Prenatal expectations and other psycho-social factors as risk factors of postnatal bonding disturbance.

The mother's bond to her baby starts to develop during pregnancy, and it is related to the baby's attachment. We study how the mother's prenatal expectations of her unborn baby, the mother's adult relationships, and postnatal psycho-social factors (stress, depression, and anxiety) are related to the risk of bonding disturbance. The study comprised 1398 mothers and their unborn babies assessed both during pregnancy and when the babies were 3 months old (47.7% girls). The mother's risk of bonding disturbance was investigated using Brockington's Postpartum Bonding Questionnaire. According to the results, 71 (5.1%) of all the mothers in the study had a risk of a bonding disturbance. In a final adjusted logistic regression model, the most important risk factors were the mother's inability to form positive expectations about relationships with the baby during the third trimester of pregnancy (AOR = 7.78, p ≤ .001), maternal postnatal stress (AOR = 4.95, p ≤ .001) and maternal postnatal depression (AOR = 3.46, p ≤ .01). The results challenge healthcare professionals to screen pregnant mothers to identify at-risk groups for post-partum bonding disturbances. Intervention programs to prevent the development of bonding disturbances, and thus their possible serious consequences for children's development, should be considered.

La unión afectiva entre la madre y su bebé comienza a desarrollarse durante el embarazo y está relacionado a la afectividad del bebé. Estudiamos cómo las expectativas prenatales que la madre tenía de su bebé aún no nacido, las relaciones adultas de la madre, así como los factores sicosociales (estrés, depresión y ansiedad) están relacionados con la alteración de la unión afectiva. El estudio incluyó a 1,398 madres y sus no nacidos bebés evaluados ambos durante el embarazo y cuando los bebés tenían tres meses de nacidos (47.7% niñas). El riesgo de la madre de alteraciones en la unión afectiva fue investigado usando el Cuestionario Brockington sobre la Unión Afectiva Posterior al Parto. De acuerdo con los resultados, 71 (5.1%) de todas las madres en el estudio presentaban un riesgo de alteración de la unión afectiva. En un modelo final de regresión logístico ajustado, los más importantes factores de riesgo fueron la inhabilidad de la madre de formar expectativas positivas acerca de las relaciones con el bebé durante el tercer trimestre del embarazo (AOR = 7.78, p < .001), el estrés materno postnatal (AOR = 4.95, p < .001) y la depresión materna postnatal (AOR = 3.46, p < .01). Los resultados presentan un reto a los profesionales del cuidado de la salud para examinar a mujeres embarazadas con el fin de identificar grupos bajo riesgo de alteraciones en la unión afectiva posterior al parto. Se deben considerar programas de intervención para prevenir el desarrollo de alteraciones en la unión afectiva y, por tanto, posibles serias consecuencias para el desarrollo de los niños.

Le lien de la mère avec son bébé commence à se développer durant la grossesse, et est lié à l'attachement du bébé. Nous étudions la manière dont les attentes prénatales que la mère se fait de son bébé à naître, les relations adultes de la mère, et les facteurs postnatals psycho-sociaux (stress, dépression, anxiété) sont liés au risque de trouble du lien. L'étude a compris 1398 mères et leurs bébé à naître évalués à la fois durant la grossesse et quand les bébés avaient trois mois (47,7% de filles). Le risque de trouble du lien de la mère a fait l'objet de l'étude, au moyen du Questionnaire du Lien Postpartum de Brockington. Selon les résultats, 71 (soit 5,1%) de toutes les mères de l'étude avaient un risque de trouble du lien. Dans un modèle de régression logistique ajusté final les facteurs de risque les plus importants étaient l'incapacité de la mère à former des attentes positives sur les relations avec le bébé durant le troisième trimestre de la grossesse (AOR - 7,78, p ≤,001), le stress postnatal maternel (AOR = 4,95, p ≤,001) et la dépression postnatale maternelle (AOR = 3,46, p ≤,01). Les résultats défient les professionnels de la santé de dépister les mères enceintes afin d'identifier les groupes à risque de troubles du lien postpartum. Des programmes d'intervention destinés à prévenir le développement de troubles du lien ainsi que leurs conséquences sévères pour le développement des enfants devraient être considérés.

A THERAPEUTIC PLAYGROUP FOR DEPRESSED MOTHERS AND THEIR INFANTS: FEASIBILITY STUDY AND PILOT RANDOMIZED TRIAL OF COMMUNITY HUGS.

Symptoms of depression negatively impact on mother-infant relationships and child outcomes. We evaluated a novel, 10-session mother-infant therapeutic playgroup-Community HUGS (CHUGS)-which combines cognitive and experiential components through psychoeducation, play, music, and movement. Participants were mothers experiencing a range of postnatal mental health difficulties, including depression, with infants ≤12 months of age. However, the aim was not to treat maternal depression but to ameliorate associated problems in the mother-infant interaction. In the feasibility study, all participants received CHUGS. In the pilot randomized controlled trial (RCT), participants were randomized between intervention and a wait-list. Outcomes were the Parenting Stress Index (PSI; R.R. Abidin, 1995), Parenting Sense of Competency Scale (Self-Efficacy subscale; J. Gibaud-Wallston & L.P. Wandersman, 1978), and the Depression, Anxiety, Stress Scales (P.F. Lovibond & S.H. Lovibond, 1995). In the feasibility study (n = 74), PSI scores dropped on all subscales, all ps < .01. Depression, p < .001, anxiety, p = .01, stress, p = .01, and self-efficacy, p < .001, all showed improvements, as did observer-rated mother-infant interactions, p < .001. In the RCT, depression, p < .001, anxiety, p = .005, and stress, p < .001, symptoms were significantly reduced for intervention participants (n = 16), as compared to wait-list participants (n = 15). The CHUGS program had high participant satisfaction and produced improvements in self-efficacy, depression, anxiety, stress, and mother-infant interactions that supported the program's acceptability and the utility of further rollout.

PARTNER INVOLVEMENT: NEGOTIATING THE PRESENCE OF PARTNERS IN PSYCHOSOCIAL ASSESSMENT AS CONDUCTED BY MIDWIVES AND CHILD AND FAMILY HEALTH NURSES.

Universal screening for maternal depression and assessment of psychosocial risks has been integrated into the routine perinatal care provided in many Australian hospitals, but to date, partners/fathers have been largely excluded from the process. This study explored the ways in which clinicians in health service settings include partners who attend antenatal and postnatal visits with women. Qualitative data were collected using observations (n = 54), interviews (n = 60), and discussion groups (n = 7) with midwives and child and family health nurses who conducted the appointments. Transcripts from observations, interviews, and discussion groups underwent qualitative analysis, and key themes were identified. Results showed partners to have little or no involvement in psychosocial assessment and depression screening. Thematic analysis revealed four key themes: negotiating partner exclusion, partial inclusion, women's business or a couple concern? and they know anyway. Partner involvement appeared to be challenged particularly by mandatory interpersonal violence screening, which, according to health service policy, is to be conducted confidentially. Overall, results highlighted partner involvement in perinatal depression screening and psychosocial assessment processes and identified some of the benefits such as partner disclosure, but also the challenges and complexities of inclusion of partners. Clinical implications and directions for further education and research are discussed.

RANDOMIZED CONTROLLED TRIAL OF PARENT-INFANT PSYCHOTHERAPY FOR PARENTS WITH MENTAL HEALTH PROBLEMS AND YOUNG INFANTS.

There is a dearth of good-quality research investigating the outcomes of psychoanalytic parent-infant psychotherapy (PIP). This randomized controlled trial investigated the outcomes of PIP for parents with mental health problems who also were experiencing high levels of social adversity and their young infants (<12 months). Dyads were clinically referred and randomly allocated to PIP or a control condition of standard secondary and specialist primary care treatment (n = 38 in each group). Outcomes were assessed at baseline and at 6-month and 12-month follow-ups. The primary outcome was infant development. Secondary outcomes included parent-infant interaction, maternal psychopathology, maternal representations, maternal reflective functioning, and infant attachment. There were no differential effects over time between the groups on measures of infant development, parent-infant interaction, or maternal reflective functioning. Infant attachment classifications, measured only at the 12-month follow-up, did not differ between the groups. There were favorable outcomes over time for the PIP-treated dyads relative to the control group on several measures of maternal mental health, parenting stress, and parental representations of the baby and their relationship. The findings indicate potential benefits of parent-infant psychotherapy for improving mothers' psychological well-being and their representations of their baby and the parent-infant relationship.