The effects of IPV and mental health symptoms on HPA axis functioning during early pregnancy.

Maternal HPA axis dysregulation during early pregnancy can negatively affect maternal functioning. However, findings are mixed regarding how intimate partner violence (IPV), a common traumatic stressor, impacts HPA axis regulation during pregnancy. Interactions between IPV and mental health symptoms as they influence cortisol production are rarely examined, especially among pregnant women. Therefore, this study examined the impact of IPV, mental health symptoms, and their interactions on the maternal HPA axis during early pregnancy; 255 pregnant women, oversampled for experiences of IPV, completed a laboratory stressor and measures of depressive and post-traumatic stress symptoms (PTSS) at 15-18 weeks of pregnancy. Participants provided saliva samples following the Trier Social Stress Test that were assayed for cortisol; the area under the curve with respect to ground (AUCg) was computed as a measure of cortisol reactivity. The interactive effects of IPV, depressive symptoms, and PTSS on AUCg were significant, but the main effects were not. At low levels of depressive symptoms, the association between IPV and AUCg was negative; at moderate levels of depressive symptoms, it was not significant, and at high levels, it was positive. At low and moderate levels of PTSS, the effects of IPV on cortisol AUCg were not significant, but at high levels, the association was positive. IPV during early pregnancy was associated with both hyperactive and blunted stress reactivity, depending on the type and severity of mental health symptoms. These patterns of dysregulation of the HPA axis may have differential effects both for women's functioning throughout pregnancy as well as for the offspring.

Conducting Virtual Assessments in Developmental Research: COVID-19 Restrictions as a Case Example.

Developmental researchers face considerable challenges regarding maximizing data collection and reducing participant attrition. In this article, we use our experiences implementing our study on the effects of timing of prenatal stress on maternal and infant outcomes during the COVID-19 pandemic as a framework to discuss the difficulties and solutions for these challenges, including the development of two types of virtual assessments. Specific information regarding use of virtual platforms, confidentiality, engaging children during video conferencing, and modifying the major assessments of our research are discussed. Feasibility data are presented, and data analytic challenges regarding statistical inference are outlined. Finally, we conclude with some of the unintended positive consequences for our research that resulted from making these modifications to our original methods.

Maternal parentification history impacts evaluative cognitions about self, parenting, and child.

Parentification occurs when children are unfairly charged with fulfilling parental instrumental and emotional needs. Parentification is associated with risk to evaluative self cognitions from childhood to emerging adulthood, but this association has not yet been studied among parents. The transition to parenthood is typically characterized by declines in self-esteem, suggesting it is a critical period for understanding the risk parentification history poses to evaluative self-cognitions and evaluative cognitions about children. The present study addresses these gaps using longitudinal data (N = 374 first-time mothers) to examine the influence of maternal parentification history domains (emotional and instrumental caregiving, role unfairness) on trajectories of maternal evaluative cognitions about the self (self-esteem, parenting self-efficacy) and about the child (difficult child temperament, dissatisfaction with child contributions to relationships) in early parenthood. A spillover model was also examined such that evaluative cognitions about the self were examined as potential mediators between parentification history and evaluative cognitions about children. Results support associations between the role unfairness domain of parentification and each domain of maternal evaluative cognitions and a significant indirect effect of unfairness on risk to maternal evaluative cognitions about child contributions via parenting self-efficacy. Implications for mother-child relationships and processes of intergenerational transmission of parentification are discussed.

La parentalización ocurre cuando a los niños se les hace asumir injustamente las necesidades instrumentales y emocionales de los padres. Se asocia la parentalización con el riesgo de auto cognición evaluativa de la niñez al naciente estado de adultez, pero esta asociación no ha sido aún estudiada entre los padres. La transición a la condición de ser padres se caracteriza típicamente por las bajas en la auto estima, lo cual sugiere que se trata de un período crítico para comprender el riesgo que el historial de la parentalización presenta para la auto cognición evaluativa y las cogniciones evaluativas sobre los niños. El presente estudio trata de estos vacíos usando datos longitudinales (N = 374 madres primerizas) para examinar la influencia de los campos del historial de la parentalización materna (el cuidado emocional e instrumental, el papel de lo que es injusto) sobre las trayectorias de las cogniciones evaluativas maternas acerca de ellas mismas (auto estima, auto efectividad en la crianza) y acerca del niño (el difícil temperamento del niño, la insatisfacción con las contribuciones del niño a las relaciones) en la temprana etapa de la maternidad. Se examinó un modelo de efectos secundarios de tal manera que se examinaron las cogniciones evaluativas acerca del yo como posibles factores de mediación entre el historial de parentalización y las cogniciones evaluativas acerca de los niños. Los resultados apoyan las asociaciones entre el papel del ámbito de lo injusto de la parentalización y cada ámbito de cogniciones evaluativas maternas y un efecto indirecto significativo de lo injusto sobre el riesgo de cogniciones evaluativas maternas sobre las contribuciones del niño por medio de la auto efectividad de la crianza. Se discuten las implicaciones de las relaciones madre-niño y los procesos de transmisión intergeneracional de la parentalización.

La parentification prend place lorsque on exige injustement des enfants qu'ils remplissent les besoins instrumentaux et émotionnels parentaux. La parentification est liée au risque d'auto-cognitions évaluatives de l'enfance au début de l'âge adulte, mais cette association n'a pas encore été étudiée chez les parents. La transition à la parenté est typiquement caractérisée par des déclins dans la confiance, suggérant que c'est une période critique pour comprendre l'histoire de risque que la parentification pose aux auto-cognitions évaluative et aux cognitions évaluatives sur les enfants. Cette étude porte sur ces écarts en utilisant des données longitudinales (N = 374 mères dont c'était la première grossesse) afin d'examiner l'influence des domaines de l'histoire de la parentification maternelle (soins émotionnels et instrumentaux, injustice du rôle) sur des trajectoires de cognition évaluative maternelle sur le moi (confiance en soi, auto-efficacité de parentage) et sur l'enfant (tempérament difficile de l'enfant, insatisfaction avec les contributions de l'enfant à la relation) au début de la parenté. Un modèle de débordement a aussi été examiné de telle manière que les cognitions évaluatives sur le self ont été examinées en tant que médiatrices potentielles entre l'histoire de parentification et les cognitions évaluatives sur les enfants. Les résultats soutiennent les liens entre le domaine de parentification de l'injustice du rôle et chaque domaine de cognitions évaluatives maternelles et un effet indirect important de l'injustice sur le risque aux cognitions évaluatives maternelles sur les contributions de l'enfant au travers de l'auto-efficacité de parentage. Les implications pour les relations mère-enfant et les processus de transmission intergénérationnelle de la parentification sont discutés.

Maternal Pregnancy Wantedness and Perceptions of Paternal Pregnancy Wantedness: Associations with Perinatal Mental Health and Relationship Dynamics.

OBJECTIVES: This study examined maternal pregnancy wantedness and perceptions of paternal wantedness, and their associations with maternal perinatal mental health symptoms and relationship dynamics. METHODS: Low-income, ethnically-diverse pregnant women (N = 101, Mage = 29.10 years, SDage = 6.56, rangeage = 18-44; 37% Latina, 22% African-American, 20% White, 21% biracial/multiracial/other) completed semi-structured interviews of pregnancy wantedness coded by trained raters, and standardized instruments of depression and PTSD symptoms during pregnancy and at 3-4-months postpartum. RESULTS: While maternal pregnancy wantedness (rated from 0-Predominately Ambivalent, 1-Mixed, and 2-Predominately Positive) showed no significant associations, a couple-level scale that combined maternal wantedness and her perceptions of paternal wantedness (Equally Positive Wantedness, Mom Wants More, Dad Wants More and Equally Ambivalent) showed several significant associations. Compared to women in the Equally Positive group, women in the Mom Wants More group had significantly higher prenatal and postnatal depression symptoms, prenatal PTSD symptoms, and prenatal and postnatal relationship conflict; and lower prenatal and postnatal relationship support. Women in the Mom Wants More group also had significantly higher prenatal and postnatal depression symptoms and prenatal conflict; and lower prenatal support than women in the Dad Wants More group. CONCLUSIONS FOR PRACTICE: Women who perceive themselves as wanting the pregnancy more than their baby's father are at higher risk for mental health and relationship problems than women who perceive themselves and their partners as equally ambivalent. Providers should ask women about their perceptions of partners' pregnancy wantedness to inform delivery of targeted mental health and relationship-based intervention during pregnancy.

Embedded Maternal Mental Health Care in a Pediatric Primary Care Clinic: A Qualitative Exploration of Mothers' Experiences.

OBJECTIVE: The American Academy of Pediatrics recommends screening parents for postpartum depression during pediatric primary care visits. Unfortunately, many women who screen positive do not obtain treatment. Providing mental health services for women in the same location as their children's primary care may facilitate treatment, but few such clinics exist. We designed a qualitative study to evaluate women's perceptions and experiences with receiving mental health services from psychiatrists embedded in a safety-net pediatric primary care clinic. METHODS: Semistructured interviews were conducted with women receiving mental health care from embedded psychiatrists in a safety-net pediatric clinic. Data were analyzed using an inductive approach. RESULTS: Twenty women participated. Five major themes emerged: 1) barriers to maternal mental health care, including psychiatric symptoms impairing access, stigma, and fear of Child Protective Services; 2) benefits of embedded care, including convenience, low barrier to entry and trust; 3) motherhood as facilitator to care, with early motherhood described as a time of vulnerability to relapse; 4) focus on parenting, including appreciation for parenting skills and normalization of the mothering experience; 5) treatment modality preferences, including concerns about medications and a preference for psychotherapy. CONCLUSIONS: Postpartum women face many barriers to psychiatric care. Mental health care embedded within the pediatric setting lowers barriers to care during this critical period. These insights should inform further collaboration between adult psychiatrists and pediatric care providers.

Recovery-Oriented Outcomes Associated with Long-Acting Injectable Antipsychotics in an Urban Safety-Net Population.

This study examined whether transitioning patients from oral antipsychotics (POs) to long-acting injectable antipsychotics (LAIs) helps patients achieve recovery-oriented goals. Data was extracted from San Francisco County's electronic medical record system for this retrospective pre-post observational study. Patients reflect a safety-net population treated in community-based mental health settings during 2015. The San Francisco Adult Strengths and Needs Assessment (SF ANSA), a measure of psychosocial functioning, was used to assess within-subject change when treated with POs versus LAIs. In our study sample (N = 77), LAI SF ANSA scores showed significant improvements in criminal behaviors (p = .017), medication adherence (p = .008), and spirituality (p = .028), and a non-significant trend for residential stability (p = .073). This is the first study to evaluate improvements in key psychosocial areas after treatment with LAIs. This work suggests that LAIs can be another tool for providers to help patients work towards their recovery-oriented goals.