Parental cognitive vulnerability during the perinatal period and its effect on mental health and the parent-infant relationship. Results from the NorBaby-study

Perinatal periode er en krevende overgang i livet, som medfører økt risiko for psykiske helseutfordringer. Nedsatt psykisk helse hos foreldrene utgjør risiko for foreldre-barn relasjonen og for barnets utvikling. Gjennom samspillet med sine omsorgsgivere utvikler barnet emosjonsregulering og sosiale ferdigheter. Foreldre som blir fanget i repeterende negative tanker kan ha lite kapasitet til å plukke opp barnets signaler. Videre kan foreldrenes egne negative barndomserfaringer virke negativt inn på deres holdninger til spedbarnet og foreldrerollen. En negativ oppmerksomhetsdreining kan føre til at foreldre henger seg mer opp i negative enn positive uttrykk hos spedbarnet. Målet for studiene i denne avhandlingen var å undersøke slike selvforsterkende mønstre hvor foreldrenes kognitive sårbarhet virker inn på foreldrenes egen psykiske helse, foreldre-barn relasjonen og på barnets utvikling. Deltagerne i NorBaby ble rekruttert under svangerskap og fulgt til 7 måneder etter fødsel. Både mødre og deres partnere ble invitert til å delta i studien. Det ble gjennomført tre målinger under svangerskap, og tre etter fødsel. Deltagerne besvarte spørreskjema og utførte kognitive tester. Etter fødsel ble i tillegg barnets regulering observert, og sosial tilbaketrekning ble vurdert ved undersøkelse av barnet. Resultatene viste at repeterende negative tanker henger sammen med foreldres mentale helse etter fødsel, og deres relasjon til barnet. Vi fant ikke signifikante effekter av andre kognitive faktorer, nemlig oppmerksomhet og implisitte holdninger. Flergangsmødre var mindre utsatt for depressive symptomer og foreldrestress, samt reguleringsvansker hos barnet og knyttet seg sterkere til barnet. For fedre derimot, så var det å ha barn fra før negativt for tilknytningen til den nyfødte, samt at det ikke virket inn på fedrenes egen helse eller barnets regulering. Sosial støtte blant familie og venner viste seg også som en viktig faktor for foreldrenes mentale helse i perinatal periode. Avhandlingen har implikasjoner for helsetjenester i perinatal periode. Repeterende negative tanker hos foreldre bør kartlegges. Hjelp til å redusere slike tanker kan ha positive ringvirkninger både for foreldrene og for deres relasjon til barnet. Helsetjenester bør bidra til å fremme sosialt nettverk rundt familier som venter barn, og være særlig bevisst på psykiske utfordringer hos førstegangsforeldre.The aim of the present thesis was to investigate thinking style and processing biases in expecting and new parents, and how this relates to their mental health, the parent-infant relationship, and infant development in the perinatal period. The perinatal period is one of the largest transitions in life and comes with increased risk of mental illness. Mental illness in the parents serve as a risk factor for the parent-infant relationship and infant development. To develop effectful interventions, understanding of the mechanisms that lead to illness is essential. Infants are dependent on their caregivers for healthy development. Through interaction with their caregivers the infant develops adaptive emotion regulation, and social skills. Parental mental illness could affect parents’ sensitivity and responsiveness to infant cues, and thereby negatively affect infant development. Being caught up in negative thoughts occupies cognitive capacity, and therefore might reduce the parental emotional availability. Further, adverse childhood experiences can have a negative effect on parents’ schemas and attitudes towards infants and the parental role. Biased attention can cause parents to notice more of the infant’s negative expressions and emotionality, which further can strengthen negative thoughts and attitudes towards the infant and parental role. Patterns like this, where vulnerability in the parents affects their own health, the parent-infant relationship and infant development, were of interest in the present thesis. The Northern Babies Longitudinal Study recruited participants in the commune of Tromso and followed them longitudinally throughout pregnancy and 7 months postnatally. Both mothers and their partners were invited to participate. There were three assessments during pregnancy, and three after birth. Participants answered a broad range of measurements, including cognitive tasks and questionnaires about their mental health, negative thoughts, adverse experiences, and sociodemographic information. After birth, the infant’s daily rhythm and regularity was observed, and signs of social withdrawal was assessed during neuropsychological screening of the infant. Results indicate that repetitive negative thoughts serve as a vulnerability trait in parents during the perinatal period, as they predict parental depressive symptoms and stress after birth, and the parent-infant relationship. Such thoughts can be identified already during pregnancy. We did not find significant relations between other cognitive factors, attentional bias and implicit attitudes, and parental health or parent-infant relationship. Further, parity was a clear protective factor for mothers, as it was related to lower levels of depressive symptoms and parenting stress, and infant regulatory problems. Parity was also related to stronger maternal bonding. In fathers, on the other hand, parity was negatively related to bonding, and did not significantly affect fathers’ mental health or infant regularity. Probably, this can be explained by the father’s engagement and responsibility for previous children during the early months after birth. Social support from friends and family also turned out as a significant protective factor for both mothers and fathers. The present thesis has important implications for perinatal health care services. Repetitive negative thoughts should be identified during pregnancy. Reduction of such thoughts could have a positive effect on parental mental health, as well as the parent-infant relationship. Perinatal health care services should also help facilitate social support for expecting parents, and be especially aware of the mental health of first-time parents

Do parental cognitions during pregnancy predict bonding after birth in a low-risk sample?

Parental bonding to their infant is important for healthy parent-infant interaction and infant development. Characteristics in the parents affect how they bond to their newborn. Parental cognitions such as repetitive negative thinking, a thinking style associated with mental health issues, and cognitive dispositions, e.g., mood-congruent attentional bias or negative implicit attitudes to infants, might affect bonding. To assess the influence of cognitive factors on bonding, 350 participants (220 pregnant women and their partners) were recruited over two years by midwives at the hospital and in the communal health care services. Participants were followed throughout the pregnancy and until the infant was seven months old as a part of the Northern Babies Longitudinal Study. Both mothers and fathers took part. First, we measured demographics, repetitive negative thinking, attentional bias, and implicit attitudes to infants during pregnancy, as predictors of bonding two months postnatally. Second, we also measured infant regulatory problems, and depressive symptoms at two months postnatally as predictors of parents’ perception of infant temperament at five months. Robust regression analyses were performed to test hypotheses. Results showed that mothers and fathers differed on several variables. Parity was beneficial for bonding in mothers but not for fathers. Higher levels of mothers’ repetitive negative thinking during pregnancy predicted weaker bonding, which was a non-significant trend in fathers. For fathers, higher education predicted weaker bonding, but not for mothers. Mothers’ perception of their infant temperament at five months was significantly affected by bonding at two months, but for fathers, their depressive symptoms were the only significant predictor of perceived infant temperament. In conclusion, for mothers, their relationship with their infant is essential for how they experience their infant, while for fathers their own wellbeing might be the most important factor. Health care providers should screen parents’ thoughts and emotions already during pregnancy to help facilitate optimal bonding

The Tromso Infant Faces Database (TIF): development, validation and application to assess parenting experience on clarity and intensity ratings

Source at http://dx.doi.org/10.3389/fpsyg.2017.00409 Newborns and infants are highly depending on successfully communicating their needs; e.g., through crying and facial expressions. Although there is a growing interest in the mechanisms of and possible influences on the recognition of facial expressions in infants, heretofore there exists no validated database of emotional infant faces. In the present article we introduce a standardized and freely available face database containing Caucasian infant face images from 18 infants 4 to 12 months old. The development and validation of the Tromsø Infant Faces (TIF) database is presented in Study 1. Over 700 adults categorized the photographs by seven emotion categories (happy, sad, disgusted, angry, afraid, surprised, neutral) and rated intensity, clarity and their valance. In order to examine the relevance of TIF, we then present its first application in Study 2, investigating differences in emotion recognition across different stages of parenthood. We found a small gender effect in terms of women giving higher intensity and clarity ratings than men. Moreover, parents of young children rated the images as clearer than all the other groups, and parents rated “neutral” expressions as more clearly and more intense. Our results suggest that caretaking experience provides an implicit advantage in the processing of emotional expressions in infant faces, especially for the more difficult, ambiguous expressions

Vurderingssamtaler – en gyllen mulighet for tillit og håp

Source at https://www.dagensmedisin.no/.Gjennom fokus på samvalg, mål og åpen dialog om hjelpebehov er vurderingssamtalen en gyllen mulighet for å skape tillit, engasjement og håp – og sikre at de kommer inn riktig dør til psykisk helsevern for barn og unge (PHBU)

Vurderingssamtaler – en gyllen mulighet for tillit og håp

Gjennom fokus på samvalg, mål og åpen dialog om hjelpebehov er vurderingssamtalen en gyllen mulighet for å skape tillit, engasjement og håp – og sikre at de kommer inn riktig dør til psykisk helsevern for barn og unge (PHBU)

Perceived Parenting Stress Is Related to Cardiac Flexibility in Mothers: Data from the NorBaby Study

Heart rate variability (HRV) is an indicator of autonomic nervous system activity, and high levels of stress and/or depressive symptoms may reduce HRV. Here, we assessed whether (a) parental stress affected HRV in mothers during the perinatal period and whether this is mediated by bonding and (b) whether antenatal maternal mental states, specifically repetitive negative thinking, depressive symptoms, and pregnancy-related anxiety, have an impact on infant HRV, and lastly, we investigated (c) the relationship between maternal HRV and infant HRV. Data are from the Northern Babies Longitudinal Study (NorBaby). In 111 parent–infant pairs, cardiac data were collected 6 months after birth. In the antenatal period, we used the Pregnancy-Related Anxiety Questionnaire—Revised, the Edinburgh Postnatal Depression Scale, and the Perseverative Thinking Questionnaire; in the postnatal period, we used the Parenting Stress Index and the Maternal Postnatal Attachment Scale. Higher levels of perceived parenting stress but not depressive symptoms were associated with lower HRV in mothers (τ = −0.146), and this relationship was not mediated by maternal bonding. Antenatal maternal mental states were not associated with infant HRV. There was no significant correlation between maternal HRV and infant HRV. Our observational data suggest that perceived stress reduces cardiac flexibility. Future studies should measure HRV and parenting stress repeatedly during the perinatal period

Emotional Infant Face Processing in Women With Major Depression and Expecting Parents With Depressive Symptoms

Processing of emotional facial expressions is of great importance in interpersonal relationships. Aberrant engagement with facial expressions, particularly an engagement with sad faces, loss of engagement with happy faces, and enhanced memory of sadness has been found in depression. Since most studies used adult faces, we here examined if such biases also occur in processing of infant faces in those with depression or depressive symptoms. In study 1, we recruited 25 inpatient women with major depression and 25 matched controls. In study 2, we extracted a sample of expecting parents from the NorBaby study, where 29 reported elevated levels of depressive symptoms, and 29 were matched controls. In both studies, we assessed attentional bias with a dot-probe task using happy, sad and neutral infant faces, and facial memory bias with a recognition task using happy, sad, angry, afraid, surprised, disgusted and neutral infant and adult faces. Participants also completed the Ruminative Responses Scale and Becks Depression Inventory-II. In study 1, we found no group difference in either attention to or memory accuracy for emotional infant faces. Neither attention nor recognition was associated with rumination. In study 2, we found that the group with depressive symptoms disengaged more slowly than healthy controls from sad infant faces, and this was related to rumination. The results place emphasis on the importance of emotional self-relevant material when examining cognitive processing in depression. Together, these studies demonstrate that a mood-congruent attentional bias to infant faces is present in expecting parents with depressive symptoms, but not in inpatients with Major Depression Disorder who do not have younger children

Early maladaptive schemas as predictors of maternal bonding to the unborn child

Background - The quality of an expectant mother’s bonding to the fetus has been shown to be associated with important developmental outcomes. Previous studies suggest that bonding quality is predicted by, for example, social support, psychological well-being, and depression. However, little is known regarding the role of maternal cognition in maternal-fetal bonding. Early maladaptive schemas (EMSs) are negative and stable assumptions about oneself and one’s relationships with others that are developed during childhood and adolescence. In the present study, we examined the associations between EMSs and the quality of the bonding to the fetus in expectant mothers. Methods - The present investigation is part of a larger study in which 220 pregnant women (approximately 12% of the pregnant women in the region) and 130 of their partners were recruited from October 2015 until December 2017. The sample for the current study comprised 165 pregnant women (mean age 30.8 years, SD 4.1 years). The participants completed the Young Schema Questionnaire Short Form 3 (YSQ-S3) between gestational weeks 24 and 37 and the Maternal Antenatal Attachment Scale (MAAS) and the Edinburgh Postnatal Depression Scale (EPDS) between gestational weeks 31 and 41. Results - All EMS domains correlated significantly and negatively with scores for quality of maternal-fetal bonding on the MAAS. Only the Disconnection and Rejection domain correlated significantly and negatively with MAAS scores for intensity of preoccupation with the fetus. The Disconnection and Rejection domain was a significant independent predictor of the quality of maternal-fetal bonding. Symptoms of depression mediated the effect of the EMS domains on the quality of maternal-fetal bonding. The EMS domains Disconnection and Rejection, Impaired Autonomy and Performance, and Impaired Limits showed significant direct effects on bonding quality. Conclusions - EMSs are related to expectant mothers’ self-reported bonding to their fetuses. This association was mediated by the mothers’ symptoms of depression. The results may have implications for the early identification of pregnant women at risk of bonding difficulties and encourage more studies on cognitive schemas and mechanisms for maternal-fetal bonding

Adult attachment style and maternal-infant bonding: the indirect path of parenting stress

Background - The quality of maternal-infant bonding is related to important child outcomes. The literature has assumed that the ability to form relationships is a relatively stable trait, and research studies have suggested that a mother’s attachment style in close adult relationships is related to mother-infant bonding. The transition to parenthood is also often stressful, and the adult attachment style may relate to parenting stress in the first year after birth. Such stress could possibly have a negative relationship with the mother-infant bond. In the present study, we examined the associations between maternal adult attachment styles and the quality of mother-infant bonding and whether this relationship is mediated by parenting stress. Methods - The present study sample comprised 168 women (mean age 31.0 years, SD 4.23 years). Between weeks 31 and 41 of gestation, the anxious and avoidant adult attachment dimensions were measured with the Experiences in Close Relationships questionnaire (ECR). Between 5 and 15 weeks after birth mother-infant bonding and parenting stress were measured with the Maternal Postnatal Attachment Scale (MPAS) and the Parenting Stress Index-Parent Domain (PSI-PD), respectively. Results - Both attachment-related avoidance and attachment-related anxiety correlated significantly and negatively with mother-infant bonding. However, a regression analysis showed that only attachment-related avoidance was a significant predictor of mother-infant bonding when controlling for demographic variables and maternal mental health history. The relationship between the adult attachment style and bonding was mediated by parenting stress. Higher scores on attachment avoidance and anxiety were related to increased stress, which was related to decreased quality of bonding. The overall parent domain and the subscale of competence in the parent-related stress dimension mediated between attachment avoidance and bonding, and the overall parent domain and the subscales of competence and role restriction mediated between attachment anxiety and bonding. There was no direct relationship between the adult attachment style and mother-infant bonding when parenting stress was included as a mediator. Conclusions - This study illustrates that maternal adult attachment style relates to mother-infant bonding. This relationship was mediated by parenting stress. The results may have implications for the early identification of mothers at risk of having bonding difficulties

The role of early adversity and cognitive vulnerability in postnatal stress and depression

Abstract The purpose of the present study was to examine vulnerability factors in expecting parents that might lead to mental illness in the perinatal period. Specifically, we studied how parental early adversity, attentional bias to infant faces, repetitive negative thinking, and demographic factors, were associated with pre- and postnatal depressive symptoms and parenting stress. Participants were expecting parents taking part in the Northern Babies Longitudinal Study, where assessments were made both pre- and postnatally. Assessments included both questionnaires and cognitive tasks. About half of the participants received the Newborn Behavior Observation (NBO)-intervention after birth, between pre- and postnatal assessments. Results show that repetitive negative thinking was a significant predictor of both depressive symptoms and parenting stress, while education, social support, and parity came out as protective factors, especially in mothers. Parental early adversity had an indirect effect on postnatal depressive symptoms and parenting stress, mediated by prenatal and postnatal depressive symptoms, respectively. The NBO intervention did not affect the results, signifying the importance of early childhood adverse events and negative thinking on parents' postnatal adjustment and mood, even when an intervention is provided. In conclusion, repetitive negative thinking is a significant vulnerability factor independent of the presence of depressive symptoms, and health professionals must be aware of parents’ thinking style both during pregnancy and after birth