBJECTIVE No previous longitudinal study has examined the impact of comorbid maternal personality disorder (PD) and depression on child development. We set out to examine whether maternal PD and depression assessed at 2 months post partum would be independently associated with adverse developmental outcomes at 18 months of age. METHOD Women were recruited into the study shortly after delivery and screened for depression and PD. Those meeting criteria for depression, PD, or both conditions, were selected for assessment at 2 months post partum, together with a comparison group with neither condition (total sample, N = 200). Assessments of cognitive, social and emotional development were conducted with their children at 18 months of age. RESULTS Maternal postpartum depression and PD were both associated with higher levels of dysregulated infant behavior. There was a significant interaction between depression and PD in the model of dysregulated behavior and the detrimental effects of maternal depression and PD were evident only among mothers with both conditions. Maternal depression was independently associated with impaired infant cognitive scores and higher levels of internalizing behavior. CONCLUSIONS Future studies of the effects of maternal depression should also take into account the effects of comorbid maternal PD. Health professionals need to be aware of the possible co-occurrence of PD among mothers presenting with postnatal depression and that mothers with these co-occurring disorders are likely to require greater support.

Measurement of mother–infant interactions and the home environment in a European setting: preliminary results from a cross-cultural study

BACKGROUND Infant development is adversely affected in the context of postnatal depression. This relationship may be mediated by both the nature of early mother-infant interactions and the quality of the home environment. AIM To establish the usefulness of the Global Ratings Scales of Mother-Infant Interaction and the Infant-Toddler version of the Home Observation for the Measurement of the Environment (IT-HOME), and to test expected associations of the measures with characteristics of the social context and with major or minor depression. METHOD Both assessments were administered postnatally in four European centres; 144 mothers were assessed with the Global Ratings Scales and 114 with the IT-HOME. Affective disorder was assessed by means of the Structured Clinical Interview for DSM-IV Disorders. RESULTS Analyses of mother-infant interaction indicated no main effect for depression but maternal sensitivity to infant behaviour was associated with better infant communication, especially for women who were not depressed. Poor overall emotional support also reduced sensitivity scores. Poor support was also related to poorer IT-HOME scores, but there was no effect of depression. CONCLUSIONS The Global Ratings Scales were effectively applied but there was less evidence of the usefulness of the IT-HOME.

Stability and outcome of persistent infant crying

Abstract Six week old infants who fussed and cried for 3 or more hrs per day (persistent criers), evening criers, and moderate criers were assessed using researcher and maternal measures of infant, maternal and family characteristics at 6 weeks, 5 months and 15 months of infant age. Convergent evidence of stable individual differences in negative behavior was found between 6 weeks – 5 months and 5 – 15 months of age. Objectively hard-to-soothe infants, particularly, were distinguished on a range of researcher and maternal measures. Between 6 weeks and 15 months, infant negative behavior was not a stable characteristic, although mothers continued to rate the same infants as fussy/difficult. In multiple regression analyses, infant negative behavior at 6 weeks did not predict maternal or researcher measures of infant negativity, temperament, behavior problems or cognition at 15 months. Maternal and family variables mediated the development of infant negative behavior.

Assessing psychosocial risk in pregnant/postpartum women using the contextual assessment of maternity experience (CAME) : Recent life adversity, social support and maternal feelings

BackgroundThe Contextual Assessment of Maternity Experience (CAME) interview was developed to characterise the psychosocial context relevant to the maternity experience by providing a detailed picture of women’s lives during the transition to motherhood. More specifically, it was designed to enable the assessment of major risk factors for emotional disturbances in pregnant and postpartum women, especially depression, within the same instrument and using a coherent methodological framework.MethodThe CAME assesses three domains relevant to motherhood: 1) recent life adversity or stressors; 2) the quality of social support and key relationships including partner relationship; and 3) maternal feelings towards pregnancy, motherhood and the baby. Two high-risk samples of inner-city London women were used to test the psychometric qualities of the CAME components.ResultsOverall, the internal consistencies of the relevant components were high in both samples examined. The validity of the three components of the measure was evidenced by their association with either maternal characteristics or parenting assessments.ConclusionIt was concluded that the CAME shows promise as a measure of the psychosocial risk factors involved in the maternity experience for future research in this field.

Do pregnancy and childbirth adversities predict infant crying and colic? Findings and recommendations

Bouts of unexplained crying in 1- to 3-month-old infants are a common problem for parents and health services. One proposed explanation has linked the crying to preceding adversities, such as maternal stress and cigarette smoking during pregnancy and complications during childbirth. In the first part of this review, we argue that studies of these links have methodological shortcomings, and make recommendations about the safeguards needed to overcome these shortcomings. In part two, we present a study that assesses the relations between adversity indices and validated measures of crying in two separate cohorts of infants. Four indices of childbirth adversity predicted infant crying separately and cumulatively in cohort 1, but not in cohort 2. We conclude that there is a need for further research that includes replication and other safeguards. Infant crying is a highly emotional issue for many parents. Before researchers add to their burden by claiming that maternal prenatal anxiety, cigarette smoking, or labour medication, contribute to their babys crying, we need to be sure of our grounds.

Differential effects of ethnic density on the risk of postnatal depression and personality dysfunction

BACKGROUND The relationship between ethnic density and psychiatric disorder in postnatal women in the UK is unclear. AIMS To examine the effect of own and overall ethnic density on postnatal depression (PND) and personality dysfunction. METHOD Multilevel analysis of ethnically mixed community-level data gathered from a sample of 2262 mothers screened at 6 weeks postpartum for PND and personality dysfunction. RESULTS Living in areas of higher own ethnic density was protective against screening positive for PND in White women (z = -3.18, P = 0.001), even after adjusting for area level deprivation, maternal age, relationship status, screening positive for personality dysfunction, parity and geographical clustering (odds ratio (OR) 0.98 (95% CI 0.96-0.99); P = 0.002), whereas the effect on personality dysfunction (z = -2.42, P = 0.016) was no longer present once the effect of PND was taken into account (OR = 0.99 (95% CI 0.90-1.0); P = 0.13). No overall ethnic density effect was found for women screening positive for PND or personality dysfunction. CONCLUSIONS In White women, living in areas of higher own ethnic density was protective against developing PND.

Mental health screening and early intervention: clinical research study for under 5-year-old children in care in an inner London borough

Typically the social-emotional development or mental health of under 5-year-old Children in Care (CiC) is not routinely assessed and there are few published data in the UK on the prevalence of difficulties for these children. Our hypothesis was that there could be a significant level of unidentified and unmet need within this group. A screening procedure was developed and piloted in a 12-month study assessing both child factors and the developing relationships between children and their caregivers. Previous screening studies have shown that recommendations for interventions are not reliably expedited. An intervention component was incorporated to address this and minimise delay in the children and their carers receiving support. Close inter-agency collaboration was integral to the establishment, implementation and high level of participation in the study. The screening proved acceptable to the majority of birth parents and caregivers, with 94% uptake of participants. In the year prior to screening only 10% of under-fives coming into care were identified as having difficulties in contrast to 67% of children in the screening cohort. The brief interventions offered were taken up in three-quarters of cases, leading to increased referrals on and access to mental health services for these children.