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Background: Depression is frequently seen among pregnant women. This is called antenatal depression (AND). Aim: Our aim was to identify clusters of AND and its core symptoms. Methods: The Patient Health Questionnaire-9 (PHQ-9), Pregnancy-Unique Quantification of Emesis and Nausea (PUQE-24), and Nausea and Vomiting of Pregnancy Quality of Life Questionnaire (NVP-QOL) were distributed to 382 pregnant women with a gestational age of 10 to 13 weeks who were attending antenatal clinics. The two PHQ-9 subscale scores were entered into a 2-step cluster analysis. The PHQ-9 items’ capacity to identify AND were examined in terms of the area under curve (AUC) of a receiver operating characteristic (ROC) analysis. The selected symptom items were examined for their diagnostic capability in terms of the graded response model (GRM) in the item response theory (IRT) analysis. Results: Three clusters emerged. Cluster 3 scored highly in the scores of the two PHQ-9 subscales and the two emesis scales. In the ROC, five items showed an AUC > 0.80. The GRM identified four items with high information: ‘loss of interest’, ‘depressed mood’, ‘self-esteem’, and ‘poor concentration’. Conclusions: The core symptoms of antenatal depression were four non-somatic symptoms; particularly, ‘depressed mood’ and ‘loss of interest’. AND did not exist alone, but was accompanied by nausea and vomiting. Hence, we propose a new category: emesis–depression complex among pregnant women.

Insomnia is associated with adverse outcomes in women in the perinatal period; thus, the assessment of insomnia is important for pregnant women. The Insomnia Severity Index (ISI) is an instrument used globally to assess the severity of insomnia. However, its factor structure and structural invariance for pregnant women have not been studied. Therefore, we aimed to conduct factor analyses to search for the best model to fit its structural invariance. A cross-sectional study with the ISI was conducted at one hospital and five clinics in Japan from January 2017 to May 2019. A set of questionnaires was administered on two occasions with a one-week interval. The study included 382 pregnant women ranging in gestational age from 10 to 13 weeks. One week later, 129 participants answered the retest. After exploratory and confirmatory factor analyses, the measurement and structural invariance between parity and two time points was tested. The two-factor structure model showed an acceptable fit for the ISI in pregnant women (χ2 (12) = 28.516, CFI = 0.971, RMSEA = 0.089). The model also showed satisfactory measurement and structure invariance between parity and time points. The findings indicate that the ISI’s use would be appropriate for pregnant women as a two-factor subscale of “severity” and “impact”, regardless of the parity or time point. The ISI’s factor structure may vary by subject; hence, it is necessary to confirm the measurement and structural invariance of the subject for whom the ISI will be used. Furthermore, interventions that focus not only on total scores and cutoff points but also on the phenomenon of subscales should be considered.

Background Despite the research and clinical significance of the Postpartum Bonding Questionnaire (PBQ), its psychometric properties have not been studied intensively. The goodness-of-fit of proposed factor models of the PBQ is poor. Configural and measurement invariance have never been reported. Methods As a secondary analysis of the previous paper ( Ohashi et al., 2016a , Ohashi et al., 2016b ), we analysed the PBQ data at 5 days and 1 month after childbirth among 247 mothers of a singleton. We created 9 parcels of PBQ items to perform confirmatory factor analysis (CFA). We also examined configural and measurement invariances of the PBQ factor structure between the two observation times. Results The CFI of the 3-factor model of the PBQ was .936 and .968 for 5 days and 1 month after childbirth, respectively. Configural, measurement (metric, scalar, and residual), and structural (factor variance and factor covariance) invariances were accepted. The mean of only ‘anger and restrictedness’ factor was scored higher at 1 month than 5 days after childbirth. Conclusion The 3-factor model of the PBQ was good in its fit with the data as well as robust in its measurement between the two observation time periods.

Background: Depression is frequently seen among pregnant women. The PHQ-9 is a diagnostic criteria-based screening instrument. Objective: The objective is to identify the factor structure of the Patient Health Questionnaire-9 (PHQ-9) and to confirm its measurement and structural invariance regarding parity and observation time, as well as to examine reliability by calculating omega indices in a population of pregnant Japanese women. Methods: The PHQ-9 was distributed to 382 pregnant women with a gestational age of 10 to 13 weeks who were attending antenatal clinics. Of these women, 129 were tested again with the PHQ-9 one week later. Results: Exploratory factor analyses (EFAs) of the PHQ-9 items were conducted using a halved sample. Confirmatory factor analyses (CFAs) among the other halved sample compared the single-, two-factor models derived from the EFAs, literature model and bifactor model. The bifactor model was significantly better in terms of goodness-of-fit indices: χ2/df = 1.030 (18), CFI = 0.999, RMSEA = 0.012. ECV suggested multidimensionality. Internal consistency was excellent: ω = 0.868, ω. Somatic factor = 0.756, ω. Non-somatic factor = 0.817. ωH = 0.795, ωHS. Somatic factor = 0.330, ωHS. Non-somatic factor = 0.032. The bifactor structure model showed configural, measurement, and structural invariances between primiparas and multiparas as well as at two observation occasions. Conclusion: The findings suggested that the PHQ-9 used among pregnant women was robust in its factor structure.

The Infant Behavior Questionnaire-Revised (IBQ-R) assesses the temperament of infants in Western and non-Western countries. Although its factor analyses revealed three factors—surgency, negative affectivity, and effortful control—in the Western culture, the degree to which these are universal or culturally specific is unclear. This study developed a Vietnamese version of the IBQ-Revised Very Short Form (R-VSF) and examined its factor structure in a Vietnamese population. The Vietnamese IBQ-R VSF was administered to 292 mothers of infants between the ages of 3 and 18 months in Nha Trang city, Vietnam, between July and September 2019. After deleting items to achieve sufficient Cronbach’s alphas for each scale (surgency, negative affectivity, and orienting/regulation), the remaining 28 items were aggregated to parcels subjected to exploratory factor analyses (EFAs). EFAs revealed a 3-factor model corresponding to the original theory, and confirmatory factor analyses indicated a good fit of this structural model. The final 3-factor model with parcels indicated measurement and structural invariance between mothers of boys and girls.

Intense fear of childbirth by expectant women is called tokophobia. Because there are no qualitative studies targeting women with an intense fear of childbirth in Japan, it is unknown whether there is any link between the type of fear of objects/situations among tokophobic women and their psychological/demographic background. Furthermore, there is no available summary of the lived experience of Japanese women with tokophobia. This study aims to identify the intensity patterns of various types of fear among the participants and summarize the lived experience of having intense fear of childbirth. A qualitative descriptive study was conducted using a semi-structured interview. Pregnant women with an intense fear of childbirth participated in individual interviews facilitated by a psychiatrist and a midwife. Audio recordings of the interviews were transcribed and analyzed using a content analysis approach. The number of participants was ten. The types of feared objects varied individually and these were categorized as being related to either prospective or retrospective fear. The participants’ experiences were grouped into three categories: difficulty in daily life, preoccupied negative expectation towards childbirth, and psychological adaptation to the upcoming childbirth. The results imply that women with tokophobia continuously suffer from fear in their daily life; hence, a special approach is needed to detect and reduce their fear.

Little is known about the causality of antenatal depression (AND). We focused on the causal relationships between AND, fear of childbirth (FOC), and obsessive-compulsive symptoms (OCS) during the COVID-19 pandemic in Japan. We also examined whether the perceived threat of COVID-19 is associated with AND. Participants were recruited for an Internet survey conducted in December 2020. A total of 245 pregnant women completed the online survey at 12 to 15 weeks’ gestational age (Time 1) and approximately 10 weeks later (Time 2). AND was estimated using the first two diagnostic items of Major Depressive Episode. The estimated prevalence of AND was 4.5% and 2.9% at Time 1 and Time 2, respectively. At both time points, no association was found between AND and the perception of COVID-19 threat. Structural equation modeling showed that AND predicted OCS (β = 0.16, p < 0.001), which, in turn, predicted FOC (β = 0.09, p = 0.042); FOC, in turn, predicted AND (β = 0.23, p < 0.001). AND, OCS, and FOC were predicted by borderline personality traits. Insecure adult attachment influenced AND and FOC via the perceived negative impact of the current pregnancy. Perinatal care providers should assess the personality and perception of pregnancy to prevent depression and pay attention to symptoms such as FOC and OCS in addition to those of depression.

Background: Many pregnant women experience impairments in social, occupational, or other important functioning. Aim: This study aimed to confirm measurement and structural invariance of the Sheehan Disability Scale (SDS) and its validity during early pregnancy. Design: Longitudinal study with two observations. Methods: Questionnaires were distributed to pregnant women attending antenatal clinics at gestational weeks 10–13. Of 382 respondents, 129 responded to the SDS again 1 week later. Results: Confirmatory factor analysis shows good fit with the data: χ2/df = 0, comparative fit index (CFI) = 1.000, standardized root mean square residual (SRMR) = 0, and root mean square error of approximation (RMSEA) = 0.718. There is acceptable configural, measurement, and structural invariance of the factor structure between primiparas and multiparas as well as between two observation occasions. The Pregnancy–Unique Quantification of Emesis and Nausea, Patient Health Questionnaire-9, and Insomnia Severity Index subscales explain 47% of the variance in SDS scores. Conclusion: Perinatal health care professionals should pay more attention to the difficulties and disabilities that pregnant women face.

Background: The severity of nausea and vomiting of pregnancy (NVP) correlates with pregnancy complications. This study aimed to confirm the measurement and structural invariance of the 24 h Pregnancy-Unique Quantification of Emesis and Nausea (PUQE-24) regarding parity and observation time among pregnant women during the first trimester. Methods: Questionnaires including the PUQE-24 and the Health-Related Quality of Life for Nausea and Vomiting during Pregnancy (NVP-QOL) questionnaire were distributed to pregnant women from 10 to 13 weeks of gestation who were attending antenatal clinics. There were 382 respondents, and of these, 129 responded to the PUQE-24 again one week later. Results: Confirmatory factor analysis of this single factor model showed a good fit with the data: CFI = 1.000. The PUQE-24 factor and NVP-QOL factor were strongly correlated (r = 82). Configural, measurement, and structural invariance of the factor structure of the PUQE items were confirmed between primiparas and multiparas as well as at the test and retest observation occasions. Conclusion: The findings suggested that using the PUQE-24 among pregnant women in the first trimester was robust in its factor structure. The PUQE-24 may be a promising tool as an easy and robust measure of the severity of nausea and vomiting among pregnant women.

Background The Japanese version of the mother-to-infant bonding scale (MIBS-J), a self-report of postnatal bonding disorder, is widely used in Japan. However, its psychometric properties, particularly measurement invariance, have rarely been reported, and the appropriateness of the use of the MIBS-J among perinatal fathers remains to be investigated. This study aimed to select and to validate MIBS-J items suitable for mothers and fathers at three time points (postpartum hospitalization period and 1 and 4 months postpartum) commonly used in clinical practice in Japan. Methods Postpartum mothers (n = 543) and fathers (n = 350) were surveyed at 5 days, 1 month, and 4 months postpartum. All participants were randomly divided into two subgroups, one for exploratory factor analyses (EFAs) and another for confirmatory factor analyses. Measurement invariance of the best model was tested using the entire sample, between fathers and mothers, and across the three observation periods. Results A three-item structure (items 1, 6, and 8) extracted through EFAs showed acceptable configural invariance. This model was accepted for scalar invariance between fathers and mothers and for metric invariance across the three time points. Conclusions This study showed that the three-item MIBS-J could be used reliably among Japanese parents in the first four postpartum months. Currently, all 10 MIBS-J items are used in clinical and research settings at various time points during the perinatal period. Our findings suggest that the MIBS-J with only three items is sufficient for diagnosis of postnatal bonding disorder, at least during the first four postpartum months.

Based on the facts that child abuse rarely exists in isolation from one or more of the other child abuse subcategories, a depressive affect at some particular point includes both reactively provoked one and persistent one, and depressive affect and borderline personality organization are inseparable, this study explored the influence of each child abuse subcategory on later development of borderline personality organization, as well as on persistent depressive affect, examining whether the causality between some particular child abuse subcategory and depression is direct or indirect, i.e. mediated by borderline personality pathology. Three hundred four Japanese university students were the target for analysis. Questionnaire surveys were conducted over a six-week period on three occasions. Structural equation modeling was used for the statistical analysis. Self-Rating Depressive Scale (SDS), Inventory of Personality Organization (IPO), and Child Abuse and Trauma Scale (CATS) were used for assessing depressive affects, borderline personality organization, and past experience of child abuse, respectively. “Neglect and Emotional Abuse” had a deteriorating effect on children’s later mental health. “Sexual Abuse” and “Authoritarianism” had indirect influence via borderline personality organization. Although “Physical Punishment and Scolding” and “Marital Disharmony” per se did not have a significant negative impact on later mental health, it should be noted that they are frequently accompanied by “Neglect and Emotional Abuse.”

Background: Whereas the majority of studies on temperament are variable-centered, temperament structure has rarely been challenged from a person-centered perspective (i.e., typology of temperament). The purpose of our study is to identify temperamental typology of Japanese toddlers using the EASI survey and a two-step cluster analysis. Methods: Net-survey collected data from 531 mothers and 369 fathers of a 3- or 4-year-old child in Japan. They were distributed the EASI with 4 subscales (Emotionality (E), Activity (A), Sociability (S), and Impulsivity (I)) and the Child Behavior Checklist (CBCL). Results: A two-step cluster analysis yielded 4 clusters: The first cluster (n = 288) was characterized the highest S and mildly high A and I, and thus interpreted as Average-Active. The second cluster (n = 179) was low in E, A, and I, but mildly high in S, and thus interpreted as Regulated. The third cluster (n = 288) was almost the same level in I and E as the first cluster, but mildly low in A and S, and thus interpreted as Average-Quiet. The fourth cluster (n = 145) was high in E, A, and I, but low in S, and thus interpreted as Sensitive/Hyperreactive. Regulated children scored the lowest in internalizing and externalizing behaviors on the CBCL subscales whereas Sensitive/Hyperreactive children scored the highest on these subscales. Conclusion: We identified four typologies of children’s temperament patterns interpretable as Average-Active, Regulated, Average-Quiet, and Sensitive/Hyper-reactive.

Background:The Edinburgh Postnatal Depression Scale (EPDS; Cox, Holden & Sagovsky, 1987) has been widely used as a screening instrument. It is also used as a measure of Postnatal Depression (PND) severity. Various EPDS factor structure models have been proposed in many studies without an unequivocal conclusion. We compared first-order, higher-order factor, and bifactor models of the EPDS, and examined possible predictors of subscales by Structural Equation Modelling (SEM).Methods:Data came from a follow-up study of 758 women after childbirth on two occasions (five days and one month postnatal). We used the EPDS together with items tapping Negative Life Events (NLEs) and coping styles and behaviours.Results:The bifactor model showed the best fit with data compared with all other models: CFI = 0.999, RMSEA = 0.14, and AIC = 79.637. A single general dimension alongside three distinct subfactors (anhedonia, anxiety, and dysphoria) was predicted differentially by various predictor variables.Conclusion:Our study expanded on a previous factor structural study of the EPDS and developed the hierarchical (bifactor) model. The model’s construct validity was confirmed by its meaningful associations with NLEs and coping styles and behaviours.

Background The severity of nausea and vomiting of pregnancy (NVP) correlates with pregnancy complications. This study aimed to confirm the measurement and structural invariance of the 24-hour Pregnancy-Unique Quantification of Emesis and Nausea (PUQE-24) regarding parity and observation time among pregnant women during the first trimester. Methods Questionnaires including the PUQE-24 and the Health-Related Quality of Life for Nausea and Vomiting during Pregnancy (NVP-QOL) questionnaire were distributed to pregnant women from 10 to 13 weeks of gestation who were attending antenatal clinics. There were 383 respondents, and of these, 130 responded to the PUQE-24 again one week later. Results Confirmatory factor analysis of this single factor model showed good fit with the data: CFI = 1.000. The PUQE-24 factor and NVP-QOL factor were strongly correlated (r = 82). Configural, measurement, and structural invariance of the factor structure of the PUQE items were confirmed between primiparas and multiparas as well as at the test and retest observation occasions. Conclusion The findings suggested that using the PUQE-24 among pregnant women in the first trimester was robust in its factor structure. The PUQE-24 may be a promising tool as an easy and robust measure of the severity of nausea and vomiting among pregnant women.

The Caesarean section rate in urban Vietnam is 43% in 2014, which is more than twice the recommended rate (10%&ndash, 15%) by the World Health Organization. This qualitative study aims to identify the perceptions of pregnant mothers and health care professionals on the medical and social factors related to the increased Caesarean section rate in Vietnam. A qualitative descriptive study was conducted among pregnant mothers and healthcare professionals at two public hospitals in Nha Trang city. A content analysis was adopted in order to identify social and medical factors. As a result, 29 pregnant women and 19 health care professionals were invited to participate in the qualitative interviews. Private interviews were conducted with 10 women who wished to have a Caesarean section, and the others participated in focus group interviews. The main themes of the social factors were &lsquo, request for Caesarean section,&rsquo, &lsquo, mental strain of obstetricians,&rsquo, and &lsquo, decision-making process.&rsquo, To conclude, this qualitative study suggests that there were unnecessary caesarean sections without a clear medical indication, which were requested by women and family members. Psychological fear occurred among women and family, and doctors were the main determinants for driving the requests for Caesarean section, which implies that education and emotional encouragement is necessary by midwives. In addition, a multi-faced approach including a mandatory reporting system in clinical fields and involving family members in antenatal education is important.

A lack of social support for pregnant women is associated with depression after childbirth. However, few studies have examined the impact of the partners’ understanding of and support for the women’s aspirations (personal goals in life) on the severity of depression after childbirth. To examine the relationship between a partner’s attitude to his wife’s aspirations and depression after childbirth, a longitudinal study was conducted of 290 primipara women from five university hospitals between October 1997 and March 2000. Three questionnaires were administered to participant women. During their third trimester, they were asked about their aspirations (Aspiration Index) and their perception of their partners’ understanding of and support for their aspirations. At one month and three months after childbirth, they were asked about the severity of their depression (Edinburgh Postnatal Depression Scale). Correlation analyses and structural equation modelling showed that the partners’ poor understanding and support predicted the severity of depression after childbirth. Perinatal health professionals should be encouraged to assess the pregnant women’s aspirations and their partners’ understanding and support regarding the women’s goals in life.

Background:Despite its clinical and public policy-making importance, neonatal abuse has been only minimally studied.Purpose:To identify predictors of mothers’ emotional abuse towards their infants at 1 month after childbirth.Methods:We studied a cohort of 252 women at three time points: late pregnancy and 5 days and 1 month after childbirth. At each time point, the women were administered a set of questionnaires about their depression (Edinburgh Postnatal Depression Scale), bonding towards the foetus or neonate (Maternal Antenatal Attachment Scale and Postnatal Bonding Questionnaire, respectively), and, at 1 month after childbirth, emotional abuse (Conflict Tactic Scale).Results:Structural equation modeling (SEM) analysis revealed that neonatal emotional abuse was predicted by bonding difficulties at 5 days after childbirth but not by depression at that time point.Conclusion:Assessment for maternal bonding problems in the early post-natal period should be routinely performed by perinatal health professionals.

Aim The aim of this study was to identify women with thoughts of self-harm preceded by suicidal ideation, during the perinatal period, on cluster analysis and to clarify their psychological correlates. Methods A secondary analysis was conducted using the data from a longitudinal study involving 18 obstetric clinics between 2011 and 2012 in Kumamoto Prefecture (Japan). Self-administered questionnaires including demographic data, Edinburgh Postnatal Depression Scale, Temperament and Character Inventory, and the Postnatal Bonding Questionnaire were distributed during the third trimester of pregnancy (wave 1), at 5 days (wave 2), and 1 month postpartum (wave 3). Results On cluster analysis using the data of participants who answered all observational points, the participants were divided into two groups: cluster 1, normal (n = 201); and cluster 2, thoughts of self-harm (n = 42). Low self-directedness, low cooperativeness, higher anxiety, depression, and lack of affection and anger and rejection towards the baby were associated with cluster 2. Conclusions The finding that low self-directedness and low cooperativeness were related to the cluster 2 group suggests that immature personality traits may work as a predisposing factor mediating between anxiety, depression and thoughts of self-harm.

The presently reported patient was a 37-year-old married primipara with peripartum depression comorbid with bonding disorder. Care anxiety and a lack of affection towards her baby first appeared at around the time of delivery, and the patient developed major depression at one month after the birth of her healthy baby. At first, standard treatment for major depression including the use of antidepressants, electroconvulsive therapy, and supportive psychotherapy were provided. However, bonding problems appeared to impede and obstruct the amelioration of depression. Although treatment methods for bonding disorder have not yet been established, Kangaroo Care was introduced to facilitate skin-to-skin contact. We also educated her in better parenting behavior and provided repeated motivational interviews with her family because a lack of partner and social support and personal temperament (low self-directedness and cooperativeness) were thought to be related to her bonding disorder. This case suggests the effectiveness of Kangaroo Care, which promotes a humanizing maturation of both baby and parent alike, for mothers with postpartum depression and comorbid severe bonding disorder.

An interleaved boost chopper is used between the battery module and the traction inverter in electric vehicles including fuel cell vehicles and hybrid electric vehicles as one of the applications. However, this circuit requires the increased number of components such as inductors and switching devices in comparison with a general chopper. This paper proposes a new type of magnetically-loosely-coupled inductor for a four-phase interleaved boost chopper and compares the characteristics between the proposed and non-coupled inductors used in the chopper. As a result in the experiment, it is shown that the magnitude of the current ripple in the proposed inductor is 74~83 % smaller than that of the non-coupled inductor. In addition, the power conversion efficiency of the chopper using the proposed inductor is higher than that using the non-coupled inductor in a case where the inductor current flows continuously.

Background Accuracy of temperament assessment is a prerequisite in research studies. To identify the extent to which parental assessment of child temperament is biased by their personal attributes, we proposed a new structural equation model, in which biases of parental attributes in their assessment of child temperament can be separated from the true (i.e. non-biased) associations between the two. Methods We examined 234 father–mother pairs using questionnaires including Emotionality, Activity, Sociability, and Impulsivity; Social Desirability Scale; Hospital Anxiety and Depression Scale; Temperament and Character Inventory; and State–Trait Anger Expression Inventory. Results Paternal Depression and Persistence, maternal Trait Anger, and parental Novelty Seeking showed significant bias in assessment of Emotionality. Maternal Self-transcendence showed significant bias in assessment of child Impulsivity. Conclusion Researchers should be cautious about biases in parental assessment of children's Emotionality and Impulsivity, but other temperament traits may be free from such biases.

Objectives: The present study was aimed at constructing the Japanese version of the Brief Illness Perception Questionnaire for breast cancer (Brief IPQ-JBC), for use with Japanese middleand early old-aged women who had not previously undergone mammography. We also examined the psychometric properties of the translated instrument. Methods: Patients were 824 middleand early old-aged women living in all parts of Japan, who Original Research Article Adachi et al.; BJMMR, 5(12): 1491-1501, 2015; Article no.BJMMR.2015.169 1492 completed surveys on the Internet in January 2014. Of these, 282 had not previously undergone mammography and were included in this study, completing the Internet survey again, six months later, in July 2014.The participants were evaluated on the basis of a battery of questionnaires comprising demographic details, the tentative version of the Brief IPQ-JBC, the Japanese version of the Illness Perception Questionnaire (J-IPQ), Self-Directedness subscale from the Japanese version of the Temperament and Character Inventory-125 items, perceived breast cancer risk, and anticipated worry about breast cancer. Results: The Brief IPQ-JBC was found to have good long-term test-retest reliability, as well as concurrent validity with the J-IPQ. The scale also showed good construct validity, based on the results of a path model using structural equation modeling, thus supporting the theoretical perspective of the common-sense model of self-regulation. Conclusion: We have validated the Brief-JBC in a sample of Japanese middleand earlyold-aged women and believe our results will be useful for subsequent research.

Perinatal depression is prevalent worldwide. However, there are few available studies that discuss the different cultural factors affecting perinatal depression within Asian countries. This study aims to compare the literature regarding related factors relating to perinatal depression in India and Japan, and to synthesize the evidence common to both countries in addition to the country-specific evidence. We conducted a systematic review using several databases (CINAHL, MEDLINE, Pubmed, Ovid, SCOPUS, IndMED, and ICHUSI). Keywords were "antenatal depression" or "postpartum depression", and "India" or "Japan". Both Japanese and English language papers were reviewed. The identified evidence was compared between the two countries, as well as with non-Asian countries based on previous reports. In total, 15 articles on India and 35 on Japan were reviewed. Although several factors were shared between the two countries as well as with other non-Asian countries (vulnerable personality, being abused, age, marital conflict, and lower socio-demographic status), some differing factors were identified between India and Japan and non-Asian countries; India: poor socioeconomic status, living only with the husband, pregnancy not welcomed by the husband, a female baby, and poor relationship with in-laws; Japan: infertility treatment, conflict with work-life balance, poor relationships with biological mother or in-laws, and concerns about social relations with the other mother's friends. To conclude, involving the family and community may be important for implementing both global standardized and culture-specific interventions. In India, treatment involving the in-laws may be effective because large family structure is a significant predictor of perinatal depression. In Japan, a family/community approach involving not only the mother's family of origin but also the working environment is essential.

Aims and objective: The aim of this study was to determine whether the training would influence the psychological mindedness of nurses and midwives. In addition, we explored the relationship of the change of psychological mindedness before and after the training and the correlation with their personality traits. Background: It is important for perinatal health professionals such as nurses and midwives to acquire intervention skills such as psychotherapy and counselling techniques. We think that one of the essential requisites is psychological mindedness. Method: A total of 45 perinatal health professionals who participated in the postpartum depression prevention programme were distributed a set of questionnaires including the Psychological Mindedness Scale (PMS) and Temperament and Character Inventory (TCI) at the beginning and end of the training. Results: The PMS scores increased significantly after the training. A structured equation modelling suggested that PMS and self-directedness predicted each other whereas PMS predicted low harm avoidance. Conclusion: These findings indicate that the psychological mindedness of nurses and midwives could be advanced by a course of training and that this could be supported by high self-directedness. The harm avoidance trait may be reduced by increased psychological mindedness. Relevance to clinical practice: Nurses and nursing students are apt to psychological skill training in the advancement of psychological mindedness.

Background Difficulty of maternal bonding towards a baby is widely recognised. It is unclear whether this phenomenon is dimensional or categorical. If categorical, an optimal cut-off score of a screening instrument is needed in clinical settings. Aims In this study, we investigated whether maternal bonding is dimensional or categorical phenomenon and try to set optimal cut-off score of screening instruments. Methods Self-report questionnaire studies were conducted in a general hospital and four antenatal clinics. Two-step cluster analysis was conducted for the Mother-to-Infant Bonding Scale (MIBS) subscale scores in 723 mothers of neonates. ROC curves and optimal cut-off points of the MIBS scores were calculated based on cluster-analysis derived groups. Results A 2-cluster structure appeared: “normal” ( n = 619) vs. “pathological maternal bonding” ( n = 104). Mothers of the latter category scored significantly higher in terms of postnatal depression and neonatal abuse than those of the former category. AUC of the ROC curve by the total MIBS scores both 5 days and 1 month after childbirth were > 0.9. The optimal cut off scores were 3/4 at 5 days, and 4/5 at 1 month, after childbirth. Conclusions There was a group of mothers with high MIBS scores discretely different from those with low MIBS scores. MIBS may be a useful tool to identify mothers with a severe bonding disorder that needs clinical intervention.