Self-efficacy, coping strategies and quality of life in women and men requiring assisted reproductive technology treatments for anatomical or non-anatomical infertility.

OBJECTIVE: To examine the magnitude and the predictors of emotional reactions to an infertility diagnosis, comparing women and men who were clinically diagnosed with an anatomical cause of infertility or non-anatomical cause of infertility. STUDY DESIGN: Cross-sectional study involving a total of 133 adults waiting for infertility treatment at the IVF and Infertility Unit of the S. Orsola University Hospital in Bologna (Italy). Of these, 107 patients (55 with anatomical causes of infertility and 52 with non-anatomical causes of infertility; response rate: 80%) took part to the study. After providing informed written consent, each participant was asked to complete the Infertility Self-efficacy Scale, the Fertility Quality of Life, and the Brief Coping Orientation to Problem Experienced, which they returned at their second access to the Unit. Differences between the groups were analyzed through a series of univariate ANOVA, whereas a multiple regression analysis was used to jointly examine the predictors of fertility quality of life. RESULTS: Results showed both gender related and diagnosis related differences. Women had statistically significant lower scores than men on the Infertility Self-Efficacy Scale and on the global, emotional, and mind-body subscales of the Fertility Quality of Life, while they scored significantly higher on the emotion focused and socially supported subscales of the Coping Orientation to Problem Experienced. Independently of gender, patients with non-anatomical causes of infertility scored poorly than patients with anatomical causes of infertility on the relational subscale of the Fertility Quality of Life and on the Avoidant scale of the Brief Coping Orientation to Problem Experienced. Hierarchical multiple regression analyses revealed that higher levels of self-efficacy and a lower use of avoidant coping strategies predicted a more positive quality of life over and above gender and cause of infertility. CONCLUSION: This study partly confirms data on gender differences in experiencing the psychological burden of infertility and adds some new information, particularly with respect to the prediction of quality of life indicators over and above infertility cause.

The Focal Play Therapy: An Empirical Study on the Parent-Therapist Alliance, Parent-Child Interactions and Parenting Stress in a Clinical Sample of Children and Their Parents.

The present study aims to investigate the outcomes of the Focal Play Therapy with Children and Parents (FPT-CP) in terms of parent-therapist alliance, parent-child interactions, and parenting stress. Thirty parental couples (N = 60; 30 mothers and 30 fathers) and their children presenting behavioral, evacuation and eating disorders took part to the study. Through a multi-method longitudinal approach, data were collected at two time points (first and seventh sessions) marking the first phase of the intervention specifically aimed to build the alliance with parents, a crucial variable for the remission of the child's symptoms (and to the assessment of the child's symptoms within family dynamics.) Therapeutic alliance was assessed by the Working Alliance Inventory by therapists and parents. Parent-child interactions and parenting stress were evaluated using the Emotional Availability Scales and the Parenting Stress Index, respectively. Results showed that a positive parent-therapist alliance was developed and maintained during the first seven sessions. Furthermore, parent-child interactions significantly improved on both parents' and child's dimensions. However, parenting stress levels remained unchanged between the two time points. The findings should enrich scientific knowledge about the role of parental engagement in preschool child-focused treatments as to better inform practice and improve the quality of care for children and their families.

The Focal Play Therapy: A Clinical Approach to Promote Child Health and Family Well-being.

Eating and evacuation disorders can cause serious health problems for children. Early recognition and early treatment require a multifactor intervention based on a collaborative relationship between pediatricians, psychotherapists and other health professionals. In this context the Focal Play Therapy (FPT) with children and parents is a psychodynamic model of intervention that improves parental ability to cope with child's difficulties. Parental engagement in child interventions allows to understand child's symptoms within family dynamics and to build an alliance with parents that represents a crucial variable of an effective psychological support for children and families. In the present study data were collected from 17 parental couples and their preschool children at two time points (1st and 6th FPT sessions) marking the first phase of this intervention. This phase was aimed to the assessment of child's symptoms within family relationships and to the promotion of the alliance with parents. Families were in treatment at the Psychological Consultation Center for Children and Parents located at the Department of Psychology of the University of Bologna (Italy). This Center provides health assessment and intervention services to children and their families. We investigated the alliance from both parents and therapist points of view along with other parental and child outcome variables implied in clinical works with children and families. Alliance scores were obtained through the Working Alliance Inventory and the System for Observing Family Therapy Alliances, two measures used in individual and family settings, respectively. Parenting stress and parent-child interactions were investigated using the Parenting Stress Index and the Emotional Availability Scales. Furthermore, paired t-tests were run to detect changes on parental and child variables. Findings advise that special attention should be paid to the building of an early alliance with parents. In this regard the FPT is specifically designed to promote the parent-therapist alliance in the context of child health and family well-being.

Mother-Toddler Play Interaction in Extremely, Very Low Birth Weight, and Full-Term Children: A Longitudinal Study.

Introduction: Although preterm birth represents a risk factor for early mother-infant interactions, few studies have focused on toddlerhood, an important time for the development of symbolic play, autonomous skills, and child's socialization competences. Moreover, no study has looked at the effect of birth weight on mother-child interactions during this period. Expanding on the available literature on prematurity, the main objective of this study was to explore the quality of mother-toddler interactions during play, using a longitudinal research design, as well as taking into account the effect of birth weight. Method: 16 Extremely Low Birth Weight (ELBW), 24 Very Low Birth Weight (VLBW), 25 full-term children, and their mothers were recruited for the present study. Mother-child dyads were evaluated at 18, 24, and 30 months of child age. Ten minutes of mother-child play interaction were recorded and later coded according to the Emotional Availability Scales (EAS). Furthermore, the child's level of development was assessed through the Griffiths Scale, and its contribution controlled for. Results: ELBW dyads showed an overall lower level of emotional availability, compared to VLBW and full-term dyads, but no main effect of birth weight was found on specific EA dimensions. Moreover, a significant effect of child age emerged. Overall scores, and Child Responsiveness and Involvement scores improved over time, independently of birth weight. Lastly, a significant effect of the interaction between birth weight and child age was found. Between 18 and 30 months, the overall quality of the interaction significantly increased in ELBW and VLBW dyads. Additionally, between 18 and 30 months, VLBW children significantly improved their responsiveness, while their mothers' sensitivity, structuring, and non-intrusive behaviors improved. In contrast, no change emerged in full-term dyads, although scores were consistently higher than those of the other groups. Discussion: Birth weight affects the quality of mother-toddler interactions. Monitoring the relational patterns of preterm dyads during toddlerhood is important, especially in the case of ELBW children.

Pattern of mother-child feeding interactions in preterm and term dyads at 18 and 24 months.

Literature on mother-child feeding interactions during the transition to self-feeding in preterm populations is lacking, particularly through observational methods. The present research study aims to look at the longitudinal patterns of mother-toddler feeding interactions, comparing preterm and full term dyads. To this end, a multi-method approach was used to collect data from 27 preterm to 20 full-term toddlers and their mothers. For each dyad, mother-child interactions were observed during the snack time at 18 and 24 months of age and then assessed through the Italian version of the Feeding Scale. Higher scores on the scale indicate a less healthy pattern of interaction. Additionally, at both points in time, mothers completed the BDI-II questionnaire as a screen for maternal depression and the child's developmental stage was assessed using the Griffiths Scales. A series of repeated measures Analysis of Variances were run to detect differences in feeding interactions between the two groups at the time of assessment. Our results show that preterm dyads report overall higher levels of maternal negative affection, interactional conflicts, and less dyadic reciprocity during the meal compared to full-term dyads. Additionally, longitudinal data show that dyadic conflict decreases in both groups, whereas the child's food refusal behaviors increase in the preterm group from 18 to 24 months. No differences were reported for both the BDI-II and the child's development for the two groups. The results reveal that regardless of maternal depression and the child's developmental stage, the two groups show different trajectories in the pattern of feeding interactions during the transition to self -feeding, at 18 and 24 months, with overall less positive interactions in preterm mother-child dyads.

Mother-preterm infant interactions at 3 months of corrected age: influence of maternal depression, anxiety and neonatal birth weight.

Maternal depression and anxiety represent risk factors for the quality of early mother-preterm infant interactions, especially in the case of preterm birth. Despite the presence of many studies on this topic, the comorbidity of depressive and anxious symptoms has not been sufficiently investigated, as well as their relationship with the severity of prematurity and the quality of early interactions. The Aim of this study was to evaluate the quality of early mother-infant interactions and the prevalence of maternal depression and anxiety comparing dyads of extremely low birth weight (ELBW) and very low birth weight (VLBW) preterm infants with full-term ones. Seventy seven preterm infants (32 ELBW; 45 VLBW) and 120 full term (FT) infants and their mothers were recruited. At 3 months of corrected age, 5 min of mother-infant interactions were recorded and later coded through the Global Ratings Scales. Mothers completed the Edinburgh Postnatal Depression Scale and Penn State Worry Questionnaire. Infant levels of development were assessed through the Griffiths Mental Development Scales. A relation emerged among the severity of prematurity, depression, anxiety, and the quality of interactions. When compared with the FT group, the ELBW interactions were characterized by high maternal intrusiveness and low remoteness, while the VLBW dyads showed high levels of maternal sensitivity and infant communication. Depression was related to maternal remoteness and negative affective state, anxiety to low sensitivity, while infant interactive behaviors were impaired only in case of comorbidity. ELBW's mothers showed the highest prevalence of depressive and anxious symptoms; moreover, only in FT dyads, low maternal sensitivity, negative affective state and minor infant communication were associated to the presence of anxious symptoms. The results confirmed the impact of prematurity on mother-infant interactions and on maternal affective state. Early diagnosis can help to plan supportive interventions.

Antenatal depressive symptoms associated with specific life events and sources of social support among Italian women.

This study aimed to identify different kinds of stressful life events and social support associated with antenatal depressive symptoms in a sample of pregnant Italian women. We conducted the study at a primary health-care centre in an urban area (northeast Italy). Mainly recruited at antenatal classes, 404 eligible pregnant women completed a socio-demographic questionnaire that included questions about the present pregnancy, the Edinburgh Depression Scale (EDS) to estimate the prevalence of depressive symptoms, the Multidimensional Scale of Perceived Social Support and List of Threatening Experiences Questionnaire to investigate the quality and nature of social support and recent negative life events. Of the 404 women, 60 (14.9 %) scored 13 or higher on the EDS. This group reported significantly lower social support from various sources-family, friends, and significant others; only in primiparous women were depressive symptoms significantly related to lower support from friends. Women with EDS scores equal or higher than 13 also reported a higher occurrence of recent stressful life events-specifically, death or a serious problem with a close friend or relative, unemployment, financial problems, and moving or housing difficulties. Regression analyses showed that women with high levels of social support or with a positive experience of pregnancy were less likely to experience antenatal depressive symptoms. Our results underscore the associations among antenatal depression, specific life stressors, and low social support from various sources. Clinical attention to these psychosocial correlates is recommended toward detecting vulnerability to antenatal depressive symptoms.