Optimizing the Assessment of Parental Burnout: A Multi-informant and Multimethod Approach to Determine Cutoffs for the Parental Burnout Inventory and the Parental Burnout Assessment.

Parental burnout (PB) is a chronic stress-related condition resulting from long-lasting exposure to overwhelming parenting stress. Previous studies showing the seriousness of this condition stressed the urgent need to provide researchers and practitioners with effective assessment tools. Validated PB measures are the Parental Burnout Inventory (PBI) and the Parental Burnout Assessment (PBA). The good psychometric properties of these instruments have been replicated across different samples and countries, but thresholds for identifying impairing PB levels (i.e., cutoff scores) have not yet been established. The present study aims to fill this gap by adopting a multi-informant and multimethod approach to a sample of 192 burned-out and control parents. PBI and PBA cutoffs were derived from the combination of several PB indicators, based on a preregistered analysis strategy. Results identified a score of 74.6 (95% confidence interval (CI) = [69.48-79.68]) for the PBI and 86.3 (95% CI = [79.49-93.03]) for the PBA as indicators of the most severe PB levels.

A comparative study of orthorexia between premenopausal, perimenopausal, and postmenopausal women.

PURPOSE: Studies suggested that menopause is a period of vulnerability for disordered eating behaviors, but whether menopause could be linked to orthorexia nervosa (ON) remains unexplored. METHODS: A sample composed of 709 women aged between 30 and 71 years (mean age = 43.08 years, SD = 9.24) answered self-administered questionnaires assessing ON (Düsseldorfer Orthorexia Skala, DOS), body image, self-esteem, and psychopathological symptoms. The sample included a Premenopause group of 441 women reporting regular menses, a Perimenopause group of 94 women reporting the recent onset of amenorrhea or menstrual irregularities, and a Postmenopause group of 174 women reporting amenorrhea of natural onset for more than 12 months. RESULTS: Group comparison using analysis of covariance with age as covariate showed that ON scores were statistically higher in the two groups of participants dealing with menopause (Peri- and Postmenopause) when compared with women not yet concerned by menopause (Premenopause). A Kendall's tau-b correlation performed between the menopausal status (Pre, Peri, or Postmenopause) and DOS categories (No ON; At risk of ON; Presence of ON) showed a weak but statistically significant positive correlation between the menopausal group and DOS categories (tau-b = 0.136, p < 0.001). In addition, Fisher's exact tests indicated that the percentages of participants in the "At risk of ON" and "Presence of ON" categories were statistically higher in the Postmenopause group in comparison with the Premenopause group (p < 0.001). Depressive symptoms were statistically higher in the Peri- and Post-groups, while anxiety symptoms were stronger in the Peri-group when compared with the Pre-group. CONCLUSIONS: This study shows an increase of ON in women concerned with menopause, suggesting the existence of a relationship between menopause and ON. Further studies are necessary to identify factors involved in this association. LEVEL OF EVIDENCE: Descriptive (cross-sectional) study, level V.

Development and preliminary validation of the Maternal Burnout Scale (MBS) in a French sample of mothers: bifactorial structure, reliability, and validity.

The study and evaluation of burnout in the context of parenthood have been of growing interest over the last years. The aim of this study is to develop and validate the Maternal Burnout Scale (MBS) to contribute knowledge of the assessment of parental burnout. Items were developed based on elements from an extensive literature review that defined the significant dimensions interesting to the parental context. These items were also examined by expert clinicians. The revised version was submitted for an exploratory testing on 673 French mothers (mean age 31.69 ± 5.52 years) having at least one child living at home (0-25 years); then, it was submitted for a confirmatory analysis of 1277 (mean age 32.67 ± 5.49 years) mothers having the same parental profile (child aged 0.1-24 years). The exploratory analysis suggests a three-factor structure that accounted for 51% of the variance: negative emotional-behavioral manifestations (25%), physical and emotional exhaustion (15%), and a sense of parental achievement (13%). The confirmatory analysis retained a bifactorial structure recognizing maternal burnout as a common factor as well as the three other factors. According to the established threshold scores, 6.6% (n = 84) of the mothers could experience clinical maternal burnout. Indeed, Maternal Burnout Scale (MBS) has shown good psychometric properties with a high internal consistency both for the general score and for subscales. Furthermore, the validity of the scale was also confirmed. The MBS appears to be an applicable and reliable tool to determine the presence and severity of burnout symptoms among mothers. As a conclusion, the prevalence of maternal burnout indicates the importance of studying this syndrome in order to establish measures of prevention and actions to be taken.

Depression, anxiety, and guilt in mothers with burnout of preschool and school-aged children: Insight from a cluster analysis.

INTRODUCTION: The primary objective of this study is to identify the typology of exhausted mothers based on, depressive, anxiety, and guilt symptoms. And, secondarily, evaluate whether these profiles differ on parental stress, environmental stress, and parental burnout. METHODS: Five hundred and fifty French-speaking mothers suffering from exhaustion completed several questionnaires assessing parental stress, general perceived stress, maternal guilt, and depressive and anxious symptomology. Results from two hundred and ten mothers with burnout symptoms were explored (mean age [SD] = 33.69 [5.1] years). In order to identify possible subgroups, a hierarchical cluster analysis was performed. RESULTS: Three profiles were highlighted from the sample (Wilks' λ = 0.156, p < .0001): the first was characterized by high feelings of guilt (29.52%; n = 62), the second showed a dominance of anxiety symptoms and high feelings of guilt (36.19%; n = 76), and the fourth presented low levels of depression, anxiety, and feelings of guilt (23.3%, n = 49). DISCUSSION: These findings suggest different profiles of burned out mothers that vary according to severity of anxiety, depression, and guilt. That suggests that parental burnout, depression and anxiety are distinct disorders. This study also makes it possible to show the aggravating effect of guilt in the experience of burnout. Additional research is warranted as it is important to more carefully consider possible appropriate intervention strategies given the differing experiences of burned out mothers.

Childbirth as a forthcoming traumatic event: pretraumatic stress disorder during pregnancy and its psychological correlates.

BACKGROUND: Recent research has suggested that pretraumatic stress related to a forthcoming predictable traumatic event might exist and that such stress reactions would be a key, 'but largely ignored', aspect of the etiology of Posttraumatic Stress Disorder (PTSD). While it is now acknowledged that childbirth may lead to PTSD, less is known regarding pretraumatic reactions in pregnancy. This study aims to (a) explore the frequency of PTSD, Fear of Childbirth and tokophobia associated with the forthcoming delivery and (b) highlight associated features of pre-traumatic stress symptoms. METHODS: At 34 weeks' gestation, a sample of 102 women completed questionnaires assessing anticipated labour pain, fear of childbirth, fear of pain, pretraumatic stress symptoms, perceived social support and depressive and anxiety symptoms. RESULTS: 8.8% of women met DSM-IV-TR criteria for PTSD related to the threatening forthcoming delivery. Fear of childbirth, anticipated labour pain, anxiety, and depressive symptoms were significant predictors of pretraumatic stress intensity. CONCLUSION: Our results extend prior findings on postpartum PTSD by showing that fear of labour pain is a specific construct, clearly independent from the experience of general pain. Our results suggest that childbirth may be experienced as threatening and traumatic and that this traumatic impact might develop way before the delivery. As a potential traumatic continuum from pre- to posttraumatic stress might exist, further longitudinal studies assessing pre-, peri- and posttraumatic reactions is needed to provide support for this hypothesis.

Body image, satisfaction with sexual life, self-esteem, and anxiodepressive symptoms: A comparative study between premenopausal, perimenopausal, and postmenopausal women.

Menopause is an important life transition in women, and it is associated with significant physical and psychological changes. This study aimed at examining how the menopausal transition influences body image and satisfaction with sexual life. To this aim, body image dissatisfaction, sexual dissatisfaction, and self-esteem were compared in three groups of women with distinct menopausal status (premenopausal n = 142, perimenopausal n = 66, or postmenopausal n = 149), while controlling for depressive and anxiety symptoms and BMI. Using ANOVA between these three groups, we observed that dissatisfaction with body image was significantly higher in the perimenopausal sample compared with its premenopausal counterpart. In the postmenopausal sample, body image improved, as this group displayed body image scores close to the premenopausal level. In addition, sexual dissatisfaction was significantly increased in the perimenopausal and postmenopausal samples, which is compatible with the concept that higher body appreciation positively predicted sexual function. We conclude that body image dissatisfaction reaches a maximum during the perimenopausal phase, before returning to a level nearly identical between the premenopausal and the postmenopausal phases.

When Fear of Childbirth is Pathological: The Fear Continuum.

OBJECTIVES: Given that prepartum psychiatric symptoms have been reported to be associated with postpartum disorders, focusing on the prepartum period appears of prime importance. The aim of the current study was threefold: (a) to identify the prevalence rates of women suffering from fear of childbirth (FOC) and tokophobia (b) to explore the association between FOC, obstetrical and psychopathological variables and (c) to identify the independent predictors of the intensity of FOC symptoms, FOC and tokophobia. METHODS: at 36 weeks' gestation, 98 women completed questionnaires assessing FOC, pretraumatic stress, fear of pain, depressive and anxiety symptomatology as well as perceived social support. Socio-demographic and gynecological data were also gathered. RESULTS: 22.45% of women reported a probable FOC and 20.41% suffered from a potential tokophobia. Epidural anesthesia (ß = 5.62, p < 0.05), and the intensity of pretraumatic stress symptoms (ß= 0.69, p < 0.05), were independently associated with the intensity of FOC symptoms. Planning a c-section was significantly related to FOC (ß = 0.09, p = 0.03). Planning an epidural anesthesia was also an independent predictor of both FOC and tokophobia (ß = 1.33, p = 0.03; ß = 1.26, p = 0.04, respectively). CONCLUSIONS: Given the high rates of FOC and tokophobia highlighted, developing an appropriate preparation to childbirth is of great relevance. Longitudinal studies should be developed in order to provide an in-depth examination of the course of prepartum psychiatric disorders, maintenance of symptoms and their impact on subsequent infant development.

Relative contributions of acculturation and psychopathological factors to cannabis use among adolescents from migrant parents.

Immigrant adolescents and adolescents born of immigrant parents are at increased risk of substance use which has been linked to difficulties in acculturation processes. However very few studies have examined the role of the different acculturation strategies and none of them have controlled for relevant psychopathological and socio-familial factors. The aim of this study was to investigate the role of acculturation in cannabis use in a sample of adolescents born of immigrant parents taking into account potential confounding variables. A sample of 292 high school students born in France from at least one foreign parent completed a questionnaire assessing cannabis use, acculturation orientations, ethnic identity and the most relevant potential confounders (depressive symptoms, sensation seeking, borderline and psychopathic traits, alcohol and tobacco use, parental attachment, life events, socioeconomic status and academic achievement). A regression analysis showed that acculturation orientations and ethnic identity explained a significant part of the variance in the frequency of cannabis use. Individualism, integration and assimilation were negatively associated with the frequency of cannabis use suggesting they might serve as protective factors.

Fatigue and breastfeeding: an inevitable partnership?

Postpartum fatigue is a normal condition that most women experience. Breastfeeding is often associated in women's minds as contributing to the feeling of overall perceived fatigue, and many women indicate that they have ceased breastfeeding because of fatigue. However, the relationship between feeding choice and perceived fatigue has never been established. Two hundred and fifty-three women participated in a study examining whether perceived fatigue differed for bottle-feeding and breastfeeding women at 3 different times during the postpartum period (2-4 days, 6 weeks, and 12 weeks postpartum). Results showed no significant differences for these 2 groups, suggesting that perceived fatigue during the postpartum period is not dependent on feeding choice. Additional analyses examining other variables with a potential effect were nonsignificant. Because perceived physical fatigue does not appear to be dependent on feeding choice, women should be prepared for the feeling of perceived fatigue during the postpartum period while at the same time be reassured that feeding choice is not correlated.