Assessment and Promotion of Partner Support: A Prevention-Focused Intervention for Perinatal Depression in Primary Care

Perinatal depression significantly impacts the mother, her partner, the unborn fetus, and the infant/child after delivery. A review of the literature supports the need for preventive intervention methods as research has shown that even with successful treatment, disruptions in attachment, temperament, and cognitive development often remain. Primary care settings are ideal targets for prevention given that they can reach a number of people at low-cost without the stigma associated with seeking help in a mental health facility. This paper purposes a preventive intervention method for perinatal depression that can be implemented in primary care settings in both Western and non-Western countries. The intervention targets two of the primary risk factors for perinatal depression; partner support and relationship quality. The intervention is structured around key target periods in gestational development and during the early weeks after delivery. Suggestions for each target visit are based on prior research that has demonstrated how psychoeducation about the transition to parenthood, as well as increased communication, can positively affect partner support and relationship quality. The ultimate goal of the intervention is not only to prevent perinatal depression but also to improve the mental health and wellbeing of the entire family system.

Parent Loss in Adolescence and its Impact on Sense of Self: When an Adolescent Boy Loses His Mother.

Adolescence is a developmental phase that involves physical, emotional, and cognitive changes. Often this period is one of transition that requires significant adjustment both with the individual and the family. It is considered to start with puberty, sometime between the ages of 10 and 13, and end with the transition into adulthood (Kruse & Walper, 2008). Puberty is a term that is used to describe the physical changes that generally occur during adolescence. It is an aspect of the changes that occur during the overarching phase of development. Within adolescence, individuals are confronted with many developmental tasks such as establishing an individual identity, making decisions about the future, and moving from dependence on families to independence (Austrian, 2008).There are many changes that occur during adolescence, including sexual maturation and functioning, endocrine developments, and skeletal and muscular changes. Boys will see a growth of body, pubic, and facial hair, their voice will deepen, and they will begin having erections and wet dreams (Kruse & Walper, 2008). The accelerated transformation of this phase generally has an emotional impact and individuals may feel concerned or self-conscious about their appearance. Ausubel, Montemayor, and Svajian (1977) suggest that adolescents may be more sensitive during this period of development. This sensitivity may be in part due to the rapid growth resulting in a sense of awkwardness in appearance and physical coordination.

Patterns and Predictors of Stability and Change in Representations of Romantic Relationships in Adolescence and Young Adulthood

Research on the stability of attachment representations across the lifespan has led to two alternative perspectives: the prototype and revisionist perspectives (Fraley, 2002). The prototype perspective posits that there is a stable factor underlying fluctuations in representations and the revisionist perspective argues that there is no inherently stable factor. The current study employed a latent trait-state model to investigate these alternative models of stability and change in representations of romantic relationships in adolescence and young adulthood. The study also sought to identify individual characteristics and relationship experiences that are associated with changes in representations. In a sample of 200 participants, representations were assessed by interview and self-report over seven measurement occasions between ages 15 and 23. Results were consistent with the prototype perspective emphasizing that a stable, latent factor exerts a consistent influence over the lifespan. In addition to a stable component, representations incorporated a component that varies over time. Findings showed that this fluctuating component of representations was associated with internalizing and externalizing symptomatology as well as experiences of support and negative interaction in relationships.

Examining the relationship among genes, attention bias to emotion, and depression in youth

The investigation of biologically initiated pathways to psychological disorder is critical to advance our understanding of mental illness. Research has suggested that attention bias to emotion may be an intermediate trait for depression associated with biologically plausible candidate genes, such as the serotonin transporter (5-HTTLPR) and catechol-o-methyl-transferase (COMT) genes, yet there have been mixed findings in regards to the precise direction of effects. The experience of recent stressful life events (SLEs) may be an important, yet currently unstudied, moderator of the relationship between genes and attention bias as SLEs have been associated with both gene expression and attention to emotion. Additionally, although attention biases to emotion have been studied as a possible intermediate trait associated with depression, no study has examined whether attention biases within the context of measured genetic risk lead to increased risk for clinical depressive episodes over time. Therefore, this research investigated both whether SLEs moderate the link between genetic risk (5-HTTLPR and COMT) and attention bias to emotion and whether 5-HTTLPR and COMT moderated the relationship between attention biases to emotional faces and clinical depression onset prospectively across 18 months within a large community sample of youth (n= 467). Analyses revealed a differential effect of gene. Youth who were homozygous for the low expressing allele of 5-HTTLPR (S/S) and had experienced more recent SLEs within the last three months demonstrated preferential attention toward negative emotional faces (angry and sad). However, youth who were homozygous for the high expressing COMT genotype (Val/Val) and had experienced more recent SLEs showed attentional avoidance of positive facial expressions (happy). Additionally, youth who avoided negative emotion (i.e., anger) and were homozygous for the S allele of the 5-HTTLPR gene were at greater risk for prospective depressive episode onset. Increased risk for depression onset was specific to the 5-HTTLPR gene and was not found when examining moderation by COMT. These findings highlight the importance of examining risk for depression across multiple levels of analysis, such as combined genetic, environmental, and cognitive risk, and is the first study to demonstrate clear evidence of attention biases to emotion functioning as an intermediate trait predicting depression.

Phototherapy as an Intervention in Identity Development with Adolescents.

Identity development in adolescence is a period of exploration and experimentation. During this stage of development, adolescents are defining their identity in terms of ethnicity, sexual orientation, and gender. It can be a confusing time and the lack of resources and support influence the ability of the adolescent to form a cohesive identity. This struggle to define an identity may lead to symptoms of depression and difficulties with interpersonal relationships. Identity interventions are limited and primarily involve the adolescent talking to a therapist and attempting to verbalize and define subjective distress. The use of a phototherapy intervention focuses on using an adolescent's subjective experiences. Phototherapy provides a way for the therapist and client to explore the photographs the client takes and opens different avenues in the areas of non-verbal and visual communication. Photographs can also promote increased communication about an adolescent's ethnic, sexual or gender identity. Interpretations made by the adolescent about images in the photographs will get in touch with emotional experiences that may be missed in traditional "talk therapy." This paper reviews literature on identity development, specifically in the areas of ethnicity, sexual orientation, and gender identity. Phototherapy, the use of photography to enhance traditional psychotherapy, is described and a rationale is provided for the utilization of phototherapy in adolescent identity development. Vignettes are provided illustrating how phototherapy can be used when working with adolescents who are questioning and exploring ethnic identity, sexual orientation, and gender identity.