Patterns and factors associated with low adherence to psychotropic medications during pregnancy-a cross-sectional, multinational web-based study.

BACKGROUND: No previous studies have explored how closely women follow their psychotropic drug regimens during pregnancy. This study aimed to explore patterns of and factors associated with low adherence to psychotropic medication during pregnancy. METHODS: Multinational web-based study was performed in 18 countries in Europe, North America, and Australia. Uniform data collection was ensured via an electronic questionnaire. Pregnant women were eligible to participate. Adherence was measured via the 8-item Morisky Medication Adherence Scale (MMAS-8). The Beliefs about Prescribed Medicines Questionnaire (BMQ-specific), the Edinburgh Postnatal Depression Scale (EPDS), and a numeric rating scale were utilized to measure women's beliefs, depressive symptoms, and antidepressant risk perception, respectively. Participants reporting use of psychotropic medication during pregnancy (n = 160) were included in the analysis. RESULTS: On the basis of the MMAS-8, 78 of 160 women (48.8%, 95% CI: 41.1-56.4%) demonstrated low adherence during pregnancy. The rates of low adherence were 51.3% for medication for anxiety, 47.2% for depression, and 42.9% for other psychiatric disorders. Smoking during pregnancy, elevated antidepressant risk perception (risk≥6), and depressive symptoms were associated with a significant 3.9-, 2.3-, and 2.5-fold increased likelihood of low medication adherence, respectively. Women on psychotropic polytherapy were less likely to demonstrate low adherence. The belief that the benefit of pharmacotherapy outweighed the risks positively correlated (r = .282) with higher medication adherence. CONCLUSIONS: Approximately one of two pregnant women using psychotropic medication demonstrated low adherence in pregnancy. Life-style factors, risk perception, depressive symptoms, and individual beliefs are important factors related to adherence to psychotropic medication in pregnancy.

A violência doméstica como indicador de risco no rastreamento da depressão pós-parto

OBJETIVO: apurar a freqüência de risco para depressão pós-parto (DP) em puérperas de hospital de São Paulo, região Sudeste do Brasil, e determinar fatores associados - entre eles a violência doméstica (VD). MÉTODOS: estudo descritivo, tipo corte transversal. Participaram 133 mulheres, que tiveram partos com idade gestacional de 20 semanas ou mais, no período de agosto a setembro de 2005, em maternidade terciária em São Paulo (Brasil). Foram entrevistadas empregando-se a versão em português do Abuse Assessment Screen para o diagnóstico de violência e responderam questionário de auto-avaliação do risco de DP (Edinburgh Postnatal Depression Scale). As variáveis foram representadas por freqüências absoluta e relativa. A associação entre as variáveis de interesse e DP foi avaliada pelo teste do chi2 ou exato de Fisher. Adotou-se o nível de significância de 5%. RESULTADOS: o risco de DP foi identificado em 24 puérperas (18%). Das mulheres entrevistadas, 38,3% referiram história de abusos. Observou-se associação entre a ocorrência de VD após os 15 anos de idade e o risco de depressão (p=0,03). A ocorrência de abusos no grupo de mulheres com probabilidade de apresentar DP foi de 58,3%, proporção significativamente maior do que a observada no grupo controle com 33,9%. CONCLUSÕES: a probabilidade de apresentar depressão foi alta entre as puérperas assistidas em maternidade terciária da região Sudeste do Brasil. A VD sofrida após os 15 anos de idade esteve estatisticamente associada ao risco de DP.

Vanhempien psyykkinen hyvinvointi ja kiintymyksen kehittyminen keskosvauvaan Vanhemmat vahvasti mukaan -koulutusprojektin jälkeen

Tutkimuksen aiheena oli tutkia keskoslapsen vanhemman psyykkistä hyvinvointia ja kiintymyksen kehittymistä vauvaan keskosen sairaalahoidon aikana sekä kotiutumisen jälkeen. Tarkoituksena oli selvittää, oliko vanhempien välillä eroa masennuksen, tehohoitoympäristöstä aiheutuvan stressin ja kiintymyksen kehittymisessä keskoseen, ja muuttuivatko nämä ajan kuluessa. Lisäksi haluttiin selvittää liittyivätkö masennus, stressi ja kiintymys toisiinsa. Tutkimusaineisto koostui alle 34 raskausviikolla syntyneistä 55 keskosista ja heidän vanhemmistaan (48 äitiä ja 36 isää), jotka olivat osallistuneet Vanhemmat vahvasti mukaan (VVM) -evaluaatiotutkimukseen. Tutkimusaineistoa kerättiin kyselylomakkeilla kolmessa eri mittauspisteessä: 7±3 vuorokautta syntymästä, kotiutusajankohtana ja keskoslapsen korjatussa kuuden kuukauden iässä. Masennusta arvioitiin EPDS-mittarin (Edinburgh Postnatal Depression Scale) avulla kaikissa kolmessa aikapisteessä. Tehohoitoympäristöstä aiheutuvaa stressiä arvioitiin PSS:NICU-mittarilla (Parental Stressor Scale: Neonatal Intensive Care Unit) ja kiintymyksen kehittymistä keskosvauvaan BABY & YOU -mittarilla kahdessa ensimmäisessä mittauspisteessä. Vanhempien kokema masennus oli vähäistä, sillä keskoslapsen korjatussa kuuden kuukauden iässä 2,9 % äideistä oli masentuneita. Äidit kokivat isiin verrattuna enemmän masennusta, ja vanhempien masennus väheni syntymästä keskosen korjattuun kuuden kuukauden ikään. Vanhemmat kokivat tehohoitoympäristöstä aiheutuvan kokonaisstressin vähäisenä (äideillä ka=1,89 kh=0,52; isillä ka=1,56 kh=0,52). Äidit kokivat isiä enemmän stressiä syntymäaikapisteessä, ja äitien kokonaisstressi väheni keskosen kotiutusajankohtaan mennessä. Vanhempien kokonaisstressi tehohoitoympäristöstä korreloi hyvin vahvasti masennuksen kanssa kaikissa aikapisteissä, ja yksittäisenä eniten stressiä aiheuttavana tekijänä vanhemmat kokivat erossaolon vauvastaan. BABY & YOU -mittarilla arvioituna äidit kokivat isiä enemmän huolta ja eroahdistusta keskosvauvastaan. Syntymäaikapisteessä huoli keskosesta korreloi positiivisesti masennuksen kanssa. Äidit kokivat vähemmän masennusta, stressiä ja huolta keskosestaan, mikäli raskausaika oli ollut onnellinen. Vanhempien vähäinen masennus ja stressi voivat mahdollisesti liittyä VVM-koulutusprojektiin, jonka tavoitteena oli antaa vanhemmille vahva emotionaalinen tuki vauvansa hoitoon.

Äidin raskaudenaikaisen masennusoireilun ja vanhemmuuteen liittyvän stressin yhteys imetyksen kestoon

Tämän tutkimuksen tavoitteena oli tutkia äidin raskaudenaikaisten ja synnytyksenjälkeisten masennusoireiden vaikutuksia imetyksen kestoon ja vanhemman kokemukseen ruokailutilanteista lapsen ollessa yhden vuoden ikäinen. Lisäksi tavoitteena oli selvittää, miten äidin synnytyksenjälkeinen vanhemmuuteen liittyvä stressi vaikuttaa imetyksen kestoon ja kokemuksiin ruokailutilanteista vauvan kanssa. Tämä syventävien opintojen tutkielma on tehty FinnBrainin syntymäkohortin pilottiaineistosta, johon osallistui 203 äitiä ja lasta. Tutkimukseen rekrytoitiin vapaaehtoisia raskaana olevia naisia kumppaneineen Turusta, lähikunnista ja Ahvenanmaalta 12. raskausviikon ultraäänitutkimuksen yhteydessä. Tutkimusaineisto on kerätty kyselykaavakkeilla raskausviikoilla 18–22, 32–34, sekä lapsen ollessa kolmen ja kuuden kuukauden ikäinen. Tutkimusjoukon muodostivat henkilöt, jotka palauttivat kyselyn vähintään kerran raskauden aikana ja kuuden kuukauden kohdalla synnytyksestä. Masennusoireilua mitattiin Edinburgh Postnatal Depression Scale –kyselyllä ja synnytyksenjälkeistä vanhemmuuteen liittyvää stressiä lyhyellä versiolla The Swedish Parenthood Stress Questionnairesta. Sekoittavina tekijöinä tutkittiin äidin ikää, koulutusta, tupakointia ja synnytysten määrää. Tutkimuksessa ei havaittu yhteyttä raskaudenaikaisen ja synnytyksenjälkeisen masennuksen ja imetyksen keston tai vanhempien vauvan kanssa hankaliksi kokemien ruokailutilanteiden väliltä. Myöskään synnytyksenjälkeinen vanhemmuuteen liittyvä stressi ei ollut yhteydessä imetyksen kestoon tai hankaliin ruokailutilanteisiin lapsen kanssa. Aineistomme on pieni ja merkittäviä masennusoireita oli vain muutamalla äidillä. Raskaudenaikainen ja synnytyksenjälkeinen masennusoireilu oli lähes tilastollisesti merkitsevästi yhteydessä imetyksen kestoon, mutta tutkimuksen voima ei ollut riittävä. Masennusoireilun yhteys vanhemman kokemiin hankaliin ruokailutilanteisiin lapsen kanssa oli lähellä tilastollisesti merkitsevää. Pilottiaineiston tulokset viittaavat siihen, että tilastollisesti merkitseviä yhteyksiä saattaa löytyä, kun tutkittavien määrä kasvaa. Masennusoireista ja vanhemmuuteen liittyvästä stressistä kärsivät äidit on tärkeää löytää, jotta oireiluun voidaan puuttua ajoissa ja tukea imetyksen jatkamista.

Effets d’un programme prénatal de groupe adressé aux couples parentaux pour prévenir la dépression postnatale des femmes de classes moyenne et défavorisée habitant en Catalogne Nord et en France Sud

La dépression postnatale (DP) est un problème de santé publique très fréquent dans différentes cultures (Affonso et al, 2000). En effet, entre 10% à 15% des mères souffrent d’une symptomatogie dépressive ainsi que l’indiquent Gorman et al. (2004). La prévention de la DP est l’objectif de différents programmes prénatals et postnatals (Dennis, 2005; Lumley et al, 2004). Certains auteurs notent qu’il est difficile d’avoir accès aux femmes à risque après la naissance (Evins et al, 2000; Georgiopoulos et al, 2001). Mais, les femmes fréquentent les centres de santé pendant la grossesse et il est possible d’identifier les cas à risque à partir des symptômes prénataux dépressifs ou somatiques (Riguetti-Veltema et al, 2006); d’autant plus qu’un grand nombre de facteurs de risque de la DP sont présents pendant la grossesse (O’Hara et Gorman, 2004). C’est pourquoi cette étude fut initiée pendant le premier trimestre de la grossesse à partir d’une détection précoce du risque de DP chez n= 529 femmes de classes moyenne et défavorisée, et, cela, au moyen d’un questionnaire validé utilisé à l’aide d’une entrevue. L’étude s’est effectuée dans trois villes : Barcelone, Figueres, et Béziers au cours des années 2003 à 2005. Objectif général : La présente étude vise à évaluer les effets d’un programme prénatal de groupes de rencontre appliqué dans la présente étude chez des couples de classe socioéconomique non favorisée dont les femmes sont considérées comme à risque de dépression postnatale. L’objectif spécifique est de comparer deux groupes de femmes (un groupe expérimental et un groupe témoin) par rapport aux effets du programme prénatal sur les symptômes de dépression postnatale mesurés à partir de la 4ème semaine après l’accouchement avec l’échelle EPDS. Hypothèse: Les femmes participant au programme prénatal de groupe adressé aux couples parentaux, composé de 10 séances hebdomadaires et inspiré d’une orientation psychosomatique présenteront, au moins, un taux de 6% inférieur de cas à risque de dépression postnatale que les femmes qui ne participent pas, et cela, une fois évaluées avec l’échelle EPDS (≥12) 4 semaines après leur accouchement. Matériel et méthode: La présente étude évaluative est basée sur un essai clinique randomisé et longitudinal; il s’étend de la première ou deuxième visite d’échographie pendant la grossesse à un moment situé entre la 4ème et la 12ème semaine postnatale. Les participants à l’étude sont des femmes de classes moyenne et défavorisée identifiées à risque de DP et leur conjoint. Toutes les femmes répondant aux critères d’inclusion à la période du recrutement ont effectué une entrevue de sélection le jour de leur échographie prénatale à l’hôpital (n=529). Seules les femmes indiquant un risque de DP furent sélectionnées (n= 184). Par la suite, elles furent distribuées de manière aléatoire dans deux groupes: expérimental (n=92) et témoin (n=92), au moyen d’un programme informatique appliqué par un statisticien considérant le risque de DP selon le questionnaire validé par Riguetti-Veltema et al. (2006) appliqué à l’aide d’une entrevue. Le programme expérimental consistait en dix séances hebdomadaires de groupe, de deux heures et vingt minutes de durée ; un appel téléphonique entre séances a permis d’assurer la continuité de la participation des sujets. Le groupe témoin a eu accès aux soins habituels. Le programme expérimental commençait à la fin du deuxième trimestre de grossesse et fut appliqué par un médecin et des sages-femmes spécialement préparées au préalable; elles ont dirigé les séances prénatales avec une approche psychosomatique. Les variables associées à la DP (non psychotique) comme la symptomatologie dépressive, le soutien social, le stress et la relation de couple ont été évaluées avant et après la naissance (pré-test/post-test) chez toutes les femmes participantes des deux groupes (GE et GC) utilisant : l’échelle EPDS (Cox et al,1987), le Functional Social Support Questionnaire (Broadhead et al, 1988), l’évaluation du stress de Holmes et Rahe (1967) et, l’échelle d’ajustement dyadique de Spanier (1976). La collecte des données prénatales a eu lieu à l’hôpital, les femmes recevaient les questionnaires à la fin de l’entrevue, les complétaient à la maison et les retournaient au rendez-vous suivant. Les données postnatales ont été envoyées par les femmes utilisant la poste locale. Résultats: Une fois évalués les symptômes dépressifs postnatals avec l’échelle EPDS entre la 4ème et la 12ème semaine postnatale et considérant le risque de DP au point de césure ≥ 12 de l’échelle, le pourcentage de femmes à risque de DP est de 39,34%; globalement, les femmes étudiées présentent un taux élevé de symptomatologie dépressive. Les groupes étant comparables sur toutes les variables prénatales, notons une différence dans l’évaluation postnatale de l’EPDS (≥12) de 11,2% entre le groupe C et le groupe E (45,5% et 34,3%). Et la différence finale entre les moyennes de l’EPDS postnatal est de 1,76 ( =11,10 ±6,05 dans le groupe C et =9,34 ±5,17 dans le groupe E) ; cette différence s’aproche de la limite de la signification (p=0,08). Ceci est dû à un certain nombre de facteurs dont le faible nombre de questionnaires bien complétés à la fin de l’étude. Les femmes du groupe expérimental présentent une diminution significative des symptômes dépressifs (t=2,50 / P= 0,01) comparativement au pré-test et indiquant une amélioration au contraire du groupe témoin sans changement. Les analyses de régression et de covariance montrent que le soutien social postnatal, les symptômes dépressifs prénatals et le stress postnatal ont une relation significative avec les symptômes dépressifs postnatals (P<0,0001 ; P=0.003; P=0.004). La relation du couple n’a pas eu d’impact sur le risque de DP dans la présente étude. Par contre, on constate d’autres résultats secondaires significatifs: moins de naissances prématurées, plus d’accouchements physiologiques et un plus faible taux de somatisations non spécifiques chez les mères du groupe expérimental. Recommandations: Les résultats obtenus nous suggèrent la considération des aspects suivants: 1) il faudrait appliquer les mesures pour détecter le risque de DP à la période prénatale au moment des visites d’échographie dont presque toutes les femmes sont atteignables; il est possible d’utiliser à ce moment un questionnaire de détection validé car, son efficacité semble démontrée; 2) il faudrait intervenir auprès des femmes identifiées à risque à la période prénatale à condition de prolonger le programme préventif après la naissance, tel qu’indiqué par d’autres études et par la demande fréquente des femmes évaluées. L’intervention prénatale de groupe n’est pas suffisante pour éviter le risque de DP chez la totalité des femmes. C’est pourquoi une troisième recommandation consisterait à : 3) ajouter des interventions individuelles pour les cas les plus graves et 4) il paraît nécessaire d’augmenter le soutien social chez des femmes défavorisées vulnérables car cette variable s’est révélée très liée au risque de dépression postnatale.

Conversations around homework: links to parental mental health, family characteristics and child psychological functioning

Parents are increasingly expected to supplement their children's school-based learning by providing support for children's homework. However, parents' capacities to provide such support may vary and may be limited by the experience of depression. This may have implications for child development. In the course of a prospective, longitudinal study of children of postnatally depressed and healthy mothers, we observed mothers (N = 88) and fathers (N = 78) at home during maths homework interactions with their 8-year-old children. The quality of parental communication was rated and analysed in relation to child functioning. The quality of communication of each of the parents was related to their mental state, social class and IQ. While postnatal depression was not directly related to child development, there was some evidence of the influence of maternal depression occurring in the child's school years. Different aspects of parental communication with the child showed specific associations with different child outcomes, over and above the influence of family characteristics. In particular, child school attainment and IQ were associated with parental strategies to encourage representational thinking and mastery motivation, whereas child behavioural adjustment at school and self-esteem were linked to the degree of parental emotional support and low levels of coercion. Notably, the influence of maternal homework support was more strongly related to child outcome than was paternal support, a pattern reflected in mothers' greater involvement in children's schools and school-related activities. Some parents may need guidance in how to support their children's homework if it is to be of benefit to child functioning.

Mental health of parents caring for infants

The postpartum period is a sensitive time due to the presence and demands of the developing infant. The care provided by a mother to her infant during this period may be compromised if she is suffering from postnatal depression or postpartum psychosis. Evidence has been emerging which suggests that postnatal depression and postpartum psychoses have adverse effects on the quality of the mother-infant relationship and also on the infants subsequent cognitive and emotional development. Presented is a review of the literature relating to how these conditions impact on parenting and infant outcomes, what measures are in place to detect these conditions and evidence-based models of best clinical practice are proposed.

The development of children of postnatally depressed mothers: evidence from the Cambridge longitudinal study

Children with a parent who suffers from depression are at raised risk for the disorder themselves. Relatively little is known about the development of psychological vulnerability to depression through childhood, particularly during infancy and early childhood. This paper describes results from a longitudinal prospective study of the development of children, studied from birth to 16 years, of mothers who experienced postnatal depression; it highlights the roles of the developing mother-child relationship, and of physiological functioning and social relationships in the development of adolescent vulnerability.

Measurement of mother-infant interactions and the home environment in a European setting: preliminary results from a cross-cultural study

Background Infant development is adversely affected in the context of postnatal depression. This relationship may be mediated by both the nature of early mother-infant interactions and the quality of the home environment. Aim To establish the usefulness of the Global Ratings Scales of Mother-Infant Interaction and the Infant-Toddler version of the Home Observation for the Measurement of the Environment (IT-HOME), and to test expected associations of the measures with characteristics of the social context and with major or minor depression. Method Both assessments were administered postnatally in four European centres; 144 mothers were assessed with the Global Ratings Scales and 114 with the IT-HOME. Affective disorder was assessed by means of the Structured Clinical Interview for DSM-IV Disorders. Results Analyses of mother-infant interaction indicated no main effect for depression but maternal sensitivity to infant behaviour was associated with better infant communication, especially for women who were not depressed. Poor overall emotional support also reduced sensitivity scores. Poor support was also related to poorer IT-HOME scores, but there was no effect of depression. Conclusions The Global Ratings Scales were effectively applied but there was less evidence of the usefulness of the IT-HOME. Declaration of interest None.

Improving quality of mother-infant relationship and infant attachment in socioeconomically deprived community in South Africa: randomised controlled trial

Objective To assess the efficacy of an intervention designed to improve the mother-infant relationship and security of infant attachment in a South African peri-urban settlement with marked adverse socioeconomic circumstances. Design Randomised controlled trial. Setting Khayelitsha, a peri-urban settlement in South Africa. Participants 449 pregnant women. Interventions The intervention was delivered from late pregnancy and for six months postpartum. Women were visited in their homes by previously untrained lay community workers who provided support and guidance in parenting. The purpose of the intervention was to promote sensitive and responsive parenting and secure infant attachment to the mother. Women in the control group received no therapeutic input from the research team. Main outcome measures Primary outcomes: quality of mother-infant interactions at six and 12 months postpartum; infant attachment security at 18 months. Secondary outcome: maternal depression at six and 12 months. Results The intervention was associated with significant benefit to the mother-infant relationship. At both six and 12 months, compared with control mothers, mothers in the intervention group were significantly more sensitive (6 months: mean difference=0.77 (SD 0.37), t=2.10, P<0.05, d=0.24; 12 months: mean difference=0.42 (0.18), t=-2.04, P<0.05, d=0.26) and less intrusive (6 months: mean difference=0.68 (0.36), t=2.28, P<0.05, d=0.26; 12 months: mean difference=-1.76 (0.86), t=2.28, P<0.05, d=0.24) in their interactions with their infants. The intervention was also associated with a higher rate of secure infant attachments at 18 months (116/156 (74%) v 102/162 (63%); Wald=4.74, odds ratio=1.70, P<0.05). Although the prevalence of maternal depressive disorder was not significantly reduced, the intervention had a benefit in terms of maternal depressed mood at six months (z=2.05, P=0.04) on the Edinburgh postnatal depression scale). Conclusions The intervention, delivered by local lay women, had a significant positive impact on the quality of the mother-infant relationship and on security of infant attachment, factors known to predict favourable child development. If these effects persist, and if they are replicated, this intervention holds considerable promise for use in the developing world. Trial registration Current Controlled Trials ISRCTN25664149.

Disturbances in early parenting of depressed mothers and cortisol secretion in offspring: A preliminary study

Background: Disturbances in cortisol secretion are associated with risk for psychiatric disorder, including depression. Animal research indicates that early care experiences influence hypothalamic-pituitary-adrenal (HPA) axis functioning in offspring. Similar effects are suggested in human development, but evidence of longitudinal associations between observed early parenting and offspring cortisol secretion is extremely limited. We studied associations between parenting disturbances occurring in the context of maternal postnatal depression (PND), and elevations in morning cortisol secretion in the adolescent offspring of PND mothers. Methods: We observed maternal parenting behaviour on four occasions through the first year and at five-year follow up in postnatally depressed (n = 29) and well (n = 20) mothers. Observations were coded for maternal sensitivity and withdrawal. Basal offspring salivary cortisol secretion was measured at 13-years, using collections over 10-days. Results: Postnatal, but not five-year, maternal withdrawal predicted elevated mean and maximum morning cortisol secretion in 13-year-old offspring. There were no significant associations between maternal sensitivity and offspring cortisol secretion. Limitations: The sample size was relatively small, and effects tended to be reduced to trend level when covariates were considered. The correlational nature of the study (albeit longitudinal) limits conclusions regarding causality. Conclusions: Individual differences in early maternal parenting behaviour may influence offspring cortisol secretion, and thereby risk for depression. Parenting interventions that facilitate active maternal engagement with the infant may be indicated for high risk populations.

The representation of fathers by children of depressed mothers: refining the meaning of parentification in high-risk samples

Background: Children’s representations of mothers in doll-play are associated with child adjustment. Despite the importance of fathers for children’s adjustment, especially in the context of maternal psychopathology, few studies have considered children’s representations of their fathers. Method: We examined the portrayal of fathers by 5-year-old children of depressed (N = 55) and non-depressed (N = 39) mothers in a doll-play procedure concerning family experience. Results: Children gave equal prominence in their play to mothers and fathers. Representations of fathers were unrelated to maternal mood, but were associated with parental conflict. Representations of child care for the father that was unreciprocated predicted poor child adjustment in school, but only in children exposed to maternal postnatal depression. Conclusions: It may be clinically useful to consider children’s distinctive representations of their mother and father; but the concept of parentification in relation to risk and resilience effects requires refinement.

Maternal affective disorder and children’s representation of their families

Children’s perceptions of family relationship are related to their later emotional and social adjustment. This is of particular relevance in the context of family stressors such as maternal affective disorder. This study investigated the effects of maternal postnatal depression and anxiety on children’s family representations. In our sample of postnatally depressed mothers we also explored marital conflict as mediator between maternal psychopathology and children’s representations. Family drawings of 235 4–5 year-old children (93 control, 53 depressed and 89 anxious) were examined. When compared to controls, children of depressed, but not of anxious mothers, were more likely to draw themselves as less prominent than other family members and to represent a dysfunctional family, less likely to represent themselves with a happy face and showed a greater tendency of drawing bizarre pictures. Marital conflict mediated the association between maternal depression and dysfunctionality in drawings.

Improving quality of mother-infant relationship and infant attachment in socioeconomically deprived community in South Africa: randomised controlled trail

Objective To assess the efficacy of an intervention designed to improve the mother-infant relationship and security of infant attachment in a South African peri-urban settlement with marked adverse socioeconomic circumstances. Design Randomised controlled trial. Setting Khayelitsha, a peri-urban settlement in South Africa. Participants 449 pregnant women. Interventions The intervention was delivered from late pregnancy and for six months postpartum. Women were visited in their homes by previously untrained lay community workers who provided support and guidance in parenting. The purpose of the intervention was to promote sensitive and responsive parenting and secure infant attachment to the mother. Women in the control group received no therapeutic input from the research team. Main outcome measures Primary outcomes: quality of mother-infant interactions at six and 12 months postpartum; infant attachment security at 18 months. Secondary outcome: maternal depression at six and 12 months. Results The intervention was associated with significant benefit to the mother-infant relationship. At both six and 12 months, compared with control mothers, mothers in the intervention group were significantly more sensitive (6 months: mean difference=0.77 (SD 0.37), t=2.10, P<0.05, d=0.24; 12 months: mean difference=0.42 (0.18), t=−2.04 , P<0.05, d=0.26) and less intrusive (6 months: mean difference=0.68 (0.36), t=2.28, P<0.05, d=0.26; 12 months: mean difference=−1.76 (0.86), t=2.28 , P<0.05, d=0.24) in their interactions with their infants. The intervention was also associated with a higher rate of secure infant attachments at 18 months (116/156 (74%) v 102/162 (63%); Wald=4.74, odds ratio=1.70, P<0.05). Although the prevalence of maternal depressive disorder was not significantly reduced, the intervention had a benefit in terms of maternal depressed mood at six months (z=2.05, P=0.04) on the Edinburgh postnatal depression scale). Conclusions The intervention, delivered by local lay women, had a significant positive impact on the quality of the mother-infant relationship and on security of infant attachment, factors known to predict favourable child development. If these effects persist, and if they are replicated, this intervention holds considerable promise for use in the developing world.

Insecure attachment during infancy predicts greater amygdala volumes in early adulthood

Background The quality of the early environment is hypothesized to be an influence on morphological development in key neural areas related to affective responding, but direct evidence to support this possibility is limited. In a 22-year longitudinal study, we examined hippocampal and amygdala volumes in adulthood in relation to early infant attachment status, an important indicator of the quality of the early caregiving environment. Methods Participants (N = 59) were derived from a prospective longitudinal study of the impact of maternal postnatal depression on child development. Infant attachment status (24 Secure; 35 Insecure) was observed at 18 months of age, and MRI assessments were completed at 22 years. Results In line with hypotheses, insecure versus secure infant attachment status was associated with larger amygdala volumes in young adults, an effect that was not accounted for by maternal depression history. We did not find early infant attachment status to predict hippocampal volumes. Conclusions Common variations in the quality of early environment are associated with gross alterations in amygdala morphology in the adult brain. Further research is required to establish the neural changes that underpin the volumetric differences reported here, and any functional implications.