Adverse childhood experiences (ACE) result in somatic and mental health disturbances. Their influence on antenatal depression is scarcely studied. This study examined the association between experience of ACE and antenatal depressive symptomatology.
1257 women from 172 antenatal clinics in Sweden were surveyed during pregnancy and 1 year after delivery. Demographics, previous medical history and Edinburgh Postpartum Depression Scale (EPDS) were collected in pregnancy and postpartum and ACE 1 year postpartum. ACEs were partitioned into 10 categories. Statistical analyses used linear and logistic regression with EPDS score as main outcome measure.
736 (58.6%) women reported at least one ACE category and 88 women (7%) reported five or more ACE categories. An EPDS score of =13, which qualifies for a probable depression diagnosis, was reported by 277 (23%) women. In simple regression analyses the EPDS score was positively associated with the number of ACEs, cigarette smoking before pregnancy, body mass index and psychiatric disorders, whereas education level was inversely associated. In a multiple regression analysis, ACEs, education level and psychiatric disorder remained associated to the EPDS score. Among women with an ACE score =5, the odds ratio of having an EPDS score indicating probable depression was 4.2 (CI 2.5-7.0).
ACE was commonly reported. ACE and depressive symptomatology in late pregnancy were strongly associated in a dose-response manner. Women with several ACEs had high odds of depressive symptomatology in late pregnancy and were more likely to report depressive symptoms both in late pregnancy and postpartum.
Centre for Research on Inner City Health, The Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond St, Toronto, ON, M5B 1W8, Canada. pat.ocampo@utoronto.ca
There is increasing interest in the study of the social determinants of maternal and child health. While there has been growth in the theory and empirical evidence about social determinants, less attention has been paid to the kind of modeling that should be used to understand the impact of social exposures on well-being. We analyzed data from the nationwide 2006 Canadian Maternity Experiences Survey to compare the pervasive disease-specific model to a model that captures the generalized health impact (GHI) of social exposures, namely low socioeconomic position. The GHI model uses a composite of adverse conditions that stem from low socioeconomic position: adverse birth outcomes, postpartum depression, severe abuse, stressful life events, and hospitalization during pregnancy. Adjusted prevalence ratios and 95% confidence intervals from disease-specific models for low income (
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Cites: Am J Epidemiol. 1976 Aug;104(2):107-23782233
Emerging evidence suggests that prenatal stress does not solely undermine child functioning but increases developmental plasticity to both negative and positive postnatal experiences. Here we test this proposition using the Norwegian Mother and Child Cohort study while implementing an extreme-group (i.e., high vs. low prenatal stress) design (n = 27,889 children for internalizing and n = 27,892 for externalizing problems). To measure prenatal stress, mothers reported on depressive and anxiety symptoms at gestational weeks 17 and 30 and of stressful life events at gestational week 30. We then evaluated whether, collectively, such prenatal stress amplified the effect of mothers' postnatal depressive and anxiety symptoms on children's internalizing and externalizing behavior problems at age 5 years. Results showed prenatal stress amplified effects of postnatal maternal depression/anxiety on child internalizing but not externalizing behavior, with some indication that this Prenatal-Stress-×-Postnatal-Maternal-Depression interaction proved more consistent with differential susceptibility than diathesis stress thinking: Children exposed to prenatal stress evinced greater internalizing problems if exposed to more postnatal maternal depressive/anxiety symptoms and, somewhat less strongly, displayed less internalizing problems if they experienced lower postnatal maternal depressive/anxiety symptoms. However, analyses using the whole sample instead of extreme groups yielded opposing results with children exposed to the least prenatal stress evincing greater sensitivity to postnatal maternal depressive/anxiety symptoms with regards to externalizing and internalizing behavior. Taken together, it appears that prenatal stress may have differing effects on plasticity depending on prenatal stress severity. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
Evaluate the prevalence and phenomenology of dream-associated behaviors affecting pregnant and postpartum mothers. Episodes consist of anxious dreams and nightmares about the new infant that are accompanied by complex behaviors (motor activity, speaking, expressing emotion).
Three-group design (postpartum, pregnant, null gravida), self-report, and repeated measures.
Pregnancy and postpartum groups: completion of questionnaires in hospital room within 48 hours of giving birth and home telephone interviews; null gravida group: completion of questionnaires and interview in person or by telephone.
Two hundred seventy-three women in 3 groups: postpartum: n = 202 (mean age = 29.7 +/- 4.94 years; 95 primiparas, 107 multiparas); pregnant: n = 50 (mean age = 31.1 +/- 5.44 years); null gravida: n = 21 (mean age = 28.5 +/- 6.34 years).
Subjects completed questionnaires about pregnancy and birth factors, personality, and sleep and participated in interviews concerning the prevalence of recent infant dreams and nightmares, associated behaviors, anxiety, depression, and other psychopathologic factors.
Most women in all groups recalled dreams (88%-91%). Postpartum and pregnant women recalled infant dreams and nightmares with equal prevalence, but more postpartum women reported they contained anxiety (75%) and the infant in peril (73%) than did pregnant women (59%, P
Fatigue is prevalent during the postpartum period and may be heightened in postpartum depressed women.
To evaluate the efficacy of a home-based exercise intervention in reducing physical and mental fatigue scores in postpartum depressed women.
Eighty-eight women in the postpartum (4-38 weeks) obtaining a score > or =10 on the Edinburgh Postnatal Depression Scale (EPDS) were randomly assigned to a 12-week individualized home-based intervention (n = 46) or a control group (n = 42). All participants completed a cardiovascular fitness test at baseline. Outcomes were physical and mental fatigue scores and were measured at baseline, posttreatment and 3 months posttreatment.
On the basis of intent-to-treat analyses, compared to the control group, women in the exercise group showed significantly greater reduction in physical fatigue at posttreatment [mean change = -4.07, (95% CI, (-5.15, -2.98)] and 3 months posttreatment [mean change = -4.24, (95% CI, (-5.36, -3.12)]. Significant reductions in mental fatigue with exercise were observed at posttreatment for women reporting lower physical fatigue at baseline.
Fatigue is a common symptom experienced in the postpartum that can be heightened by depression. The findings show that home-based exercise can reduce physical and mental fatigue in postpartum depressed women.
This study explored the effects of mothers' and fathers' prenatal and postnatal depressive symptoms and marital distress on breastfeeding initiation and exclusive breastfeeding (EBF) duration.
This was a prospective follow-up of a cohort sample of 873 families participating to an intensive follow-up cohort of longitudinal Steps to the Healthy Development and Well-being of Children study (The STEPS study) in Southwestern Finland. The depressive symptoms were evaluated by The Edinburgh Postpartum Depression Scale and marital distress by the Revised Dyadic Adjustment Scale at 20th gestational week and at 4 months postpartum. EBF was self-reported real-time and defined as an infant receiving no food or drink other than mother's breast milk since birth, except occasionally water.
Neither parents' prenatal depressive symptoms predicted breastfeeding initiation or EBF duration. The mothers' prenatal depressive symptoms, in turn, predicted their postnatal depressive symptoms, which were associated with shorter duration of EBF. The EBF duration was shortest amongst the mothers who had depressive symptoms both pre- and postnatally compared to mothers who had depressive symptoms only in either time point alone (M = 1.54, 2.06 and 2.04 months, respectively). Higher prenatal maternal marital distress was associated with longer EBF duration.
The findings suggest that the continuity of maternal depressive symptoms throughout the perinatal period has adverse effect on EBF duration. Identification and treatment of mothers' depressive symptoms already during the prenatal period may improve breastfeeding practices. The finding of mothers' marital distress having positive impact on breastfeeding practices requires further investigation.
Postpartum depression (PPD) afflicts up to 15% of Canadian women following childbirth. Minimal research has focused on therapist-assisted internet-delivered cognitive behavior therapy (ICBT) for PPD. The purpose of this paper was to illustrate this novel treatment approach that was offered to a woman afflicted with PPD. A first-time mother participated in therapist-assisted ICBT for PPD. She completed the seven-module intervention in 12 weeks, sent seven emails to her therapist, and received 13 therapeutic emails. Therapeutic exchanges are presented. Treatment progress, therapeutic alliance, and treatment satisfaction were assessed. Symptom reduction was observed on all measures at post-treatment. Treatment satisfaction and a strong therapeutic alliance were also reported. The case will expand clinician understanding in therapist-assisted ICBT for PPD and may serve to stimulate clinician interest. Future research directions stemming from this case are presented.
The objectives of the present study were to examine the life circumstances, childhood abuse, and types of homicidal acts of 48 mothers who killed/attempted to kill their child(ren) under age 12 between 1970-96 in Finland. Data on the mothers'life stresses, psychological problems, and childhood abuse were collected from mental state examination (MSE) reports. The cases were divided into 15 neonaticides and 33 mothers who killed an older child. Childhood abuse was documented in 63% of the mothers' MSE reports. Qualitative analysis identified neonaticides,joint homicide-suicide attempts, impulsive aggression, psychotic acts, postpartum depression, and abusive acts. Nonlinear principal components analysis showed that different variables were related to the neonaticide and non-neonaticide cases. We concluded that despite differences in the psychosocial profiles of neonaticides and other maternal homicidal acts the cycle of violence perspective can be applied to both cases, even though it may not be a sufficient explanation for maternal child killings.
Neonaticide is a sad and infrequent crime with possibly a high level of underreporting. The aim of this study was to examine the circumstances of neonaticide, and whether there are subtypes of offenders, or suggestions for prevention. The study was retrospective and register-based using comprehensive nation-wide material of all cases of suspected neonaticide during 1980-2000 in Finland. Out of the 50 suspected cases, 32 women were included in the final analyses as neonaticide offenders. Most women (91%) had concealed their pregnancy, which was not the first for 66%. Most (66%) were not quite sure why they had offended, and the most frequent (63%) method of operation was neglect. Four women were diagnosed psychotic and formed a specific group. We concluded that there might be specific subgroups of offenders - even though our small population limited conclusions. Furthermore, prevention might be heightened. We call for international joint projects for enlarged material to enable grouping, as well as education and discussion among the public and the professionals to prevent neonaticide, unify its jurisprudence and improve the treatment of the offenders.
