1
|
Sawyer A, Simpson B, Reece C, Richardson V, Carbone J, John M, Linke R, Russo K, Turnbull D, Sawyer M. Protocol for an intervention for new parents experiencing moderate psychosocial adversity: pilot feasibility randomised trial. J Reprod Infant Psychol 2024:1-22. [PMID: 39158028 DOI: 10.1080/02646838.2024.2390903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 08/06/2024] [Indexed: 08/20/2024]
Abstract
BACKGROUND Parents exposed to psychosocial adversities often experience challenges which, combined with the needs of a new-born infant, can be difficult to manage and increase the risk of poor outcomes for both parents and infants. Psychosocial adversity can disrupt the development of parental-foetal attachment to the baby during pregnancy, which can have a negative effect on parental care and quality of interaction during the postnatal period. This intervention is based on the proposition that enhanced parental capacity to mentalise and emotionally connect to unborn children during pregnancy, and better understanding about how to manage distressing infant behaviour (i.e., persistent crying and sleep problems) will: (i) promote the development of secure parent-infant attachment; (ii) improve antenatal bonding and postnatal parenting; and, (ii) reduce parental distress. METHOD This protocol is for a pilot randomised control trial evaluating a new intervention, which makes use of innovative technologies to support parents experiencing moderate psychosocial adversity (Australian New Zealand Clinical Trials Registry: ACTRN12622000287730). The New Technology for New Parents (NTNP) intervention provides support using antenatal ultrasound scans and 'virtual home visits' during the perinatal period. Quantitative outcomes include mentalising capacity, parental-foetal/infant attachment, and parental competence. CONCLUSION To the best of our knowledge, no study has evaluated the combined effectiveness of two novel technologies (3D/4D ultrasound scans and virtual home visits) to support parents across the antenatal and postnatal periods. This protocol, which includes the rationale for this innovative intervention, addresses a gap in services for parents experiencing moderate psychosocial adversity.
Collapse
Affiliation(s)
- Alyssa Sawyer
- School of Psychology, University of Adelaide, Adelaide, Australia
| | - Bronni Simpson
- Women's and Babies Division, Department of Obstetrics and Gynaecology, Women's and Children's Hospital, Adelaide, Australia
| | - Christy Reece
- School of Psychology, University of Adelaide, Adelaide, Australia
| | - Vanessa Richardson
- Child Protection Services, Women's and Children's Hospital, Adelaide, Australia
| | - Josephine Carbone
- Child Protection Services, Women's and Children's Hospital, Adelaide, Australia
| | - Melissa John
- Child Protection Services, Women's and Children's Hospital, Adelaide, Australia
| | - Rebecca Linke
- South Australia Medical Imaging, Women's and Children's Hospital Campus, Adelaide, Australia
| | - Kate Russo
- South Australia Medical Imaging, Women's and Children's Hospital Campus, Adelaide, Australia
- College of Clinical Sciences, Central Queensland University, Adelaide, Adelaide
| | - Deborah Turnbull
- School of Psychology, University of Adelaide, Adelaide, Australia
| | - Michael Sawyer
- School of Psychology, University of Adelaide, Adelaide, Australia
| |
Collapse
|
2
|
Røhder K, Baumann MV, Karstoft KI, Schleicher I, George C, Harder S. The prenatal caregiving expectations questionnaire‐revised version: Factor structure, internal consistency, and initial construct validity. Infant Ment Health J 2024. [PMID: 38992864 DOI: 10.1002/imhj.22128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 04/12/2024] [Accepted: 06/13/2024] [Indexed: 07/13/2024]
Abstract
An efficient, multidimensional instrument is needed to screen non-optimal prenatal parental representations predictive of postnatal parenting behavior and child attachment. The present work aimed to revise and validate the Prenatal Caregiving Expectations Questionnaire-Revised (PCEQ-R). Survey data from two independent samples of pregnant, primarily Danish, women (N = 300/322) were collected to 1) test the factor structure and select items for a 20-item version, and 2) confirm the factor structure, examine internal consistency, and establish initial construct validity. Confirmatory factor analysis supported a three-factor model of helpless-dysregulated, anxious-hyperactivated, and avoidant-deactivated caregiving representations. Internal consistency was acceptable (α > .73). Construct validity analyses showed that higher helpless-dysregulated caregiving was associated with low maternal antenatal attachment quality (rs = -.36) and intensity (rs = -.11), increased risk of perinatal depression (rs = .37), and trait anxiety (rs = .37). Higher anxious-hyperactivated caregiving was associated with better maternal antenatal attachment quality (rs = .20) and higher intensity (rs = .26), while avoidant-deactivated caregiving was not associated with maternal antenatal attachment. These findings support the validity and multidimensional structure of the measure. The homogenous nature of the sample limits generalizability of results. Future studies should examine predictive validity of the PCEQ-R and include clinical samples.
Collapse
Affiliation(s)
- Katrine Røhder
- Department of Psychology, Center for Early Intervention and Family Studies, University of Copenhagen, Kobenhavn, Denmark
| | | | | | - Ida Schleicher
- Department of Psychology, University of Copenhagen, Kobenhavn, Denmark
| | - Carol George
- Psychology Department, Mills College at Northeastern University, Oakland, California, USA
| | - Susanne Harder
- Department of Psychology, University of Copenhagen, Kobenhavn, Denmark
| |
Collapse
|
3
|
Pontoppidan M, Nygaard L, Hirani JC, Thorsager M, Friis-Hansen M, Davis D, Nohr EA. Effects on Child Development and Parent-Child Interaction of the FACAM Intervention: A Randomized Controlled Study of an Interdisciplinary Intervention to Support Women in Vulnerable Positions through Pregnancy and Early Motherhood. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:587. [PMID: 38791801 PMCID: PMC11121224 DOI: 10.3390/ijerph21050587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/26/2024] [Accepted: 04/30/2024] [Indexed: 05/26/2024]
Abstract
Health inequality can have a profound impact on a child's life. Maternal mental health challenges can hinder bonding, leading to impaired functioning and poorer child outcomes. To provide extra support for vulnerable pregnant women, the FACAM intervention offers the services of a health nurse or family therapist from pregnancy until the child starts school. This study examined the effects of FACAM intervention on pregnant women in vulnerable positions and their children until the child turned two years old. We randomly assigned 331 pregnant women to either FACAM intervention or care as usual and assessed them at baseline and when the infant was 3-6, 12-13.5, and 24 months old. The primary outcome was maternal sensitivity measured by Coding Interactive Behavior (CIB). Secondary outcomes included the parent-child relationship, child social-emotional development, child developmental progress, parent-child interaction, and child development. Our findings indicate that care-as-usual children were significantly more involved than FACAM children when the child was 4-6 months old (b = -0.25, [-0.42; -0.08] d = -0.42). However, we suspect this result is due to a biased dropout. We did not find any significant differences in any other outcomes. Therefore, the study suggests that the FACAM intervention is not superior to care as usual regarding child development and parent-child interaction outcomes.
Collapse
Affiliation(s)
- Maiken Pontoppidan
- VIVE—The Danish Centre for Social Science Research, Herluf Trolles Gade 11, 1052 Copenhagen, Denmark; (J.C.H.); (M.T.); (M.F.-H.)
| | - Lene Nygaard
- Research Unit for Gynecology and Obstetrics, Department of Clinical Research, University of Southern Denmark, 5230 Odense, Denmark; (L.N.); (E.A.N.)
- Department of Gynaecology and Obstetrics, Odense University Hospital, 5230 Odense, Denmark
| | - Jonas Cuzulan Hirani
- VIVE—The Danish Centre for Social Science Research, Herluf Trolles Gade 11, 1052 Copenhagen, Denmark; (J.C.H.); (M.T.); (M.F.-H.)
| | - Mette Thorsager
- VIVE—The Danish Centre for Social Science Research, Herluf Trolles Gade 11, 1052 Copenhagen, Denmark; (J.C.H.); (M.T.); (M.F.-H.)
| | - Mette Friis-Hansen
- VIVE—The Danish Centre for Social Science Research, Herluf Trolles Gade 11, 1052 Copenhagen, Denmark; (J.C.H.); (M.T.); (M.F.-H.)
| | - Deborah Davis
- Faculty of Health, University of Canberra and ACT Health, Bruce, ACT 2617, Australia;
| | - Ellen Aagaard Nohr
- Research Unit for Gynecology and Obstetrics, Department of Clinical Research, University of Southern Denmark, 5230 Odense, Denmark; (L.N.); (E.A.N.)
- Department of Gynaecology and Obstetrics, Odense University Hospital, 5230 Odense, Denmark
| |
Collapse
|
4
|
Insua-Summerhays B, Knowles Bevis B, Barlow PJ. What tools should be used to identify women in need of additional support in pregnancy? J Reprod Infant Psychol 2024; 42:234-268. [PMID: 35930009 DOI: 10.1080/02646838.2022.2103525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/13/2022] [Indexed: 10/16/2022]
Abstract
OBJECTIVE This study aimed to identify and inform recommendation of self-report and interview-based instruments that are feasible, reliable and valid to evaluate the quality of the maternal-fetal relationship (MFR). BACKGROUND Several constructs predicting parent-infant interaction and later infant adjustment are used to assess mothers' thoughts and feelings towards their unborn baby, including reflective functioning, mind-mindedness, representation, and fetal attachment. As yet, there is no existing review comparing the quality and accessibility of instruments across each of these constructs. METHODS A systematic literature review was undertaken to synthesise psychometric information on measures reporting on the MFR. Searches of six databases were conducted. English articles were selected based on inclusion and exclusion criteria. The QATSDD checklist was used to assess study quality. RESULTS Of 669 studies identified, 28 met inclusion criteria. Thirteen different instruments were identified for evaluation. Reported reliability and validity varied significantly across instruments, as well as availability for research and/or clinical use. CONCLUSION Suggestions for research and clinical practice include further evaluation of the psychometric properties of tools, particularly for self-report measures of reflective functioning, use of interviews to scaffold reflexivity, and development of clinical policies and procedures to clarify care pathways for expectant mothers needing further support.
Collapse
Affiliation(s)
- Bryony Insua-Summerhays
- Department of Social Policy and Intervention, Oxford Institute of Clinical Psychology Training and Research, Isis Education Centre, Warneford Hospital, Headington, UK
| | - Becca Knowles Bevis
- Department of Social Policy and Intervention, Oxford Institute of Clinical Psychology Training and Research, Isis Education Centre, Warneford Hospital, Headington, UK
| | | |
Collapse
|
5
|
Sirkiä C, Laakkonen E, Nordenswan E, Karlsson L, Korja R, Karlsson H, Kataja EL. Sense of coherence, its components and depressive and anxiety symptoms in expecting women and their partners - A FinnBrain Birth Cohort Study. SEXUAL & REPRODUCTIVE HEALTHCARE 2024; 39:100930. [PMID: 38056383 DOI: 10.1016/j.srhc.2023.100930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/22/2023] [Accepted: 11/23/2023] [Indexed: 12/08/2023]
Abstract
OBJECTIVE Expecting mothers with high sense of coherence (SOC) exhibit improved physical, emotional, and childbearing health. However, the dimensions of SOC and the factor structure of the SOC-13 scale during prenatal period is slightly known. Especially the differences in experiencing SOC and its components (comprehensibility, manageability, meaningfulness) among both expecting parents (mothers and fathers) is poorly understood. The association between SOC and mood disorder symptoms (depression and anxiety) during pregnancy is scarcely studied. METHODS The structure of the SOC-13 scale, differences in SOC experiences, and the associations between SOC and depressive and anxiety symptoms were studied in a sample of 2784 pregnant women (mothers) and 1661 men/partners (fathers) belonging to the FinnBrain Birth Cohort Study. Self-reports (SOC-13, EPDS, SCL-90: ANX) from gestational week 24 were used. Confirmatory factor analysis (CFA) and invariance testing was carried out to investigate the factorial structure of SOC-13 among both groups (mothers and fathers). Group comparisons were used to study differences in the level of SOC among mothers vs. fathers, low vs. high depression and anxiety subgroups, and multiparous vs. nulliparous mothers. RESULTS A two-factor model for SOC-13 consisting of comprehensibility-manageability and meaningfulness fitted the data best. Mothers reported higher levels of meaningfulness, whereas fathers reported higher levels of comprehensibility-manageability. SOC was significantly higher among fathers vs. mothers, but mothers with depressive symptoms reported higher SOC than fathers with depressive symptoms. CONCLUSIONS During pregnancy, SOC can be viewed as a two-dimensional (vs. one- or three-dimensional) concept, and mothers and fathers have differences in the components of SOC. Importantly, mothers vs. fathers with depressive symptoms express higher overall SOC indicating that pregnancy may relate to higher than usual SOC especially among women with psychological distress. Understanding how expecting mothers and fathers experience SOC during pregnancy, particularly in relation to depressive symptoms, helps midwives and maternity care providers to focus health promoting support more precisely.
Collapse
Affiliation(s)
- Carlos Sirkiä
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland; Department of Psychology, University of Turku, Turku, Finland.
| | - Eero Laakkonen
- Department of Teacher Education, University of Turku, Turku, Finland
| | - Elisabeth Nordenswan
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Linnea Karlsson
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland; Centre for Population Health Research, Turku University Hospital and University of Turku, Turku, Finland; Departments of Psychiatry and Paediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Riikka Korja
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland; Department of Psychology, University of Turku, Turku, Finland
| | - Hasse Karlsson
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland; Centre for Population Health Research, Turku University Hospital and University of Turku, Turku, Finland; Departments of Psychiatry and Paediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Eeva-Leena Kataja
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland; Departments of Psychiatry and Paediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland
| |
Collapse
|
6
|
Ierardi E, Fantoni S, Moioli M, Albizzati A, Riva Crugnola C. Mind-mindedness and styles of interaction of young fathers with their infants at three months: a pilot study. BMC Psychol 2023; 11:430. [PMID: 38057917 DOI: 10.1186/s40359-023-01480-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 12/04/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Fatherhood at a young age can be characterized by a multiproblematic background with several risk factors that can negatively affect father-child relationships, the father's well-being and child's social-emotional development. METHODS This pilot study evaluated paternal interaction styles and mentalization in a sample of 22 young fathers and their 3-month-old infants and compared these variables with those of 22 adolescent and young mothers (the fathers' partners). Parent-infant interaction were codified with Care-Index to evaluate styles of interaction and with Mind-Mindedness system to evaluate mentalization. RESULTS The results showed that young fathers had high scores in controlling behaviors and low scores in sensitivity, placing them in a risk range. The young father's interaction profile did not differ from the young mother's interaction profile. Infants had high scores in passive behaviors and low scores in cooperative behaviors, placing them in a high-risk range. Moreover, young fathers had more nonattuned mind-related comments than their partners. CONCLUSIONS The findings indicate that low responsiveness and low mind-mindedness characterize the quality of adolescent and young father-infant interactions, highlighting the value of providing early intervention to support the father-child relationship, enhancing the father's sensitivity and his ability to keep the infant in mind.
Collapse
Affiliation(s)
- Elena Ierardi
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
- Child Neuropsychiatric Unit 2, ASST Santi Paolo and Carlo, Milan, Italy
| | - Simona Fantoni
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Margherita Moioli
- Child Neuropsychiatric Unit 2, ASST Santi Paolo and Carlo, Milan, Italy
| | | | | |
Collapse
|
7
|
Sørensen ER, Rasmussen IS, Overbeck G, Siersma V, Appel CL, Wilson P. Uptake of signposting to web-based resources: pregnant women's use of a preventive web-based intervention. BMC PRIMARY CARE 2023; 24:189. [PMID: 37716967 PMCID: PMC10504765 DOI: 10.1186/s12875-023-02130-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 08/21/2023] [Indexed: 09/18/2023]
Abstract
BACKGROUND Signposting to web-based interventions is becoming increasingly popular in primary care. Most resources are focused on individuals with clinical problems, but less is known about the uptake of general practice (GP) signposted web-based interventions. GPs in Denmark are responsible for scheduled preventive care during pregnancy and the child's first five years. In the "Family Well-being in General Practice" trial the web-based intervention "Resilientchild.dk" is introduced at these consultations. Resilientchild.dk is designed to improve the capacity of parents to understand the mental state of themselves, their partners, and their children. In this study we assess the uptake and use of this web-based intervention. OBJECTIVE To describe participant and practice characteristics associated with the use of a web-based psychoeducational intervention. Eligible participants were pregnant women presenting at their first antenatal assessment, usually around 6-10 gestational weeks. METHODS The study was nested in a cluster randomised trial of resilientchild.dk. We conducted a relative importance analysis, which allows for determination of the variables most strongly associated with website use. To assess the direction and magnitude of the influences of the identified variables, we applied multinomial generalized linear mixed modelling. A practice random effect allows us to account for clustering of women within practices. RESULTS Parity and the absence of a nurse or midwife in the practice were important factors driving a decrease in the likelihood of using resilientchild.dk. Being a student or living outside the capital city were important factors driving an increase in the likelihood of using resilientchild.dk. CONCLUSION The data offer unique opportunities to assess the utilisation of a web-based mental health-promotion intervention following advice from a clinician. This study draws conclusions about which patients are likely to access similar resources and which practice characteristics encourage their use. TRIAL REGISTRATION Registered in clinicaltrials.gov, Trial number: NCT04129359 Date of registration: 16/10/2019 ( https://clinicaltrials.gov/ct2/show/NCT04129359 ).
Collapse
Affiliation(s)
- Emil Rønn Sørensen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Ida Scheel Rasmussen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Gritt Overbeck
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Volkert Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Clara Lundmark Appel
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Philip Wilson
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Centre for Rural Health, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland
| |
Collapse
|
8
|
Arkle P, Larkin F, Wang Y, Lee Y, Fernandez A, Li LY, Meins E. Early psychosocial risk factors and postnatal parental reflective functioning. INFANCY 2023; 28:864-881. [PMID: 37243878 DOI: 10.1111/infa.12552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 04/17/2023] [Accepted: 04/28/2023] [Indexed: 05/29/2023]
Abstract
Psychosocial factors have been found to relate to parental reflective functioning (PRF), a parent's ability to mentalize about themselves and their child. Relations between maternal psychosocial risk factors and PRF were investigated in a community sample. A sample of mothers (n = 146) was assessed for risk factors when infants were 6 months, infant temperament was assessed using an observational measure, and PRF was assessed with the Parent Development Interview-Revised (PDI). PRF was measured again with the Parental Reflective Functioning Questionnaire (PRFQ) when children were 4 years (n = 105) and 5 years (n = 92), with an additional sample of mothers (n = 48) tested at these two timepoints. Results showed that in infancy, total maternal psychosocial risk related to lower PDI-PRF; regression analyses highlighted low socioeconomic status, unplanned pregnancy, and low maternal anxiety as independent predictors of lower PDI-PRF. PDI-PRF scores at 6 months did not relate to PRFQ scores, but PRFQ subscales showed stability over time from age 4-5. Results are discussed with regard to the impact of maternal psychosocial risk and infant temperament on PRF and the stability and concordance of PRF measures.
Collapse
Affiliation(s)
| | | | - Ying Wang
- University of York, York, UK
- Auckland University of Technology, Auckland, New Zealand
| | | | | | - Lydia Y Li
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | |
Collapse
|
9
|
Georg AK, Meyerhöfer S, Taubner S, Volkert J. Is parental depression related to parental mentalizing? A systematic review and three-level meta-analysis. Clin Psychol Rev 2023; 104:102322. [PMID: 37572565 DOI: 10.1016/j.cpr.2023.102322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 05/12/2023] [Accepted: 07/12/2023] [Indexed: 08/14/2023]
Abstract
This systematic review and meta-analysis is aimed to summarize the state of research on the relation between parental depression and parental mentalizing. To account for the multifaceted nature of parental mentalizing, several conceptualizations and measures were included and compared. The last database search was conducted on March 13, 2023. Using three-level meta-analytic modelling, we analyzed a total of 12,665 participants from 63 studies with 233 effect sizes. Taken together, higher depression was only weakly associated with lower mentalizing (r = -0.06). Specifically, parents with higher depression scored lower on questionnaire measures of parental reflective functioning (r = -0.11). No significant correlations were found for interview measures of parental reflective functioning, the observational and interview measure of mind-mindedness, or insightfulness. The data showed substantial heterogeneity. The mean effect size for self-reported pre-mentalizing (r = -0.23 for reverse-coded subscale scores) was significantly stronger compared to other self-report subscales. In studies including parents with diagnosis and controls, there was limited evidence suggesting a larger negative correlation between depression, mind-mindedness, and insightfulness. Therefore, more research is needed in clinical samples. Due to their correlational nature, our results do not allow causal inferences. Future studies should target moderators that explain variability (e.g., comorbid psychological problems, coparenting, child behavior).
Collapse
Affiliation(s)
- Anna K Georg
- Institute for Psychosocial Prevention, University Hospital Heidelberg, Germany.
| | | | - Svenja Taubner
- Institute for Psychosocial Prevention, University Hospital Heidelberg, Germany
| | - Jana Volkert
- Department of Psychology, MSB Medical School Berlin, Germany
| |
Collapse
|
10
|
Svendsrud H, Fredriksen E, Moe V, Smith L, Tsotsi S, Ullebø AK, Brean GV, Kaasen A, Bekkhus M. Becoming Dad: Expectant Fathers' Attachment Style and Prenatal Representations of the Unborn Child. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1187. [PMID: 37508684 PMCID: PMC10377903 DOI: 10.3390/children10071187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 07/02/2023] [Accepted: 07/05/2023] [Indexed: 07/30/2023]
Abstract
How expectant fathers think and feel about the unborn child (prenatal representations), has shown associations with fathers' postnatal parenting behaviors, observed father-infant interactional quality and child cognitive development. There is limited knowledge about fathers' prenatal representations. The present study examined if fathers' partner-related attachment styles were related to their prenatal representations of the unborn child. In the "Little in Norway Study", an ongoing prospective, longitudinal population-based study, 396 expectant fathers completed the Experiences in Close Relationships Scale at enrollment (mean gestational week = 23.76, SD = 4.93), and in gestational weeks 27-35 completed three questions assessing prenatal representations. Correlations of attachment style and prenatal representations were reported using logistic regression analyses. We found that an avoidant attachment style by fathers were predicted to have absent or negative representations on all three items (1) "strongest feeling about the unborn child" (Cl = 1.19-2.73), (2) "thoughts about child personality" (Cl = 1.16-1.87), and (3) "experiences of relationship with the child" (Cl = 1.14-1.75). Father anxious attachment style was not significantly associated with absent or negative prenatal representations. Results suggest that expectant fathers with a partner related avoidant attachment style have an increased risk of having absent or negative prenatal representations of the unborn child.
Collapse
Affiliation(s)
- Hedvig Svendsrud
- Department of Psychology, University of Oslo, 0373 Oslo, Norway
- Vestfold Hospital Trust, 3103 Tønsberg, Norway
| | | | - Vibeke Moe
- Department of Psychology, University of Oslo, 0373 Oslo, Norway
| | - Lars Smith
- Department of Psychology, University of Oslo, 0373 Oslo, Norway
| | - Stella Tsotsi
- Department of Psychology, University of Oslo, 0373 Oslo, Norway
| | | | - Gro Vatne Brean
- Center for Child and Adolescent Mental Health, Southern and Eastern Norway, 0484 Oslo, Norway
| | - Anne Kaasen
- Department of Nursing and Health Promotion, Oslo Metropolitan University, 0130 Oslo, Norway
| | - Mona Bekkhus
- Department of Psychology, University of Oslo, 0373 Oslo, Norway
| |
Collapse
|
11
|
Schwartz M, Rasmussen IS, Wilson P, Overbeck G, Siersma V. Evaluation of the Danish version of the prenatal parental reflective functioning questionnaire in early pregnancy as a screening tool. Infant Ment Health J 2023; 44:387-405. [PMID: 36864697 DOI: 10.1002/imhj.22045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 01/30/2023] [Indexed: 03/04/2023]
Abstract
Parental reflective functioning (PRF) is the capacity to focus on feelings and experiences in oneself as a parent and in the child. Research has demonstrated that, the better the PRF the better outcomes for the child. This paper evaluated the Danish version of the prenatal parental reflective functioning questionnaire (P-PRFQ). We used data from a cluster-randomized trial of pregnant women recruited from Danish general practice. The sample included 605 mothers. Factor structure and internal consistency were investigated. Linear regression analysis was used to examine the associations between the P-PRFQ score and the five most predictive variables. The confirmatory factor analyses supported the three-factor model. The P-PRFQ had moderate internal consistency. The regression analysis showed a decrease in the P-PRFQ score with increasing age, increasing parity, current employment, better self-reported health, lower anxiety score, and fewer negative life events with persistent impact. The directions of the associations between P-PRFQ score and the predictive variables were opposite of what was hypothesized raising questions about whether the P-PRFQ can be used as an early pregnancy screening tool assessing prenatal PRF. Further validation studies are required to assess the extent to which the P-PRFQ truly measures reflective functioning.
Collapse
Affiliation(s)
- Mads Schwartz
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Ida Scheel Rasmussen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Philip Wilson
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Centre for Rural Health, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Gritt Overbeck
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Volkert Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
12
|
Rutherford HJV, Yatziv T, Vess M, Brooker RJ. Envisioning motherhood: Mental-state language in caregiving narratives across the perinatal period. Infant Ment Health J 2023; 44:218-227. [PMID: 36862383 PMCID: PMC10559800 DOI: 10.1002/imhj.22048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 01/14/2023] [Indexed: 03/03/2023]
Abstract
Nancy Suchman's work highlighted the fundamental role of maternal mentalization in maternal addiction, mental health, and caregiving challenges. In this study, we aimed to examine the role of mental-state language (MSL) as a measure of mentalization in prenatal and postnatal narratives and their sentiment in a sample of 91 primarily White mothers from the western United States, followed from the second trimester of pregnancy, through the third trimester, to 4 months postpartum. Specifically, we investigated the use of affective and cognitive MSL in prenatal narratives when mothers visualized caring for their baby and postnatal narratives when mothers compared their prenatal visualization to the current caregiving reality. Results indicated moderate consistency in MSL between the second and third trimesters, but prenatal and postnatal MSL was not significantly correlated. Across all time points, higher use of MSL was related to more positive sentiment, indicating an association between mentalization and positive caregiving representations across the perinatal period. Women used more affective than cognitive MSL in prenatal imagination of caregiving, but this pattern was reversed in their postpartum reflection. Implications on assessing parental mentalization prenatally and considering the relative dominance of affective and cognitive mentalizing are discussed while considering study limitations.
Collapse
Affiliation(s)
| | - Tal Yatziv
- Yale Child Study Center, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Matthew Vess
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, Texas, USA
| | - Rebecca J Brooker
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, Texas, USA
| |
Collapse
|
13
|
Lindblom J, Pajulo M, Nolvi S, Tervahartiala K, Karlsson H, Karlsson L, Korja R. Early pathways of maternal mentalization: Associations with child development in the FinnBrain birth cohort study. Front Psychol 2022; 13:855190. [PMID: 36582339 PMCID: PMC9792295 DOI: 10.3389/fpsyg.2022.855190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 11/09/2022] [Indexed: 12/12/2022] Open
Abstract
Parental mentalization refers to a parents' capacity and interest to consider the individual experience and mental state underlying the behaviors of the child. Higher mentalization is considered a key aspect for parental sensitivity in interaction, fostering child's socioemotional and self-regulatory development. Yet, previous studies have not examined the dynamic pathways through which the maternal mentalization may develop, nor their effects on child development. Thus, in the current person-oriented study, first, we identify distinct profiles and longitudinal trajectories of maternal mentalization from pregnancy to child's 2 years of age. Second, we test how the profiles and trajectories associate with children's internalizing and externalizing problems, social-emotional competence and effortful control at the age of 2 years. Third, we examine how the profiles and trajectories associate with contextual demographic and child related. The substudy was part of the FinnBrain Birth Cohort and included families from general population (n = 2,687). Mothers reported their parental reflective functioning (PRF) at late pregnancy, 6 months and 2 years of child's age. Both mothers (n = 1,437) and fathers (n = 715) reported the developmental child outcomes at the child's age of 2 years. Latent Profile Analysis and Latent Transition Analysis were used to identify PRF profiles and trajectories. The results showed decreasing heterogeneity in PRF from pregnancy to child's age of 6 months and 2 years (i.e., four, three and two latent classes, respectively). Most mothers progressed towards high PRF over time. Second, the profiles and trajectories depicting high PRF associated with child high social-emotional competence at the age of 2 years, yet no clear positive effects were found on child's problems and effortful control. The group of mixed PRF trajectories showed strongest association with child's internalizing and externalizing problems. Finally, there were theoretically meaningful associations between the PRF trajectories and both the contextual (e.g., parity) and child related (e.g., infant temperament) factors. This was the first study to explore the early unfolding of maternal mentalization. The results are discussed in relation with the potential mechanisms accounting for child development and with the nature and limitations of self-reported parental mentalization.
Collapse
Affiliation(s)
- J. Lindblom
- The FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland,Faculty of Social Sciences, Tampere University, Tampere, Finland,*Correspondence: J. Lindblom,
| | - M. Pajulo
- The FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland,Department of Child Psychiatry, University of Turku and Turku University Hospital, Turku, Finland
| | - S. Nolvi
- The FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland,Turku Institute for Advanced Studies, University of Turku, Turku, Finland,Department of Psychology and Speech Language Pathology, University of Turku, Turku, Finland
| | - K. Tervahartiala
- The FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland,Centre for Population Health Research, University of Turku and Turku University, Turku, Finland
| | - H. Karlsson
- The FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland,Centre for Population Health Research, University of Turku and Turku University, Turku, Finland,Department of Psychiatry, Turku University Hospital and University of Turku, Turku, Finland
| | - L. Karlsson
- The FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland,Centre for Population Health Research, University of Turku and Turku University, Turku, Finland,Department of Psychiatry, Turku University Hospital and University of Turku, Turku, Finland
| | - R. Korja
- The FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland,Department of Psychology and Speech Language Pathology, University of Turku, Turku, Finland
| |
Collapse
|
14
|
Hood R, Zabatiero J, Silva D, R Zubrick S, Straker L. 'There's good and bad': parent perspectives on the influence of mobile touch screen device use on prenatal attachment. ERGONOMICS 2022; 65:1593-1608. [PMID: 35164662 DOI: 10.1080/00140139.2022.2041734] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 01/18/2022] [Indexed: 06/14/2023]
Abstract
The potential for human-computer interaction to have a substantial impact on adults is well documented. However, its potential importance prior to birth has rarely been reported. Parental use of smartphones and tablet computers could influence the relationship between parent and baby during pregnancy (prenatal attachment) and thus child development. Twenty-seven families were interviewed to explore how parents used these devices during pregnancy, and how device use influenced parents' thoughts, feelings and behaviours towards their baby while in utero. All used devices for a variety of purposes, and all described good levels of prenatal attachment. Parents described both disrupted and enhanced connectedness as a result of device use, and increased parental stress. The findings highlight a new opportunity for how device design and use guidelines could support families to maximise benefits and reduce detriments of device use to optimise prenatal attachment, and thus future parent-child attachment and child development. Practitioner summary: Many parents regularly use smartphones and tablet computers while pregnant. This qualitative study found that how devices were used either enhanced or disrupted feelings of prenatal attachment. Practitioners should be aware of potential beneficial and detrimental impacts of device use during pregnancy given implications for future attachment and child development.
Collapse
Affiliation(s)
- Rebecca Hood
- Curtin School of Allied Health and enAble Institute, Curtin University, Perth, Australia
| | - Juliana Zabatiero
- Curtin School of Allied Health and enAble Institute, Curtin University, Perth, Australia
| | - Desiree Silva
- Telethon Kids Institute, Perth, Australia
- School of Medicine, The University of Western Australia, Perth, Australia
- School of Medicine & Health Sciences, Edith Cowan University, Perth, Australia
| | - Stephen R Zubrick
- Telethon Kids Institute, Perth, Australia
- School of Medicine, The University of Western Australia, Perth, Australia
| | - Leon Straker
- Curtin School of Allied Health and enAble Institute, Curtin University, Perth, Australia
| |
Collapse
|
15
|
Briscoe L, Marsland L, Doyle C, Docherty G, Flynn A, Gichuru P. A mixed method study to explore the maternal impact and outcomes of a specialist Building Attachment and Bonds Service (The BABS Study). Health Care Women Int 2022:1-22. [PMID: 36322644 DOI: 10.1080/07399332.2022.2129643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 09/23/2022] [Accepted: 09/23/2022] [Indexed: 06/16/2023]
Abstract
Our intent was to explore if maternal anxiety, depression, reflective functioning and level of attachment significantly changed after the Building Bonds and Attachment Service (BABS) Intervention. We measured outcomes for 46 at risk mothers via HADS; MAAS; MPAS and P-PRFQ. Our findings, triangulated with 32 semi structured interviews identified that BABS intervention made a significant difference to participants who were admitted during the antenatal period (Pregnant group: depression 9.63[CI:7.63-11.63; p < 0.001]; anxiety 9.40[CI: 7.56-11.24]; p < 0.001]; reflective functioning 30.78[CI:24.84-36.72; p < 0.001] and maternal attachment 8.78[CI:4.08-13.48]; p 0.001). Suicidal contemplation was prevented for two women. Our conclusions explained the service made a significant difference to the lives of mothers between baseline and post intervention for pregnant mothers with anxiety and depression who struggled to bond with their baby. Appropriate referral may help to increase accessibility to those who may benefit most. Further research needs to test if this care model would be acceptable to culturally diverse populations.
Collapse
Affiliation(s)
- Lesley Briscoe
- Maternal and Neonatal Health Researcher, Medical Education Department, Edge Hill University, Lancashire, UK
| | - Lisa Marsland
- Parent Infant Mental Health & Service Lead for Mersey Care NHS Foundation Trust, Liverpool, UK
| | - Carmel Doyle
- Midwifery Department, Liverpool Women's Hospital NHS Trust, Liverpool, UK
| | - Gemma Docherty
- Administration Department Mersey Care, NHS Foundation Trust, UK
| | - Anita Flynn
- Department of Nursing, Faculty of Health Social Care and Medicine, Edge Hill University, Lancashire, UK
| | - Phillip Gichuru
- Medical Education Department, Edge Hill University, Lancashire, UK
| |
Collapse
|
16
|
Salo SJ, Lipsanen JO, Sourander J, Pajulo M, Kalland M. Parental relationship satisfaction, reflective functioning, and toddler behavioral problems: A longitudinal study from pregnancy to 2 years postpartum. Front Psychol 2022; 13:904409. [PMID: 36033052 PMCID: PMC9416229 DOI: 10.3389/fpsyg.2022.904409] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 07/19/2022] [Indexed: 12/04/2022] Open
Abstract
Parent relationship satisfaction and parental reflective functioning (PRF) are significant factors in the transition to first-time parenting and are likely to affect a child’s later wellbeing. However, little is known about their joint longitudinal effects from pregnancy onward. Starting in the prenatal period, this follow-up study of 1016 Finnish first-time parents (358 fathers and 658 mothers at baseline) examined the stability and the reciprocal associations between relationship satisfaction and PRF in predicting child behavioral problems (CBCL) at age 2. First, the results of the random-intercept cross-lagged panel models showed that both relationship satisfaction and PRF were stable from pregnancy onward for both mothers and fathers, with the exception of mothers’ prenatal PRF. Second, there were significant reciprocal associations between low prenatal PRF and low relationship satisfaction at age 1, and vice versa. Third, for both mothers and fathers, a low level of relationship satisfaction, but not PRF, predicted consistently higher levels of child behavioral problems at age 2. These results suggest that parent relationship satisfaction and PRF are stable but largely independent parental factors during the transition to parenthood. In addition, our results highlight the significant role of parent relationship satisfaction in predicting toddler behavior problems, which indicates the relevance of early relationship-orientated help for first-time parents.
Collapse
Affiliation(s)
- Saara Johanna Salo
- Department of Education, University of Helsinki, Helsinki, Finland
- *Correspondence: Saara Johanna Salo,
| | | | | | - Marjukka Pajulo
- Department of Child Psychiatry, University of Turku, Turku, Finland
| | - Mirjam Kalland
- Department of Education, University of Helsinki, Helsinki, Finland
| |
Collapse
|
17
|
The structure and correlates of the 20-item Maternal-Fetal Attachment Scale in a population-based sample of Hungarian expectant women. Midwifery 2022; 112:103422. [DOI: 10.1016/j.midw.2022.103422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/27/2022] [Accepted: 07/01/2022] [Indexed: 10/17/2022]
|
18
|
"I would never be able to forgive myself if it ended up having consequences for the child": A qualitative study of perceptions of stress and worries among healthy first-time pregnant Danish women. Midwifery 2022; 112:103421. [DOI: 10.1016/j.midw.2022.103421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/10/2022] [Accepted: 07/01/2022] [Indexed: 11/23/2022]
|
19
|
Pontoppidan M, Thorsager M, Friis-Hansen M, Slade A, Sadler LS. Minding the Baby versus usual care: study protocol for a quasi-cluster-randomized controlled study in Denmark of an early interdisciplinary home-visiting intervention for families at increased risk for adversity. Trials 2022; 23:529. [PMID: 35751089 PMCID: PMC9229526 DOI: 10.1186/s13063-022-06434-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 05/27/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Inequality in health can have profound effects on a child's opportunities later in life. To prevent these downstream effects in families at increased risk of adversity, programs are needed to provide support and improve well-being across several domains. The present trial is aimed at assessing the effectiveness of the Minding the Baby® (MTB) home visiting intervention in improving the mother-child relationship, parental reflective functioning, well-being, and mental health, as well as child development and well-being in families at known risk of adverse health, relational, and developmental outcomes. METHODS The study is a pragmatic, prospective, quasi-cluster-randomized controlled trial in which seven Danish municipalities were randomized to MTB training in either 2018 or 2019. A total of 250 pregnant women at increased risk of adversity will be recruited (75 care as usual families and 175 intervention families). Care as usual families will be recruited before and after the MTB training. The MTB intervention is an attachment-based, interdisciplinary home visiting intervention offered from the third trimester of pregnancy until the child is 2 years old. The participants are assessed at baseline, and when the infant is 3, 12, and 24 months old. The primary outcome is maternal sensitivity measured by the Coding Interactive Behavior scale applied to video recordings of mother-infant interactions. Secondary outcomes include parent-child interaction, parental reflective functioning, parental mental health, maternal satisfaction, parental stress, and child development and well-being. The treatment effect is estimated as a fixed effect using a binary indicator of MTB treatment, and cluster-robust standard errors based on wild bootstrap are used for inference. DISCUSSION This is the first trial of MTB in a Scandinavian context and will include the largest sample yet in a trial of MTB. The trial is expected to contribute to knowledge about the effect of early support for pregnant women, their infants, and their families at increased risk of adversity. TRIAL REGISTRATION ClinicalTrials.gov NCT03495895 . The study was registered on April 12, 2018.
Collapse
Affiliation(s)
- Maiken Pontoppidan
- VIVE - The Danish Centre for Social Science Research, Herluf Trolles Gade 11, 1052, Copenhagen, Denmark.
| | - Mette Thorsager
- VIVE - The Danish Centre for Social Science Research, Herluf Trolles Gade 11, 1052, Copenhagen, Denmark
| | - Mette Friis-Hansen
- VIVE - The Danish Centre for Social Science Research, Herluf Trolles Gade 11, 1052, Copenhagen, Denmark
| | - Arietta Slade
- Yale Child Study Center, 230 S Frontage Rd, New Haven, CT, USA
| | - Lois S Sadler
- Yale Child Study Center, 230 S Frontage Rd, New Haven, CT, USA
- Yale University School of Nursing, 400 West Campus Drive, Orange, CT, USA
| |
Collapse
|
20
|
Branger MC, Emmen RA, Woudstra MLJ, Alink LR, Mesman J. Narrative coherence across the transition to parenthood: Primiparous parents' representations of their child in relation to parental sensitivity. Acta Psychol (Amst) 2022; 226:103581. [PMID: 35367638 DOI: 10.1016/j.actpsy.2022.103581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 03/24/2022] [Accepted: 03/28/2022] [Indexed: 11/01/2022] Open
Abstract
Narrative coherence reflects parents' ability to provide a believable, clear, relevant, and internally consistent story about their child. Parents demonstrating more narrative coherence have been theorized to show higher parental sensitivity, but this has not been examined in a normative sample, nor across the transition to parenthood, and only once in fathers. The aim of this study was to examine stability and change in narrative coherence across the transition to parenthood in mothers and fathers, as well as the relation between pre- and postnatal narrative coherence and postnatal parental sensitivity. The sample consisted of 105 primiparous expecting parents. Narrative coherence was measured at 36-weeks pregnancy and when the child was 4 months old, using the Five Minute Speech Sample procedure. Parental sensitivity was observed in three episodes. Results demonstrated that narrative coherence was moderately stable (correlations) across the transition to parenthood in fathers only. Both mothers' and fathers' narrative coherence improved over time. Furthermore, mothers and fathers were overall equally coherent, and maternal and paternal narrative coherence were positively interrelated during pregnancy only. Lastly, our findings showed weak evidence for the theorized link between narrative coherence and parental sensitivity: only postnatal narrative coherence predicted paternal sensitivity, only during free play. Our findings give new insight in the development of narrative coherence across the transition to parenthood, and how it relates to actual parenting. More research is needed to confirm our findings and further explore this topic.
Collapse
|
21
|
Charpentier Mora S, Bastianoni C, Koren-Karie N, Cavanna D, Tironi M, Bizzi F. Parental Mentalizing during Middle Childhood: How Is the Adoption of a Reflective Stance Associated with Child's Psychological Outcomes? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19106205. [PMID: 35627742 PMCID: PMC9140343 DOI: 10.3390/ijerph19106205] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/12/2022] [Accepted: 05/16/2022] [Indexed: 02/01/2023]
Abstract
This exploratory cross-sectional study attempts to understand the mechanisms underlying the role of parental mentalizing in a child's psychological functioning during middle childhood by using Parental Reflective Functioning (PRF) and Parental Insightfulness (PI) constructs. The main aims are to examine the role of PI and PRF as processes capable of influencing a child's psychological functioning in terms of emotional-behavioral difficulties and social-emotional competencies. Eighty-six community parents (48 mothers, 38 fathers) and their 50 children in middle childhood (Mage = 10.10, SD = 1.13) participated in this study, recruited through a non-probabilistic sampling. The following measures were used to assess the aims of this study: Insightfulness Assessment, Parental Reflective Functioning Questionnaire, Child Behavior Checklist (CBCL) and Devereux Student Strengths Assessment (DESSA) questionnaires. Results showed that parental mentalizing was found to be significantly associated with both child's internalizing and externalizing symptoms and social-emotional competencies as reported by parents through the CBCL and DESSA questionnaires. This study may offer a contribution to the study of parental mentalizing during middle childhood, supporting the hypothesis that both parents' ability to understand their child's mental states could affect the child's psychological functioning. Clinical and theoretical implications are geared toward a family-based view with a specific focus on the importance of fostering in both parents a positive attitude toward mentalizing processes.
Collapse
Affiliation(s)
- Simone Charpentier Mora
- Department of Educational Sciences, University of Genova, 16128 Genoa, Italy; (S.C.M.); (C.B.); (D.C.); (M.T.)
| | - Chiara Bastianoni
- Department of Educational Sciences, University of Genova, 16128 Genoa, Italy; (S.C.M.); (C.B.); (D.C.); (M.T.)
| | - Nina Koren-Karie
- The Center for the Study of Child Development, School of Social Work, University of Haifa, Haifa 3498838, Israel;
| | - Donatella Cavanna
- Department of Educational Sciences, University of Genova, 16128 Genoa, Italy; (S.C.M.); (C.B.); (D.C.); (M.T.)
| | - Marta Tironi
- Department of Educational Sciences, University of Genova, 16128 Genoa, Italy; (S.C.M.); (C.B.); (D.C.); (M.T.)
| | - Fabiola Bizzi
- Department of Educational Sciences, University of Genova, 16128 Genoa, Italy; (S.C.M.); (C.B.); (D.C.); (M.T.)
- Correspondence:
| |
Collapse
|
22
|
Stuhrmann LY, Göbel A, Bindt C, Mudra S. Parental Reflective Functioning and Its Association With Parenting Behaviors in Infancy and Early Childhood: A Systematic Review. Front Psychol 2022; 13:765312. [PMID: 35310277 PMCID: PMC8927808 DOI: 10.3389/fpsyg.2022.765312] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 01/31/2022] [Indexed: 12/04/2022] Open
Abstract
Background Parental reflective functioning (PRF) refers to parents' mental capacity to understand their own and their children's behaviors in terms of envisioned mental states. As part of a broader concept of parental mentalization, PRF has been identified as one of the central predictors for sensitive parenting. However, the unique contribution of PRF to the quality of various parenting behaviors has not yet been addressed systematically. Thus, the present article provides a systematic overview of current research on the associations between PRF or its sub-dimensions and observed parenting behaviors in infancy and early childhood, while considering the influence of contextual factors. Methods The review was conducted following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Systematic searches were carried out in five electronic databases. The eligibility and methodological quality of the identified studies were assessed using pre-defined criteria and a standardized checklist. Results Sixteen studies with moderate to high quality on a total of 15 parenting behaviors were included, the majority of which examined positive parenting behaviors, while negative parenting behaviors were rarely investigated. Most of the associations indicated a positive effect of PRF on parenting behavior, with mostly small-sized effects. The strength and direction of the associations varied depending on the dimensionality of PRF, observation settings, sample types, socioeconomic factors, and cultural background. Moreover, five assessment instruments for PRF and 10 observation instruments for parenting behaviors were identified. Conclusion In summary, PRF has shown a positive association with parenting quality. However, its complex interaction with further contextual factors emphasizes the need for differentiation of PRF dimensions and the consideration of the observation settings, assessment time points, psychosocial risks, and sample types in observational as well as intervention studies. Further high-quality studies with multivariate analyses and diverse study settings are required.
Collapse
Affiliation(s)
- Lydia Yao Stuhrmann
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | | | | |
Collapse
|
23
|
Pontoppidan M, Nygaard L, Thorsager M, Friis-Hansen M, Davis D, Nohr EA. The FACAM study: protocol for a randomized controlled study of an early interdisciplinary intervention to support women in vulnerable positions through pregnancy and the first 5 years of motherhood. Trials 2022; 23:73. [PMID: 35073975 PMCID: PMC8785506 DOI: 10.1186/s13063-022-06022-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 01/12/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Inequality in health can have profound short- and long-term effects on a child's life. Infants develop in a responsive environment, and the relationship between mother and infant begins to develop during pregnancy. The mother's ability to bond with the fetus and newborn child may be challenged by mental health issues which can cause impaired functioning and poorer health outcomes. Families with complex problems need interdisciplinary interventions starting in early pregnancy to be prepared for motherhood and to ensure healthy child development. This study aims to examine the effects of an early and coordinated intervention (the Family Clinic and Municipality (FACAM) intervention) offered to vulnerable pregnant women during pregnancy and the child's first year of life on the mother-child relationship, maternal social functioning, mental health, reflective functioning, well-being, parental stress, and the development and well-being of the child. METHODS The study is a prospective randomized controlled trial where we will randomize 320 pregnant women enrolled to receive antenatal care at the family clinic at Odense University Hospital, to either FACAM intervention or usual care. The FACAM intervention consists of extra support by a health nurse or family therapist during pregnancy and until the child starts school. The intervention is most intensive in the first 12 months and also includes attachment-based support provided either individually or in groups. The participants are assessed at baseline, and when the infant is 3 and 12 months old. The primary outcome is maternal sensitivity measured by the Coding Interactive Behavior (CIB) instrument. Secondary outcomes include prenatal parental reflective functioning, mental well-being, depressive symptoms, breastfeeding duration, maternal satisfaction, child development, parent competence, parental stress, and activities with the child. DISCUSSION The trial is expected to contribute knowledge about the effect of early coordinated support in antenatal and postnatal care for vulnerable pregnant women and their families. TRIAL REGISTRATION ClinicalTrials.gov NCT03659721 . Registered on September 6, 2018.
Collapse
Affiliation(s)
- Maiken Pontoppidan
- VIVE - The Danish Centre for Social Science Research, Herluf Trolles Gade 11, 1052, Copenhagen, Denmark.
| | - Lene Nygaard
- University of Canberra and ACT Health, Bruce, Australia
- Research Unit for Gynecology and Obstetrics, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Mette Thorsager
- VIVE - The Danish Centre for Social Science Research, Herluf Trolles Gade 11, 1052, Copenhagen, Denmark
| | - Mette Friis-Hansen
- VIVE - The Danish Centre for Social Science Research, Herluf Trolles Gade 11, 1052, Copenhagen, Denmark
| | - Deborah Davis
- University of Canberra and ACT Health, Bruce, Australia
| | - Ellen Aagaard Nohr
- Research Unit for Gynecology and Obstetrics, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark
| |
Collapse
|
24
|
Ekblad MO, Wallin HP, Pajulo M, Korhonen PE. Design of a prospective follow-up study on early parenthood and smoking behaviour during pregnancy in Finnish primary healthcare. Scand J Public Health 2021; 49:970-980. [PMID: 34148504 PMCID: PMC8573631 DOI: 10.1177/14034948211022433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Aims: The primary aim of the study is to explore different factors affecting parents’ smoking behaviour, and especially how smoking may be connected with individual differences in the psychological process of becoming a parent. In the current paper, we present the study design together with basic information on the study population. Methods: The Central Satakunta Maternity and Child Health Clinic (KESALATU) Study is an ongoing prospective follow-up study in primary healthcare of the Satakunta region of southwest Finland. Families were recruited during their first maternity clinic visit between 1 September 2016 and 31 December 2019, and participation will continue until the child is 1.5 years of age. The study combines different sources and types of data: e.g. routine data obtained from primary healthcare clinic records, specific parental self-report data and data from a new exhaled carbon monoxide meter indicating maternal smoking. The data are collected using frequently repeated assessments both during pregnancy and postnatally. The methods cover the following areas of interest: family background factors (including smoking and alcohol use), self-reported parental–foetal/infant attachment and mentalization, self-reported stress, depression and quality of life. Results: 589 pregnant women and their partners were asked to participate in the study during the collection time period. The final study population consisted of 248 (42.1%) pregnant women and 160 (27.1%) partners. Conclusions: The new methods and study design have the potential to increase our understanding about the link between early parenting psychology, prenatal psychosocial risk factors and parental health behaviour.
Collapse
Affiliation(s)
- Mikael O Ekblad
- Department of General Practice, University of Turku and Turku University Hospital, Finland
| | - Hanna P Wallin
- Department of General Practice, University of Turku and Turku University Hospital, Finland.,Central Satakunta Federation of Municipalities, Finland
| | - Marjukka Pajulo
- Department of Child Psychiatry, University of Turku, Finland
| | - Päivi E Korhonen
- Department of General Practice, University of Turku and Turku University Hospital, Finland
| |
Collapse
|
25
|
Skovbjerg S, Birk D, Bruggisser S, Wolf ALA, Fjorback L. Mindfulness-based stress reduction adapted to pregnant women with psychosocial vulnerabilities-a protocol for a randomized feasibility study in a Danish hospital-based outpatient setting. Pilot Feasibility Stud 2021; 7:118. [PMID: 34082839 PMCID: PMC8173971 DOI: 10.1186/s40814-021-00860-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 05/24/2021] [Indexed: 11/27/2022] Open
Abstract
Background This protocol is for a feasibility study of a mindfulness-based stress reduction (MBSR) program adapted for pregnant women with psychosocial vulnerabilities. The rationale for the study is the need for a wider array of evidence-based options to address prenatal mental health care needs in pregnant women. MBSR is a promising mental health intervention but has not yet been adapted for pregnant women with the aim of addressing prenatal mental health. The purpose is thus to evaluate the feasibility, acceptability, and clinical outcomes of an adapted MBSR program, prenatal MBSR, compared to usual care to inform a randomized controlled trial. Methods/design Pregnant women (n = 60) referred to an outpatient clinic at Copenhagen University Hospital, Amager and Hvidovre, Denmark, will be recruited for the study. The design is a single-center feasibility trial, with prenatal MBSR, as an add-on to usual care. The primary outcome is to assess the feasibility of a full-scale randomized controlled trial. The secondary feasibility outcome includes possible effects of the adapted MBSR program estimated by self-report questionnaires measuring stress, anxiety, depression, well-being, decentering, reflective functioning, mindfulness, and compassion. Participants will be randomized in a 1:1 ratio to prenatal MBSR or usual care. Discussion The study is part of the Good Start to Family Life study anchored at Copenhagen University Hospital, Amager and Hvidovre, Denmark. Teaching the skills of mindfulness meditation to a psychosocially vulnerable group of pregnant women could prove a viable and non-pharmacological approach to reduce stress, improve mental health, and provide support in the transition to parenthood. The outcomes of the feasibility study will inform the design of a fully powered randomized controlled trial. Trial registration ClinicalTrials.gov, NCT04571190. Registered on September 30, 2020 Supplementary Information The online version contains supplementary material available at 10.1186/s40814-021-00860-w.
Collapse
Affiliation(s)
- S Skovbjerg
- The Danish Center for Mindfulness, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - D Birk
- Department of Obstetrics and Gynecology, Copenhagen University Hospital, Hvidovre, Denmark
| | - S Bruggisser
- The Danish Center for Mindfulness, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - A L A Wolf
- Department of Obstetrics and Gynecology, Copenhagen University Hospital, Hvidovre, Denmark
| | - L Fjorback
- The Danish Center for Mindfulness, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| |
Collapse
|
26
|
Psychometric properties of the prenatal-parental reflective functioning questionnaire in Iranian mothers and fathers. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-01909-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
27
|
Assessing reflective functioning in prospective adoptive parents. PLoS One 2021; 16:e0245852. [PMID: 33497406 PMCID: PMC7837464 DOI: 10.1371/journal.pone.0245852] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 01/10/2021] [Indexed: 11/25/2022] Open
Abstract
The capacity for reflective functioning (RF) or mentalizing of adoptive parents is hypothesized to play an important role in fostering socio-emotional development in adopted children. This paper reports on the development and preliminary validation of the Adoption Expectations Interview (AEI), a semi-structured interview to assess RF in prospective adoptive parents. The AEI was developed based on the Pregnancy Interview, Parent Development Interview, and Working Model of the Child Interview, three interviews that have been used to assess RF in biological parents, to capture RF before child arrival in prospective adoptive parents. In a sample of 96 prospective adoptive parents, the Reflective Functioning Scale, as applied to the AEI (AEI-RFS) showed good reliability, with strong correlations between the different demand items, high internal consistency, and good to excellent inter-rater reliability. A principal component analysis yielded one component, suggesting that the items measured a unidimensional factor. Preliminary evidence for the construct validity of the AEI-RFS was demonstrated by significant associations between the AEI-RFS and well-validated measures of mentalizing, attachment dimensions, and interpersonal functioning.
Collapse
|
28
|
Røhder K, Væver MS, Aarestrup AK, Jacobsen RK, Smith-Nielsen J, Schiøtz ML. Maternal-fetal bonding among pregnant women at psychosocial risk: The roles of adult attachment style, prenatal parental reflective functioning, and depressive symptoms. PLoS One 2020; 15:e0239208. [PMID: 32941499 PMCID: PMC7498041 DOI: 10.1371/journal.pone.0239208] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 09/02/2020] [Indexed: 11/18/2022] Open
Abstract
Pregnancy offers a unique period for initiating preventive parenting interventions. Disturbances in maternal-fetal bonding may indicate suboptimal parenting and a need for intervention. However, more knowledge is needed on the development of maternal-fetal bonding among at-risk groups. The study aim was to examine psychosocial correlates of maternal-fetal bonding among pregnant women identified to be at risk socially and regarding their mental health. The sample consisted of 78 at-risk pregnant women participating in a perinatal intervention study: Godt på Vej Sammen [A Good Start to Life—an Early Cross-sectorial Intervention]. This study was cross-sectional reporting on the baseline characteristics of the participants. In the beginning of the second trimester, participants completed questionnaires assessing maternal-fetal bonding (the Maternal Antenatal Attachment Scale [MAAS]), prenatal parental reflective functioning, adult attachment style, and depressive symptoms. We compared the distribution of MAAS styles with norms from a recent Dutch community sample. In addition, we tested associations between psychosocial variables and the quality and intensity of MAAS scores in regression models and performed Chi-square analyses to assess the association of MAAS styles with psychosocial variables. First, compared to women from a community sample, approximately half of the women in our sample presented lower and suboptimal MAAS scores. Second, insecure avoidant adult attachment style was negatively associated with MAAS intensity, and depressive symptoms were negatively associated with MAAS quality. Third, prenatal parental reflective functioning positively correlated with both quality and intensity of MAAS. Fourth, we found no association between insecure anxious adult attachment style and MAAS scores. Fifth, women with a negative disinterested MAAS style demonstrated the highest avoidant attachment scores, while women with a positively preoccupied MAAS style demonstrated the highest prenatal parental reflective functioning scores. The results suggest that there is a need to differentiate among at-risk pregnant woman and that prenatal screening using the MAAS may help identify those who need preventive parenting interventions and what those interventions should focus on. A main limitation of the study is the lack of a representative group of at-risk pregnant women which limits the generalizability of the study results to all risk groups.
Collapse
Affiliation(s)
- Katrine Røhder
- Center for Clinical Research and Prevention, Frederiksberg Hospital, Capital Region of Denmark, Copenhagen, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
- * E-mail:
| | | | - Anne Kristine Aarestrup
- Center for Clinical Research and Prevention, Frederiksberg Hospital, Capital Region of Denmark, Copenhagen, Denmark
| | - Rikke Kart Jacobsen
- Center for Clinical Research and Prevention, Frederiksberg Hospital, Capital Region of Denmark, Copenhagen, Denmark
| | | | - Michaela L. Schiøtz
- Center for Clinical Research and Prevention, Frederiksberg Hospital, Capital Region of Denmark, Copenhagen, Denmark
| |
Collapse
|
29
|
Minding the Baby®: Enhancing parental reflective functioning and infant attachment in an attachment-based, interdisciplinary home visiting program. Dev Psychopathol 2020; 32:123-137. [PMID: 30636649 DOI: 10.1017/s0954579418001463] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
In this article, we describe the results of the second phase of a randomized controlled trial of Minding the Baby (MTB), an interdisciplinary reflective parenting intervention for infants and their families. Young first-time mothers living in underserved, poor, urban communities received intensive home visiting services from a nurse and social worker team for 27 months, from pregnancy to the child's second birthday. Results indicate that MTB mothers' levels of reflective functioning was more likely to increase over the course of the intervention than were those of control group mothers. Likewise, infants in the MTB group were significantly more likely to be securely attached, and significantly less likely to be disorganized, than infants in the control group. We discuss our findings in terms of their contribution to understanding the impacts and import of intensive intervention with vulnerable families during the earliest stages of parenthood in preventing the intergenerational transmission of disrupted relationships and insecure attachment.
Collapse
|
30
|
Cox H, James A, Day C, Reissland N. Feasibility of a psychoeducational group intervention to improve parental reflective functioning and bonding in pregnancy: a randomised trial. J Reprod Infant Psychol 2020; 39:499-515. [PMID: 32627592 DOI: 10.1080/02646838.2020.1786036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To develop and evaluate Baby CHAT, a single-session psychoeducational intervention for expectant parents. Baby CHAT aims to improve parental reflective functioning (RF) and bonding. BACKGROUND The early years of a child's life, including pregnancy, are vital for healthy physical and emotional development. Caregivers who provide responsive parenting, enhanced through strong bonds and good RF, can aid healthy development.. However, limited interventions exist to enhance RF and bonding in expectant parents. METHODS Feasibility of Baby CHAT was assessed using a mixed methods randomised controlled trial design. It evaluated uptake and retention of participants, effect size calculations, and acceptability and satisfaction with Baby CHAT. RESULTS Participants (N = 20) were aged 30-39 years (n = 17) in their third trimester of pregnancy (n = 12). Nine males and 11 females were recruited. Content analysis of qualitative feedback after the intervention resulted in four themes; positive group aspects, group improvements, 4D scan footage and relating content to my baby. CONCLUSIONS Baby CHAT can help expectant parents think about their baby as a separate person and has potential to improve prenatal RF and bonding. However, further research is required to assess the effectiveness of Baby CHAT to improve bonding and RF.
Collapse
Affiliation(s)
- Hannah Cox
- Clinical Psychology Department, Royal Holloway University, London, UK
| | - Alana James
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Crispin Day
- Centre for Parent and Child Support, South London and Maudsley NHS Foundation Trust, Michael Rutter Centre, Camberwell, London
| | | |
Collapse
|
31
|
Aarestrup AK, Skovgaard Væver M, Petersen J, Røhder K, Schiøtz M. An early intervention to promote maternal sensitivity in the perinatal period for women with psychosocial vulnerabilities: study protocol of a randomized controlled trial. BMC Psychol 2020; 8:41. [PMID: 32345375 PMCID: PMC7189589 DOI: 10.1186/s40359-020-00407-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 04/12/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Maternal mental well-being and social circumstances during pregnancy and early childhood impact the child's well-being and development. Supportive and sensitive parenting is one of the strongest predictors of positive emotional, social and behavioral outcomes for the child. Knowledge is needed about how to detect and support vulnerable families already during pregnancy and in the postnatal period. The aim of this study is to assemble and evaluate an interdisciplinary cross-sectoral intervention to promote maternal sensitivity among women with psychological or social vulnerabilities. METHODS/DESIGN This randomized controlled trial tests the efficacy of an intervention program in the perinatal period compared to care as usual in enhancing maternal sensitivity in a group of psychologically or socially vulnerable women in the Capital Region of Denmark. The intervention consists of four components: 1) detecting symptoms of mental illness in vulnerable pregnant women and initiating treatment if indicated, 2) strengthening parenting skills using the Circle of Security Parenting program, 3) supporting breastfeeding, and 4) sharing knowledge and organizing treatment pathways for families across sectors. Seventy-six families will be randomly assigned to the intervention or care-as-usual. Data will be obtained at study inclusion at 3-5 months of pregnancy, eight weeks after childbirth, and nine months after childbirth. The primary outcome is maternal sensitivity. Secondary outcomes include infant's socio-emotional development, parents' mentalization, parental stress, depressive symptoms, and parental wellbeing. Qualitative data will provide insight into the implementation process. DISCUSSION This paper presents the rational and background for developing the intervention. Furthermore, the design and protocol of the randomized controlled trial. It is hypothesized that the intervention will be associated with positive changes in primary and secondary outcomes. If effective, the intervention will provide insights into prenatal risk profiles among an identified group of psychosocial vulnerable women important for early screening and point to effective preventive interventions that can support women in the perinatal period, increase maternal sensitivity and promote positive child development -starting before the child is born. TRIAL REGISTRATION ClinicalTrials.gov: ID: NCT03190707. Registered June 16, 2017.
Collapse
Affiliation(s)
- Anne Kristine Aarestrup
- Center for Clinical Research and Prevention, Frederiksberg Hospital, Nordre Fasanvej 57, Vej 8, Indgang 1, 1.sal, 2000 Frederiksberg, Denmark
| | - Mette Skovgaard Væver
- Centre for Early Intervention and Family Studies, Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Janne Petersen
- Center for Clinical Research and Prevention, Frederiksberg Hospital, Nordre Fasanvej 57, Vej 8, Indgang 1, 1.sal, 2000 Frederiksberg, Denmark
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Katrine Røhder
- Center for Clinical Research and Prevention, Frederiksberg Hospital, Nordre Fasanvej 57, Vej 8, Indgang 1, 1.sal, 2000 Frederiksberg, Denmark
| | - Michaela Schiøtz
- Center for Clinical Research and Prevention, Frederiksberg Hospital, Nordre Fasanvej 57, Vej 8, Indgang 1, 1.sal, 2000 Frederiksberg, Denmark
| |
Collapse
|
32
|
Jussila H, Pajulo M, Ekholm E. A Novel 4D Ultrasound Parenting Intervention for Substance Using Pregnant Women in Finland: Participation in Obstetric Care, Fetal Drug Exposure, and Perinatal Outcomes in a Randomized Controlled Trial. Matern Child Health J 2020; 24:90-100. [PMID: 31250239 PMCID: PMC6957471 DOI: 10.1007/s10995-019-02773-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Objectives The aim of the study was to explore the effect of a new prenatal intervention on participation in obstetric care, fetal drug exposure, and perinatal outcomes among substance using pregnant women in Finland. Methods The participants were 90 women referred to a hospital obstetric outpatient clinic due to current or recent substance use. The intervention group (n = 46) was offered three interactive ultrasounds at 24, 30 and 34 gestational weeks and a pregnancy diary accompanied by three prenatal infant mental health consultations. The intervention elements were designed to enhance parental mentalization and prenatal attachment. A randomized control group (n = 44) design was used. All participants were offered treatment-as-usual in the obstetric tertiary setting. Medical record data and meconium toxicology were analyzed. Results The retention rate in the whole sample was 89%. Retention was higher in the intervention group (96% vs. 82%, p < 0.05), of which 74% attended all three ultrasound sessions. However, the pregnant women in the intervention group participated less often in all the scheduled obstetric standard care visits (59% vs. 83%, p = 0.02). Fetal drug exposure and perinatal outcomes were similar in both groups. Within the whole sample, 13% of the neonates were preterm, 12% small for gestational age and 7% had exposure to drugs. Conclusions for Practice Retention in the intervention was very good. Watching the fetus with parenting focus seemed to motivate these high-risk women. Interestingly, the pregnant women in the intervention group tended to prefer the intervention sessions to the routine care. Clinical implications of this finding are discussed. Trial Registry The trial registration number in ClinicalTrials.gov: NCT03413631.
Collapse
Affiliation(s)
- Heidi Jussila
- Doctoral Programme of Clinical Investigation, Department of Child Psychiatry, University of Turku, 20014 Turku, Finland
- Department of Child Psychiatry, Turku University Hospital, Kiinamyllynkatu 4-8, PL 52, 20521 Turku, Finland
| | - Marjukka Pajulo
- Department of Child Psychiatry and The FinnBrain, University of Turku, 20014 Turku, Finland
| | - Eeva Ekholm
- Department of Obstetrics and Gynecology, Turku University Hospital, Kiinamyllynkatu 4-8, PL 52, 20521 Turku, Finland
- Department of Obstetrics and Gynecology, University of Turku, 20014 Turku, Finland
| |
Collapse
|
33
|
Ahrnberg H, Pajulo M, Scheinin NM, Karlsson L, Karlsson H, Karukivi M. Association between parental alexithymic traits and self-reported postnatal reflective functioning in a birth cohort population. Findings from the FinnBrain Birth Cohort Study. Psychiatry Res 2020; 286:112869. [PMID: 32105969 DOI: 10.1016/j.psychres.2020.112869] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 02/15/2020] [Accepted: 02/16/2020] [Indexed: 10/25/2022]
Abstract
Parental reflective functioning (PRF) refers to a parent's effort to see his/her child as a separate individual person from early on, and to be curious of the child's own thoughts and feelings. Parenting abilities are affected by the parent's emotion regulation and emotional availability. Alexithymia as a personality construct with emotional deficits and poor imagination could potentially affect also PRF, but studies on parental alexithymia are still scarce. The aim of the present study was to examine the association between parental alexithymic traits and PRF, which to date has not been explored. As most of the parenting research concern only mothers, an additional aim was to study also fathers. The 20-item Toronto Alexithymia Scale (TAS-20) and the 14-item Parental Reflective Functioning Questionnaire (PRFQ-Fi) were filled by 1882 mothers and 994 fathers at six months postpartum as part of the FinnBrain Birth Cohort Study. A significant negative association between TAS-20 total score and PRFQ-Fi total score among both genders was found. The main alexithymia dimension responsible for this association was Externally Oriented Thinking. The results suggest that alexithymic traits indeed are related to parental reflective functioning, but more studies are needed to explore the direction of this relation.
Collapse
Affiliation(s)
- Hanna Ahrnberg
- Department of Psychiatry, University of Turku and Turku University Hospital, Turku, Finland; FinnBrain Birth Cohort Study, Institute of Clinical Medicine, Turku Brain and Mind Center, University of Turku, Lemminkäisenkatu 3, 20014, Finland; Unit of Adolescent Psychiatry, Satakunta Hospital District, Pori, Finland.
| | - Marjukka Pajulo
- FinnBrain Birth Cohort Study, Institute of Clinical Medicine, Turku Brain and Mind Center, University of Turku, Lemminkäisenkatu 3, 20014, Finland; Department of Child Psychiatry, University of Turku and Turku University Hospital, Turku, Finland
| | - Noora M Scheinin
- Department of Psychiatry, University of Turku and Turku University Hospital, Turku, Finland; FinnBrain Birth Cohort Study, Institute of Clinical Medicine, Turku Brain and Mind Center, University of Turku, Lemminkäisenkatu 3, 20014, Finland
| | - Linnea Karlsson
- FinnBrain Birth Cohort Study, Institute of Clinical Medicine, Turku Brain and Mind Center, University of Turku, Lemminkäisenkatu 3, 20014, Finland; Department of Child Psychiatry, University of Turku and Turku University Hospital, Turku, Finland
| | - Hasse Karlsson
- Department of Psychiatry, University of Turku and Turku University Hospital, Turku, Finland; FinnBrain Birth Cohort Study, Institute of Clinical Medicine, Turku Brain and Mind Center, University of Turku, Lemminkäisenkatu 3, 20014, Finland
| | - Max Karukivi
- Department of Psychiatry, University of Turku and Turku University Hospital, Turku, Finland; FinnBrain Birth Cohort Study, Institute of Clinical Medicine, Turku Brain and Mind Center, University of Turku, Lemminkäisenkatu 3, 20014, Finland; Unit of Adolescent Psychiatry, Satakunta Hospital District, Pori, Finland
| |
Collapse
|
34
|
Walsh TB. Your baby is so happy, active, uncooperative: How prenatal care providers contribute to parents' mental representations of the baby. Midwifery 2020; 83:102630. [PMID: 32006801 DOI: 10.1016/j.midw.2020.102630] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 11/29/2019] [Accepted: 01/13/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Parents' prenatal mental representations (i.e., thoughts and expectations) of their future child and relationship to that child have been associated with parenting and parent-child relationships after birth. OBJECTIVE To explore how prenatal care providers contribute to parents' mental representations of the baby they are expecting. METHODS Routine prenatal ultrasounds of 22 pregnant women recruited through prenatal care were observed. Detailed notes were taken using an adaptation of the "Observation of Routine Screen Form" (Boukydis, 2006). Data collection included interaction among parents and providers relevant to the relational, rather than medical, aspect of the exam (e.g., comments on the "personality" of the fetus, speculation about how the future baby will be like and unlike parents). Principles of grounded theory informed thematic analysis of the data. FINDINGS Providers varied widely in their recognition of the relational aspect of prenatal ultrasound and their interactive style. Through informal interactions during ultrasounds, providers alternately inhibited, amplified, and shaped parents' mental representations of their baby. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE The manner in which providers narrate and interpret images has implications for parents' prenatal mental representations of the baby. Given the importance of prenatal representations for future parenting and parent-child relationships, providers should attend to and facilitate parents' efforts to develop their own mental representations and establish feelings of connection to the baby.
Collapse
Affiliation(s)
- Tova B Walsh
- University of Wisconsin-Madison School of Social Work, 1350 University Avenue, Madison, WI 53706, United States.
| |
Collapse
|
35
|
Jussila H, Ekholm E, Pajulo M. A New Parental Mentalization Focused Ultrasound Intervention for Substance Using Pregnant Women. Effect on Self-reported Prenatal Mental Health, Attachment and Mentalization in a Randomized and Controlled Trial. Int J Ment Health Addict 2020. [DOI: 10.1007/s11469-019-00205-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
AbstractThe effect of a novel mentalization-based parenting intervention was explored on prenatal self-reported mentalization (P-PRFQ), attachment (MFAS), depression (EPDS) and anxiety (STAI) among women with substance use problems. The participants were 90 pregnant women referred to obstetric outpatient care due to recent or current substance use and randomized into intervention (n = 46) and control (n = 44) groups. The intervention group received three interactive 4D ultrasound sessions and a week-by-week pregnancy diary. The control condition was constituted of treatment-as-usual in obstetric care. Unfortunately, the efficacy of the intervention on maternal prenatal mental health, attachment, and parental mentalization was not substantiated. The negative results may be related to the small sample size, the patient-reported outcomes, or insufficient efficacy within this high-risk group. In the context of high psychosocial risks and follow-up by Child Welfare Services, the patient-reported outcomes may have underestimated prenatal adversity. The role of the research context, methodology, and possible sources of bias in the outcome assessment are discussed.The trial registration number in the ClinicalTrials.gov: NCT03413631
Collapse
|
36
|
Karlsson L, Tolvanen M, Scheinin NM, Uusitupa HM, Korja R, Ekholm E, Tuulari JJ, Pajulo M, Huotilainen M, Paunio T, Karlsson H. Cohort Profile: The FinnBrain Birth Cohort Study (FinnBrain). Int J Epidemiol 2019; 47:15-16j. [PMID: 29025073 DOI: 10.1093/ije/dyx173] [Citation(s) in RCA: 154] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2017] [Indexed: 12/29/2022] Open
Affiliation(s)
- Linnea Karlsson
- Institute of Clinical Medicine, Turku Brain and Mind Center, FinnBrain Birth Cohort Study.,Department of Child Psychiatry
| | - Mimmi Tolvanen
- Institute of Clinical Medicine, Turku Brain and Mind Center, FinnBrain Birth Cohort Study.,Department of Community Dentistry
| | - Noora M Scheinin
- Institute of Clinical Medicine, Turku Brain and Mind Center, FinnBrain Birth Cohort Study.,Department of Psychiatry
| | - Henna-Maria Uusitupa
- Institute of Clinical Medicine, Turku Brain and Mind Center, FinnBrain Birth Cohort Study
| | - Riikka Korja
- Institute of Clinical Medicine, Turku Brain and Mind Center, FinnBrain Birth Cohort Study.,Department of Psychology, University of Turku
| | - Eeva Ekholm
- Institute of Clinical Medicine, Turku Brain and Mind Center, FinnBrain Birth Cohort Study.,Department of Obstetrics and Gynecology, University of Turku and Turku University Hospital, Turku, Finland
| | - Jetro J Tuulari
- Institute of Clinical Medicine, Turku Brain and Mind Center, FinnBrain Birth Cohort Study
| | - Marjukka Pajulo
- Institute of Clinical Medicine, Turku Brain and Mind Center, FinnBrain Birth Cohort Study.,Department of Child Psychiatry
| | - Minna Huotilainen
- Institute of Clinical Medicine, Turku Brain and Mind Center, FinnBrain Birth Cohort Study.,University of Helsinki, Cognitive Brain Research Unit and CICERO Learning Network, Helsinki, Finland
| | - Tiina Paunio
- National Institute for Health and Welfare, the Genomics and Biomarkers Unit, Helsinki, Finland.,University of Helsinki and Helsinki University Hospital, Department of Psychiatry, Helsinki, Finland
| | - Hasse Karlsson
- Institute of Clinical Medicine, Turku Brain and Mind Center, FinnBrain Birth Cohort Study.,Department of Psychiatry
| | | |
Collapse
|
37
|
Pajulo M, Tolvanen M, Pyykkönen N, Karlsson L, Mayes L, Karlsson H. Exploring parental mentalization in postnatal phase with a self-report questionnaire (PRFQ): Factor structure, gender differences and association with sociodemographic factors. The Finn Brain Birth Cohort Study. Psychiatry Res 2018; 262:431-439. [PMID: 28939390 DOI: 10.1016/j.psychres.2017.09.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Revised: 08/25/2017] [Accepted: 09/08/2017] [Indexed: 10/18/2022]
Abstract
The objective was to explore the preliminary functioning of a self-report questionnaire designed to assess parental reflective functioning (PRFQ, Luyten et al., 2009, unpublished manual) during early postnatal phase and with a large population-based sample. Parental reflective functioning (PRF) refers to parental capacity to focus on experience and feelings, within self, in the child and underlying observed reactions. Individual differences in PRF reportedly affect child attachment and socio-emotional development. Cost-effective tools to assess key areas of early parenting are needed for both research and clinical purposes. The factor structure of a 36-item version suitable for early postnatal phase was explored using population-based data from the Finn Brain Birth Cohort Study (425 mothers and 237 fathers). Exploratory and confirmatory factor analysis resulted in a 14-item version comprising four factors capturing relevant aspects of early PRF. The factor structure was further tested with separate participants from the cohort (1030 mothers and 422 fathers). Mothers tended to score higher than fathers in PRF. Among mothers, parity, age, and financial situation were associated with postnatal mentalization. Level of education was associated with postnatal mentalization in both genders. The 14-item PRFQ-Fi has potential to serve as a new screening tool for very early parenting.
Collapse
Affiliation(s)
- Marjukka Pajulo
- Finn Brain, Institute of Clinical Medicine, University of Turku, Finland; Department of Child Psychiatry, Institute of Clinical Medicine, University of Turku, Finland.
| | - Mimmi Tolvanen
- Finn Brain, Institute of Clinical Medicine, University of Turku, Finland; Department of Community Dentistry, University of Turku, Finland
| | - Nina Pyykkönen
- Finn Brain, Institute of Clinical Medicine, University of Turku, Finland; Department of Child Psychiatry, Institute of Clinical Medicine, University of Turku, Finland
| | - Linnea Karlsson
- Finn Brain, Institute of Clinical Medicine, University of Turku, Finland; Department of Child Psychiatry, Institute of Clinical Medicine, University of Turku, Finland; Department of Mental Health and Substance Use Services, National Institute for Health and Welfare, Helsinki, Finland
| | - Linda Mayes
- Yale Child Study Center, School of Medicine, Yale University, CT, USA
| | - Hasse Karlsson
- Finn Brain, Institute of Clinical Medicine, University of Turku, Finland; Department of Psychiatry, Institute of Clinical Medicine, University of Turku, Finland
| |
Collapse
|
38
|
Cooke D, Priddis L, Luyten P, Kendall G, Cavanagh R. PATERNAL AND MATERNAL REFLECTIVE FUNCTIONING IN THE WESTERN AUSTRALIAN PEEL CHILD HEALTH STUDY. Infant Ment Health J 2017; 38:561-574. [PMID: 28833359 DOI: 10.1002/imhj.21664] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
While past research on the care of infants has been mostly with mothers, in recent times there has been a renewed attention to the father-infant relationship. This study examined differences between mother and father parental reflective functioning (PRF) or parental mentalizing; that is, the parental capacity to reason about their own and their children's behaviors by taking into consideration intentional mental states. Data were collected from 120 couples with a 1-year-old child who were participants in the West Australian Peel Child Health Study. Parental mentalizing was assessed using the Parental Reflective Functioning Questionnaire (PRFQ; Luyten, Mayes, Nijssens, & Fonagy, ). Results showed that mother and father mentalizing with their children was independent and that mothers scored slightly higher levels of mentalizing than did fathers. Paternal mentalizing was weakly associated with family income and father education, and was more strongly associated with family functioning than with maternal mentalizing. Implications for theorizing on PRF and fatherhood more generally are discussed.
Collapse
Affiliation(s)
| | | | - Patrick Luyten
- University of Leuven, Belgium and University College London
| | | | | |
Collapse
|
39
|
Luyten P, Mayes LC, Nijssens L, Fonagy P. The parental reflective functioning questionnaire: Development and preliminary validation. PLoS One 2017; 12:e0176218. [PMID: 28472162 PMCID: PMC5417431 DOI: 10.1371/journal.pone.0176218] [Citation(s) in RCA: 198] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 04/09/2017] [Indexed: 11/19/2022] Open
Abstract
This paper reports on three studies on the development and validation of the Parental Reflective Functioning Questionnaire (PRFQ), a brief, multidimensional self-report measure that assesses parental reflective functioning or mentalizing, that is, the capacity to treat the infant as a psychological agent. Study 1 investigated the factor structure, reliability, and relationships of the PRFQ with demographic features, symptomatic distress, attachment dimensions, and emotional availability in a socially diverse sample of 299 mothers of a child aged 0-3. In Study 2, the factorial invariance of the PRFQ in mothers and fathers was investigated in a sample of 153 first-time parents, and relationships with demographic features, symptomatic distress, attachment dimensions, and parenting stress were investigated. Study 3 investigated the relationship between the PRFQ and infant attachment classification as assessed with the Strange Situation Procedure (SSP) in a sample of 136 community mothers and their infants. Exploratory and confirmatory factor analyses suggested three theoretically consistent factors assessing pre-mentalizing modes, certainty about the mental states of the infant, and interest and curiosity in the mental states of the infant. These factors were generally related in theoretically expected ways to parental attachment dimensions, emotional availability, parenting stress, and infant attachment status in the SSP. Yet, at the same time, more research on the PRFQ is needed to further establish its reliability and validity.
Collapse
Affiliation(s)
- Patrick Luyten
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
- Research Department of Clinical, Education and Health Psychology, UCL, London, United Kingdom
- Yale Child Study Center, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Linda C. Mayes
- Yale Child Study Center, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Liesbet Nijssens
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Peter Fonagy
- Research Department of Clinical, Education and Health Psychology, UCL, London, United Kingdom
| |
Collapse
|
40
|
Luyten P, Nijssens L, Fonagy P, Mayes LC. Parental Reflective Functioning: Theory, Research, and Clinical Applications. PSYCHOANALYTIC STUDY OF THE CHILD 2017. [DOI: 10.1080/00797308.2016.1277901] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Patrick Luyten
- Faculty of Psychology and Educational Sciences, KU Leuven
- Research Department of Clinical, Educational and Health Psychology, University College London
| | | | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London
| | | |
Collapse
|
41
|
Smaling HJA, Huijbregts SCJ, van der Heijden KB, Hay DF, van Goozen SHM, Swaab H. Prenatal Reflective Functioning and Development of Aggression in Infancy: the Roles of Maternal Intrusiveness and Sensitivity. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2017; 45:237-248. [PMID: 27344154 PMCID: PMC5241342 DOI: 10.1007/s10802-016-0177-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Maternal reflective functioning (RF) has been associated with quality of parent-child interactions and child development. This study investigated whether prenatal RF predicted the development of infant physical aggression and whether maternal sensitivity and/or intrusiveness mediated or moderated this association. The sample consisted of 96 first-time mothers (M = 22.57 years, SD = 2.13) and their infants (54 % male). Prenatal RF was measured with an interview, maternal behavior was observed during free play at 6 months post-partum, and infant physical aggression was assessed at 6, 12, and 20 months using maternal reports. Multivariate analyses of variance showed that relatively poor prenatal RF was related to relatively high infant physical aggression. These associations were moderated by maternal intrusiveness, with significant differences in physical aggression between RF-groups reportedly only in the absence of intrusiveness. Generally, mothers reported an increase in physical aggression between 6 and 12 months, except when they had both low RF-skills and were relatively less sensitive. It is concluded that prenatal RF is associated with (development of) infant physical aggression, and may be targeted in intervention programs aimed at reducing early physical aggression. Less adequate parenting, however, may counteract the beneficial effects of good RF, or obscure insight into children's behavioral development.
Collapse
Affiliation(s)
- H J A Smaling
- Department of Clinical Child and Adolescent Studies, Leiden University, P.O. Box 9555, 2300 RB, Leiden, The Netherlands.
- Leiden Institute for Brain and Cognition, Leiden University, Leiden, The Netherlands.
| | - S C J Huijbregts
- Department of Clinical Child and Adolescent Studies, Leiden University, P.O. Box 9555, 2300 RB, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden University, Leiden, The Netherlands
| | - K B van der Heijden
- Department of Clinical Child and Adolescent Studies, Leiden University, P.O. Box 9555, 2300 RB, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden University, Leiden, The Netherlands
| | - D F Hay
- School of Psychology, Cardiff University, Cardiff, UK
| | - S H M van Goozen
- Department of Clinical Child and Adolescent Studies, Leiden University, P.O. Box 9555, 2300 RB, Leiden, The Netherlands
- School of Psychology, Cardiff University, Cardiff, UK
| | - H Swaab
- Department of Clinical Child and Adolescent Studies, Leiden University, P.O. Box 9555, 2300 RB, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden University, Leiden, The Netherlands
| |
Collapse
|
42
|
Camoirano A. Mentalizing Makes Parenting Work: A Review about Parental Reflective Functioning and Clinical Interventions to Improve It. Front Psychol 2017; 8:14. [PMID: 28163690 PMCID: PMC5247433 DOI: 10.3389/fpsyg.2017.00014] [Citation(s) in RCA: 137] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 01/03/2017] [Indexed: 01/08/2023] Open
Abstract
In the last decade several studies have investigated the role of parental reflective functioning (RF), defined as the parental ability to understand his/her child’s mental states, on the child’s development. Herein, a narrative review on parental RF is presented aimed at (1) presenting an overview of the existing empirical studies, (2) pinpointing unrequited questions, and (3) identifying future research directions. Specifically, the current review focused on (a) the impact of parental RF on the quality of caregiving and the child’s attachment security, (b) the effect of parental RF on the child’s emotion regulation and the child’s RF, (c) maternal RF in women with a history of neglect and abuse, (d) the efficacy of mentalization-based clinical interventions, and (e) the recently developed Parental Reflective Questionnaire. The following terms “maternal RF,” “paternal RF,” “parental RF,” “parental mentalization,” “maternal mentalization,” and “paternal mentalization” were searched in titles, abstracts, and main texts using Medline, Web of Science, and Scopus databases. Next, a search in Mendeley was also conducted. Inclusion criteria comprised original articles if they refer to the RF Scale (Fonagy et al., 1998) and were published in an English language, peer-reviewed journal before July, 2016. According to exclusion criteria, dissertations, qualitative or theoretical papers, and chapters in books were not taken into account. The review includes 47 studies that, taken together, supported the notion that higher parental RF was associated with adequate caregiving and the child’s attachment security, whereas low maternal RF was found in mothers whose children suffered from anxiety disorders, impairment in emotion regulation, and externalizing behaviors. In addition, higher parental RF was associated with better mentalizing abilities in children. However, unexpected findings have emerged from the most recent randomized controlled trials that tested the efficacy of mentalization-based interventions in high risk samples of mothers, raising questions about the suitability of the verbal measures in capturing the mentalizing processes at the root of the parental capacity to be adequately responsive to the child’s emotional needs.
Collapse
|
43
|
Luyten P, Mayes LC, Nijssens L, Fonagy P. The parental reflective functioning questionnaire: Development and preliminary validation. PLoS One 2017. [PMID: 28472162 DOI: 10.1371/journal.pone.0176218m] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023] Open
Abstract
This paper reports on three studies on the development and validation of the Parental Reflective Functioning Questionnaire (PRFQ), a brief, multidimensional self-report measure that assesses parental reflective functioning or mentalizing, that is, the capacity to treat the infant as a psychological agent. Study 1 investigated the factor structure, reliability, and relationships of the PRFQ with demographic features, symptomatic distress, attachment dimensions, and emotional availability in a socially diverse sample of 299 mothers of a child aged 0-3. In Study 2, the factorial invariance of the PRFQ in mothers and fathers was investigated in a sample of 153 first-time parents, and relationships with demographic features, symptomatic distress, attachment dimensions, and parenting stress were investigated. Study 3 investigated the relationship between the PRFQ and infant attachment classification as assessed with the Strange Situation Procedure (SSP) in a sample of 136 community mothers and their infants. Exploratory and confirmatory factor analyses suggested three theoretically consistent factors assessing pre-mentalizing modes, certainty about the mental states of the infant, and interest and curiosity in the mental states of the infant. These factors were generally related in theoretically expected ways to parental attachment dimensions, emotional availability, parenting stress, and infant attachment status in the SSP. Yet, at the same time, more research on the PRFQ is needed to further establish its reliability and validity.
Collapse
Affiliation(s)
- Patrick Luyten
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
- Research Department of Clinical, Education and Health Psychology, UCL, London, United Kingdom
- Yale Child Study Center, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Linda C Mayes
- Yale Child Study Center, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Liesbet Nijssens
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Peter Fonagy
- Research Department of Clinical, Education and Health Psychology, UCL, London, United Kingdom
| |
Collapse
|
44
|
Heffron MC, Reynolds D, Talbot B. REFLECTING TOGETHER: REFLECTIVE FUNCTIONING AS A FOCUS FOR DEEPENING GROUP SUPERVISION. Infant Ment Health J 2016; 37:628-639. [DOI: 10.1002/imhj.21608] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
45
|
Smaling HJA, Huijbregts SCJ, van der Heijden KB, van Goozen SHM, Swaab H. Maternal reflective functioning as a multidimensional construct: Differential associations with children's temperament and externalizing behavior. Infant Behav Dev 2016; 44:263-74. [PMID: 27522031 DOI: 10.1016/j.infbeh.2016.06.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 04/20/2016] [Accepted: 06/12/2016] [Indexed: 10/21/2022]
Abstract
Maternal reflective functioning (RF) has been associated with children's behavioral development. This study examined maternal prenatal and postnatal RF, as measured by the Pregnancy Interview and Parent Development Interview, as multidimensional constructs. It was also examined whether the RF-dimensions were associated with children's temperament and externalizing behavior, as assessed by several questionnaires. The sample consisted of 123 first-time mothers (M age=22.85years, SD=2.21) and their children (M age=19.97months, SD=0.85, 56% male). Two related but distinct dimensions were found for prenatal RF, termed self-focused and child-focused mentalization. Three dimensions were observed for postnatal RF, termed self-focused, child-focused, and relation-focused mentalization. Results showed that prenatal RF negatively related to reported child physical aggression. Postnatal self-focused RF was positively linked to externalizing behavior and negative emotionality in offspring, while relation-focused RF scores were negatively associated with child physical aggression. Findings show that it is important to also look at the specific RF-dimensions when examining the effects of maternal RF on children's behavioral development, as differential associations with behavioral outcomes exist. Discussion further focuses on the importance of these findings in prevention and clinical practice, and suggestions are being made to further improve the measurement of maternal RF-dimensions.
Collapse
Affiliation(s)
- H J A Smaling
- Department of Clinical Child and Adolescent Studies, Leiden University, Leiden, The Netherlands; Leiden Institute for Brain and Cognition, Leiden University, Leiden, The Netherlands.
| | - S C J Huijbregts
- Department of Clinical Child and Adolescent Studies, Leiden University, Leiden, The Netherlands; Leiden Institute for Brain and Cognition, Leiden University, Leiden, The Netherlands
| | - K B van der Heijden
- Department of Clinical Child and Adolescent Studies, Leiden University, Leiden, The Netherlands; Leiden Institute for Brain and Cognition, Leiden University, Leiden, The Netherlands
| | - S H M van Goozen
- Department of Clinical Child and Adolescent Studies, Leiden University, Leiden, The Netherlands; School of Psychology, Cardiff University, Cardiff, United Kingdom
| | - H Swaab
- Department of Clinical Child and Adolescent Studies, Leiden University, Leiden, The Netherlands; Leiden Institute for Brain and Cognition, Leiden University, Leiden, The Netherlands
| |
Collapse
|
46
|
SUBSTANCE-ABUSING PREGNANT WOMEN: PRENATAL INTERVENTION USING ULTRASOUND CONSULTATION AND MENTALIZATION TO ENHANCE THE MOTHER-CHILD RELATIONSHIP AND REDUCE SUBSTANCE USE. Infant Ment Health J 2016; 37:317-34. [DOI: 10.1002/imhj.21574] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 03/23/2016] [Accepted: 04/18/2016] [Indexed: 02/05/2023]
|