Re-thinking the programming hypothesis

• Svendsrud, Hedvig; Bekkhus, Mona; Lund, Olaf; Shai, Dana; Spencer, Rose & Smith, Lars [Show all 10 contributors for this article] (2026). Does expectant fathers' attachment style or depressive mood relate to their embodied mentalizing capacity of their 12-month-old infant? Acta Psychologica. ISSN 0001-6918. 263, p. 1–12. doi: 10.1016/j.actpsy.2026.106224. Full text in Research Archive Show summary

  Parental embodied mentalizing is about how parents show with their body that they hold in mind their infants' mind. The main study's aim was to explore what influences fathers' embodied mentalizing. A random sample of 200 fathers and their 12-month-old infants were drawn from a large longitudinal, population-based dataset, the "Little in Norway (LiN)" study. Fathers' partner related attachment style was assessed at enrollment, symptoms of depression were measured four times during pregnancy and at 12 months postpartum, as was also parenting stress. Videotaped father-infant interactions were coded with the Parental Embodied Mentalizing Assessment (PEMA). Results showed that fathers of girls were demonstrating a higher capacity for embodied mentalizing compared to fathers of boys. There were no direct effects of prenatal depressive symptoms or attachment style on fathers embodied mentalizing, suggesting that lower levels of attachment insecurity and depressive symptoms do not necessarily compromise fathers' capacity for embodied mentalizing. However, depressive symptoms during pregnancy increased the likelihood of postpartum depressive symptoms and parenting stress. In combination, these increased risks were related to poorer embodied mentalizing in fathers. This suggests that being depressed both during pregnancy and when the infant is 12 months, as well as experiencing stress in the parenting role, may be risk factors for compromised embodied mentalizing.

• Braithwaite, Elizabeth C.; Haftorn, Kristine Løkås; Oftedal, Aurora; Ayorech, Ziada; Kaasen, Anne & Murgatroyd, Christopher [Show all 9 contributors for this article] (2025). Associations between lifetime history of depression, prenatal OXTR DNA methylation and breastfeeding outcomes. Clinical Epigenetics. 18(1), p. 1–12. doi: 10.1186/s13148-025-02030-8. Full text in Research Archive Show summary

  Abstract Background Women with depression are less likely to breastfeed and experience more breastfeeding challenges. Potential biological mechanisms that link maternal depression with poor breastfeeding outcomes have not been investigated. This study examined associations between lifetime history of depression (LHD), prenatal oxytocin receptor gene ( OXTR ) DNA methylation, and breastfeeding outcomes. Results Longitudinal observational data from the Norwegian Mother, Father and Child Cohort Study (MoBa) were analysed (N = 3607). LHD was self-reported during pregnancy (week 15). Blood samples were collected at 16–18 weeks of pregnancy, and DNA methylation was measured using the Illumina Methylation EPIC BeadChip 850 K array. This array includes 22 CpG sites on the OXTR gene, which were used in analyses. Mothers self-reported breastfeeding initiation (breastmilk given to child in first month), breastfeeding maintenance (breastmilk given to child for 6 months or more) and breastfeeding problems. Maternal LHD was not associated with OXTR DNA methylation. There was some evidence that prenatal OXTR DNA methylation was associated with breastfeeding outcomes. There was an association between CpG cg26455676 and breastfeeding maintenance to 6 months (odds ratio = 1.59, 95% confidence intervals = 1.11–2.27, raw p  = 0.01, adjusted p  = 0.04). Higher levels of DNA methylation at CpG cg26455676 was associated with a greater likelihood of maintaining breastfeeding to 6 months. Conclusions This highly novel study highlights the intriguing possibility that maternal prenatal DNA methylation at genes important for breastfeeding may be associated with breastfeeding experiences. Further understanding of vastly differing breastfeeding experiences would assist with the targeting efforts to support breastfeeding women, particularly those who are vulnerable, such as mothers who have depression.

• Oftedal, Aurora; Kaasen, Anne; Karlsen, Taran; Haugen, Guttorm Nils & Bekkhus, Mona (2025). Maternal Distress in Pregnancies After Previous Fetal Anomaly: A Longitudinal Cohort Study. BJOG: An International Journal of Obstetrics and Gynaecology. ISSN 1470-0328. doi: 10.1111/1471-0528.18343. Full text in Research Archive Show summary

  Objective To assess mental health throughout pregnancy among women with a history of diagnosis of fetal anomaly. Design Prospective observational study. Setting Tertiary referral centre for fetal medicine. Population Pregnant women with a history of fetal anomaly (study group; n  = 75) and women without such a history (comparison group; n  = 111). A subgroup of women in the study group ( n  = 28) participated in two different pregnancies, where the first had a diagnosis of fetal anomaly and the second did not. Methods Women completed the Edinburgh Postnatal Depression Scale (EPDS) and Impact of Events Scale (IES) at four timepoints between gestational age 18 weeks and 36 weeks. Main Outcomes Trajectories of EPDS and IES across time in the study group and comparison group, as well as differences in EPDS and IES in the healthy pregnancy and the pregnancy with a diagnosis of fetal anomaly in the subgroup. Results Having a history of previous diagnosis of fetal anomaly was associated with elevated levels of depression and traumatic stress throughout pregnancy, even in healthy pregnancies (e.g., EPDS mean difference = 2.65, 95% CI [1.91, 3.21]). The difference between groups was largest early in pregnancy and decreased with increasing gestational age. Furthermore, women in the subgroup experienced much higher levels of distress in the pregnancy with a diagnosis of fetal anomaly than in their healthy pregnancy (e.g., EPDS mean difference = 8.7, 95% CI [6.40, 11.15]). Conclusion The results highlight the importance of considering women's history of fetal anomaly and prenatal loss even in healthy pregnancies.

• Austerberry, Chloe; Zayats, Tetyana; Ronald, Angelica; Corfield, Elizabeth Claire; Smajlagic, Dinka & Havdahl, Alexandra [Show all 11 contributors for this article] (2025). Evocative effects of children's education-associated genetics on maternal parenting: results from the Norwegian mother, father and child cohort study. Journal of Child Psychology and Psychiatry. ISSN 0021-9630. 67(2), p. 158–170. doi: 10.1111/jcpp.70025. Full text in Research Archive Show summary

  Background: It has long been hypothesized that increasing heritability with age of cognitive and educational performance is partly attributable to evocative gene–environment correlation. However, this hypothesis has not been widely tested. Methods: We addressed this gap by examining whether children's education polygenic scores (PGSedu) were associated with maternal self-reported positive and literacy-focused parenting when children were 5 years old, and if evoked parenting differences mediated genetic effects on children's educational outcomes (mother-reported at 6–8 years of age), while controlling for parental PGSedu. We also investigated whether maternal reports of children's language at 5 years old were associated with parenting and mediated genetic effects on educational performance. These questions were addressed in a sample of 83,627 parent-offspring trios from the Norwegian Mother, Father and Child Cohort Study, a longitudinal population-based pregnancy cohort. Results: Children's PGSedu were significantly associated with maternal literacy-focused (β = .03, 95% CI [0.01, 0.05], p = .021) but not positive parenting (β = 0.01, 95% CI [−0.02, 0.05], p = .410), and literacy-focused parenting significantly mediated the effects of children's PGSedu on their educational performance (β = 0.01, 95% CI [1 × 10−3, 0.01], p = .023). Children's language was associated with maternal parenting and mediated the effects of children's PGSedu on their educational performance (β = 0.01, 95% CI [3 × 10−3, 0.02], p = .002). Conclusions: These findings support our hypotheses and suggest early language and parenting may be mechanisms implicated in the pathways from children's genetics to their educational outcomes.

• Hygen, Beate Wold; Skalicka, Vera; Coplan, Robert; Soest, Tilmann von; Fredriksen, Eivor & Bekkhus, Mona (2024). Norwegian Adolescents in the Initial Stages of COVID-19 Restrictions. Links Between Interactions, Digital Media Use, Loneliness, and Mental Health Problems. Journal of Media Psychology. ISSN 1864-1105. 36(5). doi: 10.1027/1864-1105/a000401. Full text in Research Archive Show summary

  In response to the COVID-19 pandemic outbreak in March 2020, the Norwegian government closed schools and limited leisure activities. In this cross-sectional study, we examined how different types of digital versus in-person social interactions and digital media use were associated with loneliness and mental health problems among adolescents during the initial COVID-19 lockdown. Participants (N = 703, 79.7% girls, Mage = 17.3 years) completed a questionnaire assessing loneliness, mental health problems, digital media use, and in-person interactions. Both in-person and digital social interaction (texting) with friends were negatively associated with adolescents’ mental health problems and loneliness. By contrast, time spent alone on screen and on social media was positively related to mental health problems. The findings highlight that during the first weeks of the pandemic and of social distancing, increased interactions (either in-person or digital) among adolescents and their friends coincided with lower lev

• Bekkhus, Mona; Oftedal, Aurora; Haugen, Guttorm Nils; Mortensen, Berit & Kaasen, Anne (2024). Acute symptoms of depression and traumatic stress in men and women who terminate pregnancy after detection of fetal anomaly: A prospective observational study. BJOG: An International Journal of Obstetrics and Gynaecology. ISSN 1470-0328. doi: 10.1111/1471-0528.17884. Full text in Research Archive Show summary

  Objective: To assess acute and long-term stress in men and women after the detection of fetal anomalies leading to pregnancy termination. Design: Prospective observational study. Setting: Tertiary referral centre for fetal medicine. Population: From the initial sample of 180 pregnant women with a fetal anomaly detected by ultrasound examination, a total of 87 women terminated their pregnancy, with 72 partners included in the sample. At the time of detection, the group of women (n = 93) and their partners (n = 81) who did not terminate the pregnancy following a diagnosis were included as a comparison group. Methods: These women and their partners were asked to complete the Edinburgh Postnatal Depression Scale (EPDS) and the Impact of Events Scale (IES) questionnaires, both at the time of initial detection and at 6 weeks after the termination of the pregnancy. Main outcome measures: Responses to the EPDS and the IES at the time of initial detection and at 6 weeks after pregnancy termination. Results: Women who underwent pregnancy termination reported higher symptom levels of depression, but not traumatic stress, prior to the termination than women who chose not to terminate their pregnancy. Among men, there was a difference across depression and all subscales of traumatic stress (e.g. IES intrusion: mean difference 5.31; 95% CI 2.32–8.31). Women experienced more depressive symptoms over time than men (β = 4.33, P < 0.001) and higher symptom levels on all subscales of traumatic stress (e.g. IES intrusion: β = 5.27; P < 0.001). Conclusions: Overall, our study underscores the heightened levels of depression and traumatic stress experienced by prospective parents, particularly prior to the decision to terminate a pregnancy following the detection of a fetal anomaly. Although women generally report more pronounced symptoms, it is noteworthy that men also experience considerable traumatic stress during this challenging time.

• Salontaji, Kristina; Haftorn, Kristine Løkås; Sanders, Faye; Page, Christian Magnus; Walton, Esther & Felix, Janine F. [Show all 10 contributors for this article] (2024). Gestational epigenetic age and ADHD symptoms in childhood: a prospective, multi-cohort study. Molecular Psychiatry. ISSN 1359-4184. 29, p. 2911–2918. doi: 10.1038/s41380-024-02544-2. Full text in Research Archive
• Braithwaite, Elizabeth C.; Oftedal, Aurora; Kaasen, Anne; Ayorech, Ziada & Bekkhus, Mona (2024). A history of depression and prenatal depression are associated with a lower likelihood of breastfeeding initiation and maintenance, and more breastfeeding problems. Archives of Women's Mental Health. ISSN 1434-1816. 28, p. 139–146. doi: 10.1007/s00737-024-01479-5. Full text in Research Archive Show summary

  Purpose This study tests the hypotheses that lifetime history of depression, and prenatal depression, are associated with a reduced likelihood of breastfeeding initiation (giving the baby any breastmilk during the first week of life) and breastfeeding maintenance (giving the baby breastmilk for at least 6 months), and a greater likelihood of reporting breastfeeding problems. Methods We analyzed data from the Norwegian Mother, Father, and Child cohort study (MoBa), N=78,307. Mothers reported a lifetime history of depression during the second trimester of pregnancy, and current symptoms of depression during the third trimester using the Hopkins Symptoms Checklist short version (SCL-8). At six months postpartum, mothers self-reported breastfeeding initiation, maintenance, and difficulties. Results Using binary logistic regression analyses, we report that a lifetime history of depression is associated with a lower likelihood of breastfeeding initiation (OR=0.751, 95%CI=0.650–0.938), breastfeeding maintenance (OR=0.712, 95%CI=0.669–0.785), and a greater likelihood of breastfeeding difficulties (OR=1.86, 95%CI=1.72–2.06). Similarly, prenatal depression was associated with a lower likelihood of breastfeeding initiation (OR=0.904, 95%CI=0.878–0.929), breastfeeding maintenance (OR=0.929, 95%CI=0.920–0.938), and a greater likelihood of breastfeeding difficulties (OR=1.10, 95%CI=1.09–1.12). Results remained largely unchanged when covaried for several confounding variables, including medication use. Conclusion We provide novel evidence that pre-conception and prenatal symptoms of depression are associated with breast-feeding outcomes. This information could be used to identify women very early in pregnancy who may need additional support with breastfeeding. There is also a need to fully understand the biopsychosocial mechanisms that mediate the relationship between depression prior to birth and breastfeeding outcomes.

• Fardzadeh, Haghish Ebad; Nes, Ragnhild Bang; Obaidi, Milan; Qin, Ping; Stänicke, Line Indrevoll & Bekkhus, Mona [Show all 8 contributors for this article] (2023). Unveiling Adolescent Suicidality: Holistic Analysis of Protective and Risk Factors Using Multiple Machine Learning Algorithms. Journal of Youth and Adolescence. ISSN 0047-2891. 53, p. 507–525. doi: 10.1007/s10964-023-01892-6. Full text in Research Archive Show summary

  Abstract Adolescent suicide attempts are on the rise, presenting a significant public health concern. Recent research aimed at improving risk assessment for adolescent suicide attempts has turned to machine learning. But no studies to date have examined the performance of stacked ensemble algorithms, which are more suitable for low-prevalence conditions. The existing machine learning-based research also lacks population-representative samples, overlooks protective factors and their interplay with risk factors, and neglects established theories on suicidal behavior in favor of purely algorithmic risk estimation. The present study overcomes these shortcomings by comparing the performance of a stacked ensemble algorithm with a diverse set of algorithms, performing a holistic item analysis to identify both risk and protective factors on a comprehensive data, and addressing the compatibility of these factors with two competing theories of suicide, namely, The Interpersonal Theory of Suicide and The Strain Theory of Suicide. A population-representative dataset of 173,664 Norwegian adolescents aged 13 to 18 years (mean = 15.14, SD = 1.58, 50.5% female) with a 4.65% rate of reported suicide attempt during the past 12 months was analyzed. Five machine learning algorithms were trained for suicide attempt risk assessment. The stacked ensemble model significantly outperformed other algorithms, achieving equal sensitivity and a specificity of 90.1%, AUC of 96.4%, and AUCPR of 67.5%. All algorithms found recent self-harm to be the most important indicator of adolescent suicide attempt. Exploratory factor analysis suggested five additional risk domains, which we labeled internalizing problems, sleep disturbance, disordered eating, lack of optimism regarding future education and career, and victimization. The identified factors provided stronger support for The Interpersonal Theory of Suicide than for The Strain Theory of Suicide. An enhancement to The Interpersonal Theory based on the risk and protective factors identified by holistic item analysis is presented.

• Oftedal, Aurora; Tsotsi, Stella; Kaasen, Anne; Mayerhofer, Lilian Juliane Kozlowski; Røysamb, Espen & Smajlagic, Dinka [Show all 8 contributors for this article] (2023). Anxiety and depression in expectant parents: ART versus spontaneous conception. Human Reproduction. ISSN 0268-1161. 38(9), p. 1755–1760. doi: 10.1093/humrep/dead133. Full text in Research Archive Show summary

  STUDY QUESTION: Do expectant parents experience increased anxiety and depression during pregnancies conceived through ART compared to spontaneous conception? SUMMARY ANSWER: Among all expectant parents in the sample, those who conceived through ART reported overall lower levels of anxiety and depression in pregnancy compared to expectant parents who conceived spontaneously, while in the subsample of parents who conceived both through ART and spontaneous conception, expectant mothers experienced increased anxiety and de- pression in early pregnancy following ART compared to spontaneous conception. WHAT IS KNOWN ALREADY: Previous research on expectant parents’ psychosocial adjustment in response to ART has found mixed results, with some studies suggesting ART is associated with increased anxiety and depression, and other studies suggesting im- proved mental health or no relationship. Mixed findings may relate to the use of cross-sectional designs that do not account for con- founding differences between groups, or variability in the timing of assessment. STUDY DESIGN, SIZE, DURATION: This prospective cohort study used data from the Norwegian Mother, Father and Child Cohort Study (MoBa), which includes 2960 pregnant women who underwent ART and 108 183 women who conceived spontaneously. Of these, a subsample of expectant parents had two consecutive pregnancies with one pregnancy resulting from ART and one conceived spontaneously (n 1⁄4 286 women, n 1⁄4 211 partners). Women self-reported their composite symptoms of anxiety and depression at two timepoints during each pregnancy (gestational weeks 17 and 30). Their partners self-reported composite symptoms of anxiety and depression at 17 weeks gestation during each pregnancy. Couples reported their relationship satisfaction at 17 weeks gestation. MAIN RESULTS AND THE ROLE OF CHANGE: Using a conventional full-cohort analysis we found that ART was associated with less total anxiety and depression and greater relationship satisfaction, compared to spontaneous conception among both women and men. However, in the subsample of parents who experienced both ART and spontaneous pregnancies, ART was associated with in- creased levels of maternal anxiety and depression at gestational age 17weeks (M1⁄41.19), compared to spontaneous pregnancies (M 1⁄4 1.15), 95% CI of the mean difference 0.006, 0.074. At 30 weeks gestation, anxiety and depression were similar across both types of pregnancies. Expectant fathers reported similar levels of anxiety and depression at 17weeks gestation during both pregnancies. Among women relationship satisfaction was higher following ART conception than spontaneous conception. LIMITATIONS, REASONS FOR CAUTION: There is potential for selection effects in the sample, as women who have conceived through both ART and spontaneous conception in their first two pregnancies are rare. In addition, several factors that may be important predic- tors of mental health in this context, such as previous miscarriages and long-term infertility, were not assessed in the current study. WIDER IMPLICATIONS OF THE FINDINGS: Our findings indicate that previous discrepancies in the literature may be related to in- herent differences between the groups of parents receiving reproductive treatment and those who do not. This study addresses that limitation by prospectively comparing different types of pregnancies within the same expectant parents. Earlier inconsistencies may also relate to variations in gestational age when anxiety and depression were assessed. By examining symptoms at two timepoints in each pregnancy, we were able to examine the relation between gestational age and symptoms of anxiety and depression.

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