Impact of perinatal asphyxia on parental mental health and bonding with the infant: a questionnaire survey of Swiss parents

Objective To compare current mental health symptoms and infant bonding in parents whose infants survived perinatal asphyxia in the last 2 years with control parents and to investigate which sociodemographic, obstetric and neonatal variables correlated with parental mental health and infant bonding in the asphyxia group. Design Cross-sectional questionnaire survey of parents whose children were registered in the Swiss national Asphyxia and Cooling register and of control parents (Post-traumatic Diagnostic Scale, Hospital Anxiety and Depression Scale, Mother-to-Infant Bonding Scale). Results The response rate for the asphyxia group was 46.5%. Compared with controls, mothers and fathers in the asphyxia group had a higher frequency of post-traumatic stress disorder (PTSD) symptoms (p<0.001). More mothers (n=28, 56%) had a symptom diagnosis of either full or partial PTSD than controls (n=54, 39%) (p=0.032). Similarly, more fathers (n=31, 51%) had a symptom diagnosis of either partial or full PTSD than controls (n=19, 33%) (p=0.034). Mothers reported poorer bonding with the infant (p=0.043) than controls. Having a trauma in the past was linked to more psychological distress in mothers (r=0.31 (95% CI 0.04 to 0.54)) and fathers (r=0.35 (95% CI 0.05 to 0.59)). For mothers, previous pregnancy was linked to poorer bonding (r=0.41 (95% CI 0.13 to 0.63)). In fathers, therapeutic hypothermia of the infant was related to less frequent PTSD symptoms (r=−0.37 (95% CI −0.61 to −0.06)) and past psychological difficulties (r=0.37 (95% CI 0.07 to 0.60)) to more psychological distress. A lower Apgar score was linked to poorer bonding (r=−0.38 (95% CI −0.64 to −0.05)). Conclusions Parents of infants hospitalised for perinatal asphyxia are more at risk of developing PTSD than control parents

Burnout, Psychological Symptoms, and Secondary Traumatic Stress Among Midwives Working on Perinatal Wards: A Cross-Cultural Study Between Japan and Switzerland.

The aim of this study was to explore cross-cultural differences in symptoms of burnout, anxiety, depression, general psychological distress, and secondary traumatic stress between Asian (Japan) and European (Switzerland) midwives. One hundred seventy midwives participated in the study. There were significant differences in age group [χ <sup>2</sup> (3) = 24.2, <i>p</i> < 0.01], marital or relationship status [χ <sup>2</sup> (2) = 28.4, <i>p</i> < 0.01], and years of experience [χ <sup>2</sup> (2) = 17.8, <i>p</i> < 0.01] between the two countries. The Japanese staff were younger, more often unmarried, and had less experience than the Swiss staff. The mean score of depersonalization was significantly higher in Switzerland (4.8 ± 3.8) than in Japan (3.2 ± 3.7; | <i>z</i> | = 2.71, <i>p</i> < 0.01). The mean score of general psychological distress in the Swiss sample (12.8 ± 6.5) was significantly higher than that in the Japanese sample (10.3 ± 6.2; | <i>z</i> | = 2.04, <i>p</i> = 0.04). In addition, the mean score of secondary traumatic stress was higher in the Swiss sample (31.8 ± 9.7) than in the Japanese sample (24.1 ± 8.6; | <i>z</i> | = 4.56, <i>p</i> < 0.01). These results may reflect cultural differences such as working conditions or family environment between Japan and Switzerland

Reducing intrusive traumatic memories after emergency caesarean section: A proof-of-principle randomized controlled study.

UNLABELLED: Preventative psychological interventions to aid women after traumatic childbirth are needed. This proof-of-principle randomized controlled study evaluated whether the number of intrusive traumatic memories mothers experience after emergency caesarean section (ECS) could be reduced by a brief cognitive intervention. 56 women after ECS were randomized to one of two parallel groups in a 1:1 ratio: intervention (usual care plus cognitive task procedure) or control (usual care). The intervention group engaged in a visuospatial task (computer-game 'Tetris' via a handheld gaming device) for 15 min within six hours following their ECS. The primary outcome was the number of intrusive traumatic memories related to the ECS recorded in a diary for the week post-ECS. As predicted, compared with controls, the intervention group reported fewer intrusive traumatic memories (M = 4.77, SD = 10.71 vs. M = 9.22, SD = 10.69, d = 0.647 [95% CI: 0.106, 1.182]) over 1 week (intention-to-treat analyses, primary outcome). There was a trend towards reduced acute stress re-experiencing symptoms (d = 0.503 [95% CI: -0.032, 1.033]) after 1 week (intention-to-treat analyses). Times series analysis on daily intrusions data confirmed the predicted difference between groups. 72% of women rated the intervention "rather" to "extremely" acceptable. This represents a first step in the development of an early (and potentially universal) intervention to prevent postnatal posttraumatic stress symptoms that may benefit both mother and child. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials.gov, NCT02502513

Mental Health Symptoms and Work-Related Stressors in Hospital Midwives and NICU Nurses: A Mixed Methods Study.

Hospital midwives and neonatal intensive care (NICU) nurses frequently encounter work-related stressors and are therefore vulnerable to developing mental health problems, such as secondary traumatic stress, burnout, anxiety, and depression. However, so far, the exact nature of these work-related stressors (traumatic vs. non-traumatic stressors) has not been investigated. This concurrent triangulation mixed methods cross-sectional study aimed to compare mental health symptoms in hospital midwives and NICU nurses, and to identify and compare work-related traumatic and non-traumatic stressors for both professional groups. 122 midwives and 91 NICU nurses of two Swiss university hospitals completed quantitative measures (Secondary Traumatic Stress Scale, STSS; Hospital Anxiety and Depression Scale, HADS; Maslach Burnout Inventory, MBI) and one qualitative question in an online survey. When controlling for socio-demographic variables, NICU nurses had a higher STSS total score and higher STSS subscales scores and less HADS anxiety subscale scores than hospital midwives. Work-related stressors were classified into five themes: "Working environment," "Nursing/midwifery care," "Dealing with death and dying," "Case management" and "Others." Forty-six (46.3%) percent of these were classified as traumatic work-related stressors. NICU nurses reported more traumatic stressors in their working environment but no other differences between professional groups regarding the total number of work-related traumatic vs. non-traumatic stressors were found. Measures, such as teaching strategies to amend the subjective appraisal of the traumatic stressors or providing time to recover in-between frequently occurring work-related traumatic stressors might not only improve the mental health of professionals but also decrease sick leave and improve the quality of patient care

Electrophysiological correlates of visual backward masking in schizotypy

Visual backward masking is strongly deteriorated in both schizophrenia and healthy students high as compared to low in cognitive disorganisation (CD; no relationship with positive or negative schizotypy). In patients, this deterioration was also reflected in reduced amplitudes of the EEG (global field power: GFP). Here, we investigated whether reduced GFP during visual backward masking is also evident in high as compared to low CD scorers. The results of the GFP analysis confirmed this assumption. We also found a late EEG component in high CD scorers which was absent in low CD scorers and patients. This might reflect compensation mechanisms that are affected in patients. CD might be a risk marker for psychosis, while positive and negative schizotypy may reflect healthy personality traits, at least when performance in this potential endophenotype of schizophrenia is considered. Underlying mechanisms for the current deficit could be diminished target processing

Visual backward masking deficits in schizotypy

In visual backward masking, a briefly presented target is followed by a mask, which impairs target discrimination. Backward masking is strongly impaired in schizophrenic patients and their unaffected relatives. We found that masking deficits correlated well with a mutation (SNP) related to the cholinergic nicotinic receptor alpha 7 subunit and strongly reduced amplitudes in the EEG (Bakanidze et al., 2013; Plomp et al., 2013). This is why visual masking is a potential endophenotype of schizophrenia. Here we tested the brain activity during this task in 24 healthy students with high (N=12) and low scores (N=12) in self-reported cognitive disorganization, one of the three schizotypy dimensions

Electrophysiological Correlates of Visual Backward Masking in Schizotypy

Visual deficits are well documented in schizophrenia. For example, a Vernier is followed by a blank inter-stimulus interval (ISI) and then a grating mask. Observers indicate the direction of the Vernier offset (left vs right). Patients need ISIs that are 120ms longer than in healthy controls (Herzog et al. 2004). Interestingly, these masking deficits are reflected in strongly reduced EEG amplitudes in schizophrenia patients when compared to healthy controls (Plomp et al. 2013). Schizophrenia is considered to be on a continuum ranging from strongly affected patients to healthy people with schizotypic personality traits. Schizotypic traits are measured with self report questionnaires such as the sO-LIFE (Mason et al. 2005). In analogy to patients, schizotypic traits are divided in positive traits (e.g., hallucinations), negative traits (e.g., anhedonia) and cognitive disorganization (CogDis). It has been shown that healthy students scoring high in CogDis show higher masking deficits than students scoring low in CogDis. On average, high CogDis students need ISIs that are 20ms longer than in low CogDis students (Cappe et al. 2012)

Endophenotypes of schizophrenia: electrophysiological correlates

Endophenotypes are of crucial interest for schizophrenia research linking genetic abnormalities to pathology. During the last NCCR period, we have characterized one endophenotype, based on visual backward masking deficits, behaviourally and genetically (poster #1). We used high density EEG to determine the electrophysiological correlates of these deficits. We found strongly reduced global field power (GFP) amplitudes to masked stimuli in schizophrenic patients (Plomp et al., 2013), in 22q11 patients (Cooperation: Rihs & Eliez, ongoing) and, interestingly, also in healthy students with high scores of cognitive disorganization but at a lesser extent (Cappe et al., 2012; Cappe et al., in preparation; Cooperation: Draganski, Mohr, ongoing). In addition, resting state EEG of patients showed clear abnormalities (Cooperation: Michel, ongoing). Visual backward masking seems to be a very sensitive endophenotype for the schizophrenic spectrum. Our results link schizophrenia to dysfunctions of stabilization of fragile information (Herzog et al., 2013)