Maternal Affective Symptoms and Infant Healthcare Utilization:

1
Maternal Affective Symptoms and Infant Healthcare
Utilization The Mediating Role of Parenting
Self-Efficacy
Tracy E. Moran, Michael W. OHara, Robert D.
Latzman Department of Psychology University of
Iowa
Assessment Schedule Time 1 On maternity
ward -Informed Consent release to obtain infant
medical records -Sociodemographic, Mini-MASQ,
MEQ Time 2, 3, 4 (2,4,6 months postpartum)
Phone Interviews -Mini-MASQ -MEQ -LIFE-II, Infant
and Maternal Treatment sections Time 4 (6 months
postpartum) Infant medical chart review
-Obtained from providers -ITI completed HYPOTHES
IZED MODEL
BACKGROUND Prior difficulties modeling child HCU
(Janicke Finney, 2001) -Very little research
specific to infants -Large degree of unexplained
variance -Child health status 1/6 of
variance Importance of caregivers (Riley et al.,
1993) -Sociodemographic, enabling,
psychosocial variables -Significant predictors
as evidence -e.g. high maternal education level,
nonworking mother, small family
size Participants Current n 32 -Projected n
200-300 women newborns Inclusion 18 yoa,
English fluency, full term infant ( 36 weeks),
singleton Exclusion -NICU treatment Maternit
y ward recruitment Maternal Predictors Maternal
HCU (Newacheck Halfon, 1986) -Support for
positive correlation w/ child HCU Parenting
Self-Efficacy (PSE) (Teti et al., 1996) -Little
research w/ HCU -Mediator between psychosocial
variables competence/ parenting
behaviors Negative Affect (NA) (Costa McCrae,
1985 Watson Pennebaker, 1989) -Strong support
for positive relation to HCU -Depression
infant HCU dose-response relationship -Anxiety
as a moderator direct predictor Measures Sociod
emographic -Self-report measure Mini-Mood
Anxiety Symptom Questionnaire (Mini-MASQ) (Clark
Watson, 1997) -26-items -General Distress
(GD), Anxious Arousal (AA), Anhedonia
(AD) Maternal Efficacy Questionnaire (MEQ)
(Teti Gelfand,1991) -10-items 9 task level,
1 global Longitudinal Interview Follow-up
Evaluation-II (LIFE-II) (Keller et al.,
1987) -Semi-structured interview -Maternal
infant HCU -Inpatient outpatient visits,
dates, phone contacts, symptoms/diagnoses,
provider, location Infant Treatment Index
(ITI) -Information from medical records
maternal report -Well baby acute visits
separate (ICD-9 codes) -Phone consultations

DISCUSSION Conclusions PSE a full mediator of
relationship between 1. Maternal AD symptoms
total infant HCU 2. Maternal GD symptoms (NA)
total infant HCU Maternal AA symptoms not a
moderator -Contrary to hypothesized
model -Consistent with AA as physiological
anxiety, not generalized worry -Worry included
in GD symptoms Sociodemographic variables not
accounting for significant variance Limitations
Preliminary report -n32 -Limits
power Generalizability -Predominantly Caucasian
sample (80.8) -Predominantly married
(83.3) -Vast majority with insurance coverage
for infant (98.7) Implications Psychological
Treatment -Infant visits used to screen for
maternal symptomatology -Early intervention/
preventative efforts -Pediatrician aid in
bolstering PSE -Decreased likelihood of negative
impact of maternal symptomatology on
infant Healthcare System -Lessened exposure
of infant to medically unfounded medical visits,
procedures, etc. -Reduced stress on infant and
family -Significant savings in time and money
for healthcare providers -Patterns of use
stable over childhood -Greater allocation of
healthcare to children in need Theoretical
-Common Sense Model (CSM) of Healthcare
Utilization (Leventhal et al, 1992) -Affective
contribution to HCU research -Emotional
response to symptom(s) partially determine
whether treatment is sought -Connection to
rumination, hypervigilance, catastrophizing
(i.e., cognitive component of
CSM) -Care-seeking as attempted emotional
regulation -Clarification of role of negative
affect in HCU -Depressive symptoms -Anxiet
y symptoms -Negative affect

Maternal AA
Maternal AD or GD
PSE
Infant HCU
Maternal AA
RESULTS Descriptives MEAN STD DEV
Maternal Age 29.5 5.4 Marital
Status ( Married) 83.3 Education (Yrs)
15.0 3.0 Race ( Caucasian) 80.8 Yea
rly Income (lt30K) 29.5 Insurance (
Insured) 98.7 Healthcare Utilization Total
Contacts 9.9 5.1 Well
Visits 4.0 1.4 Acute
Visits 4.1 3.5 Phone Contacts
1.5 2.0 MASQ (Mean of 4 Time Points)
GD Scale 12.5 3.4 AA Scale
12.5 2.1 AD Scale 17.3
4.1 MEQ (Mean of 4 Time Points) 34.6
2.8
Stepwise Regressions Dependent variable is total
infant HCU for all analyses. The following
variables were entered into Step 1 for all
analyses maternal age, marital status,
education, race, income, insurance coverage.
Alpha to enter 0.05, to remove 0.10. Mediated
Moderation Hypothesis with MASQ-AD, Only
Significant Models Reported Predictor
Variable R2? R2 Std ß p Model
1 0.18 0.18 0.42
0.02 MASQ-AD Model 2 0.15 0.33
lt0.01 MASQ-AD 0.23 0.20 MEQ
-0.43 0.02 The following
MASQ variables were entered into Step 2 AA, AD,
AAAD Mediated Moderation Hypothesis with
MASQ-GD, Only Significant Models
Reported Predictor Variable R2? R2 Std ß
p Model 1 0.20 0.20 0.44
0.01 MASQ-GD Model 2 0.16 0.36
lt0.01 MASQ-GD 0.29 0.09 MEQ
-0.43 0.01 The following MASQ
variables were entered into Step 2 AA, GD, AAGD