Dr Nicole Letourneau

Intergenerational transmission of early life adversity via maternal depression and anxiety and moderation by child sex

by Letourneau, N., Dewey, D., Kaplan, B., Ntanda, H., Thomas, J., Deane, AJ., Leung, B., Pon, K., Giesbrecht, G. & APrON Studies Team

Published by Journal of Developmental Origins of Health and Disease

September 3, 2018

Adverse childhood experiences (ACEs) of parents are associated with a variety of negative health outcomes in offspring. Little is known about the mechanisms by which ACEs are transmitted to the next generation. Given that maternal depression and anxiety are related to ACEs and negatively affect children’s behaviour, these exposures may be pathways between maternal ACEs and child psychopathology. Child sex may modify these associations. Our objectives were to determine: (1) the association between ACEs and children’s behaviour, (2) whether maternal symptoms of prenatal and postnatal depression and anxiety mediate the relationship between maternal ACEs and children’s behaviour, and (3) whether these relationships are moderated by child sex. Pearson correlations and latent path analyses were undertaken using data from 907 children and their mothers enrolled the Alberta Pregnancy Outcomes and Nutrition study. Overall, maternal ACEs were associated with symptoms of anxiety and depression during the perinatal period, and externalizing problems in children. Furthermore, we observed indirect associations between maternal ACEs and children’s internalizing and externalizing problems via maternal anxiety and depression. Sex differences were observed, with boys demonstrating greater vulnerability to the indirect effects of maternal ACEs via both anxiety and depression. Findings suggest that maternal mental health may be a mechanism by which maternal early life adversity is transmitted to children, especially boys. Further research is needed to determine if targeted interventions with women who have both high ACEs and mental health problems can prevent or ameliorate the effects of ACEs on children’s behavioural psychopathology.

URL: https://www.cambridge.org/core/journals/journal-of-developmental-origins-of-health-and-disease/article/intergenerational-transmission-of-adverse-childhood-experiences-via-maternal-depression-and-anxiety-and-moderation-by-child-sex/5CAEF677E3B83E52B1505CFAF16A8E1E

Nursing Child Assessment Satellite Training Parent-Child Interaction Scales: Comparing American and Canadian Normative and High-Risk Samples

by Letourneau, N., Tryphonopoulos, P., Novick, J., Hart, M., Giesbrecht, G.

Published by Journal of Pediatric Nursing

June 30, 2018

PurposeMany nurses rely on the American Nursing Child Assessment Satellite Training (NCAST) Parent-Child Interaction (PCI) Teaching and Feeding Scales to identify and target interventions for families affected by severe/chronic stressors (e.g. postpartum depression (PPD), intimate partner violence (IPV), low-income). However, the NCAST Database that provides normative data for comparisons may not apply to Canadian families. The purpose of this study was to compare NCAST PCI scores in Canadian and American samples and to assess the reliability of the NCAST PCI Scales in Canadian samples. MethodsThis secondary analysis employed independent samples t-tests (p < 0.005) to compare PCI between the American NCAST Database and Canadian high-risk (families with PPD, exposure to IPV or low-income) and community samples. Cronbach's alphas were calculated for the Canadian and American samples. ResultsIn both American and Canadian samples, belonging to a high-risk population reduced parents' abilities to engage in sensitive and responsive caregiving (i.e. healthy serve and return relationships) as measured by the PCI Scales. NCAST Database mothers were more effective at executing caregiving responsibilities during PCI compared to the Canadian community sample, while infants belonging to the Canadian community sample provided clearer cues to caregivers during PCI compared to those of the NCAST Database. Internal consistency coefficients for the Canadian samples were generally acceptable. Conclusions: The NCAST Database can be reliably used for assessing PCI in normative and high-risk Canadian families. Practical implicationsCanadian nurses can be assured that the PCI Scales adequately identify risks and can help target interventions to promote optimal parent-child relationships and ultimately child development.

URL: https://www.sciencedirect.com/science/article/pii/S0882596317303524

The effect of perinatal depression treatment for mothers on parenting and child development: A systematic review

by Letourneau, N., Dennis, C., Cosic, N., & Linder, J

Published by Depression and Anxiety

September 29, 2017

Antenatal and postpartum depression are very common and have significant consequences for mothers and their children. This review examines which antenatal depression (AD) and postpartum depression (PPD) treatment interventions are most efficacious in improving parenting and/or child development. CINAHL, Scopus, Cochrane Systematic Reviews, Cochrane Controlled Trials, Medline (OVID), Embase (OVID), PsychINFO, PsycARTICLES, AMED, and reference lists were searched. Randomized controlled trials (RCTs) and quasi‐experimental studies assessing the effect of AD, PPD, or both treatment interventions on parenting and/or child development were included. Meta‐analysis was conducted using random effects when possible. Thirty‐six trials (within 40 articles) met criteria for review. Interventions include interpersonal psychotherapy (IPT), cognitive behavioural therapy (CBT), peer support, maternal‐child interaction guidance, and other interventions, such as massage. For AD, IPT, CBT, and massage produced large effects on parenting (e.g. adjustment and attention toward infant) and child development (e.g. behaviour). For PPD, maternal‐child interaction guidance and psychotherapeutic group support produced large effects on parenting (e.g. sense of competence) and child development (e.g. cortisol). However, meta‐analysis revealed nonsignificant effects of IPT on maternal‐child attachment and CBT on parenting stress. Promising findings exist for IPT, CBT, maternal‐child interaction guidance, massage, and psychotherapeutic group support for specific parenting and/or child development outcomes. Additional RCTs using measures already employed in the literature are required to conduct necessary meta‐analysis and fully elucidate treatment effects.

URL: https://onlinelibrary.wiley.com/doi/10.1002/da.22687

Maternal sensitivity and social support protect against childhood atopic dermatitis

by Letourneau, N. Kozyrskyj, A. Cosic, N., Ntanda, H. Anis, L., Hart, M., & Giesbrecht, G

Published by Allergy, Asthma & Clinical Immunology

May 26, 2017

Many studies have identified associations between qualities of maternal–child relationships and childhood asthma, but few have examined associations with childhood atopic dermatitis (AD), a common precursor to asthma. Moreover, maternal psychological distress, including prenatal and postnatal depression, anxiety and stress, may increase risk, while social support from partners may reduce risk for childhood AD. We sought to uncover the association between maternal–infant relationship qualities (maternal sensitivity towards infant behavioral signals, controlling behavior, and unresponsiveness) and child AD after accounting for risk (i.e., prenatal and postnatal maternal depression, anxiety and stress) and protective (i.e., social support) factors. Methods We conducted a secondary analysis of data collected on a subsample of 242 women and their infants enrolled during pregnancy in the ongoing Alberta Pregnancy Outcomes and Nutrition cohort study. Inclusion criteria required mothers to be >16 years of age, English speaking and <22 weeks gestational age at enrollment. Data on depression, anxiety and stress in the prenatal and postnatal periods and physician diagnosis of childhood AD at 18 months were gathered via maternal report. Maternal sensitivity, unresponsiveness and controlling behaviours were assessed via videotaped observations using the Child-Adult Relationship Experimental (CARE)-Index at 6 months of infant age. Results Higher maternal sensitivity, or the inability of the mother to appropriately understand and respond to infant needs based on behavioral signals, predicted reduced odds of AD independent of and in combination with low prenatal and postnatal anxiety and high paternal support. After adjustment, higher maternal controlling behaviours and unresponsiveness also predicted greater odds of AD. Conclusions Low maternal sensitivity is a risk factor for childhood AD, independently and in combination with perinatal anxiety and low social support. Thus, interventions that improve maternal–infant relationship quality, especially sensitivity, reduce anxiety and improve social support from partners could reduce odds of childhood AD.

URL: https://aacijournal.biomedcentral.com/articles/10.1186/s13223-017-0199-4

Association between non-parenting adult’s attachment patterns and brain structure and function: A systematic review of neuroimaging studies

by Letourneau, N. L., Hart, J. M., & MacMaster, F.

Published by SAGE Open Nursing

March 1, 2017

Nursing has a long history of attending to the importance of early attachment experiences to later development. Attachment strategies formed in infancy and early childhood can have lifelong effects on an individual’s behavior and health. Advances in neuroimaging technology allow us to understand how these early experiences map onto the structure and function of the brain and ultimately behavior and health. Previous reviews have discussed the findings of studies observing correlations between attachment strategy and neural function and structure in romantic partners and parents, but far less has been said about nonparenting adults. This article reviews the relationship between attachment strategies developed in childhood and brain structure and function in nonparenting adults. A total of 14 studies met inclusion criteria. Results showed adult attachment patterns of nonparenting adults are pervasively correlated with brain structure and function, with most associations observed in executive regions, followed by affective and reward processing. Notably, no studies found associations between attachment pattern and stress response, in contrast with studies of mothers. These brain regions are linked to the many behavioral, mood and substance abuse disorders observed in adults with insecure attachment patterns. Nurses can use these findings to help prevent, assess and address these health risks in nonparenting adults, as well as provide the brain-based evidence to support the utility of nursing interventions designed to further promote healthy parent–child relationships and secure parent–child attachment.

URL: https://journals.sagepub.com/doi/abs/10.1177/2377960816685572