Postpartum-Specific Anxiety and Maternal-Infant Bonding: A Predictive Validity Study amongst Italian Women.

The role of anxiety is unknown in relation to postpartum bonding, unlike the well-known detrimental effect that postpartum depression has on the relationship between a mother and child. This study investigates how anxiety affects mother-infant bonding after childbirth, comparing the Italian version of the Postpartum Specific Anxiety Scale (PSAS-IT) with generalized measures of anxiety. Examining 324 non-randomly-selected participants responding to various scales, including the Edinburgh postnatal depression scale (EPDS), generalized anxiety disorder (GAD), postpartum-specific anxiety scale (PSAS-IT), postpartum bonding questionnaire (PBQ), and baby care questionnaire (BCQ-2), initial results suggest a link between certain postpartum anxiety symptoms and attachment problems. Surprisingly, anxiety measured with the PSAS has no direct influence on attachment; however, it is a strong predictor of bonding, even when maternal age, general anxiety, and depression are taken into account, explaining 3% of the variance in scores (ß = 0.26, p < 0.001). This emphasizes the importance of early identification and intervention of postpartum anxiety in promoting bonding between mother and child.

The Italian language postpartum specific anxiety scale [PSAS-IT]: translation, psychometric evaluation, and validation.

Introduction: While often positive, the lifecourse transition to motherhood is susceptible to the risk for developing mood disorders. Postpartum anxiety has often been overshadowed by other perinatal-specific mental health disorders, such as postpartum depression, and therefore has not been at the forefront or center of as much empirical study. This has meant there is a lack of effective and reliable tools with which to measure it, despite growing evidence suggesting its detrimental impact on mothers, their babies, wider family and social contacts, and on healthcare systems. This current study aimed to translate and validate the Postpartum Specific Anxiety Scale [PSAS] into the Italian language, and to validate the tool for its use in detecting anxiety specific to motherhood. Methods: The study (N = 457) comprised 4 stages: English-Italian translation and back-translation to obtain the Italian version [PSAS-IT]; a preliminary pilot study to adapt the PSAS to the characteristics of the Italian population; measurement invariance; and internal reliability of subscales. Results: The PSAS-IT demonstrates similar psychometric properties as the original English-language PSAS, with acceptable acceptability, construct and convergent validity, and internal consistency. Confirmatory factor analysis for multiple groups (Italy and United Kingdom) showed that the factor structure of the PSAS was valid for both groups [χ2 (2436) = 4679.481, p < 0.001, TLI = 0.969, CFI =0.972, RMSEA = 0.045, SRMR =0.064]. Discussion: The resulting findings offer a reliable measure of postpartum anxiety in Italian language up to six months after birth.

Perinatal Depression and Anxiety Symptoms, Parental Bonding and Dyadic Sensitivity in Mother-Baby Interactions at Three Months Post-Partum.

The quality of the early parent-infant relationship is crucial for the child's optimal development, and parental sensitivity plays a key role in early interactions. The purpose of the study was to evaluate the influence of maternal perinatal depression and anxiety symptoms on dyadic sensitivity at three months post-partum, also considering a large set of maternal and infant variables. At the third trimester of pregnancy (T1) and at three months postpartum (T2), 43 primiparous women filled in a set of questionnaires evaluating symptoms of depression (CES-D) or anxiety (STAI), the woman's parental bonding experiences (PBI), alexithymia (TAS-20), maternal attachment to the baby (PAI, MPAS) and the perceived social support (MSPSS). At T2 mothers also completed a questionnaire on infant temperament and took part in the CARE-Index videotaped procedure. Dyadic sensitivity was predicted by higher maternal trait anxiety scores in pregnancy. In addition, the mother's experience of being cared for by her father in childhood was predictive of her infant's lower compulsivity, while paternal overprotection predicted higher unresponsiveness. The results highlight the influence of perinatal maternal psychological well-being and maternal childhood experiences on the quality of the dyadic relationship. The results may be useful to foster mother-child adjustment during the perinatal period.

Women's interpretation, understanding and attribution of the anhedonia question in the PHQ-4 and modified-Whooley questions in the antenatal period.

OBJECTIVES: To report on the rates of misinterpretation, confusion, and attribution of the anhedonia question in the PHQ-4 and Whooley questions by pregnant women. BACKGROUND: The NICE Perinatal Mental Health guidelines recommend the use of the anhedonia question for depression screening, yet evidence suggests it may be misinterpreted or not be related to mood. METHOD: Women attending a public hospital's antenatal clinic, communicating in English as their language of choice, completed either the PHQ-4 or the Whooley questions. Following comments to general evaluation questions in the first sample, women were asked a targeted anhedonia interpretation question, an anhedonia attribution question, and an ease of understanding question (PHQ-4: N = 37-119; Whooley: N = 31-100). RESULTS: Across the PHQ-4 and Whooley formats around 15% of participants completely misinterpreted the anhedonia question, with a further 17% finding it difficult to understand. Around two-thirds of those experiencing the symptom said it was due to normal symptoms of pregnancy, and not related to their mood. In the PHQ-4 format, which included all three questions, 48% of the women had one or more of these issues. While CALD women appear to have greater difficulty understanding the question, there were no meaningful associations with whether English was spoken at home. CONCLUSION: Almost half of the women incorrectly interpreted the anhedonia question, or said that it was confusing, or that it did not reflect low mood. These data indicate that the anhedonia question should not be used in screening women in the antenatal period, whether in the PHQ-4 or Whooley formats.

An exploratory and confirmatory factor analysis study of the EPDS in postnatal Italian-speaking women.

BACKGROUND: Depression and anxiety are the most prevalent emotional difficulties in the perinatal period and there is agreement that early intervention is an important strategy to prevent long-lasting effects on mother and child. Literature has recently shown that the Edinburgh Postnatal Depression Scale (EPDS) is able to measure not only depression but also anxiety. OBJECTIVE: To investigate the factorial structure of the EPDS in Italian-speaking new mothers. METHOD: 416 women attending vaccination services between 2 and 4 months postpartum filled in the EPDS. Exploratory (EFA) and Confirmatory (CFA) analyses were carried out. RESULTS: The EFA on the first part of the sample (n = 208) showed a two-factor structure. The CFAs on the second sample of mothers (n = 208) provided support for the 'EPDS-4A', with items 3,4,5,6 belonging to the Anxiety factor and items 1,2,7,8,9,10 to the Depression factor. The fit for the model was good: χ2/df = 1.41, p <.001; GFI =.99; CFI =.99; TLI =.88; RMSEA =.04. CONCLUSION: A two-factor structure of the EPDS was confirmed suggesting that the EPDS can be used to screen for both depression and anxiety for Italian mothers in the postnatal period.

Pre-natal Attachment and Parent-To-Infant Attachment: A Systematic Review.

During the perinatal period, the establishment of the attachment relationship with the fetus and subsequently with the real child is crucial for the parents' and the child's well-being. Coherently with the assumption that the attachment relationship starts to develop during pregnancy, this systematic review aims to analyze and systematize studies focused on the association between pre-natal attachment and parent-to-infant attachment, in order to clarify the emerging results and provide useful information for clinical purposes. Nineteen studies were included. Sixteen researches identified a positive relationship between pre-natal attachment and parent-to-infant attachment, and three articles highlighted a negative association between antenatal attachment and post-partum bonding disorders. These results were found both in women and men, in normative and at-risk pregnancies, adopting different assessment approaches (i.e., self-report measures, observations, and projective measures). However, only small or moderate associations were found. Future studies are needed to further confirm these findings across different populations (e.g., male samples, non-normative samples or samples in disadvantaged conditions) and with different methodological approaches (e.g., observational measures). Moreover, studies would be needed in order to clarify mechanisms through which pre-natal attachment influences parent-to-infant attachment, as well as protective and risk factors which intervene between these two variables.

A validation of the Postpartum Specific Anxiety Scale 12-item research short-form for use during global crises with five translations.

BACKGROUND: Global crises inevitably increase levels of anxiety in postpartum populations. Effective and efficient measurement is therefore essential. This study aimed to create a 12-item research short form of the 51-item Postpartum Specific Anxiety Scale [PSAS] and validate it for use in rapid response research at a time of global crises [PSAS-RSF-C]. We also present the same 12-items, in five other languages (Italian, French, Chinese, Spanish, Dutch) to increase global accessibility of a psychometric tool to assess maternal mental health. METHODS: Twelve items from the PSAS were selected on the basis of a review of their factor loadings. An on-line sample of UK mothers (N = 710) of infants up to 12 weeks old completed the PSAS-RSF-C during COVID-19 'lockdown'. RESULTS: Principal component analyses on a randomly split sample (n = 344) revealed four factors, identical in nature to the original PSAS, which in combination explained 75% of the total variance. Confirmatory factor analyses (n = 366) demonstrated the four-factor model fit the data well. Reliability of the overall scale and of the underlying factors in both samples proved excellent. CONCLUSIONS: Findings suggest the PSAS-RSF-C may prove useful as a clinical screening tool and is the first postpartum-specific psychometric scale to be validated during the COVID-19 pandemic. This offers psychometrically sound assessment of postpartum anxiety. By increasing the accessibility of the PSAS, we aim to enable researchers the opportunity to measure maternal anxiety, rapidly, at times of global crisis.

Attachment representations to parents and emotional-behavioral problems: A comparison between children with type 1 diabetes mellitus and healthy children in middle childhood.

Type 1 diabetes mellitus (T1D) is one of the most demanding chronic diseases for children and their families, since controlling diabetes involves a process of co-regulation with attachment figures. However, there is insufficient evidence in middle childhood on psychological mechanisms involved that might complicate the adaptation of these children. Therefore, 106 children (N = 31 with T1D and N = 75 as matched healthy group [HG]) aged 8 to 13 were assessed using the Child Attachment Interview, the Child Behavior Checklist, and the measure of glycated hemoglobin. Results showed that insecure T1D children did not have worse diabetes control than the secure ones. However, T1D children differed from HG for higher levels of idealization to father and withdrawn/depressed problems. Moreover, T1D children with insecure attachment to mother scored significantly higher in anxious/depressed, withdrawn/depressed, attention problems, and rule-breaking behavior, while T1D children with insecure attachment to father scored significantly higher only in the withdrawn/depressed scale compared to the remaining children. Therefore, diabetes does not in itself determine a psychological vulnerability in middle childhood, but the presence of an insecure attachment, especially to the mother, worsens the psychological adaptation of T1D children. Psychological support should be provided for these young patients and their families.

Correlation between human nervous system development and acquisition of fetal skills: An overview.

Understanding the association between fetal nervous system structure and functioning should be an important goal in neurodevelopmental sciences, especially when considering the emerging knowledge regarding the importance of prenatal onset. Intrauterine development of the human central nervous system consists of specific processes: neurogenesis, neuronal migration, synaptogenesis, and myelination. However, as extensively shown by the neurobehavioral studies in the last century, the development of the central nervous system involves both structure and functioning. It is now recognised that the developing motor and sensory systems are able to function long before they have completed their neural maturation and that the intrauterine experience contributes to neurobehavioral development. This review analyzes the recent literature, looking at the association between the human nervous system maturation and fetal behavior. This article will follow the development and skill acquisition of the anatomical nervous system across the three trimesters of the gestation period.

A comparison of two measures to screen for emotional health difficulties during pregnancy.

OBJECTIVE: To compare the performance of a generic mood questionnaire (Matthey Generic Mood Questionnaire, MGMQ) against the established Edinburgh Postnatal Depression Scale (EPDS) in perinatal mental health mood screening. BACKGROUND: Many perinatal clinical services use the EPDS to screen for depression, and some may consider using it to screen for anxiety. A new scale, the MGMQ, is designed to screen for a wide variety of emotions, not just depression or anxiety. It comprises a generic distress question, an impact question, as well as two clinical questions. Its brevity, and categorical scoring format, may also mean it is less susceptible than the EPDS to needing a myriad of different screen-positive scores for women from different cultures and during different perinatal time periods. METHODS: Two hundred and ten Italian women in their third trimester of pregnancy completed the EPDS and MGMQ while attending routine antenatal clinic appointments or antenatal classes in the north of Italy, between 2015 and 2016. RESULTS: The Distress and Lower Impact question thresholds showed acceptable receiver operating characteristics with the various EPDS screen positive thresholds. The Higher Impact question threshold, however, had lower than acceptable sensitivity. By contrast, the EPDS was poor at detecting women who on the MGMQ said that they were distressed and significantly bothered by their mood. The possible reasons for the discrepancies in screen-positive status between the two measures are discussed. CONCLUSION: The MGMQ is a useful tool to aid in screening for a wide range of emotional difficulties in the perinatal period.

Surveying prenatal attachment in fathers: the Italian adaptation of the Paternal Antenatal Attachment Scale (PAAS-IT).

OBJECTIVE: This study focuses on the process of the father's bonding with the fetus and aims to assess the psychometric properties of the Italian translation of the Paternal Antenatal Attachment Scale (PAAS). BACKGROUND: The construct of prenatal attachment has been created to systematically investigate the nature of the particular bond that develops in the minds of parents expecting a child. Paternal attachment to the unborn child has not been well explored until now, despite its undoubted importance. The PAAS is a 16-item questionnaire evaluating paternal thoughts, feelings, attitudes and emotions towards the fetus validated with Australian fathers. METHODS: This is a cross-sectional study. A forward-backward translation was used to obtain the PAAS Italian version (PAAS-IT). A sample of 165 Italian fathers completed the PAAS-IT, the 20-Toronto Alexithymia Scale and a sociodemographic questionnaire also investigating the father's attitudes towards the fetus. The reliability and construct validity of the PAAS-IT were evaluated. A Principal Component Analysis (PCA) and a Confirmatory Factor Analysis (CFA) using Structural Equation Modelling (SEM) were conducted. RESULTS: The PAAS-IT psychometric characteristics were adequate. The PCA yielded a two-dimensional model explaining 34% of the variance. The CFA acknowledges the truthfulness of this model. The items loading on the two factors did not exactly match that found in the original PAAS, suggesting the influence of specific cultural features. CONCLUSIONS: The PAAS-IT is a reliable and valid instrument to use in Italian clinical settings to investigate the development of the paternal attachment towards the unborn child.

The Walsh Family Resilience Questionnaire: the Italian version.

BACKGROUND: Resilience focuses on strength under stress, in the context of adversity. Walsh's theoretical model identifies relational processes that allow families to tackle and overcome critical situations, dividing them into three domains of family function. The aim of this study was to assess resilience in families of patients with a chronic disease by adapting and validating the Italian version of the Walsh Family Resilience Questionnaire (Walsh-IT). PATIENTS AND METHODS: An Italian adult sample of 421 participants (patients and relatives) was collected with the aim to assess the reliability and validity of the Walsh-IT. Concurrent validity was carried out by comparing this instrument with the Family Adaptability and Cohesion Evaluation Scale III (FACES III) administered at the same time as the Walsh-IT. RESULTS: Reliability showed high correlation between repeated measurements. The alpha coefficient was 0.946. Both parallel analysis and minimum average partial criteria suggested that the best number of domains is equal to 3, explaining 50.4% of the total variance. Based on the results obtained from the Rasch analysis, items 10, 11, 16, 22, and 23 have been removed resulting in a short-form questionnaire (Walsh-IT-R) of 26 items with three domains: shared beliefs and support (SBS, α=0.928); family organization and interaction (FOI, α=0.863); and utilization of social resources (USR, α=0.567). The total score of the Walsh-IT-R was strongly correlated with the total score of FACES III Real Family Scale (r=0.68; p<0.0001). CONCLUSION: Results support that the Walsh-IT-R is a valid instrument for the assessment of family resilience in Italy when contending with the challenges of chronic disease. It could be used in pre- and post-assessment in practice effectiveness research, offering a profile of family resilience processes at the start and end of interventions and follow-up.

Work-related disorders of the upper limb in female workers using orbital sanders.

OBJECTIVES: To investigate the prevalence of vascular, neurological and musculoskeletal disorders of the upper limb in a group of female workers performing either mechanical or hand sanding in the furniture industry (n=100) and in a control group of female office workers (n=100). A further aim was to study the possible adverse effects of exposure to a combination of vibration and ergonomic risk factors in female workers. METHODS: All female workers underwent a medical interview and a complete physical investigation. The clinical diagnoses of Raynaud's phenomenon and carpal tunnel syndrome (CTS) were made according to international consensus criteria. Hand-transmitted vibration from orbital sanders was measured according to International Organization for Standardization (ISO) recommendations. Daily vibration exposure was assessed in terms of 8-h energy-equivalent frequency-weighted acceleration [A(8)] according to the European Directive on physical agents. Ergonomic load on the upper limbs was estimated by means of strain index methodology. RESULTS: There was no significant difference in the prevalence of Raynaud's phenomenon between the furniture workers (4%) and the controls (8%). The prevalence of CTS, peripheral sensorineural disturbances (after exclusion of CTS cases) and upper-limb musculoskeletal complaints was significantly greater in the furniture workers than in the controls. CTS was clinically diagnosed in 19% of the furniture workers and 8% of the controls. A log-binomial regression analysis showed that the occurrence of soft-tissue disorders of the upper limb increased significantly with the increase of both daily vibration exposure and the strain index score. It was estimated that the risk for CTS increased by a factor of 1.30 (95% CI 1.11-1.53) for each unit of increase in A(8) (ms(-2)), and by 1.09 (95% CI 1.02-1.15) for each unit of increase in the strain index score. CONCLUSIONS: Even though the cross-sectional design of this epidemiological study does not allow aetiological considerations, our findings suggest a significant association between occupational use of vibratory tools and soft-tissue disorders in the upper limbs of female workers. Quantitative estimation of vibration exposure and ergonomic stress showed that these physical risk factors seem to contribute in a multiplicative way to the occurrence of chronic nerve and musculoskeletal disorders in female workers operating hand-held vibrating tools in the furniture industry.