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Subbiah GK, de Kroon MLA, Boere-Boonekamp MM, van der Zee-van den Berg AI, Hartman CA, Reijneveld SA. Maternal postpartum mental health negatively affects infants' health related quality of life. J Affect Disord 2025; 374:381-389. [PMID: 39798715 DOI: 10.1016/j.jad.2025.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 12/31/2024] [Accepted: 01/07/2025] [Indexed: 01/15/2025]
Abstract
OBJECTIVES To assess the association of early and late postpartum maternal mental health with infants' health related quality of life (HRQoL). METHODS The study was embedded within the POST-UP trial (n = 1843). Infants' HRQoL was assessed with the Infant and Toddler Quality of Life Questionnaire Short Form-47 at ages 1 month (1 m), and 12 m. Maternal mental health regarded postpartum depression (PPD), measured with the Edinburgh Postnatal Depression Scale at 1 m and 6 m (early/late), and postpartum anxiety (PPA) with the short version of the state form of the Spielberger State-Trait Anxiety inventory at 1 m and 12 m (early/late). We used linear regression analyses. RESULTS Early and late PPD and PPA were negatively associated with infants' HRQoL at ages 1 m and 12 m. The negative associations with infants' HRQoL at 1 m were most pronounced for the domain infant temperament (standardized regression coefficient, (95% confidence interval)): -0.30 (-0.34; -0.25), and -0.37 (-0.41; -0.32) for PPD and PPA respectively, and weakest for the domain bodily pain: -0.14 (-0.19; -0.09), and -0.22 (-0.26; -0.17) for PPD and PPA respectively. The negative associations of early postpartum maternal health with infants' HRQoL at age 12 months were less pronounced. Moreover, associations with infants' HRQol were weaker for late than for early PPD and PPA. LIMITATION Usage of maternal proxy reports for assessing infant HRQoL. CONCLUSION Postpartum maternal mental health is negatively associated with infants' HRQoL at age 1 m and 12 m. This confirms the need for regular screening of maternal mental health in the postpartum period.
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Affiliation(s)
- Gireesh K Subbiah
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, the Netherlands.
| | - Marlou L A de Kroon
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, the Netherlands; Environment and Health, Department of Public Health and Primary Care, KU Leuven, Belgium
| | - Magda M Boere-Boonekamp
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, the Netherlands
| | | | - Catharina A Hartman
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University Medical Center Groningen, University of Groningen, the Netherlands
| | - Sijmen A Reijneveld
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, the Netherlands
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Trautmann-Villalba P, Heine E, Kribs A, Mehler K. Does early skin-to-skin contact have a long-term effect on the emotional and behavioral development of very preterm infants? Front Psychol 2024; 15:1484419. [PMID: 39588126 PMCID: PMC11586174 DOI: 10.3389/fpsyg.2024.1484419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2024] [Accepted: 10/23/2024] [Indexed: 11/27/2024] Open
Abstract
Introduction Premature birth may impair a sensitive, responsive, enjoyable, and regulating parenting style, potentially leading to behavioral, cognitive, and emotional deficits in children. Additionally, the emotional bond between the parent and infant may be disturbed due to the restrictions and difficulties at the neonatal intensive care unit (NICU), further negatively impacting child development. Skin-to-skin contact (SSC) directly after birth is strongly recommended also for preterm or low birth weight infants since there is high-certainty evidence that SSC has positive effects on neonatal and maternal health as well as on the quality of the parent-child relationship. The aim of this study was to examine the effect of skin-to-skin contact immediately after childbirth on the development of emotional and behavioral problems in children born preterm entering school. Methods This study is part of a randomized controlled delivery room skin-to-skin study (Deisy Study). A total of 33 children (aged 6-8 years) were assessed at school start. The German version of the CBCL/6-18R was used to evaluate the presence of behavior problems. Results The perceived parental stress 6 months after discharge was the variable that most contributed to the variance explanation. SSC immediately after childbirth was not significant in the prediction of emotional and behavioral problems at school start. Limitations The study was conducted in a small study group. Partners' variables were not included. Information regarding sociodemographic variables and bonding quality was collected 6 months (corrected age) after birth. The measurement of children's behavioral problems is not objective and corresponds to the parents' perception. Clinical Trial Registration https://clinicaltrials.gov, deisy study NCT01959737, deisy follow up NCT03366285.
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Affiliation(s)
| | - Eva Heine
- Department of Paediatrics, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Angela Kribs
- Department of Paediatrics, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Katrin Mehler
- Department of Paediatrics, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
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Brugnaro BH, Abreu RWFD, Verdério BN, Lima CRG, Kraus de Camargo O, Teplicky R, Dos Santos MM, Khetani MA, Rocha NACF. Home Participation of Infants With and Without Biological Risk in the First Year of Life: A Cross-Sectional and Comparative Study. Phys Occup Ther Pediatr 2024; 45:185-200. [PMID: 39471828 DOI: 10.1080/01942638.2024.2419643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 09/17/2024] [Accepted: 10/09/2024] [Indexed: 11/01/2024]
Abstract
AIM To compare caregiver-reported current and desired home participation of infants with and without biological risk in the first year of life. METHOD Observational, cross-sectional and comparative study. Caregivers of 48 infants with (mean corrected age = 5.6(±2.3) months) and 32 without (mean corrected age = 5.8(±1.9) months) biological risk completed the Young Children's Participation and Environment Measure home section. Caregivers reported on their infant's current participation (frequency and involvement) in 13 activities within the domains of basic care routines, household chores, interactive and organized play, and socializing with friends and family, as well as their desire for change(s) in their infant's home participation. We compared groups using comparative tests (Bonferroni's correction for multiple comparisons; p < 0.0125). RESULTS Infants with biological risk participated less frequently in the domain household chores (U = 383.000; p < 0.001); and were less involved in the domain household chores (U = 407.000; p < 0.001). No significant group differences were found in desire for change. CONCLUSION Results suggest that home participation restriction can be identified for infants with biological risk in one out of four domains, which may allow health professionals to develop strategies to intervene early in the participation of children at risk in this specific area of household chores.
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Affiliation(s)
- Beatriz Helena Brugnaro
- Child Development Analysis Laboratory (LADI), Department of Physical Therapy, Federal University of São Carlos (UFSCar), São Carlos, SP, Brazil
| | - Raissa Wanderley Ferraz de Abreu
- Child Development Analysis Laboratory (LADI), Department of Physical Therapy, Federal University of São Carlos (UFSCar), São Carlos, SP, Brazil
| | - Bruna Nayara Verdério
- Child Development Analysis Laboratory (LADI), Department of Physical Therapy, Federal University of São Carlos (UFSCar), São Carlos, SP, Brazil
| | - Camila Resende Gâmbaro Lima
- Child Development Analysis Laboratory (LADI), Department of Physical Therapy, Federal University of São Carlos (UFSCar), São Carlos, SP, Brazil
| | - Olaf Kraus de Camargo
- CanChild Centre for Childhood-onset Disability Research, Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Rachel Teplicky
- CanChild Centre for Childhood-onset Disability Research, Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Mariana Martins Dos Santos
- Child Development Analysis Laboratory (LADI), Department of Physical Therapy, Federal University of São Carlos (UFSCar), São Carlos, SP, Brazil
| | - Mary A Khetani
- CanChild Centre for Childhood-onset Disability Research, Department of Pediatrics, McMaster University, Hamilton, ON, Canada
- Children's Participation in Environment Research Lab, Department of Occupational Therapy, University of Illinois Chicago, Chicago, Illinois, USA
| | - Nelci Adriana Cicuto Ferreira Rocha
- Child Development Analysis Laboratory (LADI), Department of Physical Therapy, Federal University of São Carlos (UFSCar), São Carlos, SP, Brazil
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Klein CC, McDonald NM. Parenting Stress Following a Neonatal Intensive Care Unit Hospitalization: A Longitudinal Study of Mothers and Fathers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:970. [PMID: 39200581 PMCID: PMC11353428 DOI: 10.3390/ijerph21080970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2024] [Revised: 07/16/2024] [Accepted: 07/22/2024] [Indexed: 09/02/2024]
Abstract
A neonatal intensive care unit (NICU) hospitalization can add significant stress to the postpartum period. Parents experience isolation and uncertainty, which can affect their capacity to bond with their new baby. Understanding how stress is shaped by and changes following a NICU experience will help in developing supports for these families. We examined patterns of parenting stress over the first year of life following a NICU stay to better understand changes in stress, differences in maternal and paternal stress, and how medical and developmental variables impact parent stress. Parents of infants (n = 51) who had experienced a NICU hospitalization and met criteria for California's High-Risk Infant Follow-Up program completed assessments at 6, 9, and 12 months. A comparison group (n = 38) from a historic dataset included parents of infants born full term without medical complications. NICU parents reported higher levels of parenting stress at 6 months, but not 12 months, with mothers and fathers reporting similar stress levels. Parenting-related stress was found to be relatively stable and consistent over this period. Among NICU parents, lower developmental level at 12 months was associated with more distress in interacting with their child. These findings highlight the importance of monitoring parenting stress following discharge from the NICU and developing interventions for supporting parents of NICU graduates showing developmental delays.
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Affiliation(s)
- Corinna C. Klein
- Semel Institute of Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA;
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Blangis F, Drouin J, Launay E, Miranda S, Zureik M, Cohen JF, Weill A, Dray-Spira R, Chalumeau M. Maternal, prenatal and postnatal risk factors for early child physical abuse: a French nationwide cohort study. THE LANCET REGIONAL HEALTH. EUROPE 2024; 42:100921. [PMID: 39070743 PMCID: PMC11281928 DOI: 10.1016/j.lanepe.2024.100921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 04/11/2024] [Accepted: 04/16/2024] [Indexed: 07/30/2024]
Abstract
Background Identifying risk factors for early child physical abuse (CPA) is crucial for understanding its mechanisms and defining effective preventive interventions. We aimed to identify maternal, prenatal and postnatal factors associated with early CPA. Methods This cohort study was based on comprehensive data from the Mother-Child EPI-MERES nationwide register and included all infants born alive in France between 2010 and 2019. Factors associated with early CPA (before age 1) were identified with a multilevel Cox regression model with random intercepts at the regional level. Findings Among the 6,897,384 included infants, 2994 (40/100,000) had a diagnosis of early CPA, at a median age of 4 months. Independent factors most strongly associated with early CPA were maternal low financial resources (adjusted hazard ratio [aHR] 1.91; 95% confidence interval [95% CI] 1.67-2.18), maternal age <20 years versus 35-40 years (aHR 7.06; 95% CI 6.00-8.31), maternal alcohol use disorder (aHR 1.85; 95% CI 1.48-2.31), opioid use disorder (aHR 1.90; 95% CI 1.41-2.56), intimate partner violence (aHR 3.33; 95% CI 2.76-4.01), diagnosis of a chronic mental disorder (aHR 1.50; 95% CI 1.14-1.97) or somatic disorder (aHR 1.55; 95% CI 1.32-1.83), hospitalisation for a mental disorder (aHR 1.88; 95% CI 1.49-2.36), very preterm birth (aHR 2.15; 95% CI 1.68-2.75), and diagnosis of a chronic severe neurocognitive disorder in the infant (aHR 14.37; 95% CI 11.85-17.44). Interpretation Independent risk factors of early CPA identified at the national level in France may help in understanding CPA mechanisms and developing effective prevention programs including risk-stratification tools to optimise the allocation of parenting interventions to parents who could most benefit from them. Funding Ile-de-France regional council, L'Oréal-UNESCO For Women In Science France Young Talent Award, French National Observatory for Child Protection [ONPE], French Association of Ambulatory Paediatrics [AFPA], HUGO university hospitals network, Mustela Foundation and Sauver la Vie prizes.
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Affiliation(s)
- Flora Blangis
- EPI-PHARE Scientific Interest Group, French National Agency for Medicines and Health Products Safety (ANSM), French National Health Insurance (CNAM), F-93200, Saint-Denis, France
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Centre of Research in Epidemiology and StatisticS, Université Paris Cité, INSERM, F-75014, Paris, France
- Inserm CIC 1413, Nantes University Hospital, F-44000, Nantes, France
- Child Protection Unit - Department of General Pediatrics and Pediatric Infectious Diseases, AP-HP, Necker-Enfants Malades Hospital, Université Paris Cité, F-75015, Paris, France
| | - Jérôme Drouin
- EPI-PHARE Scientific Interest Group, French National Agency for Medicines and Health Products Safety (ANSM), French National Health Insurance (CNAM), F-93200, Saint-Denis, France
| | - Elise Launay
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Centre of Research in Epidemiology and StatisticS, Université Paris Cité, INSERM, F-75014, Paris, France
- Inserm CIC 1413, Nantes University Hospital, F-44000, Nantes, France
- Department of Pediatric Emergency Care, Nantes University Hospital, F-44000, Nantes, France
| | - Sara Miranda
- EPI-PHARE Scientific Interest Group, French National Agency for Medicines and Health Products Safety (ANSM), French National Health Insurance (CNAM), F-93200, Saint-Denis, France
| | - Mahmoud Zureik
- EPI-PHARE Scientific Interest Group, French National Agency for Medicines and Health Products Safety (ANSM), French National Health Insurance (CNAM), F-93200, Saint-Denis, France
- Université Versailles Saint-Quentin-en-Yvelines, F-78180, Montigny-le-Bretonneux, France
| | - Jérémie F. Cohen
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Centre of Research in Epidemiology and StatisticS, Université Paris Cité, INSERM, F-75014, Paris, France
- Child Protection Unit - Department of General Pediatrics and Pediatric Infectious Diseases, AP-HP, Necker-Enfants Malades Hospital, Université Paris Cité, F-75015, Paris, France
| | - Alain Weill
- EPI-PHARE Scientific Interest Group, French National Agency for Medicines and Health Products Safety (ANSM), French National Health Insurance (CNAM), F-93200, Saint-Denis, France
| | - Rosemary Dray-Spira
- EPI-PHARE Scientific Interest Group, French National Agency for Medicines and Health Products Safety (ANSM), French National Health Insurance (CNAM), F-93200, Saint-Denis, France
| | - Martin Chalumeau
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Centre of Research in Epidemiology and StatisticS, Université Paris Cité, INSERM, F-75014, Paris, France
- Child Protection Unit - Department of General Pediatrics and Pediatric Infectious Diseases, AP-HP, Necker-Enfants Malades Hospital, Université Paris Cité, F-75015, Paris, France
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Schalla MA, Stengel A. The role of stress in perinatal depression and anxiety - A systematic review. Front Neuroendocrinol 2024; 72:101117. [PMID: 38176543 DOI: 10.1016/j.yfrne.2023.101117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/29/2023] [Accepted: 12/31/2023] [Indexed: 01/06/2024]
Abstract
Perinatal depression (PND) and anxiety affect around 20% of women, but available pharmacotherapy is not sufficiently effective in 20-60% of them, indicating a need for better understanding of these diseases. Since stress is a significant risk factor for PND, the aim was to examine the role of biological, environmental and psychological stress in PND and anxiety through a systematic literature search. Overall 210 studies were included, among which numerous rodent studies showed that perinatal stress induced depressive-like and anxious behavior, which was associated with HPA-axis alterations and morphological brain changes. Human studies indicated that the relationship between cortisol and perinatal depression/anxiety was not as clear and with many contradictions, although social and psychological stress were clearly positively associated with PND. Finally, oxytocin, synthetic neuroactive steroid and n-3 PUFA diet have been identified as potentially beneficial in the therapy of PND and anxiety, worth to be investigated in the future.
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Affiliation(s)
- M A Schalla
- Charité Center for Internal Medicine and Dermatology, Department for Psychosomatic Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 12203 Berlin, Germany; Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Germany; Department of Gynecology and Obstetrics, Helios Clinic, Rottweil, Germany
| | - A Stengel
- Charité Center for Internal Medicine and Dermatology, Department for Psychosomatic Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 12203 Berlin, Germany; Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Germany; German Center für Mental Health (DZPG), Site Tübingen, Germany.
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Traino KA, Fisher RS, Basile NL, Dattilo TM, Baskin LS, Buchanan CL, Chan YM, Cheng EY, Coplen DE, Kolon TF, Lakshmanan Y, Palmer BW, Mullins LL, Ciciolla LM, Wisniewski AB. Adverse Birth Experiences and Parent Adjustment Associated With Atypical Genital Appearance Due to Differences of Sex Development. J Pediatr Psychol 2023; 48:759-767. [PMID: 37500595 PMCID: PMC10516460 DOI: 10.1093/jpepsy/jsad042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 06/22/2023] [Accepted: 06/23/2023] [Indexed: 07/29/2023] Open
Abstract
OBJECTIVE Differences/disorders of sex development (DSDs) are rare, congenital conditions involving discordance between chromosomes, gonads, and phenotypic sex and are often diagnosed in infancy. A key subset of parents of children newly diagnosed with a DSD experience clinically elevated distress. The present study examines the relationship between perinatal factors (i.e., gestational age, delivery method) and trajectories of parental adjustment. METHODS Parent participants (mothers = 37; fathers = 27) completed measures at baseline, 6- and 12-month follow-up. Multilevel linear regression controlled for clustering of the data at three levels (i.e., time point, parent, and family) and examined the relationship between perinatal factors and trajectories of depressive and anxious symptoms. Two-way interactions between perinatal factors and parent type were evaluated. RESULTS Overall depressive and anxious symptoms decreased over time. There were significant interactions between gestational age and parent type for depressive and anxious symptoms, with younger gestational age having a stronger negative effect on mothers vs. fathers. There was a significant interaction between time and gestational age for depressive symptoms, with 36 weeks' gestational age demonstrating a higher overall trajectory of depressive symptoms across time compared to 38 and 40 weeks. Findings for the delivery method were not significant. CONCLUSIONS Findings uniquely demonstrated younger gestational age was associated with increased depressive symptoms, particularly for mothers compared to fathers. Thus, a more premature birth may predispose parents of infants with DSD to distress. Psychosocial providers should contextualize early diagnosis-related discussions within stressful birth experiences when providing support.
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Affiliation(s)
- Katherine A Traino
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, USA
| | - Rachel S Fisher
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, USA
| | - Nathan L Basile
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, USA
| | - Taylor M Dattilo
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, USA
| | - Laurence S Baskin
- Department of Urology, University of California San Francisco Medical Center, USA
| | - Cindy L Buchanan
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, USA
| | - Yee-Ming Chan
- Division of Endocrinology, and Harvard Medical School, Boston Children’s Hospital, USA
| | - Earl Y Cheng
- Department of Urology, Ann & Robert H. Lurie Children’s Hospital of Chicago, USA
| | - Douglas E Coplen
- Division of Urologic Surgery, St. Louis Children’s Hospital, USA
| | - Thomas F Kolon
- Division of Urology, Children’s Hospital of Philadelphia, USA
| | | | - Blake W Palmer
- Department of Pediatric Urology, Cook Children’s Medical Center, USA
| | - Larry L Mullins
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, USA
| | - Lucia M Ciciolla
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, USA
| | - Amy B Wisniewski
- Department of Psychology, Center for Pediatric Psychology, Oklahoma State University, USA
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Arnautovic TI, Dammann CEL. The neonatal perspective of paid family medical leave (PFML). J Perinatol 2023; 43:1055-1058. [PMID: 35132148 DOI: 10.1038/s41372-021-01300-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/16/2021] [Accepted: 12/09/2021] [Indexed: 12/24/2022]
Abstract
Paid family medical leave (PFML) offers infants, parents, and society at large numerous health and economic benefits. It has been shown to improve neonatal and maternal outcomes, breastfeeding rates, familial relationships, and decrease gender inequalities in the workplace. Though the economic feasibility of PFML has been well established in many countries, the USA lacks a cohesive and comprehensive federal PFML policy. Neonatal healthcare providers play a critical role in impacting neonatal health and should actively advocate for the development and promotion of a federal PFML policy, particularly one that is inclusive of both mothers and fathers and is at least 12 weeks in duration.
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Affiliation(s)
- Tamara I Arnautovic
- Division of Newborn Medicine, Department of Pediatrics, Tufts Children's Hospital, Tufts University School of Medicine, Boston, MA, USA.
| | - Christiane E L Dammann
- Division of Newborn Medicine, Department of Pediatrics, Tufts Children's Hospital, Tufts University School of Medicine, Boston, MA, USA
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Legge N, Popat H, Fitzgerald D. Examining the impact of premature birth on parental mental health and family functioning in the years following hospital discharge: A review. J Neonatal Perinatal Med 2023:NPM221107. [PMID: 37182844 DOI: 10.3233/npm-221107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND This review provides an update of the current research related to the impact of extreme and very premature birth on parental mental health and family functioning following discharge from hospital. METHODS Full-text peer reviewed articles in English, describing parents' and families' health and wellbeing after the discharge from hospital of their baby using validated questionnaires, were evaluated. Results of included studies are presented in a summarized format. Embase, Medline and PsycINFO databases were accessed in January 2021. RESULTS 38 studies were included. Nine manuscripts reported on parental mental health and 13 on stress, which are a concern after the birth of a premature infant, especially in the first year. Depression, anxiety, and stress are known to measure higher compared to parents of infants born at term. Over several years, these measures of mental health decrease significantly. Four reported on quality of life for parents of premature infants, which is reduced immediately after discharge, but then improves over time. The impact of premature birth on the family functioning was described in ten included studies and was described to have positive and negative consequences. CONCLUSION The negative impact of the premature birth and hospital journey on parental mental health lessens significantly with time.
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Affiliation(s)
- Nele Legge
- Department of Neonatal Intensive Care, Liverpool Hospital, Liverpool, Australia
- Discipline of Child and Adolescent Health, Sydney Medical School, Faculty of Health Sciences, University of Sydney, Australia
| | - H Popat
- Discipline of Child and Adolescent Health, Sydney Medical School, Faculty of Health Sciences, University of Sydney, Australia
- The Children's Hospital at Westmead, Westmead, Australia
| | - D Fitzgerald
- Discipline of Child and Adolescent Health, Sydney Medical School, Faculty of Health Sciences, University of Sydney, Australia
- The Children's Hospital at Westmead, Westmead, Australia
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McLean MA, Scoten OC, Chau CMY, Synnes A, Miller SP, Grunau RE. Association of Neonatal Pain-Related Stress and Parent Interaction With Internalizing Behaviors Across 1.5, 3.0, 4.5, and 8.0 Years in Children Born Very Preterm. JAMA Netw Open 2022; 5:e2238088. [PMID: 36269352 PMCID: PMC9587482 DOI: 10.1001/jamanetworkopen.2022.38088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
IMPORTANCE Internalizing (anxiety and/or depressive) behaviors are prevalent in children born very preterm (24-32 weeks' gestation). Procedural pain-related stress in the neonatal intensive care unit (NICU) is associated with long-term internalizing problems in this population; however, whether positive parenting during toddlerhood attenuates development of internalizing behaviors across childhood is unknown. OBJECTIVE To investigate whether neonatal pain-related stress is associated with trajectories of internalizing behaviors across 1.5, 3.0, 4.5, and 8.0 years, and whether supportive parenting behaviors and lower parenting stress at 1.5 and 3.0 years attenuate this association. DESIGN, SETTING, AND PARTICIPANTS In this prospective longitudinal cohort study, preterm neonates (born at 24-32 weeks' gestation) were recruited from August 16, 2006, to September 9, 2013, with follow-up visits at ages 1.5, 3.0, 4.5, and 8.0 years. The study was conducted at BC Women's Hospital, Vancouver, Canada, with recruitment from a level III neonatal intensive care unit and sequential developmental assessments performed in a Neonatal Follow-up Program. Data analysis was performed from August to December 2021. MAIN OUTCOMES AND MEASURES Parental report of child internalizing behaviors on the Child Behavior Checklist at 1.5, 3.0, 4.5, and 8.0 years. RESULTS A total of 234 neonates were recruited, and 186 children (101 boys [54%]) were included in the current study across ages 1.5 (159 children), 3.0 (169 children), 4.5 (162 children), and 8.0 (153 children) years. After accounting for clinical factors associated with prematurity, greater neonatal pain-related stress was associated with more internalizing behaviors across ages (B = 4.95; 95% CI, 0.76 to 9.14). Higher parenting stress at age 1.5 years (B = 0.17; 95% CI, 0.11 to 0.23) and a less supportive parent environment (less sensitivity, structure, nonintrusiveness, nonhostility, and higher parenting stress; B = -5.47; 95% CI, -9.44 to -1.51) at 3.0 years were associated with greater internalizing problems across development to age 8.0 years. CONCLUSIONS AND RELEVANCE In this cohort study of children born very preterm, exposure to repetitive neonatal pain-related stress was associated with persistent internalizing behavior problems across toddlerhood to age 8.0 years. Supportive parenting behaviors during early childhood were associated with better long-term behavioral outcomes, whereas elevated parenting stress was associated with more child anxiety and/or depressive behaviors in this population. These findings reinforce the need to prevent pain in preterm neonates and inform future development of targeted parent-led behavioral interventions.
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Affiliation(s)
- Mia A. McLean
- BC Children’s Hospital Research Institute, Vancouver, British Columbia, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Olivia C. Scoten
- BC Children’s Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Cecil M. Y. Chau
- BC Children’s Hospital Research Institute, Vancouver, British Columbia, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anne Synnes
- BC Children’s Hospital Research Institute, Vancouver, British Columbia, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
- BC Women’s Hospital, Vancouver, British Columbia, Canada
| | - Steven P. Miller
- Department of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Ruth E. Grunau
- BC Children’s Hospital Research Institute, Vancouver, British Columbia, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
- BC Women’s Hospital, Vancouver, British Columbia, Canada
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11
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Delanerolle G, Zeng YT, Phiri P, Phan T, Tempest N, Busuulwa P, Shetty A, Raymont V, Rathod S, Shi JQ, Hapangama DK. Mental health impact on Black, Asian and Minority Ethnic populations with preterm birth: A systematic review and meta-analysis. World J Psychiatry 2022; 12:1233-1254. [PMID: 36186507 PMCID: PMC9521531 DOI: 10.5498/wjp.v12.i9.1233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/16/2022] [Accepted: 08/05/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Preterm birth (PTB) is one of the main causes of neonatal deaths globally, with approximately 15 million infants are born preterm. Women from the Black, Asian, and Minority Ethnic (BAME) populations maybe at higher risk of PTB, therefore, the mental health impact on mothers experiencing a PTB is particularly important, within the BAME populations.
AIM To determine the prevalence of mental health conditions among BAME women with PTB as well as the methods of mental health assessments used to characterise the mental health outcomes.
METHODS A systematic methodology was developed and published as a protocol in PROSPERO (CRD42020210863). Multiple databases were used to extract relevant data. I2 and Egger’s tests were used to detect the heterogeneity and publication bias. A trim and fill method was used to demonstrate the influence of publication bias and the credibility of conclusions.
RESULTS Thirty-nine studies met the eligibility criteria from a possible 3526. The prevalence rates of depression among PTB-BAME mothers were significantly higher than full-term mothers with a standardized mean difference of 1.5 and a 95% confidence interval (CI) 29%-74%. The subgroup analysis indicated depressive symptoms to be time sensitive. Women within the very PTB category demonstrated a significantly higher prevalence of depression than those categorised as non-very PTB. The prevalence rates of anxiety and stress among PTB-BAME mothers were significantly higher than in full-term mothers (odds ratio of 88% and 60% with a CI of 42%-149% and 24%-106%, respectively).
CONCLUSION BAME women with PTB suffer with mental health conditions. Many studies did not report on specific mental health outcomes for BAME populations. Therefore, the impact of PTB is not accurately represented in this population, and thus could negatively influence the quality of maternity services they receive.
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Affiliation(s)
- Gayathri Delanerolle
- Nuffield Department of Primary Care Health Science, University of Oxford, Oxford OX3 7JX, United Kingdom
- Research and Innovation, Southern Health NHS Foundation Trust, Southampton SO30 3JB, United Kingdom
| | - Yu-Tian Zeng
- Southern University of Science and Technology, Shenzhen 518055, Guangdong Province, China
| | - Peter Phiri
- Research and Innovation, Southern Health NHS Foundation Trust, Southampton SO30 3JB, United Kingdom
- Psychology Department, Faculty of Environmental and Life Sciences, University of Southampton, Southampton SO17 1BJ, United Kingdom
| | - Thuan Phan
- Department of Women's and Children's Health, University of Liverpool, Liverpool L7 8TX, United Kingdom
| | - Nicola Tempest
- Department of Women's and Children's Health, University of Liverpool, Liverpool L7 8TX, United Kingdom
- Gynaecology Directorate and Hewitt Centre for Reproductive Medicine, Liverpool Women's NHS Foundation, Liverpool L8 7SS, United Kingdom
| | - Paula Busuulwa
- Department of Women's and Children's Health, University of Liverpool, Liverpool L7 8TX, United Kingdom
| | - Ashish Shetty
- National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London W1T 4AJ, United Kingdom
| | - Vanessa Raymont
- Department of Psychiatry, University of Oxford, Oxford OX3 7JX, United Kingdom
| | - Shanaya Rathod
- Research and Innovation, Southern Health NHS Foundation Trust, Southampton SO30 3JB, United Kingdom
| | - Jian-Qing Shi
- National Centre for Applied Mathematics Shenzhen, Shenzhen 518055, Guangdong Province, China
- Department of Statistics, Southern University of Science and Technology, Shenzhen 518055, Guangdong Province, China
| | - Dharani K Hapangama
- Department of Women's and Children's Health, University of Liverpool, Liverpool L7 8TX, United Kingdom
- Gynaecology Directorate and Hewitt Centre for Reproductive Medicine, Liverpool Women's NHS Foundation, Liverpool L8 7SS, United Kingdom
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12
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Martínez-Shaw ML, Sánchez-Sandoval Y. Effective stress intervention programs for parents of premature children: A systematic review. Stress Health 2022; 39:236-254. [PMID: 36029285 DOI: 10.1002/smi.3194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 07/25/2022] [Accepted: 08/16/2022] [Indexed: 11/10/2022]
Abstract
The birth of a child alters family dynamics and can be stressful for parents, especially in the case of prematurity. This article carried out a systematic review on interventions in parents to reduce the stress experienced by the birth of a premature infant. The aims were to describe and classify the different interventions and to have an overview of their effectiveness. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guide and the PICO model. For searching the bibliography, we used Web of Science, Science Direct, PubMed and PsycINFO databases. From a total of 450 articles identified, this review finally included 46 studies with empirical evidence. The articles clustered into different types of interventions, such as psychoeducational and parental or maternal support programs, relaxation techniques, expressive writing, art therapy, music therapy and interventions related to interaction and tactile stimulation. There is a wide range of effectiveness in reducing parental stress to a greater or lesser degree. There is a great heterogeneity of interventions. Despite that, they all have a parental educational component that needs to be studied in greater depth.
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Affiliation(s)
- Melissa Liher Martínez-Shaw
- Departamento de Psicología, Instituto de Investigación e Innovación Biomédica de Cádiz (INIBICA), Universidad de Cádiz, Cádiz, Spain
| | - Yolanda Sánchez-Sandoval
- Departamento de Psicología, Instituto de Investigación e Innovación Biomédica de Cádiz (INIBICA), Universidad de Cádiz, Cádiz, Spain
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13
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Lin HC, Zehnah PL, Koire A, Mittal L, Erdei C, Liu CH. Maternal Self-Efficacy Buffers the Effects of COVID-19-Related Experiences on Postpartum Parenting Stress. J Obstet Gynecol Neonatal Nurs 2022; 51:177-194. [PMID: 35114164 PMCID: PMC8709937 DOI: 10.1016/j.jogn.2021.12.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To examine the associations of maternal self-efficacy (MSE) and perceived social support with parenting stress during the postpartum period during the COVID-19 pandemic and whether these two psychosocial factors account for variance in parenting stress in addition to the effects of COVID-19-related experiences and sociodemographic factors. DESIGN Cross-sectional survey. SETTING Online survey, the Perinatal Experiences and COVID-19 Effects (PEACE) study, launched in May 2020. PARTICIPANTS Participants included 310 women who gave birth in the past 24 weeks. METHODS The survey included self-report quantitative measures of MSE, social support, COVID-19-related experiences, parenting stress, symptoms of depression and anxiety, and a range of sociodemographic factors. RESULTS Hierarchical multiple regression analysis indicated that MSE and social support were negatively associated with postpartum parenting stress in addition to the effects of COVID-19-related experiences, maternal symptoms of depression and anxiety, and a range of demographic factors. Furthermore, MSE interacted with COVID-19-related experiences such that higher levels of MSE mitigated the effects of COVID-19-related experiences on parenting stress. CONCLUSION Our findings underscore the importance of protective factors at the individual and interpersonal levels and provide insights for prevention and intervention programs aimed at mitigating postpartum parenting stress during a wide-scale disaster such as the COVID-19 pandemic.
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14
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Nowakowski-Sims E. Integrative Body, Mind, and Spirit Interventions used with Parents in the Child Welfare System. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2022; 15:121-129. [PMID: 35222779 PMCID: PMC8837741 DOI: 10.1007/s40653-021-00388-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/02/2021] [Indexed: 06/14/2023]
Abstract
Parenting is a critical component of child welfare's intervention efforts; however, child welfare interventions attempt to correct dysfunctional parenting practices rather than address their shared underlying causes, such as parental stress and trauma. Ongoing stress can overload a parents' ability to access logical decision-making capabilities. Parents can utilize integrative body, mind, and spirit interventions to remain calm when they experience chronic stress. These interventions can offer stressed out parents techniques that focus on emotional regulation, and subsequently reduce the risk of child maltreatment. This article offers a comprehensive review of the literature identifying parental stress as a critical component of child welfare as well as the usefulness of including integrative mind, body, and spirit interventions with parents in the child welfare system.
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15
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Tomoyasu Y, Sobue I, Rahman MM. Parenting Record Handbook: The Needs of Mothers Raising Low Birth Weight Infants. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052520. [PMID: 35270210 PMCID: PMC8909591 DOI: 10.3390/ijerph19052520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/18/2022] [Accepted: 02/19/2022] [Indexed: 11/25/2022]
Abstract
This study investigated the necessity for a parenting record handbook that is specifically tailored to the needs of low birth weight infants (LBWIs) and their families, especially mothers, who face parenting difficulties and challenges. The participants were 20 mothers, raising LBWIs, discharged from the neonatal intensive care unit. The mean age and weight of the children were 2.75 ± 0.35 years and 1417.50 ± 152.06 g, respectively; the mean duration of neonatal intensive care unit hospitalization was 78.75 ± 14.10 days. At the time of the study, 35% (7/20) were nursery children, 10% (2/20) were kindergarten children, 20% (4/20) were using rehabilitation centers, and 10% (2/20) were using the medical rehabilitation handbook. The needs of the mothers were investigated through focus group interviews or individual interviews, and content analyses were performed. The mothers required the promotion of peer support that assists the alleviation of mental burden and postpartum mental and physical care, as well as the publication of counseling service counters and reliable information sources for parenting difficulties in the parenting record handbook. The mothers required the publication and recording of the growth indicators of LBWIs, parenting records, information management of children since birth, and for the handbook to function as a multidisciplinary information sharing tool. In addition, the requirements for the parenting record handbook were the early provision of the parenting record handbook and measures to cope with poor maternal physical condition. The results of this study suggest that mothers with LBWIs require a parenting record handbook that can provide comprehensive maternal and child health assurance, starting from pregnancy, to resolve childcare difficulties for LBWIs, as well as mental support.
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Affiliation(s)
- Yukiko Tomoyasu
- Faculty of Nursing, Hiroshima International University, Kure 737-0112, Japan
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8553, Japan;
- Correspondence: (Y.T.); (I.S.)
| | - Ikuko Sobue
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8553, Japan;
- Correspondence: (Y.T.); (I.S.)
| | - Md Moshiur Rahman
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8553, Japan;
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16
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Dollberg DG, Harlev Y, Malishkevitch S, Leitner Y. Parental Reflective Functioning as a Moderator of the Link Between Prematurity and Parental Stress. Front Psychiatry 2022; 13:804694. [PMID: 35280157 PMCID: PMC8905191 DOI: 10.3389/fpsyt.2022.804694] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 01/27/2022] [Indexed: 11/13/2022] Open
Abstract
We examined group differences between parents, both mothers and fathers, of premature and full-term infants to determine whether they differed in their reports of subjective parenting stress and in their level of parental reflective functioning (PRF). We also tested whether each parent's reflective functioning moderated the links between birth status (prematurity vs. full-term) and parenting stress. A sample of 73 cohabiting, heterosexual Israeli families with a premature (28-36th week gestational age, N = 34) or full-term infant (37th week and above gestational age, N = 39) participated, comprising the two parents' groups. Infants' age averaged 7.07 months (SD = 1.28). Each parent completed the Parent Stress Inventory (PSI) individually to determine his/her subjective personal and childrearing stress levels. The Parent Development Interview (PDI-R2-S) was used to obtain each parent's PRF (self and child/relation-focused) level. Findings showed that the premature and full-term parents did not differ in their PSI scores or PRF levels. However, mothers' self-focused PRF moderated the link between prematurity and personal parenting stress, whereas fathers' self-focused PRF moderated the link between prematurity and childrearing parenting stress. Furthermore, fathers' and mothers' PRF operated differently in the premature and full-term parents' groups. The findings highlight the importance of mothers' and fathers' PRF in predicting parents' subjective stress in general and particularly in the case of infant prematurity. We discuss these findings and their relevance for preventive and therapeutic perinatal interventions.
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Affiliation(s)
- Daphna G Dollberg
- School of Behavioral Sciences, The Academic College of Tel Aviv-Yaffo, Tel Aviv, Israel
| | - Yael Harlev
- School of Behavioral Sciences, The Academic College of Tel Aviv-Yaffo, Tel Aviv, Israel
| | - Sivan Malishkevitch
- School of Behavioral Sciences, The Academic College of Tel Aviv-Yaffo, Tel Aviv, Israel
| | - Yael Leitner
- Child Development Center, Dana-Dwek Children's Hospital, Sourasky Medical Center, Tel Aviv, Israel
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Fuchs A, Resch F, Kaess M, Moehler E. Early Parenting Stress Links Obstetric Complications and Child Psychopathology in Middle Childhood in an At-Risk Sample. J Dev Behav Pediatr 2022; 43:e48-e55. [PMID: 33908374 DOI: 10.1097/dbp.0000000000000960] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 03/03/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Obstetric complications (OCs) are adverse events during pregnancy, birth, or immediately after birth. Evidence on cumulative OC and longitudinal associations with child psychopathology is sparse. Prospective studies testing mediating pathways such as parenting stress are needed. This study aimed to investigate the impact of OC on child psychopathology in middle childhood and to highlight whether and which type of parenting stress specifically mediates this association. METHODS We investigated n = 54 mother-child dyads from 5 months to 8 years of age. Child psychopathology at 8 years and parenting stress at 12 months were assessed using the Child Behavior Checklist (CBCL) and the Parenting Stress Index. OCs were evaluated by the Steinhausen Questionnaire and through access to official pregnancy records at the 5-month visit. Half of the mothers had experienced early-life maltreatment (ELM), assessed with the Childhood Trauma Questionnaire. RESULTS There was a significant indirect effect of maternal parenting stress at 12 months mediating the association between OC and child psychopathology at 8 years (β = 0.26; p < 0.01; 95% [0.35-1.83]). A significant proportion of 35% of CBCL-variance was explained. The significant effect remained even when maternal ELM and maternal psychological distress were controlled for. On the subscale level, only the "Difficult Child" subscale was a significant mediator. CONCLUSION Our findings suggest that parenting stress should be targeted to prevent adverse effects of OC on child psychopathology. More research focusing on families subjected to OC is needed to highlight how maternal parenting stress and child regulatory functioning interact to affect child development longitudinally.
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Affiliation(s)
- Anna Fuchs
- Centre for Psychosocial Medicine, Department of Child and Adolescent Psychiatry, University Hospital Heidelberg, Heidelberg, Germany
- Department of Psychology, Pennsylvania State University, University Park, PA
| | - Franz Resch
- Centre for Psychosocial Medicine, Department of Child and Adolescent Psychiatry, University Hospital Heidelberg, Heidelberg, Germany
| | - Michael Kaess
- Centre for Psychosocial Medicine, Department of Child and Adolescent Psychiatry, University Hospital Heidelberg, Heidelberg, Germany
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Eva Moehler
- Centre for Psychosocial Medicine, Department of Child and Adolescent Psychiatry, University Hospital Heidelberg, Heidelberg, Germany
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Saarland, Homburg, Germany
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18
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Malliarou M, Karadonta A, Mitroulas S, Paralikas T, Kotrotsiou S, Athanasios N, Sarafis P. Preterm Parents' Stress and Coping Strategies in a Neonatal Intensive Care Unit in a University Hospital of Central Greece. Mater Sociomed 2021; 33:244-249. [PMID: 35210945 PMCID: PMC8812370 DOI: 10.5455/msm.2021.33.244-249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 12/22/2021] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND The early birth of a newborn and the hospital care in the intensive care causes stress to parents. OBJECTIVE The main objective of this study was to investigate preterm parents' level of stress and which coping strategies do they use in a Neonatal Intensive care Unit in a University Hospital of Central Greece. METHODS This cross-sectional study used a group of 82 preterm parents in the Neonatal Intensive care unit in a University Hospital of Central Greece. They were asked to answer a questionnaire with the Parental Stressor Scale: Neonatal Intensive Care Unit (PSS: NICU), Coping Orientation to Problems Experienced (BRIEF/COPE), Daily Spiritual Experience Scale (DSES). The McNemar test was used to compare fathers 'and mothers' views on psychological support. The paired t-test or the Wilcoxon-signed rank test was used to compare scores between fathers and mothers. The levels of importance are bilateral and the statistical importance was defined as 0.5. For the analysis SPSS 22.0 was used. RESULTS The most common cause of admission to NICU was low birth weight. The severity of the preterm's condition was found to be independently correlated with PSS-NICU score due to "sights and sounds" and due to "Infant Appearance and behaviour" in the NICU. The severity of the child's condition and the parents' DSES score were found to be independently correlated to the stress score due to their "parent-infant relationship". Mothers 'and fathers' scores on the dimensions of the Brief-COPE Questionnaire were similar, suggesting a similar way of managing stress. Substance use, religion, humor were found to correlate with total score of PSS-NICU. More specifically PSS-NICU correlated negatively with substance use (r=-0.30 p=0.009) and humor (r=-0.28 p=0.016) while it correlated positively with religion (r=0.29 p=0.011). CONCLUSION Mothers and fathers of preterm need support. Spirituality and religion, helps then face the challenges of having their baby hospitalized in a NICU.
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Affiliation(s)
- Maria Malliarou
- University of Nursing, University of Thessaly, Larissa, Greece
| | | | | | | | | | | | - Pavlos Sarafis
- University of Nursing, University of Thessaly, Larissa, Greece
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19
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Walczak-Kozłowska T, Chrzan-Dętkoś M, Harciarek M. Heterogeneity of the attentional system's efficiency among very prematurely born pre-schoolers. Child Neuropsychol 2021; 28:120-142. [PMID: 34348594 DOI: 10.1080/09297049.2021.1961702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Very preterm birth increases the risk of ADHD as well as other neurodevelopmental disorders. Deficits within the attentional system were previously signaled in preterm children; however, studies lacked in consideration of an intragroup differentiation. Thus, this study aimed to verify whether deficits in the attentional mechanisms are inter-individually differentiated among very prematurely born children and if so, which biomedical and non-biomedical factors are associated with the profile of deficits within the attentional system. We tested the efficiency of attentional processes among 5-year-old children with the Attention Network Task - Child Version. The results have indicated that 26% of very preterm children presented with the suboptimal functioning of the attentional system (more than 1 SD below mean score of full-term children in attentional alerting and orienting), whereas 74% were characterized by the normal efficiency of attention. The profile of attentional deficits observed among very preterm preschoolers was associated with significantly lower birth weight and decreased family living standard. Very prematurely born children are thus a relatively heterogeneous group in terms of the efficiency of attentional system and deficits apply to only some of those children. Early developmental support aimed at enhancing attentional functioning should be addressed to children with lower birth weight in the first place.
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Affiliation(s)
- Tamara Walczak-Kozłowska
- Division of Neuropsychology, Institute of Psychology, Department of the Social Sciences, University of Gdańsk, Gdańsk, Poland
| | - Magdalena Chrzan-Dętkoś
- Division of Developmental Psychology and Psychopathology, Institute of Psychology, Department of the Social Sciences, University of Gdańsk, Gdańsk, Poland
| | - Michał Harciarek
- Division of Neuropsychology, Institute of Psychology, Department of the Social Sciences, University of Gdańsk, Gdańsk, Poland
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20
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Sullivan JA, Zvara BJ, Keim SA, Andridge R, Anderson SE. Knowledge of Infant Development and Parent Well-Being: Cross-Sectional Analysis of Toddlers. J Dev Behav Pediatr 2021; 42:442-449. [PMID: 34397572 PMCID: PMC8371675 DOI: 10.1097/dbp.0000000000000918] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 12/01/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Knowledge about child development is associated with parenting and children's outcomes. Parents with less accurate knowledge about developmental milestones may have unrealistic expectations for their child's behavior, which may affect parent well-being. Limited research has examined this topic relative to depression, but other aspects of parent well-being (e.g., parenting stress) are unexplored. METHODS Cross-sectional analysis of an ongoing prospective cohort study of 300 families in central Ohio enrolled when children were a mean (SD) calendar age of 18.2 (0.7) months. Children of all gestational ages at birth are included, and 37% were born preterm (<37 weeks' gestation.) Primary caregivers (93% mothers) completed the 20-item Knowledge of Infant Development Index (KIDI) and questionnaires for child temperament and 3 aspects of parent well-being (depressive and anxious symptoms, parenting stress, and general health). Covariate-adjusted regression models assessed relationships between the KIDI score and each well-being outcome. We hypothesized that parents with less knowledge would have more symptoms of depression and anxiety, greater parenting stress, and poorer health. Whether associations were stronger for parents of children born preterm or who had high negative affect was explored. RESULTS Knowledge of Infant Development Index scores were associated with sociodemographic characteristics, child temperament, and gestational age (more knowledge: higher socioeconomic position, less child negative affect, and full-term birth). KIDI scores did not predict any aspect of parent well-being, and there was no evidence that child temperament or preterm birth altered these findings. CONCLUSION In this sample of parents of toddlers assessed in 2018/19, greater knowledge of infant development was not associated with parent well-being.
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Affiliation(s)
- Jacqueline A. Sullivan
- The Research Institute, Center for Biobehavioral Health, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Bharathi J. Zvara
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina Chapel Hill, Chapel Hill, NC, USA
| | - Sarah A. Keim
- The Research Institute, Center for Biobehavioral Health, Nationwide Children’s Hospital, Columbus, OH, USA
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH, USA
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Rebecca Andridge
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Sarah E. Anderson
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
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21
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Preventive Intervention Program on the Outcomes of Very Preterm Infants and Caregivers: A Multicenter Randomized Controlled Trial. Brain Sci 2021; 11:brainsci11050575. [PMID: 33946995 PMCID: PMC8145332 DOI: 10.3390/brainsci11050575] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/25/2021] [Accepted: 04/26/2021] [Indexed: 11/25/2022] Open
Abstract
Increased survival in the very preterm population results in a higher risk of developing neurodevelopmental and behavioral disabilities among survivors. We examined the outcomes of very preterm infants and parents after a preventive intervention program of four home visits by a specialized nurse, 5 days, 2 weeks, and 1 month after discharge, respectively, and at CA 2 months, followed by up to 12 times of group sessions between CA 3 and 6 months. Our multicenter randomized controlled trial assessed 138 preterm infants (gestational age ≤30 weeks or birth weight ≤1500 g) enrolled from the three participating hospitals. We randomly allocated the preterm babies to either the intervention or the control group. The primary outcome was the neurodevelopmental outcomes of Bayley-III scores at CA 10 and 24 months. At CA 10 months and 24 months, there were no significant differences between the intervention and control groups in the cognitive, motor, and language domains of Bayley-III scores. In addition, there were no significant differences in the mother’s depression scale, mother–child attachment, and the modified Infant and Toddler Social and Emotional Assessment.
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22
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Vaccaro SM, Tofighi D, Moss N, Rieger R, Lowe JR, Phillips J, Erickson SJ. The association of infant temperament and maternal sensitivity in preterm and full-term infants. Infant Ment Health J 2021; 42:374-385. [PMID: 33836096 DOI: 10.1002/imhj.21915] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 09/20/2020] [Accepted: 11/24/2020] [Indexed: 01/30/2023]
Abstract
Infants who experience sensitive caregiving are at lower risk for numerous adverse outcomes. This is especially true for infants born preterm, leading them to be more susceptible to risks associated with poorer quality caregiving. Some research suggests that preterm and full-term infants differ on temperament, which may contribute to these findings. This study aimed to investigate associations between infant temperament (negative emotionality, positive affectivity/surgency, and orienting/regulatory capacity) and maternal sensitivity among infants born preterm (M = 30.2 weeks) and full term. It was hypothesized that mothers of infants born preterm and mothers of infants with more difficult temperaments would display lower sensitivity, indicated by lower responsiveness to nondistress, lower positive regard, and higher intrusiveness. Videotaped play interactions and a measure of temperament (Infant Behavior Questionnaire) were coded for 18 preterm and 44 full-term infants at 9 months (corrected) age. Results suggest that mothers of preterm and full-term infants differed significantly in responding to their infants, but these results cannot be explained by infant temperament. Preterm status and sociodemographic risk emerged as correlates of maternal behavior, such that mothers of infants born preterm and mothers with greater sociodemographic risk displayed lower levels of maternal sensitivity.
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Affiliation(s)
- Suzanne M Vaccaro
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Davood Tofighi
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Natalia Moss
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Rebecca Rieger
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Jean R Lowe
- Department of Pediatrics, University of New Mexico, Albuquerque, New Mexico, USA
| | - John Phillips
- The Mind Research Network, Albuquerque, New Mexico, 87106, USA
| | - Sarah J Erickson
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico, USA
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Mind-Mindedness and Parenting Stress: A Cross-Sectional Study in a Cohort of Mothers of 3-Month-Old Full-Term and Preterm Infants. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17217735. [PMID: 33105872 PMCID: PMC7660160 DOI: 10.3390/ijerph17217735] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 10/17/2020] [Accepted: 10/19/2020] [Indexed: 12/11/2022]
Abstract
The preterm birth of a child is a sudden event that can disturb the overall family system and its functioning. Many studies have been conducted with the aim of exploring how and the degree to which this event affects the early mother–infant dyadic relationship and maternal well-being, with often mixed findings. The present study investigates the combined effect of preterm birth and parenting stress on mind-mindedness, a parenting dimension that captures how parents represent and treat their children as separate individuals with their own mental states and activities. A hundred and ten mothers and their three-month-old infants (preterm = 54; full-term = 56) participated in the study. Mind-mindedness was assessed by coding mothers’ comments about infant’s mental states during dyadic face-to-face interaction. Parenting stress was evaluated with the Parenting Stress Index Short Form questionnaire. Mothers of preterm infants reported similar levels of appropriate and non-attuned mind-related comments to mothers of full-term infants. The reported parenting stress levels were also comparable. Interestingly, only mothers of preterm infants who reported higher stress in parenting showed more non-attuned comments during the interaction. The results underline the need to address preterm birth as a complex event, going beyond group differences and considering its interplay with other risk or protective factors in shaping children’s and parents’ adjustments and well-being.
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Suttora C, Salerni N, Selvagno E, Porro M, Gangi S, Squarza C, Gardon L, Picciolini O. Mind-mindedness and parenting stress in mothers of preterm and full-term infants: The moderating role of perceived social support. Infant Ment Health J 2020; 42:35-46. [PMID: 32965688 DOI: 10.1002/imhj.21891] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The goal of this study was to examine the effects of preterm birth and maternal childbirth-related posttraumatic stress and parenting stress on maternal mind-mindedness (MM). The study also investigated the effects of perceived social support on parenting stress and MM. Sixty-five preterm (N = 32) and full-term (N = 33) mother-infant dyads were observed at 6 months. Measures of maternal MM were obtained from observations of mother-infant interaction. Mothers also provided ratings of their posttraumatic stress disorder (PTSD) symptoms, parenting stress, and perceived social support via an online survey. Experiencing a preterm birth did not affect mothers' use of mental state descriptors during mother-infant interaction. Neither childbirth-related posttraumatic stress nor parenting stress directly affected maternal ability to comment on the child's mental states appropriately. However, at medium and high levels of perceived social support, a negative association between parenting stress and MM was observed. Maternal perception of being emotionally supported by significant others promoted MM in mothers showing low or mild levels of parenting stress, but not in mothers experiencing high stress in parenting their infants. Results suggest that a proclivity to MM might be affected by the interaction between parenting stress and social support, rather than by childbirth-related variables, such as prematurity.
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Affiliation(s)
- Chiara Suttora
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Nicoletta Salerni
- Department of Psychology, University of Milano-Bicocca, Milano, Italy
| | - Elena Selvagno
- Department of Psychology, University of Milano-Bicocca, Milano, Italy
| | - Matteo Porro
- Servizio di Follow-up del neonato a rischio evolutivo, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.,UO Medicina Fisica e Riabilitativa Pediatrica, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Silvana Gangi
- Servizio di Follow-up del neonato a rischio evolutivo, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.,UO di Neonatologia e Terapia Intensiva neonatale, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Chiara Squarza
- Servizio di Follow-up del neonato a rischio evolutivo, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Laura Gardon
- Servizio di Follow-up del neonato a rischio evolutivo, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Odoardo Picciolini
- Servizio di Follow-up del neonato a rischio evolutivo, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.,UO Medicina Fisica e Riabilitativa Pediatrica, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
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25
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Dempsey AG, Keller-Margulis MA. Developmental and medical factors associated with parenting stress in mothers of toddlers born very preterm in a neonatal follow-up clinic. Infant Ment Health J 2020; 41:651-661. [PMID: 32845537 DOI: 10.1002/imhj.21890] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The purpose of this exploratory, cross-sectional study was to identify child-related factors associated with maternal parenting stress in toddlers born very preterm and followed in a neonatal follow-up (NFU) clinic. The study aimed to describe the associations of current medical complications and presence of developmental delays with total parenting stress. Participants were 53 mother-child dyads presenting in a NFU clinic. Mothers completed the Parenting Stress Index-Short Form (PSI-SF), and children were administered the Brigance Early Head Start Screen II. Medical variables were also collected from the child's medical record. Approximately 24% of mothers had at least one elevated subscale score on the PSI-SF. Regression analyses indicated that receipt of early intervention services was associated with increased parenting stress among mothers of toddlers born very preterm, though number of current medical complications was not. Parents of children born very preterm are at increased risk for parenting stress that extends beyond discharge from the neonatal intensive care unit . Clinicians working in NFU clinics are positioned to monitor for increased parenting stress, particularly among families of children with emerging signs of developmental delay.
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Affiliation(s)
- Allison G Dempsey
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, Colorado
| | - Milena A Keller-Margulis
- Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, Texas
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Resch B, Hofbauer-Krug C, Pansy J, Prechtl K, Avian A, Kurz R. Prospective Randomized Observational Pilot Trial Evaluating the Effect of Different Durations of Interdisciplinary Early Intervention and Family Support in Parents of Very Low Birth Weight Infants (Early Bird Study). Front Public Health 2020; 8:242. [PMID: 32719760 PMCID: PMC7349967 DOI: 10.3389/fpubh.2020.00242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 05/19/2020] [Indexed: 01/05/2023] Open
Abstract
Background: Early childhood intervention (ECI) is a holistic approach for infants with or at risk for psychomotor and/or cognitive and/or behavioral impairment. It aims to optimally support them and positively influence their neurodevelopmental outcome. The right dosage of intervention and when the intervention should start are still to be determined. Hypothesis: Parents are more satisfied when the duration of ECI is longer (120 min once a week) than the usual 90-min session. Methods: We developed a parental questionnaire (both mother and father) that evaluated the level of satisfaction of parents with the intervention. We compared 120 with 90 min of ECI per week during the school year 2017/18. Included were parents of very low birth weight infants (<1,500 g) following informed consent. ECI was initiated at the NICU at an infant age of ≥ 2 weeks. Parents were randomized (https://www.randomizer.at/) to a 120- or 90-min duration and had to answer the questionnaire to the approximate time-point of 1, 3, and 6 months. Answers were classified as strongly agree, agree, neither agree nor disagree, disagree, and strongly disagree except for the last question, which directly rated the ECI professional. Results: Eleven fathers (55%) and 19 mothers (95%) of the 10 parents of each group participated in the study. Demographic data did not differ between groups, and the median time-points of questionnaire answers were 77, 137, and 220 days, respectively. Overall, 120-min ECI sessions were not superior to 90-min sessions for both parents regarding parental satisfaction during the study time. We found no differences between fathers and mothers and minimal changes over time. All parents were satisfied with the ECI professionals, irrespective of ECI duration. Conclusion: An ECI duration of 120 min once per week was not superior to a 9- min duration regarding parental satisfaction with ECI professionals and their work.
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Affiliation(s)
- Bernhard Resch
- University Course for Interdisciplinary Early Intervention and Family Support, Postgraduate School, Medical University of Graz, Graz, Austria.,Research Unit for Neonatal Infectious Diseases and Epidemiology, Medical University of Graz, Graz, Austria.,Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Claudia Hofbauer-Krug
- University Course for Interdisciplinary Early Intervention and Family Support, Postgraduate School, Medical University of Graz, Graz, Austria.,Institute for Social and Orthopedagogic Interventions (SHFI), Graz, Austria
| | - Jasmin Pansy
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Karin Prechtl
- Institute for Social and Orthopedagogic Interventions (SHFI), Graz, Austria
| | - Alexander Avian
- Institute for Statistics, Medical University of Graz, Graz, Austria
| | - Ronald Kurz
- University Course for Interdisciplinary Early Intervention and Family Support, Postgraduate School, Medical University of Graz, Graz, Austria.,Institute for Social and Orthopedagogic Interventions (SHFI), Graz, Austria
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27
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Lau C, Turcich MR, Smith EO. Early detection of parenting stress in mothers of preterm infants during their first-year home. BMC Psychol 2020; 8:66. [PMID: 32576260 PMCID: PMC7313173 DOI: 10.1186/s40359-020-00435-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 06/17/2020] [Indexed: 11/11/2022] Open
Abstract
Background Maternal stress following the birth of an infant is well acknowledged. It is particularly so when infants are born prematurely as their mothers cannot fully take on their parenting role until their infant(s) is discharged from neonatal intensive care units (NICUs). In this exploratory study, we examined whether these mothers’ parenting stress would lessen during their first-year reunification with their infant(s) as they settle into motherhood at home. Methods Two groups of mothers with infants born between 24- and 33-week gestational age were recruited. A group of 25 mothers were monitored at their infants’ 1-month corrected age (CA) and a second group of 24 mothers were monitored at their infants’ 12-month CA. Subjects completed the long form Parental Stress Index (PSI) ranking how stressful they perceive the individual subscales in the Child and Parent Domains of the self-reported questionnaire (PSI-3; Abidin; PAR Inc). The PSI theorizes that the stress mothers perceive is a resultant of their respective characteristics, interactions with their infant(s), family, and environment. Statistical analyses include descriptive statistics, χ2 square analysis, and independent t-test. Results There was no significant difference in the levels of perceived stress in the PSI subscales between the two groups of mothers at 1- and 12-month CA. Scores for the majority of respondents fell within the 15th to 80th percentile (% ile) distribution of Abidin’s normative population, with some mothers falling below the 15th % ile. Discussion/conclusion The data collected suggest that: 1. the perceived stress experienced by mothers during their first-year reunited with their preterm infants is within the normal range observed in Abidin’s normative population. 2. As the PSI is a self-reported survey, care providers need to be aware that some mothers may downplay their stress responses. 3. With the ability to monitor individual participants, the PSI can be readily offered to mothers at their infants’ first year routine clinical visits to assist in the early identification of parenting issues that may threaten the development of a healthy mother-infant dyad. Early appropriate guidance and social support would help “at-risk” mothers develop more constructive parenting routines.
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Affiliation(s)
- C Lau
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, 77030, USA.
| | - M R Turcich
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, 77030, USA
| | - E O Smith
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, 77030, USA
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Landsem IP, Handegård BH, Ulvund SE. Temperamental Development among Preterm Born Children. An RCT Follow-Up Study. CHILDREN-BASEL 2020; 7:children7040036. [PMID: 32340334 PMCID: PMC7230507 DOI: 10.3390/children7040036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 03/27/2020] [Accepted: 04/21/2020] [Indexed: 12/20/2022]
Abstract
A randomized controlled trial study recruited 146 preterm born children, either to participate in a modified version of the Mother–Infant Transaction Program (MITP-m) or to receive the usual follow-up services, before and after discharge from a neonatal intensive care unit. This follow-up study investigates whether MITP participation is associated with parental perceptions of child temperament from two to seven years. Children’s temperament was reported by mothers and fathers separately at children’s ages of 2, 3, 5, and 7 years. Parents in the MITP-m group reported lower levels of negative emotionality in their children compared to the control group. In maternal reports, a group effect (F(1, 121) = 9.7, p = 0.002) revealed a stable difference in children’s negative emotionality from two to seven years, while a group-by-time interaction related to an increasing difference was detected in reports from fathers (F(1, 94) = 4.8, p = 0.03). Another group difference appeared in fathers’ reports of children’s soothability (F(1, 100) = 14.2, p < 0.0005). MITP-m fathers seemed to perceive their children as easier to soothe at all ages as no interaction with time appeared. Parental reports on children’s sociality, shyness, and activity did not differ between the groups.
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Affiliation(s)
- Inger Pauline Landsem
- Child & Adolescent Department, University Hospital of North Norway, 9019 Tromsø, Norway
- Health Research Faculty, UIT the Arctic University of Norway, 9019 Tromsø, Norway;
- Correspondence:
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29
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Grunberg VA, Geller PA, Patterson CA. Infant illness severity and family adjustment in the aftermath of NICU hospitalization. Infant Ment Health J 2020; 41:340-355. [PMID: 32057129 DOI: 10.1002/imhj.21848] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Up to 15% of parents have an infant who will spend time in a neonatal intensive care unit (NICU). After discharge, parents may care for a medically fragile infant and worry about their development. The current study examined how infant illness severity is associated with family adjustment. Participants included parents with infants who had been discharged from the NICU 6 months to 3 years prior to study participation (N = 199). Via a Qualtrics online survey, parents reported their infants' medical history, parenting stress, family burden, couple functioning, and access to resources. Multivariable regression analyses revealed that more severe infant medical issues during hospitalization (e.g., longer length of stay and more medical devices) were associated with greater family burden, but not stress or couple functioning. Infant health issues following hospitalization (i.e., medical diagnosis and more medical specialists) were associated with greater stress, poorer couple functioning, and greater family burden. Less time for parents was associated with increased stress and poorer couple functioning. Surprisingly, parents of infants who were rehospitalized reported less stress and better couple functioning, but greater family burden. Family-focused interventions that incorporate psychoeducation about provider-patient communication, partner support, and self-care may be effective to prevent negative psychosocial sequelae among families.
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Affiliation(s)
- Victoria A Grunberg
- Department of Psychology, College of Arts and Sciences, Drexel University, Philadelphia, Pennsylvania
| | - Pamela A Geller
- Department of Psychology, College of Arts and Sciences, Drexel University, Philadelphia, Pennsylvania.,Department of Obstetrics & Gynecology, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Chavis A Patterson
- Department of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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30
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Lemos RA, Veríssimo MDLÓR. Methodological strategies for the elaboration of educational material: focus on the promotion of preterm infants' development. CIENCIA & SAUDE COLETIVA 2020; 25:505-518. [PMID: 32022191 DOI: 10.1590/1413-81232020252.04052018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 06/18/2018] [Indexed: 11/22/2022] Open
Abstract
This study aimed to describe and analyze the process of elaborating educational material to promote the development of preterm infants. The procedures included participative exploratory research with the target audience, integrative reviews of the literature on the subject, and systematization of contents through robust theoretical references. Popular Education in Health guided the elaboration of the educational material, and the participatory approach; the Bioecological Theory of Human Development conducted the analysis and systematization of the contents; and Simply Put guided the graphic organization of the material. The theoretical model of the development of preterm infants, and data systematization and organization, allowed the elaboration of an interactive educational material, a technology in a book format for the family. The multiple research strategies and theoretical references have provided methodological rigor, increasing the educational material's action potential, which draws family experience closer to the updated scientific knowledge, thus enhancing child health promotion.
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Affiliation(s)
- Rayla Amaral Lemos
- Faculdade de Fisioterapia, Universidade Federal de Juiz de Fora. R. Eugênio do Nascimento s/n, Bairro Dom Bosco. 36038-330, Juiz de Fora, MG, Brasil.
| | - Maria de La Ó Ramallo Veríssimo
- Departamento de Enfermagem Materno-Infantil e Psiquiátrica, Escola de Enfermagem, Universidade de São Paulo. São Paulo, SP, Brasil
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31
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Weigl T, Schneider N, Stein A, Felderhoff-Müser U, Schedlowski M, Engler H. Postpartal Affective and Endocrine Differences Between Parents of Preterm and Full-Term Infants. Front Psychiatry 2020; 11:251. [PMID: 32296356 PMCID: PMC7139630 DOI: 10.3389/fpsyt.2020.00251] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 03/16/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND During the postpartum period, new parents frequently experience emotional stress and exhibit symptoms of depression and anxiety, accompanied by substantial endocrine changes. However, evidence predominantly exists from parents of full-term infants, while data on parents of preterm infants are scarce. In this exploratory, cross-sectional study, we compared psychological well-being and endocrine parameters in parents of very preterm and term born infants. METHODS Mothers (N = 28) and fathers (N = 30) of full-term infants as well as mothers (N = 18) and fathers (N = 21) of very or extreme preterm infants (< 32nd gestational week) were recruited in the days following birth. Anxiety, depression, and perceived stress were assessed with the State-Trait Anxiety Inventory (STAI), the Beck Depression Inventory (BDI), and the Perceived Stress Questionnaire (PSQ), respectively. Physiological measures included serum levels of estradiol, progesterone, prolactin, and thyroid-stimulating hormone (mothers only), as well as the salivary cortisol awakening response (mothers and fathers). RESULTS New mothers and fathers of very preterm infants exhibited higher scores of depression, anxiety and stress than parents of term infants. Besides, mothers of very preterm infants showed lower levels of estradiol, progesterone, and prolactin, as well as a heightened post-awakening cortisol response compared to mothers of term infants. Furthermore, in mothers of preterm infants we found significant negative associations between serum prolactin levels and BDI and STAI scores, respectively. CONCLUSIONS Parents of very preterm infants suffered from a higher burden of psychological distress than parents of full-term infants. The affective symptoms in preterm mothers were accompanied by altered endocrine profiles that, at least to some extent, may contribute to the psychological changes. The profound psychological and physiological disturbances in mothers of preterm infants may have an impact on long-term mental health and early pharmacological and psychological interventions may help to ameliorate postpartum affective symptoms.
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Affiliation(s)
- Tobias Weigl
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,Psychology School, Fresenius University of Applied Sciences Düsseldorf, Düsseldorf, Germany
| | - Nora Schneider
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,Department of Pediatrics I, Neonatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Anja Stein
- Department of Pediatrics I, Neonatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Ursula Felderhoff-Müser
- Department of Pediatrics I, Neonatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Manfred Schedlowski
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Harald Engler
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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32
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Takács L, Smolík F, Putnam S. Assessing longitudinal pathways between maternal depressive symptoms, parenting self-esteem and infant temperament. PLoS One 2019; 14:e0220633. [PMID: 31381596 PMCID: PMC6681961 DOI: 10.1371/journal.pone.0220633] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 07/19/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Previous studies of relations between parenting self-concepts, parental adjustment and child temperament have been ambiguous regarding the direction of influence; and have rarely followed families from pregnancy through the first year of life. The current study examines change and stability in maternal depressive symptoms, parenting competences and child temperament through the perinatal period until nine months postpartum. METHODS Czech mothers (N = 282) participated at three time points: the third trimester of pregnancy (Time 1), six weeks (Time 2) and nine months postpartum (Time 3). Questionnaire data concerned depressive symptoms (T1, T2, T3), maternal parenting self-esteem (T1, T2) and sense of competence (T3), and child temperament (T2, T3). A path model was used to examine concurrent and longitudinal relations between these variables. RESULTS The analyses indicated longitudinal stability of all constructs, as well as concurrent relations between them. Longitudinal relations supported child-to-parent, rather than parent-to-child, effects: child difficult temperament predicted decreases in perceived maternal parenting competences, but maternal variables did not predict change in infant temperament. In addition, we observed weak mutual relations between maternal depression levels and parenting competences, such that maternal depression diminished perceived parenting competences that in turn contributed to higher levels of depression. CONCLUSION Mothers' confidence in their ability to parent is influenced by their experience with a difficult infant and by their depressive symptoms during the child's first year of life. Depressive symptoms are, in turn, aggravated by mothers' low perceived competences in the parenting role.
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Affiliation(s)
- Lea Takács
- Department of Psychology, Faculty of Arts, Charles University, Prague, Czech Republic
- * E-mail:
| | - Filip Smolík
- Institute of Psychology, Czech Academy of Sciences, Prague, Czech Republic
| | - Samuel Putnam
- Department of Psychology, Bowdoin College, Brunswick, Maine, United States of America
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33
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Stotts AL, Villarreal YR, Klawans MR, Suchting R, Dindo L, Dempsey A, Spellman M, Green C, Northrup TF. Psychological Flexibility and Depression in New Mothers of Medically Vulnerable Infants: A Mediational Analysis. Matern Child Health J 2019; 23:821-829. [PMID: 30610529 DOI: 10.1007/s10995-018-02699-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Objectives Maternal depression in the postpartum period is prevalent and associated with negative child outcomes, including behavior problems and cognitive delays. Mothers of children admitted directly after birth to the neonatal intensive care unit (NICU) are at even higher risk for depressive symptoms and infants born premature and/or at low birth weight may be more vulnerable to the adverse effects of maternal depression. Understanding mechanisms, particularly modifiable mechanisms, involved in the development or persistence of depressive symptoms is critically important for developing effective treatments. Methods The longitudinal, secondary analysis investigated the role of psychological inflexibility (rigidly avoiding or attempting to control distressing internal experiences, precluding present moment awareness of contingencies and engagement with important values) as a mediator of the relationship between early (1-2 weeks postpartum) and later (3 and 6 months postpartum) depressive symptoms among mothers with an infant in the NICU. Results Psychological inflexibility measured 2 weeks after infant discharge from the hospital fully mediated the relationship between early and later depressive symptoms at 3 months postpartum, with partial mediation at 6 months, while controlling for factors previously found predictive of postpartum depression. Conclusions for Practice Psychological inflexibility may be a mechanism by which postpartum depressive symptoms persist after hospital discharge among new mothers with a NICU infant. Acceptance and Mindfulness therapies which specifically target psychological inflexibility may be promising interventions to reduce depressive symptoms postpartum.
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Affiliation(s)
- Angela L Stotts
- Department of Family and Community Medicine, McGovern Medical School at UTHealth, 6431 Fannin, JJL 324, Houston, TX, 77030, USA. .,Department of Psychiatry and Behavioral Science, McGovern Medical School at UTHealth, 1941 East Rd., Houston, TX, 77054, USA.
| | - Yolanda R Villarreal
- Department of Family and Community Medicine, McGovern Medical School at UTHealth, 6431 Fannin, JJL 324, Houston, TX, 77030, USA
| | - Michelle R Klawans
- Department of Family and Community Medicine, McGovern Medical School at UTHealth, 6431 Fannin, JJL 324, Houston, TX, 77030, USA
| | - Robert Suchting
- Department of Family and Community Medicine, McGovern Medical School at UTHealth, 6431 Fannin, JJL 324, Houston, TX, 77030, USA.,Department of Psychiatry and Behavioral Science, McGovern Medical School at UTHealth, 1941 East Rd., Houston, TX, 77054, USA
| | - Lillian Dindo
- Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA
| | - Allison Dempsey
- Department of Family and Community Medicine, McGovern Medical School at UTHealth, 6431 Fannin, JJL 324, Houston, TX, 77030, USA
| | - Mackenzie Spellman
- Department of Family and Community Medicine, McGovern Medical School at UTHealth, 6431 Fannin, JJL 324, Houston, TX, 77030, USA
| | - Charles Green
- Department of Psychiatry and Behavioral Science, McGovern Medical School at UTHealth, 1941 East Rd., Houston, TX, 77054, USA
| | - Thomas F Northrup
- Department of Family and Community Medicine, McGovern Medical School at UTHealth, 6431 Fannin, JJL 324, Houston, TX, 77030, USA
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34
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Erdmann KA, Vetter VC, Schäferling M, Reuner G, Hertel S. “How Do We Solve This Task?”. ZEITSCHRIFT FUR ENTWICKLUNGSPSYCHOLOGIE UND PADAGOGISCHE PSYCHOLOGIE 2019. [DOI: 10.1026/0049-8637/a000215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Abstract. The study examines (a) whether gestational age relates to parental scaffolding (SCA), when controlling for child cognitive development, parenting stress, and socioeconomic status, and (b) how SCA links to parent–child problem-solving performance. The sample included 142 parents with a full-term or preterm 2-year-old toddler (corrected age). Parents’ SCA during one of two (randomly assigned) problem-solving tasks was rated on five scales (use of SCA means, cognitive support, metacognitive support, transfer or responsibility, contingency management). The results suggest that gestational age is positively related to parents’ transfer of responsibility and metacognitive support. The effects decrease, however, once covariates are controlled for. Regarding the problem-solving performance, direct effects were observed from parents’ cognitive and metacognitive support, transfer of responsibility, and contingency management. The data also confirm an indirect effect of parents’ use of SCA means on the problem-solving performance, partially mediated via parents’ cognitive support. Implications for the design of interventions are discussed.
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Affiliation(s)
| | - Verena Clara Vetter
- Institut für Bildungswissenschaft, Universität Heidelberg
- Zentrum für Kinder- und Jugendmedizin, Sektion für Neuropädiatrie und Stoffwechselmedizin, Universitätsklinikum Heidelberg
| | - Michaela Schäferling
- Zentrum für Kinder- und Jugendmedizin, Sektion für Neuropädiatrie und Stoffwechselmedizin, Universitätsklinikum Heidelberg
| | - Gitta Reuner
- Institut für Bildungswissenschaft, Universität Heidelberg
- Zentrum für Kinder- und Jugendmedizin, Sektion für Neuropädiatrie und Stoffwechselmedizin, Universitätsklinikum Heidelberg
| | - Silke Hertel
- Institut für Bildungswissenschaft, Universität Heidelberg
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Effect of Preterm Infant Massage by the Mother on the Mood of Mothers Having Preterm Infants. J Chiropr Med 2019; 18:67-76. [PMID: 31193199 DOI: 10.1016/j.jcm.2018.11.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Revised: 11/01/2018] [Accepted: 11/18/2018] [Indexed: 11/21/2022] Open
Abstract
Objective The purpose of this study was to determine the effect of preterm infant massage by the mother on the mood state of mothers of preterm infants. Methods This experimental study assessed 52 mothers of preterm infants (born at 30-37 weeks of gestation) hospitalized in the neonatal intensive care unit of Afzalipour Hospital of Kerman University of Medical Sciences, Iran. Recruitment was done using the convenience sampling method, and participants were randomly assigned into intervention and control groups. In the intervention group, massage therapy was done once a day for 5 consecutive days. Infants in the control group received the usual care. Data were collected using a questionnaire of demographic information and the Profile of Mood State questionnaire and analyzed using SPSS version 19 (IBM Corp, Armonk, New York) and Kruskal-Wallis, Mann-Whitney U, Wilcoxon, and χ2 tests. Results Comparison of the mothers' mean mood scores between the intervention and control groups showed no significant difference before the intervention (P = .51), whereas mean scores differed significantly after the intervention between the groups (P = .005). Mothers' mean mood scores improved significantly in the control group (P = .02) and the intervention group (P < .001), whereas the intervention group showed a greater improvement (-4.155 vs -2.238). Conclusion Those mothers performing massage on their preterm infants showed greater improvement in their mood compared with those in the control group. Teaching massage to the mothers of these infants could be considered as a possible intervention to enhance a mother's mood and the quality of care she provides to her infant.
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Astuti ES, Nursalam N, Devy SR, Etika R. Knowledge, Family Support and Self-Reliance Capital when Caring for Low Birth Weight Babies. JURNAL NERS 2019. [DOI: 10.20473/jn.v14i1.12734] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction: Low birth weight (LBW) infants are very susceptible to illness.LBW treatment with the principle of preventing infection is very important athome. The purpose of this study was to determine the relationship betweenmaternal knowledge and family support with the prevention of infection at home.Methods: This study used a correlation design. The samples were 160 motherswho had low birth weight infants with inclusion criteria mothers give birth tobabies weighing less than 2,500 grams with ages 0-2 months. The samples wereobtained through purposive sampling. The dependent variable was the mother'sability to prevent infection while the independent variable was the mother'sknowledge and family support. The instruments used were questionnaires. Thisresearch analyzed using Spearman Rho.Results: The results showed that there was a strong correlation betweenknowledge and the ability to prevent infection in treating low birth weight (r =0.696; p = 0.00) and that there was a moderate correlation between familysupport and infection prevention ability when treating a low birth weight (r =0.54. p = 0.000).Conclusion: Factors of maternal knowledge about infection prevention andfamily support need to be considered in increasing the ability of mothers to carefor babies with LBW. The factor of maternal knowledge about prevention ofinfection has a strong correlation value when compared to family support factors.Further research is needed on the model of increasing maternal knowledge aboutLBW infants during home care.
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NICU infant health severity and family outcomes: a systematic review of assessments and findings in psychosocial research. J Perinatol 2019; 39:156-172. [PMID: 30514968 DOI: 10.1038/s41372-018-0282-9] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 11/13/2018] [Indexed: 01/09/2023]
Abstract
Many infants (7-15%) spend time in the neonatal intensive care unit (NICU) and continue to experience medical issues after discharge. Family psychological responses range widely depending on burden of care, access to resources, and parental characteristics. The current systematic review examined how infant health severity is assessed and related to family psychological (e.g., mental health) and social (e.g., parent-infant attachment) outcomes. Seventy articles were deemed relevant. Infant health was operationalized in several ways including validated assessments, indices of infant health (e.g., diagnosis, length of stay), or novel measures. Parents of infants with increased medical complications reported greater family impact, increased stress, and more intrusive parenting style. A validated assessment of infant health that utilizes parent report is warranted to allow for more accessible and easily disseminated research across medical centers. Understanding NICU infant health severity and family outcomes can be used to identify families at risk for negative psychosocial sequelae.
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Abstract
BACKGROUND Little is known about health-related quality of life in young children undergoing staged palliation for single-ventricle CHD. The aim of this study was to assess the impact of CHD on daily life in pre-schoolers with single-ventricle CHD and to identify determinants of health-related quality of life. METHOD Prospective two-centre cohort study assessing health-related quality of life using the Preschool Paediatric Cardiac Quality of Life Inventory in 46 children at a mean age of 38 months and 3 weeks. Children with genetic anomalies were excluded. Scores were compared with reference data of children with biventricular CHD. Multiple linear regression analysis was used to identify determinants of health-related quality of life. RESULTS Health-related quality of life in pre-schoolers with single-ventricle CHD was comparable to children with biventricular CHD. Preterm birth and perioperative variables were significant predictors of low health-related quality of life. Notably, pre-Fontan brain MRI findings and neurodevelopmental status were not associated with health-related quality of life. Overall, perioperative variables explained 24% of the variability of the total health-related quality of life score.InterpretationDespite substantial health-related burden, pre-schoolers with single-ventricle CHD showed good health-related quality of life. Less-modifiable treatment-related risk factors and preterm birth had the highest impact on health-related quality of life. Long-term follow-up assessment of self-reported health-related quality of life is needed to identify patients with poorer health-related quality of life and to initiate supportive care.
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Effects on Parental Stress of Early Home-Based CareToy Intervention in Low-Risk Preterm Infants. Neural Plast 2019; 2019:7517351. [PMID: 30804992 PMCID: PMC6362470 DOI: 10.1155/2019/7517351] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 11/28/2018] [Indexed: 12/04/2022] Open
Abstract
Parenting a preterm infant is more challenging than a full-term one. Parent involvement in early intervention programs seems to have positive psychosocial effects on both the child and parent. CareToy is an innovative smart system that provides an intensive individualized home-based family-centred EI in preterm infants between 3 and 9 age-corrected months. A RCT study, preceded by a pilot study, has been recently carried out to evaluate the effects of CareToy intervention on neurodevelopmental outcomes with respect to Standard Care. This study aims at evaluating the effects of CareToy early intervention on parenting stress in preterm infants. Parents (mother and father) of a subgroup of infants enrolled in the RCT filled out a self-report questionnaire on parenting stress (Parenting Stress Index-Short Form (PSI-SF)) before (T0) and after (T1) the CareToy or Standard Care period (4 weeks), according to the allocation of their preterm infant. For twins, an individual questionnaire for each one was filled out. Results obtained from mothers and fathers were separately analysed with nonparametric tests. 44 mothers and 44 fathers of 44 infants (24 CareToy/20 Standard Care) filled out the PSI-SF at T0 and at T1. CareToy intervention was mainly managed by mothers. A significant (p < 0.05) reduction in Parental Distress subscale in the CareToy group versus Standard Care was found in the mothers. No differences were found among the fathers. CareToy training seems to be effective in reducing parental distress in mothers, who spent more time on CareToy intervention. These findings confirm the importance of parental involvement in early intervention programs. This trial is registered with Clinical Trial.gov NCT01990183.
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Babore A, Bramanti SM, Lombardi L, Stuppia L, Trumello C, Antonucci I, Cavallo A. The role of depression and emotion regulation on parenting stress in a sample of mothers with cancer. Support Care Cancer 2018; 27:1271-1277. [PMID: 30564939 DOI: 10.1007/s00520-018-4611-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 12/11/2018] [Indexed: 12/16/2022]
Abstract
PURPOSE The aim of the current study was to investigate if and to what extent depression and emotional regulation strategies (namely, cognitive reappraisal and expressive suppression) might lead to parenting stress in a sample of mothers with cancer and in a sample of healthy mothers. METHODS A sample of mothers with cancer (clinical group; n = 64) and a sample of healthy mothers (control group; n = 80) were administered self-report questionnaires investigating parenting stress (the parenting stress index), depressive symptoms (the Zung depression self-rating scale) and emotion regulation strategies (the emotion regulation questionnaire). RESULTS Depressive levels represented the most significant predictor of maternal parenting stress in both groups (p < .001). In addition, cognitive reappraisal (p < .05) but not expressive suppression significantly predicted parenting stress exclusively in the group of mothers with cancer. Finally, cognitive reappraisal was negatively and significantly associated with time since cancer diagnosis to survey. CONCLUSIONS This study highlights that depressive levels and cognitive reappraisal may play a significant role in parenting stress. The systematic assessment of these variables in women with an oncological diagnosis might help mental health professionals to identify those mothers at risk of developing higher levels of parenting stress ensuring adequate support and preventing negative effects on the parent-child relationship.
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Affiliation(s)
- Alessandra Babore
- Department of Psychological, Health and Territory Sciences, School of Medicine and Health Sciences, University «G. d'Annunzio», via deiVestini, 31, 66100, Chieti, Italy.
| | - Sonia M Bramanti
- Department of Psychological, Health and Territory Sciences, School of Medicine and Health Sciences, University «G. d'Annunzio», via deiVestini, 31, 66100, Chieti, Italy
| | - Lucia Lombardi
- Department of Psychological, Health and Territory Sciences, School of Medicine and Health Sciences, University «G. d'Annunzio», via deiVestini, 31, 66100, Chieti, Italy
| | - Liborio Stuppia
- Department of Psychological, Health and Territory Sciences, School of Medicine and Health Sciences, University «G. d'Annunzio», via deiVestini, 31, 66100, Chieti, Italy
| | - Carmen Trumello
- Department of Psychological, Health and Territory Sciences, School of Medicine and Health Sciences, University «G. d'Annunzio», via deiVestini, 31, 66100, Chieti, Italy
| | - Ivana Antonucci
- Department of Psychological, Health and Territory Sciences, School of Medicine and Health Sciences, University «G. d'Annunzio», via deiVestini, 31, 66100, Chieti, Italy
| | - Alessandra Cavallo
- Department of Psychological, Health and Territory Sciences, School of Medicine and Health Sciences, University «G. d'Annunzio», via deiVestini, 31, 66100, Chieti, Italy
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Rogers CE, Lean RE, Wheelock MD, Smyser CD. Aberrant structural and functional connectivity and neurodevelopmental impairment in preterm children. J Neurodev Disord 2018; 10:38. [PMID: 30541449 PMCID: PMC6291944 DOI: 10.1186/s11689-018-9253-x] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 11/14/2018] [Indexed: 12/15/2022] Open
Abstract
Background Despite advances in antenatal and neonatal care, preterm birth remains a leading cause of neurological disabilities in children. Infants born prematurely, particularly those delivered at the earliest gestational ages, commonly demonstrate increased rates of impairment across multiple neurodevelopmental domains. Indeed, the current literature establishes that preterm birth is a leading risk factor for cerebral palsy, is associated with executive function deficits, increases risk for impaired receptive and expressive language skills, and is linked with higher rates of co-occurring attention deficit hyperactivity disorder, anxiety, and autism spectrum disorders. These same infants also demonstrate elevated rates of aberrant cerebral structural and functional connectivity, with persistent changes evident across advanced magnetic resonance imaging modalities as early as the neonatal period. Emerging findings from cross-sectional and longitudinal investigations increasingly suggest that aberrant connectivity within key functional networks and white matter tracts may underlie the neurodevelopmental impairments common in this population. Main body This review begins by highlighting the elevated rates of neurodevelopmental disorders across domains in this clinical population, describes the patterns of aberrant structural and functional connectivity common in prematurely-born infants and children, and then reviews the increasingly established body of literature delineating the relationship between these brain abnormalities and adverse neurodevelopmental outcomes. We also detail important, typically understudied, clinical, and social variables that may influence these relationships among preterm children, including heritability and psychosocial risks. Conclusion Future work in this domain should continue to leverage longitudinal evaluations of preterm infants which include both neuroimaging and detailed serial neurodevelopmental assessments to further characterize relationships between imaging measures and impairment, information necessary for advancing our understanding of modifiable risk factors underlying these disorders and best practices for improving neurodevelopmental trajectories in this high-risk clinical population.
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Affiliation(s)
- Cynthia E Rogers
- Departments of Psychiatry and Pediatrics, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8504, St. Louis, MO, 63110, USA.
| | - Rachel E Lean
- Departments of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8504, St. Louis, MO, 63110, USA
| | - Muriah D Wheelock
- Departments of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8504, St. Louis, MO, 63110, USA
| | - Christopher D Smyser
- Departments of Neurology, Pediatrics and Mallinckrodt Institute of Radiology, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8111, St. Louis, MO, 63110, USA
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Gray PH, Edwards DM, Hughes IP, Pritchard M. Social-emotional development in very preterm infants during early infancy. Early Hum Dev 2018; 121:44-48. [PMID: 29775884 DOI: 10.1016/j.earlhumdev.2018.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 04/23/2018] [Accepted: 05/03/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Peter H Gray
- Growth and Development Unit, Mater Mothers' Hospital, South Brisbane, Queensland, Australia; Mater Research Institute, University of Queensland, South Brisbane, Queensland, Australia.
| | - Dawn M Edwards
- Growth and Development Unit, Mater Mothers' Hospital, South Brisbane, Queensland, Australia
| | - Ian P Hughes
- Mater Research Institute, University of Queensland, South Brisbane, Queensland, Australia.
| | - Margo Pritchard
- Mater Research Institute, University of Queensland, South Brisbane, Queensland, Australia; Australian Catholic University, Mater Health Services, South Brisbane, Queensland, Australia.
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Gärtner KA, Vetter VC, Schäferling M, Reuner G, Hertel S. Training of parental scaffolding in high-socio-economic status families: How do parents of full- and preterm-born toddlers benefit? BRITISH JOURNAL OF EDUCATIONAL PSYCHOLOGY 2018; 88:300-322. [PMID: 29603723 DOI: 10.1111/bjep.12218] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 11/06/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Preterm children have an increased risk regarding self-regulation development. Given the strong link between parenting behaviour (i.e., scaffolding and sensitivity) and children's self-regulation, parental training presents a promising way to counteract the negative consequences of preterm birth. AIMS We explored the effectiveness of parental training by comparing a basic scaffolding training and a combined scaffolding/sensitivity training to an active treatment-control group (stress management). Basic and combined treatments should increase parents' domain-specific self-efficacy (DSSE) and beliefs on parental co-regulation and the promotion of learning (BCL) more than the control treatment should. No such differences were expected for parents' domain-general self-efficacy (DGSE). We examined whether parents of preterm and full-term children benefitted equally from training conditions. SAMPLE(S) A total of 87 parents of full-term and 35 parents of preterm toddlers (24-36 months of age, corrected for prematurity) participated. METHODS Based on a quasi-experimental pre-test-post-test follow-up design, parents were randomly assigned to treatments. A multimethod approach was applied, including self-report, parent-child interactions, and standardized behavioural tasks. The presented study is limited to questionnaire data on parents' DGSE, DSSE, and BCL. RESULTS An overall increase resulted from pre- to post-test and/or follow-up. Parents' BCL changed significantly stronger in the combined training than in the control group. Parents of preterm and full-term children benefitted equally from basic and combined training. CONCLUSIONS The combined training enhanced BCL among parents of full-term and preterm children the most. If such training also yields improvement on the behavioural level, this finding will advance preterm aftercare.
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Affiliation(s)
| | - Verena Clara Vetter
- Clinic I, Division of Neuropediatrics and Metabolic Medicine, Centre for Pediatric and Adolescent Medicine, University Hospital Heidelberg, Germany
| | - Michaela Schäferling
- Clinic I, Division of Neuropediatrics and Metabolic Medicine, Centre for Pediatric and Adolescent Medicine, University Hospital Heidelberg, Germany
| | - Gitta Reuner
- Clinic I, Division of Neuropediatrics and Metabolic Medicine, Centre for Pediatric and Adolescent Medicine, University Hospital Heidelberg, Germany
| | - Silke Hertel
- Institute for Education Studies, Heidelberg University, Germany
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Matvienko-Sikar K, Murphy G, Murphy M. The role of prenatal, obstetric, and post-partum factors in the parenting stress of mothers and fathers of 9-month old infants. J Psychosom Obstet Gynaecol 2018. [PMID: 28635525 DOI: 10.1080/0167482x.2017.1286641] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION The aim of this paper was to examine the role of perinatal, obstetric and post partum factors on maternal and paternal stress. It will present the first examination of the role of prenatal, obstetric, post-partum, and demographic variables in parenting stress for mothers and fathers at 9 months. METHODS Data from 6821 parental dyads of 9-month-old infants were extracted from the Growing Up in Ireland National Longitudinal Study of Children. Participants completed the Parental Stress Scale, the Dyadic Adjustment Scale, the Quality of Attachment Sub-scale from the Maternal and Paternal Postnatal Attachment Scales, and a single item health status question from the Short Form 12 Health Survey. Information on prenatal care, pregnancy complications, obstetric outcomes, infant health, and participant demographics were also collected. Separate hierarchical linear regressions were conducted for mothers and fathers Results: Mothers reported higher levels of parenting stress than fathers (p < 0.001). Maternal parenting stress was predicted by attachment, own health status, average sleep, occupation, household income, and having a very rapid labor. Paternal parenting stress was predicted by attachment and own health status. DISCUSSION A range of perinatal factors was associated with an increased risk of higher parenting stress at 9 months post-partum and the roles of these factors differ between mothers and fathers. These findings are important for predicting and reducing risk of parenting stress in both genders.
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Affiliation(s)
| | - Gillian Murphy
- b School of Applied Psychology, University College Cork , Ireland
| | - Mike Murphy
- b School of Applied Psychology, University College Cork , Ireland
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Abstract
Objective To investigate the extent to which disabling infant health conditions are associated with adverse childhood experiences at age 5. Methods We conducted a secondary analysis of data from the Fragile Families and Child Wellbeing Study, a national urban birth cohort. We estimated logistic regression models of associations between the presence of a disabling infant health condition and the child's ACE exposures at age 5, controlling for factors that preceded the child's birth, including the mother's sociodemographic characteristics, physical health, mental illness, and substance abuse and the parents' criminal justice system involvement and domestic violence or sexual abuse. ACEs included 4 categories of child maltreatment (physical, sexual, psychological abuse, neglect) and 5 categories of household dysfunction (father absence, substance use, mental illness, caregiver treated violently, incarceration). Results 3.3% of the children were characterized as having a disabling health condition that was likely present at birth. Logistic regression estimates indicate that having a disabling infant health condition was associated with 83% higher odds of the child experiencing 2 or more ACEs (AOR 1.83, CI 1.14-2.94) and 73% higher odds of the child experiencing 3 or more ACEs (AOR 1.73, CI 1.07-2.77) at age 5. Conclusions for Practice The finding of strong links between disabling infant health conditions and ACEs at age 5 suggests that child health and ACEs play intertwining and mutually reinforcing roles during the early lifecourse and highlights the critical importance of investing in systems that simultaneously promote optimal child development and address childhood adversity.
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Affiliation(s)
- Nancy E Reichman
- Department of Pediatrics and Child Health Institute of New Jersey, Rutgers University-Robert Wood Johnson Medical School, 89 French St., Room 3272, New Brunswick, NJ, 08903, USA.
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
| | - Hope Corman
- Department of Finance and Economics, Rider University, 2083 Lawrenceville Rd., Lawrenceville, NJ, 08648, USA
- National Bureau of Economic Research, New York, NY, USA
| | - Kelly Noonan
- Department of Finance and Economics, Rider University, 2083 Lawrenceville Rd., Lawrenceville, NJ, 08648, USA
- National Bureau of Economic Research, New York, NY, USA
- Department of Economics, Princeton University, 222 Julis Romo Rabinowitz Building, Princeton, NJ, 08544, USA
| | - Manuel E Jiménez
- Department of Pediatrics, Boggs Center for Developmental Disabilities, Child Health Institute of New Jersey, and Department of Family Medicine, Rutgers University-Robert Wood Johnson Medical School, 89 French St., Room 3271, New Brunswick, NJ, 08903, USA
- Children's Specialized Hospital, New Brunswick, NJ, USA
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Pelc K, Gajewska A. Early intervention and environmental factors: optimizing the development of infants born preterm. Dev Med Child Neurol 2018; 60:7. [PMID: 29139547 DOI: 10.1111/dmcn.13626] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Karine Pelc
- Department of Paediatrics, CHU Saint-Pierre, Université libre de Bruxelles, Brussels, Belgium.,Department of Neurology, Hôpital Universitaire des Enfants Reine Fabiola, Université libre de Bruxelles, Brussels, Belgium
| | - Aleksandra Gajewska
- Department of Neurology, Hôpital Universitaire des Enfants Reine Fabiola, Université libre de Bruxelles, Brussels, Belgium
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Gray PH, Edwards DM, Gibbons K. Parenting stress trajectories in mothers of very preterm infants to 2 years. Arch Dis Child Fetal Neonatal Ed 2018; 103:F43-F48. [PMID: 28659361 DOI: 10.1136/archdischild-2016-312141] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 04/25/2017] [Accepted: 04/26/2017] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To examine levels of parenting stress in mothers of preterm and term infants when the children were 2 years old; to determine the trajectory of stress over three time periods and to examine the association of maternal and neonatal factors and developmental outcomes with parenting stress. DESIGN It is a prospective longitudinal study to determine parenting stress in mothers of preterm and term infants with outcomes having been previously obtained at 4 and 12 months. At 2 years, 79 preterm mothers (96 babies) and 64 term mothers (77 babies) participated. The mothers completed the Parenting Stress Index-Short Form (PSI-SF), the Depression, Anxiety, Stress Scale (DASS) and the Child Behaviour Checklist (CBCL). The infants had a neurological examination and the Bayley-III scales were administered. RESULTS The mean total PSI-SF at 2 years was significantly higher for the preterm group compared with the term group of mothers (p=0.007). There was a significant increase in the mean total PSI over time for the preterm mothers (p<0.001). For mothers at 2 years, there was an association with high levels of parenting stress and abnormal scores on the DASS (p<0.001) and high total T-scores on the CBCL (internalising p<0.001; externalising p=0.006). There was no association between parenting stress and maternal demographics, neonatal factors or Bayley-III results. CONCLUSIONS Parenting stress in mothers of preterm infants continues to be high at 2 years having increased over time. Maternal mental health problems and infant behavioural issues contribute to the stress.
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Affiliation(s)
- Peter H Gray
- Growth and Development Unit, Mater Mothers' Hospital, South Brisbane, Queensland, Australia.,Mothers, Babies and Women's Health Programme, Mater Research Institute-University of Queensland, South Brisbane, Queensland, Australia
| | - Dawn M Edwards
- Growth and Development Unit, Mater Mothers' Hospital, South Brisbane, Queensland, Australia
| | - Kristen Gibbons
- Mothers, Babies and Women's Health Programme, Mater Research Institute-University of Queensland, South Brisbane, Queensland, Australia
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Gatta M, Miscioscia M, Svanellini L, Peraro C, Simonelli A. A Psychological Perspective on Preterm Children: The Influence of Contextual Factors on Quality of Family Interactions. BIOMED RESEARCH INTERNATIONAL 2017; 2017:9152627. [PMID: 29159182 PMCID: PMC5660765 DOI: 10.1155/2017/9152627] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 08/14/2017] [Accepted: 08/21/2017] [Indexed: 11/29/2022]
Abstract
Preterm birth has a critical influence on interactive, communicative, and expressive child behaviour, particularly during the first years of life. Few studies have stressed the assessment of mother-father-child interaction in families with preterm children, generating contradictory results. The present study wished to develop these fields: (i) comparing the quality of family interactions between families with preterm children and families with children born at full term; (ii) observing the development of family interactions after six months in the families with children born preterm; (iii) assessing family and contextual factors, as parental stress and social support, in parents of preterm children in order to observe their influence on the quality of family interactions. 78 families are recruited: 39 families with preterm children (M = 19,8 months, SD = 11,05) and 39 families with full-term children (M = 19,66 months; SD = 13,10). Results show that families with preterm children display a low quality of mother-father-child interactions. After six months, family interactions result is generally stable, except for some LTP-scales reflecting a hard adjustment of parenting style to the evolution of the child. In families with preterm children, the parenting stress seemed to be correlated with the quality of mother-father-child interactions.
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Affiliation(s)
- Michela Gatta
- Childhood Adolescence Family Unit, ULSS6 Veneto, Padua, Italy
- Department of Women's and Children's Health, Padua University, Padua, Italy
| | - Marina Miscioscia
- Department of Women's and Children's Health, Padua University, Padua, Italy
- Department of Developmental and Social Psychology, Padua University, Padua, Italy
| | - Lorenza Svanellini
- Department of Women's and Children's Health, Padua University, Padua, Italy
| | - Chiara Peraro
- Department of Developmental and Social Psychology, Padua University, Padua, Italy
| | - Alessandra Simonelli
- Department of Developmental and Social Psychology, Padua University, Padua, Italy
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Gatta M, Miscioscia M, Svanellini L, Brianda ME, Guerra G, Battistella PA, Simonelli A. Triadic interactions in families with preterm children: a comparative study with children born at term. Neuropsychiatr Dis Treat 2017; 13:2375-2388. [PMID: 28979125 PMCID: PMC5602454 DOI: 10.2147/ndt.s129225] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The relationship between parents and infants born preterm is multifaceted and could present some relational patterns which are believed to predict psychological risk more than others. For example, insensitive parenting behavior has been shown to place very preterm children at greater risk of emotional and behavioral dysregulation. The main objective of this study was to compare the quality of family interactions in a sample of families with preterm children with one of the families with at-term children, exploring possible differences and similarities. The second aim of this research was to consider the associations among family interactions and parental empowerment, the child's temperament, parenting stress, and perceived social support. The sample consisted of 52 children and their families: 25 families, one with two preterm brothers with preterm children (mean 22.3 months, SD 12.17), and 26 families with children born at term (mean 22.2 months, SD 14.97). The Lausanne Trilogue Play procedure was administered to the two groups to assess the quality of their family interactions. The preterm group was also administered the Questionari Italiani del Temperamento, the Family Empowerment Scale, the Multidimensional Scale of Perceived Social Support, and the Parenting Stress Index - Short Form. Differences in the quality of family interactions emerged between the preterm and at-term groups. The preterm group showed significantly lower quality of family interactions than the at-term group. The parenting stress of both parents related to their parental empowerment, and maternal stress was also related to the partner's parental empowerment. Social support had a positive influence on parenting stress, with maternal stress also related to perceived social support from the partner, which underscores the protective role of the father on the dyad.
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Affiliation(s)
- Michela Gatta
- Childhood Adolescence Family Unit AULSS 6 Veneto
- Department of Women’s and Children’s Health
| | - Marina Miscioscia
- Department of Women’s and Children’s Health
- Department of Developmental Psychology and Socialization, University of Padova, Padova, Italy
| | | | - Maria Elena Brianda
- Department of Developmental Psychology and Socialization, University of Padova, Padova, Italy
| | - Giada Guerra
- Department of Developmental Psychology and Socialization, University of Padova, Padova, Italy
| | | | - Alessandra Simonelli
- Department of Developmental Psychology and Socialization, University of Padova, Padova, Italy
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Choi H, Shin Y. Predictors of Quality of Life in Mothers of Premature Infant. KOREAN JOURNAL OF WOMEN HEALTH NURSING 2017; 23:191-200. [PMID: 37684898 DOI: 10.4069/kjwhn.2017.23.3.191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 06/29/2017] [Accepted: 06/10/2017] [Indexed: 09/10/2023] Open
Abstract
PURPOSE The purpose of this study was to determine the factors that may affect quality of life of mothers who delivered premature infants. METHODS With survey design, data were collected from 145 mothers of premature infants with corrected age of 2 months to 12 months from January 9 to February 2, 2017. Quality of life was assessed with two measures of direct survey in the selected hospital and online survey. A self-report questionnaire was administered regarding personality of the mothers and the infants, postpartum depression, parenting stress, social support, and the quality of life. Data were analyzed using t-test, ANOVA, Pearson correlation coefficients, and multiple regression. RESULTS The quality of life of the mothers of the premature infants was influenced by postpartum depression, parenting stress, parents-infant dysfunctional interactions, and social support accounted for 65% of the variance. CONCLUSION These results indicate that early screening and continuous management of postpartum depression during postpartum period are important to improve the quality of life of the mothers of the premature infants. Education program and information and social support systems need to be developed to monitor mother-infant interaction and their role development.
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Affiliation(s)
- Hyosin Choi
- Department of Nursing, Daegu Health College, Daegu, Korea
| | - Yeonghee Shin
- Department of Nursing, Daegu Health College, Daegu, Korea
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