Prepartum and postpartum mothers' and fathers' feelings of frustration in response to infant crying.

In this cross-sectional study performed in Canada, we evaluated the frustration levels of prepartum and postpartum mother and father couple-pairs. Our goal was to determine if there were differences in frustration levels between mothers and fathers while listening to prolonged infant crying, and further, how frustration levels might differ between prepartum and postpartum samples. Using two discrete groups, prepartum (Sample 1; N = 48) and postpartum (Sample 2; N = 44) mother and father couple-pairs completed 600 s of listening to audio-recorded infant cry sounds. Participants continuously reported their subjective frustration using a computerized Continuous Visual Analog Scale (CVAS). There was no significant difference in frustration responses between mothers and fathers across both prepartum and postpartum samples. Postpartum mothers and fathers experienced greater frustration than their prepartum counterparts, and frustration increased faster in postpartum couples compared to prepartum couples. Informing first-time parents of the universal experiences of frustration to prolonged crying bouts that are characteristic of their infant's early weeks of life may lead to greater understanding towards their infant, and perhaps decreased instances of harmful responses.

En este estudio transeccional, evaluamos los niveles de frustración de las parejas de mamás y papás antes y después del parto. Nuestro propósito fue determinar si hay diferencias entre mamás y papás en cuanto a los niveles de frustración mientras escuchan el prolongado llanto del infante, y cómo los niveles de frustración pudieran diferir entre grupos­muestra antes y después del parto. Usando dos grupos discretos, antes del parto (grupo­muestra 1; N = 48) y después del parto (grupo­muestra 2; N = 44), las parejas de mamás y papás completaron 600 segundos escuchando sonidos grabados en audio de llanto de infante. Los participantes continuamente reportaron su frustración subjetiva usando una escala análoga visual continua computarizada (CVAS). No hubo diferencia significativa en las respuestas de frustración entre mamás y papás a lo largo de los grupos­muestra tanto antes del parto como después del parto. Las mamás y papás en el grupo­muestra después del parto experimentaron mayor frustración que sus homólogos en el grupo­muestra antes del parto, y la frustración aumentó más rápido en las parejas del grupo­muestra después del parto tal como se les comparó con las parejas del grupo­muestra antes del parto. Estos resultados sugieren que las parejas primíparas posterior al parto están más propensas a experimentar considerables cantidades de frustración como respuesta al llanto del infante después que el bebé ha nacido. Informarles a los progenitores primerizos acerca de las experiencias generales de la frustración a los prolongados ataques de llanto que son característicos de las primeras semanas de vida de su infante pudiera llevar a una mayor comprensión hacia su infante y quizás disminuir las instancias de respuestas dañinas.

Dans cette étude transversale nous avons évalué les niveaux de frustration des couples­paires mère et père avant et après la naissance. Notre but était de déterminer s'il existe des différences entres les mères et les pères dans leurs niveaux de frustration en entendant des pleurs de bébé prolongés et de quelle manière les niveaux pourraient différer entre les échantillons avant la naissance et après la naissance. En utilisant deux groupes discrets, avant la naissance (Echantillon 1; N = 48) et après la naissance (Echantillon 2; N = 44) les couples­paires mère et père ont écouté 600 seconds d'enregistrements de pleurs de bébés. Les participants ont fait état de leur frustration subjective en utilisant une échelle analogique visuelle continue informatisée (CVAS). Il s'est avéré n'y avoir aucune différence importante dans les réactions de frustration entre les mères et les pères au travers des échantillons à la fois avant l'accouchement et après l'accouchement. Ces résultats suggèrent que les coupes postpartum primipares sont plus à même de faire l'expérience de niveaux élevés de frustration en réaction aux pleurs du bébé une fois le bébé arrivé. Informer les parents qui sont parents pour la première fois des expériences universelles de frustration aux crises de pleurs prolongées qui caractérisent les premières semaines de la vie des bébés peut mener à une plus grande compréhension de leur bébé et peut­être à une baisse des case d réactions néfastes.

Infant carrying: Associations with parental reflective functioning, parental bonding and parental responses to infant crying.

Infant carrying may have beneficial effects on the parent-infant relationship but only limited research has been conducted in this area. Therefore, the main aim of the current study was to investigate whether infant carrying is associated with parental reflective functioning, parental bonding, and parental (emotional) and behavioral responses to infant crying, key elements within the parent-infant relationship, promoting infant development. Parents reporting high levels (N = 389) of infant carrying (six times a week or daily) and parents reporting low levels (N = 128) of infant carrying (less than once a week or not at all) who participated in an online survey about the developing parent-infant relationship in Germany were included in the present study. Standardized questionnaires were used to assess parental reflective functioning, parental bonding impairments, and emotional responses to infant crying. Further insensitive (non-responsive and hostile) behaviors in response to infant crying were assessed. Parents with high levels of infant carrying showed better parental reflective functioning, lower parental bonding problems, less negative emotions, and less insensitive behaviors in response to infant crying.

Cargar al infante pudiera tener efectos beneficiosos para la relación progenitor­infante, pero sólo una limitada investigación se ha llevado a cabo en esta área. Por tanto, el objetivo principal del presente estudio fue investigar si cargar al infante se asocia con que el funcionamiento con reflexión del progenitor, los lazos de afectividad del progenitor, así como las respuestas de comportamiento (emocional) del progenitor al llanto del infante, elementos claves dentro de la relación progenitor­infante, promueven el desarrollo del infante. Se incluyó en el presente estudio a los progenitores que reportaron altos niveles (N=389) de llanto del infante (seis veces por semana o diariamente) y a los progenitores que reportaron bajos niveles (N=128) del llanto del infante (menos de una vez por semana o nunca), quienes participaron en una encuesta electrónica acerca de la relación progenitor­infante en desarrollo, en Alemania. Se usaron cuestionarios estandarizados para evaluar el funcionamiento con reflexión del progenitor, los impedimentos de lazos afectivos del progenitor, así como las respuestas emocionales al llanto del infante. Se evaluaron además comportamientos insensibles (sin respuesta afectiva y hostil) como respuesta al llanto del infante. Los progenitores con altos niveles de cargar al infante demostraron un mejor funcionamiento con reflexión del progenitor, más bajos problemas en cuanto a lazos de afectividad del progenitor, menos emociones negativas y menos comportamientos insensibles como respuesta al llanto del infante.

Porter un bébé peut avoir des effets bénéfiques sur la relation parent­bébé mais il n'existe que peu de recherches sur ce domaine. C'est pour cette raison que le but principal de cette étude était d'investiguer si le fait de porter un bébé est lié avec une fonction réflexive parentale, le lien parental et les réactions parentales (émotionnelles) et comportementales aux pleurs du bébé, des éléments clef au sein de la relation parent­bébé, promouvant le développement du bébé. Les parents faisant état de niveaux élevés (N=389) de portage du bébé (six fois par semaine ou tous les jours) et les parents faisant état de niveaux bas (N=128) de portage du bébé (moins d'une semaine ou pas du tout) qui ont participé à un questionnaire en ligne sur la relation parent­bébé se développant en Allemagne ont été inclus dans cette étude. Des questionnaires standardisés ont été utilisés afin d'évaluer la fonction réflexive parentale, les troubles du lien parental, et les réactions émotionnelles aux pleurs du bébé. D'autres comportement insensibles (non­réactifs et hostile) en réaction aux pleurs du bébé ont été évalués. Les parents avec des niveaux élevés de portage du bébé ont fait preuve d'une meilleure fonction réflexive parentale, de moins de problèmes de lien parental, de moins d'émotions négatives, et de moins de comportements insensibles en réaction aux pleurs du bébé.

[Early childhood mental disorders: excessive crying, sleep and feeding disorders, and interventions using the "Munich model" as an example]. / Frühkindliche psychische Störungen: Exzessives Schreien, Schlaf- und Fütterstörungen sowie Interventionen am Beispiel des "Münchner Modells".

About 20% of all healthy infants and toddlers show problems in the area of mental health during their first years of life such as inconsolable crying (so-called cry-babies), sleeping problems, and feeding problems. The prevalence of enduring feeding problems and sleeping problems is distinctly higher in premature children and in children with neuropediatric disorders. These problems present a higher risk for the development of internalizing and externalizing disorders of mental health in later childhood. The parent-child relationship is often strained. Parents report experiencing severe exhaustion, extreme uncertainty, and helplessness.Pediatricians and midwives are the first points of contact for families. Outpatient clinics for cry-babies such as the "Munich Consultation for Cry-Babies," founded by Mechthild Papousek in 1991 at the kbo-Children's Center Munich, provide a low-threshold service for the highly stressed families. They can contribute to the prevention of neglect, maltreatment, and psychological secondary disorders of the child. Intervention strategies are based on parent-infant and attachment research and integrate child- and parent-oriented approaches.During the COVID-19 pandemic, psychosocial stress factors in families increased. This development was also observable in the outpatient clinics for cry-babies.

Maternal perceived stress and infant behavior during the COVID-19 pandemic.

BACKGROUND: Maternal stress has negative consequences on infant behavioral development, and COVID-19 presented uniquely stressful situations to mothers of infants born during the pandemic. We hypothesized that mothers with higher levels of perceived stress during the pandemic would report higher levels of infant regulatory problems including crying and interrupted sleep patterns. METHODS: As part 6 sites of a longitudinal study, mothers of infants born during the pandemic completed the Perceived Stress Scale, the Brief Infant Sleep Questionnaire, and an Infant Crying survey at 6 (n = 433) and 12 (n = 344) months of infant age. RESULTS: Maternal perceived stress, which remained consistent at 6 and 12 months of infant age, was significantly positively correlated with time taken to settle infants. Although maternal perceived stress was not correlated with uninterrupted sleep length, time taken to put the infant to sleep was correlated. Perceived stress was also correlated with the amount of infant crying and fussiness reported at 6 months. CONCLUSIONS: Mothers who reported higher levels of perceived stress during the pandemic reported higher levels of regulatory problems, specifically at 6 months. Examining how varying levels of maternal stress and infant behaviors relate to overall infant developmental status over time is an important next step. IMPACT: Women giving birth during the COVID-19 pandemic who reported higher levels of stress on the Perceived Stress Scale also reported higher levels of infant fussiness and crying at 6 months old, and more disruptive sleep patterns in their infants at 6 months and 12 months old. Sleeping problems and excessive crying in infancy are two regulatory problems that are known risk factors for emotional and behavioral issues in later childhood. This paper is one of the first studies highlighting the associations between maternal stress and infant behaviors during the COVID-19 pandemic.

Maternal depressive symptoms and affective responses to infant crying and laughing.

Depressive symptoms are common in the postpartum period and can affect mother-infant interaction. To better understand the role of depressive symptoms in the mother-infant interchange, this study examined whether maternal depressive symptoms are associated with self-reported, physiological, and facial expressive responses to infant crying and laughing sounds. A nonclinical sample was used, consisting of 101 mothers (Age M = 30.88 years, 33% scored 7 or higher on the Edinburgh Postnatal Depression Scale) with a young child. Mothers were exposed to standard infant crying and laughing sounds. Affect, perception of crying and laughing, intended caregiving responses, skin conductance level reactivity, and facial expressive responses to infant crying and laughing were measured. Higher levels of depressive symptoms were associated with more self-reported negative affect in general and a more negative perception of infant crying. Depressive symptoms were not associated with intended caregiving responses and physiological responses to infant crying. Infant laughing increased self-reported positive affect and happy facial expressions in mothers with all levels of depressive symptoms. Higher levels of depressive symptoms were associated with higher sad facial expressivity in general. Depressive symptoms were not related to positive perception of infant laughing, intended caregiving responses, and physiological responses to infant laughing. The findings suggest that mothers who score high on depressive symptoms send subtle facial cues showing sadness, which may overshadow happy facial expressions during infant laughing and may affect mother-infant interaction. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Childhood maltreatment predicts maternal sensitivity to distress: Negative attributions during the transition to parenthood.

Childhood maltreatment is a predictor of subsequent parenting behaviors; however, the mechanisms explaining this association have been understudied. The present study examined the indirect effect of childhood maltreatment on maternal sensitivity to distress via (a) emotion regulation difficulties, (b) negative attributions about infant crying, (c) minimizing attributions about infant crying, and (d) situational attributions about infant crying. The sample included 259 primiparous mothers (131 Black and 128 White) and their 6-month-old infants (52% female). Mothers retrospectively reported on their childhood history of maltreatment when their infants were about 2 years old. Emotion regulation difficulties and causal attributions about infant crying were assessed prenatally. Maternal sensitivity to distress was rated during three distress-eliciting tasks when children were 6 months old. Results from the structural equation model demonstrated that maternal childhood maltreatment was significantly positively associated with negative attributions about infant crying but not with emotion regulation difficulties, minimizing attributions, or situational attributions about crying. Furthermore, negative attributions about crying were associated with lower sensitivity to distress, and there was an indirect effect of childhood maltreatment on sensitivity to distress via negative attributions about infant distress. These effects were significant above and beyond the effects of coherence of mind, concurrent depressive symptoms, infant affect, maternal age, race, education, marital status, and income-to-needs ratio. The results suggest that altering negative attributions about infant crying may be an important area to intervene during the prenatal period to reduce continuity in maladaptive parenting across generations. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Can cry tolerance be increased in mothers of infants with sleep problems, and why does it matter? A quasi-experimental study.

STUDY OBJECTIVES: Infant sleep problems are one of the most common complaints of new parents. Research to date has demonstrated a relationship between low parental cry tolerance and infant sleep problems. The aim of this study was to explore whether three emotion regulation strategies could increase parental cry tolerance. METHODS: This study utilised a quasi-experimental design. We recruited 83 females (Mage= 32, SD= 5.26) comprising 3 groups: mothers of good sleeping infants aged 6-24 months, mothers of poor sleeping infants aged 6-24 months, and good sleeping women aged 23-40 years without children. Participants were instructed to listen to crying audio segments and indicate when they felt the child needed to be tended to (measured in seconds). This crying audio was paired with one of three emotion-regulation strategies (i.e., music, gaming, reappraisal). Each participant completed all 4 cry conditions which were counterbalanced to control for order effects. RESULTS: We found that all three strategies yielded significantly longer reaction times (indicating higher cry tolerance) compared to the control condition (p <.001). We also found that mothers of poor sleepers and good sleeping women benefitted from all three emotion regulation strategies compared to control (p <.001 and p= <.05, respectively). The cry tolerance of mothers of good sleepers, on the other hand, did not differ between the control condition and any of the strategies (all ps >.05). CONCLUSIONS: This demonstrates that cry tolerance can be increased using emotion regulation strategies, such as distraction via music or gaming, and reappraisal. This has clinical implications for families implementing behavioural sleep interventions.

Frustration responses of single and partnered mothers to prolonged infant crying.

Prolonged infant crying can be a trigger for maternal frustration and can even predict intrusive infant-related thoughts of harm. In this study, we compared frustration responses to prolonged infant crying between single and partnered mothers and attempted to identify variables that mediated any difference between the two groups. We also identified acoustic characteristics of infant cries that were related to higher levels of reported maternal frustration. Twenty-five single and 25 partnered mothers with infants under the age of 6 months completed several mental health questionnaires, and then rated their frustration level after listening to each of 50 consecutive 15s infant cry videos from 50 different infants. As expected, greater maternal perceived stress was associated with higher frustration ratings in response to infant crying, and this was mediated by increased maternal negative affect. Also as expected, both financial strain and low social support were associated with greater perceived stress. However, our sample of single mothers did not experience more stress than our sample of partnered mothers. Nor did they find infant crying to be more frustrating, perhaps due to a recruitment bias toward higher functioning single mothers. Finally, several cry acoustic characteristics were associated with increased maternal frustration, including higher fundamental frequency, air energy, shimmer and longer duration of expiratory phonations, as well as a longer cumulative duration of crying. Our results suggest that maternal frustration in response to infant crying may be decreased by lowering maternal stress levels, and this may be achieved by increasing social support and decreasing financial strain. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Infant crying predicts real-time fluctuations in maternal mental health in ecologically valid home settings.

Exposure to infant crying is a well-established predictor of mothers' mental health. However, this association may reflect many potential mechanisms. Capturing dynamic fluctuations in mothers' states simultaneously with caregiving experiences is necessary to identify the real-time processes influencing mental health. In this study, we leveraged ecological momentary assessments (EMAs) and infant-worn audio recorders to capture variability in mothers' mental health symptoms and their exposure to infant crying over one week in a racially and socio-economically diverse urban North-American sample (N = 53). We use multilevel modeling to characterize within- and between-person effects of crying on maternal negative affect and symptoms of depression and anxiety. Within participants, when infants cried more than average in the 10 min, 1 hr, and 8 hr prior to an EMA report, mothers' negative affect subsequently increased, controlling for mean levels of infant crying. In contrast to findings from laboratory studies, in everyday settings crying exposure did not immediately increase feelings of depression. Only when crying was above average for 8 hr prior to EMA did mothers report increases in subsequent depression symptoms, suggesting that the effects of crying on maternal mental health take hours to unfold in ecologically valid home settings. Between participants, mothers of infants who cried more on average did not report higher negative affect or symptoms of depression or anxiety. Overall, our findings reveal that crying exposure dynamically influences maternal negative affect and depression but not anxiety in ecologically valid real-world settings. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

A magnetoencephalography study of first-time mothers listening to infant cries.

Studies using magnetoencephalography (MEG) have identified the orbitofrontal cortex (OFC) to be an important early hub for a "parental instinct" in the brain. This complements the finding from functional magnetic resonance imaging studies linking reward, emotion regulation, empathy, and mentalization networks to the "parental brain." Here, we used MEG in 43 first-time mothers listening to infant and adult cry vocalizations to investigate the link with mother-infant postpartum bonding scores and their level of sleep deprivation (assessed using both actigraphy and sleep logs). When comparing brain responses to infant versus adult cry vocalizations, we found significant differences at around 800-1,000 ms after stimuli onset in the primary auditory cortex, superior temporal gyrus, hippocampal areas, insula, precuneus supramarginal gyrus, postcentral gyrus, and posterior cingulate gyrus. Importantly, mothers with weaker bonding scores showed decreased brain responses to infant cries in the auditory cortex, middle and superior temporal gyrus, OFC, hippocampal areas, supramarginal gyrus, and inferior frontal gyrus at around 100-300 ms after the stimulus onset. In contrast, we did not find correlations with sleep deprivation scores. The significant decreases in brain processing of an infant's distress signals could potentially be a novel signature of weaker infant bonding in new mothers and should be investigated in vulnerable populations.

Linking maternal psychopathology to children's excessive crying and sleeping problems in a large representative German sample-The mediating role of social isolation and bonding difficulties.

Attaining self-regulation is a major developmental task in infancy, in which many children show transient difficulties. Persistent, clinically relevant difficulties in self-regulation include excessive crying or sleeping disorders. Many families with affected children are burdened with multiple psychosocial risk. This suggests that regulatory problems are best conceptualized as the maladaptive interplay of overly burdened parents and a dysfunctional parent-child interaction. The current study examines whether social isolation and bonding difficulties function as mediating mechanisms linking maternal psychopathology to (1) children's excessive crying and (2) sleeping problems. The sample comprised N = 6598 mothers (M = 31.51 years) of children between zero to three years of age (M = 14.08 months, 50.1% girls). In addition to socio demographic data, the written questionnaire included information on maternal depression/anxiety, isolation, bonding, and children's regulatory problems. Hypotheses were tested with a mediation model controlling for psychosocial risk and child characteristics. As expected, maternal symptoms of depression/anxiety were linked to infants' excessive crying and sleeping problems. Social isolation and bonding difficulties mediated this association for excessive crying as well as for sleeping problems, but social isolation was a single mediator for sleeping problems only. The findings provide important insights in the mediating pathways linking maternal psychopathology to children's regulatory problems.

When they cry: Tears facilitate responses toward members of socially disadvantaged groups.

Emotional tears are vehicles for bonding between individuals, even with those belonging to different social categories. Yet, little is known about the reactions they provoke toward members of underprivileged groups such as immigrants or the explanatory mechanisms of their effects. Across three experiments (with 546 adults) using standardized images of emotional displays, we tested the effects of tears on cognitive inferences (of warmth and competence) and self-reported affective responses (such as compassion or discomfort), and both directly and indirectly on self-reported prosocial behavioral intentions toward an immigrant male. Compared with nontearful (i.e., neutral and sad) expressions, observers perceived a tearful immigrant as warmer but not as less competent (except for study 3). They also felt more compassion (but not discomfort) and were more willing to offer an immigrant person emotional (i.e., to approach and comfort) and instrumental support (i.e., to donate money to an organization helping immigrants but not volunteer their time). Inferred warmth and felt compassion (or compassion-related emotions) explained the effects of tears on emotional support and donation intentions. This research highlights the need to study emotion expression in the context of interethnic and, more broadly, intergroup relations and the effects of emotional tears beyond the willingness to provide immediate assistance. We also discuss implications that tears might have for promoting different types of solidarity with members of underprivileged groups such as immigrants. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Intensity of Maternal Anxiety and Depressive Symptoms in Pregnancy Is Associated with Infant Emotional Regulation Problems.

This study aimed to investigate the effects of the intensity and directionality of antenatal maternal depressive and anxiety symptoms on infant negative affectivity and crying, also taking into account potential confounders. The role of socioeconomic status (SES) as a possible moderating factor of the association between antenatal maternal distress and infant negative outcomes was also explored. More than one hundred women filled in the Edinburgh Postnatal Depression Scale and the State-Trait Anxiety Inventory to assess depressive and anxiety symptoms, respectively, during the third trimester of pregnancy and three months after delivery. Mothers also filled in the Infant Behavior Questionnaire and a parental diary to evaluate negative affectivity and crying, respectively, when their infants were 3 months old. SES was assessed through the Hollingshead classification. The intensity of antenatal maternal symptoms and SES were associated with infant negative affectivity, but not with crying. However, SES moderated the association between the intensity of maternal symptoms and infant crying. The direction of maternal symptoms (anxiety versus depression) was not associated with both infant negative affectivity and crying. Our findings contribute to elucidating the role played by the intensity of maternal stress in pregnancy-alone and in interaction with SES-in determining individual differences in infant emotional regulation, thus emphasizing the importance of timely psychological interventions for pregnant women who experience psychological distress.

Pharmaceutical interventions for emotionalism after stroke.

BACKGROUND: Antidepressants may be useful in the treatment of abnormal crying associated with stroke. This is an update of a Cochrane Review first published in 2004 and last updated in 2019. OBJECTIVES: To evaluate the benefits and harms of pharmaceutical treatment in people with emotionalism after stroke. SEARCH METHODS: We searched the Cochrane Stroke Group Register, CENTRAL, MEDLINE, Embase, four other databases, and three trials registers (May 2022). SELECTION CRITERIA: We included randomised controlled trials (RCTs) and quasi-RCTs comparing psychotropic medication to placebo in people with stroke and emotionalism (also known as emotional lability, pathological crying or laughing, emotional incontinence, involuntary emotional expression disorder, and pseudobulbar affect). DATA COLLECTION AND ANALYSIS: Two review authors independently selected trials, assessed risk of bias, extracted data from all included trials, and used GRADE to assess the certainty of the body of evidence. We calculated the mean difference (MD) or standardised mean difference (SMD) for continuous data and the risk ratio (RR) for dichotomous data, with 95% confidence intervals (CIs). We assessed heterogeneity using the I2 statistic. The primary emotionalism measures were the proportion of participants achieving at least a 50% reduction in abnormal emotional behaviour at the end of treatment, improved score on the Center for Neurologic Study - Lability Scale (CNS-LS) or Clinician Interview-Based Impression of Change (CIBIC), or diminished tearfulness. MAIN RESULTS: We did not identify any new trials for this update. We included seven trials with a total of 239 participants. Two trials had a cross-over design, but outcome data were not available from the first phase (precross-over) in an appropriate format for inclusion as a parallel randomised controlled trial (RCT). Thus, the results of the review are based on five trials with a total of 213 participants. It is uncertain whether fluoxetine increases the number of people who have a 50% reduction in emotionalism when compared to placebo (risk ratio (RR) 0.26, 95% CI 0.09 to 0.77; P = 0.02; 1 trial, 19 participants) because the certainty of evidence is very low. Sertraline may lead to little to no difference in Center for Neurologic Study - Lability Scale (CNS-LS) scores and Clinician Interview-Based Impression of Change (CIBIC) scores when compared to placebo (RR 0.20, 95% CI 0.03 to 1.50; P = 0.12; 1 trial, 28 participants; low-certainty evidence). Antidepressants probably increase the number of people who experience a reduction in tearfulness (RR 0.32, 95% CI 0.12 to 0.86; P = 0.02; 3 trials, 164 participants; moderate-certainty evidence). No trials were found that evaluated the impact of other pharmaceutical interventions. Only two trial authors systematically recorded and reported adverse events, resulting in limited data on the potential harms of treatment. Six trials reported death as an adverse event and found no difference between the groups (antidepressants versus placebo) in the number of deaths reported (RR 0.59, 95% CI 0.08 to 4.50; P = 0.61; 172 participants; moderate-certainty evidence). This review provides very low- to moderate-certainty evidence that antidepressants may reduce the frequency and severity of emotionalism. The included trials were small and had some degree of bias. AUTHORS' CONCLUSIONS: Antidepressants may reduce the frequency and severity of crying or laughing episodes when compared to placebo, based on very low-certainty evidence. Our conclusions must be qualified by several methodological deficiencies in the trials and interpreted with caution despite the effect being very large. The effect does not seem specific to one drug or class of drugs. More reliable data are required before appropriate conclusions can be made about the treatment of post-stroke emotionalism. Future trialists investigating the effect of antidepressants in people with emotionalism after stroke should consider developing and using a standardised method to diagnose emotionalism, determine severity, and assess change over time; provide treatment for a sufficient duration and follow-up to better assess rates of relapse or maintenance; and include careful assessment and complete reporting of adverse events.

Impact of the COVID-19 pandemic on mental health in parents of infants with colic and on healthcare use.

AIM: To examine the impact of the COVID-19 pandemic on the mental health of parents of infants with colic and on healthcare use. METHODS: Retrospective cohort study. Data of 64 parents of infants with colic prepandemic and 43 parents of infants with colic during the pandemic were analysed using validated questionnaires on parental stress, depression and anxiety. Additionally, we evaluated the number of outpatient clinic visits and admission rates pre- and during the pandemic by collecting data on the diagnosis treatment combination 'excessive crying' from electronic patient files in three secondary hospitals in the Netherlands. RESULTS: Mothers in the pandemic group reported significantly higher levels of depression than mothers in the prepandemic group (12.3 ± 7.0 and 8.8 ± 5.2; p = 0.04). Moreover, mothers showed a trend towards higher stress levels during the pandemic (29.6 ± 9.6 and 25.2 ± 8.1; p = 0.06). During the pandemic, admission numbers of infants with colic compared to prepandemic data increased with 34% (146 vs. 196). CONCLUSION: Mothers of infants with colic reported significantly more feelings of depression during the COVID-19 pandemic. Furthermore, the pandemic was associated with increased healthcare use amongst infants with colic. With the continuing pandemic, we recommend active perinatal support for this vulnerable population.

Adults learn to identify pain in babies' cries.

Because the expression of pain in babies' cries is based on universal acoustic features, it is assumed that adult listeners should be able to detect when a crying baby is experiencing pain1-3. We report that detecting that a baby's cry expresses pain actually requires learning through experience. Our psychoacoustic experiments reveal that adults with no experience of caring for babies are unable to identify whether a baby's cry is a pain cry induced by vaccination or a mild discomfort cry recorded during a bath, even when they are familiar with the discomfort cries from this particular baby. In contrast, people with prior experience of babies - parents or professional caregivers - identify a familiar baby's pain cries without having heard these cries before. Parents of very young children are even able to identify the pain cries of a baby who is completely unfamiliar to them. Exposure through caregiving and/or parenting thus shapes the auditory and cognitive abilities involved in decoding the information conveyed by the baby's communication signals.

Pathological laughter and crying in neurological disorders: recognition and treatment.

Pathological laughter and crying is a disabling symptom complex associated with damage to various central nervous system pathways that control the reflex motor component of emotional expression. Many underlying conditions-including neurodegenerative diseases, CNS inflammation, vascular lesions and traumatic brain injury-can be associated with disinhibition of emotional reflex control. This suggests a disruption of anatomical and functional networks, rather than any specific unifying pathological process. There is a wide differential diagnosis, including depression, dementia and other forms of behavioural disturbance. Diagnostic criteria and rating scales can help with clinical assessments and facilitate clinical trials. There is now good-quality evidence for a combination of dextromethorphan and quinidine, with weaker evidence for tricyclic and selective serotonin reuptake inhibitor antidepressants. Pathological laughter and crying is disabling and underdiagnosed but potentially treatable, and its wider recognition is important.

Involuntary Emotional Expression Disorder in a Patient With Toluene Leukoencephalopathy.

OBJECTIVE: Inhalant users may develop toluene leukoencephalopathy, a devastating neuropsychiatric disorder. We present a case of toluene-induced damage to the corticospinal and the corticonuclear tracts, which presented with involuntary emotional expression disorder. METHODS: Case study of a 20-year-old man with a 3-year history of frequent solvent abuse was admitted to the Neuropsychiatry Unit of the National Institute of Neurology and Neurosurgery because "he could not speak or walk" but would keep "laughing and crying without reason". RESULTS: Neuropsychiatric examination revealed pathological laughter and crying, facial and speech apraxia, a bilateral pyramidal syndrome, and lack of control of urinary sphincter. Magnetic resonance imaging revealed a highly selective bilateral damage to the pyramidal system and the somatosensory pathway. SPECT imaging showed left fronto-parietal hypoperfusion. CONCLUSIONS: This document provides support for the understanding of involuntary emotional expression disorders as a differential diagnosis in the clinical practice of psychiatrists, as well as the functional anatomy of these conditions.

Do responsive sleep interventions impact mental health in mother/infant dyads compared to extinction interventions? A pilot study.

Methods to improve sleep in infants commonly involve some ignoring (extinction) but are often unpopular with mothers worried about infant distress when left to cry. Alternative more responsive methods are needed. This pilot study evaluated stress, maternal depressive symptomology and sleep in mother/infant dyads, between Responsive, Controlled Crying and Control groups. From 199 mother/infant dyads from any cultural background, 41 infants 4-12 months were randomly allocated to Responsive (RG, n = 15), Controlled Crying (CCG, n = 18) or Controls (Treatment as Usual, TAUG, n = 8), with 10 withdrawing after randomisation. Infant sleep (7-day sleep diaries) and stress (oral cortisol on two nights), maternal self-reported stress (Subjective Units of Distress, SUDS), maternal perceived infant distress (MPI-S) and symptoms of maternal depression (Edinburgh Post-natal Depression Scale, EPDS) were measured four times across 8 weeks. Sleep duration was not different between groups but Responsive woke less (p = .008). There were no differences in cortisol between groups across time points. Maternal SUDS was positively correlated with infant cortisol and MPI-S (p < 0.05) and mothers in the Responsive group were significantly less stressed (p = 0.02) and reported less symptoms of depression (p < 0.05). Findings in this small sample show Responsive methods are comparable to the extinction (Controlled Crying) in sleep outcomes but from a relational and maternal mental health perspective, are less stressful, offering families potential choices of sleep interventions.

Do empathy and oxytocin predict responsiveness to a crying infant simulator in expecting and non-expecting couples? A multilevel study.

Infant crying is a strong emotional stimulus that elicits caregiving responses in adults. Here we examine the role of empathy (measured with the Polish version of Interpersonal Reactivity Index) and salivary oxytocin in modulating sensitive responsiveness to a crying infant simulator in two groups of heterosexual couples: 111 expecting or 110 not expecting a baby. Sensitive responsiveness was observed during a standardized procedure using the Ainsworth Sensitivity Scale while participants took care of the infant simulator, both individually and as a couple. Other-oriented empathy predicted elevated levels of individual but not couple sensitive responsiveness. More OT reactivity to crying predicted less responsiveness in non-expecting couples, which might be explained by their stronger focus on task performance. This study uniquely combined hormonal, observational and self-report measures in couples, and showed that personality and hormonal correlates of sensitive responsiveness might be studied before the child's birth with the use of infant simulators.