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

Parental reflective functioning in mothers and fathers of preschoolers: Associations with adult attachment and parenting behavior

Parental reflective functioning (PRF) is considered a key parental competence. Since most research on PRF has focused on infancy or the first years of life, there is a gap in our understanding of PRF among parents of older children. Therefore, we investigated PRF in mothers and fathers with preschool-aged children, examining associations between PRF, parent's romantic attachment, and observed parenting behavior. The sample comprised 50 mothers, 40 fathers, and their 5-year-old children. PRF was assessed using the parental reflective functioning questionnaire (PRFQ), parental romantic attachment was assessed using the experiences in close relationships scale-revised (ECR-R), and parenting behavior was assessed during a parent-child free-play interaction with the coding interactive behavior (CIB) coding system. Results showed that mothers scored higher on the interest and curiosity scale than fathers, indicating that mothers show a more active interest and curiosity in their child's mental states. Further, higher levels of attachment anxiety in fathers were associated with higher levels of pre-mentalizing modes. In mothers, higher levels of attachment avoidance were associated with lower levels of interest and curiosity. Finally, and unexpectedly, higher levels of interest and curiosity in mothers were associated with less sensitivity during free play. In summary, the study found meaningful associations between mothers' and fathers' romantic attachment and their PRF indicating a spill-over of their attachment strategies into their relationship with their child. Further, the study results suggest that very high levels of interest and curiosity in mothers reflect hypermentalizing.

Psychometric evaluation of the Parental Reflective Functioning Questionnaire in Polish mothers

Parental reflective functioning (PRF) refers to a parent's capacity to reflect on and understand the inner mental states of their child, their own mental states with regard to their child, and how these mental states may influence their behavior and interactions. This capacity has been shown to foster secure attachment in children and their socio-emotional development. The present study examined the psychometric properties of the Polish translation of the Parental Reflective Functioning Questionnaire (PRFQ), a brief screening measure of PRF, in a large community sample of Polish mothers of children aged 0-5 years (N = 979). Confirmatory factor analysis supported the hypothesized three-factor structure of the PRFQ, which consists of three subscales: prementalizing modes, certainty about mental states, and interest and curiosity in mental states. However, item loadings suggested that the 15-item version fitted the data better than the original 18-item version. These three PRFQ subscales exhibited satisfactory and moderate six-month test-retest reliability. They also correlated in theoretically expected ways with several criterion measures such as maternal attachment, maternal parenting stress, parental role restriction, depression severity, and borderline symptoms. In conclusion, this study is the first to provide preliminary evidence for the reliability and validity of the PRFQ as a measure of parental reflective functioning in Polish mothers.

Is parental depression related to parental mentalizing? A systematic review and three-level meta-analysis

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).

The effect of childhood maltreatment on adult survivors' parental reflective function, and attachment of their children: A systematic review

BACKGROUND

Parental reflective function (PRF) is a candidate mechanism in the transmission of intergenerational trauma. This systematic review examined (1) the association between parental history of childhood maltreatment and PRF, (2) how PRF relates to attachment in children of parent survivors, and (3) whether PRF moderates the association between parental maltreatment history and child attachment.

METHODS

Ten databases were searched (from inception to 10^th November 2021). Inclusion criteria were primary study, quantitative, parent participants, measures of childhood maltreatment, and postnatal PRF. Exclusion criteria were qualitative, intervention follow-up, gray literature, or a review study. Risk of bias was assessed using recommended tools. Data were narratively synthesized.

RESULTS

One-thousand-and-two articles were retrieved, of which eleven met inclusion criteria (N = 974 participants). Four studies found a significant association between parental childhood maltreatment and disrupted PRF, six did not, one found mixed results. One study reported the association between childhood maltreatment and attachment (nonsignificant results).

DISCUSSION

There is no clear evidence PRF is routinely disrupted in parent survivors, though there is high heterogeneity in studies. Future research should standardize design to better understand whether PRF is a candidate mechanism in intergenerational trauma.

OTHER

PROSPERO CRD42020223594.

Evaluation of the Danish version of the prenatal parental reflective functioning questionnaire in early pregnancy as a screening tool

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.

Self-report measure of parental reflective functioning: A study of reliability and validity across three samples of varying clinical risk

The Parental Reflective Functioning Questionnaire (PRFQ) provides an efficient way to measure a parent's capacity to recognize their child's mental states and to understand the relationship between underlying mental states and behavior. To date, limited work evaluates its psychometric properties beyond initial validation studies. Here we examined the reliability and validity of the PRFQ in three samples of varying clinical risk (e.g., community sample, previous mental health diagnosis, substance use disorder diagnosis). Across samples, the majority (e.g., 75%-78%) of mothers identified as White; all mothers were from the USA. We compared the PRFQ to task-based measures of mentalization, the Parent Development Interview (PDI), and measures of the parent-child relationship. The PRFQ was a reliable measure across samples, and it was associated in theoretically consistent ways with task-based measures of mentalization. Parental RF across the PDI and PRFQ were not highly correlated in a sample of mothers with substance use disorders. Existing RF measures may be tapping into a different component of the broader construct of parental reflective functioning (PRF). The PRFQ was further validated by demonstrating relationships with parent-report measures of the parent-child relationship. Taken together, these findings provide additional support for the reliability and validity of the PRFQ.

The parental reflective functioning questionnaire: Infant version in fathers of infants and association with paternal postpartum mental health

The parents' capacity to reflect upon the psychological processes in their child, termed parental reflective functioning (PRF) can be impaired by parental mental health problems. The present study aimed to investigate the factor structure of an infant version of the Parental Reflective Functioning Questionnaire (PRFQ-I) in a low-risk sample of 259 Danish fathers of 1-11-month-old infants to investigate measurement invariance of the PRFQ-I between fathers and mothers; and to examine the association between PRF and paternal depressive symptoms, psychological distress, and parenting stress. Confirmatory factor analysis supported a three-factor model of the PRFQ-I. Multi-group factor analysis indicated partial measurement invariance. Multiple linear regressions showed that paternal depressive symptoms were not associated with PRF. There was an interaction effect of paternal depressive symptoms and general psychological distress on paternal interest and curiosity in their infant's mental state and certainty of infant mental state. Increased parenting stress was associated with impaired PRF on all three subscales of the PRFQ-I. These results provide further evidence for a multidimensional, brief assessment of paternal reflective skills and insight into how variability in paternal psychological functioning relates to impaired PRF in the postpartum period.

Parental relationship satisfaction, reflective functioning, and toddler behavioral problems: A longitudinal study from pregnancy to 2 years postpartum

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.

Parental Reflective Functioning and Its Association With Parenting Behaviors in Infancy and Early Childhood: A Systematic Review

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.

Psychometric evaluation of the German version of the Brief Reflective Functioning Interview

OBJECTIVES

To measure mentalization in a feasible manner, various instruments have been designed in recent years. The Brief Reflective Functioning Interview (BRFI) is a short interview that is based on the Adult Attachment Interview (AAI). The aim of both studies was to examine the psychometric properties of the German version of the BRFI and to compare them to those of the AAI.

METHODS

In Study 1, we examined 60 students using the BRFI and the AAI. In Study 2, the validity of the BRFI was examined using a mixed sample of students and patients (N = 149). Trained coders evaluated the Reflective Functioning Scale (RFS) for the BRFI and the AAI.

RESULTS

We found a significant positive correlation between the RFS total scores of the BRFI and those of the AAI. In addition, both interviews showed excellent internal consistency. We could also show that persons with mental disorders exhibit lower levels of RF score than mentally stable individuals. Women had higher RF scores in the BRFI than men in both samples. Persons whose mentalization capacity was rated below average in either the BRFI or the AAI also reported significantly lower mentalization ability in the self-assessment (p < .01).

CONCLUSIONS

Our results revealed that the RFS scores measured by the BRFI are highly comparable to those measured by the AAI. Our findings support the results of previous studies, suggesting that the BRFI is a reliable, valid and easy-to-administer alternative to the AAI.

PRACTITIONER POINTS

The German version of the Brief Reflective Functioning Interview (BRFI) proved to be a reliable and valid instrument for the assessment of reflective functioning that is shorter in terms of time to complete and the evaluation process than the measurement via the Adult Attachment Interview (AAI). Reflective functioning is negatively associated with psychopathology.

Design of a prospective follow-up study on early parenthood and smoking behaviour during pregnancy in Finnish primary healthcare

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.

Association between parental alexithymic traits and self-reported postnatal reflective functioning in a birth cohort population. Findings from the FinnBrain Birth Cohort Study

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.

The protective role of mentalizing: Reflective functioning as a mediator between child maltreatment, psychopathology and parental attitude in expecting parents

BACKGROUND

Childhood maltreatment impacts parenting and has intergenerational consequences. It is therefore crucial to identify clinically responsive resilience-promoting factors in pregnant women and expecting men with history of childhood maltreatment. Mentalization, or reflective functioning, appears as a promising concept to understand risk and resilience in the face of childhood maltreatment.

OBJECTIVE

This study evaluated the multivariate relationship between exposure to childhood maltreatment, reflective functioning, psychological symptoms and parental attitude in expecting parents.

METHODS

Two hundred and thirty-five pregnant women and 66 expecting fathers completed self-report assessment measures of childhood trauma, reflective functioning, depression, post-traumatic stress disorder, parental sense of competence and antenatal attachment. Twenty-eight percent (n = 85) of the community sample reported personal histories of childhood maltreatment.

RESULTS

Structural equation modeling indicated that reflective functioning (a) partially mediated the association between childhood maltreatment and psychological symptoms during pregnancy and (b) independently predicted participants' perception of parental competence and psychological investment toward the unborn child.

CONCLUSION

Overall, this study provides empirical evidence of the protective role of reflective functioning during the prenatal period in parents with histories of childhood maltreatment.

Childhood obesity and parental reflective functioning: Is there a relation?

Background/Objective

In recent decades, the prevalence of childhood obesity has increased, with the major implications for public health. However, the factors that contribute to obesity in children are still poorly understood. The present study aimed to investigate the role of parental reflective functioning (PRF) in childhood obesity.

Method

In a cross-sectional design, 120 sets of parents of 60 children (n = 30 with obesity, age range 6-11) were recruited by local paediatricians. Parents completed the Parental Reflective Functioning Questionnaire. Children's and parents' weight (assessed by BMI), as well as their socio-economic status (SES), were assessed to explore the contribution of PRF in the prediction of children's weight, controlling for parents' weight and SES.

Results

t-test showed significant differences with medium effect sizes in BMI, SES and PRF between parents of children with and without obesity. The best model resulted from hierarchical multiple regression analyses and showed that mothers' PRF predicted children's BMI above and beyond the prediction by parents' BMI and SES.

Conclusions

Low maternal PRF could be an important target for intervention strategies, highlighting the need to consider parental responses to children's emotions in the treatment of childhood obesity, particularly in parents with low SES and high BMI.