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Post-partum depression (PPD) is a significant mental health problem for women during the reproductive years and is highly prevalent among Saudi women. Studies have shown, Saudi women experience higher rates of PPD (up to 38.5%) compared to 12% of new mothers in the United States. PPD is associated with cognitive impairment and the potential for deficits in social cognitive function, which is the ability to identify, perceive, interpret, and respond to social stimuli. Social cognition has several components, including emotion recognition, empathy, and theory of mind (ToM). Impaired social cognition can impact the mother’s ability to care for her infant, read infant cues, and can potentially affect the infant’s development. However, there is little research on Saudi women with PPD and its effect on social cognition. The aim of this study is to compare social cognitive performance in Saudi women with and without PPD, examine the relationship between biological, psychological, and social variables on social cognition, and identify predictors of social cognition. Participants were screened at 6 weeks postpartum for depressive symptoms and assigned to either PPD or without PPD group using the Edinburgh Postnatal Depression Scale (EPDS). Participants completed a demographic form and measures of social cognition including Emotion Recognition Task (ERT), Interpersonal reactivity Index (IRI), and Reading the Mind Test (RMET). In addition, participants completed the Multidimensional Scale of Perceived Social Support (MPSS), the Generalized Anxiety Disorder-7 (GAD-7), and the Perceived Stress Scale (PSS). Variables related to maternal characteristics (planned pregnancy, delivery mode) and infant characteristics (birth weight, gestational age) were extracted from medical records. Descriptive and inferential statistics were used to assess group differences, correlations, and predictors of social cognition. One hundred and twenty-five eligible women (60 with PPD and 65 without PPD

BackgroundSouth African mothers confront synergistic challenges from depression, alcohol use, and HIV/AIDS. The importance of maternal functioning for child development motivates interventions, yet long-term outcomes seldom are tracked. Furthermore, little is known about trajectories and the role of social-cultural factors in maternal depression and alcohol use across parenthood in low- and middle-income countries.MethodsWe examined maternal outcomes at 5- and 8-years' post-birth, from the Philani Intervention Program (PIP), a randomized controlled trial of a prenatally-initiated home visiting intervention lasting through 6 months' post-birth which yielded some benefits for children and mothers through 3 years. Longitudinal Bayesian mixed-effects models assessed intervention effects for maternal depression and alcohol use from pre-birth through 8 years post-birth. We plotted trajectories of depression and alcohol use and analyzed their relationship over time.ResultsMaternal benefits appeared limited and intervention outcomes differed at 5 and 8 years. Reduced depression in PIP versus standard care (SC) mothers at 3 years disappeared by 5 and 8 years. Depression prevalence declined from 35.1% prenatally to 5.5% at 8 years, independent of intervention or alcohol use. Alcohol use in both groups rebounded from a post-birth nadir; fewer PIP than SC mothers drank alcohol and reported problematic use at 5 but not 8 years. HIV+ prevalence did not differ by condition and increased from 26% to 45% over the reported period.ConclusionsDissipation of early child benefits from home visiting by age 8 years likely reflects lack of durable change in maternal behaviors compounded by social-cultural factors and cumulative effects of community deprivation. High prenatal rates warrant screening and treatment for depression in standard antenatal care. Low-and-middle income countries may need sustained interventions, including alcohol use reduction, to capitalize on initial gains fro

We here address the causal relationship between the maternal genetic risk for depression and child human capital using UK birth-cohort data. We find that an increase of one standard deviation (SD) in the maternal polygenic risk score for depression reduces their children’s cognitive and non-cognitive skill scores by 5 to 7% of a SD throughout adolescence. Our results are robust to a battery of sensitivity tests addressing, among others, concerns about pleiotropy and dynastic effects. Our Gelbach decomposition analysis suggests that the strongest mediator is genetic nurture (through maternal depression itself), with genetic inheritance playing only a marginal role.

We here address the causal relationship between the maternal genetic risk for depression and child human capital using UK birth-cohort data. We find that an increase of one standard deviation (SD) in the maternal polygenic risk score for depression reduces their children’s cognitive and non-cognitive skill scores by 5 to 7% of a SD throughout adolescence. Our results are robust to a battery of sensitivity tests addressing, among others, concerns about pleiotropy and dynastic effects. Our Gelbach decomposition analysis suggests that the strongest mediator is genetic nurture (through maternal depression itself), with genetic inheritance playing only a marginal role.

Prenatal and postpartum depression are highly prevalent worldwide, and emerging evidence suggests they contribute to impairments in children's executive functions. Studies of maternal depression, however, have focused on the postpartum and postnatal periods with relatively less consideration of prenatal influences on child development. This study of the large population-based Avon Longitudinal Study of Parents and Children U.K. cohort estimates latent classes of maternal depression across the prenatal, postpartum, and postnatal periods to capture heterogeneity in the developmental timing and length of maternal depression, as well as to test whether latent classes differ in children's executive function impairments in middle childhood. Repeated measures latent class analysis yielded five groups demonstrating unique patterns of change in maternal depression from pregnancy through early childhood (n = 13,624). Latent classes differed in executive functions at age 8 among a subsample of children (n = 6,870). Children exposed to chronic maternal depression beginning in utero showed the most impairments in inhibitory control while accounting for child sex, verbal IQ, parents' highest education level, and average family income in childhood. The critical roles of the timing and length of children's exposure to maternal depression are discussed in relation to executive function development, prevention, and intervention. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

A child's diagnosis of autism spectrum disorder (ASD) alters family dynamics, heightens marital discord and parenting stress, and may result in parental psychopathology. This may impact the long-term prospects for their children. This study aimed to evaluate the prevalence of depression among parents of autistic children and the factors that predict these conditions. Two hundred and thirty file children were diagnosed with autism and their mothers were enlisted from the Sindh Institute of Physical Medicine & Rehabilitation (SIPM&R), Karachi Sindh Pakistan. Beck Depression Inventory (BDI) and The Childhood Autism Rating Scale (CARS) were used to assess depression and the severity of autism, respectively. The demographic information was composed through a predesigned questionnaire. Data were analysed on SPSS version 20. Descriptive and correlation analyses were used for statistical evaluations. The analysis outcomes exhibited that mainstream mothers hold a master’s degree (54.5%), belong to middle-class families (72.8%), have a nuclear family setup (67.2%), and are housewives (86.8%). The mothers of these children tended to experience moderate depression (65.1%). The severity of an ASD child’s IQ level, adaptive behaviour, and communication characteristics were significantly correlated with depression in the mother (p<0.01). The mothers of children who were receiving treatment had significantly higher BDI scores than those mothers whose children were not under treatment (p<0.01). Hence, offering mental health support to mothers experiencing distress along with researching to explore the root causes of depression is found to be crucial. There is a need to strategise financial and moral support for couples with ASD children to help reduce depression among them.

A child's diagnosis of autism spectrum disorder (ASD) alters family dynamics, heightens marital discord and parenting stress, and may result in parental psychopathology. This may impact the long-term prospects for their children. This study aimed to evaluate the prevalence of depression among parents of autistic children and the factors that predict these conditions. Two hundred and thirty file children were diagnosed with autism and their mothers were enlisted from the Sindh Institute of Physical Medicine & Rehabilitation (SIPM&R), Karachi Sindh Pakistan. Beck Depression Inventory (BDI) and The Childhood Autism Rating Scale (CARS) were used to assess depression and the severity of autism, respectively. The demographic information was composed through a predesigned questionnaire. Data were analysed on SPSS version 20. Descriptive and correlation analyses were used for statistical evaluations. The analysis outcomes exhibited that mainstream mothers hold a master’s degree (54.5%), belong to middle-class families (72.8%), have a nuclear family setup (67.2%), and are housewives (86.8%). The mothers of these children tended to experience moderate depression (65.1%). The severity of an ASD child’s IQ level, adaptive behaviour, and communication characteristics were significantly correlated with depression in the mother (p<0.01). The mothers of children who were receiving treatment had significantly higher BDI scores than those mothers whose children were not under treatment (p<0.01). Hence, offering mental health support to mothers experiencing distress along with researching to explore the root causes of depression is found to be crucial. There is a need to strategise financial and moral support for couples with ASD children to help reduce depression among them.

A child's diagnosis of autism spectrum disorder (ASD) alters family dynamics, heightens marital discord and parenting stress, and may result in parental psychopathology. This may impact the long-term prospects for their children. This study aimed to evaluate the prevalence of depression among parents of autistic children and the factors that predict these conditions. Two hundred and thirty file children were diagnosed with autism and their mothers were enlisted from the Sindh Institute of Physical Medicine & Rehabilitation (SIPM&R), Karachi Sindh Pakistan. Beck Depression Inventory (BDI) and The Childhood Autism Rating Scale (CARS) were used to assess depression and the severity of autism, respectively. The demographic information was composed through a predesigned questionnaire. Data were analysed on SPSS version 20. Descriptive and correlation analyses were used for statistical evaluations. The analysis outcomes exhibited that mainstream mothers hold a master’s degree (54.5%), belong to middle-class families (72.8%), have a nuclear family setup (67.2%), and are housewives (86.8%). The mothers of these children tended to experience moderate depression (65.1%). The severity of an ASD child’s IQ level, adaptive behaviour, and communication characteristics were significantly correlated with depression in the mother (p<0.01). The mothers of children who were receiving treatment had significantly higher BDI scores than those mothers whose children were not under treatment (p<0.01). Hence, offering mental health support to mothers experiencing distress along with researching to explore the root causes of depression is found to be crucial. There is a need to strategise financial and moral support for couples with ASD children to help reduce depression among them.

Objective To assess the association between trajectories of comorbid anxiety and depressive (CAD) symptoms assessed in each pregnancy trimester and physiological birth. Design Large longitudinal prospective cohort study with recruitment between January 2013 and September 2014. Setting Primary care, in the Netherlands. Population Dutch-speaking pregnant women with gestational age at birth ≥37 weeks, and without multiple pregnancy, severe psychiatric disorder or chronic disease history. Methods Pregnancy-specific anxiety and depressive symptoms were measured prospectively in each trimester of pregnancy using the negative affect subscale of the Tilburg Pregnancy Distress Scale and Edinburgh (Postnatal) Depression Scale. Data on physiological birth were obtained from obstetric records. Multivariate growth mixture modelling was performed in MPLUS to determine longitudinal trajectories of CAD symptoms. Multiple logistic regression analysis was used to examine the association between trajectories and physiological birth. Main outcome measures Trajectories of CAD symptoms and physiological birth. Results Seven trajectories (classes) of CAD symptoms were identified in 1682 women and subsequently merged into three groups: group 1—persistently low levels of symptoms (reference class 1; 79.0%), group 2—intermittently high levels of symptoms (classes 3, 6 and 7; 11.2%), and group 3—persistently high levels of symptoms (classes 2, 4 and 5; 9.8%). Persistently high levels of CAD symptoms (group 3) were associated with a lower likelihood of physiological birth (odds ratio 0.67, 95% confidence interval 0.47–0.95, P = 0.027) compared with the reference group (persistently low levels of symptoms), after adjusting for confounders. Conclusions This study is the first showing evidence that persistently high CAD levels, assessed in each pregnancy trimester, are associated with a lower likelihood

Background Depression or depressive symptoms are common among pregnant women. The use of antidepressants during pregnancy has grown steadily. The risk of offspring being born small for gestational age or prematurely when exposed to duloxetine during pregnancy is not established. Objective We aimed to investigate the association between duloxetine exposure during pregnancy and offspring being born small for gestational age or prematurely. Methods We conducted an observational study including live births in Sweden and Denmark (2004-2016). Duloxetine exposure during early (0-140 days) or late (141 to delivery) pregnancy compared with duloxetine-non-exposed, selective serotonin reuptake inhibitor-exposed, venlafaxine-exposed, and duloxetine discontinuers. Results In total, 2,083,467 pregnancies were identified, where 1589 and 450 were duloxetine exposed in early and late pregnancy, respectively. For small for gestational age, no increased risk was seen for duloxetine across comparators. In the early and late exposure windows, propensity score-matched odds ratios for small for gestational age ranged between 0.64 (95% confidence interval 0.44-0.95) and 1.48 (95% confidence interval 0.85-2.57). For preterm birth, the findings differed across comparators and exposure-time windows, but trended towards an increased risk for duloxetine-exposed when compared with duloxetine-non-exposed, selective serotonin reuptake inhibitor-exposed, and duloxetine discontinuers in both early exposure and late exposure. The odds ratios ranged between 1.17 and 2.04, of which some did not reach statistical significance. No clear association was observed when compared with venlafaxine exposed, 0.91 (95% confidence interval 0.73-1.14) for early exposure and 1.26 (95% confidence interval 0.86-1.86) for late exposure. Most preterm births (79.2%) occurred in weeks 33-36 of gestation. Conclusions Duloxetine exposure during pregnancy is unlikely to increase the risk of small for gestational age. Alth

Background Depression or depressive symptoms are common among pregnant women. The use of antidepressants during pregnancy has grown steadily. The risk of offspring being born small for gestational age or prematurely when exposed to duloxetine during pregnancy is not established. Objective We aimed to investigate the association between duloxetine exposure during pregnancy and offspring being born small for gestational age or prematurely. Methods We conducted an observational study including live births in Sweden and Denmark (2004-2016). Duloxetine exposure during early (0-140 days) or late (141 to delivery) pregnancy compared with duloxetine-non-exposed, selective serotonin reuptake inhibitor-exposed, venlafaxine-exposed, and duloxetine discontinuers. Results In total, 2,083,467 pregnancies were identified, where 1589 and 450 were duloxetine exposed in early and late pregnancy, respectively. For small for gestational age, no increased risk was seen for duloxetine across comparators. In the early and late exposure windows, propensity score-matched odds ratios for small for gestational age ranged between 0.64 (95% confidence interval 0.44-0.95) and 1.48 (95% confidence interval 0.85-2.57). For preterm birth, the findings differed across comparators and exposure-time windows, but trended towards an increased risk for duloxetine-exposed when compared with duloxetine-non-exposed, selective serotonin reuptake inhibitor-exposed, and duloxetine discontinuers in both early exposure and late exposure. The odds ratios ranged between 1.17 and 2.04, of which some did not reach statistical significance. No clear association was observed when compared with venlafaxine exposed, 0.91 (95% confidence interval 0.73-1.14) for early exposure and 1.26 (95% confidence interval 0.86-1.86) for late exposure. Most preterm births (79.2%) occurred in weeks 33-36 of gestation. Conclusions Duloxetine exposure during pregnancy is unlikely to increase the risk of small for gestational age. Alth

To examine postpartum depressive symptom trajectories from birth to age 5 and their risk factors in a national sample of mothers of preterm and full-term infants. The racially and ethnically diverse sample comprised 11,320 maternal participants (Mage = 29; SD = 5.9) in the Environmental influences on Child Health Outcomes (ECHO) Program in the USA with data on newborn gestational age at birth (≥ 22 weeks) and maternal depression symptoms during the first 5 years following childbirth. Growth mixture models determined the number and trajectory of postpartum depression classes among women in the preterm and full-term groups, and we examined predictors of class membership. Five trajectories described depressive symptoms for both groups; however, notable differences were observed. One in 5 mothers of preterm infants developed clinically relevant depressive symptoms over time compared with 1 in 10 mothers of full-term infants. Among women who delivered preterm compared with those who delivered full-term, symptoms were more likely to increase over time and become severe when offspring were older. Distinct subgroups describe mothers depressive symptom trajectories through 5 years following childbirth. Mild to moderate depressive symptoms may onset or persist for many women beyond the initial postpartum period regardless of newborn gestational age at birth. For women with preterm infants, initially mild symptoms may increase to high levels of severity during the preschool and toddler years.

ObjectiveChildhood trauma exacts a lasting toll on one's own mental health and the health of one's offspring; however, limited research has examined the pathways through which this intergenerational transmission occurs. This study aimed to identify the transactions and mechanisms that link maternal early life trauma, maternal depressive symptoms, and children's internalizing symptoms.MethodA pregnancy cohort of N = 1462 mothers (66% Black, 32% White, 2% Other race) reported their childhood trauma exposure and depressive symptoms during pregnancy. Maternal depressive and children's internalizing symptoms were measured repeatedly when offspring were 12, 24, 36, and 48-60 months of age. A path model tested the transactional associations between maternal and child symptomatology and mediation of maternal childhood trauma on offspring symptoms via maternal depressive symptoms.ResultsMothers' childhood trauma history was related to greater prenatal and postnatal (12 and 24 months) maternal depressive symptoms, which were prospectively associated with offspring internalizing problems at 36 and 48-60 months. Child-directed effects on maternal depressive symptoms were not observed. The association of maternal trauma on children's internalizing at 36 months was mediated by maternal depressive symptoms at 24 months.LimitationsAssessments of the key study variables were provided by mothers. Childhood trauma was evaluated retrospectively.ConclusionWomen's experiences of adversity in childhood have persistent and cumulative effects on their depression during the transition to parenthood, which is associated with risk for children's internalizing. Given the two-generation influence of maternal childhood trauma exposure, attending to its impact may protect both caregivers and their children.

Previous research shows that maternal depression and anxiety can change the way mothers interact with their infants. However, there is little research that explores both the impact of maternal depression and anxiety, the two most common adult mental health problems, on mother-child communication and emotional expression, nor with each of these components in the same study and with a preschool population. The current study examined several aspects of communication between 24 mothers and their preschoolers; total amount of speech, responsiveness of the mother, vocal affect of the mother and preschooler, emotion words used by the mother and preschooler, and maternal pitch. Mothers answered various questionnaires used to evaluate their symptoms of depression, then read a story to their child on camera. Unfortunately, anxiety measures were unusable for the analysis. Trained research assistants watched these videos and assessed the previously mentioned communication variables. Simple linear regressions explored how these variables varied across mothers with current depression and their child of 3-4 years of age (M = 3.7). The study did not find evidence that symptoms of current depression (M = 8.79) significantly impacted total amount of speech (M = 100.88), responsivity (M = 8.96), vocal affect (M = 1.02), use of emotion words (M = 39.04), mean pitch (M = 230.20) or pitch range (357.20) of mothers (M = 357.20). Additionally, current symptoms of depression in mothers did not significantly impact preschoolers’ amount of speech (M = 23.17), vocal affect (M = 0.92) or use of emotion words (M = 4.04). These nonsignificant results may be attributed to the small sample size, the non-clinical population recruited, and the structured activity in which mothers participated. Further research in this area is suggested.

Insecure attachment has been described as mediating the relationship between childhood trauma and dysfunctional personality traits in different mental disorders. Despite the role insecure attachment and childhood trauma have independently demonstrated to play as determinants of borderline personality disorder, less is known about the mediating mechanisms explaining these associations. For the first time, we assessed adult attachment, childhood trauma and dimensional personality pathology in a sample of outpatients with borderline personality disorder and tested whether the association between childhood trauma and personality dysfunction was at least partially attributable to insecure attachment. The results showed that attachment anxiety fully mediated the relationship between specific types of trauma (emotional abuse and physical neglect) and emotional dysregulation. Further, emotional abuse was both directly associated with dissocial behaviour and indirectly via attachment anxiety (partial mediation). Emotional abuse has been described as an essential environmental factor for the development of borderline personality disorder and emotional dysregulation, on its part, as the core feature of the condition. Our results indicate that attachment anxiety explains the link between these central aspects of borderline personality disorder. Our findings are consistent with previous research and current etiological understanding of the condition and provide support for recommending a careful assessment of childhood traumatic experiences and adult attachment style to gain a more comprehensive insight into the symptoms and its heterogeneity. As a secondary aim, we assessed the effect parental mental illness may have in these mediation models, but no significant influence on childhood trauma, attachment or personality was found.

Background: Maternal depression and anxiety in the perinatal period affect the quality of maternal sensitivity and mentalizing abilities. Few studies analyzed implicit mentalizing in relation to maternal distress. The aims of the study were: to examine the relation between nonverbal mentalizing - parental embodied mentalizing (PEM) - and maternal depression and anxiety, verbal mentalizing, and maternal styles of interaction; and to test PEM as a mediator of the effect of maternal distress on styles of interaction. Method: 81 mother-infant dyads have been recruited. At infant three months, maternal depression was assessed using the Edinburgh Postnatal Depression Scale, anxiety with State Trait Anxiety Inventory, and reflective functioning with Reflective Functioning Scale. Mother–infant interactions were coded with various approaches: PEM for nonverbal mentalizing, Mind-mindedness coding system for Mind-mindedness, and CARE-Index for maternal styles of interaction. Results: Maternal depression and state anxiety were negatively correlated with PEM. PEM was also negatively correlated to maternal controlling style. Mothers with psychopathological problems (vs. mothers with no psychopathological problems) had lower PEM and sensitivity and more controlling style. Moreover, maternal depression and anxiety had direct effects on maternal sensitivity and had indirect effects mediated by PEM on controlling style. Limitations: The study evaluates interactions at three months; longitudinal studies will be able to examine maternal mentalizing and sensitivity in various stages and identify the effect on the child's attachment. Conclusions: PEM is associated to maternal anxiety and depression and mediates the effects of depression and anxiety on mother controlling style. These results emphasize the importance of early prevention programs for mothers focused also on implicit mentalizing.

BACKGROUND: Maternal-fetal attachment (MFA) is the emotional bond between a mother and her fetus and is influenced by numerous risk and protective factors during pregnancy. However, according to the literature, the results relating to the influence of these factors are mixed. METHOD: The aim of the study is to identify the relationship between MFA and maternal distress, evaluated as maternal depression and anxiety, alexithymia, and perceived social support during the prenatal period in an Italian community sample. Ninety-four pregnant women completed self-report questionnaires. RESULTS: Results showed that total MFA was negatively associated with maternal anxiety and alexithymia and was positively associated with social support. Moreover, maternal depression was negatively associated with the quality subscale of MFA The quality subscale of MFA was negatively associated with maternal state and trait anxiety and alexithymia and was positively associated with social support. The intensity subscale of MFA was positively associated with social support. Multiple regression showed that alexithymia and social support predicted MFA with a higher effect than maternal depression and anxiety. CONCLUSIONS: The results are useful for planning interventions aimed at supporting the mother-infant bond starting from pregnancy.

Parent–infant EEG is a novel hyperscanning paradigm to measure social interaction simultaneously in the brains of parents and infants. The number of studies using parent–infant dual-EEG as a theoretical framework to measure brain-to-brain synchrony during interaction is rapidly growing, while the methodology for measuring synchrony is not yet uniform. While adult dual-EEG methodology is quickly improving, open databases, tutorials, and methodological validations for dual-EEG with infants are largely missing. In this practical guide, we provide a step-by-step manual on how to implement and run parent–infant EEG paradigms in a neurodevelopmental laboratory in naturalistic settings (e.g., free interactions). Next, we highlight insights on the variety of choices that can be made during (pre)processing dual-EEG data, including recommendations on interpersonal neural coupling metrics and interpretations of the results. Moreover, we provide an exemplar dataset of two mother–infant dyads during free interactions (“free play”) that may serve as practice material. Instead of providing a critical note, we would like to move the field of parent–infant EEG forward and be transparent about the challenges that come along with the exciting opportunity to study the development of our social brain within the naturalistic context of dual-EEG.

Previous research shows that maternal depression and anxiety can change the way mothers interact with their infants. However, there is little research that explores both the impact of maternal depression and anxiety, the two most common adult mental health problems, on mother-child communication and emotional expression, nor with each of these components in the same study and with a preschool population. The current study examined several aspects of communication between 24 mothers and their preschoolers; total amount of speech, responsiveness of the mother, vocal affect of the mother and preschooler, emotion words used by the mother and preschooler, and maternal pitch. Mothers answered various questionnaires used to evaluate their symptoms of depression, then read a story to their child on camera. Unfortunately, anxiety measures were unusable for the analysis. Trained research assistants watched these videos and assessed the previously mentioned communication variables. Simple linear regressions explored how these variables varied across mothers with current depression and their child of 3-4 years of age (M = 3.7). The study did not find evidence that symptoms of current depression (M = 8.79) significantly impacted total amount of speech (M = 100.88), responsivity (M = 8.96), vocal affect (M = 1.02), use of emotion words (M = 39.04), mean pitch (M = 230.20) or pitch range (357.20) of mothers (M = 357.20). Additionally, current symptoms of depression in mothers did not significantly impact preschoolers’ amount of speech (M = 23.17), vocal affect (M = 0.92) or use of emotion words (M = 4.04). These nonsignificant results may be attributed to the small sample size, the non-clinical population recruited, and the structured activity in which mothers participated. Further research in this area is suggested.

This thesis examines the cyclical nature of interpersonal violence and its adverse impact on birth outcomes and maternal wellbeing in Vietnam. The mixed-methods design included a systematic review and meta-analysis, a qualitative needs and resources assessment with health and social care professionals, and a short-term prospective birth cohort study with women recruited in the third trimester of pregnancy. Exposure to violence during pregnancy is associated with mothers’ mental distress and adverse birth outcomes. The study also reveals health problems linked with the mothers’ exposure to violence when they were children. Findings can be applied to improving maternal healthcare services.

Background In many countries, there is limited consideration of the psychological wellbeing of women during antenatal and postnatal care. Among a range of contributing factors, one practical reason is that brief, valid and reliable screening tools are not widely used to guide clinical interviews. The present study evaluated psychometric properties of three brief scales that measure recent wellbeing (the WHO-5 index), perceived stress (the PSS-10) and depression (the PHQ-9). Methods A prospective birth cohort study was completed in Hue City, central Vietnam with 148 pregnant women in the third trimester of pregnancy, with follow-up 3–5 months after childbirth. Moderate-to-severe antenatal depressive symptoms were used as the reference standard to validate the WHO-5 and PSS-10. Results Approximately one-third of the women indicated significant stress and 12% reported moderate to severe depressive symptoms during pregnancy. The WHO-5 and PSS had good internal consistency (Cronbach's alpha=0.76–0.81) and good discriminant properties against prenatal depression. Area Under the Curve (AUC) values showed good predictive validity to detect postpartum depressive symptoms for the WHO-5 [AUC=0.73, 95% CI (0.60 – 0.86)] and the PSS-10 [AUC=0.69, 95% CI (0.45 – 0.92)]. WHO-5 scores ≤ 60/100 and PSS-10 scores ≥ 20/40 provided good sensitivity (approx.83%) and fair specificity (approx.61%) to detect depression pre- and post-natally. Conclusions Given these satisfactory psychometric properties, brief but broad screening that includes questions about positive wellbeing and recent stress in addition to depressive symptoms should be integrated into routine psychosocial care for pregnant women in Vietnam and similar cultural contexts.

Contemporary literature confirms that “good mother” ideology dominates cultural discourses of motherhood in Australia, USA, United Kingdom, and Korea. Within this context, maternal shame refers to a domain-specific shame arising from negative evaluation of the maternal self-concept against socio-culturally derived ideals of motherhood. This study investigated whether incongruence between mothers’ maternal self-concept and “good mother” ideologies was associated with postnatal depression (PND) symptom severity in women up to 12 months postpartum, and whether these associations were explained by maternal shame. We hypothesised that a larger discrepancy between women’s maternal self-concept and both their own and sociocultural good mother ideals would be associated with more severe PND symptomology, and that these associations would be mediated by maternal shame. In this cross-sectional study, a community sample of 230 birth mothers with an infant aged 2 weeks to 12 months completed an online survey comprising established measures for the hypothesised variables, plus demographic, depression history, and partner support details. Mothers who experienced greater incongruence between their maternal self-concept and “good mother” ideals experienced more severe PND symptomology after controlling for partner support and previous depression. Maternal shame mediated these relationships. Findings suggest that good mother ideology may be implicated in mothers’ postnatal mental health.

Maternal anxiety and depression symptomatology are risk factors for the development of children’s internalizing and externalizing behavior problems. However, it is still unclear whether chronic and transient symptoms relate differently to child behavior. The aim of this prospective longitudinal study (N = 193) was to investigate the associations between anxiety and depression symptomatology in a community sample across the first 12.5 years of parenthood, and children’s internalizing and externalizing problems. Maternal anxiety and depression were measured at the child’s age of 3, 6, and 12 months, and 2.5, 4, 6, 8, 10 and 12.5 years. At 12.5 years of age, both mothers and children reported on children’s internalizing and externalizing problems. Trait–state occasion modeling was used to disentangle the chronic (trait) part of maternal symptomatology from the transient (occasion-specific) part. On average, 66.6% of the variance in maternal anxiety and depression symptomatology could be explained by the chronic trait factor. For both anxiety and depression, the chronic variance in maternal symptomatology was related to mother-reported internalizing, but not externalizing, problems of the child. Also, for childreported internalizing problems, a significant association with maternal anxiety and depression symptomatology emerged. Only the occasion-specific part of maternal depression symptomatology at the child’s age of 12.5 years was marginally related to mother-reported internalizing problems. Given that chronic subclinical symptomatology seems to be associated with child internalizing problems, prevention and treatment of maternal anxiety and depression symptomatology might be worthwhile regardless of the degree of severity.

Purpose: This project aimed to increase obstetric healthcare providers’ willingness to administer depression screenings during pregnancy and increase depression screening practice frequency to provide a pathway in compliance with the ACOG and USPSTF recommendations.Background: Previous undiagnosed depressive episodes have been associated with postpartum depression resulting in serious concerns that affect the mother and the baby. There are multifactorial symptoms associated with pregnancy requiring depression screening during pregnancy using a universal tool. A lack of training and confidence in treating or referring patients that limit depression screening are barriers associated with the underdiagnosis of depression. There are also varying practices in the frequency of screening amongst providers. To satisfy the ACOG and USPSTF recommendations, screening for depression should occur at least once during pregnancy. Methods: Using a pretest/posttest design among a single group of obstetric healthcare providers in Arizona, participants were given a survey before and following an evidence-based educational intervention on perinatal depression screening using the patient health questionnaire-9 (PHQ-9). The pretest and posttests evaluated the participants’ current and future depression screening practices, knowledge of perinatal depression, understanding of the PHQ-9 depression screening tool, expertise level in administering the PHQ-9, the comfort level of administering the PHQ-9, and willingness to implement depression screening into practice in perinatal patients during pregnancy. Results: Seven participants completed the quality improvement project. Key findings indicated an increase in the participants' knowledge of perinatal depression, the expertise and comfort of administering and interpreting the PHQ-9, treating depression during pregnancy, and the number of participants who plan to always screen for depression during pregnancy in the future. Conclusions: The re

Postpartum depression (PPD) is a devastating disorder affecting not only more than 10% of all women giving birth, but also the baby, the family, and the society. Compiling evidence suggests the involvement of the immune system in the pathophysiology of major depression; yet, the immune response in perinatal depression is not as well studied. The aim of this study was to investigate the alterations in peripheral levels of inflammatory biomarkers in 169 Swedish women with and without depressive symptoms according to the Edinburgh postnatal depression scale or the M.I.N.I neuropsychiatric interview at eight weeks postpartum. Among the 70 markers analyzed with multiplex proximity extension assay, five were significantly elevated in women with postpartum depressive symptoms in the adjusted LASSO logistic regression analysis: Tumor necrosis factor ligand superfamily member (TRANCE) (OR-per 1 SD increase = 1.20), Hepatocyte growth factor (HGF) (OR = 1.17) Interleukin (IL)-18 (OR = 1.06), Fibroblast growth factor 23 (FGF-23) (OR = 1.25), and C-X-C motif chemokine 1 (CXCL1) (OR 1.11). These results indicate that women with PPD have elevated levels of some inflammatory biomarkers. It is, therefore, plausible that PPD is associated with a compromised adaptability of the immune system.

Emerging evidence suggests that prenatal stress does not solely undermine child functioning but increases developmental plasticity to both negative and positive postnatal experiences. Here we test this proposition using the Norwegian Mother and Child Cohort study while implementing an extreme-group (i.e., high vs. low prenatal stress) design (n = 27,889 children for internalizing and n = 27,892 for externalizing problems). To measure prenatal stress, mothers reported on depressive and anxiety symptoms at gestational weeks 17 and 30 and of stressful life events at gestational week 30. We then evaluated whether, collectively, such prenatal stress amplified the effect of mothers' postnatal depressive and anxiety symptoms on children's internalizing and externalizing behavior problems at age 5 years. Results showed prenatal stress amplified effects of postnatal maternal depression/anxiety on child internalizing but not externalizing behavior, with some indication that this Prenatal-Stress-×-Postnatal-Maternal-Depression interaction proved more consistent with differential susceptibility than diathesis stress thinking: Children exposed to prenatal stress evinced greater internalizing problems if exposed to more postnatal maternal depressive/anxiety symptoms and, somewhat less strongly, displayed less internalizing problems if they experienced lower postnatal maternal depressive/anxiety symptoms. However, analyses using the whole sample instead of extreme groups yielded opposing results with children exposed to the least prenatal stress evincing greater sensitivity to postnatal maternal depressive/anxiety symptoms with regards to externalizing and internalizing behavior. Taken together, it appears that prenatal stress may have differing effects on plasticity depending on prenatal stress severity. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Infants are uniquely vulnerable to maternal depression's noxious effects, but few longitudinal studies have tried to identify discrete postnatal trajectories of maternal depressive symptoms (MDS) beginning in infancy. This study extends evidence of heterogeneous change in postnatal MDS by examining their cross-contextual antecedents in infancy and their consequences for children's early behavior problems and language skills in late toddlerhood. A community sample of mother-child dyads (N = 235, 72% Caucasian) was assessed when children were 7, 15, and 33 months old. Mothers reported their socioeconomic status (SES), social support, marital relationship quality, family dysfunction, parenting stress, and infants' functional regulatory problems at 7 months postpartum, and children's internalizing and externalizing symptoms at 33 months. Children completed a receptive vocabulary assessment at 33 months in the lab. Latent class growth analysis identified three postnatal MDS trajectory classes that fit the data best: low-decreasing, moderate, and increasing. Psychosocial measures at seven months postpartum primarily predicted membership to these postnatal trajectory classes, which subsequently differed in children's internalizing, externalizing, and receptive vocabulary in late toddlerhood, controlling for family SES and functional regulatory problems in infancy. We discuss salient antecedents and consequences of postnatal depression for mothers and their offspring.

BackgroundMore than 50% of Africa's population lives in rural areas, which have few professional health workers. South Africa has adopted task shifting health care to Community Health Workers (CHWs) to achieve the Sustainable Development Goals, but little is known about CHWs' efficacy in rural areas.MethodsIn this longitudinal prospective cohort study, almost all mothers giving birth (N = 470) in the Zithulele Hospital catchment area of the OR Tambo District were recruited and repeatedly assessed for 2 years after birth with 84.7-96% follow-up rates. During the cohort assessment we found that some mothers had received standard antenatal and HIV care (SC) (n = 313 mothers), while others had received SC, supplemented with home-visiting by CHWs before and after birth (HV) (n = 157 mothers, 37 CHWs). These visits were unrelated to the cohort study. Multiple linear and logistic regressions evaluated maternal comorbidities, maternal caretaking, and child development outcomes over time.ResultsCompared to mothers receiving SC, mothers who also received home visits by CHWs were more likely to attend the recommended four antenatal care visits, to exclusively breastfeed at 3 months, and were less likely to consult traditional healers at 3 months. Mothers in both groups were equally likely to secure the child grant, and infant growth and achievement of developmental milestones were similar over the first 2 years of life.ConclusionCHW home visits resulted in better maternal caretaking, but did not have direct benefits for infants in the domains assessed. The South African Government is planning broad implementation of CHW programmes, and this study examines a comprehensive, home-visiting model in a rural region.

AIMS: The first year after childbirth involves a major transition for women, which can accentuate inadequacies and feelings of powerlessness, making them vulnerable to depression. The aim of this study was to investigate the prevalence and frequency of maternal postpartum depressive symptoms at different times after giving birth (0-21 months). METHODS: Data were collected cross-sectionally using a web questionnaire containing the Edinburgh Postnatal Depression Scale (EPDS). A total of 888 mothers with children in the age range 0-21 months responded. RESULTS: The results showed different levels of depression over the range of months included in the study. The overall prevalence using EPDS ⩾ 12 was 27.8%. There were higher levels at 9-12 months and 17-21 months. The highest levels of symptoms of depression were found at nine, 12, and 17 months after birth, and the lowest levels at two and 16 months. CONCLUSIONS: Many mothers experience symptoms of depression after giving birth that can continue well beyond the child's first year. We have identified different levels of depression at different points in time after giving birth, with highs and lows throughout the first 21 months. This highlights a need to screen for depression more than once during the first years, as well as a closer cooperation between midwives and child healthcare nurses in supporting mothers in the transition to motherhood. This is an important aspect of public health, which not only involves mothers with symptoms of depression, but also their ability to care for their child and a possible negative impact on the child's development., First Published December 14, 2020

Published: 12 December 2020, Maternal depression and anxiety have been proposed to increase the risk of adverse outcomes of language development in the early years of life. This study investigated the e ects of maternal depression and anxiety on language development using two approaches: (i) a categorical approach that compared lexical abilities in two groups of children, a risk group (mothers with clinical-level symptomatology) and a control non-risk group, and (ii) a continuous approach that assessed the relation between individual mothers’ clinical and subclinical symptomatology and their infants’ lexical abilities. Infants’ lexical abilities were assessed at 18 months of age using an objective lexical processing measure and a parental report of expressive vocabulary. Infants in the risk group exhibited lower lexical processing abilities compared to controls, and maternal depression scores were negatively correlated to infants’ lexical processing and vocabulary measures. Furthermore, maternal depression (not anxiety) explained the variance in infants’ individual lexical processing performance above the variance explained by their individual expressive vocabulary size. These results suggest that significant di erences are emerging in 18-month-old infants’ lexical processing abilities, and this appears to be related, in part, to their mothers’ depression and anxiety symptomatology during the postnatal period.

Abstract Objective Mothers of infants born very preterm (VPT) are at high risk of mental health difficulties. However, less is known about the course of fathers’ depressive and anxiety symptoms over time, and the implications this may have for early parenting behaviors. Methods In total, 100 fathers of 125 infants born VPT (<30 weeks’ gestation) completed questionnaires assessing depressive and anxiety symptoms shortly after their infant’s birth, and when their infant reached term-equivalent age, 3 months, 6 months, and 12 months’ corrected age. At 12 months’ corrected age, fathers’ parenting behaviors were assessed using the Emotional Availability Scales. Longitudinal latent class analysis was used to identify trajectories of fathers’ depressive and anxiety symptoms, and linear regression equations examined relationships between these trajectories and fathers’ parenting behaviors. Results For both depressive and anxiety symptoms, two distinct trajectories were identified. For depression, most fathers were assigned to the persistently low symptom trajectory (82%), while the remainder were assigned to the persistently high symptom trajectory (18%). For anxiety, 49% of fathers were assigned to the persistently low symptom trajectory, while 51% were assigned to the trajectory characterized by moderate symptoms over the first postnatal year. There were no significant differences in parenting behaviors between fathers assigned to the different depressive and anxiety symptom trajectories. Conclusions Fathers of infants born VPT are at risk of chronic depressive and anxiety symptoms over the first postnatal year, highlighting the need for screening and ongoing support.

Published: 12 December 2020, Maternal depression and anxiety have been proposed to increase the risk of adverse outcomes of language development in the early years of life. This study investigated the e ects of maternal depression and anxiety on language development using two approaches: (i) a categorical approach that compared lexical abilities in two groups of children, a risk group (mothers with clinical-level symptomatology) and a control non-risk group, and (ii) a continuous approach that assessed the relation between individual mothers’ clinical and subclinical symptomatology and their infants’ lexical abilities. Infants’ lexical abilities were assessed at 18 months of age using an objective lexical processing measure and a parental report of expressive vocabulary. Infants in the risk group exhibited lower lexical processing abilities compared to controls, and maternal depression scores were negatively correlated to infants’ lexical processing and vocabulary measures. Furthermore, maternal depression (not anxiety) explained the variance in infants’ individual lexical processing performance above the variance explained by their individual expressive vocabulary size. These results suggest that significant di erences are emerging in 18-month-old infants’ lexical processing abilities, and this appears to be related, in part, to their mothers’ depression and anxiety symptomatology during the postnatal period.

Infants are uniquely vulnerable to maternal depression's noxious effects, but few longitudinal studies have tried to identify discrete postnatal trajectories of maternal depressive symptoms (MDS) beginning in infancy. This study extends evidence of heterogeneous change in postnatal MDS by examining their cross-contextual antecedents in infancy and their consequences for children's early behavior problems and language skills in late toddlerhood. A community sample of mother-child dyads (N = 235, 72% Caucasian) was assessed when children were 7, 15, and 33 months old. Mothers reported their socioeconomic status (SES), social support, marital relationship quality, family dysfunction, parenting stress, and infants' functional regulatory problems at 7 months postpartum, and children's internalizing and externalizing symptoms at 33 months. Children completed a receptive vocabulary assessment at 33 months in the lab. Latent class growth analysis identified three postnatal MDS trajectory classes that fit the data best: low-decreasing, moderate, and increasing. Psychosocial measures at seven months postpartum primarily predicted membership to these postnatal trajectory classes, which subsequently differed in children's internalizing, externalizing, and receptive vocabulary in late toddlerhood, controlling for family SES and functional regulatory problems in infancy. We discuss salient antecedents and consequences of postnatal depression for mothers and their offspring.

Emerging evidence suggests that prenatal stress does not solely undermine child functioning but increases developmental plasticity to both negative and positive postnatal experiences. Here we test this proposition using the Norwegian Mother and Child Cohort study while implementing an extreme-group (i.e., high vs. low prenatal stress) design (n = 27,889 children for internalizing and n = 27,892 for externalizing problems). To measure prenatal stress, mothers reported on depressive and anxiety symptoms at gestational weeks 17 and 30 and of stressful life events at gestational week 30. We then evaluated whether, collectively, such prenatal stress amplified the effect of mothers' postnatal depressive and anxiety symptoms on children's internalizing and externalizing behavior problems at age 5 years. Results showed prenatal stress amplified effects of postnatal maternal depression/anxiety on child internalizing but not externalizing behavior, with some indication that this Prenatal-Stress-×-Postnatal-Maternal-Depression interaction proved more consistent with differential susceptibility than diathesis stress thinking: Children exposed to prenatal stress evinced greater internalizing problems if exposed to more postnatal maternal depressive/anxiety symptoms and, somewhat less strongly, displayed less internalizing problems if they experienced lower postnatal maternal depressive/anxiety symptoms. However, analyses using the whole sample instead of extreme groups yielded opposing results with children exposed to the least prenatal stress evincing greater sensitivity to postnatal maternal depressive/anxiety symptoms with regards to externalizing and internalizing behavior. Taken together, it appears that prenatal stress may have differing effects on plasticity depending on prenatal stress severity. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

BackgroundMore than 50% of Africa's population lives in rural areas, which have few professional health workers. South Africa has adopted task shifting health care to Community Health Workers (CHWs) to achieve the Sustainable Development Goals, but little is known about CHWs' efficacy in rural areas.MethodsIn this longitudinal prospective cohort study, almost all mothers giving birth (N = 470) in the Zithulele Hospital catchment area of the OR Tambo District were recruited and repeatedly assessed for 2 years after birth with 84.7-96% follow-up rates. During the cohort assessment we found that some mothers had received standard antenatal and HIV care (SC) (n = 313 mothers), while others had received SC, supplemented with home-visiting by CHWs before and after birth (HV) (n = 157 mothers, 37 CHWs). These visits were unrelated to the cohort study. Multiple linear and logistic regressions evaluated maternal comorbidities, maternal caretaking, and child development outcomes over time.ResultsCompared to mothers receiving SC, mothers who also received home visits by CHWs were more likely to attend the recommended four antenatal care visits, to exclusively breastfeed at 3 months, and were less likely to consult traditional healers at 3 months. Mothers in both groups were equally likely to secure the child grant, and infant growth and achievement of developmental milestones were similar over the first 2 years of life.ConclusionCHW home visits resulted in better maternal caretaking, but did not have direct benefits for infants in the domains assessed. The South African Government is planning broad implementation of CHW programmes, and this study examines a comprehensive, home-visiting model in a rural region.

BackgroundThe study examined the association between prenatal tobacco or co-exposure to tobacco and cannabis and children's cortisol reactivity at kindergarten age and the role of child sex, maternal negative mood (depression/perceived stress), and parenting behavior during play interactions as moderators of this association.MethodsThe sample was 238 mother-child dyads (67 tobacco users, 83 co-users of tobacco and cannabis, and 88 non-users). Data used were obtained from pregnancy assessments and six postnatal assessments at 2, 9, 16, 24, and 36 months and kindergarten age. Infant cortisol was measured in response to two laboratory stress paradigms.ResultsCo-exposed children had a significantly greater decrease from pre-stressor to post-stressor and overall lower cortisol response compared with non-exposed children. This association was moderated by maternal harshness during play interactions across early childhood. Co-exposed children had flatter cortisol responses regardless of the mother's level of harshness or stress/depression. However, non-exposed children who experienced low harshness had the normative cortisol peak 20 min post-stressor, while non-exposed children with high maternal harshness had a flatter cortisol pattern. Similarly, non-exposed children with more depressed/stressed mothers had higher pre-stressor cortisol levels, while those who experienced low maternal depression/stress had lower pre-stressor cortisol but peaked post-stress.ConclusionsResults suggest that prenatal polysubstance exposure is associated with greater risk for lower cortisol response in children and highlight the role of parenting behavior for non-exposed but not the co-exposed children.

This thesis consists of three essays that address questions in health economics using different datasets and econometric approaches. In the first essay, I apply novel non-parametric econometric techniques to estimate the causal effect of retirement on health using the U.S. Health and Retirement Study (HRS) survey. I use a non-parametric Fuzzy Regression Discontinuity Design (RDD) technique for my analysis to avoid restrictive assumptions on a particular functional form and to capture the potential reverse causality from health to retirement (endogeneity issue) by exploiting the exogenous variation in retirement decisions induced by U.S. pension eligibility ages at 62 and 65. The results show that retirement is associated with an 8% decline in the cognitive functioning score of retirees, and 0.42 points increase in the CESD depression scale. Retirees also are 13 percentage points less likely to report good general health status, 8.8 percentage points less likely to be drinkers, and they are 4 percentage points less likely to consume alcohol more than three times per week. In the second essay, I use an administrative database to investigate the impact of the timing of first exposure to maternal depression on a comprehensive measure of children’s school readiness that incorporates multidimensional developmental domains that underlie school class adaptation and later success. I find that exposure to maternal depression is associated with developmental vulnerability in emotional, physical, social, and cognitive domains. The strongest adverse effects on development are from exposure to depression during pregnancy, followed by exposure during the preschool period. In the third essay, I examine the impact of Type I Diabetes Mellitus (TIDM) during childhood on educational attainment and labor market outcomes in adulthood using the National Health Interview Survey (NHIS). The results show that individuals who developed Type I diabetes early in life are 7 to 17 percentage poin

Published: 12 December 2020, Maternal depression and anxiety have been proposed to increase the risk of adverse outcomes of language development in the early years of life. This study investigated the e ects of maternal depression and anxiety on language development using two approaches: (i) a categorical approach that compared lexical abilities in two groups of children, a risk group (mothers with clinical-level symptomatology) and a control non-risk group, and (ii) a continuous approach that assessed the relation between individual mothers’ clinical and subclinical symptomatology and their infants’ lexical abilities. Infants’ lexical abilities were assessed at 18 months of age using an objective lexical processing measure and a parental report of expressive vocabulary. Infants in the risk group exhibited lower lexical processing abilities compared to controls, and maternal depression scores were negatively correlated to infants’ lexical processing and vocabulary measures. Furthermore, maternal depression (not anxiety) explained the variance in infants’ individual lexical processing performance above the variance explained by their individual expressive vocabulary size. These results suggest that significant di erences are emerging in 18-month-old infants’ lexical processing abilities, and this appears to be related, in part, to their mothers’ depression and anxiety symptomatology during the postnatal period.

Background Postpartum depression is common in the perinatal period and poses a risk for the development of the infant and the mother-infant relationship. Infancy is a critical developmental period of life and supportive parenting is crucial for healthy development, however, the effects of interventions aimed at improving parenting among mothers with depression are uncertain. Aims To assess the effects of parenting interventions on parent-child relationship and child development among mothers with depressive symptoms with 0-12-month-old infants. Method We conducted a systematic review with the inclusion criteria: (a) randomised controlled trials of structured psychosocial parenting interventions for women with depressive symptoms and a child aged 0-12 months in Western Organisation for Economic Co-operation and Development countries, (b) minimum three sessions with at least half of these delivered postnatally and (c) outcomes relating to the parent-child-relationship and/or child development. Publications were extracted from 10 databases in September 2018 and supplemented with grey search and hand search. We assessed risk of bias, calculated effect sizes and conducted meta-analysis. Results Eight papers representing seven trials were included. We conducted meta-analysis on the post-intervention parent-child relationship. The analysis included six studies and showed no significant effect. For individual study outcomes, no significant effects on the majority of both the parent-child relationship and child development outcomes were reported. Conclusions No evidence of the effect of parenting interventions for mothers with depressive symptoms was found on the parent-child relationship and child development. Larger studies with follow-up assessments are needed, and future reviews should examine the effects in non-Western countries.

Background: Concerns have been raised that synthetic oxytocin, a widely used obstetric tool for labor induction and augmentation, may have deleterious e ffects on the neuropsychological development of children. Few studies have examined the relationship between oxytocin-stimulated labor and emotional disorders. Methods: We conducted a nationwide register-based cohort study including 677,629 singletons born in Denmark in the years 2000 to 2012 and followed through 2016 (median age = 10.6 years). Data on oxytocin-stimulation were obtained from the Danish Medical Birth Register. Cases of emotional disorders-anxiety, ob-sessive-compulsive disorder, mood or traumatic stress disorders or a redeemed prescription for a selective ser-otonin reuptake inhibitor-were identi fied using Danish patient and prescription registries. Results: Oxytocin was used to stimulate 31% of births, and oxytocin-stimulated labor was not associated with childhood emotional disorders (HR = 1.05, 95% CI 0.99, 1.11) after adjustment for maternal history of psy-chopathology, antidepressants during pregnancy, cohabitation status, highest educational attainment, smoking status during pregnancy, birth year, and indications for labor stimulation. The crude cox model was also small and close to unity (HR = 1.09, 95% CI 1.03, 1.15). Limitations: About 50% of our population had reached the age of 10 years, but the outcome included dis-orders with later average debut ages. Oxytocin dosage levels are not recorded in the registers. Conclusions: Our small e ffect size estimates suggest that perinatal synthetic oxytocin does not contribute to the development of emotional disorders. Current evidence does not warrant revision of guidelines for the use of oxytocin in obstetrics.

Background Postpartum depression is common in the perinatal period and poses a risk for the development of the infant and the mother-infant relationship. Infancy is a critical developmental period of life and supportive parenting is crucial for healthy development, however, the effects of interventions aimed at improving parenting among mothers with depression are uncertain. Aims To assess the effects of parenting interventions on parent-child relationship and child development among mothers with depressive symptoms with 0-12-month-old infants. Method We conducted a systematic review with the inclusion criteria: (a) randomised controlled trials of structured psychosocial parenting interventions for women with depressive symptoms and a child aged 0-12 months in Western Organisation for Economic Co-operation and Development countries, (b) minimum three sessions with at least half of these delivered postnatally and (c) outcomes relating to the parent-child-relationship and/or child development. Publications were extracted from 10 databases in September 2018 and supplemented with grey search and hand search. We assessed risk of bias, calculated effect sizes and conducted meta-analysis. Results Eight papers representing seven trials were included. We conducted meta-analysis on the post-intervention parent-child relationship. The analysis included six studies and showed no significant effect. For individual study outcomes, no significant effects on the majority of both the parent-child relationship and child development outcomes were reported. Conclusions No evidence of the effect of parenting interventions for mothers with depressive symptoms was found on the parent-child relationship and child development. Larger studies with follow-up assessments are needed, and future reviews should examine the effects in non-Western countries.

The hippocampus has been implicated in the pathophysiology of depression. This study examined whether youth hippocampal subregion volumes were differentially associated with maternal depression history and youth’s depressive symptoms across the transition to adolescence. 74 preadolescent offspring (Mage=10.74+/-.84 years) of mothers with (n=33) and without a lifetime depression history (n=41) completed a structural brain scan. Youth depressive symptoms were assessed prior to the neuroimaging assessment at age 9 (Mage=9.08+/-.29 years), at the neuroimaging assessment, and in early adolescence (Mage=12.56+/-.40 years). Maternal depression was associated with preadolescent offspring’s reduced bilateral hippocampal head volumes and increased left hippocampal body volume. Reduced bilateral head volumes were associated with offspring’s increased concurrent depressive symptoms. Furthermore, reduced right hippocampal head volume mediated associations between maternal depression and increases in offspring depressive symptoms from age 9 to age 12. Findings implicate reductions in hippocampal head volume in the intergenerational transmission of risk from parents to offspring.

BACKGROUND: The study examined the association between prenatal tobacco or co-exposure to tobacco and cannabis and childrens cortisol reactivity at kindergarten age and the role of child sex, maternal negative mood (depression/perceived stress), and parenting behavior during play interactions as moderators of this association. METHODS: The sample was 238 mother-child dyads (67 tobacco users, 83 co-users of tobacco and cannabis, and 88 non-users). Data used were obtained from pregnancy assessments and six postnatal assessments at 2, 9, 16, 24, and 36 months and kindergarten age. Infant cortisol was measured in response to two laboratory stress paradigms. RESULTS: Co-exposed children had a significantly greater decrease from pre-stressor to post-stressor and overall lower cortisol response compared with non-exposed children. This association was moderated by maternal harshness during play interactions across early childhood. Co-exposed children had flatter cortisol responses regardless of the mothers level of harshness or stress/depression. However, non-exposed children who experienced low harshness had the normative cortisol peak 20 min post-stressor, while non-exposed children with high maternal harshness had a flatter cortisol pattern. Similarly, non-exposed children with more depressed/stressed mothers had higher pre-stressor cortisol levels, while those who experienced low maternal depression/stress had lower pre-stressor cortisol but peaked post-stress. CONCLUSIONS: Results suggest that prenatal polysubstance exposure is associated with greater risk for lower cortisol response in children and highlight the role of parenting behavior for non-exposed but not the co-exposed children.

This thesis consists of three essays that address questions in health economics using different datasets and econometric approaches. In the first essay, I apply novel non-parametric econometric techniques to estimate the causal effect of retirement on health using the U.S. Health and Retirement Study (HRS) survey. I use a non-parametric Fuzzy Regression Discontinuity Design (RDD) technique for my analysis to avoid restrictive assumptions on a particular functional form and to capture the potential reverse causality from health to retirement (endogeneity issue) by exploiting the exogenous variation in retirement decisions induced by U.S. pension eligibility ages at 62 and 65. The results show that retirement is associated with an 8% decline in the cognitive functioning score of retirees, and 0.42 points increase in the CESD depression scale. Retirees also are 13 percentage points less likely to report good general health status, 8.8 percentage points less likely to be drinkers, and they are 4 percentage points less likely to consume alcohol more than three times per week. In the second essay, I use an administrative database to investigate the impact of the timing of first exposure to maternal depression on a comprehensive measure of children’s school readiness that incorporates multidimensional developmental domains that underlie school class adaptation and later success. I find that exposure to maternal depression is associated with developmental vulnerability in emotional, physical, social, and cognitive domains. The strongest adverse effects on development are from exposure to depression during pregnancy, followed by exposure during the preschool period. In the third essay, I examine the impact of Type I Diabetes Mellitus (TIDM) during childhood on educational attainment and labor market outcomes in adulthood using the National Health Interview Survey (NHIS). The results show that individuals who developed Type I diabetes early in life are 7 to 17 percentage poin

Children vary in the extent to which they benefit from parenting programs for conduct problems. How does parental mental health change if children benefit less or more? We assessed whether changes in conduct problems and maternal depressive symptoms co-occur following participation in the Incredible Years parenting program. We integrated individual participant data from 10 randomized trials (N = 1280; children aged 2–10 years) and distinguished latent classes based on families' baseline and post-test conduct problems and maternal depressive symptoms, using repeated measures latent class analysis (RMLCA) and latent transition analysis (LTA). Classes differed mainly in severity of conduct problems and depression (RMLCA; 4 classes). Conduct problems reduced in all classes. Depressive symptoms did not change in most classes, except in a class of families where conduct problems and depression were particularly severe. Incredible Years led to a greater likelihood of families with particularly severe conduct problems and depression moving to a class with mild problems (LTA; 3 classes). Our findings suggest that for the majority of families, children's conduct problems reduce, but maternal depressive symptoms do not, suggesting relative independence, with the exception of families with severe depression and severe conduct problems where changes for the better do co-occur.

Children vary in the extent to which they benefit from parenting programs for conduct problems. How does parental mental health change if children benefit less or more? We assessed whether changes in conduct problems and maternal depressive symptoms co-occur following participation in the Incredible Years parenting program. We integrated individual participant data from 10 randomized trials (N = 1280; children aged 2–10 years) and distinguished latent classes based on families’ baseline and post-test conduct problems and maternal depressive symptoms, using repeated measures latent class analysis (RMLCA) and latent transition analysis (LTA). Classes differed mainly in severity of conduct problems and depression (RMLCA; 4 classes). Conduct problems reduced in all classes. Depressive symptoms did not change in most classes, except in a class of families where conduct problems and depression were particularly severe. Incredible Years led to a greater likelihood of families with particularly severe conduct problems and depression moving to a class with mild problems (LTA; 3 classes). Our findings suggest that for the majority of families, children’s conduct problems reduce, but maternal depressive symptoms do not, suggesting relative independence, with the exception of families with severe depression and severe conduct problems where changes for the better do co-occur.