No abstract

Depression is a common and debilitating mood disorder that increases in prevalence during pregnancy. Worldwide, 7 to 12% of pregnant women experience depression, in which the associated risk factors include socio-demographic, psychological, and socioeconomic variables. Maternal depression could have psychological, anatomical, and physiological consequences in the newborn. Depression has been related to a downregulation in serotonin levels in the brain. Accordingly, the most commonly prescribed pharmacotherapy is based on selective serotonin reuptake inhibitors (SSRIs), which increase local serotonin concentration. Even though the use of SSRIs has few adverse effects compared with other antidepressants, altering serotonin levels has been associated with the advent of anatomical and physiological changes in utero, leading to defects in craniofacial development, including craniosynostosis, cleft palate, and dental defects. Migration and proliferation of neural crest cells, which contribute to the formation of bone, cartilage, palate, teeth, and salivary glands in the craniofacial region, are regulated by serotonin. Specifically, craniofacial progenitor cells are affected by serotonin levels, producing a misbalance between their proliferation and differentiation. Thus, it is possible to hypothesize that craniofacial development will be affected by the changes in serotonin levels, happening during maternal depression or after the use of SSRIs, which cross the placental barrier, increasing the risk of craniofacial defects. In this review, we provide a synthesis of the current research on depression and the use of SSRI during pregnancy, and how this could be related to craniofacial defects using an interdisciplinary perspective integrating psychological, clinical, and developmental biology perspectives. We discuss the mechanisms by which serotonin could influence craniofacial development and stem/progenitor cells, proposing some transcription factors as mediators of serotonin signaling, and craniofacial stem/progenitor cell biology. We finally highlight the importance of non-pharmacological therapies for depression on fertile and pregnant women, and provide an individual analysis of the risk–benefit balance for the use of antidepressants during pregnancy

Nonverbal cues have been fundamental to the survival of our species, and they remain a critical aspect of communication. Starting at the moment of birth, children's facial expressions and body gestures reflecting pleasure and discomfort elicit different responses from caregivers, which can shape the trajectory of child development. Although early expressions of emotion are universal, socialization of the intensity of expressions begins in infancy and may be influenced by the place the child is born, family characteristics, and other factors. The aim of this study is to describe the differences in the intensity of emotional expression between Chilean and U.S. infants at approximately 1 year of age. Infants' emotional expressions of pleasure and discomfort are described in terms of total intensity and specific facial and corporal intensities. The expressions were assessed by videotaping and coding the children's behaviours during a sequence of pleasurable and displeasing activities. The analyses revealed that the U.S. children expressed pleasure and discomfort with greater intensity compared with the Chilean children, specifically through corporal expressions. Highlights This study explores differences in the intensity of emotional expression of Chilean and U.S. infants around 1 year of age. Assessment involved a sequence of videotaped tasks and showed U.S. infants expressed pleasure and discomfort with higher intensity than Chilean infants. Differences between both samples at 1 year reveal the possibility that cultural emotion socialization shapes emotional expressions very early in development.

The present single case study explored and described the intervention process and therapeutic change expression through the Generic Change Indicators model (GCI) aiming to answer the question of “What changes when you change?”. We reasoned that psychotherapy process research in child and dyadic psychotherapy is scarce, as well as needed because it accounts for the content and mechanisms related to the therapeutic change and its association with interventions’ effectiveness.  To explore this possibility, we conducted a single case qualitative study to explore and describe the intervention process through the GCI within a brief intervention mentalization-informed with video-feedback, with a depressive mother and her baby. Specifically, Patient’s ongoing change was determined through the identification of Episodes of Change (EC) and the Moment of Change (MC) that occurs within it. Each MC was then labeled with one of the 19 GCIs. Results of the single case study showed that the GCI model is a feasible model to observe and comprehend dyadic interventions. GCI were observed from the beginning of the intervention, increasing the hierarchical level of the GCI throughout the intervention, and associated with the video-feedback situation. To investigate processes of intervention using the methodology here proposed, allows us to understand the intervention not only from a perspective of effectivity and outcomes but considering the ongoing therapeutic change. In this sense, research like this contributes to the growing body of evidence supporting the training and supervision of psychotherapists.

The unprecedented COVID-19 pandemic has impacted families' mental health around the globe. In June 2020, 1163 parents of high (43%), middle (47%), and low socioeconomic status (SES) (10%) participated in an online survey developed to explore how daily life changes and restrictions that came with COVID-19 affected the experiences of pregnancy and/or parenting children under the age of 5 in Chile. The survey's design had an exploratory and descriptive scope, with a mix of qualitative and quantitative questions. With the aim of exploring differences before and after COVID-19, two time periods were established, and the 47-item questionnaire covered participants' sociodemographic information, support networks, health concerns, mood changes, self-regulation, adult and children's perceived well-being, parental competencies and parents' perceptions of the unborn baby and/or their children's needs.The results relative to retrospective reporting of pre-pandemic levels, showed an increase in children's crying and tantrums as well as in parental irritability and sadness. Additionally, decreases in the ability to calm down and sleep quality in both parents and children were identified. Finally, at a qualitative level, COVID-19 stands out both as an opportunity to get to know their children better and as a stressor related to parental burn-out and discomfort.

Background Women around the globe are increasingly engaging with pregnancy and parenting apps, almost becoming a routine part of the maternity experience. However, little is known about what perinatal women and health care professionals feel about those apps in Latin American countries, where the digital transformation has been slower but where digital technologies could also bridge gaps in access to quality health care. Methods This study aimed to assess views towards pregnancy and parenting apps in perinatal women and perinatal health care professionals in Chile through an online survey. In perinatal women, we explored app use, what they value in the apps they use, and what an “ideal app” would be for them. In health professionals, we explored opinions about women using perinatal apps and what they think a perfect app for their clients would be. Results The survey was completed by 451 perinatal women and 54 perinatal health care professionals. Results show that perinatal women in Chile frequently use perinatal apps, and they and health care professionals show a positive attitude towards them. The most valued attributes are information and monitoring of body changes during pregnancy, information and monitoring of the baby’s development (in the uterus and after birth), information and tips on how to stay healthy, and having the possibility to interact with other women. Conclusions Perinatal apps are accepted by perinatal women and health care professionals in Chile. Some needs for an “ideal app” emerged. Participants mentioned the need to address mental health, including the mental health of their partner, and the need for support during the transition to parenthood.

Background: Depressive symptoms in the postpartum period are a highly prevalent mental health problem. COVID-19 restrictions have increased maternal clinical symptoms during the postpartum period, leading to a high demand for mental health assistance and the need for cost-effective care adjusted to this new context. Video feedback (VF) has been a particularly cost-effective strategy in early interventions focused on maternal sensitivity. However, these interventions usually do not include mentalization as one of the critical elements involved in sensitive and attachment relationships. Also, these interventions are generally carried out in face-to-face settings. This study's main goal is to evaluate the feasibility and acceptability of a brief internet mentalization informed with VF to improve the sensitive response in mother-baby dyads with postpartum depressive symptoms attended in primary health centers.Methods/design: This randomized feasibility trial will include 60 mother-baby dyads. Participants will be randomized and allocated in a 1:1 ratio. A random number sequence will be computer-generated in varying block sizes (2&4) and stratified by center. The intervention aims to improve maternal sensitivity and mentalizing by using a model based on video-feedback methodology in a virtual modality. The intervention consists of four sessions plus one pre-intervention assessment session and psychoeducational cards. Control dyads will receive only psychoeducational cards once a week. Additionally, dyads from both groups will receive the health center’s treatment as usual. A MI-VF manual guides each intervention session, but its application is tailored to each dyad, VF therapists will receive one weekly group supervision session. Data will be collected at baseline, 4 weeks and 3 months follow-up. The main goal of this trial is to assess feasibility outcomes (recruitment rate and data completion) and change in maternal sensibility.Discussion: This study will inform parameters for the future implementation of a large randomized controlled clinical trial, contributing to the current scarce evidence on mentalization informed interventions that use VF as their primary intervention strategy. Also, this study will provide a cost-effective internet-based intervention model, feasible to be implemented in public health settings.Trial registration: NCT04748731

Las experiencias adversas durante la infancia pueden constituirse en  eventos traumáticos que impactan la calidad de los vínculos y la salud mental a lo largo del ciclo vital, siendo la depresión un trastorno frecuente en quienes reportan estas vivencias. La depresión ha sido asociada positivamente a la adversidad temprana y negativamente a la satisfacción de pareja durante la adultez, pero no contamos con estudios que evalúen el valor explicativo de ambas variables en los niveles de satisfacción de pareja. Considerando estos antecedentes, se desarrolló un estudio transversal, correlacional y comparativo en 160 padres y madres. Los resultados mostraron altos niveles de satisfacción de pareja y una asociación positiva entre las experiencias adversas y la depresión en padres y madres. Las madres presentaron mayores puntajes que los padres en depresión [t(79) =4,72, p<,001] y en experiencias adversas [t(79)= 3,468, p<.001],  explicando la depresión un 53% de la satisfacción de pareja en las mujeres. En cuanto al padre, su sintomatología depresiva, sus experiencias adversas infantiles y la sintomatología depresiva de la madre, explicaron un 35% de su satisfacción de pareja.