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Archives of Women's Mental Health

, Volume 16, Issue 5, pp 391–399 | Cite as

The mental health of mothers of unsettled infants: is there value in routine psychosocial assessment in this context?

  • Bettina Christl
  • Nicole Reilly
  • Michelle Smith
  • Deborah Sims
  • Fran Chavasse
  • Marie-Paule AustinEmail author
Original Article

Abstract

This study aims to investigate the (1) pattern of psychosocial risk factors among mothers of unsettled infants, (2) the relationship between these risk factors and current mental health status and (3) acceptability of psychosocial risk assessment in the parentcraft setting. Women with unsettled infants aged up to 12 months were assessed using the Edinburgh Postnatal Depression Scale, a diagnostic interview (Mini-International Neuropsychiatric Interview (MINI)) and a psychosocial assessment tool, the Postnatal Risk Questionnaire (PNRQ). Of the women, 27.5 % met the MINI diagnostic criteria for a current (predominantly) anxiety disorder, and 43.1 %, for a past psychiatric diagnosis. On the Edinburgh Postnatal Depression Scale, 29.9 % of women scored above 12 (mean 9.8; SD 5.1). The most common psychosocial risk factors were high trait anxiety (40.9 %), past mental health problems (40.7 %), perfectionistic traits (38.1 %) and ‘abuse trauma’ of any kind (31.6 %). The likelihood of meeting diagnostic criteria for a current mental illness was significantly increased for women who experienced emotional abuse during childhood (adj. odds ratio (OR) 3.386; p = 0.006), had high trait anxiety (adj. OR = 2.63, p = 0.003) or had a negative birth experience (adj. OR 2.78; p = 0.015). The majority of women (78 %) felt moderately to very comfortable completing the PNRQ. The results showed high rates of current anxiety disorders (almost twice that of the general postnatal population) and multiple significant psychosocial risk factors among mothers with unsettled infants. Identification of specific psychosocial risk factors in mothers of unsettled infants can help to address issues beyond infant settling difficulties such as mother–infant interaction, especially for mothers with unresolved issues around their own parenting or trauma history.

Keywords

Postnatal period Mental health Psychosocial risk assessment Parent craft Unsettled infants 

Notes

Acknowledgements

We gratefully acknowledge the Tresillian mothers and staff for supporting this study, the Research Fellowship funding from the NSW Institute of Psychiatry, the St John of God Health Care and Anne-Lyse De Guio and Catherine Fowler for facilitating the study at the Tresillian Family Centres.

Conflict of interest

There are no conflicts of interest, actual or potential, related to the submitted manuscript.

References

  1. Alcorn KL, O’Donovan A, Patrick JC, Creedy D, Devilly GJ (2010) A prospective longitudinal study of the prevalence of post-traumatic stress disorder resulting from childbirth events. Psychol Med 40(11):1849–1859PubMedCrossRefGoogle Scholar
  2. Armstrong KL, O’Donnell H, McCallum R, Dadds M (1998) Childhood sleep problems: association with prenatal factors and maternal distress/depression. J Paediatr Child Health 34(3):263–266PubMedCrossRefGoogle Scholar
  3. Austin MP, Colton J, Priest S, Reilly N, Hadzi-Pavlovic D (2011a) The antenatal risk questionnaire (ANRQ): acceptability and use for psychosocial risk assessment in the maternity setting. Women Birth 26(1):17–25PubMedCrossRefGoogle Scholar
  4. Austin M-P, Hadzi-Pavlovic D, Leader L, Saint K, Parker G (2005) Maternal trait anxiety, depression and life event stress in pregnancy: relationships with infant temperament. Early Human Dev 81(2):183–190CrossRefGoogle Scholar
  5. Austin MP, Highet N, the Guidelines Expert Advisory Committee (2011) Clinical practice guidelines for depression and related disorders—anxiety, bipolar disorder and puerperal psychosis—in the perinatal period. A guideline for primary care health professionals providing care in the perinatal period. Melbourne, beyondblue: the national depression initiativeGoogle Scholar
  6. Austin M-P, Priest SR (2005) Clinical issues in perinatal mental health: new develoments in the detection and treatment of perinatal mood and anxiety disorders. Acta Psychiatrica Scandinavica 112:97–104Google Scholar
  7. Buist A (1998) Childhood abuse, postpartum depression and parenting difficulties: a literature review of associations. Aust N Z J Psychiatry 32(3):370–378PubMedCrossRefGoogle Scholar
  8. Buist A, Condon J, Brooks J, Speelman C, Milgrom J, Hayes B, Ellwood D, Barnett B, Kowalenko N, Matthey S, Austin MP, Bilszta J (2006) Acceptability of routine screening for perinatal depression. J Affect Disord 93(1–3):233–237PubMedCrossRefGoogle Scholar
  9. Carroll JC, Reid AJ, Biringer A, Midmer D, Glazier RH, Wilson L, Permaul JA, Pugh P, Chalmers B, Seddon F, Stewart DE (2005) Effectiveness of the antenatal psychosocial health assessment (ALPHA) form in detecting psychosocial concerns: a randomized controlled trial. CMAJ 173(3):253–259PubMedGoogle Scholar
  10. Cox JL, Holden JM, Sagovsky R (1987) Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry 150(6):782–786PubMedCrossRefGoogle Scholar
  11. Fairbrother N, Woody SR (2007) Fear of childbirth and obstetrical events as predictors of postnatal symptoms of depression and post-traumatic stress disorder. J Psychosom Obstet Gynaecol 28(4):239–242PubMedCrossRefGoogle Scholar
  12. First MB, Spitzer RL, Gibbon M, Williams JBW (2002) Structured clinical interview for DSM-IV-TR axis I disorders, research version, patient edition (SCID-I/P). Biometrics Research, New York State Psychiatric Institute, New YorkGoogle Scholar
  13. Fisher J, Rowe H, Hammarberg K (2011a) Admission of women, with their infants, for psychological and psychiatric causes in Victoria, Australia. Aust N Z J Public Health 35(2):146–150PubMedCrossRefGoogle Scholar
  14. Fisher J, Rowe H, Hiscock H, Jordan B, Bayer J, Colahan A, Amery V (2011). Understanding and responding to unsettled infant behaviour: a discussion paper for the Australian Research Alliance for Children and Youth (ARACY)Google Scholar
  15. Fisher JRW, Feekery CJ, Rowe-Murray HJ (2002) Nature, severity and correlates of psychological distress in women admitted to a private mother–baby unit. J Paediatr Child Health 38(2):140–145PubMedCrossRefGoogle Scholar
  16. Fowler C, Lee A, Dunston R, Chiarella M, Rossiter C (2012) Co-producing parenting practice: learning how to do child and family health nursing differently. Aust J Child Fam Health Nurs 9(1):7Google Scholar
  17. Gavin NI, Gaynes BN, Lohr KN, Meltzer-Brody S, Gartlehner G, Swinson T (2005) Perinatal depression: a systematic review of prevalence and incidence. Obstet Gynecol 106(5 Pt 1):1071–1083PubMedCrossRefGoogle Scholar
  18. Gemmill AW, Leigh B, Ericksen J, Milgrom J (2006) A survey of the clinical acceptability of screening for postnatal depression in depressed and non-depressed women. BMC Publ Health 6:211CrossRefGoogle Scholar
  19. Gladstone GL, Parker GB (2005) The role of parenting in the development of psychopathology: an overview of research using the Parental Bonding Instrument. In: Hudson JL, Rapee RM (eds) Psychopathology and the family. Elsevier, Sydney, pp 21–33CrossRefGoogle Scholar
  20. Grant KA, Bautovich A, McMahon C, Reilly N, Leader L, Austin MP (2012) Parental care and control during childhood: associations with maternal perinatal mood disturbance and parenting stress. Arch Women’s Mental Health 15(4):297CrossRefGoogle Scholar
  21. Hosmer DW, Lemeshow S (2004) Model-building strategies and methods for logistic regression. Applied Logistic Regression. Wiley, Hoboken, pp 91–142Google Scholar
  22. IBM (2010). SPSS: statistical package of the social sciences. ChicagoGoogle Scholar
  23. Kessler RC, Üstün TB (2004) The World Mental Health (WMH) Survey Initiative version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). Intern J Methods Psychiatr Res 13(2):93–121CrossRefGoogle Scholar
  24. Lang AJ, Rodgers CS, Lebeck MM (2006) Associations between maternal childhood maltreatment and psychopathology and aggression during pregnancy and postpartum. Child Abuse & Neglect 30:17–25CrossRefGoogle Scholar
  25. Li Z, McNally L, Hilder L, Sullivan EA (2011). Australia’s mothers and babies 2009. Perinatal statistics series no. 25. Cat no: PER 52. AIHW National Perinatal Epidemiology and Statistics Unit, SydneyGoogle Scholar
  26. Matthey S (2008) Using the Edinburgh Postnatal Depression Scale to screen for anxiety disorders. Depress Anxiety 25(11):926–931PubMedCrossRefGoogle Scholar
  27. Matthey S, Barnett B, Howie P, Kavanagh DJ (2003) Diagnosing postpartum depression in mothers and fathers: whatever happened to anxiety? J Affect Disord 74(2):139–147PubMedCrossRefGoogle Scholar
  28. Matthey S, White T, Phillips J, Taouk R, Chee TT, Barnett B (2005) Acceptability of routine antenatal psychosocial assessments to women from English and non-English speaking backgrounds. Arch Women’s Mental Health 8(3):171–180CrossRefGoogle Scholar
  29. McMahon C, Barnett B, Kowalenko N, Tennant C, Don N (2001) Postnatal depression, anxiety and unsettled infant behaviour. Aust N Z J Psychiatry 35:581–588PubMedCrossRefGoogle Scholar
  30. Milgrom J, Gemmill AW, Bilszta JL, Hayes B, Barnett B, Brooks J, Ericksen J, Ellwood D, Buist A (2008) Antenatal risk factors for postnatal depression: a large prospective study. J Affect Disord 108(1–2):147–157PubMedCrossRefGoogle Scholar
  31. Mullen PE, Walton VA, Romans-Clarkson SE, Peter Herbison G (1988) Impact of physical and sexual abuse on women’s mental health. Lancet 331(8590):841–845CrossRefGoogle Scholar
  32. Murray L, Cooper PJ (1997) Effects of postnatal depression on infant development. Arch Dis Child 77(2):99–101PubMedCrossRefGoogle Scholar
  33. Parker G (1981) Parental reports of depressives. An investigation of several explanations. J Affect Disord 3:131–140PubMedCrossRefGoogle Scholar
  34. Phillips J, Charles M, Sharpe L, Matthey S (2009) Validation of the subscales of the Edinburgh Postnatal Depression Scale in a sample of women with unsettled infants. J Affect Disord 118(1–3):101–112PubMedCrossRefGoogle Scholar
  35. Phillips J, Sharpe L, Matthey S (2007) Rates of depressive and anxiety disorders in a residential mother-infant unit for unsettled infants. Aust N Z J Psychiatry 41(10):836–842, Erratum appears in Aust N Z J Psychiatry. 2009 Nov;43(11):1087PubMedCrossRefGoogle Scholar
  36. Phillips J, Sharpe L, Nemeth D (2010) Maternal psychopathology and outcomes of a residential mother-infant intervention for unsettled infant behaviour. Aust N Z J Psychiatry 44(3):280–289PubMedCrossRefGoogle Scholar
  37. Priest S, Austin MP, Barnett B, Buist A (2008) A psychosocial risk assessment model (PRAM) for use with pregnant and postpartum women in primary care settings. Arch Womens Mental Health 11(5–6):307–317CrossRefGoogle Scholar
  38. Priest SR (2010) Midwife led psychosocial risk assessment: a primary care model. LAP LAMBERT Academic, SaarbruckenGoogle Scholar
  39. Robertson E, Grace S, Wallington T, Stewart DE (2004) Antenatal risk factors for postpartum depression: a synthesis of recent literature. Gen Hosp Psychiatry 26(4):289–295PubMedCrossRefGoogle Scholar
  40. Rowe H, Fisher J (2010) The contribution of Australian residential early parenting centres to comprehensive mental health care for mothers of infants: evidence from a prospective study. Int J Ment Health Syst 4:6PubMedCrossRefGoogle Scholar
  41. Rowe H, Fisher J, Loh W (2008) The Edinburgh Postnatal Depression Scale detects but does not distinguish anxiety disorders from depression in mothers of infants. Arch Women’s Mental Health 11(2):103–108CrossRefGoogle Scholar
  42. Sheehan DV, Lecrubier Y, Sheehan H, Amorim P, Janavs J, Weiller E, Hergueta T, Baker R, Dunbar GC (1998) The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 59(suppl 20):22–33PubMedGoogle Scholar
  43. Wenzel A, Haugen EN, Jackson LC, Brendle JR (2005) Anxiety symptoms and disorders at eight weeks postpartum. J Anxiety Disord 19(3):295–311PubMedCrossRefGoogle Scholar
  44. Zaers S, Waschke M, Ehlert U (2008) Depressive symptoms and symptoms of post-traumatic stress disorder in women after childbirth. J Psychosom Obstet Gynaecol 29(1):61–71PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Wien 2013

Authors and Affiliations

  • Bettina Christl
    • 1
  • Nicole Reilly
    • 1
  • Michelle Smith
    • 2
    • 3
    • 4
  • Deborah Sims
    • 1
  • Fran Chavasse
    • 5
    • 6
  • Marie-Paule Austin
    • 7
    Email author
  1. 1.Perinatal and Women’s Mental Health Unit, St John of God Health Care and School of PsychiatryUniversity of New South WalesBurwoodAustralia
  2. 2.St John of God Hospital BurwoodBurwoodAustralia
  3. 3.Prince of Wales Hospital RandwickRandwickAustralia
  4. 4.University of New South WalesRandwickAustralia
  5. 5.Tresillian Family Care CentreBelmoreAustralia
  6. 6.University of Technology SydneySydneyAustralia
  7. 7.St John of God Chair Perinatal and Women’s Mental Health, Perinatal and Women’s Mental Health Unit, St John of God Health Care and School of PsychiatryUniversity of New South WalesBurwoodAustralia

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