Perinatal Mental Health Flashcards
1
Q
What is perinatal mental health?
A
- Refers to the mental health and the wellbeing of aa parent over the period that stretches from pregnancy until 1 year post the child’s birth
Encompasses a range of psychological phenomena including:
- Depression
- Stress
- Anxiety
- OCD
- Psychosis
- Perinatal PTSD
2
Q
What is perinatal depression (PND)?
A
- Depression onsetting during pregnancy up to the end of the first year post birth
- Rates of perinatal depression not screened for in fathers
- In mothers the rates commonly seen are 10-20% of new and expectant mothers but the WHO refers to this as a drastic underestimate or statistic of privilege –> Cross cultural studies and representative cohorts suggest rate may be high as 39%
- Most studied perinatal mental illness and one that most health professionals and public are aware of
3
Q
What are baby blues?
A
- Term used to describe mild mood changes and feelings of worry, unhappiness, and exhaustion that many parents experience in the first 2 weeks
- Babies require around the clock care so its normal to feel tired or overwhelmed
- If mood changes are severe or if they last. longer than 2 weeks a parent may. have postpartum depression
- Parents with postpartum depression generally will not feel better unless they. receive treatment
4
Q
Treatment of PND
A
- Psychopharmacology
- Talking therapies
- Electro convulsive therapy (ECT)
- Mother and baby units in community care
- With early diagnosis and treatment, recovery rate is high (even with more acute cases) once diagnosed and treatment started, even in acute cases
5
Q
What are PND risk factors?
A
- History of mental health illness
- Young/teen pregnancy.
- Unintended pregnancy
- Lack of support from partner/family/friends
- Traumatic pregnancy/birth/preterm birth
- Infant ill health
- Multiple births (twins etc)
- History of infertility
- Economic strain
- Minority stress (LGBT, BAME)
- Alcohol/drug use
- Parenting in a pandemic
- Experience of domestic conflict and violence
6
Q
Etiology of perinatal depression
A
In the PND review by Howard et al (2014) the following causes or etiology were reported:
- Significant shifts in endocrinology across pregnancy and postnatal period. These changes include changes in oxytocin, serotonin, dopamine and cortisol –> associated with mood
- Significant life changes which may include changes to romantic relationships, occupations, family economy, a parents role in the family and in friendships –> affect mood
- Sleep deprivation is also an almost ubiquitous feature of new parenting. Known form of psychological torture and has a drastic effect on human physiology, endocrinology and mood
7
Q
Impact of perinatal depression on human health and development
Stein et al (2014)
A
Physical child outcomes:
- 1.5x increase in rate of preterm birth
- Reduced birth weight
- Reduced APGAR score at birth (measure of physical responsiveness and health)
- Increased risk of admission to SCUBU or NICU and extended hospitalisations
- Poor motor control
- Stunted growth post birth
8
Q
Child social-emotional outcomes of PND
A
- Disorganised or insecure attachment style
- Externalising and internalising symptoms
- Affective dysregulation
- Depressive symptoms
- Reduced social engagement
- Poor fear regulation
- Low peer social competence and resilience
- Antisocial behaviour
9
Q
Child cognitive outcomes of PND
A
- Lower IQ
- Milestones missed or delayed
- Global cognitive development scores lower
- Strengths and difficulties questionnaire score higher on difficulties and lower on strengths
- Poor attention
- Hyperactivity, impulsivity and inattention symptoms
10
Q
What is Perinatal Anxiety? (PNA)
A
A state of acute and/or chronic increased physiological, affective, cognitive arousal inducing a state of panic, agitation, worry, frustration, anger
11
Q
PNA prevalence
A
- Estimates vary
- Range from upwards of 15% of new and expectant mothers
- Data is not available on global prevalence for fathers
12
Q
PNA treatment and recovery
A
- Psychopharmacology
- Talking therapies
13
Q
Symptoms of PNA
A
- Fear
- Worrying
- Panic attacks
- Muscle tension
- Difficulty relaxing or sleeping
- Concerns they have poor parenting skills or that something will go wrong for their baby
14
Q
Social-emotional child outcomes of PNA
A
- Increased child negative affectivity
- Child internalising symptoms
15
Q
Neurodevelopmental child outcomes of PNA
A
- Lower CBCL score (global score of child development)
16
Q
Cognitive child outcomes of PNA
A
- More distress to novelty
- Poor attention
17
Q
Physical symptoms of child from PNA
A
- Lower birth weight
- Reduced APGAR (global health score)
- Increased prevalence of preterm birth
18
Q
What are the mechanisms for perinatal mental illness affecting children?
A
- Genetics: genetic contributions accounted for 54% in twin studies
- Epigenetic: experience of stress in utero or post birth may disrupt neurodevelopment and alter foetal programming by affecting expression of genes
- Endocrinological changes crossing the placenta: may prime child through HPA axis to be overly reactive to stressors and slow to recover
- Early birth: cause of significant risk of mortality and long-lasting morbidity
- Parenting quality affected by PNI: reduced sensitivity, responsiveness, and bonding between parent and child
- Reduced rates and durations of breastfeeding
- Reduced engagement with others outside of the home
- Economic impact on the family
- Cultural variations in stigma and isolation
19
Q
How can theories in psychology be evaluated?
A
Whether they are:
- Consistent with empirical observations
- Precise
- Parsimonious
- Explanatorily broad
- Falsifiable
- Promotes scientific progress
20
Q
Attachment theory and perinatal mental health: Impacts on child health and development
A
- Developmental theory, focused on change over time
- Bowlby (1969): evolutionary adaptation of social bonds
- Timeline of attachments beginning to form over the infants first year
- Ainsworth, Blehar, Waters, and Wall (1978): variation in parent sensitivity to infant cues predictive of quality of child attachment quality (secure, avoidant, resistant, disorganised). Parental sensitivity to infant cues affected by parent cognitive/affective resources, as well as infant cues.
- Wolff and Ijzendoorn (1997) systematic review: moderately strong association of parenting quality and child attachment
21
Q
Predictions from attachment theory: Etiology
A
- Perinatal mental illness may reduce the cognitive and affective resources that a parent has
- This reduction in parenting cognitive and affective resources may then impact on parenting sensitivity/parenting quality
- This disruption in parenting quality then hypothesised to lead to increased insecure attachment development
22
Q
Predictions from attachment theory: Moderators
A
- The degree of perinatal mental illness on child attachment (i.e. moderators) may be driven by the timing of the illness, the severity of the illness, the available support for parent and child
23
Q
Predictions from attachment theory: Child outcomes
A
- Early attachment quality theorised to build the foundation for later emotion regulation, and form the schemas for what is expected for later relationships of different forms
- Insecure attachment predicted to be associated with poorer emotional and cognitive regulation and wellbeing, relational functioning and wellbeing
24
Q
Predictions from attachment theory: Theoretical focused interventions to benefit parent-child attachment
A
- Focus on symptoms of perinatal mental health to support parental emotional and cognitive resources
- Focus on supporting parental sensitivity to infant cues and responsivity to infant for parent-child bonding
25
Review of the relationship between perinatal depression, PTSD, parenting quality and mother-infant attachment quality
Erickson et al (2019)
- Studies over the last 4 decades, children's age from birth to beyond 5 years
- Mixed methods and combination of cross-sectional and longitudinal study designs
- Parenting quality associated with attachment quality
- Attachment quality associated with social emotional wellbeing and cognitive development in the short and long term across a range of measures, samples and ages
- Perinatal mental illness was associated with reduced parenting sensitivity to infant cues, and increased insecure attachment consistently, with moderate effect size
- Interventions and support for those experiencing perinatal mental illness that include parenting support for parent-child attachments shown to improve parent recovery and infant mental health and development
26
Review on perinatal mental illness: Key mechanisms of disturbance in foetus/infant development
Stein et al (2014)
- Parenting quality
- Timing of the parental mental illness
- Moderators: Social (including partner) and material support
27
Review on perinatal mental illness: Outcomes for child
Stein et al (2014)
- Extensive range of child outcomes across a range of ages (short and long term outcomes)
- Outcomes for social-emotional, cognitive, communicative development associated with PNI (mainly maternal-centric in focus)
28
Has research impacted perinatal mental health policy/practice?
- While there still remains significant challenges in translating research into evidence-based policy and practice for perinatal mental health and its impacts on child health and development, there have also been some gains
- With researcher's increased understanding of the etiology, risk factors, treatments, and direct and indirect effects of PNI on children we are in a better position to reduce the incidence and impact of perinatal mental illness
- Research into perinatal mental health over the decades has changed the prevailing view of PNH so screening is more common, early intervention is advocated for, and mothers and babies are now tried to be kept together if mothers are admitted with acute PNI
