A deeper look at the association between childhood maltreatment and reflective functioning

Childhood maltreatment is theorized as impeding the development of reflective functioning (RF; ability to perceive and interpret oneself and others in terms of mental states). However, previous research typically failed to support this association or yielded small sized and mixed associations. This study aims to provide a deeper look at the association between childhood maltreatment and RF by characterizing two non-mentalizing categories. One-hundred-and-sixteen pregnant women (mean age = 27.62, SD = 4.52) from the community (48.3% with a university degree, 96.5% in a relationship with the other parent) retrospectively reported on childhood abuse and neglect using the Childhood Trauma Questionnaire. They also participated in the Adult Attachment Interview subsequently coded using the Reflective Functioning Scale. Participants with poor to low RF were allocated to one of two groups (disavowal-distancing or distorted-inconsistent) using indicators provided in the RF Scale. No association was found between childhood maltreatment and overall RF when controlling for education level. A multinomial logistic regression revealed that childhood maltreatment was strongly predictive of a disrupted, over-analytical and inconsistent reflection about mental states but not of a tendency to discourse little about mental states. This tendency was rather only predicted by education level. Findings suggest that childhood maltreatment would lead to specific impairments in RF and that not considering how individuals fail to mentalize about attachment relationships may mask strong associations between RF and its determinants and correlates, including childhood maltreatment

Cumulative childhood trauma and complex psychiatric symptoms in pregnant women and expecting men

Background: Women and men having been exposed to childhood trauma would be at high risk of various mental health symptoms while awaiting a child. This study aimed to evaluate the association between cumulative childhood trauma and the accumulation of symptoms belonging to different psychiatric problems in pregnant women and expecting men. Methods: We first examined prevalence rates of childhood trauma across our samples of 2853 pregnant women and 561 expecting men from the community. Second, we evaluated the association between cumulative childhood trauma and symptom complexity (i.e., the simultaneous presentation of symptoms belonging to multiple psychiatric problems) using subsamples of 1779 pregnant women and 118 expecting men. Participants completed self-reported measures of trauma (Childhood Trauma Questionnaire) and psychiatric symptoms (PTSD Checklist for DSM-5; Kessler Psychological Distress Scale; State-Trait Anger Expression Inventory-2; Self and Interpersonal Functioning Scale). Results: Trauma was more frequent in pregnant women than in expecting men and in participants reporting sociodemographic risk factors than in those not reporting any. A dose-response relationship was observed between the number of different traumas reported by pregnant women and expecting men and the complexity of their psychiatric symptoms, even when controlling for the variance explained by other risk factors. Women having been exposed to cumulative childhood trauma were 4.95 times more at risk of presenting comorbid psychiatric problems during pregnancy than non-exposed women. Conclusions: Childhood trauma is frequent in the general population of pregnant women and expecting men and is associated with symptom complexity during the antenatal period. These findings call for delivering and evaluating innovative trauma-informed antenatal programs to support mental health and adaptation to parenthood in adults having been exposed to childhood trauma. © 2021, The Author(s)

Maternal childhood abuse and neglect predicts offspring development in early childhood: the roles of reflective functioning and child sex

Background: Recent evidence suggests that offspring of mothers having been exposed to childhood abuse and neglect (CA&N) are at increased risk of developmental problems and that boys are more affected by maternal CA&N than girls. Since impairments in reflective functioning (RF) have been associated with maternal CA&N and offspring development, RF could represent a key mechanism in these intergenerational risk trajectories. Objective: This study evaluated mediating (RF) and moderating (child sex) mechanisms in the association between maternal CA&N and child development. Participants and setting: In a longitudinal setting, 111 mothers completed measures during pregnancy and between 11 and 36 months postpartum. Methods: CA&N and impairments in RF were assessed during pregnancy and offspring development was measured during the longitudinal follow-up using the Ages and Stages Questionnaires (ASQ-3). Child development was operationalized in two ways: using the global score at the ASQ-3 and using a dichotomous score of accumulation of delays across domains of development. Results: Structural equation modeling indicated that RF mediated the association between maternal CA&N and offspring development. Child sex moderated the association between CA&N and the clustering of developmental problems (Wald = 5.88, p = 0.02), with boys being particularly likely to accumulate developmental delays when their mother experienced CA&N (RR = 2.62). Accumulation of developmental problems was associated with impairments in maternal RF in girls and with maternal exposure to CA&N in boys. Conclusions: Results provide novel insights on the role of mentalization and child sex in the association between maternal CA&N and child development. © 2021 The Author

Paucity of intervention research in childhood maltreatment contrasts with the long known relation with mental health disorders: is trauma research translational enough?

The damaging consequences of child abuse and neglect for child development and psychiatric disorders have been known for decades. However, there would be a relative paucity of translational research on childhood maltreatment in comparison to the numerous correlational studies in the field. To assess the extent to which previous research on childhood maltreatment addressed intervention, we reviewed all articles on child abuse and neglect published in 2016 and evaluated the main objective of each study. References were identified through PsycINFO (ƙ = 2139) and Medline (ƙ = 2955). Of the 3792 studies retained after removal of overlapping references, 1157 met inclusion criteria. The main objective of each study was coded according to one of the following categories: Consequences, Mechanisms, Intervention, Prevention and Others. The review showed that half of the studies (ƙ = 572; 50%) described the damaging consequences of child abuse and neglect. A mere 19% of the studies (ƙ = 225) aimed to identify mediators or moderators of the association between childhood maltreatment and outcome. Only 6% (ƙ = 66) of studies reported on treatments and 2% (ƙ = 29) on preventive interventions. The remaining articles (23%, ƙ = 265) focused on other topics, such as the assessment of childhood trauma (ƙ = 33), epidemiology (ƙ = 118) and legal or organizational issues (ƙ = 114). Our results revealed an unquestionable paucity of research published on interventions and a relatively scarce number of mechanistic studies that nonetheless may provide meaningful practical orientations for clinical practice and future research

Une intervention de groupe brève pour favoriser le bien-être des femmes enceintes pendant la pandémie de COVID-19 et soutenir la résilience des familles

Contexte: La pandémie de COVID-19 a été associée à une augmentation de la détresse psychologique chez les femmes enceintes. Le présent article vise à évaluer l’acceptabilité du programme STEP-COVID (Soutenir la Transition et l’Engagement dans la Parentalité dans le contexte de la pandémie de COVID-19), une intervention prénatale de groupe en ligne, en mode synchrone, visant à soutenir le bien-être, la mentalisation et la résilience. Méthode: Vingt et une femmes enceintes québécoises ont participé au programme et ont complété des mesures des symptômes psychologiques et de la mentalisation avant et après l’intervention ainsi qu’une échelle évaluant leur perception de changements sur des domaines associés à la résilience. Après chaque rencontre, elles ont rempli un questionnaire évaluant leur appréciation du programme. Résultats: Les 18 participantes (86 %) ayant complété le programme ont rapporté de hauts taux de satisfaction après chacune des rencontres et au terme de l’intervention. Une diminution des symptômes anxio-dépressifs et des symptômes de stress post-traumatiques et une amélioration des fonctions réflexives sont observées entre le début et la fin du programme. Les participantes ont également rapporté des changements positifs sur des sphères de fonctionnement associées à la résilience. Conclusion: Les résultats soutiennent l’acceptabilité du programme STEP-COVID et suggèrent que l’offre d’une intervention de groupe brève en ligne est appréciée par les participantes, semble favoriser une diminution de la détresse psychologique et une amélioration de la mentalisation et pourrait contribuer à la résilience dans le contexte de la pandémie de COVID-19

Development and validation of a self-report measure assessing failures in the mentalization of trauma and adverse relationships

Background: The way people process trauma and adverse relationships may be more predictive of subsequent adaptation than trauma exposure in itself. However, there is currently no self-report instrument assessing failures in the mentalization of trauma and adverse relationships. Objective: We developed the Failure to Mentalize Trauma Questionnaire (FMTQ) and evaluated its psychometric properties. The FMTQ is a 29-item self-report instrument designed to assess different indications of failures in the mentalization of trauma and adverse relationships. Participants and setting A total of 975 participants (84 % women; 37 % exposed to child maltreatment) were recruited in the course of larger research protocols on parenting. Methods: Participants completed the FMTQ and measures of childhood maltreatment, psychopathology (post-traumatic stress symptoms, dissociative symptoms, level of personality dysfunction), general mentalization and intimate partner violence. Results: Exploratory factor analysis, supported by a confirmatory factor analysis, identified seven factors with good internal consistency that corresponded to different types of failures in the mentalization of trauma and adverse relationships and that loaded on a general factor. A dose-effect association was observed between the severity of childhood maltreatment, and the severity of failures in the mentalization of trauma and adverse relationships (rs = .49, p < .01). The FMTQ total score explained a significant proportion of variance in psychopathology and intimate partner violence, both in participants with histories of childhood maltreatment and participants without childhood maltreatment. Conclusion: The FMTQ is a promising, concise and efficient measure of failures in the mentalization of trauma and adverse relationships that may facilitate clinical screening and research with adults who experienced trauma

Beyond abuse and neglect: Validation of the childhood interpersonal trauma inventory in a community sample of adults

Abstract Introduction Childhood trauma is not restricted to abuse or neglect and other potentially traumatic experiences need to be pondered in practice and research. The study aimed to collect validity evidence of a new measure of exposure to a broad range of potentially traumatic experiences, the Childhood Interpersonal Trauma Inventory (CITI), by evaluating whether the CITI provides important additional information compared to a gold standard measure of childhood trauma. Methods The sample consisted of 2,518 adults who completed the CITI and self-reported measures of trauma (Childhood Trauma Questionnaire; CTQ) and psychiatric symptoms (PTSD Checklist for DSM-5; Kessler Psychological Distress Scale; Dissociative Experiences Scale). Results First, the sensitivity to properly detect participants having been exposed to childhood maltreatment, as measured by the CTQ (here used as the gold standard), ranged between 64.81% and 88.71%, and the specificity ranged between 68.55% and 89.54%. Second, hierarchical regressions showed that the CITI predicted between 5.6 and 14.0% of the variance in psychiatric symptoms while the CTQ only captured a very small additional part of variance (0.3 to 0.7%). Finally, 25% (n = 407) of CTQ-negative participants screened positive at the CITI. The latter reported higher severity of psychiatric symptoms than participants without trauma, suggesting that the CITI permits the identification of adults exposed to significant traumas that remain undetected using other well-validated measures. Discussion The findings underscore the utility of the CITI for research purposes and the latter’s equivalence to a gold standard self-reported questionnaire to predict negative outcomes

Spillover effects on the relationship with the partner of a mentalization-based intervention for pregnant women

Abstract The birth of a child has been associated with a decline in couple satisfaction, which has implications for the child's social-emotional development. This study investigated the potential spillover effect on pregnant women's perceptions of their relationships with their partners of the Supporting the Transition to and Engagement in Parenthood (STEP) program, a brief trauma-informed mentalization-based prenatal group intervention. Participants (94% White) were recruited in prenatal clinics and through online advertisements in Quebec, Canada. Both quantitative and qualitative data were collected from participants assigned to the STEP program (n = 42) and those receiving treatment-as-usual (TAU; n = 125). Women participating in STEP reported significant improvements in their relationships with their partners compared to those assigned to TAU. More precisely, they reported higher couple satisfaction, enhanced communication, and increased interest in their partners’ emotional experience. The qualitative analysis further substantiated these results, with participants reporting having involved their partners in their pregnancy, shared their insights about themselves with their partners and gained fresh perspectives on their relationships. Participants in STEP also expressed sharing program materials with their partners and considered that such interventions should be extended to expecting fathers. This study underscores the potential of mentalization-based interventions to indirectly contribute to couple relationships, which may have positive implications for parenting and the infant

Childhood trauma may increase risk of psychosis and mood disorder in genetically high-risk children and adolescents by enhancing the accumulation of risk indicators

Background: Genetically high-risk children carry indicators of brain dysfunctions that adult patients with schizophrenia or bipolar disorder display. The accumulation of risk indicators would have a higher predictive value of a later transition to psychosis or mood disorder than each individual risk indicator. Since more than 50% of adult patients report having been exposed to childhood trauma, we investigated whether exposure to trauma during childhood was associated with the early accumulation of risk indicators in youths at genetic risk. Methods: We first inspected the characteristics of childhood trauma in 200 young offspring (51% male) born to a parent affected by DSM-IV schizophrenia, bipolar disorder, or major depressive disorder. A subsample of 109 offspring (51% male) had measurements on four risk indicators: cognitive impairments, psychotic-like experiences, nonpsychotic nonmood childhood DSM diagnoses, poor global functioning. Trauma was assessed from direct interviews and reviews of lifetime medical and school records of offspring. Results: Trauma was present in 86 of the 200 offspring (43%). The relative risk of accumulating risk indicators in offspring exposed to trauma was 3.33 (95% CI 1.50, 7.36), but more pronounced in males (RR = 4.64, 95% CI 1.71, 12.6) than females (RR = 2.01, 95% CI 0.54, 7.58). Conclusion: Childhood trauma would be related to the accumulation of developmental precursors of major psychiatric disorders and more so in young boys at high genetic risk. Our findings may provide leads for interventions targeting the early mechanisms underlying the established relation between childhood trauma and adult psychiatric disorders

Socioemotional development in infants of pregnant women during the COVID-19 pandemic : The role of prenatal and postnatal maternal distress

Background An upsurge in psychological distress was documented in pregnant women during the COVID-19 pandemic. We investigated with a longitudinal design whether prenatal and postnatal maternal distress during the COVID-19 pandemic was associated with lower infant socioemotional development. Methods Pregnant women (N = 468, Mage = 30,00, 97.6% White) were recruited during the first COVID-19 mandatory lockdown in Quebec, Canada, from April 2nd to April 13th 2020 and were re-contacted at two months postpartum to complete self-reported measures of general (i.e. not specifically related to the COVID-19 pandemic) anxio-depressive symptoms and infant development. Structural equation modeling analyses were performed using maximum likelihood parameter estimation. Results Higher maternal prenatal distress significantly contributed to poorer infant socioemotional development. A mediation model showed that postnatal distress significantly mediated the association between prenatal distress and infant socioemotional development, whereas the direct effect of prenatal distress was no longer significant. Prenatal and postnatal maternal distress accounted for 13.7% of the variance in infant socioemotional development. Conclusion Our results call for special means of clinical surveillance in mothers and for innovative (online) interventions aiming to support maternal mental health during pregnancy and after delivery