Psychosocial predictors of maternal emotional availability: Longitudinal analyses of the Mercy Pregnancy and Emotional Wellbeing Study (MPEWS) pregnancy cohort

Understanding the psychosocial predictors of the mother-infant relationship may provide important information to explain the variation in interaction quality observed between dyads. This research examined specific psychosocial predictors of maternal emotional availability (EA): maternal depression and trauma. In addition, the maternal psychosocial predictors of pacifier use during a mother-infant interaction were investigated. Data for the three empirical studies was drawn from 210 women recruited in early pregnancy until six-months postpartum within an Australian pregnancy cohort, the Mercy Pregnancy and Emotional Wellbeing Study. Women video-recorded interacting with their infants at six months postpartum were included, with the quality of their interactions assessed using the EA Scales (EAS). Depression was measured symptomatically and diagnostically at three time points from early pregnancy to six-months postpartum. Maternal trauma was specified as childhood trauma, childbirth experience and also included stressful life events. Observational data regarding pacifier use was collected by the viewing of each interaction, with the fourth translational study including a systematic review of the EA literature to facilitate integration of the EAS into clinical practice. First, results showed a small negative association between antenatal depressive symptoms and maternal EA. Second, moderate to severe childhood trauma and current stressful life events were negatively associated with maternal EA. Third, maternal EA status was associated with pacifier use during the mother-infant interaction. This dissertation highlights that beyond women with depression or trauma, there are other women experiencing reduced EA at six months postpartum. Given maternal EA could be a protective factor for both child outcomes, and the future mother-child relationship, consideration of integrating the EAS into a clinical setting should be explored

Infant sleep and anxiety disorders in early childhood: Findings from an Australian pregnancy cohort study

Emphasis on continuous infant sleep overnight may be driven by parental concern of risk to child mental health outcomes. The Mercy Pregnancy and Emotional Wellbeing Study (MPEWS) examined whether infant sleep at 6 and 12 months postpartum predicts anxiety disorders at 2–4 years, and whether this is moderated by maternal depression, active physical comforting (APC) or maternal cognitions about infant sleep. Data included 349 women and infants. Infant sleep was measured using the Brief Infant Sleep Questionnaire and child anxiety disorders by the Preschool Age Psychiatric Assessment. The risk of developing generalised anxiety or social phobia disorders at 3–4 years was reduced by 42% (p = 0.001) and 31% (p = 0.001), respectively, for a one standard deviation increase in total sleep at 12 months. No other infant sleep outcomes were associated. Maternal depression, APC and cognitions about infant sleep did not significantly moderate these relationships. Focus may need to be on total infant sleep, rather than when sleep is achieved. Highlights: To assess whether infant sleep outcomes (i.e., frequency of nocturnal wakes; nocturnal wakefulness and total sleep per day) at 6 and 12 months predict early childhood anxiety disorders at 3–4 years of age. Maternally reported infant sleep outcomes were not associated with the risk of developing early childhood anxiety disorders at 3–4 years. It may be total infant sleep, irrespective of when sleep occurs or night waking and, independently, active physical comforting that requires further investigation

Maternal social support, depression and emotional availability in early mother-infant interaction: Findings from a pregnancy cohort

Background: Social support theory suggests that parental social support may influence the nature of early parenting behaviours and specifically the mother-infant relationship. This study examines whether support from a partner, friends or family is associated with differences in quality of mother-infant interactions in the context of maternal depression. Methods: 210 women were followed from early pregnancy to six months postpartum within Australian pregnancy cohort, the Mercy Pregnancy and Emotional Wellbeing Study (MPEWS). Mother-infant interactions within a standardised observation at six months postpartum were measured by the Emotional Availability (EA) Scales using total scores of the parental scales. In early and late pregnancy and at six months postpartum, mothers rated perceived maternal social support from a partner, family and friends using subscales of the Multidimensional Scale of Perceived Social Support. Depression was measured in early pregnancy and at six months postpartum using the Structured Clinical Interview for the DSM-IV-TR, with repeated measurement of depressive symptoms by the Edinburgh Postnatal Depression Scale (EPDS). Data was analysed using structural equation models. Results: There were significant interactions between depressive symptoms in early pregnancy and perceived maternal support from a partner (B = .18, 95% CI = 03, .31) and separately from family (B = .12, 95% CI = .03, .32) in predicting maternal emotional availability. No such interaction was found for support from friends. While partner and family support moderated the association between early depressive symptoms and emotional availability, there were no direct associations between maternal depressive disorder in early pregnancy and perceived support, and further, maternal depression was not a significant predictor of emotional availability. Limitations: Future studies should consider extending measurement of the mother-infant relationship beyond the EA Scales, inclusion of a measure of maternal childhood trauma, and replicating our findings. Conclusion: Maternal perception of partner and family support in the postpartum is a predictor of the association between early pregnancy depressive symptoms and maternal emotional availability

Major depression as a predictor of the intergenerational transmission of attachment security: Findings from a pregnancy cohort study

OBJECTIVE: Understanding the relationship between attachment and mental health has an important role in informing management of perinatal mental disorders and for infant mental health. It has been suggested that experiences of attachment are transmitted from one generation to the next. Maternal sensitivity has been proposed as a mediator, although findings have not been as strong as hypothesised. A meta-analysis suggested that this intergenerational transmission of attachment may vary across populations with lower concordance between parent and infant attachment classifications in clinical compared to community samples. However, no previous study has examined major depression and adult attachment in pregnancy as predictors of infant-parent attachment classification at 12 months postpartum. METHODS: Data were obtained on 52 first-time mothers recruited in early pregnancy, which included 22 women who met diagnostic criteria for current major depression using the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders. The Adult Attachment Interview was also administered before 20 weeks of pregnancy. A history of early trauma was measured using the Childhood Trauma Questionnaire and maternal sensitivity was measured at 6 months postpartum using the observational measure of the Emotional Availability Scales. Infant-parent attachment was measured using the Strange Situation Procedure at 12 months. RESULTS: Overall, we found no significant association between the Adult Attachment Interview and the Strange Situation Procedure classifications. However, a combination of maternal non-autonomous attachment on the Adult Attachment Interview and major depression was a significant predictor of insecure attachment on the Strange Situation Procedure. We did not find that maternal sensitivity mediated parental and infant attachment security in this sample. CONCLUSION: While previous meta-analyses identified lower concordance in clinical samples, our findings suggest women with major depression and non-autonomous attachment have a greater concordance with insecure attachment on the Strange Situation Procedure. These findings can guide future research and suggest a focus on depression in pregnancy may be important for subsequent infant attachment