Maternal anxiety, risk factors and parenting in the first post-natal year

The antecedents and consequences of maternal post-natal anxiety have received comparatively less attention than depression despite being one of the most frequently reported mental health difficulties experienced by parents following childbirth. The aim of this study was to extend emerging literature on post-natal anxiety by investigating the prevalence of maternal anxiety symptoms, and its relationship with parenting behaviours (i.e. warmth, hostility) and experiences (i.e. parenting efficacy and satisfaction) within the first post-natal year. The psychosocial risk factors for post-natal anxiety symptoms were also explored. Methods: A community sample of 224 Australian mothers of infants (aged 0-12 months) completed a self-report questionnaire. Results: Mothers in the current sample reported significantly more symptoms of anxiety compared with a normative sample. Approximately 18% of mothers reported mild to extremely severe symptoms of anxiety, with a high proportion experiencing co-morbid depressive symptoms. Maternal anxiety was associated with low parenting warmth, involvement, efficacy and satisfaction, and high parenting hostility. Yet, co-morbid depression and anxiety was more strongly associated with these parenting behaviours and experiences than anxiety alone. Conclusion: A range of psychosocial risk factors (e.g. education, sleep, relationship quality) were associated with maternal post-natal anxiety symptoms, providing opportunities for early identification and targeted early intervention

Wide Awake Parenting: Study protocol for a randomised controlled trial of a parenting program for the management of post-partum fatigue

Background: Exhaustion and fatigue are commonly experienced by parents during the post-partum period, and can have implications for daily functioning, mental health and parenting practices. There is a need for the development of effective interventions to assist parents with the management of fatigue. This paper outlines the procedure for a randomised controlled study which aims to test the efficacy of Wide Awake Parenting, a program for the management of fatigue in the postnatal period. Methods/design. Parents with an infant less than 6 months of age, and from seven Local Government Areas in Melbourne, Australia were invited to participate in this study. Parents were randomised to receive the Wide Awake Parenting program (intervention groups) or usual care (control group) offered by health services. The Wide Awake Parenting program provides parents with psycho-education and information about fatigue, and strategies to reduce its effects either via a self-directed method, or professionally led with a home visit and telephone support. Baseline data will be collected prior to randomisation, and further data will be collected at 2- and 6-weeks post intervention. Discussion. To our knowledge this is the first randomised controlled trial of a program which compares the efficacy of a self-management approach and health professional assistance for the management of fatigue in the early post-partum period. If effective, it could offer an important, universal public health management approach to this common health concern. Trial registration number. Australian New Zealand Clinical Trials Registry, ACTRN12611000133932. © 2013 Dunning et al.; licensee BioMed Central Ltd

The Efficacy of an Intervention for the Management of Postpartum Fatigue

Objective: To assess the efficacy of a psychoeducational intervention, Wide Awake Parenting (WAP), to decrease symptoms of postnatal fatigue. Design: A randomized controlled trial. Setting: Local government areas within the Australian state of Victoria. Participants: Two hundred and two mothers were randomly allocated to either the professionally-led telephone support intervention (n = 63), self-directed written intervention (n = 67), or waitlist control (n = 72). Methods: The professionally-led group received a workbook, home visit, and three telephone support calls. The self-directed written group received the workbook only, and the control group received usual health care services. Primary outcomes were symptoms of fatigue, depression, anxiety and stress, and health care beliefs and behaviors. Mothers were followed up at 2-and 6-weeks postintervention. Results: Mothers in the professionally-led group reported fewer symptoms of fatigue than mothers in the control condition at 6 weeks postintervention. Mothers in either intervention had more positive attitudes toward their health- and self-care behaviors at postintervention and follow-up. Mothers in the professionally-led intervention reported fewer symptoms of depression, anxiety, and stress than mothers in the other conditions at postintervention. Conclusion: Wide Awake Parenting is effective in promoting mothers' self-efficacy to prioritize, plan for, and engage in health and self-care behaviors to promote mental health and manage fatigue. Implications and future opportunities for WAP are discussed

Fatigue, stress and coping in mothers of children with an autism spectrum disorder

Raising a child with an autism spectrum disorder (ASD) can be exhausting, which has the potential to impact on parental health and wellbeing. The current study investigated the influence of maternal fatigue and coping on the relationship between children's problematic behaviours and maternal stress for 65 mothers of young children (aged 2-5 years) with ASDs. Results showed that maternal fatigue but not maladaptive coping mediated the relationship between problematic child behaviours and maternal stress. These findings suggest child behaviour difficulties may contribute to parental fatigue, which in turn may influence use of ineffective coping strategies and increased stress. The significance of fatigue on maternal wellbeing was highlighted as an important area for consideration in families of children with an ASD. © 2012 Springer Science+Business Media New York

Socioecological factors associated with fathers' well-being difficulties in the early parenting period

Background Well-being difficulties such as depression, anxiety, stress, and fatigue are common among fathers. However, little is understood about factors that might place fathers at increased risk of well-being difficulties or protective factors that reduce the likelihood of experiencing these problems. The aim of the present study was to use a socioecological perspective to explore a range of individual and microsystem factors associated with depression, anxiety, stress, and fatigue in fathers. Methods The study sample consisted of 133 Australian fathers of young children, aged 0-6 years, who had completed a parent well-being survey. Results Multiple regressions revealed that a range of individual and microsystem factors significantly explained variance in depression, anxiety, stress, and fatigue, including poor sleep quality, a number of coping strategies, parental self-efficacy, and social support. Conclusions Fathers are at risk of experiencing a range of well-being difficulties. Implications for potential targets for interventions to improve the well-being of fathers are discussed. © 2013 The Australian Psychological Society

Family functioning and behaviour problems in children with Autism Spectrum Disorders: The mediating role of parent mental health

Background Parents of young children with Autism Spectrum Disorders (ASDs) are often relied on to help implement therapy with their child, which occurs within a family context. Therefore, it is important to understand and support families where there is a child with an ASD. Although individual parent factors have received substantial research attention, fewer studies have investigated family functioning. This study explored the relationship between child behaviour problems and family functioning in families where there was a preschooler with an ASD. Parent mental health difficulties, including stress, fatigue, and depressive symptoms, were investigated as mediators in this relationship. Method Participants included 97 parents with a preschooler diagnosed with an ASD. Parents completed an online questionnaire reporting on child behaviour problems, their own symptoms of stress, depression and fatigue, and family functioning. Results Path analysis showed that the relationship between child behaviour problems and family functioning was mediated by depressive symptoms, but not stress and fatigue. Conclusions These results highlighted one way that ASDs can impact on the family system, suggesting that when parents are overburdened by behaviour problems, there are implications for the family. The importance of providing clinical interventions and support to strengthen parent mental health and family functioning is discussed

A longitudinal study of the relationships between sleep problems in autistic children and maternal mental health

Autistic children experience a high rate of sleep problems, which have been associated with maternal mental health difficulties. However, the directionality of these relationships has received little attention. The extent to which children’s sleep problems influence maternal mental health difficulties and vice versa remains unclear. The aim of this study was to examine the bidirectional relationships between the sleep problems of autistic children and maternal mental health difficulties over 12 years. Six biennial waves of longitudinal data from when children were 4 to 5 years old were drawn from the Longitudinal Study of Australian Children. The sample comprised 397 child–mother dyads. Maternal mental health was assessed with the Kessler-6, while sleep problems were assessed through a series of questions relating to common sleep problems in children. The results demonstrated significant bidirectional effects between maternal mental health and child sleep problems at key developmental transition time points. Specifically, when children transitioned from preschool to primary school and again when the children transitioned from primary school to high school. These findings highlight the need for increased support for both the child and mother at these critical time points to reduce the negative impact of maternal psychological distress on child sleep problems and vice versa. Lay abstract: Autistic children experience increased the rates of sleep problems. These sleep problems have been associated with mother’s mental health symptoms. However, the direction of these relationships is not well understood. This study investigated the relationships between autistic children’s sleep problems and mothers’ mental health over a 12-year period using data collected as part of the Longitudinal Study of Australian Children. Data from 397 autistic children and their mothers were included in this study. Mothers completed a questionnaire about their own mental health and common childhood sleep problems at four time points from 4–5 years to 14–15 years. The results showed important relationships between mothers’ mental health symptoms and child sleep problems at two time points. Specifically, (1) mothers’ mental health symptoms when the child was aged 4 to 5 years predicted child sleep problems at age 6 to 7 years; and (2) child sleep problems at age 12–13 years predicted mothers’ mental health symptoms when the child was aged 14 to 15 years. Interestingly, these significant relationships also coincide with key developmental transition time points, when the child is transitioning in and out of primary school. These findings highlight the need for increased support for both the child and mother at these times to optimise outcomes for both

Factors associated with the course of maternal fatigue across the early postpartum period

Background: Relatively little is known about the course and persistence of fatigue across the postpartum period, despite the potentially adverse effects fatigue has on maternal daily functioning, well-being, parenting behaviour and parent–child interactions. Objective: Using multi-wave data over a 4-month period in the postpartum, the present study sought to: (a) examine the course of maternal fatigue, and (b) identify a range of potentially modifiable individual and contextual factors associated with the course of fatigue over this time. Methods: Seventy mothers of infants aged between 0 and 7 months participated in the current study. To measure change over time and predictors of fatigue, latent growth curve analysis was used. Results: The results indicated that maternal fatigue at approximately three months postpartum was moderate to high, with little or no change in fatigue severity over time. Higher fatigue scores at three months postpartum were also significantly associated with younger maternal age, higher socioeconomic disadvantage, low self-efficacy to engage in health behaviours and poor sleep quality. Older maternal age and poor sleep quality were associated with stability of fatigue over time. Conclusions: Findings underscore the importance of identifying and supporting women experiencing high levels of fatigue in the first seven months postpartum. Additionally, findings highlight potential risk factors for initial and persistent fatigue, possibly allowing the identification of women who might be more vulnerable to fatigue. Implications for future research and practice are discussed

Risk factors associated with the mental health of fathers of children with an intellectual disability in Australia

Background: Raising a child with a disability places considerable demands and stress on parents, which can contribute to mental health difficulties. Research has primarily focused on mothers' mental health, and our understanding of the effects on fathers remains limited. The factors that place fathers at increased risk of mental health difficulties are also poorly understood. This study aimed to redress these gaps by reporting on the mental health of a large sample of fathers of children with an intellectual disability (ID) (aged 3-15 years), comparing this to published Australian norms and mothers of children with ID. The second aim of the study was to explore risk factors associated with fathers' mental health. Method: The data for this study come from 315 Australian fathers of children (aged 3-15 years) with ID, who participated in the large-scale evaluation of the Signposts for building better behaviour programme. Fathers completed a range of self-report questionnaires at baseline including the Depression Anxiety Stress Scale (DASS). Results: Fathers in the present sample reported significantly more symptoms of depression and stress than the Australian normative data, with approximately 6-8% reporting symptoms in the severe to extremely severe range. The strongest predictors of fathers' mental health difficulties were children's behaviour problems, daily stress arising from fathers' own needs and children's care needs, and low parenting satisfaction. Socio-economic factors did not predict mental health difficulties. Conclusion: This study is among one of the first to report the mental health of fathers of children with a disability in Australia. Findings highlight that some fathers of children with ID are at heightened risk of experiencing mental health difficulties, underscoring the importance of the provision of information and interventions to promote their mental health

Acceptability of Wide Awake Parenting: A psycho-educational intervention to manage parental fatigue

Objective: This article reports on the pilot evaluation of Wide Awake Parenting (WAP), a novel intervention to assist parents of young children to manage fatigue. It was trialled with parents of infants and children (aged 0-4 years) with sleep and settling problems. Background: Fatigue is a common health concern for parents of young children that has the potential to impact upon daily functioning, mental health and parenting. Methods: Forty-nine parents attending a residential parenting programme for child sleep problems participated in a pre-post evaluation of a workshop targeting the management of fatigue. Results: High acceptability and satisfaction of the workshop content and delivery was reported. Following participation in the workshop, parents reported a significant increase in their perceived importance, self-efficacy and intention to engage in self-care behaviours to manage fatigue. Conclusions: The results of this pilot are encouraging and provide initial support for WAP, and scope for further development and rigorous evaluation. © 2012 Copyright Society for Reproductive and Infant Psychology