Factor structure of the parental reflective functioning questionnaire and association with maternal postpartum depression and comorbid symptoms of psychopathology

Evaluating the efficacy of Circle of Security-Parenting as an addition to care-as-usual in families affected by maternal postpartum depression and/or infant social withdrawal: A randomized controlled trial

The Circle of Security - Parenting (COSP™) is a psychoeducational intervention aiming at fostering secure child-parent attachment relationships. In a randomized controlled trial, we investigate the effect of COSP™ as an adjunct to care-as-usual compared to only care-as-usual for at-risk families. Mothers and their 2-12-month-old infants were randomized into COSP™ +care-as-usual (n = 197) for at-risk families in Copenhagen or only care-as-usual (n = 100). At-risk status was either mothers diagnosed with postpartum depression and/or infants showed social withdrawal. The primary outcome was maternal sensitivity which was coded with the Coding Interactive Behavior. Our secondary outcomes were maternal reflective functioning, assessed with the Parental Reflective Functioning Questionnaire - Infant Version, and child-mother attachment, assessed with the Strange Situation Procedure. Results showed no significant differences between the RCT groups on either the primary or secondary outcomes (all ps ≥ .146). We discuss these findings in relation to the applicability and targeted population who can benefit from COSP™, and whether alternative programs would be more effective for at-risk families with infants.

Validating the parental reflective functioning questionnaire - infant version using a rasch model

Parental reflective functioning is the parent's ability to reflect on the psychological processes in their child and in themselves as a parent. Recently, an infant version of the Parental Reflective Functioning Questionnaire, PRFQ-I, has been developed and validated using confirmatory factor analyses. The present study aims to validate the PRFQ-I using a Rasch model in a sample of 531 Danish mothers at risk of depression and their infants aged 2-11 months. Our findings indicate that seven response categories were too many for the mothers to distinguish across all items. Prementalizing showed adequate psychometric properties, while Certainty of Mental States and Interest and Curiosity required recoding with 4 and 5 as the optimal scores, respectively. After rescoring, both subscales overall showed adequate psychometric properties. However, shortening Certainty of Mental States may be advisable due to local dependency between items 8 and 17. Additionally, items 2 and 14 ("I always know what my child wants" and "I always know why I do what I do to my child") may function better as a separate subscale. We recommend that scores on both Certainty of Mental States and Interest and Curiosity should be analyzed and interpreted in a curvilinear rather than linear manner.

Modelling the associations between parental depressive symptoms, hypomanic traits, and infant socio-emotional development: The mediating role of parental reflective functioning

BACKGROUND

Although understanding of maternal hypomania in the postpartum period is gradually improving, the intergenerational pathways of risk associated with hypomania in the context of postpartum depression remain unknown. It is also unclear whether distinct or shared pathways of risk exist for infants exposed to different parental mood characteristics and whether these pathways are mediated by parental reflective functioning.

METHODS

An online survey was administered to 1788 parents (89 % mothers, 50 % White) who were primary caregivers of a child under 2. Structural equation modelling techniques were employed to model direct and indirect associations between parental depressive symptoms, hypomanic traits and infant socio-emotional development, investigating the mediating role of parental reflective functioning.

RESULTS

Elevated levels of parental depressive symptoms, in the presence of hypomanic personality traits, were directly associated with infant socio-emotional challenges, without affecting parental reflective functioning. However, higher levels of parental hypomanic traits in the postnatal period displayed a fully mediated pathway of risk transmission to infants' socio-emotional development via their negative association with parental reflective functioning.

LIMITATIONS

Results should be interpreted with caution as the reliance on self-and-parent-reported scales may have introduced biases influenced by individual perceptions and situational factors. Additionally, the cross-sectional design of this study inhibits establishing cause-and-effect relationships.

CONCLUSIONS

Overall, these results highlight the critical role of both parental depressive symptoms and hypomanic traits on infant socio-emotional development, suggesting that supporting parental mood regulation and mentalizing abilities in the postnatal period could reduce the risk of early maladaptive socio-emotional trajectories in children.

The parent's and the child's internal working models of each other moderate cascades from child difficulty to socialization outcomes: Preliminary evidence for dual moderation?

Infants' difficulty, typically characterized as proneness to negative emotionality, is commonly considered a risk for future maladaptive developmental trajectories, mostly because it often foreshadows increased parental power assertion, typically linked to future negative child outcomes. However, growing evidence of divergent developmental paths that unfold from infant difficulty has invigorated research on causes of such multifinality. Kochanska et al. (2019) proposed that parent and child Internal Working Models (IWMs) of each other are key, with the parent's IWM of the child moderating the link between child difficulty and parental power assertion, and the child's IWM of the parent moderating the link between power assertion and child outcomes. In Children and Parents Study (200 community mothers, fathers, and children), child difficulty was observed at 8 months, parents' power assertion at 16 months, and children's outcomes rated by parents at age 3. Parents' IWMs were assessed with a mentalization measure at 8 months and children's IWMs were coded from semi-projective narratives at age 3. The cascade from infant difficulty to maternal power assertion to negative child outcomes was present only when both the mother's and the child's IWMs of each other were negative. We did not support the model for father-child dyads.

Offline and online parental mentalizing in mothers with symptoms of postpartum depression: Examining the association between self-reported parental reflective functioning and interactional mind-mindedness

Mentalizing is, to a certain extent, considered context specific. However, research on the association between parents' abilities to reflect upon their infant's mental states outside social interaction (offline) versus during ongoing parent-infant interaction (online) is currently limited. This study investigated the association between self-reported offline and online mentalizing in a sample of primarily ethnically Danish mothers (N = 142), with symptoms of postpartum depression, and their 1-11-month-old infants. Offline mentalizing was assessed with the Parental Reflective Functioning Questionnaire-Infant Version (PRFQ-I) and online mentalizing was assessed with interactional mind-mindedness. Ordinal logistic regressions showed that a higher score on the PRFQ-I prementalizing subscale was negatively related to number of overall mind-related comments and appropriate mind-related comments produced by mothers during interaction with their infant. Our results indicate partial overlaps between self-reported parental reflective functioning and mind-mindedness, that is, that particularly offline maladaptive mentalizing is associated with lower levels of mentalizing during interaction in mothers with symptoms of depression. Post-hoc examination of the interaction effect of postpartum depression showed that this association was only evident in mothers with medium to high levels of depression. Findings and implications are discussed.

Psychometric evaluation of the Parental Reflective Functioning Questionnaire in Polish mothers

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

The significance of parental mentalizing for four-year-old children's solitary pretend play

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'.

Early psychosocial risk factors and postnatal parental reflective functioning

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.

The relationship between parental mental health, reflective functioning coparenting and social emotional development in 0-3 year old children

Introduction

The transition to parenthood is a high-risk period for many parents and is an important period for child development. Research has identified that parental mental health, reflective functioning (capacity to consider mental states of oneself and others) and coparenting (capacity to work together well as a parenting team) may be particularly significant predictors of later child outcomes, however these factors have seldom been considered together. The present study therefore aimed to investigate the relationship between these factors and the extent to which they predict child social emotional development.

Methods

Three hundred and fifty parents of infants aged 0 to 3 years 11 months were recruited to complete an online Qualtrics questionnaire.

Results

Results indicate that both positive coparenting and parental reflective functioning (Pre-mentalizing and Certainty subscales) were found to significantly predict child development. General reflective functioning (Uncertainty subscale) predicted parental depression and anxiety, however unexpectedly, parental mental health was not a significant predictor of child development, but did predict coparenting. General reflective functioning (Certainty subscale) was also found to predict coparenting, which in turn was found to predict parental reflective functioning. We found an indirect effect of general reflective functioning (Certainty) on child SE development via parental reflective functioning (Pre-mentalizing). We also found an indirect effect of negative coparenting on child development via parental reflective functioning (Pre-mentalizing).

Discussion

The current results support a growing body of research highlighting the important role reflective functioning plays in child development and wellbeing as well as parental mental health and the interparental relationship.

Validation of the Parental Reflective Functioning Questionnaire among maltreating and nonmaltreating mothers

The Parental Reflective Functioning Questionnaire (PRFQ; Luyten et al., 2017) is a central measure of parental reflective functioning (i.e., the tendency to consider children's mental experiences); still, little is known about the psychometric properties of the PRFQ among maltreating and nonmaltreating mothers. Maltreating mothers may have difficulties with parental reflective functioning given their risk for biased child-related cognitions and difficulties with sensitive emotion socialization. The present study investigated measurement invariance and the concurrent validity of the PRFQ in a sample of racially diverse, low-income maltreating (n = 165) and nonmaltreating (n = 83) mothers of preschoolers. Mothers were enrolled in a randomized controlled trial of a brief intervention (Valentino et al., 2019). A three-factor model emerged, representing the subscales (prementalization, certainty about mental states, and interest and curiosity) identified in a previous validation study of the PRFQ (Luyten et al., 2017); however, three items were excluded due to low factor loadings. Scalar group-based (maltreating vs. nonmaltreating) and longitudinal measurement invariance was found. Maternal prementalization and interest and curiosity were associated with emotion socialization behavior. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Early pathways of maternal mentalization: Associations with child development in the FinnBrain birth cohort study

Parental mentalization refers to a parents' capacity and interest to consider the individual experience and mental state underlying the behaviors of the child. Higher mentalization is considered a key aspect for parental sensitivity in interaction, fostering child's socioemotional and self-regulatory development. Yet, previous studies have not examined the dynamic pathways through which the maternal mentalization may develop, nor their effects on child development. Thus, in the current person-oriented study, first, we identify distinct profiles and longitudinal trajectories of maternal mentalization from pregnancy to child's 2 years of age. Second, we test how the profiles and trajectories associate with children's internalizing and externalizing problems, social-emotional competence and effortful control at the age of 2 years. Third, we examine how the profiles and trajectories associate with contextual demographic and child related. The substudy was part of the FinnBrain Birth Cohort and included families from general population (n = 2,687). Mothers reported their parental reflective functioning (PRF) at late pregnancy, 6 months and 2 years of child's age. Both mothers (n = 1,437) and fathers (n = 715) reported the developmental child outcomes at the child's age of 2 years. Latent Profile Analysis and Latent Transition Analysis were used to identify PRF profiles and trajectories. The results showed decreasing heterogeneity in PRF from pregnancy to child's age of 6 months and 2 years (i.e., four, three and two latent classes, respectively). Most mothers progressed towards high PRF over time. Second, the profiles and trajectories depicting high PRF associated with child high social-emotional competence at the age of 2 years, yet no clear positive effects were found on child's problems and effortful control. The group of mixed PRF trajectories showed strongest association with child's internalizing and externalizing problems. Finally, there were theoretically meaningful associations between the PRF trajectories and both the contextual (e.g., parity) and child related (e.g., infant temperament) factors. This was the first study to explore the early unfolding of maternal mentalization. The results are discussed in relation with the potential mechanisms accounting for child development and with the nature and limitations of self-reported parental mentalization.

Efficacy of a randomized controlled trial of a perinatal adaptation of COS-P in promoting maternal sensitivity and mental wellbeing among women with psychosocial vulnerabilities

Pregnant women with psychosocial vulnerabilities should be offered perinatal interventions that include a parenting component to ameliorate the potential negative effects of maternal mental health problems and/or poor social network on parenting. One such intervention program is the Circle of Security-Parenting intervention (COS-P). The COS-P is a manualized video-based intervention that based on attachment theory seek to enhance maternal sensitivity and decrease the risk on insecure and disorganized attachment. We carried out a randomized controlled trial examining the efficacy of a perinatal adapted version of COS-P for women with psychosocial vulnerabilities (e.g. histories of mental health problems and/or poor social networks). Eligible participants (N = 78) were recruited to the study by midwives during regular prenatal sessions. Interventions were delivered individually at home by trained health nurses both pre and post birth. The primary outcome was maternal sensitivity assessed with the Coding Interactive Behavior Manual by blinded coders from video-recordings of mother-infant free play interactions. Secondary outcomes were mother-reported depressive symptoms, parental reflective functioning, parental stress, infant socio-emotional functioning, and maternal wellbeing. All outcomes were assessed at nine months infant age. We did not find an effect of the intervention on the primary outcome of maternal sensitivity (β = -0.08; 95% CI [-0.41, 0.26], p = .66). Neither did we find intervention effects on the secondary outcomes of depressive symptoms, parental reflective functioning, maternal well-being, or infant socio-emotional functioning. We did however find that the intervention decreased parental stress (β = -8.51; 95% CI [-16.6;-0.41], p = .04). The results are discussed in light of existing findings on the effect of COS-P and sample heterogeneity. Furthermore, we discuss the challenges of adapting the COS-P for pregnant women, some without prior experiences with caregiving. Future research with larger at-risk samples examining moderation factors (e.g. adult attachment, depression maternal-fetal attachment) are recommended.

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

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

Understanding Your Baby: protocol for a controlled parallel group study of a universal home-based educational program for first time parents

Background

Infant mental health represents a significant public health issue. The transition to parenthood provides optimal opportunities for supporting parenting competence. Especially parental mentalization, i.e. the caregiver’s ability to notice and interpret the child’s behavior in terms of mental states, is important in infancy where the caregiver-infant communication is based solely on the infant’s behavioral cues.

Methods

This study evaluates the efficacy of the intervention Understanding Your Baby (UYB) compared to Care As Usual (CAU) in 10 Danish municipalities. UYB aims at promoting parental competence in new parents by supporting them in noticing their infants’ behavioral cues and interpreting them in terms of mental states. Participants will be approximately 1,130 singletons and their parents. Inclusion criteria are first-time parents, minimum 18 years old, living in one of the 10 municipalities, and registered in the Danish Civil Registration Register (CPR). Around 230 health visitors deliver the UYB as part of their routine observation of infant social withdrawal in the Danish home visiting program. During an interaction between the health visitor and the infant, the health visitor articulates specific infant behaviors and helps the caregivers interpret these behaviors to mental states. The study is a controlled parallel group study with data obtained at four time points in two phases: First in the control group receiving the publicly available postnatal care (CAU), secondly in the intervention group after UYB implementation into the existing postnatal services. The primary outcome is maternal competence. Secondary measures include paternal competence, parental stress, parental mentalizing, and infant socioemotional development. Analysis will employ survey data and data from the health visitors’ register.

Discussion

Results will provide evidence regarding the efficacy of UYB in promoting parenting competences. If proved effective, the study will represent a notable advance to initiating the UYB intervention as part of a better infant mental health strategy in Denmark. Conversely, if UYB is inferior to CAU, this is also important knowledge in regard to promoting parenting competence and infant mental health in a general population.

Trial registrationhttps://ClinicalTrials.gov with ID no. NCT03991416. Registered at 19 June 2019—Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03991416

Supplementary Information

The online version contains supplementary material available at 10.1186/s40359-022-00924-3.