The Stafford Interview : A comprehensive interview for mother-infant psychiatry.

This article describes an interview exploring the social, psychological and psychiatric events in a single pregnancy and puerperium. It has been in development since 1992 and is now in its 6th edition. It takes approximately 2 h to administer and has 130 compulsory probes and 185 ratings. It is suitable for clinical practice, teaching and research.

Transition to parenthood and mental health in first-time parents.

This study aimed to examine the transition to parenthood and mental health in first-time parents in detail and explore any differences in this transition in the context of parental gender and postpartum mental health. Semistructured clinical interviews (Birmingham Interview for Maternal Mental Health) were carried out with 46 women and 40 men, 5 months after birth. Parents were assessed on pre- and postpartum anxiety, depression, and postpartum posttraumatic stress disorder (PTSD), and a range of adjustment and relationship variables. One fourth of the men and women reported anxiety in pregnancy, reducing to 21% of women and 8% of men after birth. Pregnancy and postpartum depression rates were roughly equal, with 11% of women and 8% of men reporting depression. Postpartum PTSD was experienced by 5% of parents. Postpartum mental health problems were significantly associated with postpartum sleep deprivation (odds ratio [OR] = 7.5), complications in labor (OR = 5.1), lack of postpartum partner support (OR = 8.0), feelings of parental unworthiness (OR = 8.3), and anger toward the infant (OR = 4.4). Few gender differences were found for these variables. This study thus highlights the importance of focusing interventions on strengthening the couple's relationship and avoiding postnatal sleep deprivation, and to address parents' feelings of parental unworthiness and feelings of anger toward their baby.

Postnatal mental health and parenting: The importance of parental anger.

Parents' postnatal mental health and subjective perceptions of their baby are likely to influence the quality of their relationship with their baby. To date, this has largely been examined in mothers; therefore, this study aimed to also explore this in both parents. Semistructured clinical interviews [The Birmingham Interview for Maternal Mental Health (BIMMH); Brockingon, Chandra et al., 2006] were carried out with 85 first-time parents. The BMMHI identifies disorders of anxiety, depression, PTSD, and parental anger. Sections of the BMMHI also elicit qualitative accounts of parenthood. These were transcribed and analyzed using thematic analysis. Differences in the frequency of themes were examined for parents with or without mental health disorders or parental anger. Themes are reported for (a) baby characteristics, needs, and development; (b) parents' emotions, responses, coping strategies, and general parenthood; and (c) parent and baby relationship. Results indicated that both the presence of parental mental health problems and, more notably, parental anger were associated with more negative accounts of the self, the baby, and parenthood. This study provides insight into first-time parents' perceptions of early parenthood. Results especially highlight the need to consider parental experiences of anger in more detail for assessment and interventions in the early postpartum period.

The role of adult attachment style, birth intervention and support in posttraumatic stress after childbirth: a prospective study.

BACKGROUND: There is converging evidence that between 1% and 3% of women develop posttraumatic stress disorder (PTSD) after childbirth. Various vulnerability and risk factors have been identified, including mode of birth and support during birth. However, little research has looked at the role of adult attachment style in how women respond to events during birth. This study prospectively examined the interaction between attachment style, mode of birth, and support in determining PTSD symptoms after birth. METHOD: A longitudinal study of women (n=57) from the last trimester of pregnancy to three months postpartum. Women completed questionnaire measures of attachment style in pregnancy and measures of PTSD, support during birth, and mode of birth at three months postpartum. RESULTS: Avoidant attachment style, operative birth (assisted vaginal or caesarean section) and poor support during birth were all significantly correlated with postnatal PTSD symptoms. Regression analyses showed that avoidant attachment style moderated the relationship between operative birth and PTSD symptoms, where women with avoidant attachment style who had operative deliveries were most at risk of PTSD symptoms. LIMITATIONS: The study was limited to white European, cohabiting, primiparous women. Future research is needed to see if these findings are replicated in larger samples and different sociodemographic groups. CONCLUSIONS: This study suggests avoidant attachment style may be a vulnerability factor for postpartum PTSD, particularly for women who have operative births. If replicated, clinical implications include the potential to screen for attachment style during pregnancy and tailor care during birth accordingly.

The impact of parents' mental health on parent-baby interaction: a prospective study.

The aims of the current study were to examine the effect of fathers' and mothers' pre and postnatal mental health on mother-infant and father-infant interactions. Mental health was broadly defined to include anxiety, depression and PTSD. A community sample of 44 mothers and 40 fathers from 45 families completed questionnaire measures of mental health in late pregnancy and three months postpartum. Mother-infant and father-infant interactions were observed and videoed three months postpartum and analysed using the CARE-index. Results showed that prenatal mental health, in particular anxiety, was associated with parent-infant interactions to a greater extent than postnatal mental health. Fathers' prenatal symptoms were associated with higher paternal unresponsiveness and infant passivity whilst fathers' postnatal symptoms were associated with higher levels of infant difficulty in the father-baby interaction. The results also indicated that mothers and fathers interaction with their babies were similar, both on average and within the couples, with 34% being inept or at risk. These findings highlight the need for early detection and prevention of both mental health and parent-infant relationship problems in fathers as well as mothers. However, further prospective and longitudinal studies are needed to understand the influences of parental mental health on the parent-infant interactions further. Also it should be noted that the mental health scores were low in this sample, which may reflect the sample characteristics. Future studies therefore would benefit from focusing on more vulnerable groups of parents.

Posttraumatic stress disorder after childbirth: analysis of symptom presentation and sampling.

BACKGROUND: There is converging evidence that approximately 2% of women fulfill PTSD criteria following childbirth. This study examined the presentation and symptom structure of PTSD after birth and key risk factors in women from internet and community samples. METHODS: PTSD was measured in 1423 women after birth recruited via the community (n=502) or internet (n=921). Demographic, obstetric, and trauma history variables were also measured. RESULTS: Full PTSD diagnostic criteria were endorsed by 2.5% of women from the community and 21% of women on the internet. Many more endorsed individual PTSD symptom criteria, suggesting this might be inflated by postnatal factors. Samples differed on demographic and obstetric characteristics. Factor analysis found two PTSD symptom clusters of re-experiencing and avoidance (RA) and numbing and arousal (NA). PTSD cases were predicted by parity, delivery type, NA and RA symptoms, and the interaction between sexual trauma and delivery type. This correctly identified 60% of PTSD cases. LIMITATIONS: Questionnaire measurement of PTSD means prevalence rates may be over-estimated. Differences between samples suggest that internet samples over represent symptomatic women. CONCLUSIONS: Results emphasise the importance of measuring full diagnostic criteria in postnatal samples, as reports of symptoms may be inflated. In addition a few risk factors are identified that could be used to screen for women at risk.