How Do Maternal Subclinical Symptoms Influence Infant Motor Development during the First Year of Life?

An unavoidable reciprocal influence characterizes the mother-child dyad. Within this relationship, the presence of depression, somatization, hostility, paranoid ideation, and interpersonal sensitivity symptoms at a subclinical level and their possible input on infant motor competences has not been yet considered. Bearing in mind that motor abilities represent not only an indicator of the infant\u2019s health-status, but also the principal field to infer his/her needs, feelings and intentions, in this study the quality of infants\u2019 movements were assessed and analyzed in relationship with the maternal attitudes. The aim of this research was to investigate if/how maternal symptomatology may pilot infant\u2019s motor development during his/her first year of life by observing the characteristics of motor development in infants aged 0\u201311 months. Participants included 123 mothers and their infants (0\u201311 months-old). Mothers\u2019 symptomatology was screened with the Symptom Checklist-90-Revised (SCL-90-R), while infants were tested with the Peabody Developmental Motor Scale-Second Edition. All dyads belonged to a non-clinical population, however, on the basis of SCL-90-R scores, the mothers\u2019 sample was divided into two groups: normative and subclinical. Descriptive, t-test, correlational analysis between PDMS-2 scores and SCL-90-R results are reported, as well as regression models results. Both positive and negative correlations were found between maternal perceived symptomatology, Somatization (SOM), Interpersonal Sensitivity (IS), Depression (DEP), Hostility (HOS), and Paranoid Ideation (PAR) and infants\u2019 motor abilities. These results were further verified by applying regression models to predict the infant\u2019s motor outcomes on the basis of babies\u2019 age and maternal status. The presence of positive symptoms in the SCL-90-R questionnaire (subclinical group) predicted good visual-motor integration and stationary competences in the babies. In particular, depressive and hostility feelings in mothers seemed to induce an infant motor behavior characterized by a major control of the environmental space. When mothers perceived a higher level of hostility and somatization, their babies showed difficulties in sharing action space, such as required in the development of stationary positions and grasping abilities. In a completely different way, when infants can rely on a mother with low-perceived symptoms (normative group) his/her motor performances develop with a higher degree of freedom/independence. These findings suggest, for the first time, that even in a non- clinical sample, mother\u2019s perceived-symptoms can produce important consequences not in infant motor development as a whole, but in some specific areas, contributing to shape the infant\u2019s motor ability and his/her capability to act in the world

The relationship between parental mentalization and maternal psychopathology: during and after postpartum period

Aims: This review aimed to evaluate the literature that examines factors (maternal age, ethnicity, antenatal depressive symptoms and support) in relation to Postpartum Depressive (PPD) symptomatology in adolescent mothers. Methods: A systematic literature search was conducted using databases PsychINFO, MEDLINE, EMBASE, CINAHL and Maternity and Infant Care. After inclusion and exclusion criteria were applied, 17 studies were identified as suitable for this review. Results: Results showed antenatal depressive (AND) symptoms and support to be associated with PPD symptoms, but not maternal age or ethnicity. Studies highlighted parental competence and conflict as potentially accounting for the relationship between support and PPD symptoms. Contributing factors to this relationship were relationship status, living arrangement, antenatal expectation and socioeconomic status. Due to most studies being part of a larger project, a broad range of other variables were measured often with limited rationale for their inclusion. Conclusion: The current literature indicates AND symptoms and support are related to PPD symptoms. However, there remains a lack of specificity to these relationships. Further research is needed to improve our understanding of the interaction between the relevant factors involved

Prenatal Attachment and Perinatal Depression: A Systematic Review

Pregnancy is a period of complex bio-psychological changes, during which the development of an attachment bond to the fetus takes on a central role. Depressive symptoms are common during this period. Both symptoms of depression and low levels of prenatal attachment are related to negative outcomes in caregivers and infants. Following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement, this systematic review analyzes and systematizes 41 studies concerning the association between prenatal attachment and perinatal depression. The majority of the studies reported a significant association between the two. Specifically, prenatal depressive symptoms were found to be negatively associated with prenatal attachment. Furthermore, lower levels of prenatal attachment were related to higher postnatal depressive symptoms, although fewer studies assessed this association. While these results were found across different populations, conflicting findings emerged, suggesting they should be interpreted with caution, particularly in male samples and in non-normative pregnancies (e.g., high-risk pregnancies, medically assisted pregnancies, and pregnancies with previous perinatal losses). These results are clinically important for the perinatal screening process and for implementing preventive and treatment programs. However, future studies are needed to further confirm and generalize these results

The functions of postpartum depression

Evolutionary approaches to parental care suggest that parents will not automatically invest in all offspring, and should reduce or eliminate investment in their children if the costs outweigh the benefits. Lack of paternal or social support will increase the costs born by mothers, whereas infant health problems will reduce the evolutionary benefits to be gained. Numerous studies support the correlation between postpartum depression (PPD) and lack of social support or indicators of possible infant health and development problems. PPD may be an adaptation that informs mothers that they are suffering or have suffered a fitness cost, that motivates them to reduce or eliminate investment in offspring under certain circumstances, and that may help them negotiate greater levels of investment from others. PPD also appears to be a good model for depression in general

Risk Factors in the Development of Postnatal Anxiety Symptomatology

ABSTRACT Objectives: Research into postpartum psychopathology has focused largely on depression and only more recently has it been recognised that postnatal anxiety requires its own systematic research. As yet, only a limited number of studies have investigated interpersonal risk factors in relation to postnatal anxiety. This study aimed to further investigate the role of these factors by using a prospective design and standardised measures. Attachment theory is presented as a theoretical framework. It has been debated whether anxiety symptoms in the postpartum should be understood as a feature of postnatal depression, or as a separate clinical entity. This study used the DASS-21, a measure with good discriminant validity, to enable comparison of the risk factors in relation to depression and anxiety symptomatology. Design: Using a prospective design, 81 women were assessed in the third trimester of pregnancy and at approximately 12 weeks postpartum. At Time 1 participants completed measures of social support, relationship satisfaction, adult attachment anxiety, and experiences of parents in childhood. At Time 2 postnatal anxiety and depression symptomatology was assessed. Results: Significant associations were found between postnatal anxiety symptomatology and the majority of the interpersonal variables. In regression analyses these explained 12% of the variance in postnatal anxiety symptomatology. A similar pattern of associations was found for postnatal depression symptomatology, but only 6% of the variance in scores was explained. iii Conclusions: Despite limitations, this study provides preliminary evidence of the contribution of interpersonal risk factors to the development of postnatal anxiety symptomatology, and support for the attachment theory perspective. This indicates the potential importance of interventions that focus on interpersonal relationships. A low rate of comorbidity with depression symptomatology, and differences in the regression models, appear to support the view of postnatal anxiety and depression as being distinct but closely related. Further research is needed with more representative samples

Maternal Child Attachment and Perinatal Depression

ABSTRACT Traditionally, pregnancy has been thought of as a period of well-being and happiness. The pregnancy state itself has been thought to protect women from depression. However, women of child-bearing age frequently suffer from major depression. Approximately 10 to 15% of women experience a clinically significant major depressive episode during pregnancy or the early postpartum period. These prevalences predominantly reflect rates of depressive symptoms in developed countries; there is evidence that rates of depression change aspect widely in non-developed countries. In addition to the distress and impairment experienced by depressed women, depression during this time period is associated with further adverse outcomes for both mother and child. Women who experience perinatal depressive episodes are at increased risk for subsequent episodes of both postpartum and non-postpartum depression. Anxiety symptoms are frequently reported by pregnant women and are often considered as part of the normal psychic experiences of pregnancy, especially if they are focused on the baby's health or on future maternal competencies. The emotional image of the baby inside is what is called the mother fetus relationship. Cranley (1981) describes the nature of mother’s experiences as ‘physical and kinesthetic awareness of the fetus’, and an ‘intellectual knowledge of her child’. Nowadays, the concept of prenatal attachment is more accurately defined and it generally refers to the maternal–fetal relationship, which normally develops during the pregnancy; it represents the earlier internalized representation of the fetus that both parents typically acquire and elaborate. Pregnancy can also represent a crisis period for many women, with manifest effect on antenatal attachment. Condon and Corkindale (1997) explore the hypothesis that feelings of anxiety or depression and lack of social support would be an interference issue in the development of maternal antenatal attachment. Women characterized by low attachment are associated with high levels of depression and anxiety, weak external social support, and high control and criticism in the partner relationship. Antepartum depression is also common in women with a history of depressive illness, such that some researchers now believe pregnancy to be a risk factor for a mood disorder in those with such a history. Despite the prevalence of depression during pregnancy and the growing body of literature associated with its treatment, whether pharmacologic or otherwise, large numbers of women are untreated. Also “parental-fetal attachment” or perinatal term has been created to define the specific bond that parents develop towards the fetus during pregnancy. Since Winnicott’s (1958) concept of a pregnant woman’s “primary maternal preoccupation”, the quality of the parent-prenatal emotional bond has been considered as particularly important for the subsequent attachment relationship and for the infant’s psychological development. In 1981 Cranley defined the “maternal-fetal attachment” construct and created a tool to measure it. The author describes the nature of mother’s experiences as ‘physical and kinesthetic awareness of the fetus’, and an ‘intellectual knowledge of her child’. Nowadays a specific field of research which studies the characteristics of the emotional bond which parents-to-be develop is progressively growing. Some aspects of current knowledge relating to development of prenatal attachment and the implication of low levels of prenatal attachment and risk to the fetus, is considered in this study. Aim of the study: The aim of this study was to assess the quality of maternal child attachment on mothers enrolled in post partum during the first month after delivery .The sample has been compared with a group of women enrolled during the first month of pregnancy and followed for twelve months like the sample of the previous study. Furthermore, we investigated the differences between the women enrolled in first month of pregnancy and after delivery. We tried to find a correlation looking at score on maternal attachment scale (MAAS) and a possible development of depression (EPDS ≥12), anxiety symptoms (STAI-Y ≥40). Even risk factors during pregnancy has been evaluated to assess the specific role of antenatal attachment as risk factor for depression (EPDS≥12), as anxiety symptoms (STAI ≥ 40) during pregnancy. . Methods: The PND-ReScU II® study is a naturalistic longitudinal study deputated to found risks factors and a possible role of psychiatric and psychopathological prevention on perinatal disorders. This study has been performed in five Clinical Center in Tuscany (Italy) in cooperation with U.O. II Department of Psychiatry and Gynecology Department of the Azienda Ospedaliera Universitaria Pisana (AOUP). Women has been randomized and enrolled in the study during pregnancy on the first month and on the first month after delivery. From January to August 2010 a sample of women (N= 946) by the Perinatal Research and Screening Unit (PND-ReScU). The Perinatal Depression-Research and Screening Unit (PND-ReScU) is based on an ongoing collaboration between the Department of Obstetrics and Gynecology and the Department of Psychiatry, Neurobiology, Pharmacology, and Biotechnologies of the AUOP. The primary aim of the PND-ReScU was to evaluate the effectiveness of screening for early identification and the intervention strategies to reduce and treat mood disorders in the perinatal period. Furthermore, PND-ReScU aims were looking for individualized a battery of instruments that can be easily administered in a primary prevention setting. Women were recruited for the study during pregnancy, at the time of delivery of the pregnancy book, or in the immediate post-partum period (during hospitalization). To have a significative relevance it was estimated to enroll 320 women during post partum period and 320 women during pregnancy. In June 2010, 491 women were recruited during post partum and at the end of August 2010 there were enrolled 455 women during pregnancy. Instruments: Symptoms of maternal depression were assessed using the 10-item Edinburgh Postnatal Depression Scale (Cox et al., 1987). The Post-partum Depression Predictors Inventory-Revised (PDPI-R) (Beck, 2002) was used to identify the risk factors for PPD. Prenatal and postnatalmaternal attachment were assessed using the Maternal Antenatal Attachment Scale (MAAS) and Maternal and paternal antenatal attachment scale (MPAS). Anxiety symptoms were assessed using STAI-Y ( State Trait Anxiety Inventory form Y-1.) Statistical analysis: Data are presented as means (standard deviations), or percentages. Chi-square tests were used to compare percentages and ANOVA were used to compare mean scores. Using analysis of variance (ANOVA) was able to compare two groups of data comparing the internal variability in these groups with the variability between groups. To check the intensity and direction of the relationships between depression and maternal attachment to the fetus and risk factors, was performed Pearson bivariate correlation. Analyses were conducted using SPSS, version 15. Results: Eligible women were 1363 , 455 (48%) recruited during pregnancy and 491 (52%) during post partum; among them, 417 (30,6%) refusedto partecipate in the study. The mean age in the first group G1 is 32.75± 4,84 and in the second gropu G2 is 33.39±4,81 years old, and in unrolled women (G3) is 32.5 ± 5.7 years old. Other sociodemographic variabilites had been evaluated and χ2 has been performed test fo find significant differences among the three groups. Most of the women of the three groups were married (G 1: n=381, 90.9%; G 2: n=389, 89.8%; G3 n=353, 87.2%); there were no differences in the groups (χ2= 8.48; p=0.01). Looking at the sample most part of women had Italian nationality bwhile unenrolled women showed almosty foreign nationality (χ2= 63.12*, p< 0,01) . 61.6% of the sample is composed of women at the first pregnancy. A comparison between the scales administered for the two groups ( G1, G2) was performed at the first month of post partum period at T4 during the first month of pregnancy ( G1,T4; G2 T4 bis). The EPDS mean score s were 3,37 (±3,37) in the first group and the second group scored 6,3(±4,2; p=0.01) , the STAI mean scores were 45,4(±3,8) and 44,6(±3,7) in G1 and G2 respectively. The PDPI-R mean scores were 27,5(±2,8) in G1 and 3,83 (±3,2) in G2 (p<.003) during pregnancy and 3.5 (±3.4) in G1 and 4.95(3,6) in G2 (p<.001) during post partum. The average of the MAAS total scores at T2 ( 6° month of pregnancy) was 76.95 ± 6.3, while at T3( 8° month of pregnancy) , the average was 78.54 ± 6.29. Considering the MAAS T2 Preoccupation subscale the average is 28.12 ± 4.2 and 29.33 ± 4.21 at T3. Considering the Quality of Attachment subscale MAAS, the average was 47.2 ± 3.29, and 47.71 ± 2.98 at T2 and T3 respectively. Correlation between depression during pregnancy, good antenatal attachment , anxiety symptoms and risk factors is reported for PDD during pregnancy In our sample we don’t find any association between antenatal maternal attachment and demographic characteristics except for women in their first pregnancy in which we discover higher MAAS scores than other women in sample. Conclusions: In the last five decades the study on the maternal attachment show a primary role for the future development of the newborn. For this reason it is essential that treatment providers in obstetric offices, primary care settings, and mental health clinics be attuned to the signs of anxiety disorders (Weisberg and Paquette, 2002). In our research we try to find the consequences of depression on newborns. We find a negative relationship between the develop of a attachment and depressive symptoms during pregnancy . The quality of attachment in this record seems to be poor in mothers with depression and more risks factor for PDD during pregnancy. In particular, as regards the analysis of the qualitative aspects of attachment in the second and third trimesters of pregnancy, the data confirmed a negative correlation between attachment, depressive symptoms and risk factors for the whole period of pregnancy. Analysis of data for the period following childbirth, we found that women enrolled in the first month post-partum have an increased vulnerability to risk factors for developing postpartum depression than women enrolled in the first month of pregnancy , both with respect to the period of pregnancy (p <.003) that the postpartum period (p <.001); probably early screening and the role of caregivers in this study may have acted as protective factors. Women enrolled in post-partum seem to have a different perception about respect to family support, support from friends and the partner, and seem to experienced higher difficulties regarding health problems, sleep and temperament in the newborn. The women in group 2, as assumed from the data of PDPI-R, were significantly more depressed than in group 1, presenting an attachment toward their child's worst than the first group. Preliminary data of our study, which appear to be the first, to our knowledge, because explores both pregnant and post-partum periods, seem to confirm this assumption and emphasize the importance of an early screening of depressive phenomenal at the earliest stages of pregnancy

Examining the relationship between maternal childhood abuse history and mother-infant bonding : The mediating roles of postpartum depression and maternal self-efficacy

Background The detrimental effects of childhood abuse on long-term outcomes are well-known, however few studies have examined these effects in the context of postpartum psychopathology, maternal self-efficacy, and mother-infant bonding quality. Objective This study aimed to examine the relationship between a maternal childhood abuse experience (i.e., physical, psychological, and sexual) and mother-infant bonding disturbances, and whether this relationship was mediated by postnatal depression symptomatology and maternal self-efficacy. Method A sample of 191 postpartum women (Mage = 32.88, SD = 4.20) recruited online from the general population completed self-report measures of the constructs of interest. Results Postnatal depression symptomatology and maternal self-efficacy were found to fully mediate the relationship between psychological child abuse experience and mother-infant bonding disturbances (β = 0.06, SE = 0.03, 95% CI: 0.01, 0.12). Postnatal depression symptomatology (but not maternal self-efficacy) was an independent mediator between psychological child abuse experience and mother-infant bonding (β = 0.07, SE = 0.03, 95 % CI: 0.01, 0.13). After inclusion of other abuse types as covariates in the analyses, the findings for maternal child physical abuse attenuated to non-significance. Child sexual abuse was not associated with the mediating or outcome variables, highlighting the issue of disclosure despite the anonymous online environment. Conclusion This study highlights the negative impact of psychological childhood abuse experience on the quality of the mother-infant bond during the postpartum period and potential pathways that underlie this relationship. This study also draws attention to the need to recognize comorbidity of abuse types in research