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Childhood maltreatment is theorized as impeding the development of reflective functioning (RF; ability to perceive and interpret oneself and others in terms of mental states). However, previous research typically failed to support this association or yielded small sized and mixed associations. This study aims to provide a deeper look at the association between childhood maltreatment and RF by characterizing two non-mentalizing categories. One-hundred-and-sixteen pregnant women (mean age = 27.62, SD = 4.52) from the community (48.3% with a university degree, 96.5% in a relationship with the other parent) retrospectively reported on childhood abuse and neglect using the Childhood Trauma Questionnaire. They also participated in the Adult Attachment Interview subsequently coded using the Reflective Functioning Scale. Participants with poor to low RF were allocated to one of two groups (disavowal-distancing or distorted-inconsistent) using indicators provided in the RF Scale. No association was found between childhood maltreatment and overall RF when controlling for education level. A multinomial logistic regression revealed that childhood maltreatment was strongly predictive of a disrupted, over-analytical and inconsistent reflection about mental states but not of a tendency to discourse little about mental states. This tendency was rather only predicted by education level. Findings suggest that childhood maltreatment would lead to specific impairments in RF and that not considering how individuals fail to mentalize about attachment relationships may mask strong associations between RF and its determinants and correlates, including childhood maltreatment.

The COVID-19 pandemic has been associated with a global increase in psychological distress in pregnant women. This study evaluated the effects of STEP-COVID, a six-session mentalization-based prenatal group program offered online during the COVID-19 pandemic. The 100 participants were allocated to STEP-COVID or to the natural trajectory of prenatal care. Pre- and post-intervention assessments included measures of psychological distress, post-traumatic symptoms and positive affectivity. Perception of change during pregnancy on resilience-promoting factors was also assessed at post-intervention. A significant decrease in psychological distress and post-traumatic symptoms and an increase in positive affectivity were observed in participants in the intervention condition, whereas only post-traumatic symptoms improved in the control condition. Women who participated in STEP-COVID also reported greater changes during pregnancy on resilience-promoting factors than women in the control condition. Results hold promise for buffering the effect of the pandemic on the mental health of pregnant women using brief online interventions. Clinical trial registration: NCT05419167 (15/06/2022)

Introduction: This study aimed to clarify the role of mentalizing in pathways from attachment to Post Traumatic Stress Symptoms (PTSS) in survivors of childhood maltreatment (CM). We focused on the transition to parenting, a critical period for reworking parenting representations to reduce intergenerational maltreatment cycles. Method: Study participants included 100 pregnant CM survivors. We assessed PTSS with the SCID and attachment and mentalizing with the Adult Attachment Interview (AAI), which was rated for Attachment and Reflective Functioning (RF). Results: Regarding Re-experiencing trauma symptoms, the results of the path analysis were consistent with mediation. CM survivors' mentalizing about their early relationships with their parents (RF-Other) directly impacted Re-experiencing trauma symptoms, and attachment had an effect on Re-experiencing trauma symptoms through mentalizing (RF-Other). Regarding Arousal/Reactivity symptoms, the results of the pathways analysis were consistent with partial mediation by mentalizing about early relationships with parents (RF-Other). In addition to the pathway from attachment via mentalizing (RF-Other) to Arousal/Reactivity, the pathway between attachment and Arousal/Reactivity also remained significant. Discussion: This study provides new evidence of a mentalizing and attachment model of PTSS in CM survivors. The findings indicate that increased mentalizing about early relationships with parents is an important process associated with lower PTSS. Finally, we discuss the implications of developing interventions for CM survivors to reduce PTSS. Scaffolding the development of mentalizing regarding attachment relationships in which CM occurred may help CM survivors reduce the intrusion of traumatic memories and decrease trauma-related arousal and reactivity symptoms. Interventions to help CM survivors mentalize regarding parents and attachment relationships in which trauma occurred may be particularly important duri

Background: Women and men having been exposed to childhood trauma would be at high risk of various mental health symptoms while awaiting a child. This study aimed to evaluate the association between cumulative childhood trauma and the accumulation of symptoms belonging to different psychiatric problems in pregnant women and expecting men. Methods: We first examined prevalence rates of childhood trauma across our samples of 2853 pregnant women and 561 expecting men from the community. Second, we evaluated the association between cumulative childhood trauma and symptom complexity (i.e., the simultaneous presentation of symptoms belonging to multiple psychiatric problems) using subsamples of 1779 pregnant women and 118 expecting men. Participants completed self-reported measures of trauma (Childhood Trauma Questionnaire) and psychiatric symptoms (PTSD Checklist for DSM-5; Kessler Psychological Distress Scale; State-Trait Anger Expression Inventory-2; Self and Interpersonal Functioning Scale). Results: Trauma was more frequent in pregnant women than in expecting men and in participants reporting sociodemographic risk factors than in those not reporting any. A dose-response relationship was observed between the number of different traumas reported by pregnant women and expecting men and the complexity of their psychiatric symptoms, even when controlling for the variance explained by other risk factors. Women having been exposed to cumulative childhood trauma were 4.95 times more at risk of presenting comorbid psychiatric problems during pregnancy than non-exposed women. Conclusions: Childhood trauma is frequent in the general population of pregnant women and expecting men and is associated with symptom complexity during the antenatal period. These findings call for delivering and evaluating innovative trauma-informed antenatal programs to support mental health and adaptation to parenthood in adults having been exposed to childhood trauma. © 2021, The Author(s).

Background: Genetically high-risk children carry indicators of brain dysfunctions that adult patients with schizophrenia or bipolar disorder display. The accumulation of risk indicators would have a higher predictive value of a later transition to psychosis or mood disorder than each individual risk indicator. Since more than 50% of adult patients report having been exposed to childhood trauma, we investigated whether exposure to trauma during childhood was associated with the early accumulation of risk indicators in youths at genetic risk. Methods: We first inspected the characteristics of childhood trauma in 200 young offspring (51% male) born to a parent affected by DSM-IV schizophrenia, bipolar disorder, or major depressive disorder. A subsample of 109 offspring (51% male) had measurements on four risk indicators: cognitive impairments, psychotic-like experiences, nonpsychotic nonmood childhood DSM diagnoses, poor global functioning. Trauma was assessed from direct interviews and reviews of lifetime medical and school records of offspring. Results: Trauma was present in 86 of the 200 offspring (43%). The relative risk of accumulating risk indicators in offspring exposed to trauma was 3.33 (95% CI 1.50, 7.36), but more pronounced in males (RR = 4.64, 95% CI 1.71, 12.6) than females (RR = 2.01, 95% CI 0.54, 7.58). Conclusion: Childhood trauma would be related to the accumulation of developmental precursors of major psychiatric disorders and more so in young boys at high genetic risk. Our findings may provide leads for interventions targeting the early mechanisms underlying the established relation between childhood trauma and adult psychiatric disorders.

Background An upsurge in psychological distress was documented in pregnant women during the COVID-19 pandemic. We investigated with a longitudinal design whether prenatal and postnatal maternal distress during the COVID-19 pandemic was associated with lower infant socioemotional development. Methods Pregnant women (N = 468, Mage = 30,00, 97.6% White) were recruited during the first COVID-19 mandatory lockdown in Quebec, Canada, from April 2nd to April 13th 2020 and were re-contacted at two months postpartum to complete self-reported measures of general (i.e. not specifically related to the COVID-19 pandemic) anxio-depressive symptoms and infant development. Structural equation modeling analyses were performed using maximum likelihood parameter estimation. Results Higher maternal prenatal distress significantly contributed to poorer infant socioemotional development. A mediation model showed that postnatal distress significantly mediated the association between prenatal distress and infant socioemotional development, whereas the direct effect of prenatal distress was no longer significant. Prenatal and postnatal maternal distress accounted for 13.7% of the variance in infant socioemotional development. Conclusion Our results call for special means of clinical surveillance in mothers and for innovative (online) interventions aiming to support maternal mental health during pregnancy and after delivery.

Contexte: La pandémie de COVID-19 a été associée à une augmentation de la détresse psychologique chez les femmes enceintes. Le présent article vise à évaluer l’acceptabilité du programme STEP-COVID (Soutenir la Transition et l’Engagement dans la Parentalité dans le contexte de la pandémie de COVID-19), une intervention prénatale de groupe en ligne, en mode synchrone, visant à soutenir le bien-être, la mentalisation et la résilience. Méthode: Vingt et une femmes enceintes québécoises ont participé au programme et ont complété des mesures des symptômes psychologiques et de la mentalisation avant et après l’intervention ainsi qu’une échelle évaluant leur perception de changements sur des domaines associés à la résilience. Après chaque rencontre, elles ont rempli un questionnaire évaluant leur appréciation du programme. Résultats: Les 18 participantes (86 %) ayant complété le programme ont rapporté de hauts taux de satisfaction après chacune des rencontres et au terme de l’intervention. Une diminution des symptômes anxio-dépressifs et des symptômes de stress post-traumatiques et une amélioration des fonctions réflexives sont observées entre le début et la fin du programme. Les participantes ont également rapporté des changements positifs sur des sphères de fonctionnement associées à la résilience. Conclusion: Les résultats soutiennent l’acceptabilité du programme STEP-COVID et suggèrent que l’offre d’une intervention de groupe brève en ligne est appréciée par les participantes, semble favoriser une diminution de la détresse psychologique et une amélioration de la mentalisation et pourrait contribuer à la résilience dans le contexte de la pandémie de COVID-19.

Résumé Contexte : Le programme STEP est une intervention prénatale de groupe destinée aux femmes enceintes ayant vécu des traumatismes interpersonnels au cours de leur enfance tels que la maltraitance. La présente étude vise à décrire l’expérience des participantes de leur participation au programme. Méthodologie : Des entretiens individuels ont été réalisés auprès de 21 participantes ayant complété le programme afin de sonder leur appréciation de l’intervention, l’adéquation entre le contenu et leurs attentes, les points forts et les points faibles, la sensibilité à leur réalité personnelle, familiale et culturelle ainsi que l’importance qu’elles attribuent aux différents thèmes abordés. Résultats : Les participantes se représentent le programme STEP comme une occasion unique d’exploration de soi à titre d’individu et de mère et considèrent que le programme favorise un sentiment subjectif de mieux-être. Trois dimensions ont été identifiées au coeur de cette expérience : (1) le contenu du programme est perçu comme étant sensible, équilibré, concret et progressif, (2) le collectif/entre-mères favorise la socialisation de la maternité, la prise de recul, les échanges et la validation de soi et (3) le cadre d’animation sécurisant est perçu par le biais de la bienveillance de l’équipe d’animation, sa compétence, sa cohésion et la réciprocité dont elle fait preuve dans sa relation avec les participantes. Discussion : Les résultats soutiennent que les femmes enceintes ayant vécu une forme de traumatisme interpersonnel perçoivent que le programme STEP répond à leurs besoins et que ses composantes favorisent une expérience plus profonde et sereine de leur grossesse ainsi qu’une meilleure disposition à accueillir leur enfant. Abstract Background: The STEP program is a prenatal group intervention for pregnant women who experienced childhood interpersonal traumas such as child abuse or neglect. The study aims to document participants’ experience of their participation in the p

This chapter aims to review the current knowledge about the effects of parental cannabis use on parenting behaviors and offspring development and to discuss the covering of the issue of parental cannabis use by mass media and public health organizations. Existing research has generally concluded that parental cannabis use is a significant risk factor for parenting and child development. However, there is still a paucity of empirical studies on this topic, and existing research presents important limitations, restraining our ability to conclude about the dangers of using cannabis when caring for a child. At this point, very little is known about the circumstances under which the use of cannabis is a risk factor for parenting and about the mechanisms through which parental cannabis use influences offspring development. The lack of hard facts addressing these issues allows for mass media to promote opinion-based publications that praise the parental use of cannabis.

Background: Childhood trauma would negatively affect pregnant women's mental health and would have intergenerational repercussions. However, there is a paucity of prenatal interventions specifically designed for women exposed to childhood trauma. The study aims to evaluate the acceptability of STEP, a manualized group intervention designed for pregnant women having experienced early life adversity. Methods: The acceptability of STEP was assessed in four phases. In Phase 1, six experts evaluated whether the program activities were pertinent and trauma sensitive. In Phase 2, three parents read the intervention manuals and evaluated whether they considered each session relevant, interesting, and clear. In Phase 3, the program was briefly presented by phone to 309 pregnant women from the community. Women were inquired about their interest in the program, and the reasons for their lack of interest were assessed. In Phase 4, 30 pregnant women exposed to childhood trauma participated in the program and completed anonymous satisfaction questionnaires after each session. Psychological distress was also measured before and after the program. Results: All activities were rated by independent experts as highly pertinent, adequate, and sufficiently safe to be offered to pregnant women. Parents who read through the intervention manuals also considered that the sessions were relevant, clear, and interesting. About half of the pregnant women from the community showed interest in the program. Participants reported very high levels of satisfaction and a significant decrease in psychological distress during the program. Conclusions: Our findings show a high level of convergence among various indicators of program acceptability.

Background: Recent evidence suggests that offspring of mothers having been exposed to childhood abuse and neglect (CA&N) are at increased risk of developmental problems and that boys are more affected by maternal CA&N than girls. Since impairments in reflective functioning (RF) have been associated with maternal CA&N and offspring development, RF could represent a key mechanism in these intergenerational risk trajectories. Objective: This study evaluated mediating (RF) and moderating (child sex) mechanisms in the association between maternal CA&N and child development. Participants and setting: In a longitudinal setting, 111 mothers completed measures during pregnancy and between 11 and 36 months postpartum. Methods: CA&N and impairments in RF were assessed during pregnancy and offspring development was measured during the longitudinal follow-up using the Ages and Stages Questionnaires (ASQ-3). Child development was operationalized in two ways: using the global score at the ASQ-3 and using a dichotomous score of accumulation of delays across domains of development. Results: Structural equation modeling indicated that RF mediated the association between maternal CA&N and offspring development. Child sex moderated the association between CA&N and the clustering of developmental problems (Wald = 5.88, p = 0.02), with boys being particularly likely to accumulate developmental delays when their mother experienced CA&N (RR = 2.62). Accumulation of developmental problems was associated with impairments in maternal RF in girls and with maternal exposure to CA&N in boys. Conclusions: Results provide novel insights on the role of mentalization and child sex in the association between maternal CA&N and child development. © 2021 The Authors

Background: The way people process trauma and adverse relationships may be more predictive of subsequent adaptation than trauma exposure in itself. However, there is currently no self-report instrument assessing failures in the mentalization of trauma and adverse relationships. Objective: We developed the Failure to Mentalize Trauma Questionnaire (FMTQ) and evaluated its psychometric properties. The FMTQ is a 29-item self-report instrument designed to assess different indications of failures in the mentalization of trauma and adverse relationships. Participants and setting A total of 975 participants (84 % women; 37 % exposed to child maltreatment) were recruited in the course of larger research protocols on parenting. Methods: Participants completed the FMTQ and measures of childhood maltreatment, psychopathology (post-traumatic stress symptoms, dissociative symptoms, level of personality dysfunction), general mentalization and intimate partner violence. Results: Exploratory factor analysis, supported by a confirmatory factor analysis, identified seven factors with good internal consistency that corresponded to different types of failures in the mentalization of trauma and adverse relationships and that loaded on a general factor. A dose-effect association was observed between the severity of childhood maltreatment, and the severity of failures in the mentalization of trauma and adverse relationships (rs = .49, p < .01). The FMTQ total score explained a significant proportion of variance in psychopathology and intimate partner violence, both in participants with histories of childhood maltreatment and participants without childhood maltreatment. Conclusion: The FMTQ is a promising, concise and efficient measure of failures in the mentalization of trauma and adverse relationships that may facilitate clinical screening and research with adults who experienced trauma.

Among at-risk groups for psychological distress in the context of the Coronavirus Disease 2019 (COVID-19) pandemic, pregnant women might be especially vulnerable. Identifying subgroups of pregnant women at high risk of poor adaptation might optimize clinical screening and intervention, which could, in turn, contribute to mitigating the potentially devastating effects of prenatal stress on mothers and fetus. Level of personality functioning may be a good indicator of who may be more vulnerable to distress in challenging periods like the COVID-19 pandemic, as adults with high levels of personality dysfunction may experience significant difficulties in mentalizing threatening situations. The aims of the present study are (a) to determine the impact of level of personality pathology on affective, behavioral, and thought problems in pregnant women during the COVID-19 pandemic; and (b) to test a model where mentalization of trauma mediates the impact of personality pathology on symptomatology. Data from 1,207 French-Canadian pregnant women recruited through social media during the COVID-19 pandemic were analyzed. Latent profile analysis, using the Criterion A elements of the alternative model for personality disorders (Identity, Self-Direction, Empathy, Intimacy) as latent indicators, yielded four profiles: Healthy, Mild Self-Impairment, Intimacy Impairment, and Personality Disorder. Profiles showed significant associations with diverse indicators of symptomatology. Mediation models showed both direct and indirect (through mentalization of trauma) significant associations between level of personality functioning and affective/behavioral/thought problems. Results have clinical implications on prophylactic measures for at-risk pregnant women, especially in challenging contexts such as the COVID-19 pandemic.

Background: The 11th version of the World Health Organization's International Classification of Diseases (ICD-11) has adopted a dimensional approach to personality disorder (PD) nosology. Notably, it includes an assessment of PD degree of severity, which can be classified according to five categories. To date, there is no gold standard measure for assessing degree of PD severity based on the ICD-11 model, and there are no empirically-based anchor points to delineate the proposed categories. With the operationalization of PD degrees of severity in the ICD-11 PD model now being closely aligned with Criterion A of the DSM-5 Alternative Model for Personality Disorders (AMPD), sharing a focus on self and interpersonal dysfunction, self-report instruments developed for the latter model might prove useful as screening tools to determine degrees of severity in the former.Methods: The Self and Interpersonal Functioning Scale, a brief validated self-report questionnaire originally designed to assess level of personality pathology according to the AMPD framework, was used to derive anchor points to delineate the five severity degrees from the ICD-11 PD model. Data from five clinical and non-clinical samples (total N = 2,240) allowed identifying anchor points for classification, based on Receiver Operating Characteristic curve analysis, Latent Class Analysis, and data distribution statistics. Categories were validated using multiple indices pertaining to externalizing and internalizing symptoms relevant to PD.Results: Analyses yielded the following anchor points for PD degrees of severity: No PD = 0–1.04; Personality Difficulty = 1.05–1.29; Mild PD = 1.30–1.89; Moderate PD = 1.90–2.49; and Severe PD = 2.50 and above. A clear gradient of severity across the five categories was observed in all samples. A high number of significant contrasts among PD categories were also observed on external variables, consistent with the ICD-11 PD degree of severity operationalization.Conclusions

The damaging consequences of child abuse and neglect for child development and psychiatric disorders have been known for decades. However, there would be a relative paucity of translational research on childhood maltreatment in comparison to the numerous correlational studies in the field. To assess the extent to which previous research on childhood maltreatment addressed intervention, we reviewed all articles on child abuse and neglect published in 2016 and evaluated the main objective of each study. References were identified through PsycINFO (ƙ = 2139) and Medline (ƙ = 2955). Of the 3792 studies retained after removal of overlapping references, 1157 met inclusion criteria. The main objective of each study was coded according to one of the following categories: Consequences, Mechanisms, Intervention, Prevention and Others. The review showed that half of the studies (ƙ = 572; 50%) described the damaging consequences of child abuse and neglect. A mere 19% of the studies (ƙ = 225) aimed to identify mediators or moderators of the association between childhood maltreatment and outcome. Only 6% (ƙ = 66) of studies reported on treatments and 2% (ƙ = 29) on preventive interventions. The remaining articles (23%, ƙ = 265) focused on other topics, such as the assessment of childhood trauma (ƙ = 33), epidemiology (ƙ = 118) and legal or organizational issues (ƙ = 114). Our results revealed an unquestionable paucity of research published on interventions and a relatively scarce number of mechanistic studies that nonetheless may provide meaningful practical orientations for clinical practice and future research.