A systematic review and empirical study investigating the impact of maternal perinatal anxiety on mother-infant interaction at six-months postpartum and children's emotional problems at age three.

The presented thesis was completed by Sarah Rees for the Doctorate degree of Clinical Psychology (DClinPsy) at Cardiff University. The thesis title is ‘A systematic review and empirical study investigating the impact of perinatal anxiety on mother-infant interaction at six-months postpartum and children’s emotional problems at age three years’. This thesis was submitted on the 30th May 2017 and comprises three papers. Papers 1 and 2 have been prepared for submission to European Child and Adolescent Psychiatry. Paper 1 presents a systematic review on the evidence for the impact of perinatal anxiety on children’s emotional problems. A literature search was conducted and 14 studies were identified that satisfied inclusion criteria for the review. Whilst the findings of this review indicate that there is evidence for both maternal antenatal and postnatal anxiety having an adverse impact on child emotional outcomes, the evidence appears stronger for the negative impact of antenatal anxiety. Several methodological weaknesses make conclusions problematic and replication of findings is required to improve identification of at-risk parents and children with appropriate opportunities for intervention and prevention. Paper 2 presents an experimental study, which explores the role of antenatal and postnatal anxiety on children’s emotional problems at age three years. A sample of 186 women and their first-born children were followed from pregnancy to age three years postpartum. Mothers completed antenatal and postnatal anxiety measures. Maternal care-giving behaviour was assessed using observations of a mother-infant interaction task. At three years, the Child Behaviour Check List (CBCL) was administered to assess for children’s emotional problems. Results indicated that maternal antenatal anxiety and postnatal depression independently predicted higher reported emotional problems in children at age 3 years after controlling for postnatal anxiety and antenatal depression symptoms. Postnatal depression was found to partially mediate the association between antenatal anxiety and children’s emotional problems. Antenatal anxiety was associated with elevated maternal negative affect at 6 months postpartum. However, the association between antenatal anxiety and children’s elevated emotional problems at age 3 was not explained by maternal negative affect at 6 months postpartum. These data suggest that children’s emotional problems are adversely affected by maternal antenatal anxiety and postnatal depression. This has implications for targeting intervention or prevention in the antenatal period to prevent adverse emotional outcomes in children. Paper 3 is a critical reflection of the systematic review, the empirical paper and the research process as a whole. Strengths and limitations are discussed as well as clinical and research implications