Parental Reflective Functioning Affects Sensitivity to Distress in Mothers with Postpartum Depression
Parental reflective functioning (PRF) refers to the capacity of caregivers to reflect upon their children’s internal mental states and intentions, which is seen as crucial for parental sensitivity, defined as the adequate behavioral response to an infant’s signals. In this study, the effect of maternal PRF on sensitivity during the mother–infant interaction was examined in a clinical sample of 50 mothers who were experiencing postpartum depression and their infants aged three to 10 months. Mother and infant were exposed to emotional distress using the still-face procedure. It was hypothesized that low levels of PRF are associated with a decrease in maternal sensitivity in response to distress. Maternal PRF was assessed using the parental reflective functioning questionnaire (PRF). The subscales measured interest and curiosity in mental states, certainty about mental states (i.e., the recognition of the opacity of mental states), and pre-mentalizing modes (i.e., non-mentalizing modes), whereas sensitivity was evaluated using the maternal behavior Q-sort (Mini-MBQS-V). The results revealed a significant overall decrease in maternal sensitivity. As expected, the higher the scores on the pre-mentalizing modes, which indicated low levels of mentalizing through the mothers’ repudiation or defense against it, the greater the decreases in sensitivity. No effects with respect to the interest and curiosity in mental states or the certainty about mental states were found. Our findings determined that the pre-mentalizing modes are predictive of sensitivity to distress in mothers with postpartum depression.
KeywordsPostpartum depression Parental reflective functioning Maternal sensitivity Still-face procedure.
S.K. assisted with the sensitivity rating, preformed the statistical analyses, and prepared the manuscript. C.M.: assisted with the statistical analyses. P.L. participated in the preparation of the manuscript. G.R. participated in the preparation of the manuscript. B.R. principle investigator of the study prepared the manuscript.
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.
The ethics committee of the Medical Association of Hamburg authorized the overall project (reference number PV3269).
Informed consent was obtained from both parents.
- Ainsworth, M. D., Blehar, M. C., Waters, E., & Wall, S. (1978). Patterns of attachment—a psychological study of the strange situation. Oxford: Lawrence Erlbaum.Google Scholar
- American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Arlington, VA: American Psychiatric Publishing.Google Scholar
- Beck, A. T., & Steer, R. A. (1987). Manual for the beck depression inventory. San Antonio, TX: Psychological Corporation.Google Scholar
- Braungart-Rieker, J., Garwood, M. M., Powers, B. R., & Notaro, P. C. (1998). Infant affect and affect regulation during the still-face paradigm with mothers and fathers: The role of infant characteristics and parental sensitivity. Developmental Psychology, 34(6), 1428–1437.PubMedCrossRefGoogle Scholar
- Carlson, E. A. (1998). A prospective longitudinal study of attachment disorganization/ disorientation. Child Development, 69, 1107–1128. https://doi.org/10.1111/j.1467-8624.1998.tb06163.x.PubMedGoogle Scholar
- Closa-Monasterolo, R., Gispert-Llaurado, M., Canals, J., Luque, V., Zaragoza-Jordana, M., Koletzko, B. & Verduci, E. (2017). The effect of postpartum depression and current mental health problems of the mother on child behaviour at eight years. Maternal and Child Health Journal, 21, 1563–1572.PubMedCrossRefGoogle Scholar
- Cordes, K., Smith-Nielsen, J., Tharner, A., Katznelson, H., Steele, H., Væver, M. S. (2017). Reflective functioning in postpartum depressed women with and without comorbid personality disorder. Psychoanalytic Psychology, 34(4), 414–421Google Scholar
- Fonagy, P., & Target, M. (2006). Psychoanalyse und die Psychopathologie der Entwicklung. Stuttgart: Klett-Cotta. Original 2003: Psychoanalytic Theories - Perspectives from Developmental Psychopathology.Google Scholar
- Fonagy, P., Target, M., Steele, H., & Steele, M. (1998). Reflective functioning manual, version 5.0, for application to adult attachment interviews. London, GB: Psychoanalysis Unit, Sub-Department of Clinical Health Psychology, University College London. Unpublished manual.Google Scholar
- Grienenberger, J., Kelly, K., & Slade, A. (2005). Maternal reflective functioning, mother-infant affective communication, and infant attachment: Exploring the link between mental states and observed caregiving behavior in the intergenerational transmission of attachment. Attachment & Human Development, 7, 299–311. https://doi.org/10.1080/14616730500245963.Google Scholar
- International Standard Classification of Education I S C E D. UNESCO (1997). http://www.unesco.org/education/information/nfsunesco/doc/isced_1997.htm.
- Luyten, P., Mayes, L. C., Sadler, L., Fonagy, P., Nicholls, S., Crowley, M., & Slade, A. (2009). The parental reflective functioning questionnaire-1 (PRFQ-1). Leuven: University of Leuven. Unpublished manual.Google Scholar
- Moore, G. A., Hill-Soderlund, A. L., Propper, C. B., Calkins, S. D., Mills-Koonce, W. R., & Cox, M. J. (2009). Mother-infant vagal regulation in the face-to-face still-face paradigm is moderated by maternal sensitivity. Child Development, 80, 209–223. https://doi.org/10.1111/j.1467-8624.2008.01255.x.PubMedGoogle Scholar
- Moran, G. (2009a). Mini-MBQS-V revised mini-MBQS 25 item for video coding. Ontario, CA: Western University. http://works.bepress.com/gregmoran/49/.Google Scholar
- Moran, G. (2009b). Mini-MBQS (25 items). Ontario, CA: Western University.Google Scholar
- Pederson, D. R., Moran, G., & Bento, S. (2009). Assessing Maternal sensitivity and the quality of mother-infant interactions using the maternal behaviour Q‐Sort (MBQS). Unpublished Manual.Google Scholar
- Pederson, D. R., Moran, G., Sitko, C., Campbell, K., Ghesquire, K., & Acton, H. (1990). Maternal sensitivity and the security of infant-mother attachment: A Q-sort study. Child Development, 61(6), 1974–1983. http://www.ncbi.nlm.nih.gov/pubmed/2083509
- Pereira, J., Vickers, K., Atkinson, L., Gonzalez, A., Wekerle, C. & Levitan, R. (2012). Parenting stress mediates between maternal maltreatment history and maternal sensitivity in a community sample. Child Abuse Neglect, 36(5), 433–437. https://doi.org/10.1016/j.chiabu.2012.01.006.PubMedGoogle Scholar
- Ramsauer, B., Lotzin, A., Mühlhan, C., Romer, G., Nolte, T., Fonagy, P., & Powell, B. (2014). A randomized controlled trial comparing Circle of Security Intervention and treatment as usual as interventions to increase attachment security in infants of mentally ill mothers: Study Protocol. BMC Psychiatry, 14, 1–11. https://doi.org/10.1186/1471-244X-14-24.Google Scholar
- Rutherford, H. J. V., Goldberg, B., Luyten, P., & Bridgett, D. J. (2013). Parental reflective functioning is associated with tolerance of infant distress but not general distress: Evidence for a specific relationship using a simulated baby paradigm. Infant Behavior & Development, 26, 635–641. https://doi.org/10.1016/j.infbeh.2013.06.008.Google Scholar
- Smaling, H. J. A., Huijbregts, S. C. J., Suurland, J., van der Heiden, K. B., Mesman, J., et al. (2016). Prenatal reflective functioning and accumulated risk as predictors of maternal interactive behavior during free play, the still-face paradigm, and two teaching tasks. Infancy, 21(6), 766–784. http://doi.org/10.1111/infa.12137.Google Scholar
- Stacks, A. M., Muzik, M., Wong, K., Beeghly, M., Huth-Bocks, A., Irwin, J. L., & Rosenblum, K. L. (2014). Maternal reflective functioning among mothers with childhood maltreatment histories: Links to sensitive parenting and infant attachment security. Attachment & Human Development, 16(5), 515–533.CrossRefGoogle Scholar
- Suchman, N. E., DeCoste, C., Castiglioni, N., McMahon, T. J., Rounsaville, B., & Mayes, L. (2010). The Mothers and Toddlers Program, an attachment-based parenting intervention for substance using women: Post-treatment results from a randomized clinical pilot. Attachment & Human Development, 12(5), 483–504.CrossRefGoogle Scholar
- Tarabulsy, G. M., Provost, M. A., Bordeleau, S., Trudel-Fitzgerald, C., Moran, G., Pederson, D., & Pierce, T. (2009). Validation of a short version of the maternal behaviour Q-Set applied to a brief video record of mother-infant interaction [Abstract]. Infant Behavior and Development, 32, 132–136.PubMedCrossRefGoogle Scholar
- Wittchen, H.-U., Wunderlich, U., Gruschwitz, S., & Zaudig, M. (1997). Strukturiertes Klinisches Interview für DSM-IV (SKID). Göttingen: Hogrefe.Google Scholar