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Background: Limited research exists on mother-infant interaction in women at-risk-of postpartum psychosis (PP). This study aimed to investigate potential predictors of mother-infant interaction quality in women at-risk-of-PP during the first postnatal year. Potential predictors investigated were: maternal ability to recognize emotions, childhood maltreatment, parenting stress, and infant social-interactive behaviour at birth., Methods: 98 women (and their offspring) were included, 40 at-risk-of-PP because of a diagnosis of Bipolar Disorder, Schizoaffective Disorder or previous PP, and 58 with no current/previous mental illness or family history of PP. Mother-infant interaction was assessed using the CARE-Index at 8 weeks and 12 months postpartum. Maternal ability to recognize emotions was assessed with the VERT-K, maternal experience of childhood maltreatment with the CECA-Q, maternal parenting stress with the PSI-SF and infant social-interactive behaviour with the NBAS., Results: Women at-risk-of-PP were less able to recognize fear than healthy controls and this predicted the quality of the mother-infant interaction at 8 weeks' and 12 months' post partum, over and above the effect of maternal Group (respectively, β = 0.33, p = .015; β = 0.40, p = .006). Infant social-interactive behaviour at birth was a significant predictor for mother-infant interaction at 12 months (β = 0.32, p = .031), although this did not differ significantly between the groups., Limitations: A relatively small sample size precluded a more in-depth investigation of indirect pathways and other potential predictors., Conclusions: These results are important as they suggest that preventive interventions targeting emotion recognition may be implemented in women at-risk-of-PP, with the aim of improving mother-infant interaction and potentially also the infant long-term development., Competing Interests: Declaration of competing interest PD has received speaker's fees from Lundbeck and Janssen. CMP has received research funding from Johnson & Johnson for research on depression and inflammation and is funded by the Wellcome Trust strategy award to the Neuroimmunology of Mood Disorders and Alzheimer's Disease (NIMA) Consortium (104025), which is also funded by Janssen, GlaxoSmithKline, Lundbeck and Pfizer. LMH has received funding from the NIHR and the Nuffield Foundation for Research Programmes on maternal mental disorders. MAM has received research funding from Takeda Pharmaceuticals, Lundbeck, Johnson & Johnson and support in kind from AstraZeneca and has acted as a consultant for Lundbeck and Takeda. However, this paper is independent from this funding; there are no further declarations of interest., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Interpersonal traumas are common among expectant and new mothers and are found to have considerable impacts on women's mental health. These experiences may disrupt maternal perceptions of the mother-infant relationship, which is essential for healthy infant development, but findings are inconsistent. This study aims to explore associations between lifetime interpersonal traumas and their impact on self-reported mother-infant bonding., Methods: Secondary data analysis of a representative cohort of 453 women attending at a South London maternity service. Lifetime interpersonal trauma experience and its association with self-reported mother-infant bonding (Postpartum Bonding Questionnaire) was assessed in uni- and multivariable linear regressions, the latter adjusted to account for antenatal depressive and posttraumatic symptoms, measured using the Edinburgh Postnatal Depression Scale and Posttraumatic Stress Disorder Scale, and key sociodemographic risk factors., Results: Maternal lifetime trauma was not associated with perceived difficulties in mother-infant bonding at three months postnatal; however antenatal depressive symptoms, both with continuous EPDS score (0.33, 95% CI 0.17-0.50, p<0.001) and clinical cut-off ≥13 (4.26, 95% CI 2.02-6.49, p<0.001) were associated with self-reported bonding difficulties., Limitations: The composite trauma measurement did not allow for a comprehensive assessment of individual trauma types., Conclusions: There was no evidence for a link between maternal lifetime trauma experiences and self-reported bonding difficulties. However, an association between antenatal depressive symptoms and perceived postpartum bonding impairment was found. This highlights the importance of identification and treatment of depressive symptoms during pregnancy and offering women support in facilitating a positive mother-infant relationship., (Copyright © 2021. Published by Elsevier B.V.)

Background: Postpartum psychosis (PP) is the most severe psychiatric disorder associated with childbirth. However, there is little research on maternal bonding towards the infant and parenting stress in this clinical population., Methods: We investigated maternal bonding during pregnancy and post-partum in 75 women: 46 at risk of PP (AR), because of a DSM-IV diagnosis of bipolar disorder, schizoaffective disorder or previous PP, and 29 healthy controls. Of the AR women, 19 developed a psychiatric relapse within 4 weeks' post-partum (AR-unwell), while 27 remained symptom-free (AR-well). We investigated childhood maltreatment, parenting stress and psychiatric symptoms as potential predictors of maternal bonding., Results: In pregnancy, AR-unwell women reported a more negative affective experience towards their infants than AR-well women (d = 0.87, p = .001), while postnatally there was no significant difference in bonding. In contrast, AR women as a group reported a more negative affective experience than HC postnatally (d = 0.69, p = .002; d = 0.70, p = .010), but not antenatally. Parenting stress and psychiatric symptoms significantly predicted less optimal postnatal bonding (b = -0.10, t = -4.29, p < .001; b = -0.37, t = -4.85, p < .001) but only psychiatric symptoms explained the difference in bonding between AR and HC (b = -1.18, 95% BCa CI [-2.70,-0.04])., Limitations: A relatively small sample size precluded a more in-depth investigation of underlying pathways., Conclusion: This study provides new information on maternal bonding in women at risk of PP, and particularly in those that do and do not develop a postpartum relapse. The results suggest that improving maternal symptoms and parenting stress in the perinatal period in women at risk of PP could also have positive effects on bonding., (Copyright © 2021. Published by Elsevier B.V.)

Introduction: Depression and self-harm are leading causes of disability in young people, but prospective data on how maternal depression and self-harm thoughts contribute to these outcomes, and how they may interact is lacking., Methods: The study sample consisted of 8,425 mothers and offspring from the Avon Longitudinal Study of Parents and Children, an ongoing birth cohort study. Exposures were maternal self-harm ideation and depression measured using the Edinburgh Postnatal Depression Scale, collected at eleven time points over the period 18 weeks' gestation to 18 years post-partum. Outcomes were offspring past-year major depressive disorder and lifetime self-harm assessed at age 24., Results: Nearly one-fifth (16.7%) of mothers reported thoughts of self-harm on at least one of the eleven assessment points. The frequency of maternal self-harm ideation was related to both outcomes in a dose-response manner. Young adults whose mothers had self-harm ideation on 5-11 occasions were over three times more likely (Odds ratio (OR), 3.32; 95% CI, 1.63-6.76) to be depressed and over 1.5 times as likely (OR, 1.55; 95% CI, 0.73, 3.29) to have self-harmed than their peers whose mothers had never reported self-harm thoughts. Maternal self-harm thoughts remained associated with both offspring outcomes independent of maternal depression, and no evidence was found for an interaction between the two exposures., Discussion: Clinicians collecting data on maternal depression may consider paying attention to questions about self-harm ideation in assessments. Examining accumulated maternal self-harm ideation over time may provide insights into which children are most at risk for later self-harm and depression., (Copyright © 2021 The Author(s). Published by Elsevier B.V. All rights reserved.)

Background: anxiety and depression are common in women with gestational diabetes but it is not clear whether they are more likely to precede the onset of gestational diabetes or to co-occur with it. Our aims were to compare the strength of association between common mental disorders of anxiety and depression (i) before pregnancy and (ii) during pregnancy in women with and without gestational diabetes., Methods: the sample comprised 12,239 women with 13,539 pregnancies from the UK's Born in Bradford cohort. Gestational diabetes was diagnosed by oral glucose tolerance test (OGTT). Indicators of common mental disorders were obtained from linked primary care records. Multivariable robust Poisson and logistic regression were employed. Multiple imputation by chained equations was implemented to handle missing data. Models were adjusted for maternal age, ethnicity, education and obstetric complications. Analyses of common mental disorders during pregnancy were additionally adjusted for maternal smoking, pre-pregnancy BMI, multiple pregnancy and common mental disorders prior to pregnancy., Results: there was no evidence for an association between common mental disorders prior to pregnancy and gestational diabetes (adjusted RR 0.96; 95% CI 0.80,1.15) or between gestational diabetes and common mental disorders during pregnancy (adjusted OR 0.91; 95% CI 0.73,1.12)., Limitations: high levels of deprivation and multi-ethnic composition of the cohort may limit generalisability of these findings to other populations., Conclusions: routine primary care records did not identify an increased risk of gestational diabetes in women with common mental disorders prior to pregnancy or of gestational diabetes in women with common mental disorders during pregnancy., (Copyright © 2020 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Depression is a common antenatal mental disorder associated with significant maternal morbidity and adverse fetal outcomes. However, there is a lack of research on the effectiveness or cost-effectiveness of psychological interventions for antenatal depression., Methods: A parallel-group, exploratory randomised controlled trial across five hospitals. The trial compared Guided Self-Help, modified for pregnancy, plus usual care with usual care alone for pregnant women meeting DSM-IV criteria for mild-moderate depression. The trial objectives were to establish recruitment/follow-up rates, compliance and acceptability, and to provide preliminary evidence of intervention efficacy and cost-effectiveness. The primary outcome of depressive symptoms was assessed by blinded researchers using the Edinburgh Postnatal Depression Scale at 14-weeks post-randomisation., Results: 620 women were screened, 114 women were eligible and 53 (46.5%) were randomised. 26 women received Guided Self-Help - 18 (69%) attending ≥4 sessions - and 27 usual care; n = 3 women were lost to follow-up (follow-up rate for primary outcome 92%). Women receiving Guided Self-Help reported fewer depressive symptoms at follow-up than women receiving usual care (adjusted effect size -0.64 (95%CI: -1.30, 0.06) p = 0.07). There were no trial-related adverse events. The cost-effectiveness acceptability curve showed the probability of Guided Self-Help being cost-effective compared with usual care ranged from 10 to 50% with a willingness-to-pay range from £0 to £50,000., Conclusions and Limitations: Despite intense efforts we did not meet our anticipated recruitment target. However, high levels of acceptability, a lack of adverse events and a trend towards improvements in symptoms of depression post-treatment indicates this intervention is suitable for talking therapy services., (Copyright © 2019 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Self-harm is prevalent, particularly among young women, and is associated with mental disorders. However, little is known about the mental health of pregnant women who have a history of self-harm. This study examined whether lifetime self-harm was associated with increased risk of antenatal mental disorders., Methods: Cross-sectional study of 544 pregnant women recruited after their first antenatal appointment, oversampling those who responded positively to the depression-screening Whooley questions. The Structured Clinical Interview for DSM-IV-TR was delivered, including questions about the lifetime occurrence of self-harm. The associations between lifetime self-harm and the presence of mental disorders, and more specifically anxiety and depressive disorders, were examined using survey-weighted logistic regression. The association between lifetime self-harm and symptoms of personality disorder, was investigated using survey-weighted linear regression., Results: After survey weighting, history of self-harm had a prevalence of 7.9% (95%CI 5.5-11.2%) and was associated with increased risk for mental disorders in early pregnancy (adjusted odds ratio [AOR] 5.03; 95%CI: 2.22-11.37; p < 0.0001; n = 517). Women with a history of self-harm were more likely to experience antenatal anxiety disorders (AOR 4.41; 95%CI: 1.85-10.51; p = 0.001; n = 517) and antenatal depression (AOR 2.71; 95%CI: 1.04-7.05; p = 0.042; n = 517) than women who did not report self-harm. History of self-harm was also associated with higher SAPAS scores (adjusted coefficient 0.69; 95%CI: 0.21-1.17; n = 517)., Limitations: Information on the timing and persistence of self-harm was not available., Conclusions: Women with a history of self-harm are more vulnerable to mental disorders in pregnancy. Further research should include more comprehensive assessments of self-harm and the social context of pregnant women., (Copyright © 2019. Published by Elsevier B.V.)

Background: Few intervention studies of postnatal depression (PND) have evaluated accompanying changes in parenting, in spite of mounting evidence that exposure to chronic depression is detrimental to infant development. This study examined maternal attitudes and adjustment over the first postnatal year within a treatment trial. The aim was to examine whether maternal adjustment improved with earlier remission, and with combined medical and psychological treatment., Methods: As part of a multicentre pragmatic randomised controlled trial of treatment for PND, mothers completed a measure of maternal adjustment and attitudes and the Edinburgh Postnatal Depression Scale at an initial home visit (week 0) and three follow-ups (weeks 4, 18 and 44)., Results: Maternal attitudes and adjustment improved with PND remission; earlier remission conferred no additional benefit by 44-week follow-up. In line with previous studies, no particular treatment modality (antidepressant or health-visitor delivered non-directive counselling), or combination of treatments, was more effective for improving adjustment to parenthood. However, the earlier start of antidepressant treatment provided a short-term advantage for improving attitudes and reducing perceived stress., Limitations: As a result of the study's pragmatic trial design, there was high treatment non-compliance and no 'pure' control group. More depressed mothers may have been less likely to complete the maternal adjustment and attitudes measure., Conclusions: Effective treatment of PND is important not only for the mother's wellbeing but also for healthy adjustment to parenthood. Provision of treatment choice and early antidepressant treatment are suggested for optimising maternal attitudes and adjustment., (Copyright © 2011 Elsevier B.V. All rights reserved.)