Adolescent attachment to parents and peers in singletons and twins born with assisted and natural conception.

STUDY QUESTION: Does adolescent attachment to parents and peers differ between singletons and twins born with ART or natural conception (NC)? SUMMARY ANSWER: Adolescent attachment anxiety with the father was higher among NC singletons than among ART and NC twins, whereas attachment avoidance with the father was higher in ART singletons than in NC singletons and NC twins. No differences were found in attachment to the mother, best friend or romantic partner. WHAT IS KNOWN ALREADY: Most studies have not found differences between ART and NC singletons in parent-adolescent relationships, but twin relationships may be more at risk. No previous study has examined all four groups in the same study, or specifically looked at attachment relationships. STUDY DESIGN SIZE DURATION: This was an 18-year, prospective and controlled longitudinal study with families of 496 ART singletons, 101 ART twin pairs, 476 NC singletons and 22 NC twin pairs. Families were recruited during the second trimester of pregnancy; the ART group was recruited from five infertility clinics in Finland and the control group was recruited from a hospital outpatient clinic during a routine visit. PARTICIPANTS/MATERIALS SETTING METHODS: Mothers and fathers gave background information for this study during pregnancy, and during the child's first year and early school age (7-8 years). For the ART group, infertility characteristics and prenatal medical information was also obtained from the patient registry of the infertility clinics. Children (originally 50% girls) filled in electronic questionnaires related to their attachment to mother, father, best friend and romantic partner (Experiences in Close Relationships-Relationship Structures) at 17-19 years of age. MAIN RESULTS AND THE ROLE OF CHANCE: Adolescent attachment anxiety to father was higher in NC singletons than in ART twins, P = 0.004 and marginally higher than in NC twins, P = 0.06. Adolescent attachment avoidance to father was higher in ART singletons than in NC singletons, P = 0.006 and marginally higher than in NC twins, P = 0.055. LIMITATIONS REASONS FOR CAUTION: The sample size was small especially in the NC twin group and there was drop-out over the 18-year time period, especially among boys and families with lower parental education level. The study only included native Finnish-speaking families. The results could differ in a more diverse population. ART singletons were younger and had fewer siblings than ART twins and NC children, and ART and NC twins had more newborn health risks than ART and NC singletons. WIDER IMPLICATIONS OF THE FINDINGS: The study adds to a growing body of evidence that neither ART treatments nor being a twin places mother-child relationships or peer relationships at long-term risk. However, in our study, which was the first to examine both ART and twinhood simultaneously, we found that there may be more problems in father-adolescent relationships, but only in ART singletons and only related to attachment avoidance. Our findings suggest that men, as well as women, should receive enough support in pre- and peri-natal health care during and after infertility treatments. STUDY FUNDING/COMPETING INTERESTS: This study was funded by Academy of Finland (grant number 2501308988), the Juho Vainio Foundation and the Finnish Cultural Foundation. The authors report no conflict of interest. TRIAL REGISTRATION NUMBER: N/A.

Maternal substance use disorder predicting children's emotion regulation in middle childhood: the role of early mother-infant interaction.

BACKGROUND: Maternal prenatal substance use disorder (SUD) represents a dual risk for child wellbeing due to teratogenic impacts and parenting problems often inherent in SUD. One potential mechanism transferring this risk is altered development of children's emotion regulation (ER). The present study examines how mother's prenatal SUD and early mother-infant interaction quality predict children's ER in middle childhood. METHOD: The participants were 52 polysubstance using mothers and 50 non-users and their children. First-year mother-infant interaction quality was assessed with the Emotional Availability (EA) Scales and children's ER with the Children's Emotion Management Scales (CEMS), and its parent version (P-CEMS) at 8-12 years. RESULTS: Mother's prenatal SUD predicted a low level of children's adaptive ER strategies, whereas early mother-infant interaction problems predicted a high level of emotion dysregulation. The dyadic interaction also mediated the effect of SUD on emotion dysregulation. In the SUD group, more severe substance use predicted high emotion inhibition. CONCLUSION: Early mother-infant interaction quality is critical in shaping children's ER, also in middle-childhood. Interventions aimed for mothers with prenatal SUD should integrate parenting components to support the optimal development of multiply vulnerable children.

The effectiveness of Nurture and Play: a mentalisation-based parenting group intervention for prenatally depressed mothers.

AIM: This randomised control trial (RCT) study examined the effectiveness of a mentalisation-based perinatal group intervention, Nurture and Play (NaP), in improving mother-infant interaction quality and maternal reflective functioning and in decreasing depressive symptoms. BACKGROUND: Few preventive prenatal interventions have been developed for primary health care settings for mothers with depressive symptoms. Furthermore, previous prenatal intervention studies have only concentrated on reducing depressive symptoms and have not directly addressed enhancing optimal parenting qualities. METHODS: The participants were 45 pregnant women with depressive symptoms. Women in the randomly assigned intervention group (n = 24) participated in the manualised, short-term NaP intervention group from pregnancy until the baby's age of seven months, whereas control group women received treatment as usual (TAU). Maternal emotional availability (EA), reflective functioning (RF) and depressive symptoms were measured before the intervention and at the infants' 12 months of age, and changes were evaluated using repeated measure analyses of variances (ANOVAs). FINDINGS: The results showed that the intervention group displayed higher maternal sensitivity and RF and more reduction in depressive symptoms than the control group when babies were 12 months old. These findings provide preliminary support for the effectiveness of the NaP intervention.

Mental health of mothers and fathers of twins conceived via assisted reproduction treatment: a 1-year prospective study.

BACKGROUND: Although twin deliveries after assisted reproduction treatment (ART) are common, the mental health of the parents has scarcely been addressed. Therefore, we evaluated the psychological well-being of ART and spontaneously conceiving parents of twins and singletons. Furthermore, the impact of parity and children's health-related factors on mental health was evaluated. METHODS: We conducted a prospective longitudinal questionnaire study among ART parents of 91 pairs of twins and of 367 singletons and on control parents of 20 pairs of twins and of 379 singletons in the 2nd trimester of pregnancy (T1), and when the children were 2 months (T2) and 1-year old (T3). Symptoms of depression and anxiety, sleeping difficulties and social dysfunction were addressed via a questionnaire. The effects of parity and child-related factors were assessed at T2. RESULTS: At T1, ART mothers of twins showed fewer symptoms of depression than control mothers of twins (P < 0.05). At T2, both ART and control mothers of twins had more symptoms of depression and anxiety than all mothers of singletons (F = 5.20, P < 0.05 and F = 3.93, P < 0.05, respectively). At T3, both ART and control mothers of twins continued to report more symptoms of depression than the mothers of singletons (F = 10.01, P < 0.01), but a difference in anxiety symptoms was seen only in the control group. All fathers had similar mental health at T1. At T2, ART and control fathers of twins reported more symptoms of depression (F = 4.15, P < 0.05) and social dysfunction than fathers of singletons. At T3, both ART and control fathers of twins had more symptoms of depression (F = 4.29, P < 0.05) and anxiety (F = 5.40, P < 0.05) than fathers of singletons. Control fathers of twins had more sleeping difficulties than fathers of singletons (F = 6.66, P < 0.01). Parity did not differently affect parental mental health at T2 in the study groups. Prematurity did not affect maternal mental health, but it had a negative impact on control fathers' social dysfunction (F = 3.34, P < 0.05). CONCLUSIONS: Twin parenthood, but not ART, has a negative impact on the mental health of mothers and fathers during the transition to parenthood. ART parents' mental health was not affected by parity or children's health-related factors.

Infertility treatment and marital relationships: a 1-year prospective study among successfully treated ART couples and their controls.

BACKGROUND: Evidence about the effects of infertility and assisted reproduction technique (ART) on marital relationships is discrepant. Here, we examined the impact of ART on marital relationships. The roles of life stressors, infertility and treatment characteristics in predicting marital relations were also evaluated. SUBJECTS: 367 couples with singleton IVF/ICSI pregnancies. CONTROLS: 379 couples with spontaneous singleton pregnancies. Women and men were assessed when the child was 2 months (T2) and 12 months old (T3). They further reported stressful life events at T2 and depression in pregnancy. RESULTS: No between-group differences were found in marital satisfaction and dyadic cohesion. Dyadic consensus deteriorated from T2 to T3 only among control women. Sexual affection was low among control men at T2 and stressful life events decreased it further. Depression during pregnancy predicted deteriorated marital relations only in control couples. Several unsuccessful treatment attempts were associated with good dyadic consensus and cohesion among ART women. Spontaneous abortions and multiple parity predicted poor marital satisfaction in ART women, whereas long duration of infertility and multiple parity predicted poor marital relations in ART men. CONCLUSIONS: Successful ART does not constitute a risk for marital adjustment. The shared stress of infertility may even stabilize marital relationships.

Fear of childbirth and pregnancy-related anxiety in women conceiving with assisted reproduction.

OBJECTIVE: To compare the prevalence and predictors of severe fear of childbirth and pregnancy-related anxiety in groups of assisted reproduction treatment (ART) and spontaneously conceiving women with singleton pregnancies. METHODS: The ART group (n = 367, nulliparous 260) represented a cohort from five Finnish infertility clinics in 1999. The control group (n = 379, nulliparous 135) was enrolled in this study by consecutive sampling the same year. Fear of childbirth was assessed by means of the revised version of the Fear-of-Childbirth Questionnaire and pregnancy-related anxiety by means of the Pregnancy Anxiety Scale at gestational week 20 +/- 3.2 (mean+/-standard deviation). RESULTS: The frequency of severe fear of childbirth and anxiety (classified as total scores in the 90th percentile or higher in the revised Fear of Childbirth Questionnaire and Pregnancy Anxiety Scale) did not differ between the groups. Nulliparity was associated with more frequent severe anxiety only in the controls. In nulliparous participants, a partnership of more than 5 years decreased the risk of severe fear of childbirth (odds ratio 0.3, 95% confidence interval 0.2-0.7). In the nulliparous ART group, a long duration of infertility (7 or more years) increased the risk of severe fear of childbirth (odds ratio 4.4, 95% confidence interval 1.2-16.9). CONCLUSION: Women conceiving after ART do not experience severe fear of childbirth or pregnancy-related axiety more often than spontaneously conceiving controls. However, a long duration of infertility is an independent risk factor regarding severe fear of childbirth. LEVEL OF EVIDENCE: II-2.

Impact of infertility characteristics and treatment modalities on singleton pregnancies after assisted reproduction.

Obstetric and neonatal outcomes of assisted reproduction and control singletons were evaluated after taking into account treatment characteristics and infertility background. The elective single embryo transfer (eSET) group (n = 45) was compared with the compulsory single embryo transfer (cSET; n = 52), double embryo transfer (DET; n = 227) and control (n = 304) groups. Infertility-related prognostic factors for neonatal outcomes were also analysed. Data were collected with structured questionnaires at gestational week 20 and 8 weeks after delivery. Spontaneous onset of delivery was more typical of the eSET group than of cSET and DET groups (68.9 versus 52.0%, P = 0.02). Mean (+/-SD) gestation at birth (39.3 +/- 1.6 weeks) and mean birth weight (3,470 +/- 505 g) of eSET singletons were comparable with other assisted reproduction groups, but gestational duration was lower than in the eSET group than in the control group (39.9 +/- 1.4; P < 0.05). However, numbers of preterm births and low birth weight infants were similar between groups. History of induced abortion increased risk of preterm birth (OR 4.5 and 95% CI 1.2-17.1) in assisted reproduction singletons. A small though clinically unimportant difference in gestational age at birth and birth weight between assisted reproduction and control singletons was found regardless of the number of embryos transferred.

The impact of successful assisted reproduction treatment on female and male mental health during transition to parenthood: a prospective controlled study.

BACKGROUND: The dynamics of mental health during the transition to parenthood have not been a focus of research. Our prospective longitudinal study was designed to reveal whether there are differences in mental health during the transition to parenthood between parents undergoing treatment with assisted reproduction techniques (ART) and those who conceive spontaneously. STUDY GROUP: 367 couples with a singleton ART pregnancy using their own gametes. CONTROL GROUP: 379 couples with a spontaneous singleton pregnancy. Men and women separately filled in questionnaires including the General Health Questionnaire: at the 18th-20th week of pregnancy, 2 months postpartum and 1 year postpartum (T3). The effect of social and child-related factors on mental health was examined. RESULTS: ART women had fewer depressive symptoms during pregnancy than controls, but at T3 their depressive symptoms were at the same level as seen in controls. Anxiety symptoms increased among control but not among ART women across the transition. ART men reported generally fewer mental health symptoms than their controls. Social and child-related stressors had negative impacts on mental health changes among control couples, whereas no impact was found among ART couples. CONCLUSIONS: Successful ART did not predict mental health problems during the transition to parenthood. Moreover, ART couples' mental health was remarkably resistant to social and child-related stress during the transition to parenthood.

Attachment patterns and working alliance in trauma therapy for victims of political violence.

We examined the development of alliance in therapy in different attachment groups in a naturalistic setting. The participants were 36 self-referred Palestinian political ex-prisoners, who were victims of torture and ill treatment and had sought psychotherapy. Their therapy lasted for 10-12 months. The analyses showed that the development of alliance during therapy followed different patterns across the attachment groups. Yet early alliance did not differ between the groups. For the autonomous individuals, alliance dropped in the middle of therapy, and increased back to its initial level by the end. Similarly, for the preoccupied individuals alliance decreased steeply in the middle of the therapy, and then increased even more steeply by the end. In contrast, for the dismissing individuals, alliance was approximately the same at the beginning and in the middle of the therapy, and then it decreased at the end.

Memory and metamemory functioning among depressed patients.

Memory and metamemory functioning were studied among 30 adult patients suffering from major depression. The results indicate that, besides showing signs of cognitive slowing, the patients were especially vulnerable to visual memory impairment, whereas verbal, short-term memory, and recall by recognition were more often unaffected. The patients whose depression was characterized by physiological symptoms, such as loss of appetite and sleep disturbances, showed impairment in traditional short-term memory measures, whereas there was no firm connection between cognitive or behavioral depressive symptoms and memory functioning. The depressive patients' generalized view of their memory capability was strongly underestimated, whereas online metamemory accuracy by which one perceives and makes inferences about one's performance was adequate.

Models of traumatic experiences and children's psychological adjustment: the roles of perceived parenting and the children's own resources and activity.

The relations between traumatic events, perceived parenting styles, children's resources, political activity, and psychological adjustment were examined among 108 Palestinian boys and girls of 11-12 years of age. The results showed that exposure to traumatic events increased psychological adjustment problems directly and via 2 mediating paths. First, the more traumatic events children had experienced, the more negative parenting they experienced. And, the poorer they perceived parenting, the more they suffered from high neuroticism and low self-esteem. Second, the more traumatic events children had experienced, the more political activity they showed, and the more active they were, the more they suffered from psychological adjustment problems. Good perceived parenting protected children's psychological adjustment by making them less vulnerable in two ways. First, traumatic events decreased their intellectual, creative, and cognitive resources, and a lack of resources predicted many psychological adjustment problems in a model excluding perceived parenting. Second, political activity increased psychological adjustment problems in the same model, but not in the model including good parenting.

Experiences of torture and ill-treatment and posttraumatic stress disorder symptoms among Palestinian political prisoners.

The relationship between the nature and severity of experiences of torture and ill-treatment and posttraumatic stress disorder (PTSD) symptoms was studied in 550 male nonhelp-seeking Palestinian political ex-prisoners from the Gaza Strip. Results showed that the more a prisoner had been exposed to physical, chemical and electric torture, psychological ill-treatment, and sensory deprivation or bombardment, the more he subsequently suffered from intrusive reexperiencing, withdrawal and numbness, and hyperarousal. Existential problems were not related to torture experiences. Furthermore, duration of imprisonment, health problems during the imprisonment, harassment during arrest and after release, family, marriage and economic difficulties all predicted intrusive reexperiences of trauma. Also, ex-prisoners who continued to be harassed by military authorities and had economic problems suffered more from withdrawal, numbness, and hyperarousal than others.

Can ideological commitment protect children's psychological well-being in situations of political violence?

The mental health role of ideological commitment (operationalized as glorification of war, patriotic involvement, and defiant attitudes toward the enemy) was studied among 385 Israeli girls and boys (mean age 12 +/- 2.50). It was hypothesized that experiences of political hardships do not increase psychosocial problems if children have strong ideological commitment. The hypothesis was conditionally substantiated concerning symptoms of anxiety and insecurity, and depression and feelings of failure. Exposure to political hardships did not increase the presence of these symptoms among children who showed strong ideological commitment. In contrast, among children with weak ideological commitment, exposure increased these symptoms, but not linearily. Furthermore, injury and loss decreased social support if children show weak ideological commitment. There was also the mediating role of ideological commitment, showing that political hardships increased the ideological commitment that, in turn, was related to a low level of psychosocial problems.

The impact of the peace treaty on psychological well-being: a follow-up study of Palestinian children.

This research examined the impact of the Israeli-Palestinian peace treaty and Palestinian children's perception of it on their self-esteem and neuroticism. We also studied the relative importance of earlier exposure to traumatic experiences and psychosocial resources indicated by the children's creativity, intelligence and political activity in influencing their psychological well-being after the peace treaty. The sample used was a follow-up group of 64 Palestinian children of 11-12 years of age, living in the Gaza Strip. The results showed that the level of neuroticism was significantly lower after the peace treaty than before. The children's earlier exposure to traumatic experiences was still significantly related to high neuroticism and low self-esteem after the peace treaty. Acceptance of the treaty and participating in the subsequent festivities mitigated the negative impact of the traumatic experiences on their well-being. Increased neuroticism and decreased self-esteem were found only among children who refused to accept the peace treaty and did not participate in the festivities. Creativity and Intifada activity promoted their post-peace treaty well-being, in terms of psychosocial resources. The more creative the children were, the more their neurotic symptoms decreased because of the treaty and the higher self-esteem they had after it. The more active the children were during the Intifada, the more their self-esteem increased because of the treaty.

Content and predictors of consultation experiences among Finnish primary care patients.

The study focuses on how patients' explanations of their illnesses, their own diagnoses and their expectations are related to their experience of general practice consultations. Before seeing the General Practitioner (GP) on call, 127 Finnish acute health centre patients were interviewed about their interpretation of their symptoms, their explanations for the causes of their illnesses and their expectations of the forthcoming consultations. After seeing the GP they were asked to describe what happened in the consultations and to evaluate their experiences. In the qualitative analysis, the following consultation experiences were found: (1) being treated with holistic approach; (2) enjoyment of support and consolation; (3) receipt of important information; (4) subjection to routine and ritualistic conduct; (5) experience of insecurity and helplessness; and (6) experience of indifference and neglect. Loglinear models for predicting the success of medical consultations showed that 'negative medical consultation' is more likely to happen if: (a) the patient's illness explanation integrates both biomedical and psychosocial models; and (b) there is no match between the patient's own and the doctor's diagnosis.

Self-care and mastery among primary health care patients.

In this paper the content of everyday mastery is described, and related background variables are analyzed. Health maintenance, self-care practices, coping resources and feelings of helplessness, as indicators of daily mastery, were studied among a group of 142 Finnish primary care patients using a two-week diary method. The main themes related to health maintenance, self-care, and coping resources were found to be: meaningfulness of life, social relations and togetherness, activities, recreation and enjoyment, discipline and good health, and treatment of symptoms and diseases. The most frequent causes of feelings of helplessness were: diseases and symptoms, discrepancies between demands and capabilities, and negative psychological and emotional states. When writing about mastery, women mentioned philosophy and faith, social relations and togetherness, as well as food and dieting more often than men. Women recorded more helplessness due to discrepancies between demands and capabilities and to negative psychological and emotional states, whereas men recorded more helplessness due to global, political, and societal conditions. Older people recorded philosophy and faith and lay care more frequently as sources of mastery more than younger people. Helplessness due to the discrepancies between demands and capabilities was more evident among older people.

[Mastery among primary health care patients]. / Terveyskeskusasiakkaan itsehallinta terveyspäiväkirjan perusteella.

The aim of the study was to describe and understand the experiences and activities that people use in order to master their everyday health. Data was collected among 142 primary health care patients, who were given a semi-structured diary to fill for two weeks. The diaries were analysed by using qualitative methods of content analysis and grounded method. The main theme of diaries were analysed in order to depict the different orientations of mastery. Four different types were found: Daily life dominated by one theme, such as sport, faith or diet; Daily life as struggle with pain and illness, Regular daily life, Daily life as an ordeal and Daily life characterized by abundant joyful life.

Impact of political change on the psychological stress process among West Bank Palestinian women.

This article reports the relationships between political change, personal factors and the psychological stress process among 40 West Bank Palestinian women. The women were tested in spring 1982 and in autumn 1985. The stress process assessed consists of exposure to stressful life events, the way that women perceive the severity of stress (worry) and appraise their own resources to cope with it (locus of control), as well as actual coping modes, and mental health problems. The results show that the Palestinian women had more personal and political worries, and showed more personal helplessness (external locus of control) after the Lebanon war in 1985 than in 1982. The results further show that women employed less avoidance and retreat, and less denial as coping modes in 1985 than in 1982. No changes between these years were found in the women's mental health, their locus of control on the Palestinian issue, and coping modes of aggressive action and social-political activity. The results on the roles of personal factors in the stress process show that younger women expressed more political worries and initiative (internal locus of control) on the Palestinian issue. Furthermore, women who had many children had fewer political worries and more personal worries, and were less external in their locus of control on the Palestinian issue than women with few children.

Predictors and effectiveness of coping with political violence among Palestinian children.

Relationships between exposure to political hardships, social-economic status and mother's psychological responses, and children's coping modes, were analysed among 66 Palestinian boys and girls aged 8-14 who lived in the West Bank and the Gaza Strip. The effectiveness of children's coping modes in protecting their mental health from the negative impact of political hardships was also analysed. The coping modes were assessed on the intentional (passive-active), cognitive (defensive-purposive), and emotional (helpless-courageous) levels. The results showed that the more children were exposed to political hardships, the more they employed active and courageous coping modes. Furthermore, the more mothers showed psychological symptoms the more their children used active coping modes. The more political activity the mothers used as a coping mode, the more their children used purposive coping. Exposure to political hardships increased children's psychological symptoms, and none of the children's psychological coping modes were effective in mitigating this relationship.