Rutter Malaise Inventory Research Articles

The association between caesarean and postnatal psychological distress: Effect modification by mental health history.

The association between mode of delivery and postnatal depression is uncertain. Mental health history may modify the association. The objective of this study was to determine whether the association between caesarean and postnatal psychological distress (PPD) differs according to long-standing depression/anxiety. Analysis of the UK-based Millennium Cohort Study of women who gave birth 2000-2002 was carried out. The outcomes were PPD at 9months by Rutter Malaise Inventory and actively treated physician-diagnosed depression/severe anxiety at 3years. The exposure was mode of delivery. Adjusted relative risks were estimated using Poisson regression. Effect modification according to long-standing depression/anxiety was investigated multiplicatively and additively. We included 15,936 women, of whom 2346 (13.4%, weighted) reported PPD. Women with long-standing depression/anxiety were at 34% lower risk of PPD following elective caesarean, compared with vaginal birth: relative risk (RR) 4.36 (95% confidence interval [CI] 3.76, 5.05), RR 3.25 (95% CI 2.23, 4.75) and RR 4.92 (95% CI 3.67, 6.59) for vaginal, elective and emergency caesarean births, respectively, with relative excess risk due to interaction (RERI) -1.28 (95% CI -2.73, 0.16), ratio of RRs 0.66 (95% CI 0.42, 1.05). Women with long-standing depression/anxiety were at greatest risk of later treatment following emergency caesarean, with RR 4.95 (95% CI 3.86, 6.34), RR 4.09 (95% CI 2.51, 6.65) and RR 6.74 (95% CI 4.87, 9.32), for vaginal, elective and emergency caesarean births, respectively; RERI 1.79 (95% CI -0.13, 3.71), ratio of RRs 1.36 (95% CI 0.94, 1.99); all RRs with reference to vaginal birth in the absence of long-standing depression/anxiety. There was no evidence of a similar association between emergency caesarean and PPD nor elective caesarean and later treatment. Women with long-standing depression or anxiety who had elective caesarean had a lower risk of postnatal distress. When this group had emergency caesarean, there was greater risk of actively treated depression/anxiety at 3years. These associations were not observed in women without long-standing depression/anxiety.

Gestational age on trajectories of social competence difficulties into adolescence

ObjectivesTo examine if gestational age groups predict the development of social competence difficulties (SCDs) from childhood into mid-adolescence and to assess the mediation by maternal psychological distress during infancy on...

Links between perinatal risk factors and maternal psychological distress: A network analysis.

This paper explores a range of perinatal risk factors that may increase maternal vulnerability to postnatal psychological distress in a sample of 17531 women participating in the Millennium Cohort Study, a diverse British, longitudinal birth cohort study. Using a graphical network modeling framework, this study models the links between postnatal psychological distress and perinatal risk factors, while controlling for sociodemographic factors and history of depression and anxiety. Postnatal psychological distress was assessed at 9months postpartum using the Rutter Malaise Inventory. Results of the graphical network models indicate that lower levels of happiness about the pregnancy (Edge weight [w]=0.084, 95% CI=0.069-0.100, b=0.095), smoking during pregnancy (w=0.026, 95% CI=-0.009-0.060, b=0.029), infection during pregnancy (w=0.071, 95% CI=0.024-0.118, b=0.090), hyperemesis gravidarum (w=0.068, 95% CI=0.013-0.123, b=0.083), baby in special care (w=0.048, 95% CI=-0.004-0.099, b=0.062), not being white (w=0.101, 95% CI=0.062-0.140, b=0.118), being from a more deprived area (w=-0.028, 95% CI=-0.051 to -0.005, b=-0.039), lower income (w=-0.025, 95% CI=-0.055-0.005, b=-0.036), and history of depression or anxiety (w=0.574, 95% CI=0.545-0.603, b=0.764) were associated with increased psychological distress. Some perinatal risk factors may be directly associated with postnatal psychological distress, but many risk factors appear to be primarily associated with demographic factors. This emphasizes the importance of taking a holistic approach when evaluating an individual's risk of developing postnatal psychological distress.

Unplanned pregnancy and subsequent psychological distress in partnered women: a cross-sectional study of the role of relationship quality and wider social support

BackgroundResearch into the impact of unintended pregnancy on the wellbeing of women tends to focus on pregnancies ending in either termination or lone motherhood. Unintended pregnancy is common in partnered women, but little is known about the association between unintended pregnancy and postpartum affective disorders, such as depression and anxiety in this group. Poor relationship quality and lack of social support are considered risk factors for psychological distress (PD). We examined the association between unplanned motherhood and subsequent PD in partnered women, for whom evidence is sparse, accounting for the role of relationship quality and social support.MethodsData for 12,462 partnered mothers were drawn from the first survey of Millennium Cohort Study, completed at 9 months postpartum. Women reported whether their baby was planned, and how they felt when they discovered that they were pregnant. Pregnancy intention is categorised as “planned”, “unplanned/happy”, “unplanned/ambivalent” and “unplanned/unhappy”. PD was assessed using the modified 9-item Rutter Malaise Inventory. Social support was measured by a composite score for perceived support, and a measure of actual support from friends and family. Relationship quality was assessed using a modified Golombok-Rust Inventory of Marital State. The effect of pregnancy intention on the odds of PD at 9 months was estimated, adjusting for potential confounding factors. All analyses were weighted for response and design effects.ResultsIn total 32.8%(weighted) (4343/12462) of mothers reported an unplanned pregnancy: 23.3 wt% (3087) of mothers felt happy, 3.5 wt% (475) ambivalent, and 6.0 wt% (781) unhappy upon discovery. Unplanned pregnancy was associated with a significantly increased odds of PD compared to planned (OR 1.73 (95%CI: 1.53, 1.95)). This was more pronounced among women who reported negative or ambivalent feelings in early pregnancy (OR 2.72 (95%CI:2.17, 3.41) and 2.56 (95%CI:1.95, 3.34), respectively), than those who reported positive feelings (OR 1.39 (95%CI:1.21, 1.60)). Adjustment for relationship quality, in particular, reduced odds of PD after unplanned pregnancy (e.g. from 2.19 (95%C: 1.74, 2.74) to 1.63 (95% CI: 1.29, 2.07 in the unplanned, unhappy group compared to the planned).ConclusionsA third of partnered mothers reported that their pregnancy was unintended, yet this group is under-researched. Unplanned motherhood was associated with increased risk of PD at 9 months postpartum, particularly among women who felt unhappy or ambivalent at the start. The roles of relationship quality and social support require further investigation, as possible means to intervene and improve maternal wellbeing.

Risk of psychological distress in parents of preterm children in the first year: evidence from the UK Millennium Cohort Study

ObjectiveTo assess whether the parents of babies born preterm (PT; <37 weeks completed gestation) are at excess risk of psychological distress (PD) at 9 months postpartum, and to explore the...

Parental separation and adult psychological distress: an investigation of material and relational mechanisms

BackgroundAn association between parental separation or divorce occurring in childhood and increased psychological distress in adulthood is well established. However relatively little is known about why this association exists and how the mechanisms might differ for men and women. We investigate why this association exists, focussing on material and relational mechanisms and in particular on the way in which these link across the life course.MethodsThis study used the 1970 British Cohort Study (n = 10,714) to investigate material (through adolescent and adult material disadvantage, and educational attainment) and relational (through parent–child relationship quality and adult partnership status) pathways between parental separation (0–16 years) and psychological distress (30 years). Psychological distress was measured using Rutter’s Malaise Inventory. The inter-linkages between these two broad mechanisms across the life course were also investigated. Missing data were multiply imputed by chained equations. Path analysis was used to explicitly model prospectively-collected measures across the life course, therefore methodologically extending previous work.ResultsMaterial and relational pathways partially explained the association between parental separation in childhood and adult psychological distress (indirect effect = 33.3% men; 60.0% women). The mechanisms were different for men and women, for instance adult partnership status was found to be more important for men. Material and relational factors were found to interlink across the life course. Mechanisms acting through educational attainment were found to be particularly important.ConclusionsThis study begins to disentangle the mechanisms between parental separation in childhood and adult psychological distress. Interventions which aim to support children through education, in particular, are likely to be particularly beneficial for later psychological health.

The impact of adolescent stuttering and other speech problems on psychological well‐being in adulthood: evidence from a birth cohort study

Developmental stuttering is associated with increased risk of psychological distress and mental health difficulties. Less is known about the impact of other developmental speech problems on psychological outcomes, or the impact of stuttering and speech problems once other predictors have been adjusted for. To determine the impact of parent-reported adolescent stuttering and other speech difficulties on psychological distress and associated symptoms as measured by the Rutter Malaise Inventory. A British birth cohort dataset provided information about 217 cohort members who stuttered and 301 cohort members who had other kinds of speech problem at age 16 according to parental report, and 15,694 cohort members who had experienced neither stuttering nor other speech difficulties. The main analyses concerned associations between adolescent stuttering or speech difficulty and score on the Rutter Malaise Inventory at age 42. Other factors that had previously been shown to be associated with score on the Malaise Inventory were also included in the analyses. In the adjusted analyses that controlled for other predictors, cohort members who were reported to stutter had higher malaise scores than controls overall, indicating a higher level of psychological distress, but they were not at significantly more likely to have malaise scores in the range indicating a risk of serious mental health difficulties. Cohort members who were reported to have other speech difficulties during adolescence had malaise scores that overall did not differ significantly from those of controls in the adjusted analyses, but they were at significantly greater risk of serious mental health difficulties. These findings support those of other studies that indicate an association between stuttering and psychological distress. This study is the first to have shown that adolescents who experience speech difficulties other than stuttering are more likely than controls to be at risk of poorer mental health in adulthood. The results suggest a need for therapeutic provision to address psychosocial issues for both stuttering and other developmental speech disorders in adulthood, as well as further research into the consequences in adulthood of stuttering and other developmental speech disorders.

010 Parental separation and psychological distress in early adulthood: has the effect reduced over time? Evidence from two British birth cohort studies

BackgroundAn association between parental separation occurring during childhood and psychological distress has been shown many times. UK divorce rates have increased rapidly since the mid-twentieth century. The “reduced effect hypothesis”...

Comparison of prevalence of depression in mothers of twins and mothers of singletons.

To determine whether the apparent additional and exceptional stresses associated with bearing and parenting twins affect the emotional wellbeing of mothers. Great Britain, 1970-5. Cohort study of 13,135 children born between 4 April and 11 April 1970. Mothers of all children, both singletons and twins, were interviewed by health visitors (providing demographic data) and completed a self report measure of emotional well-being (the Rutter malaise inventory) when the child was 5 years of age. The malaise scores of mothers of twins were compared with those of all mothers of singletons and then with those of mothers categorised by the age spacing of their children (only one child, widely spaced, or closely spaced), taking account of maternal age, social class, and whether the study child had a disability, by using logistic regression. 139 mothers of twins--122 pairs of twins and 17 twins whose cotwin had died--and 12,573 controls, who were mothers of singletons. A significantly higher proportion of mothers of twins at 5 years had malaise scores indicative of depression than mothers of singletons at the same age. Mothers who had borne twins, one of whom had subsequently died, had the highest malaise scores and were three times more likely than mothers of singletons to experience depression. Both mothers of twin pairs and mothers of singletons closely spaced in age were at significantly higher risk of experiencing depression than mothers of children widely spaced in age or mothers of only one child (p less than 0.0001). Odds ratios indicated that the risk of depression in mothers of twins was higher than that in mothers of closely spaced singletons. Mothers of twins are more likely to experience depression. This suggests a relation between the additional and exceptional stresses that twins present and the mother's emotional wellbeing.

A reappraisal of the Malaise Inventory

In recent years Rutter's Malaise Inventory has been used increasingly to measure levels of stress among those who care for people with dependency needs. Although there has been an element of dispute in the literature about the unidimensional nature of the scale, later work (Bebbington and Quine 1987) tends to suggest that Malaise Inventory scores can be used as a single internally consistent measure of stress. In this study consideration is given to the results of a national sample survey of 527 members of the Association of Carers (now Carers: National Association) which suggests the existence of two valid dimensions to the Malaise Inventory across a wider range of carer groups. Implications for future development and administration of the scale as a measure of stress are discussed.

The relative value of screening instruments in adolescence

The phase of development that equips a child to become an adult is a period of transition. To date no instrument has become established as the routine screening measure for this age group in the same way as the Rutter B2 Scale has in children. During a major population study of adolescent functioning, the pupils drawn from four comprehensive schools were used to compare the validity of several screening measures in this age group. The results show that screen instruments tend to be behaviour specific and that antisocial and neurotic behaviour are relatively sex specific. The Rutter Malaise Inventory had the highest correlation with the psychiatrist's diagnosis of neurotic disorder, although the General Health Questionnaire also proved to be reasonably efficient. The antisocial subscale of the Rutter B2 Scale showed the best correlation with the psychiatrist's diagnosis of conduct disorder.

Parents' report of family life with a developmentally delayed child

This study was undertaken to investigate how parents who have a child with some degree of handicap perceive the effect of the child on family life. Also, a measure of parental health was taken. The parents' response was compared with that of parents of age-matched children without any known developmental difficulties. The parents and children were grouped according to the manifested handicap of the child [Down's syndrome, developmental quotient (DQ) greater than 65, DQ less than 65 with/without limb dysfunction and normal controls]. The children's ages ranged from 4 to 126 months and they all had received the South Galmorgan Home Advisory Service (HAS) at some time. Sixty-one families completed a questionnaire concerning family life and activities and Rutter's Malaise Inventory (Rutter et al. 1971). Thirty-one control families also completed the questionnaire and Malaise Inventory. The findings showed very little difference between the control group and handicapped groups and suggested that the presence of a delayed child in the family unit does not appear to change the family routine to any large extent. Parents of handicapped children were not found to suffer from significantly greater ill health when compared with the parents of normal children. The implication of the results is that provision should be made available for both fathers and mothers to play an equal part in the support facilities and guidance offered.