Ecological momentary assessment of postpartum outcomes in mothers of multiples: lower maternal-infant bonding, higher stress, and more disrupted sleep.

Research on mental health in mothers of multiples has neglected important outcomes like postpartum bonding and relationship satisfaction and is limited by reliance on single-administration, retrospective measures. This study fills these gaps by assessing previously unexamined variables and using ecological momentary assessment (EMA), wherein participants answer repeated, brief surveys to measure real-world, real-time outcomes. This online study recruited 221 women and compared outcomes in those who birthed multiples (n = 127, 57.47%) vs. singletons (n = 94, 42.53%). When recruited, participants were either 6-12 (n = 129, 58.37%) or 18-24 (n = 83, 37.56%) weeks postpartum. All 221 participants completed baseline measures of self-reported depression, anxiety, stress, sleep, relationship satisfaction, and maternal-infant bonding. One hundred thirty participants (58.82%) engaged in 7 days of EMA assessing self-reported momentary mood, stress, fatigue, bonding, and sleep. Data were analyzed using two-by-two ANOVAs and hierarchical linear modeling. Mothers of multiples reported more baseline parenting stress and less maternal-infant bonding than mothers of singletons (ps < .05). Mothers of multiples who were 6-12 weeks postpartum reported the lowest bonding (p = .03). Mothers of multiples also reported more momentary stress, overwhelm, nighttime awakenings, and wake time after sleep onset (ps < .05). The latter two variables positively correlated with momentary fatigue, stress, and worse mood (ps < .05). Mothers of multiples experienced worse postpartum bonding, more stress, and more interrupted sleep than mothers of singletons. This population may benefit from tailored postpartum interventions to decrease stress, increase bonding, and improve sleep.

Perinatal Mental Health Treatment Needs, Preferences, and Barriers in Parents of Multiples.

PURPOSE: Many parents of multiples experience elevated mental health symptoms in the perinatal period. This population often presents with unique treatment needs and barriers to care; however, no tailored interventions have been developed for pregnant or postpartum mothers of multiples and/or their partners. This study involved an initial exploration of the perceived mental health treatment needs, preferences, and barriers to care in this population, as a first step toward developing such an intervention. METHODS: Participants were 241 parents of multiples who were recruited in-person and online. They completed self-report measures assessing treatment history/preferences, barriers to care, and symptoms during the perinatal period. RESULTS: Participants identified postpartum months 0 to 3 as the most difficult time. Few participants received any form of mental health treatment, although a significant percentage (approximately half) expressed interest in such treatment. Treatment interest was high for a range of clinical concerns. Participants were interested in both traditional treatment paradigms and eHealth approaches. Barriers to care were common, with the most common barrier being lack of time. CONCLUSIONS: There is a large, unmet need for mental health treatment in parents of multiples in the perinatal period, especially the early postpartum months. eHealth strategies seem particularly feasible and acceptable in this population and may help circumvent common barriers to care. Clinical recommendations and considerations in treatment development are discussed.

Use of ecological momentary assessment in mood disorders research.

Ecological momentary assessment (EMA) entails repeated, intensive sampling of respondents' current experiences while they are engaged in their typical daily routines, in their natural environments. In this article we discuss benefits of using EMA techniques in mood disorders research, provide an overview of the various specific EMA techniques that have been used with mood-disordered populations to date, and summarize the diverse range of research questions that EMA has been used to explore in this field. In addition, we evaluate the feasibility and acceptability of using EMA techniques with this population and suggest additional areas that might be fruitful to investigate, with a focus on the extension of EMA techniques into treatment research. Overall, data suggest that using EMA techniques in mood disorders research is feasible, generally acceptable, and highly promising. We conclude with a discussion of caveats, limitations, and ethical considerations.