Abstract Background Preterm birth and survival rates of very low birth-weight (VLBW: <1.500 g) infants have increased. Although new parents are frequently affected by depressive symptoms, little is ...known about prevalence, risk, and predictors of parental postpartum depression (PPD) following VLBW birth. Furthermore, most studies assessing PPD in parents of preterm children relied on self-report only. Methods As part of the HaFEn cohort-study, data from the index groups of parents with VLBW infants and the control group of parents with term infants were cross-sectionally analysed. Families were recruited at the three largest centres of perinatal medical care in Hamburg, Germany. PPD was evaluated one month postpartum using standardized questionnaires and clinical interviews. Socioeconomic status, social support, risks during pregnancy, and psychiatric lifetime diagnoses were also assessed. A multiple random coefficient model was used to examine predictors of PPD in both parents simultaneously. Results 230 mothers and 173 fathers were included. Depending on the measure, the risk of being postnatally depressed was 4 to 18 times higher in mothers and 3 to 9 times higher in fathers from the index group. The most relevant risk factor for PPD was the birth of a VLBW infant, followed by female sex, lifetime psychiatric disorder, and low social support. Limitations Results presented here, are based on cross sectional data. Therefore no temporal relationships can be established. Conclusions Our findings highlight the importance of early screening for PPD in both parents of VLBW infants. Factors contributing to developing depression should also be considered in neonatal care.
Previous research suggests that the birth of a preterm child with very low birth weight (VLBW; <1,500 g) can be traumatic for both parents and lead to short-term consequences like clinical levels of ...posttraumatic stress symptoms (PTSS) or even to the development of a Posttraumatic Stress Disorder (PTSD). However, little is known about possible mid- and long-term psychological consequences in affected parents. The purpose of this study were (a) to examine the prevalence of parental birth-related PTSS and PTSD in a group of parents with VLBW preterm infants compared to parents of full-term infants 5 years after birth and (b) to investigate potential associations with risk factors for parental PTSS at 5 years postpartum. Perinatal factors (VLBW preterm or term, perceived stress during birth), psychological factors (perceived social support and PTSS 4-6 weeks postpartum, psychiatric lifetime diagnosis) and sociodemographic characteristics (number of children, singleton or multiple birth, socio-economic status), were included in the analysis. The sample consisted of 144 families (77 VLBW, 67 term birth) who participated in the prospective longitudinal cohort study "Hamburg study of VLBW and full-term infant development" (HaFEn-study) and were initially recruited at three perinatal care centers in Hamburg, Germany. PTSD prevalence and PTSS of mothers and fathers were assessed with the Impact of Event Scale-Revised (IES-R), social support with the Questionnaire of Social Support (SOZU-K-22), and lifetime psychiatric diagnoses with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (SCID-I). Data were analyzed by hierarchic multiple regression analyses. Results showed that 5 years after birth none of the parents fulfilled the criteria for a birth-related PTSD diagnosis. For mothers, postnatal PTSS and a VLBW preterm birth significantly predicted PTSS 5 years postpartum. For fathers, psychiatric lifetime diagnosis and postnatal PTSS significantly predicted PTSS 5 years after birth. Early identification of parents with higher risk of PTSS, especially after VLBW preterm birth, and their clinical needs seems beneficial to reduce the risk of long-term consequences. More research is needed on the paternal perspective and on potential effects of preterm birth on both parents and their children's mental health outcomes.
•Posttraumatic stress and disorders in parents after preterm and birth at term were examined.•Postpartum posttraumatic stress (PTSS) was higher in parents of preterm infants.•This risk for acute ...stress disorders was increased in mothers with preterm infants.•The risk for postpartum stress disorders was not elevated in parents with preterm infants.•Important risk factors for PTSS were stress during birth, social support and preterm birth.
The birth of a preterm infant can be stressful and traumatic for parents and may cause posttraumatic stress symptoms and disorders. There is a dearth of data from controlled studies regarding level, prevalence, risk, and predictors of these symptoms in parents after preterm birth.
As part of the longitudinal HaFEn-study, data from parents of infants with very low birth weight (VLBW), and term infants were cross-sectionally analyzed. We recruited parents at the three largest perinatal care centers in Hamburg, Germany. Posttraumatic stress symptoms were assessed with a standardized questionnaire, and acute and posttraumatic stress disorders with a clinical interview one month postpartum. Stress during birth, lifetime psychiatric diagnoses, social support, pregnancy risks, and mode of delivery were also evaluated. To examine predictors of posttraumatic stress symptoms in both parents simultaneously, we constructed multiple random coefficient models.
230 mothers and 173 fathers were included. The risk for acute stress disorder was increased in mothers with VLBW infants but not in fathers. While the risk for posttraumatic stress disorder was not elevated, the level of posttraumatic stress symptoms was higher in both parents with VLBW infants. Predictors for posttraumatic stress symptoms were stress during birth, low social support, psychiatric lifetime diagnoses, the birth of a VLBW infant, and female parent sex.
Results reported here are cross-sectional. Thus, no temporal relationships can be established.
Although posttraumatic stress disorders were rare, our results suggest that posttraumatic stress symptoms and acute stress disorders are common in parents of VLBW infants.
A very low birth weight (VLBW) is considered as a significant risk factor for early-onset developmental problems in infants, but is also discussed as a potential risk factor for the development of ...depressive symptoms in affected parents.
In this study, the 5-year courses of maternal and paternal depression with VLBW and term born infants (n = 250 families) are modeled and predicted by factors existing at the time of birth.
The dyadic trajectories of depression could be best described by five classes (I no depression, II minor maternal depression, III increasing dyadic depression, IV significant maternal depression, V highly depressed mothers). VLBW was a significant predictor for the course of parental depression – even under control of preexisting psychiatric disorders and other confounders. Interaction effects and a dose-response relationship were not existent.
Class IV and V had to be merged for the prediction analysis, a missing bias could not be ruled out, and families with a low birth weight (between 2500 and 1500g) were not included.
The results are well in line with what is known from studies so far, suggesting that maternal and paternal trajectories of depression show distinctable patterns which are associated with a VLBW. An early screening of mothers and fathers of a VLBW infant seems reasonable to prevent the development of a depression in parents and further difficulties for the child.
•A very low birth weight (VLBW) is a risk for developmental problems in infants.•Mothers and fathers show typical dyadic trajectories of postpartum depression.•VLBW is a statistically significant predictor of these trajectories.•The mental health of parents with a VLBW infant should be routinely monitored.
Abstract Background Both preterm delivery and survival rates of very low birth weight (VLBW: <1500 g) infants are increasing. To date, the focus on studies about postpartum mental health after ...preterm birth has been on depression and on women. There is a paucity of research regarding prevalence, risks, and predictors of postpartum anxiety in parents after VLBW birth. Methods Parents with VLBW infants and parents with term infants were recruited into the longitudinal HaFEn-study at the three largest centers of perinatal care in Hamburg, Germany. State anxiety was assessed with the State-Trait-Anxiety Inventory and anxiety and adjustment disorders with a clinical interview one month postpartum. Psychiatric lifetime diagnoses, social support, trait anxiety, stress during birth, socioeconomic status, risks during pregnancy, and mode of delivery were also evaluated. To examine predictors of postpartum state anxiety in both parents simultaneously a multiple random coefficient model was used. Results 230 mothers and 173 fathers were included. The risk for minor/major anxiety symptoms and adjustment disorders was higher in parents with VLBW infants compared to the term group. The risk for anxiety disorders was not higher in parents with VLBW infants. The most important predictors for postpartum state anxiety were high trait anxiety, the birth of a VLBW infant, high stress during birth, and low social support. Limitations Data reported here are cross-sectional. Thus, temporal relationships cannot be established. Conclusions Our results emphasize the importance of early screening for postpartum anxiety in both parents with VLBW infants.
•Internalizing symptoms in preterm and term preschoolers were assessed from four perspectives.•From the parents’ perspective, higher levels of internalizing symptoms were found in preterm ...children.•From the teacher's and the child's own perspective, the group differences were not significant.•Parental postpartum psychological distress predicted higher levels of children´s internalizing symptoms.•Prematurity did not predict internalizing symptoms from any of the four perspectives.
Preterm births rates of infants with very low birth weight (VLBW < 1500 g) are increasing. Prematurity poses several risks for emotional child development, e.g., internalizing symptoms. Our understanding of this condition in young children is limited, for at preschool age, symptoms have mostly been assessed from the mother's perspective only.
As part of the longitudinal HaFEn cohort-study in Hamburg, Germany, we measured the level of internalizing symptoms in VLBW and term preschoolers as well as predictors from four informants’ perspectives: mother, father, teacher, and child. A multilevel model was constructed to examine predictors of internalizing symptoms. n = 104 VLBW and n = 79 term children were included.
From both their parents’ perspective, children with VLBW had a significantly higher level of internalizing symptoms. From the teacher's and child's own perspectives, there were no significant mean group differences. In the multilevel analyses, the results were different regarding the four perspectives. VLBW did not predict internalizing symptoms. From mother's perspective, her own postpartum psychological distress, and from father's perspective, his postpartum and current psychological distress predicted a higher level of internalizing symptoms in their offspring. From teacher's perspective, socio-economic status predicted internalizing symptoms.
The sample size was relatively small. Exclusion criteria and drop out of families could have created some selection bias.
Our findings point to the importance of early identification of parental postpartum psychological distress given the potential for later internalizing symptoms in their children or the perception of their offspring as vulnerable and symptomatic, which may also impact the child's development.
Aims
This study used a large database to develop a reliable and valid shortened form of the Edinburgh Postnatal Depression Scale (EPDS), a self‐report questionnaire used for depression screening in ...pregnancy and postpartum, based on objective criteria.
Methods
Item responses from the 10‐item EPDS were obtained from 5157 participants (765 major depression cases) from 22 primary screening accuracy studies that compared the EPDS to the Structured Clinical Interview for DSM (SCID). Unidimensionality of the EPDS latent construct was verified using confirmatory factor analysis, and an item response theory model was fit. Optimal test assembly (OTA) methods identified a maximally informative shortened form for each possible scale length between 1 and 9 items. The final shortened form was selected based on pre‐specified validity and reliability criteria and non‐inferiority of screening accuracy of the EPDS as compared to the SCID.
Results
A 5‐item short form of the EPDS (EPDS‐Dep‐5) was selected. The EPDS‐Dep‐5 had a Cronbach's alpha of 0.82. Sensitivity and specificity of the EPDS‐Dep‐5 for a cutoff of 4 or greater were 0.83 (95% CI, 0.73, 0.89) and 0.86 (95% CI, 0.80, 0.90) and were statistically non‐inferior to the EPDS. The correlation of total scores with the full EPDS was high (r = 0.91).
Conclusion
The EPDS‐Dep‐5 is a valid short form with minimal loss of information when compared to the full‐length EPDS. The EPDS‐Dep‐5 was developed with OTA methods using objective, pre‐specified criteria, but the approach is data‐driven and exploratory. Thus, there is a need to replicate results of this study in different populations.
Background: Aimed to develop a unitary scoring system for the ‘Health Behaviour in school-aged Children’ (HBSC) symptom checklist that would facilitate cross-national comparisons and interpretation. ...Rasch measurement analysis and investigation of differential item functioning (DIF) were conducted. Methods: Data were obtained from the ‘WHO collaborative study HBSC 2001/2002’. A total of 162 305 students aged 11, 13 and 15 years from 35 European and North American Countries were surveyed. Unidimensionality of the items and local independence were tested using means of confirmatory factor analysis. DIF across countries, age groups and gender was investigated using a logistic regression procedure. Item and person parameters were estimated according to the Rating Scale Model (RSM). Results: All items proved to be unidimensional. One item displayed noticeable DIF across countries and was discarded. The remaining items were functioning equally across subgroups. The RSM analysis resulted in Rasch model conform item parameter estimation. Infit mean square values between 0.84 and 1.35 revealed acceptable item fit. Conclusion: The control of DIF enables comparable and unbiased assessment of subjective health complaints across countries, age groups and gender. A scoring algorithm could be developed which enables a cross-cultural comparable and interval-scaled assessment of subjective health complaints.
The application of intermetallic γ-TiAl-based alloys is limited by the deterioration in strength and creep resistance as well as reduction in oxidation resistance above 750 °C. The deposition of ...protective coatings is a promising opportunity to enhance the oxidation resistance or the lifetime with regard to the sustainability by several orders of magnitude. Moreover, additive manufacturing processes could enable the production of components with more complex geometries in the future. Thus, designs of γ-TiAl turbine blades with internal cooling systems could be feasible in the near future. In this context, the deposition of thermal barrier coatings and, therefore, oxidation protective bond coatings became important. MAX phases are of increasing interest as coating materials for high temperature applications due to their unique combination of metallic and ceramic properties. Especially the alumina forming MAX phases such as Cr2AlC, Ti2AlC or Ti2AlN are promising coating materials.
In the present work a Ti2AlC MAX-phase based coating was deposited by DC magnetron sputtering. Using three pure elemental target materials - Ti, Al and C and a two-fold rotation, a homogenous all-around coating was applied on the γ-TiAl alloy TiAl48-2-2 with a coating thickness of 10 μm. After the deposition process the stochiometric Ti2AlC coating was X-ray amorphous, therefore a post-heat treatment at 800 °C for 1 h was performed to achieve the desired hexagonal phase. Finally, the MAX-phase coated TiAl48-2-2 alloy was subjected to a cyclic oxidation test at 850 °C in laboratory air. The Ti2AlC MAX-phase coated TiAl48-2-2 alloy exhibits an excellent oxidation behavior, due to the formation of a thermally grown alumina top layer with the desired hexagonal Ti2AlC MAX-phase below. Extensive TEM analyses also showed the dependence of Al2O3 formation on post-heat treatment. θ-Al2O3 with a lower protective effect and the concomitant formation of TiN under the TGO was observed with post-heat treatment in Ar, while post-heat treatment in air lead to the formation of a protective α-Al2O3 layer.
•Production of a Ti2AlC MAX phase forming coating by magnetron sputtering.•Attainment of a coating thickness of 10 μm, suitable for high-temperature applications.•The generation of a protective TGO from α-Al2O3 is contingent upon the atmosphere during a post heat-treatment process.•Demonstrated oxidation protection for TiAl alloy in cyclic conditions at 850°C in air.
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