Psychological Flexibility and Depression in New Mothers of Medically Vulnerable Infants: A Mediational Analysis

Abstract

Objectives.-Maternal depression in the postpartum period is prevalent and associated with negative child outcomes, including behavior problems and cognitive delays. Mothers of children admitted directly after birth to the neonatal intensive care unit (NICU) are at even higher risk for depressive symptoms and infants born premature and/or at low birth weight may be more vulnerable to the adverse effects of maternal depression. Understanding mechanisms, particularly modifiable mechanisms, involved in the development or persistence of depressive symptoms is critically important for developing effective treatments.Methods.-The longitudinal, secondary analysis investigated the role of psychological inflexibility (rigidly avoiding or attempting to control distressing internal experiences, precluding present moment awareness of contingencies and engagement with important values) as a mediator of the relationship between early (1-2 weeks postpartum) and later (3 and 6 months postpartum) depressive postpartum symptoms among mothers (N = 360) with an infant in the neonatal intensive care unit.Results.-Psychological inflexibility measured two weeks after infant discharge from the hospital fully mediated the relationship between early and later depressive symptoms at 3 months postpartum, with partial mediation at 6 months, while controlling for factors previously found predictive of postpartum depression.Conclusions.-Acceptance and Mindfulness therapies which specifically target psychological inflexibility may be promising interventions to reduce depressive symptoms postpartum among new mothers with a NICU infant.

Randomized controlled trial of a brief online self‐compassion intervention for mothers of infants: Effects on mental health outcomes

“…Lower self‐compassion is associated with symptoms of anxiety and depression (Felder et al, 2016; Monteiro et al, 2019; Psychogiou et al, 2016) and increased parenting stress in mothers (Moreira et al, 2015), whereas higher self‐compassion is linked with better mother–infant attachment (Kordi & Mohamadirizi, 2018). Likewise, lower maternal psychological flexibility is associated with depressive and anxious symptoms (Evans et al, 2012; Monteiro et al, 2019; Shea & Coyne, 2011; Stotts et al, 2019), whereas higher maternal psychological flexibility is associated with greater maternal responsiveness (Evans et al, 2012).…”

Duration of breastmilk feeding of NICU graduates who live with individuals who smoke

“…It is likely that mothers who are concerned about one health behavior, such as secondhand smoke, are also concerned about multiple other health behaviors, such as breastfeeding, which may represent a more general perspective with regard to individual and family health. Further, it is possible that interventions targeting one health behavior may positively influence others (e.g., 44 , 45 ). Notably, very few mothers reported concerns about nicotine present in their breastmilk as a reason for stopping breastfeeding, but we did not explore the 46 “other” reasons for breastfeeding cessation, some of which may have been unique concerns for mothers who do not smoke but live with others who do.…”

Coached, Coordinated, Enhanced Neonatal Transition (CCENT): protocol for a multicentre pragmatic randomised controlled trial of transition-to-home support for parents of high-risk infants

“…Research has shown that increasing psychological flexibility through mindfulness therapies reduced maternal depression during the NICU admission and after discharge. 58 ACT interventions can be delivered by a variety of trained facilitators, 24 and demonstrate improved mental health outcomes for parents of children with life-threatening illness, 59 asthma 60 and autism. 61 ACT may be more appropriate for parents in the NICU compared with interventions such as cognitive-behavioural therapy, 24 which demonstrates effectiveness in reducing depression but not anxiety for NICU mothers.…”