Maternal interpretation of infant emotions related to mothers' mindfulness and mother-infant stress.

We aimed to identify maternal characteristics predicting interpretation of infant emotions, as well as relations between such interpretations and mother-infant stress. Specifically, we investigated (1) prospective associations between maternal dispositional mindfulness and interpretation of infant emotions, and (2) concurrent associations between maternal interpretation of infant emotions and mothers' and infants' cortisol during a dyadic stressor in a non-clinical community sample (n = 78) of mother-infant dyads. Mothers completed the Five Facet Mindfulness Questionnaire at 3 months postnatal, and the IFEEL Picture infant emotion interpretation task at 6 months postnatal. At 6-months, mother-infant dyads completed the Face-to-Face Still Face paradigm, and physiological stress was assessed via salivary cortisol. Regression analyses revealed significant links between aspects of maternal mindfulness - specifically, Observing, Describing, and Acting with Awareness facets - and infant emotion interpretation; more mindful mothers' emotion ratings were less negatively biased and covered the full spectrum of infant emotions, congruent with the range of responses given by a low-risk reference sample. In turn, less negativity bias and greater interpretive congruence predicted lower infant and mother cortisol during the stress session, with effects small-medium in size. Findings highlight the potential role of maternal interpretation of infant emotions in mindful parenting.

Impact of maternal trauma-related psychopathology and life stress on HPA axis stress response.

To understand and curb intergenerational transmission of stress-related disorder, it is important to identify how trauma-related psychopathology in mothers impacts their psychophysiological stress regulation, particularly in the context of parenting their infants. In this study we investigated associations between mothers' trauma-related psychopathology and life stress and HPA axis response to a personally relevant stressor (infant separation stress) in a non-clinical sample followed longitudinally postpartum. A community sample of low-income mothers (n = 73) and their infants completed laboratory sessions at 3, 6, 12, and 18 months postnatal, and salivary cortisol samples collected before and after dyadic stress tasks at the latter three sessions. These tasks were used to assess HPA function. A three-level hierarchical linear model of repeated cortisol measures nested within sessions within mother-infant dyads did not reveal significant main effects of trauma-related psychopathology on maternal cortisol response, but there was evidence that both a clinical interviewer-rated diagnosis of PTSD and ongoing self-reported trauma symptoms blunted effects of life events on cortisol reactivity. Region of significance analyses indicated that current life stress predicted more pronounced cortisol reactivity only among mothers without trauma-related psychopathology; for those with trauma-related psychopathology, life stress did not relate to cortisol response. Effects held when controlling for childhood trauma and previous (prenatal) maternal distress symptoms, suggesting they did not reflect ongoing impacts of past trauma exposure and/or psychopathology. Blunting effects of trauma-related psychopathology on maternal life stress responsiveness may help clarify how stress sensitivities and mental health are transmitted from parent to child.

Disentangling levels of mother-infant neuroendocrine attunement and longitudinal relations with maternal risk and protective factors.

Scientific understanding of mother-infant HPA axis attunement has been limited by discrepant methods for assessing attunement that often conflate different levels of association. We sought to refine the conceptualization of attunement by investigating whether mother-infant cortisol attunement exists as coupling of response trajectories within an acute stress episode, separate from shared developmental patterns and/or overall dyadic similarity in cortisol levels, and whether the degree of attunement depends on within- or between-dyad differences in maternal risk and protective factors. We examined these questions using a longitudinal study with mother/infant salivary cortisol during dyadic stressors at 6, 12, and 18 months postnatal. A three-level hierarchical linear model showed that sample-wide associations between mother and infant cortisol were not significant at any level, suggesting normative lack of attunement; however, there was significant variability in degree of attunement across dyads. Concurrent levels of family resources and social support satisfaction predicted lower mother-infant cortisol attunement within the session, and overall (mean) parenting stress predicted the opposite. Follow-up analyses showed this was typically due to an increase in infants' (but not their mothers') within-session cortisol response slopes with increasing support and decreasing stress. Implications for the role of mother-infant cortisol attunement in intergenerational stress transmission are discussed.

Maternal stress and social support prospectively predict infant inflammation.

Maternal stress has been suggested to be a risk factor for offspring health, while social support has been shown to be a protective factor for offspring functioning. Currently, research has yet to investigate how both of these factors may relate to infant inflammatory processes and associated biological aging in the first years of life. In 48 mother-infant dyads, we investigated whether maternal parenting stress and social support when infants were 12 and 18 months of age were cross-sectionally associated with infant salivary C-reactive protein (sCRP) during these times. In addition, we investigated whether parenting stress and social support were prospectively associated with later sCRP and changes in sCRP from 12 to 18 months of age, as well as whether those changes in sCRP were associated with subsequent infant salivary telomere length (sTL), a marker of biological aging. Analyses revealed that while there were no cross-sectional associations between maternal factors and infant sCRP, maternal parenting stress and social support when infants were 12 months of age predicted infant sCRP at 18 months of age. Further, maternal social support predicted changes in infant sCRP from 12 to 18 months of age. We observed a null association between infant sCRP and sTL. Implications for the ways that maternal mental health and social support may impact biological mechanisms related to disease processes in infants are discussed.

Effects of prenatal mindfulness-based childbirth education on child-bearers' trajectories of distress: a randomized control trial.

BACKGROUND: The perinatal period is a time of immense change, which can be a period of stress and vulnerability for mental health difficulties. Mindfulness-based interventions have shown promise for reducing distress, but further research is needed to identify long-term effects and moderators of mindfulness training in the perinatal period. METHODS: The current study used data from a pilot randomized control trial (RCT) comparing a condensed mindfulness-based childbirth preparation program-the Mind in Labor (MIL)-to treatment as usual (TAU) to examine whether prenatal mindfulness training results in lower distress across the perinatal period, and whether the degree of benefit depends on child-bearers' initial levels of risk (i.e., depression and anxiety symptoms) and protective (i.e., mindfulness) characteristics. Child-bearers (N = 30) in their third trimester were randomized to MIL or TAU and completed assessments of distress-perceived stress, anxiety, and depressive symptoms-at pre-intervention, post-intervention, six-weeks post-birth, and one-year postpartum. RESULTS: Multilevel modeling of distress trajectories revealed greater decreases from pre-intervention to 12-months postpartum for those in MIL compared to TAU, especially among child-bearers who were higher in anxiety and/or lower in dispositional mindfulness at baseline. CONCLUSIONS: The current study offers preliminary evidence for durable perinatal mental health benefits following a brief mindfulness-based program and suggests further investigation of these effects in larger samples is warranted. TRIAL REGISTRATION: The ClinicalTrials.gov identifier for the study is: NCT02327559 . The study was retrospectively registered on June 23, 2014.

Childhood Trauma Exposure Exacerbates the Impact of Concurrent Exposure to Intimate Partner Violence on Women's Posttraumatic Symptoms.

Although it is well established that intimate partner violence (IPV) is detrimental to women's mental health, it remains unclear to what extent symptoms can be attributed to the proximal effects of IPV exposure itself as opposed to more stable scarring effects or co-occurring risk factors. Heterogeneity in the magnitude of IPV effects further suggests that IPV-exposed individuals are differentially susceptible to disorder, and an investigation of moderating factors that may make women more vulnerable is warranted. We used a prospective longitudinal study of low-income mothers followed from 3 to 18 months postpartum to distinguish the concurrent mental health effects of IPV exposure from overall person-level IPV-mental health associations, as well as to test the moderating role of prior relational traumatic experiences in the form of childhood maltreatment. Multilevel modeling results demonstrated a unique concurrent association between increasing IPV and women's posttraumatic symptoms over time, even after controlling for an overall association between mean IPV and symptom levels. The effects of concurrent IPV were heightened in women who reported a history of childhood maltreatment. Model effects were medium to large, R2 = .27-.35. The implications of these findings for the identification of and intervention with women at the highest risk for relational trauma-related mental health difficulties are discussed.

The quality of early infant-caregiver relational attachment and longitudinal changes in infant inflammation across 6 months.

The quality of early caregiver-infant relationships has powerful implications for health trajectories across the lifespan, including associations with adult inflammation. However, because relatively few studies have examined this association during infancy, it remains unclear when this impact occurs and whether it is associated with longitudinal changes in salivary concentrations of inflammation across infancy. In 45 infants, we investigated whether the quality of infant-caregiver attachment (secure vs. insecure) was associated not only with levels of salivary C-reactive protein (sCRP) cross-sectionally, but also with changes in sCRP across 6 months. Interestingly, while there were no cross-sectional associations between infant-caregiver attachment and inflammation at 12 months of age, infant-caregiver attachment security predicted lower levels of sCRP 6 months later. In addition, attachment security predicted decreasing levels of sCRP from 12 months to 18 months of age. Implications for understanding the influence of the quality of early relationships on biological mechanisms related to disease are discussed.

Out of harm's way: Secure versus insecure-disorganized attachment predicts less adolescent risk taking related to childhood poverty.

Although some risk taking in adolescence is normative, evidence suggests that adolescents raised in conditions of socioeconomic disadvantage are disproportionately burdened with risk taking and its negative consequences. Using longitudinal data from the NICHD Study of Early Child Care and Youth Development, we investigated quality of the early caregiving environment as a potential prospective buffer against the long-term association between childhood poverty and adolescent risk taking. Multicategorical moderation model results indicated that if raised in poverty across age 1-54 months (average family income to needs ratio ≤ 1.02), relative to affluence (income to needs ratio ≥ 6.16), adolescents with histories of secure attachment to caregivers exhibited two times the number of risk behaviors at age 15, whereas adolescents with insecure-disorganized histories exhibited nearly five times the number of risk behaviors. Both early family economic hardship and history of insecure-disorganized attachment remained significant predictors of increased adolescent risk taking, alongside the interactive effect. Probing the interaction's region of significance revealed that history of secure (vs. insecure-disorganized) attachment is associated with protective reductions in risk taking below a family income to needs ratio of 2.24, or about 220% poverty level. Findings support a diathesis-stress model in which children with secure attachment histories are less deleteriously impacted by early socioeconomic adversity than their insecure-disorganized peers.

Examining Morning HPA Axis Activity as a Moderator of Hostile, Over-reactive Parenting on Children's Skills for Success in School.

This study examined children's morning HPA axis activation as a moderator of links between hostile, over-reactive parenting at age 4.5 years and children's skills for success in school (higher executive function and literacy, and less externalizing behavior) at age 6. Participants included 361 adoptive families. Parenting was self-reported. HPA axis activation was measured by basal levels in morning cortisol. Executive function and literacy were assessed via standardized tasks. Externalizing behavior was reported by teachers. Results indicated that hostile, over-reactive parenting predicted more externalizing behavior and lower executive functioning regardless of children's morning HPA axis activation. HPA axis activation moderated the effects of hostile, over-reactive parenting on literacy. Among children with moderate to high morning HPA axis activation (approximately 60% of the sample), harsh parenting was linked with lower literacy; children with low morning HPA axis activation exhibited better literacy in the context of more hostile, over-reactive parenting. Yet, across the sample, hostile, over-reactive parenting remained in the low to moderate range, not in the high range. Findings are discussed in the context of considering not only whether children's stress system activation moderates responses to their environments, but also how these processes operate for different developmental outcomes.

Perceived Discrimination, Racial Identity, and Multisystem Stress Response to Social Evaluative Threat Among African American Men and Women.

OBJECTIVE: Understanding individual differences in the psychobiology of the stress response is critical to grasping how psychosocial factors contribute to racial and ethnic health disparities. However, the ways in which environmentally sensitive biological systems coordinate in response to acute stress is not well understood. We used a social-evaluative stress task to investigate coordination among the autonomic nervous system, hypothalamic-pituitary-adrenal axis, and immune/inflammatory system in a community sample of 85 healthy African American men and women. METHODS: Six saliva samples, 2 at each of baseline, event, and recovery phases of the stressor task, were assayed for cortisol, dehydroepiandrosterone-sulfate, salivary alpha-amylase, and salivary C-reactive protein. Individual differences in perceived discrimination and racial identity were also measured. RESULTS: Factor analysis demonstrated that stress systems were largely dissociated before stressor exposure but became aligned during event and recovery phases into functional biological stress responses (factor loadings ≥ .58). Coordinated responses were related to interactions of perceived discrimination and racial identity: when racial identity was strong, highly perceived discrimination was associated with low hypothalamic-pituitary-adrenal axis activity at baseline (B's = .68-.72, p < .001), low stress mobilization during the task (B's = .46-.62, p < .049), and a robust inflammatory response (salivary C-reactive protein) during recovery (B's = .72-.94, p < .002). CONCLUSION: Culturally relevant social perceptions may be linked to a specific pattern of changing alignment in biological components of the stress response. Better understanding these links may significantly advance understanding of stress-related illnesses and disparities.

Shaping emotion regulation: attunement, symptomatology, and stress recovery within mother-infant dyads.

The foundations of emotion regulation are organized, in part, through repeated interactions with one's caregiver in infancy. Less is known about how stress physiology covaries between a mother and her infant within these interactions, leaving a gap in our understanding of how the biological basis of emotion regulation develops. This study investigated physiological attunement between mothers and their 5-month-old infants, as well as the influence of maternal depression and anxiety, during stress recovery. During the reengagement phase of the Still Face Paradigm, mother-infant dyads exhibited negative attunement, as measured by inverse covariation of respiratory sinus arrhythmia (RSA). Increases in maternal RSA corresponded to decreases in infant RSA, underscoring dyadic adjustment during recovery. Moreover, infant regulation differed as a function of maternal anxiety, with more anxious mothers having infants with higher RSA during reengagement. Implications for the consolidation of regulatory capabilities within the context of the early caregiving relationship are discussed.

Differential relations between youth internalizing/externalizing problems and cortisol responses to performance vs. interpersonal stress.

Efforts to define hypothalamic-pituitary-adrenal (HPA) axis profiles conferring risk for psychopathology have yielded inconclusive results, perhaps in part due to limited assessment of the stress response. In particular, research has typically focused on HPA responses to performance tasks, while neglecting the interpersonal stressors that become salient during adolescence. In this study we investigated links between psychosocial adjustment - youth internalizing and externalizing problems, as well as competence - and HPA responses to both performance and interpersonal stressors in a normative sample of children and adolescents. Participants (n = 59) completed a set of performance (public speaking, mental arithmetic, mirror tracing) and/or interpersonal (peer rejection) tasks and gave nine saliva samples, which were assayed for cortisol. Hierarchical linear models of cortisol response trajectories in relation to child behavior checklist (CBCL) scores revealed stressor- and sex-specific associations. Whereas internalizing problems related to earlier peaking, less dynamic cortisol responses to interpersonal stress (across males and females), externalizing problems related to lower, earlier peaking and less dynamic cortisol responses to performance stress for males only, and competence-related to later peaking cortisol responses to interpersonal stress for females only. Implications for understanding contextual stress profiles underlying different forms of psychopathology are discussed.

Mindfulness during romantic conflict moderates the impact of negative partner behaviors on cortisol responses.

This study was designed to test whether romantic partners' mindfulness-present moment, nonjudgmental awareness-during a conflict discussion could buffer the effects of negative partner behaviors on neuroendocrine stress responses. Heterosexual couples (n=88 dyads) provided 5 saliva samples for cortisol assay during a laboratory session involving a conflict discussion task. Conflict behaviors were coded by outside observers using the System for Coding Interactions in Dyads, and partners rated their mindfulness during the task using the Toronto Mindfulness Scale. Interactions tested using multilevel modeling revealed that participants with higher levels of mindfulness during the conflict showed either quicker cortisol recovery or an absence of slowed recovery in the presence of more negative partner behaviors. Whereas the attitudinal component of mindfulness (curiosity) moderated effects of negative partner engagement in the conflict (i.e., attempts to control, coerciveness, negativity and conflict), the attentional component of mindfulness (decentering) moderated the effect of partner disengagement (i.e., withdrawal). These findings lend support to the idea that mindfulness during a stressful interaction can mitigate the physiological impacts of negative behaviors.

Understanding the unfolding of stress regulation in infants.

Early identification of problems with psychosocial stress regulation is important for supporting mental and physical health. However, we currently lack knowledge about when reliable individual differences in stress-responsive physiology emerge and which aspects of maternal behavior determine the unfolding of infants' stress responses. Knowledge of these processes is further limited by analytic approaches that do not account for multiple levels of within- and between-family effects. In a low-risk sample (n = 100 dyads), we observed infant cortisol and mother/infant behavior during regular play and stress sessions longitudinally from age 1 to 3, and used a three-level model to separately examine variability in infant cortisol trajectories within sessions, across years, and across infants. Stable individual differences in hypothalamus-pituitary-adrenal axis regulation were observed in the first 3 years of life. Infants of less sensitive and more intrusive mothers manifested stress sensitization, that is, elevated cortisol levels during and following stress exposure, a profile related to behavioral distress. These findings have important practical implications, suggesting that children at risk for long-term stress dysregulation may be identified in the earliest years of life.

Combined Influences of Genes, Prenatal Environment, Cortisol, and Parenting on the Development of Children's Internalizing Versus Externalizing Problems.

Research suggests that genetic, prenatal, endocrine, and parenting influences across development individually contribute to internalizing and externalizing problems in children. The present study tests the combined contributions of genetic risk for psychopathology, prenatal environments (maternal drug use and internalizing symptoms), child cortisol at age 4.5 years, and overreactive parenting influences across childhood on 6-year-old children's internalizing and externalizing problems. We used data from an adoption design that included 361 domestically adopted children and their biological and adopted parents prospectively followed from birth. Only parenting influences contributed (independently) to externalizing problems. However, genetic influences were indirectly associated with internalizing problems (through increased prenatal risk and subsequent morning cortisol), and parenting factors were both directly and indirectly associated with internalizing problems (through morning cortisol). Results suggest that prenatal maternal drug use/symptoms and children's morning cortisol levels are mechanisms of genetic and environmental influences on internalizing problems, but not externalizing problems, in childhood.

HPA stability for children in foster care: mental health implications and moderation by early intervention.

Research on stress-sensitive biological systems has typically focused on activation at one time, yet recent theories emphasize dynamic, context-specific adaptation. This study tested hypothesized calibration of one such system by examining both mean levels and longitudinal stability of daily cortisol--reflecting hypothalamic-pituitary-adrenal axis activation--in children exposed to high-risk versus lower-risk caregiving contexts. Context-specific effects of longitudinal cortisol profiles were addressed via relations with child psychiatric symptoms. Children from regular foster care, foster children participating in a family-based intervention, and community comparison children (n = 96 total) collected saliva samples for cortisol assay at 29 timepoints across 6+ years. High-risk (regular foster care) children showed lower and more variable cortisol levels than their lower-risk (treatment foster care, community comparison) counterparts. For the high-risk children only, higher and more stable cortisol related to elevated anxiety symptoms. Implications for contextual calibration of stress systems and family intervention mechanisms are discussed.

Stress system development from age 4.5 to 6: family environment predictors and adjustment implications of HPA activity stability versus change.

This study addressed early calibration of stress systems by testing links between adversity exposures, developmental stability of hypothalamic-pituitary-adrenal (HPA) axis activity, and behavior problems in a sample of adopted children. Families (n=200) were assessed when the child was 9, 18, and 27 months, 4.5 and 6 years to collect adversity information-parent psychopathology, stress, financial need, and home chaos. Morning and evening cortisol samples at the final two assessments indexed child HPA activity, and parent-reported internalizing and externalizing at the final assessment represented child behavior outcomes. Increases in cumulative adversity from 4.5 to 6 related to higher child morning cortisol, whereas age six cumulative adversities related to lower, unstable child evening cortisol. Examination of specific adversity dimensions revealed associations between (1) increasing home chaos and stable morning cortisol, which in turn related to internalizing problems; and (2) high parental stress and psychopathology and lower, unstable evening cortisol, which in turn related to externalizing problems.

The eye of the begetter: predicting infant attachment disorganization from women's prenatal interpretations of infant facial expressions.

Infant-caregiver attachment disorganization has been linked to many long-term negative psychosocial outcomes. While various prevention programs appear to be effective in preventing disorganized attachment, methods currently used to identify those at risk are unfortunately either overly general or impractical. The current investigation tested whether women's prenatal biases in identifying infant expressions of emotion--tendencies previously shown to relate to some of the maternal variables associated with infant attachment, including maternal traumatization, trauma symptoms, and maternal sensitivity--could predict infant attachment classification at 18 months postpartum. Logistic regression analyses revealed that together with women's adult history of high betrayal traumatization, response concordance with a normative reference sample in labeling infant expressions as negatively valenced, and the number of infant facial expressions that participants classified as "sad" and "angry" predicted subsequent infant attachment security versus disorganization. Implications for screening and prevention are discussed.

Childhood maltreatment exposure is differentially associated with transdiagnostic perinatal depression symptoms.

History of childhood maltreatment (CM) is common and robustly associated with prenatal and postpartum (perinatal) depression. Given perinatal depression symptom heterogeneity, a transdiagnostic approach to measurement could enhance understanding of patterns between CM and perinatal depression. METHODS: In two independently collected samples of women receiving care at perinatal psychiatry clinics (n = 523 and n = 134), we categorized longitudinal symptoms of perinatal depression, anxiety, stress, and sleep into transdiagnostic factors derived from the Research Domain Criteria and depression literatures. We split the perinatal period into four time points. We conducted a latent profile analysis of transdiagnostic factors in each period. We then used self-reported history of CM (total exposure and subtypes of abuse and neglect) to predict class membership. RESULTS: A three-class solution best fit our data. In relation to positive adaptive functioning, one class had relatively more positive symptoms (high adaptive), one class had average values (middle adaptive), and one class had fewer adaptive symptoms (low adaptive). More total CM and specific subtypes associated with threat/abuse increased an individual's likelihood of being in the Low Adaptive class in both samples (ORs: 0.90-0.97, p < .05). LIMITATIONS: Generalizability of our results was curtailed by 1) limited racial/ethnic diversity and 2) missing data. CONCLUSIONS: Our results support taking a person-centered approach to characterize the relationship between perinatal depression and childhood maltreatment. Given evidence that increased exposure to childhood maltreatment is associated with worse overall symptoms, providers should consider incorporating preventative, transdiagnostic interventions for perinatal distress in individuals with a history of childhood maltreatment.

Salivary nerve growth factor reactivity to acute psychosocial stress: a new frontier for stress research.

OBJECTIVE: Neurotrophins such as nerve growth factor (NGF) may represent a stress-responsive system complementing the better known neuroendocrine (hypothalamic-pituitary-adrenal axis) and autonomic nervous system, but there is little evidence for NGF response to acute stress in humans because noninvasive measures have not been available. We investigated salivary NGF (sNGF) in 40 healthy young adults confronting a romantic conflict stressor. METHODS: Five saliva samples-two collected before and three after the conflict-were assayed for sNGF, cortisol (hypothalamic-pituitary-adrenal marker), and α-amylase (sAA; ANS marker). In addition, a control group (n = 20) gave saliva samples at the same time intervals to determine whether sNGF changes were specific to the conflict stressor. RESULTS: sNGF showed significant reactivity from entry to the first poststress sample among study participants (ß = .13, p = .001), with nonsignificant change across poststress samples. Control participants showed no change in sNGF across the same period. Within-person changes in sNGF were generally aligned with both cortisol (ß = .17, p = .003) and sAA (ß = .17, p = .021) responses. Preconflict negative emotion predicted lower sNGF reactivity (ß = -.08, p = .009) and less alignment with sAA (ß = -.09, p = .040), whereas positive emotion predicted less alignment with cortisol (ß = -.10, p = .019). CONCLUSIONS: This study is the first to document sNGF as a marker that responds to stress in humans.