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Bodunde EO, Buckley D, O'Neill E, Al Khalaf S, Maher GM, O'Connor K, McCarthy FP, Kublickiene K, Matvienko‐Sikar K, Khashan AS. Pregnancy and birth complications and long-term maternal mental health outcomes: A systematic review and meta-analysis. BJOG 2025; 132:131-142. [PMID: 38887891 PMCID: PMC11625657 DOI: 10.1111/1471-0528.17889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 05/21/2024] [Accepted: 05/29/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND Few studies have examined the associations between pregnancy and birth complications and long-term (>12 months) maternal mental health outcomes. OBJECTIVES To review the published literature on pregnancy and birth complications and long-term maternal mental health outcomes. SEARCH STRATEGY Systematic search of Cumulative Index to Nursing and Allied Health Literature (CINAHL), Excerpta Medica Database (Embase), PsycInfo®, PubMed® and Web of Science from inception until August 2022. SELECTION CRITERIA Three reviewers independently reviewed titles, abstracts and full texts. DATA COLLECTION AND ANALYSIS Two reviewers independently extracted data and appraised study quality. Random-effects meta-analyses were used to calculate pooled estimates. The Meta-analyses of Observational Studies in Epidemiology (MOOSE) guidelines were followed. The protocol was prospectively registered on the International Prospective Register of Systematic Reviews (PROSPERO: CRD42022359017). MAIN RESULTS Of the 16 310 articles identified, 33 studies were included (3 973 631 participants). Termination of pregnancy was associated with depression (pooled adjusted odds ratio, aOR 1.49, 95% CI 1.20-1.83) and anxiety disorder (pooled aOR 1.43, 95% CI 1.20-1.71). Miscarriage was associated with depression (pooled aOR 1.97, 95% CI 1.38-2.82) and anxiety disorder (pooled aOR 1.24, 95% CI 1.11-1.39). Sensitivity analyses excluding early pregnancy loss and termination reported similar results. Preterm birth was associated with depression (pooled aOR 1.37, 95% CI 1.32-1.42), anxiety disorder (pooled aOR 0.97, 95% CI 0.41-2.27) and post-traumatic stress disorder (PTSD) (pooled aOR 1.75, 95% CI 0.52-5.89). Caesarean section was not significantly associated with PTSD (pooled aOR 2.51, 95% CI 0.75-8.37). There were few studies on other mental disorders and therefore it was not possible to perform meta-analyses. CONCLUSIONS Exposure to complications during pregnancy and birth increases the odds of long-term depression, anxiety disorder and PTSD.
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Affiliation(s)
- Elizabeth O. Bodunde
- School of Public HealthUniversity College CorkCorkIreland
- INFANT Research CentreUniversity College CorkCorkIreland
| | - Daire Buckley
- INFANT Research CentreUniversity College CorkCorkIreland
| | - Eimear O'Neill
- Perinatal Mental HealthAcute Mental Health Services (AMHS) and Child and Adolescent Mental Health Services (CAMHS), University College CorkCorkIreland
| | | | - Gillian M. Maher
- School of Public HealthUniversity College CorkCorkIreland
- INFANT Research CentreUniversity College CorkCorkIreland
| | - Karen O'Connor
- RISE, Early Intervention in Psychosis TeamSouth Lee Mental Health ServicesCorkIreland
- Department of Psychiatry and Neurobehavioral ScienceUniversity College CorkCorkIreland
| | - Fergus P. McCarthy
- INFANT Research CentreUniversity College CorkCorkIreland
- Department of Obstetrics and GynaecologyCork University Maternity HospitalCorkIreland
| | - Karolina Kublickiene
- Division of Renal Medicine, Department of Clinical Science, Intervention and TechnologyKarolinska InstitutetStockholmSweden
| | | | - Ali S. Khashan
- School of Public HealthUniversity College CorkCorkIreland
- INFANT Research CentreUniversity College CorkCorkIreland
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Sandnes R, Le Floch M, Riquin E, Nocus I, Müller JB, Bacro F. Parental stress and mental health outcomes following very preterm birth: A systematic review of recent findings. J Affect Disord 2024; 355:513-525. [PMID: 38556094 DOI: 10.1016/j.jad.2024.03.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 03/06/2024] [Accepted: 03/25/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND In recent years, there has been a wide array of research studies published on parental mental health and stress following very preterm birth. This review aims at reviewing the prevalence and risk factors of long-term parental depression, anxiety, post-traumatic stress symptoms and parenting stress following very preterm birth. METHODS We searched PubMed, PsychINFO and Web of Science for descriptive, cross-sectional and longitudinal studies published between January 2013 and August 2022. RESULTS 45 studies met our inclusion criteria. In the first two years, depression, anxiety, post-traumatic stress symptoms and parenting stress were present in ∼20 % of mothers of extreme and very low birth weight (E/VLBW) infants. Long-term psychological distress symptoms could be observed, although few studies have focused on symptoms into school age and longer. Fathers of VLBW infants might experience more psychological distress as well, however, they were only included in ten studies. We found that parental distress is more common when the co-parent is struggling with mental health symptoms. Many risk factors were identified such as social risk, history of mental illness, interpersonal factors (i.e. social support) and child-related factors (i.e. intraventricular hemorrhage, disability, use of medical equipment at home). LIMITATIONS Several studies have methodological issues, such as a lack of control of known confounders and there is a large variety of measures employed. CONCLUSION Important risk factors for stress and mental health symptoms were identified. More evidence is needed to determine if long-term symptoms persist into school age. Research should focus on taking a family-based approach in order to identify preventive strategies and resilience factors in parents of VLBW infants.
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Affiliation(s)
- Ramona Sandnes
- Faculty of Psychology, Centre de Recherche en Education de Nantes (CREN - UR 2661), Nantes University, Nantes, France.
| | - Marine Le Floch
- Department of Child and Adolescent Psychiatry, University Hospital of Angers, France
| | - Elise Riquin
- Department of Child and Adolescent Psychiatry, University Hospital of Angers, France; Univ Angers, [CHU Angers], LPPL EA4638, F-49000 Angers, France; Fondation de Santé des Étudiants de France, clinique de Sablé sur Sarthe, Sablé sur Sarthe, France
| | - Isabelle Nocus
- Faculty of Psychology, Centre de Recherche en Education de Nantes (CREN - UR 2661), Nantes University, Nantes, France
| | - Jean Baptiste Müller
- Loire Infant Follow-Up Team (LIFT) Network, Pays de Loire, France; Department of Neonatal Medicine, Nantes University Hospital, Nantes, France
| | - Fabien Bacro
- Faculty of Psychology, Centre de Recherche en Education de Nantes (CREN - UR 2661), Nantes University, Nantes, France
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Franco F, Chifa M, Politimou N. Home Musical Activities Boost Premature Infants' Language Development. CHILDREN (BASEL, SWITZERLAND) 2024; 11:542. [PMID: 38790537 PMCID: PMC11120229 DOI: 10.3390/children11050542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 03/21/2024] [Accepted: 04/03/2024] [Indexed: 05/26/2024]
Abstract
Infants born prematurely are considered at risk for language development delay and impairments. Using online parental reports, the present study investigated the influence of early musical experience in the home environment (Music@Home Infant Questionnaire) on language development (MacArthur-Bates Communicative Development Inventory) while controlling for general enrichment at home (Stim-Q Cognitive Home Environment Questionnaire) and perinatal post-traumatic stress disorder (Perinatal PTSD Questionnaire). Caregivers of 117 infants between 8 and 18 months of age (corrected age) without reported developmental difficulties completed an online survey. Results revealed that the musical home environment significantly predicted outcomes in reported infants' receptive vocabulary and gestural communication, independently from infants' corrected age and general enrichment of home activities. These findings constitute the first evidence that an enriched musical experience can enhance the development of early communication skills in a population at risk for language delays, namely infants born prematurely, opening the path for future intervention research in home and/or early childcare settings. Given that the majority of participants in this study were highly educated and from socioeconomically stable backgrounds, considerations regarding the generalizability of these results are discussed.
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Affiliation(s)
- Fabia Franco
- Psychology Department, Faculty of Science and Technology, Middlesex University, London NW4 4BT, UK;
| | - Maria Chifa
- Psychology Department, Faculty of Science and Technology, Middlesex University, London NW4 4BT, UK;
| | - Nina Politimou
- Department of Psychology and Human Development, IOE Faculty of Education and Society, University College London, London WC1H 0AA, UK
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Mao W, Chen Y, He Z, Wang Z, Xiao Z, Sun Y, He L, Zhou J, Guo W, Ma C, Zhao L, Kendrick KM, Zhou B, Becker B, Liu T, Zhang T, Jiang X. Brain Structural Connectivity Guided Vision Transformers for Identification of Functional Connectivity Characteristics in Preterm Neonates. IEEE J Biomed Health Inform 2024; 28:2223-2234. [PMID: 38285570 DOI: 10.1109/jbhi.2024.3355020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Abstract
Preterm birth is the leading cause of death in children under five years old, and is associated with a wide sequence of complications in both short and long term. In view of rapid neurodevelopment during the neonatal period, preterm neonates may exhibit considerable functional alterations compared to term ones. However, the identified functional alterations in previous studies merely achieve moderate classification performance, while more accurate functional characteristics with satisfying discrimination ability for better diagnosis and therapeutic treatment is underexplored. To address this problem, we propose a novel brain structural connectivity (SC) guided Vision Transformer (SCG-ViT) to identify functional connectivity (FC) differences among three neonatal groups: preterm, preterm with early postnatal experience, and term. Particularly, inspired by the neuroscience-derived information, a novel patch token of SC/FC matrix is defined, and the SC matrix is then adopted as an effective mask into the ViT model to screen out input FC patch embeddings with weaker SC, and to focus on stronger ones for better classification and identification of FC differences among the three groups. The experimental results on multi-modal MRI data of 437 neonatal brains from publicly released Developing Human Connectome Project (dHCP) demonstrate that SCG-ViT achieves superior classification ability compared to baseline models, and successfully identifies holistically different FC patterns among the three groups. Moreover, these different FCs are significantly correlated with the differential gene expressions of the three groups. In summary, SCG-ViT provides a powerfully brain-guided pipeline of adopting large-scale and data-intensive deep learning models for medical imaging-based diagnosis.
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Hamon E, Bourdin B, Le Driant B. Parental representations after preterm birth: a narrative review. Front Psychol 2023; 14:1114418. [PMID: 37731868 PMCID: PMC10507618 DOI: 10.3389/fpsyg.2023.1114418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 07/06/2023] [Indexed: 09/22/2023] Open
Abstract
Preterm birth accounts for nearly 15 million births annually worldwide and constitutes a considerable risk factor for atypical development. This birth context is a source of stress for the parents and often leads to an early separation between their child and them. Research on the influence of the birth status on the infant's attachment style has shown no systematic link between preterm birth and the development of insecure attachment in children born preterm. This has opened up research perspectives in understanding the role of environmental factors. A literature review was conducted to present an overview of the current findings on parental representations (PR), particularly maternal ones, and their role in the context of preterm birth. PR quality appears to be associated with specific dyadic interaction patterns, thus exposing vulnerability factors. Studies exploring PR have pointed out the importance of considering parental mental elaboration mechanisms and contextual moderators in supporting socio-emotional development among children born preterm. We discussed the challenges of investigating PR in the context of preterm birth for future studies and emphasized the need for research studies to be conducted according to a developmental and non-deterministic perspective. This narrative review also aimed to highlight the importance of family centered care interventions in the context of a public policy focused on the child's "First 1,000 days" of life.
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Affiliation(s)
- Emeline Hamon
- Centre de Recherche en Psychologie: Cognition, Psychisme et Organisations (UR 7273), Université de Picardie Jules Verne, Amiens, France
- FHU “1000 jours pour la santé” prendre soin avant de soigner, Université de Lille, Lille, France
| | - Béatrice Bourdin
- Centre de Recherche en Psychologie: Cognition, Psychisme et Organisations (UR 7273), Université de Picardie Jules Verne, Amiens, France
- FHU “1000 jours pour la santé” prendre soin avant de soigner, Université de Lille, Lille, France
| | - Barbara Le Driant
- Centre de Recherche en Psychologie: Cognition, Psychisme et Organisations (UR 7273), Université de Picardie Jules Verne, Amiens, France
- FHU “1000 jours pour la santé” prendre soin avant de soigner, Université de Lille, Lille, France
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Grigoropoulos I. Difficulties Imposed on the Parent-Child Relationship Due to the COVID-19 Pandemic. JOURNAL OF FAMILY ISSUES 2023; 44:1971-1983. [PMID: 37337599 PMCID: PMC10271812 DOI: 10.1177/0192513x211067527] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
The present study tested whether emotionally burdened parents due to the COVID-19 pandemic might appraise their relationship with their children more negatively. The current cross-sectional study was circulated through social media. A total of 265 respondents took part in the study. Multiple linear regression analysis was used to examine the association between predictor variables and the parent-child relationship. This study's results report that older fathers with higher levels of COVID-19 related fear are more likely to appraise negatively their relationship with their children. Therefore, this study suggests the need for family-level strategies to address better the psychological aspects related to the pandemic outbreak.
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Affiliation(s)
- Iraklis Grigoropoulos
- Early Childhood Education and Care Department, International Hellenic University, Thessaloniki, Greece
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Oftedal A, Bekkhus M, Haugen G, Hjemdal O, Czajkowski NO, Kaasen A. Long-Term Impact of Diagnosed Fetal Anomaly on Parental Traumatic Stress, Resilience, and Relationship Satisfaction. J Pediatr Psychol 2022; 48:181-192. [PMID: 36399086 PMCID: PMC9941832 DOI: 10.1093/jpepsy/jsac085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 10/18/2022] [Accepted: 10/18/2022] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Knowledge regarding the long-term psychological adjustment of parents to children with prenatal diagnosis of congenital malformation is scarce. The aim of this study is to examine traumatic stress trajectories, resilience, and relationship satisfaction among parents to children with prenatal diagnosis of a congenital malformation, and to compare this to a sample of non-affected parents. METHODS A prospective longitudinal cohort study was conducted at a tertiary perinatal referral center. Ninety-three mothers and 80 fathers who received a diagnosis of fetal anomaly during obstetric ultrasound examination (study group), and 110 mothers and 98 fathers with normal ultrasound findings (comparison group), reported their traumatic stress at four timepoints during pregnancy (T1-T4), 6 weeks after birth (T5), and 10-12 years after birth (T6). Resilience and relationship satisfaction was reported at 10-12 years after birth. RESULTS Parents to children with a congenital malformation experienced significantly elevated traumatic stress levels over time, compared with parents of children without congenital malformation. The difference between groups was largest acutely after diagnosis and remained significant 10-12 years after the birth of the child. Resilience and relationship satisfaction levels were similar in both groups. CONCLUSIONS Despite experiencing high levels of traumatic stress over time, parents to children with a congenital malformation reported resilience and relationship satisfaction at similar levels to non-affected parents. This suggests that despite ongoing long-term distress, parents are still able to maintain positive psychological coping resources.
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Affiliation(s)
- Aurora Oftedal
- All correspondence concerning this article should be addressed to Aurora Oftedal, Faculty of Health Science, Oslo Metropolitan University, Pilestredet 32, 0166 Oslo, Norway. E-mail:
| | - Mona Bekkhus
- Promenta Research Center, Department of Psychology, University of Oslo, Oslo, Norway
| | - Guttorm Haugen
- Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway,Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Odin Hjemdal
- Department of Psychology, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Nikolai Olavi Czajkowski
- Promenta Research Center, Department of Psychology, University of Oslo, Oslo, Norway,Department of Mental Disorders, Norwegian Institute of Public Health, Norway
| | - Anne Kaasen
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
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Delanerolle G, Zeng YT, Phiri P, Phan T, Tempest N, Busuulwa P, Shetty A, Raymont V, Rathod S, Shi JQ, Hapangama DK. Mental health impact on Black, Asian and Minority Ethnic populations with preterm birth: A systematic review and meta-analysis. World J Psychiatry 2022; 12:1233-1254. [PMID: 36186507 PMCID: PMC9521531 DOI: 10.5498/wjp.v12.i9.1233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/16/2022] [Accepted: 08/05/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Preterm birth (PTB) is one of the main causes of neonatal deaths globally, with approximately 15 million infants are born preterm. Women from the Black, Asian, and Minority Ethnic (BAME) populations maybe at higher risk of PTB, therefore, the mental health impact on mothers experiencing a PTB is particularly important, within the BAME populations.
AIM To determine the prevalence of mental health conditions among BAME women with PTB as well as the methods of mental health assessments used to characterise the mental health outcomes.
METHODS A systematic methodology was developed and published as a protocol in PROSPERO (CRD42020210863). Multiple databases were used to extract relevant data. I2 and Egger’s tests were used to detect the heterogeneity and publication bias. A trim and fill method was used to demonstrate the influence of publication bias and the credibility of conclusions.
RESULTS Thirty-nine studies met the eligibility criteria from a possible 3526. The prevalence rates of depression among PTB-BAME mothers were significantly higher than full-term mothers with a standardized mean difference of 1.5 and a 95% confidence interval (CI) 29%-74%. The subgroup analysis indicated depressive symptoms to be time sensitive. Women within the very PTB category demonstrated a significantly higher prevalence of depression than those categorised as non-very PTB. The prevalence rates of anxiety and stress among PTB-BAME mothers were significantly higher than in full-term mothers (odds ratio of 88% and 60% with a CI of 42%-149% and 24%-106%, respectively).
CONCLUSION BAME women with PTB suffer with mental health conditions. Many studies did not report on specific mental health outcomes for BAME populations. Therefore, the impact of PTB is not accurately represented in this population, and thus could negatively influence the quality of maternity services they receive.
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Affiliation(s)
- Gayathri Delanerolle
- Nuffield Department of Primary Care Health Science, University of Oxford, Oxford OX3 7JX, United Kingdom
- Research and Innovation, Southern Health NHS Foundation Trust, Southampton SO30 3JB, United Kingdom
| | - Yu-Tian Zeng
- Southern University of Science and Technology, Shenzhen 518055, Guangdong Province, China
| | - Peter Phiri
- Research and Innovation, Southern Health NHS Foundation Trust, Southampton SO30 3JB, United Kingdom
- Psychology Department, Faculty of Environmental and Life Sciences, University of Southampton, Southampton SO17 1BJ, United Kingdom
| | - Thuan Phan
- Department of Women's and Children's Health, University of Liverpool, Liverpool L7 8TX, United Kingdom
| | - Nicola Tempest
- Department of Women's and Children's Health, University of Liverpool, Liverpool L7 8TX, United Kingdom
- Gynaecology Directorate and Hewitt Centre for Reproductive Medicine, Liverpool Women's NHS Foundation, Liverpool L8 7SS, United Kingdom
| | - Paula Busuulwa
- Department of Women's and Children's Health, University of Liverpool, Liverpool L7 8TX, United Kingdom
| | - Ashish Shetty
- National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London W1T 4AJ, United Kingdom
| | - Vanessa Raymont
- Department of Psychiatry, University of Oxford, Oxford OX3 7JX, United Kingdom
| | - Shanaya Rathod
- Research and Innovation, Southern Health NHS Foundation Trust, Southampton SO30 3JB, United Kingdom
| | - Jian-Qing Shi
- National Centre for Applied Mathematics Shenzhen, Shenzhen 518055, Guangdong Province, China
- Department of Statistics, Southern University of Science and Technology, Shenzhen 518055, Guangdong Province, China
| | - Dharani K Hapangama
- Department of Women's and Children's Health, University of Liverpool, Liverpool L7 8TX, United Kingdom
- Gynaecology Directorate and Hewitt Centre for Reproductive Medicine, Liverpool Women's NHS Foundation, Liverpool L8 7SS, United Kingdom
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Suarez C, Adair P, Doherty N, McCormack D. Exploring Adjustment and Parent-Infant Relations in Mothers of Premature Infants: Thematic Analysis Using a Multisensory Approach. J Pediatr Psychol 2022; 47:827-839. [PMID: 35286395 PMCID: PMC9297088 DOI: 10.1093/jpepsy/jsac007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 01/26/2022] [Accepted: 01/28/2022] [Indexed: 11/13/2022] Open
Abstract
Objective The aim of the study was to explore mothers’ experiences of having an infant born prematurely (28–32 weeks gestation). In particular, the study aimed to explore the developing parent–infant relationship 12–30 months since birth and the developing parental identity during hospitalization and discharge. Methods Twelve mothers, aged between 22 and 43, participated in the semi-structured interviews. The mean age of infants was 19 months. Interviews comprised open-ended questions and visual stimuli consisting of photographs brought by participants, word selection, and card sorting techniques. Data were analyzed using Braun and Clarke’s thematic analysis (Braun & Clarke, 2013). Results Three themes arose from a clustering of 10 subthemes: (a) Emotional Impact, (b) Searching for Parent Identity, and (c) Moving Beyond Adversity. Participants expressed experiencing heightened emotional distress during the time of their infants’ birth and hospitalization and initially not feeling like parents. Their parental identity strengthened as they became more involved in the care of their infant and began to accept the situation. Participants described parenting their premature infants differently compared with parents of full-term infants, and described adjusting to this difference over time. Conclusions The findings highlight the emotional experience and adjustment of mothers of premature infants, from hospital and postdischarge. The need for psycho-educational interventions postdischarge and parent-partnered models during hospitalization is discussed. In addition, the study demonstrates the use of integrating visual stimuli in qualitative data collection procedures, to elicit further meaning and interaction from participants with the interview process.
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Affiliation(s)
- Catalina Suarez
- Department of Psychology, Queen's University Belfast, Belfast, Northern Ireland
| | - Pauline Adair
- Department of Psychology, Queen's University Belfast, Belfast, Northern Ireland
| | - Nicola Doherty
- Western Health and Social Care Trust, Londonderry, Northern Ireland
| | - David McCormack
- Department of Psychology, Queen's University Belfast, Belfast, Northern Ireland
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Dollberg DG, Harlev Y, Malishkevitch S, Leitner Y. Parental Reflective Functioning as a Moderator of the Link Between Prematurity and Parental Stress. Front Psychiatry 2022; 13:804694. [PMID: 35280157 PMCID: PMC8905191 DOI: 10.3389/fpsyt.2022.804694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 01/27/2022] [Indexed: 11/13/2022] Open
Abstract
We examined group differences between parents, both mothers and fathers, of premature and full-term infants to determine whether they differed in their reports of subjective parenting stress and in their level of parental reflective functioning (PRF). We also tested whether each parent's reflective functioning moderated the links between birth status (prematurity vs. full-term) and parenting stress. A sample of 73 cohabiting, heterosexual Israeli families with a premature (28-36th week gestational age, N = 34) or full-term infant (37th week and above gestational age, N = 39) participated, comprising the two parents' groups. Infants' age averaged 7.07 months (SD = 1.28). Each parent completed the Parent Stress Inventory (PSI) individually to determine his/her subjective personal and childrearing stress levels. The Parent Development Interview (PDI-R2-S) was used to obtain each parent's PRF (self and child/relation-focused) level. Findings showed that the premature and full-term parents did not differ in their PSI scores or PRF levels. However, mothers' self-focused PRF moderated the link between prematurity and personal parenting stress, whereas fathers' self-focused PRF moderated the link between prematurity and childrearing parenting stress. Furthermore, fathers' and mothers' PRF operated differently in the premature and full-term parents' groups. The findings highlight the importance of mothers' and fathers' PRF in predicting parents' subjective stress in general and particularly in the case of infant prematurity. We discuss these findings and their relevance for preventive and therapeutic perinatal interventions.
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Affiliation(s)
- Daphna G Dollberg
- School of Behavioral Sciences, The Academic College of Tel Aviv-Yaffo, Tel Aviv, Israel
| | - Yael Harlev
- School of Behavioral Sciences, The Academic College of Tel Aviv-Yaffo, Tel Aviv, Israel
| | - Sivan Malishkevitch
- School of Behavioral Sciences, The Academic College of Tel Aviv-Yaffo, Tel Aviv, Israel
| | - Yael Leitner
- Child Development Center, Dana-Dwek Children's Hospital, Sourasky Medical Center, Tel Aviv, Israel
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Walczak-Kozłowska T, Chrzan-Dętkoś M, Harciarek M. Heterogeneity of the attentional system's efficiency among very prematurely born pre-schoolers. Child Neuropsychol 2021; 28:120-142. [PMID: 34348594 DOI: 10.1080/09297049.2021.1961702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Very preterm birth increases the risk of ADHD as well as other neurodevelopmental disorders. Deficits within the attentional system were previously signaled in preterm children; however, studies lacked in consideration of an intragroup differentiation. Thus, this study aimed to verify whether deficits in the attentional mechanisms are inter-individually differentiated among very prematurely born children and if so, which biomedical and non-biomedical factors are associated with the profile of deficits within the attentional system. We tested the efficiency of attentional processes among 5-year-old children with the Attention Network Task - Child Version. The results have indicated that 26% of very preterm children presented with the suboptimal functioning of the attentional system (more than 1 SD below mean score of full-term children in attentional alerting and orienting), whereas 74% were characterized by the normal efficiency of attention. The profile of attentional deficits observed among very preterm preschoolers was associated with significantly lower birth weight and decreased family living standard. Very prematurely born children are thus a relatively heterogeneous group in terms of the efficiency of attentional system and deficits apply to only some of those children. Early developmental support aimed at enhancing attentional functioning should be addressed to children with lower birth weight in the first place.
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Affiliation(s)
- Tamara Walczak-Kozłowska
- Division of Neuropsychology, Institute of Psychology, Department of the Social Sciences, University of Gdańsk, Gdańsk, Poland
| | - Magdalena Chrzan-Dętkoś
- Division of Developmental Psychology and Psychopathology, Institute of Psychology, Department of the Social Sciences, University of Gdańsk, Gdańsk, Poland
| | - Michał Harciarek
- Division of Neuropsychology, Institute of Psychology, Department of the Social Sciences, University of Gdańsk, Gdańsk, Poland
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12
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Chifa M, Hadar T, Politimou N, Reynolds G, Franco F. The Soundscape of Neonatal Intensive Care: A Mixed-Methods Study of the Parents' Experience. CHILDREN-BASEL 2021; 8:children8080644. [PMID: 34438535 PMCID: PMC8391440 DOI: 10.3390/children8080644] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/21/2021] [Accepted: 07/23/2021] [Indexed: 12/03/2022]
Abstract
Parents who have infants hospitalised in neonatal intensive care units (NICUs) experience high levels of stress, including post-traumatic stress disorder (PTSD) symptoms. However, whether sounds contribute to parents’ stress remains largely unknown. Critically, researchers lack a comprehensive instrument to investigate the relationship between sounds in NICUs and parental stress. To address this gap, this report presents the “Soundscape of NICU Questionnaire” (SON-Q), which was developed specifically to capture parents’ perceptions and beliefs about the impact that sound had on them and their infants, from pre-birth throughout the NICU stay and in the first postdischarge period. Parents of children born preterm (n = 386) completed the SON-Q and the Perinatal PTSD Questionnaire (PPQ). Principal Component Analysis identifying underlying dimensions comprising the parental experience of the NICU soundscape was followed by an exploration of the relationships between subscales of the SON-Q and the PPQ. Moderation analysis was carried out to further elucidate relationships between variables. Finally, thematic analysis was employed to analyse one memory of sounds in NICU open question. The results highlight systematic associations between aspects of the NICU soundscape and parental stress/trauma. The findings underscore the importance of developing specific studies in this area and devising interventions to best support parents’ mental health, which could in turn support infants’ developmental outcomes.
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Affiliation(s)
- Maria Chifa
- Psychology Department, Faculty of Science and Technology, Middlesex University, London NW4 4BT, UK; (M.C.); (G.R.)
| | - Tamar Hadar
- Division of Expressive Therapies, Graduate School of Arts & Social Sciences, Lesley University, Cambridge, MA 02138, USA;
| | - Nina Politimou
- Institute of Education, University College London, London WC1H 0AA, UK;
| | - Gemma Reynolds
- Psychology Department, Faculty of Science and Technology, Middlesex University, London NW4 4BT, UK; (M.C.); (G.R.)
| | - Fabia Franco
- Psychology Department, Faculty of Science and Technology, Middlesex University, London NW4 4BT, UK; (M.C.); (G.R.)
- Correspondence:
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Taubman-Ben-Ari O, Ben-Yaakov O, Chasson M. Parenting stress among new parents before and during the COVID-19 pandemic. CHILD ABUSE & NEGLECT 2021; 117:105080. [PMID: 33930664 PMCID: PMC9754858 DOI: 10.1016/j.chiabu.2021.105080] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 04/16/2021] [Accepted: 04/19/2021] [Indexed: 05/17/2023]
Abstract
BACKGROUND The outbreak of COVID-19 has forced parents to deal with a challenging crisis, which may have increased their stress levels, negatively affecting their parenting and putting their infants at risk of abuse. OBJECTIVE To examine the contribution of the pandemic to parenting stress, exploring differences in parenting stress among new parents before and during the crisis, the role of background and personal variables, and the possibility that the study phase moderated the associations of gender and personal resources with parenting stress. METHOD Israeli parents (n = 1591) whose first child was 3-12 months old were recruited twice through social media: in 2019, before the spread of COVID-19 (n = 985); and in March 2020, during the pandemic (n = 606). RESULTS Sociodemographic variables, perception of the childbirth as traumatic, lower meaning in life, higher search for meaning, less marital satisfaction, and study phase all contributed to greater parenting stress. In addition, the association between gender and stress was moderated by study phase, with fathers reporting a greater increase in stress during the pandemic. Moreover, only during the pandemic did fathers report higher parenting stress than mothers. CONCLUSIONS The findings highlight the vulnerability of new parents of young infants to parenting stress during the crisis, and the special attention which should be paid to fathers. They indicate the value of strengthening meaning in life and preserving good marital relationships as resources that help to cope with the heightened parenting stress at this time.
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Affiliation(s)
| | - Ofir Ben-Yaakov
- The Louis and Gabi Weisfeld School of Social Work, Bar-Ilan University, Israel
| | - Miriam Chasson
- The Louis and Gabi Weisfeld School of Social Work, Bar-Ilan University, Israel
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14
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Spinelli M, Lionetti F, Setti A, Fasolo M. Parenting Stress During the COVID-19 Outbreak: Socioeconomic and Environmental Risk Factors and Implications for Children Emotion Regulation. FAMILY PROCESS 2021; 60:639-653. [PMID: 32985703 DOI: 10.1111/famp.12601] [Citation(s) in RCA: 131] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
The COVID-19 outbreak imposed to Italian families many changes in their daily life increasing the risk of developing psychological problems. The present study explored risk factors associated with parenting stress and implications for children's emotion regulation in families with different socioeconomic risks. Parents of 2-14 years old children completed a survey reporting difficulties experienced due to the lockdown, level of household chaos, parenting stress, parent involvement in the child's daily life, and children emotion regulation competences. The general mean levels of parenting stress and children emotion regulation abilities were not at clinical level compared with Italian norms. Household chaos predicted higher levels of parenting stress, which, in turn, was associated with less effective emotion regulation in children through the mediating role of parental involvement. More stressed parents were less involved in their children's activities, decreasing children's effective emotion regulation. Only for SES no-risk families, the lockdown constraints increased parenting stress. For SES at-risk families, the impact of parenting stress and involvement on children regulation strategies was stronger, with a protective role played by parental involvement on children's negativity not evident for SES no-risk families. Dealing with the lockdown is a stressful experience for parents who have to balance personal life, work, and children upbringing, without other help. This situation potentially impairs their ability to be supportive caregivers and is consequently detrimental for children well-being. Policies should take into consideration the implications of the lockdown for families' mental health and tailor supportive interventions according to family's risk factors.
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Affiliation(s)
- Maria Spinelli
- Department of Neurosciences Imaging and Clinical Sciences, University G. D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Francesca Lionetti
- Department of Neurosciences Imaging and Clinical Sciences, University G. D'Annunzio Chieti-Pescara, Chieti, Italy
| | | | - Mirco Fasolo
- Department of Neurosciences Imaging and Clinical Sciences, University G. D'Annunzio Chieti-Pescara, Chieti, Italy
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15
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Kang SR, Cho H. Research Trends of Follow-Up Care after Neonatal Intensive Care Unit Graduation for Children Born Preterm: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3268. [PMID: 33809933 PMCID: PMC8004188 DOI: 10.3390/ijerph18063268] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 03/16/2021] [Accepted: 03/19/2021] [Indexed: 11/23/2022]
Abstract
The purpose of this study was to describe the trends of research on follow-up care after neonatal intensive care unit (NICU) graduation for children born preterm. This scoping review was conducted according to Arksey and O'Malley's guidelines. Reviewed studies were searched in PubMed, CHINAHL, and Web of Science. Fifteen studies were analyzed according to general characteristics, elements of follow-up care after NICU graduation, and characteristics of follow-up care intervention after NICU graduation. Most research was conducted in the medical field (60%), with experimental studies (40%) being the majority, and a few studies focused on families (3%) and parents (3%). The major follow-up care after NICU graduation elements were growth/developmental monitoring and support, continuity of care, parent- and family-centered elements, and a multidisciplinary approach. The intervention methods included home visits, phone calls, video calls, and applications. In addition, the intervention period ranged from two weeks to three years. It is suggested that multidisciplinary research with interactive media for a various age of children over longer periods for further study.
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Affiliation(s)
- So Ra Kang
- College of Nursing, Ewha Womans University, Seoul 03760, Korea;
| | - Haeryun Cho
- Department of Nursing, Wonkwang University, Iksan 54538, Korea
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16
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Mind-Mindedness and Parenting Stress: A Cross-Sectional Study in a Cohort of Mothers of 3-Month-Old Full-Term and Preterm Infants. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17217735. [PMID: 33105872 PMCID: PMC7660160 DOI: 10.3390/ijerph17217735] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 10/17/2020] [Accepted: 10/19/2020] [Indexed: 12/11/2022]
Abstract
The preterm birth of a child is a sudden event that can disturb the overall family system and its functioning. Many studies have been conducted with the aim of exploring how and the degree to which this event affects the early mother–infant dyadic relationship and maternal well-being, with often mixed findings. The present study investigates the combined effect of preterm birth and parenting stress on mind-mindedness, a parenting dimension that captures how parents represent and treat their children as separate individuals with their own mental states and activities. A hundred and ten mothers and their three-month-old infants (preterm = 54; full-term = 56) participated in the study. Mind-mindedness was assessed by coding mothers’ comments about infant’s mental states during dyadic face-to-face interaction. Parenting stress was evaluated with the Parenting Stress Index Short Form questionnaire. Mothers of preterm infants reported similar levels of appropriate and non-attuned mind-related comments to mothers of full-term infants. The reported parenting stress levels were also comparable. Interestingly, only mothers of preterm infants who reported higher stress in parenting showed more non-attuned comments during the interaction. The results underline the need to address preterm birth as a complex event, going beyond group differences and considering its interplay with other risk or protective factors in shaping children’s and parents’ adjustments and well-being.
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17
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Suttora C, Salerni N, Selvagno E, Porro M, Gangi S, Squarza C, Gardon L, Picciolini O. Mind-mindedness and parenting stress in mothers of preterm and full-term infants: The moderating role of perceived social support. Infant Ment Health J 2020; 42:35-46. [PMID: 32965688 DOI: 10.1002/imhj.21891] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The goal of this study was to examine the effects of preterm birth and maternal childbirth-related posttraumatic stress and parenting stress on maternal mind-mindedness (MM). The study also investigated the effects of perceived social support on parenting stress and MM. Sixty-five preterm (N = 32) and full-term (N = 33) mother-infant dyads were observed at 6 months. Measures of maternal MM were obtained from observations of mother-infant interaction. Mothers also provided ratings of their posttraumatic stress disorder (PTSD) symptoms, parenting stress, and perceived social support via an online survey. Experiencing a preterm birth did not affect mothers' use of mental state descriptors during mother-infant interaction. Neither childbirth-related posttraumatic stress nor parenting stress directly affected maternal ability to comment on the child's mental states appropriately. However, at medium and high levels of perceived social support, a negative association between parenting stress and MM was observed. Maternal perception of being emotionally supported by significant others promoted MM in mothers showing low or mild levels of parenting stress, but not in mothers experiencing high stress in parenting their infants. Results suggest that a proclivity to MM might be affected by the interaction between parenting stress and social support, rather than by childbirth-related variables, such as prematurity.
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Affiliation(s)
- Chiara Suttora
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Nicoletta Salerni
- Department of Psychology, University of Milano-Bicocca, Milano, Italy
| | - Elena Selvagno
- Department of Psychology, University of Milano-Bicocca, Milano, Italy
| | - Matteo Porro
- Servizio di Follow-up del neonato a rischio evolutivo, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.,UO Medicina Fisica e Riabilitativa Pediatrica, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Silvana Gangi
- Servizio di Follow-up del neonato a rischio evolutivo, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.,UO di Neonatologia e Terapia Intensiva neonatale, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Chiara Squarza
- Servizio di Follow-up del neonato a rischio evolutivo, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Laura Gardon
- Servizio di Follow-up del neonato a rischio evolutivo, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Odoardo Picciolini
- Servizio di Follow-up del neonato a rischio evolutivo, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.,UO Medicina Fisica e Riabilitativa Pediatrica, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
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18
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Faleschini S, Matte-Gagné C, Luu TM, Côté S, Tremblay RE, Boivin M. Trajectories of Overprotective Parenting and Hyperactivity-Impulsivity and Inattention Among Moderate-Late Preterm Children: A Population-Based Study. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2020; 48:1555-1568. [PMID: 32936392 DOI: 10.1007/s10802-020-00704-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2020] [Indexed: 11/24/2022]
Abstract
Parents of preterm children are more likely to adopt non-optimal parenting behaviors than parents of full-term (FT) children. However, there is a lack of studies on parents of children born moderate to late preterm (MLP; 32-36 gestational weeks). In this study, we aimed to examine: (1) the association between MLP birth status and the trajectory of parental overprotection throughout preschool years, and (2) the role of parental overprotection, MLP birth status, and their interaction in the prediction of the trajectories of hyperactivity-impulsivity and inattention throughout childhood. Data comes from a Canadian representative population-based cohort including 2028 FT, 100 MLP children, and their parents. Overprotective parenting was measured when children were 5, 17, and 29 months old. Hyperactivity-impulsivity and inattention symptoms were measured repeatedly from 4 to 8 years of age. Trajectories of parents' overprotectiveness and children's hyperactivity-impulsivity and inattention were modeled. MLP birth status was associated with an increase in parental overprotectiveness across the preschool period. MLP birth status and parental overprotection were both found to be associated with higher levels of hyperactivity-impulsivity symptoms across childhood. No interaction was found between birth status and parental overprotection. The results suggest that parents of MLP children become more overprotective across time compared to parents of FT children and that children born MLP and/or exposed to higher levels of parental overprotection demonstrated higher levels of hyperactivity-impulsivity symptoms across childhood.
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Affiliation(s)
| | | | - Thuy Mai Luu
- Department of Pediatrics, Sainte-Justine University Hospital Research Centre, University of Montreal, Montreal, Canada
| | - Sylvana Côté
- Department of Social and Preventive Medicine, University of Montreal, Montreal, Canada
| | - Richard E Tremblay
- Department of Pediatrics, Sainte-Justine University Hospital Research Centre, University of Montreal, Montreal, Canada
| | - Michel Boivin
- School of Psychology, Laval University, Quebec, Canada
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19
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Comparative Evaluation of Parental Stress Experiences Up to 2 to 3 Years After Preterm and Term Birth. Adv Neonatal Care 2020; 20:301-313. [PMID: 32108660 PMCID: PMC7379044 DOI: 10.1097/anc.0000000000000714] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Parenting stress after preterm birth (PTB) has negative long-term effects on parenting. Research about parental experiences after PTB and on parenting stress in early childhood has focused on mothers.
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20
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Lemos RA, Veríssimo MDLÓR. Methodological strategies for the elaboration of educational material: focus on the promotion of preterm infants' development. CIENCIA & SAUDE COLETIVA 2020; 25:505-518. [PMID: 32022191 DOI: 10.1590/1413-81232020252.04052018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 06/18/2018] [Indexed: 11/22/2022] Open
Abstract
This study aimed to describe and analyze the process of elaborating educational material to promote the development of preterm infants. The procedures included participative exploratory research with the target audience, integrative reviews of the literature on the subject, and systematization of contents through robust theoretical references. Popular Education in Health guided the elaboration of the educational material, and the participatory approach; the Bioecological Theory of Human Development conducted the analysis and systematization of the contents; and Simply Put guided the graphic organization of the material. The theoretical model of the development of preterm infants, and data systematization and organization, allowed the elaboration of an interactive educational material, a technology in a book format for the family. The multiple research strategies and theoretical references have provided methodological rigor, increasing the educational material's action potential, which draws family experience closer to the updated scientific knowledge, thus enhancing child health promotion.
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Affiliation(s)
- Rayla Amaral Lemos
- Faculdade de Fisioterapia, Universidade Federal de Juiz de Fora. R. Eugênio do Nascimento s/n, Bairro Dom Bosco. 36038-330, Juiz de Fora, MG, Brasil.
| | - Maria de La Ó Ramallo Veríssimo
- Departamento de Enfermagem Materno-Infantil e Psiquiátrica, Escola de Enfermagem, Universidade de São Paulo. São Paulo, SP, Brasil
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21
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Barthel D, Göbel A, Barkmann C, Helle N, Bindt C. Does Birth-Related Trauma Last? Prevalence and Risk Factors for Posttraumatic Stress in Mothers and Fathers of VLBW Preterm and Term Born Children 5 Years After Birth. Front Psychiatry 2020; 11:575429. [PMID: 33384624 PMCID: PMC7769835 DOI: 10.3389/fpsyt.2020.575429] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 11/23/2020] [Indexed: 11/25/2022] Open
Abstract
Previous research suggests that the birth of a preterm child with very low birth weight (VLBW; <1,500 g) can be traumatic for both parents and lead to short-term consequences like clinical levels of posttraumatic stress symptoms (PTSS) or even to the development of a Posttraumatic Stress Disorder (PTSD). However, little is known about possible mid- and long-term psychological consequences in affected parents. The purpose of this study were (a) to examine the prevalence of parental birth-related PTSS and PTSD in a group of parents with VLBW preterm infants compared to parents of full-term infants 5 years after birth and (b) to investigate potential associations with risk factors for parental PTSS at 5 years postpartum. Perinatal factors (VLBW preterm or term, perceived stress during birth), psychological factors (perceived social support and PTSS 4-6 weeks postpartum, psychiatric lifetime diagnosis) and sociodemographic characteristics (number of children, singleton or multiple birth, socio-economic status), were included in the analysis. The sample consisted of 144 families (77 VLBW, 67 term birth) who participated in the prospective longitudinal cohort study "Hamburg study of VLBW and full-term infant development" (HaFEn-study) and were initially recruited at three perinatal care centers in Hamburg, Germany. PTSD prevalence and PTSS of mothers and fathers were assessed with the Impact of Event Scale-Revised (IES-R), social support with the Questionnaire of Social Support (SOZU-K-22), and lifetime psychiatric diagnoses with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (SCID-I). Data were analyzed by hierarchic multiple regression analyses. Results showed that 5 years after birth none of the parents fulfilled the criteria for a birth-related PTSD diagnosis. For mothers, postnatal PTSS and a VLBW preterm birth significantly predicted PTSS 5 years postpartum. For fathers, psychiatric lifetime diagnosis and postnatal PTSS significantly predicted PTSS 5 years after birth. Early identification of parents with higher risk of PTSS, especially after VLBW preterm birth, and their clinical needs seems beneficial to reduce the risk of long-term consequences. More research is needed on the paternal perspective and on potential effects of preterm birth on both parents and their children's mental health outcomes.
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Affiliation(s)
- Dana Barthel
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
| | - Ariane Göbel
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
| | - Claus Barkmann
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
| | - Nadine Helle
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
| | - Carola Bindt
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
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22
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Molgora S, Fenaroli V, Saita E. The association between childbirth experience and mother's parenting stress: The mediating role of anxiety and depressive symptoms. Women Health 2019; 60:341-351. [PMID: 31264529 DOI: 10.1080/03630242.2019.1635563] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Childbirth is one of the most significant experiences in women's lives. A bad experience could lead to psychological distress, including severe disease. This experience has a significant impact not only on the mother's well-being, but also on her first interactions with the baby. The present study thus had two aims: 1) investigate the association between the childbirth experience and parenting stress; and 2) analyze if this relation can be mediated by the woman's psychological well-being (anxiety and depressive symptoms). One hundred fifty-eight Italian primiparous women, with a single pregnancy, recruited between January 2016 and December 2016, completed three months after delivery the following scales: Wijma Delivery Experience Questionnaire; State-Trait Anxiety Inventory; Edinburgh Postnatal Depression Scale and Parenting Stress Index (Short Form). Data were analyzed through path analyses. Results revealed that the birth experience was not directly associated with parenting stress. The final model confirmed that the childbirth experience was related to parenting stress through the full mediation of anxiety and depressive symptoms. These findings highlight the importance of making mothers' childbirth experience as positive as possible, considering the crucial impact of this experience not only on their global functioning but also on their first relationships with the baby.
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Affiliation(s)
- Sara Molgora
- Department of Psychology, Catholic University of Milan, Italy
| | | | - Emanuela Saita
- Department of Psychology, Catholic University of Milan, Italy
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23
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Taubman-Ben-Ari O, Skvirsky V, Strauss T, Morag I. Pre-term delivery, optimism and initial personal growth as predictors of mothers' long-term personal growth. J Reprod Infant Psychol 2018; 37:277-289. [PMID: 30525992 DOI: 10.1080/02646838.2018.1554245] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Introduction: Positive outcomes in the aftermath of childbirth have increasingly been studied in the last decade. However, most of the studies concentrate on short-term outcomes. The current study examined the perceived personal growth of mothers four years after childbirth, investigating the contribution of the event characteristics (full-term/pre-term birth), internal resources (optimism, self-esteem) and personal growth as measured one year after the birth. Methods: Mothers (n=259) participated in the study by completing a set of self-report questionnaires one and four years following the birth of their child/ren. Results: Personal growth after four years was found to be higher among mothers of pre-terms than of full-terms, and higher four years after the birth than it had been three years earlier. Furthermore, regression analysis indicated the significant contributions of being a mother to pre-term baby/ies, optimism and personal growth one year after the birth to women's personal growth three years later. Discussion: The results highlight the potential long-term effects of giving birth to a pre-term baby on personal growth, as well as the contribution of optimism as an important internal resource. They also indicate the development of personal growth over time. Explanations for the findings are offered and their practical implications are discussed.
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Affiliation(s)
- Orit Taubman-Ben-Ari
- a The Louis and Gabi Weisfeld School of Social Work , Bar Ilan University , Ramat Gan , Israel
| | - Vera Skvirsky
- a The Louis and Gabi Weisfeld School of Social Work , Bar Ilan University , Ramat Gan , Israel
| | - Tzipora Strauss
- b Department of Neonatology, the Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center and Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Iris Morag
- b Department of Neonatology, the Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center and Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
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24
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Trumello C, Candelori C, Cofini M, Cimino S, Cerniglia L, Paciello M, Babore A. Mothers' Depression, Anxiety, and Mental Representations After Preterm Birth: A Study During the Infant's Hospitalization in a Neonatal Intensive Care Unit. Front Public Health 2018; 6:359. [PMID: 30581812 PMCID: PMC6293875 DOI: 10.3389/fpubh.2018.00359] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 11/22/2018] [Indexed: 12/04/2022] Open
Abstract
Aim: This paper aimed to explore psychological functioning and mental representations in mothers of preterm infants during the child's hospitalization in a Neonatal intensive care unit (NICU). Methods: A sample including 62 mothers of premature infants (gestational age < 37 weeks) was recruited in a NICU. According to the gestational age at the time of delivery, we considered two groups: Group A included mothers whose children were born before 32 weeks of pregnancy; Group B included mothers whose children were born at or after 32 weeks of pregnancy. Within one week of childbirth, mothers were administered two self-report questionnaires: the Edinburgh Postnatal Depression Scale (EPDS) and the State-Trait Anxiety Inventory (STAI). When their infants' medical conditions became stable, the Clinical Interview for Parents of High-Risk Infants (CLIP) was administered to mothers. Results: The results showed high levels of depression and anxiety in both groups of mothers, with higher state anxiety scores in Group A than Group B. Besides, a series of hierarchical regression analyses were conducted with STAI, EPDS, and gestational age as predictors on the CLIP scores. Results indicated that EPDS scores predicted CLIP scores on parental self-image, support system, and readiness for discharge (p < 0.001); moreover, the interaction among depression, anxiety, and gestational age predicted the CLIP dimension of feeling of mutual recognition (p < 0.005). Conclusions: These findings suggested that a premature birth and the child's hospitalization might exert a negative effect on the mothers' emotional state, their perception of parental self-image and, consequently, the early bond with the child—independent from the infants' gestational age at the time of the preterm delivery. The data underlined the importance of involving NICU nurses and clinicians in order to optimize the care for mothers immediately after the preterm birth and during the infant's hospitalization, taking into account psychological needs of mothers of both very preterm and moderately preterm infants.
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Affiliation(s)
- Carmen Trumello
- Department of Psychological, Health and Territorial Sciences, Università degli studi G.D'Annunzio Chieti Pescara, Chieti, Italy
| | - Carla Candelori
- Department of Psychological, Health and Territorial Sciences, Università degli studi G.D'Annunzio Chieti Pescara, Chieti, Italy
| | - Marika Cofini
- Department of Psychological, Health and Territorial Sciences, Università degli studi G.D'Annunzio Chieti Pescara, Chieti, Italy
| | - Silvia Cimino
- Department of Dynamic and Clinical Psychology, Faculty of Psychology, Sapienza University of Rome, Rome, Italy
| | - Luca Cerniglia
- Università Telematica Internazionale Uninettuno, Rome, Italy
| | | | - Alessandra Babore
- Department of Psychological, Health and Territorial Sciences, Università degli studi G.D'Annunzio Chieti Pescara, Chieti, Italy
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Yatziv T, Kessler Y, Atzaba-Poria N. What's going on in my baby's mind? Mothers' executive functions contribute to individual differences in maternal mentalization during mother-infant interactions. PLoS One 2018; 13:e0207869. [PMID: 30500853 PMCID: PMC6267990 DOI: 10.1371/journal.pone.0207869] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Accepted: 11/07/2018] [Indexed: 01/05/2023] Open
Abstract
Maternal mentalization refers to a mother's capacity to understand mental-states of herself and her child and to regard her child as a psychological agent. In mother-infant interactions, this capacity is commonly conceptualized as maternal mind-mindedness, which can be divided into two dimensions: appropriate and nonattuned interpretations of the infants' mental-states. Appropriate mind-mindedness refers to interpretations that seem to be compatible with the infant's behaviors, whereas nonattuned mind-mindedness refers to noncompatible interpretations. The aim of this study was to investigate the cognitive mechanisms that contribute to mind-mindedness. Specifically, we investigated the role of executive functions in appropriate and nonattuned mind-mindedness, and the moderating roles of two infant-related factors, prematurity (as a stressful context) and child temperament (as a context of unpredictability and negative emotionality). To this end, mother-infant free play interactions were coded for mind-mindedness in a sample of 102 mothers and their 6-month-old infants (61 preterm, 41 full-term). When children were 66-months old, mothers completed cognitive tasks that assessed working memory updating, resistance to interference, response inhibition, and shifting. Appropriate mind-mindedness was positively associated with updating, and this link was stronger when infant temperament was rated as more difficult. Furthermore, among mothers of full-term infants, mothers' resistance to interference was negatively associated with nonattuned mind-mindedness. This link was not evident in the stressful context of premature birth. Mothers' response inhibition and shifting were not associated with either of the mind-mindedness dimensions. Implications on understanding variability in maternal mentalization during mother-infant interactions and the roles of executive functions in parenting are discussed.
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Affiliation(s)
- Tal Yatziv
- Department of Psychology, Ben-Gurion University of the Negev, Beer Sheva, Israel
- Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Yoav Kessler
- Department of Psychology, Ben-Gurion University of the Negev, Beer Sheva, Israel
- Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Naama Atzaba-Poria
- Department of Psychology, Ben-Gurion University of the Negev, Beer Sheva, Israel
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Vignato J, Connelly CD, Bush RA, Georges JM, Semino-Asaro S, Calero P, Horwitz SM. Correlates of Perinatal Post-Traumatic Stress among Culturally Diverse Women with Depressive Symptomatology. Issues Ment Health Nurs 2018; 39:840-849. [PMID: 30277842 PMCID: PMC6397067 DOI: 10.1080/01612840.2018.1488313] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 06/06/2018] [Accepted: 06/08/2018] [Indexed: 10/28/2022]
Abstract
Post-traumatic stress disorder (PTSD) is an important and often neglected comorbidity of pregnancy; left untreated, it can lead to serious health complications for the mother and developing fetus. Structured interviews were conducted to identify risk factors of PTSD among culturally diverse women with depressive symptomatology receiving perinatal services at community obstetric/gynecologic clinics. Women abused as adults, with two or more instances of trauma, greater trauma severity, insomnia, and low social support were more likely to present perinatal PTSD symptoms. Perinatal PTSD is prevalent and has the potential for chronicity. It is imperative healthcare providers recognize salient risk factors and integrate culturally sensitive screening, appropriate referral, and treatment services for perinatal PTSD.
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Affiliation(s)
- Julie Vignato
- College of Nursing, University of Iowa, 305 College of Nursing Building, 50 Newton Road, Iowa City, IA 52242, USA
| | - Cynthia D. Connelly
- Hahn School of Nursing and Health Science, Beyster Institute for Nursing Research, University of San Diego, 5998 Alcalá Park, San Diego, CA 92110, USA
| | - Ruth A. Bush
- Hahn School of Nursing and Health Science, Beyster Institute for Nursing Research, University of San Diego, 5998 Alcalá Park, San Diego, CA 92110, USA
| | - Jane M. Georges
- Hahn School of Nursing and Health Science, Beyster Institute for Nursing Research, University of San Diego, 5998 Alcalá Park, San Diego, CA 92110, USA
| | - Semira Semino-Asaro
- Hahn School of Nursing and Health Science, Beyster Institute for Nursing Research, University of San Diego, 5998 Alcalá Park, San Diego, CA 92110, USA
| | - Patricia Calero
- Hahn School of Nursing and Health Science, Beyster Institute for Nursing Research, University of San Diego, 5998 Alcalá Park, San Diego, CA 92110, USA
| | - Sarah McCue Horwitz
- Department of Child and Adolescent Psychiatry, New York University School of Medicine, 1 Park Avenue, 8 Floor, New York, NY 10016, USA
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Yatziv T, Gueron-Sela N, Meiri G, Marks K, Atzaba-Poria N. Maternal Mentalization and Behavior Under Stressful Contexts: The Moderating Roles of Prematurity and Household Chaos. INFANCY 2018. [DOI: 10.1111/infa.12233] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Tal Yatziv
- Department of Psychology and Zlotowski Center for Neuroscience; Ben-Gurion University of the Negev
| | - Noa Gueron-Sela
- Department of Psychology; Ben-Gurion University of the Negev
| | - Gal Meiri
- Soroka University Medical Center and the Faculty of Health Sciences; Ben-Gurion University of the Negev
| | - Kayla Marks
- Soroka University Medical Center and the Faculty of Health Sciences; Ben-Gurion University of the Negev
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Aftyka A, Rybojad B, Rosa W, Wróbel A, Karakuła-Juchnowicz H. Risk factors for the development of post-traumatic stress disorder and coping strategies in mothers and fathers following infant hospitalisation in the neonatal intensive care unit. J Clin Nurs 2017; 26:4436-4445. [PMID: 28231614 DOI: 10.1111/jocn.13773] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2017] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES The aim of this study was to identify the potential risk factors for the development of post-traumatic stress disorder in mothers and fathers following infant hospitalisation in the neonatal intensive care unit. BACKGROUND The development of neonatal intensive care units has increased the survival rate of infants. However, one of the major parental problems is post-traumatic stress disorder. DESIGN An observational study covered 125 parents (72 mothers and 53 fathers) of infants aged 3-12 months who were hospitalised in the neonatal intensive care unit during the neonatal period. SETTING Third-referral neonatal intensive care unit. Several standardised and self-reported research tools were used to estimate the level of post-traumatic stress symptoms (Impact Event Scale-Revised), perceived stress (Perceived Stress Scale) and coping strategies (COPE Inventory). The respondents also completed a Parent and Infant Characteristic Questionnaire. RESULTS The mothers and fathers did not differ in their parental and infant characteristics. Post-traumatic stress disorder was present in 60% of the mothers and 47% of the fathers. Compared to the fathers, the mothers felt greater stress (p = .020) and presented a higher severity of post-traumatic stress disorder (p < .001). Previous miscarriages (p = .023) and the presence of chronic diseases (p = .032) were risk factors for post-traumatic stress disorder in the mothers. In the fathers, an Apgar test at 1 min after birth (p = .030) and a partner's post-traumatic stress disorder (p = .038) were related to post-traumatic stress disorder. The mothers compared to the fathers were more likely to use strategies such as: positive reinterpretation and growth, focusing on and venting of emotions, instrumental social support, religious coping and acceptance. In the fathers, the predictors included an Apgar score at 1 min after birth, a lack of congenital anomalies in the child and mental disengagement. CONCLUSION Risk factors for post-traumatic stress disorder, as well as coping strategies, differ in women compare to men. RELEVANCE TO CLINICAL PRACTICE Knowledge of risk factors for post-traumatic stress disorder, specific to men and women, may help identify the parents in whom probability of the occurrence of this disorder is increased.
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Affiliation(s)
- Anna Aftyka
- Department of Nursing Anesthesia and Intensive Care, Medical University of Lublin, Lublin, Poland
| | - Beata Rybojad
- Department of Emergency Unit, Medical University of Lublin, Medical University of Lublin, Lublin, Poland.,Department of Anesthesiology and Intensive Care, Pediatric University Hospital of Lublin, Lublin, Poland
| | - Wojciech Rosa
- Department of Applied Mathematics, Lublin University of Technology, Lublin, Poland
| | - Aleksandra Wróbel
- Department of Nursing Anesthesia and Intensive Care, Medical University of Lublin, Lublin, Poland
| | - Hanna Karakuła-Juchnowicz
- Department of Clinical Neuropsychiatry, Medical University of Lublin, Lublin, Poland.,Ist Department of Psychiatry, Psychotherapy and Early Intervention, Medical University of Lublin, Lublin, Poland
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Ayers S, Bond R, Bertullies S, Wijma K. The aetiology of post-traumatic stress following childbirth: a meta-analysis and theoretical framework. Psychol Med 2016; 46:1121-1134. [PMID: 26878223 DOI: 10.1017/s0033291715002706] [Citation(s) in RCA: 330] [Impact Index Per Article: 36.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
There is evidence that 3.17% of women report post-traumatic stress disorder (PTSD) after childbirth. This meta-analysis synthesizes research on vulnerability and risk factors for birth-related PTSD and refines a diathesis-stress model of its aetiology. Systematic searches were carried out on PsycINFO, PubMed, Scopus and Web of Science using PTSD terms crossed with childbirth terms. Studies were included if they reported primary research that examined factors associated with birth-related PTSD measured at least 1 month after birth. In all, 50 studies (n = 21 429) from 15 countries fulfilled inclusion criteria. Pre-birth vulnerability factors most strongly associated with PTSD were depression in pregnancy (r = 0.51), fear of childbirth (r = 0.41), poor health or complications in pregnancy (r = 0.38), and a history of PTSD (r = 0.39) and counselling for pregnancy or birth (r = 0.32). Risk factors in birth most strongly associated with PTSD were negative subjective birth experiences (r = 0.59), having an operative birth (assisted vaginal or caesarean, r = 0.48), lack of support (r = -0.38) and dissociation (r = 0.32). After birth, PTSD was associated with poor coping and stress (r = 0.30), and was highly co-morbid with depression (r = 0.60). Moderator analyses showed that the effect of poor health or complications in pregnancy was more apparent in high-risk samples. The results of this meta-analysis are used to update a diathesis-stress model of the aetiology of postpartum PTSD and can be used to inform screening, prevention and intervention in maternity care.
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Affiliation(s)
- S Ayers
- Centre for Maternal and Child Health Research,City University London,London,UK
| | - R Bond
- School of Psychology, University of Sussex,Brighton,UK
| | - S Bertullies
- Centre for Maternal and Child Health Research,City University London,London,UK
| | - K Wijma
- Unit of Medical Psychology,Department of Clinical and Experimental Medicine,Faculty of Medicine and Health Sciences,Linköping University,Linköping,Sweden
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Spinelli M, Frigerio A, Montali L, Fasolo M, Spada MS, Mangili G. 'I still have difficulties feeling like a mother': The transition to motherhood of preterm infants mothers. Psychol Health 2015; 31:184-204. [PMID: 26359768 DOI: 10.1080/08870446.2015.1088015] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE The premature birth of their infant can constitute a sudden interruption of the transition to motherhood that requires a reorganisation of the process. The present study aimed to analyse the experience of the transition to motherhood of preterm infants' mothers, framing it within Stern's transition to motherhood theory. METHOD A semi-structured interview was administered to 30 mothers during the recovery of the infant in the Neonatal Intensive Care Unit. The interview explored the experience of mothers related to pregnancy, the infant's birth and recovery. RESULTS Thematic Analyses evidenced four interrelated themes: disconnection from the child, perception of maternal inadequacy, loss of parental role and temporal suspension. The themes showed that the mothers' experience of preterm birth not only concerns the traumatic delivery, but is also embedded in the entire process of becoming a mother within an institutional context. CONCLUSIONS Results were connected to Stern's theory. Findings revealed difficulties for preterm mothers that could affect the development of the maternal constellation and thus their transition to motherhood. These difficulties may influence the construction of maternal identity, mother's representation of their child and the bond with their child.
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Affiliation(s)
- Maria Spinelli
- a Department of Psychology , University of Milano-Bicocca , Milano , Italy
| | | | - Lorenzo Montali
- a Department of Psychology , University of Milano-Bicocca , Milano , Italy
| | - Mirco Fasolo
- a Department of Psychology , University of Milano-Bicocca , Milano , Italy
| | | | - Giovanna Mangili
- c Neonatal Pathology , Azienda Ospedaliera Papa Giovanni XXIII , Bergamo , Italy
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McKenzie-McHarg K, Ayers S, Ford E, Horsch A, Jomeen J, Sawyer A, Stramrood C, Thomson G, Slade P. Post-traumatic stress disorder following childbirth: an update of current issues and recommendations for future research. J Reprod Infant Psychol 2015. [DOI: 10.1080/02646838.2015.1031646] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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