Thinking about the next generation: The case for a mentalization-informed approach to perinatal and intergenerational mental health.

BACKGROUND: There has been substantial progress made across multiple disciplines to emphasize the importance of perinatal mental health both for parents and offspring. This focuses on what has been termed the 'First 1000 Days' from conception to the child's second birthday. We argue that our understanding of this issue can go further to create an intergenerational approach to mental health. Despite the existence of theoretical frameworks and practical approaches to implementation, there are gaps in the understanding of perinatal and intergenerational mental health including which psychological mechanisms are implicated in the transmission of risk and resilience within the perinatal period; and how to leverage these into treatment approaches. AIMS AND METHODS: In this paper, we explore the potential for mentalization as a candidate psychological approach to intergenerational mental health. RESULTS: We contextualize this issue in terms of the points of contact between mentalization and broader theoretical models such as the social determinants of health and the Developmental Origins of Health and Disease (DoHaD) model. Further, we provide an overview of the existing evidence base for the relevance of mentalization to perinatal mental health. DISCUSSION: Finally, we sketch out an outline model for integrating mentalization into perinatal and intergenerational mental health, highlighting several areas of opportunity to develop research and practice from diverse geographies and demographics. Here, we suggest that integration of mentalization with other conceptual frameworks such as DoHaD can mutually enrich the understanding of each model, pointing the way towards more effective early and preventative interventions.

The association of different presentations of maternal depression with children's socio-emotional development: A systematic review.

Maternal depression from the perinatal period onwards is a global health priority associated with an increased likelihood of suboptimal socio-developmental outcomes in offspring. An important aspect of this association is the extent to which sustained maternal depression impacts on these outcomes. The current review synthesised the evidence on maternal depression from the perinatal period onwards and offspring internalising, externalising, and social competence outcomes. We also identified sources of methodological bias. A systematic review following PRISMA guidelines was conducted. Longitudinal studies targeting biological mothers with depressive symptomology, detailing onset, using repeated validated measures, and assessing children's outcomes between three and 12 years were included. Twenty-four studies met inclusion criteria. Findings supported the validity of different presentations of maternal depression, including consistent identification of a group of chronically depressed mothers across countries. Mothers within this group reported poorer internalising, externalising, and social competence outcomes for their offspring, with the highest levels of child problems associated with greater maternal chronicity and symptom severity. Results differed by measurement type with mothers rating poorer outcomes in comparison to teachers reports. For timing of depression, evidence was inconsistent for independent effects of antenatal or postnatal depression on child outcomes. There was substantial variability in study quality assessment. Assessing different presentations of maternal depression is essential for capturing the longitudinal associations between maternal depression and offspring outcomes to inform targets of early intervention. Chronicity, severity, and concurrent maternal depression have important implications for children's development and should be targeted in future programme planning. Further research in low- and middle-income countries is warranted.

"There's more love between us": The parental experience of attending Mellow Babies, a targeted, early intervention program for parents and their babies.

It is recognized that parenthood in the context of psychosocial adversity can have negative implications for infant development. Parenting programs are the first line of intervention to improve outcomes for families; however, evidence for the effectiveness of group-based, targeted early interventions is still scarce. Preliminary findings indicate Mellow Babies (MB) as a promising group-based parenting program for families at risk for parenting difficulties. Using thematic analysis, we aimed to understand: (i) the aspects of the intervention that enabled parents to complete the program and (ii) the relational and behavioral changes perceived as valuable for parents and their babies post-intervention. In total, 68 parents residing in the United Kingdom were interviewed after completing MB (49 mothers and 19 fathers; 88% self-identified as British). Three themes and six subthemes were generated from the data. Parents identified several intervention components as beneficial, including the facilitators' interpersonal skills and multi-dimensional, group-based approach. Participant reflections highlighted three underlying mechanisms that enabled positive change: (i) the sense of community cultivated within the group, (ii) the process of formulating and re-conceptualizing one's difficulties, and (iii) the opportunity to reshape interpersonal interactions. Findings are discussed within the context of perinatal and infant mental health.

Se reconoce que la paternidad/maternidad dentro del contexto de la adversidad sicosocial puede tener implicaciones negativas para el desarrollo del infante. Los programas sobre la crianza son la línea frontal de intervención para mejorar los resultados para las familias, sin embargo, la evidencia para la eficacia de las intervenciones tempranamente identificadas, con base en el grupo, es escasa. Los resultados preliminares indican que Bebés Apacibles (Mellow Babies / MB) es un prometedor programa de crianza con base en el grupo para familias bajo riesgo de dificultades en la crianza. Haciendo uso de análisis temáticos, nos propusimos comprender: i) los aspectos de la intervención que les permite a los progenitores completar el programa y ii) los cambios relacionales y de comportamiento que se percibieron como valiosos para los progenitores y sus bebés con posterioridad a la intervención. En total, se entrevistaron 68 progenitores residentes del Reino Unido después de completar MB (49 mamás y 19 papás; 88% autoidentificados como británicos). De la información surgieron tres temas y seis subtemas. Los progenitores identificaron como beneficiosos varios componentes de la intervención, incluyendo las habilidades interpersonales de quienes facilitaban la participación y el acercamiento multidimensional con base en el grupo. Las reflexiones de los participantes subrayaron tres mecanismos subyacentes que permitieron el cambio positivo: i) el sentido de comunidad cultivado dentro del grupo; ii) el proceso de formular y reconceptualizar las propias dificultades; y iii) la oportunidad de volver a darle forma a las interacciones interpersonales. Los resultados se discuten dentro del contexto de la salud mental perinatal y del infante.

On reconnaît généralement que la parentalité dans le contexte d'adversité psychosociale peut avoir des implications négatives pour le développement du bébé. Les programmes de parentage sont la première ligne d'intervention afin d'améliorer les résultats pour les familles. Cependant les preuves de l'efficacité d'interventions précoces ciblées et basées sur un groupe sont encore rares. Des résultats préliminaires indiquent que Bébés d'humeur joyeuse, Mellow Babies (MB) est un programme de parentage basé sur un groupe prometteur pour les familles à risque de difficultés de parentage. En utilisant une analyse thématique nous nous sommes donné pour but de comprendre: i) les aspects de l'intervention qui permettent aux parents de finir le programme et ii) les changements relationnels et comportementaux qui sont perçus comme étant précieux pour les parents et leurs bébé après l'intervention. Au total 68 parents résidant au Royaume Uni ont été interviewés après avoir terminé le programme MB (49 mères et 19 pères; 88% s'étant auto-identifiés comme britanniques). Trois thèmes et six sous-thèmes ont émergé des données. Les parents ont identifié plusieurs composantes de l'intervention comme étant bénéfiques, y compris les compétences interpersonnelles du facilitateur ou de la facilitatrice et son approche multi-dimensionnelle, basée sur un groupe. Les réflexions des participants ont mis en lumière trois mécanismes sous-jacents qui permettait un changement positif: i) le sens de communauté cultivé au sein du groupe; ii) les processus de formulation et de ré-conceptualisation de ses propres difficultés; et iii) l'opportunité de refaçonner les interactions interpersonnelles. Les résultats sont discutés dans le contexte de la santé mentale du nourrisson et périnatale.

Promoting sensitive parenting in 'at-risk' mothers and fathers: A UK outcome study of Mellow Babies, a group-based early intervention program for parents and their babies.

BACKGROUND: The objective of this study was to evaluate the effectiveness of Mellow Babies (MB) in the UK. MB is a 14-week early parenting intervention program that is delivered in groups and is targeted at 'at-risk' parents (both mothers and fathers) and their babies up to 18 months old. METHOD: The study used a pragmatic pre-post intervention design. Outcomes were parental mental health, parenting confidence, quality of life, socio-emotional development of children, and perceived parent-child relationship. Fifteen groups representing n = 91 parent-baby dyads were recruited across the UK between 2017-2018. The sample consisted of 10 Mellow Mums groups (70 mother-baby dyads) and 5 Mellow Dads groups (21 father-baby dyads). Intention-to-treat and 'completer' analyses were performed. RESULTS: Findings suggest short-term positive outcomes for parents attending MB. Completion of the program was associated with significant improvements in anxiety and overall wellbeing, parenting confidence, and perceived closeness of the parent-child relationship. The significance of these improvements, except for parenting confidence, was maintained in the intention-to-treat analysis. MB engaged and retained a high proportion of parents who could be considered 'at-risk' and benefitted fathers and mothers attending the intervention equally. CONCLUSIONS: This is the first prospective study to explore MB participation for both mothers and fathers and to indicate engagement and potential benefits specifically for 'at-risk' parents. Findings further demonstrate the effectiveness of MB as an early intervention program for parents experiencing psychosocial difficulties. Replication by studies using a contrast or control group also incorporating follow-up data would further improve the evidence base for MB.

The problem of overcontrol: Perfectionism, emotional inhibition, and personality disorders.

BACKGROUND AND AIMS: Some individuals with Personality Disorders (PD), particularly of a non-Borderline type, present with difficulties relating to over-control of cognitions, emotion and behavior, perfectionistic traits, and impaired social interactions. The current study sought to evaluate the strength of association, and interactions of both emotional inhibition and perfectionism in PD's, after controlling for symptoms and interpersonal problems. METHOD: We recruited a sample of 578 treatment seeking outpatients. Diagnosis of PD was made with the SCID-II. Individual's completed measures of perfectionism (Frost-MPS), Emotional Inhibition (EIS), Depression (BDI-II), Anxiety (STAI-Y), Global symptoms (SCL-90-R), and interpersonal problems (IIP-32). RESULTS: Perfectionism was related to interpersonal problems, to the majority of PD symptomatology and to PD severity via number of SCID-II criteria met. Emotional inhibition was linked to symptoms and interpersonal problems as well as with avoidant, dependent, depressive and paranoid PDs; and with overall PD Severity. Inhibition and perfectionism were correlated with each other. Both variables predicted PD above and beyond other variables assessed. Mediation modeling demonstrated that the effect of emotional inhibition on PD severity was fully mediated by perfectionism and interpersonal problems. CONCLUSIONS: Psychological mechanisms of overcontrol are a maintaining factor in many PDs. Both perfectionism and emotional inhibition impact on a broad range of PDs and there is an urgent need for research into these processes, and to adapt psychological interventions to consider these factors.

Clinical staging model in offspring of parents with bipolar disorder: a systematic review.

OBJECTIVE: We sought to systematically review the literature on the psychiatric risk of offspring of parents with bipolar disorder (OPBD) using a developmental psychopathology framework. The review also sought to establish the utility of clinical stage modelling as a framework for identifying precursor disorders to later onset of bipolar disorder (BD) in OPBD. METHODS: A systematic search was performed using EMBASE, PsychINFO and Medline. Reference lists of included studies and previous reviews were also searched. Studies were included if they reported diagnostic outcomes for child, adolescent and young adult offspring of parents diagnosed with BD. RESULTS: Twenty-six studies were identified representing 21 individual cohorts. The review identified that OBPD present as a high-risk group for a range of mood and non-mood disorders in childhood, adolescence and young adulthood. The trajectory of risk was from non-mood disorders in childhood via non-bipolar mood disorders in early adolescence towards mania/hypomania in late adolescence and early adulthood. From a clinical staging perspective, childhood anxiety disorders were associated with later onset of BD. Recurrent substance use disorder was identified as a risk in OPBD during late adolescence and early adulthood. Quality ratings indicated that studies were methodologically robust. CONCLUSIONS: Our review provides evidence for a developmental psychopathology trajectory of precursor risks to BD in OPBD. There is support for clinical stage modelling as a conceptual framework for understanding developmental risk in OPBD and as a tool for developing early and individualized intervention strategies.