Online Intervention Targeting Postnatal Depression and Anxiety in Chilean First-Time Mothers: Feasibility Trial.

OBJECTIVE: Internet-based interventions may positively impact maternal symptoms of postnatal depression and anxiety. This study assessed the feasibility, acceptability, perceived usefulness, and preliminary effectiveness of an m-Health version of "What Were We Thinking?" (m-WWWT). METHODS: A mixed-methods with a 2-arm randomized parallel design was used. From a total of 477 women, 157 met the inclusion criteria. 128 first-time mothers of full-term infants, aged 4-10 weeks, who received health care at primary public health centers in Chile, were randomly assigned to the experimental (EG, n = 65) or control (CG, n = 63) groups; data of 104 of them (53 and 51, respectively) was analyzed. We used percentages and rates to measure feasibility outcomes and mixed analysis of variance (ANOVA) and latent class analyses (LCA) to assess preliminary effectiveness. Participants completed questionnaires on mental health, social support, and maternal self-efficacy upon recruitment and 3 months after completing the intervention. For the qualitative component, 12 women from the EG were interviewed. RESULTS: Quantitative results show good feasibility outcomes, such as high recruitment (82%), low attrition (EG = 12% and CG = 17%), and high follow-up (EG = 97% and CG = 91%) rates. Qualitative results indicate high acceptability and perceived usefulness of m-WWWT. Mixed ANOVA did not show significant differences between the groups (all p >.05). However, multinomial regression analysis in LCA showed that women with low baseline symptoms of depression and anxiety benefit from the intervention (B = 0.43, 95% confidence interval 1.09-2.16). CONCLUSION: m-WWWT is feasible to be implemented in Chile; future studies are needed to assess the intervention's effectiveness.

An explanatory model of parental sensitivity in the mother-father-infant triad.

Quality of early family interactions has been associated with child development, bonding, and mental health. Childhood adversity, stress, and depression impact parenting, affecting the quality of the interaction within the mother-father-child triad. The aim of the present study was to analyze the influence of parents' adverse childhood experiences, depressive symptoms, and parental stress, on their sensitive response toward their tooddler and quality of traidic interactions. A correlational cross-sectional method was used. The sample included 80 mother-father-child triads, of toddlers with social-emotional difficulties. Parents early adverse experiences, parental stress, and depressive symptoms were assessed through self-report measures. Observational measures on parental sensitivity and triadic interaction were used. For mothers and fathers, adverse childhood experiences were associated with depressive symptoms in adulthood. Sensitivity toward their child and stress were positively associated among both parents. Symptoms of depression in mothers were associated with lower sensitivity toward their child, but in fathers, their sensitive response was influenced by the level of parental stress in the mother. In both parents, greater sensitivity in the dyadic interaction with the child was associated with a higher quality of the triadic interactions, in the triad as a whole, and in the regulation and involvement of the child.

Se ha asociado la calidad de las tempranas interacciones de familia con el desarrollo, la unión afectiva y la salud mental del niño. La adversidad en la niñez, el estrés y la depresión tienen un impacto en la crianza, lo cual afecta la calidad de la interacción dentro de la tríada madre-padre-niño. El propósito del presente estudio fue analizar la influencia que las adversas experiencias de niñez de los padres, los síntomas depresivos y el estrés de crianza ejercen sobre sus sensibles respuestas hacia su niño pequeñito y la calidad de las interacciones tríadicas. Se utilizó un método correlacional entre las secciones. El grupo muestra estuvo compuesto de 80 tríadas madre-padre-niño, de niños pequeñitos con dificultades socio-emocionales. A través de medidas de auto-reportes, se evaluaron las tempranas experiencias adversas de los padres, el estrés de crianza, así como los síntomas depresivos. Se usaron medidas de observación de la sensibilidad de los padres y la interacción tríadica. Para mamás y papás, las adversas experiencias de niñez estuvieron asociadas con síntomas depresivos en la edad adulta. La sensibilidad hacia su niño y el estrés se asociaron positivamente entre ambos padres. Se asociaron los síntomas de depresión en las madres con una más baja sensibilidad hacia su niño, pero en los papás la respuesta sensible estuvo influida por el nivel de estrés de crianza de la madre. En ambos padres, una mayor sensibilidad en la interacción diádica con el niño se asoció con una más alta calidad de las interacciones tríadicas, en la tríada en general, así como en la regulación y participación del niño.

La qualité des interactions précoces de la famille a été liée au développement de l'enfant, à la connexion et à la santé mentale. L'adversité durant l'enfant, le stress et la dépression impactent le parentage, affectant la qualité de l'interaction au sein de la triade mère-père-enfant. Le but de cette étude était d'analyser l'influence d'expériences négatives de l'enfance, de symptômes dépressifs et de stress parental sur leur réaction sensible envers leur petit enfant et la qualité des interactions triadiques. Une méthode transversale corrélative a été utilisée. L'échantillon a inclus 80 triades mère-père-enfant, de jeunes enfants avec des difficultés socio-émotionnelles. Les expériences négatives précoces des parents, le stress parental, et les symptômes dépressifs ont été évalués au travers de mesures d'auto-évaluation. Des mesures d'observation de la sensibilité parentale et de l'interaction triadique ont été utilisées. Pour les mères et les pères les expériences négatives de l'enfance étaient liées à des symptômes dépressifs à l'âge adulte. La sensibilité envers leur enfant et le stress étaient liés de manière positive chez les deux parents. Les symptômes de dépression chez les mères étaient liés à une sensibilité moindre envers leur enfant mais chez les pères leur réaction sensible était influencée par le niveau de stress parental chez la mère. Chez les deux parents une plus grande sensibilité dans l'interaction dyadique avec l'enfant était liée à une qualité plus élevée des interactions triadiques, dans la triade dans son ensemble, et dans la régulation et l'engagement de l'enfant.

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.

Triadic interactions, parental reflective functioning, and early social-emotional difficulties.

Early childhood is a critical period for social-emotional development; during this period, the child's immediate family is the system with the greatest influence on his or her development. The parents' capacity to reflect on the children's ability to process and interact within a social environment, called parental reflective functioning (RF), is considered an important factor in protecting children from highly prevalent social-emotional difficulties and may have a strong influence on children's long-term development. OBJECTIVE: To describe and analyze the relationships among parents' RF, the quality of the mother-father-child triadic interaction, and children's social-emotional difficulties. METHOD: A nonexperimental, cross-sectional, correlational study was conducted. Fifty mother-father-child triads, each in a current relationship that included at least one child aged 12-36 months, were evaluated. Sociodemographic background, triadic interaction, parental RF, and social-emotional difficulties were assessed. RESULTS: Triadic interaction was found to have a significant effect on the child's social-emotional difficulties, explaining 9% of the variance. In addition, the mothers' RF had a significant influence on triadic interaction, explaining 19% of the variance. An exploratory finding showed that triadic interaction mediates the relationship between mothers' RF and children's social-emotional difficulties.

La temprana niñez es un período crítico para el desarrollo socio-emocional; durante este período, el núcleo familiar del niño es el sistema con la mayor influencia en su desarrollo. La capacidad de los padres de reflexionar sobre la habilidad del niño de procesar e interactuar dentro del ambiente social, llamada la función reflexiva de los padres (RF), es considerada un factor importante en la protección del niño en cuanto a dificultades socio-emocionales altamente prevalentes y pudiera tener una fuerte influencia en el desarrollo del niño a largo plazo. OBJETIVO: Describir y analizar la relación entre la función reflexiva de los padres (RF), la calidad de la interacción tríadica entre mamá, papá y niño, y las dificultades socio-emocionales de los niños. MÉTODO: Se llevó a cabo un estudio no experimental, transversal y correlacional. Se evaluaron cincuenta tríadas de mamá, papá y niño, cada una de ellas en una relación presente que incluía por lo menos un niño de edad entre 12 y 36 meses. Se evaluaron el trasfondo demográfico, la interacción tríadica, la RF de los padres, así como las dificultades socio-emocionales. RESULTADOS: Se encontró que las interacciones tríadicas tenían un efecto significativo en las dificultades socio-emocionales del niño, lo cual explica el 9% de la variación. Adicionalmente, la RF de las mamás tuvo una influencia significativa en la interacción tríadica, lo cual explica el 19% de la variación. Un resultado exploratorio mostró que la interacción tríadica sirve de mediadora en la relación entre la RF de la mamá y las dificultades socio-emocionales de los niños.

La petite enfance est une période critique pour le développement socio-émotionnel. Durant cette période la famille proche de l'enfant est le système ayant la plus grande influence sur son développement. La capacité des parents à réfléchir à la capacité des enfants à traiter et à interagir avec l'environnement social, appelée le fonctionnement de réflexion parentale (abrégé en anglais RF), est considérée comme étant un facteur important qui protège les enfants de difficultés socio-émotionnelles extrêmement prévalente et qui peut avoir une forte influence sur le développement long-terme des enfants. OBJECTIF: Décrire et analyser les relations entre le RF des parents, la qualité de l'interaction triadique mère-père-enfant, et les difficultés socio-émotionnelles des enfants. MÉTHODE: Une étude non-expérimentale, corrélationnelle, avec une coupe transversale a été effectuée. Cinquante triades mère-père-enfant, chacune dans la relation actuelle qui incluait au moins un enfant âgé de 12 à 36 mois, ont été évaluées. Le contexte sociodémographique, l'interaction triadique, le RF parents, et les difficultés socio-émotionnelles ont été évalués. RÉSULTATS: On a trouvé que l'interaction triadique avait un effet important sur les difficultés socio-émotionnelles de l'enfant, expliquant 9% de l'écart. De plus, le RF des mères s'est avéré avoir une influence importante sur l'interaction triadique, expliquant 19% de l'écart. Un résultat exploratoire a montré que l'interaction triadique affecte la relation entre es le RF des mères et les difficultés socio-émotionnelles des enfants.

[Low quality of mother-child interaction in infants at psychosocial risk is associated with risk of developmental delay]. / Baja calidad de interacción madre-hijo/a en lactantes en riesgo psicosocial se asocia con riesgo de retraso del desarrollo.

INTRODUCTION: Early childhood is a fundamental period in children's development and depends largely on their in teractions with their main caregivers. OBJECTIVES: To evaluate the association between risk of psycho motor developmental delay (PDD) with mother-child interaction quality, postpartum depressive symptoms, and other factors related to care and environment in healthy infants at psychosocial risk. PATIENTS AND METHOD: Analytical cross-sectional study in 181 mothers at psychosocial risk and their children aged under one year seen in Primary Health Care. The presence of risk of PDD was deter mined using the Ages & Stages Questionnaire and its association with interaction quality (CARE In dex), postpartum depressive symptoms (Edinburgh Postpartum Depression Scale), and other factors related to environment and care (questionnaire applied to the mother) was studied through bivariate and multivariate analyses, adjusting for confusing variables. RESULTS: 20% of infants were at risk of PDD. There was an increased risk of presenting risk of PDD after adjusting for predefined control variables with: low-quality mother-child interaction (OR = 2.46, p = 0.03), exclusive breastfeeding (EBF) <6 months (OR = 2.58, p = 0.01), and partner does not help with childcare (OR = 2.97, p = 0.03). No significant association was observed with postpartum depressive symptoms. CONCLUSIONS: In healthy infants at psychosocial risk, low-quality mother-child interaction, EBF <6 months, and the non-involvement of the father in the childcare are associated with a higher risk of PDD.

[Barriers restricting postpartum depression treatment in Chile]. / Barreras de acceso a tratamiento de la depresión posparto en Centros de Atención Primaria de la Región Metropolitana: un estudio cualitativo.

BACKGROUND: In Chile, postpartum depression is a prevalent and disabling condition. Universal screening is available but has not been translated into better treatment rates, suggesting the existence of access barriers. AIM: To describe access barriers to postpartum depression treatment in six primary health care clinics in Metropolitan Santiago, Chile. MATERIAL AND METHODS: Twenty women with postpartum depression and 18 primary health care professionals were subjected to a semi-structured interview. A qualitative methodology based on Grounded Theory was used. RESULTS: There are user associated barriers such as lack of knowledge about the disease, a negative conceptualization and rejection of available treatment options. There are also barriers associated with poor network support and some features of the health care system such as long waiting times and lack of coordination between clinical and administrative decisions. CONCLUSIONS: Patient and provider related barriers restricting treatment of postpartum depression were identified.

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.

Maternal mental health and impact on the newborn during the COVID-19 pandemic. / Salud mental materna y efectos en el recién nacido durante la pandemia por COVID-19.

The deterioration of mental health in the general population has been one of the main consequences of the COVID-19 health crisis, with differences in diverse groups. Specifically, recent studies report an increased risk for the development of symptoms of anxiety and depression during the perinatal period, as well as a negative impact on the newborn. OBJECTIVE: The objective of this study was to examine the differences in mental health, infant and obstetric variables, and childbirth experience in the public and private health systems in Chilean primiparous women before and during the CO- VID-19 pandemic. SUBJECTS AND METHOD: This quantitative study compared two cohorts. The first one included mothers with babies born before the COVID-19 pandemic (N = 81) and the second one involved mothers who delivered during the pandemic (N = 71). Sociodemographic and obstetric history, depression, anxiety, and stress were evaluated in both groups using self-report questionnaires (EPDS, DASS-21). Differences between groups were assessed with ANCOVA, t-tests, and chi-square tests. RESULTS: Women who delivered during the pandemic reported greater depressive symptoms and their babies were smaller and had less weeks of gestation than babies born before the COVID-19 pandemic. However, this group maintained exclusive breastfeeding for a longer period. There were no differences in the experience of childbirth between the groups, but there were differences in relation to the public or private nature of the hospital where the mothers were seen. CONCLUSIONS: The pandemic negatively affected the mental health of mothers, posing significant challenges to promoting the emotional well-being of mothers and their infants.

Shared Components of Worldwide Successful Sexuality Education Interventions for Adolescents: A Systematic Review of Randomized Trials.

A crucial aspect of human development is sexuality which has implications for health, particularly in adolescence, since unfavorable sexual experiences may result in physical and mental problems. Sexuality education interventions (SEI) are one of the most used actions to promote sexual health in adolescents. Nevertheless, there is variability across their components; therefore, key elements for an effective SEI targeted at adolescents (A-SEI) are not well known. Based on this background, this study aims to identify the shared components of successful A-SEI through a systematic review of randomized controlled trials (RCT). This study followed the preferred reporting items for systematic reviews and meta-analyses statement. A search was conducted in CINAHL, PsycInfo, PubMed, and Web of Science between November and December 2021. A total of 21 studies passed the inclusion test after the review of 8318 reports. A total of 18 A-SEIs were identified in these studies. The components analyzed were the intervention's approach, dose, type of intervention, theoretical framework, facilitators' training, and intervention methodology. The results established that components that should be present in the design of an effective A-SEI are behavior change theoretical models, the use of participatory methodology, be targeted at mixed-sex groups, facilitators' training, and at least ten hours of weekly intervention.

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.

A Group Videoconferencing Intervention (C@nnected) to Improve Maternal Sensitivity: Protocol for a Randomized Feasibility Trial.

BACKGROUND: Early childhood development is highly dependent on the sensitive care provided by caregivers, and interventions focused on supporting parents to improve their sensitivity have shown to be effective. The COVID-19 pandemic has had a significant impact on mental health, with pregnant women and mothers of infants being an especially vulnerable group and maternal sensitivity particularly affected. However, access to face-to-face interventions is restricted; thus, it is important to have remote interventions to support this group of mothers. OBJECTIVE: The objective of this study is to evaluate the feasibility and acceptability of C@nnected, a group videoconferencing intervention to improve maternal sensitivity aimed at mother-infant dyads attending primary health care centers in vulnerable areas of Santiago, Chile. METHODS: This is a randomized feasibility single-masked (outcome assessor) study with a qualitative component. It will involve a block randomization procedure to generate a 3:2 allocation ratio (with more people allocated to the intervention arm). The intervention consists of 4 group videoconferencing sessions adapted from a face-to-face intervention with proven effectiveness. The control group will receive treatment as usual, along with educational brochures. The feasibility and acceptability of this study will be quantitatively and qualitatively assessed. Changes in clinical outcomes relating to maternal sensitivity, depressive symptoms, postpartum maternal attachment, and infant socioemotional development will also be evaluated. RESULTS: We finished adapting the face-to-face intervention to the videoconferencing format in July 2021. The study began recruitment in August 2021, and enrollment is expected to end in August 2022, with final study results expected in December 2022. CONCLUSIONS: This study will contribute evidence for the use of eHealth interventions to promote maternal sensitivity. It will also inform the design and implementation of a future randomized clinical trial. TRIAL REGISTRATION: ClinicalTrials.gov NCT04904861; https://clinicaltrials.gov/ct2/show/NCT04904861. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/35881.

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.

Online intervention to prevent postnatal depression and anxiety in Chilean new mothers: Protocol for a feasibility trial.

Symptoms of postpartum depression and anxiety in new mothers are prevalent and negatively impact maternal emotional wellbeing and infant development. Barriers to accessing treatment prevent women from receiving mental health care, a situation that has worsened due to the COVID-19 pandemic. mHealth interventions hold the potential to support women during the transition to parenthood despite these barriers and to promote the use of preventive interventions. This study uses a mixed methods design to assess the feasibility and preliminary effectiveness of a psychoeducational, guided mHealth intervention to prevent postpartum mental health difficulties in women who receive care in primary health centers in Chile. The study will contribute to evidence-based research on the effectiveness of mHealth interventions for new mothers from an understudied cultural background. The findings will also enable the development of a larger randomized controlled trial to assess the effectiveness of the intervention, which, if effective, could significantly contribute to the emotional wellbeing of women and their families.

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 Intervention Therapy for primary caregivers in a child psychiatry unit: a randomized feasibility trial.

BACKGROUND: During child psychiatry hospitalization, working with the families or attachment figures is a challenge, most of the children who are admitted to these units come from multi-problem families, with limited research in this area. Video feedback (VF) interventions have proved to be a powerful resource to promote parental and child well-being in small children and has been used with parents with a psychiatric condition. Parental Reflective Functioning (PRF) is one of the parental abilities that can be improved with VF and could be especially important in coping with conflict and negative emotions in older children. The aim of this study is to implement Video Intervention Therapy (VIT) to enhance PRF in primary caregivers of inpatient psychiatric children. As there is no published research using VF with parents of children with severe psychopathology in a hospitalized context. This report, then, becomes a much needed pilot study providing evidence for a larger randomized control trial (RCT). METHODS: The study is a single-center, two-arm feasibility randomized control trial with a qualitative component. Block randomization was done to generate a 2:1 allocation, leaving more participants in the intervention group. The intervention comprises four modules; every module has both one video-recorded play session and one VIT session (in a group setting) per week. Evaluation of the caregivers included assessments of PRF and well-being, and child assessment included parent-ratings and clinician-ratings of symptomatology and general functioning. RESULTS: Thirty participants were randomized; eligibility and recruitment rate were 70.6% and 83.3%, respectively. The compliance-to-intervention rate was 85% in the VIT group and 90% in the control group. All participants completed entry evaluation and 90% at the 3-month follow-up. The intervention was acceptable to participants and feasible for therapists to deliver. Outcome data must be treated with caution due to the small numbers involved, yet indicate that the VIT may have a positive effect in improving parental and child mental health outcomes. CONCLUSIONS: VIT for primary caregivers of child inpatient children was feasible to deliver and acceptable for participants, therapist, and the staff unit involved; there is sufficient evidence to undertake a full-scale effectiveness RCT. TRIAL REGISTRATION: ClinicalTrials.gov NCT03374904 . Registered on 14 December 2017.