The goal of this special issue entitled, “Perinatal mood symptoms and postpartum maternal functioning: Describing the evidence related to effective and ineffective interventions,” was to highlight interventions that have been evaluated in peer-reviewed research in regards to their efficacy toward improving perinatal mood symptoms and/or postpartum maternal functioning. While there is a comparatively rich body of research surrounding perinatal depression and anxiety, postpartum maternal functioning has exacted less attention, to date (–). There are several reasons for this including: (1) an early and almost exclusive focus on postpartum depression (PPD) as the primary mental health concern of interest in new mothers (), (2) a lack of current, quick, and accurate tools to assess postpartum functional status (), (3) inadequate attention paid to mothers and their needs post childbirth (, ), and a predominant focus on infant health and the clinical outcomes of the pregnancy (). However, over the past 10 years, assessment of maternal functioning has made its way into the conversation, and also into domestic (–), international (–), and industry-sponsored studies (, ). Though the evidence base is still growing, we do know that some interventions seem to improve maternal functioning. For example, women who participated in the Visiting Moms® program in Waltham, Massachusetts (n = 149), scored, on average, 16 points higher on the Barkin Index of Maternal Functioning (BIMF) () at program completion (relative to program intake) (). This intervention included weekly home visits from trained volunteers through the baby's first year of life and corroborates the knowledge base indicating that social support is a protective factor (). Postpartum patient education via the Skills Training Approach (STA) also appeared efficacious at improving maternal functioning—across all domains—in a small randomized controlled (n = 68) trial of Iranian women (). In fact, the group of women who received maternal skills training shortly after childbirth had an average BIMF score of 95.8 vs. 70.3 in the control group (). Stated differently, the women who received postpartum education were functioning, on average, 25 points higher than those who received usual care, making the case for more education-centered approaches to functional improvement. Clinical interventions such as the Hennepin Healthcare Mother-Baby Day Hospital, where perinatal women with severe to moderate psychiatric illness receive trauma-informed group-based therapy and psychiatric care, have shown great promise and significant improvements in depression, anxiety, and maternal functioning (). Intensive Outpatient Programs (I.O.P.s) have likewise reported success in achieving functional improvement in postpartum women ().
Through this special issue, both promising interventions and risk/protective factors associated with perinatal mental health are explored. For example, Deif et al. examine the complex role of breastfeeding in relation to maternal mood (), via a literature review focused on Dysphoric Milk Ejection Reflex (D-MER). Likewise, Iodice et al. consider the role of Oxytocin, concluding that the hormone may play a protective role in the development of perinatal depression. In a hygiene-focused study, Jiang et al. explored the association between caregiver hand washing practice and postpartum mental health; results from this cross-sectional study implicate suboptimal hand washing practice as a risk factor for maternal depression, anxiety, and stress. In terms of new behavioral health interventions, Flynn et al., Monteiro et al., and Peifer et al. each report compelling results and innovative programming. The special issue is nicely rounded out with an opinion piece by Albanese et al. who call for more patient-centered research and interventions for new mothers, whose mental health needs have been historically minimized ().
While we continue to think about ways to support pregnant and postpartum women toward holistic mental health and optimal daily functioning, there is a looming threat (risk factor) on the horizon and its name is the climate crisis (). In fact, the World Bank recently issued a report estimating that more then 200 million people are likely to be displaced due to climate change/extreme weather events (EWEs) over the next 30 years (). We also know that women and children are vulnerable subgroups and are disproportionately affected (). As the climate crisis intensifies, more pregnant and postpartum women will be impacted economically, socially, mentally, and physically. Organizations that assist new mothers, such as Postpartum Support International (PSI) (), should strongly consider incorporation of climate change effects into their programming. Healthcare providers serving the perinatal population will need to consider environmental factors, including extreme heat, when assessing their patients' mental (and physical) wellness.
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
Statements
Author contributions
The author confirms being the sole contributor of this work and has approved it for publication.
Conflict of interest
The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
References
1.
BarkinJLWisnerKLBrombergerJTBeachSRTerryMAWisniewskiSR. Development of the Barkin index of maternal functioning. J Womens Health. (2010) 19:2239–46. 10.1089/jwh.2009.1893
2.
BarkinJLWisnerKLBrombergerJTBeachSRWisniewskiSR. Assessment of functioning in new mothers. J Womens Health. (2010) 19:1493–9. 10.1089/jwh.2009.1864
3.
BarkinJLWisnerKLWisniewskiSR. The psychometric properties of the Barkin index of maternal functioning. J Obstetr Gynecol Neonatal Nurs. (2014) 43:792–802. 10.1111/1552-6909.12505
4.
BarkinJLBealsLBridgesCCEzeamamaASeratiMBuoliMet al. Maternal functioning and depression scores improve significantly with participation in visiting moms® program. J Am Psychiatr Nurs Assoc. (2021) 27:54–63. 10.1177/1078390319877444
5.
BarkinJLCurryCLGossL. That is one important wrapper: mental health considerations related to climate change in the perinatal period. Perspect Psychiatr Care. (2021) 58:7–8. 10.1111/ppc.13019
6.
BarkinJLWisnerKL. The role of maternal self-care in new motherhood. Midwifery. (2013) 29:1050–5. 10.1016/j.midw.2012.10.001
7.
JamesKFAycockDMFouquierKHiresKABarkinJL. Racial identity clusters and their relation to postpartum maternal functioning in black women. Matern Child Health J. (2022) 26:788–95. 10.1007/s10995-021-03280-7
8.
AlbaneseAMGellerPASteinkampJMBlochJRSikesCBarkinJL. Introducing the postpartum toolkit: an examination of the feasibility, acceptability and pilot efficacy of an online clinical tool to enhance postpartum functioning and emotional wellbeing. J Clin Med. (2022) 11:2748. 10.3390/jcm11102748
9.
BarrowKMcGrealALiVeccheDVan CleveSSikesCBuoliMet al. Are pediatric providers on-board with current recommendations related to maternal mental health screening at well-child visits in the state of Georgia?J Am Psychiatr Nurs Assoc. (2020) 11:1078390320971358. 10.1177/1078390320971358
10.
BarkinJLMcKeeverALianBWisniewskiSR. Correlates of postpartum maternal functioning in a low-income obstetric population. J Am Psychiatr Nurs Assoc. (2017) 23:149–58. 10.1177/1078390317696783
11.
KrohnHGuintivanoJFrischeRSteedJRackersHMeltzer-BrodyS. App-Based ecological momentary assessment to enhance clinical care for postpartum depression: pilot acceptability study. JMIR Format Res. (2022) 6:e28081. 10.2196/28081
12.
ChamgurdaniFKBarkinJLEsmaeilpourKMalakoutiJBuoliMMirghafourvandM. The effect of counseling with a skills training approach on maternal functioning: a randomized controlled clinical trial. BMC Womens Health. (2020) 20:51. 10.1186/s12905-020-00914-w
13.
LawKHDimmockJAGuelfiKJNguyenTBennettEGibsonLet al. A peer support intervention for first-time mothers: feasibility and preliminary efficacy of the mummy buddy program. Women Birth. (2021) 34:593–605. 10.1016/j.wombi.2020.10.009
14.
DeligiannidisKMMeltzer-BrodySGunduz-BruceHDohertyJJonasJLiSet al. Effect of zuranolone vs placebo in postpartum depression: a randomized clinical trial. JAMA Psychiatry. (2021) 78:951–9. 10.1001/jamapsychiatry.2021.1559
15.
KanesSColquhounHGunduz-BruceHRainesSArnoldRSchacterleAet al. Brexanolone (SAGE-547 injection) in post-partum depression: a randomised controlled trial. Lancet. (2017) 390:480–9. 10.1016/S0140-6736(17)31264-3
16.
AydinRKukuluK. Adaptation of the Barkin scale of maternal functioning and examination of the psychometric properties. Health Care Women Int. (2018) 39:50–64. 10.1080/07399332.2017.1385616
17.
KimHGEricksonNLFlynnJM. Keeping parent, child, and relationship in mind: Clinical effectiveness of a trauma-informed, multigenerational, attachment-based, mother-baby partial hospital program in an urban safety net hospital. Matern Child Health J. (2021) 25:1776–86. 10.1007/s10995-021-03221-4
18.
GellerPAPosmontierBHorowitzJABonacquistiAChiarelloLA. Introducing mother baby connections: a model of intensive perinatal mental health outpatient programming. J Behav Med. (2018) 41:600–13. 10.1007/s10865-018-9974-z
19.
ClementVRigaudKKde SherbininAJonesBAdamoSScheweJet al. Groundswell Part 2: Acting on Internal Climate Migration. Washington, DC: World Bank (2021). 10.1596/36248
20.
BarkinJLBuoliMCurryCLVon EsenweinSAUpadhyaySKearneyMBet al. Effects of extreme weather events on child mood and behavior. Dev Med Child Neurol. (2021) 63:785–90. 10.1111/dmcn.14856
21.
PSI. Postpartum Support International. (2022). Available online at: https://www.postpartum.net/
Summary
Keywords
postpartum functioning, perinatal mental health, maternal functioning, Barkin Index of Maternal Functioning, climate anxiety
Citation
Barkin JL (2022) Editorial: Perinatal mood symptoms and postpartum maternal functioning: Describing the evidence related to effective and ineffective interventions. Front. Psychiatry 13:975078. doi: 10.3389/fpsyt.2022.975078
Received
21 June 2022
Accepted
01 July 2022
Published
28 July 2022
Volume
13 - 2022
Edited and reviewed by
Marcin Siwek, Jagiellonian University, Medical College, Poland
Updates
Copyright
© 2022 Barkin.
This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Jennifer L. Barkin barkinj@gmail.com
This article was submitted to Mood Disorders, a section of the journal Frontiers in Psychiatry
Disclaimer
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.