Intimate partner violence across pregnancy and the postpartum and the relationship to depression and perinatal wellbeing: findings from a pregnancy cohort study.

PURPOSE: To compare the prevalence of emotional and physical intimate partner violence (IPV) across pregnancy and the first year postpartum in those with and without clinical depression and assess the association between maternal childhood trauma, current stressful life events and depression and IPV over the perinatal period. METHODS: Data were obtained from 505 pregnant women from the Mercy Pregnancy and Emotional Wellbeing Study (MPEWS), a cohort study with data collected across pregnancy until 12 months postpartum. Maternal antenatal depression was measured using the Structured Clinical Interview for DSM-IV (SCID-IV) with repeat measurement of perinatal depressive symptoms using the Edinburgh Postnatal Depression Scale (EPDS). Trauma was measured using the Childhood Trauma Questionnaire, and experiences of physical and emotional intimate partner violence using items in the Stressful Life Events Scale. RESULTS: Women experiencing IPV across the perinatal period were significantly more likely to score over 13 on the EPDS (p < .001) at each timepoint in pregnancy and the postpartum and physical IPV was associated with clinical depression. Further, a history of childhood trauma and current additional stressful life events were significantly associated with reporting current IPV in the perinatal period. CONCLUSIONS: This study confirmed the risk factors of childhood trauma and current stressful life events for reporting experiences of IPV in the perinatal period. Furthermore, women experiencing IPV reported higher depressive symptoms, providing evidence supporting the value of assessing those women who screen higher on the EPDS for IPV. Together these findings also support trauma informed care across pregnancy and the postpartum.

Stressful life events and depression in late pregnancy: Comparison between rural and metropolitan women using data from an Australian cohort study.

OBJECTIVE: To identify whether a diagnosis of depression combined with rurality, compared with either depression or living in metropolitan areas alone, is associated with experiencing more stressful life events in pregnancy. DESIGN: This study uses data from 402 pregnant women (206 metropolitan and 196 rural), enrolled in the Western Australian arm of the Mercy Pregnancy and Emotional Wellbeing Study. Mercy Pregnancy and Emotional Wellbeing Study is a prospective, longitudinal cohort with women recruited during early pregnancy (<20 weeks) across 3 groups: those with diagnosed depression, those taking antidepressant medication and control. PARTICIPANTS: Women were recruited from 3 metropolitan and 3 rural hospitals in Western Australia from 2017 to 2018 and 2018 to 2020, respectively. This study uses antenatal data collected at recruitment and during third trimester (weeks 32-34). MAIN OUTCOME MEASURES: The Stressful Life Events Scale was used to measure the number of self-reported stressful events. The degree of perceived stress due to the stressful event was also reported. RESULTS: Compared to pregnant metropolitan women diagnosed with depression, pregnant rural women with depression were more likely to report experiencing at least 1 stressful life event. Despite this, pregnant women with depression in both regions reported similar numbers of stressful life events. CONCLUSIONS: This study highlights women in rural Western Australia diagnosed with depression might be more vulnerable to experiencing stressful life events than rural women without depression and their metropolitan counterparts. Due to known adverse effects of antenatal depression and stress on maternal well-being and child outcomes, there is a clear need for targeted, preventative interventions for Australian rural women during this period.

A psychometric study of the Emotional Availability Scales: Construct validity and measurement invariance between depressed and nondepressed mother-infant dyads.

The Emotional Availability Scales (EAS) are the most widely reported observational assessment measure of parent-child relationships and has been of particular interest in understanding differences between samples of depressed and nondepressed mothers and their offspring. Despite its widespread use, psychometric validation of the factor structure in normative samples and the measurement of invariance within clinical samples has not been published. We evaluated the internal structure (dimensionality, reliability, convergent, and discriminant validity) of the EAS fourth edition using a nondepressed sample of 157 Australian women and their infants aged 6 months, including testing the measurement invariance of the EAS between the same nondepressed sample (n = 157), and a depressed group (n = 185) of mother-infant dyads, using MPlus. Participants were recruited from tertiary hospitals, and depression status was established using a diagnostic measure. Higher-order confirmatory factor analyses on the EAS' six dimensions supported a unidimensional factor solution in our data. Full measurement invariance was not demonstrated due to metric noninvariance of the maternal nonintrusiveness and child responsiveness dimensions. Full scalar invariance supported mean comparisons, and a medium effect of .78SD lower mean emotional availability for the depressed group was found; Cohen's d = .63, 95% CI [.41, .85]. While arguments exist for the clinical utility of differentiating between multiple dimensions of emotional availability, the current findings do not support a multidimensional factor structure or full multigroup measurement invariance of the EAS. Similar psychometric investigations of the EAS in clinical and nonclinical samples are needed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Major depression as a predictor of the intergenerational transmission of attachment security: Findings from a pregnancy cohort study.

OBJECTIVE: Understanding the relationship between attachment and mental health has an important role in informing management of perinatal mental disorders and for infant mental health. It has been suggested that experiences of attachment are transmitted from one generation to the next. Maternal sensitivity has been proposed as a mediator, although findings have not been as strong as hypothesised. A meta-analysis suggested that this intergenerational transmission of attachment may vary across populations with lower concordance between parent and infant attachment classifications in clinical compared to community samples. However, no previous study has examined major depression and adult attachment in pregnancy as predictors of infant-parent attachment classification at 12 months postpartum. METHODS: Data were obtained on 52 first-time mothers recruited in early pregnancy, which included 22 women who met diagnostic criteria for current major depression using the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders. The Adult Attachment Interview was also administered before 20 weeks of pregnancy. A history of early trauma was measured using the Childhood Trauma Questionnaire and maternal sensitivity was measured at 6 months postpartum using the observational measure of the Emotional Availability Scales. Infant-parent attachment was measured using the Strange Situation Procedure at 12 months. RESULTS: Overall, we found no significant association between the Adult Attachment Interview and the Strange Situation Procedure classifications. However, a combination of maternal non-autonomous attachment on the Adult Attachment Interview and major depression was a significant predictor of insecure attachment on the Strange Situation Procedure. We did not find that maternal sensitivity mediated parental and infant attachment security in this sample. CONCLUSION: While previous meta-analyses identified lower concordance in clinical samples, our findings suggest women with major depression and non-autonomous attachment have a greater concordance with insecure attachment on the Strange Situation Procedure. These findings can guide future research and suggest a focus on depression in pregnancy may be important for subsequent infant attachment.

Maternal social support, depression and emotional availability in early mother-infant interaction: Findings from a pregnancy cohort.

BACKGROUND: Social support theory suggests that parental social support may influence the nature of early parenting behaviours and specifically the mother-infant relationship. This study examines whether support from a partner, friends or family is associated with differences in quality of mother-infant interactions in the context of maternal depression. METHODS: 210 women were followed from early pregnancy to six months postpartum within Australian pregnancy cohort, the Mercy Pregnancy and Emotional Wellbeing Study (MPEWS). Mother-infant interactions within a standardised observation at six months postpartum were measured by the Emotional Availability (EA) Scales using total scores of the parental scales. In early and late pregnancy and at six months postpartum, mothers rated perceived maternal social support from a partner, family and friends using subscales of the Multidimensional Scale of Perceived Social Support. Depression was measured in early pregnancy and at six months postpartum using the Structured Clinical Interview for the DSM-IV-TR, with repeated measurement of depressive symptoms by the Edinburgh Postnatal Depression Scale (EPDS). Data was analysed using structural equation models. RESULTS: There were significant interactions between depressive symptoms in early pregnancy and perceived maternal support from a partner (B = .18, 95% CI = 03, .31) and separately from family (B = .12, 95% CI = .03, .32) in predicting maternal emotional availability. No such interaction was found for support from friends. While partner and family support moderated the association between early depressive symptoms and emotional availability, there were no direct associations between maternal depressive disorder in early pregnancy and perceived support, and further, maternal depression was not a significant predictor of emotional availability. LIMITATIONS: Future studies should consider extending measurement of the mother-infant relationship beyond the EA Scales, inclusion of a measure of maternal childhood trauma, and replicating our findings. CONCLUSION: Maternal perception of partner and family support in the postpartum is a predictor of the association between early pregnancy depressive symptoms and maternal emotional availability.

Maternal trauma and emotional availability in early mother-infant interaction: findings from the Mercy Pregnancy and Emotional Well-being Study (MPEWS) cohort.

Understanding how a mother's traumatic experiences influence her interactions with her infant may have importance for understanding infant development and mental health. Data for this study were drawn from an Australian pregnancy cohort, the Mercy Pregnancy and Emotional Wellbeing Study. Maternal trauma from Childhood, Childbirth Experiences, and Stressful Life Events were examined. At six-months postpartum, 211 predominantly first-time mothers (mean age 31.5 years), and their infants, were video-recorded interacting for 40 minutes. Interactions were assessed with the Emotional Availability (EA) Scales. Using structural equation modelling to test multiple mediation pathways, moderate-to-severe childhood trauma had only a direct effect on reducing maternal EA with the infant (ß=-.17, p=.031), as did current stressful life events (ß=-.19, p=.019), after controlling for maternal depression, age, and tertiary education. This highlights that proximate trauma specific to the perinatal period may not account for the effect of distal childhood trauma on maternal EA at six-months postpartum.

Maternal psychosocial predictors of pacifier use in a mother-infant interaction task: An observational study from the MPEWS pregnancy cohort.

The prevalence of pacifier use is high but when it occurs outside of the recommended sleep context, it becomes more controversial. Using 211 mother-infant dyads recorded as part of the Mercy Pregnancy and Emotional Wellbeing Study, we examined the maternal psychosocial predictors of pacifier use within an interaction task (i.e., ten minutes face-to-face followed by 30-minutes unstructured play). Predictors included maternal emotional availability measured with the Emotional Availability Scales; depression measured by the Structured Clinical Interview for the DSM-IV-TR Clinician Version; and maternal history of childhood trauma measured by the Childhood Trauma Questionnaire. An unadjusted odds ratio demonstrated that women classified as non-emotionally available to their infants were three-and-a-half-times more likely to use a pacifier. Multivariate logistic regression including all maternal psychosocial predictors demonstrated that even when adjusting for cessation of breastfeeding, maternal emotional availability remained the only significant predictor of pacifier use. This is the first time that predictors of pacifier use have been examined with a sample of clinically depressed women, as well as women with childhood trauma history. The results provide preliminary evidence that women who are not emotionally available might be more likely to rely on a pacifier during mother-infant interaction.

Maternal perinatal depression, circulating oxytocin levels and childhood emotional disorders at 4 years of age: The importance of psychosocial context.

Oxytocin has been a hormone of interest in understanding both depression and parenting. Here, the role of oxytocin has been explored in understanding the interaction between perinatal depression, history of trauma and subsequent longer-term child socio-emotional outcomes. Data were obtained from 203 pregnant women from the Mercy Pregnancy and Emotional Wellbeing Study (MPEWS), a pregnancy cohort study with data collected across pregnancy, postpartum and until 4 years for mother and child. Maternal antenatal depression was measured using the Structured Clinical Interview for DSM-IV (SCID-IV) together with the Childhood Trauma Questionnaire to measure maternal trauma history. Maternal oxytocin levels were measured by enzyme immunoassay following extraction at four time points across pregnancy and the postpartum. The offspring consisted of 203 children followed up from birth until 4 years of age when they were assessed for DSM 5 depression and anxiety disorders (emotional disorders) using the Preschool Age Psychiatric Assessment. Maternal oxytocin levels increased over pregnancy and the postpartum in both control and depressed women with no difference between groups. Maternal childhood trauma and antenatal antidepressant use was also not associated with maternal oxytocin levels. Lower gestational age, maternal depression and early childhood trauma, and late pregnancy oxytocin concentrations were associated with later childhood emotional disorders; together they predicted 10% of variance for emotional disorders. Oxytocin is a hormone whose role in understanding intergenerational risk from pregnancy to child emotional disorders is dependent on relational context. Future research can expand on understanding these important early predictors of childhood mental health.

Maternal depression and the emotional availability of mothers at six months postpartum: Findings from the Mercy Pregnancy and Emotional Wellbeing Study (MPEWS) pregnancy cohort.

BACKGROUND: Existing research suggests maternal depression may reduce the quality of early mother-infant interaction and this might increase our understanding of how maternal mental health impacts on child development outcomes. However, most studies recruit from community samples and few include both a diagnostic measure of maternal depression together with an observational measure of the quality of the mother-infant relationship. METHODS: Data was drawn from 210 women recruited in early pregnancy until 6 months postpartum within an Australian pregnancy cohort, the Mercy Pregnancy and Emotional Wellbeing Study. Those women who at six months postpartum were video recorded interacting with their infant for at least 40-minutes were included in this study, with the quality of those interactions assessed using the Emotional Availability Scales coding system. Depression was measured using the Structured Clinical Interview for the DSM-IV-TR Clinician Version and the Edinburgh Postnatal Depression Scale, and covariates included maternal age and education. RESULTS: Whilst results showed a small negative association between antenatal depressive symptoms in trimester one of pregnancy and maternal EA, there was no effect of maternal depression diagnosis or of maternal depressive symptoms in later pregnancy or postpartum. LIMITATIONS: This study focuses exclusively on mothers and does not account for the role of partners. CONCLUSIONS: Maternal depression might have a smaller effect on maternal EA then some existing research implies, with that effect most prevalent in early pregnancy. Clinical intervention might not be necessary for all mother-infant dyads experiencing depressive symptomology, but instead be directed to those with additional risk factors.

Refugee children's play: Before and after migration to Australia.

AIM: Play is vital to children's development, health and resilience. Play modulates cognitive, emotional and social well-being. Children constitute approximately half of all humanitarian refugee entrants resettled in Australia. Refugee children are commonly victims and witnesses of war and persecution, living across resource-poor environs during transit. Little is known about the effects of refugee migration on play. This study explores how refugee children engaged in play pre-migration (in their home country) and post-migration (Australia). METHODS: Refugee children attending the Refugee Health Clinic of a tertiary children's hospital were invited to complete a qualitative descriptive study of play. The children were asked to draw how they played pre- and post-migration. Drawings were analysed for (i) the presence of play; (ii) location of play; and (iii) drawing detail. RESULTS: Nineteen refugee children were recruited (mean age 8.5 years ± standard deviation 6.4 months). Significantly fewer children drew play pre- versus post-migration (11/19, 58% vs. 18/19, 95% P < 0.03). Girls had greater comparative changes in play with migration (pre: 2/8, 25% vs. post: 7/8, 87%, P = 0.06), trending to significance. Of those children who drew play, almost all drew playing outside (pre-migration: 10/11, 90.9%; post-migration: 17/18, 94.4%). Drawings showed equivalent detail pre- and post-migration. CONCLUSION: Resettled refugee children, especially girls, demonstrated limited play pre-migration, with higher levels of engagement post-resettlement. Facilitating opportunities for variety of play may strengthen positive resettlement outcomes for children and parents. Larger longitudinal studies examining play in refugee children and associations with physical, development and psychological well-being are warranted.