BackgroundThe concept of resilience has captured the imagination of researchers and policy makers over the past two decades. However, despite the ever growing body of resilience research, there is a paucity of relevant, comprehensive measurement tools. In this article, the development of a theoretically based, comprehensive multi-dimensional measure of resilience in adolescents is described.MethodsExtensive literature review and focus groups with young people living with chronic illness informed the conceptual development of scales and items. Two sequential rounds of factor and scale analyses were undertaken to revise the conceptually developed scales using data collected from young people living with a chronic illness and a general population sample.ResultsThe revised Adolescent Resilience Questionnaire comprises 93 items and 12 scales measuring resilience factors in the domains of self, family, peer, school and community. All scales have acceptable alpha coefficients. Revised scales closely reflect conceptually developed scales.ConclusionsIt is proposed that, with further psychometric testing, this new measure of resilience will provide researchers and clinicians with a comprehensive and developmentally appropriate instrument to measure a young person's capacity to achieve positive outcomes despite life stressors.

ObjectivesChildren exposed to social adversity—hardship as a result of social circumstances such as poverty or intergenerational trauma—are at increased risk of poor outcomes across the life course. Understanding what promotes resilient outcomes is essential for the development of evidence informed intervention strategies. We conducted a systematic review to identify how child resilience is measured and what factors are associated with resilient outcomes.DesignSystematic search conducted in CINAHL, MEDLINE and PsychInfo from January 2004 to October 2018 using the keywords ‘resilien* and child* in the title or abstract. Eligible studies: (1) described children aged 5–12 years; (2) identified exposure to social adversity; (3) identified resilience; and (4) investigated factors associated with resilience.Outcome measures(1) approaches to identifying resilience and (2) factors associated with resilient outcomes.ResultsFrom 1979 studies retrieved, 30 studies met the inclusion criteria. Most studies were moderate to high quality, with low cultural competency. Social adversity exposures included poverty, parent loss, maltreatment and war. Only two studies used a measure of child resilience; neither was psychometrically validated. Remaining studies classified children as resilient if they showed positive outcomes (eg, mental health or academic achievement) despite adversity. A range of child, family, school and community factors were associated with resilient outcomes, with individual factors most commonly investigated. The best available evidence was for cognitive skills, emotion regulation, relationships with caregivers and academic engagement.ConclusionsWhile there is huge variation in the type and severity of adversity that children experience, there is some evidence that specific individual, relational and school factors are associated with resilient outcomes across a range of contexts. Such factors provide an important starting point for effective public health interventions to promote resilience and to prevent or ameliorate the immediate and long-term impacts of social adversity on children.

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Objective To describe the prevalence of maternal depression from pregnancy to 4 years postpartum, and the risk factors for depressive symptoms at 4 years postpartum.Design Prospective pregnancy cohort study of nulliparous women.Setting Melbourne, Australia.Sample In all, 1507 women completed baseline data in pregnancy (mean gestation 15 weeks).Methods Women were recruited from six public hospitals. Questionnaires were completed at recruitment and 3, 6, 12 and 18 months postpartum, and 4 years postpartum.Main outcome measures Scores ≥13 on the Edinburgh Postnatal Depression Scale were used to indicate depressive symptoms.Results Almost one in three women reported depressive symptoms at least once in the first 4 years after birth. The prevalence of depressive symptoms at 4 years postpartum was 14.5%, and was higher than at any time-point in the first 12 months postpartum. Women with one child at 4 years postpartum were more likely to report depressive symptoms at this time compared with women with subsequent children (22.9 versus 11.3%), and this association remained significant in adjusted models (Adjusted odds ratio 1.71, 95% confidence interval 1.12-2.63).Conclusions Maternal depression is more common at 4 years postpartum than at any time in the first 12 months postpartum, and women with one child at 4 years postpartum report significantly higher levels of depressive symptoms than women with subsequent children. There is a need for scaling up of current services to extend surveillance of maternal mental health to cover the early years of parenting.

Children exposed to maternal depression during pregnancy and in the postnatal period are at increased risk of a range of health, wellbeing and development problems. However, few studies have examined the course of maternal depressive symptoms in the perinatal period and beyond on children's wellbeing. The present study aimed to explore the relationship between both the severity and chronicity of maternal depressive symptoms across the early childhood period and children's emotional-behavioural difficulties at 4 years of age. Data from over 1,085 mothers and children participating in a large Australian prospective pregnancy cohort were used. Latent class analysis identified three distinct trajectories of maternal depressive symptoms from pregnancy to 4 years postpartum: (1) no or few symptoms (61%), (2) persistent subclinical symptoms (30%), and (3) increasing and persistently high symptoms (9%). Regression analyses revealed that children of mothers experiencing subclinical and increasing and persistently high symptoms were at least two times more likely to have emotional-behavioural difficulties than children of mothers reporting minimal symptoms, even after accounting for known risk factors for poor outcomes for children. These findings challenge policy makers and health professionals to consider how they can tailor care and support to mothers experiencing a broader spectrum of depressive symptoms across the early childhood period, to maximize opportunities to improve both short-and long-term maternal and child health outcomes.

Objective To investigate the relationship between mode of delivery, perineal trauma and dyspareunia.Design Prospective cohort study.Setting Six maternity hospitals in Melbourne, Australia.Sample A total of 1507 nulliparous women recruited in the first and second trimesters of pregnancy.Method Data from baseline and postnatal questionnaires (3, 6, 12 and 18 months) were analysed using univariable and multivariable logistic regression.Main outcome measure Study-designed self-report measure of dyspareunia at 18 months postpartum.Results In all, 1244/1507 (83%) women completed the baseline and all four postpartum questionnaires; 1211/1237 (98%) had resumed vaginal intercourse by 18 months postpartum, with 289/ 1211 (24%) women reporting dyspareunia. Compared with women who had a spontaneous vaginal delivery with an intact perineum or unsutured tear, women who had an emergency caesarean section (adjusted odds ratio [aOR] 2.41, 95% confidence interval [95% CI] 1.4-4.0; P = 0.001), vacuum extraction (aOR 2.28, 95% CI 1.3-4.1; P = 0.005) or elective caesarean section (aOR 1.71, 95% CI 0.9-3.2; P = 0.087) had increased odds of reporting dyspareunia at 18 months postpartum, adjusting for maternal age and other potential confounders.Conclusions Obstetric intervention is associated with persisting dyspareunia. Greater recognition and increased understanding of the roles of mode of delivery and perineal trauma in contributing to postpartum maternal morbidities, and ways to prevent postpartum dyspareunia where possible, are warranted.

Objective To examine maternal depressive symptoms during and after pregnancy and explore their relationship with intimate partner violence in the 12 months after birth.Design Prospective pregnancy cohort study of nulliparous women.Setting Melbourne, Australia.Population In all, 1507 eligible women completed baseline data (mean gestation 15 weeks). Analyses are presented for 1305 women who completed all follow-up questionnaires.Methods Women were recruited from six public hospitals at between 6 and 24 weeks of gestation. Written questionnaires were completed at recruitment and at 3, 6 and 12 months postpartum.Main outcome measures Depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS). Intimate partner violence was assessed using the short version of the Composite Abuse Scale.Results Sixteen per cent of women reported depressive symptoms (EPDS ‡ 13) in the 12 months postpartum, with most women first reporting depressive symptoms in the second 6 months after birth. Around 40% of women reporting depressive symptoms at each follow up also reported intimate partner violence. Factors associated with postpartum depressive symptoms in multivariable models were: emotional abuse alone (adjusted odds ratio [OR] 2.72, 95% CI 1.72-4.13), physical abuse (adjusted OR 3.94, 95% CI 2.44-6.36), depression in pregnancy (adjusted OR 2.89, 95% CI 1.75-4.77) and unemployment in early pregnancy (adjusted OR 1.60, 95% CI 1.03-2.48).Conclusions Screening for maternal depression at 3 months postpartum or earlier may miss over half the women with depression in the first 12 months after birth. Intimate partner violence is common among women reporting postnatal depressive symptoms and may be an important factor for health professionals to consider in their management.

Objectives To investigate frequency, severity and risk factors for urinary incontinence and faecal incontinence 4 years after a first birth.Design Prospective pregnancy cohort study.Setting Melbourne, Australia.Sample A total of 1011 nulliparous women recruited in early pregnancy.Methods Participants were followed up at 32 weeks of gestation; then at 3, 6, 9 and 12 months and 4 years postpartum.Main outcome measures Frequency and severity of urinary and faecal incontinence.Results At 4 years, 29.6% of women reported urinary incontinence and 7.1% reported faecal incontinence. Compared with women having only spontaneous vaginal births, women who delivered exclusively by caesarean section were less likely to have urinary incontinence at 4 years postpartum (adjusted odds ratio 0.4, 95% confidence interval 0.3-0.6). Women who reported urinary incontinence before or during the index pregnancy, and those experiencing symptoms in the first year postpartum had increased odds of incontinence at 4 years, with the highest odds (6-12 times higher) among women who had previously reported moderate or severe symptoms. The odds of reporting faecal incontinence at 4 years were two to six times higher for women experiencing symptoms in pregnancy, and around four to eight times higher for those with symptoms in the first year postpartum.Conclusion Urinary and faecal incontinence are prevalent conditions 4 years after a first birth. Women reporting urinary or faecal incontinence during pregnancy had markedly higher odds of reporting symptoms at 4 years postpartum, suggesting a need for further investigation and elucidation of aetiological pathways involving nonbirth-related risk factors.Keywords Faecal incontinence, maternal health, mode of birth, pregnancy cohort, urinary incontinence.Tweetable abstract Moderate/severe incontinence prevalent 4 years after first birth in population cohort. Prior symptoms are biggest predictor.