Mood state and psychological adjustment to pregnancy

Summary The aim of this study was to investigate whether there is an association between antenatal mood state (depression and anxiety) and psychological adjustment to pregnancy. Participants were first-time, low obstetric risk mothers at a Sydney teaching hospital who completed self-report questionnaires measuring depression, anxiety, thoughts about motherhood and self as mother and relationship with the fetus. Higher symptom levels of antenatal anxiety were related to less optimal maternal-fetal quality of attachment, more negative attitudes towards motherhood and the self as mother. Similar trends were found for symptoms of depression, however depression was not significantly related to psychological adjustment to pregnancy variables. The significance of anxiety in the current study highlights the importance of considering anxiety in the psychological adjustment to pregnancy, as well as the in the context of perinatal mental health more generally. Implications of these findings for intervention are also briefly discussed.     

Exploring the paths between dysfunctional attitudes towards motherhood and postpartum depressive symptoms: The moderating role of self‐compassion

Better understanding how cognitive processes operate to influence women's depressive symptoms during the postpartum period is crucial for informing preventive and treatment approaches. The present study aimed to examine the relationship between women's dysfunctional attitudes towards motherhood and depressive symptoms, considering the mediating role of negative automatic thoughts and the moderating role of self‐compassion. A sample of 387 women in the postpartum period cross‐sectionally answered a set of questionnaires to assess dysfunctional attitudes towards motherhood, negative automatic thoughts (general and postpartum‐specific), depressive symptoms, and self‐compassion. Women with clinically significant depressive symptoms presented more dysfunctional attitudes towards motherhood, more frequent negative thoughts, and lower self‐compassion. More dysfunctional beliefs about others' judgments and about maternal responsibility were associated with higher depressive symptoms, and this effect occurred through both general and postpartum‐specific thoughts related to the metacognitive appraisal of the thought content. Moreover, these relationships occurred only when women presented low or moderate levels of self‐compassion. These results highlight the need to comprehensively assess women's cognitive variables during the postpartum period with appropriate measures, for the early identification of women with more dysfunctional beliefs about motherhood, who may be at higher risk of depression. Moreover, preventive/treatment approaches should aim not only to challenge women's preexisting dysfunctional beliefs but also to promote a more self‐compassionate attitude towards themselves.     

The Anxiety Attitude and Belief Scale: initial psychometric properties in an undergraduate sample

The development of a measure of attitudes and beliefs intended to index a psychological vulnerability to anxiety problems is described. Items for the Anxiety Attitude and Belief Scale (AABS) were developed by polling researchers and clinicians active in the area of anxiety disorders. The initial psychometric properties of the resulting scale were examined in a sample of undergraduates. The three factors underlying the AABS appear to index theoretically interesting domains, and both the total and factor scores showed adequate reliability. Confirmatory factor analyses suggested that the AABS indexes a distinct, although likely overlapping, domain from the Dysfunctional Attitude Scale (A. N. Weissman and A. T. Beck, presentation at the meeting of the Association for the Advancement of Behavior Therapy, Chicago, IL, 1978), a theoretically related scale of cognitive vulnerability to depression and other emotional disorders. Finally, a cross‐ lagged panel analysis indicated no causal relationship between the AABS and depression. On the other hand, this analysis suggested a causal relationship between the AABS and anxiety, with prior AABS scores predicting later anxiety, rather than the reverse. Copyright © 2000 John Wiley & Sons, Ltd.     

The Pregnancy Related Beliefs Questionnaire (PRBQ): An examination of the psychometric properties in perinatal samples

Background

Identifying vulnerability to perinatal depression is an important public health issue. Risk factors include general and maternal‐specific dysfunctional attitudes. Scales of maternal attitudes have a number of shortcomings. Further, it is not known whether antenatal maternal attitudes predict post‐natal depression, independently of general dysfunctional attitudes (GDA). The aim of the current study was to examine the psychometric properties of the Pregnancy Related Beliefs Questionnaire (PRBQ) and to establish, prospectively, the utility of the revised PRBQ in predicting the symptoms of post‐natal depression.

Method

In Study 1, a cross‐sectional sample of 344 participants, who were either pregnant or in the post‐natal period, completed a battery of questionnaires assessing background factors, GDA, attitudes specific to motherhood (PRBQ), and depression. In Study 2, a sample of 210 women completed a battery of questionnaires, including a measure of GDA, the PRBQ‐8, and depression, on two occasions: early in the second trimester of pregnancy and post‐natally.

Results

Exploratory and confirmatory factor analyses supported a one‐factor, eight‐item measure of maladaptive attitudes specific to motherhood (PRBQ‐8). The PRBQ‐8 was found to have good convergent, concurrent, and predictive validity and high internal and test–retest reliability. A hierarchical regression analysis revealed that antenatal PRBQ‐8 scores predict the severity of post‐natal depression symptoms, after controlling for background factors, antenatal depression, and GDA.

Conclusions

The PRBQ‐8 is a psychometrically sound measure of maternal attitudes that can be used antenatally to identify women at risk of post‐natal depression.     

Individualized measurement of irrational beliefs in remitted depressives

Recent reviews of cognitive theories of depression have noted that individualized assessment strategies might help to resolve mixed findings regarding the stability of depressotypic beliefs and attitudes. We describe encouraging results for an individualized measure of one such cognitive construct, irrational beliefs. Twenty depression-prone women (recurrent major depressives in full remission) and twenty closely matched never-depressed controls completed leading forced-choice measures of irrational beliefs (the Belief Scale; BS) and sociotropy-autonomy (The Revised Personal Style Inventory), as well as the Specific Demands on Self Scale (SDS). The BS requires participants to rate their agreement with twenty preselected statements of irrational beliefs, while the SDS focuses on whether participants harbor any strongly held irrational beliefs, even if uncommon or idiosyncratic. Consistent with previous research, there were no group differences on the traditional measure of irrational beliefs. In contrast, depression-prone participants strongly exceeded controls on the SDS, and this difference persisted after controlling for residual depression, anxiety symptoms, anxiety diagnoses, sociotropy, and autonomy. These findings provide some initial support for a key assumption of the rational-emotive model of depression, and, more broadly, suggest that individualized assessment strategies may help researchers capture the core negative beliefs of asymptomatic individuals, even in the absence of mood or cognitive priming.     

Metacognitive,cognitive and developmental predictors of generalised anxiety disorder symptoms

Generalised anxiety disorder (GAD) is the most significant and common of the anxiety disorders. Intolerance of uncertainty (IU) and negative metacognitive beliefs are two prominent cognitive factors in models of GAD, however only one study to date has examined the relative contribution of these factors. Therefore, this study aimed to investigate and compare these cognitive factors in their prediction of GAD symptoms, and also to examine possible developmental influences on GAD by examining the link between symptoms and the parentification style of childrearing. In this analogue study, 119 non‐clinical participants (M age 22.90 years; 95 females, 24 males) completed measures of these constructs. Results indicated that both IU and negative beliefs about worry significantly related to GAD symptoms, however, the degree to which they predicted GAD symptoms did not significantly differ. Although a weak but significant relationship was found between parentification and GAD, this relationship did not remain significant after controlling for depression. Implications and limitations are discussed.     

Depression and anxiety symptoms of mothers of preterm infants are decreased at 4 months corrected age with Family Nurture Intervention in the NICU

Preterm delivery can precipitate maternal psychological morbidities. Family Nurture Intervention (FNI) was designed to minimize these by facilitating the emotional connection between mother and infant, beginning early in the infant’s neonatal intensive care unit (NICU) stay. We examined depression and anxiety symptoms of mothers of preterm infants at 4 months infant corrected age (CA). One hundred fifteen mothers who delivered between 26 and 34 weeks gestational age were randomized to receive standard care (SC) or standard care plus FNI. Mothers’ self-reported depressive symptoms (Center for Epidemiologic Studies Depression Scale: CES-D) and state anxiety (Spielberger State-Trait Anxiety Inventory: STAI) symptoms were assessed at enrollment, near to term age, and 4 months (CA). At 4 months CA, mean CES-D and STAI scores were significantly lower in FNI mothers compared to SC mothers. Effectiveness of FNI can only be evaluated as an integrated intervention strategy as it was not possible to control all aspects of FNI activities. Although there was considerable loss to follow-up, analyses suggest that resulting biases could have masked rather than inflated the measured effect size for depressive symptoms. FNI may be a feasible and practicable way to diminish the impact of premature delivery on maternal depressive and anxiety symptoms.     

Psychological factors associated with persistent postnatal depression: past and current relationships, defence styles and the mediating role of insecure attachment style

BACKGROUND: This study prospectively investigated the factors underlying the maintenance and persistence of postnatal depression beyond the first year after birth. METHOD: One hundred primiparous women who were admitted to a parentcraft hospital for a week were assessed after discharge at 4 and 12 months postpartum. Various measures of mood, interpersonal relationships and defence styles were administered at 4 months and the relation between these measures and clinically elevated symptoms of depression at 12 months was examined. RESULTS: At 12 months, 30% of all mothers and 60% of those diagnosed depressed at 4 months continued to report clinically significant levels of depressive symptomatology. The strongest predictor of depression at 12 months was severity of symptoms at 4 months, and women from a non-English speaking background were significantly more likely to remain depressed. Reports of low maternal care in childhood, marital dissatisfaction at 4 months, an attachment style characterised by anxiety over relationships and immature defence styles were significant predictors of clinically elevated depression scale scores at 12 months. Furthermore, an insecure attachment style was shown to mediate the effect of low maternal care in childhood, while other cognitive and interpersonal factors appeared to contribute additively in maintaining depressive symptoms. LIMITATIONS: Self-report measures were used to measure insecure attachment styles and depression at 12 months. CONCLUSIONS: Findings demonstrate that both childhood and concurrent relationship difficulties contribute to the maintenance of postpartum depression. Interventions for persistent depression need to address relationship difficulties as well as depressive symptomatology.     

Predicting adolescent postpartum caregiving from trajectories of depression and anxiety prior to childbirth: a 5-year prospective study

Symptoms of depression and anxiety in pregnancy have been linked to later impaired caregiving. However, mood symptoms are often elevated in pregnancy and may reflect motherhood-specific concerns. In contrast, little is known about the effects of prepregnancy depression and anxiety on postpartum caregiving. Understanding these developmental risk factors is especially important when childbearing also occurs during adolescence. The sample comprised 188 adolescent mothers (ages 12–19 years) who had participated in a longitudinal study since childhood. Mothers were observed in face-to-face interaction with the infant at 4 months postpartum, and caregiving behaviors (sensitivity, hostile-intrusive behavior, and mental state talk) were coded independently. Data on self-reported depression and anxiety gathered in the 5 years prior to childbirth were drawn from the large-scale longitudinal study. Parallel process latent growth curve models revealed unique effects of distal anxiety and slow decline in anxiety over time on lower levels of maternal mental state talk after accounting for the overlap with depression development. Depressive symptoms showed significant stability from distal measurement to the postpartum period, but only concurrent postpartum mood was associated with poorer quality of maternal speech. The results highlight specific targets for well-timed preventive interventions with vulnerable dyads.     

The effects of maternal risk factors during pregnancy on the onset of sleep difficulties in infants at 3 months old

Sleep problems in young children are among the most common concerns reported to paediatricians. Sleep is thought to have important regulatory functions, and sleep difficulties in early childhood are linked to several psychosocial and physiological problems. Moreover, several prenatal factors have been found to influence infants’ sleep. Among them, most of the studies have been focused on maternal prenatal depression and/or anxiety as potential risk factors for sleep problems in childhood, whereas other relevant psychological factors during pregnancy have not received as much attention. Therefore, we aimed to examine the effect of several psychiatric maternal risk factors during pregnancy (i.e. symptoms of anxiety, depression, insomnia, alcohol use, seasonality, attention deficit and hyperactivity disorder and/or stressful life events) on the onset of some sleep problems related to sleep quality and sleep practices in 3‐month‐old infants. We examined 1,221 cases from a population‐based birth cohort, with subjective measures during pregnancy in mothers, and at 3 months after birth in the infants. The findings showed that all the maternal risk factors during pregnancy, except for symptoms of alcoholism and sleepiness, were related to sleep difficulties in infants. Interestingly, attention deficit and hyperactivity disorder symptomatology in mothers during pregnancy was the only variable that predicted more than two sleeping difficulties (i.e. long sleep‐onset latency, co‐sleeping with parents and irregular sleeping routines) at 3 months old. Our results highlight the relevance of maternal risk factors during pregnancy, and not only prenatal depression and/or anxiety, as variables to be considered when examining sleep difficulties in infants.     

Depression and anxiety in perinatal period: prevalence and risk factors in an Italian sample

Accumulating evidence suggests that pregnancy does not protect women from mental illness. The aim of this study was to assess the prevalence, sociodemographic correlates, and the risks factors for perinatal depression and anxiety. Five hundred ninety women between 28th and the 32nd gestational weeks were recruited and submitted to a sociodemographic, obstetric, and psychological interview. The Edinburgh Postnatal Depression Scale (EPDS) and the state-trait anxiety inventory (STAI-Y) were also administered in antenatal period and 3?months postnatally. The Structured Clinical Interview for DSM-IV (SCID-I) was used to diagnose mood and anxiety disorders. Three months after delivery, EPDS was administered by telephone interview. Women with an EPDS score ≥10 were 129 in antenatal period (21.9%) and 78 in postnatal period (13.2%). During pregnancy 121 women (20.5%) were positive for STAI-Y state and 149 women (25.3%) for STAI-Y trait. The most important risk factors for antenatal depression are: foreign nationality, conflictual relationship with family and partner, and lifetime psychiatric disorders. The principal risk factors for postnatal depression are: psychiatric disorders during pregnancy and artificial reproductive techniques. Psychiatric disorders, during and preceding pregnancy, are the strongest risk factors for antenatal state and trait anxiety. Antenatal depressive and anxiety symptoms appear to be as common as postnatal symptoms. These results provide clinical direction suggesting that early identification and treatment of perinatal affective disorders is particularly relevant to avoid more serious consequences for mothers and child.     

Explaining depression symptoms in patients with social anxiety disorder: Do maladaptive metacognitive beliefs play a role?

Social anxiety disorder (SAD) is a major risk factor for developing symptoms of depression. Severity of social anxiety has previously been identified as a risk factor, and cognitive models emphasize dysfunctional schemas and self‐processing as the key vulnerability factors underlying general distress in SAD. However, in the metacognitive model, depressive and other symptoms are related to metacognitive beliefs. The aim of this study was therefore to test the relative contribution of metacognitions when controlling for SAD severity and factors postulated in cognitive models. In a cross‐sectional design, 102 patients diagnosed with primary SAD were included. We found that negative metacognitive beliefs concerning uncontrollability and danger and low confidence in memory emerged as the only factors explaining depressive symptoms in the regression model, suggesting that metacognitive beliefs are associated with increased depressive symptoms in SAD patients.     

Toward Establishing the Transcultural Validity of Sluggish Cognitive Tempo: Evidence From a Sample of South Korean Children

All sluggish cognitive tempo (SCT) research has been conducted in North America and Western Europe, with the addition of 1 study in Chile. Our objective was to determine the internal and external validity of 9 SCT and 9 Diagnostic and Statistical Manual of Mental Disorders (5th ed.) attention deficit/hyperactivity disorder inattention (ADHD-IN) symptoms in South Korean children. Mothers, fathers, and teachers rated SCT, ADHD-IN, ADHD hyperactivity/impulsivity (HI), oppositional defiant disorder (ODD), anxiety, depression, academic impairment, and social impairment in 1st- to 6th-grade children (6–13 years of age) from South Korea (Sample 1: mothers rated 885 children and fathers rated 646 children; 941 unique children, 54% girls; Sample 2: 99 teachers rated 297 children, 44% girls). The SCT and ADHD-IN symptoms showed convergent validity (substantial loadings on their respective factors) and discriminant validity (loadings near zero on the alternative factor) across all three raters. Although ADHD-IN showed a positive relationship with ADHD-HI and ODD even after controlling for SCT across all three raters, SCT was nonsignificantly (mothers and fathers) or negatively (teachers) related to ADHD-HI and ODD after controlling for ADHD-IN. Higher SCT scores predicted higher anxiety, depression, academic impairment (teachers only), and social impairment (teachers only) even after controlling for ADHD-IN, whereas higher ADHD-IN scores predicted higher anxiety (mothers and fathers only), depression, academic impairment, and social impairment after controlling for SCT. The study provides initial evidence for the internal and external validity of SCT relative to ADHD-IN in South Korean children, thereby providing the first evidence for SCT’s validity in Asian children.     

Body mass index, eating attitudes, and symptoms of depression and anxiety in pregnancy and the postpartum period

OBJECTIVE: This report describes associations between body mass index (BMI; kg/m2), eating attitudes, and affective symptoms across pregnancy and the postpartum period in a sample of 64 women. METHODS: As part of a larger study, women were recruited during pregnancy and followed prospectively to 14 months postpartum. Measures included self-reported prepregnancy and 4-month postpartum BMI as well as pregnancy, 4-month, and 14-month postpartum eating attitudes (EAT), depressive symptoms (CES-D), and anxiety symptoms (STAI). RESULTS: During pregnancy, symptoms of depression or anxiety were not significantly correlated with concurrent eating attitudes or measures of BMI. However, at 14 months postpartum, measures of eating attitudes and both depression and anxiety symptoms were associated. Measures of BMI were associated with depressive and anxiety symptoms at both 4 and 14 months postpartum. Four-month eating attitudes and BMI predicted 14-month postpartum depressive symptoms, beyond pregnancy, and 4-month postpartum measures of affective symptoms. Results suggested that overweight women were at risk for elevated anxiety at 4 months and depressive symptoms at both 4 and 14 months postpartum. CONCLUSIONS: These results provide evidence for a significant, albeit moderate, relationship between BMI, eating attitudes, and symptoms of depression and anxiety in the postpartum period that are not present during pregnancy.     

An evaluation of two bonding questionnaires: a comparison of the Mother-to-Infant Bonding Scale with the Postpartum Bonding Questionnaire in a sample of primiparous mothers

Summary The emotions and attitudes of mothers towards their infants are crucial for the child’s well-being and development. Some mothers experience a delay in the onset of maternal affection after childbirth and occasionally a longer lasting failure to bond will ensue. Little is known about the precise prevalence of these difficulties, how they relate to maternal mental health, how they develop over time and what their biological and psychosocial correlates are. In research studies the mother-infant relationship has traditionally been assessed using observational methods but these are time consuming and not suited for screening in clinical practice. Two self-rating instruments have recently been developed to assess maternal bonding. Both can be used in large samples of recently delivered mothers including those suspected to be at high risk of bonding disorders. In this study, the psychometric properties of the 8-item Mother-to-Infant Bonding Scale (MIB) and the 25-item screening questionnaire for mother–infant bonding disorders, namely the Postpartum Bonding Questionnaire (PBQ), were examined in a sample of first-time mothers in order to establish their reliability and validity. Ninety-six women completed the MIB, PBQ and the Kennerley Blues Scale on day 2–4 postpartum. Both bonding instruments demonstrated acceptable reliability and reasonable validity, with the exception of the PBQ subscale of risk of abuse.     

Role of self-compassion in psychological well-being among perinatal women

Self-compassion is associated with depression and anxiety in general samples. Although recent research indicates that dysfunctional maternal attitudes predict the development of perinatal depression and anxiety symptoms, no research to date has examined the construct of self-compassion and its relationship with psychological well-being in perinatal women. Pregnant and postpartum women (N?=?189) completed self-report measures of depression and anxiety history, current depression and anxiety symptom severity, and self-compassion. Women with higher depression and anxiety symptom severity had significantly lower self-compassion. Additionally, women with self-reported prior history of depression or anxiety had significantly lower self-compassion even while controlling for current depression or anxiety symptom severity, respectively. Our results suggest that self-compassion warrants further attention in the study of the development, maintenance, and treatment of perinatal mood and anxiety disorders.     

Depression and anxiety among postpartum and adoptive mothers

Similar to biological mothers during the postpartum period, women who adopt children experience increased stress and life changes that may put them at risk for developing depression and anxiety. The purpose of the current study was to compare levels of depression and anxiety symptoms between postpartum and adoptive women and, among adoptive women, to examine associations between specific stressors and depressive symptoms. Data from adoptive mothers (n = 147), recruited from Holt International, were compared to existing data from postpartum women (n = 147). Differences in the level of depression and anxiety symptoms as measured by the Inventory of Depression and Anxiety Symptoms among postpartum and adoptive women were examined. Associations between specific stressors and depressive symptoms were examined among adoptive mothers. Postpartum and adoptive women had comparable levels of depressive symptoms, but adoptive women reported greater well-being and less anxiety than postpartum women. Stressors (e.g., sleep deprivation, history of infertility, past psychological disorder, and less marital satisfaction) were all significantly associated with depressive symptoms among adoptive women. The level of depressive symptoms was not significantly different between the two groups. In contrast, adoptive women experienced significantly fewer symptoms of anxiety and experienced greater well-being. Additionally, adoptive mothers experienced more depressive symptoms during the year following adoption when the stressors were present. Thus, women with these characteristics should be routinely screened for depression and anxiety.     

Risk and resistance factors in the adaptation in mothers of children with juvenile rheumatoid arthritis

OBJECTIVE: To examine the importance of illness severity, child functional status, psychosocial stress, intrapersonal factors, stress processing, and social-ecological factors in predicting psychological symptoms among mothers of children with juvenile rheumatoid arthritis (JRA). METHODS: Mothers of 92 children with JRA completed surveys while waiting with their children for physician appointments or during JRA meeting breaks. RESULTS: Mothers reported higher mean levels of psychological symptoms than a normative group. Higher levels of psychosocial stress predicted increased psychological symptoms after accounting for disease severity and functional status. Maternal appraisal of the illness tended to moderate the relationship between illness stress and psychological symptoms, and maternal education moderated the relationship between daily hassles stress and psychological symptoms. CONCLUSIONS: These data indicate that mothers of children with JRA are at risk for psychological distress. Inteventions that take into account the buffering effects of maternal education and appraisal may serve to decrease the effects of maternal stress.     

Health beliefs and perceived need for mental health care of anxiety and depression--the patients' perspective explored

Patients' illness representations and beliefs about treatment for depression and anxiety, as well as their perceived needs, are important for treatment. A systematic review was conducted of 71 studies describing the beliefs or perceived needs of patients and non-patients. Patients give multi-dimensional explanations for depression and see both psychological and medication treatment as helpful. People who suffer from depression have more positive beliefs about biological etiology and medication treatment than healthy people, or those with less severe depressive symptoms. Anxiety patients view psychological interventions as their best treatment option. Between 49% and 84% of the patients with depression or anxiety perceive a need for treatment, mostly for counseling and medication. All patients prefer psychological treatment forms to medication. A majority of patients view antidepressants as addictive and many perceive stigma and see practical and economic barriers to care. The most vulnerable groups in terms of seeking and receiving mental health care for depression and anxiety seem to be minority groups, as well as younger and older patients. More research is required into the specific needs of anxiety and depression patients. Open communication between patient and provider could lead to valuable improvements in treatment.     

Predictors for exacerbation/improvement of postpartum depression—A focus on anxiety,the mothers' experiences of being cared for by their parents in childhood and borderline personality: A perspective study in Japan

Objective

To investigate the course and influencing factors of postpartum depression in women during the child rearing period.

Methods

Data were collected during 0-year-old baby check-ups and a follow-up investigation. 262 participants were included in the analysis. Both surveys employed the Zung Self-Rating Depression Scale (ZSDS). The first also comprised the State Trait Anxiety Inventory, Parental Bonding Instrument (PBI), and Borderline Scale Index, enabling sub-division of participating subjects into healthy/pathological groups. ZSDS group and survey scores were compared using the t-test.

Results

The average ages of the children and the ZSDS scores in both surveys were 7.0±3.2 and 21.8±2.4 months, 40.6±7.9 and 40.1±8.7, respectively, with no significant differences among depression scores. When subjects were divided according to individual scale scores, and survey scores compared, depression significantly improved in the high trait/state anxiety group, high PBI maternal care score group, nonborderline personality (BP) trait group, and breast feeding group, whereas depression was significantly exacerbated in the low PBI maternal care score group.

Discussion

Postpartum depression characterized by strong anxiety and a depressive state in mothers with favorable psychological backgrounds showed gradual improvement. We noted an exacerbation of depression during the separation period in mothers who had received poor maternal care. We assume that the feeling of abandonment induced by individuation of their children is a major factor.

Limitations

There is concern that some depressive women may have dropped out due to a performance bias.

Conclusions

Sharing our findings about exacerbation/improvement of depression among medical staff may be beneficial for postpartum mothers.