Early styles of interaction in mother-twin infant dyads and maternal mental health.

Transition to parenthood is considered a critical process for mothers of twins. There are, however, few studies on the subject. This study aims to evaluate the differences between mother-twin infant dyads and mother-singleton infant dyads with regard to maternal depression, anxiety, parenting stress, and the quality of mother-infant interaction. Mothers of twin infants (N = 40) were compared to mothers of singletons (N = 72). At infant 3 months, maternal depression, anxiety, and parenting stress were assessed via a questionnaire and styles of interaction with the Care-Index. The results indicated that mothers of twins (vs mothers of singletons) had significantly higher state anxiety and higher scores on the Difficult Child Scale of the Parenting Stress Index at infant 3 months. No significant differences between the two groups were found with regard to maternal depression. Mothers of twins had significantly lower sensitivity and were more unresponsive than mothers of singletons. Twin infants had significantly more difficult and compliant behaviours than singleton infants. Assisted reproductive treatment (ART) and prematurity had no effect on any of the examined variables. State anxiety was shown to partially mediate the relationship between twin parenthood and maternal sensitivity and to completely mediate the relationship between twin parenthood and infant difficult style. Maternal unresponsiveness was shown to be exclusively linked to being the parent of twins. The study shows that twin parenthood has a significant effect on maternal mental health and on the quality of mother-infant interaction and highlights the importance of early prevention programmes for twin parents.

Maternal and paternal depression and anxiety: their relationship with mother-infant interactions at 3 months.

While there have been studies on the effects of maternal depression and anxiety on mother-infant styles of interaction in infancy, there have been no studies on the effects of paternal depression and anxiety or on the joint effects of maternal and paternal depression and anxiety on mother-infant styles of interaction. The aims of the study were to examine the associations between maternal depression and anxiety and paternal depression and anxiety and to examine the relationship between maternal and paternal depression and anxiety and mother-infant styles of interaction at infant 3 months. Seventy mother and father couples were administered the EPDS for depression and the STAI-Y for anxiety and mother-infant interactions were video-recorded and coded with the CARE-INDEX. Analyses with Pearson correlation indicated an association between maternal depression and paternal anxiety and between maternal anxiety with paternal depression and anxiety. Moreover maternal and paternal depression and anxiety were found to be associated with the quality of maternal style of interaction. Maternal sensitive style was negatively associated with maternal depression and state anxiety. Maternal unresponsive style was positively associated with both paternal depression and state and trait anxiety. Multiple regression analysis has shown that maternal state anxiety was a greater predictor of a lower level of maternal sensitivity than maternal depression.

Reflective functioning, maternal attachment, mind-mindedness, and emotional availability in adolescent and adult mothers at infant 3 months.

The study evaluated reflective functioning (RF), maternal attachment, mind-mindedness, and emotional availability among 44 adolescent mother-infant dyads and 41 adult mother-infant dyads. At infant age 3 months, mother-infant interaction was coded with the mind-mindedness coding system and Emotional Availability Scales; mother attachment and RF were evaluated with the Adult Attachment Interview (AAI). Adolescent mothers (vs. adult mothers) were more insecure and had lower RF; they were also less sensitive, more intrusive and hostile, and less structuring of their infant's activity; they used fewer attuned mind-related comments and fewer mind-related comments appropriate to infant development. In adult mothers, the Mother Idealizing and Lack of Memory AAI scales were correlated to non-attuned mind-related comments and the Father Anger scale to negative mind-related comments. In adult mothers, RF was associated with sensitivity. This was not the case with adolescent mothers. In both groups of mothers, there were no associations between sensitivity and mind-mindedness.

Mother-Infant Emotion Regulation at Three Months: The Role of Maternal Anxiety, Depression and Parenting Stress.

BACKGROUND: While the association between anxiety and postpartum depression is well known, few studies have investigated the relationship between these two states and parenting stress. Furthermore, a number of studies have found that postpartum depression affects mother-infant emotion regulation, but there has been only one study on anxiety and emotion regulation and no studies at all on parenting stress and emotion regulation. Therefore, the primary aim of our study is to identify, in a community sample of 71 mothers, the relationship between maternal depression, anxiety, and parenting stress. The second aim is to examine the relationship between anxiety, postpartum depression, and parenting stress and mother-infant emotion regulation assessed at 3 months. METHODS: Mother-infant interaction was coded with a modified version of the Infant Caregiver and Engagement Phases (ICEP) using a microanalytic approach. The Edinburgh Postnatal Depression Scale (EPDS), State-Trait Anxiety Inventory (STAI), and Parenting Stress Index-Short Form (PSI-SF) were administered to the mothers to assess depression, anxiety, and parenting stress, respectively. RESULTS: Analysis revealed correlations between anxiety and depression, showing that parenting stress is associated with both states. In a laboratory observation, depression was correlated with both negative maternal states and negative dyadic matches as well as infant positive/mother negative mismatches; anxiety was correlated with both negative maternal states and infant negative states as well as mismatches involving one of the partners having a negative state. Multiple regression analysis showed that anxiety is a greater predictor than depression of less adequate styles of mother-infant emotion regulation. Parenting stress was not shown to predict such regulation.

Maternal attachment influences mother-infant styles of regulation and play with objects at nine months.

We examined the association between the quality of maternal representations of attachment evaluated by the Adult Attachment Interview (AAI) and mother styles of regulating attention and emotion during free play with objects in 41 mother dyads when infants were nine months old. The secure mother dyads showed a greater duration of engagement matches, with more positive matches, and a greater capacity to move from non-matched to matched states. Secure mother dyads demonstrated greater involvement in play with objects than insecure mother dyads. Insecure mother dyads showed a greater duration of mismatches and spent more time in negative matches. Correlations between maternal AAI scores and the variables studied also showed that the maternal Passivity and Unresolved scales were associated with less adequate dyadic attention and emotion regulation, while the maternal Coherence scale was associated with more adequate dyadic attention and emotion regulation.

Mind-mindedness and styles of interaction of young fathers with their infants at three months: a pilot study.

BACKGROUND: Fatherhood at a young age can be characterized by a multiproblematic background with several risk factors that can negatively affect father-child relationships, the father's well-being and child's social-emotional development. METHODS: This pilot study evaluated paternal interaction styles and mentalization in a sample of 22 young fathers and their 3-month-old infants and compared these variables with those of 22 adolescent and young mothers (the fathers' partners). Parent-infant interaction were codified with Care-Index to evaluate styles of interaction and with Mind-Mindedness system to evaluate mentalization. RESULTS: The results showed that young fathers had high scores in controlling behaviors and low scores in sensitivity, placing them in a risk range. The young father's interaction profile did not differ from the young mother's interaction profile. Infants had high scores in passive behaviors and low scores in cooperative behaviors, placing them in a high-risk range. Moreover, young fathers had more nonattuned mind-related comments than their partners. CONCLUSIONS: The findings indicate that low responsiveness and low mind-mindedness characterize the quality of adolescent and young father-infant interactions, highlighting the value of providing early intervention to support the father-child relationship, enhancing the father's sensitivity and his ability to keep the infant in mind.

Data mining versus manual screening to select papers for inclusion in systematic reviews: a novel method to increase efficiency.

Systematic reviews rely on identification of studies, initially through electronic searches yielding potentially thousands of studies, and then reviewer-led screening studies for inclusion. This standard method is time- and resource-intensive. We designed and applied an algorithm written in Python involving computer-aided identification of keywords within each paper for an exemplar systematic review of arm impairment after stroke. The standard method involved reading each abstract searching for these keywords. We compared the methods in terms of accuracy in identification of keywords, abstracts' eligibility, and time taken to make a decision about eligibility. For external validation, we adapted the algorithm for a different systematic review, and compared eligible studies using the algorithm with those included in that review. For the exemplar systematic review, the algorithm failed on 72 out of 2,789 documents retrieved (2.6%). Both methods identified the same 610 studies for inclusion. Based on a sample of 21 randomly selected abstracts, the standard screening took 1.58 ±â€…0.26 min per abstract. Computer output screening took 0.43 ±â€…0.14 min per abstract. The mean difference between the two methods was 1.15 min ( P  < 0.0001), saving 73% per abstract. For the other systematic review, use of the algorithm resulted in the same studies being identified. One study was excluded based on the interpretation of the comparison intervention. Our purpose-built software was an accurate and significantly time-saving method for identifying eligible abstracts for inclusion in systematic reviews. This novel method could be adapted for other systematic reviews in future for the benefit of authors, reviewers and editors.

Attachment styles, mental health, and trauma during the first wave of COVID-19 pandemic in an Italian adult population.

The COVID-19 pandemic has negatively impacted adults' mental health around the world. Various studies highlighted the role of sociodemographic risk factors, including age, gender, and level of education, in increasing this impact. Although insecure attachment styles are considered a vulnerability factor for psychopathology and difficulties in coping with stressful situations, few studies have examined the role of attachment styles in relation to psychological responses to the COVID-19 pandemic. This study aims to investigate the role of attachment styles in affecting psychopathological problems and post-traumatic symptoms during the COVID-19 pandemic in a sample of Italian adults (N=1548). During the first lockdown in Italy, the Attachment Style Questionnaire, the Impact of Event Scale-Revised, and Symptom Checklist 90-Revised were administered to the participants to assess attachment styles, trauma-related symptoms, and psychopathological problems. The results showed that 41% of the participants had symptoms of clinical and subclinical relevance during the pandemic. Anxious and avoidant insecure attachment styles predicted psychopathological problems and post-traumatic symptoms, whereas secure attachment style was a protective factor. Our results highlighted the significant role played by the quality of attachment styles on adult mental health during the pandemic, providing valuable elements for targeted psychological support interventions.

Understanding psychoanalytic work online and back to the couch in the wake of the COVID-19 pandemic: an investigation among Italian psychoanalysts.

Background: Worldwide, psychotherapists' clinical experience went through rapid developments with transition to teletherapy during the COVID-19 pandemic. Literature on the use of remote psychoanalysis was not conclusive, leaving the issue of the consequences of the necessary setting alternation open. This study aimed to investigate the psychoanalysts' experiences of shifting to remote work and then returning to in-person setting, considering the effect of the patients' attachment styles and personality configurations. Method: Seventy-one analysts of the Italian Psychoanalytic Society were asked to fill out an online survey about patients who found the transition easier and patients who found it more difficult. General questions on therapeutic work, ISTS (Interpretive and Supportive Technique Scale) for interpretive and supportive aspects of technique, WAI-S-TR (Working Alliance Inventory-Short Revised-Therapist) for therapeutic alliance, RQ (Relationship Questionnaire) for attachment style, and PMAI (Prototype Matching of Anaclitic-Introjective Personality Configuration) for personality configurations were administered. Results: All of the analysts chose to continue the treatment using audio-visual tools. Patients with difficult transitions had a significantly higher frequency of insecure attachment and a higher score on RQ Dismissing scale than patients with easy transitions. No significant differences were found between the two groups in personality configurations, psychotherapeutic alliance, and psychotherapeutic technique. Moreover, a higher level of therapeutic alliance was positively correlated to RQ Secure scale and was negatively correlated to RQ Dismissing scale. Patients with easy transition both to remote work and back to in-person setting had higher scores of therapeutic alliances than those with difficult transition both to remote work and back to in-person setting. Conclusion: Online psychoanalytic therapy was widely used during the COVID-19 pandemic. Patients with insecure attachment styles had greater difficulties in adapting to setting alternations, thus confirming that insecure attachment is a vulnerability factor not only for psychopathological problems but also for a well-functioning therapeutic collaboration. Patient's personality configuration did not influence their adaptation to the setting alternation. The supportive and interpretive styles did not undergo significant changes in the transition from in-person setting to remote setting and vice versa, thus suggesting a continuity in the analysts' "internal setting."

Psychopathological and Psychosocial Risk Profile, Styles of Interaction and Mentalization of Adolescent and Young Mother-Infant Dyads.

This study examined the psychopathological and psychosocial risk profile and the quality of mother-infant interaction in 98 adolescent and young mother-infant dyads. At their infant's age of 3 months, mothers filled in a socio-demographic form and completed a test battery: EPDS for depression, STAY-I for anxiety, PSI-SF for parenting stress, MPSS for social support, AAI for maternal attachment and reflective functioning, CECA for adverse childhood experiences, Care-Index and Mind-mindedness coding system for mother-infant interaction. Results showed that motherhood in adolescence was associated with several psychosocial risk factors. Adolescent and young mothers have depression (25%), anxiety (29%) and insecure attachment (65%), with low reflective functioning, of whom 18% have disorganized attachment. A total of 54% of the mothers had at least one adverse childhood experience. Furthermore, adolescent mothers had low sensitivity and mind-mindedness and high intrusiveness, and their infant had low responsiveness and high passive behaviors. Mothers under 18 have experienced more sexual abuse, are more likely to be single and have been followed by child social services more than mothers aged 18-21. Adolescent mothers have a high-risk psychopathological and psychosocial profile that affects their ability to mentalize and build an adequate relationship with the child. It appears to be important to support the adolescent mother-child relationship.

Effectiveness of an online versus face-to-face psychodynamic counselling intervention for university students before and during the COVID-19 period.

BACKGROUND: The COVID-19 pandemic has increased online counselling interventions, including those aimed at university students. The principal aim of the study is to evaluate the effectiveness of the online counselling intervention during the COVID-19 pandemic, also with regards to the effectiveness of the face-to-face intervention. METHODS: 34 students (Mean age = 23.74; Female = 27) who requested online university counselling during COVID-19 have been compared with 81 (Mean age = 22.8; Female = 60) students who requested university face-to-face counselling before the pandemic. The psychopathological problems were assessed with the Symptom Checklist 90 Revised, attachment styles with the Attachment Style Questionnaire, adverse childhood experiences with Adverse Childhood Experiences Questionnaire, and life satisfaction with the Life Satisfaction Scale. RESULTS: At the pre-intervention phase, psychological distress was similar in both groups with no differences in the General Severity Index of the SCL-90 R, and there were no significant differences for secure/insecure attachment, adverse childhood experiences, and life satisfaction. The online counselling intervention during the pandemic was effective in reducing psychological distress scales as depression (p = .008), obsessive-compulsive (p = .008), interpersonal sensitivity (p = .005), and anxiety (p = .011), and in the total scale of the SCL-90 R (p = .017). The face-to-face counselling intervention was effective in reducing psychological distress in all subscales and in the total scale of the SCL-90 R (p = .000) and in increasing the level of life satisfaction (p = .023). Attachment style did not moderate the effectiveness of the online and face-to-face interventions. CONCLUSIONS: Students seeking counselling, both before and during the pandemic, show similar levels of psychological distress. The online counselling intervention was almost as effective as face-to-face counselling intervention with respect to psychological distress; it was not effective in increasing life satisfaction.

Parental embodied mentalizing: Associations with maternal depression, anxiety, verbal mentalizing, and maternal styles of interaction.

BACKGROUND: Maternal depression and anxiety in the perinatal period affect the quality of maternal sensitivity and mentalizing abilities. Few studies analyzed implicit mentalizing in relation to maternal distress. The aims of the study were: to examine the relation between nonverbal mentalizing - parental embodied mentalizing (PEM) - and maternal depression and anxiety, verbal mentalizing, and maternal styles of interaction; and to test PEM as a mediator of the effect of maternal distress on styles of interaction. METHOD: 81 mother-infant dyads have been recruited. At infant three months, maternal depression was assessed using the Edinburgh Postnatal Depression Scale, anxiety with State Trait Anxiety Inventory, and reflective functioning with Reflective Functioning Scale. Mother-infant interactions were coded with various approaches: PEM for nonverbal mentalizing, Mind-mindedness coding system for Mind-mindedness, and CARE-Index for maternal styles of interaction. RESULTS: Maternal depression and state anxiety were negatively correlated with PEM. PEM was also negatively correlated to maternal controlling style. Mothers with psychopathological problems (vs. mothers with no psychopathological problems) had lower PEM and sensitivity and more controlling style. Moreover, maternal depression and anxiety had direct effects on maternal sensitivity and had indirect effects mediated by PEM on controlling style. LIMITATIONS: The study evaluates interactions at three months; longitudinal studies will be able to examine maternal mentalizing and sensitivity in various stages and identify the effect on the child's attachment. CONCLUSIONS: PEM is associated to maternal anxiety and depression and mediates the effects of depression and anxiety on mother controlling style. These results emphasize the importance of early prevention programs for mothers focused also on implicit mentalizing.

Psychological distress and attachment styles in emerging adult students attending and not attending a university counselling service.

Emerging adulthood is a turning point in the life cycle with regard mental health. To assess psychological distress and attachment styles 688 university students of which 370 requested a counselling support responded to Symptom Checklist 90 Revised and Attachment Style Questionnaire. Counselling attending students (vs counselling non-attending students) have a higher psychological risk profile, with more psychological distress and insecure attachment. A marked percentage of students not attending counselling presents psychological distress. In both groups associations emerged between psychopathological problems and insecure attachment. The importance of communication strategies aimed to those students who, albeit non requesting psychological help, display psychological distress is discussed.

Short-term psychological consequences of the COVID-19 pandemic: Results of the first wave of an ecological daily study in the Italian population.

COVID-19 pandemic involved several psychosocial consequences. We aimed at monitoring the mental health of Italian adults during the lockdown imposed by the government. We present here results from the baseline assessment of the "EmotionalThermometer [TermometroEmotivo] project on a sample of 1548 Italian adults. We assessed the socio-demographic conditions of participants, individuals' perception of the COVID-19-situation, psychological distress, emotion regulation strategies, and perceived social support. Having a worse representation of COVID-19 and consulting news more frequently, with higher anxiety and less credibility of different sources of information, were positively associated with psychological distress and post-traumatic responses. Being female, younger age, living in high-risk regions, having symptoms of COVID-19, and having relatives/friends with such symptoms represented risk factors for a worse perception of COVID-19 and distress. Social support and cognitive reappraisal represented protective factors for mental health.

Effectiveness of a university counseling intervention based on a psychodynamic approach.

The study examined the effectiveness of a brief psychodynamic counseling intervention on psychological distress and general life satisfaction in a sample of 124 students by comparing pre- and posttreatment data. The authors also tested the moderating role of pretreatment attachment styles. Results showed that most participants (57%) can be classified as a nonclinical population, whereas only a minority of participants belong to a clinical population (17%) and a subclinical population (26%) according to the Symptom Checklist 90 Revised (SCL-90-R). Psychodynamic counseling intervention was shown to be associated with a decrease in the Global Severity Index and the anxiety and depression subscales of the SCL-90-R. Clinical effectiveness was greater for participants belonging to the clinical group. General life satisfaction increased significantly for all students. The authors found no moderation effect of attachment styles. Brief psychodynamic counseling intervention was associated with a reduction of psychological distress and an increase in life satisfaction.

Childhood experiences of maltreatment, reflective functioning and attachment in adolescent and young adult mothers: Effects on mother-infant interaction and emotion regulation.

BACKGROUND: Maternal childhood experiences of maltreatment affect parenting and have consequences for a child's social-emotional development. Adolescent mothers have a higher frequency of a history of maltreatment than adult mothers. However few studies have analyzed the interactions between adolescent mothers with a history of childhood maltreatment and their infants. OBJECTIVE: The aim of the study was to examine the effect of maternal childhood experiences of maltreatment on mother-infant emotion regulation at infant 3 months, considering both infant and mother individual emotion regulation and their mutual regulation. PARTICIPANTS: Participants were 63 adolescent and young adult mother-infant dyads recruited at a hospital. METHODS: The mothers were administered the Adult Attachment Interview to evaluate reflective functioning and attachment and the Childhood Experiences of Care and Abuse was used to evaluate maternal childhood experiences of maltreatment. Mother-infant interactions were coded with a modified version of the Infant Caregiver Engagement Phases. RESULTS: Dyads with mothers with childhood maltreatment (vs dyads with mothers with no maltreatment) spent more time in negative emotional mutual regulation (p = .009) and less time in positive and neutral mutual emotion regulation (p = .019). Cumulative maternal childhood experiences of maltreatment were associated positively with mother and infant negative states at individual and dyadic level and with the AAI scales of Passivity and Unresolved Trauma (p < .05). The effect of cumulative maternal childhood experiences of maltreatment on mother-infant emotion regulation was direct and not mediated by maternal attachment and reflective function. CONCLUSIONS: Maternal childhood experiences of maltreatment increase the risk connected to early motherhood, affecting mother-infant emotion regulation.

Parenting Stress, Mental Health, Dyadic Adjustment: A Structural Equation Model.

Objective: In the 1st year of the post-partum period, parenting stress, mental health, and dyadic adjustment are important for the wellbeing of both parents and the child. However, there are few studies that analyze the relationship among these three dimensions. The aim of this study is to investigate the relationships between parenting stress, mental health (depressive and anxiety symptoms), and dyadic adjustment among first-time parents. Method: We studied 268 parents (134 couples) of healthy babies. At 12 months post-partum, both parents filled out, in a counterbalanced order, the Parenting Stress Index-Short Form, the Edinburgh Post-natal Depression Scale, the State-Trait Anxiety Inventory, and the Dyadic Adjustment Scale. Structural equation modeling was used to analyze the potential mediating effects of mental health on the relationship between parenting stress and dyadic adjustment. Results: Results showed the full mediation effect of mental health between parenting stress and dyadic adjustment. A multi-group analysis further found that the paths did not differ across mothers and fathers. Discussion: The results suggest that mental health is an important dimension that mediates the relationship between parenting stress and dyadic adjustment in the transition to parenthood.

Effectiveness of an Attachment-Based Intervention Program in Promoting Emotion Regulation and Attachment in Adolescent Mothers and their Infants: A Pilot Study.

This pilot study examined the effectiveness of an attachment-based intervention program, PRERAYMI, based on video technique, psychological counseling and developmental guidance in improving the style of interaction and emotion regulation of adolescent mothers and their infants after 3 and 6 months of intervention. Analyses revealed that adolescent mothers who participated in the intervention (vs. control group adolescent mothers) increased their Sensitivity and reduced their Controlling style after both 3 and 6 months of treatment. Infants who participated in the intervention (vs. control group infants) increased their Cooperative style and reduced their Passive style from 3 to 9 months. Moreover, the intervention group dyads (vs. control group dyads) increased the amount of time spent in affective positive coordination states (matches), decreased the amount of time spent in affective mismatches, and had a greater ability to repair mismatches from 3 to 9 months. Furthermore, the intervention group dyads (vs. control group dyads) increased the amount of time spent in reciprocal involvement in play with objects from 3 to 9 months. The quality of maternal attachment did not affect the intervention effect.

Motherhood in adolescent mothers: maternal attachment, mother-infant styles of interaction and emotion regulation at three months.

Early motherhood is considered a risk factor for an adequate relationship between mother and infant and for the subsequent development of the infant. The principal aim of the study is to analyze micro-analytically the effect of motherhood in adolescence on the quality of mother-infant interaction and emotion regulation at three months, considering at the same time the effect of maternal attachment on these variables. Participants were 30 adolescent mother-infant dyads compared to 30 adult mother-infant dyads. At infant 3 months, mother-infant interaction was video-recorded and coded with a modified version of the Infant Caregiver Engagement Phases and the Adult Attachment Interview was administered to the mother. Analysis showed that adolescent mothers (vs. adult mothers) spent more time in negative engagement and their infants spent less time in positive engagement and more time in negative engagement. Adolescent mothers are also less involved in play with their infants than adult mothers. Adolescent mother-infant dyads (vs. adult mother-infant dyads) showed a greater duration of negative matches and spent less time in positive matches. Insecure adolescent mother-infant dyads (vs. insecure adult mother-infant dyads) demonstrated less involvement in play with objects and spent less time in positive matches. To sum up adolescent mother-infant dyads adopt styles of emotion regulation and interaction with objects which are less adequate than those of dyads with adult mothers. Insecure maternal attachment in dyads with adolescent mothers (vs. adult mother infant dyads) is more influential as risk factor.