Erasmus MC heeft ervoor gezorgd dat je Mijn BSL eenvoudig en snel kunt raadplegen. Je kunt je links eenvoudig registreren. Met deze gegevens kun je thuis, of waar ook ter wereld toegang krijgen tot Mijn BSL.
Om ook buiten de locaties van Erasmus MC, thuis bijvoorbeeld, van Mijn BSL gebruik te kunnen maken, moet je jezelf eenmalig registreren. Dit kan alleen vanaf een computer op een van de locaties van Erasmus MC.
Eenmaal geregistreerd kun je thuis of waar ook ter wereld onbeperkt toegang krijgen tot Mijn BSL.
Login
Als u al geregistreerd bent, hoeft u alleen maar in te loggen om onbeperkt toegang te krijgen tot Mijn BSL.
Parenting is a product of complex, interactive, and interwoven factors, which are affected by a variety of characteristics, including parent characteristics and the family environment. Such characteristics, including marital dissatisfaction and poor mental health, could place infants at an increased risk for affect regulation difficulties. The current longitudinal study extended previous research by examining how multiple factors of the parenting environment are associated with infant affect regulation with mothers and fathers. Families (n = 89, primarily White) from the Southeastern United States were assessed at 4 and 8 months of age. Parent mental health (anxiety and depression symptoms, well-being) and marital satisfaction were measured by questionnaires when infants were 4 months old. Infant affect regulation was measured via infant affect observational ratings during a face-to-face play task at 4 and 8 months of age. Mothers, who were higher in well-being, had infants lower in negative affect. Infants, whose fathers were low in social anxiety and had higher marital satisfaction, had decreased levels of negative affect. Findings provide target areas for promoting infant affect regulation, such as parent marital satisfaction and parent mental health.
Opmerkingen
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
The development of regulatory abilities is a hallmark of early childhood. Although regulation development is fluid and changes throughout the lifespan, there is empirical evidence to suggest that experiences during early infancy serve as the foundation for the trajectory of regulation throughout childhood (Cole et al., 2004; Granat et al., 2017). Beginning in infancy, parents play an essential role in the development of children’s regulatory abilities (Morris et al., 2017) and subsequent child developmental outcomes, including social competence and mental health (Moutsiana et al., 2014). Ample research has demonstrated that infants’ caregiving environment is critical for fostering adaptive social and emotional competence (Doyle & Cicchetti, 2017). Research has examined the degree to which both parent intrinsic characteristics (e.g., mental health) and interpersonal factors (e.g., marital quality) place infants at an increased risk for regulation difficulties within the context of the family (Fosco & Grych, 2013; Taraban & Shaw, 2018). Parents who are sensitive, supportive, and receptive to their child’s emotional experience create contexts in which their child can learn adaptive skills, such as regulation (Fosco & Grych, 2013). However, parents’ mental health, or a lack of supportiveness or being receptive to their child’s emotions, can spill over into other aspects of the family, including the marital relationship (Fosco & Grych, 2013) or the parent-child relationship (West & Newman, 2003). When examined together, both intrinsic and relational factors can provide a rich understanding of individual differences in infant affect regulation development. The current study aimed to add to the literature by examining both intrinsic and relational factors in the same study during early infancy with both mothers and fathers.
Infant Negative Affect Regulation
The development of effective regulatory abilities, namely a child’s ability to monitor, evaluate, and adjust emotional reactions to accomplish a goal, is a central task of early childhood (Cole et al., 2004; Moutsiana et al., 2014), but individual differences do emerge in regulation abilities and strategies (Diaz & Eisenberg (2015)). The family context also plays a crucial role in the development of regulatory abilities (Morris et al., 2017). Infants become exposed to regulation through socialization of emotions and observation of their caregivers and rely heavily on parents for external regulation of emotional distress (Morris et al., 2017). Inadequate regulation development progress in childhood is a core feature of psychopathology, behavioral problems, and social and emotional issues later in development (Moutsiana et al., 2014). One commonly assessed domain during infancy is affect regulation, which refers to the external expression of emotions, moods, and feelings to reach an affective homeostasis (Taipale, 2016). Affect dysregulation is characterized by children’s inability to successfully obtain affective homeostasis due to failure to regulate their heightened negative emotional state; despite attempts to soothe or alleviate distress (Dvir et al., 2014). Infants higher in affect dysregulation exhibit escalated distress, heightened levels of negative affect, and take longer to soothe (Bridgett et al., 2013; Granat et al., 2017). They also cannot regulate themselves when stressed during frustrating parent-infant interactions, such as the Still-Face Paradigm (Braungart‐Rieker et al. (2001); NICHD Early Child Care Research Network, 2004). Affect dysregulation has consistently been found as a risk factor for internalizing and externalizing symptoms as well as a higher likelihood of being diagnosed with anxiety disorder prior to adolescence (Clauss & Blackford, 2012). Thus, understanding predictors of individual differences in affect dysregulation during infancy is critical for promoting adaptive social and emotional development (Diaz & Eisenberg (2015); Dvir et al., 2014).
Parents’ marital satisfaction and mental health are two environmental factors that could significantly influence infant affect dysregulation (Frankel et al., 2015). Parents who experience marital dissatisfaction may use less favorable parenting techniques or withdraw from interacting with their infants, leading to difficulties in the parent-infant relationship (Barry & Kochanska, 2010) and modeling of negative emotions to their child (Morris et al., 2017). In addition, parents who report higher levels of depressive and anxiety symptoms are more likely to have infants with increased negative emotionality (Ierardi et al., 2019), including negative affect (Granat et al., 2017). Therefore, parents’ martial satisfaction and mental health were examined in the current study.
Parent Marital Satisfaction
Marital satisfaction has been extensively examined as a predictor of caregiving behaviors (Frankel et al., 2015) and child outcomes across early infancy through adolescence (Belsky & Jaffee, 2006; Knopp et al., 2017). The birth of a child can be particularly stressful on the marital relationship. Couples might experience decreases in marital satisfaction immediately following the addition of a new child (Kohn et al., 2012), making early infancy an opportune time to examine the associations between marital dissatisfaction and infant outcomes. These changes in the marital relationship can also spill over into the parent-child relationship differently for mothers and fathers (Camisasca et al., 2016). Mothers tend to be more likely than fathers to compartmentalize their spouse and parenting roles and are less likely to allow problems in the marital relationship to affect their parent-child interactions (Kouros et al., 2014). Fathers are more likely than mothers to decrease in their parental involvement when their marital satisfaction is low (Gallegos et al., 2017). However, few studies have examined these associations in early infancy (Frankel et al., 2015; Gallegos et al., 2017). Research suggests that lower marital satisfaction in infancy is associated with increased toddler negative and flat affect (Frankel et al., 2015), suggesting that marital satisfaction may be impacting children’s early regulation.
Parent Mental Health
In addition to family-level factors like parent marital satisfaction, parent-level factors are also associated with infant regulation (Belsky & Jaffee, 2006; Frankel et al., 2015). Parent mental health is one stressor that has been found to impact an infant’s susceptibility to negative outcomes (Aktar et al., 2013). Parental depression and anxiety are often assessed as potential risk factors of negative infant socioemotional development outcomes (Aktar et al., 2013), given that young infants are highly reliant on their caregivers to help regulate their emotions (Calkins & Hill, 2007). Caregivers, who exhibit depressive or anxiety symptoms, are more likely to exhibit flat affect and distorted cognitions about their children, which in turn undermines high quality caregiving and communicates negative emotions to their infants (Gallegos et al., 2017). This puts infants at an increased risk for developing their own internalizing symptoms and emotional dysregulation (Lewis et al., 2011), specifically later child regulatory disorders (Postert et al., 2012) and behavioral disorders, such as aggression and withdrawal (Karimzdeh et al., 2017). However, more recent work that has examined both parental depression and anxiety have argued that though the two are often comorbid with each other, they can make unique contributions to their child’s development (Epkins & Harper, 2016; Sandre et al., 2022). Additionally, most studies examining parent anxiety use the prenatal period or later childhood (Lewis et al., 2011; Ramchandani et al., 2011) or with only one caregiver (Ramchandani et al., 2011). Therefore, there is a need to examine parent anxiety within the context of the parent-infant relationship (Ramchandani et al., 2011) with both mothers and fathers in the same study.
Parent Depressive Symptoms
Depressed mothers are more likely to use less positive affect with their children and influence several domains of development including social, cognitive, and physical development (Ramchandani et al., 2005). Depressed fathers are more likely to withdraw from parent-child interactions (Sethna et al., 2015), lending their children to be at an increased risk of behavioral and emotional problems during childhood (Ramchandani et al., 2005). However, research on paternal depression tends to be during developmental periods outside of infancy (Ramchandani et al., 2011). Fathers are now more involved with their infants than before, and are playing a larger role in infant development (Cabrera, 2020). This highlights the importance of examining fathers’ depressive symptoms during infancy.
Parent Anxiety Symptoms
There is less work examining the effects of parental anxiety on infant outcomes (Mӧller et al., 2015; Ramchandani et al., 2011) as well as inconsistencies in how parental anxiety is defined and measured (Mӧller et al., 2015). For example, Mӧller & colleagues (2015) found that generalized anxiety disorder symptoms predicted higher levels maternal overinvolvement, whereas social anxiety disorder predicted lower levels of overinvolvement. Other researchers have found that both mothers and fathers, who are higher in social anxiety, are more likely to exhibit intrusive behaviors towards their children (Kiel & Buss, 2013). When specifically examining infant related outcomes with parental anxiety, research has shown that the anxiety is not related to increased negative infant affect or emotion dysregulation as it does with parental depression (Kaitz et al., 2010), but can lead to later anxious behaviors in childhood (Edwards et al., 2010). Thus, even though they are often found to be comorbid with each other, strictly measuring parental depression or generalized anxiety symptoms does not allow for the disentanglement of other components of psychopathology anxiety, such as social anxiety, panic, and excessive worrying (Mӧller et al., 2015; Sandre et al., 2022). These inconsistencies in measurement suggest the need to examine parent anxiety separately from depression and more on a symptom level. There is also a lack of studies examining associations between paternal anxiety and child development (Lucassen et al., 2018; Ramchandani et al., 2011). Research that has examined fathers has primarily focused on how paternal anxiety affects their levels of sensitivity with their child and family stress (Lucassen et al., 2018).
Parent Well-Being
Most of the research on parent mental health during infancy has focused on the negative impact internalizing disorders can have on infant regulation (Ramchandani et al., 2011; Trivette et al., 2010). Researchers have examined how positive aspects of parent mental health can serve as protective factors and foster infant regulation (Richter et al., 2018). Parental well-being, which reflects high energy, positive affect, and general optimism, is associated with child emotional health, including regulation (Richter et al., 2018; Trivette et al., 2010). Mothers who report higher levels of well-being had children with more adaptive regulation and prosocial behavior (Richter et al., 2018). Similarly, a meta-analysis conducted by Trivette & colleagues (2010) found that maternal well-being, which was measured as positive affect and a positive sense of involvement, was positively associated with child regulation. Maternal optimism, a component of well-being, is also associated with lower levels of child negative affectivity in later infancy and toddlerhood (Heinonen et al., 2006). However, there are two major limitations in the extant literature. First, very little research has examined parental well-being and its role in early infancy; a time when children are highly susceptible to parent influences due to their reliance on them for regulation. Second, previous literature has predominantly focused on mothers’ well-being, ignoring the role that paternal well-being may play in father-child interactions and subsequent development. The few studies that have included father well-being have shown that increased father well-being is associated with decreased infant crying (Huhtala et al., 2012; Smart & Hiscock, 2007). In sum, previous research has illustrated the importance of examining multiple domains of parent mental health (e.g., depression and anxiety) as risk factors for negative infants’ regulation outcomes.
Interplay of Parent Marital Satisfaction and Mental Health
The birth of a child can be very stressful on a marriage, but also can be particularly stressful for parents’ mental health. Married individuals who are experiencing psychopathology symptoms report less satisfaction compared to those who report lower levels of symptoms (Bögels et al., 2014). Psychopathology symptoms can also moderate the link between marital quality and parent-child relationship quality, such that parents with increased psychopathology symptoms and heightened marital dissatisfaction are more likely to have poorer parent-child relationships (Kouros et al., 2014). Marital satisfaction and parent psychopathology symptoms may also interact to predict children’s regulation with children of parents with higher levels of psychopathology symptoms being particularly susceptible to lower marital satisfaction (Whisman et al., 2004). Therefore, examining both marital satisfaction and parent mental health is critical to have a deeper understanding of their relationship with infant regulation.
The Current Study
The present study examined the extent to which marital satisfaction and parent mental health (e.g., depression, anxiety, and well-being) were associated with infant negative affect during a mildly distressing task with mothers and fathers from 4 to 8 months. We also examined the degree to which the association between marital satisfaction and infant negative affect were moderated by parent mental health. In the current study, increased infant negative affect reactivity during the still-face episode of the Still-Face Paradigm (Tronick et al., 1978), was used as an indicator of affect dysregulation at 8 months (NICHD Early Child Care Research Network, 2004). Only the still-face episode was used due to infants having higher negative affect as well as more variability in responses in comparison to the play and reunion episodes (Ekas, Lickenbrock, & Braungart-Rieker, 2013). This episode has been found to evoke only mild to moderate levels of negative affect, and not all infants are found to become distressed (Ekas, Haltigan, & Messenger, 2013). In addition, infants are also relying entirely on their own regulation systems rather than relying on aid from their caregiver to help them regulate (Mesman et al., 2009). Overall, we expected that parents’ mental health would moderate the association between marital satisfaction and infant negative affect from 4 to 8 months, but the associations would differ depending on the specific component of parent mental health (i.e., parent depressive symptoms, anxiety symptoms, and well-being), as elaborated below.
Hypothesis 1: Effects of Marital Satisfaction on Infant Negative Affect Dysregulation
First, we hypothesized that there would be a negative association between parents’ report of marital satisfaction and observed infant negative affect dysregulation from 4- to 8-months, such that higher levels of marital satisfaction would be associated with decreased levels of infant negative affect across early infancy (Frankel et al., 2015).
Hypothesis 2: Parents’ Psychopathology Symptoms as a Moderator
Second, we hypothesized that parents’ depressive symptoms (Hypothesis 2A) and anxiety symptoms (Hypothesis 2B) would moderate the association between marital satisfaction and infant negative affect from 4 to 8 months. Higher parent psychopathology symptoms and lower marital satisfaction were expected to operate as negative stressors, putting infants at higher risk for increased negative affect.
Hypothesis 3: Parents’ Well-Being as a Moderator
Third, we hypothesized that higher levels of parent well-being would moderate the association between marital satisfaction and infant negative affect from 4- to 8-months. Specifically, for parents who were high in well-being, the association between marital satisfaction and infant affect dysregulation will be weaker compared to parents who report being low in well-being.
Exploratory Hypothesis: Differences between Mothers and Fathers
Lastly, it is expected that the above moderation models might vary depending on parent gender. Previous research has found that infants respond differently to mothers compared to fathers (Cabrera, 2020; Forbes et al., 2004). In addition, an extensive body of research has shown that the father-infant relationship is more affected by the quality of the marital relationship compared to the mother-infant relationship (Taraban & Shaw, 2018). However, this hypothesis was more exploratory in nature.
Method
Participants
Participants included heterosexual families (mother, father, and infant) from a larger longitudinal study when infants were 4, 6, and 8 months of age. The current study only examined the 4- and 8-month time-points, which included 89 families (60% of infants were male, 56% primiparous). Families were recruited using a variety of methods: flyers advertising a study about infant social and emotional development were dispersed to local businesses and doctor’s offices, letters were sent to families who printed a birth announcement in the local newspaper, and a research assistant attended expectant parent fairs and newborn classes held at a local hospital. When interested parents contacted the laboratory for more information, further details outlining the participation were provided. Criteria for participation included: both mother and father can read, write, and understand English, full-term pregnancy (≥37 weeks, ≥5.5 lbs. birthweight), no major birth complications, and the entire family (i.e., mother, father, and infant) were available for each visit and was not moving out of the community during participation. Each family was compensated $20 for completing each visit ($60 maximum for completing all three visits). This study received Institutional Review Board approval at Western Kentucky University [IRB #s 19-134, formerly 16-228, 13-202], and informed consent was obtained from participants at their first laboratory visit. Data from the current study were collected before the COVID-19 pandemic. The data are not shared publicly due to ethical considerations.
Most families from the current study were White (infants: 89%, mothers: 92%, fathers: 92%). Families also reported identifying as Black or African American (infants: 1.1%, mothers: 2.2%, fathers: 2.2%), Asian (fathers: 1.1%), American Indian or Alaskan Native (infants:1.1%, mothers: 1.1%, fathers: 1.1%), Other (infants: 9%, mothers: 4.5%, fathers: 3.4%), and Multiracial (infants: 7.9%, mothers: 4.5%, fathers: 1.1%). A small percentage identified as Hispanic/Latinx (infants: 6%, mothers: 3%, fathers: 5%). These percentages are relatively comparable to census data of the area in which data collection occurred. Families ranged in income but trended toward middle- and upper-income levels: 10% reported an income of less than $30,000, 45% reported an income between $30,000 to $74,999, and 45% reported an income of $75,000 or above. Parents’ ages ranged from 19 to 44 (M = 30.39, SD = 5.18) for mothers and 19 to 55 (M = 32.11, SD = 6.32) for fathers. Levels of parent education varied widely with the majority having post-high school education: 3% of fathers attended but did not complete high school, 3% of mothers and 10% of fathers just completed high school, 1% of mothers and fathers attended trade school, 17% of mothers and 10% of fathers attended but did not complete college, 35% of mothers and 44% of fathers completed either an Associate’s or Bachelor’s Degree, and 44% of mothers and 32% of fathers reported having some postgraduate training or completed postgraduate training. Parents were predominantly employed and were working at least part time (mothers: 70%, fathers: 96%); 29% of mothers and 3% of fathers reported being unemployed. Most parents from the current study reported being married and living together (92%); 7% reported being unmarried and living together, and 1% reported being single.
Attrition was moderate (24%) from 4 months to 8 months. Statistical comparisons between the families that had completed the study (n = 68) from the total sample (n = 89) along different demographic variables revealed that fathers who completed the study were more educated compared to fathers that did not (χ2 (7) = 14.33, p < 0.04). Of the 89 families who completed the study, 56 mother-infant and 55 father-infant dyads had complete data on all study variables at 4 and 8 months. In addition to complete attrition (i.e., entire family dropped from study), reasons for missing data included incomplete questionnaire data at 4 months (families: n = 4; mother only: n = 1) and incomplete laboratory visits at either wave (families: n = 5, mother only n = 4).
Procedure
A questionnaire packet was mailed to the participating family ahead of their appointment, and parents were instructed to complete them separately and bring them to their appointment. Prior to the family arriving, the lead experimenter randomly assigned the mother or father to participate first with their infant in the laboratory tasks. Upon arrival at the laboratory, the lead experimenter obtained informed consent for participation and collected demographic information from the parents. Parents also completed a second set of questionnaires at the laboratory visit. Parents and infants participated in a Still-Face Paradigm (SFP) procedure consisting of three, 90 second episodes (Tronick et al., 1978): play, still-face, and reunion. First, the parent played with their infant (play). Second, the parent sat back in their seat with a blank face and did not play or speak to their infant (still-face). Third, the parent played with their infant again (reunion). Once the infant was in a positive/neutral state, the second parent completed the SFP with their infant. The procedure was the same for each time point and were video-recorded.
Measures
Parent Mental Health
Mothers and fathers individually completed the Inventory of Depression and Anxiety Symptoms (IDAS; Watson et al., 2007) to measure parent anxiety symptoms, depression symptoms, and well-being. The IDAS has 64 items with a 5-point Likert scale ranging from 1 (not at all) to 5 (extremely), and assesses 10 specific symptom scales (i.e., suicidality, lassitude, insomnia, appetite loss, appetite gain, ill temper, well-being, panic, social anxiety, and traumatic intrusions) and two broad general depression and dysphoria scales. We used four subscales in the current study: general depression, social anxiety, non-social anxiety, and well-being. The general depression scale consisted of 20 items from the dysphoria, suicidality, lassitude, insomnia, appetite loss, and well-being (reverse scored) scales. The social anxiety scale consisted of 5 items assessing specific social anxiety behaviors. The non-social anxiety scale was created specifically for this study and consists of 8 items related to panic behaviors, 4 items related to traumatic intrusions, and 5 items related to ill temper behaviors. These scales were chosen, because these are symptoms that are linked to general anxiety disorder (Watson et al., 2007). Well-being includes 8 items related to optimism, self-esteem, and hopefulness.
Scores were summed, and higher scores indicate higher general depression, social anxiety, non-social anxiety, and well-being. The total possible scores for the current study’s scales are the following: General Depression: 100; Social Anxiety: 25; Non-social anxiety: 85; Well-being: 40. The IDAS showed internal consistency in Watson and colleagues’ (2007) tested adult community sample (α = 0.81–0.92) and postpartum sample (α = 0.74–0.91). Cronbach alphas are as follows for each subscale and for mothers and fathers, respectively: general depression αs = 0.87 and 0.90; social anxiety: αs = 0.77 and 0.82; non-social anxiety αs = 0.74 and 0.82; and well-being αs = 0.87 and 0.91.
Marital Satisfaction
Like previous studies examining the effects of marital satisfaction on infant socioemotional development (e.g., Belsky & Jaffee, 2006; Knopp et al., 2017; Lickenbrock & Braungart-Rieker, 2015), global marital satisfaction was measured using the Short Marital Adjustment Test (SMAT; Locke & Wallace, 1959). The SMAT consists of 15 items and response formats range from a 7-point Likert 1 (very unhappy) to 7 (very happy) to forced choice (yes/no). Mothers and fathers separately completed the questionnaire. An overall marital adjustment score was created for each parent by summing the 15 items (Locke & Wallace, 1959). Possible scores can range from 1 to 158; scores < 100 indicate marital distress (Locke & Wallace, (1959). In our sample, 9 mothers (11%) and 14 fathers (16%) had scores < 100. Locke & Wallace, (1959) reported a reliability coefficient of 0.90 (i.e., split-half technique, Spearman-Brown formula corrected). For the present study, the Cronbach α equaled 0.72 for mothers and 0.60 for fathers (still in an acceptable range, Taber, 2018).
Infant Negative Affect
Infant facial expressions and vocalizations were rated at 4 and 8 months during all episodes of the SFP (Tronick et al., 1978) on a second-by-second basis (Ekas et al., 2013). Like previous studies examining infant negative affect (Braungart‐Rieker et al., 2001; Ekas et al., 2013), we only used ratings from the still-face episode of the SFP. Codes ranged from −3 (screaming, extreme crying, large grimace, mouth open) to 3 (squealing with delight, intense laughing, smile with mouth opened widely). Coders trained using a sample of videos until achieving sufficient inter-rater reliability (intraclass correlations, ICCs ≥ 0.80). Once reliable, coders did not rate the same infant with mother and father during the same time-point to avoid bias. Coders overlapped on 32% of overall the infant-mother videos and 29% of overall infant-father videos, and ICCs were calculated to assess inter-rater reliability during the still-face episode of the SFP (4mos ICCs: Mother = 0.88; Father = 0.93; 8mos ICCs: Mother = 0.94; Father = 0.96). Negative affect proportion scores during the still-face episode were created by calculating the proportion of time infants displayed negative affect (codes −1 to −3; Braungart‐Rieker et al., 2001; Ekas et al., 2013) with each parent at 4 and 8 months. Higher scores indicate greater proportions of negative affect.
Results
Data Analysis
Preliminary analyses were conducted to examine inclusion of covariates, examination of missing data patterns, and correlations. Each parent was treated as an individual participant and provided with a unique ID (N = 178). Family ID was also specified to indicate which parents were reporting about the same child. We tested the three main research questions from the main analyses: (1) What is the association between marital satisfaction and infant negative affect dysregulation? (2) How do parent psychopathology symptoms (i.e., depression, social anxiety, and non-social anxiety) moderate this association? and (3) How does parent well-being moderate this association? All independent variables were mean centered before being entered into the regression analyses. To account for nesting within families, we used cluster robust standard errors using the sandwich package in R Studio. In these hierarchical regression models, Step 1 included the main effects of parent order, parent gender (0 = father, 1 = mother), infant affect at 4-months, marital satisfaction, and the parent mental health variable of interest. Step 2 included two-way interactions (i.e., parent gender X marital satisfaction, parent gender X parent mental health, marital satisfaction X parent mental health). Step 3 included the three-way interactions (i.e., parent gender X marital satisfaction X parent mental health). Significant interactions were probed at one standard deviation above and below the mean if there was not a significant higher order interaction (i.e., two-way interactions were only interpreted if the three-way interaction for the model was not statistically significant).
Preliminary Analyses
Descriptive statistics of the study variables are presented in Table 1. Primary variables of interest were normally distributed. Preliminary analyses were run to determine how demographic variables (i.e., age, education, ethnicity, infant sex, family income, marital status, and parity) were related to variables of interest. Mothers who were older had infants with higher infant negative affect at 8 months (r = 0.27, p = 0.04). Like previous studies that have utilized the SFP with both mother-infant and father-infant dyads, parent order (i.e., who went first during the SFP) was included as a covariate (Braungart‐Rieker et al., 2001; Ekas et al., 2013) but no demographic variables were included in the remaining analyses to be consistent with mother and father models.
Table 1
Descriptive statistics for variables of interest
Mothers
Fathers
N
Min
Max
M
SD
N
Min
Max
M
SD
4-month General Depression
85
21
68
40.69
9.86
84
22
71
39.17
10.91
4-month Well-Being
85
12
37
25.84
5.37
84
13
38
25.86
6.21
4-month Social Anxiety
85
5
23
7.85
3.21
84
5
22
7.06
3.03
4-month Non-Social Anxiety
85
17
36
22.48
4.60
84
17
50
22.56
5.57
4-month Marital Satisfaction
84
56
155
121.40
19.29
84
60.68
155
119.43
18.55
4-month Infant Negative Affect
84
0
1
0.25
0.36
80
0
1
0.25
0.37
8-month Infant Negative Affect
67
0
1
0.29
0.36
66
0
1
0.27
0.34
Descriptive statistics are from raw, pre-imputed data. There were no significant differences between any of the values for mothers and fathers
Missing data and imputation
The percentage of missing values across 15 variables ranged from 6 to 26% (overall missing = 9%). Data were missing because either (a) only one parent participated at any given wave, (b) participants were unable to schedule despite multiple attempts to contact, (c) in-visit events that prohibited data collection (e.g., infant too distressed to complete SFP), (d) and post-visit coding issues (e.g., parent blocking infant’s face in videos for extended time). Little’s MCAR test indicated that data were missing completely at random (χ2 (109) = 89.06, p = 0.92). Missing data were handled using multiple imputation in SPSS (Version 26). Given that overall missingness was less than 10%, five imputations were deemed sufficient (van Burren, 2012). Mother and father data were imputed in the same file, and independent and dependent variables were included in the imputation.
Within- and between-parent correlations and analyses
Correlations among variables of interest are presented in Table 2. Infant negative affect with mothers at 8-months was positively correlated with mother well-being at 4-months. Paired samples t tests were also run to examine differences in variables of interest between mothers and fathers, and no significant differences emerged between psychopathology symptoms, well-being, marital satisfaction, and infant affect with mothers and fathers (see Table 2).
Table 2
Within and between parent correlations
Fathers
1.
2.
3.
4.
5.
6.
7.
Mothers
1. 4-month General Depression
0.35**
−0.49**
0.39**
0.67**
−0.35**
−0.17
0.02
2. 4-month Well-being
−0.48**
0.15
−0.09
−0.17
0.37**
0.10
−0.05
3. 4-month Social Anxiety
0.51**
−0.14
0.08
0.38**
−0.15
−0.06
0.04
4. 4-month Non-Social Anxiety
0.71**
−0.27*
0.61**
0.38**
−0.28
−0.11
0.01
5. 4-month Marital Satisfaction
−0.43**
0.34**
−0.13
0.34**
0.57**
0.12
−0.05
6. 4-month Infant Negative Affect
0.01
0.02
0.21t
0.06
0.14
0.10
0.15
7. 8-month Infant Negative Affect
0.09
−0.25*
−0.11
−0.03
0.03
−0.01
0.27*
Mother correlations are presented below the diagonal. Father correlations are presented above the diagonal. Between parent correlations are presented on the diagonal
** p < 0.01. *p < 0.05, tp < 0.10
Hypothesis 1: Effects of Marital Satisfaction on Infant Negative Affect Regulation
Results that examined Hypothesis 1 are presented in Tables 3–6. No significant main effects of marital satisfaction emerged for mothers or fathers in any of the models.
Table 3
Regression model with parental social anxiety
Model
Independent variables
B (SE)
β
p
R2
Step 1
0.07
Parent Order
−0.17
−0.25
0.003
4-month Infant Negative Affect
−0.08
0.08
0.260
Marital Satisfaction
−0.0004
−0.03
0.740
Social Anxiety
−0.002
−0.02
0.766
Parent Gender
0.03
0.04
0.472
Step 2
0.09
Parent Order
−0.18
−0.26
0.001
4-month Infant Negative Affect
0.09
0.10
0.182
Marital Satisfaction
−0.002
−0.10
329
Social Anxiety
0.01
0.09
0.436
Parent Gender
0.03
0.04
0.480
Marital Satisfaction X Social Anxiety
0.0004
0.10
0.025
Marital Satisfaction X Parent Gender
0.002
0.08
0.345
Social Anxiety X Parent Gender
−0.02
−0.14
0.143
Step 3
0.11
Parent Order
−0.20
−0.28
0.001
4-month Infant Negative Affect
0.10
0.11
0.144
Marital Satisfaction
−0.0003
−0.02
0.833
Social Anxiety
0.02
0.20
0.082
Parent Gender
0.01
0.02
0.733
Marital Satisfaction X Social Anxiety
0.002
0.28
0.001
Marital Satisfaction X Parent Gender
0.0004
0.01
0.855
Social Anxiety X Parent Gender
−0.03
−0.23
0.018
Marital Satisfaction X Social Anxiety X Parent Gender
−0.002
−0.18
0.028
Parent gender: 0 = Fathers, 1 = Mothers
Table 4
Regression models with parental non-social anxiety
Model
Independent Variables
B (SE)
β
p
R2
Step 1
0.07
Parent Order
−0.18
−0.25
0.002
4-month Infant Negative Affect
0.08
0.08
0.265
Marital Satisfaction
−0.0004
−0.02
0.797
Non-Social Anxiety
0.001
0.02
0.797
Parent Gender
0.03
0.04
0.486
Step 2
0.08
Parent Order
−0.19
−0.27
0.001
4-month Infant Negative Affect
0.08
0.09
0.231
Marital Satisfaction
−0.002
−0.09
0.366
Non-Social Anxiety
0.01
0.08
0.321
Parent Gender
0.03
0.04
0.519
Marital Satisfaction X Non-Social Anxiety
0.0004
0.11
0.019
Marital Satisfaction X Parent Gender
0.002
0.09
0.337
Non-Social Anxiety X Parent Gender
−0.01
−0.06
0.342
Step 3
0.08
Parent Order
−0.19
−0.27
0.001
4-month Infant Negative Affect
0.08
0.09
0.249
Marital Satisfaction
−0.002
−0.09
0.371
Non-Social Anxiety
0.01
0.08
0.340
Parent Gender
0.03
0.04
0.529
Marital Satisfaction X Non-Social Anxiety
0.0004
0.11
0.134
Marital Satisfaction X Parent Gender
0.002
0.09
0.340
Non-Social Anxiety X Parent Gender
−0.01
−0.05
0.375
Marital Satisfaction X Non-Social Anxiety X Parent Gender
0.0001
0.01
0.873
Parent gender: 0 = Fathers, 1 = Mothers
Table 5
Regression models with parental depression
Model
Independent variables
B (SE)
β
p
R2
Step 1
0.08
Parent Order
−0.18
−0.26
0.001
4-month Infant Negative Affect
0.08
0.09
0.233
Marital Satisfaction
0.0001
0.01
0.897
Depression
0.003
0.10
0.190
Parent Gender
0.02
0.03
0.568
Step 2
Independent Variables
B (SE)
β
p
0.11
Parent Order
−0.19
−0.27
0.001
4-month Infant Negative Affect
0.08
0.08
0.246
Marital Satisfaction
−0.001
−0.07
0.499
Depression
0.003
0.09
0.327
Parent Gender
0.02
0.04
0.523
Marital Satisfaction X Depression
0.0003
0.18
0.001
Marital Satisfaction X Parent Gender
0.002
0.09
0.348
Depression X Parent Gender
0.002
0.05
0.580
Step 3
Independent Variables
B (SE)
β
p
0.11
Parent Order
−0.19
−0.27
0.001
4-month Infant Negative Affect
0.08
0.08
0.243
Marital Satisfaction
−0.001
−0.07
0.484
Depression
0.003
0.10
0.311
Parent Gender
0.02
0.03
0.684
Marital Satisfaction X Depression
0.0003
0.21
0.009
Marital Satisfaction X Parent Gender
0.002
0.09
0.339
Depression X Parent Gender
0.002
0.04
0.625
Marital Satisfaction X Depression X Parent Gender
−0.0001
−0.04
0.606
Parent gender: 0 = Fathers, 1 = Mothers
Table 6
Regression models with parental well-being
Model
Independent variables
B (SE)
β
p
R2
Step 1
0.09
Parent Order
−0.17
−0.25
0.003
4-month Infant Negative Affect
0.08
0.08
0.255
Marital Satisfaction
0.001
0.03
0.711
Well-Being
−0.01
−0.16
0.055
Parent Gender
0.03
0.04
0.483
Step 2
0.12
Parent Order
−0.18
−0.25
0.002
4-month Infant Negative Affect
0.07
0.08
0.287
Marital Satisfaction
−0.001
−0.07
0.524
Well-Being
−0.002
−0.04
0.698
Parent Gender
0.03
0.04
0.472
Marital Satisfaction X Well-Being
−0.0003
−0.09
0.298
Marital Satisfaction X Parent Gender
0.003
0.14
0.114
Well-Being X Parent Gender
−0.02
−0.19
0.030
Step 3
0.12
Parent Order
−0.17
−0.25
0.002
4-month Infant Negative Affect
0.08
0.08
0.273
Marital Satisfaction
−0.001
−0.06
0.552
Well-Being
−0.002
−0.03
0.787
Parent Gender
0.05
0.07
0.278
Marital Satisfaction X Well-Being
−0.0001
−0.02
0.885
Marital Satisfaction X Parent Gender
0.003
0.13
0.131
Well-Being X Parent Gender
−0.02
−0.20
0.019
Marital Satisfaction X Well-Being X Parent Gender
−0.001
−0.11
0.238
Parent gender: 0 = Fathers, 1 = Mothers
Hypothesis 2: Parent Psychopathology as Moderators
Results involving parental social anxiety are presented in Table 3. In the final model, the three-way interaction of marital satisfaction X social anxiety X parent gender was statistically significant. Using the interactions package in R, we plotted the interaction for mothers and fathers at one standard deviation above and below the mean of social anxiety (see Fig. 1). We found that for fathers who were higher in social anxiety, there was a positive association between marital satisfaction and infant negative affect (B = 0.01, SE < 0.000, p < 0.001). For fathers who were lower in social anxiety, we found a significant negative association between marital satisfaction and infant negative affect (B = −0.01, SE < 0.000, p < 0.001). The interaction was not statistically significant for mothers. The remaining significant two-way interactions from these analyses pertaining to social anxiety were qualified by the three-way interaction and were not interpreted.
Fig. 1
Interaction between marital satisfaction, social anxiety, and parent gender
×
Results pertaining to parental non-social anxiety are presented in Table 4. In the final model, the three-way interaction between marital satisfaction, non-social anxiety, and parent gender was not statistically significant. However, in Step 2, there was a significant two-way interaction between marital satisfaction and non-social anxiety. When probed (see Fig. 2), we found that when non-social anxiety was low, there was a significant, negative association between marital satisfaction and infant negative affect (B = −0.01, SE < 0.00, p < 0.001). This association was not statistically significant when non-social anxiety was high. These effects were consistent across both mothers and fathers, evidenced by the lack of three-way interaction.
Fig. 2
Interaction between marital satisfaction and non-social anxiety
×
Results that included parental depression are presented in Table 5. In the final model, the three-way interaction between marital satisfaction, depression, and parent gender was not statistically significant. However, in Step 2, there was a significant marital satisfaction X depression interaction. When probed (see Fig. 3), we found that when depression was low, there was a significant, negative association between marital satisfaction and infant negative affect (B = −0.01, SE < 0.00, p < 0.001). When depression was high, there was a significant positive association between marital satisfaction and infant negative affect (B = 0.01, SE < 0.00, p < 0.001). These effects were consistent across both mothers and fathers.
Fig. 3
Interaction between marital satisfaction and depression
×
Hypothesis 3: Parent Well-Being as a Moderator
Results pertaining to examining the extent to which parental well-being is a moderator are presented in Table 6. In the final model, the three-way interaction between marital satisfaction, well-being, and parent gender was not statistically significant. However, there was a significant well-being X parent gender interaction. When probed (see Fig. 4), we found that for mothers, there was a significant, negative association between well-being and infant negative affect (B = −0.02, SE < 0.00, p < 0.001). For fathers, this association was not statistically significant.
Fig. 4
Interaction between well-being and parent gender
×
Discussion
The primary goal of the current study was to examine the extent to which marital satisfaction and parent mental health were associated with later infant negative affect dysregulation with mothers and fathers. We examined whether specific components of parent mental health would serve as either risk (e.g., parent depressive and anxiety symptoms) or protective (e.g., parent well-being) factors in infants’ negative affect from 4 to 8 months. We also examined whether parent psychopathology would moderate the relationship between marital satisfaction and infant negative affect. Results suggest that when parents’ non-social anxiety was low, there was a negative association between reported marital satisfaction and infant negative affect regulation. Secondly, when depression was low, there as a negative association between marital satisfaction and infant affect regulation. Lastly, we explored whether these risk or protective factors varied between mothers and fathers. Specifically, social anxiety and marital satisfaction interaction were found to have an association with infant affect regulation at 8-months, but only for fathers, and not for mothers. Additionally, maternal, not paternal, well-being was associated with infant affect regulation at 8-months.
Parent Psychopathology Symptoms as Risk Factors
It was hypothesized that parents’ depressive symptoms would moderate the association between marital satisfaction and infant negative affect from 4 to 8 months, acting as negative stressors, putting infants at higher risk for increased negative affect. In the current study, when depression was low for both mothers and fathers, there was a negative association between marital satisfaction and infant affect regulation. In the context of higher depressive symptoms, parents’ marital satisfaction was not protective of infant negative affect. However, in the context of lower depressive symptoms, marital satisfaction may be an important contributor to adaptive infant regulation. Like previous research, the current study has found support that parents’ depressive symptoms are associated with child dysregulation (Goodman et al., 2011). However, the majority of previous work focuses on toddlerhood and childhood (Frankel et al., 2015; Gallegos et al., 2017), whereas the current study found support for this association in infancy.
For non-social anxiety, it was also hypothesized that these symptoms would act as a negative stressor and would put infants at a higher risk for increased negative affect. Like depressive symptoms, when non-social anxiety symptoms were low for both mothers and fathers, there was a negative association between marital satisfaction and infant affect regulation. For higher levels of non-social anxiety, marital satisfaction did not play a protective role, but did for lower levels of non-social anxiety. However, unlike parental depressive symptoms, non-social anxiety symptoms are not typically associated with negative infant affect or emotion dysregulation (Kaitz et al.,. 2010). More specifically, it has traditionally been associated with later anxious behaviors in childhood (Edwards et al., 2010). Therefore, this result provides evidence that non-social anxiety is associated with child dysregulation, as early as infancy, which may be associated with anxiety in childhood. Future work should examine the possibility of this association from infancy to early childhood.
It was hypothesized that for fathers higher in social anxiety symptoms, lower levels of marital satisfaction would be associated with increases in infant negative affect. It was expected that infants exposed to negative environmental influences, such as their fathers experiencing social anxiety symptoms or being unsatisfied in their marriages, would have infants with increased negative affect. The results were the opposite of our hypothesis; negative affect decreased for infants whose fathers were low in social anxiety but high in marital satisfaction. Previous work suggests that fathers who are lower in social anxiety are more likely to put their children in new situations where they gain experience interacting with others (Crosby-Budinger et al., 2013). When fathers are satisfied in their marriage, they are also more likely to have higher quality parent-child interactions and increased involvement compared to fathers who are unsatisfied with their marriage (Barry & Kochanska, 2010). The significant father social anxiety X marital satisfaction interaction from the current study illustrates that fathers’ lower levels of social anxiety symptoms and feelings of increased marital satisfaction might lead to decreased infant negative affect dysregulation (less negative affect).
Contrary to our hypotheses, there were no significant findings with mothers’ specific psychopathology symptoms. Research suggests that maternal social anxiety is not associated with infants’ affect dysregulation in the same manner as other psychopathology symptoms, such as depression (Kaitz et al., 2010). Mothers high in social anxiety might appear to be involved and protective of their infants, but their symptoms can lead to over-involvement and over-protection later in childhood and adolescence (Rork & Morris, 2009). When these mothers engage in over-involvement or over-protective behaviors, they tend to be more restrictive when their children are exploring their environments and interacting with others, leading to more anxious child behaviors later in life (Edwards et al., 2010). Future research should try to replicate our findings pertaining to associations between maternal social anxiety symptoms and child regulation longitudinally from infancy into childhood.
Parental Well-Being as a Protective Factor
Previous research has found that maternal well-being is associated with positive child outcomes (Richter et al., 2018). We predicted that maternal well-being would act as a protective factor; buffering the potentially negative effects of low marital satisfaction on infants’ affect dysregulation. Instead of an interaction, we found a negative effect of maternal well-being on infant negative affect dysregulation; as maternal well-being increased, the occurrence of infant negative affect decreased. Mothers, who are higher in general well-being, may be more optimistic and agreeable compared to mothers who are lower in well-being (Musick et al., 2016). Mothers, who report feelings of high general life satisfaction and well-being, have children with positive developmental outcomes (i.e., self-regulation; Richter et al., 2018). These mothers are more likely to spend quality time with their children and involve them in more activities, leading to increased prosocial behavior and affect regulation (Richter et al., 2018). However, these findings are based on mother-child dyads in toddlerhood and early childhood. Whereas, in the current study, we examined infancy and found that these effects emerged as early as 4 and 8 months. Future studies should further examine these associations from infancy through early childhood. The lack of significant marital satisfaction X mother well-being interaction supports previous studies that reported mothers are more likely to compartmentalize their parenting and spouse roles (Mastrothedoros et al., 2019). These findings illustrate that maternal well-being might be associated with positive child outcomes as early as infancy.
Contrary to our hypothesis, paternal well-being was not associated with infant negative affect. Although fathers are more involved with their children than in previous decades (Cabrera, 2020), there is still an effect of child age on father involvement (Musick et al., 2016). Fathers are less likely to engage in caretaking activities with young infants (e.g., feeding, changing, bathing), but their involvement increases as children age. It is possible that additional paternal characteristics might take more time to carry over into the father-child relationship. Previous work does suggest that father well-being plays a larger role as their children age and they become more involved (Musick et al., 2016; Richter et al., 2018). Future research should further explore the role of paternal involvement in the associations between paternal well-being and child affect regulation in infancy and childhood. It is also important to note that our models examined the extent to which parent variables predicted infant negative affect. It is possible that infant negative affect might predict parent well-being. Future studies should further examine transactional associations between parental well-being, marital satisfaction, and infant negative affect.
The Spillover Effect
Based on the significant findings in the current study, it is possible that a spillover relationship could be occurring. Although we did not examine the effects of marital satisfaction and psychopathology on parenting; as the spillover effect is typically conceptualized, we believe that similar processes are at play. Characteristics of the caregiving environment, outside of caregiving quality itself, are directly related to infant development. Research on the spillover effect suggests that mothers are more likely to compartmentalize their various roles (i.e., spouse, parent), where marital dissatisfaction does not negatively influence their mother-child interactions (Kouros et al., 2014; Mastrothedoros et al., 2019). Fathers, however, are not as effective as mothers at compartmentalizing their various roles (Mastrothedoros et al., 2019), and might withdraw from interacting with their child (Barry & Kochanska, 2010). The current study extends previous work by providing evidence that suggests that marital dissatisfaction may not spill-over into the father-infant relationship for all fathers. The spillover effect might only occur for fathers who are low in both social anxiety and marital satisfaction. These findings are in line with previous work finding that fathers who are high in social anxiety may overcompensate and be overprotective of their children (Rork & Morris, 2009). This overprotectiveness may become more prominent when children are older and interacting with others outside of their immediate family more frequently (e.g., peers). Future research should explore longitudinal trajectories of fathers’ social anxiety beginning in infancy through childhood. Future work could also include parenting variables, such as sensitivity and intrusiveness, to test if they could further explain a connection between marital satisfaction and infant negative affect through parenting behaviors toward the infant. Future work could also examine the extent to which early parent mental health, marital satisfaction, and infant negative affect dysregulation in early infancy might predict later attachment security with mothers and fathers.
Strengths, Limitations, and Future Directions
The current study has several strengths. It is one of the first to examine associations between parent mental health, marital satisfaction, and infant negative affect dysregulation across early infancy with mothers and fathers. Previous work in this area has predominately focused on later childhood and adolescence (Gallegos et al., 2017), missing a critical time in which children are very susceptible to their environment. Second, both mothers and fathers were included in one study. Previous work suggests that infants respond differently to their mothers and fathers (Cabrera, 2020), which may be explained by differing parenting roles and levels of involvement during early infancy (Musick et al., 2016). This study also has several methodological strengths, including the longitudinal design as well as a blend of methodologies (i.e., parent-report, observational measures).
However, there are several limitations. First, caregiving behaviors were not examined, which have been found to be one of the main avenues through which parent mental health and/or marital satisfaction are being transferred to children (Lewis et al., 2011). Parenting variables, such as intrusiveness or sensitivity, could further explain the mechanism through which father social anxiety and marital satisfaction influence infant negative affect. Second, the current study had a modest sample size. Even though mother and father data were examined in the same models, more complex dyadic models via actor/partner models could be examined by future research. The sample was also a predominately White, middle-class, married sample, limiting the generalizability of the results. Future studies should attempt to replicate the current study’s findings in larger, more diverse samples to see if the findings hold. Third, even though this was a multi-method study, parent mental health data and marital satisfaction data were collected using single self-reported measures at one point. It is possible that chronic depression/anxiety symptoms, the number of depression/anxiety episodes, or changes in marital satisfaction might play a role in child adjustment (Gao, et al., 2022; Granat et al., 2017). The parent mental health measure used was also a general measure of symptomatology. Future work should include additional, more comprehensive longitudinal measures of parent mental health that better capture both changes in severity and duration of psychopathology symptoms as well as the marital relationship. Lastly, even though infant affect dysregulation was considered at two time points, 4 and 8 months, it was only considered in the context of the still-face episode of the Still-Face Paradigm (Tronick et al., 1978). Future work should examine infant affect dysregulation across the Still-Face Paradigm in order to examine the role of caregiver facilitated regulation. In addition, future work should examine infant affect regulation across multiple contexts.
Implications and Conclusions
Even when considering the limitations, the current study has important implications. Overall, the findings from the current study could be used to inform parenting intervention programs that are used to help educate the implications and role of parenting characteristics. More specifically, these findings can help with addressing both positive and negative correlates between parenting factors and infant negative affect dysregulation. The findings also provide target areas for improvement, such as parent marital satisfaction and parent mental health. Additional research is still needed to better understand the specific mechanisms of these parenting characteristics, but the current study helps provide evidence of how early these associations can become significant to infant development.
Results from the current study suggest that parent characteristics, such as mental health and marital satisfaction, in early infancy can act as protective factors of infant negative affect dysregulation across early infancy. Specifically, parents with lower psychopathology symptoms coupled with positive relationships may provide their infants with the most optimal environments to develop adaptive affect regulation. Overall, results stress both the complexity and the importance of examining associations between parent mental health, marital satisfaction, and infant negative affect dysregulation across early infancy with mothers and fathers.
Acknowledgements
This research was supported in part by the National Institutes of Health-National Institute of General Medical Sciences grant P20GM103436-22 (KY INBRE), and Western Kentucky University, Ogden College of Science and Engineering-Quick Turnaround Grants as well as Research and Creative Activity Grant awarded to the second author. The third author’s time, in part, was supported by Training Grant T32MH18921. We would like to thank the families who participated in the study, as well as our research assistants.
This study received Institutional Review Board approval at Western Kentucky University.
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Met BSL Psychologie Totaal blijf je als professional steeds op de hoogte van de nieuwste ontwikkelingen binnen jouw vak. Met het online abonnement heb je toegang tot een groot aantal boeken, protocollen, vaktijdschriften en e-learnings op het gebied van psychologie en psychiatrie. Zo kun je op je gemak en wanneer het jou het beste uitkomt verdiepen in jouw vakgebied.
