Search

Background: Experiences of early life adversity pose significant psychological and physical health risks to exposed individuals. Emerging evidence suggests that these health risks can be transmitted across generations; however, the mechanisms underlying the intergenerational impacts of maternal early-life trauma on child health remain unknown., Methods: The current study used a prospective longitudinal design to determine the unique and joint contributions of maternal childhood trauma (neglect and abuse) and maternal prenatal and postnatal mental health (anxiety and depressive symptoms) (N = 541) to children's resting frontoamygdala functional connectivity at 6 years (N = 89) and emotional health at 7-8 years, as indexed by parent-reported internalizing problems and child self-reported anxiety and depressive symptoms (N = 268-418)., Results: Greater maternal childhood neglect was indirectly associated with greater internalizing problems serially through a pathway of worse maternal prenatal and postnatal mental health (greater maternal anxiety and depressive symptoms). Worse maternal postnatal mental health was also uniquely associated with more negative child frontoamygdala resting-state functional connectivity, over and above maternal childhood trauma (both neglect and abuse) and prenatal mental health. More negative frontoamygdala functional connectivity was, in turn, associated with poorer child emotional health outcomes., Conclusions: Findings from the current study provide support for the existence of intergenerational influences of parental exposure to childhood trauma on childhood risk for psychopathology in the next generation and point to the importance of maternal factors proximal to the second generation (maternal prenatal and postnatal mental health) in determining the intergenerational impact of maternal early experiences., (© 2022 Association for Child and Adolescent Mental Health.)

Perinatal maternal symptoms of depression and anxiety compromise psychosocial function and influence developmental outcomes in the offspring. The onset of symptoms remains unclear with findings that suggest a preconceptual origin. We addressed this issue with a prospective analysis of anxiety and depressive symptom profiles from preconception through to parturition. Women were recruited into a preconception study to assess (a) variation in symptom levels of depression and anxiety from pre- to post-conception and (b) if the symptom network profiles of depression and anxiety change from pre-conception to post-conception. A within-subject intraclass correlation analyses revealed that symptoms of depression or anxiety in the preconception phase strongly predicted those across pregnancy and into the early postnatal period. The symptom network analysis revealed that the symptom profiles remained largely unchanged from preconception into the second trimester. Our findings suggest that for a significant portion of women, maternal mental health remains stable from preconception into pregnancy. This finding highlights the need for early intervention studies on women's mental health to be targeted during the preconception period and to be extended across the population.

The quality of prenatal maternal mental health, from psychological stress and depressive symptoms to anxiety and other nonpsychotic mental disorders, profoundly affects fetal neurodevelopment. Despite the evidence for the influence of positive mental well-being on health, there is, to our knowledge, no research examining the possible effects of positive antenatal mental health on the development of the offspring. Using exploratory bifactor analysis, this prospective study (n = 1,066) demonstrated the feasibility of using common psychiatric screening tools to examine the effect of positive maternal mental health. Antenatal mental health was assessed during 26th week of pregnancy. The effects on offspring were assessed when the child was 12, 18, and 24 months old. Results showed that positive antenatal mental health was uniquely associated with the offspring's cognitive, language and parentally rated competences. This study shows that the effects of positive maternal mental health are likely to be specific and distinct from the sheer absence of symptoms of depression or anxiety.

Maternal depression and anxiety through pregnancy have lasting societal impacts. It is thus crucial to understand the trajectories of its progression from preconception to postnatal period, and the risk factors associated with it. Within the Bayesian framework, we propose to jointly model seven outcomes, of which two are physiological and five non-physiological indicators of maternal depression and anxiety over time. We model the former two by a Gaussian process and the latter by an autoregressive model, while imposing a multidimensional Dirichlet process prior on the subject-specific random effects to account for subject heterogeneity and induce clustering. The model allows for the inclusion of covariates through a regression term. Our findings reveal four distinct clusters of trajectories of the seven health outcomes, characterising women's mental health progression from before to after pregnancy. Importantly, our results caution against the loose use of hair corticosteroids as a biomarker, or even a causal factor, for pregnancy mental health progression. Additionally, the regression analysis reveals a range of preconception determinants and risk factors for depressive and anxiety symptoms during pregnancy. [ABSTRACT FROM AUTHOR]

Summary: Perinatal depression and anxiety are common and associated with sleep problems in the offspring. Depression and anxiety are commonly comorbid, yet often studied independently. Our study used an integrative measure of anxiety and depressive symptoms to examine the associations of maternal mental health (mid‐pregnancy and postnatal) with infant sleep during the first year of life. A total of 797 mother–child dyads from the 'Growing Up in Singapore Towards healthy Outcome' cohort study provided infant sleep data at 3, 6, 9 and 12 months of age, using the caregiver reported Brief Infant Sleep Questionnaire. Maternal mental health was assessed at 26–28 weeks gestation and 3 months postpartum using the Edinburgh Postnatal Depression Scale, Beck Depression Inventory and State–Trait Anxiety Inventory. Bifactor modelling with the individual questionnaire items produced a general affect factor score that provided an integrated measure of anxiety and depressive symptoms. Linear mixed models were used to model the sleep outcomes, with adjustment for maternal age, education, parity, ethnicity, sex of the child and maternal sleep quality concurrent with maternal mental health assessment. We found that poorer mid‐pregnancy, but not postpartum, maternal mental health was associated with longer wake after sleep onset duration across the first year of life (β = 49, 95% confidence interval 13–85 min). Poor maternal mental health during mid‐pregnancy is linked to longer period of night awakening in the offspring during infancy. Interventions that aim to improve maternal antenatal mental health should examine infant sleep outcomes. [ABSTRACT FROM AUTHOR]

Background: Distinguishing whether and how pre-existing characteristics impact maternal responses to adversity is difficult: Does prior well-being decrease the likelihood of encountering stressful experiences? Does it protect against adversity's negative effects? We examine whether the interaction between relatively uniformly experienced adversity (due to COVID-19 experience) and individual variation in pre-existing (i.e., pre-pandemic onset) distress predicted mothers' pandemic levels of distress and insensitive caregiving within a country reporting low COVID-19 death rates, and strict nationwide regulations. Method: Fifty-one Singaporean mothers and their preschool-aged children provided data across two waves. Pre- pandemic onset maternal distress (i.e., psychological distress, anxiety, and parenting stress) was captured via self-reports and maternal sensitivity was coded from videos. Measures were repeated after the pandemic's onset along with questionnaires concerning perceived COVID-19 adversity (e.g., COVID-19's impact upon stress caring for children, housework, job demands, etc.) and pandemic-related objective experiences (e.g., income, COVID-19 diagnoses, etc.). Regression analyses (SPSS v28) considered pre-pandemic onset maternal distress, COVID-19 stress, and their interaction upon post-pandemic onset maternal distress. Models were re-run with appropriate covariates (e.g., objective experience) when significant findings were observed. To rule out alternative models, follow up analyses (PROCESS Model) considered whether COVID-19 stress mediated pre- and post-pandemic onset associations. Models involving maternal sensitivity followed a similar data analytic plan. Results: Pre-pandemic maternal distress moderated the association between COVID-19 perceived stress and pandemic levels of maternal distress (β = 0.22, p < 0.01) but not pandemic assessed maternal sensitivity. Perceived COVID-19 stress significantly contributed to post-pandemic onset maternal distress for mothers with pre-pandemic onset distress scores above (β = 0.30, p = 0.05), but not below (β = 0.25, p = 0.24), the median. Objective COVID-19 adversity did not account for findings. Post-hoc analyses did not suggest mediation via COVID-19 stress from pre-pandemic to pandemic maternal distress. Conclusions: Pre-existing risk may interact with subsequent perceptions of adversity to impact well-being. In combination with existing research, this small study suggests prevention programs should focus upon managing concurrent mental health and may highlight the importance of enhanced screening and proactive coping programs for people entering high stress fields and/or phases of life. [ABSTRACT FROM AUTHOR]

Objective: Balint groups provide a safe space for clinicians to discuss difficult cases, with the aim of deepening the clinician-patient relationship and providing space for self-introspection and personal development. During this COVID-19 period, mental health clinicians need a platform to undergo professional supervision and peer learning sessions, which can be provided for by Tele-Balint sessions. This study aims to understand the workings of Balint groups in a multi-disciplinary team, through exploring the experience and perceptions of mental health clinicians in a tertiary obstetrics- and paediatrics-focused hospital in Singapore towards Tele-Balint groups, and examining if these groups can address their professional needs. Method: A mixed-methods study was conducted. 26 mental health clinicians who had participated in Tele-Balint groups since March 2020 completed a semi-structured questionnaire, and 12 of them were interviewed. Qualitative analysis of interview transcripts was performed. Results: Qualitative analysis revealed 5 themes. The first 4: professional and personal growth of clinicians, providing emotional support to clinicians, burnout in clinicians: what contributes and what helps, and psychological safety, address whether Tele-Balint groups meet clinicians' needs. The last theme, evolution of nature of Balint groups, addresses whether Tele-Balint groups meet clinicians' needs during the time of a pandemic. Conclusions: Tele-Balint group participation was found to be beneficial in facilitating personal and professional growth, providing emotional support and preventing burnout, despite some limitations. Members should maintain flexibility towards the Balint process, in order to accommodate others who have differing needs, especially in a multi-disciplinary group. [ABSTRACT FROM AUTHOR]

Attachment disorganization is a risk factor for difficulties in attention, social relationships, and mental health. Conceptually, attachment disorganization may indicate a breakdown in fear regulation resulting from repeated exposure to frightening maternal care. In addition, past research has examined the influence of stress-inducing contextual factors and/or child factors upon the development of disorganization. However, no past work has assessed whether infant neuroanatomy, important to stress regulation, moderates the association between maternal care and levels of disorganized behavior. Here, utilizing data from a subsample of 82 dyads taking part in the “Growing Up in Singapore towards Healthy Outcomes” (GUSTO) cohort, we assessed the prediction frommaternal sensitive caregiving at 6 mo and levels of attachment disorganization at 1.5 y, as moderated by hippocampal and amygdala volume determined within the first 2 weeks of life. Results indicate a significant interaction between neonatal left hippocampal volume and maternal sensitivity upon levels of disorganized behavior. Although these results require substantiation in further research, if replicated, they may enable new strategies for the identification of processes important to child mental health and points for intervention. This is because neonatal neuroanatomy, as opposed to genetic variation and sociodemographic risk, may be more directly linked to stress responses within individuals. [ABSTRACT FROM AUTHOR]

Background: Choline and betaine status have previously been associated with symptoms of depression. However, the relation of maternal plasma choline and betaine concentrations in pregnancy to peripartum maternal mood is unknown.Methods: Maternal plasma choline and betaine concentrations (μmol/L) were measured at 26-28 weeks gestation in the Growing Up in Singapore Toward healthy Outcomes (GUSTO) mother-offspring cohort. Participants completed the State-Trait Anxiety Inventory (STAI) and Edinburgh Postnatal Depression Scale (EDPS) at 26-28 weeks gestation (n = 949) and at 3 months postnatal (n = 689): higher scores are indicative of more symptoms of anxiety and depression. Multivariate linear regression models were used to estimate the association of choline and betaine with ante- and postnatal mental well-being adjusting for covariates.Results: Mean (SD) antenatal plasma choline and betaine concentrations were 9.2 μmol/L (1.6) and 13.1 μmol/L (2.7), respectively. Plasma choline concentrations were positively associated with antenatal depressive (β = .24 EPDS score [95% CI: 0.05-0.43] per μmol/L] and anxiety symptoms (β = .46 STAI-state score [95% CI: 0.03-0.88] per μmol/L) adjusting for covariates. Plasma betaine concentrations were not associated with antenatal depression or anxiety symptoms. No associations were observed between pregnancy choline or betaine and postnatal mental well-being.Conclusion: This study suggests that higher maternal plasma choline status during pregnancy is associated with more symptoms of antenatal depression and anxiety, whereas plasma betaine concentrations showed no associations. No associations were observed for postnatal mental well-being. Prospective studies are required to replicate these findings and further examine the direction of causality and possible biological mechanisms. [ABSTRACT FROM AUTHOR]

This study investigated the relationships between pre- and early post-natal maternal depression and their changes with frontal electroencephalogram (EEG) activity and functional connectivity in 6- and 18-month olds, as well as externalizing and internalizing behaviors in 24-month olds (n = 258). Neither prenatal nor postnatal maternal depressive symptoms independently predicted neither the frontal EEG activity nor functional connectivity in 6- and 18-month infants. However, increasing maternal depressive symptoms from the prenatal to postnatal period predicted greater right frontal activity and relative right frontal asymmetry amongst 6-month infants but these finding were not observed amongst 18-month infants after adjusted for post-conceptual age on the EEG visit day. Subsequently increasing maternal depressive symptoms from the prenatal to postnatal period predicted lower right frontal connectivity within 18-month infants but not among 6-month infants after controlling for post-conceptual age on the EEG visit day. These findings were observed in the full sample and the female sample but not in the male sample. Moreover, both prenatal and early postnatal maternal depressive symptoms independently predicted children’s externalizing and internalizing behaviors at 24 months of age. This suggests that the altered frontal functional connectivity in infants born to mothers whose depressive symptomatology increases in the early postnatal period compared to that during pregnancy may reflect a neural basis for the familial transmission of phenotypes associated with mood disorders, particularly in girls. [ABSTRACT FROM AUTHOR]

Background:Data arising from the Edinburgh Postnatal Depression Scale (EPDS), used as screening tool for perinatal depression, have been analysed as unidimensional in some studies and multidimensional in others. This study evaluates the dimensionality and item properties of the EPDS.Methods:920 women recruited in antenatal clinics from two government tertiary hospitals completed the English EPDS between 26 and 28 weeks of pregnancy. Classical test theory and factor analyses were used to evaluate dimensionality. Item response theory was used to investigate item functioning.Results:The EPDS was essentially unidimensional. It has a common factor, ‘antenatal dysphoria’ and 3 subdomains ‘depressive’ (items 7–10), ‘anxiety’ (items 3–5) and ‘anhedonic symptoms’ (items 1, 2). Item 8 (I have felt sad or miserable) (discrimination = 3.13. SE = 0.24), item 9 (I have been so unhappy that I have been crying) (discrimination = 2.39. SE = 0.17) and item 10 (The thought of harming myself has occurred to me) (discrimination = 2.27. SE = 0.21) best discriminated participants that had dysphoria. Item 1 (I have been able to laugh and see the funny side of things) (threshold 1 = 1.49, SE = 0.14), item 2 (I have looked forward with enjoyment to things) (threshold 1 = 1.21, SE = 0.11) and item 10 (The thought of harming myself has occurred to me) (threshold 1 = 1.19, SE = 0.21) indicated dysphoria severity.Conclusions:The EPDS measures antenatal dysphoria rather than just depression. It could be used to screen for antenatal depressive, anxiety and anhedonic symptoms. The items discriminate and grade dysphoria unequally. The findings may impact on scale use and interpretation. [ABSTRACT FROM PUBLISHER]

Objective: To compare responses to a mental health literacy survey by general practitioners in Singapore and Australia. Method: Cross-sectional surveys of general practitioners were undertaken in Australia in 1996 (n = 872) and in Singapore in 1999 (n = 264). Questionnaires provided vignettes of schizophrenia and depression, and sought responses to a range of information assessing mental health literacy. Results: The two groups returned generally similar responses, with high diagnostic accuracy and distinctly high agreement in judging the likely helpfulness of a range of resource people, activities and therapies. In addition to a few minor differences, the Singaporean practitioners tended to view outcome for the disorders more optimistically and to differentiate less in estimating outcome for the two disorders. Conclusions: Previous reports of the responses by the Australian general practitioners had generally shown their views to be consistent with mental health professionals and, on several important parameters, discordant with the views of the Australian general public. This report highlights distinct similarities in general practitioner responses across cultures. [ABSTRACT FROM AUTHOR]

Objective: The objectives of this study are, first, to replicate and extend an Australian approach to assessing mental health literacy by studying a sample of Singapore mental health professionals, and to focus on differences between judgements made by the psychiatrists in comparison with the other mental health professionals. Second, to compare the psychiatrists’ judgements with those of Australian psychiatrists. Method: The Australian questionnaire, assessing responses in relation to vignettes of major depression and to schizophrenia was extended by adding a third vignette of mania, and by the addition of several region-specific response options. Nearly 500 questionnaires were distributed to representative staff (psychiatrists, nurses and allied health) of a large psychiatric institution in Singapore, with a response rate of 81%. Psychiatrists’ judgements were compared with all other hospital staff, and with Australian psychiatrists’ judgements. Results: The two principal contrast groups (Singapore psychiatrists and other Singapore mental health professionals) differed slightly in terms of diagnostic accuracy. The psychiatrists differed in favouring a more professionally focused model of intervention, while both professional groups viewed traditional healers and their practices as distinctly unhelpful. Direct comparison of psychiatrist ratings generated in Singapore and in Australia revealed quite similar response profiles. Conclusions: In addition to generating data of some intrinsic importance, comparison with Australian survey data allows the potential impact of regional and cultural differences, as well as of varying psychiatric practices, to be identified. Responses identified more similarities than differences in the judgements of the psychiatrists from the two countries. [ABSTRACT FROM AUTHOR]

Background: Antenatal depression has been associated with poor maternal and fetal outcomes, and threatened miscarriage is often seen clinically to impact adversely on maternal wellbeing, notwithstanding the limited research evidence. Our study aims to examine the link between threatened miscarriage and antenatal depression and anxiety in an Asian obstetric population.Methods: We recruited 121 women and 68 partners facing threatened miscarriage, and 241 women and 180 partners experiencing uncomplicated pregnancies from a tertiary maternity hospital in Singapore. All participants completed a Patient Information Questionnaire and the Edinburgh Postnatal Depression Scale (EPDS).Results: The proportion of women with major depressive and anxiety symptomatology was significantly higher among women facing threatened miscarriage compared to those with stable pregnancies (depressive: 33.1% vs. 17.0%, p = 0.008; anxiety: 48.8% vs. 23.7%, p < 0.0001). Amongst their partners, there was a non-significant trend towards a similar finding (depressive: 10.3% vs. 7.2%, p = 0.439; anxiety: 23.5% vs. 18.9%, p = 0.478). Threatened miscarriage remained significantly associated with major depressive symptomatology after adjusting for potential confounders among women (OR 2.70; 95% CI 1.55, 4.71; p < 0.0001) but not among their partners (OR 1.47; 95% CI 0.56, 3.87; p = 0.430).Limitations: This study is limited by its cross-sectional design and relatively small sample size for male partners.Conclusion: Antenatal depressive and anxiety symptomatology affects one in four women in their first trimester, with even higher prevalence among women facing threatened miscarriage. Targeted depression and anxiety screening that includes women facing threatened miscarriages may facilitate early and efficient detection and management of mental health problems among pregnant women. [ABSTRACT FROM AUTHOR]

Poor sleep quality may elevate cortisol levels and affect prenatal mental health through altered HPA axis functioning. This study aims to examine whether subjective sleep quality during preconception moderates the association between preconception hair cortisol levels and mental health from preconception to pregnancy trimesters. Women from a prospective cohort study completed the Pittsburgh Sleep Quality Index (PSQI), the Edinburgh Postnatal Depression Scale (EPDS), and the State-Trait Anxiety Inventory (STAI) questionnaires during preconception (T0) and at each pregnancy trimesters (T1, T2, and T3). We analyzed 266 of these women who conceived and had fully completed measures at preconception for hair cortisol, sleep quality and either EPDS or STAI-state. Changes in EPDS and STAI-state scores were derived (i.e., T1–T0, T2–T0, T3–T0). Johnson-Neyman technique identified PSQI scores with significant moderation of cortisol on mental health. After adjusting for potential covariates, there was a significant positive correlation between preconception hair cortisol levels and depressive symptom at the second trimester (r s (144) = 0.22, p = 0.008), but not the first and third trimesters (all p s > 0.05). The positive association between preconception hair cortisol and change in depressive symptoms between third trimester and preconception was significant only among women with poor preconception sleep quality (PSQI ≥ 7). Sleep quality and prenatal mood were derived from self-reported questionnaires, which may be more susceptible to bias. The positive association between preconception hair cortisol and change in prenatal depressive symptoms is significant among women who reported poor sleep quality during preconception. Improving preconception sleep quality can potentially mitigate the association between preconception hair cortisol and depressive symptoms during pregnancy. • Preconception sleep quality moderates the association between preconception hair cortisol and change in depressive symptoms. • Prenatal anxiety, but not prenatal depressive symptoms vary among pregnant women. • Poor preconception sleep quality correlated with preconception and prenatal depressive and anxiety symptoms. [ABSTRACT FROM AUTHOR]

Background: Evidence suggests a relation between plasma tryptophan concentrations and sleep and mental well-being. As no studies have been performed in pregnant women, we studied the relation of plasma tryptophan concentrations during pregnancy with sleep quality, and mood during and after pregnancy.Methods: Pregnant women (n = 572) from the Growing Up in Singapore Towards healthy Outcomes study completed the Pittsburgh Sleep Quality Index (PSQI), the Edinburgh Postnatal Depression Scale (EPDS) and the State-Trait Anxiety Inventory (STAI) at 26-28 weeks gestation and three months post-delivery. Plasma tryptophan concentrations were measured at 26-28 weeks gestation. Poisson regressions estimated prevalence ratios (PR) for the association between tryptophan and poor sleep quality (PSQI global score > 5), probable antenatal depression (EPDS ≥ 15) and probable anxiety (STAI-state ≥ 41) were calculated adjusting for covariates.Results: Mean plasma tryptophan concentrations was 48.0µmol/L (SD: 8.09). Higher plasma tryptophan concentrations were associated with a lower prevalence of antenatal poor sleep quality adjusting for covariates [PR: 0.88 (95% CI 0.80, 0.97) per 10µmol/L], especially in those participants who also suffered from anxiety symptoms [PR: 0.80 (95% CI 0.67, 0.95)]. No associations were observed between tryptophan concentrations during pregnancy and postnatal sleep quality or mental well-being.Limitation: Subjective measures were used to assess sleep and mental well-being.Conclusions: We observed that higher plasma tryptophan concentrations were associated with a 12% lower prevalence of poor sleep quality during pregnancy, in particular among those with anxiety symptoms. These findings suggest the importance of having adequate tryptophan concentrations during pregnancy. [ABSTRACT FROM AUTHOR]