Offline and online parental mentalizing in mothers with symptoms of postpartum depression: Examining the association between self-reported parental reflective functioning and interactional mind-mindedness.

Mentalizing is, to a certain extent, considered context specific. However, research on the association between parents' abilities to reflect upon their infant's mental states outside social interaction (offline) versus during ongoing parent-infant interaction (online) is currently limited. This study investigated the association between self-reported offline and online mentalizing in a sample of primarily ethnically Danish mothers (N = 142), with symptoms of postpartum depression, and their 1-11-month-old infants. Offline mentalizing was assessed with the Parental Reflective Functioning Questionnaire-Infant Version (PRFQ-I) and online mentalizing was assessed with interactional mind-mindedness. Ordinal logistic regressions showed that a higher score on the PRFQ-I prementalizing subscale was negatively related to number of overall mind-related comments and appropriate mind-related comments produced by mothers during interaction with their infant. Our results indicate partial overlaps between self-reported parental reflective functioning and mind-mindedness, that is, that particularly offline maladaptive mentalizing is associated with lower levels of mentalizing during interaction in mothers with symptoms of depression. Post-hoc examination of the interaction effect of postpartum depression showed that this association was only evident in mothers with medium to high levels of depression. Findings and implications are discussed.

Se considera, hasta cierto punto, que la mentalización se corresponde con un contexto específico. Sin embargo, la investigación acerca de la asociación entre las habilidades de los padres de reflexionar sobre los estados mentales de sus infantes fuera de la interacción social (no conectada a la internet / fuera de línea) versus la continua interacción progenitor­infante (en línea) es actualmente limitada. Este estudio investigó la asociación entre la auto­reportada mentalización tanto fuera de línea como en línea en un grupo muestra primariamente de madres étnicamente danesas (N = 142), con síntomas de depresión posterior al parto, y sus infantes de 1 a 11 meses de edad. La mentalización fuera de línea se evaluó por medio del Cuestionario del Funcionamiento con Reflexión del Progenitor ­ Versión del Infante (PRFQ­I) y la mentalización en línea se evaluó con el sistema de codificación de Conciencia Mental. La regresión logística ordinal mostró que un puntaje más alto en la sub­escala de pre­mentalización del PRFQ­I se asoció negativamente con el número en general de comentarios relacionados con la mente y de apropiados comentarios relacionados con la mente producidos por las madres durante la interacción con sus infantes. Nuestros resultados indican que hay superposiciones coincidentes parciales entre el funcionamiento con reflexión auto­reportado por el progenitor y la conciencia mental, v.g. que particularmente la mentalización fuera de línea inadaptada se asocia con una conciencia mental en línea menos óptima en madres con síntomas de depresión. Las posteriores examinaciones que el efecto de la interacción de la Escala de Depresión Postnatal de Edimburgo (EPDS) tiene sobre la asociación mostraron que esta característica sólo fue evidente en madres con niveles medianos a altos de depresión. Se discuten los resultados y las implicaciones.

La mentalisation est, dans une certaine mesure, considérée comme étant spécifique au contexte. Cependant les recherches sur le lien entre les capacités des parents à réfléchir sur les états mentaux de leur bébé en dehors de l'interaction sociale (hors connexion) par rapport à l'interaction continue parent­bébé (en ligne) sont en ce moment limitées. Cette étude s'est penchée sur le lien entre la mentalisation auto­déclarée hors connexion et en ligne chez un échantillon de mères en grande partie danoises (N = 142), avec des symptômes de dépression postpartum et leurs bébés âgés de 1 à 11 mois. La mentalisation hors connexion a été évaluée au moyen du Questionnaire de la Fonction Réflexive Parentale ­ Version Nourrisson (en anglais PRFQ­I) et la mentalisation en ligne a été évaluée au moyen du système de codage esprit­sensibilité. Des régressions logistiques ordinales ont montré qu'un score plus élevé à la sous­échelle PRFQ­I était lié de manière négative au nombre de commentaires généraux liés à l'esprit et à des commentaires liés à l'esprit appropriés produits par les mères durant l'interaction avec leur bébé. Nos résultats indiquent des chevauchement spartiels entre la fonction réflexive parentale auto­rapportée et la sensibilité, c'est­à­dire que la mentalisation inadaptée en particulier hors­connexion est liée à une sensibilité moins qu'optimale chez les mères avec des symptômes de dépression. L'examen a posteriori des effets de l'interaction de l'EPDS sur ce lien a montré que cela n'était que vrai chez les mères avec des niveaux de dépression de moyens à élevés. Les résultats et implications sont discutés.

The significance of parental mentalizing for four-year-old children's solitary pretend play.

BACKGROUND: Pretend play is a signature behavior of early childhood and is considered to reflect the child's emerging symbolic function, enabling the interpretation of social signals, language development, and emotion understanding. While theory links parental mentalizing with children's pretend play, only a few studies have investigated this association. These studies are limited to infancy and early toddlerhood, and child pretend play is assessed during play with an adult (social play). Based on the assumption that child solitary pretend play reflects the child's 'baseline' pretend play ability, in this study, we investigated children's pretend play at its peak, i.e., during the preschool age, without the facilitation of another player. The overall objective was to investigate if parental mentalizing increases pretend play complexity in children. METHODS: The sample consisted 99 Danish mothers and their 4-year-old children. Employing a cross-sectional design, we hypothesized that parental mental state language, as an indicator of 'online' mentalizing during interaction with the child, is a mechanism through which 'offline' mentalizing, measured as parental reflective functioning, is associated with child solitary pretend play. Child pretend play complexity was observed and coded with an adapted version of the 12-Step Play Scale. Maternal offline mentalizing was assessed with the Parental Reflective Functioning Questionnaire, and maternal online mentalizing was assessed by coding the mothers' mental state language during interaction with the child using a modified version of the mind-mindedness coding scheme. RESULTS: While there was no direct effect of maternal offline reflective functioning on child pretend play, online mental state language mediated the link between offline maternal reflective functioning and child pretend play. CONCLUSIONS: These results provide support for the theoretically assumed link between parental mentalizing and children's capacity for pretend play. Furthermore, our study contributes to the literature on parental mentalization, suggesting that parental mentalizing facilitates child development only if the parent can translate this ability into 'mentalizing in action'.

Story stems in early mother-infant interaction promote pretend play at 30 months.

During early childhood, play develops through levels of sensory exploration and manipulation, to functional activities and during the second year of life to the level of pretend and symbolic play. However, little is known about the factors contributing to individual variations in the development of play. The present study investigated associations between maternal sensitivity and play conditions with different ways of engaging and participating and children's development of pretend play. Participants were 64 primiparous mothers and their 30-months-old children. Sensitivity was assessed using the Coding Interactive Behavior (CIB) coding system, and children's play was coded using the 12 Step Play Scale. Analyses showed no significant associations between sensitivity and children's play development but a play condition introducing a story stem was associated with a higher developmental play level and longer duration of pretend play compared to free interactive play. The findings suggest that the use of a story stem may promote pretend play in interactive settings with the mother.

Four-year-old children's pretend play complexity during free play and story stem play and associations with maternal sensitivity.

Theory and research have linked pretend play in early childhood with the development of language and theory of mind. In 102 mother-child dyads at 4.5 years, we examined whether (1) introducing a story stem (a play narrative with socioemotional dilemmas) in a mother-child play context increases pretend play complexity compared with mother-child free play; and (2) maternal sensitivity is associated with pretend play complexity. Further, we explored whether the story stem increased child pretend play complexity more in dyads with mothers with low sensitivity compared with highly sensitive mothers. Sensitivity was coded using Coding Interactive Behavior and pretend play complexity with a global, integrated measure of the developmental level and quantity of play. Using generalized estimating equations, we found that pretend play complexity was positively associated with introducing a story stem and maternal sensitivity. Mixed methods ancova showed no significant interaction between play situation and maternal sensitivity. The findings stress the importance of maternal sensitivity and participation for play and how introducing a story stem may help promote child pretend play complexity.

The parental reflective functioning questionnaire: Infant version in fathers of infants and association with paternal postpartum mental health.

The parents' capacity to reflect upon the psychological processes in their child, termed parental reflective functioning (PRF) can be impaired by parental mental health problems. The present study aimed to investigate the factor structure of an infant version of the Parental Reflective Functioning Questionnaire (PRFQ-I) in a low-risk sample of 259 Danish fathers of 1-11-month-old infants to investigate measurement invariance of the PRFQ-I between fathers and mothers; and to examine the association between PRF and paternal depressive symptoms, psychological distress, and parenting stress. Confirmatory factor analysis supported a three-factor model of the PRFQ-I. Multi-group factor analysis indicated partial measurement invariance. Multiple linear regressions showed that paternal depressive symptoms were not associated with PRF. There was an interaction effect of paternal depressive symptoms and general psychological distress on paternal interest and curiosity in their infant's mental state and certainty of infant mental state. Increased parenting stress was associated with impaired PRF on all three subscales of the PRFQ-I. These results provide further evidence for a multidimensional, brief assessment of paternal reflective skills and insight into how variability in paternal psychological functioning relates to impaired PRF in the postpartum period.

La capacidad de los progenitores de reflexionar sobre los procesos sicológicos en sus niños, a lo cual se le denomina funcionamiento reflexivo de los progenitores (PRF), puede ser debilitado por los problemas de salud mental de los progenitores. El presente estudio se propuso investigar la estructura de factores de una versión infantil del Cuestionario de Funcionamiento Reflexivo de los Progenitores (PRFQ-I) en un grupo muestra de bajo riesgo de 259 papás daneses de infantes de 1-11 meses de nacidos para investigar la invariabilidad de las medidas del PRFO-I entre papás y mamás; y para examinar la asociación entre PRF y los síntomas depresivos paternos, la angustia sicológica y el estrés de crianza. Los confirmatorios análisis de factores apoyaron un modelo de tres factores del PRFQ-I. Los análisis de factores de multigrupos indicaron la parcial invariabilidad de las medidas. Regresiones múltiples lineales mostraron que los síntomas depresivos paternos no estaban asociados con PRF. Se dio un efecto de interacción de los síntomas depresivos paternos y la angustia sicológica general sobre el interés y la curiosidad paternas en cuanto al estado mental de sus infantes, así como la certeza en cuanto al estado mental infantil. Se asoció el aumento de estrés de crianza con un debilitado PRF en todas las tres subescalas del PRFQ-I. Estos resultados proveen evidencia adicional para una evaluación multidimensional, breve, de las habilidades reflexivas del progenitor e información acerca de cómo la variabilidad en el funcionamiento sicológico paterno se relaciona con el debilitado PRF en el período posterior al parto.

La capacité des parents à réfléchir aux processus psychologiques chez leur enfant, appelée fonctionnement de réflexion parentale (PRF en anglais) peut être compromise par des problèmes de santé mentale parentale. Cette étude s'est donné pour but d'étudier le facteur de structure d'une version nourrisson du Questionnaire de Fonctionnement de Réflexion Parentale (abrégé en anglais PRFQ-I) chez un échantillon à faible risque de 259 pères danois de bébé de 1-11 mois pour étudier l'invariance de mesure du PRFQ-I entre les pères et les mères; et pour examiner le lien entre le PRF et les symptômes dépressifs paternels, la détresse psychologique, et le stress de parentage. Une analyse factorielle confirmatoire a soutenu le modèle à trois facteurs du PRFQ-I. Une analyse factorielle multi-groupes a indiqué une invariance de mesure partielle. De multiples régressions linéaires ont montré que les symptômes dépressifs paternels n'étaient pas liés au PRF. On a noté un effet d'interaction des symptômes dépressifs paternels et de la détresse psychologique générales sur l'intérêt paternel et la curiosité pour l'état mental de leur bébé et la certitude de l'état mental du bébé. Le stress de parentage accru était lié à un PRF altéré sur toutes les trois sous-échelles du PRFQ-I. Ces résultats offrent une justification pour une évaluation brève et pluridimensionnelle des compétences de réflexion paternelles et un aperçu sur la manière dont la variabilité dans les fonctionnement psychologique paternel se rapporte au PRF altéré dans la période postpartum.

Understanding Your Baby: protocol for a controlled parallel group study of a universal home-based educational program for first time parents.

BACKGROUND: Infant mental health represents a significant public health issue. The transition to parenthood provides optimal opportunities for supporting parenting competence. Especially parental mentalization, i.e. the caregiver's ability to notice and interpret the child's behavior in terms of mental states, is important in infancy where the caregiver-infant communication is based solely on the infant's behavioral cues. METHODS: This study evaluates the efficacy of the intervention Understanding Your Baby (UYB) compared to Care As Usual (CAU) in 10 Danish municipalities. UYB aims at promoting parental competence in new parents by supporting them in noticing their infants' behavioral cues and interpreting them in terms of mental states. Participants will be approximately 1,130 singletons and their parents. Inclusion criteria are first-time parents, minimum 18 years old, living in one of the 10 municipalities, and registered in the Danish Civil Registration Register (CPR). Around 230 health visitors deliver the UYB as part of their routine observation of infant social withdrawal in the Danish home visiting program. During an interaction between the health visitor and the infant, the health visitor articulates specific infant behaviors and helps the caregivers interpret these behaviors to mental states. The study is a controlled parallel group study with data obtained at four time points in two phases: First in the control group receiving the publicly available postnatal care (CAU), secondly in the intervention group after UYB implementation into the existing postnatal services. The primary outcome is maternal competence. Secondary measures include paternal competence, parental stress, parental mentalizing, and infant socioemotional development. Analysis will employ survey data and data from the health visitors' register. DISCUSSION: Results will provide evidence regarding the efficacy of UYB in promoting parenting competences. If proved effective, the study will represent a notable advance to initiating the UYB intervention as part of a better infant mental health strategy in Denmark. Conversely, if UYB is inferior to CAU, this is also important knowledge in regard to promoting parenting competence and infant mental health in a general population. Trial registration https://ClinicalTrials.gov with ID no. NCT03991416. Registered at 19 June 2019-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03991416.

How are mothers negatively affected and supported by following parenting-related Instagram profiles? A mixed-methods study.

Many parents use social media to seek knowledge about child development and parenting, but parents are an understudied population in social media research. In this study, we use a mixed-methods approach to examine mothers' experience of following three different types of Instagram profiles: InstaParents, i.e. influencers sharing their personal experiences with parenthood, professional profiles disseminating knowledge about parenting and child development, and a university-based profile disseminating knowledge about child socioemotional development. The participants were 270 mothers with children aged 0-6 years, who completed an online questionnaire regarding their experience and use of Instagram. Generalized Estimating Equations were used to examine associations between mothers' social comparison orientation and their experience of following the different types of profiles. Content analysis of mothers' responses to open-ended questions was used to examine how mothers were negatively affected and supported by the different profiles. Results showed that mothers with higher levels of social comparison orientation were more negatively affected by following all three types of profiles, but also more supported by following InstaParents. The content analysis suggested that mothers were negatively affected by InstaParents by making upward comparisons and supported by making horizontal comparisons. Mothers were supported by professional profiles, including the university-based profile, by improved knowledge, but these profiles could also lead to a decreased sense of parenting competence. Results inform professionals in relation to how to support mothers through content on Instagram and how to talk to mothers about their digital use and well-being.

Associations between symptoms of maternal postpartum depression, gestational age and infant social withdrawal: A longitudinal study in a community cohort.

Infant social withdrawal is a risk factor for non-optimal child development; thus, it is important to identify risk factors associated with withdrawal. In a large community sample (N = 19,017), we investigate whether symptoms of maternal and partner postpartum depression (PPD; measured with the Edinburgh Postnatal Depression Scale) and prematurity are predictors of infant social withdrawal (measured with the Alarm Distress Baby Scale). Withdrawal was assessed at 2-3, 4-7 and 8-12 months postpartum. Linear regressions showed that prematurity predicted higher infant social withdrawal at all time points, and maternal symptoms of PPD were positively associated with withdrawal at 2-3 months. Logistic regressions showed that odds for elevated social withdrawal were increased with elevated levels of maternal symptoms of PPD at 2-3 and 8-12 months. Partner's symptoms of PPD were not associated with withdrawal. Future studies should investigate how PPD symptoms and prematurity may impact the individual development of social withdrawal.

Opportunities for strengthening sexual health education in schools: Findings from a student needs assessment in NSW.

ISSUE ADDRESSED: Comprehensive sexuality education (CSE) is important for the sexual and reproductive health of young people. To better understand young people's views and experiences of sexual health education in NSW, a student needs assessment survey was conducted in 2017. METHODS: This paper presents the findings from 1603 NSW students in Years 8-12 following online recruitment. Descriptive analyses explored students' views and experiences in relation to sources of sexual health information, education providers, school-based topics covered and resources drawn on. RESULTS: Findings indicate that school, parents, friends and social media are students' most common sources of information on sexual and reproductive health. Approximately one-third of students reported wanting more information on topics related to relationships, reproductive health, consent and sexual decision-making and sexual harassment, abuse and bullying, and two-thirds of transgender and gender diverse students wanted more information on gender identity. For the topics which students reported receiving the least information about at school, they were most likely to seek this out on social media and websites. CONCLUSION: Findings provide valuable insight for improving CSE in NSW. The influence of social media, parents and the internet should be taken into consideration when developing resources and programme content. Professional development for educators could contribute to improving the quality of CSE delivered. Accurate and up to date resources must be utilised to support student engagement and effective learning.

Associations of maternal sensitivity and embodied mentalizing with infant-mother attachment security at one year in depressed and non-depressed dyads.

Parental Embodied Mentalizing (PEM) captures the parent's capacity to extrapolate the child's mental states from movement and respond on a nonverbal level. Little is known about PEM's relation to other established measures of parent-child interactive behavior, such as maternal sensitivity and attachment. This is investigated in a sample of four months old infants and mothers with (n = 27) and without a diagnosis of postpartum depression (n = 44). Video-recorded infant-mother interactions were coded independently using PEM and Coding Interactive Behavior. Attachment was assessed at 13 months using the Strange Situation Procedure. Sensitivity and PEM was positively associated, but only sensitivity predicted attachment security and only the nonclinical group. This indicates that PEM and sensitivity are moderately related as well as capturing different aspects of infant-mother interactions. The study confirms previous findings of sensitivity predicting attachment in nonclinical groups. More research is required to further understand predictors of attachment in clinical samples.

Factor structure of the parental reflective functioning questionnaire and association with maternal postpartum depression and comorbid symptoms of psychopathology.

Parental reflective functioning (PRF) refers to the parent's capacity to envision mental states in the infant and in themselves as a parent, and to link such underlying mental process with behavior, which is important for parenting sensitivity and child socio-emotional development. Current findings have linked maternal postpartum depression to impaired reflective skills, imposing a risk on the developing mother-infant relationship, but findings are mixed, and studies have generally used extensive methods for investigating PRF. The present study examined the factor structure and measurement invariance of the Danish version of the 18-item self-report Parental Reflective Functioning Questionnaire (PRFQ) in a sample of mothers with and without diagnosed postpartum depression. Moreover, the association between PRF and maternal postpartum depression in mothers with and without comorbid symptoms of personality disorder and/or clinical levels of psychological distress was investigated. Participants included 423 mothers of infants aged 1-11 months. Confirmatory factor analysis supported a three-factor structure of the PRFQ; however, item loadings suggested that a 15-item version was a more accurate measure of PRF in mothers of infants. Multi-group factor analysis of the 15-item PRFQ infant version indicated measurement invariance among mothers with and without diagnosed postpartum depression. Multinomial logistic regression showed that impaired PRF was associated with maternal psychopathology, although only for mothers with postpartum depression combined with other symptoms of psychopathology. These results provide new evidence for the assessment of maternal self-reported reflective skills as measured by a modified infant version of the PRFQ, as well as a more nuanced understanding of how variance in symptomatology is associated with impaired PRF in mothers in the postpartum period in differing ways.

A longitudinal examination of daily amounts of screen time and technoference in infants aged 2-11 months and associations with maternal sociodemographic factors.

This study aimed to examine longitudinal developmental patterns in the daily amounts of screen time and technoference in infants aged 2, 4, 7, and 11 months and to examine associations with maternal sociodemographic factors across all age groups. The results showed that the amount of screen time varied between 6 and 17 min a day, while interruptions in mother-infant interactions due to maternal use of digital technology occurred between 5 and 6 times a day. There was a significant increase in infant screen time from 2 to 4 months, from 4-7 months, and from 7-11 months, and in technoference from 2 to 4 months and from 4-7 months. Maternal age and household income were not associated with infant screen time, but maternal educational level was negatively associated with infant screen time throughout the first year. No associations were found between technoference and maternal age, maternal educational level, or household income. Future research focusing on infant screen time and technoference should aim at including samples that reflect the general population, include measures of screen time and technoference that do not rely on parental report, and include measures of the effects of early infant screen time and technoference on later development.

Temporal coordination between maternal looming and infant gaze in depressed and nondepressed dyads: A bootstrapping approach.

In this study, we examine the convergent validity of a measure of maternal looming derived using a motion capture system, and the temporal coordination between maternal loom and infant gaze using an event-based bootstrapping procedure. The sample comprised 26 mothers diagnosed with postpartum depression, 43 nondepressed mothers, and their 4-month-old infants. Mother-infant interactions were recorded during a standard face-to-face setting using video cameras and a motion capture system. First, results showed that maternal looming was correlated with a globally coded measure of maternal overriding. Maternal overriding is an intrusive behavior occurring when the mother re-directs the infant's attention to parent-led activities. Thus, this result confirms that maternal looming can be considered a spatial intrusion in early interactions. Second, results showed that compared to nondepressed dyads, depressed dyads were more likely to coordinate maternal loom and infant gaze in a Loom-in-Gaze-pattern. We discuss the use of automated measurement for analyzing mother-infant interactions, and how the Loom-in-Gaze pattern can be interpreted as a disturbance in infant self-regulation.

How to screen for social withdrawal in primary care: An evaluation of the alarm distress baby scale using item response theory.

Background: Early identification of infants at-risk is imperative for proper referral to intervention programs. The Alarm Distress Baby Scale (ADBB) is an eight-item observer-rated screening tool detecting social withdrawal in infants. Previously, a shortened five-item version of the scale (m-ADBB) has been proposed. To date, few studies have examined the validity of the two scales, and no studies have examined the validity of the ADBB after implementation as a universal screening tool in primary care. Objective: The aim of this study is to use Item Response Theory (IRT) to examine the construct validity of the ADBB when used by public health visitors in primary care. Methods: Participants were 24,752 infants (aged: 2-12.9 months) screened by public health visitors using the ADBB. Screenings were categorized into three waves according to the infant's age at the screening time (2-3.9 months, 4-7.9 months, and 8-12.9 months). Analyses were conducted separately on each wave. We checked IRT assumptions: (a) Unidimensionality, (b) Monotonicity, (c) Local independence, and (d) No DIF in relation to infant sex and gestational age. The 2PLM was used to assess model fit and estimate model parameters. Results: Items fulfilled assumptions regarding unidimensionality, monotonicity, and no clinical and significant DIF. Local independence was not present for all items (i.e. 2, 7, and 8). The items showed moderate to good discriminatory abilities (alpha values ≥ 1.11) and discriminated best above average levels of social withdrawal (theta values ≥ 1.33). Items 7 and 8 showed nearly identical ICC suggesting that the two items discriminate equally well at the same level of social withdrawal. In addition, items 4 and 6 discriminated best at very high levels of social withdrawal, which might be of limited interest for screening purposes. Finally, the items showed similar patterns in terms of discrimination and location parameters across the three waves. Conclusions: The ADBB shows several psychometric strengths when used by public health visitors in primary care, and the items show good discriminatory abilities at the levels of social withdrawal of interest for screening purposes. Yet, the results also suggest that for first-line screening, the validity of the scale might be improved with the removal of items 4, 6, and 8 as suggested in the m-ADBB. However, before recommending implementation of the m-ADBB, studies comparing the criterion-related validity of the two scales are needed.

Does Postpartum Depression Affect Parental Embodied Mentalizing in Mothers With 4-Months old Infants?

Parental Embodied Mentalizing (PEM) regards parents' nonverbal capacity to understand the infant's bodily manifested mental states and adjust his or her own movements accordingly. Little is known about how mothers suffering from postpartum depression (PPD) mentalize the infant on an embodied level. The aims of the present study were to investigate whether mothers meeting criteria for a PPD diagnosis differ from non-clinical mothers in regard to their PEM capacities and whether the severity of depressive symptoms was associated with PEM in mothers meeting criteria for a PPD diagnosis compared to non-clinical mothers. 10-minute long lab-based face-to-face interactions were coded with the PEM coding scheme at 4-months postpartum in mother-infant dyads with mothers meeting criteria for a PPD diagnosis (n = 29) and non-clinical mothers (n = 51). Results showed that mothers with and without a PPD diagnosis differ in their capacity to mentalize on an embodied level, but only when controlling for scores on the Edinburgh Postnatal Depression Scale (EPDS). However, more depressive symptoms as measured with the EPDS was not in itself associated with lower PEM in either group. This finding may indicate the presence of a threshold effect, i.e. that maternal PEM may be affected only when a certain degree of severity and duration in depressive symptoms is beyond a certain threshold. The importance of the findings in regard to the assessment of depression as well as more clinical perspectives are discussed.

Cervical screening using visual inspection with acetic acid (VIA) and treatment with cryotherapy in Fiji.

The purpose of this study was to demonstrate the feasibility of VIA screening with cryotherapy and to record normative values for indicators anticipated in similar low resource settings. Women aged 30-49 years were targeted, resulting in 1961 women screened and treated at two primary health care (PHC) centres near Suva, Fiji. Recruitment was through provision of information, education and communication (IEC). Referrals to a gynaecology outpatient department (OPD) at a referral hospital occurred throughout the screening pathway. Participation was 32% (95%CI 31-33%), higher in iTaukei (Melanesians) women (34%, 95%CI 33-36) compared to Fijians of Indian descent (26%, 95%CI 24-28). Regression analysis, adjusted for confounders, indicated significantly lower participation in those of Indian descent, and age groups 35-39 and 45-49 years. Of those examined by VIA, 190 were positive with aceto-white lesions (9.9%), within the expected range of 8-15%, with minor geographic and ethnic variation. Positive VIA results were more common in the peri-urban area, and in those aged 35-39 years. Of women aged 30-49 years, 59 received cryotherapy (none of whom had significant complications), 91 were referred to OPD, two cervical carcinomas were identified and eight cervical intra-epithelial neoplasms (CIN) II-III were diagnosed. These results provide normative findings from a community-based VIA screening program for other similar low resource settings.