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Highlights • 18% of the women experienced at least one mistreatment type during childbirth. • Verbal abuse increased the likelihood of having postpartum depression. • The effect of verbal abuse was greater among women without antenatal depression. • Physical abuse increased the odds of having moderate/severe postpartum depression., Background This study examined the association between disrespect and abuse of women during facility-based childbirth and postpartum depression (PD) occurrence. Methods We used data from the 2015 Pelotas (Brazil) Birth Cohort, a population-based cohort of all live births in the city. We assessed 3065 mothers at pregnancy and 3-months after birth. Self-reported disrespect and abuse experiences included physical abuse, verbal abuse, denial of care, and undesired procedures. We estimate the occurrence of each disrespect and abuse type, one or more types and disrespect and abuse score. The Edinburgh Postnatal Depression Scale (EPDS) was used to assess PD. EPDS scores ≥13 and ≥15 indicated at least moderate PD and marked/severe. Odds ratios (OR) were calculated by logistic regression. Results The prevalence of at least moderate PD and marked/severe PD was 9.4% and 5.7%, respectively. 18% of the women experienced at least one type of disrespect and abuse. Verbal abuse increased the odds of having at least moderate PD (OR = 1.58; 95%CI 1.06–2.33) and marked/severe PD (OR = 1.69; 95%CI 1.06–2.70) and the effect among women who did not experience antenatal depressive symptoms was greater in comparison to those who did (OR = 2.51; 95%CI 1.26–5.04 and OR = 4.27; 95%CI 1.80–10.12). Physical abuse increased the odds of having marked/severe PD (OR = 2.28; 95%CI 1.26–4.12). Having experienced three or more mistreatment types increased the odds of at least moderate PD (OR = 2.90; 95%CI 1.30 - 35.74) and marked/severe PD (OR=3.86; 95%CI 1.58–9.42). Limitations Disrespect and abuse experiences during childbirth were self-reported. Conclusions Disrespect and abuse during childbirth increased the odds of PD three months after birth. Strategies to promote high quality and respectful maternal health care are needed to prevent mother-child adverse outcomes.

Background: Depressive recurrence is highly prevalent and adds significantly to the burden of depressive disorder. Whilst some clinical predictors of recurrence have been clearly demonstrated (e.g. residual symptoms, previous episodes), the cognitive and psychological processes that may contribute to recurrence risk are less well established. In this study we examine whether cognitive flexibility deficits and rumination are related to recurrence in a remitted clinical sample. Method: We compared remitted patients with 2 or more previous depressive episodes (N = 69) to a matched group of healthy controls (N = 43). Cognitive flexibility was measured using the Internal Shift Task (IST) and a version of the Exogenous Cueing Task (ECT); rumination was assessed with the Ruminative Responses Scale. Results: IST and ECT performance did not differ between remitted patients and controls. Remitted patients had higher levels of rumination than controls. Within the remitted patient group, faster disengagement from angry and happy faces on the ECT was predictive of shorter time to recurrence (hazard ratio for 1 standard deviation, (HRSD) = 0.563 [CI, 0.381–0.832], p = 0.004, (HRSD) = 0.561 [CI, 0.389–0.808], p = 0.002, respectively). Rumination predicted recurrence (HRSD = 1.526 [CI, 1.152–2.202]; p = 0.003) but was not related to emotional disengagement. Limitations: We had low power to detect small effects for the analysis within remitted patients. Conclusions: Whilst cognitive flexibility in remitted patients was not impaired relative to controls, rapid disengagement from emotional stimuli and rumination were independently associated with time to recurrence. Cognitive flexibility may be an important indicator of recurrence risk, and a target for interventions to reduce recurrence.

Summary: Background: Parents of babies admitted to neonatal units (NNU) are exposed to a range of potentially distressing experiences, which can lead to mental health symptoms such as increased anxiety and post-traumatic stress (PTS). This review aimed to describe how anxiety and PTS are defined and assessed, and to estimate anxiety and PTS prevalence among parents of babies admitted to NNU. Method: Medline, Embase, PsychoINFO, Cumulative Index to Nursing and Allied Health literature were searched to identify studies published prior to April 14, 2021. Included studies were assessed using Hoy risk of bias tool. A random-effects model was used to estimate pooled prevalence with 95% CIs. Potential sources of variation were investigated using subgroup analyses and meta-regression. The review is registered with PROSPERO (CRD42020162935). Findings: Fifty six studies involving 6,036 parents met the review criteria; 21 studies assessed anxiety, 35 assessed PTS, and 8 assessed both. The pooled prevalence of anxiety was 41.9% (95%CI:30.9, 53.0) and the pooled prevalence of PTS was 39.9% (95%CI:30.8, 48.9) among parents up to one month after the birth. Anxiety prevalence decreased to 26.3% (95%CI:10.1, 42.5) and PTS prevalence to 24.5% (95%CI:17.4, 31.6) between one month and one year after birth. More than one year after birth PTS prevalence remained high 27.1% (95%CI:20.7, 33.6). Data on anxiety at this time point were limited. There was high heterogeneity between studies and some evidence from subgroup and meta-regression analyses that study characteristics contributed to the variation in prevalence estimates. Interpretation: The prevalence of anxiety and PTS was high among parents of babies admitted to NNU. The rates declined over time, although they remained higher than population prevalence estimates for women in the perinatal period. Implementing routine screening would enable early diagnosis and effective intervention. Funding: This research is funded by the National Institute for Health Research (NIHR) Policy Research Programme, conducted through the Policy Research Unit in Maternal and Neonatal Health and Care, PR-PRU-1217-21202. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.

When interacting with an infant, parents intuitively enact a range of behaviours that support infant communicative development. These behaviours include altering speech, establishing eye contact and mirroring infant expressions and are argued to occur largely in the absence of conscious intent. Here, we describe studies investigating early, pre-conscious neural responses to infant cues, which we suggest support aspects of parental intuitive behaviour towards infants. This work has provided converging evidence for rapid differentiation of infant cues from other salient social signals in the adult brain. In particular, the orbitofrontal cortex may be important in supporting quick orienting responses and privileged processing of infant cues, processes fundamental to intuitive parenting behaviour.

With the widespread use of antiretroviral therapy and successful prevention of mother-to-child transmission the development of HIV-negative children with HIV-positive parents has become an important focus. There is considerable evidence that children’s developmental risk is heightened because a parental HIV-diagnosis is associated with a range of potential problems such as depression, stigma and financial difficulties. Up to a third of children in sub-Saharan Africa (SSA) are cared for by an HIV-positive parent or caregiver. We review the mechanisms by which HIV affects parenting including its negative effects on parental responsiveness in the early years of parenting and parental avoidant coping styles and parenting deficits in the later years. We describe low-cost parenting interventions suited for low resourced HIV endemic settings.

Whether it is the sound of a distressed cry or the image of a cute face, infants capture our attention. Parents and other adults alike are drawn into interactions to engage in play, nurturance and provide care. Responsive caregiving behaviour is a key feature of the parent-infant relationship, forming the foundation upon which attachment is built. Infant cues are considered to be 'innate releasers' or 'motivational entities' eliciting responses in nearby adults (Lorenz 1943; Murray, 1979) [42,43]. Through the advent of modern neuroimaging, we are beginning to understand the initiation of this motivational state at the neurobiological level. In this review, we first describe a current model of the 'parental brain', based on functional MRI studies assessing neural responses to infant cues. Next, we discuss recent findings from temporally sensitive techniques (magneto- and electroencephalography) that illuminate the temporal dynamics of this neural network. We focus on converging evidence highlighting a specific role for the orbitofrontal cortex in supporting rapid orienting responses to infant cues. In addition, we consider to what extent these neural processes are tied to parenthood, or whether they might be present universally in all adults. We highlight important avenues for future research, including utilizing multiple levels of analysis for a comprehensive understanding of adaptive caregiving behaviour. Finally, we discuss how this research can help us understand disrupted parent-infant relationships, such as in situations where parents' contingent responding to infant cues is disrupted; for example, in parental depression or anxiety where cognitive attentional processes are disrupted.

Introduction Children's understanding of HIV and death in epidemic regions is under-researched. We investigated children's death-related questions post maternal HIV-disclosure. Secondary aims examined characteristics associated with death-related questions and consequences for children's mental health. Methods HIV-infected mothers (N = 281) were supported to disclose their HIV status to their children (6–10 years) in an uncontrolled pre-post intervention evaluation. Children's questions post-disclosure were collected by maternal report, 1–2 weeks post-disclosure. 61/281 children asked 88 death-related questions, which were analysed qualitatively. Logistic regression analyses examined characteristics associated with death-related questions. Using the parent-report Child Behaviour Checklist (CBCL), linear regression analysis examined differences in total CBCL problems by group, controlling for baseline. Results Children's questions were grouped into three themes: ‘threats’; ‘implications’ and ‘clarifications’. Children were most concerned about the threat of death, mother's survival, and prior family deaths. In multivariate analysis variables significantly associated with asking death-related questions included an absence of regular remittance to the mother (AOR 0.25 [CI 0.10, 0.59] p = 0.002), mother reporting the child's initial reaction to disclosure being “frightened” (AOR 6.57 [CI 2.75, 15.70] p=, Highlights • Children living in HIV epidemic communities are exposed to death at young ages. • Primary-school aged children understand information on HIV, illness and death. • Intervention training successfully prepared mothers to communicate about death. • Communication about death did not increase children’s mental health problems. • HIV disclosure creates opportunities to communicate with and reassure children.

Stress affects brain function, and may lead to post-traumatic stress disorder (PTSD). Considerable empirical data for the neurobiology of PTSD has been derived from neuroimaging studies, although findings have proven inconsistent. We used an activation likelihood estimation analysis to explore differences in brain activity between adults with and without PTSD in response to affective stimuli. We separated studies by type of control group: trauma-exposed and trauma-naïve: this revealed distinct patterns of differences in functional activity. Compared to trauma-exposed controls, regions of the basal ganglia were differentially active in PTSD; whereas the comparison with trauma-naïve controls revealed differential involvement in the right anterior insula, precuneus, cingulate and orbitofrontal cortices known to be involved in emotional regulation. Changes in activity in the amygdala and parahippocampal cortex distinguished PTSD from both control groups. Results suggest that trauma has a measurable, enduring effect upon the functional dynamics of the brain, even in individuals who experience trauma but do not develop PTSD. These findings contribute to the understanding of whole-brain network activity following trauma, and its transition to clinical PTSD.

Summary Mental disorders are among the most common morbidities of pregnancy and the postnatal period, and can have adverse effects on the mother, her child, and family. This Series paper summarises the evidence about epidemiology, risk factors, identification, and interventions for non-psychotic mental disorders. Although the phenomenology and risk factors for perinatal mental disorders are largely similar to those for the disorders at other times, treatment considerations differ during pregnancy and breastfeeding. Most randomised controlled trials have examined psychosocial and psychological interventions for postnatal depression, with evidence for effectiveness in treating and preventing the disorder. Few high-quality studies exist on the effectiveness or safety of pharmacological treatments in the perinatal period, despite quite high prescription rates. General principles of prescribing of drugs in the perinatal period are provided, but individual risk–benefit analyses are needed for decisions about treatment.

We undertook a systematic search and review of individual, family, community, and societal risk and protective factors for mental health in children and adolescents who are forcibly displaced to high-income countries. Exposure to violence has been shown to be a key risk factor, whereas stable settlement and social support in the host country have a positive eff ect on the child’s psychological functioning. Further research is needed to identify the relevant processes, contexts, and interplay between the many predictor variables hitherto identifi ed as aff ecting mental health vulnerability and resilience. Research designs are needed that enable longitudinal investigation of individual, community, and societal contexts, rather than designs restricted to investigation of the associations between adverse exposures and psychological symptoms. We emphasise the need to develop comprehensive policies to ensure a rapid resolution of asylum claims and the eff ective integration of internally displaced and refugee children.

Background Although the prevalence of depression is similar in pregnant, postpartum and non-pregnant women, the onset of new depression is higher during the perinatal period. Women of low-income, and those living in low and middle income countries, are known to be at particularly high risk. Early identification and treatment of antenatal depression may improve pregnancy outcomes and could serve as an early indicator of postnatal depression. Culturally sensitive and accurate diagnostic tools are urgently needed. Methods A consecutive series of 109 pregnant women were recruited in the third trimester at a primary health clinic, in a rural part of South Africa, with a high HIV prevalence. A cross sectional assessment of depression was completed using a structured clinical interview method and DSM-IV diagnostic criteria. Qualitative data on women's descriptions of depressive symptoms was also collected. The aim was to examine the prevalence of depression and to better understand the presentation of depressive symptomatology in this population. Results Prevalence of depression was high, 51/109 (47%), with over half of the depressed women 34/51(67%) reporting episode duration greater than two months. 8/51 reported a prior history of depression. Women used psychological language to describe symptoms and, as a result, standardised diagnostic tools were culturally sensitive. Somatic pregnancy symptoms were frequently reported, but did not overestimate depression. Both HIV positive (27/51) and HIV negative (24/51) women were at risk of being depressed. Limitations The study is limited by the small sample size and possible attrition biases. Conclusion Antenatal depression is high and clinical presentation is similar to high income countries. Standardised diagnostic tools are culturally sensitive and adequate for early detection.

Postnatal maternal depression is associated with difficulties in maternal responsiveness. As most signals arising from the infant come from facial expressions one possible explanation for these difficulties is that mothers with postnatal depression are differentially affected by particular infant facial expressions. Thus, this study investigates the effects of postnatal depression on mothers’ perceptions of infant facial expressions. Participants (15 controls, 15 depressed and 15 anxious mothers) were asked to rate a number of infant facial expressions, ranging from very positive to very negative. Each face was shown twice, for a short and for a longer period of time in random order. Results revealed that mothers used more extreme ratings when shown the infant faces (i.e. more negative or more positive) for a longer period of time. Mothers suffering from postnatal depression were more likely to rate negative infant faces shown for a longer period more negatively than controls. The differences were specific to depression rather than an effect of general postnatal psychopathology—as no differences were observed between anxious mothers and controls. There were no other significant differences in maternal ratings of infant faces showed for short periods or for positive or neutral valence faces of either length. The findings that mothers with postnatal depression rate negative infant faces more negatively indicate that appraisal bias might underlie some of the difficulties that these mothers have in responding to their own infants signals.

The aim of this study is to compare the interaction of fathers and mothers with their 10–12 months old infants (n = 97; parental sensitivity and mood, and infant mood) during five structured contiguous play segments, and to examine the utility of individual growth modeling. Conventional comparison of means across play-segments showed that parents were equally responsive, but mothers were happier than fathers, and infants were equally happy during interaction with both parents. Sensitivity and mood were more strongly related for mothers than for fathers. Uni- and multivariate growth models revealed fine-grained patterns not seen in conventional analysis: (a) parental and infant mood decreased across play more for mothers than for fathers, (b) parental sensitivity in one play-segment predicted parental mood and infant mood in the next segment, (c) change in infants’ mood was related to change in sensitivity in mothers, and to change in mood in fathers, and (d) mothers’ sensitive interaction with the infant was predicted by family socio-demographic background.

OBJECTIVE: To assess whether parental psychological and physical factors and child factors measured in the first year of life were associated with recurrent abdominal pain (RAP) in children at age 6(3/4) years. METHOD: A longitudinal cohort study (the Avon Longitudinal Study of Parents and Children), followed 8,272 children from pregnancy to age 6(3/4) years. Parental reports of child and parent functioning were gathered. Associations between parental and child functioning assessed at 6 to 8 months postpartum, and RAP measured at age 6(3/4) years were investigated. RESULTS: The prevalence of RAP in this sample was 11.8%. Both maternal anxiety (adjusted odds ratio = 1.53; 95% confidence interval 1.24-1.89) and paternal anxiety (adjusted odds ratio = 1.38; 95% confidence interval 1.12-1.71) in the first year of a child's life were associated with later childhood RAP. Parent reports of child temperament features such as irregular feeding and sleeping were also associated with later RAP. CONCLUSIONS: This is the first evidence from a prospective study that anxiety in both mothers and fathers and child temperament features predate the occurrence of RAP in children. These findings highlight the potential importance of addressing parental anxiety in families in which children present with RAP, although some caution should be exercised in their interpretation because of possible reporting bias.

The relation between a number of psychosocial factors and the early termination of breast- feeding was examined in two large independent samples of puerperal women. The findings were remarkably similar. In both cohorts there was a significant association with depressive disorder which in the great majority preceded the cessation of breast-feeding. Other factors of importance were low social class, being young and lower educational attainment.

Background Many reports have charted trends in child and adolescent psychological disorders but few from low-income and middle-income countries, and very few cover the pre-school period. We investigated changes in pre-school behavioural and emotional disorders in two birth cohorts born 11 years apart in Brazil. Methods We did this cohort study of two birth cohorts from Pelotas, Brazil. In 1993 and 2004, all mothers giving birth to children who lived in the urban area of Pelotas were asked to have their children included in a birth cohort study. We included 4-year-old children born in 1993 (n=634) and 2004 (n=3750). We used the Child Behaviour Checklist, completed by participants' mothers, to assess any behavioural or emotional disorders. Findings Response rates in these two cohorts were above 90%. Mean total score was 27·9 (SE 0·8) in 1993 versus 34·7 (SE 0·3) in 2004; 5·7 (0·2) versus 6·3 (0·1) for internalising scores, and 12·4 (0·4) versus 15·5 (0·1) for externalising scores. After adjustment for confounding variables (age, socioeconomic status, maternal and child characteristics, maternal employment, and maternal psychiatric problems), the largest increase from 1993 to 2004 was for the aggressive behaviour syndrome score (Cohen's d 0·50), followed by the externalising problem score (Cohen's d 0·40), and total score (Cohen's d 0·36). The increase was greatest for children from poorer families and those with less-educated mothers. Interpretation Pre-school behavioural disorders have increased among children in Brazil up to 2004. Because of the potential long-term effects of childhood psychological disdorders, early identification of such problems should be a priority for mental health services. Funding Wellcome Trust, CNPq.

We have measured 43 transitions in the pure rotational and fundamental vibrational spectra of 18 OH + . These data, together with all ground state transitions and combination differences of OH + and 16 OH + available from the literature, have been fit to an explicity internuclear distance dependent rovibrational Hamiltonian to yield several descriptions of the OH + potential function. Significant adiabatic and rotationally and vibrationally nonadiabatic corrections are required to fit all 407 isotopomeric transitions simultaneously. Similar fits are also performed on the closed shell species ArH + , yielding an approximate vibrational correction to the recently determined experimental permanent dipole moment of that ion.

This report describes a computer system that generates reconstructions of film autoradiographs of the cerebral cortex. The reconstructions preserve 4 dimensions of the data including the (1) rostro-caudal and (2) medio-lateral cortical dimensions, (3) cortical thickness and (4) optical density value. This system is especially useful as it removes the subjectivity in analyzing the autoradiographs and provides a method for objectively reconstructing large amounts of data.

A system was constructed to allow direct visualization of the coronary microcirculation of a beating rat heart under a microscope. An electrocardiogram (EKG) triggered strobe is used on the video recording and display system to "stop" the action of the beating heart so the surface microvessels can be directly observed. Experimental results are recorded on videotape and played back for frame-by-frame analysis of the data using digital image extraction, image enhancement and edge detection. The digital image processing techniques are designed for multi-purpose applications using recorded video images.