The impact of postpartum social support on postpartum mental health outcomes during the COVID-19 pandemic.

Social support is an influential component of postpartum recovery, adjustment, and bonding, which was disrupted by social distancing recommendations related to the COVID-19 pandemic. This study reports on changes in the availability of social support for postpartum women during the pandemic, investigates how those changes may have contributed to postpartum mental health, and probes how specific types of social support buffered against poor postpartum mental health and maternal-infant bonding impairment. Participants were 833 pregnant patients receiving prenatal care in an urban USA setting and using an electronic patient portal to access self-report surveys at two time points, during pregnancy (April-July 2020) and at ~12 weeks postpartum (August 2020-March 2021). Measures included an assessment of COVID-19 pandemic-related change in social support, sources of social support, ratings of emotional and practical support, and postpartum outcomes including depression, anxiety, and maternal-infant bonding. Overall self-reported social support decreased during the pandemic. Decreased social support was associated with an increased risk of postpartum depression, postpartum anxiety, and impaired parent-infant bonding. Among women reporting low practical support, emotional support appeared to protect against clinically significant depressive symptoms and impaired bonding with the infant. Decreases in social support are associated with a risk for poor postpartum mental health outcomes and impaired maternal-infant bonding. Evaluation and promotion of social support are recommended for healthy adjustment and functioning of postpartum women and families.

Maternal pandemic-related stress during pregnancy associates with infants' socio-cognitive development at 12 months: A longitudinal multi-centric study.

BACKGROUND: Prenatal maternal stress is a key risk factor for infants' development. Previous research has highlighted consequences for infants' socio-emotional and cognitive outcomes, but less is known for what regards socio-cognitive development. In this study, we report on the effects of maternal prenatal stress related to the COVID-19 pandemic on 12-month-old infants' behavioral markers of socio-cognitive development. METHODS: Ninety infants and their mothers provided complete longitudinal data from birth to 12 months. At birth, mothers reported on pandemic-related stress during pregnancy. At infants' 12-month-age, a remote mother-infant interaction was videotaped: after an initial 2-min face-to-face episode, the experimenter remotely played a series of four auditory stimuli (2 human and 2 non-human sounds). The auditory stimuli sequence was counterbalanced among participants and each sound was repeated three times every 10 seconds (Exposure, 30 seconds) while mothers were instructed not to interact with their infants and to display a neutral still-face expression. Infants' orienting, communication, and pointing toward the auditory source was coded micro-analytically and a socio-cognitive score (SCS) was obtained by means of a principal component analysis. RESULTS: Infants equally oriented to human and non-human auditory stimuli. All infants oriented toward the sound during the Exposure episode, 80% exhibited any communication directed to the auditory source, and 48% showed at least one pointing toward the sound. Mothers who reported greater prenatal pandemic-related stress had infants with higher probability of showing no communication, t = 2.14 (p = .035), or pointing, t = 1.93 (p = .057). A significant and negative linear association was found between maternal prenatal pandemic-related stress and infants' SCS at 12 months, R2 = .07 (p = .010), while adjusting for potential confounders. CONCLUSIONS: This study suggests that prenatal maternal stress during the COVID-19 pandemic might have increased the risk of an altered socio-cognitive development in infants as assessed through an observational paradigm at 12 months. Special preventive attention should be devoted to infants born during the pandemic.

[Traumatic motherhood in Covid-19 times]. / Maternités traumatiques en temps de Covid-19.

In the context of maternal vital emergency due to Covid-19, dire situations of birth questioned the health practitioners of a neonatal intensive care unit. How can mothers take care of their baby when their own life has been threatened ? The analysis of two clinical cases underlines the importance of talking for these mothers who have been through disastrous experiences, which could lead to a post-traumatic stress disorder. Restoring a connection to outside reality thanks to psychological care in the acute post-trauma period helps these mothers take care of their child.

Depression, Anxiety, and Mother-Infant Bonding in Women Seeking Treatment for Postpartum Depression Before and During the COVID-19 Pandemic.

Objective: The conditions created by the COVID-19 pandemic could negatively affect maternal mental health and the mother-infant relationship. The aim of this study is to determine the impact of the COVID-19 pandemic on depression, anxiety, and mother-infant bonding among women seeking treatment for postpartum depression (PPD).Methods: Baseline data collected in two separate randomized controlled trials of a psychoeducational intervention for PPD in the same geographic region, one prior to COVID-19 (March 2019-March 2020) and one during the COVID-19 pandemic (April-October 2020), were compared. Eligible participants had an Edinburgh Postnatal Depression Scale (EPDS) score of ≥ 10, were ≥ 18 years of age, had an infant < 12 months old, and were fluent in English. Outcomes included PPD (EPDS), anxiety (Generalized Anxiety Disorder-7 [GAD-7]), and mother-infant relationship (Postpartum Bonding Questionnaire [PBQ]). All were measured continuously and dichotomized at accepted clinical cutoffs.Results: Of the 603 participants (305 pre-COVID-19; 298 during COVID-19), mothers enrolled during the COVID-19 pandemic reported higher levels of symptoms of PPD (B = 1.35; 95% CI, 0.64 to 2.06; Cohen d = 0.31) and anxiety (B = 1.52; 95% CI, 0.72 to 2.32; Cohen d = 0.30). During COVID-19, women had 65% higher odds of clinically significant levels of depression symptoms (OR = 1.65; 95% CI, 1.13 to 2.31) and 46% higher odds of clinically relevant anxiety symptoms (OR = 1.46; 95% CI, 1.05 to 2.05). However, there were no statistically significant differences in mother-infant bonding.Conclusions: The findings of this study suggest that rates and severity of PPD and anxiety symptoms among women seeking treatment for PPD have worsened in Canada during the COVID-19 pandemic. However, treatment-seeking mothers have consistently maintained good relationships with their infants. Considering the difficulties women with PPD face when accessing treatment, it is important that strategies are developed and disseminated to safely identify and manage PPD to mitigate potential long-term adverse consequences for mothers and their families.Trial Registration: ClinicalTrials.gov identifiers: NCT03654261 and NCT04485000.

Depression in Early Childhood.

According to data from the WHO, the COVID-19 pandemic has created an increase in anxiety and depression around the world. In particular, there has been an increase in Depressive Disorder in childhood: the closure of childcare centers has caused great stress in parents, especially in mothers who have developed more depressive disorders. Maternal depression appears to have created problematic behaviors in preschool children. This phenomenon is explained by several studies that over the years have shown that a good mother-child interaction is essential for the child's psychophysical health and that interactions with depressed mothers have caused depression in children already in early childhood. The purpose of this work is a review of the scientific literature, from 1927 to 2022, on depression in early childhood, from 0 to 5 years of age. Research has been carried out on Medline PubMed, Google Scholar and specialist scientific journals of psychiatry, psychology and child neuropsychiatry, using the following keywords: infant depression, anaclitic depression, hospitalism, early chilhood depression, depressive position, attachement and mother-infant dyad. The depressive illness of the mother, the lack of care, attention and stimulation to the vocalizations of the young child can induce negative reactions in the relationship between mother and child. Early identification and treatment of perinatal depression is critical to ensuring the child's optimal development and future mental health. In addition to maternal depression there are also other factors that can generate depression in the child as well as a prolonged separation from her. The authors' conclusions are that it is essential to train and inform educators and family members on depression in childhood to allow for the recognition of the child's suffering and for it to be examined by the doctor. It is important an early intervention both on the family and on the child to avoid relapses, chronicity and any serious damage.

Effect of the Covid 19 pandemic on depression and mother-infant bonding in uninfected postpartum women in a rural region.

BACKGROUND: Postpartum depression and maternal-infant attachment scores were examined in uninfected women during the COVID 19 pandemic in Kutahya, a rural province in Turkey's North Aegean region. METHODS: This cohort study was conducted in the Kutahya Health Sciences University Hospital obstetrics unit between April 2021 and August 2021. 178 low-risk term pregnant women who gave birth were given the surveys Edinburgh Postpartum Depression Scale and Mother-to-Infant Bonding Scale (MIBQ) 6 weeks after birth. The Edinburgh Postpartum Depression Scale was used to determine postpartum depression and the Mother-to-Infant Bonding Scale was used to determine maternal attachment. RESULTS: In this study, the postpartum depression rate was calculated as 17.4%. When depressed and non-depressed patients were compared, education level, maternal age, BMI, MIBQ score, history of previous pregnancies, route of delivery, previous operation history, economic status, employment status and pregnancy follow-up information were found to be similar (p > 0.05). The ratings on the Mother-to-Infant Bonding Scale were found to be similar in depressed and non-depressed patients (p > 0.05). The odds of maternal depression for patients who received guests at home was 3.068 (95%CI [1.149-8.191]) times the odds of patients who did not receive guests at home. CONCLUSIONS: Although a relationship has been found between accepting guests in the postpartum period and postpartum depression, it is necessary to investigate in further studies whether there is a causal relationship.

COVID-19 related worry moderates the association between postpartum depression and mother-infant bonding.

The aim of this study was to ask whether a substantial external stressor, such as the COVID-19 pandemic, affects the association between postpartum depression (PPD) and mother-infant bonding. Specifically, we aimed to determine whether worry regarding such an external threat differentially affected PPD and bonding by analyzing a longitudinal sample of postpartum women assessed before and during the pandemic. One-hundred forty women responded to online questionnaires at (T1) Pre-COVID-19: Six months postpartum (February 2018 to December 2019), and (T2) During COVID-19: Twenty-one months postpartum (April 2020 to January 2021). The strength of correlation between mother-infant bonding and PPD significantly declined from before (T1: R = 0.64, p < 0.00) to during the pandemic (T2: R = 0.44, p < 0.001; Difference = 0.20, p = 0.05). Furthermore, only PPD correlated with the worry due to the pandemic; thus the PPD-bonding association was weaker among women who were less concerned about the pandemic (F(3, 136) = 15.4, R2 = 0.25). The study suggests that emotions and cognitions related to motherhood, such as mother-infant bonding, may be more resilient to external pressures such as a pandemic than affective states such as PPD. (174 words).

Resilience in mothers during the COVID-19 pandemic.

The coronavirus disease (COVID-19) pandemic has brought immense psychological pressure and disruptions to daily life for all individuals, and particularly children, parents, and families. Despite these difficulties, parents are able to show resilience through adaptive coping and positive parenting behaviors. Although there is robust research on resilience in children, very little research has tested predictors of parental resilience. The present study presents descriptive information about mothers' pandemic-related stressors and positive changes and then tests whether prepandemic maternal well-being and child effortful control predicted mothers' resilient parental outcomes (positive behavior and coping) through the mediators of maternal self-compassion, adherence to family routines, and child coping. The sample comprised 95 mothers (95.38% European American, 3.2% African American, and 1.1% Asian American) with a mean age of 38.21 years (SD = 5.71 years, Range = 25.72-51.60 years) and education ranging from a high school to an advanced degree (M = 16.26 years, SD = 2.28 years, Range = 12-21 years). Results revealed that prepandemic maternal well-being predicted adaptive coping both directly and indirectly through self-compassion. Children's effortful control predicted maternal adaptive coping indirectly through children's own adaptive coping, and predicted mothers' positive parenting behaviors directly. Posthoc models revealed adherence to routines to be a correlate and outcome, rather than predictor, of positive parenting and bidirectional relations between parent and child coping. This study provides evidence for parent, child, and family-level factors related to parental resilience during the COVID-19 pandemic. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Child internalizing symptoms during the COVID-19 pandemic among maltreating and non-maltreating families: Examining the effects of family resources and the Reminiscing and Emotion Training intervention.

BACKGROUND: The effects of the COVID-19 pandemic on child functioning have been especially pronounced among low-income families. Protective factors, including sensitive reminiscing and sufficient family resources, may reduce the negative effects of the pandemic on child adjustment. OBJECTIVE: The current study investigated how family resources during the pandemic, race, maltreatment, and pre-pandemic involvement in an emotion socialization intervention (Myears ago = 4.37, SD = 1.36) were associated with child internalizing symptoms during the pandemic. PARTICIPANTS AND SETTING: The study utilized longitudinal data following 137 maltreating and low-income nonmaltreating mother-child dyads (Mage = 9.08, SD = 1.88; 54.7% Male). METHODS: Mother-child dyads engaged in a randomized controlled trial of the Reminiscing and Emotion Training (RET; Valentino et al., 2019) intervention prior to the pandemic. Dyads discussed shared, past emotional experiences, and during the pandemic, mothers reported on their family resources and their child's internalizing symptoms. A path analysis examined the effects of family resources, race, maltreatment, and the RET intervention on child internalizing symptoms. RESULTS: Family resources during the pandemic were significantly and inversely associated with child internalizing symptoms, b = -0.07, SE = 0.02, p < .01. There was a significant indirect effect of RET on child internalizing symptoms through sensitive reminiscing and a prior assessment of child maladjustment (95% CI [-0.294, -0.001]). CONCLUSIONS: These findings suggest adequate family resources and sensitive maternal emotion socialization may be protective against child internalizing symptoms during the pandemic.

Skin-to-Skin Contact (Kangaroo Care) During the COVID-19 Pandemic.

Early recommendations to separate mothers from their newborns during the coronavirus disease 2019 (COVID-19) pandemic have created a detrimental separation practice. This article presents a review of the latest information regarding the (1) 3 modes of transmission of the virus to the neonate; (2) incidence, clinical signs, and severity of COVID-19 in the neonate; (3) factors to be considered to balance risk and benefits of separation and skin-to-skin contact (SSC) when conducting shared decision making; and (4) compendium of published SSC guidelines; and concludes with recommendations for safe practice of SSC to prevent and/or restrict COVID-19 infection in neonates.

COVID-19 and the NICU: #Zeroseparation.

COVID-19's first wave created chaos for new NICU families as they struggled to cope with the challenge of a fragile infant along with a pandemic. Safety was paramount due to a lack of understanding around how the virus transmits, but much has been learned since then. The next wave of the virus needs to have a rethink around family separation. World leader organization European Foundation for the Care of Newborn Infants (EFCNI) provides insight into the challenges with the first wave and suggests ideas around rethinking how families interact with their baby in the subsequent waves.

Adult daughters' emotional response to COVID-19: the role of worry, solidarity, conflict, and ambivalence in the relationship with the mother.

Objectives: Older adults' greater susceptibility to mortality from COVID-19 may have meaningful psychological implications not only for them, but also for their children. In this study, we focused on daughters of older women and examined the intergenerational relationships as a correlate of daughters' anxiety, depressive symptoms, and psychosomatic complaints.Method: Data were collected from 456 daughters of older mothers (M(age) = 40.82) during the first wave of the COVID-19 outbreak in Israel, when a relatively strict lockdown was enforced, separating mothers and daughters.Results: Findings suggest that while mothers' objective risk factors (age and morbidity) were mostly not associated with their daughters' distress, the daughters' concern about their mothers, and their perceived ambivalence in the relationship with the mother, as well as structural and affectual solidarity, were.Conclusion: We conclude that the mother-daughter relationship is an important correlate of daughters' reactions to this health crisis. Practically, it suggests that some daughters to aging mothers could be at a greater risk for emotional distress following the COVID-19 outbreak.

Postpartum during COVID-19 pandemic: Portuguese mothers' mental health, mindful parenting, and mother-infant bonding.

BACKGROUND: Millions of people worldwide have been diagnosed with coronavirus disease 2019 (COVID-19), which has impacted maternal mental health and mother-infant relationships during the postpartum period. OBJECTIVES: To explore how mothers' anxious and depressive symptoms, parenting stress, mindful parenting, and mother-infant bonding vary as a function of the moment of the baby's birth (pre-COVID-19 or post-COVID-19) and to examine the contribution of those variables to mother-infant bonding. METHODS: The sample was recruited online and comprises 567 mothers (18-46 years) with an infant aged between 0 and 12 months old. RESULTS: Approximately 27.5% of the mothers presented clinically significant levels of anxious and depressive symptoms. Mothers who gave birth during the COVID-19 pandemic presented lower levels of Emotional Awareness of the Child and a more impaired mother-infant bonding than mothers who gave birth before the pandemic started. Approximately 49% of the mother-infant bonding variance was explained by parenting stress and by several dimensions of mindful parenting. CONCLUSION: Our findings provide important insights into the impact of COVID-19 on maternal mental health and parenting.

When separation is not the answer: Breastfeeding mothers and infants affected by COVID-19.

The World Health Organization (WHO) has provided detailed guidance on the care of infants of women who are persons under investigation (PUI) or confirmed to have COVID-19. The guidance supports immediate post-partum mother-infant contact and breastfeeding with appropriate respiratory precautions. Although many countries have followed WHO guidance, others have implemented infection prevention and control (IPC) policies that impose varying levels of post-partum separation and discourage or prohibit breastfeeding or provision of expressed breast milk. These policies aim to protect infants from the potential harm of infection from their mothers, yet they may fail to fully account for the impact of separation. Global COVID-19 data are suggestive of potentially lower susceptibility and a typically milder course of disease among children, although the potential for severe disease in infancy remains. Separation causes cumulative harms, including disrupting breastfeeding and limiting its protection against infectious disease, which has disproportionate impacts on vulnerable infants. Separation also presumes the replaceability of breastfeeding-a risk that is magnified in emergencies. Moreover, separation does not ensure lower viral exposure during hospitalizations and post-discharge, and contributes to the burden on overwhelmed health systems. Finally, separation magnifies maternal health consequences of insufficient breastfeeding and compounds trauma in communities who have experienced long-standing inequities and violence, including family separation. Taken together, separating PUI/confirmed SARS-CoV-2-positive mothers and their infants may lead to excess preventable illnesses and deaths among infants and women around the world. Health services must consider the short-andlong-term impacts of separating mothers and infants in their policies.