Psychosocial predictors of postnatal anxiety and depression: Using Structural Equation Modelling to investigate the relationship between pressure to breastfeed, healthcare professional support, postnatal guilt and shame, and postnatal anxiety and depression within an infant feeding context

In high income settings, high perceived pressure to breastfeed and poor perceived quality of healthcare professional support have been associated with early breastfeeding cessation, guilt, and shame. This is important because guilt and shame significantly predict postnatal anxiety and depression. No previous attempts have been made to provide quantitative evidence for relationships mapped between the postnatal social context, infant feeding method, and emotional wellbeing outcomes. The current study aimed to empirically investigate aforementioned pathways. Structural equation modelling was applied to survey data provided online by 876 mothers. Guilt and shame both significantly predicted anxiety and depression. Poor healthcare professional support and high pressure to breastfeed increased anxiety and depression, and these effects were explained by indirect pathways through increases in guilt and shame. Formula feeding exclusivity was negatively correlated with postnatal anxiety symptoms. This finding may be explained by feelings of relief associated with observed infant weight gain and being able to share infant feeding responsibilities with others e.g., one’s partner. This relationship, however, was counterbalanced by an indirect pathway where greater formula feeding exclusivity positively predicted guilt, which in turn increased postnatal anxiety score. While guilt acted as mediator of infant feeding method to increase postnatal depression and anxiety, shame acted independently of infant feeding method. These identified differences provide empirical support for the transferability of general definitions of guilt (i.e., as remorse for having committed a moral transgression) and shame (i.e., internalisation of transgressive remorse to the self), to an infant feeding context. Recommendations for healthcare practitioners and the maternal social support network are discussed

Attempting to prevent postnatal depression by targeting the mother–infant relationship: a randomised controlled trial

Aim: The purpose of the study was to investigate whether a supportive psychotherapeutic intervention which focussed on enhancing the quality of the other-infant relationship would prevent the development of postnatal depression (PND) and the associated impairments in parenting and adverse effects on child development. Background: Recent meta-analytic examinations report a modest preventive effect of psychological treatments for women vulnerable to the development of postnatal depression. However, given the strong evidence for an impact of PND on the quality of the mother-infant relationship and on child development, it is notable that there are limited data on the impact of preventive interventions on these outcomes. This is clearly a question that requires research attention. Accordingly, a randomized controlled trial was conducted of such a preventive intervention. Methods: A large sample of pregnant women was screened to identify those at risk of PND. 91 were randomly assigned to the index intervention and received home visits from research health visitors, and 99 were assigned to a control group who received normal care. In an adjacent area 76 women received the index intervention from trained NHS health visitors. The index intervention involved 11 home visits, two antenatally and nine postnatally. They were supportive in nature, with specific measures to enhance maternal sensitivity to infant communicative signals. Independent assessments were made at18 weeks postpartum, and at 12 and 18 months postpartum of maternal mood, maternal sensitivity in mother-infant engagement, and infant behaviour problems, attachment and cognition. Findings: The index intervention, whether delivered by research or NHS health visitors, had no discernible impact on maternal mood or the quality of the maternal parenting behaviours. Neither did it benefit the infant outcomes assessed. For girl children a benefit of the intervention was found for cognitive development. Overall the findings indicate that this approach to preventing PND cannot be recommended

Longitudinal association between child emotion regulation and aggression, and the role of parenting: a comparison of three cultures

Background: The ability to regulate emotions is a key developmental achievement acquired during social interactions and associated with better behavioral and social outcomes. We examined the influence of culture on child emotion regulation (ER) and aggression and on early parenting practices, and the role of parenting in child ER. Methods: We assessed 48 mother-infant dyads from three cultures (1 UK, 2 South African) at infant age of 3 months for maternal sensitivity during face-to-face interactions and responses to infant distress during daily life, and at 2 years for child ER strategies and maternally reported aggression. Results: There were cultural differences in child ER, and these were associated with differences in levels of aggression. Maternal strategies in response to early infant distress also differed by culture and predicted later child ER. Maternal sensitivity during face-to-face interactions was not associated with culture and showed no clear relationship with child ER. Conclusion: Cultural differences in maternal responses to infant distress mediated differences in child ER that are, in turn, related to differences in child aggression

Beyond aerodigestion: exaptation of feeding-related mouth movements for social communication in human and non-human primates

Three arguments are advanced from human and non-human primate infancy research for the exaptation of ingestive mouth movements (tongue-protrusion and lip-smacking) for the purposes of social communication: Their relation to affiliative behaviours; their sensitivity to social context; and their role in social development. Although these behaviours may have an aerodigestive function, such an account of their occurrence is only partial

Similarities and differences in the functional architecture of mother-infant communication in rhesus macaque and British mother-infant dyads

Similarly to humans, rhesus macaques engage in mother-infant face-to-face interactions. However, no previous studies have described the naturally occurring structure and development of mother-infant interactions in this population and used a comparative-developmental perspective to directly compare them to the ones reported in humans. Here, we investigate the development of infant communication, and maternal responsiveness in the two groups. We video-recorded mother-infant interactions in both groups in naturalistic settings and analysed them with the same micro-analytic coding scheme. Results show that infant social expressiveness and maternal responsiveness are similarly structured in humans and macaques. Both human and macaque mothers use specific mirroring responses to specific infant social behaviours (modified mirroring to communicative signals, enriched mirroring to affiliative gestures). However, important differences were identified in the development of infant social expressiveness, and in forms of maternal responsiveness, with vocal responses and marking behaviours being predominantly human. Results indicate a common functional architecture of mother-infant communication in humans and monkeys, and contribute to theories concerning the evolution of specific traits of human behaviour

Maternal gaze to the infant face: effects of infant age and facial configuration during mother-infant engagement in the first nine weeks

Background Adult gaze plays an important role in early infant development, and infants are highly sensitive to its presence and direction. Little is known, however, about how adults look at infants while interacting with them. Using eye-tracking technology, this study investigated maternal gaze during naturalistic interactions, and how it was influenced by infant age, focusing on the transition from the first to the second month when social expressiveness emerges, and by infant facial configuration, focusing on the effect of cleft lip. Methods Thirty infants (10 with a cleft lip), and their mothers, were seen at 1, 3, 5, 7, and 9 weeks. Mothers were asked to interact with their infants while wearing eye-tracking glasses. Fixation duration and count were calculated for general (infant face, body, and surrounding environment), and infant facial (eyes, mouth, other) areas. Results At all ages, mothers gazed almost exclusively towards their infant’s face, but this was reduced in the presence of a cleft lip. Within the infant’s face, the eyes attracted the greatest attention, for all mothers, at all ages. From the first to the second month, all mothers increased their visual attention towards their infant’s mouth. Regardless of infant age, the presence of a cleft lip was associated with decreased maternal gaze to the infant’s mouth. Conclusions This study provides novel findings concerning maternal gaze to infant faces during naturalistic interactions. Maternal gaze changes with infant age, in line with established shifts in social development, and according to infant facial configuration. Decreased gaze to the mouth area associated with infant cleft lip might affect maternal responsiveness, and suggests new dimensions to target in supporting these mothers

The effects of maternal mirroring on the development of infant social expressiveness: the case of infant cleft lip

Parent-infant social interactions start early in development, with infants showing active communicative expressions by just two months. A key question is how this social capacity develops. Maternal mirroring of infant expressions is considered an important, intuitive, parenting response, but evidence is sparse in the first two months concerning the conditions under which mirroring occurs and its developmental sequelae, including in clinical samples where the infant’s social expressiveness may be affected. We investigated these questions by comparing the development of mother-infant interactions between a sample where the infant had cleft lip and a normal, unaffected, comparison sample. We videotaped dyads in their homes five times from one to ten weeks and used a microanalytic coding scheme for maternal and infant behaviours, including infant social expressions, and maternal mirroring and marking responses. We also recorded maternal gaze to the infant, using eye-tracking glasses. Although infants with cleft lip did show communicative behaviours, the rate of their development was slower than in comparison infants. This group difference was mediated by a lower rate of mirroring of infant expressions by mothers of infants with cleft lip; this effect was, in turn, partly accounted for by reduced gaze to the infant’s mouth, although the clarity of infant social expressions (indexed by cleft severity) and maternal self-blame regarding the cleft were also influential. Results indicate the robustness of parent-infant interactions but also their sensitivity to specific variations in interactants’ appearance and behaviour. Parental mirroring appears critical in infant social development, likely supported by the mirror neuron system and underlying clinical and, possibly, cultural differences in infant behaviour. These findings suggest new avenues for clinical intervention

The social and healthcare professional support drawn upon by women antenatally during the COVID-19 pandemic:A recurrent, cross-sectional, thematic analysis

Objective: To explore antenatal experiences of social and healthcare professional support during different phases of social distancing restriction implementation in the UK. Design: Semi-structured interviews were conducted via telephone or video-conferencing software between 13 July 2020 – 2 September 2020. Interviews were transcribed and a recurrent, cross-sectional, thematic analysis was conducted. Participants: Twelve antenatal women were interviewed during UK social distancing restrictions (Timepoint 1; T1) and a separate sample of twelve women were interviewed in the initial easing of these restrictions (Timepoint 2; T2). Findings: T1 themes were: ‘Maternity care as non-essential’ and ‘Pregnancy is cancelled’. T2 themes were: ‘Technology is a polarised tool’ and ‘Clinically vulnerable, or not clinically vulnerable? That is the question’. Key conclusions: At T1, anxieties were ascribed to the exclusion of partners from routine care, and to perceived insensitivity and aggression from the public. For T2, insufficient Governmental transparency led to disillusionment, confusion, and anger. Covert workplace discrimination also caused distress at T2. Across timepoints: deteriorated mental wellbeing was attributed to depleted opportunities to interact socially and scaled back maternity care. Implications for practice: Recommendations are made to: protect maternal autonomy; improve quality of mental health and routine care signposting; prioritise parental community support in the re-opening of ‘non-essential’ services; prioritise the option for face-to-face appointments when safe and legal; and protecting the rights of working mothers.</p

Socially anxious mothers’ narratives to their children, and their relation to child representations and adjustment

Anxious mothers’ parenting, particularly transfer of threat information, has been considered important in their children’s risk for social anxiety disorder (SAnxD), and maternal narratives concerning potential social threat could elucidate this contribution. Maternal narratives to their pre-school 4-5 year-old children, via a picture book about starting school, were assessed in socially anxious (N=73), and non-anxious (N=63) mothers. Child representations of school were assessed via Doll Play (DP). After one school term, mothers (CBCL) and teachers (TRF) reported on child internalizing problems, and child SAnxD was assessed via maternal interview. Relations between these variables, infant behavioral inhibition, and attachment, were examined. Socially anxious mothers showed more negative (higher threat attribution), and less supportive (lower encouragement) narratives, than controls, and their children’s DP representations, SAnxD and CBCL scores were more adverse. High narrative threat predicted child SAnxD; lower encouragement predicted negative child CBCL scores and, particularly for behaviorally inhibited children, TRF scores and DP representations. In securely attached children, CBCL scores and risk for SAnxD were affected by maternal anxiety and threat attributions, respectively. Low encouragement mediated the effects of maternal anxiety on child DP representations, and CBCL scores. Maternal narratives are affected by social anxiety, and contribute to adverse child outcome

Psychosocial experiences of postnatal women during the COVID-19 pandemic. A UK-wide study of prevalence rates and risk factors for clinically relevant depression and anxiety

Background When the vulnerabilities of the postnatal period are combined with the impact of the COVID-19 pandemic, psychosocial outcomes are likely to be affected. Specifically, we aim to: a) explore the psychosocial experiences of women in the early postnatal period; b) describe prevalence rates of clinically-relevant maternal anxiety and depression; and c) explore whether psychosocial change occurring as a result of COVID-19 is predictive of clinically-relevant maternal anxiety and depression. Methods A sample of UK mothers (N=614) with infants aged between birth and twelve weeks were recruited via convenience sampling. A cross-sectional survey design was utilised which comprised demographics, COVID-19 specific questions, and a battery of validated psychosocial measures, including the EPDS and STAI-S which were used to collect prevalence rates of clinically relevant depression and anxiety respectively. Data collection coincided with the UK government\u2019s initial mandated \u201clockdown\u201d restrictions and the introduction of social distancing measures in 2020. Findings Descriptive findings from the overall sample indicate that a high percentage of mothers self-reported psychological and social changes as a result of the introduction of social distancing measures. For women who reported the presence of psychosocial change, these changes were perceived negatively. Whilst seventy women (11.4%) reported a current clinical diagnosis of depression, two hundred and sixty-four women (43%) reported a score of 6513 on the EPDS, indicating clinically relevant depression. Whilst one hundred and thirteen women (18.4%) reported a current clinical diagnosis of anxiety, three hundred and seventy-three women (61%) reported a score of 6540 on STAI-S, indicating clinically relevant anxiety. After accounting for current clinical diagnoses of depression or anxiety, and demographic factors known to influence mental health, only perceived psychological change occurring as a result of the introduction of social distancing measures predicted unique variance in the risk of clinically relevant maternal depression (30%) and anxiety (33%). Interpretation To our knowledge, this is the first national study to examine the psychosocial experiences of postnatal women during the COVID-19 pandemic in the UK. Prevalence rates of clinically relevant maternal depression and anxiety were extremely high when compared to both self-reported current diagnoses of depression and anxiety, and pre-pandemic prevalence studies. Perceived psychological changes occurring as a result of the introduction of social distancing measures predicted unique variance in the risk for clinically relevant maternal depression and anxiety. This study provides vital information for clinicians, funders, policy makers, and researchers to inform the immediate next steps in perinatal care, policy, and research during COVID-19 and future health crises