BackgroundSeveral studies have reported significantly higher stress levels, both short and long terms, among mothers giving preterm birth compared with mothers giving birth at term. Stress, however, is a psychological phenomenon that may present as anxiety, depression and/or trauma reactions. In this study, the long-term mental health outcomes and the prevalence of anxiety, depression and trauma reactions in women experiencing preterm birth were explored. Interactional, main effect variables and predictors were identified.MethodsTwenty-nine mothers of 35 premature children born before the 33rd week of pregnancy were assessed within 2 weeks postpartum (T0), 2 weeks after hospitalization (T1), 6 months post-term (T2), and 18 months post-term (T3). The standardized psychometric methods Impact of Event Scale (IES), General Health Questionnaire (GHQ) and State Anxiety Inventory (STAI-X1) assessed the maternal mental health outcomes.ResultsThe maternal mental health problems except state anxiety decreased from T0 to T1, but remained high and stable at T3. The prevalence of posttraumatic stress reactions (PTSR) and posttraumatic stress disorder (PTSD) at T0 and T3 was 52% and 23%, respectively. We identified the time period between T0 and T1 to have a significant main effect on mental health outcomes. The predictors of higher levels of mental health problems were preeclampsia, previous psychological treatment, age, trait anxiety and infant's postnatal intraventricular haemorrhage. Bleeding in pregnancy predicted lower levels of mental health problems.ConclusionsThe prevalence of maternal mental health problems remained high, emphasizing the importance of effective interventions.

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Strategies of democratization in societal and organizational contexts that are aimed at reducing the influence gap merely through increased opportunities for communi cation are critized. As an alternative to the power-through-communication para digm, which such strategies seem to be based upon, a power-through-model paradigm is suggested: Models are required in order to utilize information offers and exert and withstand influence. This is illustrated by contrasting the operations of two systems, one of which lacks model resources and thus is completely dependent upon external feedback. The other system may carry out internal trials through simulation, and strengthen its model power through comparisons between real and simulated outcomes. If a model-strong actor and model-weak actor are coupled in an open information exchange system, the former may be expected to gradually increase his control of the other actor. Offers of information are useful only to the extent that there is model capacity for processing the information offered. Thus a successful transition in the name of democratization to a more open communi cation structure may freeze - or even increase - the influence gap. Independent development of system model resources among the less influentials is required.