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This study aimed to investigate mother–infant interaction and infant development in women at-risk of postpartum psychosis (PP), with and without a postpartum relapse.
103 women (and their offspring) were included, 43 at-risk-of-PP because of a diagnosis of bipolar disorder, schizoaffective disorder or previous PP, and 60 with no current/previous mental illness or family history of PP. Of the at-risk women, 18 developed a psychiatric relapse within 4 weeks after delivery (AR-unwell), while 25 remained symptom-free (AR-well). Mother–infant interaction was assessed using the CARE-Index at 8 weeks' and 12 months' postpartum and infant development using the Bayley-III at 12 months' postpartum.
Women at-risk-of-PP as a group, regardless of whether they developed a psychiatric relapse within 4 weeks after delivery, had less synchronous mother–infant interactions and had infants with less optimal cognitive, language, motor and socio-emotional development than healthy controls. In particular, boys of at-risk women had the lowest scores in cognitive, language and motor development and in mother–infant interaction, while girls of the at-risk women had the lowest scores in socio-emotional development. The synchrony in the dyad predicted infant cognitive and language development. There was no evidence for a difference in mother–infant interaction nor in infant development between the AR-unwell and AR-well groups.
These results suggest that, while there is a lack of evidence that an early postpartum relapse in women at-risk-of-PP could represent a risk for the infant per se, maternal risk for PP may be associated with less optimal mother–infant interaction and infant development.
Psychiatric mother and baby units (MBUs) are recommended for severe perinatal mental illness, but effectiveness compared with other forms of acute care remains unknown.
We hypothesised that women admitted to MBUs would be less likely to be readmitted to acute care in the 12 months following discharge, compared with women admitted to non-MBU acute care (generic psychiatric wards or crisis resolution teams (CRTs)).
Quasi-experimental cohort study of women accessing acute psychiatric care up to 1 year postpartum in 42 healthcare organisations across England and Wales. Primary outcome was readmission within 12 months post-discharge. Propensity scores were used to account for systematic differences between MBU and non-MBU participants. Secondary outcomes included assessment of cost-effectiveness, experience of services, unmet needs, perceived bonding, observed mother–infant interaction quality and safeguarding outcome.
Of 279 women, 108 (39%) received MBU care, 62 (22%) generic ward care and 109 (39%) CRT care only. The MBU group (n = 105) had similar readmission rates to the non-MBU group (n = 158) (aOR = 0.95, 95% CI 0.86–1.04, P = 0.29; an absolute difference of −5%, 95% CI −14 to 4%). Service satisfaction was significantly higher among women accessing MBUs compared with non-MBUs; no significant differences were observed for any other secondary outcomes.
We found no significant differences in rates of readmission, but MBU advantage might have been masked by residual confounders; readmission will also depend on quality of care after discharge and type of illness. Future studies should attempt to identify the effective ingredients of specialist perinatal in-patient and community care to improve outcomes.
Little is known about the effects of depression before birth on the quality of the mother–infant interaction.
To understand whether depression, either in pregnancy or in lifetime before pregnancy, disrupts postnatal mother–infant interactions.
We recruited 131 pregnant women (51 healthy, 52 with major depressive disorder (MDD) in pregnancy, 28 with a history of MDD but healthy pregnancy), at 25 weeks’ gestation. MDD was confirmed with the Structured Clinical Interview for DSM-IV Disorders. Neonatal behaviour was assessed at 6 days with the Neonatal Behavioural Assessment Scale, and mother–infant interaction was assessed at 8 weeks and 12 months with the Crittenden CARE-Index.
At 8 weeks and 12 months, dyads in the depression and history-only groups displayed a reduced quality of interaction compared with healthy dyads. Specifically, at 8 weeks, 62% in the depression group and 56% in the history-only group scored in the lowest category of dyadic synchrony (suggesting therapeutic interventions are needed), compared with 37% in the healthy group (P = 0.041); 48% and 32%, respectively, scored the same at 12 months, compared with 14% in the healthy group (P = 0.003). At 6 days, neonates in the depression and history-only groups exhibited decreased social-interactive behaviour, which, together with maternal socioeconomic difficulties, was also predictive of interaction quality, whereas postnatal depression was not.
Both antenatal depression and a lifetime history of depression are associated with a decreased quality of mother–infant interaction, irrespective of postnatal depression. Clinicians should be aware of this, as pregnancy provides an opportunity for identification and intervention to support the developing relationship.
Mother and Baby Units (MBUs) are usually preferred by patients and clinicians. Current provision is limited, although expansion is in progress. To ensure successful investment in services, outcome measurement is vital.
To describe maternal outcomes, mother–infant outcomes and their relationship in one MBU.
Paired maternal Brief Psychiatric Rating Scale (BPRS) scores, Health of the Nation Outcome Scales (HoNOS) scores and Crittenden CARE-Index (CCI) mother–infant interaction data were collected at admission and discharge.
There were significant improvements in BPRS (n = 152), HoNOS (n = 141) and CCI (n = 62) scores across diagnostic groups. Maternal BPRS scores and mother–infant interaction scores were unrelated. Improvement in maternal HoNOS scores was associated with improved maternal sensitivity and reduction in maternal unresponsiveness and infant passiveness.
Positive outcomes were achieved for mothers and babies across all diagnostic groups. Reduction in maternal symptoms, as measured by BPRS, does not necessarily confer improvement in mother–infant interaction. MBU treatment should focus on both maternal symptoms and mother–infant interaction.
Studies have shown that a mother's history of childhood maltreatment is associated with her child's experience of internalising and externalising difficulties.
To characterise the mediating pathways that underpin this association.
Data on a mother's history of childhood maltreatment, depression during pregnancy, postnatal depression, maladaptive parenting practices and her child's experience of maltreatment and internalising and externalising difficulties were analysed in an Avon Longitudinal Study of Parents and Children (ALSPAC) sample of 9397 mother–child dyads followed prospectively from pregnancy to age 13.
Maternal history of childhood maltreatment was significantly associated with offspring internalising and externalising difficulties. Maternal antenatal depression, postnatal depression and offspring child maltreatment were observed to significantly mediate this association independently.
Psychological and psychosocial interventions focused around treating maternal depression, particularly during pregnancy, and safeguarding against adverse childhood experiences could be offered to mothers with traumatic childhood histories to help protect against psychopathology in the next generation.
Studies 1 and 2 investigated how maternal severe mental illness (SMI) related to mothers’ mind–mindedness (appropriate and nonattuned mind-related comments). Study 1 showed that mothers with SMI (n = 50) scored lower than psychologically well mothers for both appropriate and nonattuned comments, whereas mothers with SMI in Study 2 (n = 22) had elevated levels of nonattuned comments. Study 2 also tested the efficacy of a single-session video-feedback intervention to facilitate mind–mindedness in mothers with SMI. The intervention was associated with a decrease in nonattuned comments, such that on discharge, mothers did not differ from psychologically well controls. Study 3 assessed infant–mother attachment security in a small subset of intervention-group mothers from Study 2 (n = 9) and a separate group of standard care mothers (n = 30) at infant mean age 17.1 months (SD = 2.1). Infants whose mothers completed the intervention were more likely to be securely attached and less likely to be classified as insecure–disorganized than those of mothers who received standard care. We conclude that a single session of video-feedback to facilitate mind–mindedness in mothers with SMI may have benefits for mother–infant interaction into the second year of life.
The relationship between ethnic density and psychiatric disorder in
postnatal women in the UK is unclear.
To examine the effect of own and overall ethnic density on postnatal
depression (PND) and personality dysfunction.
Multilevel analysis of ethnically mixed community-level data gathered
from a sample of 2262 mothers screened at 6 weeks postpartum for PND and
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.
In White women, living in areas of higher own ethnic density was
protective against developing PND.
Studies have shown that maternal depression during pregnancy predicts offspring depression in adolescence. Child maltreatment is also a risk factor for depression.
To investigate (a) whether there is an association between offspring exposure to maternal depression in pregnancy and depression in early adulthood, and (b) whether offspring child maltreatment mediates this association.
Prospectively collected data on maternal clinical depression in pregnancy, offspring child maltreatment and offspring adulthood (18–25 years) DSM-IV depression were analysed in 103 mother–offspring dyads of the South London Child Development Study.
Adult offspring exposed to maternal depression in pregnancy were 3.4 times more likely to have a DSM-IV depressive disorder, and 2.4 times more likely to have experienced child maltreatment, compared with non-exposed offspring. Path analysis revealed that offspring experience of child maltreatment mediated the association between exposure to maternal depression in pregnancy and depression in adulthood.
Maternal depression in pregnancy is a key vulnerability factor for offspring depression in early adulthood.
Antenatal depression and childhood maltreatment have each been associated
with offspring psychopathology, but have never been examined in the same
To determine whether childhood maltreatment influences the association
between antenatal depression and offspring psychopathology.
Prospectively collected data on antenatal depression, offspring
maltreatment (age 11) and offspring psychopathology (age 11 and 16) were
analysed in 120 mother–offspring dyads from the community-based South
London Child Development Study.
Antenatal depression increased the risk of maltreatment in the offspring
by almost four times. Children exposed only to antenatal depression or
only to childhood maltreatment were no more at risk of developing
psychopathology; however, children exposed to both antenatal depression
and childhood maltreatment were at almost 12 times greater risk of
developing psychopathology than offspring not so exposed.
Research investigating exposure to adverse events in
utero and offspring psychopathology should take account of
postnatal adverse events such as maltreatment.
Cerebral ventricular enlargement and reduced cortical volume are correlates of chronic schizophrenia. We investigated whether genetic risk for psychosis is related to differences in foetal brain development as measured by prenatal ultrasonography. Routine foetal cerebral measures at 19–23 weeks of gestation were compared between the offspring of 35 women with a history of psychosis and 105 control women matched for gestational age. Overall, no significant differences were found between the high-risk and control groups. There was a non-significant trend in the adjusted analysis towards increased lateral ventricular width in the offspring of mothers with psychosis.
The aim of the study was to examine long-term sequelae in the children of mothers who were depressed at 3 months postpartum. In a community sample from two general practices in South London, 149 women were given psychiatric interviews at 3 months postpartum and 132 of their children (89%) were tested at 11 years of age. The children of women who were depressed at 3 months postpartum had significantly lower IQ scores. They also had attentional problems and difficulties in mathematical reasoning, and were more likely than other children to have special educational needs. Boys were more severely affected than girls, with the sex difference most pronounced on Performance IQ. The links between postnatal depression and the children's intellectual problems were not mediated by parental IQ and were not accounted for by measures of social disadvantage nor by the mother's later mental health problems. Breastfeeding did not remove the effect of the mother's illness on Full Scale IQ, but exerted its own influence on Verbal IQ and appeared to mediate the link with mathematical ability. The findings show that adverse experiences in infancy predict cognitive ability and academic performance a decade later.
Correlates of parents' ratings of behavioural problems were explored in a sample of 93
British families, in which mothers and fathers rated their children at the time of the fourth
birthday on the Achenbach Child Behavior Checklist. As in other samples, there was
moderate convergence in mothers' and fathers' total problem scores, but also signs that they
were reporting different sorts of problems linked to different influences. The father's rating
was primarily associated with the child's cognitive ability. The mother's rating was primarily
affected by her own mental state and view of her marriage. The father's but not the mother's
rating provided unique information that predicted teachers' reports of the children's
problems 7 years later. In general, parents' ratings of preschool children's problems
reflect particular informants' perspectives on family life.
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