Longitudinal changes in term and preterm infant night wakings: The role of caregiver anxious-depression.

Changes in infant night waking during the first year of life are associated with individual (e.g., prematurity) and family (e.g., caregiver psychopathology) factors. This study examined the association between infant night waking and caregiver anxious-depressive symptoms during the first year of life in preterm and term infants. We considered between-person differences and within-person changes in caregiver anxious-depressive symptoms in relation to changes in infant night waking from 2- to 9-months. Racially (30.0% Black, 60.4% White, 9.5% multiracial/other) and socioeconomically (40.0% below median household income) diverse caregivers (N = 445) of full term (n = 258) and preterm (n = 187) infants were recruited from hospitals and clinics in two midwestern states. Caregivers completed measures of anxious-depression and their infant's night waking at four sampling periods (2-, 4-, 6-, and 9-months). Infant night wakings declined from 2- to 9-months. Between-person differences were observed, such that caregivers with higher average anxious-depressive symptoms or infants born full term reported more night wakings. Within-person effects of caregiver anxious-depressive symptoms were not significant. Caregiver anxious-depression is closely associated with infant night wakings. By considering a caregiver's average severity of anxious-depression, healthcare providers can more effectively plan infant sleep interventions. If caregiver anxious-depressive symptoms are ameliorated, night wakings may also decrease.

Los cambios en el despertar nocturno del infante durante el primer año de vida se asocian con factores individuales (v.g. nacimiento prematuro) y familiares (v.g. sicopatología de quien presta el cuidado). Este estudio examinó la asociación entre el despertar nocturno del infante y los síntomas de depresión por ansiedad de quien presta el cuidado durante el primer año de vida de infantes nacidos prematuramente y de ciclo completo. Tomamos en cuenta las diferencias entre las personas y los cambios dentro de las personas en los síntomas de depresión por ansiedad de quien presta el cuidado con relación a los cambios en el despertar nocturno del infante de los 2 a los 9 meses. Se reclutaron en hospitales y clínicas de dos estados del medio oeste cuidadores (N = 445) racial (30.0% de raza negra, 60.4% blancos, 9.5% multirraciales o de otra raza) y socioeconómicamente (40.0% por debajo del promedio de ingresos caseros) diversos, de infantes de ciclo completo (n = 258) y prematuros (n = 187). Los cuidadores completaron medidas de depresión por ansiedad y el despertar nocturno de sus infantes en cuatro períodos muestra (a los 2, 4, 6 y 9 meses). El despertar nocturno del infante declinó de los 2 a los 9 meses. Se observaron las diferencias entre personas, de tal manera que los cuidadores con un promedio mayor de síntomas de depresión por ansiedad o infantes nacidos en el ciclo completo reportaron más despertar nocturno. Los efectos de dentro de las personas de los síntomas de depresión por ansiedad del cuidador no fueron significativos. La depresión por ansiedad del cuidador se asocia cercanamente con el despertar nocturno del infante. Por medio de considerar el promedio de la severidad de la depresión por ansiedad del cuidador, quienes ofrecen el cuidado de salud pueden planear más eficazmente las intervenciones en cuanto al sueño del infante. Si se mejoran los síntomas de depresión por ansiedad de quien presta el cuidado, el despertar nocturno también podría disminuir.

Les changements dans le réveil nocturne du bébé pendant la première année sont liés à des facteurs individuels (par exemple la prématurité) et familiaux (par exemple la psychopathologie de la personne prenant soin de l'enfant). Cette étude a examiné le lien entre le réveil nocturne du bébé et les symptômes anxieux-dépressifs de la personne prenant soin de l'enfant durant la première année de vie de bébés prématurés et à terme. Nous avons considéré les différences entre les personnes et les changements au sein de la personne dans les symptômes anxieux-dépressifs de la personne prenant soin de l'enfant, en lien aux changements dans le réveil nocturne du bébé de 2 à 9 mois. Des personnes (N = 445) prenant soin d'un bébé à plein terme (n = 258) et prématuré (n = 187), divers du point de vue de leur race (30,0% noirs, 60,4% blancs, 9,5% multiracial/autre) et de leur statut socioéconomique (40,0% en dessous du revenu moyen d'une famille) ont été recrutés dans des hôpitaux et des cliniques des états au centre nord des Etats-Unis. Les personnes prenant soin du bébé ont rempli des mesures de dépression anxiété et de la nuit de leur bébé à quatre périodes de prélèvement des renseignements (2-, 4-, 6-, et 9- mois). Les réveils nocturnes du bébé ont décliné de 2- à 9- mois. Des différences entre les personnes ont été observées, au point que les personnes prenant soin du bébé avec la moyenne de symptômes anxieux-dépressifs la plus élevée ou des bébé nés à terme ont fait état de plus de réveils nocturnes. Les effets au sein de la personne des personnes prenant soin du bébé avec des symptômes anxieux-dépressifs n'étaient pas importants. La personne prenant du bébé avec une dépression anxieuse est fortement liée aux réveils nocturnes du bébé. En considérant la sévérité moyenne de la dépression anxieuse de la personne prenant soin du bébé, les prestataires de santé peuvent planifier les interventions concernant le sommeil du bébé de manière plus efficace. Si les symptômes anxieux-dépressifs de la personne prenant soin du bébé sont améliorer, alors les réveils nocturnes pourraient aussi diminuer.

Cumulative risk, infant sleep, and infant social-emotional development.

The effect of cumulative biological, psychosocial, and demographic risk and infant sleep on infant social-emotional functioning in 12-month-old infants (46% female) was examined in data from racially (30% Black, 60% White, 10% multiracial/other) and socioeconomically (41% below median income) diverse caregivers (N = 468, M = 30.42 years old, SD = 5.65) recruited from two midwestern states in 2019-2020. Due to the major changes in sleep patterns during infancy and the reported association between sleep and social-emotional functioning, this study also examined whether sleep moderates the association between risk and infant social-emotional functioning and potentially promotes healthy social-emotional functioning despite risk. Greater cumulative risk was associated with poorer sleep efficiency and more social-emotional problems, but was not associated with the general acquisition of social-emotional milestones. Results also suggested that poorer sleep efficiency was associated with more social-emotional problems and poorer social-emotional milestone acquisition. No significant interaction effects were found between cumulative risk and infant sleep. Risk and sleep appear to have unique associations with infant social-emotional problems and development; thus both could be targeted in early intervention to promote social-emotional functioning during infancy and early childhood.

Changes in Defense Mechanisms in Mothers From Pregnancy to 2 Years Postpregnancy.

ABSTRACT: The objective of this study was to assess changes in maternal defensive functioning from the third trimester of pregnancy to 2 years postpregnancy. A community sample of at-risk mothers ( N = 84; non-White [61%], unmarried [67%], high school or less education [72%], and income less than $20,000 [50%]) were recruited for this longitudinal study. Mothers responded to a semistructured interview during pregnancy and at 2 years postpregnancy about the parent-infant relationship; interview transcripts were coded using the Defense Mechanism Rating Scale (DMRS). Results indicated a significant increase in both total defense mechanisms used and the relative percentage of immature defense mechanisms used over time. A significant decrease in the relative percentage of healthy/adaptive defenses was noted. When all seven levels of defenses of the DMRS were assessed, it was an increase in minor image-distorting defenses, mechanisms that supported vulnerable self-esteem, that accounted for most of the change in immature defenses. Stability coefficients of defense mechanisms were reported, with large effect sizes, for overall defensive functioning, and mature and immature defenses over a 2-year period. These findings lend support to the importance of assessing defense mechanisms to better understand stressful life transitions in mothers.

Disrupted caregiving behavior as a mediator of the relation between disrupted prenatal maternal representations and toddler social-emotional functioning.

The development of maternal representations of the child during pregnancy guides a mother's thoughts, feelings, and behavior toward her child. The association between prenatal representations, particularly those that are disrupted, and toddler social-emotional functioning is not well understood. The present study examined associations between disrupted prenatal representations and toddler social-emotional functioning and to test disrupted maternal behavior as a mediator of this association. Data were drawn from 109 women from a larger prospective longitudinal study (N=120) of women and their young children. Prenatal disrupted maternal representations were assessed using the Working Model of the Child Interview disrupted coding scheme, while disrupted maternal behavior was coded 12-months postpartum from mother-infant interactions. Mother-reported toddler social-emotional functioning was assessed at ages 12 and 24 months. Disrupted prenatal representations significantly predicted poorer toddler social-emotional functioning at 24 months, controlling for functioning at 12 months. Further, disrupted maternal behavior mediated the relation between disrupted prenatal representations and toddler social-emotional problems. Screening for disrupted representations during pregnancy is needed to facilitate referrals to early intervention and decrease the likelihood of toddler social-emotional problems.

Maternal secure base scripts predict child attachment security in an at-risk sample.

Accumulating evidence indicates that individuals possess attachment, or secure base, scripts based on experiences with attachment figures, and these attachment scripts predict important outcomes such as caregiving behaviors and offspring social-emotional adjustment. However, less is known about the association between parents' secure base scripts and child attachment security within at-risk samples, i.e., those known to be at greater risk for insecurity. The current study examined the relation between maternal secure base script representations and child attachment security by extending the use of the Attachment Script Assessment (ASA; Waters & Rodrigues-Doolabh, 2004) to an at-risk sample. One-hundred mother-child pairs from a larger longitudinal study participated; the larger study focused on psychosocial risks related to parenting in a primarily low-income sample. In the present study, overall ASA script scores were first compared with two independent middle-class samples, one from a U.S. study, the other an international study. Scores and statistical patterns were comparable across all samples, indicating that the ASA was successful in tapping into maternal secure base script knowledge in our at-risk sample. The relation between maternal script scores and children's Attachment Q-Set (AQS; Waters, 1995) security scores were examined at ages 1 and 2 years. Dependency scores from the AQS were also included to establish discriminant validity for the script scores. Results indicated that maternal script knowledge predicted child security, while showing no relation to dependency scores. Findings indicate that the ASA can be an important and viable measure for assessing attachment representations in at-risk samples of caregivers.

Intergenerational transmission of trauma from mother to infant: the mediating role of disrupted prenatal maternal representations of the child.

Data from a multi-method, longitudinal study involving a community sample (N = 120) of pregnant women aged 18-42 were used to examine disrupted maternal representations of the child as a mechanism of the transmission of trauma from mother to infant. Using structural equation modeling, the best fitting model indicated that severity of mothers' childhood interpersonal trauma was associated with severity of disruption in prenatal representations of the child, which in turn was associated with less secure infant-mother attachment at 1 year of age. There was a significant indirect effect of maternal childhood interpersonal trauma on infant-mother attachment insecurity via disrupted prenatal maternal representations. Findings highlight an important mechanism of trauma transmission that could be targeted in interventions with mother-infant dyads.

The emotional tone of child descriptions during pregnancy is associated with later parenting.

INTRODUCTION: How parents think and feel about their young children has implications for the parent-child relationship. We examined prospective associations between prenatal descriptions of the unborn child's personality and later parenting behavior. METHODS: Pregnant women (N = 120; mean age = 26.16, SD = 5.71) were recruited in their third trimester for a longitudinal study. The sample is demographically diverse and predominantly economically disadvantaged. During prenatal interviews, women described their unborn child's personality, from which positive and negative emotion words were coded. Parenting behavior was coded 12 months postpartum (n = 105 for longitudinal analyses). RESULTS: Use of positive and negative words was negatively correlated (r = -.34, p < .001). Greater use of positive words to describe the unborn child's personality was associated with higher observed sensitivity, warmth, and engagement during mother-infant interactions, whereas negative words were associated with higher interference and lower levels of sensitivity. Mothers who used anxiety- and/or anger-related words to describe their unborn child, relative to mothers who did not, demonstrated higher interference and lower warmth and sensitivity. CONCLUSION: Descriptions of a child's personality before the child is born were associated with postnatal parenting behavior. Prenatal interventions that address negative thoughts and feelings regarding the child may be beneficial for promoting positive parenting postnatally.

Maternal Psychological Well-Being and Infant Emergency Department Utilization.

BACKGROUND: A mother's psychological well-being impacts her own and her infant's health. Challenges to maternal psychological well-being (eg, depression, anxiety) are associated with increased infant emergency department (ED) utilization. It is not known if other maternal psychological factors, such as relational health and past maltreatment during one's own childhood, are also associated with child ED utilization. OBJECTIVE: Examine maternal psychological factors (ie, childhood maltreatment, mental health, and relational health) associated with infant ED utilization in the first year of life. DESIGN/METHODS: Participants included 120 economically disadvantaged women recruited into a prospective longitudinal study during pregnancy and followed across the first year of their child's life. Mothers reported number of infant ED visits from birth to 1 year (assessed 12-months postpartum), as well as on their own childhood maltreatment, relational health, and mental health (assessed prenatally). Associations between maternal experiences and infant ED utilization were assessed via bivariate correlations and regression analyses. RESULTS: Infants attended on average 0.79 ED visits (range 0-6). Maltreatment during the mother's own childhood, poor relational health, and prenatal mental health symptoms were each associated with greater infant ED visits; maternal age, income, and education were not. In a Poisson regression, childhood sexual abuse was the strongest predictor of infant ED utilization, followed by low acceptance from the mother's father figure and prenatal depression. CONCLUSIONS: Prenatal assessment of psychosocial factors may help identify risk for higher ED use. Women with psychosocial risk factors may need additional support establishing supportive primary and behavioral health care before and after birth.

Prenatal Identification of Risk for Later Disrupted Parenting Behavior Using Latent Profiles of Childhood Maltreatment.

A history of maltreatment during childhood (e.g., physical and sexual abuse, neglect) can threaten the fundamental human need to form and maintain relationships across development, which ensure safety and security. Furthermore, parental maltreatment history presents considerable risk for the emergence of disrupted parenting behaviors (i.e., contradictory communication, sexualized/role-reversed behavior, disorientation, intrusiveness/negativity, and severe withdrawal), which in turn are associated with children's social-emotional development. The purpose of the present study was to examine whether experiences of childhood maltreatment during pregnancy can predict risk for disrupted parenting behavior before the birth of the child. Given the inherent variability in parenting behaviors, we were interested in how different types or combinations of experiences of maltreatment during childhood are associated with later parenting behaviors. Data were drawn from 120 women from a longitudinal study that spanned from the third trimester of pregnancy through 3-year postpartum. In the current study, mothers' experiences of childhood maltreatment were assessed during pregnancy, and disrupted parenting behaviors were coded from videotaped mother-infant interactions 1-year postpartum. Four profiles of childhood maltreatment were identified using latent profile analysis: low exposure, high exposure, high sexual maltreatment, and high physical and emotional maltreatment. Results revealed that high exposure to multiple types of childhood maltreatment most strongly predicted later disrupted parenting behavior. Women with multiple exposures to different types of maltreatment during childhood may require more intense intervention during pregnancy to prevent risk for the development of disrupted parenting behavior.

Infant mental health home visiting therapists' fidelity to the Michigan IMH-HV model in community practice settings.

Implementation research suggests that fidelity to a therapeutic model is important for enhancing outcomes, yet can be difficult to achieve in community practice settings. Furthermore, few published studies have reported on characteristics of treatment fidelity. The present study examined fidelity to the Infant Mental Health Home Visiting (IMH-HV) model among 51 therapists with a range of experience practicing in community settings across the state of Michigan. IMH therapists completed fidelity checklists after every session with participating families to track use of 15 treatment strategies central to the IMH-HV model across the 12-month study period. Results indicated that the most commonly endorsed components utilized in home visits were developmental guidance and infant-parent psychotherapy, followed by the provision of emotional support. Use of IMH-HV components did not vary over time for the entire sample; however, patterns of strategies used showed somewhat more variability among more experienced therapists and when serving higher risk families. Findings demonstrate that IMH-HV therapists report a range of adherence to the model in community settings, with greatest fidelity to several model core components. Ongoing training in the flexible use of all core strategies may further enhance fidelity and contribute to positive outcomes for caregivers and their children receiving IMH-HV services.

Infant mental health home visiting therapists' reflective supervision self-efficacy in community practice settings.

In recent years, there has been an increase in the research on reflective supervision, including the development of tools designed to measure reflective practice in the context of reflective supervision. The Reflective Supervision Self-Efficacy Scale for Supervisees (RSSESS) is a self-report measure that has been used in previous evaluations and is designed to assess perceived reflective practice self-efficacy for Infant Mental Health-Home Visiting (IMH-HV) therapists. Properties of the RSSESS including factor structure and reliability are explored in a first study that lays the foundation for the use of the RSSESS in an IMH-HV evaluation in the State of Michigan. IMH-HV therapists completed the RSSESS at 4 time points over a 12-month period and also completed a Clinician Profile Form that included questions about their IMH background and their work experience, including job satisfaction and burnout. Results indicated that the RSSESS is a reliable tool to measure change in reflective practice skills. IMH-HV therapists demonstrated growth in their use of reflective practice skills with families and their observational skills over the 12-month period. In addition, results indicated correlations between reflective supervision self-efficacy and job satisfaction as well as burnout.

THE CAREGIVING HELPLESSNESS QUESTIONNAIRE: EVIDENCE FOR VALIDITY AND UTILITY WITH MOTHERS OF INFANTS.

Severe disruptions in the caregiving system can lead to disorganized caregiving characterized by maternal helplessness and fear. Such caregivers abdicate their caregiving role and fail to provide protection to the child. The measurement of disorganized caregiving has historically been limited to lengthy, labor-intensive interviews, indicating a need for other feasible tools to assess this important construct. Furthermore, few studies have investigated correlates of disorganized caregiving. Participants included 120 diverse, primarily economically disadvantaged women who were part of a longitudinal study examining psychosocial risk factors before and after the birth of a child. Participants completed the Caregiving Helplessness Questionnaire (CHQ; C. George & J. Solomon, 2011) along with measures assessing maternal mental health, trauma exposure, parenting stress, and infant socioemotional adjustment. Results indicated that caregiver helplessness and fear, based on the CHQ, were positively associated with maternal depression, parenting stress, and perceptions of infant socioemotional problems. Importantly, results also revealed significant associations between current maternal trauma experiences and mothers' reports of helplessness and fear. Findings from the present study indicate that the CHQ may be a valid screening tool for disorganized caregiving among mothers of infants. In addition, a number of maternal experiences may be related to disorganized caregiving following the birth of a child.

The influence of interpersonal aggression on maternal perceptions of infant emotions: Associations with early parenting quality.

The current study tested the hypothesis that mothers who have experienced child maltreatment and aggression within their adult relationships may be at particular risk for misinterpreting infant emotions, leading to less sensitive parenting behaviors. Participants were 120 pregnant women recruited for a larger, longitudinal study investigating the role of psychosocial and environmental risk on women and their young children. Data were collected during the third trimester of pregnancy, and when children were 1 and 2 years of age. Participants completed a projective test designed to elicit individual differences in perceptions of infant emotions and an observer-rated assessment of parenting behaviors was conducted in the family home. Using structural equation modeling, we tested associations between maternal interpersonal aggression exposure and perceptions of infant emotion and parenting behaviors. Results demonstrated that a history of child abuse and intimate partner conflict were associated with a maternal tendency to view ambiguous infant facial expressions as negative (i.e., negative attribution bias), and in turn, with less parenting sensitivity over time. Findings suggest that negative attributions of infant emotion may be 1 mechanism by which a history of trauma and violence exposure contributes to less sensitive parenting for some mothers. Implications for intervention include the need for trauma-informed clinical services and psychoeducational methods that help mothers more accurately read and respond to infant emotional expression and bids for connection. (PsycINFO Database Record

Secure base scripts are associated with maternal parenting behavior across contexts and reflective functioning among trauma-exposed mothers.

There is growing evidence that "secure-base scripts" are an important part of the cognitive underpinnings of internal working models of attachment. Recent research in middle class samples has shown that secure-base scripts are linked to maternal attachment-oriented behavior and child outcomes. However, little is known about the correlates of secure base scripts in higher-risk samples. Participants in the current study included 115 mothers who were oversampled for childhood maltreatment and their infants. Results revealed that a higher level of secure base scriptedness was significantly related to more positive and less negative maternal parenting in both unstructured free play and structured teaching contexts, and to higher reflective functioning scores on the Parent Development Interview-Revised Short Form. Associations with parent-child secure base scripts, specifically, indicate some level of relationship-specificity in attachment scripts. Many, but not all, significant associations remained after controlling for family income and maternal age. Findings suggest that assessing secure base scripts among mothers known to be at risk for parenting difficulties may be important for interventions aimed at altering problematic parental representations and caregiving behavior.

Intimate partner violence and infant socioemotional development: the moderating effects of maternal trauma symptoms.

The aim of the present study was to investigate the impact of intimate partner violence (IPV) on infant regulatory difficulties at 3 months of age and infant socioemotional problems at 12 months of age. Maternal trauma symptoms were explored as potential moderators of these associations. Participants included 120 primarily low-income, ethnically diverse women and their infants. Results revealed that infants whose mothers experienced IPV during pregnancy did not have significantly more regulatory difficulties at 3 months than did infants whose mothers did not experience prenatal IPV. However, infants whose mothers experienced IPV during the first year after birth displayed significantly more socioemotional problems at 12 months, as evidenced by both maternal report and observational data. Furthermore, maternal posttraumatic stress avoidance symptoms served as a moderator of the association between prenatal IPV and infant regulatory difficulties at 3 months whereas maternal posttraumatic stress hyperarousal and reexperiencing symptoms served as moderators of the association between IPV during the first year after birth and infant socioemotional problems at 12 months. The findings highlight the detrimental impact that IPV can have on very young children and the importance of maternal trauma symptoms as a context for understanding the effect of IPV on young children's functioning.

Relational trauma and posttraumatic stress symptoms among pregnant women.

Women experience remarkably high rates of relational trauma including childhood abuse and neglect and intimate partner violence (IPV) during adulthood, and the childbearing years are no exception. The meaning of past and current relational trauma perpetrated by primary caregivers and significant others may be unique during pregnancy, in particular, because pregnancy is a salient time when mothers' important relationships are reworked and reorganized to "make room" for the relationship with the baby. The present study examined associations between different forms of relational trauma and posttraumatic stress symptoms in 120 women during the last trimester of pregnancy. Women were between the ages of 18 and 42 years and came from diverse economic and ethnic backgrounds. Results indicated that severity of childhood maltreatment was significantly related to severity of IPV during pregnancy, and both types of trauma made unique, significant contributions to posttraumatic stress symptoms. Furthermore, emotional/psychological violence had the largest associations with posttraumatic stress symptoms compared to other forms of violence. Findings indicate that it is critically important for clinicians working with pregnant women to conduct a thorough assessment of current and past relational trauma, including emotional/psychological trauma, in order to improve the well-being of the mother, the infant, and the mother-infant relationship.

The effects of domestic violence on the stability of attachment from infancy to preschool.

We hypothesized that trajectories of domestic violence (DV), maternal depression, and household income (from pregnancy to age 4) would be differentially associated with instability and stability of attachment, as measured by the Strange Situation at ages 1 and 4. Participants were 150 women and children. Women were first assessed during pregnancy and then yearly when the children were 1 to 4 years old. Overall, attachment was unstable for 56% of the sample from age 1 to age 4. Trajectories of DV and income both predicted attachment patterns. Positive outcomes (secure-secure and insecure-secure) were related to initially low levels of DV that stayed constant or became lower as well as initially high or low levels of income that increased over time.

A social-contextual understanding of concordance and discordance between maternal prenatal representations of the infant and infant-mother attachment.

This prospective study examined the relationship between maternal prenatal representations of the infant and later infant-mother attachment, including contextual factors related to concordance and discordance among dyads over time. Participants were 173 pregnant women between the ages of 18 and 40 who were interviewed during their last trimester of pregnancy and 2 and 13 months after birth. Maternal representations were assessed by the Working Model of the Child Interview during pregnancy (WMCI; C.H. Zeanah, D. Benoit, L. Hirshberg, M.L. Barton, & C. Regan, 1994), and infant-mother attachment was assessed through the Strange Situation procedure (M.D.S. Ainsworth, M. Blehar, E. Waters, & S. Wall, 1978) when infants were 13 months old. There was substantial discordance between maternal and infant classifications, although a significant concordance rate was found when classifications were collapsed into balanced/secure and nonbalanced/insecure groups based on prenatal representations and postnatal infant attachment groups (60%; χ2 = 6.90, p < .01; κ .20). As expected, discordance between maternal representations and infant-mother attachment was meaningfully related to contextual risk factors, maternal depression, and infant behaviors.

Assessment of psychiatrically hospitalized suicidal adolescents: self-report instruments as predictors of suicidal thoughts and behavior.

OBJECTIVE: The validity and clinical utility of the Reynolds Adolescent Depression Scale, Beck Hopelessness Scale, Suicidal Ideation Questionnaire-Junior, and Suicide Probability Scale (SPS) were examined longitudinally among suicidal adolescents. METHOD: Between 1998 and 2000, 289 psychiatrically hospitalized, suicidal youth, ages 12 to 17 years, participated in this study. Self-report measures were completed at baseline. Clinician-rated suicidality and suicide attempt were collected at baseline and 6-month follow-up. RESULTS: Baseline self-reports were internally consistent and strongly intercorrelated within male, female, white, and black subsamples. All of the measures predicted follow-up suicidality and suicide attempts. Using published cutoff scores, the Beck Hopelessness Scale and SPS were moderately to highly sensitive predictors of subsequent suicide attempts, as was the Suicidal Ideation Questionnaire-Junior for predicting suicide attempts and broad suicidality. Alternative cutoff scores that predicted outcomes with moderate and high sensitivity also were examined, with attention to resultant sacrifices in specificity. CONCLUSIONS: Baseline self-report scores predicted follow-up suicidality. SPS contributed uniquely to prediction of future suicidality and suicide attempt. SPS may supplement other sources of information when assessing suicide risk with this population.

Stability and change in mothers' internal representations of their infants over time.

This study examined predictors of stability and change in women's maternal representations of their children. Participants were 180 women, recruited from the community, half of whom had experienced domestic violence during pregnancy. Maternal representations of were assessed with the Working Model of the Child Interview (WMCI; Zeanah, Benoit, Hirshberg, Barton, & Regan, 1994) during the last trimester of pregnancy and again at the child's first birthday. Results indicated that when collapsed into balanced and non-balanced categories, 71% of the sample was stable over time, and women who had balanced representations had significantly more stable representations than women who had non-balanced representations (p < .001). Income, single parenthood, abuse status, and depressive symptomatology predicted change. In addition, women who became non-balanced postnatally benefited from having balanced representations while pregnant to buffer the quality of their interactions with their children.