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From Pregnancy to Postpartum: When Mental Health and Wellbeing Are Threatened

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Mental Health".

Deadline for manuscript submissions: closed (30 September 2022) | Viewed by 37776

Special Issue Editors

Department of Psychology, University of Torino, 10124 Torino, Italy
Interests: homo/lesbo/bi/trans-phobia; parenthood; perinatal mental health; twinship; intimate partner violence; gender violence; same sex intimate partner violence; same sex parenting; sexual minorities; minorities stress; attachment
Special Issues, Collections and Topics in MDPI journals
Department of Education, Psychology, Philosophy, Faculty of Human Studies, University of Cagliari, 09123 Cagliari, Italy
Interests: perinatal mental health; attachment; mental representations; family dynamics; developmental psychopathology

Special Issue Information

Dear Colleagues,

The transition to parenthood, from pregnancy to postpartum, is a time of neurobiological, relational, and psychological changes for both parents that can impact their individual or collective psychological wellbeing in different ways. In line with the WHO's mental health action plan (2019–2023), the current Special Issue aims at demonstrating the relevance of perinatal health for parents and children for the wellness of the whole community. Therefore, theoretical and empirical evidence is needed to support the utility of preventive and intervention programs during the pre- and postpartum periods. Indeed, parenthood appears difficult and complex even when it comes as a natural event, and it becomes even more problematic when objective and emotional difficulties arise. The study of parental mental health issues in the pre- and postpartum periods, such as depression, anxiety, and parental stress, and their links to other relevant factors including couple relationship, attachment styles, infants’ temperament, and neurobiological measures, highlights the need to think about models and methodologies that can be adapted to different contexts, particularly today’s new family configurations.

This Special Issue aims to collect scientific and multidisciplinary contributions on the wellbeing of parents and their children from pregnancy to postpartum. We encourage contributions from a variety of areas including original qualitative and quantitative articles, reviews, and meta-analyses focused on parental mental health and correlated constructs and variables. We also encourage contributions on preventive and intervention models during pregnancy and the postpartum period to improve the parents’ and their children’s wellbeing. 

Prof. Dr. Luca Rollè
Prof. Dr. Laura Vismara
Guest Editors

Manuscript Submission Information

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • pre- and postnatal depression
  • mother and father wellbeing
  • risk and protective factors
  • perinatal psychopathology
  • couple relationship and parenthood
  • parenting stress
  • parents wellbeing
  • fear of childbirth
  • pregnancy
  • attachment style and wellbeing
  • parents’ mental health
  • perinatal mental health

Published Papers (18 papers)

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10 pages, 359 KiB  
Article
The Impact of COVID-19 Related Distress on Antenatal Depression in Australia
Int. J. Environ. Res. Public Health 2023, 20(6), 4783; https://doi.org/10.3390/ijerph20064783 - 08 Mar 2023
Viewed by 1429
Abstract
Globally, the impact of COVID-19 on mental health has been significant. Pregnant women are known to be a vulnerable population in relation to mental health. In Australia, there was an unprecedented demand during the pandemic for mental health services, including services for pregnant [...] Read more.
Globally, the impact of COVID-19 on mental health has been significant. Pregnant women are known to be a vulnerable population in relation to mental health. In Australia, there was an unprecedented demand during the pandemic for mental health services, including services for pregnant women. Maternal mental health has unique and enduring features that can significantly shape a child’s overall development and poor maternal mental health can have considerable social and economic costs. This cross-sectional study evaluated symptoms of antenatal depression and COVID-19-related distress in a sample of two hundred and sixty-nine pregnant women residing in Australia aged between 20 and 43 (M = 31.79, SD = 4.58), as part of a larger study. Social media advertising was used to recruit participants between September 2020 and November 2021. Prevalence rates for antenatal depression were found to be higher in this study (16.4%) compared with previous Australian prevalence rates (7%). COVID-19 distress in relation to having a baby during a COVID-19 outbreak significantly predicted symptoms of antenatal depression, B = 1.46, p < 0.001. Results from this study suggest that mothers and families may have increased mental health vulnerabilities as a consequence of the pandemic for some time yet. Full article
16 pages, 407 KiB  
Article
Perinatal Depression and Anxiety Symptoms, Parental Bonding and Dyadic Sensitivity in Mother–Baby Interactions at Three Months Post-Partum
Int. J. Environ. Res. Public Health 2023, 20(5), 4253; https://doi.org/10.3390/ijerph20054253 - 27 Feb 2023
Cited by 1 | Viewed by 1786
Abstract
The quality of the early parent–infant relationship is crucial for the child’s optimal development, and parental sensitivity plays a key role in early interactions. The purpose of the study was to evaluate the influence of maternal perinatal depression and anxiety symptoms on dyadic [...] Read more.
The quality of the early parent–infant relationship is crucial for the child’s optimal development, and parental sensitivity plays a key role in early interactions. The purpose of the study was to evaluate the influence of maternal perinatal depression and anxiety symptoms on dyadic sensitivity at three months post-partum, also considering a large set of maternal and infant variables. At the third trimester of pregnancy (T1) and at three months postpartum (T2), 43 primiparous women filled in a set of questionnaires evaluating symptoms of depression (CES-D) or anxiety (STAI), the woman’s parental bonding experiences (PBI), alexithymia (TAS-20), maternal attachment to the baby (PAI, MPAS) and the perceived social support (MSPSS). At T2 mothers also completed a questionnaire on infant temperament and took part in the CARE-Index videotaped procedure. Dyadic sensitivity was predicted by higher maternal trait anxiety scores in pregnancy. In addition, the mother’s experience of being cared for by her father in childhood was predictive of her infant’s lower compulsivity, while paternal overprotection predicted higher unresponsiveness. The results highlight the influence of perinatal maternal psychological well-being and maternal childhood experiences on the quality of the dyadic relationship. The results may be useful to foster mother–child adjustment during the perinatal period. Full article
15 pages, 410 KiB  
Article
The Relationship between Attachment, Dyadic Adjustment, and Sexuality: A Comparison between Infertile Men and Women
Int. J. Environ. Res. Public Health 2023, 20(4), 3020; https://doi.org/10.3390/ijerph20043020 - 09 Feb 2023
Cited by 2 | Viewed by 1299
Abstract
Infertility impacts several life dimensions. Among them, sexuality is particularly affected; yet studies have mainly focused on infertile women. We aimed to explore infertile men’s and women’s experiences in sexual satisfaction, internal control, and anxiety, and the relationship between attachment, dyadic adjustment, and [...] Read more.
Infertility impacts several life dimensions. Among them, sexuality is particularly affected; yet studies have mainly focused on infertile women. We aimed to explore infertile men’s and women’s experiences in sexual satisfaction, internal control, and anxiety, and the relationship between attachment, dyadic adjustment, and sexuality. The sample consisted of 129 infertile people (47.3% females, 52.7% males, Mage = 39 years) who fulfilled an ad hoc questionnaire, the Multidimensional Sexuality Questionnaire (MSQ), the Experiences in Close Relationship-Revised (ECR-R), and the Dyadic Adjustment Scale (DAS). We found a significant effect of type of infertility and infertility factors on sexual anxiety only in infertile men. As regards infertile women, dyadic adjustment predicted sexual satisfaction, anxious attachment decreased sexual internal control, and avoidant attachment reduced sexual anxiety. As regards infertile men, high dyadic adjustment increased sexual satisfaction and a high avoidant attachment predicted high levels of sexual internal control. There was no relationship between attachment, dyadic adjustment, and sexual anxiety for infertile men. From the results, it emerges how important is to consider both dyadic adjustment and attachment in studying how infertility impacts women’s and men’s lives. Full article
8 pages, 313 KiB  
Article
Traumatic Childbirth Experience and Childbirth-Related Post-Traumatic Stress Disorder (PTSD): A Contemporary Overview
Int. J. Environ. Res. Public Health 2023, 20(4), 2775; https://doi.org/10.3390/ijerph20042775 - 04 Feb 2023
Cited by 4 | Viewed by 3194
Abstract
With this manuscript we provide an overview of the prevalence, symptoms, risk factors, screening, support, and treatment for women with a traumatic childbirth experience or childbirth-related PTSD. This overview is based on both recent literature and the authors’ clinical experiences from the fields [...] Read more.
With this manuscript we provide an overview of the prevalence, symptoms, risk factors, screening, support, and treatment for women with a traumatic childbirth experience or childbirth-related PTSD. This overview is based on both recent literature and the authors’ clinical experiences from the fields of obstetrics, psychiatry and medical psychology to provide up-to-date knowledge about recognizing, preventing and treating CB-PTSD from a clinical perspective. We pay substantial attention to prevention as there are many things health care professionals can do or not do to contribute to a positive childbirth experience, and save women, their infants and families from a sub-optimal start due to childbirth-related trauma. Full article
10 pages, 619 KiB  
Article
Intensity of Maternal Anxiety and Depressive Symptoms in Pregnancy Is Associated with Infant Emotional Regulation Problems
Int. J. Environ. Res. Public Health 2022, 19(23), 15761; https://doi.org/10.3390/ijerph192315761 - 26 Nov 2022
Cited by 1 | Viewed by 1058
Abstract
This study aimed to investigate the effects of the intensity and directionality of antenatal maternal depressive and anxiety symptoms on infant negative affectivity and crying, also taking into account potential confounders. The role of socioeconomic status (SES) as a possible moderating factor of [...] Read more.
This study aimed to investigate the effects of the intensity and directionality of antenatal maternal depressive and anxiety symptoms on infant negative affectivity and crying, also taking into account potential confounders. The role of socioeconomic status (SES) as a possible moderating factor of the association between antenatal maternal distress and infant negative outcomes was also explored. More than one hundred women filled in the Edinburgh Postnatal Depression Scale and the State-Trait Anxiety Inventory to assess depressive and anxiety symptoms, respectively, during the third trimester of pregnancy and three months after delivery. Mothers also filled in the Infant Behavior Questionnaire and a parental diary to evaluate negative affectivity and crying, respectively, when their infants were 3 months old. SES was assessed through the Hollingshead classification. The intensity of antenatal maternal symptoms and SES were associated with infant negative affectivity, but not with crying. However, SES moderated the association between the intensity of maternal symptoms and infant crying. The direction of maternal symptoms (anxiety versus depression) was not associated with both infant negative affectivity and crying. Our findings contribute to elucidating the role played by the intensity of maternal stress in pregnancy—alone and in interaction with SES—in determining individual differences in infant emotional regulation, thus emphasizing the importance of timely psychological interventions for pregnant women who experience psychological distress. Full article
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12 pages, 1369 KiB  
Article
Transition to Motherhood: A Study on the Association between Somatic Symptoms during Pregnancy and Post-Partum Anxiety and Depression Symptoms
Int. J. Environ. Res. Public Health 2022, 19(19), 12861; https://doi.org/10.3390/ijerph191912861 - 07 Oct 2022
Cited by 3 | Viewed by 1955
Abstract
Several authors found that somatic symptoms during pregnancy such as nausea, vomiting, and levels of sleep, and fear of childbirth were associated with women’s post-partum psychopathological difficulties. The present study aimed to verify whether fear of childbirth can mediate the relationship between some [...] Read more.
Several authors found that somatic symptoms during pregnancy such as nausea, vomiting, and levels of sleep, and fear of childbirth were associated with women’s post-partum psychopathological difficulties. The present study aimed to verify whether fear of childbirth can mediate the relationship between some somatic symptoms experienced during pregnancy (i.e., nausea, vomiting, and daily sleep duration) and the post-partum depressive and anxious symptoms. N = 258 mothers of children between 3 and 6 months of age filled out self-report questionnaires assessing somatic symptoms during pregnancy, fear of childbirth, and anxious and depressive symptoms during post-partum. Results showed that levels of vomiting during pregnancy (but not nausea and daily sleep duration) was associated with post-partum depression and anxiety. Furthermore, findings showed that fear of childbirth partially mediated the relationships between the levels of vomiting during pregnancy and post-partum state anxiety and depression. These results can have several clinical implications, allowing to implement preventive programs for post-partum depression, considering vomiting and fear of childbirth as important risk factors. Full article
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9 pages, 802 KiB  
Article
Pregnancy Complications in Pandemics: Is Pregnancy-Related Anxiety a Possible Physiological Risk Factor?
Int. J. Environ. Res. Public Health 2022, 19(19), 12119; https://doi.org/10.3390/ijerph191912119 - 25 Sep 2022
Cited by 3 | Viewed by 1501
Abstract
Background: Birth and pregnancy complications increased by 10.2% during the 2019 coronavirus (COVID-19) pandemic. Pregnant women are at high risk for anxiety, which might trigger physio-logical stress, leading to pregnancy complications. Aim: This study aimed to investigate factors leading to antenatal anxiety during [...] Read more.
Background: Birth and pregnancy complications increased by 10.2% during the 2019 coronavirus (COVID-19) pandemic. Pregnant women are at high risk for anxiety, which might trigger physio-logical stress, leading to pregnancy complications. Aim: This study aimed to investigate factors leading to antenatal anxiety during the COVID-19 pandemic. We also aimed to discuss our find-ings with regard to the current literature about pregnancy complications. Methods: This cross-sectional study interviewed 377 pregnant women and assessed anxiety using a validated 7-item general anxiety disorder (GAD-7) scale. Anxiety was related to physiological and demo-graphic parameters. Anxiety was subdivided into pandemic- and pregnancy-related anxiety to minimize results bias. Results: Our results showed that 75.3% of pregnant women were anxious. The mean GAD-7 score was 8.28 ± 5. Linear regression analysis showed that for every increase in the number of previous pregnancies, there was a 1.3 increase in anxiety level (p < 0.001). Women with no previous miscarriages were more anxious (p < 0.001). Surprisingly, pregnant women who were previously infected with COVID-19 were 6% less stressed. Pregnant women with comorbid-ities were more stressed (p < 0.001). Low income (p < 0.001) and age (p < 0.05) were the demo-graphic factors most significantly related to increased anxiety. Conclusions: The prevalence of pregnancy-related anxiety increased threefold in Saudi Arabia due to the COVID-19 pandemic. Healthcare support should be available remotely during pandemics; pregnant women (especially those with comorbidities) should be educated about the risks of infection and complications to prevent anxiety-related complications during pregnancy. Full article
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20 pages, 726 KiB  
Article
Uncovering the Model and Philosophy of Care of a Psychiatric Inpatient Mother-Baby Unit in a Qualitative Study with Staff
Int. J. Environ. Res. Public Health 2022, 19(15), 9717; https://doi.org/10.3390/ijerph19159717 - 07 Aug 2022
Viewed by 1711
Abstract
The postnatal period is high-risk time for the first onset and recurrence of maternal mental health disorders. Untreated maternal mental illness can have significant adverse impacts on a woman, her baby, and the wider family unit. For women with mental illnesses that cannot [...] Read more.
The postnatal period is high-risk time for the first onset and recurrence of maternal mental health disorders. Untreated maternal mental illness can have significant adverse impacts on a woman, her baby, and the wider family unit. For women with mental illnesses that cannot be managed in the community, psychiatric inpatient mother-baby units are the gold standard treatment whereby mothers are co-admitted with their infant for specialist perinatal and infant mental health assessment and treatment. The study explores the model of care and examines the philosophies of care that are used within a psychiatric mother-baby unit. Purposive sampling was used to conduct semi-structured focus group and individual interviews with multidisciplinary staff members at a single mother-baby unit. Themes derived from these interviews were coded into two primary themes and a range of sub-themes. The first primary theme focused on the Model of Care consisting of the following sub-themes: mental health care, physical health care, babies’ care, building mother-baby relationship, fostering relationships with supports, and facilitating community support. The second primary theme centered around the Philosophy of Care comprising of: person-centered care, trauma-informed care, compassion-centered care, recovery-oriented care, attachment-informed care, non-judgmental care, strengths-based care and interdisciplinary care. The model can be used to provide consistency across mother-baby units and to support core capabilities of staff in providing an optimal level of care. Full article
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14 pages, 868 KiB  
Article
Parenting Stress, Maternal Self-Efficacy and Confidence in Caretaking in a Sample of Mothers with Newborns (0–1 Month)
Int. J. Environ. Res. Public Health 2022, 19(15), 9651; https://doi.org/10.3390/ijerph19159651 - 05 Aug 2022
Cited by 4 | Viewed by 2377
Abstract
A mother’s responses to her newborn and her confidence in the child’s caretaking depend on her attachment security, general parental stress, and perceived self-efficacy. However, few studies have analyzed maternal confidence in caretaking and how it is influenced by some mothers’ characteristics. We [...] Read more.
A mother’s responses to her newborn and her confidence in the child’s caretaking depend on her attachment security, general parental stress, and perceived self-efficacy. However, few studies have analyzed maternal confidence in caretaking and how it is influenced by some mothers’ characteristics. We aimed to examine the association between maternal adult attachment and confidence in a child’s caretaking and to understand whether this relationship was mediated by parenting stress and maternal self-efficacy. The sample consisted of 96 mothers with a mean age of 33 years with newborn children aged between 3 and 30 days. The instruments used were the Experiences in Close Relationships-Revised (ECR-R), the Mother and Baby Scale (MABS), the Parenting Stress Index Short Form (PSI-SF), and the Maternal Self-Efficacy Questionnaire (MEQ). The results showed a positive association between attachment avoidance and lack of confidence in caretaking, and this association was mediated by parenting stress. Conversely, attachment anxiety appeared not to influence confidence in caretaking, and maternal self-efficacy did not appear to mediate the relationship between attachment and confidence in the caretaking of infants. Our results could guide new research in studying confidence in caretaking and enable healthcare professionals to recognize at-risk situations early from the first month after childbirth. Full article
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15 pages, 1209 KiB  
Article
Does Parental Reflective Functioning Mediate the Associations between the Maternal Antenatal and Postnatal Bond with the Child in a Community Sample?
Int. J. Environ. Res. Public Health 2022, 19(12), 6957; https://doi.org/10.3390/ijerph19126957 - 07 Jun 2022
Cited by 4 | Viewed by 1700
Abstract
Although establishing an affective tie with a child during perinatality is considered one of the most important maternal tasks, little is still known about the mediators of the association between maternal antenatal and postnatal bonding with the infant. This prospective study addresses this [...] Read more.
Although establishing an affective tie with a child during perinatality is considered one of the most important maternal tasks, little is still known about the mediators of the association between maternal antenatal and postnatal bonding with the infant. This prospective study addresses this gap by evaluating a community sample of 110 Italian women to assess whether maternal pre- and postnatal bonds with the infant are mediated by parental reflective functioning (PRF), as assessed at the third trimester of pregnancy and three months postpartum. Controlling for confounding variables, the hierarchical regression analyses show the maternal prenatal quality of attachment to the fetus as the main predictor of maternal postnatal attachment to the child (β = 0.315; t = 0.2.86; p = 0.005). The mediation analyses show that mothers’ PRF (b = 0.245; SE = 0.119; 95% CI = 0.071, 0.531) explains 39% of the relationship between maternal pre- and postnatal bonding with the child. The findings of this study contribute to research on the association between prenatal and mother-to-infant bonding by additionally investigating the importance of taking into account maternal PRF as a mediating variable. This provides support for the clinical utility of interventions focused on maternal PRF. Full article
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17 pages, 975 KiB  
Article
Tobacco Smoking during Pregnancy: Women’s Perception about the Usefulness of Smoking Cessation Interventions
Int. J. Environ. Res. Public Health 2022, 19(11), 6595; https://doi.org/10.3390/ijerph19116595 - 28 May 2022
Cited by 4 | Viewed by 2207
Abstract
Tobacco consumption during pregnancy is a serious public health problem due to its negative effects on fetal development and on pregnant women’s health and well-being. Thus, it is of utmost importance to plan and implement smoking cessation interventions, to prevent the negative impact [...] Read more.
Tobacco consumption during pregnancy is a serious public health problem due to its negative effects on fetal development and on pregnant women’s health and well-being. Thus, it is of utmost importance to plan and implement smoking cessation interventions, to prevent the negative impact of this risk factor, namely on children’s health and development. This cross-sectional study aimed at exploring the perceptions and beliefs about the usefulness of smoking cessation interventions during pregnancy, in a sample of pregnant Portuguese women. The smoking use by pregnant women, as well as the risk factors associated with tobacco smoking during pregnancy, were also analyzed. The sample included 247 pregnant Portuguese women aged between 18–43-years-old (M = 30.30, SD = 5.02): 42.5% never smoked, 18.3% quit smoking before pregnancy, 19.0% quit smoking after getting pregnant and 20.2% were current smokers. The pregnant Portuguese women who smoked during pregnancy (current smokers or who quit smoking after getting pregnant) were mostly single or divorced, with lower education levels, showed a higher prevalence of clinically significant anxiety symptoms, and perceived smoking cessation interventions during pregnancy as less useful when compared to women who never smoked or quit smoking prior pregnancy. Daily or weekly smoking cessation interventions, implemented by health professionals such as doctors, nurses, or psychologists are the ones perceived as the most useful for pregnant women. These findings provide important clues for the planning of smoking cessation interventions during pregnancy, highlighting the domains that should be carefully monitored by health professionals. Specific strategies should also be used by health professionals to promote smoking cessation considering the demands of pregnancy and postpartum. Full article
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13 pages, 1014 KiB  
Article
Evaluation of the Effect of Supervised Group Exercise on Self-Reported Sleep Quality in Pregnant Women with or at High Risk of Depression: A Secondary Analysis of a Randomized Controlled Trial
Int. J. Environ. Res. Public Health 2022, 19(10), 5954; https://doi.org/10.3390/ijerph19105954 - 13 May 2022
Cited by 3 | Viewed by 2103
Abstract
Poor sleep quality is common during pregnancy. Our objective was to evaluate the effect of supervised group physical exercise on self-reported sleep quality in pregnant women with or at high risk of depression, and secondly, to describe the association between sleep quality and [...] Read more.
Poor sleep quality is common during pregnancy. Our objective was to evaluate the effect of supervised group physical exercise on self-reported sleep quality in pregnant women with or at high risk of depression, and secondly, to describe the association between sleep quality and psychological well-being during pregnancy and postpartum. This was a secondary analysis of a randomized controlled trial (n = 282) (NCT02833519) at Rigshospitalet, Denmark. Sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI), psychological well-being by the five-item WHO Well-Being Index (WHO-5). The intention-to-treat analysis showed no difference in mean global PSQI score neither at 29–34 weeks, 6.56 (95% CI: 6.05–7.07) in the intervention group and 7.00 (95% CI: 6.47–7.53) in the control group, p = 0.2, nor at eight weeks postpartum. Women with WHO-5 ≤ 50 reported higher mean global PSQI scores at baseline, 7.82 (95% CI: 7.26–8.38), than women with WHO-5 score > 50, mean 5.42 (95% CI: 5.02–5.82), p < 0.0001. A significant difference was also present post-intervention and eight weeks postpartum. No significant effect of group exercise regarding self-reported sleep quality was seen at 29–34 weeks of gestation or postpartum. Low psychological well-being was associated with poor sleep quality during pregnancy and postpartum. Full article
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15 pages, 363 KiB  
Article
Evaluation of an Inpatient Psychiatric Mother-Baby Unit Using a Patient Reported Experience and Outcome Measure
Int. J. Environ. Res. Public Health 2022, 19(9), 5574; https://doi.org/10.3390/ijerph19095574 - 04 May 2022
Cited by 2 | Viewed by 1936
Abstract
Understanding the patient experience of admission to a psychiatric mother-baby unit (MBU) informs service improvement and strengthens patient-centered care. This study aims to examine patients’ experience, satisfaction, and change in mental health status related to MBU admission. At discharge, 70 women admitted to [...] Read more.
Understanding the patient experience of admission to a psychiatric mother-baby unit (MBU) informs service improvement and strengthens patient-centered care. This study aims to examine patients’ experience, satisfaction, and change in mental health status related to MBU admission. At discharge, 70 women admitted to a public MBU completed the Patient Outcome and Experience Measure (POEM), rated the usefulness of therapeutic groups, and provided written qualitative feedback. Paired sample t-tests, correlations, and thematic content analysis were completed. Women were highly satisfied with the level of care and support received, particularly for those who were voluntarily admitted. Women reported an improvement in mental health from admission to discharge. Women appreciated the staff’s interpersonal skills, provision of practical skills, education, advice, support from other women, and therapeutic groups offered. Women suggested improvements such as having greater food choices, more MBU beds, more group sessions, family visitations, which had been restricted due to COVID-19, environmental modifications, and clarity of communication surrounding discharge. This study highlights the benefits of MBUs and the specific aspects of care that are favorable in treating women with mental illnesses who are co-admitted with their baby in an MBU. Full article
16 pages, 366 KiB  
Article
Psychopathological and Psychosocial Risk Profile, Styles of Interaction and Mentalization of Adolescent and Young Mother–Infant Dyads
Int. J. Environ. Res. Public Health 2022, 19(8), 4737; https://doi.org/10.3390/ijerph19084737 - 14 Apr 2022
Cited by 2 | Viewed by 1765
Abstract
This study examined the psychopathological and psychosocial risk profile and the quality of mother–infant interaction in 98 adolescent and young mother–infant dyads. At their infant’s age of 3 months, mothers filled in a socio-demographic form and completed a test battery: EPDS for depression, [...] Read more.
This study examined the psychopathological and psychosocial risk profile and the quality of mother–infant interaction in 98 adolescent and young mother–infant dyads. At their infant’s age of 3 months, mothers filled in a socio-demographic form and completed a test battery: EPDS for depression, STAY-I for anxiety, PSI-SF for parenting stress, MPSS for social support, AAI for maternal attachment and reflective functioning, CECA for adverse childhood experiences, Care-Index and Mind-mindedness coding system for mother–infant interaction. Results showed that motherhood in adolescence was associated with several psychosocial risk factors. Adolescent and young mothers have depression (25%), anxiety (29%) and insecure attachment (65%), with low reflective functioning, of whom 18% have disorganized attachment. A total of 54% of the mothers had at least one adverse childhood experience. Furthermore, adolescent mothers had low sensitivity and mind-mindedness and high intrusiveness, and their infant had low responsiveness and high passive behaviors. Mothers under 18 have experienced more sexual abuse, are more likely to be single and have been followed by child social services more than mothers aged 18–21. Adolescent mothers have a high-risk psychopathological and psychosocial profile that affects their ability to mentalize and build an adequate relationship with the child. It appears to be important to support the adolescent mother–child relationship. Full article
10 pages, 1028 KiB  
Article
Couple’s Relationship and Depressive Symptoms during the Transition to Parenthood and Toddler’s Emotional and Behavioral Problems
Int. J. Environ. Res. Public Health 2022, 19(6), 3610; https://doi.org/10.3390/ijerph19063610 - 18 Mar 2022
Cited by 1 | Viewed by 1398
Abstract
The couple’s relationship and mother and father’s depressive symptoms during the transition to parenthood were associated with the toddler’s emotional and behavioral problems. This study aimed to analyze how the couple’s positive and negative interactions and mother and father’s depressive symptoms during the [...] Read more.
The couple’s relationship and mother and father’s depressive symptoms during the transition to parenthood were associated with the toddler’s emotional and behavioral problems. This study aimed to analyze how the couple’s positive and negative interactions and mother and father’s depressive symptoms during the transition to parenthood impact toddlers’ emotional and behavioral problems. A sample of 95 mothers and fathers (N = 190) were recruited and individually completed questionnaires to assess couples’ positive and negative interactions and depressive symptoms during the first trimester of pregnancy and at 3 and 30 months postpartum, and they completed the Child Behavior Checklist 1.5–5 at 30 months postpartum. The path analyses revealed that the couple’s postnatal negative interaction partially mediates the impact of the mother’s prenatal depressive symptoms on the toddler’s internalizing problems at 30 months postpartum. The father’s postnatal depressive symptoms and the couple’s concurrent positive interaction mediated the impact of the couple’s prenatal positive interaction on the toddler’s externalizing problems at 30 months postpartum. The screening of the couple’s negative interaction and depressive symptoms during pregnancy and the postnatal period can help to identify mothers, fathers, and toddlers at risk for mental health problems. Full article
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12 pages, 342 KiB  
Article
Does Prenatal Physical Activity Affect the Occurrence of Postnatal Anxiety and Depression? Longitudinal Study
Int. J. Environ. Res. Public Health 2022, 19(4), 2284; https://doi.org/10.3390/ijerph19042284 - 17 Feb 2022
Cited by 5 | Viewed by 2107
Abstract
The aim of the foregoing study was to assess whether physical activity during pregnancy affects the occurrence of anxiety and depression during pregnancy, postpartum and 6 months following childbirth. This study tried to answer the following questions: How was the incidence of depression [...] Read more.
The aim of the foregoing study was to assess whether physical activity during pregnancy affects the occurrence of anxiety and depression during pregnancy, postpartum and 6 months following childbirth. This study tried to answer the following questions: How was the incidence of depression and anxiety different in the pre- and postpartum periods? What intensity level of physical activity protects against the symptoms of anxiety and depression? Does the time spent engaged in sedentary activities and MVPA affect the occurrence of depression and anxiety before and after childbirth? The study group under analysis consisted of 187 women aged 19–41 years. The research was conducted between April 2016 and November 2020. The study was divided into four stages: T0—qualification to participate in the study; T1—medical history acquisition, consisting of a short questionnaire and two long questionnaires (the Edinburgh Postnatal Depression Scale (EPDS) and General Anxiety Disorder-7 (GAD-7)), as well as an assessment of 7-day physical activity using Actigraph accelerometers during the pregnancy; T2—the completion of the EPDS and GAD-7 questionnaires after the birth; T3—the completion of the EPDS and GAD-7 questionnaire 6 months after giving birth. The obtained results were statistically processed in the Statistica 13.3 software package. A significance level of p < 0.05 was assumed. The highest percentage of depression occurred immediately after the delivery, followed by 6 months after delivery, and the smallest number of women suffered from depression before the birth (p < 0.001). The analysis of correlations of physical activity with anxiety symptoms did not show significant correlations. However, the situation is different in the case of depression symptoms. Women taking fewer steps before delivery showed a greater tendency to develop depressive symptoms before, immediately after and 6 months after the delivery (p < 0.001). Women who were less active (took fewer steps per day, spent less time in moderate-to-vigorous physical (MVPA) activities or spent more time being sedentary) showed symptoms of depression on the EPDS scale. It appeared that those with severe anxiety symptoms had the highest sedentary time scores before the delivery (p = 0.020). Reduced physical activity promotes the onset of postnatal depression, while being active reduces this risk. Interestingly, even light physical activity “protects” against the occurrence of depression and is better than sedentary activities. Such clear conclusions cannot be drawn in relation to anxiety symptoms. Sedentary behaviour may promote anxiety symptoms immediately after childbirth, but this study should be continued in order to confirm it during other time periods. Full article
11 pages, 339 KiB  
Article
Maternal Attachment Representations during Pregnancy, Perinatal Maternal Depression, and Parenting Stress: Relations to Child’s Attachment
Int. J. Environ. Res. Public Health 2022, 19(1), 69; https://doi.org/10.3390/ijerph19010069 - 22 Dec 2021
Cited by 4 | Viewed by 3033
Abstract
Background: This paper aimed to explore the associations between maternal representations of attachment evaluated during pregnancy, pre and postnatal maternal depression, parenting stress and child’s attachment at 15 months after childbirth. Methods: Mothers (n = 71), and their infants participated in a [...] Read more.
Background: This paper aimed to explore the associations between maternal representations of attachment evaluated during pregnancy, pre and postnatal maternal depression, parenting stress and child’s attachment at 15 months after childbirth. Methods: Mothers (n = 71), and their infants participated in a longitudinal study of maternal attachment, pre and postnatal depression, parenting stress and child attachment. Adult Attachment Interview (AAI) was conducted between 24 and 26 weeks of pregnancy (Time 1), depression was assessed using the Edinburgh Perinatal Depression Scale (EPDS) (at Time 1 and 6 months after childbirth, i.e., Time 2), parenting stress was assessed using the Parenting Stress Index—Short Form (PS-SF) (at Time 2) and the Strange Situation Procedure (SSP) at child’s 15 months of age (Time 3). Results: Free-autonomous maternal classification of attachment increases the likelihood of secure child classification in her offspring, while decreases that of avoidance and ambivalence. Insecure maternal representation of attachment evaluated during pregnancy and higher levels of parenting stress at six months after childbirth was associated with higher rates of infant insecure attachment at 15 months. Conclusions: Our study validates the importance of considering maternal representations of attachment crucial in determining the quality of the caregiving environment, thereby the healthy development of children, despite the presence of other contextual risk. Full article

Review

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29 pages, 1096 KiB  
Review
Resilience in the Perinatal Period and Early Motherhood: A Principle-Based Concept Analysis
Int. J. Environ. Res. Public Health 2022, 19(8), 4754; https://doi.org/10.3390/ijerph19084754 - 14 Apr 2022
Cited by 1 | Viewed by 2497
Abstract
A context-specific delineation of research approaches to resilience in the perinatal and early motherhood literature is currently lacking. A principle-based concept analysis was used to establish a description of how women’s resilience is currently conceptualised and operationalised within empirical research in the perinatal [...] Read more.
A context-specific delineation of research approaches to resilience in the perinatal and early motherhood literature is currently lacking. A principle-based concept analysis was used to establish a description of how women’s resilience is currently conceptualised and operationalised within empirical research in the perinatal period and early motherhood (defined as up to five-years postpartum). CINAHL, Medline, PsychInfo, EMBASE, ASSIA, Web of Science, Scielo, Maternity and Infant Care, the Cochrane Library, and the World Health Organization were systematically searched (January/February 2020 and March 2022). Fifty-six studies met the inclusion criteria. Analysis demonstrated interchangeable use of associated concepts such as ‘coping’, ‘coping strategies’, and ‘adaptation’. Resilience was frequently operationalised as the absence of illness symptomatology, rather than the presence of mental well-being. Investigations of positive areas of functioning were predominately related to the mother’s family role. There was limited qualitative exploration of women’s perspectives. Recommendations for the pragmatic application of resilience research were not well developed. The narrow operationalisation of resilience by mental ill-health and parental role, and the distinct absence of women’s perspectives, restricts the logical maturity and pragmatic application of the concept. Future research may benefit from exploration of women’s insights on indicators that might best reflect positive functioning and resilience in this period. Full article
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