Maternal Psychosocial Functioning Research Articles

Uptrend in Distress and Psychiatric Symptomatology in Pregnant Women During the Coronavirus Disease 2019 Pandemic

(Acta Obstet Gynecol Scand. 2020;99:848–855) It is well established that psychological distress in pregnancy is associated with a range of negative outcomes, including delivery at an earlier gestational age, lower neonatal birthweight, and poor maternal psychosocial functioning. Expectant mothers of all social classes and educational levels can experience antenatal psychological distress, and the COVID-19 pandemic has introduced additional stress to people around the world. Most obstetric research on COVID-19 has focused on respiratory issues rather than mental health implications. This study aimed to provide data on any increase in prenatal psychological distress symptoms caused by the COVID-19 pandemic. As a secondary objective, the study aimed to identify which subgroup of women would be particularly vulnerable.

Maternal psychosocial functioning, obstetric health history, and newborn telomere length

There is growing interest in elucidating the determinants of newborn telomere length, given its potential as a biomarker of lifetime disease risk affected by prenatal exposures. There is limited evidence that increased maternal stress during pregnancy predicts shorter newborn telomere length. However, the few studies published to date have been conducted primarily with small samples utilizing inconsistent definitions of maternal stress. Moreover, the potential influence of fetal sex as a moderator of maternal stress effects on newborn telomere length has been largely ignored despite compelling evidence of likely impact. In a prospective cohort study of pregnant women seeking routine prenatal care, we tested whether a range of maternal measures of stressor exposures, subjective feelings of stress, and mental health (depression, anxiety) were associated with newborn telomere length assessed from cord blood among 146 pregnant women and their newborn infants. We further examined whether the pattern of associations differed by infant sex. Sociodemographic and maternal and newborn health indicators were considered as potential covariates. When examined within the whole sample, none of the maternal psychosocial measures were associated with newborn telomere length. Among potential covariates, maternal history of smoking and preeclampsia in a previous pregnancy were negatively associated with newborn telomere length. In adjusted linear regression analyses that considered potential sex-specific effects, maternal depression, general anxiety, and pregnancy-specific anxiety symptoms were positively associated with newborn telomere length among males. Overall, the findings provide some evidence for an association between maternal psychosocial wellbeing in pregnancy and newborn telomere length in males, although in the opposite direction than previously reported. Maternal smoking and obstetric history prior to conception may be associated with shorter offspring telomere length.

Protective and risk factors of toddlers' sleep and parental stress

En el presente estudio se examinó la red de relaciones entre la calidad del sueño y la regulación de las emociones de los niños pequeños, las prácticas y la participación de los padres a la hora de acostarse, el apoyo social y el estrés de los padres, integrando una novedosa combinación de dimensiones psicosociales en un modelo predictivo de la calidad del sueño y el estrés de los padres en una muestra de 80 familias con niños de 2 a 3 años de edad. Los resultados indicaron que la regulación de las emociones de los lactantes, así como las variables de contexto próximo, teniendo en cuenta el funcionamiento psicosocial tanto materno como paterno, predecían la varianza de los niveles de estrés de los padres. Además, los resultados mostraron que el número de vigilancias nocturnas del niño comunicadas por las madres y el tiempo solicitado por los niños pequeños para dormirse, estaban significativamente relacionados con los niveles de estrés de los padres según lo referido por ambos padres.

Being a mother after a cancer diagnosis during pregnancy: Maternal psychosocial functioning and child cognitive development and behavior.

Up to 51.5% of women diagnosed with cancer during pregnancy experience trauma (eg, intrusive thoughts, avoidance) and 20% report anxiety. Maternal anxiety can negatively affect child behavior among the noncancer population. This study aims to elucidate relationships between maternal distress, parenting style, and child behavior and development among women with cancer during pregnancy. This cross-sectional study of child cognitive, language and motor development analyze child behavior in the context of maternal psychosocial well-being after a cancer diagnosis during pregnancy. A subset of women (N = 69) enrolled in the Cancer and Pregnancy Registry, had children undergo developmental testing. The majority underwent Bayley Scales III (children 6-42 months of age; 0-3.5 years) to assess language, cognitive, and motor performance. Women completed the Basic Symptom Inventory, Impact of Events Scale, Parent Behavior Checklist, and Child Behavioral Checklist. Maternal and child assessments were performed concurrently. Sixty-nine women and 71 children (2 sets of twins) ages 6 months to 12 years participated. Maternal depressive and somatic symptoms were associated with more externalizing behaviors. Among younger children (0-3.5 years), maternal somatic symptoms were associated with poorer language performance. Moderation analysis showed that mothers with fewer somatic symptoms and utilization of less discipline had children with less externalizing behaviors and higher language scores (ie, stronger verbal ability). Given the interplay of psychosocial factors on child behavior and development, findings highlight the importance of early screening and psychosocial intervention and support for mothers diagnosed with cancer in pregnancy.

Maternal Smoking and Psychosocial Functioning: Impact on Subsequent Breastfeeding Practices.

Introduction: Breastfeeding is a protective factor for women and children. Women who smoke cigarettes during pregnancy are less likely to initiate or persist in breastfeeding. However, less is known about why this is the case. Materials and Methods: The present study (n = 247) prospectively examined maternal/child factors that influence breastfeeding in a low-income, racially diverse at-risk sample of smoking and nonsmoking women. Pregnant women were recruited at their first prenatal appointment in an urban hospital and followed through 24-month postnatally. Women reported on the average number of cigarettes smoked/day during pregnancy, psychopathology, breastfeeding behavior, and infant reactivity. Results: Although a greater number of cigarettes smoked/day during pregnancy was associated with a lower likelihood of initiating or persisting in breastfeeding, maternal age, education, and infant reactivity offered predictive utility above and beyond maternal smoking. Conclusion: Smokers were less likely to initiate breastfeeding and breastfed for shorter duration than demographically similar nonsmokers; however, one of the mechanisms for reduced breastfeeding may be the psychosocial factors of younger age and lower education. Further, infant reactivity was also found to reduce the likelihood of initiating and persisting with breastfeeding.

Testing competing mediators of the association between pre-conception maternal depression and child health-related quality of life: the MatCH study.

Maternal depression is a potent risk factor for poor child development across a number of domains but the mechanisms of transmission are poorly understood. This study aimed to test competing mediators of the association between pre-conception maternal depression and child psychosocial functioning. In 2016, mothers in the 1973-1978 cohort of the Australian Longitudinal Study on Women's Health were asked to be part of the Mothers and their Children's Health study and to complete surveys on the health of their three youngest children under 13years. The current study includes children aged 0-12years (N = 5532, M = 6.99years, SD = 3.22years) and their mothers (N = 2917). We used the CESD-10 to measure depression and the PedsQL to measure psychosocial functioning, and used multilevel structural equation modeling to test hypotheses. Pre-conception maternal depression was associated with poorer maternal mental health and parenting after birth. The effect of pre-conception maternal depression was mediated by post-birth maternal depression in children aged 0-4years (unstandardized regression coefficient (B) = - 0.26, 95%CI - 0.38, - 0.13) and children aged 5-12years (B = - 0.25, 95%CI - 0.34, - 0.16), and by post-birth maternal stress (B = - 0.04, 95%CI - 0.08, - 0.01), and parenting (B = - 0.03, 95%CI - 0.04, - 0.02) in children aged 5-12years. Post-birth maternal depression was the strongest mediator. Pre-conception is the optimal time for depression intervention. Post-birth interventions should include a focus on reducing depression and improving negative parenting aspects such as hostility and discipline.

Video feedback promotes relations between infants and vulnerable first-time mothers: a quasi-experimental study

BackgroundSupporting early mother-infant relationships to ensure infants’ future health has been recommended. The aim of this study was to investigate whether video feedback using the Marte Meo method promotes a healthy early relationship between infants and vulnerable first-time mothers. Video feedback or usual care was delivered by health visitors during home visits in Danish municipalities.MethodsThis quasi-experimental study included pre- and post-tests of 278 vulnerable families. Mothers were allocated to an intervention group (n = 69), a comparison group (n = 209) and an exactly matched video subsample from the comparison group (n = 63). Data consisted of self-reported questionnaires and video recordings of mother-infant interactions. Outcomes were mother-infant dyadic synchrony (CARE-Index), maternal confidence (KPCS), parental stress (PSS), maternal mood (EPDS) and infant socialemotional behaviours (ASQ:SE). The data were analysed using descriptive and linear multiple regression analysis.ResultsThe levels of dyadic synchrony in the intervention group had significantly improved (p < 0.001) at follow-up with a mean score of 9.51 (95%CI;8.93–10.09) compared with 7.62 (95%CI;7.03–8.21). The intervention group also showed a higher level of maternal sensitivity with a mean score of 9.55 (95%CI;8.96–10.14) compared with 7.83 (95%CI;7.19–8.46) in the matched video subsample (p < 0.001). With respect to infant cooperation, similar improvements were found with a mean score of 9.43 (95% CI;8.88–9.99) in the intervention group compared with 7.73 (95%CI;7.13–8.33) in the matched video subsample from the comparison group (p < 0.001). Furthermore, mothers in the intervention group reported significantly lower levels of parental stress with a mean score of 32.04 (95%CI;30.13–33.94) compared with 35.29 (95%CI;34.07–36.52) in the comparison group (p = 0.03), as well as higher levels of maternal confidence with a mean score of 41.10 (95%CI;40.22–41.98) compared with 40.10 (95%CI;39.65–40.56) in the comparison group (p = 0.04). No significant differences were found in EPDS and ASQ:SE.ConclusionThe findings support the assumption that video feedback using the Marte Meo method early after birth may strengthen the relationship between infants and vulnerable firsttime mothers as well as improve maternal psychosocial functioning. Further research applying random assignment is needed to strengthen these conclusions; further research is also needed to assess any long term effects of the video feedback intervention using the Marte Meo method.Trial registrationThis study was registered on 24 January 2013 in ClinicalTrials.gov with the identifier: NCT01799447.

Effect of a food supplementation and psychosocial stimulation trial for severely malnourished children on the level of maternal depressive symptoms in Bangladesh.

Maternal depression is associated with poor child development and growth in low-income countries. This paper evaluates the effect of a community-based trial providing psychosocial stimulation and food supplements to severely malnourished children on maternal depressive symptoms in Bangladesh. Severely underweight (weight-for-age Z-score < -3) hospitalized children aged 6-24 months (n = 507), were randomly assigned to: psychosocial stimulation (PS), food supplementation (FS), PS+FS, clinic control (CC) and hospital control (CH) at discharge. PS included play sessions with children and parental counselling to mothers during fortnightly follow-up visit at community clinics, conducted by trained play leaders for 6 months. FS involved cereal-based supplements (150-300 kcal/day) for 3 months. All groups received medical care, micronutrient supplements and growth monitoring. We used Bayley scales, Home Observation for Measurement of Environment (HOME) inventory and a parenting questionnaire to assess child development, home stimulation and mothers' child-rearing practices, respectively. We assessed mothers' depressive symptoms using a modified version of Centre for Epidemiologic Studies Depression Scale at baseline and at 6 months post intervention. Maternal depressive symptoms were significantly lower in the CH group at baseline (P = 0.014). After 6 months of intervention there was no significant effect of intervention after adjusting for baseline scores and all possible confounders. Maternal depressive symptoms were higher among poorer (P = 0.06), older (P = 0.057) and less educated (P = 0.019) mothers, who were housewives (P = 0.053), and whose husbands had more unstable jobs (P = 0.058). At 6 months post intervention, children's cognitive (P = 0.045) and motor (P = 0.075) development, HOME (P = 0.012) and mother's parenting score (P = 0.057) were higher among mothers with lower depressive symptoms. The study did not show a significant effect of the intervention on the level of maternal depressive symptoms. Interventions with higher intensity and/or of longer duration focusing directly on maternal psychosocial functioning are probably needed to reduce maternal depressive symptoms.

Maternal Expressed Emotion in Relation to Child Behavior Problems: Differential and Mediating Effects

Maternal expressed emotion (EE), including maternal criticism and emotional over-involvement, is considered an index of family emotional climate that is critical for children’s psychological well-being. Limited research investigates how each element of EE differentially contributes to child behavior problems, or explores the mechanisms, such as child emotion dysregulation, through which parental EE influences child psychosocial outcomes. This study examined maternal EE, child emotion dysregulation, and child behavior problems among 60 mother–child dyads from a community sample, utilizing multi-method and multi-reporter assessment. Findings indicated that maternal expressed criticism toward the child was positively associated with child externalizing symptoms through its relation to increased child emotion dysregulation, whereas maternal emotional over-involvement was negatively associated with child externalizing symptoms through its negative relation to child emotion dysregulation. These results provided increased support for a model in which maternal criticism remains negatively associated with child psychosocial outcomes, but the construct of emotional over-involvement is not necessarily associated with youth psychosocial problems. This study also illustrated one pathway through which maternal EE influence child psychosocial functioning, thus placing EE research in the broader context of research on family emotion socialization.

Maternal depressive symptoms: Associations with adolescents’ internalizing and externalizing problems and social competence

Background: The negative effect of maternal depressive symptoms on child wellbeing has been quite extensively studied. There is, however, debate as to whether it is the timing, the recurrence or the chronicity of maternal depressive symptoms that puts the child's wellbeing at risk. Aims: This study explores the associations between the timing, recurrence and the patterns of maternal depressive symptoms and adolescent psychosocial functioning. Methods: One hundred and ninety-one mothers and 192 adolescents were followed up from the mother's pregnancy to the child's adolescence. Maternal depressive symptoms were screened with the Edinburgh Postnatal Depression Scale prenatally, postnatally, in early and middle childhood, and at adolescence. The adolescents’ outcomes were screened using Child Behavior Checklists and Youth Self Reports. Results: The results indicate that the initial exposure to maternal depressive symptoms at pregnancy is associated with more externalizing problems in adolescence, 2 months postnatally with more internalizing problems, in early childhood with poorer social competence and concurrently with more externalizing problems. Combined analyses indicate that recurrent maternal depressive symptoms best explain adolescents’ internalizing problems and the chronic pattern of maternal depressive symptoms externalizing problems. The chronic and intermittent patterns of maternal depressive symptoms best explained adolescents’ poorer social competence. Conclusions: Recurrent or chronic maternal depressive symptoms rather than the timing predict adolescents’ psychosocial problems better. The timing, however, may explain the different kinds of problems in adolescence depending on the developmental task at the time of the exposure. The findings should be noted when treating both mothers and children in psychiatric clinics and other health services.

Maternal relationship security as a moderator of home visiting impacts on maternal psychosocial functioning.

There is variability in home visiting program impacts on the outcomes achieved by high risk families. An understanding of how effects vary among families is important for refining service targeting and content. The current study assessed whether and how maternal attributes, including relationship security, moderate short- and long-term home visiting impacts on maternal psychosocial functioning. In this multisite RCT of home visiting in a population-based, ethnically-diverse sample of families at risk for maltreatment of their newborns (n = 643), families were randomly assigned to home visited (HV) and control groups. HV families were to receive intensive services by trained paraprofessionals from birth-3years. Outcome data were collected when children were 1, 2, and 3years old and 7, 8, and 9years old. Overall, short- and long-term outcomes for HV and control mothers did not differ significantly. Demographic attributes, a general measure of overall maternal risk, and partner violence did not moderate program impact on psychosocial functioning outcomes. Maternal relationship security did moderate program impact. Mothers who scored high on relationship anxiety but not on relationship avoidance showed the greatest benefits, particularly at the long-term follow-up. Mothers scoring high for both relationship anxiety and avoidance experienced some adverse consequences of home visiting. Further research is needed to determine mediating pathways and to inform and test ways to improve the targeting of home visiting and the tailoring of home visit service models to extend positive home visiting impacts to targeted families not benefiting from current models.

War trauma lingers on: Associations between maternal posttraumatic stress disorder, parent-child interaction, and child development.

Maternal traumatization has been proposed as a risk factor for child development, but the mechanisms involved are poorly understood. This study analyzed the interrelations among maternal posttraumatic stress symptoms, parent-child interaction (emotional availability), and infants' psychosocial functioning and development among 49 asylum-seeker and refugee mothers and their children (18-42 months). Measures included assessment of mothers' trauma and comorbid symptoms (Harvard Trauma Questionnaire: R.F. Mollica et al., 1992; Hopkins Symptom Checklist: L. Derogatis, R. Lipman, K. Rickels, E. Uhlenhuth, & L. Covi, 1974), emotional availability within parent-child interaction (Emotional Availability Scales: Z. Biringen, 2008), and infants' psychosocial functioning (Child Behavior Checklist: T.M. Achenbach & L.A. Rescorla, 2000) and development (Bayley Scales of Infant Development: B.F. van der Meulen, S.A.J. Ruiter, H.C. Spelberg, & M. Smrkovsky, 2000). The results show that higher levels of maternal posttraumatic stress symptoms are associated with a higher level of psychosocial problems of infants, but not with delays in their mental or psychomotor development. The results also show that higher levels of maternal posttraumatic stress symptoms are associated with higher levels of insensitive, unstructuring, or hostile, but not intrusive, parent-child interactions. Infants show lower levels of responsiveness and involvement to their traumatized mothers. Parent-child interaction did not function as a mediator between maternal trauma symptoms and infants' psychosocial functioning. Results are discussed in relation to the dyad's regulation of emotions. Results implicate a need to reestablish attunement between traumatized mothers and their nontraumatized children.

Characterizing Anxious Children with an Obsessive Difficult Temperament

This exploratory study sought to characterize anxious children displaying an Obsessive Difficult Temperament (ODT), and examined features that may differentiate them from anxiety disordered, non ODT children. Participants comprised 67 children, aged 4 to 7 years, consecutively referred to an anxiety disorders clinic at an urban children's hospital. Retrospective categorization of the participants' temperament profile was undertaken, with 21 children appearing to display ODT. Groups were compared on the bases of child functioning (parent and clinician rated), the presence of comorbid disorders (based on structured interview), and parental stress and symptomatology. Participants with ODT were found to display a specific profile of temperament traits. Compared to non ODT participants, they showed a significantly poorer social functioning, more comorbid externalizing disorders, elevated levels of maternal stress, and increased maternal psychiatric symptoms. To conclude, anxious children expressing ODT present with significant impairments in functioning and require further investigation. Associated parental stress and impaired maternal psychosocial functioning are evident.

Mothers' violence victimization and child behavior problems: Examining the link.

The current study examined the link between parents' experience of violence victimization and child outcomes, in 197 mother-child dyads recruited from low-income urban neighborhoods. At recruitment (when children were between 6 and 18 months old), demographic factors, child behavioral outcomes, mother-child interactions, mothers' psychosocial functioning, and mothers' history of violence victimization were assessed. Child behavioral outcomes, mother-child interactions, and mothers' psychosocial functioning were assessed again at age 4. Mothers' history of victimization as children (but not as adults) uniquely predicted child behavior problems at age 4. Three classes of possible mediators were examined: demographics, maternal psychosocial functioning, and mother-child interactions. Of these, only mother psychological aggression toward child met preliminary criteria for mediation; it partially mediated the link between mother childhood victimization and child behavioral outcomes. Maternal depressive symptoms and young age at child's birth independently predicted child behavior problems, but did not act as mediators. Mothers' early experiences with violence victimization appear to exert an important influence on child behavioral outcomes; this influence appears to be mediated, in part, by mothers' psychological aggression toward their children.

ADHD and Infant Disorganized Attachment

Objective: To examine whether infant disorganized attachment predicts ADHD at school age. Method: A cohort of 53 children who had been identified as having significant levels of disorganized attachment in infancy is compared to a control group. Symptoms and signs of ADHD at age 7 are evaluated together with a range of relevant maternal variables. Results: An association is found between infant disorganized attachment scores and teacher-rated symptoms of ADHD (but not ADHD caseness). Probable ADHD caseness in the child is associated with self-rated retrospective ADHD scores in mothers. Possible ADHD caseness is associated with a measure of unresolved mourning in mothers. Mother-rated ADHD in the child was associated with low overall maternal psychosocial functioning. Conclusion: The finding of a link between scores for disorganized attachment at 1 year and later teacher-rated symptoms of ADHD suggests the need for further studies.

Coparent Support and Conflict in African American Single Mother-Headed Families: Associations With Maternal and Child Psychosocial Functioning

This longitudinal investigation examined main and interactive effects of coparent support and conflict on mother and child adjustment in 248 low-income, African American, single mother-headed families. The findings indicated that coparent conflict was a more robust predictor of mother and child maladjustment both cross-sectionally and longitudinally than was coparent support. Moreover, findings revealed that coparent conflict and support interacted to predict one parenting behavior, monitoring, both cross-sectionally and longitudinally. Coparent relationships characterized by high levels of support and low levels of conflict were associated with the highest levels of parental monitoring behavior, whereas coparent relationships characterized by low levels of support and high levels of conflict were associated with the lowest levels of monitoring. The findings highlight the importance of examining both positive and negative aspects of coparent relationships in this at-risk, but understudied, group.

Parent‐Training Programmes for Improving Maternal Psychosocial Health

Parent‐Training Programmes for Improving Maternal Psychosocial Health

Executive Functioning in Preschool‐Age Children Prenatally Exposed to Alcohol, Cocaine, and Marijuana

Background: Reports from clinical and experimental (animal) research converge on the suggestion that prenatal exposure to alcohol, cocaine, or marijuana undermines executive functioning (EF) and its neurological underpinnings. However, large, adequately controlled, prospective studies of alcohol and marijuana effects on EF have reported conflicting findings, and there have been no such studies of cocaine exposure.Methods: EF was investigated in a cohort (n= 316) of 4‐year‐old children the majority of whose mothers had used varying combinations of cocaine, alcohol, and marijuana during pregnancy. With use of postpartum maternal report and biological assay, children were assigned to overlapping prenatal cocaine‐exposed, alcohol‐exposed, and marijuana‐exposed groups and to complementary control groups. The postnatal environmental assessment included measures of maternal intellectual and psychosocial functioning, current drug or alcohol use, and home environment.Results: The children in the alcohol‐exposed group had worse tapping‐inhibition performance than children in the non‐alcohol‐exposed group, and this effect persisted when potential confounding environmental variables, other drug variables, and concurrent verbal intelligence were controlled for.Conclusions: Prenatal alcohol is predictive of decreased EF in early childhood that could not be attributed to environmental factors. The results are discussed in terms of the age and overall high‐risk status of the children.

Childhood adversity, parental vulnerability and disorder: examining inter-generational transmission of risk.

An investigation of intergenerational factors associated with psychiatric disorder in late adolescence/early adulthood was undertaken to differentiate influences from maternal disorder, maternal poor psychosocial functioning and poor parenting, on offspring. The sample comprised an intensively studied series of 276 mother-offspring pairs in a relatively deprived inner-city London area with high rates of lone parenthood and socio-economic disadvantage. The paired sample was collected over two time periods: first a consecutively screened series of mothers and offspring in 1985-90 (n = 172 pairs) and second a 'vulnerable' series of mothers and offspring in 1995-99 (n = 104 pairs). The vulnerable mothers were selected for poor interpersonal functioning and/or low self-esteem and the consecutive series were used for comparison. Rates of childhood adversity and disorder in the offspring were examined in the two groups. Maternal characteristics including psychosocial vulnerability and depression were then examined in relation to risk transmission. Offspring of vulnerable mothers had a fourfold higher rate of yearly disorder than those in the comparison series (43% vs. 11%, p < .001). They were twice as likely as those in the comparison series to have experienced childhood adversity comprising either severe neglect, physical or sexual abuse before age 17. Physical abuse, in particular, perpetrated either by mother or father/surrogate father was significantly raised in the vulnerable group. Analysis of the combined series showed that maternal vulnerability and neglect/abuse of offspring provided the best model for offspring disorder. Maternal history of depression had no direct effect on offspring disorder; its effects were entirely mediated by offspring neglect/abuse. Maternal childhood adversity also had no direct effect. Results are discussed in relation to psychosocial models of risk transmission for disorder. Maternal poor psychosocial functioning needs to be identified as a factor requiring intervention in order to stem escalation of risk across generations.

Exposure to Violence and Behavior Problems During Early Childhood

The purpose of this study was to use an ecological framework to examine the potential predictors of behavior problems among children of cocaine-using mothers. Four potential predictors of child behavior problems were examined in this study: maternal substance use, maternal psychosocial functioning, maternal and child experiences with violence, and instability or inadequacy of caregiving. Maternal and child exposure to violence were considered distal ecological variables, whereas substance use and caregiving were considered to be more proximal variables. The study investigated whether the violent experiences contributed significantly to child behavior problems even after controlling for the more proximal variables. The participants were 61 African American or Hispanic mothers (26 cocaine using and 35 control) living below the poverty limit with children between the ages of 2 to 5 years. The results are discussed in terms of implications of interventions with children of cocaine-using mothers who are at high risk for behavior problems.