Parenting stress in mothers of very preterm infants — Influence of development,temperament and maternal depression

Objective

To measure levels of parenting stress and postnatal depression in mothers of very preterm infants in comparison with mothers of infants born at term is the objective of this study. The study also aimed to explore factors associated with parenting stress in the mothers of the preterm infants.

Methods

One hundred and five mothers who delivered 124 babies at ≤ 30 weeks gestation were enrolled together with 105 term mothers who delivered 120 babies. At one year of age (corrected for prematurity for the preterm cohort), the mothers completed the Parenting Stress Index Short Form (PSI), the Edinburgh Postnatal Depression Scale (EPDS) and the Short Temperament Scale for Toddlers. The infants had neurodevelopmental assessment. The preterm and term groups were compared.

Results

Questionnaires were completed by 101 of the preterm mothers and 98 of the term mothers. The mean PSI Total Stress score was significantly higher for the preterm mothers (70.28 vs 64.52, p = 0.022), with 19% of the preterm group and 9% of the term group having high scores (p = 0.038).There was no group difference on the EPDS or measures of temperament, with disability being greater in the preterm infants. For the preterm group, maternal depression and infant temperament were independent predictors of Total Stress scores on multivariate analysis.

Conclusions

Parenting stress in mothers of preterm infants at one year of age is significantly greater than that found in mothers of term infants. For preterm mothers, symptoms of depression and infant temperament are independent risk factors for higher levels of parenting stress.     

Association between maternal job burnout and adolescent depression: the chain mediating effect of maternal depression and parenting style北大核心CSCD

目的研究母亲职业倦怠与青少年抑郁的关系,以及母亲抑郁、教养方式在其中的中介作用。方法采用横断面研究设计,于2021年4—5月在上海市7所初中进行整群随机抽样,对7所初中2572名青少年及其母亲进行问卷调查。研究工具包括一般资料调查表、职业倦怠量表、流调中心抑郁量表、简式父母教养方式问卷及儿童抑郁量表。建立结构方程模型,使用Bootstrap法进行中介效应检验。结果青少年抑郁症状检出率为12.71%(327/2572)。母亲职业倦怠得分、母亲抑郁得分、消极教养方式得分与青少年抑郁得分呈显著正相关(P<0.05),而积极教养方式得分与青少年抑郁得分呈显著负相关(P<0.05)。母亲抑郁、教养方式在职业倦怠与青少年抑郁间起中介作用,包括母亲抑郁的独立中介、积极教养方式的独立中介及抑郁-消极/积极教养方式的链式中介。结论母亲的职业倦怠可通过抑郁、教养方式、抑郁-教养方式3条中介路径影响青少年抑郁,提示降低母亲职业倦怠、改善母亲的抑郁情绪、增加积极教养行为、减少消极教养行为,有助于减少青少年抑郁症状的发生。     

The temporal relation between depression and comorbid psychopathology in adolescents at varied risk for depression

Background: This study examined the temporal comorbidity of depressive disorders with anxiety, externalizing, and substance use disorders in adolescents who varied in risk for depression. Methods: Participants were 240 adolescents and their mothers who had either a history of depression (high‐risk, n = 185) or were lifetime‐free of psychiatric disorders (low‐risk, n = 55). Children (54.2% females) were first evaluated in 6th grade (mean age = 11.86, SD = .57) with the K‐SADS‐PL to assess current and lifetime diagnoses, and then annually through 12th grade with the A‐LIFE to assess diagnoses since the previous evaluation. Results: For girls, the rate of depression was high regardless of prior anxiety, whereas for boys, the odds that those with prior subthreshold anxiety would have subsequent subthreshold depression were 1.5 times those of boys with no prior subthreshold anxiety, controlling for risk. In addition, the odds that girls with prior substance use disorders would have a threshold depressive disorder subsequently were three times those of girls with no prior substance use disorders, controlling for risk. Conclusions: These results highlight the importance of early detection of various forms of psychopathology in youth who then can be targeted for intervention. The prospective paths to comorbidity differed by sex, thus suggesting that interventions need to be constructed with sensitivity to these distinct diagnostic trajectories.     

Emotion regulation in preschoolers: the roles of behavioral inhibition, maternal affective behavior, and maternal depression

Background:  This study examined preschoolers' emotion regulation (ER) strategies and the association with temperament, maternal interactive style, and maternal history of childhood-onset depression (COD).
Methods:  Participants were 62 children and their mothers, 37 of whom had mothers with COD. Children's ER was assessed using a disappointment paradigm; temperament assessment also was laboratory-based.
Results:  Maternal COD was inversely related to offspring's active ER and positive mood. Among children of COD mothers, behavioral inhibition was associated with passive regulation and sadness, and maternal positivity toward these children was associated with child active ER and positive mood.
Conclusion:  Behavioral inhibition may place children of COD mothers at risk for developing maladaptive ways of regulating negative emotion, whereas mothers' positivity may serve as a protective factor for them.     

Infant temperament,maternal feeding behaviours and the timing of solid food introduction

Despite guidance from the World Health Organization and the U.K. Department of Health, many mothers introduce solid food before their infant is 6 months old. The current study aimed to investigate relationships between maternal feeding behaviours (preintroduction and postintroduction to solids), infant temperament, and the timing of introduction to solid food. Eighty‐one women were recruited on low‐risk maternity units and were contacted at 1 week, 3, and 6 months postpartum. Mothers of infants (45 males, 36 females, mean birth weight 3.52 kg [SD 0.39]) completed the behaviours component of the Infant Feeding Style Questionnaire via telephone interview at 3 months. At 6 months, they were observed feeding their infant solid food at home and reported infant temperament using the Infant Behaviour Questionnaire‐Revised (short form). Partial correlations (covariates: birth weight, maternal age, breastfeeding duration, and postnatal depression) revealed negative associations between age of introduction to solid food and temperament (smiling and laughter) and laissez‐faire milk feeding behaviours; and positive associations between age of introduction to solid food and restrictive milk feeding behaviours and verbal involvement during an observed mealtime. Hierarchical multiple regression analysis revealed that an infant's birth weight and the degree to which their mothers perceive them to smile and laugh are key predictors of when they will be introduced to solid food, over and above other variables of interest (e.g., maternal milk feeding behaviours, breastfeeding duration, and postnatal depression).     

Maternal depression and infant cortisol: influences of timing, comorbidity and treatment

Background: The current study examines the relationship between maternal depression and infant cortisol concentrations. The potential roles of comorbid maternal anxiety disorders, timing of maternal depression, and maternal treatment with psychotropic medications during pregnancy are addressed. Methods: Women with 6‐month‐old infants (105 boys and 84 girls) participated in a laboratory paradigm that included infant saliva collection at six points, noise burst and arm restraint stressor tasks, and a diagnostic interview of the mother. Results: Lifetime history of maternal depression was associated with increased baseline and mean (average) infant cortisol levels. Comorbidity with anxiety disorder was related to infant cortisol reactivity. Peripartum (prepartum and/or postpartum) maternal depression, rather than a pre‐pregnancy history of disorder, was associated with higher infant cortisol reactivity. Prenatal and postnatal exposure to maternal disorder had similar effects, but prenatal maternal psychotropic medication treatment appeared to attenuate infant cortisol increases associated with prenatal maternal disorder exposure. Conclusions: These data suggest that exposure to maternal depression and anxiety during pregnancy and the postpartum period may increase infant salivary cortisol. This maternal depression–infant cortisol association is independent of the effects of delivery complications, and appears to be modulated by prenatal maternal psychotropic treatment.     

The possible role of the kynurenine pathway in adolescent depression with melancholic features

Background: Although adolescent major depressive disorder (MDD) is acknowledged to be a heterogeneous disorder, no studies have reported on biological correlates of its clinical subgroups. This study addresses this issue by examining whether adolescent MDD with and without melancholic features (M‐MDD and NonM‐MDD) have distinct biological features in the kynurenine pathway (KP). The KP is initiated by pro‐inflammatory cytokines via induction of the enzyme indoleamine 2,3‐dioxygenase (IDO), which degrades tryptophan (TRP) into kynurenine (KYN). KYN is further metabolized into neurotoxins linked to neuronal dysfunction in MDD. Hypotheses were that, compared to healthy controls and to NonM‐MDD adolescents, adolescents with M‐MDD would exhibit: (i) increased activation of the KP [i.e., increased KYN and KYN/TRP (reflecting IDO activity)]; (ii) greater neurotoxic loads [i.e., increased 3‐hydroxyanthranilic acid (3‐HAA, neurotoxin) and 3‐HAA/KYN (reflecting production of neurotoxins)]; and (iii) decreased TRP. We also examined relationships between severity of MDD and KP metabolites. Methods: Subjects were 20 adolescents with M‐MDD, 30 adolescents with NonM‐MDD, and 22 healthy adolescents. MDD episode duration had to be ≥ 6 weeks and Children’s Depression Rating Scale‐Revised (CDRS‐R) scores were ≥ 36. Blood samples were collected at AM after an overnight fast and analyzed using high‐performance liquid chromatography. Group contrasts relied on analysis of covariance based on ranks, adjusted for age, gender, and CDRS‐R scores. Analyses were repeated excluding medicated patients. Fisher’s protected least significant difference was used for multiple comparisons. Results: As hypothesized, KYN/TRP ratios were elevated and TRP concentrations were reduced in adolescents with M‐MDD compared to NonM‐MDD adolescents (p = .001 and .006, respectively) and to healthy controls (p = .008 and .022, respectively). These findings remained significant when medicated patients were excluded from the analyses. Significant correlations were obtained exclusively in the M‐MDD group between KYN and 3‐HAA/KYN and CDRS‐R. Conclusions: Findings support the notion that adolescent M‐MDD may represent a biologically distinct clinical syndrome.     

When more is not better: the role of cumulative risk in child behavior outcomes

BACKGROUND: Cumulative risk research has established the deleterious effects of co-occurring risk factors on child behavior outcomes. However, extant literature has not addressed potential differential effects of cumulative risk at different points in development and has left open questions about whether a threshold model or a linear risk model better describes the impact of cumulative risk on behavior outcomes. The current study examined the impact of cumulative risk factors (i.e., child maltreatment, inter-parental violence, family disruption, low socioeconomic status, and high parental stress) in early and middle childhood on child behavior outcomes in adolescence. METHODS: Using data from an ongoing longitudinal study of at-risk urban children (N=171), the cumulative effects of these five risk factors across early and middle childhood were investigated. RESULTS: The findings support the cumulative risk hypothesis that the number of risks in early childhood predicts behavior problems in adolescence. Evidence for a linear but not a threshold model of cumulative risk was found; the more risks present, the worse the child outcome. Moreover, the presence of multiple risks in early childhood continues to explain variations in predicting adolescent behavior outcomes even after including the effects of risk in middle childhood. CONCLUSIONS: The results support the need for comprehensive prevention and early intervention efforts with high-risk children, such that there does not appear to be a point beyond which services for children are hopeless, and that every risk factor we can reduce matters.     

Postpartum maternal anxiety and depression during COVID-19 pandemic: Rates,risk factors and relations with maternal bonding

ObjectivesThis study aims to determine the rates of clinically-significant anxiety and depressive symptoms during the immediate postpartum in a sample of women referred to a university maternity department, as well as the associated risk factors and the relations with the level of maternal bonding.Patients and methodsDuring the third national lockdown for the COVID-19 pandemic (February-April 2021), on days 2–3 after delivery 127 mothers were administrated the Edinburgh postnatal depression scale (EPDS), the state-trait anxiety inventory (STAI-YA), the mother-to-infant bonding scale (MIBS) and questions issued from the coronavirus health impact survey questionnaire (CRISIS).ResultsThe rate of perinatal clinically-significant symptoms were 17% for depression (EPDS cut-off ≥ 12) and 15% for anxiety (STAI-YA cut-off ≥ 40). In the multivariate analysis, being a single mother, risk of being infected by the SARS-CoV2, risk that a close relative might be infected by the SARS-CoV2 and the length of stay in maternity were associated with an increased EPDS total score, while breastfeeding was associated with a lower EPDS total score. Six variables remained positively associated with the STAI-YA total score in the multivariate model: the maternal level of academic achievement, a hospitalization during the pregnancy, peripartum medical complications, risk of being infected by the SARS-CoV2, risk of a close relative being infected by the SARS-CoV2 and physical fatigue. Low but statistically significant correlations were found between the MIBS total score and the EPDS total score (rs = 0.26) and with the STAI-YA total score (rs = 0.26).DiscussionThe observed rates of anxiety and depressive symptoms were in the same range as those reported in observational studies conducted in high-resource countries during the COVID-19 pandemic. Risk of being infected by the SARS-CoV2 was both an independent risk factor for anxiety and depressive symptoms. The relations between the measure of maternal bonding and the severity of maternal emotional symptoms call for a better consideration of the long-term consequences of the pandemic on children's socio-emotional development.     

Comparison of salivary cortisol, heart rate, and oxygen saturation between early skin-to-skin contact with different initiation and duration times in healthy, full-term infants

Background

There are few studies that compare the physiological and biological efficacies between different early skin-to-skin contacts (SSC) post birth.

Aim

To investigate physiologically and biochemically how early SSC with different initiation and duration time influence the stress post birth for full-term infants.

Study design

Non-experimental study.

Subjects

Study I; Thirty-two infants who began SSC 5 min or less [birth SSC, mean initiation time (standard deviation): 1.6 (1.1) min] after birth and 36 infants who did so more than 5 min [very early SSC, 26.3 (5.0) min] in heart rate (HR) and oxygen saturation (SpO₂) analysis. Study II; Eighteen infants who underwent SSC for 60 min or less [mean initiation time: 7.5 (12.2) min] and 61 infants who did so for more than 60 min [15.3 (12.5) min] in salivary cortisol analysis.

Outcome measures

HR and SpO₂ measured for 30 min post birth. Salivary cortisol concentration measured at 1 min, 60 min, and 120 min post birth.

Results

Birth SSC group reached HR stability of 120-160 bpm significantly faster than very early SSC group by Kaplan-Meier analysis (P = 0.001 by log-rank test). As for SpO₂ stability of 92% and 96%, no significantly between-group difference was found. Salivary cortisol levels were significantly lower between 60 and 120 min after birth in SSC group, continuing for more than 60 min compared with SSC group for 60 min or less after adjustment for salivary cortisol level at 1 min besides the infant stress factors (P = 0.046).

Conclusions

Earlier SSC beginning within 5 min post birth and longer SSC continuing for more than 60 min within 120 min post birth are beneficial for stability of cardiopulmonary dynamics and the reduction of infant stress during the early period post birth.     

Error‐related brain activity in young children: associations with parental anxiety and child temperamental negative emotionality

Background: There is increasing interest in error‐related brain activity in anxiety disorders. The error‐related negativity (ERN) is a negative deflection in the event‐related potential approximately 50 ms after errors compared to correct responses. Recent studies suggest that the ERN may be a biomarker for anxiety, as it is positively associated with anxiety disorders and traits in adults and older youth. However, it is not known if the ERN in young children is related to risk for anxiety disorders. We addressed this by examining the association of six‐year olds' ERNs with two established risk factors for anxiety: parental anxiety disorder and child temperamental negative emotionality (NE). Method: The ERN was assessed using a Go/No‐Go task in a community sample of 413 six‐year olds. In a prior assessment at age 3, child temperament was evaluated using a laboratory observational measure and parental psychopathology was assessed using semi‐structured diagnostic interviews. Results: Children of mothers with anxiety disorders and children with greater temperamental NE (particularly fearfulness) exhibited significantly smaller ERNs than their peers. Paternal psychopathology, maternal mood and substance use disorders, and child positive emotionality were not associated with children's ERNs. Conclusion: Both maternal anxiety disorders and child NE (particularly fearfulness) were significantly associated with children's ERNs. However, the direction of these associations was opposite to the relations between ERNs and anxiety in older youth and adults. These results suggest that there may be a difference between risk and disorder status in the relation of error‐related brain activity to anxiety between early childhood and late childhood/ early adolescence.     

Risk factors for preschool depression: the mediating role of early stressful life events

BACKGROUND: Family history of mood disorders and stressful life events are both established risk factors for childhood depression. However, the role of mediators in risk trajectories, which are potential targets for intervention, remains understudied. To date, there have been no investigations of mediating relationships between risk factors and very early onset depression, a developmental period during which intervention may be more effective. The current study used regression analyses to examine the relationships between family history of mood disorders and stressful life events as risk factors for depression in a preschool sample. METHOD: Preschoolers 3.0 to 5.6 years of age participated in a comprehensive mental health assessment. Caregivers were interviewed about their children using a structured diagnostic measure to derive DSM-IV major depressive disorder (MDD) diagnoses and dimensional depression severity scores. Family history of psychiatric disorders and preschoolers' stressful life events was obtained. RESULTS: Both family history and stressful life events predicted depression severity scores 6 months later. Analyses examining the influence of family history of mood disorders and stressful life events on preschoolers' depression severity demonstrated that stressful life events mediated the relationship between family history and preschoolers' depression. CONCLUSIONS: Findings outline the key role of exposure to early stressful life events as a mediator of familial mood disorder risk in preschool onset depression. This finding in a preschool sample provides support for the hypothesis that psychosocial factors may have increased importance as mediators of risk in younger age groups. Findings suggest that psychosocial factors should be considered key targets for early intervention in depression.     

Sex differences in the relation between prenatal maternal emotional complaints and child outcome

Background

Sex differences are found in animal studies concerning the relationship between prenatal maternal stress and outcome of the offspring. Most human studies in this field have not addressed sex differences, although differences between boys and girls may elucidate the biochemical as well as psychological processes involved. Associations between prenatal maternal emotional complaints and behavioural problems of toddlers and preschoolers as assessed by both mothers and fathers are studied separately for boys and girls.

Methods

Healthy Dutch Caucasian singleton, pregnant women (N = 444) answered questionnaires about anxiety and depression in every trimester of pregnancy. When their children (227 boys, 217 girls) were between 14 and 54 months old, both parents reported on their current feelings of depression and anxiety and on the behavioural problems of their children.

Results

Prenatal maternal emotional complaints were found to be associated with child behavioural problems both in boys and in girls, but in different ways. Prenatal maternal emotional complaints during the first trimester were associated with total and internalizing behavioural problems for boys. Emotional complaints during the third trimester were associated with total, internalizing, as well as externalizing behavioural problems for girls.

Conclusions

Differentiation according to sex and information on timing of emotional complaints during pregnancy is needed in studies concerning the relation between prenatal maternal emotional complaints and child outcome.     

The relation of maternal job strain and cortisol levels during early pregnancy with body composition later in the 5-year-old child: the ABCD study

Background

Prenatal exposure to maternal stress may program the fetal HPA axis, potentially leading to altered metabolism in later life, associated with adiposity and diabetes.

Aims

This association is little studied in humans, and thus we explore whether high maternal job strain during early pregnancy, as well as maternal cortisol levels are associated with increased body mass index (BMI), central adiposity or body fat mass in the offspring at age five. Additionally, we explore whether these associations are modified by gender or mediated by gestational age and fetal growth restriction.

Study design

2939 pregnant women (ABCD cohort study) completed a questionnaire around gestational week 16 including the Job Content Questionnaire, assessing job strain. Serum total cortisol was assessed in a subsample (n = 1320). Gestational age (≥ 37 weeks), standardized birth weight and information on many covariates were available. At the age five health check, height, weight (BMI, kg/m²), waist circumference (waist-to-height ratio, WHtR) and Fat Mass Index (FMI, kg/m²) were assessed.

Results

Job strain was not associated with higher BMI, WHtR or FMI. Higher maternal cortisol was independently associated with marginally higher FMI in girls, but marginally lower FMI in boys (β 0.09 and β −0.10 per 100 unit increase in serum cortisol, respectively. p < 0.01). This association was not mediated by gestational age or fetal growth restriction.

Conclusions

Results show that prenatal maternal job strain and cortisol may not program obesity and adiposity in the next generation in humans, but gender differences should always be considered.