Understanding and optimising gratitude interventions: the right methods for the right people at the right time.

OBJECTIVE: Gratitude has consistently been associated with various beneficial health-related outcomes, including subjective wellbeing, positive mental health, and positive physical health. In light of such effects, positive psychology researchers and practitioners have often implemented gratitude interventions in an attempt to build individuals' orientations toward appreciation and thankfulness. Recent meta-analyses and reviews have revealed, however, that these interventions often have mixed effects on gratitude or other health outcomes. With this issue in mind, we aimed to identify (a) contextual considerations that may impact the effectiveness of these approaches, and (b) recommendations for the optimisation of gratitude interventions. METHODS AND MEASURES: Seventeen mental health professionals or experienced health psychology researchers engaged in semi-structured interviews to address the research questions. RESULTS: Thematic analysis of the data resulted in three contextual themes-cultural considerations, personal characteristics, and life experience-that were discussed as factors likely to influence intervention effectiveness. With respect to recommendations, participants highlighted the importance of encouraging deep engagement in gratitude tasks, consistent repetition of those tasks, and the value of interpersonal expressions of gratitude. CONCLUSION: Discussion is centred on suggestions for future research on gratitude and on implications for the implementation of gratitude interventions.

Associations between maternal psychological distress and mother-infant bonding: a systematic review and meta-analysis.

PURPOSE: Maternal psychological distress and mother-infant bonding problems each predict poorer offspring outcomes. They are also related to each other, yet the extensive literature reporting their association has not been meta-analysed. METHODS: We searched MEDLINE, PsycINFO, CINAHL, Embase, ProQuest DTG, and OATD for English-language peer-reviewed and grey literature reporting an association between mother-infant bonding, and multiple indicators of maternal psychological distress. RESULTS: We included 133 studies representing 118 samples; 99 samples (110,968 mothers) were eligible for meta-analysis. Results showed concurrent associations across a range of timepoints during the first year postpartum, between bonding problems and depression (r = .27 [95% CI 0.20, 0.35] to r = .47 [95% CI 0.41, 0.53]), anxiety (r = .27 [95% CI 0.24, 0.31] to r = .39 [95% CI 0.15, 0.59]), and stress (r = .46 [95% CI 0.40, 0.52]). Associations between antenatal distress and subsequent postpartum bonding problems were mostly weaker and with wider confidence intervals: depression (r = .20 [95% CI 0.14, 0.50] to r = .25 [95% CI 0.64, 0.85]), anxiety (r = .16 [95% CI 0.10, 0.22]), and stress (r = .15 [95% CI - 0.67, 0.80]). Pre-conception depression and anxiety were associated with postpartum bonding problems (r = - 0.17 [95% CI - 0.22, - 0.11]). CONCLUSION: Maternal psychological distress is associated with postpartum mother-infant bonding problems. Co-occurrence of psychological distress and bonding problems is common, but should not be assumed. There may be benefit in augmenting existing perinatal screening programs with well-validated mother-infant bonding measures.

Association of maternal and paternal perinatal depression and anxiety with infant development: A longitudinal study.

BACKGROUND: Maternal and paternal perinatal depression and anxiety are theorised to adversely impact infant development. Yet, few studies have assessed both mental health symptoms and clinical diagnoses within the one study. Moreover, research on fathers is limited. This study therefore aimed to examine the association between symptoms and diagnoses of maternal and paternal perinatal depression and anxiety with infant development. METHOD: Data were from the Triple B Pregnancy Cohort Study. Participants included 1539 mothers and 793 partners. Depressive and anxiety symptoms were assessed using the Edinburgh Postnatal Depression Scale and Depression Anxiety Stress Scales. Major depressive disorder, generalized anxiety disorder, social anxiety disorder, panic disorder, and agoraphobia were assessed using the Composite International Diagnostic Interview in trimester three. Infant development was assessed at 12-months using the Bayley Scales of Infant and Toddler Development. RESULTS: Antepartum, maternal depressive and anxiety symptoms were associated with poorer infant social-emotional (d = -0.11, p = .025) and language development (d = -0.16, p = .001). At 8-weeks postpartum, maternal anxiety symptoms were associated with poorer overall development (d = -0.11, p = .030). No association was observed for clinical diagnoses in mothers, nor paternal depressive and anxiety symptoms or clinical diagnoses; albeit risk estimates were largely in the expected direction of adverse effects on infant development. CONCLUSIONS: Evidence suggests that maternal perinatal depression and anxiety symptoms may adversely impact infant development. Effects were small but findings underscore the importance of prevention, early screening and intervention, alongside consideration of other risk factors during early critical periods.

Association of adolescent and young adult depression and anxiety with perinatal mental health in fathers: Findings from an Australian longitudinal study.

The current study examined associations between preconception diagnoses of major depressive disorder (MDD) and anxiety disorders in adolescence and young adulthood and perinatal depression and anxiety symptoms in early fatherhood. In an Australian community cohort study of health and development, earlier history of MDD and anxiety disorders (extending back to adolescence) were assessed retrospectively in the third trimester of pregnancy via the Composite International Diagnostic Interview. Paternal perinatal depression and anxiety were then assessed prospectively over three timepoints (third trimester of pregnancy, 8 weeks and 12 months postpartum), using established cut-points on the Edinburgh Postnatal Depression Scale and the Depression Anxiety Stress Scales (anxiety subscale). Mixed-effects regression models examined risk associations between preconception diagnoses of MDD and anxiety disorders, and perinatal depression and anxiety symptoms at each timepoint, adjusting for socio-demographic factors and concurrent maternal mental health difficulties. The odds of clinically concerning levels of paternal perinatal depression and anxiety were 6-fold and 4-fold higher, respectively, in men with a preconception history of MDD. The odds of perinatal depression were 3-fold higher in men with a preconception history of an anxiety disorder. Less evidence was found for an association between preconception diagnoses of an anxiety disorder and perinatal anxiety in fathers. Interventions aimed at improving mental health in men during adolescence and young adulthood may promote continued psychological health in men during early fatherhood.

Strengthening Peer Mentoring Relationships for New Mothers: A Qualitative Analysis.

(1) Background: The transition to motherhood can be challenging, especially for first-time mothers, and can accompany maternal distress. Social support-such as that offered by peers-can be important in assisting mothers to manage such distress. Although primiparous mothers often seek out and value peer support programs, few researchers have investigated factors that may influence the strength of relationships in non-professional maternal peer support programs. Insight into these factors can be key to enhancing the success of future peer support interventions. (2) Methods: Reflexive thematic analysis was applied to data gathered from 36 semi-structured interviews conducted with 14 primiparous mothers and 17 peer mentors in a peer support program. (3) Results: Four themes related to successful mentorship were identified: expectations of peer relationship, independence of peer mentor, contact, and similarities. (4) Conclusions: For primiparous mothers who are developing their support network, these factors appear important for promoting close and effective peer support relationships. Interventions that harness the dynamics between these factors may contribute to more successful peer support relationships and mental health outcomes for participants.

Methods and Applications of Social Media Monitoring of Mental Health During Disasters: Scoping Review.

BACKGROUND: With the increasing frequency and magnitude of disasters internationally, there is growing research and clinical interest in the application of social media sites for disaster mental health surveillance. However, important questions remain regarding the extent to which unstructured social media data can be harnessed for clinically meaningful decision-making. OBJECTIVE: This comprehensive scoping review synthesizes interdisciplinary literature with a particular focus on research methods and applications. METHODS: A total of 6 health and computer science databases were searched for studies published before April 20, 2021, resulting in the identification of 47 studies. Included studies were published in peer-reviewed outlets and examined mental health during disasters or crises by using social media data. RESULTS: Applications across 31 mental health issues were identified, which were grouped into the following three broader themes: estimating mental health burden, planning or evaluating interventions and policies, and knowledge discovery. Mental health assessments were completed by primarily using lexical dictionaries and human annotations. The analyses included a range of supervised and unsupervised machine learning, statistical modeling, and qualitative techniques. The overall reporting quality was poor, with key details such as the total number of users and data features often not being reported. Further, biases in sample selection and related limitations in generalizability were often overlooked. CONCLUSIONS: The application of social media monitoring has considerable potential for measuring mental health impacts on populations during disasters. Studies have primarily conceptualized mental health in broad terms, such as distress or negative affect, but greater focus is required on validating mental health assessments. There was little evidence for the clinical integration of social media-based disaster mental health monitoring, such as combining surveillance with social media-based interventions or developing and testing real-world disaster management tools. To address issues with study quality, a structured set of reporting guidelines is recommended to improve the methodological quality, replicability, and clinical relevance of future research on the social media monitoring of mental health during disasters.

Critical measurement issues in the assessment of social media influence on body image.

Progress towards understanding how social media impacts body image hinges on the use of appropriate measurement tools and methodologies. This review provides an overview of common (qualitative, self-report survey, lab-based experiments) and emerging (momentary assessment, computational) methodological approaches to the exploration of the impact of social media on body image. The potential of these methodologies is detailed, with examples illustrating current use as well as opportunities for expansion. A key theme from our review is that each methodology has provided insights for the body image research field, yet is insufficient in isolation to fully capture the nuance and complexity of social media experiences. Thus, in consideration of gaps in methodology, we emphasise the need for big picture thinking that leverages and combines the strengths of each of these methodologies to yield a more comprehensive, nuanced, and robust picture of the positive and negative impacts of social media.

The Role of Antenatal and Postnatal Maternal Bonding in Infant Development.

OBJECTIVE: The affectional bond experienced by a mother toward her developing fetus/infant has been theorized to be a critical factor in determining infant developmental outcomes; yet there remains a paucity of research in this area, and a lack of high-quality longitudinal studies. This study aimed to examine the extent to which mother-to-infant bonding predicted infant development in a multi-wave longitudinal pregnancy cohort study (N = 1,347). METHOD: Self-reported bonding was assessed using the Maternal Antenatal Attachment Scale at each trimester, and the Maternal Postnatal Attachment Scale at 8 weeks and 12 months postpartum. Infant development was assessed using the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III) at 12 months. RESULTS: Bonding predicted indicators of infant social-affective development, including social-emotional, behavioral, and temperamental outcomes. Effect sizes ranged from small to moderate, increasing over the perinatal period (ß = 0.11-0.27). Very small effects were also identified in the relationship between bonding and cognitive, language, and motor development (ß = 0.06-0.08). CONCLUSION: Findings suggest that a mother's perceived emotional connection with her child plays a role in predicting social-affective outcomes; prediction may not extend to other domains of infant development. Maternal bonding may therefore be a potentially modifiable predictor of infant social-affective outcomes, offering important considerations for preventive intervention.

Parent and child mental health trajectories April 2020 to May 2021: Strict lockdown versus no lockdown in Australia.

OBJECTIVE: To control a second-wave COVID-19 outbreak, the state of Victoria in Australia experienced one of the world's first long and strict lockdowns over July-October 2020, while the rest of Australia experienced 'COVID-normal' with minimal restrictions. We (1) investigate trajectories of parent/child mental health outcomes in Victoria vs non-Victoria and (2) identify baseline demographic, individual and COVID-19-related factors associated with mental health trajectories. METHODS: Online community sample of 2004 Australian parents with rapid repeated assessment over 14 time-points over April 2020 to May 2021. Measures assessed parent mental health (Depression, Anxiety and Stress Scales-21), child depression symptoms (13-item Short Mood and Feelings Questionnaire) and child anxiety symptoms (four items from Brief Spence Children's Anxiety Scale). RESULTS: Mental health trajectories shadowed COVID-19 infection rates. Victorians reported a peak in mental health symptoms at the time of the second-wave lockdown compared to other states. Key baseline predictors, including parent and child loneliness (standardized regression coefficient [ß] = 0.09-0.46), parent/child diagnoses (ß = 0.07-0.21), couple conflict (ß = 0.07-0.18) and COVID-19 stressors, such as worry/concern about COVID-19, illness and loss of job (ß = 0.12-0.15), predicted elevated trajectories. Effects of predictors on parent and child mental health trajectories are illustrated in an online interactive app for readers (https://lingtax.shinyapps.io/CPAS_trend/). CONCLUSION: Our findings provide evidence of worse trajectories of parent and child mental health symptoms at a time coinciding with a second COVID-19 outbreak involving strict lockdown in Victoria, compared to non-locked states in Australia. We identified several baseline factors that may be useful in detecting high-risk families who are likely to require additional support early on in future lockdowns.

Monitoring Australian parents' shifting receptiveness to digital mental health interventions during the COVID-19 pandemic.

BACKGROUND: Nascent evidence indicates that the mental health of parents and children has markedly declined during the COVID-19 pandemic. Considering disruptions to traditional face-to-face mental health services resultant from stay-at-home orders, the potential value of digital mental health interventions has become extremely apparent. Despite this, uptake of digital interventions remains poor, indicating that a better understanding is needed of factors that determine a willingness to use digital platforms. METHOD: The present multi-wave, longitudinal study of 2365 Australian parents explored between-person and within-person predictors of intentions to use digital interventions during the pandemic. RESULTS: More than one-third of parents reported likely use of a self-guided and therapist-guided digital intervention, with the most endorsed reason for use being to support their child's mental health. Between-person baseline predictors of higher intention ratings were parent's prior mental illness, not living with a partner and recent environmental stressors. Within-person predictors of higher intention ratings were endorsement of mindful parenting strategies, child access to the Internet, better perceived management of child's education, lower social support and financial hardship. CONCLUSION: Findings demonstrate that willingness to engage in digital interventions fluctuates in response to changing circumstances. Identifying novel ways to increase acceptance and uptake of digital interventions based on modifiable predictors established here is needed to realize the full potential of these modes of care in times of need.

Exploring the features of an app-based just-in-time intervention for depression.

BACKGROUND: Technological advancements make it possible to deliver depression interventions via smartphone applications ("Apps"), including those that deliver content "just-in-time" (e.g., in response to acute negative mood states). This study examined whether an app-based just-in-time intervention (ImproveYourMood+) decreased depressive symptoms, and whether the following features were related to symptom improvement: micro-intervention content, mood monitoring, and just-in-time prompts to use content. METHODS: Participants (n = 235) from the general population who self-identified as wanting to improve their negative mood were randomised to a waitlist control group (n = 55) or one of three intervention groups: MoodTracker (monitoring-only, n = 58), ImproveYourMood (monitoring and content; n = 62), or ImproveYourMood+ (monitoring, content, and prompts; n = 60). The active intervention phase was 3 weeks. Depressive and anxiety symptoms, and negative automatic thoughts were assessed at baseline, immediately post-intervention, and one month following post-intervention. RESULTS: Linear mixed modelling revealed greater declines over time in depressive and anxiety symptoms and negative automatic thoughts for the ImproveYourMood group (standardized mean differences [SMDs] ranged from .32 to .40) and improves for the ImproveYourMood+ group for negative automatic thoughts (SMDs ≥ .37) compared to the waitlist control group. No between-group differences were observed between the MoodTracker and control groups (SMDs = .04-.23). User experience appeared to be superior in more comprehensive/multi-modal versions. LIMITATIONS: The study employed a naturalistic design, whereby participants self-selected to utilise the program, did not complete eligibility assessments, and did not receive compensation. The study therefore attained considerable drop-out rate (~50% by the follow-up timepoints), potentially reflecting the usage patterns of real-world mental health apps. CONCLUSIONS: The findings suggest that micro-interventions can be an effective way to reduce depressive symptoms both in the moment and 1-2 months later. Integration of micro-interventions with full treatment programs is a viable next step in micro-intervention research.

Paternal coping and psychopathology during the perinatal period: A mixed studies systematic review and meta-analysis.

How fathers cope with stress may be critical to their mental health during the perinatal period. Using a sequential explanatory design for systematic review and meta-analysis, we aimed to identify associations and causal relations between higher- and lower-order avoidant and approach coping strategies and paternal psychopathology. We searched five electronic databases and grey literature, and used random-effects models to calculate pooled effects from 11 quantitative studies. Meta-analytic results were integrated with findings from 18 qualitative studies. Fathers' avoidant coping was positively associated with global psychopathology and depression. Approach-oriented coping, particularly problem-solving, was associated with positive affect but not psychopathology. Qualitative findings indicate distressed fathers employ avoidant coping strategies such as suppression, distraction, and social withdrawal. Approach-oriented coping strategies such as problem-solving and cognitive reappraisals appeared to be constructive components of men's coping repertoires supporting adaptation to fatherhood. Different coping strategies and approaches may reflect enactment of constrictive, moderate, or reinterpreted masculine norms. Study designs did not allow conclusions about causal relations between coping and psychopathology. Screening for, and targeting of, high avoidant coping among expectant and new fathers may help detect men at risk of or experiencing mental health difficulties and inform clinical response to psychopathology. Research examining whether different patterns of avoidant and approach coping are associated with psychopathology over time could inform interventions to support men's mental health and adaptation to fatherhood.

Maternal bonding, negative affect, and infant social-emotional development: A prospective cohort study.

BACKGROUND: Theoretical perspectives and empirical evidence suggest that maternal bonding and negative affect play a role in supporting infant social-emotional development (Branjerdporn et al., 2017; Kingston et al., 2012; O'Donnell et al., 2014; Van den Bergh et al., 2017). However, the complex pathways likely to exist between these constructs remain unclear, with limited research examining the temporal and potentially bi-directional associations between maternal bonding and negative affect across pregnancy and infancy. METHODS: The interrelationships between maternal bonding, negative affect, and infant social-emotional development were examined using multi-wave perinatal data from an Australian cohort study (N = 1,579). Self-reported bonding and negative affect were assessed at each trimester, and 8 weeks and 12 months postpartum. The Bayley-III social-emotional scale was administered at age 12 months. RESULTS: Results revealed strong continuities in bonding and negative affect across pregnancy and postpartum. Small associations (ß = -.10 to -.20) existed between maternal negative affect during pregnancy and poor early bonding. Higher postnatal maternal bonding predicted infant social-emotional development (ß = .17). LIMITATIONS: Limitations include a somewhat advantaged and predominantly Anglo-Saxon sample of families, and the use of self-report measures (though with strong psychometric properties). These limitations should be considered when interpreting the study findings. CONCLUSIONS: Maternal bonding and negative affect are interrelated yet unique constructs, with suggested developmental interplay between mother-to-infant bonding and infant social-affective development.

Study Protocol for the COVID-19 Pandemic Adjustment Survey (CPAS): A Longitudinal Study of Australian Parents of a Child 0-18 Years.

BACKGROUND: The COVID-19 pandemic presents significant risks to the mental health and wellbeing of Australian families. Employment and economic uncertainty, chronic stress, anxiety, and social isolation are likely to have negative impacts on parent mental health, couple and family relationships, as well as child health and development. OBJECTIVE: This study aims to: (1) provide timely information on the mental health impacts of the emerging COVID-19 crisis in a close to representative sample of Australian parents and children (0-18 years), (2) identify adults and families most at risk of poor mental health outcomes, and (3) identify factors to target through clinical and public health intervention to reduce risk. Specifically, this study will investigate the extent to which the COVID-19 pandemic is associated with increased risk for parents' mental health, lower well-being, loneliness, and alcohol use; parent-parent and parent-child relationships (both verbal and physical); and child and adolescent mental health problems. METHODS: The study aims to recruit a close to representative sample of at least 2,000 adults aged 18 years and over living in Australia who are parents of a child 0-4 years (early childhood, N = 400), 5-12 years (primary school N = 800), and 13-18 years (secondary school, N = 800). The design will be a longitudinal cohort study using an online recruitment methodology. Participants will be invited to complete an online baseline self-report survey (20 min) followed by a series of shorter online surveys (10 min) scheduled every 2 weeks for the duration of the COVID-19 pandemic (i.e., estimated to be 14 surveys over 6 months). RESULTS: The study will employ post stratification weights to address differences between the final sample and the national population in geographic communities across Australia. Associations will be analyzed using multilevel modeling with time-variant and time-invariant predictors of change in trajectory over the testing period. CONCLUSIONS: This study will provide timely information on the mental health impacts of the COVID-19 crisis on parents and children in Australia; identify communities, parents, families, and children most at risk of poor outcomes; and identify potential factors to address in clinical and public health interventions to reduce risk.

Social Media Markers to Identify Fathers at Risk of Postpartum Depression: A Machine Learning Approach.

Postpartum depression (PPD) is a significant mental health issue in mothers and fathers alike; yet at-risk fathers often come to the attention of health care professionals late due to low awareness of symptoms and reluctance to seek help. This study aimed to examine whether passive social media markers are effective for identifying fathers at risk of PPD. We collected 67,796 Reddit posts from 365 fathers, spanning a 6-month period around the birth of their child. A list of "at-risk" words was developed in collaboration with a perinatal mental health expert. PPD was assessed by evaluating the change in fathers' use of words indicating depressive symptomatology after childbirth. Predictive models were developed as a series of support vector machine classifiers using behavior, emotion, linguistic style, and discussion topics as features. The performance of these classifiers indicates that fathers at risk of PPD can be predicted from their prepartum data alone. Overall, the best performing model used discussion topic features only with a recall score of 0.82. These findings could assist in the development of support and intervention tools for fathers during the prepartum period, with specific applicability to personalized and preventative support tools for at-risk fathers.

Association Between Maternal Perinatal Depression and Anxiety and Child and Adolescent Development: A Meta-analysis.

Importance: There is widespread interest in associations between maternal perinatal depression and anxiety and offspring development; however, to date, there has been no systematic, meta-analytic review on the long-term developmental outcomes spanning infancy through adolescence. Objective: To provide a comprehensive systematic review and meta-analysis of the extant literature on associations between maternal perinatal depression and anxiety and social-emotional, cognitive, language, motor, and adaptability outcomes in offspring during the first 18 years of life. Data Sources: Six databases were searched (CINAHL Complete, Cochrane Library, Embase, Informit, MEDLINE Complete, and PsycInfo) for all extant studies reporting associations between perinatal maternal mental health problems and offspring development to March 1, 2020. Study Selection: Studies were included if they were published in English; had a human sample, quantitative data, a longitudinal design, and measures of perinatal depression and/or anxiety and social-emotional, cognitive, language, motor, and/or adaptability development in offspring; and investigated an association between perinatal depression or anxiety and childhood development. Data Extraction and Synthesis: Of 27 212 articles identified, 191 were eligible for meta-analysis. Data were extracted by multiple independent observers and pooled using a fixed- or a random-effects model. A series of meta-regressions were also conducted. Data were analyzed from January 1, 2019, to March 15, 2020. Main Outcomes and Measures: Primary outcomes included social-emotional, cognitive, language, motor, and adaptability development in offspring during the first 18 years of life. Results: After screening, 191 unique studies were eligible for meta-analysis, with a combined sample of 195 751 unique mother-child dyads. Maternal perinatal depression and anxiety were associated with poorer offspring social-emotional (antenatal period, r = 0.21 [95% CI, 0.16-0.27]; postnatal period, r = 0.24 [95% CI, 0.19-0.28]), cognitive (antenatal period, r = -0.12 [95% CI, -0.19 to -0.05]; postnatal period, r = -0.25 [95% CI, -0.39 to -0.09]), language (antenatal period, r = -0.11 [95% CI, -0.20 to 0.02]; postnatal period, r = -0.22 [95% CI, -0.40 to 0.03]), motor (antenatal period, r = -0.07 [95% CI, -0.18 to 0.03]; postnatal period, r = -0.07 [95% CI, -0.16 to 0.03]), and adaptive behavior (antenatal period, r = -0.26 [95% CI, -0.39 to -0.12]) development. Findings extended beyond infancy, into childhood and adolescence. Meta-regressions confirmed the robustness of the results. Conclusions and Relevance: Evidence suggests that perinatal depression and anxiety in mothers are adversely associated with offspring development and therefore are important targets for prevention and early intervention to support mothers transitioning into parenthood and the health and well-being of next-generation offspring.

Efficacy of a Smartphone App Intervention for Reducing Caregiver Stress: Randomized Controlled Trial.

BACKGROUND: Caregivers play a pivotal role in maintaining an economically viable health care system, yet they are characterized by low levels of psychological well-being and consistently report unmet needs for psychological support. Mobile app-based (mobile health [mHealth]) interventions present a novel approach to both reducing stress and improving well-being. OBJECTIVE: This study aims to evaluate the effectiveness of a self-guided mobile app-based psychological intervention for people providing care to family or friends with a physical or mental disability. METHODS: In a randomized, single-blind, controlled trial, 183 caregivers recruited through the web were randomly allocated to either an intervention (n=73) or active control (n=110) condition. The intervention app contained treatment modules combining daily self-monitoring with third-wave (mindfulness-based) cognitive-behavioral therapies, whereas the active control app contained only self-monitoring features. Both programs were completed over a 5-week period. It was hypothesized that intervention app exposure would be associated with decreases in depression, anxiety, and stress, and increases in well-being, self-esteem, optimism, primary and secondary control, and social support. Outcomes were assessed at baseline, postintervention, and 3-4 months postintervention. App quality was also assessed. RESULTS: In total, 25% (18/73) of the intervention participants were lost to follow-up at 3 months, and 30.9% (34/110) of the participants from the wait-list control group dropped out before the postintervention survey. The intervention group experienced reductions in stress (b=-2.07; P=.04) and depressive symptoms (b=-1.36; P=.05) from baseline to postintervention. These changes were further enhanced from postintervention to follow-up, with the intervention group continuing to report lower levels of depression (b=-1.82; P=.03) and higher levels of emotional well-being (b=6.13; P<.001), optimism (b=0.78; P=.007), self-esteem (b=-0.84; P=.005), support from family (b=2.15; P=.001), support from significant others (b=2.66; P<.001), and subjective well-being (b=4.82; P<.001). On average, participants completed 2.5 (SD 1.05) out of 5 treatment modules. The overall quality of the app was also rated highly, with a mean score of 3.94 out of a maximum score of 5 (SD 0.58). CONCLUSIONS: This study demonstrates that mHealth psychological interventions are an effective treatment option for caregivers experiencing high levels of stress. Recommendations for improving mHealth interventions for caregivers include offering flexibility and customization in the treatment design. TRIAL REGISTRATION: Australian New Zealand Clinical Trial Registry ACTRN12616000996460; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371170.

Sleep, mental health and wellbeing among fathers of infants up to one year postpartum: A scoping review.

BACKGROUND: Sleep disturbance among adults has consequences for their health and functioning. Among mothers of infants, there is evidence that fatigue and sleep disturbance are significantly associated with depression, anxiety and impaired relationships with partners and infants. It is not known whether consistent evidence of such associations exists for fathers. PURPOSE: The aim of this review was to describe what is known about fathers' sleep and its associations with mental health and wellbeing, in the first 12 months postpartum. METHODS: A scoping review was conducted, searching MEDLINE complete, Scopus, PsycINFO and CINAHL complete, from 1990 to 13 May 2019. Reference lists of relevant reviews were also searched. Articles were included if they were published in English, and reported on sleep among men cohabiting with their infants from birth to 12 months. FINDINGS: Thirty papers reporting on 27 separate studies met inclusion criteria. Sleep constructs and assessment of these varied greatly. While some measures of fathers' sleep improved, fathers' fatigue increased significantly with increasing infant age. In adjusted analyses, fathers' sleep problems were associated with poorer mental health, relationships with partners, and safety compliance at work. KEY CONCLUSIONS: Health professionals should consider a brief assessment of fathers' sleep when they consult families with young infants. Psycho-education regarding management of poor infant sleep could help to prevent long-term fatigue and its consequences among fathers.

schema: an open-source, distributed mobile platform for deploying mHealth research tools and interventions.

BACKGROUND: Mobile applications for health, also known as 'mHealth apps', have experienced increasing popularity over the past ten years. However, most publicly available mHealth apps are not clinically validated, and many do not utilise evidence-based strategies. Health researchers wishing to develop and evaluate mHealth apps may be impeded by cost and technical skillset barriers. As traditionally lab-based methods are translated onto mobile platforms, robust and accessible tools are needed to enable the development of quality, evidence-based programs by clinical experts. RESULTS: This paper introduces schema, an open-source, distributed, app-based platform for researchers to deploy behavior monitoring and health interventions onto mobile devices. The architecture and design features of the platform are discussed, including flexible scheduling, randomisation, a wide variety of survey and media elements, and distributed storage of data. The platform supports a range of research designs, including cross-sectional surveys, ecological momentary assessment, randomised controlled trials, and micro-randomised just-in-time adaptive interventions. Use cases for both researchers and participants are considered to demonstrate the flexibility and usefulness of the platform for mHealth research. CONCLUSIONS: The paper concludes by considering the strengths and limitations of the platform, and a call for support from the research community in areas of technical development and evaluation. To get started with schema, please visit the GitHub repository: https://github.com/schema-app/schema.

Attachment and child behaviour and emotional problems in autism spectrum disorder with intellectual disability.

BACKGROUND: Behaviour and emotional problems are highly prevalent in children with autism spectrum disorder (ASD). In typically developing children, attachment quality acts as a risk/protective factor for behavioural outcomes and adjustment, warranting investigation in children with ASD. METHOD: We investigated the relationship between attachment and child behaviour and emotional problems in children with ASD and comorbid intellectual disability. Data were collected from parent-child dyads where children were diagnosed with ASD and ID (n = 28) or other developmental disabilities (n = 20). RESULTS: Children with ASD had higher levels of behaviour and emotional problems and more attachment difficulties than children with other developmental disabilities. Poorer attachment quality contributed uniquely to the variance in child behaviour and emotional problems. CONCLUSIONS: Interventions targeting behaviour and emotional problems in children with ASD may benefit from an attachment model which addresses the child's difficulty in using caregivers as a coregulatory agent of emotions.