Parental cognitive vulnerability during the perinatal period and its effect on mental health and the parent-infant relationship. Results from the NorBaby-study

Abstract

Perinatal periode er en krevende overgang i livet, som medfører økt risiko for psykiske helseutfordringer. Nedsatt psykisk helse hos foreldrene utgjør risiko for foreldre-barn relasjonen og for barnets utvikling. Gjennom samspillet med sine omsorgsgivere utvikler barnet emosjonsregulering og sosiale ferdigheter. Foreldre som blir fanget i repeterende negative tanker kan ha lite kapasitet til å plukke opp barnets signaler. Videre kan foreldrenes egne negative barndomserfaringer virke negativt inn på deres holdninger til spedbarnet og foreldrerollen. En negativ oppmerksomhetsdreining kan føre til at foreldre henger seg mer opp i negative enn positive uttrykk hos spedbarnet. Målet for studiene i denne avhandlingen var å undersøke slike selvforsterkende mønstre hvor foreldrenes kognitive sårbarhet virker inn på foreldrenes egen psykiske helse, foreldre-barn relasjonen og på barnets utvikling. Deltagerne i NorBaby ble rekruttert under svangerskap og fulgt til 7 måneder etter fødsel. Både mødre og deres partnere ble invitert til å delta i studien. Det ble gjennomført tre målinger under svangerskap, og tre etter fødsel. Deltagerne besvarte spørreskjema og utførte kognitive tester. Etter fødsel ble i tillegg barnets regulering observert, og sosial tilbaketrekning ble vurdert ved undersøkelse av barnet. Resultatene viste at repeterende negative tanker henger sammen med foreldres mentale helse etter fødsel, og deres relasjon til barnet. Vi fant ikke signifikante effekter av andre kognitive faktorer, nemlig oppmerksomhet og implisitte holdninger. Flergangsmødre var mindre utsatt for depressive symptomer og foreldrestress, samt reguleringsvansker hos barnet og knyttet seg sterkere til barnet. For fedre derimot, så var det å ha barn fra før negativt for tilknytningen til den nyfødte, samt at det ikke virket inn på fedrenes egen helse eller barnets regulering. Sosial støtte blant familie og venner viste seg også som en viktig faktor for foreldrenes mentale helse i perinatal periode. Avhandlingen har implikasjoner for helsetjenester i perinatal periode. Repeterende negative tanker hos foreldre bør kartlegges. Hjelp til å redusere slike tanker kan ha positive ringvirkninger både for foreldrene og for deres relasjon til barnet. Helsetjenester bør bidra til å fremme sosialt nettverk rundt familier som venter barn, og være særlig bevisst på psykiske utfordringer hos førstegangsforeldre.

<p>The aim of the present thesis was to investigate thinking style and processing biases in expecting and new parents, and how this relates to their mental health, the parent-infant relationship, and infant development in the perinatal period. The perinatal period is one of the largest transitions in life and comes with increased risk of mental illness. Mental illness in the parents serve as a risk factor for the parent-infant relationship and infant development. To develop effectful interventions, understanding of the mechanisms that lead to illness is essential. <p>Infants are dependent on their caregivers for healthy development. Through interaction with their caregivers the infant develops adaptive emotion regulation, and social skills. Parental mental illness could affect parents’ sensitivity and responsiveness to infant cues, and thereby negatively affect infant development. Being caught up in negative thoughts occupies cognitive capacity, and therefore might reduce the parental emotional availability. Further, adverse childhood experiences can have a negative effect on parents’ schemas and attitudes towards infants and the parental role. Biased attention can cause parents to notice more of the infant’s negative expressions and emotionality, which further can strengthen negative thoughts and attitudes towards the infant and parental role. Patterns like this, where vulnerability in the parents affects their own health, the parent-infant relationship and infant development, were of interest in the present thesis. <p>The Northern Babies Longitudinal Study recruited participants in the commune of Tromso and followed them longitudinally throughout pregnancy and 7 months postnatally. Both mothers and their partners were invited to participate. There were three assessments during pregnancy, and three after birth. Participants answered a broad range of measurements, including cognitive tasks and questionnaires about their mental health, negative thoughts, adverse experiences, and sociodemographic information. After birth, the infant’s daily rhythm and regularity was observed, and signs of social withdrawal was assessed during neuropsychological screening of the infant. <p>Results indicate that repetitive negative thoughts serve as a vulnerability trait in parents during the perinatal period, as they predict parental depressive symptoms and stress after birth, and the parent-infant relationship. Such thoughts can be identified already during pregnancy. We did not find significant relations between other cognitive factors, attentional bias and implicit attitudes, and parental health or parent-infant relationship. Further, parity was a clear protective factor for mothers, as it was related to lower levels of depressive symptoms and parenting stress, and infant regulatory problems. Parity was also related to stronger maternal bonding. In fathers, on the other hand, parity was negatively related to bonding, and did not significantly affect fathers’ mental health or infant regularity. Probably, this can be explained by the father’s engagement and responsibility for previous children during the early months after birth. Social support from friends and family also turned out as a significant protective factor for both mothers and fathers. <p>The present thesis has important implications for perinatal health care services. Repetitive negative thoughts should be identified during pregnancy. Reduction of such thoughts could have a positive effect on parental mental health, as well as the parent-infant relationship. Perinatal health care services should also help facilitate social support for expecting parents, and be especially aware of the mental health of first-time parents.