Maternal alcohol disorders and school achievement: a population cohort record linkage study in Western Australia.

OBJECTIVE: Maternal alcohol use disorder is a risk factor for a range of developmental outcomes in children. This study examines school achievement in children of Indigenous and non-Indigenous mothers with an alcohol-related diagnosis. DESIGN, SETTING AND PARTICIPANTS: This is a Western Australian population cohort study of mothers with a record of an alcohol-related diagnosis classified by the International Classification of Diseases Revisions 9/10 codes as recorded on administrative databases, and of their offspring born between 1989 and 2007 (n=18 486 exposed children), with a frequency matched comparison cohort of mothers with no record of alcohol diagnosis and their offspring (n=48 262 comparison children). OUTCOMES: Records were linked with school achievement data for numeracy and literacy from Years 3, 5, 7 and 9 (age range: ~8-14 years) based on statewide and national testing. Mixed multivariate models with a random intercept per child were used to assess the relationship between exposure and the timing of exposure with failure to meet minimum standardised benchmarks. RESULTS: Academic achievement was lower in all testing domains (reading, writing, spelling and numeracy) among children of mothers with an alcohol diagnosis and persisted across all year groups examined. The highest ORs at Year 9 for non-Indigenous children were in reading (adjusted OR (aOR) 1.6, 95% CI 1.4 to 1.8) and in writing for Indigenous children (aOR 2.0, 95% CI 1.8 to 2.3). CONCLUSION: Children of mothers with alcohol use disorders are at risk of not meeting minimum educational benchmarks in numeracy and literacy, with the risk highest among Indigenous children.

Using daily monitoring of psychiatric symptoms to evaluate hospital length of stay.

BACKGROUND: Routine symptom monitoring and feedback improves out-patient outcomes, but the feasibility of its use to inform decisions about discharge from in-patient care has not been explored. AIMS: To examine the potential value to clinical decision-making of monitoring symptoms during psychiatric in-patient hospitalisation. METHOD: A total of 1102 in-patients in a private psychiatric hospital, primarily with affective and neurotic disorders, rated daily distress levels throughout their hospital stay. The trajectories of patients who had, and had not, met a criterion of clinically significant improvement were examined. RESULTS: Two-thirds of patients (n=604) met the clinically significant improvement criterion at discharge, and three-quarters (n=867) met the criterion earlier during their hospital stay. After meeting the criterion, the majority (73.2%) showed stable symptoms across the remainder of their hospital stay, and both classes showed substantially lower symptoms than at admission. CONCLUSIONS: Monitoring of progress towards this criterion provides additional information regarding significant treatment response that could inform clinical decisions around discharge readiness. DECLARATION OF INTEREST: None. COPYRIGHT AND USAGE: © The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license.

Older maternal age is associated with depression, anxiety, and stress symptoms in young adult female offspring.

The evidence regarding older parental age and incidence of mood disorder symptoms in offspring is limited, and that which exists is mixed. We sought to clarify these relationships by using data from the Western Australian Pregnancy Cohort (Raine) Study. The Raine Study provided comprehensive data from 2,900 pregnancies, resulting in 2,868 live born children. A total of 1,220 participants completed the short form of the Depression Anxiety Stress Scale (DASS-21) at the 20-year cohort follow-up. We used negative binomial regression analyses with log link and with adjustment for known perinatal risk factors to examine the extent to which maternal and paternal age at childbirth predicted continuous DASS-21 index scores. In the final multivariate models, a maternal age of 30-34 years was associated with significant increases in stress DASS-21 scores in female offspring relative to female offspring of 25- to 29-year-old mothers. A maternal age of 35 years and over was associated with increased scores on all DASS-21 scales in female offspring. Our results indicate that older maternal age is associated with depression, anxiety, and stress symptoms in young adult females. Further research into the mechanisms underpinning this relationship is needed.

The structure of negative emotional states in a postpartum inpatient sample.

BACKGROUND: Depression and anxiety disorders exhibit comorbidity, and the same relationships have been observed in postpartum samples. The tripartite model posits that anxiety and depression overlap due to shared and unique symptom components. The present study tested whether a one-factor model, or a three-factor model consistent with the tripartite model, provided a better fit to anxiety and depression symptoms in a postpartum sample. METHODS: The sample consisted of 663 postpartum psychiatric inpatients who completed self-reported questionnaires assessing symptoms of anxiety and depression. RESULTS: Confirmatory factor analysis revealed that a three-factor model consistent with the tripartite model provided a good fit to anxiety/depression data. This model consisted of three factors: positive affect, negative affect, and autonomic arousal. Positive affect was related to depressive diagnoses and negatively related to anxiety diagnoses; autonomic arousal was related to anxiety diagnoses; and negative affect was uniquely related to mixed anxiety-depressive diagnoses. LIMITATIONS: The sample consisted of postpartum psychiatric inpatients and the generalisability of results to other postpartum samples is not known. CONCLUSIONS: Postpartum anxiety and depression appear to be characterised by three differentiable symptom clusters. Postpartum anxiety, depression, and mixed anxiety-depressive diagnoses are differentially associated with these symptom clusters. These findings suggest that the tripartite model may be useful in guiding assessment, differentiation, and treatment of postpartum emotional disorders.

Playgroup Participation and Social Support Outcomes for Mothers of Young Children: A Longitudinal Cohort Study.

OBJECTIVE: This study aimed to examine friendship networks and social support outcomes for mothers according to patterns of playgroup participation. METHODS: Data from the Longitudinal Study of Australian Children were used to examine the extent to which patterns of playgroup participation across the ages of 3-19 months (Wave 1) and 2-3 years (Wave 2) were associated with social support outcomes for mothers at Wave 3 (4-5 years) and four years later at Wave 5 (8-9 years). Analyses were adjusted for initial friendship attachments at Wave 1 and other socio-demographic characteristics. RESULTS: Log-binomial regression models estimating relative risks showed that mothers who never participated in a playgroup, or who participated at either Wave 1 or Wave 2 only, were 1.7 and 1.8 times as likely to report having no support from friends when the child was 4-5 years, and 2.0 times as likely to have no support at age 8-9 years, compared with mothers who persistently participated in playgroup at both Wave 1 and Wave 2. CONCLUSION: These results provide evidence that persistent playgroup participation may acts as a protective factor against poor social support outcomes. Socially isolated parents may find playgroups a useful resource to build their social support networks.

Detecting the severity of perinatal anxiety with the Perinatal Anxiety Screening Scale (PASS).

BACKGROUND: The Perinatal Anxiety Screening Scale (PASS; Somerville et al., 2014) reliably identifies perinatal women at risk of problematic anxiety when a clinical cut-off score of 26 is used. This study aimed to identify a severity continuum of anxiety symptoms with the PASS to enhance screening, treatment and research for perinatal anxiety. METHODS: Antenatal and postnatal women (n=410) recruited from the antenatal clinics and mental health services at an obstetric hospital completed the Edinburgh Postnatal Depression Scale (EPDS), the Depression, Anxiety and Stress Scale (DASS-21), the Spielberg State-Trait Anxiety Inventory (STAI), the Beck Depression Inventory II (BDI), and the PASS. The women referred to mental health services were assessed to determine anxiety diagnoses via a diagnostic interview conducted by an experienced mental health professional from the Department of Psychological Medicine - King Edward Memorial Hospital. Three normative groups for the PASS, namely minimal anxiety, mild-moderate anxiety, and severe anxiety, were identified based on the severity of anxiety indicated on the standardised scales and anxiety diagnoses. RESULTS: Two cut-off points for the normative groups were calculated using the Jacobson-Truax method (Jacobson and Truax, 1991) resulting in three severity ranges: 'minimal anxiety'; 'mild-moderate anxiety'; and 'severe anxiety'. LIMITATIONS: The most frequent diagnoses in the study sample were adjustment disorder, mixed anxiety and depression, generalised anxiety, and post-traumatic stress disorder. This may limit the generalisability of the severity range results to other anxiety diagnoses including obsessive compulsive disorder and specific phobia. CONCLUSIONS: Severity ranges for the PASS add value to having a clinically validated cut-off score in the detection and monitoring of problematic perinatal anxiety. The PASS can now be used to identify risk of an anxiety disorder and the severity ranges can indicate developing risk for early referrals for further assessments, prioritisation of access to resources and tracking of clinically significant deterioration, improvement or stability in anxiety over time.

Does the Edinburgh Postnatal Depression Scale measure the same constructs across time?

The Edinburgh Postnatal Depression Scale is the most widely used measure for screening for depression in perinatal populations. A weakness is that the factor structure of the scale is inconsistent across studies. It is unclear the degree to which this inconsistency results from variability arising from the Edinburgh Postnatal Depression Scale (EPDS). The present study aimed to determine whether the EPDS factor structure remained stable in the same individuals reporting on their levels of distress across two testing occasions. Data were analysed for 636 postpartum inpatient females who were administered the EPDS at admission and discharge from a psychiatric mother and baby unit. Exploratory factor analyses (EFAs) and confirmatory factor analyses (CFAs) were conducted separately on the admission and discharge data to determine the optimal factor structure at each time point. The EFAs and CFAs supported a two-factor model at admission and a three-factor model at discharge. Given that the EPDS did not demonstrate an invariant number of factors, no further tests of measurement invariance were conducted. The EPDS does not appear to be invariant from admission to discharge. These findings suggest that individuals may respond differently to items depending on their level of distress. Potential implications for the EPDS in terms of comparability of scores across groups/time and its screening abilities are discussed.

The structure of emotional symptoms in the postpartum period: is it unique?

BACKGROUND: In perinatal mental health there is a lack of consensus as to whether postpartum emotional disorders are unique in their aetiology and clinical presentation. If the clinical presentation is unique, then the factor structure should be different in a postpartum sample. METHODS: Admission and discharge scores on the Depression Anxiety Stress Scales (DASS; Lovibond and Lovibond, 1995b) scores were collected for 527 inpatients admitted to a Psychiatric Mother and Baby Unit. Reliability and validity of the DASS were examined, and confirmatory factor analysis evaluated the fit of a series of models of the DASS. RESULTS: The DASS had sound reliability and validity in the postpartum inpatient sample. The optimal fitting factor solution for the DASS was a revised three-factor model previously supported in studies of other clinical and non-clinical populations. The factor structure was invariant across admission and discharge. LIMITATIONS: The sample consisted of postpartum inpatients and the generalisability of results to other postpartum samples is not known. CONCLUSIONS: Postpartum emotional symptoms have the same factor structure previously observed in non-postpartum populations, consistent with the hypothesis that postpartum emotional disorders are similar to those occurring at other times. The present study provides support for the reliability and validity of the DASS in the postpartum period.