The Dutch Infant Caregiving Assessment Scales: Psychometric properties in mothers with and without a severe psychiatric disorder

Attachment security and disorganization in infants of mothers with severe psychiatric disorder: Exploring the role of comorbid personality disorder

The aim of this preliminary study was to explore infant-mother attachment quality in a Dutch clinical sample of mothers with severe psychiatric disorder, with or without comorbid personality disorder. Thirty-two mothers were recruited through specialized secondary and tertiary outpatient clinics and mental health institutions. Maternal psychiatric and personality diagnoses were verified with structured clinical interviews during pregnancy. Maternal concurrent level of psychiatric symptoms was assessed by self-report and infant-mother attachment quality by observation in the Strange Situation Procedure at 14 months postpartum. In the full sample, almost half of the infants were classified as disorganized. All infants of mothers with a comorbid personality disorder were classified as either insecure or disorganized. Infants of mothers with a comorbid personality disorder had a significantly higher disorganization score than infants of mothers with a psychiatric disorder only. Continuous attachment security scores did not differ significantly between groups. In the full sample, continuous infant attachment security and disorganization score were not significantly correlated with the level of maternal concurrent psychiatric symptoms. Our exploratory findings suggest a specific link between maternal psychiatric and comorbid personality disorder and attachment disorganization. Moreover, chronicity of symptoms appears more relevant for attachment behaviors than the severity of concurrent psychiatric symptoms. Maternal personality disorder may have a strong formative impact on infant attachment security and disorganization, which warrants further research to inform clinical practice, in order to reduce the risk of intergenerational transmission of maternal psychopathology.

Early Maternal Caregiving Capacities in Highly Vulnerable, Multi-Problem Families

Caregiving capacities may be an important link between multi-problem circumstances and adverse child development. This study aims to assess caregiving capacities and their correlations in highly vulnerable, multi-problem families in Rotterdam, the Netherlands. Caregiving capacity (overall, emotional and instrumental) was prospectively assessed in 83 highly vulnerable women using video-observations of daily caregiving tasks, six week postpartum. Supporting data were collected at three time points: at inclusion, six weeks after inclusion and six weeks postpartum, and these included psychological symptoms, self-sufficiency, problematic life domains, home environment, income, depression, anxiety and stress. Pregnancy- and delivery-related information was collected from obstetric care professionals. Maternal caregiving scores averaged below adequate quality. Mothers living in an unsafe home environment (B = 0.62) and mothers with more problematic life domains (≤3 domains, B = 0.32) showed significantly higher instrumental caregiving capacities. Other variables were not related to caregiving capacities. Caregiving capacity in this highly vulnerable population was below adequate quality. However, in most cases there was no significant association between caregiving and the variables related to vulnerability. This means that a potential association between vulnerability and caregiving capacities might be driven by the interaction between several problems, rather than the type or number of problems.