The effects of IPV and mental health symptoms on HPA axis functioning during early pregnancy.

Maternal HPA axis dysregulation during early pregnancy can negatively affect maternal functioning. However, findings are mixed regarding how intimate partner violence (IPV), a common traumatic stressor, impacts HPA axis regulation during pregnancy. Interactions between IPV and mental health symptoms as they influence cortisol production are rarely examined, especially among pregnant women. Therefore, this study examined the impact of IPV, mental health symptoms, and their interactions on the maternal HPA axis during early pregnancy; 255 pregnant women, oversampled for experiences of IPV, completed a laboratory stressor and measures of depressive and post-traumatic stress symptoms (PTSS) at 15-18 weeks of pregnancy. Participants provided saliva samples following the Trier Social Stress Test that were assayed for cortisol; the area under the curve with respect to ground (AUCg) was computed as a measure of cortisol reactivity. The interactive effects of IPV, depressive symptoms, and PTSS on AUCg were significant, but the main effects were not. At low levels of depressive symptoms, the association between IPV and AUCg was negative; at moderate levels of depressive symptoms, it was not significant, and at high levels, it was positive. At low and moderate levels of PTSS, the effects of IPV on cortisol AUCg were not significant, but at high levels, the association was positive. IPV during early pregnancy was associated with both hyperactive and blunted stress reactivity, depending on the type and severity of mental health symptoms. These patterns of dysregulation of the HPA axis may have differential effects both for women's functioning throughout pregnancy as well as for the offspring.

Developmental Consequences of Intimate Partner Violence on Children.

Numerous studies associate childhood exposure to intimate partner violence (IPV) with adverse adjustment in the domains of mental health, social, and academic functioning. This review synthesizes this literature and highlights the critical role of child self-regulation in mediating children's adjustment outcomes. We discuss major methodological problems of the field, including failure to consider the effects of prenatal IPV exposure and the limitations of variable-oriented and cross-sectional approaches. Finally, we present a comprehensive theoretical model of the effects of IPV on children's development. This model includes three mechanistic pathways-one that is unique to IPV (maternal representations) and two that are consistent with the effects of other stressors (maternal mental health and physiological functioning). In our model, the effects of these three pathways on child adjustment outcomes are mediated through parenting and child self-regulation. Future research directions and clinical implications are discussed in the context of the model.

Geotemporal analysis of perinatal care changes and maternal mental health: an example from the COVID-19 pandemic.

Our primary objective was to document COVID-19 induced changes to perinatal care across the USA and examine the implication of these changes for maternal mental health. We performed an observational cross-sectional study with convenience sampling using direct patient reports from 1918 postpartum and 3868 pregnant individuals collected between April 2020 and December 2020 from 10 states across the USA. We leverage a subgroup of these participants who gave birth prior to March 2020 to estimate the pre-pandemic prevalence of specific birthing practices as a comparison. Our primary analyses describe the prevalence and timing of perinatal care changes, compare perinatal care changes depending on when and where individuals gave birth, and assess the linkage between perinatal care alterations and maternal anxiety and depressive symptoms. Seventy-eight percent of pregnant participants and 63% of postpartum participants reported at least one change to their perinatal care between March and August 2020. However, the prevalence and nature of specific perinatal care changes occurred unevenly over time and across geographic locations. The separation of infants and mothers immediately after birth and the cancelation of prenatal visits were associated with worsened depression and anxiety symptoms in mothers after controlling for sociodemographic factors, mental health history, number of pregnancy complications, and general stress about the COVID-19 pandemic. Our analyses reveal widespread changes to perinatal care across the US that fluctuated depending on where and when individuals gave birth. Disruptions to perinatal care may also exacerbate mental health concerns, so focused treatments that can mitigate the negative psychiatric sequelae of interrupted care are warranted.

Conflict Appraisals and Trauma Symptoms in Children Exposed to Intimate Partner Violence.

Children exposed to intimate partner violence (IPV) are at risk for posttraumatic stress symptoms (PTSS) and alterations in hypothalamic-pituitary-adrenal (HPA) axis functioning. The current study investigated children's threat and self-blame appraisals about parental conflict as potential mechanisms leading to these adverse outcomes. Parent-child relationships were also examined. The sample consisted of 119 10-year-olds and their mothers who were recruited from the community as part of a larger study of IPV. Children's reports of IPV directed at their mother in the past year were not associated with PTSS; however, IPV exposure was associated with attenuated cortisol output in response to a social stressor. IPV exposure was also associated with greater threat appraisals and poorer quality parent-child relationships. These results provide further evidence that witnessing IPV is threatening for children, has negative consequences for parent-child relationships, and can impact children's HPA axis functioning.

Do different data analytic approaches generate discrepant findings when measuring mother-infant HPA axis attunement?

Attunement between mothers and infants in their hypothalamic-pituitary-adrenal (HPA) axis responsiveness to acute stressors is thought to benefit the child's emerging physiological and behavioral self-regulation, as well as their socioemotional development. However, there is no universally accepted definition of attunement in the literature, which appears to have resulted in inconsistent statistical analyses for determining its presence or absence, and contributed to discrepant results. We used a series of data analytic approaches, some previously used in the attunement literature and others not, to evaluate the attunement between 182 women and their 1-year-old infants in their HPA axis responsivity to acute stress. Cortisol was measured in saliva samples taken from mothers and infants before and twice after a naturalistic laboratory stressor (infant arm restraint). The results of the data analytic approaches were mixed, with some analyses suggesting attunement while others did not. The strengths and weaknesses of each statistical approach are discussed, and an analysis using a cross-lagged model that considered both time and interactions between mother and infant appeared the most appropriate. Greater consensus in the field about the conceptualization and analysis of physiological attunement would be valuable in order to advance our understanding of this phenomenon.

Infant adrenocortical reactivity and behavioral functioning: relation to early exposure to maternal intimate partner violence.

Prenatal stress negatively affects fetal development, which in turn may affect infant hypothalamic-pituitary-adrenal (HPA) axis regulation and behavioral functioning. We examined effects of exposure to a traumatic stressor in families [intimate partner violence (IPV)] on both infants' HPA axis reactivity to stress and their internalizing and externalizing behaviors. Infants (n = 182, 50% girls, x age = 11.77 months) were exposed to a laboratory challenge task designed to induce frustration and anger (i.e. arm restraint). Saliva samples were taken pre-task and 20 and 40 min post-task and then assayed for cortisol. Mothers reported on their pregnancy and postpartum IPV history, current mental health, substance use and their infants' behaviors. Structural equation modeling revealed that prenatal, but not postnatal, IPV was independently associated with infant cortisol reactivity and problem behavior. Maternal mental health predicted infant behavioral functioning but not infant HPA axis reactivity. These findings are consistent with the prenatal programing hypothesis; that is, early life stress affects later risk and vulnerability for altered physiological and behavioral regulation.

The influence of prenatal intimate partner violence exposure on hypothalamic-pituitary-adrenal axis reactivity and childhood internalizing and externalizing symptoms.

This prospective longitudinal study examines the long-term influence of intimate partner violence (IPV) exposure in utero. We hypothesized that (a) prenatal IPV increases risk for internalizing and externalizing problems as well as for a profile of dysregulated cortisol reactivity, and (b) patterns of cortisol hyper- and hyporeactivity are differentially associated with internalizing and externalizing problems. The participants were 119 10-year-old children. Their mothers reported their IPV experiences and distress during pregnancy. Child and maternal reports of internalizing and externalizing problems as well as lifetime IPV exposure were obtained. Salivary cortisol was assessed at baseline, 20 min, and 40 min after challenge. The results partially supported our hypotheses: Exposure to IPV during pregnancy predicted child-reported internalizing and externalizing problems, mother ratings of child externalizing problems, and a profile of high cortisol secretion before and after stress challenge. The results were significant above and beyond the influence of maternal distress during pregnancy and IPV that occurred during the child's life. In addition, a profile of high cortisol secretion was associated with maternal reports of child internalizing behaviors. Findings support the growing consensus that prenatal stress can lead to lasting disruptions in adaptation and highlight the need for more longitudinal examinations of prenatal IPV exposure.

National Institutes of Health Pathways to Prevention Workshop: the role of opioids in the treatment of chronic pain.

This National Institutes of Health (NIH) Pathways to Prevention Workshop was cosponsored by the NIH Office of Disease Prevention (ODP), the NIH Pain Consortium, the National Institute on Drug Abuse, and the National Institute of Neurological Disorders and Stroke. A multidisciplinary working group developed the workshop agenda, and an evidence-based practice center prepared an evidence report through a contract with the Agency for Healthcare Research and Quality to facilitate the workshop discussion. During the 1.5-day workshop, invited experts discussed the body of evidence, and attendees had opportunities to provide comments during open discussion periods. After weighing evidence from the evidence report, expert presentations, and public comments, an unbiased, independent panel prepared a draft report that identified research gaps and future research priorities. The report was posted on the ODP Web site for 2 weeks for public comment. This article is an abridged version of the panel's full report, which is available at https://prevention.nih.gov/programs-events/pathways-to-prevention/workshops/opioids-chronic-pain/workshop-resources#final report.

Economic Hardship Predicts Intimate Partner Violence Victimization During Pregnancy.

Objective: Intimate partner violence (IPV) during pregnancy is associated with negative physical and mental health consequences for both mothers and infants. Economic hardship is often exacerbated during pregnancy and is associated with increased rates of IPV in non-pregnant samples. However, temporal associations between economic hardship and IPV victimization have not been well characterized during pregnancy. The present study used data collected at the weekly level to examine the interindividual and intraindividual effects of economic hardship on IPV victimization during pregnancy and determine whether longitudinal changes in IPV across pregnancy vary based on level of economic hardship. Method: Two hundred ninety-four women reported on weekly experiences of IPV and economic hardship (i.e., food insecurity and other money problems) during weeks 17-40 of pregnancy. Participants were oversampled for low income and IPV exposure. Binary logistic multilevel models were used to test study hypotheses. Results: Greater economic hardship on average during pregnancy predicted increased odds of IPV victimization. Within-person increases in economic hardship also predicted increased odds of IPV victimization in the same week. Although IPV victimization tended to decrease on average over the course of pregnancy, there was a significant time by economic hardship interaction such that IPV decreased more gradually for women reporting high levels of economic hardship. Conclusions: The present study examined weekly patterns of IPV victimization across pregnancy in a low-income community sample. Results suggest that policies aimed at increasing families' economic security during the perinatal period may reduce the individual and societal burden of IPV.

Conducting Virtual Assessments in Developmental Research: COVID-19 Restrictions as a Case Example.

Developmental researchers face considerable challenges regarding maximizing data collection and reducing participant attrition. In this article, we use our experiences implementing our study on the effects of timing of prenatal stress on maternal and infant outcomes during the COVID-19 pandemic as a framework to discuss the difficulties and solutions for these challenges, including the development of two types of virtual assessments. Specific information regarding use of virtual platforms, confidentiality, engaging children during video conferencing, and modifying the major assessments of our research are discussed. Feasibility data are presented, and data analytic challenges regarding statistical inference are outlined. Finally, we conclude with some of the unintended positive consequences for our research that resulted from making these modifications to our original methods.

Prenatal and postnatal intimate partner violence, depression, and infant-mother touch.

Touch is a primary form of communication for mother-infant dyads in the infant's first year of life. Stressors such as intimate partner violence (IPV) and maternal depression experienced during the perinatal period may interfere with mother-infant touch via prenatal programming of the stress response and disrupted parenting. Mother-infant touch research typically focuses on maternal touch, while research on infant touch is limited. However, research suggests that infants sometimes lead interactive behavior, with mothers responding and adapting to their infants. Therefore, the aim of the present study was to examine the effects of IPV and maternal depression on infant-led touch interactions and maternal touch responses. Touch behaviors were coded in 174 mother-infant dyads while they engaged in a free play. ANCOVA analyses indicated that male infants with pre- or postnatal IPV exposure initiated more negative touch (e.g., hitting, kicking, pushing) with their mothers than female or nonexposed male infants. IPV did not predict differences in maternal touch responses to infants, while postpartum depressive symptoms were associated with maternal decreased touch responsiveness to male infant touch. The results suggest that male infant touch behavior is particularly susceptible to prenatal or postnatal exposure to IPV. Importantly, aggressive behavior in early childhood predicts more aggressive behavior across time, and these early negative touch behaviors may be indicative of the beginning of a trajectory of increased physical aggression into childhood, adolescence, and adulthood. Moreover, the results support extant findings that prenatal life is a sensitive period for postnatal development, including postnatal socially interactive behavior. Finally, depressed mothers of male infants exhibited decreased touch responsiveness, suggesting that depression may alter maternal interpretation of male infant cues, resulting in maternal withdrawal.

The effects of domestic violence on the stability of attachment from infancy to preschool.

We hypothesized that trajectories of domestic violence (DV), maternal depression, and household income (from pregnancy to age 4) would be differentially associated with instability and stability of attachment, as measured by the Strange Situation at ages 1 and 4. Participants were 150 women and children. Women were first assessed during pregnancy and then yearly when the children were 1 to 4 years old. Overall, attachment was unstable for 56% of the sample from age 1 to age 4. Trajectories of DV and income both predicted attachment patterns. Positive outcomes (secure-secure and insecure-secure) were related to initially low levels of DV that stayed constant or became lower as well as initially high or low levels of income that increased over time.

A social-contextual understanding of concordance and discordance between maternal prenatal representations of the infant and infant-mother attachment.

This prospective study examined the relationship between maternal prenatal representations of the infant and later infant-mother attachment, including contextual factors related to concordance and discordance among dyads over time. Participants were 173 pregnant women between the ages of 18 and 40 who were interviewed during their last trimester of pregnancy and 2 and 13 months after birth. Maternal representations were assessed by the Working Model of the Child Interview during pregnancy (WMCI; C.H. Zeanah, D. Benoit, L. Hirshberg, M.L. Barton, & C. Regan, 1994), and infant-mother attachment was assessed through the Strange Situation procedure (M.D.S. Ainsworth, M. Blehar, E. Waters, & S. Wall, 1978) when infants were 13 months old. There was substantial discordance between maternal and infant classifications, although a significant concordance rate was found when classifications were collapsed into balanced/secure and nonbalanced/insecure groups based on prenatal representations and postnatal infant attachment groups (60%; χ2 = 6.90, p < .01; κ .20). As expected, discordance between maternal representations and infant-mother attachment was meaningfully related to contextual risk factors, maternal depression, and infant behaviors.

Child Appraisals of Interparental Conflict: The Effects of Intimate Partner Violence and Parent-Child Relationship Quality.

Children's appraisals of interparental violence, including appraisals of high threat and low coping efficacy, are robust predictors of behavioral and emotional problems. However, few studies have examined the factors that account for children's use of these maladaptive appraisals, particularly among children exposed to more severe forms of interparental conflict. The current study examines parent-child relationship quality as a mediator of the effect of intimate partner violence (IPV) exposure on children's appraisals of conflict. Participants were 118 mother-child dyads (54 girls and 64 boys), recruited from three Midwestern counties. Consistent with previous reports, child exposure to IPV, as reported by children's mothers, predicted higher threat and lower coping efficacy appraisals. In addition, mediation analyses showed child reports of parent-child relationship quality mediated the association between IPV and coping efficacy, but not the effects of IPV on threat appraisals. The role of parent-child relationships in shaping cognitive appraisals in the context of IPV exposure can have implications for prevention and intervention efforts as well as public policy.

Longitudinal prospective study examining the effects of the timing of prenatal stress on infant and child regulatory functioning: the Michigan Prenatal Stress Study protocol.

INTRODUCTION: A considerable literature implicates prenatal stress as a critical determinant of poor psychological functioning in childhood and beyond. However, knowledge about whether the timing of prenatal stress differentially influences the development of child outcomes, including psychopathology, is virtually unknown. The primary aim of our study is to examine how the timing of prenatal stress differentially affects early childhood regulatory functioning as a marker of psychopathology. Our second aim is to examine the mediating effects of maternal physiological and psychological factors during pregnancy. Our third aim is to examine the moderating effects of postnatal factors on child regulatory functioning. Our project is the first longitudinal, prospective, multimethod study addressing these questions. METHODS AND ANALYSIS: Our ongoing study recruits pregnant women, oversampled for intimate partner violence (a common event-based stressor allowing examination of timing effects), with data collection starting at pregnancy week 15 and concluding 4 years post partum. We aim to have n=335 mother-child dyads. We conduct a granular assessment of pregnancy stress (measured weekly by maternal report) in order to reveal sensitive periods during fetal life when stress particularly derails later functioning. Pattern-based statistical analyses will be used to identify subgroups of women who differ in the timing of their stress during pregnancy and then test whether these patterns of stress differentially predict early childhood self-regulatory outcomes. ETHICS AND DISSEMINATION: Due to the high-risk nature of our sample, care is taken to ensure protection of their well-being, including a safety plan for suicidal ideation and a safety mechanism (exit button in the online weekly survey) to protect participant data privacy. This study was approved by Michigan State University Institutional Review Board. Dissemination will be handled by data sharing through National Institute of Child Health and Human Development Data and Specimen Hub (DASH), as well as through publishing the findings in journals spanning behavioural neuroendocrinology to clinical and developmental psychology.

Intimate partner violence and positive parenting across early childhood: Comparing self-reported and observed parenting behavior.

The current study examined self-reported and observed positive (i.e., nurturing, sensitive, and responsive) parenting behavior among women who experienced intimate partner violence (IPV) during pregnancy and through their early parenting years. Mother-child dyads were assessed during the third trimester of pregnancy and each year postpartum until age 4. Latent growth curve models of self-reported positive parenting suggested that IPV experienced during pregnancy was related to women reporting more gradual reductions in positive parenting between ages 1 and 4 and higher levels of positive parenting behavior at age 4. However, IPV experienced during pregnancy was associated with lower levels of observed positive parenting at age 4. These findings suggest that mothers who experience IPV during pregnancy may positively distort their perceptions of their positive parenting during early childhood, such that it is inconsistent with actual parenting behavior. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Understanding the "ghosts in the nursery" of pregnant women experiencing domestic violence: Prenatal maternal representations and histories of childhood maltreatment.

Selma Fraiberg and colleagues (1975) conceptualized the "ghosts in the nursery" as experiences from a mother's past that influenced her ability to form a warm and attuned relationship with her child. Contemporary infant mental health interventions often ask the mother to reflect on her own history of attachment relationships to gain insight into as well as to strengthen her developing relationship with her child. This study investigated the association between a mother's history of childhood maltreatment (CM) and her subsequent prenatal maternal representation during the third trimester of pregnancy. Controlling for domestic violence (DV), distorted prenatal representations were associated with higher rates of self-reported childhood physical neglect. In addition, DV moderated the relationship between representations and CM, such that women who were exposed to DV during pregnancy and had distorted prenatal representations were least likely to report childhood physical and sexual abuse. Implications are discussed in relation to infant mental health interventions which rely on a parent's ability to psychologically access and reflect on childhood histories to more sensitively parent her own child.

The child as held in the mind of the mother: The influence of prenatal maternal representations on parenting behaviors.

Using a longitudinal design, this study examined the relationship of a mother's prenatal representation of her child and her parenting behavior with that child at 1 year of age in a sample of women who were either exposed or not exposed to intimate partner violence (IPV) (N = 164; M child age = 1.1 years, SD = .11 years; 52% male). Controlling for prenatal IPV, a MANCOVA analysis revealed that prenatal representational typology was significantly related to parenting behavior 1 year postpartum. Mothers whose representations were affectively deactivated (disengaged) were more behaviorally controlling with their children. Mothers whose representations were affectively overactivated (distorted) were more hostile with their children. Mothers with balanced representations demonstrated more positive parenting. Exposure to IPV did not moderate this relationship. There was no direct association between prenatal or postnatal IPV and parenting behavior. These findings suggest that prenatal representations influence postnatal parenting behavior in significant and theoretically consistent ways and that this relationship functions similarly for both abused and nonabused women. Results add to the growing literature that internal representations serve to guide behavior throughout development and suggest that maternal working models may be one important link in the intergenerational transmission of attachment relationships.

Women's appraisals of intimate partner violence stressfulness and their relationship to depressive and posttraumatic stress disorder symptoms.

Intimate partner violence (IPV) increases risk for depressive and posttraumatic stress disorder (PTSD) symptoms. Most studies use a dose-response approach to examine the impact of IPV on mental health, but they often fail to explain mental health outcome specificity as well as to assess the impact of women's subjective appraisals. The present research examined women's IPV stressfulness appraisals and their psychological functioning (depressive and PTSD symptoms). Results indicate that IPV stressfulness appraisals are associated with depressive symptoms over and above frequency and severity of IPV. PTSD symptoms were associated with frequent and stressful IPV. Women who experienced highly frequent and highly stressful IPV were most likely to display comorbid depressive and PTSD symptoms. Results underscore the importance of women's subjective experiences and the heterogeneity of women's responses to IPV.

Temporal patterns of variable relationships in person-oriented research: longitudinal models of configural frequency analysis.

This article reviews the premises of configural frequency analysis (CFA), including methods of choosing significance tests and base models, as well as protecting alpha, and discusses why CFA is a useful approach when conducting longitudinal person-oriented research. CFA operates at the manifest variable level. Longitudinal CFA seeks to identify those temporal patterns that stand out as more frequent (CFA types) or less frequent (CFA antitypes) than expected with reference to a base model. A base model that has been used frequently in CFA applications, prediction CFA, and a new base model, auto-association CFA, are discussed for analysis of cross-classifications of longitudinal data. The former base model takes the associations among predictors and among criteria into account. The latter takes the auto-associations among repeatedly observed variables into account. Application examples of each are given using data from a longitudinal study of domestic violence. It is demonstrated that CFA results are not redundant with results from log-linear modeling or multinomial regression and that, of these approaches, CFA shows particular utility when conducting person-oriented research.