Psychosocial Constraints on the Development of Resilience

Although resilience is usually thought to reside in individuals, developmental research is increasingly demonstrating that characteristics of the social context may be better predictors of resilience. When the relative contribution of early resilience and environmental challenges to later child mental health and academic achievement were compared in a longitudinal study from birth to adolescence, indicators of child resilience, such as the behavioral and emotional self-regulation characteristic of good mental health, and the cognitive self-regulation characteristic of high intelligence contributed to later competence. However, the effects of such individual resilience did not overcome the effects of high environmental challenge, such as poor parenting, antisocial peers, low-resource communities, and economic hardship. The effects of single environmental challenges become very large when accumulated into multiple risk scores even affecting the development of offspring in the next generation.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72845/1/annals.1376.010.pd

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

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

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

Ibrutinib Unmasks Critical Role of Bruton Tyrosine Kinase in Primary CNS Lymphoma.

Bruton tyrosine kinase (BTK) links the B-cell antigen receptor (BCR) and Toll-like receptors with NF-κB. The role of BTK in primary central nervous system (CNS) lymphoma (PCNSL) is unknown. We performed a phase I clinical trial with ibrutinib, the first-in-class BTK inhibitor, for patients with relapsed or refractory CNS lymphoma. Clinical responses to ibrutinib occurred in 10 of 13 (77%) patients with PCNSL, including five complete responses. The only PCNSL with complete ibrutinib resistance harbored a mutation within the coiled-coil domain of CARD11, a known ibrutinib resistance mechanism. Incomplete tumor responses were associated with mutations in the B-cell antigen receptor-associated protein CD79B

Communicating feelings: An examination of the processes linking mothers' representations of their 7 -month -old infant to early emotional development.

The present investigation was aimed towards elucidating the processes that linked maternal representations of their 7-month-old infant with individual differences in infant emotion regulation. Participants were 100 mother-infant dyads recruited from local pediatric clinics, and comprised a range of socio-economic and demographic circumstances. Mothers' representations of their infant were assessed via a semi-structured, attachment-based interview, and maternal behavior was observed in a variety of contexts, including a free play, teaching task, and the Still Face procedure. Infant emotion regulation was assessed along a number of behavioral and affective display dimensions upon resuming interaction with his or her parent following the Still Face procedure (i.e., the reengagement episode). Results indicated that mothers' representations were indeed related to differences in maternal behavior and infant emotion regulation. In general, mothers with balanced and positive/coherent representations were more sensitive, less rejecting, less intrusive and expressed more positive affect during interaction with their infant. Patterns of association between mothers' representations and behavior varied according to the nature of the interactive task, with a greater number of associations obtained for the more challenging, stress-inducing, tasks (i.e., the teaching task and Still Face procedure). In addition, the specific type of maternal behaviors associated with differences in mothers' representations varied according to the interactive task. Furthermore, mothers with balanced and positive/coherent representations had infants who demonstrated more positive affect and more attention seeking/contact maintenance upon resuming interaction following the still face, even when controlling for the amount of distress the infant displayed while his or her mother held a still face. Finally, results provided support for the hypothesis that some aspects of maternal behavior mediate the association between her representation of the infant and individual differences in infant emotion regulation. While maternal representation classifications were related to self-reported depressive symptomatology, in the present investigation, maternal depression was unrelated to infant behavior during the Still Face. Results are discussed emphasizing the important role that may be played by maternal representations in shaping mothers' behavioral and emotional responsivity and sensitivity to the infant, thus promoting intergenerational continuity in attachment representations and affect regulation style.Ph.D.Clinical psychologyDevelopmental psychologyPsychologySocial psychologyUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/132672/2/9977249.pd

Understanding Bidirectional Mother-Infant Affective Displays across Contexts: Effects of Maternal Maltreatment History and Postpartum Depression and PTSD Symptoms

Background: This study examined the bidirectional nature of mother-infant positive and negative emotional displays during social interactions across multiple tasks among postpartum women accounting for childhood maltreatment severity. Additionally, effects of maternal postpartum psychopathology on maternal affect and effects of task and emotional valence on dyadic emotional displays were evaluated. Sampling and Methods: A total of 192 mother-infant dyads (51% male infants) were videotaped during free play and the Still-Face paradigm at 6 months postpartum. Mothers reported on trauma history and postpartum depression and posttraumatic stress disorder (PTSD) symptoms. Reliable, masked coders scored maternal and infant positive and negative affect from the videotaped interactions. Results: Three path models evaluated whether dyadic affective displays were primarily mother driven, infant driven, or bidirectional in nature, adjusting for mothers\u27 maltreatment severity and postpartum psychopathology. The bidirectional model had the best fit. Child maltreatment severity predicted depression and PTSD symptoms, and maternal symptoms predicted affective displays (both positive and negative), but the pattern differed for depressive symptoms compared to PTSD symptoms. Emotional valence and task altered the nature of bidirectional affective displays. Conclusions: The results add to our understanding of dyadic affective exchanges in the context of maternal risk (childhood maltreatment history, postpartum symptoms of depression and PTSD). Findings highlight postpartum depression symptoms as one mechanism of risk transmission from maternal maltreatment history to impacted parent-child interactions. Limitations include reliance on self-reported psychological symptoms and that the sample size prohibited testing of moderation analyses. Developmental and clinical implications are discussed

Psychopathology and Parenting: An Examination of Perceived and Observed Parenting in Mothers With Depression and PTSD

Background The postpartum period represents a major transition in the lives of many women, a time when women are at increased risk for the emergence of psychopathology including depression and PTSD. The current study aimed to better understand the unique contributions of clinically significant postpartum depression, PTSD, and comorbid PTSD/depression on mother–infant bonding and observed maternal parenting behaviors (i.e., behavioral sensitivity, negative affect, positive affect) at 6 months postpartum. Methods Mothers (n=164; oversampled for history of childhood maltreatment given parent study\u27s focus on perinatal mental health in women with trauma histories) and infants participated in 6-month home visit during which dyads engaged in interactional tasks varying in level of difficulties. Mothers also reported on their childhood abuse histories, current depression/PTSD symptoms, and bonding with the infant using standardized and validated instruments. Results Mothers with clinically significant depression had the most parenting impairment (self-report and observed). Mothers with clinically significant PTSD alone (due to interpersonal trauma that occurred predominately in childhood) showed similar interactive behaviors to those who were healthy controls or trauma-exposed but resilient (i.e., no postpartum psychopathology). Childhood maltreatment in the absence of postpartum psychopathology did not infer parenting risk. Limitations Findings are limited by (1) small cell sizes per clinical group, limiting power, (2) sample size and sample demographics prohibited examination of third variables that might also impact parenting (e.g., income, education), (3) self-report of symptoms rather than use of psychiatric interviews. Conclusions Findings show that in the context of child abuse history and/or current PTSD, clinically significant maternal depression was the most salient factor during infancy that was associated with parenting impairment at this level of analysis