Parental bonding and education level as moderators of the relationship between spiritual well-being and maternal attachment in pregnant women

To examine the relationship between the perception of traumatic birth and maternal attachment in pregnant women. This descriptive and correlational study recruited 370 pregnant women who applied for an antenatal visit to outpatient clinics of a state hospital. The data were collected using a Personal Information Form, Maternal Antenatal Attachment Scale (MAAS), and Traumatic Birth Perception Scale (TBPS). Data were collected using the face-to-face method. The study was reported according to the STROBE. The mean total score of MAAS was 75.71 ± 7.72 and the mean TBPS score was 73.21 ± 28.34. Normal birth pain was perceived as "severe" by 38.3% of pregnant women and as "very severe" by 46.1%. It was determined that 29.2% of pregnant women had a "high" level of traumatic birth perception and 14.5% had a "very high" level. A negative correlation was found between the mean scores of MAAS and TBPS of pregnant women. The trimester of pregnancy, listening to the birth story, planned pregnancy, and traumatic birth perception, was a significant predictor of maternal antenatal attachment. As the maternal antenatal attachment levels of pregnant women increased, their perceptions of traumatic birth decreased.

This study aims to examine the acceptability and effectiveness of an antenatal group intervention designed to reduce the severity of depression and anxiety symptoms and improve maternal attachment in pregnant women with current or emerging depression and anxiety. Women who participated in the program completed pre- and posttreatment measures of depression (Centre of Epidemiological Studies Depression Scale) and Edinburgh Postnatal Depression Scale), anxiety (State-Trait Anxiety Inventory) and maternal attachment (Condon Maternal Antenatal Attachment Scale). Participants also completed a satisfaction questionnaire and provided general feedback about the group intervention and experience. A total of 48 women (M = 26weeks of gestation) commenced and 37 (77%) completed at least 80% of the six session group intervention. Significant improvements with moderate to large effect sizes were observed for depression as measured on the Centre of Epidemiological Studies Depression Scale (CES-D) (p < 0.001), Edinburgh Postnatal Depression Scale (EPDS) (p < 0.001), state anxiety (p < 0.001) and maternal attachment (p = 0.006). Improvements in posttreatment depression scores on the EPDS were maintained at 2months postpartum. Participants reported that the program had met their expectations. Partners (n = 21) who completed evaluation forms indicated that their attendance had improved their awareness of their partner's mental health issues and resources available to their family and would recommend the program to other fathers. These preliminary findings suggest that our antenatal group program is an effective and acceptable intervention for a clinical sample of women and partners. It is a feasible addition or alternative treatment option to perinatal mental health care. Future directions could involve more comprehensive randomised controlled trials (RCT) to examine the effectiveness of the group intervention.

Background: Prenatal attachment and positive adaptation with the concept of motherhood play a pivotal role in maternal and fetal health. The present study aimed to evaluate the effect of the beliefs, attitudes, subjective norms, and enabling factors (BASNEF) model on maternal fetal attachment in the pregnant women referring to prenatal clinics. Methods: This quasi-experimental study was conducted on 100 nulliparous women in their third pregnancy trimester (36-41 weeks), who referred to the selected prenatal clinics in Shiraz, Iran during 2011-2012. Intervention was performed based on the BASNEF model in six training sessions for 90 minutes. Data collection tools were the Cranley’s maternal-fetal attachment scale and BASNEF model. Data analysis was performed in SPSS version 18 using Pearson’s correlation-coefficient, independent t-test, and Chi-square at the significance level of 0.05.Results: After the intervention, a significant difference was observed in the mean score of maternal-fetal attachment in the intervention group compared to the control group (P<0.001). In addition, there was a significant positive correlation between the score of maternal-fetal attachment and enabling factors one month after the training in the intervention group (P=0.039). Conclusion: According to the results, training based on the BASNEF model could increase the maternal-fetal attachment in nulliparous pregnant women and improve the psychological health indicators of the neonates.

Pregnant women have faced novel physical and mental health risks during the pandemic. This situation is remarkable because a parent's emotional bond with their unborn baby (also known as prenatal attachment) is related to the parent's mental state. Prenatal attachment helps parents psychologically prepare forthe transition into parenthood. Moreover, it plays a pivotal role in the future parentchild relationship and psychosocial development of the baby. Based on the available literature, the current study integrated risk perception theories with mental healthindicators to examine maternal prenatal attachment during the pandemic. Pregnant women (n = 258) completed the Pregnancy-Related Anxiety Questionnaire-Revision 2 (PRAQ-R2), theWHO Well-being Index (WHO-5), the Prenatal Attachment Inventory (PAI), and answeredquestions about COVID-19 risk perception. The findings illustrated that pregnancy-related anxiety was positively associated with maternal prenatal attachment. Moreover, COVID-19 risk perception and well-being mediated this relationship. In other words, the higher levels of pregnancy-related anxiety were associated with increased COVID-19 risk perception and decreased well-being, inhibiting prenatal attachment in pregnant women. Considering the importance of prenatal attachment, it is crucial to understand the experiences of pregnant women and develop policies for promoting prenatal attachment, especially during challenging times such as the COVID-19 pandemic.

Maintained thymic output of conventional and regulatory T cells during human pregnancy

BackgroundPerinatal depression, especially minor depression, is common during pregnancy and is likely to continue into the postpartum period. It may impair the mother’s health, the infant’s neurodevelopment, and the mother-infant relationship. Screening for perinatal depression is recommended; however, there is no consensus on how to treat depressive symptoms while simultaneously supporting the mother-infant relationship. Ultrasound examination has been shown to improve maternal-fetal attachment among pregnant women. Our aim is to develop a four-dimensional (4D) based interactive ultrasound intervention and test whether it relieves minor depressive symptoms and improves maternal-fetal attachment. Previous studies show that supporting the mother-infant relationship aids in relieving maternal depression. Until now, few studies have combined pregnancy ultrasound and psychological support.MethodsA controlled randomized setting was designed to assess whether interactive 4D-ultrasound intervention would decrease maternal depressive symptoms, strengthen maternal-fetal attachment, and mother-infant relationship. An obstetrician and a psychologist specialized in infant mental health conduct the interventions. The focus is to jointly observe the behavior of the fetus according to the mothers’ wishes. Altogether, 100 women scoring 10–15 on Edinburgh Pre-/Postnatal Depression Scale (EPDS) and with singleton pregnancy are recruited using a web-based questionnaire. Half of the participants will be randomized to the intervention group and will undergo three interactive ultrasound examinations. The primary outcomes are a decrease in perinatal depressive symptoms assessed with EPDS and an increase in maternal attachment. The maternal attachment was assessed using the Working Model of the Child Interview (WMCI), the Maternal Antenatal Attachment Scale (MAAS), and the Maternal Postnatal Attachment Scale (MPAS). Secondly, we hypothesize that if the intervention decreases prenatal depressive symptoms and improves prenatal attachment, the decrease in depressive symptoms and improvement in mother-infant relationship is seen postnatally.DiscussionUltrasound is widely used during pregnancy. The interactive approach is unique and may be feasible as part of routine screenings and maternity clinic visits. Intervention that decreases depression and simultaneously supports maternal-fetal attachment would be a valuable addition to the treatment of minor depression among pregnant women.Trial registrationClinicalTrials.gov NCT03424642. Registered on January 5 2018.

P-996 - Risk factors of depression and anxiety during pregnancy: maternal antenatal attachment

Background: African American (AA) women are disproportionately affected by hypertension and are less likely to adhere to their medication regimen when compared to White and Hispanic women. Very little is known about social factors associated with medication adherence among AA women. Spiritual well-being (SWB), religious well-being (RWB), and social determinants of health (SDOH) may be associated with self-efficacy for appropriate medication use (SEAM). Purpose: The purpose of the study is to: (1) examine the relationships among SDOH, namely age, education level, household income, and marital and insurance status, and SWB and RWB; (2) examine the relationships between SDOH and SEAM; and (3) assess the potential associations of SWB and RWB with SEAM. Methods: The study employed a cross-sectional correlational design. An online survey was used to collect data. A purposive sample of 187 AA women with hypertension diagnosis over 1 year was recruited. SWB and RWB were measured using the Spiritual Well-Being Scale, and SEAM was measured using the Self-Efficacy for Appropriate Medication Use Scale. SDOH were adopted from Healthy People 2030. Linear regression analysis was conducted to assess the adjusted association of SWB and RWB with SEAM, and p &lt; .05 was considered significant. Results: The women of the study were middle aged (M = 57.34 years, SD = 12.89) and had moderate SWB and RWB scores. Only age and education were positively associated with SEAM ( p &lt; .001 and p = .025, respectively). There was no association of SWB or RWB with SEAM. Discussion and Conclusion: SWB and RWB scores did not predict SEAM in this sample of AA women with hypertension. However, this could be due to lack of power due to a small sample size. Older age and higher education level were associated with higher self-efficacy. Interventions to improve adherence to antihypertension drug treatments aimed at younger AA women with lower educational attainment could help in improving care and reducing disparities in health outcomes for this population.

Human and animal models suggest that maternal hormonal and physiological adaptations during pregnancy shape maternal brain functioning and behavior crucial for offspring care and survival. Less sensitive maternal behavior, often associated with psychobiological dysregulation and the offspring's behavioral and emotional disorders, has been observed in mothers who have experienced adverse childhood experiences. Strong evidence shows that children who are exposed to domestic violence (DV) are at risk of being abused or becoming abusive in adulthood. Yet little is known about the effect of childhood exposure to DV on the expecting mother, her subsequent caregiving behavior and related effects on her infant. Thus, the present study examined the association of maternal exposure to DV during childhood on prenatal maternal attachment, maternal heart rate reactivity to an infant-crying stimulus and post-natal infant emotional regulation. Thirty-three women with and without exposure to DV during childhood were recruited during the first trimester of pregnancy and followed until 6-month after birth. The Maternal Antenatal Attachment Scale (MAAS) was used to measure prenatal attachment of the mother to her fetus during the second trimester of pregnancy, maternal and fetal heart rate reactivity to an infant-crying stimulus was assessed at the third trimester of pregnancy, and the Infant Behavior Questionnaire-Revised (IBQ-R) was used to assess infant emotional regulation at 6-months. Results showed that pregnant women that were exposed to DV during childhood had a poorer quality of prenatal attachment of mother to fetus, regardless of whether they also experienced DV during adulthood. In addition, maternal exposure to DV during childhood was associated with increased maternal heart rate to infant-crying stimulus and worse infant emotional regulation. These findings highlight the importance of prenatal screening for maternal exposure to DV during childhood as a risk factor for disturbances in the development of maternal attachment, dysfunctional maternal behavior and emotion dysregulation.

Background: Spiritual well-being of providers and patients is paramount for holistic care in nursing. Spiritual well-being is reflected in relationships in four areas, namely with self, others, environment and/or Transcendent Other. Method: Fisher’s 20-item Spiritual Health and Life-Orientation Measure (SHALOM) was used to assess these four key components of spiritual health. A survey was completed by staff and family members of residents in a dementia care unit, to record three responses on SHALOM, namely their ideals for spiritual health, their lived experiences, and what they thought residents need for spiritual nurture in these four areas. Demographic variables were investigated, with respect to any impact on respondents’ spiritual well-being. Results: Variations were found in the staff’s and family members’ spiritual well-being based on age, religious group membership and activities, and whether or not the respondent was facing a spiritual challenge. However, regression analyses showed that these variables had no significant influence on the help that staff thought residents need to nurture their spiritual well-being. Regression analyses did show that staff’s ideals contributed greatest explanation of variance in terms of help staff believe is needed for spiritual nurture of residents. On the other hand, it was the lived experiences of family members that showed greatest influence on what help they thought residents needed. This was especially true for family members who had difficulty living up to their own ideals. Even though they based their judgements on different rationale, staff and family members agreed on the priorities to be set in nurturing residents’ spiritual well-being in a dementia care unit. Conclusion: Congruence was found between staff’s and family members’ perceptions of help needed to nurture residents’ spiritual well-being. This study, using the spiritual well-being questionnaire called SHALOM, revealed that staff acted professionally basing their judgment on ideals, whereas family members reflected their own lived experience, when determining what they thought was needed to help nurture residents’ spiritual well-being.

The purpose of this study was to explore the relationship between pregnant women's fear of coronavirus (COVID-19), depression, and spiritual well-being. This cross-sectional research was carried out with 336 pregnant women living in a city in the Eastern Anatolia region of Turkey between the 1st of March and 30th of March 2021. For data collection, the scales of the Fear of COVID-19, the Beck Depression Inventory, and the Spiritual Well-being were administered to the participants. The pregnant women’s fear of COVID-19 was found to be at a moderate level, their depression was at a mild level, and their spiritual well-being was above the moderate level. It was found that there was a significant negative correlation between the spiritual well-being levels of pregnant women and their fear of COVID-19 and depression. Moreover, it was also found that there was a significant positive correlation between pregnant women’s levels of fear of COVID-19 and depression (p < 0.001). It is recommended that relevant spiritual care practices can be disseminated and implemented effectively to reduce pregnant women’s fear and depression during the pandemic. In addition, when providing care to pregnant women, health professionals can adopt a holistic approach to increase pregnant women’s spiritual well-being.

Introduction: Life satisfaction is considered one of the basic concepts related to health, which is influenced by various factors including spiritual well-being. The purpose of this study was to investigate the relationship between spiritual well-being and life satisfaction in relation to the mediating role of social support in pregnant women referred to Qazvin health-care centers, Iran. Methods: This cross-sectional study was conducted in 2018. Participants were 160 pregnant women referred to Qazvin health-care centers to receive prenatal care. Two-step sampling was performed considering the health-care centers as clusters. Questionnaires of demographic characteristics, Diener Life Satisfaction scale, Vaux Social Protection scale, and Dehshiri Spiritual Well-being scale were used to gather data. Data were analyzed using the Pearson's correlation coefficient test and mediation analysis via the SPSS software. Results: Life satisfaction was significantly correlated with spiritual well-being (r= 0.38) and social support (r = 0.39). In addition, there was a positive and significant relationship between spiritual well-being (r = 0.43) and social support (P &lt; 0.01). Given the significant relationship between life satisfaction, social support, and spiritual well-being, and taking into account the mediating role of social support, spiritual well-being (b = 0.035) had an indirect effect on life satisfaction (P = 0.01). Conclusion: Social support can positively and meaningfully improve the relationship between spiritual well-being and life satisfaction in pregnant women. Therefore, interventions for the promotion of spiritual well-being and life satisfaction in pregnant women should take into account the role of social support.

To investigate the mediating role of spiritual well-being in the association between compassion fatigue and moral resilience among nurses. Nurses are inevitably placed in situations of compassion fatigue. Their moral resilience and spiritual well-being may play a crucial role in mitigating the impacts of compassion fatigue. Nonetheless, spiritual well-being, which mediates the influence between compassion fatigue and moral resilience, remains scarce among nurses. Cross-sectional and correlational design. Nurses (n=465) from four government-owned tertiary hospitals in Saudi Arabia were recruited and completed three self-report scales from July to December 2023. Descriptive statistics (e.g., mean, standard deviation, frequency, and proportions) and inferential statistics (Spearman rho and structural equation modeling) were used for data analysis. The emerging model afforded acceptable model fit parameters. Moral resilience had a negative effect on compassion fatigue (β=-0.05, p=0.003) and a positive influence on spiritual well-being (β=0.51, p=0.003). Spiritual well-being negatively influenced compassion fatigue (β=-0.90, p=0.003). Moral resilience had a moderate, negative, indirect effect on compassion fatigue through the mediation of spiritual well-being (β=-0.47, p=0.002). Our study offered a model that validated the mediating role of spiritual well-being in the association between moral resilience and compassion fatigue. Moral resilience directly and indirectly influences spiritual well-being and compassion fatigue, respectively. Healthcare institutions that employ nurses must continually assess compassion fatigue levels and provide necessary interventions. Nurses, nurse managers, and healthcare institutions may leverage moral resilience to improve nurses' spiritual well-being while averting the negative effects of compassion fatigue. Healthcare institutions may incorporate spiritual care into their mainstream support interventions to enhance their compassion, reduce fatigue, and enhance their mental well-being.

Introduction: There are specific gaps that call for empirical research in the experiences of spiritual well-being among children 12 years old and younger with cancer. Understanding these relationships can help to develop holistic and family centered care in pediatric oncology wards. This study assessed the spiritual well-being of children with cancer in association with their general well-being, happiness, quality of life, pain intensity, and personal characteristics. Method: The data were collected in Lithuania between June 2020 and November 2021. Children with cancer (N = 81) who were hospitalized at pediatric oncology-hematology centers participated in the study. Inclusion criteria were age (from 5 to 12 years old), diagnosis of oncologic disease for the first time, and absence of other chronic diseases. The instruments used were: Feeling Good, Living Life; Oxford Happiness Questionnaire, Short Form; Well-Being Index; PedsQL™3.0 Cancer Module, and a Wong-Baker FACES® Pain Rating Scale. Results: Communal and personal domains of spiritual well-being had the highest scores among pediatric oncology patients while both dimensions of the transcendental domain scored lowest. Age, level of education, and family composition revealed differences in children's spiritual health, happiness, and well-being, and church attendance was significant for overall spiritual well-being and its transcendental domain on lived experience dimension. Happiness had the strongest effect on all four domains of spiritual well-being. Discussion: Children emphasized the importance of spiritual aspects to feel better to a greater extent than they experienced in their lives. Despite their young age, children were familiar with family traditions, that is, religious practice and church attendance, and followed them in a particular sociocultural context.

To evaluate the effect of maternal exposure to real-time 4-dimensional (4D) fetal ultrasound versus still 3-dimensional (3D) ultrasound on maternal-infant attachment. Three hundred pregnant women were recruited. Baseline assessments were performed at 18-20 weeks gestation and included the administration of the Maternal Antenatal Attachment Scale (MAAS) and Health Behaviour Questionnaire. Women were randomized to the 3D or 4D groups. The allocated ultrasound was performed at 28-30 weeks gestation and the Maternal Infant Attachment Questionnaire (MIA) was administered three weeks after delivery. The primary endpoint was the Quality of Attachment subscale of the MIA and comparisons between groups were adjusted for baseline MAAS scores. The mean MIA Quality of Attachment subscale scores were 32.7 and 32.6 for the 3D and 4D groups, respectively (adjusted mean difference was 0.16; 95% CI: -0.67 to 0.99; p = 0.7). The mean MIA Pleasure in Interaction subscale scores were 23.4 and 23.7 for the 3D and 4D groups, respectively (adjusted mean difference was -0.33; 95% CI: -0.81 to 0.15; p = 0.2). Mean scores for the MIA Absence of Hostility Subscale were 16.0 and 16.2 for the 3D and 4D groups respectively (adjusted mean difference was -0.12 95% CI: -0.70 to 0.46; p = 0.7). We found that maternal exposure to real-time 4D ultrasound did not increase maternal-infant attachment.