The prevalence of perinatal mental health disorders and psychosocial characteristics of women in Malta: A cross-sectional study.

BACKGROUND: Perinatal mental health disorders (PMHDs) are associated with a myriad of negative outcomes for women, infants, and the rest of the family unit. Understanding the prevalence of these conditions is important to guide prevention and treatment pathways. Indeed, the burden of PMHDs has been studied in many countries, but for Malta, an island with an annual birth rate of 4500 births, this burden is still to be determined. The main objective of this study was to address this gap, determine the prevalence of PMHDs among postpartum women in Malta, and study associated psychosocial determinants for this population. METHODS: A cross-sectional epidemiological study was conducted between March and April 2022 to determine the point prevalence of postpartum PMHDs in Malta. A representative, random sample of 243 postnatal mothers were recruited and screened for mental health issues using a two stage approach incorporating symptom scales and a diagnostic interview. RESULTS: The point prevalence of postnatal PMHDs in Malta, according to a diagnostic interview, was found to be 21.4%. Anxiety disorders were the most prevalent conditions (16.8%), followed by obsessive-compulsive disorder (6.1%) and borderline personality disorder (5.6%), respectively. A higher rate of 32.1% was identified with self-report measures. CONCLUSIONS: PMHDs are highly prevalent, affecting approximately 20% of women in Malta across the first postnatal year. The value of this finding accentuates the need for service availability and the implementation of perinatal mental health screening programs.

Effects of maternal depression on maternal responsiveness and infants' expressive language abilities.

High levels of maternal responsiveness are associated with healthy cognitive and emotional development in infants. However, depression and anxiety can negatively impact individual mothers' responsiveness levels and infants' expressive language abilities. Australian mother-infant dyads (N = 48) participated in a longitudinal study examining the effect of maternal responsiveness (when infants were 9- and 12-months), and maternal depression and anxiety symptoms on infant vocabulary size at 18-months. Global maternal responsiveness ratings were stronger predictors of infants' vocabulary size than levels of depression and anxiety symptoms. However, depression levels moderated the effect of maternal responsiveness on vocabulary size. These results highlight the importance of screening for maternal responsiveness-in addition to depression-to identify infants who may be at developmental risk. Also, mothers with elevated depression need support to first reduce their symptoms so that improvements in their responsiveness have the potential to be protective for their infant's language acquisition.

Social Anxiety Disorder: Associations with Peer-Liking, Discrimination, and Prejudicial Feelings in Early Adolescent Girls.

Social anxiety can have an adverse effect on social connections, educational achievement, and wellbeing. However, the extent to which students stigmatize their peers with social anxiety disorder (SAD) in female educational settings remains unknown. This study investigated the relationship between SAD, peer-liking and stigma in a cohort of early adolescent girls. The sample was 103 sixth and seventh graders attending three girls' schools in Australia. The students, aged between 10- and 13-years, were randomly allocated to either a control (n = 52) or experimental (n = 51) group. Participants completed an online survey while at school to examine their responses to one of two age-and-gender matched vignettes: a hypothetical peer with SAD (experimental condition), or without SAD (control condition). Contrary to expectations, group comparisons revealed that students with the SAD vignette liked their peer more than students with the non-SAD vignette. Also, students endorsed higher levels of pity, lower levels of fear, but similar levels of anger when considering their SAD (versus non-SAD) peer. In the SAD group, higher levels of pity were associated with greater peer-liking. The opposite pattern was evident in response to the non-SAD peer. Importantly, students discriminated less (preferred less social distance) in response to their peer with SAD. This points to the potential benefit of adolescent peer programs that aim to promote positive peer-relationships as a protective factor for students with SAD. Future research may examine gender and socio-economically diverse students to increase the confidence with which findings can be generalized to other educational settings.

Maternal Depression Affects Infants' Lexical Processing Abilities in the Second Year of Life.

Maternal depression and anxiety have been proposed to increase the risk of adverse outcomes of language development in the early years of life. This study investigated the effects of maternal depression and anxiety on language development using two approaches: (i) a categorical approach that compared lexical abilities in two groups of children, a risk group (mothers with clinical-level symptomatology) and a control non-risk group, and (ii) a continuous approach that assessed the relation between individual mothers' clinical and subclinical symptomatology and their infants' lexical abilities. Infants' lexical abilities were assessed at 18 months of age using an objective lexical processing measure and a parental report of expressive vocabulary. Infants in the risk group exhibited lower lexical processing abilities compared to controls, and maternal depression scores were negatively correlated to infants' lexical processing and vocabulary measures. Furthermore, maternal depression (not anxiety) explained the variance in infants' individual lexical processing performance above the variance explained by their individual expressive vocabulary size. These results suggest that significant differences are emerging in 18-month-old infants' lexical processing abilities, and this appears to be related, in part, to their mothers' depression and anxiety symptomatology during the postnatal period.

Depression and Anxiety in the Postnatal Period: An Examination of Infants' Home Language Environment, Vocalizations, and Expressive Language Abilities.

This longitudinal study investigated the effects of maternal emotional health concerns, on infants' home language environment, vocalization quantity, and expressive language skills. Mothers and their infants (at 6 and 12 months; 21 mothers with depression and or anxiety and 21 controls) provided day-long home-language recordings. Compared with controls, risk group recordings contained fewer mother-infant conversational turns and infant vocalizations, but daily number of adult word counts showed no group difference. Furthermore, conversational turns and infant vocalizations were stronger predictors of infants' 18-month vocabulary size than depression and anxiety measures. However, anxiety levels moderated the effect of conversational turns on vocabulary size. These results suggest that variability in mothers' emotional health influences infants' language environment and later language ability.

The relative effectiveness of extinction and counter-conditioning in diminishing children's fear.

Two behavioural strategies for reducing learned fear are extinction and counter-conditioning, and in this study we compared the relative effectiveness of the two procedures at diminishing fear in children. Seventy-three children aged 7-12 years old (M = 9.30, SD = 1.62) were exposed to pictures of two novel animals on a computer screen during the fear acquisition phase. One of these animals was paired with a picture of a scared human face (CS+) while the other was not (CS-). The children were then randomly assigned to one of three conditions: counter-conditioning (animal paired with a happy face), extinction (animal without scared face), or control (no fear reduction procedure). Changes in fear beliefs and behavioural avoidance of the animal were measured. Counter-conditioning was more effective at reducing fear to the CS + than extinction. The findings are discussed in terms of implications for behavioural treatments of childhood anxiety disorders.

The Relations Between Maternal Prenatal Anxiety or Stress and Child's Early Negative Reactivity or Self-Regulation: A Systematic Review.

In the present review, we examine the association between maternal prenatal stress or anxiety and children's early negative reactivity or self-regulation. The review includes 32 studies that focus on pregnancy-related anxiety, state or trait anxiety, perceived stress, and stressful life events in relation to child's crying, temperament, or behavior during the first 2 years of life. We searched four electronic databases and 32 studies were selected based on the inclusion criteria. Twenty-three studies found an association between maternal prenatal anxiety or stress and a child's negative reactivity or self-regulation, and typically the effect sizes varied from low to moderate. The association was found regardless of the form of prenatal stress or anxiety and the trimester in which the prenatal stress or anxiety was measured. In conclusion, several forms of prenatal anxiety and stress may increase the risk of emotional and self-regulatory difficulties during the first 2 years of life.

Prenatal Programming of Postnatal Susceptibility to Memory Impairments: A Developmental Double Jeopardy.

In the study reported here, we examined the effects of fetal exposure to a synthetic stress hormone (synthetic glucocorticoids) on children's susceptibility to postnatal sociodemographic adversity. We recruited children who were born healthy and at term. Twenty-six had been treated with steroid hormones (glucocorticoids) during the prenatal period, and 85 had not. Only children exposed to both prenatal stress hormones and postnatal sociodemographic adversity showed impaired performance on standardized tests of memory function. The association was specific to long-term memory. General intellectual functioning and expressive language were not affected by fetal glucocorticoid exposure. Results were independent of maternal intelligence and maternal depression at the time of the study. These findings are consistent with a vulnerability-stress model: Prenatal exposure to synthetic stress hormones is associated with increased susceptibility to subsequent adversity, with consequences for cognitive functioning that persist 6 to 10 years after birth.

Parental care and control during childhood: associations with maternal perinatal mood disturbance and parenting stress.

This study examined the associations between perceived parental care and control in childhood and maternal anxiety, depression and parenting stress during the transition to parenthood. Eighty-eight women completed the Parental Bonding Instrument, self-report measures of anxiety and depression and a structured diagnostic interview (Mini-plus International Neuropsychiatric Interview) during the third trimester of pregnancy. The MINI-Plus and anxiety and depression measures were re-administered at 7 months postpartum. The Parenting Stress Index was also administered at this time. Significant associations were found between maternal 'affectionless control' and prenatal and postnatal symptom measures of anxiety and depression, p values <0.005. Compared to women who reported optimal parenting, women who recalled maternal 'affectionless control' were also six times more likely to be diagnosed with an anxiety disorder during pregnancy (OR = 6.1, 95% CI = 2.17-30.11) and seven times more likely to be diagnosed with postnatal major depression (OR = 6.8, 95% CI = 1.80-25.37). Paternal 'affectionless control' was associated with significantly higher scores on symptom measures of prenatal and postnatal anxiety, p values <0.005. This study suggests that assessing a woman's own parenting history is important in identifying and managing the risk of prenatal and postnatal affective disorders and parenting stress.

Maternal sensitivity moderates the impact of prenatal anxiety disorder on infant mental development.

BACKGROUND: Animal studies have shown that postnatal rearing style can modify the association between prenatal stress exposure and offspring neurodevelopmental outcomes. However, little is known about how parenting quality impacts the association between maternal prenatal anxiety and development in human infants. AIM: This prospective study examined the impact of maternal prenatal anxiety disorder and maternal caregiving sensitivity on cognitive and psychomotor development in healthy, full-term, 7-month-old infants. MEASURES: Women completed a clinical interview during the third trimester of pregnancy to assess anxiety symptoms meeting DSM-IV diagnostic criteria. At infant age 7 months, maternal sensitivity to infant distress and non-distress were observed and coded during the still-face procedure. Maternal postnatal (concurrent) anxiety and depression were also assessed at this time. Infant mental and psychomotor development was assessed at infant age 7 months using the Bayley Scales of Infant Development II. RESULTS: Analyses were based on 77 mother-infant dyads. Maternal sensitivity to infant distress moderated the association between maternal prenatal anxiety disorder and infant mental development, F (1, 77)=5.70, p=.02. Whereas there was a significant positive association between sensitivity and mental development among infants whose mothers were anxious during pregnancy, sensitivity had little impact on mental development among infants of control (non-anxious) women. Results were independent of prenatal depression and postnatal anxiety and depression. A caregiving moderation effect was not found for infant psychomotor development, p>.10. CONCLUSIONS: These findings are consistent with a cumulative risk model suggesting that maternal prenatal anxiety and quality of maternal care act in concert to shape infant outcomes.

Maternal sensitivity moderates the impact of prenatal anxiety disorder on infant responses to the still-face procedure.

Animal studies have demonstrated the interactive effects of prenatal stress exposure and postnatal rearing style on offspring capacity to manage stress. However, little is known about how parenting quality impacts the association between maternal prenatal anxiety and stress reactivity in human infants. This prospective study examined the impact of prenatal anxiety disorder and maternal caregiving sensitivity on infants' responses to a standardised interactive stressor (still-face procedure). Eighty-four women completed a clinical interview during pregnancy to assess anxiety symptoms meeting DSM-IV diagnostic criteria. At infant age 7 months, maternal sensitivity to infant distress and infant negative affect were observed and coded during the still-face procedure. Maternal postnatal (concurrent) anxiety and depression were also assessed at this time. Results indicated a negative association between maternal sensitivity to infant distress and infant negative affect responses to the still-face procedure. An unexpected finding was a positive association between parity and infant reactivity. The main effect for sensitivity was qualified by a significant interaction, p<.05, suggesting that the impact of sensitivity was particularly marked among infants of women who experienced an anxiety disorder during pregnancy. This finding is consistent with a cumulative risk model suggesting that maternal prenatal anxiety and quality of maternal care act in concert to shape infant outcomes.

Maternal prenatal anxiety, postnatal caregiving and infants' cortisol responses to the still-face procedure.

This study prospectively examined the separate and combined influences of maternal prenatal anxiety disorder and postnatal caregiving sensitivity on infants' salivary cortisol responses to the still-face procedure. Effects were assessed by measuring infant salivary cortisol upon arrival at the laboratory, and at 15-, 25-, and 40-min following the still-face procedure. Maternal symptoms of anxiety during the last 6 months of pregnancy were assessed using clinical diagnostic interview. Data analyses using linear mixed models were based on 88 women and their 7-month-old infants. Prenatal anxiety and maternal sensitivity emerged as independent, additive moderators of infant cortisol reactivity, F (3, 180) = 3.29, p = .02, F (3, 179) = 2.68, p = .05 respectively. Results were independent of maternal prenatal depression symptoms, and postnatal symptoms of anxiety and depression. Infants' stress-induced cortisol secretion patterns appear to relate not only to exposure to maternal prenatal anxiety, but also to maternal caregiving sensitivity, irrespective of prenatal psychological state.

Maternal anxiety during the transition to parenthood: a prospective study.

BACKGROUND: This prospective study used both self-report (STAI) and clinical diagnostic interview (MINI-Plus) to examine the course of maternal anxiety across the transition to parenthood. The study also assessed i) the validity of the STAI for antenatal use in an Australian sample and ii) the relative utility of the MINI-Plus and STAI scales as antenatal measures of risk for postnatal anxiety and mood disorders. METHODS: Participants were 100 women recruited during routine antenatal assessment at a major obstetric hospital in Sydney. An antenatal screening instrument (ANRQ) identified half the sample as being at "high risk" for developing postnatal anxiety and/or depression. Participants completed the STAI during the third trimester of pregnancy and the MINI-Plus was administered during pregnancy and during the seventh postnatal month to assess anxiety and depression meeting DSM-IV criteria. RESULTS: The data indicated considerable stability in anxiety and depression from pregnancy through the postnatal period, as assessed by both diagnostic interview and maternal self-report. Antenatal anxiety meeting diagnostic criteria and antenatal trait anxiety exceeding a cut-off score of 40 on the STAI were both found to be significant predictors of postnatal anxiety and mood disorders (p-values<.05). Further analyses revealed that the measures were equivalent in their predictive utility. Finally, the STAI state and trait anxiety scales demonstrated a reasonable estimation of antenatal clinical state when tested against the MINI-Plus diagnostic interview during pregnancy. CONCLUSIONS: The findings from this study suggest that antenatal anxiety as assessed by either clinical interview or maternal self-report is an important predictor of postnatal anxiety and mood disorders. The validity of the STAI scales for use during pregnancy was also demonstrated for the first time in an Australian sample.