Perceived Parenting Stress Is Related to Cardiac Flexibility in Mothers: Data from the NorBaby Study.

Heart rate variability (HRV) is an indicator of autonomic nervous system activity, and high levels of stress and/or depressive symptoms may reduce HRV. Here, we assessed whether (a) parental stress affected HRV in mothers during the perinatal period and whether this is mediated by bonding and (b) whether antenatal maternal mental states, specifically repetitive negative thinking, depressive symptoms, and pregnancy-related anxiety, have an impact on infant HRV, and lastly, we investigated (c) the relationship between maternal HRV and infant HRV. Data are from the Northern Babies Longitudinal Study (NorBaby). In 111 parent-infant pairs, cardiac data were collected 6 months after birth. In the antenatal period, we used the Pregnancy-Related Anxiety Questionnaire-Revised, the Edinburgh Postnatal Depression Scale, and the Perseverative Thinking Questionnaire; in the postnatal period, we used the Parenting Stress Index and the Maternal Postnatal Attachment Scale. Higher levels of perceived parenting stress but not depressive symptoms were associated with lower HRV in mothers (τ = -0.146), and this relationship was not mediated by maternal bonding. Antenatal maternal mental states were not associated with infant HRV. There was no significant correlation between maternal HRV and infant HRV. Our observational data suggest that perceived stress reduces cardiac flexibility. Future studies should measure HRV and parenting stress repeatedly during the perinatal period.

Exploring public health nurses' acceptability of clinical assessment tools in a Norwegian child health centre.

BACKGROUND: Infants' symptoms of mental struggle are often diffuse and undifferentiated, and health services do not identify many infants at risk of poor development. However, primary health care is advantageous for early identification, given there are frequent consultations during the infant's first two years. Health policy encourages using evidence-based screening but use varies in primary health care. The Alarm Distress Baby Scale (ADBB) is an assessment tool targeting social withdrawal in infants 2-24 months of age. AIM: To explore contextual factors related to public health nurses' (PHNs) acceptability of clinical assessment tools in a Norwegian child health centre. METHODS: Prior to an upcoming ADBB training, we used focus group discussions with PHNs to explore their views on their professional role and practice and how this concurs with using assessment tools. FINDINGS: Thematic analysis resulted in the following themes: (1) A Role requiring Supporting the Parents and Safeguarding the Infant; (2) The Challenge of Interpreting Infant Expressions; and (3) Organisational Preconditions for Accepting New Methods. CONCLUSION: Our findings show that PHNs regard assessment tools as an aid to detect infants at risk, but that systematic use of such tools can hinder their ability to be flexible, egalitarian, and resource-focused. We also find that acceptability of assessment tools requires a system for continuous training and a well-established referral routine.

Dental anxiety and potentially traumatic events: a cross-sectional study based on the Tromsø Study-Tromsø 7.

OBJECTIVE: The objectives of the study were to describe the prevalence of dental anxiety and the possible associations between dental anxiety and potentially traumatic events in an adult population. METHOD: The study is based on cross-sectional questionnaire data from the 7th wave of the Tromsø Study, a study of the adult general population in the municipality of Tromsø carried out in 2015-2016. The Modified Dental Anxiety Scale was used to measure dental anxiety across potentially traumatic events, oral health, dental attendance (avoidance) and current mental health symptoms (Hopkins Symptom Checklist). Individuals with high and low dental anxiety scores were compared to investigate differences in the distribution of potentially traumatic events, current mental health symptoms, avoidance, sex and oral health, and hierarchical multivariable regression was used to study the influence of traumatic events on dental anxiety. RESULTS: High dental anxiety was reported by 2.9% of the sample and was most prevalent among females and in the youngest age groups. Individuals with high dental anxiety reported more current mental health symptoms, and they were more likely to report poorer oral health and more irregular dental visits compared to individuals with no or lower dental anxiety scores. Concerning traumatic events, the reporting of painful or frightening dental treatment showed the biggest difference between those with high dental anxiety and low dental anxiety scores (a moderate effect). The hierarchical regression model indicated that reporting sexual abuse, traumatic medical treatment in hospital and childhood neglect significantly predicted dental anxiety in the step they were entered in, but only sexual abuse remained a significant individual contributor after controlling for current mental health symptoms. CONCLUSIONS: The prevalence of high dental anxiety was lower than expected (2.9%), but dentally anxious individuals expressed a high burden of mental health symptoms, poor oral health and the avoidance of dental care. The regression analysis indicated that experiences with sexual abuse could affect dental anxiety levels in the absence of generalised symptoms of anxiety and depression.

Perinatal mental health around the world: priorities for research and service development in Norway.

Despite the country's generous social welfare systems, perinatal mental health problems are prevalent in Norway. National guidelines recommend that health services identify women with perinatal mental conditions, but systematic screening and clear treatment pathways are not nationally endorsed, neither are recommendations for evaluating and treating possible parent-infant interaction difficulties of affected mothers. There are no subspecialties in perinatal psychiatry or psychology, hence healthcare personnel often lack expertise about perinatal mental health. To safeguard the mental health of infants and parents, we need to establish systematic communication between primary healthcare professionals, as well as between primary- and secondary-level professionals.

'Fixing my life': young people's everyday efforts towards recovery from persistent bodily complaints.

Little is known about the perspectives of young people suffering from medically unexplained symptoms. This study aims to explore the experiences and strategies of young Norwegians related to incipient and persistent health complaints affecting everyday life functioning. The study draws on field notes, video material and interview transcripts from a multi-sited ethnographic study of healthcare services and select schools in a small Norwegian town between 2015 and 2016. A central theme is the emphasis upon social and existential constraints seemingly framed by a social imaginary of youth rather than a medical imaginary, and their active engagements to 'fix' their lives through what we identify as two main modalities of self-care. Navigating temporal and relational aspects of sociocultural configurations of youth in their social environments, they imagine and enact alternative qualifying positions better adapted to constraints, personal preferences and needs. Our findings may add to understandings of the needs and strategies of young sufferers of medically unexplained symptoms, relevant for health and social care encounters.

Adult attachment style and maternal-infant bonding: the indirect path of parenting stress.

BACKGROUND: The quality of maternal-infant bonding is related to important child outcomes. The literature has assumed that the ability to form relationships is a relatively stable trait, and research studies have suggested that a mother's attachment style in close adult relationships is related to mother-infant bonding. The transition to parenthood is also often stressful, and the adult attachment style may relate to parenting stress in the first year after birth. Such stress could possibly have a negative relationship with the mother-infant bond. In the present study, we examined the associations between maternal adult attachment styles and the quality of mother-infant bonding and whether this relationship is mediated by parenting stress. METHODS: The present study sample comprised 168 women (mean age 31.0 years, SD 4.23 years). Between weeks 31 and 41 of gestation, the anxious and avoidant adult attachment dimensions were measured with the Experiences in Close Relationships questionnaire (ECR). Between 5 and 15 weeks after birth mother-infant bonding and parenting stress were measured with the Maternal Postnatal Attachment Scale (MPAS) and the Parenting Stress Index-Parent Domain (PSI-PD), respectively. RESULTS: Both attachment-related avoidance and attachment-related anxiety correlated significantly and negatively with mother-infant bonding. However, a regression analysis showed that only attachment-related avoidance was a significant predictor of mother-infant bonding when controlling for demographic variables and maternal mental health history. The relationship between the adult attachment style and bonding was mediated by parenting stress. Higher scores on attachment avoidance and anxiety were related to increased stress, which was related to decreased quality of bonding. The overall parent domain and the subscale of competence in the parent-related stress dimension mediated between attachment avoidance and bonding, and the overall parent domain and the subscales of competence and role restriction mediated between attachment anxiety and bonding. There was no direct relationship between the adult attachment style and mother-infant bonding when parenting stress was included as a mediator. CONCLUSIONS: This study illustrates that maternal adult attachment style relates to mother-infant bonding. This relationship was mediated by parenting stress. The results may have implications for the early identification of mothers at risk of having bonding difficulties.

Newborn Behavioral Observation, maternal stress, depressive symptoms and the mother-infant relationship: results from the Northern Babies Longitudinal Study (NorBaby).

BACKGROUND: Families can experience the postpartum period as overwhelming and many report a special need for support. The Newborn Behavioral Observation (NBO) aims to promote a positive parent-infant relationship by sensitising parents to the infant's signals. This article evaluates the NBO as a universal preventive intervention within the regular well-baby clinic service on measures of maternal depressive symptoms, parental stress, the mother-infant relationship and satisfaction/benefit of the postpartum follow-up. METHODS: This investigation is part of a larger longitudinal study comprising 220 women and 130 of their partners recruited between 2015 and 2017. The study had a non-randomised cluster-controlled design with 6 measurement points. This article is based on a sample of 196 women using data from T1 (gestational weeks 13-39), T4 (5-15 weeks postpartum) and T5 (3-9 months postpartum). Participants were allocated to a group receiving the NBO (n = 82) and a care as usual comparison group (n = 114). We measured maternal depressive symptoms and parental stress using the Edinburgh Postnatal Depression Scale (EPDS) and the Parenting Stress Index (PSI). The mother-infant relationship was assessed with the Parental Reflective Functioning Questionnaire (PRFQ), the Maternal Postnatal Attachment Scale (MPAS) and the Maternal Confidence Questionnaire (MCQ). Participants also answered questions about satisfaction/benefit of the postpartum follow-up. RESULTS: A Mann-Whitney U test indicated that participants in the NBO-group learned significantly more than the comparison group from the follow-up about the baby's signals in relation to sleep/sleep patterns, social interaction and crying/fuzziness. Multivariate analyses of covariance (MANCOVA) and repeated measures ANCOVA found no significant differences between the groups for the mother-infant relationship domain and few differences in depressive symptoms and parental stress. The repeated measures ANCOVA found that participants in the NBO-group scored slightly higher on parental stress, although the difference was small. CONCLUSIONS: The results indicate that the NBO-group learned more than the comparison group about reading their child's signals in important everyday situations. However, the benefits of the NBO were limited for depressive symptoms, parental stress and self-reported mother-infant relationship. The study sample was generally well-functioning, and the results indicate that the benefits of the NBO may be limited within a well-functioning sample. TRIAL REGISTRATION: ClinicalTrials, NCT02538497, Registered 2 September 2015.

'Not a film about my slackness': Making sense of medically unexplained illness in youth using collaborative visual methods.

Persistent medically unexplained symptoms have debilitating consequences for adolescents, dramatically altering their social world and future aspirations. Few studies have focused on social and moral aspects of illness experience relevant to adolescents. In this study, the aim is to explore these aspects in depth by focusing on a single case and to address how young people attempt to create social accountability in a search for meaning when facing illness and adversity. The study is based on a view of meaning as dialogically constituted during the research process, which calls for the use of collaborative film methodology and life-mode interviewing. With a dialogic-performative approach to a narrative emplotment of medically unexplained symptoms, we present Peter as intentional and purposive, and as a person who in a reflective process of meaning making claimed his own voice and developed his own strategies of coping with his illness. The analysis brings forward a narrative of suffering, hope and intentionality that is configured by the immediate limited possibilities of agency due to Peter's medical condition. It is, however, configured to an even greater degree by aspirations, that is, to become an accountable person through social experiences and to meet sociocultural and moral expectations of being an adolescent. The study provides insight into relational and existential aspects of meaning making in dealing with contested illness in youth and points to the potential of visual and other experience-near methods for supporting adolescents in their coping attempts and in overcoming communication barriers in everyday life and clinical encounters.

Early maladaptive schemas as predictors of maternal bonding to the unborn child.

BACKGROUND: The quality of an expectant mother's bonding to the fetus has been shown to be associated with important developmental outcomes. Previous studies suggest that bonding quality is predicted by, for example, social support, psychological well-being, and depression. However, little is known regarding the role of maternal cognition in maternal-fetal bonding. Early maladaptive schemas (EMSs) are negative and stable assumptions about oneself and one's relationships with others that are developed during childhood and adolescence. In the present study, we examined the associations between EMSs and the quality of the bonding to the fetus in expectant mothers. METHODS: The present investigation is part of a larger study in which 220 pregnant women (approximately 12% of the pregnant women in the region) and 130 of their partners were recruited from October 2015 until December 2017. The sample for the current study comprised 165 pregnant women (mean age 30.8 years, SD 4.1 years). The participants completed the Young Schema Questionnaire Short Form 3 (YSQ-S3) between gestational weeks 24 and 37 and the Maternal Antenatal Attachment Scale (MAAS) and the Edinburgh Postnatal Depression Scale (EPDS) between gestational weeks 31 and 41. RESULTS: All EMS domains correlated significantly and negatively with scores for quality of maternal-fetal bonding on the MAAS. Only the Disconnection and Rejection domain correlated significantly and negatively with MAAS scores for intensity of preoccupation with the fetus. The Disconnection and Rejection domain was a significant independent predictor of the quality of maternal-fetal bonding. Symptoms of depression mediated the effect of the EMS domains on the quality of maternal-fetal bonding. The EMS domains Disconnection and Rejection, Impaired Autonomy and Performance, and Impaired Limits showed significant direct effects on bonding quality. CONCLUSIONS: EMSs are related to expectant mothers' self-reported bonding to their fetuses. This association was mediated by the mothers' symptoms of depression. The results may have implications for the early identification of pregnant women at risk of bonding difficulties and encourage more studies on cognitive schemas and mechanisms for maternal-fetal bonding.

Epistemological and methodological paradoxes: secondary care specialists and their challenges working with adolescents with medically unexplained symptoms.

BACKGROUND: Early adolescence is considered a critical period for the development of chronic and recurrent medically unexplained symptoms (MUS), and referrals and system-initiated patient trajectories often lead to an excess of examinations and hospitalizations in the cross-section between mental and somatic specialist care for this group of patients. Dimensions of the relationship and communication between clinician and patient are shown in primary care studies to be decisive for subsequent illness pathways, often creating adverse effects, but knowledge on clinical communication in specialist care is still scarce. METHODS: This study explores communicative challenges specific to clinical encounters between health professionals and adolescent patients in specialist care, as presented through interviews and focus group data with highly experienced specialists working in adolescent and child services at a Norwegian university hospital. RESULTS: The results are presented in a conceptual model describing the epistemological and methodological paradoxes inherent in the clinical uncertainty of MUS. Within these paradoxes, the professionals try to solve the dilemmas by being creative in their communication strategies; applying metaphors and other rhetorical devices to explain complex ideas; creating clinical prototypes as a way to explain symptoms and guide them in clinical action; relying on principles from patient-centered care involving empathy; and trying to balance expertise and humility. CONCLUSION: The challenges in communication arise as a result of opposing discourses on biomedicine, family, health and adolescence that create dilemmas in everyday clinical work. By moving away from a positivist and biomedical framework towards an interpretive paradigm, where culturally derived and historically situated interpretations are used to understand the social life-world of the patient, one can create a more humane health service in accordance with ideals of patient-centered care.

Protocol for the Northern babies longitudinal study: predicting postpartum depression and improving parent-infant interaction with The Newborn Behavioral Observation.

INTRODUCTION: Postpartum depression (PPD) is a prevalent disorder. Studying the factors related to PPD will help to identify families at risk and provide preventive interventions. This can in turn improve the developmental trajectories for the children. Several previous studies have investigated risk factors for PPD. However, few studies have focused on cognitive vulnerability factors. The first aim of the present study is to explore a range of protective and risk factors, including cognitive factors, for PPD, parent-infant interactions and child development. The second aim of the study is to evaluate the effectiveness of The Newborn Behavioral Observation (NBO) as a universal preventive intervention delivered in routine practice. The NBO is a brief relationship-enhancing intervention that may reduce depressive symptomatology in mothers. METHODS: The study is a longitudinal observational study with an intervention. The observational study uses a prospective cohort design, whereas the intervention study has a non-randomised cluster-controlled design comparing a group receiving NBO with a group receiving standard care. The intervention group will receive three NBO sessions within the first 4 weeks postdelivery. Between 2015 and 2018, approximately 200 families will be recruited in the municipality of Tromsø, Norway. Parents are recruited during pregnancy, and assessments will be performed during gestational weeks 16-22, 24-30 and 31, and at 6 weeks, 4 months and 6 months postdelivery. Predictor variables include several cognitive vulnerability factors including early maladaptive schemas, implicit attitudes and cognitive processing of emotionally valenced infant facial information. ETHICS AND DISSEMINATION: The Regional Committee for Medical and Health Research Ethics in Northern Norway has approved the project. The research team has collaboration with local health services and can assist participants who need more extensive follow-up. Results from the project will be disseminated in international and national peer-reviewed journals, and at courses and conferences. TRIALS REGISTRATION NUMBER: NCT02538497; Pre-results.

A school intervention for mental health literacy in adolescents: effects of a non-randomized cluster controlled trial.

BACKGROUND: "Mental health for everyone" is a school program for mental health literacy and prevention aimed at secondary schools (13-15 yrs). The main aim was to investigate whether mental health literacy, could be improved by a 3-days universal education programme by: a) improving naming of symptom profiles of mental disorder, b) reducing prejudiced beliefs, and c) improving knowledge about where to seek help for mental health problems. A secondary aim was to investigate whether adolescent sex and age influenced the above mentioned variables. A third aim was to investigate whether prejudiced beliefs influenced knowledge about available help. METHOD: This non-randomized cluster controlled trial included 1070 adolescents (53.9% boys, M age 14 yrs) from three schools in a Norwegian town. One school (n = 520) received the intervention, and two schools (n = 550) formed the control group. Pre-test and follow-up were three months apart. Linear mixed models and generalized estimating equations models were employed for analysis. RESULTS: Mental health literacy improved contingent on the intervention, and there was a shift towards suggesting primary health care as a place to seek help. Those with more prejudiced beliefs did not suggest places to seek help for mental health problems. Generally, girls and older adolescents recognized symptom profiles better and had lower levels of prejudiced beliefs. CONCLUSIONS: A low cost general school program may improve mental health literacy in adolescents. Gender specific programs and attention to the age and maturity of the students should be considered when mental health literacy programmes are designed and tried out. Prejudice should be addressed before imparting information about mental health issues.

Cognitive function in unipolar major depression: a comparison of currently depressed, previously depressed, and never depressed individuals.

There is a lack of consensus upon a conclusive cognitive profile characterizing unipolar major depression. Currently depressed (n = 37), recovered previously depressed (n = 81), and never depressed controls (n = 50) underwent assessment of executive functions, working memory, attention, and psychomotor speed. Currently depressed yielded significantly lower test scores than previously and never depressed subjects on a measure of working memory. Both currently depressed and previously depressed scored significantly lower than never depressed subjects on measures of processing speed. Recurrent depressed performed similarly to subjects with a single depressive episode. These findings indicate a mild and limited cognitive impairment during the course of a mild to moderate major depressive disorder among relatively young adults. Impaired processing speed should be considered in further studies as a potential irreversible marker for recurrent depression.

Verbal learning and memory in depression: a 9-year follow-up study.

Memory impairment is often associated with depression. However, the literature is not uniform whether such impairment constitutes state and/or trait characteristics. One-hundred-and-twelve clinically depressed (CDs), previously depressed (PDs), and never depressed (NDs) subjects (T2 diagnostic status),were assessed with the California Verbal Learning Test (CVLT) at T1 and re-assessed 9 years later with the revised version, CVLT-II. At T1 no deficit in verbal memory between CDs and PDs compared to NDs was found, in which the majority of the subjects were younger adults. At follow-up the majority of CDs and PDs had suffered one or several recurrent depressive episodes. Repeated-measures analysis of variance showed, in particular and irrespective of group, a significant decline in recall measures over time. CDs, PDs and NDs showed the same pattern of verbal memory performance over time with the exception of Short Delayed Free Recall, in which CDs and PDs showed a significant decline in performance at follow-up compared to NDs. Likewise, subjects with recurrent depression performed comparable to subjects with a single episode over the course of follow-up. Our results suggest that individuals with mild to moderate unipolar depression may not be significantly affected by verbal memory impairments over the long-term course. The comparability of the versions of the CVLT is addressed.

Depression in postmenopause: a study on a subsample of the Acupuncture on Hot Flushes Among Menopausal Women (ACUFLASH) study.

OBJECTIVE: The current study was conducted on a subsample of postmenopausal women with a high frequency of hot flashes who participated in the Norwegian Acupuncture on Hot Flushes Among Menopausal Women study. The purpose of this study was to examine the prevalence of depressive symptoms, as measured by the Beck Depression Inventory; the effect of acupuncture therapy for menopausal hot flashes on depressive symptoms; and the associations between depressive symptoms and hot flashes, sleep disturbances, and self-reported health. METHODS: The Acupuncture on Hot Flushes Among Menopausal Women study was a multicenter, pragmatic, randomized controlled trial. The present subsample consisted of 72 women who were randomized to two groups: self-care only and acupuncture in addition to self-care for a period of 12 weeks. RESULTS: The prevalence of depressive symptoms was 30.6% at baseline, decreased similarly in both study groups during the study period, and was 14.1% at the end of the intervention. Depressive symptoms were significantly associated with sleep disturbances and self-reported health, but not with frequency of hot flashes. CONCLUSIONS: Postmenopausal women experiencing a high frequency of hot flashes reported a high prevalence of depressive symptoms compared with the general female population. Study results lend support to previous findings of an increased risk for depression during menopause, at least in women with severe hot flashes. Results further indicate that symptoms of depression in postmenopausal women may be alleviated with limited resources.