Enhancing Breastfeeding Rates Among African American Women: A Systematic Review of Current Psychosocial Interventions

The goals of this article are to provide a review of key interventions and strategies that impact initiation and duration of breastfeeding with particular focus on low-income African American mothers' maternal psychological vulnerabilities during the early postpartum period using a social ecological perspective as a guiding framework. Although modest gains have been achieved in breastfeeding initiation rates in the United States, a projected gap remains between infant feeding practices and national Healthy People breastfeeding goals set for 2020, particularly among African Americans. These disparities raise concerns that socially disadvantaged mothers and babies may be at increased risk for poor postnatal outcomes because of poorer mental health and increased vulnerability to chronic health conditions. Breastfeeding can be a protective factor, strengthening the relationship between mother and baby and increasing infant health and resilience. Evidence suggests that no single intervention can sufficiently address the multiple breastfeeding barriers faced by mothers. Effective intervention strategies require a multilevel approach. A social ecological perspective highlights that individual knowledge, behavior, and attitudes are shaped by interactions between the individual woman, her friends and family, and her wider historical, social, political, economic, institutional, and community contexts, and therefore effective breastfeeding interventions must reflect all these aspects. Current breastfeeding interventions are disjointed and inadequately meet all African American women's social and psychological breastfeeding needs. Poor outcomes indicate a need for an integrative approach to address the complexity of interrelated breastfeeding barriers mothers' experience across layers of the social ecological system.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140312/1/bfm.2014.0023.pd

Does Child Sex Moderate Vulnerability to Postpartum Risk among Infants of Mothers at Risk for Psychopathology?

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/110024/1/infa12065.pd

Depression during pregnancy: detection, comorbidity and treatment

Depression during pregnancy is common (∼15%). Routine prenatal depression screening coupled with the use of physician collaborators to assist in connecting women with care is critical to facilitate treatment engagement with appropriate providers. Providers should be aware of risk factors for depression – including a previous history of depression, life events, and interpersonal conflict – and should appropriately screen for such conditions. Depression during pregnancy has been associated with poor pregnancy outcomes including preeclampsia, insufficient weight gain, decreased compliance with prenatal care, and premature labor. Current research has questioned the overall benefit of treating depression during pregnancy with antidepressants when compared to the risk of untreated depression for mother and child. Published guidelines favor psychotherapy above medication as the first line treatment for prenatal depression. Poor neonatal adaptation or withdrawal symptoms in the neonate may occur with fetal exposure in late pregnancy, but the symptoms are mild to moderate and transient. The majority of mothers who decide to stop taking their antidepressants during pregnancy suffer relapsing symptoms. If depression continues postpartum, there is an increased risk of poor mother–infant attachment, delayed cognitive and linguistic skills in the infant, impaired emotional development, and behavioral problems in later life. Bipolar depression, anxiety and substance use disorders, and/or presence of severe psychosocial stress can lead to treatment-resistance. Modified and more complex treatment algorithms are then warranted. Psychiatric medications, interpersonal or cognitive-behavioral therapy, and adjunctive parent–infant/family treatment, as well as social work support, are modalities often required to comprehensively address all issues surrounding the illness.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/79238/1/j.1758-5872.2010.00051.x.pd

Strong, Safe, And Secure: Negotiating Early Fathering And Military Service Across The Deployment Cycle

Military fathers of young children often endure repeated separations from their children, and these may disrupt the early parent–child relationship. Postdeployment reunification also poses challenges; disruptions that have occurred must often be repaired in the context of heightened emotions on the part of each family member at a time when fathers are themselves readjusting to the routines and responsibilities of family life. The current study employed qualitative research with the central aim of informing a richer understanding of these experiences. Interviews were conducted with 14 military fathers of young children who had experienced separation from their families during deployment. Narratives were coded using principles of grounded theory, and common parenting themes were extracted. Fathers shared their hopes that their young children would develop qualities of strength, confidence, and self‐sufficiency. They also discussed difficulty in supporting the development of these qualities in their young children due to problems dealing with the negative emotions and difficult behaviors that their children exhibited. Reliance on their parenting partner was commonly cited as an effective strategy as fathers transitioned back to family life. Implications for intervention programs include the provision of parenting and self‐care skills and inclusion of the father's parenting partner in the intervention. RESUMEN Padres militares de niños pequeños a menudo enfrentan repetidas separaciones de sus hijos, las cuales pueden alterar las tempranas relaciones padre‐hijo. La reunificación posterior a la asignación militar también presenta retos; las interrupciones que han ocurrido muy a menudo se arreglan en el contexto de fuertes emociones por parte de cada miembro de la familia en un momento en que los papás están ellos mismos reajustándose a rutinas y responsabilidades de la vida familiar. La investigación cualitativa puede resultar en una mejor comprensión de estas experiencias. Para el presente estudio, se entrevistó a 14 militares, padres de niños pequeños, quienes habían experimentado la separación familiar durante sus asignaciones militares. Se codificaron las narrativas usando principios de teoría básica, y se extrajeron temas de crianza comunes. Los papás compartieron sus esperanzas de que sus pequeños niños desarrollaran su fortaleza, confianza y autosuficiencia. También discutieron la dificultad de apoyar el desarrollo de estas características en sus pequeños niños después de la separación por servicio militar debido a problemas relacionados con emociones negativas y conductas difíciles que sus hijos mostraban. Se citó reiteradamente el depender de la pareja en la crianza como estrategia efectiva en la transición de vuelta a la vida familiar. Las implicaciones para programas de intervención incluyen la incorporación de la pareja de quien dependen los papás para la crianza como parte de la intervención, así como la provisión de habilidades de crianza y autocuidado. RÉSUMÉ Les pères de jeunes enfants qui servent dans l’armée endurent souvent des séparations répétées d’avec leurs enfants, séparations qui peuvent perturber la relation précoce père‐enfant. La réunification après le déploiement peut également poser certains défis: les perturbations qui se sont passées doivent aussi être réparées dans le contexte d’émotions intensifiées de la part de chaque membre de la famille à un moment où les pères eux‐mêmes se réadaptent aux routines et aux responsabilités de la vie de famille. Des recherches qualitatives peuvent mener à une compréhension plus riche de ces expériences. Cette étude a interviewé 14 pères engagés dans l’armée, pères de jeunes enfants qui avaient tous fait l’expérience de la séparation de leurs familles durant le déploiement. Les récits ont été codés en utilisant les principes de la théorie ancrée et les thèmes de parentage commun ont été extraits. Les pères ont partagé leurs espoirs que leurs jeunes enfants feraient preuve de qualités de force, de confiance et d’auto‐suffisance en grandissant. Ils ont aussi discuté la difficulté qui existe à soutenir le développement de ces qualités chez leurs jeunes enfants après le déploiement à cause de problèmes liés aux émotions et aux comportements difficiles dont faisaient preuve leurs enfants. La dépendance envers le partenaire de parentage s’est trouvé fréquemment citée comme étant une stratégie efficace alors qu’ils transitionnaient dans le retour à la vie familiale. Les implications pour des programmes d’intervention comprennent l’inclusion du partenaire de parentage du père dans l’intervention et dans l’accumulation des précautions de parentage et des capacités à prendre soin de soi. ZUSAMMENFASSUNG Väter von Kleinkindern, die im Militär dienen, erfahren oft wiederholte Trennungen von ihren Kindern, welche die frühe Eltern‐Kind‐Beziehung stören können. Auch die Wiedervereinigung nach einem Einsatz beim Militär stellt eine Herausforderung dar: Brüche, die aufgetreten sind, müssen oft im Zusammenhang mit verstärkten Emotionen auf Seiten jedes Familienmitglieds wiedergutgemacht werden. Dies geschieht zu einer Zeit, in der sich die Väter wieder den Routinen und Aufgaben des Familienlebens anpassen. Qualitative Forschung kann zu einem umfangreicheren Verständnis dieser Erfahrungen beitragen. Die aktuelle Studie befragte 14 Väter von Kleinkindern, die beim Militär waren und Trennung von ihren Familien während eines Einsatzes erlebt hatten. Narrative wurden nach den Prinzipien der „Grounded Theory“ kodiert und allgemeine Themen zur Elternschaft wurden extrahiert. Die Väter teilten ihre Hoffnung mit, dass ihre Kinder Eigenschaften wie Stärke, Selbstvertrauen und Selbstständigkeit entwickeln. Sie diskutierten auch Schwierigkeiten bei der Unterstützung der Entwicklung dieser Eigenschaften bei ihren Kleinkindern nach einem Einsatz, aufgrund von Problemen im Umgang mit negativen Emotionen und schwierigen Verhaltensweisen, die ihre Kinder zeigten. Das Vertrauen in das andere Elternteil wurde allgemein als wirksame Strategie zitiert, wenn sie zurück ins Familienleben übergegangen sind. Implikationen für Interventionsprogramme umfassen die Einbeziehung des anderen Elternteils in die Intervention und die Bereitstellung von Erziehungs‐ und Selbstfürsorge‐Fähigkeiten. ABSTRACT 抄録：幼い子どものいる軍人の父親は、子どもとの別れを繰り返すことにしばしば耐えている。そして、これは、早期の親－子関係を中断するだろう。帰還後の家族の再統合もまた問題をはらんでいる。父親自身が家族生活のルーチンと責任に再適応している時に、家族メンバーそれぞれが高揚した感情というコンテクストの中で、生じていた中断がしばしば修復されなければならない。質的研究によりこれらの経験をより豊かに理解する情報をえることができる。この研究では、配備の間に家族との別れを体験した、14人の幼い子どものいる軍人の父親にインタビューした。談話はグランデット・セオリーの原則を用いてコード化され、共通の育児のテーマが抽出された。父親達は、幼い子どもが、強さ、自信、そして自給自足という素質を発達させるだろうという希望を共有していた。彼らはまた、子ども達が示す否定的な感情や難しい行動を扱う問題のために、帰還後に幼い子どものこれらの素質を発達させるように支援するのが難しいと議論した。養育パートナーへの信頼は、彼らが家族との生活に戻る移行における効果的な戦略として、共通して言及された。介入プログラムに対して持つ意味には、父親の養育パートナーを介入に含めること、そして養育スキルとセルフケアのスキルを提供することが、含まれるPeer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/108646/1/imhj21465.pd

Are commonly used self-report inventories suitable for screening postpartum depression and anxiety disorders?

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/66459/1/j.1600-0447.2000.102001071.x.pd

Potential Neural Mediators of Mom Power Parenting Intervention Effects on Maternal Intersubjectivity and Stress Resilience

Stress resilience in parenting depends on the parent\u27s capacity to understand subjective experiences in self and child, namely intersubjectivity, which is intimately related to mimicking other\u27s affective expressions (i. e., mirroring). Stress can worsen parenting by potentiating problems that can impair intersubjectivity, e.g., problems of “over-mentalizing” (misattribution of the child\u27s behaviors) and “under-coupling” (inadequate child-oriented mirroring). Previously we have developed Mom Power (MP) parenting intervention to promote maternal intersubjectivity and reduce parenting stress. This study aimed to elucidate neural mechanisms underlying the effects of MP with a novel Child Face Mirroring Task (CFMT) in functional magnetic-resonance-imaging settings. In CFMT, the participants responded to own and other\u27s child\u27s facial pictures in three task conditions: (1) empathic mirroring (Join), (2) non-mirroring observing (Observe), and (3) voluntary responding (React). In each condition, each child\u27s neutral, ambiguous, distressed, and joyful expressions were repeatedly displayed. We examined the CFMT-related neural responses in a sample of healthy mothers (n = 45) in Study 1, and MP effects on CFMT with a pre-intervention (T1) and post-intervention (T2) design in two groups, MP (n = 19) and Control (n = 17), in Study 2. We found that, from T1 to T2, MP (vs. Control) decreased parenting stress, decreased dorsomedial prefrontal cortex (dmPFC) during own-child-specific voluntary responding (React to Own vs. Other\u27s Child), and increased activity in the frontoparietal cortices, midbrain, nucleus accumbens, and amygdala during own-child-specific empathic mirroring (Join vs. Observe of Own vs. Other\u27s Child). We identified that MP effects on parenting stress were potentially mediated by T1-to-T2 changes in: (1) the left superior-temporal-gyrus differential responses in the contrast of Join vs. Observe of own (vs. other\u27s) child, (2) the dmPFC-PAG (periaqueductal gray) differential functional connectivity in the same contrast, and (3) the left amygdala differential responses in the contrast of Join vs. Observe of own (vs. other\u27s) child\u27s joyful vs. distressed expressions. We discussed these results in support of the notion that MP reduces parenting stress via changing neural activities related to the problems of “over-mentalizing” and “under-coupling.” Additionally, we discussed theoretical relationships between parenting stress and intersubjectivity in a novel dyadic active inference framework in a two-agent system to guide future research

Ptsd Symptoms Across Pregnancy And Early Postpartum Among Women With Lifetime Ptsd Diagnosis

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/122410/1/da22465.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/122410/2/da22465_am.pd

Community- delivered infant- parent psychotherapy improves maternal sensitive caregiving: Evaluation of the Michigan model of infant mental health home visiting

The current study evaluated the effectiveness of a home- based psychotherapeutic Infant Mental Health Home Visiting (IMH- HV) intervention for enhancing parenting sensitivity; a secondary aim was to evaluate whether the use of video feedback was associated with greater treatment response. Participants were N = 78 mothers and their children (age at entry ranged from prebirth to 24- month old (M = 9.8, SD = 8.4), who were initiating IMH- HV services with community mental health- based therapists (N = 51). Dyads were assessed during extended home visits via standardized interviews and observational and questionnaire methods within the first month of treatment (baseline), and again 6 and 12 months thereafter. Following each of these extended home visits, study evaluators completed a standard Q- sort to capture observations of maternal sensitivity during the visit. Therapists completed fidelity checklists used to derive the total number of IMH- HV sessions received (i.e., dosage) and frequency with which therapists provided video feedback. Results indicated a dose- response relationship between number of sessions and maternal sensitivity, and that video review with parents independently contributed to improved maternal sensitivity. Discussion focuses on the effectiveness of this community- based psychotherapeutic home visiting model for enhancing parenting, as well as the value of video feedback as a specific therapeutic strategy.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/154891/1/imhj21840_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154891/2/imhj21840.pd

Randomized pilot trial of the “Mom Power” trauma- and attachment-informed multi-family group intervention in treating and preventing postpartum symptoms of depression among a health disparity sample

IntroductionPerinatal depression, a common complication related to childbearing, impacts mothers, children, and families. Efficacious interventions reduce perinatal depression symptoms; effort is needed to prevent the onset of perinatal depression. To determine feasibility and preliminary efficacy in reducing perinatal depression, we conducted a community-based, randomized parallel open pilot trial of Mom Power, a group-based intervention to improve mental health and parenting in mothers with young children.MethodsMom Power consists of 10 group sessions, focused on parenting, child development and self-care and three individual sessions, to build rapport and provide personalized referrals. Control group participants received psychoeducational mailings. Computer-based urn randomization assigned mothers with experiences of interpersonal violence, depression, or other traumatic experiences to Mom Power (68) or control (54).ResultsAt 3-months post-treatment, the 31 retained women assigned to Mom Power were half as likely to meet criteria for probable depression (26%) as the 22 women retained in the control group (55%), with treatment predicting lower incidence of probable depression (OR = 0.13, p = 0.015). Moreover, among the 23 women who did not meet criteria for depression diagnosis at baseline, no women in the treatment group developed depression (n = 0, 0%) compared to control group women (n = 3, 30%). Logistic regression controlling for selective attrition confirmed the treatment effect on preventing new onset of depression (OR = 0.029, p = 0.012).ConclusionThese findings support the use of Mom Power for both treatment and prevention of perinatal depression.Clinical trial registrationhttps://classic.clinicaltrials.gov/ct2/show/NCT01554215, NCT01554215