Historically, the primary belief has been that asthma is an atopic disease with the strongest risk factor for developing asthma being exposure to an allergen. However, researchers have begun to question that long held belief and are beginning to study other postnatal environmental factors such as stress. Research delving into maternal postnatal distress and the subsequent effects seen upon the developing neonatal immune system as it pertains to asthma has gained momentum. With that in mind, the focus of this research was 1) to determine if skin infections are more likely to be seen in young children who have been exposed to maternal distress, 2) to determine if skin infections in children from infancy to age 2 are associated with asthma, independent of atopic dermatitis, and 3) to determine if the association between early life skin infection and asthma was independent of recent stress biomarkers such as cortisol and dehydroepiandrostrone (DHEA). To meet the objectives listed above, the 1995 SAGE (Study of Asthma, Genes and the Environment) Manitoba birth cohort of 13980 children was used. Maternal postnatal distress, skin infection and atopic dermatitis in the infant, asthma at age 11 and other risk factors for asthma were derived from Manitoba’s health care databases. For objective 3, data on stress biomarkers (Cortisol/DHEA ratio) were obtained from the SAGE nested case-control study. Multivariable logistic regression analysis confirmed the first objective that skin infections (adj. OR 1.25, 95% CI 1.13-1.39) and or atopic dermatitis (adj. OR 1.46, 95% CI 1.26-1.70) seen in children from birth to age 2 could be used as indirect markers of stress. The second objective determined that children who exhibited an early skin infection, from birth to age two, were at an increased risk for developing asthma by age 11 independent of atopic dermatitis. However, this finding was dependent upon frequency of health care use. Those children that exhibited an early skin infection and had less than 24 health care visits over 7 years were 1.33 times (95% CI 1.01-1.75) more likely to acquire asthma by age 11 than those who did not have an early skin infection. Children with fewer health care visits were 1.44 times more likely to have asthma. The third objective was not met because the association between early skin infection and asthma was not independent of the Cortisol/DHEA ratio. However, the univariate results for skin infection in the nested case-control study were not significant. The findings of this thesis may be used by family physicians or paediatricians when looking for tangible markers that may indicate infants at risk for developing asthma by school age.

Historically, the primary belief has been that asthma is an atopic disease with the strongest risk factor for developing asthma being exposure to an allergen. However, researchers have begun to question that long held belief and are beginning to study other postnatal environmental factors such as stress. Research delving into maternal postnatal distress and the subsequent effects seen upon the developing neonatal immune system as it pertains to asthma has gained momentum. With that in mind, the focus of this research was 1) to determine if skin infections are more likely to be seen in young children who have been exposed to maternal distress, 2) to determine if skin infections in children from infancy to age 2 are associated with asthma, independent of atopic dermatitis, and 3) to determine if the association between early life skin infection and asthma was independent of recent stress biomarkers such as cortisol and dehydroepiandrostrone (DHEA). To meet the objectives listed above, the 1995 SAGE (Study of Asthma, Genes and the Environment) Manitoba birth cohort of 13980 children was used. Maternal postnatal distress, skin infection and atopic dermatitis in the infant, asthma at age 11 and other risk factors for asthma were derived from Manitoba’s health care databases. For objective 3, data on stress biomarkers (Cortisol/DHEA ratio) were obtained from the SAGE nested case-control study. Multivariable logistic regression analysis confirmed the first objective that skin infections (adj. OR 1.25, 95% CI 1.13-1.39) and or atopic dermatitis (adj. OR 1.46, 95% CI 1.26-1.70) seen in children from birth to age 2 could be used as indirect markers of stress. The second objective determined that children who exhibited an early skin infection, from birth to age two, were at an increased risk for developing asthma by age 11 independent of atopic dermatitis. However, this finding was dependent upon frequency of health care use. Those children that exhibited an early skin infection and had less than 24 health care visits over 7 years were 1.33 times (95% CI 1.01-1.75) more likely to acquire asthma by age 11 than those who did not have an early skin infection. Children with fewer health care visits were 1.44 times more likely to have asthma. The third objective was not met because the association between early skin infection and asthma was not independent of the Cortisol/DHEA ratio. However, the univariate results for skin infection in the nested case-control study were not significant. The findings of this thesis may be used by family physicians or paediatricians when looking for tangible markers that may indicate infants at risk for developing asthma by school age.

After the Second World War mothering became an object of social, political, medical and psychiatric investigation. These investigations would in turn serve as the bases for new campaigns around the practice, meaning and significance of maternity. This brought attention to mothers' emotional repertoires, and particularly their experiences of distress. In this thesis I interrogate the use of maternal distress, asking how and why maternal distress was made visible by professions, institutions and social movements in postwar Britain. To address this I investigate how maternal mental health was constituted both as an object of clinical interrogation and used as evidence of the need for reform. Social and medical studies were used to develop and circulate ideas about the causes and prevalence of distress, making possible a new series of interventions: the need for more information about users of the health care service, an enhanced interest in disorders at the milder end of the psychiatric 'spectrum', and raised expectations of health. I argue that the approaches of those studying maternal distress were shaped by their particular agendas. General practitioners, psychiatrists, activists in the Women's Liberation Movement, clinicians interested in child abuse and social scientists, sought to understand and explain mothers' emotions. These involvements were shaped by the foundation of the National Health Service in 1948 and the crystallization of support for alternative forms of care into self-help groups by 1979. The story of maternal distress is one of competing and complementary professional and political interests, set against the backdrop of increasing pessimism about the family. I argue that the figure of the distressed mother has exerted considerable influence in British society. As such, this research has important implications for our understanding of how mental distress developed into a mode of social and political critique across the late twentieth century.

Child behavior problems are commonly reported difficulties within the education community and one of the largest referral reasons for parents seeking therapeutic services for their child. These behaviors can escalate to deviant and harmful behaviors that affect a child’s home life, academic success, and relations with family and peers. Current research has identified several parenting variables related to child behavior problems. This study considered the partial mediating role of parenting techniques on the relation between maternal characteristics and child behavior problems as reported by the parents and teachers of Head Start children. Participants in the study were 161 parents with children enrolled in Head Start at one of three programs in Texas or Mississippi. Results suggested that inconsistent discipline partially mediates the relation between maternal distress and parent reported child hyperactivity and aggression. Inconsistent discipline partially mediates the relation between maternal stress and parent-reported child hyperactivity and aggression. Parental involvement was found to be significantly related to childhood attention problems above and beyond maternal distress or stress and relevant demographic characteristics; however, it did not partially mediate those relations. Analyses involving teacher reported child behaviors did not show the same mediational effects. SEM analyses indicated that overall models of partial mediation demonstrated good fit. A major advantage to this study is the collection of data at three Head Start programs in two states that service small city / rural populations, an often underrepresented sample in empirical research. Implications of this project include: (a) a better understanding of the maternal variables most influential on child behavior that can be used to enhance curricula for parent training; (b) more precise screening of at-risk families by professionals that will continue to promote a focus on the whole family and allow for multiple pathways of healthy development for the child (e.g., through direct work with child and through the parents); and (c) continued consideration of the importance of ethnicity on these relations that will continue to foster a respectful and informed therapeutic relationship between professionals and families of young, atrisk children.

This study investigates the effects of postmodern factors on the relationship between maternal distress and children's delinquency. It seeks to understand the factors associated with distress levels of mothers whose children exhibit delinquency in order to potentially decrease the cost associated with mental health problems especially in mothers. Another goal of this study is to contribute to the sociological analysis of mental health problems which seem to be the reserved domain of the discipline of psychology and related subfields. The data came from the third wave of the 3-city study with N = 1835. The ages of the children range from 5 to 18 years old. The analysis of the data using regression analysis suggests children's delinquency significantly affects maternal distress in mothers. The study also indicates postmodernity factors did not moderate the association between maternal distress and children's delinquency. However, postmodern factors have significant, separate, and direct effects on maternal distress. For example, employment and religion have positive influences on maternal distress. The research points toward weakness in the postmodern perspective. It also underlines the importance of a sociological approach to the assessment and treatment of distress problems among mothers with low-income. Agencies working with low-income families should integrate the sociological approach in their intervention programs. Additionally, the study uncovers possible problems with assessment criteria used by these agencies to determine eligibility for assistance among low-income families such as education levels; and consequently calls for further investigation.

Proximal risk factors including household chaos, parenting and maternal distress can have a broad impact on multiple domains of child development and functioning. Using multiple methodologies including a meta-analysis and structural equation modeling with an empirical, cross-sectional design from a larger longitudinal research study; in this dissertation, I examine the impact of household chaos on child executive functioning, socioemotional and physiological stress outcomes, the role that parenting plays in this association, and how maternal distress predicts chaos in the home. In study 1, I conduct a meta-analysis examining the direct association between household chaos and child executive functioning, as well as multiple potential moderators (e.g. child age, sex and race/ethnicity). It incorporates 26 studies, with 27 independent effect sizes with a total sample of 8,944 children. Overall, I found a significant effect of r = .22 between household chaos and child executive function. Among the moderators assessed, only measurement approach of executive functions (informant-completed questionnaire versus direct assessment) was significant, with informant-completed questionnaires yielding an effect of r = .27 compared to direct assessment, r = .16. I conducted a series of separate moderation analyses for questionnaire and direct assessment effects. No significant moderators emerged from the questionnaire analyses, despite heterogeneous effect sizes. Direct assessment analyses revealed that both household chaos dimensions (disorganization and instability) were significantly related to child executive functions, however instability was a stronger correlate (r = .21) than disorganization (r = .09). Composition of the sample was also a significant moderator with effects increased with the proportion of minorities, and with parents with lower levels of education. Building on this work, in studies 2 and 3, I used cross-sectional empirical data from a sample of 137 mothers and their school-aged (5-year old) children. During home visits, mothers completed questionnaires assessing their mood, stressful experiences, the home environment and their child’s socioemotional functioning. Mothers also completed a video tour of the home. Mother-child interactions were videotaped and later coded for parenting. Both mothers and children independently completed behavioural assessments of executive function. Also, hair samples were collected from mothers and children from which the stress hormone, cortisol, was extracted as a biomarker of chronic stress. In order to empirically test the findings from the meta-analysis, in my second study, I used structural equation modeling to examine the indirect effect of household chaos on child executive functioning via parenting. I found that household chaos was directly and indirectly (via maternal cognitive sensitivity and emotional availability) associated with a latent variable of child executive functioning. Furthermore, instability, but not disorganization, significantly predicted child executive functioning directly and indirectly via parenting. Finally, sex-based analyses indicated that the effect of chaos on child executive functioning was significant through indirect effects only for boys. In the third study, in order to elucidate potential contributing factors to household chaos, I used a structural equation model to examine the indirect effects of a linear regression-weighted composite variable of maternal distress (depression, negative affect and physiological stress) on child hair cortisol levels and externalizing and internalizing behaviour problems via household chaos. I found that maternal distress had both direct and indirect effects (via household chaos) on child hair cortisol levels; however, only indirect effects were significant for externalizing and internalizing behaviour problems. Also, the indirect effect was only significant for household disorganization, but not instability, for child hair cortisol and externalizing and internalizing behaviour problems. Taken together, the findings from my dissertation demonstrate that: 1) household chaos has a direct, negative effect on child executive functioning and an indirect effect via parenting; and 2) maternal distress plays an important role in predicting the levels of chaos within the home which has implications for child chronic stress levels and behavioural problems. Collectively, these findings highlight the need to take a multi-method approach to measuring executive functioning in children and further, to develop and evaluate interventions that aim to support mothers, improve parenting and promote order and stability within the home in order to foster healthy developmental trajectories for children. / Dissertation / Doctor of Philosophy (PhD) / Children exposed to household chaos may experience adverse outcomes across multiple domains. Parenting can also be negatively affected by household chaos which may impact the quality of parent-child interactions. Further, the physical and psychological health of the mother may regulate the levels of chaos in the home which has implications for child outcomes as well. This dissertation seeks to examine the influence of household chaos on child executive functioning, stress levels and socioemotional functioning, and the roles that parenting and maternal distress play. I address three primary objectives: 1) using meta-analytic techniques, I examine the magnitude of effect of household chaos on child executive functioning based on existing literature as well as potential factors that may modulate the strength of the linkage between household chaos and child executive functioning; and using cross-sectional data, I examine 2) how household chaos impacts parenting and subsequently, how parenting impacts child executive functioning; and 3) how maternal distress influences the level of chaos in the home and how this chaos impacts child stress levels and socioemotional functioning. Collectively, the results from this dissertation indicate that household chaos has a broad negative impact on child outcomes, and both parenting and maternal distress play important roles in understanding this impact. Further, it demonstrates the need for intervention research aimed at supporting the physical and psychological health of mothers, improving parenting and creating order and stability in homes for children.

Despite advances in obstetric care, hypertensive disorders continue to complicate pregnancies at a high rate. Worldwide, hypertensive disorders affect up to 10% of pregnancies. The United States has seen a 25% increase in the incidence of hypertensive disorders over the last two decades (American College of Obstetricians and Gynecologists, 2017). These complications constitute one of the greatest causes of maternal and perinatal morbidity and mortality with an estimated 50,000 to 60,000 deaths per year across the world (American College of Obstetricians and Gynecologists, 2017). Although the etiology of hypertensive disorders remains unclear, there may be an association with both maternal biological and psychological distress in the development of the disorder. Although both distress and biomarkers have been identified in association with a hypertensive disorder, little data exist examining the components of distress and the alterations in biomarkers in women developing these disorders. Due to the limited evidence, a critical need exists to examine the relationship of perceived maternal distress and biomarker measures in the development of a hypertensive disorder during pregnancy in order to better understand this phenomenon. The purposes of this dissertation were to: 1) understand the experience of having a hypertensive disorder during pregnancy; 2) to investigate the association of perceived stress and changes in immune response via biomarker measures in women who develop a hypertensive disorder during pregnancy; 3) to review, summarize, and evaluate the literature examining the relationship between perceived maternal distress (stress, anxiety, and depression) and the development of a hypertensive disorder; and 4) to investigate the association of perceived distress in the development of a hypertensive disorder during pregnancy. Data obtained from a qualitative study of women with a hypertensive disorder during pregnancy placed on bed rest reported several stressors associated with the experience. These stressors related to differing and often conflicting management plans by different providers and not feeling providers heard their concerns. The evidence supports these women experience stress during this pregnancy complication. Analysis of data obtained at each trimester of pregnancy did identify differences in biomarker levels based on perceived stress and women with a hypertensive disorder and those without a hypertensive disorder. Evidence from a systematic review of literature supporting maternal distress in the development of a hypertensive disorder was mixed. However, few studies existed and of those reviewed, most lacked rigor. Analysis of data obtained early and late in pregnancy did not indicate a relationship between psychological distress and the development of a hypertensive disorder in pregnancy. Women with a higher BMI were 12% more likely to develop a hypertensive disorder. The factors associated with the development of a hypertensive disorder are complex. Maternal perceived stress and inflammatory responses differ between women with a hypertensive disorder and those without a hypertensive disorder in pregnancy; however maternal distress did not differ between groups. Body mass index was associated with the development of hypertension in pregnancy. Clinicians need to include assessment of maternal BMI as a modifiable risk factor in the development of a hypertensive disorder during pregnancy. In addition, although psychological distress was not associated with the development of a hypertensive disorder, women still suffer with components of distress. Clinicians could identify and support women experiencing distress thereby promoting a healthier pregnancy.

Mothers of children with autism face unique challenges that can negatively impact their well-being. Frequently, these challenges require elevated amounts of time, energy, and money to address. In an effort to investigate a low-demand approach to improving well-being, this study employed a signature strengths intervention with mothers of children with autism. Thus far, research on signature strengths with this specific population is very limited. Five mothers of children with autism participated in the study. All were married and highly educated. Four identified themselves as white, one as Hispanic. They ranged in age from 25-44. Each mother had between one and three children with autism. The participants attended an online meeting with the researcher after identifying their strengths. During the meeting, they discussed ways they already used their strengths, as well as more ways they might use them in the future. The participants then entered a four-week practice period. Each week they focused on one strength, aiming to use each strength in three new ways over the allotted seven days. The participants completed surveys to measure parental distress and life satisfaction at three points: baseline, immediately after a four-week intervention phase, and one month after the end of the intervention phase. Additionally, they answered a daily question that queried life satisfaction on a Likert-scale throughout the baseline and intervention phases. Overall, the group reported a decrease in parental distress and an increase in their level of life satisfaction and daily satisfaction. These results add to other research that has found beneficial outcomes for mothers of children with autism who are taught to use their strengths more often. The use of signature strengths interventions could help to address a critical need among this group of mothers: mental health support that does not require excessive effort or time.

La dimension intersubjective familiale du devenir mère lors de la période sensible du post­ partum a été peu abordée en psychanalyse ou dans les autres courants en psychologie. Hypothèses : le défaut d'étayage de la famille dans l'immédiat post-partum impacte les processus de la maternalité chez la mère : son état psychique (dépression et anxiété), sa préoccupation primaire et sa rêverie, ainsi que le destin de ses motions hostiles dans ses relations. Approches épistémologiques : la psychologie clinique et la psychopathologie avec d'autres apports. Méthode mixte (clinique et quantitative) longitudinale et comparative sur une population de 35 familles. Outils : des entretiens, des temps d'observations et des auto-questionnaires évaluant l'état psychique de la mère (EPDS et STA I), ses relations conjugales (EAD), parentales (IAP) et ses ressources internes (RSQ et PBI). Résultats : les mères qui ont peu bénéficié de soutien familial sont plus nombreuses à présenter des signes de détresse psychique et ces signes perdurent dans le temps, 6 mois après la naissance de leur enfant. L'analyse de trois cas cliniques permet de suivre dans le temps la complexité des processus de la maternalité, leurs liens avec l'étayage familial et les facteurs intra-psychiques , intersubjectifs et sociétaux qui les soutiennent ou au contraire les fragilisent. Les motions hostiles de la mère, non contenues par la famille élargie, alimentent sa détresse et l'ensemble de ses relations, avec le conjoint, le père et/ou l'enfant. Conclusion : le travail psychique nécessaire dans le post-partum immédiat du devenir mère ne peut être envisagé sans son réseau d'étayage familial. Celui-ci est en interaction avec ses appuis internes et dépend des relations avec le père. Le contexte social l'influence. Conséquences : cette recherche montre l'importance de prendre en compte,chez la mère, le besoin dans la réalité du soutien de sa famille juste après la naissance et la mise en place d'étayage professionnel adapté. / The intersubjective family dimension of becoming a mother during the sensitive postpartum period has been little discussed in psychoanalysis or in other currents in psychology. Hypotheses: the lack of family's shoring in the immediate post-partum impact the motherhood processes: her psychic state (depression and anxiety). the establishment of maternai processes (primary maternai concern and maternai reverie), as well as the fate of her hostile motions in her relations. Epistemological approaches: clinical psychology and psychopathology with other contributions. Longitudinal and comparative mixed (clinical and quantitative) method in a sample of 35 families. Tools : interviews. observations and self-questionnaires assessing the psychic state of the mother (EPDS and STAI). her conjugal relationship (DAS), parental relationship (PAi) and her internai resources (RSQ and PBI). Results: Mothers with little family support are more likely to show signs of psychic distress and these signs persist over time, 6 months after the child birth. The analysis of three clinical cases makes it possible to follow over time the complexity of maternai processes, their links with family's shoring and the intra-psychic, intersubjective and societal factors that support or weaken them. The mother's hostile motions. not contained in the extended family, fuel her distress and her whole relationship with the spouse. father, and / or child. Conclusion: the necessary psychic work of becoming a mother in the immediate postpartum can not be considered without her family support network. This one is in interaction with her internai supports and depends on the relations with the father. The social context influences it. Consequences: this research shows the importance of taking into account, for the mother, the need in reality of the family support just after the birth and the setting up of adapted professional support.

Magister Artium - MA (Psychology) / Psychological distress during pregnancy has been a fairly neglected phenomenon and has only recently started emerging as an area of research interest. The existing body of scholarship on distress during pregnancy has largely been conducted from a positivist paradigm, emphasising the identification, incidences and risks. There is thus a dearth of qualitative inquiry into pregnant women's experiences and accounts of distress. In an attempt to address these gaps within the literature, my study explored psychological distress among a group of pregnant women from socio-economically disadvantaged contexts. The specific objectives of my study was to explore how pregnant women conceptualised psychological distress within the context of pregnancy; the feelings or symptoms of psychological distress; what pregnant women perceived as its causes; and the psychosocial needs of pregnant women in relation to antenatal distress. This study was guided by a feminist approach and a feminist standpoint epistemology in particular. This lent itself to exploring the phenomenon while departing from a clinical, decontextualised position which translated into an investigation with pregnant women who subjectively perceived themselves to be distressed.