The impact of COVID-19 on experiences of pregnancy and/or early parenting in Chile.

The unprecedented COVID-19 pandemic has impacted families' mental health around the globe. In June 2020, 1163 parents of high (43%), middle (47%), and low socioeconomic status (SES) (10%) participated in an online survey developed to explore how daily life changes and restrictions that came with COVID-19 affected the experiences of pregnancy and/or parenting children under the age of 5 in Chile. The survey's design had an exploratory and descriptive scope, with a mix of qualitative and quantitative questions. With the aim of exploring differences before and after COVID-19, two time periods were established, and the 47-item questionnaire covered participants' sociodemographic information, support networks, health concerns, mood changes, self-regulation, adult and children's perceived well-being, parental competencies and parents' perceptions of the unborn baby and/or their children's needs. The results relative to retrospective reporting of pre-pandemic levels, showed an increase in children's crying and tantrums as well as in parental irritability and sadness. Additionally, decreases in the ability to calm down and sleep quality in both parents and children were identified. Finally, at a qualitative level, COVID-19 stands out both as an opportunity to get to know their children better and as a stressor related to parental burn-out and discomfort.

La sin precedentes pandemia del COVID-19 ha tenido un impacto en la salud mental de las familias alrededor del mundo. En junio de 2020, 1,163 progenitores de condiciones socioeconómicas (SES) altas (43%), medias (47%) y bajas (10%) participaron en una encuesta por computadora desarrollada para explorar cómo los cambios en la vida diaria y las restricciones que surgieron con el COVID-19 afectaron las experiencias de embarazo y/o crianza de niños bajo la edad de 5 años en Chile. El diseño de la encuesta tenía un alcance exploratorio y descriptivo, con una mezcla de preguntas cualitativas y cuantitativas. Con el propósito de explorar las diferencias antes y después del COVID-19, se establecieron dos períodos de tiempo, y el cuestionario de 47 puntos cubría la información sociodemográfica de los participantes, las redes de apoyo, las preocupaciones relacionadas con la salud, los cambios en el estado de ánimo, la autorregulación, la percepción del bienestar de adultos y niños, las competencias de los padres y las percepciones de los padres acerca del bebé no nacido y/o las necesidades de sus niños. Los resultados relativos al reporte retrospectivo de niveles previos a la pandemia mostraron un incremento en el llanto y las rabietas de los niños como también en la irritabilidad y estado de tristeza de los padres. Adicionalmente, se identificó una disminución en la habilidad de calmar y la calidad del sueño tanto en padres como en niños. Finalmente, al nivel cualitativo, el COVID-19 se presenta tanto como una oportunidad de llegar a conocer mejor a sus niños y como un factor de estrés relacionado con la fatiga y la incomodidad de los padres.

La pandémie sans précédent du COVID-19 a impacté la santé mentale des familles dans le monde entier. En juin 2020 1163 parents issus d'un milieu socioéconomique élevé (43%), moyen (47%) et peu élevé (10%) ont participé à un questionnaire en ligne afin d'explorer comment les changements de la vie de tous les jours et les restrictions qui ont accompagné le COVID-19 ont affecté les expériences de grossesse et/ou le parentage d'enfants sous l'âge de 5 ans au Chili. La conception de l'enquête avait une portée exploratoire et descriptive, avec un mélange de questions qualitatives et quantitatives. Avec le but d'explorer les différences entre l'avant et l'après COVID-19, deux périodes de temps ont été établies, et le questionnaire de 47 éléments a couvert les renseignements sociodémographiques des participants, leurs réseaux de soutien, leurs inquiétudes relatives à la santé, les changements d'humeurs, l'auto-régulation, le bien-être perçu des adultes et des enfants, les compétences parentales et les perceptions des parents du bébé à naître et/ou des besoins de leurs enfants. Les résultats relatifs aux états de fait rétrospectifs de niveaux pré pandémiques ont montré une augmentation des pleurs des enfants et des crises des enfants ainsi qu'une augmentation de l'irritabilité et de la tristesse parentale. De plus des baisses dans la capacité à se calmer t dans la qualité de sommeil des deux parents et des enfants ont été identifiées. Finalement, au niveau qualitatif, le COVID-19 se distingue à la fois en tant qu'une chance de mieux connaître leurs enfants et en tant que facteur de stress lié au burn-out et au malaise parental.

[Tactile communication within the father-mother-baby triad]. / La communication tactile au sein de la triade père-mère-bébé.

This literature review focuses on tactile interactions between parents and their infants. Research on the dyad has explored both cultural differences in touch and the relationship between touch style and hormonal secretion in both parents. The few studies that have examined this communicative modality within the triad have investigated the frequency and type of parent-infant touch, as well as the effect of skin-to-skin contact on tactile interactions at three months postpartum.

Guided web app intervention for reducing symptoms of depression in postpartum women: Results of a feasibility randomized controlled trial.

Background: Chile faces a significant postpartum depression prevalence and treatment gap, necessitating accessible interventions. While cognitive-behavioral internet-based interventions have proven effective in high-income countries, this field is underdeveloped in Chile. Based on the country's widespread use of digital technology, a guided 8-week cognitive-behavioral web app intervention named "Mamá, te entiendo" was developed. Objective: This study aimed to assess the acceptability and feasibility of "Mamá, te entiendo", for reducing depressive symptomatology in postpartum women. Methods: Sixty-five postpartum women with minor or major depression were randomly assigned to either intervention or waitlist. Primary outcomes centered on study feasibility, intervention feasibility, and acceptability. Semi-structured interviews with a sub-sample enriched the understanding of participants' experiences. Secondary outcomes included mental health variables assessed at baseline, post-intervention, and 1-month follow-up. Results: Chilean women displayed great interest in the intervention. 44.8 % of participants completed the intervention. Participants reported high satisfaction and engagement levels, with interviewees highlighting the value of the intervention's content, exercises, and therapist's feedback. However, preliminary efficacy analysis didn't reveal a significant interaction between group and time for outcome measures. Discussion: This research represents a pioneering effort in Chile to evaluate an internet-based intervention for postpartum depression symptoms. The demonstrated feasibility and acceptability highlight the potential of integrating technology-driven approaches into mental health interventions. However, the intervention did not demonstrate superiority, as both groups exhibited similar positive progress in several outcomes. Therefore, the following research phase should involve a larger and more diverse sample to assess the intervention's effectiveness, identify influencing factors, and determine the individuals who benefit the most.

A Chilean survey of perinatal women and health care professionals' views towards perinatal apps.

Background: Women around the globe are increasingly engaging with pregnancy and parenting apps, almost becoming a routine part of the maternity experience. However, little is known about what perinatal women and health care professionals feel about those apps in Latin American countries, where the digital transformation has been slower but where digital technologies could also bridge gaps in access to quality health care. Methods: This study aimed to assess views towards pregnancy and parenting apps in perinatal women and perinatal health care professionals in Chile through an online survey. In perinatal women, we explored app use, what they value in the apps they use, and what an "ideal app" would be for them. In health professionals, we explored opinions about women using perinatal apps and what they think a perfect app for their clients would be. Results: The survey was completed by 451 perinatal women and 54 perinatal health care professionals. Results show that perinatal women in Chile frequently use perinatal apps, and they and health care professionals show a positive attitude towards them. The most valued attributes are information and monitoring of body changes during pregnancy, information and monitoring of the baby's development (in the uterus and after birth), information and tips on how to stay healthy, and having the possibility to interact with other women. Conclusions: Perinatal apps are accepted by perinatal women and health care professionals in Chile. Some needs for an "ideal app" emerged. Participants mentioned the need to address mental health, including the mental health of their partner, and the need for support during the transition to parenthood.

App-based intervention for reducing depressive symptoms in postpartum women: Protocol for a feasibility randomized controlled trial.

Background: Chile has a high prevalence of postpartum depression and a significant treatment gap. Some barriers to postpartum depression care uncover the need for more easily accessible and lower-cost interventions. Chile's high utilization of digital technologies across all social strata and the increased use of pregnancy and parenting apps open the possibility of delivering interventions through mobile devices. Cognitive-behavioral internet-based interventions have proven to be effective in reducing symptoms of depression in high-income countries. However, in Chile, this is an underdeveloped field. This manuscript describes a randomized controlled trial protocol that will examine the feasibility and acceptability of a guided 8-week cognitive-behavioral app-based intervention for Chilean postpartum women with depressive symptoms. Method: A small-scale parallel 2-arms trial will be conducted. Postpartum women with minor or major depression will be randomized to the app-based intervention or waitlist. The primary outcomes are feasibility and acceptability variables, mainly; recruitment and eligibility rates, intervention and study adherence, and participants' intervention satisfaction, use, and engagement. Semi-structured interviews with a sub-sample will provide more information about the participants' experience with the intervention. Women's depression status will be assessed at pre-treatment, post-treatment, and 1-month follow-up. Other secondary outcomes will include participants' perceived social support, mother-infant bonding, and maternal satisfaction and self-efficacy. Discussion: This will be the first internet-based intervention aimed at reducing postpartum depression symptoms developed and studied in Chile. If the intervention and procedures prove feasible and acceptable, we plan to study its efficacy in a definitive controlled trial. If the intervention demonstrates to be effective, the aim is to implement it within the Chilean healthcare setting.

Parental personality traits and emotion regulation: Its relationship with infants' socioemotional development during the perinatal period.

Socioemotional development is central throughout life, and it unfolds in an interpersonal context in which each significant caregiver has an impact, particularly during infancy. However, only a relatively small number of studies have investigated associations between mothers and fathers' personality and emotional characteristics with their infant's socioemotional development during the perinatal period. Therefore, the present article examines the relationship between maternal and paternal personality traits and emotion regulation difficulties during the prenatal period with offspring's socioemotional development. This was a non-experimental and longitudinal study that included a community sample of 55 mother-father-baby triads. Parental assessments were carried out between the second and third trimester of pregnancy, and baby's socio-emotional development was assessed during their 2nd month after birth. Results evidenced differences between maternal and paternal personality traits and emotion regulation difficulties during the perinatal period as well as distinct contributions on infant's socioemotional development.

Beyond the outcomes: generic change indicators in a video-feedback intervention with a depressed mother and her baby: a single case study.

Child and dyadic psychotherapy have been scarcely investigated from the psychotherapy process research perspective. Thus, content and mechanisms related to therapeutic change have been overlooked by research. This study aimed at testing the applicability of the generic change indicators (GCI) model to identify moments of change in the parent during dyadic interventions, as well as to explore, describe and illustrate the therapeutic process through a brief mentalization-informed intervention with a depressive mother and her baby, using video-feedback as its main strategy, which has ample evidence about its effectiveness. We conducted a single case qualitative study using the GCI model. The mother's ongoing change was determined by identifying episodes of change (EC) and moments of change (MC). Each MC was then labelled with one of the 19 GCIs. GCIs were observed from the intervention's start. GCI's hierarchical levels were increasing over the intervention, in association with the video-feedback situation. Our findings suggest that the GCI model is feasible to observe and understand dyadic interventions, contributing to the growing body of evidence supporting psychotherapists' training and supervision.

Strength-based Video-feedback to improve maternal sensitivity in mother-infant dyads with maternal depressive symptoms: Study protocol for a randomized controlled feasibility trial. / Video-retroalimentación Focalizado en los Recursos para mejorar la sensibilidad en díadas madre-infante con síntomas depresivos: protocolo de un ensayo clínico aleatorizado piloto.

Introduction: Maternal sensitivity and mentalization are fundamental for children's mental health development. These skills have been negatively associated with maternal postpartum depressive symptomatology. Moreover, its prevalence increases in low socioeconomic and psychosocial risk contexts, where the access to treatment is scarce. Even though Attachment Based Interventios, such as Video-Feedback has been internationally recognized as an effective intervention. Its cost, as well as the need for language translation and cultural adaptation makes it difficult to implement in Latinamerican countries. Aim: The present study aims to assess the feasibility and acceptability of an online Video-Feedback intervention informed n mentalization aimed at mother-infant dyads with depressive symptomatology who attend Chilean public health centers. Method: This is a pilot randomized clinical trial with two groups of 60 mother-infant dyads between 4 and 12 months of age. Participants will be randomly assigned to control and experimental groups in a 1:1 ratio. Even though both groups will receive usual treatment, the experimental group will also receive the present video-intervention. At the end of the study, feasibility will be assessed based on focus groups aimed at interveners and quantitative outcomes such as recruitment rate, questionnaire completion rate and intervention completeness. Acceptability will be assessed from in-depth interviews with participants. In addition, effect sizes of primary and secondary outcomes will be calculated. Expected results: Results are expected to generate parameters to design a larger-scale clinical trial and to preliminary assess the effect of the reported mentalization-informed intervention on maternal sensitivity. Additionally, it seeks to contribute with a mental health intervention for low-income mother-infant dyads, which can be implemented remotely, at a low cost, and that would be suitable for implementation at a mental health care system policy. The protocol of this trial's design was registered at Clinical Trials (NCT04748731).

Introducción: La sensibilidad y la mentalización materna constituyen competencias fundamentales para el desarrollo de la salud mental infantil. A su vez, dichas habilidades han sido negativamente asociadas con la presencia de sintomatología depresiva postparto, la cual aumenta su prevalencia en contextos de bajo nivel socioeconómico y riesgo psicosocial, en donde el acceso a tratamiento escasea. Paralelamente, si bien internacionalmente el video-retroalimentación constituye una herramienta efectiva en intervenciones basadas en el apego, el costo, idioma y necesidad de adaptación cultural dificultan su implementación en países latinoamericanos. Objetivo: Evaluar la factibilidad y aceptabilidad de una video-intervención informada por la mentalización, dirigida a díadas madre-bebé con sintomatología depresiva, atendidas en centros públicos de atención en salud mental en Chile. Métodos: Ensayo clínico aleatorio piloto con dos grupos de 60 díadas madre-bebé de entre 4 y 12 meses de edad, quienes serán asignados aleatoriamente a grupos control y experimental en una proporción de 1:1. Si bien ambos grupos recibirán el tratamiento habitual, el grupo experimental recibirá también la video-intervención. Al término del estudio se evaluará la factibilidad a partir de grupos focales dirigidos a interventores e indicadores de resultados cuantitativos tales como tasa de reclutamiento, de completación de cuestionarios y finalización de la intervención. La aceptabilidad se evaluará a partir de entrevistas en profundidad a las participantes. Adicionalmente se calculará tamaño del efecto de indicadores de resultados primarios y secundarios. Resultados esperados: Se espera que los resultados del estudio generen parámetros para diseñar un ensayo clínico de mayor escala y evaluar preliminarmente el efecto de la intervención informada en la mentalización en la sensibilidad materna. Se busca además contribuir con una intervención en salud mental basada en la teoría del apego dirigida a díadas madre-bebé de bajos ingresos, que pueda ser implementada de manera remota, a bajo costo y apta para ser escalada a los sistemas de atención en salud mental.

Family dynamics. An exploration of parental sensitivity and depressive symptoms among mothers and fathers of toddlers.

In studies of maternal sensitivity, the influence of mothers' depressive symptomatology has been consistently highlighted. Additionally, the relevance of both maternal and paternal sensitive responses to children's development has been recognized. However, literature regarding the dynamics of the mother-father-toddler triad is scarce. This is particularly true when understanding how parental sensitivity may be bidirectionally shaped by both parents' (i.e., mothers' and fathers' depressive symptomatology) and children's characteristics (i.e., age). Hence, the present study aims to describe and analyse the associations between parental depression, paternal sensitivity and children's socioemotional difficulties and age with mothers' sensitive responses to highlight the appropriateness of considering fathers' depressive symptoms and sensitivity to better understand the impact of maternal depressive symptomatology on mothers' sensitivity. The participants included 80 Chilean mother-father-child triads in which all children were between 1 and 3 years of age and presented some degree of socioemotional difficulty. The results reveal no differences in maternal and paternal sensitivity or higher depressive symptomatology in mothers than in fathers. Additionally, while mothers' depression was significantly associated with their sensitivity, this was not the case for fathers. Paternal depressive symptomatology was associated with the mother's depression. Finally, paternal sensitivity emerged as a mediator between maternal depressive symptoms and sensitivity. This result calls attention to the use of paternal variables to understand how maternal depression impacts mothers' sensitivity and to thus develop appropriate interventions that expand the scope of such impacts from the dyad to the triad.

Depression and Antidepressants During Pregnancy: Craniofacial Defects Due to Stem/Progenitor Cell Deregulation Mediated by Serotonin.

Depression is a common and debilitating mood disorder that increases in prevalence during pregnancy. Worldwide, 7 to 12% of pregnant women experience depression, in which the associated risk factors include socio-demographic, psychological, and socioeconomic variables. Maternal depression could have psychological, anatomical, and physiological consequences in the newborn. Depression has been related to a downregulation in serotonin levels in the brain. Accordingly, the most commonly prescribed pharmacotherapy is based on selective serotonin reuptake inhibitors (SSRIs), which increase local serotonin concentration. Even though the use of SSRIs has few adverse effects compared with other antidepressants, altering serotonin levels has been associated with the advent of anatomical and physiological changes in utero, leading to defects in craniofacial development, including craniosynostosis, cleft palate, and dental defects. Migration and proliferation of neural crest cells, which contribute to the formation of bone, cartilage, palate, teeth, and salivary glands in the craniofacial region, are regulated by serotonin. Specifically, craniofacial progenitor cells are affected by serotonin levels, producing a misbalance between their proliferation and differentiation. Thus, it is possible to hypothesize that craniofacial development will be affected by the changes in serotonin levels, happening during maternal depression or after the use of SSRIs, which cross the placental barrier, increasing the risk of craniofacial defects. In this review, we provide a synthesis of the current research on depression and the use of SSRI during pregnancy, and how this could be related to craniofacial defects using an interdisciplinary perspective integrating psychological, clinical, and developmental biology perspectives. We discuss the mechanisms by which serotonin could influence craniofacial development and stem/progenitor cells, proposing some transcription factors as mediators of serotonin signaling, and craniofacial stem/progenitor cell biology. We finally highlight the importance of non-pharmacological therapies for depression on fertile and pregnant women, and provide an individual analysis of the risk-benefit balance for the use of antidepressants during pregnancy.

Video-retroalimentación Focalizado en los Recursos para mejorar la sensibilidad en díadas madre-infante con síntomas depresivos: protocolo de un ensayo clínico aleatorizado piloto / Strength-based Video-feedback to improve maternal sensitivity in mother-infant dyads with maternal depressive symptoms: Study protocol for a randomized controlled feasibility trial

Introduction Maternal sensitivity and mentalization are fundamental for children's mental health development. These skills have been negatively associated with maternal postpartum depressive symptomatology. Moreover, its prevalence increases in low socioeconomic and psychosocial risk contexts, where the access to treatment is scarce. Even though Attachment Based Interventios, such as Video-Feedback has been internationally recognized as an effective intervention. Its cost, as well as the need for language translation and cultural adaptation makes it difficult to implement in Latinamerican countries. Aim The present study aims to assess the feasibility and acceptability of an online Video-Feedback intervention informed n mentalization aimed at mother-infant dyads with depressive symptomatology who attend Chilean public health centers. Method This is a pilot randomized clinical trial with two groups of 60 mother-infant dyads between 4 and 12 months of age. Participants will be randomly assigned to control and experimental groups in a 1:1 ratio. Even though both groups will receive usual treatment, the experimental group will also receive the present video-intervention. At the end of the study, feasibility will be assessed based on focus groups aimed at interveners and quantitative outcomes such as recruitment rate, questionnaire completion rate and intervention completeness. Acceptability will be assessed from in-depth interviews with participants. In addition, effect sizes of primary and secondary outcomes will be calculated. Expected results Results are expected to generate parameters to design a larger-scale clinical trial and to preliminary assess the effect of the reported mentalization-informed intervention on maternal sensitivity. Additionally, it seeks to contribute with a mental health intervention for low-income mother-infant dyads, which can be implemented remotely, at a low cost, and that would be suitable for implementation at a mental health care system policy. The protocol of this trial's design was registered at Clinical Trials (NCT04748731).

Introducción La sensibilidad y la mentalización materna constituyen competencias fundamentales para el desarrollo de la salud mental infantil. A su vez, dichas habilidades han sido negativamente asociadas con la presencia de sintomatología depresiva postparto, la cual aumenta su prevalencia en contextos de bajo nivel socioeconómico y riesgo psicosocial, en donde el acceso a tratamiento escasea. Paralelamente, si bien internacionalmente el video-retroalimentación constituye una herramienta efectiva en intervenciones basadas en el apego, el costo, idioma y necesidad de adaptación cultural dificultan su implementación en países latinoamericanos. Objetivo Evaluar la factibilidad y aceptabilidad de una video-intervención informada por la mentalización, dirigida a díadas madre-bebé con sintomatología depresiva, atendidas en centros públicos de atención en salud mental en Chile. Métodos Ensayo clínico aleatorio piloto con dos grupos de 60 díadas madre-bebé de entre 4 y 12 meses de edad, quienes serán asignados aleatoriamente a grupos control y experimental en una proporción de 1:1. Si bien ambos grupos recibirán el tratamiento habitual, el grupo experimental recibirá también la video-intervención. Al término del estudio se evaluará la factibilidad a partir de grupos focales dirigidos a interventores e indicadores de resultados cuantitativos tales como tasa de reclutamiento, de completación de cuestionarios y finalización de la intervención. La aceptabilidad se evaluará a partir de entrevistas en profundidad a las participantes. Adicionalmente se calculará tamaño del efecto de indicadores de resultados primarios y secundarios. Resultados esperados Se espera que los resultados del estudio generen parámetros para diseñar un ensayo clínico de mayor escala y evaluar preliminarmente el efecto de la intervención informada en la mentalización en la sensibilidad materna. Se busca además contribuir con una intervención en salud mental basada en la teoría del apego dirigida a díadas madre-bebé de bajos ingresos, que pueda ser implementada de manera remota, a bajo costo y apta para ser escalada a los sistemas de atención en salud mental.

¿En qué medida la adversidad temprana y la depresión explican la satisfacción de pareja? / How does early adversity and depression explain satisfaction of a couple?

Las experiencias adversas durante la infancia pueden constituirse en eventos traumáticos que impactan la calidad de los vínculos y la salud mental a lo largo del ciclo vital, siendo la depresión un trastorno frecuente en quienes reportan estas vivencias. La depresión ha sido asociada positivamente a la adversidad temprana y negativamente con la satisfacción de pareja durante la adultez, pero se desconoce el valor explicativo de la adversidad temprana y la depresión en los niveles de satisfacción de pareja. Considerando estos antecedentes, se desarrolló un estudio transversal, correlacional y comparativo en 160 madres y padres chilenos(as). Los resultados mostraron altos niveles de satisfacción de pareja y una asociación positiva entre las experiencias adversas y la depresión en padres y madres. Las madres presentaron mayores puntajes que los padres en depresión [t(79) =4.72, p<.001] y en experiencias adversas tempranas [t(79)= 3.468, p<.001], explicando la depresión materna y paterna junto a la satisfacción de pareja paterna un 51.8% de la satisfacción de pareja en las mujeres. En cuanto a los padres, su sintomatología depresiva y la satisfacción de la madre, explicaron un 58.9% de su satisfacción de pareja. Se discute la relevancia y las implicancias clínicas de los resultados

Adverse experiences in childhood are often traumatic events that affect relationships and mental health throughout the life cycle, with depression being a prevalent disorder in those who report them. Although depression has been positively associated with early adver-sity and negatively with couple satisfaction during adulthood, there are no studies that evaluate the explanatory value of both variables at the level of couple satisfaction. Therefore, a cross-sectional, correlational and comparative study was carried out in 160 fathers and mothers. The results showed high levels of couple satisfaction and a positive association between childhood adverse experiences and depression in parents. Mothers showed higher scores than fathers in depression [t(79) = 4.72; p <, 001] and in childhood adverse experiences [t(79) = 3,468 p <.001]. Moreover, for them, depression explained 53% of couple satisfaction. As for the father, a depressive symptomatology, childhood adverse experiences and the mother's depressive symptomatology explained 35% of his couple satisfaction