Scientific publications



Vänskä, M. (2017).  From prenatal period to middle childhood : Maternal and paternal mental health predicting child mental health and development. This dissertation study emphasizes a heterogeneous, dynamic, and timing-specific nature of early maternal and paternal mental health problems. It highlights the importance of maternal mental health for later child mental health and physiological stress regulation, and the importance of both maternal and paternal mental health for later child cognitive development. Clinically, our findings emphasize the critical role of maternity clinics and child health centers in screening both parents for mental health symptoms. Providing help to families at multiple time points during the pre- and postnatal period should aim at avoiding mental health problems to impair early parenting and further on child development. [Link to dissertation]


Lindblom, J. (2017).  Significance of Early Family Environment on Children’s Affect Regulation — From family autonomy and intimacy to attentional processes and mental health. This dissertation demonstrates the importance of considering families as holistic systems, involving both the mothers and fathers, and both the marital and parenting subsystems. In line with the developmental models of psychopathology, the findings indicate that very early family dysfunctions forecast children’s altered affect regulation, which may heighten their risk for mood disorders. Altered social-emotional information processing suggests that children may tune their affect regulation to adapt with the specific challenges they encounter in their early family environments. [Link to dissertation]


Flykt, M. (2014). Prenatal representations predicting parent-child relationship in transition to parenthood: Risk and family dynamic considerations. Reorganizational processes reflected in parental prenatal representations may be more challenging for parents with additional burdens, such as mental health or other psychosocial problems. Nonetheless, previous research on the role and nature of these early representational processes has almost exclusively focused on normative parents. The aim of this dissertation was to broaden this scope by including medical and psychosocial risk parents. Our results revealed that especially the psychosocial risk group showed unique and pronounced risks in their representational processes. The results increase empirical knowledge of risk-group parenting and can potentially inform clinicians working with parents-to-be during the period of transition to the parenthood. [Link to dissertation]


Poikkeus, P. (2010). Outcome of singleton pregnancy after assisted reproductive treatment. The aim of the present study was to evaluate the importance of infertility- and treatment-related factors on prediction of pregnancy outcome, obstetric and neonatal risks, fear-of-childbirth and pregnancy-related anxiety. An early hCG assessment maintained its good predictive value regardless of infertility- or patient-related factors. Further, we did not recognise any infertility- or patient-related factors that would expose infertile women to increased obstetric or neonatal risks. However, a long period of infertility was associated with severe fear-of-childbirth.  [Link to dissertation]


Repokari, L. (2008). Transition to parenthood after assisted reproductive treatment: Follow-up study of singleton pregnancies. In conclusion, ART parents in general seem to adapt well to the transition to parenthood. Former infertility and ART do not seem to constitute a risk for parents mental health, marital relations or experience of parenting. Even longstanding infertility with several unsuccessful treatment attempts did not create a risk as regards parenting behaviour or parents mental representations of their child. In this group, however, women were found to have fear for losing the child and difficulty in creating representations of the child during pregnancy, which in some cases may indicate need for psychosocial support. Even though our results are encouraging, infertility and infertility treatments are generally considered as a stressful experience. It is a challenge for health authorities to recognize those couples who need professional help to overcome the distressing experiences of infertility and ART. [Link to dissertation]

Journal articles

  • Sälevaara, M., Punamäki, R., Unkila‐Kallio, L., Vänskä, M., Tulppala, M., & Tiitinen, A. (2018). The mental health of mothers and fathers during pregnancy and early parenthood after successful oocyte donation treatment: A nested case‐control study. Acta Obstetricia Et Gynecologica Scandinavica, 97(12), 1478–1485. doi:10.1111/aogs.13421
  • Vänskä, M., Punamäki, R., Lindblom, J., Flykt, M., Tolvanen, A., Unkila-Kallio, L., . . . Tiitinen, A. (2017). Parental pre- and postpartum mental health predicts child mental health and development: Parental pre- and postpartum mental health. Family Relations, 66(3), 497–511. doi:10.1111/fare.12260
  • Lindblom, J., Vänskä, M., Flykt, M., Tolvanen, A., Tiitinen, A., Tulppala, M., & Punamäki, R. (2017). From early family systems to internalizing symptoms: The role of emotion regulation and peer relations. Journal of Family Psychology, 31(3), 316–326. doi:10.1037/fam0000260
  • Vänskä, M., Punamäki, R., Tolvanen, A., Lindblom, J., Flykt, M., Unkila-Kallio, L., . . . Tiitinen, A. (2017). Paternal mental health trajectory classes and early fathering experiences: Prospective study on a normative and formerly infertile sample. International Journal of Behavioral Development, 41(5), 570–580. doi:10.1177/0165025416654301
  • Lindblom, J., Peltola, M. J., Vänskä, M., Hietanen, J. K., Laakso, A., Tiitinen, A., . . . Punamäki, R. (2017). Early family system types predict children’s emotional attention biases at school age. International Journal of Behavioral Development, 41(2), 245–256. doi:10.1177/0165025415620856
  • Lindblom, J., Punamaki, R., Flykt, M., Vanska, M., Nummi, T., Sinkkonen, J., . . . Tulppala, M. (2016). Early family relationships predict children’s emotion regulation and defense mechanisms. Sage Open, 6(4).  doi:10.1177/2158244016681393
  • Punamäki, R., Tiitinen, A., Lindblom, J., Unkila-Kallio, L., Flykt, M., Vänskä, M., . . . Tulppala, M. (2016). Mental health and developmental outcomes for children born after ART: A comparative prospective study on child gender and treatment type. Human Reproduction, 31(1), 100–107. doi:10.1093/humrep/dev273
  • Vänskä, M., Punamäki, R., Lindblom, J., Tolvanen, A., Flykt, M., Unkila‐Kallio, L., . . . Tiitinen, A. (2016). Timing of early maternal mental health and child cortisol regulation. Infant and Child Development, 25(6), 461–483. doi:10.1002/icd.1948
  • Sälevaara, M., Punamäki, R., Poikkeus, P., Flykt, M., Tulppala, M., & Tiitinen, A. (2016). Fear and experience of childbirth among women who conceived with donated oocytes: A prospective cohort study. Acta Obstetricia Et Gynecologica Scandinavica, 95(7), 755–762. doi:10.1111/aogs.12888
  • Flykt, M., Palosaari, E., Lindblom, J., Vänskä, M., Punamäki, R., Poikkeus, P., . . . Tulppala, M. (2014). What explains violated expectations of parent-child relationship in transition to parenthood? Journal of Family Psychology, 28(2), 148–159. doi:10.1037/a0036050
  • Lindblom, J., Flykt, M., Tolvanen, A., Vänskä, M., Tiitinen, A., Tulppala, M., & Punamäki, R. (2014). Dynamic family system trajectories from pregnancy to child’s first year. Journal of Marriage and Family, 76(4), 796–807. doi:10.1111/jomf.12128
  • Poikkeus, P., Saisto, T., Punamaki, R., Unkila‐Kallio, L., Flykt, M., Vilska, S., . . . Tiitinen, A. (2014). Birth experience of women conceiving with assisted reproduction: A prospective multicenter study. Acta Obstetricia Et Gynecologica Scandinavica, 93(9), 880–887. doi:10.1111/aogs.12440
  • Vänskä, M., Punamäki, R., Tolvanen, A., Lindblom, J., Flykt, M., Unkila-Kallio, L., . . . Tulppala, M. (2011). Maternal pre- and postnatal mental health trajectories and child mental health and development: Prospective study in a normative and formerly infertile sample. International Journal of Behavioral Development, 35(6), 517–531. doi:10.1177/0165025411417505
  • Flykt, M., Lindblom, J., Punamäki, R., Poikkeus, P., Repokari, L., Unkila-Kallio, L., . . . Tulppala, M. (2009). Prenatal expectations in transition to parenthood: Former infertility and family dynamic considerations. Journal of Family Psychology, 23(6), 779–789. doi:10.1037/a0016468
  • Repokari, L., Punamäki, R. -., Unkila-Kallio, L., Vilska, S., Poikkeus, P., Sinkkonen, J., . . . Tulppala, M. (2007). Infertility treatment and marital relationships: A 1-year prospective study among successfully treated ART couples and their controls. Human Reproduction, 22(5), 1481–1491. doi:10.1093/humrep/dem013
  • Punamäki, R., Repokari, L., Vilska, S., Poikkeus, P., Tiitinen, A., Sinkkonen, J., & Tulppala, M. (2006). Maternal mental health and medical predictors of infant developmental and health problems from pregnancy to one year: Does former infertility matter? Infant Behavior and Development, 29(2), 230–242. doi:10.1016/j.infbeh.2005.12.001
  • Repokari, L., Punamäki, R., Poikkeus, P., Tiitinen, A., Vilska, S., Unkila-Kallio, L., . . . Tulppala, M. (2006). Ante- and perinatal factors and child characteristics predicting parenting experience among formerly infertile couples during the child’s first year: A controlled study.Journal of Family Psychology, 20(4), 670–679. doi:10.1037/0893-3200.20.4.670
  • Repokari, L., Punamäki, R. -., Poikkeus, P., Vilska, S., Unkila-Kallio, L., Sinkkonen, J., . . . Tulppala, M. (2005). The impact of successful assisted reproduction treatment on female and male mental health during transition to parenthood: A prospective controlled study. Human Reproduction, 20(11), 3238–3247. doi:10.1093/humrep/dei214