Maternal Mental Illness Research Articles

Proof of concept of a mind-mindedness intervention for mothers hospitalized for severe mental illness.

Studies 1 and 2 investigated how maternal severe mental illness (SMI) related to mothers' mind-mindedness (appropriate and nonattuned mind-related comments). Study 1 showed that mothers with SMI (n = 50) scored lower than psychologically well mothers for both appropriate and nonattuned comments, whereas mothers with SMI in Study 2 (n = 22) had elevated levels of nonattuned comments. Study 2 also tested the efficacy of a single-session video-feedback intervention to facilitate mind-mindedness in mothers with SMI. The intervention was associated with a decrease in nonattuned comments, such that on discharge, mothers did not differ from psychologically well controls. Study 3 assessed infant-mother attachment security in a small subset of intervention-group mothers from Study 2 (n = 9) and a separate group of standard care mothers (n = 30) at infant mean age 17.1 months (SD = 2.1). Infants whose mothers completed the intervention were more likely to be securely attached and less likely to be classified as insecure-disorganized than those of mothers who received standard care. We conclude that a single session of video-feedback to facilitate mind-mindedness in mothers with SMI may have benefits for mother-infant interaction into the second year of life.

Maternal mental illness and early parenting interventions

The importance of the “1001 critical days” (conception to age 2) underlies the need to act early in life to enhance children's developmental outcomes. Lack of intervention is likely to affect the children of today but also the generations to come. For adults, transition to parenthood is a major stressful life event. The strong emotional load of this experience can make this transitional period much more challenging for adults with psychological, social and economic vulnerabilities, and lead to unadjusted interactions.Then, applying the “transactional model of development” (Sameroff, 2009) to the early perinatal period helps us to understand how the needs of infants can easily affect a parent's mental state and induce inadequate parenting behaviors. These in turn make the infant's interactions more difficult and the infant's development more likely to be impaired. Perinatal mental health is thus an important public health challenge for it is essential to provide services to enhance maternal and infant emotional well-being at a moment that is simultaneously when the mother's social and emotional vulnerabilities are at their height and a critical time in the child's development.Perinatal mental health policies, including joint care of parents and infants, must provide positive support for the potential virtuous circle between the skills and vulnerabilities of the infant and the parents.This presentation will explore the different types of joined perinatal care for parents and infants that cover a range of services, from parent-infant psychotherapies to joint mother-baby hospitalizations.Disclosure of interestThe author has not supplied his declaration of competing interest.

World maternal mental health day

IntroductionAs many as 20% of mothers experiences some type of perinatal mood and anxiety disorder (PMAD) worldwide. Women of every culture, age, income level, and race are at risk for PMADs with potential effects to mother and child.ObjectivesTo promote awareness of maternal mental health and PMADs.MethodAn international task force met via online videoconference to make plans for the inaugural World Maternal Mental Health Day. The task force soon grew to include representatives from around the globe with a common goal to increase awareness of and influence policy about maternal mental health. This presentation will discuss the process, successes, challenges, and engage participants in future social marketing strategies for World Maternal Mental Health Day. International reach and impact will be discussed.ResultOrganizations from 12 countries were involved in this event, with twitter and landing page activity across the globe. A unique logo was developed and numerous organizations endorsed the event. An international social media campaign included a Twitter Feed “#Maternal Mental Health Matters” starting in Australia, Facebook page, and landing page. The first World MMH Day was held May 4, 2016.ConclusionIncreased awareness will continue to drive social change with a goal of improving the quality of care for women worldwide who experience all types of PMADs and to reduce the stigma of maternal mental illness. World Maternal Mental Health Day will be held each year on the first Wednesday of May, close to “mother's day” and “mental health week” in many countries.Disclosure of interestThe author has not supplied his/her declaration of competing interest.

The Association Between Antenatal Exposure to Selective Serotonin Reuptake Inhibitors and Autism: A Systematic Review and Meta-Analysis.

This systematic review and meta-analysis examines the relationship between antenatal selective serotonin reuptake inhibitor (SSRI) exposure and child autism, with specific attention to maternal mental illness (MMI) as a potential confounding factor. We searched MEDLINE, Embase, PsycINFO, and CINAHL from database inception to January 28, 2016. Keywords included terms for SSRIs, pregnancy, and autism. We included published, peer-reviewed articles written in English. Two reviewers used standardized instruments for data extraction and quality assessment. We generated pooled estimates for studies of the same design for SSRI exposure at any time during pregnancy and exposure during the first trimester. Subanalyses were conducted among studies with analyses (1) adjusted for MMI and (2) restricted to MMI. We included in the meta-analysis 4 case-control studies and 2 cohort studies. In the case-control studies, the adjusted pooled odds ratio (aPOR) values were 1.4 (95% CI, 1.0-2.0) (any) and 1.7 (95% CI, 1.1-2.6) (first trimester). In MMI-adjusted analyses, only first trimester exposure remained statistically significant (aPOR = 1.8; 95% CI, 1.1-3.1). In MMI-restricted analyses, neither exposure period was statistically significant. In the cohort studies, MMI-adjusted relative risk values were 1.5 (95% CI, 0.9-2.7) (any) and 1.4 (95% CI, 1.0-1.9) (first trimester). In MMI-restricted analyses, SSRI exposure at any time during pregnancy was nonsignificant. It remains unclear whether the association between first trimester SSRI exposure and child autism that was present in the case-control studies even after adjustment for MMI is a true association or a product of residual confounding. Future studies require robust measurement of MMI prior to and during pregnancy.

The emergence of functional architecture during early brain development

Early human brain development constitutes a sequence of intricate processes resulting in the ontogeny of functionally operative neural circuits. Developmental trajectories of early brain network formation are genetically programmed and can be modified by epigenetic and environmental influences. Such alterations may exert profound effects on neurodevelopment, potentially persisting throughout the lifespan. This review focuses on the critical period of fetal and early postnatal brain development. Here we collate findings from neuroimaging studies, with a particular focus on functional MRI research that interrogated early brain network development in both health and high-risk or disease states. First, we will provide an overview of the developmental processes that take place from the embryonic period through early infancy in order to contextualize brain network formation. Second, functional brain network development in the typically developing brain will be discussed. Third, we will touch on prenatal and perinatal risk factors that may interfere with the trajectories of functional brain wiring, including prenatal substance exposure, maternal mental illness and preterm birth. Collectively, studies have revealed the blueprint of adult human brain organization to be present in the neonatal brain. Distinct attributes of human brain architecture have even been detected in the developing fetal brain from as early as 24 postconceptional weeks. During postnatal brain development, the brain's wiring pattern is further sculpted and modulated to become the full facsimile of the adult human brain, with functional brain network refinement being more rigorous than structural brain network maturation. Advances in neuroimaging techniques have paved the way towards a comprehensive understanding of the maturational pathways of brain network development and of how early developmental adversity may affect these trajectories. Such insights are fundamental for our understanding of human brain functioning, for early identification of infants at risk, as well as for future neuroprotective strategies.

Changes in the prevalence of breast feeding in preterm infants discharged from neonatal units: a register study over 10 years

ObjectiveThere are indications that the prevalence of exclusively breastfed preterm infants is decreasing in Sweden. The objective was to investigate trends in exclusive breast feeding at discharge from Swedish neonatal...

Culture and Comorbidity: Intimate Partner Violence as a Common Risk Factor for Maternal Mental Illness and Reproductive Health Problems among Former Child Soldiers in Nepal.

Our objective was to elucidate how culture influences internal (psychological), external (social), institutional (structural), and health care (medical) processes, which, taken together, create differential risk of comorbidity across contexts. To develop a conceptual model, we conducted qualitative research with 13 female child soldiers in Nepal. Participants gave open-ended responses to intimate partner violence (IPV) vignettes (marital rape, emotional abuse, violence during pregnancy). Twelve participants (92%) endorsed personal responses (remaining silent, enduring violence, forgiving the husband). Twelve participants endorsed communication with one's husband. Only four participants (31%) sought family support, and three contacted police. Ultimately, 12 participants left the relationship, but the majority (nine) only left after the final IPV experience, which was preceded by prolonged psychological suffering and pregnancy endangerment. In conclusion, comorbidity risks are increased in cultural context that rely on individual or couples-only behavior, lack external social engagement, have weak law and justice institutions, and have limited health services.

Young Women’s Accounts of Caregiving, Family Relationships, and Personal Growth When Mother Has Mental Illness

Family members often serve as the primary source of care and support for loved ones living with mental illness. Although existing research has examined the role of parents and well siblings in providing care to adult children with mental illness, relatively little is known about the caregiving experiences of adult children with a parent with a psychiatric disability. Guided by a life course perspective, the present qualitative study examined first-person accounts of 10 young women attending college (ages 18–22) who were raised by a mother living with mental illness (depression, bipolar, or schizophrenia). Participants completed individual semi-structured interviews in which they described their experiences of caregiving, role reversal, and felt obligation towards mother, their ties to father and siblings, and their views of the impact of maternal mental illness on their lives. Overall, young adults’ accounts of their relationship with mother could be characterized as either predominately positive or predominately negative. In general, participants’ accounts of their caregiving experiences, views of felt obligation, and supportiveness of family ties differed depending on their reports of the overall quality of the mother–daughter relationship. Adult daughters described positive impacts of maternal mental illness on their own lives, regardless of their accounts of relationship quality with their mothers.

Psychosocial Risk Factors for Child Welfare among Postpartum Mothers with a History of Childhood Maltreatment and Neglect.

Background: Childhood maltreatment (CM) can increase the risk of psychosocial risk factors in adulthood (e. g. intimate partner violence, financial problems, substance abuse or medical problems). The transition to parenthood presents those affected by CM with particular challenges, in addition to usual birth-related stressors. Methods: In this cross-sectional study a total of 240 women were interviewed in the puerperium with respect to CM experiences, using the German version of the Childhood Trauma Questionnaire (CTQ). Current psychosocial risk factors (e. g. financial concerns, maternal mental illness, single parent) were assessed using the Constance Index (KINDEX) for early childhood risk factors. Associations between CM experience and psychosocial risk factors were calculated using simple correlation. Results: The average age of participants was 33years. On the CTQ 13.8 % of participants reported emotional abuse, 6.7 % physical abuse and 12.5 % sexual abuse, while 32.1 % reported emotional neglect and 7.5 % physical neglect during childhood. With rising severity of CM, more psychosocial risk factors (KINDEX) were present. Conclusions: This study shows a clear association between experiences of maltreatment during childhood and the presence of psychosocial stressors among women in the puerperium. Regular screening for a history of CM and parental psychosocial stressors should be conducted early, i.e. during pregnancy, to avoid negative consequences for the child.

Theory of mind as a predictor of maternal sensitivity in women with severe mental illness.

Research has shown that maternal mental illness can affect mother-infant interactions with implications for infant outcomes. Severe and chronic mental illness (SMI), particularly schizophrenia, is associated with the greatest risk. Schizophrenia is also associated with impairments in attribution of mental states, 'theory of mind' (ToM). Recent attachment research has suggested that maternal mentalizing skills are strongly associated with attachment outcome in infants. To date, no research has explored the relationship between ToM and maternal sensitivity in mothers with SMI using standard tests of ToM. The present study was designed as an exploratory study in order to investigate this. A total of 40 women with SMI in the postpartum period were administered a battery of ToM tasks and general neuropsychological tasks. The women were also filmed in an unstructured play session with their infants, which was coded for maternal sensitivity using the Crittenden CARE-Index. One ToM task, the Frith-Happé Animations, predicted maternal sensitivity across all diagnoses. There was also an effect of diagnosis, with lower sensitivity observed in women with schizophrenia. ToM impairments did not fully explain the effect of diagnosis on sensitivity. Mothers of girls were rated as being more sensitive than mothers of boys. The results suggest that ToM is a significant predictor of maternal sensitivity across all mental health diagnoses, extending the results of studies focusing on healthy populations. Clinical interventions emphasizing the importance of understanding the perspective of the infant may enhance maternal sensitivity.

Maternal Affective Illness in the Perinatal Period and Child Development: Findings on Developmental Timing, Mechanisms, and Intervention.

Maternal mental illness is one of the most reliable risks for clinically significant child adjustment difficulties. The research literature in this area is very large and broad and dates back decades. In this review, we consider recent research findings on maternal mental illness and child development by focusing particularly on affective illness the perinatal period. We do this because maternal affective illness in the perinatal period is common; recent evidence suggests that pre- and postpartum maternal depression may have lasting effects on child behavioral and somatic health; research in the perinatal period raises acute and compelling questions about mechanisms of transmission and effect; and perinatal-focused interventions may offer distinct advantages for benefitting mother and child and gaining insights into developmental mechanisms. Throughout the review, we attend to the increasing integration of psychological and biological models and the trans-disciplinary approach now required for clinical investigation.

Symptom Endorsement and Sociodemographic Correlates of Postnatal Distress in Three Low Income Countries

Background. Maternal mental illness has been implicated in adverse child development outcomes. Factors such as context and culture may influence experiences of maternal distress and explain differences in outcomes across settings. Methods. We analyzed baseline data from 5,647 mothers in Ethiopia, India (Andhra Pradesh), and Vietnam participating in an ongoing cohort study (Young Lives) to compare symptom endorsement and sociodemographic correlates of distress. Maternal distress was assessed using the Self-Reporting Questionnaire-20 Items (cutoff: ≥8). Logistic regressions were stratified by sample to identify correlates of distress. Results. Symptom endorsement was similar among distressed women, particularly with regard to feeling unhappy (76%, 80%, and 79%). Notable differences were observed in three items assessing Depressive Thoughts, which were most highly endorsed in Ethiopia (49%–56%). Having a child experiencing a life-threatening event was correlated with distress in all three samples. A variety of correlates were unique to only one sample. Conclusions. There were multiple similarities but also notable differences across sites in the expression and correlates of maternal distress. Feeling unhappy appears to be a hallmark feature of distress. Correlates highlight the relationship between distress and indicators of poverty, child wellbeing, and economic shocks. Differences demonstrate the value of further exploration of cross-cultural differences.

Cross-sectional study of perceived neighborhood collective efficacy and risk of adhd among a nationally-representative sample of children

Objectives: The development and severity of attention deficit hyperactivity disorder (ADHD) has been linked to a number of psychosocial risk factors. Research has shown that the amount of social capital in a community influences the physical and mental health of community members. We assessed the independent role of perceived neighborhood context, including physical and socioeconomic characteristics, and collective efficacy, a form of social capital, on ADHD prevalence. Methods: Cross-sectional study utilizing the 2007 National Survey of Children’s Health, a nationally representative dataset. The population of interest was children between the ages of four and seventeen living in randomly selected households. Multiple logistic regression models were used to assess the association between indices of perceived neighborhood socioeconomic conditions, built environment, and collective efficacy (study exposures) on risk of ADHD (outcome), controlling for pertinent individual and family risk factors.Results: 9.8 percent of children in the US (ages 4‐17) had ADHD as reported by their caregiver. In multivariate analysis, white race, male gender, increased geographic mobility, exposure to household smoke, exposure to > 2 hours/day TV, and maternal mental illness increased the odds of ADHD, while a two‐parent household reduced the odds. The highest level of perceived neighborhood collective efficacy was associated with reduced risk of ADHD compared to lower levels of perceived collective efficacy (adjusted OR: 0.785; 95% CI: 0.650-0.946; p=.011). Perceived neighborhood socioeconomic conditions and built environment were not associated with ADHD risk.Results: Nine percent of children in the US (ages 4-17 ) had ADHD as reported by their caregiver. Univariately, all 3 neighborhood characteristics were associated with risk of ADHD (p-value =.01, .04, and .0002 for socioeconomic conditions, built environment, and collective efficacy, respectively). After accounting for well-established risk factors for ADHD, perceived neighborhood socioeconomic conditions and built environment were no longer associated with ADHD, while collective efficacy remained significant (p=.0002). Lower level of perceived neighborhood collective efficacy was associated with increased risk of ADHD (OR: 1.7; 95\% CI: 1.3-2.2, comparing the lowest with the highest level).Conclusions: Our study suggests that perceived neighborhood collective efficacy may buffer the impact of individual-and family-level risk factors for ADHD in children.

Maternal SSRI Use, Mental Illness, and Pregnancy Outcomes

To address the ongoing question of whether pregnancy complications in women with psychiatric disorders are linked to selective serotonin reuptake

Psychopharmacology and pregnancy

The editors of this book undertook to provide an overview of the current state of knowledge concerning the use of psychotropic medication in pregnancy, with a second stated aim of producing clinical guidelines for practitioners. The historical reluctance to include pregnant women in research, and the need to consider the interests of both mother and baby, makes this a Herculean task. Here, the task is well-accomplished, with noted researchers from the field presenting us with an excellent and concise summary. The initial chapters set out the unique challenges in perinatal mental health, an understanding of which is essential when counselling a pregnant woman about the options available to her. These include the ethics of informed consent and the difficulties of interpreting a flawed evidence base. They also include explanations of how the interaction of maternal, fetal, genetic and environmental factors may mediate the effects on babies of perinatal exposure to maternal mental illness and associated medicines. Later chapters consider in turn the major categories of perinatal mental illness, in most cases providing itemised guidelines for clinicians at their conclusion. A minor criticism is that the presentation of these guidelines varies between chapters. This tends to reduce the ease of use of the book as a ‘quick reference guide’. More difficult topics such as borderline personality disorder, eating disorders and substance abuse have been included. There is a chapter on the impact of popularly used complementary and alternative treatments. Another deals with the use of ECT, a treatment with high efficacy from which pregnant women may find themselves unfairly excluded. Clinicians unfamiliar with the topic will be able to find some quick, wise pointers by turning immediately to the guideline sections. Those seeking a deeper understanding of the literature will also be rewarded.

Can we model a cognitive footprint of interventions and policies to help to meet the global challenge of dementia?

Can we model a cognitive footprint of interventions and policies to help to meet the global challenge of dementia?

Maternal mental health and risk of child protection involvement: mental health diagnoses associated with increased risk

BackgroundPrevious research shows that maternal mental illness is an important risk factor for child maltreatment. This study aims to quantify the relationship between maternal mental health and risk of child...

Creating Capabilities through Maternal Mental Health Interventions: A Case Study at Hanover Park, Cape Town

AbstractIn South Africa, approximately one third of resource‐poor women experience mental illness during pregnancy. Prevalence is higher in low‐resource settings than in developed countries. The poverty–mental illness cycle is well documented. Through the capabilities approach, this paper locates maternal mental illness in a development framework and explores the deprivational impacts of mental illness. It describes a counselling intervention in South Africa as a case study and applies a qualitative content analysis to descriptive data of a sample of five typical clients. Findings suggest that integrated maternal mental health care may act as a strategic intervention for capability formation and sustainable development. Copyright © 2015 John Wiley & Sons, Ltd.

Psychotropes pendant la grossesse et l’allaitement : mise au point pratique

Pregnancy and the postpartum periods are particular for the mother's use of drugs. Therapeutic prescription must take into account the potential risk of fetal malformation, newborn's withdrawal syndrome, feeding type and potential risk of untreated maternal mental illness. Recommendations for good practice are constantly remodeling and their conclusions are sometimes contradictory. The aim of this work is to develop an updated review, easy to use for any professional involved in the monitoring or prescription of a psychotropic medication (antidepressants, anxiolytics-hypnotics, neuroleptics, mood stabilizers and substitution treatment of opioid dependance) for pregnant or nursing women. These updates in tabular form are also based on our clinical experience as a team specializing in perinatal medicine.

Maternal use of selective serotonin reuptake inhibitors and risk of miscarriage - assessing potential biases.

The use of selective serotonin reuptake inhibitors (SSRIs) during pregnancy has been associated with miscarriage, but the association may be biased by maternal mental illness, lifestyle and exposure misclassification. A register study on all pregnancies in Denmark between 1996 and 2009 was conducted using individualised data from the Danish National Patient Register, the Medical Birth Register, the Danish Psychiatric Central Register, the Danish National Prescription database and the Danish National Birth Cohort (DNBC). A total of 1 191164 pregnancies were included in the study, of which 98275 also participated in the DNBC. Pregnancies exposed to SSRIs during or before pregnancy were more likely than unexposed pregnancies to result in first trimester miscarriage, hazard rate (HR)=1.08 [95% confidence interval (CI) 1.04, 1.13] and HR=1.26 [95% CI 1.16, 1.37], respectively. No difference was observed for second trimester miscarriage. SSRI-exposed pregnancies without a maternal depression/anxiety diagnosis from a psychiatric department were less likely to result in first trimester miscarriage than unexposed pregnancies with a diagnosis, HR=0.85 [95% CI 0.76, 0.95]. SSRI-exposed pregnancies were characterised by an unhealthier maternal lifestyle and mental health profile than unexposed pregnancies, whereas no convincing differences were observed between pregnancies exposed to SSRIs during versus before pregnancy. Substantial disagreement was found between prescriptions and self-reported use of SSRIs, but it did not affect the estimated hazard ratios. Confounding by indication and lifestyle in pregnancy may explain the association between SSRI use and miscarriage.