Maternal Emotional Well-being Research Articles

From Breastfeeding to Support in Mothers’ Feeding Choices: A Key Role in the Prevention of Postpartum Depression?

The postpartum period represents a critical phase of profound transition for women. This timeframe encompasses the physical recuperation associated with childbirth, the intricate psychosocial adjustments inherent in assuming the role of motherhood and also important alterations in steroid and peptide hormones. Hence, as women navigate the reconfiguration of relationships and strive to address the diverse needs of their infants and family members, they concurrently grapple with dramatic transformations which are characteristic of the postpartum phase. In fact, relevant prevalence ranges are reported for maternity blues, a mild condition characterized by self-limited and transient depressive symptoms, but also a well-established risk factor for more serious postpartum mood disorders, such as depression (PPD), with an incidence of 10–15%. Unlike in the US, at the European level, there are no concrete recommendations for the routine integration of the assessment of the mother’s emotional state by healthcare professionals, with a considerable risk of underdiagnosing or undertreating these conditions. In this regard, there is a growing body of scientific evidence on the important role of breastfeeding in reducing the risk of PPD and also of the importance of mothers’ compliance with this practice. Indeed, sucking the baby regulates the circadian rhythm of the HPA axis and, together with the action of prolactin, the stress response is decreased. In addition, other positive consequences of breastfeeding, which are inversely correlated with the onset of PPD, include the regulation of sleep and waking patterns for mother and baby, the improvement of the mother’s self-efficacy and her emotional involvement. It should also be considered that the request for support for breastfeeding can often conceal a request for support for motherhood itself and for the mother’s emotional well-being. It therefore emerges that the personnel involved in primary pediatric care to provide adequate support in the transition to motherhood must support mothers in their breastfeeding choices, whether breastfeeding or formula feeding, so that each choice is made conscientiously and serenely. Therefore, neonatal feeding assumes a decisive role, since if, on the one hand, it regulates specific neurohormonal pathways that are protective for maternal emotional well-being (breastfeeding), on the other hand, support in mothers’ breastfeeding choices, even in the case of formula feeding, means validating their being mothers in the absence of judgement and counteracting any feelings of inadequacy, conditions that are inversely correlated to DPP.

Maternal Wellbeing Five Years after a Very Preterm Delivery: Prevalence and Influencing Factors in a European Cohort.

(1) Background: Mothers of very preterm (VPT) infants may experience psychological symptoms compromising long-term emotional wellbeing. This study describes the emotional wellbeing of mothers of five-year-old children born VPT. We assess the association between sociodemographic, perinatal and neonatal characteristics, and the child's health and development at five years old and maternal emotional wellbeing. (2) Methods: Data are from the prospective European "Effective Perinatal Intensive Care in Europe" (EPICE) and subsequent "Screening for Health In very Preterm infantS in Europe" (SHIPS) projects including births <32 weeks' gestational age in 11 countries in 2011/12. Data were abstracted from obstetric and neonatal records. At five years old, 2605 mothers answered a parental questionnaire including the Mental Health Inventory-5 (MHI-5). Associations between sociodemographic and health characteristics and the mother's MHI-5 score were investigated using multilevel multivariate linear regression analysis with the country modelled as a random effect and inverse probability weighting to correct for attrition bias. (3) Results: The mean MHI-5 score was 71.3 (SD 16.7) out of 100 (highest emotional wellbeing) with a variation among countries from 63.5 (SD 16.8; Poland) to 82.3 (SD 15.8; the Netherlands). MHI-5 scores were significantly lower for mothers whose child had a severe health problem, developmental, or speech delay, for multiparous and single mothers, and when at least one of the parents was unemployed. (4) Conclusions: The emotional wellbeing of mothers of VPT infants differs between European countries. Identifying sociodemographic characteristics and child's health and developmental conditions that affect maternal emotional wellbeing may help to identify groups of mothers who need special assistance to cope with consequences of the delivery of a VPT child.

Deep Learning in Pediatric Neuroimaging

The integration of deep learning techniques in pediatric neuroimaging has shown significant promise in advancing various aspects of the field. This paper provides a comprehensive exploration of deep learning applications in pediatric neuroimaging, focusing on image processing and reconstruction, segmentation and classification, brain abnormalities detection, and brain development and maturation analysis. It discusses key deep-learning techniques and their relevance in pediatric neuroimaging. The paper also addresses challenges and limitations such as the lack of standardization, ethical and privacy concerns, limited and heterogeneous data, and age, gender, and developmental variations. The paper highlights future directions and opportunities, including the integration of multi-modal data, ethical considerations, diagnosing and initiating treatment during early stages, and the impact of maternal emotional well-being on brain development. The insights provided in this paper aim to contribute to understanding how deep learning can positively impact pediatric neuroimaging and inspire further research and innovation in the field. Ultimately, adopting deep learning techniques in pediatric neuroimaging can improve patient outcomes, advance diagnostic accuracy, and enhance our understanding of early brain development.

The Relationship between Forgiveness and Resilience in Parents of Down Syndrome Children

The aim of this study was to examine the relationship between Forgiveness and resilience in mothers who have children with Down syndrome. This research is important given the emotional and psychological challenges that mothers often face in this situation. The condition of Down syndrome in children can cause significant psychological stress in the mother, where Forgiveness and resilience are key factors in overcoming these challenges. The research was conducted on 100 mothers who have children with Down syndrome, using a purposive sampling method. Data were collected through questionnaires, using the Forgiveness scale from McCullough and the resilience scale from Reivich and Shatte. The research results show that the empirical average (mean) value for Forgiveness is 73.33 and for resilience is 169.15, indicating that these two variables are in the high category. With a correlation coefficient (r) of 0.459 and a significance level of 0.000 (p&lt;0.01), these results indicate a very significant positive relationship between Forgiveness and resilience. This means that the higher the level of Forgiveness in the mother, the higher the level of resilience. These findings have important implications for the development of support and intervention programs for mothers of children with Down syndrome, emphasizing the importance of emotional and psychological aspects in child care. This research also opens up opportunities for further study regarding other factors that influence maternal emotional well-being in this context.

On cloud nine? Maternal emotional wellbeing six weeks up to one year postpartum – A cross-sectional study

BackgroundLittle is known about the full scope of emotional wellbeing of mothers up to one year postpartum, to adequately support women during transition to motherhood. Reduced emotional wellbeing (REW) affects women’s adaption to the changes and challenges in becoming a mother. We aimed to increase the knowledge and understanding of mothers’ emotional wellbeing and the influencing factors. MethodsThis cross-sectional study includes 385 Flemish mothers up to one year postpartum. Online data were collected with the General Health Questionnaire-12, Postpartum Bonding Questionnaire, Personal Well-Being Index-Adult, The Basic Psychological Needs Scale, Sense of Coherence-13 and Coping Operations Preference Enquiry. ResultsA total of 63.9% of the participants reported REW. Mothers with REW more often had (a history of) psychological problems compared to mothers with healthy emotional wellbeing (p = 0.007). Multiple linear regression analysis showed negative associations between emotional wellbeing and satisfaction (p = 0.002; p < 0.001), comprehensibility (p = 0.013) and positive associations between emotional wellbeing and bonding (p < 0.001), manageability (p = 0.033), problem solving (p = 0.030) and avoidance (p = 0,011) – with an explained variance of 55.5%. LimitationsSome limitations of our study are the GHQ-12 cut-off value, the nature and implication of (a history of) psychological problems and the self-selected population. ConclusionIt would be of worth for midwives to discuss with mothers (to be) what to expect. This - to support mothers in making sense of their life as a mother and how various factors might influence their emotional wellbeing. The high prevalence of REW is worrying, but needs to be interpreted with caution.

Psychological, endocrine and polygenic predictors of emotional well-being during the COVID-19 pandemic in a longitudinal birth cohort

The COVID-19 pandemic severely affected the lives of families and the well-being of both parents and their children. Various factors, including prenatal stress, dysregulated stress response systems, and genetics may have influenced how the stress caused by the pandemic impacted the well-being of different family members. The present work investigated if emotional well-being during the COVID-19 pandemic could be predicted by developmental stress-related and genetic factors. Emotional well-being of 7–10 year-old children (n = 263) and mothers (n = 241) (participants in a longitudinal German birth cohort (POSEIDON)) was assessed during the COVID-19 pandemic using the CRISIS questionnaire at two time periods (July 2020–October 2020; November 2020–February 2021). Associations of the children’s and mothers’ well-being with maternal perceived stress, of the children’s well-being with their salivary and morning urine cortisol at 45 months, and polygenic risk scores (PRSs) for depression, schizophrenia, loneliness were investigated. Lower emotional well-being was observed in both children and mothers during compared to before the pandemic, with the children’s but not the mothers’ emotional well-being improving over the course of the pandemic. A positive association between the child and maternal emotional well-being was found. Prenatally assessed maternal perceived stress was associated with a lower well-being in children, but not in mothers. Cortisol measures and PRSs were not significantly associated with the children’s emotional well-being. The present study confirms that emotional well-being of children and mothers are linked, and were negatively affected by the COVID-19 pandemic, with differences in development over time.

P49 - Exploring the impact of a parenting information kit on experience of motherhood and maternal emotional wellbeing: a cluster randomised controlled trial

There are considerable gaps in education for new families, particularly for the most vulnerable. A parenting education resource (the ‘Kit'), developed by a tertiary hospital in Melbourne, Australia, aimed to provide evidence-based pregnancy and parenting information to prospective parents, from conception until one year after birth. The kit included; an educational book, an app and a children’s story book. The trial aimed to evaluate the impact of the ‘Kit’ on women’s experience of motherhood. Secondary aims were to evaluate the impact of the kit on maternal emotional wellbeing and parenting confidence. We undertook a two-arm cluster randomised controlled trial of first-time mothers, ≤30 weeks gestation, recruited at their pregnancy booking appointment. The intervention group received the Kit with content to be actively delivered by health professionals. The non-intervention group received standard hospital-based resources. Data were collected by telephone interview at six months assessing Experience of Motherhood Questionnaire (EMQ), and maternal emotional wellbeing using the Edinburgh Postnatal Depression Scale (EPDS) and Kessler 6 (K6). Of the 1034 women recruited, 599 women completed the follow-up interview; 301 and 298 in intervention and non-intervention arms respectively. Overall, there was no significant difference by trial arm for the EMQ ≤40 (n=415, 78.4% vs 75.6%, AOR 0.85 CI 0.53-1.36), EPDS ≥13 (n=351, 3.2% vs 3.1%, AOR 0.93 95% CI 0.27-3.19) and K6 ≥8 (n=352, 7.0% vs 9.0%, AOR 0.76, 95% CI 0.35-1.67) at six months after birth. Most women stated that their midwife or doctor never used the book (70%) or app (93%). There was no significant difference between trial arms. This may be due to the dilution and/or delivery of the intervention. Further research in this area should ensure high level engagement with staff delivering new interventions further informing the provision of pregnancy and early parenting information.

Mother’s mental health and the interaction with her moderate preterm baby in the NICU

ABSTRACT Introduction: Moderate preterm infants, born between 320/7 and 336/7 weeks, represent a significant number of preterm-born infants; however, they remain a poorly studied group despite their vulnerability. The objective of this correlational study is to describe the impact of having a moderate preterm infant hospitalised in the NICU on the mothers’ mental health and how this relates to the interaction between the dyad. Method: During the hospitalisation period, 85 moderate preterm mother-infant dyads participated in this study. The participants provided self-reports of depression, parental stress, and skin to skin and breastfeeding practices. Also, mother-infant interaction was assessed in the NICU with an observational scale. Results: Mothers evidenced high levels of stress and depressive symptoms during the hospitalization. The stress experienced by these women was significant, although weakly, associated with the interaction with their babies; and mothers of small for gestational age babies showed difficulties in this area. Conclusions: The results of this study could represent a contribution to a better understanding of the relation between the characteristics of moderate preterm babies, maternal emotional wellbeing, and the quality of mother-infant interactions in NICU settings.

COVID-19 Pandemic-Related Restrictions: Factors That May Affect Perinatal Maternal Mental Health and Implications for Infant Development.

This review aims to discuss the factors that may affect maternal mental health and infant development in COVID-19 pandemic condition. Toward this direction, the two objectives of this review are the following: (a) to discuss possible factors that may have affected negatively perinatal mental health through the pandemic-related restrictions; and (b) to present the implications of adversely affected maternal emotional wellbeing on infant development. We conclude that the pandemic may has affected maternal mental health with possible detrimental effects for the infants of the COVID-19 generation. We highlight the need for evidence-based interventions to be integrated within the health system for prenatal and postpartum care in an effort to promote maternal mental health and infant development.

Maternal self-efficacy and emotional well-being in Chilean adolescent mothers: the relationship with their children's social-emotional development.

BackgroundLow maternal self-efficacy and high levels of anxiety, depression, and stress can be triggered in adolescent mothers due to an incomplete development process that makes them physically or psychologically unprepared for the responsibilities of motherhood and parenting. These factors may be linked to difficulties with their children’s social-emotional development. The present study aims to: (a) analyze the relationship between maternal self-efficacy and stress, depression, and anxiety levels in low-income adolescent mothers; (b) examine the relationship between maternal self-efficacy and well-being with children’s social-emotional development; and (c) describe the effects of maternal self-efficacy on children’s social-emotional development, mediated by maternal well-being.MethodsA sample of 79 dyads comprising low-income Chilean adolescent mothers aged from 15 to 21 years old (M = 19.1, SD = 1.66) and their children aged 10 to 24 months (M = 15.5, SD = 4.2) participated in this research. A set of psychometric scales was used to measure maternal self-efficacy (Parental Evaluation Scale, EEP), the mothers’ anxiety and depression (Hospital Anxiety and Depression Scale, HADS), maternal stress (Parental Stress Scale, PSS), and the children’s social-emotional development (Ages and Stages Questionnaire Socio-emotional, ASQ-SE). Bivariate analyses and mediation models were employed to estimate and test the relevant relationships.ResultsA bivariate analysis showed that maternal self-efficacy was negatively related to the mother’s anxiety, depression, and stress. Moreover, there was a significant relationship between maternal self-efficacy and maternal stress, and children’s self-regulation and social-emotional development. Maternal self-efficacy, mediated by maternal anxiety, depression, and stress scores, had a significant effect on the development of children’s self-regulation.ConclusionsThe results confirm the importance of adolescent mothers’ emotional well-being and maternal self- efficacy with respect to their children’s social-emotional development. This makes it necessary to have detailed information about how emotional and self-perception status influences a mother’s role in the development of her children.

Maternal mood moderates the trajectory of emotional and behavioural problems from pre- to during the COVID-19 lockdown in preschool children.

The COVID-19 outbreak and subsequent lockdown have dramatically impacted families’ life, raising serious concerns about children’s emotional wellbeing. However, few studies have investigated whether the impact of the COVID-19 lockdown on psychological adjustment in youngest can be moderated by maternal mood and, to our knowledge, none of them has adopted a longitudinal design. The main aim of the current study was to explore if the intensity and directionality of maternal mood symptoms moderated the trajectory of emotional and behavioural problems in Italian pre-schoolers from pre- to during the lockdown adopting a longitudinal design. To assess maternal anxiety and depression symptoms, the EPDS and the STAI-Y were filled in by 94 and 88 women before the lockdown, when their children were 1 (Wave P1) and 3 years old (Wave P2), respectively, and by 74 women during the lockdown, when their children were 4 years old (Wave L). Mothers also filled in the CBCL/1 ½–5 to assess their children’s emotional and behavioural problems at each assessment wave. As a whole, children’s emotional and behavioural problems significantly increased from pre- to during the lockdown. Furthermore, maternal mood moderated this trajectory. In particular, greater maternal mood symptoms were significantly associated with a greater increase in emotional reactive, anxious-depressed, withdrawn and aggressive symptoms during the lockdown. These results contribute to shed light on the role played by maternal emotional wellbeing in buffering the impact of the COVID-19 lockdown on children’s behavioural development. Albeit preliminary, the current findings highlight the need to provide timely psychological interventions to distressed mothers to help their children to better cope with the effects of the pandemic.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00787-021-01925-0.

Examining the association between subjective childbirth experience and maternal mental health at six months postpartum

ABSTRACT Problem Childbirth experience can have long-lasting effects on maternal wellbeing. Background Positive childbirth experiences may strengthen maternal self-confidence, in contrast, negativeexperiences may promote a sense of failure or distrust. Aim To examine the contribution of maternal hospital childbirth experience on mental health at 6 months postpartum in a community-based, Chilean sample. An additional aim is to examine which childbirth-related aspects contribute to the global birth experience. Methods One hundred and forty-eight women completed self-report measures of mental health during the third trimester of pregnancy and 3 and 6 months postpartum. At 3months after childbirth, subjective childbirth experience was assessed. Logistic regression analysis examined the contribution of childbirth experience to maternal mental health. Findings Negative subjective experience of childbirth contributes to maternal depression and anxiety up to 6 months after childbirth, controlling for mental health during pregnancy and at 3 months postpartum. Quality of care from health professionals made the largest, statistically significant contribution to the global perception of childbirth. Discussion and Conclusions Subjective experience of childbirth is a modifiable risk factor for the development of postpartum maternal depression and anxiety. Health providers in direct contact with childbearing women may promote maternal emotional wellbeing through sensitive and respectful care.

The Relationship Between Children’s Social-Emotional Competence, Spiritual Health, and Maternal Meta- Emotion Structure Attachment Style

Background and Objectives: Understanding the influences of parents on children in the process of psychosocial and personality development of children and adolescents has been the focus of psychologists and sociologists. This study aimed to predict the emotional and social competence of the child based on spiritual health and maternal emotional structure according to the mediating role of children’s attachment style. Methods: The statistical population of this correlational descriptive was female primary school students and their mothers in Tehran City, Iran. Of them, 250 individuals were selected by purposive and voluntary sampling method using Klein’s method. The research instruments included Zhu and Ji’s (2012) Emotional and Social Competency Inventory, Polutzin and Ellison’s Spiritual Well-Being Scale (SWBS), and Kern’s Attachment Style Classification QuestionnaireAttachment style. The collected data were analyzed using AMOS. Results: The obtained results suggested that the structure of maternal metacognition was directly related to children’s attachment style (-0.33); maternal spiritual health and children’s attachment style (0.37); the structure of maternal metacognition and the emotional-social competence of the child (-0.26); mothers’ spiritual health and child’s emotional and social competence (0.18), and the child’s attachment style and the child’s emotional and social competence (0.49). The structure of maternal emotional well-being and the emotional-social competence of the child (-0.16) as well as the spiritual health of the mother and the emotional-social competence of the child (0.18) were indirectly related. Conclusion: Considering the importance of the child’s emotional and social competence, the emphasis on the influential factors of the present study can be promoted in developing this skill among children. Maternal spiritual health and emotional structure were related to the child’s emotional and social competence through the attachment style of the child; the strongest relationship concerned the relationship between attachment style and emotional and social competence

The risk-risk trade-offs: Understanding factors that influence women's decision to use substances to boost breast milk supply.

Galactagogues are foods, herbs or medications thought to support or increase breast milk supply. The use of galactagogues during lactation is becoming increasingly common despite limited evidence regarding effectiveness and safety, and no definitive recommendations for use in clinical practice. The aim of this study is to explore factors influencing women’s decisions to use galactagogues during lactation. Twenty-two semi-structured interviews were conducted in October and November 2019 (over the telephone or in person) with participants located in most Australian states and territories, including metro and regional areas. Interviews were audio-recorded, transcribed verbatim and thematically analysed using NVivo. Analysis revealed that following a concern about breast milk supply, the decision to use galactagogues was influenced by three core and interrelated domains: access to and quality of breastfeeding support, maternal agency and determination to provide breast milk. Women revealed many problematic experiences with health care professionals that left them feeling dismissed and confused due to provision of inconsistent and insufficient information that was sometimes at odds with their desire to provide breast milk. In this instance, some women turned to galactagogues to regain agency. A range of broader dimensions influencing decision-making also emerged. These were separated into categories that emphasise distinctions relating to breast milk supply, which included: maternal emotional wellbeing, social norms and pressures, concerns about infant development, maternal physical health and lactation history, as well as those relating specifically to galactagogue use, including: desire for a guaranteed/urgent response, risk-risk trade-off, acceptance and trust, and accessibility and cost. In understanding the complexity of decision-making concerning these substances, we identify opportunities to improve breastfeeding counselling and support. We recommend that support be individually tailored to manage conflicting information, adopt communication styles that encourage trust and processes that enable shared decision-making to enhance or restore maternal agency. There is also considerable need to address evidence gaps regarding the effectiveness and safety of commonly used galactagogues, so that women can be appropriately counselled about potential benefits and harms.

NICU-Specific Stress Following Traumatic Childbirth and Its Relationship With Posttraumatic Stress.

This mixed-methods pilot study investigated maternal perceived stress specific to infant neonatal intensive care unit (NICU) hospitalization as a moderator of the relationship between traumatic childbirth appraisal and symptoms of posttraumatic stress disorder (PTSD). NICU mothers (N = 77) were recruited via social media 1 to 4 months postpartum for a cross-sectional survey about perinatal experiences. Measures included traumatic childbirth, PTSD Checklist for DSM-5, and Parental Stressor Scale (PSS): NICU. Quantitative results indicated that, only at high levels of stress, women who reported traumatic childbirth (68%) reported significantly higher PTSD symptoms [b = 18.00, standard error = 7.18, t = 2.51, P = .015, 95% confidence interval (3.65, 32.36)]. Qualitative analysis identified additional stressors: maternal emotional well-being, dissatisfaction with care, infant health problems, breastfeeding, and additional characteristics of the NICU environment. Results provide supportive evidence that NICU mothers are at high risk for childbirth-related trauma and PTSD. Perceived stress related to the NICU may be an important intervention target when developing trauma-informed patient care. In addition to the domains captured by the PSS: NICU, maternal emotional well-being, interpersonal relationships with NICU staff, and stress related to breastfeeding are additional areas for improvement in the family-centered NICU.

The Role of Perinatal Anxiety and Depression in Breastfeeding Practices.

Objective: Maternal mental health difficulties are common during the perinatal period and have a negative impact on breastfeeding practices. Most research has focused on the role of postpartum depression, whereas maternal anxiety has been less studied, despite its high prevalence. A better understanding of the mental health variables that impact breastfeeding practices is necessary to support maternal and infant health and well-being. The aim of this study is to explore the association between breastfeeding practices and maternal mental health, with an emphasis on maternal anxiety. Materials and Methods: Two hundred twenty-nine women were followed from the third trimester of gestation to 3 and 6 months postpartum. The participants provided self-reports of depression, anxiety, and breastfeeding practices. Mental health symptoms were compared between participants who reported exclusive versus mixed breastfeeding at 3 months postpartum, and between mothers who maintained breastfeeding versus those who had weaned their infants at 6 months postpartum. Logistic regression analysis was used to explore the variables contributing to breastfeeding practices. Results: High levels of depressive symptoms during pregnancy were associated to nonexclusive breastfeeding at 3 months postpartum. At 3 months postpartum, both high levels of anxiety and depression were associated with nonexclusive breastfeeding at that time. Logistic regression analyses revealed that exclusive breastfeeding at 3 months postpartum predicted breastfeeding continuation at 6 months after childbirth. Conclusion: Both maternal depression and anxiety negatively impact breastfeeding practices. Early identification of maternal mental health problems during the perinatal period is relevant to promote maternal emotional well-being and to prevent breastfeeding difficulties.

The experiences of mothers with preterm infants within the first-year post discharge from NICU: social support, attachment and level of depressive symptoms

BackgroundThe estimated global premature birth rate for 2014 was 10.6%, equating to an estimate of 14.84 million live premature births. The experience of premature birth does not impact solely on the infant and mother as individuals but occurs in the context of a critical point in time when they are developing a relationship with one another. The aim of this study was to investigate the relationships between social support, mother to infant attachment, and depressive symptoms of mothers with preterm infants within the first 12 months’ post discharge from the Neonatal Intensive Care Unit (NICU).MethodsA correlational cross-sectional study design was used. Data were collected using a four-part online survey which included the Perinatal Social Support Questionnaire (PICSS), Maternal Postnatal Attachment Scale (MPAS) and the Edinburgh Postnatal Depression Scale (EPDS) with mothers of preterm infants (n = 140).ResultsThe prevalence of postnatal depression was 37.9% (95% CI: 29.8 to 46.4%). In univariable analyses, history of depression (p = 0.005), aged 35–39 years (p = 0.006), no formal social support (p = 0.040), less informal social supports (p = 0.018), lower overall maternal attachment (p < 0.001) and lower overall functional social support (p < 0.001) were significantly associated with a higher level of depressive symptoms. Lower scores on two of the maternal attachment subscales (quality of attachment and absence of hostility) and all four of the functional social support subscales were significantly associated with a higher level of depressive symptoms (p < 0.001 for all). In the multivariable analysis, prior history of depression (p = 0.028), lower score of maternal attachment (p < 0.001) and lower emotional functional social support (p = 0.030) were significantly associated with a higher level of depressive symptoms.ConclusionWomen who experience a premature birth, have a prior history of depression, poor infant attachment and poor emotional social support have a higher level of depressive symptoms. Results emphasise the need for professionals to encourage mobilisation of maternal formal and informal social supports. It is important to intervene early to address maternal emotional well-being and enhance the developing mother-preterm infant relationship.

Evaluation of a Technology-Based Peer-Support Intervention Program for Preventing Postnatal Depression (Part 2): Qualitative Study.

BackgroundSocial support is known to reduce risks of postnatal depression (PND) and improve maternal emotional well-being. However, the Asian cultural context is often neglected when appraising maternal needs and mothers’ preferences for social support. While many preventive efforts have experimented with technology, professionals, and paraprofessionals in providing social support to mothers in need, most studies determined the effectiveness of their interventions through quantitative measurements of maternal outcomes. Experiences and feedback from both participants and administrators are rarely discussed, especially in an Asian setting.ObjectiveThe goal of the research was to evaluate the postnatal experiences of Asian mothers at risk of PND and the perceptions of peer volunteers regarding a technology-based peer-support intervention program (PIP).MethodsA qualitative semistructured interview was conducted with 20 Asian mothers at risk of depression (10 from the control group and 10 from the intervention group) and 19 peer volunteers from a randomized controlled trial. The PIP included weekly correspondence between peer volunteers and mothers through any telecommunication means over 4 weeks. All interviews were approximately 30 to 60 minutes long, audiotaped, transcribed verbatim, and analyzed using thematic analysis. Study findings were reported according to the Consolidated Standards of Reporting Trials checklist.ResultsTwo overarching themes comprising five subthemes were generated: postnatal experience (a bouncy ride, a way forward) and evaluation of the PIP (valuable, flexible, and supportive program; building blocks of a good relationship; and lessons learned and the road ahead). Mothers from both the control and interventions groups were generally satisfied with hospital care and the support received from family. They also shared similar breastfeeding challenges and needs for more informed decisions and follow-up support from the hospital. However, mothers who received the PIP tended to have more positive outlooks of their birth experiences. Overall, peer volunteers and mothers involved in the PIP found the PIP useful and expressed satisfaction with the program’s flexibility. They also shared their personal takeaways, the qualities of their friendships, and the need for extended correspondence time and recommended outreach to non–at-risk mothers.ConclusionsThe positive endorsement of the PIP by peer volunteers and mothers suggests the success of the PIP in maintaining positive maternal emotional well-being during the postpartum period. With the help of technology, hospitals can easily provide additional peer support to at-risk mothers in addition to existing standard care offered to these mothers.Trial RegistrationISRCTN Registry ISRCTN14864807; http://www.isrctn.com/ISRCTN14864807International Registered Report Identifier (IRRID)RR2-10.2196/resprot.9416

Determinants of Persistence and Change in Early Childhood Behavioural Problems: The Roles of Parenting and Maternal Mental Health

The current study aimed to investigate factors associated with the persistence and change in behavioural difficulties during early childhood. The study used data from the Growing Up in New Zealand birth cohort. Maternal-rated behavioural difficulties were assessed when children were aged 2 and 4.5 years (N = 5885). The ninetieth percentile of the Strengths and Difficulties total difficulties score was used to identify children who showed serious behavioural difficulties at each time point, with children then categorised as showing no difficulties, improved behaviour, later difficulties, and persistent difficulties. Predictors of interest related to maternal-reported mental health and parenting behaviour, family social support and exposure to physical and verbal inter-parental conflict. Poor maternal mental health at multiple time points and authoritarian and physical punishment parenting styles were associated with an increased likelihood of developing behavioural difficulties at 4.5 years and showing persistent difficulties from 2 to 4.5 years. Physical punishment and authoritarian parenting styles also mediated the association between a history of verbal inter-parental conflict and both developing later difficulties and persistent difficulties, whereas only physical punishment parenting style mediated this association for a history of physical inter-parental conflict. The only factor that distinguished children who improved from children who persisted was maternal parenting self-evaluation at 9 months; mothers who had a better self-evaluation were more likely to have children who persisted than improved. These results demonstrate the importance of addressing mothers’ self-reported management of their children’s behavioural difficulties, inter-parental conflict and maternal emotional wellbeing.

‘Scrutinised, judged and sabotaged’: A qualitative video diary study of first-time breastfeeding mothers

ObjectiveTo explore how support impacted on mothers’ breastfeeding experiences in the first few weeks following birth. DesignA qualitative approach explored real-time experiences of breastfeeding captured by five first-time mothers in the South of England on camcorder as video diaries. A multi-dimensional approach involving thematic analysis ensured both the audio and visual elements of the data were analysed. FindingsMothers felt ‘under surveillance’ by the biomedical approach to support from the healthcare team. At best mothers felt reassured that they were ‘on the right track’. When mothers felt their breastfeeding was constantly being examined, criticised and threatened they felt ‘scrutinised, judged and sabotaged’. When they found it difficult to access healthcare support, or they avoided it altogether to circumvent further scrutiny, they felt ‘abandoned and alone’. Key conclusionsCollecting audio-visual data in real-time adds fresh insights into how support impacts mothers’ experiences of breastfeeding. The biomedical approach to support for breastfeeding is not effective. Scrutinising, judging and/or sabotaging mothers’ attempts to breastfeed can have long-lasting effects on maternal emotional wellbeing. Implications for practiceBreastfeeding support might be improved by adopting a more social model of care. Future research needs to explore how relationship-based support can be provided by the health service.