Induced abortion has no psychological effect on early parental self-efficacy and psychological well-being: The Steps to the Healthy Development and Well-being of Children study.

INTRODUCTION: An association between a history of induced abortion and psychological well-being post-abortion has been demonstrated in recently published studies, which is contrary to the findings of existing known high-quality studies. MATERIAL AND METHODS: An evaluation was conducted to determine whether a history of abortion affected the psychological well-being and parental self-efficacy of first-time mothers and their partners; this assessment was performed when the child was aged 18 months. Questionnaires were administered to 492 first-time mothers, 37 of whom had a history of abortion, and their partners (n = 436). Women with previous miscarriages, ectopic pregnancies, and deliveries were excluded. The women were allocated to an abortion group or a comparison group, depending on each woman's abortion history obtained from medical birth registry data. Psychological well-being, which encompassed social and emotional loneliness, marital satisfaction, social phobia, and depression, was evaluated as a predictor of maternal and paternal self-efficacy within the two groups. The analysis was conducted using multi-group structural equation modeling. RESULTS: Induced abortion was not predictive of maternal or paternal well-being or parental self-efficacy. Overall, maternal and paternal psychological well-being was predictive of parental self-efficacy when an assessment was performed, regardless of an abortion history. After testing the invariance of multi-group models, psychological well-being was similarly found to predict parental self-efficacy in both the abortion history and comparison groups. CONCLUSIONS: These findings suggest that the psychological well-being of parents is an important predictor of maternal and paternal self-efficacy during toddlerhood. Abortion history was not demonstrated to negatively impact the psychological well-being of parents with respect to their capacity for parental self-efficacy.

Parents' depression and loneliness during pregnancy and respiratory infections in the offspring: A prospective birth cohort study.

BACKGROUND: An association between maternal prenatal stress and increased rates of respiratory tract infections in the offspring has been described earlier. Data regarding the father's role is lacking. In this study our aim was to evaluate, whether mothers' and fathers' depressive symptoms and loneliness during pregnancy predict higher rates of respiratory tract infections in the offspring. METHODS: In this longitudinal cohort study we gathered information on parental psychological risk during gestational week 20 using the BDI-II and UCLA loneliness scale questionnaires for the parents of 929 children. Loneliness was divided into social and emotional components, the former describing patterns of social isolation and the latter a perceived lack of intimate attachments. Episodes of acute otitis media, physician visits due to respiratory tract infections, and antibiotic consumption relating to respiratory tract infections were documented in the infants, excluding twins, from birth until 10 months of age using study diaries. Analyses were carried out by structural equation modeling, which provides dynamic estimates of covariances. RESULTS: Maternal depressive symptoms during pregnancy predicted higher rates of acute otitis media in the infant and maternal emotional loneliness predicted higher rates of physician visits. Acute otitis media, physician visits and antibiotic consumption in the infant were slightly less frequent for families who reported social loneliness in the father or mother. Associations remained when taking into account confounders. CONCLUSIONS: Maternal prenatal depression and emotional loneliness predicted a higher burden of respiratory tract infections in the offspring. The protective influence of parental social loneliness on the burden of respiratory tract infections in infants was not in line with our study hypothesis, but could be explained by reduced use of healthcare services in these socially isolated families.

MOTHERS' AND FATHERS' PRENATAL REPRESENTATIONS IN RELATION TO MARITAL DISTRESS AND DEPRESSIVE SYMPTOMS.

Marital distress, parental depression, and weak quality of parental representations are all known risk factors for parent-child relationships. However, the relation between marital distress, depressive symptoms, and parents' prenatal representation is uncertain, especially regarding fathers. The present study aimed to explore how mothers' and fathers' prenatal experience of marital distress and depressive symptoms affects the organization of their prenatal representations in late pregnancy. Participants were 153 pregnant couples from a Finnish follow-up study called "Steps to the Healthy Development and Well-being of Children" (H. Lagström et al., ). Marital distress (Revised Dyadic Adjustment Scale; D.M. Busby, C. Christensen, D. Crane, & J. Larson, 1995) and depressive symptoms (Edinburgh Postnatal Depression Scale) were assessed at 20 gestational weeks, and prenatal representations (Working Model of the Child Interview; D. Benoit, K.C.H. Parker, & C.H. Zeanah, 1997; C.H. Zeanah, D. Benoit, M. Barton, & L. Hirshberg, 1996) were assessed between 29 and 32 gestational weeks. The mothers' risks of distorted representations increased significantly when they had at least minor depressive symptoms. Marital distress was associated with the fathers' prenatal representations, although the association was weak; fathers within the marital distress group had less balanced representations. Coexisting marital distress and depressive symptoms were only associated with the mothers' representations; lack of marital distress and depressive symptoms increased the likelihood for mothers to have balanced representations. The results imply that marital distress and depressive symptoms are differently related to the organizations of mothers' and fathers' prenatal representations.

Mother's marital satisfaction associated with the quality of mother-father-child triadic interaction.

Low marital satisfaction has been shown to be a risk factor for early parenthood and parent-child relationship problems (Erel & Burman, ; McHale, ). The aim of this study was to assess how parental reports of marital satisfaction related to family alliance and coordination in the observed triadic interaction. The study group included 120 families. Marital satisfaction was evaluated during pregnancy, at 4 months, and at 18 months using the Revised Dyadic Adjustment Scale (RDAS; Busby, Christensen, Crane & Larsson, ) for both parents. Mother-father-child interaction was analyzed in the Lausanne Triadic Play setting and coded using the Family Alliance Assessment Scale (Favez, Lavanchy Scaiola, Tissot, Darwiche & Frascarolo, ) when the child reached 18 months of age. The mother's higher marital satisfaction at every measuring point was associated with a cooperative family alliance and/or higher family coordination at 18 months. The father's experience of marital satisfaction was not related to family interaction at any assessment point. Our study suggests that a mother's experience of lower marital satisfaction during pregnancy may be an early sign of later problems in family relationships.

Initiation and exclusivity of breastfeeding: association with mothers' and fathers' prenatal and postnatal depression and marital distress.

INTRODUCTION: This study explored the effects of mothers' and fathers' prenatal and postnatal depressive symptoms and marital distress on breastfeeding initiation and exclusive breastfeeding (EBF) duration. MATERIAL AND METHODS: This was a prospective follow-up of a cohort sample of 873 families participating to an intensive follow-up cohort of longitudinal Steps to the Healthy Development and Well-being of Children study (The STEPS study) in Southwestern Finland. The depressive symptoms were evaluated by The Edinburgh Postpartum Depression Scale and marital distress by the Revised Dyadic Adjustment Scale at 20th gestational week and at 4 months postpartum. EBF was self-reported real-time and defined as an infant receiving no food or drink other than mother's breast milk since birth, except occasionally water. RESULTS: Neither parents' prenatal depressive symptoms predicted breastfeeding initiation or EBF duration. The mothers' prenatal depressive symptoms, in turn, predicted their postnatal depressive symptoms, which were associated with shorter duration of EBF. The EBF duration was shortest amongst the mothers who had depressive symptoms both pre- and postnatally compared to mothers who had depressive symptoms only in either time point alone (M = 1.54, 2.06 and 2.04 months, respectively). Higher prenatal maternal marital distress was associated with longer EBF duration. CONCLUSIONS: The findings suggest that the continuity of maternal depressive symptoms throughout the perinatal period has adverse effect on EBF duration. Identification and treatment of mothers' depressive symptoms already during the prenatal period may improve breastfeeding practices. The finding of mothers' marital distress having positive impact on breastfeeding practices requires further investigation.

Intercorrelations and developmental pathways of mothers' and fathers' loneliness during pregnancy, infancy and toddlerhood--STEPS study.

Our aim was to study the inter-correlations and developmental pathways of mothers' and fathers' social and emotional loneliness during pregnancy (20th pregnancy week), infancy (child aged 8 months), and early childhood (child aged 18 months). Moreover, we aimed to study whether mothers and fathers who have different developmental profiles (identified by latent growth curve mixture models) differ in their experiences of marital dissatisfaction (RDAS), social phobia (SPIN) and depression (BDI) during pregnancy. Both mothers' social and emotional loneliness and fathers' social and emotional loneliness were highly stable, and within individuals these loneliness factors were strongly correlated. However, the correlations between mothers' loneliness experiences and fathers' loneliness experiences were weaker than expected. Separate latent growth curve groups were identified, which differed in feelings of marital dissatisfaction, social phobia, and depression. These groupings revealed that the higher the loneliness was, the more the parents experience these other psychosocial problems.

Parents' psychological well-being and parental self-efficacy in relation to the family's triadic interaction.

The aim of the study was to assess whether a parent's psychological well-being and/or self-efficacy relate to interaction within the family. This study is part of a Finnish follow-up study called Steps to the Healthy Development and Well-Being of Children (STEPS;). The study group included 120 families. Mother's and father's social anxiety and depression were assessed during pregnancy and at 18 months of the child's age using self-report questionnaires; the mother's and father's self-efficacy were assessed at 18 months using a parental self-efficacy scale validated within the STEPS study. Mother-father-child triadic interaction was studied at 18 months within a Lausanne Triadic Play setting. Results showed that maternal symptoms of depression during pregnancy and maternal social anxiety at 18 months were related to triadic interaction within the family. There was no relation between father's psychological well-being and triadic interaction within the family. Father's self-efficacy in teaching tasks and the Mother's self-efficacy in emotional support were associated with family interaction. The findings suggest that maternal psychological well-being and self-efficacy in emotional support may be important components of family triadic interaction whereas paternal self-efficacy in teaching tasks seems to support family coordination in triadic interaction.

Psychological ill-being experienced by first-time mothers and their partners in pregnancy after abortion: a cohort study.

The psychological effects of abortion have been much discussed lately, with recently published studies indicating that induced abortion (IA) may, contrary to the general consensus, be contributing to psychological symptoms post-abortion. Using a cohort of first-time mothers, we assessed the likelihood of them experiencing psychological ill-being at the midpoint of their pregnancy, depending on their IA history. We also examined the psychological symptoms of their partners, the hypothesis being that ill-being in IA-experienced mothers might reflect onto their partners. Altogether 680 future first-time mothers (9.8% of whom had an IA history) and their partners were selected. Most mothers attended their 16 check-ups at maternity health clinics (MHC), where the family's physical and emotional well-being were checked. Several internationally validated questionnaires, which gauged psychological ill-being, were filled in at the 20th week of pregnancy. There were no significant differences between the study and the control group in terms of psychological ill-being during the pregnancy. The contribution of prior IA to psychological ill-being during the next pregnancy seems to be minimal. The availability of IA procedures, intensive MHC services in Finland, as well as this society's neutral attitude towards IA, may be among the reasons why the results are so positive for mothers who have previously undergone one or more IAs.

Dental fear affects adolescent perception of interaction with dental staff.

The main purpose of this study was to explore whether subjective perception of interaction with dental staff is associated with dental fear in a population-based sample of 18-yr-old adolescents (n = 773). The interaction was measured using the Patient Dental Staff Interaction Questionnaire (PDSIQ), validated with exploratory and confirmatory factor analyses, which yielded the factors of 'kind atmosphere and mutual communication', 'roughness', 'insecurity', 'trust and safety', and 'shame and guilt'. Dental fear was measured using the Modified Dental Anxiety Scale (MDAS). Gender and sense of coherence (SOC) were included as potential confounding variables. Adolescents with high dental fear more often perceived their interaction with dental staff negatively and more often felt insecure than others. This difference persisted after adjustment for gender and SOC. In conclusion, adolescents with high dental fear may perceive their interaction with dental staff more positively if the staff succeed in creating a positive, trusting, approving, and supportive atmosphere with kindness, calmness, and patience. The communication and interaction skills of dental staff may play a particularly important role when encountering highly fearful dental patients.

Dental fear and sense of coherence among 18-yr-old adolescents in Finland.

The aim was to investigate whether dental fear was associated with the sense of coherence (SOC) among 18-yr-old adolescents (n = 777). Cross-sectional data from a prospective cohort of a random sample of families from Finland and their first-born children were used. Dental fear was measured using the Modified Dental Anxiety Scale and categorized as high dental fear for scores of 19-25 and as no to moderate dental fear for scores of 5-18. Sense of coherence was measured using a 13-item version of Antonovsky's Sense of Coherence Questionnaire, dichotomized as scores 13-63 for weak SOC and as scores of 64-91 for strong SOC. Gender and education were included as background factors in the logistic regression analyses. The prevalence of high dental fear was 8%. Those reporting high dental fear reported more often a weaker SOC than did those with no to moderate dental fear (69% vs. 31%, OR = 2.5, 95% CI = 1.4-4.4), also when adjusted for gender and education (OR = 2.2, 95% CI = 1.2-3.9). According to the theory of salutogenesis, as proposed by Antonovsky, SOC is a resource instrument especially in situations of tension or strain and hence a strong SOC might protect against high dental fear.

Cohort profile: Steps to the healthy development and well-being of children (the STEPS Study).

The STEPS Study aims to search for the precursors and causes of problems in child health and well-being by using a multidisciplinary approach. The cohort consists of all mothers (Finnish or Swedish speaking) who had live deliveries in the Hospital District of Southwest Finland from January 2008 to April 2010 and their children (n=9811 mothers, n=9936 children). Of these, 1797 mothers and their 1827 children were recruited to an intensive follow-up group during the first trimester of pregnancy or soon after delivery. Information about the whole study cohort is based on pregnancy follow-up data from maternity clinics, National Longitudinal Census Files and child welfare clinics. Data from multiple sources are used to obtain a picture of the overall well-being of the child and the family. After birth, study visits include several clinical examinations. Collaboration is encouraged, and access to the data will be available when the data set is complete.

The role of gender, affectivity and parenting in the course of disordered eating: a 4-year prospective case-control study among adolescents.

BACKGROUND: Prolonged eating disturbances increase the risk for a full-blown eating disorder and lifelong health impairment. Screening will improve early detection of eating pathology, but the major question still remains: who will benefit from early treatment and who needs little or no intervention. To answer this question, information about the factors that predict the course of disordered eating is valuable. OBJECTIVES: To investigate the course of eating disturbance from middle to late adolescence, to test certain individual and parental factors potentially explaining the differences in the course of eating disturbance, and to estimate the predictive power of these factors in terms of the recurrence of eating disturbance and the onset of new presentations of eating pathology after mid-adolescence. DESIGN: A four-year follow-up study with a case-control design. SETTINGS: School health care and community settings in south-western Finland. PARTICIPANTS: Students who had reported eating disturbance at baseline (n=208, response rate 69%) and a group of non-symptomatic controls (n=514, response rate 81%) were enrolled and matched by school, grade, and gender. METHODS: At baseline assessment, mid-adolescent students (mean age 14.9 years) self-administered the SCOFF eating disorder questionnaire as part of their regular health examination. Background information, including self-reported mood questionnaire RBDI, was obtained from the students' health care records. Four years later, the participants (mean age 19.0 years) responded to the questionnaire by mail. Logistic regression analyses were used to assess the recurrence and onset of eating disturbance and the associated factors. RESULTS: Altogether 52% of girls and 17% of boys who reported eating disorder symptoms in the baseline assessment remained symptomatic at follow-up. Depressiveness--even transient--in mid-adolescence predicted recurrence of eating disturbance in late adolescence. Prolonged dissatisfaction with appearance predicted the onset of eating disturbance in previously symptom-free girls. In general, experience of average parenting was good enough for the girls in terms of recovering from eating disturbance and avoiding the onset of eating problems after mid-adolescence. CONCLUSIONS: Adolescent girls who report both eating disturbance and negative affectivity may benefit from extra support. The beneficial role that parents may have in helping these girls must not be forgotten.

Uncovering hidden eating disorders using the SCOFF questionnaire: cross-sectional survey of adolescents and comparison with nurse assessments.

BACKGROUND: The majority of individuals with an eating disorder remain undetected in healthcare. To improve the situation, screening for eating disorder symptoms is suggested to be a routine part of the health examination of adolescents. Given the busy practice of school healthcare, the screening tool needs to be brief and efficient. OBJECTIVES: To evaluate the feasibility of the Finnish version of the SCOFF questionnaire in screening for eating disorder symptoms among adolescents. DESIGN: A natural design with cross-sectional surveys. SETTING: School healthcare in a major city in southwestern Finland. PARTICIPANTS: Students, aged 14-16 years, attending the 8th grade (n=1036, response rate=71%) and the 9th grade (n=855, response rate=62%) at Finnish-speaking secondary schools during the academic years 2003-2005, and their school nurses (n=14). Adolescents attending special classes for those with learning disabilities were excluded from the study. METHODS: Students self-administered the SCOFF questionnaire as part of a health examination. Background information was obtained from the students' healthcare records. Data from school nurses were collected with semi-structured questionnaires designed for this study. Confirmatory factor analysis was used to identify the best factor model of SCOFF for girls and boys. Descriptive statistics were used to assess the efficiency of SCOFF in comparison with established health examination practice for the purpose of detecting potential eating disorder cases among adolescents. RESULTS: Confirmatory factor analyses indicated a good fit of both the unidimensional and a two-factor model of SCOFF and yielded support for the gender-free interpretation of the screening results in mid-adolescent populations. Altogether 81% of the students who self-reported eating disorder symptoms in SCOFF remained undetected in a health examination where no eating disorder questionnaire was used. CONCLUSIONS: SCOFF was found to be an appropriate instrument for screening for eating disorder symptoms in mid-adolescent populations within school healthcare. It may be a useful tool for detecting disordered eating, especially when no objective features of eating disorders appear. However, screening shall not replace a health examination but it is recommended to include it to health examinations so as to best take advantage of both procedures.

Towards understanding gender differences in disordered eating among adolescents.

AIMS AND OBJECTIVES: The aim of the study was to enhance the detection of disordered eating in adolescents. The objectives were to examine gender differences in the prevalence of eating disorder symptoms, in occurrence of health-risk factors and susceptibility to these and to investigate associations between health-risk factors and eating disorder symptoms. BACKGROUND: Disordered eating has a strong female preponderance. Reasons for the gender discrepancy are not well known. However, to develop effective strategies for eating disorder prevention, we need to understand gender differences in disordered eating and the related factors. DESIGN: This is a school-based, cross-sectional cohort study with a natural design. METHODS: The SCOFF and the R-BDI questionnaires were administered to students (14-15 years old) attending the eighth grade of secondary school. Information about health-risk factors was obtained from the adolescents' school health-care records. RESULTS: The results were based on data from 1036 (71% of the sample) students. Self-reported eating disorder symptoms were prevalent in 24% of the girls and 16% of the boys. Girls reported many of the health-risk factors studied at a higher rate than boys. However, there were no gender differences in susceptibility to these factors. Dissatisfaction with appearance or weight, use of tobacco, lack of regular meals and poor communication with parents increased the likelihood of eating disorder symptoms in both genders. CONCLUSIONS: Gender differences in disordered eating are relatively small in adolescence. To enhance the detection of eating disorder symptoms, both girls and boys should be screened for these problems in secondary school. RELEVANCE TO CLINICAL PRACTICE: The results can help nurses to use the information obtained from adolescents' health-care records, their annual health examinations and their responses to the SCOFF questionnaire to identify those who need further intervention, including adolescent boys.

Adolescents with fluctuating symptoms of eating disorders: a 1-year prospective study.

AIM: This paper is a report of a study to investigate the stability of self-reported eating disorder symptoms, factors associated with them and the predictors of their recurrence. BACKGROUND: In western cultures, eating-related problems during adolescence are common but usually temporary. However, in approximately 10% of cases disordered eating is sustained, increasing the risk of a full-blown eating disorder. To distinguish adolescents with temporary eating problems from those whose problems are likely to continue, healthcare providers need to understand the progress of disordered eating and the features of high-risk adolescents. METHODS: The two-stage prospective survey was conducted with a school-based sample of adolescents aged 15-17 years. At baseline, in 2003-2004, the SCOFF ('Sick', 'Control', 'One', 'Fat' and 'Food') questionnaire was administered to students in the 9th year of schooling in Finland. Follow-up assessment took place 1 year later, and 372 students provided data at both assessments. Binary logistic regression analysis was performed to investigate which factors predict the recurrence of eating disorder symptoms, defined as the occurrence of eating disorder symptoms at both assessments. RESULTS: Five per cent of the students reported eating disorder symptoms at both assessments. Typically, they had multiple psychological problems and health complaints. Anxiety perceived earlier in adolescence resulted in an estimated odds ratio of the logistic model of 20 for the recurrence of eating disorder symptoms. CONCLUSION: Earlier anxiety rather than dissatisfaction with appearance had a statistically significant effect on the progress of eating problems. Longitudinal research is needed to confirm the results. Until further knowledge is available, nurses should follow-up all adolescents with disordered eating to identify a possible need for intervention.

Infant temperament and maternal sensitivity behavior in the first year of life.

Maternal sensitivity behavior (MSB) and infant temperament were investigated among 56 Finnish low-risk mothers and their full-term and healthy infants. The mothers were from families with good economic status, the infant's parents lived together, and the mothers were well educated. Mothers and infants were video-recorded in free-play situations at home, and evaluated using the Parent-Child Early Relational Assessment Scale (PCERA). The infants were also assessed using the Revised Infant Temperament Questionnaire (R-ITQ) and the Toddler Temperament Questionnaire (TTQ). Most of the temperament characteristics showed moderate stability during the first year. MSB was related to infant temperament characteristics at 3, 6 and 12 months of age. Gender differences in temperament were evident already at 6 and 12 months of age. Few prior studies have reported gender differences in infancy.

Maternal sensitivity behavior and infant crying, fussing and contented behavior: the effects of mother's experienced social support.

Maternal sensitivity behavior, mother's experienced difficulties, experienced social support, and the amount of infant's crying, fussing and contented behavior were studied when the infants were 3 and 12 months of age. Fifty-seven Finnish low-risk mothers' sensitivity behavior was assessed by the Parent-Child Early Relational Assessment method. Infant's crying behavior was assessed by the Baby's Day Record and by the Crying Patterns Questionnaire. The Social Support Questionnaires (SSQ 1 and 2) were used to evaluate mother's experienced difficulties and support. The infants of More Sensitive (MS) mothers were more contented than those with Less Sensitive (LS) mothers. The MS mothers experienced fewer difficulties with their infants and experienced more support from their best friend and their husband than LS mothers. In addition, some gender differences were found concerning infant behavior.