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

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.

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

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.

Heterogeneity in the longitudinal courses of global functioning in children at familial risk of major psychiatric disorders: Association with trauma and familial characteristics.

OBJECTIVES: The extent to which heterogeneity in childhood risk trajectories may underlie later heterogeneity in schizophrenia (SZ), bipolar disorder (BP), and major depressive disorder (MDD) remains a chief question. Answers may optimally be found by studying the longitudinal trajectories of children born to an affected parent. We aimed to differentiate trajectories of global functioning and their sensitive periods from the age of 6 to 17 years in children at familial risk (FHRs). METHODS: First, a latent class mixed model analysis (LCMM) was applied to yearly ratings of the Children's Global Assessment Scale (CGAS) from the age of 6 to 17 years in 170 FHRs born to a parent affected by DSM-IV SZ (N = 37), BP (N = 82) or MDD (N = 51). Then, we compared the obtained Classes or trajectories of FHRs in terms of sex, parental diagnosis, IQ, child clinical status, childhood trauma, polygenic risk score (PRS), and outcome in transition to illness. RESULTS: The LCMM on yearly CGAS trajectories identified a 4-class solution showing markedly different childhood and adolescence dynamic courses and temporal vulnerability windows marked by a functioning decline and a degree of specificity in parental diagnosis. Moreover, IQ, trauma exposure, PRS level, and timing of later transition to illness differentiated the trajectories. Almost half (46%) of the FHRs exhibited a good and stable global functioning trajectory. CONCLUSIONS: FHRs of major psychiatric disorders show heterogeneous functional decline during development associated with parental diagnosis, polygenic risk loading, and childhood trauma.

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

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.

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.

STEP-COVID: a pilot study of a prenatal intervention for pregnant women during the COVID-19 pandemic.

The COVID-19 pandemic has been associated with a global increase in psychological distress in pregnant women. This study evaluated the effects of STEP-COVID, a six-session mentalization-based prenatal group program offered online during the COVID-19 pandemic. The 100 participants were allocated to STEP-COVID or to the natural trajectory of prenatal care. Pre- and post-intervention assessments included measures of psychological distress, post-traumatic symptoms and positive affectivity. Perception of change during pregnancy on resilience-promoting factors was also assessed at post-intervention. A significant decrease in psychological distress and post-traumatic symptoms and an increase in positive affectivity were observed in participants in the intervention condition, whereas only post-traumatic symptoms improved in the control condition. Women who participated in STEP-COVID also reported greater changes during pregnancy on resilience-promoting factors than women in the control condition. Results hold promise for buffering the effect of the pandemic on the mental health of pregnant women using brief online interventions. Clinical trial registration: NCT05419167 (15/06/2022).

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.

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.

Impact of level of personality pathology on affective, behavioral, and thought problems in pregnant women during the coronavirus disease 2019 pandemic.

Among at-risk groups for psychological distress in the context of the Coronavirus Disease 2019 (COVID-19) pandemic, pregnant women might be especially vulnerable. Identifying subgroups of pregnant women at high risk of poor adaptation might optimize clinical screening and intervention, which could, in turn, contribute to mitigating the potentially devastating effects of prenatal stress on mothers and fetus. Level of personality functioning may be a good indicator of who may be more vulnerable to distress in challenging periods like the COVID-19 pandemic, as adults with high levels of personality dysfunction may experience significant difficulties in mentalizing threatening situations. The aims of the present study are (a) to determine the impact of level of personality pathology on affective, behavioral, and thought problems in pregnant women during the COVID-19 pandemic; and (b) to test a model where mentalization of trauma mediates the impact of personality pathology on symptomatology. Data from 1,207 French-Canadian pregnant women recruited through social media during the COVID-19 pandemic were analyzed. Latent profile analysis, using the Criterion A elements of the alternative model for personality disorders (Identity, Self-Direction, Empathy, Intimacy) as latent indicators, yielded four profiles: Healthy, Mild Self-Impairment, Intimacy Impairment, and Personality Disorder. Profiles showed significant associations with diverse indicators of symptomatology. Mediation models showed both direct and indirect (through mentalization of trauma) significant associations between level of personality functioning and affective/behavioral/thought problems. Results have clinical implications on prophylactic measures for at-risk pregnant women, especially in challenging contexts such as the COVID-19 pandemic. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

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.

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.

Foster family assessment: The assessor's perspective - A qualitative study.

Children in foster care are more likely to exhibit emotional, behavioral, social, and developmental problems. Accordingly, foster families should provide them with a safe family environment that promotes their development. Therefore, to ensure that foster families adequately meet children's needs, it is crucial for youth protection services to properly assess prospective foster family applicants. However, the specific assessment methods are understudied. This study aims to capture the experiences of caseworkers and the challenges they face in assessing and selecting potential foster caregivers, as well as their needs for support to perform the assessments. Focus groups were held in child protection services agencies in the province of Québec (Canada). Three group interviews with a total of 15 caseworkers were transcribed and subjected to content analysis using NVivo 11. The caseworkers identified nine most important dimensions for assessing prospective foster families, notably motivation and engagement. Differences in the assessment process between caseworkers were observed, particularly for the type of foster family assessed. The caseworkers reported certain common needs for assessment training, primarily in interview techniques and the handling of multicultural issues. They also complained of lack of time allocated for clinical support during assessments. The results call for collaborative efforts between researchers and practitioners to provide appropriate training and tools to support the assessment process.

Evaluation of the Acceptability of a Prenatal Program for Women With Histories of Childhood Trauma: The Program STEP.

Background: Childhood trauma would negatively affect pregnant women's mental health and would have intergenerational repercussions. However, there is a paucity of prenatal interventions specifically designed for women exposed to childhood trauma. The study aims to evaluate the acceptability of STEP, a manualized group intervention designed for pregnant women having experienced early life adversity. Methods: The acceptability of STEP was assessed in four phases. In Phase 1, six experts evaluated whether the program activities were pertinent and trauma sensitive. In Phase 2, three parents read the intervention manuals and evaluated whether they considered each session relevant, interesting, and clear. In Phase 3, the program was briefly presented by phone to 309 pregnant women from the community. Women were inquired about their interest in the program, and the reasons for their lack of interest were assessed. In Phase 4, 30 pregnant women exposed to childhood trauma participated in the program and completed anonymous satisfaction questionnaires after each session. Psychological distress was also measured before and after the program. Results: All activities were rated by independent experts as highly pertinent, adequate, and sufficiently safe to be offered to pregnant women. Parents who read through the intervention manuals also considered that the sessions were relevant, clear, and interesting. About half of the pregnant women from the community showed interest in the program. Participants reported very high levels of satisfaction and a significant decrease in psychological distress during the program. Conclusions: Our findings show a high level of convergence among various indicators of program acceptability.

A Proposed Classification of ICD-11 Severity Degrees of Personality Pathology Using the Self and Interpersonal Functioning Scale.

Background: The 11th version of the World Health Organization's International Classification of Diseases (ICD-11) has adopted a dimensional approach to personality disorder (PD) nosology. Notably, it includes an assessment of PD degree of severity, which can be classified according to five categories. To date, there is no gold standard measure for assessing degree of PD severity based on the ICD-11 model, and there are no empirically-based anchor points to delineate the proposed categories. With the operationalization of PD degrees of severity in the ICD-11 PD model now being closely aligned with Criterion A of the DSM-5 Alternative Model for Personality Disorders (AMPD), sharing a focus on self and interpersonal dysfunction, self-report instruments developed for the latter model might prove useful as screening tools to determine degrees of severity in the former. Methods: The Self and Interpersonal Functioning Scale, a brief validated self-report questionnaire originally designed to assess level of personality pathology according to the AMPD framework, was used to derive anchor points to delineate the five severity degrees from the ICD-11 PD model. Data from five clinical and non-clinical samples (total N = 2,240) allowed identifying anchor points for classification, based on Receiver Operating Characteristic curve analysis, Latent Class Analysis, and data distribution statistics. Categories were validated using multiple indices pertaining to externalizing and internalizing symptoms relevant to PD. Results: Analyses yielded the following anchor points for PD degrees of severity: No PD = 0-1.04; Personality Difficulty = 1.05-1.29; Mild PD = 1.30-1.89; Moderate PD = 1.90-2.49; and Severe PD = 2.50 and above. A clear gradient of severity across the five categories was observed in all samples. A high number of significant contrasts among PD categories were also observed on external variables, consistent with the ICD-11 PD degree of severity operationalization. Conclusions: The present study provides potentially useful guidelines to determine severity of personality pathology based on the ICD-11 model. The use of a brief self-report questionnaire as a screening tool for assessing PD degrees of severity should be seen as a time-efficient support for clinical decision and treatment planning.

Association entre la fréquence de consultation des médias d'information et la détresse psychologique chez les femmes enceintes durant la pandémie de COVID-19: Association between news media consulting frequency and psychological distress in pregnant women during the COVID-19 pandemic.

OBJECTIVE: Examine the association between news media use frequency during the COVID-19 pandemic and the scale of psychological distress in pregnant women, considering this distress known harmful effects on the fetus development. METHOD: Pregnant women living in Quebec province (N = 1014) have been recruited in April 2020 through social media, while a state of health emergency was declared. Participants were divided in 4 groups, according to self-reported frequency of news media consulting (little or none; one time a day; several times a day; constant). They filled measures of depressive symptoms, negative affects, post-traumatic stress symptoms and anxiety specific to COVID-19. Instrument scores were grouped under a unique factor of psychological distress. RESULTS: An ANCOVA controlling for age, gestational age, education level, household annual revenue and a diagnosed mental disorder present at the time of participation in study shows that news media exposure frequency is significantly associated with psychological distress severity in pregnant women, during COVID-19 pandemic, F(3,998) = 27.02, p < 0.001, η2 partial = 0.08. Given the mean comparisons a posteriori, higher psychological distress rates are found as soon as news media exposure exceeds once a day (effect sizes between 0.38 and 0.81). CONCLUSIONS: The more pregnant women report consulting the news media during the COVID-19 pandemic, the more likely they are to exhibit psychological distress. Results provide one of the first empirical supports to recommendations of World Health Organization, Canada government and psychiatric associations that encourage population to limit their news media consulting during the COVID-19 pandemic.

OBJECTIF: Examiner l'association entre la fréquence d'utilisation des médias d'information durant la pandémie de COVID-19 et l'ampleur de la détresse psychologique chez les femmes enceintes, considérant les impacts délétères connus de cette détresse sur le développement du fœtus. MÉTHODE: Des femmes enceintes habitant la province de Québec (N = 1014) ont été recrutées en avril 2020 par le biais des médias sociaux, alors qu'un état d'urgence sanitaire prévalait. Les participantes ont été divisées en quatre groupes, selon la fréquence auto-rapportée de consultation des médias d'information (peu ou pas; une fois par jour; plusieurs fois par jour; constante). Elles ont rempli des mesures des symptômes dépressifs, des affects négatifs, des symptômes de stress post-traumatique et d'anxiété spécifique de la COVID-19. Les scores aux instruments se regroupaient sous un facteur unique de détresse psychologique. RÉSULTATS: Une ANCOVA contrôlant pour l'âge, l'âge gestationnel, le niveau d'éducation, le revenu familial annuel et la présence d'un trouble mental diagnostiqué au moment de la participation à l'étude montre que la fréquence d'exposition aux médias d'information est significativement associée à la sévérité de la détresse psychologique chez les femmes enceintes au moment de la pandémie de COVID-19, F(3,998) = 27,02, p < 0,001, η2 partiel = 0,08. Selon les comparaisons de moyennes a posteriori, des taux plus élevés de détresse psychologique s'observent dès que l'exposition aux médias d'information dépasse une fois par jour (tailles de l'effet entre 0,38 et 0,81). CONCLUSIONS: Plus les femmes enceintes consultent les médias d'information pendant la pandémie de COVID-19, plus elles sont sujettes à présenter de la détresse psychologique. Les résultats offrent un des premiers appuis empiriques aux recommandations de l'Organisation mondiale de la santé, du gouvernement du Canada et d'associations de psychiatres encourageant la population à limiter sa consultation des médias d'information durant la pandémie de COVID-19.

Mothers' Self-focused Reflective Functioning Interacts with Childhood Experiences of Rejection to Predict Current Romantic Relationship Quality and Parenting Behavior.

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.

Los padres expuestos al rechazo en su infancia podrían tener problemas de vinculación en sus relaciones actuales. El funcionamiento reflexivo (FR), la capacidad de comprender la conducta propia y de los demás mediante la perspectiva de los estados mentales subyacentes (cogniciones, emociones) se ha identificado como posible proceso de protección. El objetivo de este estudio longitudinal fue analizar si el FR modera el efecto de las experiencias de rechazo de los padres durante la infancia en el funcionamiento posterior de las relaciones con las parejas y los bebés. Se incluyó a mujeres embarazadas con experiencias de abuso y abandono, quienes completaron la Entrevista de Apego en los Adultos (Adult Attachment Interview), la cual se codificó para el FR y las experiencias de rechazo en la infancia. Durante dos evaluaciones de seguimiento, cuando sus bebés tenían cinco meses y diecisiete meses, las madres de nuestra muestra que tenían pareja informaron sobre la cohesión diádica con estas parejas. Además, a los cinco meses después del parto, las madres completaron tareas de interacción con sus bebés, que después se evaluaron usando instrumentos de evaluación observacionales (p. ej., CARE-Index). Los resultados de las madres con las parejas (N = 93) indicaron que el FR moderó la relación entre la cohesión diádica con las parejas a los 17 meses solamente. Además, los resultados con todas las madres de la muestra (N = 108) indicaron que el FR moderó la relación entre las experiencias de rechazo informadas retrospectivamente y las conductas dominantes e indiferentes con los bebés. El FR entre adecuado y alto se asoció con una indiferencia más baja y una satisfacción con la relación más alta en el contexto del rechazo, y a su vez se lo asoció con niveles más altos de control. Estos resultados tienen consecuencias clínicas importantes, ya que el FR es susceptible de cambios y puede, por ende, implementarse de manera más prominente dentro de diferentes intervenciones.

Uptrend in distress and psychiatric symptomatology in pregnant women during the coronavirus disease 2019 pandemic.

INTRODUCTION: Prenatal maternal distress has a negative impact on the course of pregnancy, fetal development, offspring development, and later psychopathologies. The study aimed to determine the extent to which the coronavirus disease 2019 (COVID-19) pandemic may aggravate the prenatal distress and psychiatric symptomatology of pregnant women. MATERIAL AND METHODS: Two cohorts of pregnant volunteer women were evaluated, one that was recruited before the COVID-19 pandemic (n = 496) through advertisements in prenatal clinics in Quebec, Canada, from April 2018 to March 2020; the other (n = 1258) was recruited online during the pandemic from 2 April to 13 April 2020. Prenatal distress and psychiatric symptomatology were measured with the Kessler Distress Scale (K10), Post-traumatic Checklist for DSM-5 (PCL-5), Dissociative Experiences Scale (DES-II), and Positive and Negative Affect Schedule (PANAS). RESULTS: The 1754 pregnant women (Mage  = 29.27, SD = 4.23) were between 4 and 41 gestational weeks (M = 24.80, SD = 9.42), were generally educated (91.3% had post-high-school training), and financially well-resourced (85.3% were above the low-income cut-off). A multivariate analysis of covariance controlling for age, gestational age, household income, education, and lifetime psychiatric disorders showed a large effect size (ES) in the difference between the two cohorts on psychiatric symptoms (Wilks' λ = 0.68, F6,1400  = 108.50, P < .001, partial η2  = 0.32). According to post-hoc analyses of covariance, the COVID-19 women reported higher levels of depressive and anxiety symptoms (ES = 0.57), dissociative symptoms (ES = 0.22 and ES = 0.25), symptoms of post-traumatic stress disorder (ES = 0.19), and negative affectivity (ES = 0.96), and less positive affectivity (ES = 0.95) than the pre-COVID-19 cohort. Women from the COVID-19 cohort were more likely than pre-COVID-19 women to present clinically significant levels of depressive and anxiety symptoms (OR = 1.94, χ2 [1] = 10.05, P = .002). Multiple regression analyses indicated that pregnant women in the COVID-19 cohort having a previous psychiatric diagnosis or low income would be more prone to elevated distress and psychiatric symptoms. CONCLUSIONS: Pregnant women assessed during the COVID-19 pandemic reported more distress and psychiatric symptoms than pregnant women assessed before the pandemic, mainly in the form of depression and anxiety symptoms. Given the harmful consequences of prenatal distress on mothers and offspring, the presently observed upsurge of symptoms in pregnant women calls for special means of clinical surveillance.

Prenatal Attachment, Parental Confidence, and Mental Health in Expecting Parents: The Role of Childhood Trauma.

INTRODUCTION: Exposure to childhood abuse or neglect may lead to negative outcomes during pregnancy in expecting parents, which may contribute to a negative experience of childbearing and have consequences for the developing fetus. This study examined the associations between exposure to childhood abuse or neglect, psychological symptoms, prenatal attachment, and perception of parental competence in expectant parents. METHODS: Individuals at low sociodemographic risk were recruited in community perinatal care settings and completed self-report assessment measures of depression, posttraumatic stress disorder, dissociation, personality disorders, perception of parental competence, and prenatal attachment. RESULTS: There were 322 participants (78% women), including 91 adults with a history of childhood abuse or neglect, Participants who were exposed to childhood abuse or neglect reported significantly higher levels of symptoms on all indices of mental health than nonexposed adults, even when controlling for sociodemographic risks. However, both groups reported similar levels of prenatal attachment and parental confidence. The impact of childhood maltreatment was similar in men and women. Structural equation modeling showed that childhood abuse or neglect leads to poor mental health and that poor mental health, but not childhood maltreatment, is associated with low parental confidence and prenatal attachment. DISCUSSION: Psychological symptoms are frequent in expectant parents who experienced maltreatment during their childhood. However, childhood abuse or neglect is not associated with their attitude regarding parenthood and the child in the absence of psychopathology. Supporting mental health may be an important target of parental programs offered during pregnancy to women and men with a history of childhood abuse or neglect.

Parental Cannabis Use: Contradictory Discourses in the Media, Government Publications, and the Scientific Literature.

Approximately 7% of Americans and 13% of Canadians older than 25 years old use cannabis,1,2 suggesting that millions of parents across North America are users. We hypothesize that parental cannabis use may affect children in two ways: by increasing personal exposure to the substance (eg, in utero exposure) and through its impact on parenting (Figure 1). Regarding direct exposure, scientific evidence suggests that using cannabis during pregnancy is unsafe and may lead to complications at birth, such as preterm delivery, lower birth weight, lower Apgar scores, and decreased fetal growth.3 In addition, in one study, offspring of parents consuming cannabis were more likely to use cannabis themselves in adolescence,4 which was found, in a systematic review, to be associated with higher odds of depression, suicidal behavior, and psychotic illness.5 Paradoxically, we believe that our field is not well informed by scientific research about the effects of parental cannabis use on parenting and offspring development at early developmental periods when the child is highly sensitive to the types of parental behaviors identified at the bottom of Figure 1. Such a gap in our knowledge is of definite concern for public health and child psychiatry, particularly considering that parents and professionals have access to very conflictual information on this issue. To support our standpoint that the important gaps in our knowledge about the issue of parental cannabis use open the door for highly diverse opinions regarding the harmfulness of parental cannabis use, we reviewed the portrayal of parental cannabis use provided by three sources: the scientific literature, media (online media, print news, and print media), and publications of government and other public agencies (more information on the search strategy is provided in Supplement 1, available online).