Browsing by Author "Benzies, Karen Marie"

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    The AMBIANCE-brief: An observational assessment tool of disruptive caregiving for use in applied settings with families at high social risk
    (2019-08-27) Cooke, Jessica Elizabeth; Madigan, Sheri L.; Graham, Susan A.; Noel, Melanie; Benzies, Karen Marie
    Background: A community-identified need has emerged for a well-validated indicator of caregiving difficulties for use in practice settings. Thus, a brief form of the Atypical Maternal Behavior Instrument for Assessment and Classification System (AMBIANCE) was developed for use as a screening instrument. Prior to its dissemination in practice settings, further evidence of the feasibility and validity of the AMBIANCE-Brief must be established. Objectives: The current study aims to: assess feasibility of coding disrupted caregiving in real-time; establish the convergent validity of the AMBIANCE-Brief with the full AMBIANCE, as well as its postdictive validity in relation to maternal unresolved states of mind, and its concurrent validity with infant attachment disorganization; examine if the relation between maternal unresolved states of mind and infant attachment disorganization is mediated by maternal disrupted caregiving as assessed by the AMBIANCE-Brief. Method: Adolescent mothers and their infants (N = 69 dyads) participated when infants were 6 and 12 months of age. At 6 months of age, mothers completed the Adult Attachment Interview (AAI). Dyads completed the Strange Situation Procedure (SSP), as well as play sessions with toys and without toys when infants were 12 months of age. Maternal disrupted caregiving was coded from the play sessions using the full AMBIANCE and AMBIANCE-Brief. Results: The AMBIANCE-Brief demonstrated strong convergent validity with the full AMBIANCE, postdictive validity with maternal unresolved states of mind, and concurrent validity with infant attachment disorganization in both play sessions. However, maternal disrupted caregiving, as assessed by the AMBIANCE-Brief, did not significantly mediate the association between maternal unresolved states of mind and infant attachment disorganization. Conclusions: The current work represents an initial step in the development of shorter protocols which are more efficient for practitioners to use in practice settings. Future studies are needed to establish evidence of validity and feasibility of the AMBIANCE-Brief in community agencies.
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    Association between Breastfeeding Self-Efficacy and Human Milk Feeding in Mothers of Moderate and Late Preterm Infants in a Level II NICU
    (2019-05-14) Delhenty, Samantha Elizabeth; Benzies, Karen Marie; Duffett-Leger, Linda A.; Fenton, Tanis R.
    Introduction: There is a positive association between breastfeeding self-efficacy (BSE) and breastmilk feeding duration in mothers of healthy, full-term infants. BSE refers to a mother’s perceived ability to successfully breastfeed her infant and is associated with four main factors: (a) performance accomplishments, (b) vicarious experience, (c) verbal persuasion, and (d) physiological and affective states. Limited research explores the relationship between BSE and breastmilk feeding duration for mothers of pre-term infants. Aim: The aim of this research was to explore the association between BSE and human milk feeding at discharge in mothers of moderate and late pre-term infants in a level II NICU. Methods: This study was part of a larger study known as the Family Integrated Care (FICare) study, a cluster randomized controlled trial conducted in 10 level II neonatal intensive care units (NICUs) in Alberta. BSE and breastmilk feeding rates were secondary outcomes. I conducted an observational study that involved secondary data analysis. Participants in this study included 221 maternal-infant dyads from the five control sites. BSE was collected using the modified breastfeeding self-efficacy scale – short form and human milk feeding outcomes were collected using categories recommended by Labbok and Krasovec. I aimed to look at predictors of human milk feeding at discharge and how previous breastfeeding experience may affect feeding outcomes. Results: The primary hypothesis for this study was supported and with all models (multivariable, crude, and stratified by parity analyses), BSE at admission was significantly associated with human milk feeding at discharge (p < 0.05). The secondary hypothesis was not supported since there was no important difference in the association between higher modified BSES-SF scores at admission and providing human milk at discharge when stratified by parity (p > 0.05). Conclusion: using the modified BSES-SF at admission in level II NICUs has potential as a clinical tool to support healthcare providers in identifying mothers of moderate and late pre-term infants at risk of early discontinuation of human milk feeding at discharge. Further research is needed to support the association between higher modified BSES-SF scores at admission and type of feeding at discharge with this maternal-infant dyad.
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    Barriers and Strategies of Newcomers to Canada in Forming Primary Supports During Pregnancy
    (2019-01-03) Robinson, Alexandra; Arthur, Nancy; Benzies, Karen Marie; Kassan, Anusha
    Canada has a long tradition as an immigrant-receiving country. Women who have recently immigrated to Canada contribute significantly to Canadian population growth, first by migrating to Canada, and second, by bearing children soon after arrival to Canada. Considering the crucial role that women who immigrate contribute towards the population growth of Canada, understanding her pregnancy health needs is of national importance. Surprisingly, there remains a conspicuous knowledge gap in understanding immigrant women’s experiences in pregnancy, in particular, in understanding her experiences establishing pregnancy supports. The aim in conducting this study was to address the current knowledge gap in relation to pregnancy experiences of newcomers to Canada who identify with a non-European ethnic group by identifying (a) facilitative strategies used in primary support formation, (b) the barriers to forming primary supports in Canada and, (c) what supports participants would have wanted but were unavailable to them at the time. Individual in-depth qualitative interviews were conducted with 13 participants using the Enhanced Critical Incident Technique (Butterfield, Borgen, Amundson, & Maglio, 2005). Findings from this study identified systemic barriers to forming pregnancy support networks such as acculturation issues, difficulty accessing information, language barriers, inadequate information on supports available, financial barriers, difficulty accessing maternity leave benefits, and not perceiving adequate attention from health care providers. There were also several factors identified as helpful in pregnancy support formation such as the support of their partner, persistence advocating for pregnancy care needs, pregnancy apps, community programs offering pregnancy supports for newcomers, doctors who showed concern, and mental health care services. Participants identified wanting access to information about supports that they thought would have been helpful but were not available to them at the time. This research informs primary healthcare providers about the social, psychological, and economic factors that contribute to primary support formation during pregnancy as well as specific considerations faced by newcomers to Canada. Findings from this study not only inform interventions specific to newcomers to Canada, many of the findings have elucidated barriers to primary support formations shared by pregnant women, regardless of her country of origin.
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    Cohort Profile: The All Our Babies pregnancy cohort (AOB)
    (Oxford University Press on behalf of the International Epidemiological Association, 2017-01) Tough, Suzanne C.; McDonald, Sheila W.; Collisson, Beverly Anne; Graham, Susan; Kehler, Heather L.; Kingston, Dawn E.; Benzies, Karen Marie
    Why was the cohort set up? All Our Babies (AOB) is a community-based, longitudinal pregnancy cohort developed to investigate the relationships between the prenatal and early life periods and outcomes for infants, children and mothers. The design of AOB follows a life course perspective, whereby the influence of early events on long-term health and development of both mothers and children are investigated through examining factors across life stages. AOB spans pregnancy, birth and early postpartum through childhood, and therefore provides the unique opportunity to describe the relations between prenatal events and early life development and to examine key factors that influence child and mother well-being over time. AOB was originally designed to measure maternal and infant outcomes during the perinatal period, with a particular emphasis on barriers and facilitators to accessing health care services in Calgary, Alberta. Approximately 1 year after recruitment had started, an additional objective,to examine biological and environmental determinants of adverse birth outcomes, specifically spontaneous pre-term birth, was added. Recognition of the opportunity to continue to collect relevant life course information on the AOB families, collaborations with content experts and securing additional funding has enabled ongoing follow-up of AOB mother-child dyads. The overall objective was to further investigate risk and protective factors for optimal child development, and to understand the trajectory and impact of poor maternal mental health over time. Mothers have completed questionnaires from pregnancy to 3 years postpartum, and consented to providing the research team with access to their obstetric medical records. Data collection for a 5-year follow-up questionnaire is ongoing. A subgroup within the cohort participated in the ‘prediction of preterm birth’ component and provided blood samples during pregnancy and an umbilical cord blood sample. The continuation of follow-up to 8 years is under way.
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    Cohort Profile: The All Our Babies pregnancy cohort (AOB)
    (Oxford University Press, 2017-01) Tough, Suzanne C.; McDonald, Sheila W.; Collisson, Beverly Anne; Graham, Susan A.; Kehler, Heather L.; Kingston, Dawn E.; Benzies, Karen Marie
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    Effect of Alberta Family Integrated Care (FICare) on Breastfeeding Self-Efficacy and Breastmilk Feeding in Moderate and Late Preterm Infants
    (2019-07-03) Brockway, Meredith L.; Benzies, Karen Marie; Carr, Eloise C. J.; Aziz, Khalid
    Background: Breastfeeding self-efficacy (BSE) predicts breastfeeding outcomes in mothers of full-term infants; however, neonatal intensive care unit (NICU) practices may impede BSE and breastmilk feeding in mothers of preterm infants. Alberta Family Integrated Care (FICare) integrates parents into the care of their infant while in the NICU, by enhancing parent support, parent education and information sharing. The objective of this PhD work was to explore how Alberta FICare works to inform maternal BSE and resultant infant feeding outcomes in mothers of moderate (320/7 – 336/7 weeks) and late preterm infants (340/7 – 356/7 weeks). Methods: I conducted an explanatory sequential mixed-methods sub-study of the Alberta FICare trial. Based on BSE change scores between admission and discharge for mothers in the intervention group, I invited mothers scoring in the top or bottom quintiles to participate in interviews about infant feeding experiences in the NICU. Interviews were analyzed using inductive thematic analysis. To assess the effects of FICare on BSE and breastmilk feeding rates at discharge, I used repeated measures ANCOVA and Chi square. Finally, I used an integration matrix to integrate qualitative and quantitative findings. Results: Overall, I included 457 mothers/infant dyads (70 twins; M = 336/7 weeks gestation) from the FICare trial. Interviews with 14 mothers revealed three major themes: (a) institutional influences, (b) relationship with the pump, and (c) establishing breastfeeding. FICare was effective at improving BSE for mothers of late preterm infants, F(1, 232) = 3.97, p = .048, partial η2 = .017, but not for mothers of moderate preterm infants, F(1, 191) = 0.79, p = .375. Although exclusive breastmilk feeding rates at discharge in late preterm infants enrolled in the FICare group were higher compared to the standard care group, these differences were not statistically significant, 72.3% versus 62.2%, χ2(1) = 2.90, p = 0.089; no notable difference in exclusive breastmilk feeding was observed in moderate preterm infants. Conclusion: FICare is an effective model of care to improve BSE in mothers of late preterm infants at discharge from the NICU. More research is required to understand why FICare did not improve BSE in mothers of moderate preterm infants.
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    Effectiveness of Play2Sleep with Mothers and Fathers of Infants: A Mixed Methods Study
    (2019-04-25) Keys, Elizabeth; Benzies, Karen Marie; Duffett-Leger, Linda A.; Kirk, Valerie G.
    Infant sleep disturbances distress approximately one in four Canadian families and are associated with poorer parental health, family well-being, and child developmental outcomes. Assisting families to manage infant sleep disturbances may improve well-being, as well as support child development. However, addressing only sleep-related parenting behaviors and interactions may be ineffective in improving broader parenting difficulties that may underlie infant sleep disturbances. Play2Sleep combines personalized infant sleep information with examples from a self-modelled video recorded structured parent-infant play session to provide feedback aimed at enhancing parental ability to identify and respond appropriately to their infant’s specific sleep-related and social cues. This approach could help address broader parenting difficulties that may underlie infant sleep disturbances. An explanatory sequential mixed methods design combining a randomized controlled trial with thematic analysis of semi-structured family interviews was used to answer the following research questions: Quantitative - Does one dose of Play2Sleep delivered during home visits with mothers and fathers of 5-month-old infants with infant sleep disturbances reduce the number of night wakings at age 7 months? Qualitative - What are parental perceptions of family experiences, processes, and contexts related to Play2Sleep and infant sleep disturbances? Mixed Methods - How do parental perceptions of family experiences, processes, and contexts related to infant sleep explain the effectiveness of Play2Sleep? Play2Sleep was not effective in reducing parent-reported night wakings; however, it was effective in reducing maternal-reported infant nocturnal wakefulness and the number of paternal-reported naps. With Play2Sleep, there were significant subjective improvements in problematic infant sleep that were not observed in the comparison group. Three themes (information overwhelm, learning infant cues, and working together with a sub-theme of father involvement) were developed to propose a potential mechanism for Play2Sleep. Six themes describe broader parental experiences of infant sleep disturbances: developing routines; changed attitudes and beliefs; fears, concerns, and anxieties; support; sleep associations; and context of infant sleep disturbance. Play2Sleep shows promise to reduce infant sleep disturbances. Including fathers was novel and the qualitative analysis contributed to understanding the how and why of intervention effects. Areas for future research are prevention, precision-care models, workforce development, and parent engagement.
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    Exploring Literacy and Perceptions of Genomics Among Undergraduate Nursing Students and Faculty: A Mixed Methods Study
    (2019-08-22) Dewell, Sarah Lynne; Benzies, Karen Marie; Ginn, Carla S.; Goldsworthy, Sandra; Seneviratne, Cydnee C.
    As the single largest health care profession in Canada, nurses have a remarkable opportunity to shape the implementation of genomic health care, and will need a solid foundation in genetic and genomic knowledge to do so (Calzone et al., 2010; Canadian Institute for Health Information, 2016). In the early 2000s, a dedicated group of nurse leaders provided recommendations for genetic nursing in Canada (Bottorff et al., 2004). Since that time, the literature and guidelines from Canadian nursing organizations suggest that there has been little progress in the implementation of these recommendations. A mixed-methods explanatory sequential design combining a cross-sectional administration of a survey and thematic analysis of focus group discussion was used to answer the following research questions: Quantitative - How do nursing undergraduate students and faculty perform on the Genomic Nursing Concept Inventory (GNCI)? What individual socio-demographic characteristics and previous experiences with genetics are associated with performance on the GNCI? Qualitative - What barriers and facilitators to the addition of genetic and genomic content into undergraduate nursing curricula are identified by nursing undergraduate students and faculty? Mixed Methods - How do the barriers and facilitators associated with the addition of genetic and genomic knowledge into undergraduate nursing curriculum broaden understanding and provide context for the scores on the GNCI? The average percent correct on the GNCI for the 220 participants was 45%, which is comparable to results of sample US students and faculty. Characteristics associated with higher performance on the GNCI included older age, attending site A, not being female, having taken a genetics course, a previous degree, and having a positive attitude towards nurses learning about genetics. A list of barriers and facilitators was developed, along with eight themes (gaps in understanding; complexity; gaps in curriculum; lack of role models; scope; role; application; and relevance) describing the general sense of becoming “stuck” when discussing integration of genetics into the nursing curriculum. Clear implications emerged from the integration of the quantitative results and qualitative findings, which can be used to focus future research and efforts to advance the inclusion of genetic and genomic knowledge in undergraduate nursing curricula in Canada.
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    Maternal Prenatal Anxiety, Attachment and Children’s Externalizing and Internalizing Behavioral Problems
    (2020-09-09) Ali, Elena; Letourneau, Nicole Lyn; Giesbrecht, Gerald F.; Benzies, Karen Marie
    Perinatal anxiety is common, and affects up to 15-20% of women during perinatal period (Abrar, Fairbrother, Smith, Skoll, & Albert, 2020). Regarded as a prenatal programming factor (Madigan et al., 2018), prenatal anxiety (PA) is associated with biological, cognitive, and behavioral development in offspring, increasing risk for later externalizing and internalizing problems and adult psychopathology (Finsaas et al., 2018; Vogel, Jackson, Barch, Tillman, & Luby, 2019). Child behavioral development is also influenced by the postpartum anxiety (Madigan et al., 2018; Vogel et al., 2019). Externalizing behaviors are more often observed in boys and internalizing behaviors are more often observed in girls (Martel, 2013). Maternal-child attachment is defined as an affectionate, mutually satisfying relationship between a child and a caregiver that is involved in making the child feel safe, secure, and protected (Bowlby, 1958). Maternal-child attachment may moderate the association between PA and externalizing and internalizing behavioral problems, and function differently for boys and girls. The first manuscript provides a review of women’s experiences with postpartum anxiety, showing that postpartum anxiety is common, and can have serious implications for the maternal-child relationship. The second manuscript consists of a concept analysis of parent-child attachment to advance the application of this concept in nursing practice. The third manuscript presents the results of testing associations between PA and children's behavioral problems, and the role of maternal-child attachment and child sex as moderators of this association. Maternal-child attachment security moderated the association between prenatal anxiety and children’s behavioral problems; however, the sex of the child did not. The final paper describes the sample from which the third paper was derived, the Alberta Pregnancy Outcomes and Nutrition (APrON) cohort, highlighting findings on maternal and paternal mental health from pregnancy to three years postpartum. The dissertation concludes with recommendations for nursing research, policy, education and practice.
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    A Mixed Studies Systematic Review Evaluating the Effectiveness of Adolescent Inpatient Eating Disorder Treatment
    (2019-09-25) Patel, Shruti; Ewashen, Carol J.; Benzies, Karen Marie; Hayden, K. Alix
    Research literature discussing effective treatment components for adolescents with eating disorders remains unclear. To ensure timely and informed decision-making in clinical practice for adolescent inpatient eating disorders treatment, a systematic review and synthesis of relevant literature is warranted. The objective of the mixed studies systematic review was to identify, assess, and synthesize the best available evidence on inpatient eating disorder programs for adolescents. A literature search was conducted using five electronic databases on the EBSCO and OVID interfaces. Studies were selected by two reviewers. Selection was based on mutually agreed upon inclusion and exclusion criteria targeting adolescents nine to 21 years of age diagnosed with eating disorders on an inpatient setting. Of 2389 titles and abstracts identified, 160 full text articles were screened, and 43 met the inclusion criteria. Of the 43 included studies, 22 focused on specific interventions, while 11 focused on either caregiver or patient perceptions of inpatient treatment. The Joanna Briggs Institute critical appraisal tool for randomized controlled trials, cohort studies, and case control studies was used to assess quantitative studies as appropriate, while Joanna Briggs Institute critical appraisal tool for qualitative research was used to assess qualitative studies. Although evidence around interventions and practices for inpatient eating disorders treatment is available, it is not consistent across studies. Further research should consider identifying effective, evidence-based interventions and practices for adolescent inpatient eating disorder treatment towards positive patient outcomes.
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    Parenting Stress, Maternal Perception, and Child Development in Families Experiencing Adversity
    (2020-11-08) Mughal, Muhammad Kashif; Ginn, Carla S.; Syed, Hafsa; Donnelly, Carlene; Benzies, Karen Marie
    The objective of this study was to examine the association between maternal parenting stress and child development in families living with low income, mental illness, addiction, and/or social isolation on intake to an inner-city two-generation preschool program. Our sample included 88 children (age 2.5-5 years) and their mothers entering the preceding inner-city two-generation preschool program. We administered the Parenting Stress Index – Short Form (PSI-SF) and the Battelle Developmental Inventory- Screening Test 2nd ed. (BDI-ST). Bivariate analysis demonstrated associations between PSI-SF sub-scale scores and BDI-ST personal-social and adaptive domains, and we performed two multivariable logistic regression models to investigate associations. Increased parenting stress related to maternal perception of difficult child was associated with delays in children’s development in adaptive and personal-social domains. When designing two-generation early interventions with whole-family approaches for families experiencing adversity, mindfulness of the effects of maternal stress and maternal perception of having a difficult child is essential. In families experiencing adversity, where mothers experience parenting stress due to perceptions of having a difficult child, additional support and resources for both mothers and children may mitigate the risk of children’s developmental delay. Consideration of intergenerational effects of adversity includes increasing societal contributions to environments decreasing parenting stress.
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    Predictors of Depression and Anxiety in Mothers of Moderate and Late Preterm Infants in Level II Neonatal Intensive Care Units
    (2019-11) Kearl, Julie; Benzies, Karen Marie; Lind, Candace; Nelson, Andrea L.
    Postpartum depression (PPD) and postpartum anxiety (PPA) affect up to 19% and 17% of women, respectively. In mothers of preterm infants, depression (68%) and anxiety (72%) symptoms may be increased due to the stressful neonatal intensive care (NICU) environment. In 2015, 8.7% of infants, born in Alberta, were born preterm requiring hospitalization in the NICU, with 86% categorized as moderate or late preterms. Preterm birth, together with PPD and PPA, may have serious consequences for mother and infant outcomes. This observational correlational study included 197 mothers with data collected at admission and discharge from the NICU. The aim was to explore the prevalence, time course, comorbidity and predictors of postpartum maternal depression and anxiety in the moderate and late preterm population. Mothers reported depression (18%) and anxiety (42%) symptoms at admission to the NICU, a slight decrease of symptoms from admission to discharge, comorbidity of depression and anxiety symptoms with no identifiable maternal, infant, or pregnancy-related risk factors on the admission survey for depression or anxiety symptoms. These results suggest that universal screening may be critical for early identification of PPA and PPD. Psychological support and evidence-based interventions have the potential to decrease maternal depression and anxiety to improve long-term outcomes of mother and infant.
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    Reflective Function, Maternal-Child Interaction and Child Development: Impacts of Intervention for High Risk Families, Innovative Methods, Measurement and Fidelity Assessment
    (2020-08) Anis, Lubna; Letourneau, Nicole; Benzies, Karen Marie; Ewashen, Carol J.
    Parents suffering from toxic stressors (depression, addictions, family violence) are often unable to respond sensitively to their infants. Such early, persistent stress is understood to interfere with infant brain development, placing infants at risk for health and developmental problems over their lifespan. Parental sensitivity is also influenced by parental Reflective Function (RF), the ability to envision mental states in oneself and one’s child. While many modern parenting programs aim to improve parental sensitivity to their infants to promote healthy child development, parental RF is a commonly missing component. Parental RF is modifiable by intervention and predicts improvements in maternal sensitivity and responsiveness and infant attachment security, thus clearly beneficial. However, the link between an intervention aimed at improving parental RF and child development is unexplored. Given the importance of the early years for children’s development, improved interventions for vulnerable children and families have become public health imperatives. My doctoral research sought to examine the effectiveness of an innovative parenting program called Attachment and Child Health (ATTACHTM) on parent-child interaction and child development. In this manuscript-based dissertation, the first manuscript presents the results from the ATTACHTM pilot studies, demonstrating that ATTACHTM improved outcomes. The ATTACHTM pilots employed new accelerated methods to combat time- and cost-related challenges associated with traditional randomized controlled trials. Therefore, in my second manuscript, I undertook a realist review comparing innovative methods for intervention evaluation with traditional randomized controlled trial (RCT) methods in their ability to test, mobilize knowledge and provide recommendations for best approaches to promote child health. In my third manuscript, I compared the validity of different tools to measure RF, given the increasing need for effective, efficient rapid assessment in wide-ranging settings. Finally, I prepared a manuscript on the need to deliver evidence-based programs to promote early childhood development with fidelity. I developed and assessed an intervention fidelity tool for community nursing research by using the ATTACHTM intervention as an exemplar. My dissertation concludes with a summary of the research findings, and recommendation for nursing research, policy and practice.
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    Stepping Stones to Resiliency in Families: A Longitudinal, Mixed Methods Study Following a Two-Generation Preschool Program
    (2016) Ginn, Carla Sybil; Benzies, Karen Marie; Keown, Leslie Anne; Raffin Bouchal, Donna Shelley; Thurston, Wilfreda Enid
    Complex inequities exist for Canadian families living with low income, affecting social relationships, well-being, and mental health. A two-generation preschool program at Calgary Urban Project Society (CUPS) Health Education Housing Child Development Centre (CUPS One World) has been ongoing since 2001. Program objectives include improving early childhood development and school readiness through strengthening children’s environmental influences. Program eligibility includes living with less than half the low-income cut-off (LICO), and mental illness, addiction, or social isolation within the family. The aim of this explanatory sequential mixed methods study (quant-->QUAL) was to conduct a longitudinal follow-up of families after children reached age 10 years, to develop an understanding of the mechanism of change. In Phase I (quantitative), the top and bottom 25th percentile of children’s receptive language scores were identified, using the Peabody Picture Vocabulary Test 3rd Edition (PPVT-III), informing participant selection for Phase II (qualitative). In Phase II, constructivist grounded theory was used to explore experiences of 14 biological mothers as they moved through CUPS One World. The core category, Stepping Stones to Resiliency, included four categories: Perceptions of Family; Moving Forward; Achieving Goals; and Completely Different. Perceptions of Family included the categories of CUPS Like Family (for recent immigrant families), and CUPS in Place of Family (for other Canadian-born and Aboriginal families). Recent immigrant mothers had experienced positive, trusting relationships with extended family, while other Canadian-born and Aboriginal mothers had experienced dysfunctional, chaotic relationships (due to abuse and neglect, addiction, and ongoing effects of colonization including residential schools). Moving Forward was linked with Perceptions of Family: recent immigrant families could step lightly onto this stone, as it encompassed adjusting to life in Canada; other Canadian-born and Aboriginal families required extra struggle in order to move on to the next stone, following years of overwhelming life circumstances. Achieving Goals required self-worth to set and work toward them; Completely Different included leaving CUPS One World with newfound Strength, Independence, Freedom, Competency, and Connection. Stepping Stones to Resiliency was not a linear process, it involved occasionally stepping backwards, sometimes slipping and falling, and most importantly, continued resolve to get back on.
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    Trajectories of Paternal Postpartum Depression
    (2020-07-30) Cameron, Emily; Tomfohr-Madsen, Lianne M.; Dobson, Keith S.; Benzies, Karen Marie; Kopala-Sibley, Daniel C.; Da Costa, D.
    Background: New fathers are nearly twice as likely to experience depression than men in the general population. The majority of studies examining risk factors for paternal postpartum depression (PPD) have used cross-sectional data, while extant longitudinal studies are often limited in the time that fathers are followed as well as the frequency of assessments. There is a dearth of research that examines risk and protective factors related to differing trajectories of depression. Analysis of trajectories is advantageous as it does not assume that all fathers will experience the same course of depression and allows for unique predictors of each trajectory to be evaluated. Method: The current study recruited 160 fathers in the third trimester. Each participant completed a larger baseline survey followed by a depressive symptom questionnaire at 1, 3, 6, 9, and 12 months postpartum. Group-based semiparametric modelling was used to identify trajectories of paternal PPD; multinomial logistic regression was used to evaluate prenatal predictors of each trajectory. Results: A four trajectory solution was considered the best fitting model and most clinically informative. Higher insomnia symptoms, higher anxiety, and experiencing pregnancy complications predicted group membership in the “moderate-increasing symptoms” trajectory group, while lower insomnia symptoms, lower anxiety, and experiencing an unremarkable pregnancy were protective factors predicting group membership in the “no or minimal symptoms” group. Preliminary analysis of the “clinical-increasing symptoms” group suggested that higher anxiety and maternal anxiety significant predicted group membership when controlling for Type I error (p < .01). Discussion: The current study is the first to describe trajectories of PPD in Canadian men. These findings have the capacity to aide prenatal screening measures for men transitioning to parenthood, as well as early intervention strategies.