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Firk C, Großheinrich N. Infant carrying: Associations with parental reflective functioning, parental bonding and parental responses to infant crying. Infant Ment Health J 2024; 45:263-275. [PMID: 38288564 DOI: 10.1002/imhj.22106] [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: 09/11/2023] [Revised: 01/12/2024] [Accepted: 01/13/2024] [Indexed: 02/27/2024]
Abstract
Infant carrying may have beneficial effects on the parent-infant relationship but only limited research has been conducted in this area. Therefore, the main aim of the current study was to investigate whether infant carrying is associated with parental reflective functioning, parental bonding, and parental (emotional) and behavioral responses to infant crying, key elements within the parent-infant relationship, promoting infant development. Parents reporting high levels (N = 389) of infant carrying (six times a week or daily) and parents reporting low levels (N = 128) of infant carrying (less than once a week or not at all) who participated in an online survey about the developing parent-infant relationship in Germany were included in the present study. Standardized questionnaires were used to assess parental reflective functioning, parental bonding impairments, and emotional responses to infant crying. Further insensitive (non-responsive and hostile) behaviors in response to infant crying were assessed. Parents with high levels of infant carrying showed better parental reflective functioning, lower parental bonding problems, less negative emotions, and less insensitive behaviors in response to infant crying.
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Affiliation(s)
- Christine Firk
- Department of Social Sciences, Catholic University of Applied Sciences of North Rhine-Eestphalia, Aachen, Germany
- Institute of Health Research and Social Psychiatry, Catholic University of Applied Sciences of North Rhine-Westphalia, Aachen, Germany
| | - Nicola Großheinrich
- Institute of Health Research and Social Psychiatry, Catholic University of Applied Sciences of North Rhine-Westphalia, Aachen, Germany
- Department of Social Sciences, Catholic University of Applied Sciences of North Rhine-Eestphalia, Cologne, Germany
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2
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Slade A, Sleed M. Parental Reflective Functioning on the Parent Development Interview: A narrative review of measurement, association, and future directions. Infant Ment Health J 2024. [PMID: 38650168 DOI: 10.1002/imhj.22114] [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] [Revised: 01/25/2024] [Accepted: 03/14/2024] [Indexed: 04/25/2024]
Abstract
A caregiver's capacity to mentalize is thought to be one of the most important features of secure parent-child relationships. Parental mentalizing can be measured using the Reflective Functioning (RF) coding system applied to the Parent Development Interview (PDI). In this narrative review, we summarize the research using this measure and synthesize what has been learnt about the predictors, correlates and sequelae of parental RF. Studies have consistently shown that PRF on the PDI is associated with both parent and child attachment and is an important factor in the intergenerational transmission of attachment. It is also related to the quality of parental representations, parent-child interactions, and child outcomes. While a number of social and clinical risk factors are associated with lower PRF, it is difficult to disentangle the unique contribution of each of these. We discuss these findings and present the direction of future work that is planned to expand and refine the PRF scale for the PDI.
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Affiliation(s)
- Arietta Slade
- Child Study Center, Yale University, New Haven, Connecticut, USA
| | - Michelle Sleed
- Child Attachment and Psychological Therapies Research Unit (ChAPTRe), Anna Freud Centre and University College London, London, UK
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3
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Kamza A, Luyten P, Piotrowski K. Psychometric evaluation of the Parental Reflective Functioning Questionnaire in Polish mothers. PLoS One 2024; 19:e0299427. [PMID: 38630679 PMCID: PMC11023587 DOI: 10.1371/journal.pone.0299427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 02/11/2024] [Indexed: 04/19/2024] Open
Abstract
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.
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Affiliation(s)
- Anna Kamza
- Center for Research on Personality Development, Institute of Psychology, SWPS University, Poznań, Poland
| | - Patrick Luyten
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
- Research Department of Clinical, Education and Health Psychology, UCL, London, United Kingdom
| | - Konrad Piotrowski
- Center for Research on Personality Development, Institute of Psychology, SWPS University, Poznań, Poland
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4
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Kungl MT, Gabler S, White LO, Spangler G, Vrticka P. Precursors and Effects of Self-reported Parental Reflective Functioning: Links to Parental Attachment Representations and Behavioral Sensitivity. Child Psychiatry Hum Dev 2024:10.1007/s10578-023-01654-2. [PMID: 38326634 DOI: 10.1007/s10578-023-01654-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/09/2023] [Indexed: 02/09/2024]
Abstract
Parental reflective functioning is thought to provide a missing link between caregivers' own attachment histories and their ensuing parenting behaviors. The current study sought to extend research on this association involving 115 parents, both mothers and fathers, of 5-to-6-year-old preschoolers using the German version of the Parental Reflective Functioning Questionnaire (PRFQ). Our study was the first to combine Adult Attachment Interview classifications of parental attachment, behavioral observations of parental sensitivity and PRFQ ratings while drawing on a sizable father subsample. We found theoretically consistent significant relations between all measures, while our results particularly highlighted the role of dismissing attachment for decreases in parenting quality on both cognitive and behavioral levels as the dismissing status differentially affected specific components of self-reported parental reflective functioning and observed sensitivity. Interestingly, these patterns were largely comparable in mothers and fathers. Exploratory mediation analyses further suggested that decreased parental reflective functioning may partially mediate the relationship between parents' dismissing attachment and decreased parental sensitivity. Thus, for prevention and intervention programs targeting parental sensitivity and thus children's long term healthy mental development, the interplay between parental reflective functioning and parents' own attachment history emerges as a key mechanism. Finally, our study served as a further validation of the PRFQ given the caveat that the pre-mentalizing subscale may need further revision in the German version.
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Affiliation(s)
- Melanie T Kungl
- Department of Developmental Psychology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Naegelsbachstrasse 49a, 91052, Erlangen, Germany.
| | - Sandra Gabler
- Department of Developmental Psychology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Naegelsbachstrasse 49a, 91052, Erlangen, Germany
| | - Lars O White
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University of Leipzig, Liebigstraße 18, 04103, Leipzig, Germany
- Berlin Psychological University, Am Köllnischen Park 2, 10179, Berlin, Germany
| | - Gottfried Spangler
- Department of Developmental Psychology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Naegelsbachstrasse 49a, 91052, Erlangen, Germany
| | - Pascal Vrticka
- Department of Psychology, Centre for Brain Science, University of Essex, Wivenhoe Park, Colchester, CO4 3SQ, UK
- Max Planck Institute for Human Cognitive and Brain Sciences, Stephanstraße 1A, 04103, Leipzig, Germany
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5
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Smith-Nielsen J, Stuart AC, Wendelboe KI, Egmose I, Roos CO, Væver MS. The significance of parental mentalizing for four-year-old children's solitary pretend play. PLoS One 2024; 19:e0297671. [PMID: 38295066 PMCID: PMC10830029 DOI: 10.1371/journal.pone.0297671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 01/11/2024] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Pretend play is a signature behavior of early childhood and is considered to reflect the child's emerging symbolic function, enabling the interpretation of social signals, language development, and emotion understanding. While theory links parental mentalizing with children's pretend play, only a few studies have investigated this association. These studies are limited to infancy and early toddlerhood, and child pretend play is assessed during play with an adult (social play). Based on the assumption that child solitary pretend play reflects the child's 'baseline' pretend play ability, in this study, we investigated children's pretend play at its peak, i.e., during the preschool age, without the facilitation of another player. The overall objective was to investigate if parental mentalizing increases pretend play complexity in children. METHODS The sample consisted 99 Danish mothers and their 4-year-old children. Employing a cross-sectional design, we hypothesized that parental mental state language, as an indicator of 'online' mentalizing during interaction with the child, is a mechanism through which 'offline' mentalizing, measured as parental reflective functioning, is associated with child solitary pretend play. Child pretend play complexity was observed and coded with an adapted version of the 12-Step Play Scale. Maternal offline mentalizing was assessed with the Parental Reflective Functioning Questionnaire, and maternal online mentalizing was assessed by coding the mothers' mental state language during interaction with the child using a modified version of the mind-mindedness coding scheme. RESULTS While there was no direct effect of maternal offline reflective functioning on child pretend play, online mental state language mediated the link between offline maternal reflective functioning and child pretend play. CONCLUSIONS These results provide support for the theoretically assumed link between parental mentalizing and children's capacity for pretend play. Furthermore, our study contributes to the literature on parental mentalization, suggesting that parental mentalizing facilitates child development only if the parent can translate this ability into 'mentalizing in action'.
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Affiliation(s)
| | | | | | - Ida Egmose
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
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6
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Orban E, Li LY, Gilbert M, Napp AK, Kaman A, Topf S, Boecker M, Devine J, Reiß F, Wendel F, Jung-Sievers C, Ernst VS, Franze M, Möhler E, Breitinger E, Bender S, Ravens-Sieberer U. Mental health and quality of life in children and adolescents during the COVID-19 pandemic: a systematic review of longitudinal studies. Front Public Health 2024; 11:1275917. [PMID: 38259801 PMCID: PMC10800626 DOI: 10.3389/fpubh.2023.1275917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 12/11/2023] [Indexed: 01/24/2024] Open
Abstract
Background The COVID-19 pandemic has significantly impacted the mental health of children and families, i.e., due to measures like social distancing and remote schooling. While previous research has shown negative effects on mental health and health-related quality of life (HRQoL), most studies have focused on pre-post comparisons in the early pandemic stages. This systematic review aims to examine longitudinal studies to understand the long-term impacts of the pandemic on children and adolescents. Methods This systematic review adhered to the PRISMA guidelines and was preregistered in the international prospective register of systematic reviews (Record ID: CRD42022336930). We systematically searched PubMed/MEDLINE, Web of Science, PsycINFO, PSYNDEX, and the WHO-COVID-19 database and included studies published up to August 30, 2022. Based on pre-defined eligibility criteria, longitudinal and prospective studies that assessed the mental health or quality of life of children or adolescents (0-19 years) in the general population over a longer time span (at two or more measurement points) during the COVID-19 pandemic were included in the review. The methodological quality of the included studies was assessed using an adapted version of the Effective Public Health Practice Project (EPHPP) checklist. Narrative data synthesis was used to summarize the findings. Results A total of 5,099 results were obtained from literature searches, with 4,935 excluded during title/abstract screening. After reviewing 163 full-text articles, 24 publications were included in the review. Sample sizes ranged between n = 86 and n = 34,038. The length of the investigated time periods and the number of assessment points, as well as outcomes, varied. The majority of studies were of moderate methodological quality. Mental health outcomes were more frequently studied compared to measures of HRQoL. The findings from these studies mostly suggest that children and adolescents experienced heightened mental health problems, specifically internalizing symptoms like anxiety and depression. Further, there was a decline in their overall HRQoL over the course of the COVID-19 pandemic that did not necessarily subside when lockdowns ended. Conclusion It is crucial to continue monitoring the mental health and well-being of children and adolescents following the pandemic to identify groups at risks and plan interventions. This should ideally be conducted by large systematic studies, using validated instruments, and encompassing representative samples to obtain reliable and comprehensive insights with the aim of improving youth mental health care.
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Affiliation(s)
- Ester Orban
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lydia Yao Li
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martha Gilbert
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ann-Kathrin Napp
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anne Kaman
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sabine Topf
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maren Boecker
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Child and Adolescent Psychiatry, Child Neuropsychology Section, University Hospital RWTH Aachen, Aachen, Germany
| | - Janine Devine
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Franziska Reiß
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Flora Wendel
- Faculty of Medicine, Institute of Medical Information Processing, Biometry and Epidemiology (IBE), Ludwig-Maximilians-University Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Caroline Jung-Sievers
- Faculty of Medicine, Institute of Medical Information Processing, Biometry and Epidemiology (IBE), Ludwig-Maximilians-University Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Vanessa Sophie Ernst
- Institute for Community Medicine, Epidemiology of Health Care and Community Health, University Medicine Greifswald, Greifswald, Germany
| | - Marco Franze
- Institute for Community Medicine, Epidemiology of Health Care and Community Health, University Medicine Greifswald, Greifswald, Germany
| | - Eva Möhler
- Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Saarland University Medical Center, Homburg, Germany
| | - Eva Breitinger
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Stephan Bender
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Ulrike Ravens-Sieberer
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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7
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Wright E, Martinovic J, de Camps Meschino D, Barker LC, Philipp DA, Israel A, Hussain-Shamsy N, Mukerji G, Wang V, Chatterjee A, Vigod SN. A virtual mother-infant postpartum psychotherapy group for mothers with a history of adverse childhood experiences: open-label feasibility study. BMC Psychiatry 2023; 23:950. [PMID: 38110902 PMCID: PMC10726650 DOI: 10.1186/s12888-023-05444-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 12/06/2023] [Indexed: 12/20/2023] Open
Abstract
OBJECTIVES Mothers with a history of adverse childhood experiences (ACE) are at elevated risk for postpartum mental illness and impairment in the mother-infant relationship. Interventions attending to maternal-infant interactions may improve outcomes for these parents and their children, but barriers to accessing in-person postpartum care limit uptake. We adapted a postpartum psychotherapy group for mothers with mental illness (e.g., mood, anxiety, trauma-related disorders) and ACE for live video-based delivery, and evaluated feasibility, acceptability, and preliminary efficacy in an open-label pilot study. METHODS We recruited adults with children (6-18 months) from a perinatal psychiatry program in Toronto, Canada. The intervention was a live video-based 12-week interactive psychotherapy group focused on maternal symptoms and maternal-infant relationships. The primary outcome was feasibility, including feasibility of recruitment and retention, fidelity of the intervention, and acceptability to patients and group providers. Maternal clinical outcomes were compared pre- to post-intervention, as secondary outcomes. RESULTS We recruited 31 participants (mean age 36.5 years (SD 3.9)) into 6 groups; 93.6% (n = 29) completed post-group questionnaires, and n = 20 completed an optional post-group acceptability interview. Mean weekly group attendance was 83% (IQR 80-87); one participant (3.2%) dropped out. All group components were implemented as planned, except for dyadic exercises where facilitator observation of dyads was replaced with unobserved mother-infant exercises followed by in-group reflection. Participant acceptability was high (100% indicated the virtual group was easy to access, beneficial, and reduced barriers to care). Mean maternal depressive [Edinburgh Postnatal Depression Scale: 14.6 (SD 4.2) vs. 11.8 (SD 4.2), paired t, p = 0.005] and post-traumatic stress [Posttraumatic Stress Disorder Checklist for DSM-5: 35.5 (SD 19.0) vs. 27.1 (SD 16.7)], paired t, p = 0.01] symptoms were significantly lower post vs. pre-group. No differences were observed on mean measures of anxiety, emotion regulation or parenting stress. CONCLUSIONS Recruitment and retention met a priori feasibility criteria. There were significant pre- to post-group reductions in maternal depressive and post-traumatic symptoms, supporting proceeding to larger-scale implementation and evaluation of the intervention, with adaptation of dyadic exercises.
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Affiliation(s)
- Elisabeth Wright
- Department of Psychiatry, University of Toronto, Toronto, ON, M5T 1R8, Canada.
- Department of Psychiatry, Women's College Hospital and Research Institute, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada.
| | - Jovana Martinovic
- Department of Psychiatry, University of Toronto, Toronto, ON, M5T 1R8, Canada
- Department of Psychiatry, Women's College Hospital and Research Institute, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada
| | - Diane de Camps Meschino
- Department of Psychiatry, University of Toronto, Toronto, ON, M5T 1R8, Canada
- Department of Psychiatry, Women's College Hospital and Research Institute, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada
| | - Lucy C Barker
- Department of Psychiatry, University of Toronto, Toronto, ON, M5T 1R8, Canada
- Department of Psychiatry, Women's College Hospital and Research Institute, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada
| | - Diane A Philipp
- Department of Psychiatry, University of Toronto, Toronto, ON, M5T 1R8, Canada
- Garry Hurvitz Centre for Community Mental Health at Sickkids, Toronto, ON, Canada
| | - Aliza Israel
- Department of Psychiatry, University of Toronto, Toronto, ON, M5T 1R8, Canada
- Department of Psychiatry, Women's College Hospital and Research Institute, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada
| | - Neesha Hussain-Shamsy
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, M5T 3M6, Canada
| | - Geetha Mukerji
- Department of Medicine, Temerty Faculty of Medicine, Sunnybrook Health Sciences Center, King's College Circle, University of Toronto, Toronto, ON, Canada
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, Toronto, ON, Canada
| | - Vivienne Wang
- Department of Psychiatry, Women's College Hospital and Research Institute, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada
| | - Antara Chatterjee
- Department of Psychiatry, Women's College Hospital and Research Institute, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada
| | - Simone N Vigod
- Department of Psychiatry, University of Toronto, Toronto, ON, M5T 1R8, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, M5T 3M6, Canada
- Department of Psychiatry, Women's College Hospital and Research Institute, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada
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8
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Carone N, Mirabella M, Innocenzi E, Quintigliano M, Antoniucci C, Manzi D, Fortunato A, Giovanardi G, Speranza AM, Lingiardi V. The intergenerational transmission of attachment during middle childhood in lesbian, gay, and heterosexual parent families through assisted reproduction: The mediating role of reflective functioning. Attach Hum Dev 2023:1-27. [PMID: 38078384 DOI: 10.1080/14616734.2023.2292053] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 12/04/2023] [Indexed: 12/20/2023]
Abstract
The present study examined the attachment patterns distribution of 60 lesbian mothers, 50 gay fathers, and 42 heterosexual parents through assisted reproduction and their 76 children, using the Adult Attachment Interview (AAI) and the Friends and Family Interview (FFI), respectively. The study also explored the intergenerational transmission of attachment through reflective functioning (AAI-RF). All families lived in Italy and children were aged 6-12 years (Myears = 8.11, SD = 2.17; 48.68% assigned female at birth). The AAI patterns distribution was similar across family types and did not significantly differ from international and national normative data. Similarly, children's FFI attachment patterns were evenly distributed between family types, and no significant differences emerged in comparison to international and national normative data referring to middle childhood samples. Mediational models revealed that, in all three family types, parents with greater AAI coherence of mind exhibited higher AAI-RF, which, in turn, was associated with increased FFI attachment security in children. Furthermore, parents' AAI coherence of mind directly influenced children's FFI attachment security. The results support and expand hypotheses regarding the intergenerational transmission of attachment in lesbian, gay, and heterosexual parent families through assisted reproduction, while offering unique indications to support these families during middle childhood.
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Affiliation(s)
- Nicola Carone
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Marta Mirabella
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
| | - Eleonora Innocenzi
- Department of History, Culture and Society, "Tor Vergata" University of Rome, Rome, Italy
| | - Maria Quintigliano
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
| | - Chiara Antoniucci
- Department of Developmental and Social Psychology, Sapienza University of Rome, Rome, Italy
| | - Demetria Manzi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Alexandro Fortunato
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
| | - Guido Giovanardi
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
| | - Anna Maria Speranza
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
| | - Vittorio Lingiardi
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
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9
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Sandnes K, Kårstad SB, Lydersen S, Berg-Nielsen TS. Are changes in mothers' representations of their infants related to changes in observed mother-infant interaction quality? Infant Behav Dev 2023; 73:101896. [PMID: 37866286 DOI: 10.1016/j.infbeh.2023.101896] [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: 04/11/2023] [Revised: 09/15/2023] [Accepted: 10/17/2023] [Indexed: 10/24/2023]
Abstract
Infant mental health clinicians aiming to improve mother-infant dyads at risk typically target mothers' representations of their infant or mother-infant interactions, assuming that one port of entry leads to change in the other. However, little is known about the relation between changes in mothers' representations and in mother-infant interactions. Therefore, the current study aimed to investigate this in a low- to moderate-risk community sample of 152 mothers (M = 29.7 years) of infants aged 0-2 years (M = 11.5 months) recruited from rural and urban cities in Norway. The mothers' representations were measured using the Working Model of the Child Interview, and the quality of the mother-infant interactions was measured with the Emotional Availability Scales. We found no evidence of a relation between mothers' changed representations and changed quality of mother-infant interactions. Several explanations concerning the low-risk status of the sample, the observation situation, the time between assessment points, and the homogeneous scores from the instruments used are discussed, as are the implications for clinical practice and future research.
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Affiliation(s)
- Kjersti Sandnes
- Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU Mid-Norway), Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
| | - Silja B Kårstad
- Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU Mid-Norway), Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Stian Lydersen
- Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU Mid-Norway), Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Turid Suzanne Berg-Nielsen
- Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU Mid-Norway), Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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10
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Dinzinger A, Ismair S, Brisch KH, Sperl W, Deneault AA, Nolte T, Hitzl W, Priewasser B. Mentalizing in first-time fathers: reflective functioning as a mediator between attachment representation and sensitivity. Attach Hum Dev 2023; 25:544-565. [PMID: 37815537 DOI: 10.1080/14616734.2023.2258354] [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: 11/29/2022] [Accepted: 09/09/2023] [Indexed: 10/11/2023]
Abstract
Sensitivity in parent-child interaction is essential for child development. Since fathers are increasingly involved in childrearing, identifying factors leading to paternal sensitivity is crucial. We examined the relation between attachment representation and reflective functioning (RF) as factors influencing paternal sensitivity in a longitudinal study including N = 40 first-time fathers (Mage = 33) and their 6-month-old children. We used the Adult Attachment Interview during pregnancy to assess paternal attachment representation and general RF, the Parental Development Interview to assess fathers' parental RF, and the Emotional Availability Scale to measure sensitivity at child's age of 6 month. Data show that secure paternal attachment representation, high general and parental RF are associated with higher levels of paternal sensitivity. Further, parental RF mediates the association between attachment representation and paternal sensitivity. These findings contribute to the identification of a causal interplay in that they suggest an explanatory effect of RF on the association between fathers' attachment representation, and sensitivity.
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Affiliation(s)
- Antonia Dinzinger
- Institute for Early Life Care, Paracelsus Medical University, Salzburg, Austria
- Department of Pediatrics, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Selina Ismair
- Institute for Early Life Care, Paracelsus Medical University, Salzburg, Austria
- Department of Pediatrics, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Karl Heinz Brisch
- Institute for Early Life Care, Paracelsus Medical University, Salzburg, Austria
- Dr. von Hauner Children's Hospital Ludwig Maximilians University, Munich, Germany
| | - Wolfang Sperl
- Department of Pediatrics, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | | | - Tobias Nolte
- Research Department for Clinical, Educational and Health Psychology, University College London, UK
| | - Wolfgang Hitzl
- Research and Innovation Management, Biostatistics, Paracelsus Medical University, Salzburg, Austria
| | - Beate Priewasser
- Institute for Early Life Care, Paracelsus Medical University, Salzburg, Austria
- Department of Pediatrics, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
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11
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Cooke S, Cooke DC, Hauck Y. Relationship focused mother-infant groups: Preliminary evaluation of improvements in maternal mental health, parenting confidence, and parental reflective functioning. Infant Ment Health J 2023; 44:705-719. [PMID: 37528631 DOI: 10.1002/imhj.22080] [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: 11/24/2022] [Revised: 07/02/2023] [Accepted: 07/12/2023] [Indexed: 08/03/2023]
Abstract
We report on two preliminary evaluations of a group intervention, targeting vulnerable infants and their mothers within the first 6-months postpartum. The Mother-Baby Nurture® program aims to strengthen the developing infant-mother attachment relationship by increasing maternal mentalizing. These studies were undertaken with pre-post evaluations with the mothers of infants under 10-months of age. The mother-infant dyads participated in ten 2-h group sessions. Study one (N = 69 dyads) included self-reported maternal depression, anxiety, and parenting confidence. In study two (N = 27 dyads), parenting stress and reflective functioning were measured by self-report, and reflective functioning coded on the 5 min speech sample (completed by N = 22). Results from study one confirmed a decrease in depression (p < .001, d = .79) and anxiety (p < .001, d = .72) symptoms, and an increase in mothers' scores for parenting confidence (p < .001, d = -.98). Results from Study Two demonstrated a significant decrease in parenting stress (p < .001, d = .94) and significant improvement in measures of self-report reflective functioning (p = .007, .024; d = .56, .61). These findings are preliminary yet promising indications that this program could be effective in alleviating parenting stress, depression, and anxiety, and improving mother's reflective functioning and parenting confidence. Further research is needed, with a control group and long-term follow-up assessments.
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Affiliation(s)
- Sharon Cooke
- Playgroup WA, Perth, Western Australia, Australia
| | | | - Yvonne Hauck
- School of Nursing, Curtin University, Perth, Australia
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12
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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.
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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
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13
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MacBeth A, Christie H, Golds L, Morales F, Raouna A, Sawrikar V, Gillespie-Smith K. Thinking about the next generation: The case for a mentalization-informed approach to perinatal and intergenerational mental health. Psychol Psychother 2023. [PMID: 37534856 DOI: 10.1111/papt.12483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 06/30/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND There has been substantial progress made across multiple disciplines to emphasize the importance of perinatal mental health both for parents and offspring. This focuses on what has been termed the 'First 1000 Days' from conception to the child's second birthday. We argue that our understanding of this issue can go further to create an intergenerational approach to mental health. Despite the existence of theoretical frameworks and practical approaches to implementation, there are gaps in the understanding of perinatal and intergenerational mental health including which psychological mechanisms are implicated in the transmission of risk and resilience within the perinatal period; and how to leverage these into treatment approaches. AIMS AND METHODS In this paper, we explore the potential for mentalization as a candidate psychological approach to intergenerational mental health. RESULTS We contextualize this issue in terms of the points of contact between mentalization and broader theoretical models such as the social determinants of health and the Developmental Origins of Health and Disease (DoHaD) model. Further, we provide an overview of the existing evidence base for the relevance of mentalization to perinatal mental health. DISCUSSION Finally, we sketch out an outline model for integrating mentalization into perinatal and intergenerational mental health, highlighting several areas of opportunity to develop research and practice from diverse geographies and demographics. Here, we suggest that integration of mentalization with other conceptual frameworks such as DoHaD can mutually enrich the understanding of each model, pointing the way towards more effective early and preventative interventions.
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Affiliation(s)
- Angus MacBeth
- School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | - Hope Christie
- School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | - Lisa Golds
- School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | - Francisca Morales
- School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | - Aigli Raouna
- School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | - Vilas Sawrikar
- School of Health in Social Science, University of Edinburgh, Edinburgh, UK
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14
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Jin J, Goud R, Al-Shamali H, Dzunic A, Lyons T, Reeson M, Pazderka H, Dennett L, Polzin W, Wei Y, Silverstone PH, Greenshaw AJ. Early Mental Health Foundations: A Scoping Review of Reflective Functioning in Caregiver-Child Dyads. PSYCHIAT CLIN PSYCH 2023; 33:58-69. [PMID: 38764527 PMCID: PMC11082638 DOI: 10.5152/pcp.2023.22549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 01/20/2023] [Indexed: 05/21/2024] Open
Abstract
International public health strategies indicate a need for equitable resources for wellness in younger children and their caregivers. Reflective functioning, a proxy for emotional regulation abilities, is a key area in this domain. As an emerging area, reflective functioning has not been mapped comprehensively and requires systematic investigation. This review examines "what qualitative and quantitative evidence is there for the value of reflective functioning assessment and intervention studies in caregiver-child dyads?" This scoping review focused on data published to September 2021, focusing on caregivers of children ≤36 months of age (including Medline, PsycINFO, CINAHL, ERIC, Scopus, Web of Science, and Embase). Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines were followed. From 5162 initial articles, 608 papers were screened for full text yielding a final 181 papers. Only 69 studies included multiple ethnicities. Seven of the 69 studies included at least 1 Indigenous person. No studies were conducted in low- to middle-income countries, and no studies reported data on gender identity. This review comprises a novel and comprehensive mapping of the reflective functioning literature in terms of both assessment and intervention studies. The present mapping of the reflective functioning literature indicates the importance of health disparities in caregiver-child dyads (these include gaps and needs for future research). In relation to gaps, studies of adverse childhood experience, consideration of equity, diversity, and inclusion, and global mental health are underrepresented. Future research is needed to provide information on the relevance of gender identity and low- to middle-income countries in relation to the impact on reflective functioning in this context.
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Affiliation(s)
- Jonathan Jin
- Department of Psychiatry, University of Alberta, Edmonton, Canada
| | - Rachel Goud
- University of Toronto, Temerty Faculty of Medicine, Toronto, Canada
| | - Huda Al-Shamali
- Department of Psychiatry, University of Alberta, Edmonton, Canada
| | - Anja Dzunic
- University of Alberta, School of Public Health, Edmonton, Canada
| | - Tirzah Lyons
- University of Alberta, Faculty of Education, Edmonton, Canada
| | - Matthew Reeson
- Department of Psychiatry, University of Alberta, Edmonton, Canada
| | - Hannah Pazderka
- Department of Psychiatry, University of Alberta, Edmonton, Canada
- Little Warriors Be Brave Ranch, Edmonton Alberta, Canada
| | - Liz Dennett
- JW Scott Health Sciences Library, University of Alberta, Edmonton, Canada
| | - Wanda Polzin
- Little Warriors Be Brave Ranch, Edmonton Alberta, Canada
| | - Yifeng Wei
- Department of Psychiatry, University of Alberta, Edmonton, Canada
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15
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Letourneau N, Anis L, Novick J, Pohl C, Ntanda H, Hart M. Impacts of the Attachment and Child Health (ATTACH TM) Parenting Program on Mothers and Their Children at Risk of Maltreatment: Phase 2 Results. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3078. [PMID: 36833770 PMCID: PMC9961631 DOI: 10.3390/ijerph20043078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/01/2023] [Accepted: 02/01/2023] [Indexed: 06/18/2023]
Abstract
Early adversity (e.g., family violence, parental depression, low income) places children at risk for maltreatment and negatively impacts developmental outcomes. Optimal parental reflective function (RF), defined as the parent's ability to think about and identify thoughts, feelings, and mental states in themselves and in their children, is linked to secure attachment and may protect against suboptimal outcomes. We present the results of Phase 2 randomized control trials (RCTs) and quasi-experimental studies (QES) of the Attachment and Child Health (ATTACHTM) parental RF intervention for families with children at risk for maltreatment. Phase 2 parents experiencing adversity, along with their children aged 0-5 years (n = 45), received the 10-12-week ATTACHTM intervention. Building on completed Phase 1 pilot data, Phase 2 examined outcomes of long-standing interest, including parental RF and child development, as well as new outcomes, including parental perceived social support and executive function, and children's behavior, sleep, and executive function. RCTs and QES revealed significant improvements in parents' RF, perception of social support, and executive function, children's development (i.e., communication, problem-solving, personal-social, and fine motor skills), and a decrease in children's sleep and behavioral problems (i.e., anxiety/depression, attention problems, aggressive behavior, and externalizing problems), post-intervention. ATTACH™ positively impacts parental RF to prevent negative impacts on children at risk of maltreatment.
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Affiliation(s)
- Nicole Letourneau
- Owerko Centre for Children’s Neurodevelopment and Mental Health, Alberta Children’s Hospital Research Institute, Faculty of Nursing, and Cumming School of Medicine, Departments of Pediatrics, Psychiatry and Community Health Sciences, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Lubna Anis
- Owerko Centre for Children’s Neurodevelopment and Mental Health, Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Jason Novick
- Owerko Centre for Children’s Neurodevelopment and Mental Health, Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Carrie Pohl
- Owerko Centre for Children’s Neurodevelopment and Mental Health, Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Henry Ntanda
- Owerko Centre for Children’s Neurodevelopment and Mental Health, Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Martha Hart
- Owerko Centre for Children’s Neurodevelopment and Mental Health, Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB T2N 1N4, Canada
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16
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Forresi B, Giani L, Scaini S, Nicolais G, Caputi M. The Mediation of Care and Overprotection between Parent-Adolescent Conflicts and Adolescents' Psychological Difficulties during the COVID-19 Pandemic: Which Role for Fathers? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20031957. [PMID: 36767325 PMCID: PMC9914833 DOI: 10.3390/ijerph20031957] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/03/2023] [Accepted: 01/17/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND There is evidence of a significant raise in youths' emotional and behavioral difficulties during the pandemic. Only a few studies have addressed parent-adolescent conflict, and none investigated the possible mediating effect of parenting in the association between conflicts with parents and adolescents' symptoms. This study aimed at investigating youths' psychological symptoms during the pandemic, focusing on the predicting effect of parent-adolescent conflict. The mediating role of care and overprotection was also explored, considering whether adolescent gender moderated this mediation. METHODS 195 adolescents aged 14-18 years participated in an online longitudinal study. Perceived conflict with parents and parenting dimensions (Parental Bonding Instrument; PBI) were assessed at baseline (2021). Self-reported psychological difficulties (Strengths and Difficulties Questionnaire; SDQ) were collected at baseline and after one year (2022). RESULTS A significantly severer symptomatology was found in adolescents having a conflictual relationship with one or both parents. Major conflicts with parents correlated with lower care and greater overprotection in mothers and fathers. However, parental overprotection and maternal care were not mediators of the relationship between conflict and youths' difficulties. The only exception was represented by paternal care that fully mediated this relationship in both adolescent males and females. CONCLUSIONS Although further investigations are needed to overcome limitations due to the small sample, findings extend our insight into the impact of parent-adolescent conflict, highlighting the role of fathers' care and the need to maximize their involvement in clinical interventions.
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Affiliation(s)
- Barbara Forresi
- Department of Psychology, Sigmund Freud University (Milan), Ripa di Porta Ticinese, 77-20143 Milan, Italy
| | - Ludovica Giani
- Department of Psychology, Sigmund Freud University (Milan), Ripa di Porta Ticinese, 77-20143 Milan, Italy
| | - Simona Scaini
- Department of Psychology, Sigmund Freud University (Milan), Ripa di Porta Ticinese, 77-20143 Milan, Italy
| | - Giampaolo Nicolais
- Department of Dynamic, Clinical and Health Psychology, Sapienza University of Rome, Via degli Apuli, 1-00185 Rome, Italy
| | - Marcella Caputi
- Department of Life Sciences, University of Trieste, Via E. Weiss, 2-34128 Trieste, Italy
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