- Email: [email protected]
Reflective function in first-time mothers and fathers: Association with infant temperament and parenting stress
Journal Pre-proof REFLECTIVE FUNCTION IN FIRST-TIME MOTHERS AND FATHERS: ASSOCIATION WITH INFANT TEMPERAMENT AND PARENTING STRESS Laura Vismara PH.D Cristina Sechi PH.D Loredana Lucarelli PSY.D
PII:
S2468-7499(20)30016-8
DOI:
https://doi.org/doi:10.1016/j.ejtd.2020.100147
Reference:
EJTD 100147
To appear in:
European Journal of Trauma & Dissociation
Received Date:
30 July 2019
Revised Date:
29 January 2020
Accepted Date:
29 January 2020
Please cite this article as: Vismara L, Sechi C, Lucarelli L, REFLECTIVE FUNCTION IN FIRST-TIME MOTHERS AND FATHERS: ASSOCIATION WITH INFANT TEMPERAMENT AND PARENTING STRESS, European Journal of Trauma and Dissociation (2020), doi: https://doi.org/10.1016/j.ejtd.2020.100147
This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. © 2020 Published by Elsevier.
REFLECTIVE FUNCTION IN FIRST-TIME MOTHERS AND FATHERS: ASSOCIATION WITH INFANT TEMPERAMENT AND PARENTING STRESS Laura Vismara, PH.D., Department of Education, Psychology, Philosophy, Faculty of Human Studies, University of Cagliari, Italy. [email protected] Cristina Sechi, PH.D., Department of Education, Psychology, Philosophy, Faculty of Human Studies, University of Cagliari, Italy. [email protected] Loredana Lucarelli, PSY.D., Department of Education, Psychology, Philosophy, Faculty of Human Studies, University of Cagliari, Italy. [email protected]
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Correspondence to: Laura Vismara,
Department of Education, Psychology, Philosophy, University of Cagliari
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Via Is Mirrionis, 1 – 09123 Cagliari ITALY Phone number: +390706757503
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e-mail: [email protected]
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REFLECTIVE FUNCTION IN FIRST-TIME MOTHERS AND FATHERS: ASSOCIATION WITH INFANT TEMPERAMENT AND PARENTING STRESS Abstract
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Objective: Infant temperament is biologically determined. However, there is increasing proof that environmental factors may also have a relevant influence. The present study focuses on the role of parental reflective function (RF; Fonagy et al., 1998), that is, the psychological basis of emotion regulation. Methods: RF was assessed in 40 low-risk first-time parents during the seventh month of pregnancy, using the Adult Attachment Interview (AAI; Main, Goldwyn, Hesse, 1984-2002). At the baby’s sixth month, parents responded to the Infant Behavior Questionnaire–Revised (Gartstein & Rothbart, 2003), aimed to evaluate the child’s perceived temperament and the Parenting Stress Index–SF (Abidin, 2006). Parents’ depression was measured with the Edinburgh Postnatal Depression Scale (EPDS; Benvenuti et al., 1999). Results: No difference was found between mothers and fathers regarding RF and depression scores. Selfreported depression was associated with lower scores of RF. Lower RF during pregnancy was associated with higher child dysfunctional interaction in both mothers and fathers. Also, lower maternal RF was associated with higher perceived infant sadness whereas lower paternal RF was associated with higher infant negative affectivity. Conclusions: Early parenting programs should enhance maternal and paternal reflective functioning to promote sensitive caregiving behaviors and support the child’s development. Keywords: Parental reflective function; perinatal depression; perinatal anxiety; infant temperament; parenting stress; gender differences
Introduction Mental representations
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During pregnancy, new dimensions of the self may arise, and significant modifications of mental representations may occur; in such a perspective, a revision of internal working models of early attachment experiences may also take place. Internal working models shape cognition, memory, attention, and affect; therefore, they affect emotional and behavioral regulation (Hesse, 2008; Zimmermann, 1999). In the perinatal period, parents develop representations about themselves as parents and about their child. The content and structure of these representations may indicate adaptation to pregnancy and the future parental role (Vreeswijk, Maas, & van Bakel, 2012). Indeed, balanced and coherent perceptions of caregiving, of the child, and of the relationship with the child are associated with the quality of mother-child interactions and parental sensitivity, warmth, intrusiveness,
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negativity, and hostility (Dayton, Levendosky, Davidson, & Bogat, 2010; Rosenblum, McDonough, Sameroff, & Muzik, 2008; Vreeswijk, Maas, & van Bakel, 2012).
In particular, more flexible and open representations attuned to both the child’s positive and
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negative characteristics and developmental trajectories acknowledging their attachment and affective needs have been associated with greater caregiving sensitivity (Bretherton & Munholland, 2008). Moreover, several data support a continuity between pre- and postnatal parental
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representations and the child’s development and functioning (Ammaniti, Candelori, Pola, Tambelli,
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1995; Ammaniti, Tambelli, Odorisio, D’Isidori, Vismara, & Mancone 2002; Ammaniti, Speranza, Tambelli, Muscetta, Lucarelli, Vismara, L.,... & Cimino, 2006; Bowlby, 1988; Hart & McMahon, 2006; Madigan, Moran, Schuengel, Pederson, & Otten, 2007; Lyons-Ruth et al., 1992; Lyons-Ruth
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& Block, 1996, Lyons-Ruth, Bronfman, & Parsons, 1999; Lyons-Ruth, Dutra, Schuder, & Bianchi, 2006; Olds, 2006; Porter & Hsu, 2003; Slade, Belsky, Aber, & Phelps, 1999; Van Jitender et al., 1999). Mentalization and reflective functioning seem to play a crucial role in such transmission. Mentalization and reflective functioning
Parental mentalization is defined as the caregiver's ability to understand the child’s behavior in terms of mental states (feelings, desires, beliefs, and intentions), differentiating the other’s psychological characteristics from one’s own (Suchman, DeCoste, Leigh, & Borelli, 2010). This ability is one of the most relevant components of the caregiving system, which allows flexible and efficacious emotion regulation developed from interactional exchanges (Fonagy, Target, Steele, Steele, 1998; Slade, 2005). Thus, a lack of this ability is revealed by more caregiving negativity, controlling behavior, and intrusiveness (Grienenberger, Kelly, & Slade, 2005; Huth-Bocks, Muzik, Beeghly, Earls, & Stacks, 2014; Slade, Grienenberger, Bernbach, Levy, & Locker, 2005; Stacks, Muzik, Wong, Beeghly, Huth-Bocks, Irwin, & Rosenblum, 2014), may heighten the infant’s levels of arousal, leading to increased stress reactivity and higher vulnerability to developing emotionalbehavioral problems (Bowlby, 1988; Dollberg, Feldman, & Keren, 2010; Ha, Sharp, & Goodyer, Page 2 of 18
2011; Main & Goldwyn, 1984; Sharp & Fonagy, 2008; Smaling, Huijbregts, Suurland, van der Heijden, Mesman, van Goozen, & Swaab, 2016). Although maternal mentalization and parenting behavior are crucial in promoting the infant’s regulation of state, it is important to consider that the infant’s regulatory system is essentially dyadic, involving both the infant and the mother. Emotion regulation and infant temperament Emotion regulation may be defined as the “extrinsic and intrinsic processes for monitoring, facilitating, and inhibiting heightened levels of positive and negative affect” (Buss & Goldsmith, 1998, p. 359), a core feature of temperament. Within a transactional model, infant temperament may affect the caregiver-child relationship (Thomas, Chess, Birch, Hertzig, & Korn, 1963; Sroufe,
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1985). Temperament can be considered as the biological predisposition of an individual to respond in terms of affect, attention, motor function, and sensory sensitivity to contextual stimuli (Thomas & Chess, 1977; Zentner & Bates, 2008), that is, the ability to self-regulate (Putnam, Rothbart, &
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Gartstein, 2008).
A difficult temperament, that is, negative affectivity and reactivity (Bates, 1980; Calkins,
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Fox, & Marshall, 1996; Goldsmith & Alansky, 1987; Kagan & Snidman, 1991; Prior, 1992), has been correlated with higher susceptibility to later psychopathology (Clark, 2005; Riese, 1988).
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In addition, mothers who experience perinatal anxiety and depression tend to perceive their infants as fussier, slower to adapt to novelty, and more difficult compared to helathy mothers (Austin, Hadzi-Pavlovic, Leader, Saint, & Parker, 2005; Blair, Glynn, Sandman, Sandman, & Davis, 2011;
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Buitelaar, Huizink, Mulder, de Medina, & Visser, 2003; Henrichs, Schenk, Schmidt, Velders, Hofman, Jaddoe,... & Tiemeier, 2009). In turn, perinatal depressive symptoms are associated with negative parental representations, poor coping strategies, and low caregiving self-efficacy (Ahlqvist‐Björkroth, Korja, Junttila, Savonlahti, Pajulo, Räihä,... & Aromaa, 2016; Austin, HadziPavlovi, Leader, Saint, Parker, 2005; Dunbar, McKee, Rakow, Watson, Forehand, & Compas, 2013; Surkan, Kawachi, Ryan, Berkman, Carvalho Vieira, & Peterson, 2008). Study aims Based on the above empirical and clinical evidence, the present longitudinal study had the following aims:
To evaluate RF, depressive symptoms, parenting stress, and infants’ temperament in first-time parents;
To evaluate possible differences between mothers and fathers;
To evaluate the association between RF assessed during pregnancy, and other variables measured at the infant’s sixth month.
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This study was part of a larger, ongoing longitudinal study on maternal and paternal depression in first-time parents and the development of their children’s affective regulation. In this paper, we present data concerning parents who were evaluated during the seventh month of pregnancy (Time 1) and six months after the child’s birth (Time 2).
Material and Methods Participants The study participants comprised 80 parents (40 couples) and their healthy babies (55.8% boys, 44.2% girls). Of these participants, 78% were married couples and 22% were cohabiting; 21% of the mothers and 40% of the fathers had a high-school qualification, 60% of the mothers and 34% of the
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fathers a college degree, and 16% of the mothers and 18% of the fathers had a PhD. Mothers’ mean age was 32.7 years (SD = 4.2 years), and fathers’ mean age was 36.8 years (SD = 5.4). The median income of the parents belonged to the Italian middle working class and socio-economic status, as
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assessed by a detailed questionnaire and using the Istituto Nazionale di Statistica (ISTAT) classification (2013). No participant was undergoing medical or psychological treatment at the time
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of assessment. Procedure
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The research project obtained approval from the hospital and university ethics committees. All participants signed a written informed consent form. At Time 1, data were collected during pregnancy, while at Time 2, data were collected approximately six months after birth. Parents who
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met the selection criteria and agreed to participate independently completed a demographics questionnaire, the Edinburgh Postnatal Depression Scale (EPDS), and the State-Trait Anxiety Inventory (STAI) at home, and a demographics questionnaire, the EPDS, and the STAI at Time 1. These measures were repeated at Time 2 when the parents also completed the Parenting Stress Index-Short Form (PSI-SF) and reported their infant’s temperament using the Infant Behaviour Questionnaire (IBQ). Also, at Time 1, the Adult Attachment Interview (AAI) was administered to mothers and fathers at the University Laboratory. This research was supported by grants from PRIN 2013/2016 - 20107JZAF4 Italian Ministry for Education, University and Research. Measures The AAI (Main, Goldwyn, & Hesse, 1984-2002) is a semi-structured, audiotaped interview that investigates general descriptions of relationships with the main attachment figures in childhood, specific supportive or contradicting memories, and descriptions of current relationships with their parents. Adults were asked to retrieve attachment-related autobiographical memories from early childhood and evaluate these memories and their effects from their current perspective so that the Page 4 of 18
structural dimension of the transcript is coded rather than its content. The coding system, developed by Main and Goldwyn (1984), allows the classification of adults into one of five categories for overall state of mind with respect to attachment: Secure, freely valuing of attachment (F); Dismissing attachment relationships (Ds); Preoccupied with attachment relationships (E); Unresolved with respect to past loss or trauma (U); or Cannot classify (CC). Interrater reliability for the main category was 89% (k=0.74, p= 0.001) The Reflective Function Scale (RFS; Fonagy, Target, Steele, & Steele, 1998) is applied to the AAI to assess parents’ capacity to understand mental states to evaluate the capacity to understand one’s own and others’ mental states with respect to childhood attachment experiences. RFS was initially applied to the AAI transcripts in which some questions were defined as “demand
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questions” because they explicitly triggered mentalization (e.g., “Why did your parents behave as they did during your childhood?, Do you think your childhood experiences have an influence on who you are today?”), whereas other queries were described as “permit questions” because they did
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not necessarily stimulate reflective functioning (e.g., What did you do when you were upset as a child?). An overall score was assigned, from -1 (Negative RF, i.e., rejected, bizarre, unintegrated or inappropriate RF) to 9 (exceptional RF) based on the four following dimensions: “Awareness of the
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nature of mental states,” “The explicit effort to tease out mental states underlying behavior,” interviewer.”
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“Recognizing developmental aspects of mental states,” and “Mental states in your relation to the
The EPDS (Cox, Holden, & Sagovsky, 1987) is a self-report questionnaire with ten items
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addressing depression symptoms occurring within the previous seven days. The total score is calculated by adding the individual items on a 4-point Likert scale. There were two adopted cut-off scores: 8/9, as suggested in the EPDS Italian validation (Benvenuti Ferrara, Niccolai, Valoriani, 1999), and 12/13, as suggested by Cox et al. (1987) to identify more severe depression. The PSI-SF (Abidin, 1995 Guarino, Di Blasio, D’Alessio, Camisasca, & Serantoni, 2008) is a self-report instrument that measures stress specifically associated with parenting. The PSI-SF consists of 36 statements referring to the past week. All items are rated on a 5-point scale. Parents who obtain a total stress score above the 90th percentile, or a raw score of 90, are considered to experience clinically significant parenting stress, as indicated by the Italian validation (Guarino, Di Blasio, D’Alessio, Camisasca, & Serantoni., 2008). The total stress score is a composite score of the subscale scores: parental distress, parent-child dysfunctional interaction, and difficult child. The IBQ-Revised (Garstein & Rothbart, 2003) is a parent report questionnaire aimed to measure temperament in infants between the ages of 3 and 12 months. The IBQ-Revised is composed of 191 items that yield scores on 14 scales. Scales cluster into three overarching factor scores:
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Orienting/Regulatory Capacity, Surgency/Extraversion, and Negative Affectivity. The 14 scales are as follows:
Activity Level: Movement of arms and legs, squirming, and locomotor activity
Distress to Limitations: Baby’s fussing, crying, or showing distress while a) in a confining place or position; b) involved in caretaking activities; c) unable to perform the desired action
Approach: Rapid approach, excitement, and positive anticipation of pleasurable activities
Fear: The baby’s startle or distress due to sudden changes in stimulation, novel physical objects or social stimuli; inhibited approach to novelty
Duration of Orienting: The baby’s attention to and/or interaction with a single object for
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extended periods of time Smiling and Laughter: Smiling or laughter from the child in general caretaking and play situations
Vocal Reactivity: Amount of vocalization exhibited by the baby in daily activities
Sadness: General low mood; lowered mood and activity specifically related to personal
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suffering, physical state, object loss, or inability to perform the desired action Perceptual Sensitivity: Amount of detection of slight, low intensity stimuli from the external
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environment
High Intensity Pleasure: Amount of pleasure or enjoyment related to high stimulus intensity,
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rate, complexity, novelty, and incongruity
Low Intensity Pleasure: Amount of pleasure or enjoyment related to situations involving
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low stimulus intensity, rate, complexity, novelty, and incongruity
Cuddliness: The baby’s expression of enjoyment and molding of the body to being held by a caregiver
Soothability: Baby’s reduction of fussing, crying, or distress when the caretaker uses soothing techniques
Falling Reactivity/Rate of Recovery from Distress: Rate of recovery from peak distress, excitement, or general arousal; ease of falling asleep Results
Comparison between mothers and fathers A paired sample t-test showed significant differences between Parental Distress scores for mothers and fathers in the couple (t = 2.33; p <0.05). Fathers reported significantly more psychological distress than their partners (Table 1). This result may be explained by the fact that fathers are dealing actively with their infants for the first time when the PSI is administered, whereas mothers have had time to
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practice as a caregiver and to develop their understanding of their child’s characteristics. There was no significant difference between maternal and paternal IBQ-R scores. Association between maternal RF and other studied variables The Pearson correlation coefficients between RF, EPDS, PSI, and IBQ-R mother scores at Time 1 and Time 2 are reported in Table 2. Lower RF scores are associated with higher self-reported depressive symptoms, with a higher dysfunctional parent-child interaction, and with a sadder tempered child. Table 2 Bivariate correlations among RF, EPDS, PSI and IBQ-R scores for mothers
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LOW PLEASURE CUDDLINESS DURATION OF ORIENTING SOOTHABILITY
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APPROACH VOCAL REACTIVITY HIGH PLEASURE SMILE AND LAUGHTER ACTIVITY LEVEL PERCEPTUAL SENSITIVITY SADNESS DISTRESS TO LIMITATIONS FEAR FALLING REACTIVITY
RF -.49 * -.41* -.337 -.542** -.170 -.371 .233 .029 -.039 -.163 -.322 .061 -.394* .180 -.189 .363 -.044 .205 .147 .294
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Mothers scores EPDS Time 1 EPDS Time 2 PD P-CDI DC Total Stress
Association between paternal RF and other studied variables The Pearson correlation coefficients between RF, EPDS, PSI, and IBQ-R father scores at Time 1 and Time 2 are reported in Table 3. Lower RF scores are associated with higher self-reported depressive symptoms, higher dysfunctional parent-child interactions, and higher total parenting stress; also, they perceive their child as less cuddlable and more highly reactive.
Discussion and Conclusions The birth of a child represents an unpredictable experience that is associated with a woman’s higher vulnerability to develop affective disorders, primarily perinatal anxiety and depression (Apter, Page 7 of 18
Devouche, & Gratier, 2011; Austin, Priest, & Sullivan, 2008; Barker, Jaffee, Uher, & Maughan, 2011; Feldman, Granat, Pariente, Kanety, Kuint, & Gilboa-Schechtman, 2009; Goodman, Rouse, Connell, Broth, Hall, & Heyward, 2011; McGrath, Records, Rice, 2008). Children who have experienced prenatal maternal psychological problems appear to be at increased risk of difficult temperament in their first years of life (Austin, Hadzi-Pavlovic, Leader, Saint, & Parker, 2005; Huizink et al. 2002; Davis, Glynn, Schetter, Hobel, Chicz-Demet, & Sandman, 2007; Davis, Snidman, Wadhwa, Glynn, Schetter, & Sandman, 2004; Feldman, Granat, Pariente, Kanety, Kuint, & Gilboa-Schechtman, 2009; Rouse & Goodman, 2014). However, to understand fully the long-term impact of prenatal adversities (Van den Bergh & Marcoen, 2004; Otte, Donkers, Braeken, & Van den Bergh, 2015; Buss, Davis, Muftuler, Head, &
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Sandman, 2010), it is important to consider the intervention of postnatal factors (Bergman, Sarkar, Glover, & O’Connor, 2008). Moreover, the role of fathers and the infant itself must be included. Accordingly, our study aims to identify pre- and postnatal maternal and paternal risk factors that may contribute to the infant’s perceived negative temperament and the caregivers’ parental stress.
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Our study specifically focuses on mothers’ and fathers’ RF as a protective factor for both parents
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and children in the context of self-reported depressive symptoms.
Parental mentalization consists in being genuinely curious and trying to acknowledge and
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interpret the state of mind of the child: “a meeting of minds” (Sharp & Fonagy, 2008). Our data showed that lower RF scores were associated with both higher depression symptoms and parenting stress both in mothers and fathers. Several studies have shown that maternal RF is important in
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contributing to early child temperament and externalizing behavior (Sharp & Fonagy, 2008; Moffitt & Caspi, 2001; Slade, 2005; Smaling, Huijbregts, Suurland, van der Heijden, Mesman, van Goozen, & Swaab, 2016; Smaling, Huijbregts, Suurland, Van Der Heijden, Van Goozen, & Swaab, 2015;). Moreover, mothers with depression are less likely to refer to their child’s mental states and emotional and cognitive experiences (Herrera, Reissland, Shepherd, 2004; Murray, Kempton, Woolgar, & Hooper, 1993; Pawlby, Fernyhough, Meins, Pariante, Seneviratne, & Bentall 2010; Sethna, Murray, & Ramchandani, 2012). However, little is known concerning fathers, whose role is becoming increasingly important among families. In our study, no difference emerged between mothers and fathers concerning RF scores in the context of depression. Evidence suggests that approximately 5–10% of fathers experience depression in the postnatal period (Paulson & Bazemore, 2010). The disorder is associated with both parenting difficulties (Davis, Davis, Freed, Clark, 2011; Arnott & Meins, 2007; Wilson & Durbin, 2010; Lundy, 2003) and an increased risk of behavioral and emotional problems in their children (LaBounty, Wellman, Olson, Lagattuta, & Liu, 2008; Ramchandani, Stein, O’Connor, Heron, Murray. & Evans, 2008; Paulson, Keefe, & Leiferman, 2009). Page 8 of 18
Nevertheless, differences emerged regarding the child’s perceived temperament. Mothers with low RF perceived their child as sadder, whereas fathers perceived their child as more negatively reactive in terms of their level of cuddliness and high intensity pleasure. This difference is worthy of attention. Mothers should be helped in differentiating the self from their infant in order to enhance the acknowledgment of their child’s peculiarities; mothers should also be supported in promoting curiosity toward their child and the child’s autonomy; fathers would seem to benefit by enhancing their sense of self-efficacy in their caregiving role; feeling efficacious should promote more monitoring and responsiveness, increasing the likelihood for their infants’ self-soothing and self-regulation processes.
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Limitations
Our results call for caution despite their relevance. The small size of the sample limits the generalizability of our findings. Indeed, no statistical causal analyses could be carried out; therefore, no direct, nor mediated effect of the involved variables may be asserted. As well, the use of self-
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reports—which rely on a subject’s personal views of themselves and of his or her infant—does not
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allow to give a complete and clinically informed interpretation of our findings. Moreover, different maternal and paternal RF components (self versus other) should be considered to verify its differential
Conclusion
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impact on child temperament and parental mental health.
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Our findings should be evaluated with the previously mentioned limitations in mind; however, our results illustrate that interventions should target reflective functioning in the parents, that is, the parents’ understanding of their child’s mental states and how these mental states impact behavior, cognition, and emotions. Such early parenting programs would support parents and their infants and prevent the development of problems later in life.
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Table 1 Distribution of outcomes by mother and father couples Time 1
Fathers
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Mothers
Time 2 p Value
Mothers
Fathers
p Value
Mean score (SD)
Mean score (SD)
Mean score (SD)
RF
4.5 (.7)
4.2(.8)
.21
__
__
__
EPDS Time 2
4.3(3.1)
4.2(3.2)
.95
4.5 (3.0)
3.3 (3.3)
.10
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Mean score (SD)
PSI PD
__
__
__
18.7(6.4)
21.9 (7.1)
.03
P-CDI
__
__
__
14.6 (3.6)
15.6 (3.1)
.25
DC
__
__
__
17.7 (5.1)
18.8 (4.5)
.30
Total Stress
__
__
__
51(13.5)
56.3 (12.6)
.06
APPROACH
__
__
__
5.2 (.6)
5.1 (.7)
.13
VOCAL REACTIVITY
__
__
__
5.1 (.9)
4.7 (1.0)
.06
HIGH PLEASURE
__
__
__
5.8 (.6)
5.6 (.9)
.08
SMILE AND LAUGHTER
__
__
__
4.9 (.8)
4.6 (.8)
.07
ACTIVITY LEVEL
__
__
__
4.3 (1.1)
3.9 (1.0)
.12
PERCEPTUAL SENSITIVITY
__
__
__
3.9 (1.2)
3.7 (1.2)
.32
SADNESS
__
__
__
3.2 (1.1)
3.1 (1.1)
.63
DISTRESS TO LIMITATIONS
__
__
__
3.3 (.8)
3.4 (.9)
.75
FEAR
__
__
__
2.2 (.8)
2.3 (.9)
.39
FALLING REACTIVITY
__
__
__
4.9 (1.1)
4.8(.7)
.76
LOW PLEASURE
__
__
__
5.2 (.9)
4.9 (1.1)
.17
CUDDLINESS
__
__
__
5.8 (.8)
5.6 (.7)
.56
IBQ-R
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DURATION OF ORIENTING
__
__
__
3.8 (1.0)
4.0 (1.3)
.35
SOOTHABILITY
__
__
__
4.9 1.1
4.9 (.6)
.99
Table 3 Bivariate Correlations among RF, EPDS, PSI and IBQ-R scores for fathers RF -.50 * -.39* -.370 -.592** -.258 -.449*
APPROACH VOCAL REACTIVITY HIGH PLEASURE SMILE AND LAUGHTER ACTIVITY LEVEL PERCEPTUAL SENSITIVITY SADNESS DISTRESS TO LIMITATIONS FEAR FALLING REACTIVITY
.019 .283 .411* .200 .091 .383 -.069 .138 .287 .110 .304 -.421* .019 .199
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LOW PLEASURE CUDDLINESS DURATION OF ORIENTING SOOTHABILITY
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Fathers scores EPDS Time 1 EPDS Time 2 PD P-CDI DC Total Stress
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PII:
S2468-7499(20)30016-8
DOI:
https://doi.org/doi:10.1016/j.ejtd.2020.100147
Reference:
EJTD 100147
To appear in:
European Journal of Trauma & Dissociation
Received Date:
30 July 2019
Revised Date:
29 January 2020
Accepted Date:
29 January 2020
Please cite this article as: Vismara L, Sechi C, Lucarelli L, REFLECTIVE FUNCTION IN FIRST-TIME MOTHERS AND FATHERS: ASSOCIATION WITH INFANT TEMPERAMENT AND PARENTING STRESS, European Journal of Trauma and Dissociation (2020), doi: https://doi.org/10.1016/j.ejtd.2020.100147
This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. © 2020 Published by Elsevier.
REFLECTIVE FUNCTION IN FIRST-TIME MOTHERS AND FATHERS: ASSOCIATION WITH INFANT TEMPERAMENT AND PARENTING STRESS Laura Vismara, PH.D., Department of Education, Psychology, Philosophy, Faculty of Human Studies, University of Cagliari, Italy. [email protected] Cristina Sechi, PH.D., Department of Education, Psychology, Philosophy, Faculty of Human Studies, University of Cagliari, Italy. [email protected] Loredana Lucarelli, PSY.D., Department of Education, Psychology, Philosophy, Faculty of Human Studies, University of Cagliari, Italy. [email protected]
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Correspondence to: Laura Vismara,
Department of Education, Psychology, Philosophy, University of Cagliari
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Via Is Mirrionis, 1 – 09123 Cagliari ITALY Phone number: +390706757503
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e-mail: [email protected]
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REFLECTIVE FUNCTION IN FIRST-TIME MOTHERS AND FATHERS: ASSOCIATION WITH INFANT TEMPERAMENT AND PARENTING STRESS Abstract
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Objective: Infant temperament is biologically determined. However, there is increasing proof that environmental factors may also have a relevant influence. The present study focuses on the role of parental reflective function (RF; Fonagy et al., 1998), that is, the psychological basis of emotion regulation. Methods: RF was assessed in 40 low-risk first-time parents during the seventh month of pregnancy, using the Adult Attachment Interview (AAI; Main, Goldwyn, Hesse, 1984-2002). At the baby’s sixth month, parents responded to the Infant Behavior Questionnaire–Revised (Gartstein & Rothbart, 2003), aimed to evaluate the child’s perceived temperament and the Parenting Stress Index–SF (Abidin, 2006). Parents’ depression was measured with the Edinburgh Postnatal Depression Scale (EPDS; Benvenuti et al., 1999). Results: No difference was found between mothers and fathers regarding RF and depression scores. Selfreported depression was associated with lower scores of RF. Lower RF during pregnancy was associated with higher child dysfunctional interaction in both mothers and fathers. Also, lower maternal RF was associated with higher perceived infant sadness whereas lower paternal RF was associated with higher infant negative affectivity. Conclusions: Early parenting programs should enhance maternal and paternal reflective functioning to promote sensitive caregiving behaviors and support the child’s development. Keywords: Parental reflective function; perinatal depression; perinatal anxiety; infant temperament; parenting stress; gender differences
Introduction Mental representations
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During pregnancy, new dimensions of the self may arise, and significant modifications of mental representations may occur; in such a perspective, a revision of internal working models of early attachment experiences may also take place. Internal working models shape cognition, memory, attention, and affect; therefore, they affect emotional and behavioral regulation (Hesse, 2008; Zimmermann, 1999). In the perinatal period, parents develop representations about themselves as parents and about their child. The content and structure of these representations may indicate adaptation to pregnancy and the future parental role (Vreeswijk, Maas, & van Bakel, 2012). Indeed, balanced and coherent perceptions of caregiving, of the child, and of the relationship with the child are associated with the quality of mother-child interactions and parental sensitivity, warmth, intrusiveness,
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negativity, and hostility (Dayton, Levendosky, Davidson, & Bogat, 2010; Rosenblum, McDonough, Sameroff, & Muzik, 2008; Vreeswijk, Maas, & van Bakel, 2012).
In particular, more flexible and open representations attuned to both the child’s positive and
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negative characteristics and developmental trajectories acknowledging their attachment and affective needs have been associated with greater caregiving sensitivity (Bretherton & Munholland, 2008). Moreover, several data support a continuity between pre- and postnatal parental
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representations and the child’s development and functioning (Ammaniti, Candelori, Pola, Tambelli,
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1995; Ammaniti, Tambelli, Odorisio, D’Isidori, Vismara, & Mancone 2002; Ammaniti, Speranza, Tambelli, Muscetta, Lucarelli, Vismara, L.,... & Cimino, 2006; Bowlby, 1988; Hart & McMahon, 2006; Madigan, Moran, Schuengel, Pederson, & Otten, 2007; Lyons-Ruth et al., 1992; Lyons-Ruth
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& Block, 1996, Lyons-Ruth, Bronfman, & Parsons, 1999; Lyons-Ruth, Dutra, Schuder, & Bianchi, 2006; Olds, 2006; Porter & Hsu, 2003; Slade, Belsky, Aber, & Phelps, 1999; Van Jitender et al., 1999). Mentalization and reflective functioning seem to play a crucial role in such transmission. Mentalization and reflective functioning
Parental mentalization is defined as the caregiver's ability to understand the child’s behavior in terms of mental states (feelings, desires, beliefs, and intentions), differentiating the other’s psychological characteristics from one’s own (Suchman, DeCoste, Leigh, & Borelli, 2010). This ability is one of the most relevant components of the caregiving system, which allows flexible and efficacious emotion regulation developed from interactional exchanges (Fonagy, Target, Steele, Steele, 1998; Slade, 2005). Thus, a lack of this ability is revealed by more caregiving negativity, controlling behavior, and intrusiveness (Grienenberger, Kelly, & Slade, 2005; Huth-Bocks, Muzik, Beeghly, Earls, & Stacks, 2014; Slade, Grienenberger, Bernbach, Levy, & Locker, 2005; Stacks, Muzik, Wong, Beeghly, Huth-Bocks, Irwin, & Rosenblum, 2014), may heighten the infant’s levels of arousal, leading to increased stress reactivity and higher vulnerability to developing emotionalbehavioral problems (Bowlby, 1988; Dollberg, Feldman, & Keren, 2010; Ha, Sharp, & Goodyer, Page 2 of 18
2011; Main & Goldwyn, 1984; Sharp & Fonagy, 2008; Smaling, Huijbregts, Suurland, van der Heijden, Mesman, van Goozen, & Swaab, 2016). Although maternal mentalization and parenting behavior are crucial in promoting the infant’s regulation of state, it is important to consider that the infant’s regulatory system is essentially dyadic, involving both the infant and the mother. Emotion regulation and infant temperament Emotion regulation may be defined as the “extrinsic and intrinsic processes for monitoring, facilitating, and inhibiting heightened levels of positive and negative affect” (Buss & Goldsmith, 1998, p. 359), a core feature of temperament. Within a transactional model, infant temperament may affect the caregiver-child relationship (Thomas, Chess, Birch, Hertzig, & Korn, 1963; Sroufe,
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1985). Temperament can be considered as the biological predisposition of an individual to respond in terms of affect, attention, motor function, and sensory sensitivity to contextual stimuli (Thomas & Chess, 1977; Zentner & Bates, 2008), that is, the ability to self-regulate (Putnam, Rothbart, &
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Gartstein, 2008).
A difficult temperament, that is, negative affectivity and reactivity (Bates, 1980; Calkins,
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Fox, & Marshall, 1996; Goldsmith & Alansky, 1987; Kagan & Snidman, 1991; Prior, 1992), has been correlated with higher susceptibility to later psychopathology (Clark, 2005; Riese, 1988).
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In addition, mothers who experience perinatal anxiety and depression tend to perceive their infants as fussier, slower to adapt to novelty, and more difficult compared to helathy mothers (Austin, Hadzi-Pavlovic, Leader, Saint, & Parker, 2005; Blair, Glynn, Sandman, Sandman, & Davis, 2011;
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Buitelaar, Huizink, Mulder, de Medina, & Visser, 2003; Henrichs, Schenk, Schmidt, Velders, Hofman, Jaddoe,... & Tiemeier, 2009). In turn, perinatal depressive symptoms are associated with negative parental representations, poor coping strategies, and low caregiving self-efficacy (Ahlqvist‐Björkroth, Korja, Junttila, Savonlahti, Pajulo, Räihä,... & Aromaa, 2016; Austin, HadziPavlovi, Leader, Saint, Parker, 2005; Dunbar, McKee, Rakow, Watson, Forehand, & Compas, 2013; Surkan, Kawachi, Ryan, Berkman, Carvalho Vieira, & Peterson, 2008). Study aims Based on the above empirical and clinical evidence, the present longitudinal study had the following aims:
To evaluate RF, depressive symptoms, parenting stress, and infants’ temperament in first-time parents;
To evaluate possible differences between mothers and fathers;
To evaluate the association between RF assessed during pregnancy, and other variables measured at the infant’s sixth month.
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This study was part of a larger, ongoing longitudinal study on maternal and paternal depression in first-time parents and the development of their children’s affective regulation. In this paper, we present data concerning parents who were evaluated during the seventh month of pregnancy (Time 1) and six months after the child’s birth (Time 2).
Material and Methods Participants The study participants comprised 80 parents (40 couples) and their healthy babies (55.8% boys, 44.2% girls). Of these participants, 78% were married couples and 22% were cohabiting; 21% of the mothers and 40% of the fathers had a high-school qualification, 60% of the mothers and 34% of the
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fathers a college degree, and 16% of the mothers and 18% of the fathers had a PhD. Mothers’ mean age was 32.7 years (SD = 4.2 years), and fathers’ mean age was 36.8 years (SD = 5.4). The median income of the parents belonged to the Italian middle working class and socio-economic status, as
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assessed by a detailed questionnaire and using the Istituto Nazionale di Statistica (ISTAT) classification (2013). No participant was undergoing medical or psychological treatment at the time
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of assessment. Procedure
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The research project obtained approval from the hospital and university ethics committees. All participants signed a written informed consent form. At Time 1, data were collected during pregnancy, while at Time 2, data were collected approximately six months after birth. Parents who
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met the selection criteria and agreed to participate independently completed a demographics questionnaire, the Edinburgh Postnatal Depression Scale (EPDS), and the State-Trait Anxiety Inventory (STAI) at home, and a demographics questionnaire, the EPDS, and the STAI at Time 1. These measures were repeated at Time 2 when the parents also completed the Parenting Stress Index-Short Form (PSI-SF) and reported their infant’s temperament using the Infant Behaviour Questionnaire (IBQ). Also, at Time 1, the Adult Attachment Interview (AAI) was administered to mothers and fathers at the University Laboratory. This research was supported by grants from PRIN 2013/2016 - 20107JZAF4 Italian Ministry for Education, University and Research. Measures The AAI (Main, Goldwyn, & Hesse, 1984-2002) is a semi-structured, audiotaped interview that investigates general descriptions of relationships with the main attachment figures in childhood, specific supportive or contradicting memories, and descriptions of current relationships with their parents. Adults were asked to retrieve attachment-related autobiographical memories from early childhood and evaluate these memories and their effects from their current perspective so that the Page 4 of 18
structural dimension of the transcript is coded rather than its content. The coding system, developed by Main and Goldwyn (1984), allows the classification of adults into one of five categories for overall state of mind with respect to attachment: Secure, freely valuing of attachment (F); Dismissing attachment relationships (Ds); Preoccupied with attachment relationships (E); Unresolved with respect to past loss or trauma (U); or Cannot classify (CC). Interrater reliability for the main category was 89% (k=0.74, p= 0.001) The Reflective Function Scale (RFS; Fonagy, Target, Steele, & Steele, 1998) is applied to the AAI to assess parents’ capacity to understand mental states to evaluate the capacity to understand one’s own and others’ mental states with respect to childhood attachment experiences. RFS was initially applied to the AAI transcripts in which some questions were defined as “demand
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questions” because they explicitly triggered mentalization (e.g., “Why did your parents behave as they did during your childhood?, Do you think your childhood experiences have an influence on who you are today?”), whereas other queries were described as “permit questions” because they did
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not necessarily stimulate reflective functioning (e.g., What did you do when you were upset as a child?). An overall score was assigned, from -1 (Negative RF, i.e., rejected, bizarre, unintegrated or inappropriate RF) to 9 (exceptional RF) based on the four following dimensions: “Awareness of the
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nature of mental states,” “The explicit effort to tease out mental states underlying behavior,” interviewer.”
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“Recognizing developmental aspects of mental states,” and “Mental states in your relation to the
The EPDS (Cox, Holden, & Sagovsky, 1987) is a self-report questionnaire with ten items
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addressing depression symptoms occurring within the previous seven days. The total score is calculated by adding the individual items on a 4-point Likert scale. There were two adopted cut-off scores: 8/9, as suggested in the EPDS Italian validation (Benvenuti Ferrara, Niccolai, Valoriani, 1999), and 12/13, as suggested by Cox et al. (1987) to identify more severe depression. The PSI-SF (Abidin, 1995 Guarino, Di Blasio, D’Alessio, Camisasca, & Serantoni, 2008) is a self-report instrument that measures stress specifically associated with parenting. The PSI-SF consists of 36 statements referring to the past week. All items are rated on a 5-point scale. Parents who obtain a total stress score above the 90th percentile, or a raw score of 90, are considered to experience clinically significant parenting stress, as indicated by the Italian validation (Guarino, Di Blasio, D’Alessio, Camisasca, & Serantoni., 2008). The total stress score is a composite score of the subscale scores: parental distress, parent-child dysfunctional interaction, and difficult child. The IBQ-Revised (Garstein & Rothbart, 2003) is a parent report questionnaire aimed to measure temperament in infants between the ages of 3 and 12 months. The IBQ-Revised is composed of 191 items that yield scores on 14 scales. Scales cluster into three overarching factor scores:
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Orienting/Regulatory Capacity, Surgency/Extraversion, and Negative Affectivity. The 14 scales are as follows:
Activity Level: Movement of arms and legs, squirming, and locomotor activity
Distress to Limitations: Baby’s fussing, crying, or showing distress while a) in a confining place or position; b) involved in caretaking activities; c) unable to perform the desired action
Approach: Rapid approach, excitement, and positive anticipation of pleasurable activities
Fear: The baby’s startle or distress due to sudden changes in stimulation, novel physical objects or social stimuli; inhibited approach to novelty
Duration of Orienting: The baby’s attention to and/or interaction with a single object for
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extended periods of time Smiling and Laughter: Smiling or laughter from the child in general caretaking and play situations
Vocal Reactivity: Amount of vocalization exhibited by the baby in daily activities
Sadness: General low mood; lowered mood and activity specifically related to personal
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suffering, physical state, object loss, or inability to perform the desired action Perceptual Sensitivity: Amount of detection of slight, low intensity stimuli from the external
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environment
High Intensity Pleasure: Amount of pleasure or enjoyment related to high stimulus intensity,
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rate, complexity, novelty, and incongruity
Low Intensity Pleasure: Amount of pleasure or enjoyment related to situations involving
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low stimulus intensity, rate, complexity, novelty, and incongruity
Cuddliness: The baby’s expression of enjoyment and molding of the body to being held by a caregiver
Soothability: Baby’s reduction of fussing, crying, or distress when the caretaker uses soothing techniques
Falling Reactivity/Rate of Recovery from Distress: Rate of recovery from peak distress, excitement, or general arousal; ease of falling asleep Results
Comparison between mothers and fathers A paired sample t-test showed significant differences between Parental Distress scores for mothers and fathers in the couple (t = 2.33; p <0.05). Fathers reported significantly more psychological distress than their partners (Table 1). This result may be explained by the fact that fathers are dealing actively with their infants for the first time when the PSI is administered, whereas mothers have had time to
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practice as a caregiver and to develop their understanding of their child’s characteristics. There was no significant difference between maternal and paternal IBQ-R scores. Association between maternal RF and other studied variables The Pearson correlation coefficients between RF, EPDS, PSI, and IBQ-R mother scores at Time 1 and Time 2 are reported in Table 2. Lower RF scores are associated with higher self-reported depressive symptoms, with a higher dysfunctional parent-child interaction, and with a sadder tempered child. Table 2 Bivariate correlations among RF, EPDS, PSI and IBQ-R scores for mothers
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LOW PLEASURE CUDDLINESS DURATION OF ORIENTING SOOTHABILITY
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APPROACH VOCAL REACTIVITY HIGH PLEASURE SMILE AND LAUGHTER ACTIVITY LEVEL PERCEPTUAL SENSITIVITY SADNESS DISTRESS TO LIMITATIONS FEAR FALLING REACTIVITY
RF -.49 * -.41* -.337 -.542** -.170 -.371 .233 .029 -.039 -.163 -.322 .061 -.394* .180 -.189 .363 -.044 .205 .147 .294
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Mothers scores EPDS Time 1 EPDS Time 2 PD P-CDI DC Total Stress
Association between paternal RF and other studied variables The Pearson correlation coefficients between RF, EPDS, PSI, and IBQ-R father scores at Time 1 and Time 2 are reported in Table 3. Lower RF scores are associated with higher self-reported depressive symptoms, higher dysfunctional parent-child interactions, and higher total parenting stress; also, they perceive their child as less cuddlable and more highly reactive.
Discussion and Conclusions The birth of a child represents an unpredictable experience that is associated with a woman’s higher vulnerability to develop affective disorders, primarily perinatal anxiety and depression (Apter, Page 7 of 18
Devouche, & Gratier, 2011; Austin, Priest, & Sullivan, 2008; Barker, Jaffee, Uher, & Maughan, 2011; Feldman, Granat, Pariente, Kanety, Kuint, & Gilboa-Schechtman, 2009; Goodman, Rouse, Connell, Broth, Hall, & Heyward, 2011; McGrath, Records, Rice, 2008). Children who have experienced prenatal maternal psychological problems appear to be at increased risk of difficult temperament in their first years of life (Austin, Hadzi-Pavlovic, Leader, Saint, & Parker, 2005; Huizink et al. 2002; Davis, Glynn, Schetter, Hobel, Chicz-Demet, & Sandman, 2007; Davis, Snidman, Wadhwa, Glynn, Schetter, & Sandman, 2004; Feldman, Granat, Pariente, Kanety, Kuint, & Gilboa-Schechtman, 2009; Rouse & Goodman, 2014). However, to understand fully the long-term impact of prenatal adversities (Van den Bergh & Marcoen, 2004; Otte, Donkers, Braeken, & Van den Bergh, 2015; Buss, Davis, Muftuler, Head, &
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Sandman, 2010), it is important to consider the intervention of postnatal factors (Bergman, Sarkar, Glover, & O’Connor, 2008). Moreover, the role of fathers and the infant itself must be included. Accordingly, our study aims to identify pre- and postnatal maternal and paternal risk factors that may contribute to the infant’s perceived negative temperament and the caregivers’ parental stress.
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Our study specifically focuses on mothers’ and fathers’ RF as a protective factor for both parents
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and children in the context of self-reported depressive symptoms.
Parental mentalization consists in being genuinely curious and trying to acknowledge and
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interpret the state of mind of the child: “a meeting of minds” (Sharp & Fonagy, 2008). Our data showed that lower RF scores were associated with both higher depression symptoms and parenting stress both in mothers and fathers. Several studies have shown that maternal RF is important in
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contributing to early child temperament and externalizing behavior (Sharp & Fonagy, 2008; Moffitt & Caspi, 2001; Slade, 2005; Smaling, Huijbregts, Suurland, van der Heijden, Mesman, van Goozen, & Swaab, 2016; Smaling, Huijbregts, Suurland, Van Der Heijden, Van Goozen, & Swaab, 2015;). Moreover, mothers with depression are less likely to refer to their child’s mental states and emotional and cognitive experiences (Herrera, Reissland, Shepherd, 2004; Murray, Kempton, Woolgar, & Hooper, 1993; Pawlby, Fernyhough, Meins, Pariante, Seneviratne, & Bentall 2010; Sethna, Murray, & Ramchandani, 2012). However, little is known concerning fathers, whose role is becoming increasingly important among families. In our study, no difference emerged between mothers and fathers concerning RF scores in the context of depression. Evidence suggests that approximately 5–10% of fathers experience depression in the postnatal period (Paulson & Bazemore, 2010). The disorder is associated with both parenting difficulties (Davis, Davis, Freed, Clark, 2011; Arnott & Meins, 2007; Wilson & Durbin, 2010; Lundy, 2003) and an increased risk of behavioral and emotional problems in their children (LaBounty, Wellman, Olson, Lagattuta, & Liu, 2008; Ramchandani, Stein, O’Connor, Heron, Murray. & Evans, 2008; Paulson, Keefe, & Leiferman, 2009). Page 8 of 18
Nevertheless, differences emerged regarding the child’s perceived temperament. Mothers with low RF perceived their child as sadder, whereas fathers perceived their child as more negatively reactive in terms of their level of cuddliness and high intensity pleasure. This difference is worthy of attention. Mothers should be helped in differentiating the self from their infant in order to enhance the acknowledgment of their child’s peculiarities; mothers should also be supported in promoting curiosity toward their child and the child’s autonomy; fathers would seem to benefit by enhancing their sense of self-efficacy in their caregiving role; feeling efficacious should promote more monitoring and responsiveness, increasing the likelihood for their infants’ self-soothing and self-regulation processes.
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Limitations
Our results call for caution despite their relevance. The small size of the sample limits the generalizability of our findings. Indeed, no statistical causal analyses could be carried out; therefore, no direct, nor mediated effect of the involved variables may be asserted. As well, the use of self-
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reports—which rely on a subject’s personal views of themselves and of his or her infant—does not
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allow to give a complete and clinically informed interpretation of our findings. Moreover, different maternal and paternal RF components (self versus other) should be considered to verify its differential
Conclusion
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impact on child temperament and parental mental health.
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Our findings should be evaluated with the previously mentioned limitations in mind; however, our results illustrate that interventions should target reflective functioning in the parents, that is, the parents’ understanding of their child’s mental states and how these mental states impact behavior, cognition, and emotions. Such early parenting programs would support parents and their infants and prevent the development of problems later in life.
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re
Table 1 Distribution of outcomes by mother and father couples Time 1
Fathers
lP
Mothers
Time 2 p Value
Mothers
Fathers
p Value
Mean score (SD)
Mean score (SD)
Mean score (SD)
RF
4.5 (.7)
4.2(.8)
.21
__
__
__
EPDS Time 2
4.3(3.1)
4.2(3.2)
.95
4.5 (3.0)
3.3 (3.3)
.10
Jo ur na
Mean score (SD)
PSI PD
__
__
__
18.7(6.4)
21.9 (7.1)
.03
P-CDI
__
__
__
14.6 (3.6)
15.6 (3.1)
.25
DC
__
__
__
17.7 (5.1)
18.8 (4.5)
.30
Total Stress
__
__
__
51(13.5)
56.3 (12.6)
.06
APPROACH
__
__
__
5.2 (.6)
5.1 (.7)
.13
VOCAL REACTIVITY
__
__
__
5.1 (.9)
4.7 (1.0)
.06
HIGH PLEASURE
__
__
__
5.8 (.6)
5.6 (.9)
.08
SMILE AND LAUGHTER
__
__
__
4.9 (.8)
4.6 (.8)
.07
ACTIVITY LEVEL
__
__
__
4.3 (1.1)
3.9 (1.0)
.12
PERCEPTUAL SENSITIVITY
__
__
__
3.9 (1.2)
3.7 (1.2)
.32
SADNESS
__
__
__
3.2 (1.1)
3.1 (1.1)
.63
DISTRESS TO LIMITATIONS
__
__
__
3.3 (.8)
3.4 (.9)
.75
FEAR
__
__
__
2.2 (.8)
2.3 (.9)
.39
FALLING REACTIVITY
__
__
__
4.9 (1.1)
4.8(.7)
.76
LOW PLEASURE
__
__
__
5.2 (.9)
4.9 (1.1)
.17
CUDDLINESS
__
__
__
5.8 (.8)
5.6 (.7)
.56
IBQ-R
Page 17 of 18
DURATION OF ORIENTING
__
__
__
3.8 (1.0)
4.0 (1.3)
.35
SOOTHABILITY
__
__
__
4.9 1.1
4.9 (.6)
.99
Table 3 Bivariate Correlations among RF, EPDS, PSI and IBQ-R scores for fathers RF -.50 * -.39* -.370 -.592** -.258 -.449*
APPROACH VOCAL REACTIVITY HIGH PLEASURE SMILE AND LAUGHTER ACTIVITY LEVEL PERCEPTUAL SENSITIVITY SADNESS DISTRESS TO LIMITATIONS FEAR FALLING REACTIVITY
.019 .283 .411* .200 .091 .383 -.069 .138 .287 .110 .304 -.421* .019 .199
-p
Jo ur na
lP
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LOW PLEASURE CUDDLINESS DURATION OF ORIENTING SOOTHABILITY
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Fathers scores EPDS Time 1 EPDS Time 2 PD P-CDI DC Total Stress
Page 18 of 18