Mothers’ self-focused reflective functioning interacts with childhood experiences of rejection to predict romantic relationship quality and insensitive parenting

Parents exposed to rejection in their childhood could experience bonding disturbances in their current relationships. Reflective functioning (RF), the capacity to understand one’s own and others’ behavior through the lens of underlying mental states (cognitions, emotions), has been identified as a potential protective process. The aim of this longitudinal study was to examine whether RF moderates the effect of parents’ experiences of rejection in childhood on later relationship functioning with partners and infants. Pregnant women with experiences of abuse and neglect were recruited and completed the Adult Attachment Interview, which was coded for RF and experiences of childhood rejection. During two follow‐up assessments, when their infants were 5 and 17 months old, the mothers in our sample who had partners reported on dyadic cohesion with these partners. Further, at 5 months postnatal, mothers completed interaction tasks with their infants, which were later assessed using observational measures (i.e., CARE‐Index). Results of mothers with partners (N = 93) indicated that RF moderated the relationship between dyadic cohesion with partners at 17 months only. Additionally, results with all mothers in the sample (N = 108) indicated that RF moderated the relationship between retrospectively reported experiences of rejection and controlling and unresponsive behaviors with infants. Adequate‐to‐high RF was associated with lower unresponsiveness and higher relationship satisfaction in the context of rejection, while being associated with higher levels of control. These findings have important clinical implications, as RF is amenable to change and can therefore be more prominently implemented within various interventions

Post-traumatic-stress in the context of childhood maltreatment: pathways from attachment through mentalizing during the transition to parenthood

Abstract Introduction: This study aimed to clarify the role of mentalizing in pathways from attachment to Post Traumatic Stress Symptoms (PTSS) in survivors of childhood maltreatment (CM). We focused on the transition to parenting, a critical period for reworking parenting representations to reduce intergenerational maltreatment cycles. Method: Study participants included 100 pregnant CM survivors. We assessed PTSS with the SCID and attachment and mentalizing with the Adult Attachment Interview (AAI), which was rated for Attachment and Reflective Functioning (RF). Results: Regarding Re-experiencing trauma symptoms, the results of the path analysis were consistent with mediation. CM survivors' mentalizing about their early relationships with their parents (RF-Other) directly impacted Re-experiencing trauma symptoms, and attachment had an effect on Re-experiencing trauma symptoms through mentalizing (RF-Other). Regarding Arousal/Reactivity symptoms, the results of the pathways analysis were consistent with partial mediation by mentalizing about early relationships with parents (RF-Other). In addition to the pathway from attachment via mentalizing (RF-Other) to Arousal/Reactivity, the pathway between attachment and Arousal/Reactivity also remained significant. Discussion: This study provides new evidence of a mentalizing and attachment model of PTSS in CM survivors. The findings indicate that increased mentalizing about early relationships with parents is an important process associated with lower PTSS. Finally, we discuss the implications of developing interventions for CM survivors to reduce PTSS. Scaffolding the development of mentalizing regarding attachment relationships in which CM occurred may help CM survivors reduce the intrusion of traumatic memories and decrease trauma-related arousal and reactivity symptoms. Interventions to help CM survivors mentalize regarding parents and attachment relationships in which trauma occurred may be particularly important during the transition to parenting when activation of representations of parenting can trigger PTSS

Becoming the best mom that I can: women's experiences of managing depression during pregnancy – a qualitative study

<p>Abstract</p> <p>Background</p> <p>The purpose of this constructivist grounded theory study was to develop a theoretical model that explains women's processes of managing diagnosed depression when pregnant.</p> <p>Methods</p> <p>We explored the experiences of 19 women in Ontario who were diagnosed with depression during their pregnancy.</p> <p>Results</p> <p>The model that emerged from the analysis was becoming the best mom that I can. Becoming the best mom that I can explains the complex process of the women's journey as they travel from the depths of despair, where the depression is perceived to threaten their pregnancy and their ability to care for the coming baby, to arrive at knowing the self and being in a better place. In order to reground the self and regain control of their lives, the women had to recognize the problem, overcome shame and embarrassment, identify an understanding healthcare provider, and consider the consequences of the depression and its management. When confronting and confining the threat of depression, the women employed strategies of overcoming barriers, gaining knowledge, and taking control. As a result of counseling, medication, or a combination of both, women felt that they had arrived at a better place.</p> <p>Conclusion</p> <p>For many women, the idea that depression could occur during pregnancy was antithetical to their vision of the pregnant self. The challenge for a pregnant woman who is diagnosed with depression, is that effective care for her may jeopardize her baby's future health. This provides a dilemma for about-to-be parents and their healthcare providers. Improved awareness of depression during pregnancy on the part of healthcare professionals is needed to improve the women's understanding of this disorder and their ability to recognize and seek help with depression should it occur during the prenatal period. Further qualitative research is needed to determine the specific aspects that need to be addressed in such classes.</p

Risk factors for antenatal depression, postnatal depression and parenting stress

<p>Abstract</p> <p>Background</p> <p>Given that the prevalence of antenatal and postnatal depression is high, with estimates around 13%, and the consequences serious, efforts have been made to identify risk factors to assist in prevention, identification and treatment. Most risk factors associated with postnatal depression have been well researched, whereas predictors of antenatal depression have been less researched. Risk factors associated with early parenting stress have not been widely researched, despite the strong link with depression. The aim of this study was to further elucidate which of some previously identified risk factors are most predictive of three outcome measures: antenatal depression, postnatal depression and parenting stress and to examine the relationship between them.</p> <p>Methods</p> <p>Primipara and multiparae women were recruited antenatally from two major hoitals as part of the <it>beyondblue </it>National Postnatal Depression Program <abbrgrp><abbr bid="B1">1</abbr></abbrgrp>. In this subsidiary study, 367 women completed an additional large battery of validated questionnaires to identify risk factors in the antenatal period at 26–32 weeks gestation. A subsample of these women (N = 161) also completed questionnaires at 10–12 weeks postnatally. Depression level was measured by the Beck Depression Inventory (BDI).</p> <p>Results</p> <p>Regression analyses identified significant risk factors for the three outcome measures. (1). Significant predictors for antenatal depression: low self-esteem, antenatal anxiety, low social support, negative cognitive style, major life events, low income and history of abuse. (2). Significant predictors for postnatal depression: antenatal depression and a history of depression while also controlling for concurrent parenting stress, which was a significant variable. Antenatal depression was identified as a mediator between seven of the risk factors and postnatal depression. (3). Postnatal depression was the only significant predictor for parenting stress and also acted as a mediator for other risk factors.</p> <p>Conclusion</p> <p>Risk factor profiles for antenatal depression, postnatal depression and parenting stress differ but are interrelated. Antenatal depression was the strongest predictor of postnatal depression, and in turn postnatal depression was the strongest predictor for parenting stress. These results provide clinical direction suggesting that early identification and treatment of perinatal depression is important.</p

Motherhood as a vulnerability factor in major depression: the role of negative pregnancy experiences

Adverse pregnancy experiences were examined retrospectively in relation to adult lifetime experience of clinical depression to see whether such experience conferred long-term risk for women. The sample consisted of just under 200 community-based women, half of whom were selected for high depressive-risk on the basis of adverse childhood experience. Over two-thirds of these women had experienced pregnancy. Adverse pregnancies were classified either in terms of loss (adverse non-live pregnancy/births) or in terms of live births in difficult circumstances (adverse live pregnancy/births). Intensive life history interviews collected details of all pregnancies, childhood neglect/abuse, marital adversity and a history of episodes of clinical depression. Both adverse non-live and live pregnancy experiences were significantly related to lifetime depression. The relationship remained for depression in different time periods and for those episodes unrelated to maternity experience. Both types of adverse pregnancy/birth experiences were associated with increased rates of marital problems. While adverse live pregnancy/births related to prior childhood neglect/abuse, this did not hold for those non-live. Logistic regression showed that only adverse non-live pregnancy/births together with marital adversity and childhood neglect/abuse provided the best model for lifetime depression. The findings are discussed in terms of lifetime trajectories linking difficult environments, close relationships and issues of loss

Lifetime stressors and recurrent depression: preliminary findings of the Adult Life Phase Interview (ALPHI)

Background: The well-established association between stress and depression is explored in a lifespan context in relation to adverse childhood experience. A new retrospective interview instrument, the Adult Life Phase Interview (ALPHI) examined the number of chronic stressors (or `adversities') experienced over the adult life course in relation to chronic or recurrent clinical depression. The role of such lifetime adversity in mediating the relationship between childhood neglect/abuse and adult disorder was examined. Method: The ALPHI uses an investigator-based, contextual approach suited to retrospective and time-linked enquiries. Reliability of the instrument was found to be satisfactory. Its association with both lifetime clinical depression and childhood neglect or abuse was examined in a community series of 198 women, consisting of 99 sister pairs, where one-half of the series was selected for having had adverse childhood experience and the other for comparison. Results: Adult adversity, both at settled/fixed times and at times of major life change, was significantly higher among those with prior childhood neglect or abuse. Both a high adult adversity score and childhood neglect or abuse were related to chronic or recurrent episodes of clinical depression, with logistic regression indicating both indices contributed independently to disorder. The same results held when controls were made for sister status, given possible familial bias in experience, and for age, since women under age 25 had fewer adult phases and less adversity. Conclusions: Characteristics of adult life phases and change-points are described and the relevance of the measure for intensive survey work seeking to investigate relationships between lifespan experience and depression is discussed