The profile of interpretation bias in maternal postnatal anxiety
Research type
Research Study
Full title
Exploring the profile of interpretation bias in maternal postnatal anxiety
IRAS ID
324032
Contact name
Ellen Crawford
Contact email
Sponsor organisation
Oxford Health NHS Foundation Trust (OHFT)
Clinicaltrials.gov Identifier
not applicable, not applicable
Duration of Study in the UK
0 years, 9 months, 31 days
Research summary
Research Summary:
Anxiety in new mothers can influence how mothers understand what is going on for their baby. In turn this can influence how they interact with their baby and also how their baby develops as a result of these interactions. Anxiety can impact how we think about lots of things. For instance, previous studies have found that people with higher anxiety tend to jump to more negative interpretations of neutral or ambiguous situations than less anxious people. Anxious mothers have sometimes been found to respond less sensitively to what their baby does, which may be because they misinterpret their baby’s neutral signals (i.e., when they are not obviously happy or distressed) and therefore may not respond in exactly the way their baby needs. Precisely what thinking processes may be going on when mothers are really anxious is still not completely understood. This study will investigate whether anxious mothers have tendencies to interpret ambiguous scenarios as more negative than less-anxious mothers in the first year of their baby’s life. It will also look at whether these tendencies to interpret ambiguous situations as mostly negative applies more to situations relevant to parenting or just to generally ambiguous scenarios.
Summary of Results:
Background Mental health difficulties during pregnancy and the first 1-2 postnatal years (i.e., the ‘perinatal period’) is an area of increasing attention in both research and policy, leading to the creation of specialist perinatal mental health services around the UK in recent years. This is because researchers and policy makers have become more aware of the potential wide-ranging negative impacts of unmet perinatal mental health needs, not just for parents but for the long-term development of their children too. Similarly, up to 1 in 5 women/birthing people may experience a mental health condition in this period, so unfortunately it is also relatively common. However, a lot of the research to-date has focused on postnatal depression, with anxiety receiving less attention, despite being just as (if not more) common at this time.
There is evidence suggesting anxiety in the postnatal period can impact how mothers (as this is who most research has focused on) interact with their baby such as being less ‘in-tune’ with their baby’s cues or needs, leading to mothers responding less sensitively to these. How anxiety may interfere with parents’ abilities to respond sensitively to their baby’s needs and signals, is therefore an important area to explore. Theories of anxiety, referred to as ‘cognitive’ or ‘cognitive-behavioural’ theories, suggest that what we pay attention to and how we interpret information from the world around us can be influenced by anxiety and in turn, the more we pay attention to threats and interpret information in negative or threatening ways, the more anxious we will feel. So, these negatively biased ways of thinking are thought of as both causes and maintenance factors in anxiety. It may be these thinking patterns underlie links between mothers’ anxiety and interruptions to their abilities to respond sensitively to their child’s signals.
The present research focused on exploring the way women/birthing people with high anxiety interpret unclear (ambiguous) information. It sought to understand if anxiety in a sample of postnatal mothers/birthing people was associated with more negative interpretations of ambiguous situations. Additionally, whether increased personal relevance of the ambiguous situation to mothers/birthing made a difference to tendencies to interpret the situation more negatively or not. In other words, whether anxious mothers/birthing people were more likely to negatively interpret ambiguous parenting situations than general, non-parenting scenarios.
What was done?
To test this, 115 mothers (all identifying as female) with baby’s aged 3-6 months old, completed an online study. In the survey, participants answered screening questions to identify symptoms of postnatal anxiety and postnatal depression. They also read through twenty short stories about common situations, in which the conclusions remained ambiguous (unclear). There were two types of stories; those which related to parenting situations, and those related to everyday (non-parenting) scenarios. Participants then had the story titles presented again along with 4 suggested statements, two of which resolve the ambiguity in the story (‘targets’) and another two statements which did not offer ambiguity resolutions (‘foils’). In each statement pair (i.e., targets and foils), one statement was positive in tone, and one was negative. Participants rated how similar in meaning these statements were to the original story, these ratings were used to calculate an ‘interpretation bias index’ score (with lower scores indicating tendencies to interpret unclear situations more negatively than positively).What were the findings?
Participants were mostly White British (94%), in relationships (married or co-habiting; 98%) and between the ages of 30-39 (80%), with most babies aged between 6-12 months old at the time of the study (60%). Statistical analyses indicated that mothers with high anxiety were more likely to negatively interpret the ambiguous situations compared to those with low anxiety scores. However, the type of stories (i.e., whether they were specific to parenting or general situations) did not appear to make a difference to interpretation bias scores. Depression symptoms were also significantly related to interpretation bias, explaining around 7% of the variance in scores (above that of anxiety scores). However, subtypes of postnatal anxiety (including general worry and specific fears, perfectionism, control and trauma, social anxiety, and acute anxiety and adjustment) did not significantly differ from one another in their relationship with interpretation bias scores.What are the implications?
This was the first study (to our knowledge) that has compared how mothers who are high in postnatal anxiety tend to interpret ambiguous situations which are either highly personally-relevant or less personally relevant. In other anxiety conditions, such as social anxiety, more negative interpretations are often found for ambiguous situations that are more relevant to the specific worries of an individual (such as whether others are making negative judgements of them in social interactions). However, postnatal anxiety does not appear to have the same content-specific associations with biased interpretations. So, contrary to our expectations, anxious mothers were not more likely to negatively interpret unclear situations related to parenting their child (such as interpreting one’s baby pulling an ambiguous face when trying new foods) compared to non-parenting situations (such as interpreting the significance of the seat next to you on a bus remaining empty after acquaintances get on).As such, therapeutic interventions which address broad tendencies to interpret any ambiguous situation negatively may be as effective as those tailored to anxious parenting-specific thoughts. However, there is more research needed to validate these findings and explore the role of other factors which may influence interpretations such as abilities to regulate emotions and the impact of social support, ideally within more diverse research samples.
REC name
Yorkshire & The Humber - Bradford Leeds Research Ethics Committee
REC reference
24/YH/0097
Date of REC Opinion
23 Apr 2024
REC opinion
Favourable Opinion