Adverse Childhood Experiences: Mental Health Consequences and Risk Behaviors in Women and Men in Chile.

Studies conducted worldwide indicate that adverse childhood experiences (ACEs) are among the most intense and frequent sources of stress, considerably influencing mental and physical health while also resulting in risk behaviors in adulthood. METHODOLOGY: We used data from the Pilot National Survey of Adversity and Sexual Abuse in Childhood (2020), conducted by CUIDA UC, which comprises the Adverse Childhood Experiences International Questionnaire [ACE-IQ] (Adapted). The cross-sectional methodology used made it possible to directly calculate the prevalence of adverse childhood experiences in the population sampled, at a single point in time. We performed a bivariate and univariate descriptive analysis, a correlation analysis, and a multivariate analysis, all of which will be detailed in the section entitled "General Data Analysis Procedure". RESULTS: We found equally high rates of adverse childhood experiences in men and women, with community violence exhibiting the highest prevalence. We found significant low- to moderate-sized associations between the multiple types of ACEs considered and mental health problems, substance use problems, criminal behaviors, and intrafamily violence (IFV), which differed between men and women. Significant correlations were detected between the ACE score and mental health, substance use, criminal behaviors, and IFV in both men and women. Importantly, ACEs were found to be predictors of all of these variables, with differences observed between men and women. CONCLUSIONS: Nearly all participants reported having had at least one ACE and more than half reported had four or more ACEs. Those who had had four or more ACEs were more likely to report problems throughout their life. Having an ACE of any type was found to be a better predictor of mental health problems and IFV in men than in women and might be a stronger risk factor for substance use and criminal behaviors in women than in men.

Efectividad de una intervención de video-feedback grupal en respuesta sensible de cuidadores de residencias / Effectiveness of a video-feedback intervention in sensitivity response aimed at orphanage caregivers

Resumen: El presente estudio evaluó la efectividad de una intervención de video-feedback grupal en cuidadores chilenos de residencias de preescolares y lactantes que tenía como objetivo promover la respuesta sensible. La sensibilidad del adulto se ha asociado al desarrollo de apegos seguros por parte de los infantes a su cargo. Precisamente niñas y niños que crecen en un contexto residencial tienen muchas veces alterado el sistema de apego. El estudio comprendió una muestra de 14 cuidadores diurnos de la Fundación San José divididos en 4 grupos que recibieron cada uno 5 sesiones de video-feedback. Se encontraron diferencias significativas previo y posterior a la intervención en el puntaje de sensibilidad total, en la subescala de responsividad y en la de sintonía. Los resultados preliminares son prometedores considerando que es una intervención novedosa.

Abstract: The present study evaluated the effectiveness of a group video-feedback intervention aimed at Chilean caregivers of a preschool and infants orphanage that intended to enhance adult sensitivity. Adult sensitivity has been associated with the development of secure attachments in children. Nevertheless, infants that grow in an institutional setting tend to have insecure attachment patterns. The study included a sample of 14 caregivers of Fundación San José institution, which were divided in 4 groups each receiving 5 sessions of video-feedback. Differences were found between the general score of sensitivity and the subscales of responsivity and synchronicity before and after the intervention. These preliminary results are promising considering that it was the first time that a group video-feedback intervention had been applied in orphanage caregivers.

Burnout y estrategias de regulación emocional parental: Un estudio en contexto de pandemia por Covid-19 en Chile / Burnout and parental emotional regulation strategies: A study in the context of the Covid-19 pandemic in Chile

Resumen El COVID-19 ha afectado la salud mental de la población pudiendo incrementar el riesgo de burnout parental (Griffith, 2020), definido como un síndrome resultante de la exposición duradera al estrés crónico de los padres en su rol de cuidadores (Mikolajczak et al. 2019). Este fenómeno puede tener graves implicancias en la crianza y el desarrollo normal de los niños, niñas y adolescentes, puesto que afecta múltiples áreas del funcionamiento de los padres, y lesiona el vínculo que mantienen con sus hijos (Mikolajczak et al, 2018). El objetivo de este estudio es comprender la relación entre las estrategias de regulación y el burnout parental en contexto de pandemia. La muestra se compuso de 693 participantes, recolectados mediante un muestreo no aleatorio que incluyó 133 padres y 560 madres mayores de 18 años que habitan actualmente en Chile, viviendo con al menos un hijo/a menor. Se utilizó el instrumento Parental Burnout Assessment (PBA) para evaluar el burnout parental, y comprender su relación con el impacto negativo percibido de la pandemia sobre las prácticas de crianza; el rol las estrategias de regulación emocional de supresión y reevaluación -medidas a través del Cuestionario de Regulación Emocional (ERQ)-; y el género. Los resultados arrojaron niveles más altos de burnout parental en las madres, quienes reportaron mayor impacto negativo de la crisis por COVID-19, usando más estrategias de supresión y menos de reevaluación. A partir de este estudio, se puede concluir que existe una interacción significativamente positiva entre la apreciación subjetiva que hacen los padres y madres de las consecuencias que la pandemia ha tenido sobre sus prácticas de crianza, y sus niveles de burnout parental.

Abstract: COVID-19 has affected the population's mental health, increasing the risk of parental burnout (Griffith, 2020), defined as a syndrome resulting from long-term exposure to chronic stress of parents in their role as caregivers (Mikolajczak et al. 2019). This phenomenon can have serious implications for the upbringing and normal development of children and adolescents, since it affects multiple areas of parental functioning, as well as damage the bond they maintain with their children (Mikolajczak et al, 2018). This study included 693 participants, collected through a non-random sample that included 133 fathers and 560 mothers over 18 years of age who currently live in Chile, living with at least one child. Linear regressions were performed to understand the relationship between parental burnout -measured using the Parental Burnout Assessment (PBA)- and the perceived negative impact of the pandemic on parenting practices; the role of emotional regulation strategies of suppression and reappraisal -measured through the Emotional Regulation Questionnaire (ERQ)-; and gender. Higher levels of parental burnout were found in mothers, who reported a greater negative impact of the COVID-19 crisis, using more suppression strategies and less reappraisal.

Parental Burnout Assessment (PBA) in Different Hispanic Countries: An Exploratory Structural Equation Modeling Approach.

Parental burnout is a unique and context-specific syndrome resulting from a chronic imbalance of risks over resources in the parenting domain. The current research aims to evaluate the psychometric properties of the Spanish version of the Parental Burnout Assessment (PBA) across Spanish-speaking countries with two consecutive studies. In Study 1, we analyzed the data through a bifactor model within an Exploratory Structural Equation Modeling (ESEM) on the pooled sample of participants (N = 1,979) obtaining good fit indices. We then attained measurement invariance across both gender and countries in a set of nested models with gradually increasing parameter constraints. Latent means comparisons across countries showed that among the participants' countries, Chile had the highest parental burnout score, likewise, comparisons across gender evidenced that mothers displayed higher scores than fathers, as shown in previous studies. Reliability coefficients were high. In Study 2 (N = 1,171), we tested the relations between parental burnout and three specific consequences, i.e., escape and suicidal ideations, parental neglect, and parental violence toward one's children. The medium to large associations found provided support for the PBA's predictive validity. Overall, we concluded that the Spanish version of the PBA has good psychometric properties. The results support its relevance for the assessment of parental burnout among Spanish-speaking parents, offering new opportunities for cross-cultural research in the parenting domain.

Mentalization and Parental Stress: How Do They Predict Mother-Child Interactions?

Parent-child interactions can be negatively influenced by contextual, individual, and familial factors. The present study examines how parental stress and parental mentalization predicts interactions between 36-48-month-old preschoolers and their mothers. The sample comprises 106 mother-child dyads from Santiago, Chile, from a mid-low SES. The instruments used were the Parental Stress Index-Short Form (PSI-SF), Mentalization in the Significant Adult during Interaction with the Child between 10 to 48 months old, and Parenting Interactions with Children: Checklist of Observations Linked to Outcomes (PICCOLO). A regression model was used to determine the significant impacts of mentalization and parental stress on interactions. The results indicate that the Encouragement dimension of parent-child interaction is predicted by emotional mentalization and parental distress, while the Teaching dimension of parent-child interaction is impacted by the cognitive dimension of mentalization and the perception that the child is difficult (stress difficult child). No association for the Responsivity and Affectivity dimension was observed.

Traumatic Experiences in Childhood and Maternal Depressive Symptomatology: Their Impact on Parenting in Preschool.

The goal of this study is to describe and analyze the relationship between childhood trauma and depressive symptoms and its relation to the parental interactions of mothers (19-47 years) with their 3-4 year old preschool children. Parental interactions, traumatic experiences in mothers' childhood, and current depressive symptoms were measured using the Parenting Interactions with Children: Checklist of Observations Linked to Outcomes (PICCOLO), the Childhood Trauma Questionnaire Short Form (CTQ), and the Beck Depression Inventory (BDI-I), respectively. A nonclinical sample of 81 Chilean mothers with their children was used. Results show that the presence of trauma in mothers' childhood has an impact on parenting; specifically, mothers with an emotional neglect experience showed greater difficulties in adequately promoting autonomy in their children.

Mothers' Use of Regulatory Talk with Toddlers in Chile and the US: How Do Cultural Values and Children's Gender Affect Mothers' Regulatory Talk at 12 and 30 Months?

Studies have shown that Chilean and US infants differ in their levels of self-regulation. One of the mechanisms of early socializing is the use of language, particularly mental state language. The current study seeks to deepen our knowledge of the ways in which mental state language is related to socialization processes in early childhood, including the ways both culture and children's gender influence a mothers' use of mental state talk. We used a quantitative and descriptive approach with 109 mothers and their children (64 Chilean and 45 US dyads), measured twice, at 12 and 30 months old. Mental state references related to regulation were coded during a story-sharing task, including positive (calm and patient) and negative (messy and impatient) references to regulating behavior. Chilean mothers generally showed more regulatory references than US mothers, especially if the children were at a younger age (12 month). Frequencies of regulatory references increased in US mothers at 30 months but were still less than in Chilean mothers. At the 12-month measuring point, Chilean mothers showed more negative regulatory attributes than positive regulatory attributes. Finally, US mothers mainly used references to secondary emotions (e.g., pride) and positive regulatory attributes (being obedient, mature and patient) at both ages.

Does Maternal Mental Health and Maternal Stress Affect Preschoolers' Behavioral Symptoms?

(1) Background: Maternal stress and depression are considered risk factors in children's socioemotional development, also showing high prevalence worldwide. (2) Method: Participants correspond to a longitudinal sample of 6335 mother/child pairs (18-72 months), who were surveyed in 2010 and then in 2012. The hypothesis was tested with SEM analysis, setting the child's internalized/externalized problems as dependent variable, maternal depression as independent variable, and stress as a partial mediator. (3) Results: Both depression during pregnancy and recent depression has not only a direct effect on the internalizing and externalizing symptomatology of the child, but also an indirect effect through parental stress. Significant direct and indirect relationships were found. (4) Conclusions: Maternal depression and the presence of parental stress can influence children's behavioral problems, both internalizing and externalizing.

Depressive Symptomatology and Parenting Stress: Influence on the Social-Emotional Development of Pre-Schoolers in Chile.

(1) Background: The preschool stage is a period of great psychological changes that requires the support of parents and significant adults for optimal development. Studies show that maternal mental health can be a risk factor in parenting, affecting the social-emotional development of children. (2) Methods: The present study seeks to shed light on the relation between depressive symptoms, parental stress in mothers and social-emotional development of their preschool children, using a total of 123 mother-child dyads with low Social-economic Status (SES). In mothers, depressive symptomatology and level of parental stress were evaluated, as well as social-emotional development in children. A possible mediation effect between maternal depressive symptoms and parenting stress is expected. (3) Results: The results indicate that higher levels of depressive symptoms and parenting stress in mothers relate to greater difficulties in social-emotional development of their preschool children. (4) Conclusions: These results are clinically relevant from the perspective of family therapy: Parents need support to decrease their levels of parenting stress in order not to jeopardise their children's social-emotional development.

Regulación emocional y depresión en divorciados: ¿Para quiénes es más importante esta relación? / Emotion regulation and depression among divorced: For whom this relation matters more?

Resumen: Investigaciones previas señalan que, personas con mayores dificultades de regulación emocional (DRE) presentan mayor sintomatología depresiva. Asimismo, factores como el sexo, presencia de hijos, iniciativa de la separación, estrés experimentado durante la separación y nivel socioeconómico, se relacionan con la presencia de sintomatología depresiva. Sin embargo, para quiénes el efecto de las DRE en la depresión es mayor en este contexto específico, requiere mayor exploración. El presente estudio tiene como objetivo estudiar el rol moderador de estos factores en la relación entre DRE y depresión, en una muestra de 518 personas chilenas divorciadas y separadas. Los resultados permiten concluir que el efecto de las DRE sobre los niveles de depresión, está moderado por el nivel de estrés experimentado por la ruptura y por quién tomó la iniciativa de la separación. Se discuten las implicancias clínicas de estos resultados, así como líneas de investigación futuras.

Abstract: Previous research indicates that people with greater difficulties in emotion regulation (DRE) have, in turn, higher rates of depressive symptomatology. Likewise, factors such as sex, the presence of children, the initiative of separation, the stress experienced during separation and the socioeconomic level, are related to the presence of depressive symptomatology. However, in whom or for whom, the effect of DRE on depression is greater in this specific context, it requires further exploration. The present study aims to study the moderating role of these factors in the relationship between DRE and depression in a sample of 518 divorced and separated Chilean people. The results obtained allow us to conclude that the effect of emotional dysregulation on depression levels is moderated by the level of stress experienced by the rupture and by who took the initiative of separation. Clinical implications of these results are discussed, as well as future lines of research.

Socioemotional skills between 12 and 30 months of age on Chilean children: When do the competences of adults matter?

Due to the rapid growth in early socioemotional skills during the first three years of life, significant variations in socioemotional development begin early and increase with time. Family competences as sensitivity and mentalization, contribute to differences among children of the same age. This study examines whether the level of socioemotional skills is stable or changes between 12 and 30 months of age, and whether primary caregiver sensitivity and mentalization, as well as educational level, are associated with changes in the level of socioemotional skills. One hundred and three Chilean children were evaluated. The results showed a significant change in socioemotional level between 12 and 30 months. Primary caregivers' sensitivity was associated with socioemotional skills at 12 months of age, and caregivers' educational levels was the strongest predictor. At 30 months, caregivers' sensitivity and educational level did not contribute additional influence, and only child socioemotional skills reported at 12 months acted as a predictor. Results indicate that family competences contribute to infants' socioemotional development in the first year of life, which subsequently influences their later skills.

Intervenciones basadas en la mentalización para padres y educadores: una revisión sistemática / Mentalization based interventions for parents and educators: a systematic review

Estudios recientes han mostrado la importancia de la mentalización y/o función reflexiva de los cuidadores como una de las variables que predice el desarrollo de esta habilidad y el apego seguro en el niño/a. A partir de estos antecedentes se revisa la literatura existente sobre intervenciones psicológicas focalizadas en promover la mentalización en padres y/o personal educativo de niños/as en etapa preescolar. Se consideran 17 estudios publicados entre los años 2000 y 2013. Los resultados muestran que gran parte de los estudios analizan y desarrollan modelos teóricos, siendo incipientes aquellos que consideran los estudios acerca de intervenciones basadas en la mentalización dirigidas a padres y/o agentes educativos. Dentro de estos últimos la mayoría están orientados a intervenciones tempranas en niños/as de 0 a 3 años, siendo escasos los estudios en preescolares (3 a 5 años de edad) dentro de un contexto educativo que reportan los efectos en los niños/as.

Recent studies have shown the importance of mentalizing or reflective function of caregivers as one of the variables that predict awareness and secure attachment in children. From this background there is a review of the literature on psychological interventions focused on promoting mentalizing or reflective function in parents and preschool educators. 17 studies published between 2000 and 2013 are considered. The results show that most of the studies analyzed and developed in theoretical models, with those who consider emerging studies based on mentalizing aimed at parents and educators interventions. Within the latter most are aimed at early intervention in children aged 0-3 years, with few studies in preschool children (3-5 years old) within an educational context that the effects reported in children.

Estudio comparativo de los estilos de apego adulto en un grupo de mujeres con y sin diagnóstico de depresión / Comparative study of adult attachment styles in a group of women with and without a diagnosis of depression

Numerosos estudios han asociado los estilos de apego inseguros a distintas formas de psicopatología, entre ellas la depresión, en diversas etapas del ciclo vital. Esta investigación tuvo como objetivo describir el estilo de apego de un grupo de pacientes de sexo femenino, diagnosticadas con depresión. Se estudió a un grupo de 28 pacientes, comparándolos con un grupo de 28 mujeres adultas que no presentan la enfermedad, igualando a las participantes en relación a la edad. Los resultados mostraron diferencias significativas en los estilos de apego de ambos grupos. Las pacientes diagnosticadas con depresión presentan, en su mayoría, estilos de apego inseguros (39.2 por ciento) e inclasificables (32.1 por ciento). Por su parte, el grupo de personas sin depresión presentan en su gran mayoría (85.7 por ciento) un estilo de apego seguro.

Several studies have linked the insecure attachment styles to different types of psychopathologies, i.e. depression, at diverse stages of the life cycle. This research aimed to describe the attachment style for a group of female patients diagnosed with depression. A group of 28 patients was analyzed and compared with a group of 28 female adults not presenting the psychopathology and with similar age range. Results show significant differences on the attachment style in within these two groups. The patients diagnosed with depression have, mainly, insecure attachment styles (39.2 percent) and cannot classify (32.1 percent). On the other side, the majority of the group of people without depression (85.7 percent) has a secure attachment style.

[Barriers restricting postpartum depression treatment in Chile]. / Barreras de acceso a tratamiento de la depresión posparto en Centros de Atención Primaria de la Región Metropolitana: un estudio cualitativo.

BACKGROUND: In Chile, postpartum depression is a prevalent and disabling condition. Universal screening is available but has not been translated into better treatment rates, suggesting the existence of access barriers. AIM: To describe access barriers to postpartum depression treatment in six primary health care clinics in Metropolitan Santiago, Chile. MATERIAL AND METHODS: Twenty women with postpartum depression and 18 primary health care professionals were subjected to a semi-structured interview. A qualitative methodology based on Grounded Theory was used. RESULTS: There are user associated barriers such as lack of knowledge about the disease, a negative conceptualization and rejection of available treatment options. There are also barriers associated with poor network support and some features of the health care system such as long waiting times and lack of coordination between clinical and administrative decisions. CONCLUSIONS: Patient and provider related barriers restricting treatment of postpartum depression were identified.

Apego y perdón en el contexto de las relaciones de pareja / Attachment and forgiveness in the context of couple relationships

La teoría del apego permite comprender diversos aspectos del funcionamiento interpersonal, entre ellos, la capacidad para perdonar. El objetivo de este estudio fue evaluar la asociación entre las dimensiones del apego adulto (ansiedad del abandono y evitación de la intimidad) y el perdón de transgresiones ocurridas en el contexto de relaciones de pareja. Asimismo, se buscó comparar el peso predictivo de ambas dimensiones sobre el perdón. Para ello, 647 estudiantes universitarios completaron medidas de auto-reporte del apego romántico y del perdón. Los análisis con ecuaciones estructurales permiten concluir que tanto la ansiedad como la evitación estuvieron asociadas a menor perdón. Además, se constató que las personas con alta evitación evidencian mayor dificultad para perdonar que aquellas con alta ansiedad.

Attachment theory allows the understanding of several aspects of interpersonal functioning, including the ability to forgive. The aim of this study was to evaluate the association between adult attachment dimensions (anxiety over abandonment and avoidance of intimacy) and forgiveness of transgressions occurred in romantic relationships. Additionally, it was sought to compare the predictive weight of each dimension on forgiveness. With this purpose, 647 university students completed self-report measures of romantic attachment and forgiveness. Analysis through structural equation modeling allow to conclude that both higher anxiety and/or higher avoidance were associated to lower forgiveness. Additionally, individuals with high levels of avoidance show more difficulties to forgive than those with high levels of anxiety.

Barreras de acceso a tratamiento de la depresión posparto en Centros de Atención Primaria de la Región Metropolitana: un estudio cualitativo / Barriers restricting postpartum depression treatment in Chile

Background: In Chile, postpartum depression is a prevalent and disabling condition. Universal screening is available but has not been translated into better treatment rates, suggesting the existence of access barriers. Aim: To describe access barriers to postpartum depression treatment in six primary health care clinics in Metropolitan Santiago, Chile. Material and Methods: Twenty women with postpartum depression and 18 primary health care professionals were subjected to a semi-structured interview. A qualitative methodology based on Grounded Theory was used. Results: There are user associated barriers such as lack of knowledge about the disease, a negative conceptualization and rejection of available treatment options. There are also barriers associated with poor network support and some features of the health care system such as long waiting times and lack of coordination between clinical and administrative decisions. Conclusions: Patient and provider related barriers restricting treatment of postpartum depression were identified.

Psicoterapia basada en la mentalización como tratamiento para trastornos de personalidad borderline: revisión teórica de los postulados de Fonagy / Psychoterapy based on mentalization as borderline personality Ddsorders treatment: theorical review of Fonagy’s principles

Este artículo es una revisión teórica de los postulados de Peter Fonagy respecto a los Trastornos de Personalidad Borderline (TPB) y su propuesta de abordaje a través de la psicoterapia basada en la mentalización. A partir de la revisión se concluye que el modelo planteado para comprender el desarrollo de TPB y los lineamientos para realizar intervenciones psicoterapéuticas, resultan en gran medida un aporte al manejo de estos pacientes. Ya que el mismo ha mostrado empíricamente ser efectivo en la disminución de riesgo suicida y conductas de autoagresión; siendo estos los síntomas de mayor severidad del trastorno.

This article is a theoretical review of the principles of Peter Fonagy about borderline personality disorder (BPD) and its proposed approach through the mentalization-based psychotherapy. From the review it is concluded that the proposed model for understanding the development of TPB and guidelines for psychotherapeutic interventions, are both a key contribution to the management of these patients. The same model and guidelines have proven empirically to be effective in reducing suicide risk and self-harm behaviors; which are the more severe symptoms of the disorder.

Intervenciones psicológicas perinatales en depresión materna y vínculo madre-bebé: una revisión sistemática / Psychological perinatal interventions in maternal depression and mother-child bond: a systematic review

La depresión perinatal constituye un trastorno de alta prevalencia con repercusiones negativas en la madre y en el bebé. A partir de estos antecedentes se revisa la literatura existente sobre intervenciones psicológicas focalizadas en reducir la depresión y/o favorecer un vínculo madre-infante positivo desde el embarazo hasta los dos años del niño/a. Se consideran 27 estudios publicados entre los años 1996 y 2012, que incluyen grupos experimental y control. Los resultados muestran que un mayor número de intervenciones se focalizan en la depresión perinatal como variable, distinguiendo entre intervenciones en el embarazo y postparto. Un menor número de estudios se dirige a la calidad del vínculo madre-infante y a ambas variables. Las intervenciones reportadas como exitosas, incluyen intervenciones grupales e individuales dirigidas a favorecer la sensibilidad materna y técnicas corporales.

Perinatal depression constitutes a high prevalence disorder, with negative repercussions in the mother and the baby. From these precedents, this article reviews different psychological interventions developed to reduce depression and/or to promote a mother-infant bond-quality, from pregnancy to children's second year of life. There are considered 27 studies published between 1996 and 2012, with inclusion of experimental and control groups. Results show that most of the interventions are focused in perinatal depression as a variable, differentiating between interventions during pregnancy and at postpartum. A minor number of studies focused on the mother-baby bond quality and to modify both variables in a simultaneous way. Interventions that were reported to be successful considered group and individual interventions focused on promoting maternal sensitivity and corporal techniques.

Efectividad de un programa de promoción de apego seguro en Chile / Effectiveness of a programme promoting secure attachment in Chile

El estudio muestra los efectos de una intervención temprana sobre las madres, en el apego de los niños al año de edad.

Efectividad de un programa de promoción de apego seguro en Chile / Effectiveness of a programme promoting secure attachment in Chile

El estudio muestra los efectos de una intervención temprana sobre las madres, en el apego de los niños al año de edad. (AU)