Rainbow babies: Trauma and parenting after pregnancy loss.

OBJECTIVE: Parents with a history of pregnancy loss may be at greater risk for less secure attachment (Côté-Arsenault et al., 2020) and likely experience parenting differently than those without pregnancy loss. However, existing literature regarding pregnancy loss and parenting has focused nearly exclusively on attachment and has produced inconsistent findings. The present study aims to expand the scope of previously studied parenting indices by examining the role of pregnancy loss in relation to beliefs about parenthood as well as levels of parental support, satisfaction, involvement, and limit-setting. Cumulative trauma was included in the model to assess the role of trauma exposure. METHOD: Two hundred twenty-one parents (Mage = 41.69, SD = 12.73; 72.9% female) with at least one living child were recruited from either Amazon's Mechanical Turk or a midwestern university. RESULTS: Pregnancy loss was associated with lower levels of parental support, but did not evince links with parenting perceptions or other aspects of the parent-child relationship. Mothers reported receiving less support than fathers. Racial minorities endorsed less positive child perceptions and lower levels of parental satisfaction and involvement. Cumulative trauma, surprisingly, was unrelated to all of the parenting indices. CONCLUSIONS: Pregnancy loss may be related to lower perceptions of parental support, but may not be tied to parenting beliefs or aspects of the parent-child relationship. Future research should further consider context of the loss experience to better unpack how pregnancy loss may be related to specific parenting factors. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Cumulative trauma, posttraumatic stress, and obstetric and perinatal outcomes.

OBJECTIVE: Traumatic stress is associated with increased risk for physical health conditions, emotional disorders, and reproductive challenges. Significant rates of posttraumatic stress disorder are reported during pregnancy and after childbirth (Yildiz et al., 2017). However, a dearth of research has explored how traumatic stress impacts obstetric and perinatal outcomes. The aim of this study was to examine whether cumulative trauma and posttraumatic stress symptoms (PTSS) were positively associated with adverse obstetric and perinatal outcomes (i.e., pregnancy complications, nonviable pregnancies, preterm birth, and low birth weight). Abortion was also explored in relation to trauma exposure. METHOD: Two hundred and twenty-six trauma-exposed women (Mage = 40.54, SD = 13.03) who had been pregnant at least once were recruited from Amazon's Mechanical Turk (MTurk; 63.3%) or midwestern university (36.7%) to participate in the study. RESULTS: Higher levels of PTSS were related to a greater number of nonviable pregnancies and abortions (ßs = .18-.20) as well as delivering a low birth weight baby (OR = 1.03). Yet, these same associations were not found with cumulative trauma exposure. Conversely, greater cumulative trauma was linked with delivering a baby prematurely (OR = 1.16). Pregnancy complications were unrelated to both PTSS and cumulative trauma. CONCLUSIONS: Cumulative trauma exposure and PTSS may have adverse effects on obstetric and perinatal outcomes and pregnant women with PTSS may be especially vulnerable. Further research is needed to replicate these findings and examine the temporal relationship between duration of PTSS and obstetric and perinatal outcomes. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

When Adverse Childhood Experiences Present to a Statewide Child Psychiatry Access Program.

Many children experience adversity, yet few receive needed psychiatric services. Pediatric primary care providers (PCPs) are uniquely positioned to intervene but often lack training and resources to provide patients with adverse childhood experiences (ACEs) the psychiatric support they need. The current study examines characteristics of youth with and without ACEs who were the focus of PCP contacts with a statewide child psychiatry access program (CPAP). Compared to those without ACEs, patients with ACEs were more often receiving medication treatment at time of CPAP contact, prescribed two or more psychotropic medications, and diagnosed with two or more mental health disorders. Study findings indicate that patients with ACEs for whom PCPs sought CPAP support were experiencing more clinically severe and complex mental health concerns. These findings underscore the important role of CPAPs in supporting PCPs with pediatric patients who have ACEs and will inform training provided by CPAPs to PCPs.

Pediatric Primary Care Provider Comfort with Mental Health Practices: A Needs Assessment of Regions with Shortages of Treatment Access.

OBJECTIVES: Nearly 50% of children with a mental health concern do not receive treatment. Child Psychiatry Access Programs like Behavioral Health Integration in Pediatric Primary Care (BHIPP) address regional shortages of mental health treatment access by providing training and consultation to primary care providers (PCPs) in managing mental health concerns. This study assessed PCPs' comfort with mental health practices to inform expansion of BHIPP services. METHODS: Pediatric PCPs in 114 practices in three rural regions of Maryland were recruited to participate in a survey about their comfort with mental health practices and access to mental health providers for referral. Descriptives, Friedman's test, and post hoc pairwise comparisons were used to examine survey responses. RESULTS: Participants were 107 PCPs. Most respondents were physicians (53.3%) or nurse practitioners/physician's assistants (39.3%). Friedman's test, χ2(7)= 210.15, p<.001, revealed significant within and between-group differences in PCP comfort with mental health practices. Post hoc pairwise comparisons indicated greater comfort providing mental health screening and referrals compared to prescribing psychiatric medications, providing psychoeducation or in-office mental health interventions. A Wilcoxon-signed rank test showed significantly more respondents agreed they could find a therapist than a psychiatrist in a timely manner, Z= -5.93, p<.001. CONCLUSIONS: Pediatric PCPs were more comfortable with providing mental health assessment and referrals than treatment. However, PCPs reported difficulty finding therapists and psychiatrists for their patients. Findings underscore the need for longitudinal training to increase PCP comfort with mental health treatment. Additionally, strategies such as telepsychiatry are needed to address the disproportionate need for child psychiatrists.