Self-harm thoughts among postpartum women - associated factors.

BACKGROUND: Even though in many countries suicide is the leading cause of maternal deaths during the postpartum period, the prevalence of thoughts of self-harm (SHTs), an important risk factor for suicide attempts, is still not well documented. AIM: We aimed to investigate the prevalence of SHTs in a Polish cohort of postpartum women and identify socio-demographic and maternal mental health factors associated with experiencing SHTs. METHOD: 1545 women took part in a midwife-led postpartum depression (PPD) screening. 337 of them reported SHTs. The Edinburgh Postpartum Depression Scale (EPDS) was administered. Specifically, we used an abbreviated 5-item version to assess depression symptoms, item 10 to assess SHTs, a composite score of items 1 and 2 - anhedonia, and a composite score of items 3, 4, and 5 - anxiety. Logistic regression analyses were performed to examine associations between variables. RESULTS: Approximately 2% (n = 337) of women self-reported experiencingSHTs. Within the group of postpartum mothers who self-reported SHTs, 65.60% (n = 221) manifested the symptoms of PPD, and 56.40% (n = 190) - of anxiety. The symptoms of PPD, a mood disorder diagnosed in the past, and younger age were predictors of SHTs. CONCLUSION: The results of this study can contribute to the development of prevention strategies: analysing separately items from PPD screening questionnaires focusing on SHTs can be an important part of prevention. The lack of the symptoms of PPD and anxiety risk does notexclude experiencing SHTs.

"We are in this together" - Polish midwives' reflections on perinatal care for Ukrainian women after the outbreak of war.

BACKGROUND: February 24, 2022, the beginning of Russia's invasion of Ukraine, was also the beginning of an exceptional situation and a challenge for the Polish health care system, the health care workers and Polish citizens. This study aims to conduct a qualitative analysis of midwives' experiences of maternity care for Ukrainian women after the outbreak of war. PARTICIPANTS AND PROCEDURE: Eight midwives with experience working with both Ukrainian patients and Ukrainian war refugees (who came to Poland after February 24, 2022) participated in a semi-structured interview. The interview data were transcribed and thematically analysed to identify the observations, challenges and medical personnel needs. RESULTS: The most frequently observed reactions in Ukrainian patients included crying, increased anxiety and irritability, fear, withdrawal, and constant information seeking about the current situation. Breastfeeding problems understood as a consequence of chronic stress were also observed and assisted by the midwives. All respondents pointed out the language barrier and their involvement, showing empathy and attentiveness to the patients' situation. No hospital introduced additional support for midwives. A high level of emotional burden on midwives was observed. CONCLUSIONS: The midwives were eager to help Ukrainian patients - they emphasized the more frequent need to make themselves available for them. However, the emotional involvement of the midwives is accompanied by the risk of traumatization and burnout, which are associated with exposure to the difficult experiences of patients. Implementation of training in trauma-informed care and supervision could support midwives in their work and prevent the consequences of long-term stress. Systemic solutions concerning translators' presence and hospital documents' translation are also essential.

Effectiveness of the third wave cognitive behavior therapy for peripartum depression treatment-A systematic review.

INTRODUCTION: To investigate the effectiveness of third-wave cognitive behavior therapies in the treatment of peripartum depression. METHOD: A systematic review of the effectiveness of psychological interventions in treating peripartum depression focus on the Third Wave has been conducted. The electronic databases MEDLINE, PsycINFO, Web of Science and Clinical Trials were searched, using a combination of different search terms. Data were independently extracted by two authors and a synthesis of the results was offered. Methodological quality was assessed by three authors, using ROBE-2 and MINORS. Search date was conducted in February 2022 and the search was re-run in November 2022 for new entries. FINDINGS: Six papers were included and reported, focused on, the effectiveness of Third Wave approach interventions in reducing depressive symptoms. Papers included the following intervention approaches: Behavioral intervention (n = 2), Mindfulness (n = 2), Dialectical Behavior Therapy (n = 1) and Acceptance and Commitment Therapy (n = 1). All six papers were consistent in that interventions lead to a decrease in depression symptoms. However, risk of bias evaluation showed that all were critical low, but one paper was high quality. CONCLUSION AND IMPLICATIONS FOR PRACTICE AND RESEARCH: Systematic review showed that third-wave approaches are promising in effectiveness to reduce depression symptoms in peripartum women. However, more high-quality studies with follow-up are needed.

The impact of the war in Ukraine on the perinatal period: Perinatal mental health for refugee women (pmh-rw) protocol.

Background: The aim of the Perinatal Mental Health for Refugee Women (PMH-RW) Project is to investigate the impact of the war on perinatal mental health: anxiety, post-traumatic stress, depression, and birth trauma symptoms. It will also evaluate the factors that serve as protective elements for the development of these potential diagnoses (such as personality traits, social support, sociodemographic characteristics, and access to medical/mental health services). Method: An international observational cohort study with baseline data is being assessed in Ukraine (for internal refugees) and several European Countries (for external refugees). The study includes as participants both pregnant women and those who have recently given birth (with babies up to 1 year old). The assessment includes measures on depression (EPDS), anxiety (GAD-7), experiences during birth (City Birth Questionnaire), post-traumatic stress symptoms [Impact of events scale-revised (PTSD-R)], Personality (10-Item Personality Inventory-TIPI), and a questionnaire for socio-demographic data which also such social support. Conclusion: This study will provide needed information for determining the impact of the Ukrainian Crisis on perinatal mental health by studying potential risk and protective factors. The data collected will be used to inform policymakers with useful information that can be used in the development of plans to protect and promote the mental health of the perinatal refugees impacted by this event. Also, it is our hope that data collected from this study will serve to plant the seeds for further research regarding the impact of the crisis in Ukraine on the offspring and to analyze how these events are affecting further generations. Clinical Trial Registration: ClinicalTrials.gov, Identifier: NCT05654987.

The risk of anxiety disorders in women in the first year postpartum - the results from the postpartum depression prevention program ?Next Stop: MUM". / Ryzyko zaburzen lekowych u kobiet w pierwszym roku po porodzie ­ wyniki programu profilaktycznego depresji poporodowej "Przystanek MAMA".

OBJECTIVES: The purpose of the study was to examine the severity of anxiety symptoms and the co-occurrence of anxiety disorders and mood disorders in a group of women in the first year after childbirth participating in the program for the prevention of postpartum depression. METHODS: The study included 1,514 women who were screened by midwives during a patronage visit and were followed up, and 10,454 women who took part in an online screening conducted on the project website. The Edinburgh Postpartum Depression Scale was used for screening, including factor analysis to assess the anxiety subscale, and the GAD-2 questionnaire was used too. RESULTS: The risk of anxiety disorders was observed in 9.5% of women during the patronage visit and, depending on the survey method, 21.2% (ESDP 3 A) or 13.2% (GAD-2) in the follow-up study up to 9 months postpartum. In the online study, 62.8% of women obtained results indicating a high risk of anxiety disorders. For comparison, the result of 12 points and more indicating the risk of depression was obtained by 6.3% in the first month after childbirth and 14.3% in the follow-up study. The results show that anxiety disorders and mood disorders are significantly related (r = 0.631; p < 0.01). CONCLUSIONS: The risk of having anxiety disorders after childbirth is higher or similar to that of mood disorders. It is warranted to extend screening to anxiety disorders and to develop a rapid pathway of early psychological/psychiatric intervention for women in need.

Postpartum depression crisis since the second lockdown and 'screening paradox': many women identified, very few treated.

OBJECTIVE: Exposure to stressful situations, such as emergencies, infectious diseases, and natural disasters, may lead to a heightened risk of perinatal mental health problems. Declared on March 11th, 2020, the global COVID-19 pandemic triggered an additional burden on women in the perinatal period. Safety recommendations, such as social distancing and isolation, were opposite to the usual advice given to new mothers. Besides fear, changes in financial stability and daily life reorganization contributed to increased depressive symptoms. As the periods of epidemic waves and lockdowns were associated with a more significant burden for young families, we aimed to assess the intensification of depressive and anxiety symptoms during the pandemic concerning the time intervals of the three lockdowns introduced in Poland. METHODS: 1588 postpartum women took part in the online self-assessment with the Edinburgh Postnatal Depression Scale (EPDS) and General Anxiety Disorder 2 (GAD-2) questionnaire between January 1, 2020, and March 31, 2021. This self-screening is a part of a prevention program The Next Stop: Mum, implemented in the North of Poland. RESULTS: The highest severity of PPD symptoms and anxiety were observed during the second lockdown in Poland: the mean score in the EPDS and anxiety assessment was significantly higher than the mean scores from previous pandemic periods. Since the second lockdown, the average EPDS and GAD-2 scores remained similarly high. Moreover, with the duration of the COVID-19 pandemic, the percentage of women with elevated symptoms of postpartum depression and anxiety began to increase. However, the Polish National Health Fund data indicate that only 0,7% of women giving birth in the northern macro-region of Poland received diagnosis and help from public funds. In The Next Stop: Mum project, 250 women benefited from psychological consultations. CONCLUSION: Increased severity of depression and anxiety symptoms during the pandemic indicates the need for additional psychological support for postpartum women. However, very few women are diagnosed in health facilities in the first year postpartum and thus are rarely referred for further treatment. The study shows that the availability of services and the focus on social and individual barriers may be critical factors in implementing perinatal mental health programs and practices. This may be especially needed in a country where the screening obligation is new. In case of a further pandemic, policymakers and health care professionals should be aware that the duration of the restrictions and the repetition of lockdowns are associated with the aggravation of symptoms. The online screening without the possibility to discuss the results is only partially effective in increasing referrals for possibly affected women.

'Next Stop: Mum': Evaluation of a Postpartum Depression Prevention Strategy in Poland.

In the article we present a mid-point evaluation of the postpartum depression (PPD) prevention strategy in Poland. As PPD is associated with potential negative consequences for the mother and infant, the need to introduce screening and treatment is vital. The project covered over 21,500 women in the first year postpartum. The average score in the Edinburgh Postnatal Depression Scale (EPDS), in a screening provided in direct contact, was 4.73 (SD = 4.14, n = 7222), and increased in 55% of women in the follow-up study. In online screening the average score in the EPDS assessment was 16.05 (SD = 5.975, n = 10,454). The 'probable depression' rate (EPDS > 12) in 'direct' contact is 7.3%, and on the online platform-77%. Additionally, 26% of possibly affected mothers assessed in 'direct' contact benefited from psychological consultations. The average score in the EPDS among mothers who benefitted from consultations is 16.24 (SD =4.674, n = 231). Approx. 82% of healthcare providers raised their knowledge of PPD after training sessions. Maintaining the assumptions of the program: training for medical staff, screening conducted throughout the first twelve months postpartum, online platform with the possibility of self-screening and early psychological intervention seem to be justified actions, leading to a higher number of women with risk of PPD referred.

Heterogeneity of the attentional system's efficiency among very prematurely born pre-schoolers.

Very preterm birth increases the risk of ADHD as well as other neurodevelopmental disorders. Deficits within the attentional system were previously signaled in preterm children; however, studies lacked in consideration of an intragroup differentiation. Thus, this study aimed to verify whether deficits in the attentional mechanisms are inter-individually differentiated among very prematurely born children and if so, which biomedical and non-biomedical factors are associated with the profile of deficits within the attentional system. We tested the efficiency of attentional processes among 5-year-old children with the Attention Network Task - Child Version. The results have indicated that 26% of very preterm children presented with the suboptimal functioning of the attentional system (more than 1 SD below mean score of full-term children in attentional alerting and orienting), whereas 74% were characterized by the normal efficiency of attention. The profile of attentional deficits observed among very preterm preschoolers was associated with significantly lower birth weight and decreased family living standard. Very prematurely born children are thus a relatively heterogeneous group in terms of the efficiency of attentional system and deficits apply to only some of those children. Early developmental support aimed at enhancing attentional functioning should be addressed to children with lower birth weight in the first place.

The need for additional mental health support for women in the postpartum period in the times of epidemic crisis.

BACKGROUND: This retrospective study aimed to identify possible intensification of mental health difficulties among women seeking support in the postpartum period during the epidemic state in Poland. We assumed that the epidemic crisis, social isolation, and restrictions in hospitals which affect pregnant and postpartum women - lack of family labors, lack of the possibility to be with the newborn when he/she is hospitalized, may increase fear and reduce psychosocial resources of women, hinder their normal process of transition to motherhood and thus contribute to the intensified severity of depressive symptoms. METHODS: The study participants were women seeking support at the on-line platform of the project 'Next Stop: Mum', which is a part of the postpartum depression prevention's program implemented by the Ministry of Health in Poland, and enables remote self-screening for the severity of the postpartum depression symptoms with the Edinburgh Postnatal Depression Scale developed by Cox and collaborators. The analyzed data in this study were obtained from 139 women: 61 filled forms from October 1 - November 10, 2019 (non-epidemic period), and 78 filled forms from February 20-March 30 (beginning of the COVID-19 epidemic), 2020. RESULTS: A statistically significant difference in the severity of postpartum depression symptoms were observed among women making a self-assessment with EPDS scale at the beginning of the COVID-19 epidemic in Poland (M = 15.71; SD = 6.23), compared to the pre-epidemic neutral period (M = 13.56; SD = 6.46). CONCLUSIONS: The results of this study indicate that the epidemic crisis may be associated with an increased need for additional caution and support of women's mental health in the postpartum period. We believe that recommendations for medical staff, policy, and families of women struggling with postpartum depression symptoms during crisis should be widespread as the second wave of COVID-19 disease may develop in the autumn-winter 2020 and spring 2021.

Improvement of the breastfeeding self-efficacy and postpartum mental health after lactation consultations - Observational study.

OBJECTIVE: Maternal self-efficacy in breastfeeding may be undermined by common mental health difficulties in the postpartum, leading to an early breastfeeding cessation. The relationship may also be the opposite: problems with effective breastfeeding and breastfeeding cessation may increase the postpartum mental health difficulties. The purpose of this study was the assessment of the effectiveness of lactation consultations in strengthening the breastfeeding self-efficacy and maternal postpartum mental health. DESIGN AND PARTICIPANTS: 160 Polish women (90 consultation participants and 70 controls) completed a structured interview, the General Health Questionnaire, and the Breastfeeding Self-Efficacy Scale twice: before lactation consultation and one month later. SETTING: Research was conducted in the city of Gdansk, Poland. FINDINGS: Study revealed that women seeking lactation support exhibited greater mental health difficulties while their breastfeeding self-efficacy was similar to the control group. Initial breastfeeding self-efficacy was negatively correlated with the severity of the postpartum mental health problems. One month after lactation consultations, a significant increase in the breastfeeding self-efficacy and significantly reduced symptoms of mental health difficulties (somatic symptoms, functional disorders, and anxiety and insomnia) were observed among mothers. KEY CONCLUSIONS: Women willing to benefit from the lactation consultations may exhibit symptoms of mental health difficulties that may be associated with difficulties in breastfeeding. Strengthening the breastfeeding confidence during lactation consultations, may reflect in the improvement of the woman's mental health. IMPLICATIONS FOR PRACTICE: Midwives and lactation consultants can make a difference in the mental health promotion by offering breastfeeding interventions which address the emotional needs of a mother.

How do new mothers perceive screening for perinatal depression?

BACKGROUND: Countries recognize the risk of mental health difficulties during the perinatal period and the potential benefits of screening and early detection of depressive symptom-atology. This study aimed to analyse mothers' views on screening for postpartum depression (PPD) in Poland, where a new standard of perinatal care imposed (from January 2019) the obligation to monitor women' postpartum mental state. PARTICIPANTS AND PROCEDURE: 150 women participated in the study. In the first stage, PPD symptoms were assessed with the Edinburgh Post-natal Depression Scale (EPDS) among postpartum women during midwives' home visits. The second stage consisted of a telephone survey with the EPDS and questions exploring mothers' perception of midwife competencies in screening for PPD. RESULTS: Most women identified as relatively high midwives' competencies in communicating information about PPD, interpretation of the EPDS score and their ability to create comfortable conditions of the assessment and further discussion about postpartum mental health changes. Women with an elevated level of PPD symptoms assessed as significantly lower midwives' competence in this last aspect and those who had a caesarean section tend to assess as lower the usefulness of provided information on care of a newborn. CONCLUSIONS: Midwives should be aware and prepared for a possible critical attitude of patients, which may be a sign of a depression. Otherwise, medical staff may not be willing to interact with a mother and offer her help and support. The ability to create a friendly condition in spite of adversity can contribute to the desire of women to undergo screening, discussion about the result and further treatment.

The program of psychological and breastfeeding support "Maternity step by step": an example of effective solution for the prevention, diagnostics and treatment of prenatal and postpartum depression. / Program opieki psychologiczno-laktacyjnej "Macierzynstwo krok po kroku" jako przyklad profilaktyki, diagnostyki i leczenia depresji w okresie okoloporodowym.

OBJECTIVES: Postpartum depression affects about 13-20% of women. Depression during pregnancy is observed in 19% of pregnant women. In Poland we lack asupport system for this group of patients. This article presents the elements of the pilot program of psychological interventions and breastfeeding support "Motherhood: step by step", financed by the municipality of Gdansk. The aim of the program was to provide inhabitants of Gdansk with professional breastfeeding support and psychological help during pregnancy and in the first year of infant's life. METHODS: The study involved three groups of women: 36 mothers participating in psychological consultations and short-term therapy, 123 women from breastfeeding support group and 104 women in the control group. The evaluation was based on questionnaires prepared by the researchers, the General Health Questionnaire-28 and the Parenting Stress Index -3rd version. RESULTS: The evaluation showed a significant decrease in symptoms of mental disorders in both groups of treated women: women from psychological intervention and breastfeeding intervention group. In women from psychological intervention group a significant decrease in parental stress was observed. CONCLUSIONS: Conducted analyses showed that the implemented program is characterized by high effectiveness and may be recommended for the continuation in the subsequent years. It may be considered as asolution for changes in the new standards for perinatal care in Poland.

Attachment Styles, Various Maternal Representations and A Bond to a Baby.

(1) Background: The aim of this study was to assess the relationship between: (a) new mothers' styles of attachment to their own mothers with their representation of self as a mother as well as with their representation of one's mother as a mother, (b) new mothers' representation of self as a mother with their representation of one's own mother as a mother, and (c) their bonds with their children and their styles of attachment to their own mothers. (2) Methods: A total of 86 mothers were interviewed approximately six months postpartum. The Adjective Checklist, a modified version of the Experiences in Close Relationships, and the Postpartum Bonding Questionnaire were used in the study. (3) Results: Analysis revealed a statistically significant relationship between the new mothers' styles of attachment to their own mothers and both their representation of self as a mother and their representation of one's mother as a mother. The relationship between representation of self as a mother and representation of one's mother as a mother was also statistically significant. No statistically significant relationship was observed between the style of attachment to one's mother and the bond with one's child six months postpartum. (4) Conclusions: A deeper understanding of the relationship between these variables may improve the help system directed at young mothers.

Attentional system of very prematurely born preschoolers.

Recent studies indicate that premature children are at risk for difficulties with cognitive development and have increased incidence of ADHD as well as other behavioral disorders. Although the exact mechanism accounting for these children's neuropsychological abnormalities is unknown, there is evidence to suggest that the cognitive and behavioral disturbances seen in this population may result from a slower development of the attentional system. However, it remains unclear whether prematurity affects the development of the entire attention system or if prematurely born children have a selective insufficiency of components of this system (i.e., orienting, alerting, executive). We compared the efficiency of the attentional system of very prematurely born children and full-term controls at 5 years of age, using the Attention Network Task-Child Version. In comparison to full-term peers, very preterm children exhibited inefficient orienting of attention, whereas there was no group difference in the efficiency of alerting and executive aspects of attention. The reason for the selectively suboptimal orienting of attention in very prematurely born preschoolers remains unclear; it is possible that the neural substrates of this attentional subsystem are particularly underdeveloped in the preschool period in this cohort. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

The Dynamics of Becoming a Mother during Pregnancy and After Childbirth.

BACKGROUND: The aim of this study was to explore the relationship between one's maternal attachment style and one's self-image as a mother, image of one's mother as a mother, and bond with the child over a period of several months. METHODS: A total of 86 women took part in the study The Adjective Check List (ACL), Postpartum Bonding Questionnaire (PBQ), Maternal-Fetal Attachment Scale (MFAS), and a modified version of the Experiences in Close Relationships (ECR) were used. Two measurements were used: during pregnancy and about six months after the birth of the child. RESULTS: In terms of their self-image as mothers, the women had higher results the first time they took the questionnaire, regardless of their attachment style. An interaction effect was found between attachment style and the 'need for changes' scale. The image of one's mother as a mother depended on the level of avoidance in attachment, regardless of the measurement. An interaction effect was found between attachment style and the scale of 'personal adaptation'. There was a correlation between the bond with the child during pregnancy, the bond following birth, and the style of maternal attachment; the main predictor of the bond with the child after birth is the bond with the child during the pregnancy. CONCLUSION: Those who provide care for pregnant women and new mothers should be aware of the complex psychological processes in the transition to motherhood, have knowledge about perinatal mental health, and when necessary, refer women to specialists such as support groups for new mothers, trained midwives, psychologists, psychotherapists, or psychiatrists.

Maternal attachment style during pregnancy and becoming a mother in Poland.

OBJECTIVE: This paper investigates the connections in pregnant women between their mother attachment style and their self-image as a mother, the image of their mother as a mother, and their bond with the unborn child. BACKGROUND: The relationship with one's mother plays a crucial role in the process of becoming a mother. It influences what a pregnant woman thinks about herself as a mother. This relationship is a predictor of the bond with the child during the pregnancy. METHODS: This research was participated in by 165 pregnant women. They completed the following: a modified version of the Experiences in Close Relationships (ECR) questionnaire, investigating a mother's attachment to her own mother; the Adjective Check List (ACL), developed by Gough and Heilbrun; the Maternal-Fetal Attachment Scale (MFAS); and a sociodemographic survey. RESULTS: A mother's attachment style is connected with the need for autonomy, as measured by the ACL, and with 'assuming a parental role' in the MFAS questionnaire. The strongest connection was found between a mother's attachment style and the image of one's own mother as a mother. Statistically-significant correlations were found for 32 of 37 scales on the ACL. CONCLUSION: Attachment style exerts influence upon a mother's self-image, the image of one's own mother as a mother and the bond with the unborn child.

[The intensity of anxiety and symptoms of post-traumatic stress disorder in mothers and the cognitive development of their prematurely born children].

AIM: The aim of the study was to examine the relationship between anxiety, the severity of post-traumatic stress disorder (PTSD) symptoms in mothers and hot and cool executive functions of their children who were born very prematurely. MATERIAL AND METHODS: The group consisted of 20 mothers and their children born before 32 weeks of pregnancy. The intensity of anxiety in mothers was measured using the State-Trait Anxiety Inventory (STAI), while the severity of symptoms of PTSD was assessed using the Impact of Event Scale - Revised (IES-R). Hot and cool executive functions were measured with the following tasks: Pencil tap, Balance beam, Toy sort, Toy wrap and Toy wait, from the: Preschool Self-Regulation Assessment (PSRA) battery. RESULTS: The study showed that almost half of the women surveyed suffer from symptoms of PTSD, at least in moderate intensity. The most intense symptoms refer to the Intrusion factor. Analysis of the results showed that lower scores in hot executive functions are associated with higher anxiety - understood as a feature of mothers, severe Intrusion and Avoidance, and also the general indicator of PTSD. CONCLUSIONS: 1. Among mothers, whose prematurely born children were developing property in preschool period, as many as 45% experienced at least moderate symptoms of PTSD. 2. The intensity of PTSD symptoms and anxiety in mothers is associated with worse development of hot aspect of executive functions, related to the ability to delay gratification of their children. 3. The study draws attention to the need to monitor the mental state of a parent of prematurely born child.