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

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

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

The Adult Attachment Interview (AAI) is a widely used measure in developmental science that assesses adults' current states of mind regarding early attachment-related experiences with their primary caregivers. The standard system for coding the AAI recommends classifying individuals categorically as having an autonomous, dismissing, preoccupied, or unresolved attachment state of mind. However, previous factor and taxometric analyses suggest that: (a) adults' attachment states of mind are captured by two weakly correlated factors reflecting adults' dismissing and preoccupied states of mind and (b) individual differences on these factors are continuously rather than categorically distributed. The current study revisited these suggestions about the latent structure of AAI scales by leveraging individual participant data from 40 studies (N = 3,218), with a particular focus on the controversial observation from prior factor analytic work that indicators of preoccupied states of mind and indicators of unresolved states of mind about loss and trauma loaded on a common factor. Confirmatory factor analyses indicated that: (a) a 2-factor model with weakly correlated dismissing and preoccupied factors and (b) a 3-factor model that further distinguished unresolved from preoccupied states of mind were both compatible with the data. The preoccupied and unresolved factors in the 3-factor model were highly correlated. Taxometric analyses suggested that individual differences in dismissing, preoccupied, and unresolved states of mind were more consistent with a continuous than a categorical model. The importance of additional tests of predictive validity of the various models is emphasized.

This article presents a strategy for the initial step of data harmonization in Individual Participant Data syntheses, i.e., making decisions as to which measures operationalize the constructs of interest - and which do not. This step is vital in the process of data harmonization, because a study can only be as good as its measures. If the construct validity of the measures is in question, study results are questionable as well. Our proposed strategy for data harmonization consists of three steps. First, a unitary construct is defined based on the existing literature, preferably on the theoretical framework surrounding the construct. Second, the various instruments used to measure the construct are evaluated as operationalizations of this construct, and retained or excluded based on this evaluation. Third, the scores of the included measures are recoded on the same metric. We illustrate the use of this method with three example constructs focal to the Collaboration on Attachment Transmission Synthesis (CATS) study: parental sensitivity, child temperament, and social support. This process description may aid researchers in their data pooling studies, filling a gap in the literature on the first step of data harmonization. • Data harmonization in studies using combined datasets is of vital importance for the validity of the study results. • We have developed and illustrated a strategy on how to define a unitary construct and evaluate whether instruments are operationalizations of this construct as the initial step in the harmonization process. • This strategy is a transferable and reproducible method to apply to the data harmonization process.

The study evaluated the relationship between maternal anxiety, depression and parenting stress, and maternal mind-mindedness, styles of interaction, and mother–infant emotion regulation. At infant age 3 months, EPDS, STAI, and PSI-SF were administered to 73 mothers to respectively assess depression, anxiety, and parenting stress; mother–infant interaction was coded with the mind-mindedness coding system, the CARE-Index and the Infant Caregiver Engagement Phases (ICEP). Results showed that maternal anxiety had a positive correlation with non-attuned mind-related comments, with mother’s controlling style, and with infant negative and mother negative emotional states. Maternal depression had a positive correlation with mother’s controlling style and with mother–infant dyadic negative emotion regulation. Parenting stress was associated with mother–infant emotion mismatches. To sum up, anxiety was the maternal mental health risk condition that had the greatest effect on the considered dimensions of parenting. Mind-mindedness was shown to be related to mother–infant emotion regulation, but not to sensitive style.

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

BACKGROUND: Maternal-fetal attachment (MFA) is the emotional bond between a mother and her fetus and is influenced by numerous risk and protective factors during pregnancy. However, according to the literature, the results relating to the influence of these factors are mixed. METHOD: The aim of the study is to identify the relationship between MFA and maternal distress, evaluated as maternal depression and anxiety, alexithymia, and perceived social support during the prenatal period in an Italian community sample. Ninety-four pregnant women completed self-report questionnaires. RESULTS: Results showed that total MFA was negatively associated with maternal anxiety and alexithymia and was positively associated with social support. Moreover, maternal depression was negatively associated with the quality subscale of MFA The quality subscale of MFA was negatively associated with maternal state and trait anxiety and alexithymia and was positively associated with social support. The intensity subscale of MFA was positively associated with social support. Multiple regression showed that alexithymia and social support predicted MFA with a higher effect than maternal depression and anxiety. CONCLUSIONS: The results are useful for planning interventions aimed at supporting the mother-infant bond starting from pregnancy.

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

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

The paper is an Italian contribution to the scientific dialogue between psychoanalysis and research. The 3LM constitutes a model of intervision, whose strength lies in favouring the multiplicity of participants’ experiences and enhancing the plurality of viewpoints. The 3LM studies the clinical material by subjecting it to scrutiny by several group members and at another level carries out work on the analysts’ minds in the clinic and the way theoretical concepts are implemented. The groups help to create a climate and experience aimed at learning, discussing the clinical case and working together. An evaluation form is presented in the paper to assess changes in the patient’s functioning and relationship with the therapist. The results of its use showed significant changes.

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

The pandemic situation caused by Covid-19 has led to changes in the clinical practice of hospital services, including Infant Neuropsychiatry. During the lockdown period the services had to use new intervention strategies, particularly telemedicine to meet the needs of children, teenagers and parents. The online therapy is a useful tool during situations of serious crises such as a global pandemic but like any mode of intervention have strengths and limits. Therefore, the article reports the positive and critical aspects of telemedicine and describes some work experiences in the specialist services of Infant Neuropsychiatry at the ASST Santi Paolo e Carlo in Milan.

Eighty-one adolescent and young mother–infant dyads have been divided into two groups with/without traumatic experiences in maternal history to examine the effect of maternal traumatic experiences on the quality of mother–infant relationship. At infant 3 months, mother–infant interaction was video-recorded. Results showed that adolescent and young mothers with traumatic experiences (vs. adolescent and young mothers without traumatic experiences) had less sensitive and more violent and intrusive behaviours. Infants with mothers with traumatic experiences (vs. infants with mothers without traumatic experiences) had more aggressive and reactive behaviours. Furthermore, maternal cumulative traumatic experiences predicted more negative behaviours. Findings indicated that maternal childhood traumatic experiences increased an adolescent mother’s risk for maternal–child interaction problems, worsened the high-risk condition inherent in motherhood in adolescence. Understanding the effect of adolescent mother’s traumatic experiences has important implications for promoting early intervention in the treatment of trauma and supporting the mother–child relationship.

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

Witnessing domestic violence may have serious negative consequences for the health, development and well-being of children. Only recently, witnessing domestic violence has been evaluated as a form of child maltreatment, considering the effects it may have within the family. Domestic violence is a complex and lasting experience that often results in interruptions, losses and challenges for the meaningful relationships of children. Children have very often feelings of fear, worry, guilt, helplessness and sadness and adopt strategies to deal with such traumatic situations. Moreover, children exposed to domestic violence have a high risk of having delays in cognitive, psychic, emotional and physical development with school and social interaction difficulties, internalising and externalising problems, learning disorders, aggressive behaviour and post-traumatic symptoms. Therefore, it is critical to early identify the signals that children show to help them and their family get out of the violent and abusive environment.

The study examined the effectiveness of PRERAYMI (Promoting Responsiveness Emotion Regulation and Attachment in Young Mothers and Infants) attachment-based intervention programme aimed at adolescent mother-infant dyads. The intervention used video-feedback and developmental guidance to promote maternal mind-mindedness and sensitivity. 32 adolescent mother-infant dyads in the intervention group were compared to 12 adolescent mother-infant dyads in the control group. Maternal mind-mindedness and maternal/infant styles of interaction were evaluated, at the pre-treatment (infant 3 months) and at the post-treatment (infant 9 months). The results indicated the effectiveness of the intervention in enhancing mind-mindedness, with more mind-related comments and fewer non-attuned mind-related comments, maternal sensitivity and infant cooperative behaviour, and in reducing maternal controlling behaviour, in the intervention group. Changes in mother/infant interaction styles or in mind-mindedness in the control group were not detected. The attachment based medium term intervention helped to improve adolescent mother-infant relationship, which is otherwise potentially at risk.

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

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

Adolescent motherhood is a turning point in the life of the young mother, entailing potentially positive reorganization of her developmental trajectories. Very often, however, it is weighed down by cumulative risk factors which make her relationship with the infant difficult, with short- and long-term effects on the development of the infant and on the wellbeing of the mother. In fact, early motherhood is frequently associated with several risk factors both during pregnancy and post-partum, as socio-economic disadvantage, low levels of education, lack of social support, unstable relationships with the partner, being a single parent, and living with a multi-problematic family. Adolescent mothers are also more likely than adult mothers to have insecure attachment models and to have experienced physical, sexual, and emotional abuse. Moreover, in the perinatal period, adolescent mothers often suffer from mental health issues such as depression, anxiety, and parenting stress. With regard to the relationship with their infants, adolescent mothers have difficulty understanding the needs of their infants, often adopting intrusive and neglecting behavior with harsh parenting. In turn children of adolescent mothers are at risk for insecure and disorganized attachment, for suffering maltreatment by mothers, and for having psychopathological problems. We present an attachment-based intervention program (PRERAYMI, Promoting Responsiveness, Emotion Regulation, and Attachment in Young Mothers and Infants) to support adolescent mothers from pregnancy up to 2 years of the children, involving, when present, the father. It is based on the video feedback technique, psychological counselling, and developmental guidance with the aim to improve maternal sensitivity and mentalization and child secure attachment to the mother and to prevent psychopathological problems of the mother and the child.

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