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Perinatal Mood and Anxiety Disorders: Sociobiological and Intergenerational Predictors, Interventions, and Outcomes

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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 June 2022) | Viewed by 18232

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Special Issue Editors

Dr. Nicole L. Letourneau

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Leading Guest Editor

Faculty of Nursing and Cumming School of Medicine (Pediatrics, Psychiatry & Community Health Sciences), University of Calgary, Calgary, AB T2N 1N4, Canada
Interests: parent–infant/child relationships; perinatal mental health; infant mental health; vulnerable children; parent–child interventions; social support; domestic abuse; toxic stress; adverse childhood experiences; child development and health; biological sensitivity; genetics; epigenetics

Dr. Panagiota Tryphonopoulos

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Assistant Guest Editor

Arthur Labatt Family School of Nursing, Western University, London, ON, N6A 5C1, Canada
Interests: perinatal depression; maternal mental health; infant mental health; attachment; toxic stress; parent–child interventions; community-based nursing interventions

Special Issue Information

Dear Colleagues,

We are delighted to edit this Special Issue on “Perinatal Mood and Anxiety Disorders: Sociobiological and Intergenerational Predictors, Interventions, and Outcomes”. Perinatal mood and anxiety disorders (PMADs), so called because of frequently occurring co-morbidities, include depression, anxiety, panic disorder, obsessive compulsive disorder, post-traumatic stress disorder, bipolar disorder, and psychosis that occur during the pregnancy and/or postpartum periods. The most common PMADs are prenatal and postnatal depression, which affect expectant mothers and cause considerable suffering. Fathers may also be affected, either from the distress of supporting their unwell partner or via experiencing symptoms themselves. Infants and children also experience the negative impacts of PMADs on their behaviour, cognitive development, and mental health. Considered an adverse childhood experience (ACE), PMADs often impact parents’ ability to be sensitive and responsive to their growing infants and children, placing children on a trajectory of risk. Furthermore, ACEs may increase the risk of PMADs in childbearing women, suggesting intergenerational impacts. Some women may be particularly biologically sensitive (e.g., genetically differentially susceptible) to PMADs; similarly, some children may be biologically sensitive to negative outcomes from exposure to parental PMADs. Evidence-based interventions for PMADs are available, yet most are focused on depression. How other PMADs, alone or in combination, may be effectively treated is less well-established. Innovative (e.g., virtual interventions) are on the rise and require evidence of effectiveness for PMADs. Furthermore, the degree to which ACEs or biological sensitivity impact: (1) the onset of PMADs; or (2) the effectiveness of PMAD interventions for either parent or child outcomes is just beginning to be understood. For example, when mothers are treated for PMADs, even when symptoms resolve, positive impacts on children are less observable, potentially due to biological sensitivity that has not been considered in the research design or during clinical work.

This Special Issue invites the submission of:

systematic reviews of sociobiological predictors of various PMADs;
studies examining the impact of biological sensitivity on the onset of PMADs;
studies examining the impact of biological sensitivity on the degree of negative impact of PMADs on children;
systematic reviews of intervention effectiveness for various PMADs;
studies evaluating interventions for PMADs on maternal, paternal, and child outcomes;
studies evaluating interventions for various PMADs using novel clinical interventions (e.g., virtual/online);
subgroup analyses of clinical interventions, identifying what works for whom, and under what circumstances; and
studies evaluating interventions for PMADs considering differential impacts of sociobiological covariates (e.g., various ACEs, genetic susceptibility).

Dr. Nicole L. Letourneau
Dr. Panagiota Tryphonopoulos
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

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

perinatal depression
perinatal mood disorders
interventions
systematic reviews
biological sensitivity
adverse childhood experiences
intergenerational
novel interventions

Published Papers (6 papers)

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Research

Jump to: Review

18 pages, 810 KiB

Open AccessArticle

Effect of Attachment and Child Health (ATTACH^TM) Parenting Program on Parent-Infant Attachment, Parental Reflective Function, and Parental Depression

by Lubna Anis, Kharah Ross, Henry Ntanda, Martha Hart and Nicole Letourneau

Int. J. Environ. Res. Public Health 2022, 19(14), 8425; https://doi.org/10.3390/ijerph19148425 - 10 Jul 2022

Cited by 5 | Viewed by 2190

Abstract

High-risk families exposed to toxic stressors such as family violence, depression, addiction, and poverty, have shown greater difficulty in parenting young children. In this study, we examined the effectiveness of ATTACH^TM, a 10–12 session manualized one-on-one parental Reflective Function (RF)-based parenting program designed for high-risk families. Outcomes of parent-child attachment and parental RF were assessed via the Strange Situation Procedure (SSP) and Reflective Function Scale (RFS), respectively. The protective role of ATTACH^TM on parental depression was also assessed. Data were available from caregivers and their children < 6 years of age who participated in five pilot randomized control trials (RCTs) and quasi-experimental studies (QES; n = 40). Compared with the control group, caregivers who received the ATTACH^TM-program demonstrated a greater likelihood of secure attachment with their children (p = 0.004) and higher parental RF [self (p = 0.004), child (p = 0.001), overall (p = 0.002)] in RCTs. A significant improvement in parental RF (p = 0.000) was also observed in the QES within ATTACH^TM group analysis. As attachment security increased, receiving the ATTACH^TM program may be protective for depressed caregivers. Results demonstrated the promise of ATTACH^TM for high-risk parents and their young children. Full article

(This article belongs to the Special Issue Perinatal Mood and Anxiety Disorders: Sociobiological and Intergenerational Predictors, Interventions, and Outcomes)

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13 pages, 633 KiB

Open AccessArticle

Associations among Caesarean Section Birth, Post-Traumatic Stress, and Postpartum Depression Symptoms

by Marie-Andrée Grisbrook, Deborah Dewey, Colleen Cuthbert, Sheila McDonald, Henry Ntanda, Gerald F. Giesbrecht and Nicole Letourneau

Int. J. Environ. Res. Public Health 2022, 19(8), 4900; https://doi.org/10.3390/ijerph19084900 - 18 Apr 2022

Cited by 16 | Viewed by 6584

Abstract

Caesarean section (C-section) deliveries account for nearly 30% of births annually with emergency C-sections accounting for 7–9% of all births. Studies have linked C-sections to postpartum depression (PPD). PPD is linked to reduced quality of parent-child interaction, and adverse effects on maternal and child health. New mothers’ perceptions of more negative childbirth experiences, such as unplanned/emergency C-sections, are linked to post-traumatic stress disorder (PTSD), which in turn is related to PPD. Our objectives were to determine: (1) the association between C-section type (unplanned/emergency vs. planned) and PPD symptoms, and (2) if postnatal PTSD symptoms mediate this association. Employing secondary analysis of prospectively collected data from 354 mother-child dyads between 2009 and 2013 from the Alberta Pregnancy Outcomes and Nutrition (APrON) study, conditional process modeling was employed. The Edinburgh Postnatal Depression Scale (EPDS) and the Psychiatric Diagnostic Screening Questionnaire (PDSQ) were administered at three months postpartum, to assess for postpartum depressive and post-traumatic stress symptoms. The direct effect of emergency C-section on PPD symptoms was non-significant in adjusted and non-adjusted models; however, the indirect effect of emergency C-section on PPD symptoms with PTSD symptoms as a mediator was significant after controlling for prenatal depression symptoms, social support, and SES (β = 0.17 (SE = 0.11), 95% CI [0.03, 0.42]). This suggests that mothers who experienced an emergency or unplanned C-section had increased PTSD scores of nearly half a point (0.47) compared to mothers who underwent a planned C-section, even after adjustment. Overall, emergency C-section was indirectly associated with PPD symptoms, through PTSD symptoms. Findings suggest that PTSD symptoms may be a mechanism through which emergency C-sections are associated with the development of PPD symptoms. Full article

(This article belongs to the Special Issue Perinatal Mood and Anxiety Disorders: Sociobiological and Intergenerational Predictors, Interventions, and Outcomes)

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12 pages, 595 KiB

Open AccessArticle

Exposure to War Prior to Conception: Maternal Emotional Distress Forecasts Sex-Specific Child Behavior Problems

by Roseriet Beijers, Anat Scher, Hanit Ohana, Ayala Maayan-Metzger and Micah Leshem

Int. J. Environ. Res. Public Health 2022, 19(7), 3802; https://doi.org/10.3390/ijerph19073802 - 23 Mar 2022

Cited by 4 | Viewed by 1709

Abstract

Objectives: Exposure to maternal stress during the prenatal period adversely affects child outcomes. Recent investigations have shifted to an even earlier period, the preconception period, to better understand the role of this formative period in human health and disease. We investigated the links between maternal emotional distress following preconception exposure to war, and child outcomes at age 10. Material and Methods: Before becoming pregnant, mothers were exposed to missile bombardment on the north of Israel in the 2006 war. Mothers who conceived within 12 months after the war were recruited and compared to mothers who conceived during the same period but lived in Israel but outside missile range. During the initial assessment, mothers completed a questionnaire on emotional distress. At 10 years of age, mothers and children (N = 68) reported on child socio-emotional outcomes. Results: Multiple regression analyses revealed that, in girls, higher maternal emotional distress following preconception war exposure predicted more internalizing and externalizing behavior problems, and more behavior regulation problems. In boys, maternal emotional distress was not significantly related to outcomes. Conclusion: Maternal emotional distress following preconception exposure to war forecasts sex-specific child behavioral problems as reported by the mother and the child. Though the results warrant cautious interpretation because of the relatively small sample size and differential attrition, our findings add to the small but growing body of research on the consequences of maternal stress exposure prior to conception for the next generation. Full article

(This article belongs to the Special Issue Perinatal Mood and Anxiety Disorders: Sociobiological and Intergenerational Predictors, Interventions, and Outcomes)

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13 pages, 554 KiB

Open AccessArticle

Affective Instability, Depression, and Anxiety Symptoms in a Community Sample of Pregnant and Postpartum Women: A Cross-Sectional Study

by Hua Li

Int. J. Environ. Res. Public Health 2022, 19(6), 3171; https://doi.org/10.3390/ijerph19063171 - 08 Mar 2022

Cited by 2 | Viewed by 2004

Abstract

Background: Although perinatal women experience an elevated level of affective instability (AI), limited research has been conducted to examine perinatal AI and its relation to depression and anxiety. The current study investigated correlations between AI and depression, between AI and anxiety during the perinatal period, and between current depression and anxiety and the latent factors of the Affective Lability Scale-18 (ALS-18). Methods: 202 Canadian perinatal women participated in this cross-sectional study. The ALS-18 was used to assess AI, while the Depression, Anxiety, and Stress Scale-21 measured depression, anxiety, and stress. Multiple logistic regression was performed to investigate the relationship between AI and depression and anxiety, and multiple linear regression was conducted to examine the association between current depression and anxiety and the three latent factors of ALS-18. Results: The findings revealed a significant association between AI and depression and between AI and anxiety. Current depression and anxiety were correlated with ALS-18 factors of depression/anxiety shift and depression/elation shift, while current depression was linked to ALS-18 factor of anger. Conclusions: The study findings have important implications for early detection and intervention of maternal anxiety and depression. In order to improve maternal mental health, AI should be included in routine perinatal check-ups. Full article

(This article belongs to the Special Issue Perinatal Mood and Anxiety Disorders: Sociobiological and Intergenerational Predictors, Interventions, and Outcomes)

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15 pages, 361 KiB

Open AccessArticle

Barriers and Facilitators to Resuming In-Person Psychotherapy with Perinatal Patients amid the COVID-19 Pandemic: A Multistakeholder Perspective

by Nicole Andrejek, Sabrina Hossain, Nour Schoueri-Mychasiw, Gul Saeed, Maral Zibaman, Angie K. Puerto Niño, Samantha Meltzer-Brody, Richard K. Silver, Simone N. Vigod and Daisy R. Singla

Int. J. Environ. Res. Public Health 2021, 18(22), 12234; https://doi.org/10.3390/ijerph182212234 - 22 Nov 2021

Cited by 4 | Viewed by 2448

Abstract

During the COVID-19 pandemic, outpatient psychotherapy transitioned to telemedicine. This study aimed to examine barriers and facilitators to resuming in-person psychotherapy with perinatal patients as the pandemic abates. We conducted focus group and individual interviews with a sample of perinatal participants (n = 23), psychotherapy providers (n = 28), and stakeholders (n = 18) from Canada and the U.S. involved in the SUMMIT trial, which is aimed at improving access to mental healthcare for perinatal patients with depression and anxiety. Content analysis was used to examine perceived barriers and facilitators. Reported barriers included concerns about virus exposure in a hospital setting (77.8% stakeholders, 73.9% perinatal participants, 71.4% providers) or on public transportation (50.0% stakeholders, 26.1% perinatal participants, 25.0% providers), wearing a mask during sessions (50.0% stakeholders, 25.0% providers, 13.0% participants), lack of childcare (66.7% stakeholders, 46.4% providers, 43.5% perinatal participants), general transportation barriers (50.0% stakeholders, 47.8% perinatal participants, 25.0% providers), and the burden of planning and making time for in-person sessions (35.7% providers, 34.8% perinatal participants, 27.8% stakeholders). Reported facilitators included implementing and communicating safety protocols (72.2% stakeholders, 47.8% perinatal participants, 39.3% providers), conducting sessions at alternative or larger locations (44.4% stakeholders, 32.1% providers, 17.4% perinatal participants), providing incentives (34.8% perinatal participants, 21.4% providers, 11.1% stakeholders), and childcare and flexible scheduling options (31.1% perinatal participants, 16.7% stakeholders). This study identified a number of potential barriers and illustrated that COVID-19 has fostered and amplified barriers. Future interventions to facilitate resuming in-person sessions should focus on patient-centered strategies based on empathy regarding ongoing risk-aversion among perinatal patients despite existing safety protocols, and holistic thinking to make access to in-person psychotherapy easier and more accessible for perinatal patients. Full article

(This article belongs to the Special Issue Perinatal Mood and Anxiety Disorders: Sociobiological and Intergenerational Predictors, Interventions, and Outcomes)

Review

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14 pages, 2299 KiB

Open AccessReview

Parenting and the Serotonin Transporter Gene (5HTTLPR), Is There an Association? A Systematic Review of the Literature

by Marta Landoni, Alice Dalla Muta, Sonia Di Tella, Giulia Ciuffo, Paola Di Blasio and Chiara Ionio

Int. J. Environ. Res. Public Health 2022, 19(7), 4052; https://doi.org/10.3390/ijerph19074052 - 29 Mar 2022

Cited by 1 | Viewed by 2093

Abstract

The current systematic review examines whether there is an association between the genetic 5-HTTPLR polymorphism and parenting, and the mechanisms by which this association operates. The literature was searched in various databases such as PubMed, Scopus, and ScienceDirect. In line with our inclusion criteria, nine articles were eligible out of 22. Most of the studies analysed in this review found an association between 5HTTLPR and parenting. Four studies found a direct association between 5-HTTLPR and parenting with conflicting findings: two studies found that mothers carrying the short variant were more sensitive to their infants, while two studies found that parents carrying the S allele were less sensitive. In addition, several studies found strong interaction between genetic and environmental factors, such as childhood stress and disruptive child behaviour, quality of early care experiences, poor parenting environment, and quality of the environment. Only one study found an association between children’s 5HTTLPR and parenting. Parenting can be described as a highly complex construct influenced by multiple factors, including the environment, as well as parent and child characteristics. According to the studies, maternal 5-HTTLPR polymorphism is most likely to be associated with sensitive parenting. Full article

(This article belongs to the Special Issue Perinatal Mood and Anxiety Disorders: Sociobiological and Intergenerational Predictors, Interventions, and Outcomes)

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