Trauma History Questionnaire: validation with novel samples of incarcerated women and perinatal women.

Trauma exposure is associated with numerous negative outcomes, many of which are amplified within at-risk populations. Two under-researched and at-risk populations, incarcerated women and perinatal women, both report high rates of trauma, psychopathology, and PTSD compared to the general population. One common measure of trauma exposure in various populations, including incarcerated women and perinatal women, is the Trauma History Questionnaire (THQ). However, no known studies have validated the THQ within these two unique, understudied populations. Using data from two studies of incarcerated women and one study of perinatal women, researchers explored indices of THQ construct, predictive, and convergent validity. The study also included between-sample comparisons, highlighting differences in trauma incidence between the included samples. Analyses supported statistically significant relations between THQ scores and Severity of Violence Against Women Scale (SVAWS), depressive symptoms, PTSD, and psychological distress. Prenatal women's THQ scores were also predictive of later postpartum depressive symptoms. Significantly higher THQ scores were found within the incarcerated samples compared to the perinatal sample. The study results provide further information about trauma within incarcerated and perinatal populations, as well as increase understanding of the utility of trauma assessments within these vulnerable groups.

Associations among Maternal Trauma History, Postnatal Maternal Sensitivity, and Infant Temperament.

Women are at increased risk of trauma exposure and of experiencing prolonged posttraumatic stress. Maternal trauma exposure and associated impairment may adversely impact mother-infant interaction quality, which may in turn be associated with infant temperament difficulties. More research is needed to identify which maternal trauma predictors are most robustly related to infant temperament outcomes. The present study aimed to address this gap by examining maternal sensitivity as a mediator of relations between maternal trauma and infant temperament in a longitudinal study of a rural cohort of mother-infant dyads. Mediation via maternal sensitivity was not supported in any of the primary analyses. Greater maternal trauma exposure was found to predict greater infant regulation behavior, a finding that was in opposition to expected results and which may be explained by protective factors found within the sample. The present sample was skewed toward married, educated women who reported high social support satisfaction and low trauma-associated impairment. The findings elucidate protective factors that may mitigate adverse outcomes for both mothers and infants. Future research models should include additional maternal trauma variables (e.g., recency, type, revictimization/polyvictimization), in utero maternal cortisol exposure, maternal insensitivity/ambiguous response patterns during caregiver tasks, and analysis of the IBQ-R subscales.

Socioeconomic resources moderate the relationship between maternal prenatal obsessive-compulsive symptoms and infant negative affectivity.

Perinatal maternal depression, anxiety, and stress are associated with poor infant outcomes. However, no known study has investigated the effects of perinatal maternal obsessive-compulsive symptomatology on infant outcomes while considering important situational factors such as socioeconomic resources. Therefore, we investigated the effects of prenatal and postnatal obsessive-compulsive symptomatology on infant behavioral reactivity, beyond the effects of postnatal depressive symptomatology, at 6 months of age. It was expected that socioeconomic resources would moderate this relationship. We recruited 125 pregnant women from a Health Professional Shortage Area for mental health and primary care in the Midwest United States and interviewed them at approximately 34 weeks gestation and again at 6 months postnatally. They were administered questionnaires at both time points measuring obsessive-compulsive and depressive symptoms. Infant behavioral reactivity was gathered during 6-month follow-up through behavioral observation coding and maternal-report modalities. Maternal-reported infant negative affectivity at 6 months was related to greater severity of maternal postnatal depressive symptomatology, and socioeconomic resources moderated the relationship between maternal prenatal obsessive-compulsive symptoms and maternal-reported infant negative affectivity. However, neither of these relations was statistically significant when infant reactivity was quantified using behavioral observations.

Prenatal depression moderates the relationship between maternal trauma exposure and cortisol production and predicts breastfeeding behavior.

Trauma exposure is associated with many negative outcomes for women during the prenatal and postnatal periods, including increased antenatal depressive symptomatology and dysregulation of the body's stress responses. Trauma exposure and its consequences are also tied to women's ability to breastfeed, a crucial component in maternal and infant health. Cortisol is biologically relevant to the breastfeeding process, and is also associated with depressive symptoms, which may interfere with women's ability to successfully maintain breastfeeding. However, no known studies integrate prenatal cortisol and depressive symptom severity into models of relations between trauma exposure and breastfeeding, particularly while considering trauma timing and type. Therefore, the current study did so using data from a historically understudied sample. Data were drawn from a community sample of 96 women residing in a health professional shortage area for mental health and primary care. Participants provided data during their third trimester of pregnancy and 6 months postpartum. Three moderated mediation models were tested to explore relations among history of trauma, breastfeeding, and related variables. Increased prenatal depressive symptoms were related to elevated prenatal cortisol awakening response, as well as moderated the relationship between interpersonal trauma exposure and greater prenatal cortisol awakening response. A significant positive correlation was also found between trauma and prenatal depressive symptoms, as well as a significant negative correlation between prenatal depressive symptoms and breastfeeding frequency. Results suggest that subclinical prenatal depressive symptoms may interact with trauma symptoms to affect women's stress responses and breastfeeding behaviors, and that women at risk for breastfeeding difficulty may be identified prenatally.

Placenta DNA methylation levels of the promoter region of the leptin receptor gene are associated with infant cortisol.

The intrauterine environment and early life stress regulation are widely recognized as an early foundation for lifelong physical and mental health. Methylation of CpG sites in the placenta represents an epigenetic modification that can potentially affect placental function, influence fetal development, and ultimately impact the health of offspring by programming the hypothalamic-pituitary-adrenal (HPA) axis stress response during prenatal development. Leptin, an adipokine produced by the placenta, is essential for energy homeostasis. It is also epigenetically regulated by promoter DNA methylation. Mounting evidence suggests that leptin also affects the stress response system. Though heterogeneity in the early stress response system may influence life-long mental and physical health, few studies explicitly examine the heterogeneity in the newborn stress response system. Less is known about leptin's association with the human hypothalamic-pituitary-adrenocortical (HPA) axis early in life. This study sought to serve as a proof of concept study investigating the relationship between newborn cortisol output trajectories and placental leptin DNA methylation in 117 healthy newborns from socioeconomically and racially- and ethnically-diverse families. We characterized heterogeneity in newborn cortisol output during the NICU Network Neurobehavioral Scales exam in the first week of life with latent growth mixture models. We then evaluated whether leptin promoter (LEP) methylation in placental samples was associated with newborn cortisol trajectories. Our findings suggest that increased placental LEP methylation, which corresponds to decreased leptin production, is associated with infant cortisol trajectories marked by increased cortisol output in the NNNS exam. These results provide important insights into the role of placental leptin DNA methylation in human newborn HPA axis development and subsequent developmental origins of health and disease processes.

Maternal prenatal cortisol and the interaction of income and pre-pregnancy body mass index are independently associated with newborn cortisol.

While extensive research has supported the developmental programming hypothesis regarding contributions of prenatal psychosocial or nutritional adversity to offspring stress physiology, fewer studies consider both exposures together with maternal stress physiology. This study examined newborn cortisol output during a stressor as a function of maternal pre-pregnancy health status and nutritional history (pre-pregnancy body mass index [PPBMI]), economic resources (household income), and maternal cortisol awakening response (mCAR) in late pregnancy. Participants were 102 mother-infant pairs from an economically and racial/ethnically diverse sample. Offspring salivary cortisol response to a neurobehavioral exam was assessed at 1 month. Income and maternal PPBMI were positively associated with mCAR in late pregnancy. mCAR was positively related to 1-month newborn cortisol response. The interaction of income and PPBMI was positively associated with newborn cortisol output during an exam at 1-month. Mothers with the highest PPBMI and lowest income had offspring with higher cortisol responses than offspring of mothers with higher income and lower PPBMI. There was no evidence of indirect mediation effects of predictors (PPBMI, income, and interaction) on infant cortisol via mCAR. The differential effects of the interaction of PPBMI and income suggest that these exposures influence infant cortisol output in the context of one another, independent of maternal pregnancy cortisol.

Proteasome activity modulates amyloid toxicity.

Alzheimer's disease (AD) is responsible for 60%-80% of identified cases of dementia. While the generation and accumulation of amyloid precursor protein (APP) fragments is accepted as a key step in AD pathogenesis, the precise role of these fragments remains poorly understood. To overcome this deficit, we induced the expression of the soluble C-terminal fragment of APP (C99), the rate-limiting peptide for the generation of amyloid fragments, in yeast that contain thermosensitive mutations in genes encoding proteasome subunits. Our previous work with this system demonstrated that these proteasome-deficient yeast cells, expressing C99 when proteasome activity was blunted, generated amyloid fragments similar to those observed in AD patients. We now report the phenotypic repercussions of inducing C99 expression in proteasome-deficient cells. We show increased levels of protein aggregates, cellular stress and chaperone expression, electron-dense accumulations in the nuclear envelope/ER, abnormal DNA condensation, and an induction of apoptosis. Taken together, these findings suggest that the generation of C99 and its associated fragments in yeast cells with compromised proteasomal activity results in phenotypes that may be relevant to the neuropathological processes observed in AD patients. These data also suggest that this yeast model should be useful for testing therapeutics that target AD-associated amyloid, since it allows for the assessment of the reversal of the perturbed cellular physiology observed when degradation pathways are dysfunctional.

Diet Quality and Mental Health Status among Division 1 Female Collegiate Athletes during the COVID-19 Pandemic.

The International Olympic Committee has identified mental health as a priority that significantly affects the physical health and safety of collegiate athletes. Interventions that improve diet quality have been shown to improve mental health in several populations. However, studies are needed to examine this relationship in female collegiate athletes, who have elevated risk of experiencing anxiety and depression symptoms, as well as dietary insufficiencies. In a quantitative, cross-sectional study, female student athletes at a U.S. university completed three mental health questionnaires: Depression Anxiety and Stress Scale (DASS-21), Athlete Psychological Strain Questionnaire (APSQ), and COVID Stress Scales (CSS). Each female athlete also completed a validated, web-based Diet History Questionnaire (DHQ-III) resulting in a Healthy Eating Index (HEI). Seventy-seven participants completed all survey information. HEI scores were consistently higher for athletes with poorer mental health. HEI scores were significantly positively associated with stress (p = 0.015), performance concerns (p = 0.048), CSS components of danger (p = 0.007), contamination (p = 0.006), and traumatic stress (p = 0.003). Although findings support statistically significant associations among dietary quality and mental health indicators, including broad symptom severity or stressors specific to athletics or COVID-19, these associations were in the opposite direction hypothesized. Possible reasons for results and suggestions for future research are discussed.

Perinatal Maternal Mental Health and Breastfeeding Are Associated with Infant and Toddler Sensory Profiles.

Infants' sensory processing may impact their development and daily functioning in multiple domains, as does the mental health of their mothers. Little research has been conducted exploring the novel construct of sensory processing in relation to maternal mental health and arguably one of the most important co-occupations during this sensitive time (i.e., breastfeeding), which may also be impacted by maternal mental health. Therefore, this study aims to explore associations between maternal mental health, the co-occupation of breastfeeding, and the sensory processing profiles of infants. Specifically, a sample of maternal-offspring dyads was examined from pre-gestation through the infant's age of 18 months. Mothers completed well-validated and contemporary self-report questionnaires of mental health (i.e., depression and anxiety symptom severity) and sensory processing across time points. Findings yielded statistically significant relationships between maternal prenatal and postnatal anxiety and depression symptom severity and infants' sensory processing profiles. Further connections were found between infants' sensory processing profiles and both duration and frequency of breastfeeding. The study provides health care professionals with additional perspectives on how maternal mental health status and breastfeeding may be related to infants' sensory processing profiles.

Maternal Prenatal Cortisol and Breastfeeding Predict Infant Growth.

Fetal/infant growth affects adult obesity and morbidities/mortality and has been associated with prenatal exposure to cortisol. Bidirectional relations between maternal stress and breastfeeding suggest that they interact to influence offspring growth. No models have tested this hypothesis, particularly regarding longer-term offspring outcomes. We used a subset of the IDAHO Mom Study (n = 19-95) to examine associations among maternal prenatal cortisol (cortisol awakening response (CAR) and area under the curve), and standardized weight-for-length (WLZ) and length-for-age (LAZ) z-scores from birth-18 months, and main and interactive effects of prenatal cortisol and breastfeeding on infant growth from birth-6 months. CAR was negatively associated with LAZ at birth (r = -0.247, p = 0.039) but positively associated at 13-14 months (r = 0.378, p = 0.033), suggesting infant catch-up growth with lower birth weights, likely related to elevated cortisol exposure, continues beyond early infancy. A negative correlation between breastfeeding and 10-month WLZ (r = -0.344, p = 0.037) and LAZ (r = -0.468, p = 0.005) suggests that breastfeeding assists in managing infant growth. WLZ and LAZ increased from birth to 6 months (ps < 0.01), though this was unrelated to interactions between prenatal cortisol and breastfeeding (i.e., no significant moderation), suggesting that other factors played a role, which should be further investigated. Findings add to our understanding of the predictors of infant growth.

A Cohort Study of Relations Among Caregiver-Infant Co-Occupation and Reciprocity.

Co-occupation is the mutual engagement of two people in a shared occupation. Recent research has investigated co-occupational activities during sensitive periods to inform clinical practice. However, there remains a dearth of applied research to bridge gaps between research and practice within salient co-occupational relationships between caregivers and infants. The study applied co-occupational constructs of physicality, emotionality, and intentionality within caregiver-infant dyads across infancy. These constructs were examined in relation to caregiver-infant reciprocity in other domains (i.e., language, motor, and affective) to determine the overlapping features of reciprocal co-occupation with established aspects of reciprocity. Results suggest that as infants transitioned into toddlerhood and became more mobile and intentional in behavior, there were observable changes in caregiver-infant reciprocity. Caregiver utterances, affect, touch, and co-occupation were significantly related within and across time, highlighting the need for more studies to disentangle these relations in reference to infant development.

Hepatitis C Treatment Cascade in a Federally Qualified Health Center.

Hepatitis C (HCV) care cascades have been described in diverse clinical settings, patient populations and countries, highlighting the steps in HCV care where improvements can be made and resources allocated. However, more research is needed to examine barriers to HCV treatment in rural, underserved populations and in Federally Qualified Health Centers (FQHCs). As part of a quality improvement (QI) project, this study aimed to describe and evaluate the HCV treatment cascade in an FQHC serving a large rural patient population in the Western United States. Standardized chart abstraction was utilized to aggregate data regarding patient demographics, the percentage of patients achieving each step in the treatment cascade, and relevant patient (i.e., viral load) and service variables (i.e., whether and when patients received treatment or medication). 389 patients were identified as having HCV and 86% were aware of their diagnosis. Fifty-five percent had their infection confirmed via viral load, 21% were staged for liver disease, 24% received a prescription for treatment, and 19% achieved cure. Compared to national data, the current regional sample had greater rates of diagnosis awareness and access to care, as well as sustained virologic response (SVR), but lower rates of viral load confirmation. Current findings suggest that rural patients living with HCV who receive care at FQHCs struggle to navigate the treatment cascade and achieve a cure, particularly with regard to infection confirmation, liver staging, and prescription. However, compared to national estimates, patients had greater rates of diagnosis awareness/treatment access and SVR.

A Moderated Mediation Model of Maternal Perinatal Stress, Anxiety, Infant Perceptions and Breastfeeding.

This study examined a moderated mediation model of relations among maternal perinatal stress/anxiety, breastfeeding difficulties (mediator), misperceptions of infant crying (moderator), and maternal breastfeeding duration to understand risk factors for early breastfeeding termination. It was hypothesized that more breastfeeding difficulties would mediate the relation between greater prenatal stress/anxiety and shorter breastfeeding duration, and that perceptions of response to infant crying as spoiling would moderate the relation between more breastfeeding difficulties and reduced breastfeeding duration. Additionally, it was hypothesized that participants who breastfed through 6 months would demonstrate less postnatal stress/anxiety and there would be a positive relation between fewer breastfeeding difficulties and less postnatal stress/anxiety through 6 months. Participants included 94 expectant mothers at 33-37 weeks gestation and 6 months (±2 weeks) postpartum. Greater prenatal anxiety was associated with shorter breastfeeding duration. Results presented are the first to document negative relations between prenatal (as opposed to postnatal) anxiety and breastfeeding duration (as opposed to frequency or other indicators) in a U.S. sample. Future studies should seek to replicate findings in a more diverse sample and compare findings from clinical and non-clinical samples. Studies may also wish to explore the effects of anxiety prevention/intervention on breastfeeding duration.

The Reciprocity Team: Development of an Interprofessional Research Collaboration.

The purpose of this article is to articulate and provide detail about an interprofessional research collaboration at a public university in a rural area of western United States. This interprofessional research collaboration was organized to explore infant and maternal reciprocity. As a part of the organization and process portion of the collaborative effort, the authors identify the unique attributes of their collaboration. Additionally, barriers to collaborative research are presented, with opportunities and recommendations made to support existing and future interprofessional collaborative efforts for basic science scholars, clinicians, and educators in health-related professions.

Multiple Biomarkers of Maternal Iron Predict Infant Cognitive Outcomes.

This study examined relations between multiple measures of maternal iron status assessed 3 months post-partum, and infant processing speed (longest look during visual habituation), memory (novelty preference), attention (heart rate changes), and neural response variability (in auditory event-related potentials) at 3 and 9 months. Plasma iron was associated with 9-month novelty preference and longest look, and developmental changes in longest look. Hemoglobin predicted sustained attention, and both plasma iron and soluble transferrin receptors predicted neural response variability at 9 months. Improved maternal iron appears to have a positive impact on infant cognitive development even in a well-nourished, low-risk sample.

Maternal pre-pregnancy obesity and gestational weight gain influence neonatal neurobehaviour.

Maternal weight before and during pregnancy is associated with offspring neurobehaviour in childhood. We investigated maternal weight prior to and during pregnancy in relation to neonatal neurobehaviour. We hypothesized that maternal obesity and excessive gestational weight gain would be associated with poor neonatal attention and affective functioning. Participants (n = 261) were recruited, weighed and interviewed during their third trimester of pregnancy. Pre-pregnancy weight was self-reported and validated for 210 participants, with robust agreement with medical chart review (r = 0.99). Neurobehaviour was measured with the NICU Network Neurobehavioural Scale (NNNS) administered on Days 2 and 32 postpartum. Maternal exclusion criteria included severe or persistent physical or mental health conditions (e.g. chronic disease or diagnoses of Bipolar Disorder or Psychotic Spectrum Disorders), excessive substance use, and social service/foster care involvement or difficulty understanding English. Infants were from singleton, full-term (37-42 weeks gestation) births with no major medical concerns. Outcome variables were summary scores on the NNNS (n = 75-86). For women obese prior to pregnancy, those gaining in excess of Institute of Medicine guidelines had infants with poorer regulation, lower arousal and higher lethargy. There were no main effects of maternal pre-pregnancy body mass index on neurobehaviour. Women gaining above Institute of Medicine recommendations had neonates with better quality of movement. Additional studies to replicate and extend results past the neonatal period are needed. Results could support underlying mechanisms explaining associations between maternal perinatal weight and offspring outcomes. These mechanisms may inform future prevention/intervention strategies. © 2016 Blackwell Publishing Ltd.

Relationships among Socioeconomic Status, Dietary Intake, and Stress in Breastfeeding Women.

BACKGROUND: As breastfeeding duration increases, it is important to understand diets of breastfeeding women and other factors salient to maternal/offspring health, including stress. It is important to further consider sociodemographic factors, given their associations with nutritional deficiencies and perceived stress. OBJECTIVE: We cross-sectionally compared breastfeeding women's dietary intakes from a food frequency questionnaire (assessing from pregnancy through 3 months postpartum) with Estimated Average Requirements (EARs). We hypothesized that dietary intake was related to sociodemographic variables and parenting stress. DESIGN: We examined a cohort of predominately breastfeeding women. Food frequency questionnaire results were compared with EARs, the Parenting Stress Index: Short Form, and a demographic questionnaire. PARTICIPANTS/SETTING: Participants included 101 women (of 289 recruited) who breastfed singleton, full-term infants for the first 3 months while using <28 oz formula/wk. The study included community recruitment in rural Oklahoma from 2008 to 2012. STATISTICAL ANALYSES: Mean and standard deviation or frequencies were reported. One-sample t tests compared EARs with mean dietary intakes over the past 12 months. Pearson correlations and one-way analyses of variance explored relationships among dietary, sociodemographic, and stress variables. RESULTS: Twenty-two percent of women did not meet EAR minimum energy recommendations and >40% did not meet protein recommendations. Despite widespread supplement use, some consumed less than the EAR for vitamin E (35%), calcium (22%), and vitamin C (19%). Carbohydrate consumption was positively related to the difficult child scale (r=0.19; P=0.05). Dietary riboflavin (r=-0.19; P=0.05) and vitamin D intake (r=-0.19; P=0.05) were negatively related to the parent-child dysfunction scale. CONCLUSIONS: Despite efforts to enhance education and counseling regarding adequate perinatal nutrition-related practices, even well-educated women may not meet EARs. This poor dietary intake may be associated with parenting stress and have potential long-term implications for child health.

Pre-pregnancy obesity and maternal circadian cortisol regulation: Moderation by gestational weight gain.

We investigated main and interactive effects of maternal pre-pregnancy obesity and gestational weight gain on circadian cortisol from the second to third trimester. A diverse sample of 215 pregnant women was enrolled. Maternal height and most recent pre-pregnancy weight were collected at study initiation (22% obese). Weight and circadian salivary cortisol samples were measured during second (24±4) and third (35±1 weeks) trimesters. During the third trimester, women who were obese prior to conception showed elevated evening cortisol versus normal weight women. This pattern was moderated by weight gain in excess of Institute of Medicine guidelines, such that women who were obese prior to conception and gained greater than 7.94kg by the 35±1 week visit displayed greatest elevations in evening cortisol. Given links between excessive prenatal glucocorticoid exposure and both poor maternal and offspring health outcomes, elevated maternal cortisol may be one mechanism underlying links between maternal obesity and adverse perinatal outcomes.

Lifetime major depression and comorbid disorders among current-era women veterans.

BACKGROUND: Most research on women veterans' mental health has focused on postraumatic stress disorder (PTSD) or reactions to military sexual trauma. Although depression is also a frequent diagnosis among women veterans, little is known about its characteristics, including comorbid conditions and patterns of disorder onset. We investigated lifetime diagnoses of major depressive disorder (MDD) and comorbid conditions in a primarily treatment-seeking research sample of male and female veterans to determine frequency of lifetime MDD, comorbid disorders and their temporal onset. METHOD: The 1700 veterans (346 women; 1354 men) completed diagnostic interviews as participants in a research registry. Rates of and gender differences in lifetime MDD and comorbid conditions (PTSD, other anxiety disorders, substance use and eating disorders) were calculated. We assessed the percentage of cases in which MDD preceded the comorbid condition (primary onset MDD). RESULTS: Lifetime MDD was frequent in this sample, and significantly more common in women (46.5%) than in men (36.3%). Gender differences in comorbidity were found for anxiety and eating disorders (more common in women); and for alcohol and nicotine use disorders (more common in men). However, primary onset MDD was no more common among women than among men, and was in neither case the predominant pattern of comorbid lifetime disorder onset. LIMITATIONS: The sample is not representative of all veterans, and lifetime diagnoses were based on retrospective recall. CONCLUSIONS: MDD usually follows the onset of other comorbid disorders among women veterans, indicating the need to assess for earlier lifetime disorders in veterans with MDD.

Enhancing information pertaining to client characteristics to facilitate evidence-based practice.

OBJECTIVE: Evidence-based practice (EBP) includes utilization of empirically supported treatments, application of clinical expertise, and consideration of client characteristics. The following brief report aims to elucidate barriers in the study and dissemination of research regarding these client characteristics. DESIGN: Authors examined empirical papers cited on psychologicaltreatments.org (N = 338) and categorized each according to efficacy evidence available pertaining to gender, race/ethnicity, and socioeconomic status (SES). RESULTS: Gender was most commonly considered (7% of studies), with less than 2% of studies analyzing efficacy in relation to race/ethnicity or SES. CONCLUSIONS: Available findings are summarized according to disorder. Researchers are encouraged to attend to client variables in efficacy studies and suggestions are offered for training students to include client variables in EBP.