Abstract Background Exposure to family adversities including domestic violence, parental mental ill-health, and poverty in childhood increases the risk of self-harm and suicide attempts in adolescents. However, few studies have assessed the influence of clustered family adversity and poverty trajectories throughout childhood on self-harm behaviours and suicide attempts. Methods In this population-based longitudinal study, we used data on 9316 children from the UK Millennium Cohort Study. Exposure trajectories of poverty and family adversities were characterised using group-based multi-trajectory models (age 9 months−14 years). Multivariable logistic regression models were used to examine the association of trajectories with self-harm and suicide attempts at age 17. Population-attributable fractions were calculated to quantify the contribution of family adversity and poverty to the outcomes at the country level. Results Of 9316 participants, 2087 (22.4%) reported self-harm behaviours and 659 (7.1%) had made a suicide attempt. Compared with children experiencing low poverty and adversity, children in the persistent adversity groups were more likely to report both self-harm and suicide attempts; those exposed to persistent poverty and poor parental mental health were particularly at increased risk of self-harm (OR = 1.71, 95% CI: 1.30–2.24) and suicide attempts (OR = 3.98, 95% CI: 2.76–5.74). Overall, we estimated that about 13.2% of self-harm behaviours and 36.9% of suicide attempts were attributable to persistent family adversities and poverty. Conclusions Children growing up with persistent exposure to family adversities and poverty are more likely to harm themselves and attempt suicide, particularly those who experience the combination of persistent poverty and long-term poor parental mental health. Early detection of children at risk and intervention such as anti-poverty approaches to prevent long-lasting adversities are key to alleviating risky behaviours in UK adolescents.

IntroductionIn spite of extensive evidence on the predictors of infant-related mind-mindedness (MM) in the Western context, its relevance to South Asian mothers is largely unexplored. The study examined whether mothers' own recalled parental bonding and exposure to domestic violence (DV) in the post-natal period are associated with their later caregiving behavior, assessed as infant-related mind-mindedness (MM) in a community sample of urban Indian mothers. In addition to testing the independent contribution of recalled parental bonding and post-natal DV to MM, we further examined whether presence of DV at any point during the first year postpartum, conceptualized as a significant relational stressor, might moderate any associations observed between recalled parental bonding and MM. This hypothesis was informed by theoretical perspectives suggesting that early relational experiences may increase vulnerability to maladaptive relational dynamics and later victimization in adulthood, with cumulative stressors potentially disrupting maternal representations and caregiving behavior.MethodsData from a subsample of 338 mothers was analyzed from the Bangalore Child Health and Development Study. MM was coded from Five-Minute Speech Samples obtained at infant age 1 year. Mothers' recalled parental bonding was assessed on the Parental Bonding Instrument. Presence of postpartum DV was assessed with the Indian Council of Medical Research-Domestic Violence Scale. Multiple linear regression and moderation analyses were conducted.ResultsAfter adjusting for sociodemographic variables and verbosity, recalled high maternal care marginally predicted MM (β = 0.137, p = 0.065), albeit at trend-level significance. We did not find any main effects of recalled paternal care, maternal and paternal overprotection, or post-natal DV in predicting MM. No significant interaction between DV during first year postpartum and recalled parental care or overprotection in predicting MM was observed.ConclusionThe study findings provide tentative support for intergenerational transmission of parenting. To our knowledge, this is the first study in South Asia examining the association of recalled parental bonding and levels of mind-mindedness among parents of young infants. These findings require replication in populations who typically demonstrate higher levels of MM. The study highlights the need for careful consideration of socio-cultural context, emphasizing the need for culturally-informed measurement approaches to capture maternal representation of infants and perception of parenting in non-Western contexts.

BACKGROUND:Children with conduct problems are at high risk of persisting mental health problems, making them a priority for early intervention. Group-based parent-training is effective but with a substantial failure rate. Based on evidence on the value of involving children, we developed Reflective Interpersonal Therapy for Children and Parents, (RICAP). We report feasibility and outcomes from the first pilot trial of an intervention for children with conduct problems persisting after parent training. In contrast to most studies, we used both parent and teacher report. METHODS:The sample comprised 105 children and their parents aged 4-10 years inclusive referred to UK Child and Adolescent Mental Health Services (CAMHS) with conduct problems. All were offered the Incredible Years (IY) parent training intervention, and parents provided pre- and post-treatment measures (including CBCL, SDQ). Children still above clinical threshold after IY were randomized either to RICAP or to usual CAMHS treatment (CTAU) with follow up 8 months later. Only those randomized to CTAU could receive school-based interventions. Trial Registration Number: ISRCTN25252940. RESULTS:Feasibility was supported by high retention through the initial IY (102/105) and subsequent RCT phases of the study (58/70 eligible for randomization). The majority of those randomized to RICAP attended for 11/14 or more sessions, reflecting its high acceptability to both children and parents. By parent report RICAP was superior to CTAU on CBCL externalising (d = 0.32) and internalising (d = 0.42) problems, while by teacher report CTAU was superior on SDQ total problems (d = 0.32) and reactive aggression (d = 0.27). CONCLUSIONS:We provide first evidence of the feasibility of a design in which non-responders to parent training are randomized to novel intervention or control conditions. Outcomes were different for parent and teacher reports, highlighting for future randomized controlled trials the need to attend to possible reporter and treatment context variations.

BackgroundMental health problems are common among women during the perinatal period (here defined as during pregnancy and the 2 years after birth), affecting up to 20% of women. Although there are effective treatments for perinatal mental health problems, ethnically diverse women who are at higher risk of developing perinatal mental health problems are less likely to access treatment for their perinatal mental health problems. This study explored perceptions of perinatal mental health problems and barriers to accessing treatment amongst a sample of ethnically diverse women with current or past experiences who did not receive help from a specialist team.MethodsThis study is qualitative primary research. Twenty-eight women living in England who reported they struggled with emotional and mental health challenges during their perinatal period but did not receive assistance from the specialist perinatal mental health team were recruited from community groups and adverts. Women participated in online interviews, which were transcribed. NVIVO was used to support a thematic analysis.ResultsThe study revealed that substantial barriers to seeking help arise from women's interactions with their healthcare professionals. When women feel a lack of trust, experience discrimination, or sense judgment from healthcare providers, they are less inclined to seek assistance. However, the motivation to seek help is significantly shaped by community perceptions of perinatal mental health issues, particularly for those women who have made efforts to access support. Women had a positive experience in peer support groups.ConclusionA significant barrier to accessing perinatal mental health services for ethnically diverse women is experiences with health professionals. Moreover, women from ethnically diverse groups may encounter additional problems regarding help-seeking due to cultural influences and attitudes towards mental health and motherhood roles. Hence, the intricate interplay between cultural factors and healthcare experiences highlights the urgent need for a more culturally competent approach to perinatal mental health services.

This study examined whether findings from High-Income Countries (HIC) suggesting that (1) maternal postnatal depression (PND) is associated with poorer infant neurodevelopmental outcomes, (2) maternal sensitivity to non-distress (SND) is associated with improved outcomes, (3) SND may buffer the effect of PND, are present in India. Participants were from the Bangalore Child Health and Development Study (BCHADS), a prospective longitudinal cohort study starting in pregnancy (n = 337). Mothers self-reported depression symptoms on the Edinburgh Postnatal Depression Scale; variables reflecting early PND (8 weeks) and chronic PND (factor score created from 8 weeks, 6, 12, 24 months) were examined. SND was coded from a semi-structured play observation at age 6 or 12 months. Infant neurodevelopment was assessed at 24 months using the Bayley Scales of Infant Development. Early PND, chronic PND or maternal SND were not associated with infant cognitive or language development in the whole sample, but in boys increased maternal SND was associated with improved language development. SND did not moderate associations between maternal PND and outcomes. A number of factors, such as parity, birthweight by gestational age, and the presence of an alternate caregiver, demonstrated small but significant sex-specific associations with neurodevelopment in exploratory analyses. Maternal SND was associated with improved language outcomes after accounting for multiple risks, but only in boys. Future work should examine whether broader aspects of the nurturing environment contribute to neurodevelopment in a sex-specific manner.

Background There is no recommended measure of parent-infant interaction that is psychometrically robust, feasible (i.e., brief and simple to use) and validated for use from birth to 12 months for routine use in Perinatal Mental Health Services (PMHS). This study tested the cross-sectional construct validity of the global sensitivity scale and a sensitivity composite from the NICHD Parent-Infant Interaction scales in a clinical sample of parents and babies, and the inter-rater reliability of all the NICHD scales in a sub-sample of dyads with infants under 3 months of age.Methods Secondary analysis using parent-infant interaction videos from a Randomized Controlled Trial in specialist PMHS in England were used. Participants were 275 dyads who completed baseline self-reports (parental mental health symptoms, parent-reported bonding) and parent-infant observation tasks where sensitivity was measured (free play, book sharing, clothing change). Parents with infants over 2 months of age (N = 180), also completed measures of child development. Non-parametric correlations and linear regression were conducted to assess construct validity and intra-class correlations were conducted to evaluate inter-rater reliability.Results Amongst dyads with infants 0-3 months, inter-rater reliability was good for the global and composite sensitivity scale, but poor-to-moderate for the scales of parental intrusiveness, dyadic mutuality and the infant scales. In the full sample of dyads, there was a small but significant negative association between the global and composite sensitivity scales and parental mental health symptom severity, but this association was not statistically significant when sensitivity was observed in the free play alone. In terms of child development, greater sensitivity was only associated with fewer socio-emotional problems when it was observed during the clothing change task. There was a statistically significant negative association between observed sensitivity and bonding difficulties, and the strength of this association was greater for younger infants than older infants.Conclusion These findings contribute to the evidence base of the NICHD scales in a PMHS setting and suggest ways that the clinical utility of the NICHD scales could be improved for routine practice.

In spite of extensive evidence from studies in the Western contexts that maternal sensitivity and infant temperament are associated with emotional and behavioural adjustment in early childhood, we do not know whether this is the case in non-western cultural contexts. We investigated whether early maternal sensitivity to infant's distress and irritable infant temperament predict child's externalizing and internalizing problems at age 1, and whether maternal sensitivity to distress moderated the association between irritable temperament and child mental health outcomes in a sample of mother-infant dyads in India. The sample comprised 195 dyads taking part in the Bangalore Child Health and Development Study (BCHADS) in India. Maternal sensitivity to distress was assessed during a video-recorded free-play interaction at age 6 months and coded using the National Institute of Child Health and Human Development (NICHD) coding scheme. Infant irritable temperament (distress to limitations) was assessed at 6 months using a validated 8-item subset of Infant Behavior Questionnaire - Revised (IBQ-R), and child internalizing and externalizing problems at 1 year using the Brief Infant Toddler Social Emotional Assessment (BITSEA) respectively. Data was analyzed using regression and moderation analysis. After accounting for socio-demographic confounders and maternal depressive symptoms at the time of outcome report, maternal sensitivity to distress and infant's irritable temperament at 6 months independently predicted externalizing behaviors at age 1. High infant irritability and low maternal sensitivity functioned as distinct, additive risks; no significant moderation effect was observed. Neither predictor was associated with internalizing problems. These findings provide the first evidence from India linking early sensitivity to distress with externalizing problems, and are not dissimilar to those reported in Western settings. The independent contributions of temperament and maternal sensitivity suggest a two-pronged intervention approach: enhancing maternal sensitivity while simultaneously providing specific support for parents of irritable infants.

Purpose: Existing evidence supports an association between intimate partner violence (IPV) in pregnancy and poor breastfeeding outcomes. However, most studies do not differentiate psychological and physical IPV, and all existing studies focus on partner-perpetrated IPV only. In this study we examine prospective associations between partner and mother-perpetrated physical and psychological IPV in pregnancy and breastfeeding intentions during pregnancy, and exclusive breastfeeding status at 6 weeks postpartum. Methods: Participants are members of a stratified high risk sub-sample of the Wirral Child Health and Development Study (WCHADS), a prospective UK birth cohort, who provided data during pregnancy and 9 weeks postnatally (N=260). IPV was assessed at 32-weeks’ gestation using questionnaire and interview. Mothers’ reported breastfeeding intention in pregnancy and breastfeeding status at 6 weeks post-birth. Logistic regression models were used to estimate adjusted odds ratios (aORs) for breastfeeding intention and breastfeeding at 6 weeks post-birth, controlling for relevant sociodemographic variables. Results: Psychological IPV during pregnancy (prevalence 31.9%) was associated with increased likelihood of not exclusively breastfeeding at six weeks post-birth (aOR=2.37; 95%CI: 1.18, 4.75). Physical IPV (prevalence 18.8%) was not associated with breastfeeding outcomes. When partner and mother perpetrated IPV were examined separately, the size of associations were very similar (aOR=1.82, [95%CI .68, 4.86], aOR=1.77, [95% CI .88, 3.56] respectively). Conclusion: Psychological IPV during pregnancy was associated with an increased likelihood of not exclusively breastfeeding, and associations are similar regardless of whether the partner or mother is the perpetrator. Future research should further explore the mechanisms linking psychological abuse to breastfeeding outcomes.

IntroductionEvolutionary hypotheses propose that fetuses show “predictive adaptive” responses to the prenatal environment based on likely continuity with the postnatal environment, and males and females have different adaptive priorities. Female adaptations appear to implicate hypothalamic-pituitary-adrenal (HPA) axis mechanisms moderated by early tactile stimulation. Based on these hypotheses we predict that lack of prenatal-postnatal environmental continuity (mismatch), will be associated with poorer outcomes in females, an effect that will be ameliorated by tactile stimulation. We previously reported that this prediction was supported by evidence from the Wirral Child Health and Development Study (WCHADS) of a three-way interaction between maternal prenatal anxiety, postnatal anxiety, and infant stroking in the prediction of irritability at age 7 years, seen only in girls. Here, we ask whether this effect persists over another 6 years into early adolescence.MethodsMothers in a general population cohort (WCHADS) provided self-reported anxiety scores at 20 weeks of pregnancy, and at 9 weeks, 14 months and 3.5 years postpartum, and frequency of infant stroking at 9 weeks. Their children self-reported symptoms of depression in early adolescence at age 13 years. Structural equation modelling (SEM) with maximum-likelihood estimation was conducted using data from N = 695 mother-child dyads.ResultsThere was a three-way interaction between prenatal and postnatal anxiety and maternal stroking in the prediction of early adolescent depression, seen only in girls, consistent with our previous reports. When examining self-reported depression at age 13 years, increased stroking was associated with decreased symptoms of depression in girls in the mis-match group characterised by low prenatal and high postal anxiety, but not the high prenatal and low postnatal mis-match group.DiscussionWe provide preliminary novel evidence that mechanisms likely to have evolved well before the emergence of humans, contribute to the risk of adolescent depression in girls. These findings have implications for understanding developmental origins of sex differences in adolescent depression.

Stark socioeconomic inequalities in childhood mental health have been widely reported. Understanding whether they vary with age, by type of difficulty or sex can inform public health policies to tackle socioeconomic inequalities. We investigated the effects of early life childhood socioeconomic circumstances (SECs) (maternal education and household income) on developmental trajectories of externalising and internalising difficulties in childhood and adolescence, in males and females from the UK-representative Millennium Cohort Study (N = 15383). We estimated the Slope Index of Inequality (SII) (absolute difference between the most versus least advantaged) using linear mixed-effects regression models, on parent-reported Strengths and Difficulties Questionnaire externalising and internalising difficulties score, at 5, 7, 11, 14, and 17 years(y). The mean externalising score was high at 5y (4.8 [95 %CI: 4.7, 4.9]) and decreased slightly, while mean internalising score increased over childhood, reaching 3.9 [3.8, 4.1] by 17y, with a steeper trend for females in adolescence. Lower maternal education was associated with greater externalising scores at 5y (SII, Male: 3.0 [2.7 to 3.3]; Female: 2.7 [2.4, 3.0]) with inequalities decreasing slightly up to 17y (SII Male: 2.4 [2.0 to 2.7], Female: 2.5 [2.1, 2.8]). Inequalities in internalising scores increased slightly over childhood (SII Female 5y: 1.3 [1.1, 1.6]; 17y: 1.9 [1.5, 2.3]; SII Male 5y = 1.6 [1.3, 1.8], 17y = 1.8 [1.5, 2.2]). Patterns were similar using household income. Disadvantaged SECs are associated with persistently higher levels of parent-reported mental health difficulties up to 17y, with larger effects on externalising than internalising difficulties, but little differences by sex or socioeconomic measure.

Background Children with conduct problems are at high risk of a wide range of mental health problems in later life, making them a priority for early intervention. Group-based parent-training is known to be effective but with a substantial failure rate. Based on evidence of the value of involving children, we developed Reflective Interpersonal Therapy for Children and Parents, (RICAP). We report here, feasibility and outcomes from the first trial of an intervention for children with conduct problems persisting after parent training. In contrast to most other studies, we used both parent and teacher report. Methods The sample comprised 105 children and their parents aged 5-10 years referred to UK Child and Adolescent Mental Health Services (CAMHS) with conduct problems. All were offered the Incredible Years (IY) parent training intervention, and parents provided pre- and post-treatment measures (including CBCL, SDQ). Children still above clinical threshold after IY were randomized either to RICAP or to usual CAMHS treatment (CTAU) with follow up 8 months later. Trial Registration Number: [ISRCTN25252940][1]. Results Feasibility was supported by high retention through the initial IY (102/105) and subsequent RCT phases of the study (58/70 eligible for randomization). The majority of those randomized to RICAP attended for 11/14 or more sessions, reflecting its high acceptability to both children and parents. By parent report RICAP was superior to CTAU on CBCL externalising (d=0.32) and internalising (d=0.42) problems, while by teacher report CTAU was superior on SDQ total problems (d=0.32) and reactive aggression (d = 0.27). Conclusions We provide first evidence of the acceptability and effectiveness of a novel intervention for children with persisting conduct problem following parent training. We also find differences between parent and teacher reported outcomes, pointing either to reporter or social context effects, both of which need to be addressed in future research. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Trial ISRCTN25252940 ### Funding Statement NHS National Research and Development Programme on Forensic Mental Health. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Liverpool Children's Research Ethics Committee of Cheshire and Merseyside NHS Health Authority gave ethical approval for this work. Wirral Research Ethics Committee of the Wirral National Health Service gave ethical approval for this work. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The participants of this study did not give written consent for their data to be shared publicly, so due to the sensitive nature of the research supporting data is not available. [1]: /external-ref?link_type=ISRCTN&access_num=ISRCTN25252940

Background:Perinatal mental health disorders affect one in five mothers during pregnancy or within 2 years post childbirth. These disorders can lead to poor pregnancy and childbirth outcomes and maternal deaths. Additionally, they negatively affect a child's cognitive, social and emotional development. Stigma and a lack of specialised services have limited access to mental health care. National Health Service England invested £365M in community perinatal mental health teams, but their impact on women and infants' outcomes are not known. Develop a taxonomy of community perinatal mental health teams (work package 1). Compare and validate two assessments of quality of mother-infant interaction for use by community perinatal mental health teams (work package 2). Evaluate the effectiveness and cost-effectiveness of community perinatal mental health teams (work packages 3 and 4). Design:Mixed-methods study. Setting:Community perinatal mental health teams in England. Participants:Women who were pregnant or within 2 years postnatal. Methods and outcome measures:Work package 1: Typology of community perinatal mental health teams in England. Work package 2: Reliability and validity of two observational assessments of parent-infant interaction. Work package 3: Realist evaluation interviews with women, partners/close others, and staff to determine effective community perinatal mental health team components. Work package 4: Analysis of linked data: Association of community perinatal mental health teams with access to secondary care mental health services. Risk of acute relapse and improved obstetric and neonate outcomes for women with pre-existing severe disorders in areas with community perinatal mental health teams compared to generic services. Economic analysis of cost of community perinatal mental health teams. Results:Objective 1: Community perinatal mental health team typologies revealed in 2020, 84% had basic staffing levels and 63% had more multi-professionals. Objective 2: The 'Parent Infant Interaction Observation Scale' and 'National Institute of Child Health and Human Development' assessments of mother-infant interaction were reliable and valid; the National Institute of Child Health and Human Development is more suitable for community perinatal mental health teams. Objective 3: Work package 3: Interviews with 139 women, 55 partners/close others and 80 health workers highlighted the importance of specialist perinatal knowledge, responding in a warm and non-judgemental way, working closely with other healthcare providers, optimising medication, supporting mothers to reduce conflict and improve social support, helping mother-infant bonding, and teaching emotional management. Work package 4: Analysis of linked health data revealed higher risks for obstetric and neonate problems in women with severe mental health disorders, particularly recent or very serious episodes. Work package 4: Areas with community perinatal mental health teams saw increased mental health access among perinatal women and reduced need for acute care, albeit at a higher cost and with greater neonatal risks. Limitations:High levels of missing data on diagnosis and mental health outcomes in existing health and service data. Lack of data on child outcomes. Evaluation occurred during community perinatal mental health team changes and the coronavirus disease discovered in 2019 pandemic limiting a full assessment of the impact of community perinatal mental health teams on maternal and child outcomes. Conclusions:Community perinatal mental health teams can support perinatal women with complex, moderate/severe mental health disorders, but further attention to women's physical needs is essential. The use of observational assessments of parent-infant relationships will enhance the evaluation of community perinatal mental health teams' impact on infant outcomes. Future work:Research should focus on prospective studies that gather mental health and child outcomes from community perinatal mental health teams and primary care mental health, to assess broader impacts of perinatal-specific treatment across care pathways. Study registration:This study is registered on Research Registry as researchregistry5463. Funding:This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 17/49/38) and is published in full in Health and Social Care Delivery Research; Vol. 13, No. 38. See the NIHR Funding and Awards website for further award information.

Background: Mother-adolescent interactions are important for adolescents’ emotional development, but few studies have assessed patterns of mothers’ or adolescents’ emotional expressions using ecologically valid tools. This study investigates patterns of emotional expression in mothers and adolescents using video filmed with head cameras during a novel interaction task. Methods: Participants were 26 mother-adolescent dyads (13 boys and 13 girls) from the Wirral Child Health and Development Study. Mothers and adolescents played a card game answering questions about each other whilst wearing head-cameras. Card responses were coded as correct and incorrect. The intensity of mother and adolescent emotional expressions was analysed by AI software FaceReader and collapsed into three categories: positive, negative, and neutral. Linear regressions tested the following preregistered hypotheses: (H1) mother and adolescent emotional expressions are positively associated; (H2) mothers display more positive emotions than their adolescents; (H3) mothers express more positive and neutral emotions when their adolescents are negative, whereas adolescents react more negatively to their mothers’ negativity; (H4) both mothers and adolescents display more positive emotions during agreements than during disagreements; and (H5) mothers express greater emotional variability during disagreements than during agreements. Results: Mothers demonstrated higher emotional variability during periods in which adolescents expressed a higher intensity of negative emotions, supporting H1 and H3, and expressed higher intensity of positive emotions compared to adolescents, supporting H2. There was no evidence to support H4 and H5. Conclusions: Mothers express greater positive emotional intensity than their adolescents and a wider range of emotional expressions in response to their adolescents’ negative emotions. This could inform parenting interventions and advice around the de-escalation of negative emotional states in adolescents.

BACKGROUND: Intimate partner violence (IPV) against women is a public health concern and a human rights violation. Women in low- and middle-income countries such as India experience higher rates of violence than in high-income countries. Experiencing IPV during pregnancy is associated with worse maternal, foetal and child outcomes. There is relatively limited representative population-based data on the burden and related factors of IPV experienced by women during pregnancy in India. This study aimed to ascertain the prevalence of experiences of physical IPV during pregnancy and the factors associated with it in India. METHODS: This is a secondary analysis of data collected in the Fifth Indian National Family Health Survey (NFHS-5). The primary outcome was lifetime experience of physical violence during pregnancy perpetrated by a former and/or current partner. The relationship between this outcome and sociodemographic, relationship, societal and gender-based factors characteristics were examined. Data were analysed using multivariable logistic regression. RESULTS: Among 60,579 women who had ever been married or in a union and ever been pregnant, the lifetime prevalence of physical IPV during pregnancy was 2.4%. Experience of physical violence during pregnancy was significantly more common among women experiencing diverse social and economic disadvantages such as low household wealth, being a member of a scheduled caste, or a religious minority. Women whose partners had lower educational status or who drank alcohol had higher odds of experiencing IPV during pregnancy. It was less common among women who were more empowered including having more decision-making autonomy. CONCLUSION: Despite low prevalence, the absolute numbers of women experiencing physical IPV during pregnancy in India are alarmingly high. There is an urgent need to screen and provide early interventions for IPV during pregnancy in India. Further research is needed to identify the prevalence of other forms of intimate partner violence including sexual and emotional abuse, financial abuse and coercive control experienced by women who are pregnant in India.

Background Externalising and internalising behaviours in childhood are an indicator of the risk of developing psychopathological outcomes in adulthood. Studying the effect of gene X environment interactions on these behaviours helps in a deeper understanding of the developmental origins of these behaviours.The interaction between genetic predispositions and environmental factors is complex and intricate. Understanding the specific influence of each factor and confounding effects transgenerationally helps in better prediction of the effects of gene X environment interaction on behavioural outcomes.The current study aims to find the relationship of maternal prenatal depression and child DRD4 as well as 5HTTLPR VNTR on internalising and externalising behaviour of the child at 2 years of age. Methods Data from 196 mother-child dyads in the Bangalore Child Health and Development Study, recruited from urban primary health care centres in Bengaluru, India was used. Prenatal maternal depression in the third trimester (T3 dep) and post-partum maternal depression (2Yr dep) were measured using Edinburgh Postnatal Depression (EPDS) scores. Child externalising and internalising behaviour at 2 years were measured using the Brief Infant-Toddler Social and Emotional Assessment (BITSEA) scores.The DRD4 and 5HTTLPR VNTR assay was performed in the DNA extracted from child saliva samples using PCR. The 5HTTLPR VNTR was categorised as high expression containing 16R/16R repeat genotype and low expression genotype containing 14R/16R and 14R/14R repeats. The DRD4 VNTR was categorised as high expression 2R/2R genotypes and other low expression genotypes for further analysis. (Chen et al., 2022; Green et al., 2017).A multi-locus genetic profile was obtained by identifying the presence or absence of one or more risk genotypes in both VNTRs combined. The statistical analysis was performed using SPSS 21. Results The hierarchical multiple regression (HMR) analysis for child internalising and externalising behaviour at 2 years was conducted individually with four blocks of variables. The first block included the covariates (2Yr dep, maternal age, family income, maternal education, and sex of the child). The second block had 5HTTLPR or DRD4 VNTR or multi-locus genetic profiles in different hierarchical regression models. The third Block consisted of T3 dep scores and the fourth block had the interaction term for the T3 dep and the genotype.1.The HMR models for child externalising behaviour were significant for all blocks (p < 0.007).T3 dep, 5HTTLPR VNTR, showed a significant association (b=0.952, t=1.976, p=0.050; b=0.107, t=2.518, p=0.013) with the child externalising behaviour after controlling for the covariates. DRD4 VNTR and multi-locus genetic profile did not show a significant association.Overall, when the 5HTTLPR genotype was included in the model it explained 10.1% of the variance and T3 dep explained 10.5-13% variance independent of the covariates.2.The child internalising score at 2 years did not show any significant association. Discussion The results underscore the importance of both genetic effect of 5HTTLPR and environmental contributions from prenatal depression and postnatal depression in determining the child behavioural outcomes. However, the G x E interaction was not significant. Further studies with a larger sample size are required to understand the same across different time points.

Background Pregnant women with pre-existing mental illnesses have increased risks of adverse obstetric and neonatal outcomes compared with pregnant women without pre-existing mental illnesses. We aimed to estimate these differences in risks according to the highest level of pre-pregnancy specialist mental health care, defined as psychiatric hospital admission, crisis resolution team (CRT) contact, or specialist community care only, and the timing of the most recent care episode in the 7 years before pregnancy. Methods Hospital and birth registration records of women with singleton births between April 1, 2014, and March 31, 2018 in England were linked to records of babies and records from specialist mental health services provided by the England National Health Service, a publicly funded health-care system. We compared the risks of adverse pregnancy outcomes, including fetal and neonatal death, preterm birth, and babies being born small for gestational age (SGA; birthweight <10th percentile), and composite indicators for neonatal adverse outcomes and maternal morbidity, between women with and without a history of contact with specialist mental health care. We calculated odds ratios adjusted for maternal characteristics (aORs), using logistic regression. Findings Of 2 081 043 included women (mean age 300 years; range 18-55 years; 777% White, 114% South Asian, 47% Black, and 62% mixed or other ethnic background), 151 770 (73%) had at least one pre-pregnancy specialist mental health-care contact. 7247 (03%) had been admitted to a psychiatric hospital, 29 770 (14%) had CRT contact, and 114 753 (55%) had community care only. With a pre-pregnancy mental health-care contact, risk of stillbirth or neonatal death within 7 days of birth was not significantly increased (045-049%; aOR 111, 95% CI 099-124): risk of preterm birth (<37 weeks) increased (65-98%; aOR 153, 135-173), as did risk of SGA (62- 75%; aOR 134, 130-137) and neonatal adverse outcomes (64-84%; aOR 137, 121-155). With a pre-pregnancy mental health-care contact, risk of maternal morbidity increased slightly from 09% to 10% (aOR 118, 112-125). Overall, risks were highest for women who had a psychiatric hospital admission any time or a mental health-care contact in the year before pregnancy. Interpretation Information about the level and timing of pre-pregnancy specialist mental health-care contacts helps to identify women at increased risk of adverse obstetric and neonatal outcomes. These women are most likely to benefit from dedicated community perinatal mental health teams working closely with maternity services to provide integrated care.

Background Women with a pre-existing severe mental disorder have an increased risk of relapse after giving birth. We aimed to evaluate associations of the gradual regional implementation of community perinatal mental health teams in England from April, 2016, with access to mental health care and with mental health, obstetric, and neonatal outcomes. Methods For this cohort study, we used the national dataset of secondary mental health care provided by National Health Service England, including mental health-care episodes from April 1, 2006, to March 31, 2019, linked at patient level to the Hospital Episode Statistics, and birth notifications from the Personal Demographic Service. We included women (aged >= 18 years) with an onset of pregnancy from April 1, 2016, who had given birth to a singleton baby up to March 31, 2018, and who had a pre-existing mental disorder, defined as contacts with secondary mental health care in the 10 years immediately before pregnancy. The primary outcome was acute relapse, defined as psychiatric hospital admission or crisis resolution team contact in the postnatal period (first year after birth). Secondary outcomes included any secondary mental health care in the perinatal period (pregnancy and postnatal period) and obstetric and neonatal outcomes. Outcomes were compared according to whether a community perinatal mental health team was available before pregnancy, with odds ratios (ORs) adjusted for time trends and maternal characteristics (adjORs). Findings Of 807 798 maternity episodes in England, we identified 780 026 eligible women with a singleton birth, of whom 70 323 (9.0%) had a pre-existing mental disorder. A postnatal acute relapse was found in 1117 (3.6%) of 31 276 women where a community perinatal mental health team was available and in 1745 (4.5%) of 39 047 women where one was unavailable (adjOR 0.77, 95% CI 0.64-0.92; p=0.0038). Perinatal access to any secondary mental health care was found in 9888 (31.6%) of 31 276 women where a community perinatal mental health team was available and 10 033 (25.7%) of 39 047 women where one was not (adjOR 1.35, 95% CI 1.23-1.49; p<0.0001). Risk of stillbirth and neonatal death was higher where a community perinatal mental health team was available (165 [0.5%] of 30 980 women) than where it was not (151 [0.4%] of 38 693 women; adjOR 1.34, 95% CI 1.09-1.66; p=0.0063), as was the risk of a baby small for gestational age (2227 [7.2%] of 31 030 women vs 2542 [6.6%] of 38 762 women; adjOR 1.10, 1.02-1.20; p=0.016), whereas preterm birth risk was lower (3167 [10.1%] of 31 206 women vs 4341 [11.1%] of 38 961; adjOR 0.86, 0.74-0.99; p=0.032). Interpretation The regional availability of community perinatal mental health teams reduced the postnatal risk of acute relapse and increased the overall use of secondary mental health care. Community perinatal mental health teams should have close links with maternity services to avoid intensive psychiatric support overshadowing obstetric and neonatal risks. Copyright (c) 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.