Paediatrics (RCH) - Theses
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ItemTypes and Patterns of Intimate Partner Violence and Health Outcomes for Women( 2021)Intimate partner violence (IPV) can include physical, sexual, and emotional abuse. Despite increasing recognition that women experience different types of IPV, the majority of research has focussed on physical or sexual IPV. There are very few longitudinal studies that have aimed to capture women’s experiences of multiple types of IPV, and little is known about the health outcomes associated with different types and combinations of abuse. A small number of studies have suggested that emotional IPV may precede other types of IPV, however it remains unclear whether there are distinct patterns in women’s experiences of different types of IPV over time. Drawing on data from a prospective pregnancy cohort of 1507 first time mothers, the overall aim of this research was to explore women’s exposure to different types and patterns of intimate partner violence in the first ten years of motherhood and identify health outcomes associated with these experiences. Important conceptual and measurement issues were identified in the existing literature, including the widespread segregation of emotional, physical and/or sexual IPV. In Study 1, emotional IPV alone was found to be the most common type of IPV experienced in the first 12 months postpartum, followed by combined (physical and emotional) IPV, and physical IPV alone. Women experiencing IPV were more likely to report poor health, with the strongest associations observed between experiences of combined IPV and mental health problems. Experiences of emotional IPV alone were also associated with physical and mental health problems in the first year postpartum. Study 2 demonstrated that experiences of IPV reported in the first year postpartum commonly persisted in later motherhood. Emotional IPV alone remained the most prevalent type of IPV across the first ten years of motherhood, followed by combined IPV. Associations between past year IPV and women’s mental and physical health in the tenth year of motherhood reflected findings from Study 1, with the largest effect sizes observed for combined IPV. Women who reported prior emotional IPV alone or prior combined IPV (during the first four years of motherhood but not at ten years) also reported poor health in the tenth year of motherhood. Finally, in Study 3, a novel technique for visualising data, showed that there was considerable variability in women’s experiences of IPV over the first ten years of motherhood. The prevalence of IPV remained consistent across the first ten years of motherhood. Women who reported combined IPV were more likely to report IPV at multiple time-points during this period. Maternal sociodemographic characteristics in early pregnancy (e.g., younger age, unemployment, lower income or education) were associated with an increased risk of IPV at all three time points. Overall, the findings presented in this thesis show that while there is variability in women’s experiences of IPV, there are substantial health problems associated with both types of IPV. There is a need for better understanding and recognition of the complexity and chronicity of these experiences, and the harm associated with different types of IPV, to strengthen responses and support for women who experience IPV.
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ItemReflecting on Babies in the NICU: An exploration of Parental Reflective Functioning in a quaternary neonatal intensive care unit( 2020)When an infant is admitted to the neonatal intensive care unit (NICU), parents are confronted with the challenge of developing relationships with their very sick infant while trying to comprehend the medical situation and their own emotional reactions. Although Parental Reflective Functioning (PRF) is important for early parent-infant relationships, its role in mental health and attachment relationship outcomes of infants admitted to NICU and their parents has not been evaluated. The prospective “Reflecting on Babies in NICU” (ROBIN) study aimed to determine whether PRF was measurable in NICU and predicted subsequent mental health problems. Parents of infants who were at least 3 weeks of age and admitted to a quaternary NICU at the Royal Children’s Hospital Melbourne without ever having been home were prospectively enrolled. PRF was evaluated using the Parental Reflective Functioning Questionnaire (PRFQ) and, in a nested substudy, a specifically developed NICU version of the Parent Development Interview (PDI:NICU). Acute stress disorder (ASD) and post-traumatic stress disorder (PTSD) were classified according to the Acute Stress Disorder Scale (ASDS) and Posttraumatic Stress Disorder Checklist (PCL-5) respectively. The association between baseline PRF and parent self-reported feelings of attachment, measured by the Maternal, and Paternal, Postnatal Attachment Scales (MPAS/PPAS), and parental emotional functioning, was evaluated both while the infant remained in NICU and at 10 months of infant-age. Evaluable data were available for 69 infants (67 mothers and 38 fathers) enrolled between July 2014 and April 2016. Baseline PRFQ subscale scores were similar to previously published studies. Baseline PRF scores from the PDI:NICU were available for 19 mothers. The mean overall score was 5.4 (SD 1.1, range 4-7), and the pattern of individual demand question scores was similar to previously published profiles. This indicates that PRF is measurable in the NICU-setting. Paired PRFQ results at baseline and at 10 months were available for 57 parents. For mothers, the PRFQ subscales correlated closely over time, whereas for fathers only the Pre-Mentalizing Mode subscale was correlated. This suggests that the PRF being measured in NICU may be an enduring trait, rather than a state influenced by the acute condition, more for mothers than fathers. PRF at baseline was highly correlated with self-reported attachment-quality at 10 months. Specifically, high PRFQ Pre-Mentalizing Mode (PM) subscale scores in NICU predicted dyads with subsequent “at risk” attachment, implying that parents with poorer PRF in NICU are more likely have parent-infant relationship difficulties as their child grows. Acute stress disorder affected 38% of mothers and 41% of fathers at baseline. Higher baseline PRF, especially the PRFQ Interest and Curiosity about Mental States (IC) subscale, was associated with risk of concurrent ASD. Higher baseline IC scores were also associated with risk of PTSD at 10 months in mothers. These findings present a dilemma. Lower capacity for PRF in NICU may jeopardise the developing parent-infant relationship, but higher PRF may create emotional trauma for parents. Infant Mental Health resources and a “nested mentalization” approach to care are vital for infants and their at-risk parents in NICU, so they can be held “in mind” in supported ways.