A bibliometric analysis of the quantitative schema therapy literature.

BACKGROUND: The evidence base for schema therapy has evolved significantly since it was first developed by Jeffrey Young in the 1990s. The aim of this bibliometric analysis was to summarize the trends and characteristics of the quantitative literature on schema therapy. METHOD: PsycINFO, PubMed and CINAHL Complete databases were last searched on 1 June 2023 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement to identify peer-reviewed journal articles written in English that reported on original quantitative research on schema therapy or schema therapy constructs. NVivo was used to complete a descriptive analysis of the bibliographic, sample and study characteristics, and a coding framework was applied to capture the aspect of the schema therapy model that was the focus of each study, as well as the study context (e.g., the population or outcomes under investigation). SciVal was used to complete citations and authorship analyses. VOSviewer was used to examine co-authorship networks. RESULTS: A total of 704 quantitative studies on schema therapy were published by 483 unique first authors between 1994 and mid-2023. Studies predominantly used correlational designs with small samples (Mdn N = 153) of mostly females aged 18 years or older. The articles tended to focus on early maladaptive schemas, rather than schema domains or schema modes. Schema therapy and its concepts were most frequently studied in the context of depression and personality disorders. SciVal analyses indicated that, on average, articles were cited 27 times, with a Field Weighted Citation Impact of 1.02. CONCLUSIONS: Schema therapy research output appears to have slowed in recent years and several critical research gaps were evident. Areas of high priority for future research include schema modes and coping responses, and the use of developmental and longitudinal designs to evaluate several key causal assumptions in the theory underpinning schema therapy.

Early maladaptive schemas, emotion regulation difficulties and alexithymia: A systematic review and meta-analysis.

BACKGROUND: Emotion regulation is an integral part of the schema therapy model. The aim of this systematic review and meta-analysis was to synthesize the evidence on the associations between early maladaptive schemas (EMSs), difficulties with emotion regulation and alexithymia. METHOD: PsycINFO, PubMed and CINAHL Complete databases were searched on 28 May 2022 and 3 February 2023 in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Included studies were in English, in peer-reviewed journals and reported on the association between one or more of the 18 EMSs or five schema domains and emotion regulation difficulties or alexithymia. Methodological quality was assessed using the Appraisal Tool for Cross-Sectional Studies. Meta-analyses were conducted to examine difficulties with emotion regulation and alexithymia as correlates of each EMS and domain. RESULTS: A total of 19 studies published between 2008 and 2022 were included (Pooled N = 5957). Difficulties with emotion regulation were positively correlated with all 18 EMSs (range: entitlement r(7) = .28, 95% CI [.13, .42] to negativity pessimism r(5) = .53, 95% CI [.23, .74]) and schema domains (range: impaired limits r(5) = .34, 95% CI [.08, .56] to disconnection rejection r(5) = .44, 95% CI [.33, .73]). Alexithymia was positively correlated with the other-directedness domain (r(2) = .40, 95% CI [.09, .64]) and 16 of the 18 EMSs (range: unrelenting standards r(5) = .21, 95% CI [.12, .28] to emotional inhibition r(5) = .50, 95% CI [.34, .63]). CONCLUSIONS: The findings suggested that almost all 18 EMSs are implicated in emotion regulation difficulties and alexithymia, particularly those relating to unmet needs for attachment and autonomy.

Early maladaptive schemas and obsessive-compulsive disorder: A systematic review and meta-analysis.

BACKGROUND: Obsessive-compulsive disorder (OCD) is a condition with poor treatment outcomes. Improved understanding of the aetiology can inform prevention and treatment approaches; hence several studies have assessed early maladaptive schemas (EMSs) in OCD. This systematic review and meta-analysis aimed to synthesise the evidence on relationships between the 18 EMSs and OCD. METHODS: The study was conducted according to PRISMA guidelines and registered on PROSPERO (CRD42022329337). A systematic search of PubMed, PsycINFO, and CINAHL Complete was conducted on 4 June 2022. Studies in peer-reviewed journal articles were included if they assessed EMSs and OCD (diagnosis or symptom severity) in adults with a mean age of 18 years or older. Studies were excluded if they were not in English, did not include original quantitative data, or reported on case studies. Study details were tabulated and the meta-analysis findings were presented using forest plots. Methodological quality was assessed using the Appraisal tool for Cross-Sectional Studies (AXIS). RESULTS: Based on 22 studies (pooled N = 3699), all 18 EMSs were positively correlated with OCD. The largest associations were with the dependence/incompetence (r = 0.40 95 % CI [0.32, 0.47]), vulnerability to harm or illness (r = 0.40 95 % CI [0.32, 0.48]), and negativity/pessimism schemas (r = 0.42 95 % CI [0.22, 0.58]). LIMITATIONS: Several meta-analyses showed considerable heterogeneity and publication bias. CONCLUSIONS: The findings suggest all EMSs, particularly those relating to disproportionate negative expectations and a perceived inability to cope, are implicated in OCD. Psychological prevention and treatment for OCD may benefit from targeting these schemas.

Dialectical Core Schemas Mediate the Relationships Between Dissociative Experiences and Symptomatology in a Community Sample.

BACKGROUND: Maladaptive cognitions about the self and others are associated with a wide array of dysfunctional responses and psychopathological symptoms in non-clinical and clinical samples. Dissociative experiences (e.g., depersonalization and derealization) as a coping response to stressful situations lie on a continuum from healthy to unhealthy but are generally elevated in individuals experiencing mental illness. However, the extent to which Dialectical Core Schemas explain the relationship between dissociative experiences and symptomatology is unclear. Therefore, this study aimed to investigate the mediating role of Dialectical Core Schemas on the relationship between dissociative experiences and symptomatology. METHODS: A community sample of 179 participants were recruited (Mage = 21.2 years, SD = 8.2). Data were gathered through self-report questionnaires using a cross-sectional design. RESULTS: Maladaptive core schemas about self and others correlated positively with all dissociative experiences (e.g., depersonalization/derealization, amnesia), while adaptive core schemas about the self correlated negatively with depersonalization/derealization and distractibility. Maladaptive core schemas mediated the relationship between dissociative experiences and symptomatology. CONCLUSIONS: The relationships between dissociative experiences and symptomatology are bi-directional. Exploring the mediating factors may help clinicians and researchers better understand how to enhance case conceptualization and clinical decision-making.

Parenting Self-Efficacy and Psychological Distress in Parents of Children with an Autism Spectrum Disorder.

Research suggests that challenges associated with raising a child with an Autism Spectrum Disorder (ASD) can increase parents' risk for diminished parenting self-efficacy (PSE) and psychological wellbeing. The present study aimed to explore interrelationships between noteworthy predictors of PSE and parental psychological distress, including parental mastery beliefs and the co-parenting relationship amongst 122 Australian parents of children with autism. Results indicated that greater mastery beliefs and more favourable co-parenting relationships predicted greater PSE, and higher PSE predicted less psychological distress. PSE significantly mediated relationships between mastery beliefs and psychological distress, and between the co-parenting relationship and psychological distress. Findings have implications that can aid professionals to more effectively support parents raising children on the autism spectrum.

Identifying the research priorities for schema therapy: A Delphi consensus study.

Despite the popularity of schema therapy, there exist several important gaps in research on the schema therapy model and its effectiveness. The number of gaps makes it difficult to determine the research areas of the highest strategic priority to advance schema therapy. The objective of this study was to establish consensus among schema therapy clinicians and researchers on the priority areas for future schema therapy research. A panel of experts in schema therapy (43 clinicians and 13 researchers) participated in a Delphi consensus study. The research areas rated were developed by interviewing the founder of schema therapy, Jeffrey Young, conducting a focus group with the executive board of the International Society for Schema Therapy and screening recent reviews on schema therapy for recommendations for future research. The panel rated 81 research areas in terms of priority across three rounds. Nineteen research areas were rated by 75% of the panel as 'Very high priority' or 'High priority'. These priorities reflected four broad themes: (1) schema therapy constructs and measures, (2) the theoretical assumptions underlying schema therapy, (3) schema therapy and theory in relation to different contexts and outcomes and (4) schema therapy effectiveness and mechanisms of change. The findings are important for establishing a clear research agenda for the future of schema therapy.

Overprotective parenting experiences and early maladaptive schemas in adolescence and adulthood: A systematic review and meta-analysis.

Young's schema model identifies overprotection as a type of childhood experience associated with early maladaptive schemas. This review evaluated the evidence base examining overprotective parenting as a predictor of schema endorsement in adolescence and adulthood. A systematic review and meta-analysis were conducted in accordance with the PRISMA guidelines, and registered on PROSPERO (CRD42021258990). PsycINFO, CINAHL and PubMed databases were searched on 5 June 2021 for eligible studies reporting original data on unadjusted association(s) between overprotective parenting and schema endorsement in samples with a mean age of 12 years or older. Studies were excluded if they were not in English or peer reviewed or participants were exposed to an intervention. Meta-analyses using Meta-Essentials software examined the relationship between maternal and paternal overprotective parenting with Young's 18 schemas. An adapted version of the Appraisal tool for Cross-Sectional Studies (AXIS) was used to assess methodological quality. A total of 16 articles were included. Based on 36 meta-analyses (Pooled N = 1,496 to 3,218), several schemas demonstrated positive small correlations with maternal overprotective parenting (range: r = 0.15, 95% CI = 0.10, 0.19 [Entitlement] to r = 0.29, 95% CI = 0.13, 0.43 [Enmeshment]) and paternal overprotective parenting (range: r = 0.15, 95% CI = 0.10, 0.20 [Abandonment] to r = 0.24, 95% CI = 0.10, .36 [Enmeshment]). Considerable heterogeneity was detected, but subgroup analyses were not significant. Overall, recollections of overprotective parenting experiences were primarily associated with schemas relating to disconnection and rejection, and impaired autonomy and performance. However, the literature has thus far relied on retrospective measures of parenting, and longitudinal research is needed to establish causality.

Schema therapists' perceptions of the influence of their early maladaptive schemas on therapy.

OBJECTIVE: This qualitative survey aimed to explore schema therapists' perceptions of how their early maladaptive schemas are activated in their therapeutic work, and how they manage their reactions. METHOD: An online qualitative survey was conducted with 22 schema therapists. Following brief demographic questions, participants were asked three open-ended questions about their schema activation and associated reactions. An inductive-deductive hybrid thematic analysis of the qualitative responses identified four superordinate themes and 12 subthemes. RESULTS: Participants described several negative impacts on their therapeutic work, including avoiding limit setting, becoming argumentative or aggressive, detaching or avoiding, and over-functioning. An array of strategies for managing schema and countertransference reactions were identified, including refocusing on the client's vulnerability, caring for one's own vulnerability and connecting with one's healthy adult self, and engaging in supervision, training, personal therapy, and self-care. Notably, several participants described how their internal reactions can be used advantageously to conceptualize and support clients, and to facilitate therapists' personal development. CONCLUSION: The findings highlighted that although schema and associated countertransference experiences can be challenging, awareness and effective management of therapists' reactions can benefit treatment and promote personal growth.

Adolescent maladaptive schemas and childhood abuse and neglect: A systematic review and meta-analysis.

This study aimed to review evidence on the associations between childhood emotional, physical and sexual abuse; neglect and bullying and early maladaptive schemas, as measured in adolescence. PubMed, PsycInfo and CINAHL were searched to identify peer-reviewed studies reporting original quantitative data on the association between early maladaptive schemas or schema domains (e.g., Disconnection and Rejection) and childhood emotional, physical and sexual abuse; neglect and bullying, measured in individuals aged up to 18 years. Meta-analyses were conducted to estimate the magnitude of the associations between schemas and childhood experiences. Twelve studies were included: Seven explored schemas, and five examined schema domains. Most studies had somewhat representative samples that were adequate in size, and all used validated measures of schemas or schema domains. Three studies explored emotional neglect, two each for emotional abuse, physical abuse and peer problems, one explored family violence and one adolescent stressors. Meta-analyses indicated small to medium pooled associations between emotional abuse and Emotional Deprivation, r = .33 (95% CI [.19, .46]) and Subjugation, r = .32 (95% CI [.14,.47]) and emotional neglect and Mistrust Abuse, r = .41 (95% CI [.32, .49]), Abandonment, r = .25 (95% CI [.22, .28]), Social Isolation r = .23 (95% CI [.10, .35]) and Failure, r = .35 (95% CI [.26, .44]). Associations between childhood abuse and neglect experiences and schemas were evident in adolescents. There were limited data on some adverse experiences including sexual abuse and neglect. The evidence thus far suggests that maladaptive schemas are related to experiences of childhood emotional abuse and neglect and are evident before adulthood.

Parental separation or divorce and adulthood attachment: The mediating role of the Abandonment schema.

This study investigated whether the Abandonment schema mediates the relationship between a history of parental separation or divorce and attachment styles in adulthood. Participants (N = 426; Mage = 30.78 years) completed online measures, using Qualtrics. Results demonstrated that a history of parental separation or divorce was positively associated with anxious and avoidant attachment styles in adulthood. Mediation analyses revealed that the Abandonment schema mediated these relationships (p < 0.001). This suggests that adults with a history of parental divorce or separation are more likely to report anxious and avoidant attachment styles, and this is partially accounted for by an expectation that they will be abandoned by others. These findings have implications for case formulation and can be used to inform treatment. Schema therapy focused on healing the Abandonment schema could promote attachment security in individuals with a history of parental separation or divorce. For example, limited reparenting (i.e., the therapist seeking to meet the client's unmet emotional needs, within the professional boundaries of the relationship), could be tailored to address the individual's underlying unmet need for security and stability. Further research is needed to advance our understanding of the implications of these findings for treatment.

Early maladaptive schemas and depression in adulthood: A systematic review and meta-analysis.

BACKGROUND: Improved understanding of the specific cognitive risk factors associated with depression is needed to inform prevention and treatment approaches. Recent research has examined the relationship between early maladaptive schemas (EMSs) and depression, but the findings were yet to be integrated using meta-analytic methods. The aim of this review was to synthesize the evidence on the relationship between depression and EMS. METHOD: A systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, by searching the PsycINFO, PubMed and CINAHL databases. Included studies were peer-reviewed journal articles that examined the relationship between one or more EMS and depression in adulthood in participants aged 18 years or older. RESULTS: A total of 51 studies were included (k = 743; pooled N = 17,830). All 18 EMSs were positively correlated with depression, with effect sizes ranging from small (r = .23 [.17, .29]; Entitlement) to large (r = .53 [.46, .60]; Social Isolation; r = .50, 95% CI [.45, .54]; Defectiveness/Shame). CONCLUSION: The evidence suggests that individuals who feel like they do not belong, or that they are flawed, bad or unlovable, report higher levels of depression. However, most studies used cross-sectional designs, and further longitudinal research is needed to establish the direction of the relationship between EMS and depression. These findings can guide preventative and treatment approaches. Focusing treatment on the Social Isolation and Defectiveness/Shame EMS may aid in relieving depressive symptoms.

Overlap of autism spectrum disorder and borderline personality disorder: A systematic review and meta-analysis.

Autism spectrum disorder (ASD) and borderline personality Disorder (BPD) share features, including social and emotion regulation difficulties. The evidence for the overlap in prevalence and clinical characteristics was systematically reviewed. Ovid Medline, PsycInfo, and PubMed were searched until November 30, 2020 using keywords relating to BPD and ASD. Studies that reported on the overlap of ASD and BPD diagnoses or traits and used a case, cohort, or case-controlled design were included. Of 1633 screened studies, 19 were included, of which 12 reported data suitable for meta-analysis. Most samples were of small, clinically ascertained groups, with 11 having high risk of bias. The pooled prevalence of BPD in ASD was 4% [95% CI 0%-9%] and of ASD in BPD, 3% [95% CI 1%-8%]. There were inconsistent findings across clinical areas. The prevalence of a dual diagnosis of BPD in ASD cohorts and of ASD in BPD cohorts was within population prevalence estimates of each disorder. Based on this data we were not able to assess whether there is misdiagnosis of one in favor of the other. Neurocognitive differences may underlie similar behavioral symptoms, but further research using larger, well-validated samples is needed. LAY SUMMARY: Autism spectrum disorder (ASD) and borderline personality disorder (BPD) have overlaps in their symptoms. The overlap in how frequently they co-occur and their presentation was systematically reviewed. We searched the key databases and including all studies that reported on the overlap of ASD and BPD diagnoses or traits and used a case, cohort or case-controlled design. Of 1633 studies, 19 were included, of which 12 reported data suitable for pooling. Most samples were of small, clinical groups, with 11 having high risk of bias. The pooled prevalence of BPD in ASD was 4% [95% CI 0%-9%] and of ASD in BPD, 3% [95% CI 1%-8%]. There were inconsistent findings across studies comparing ASD and BPD related symptoms and problems. The prevalence of a dual diagnosis of BPD in ASD cohorts and of ASD in BPD cohorts was similar to the population prevalence of each disorder. Further research using larger, well-validated samples is needed.

A thematic analysis of influences on parents' autism intervention decisions.

BACKGROUND: Factors impacting parents' selection of interventions for their child on the autism spectrum need to be understood in order to better support decision-making. The aim of the current study was to explore parent-reported influences on decisions. METHOD: A sample of 14 Australian parents (13 mothers; 1 father) of a child (4-11 years) diagnosed on the autism spectrum were interviewed about their decisions regarding the use of interventions. A thematic analysis was used to identify prominent themes. FINDINGS: A total of three themes, comprising 11 subthemes were identified. The primary themes were: finding interventions; meeting child and family needs; and acceptability and access. CONCLUSION: Parents' responses highlighted influences on decisions to use evidence-based practices (e.g., behavioural therapies and social skills programs), as well as those with limited empirical support (e.g., animal-assisted therapy and dietary intervention). Influences frequently reported in extant research were reported by parents in this study (e.g., recommendations, logistics of access, and children's individual needs) as well as issues that warrant further investigation (e.g., coping with challenges and stress, importance of intervention intensity, and consideration of the whole family).

Mothers' Worries During Pregnancy: A Content Analysis of Reddit Posts.

Qualitative investigations into maternal worries during pregnancy are limited. The aim of this study was to identify the content of women's pregnancy-related worries by completing a content analysis of posts on Reddit. A total of 217 posts by 196 unique users were analyzed. Most worries related to infant factors (32.6%), individual factors (27.1%), and antenatal care factors, such as medical procedures (25.2%). The remaining worries related to situational factors (10.9%) and the partner relationship (4.3%). Although most fears related to fetal well-being, other concerns included problems with family members, women's own mental health, and not being a "good mother." These findings support calls for antenatal education to more adequately address women's psychosocial concerns.

Early maladaptive schemas and intimate partner violence victimization and perpetration: A systematic review and meta-analysis.

Young's early maladaptive schemas represent a possible pathway between childhood adversity and Intimate Partner Violence (IPV). The aim of this review was to synthesize the evidence on early maladaptive schemas and IPV. PubMed, PsycInfo, and CINAHL databases were searched, in compliance with PRISMA, to identify peer reviewed studies that reported on the relationship between schema or schema domain scores and IPV victimization or perpetration. Based on nine included studies, meta-analyses indicated that IPV victimization showed a moderate association with the Disconnection and Rejection and Impaired Autonomy domains, and a small association with Other-Directedness. The Mistrust Abuse and Vulnerability to Harm schemas were moderately correlated with victimization. Mistrust Abuse was also implicated in perpetration but insufficient data were available for meta-analysis. The evidence suggests that being a victim of IPV is associated with an expectation that one's needs for love and safety will not be met and doubt regarding one's capacity to handle responsibilities or succeed in life.

Adverse childhood experiences and early maladaptive schemas in adulthood: A systematic review and meta-analysis.

BACKGROUND: Schema Therapy is based on the theory that trauma and neglect in childhood lead to early maladaptive schemas and psychopathology in adulthood. The aim of this review was to evaluate support for this theory by synthesizing the literature on childhood adversity and schemas. METHODS: A systematic review and meta-analysis were completed in compliance with PRISMA. PsycInfo, CINAHL and PubMed were searched to identify eligible studies that reported unadjusted association(s) between adverse childhood events and schema scores when participants were 18 years or older. Meta-analyses were conducted to estimate the pooled effect size of associations between schemas and experiences of childhood adversity. RESULTS: A total of 33 studies met inclusion criteria and provided sufficient data for meta-analyses on childhood experiences relating to toxic frustration of needs (emotional neglect and physical neglect) and trauma and victimization (emotional abuse, physical abuse and sexual abuse). Of the 124 meta-analyses, 65 indicated that schemas show small to large correlations with emotional neglect (range: r = .16 [Failure] to r = .51 [Emotional Deprivation]); small to moderate correlations with emotional abuse (range: r = .20 [Vulnerability to Harm] to r = .44 [Emotional Deprivation]); and small correlations with physical neglect, physical abuse and sexual abuse (range: r = .16 [Vulnerability to Harm] to .26 [Emotional Deprivation and Social Isolation]). CONCLUSIONS: Of the 33 included studies, only one used a longitudinal design. However, based on the correlational studies available, early maladaptive schemas in adulthood are associated with a history of childhood abuse and neglect.

Intimate partner violence and child attachment: A systematic review and meta-analysis.

BACKGROUND: Intimate Partner Violence (IPV) is associated with increased risk of impairment to a child's emotional, behavioural, and psychological functioning. Further, the presence of IPV is negatively associated with a child's attachment to their primary caregivers, which is an additional risk factor for social, emotional, and psychological impairment. OBJECTIVE: The aim of this systematic review and meta-analysis was to synthesise the evidence on the association between IPV and the attachment of infants, children, and adolescents to their primary caregiver/s. METHOD: A systematic review was completed, in accordance with the PRISMA statement, on IPV and the parent-child attachment of infants, children, and adolescents (18 years and younger). Meta-analyses were conducted to estimate the magnitude of these associations. RESULTS: A total of 15 studies were included. IPV was significantly associated with less secure child attachment. The pooled effect sizes (Pearson's r) for both longitudinal studies (n = 5) and cross-sectional and retrospective studies combined (n = 10) were small (r = -.22, 95 % CI [-.32, -.12], p < .001; r = -.10, 95 % CI [-.203, -.001], p = .048). Subgroup analyses identified that the effect size was larger when IPV and attachment were measured during infancy compared to childhood, and when attachment was measured via observational methods compared to self-report. CONCLUSION: While the current literature base is limited, findings can inform further research alongside clinical assessment and intervention. It can also help guide attachment- and family-based intervention for families impacted by IPV.

Systematic review of the impact of coparenting interventions on paternal coparenting behaviour.

AIMS: The aim of this study was to evaluate the efficacy of interventions to support coparenting, how partners relate to and support one another as parents, on paternal outcomes. BACKGROUND: Despite societal shifts in gender roles leading to fathers' increasing involvement in parenting and growing recognition of the need for couples-based parenting interventions, fathers have been underrepresented in parenting research. DESIGN: Systematic review. DATA SOURCES: Medline, Embase, Healthstar, and PsycInfo. REVIEW METHODS: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses to identify peer-reviewed articles published up to 2016 that evaluated the effectiveness of coparenting interventions for expectant fathers or fathers of children <18 years. Study quality was assessed using Cochrane risk of bias criteria for Effective Practice and Organisation of Care reviews; Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) criteria were used to summarize quality of the evidence. The primary outcome was coparenting behaviour among men. RESULTS: We identified 16 randomized controlled trials that evaluated 14 coparenting interventions. Nine interventions targeted partners in the perinatal period; five targeted parents of children. All but one involved face-to-face contact, but this varied in duration and intensity. Of the 12 trials that examined coparenting outcomes, eight reported an effect on at least one measure of paternal coparenting behaviour. The quality of the evidence was at a low level. CONCLUSION: Success was moderate, supporting the need for future research to explore the use of additional approaches to increase efficacy, including technology-based interventions, to improve uptake among men.

The prevalence and correlates of self-harm ideation trajectories in Australian women from pregnancy to 4-years postpartum.

OBJECTIVES: Women in the perinatal period are at increased risk of experiencing self-harm ideation. The current study longitudinally examines the prevalence, trajectories, and correlates of self-harm ideation in a population-based sample of Australian women from pregnancy through to the early years of parenting. METHODS: Drawing on data from 1507 women participating in a prospective pregnancy cohort study, data were collected during pregnancy, at 3-, 6-, 12-, and 18-months postpartum, and 4-years postpartum. Longitudinal Latent Class Analysis was conducted to identify groups of women based on their responses to thoughts of self-harm at each time-point. Logistic regression analysis was used to identify factors associated with group membership. RESULTS: Approximately 4-5% of women reported experiencing self-harm ideation at each time-point from pregnancy to 4-years postpartum. Cross-sectional analyses revealed that self-harm ideation was most frequently endorsed in the first 12-months postpartum (4.6%), and approximately 15% of women reported self-harm ideation at least once during the study period. Longitudinally, approximately 7% of women had an enduring pattern of self-harm ideation from pregnancy to 4-years postpartum. Women who had experienced a range of preconception and current social health issues and disadvantage were at increased risk of self-harm ideation over time. LIMITATIONS: Limitations included use of brief measures, along with an underrepresentation of participants with particular socio-demographic characteristics. CONCLUSIONS: A proportion of women are at increased risk of experiencing self-harm ideation during the perinatal period and in the early years of parenting, underscoring the need for early identification during pregnancy and early postpartum to facilitate timely early intervention.

Physical, sexual and social health factors associated with the trajectories of maternal depressive symptoms from pregnancy to 4 years postpartum.

PURPOSE: Few studies have examined the course of maternal depressive across pregnancy and early parenthood. The aim of this study was to identify the physical, sexual and social health factors associated with the trajectories of maternal depressive symptoms from pregnancy to 4 years postpartum. METHOD: Data were drawn from 1102 women participating in the Maternal Health Study, a prospective pregnancy cohort study in Melbourne, Australia. Self-administered questionnaires were completed at baseline (<24 weeks gestation), and at 3-, 6-, 12-, and 18 months, and 4 years postpartum. RESULTS: Latent class analysis modelling identified three distinct classes representing women who experienced minimal depressive symptoms (58.4%), subclinical symptoms (32.7%), and persistently high symptoms from pregnancy to 4 years postpartum (9.0%). Risk factors for subclinical and persistently high depressive symptoms were having migrated from a non-English speaking country, not being in paid employment during pregnancy, history of childhood physical abuse, history of depressive symptoms, partner relationship problems during pregnancy, exhaustion at 3 months postpartum, three or more sexual health problems at 3 months postpartum, and fear of a partner since birth at 6 months postpartum. CONCLUSIONS: This study highlights the complexity of the relationships between emotional, physical, sexual and social health, and underscores the need for health professionals to ask women about their physical and sexual health, and consider the impact on their mental health throughout pregnancy and the early postpartum.