A study of the role of parental reflective functioning on maternal and child mental health and the efficacy of the circle of security : parenting among mothers receiving psychiatric service

Abstract

Infancy and toddlerhood are important but vulnerable stages in human development and the role of primary caregiver is crucial in the child’s developmental trajectories. Parental Reflective Functioning (PRF) refers to parents’ capacity to envision the mental state of the children in the parenting context and is found to have significant influences on child development as well as parenting behaviors. Studies on the impact of mother-child relationship on maternal depression are evolving, and interventions that aim to enhance mother’s bonding with her infant is recommended as one of the treatment approaches for maternal depression. The specific relationship of PRF with maternal depression is less investigated. The current research consisted of two studies. The first study aimed to investigate the role of PRF on maternal and child mental health outcomes in a Hong Kong community sample and the mechanisms through which PRF affects maternal and child mental health outcomes. The second study investigated the efficacy of Circle of Security – Parenting (COS-P), which is a rapidly growing attachment-based parenting program aiming at enhancing the PRF of caregivers, on maternal and child mental health outcomes (including maternal depressive symptoms and child internalizing and externalizing behaviors) and parenting variables (including parenting stress, parental sense of competence, and parenting behaviors) in a group of mothers receiving psychiatric services in Hong Kong. In Study 1, a community sample of 298 Hong Kong mothers with children aged 0-5 completed an online survey. PRF was measured along the three dimensions of Prementalizing mode (PM), Certainty of Mental State (CMS) and Interest and Curiosity of Mental State (IC). Outcome measures included maternal depressive symptoms and child mental health problems. Mediating variables examined included parenting stress, parental sense of competence and parenting behaviors. The results showed that PRF was associated with both maternal depressive symptoms and child mental health. All factors of PRF (PM, CMS and IC) were found to be associated with maternal depressive symptoms and mediated by parenting stress and parental sense of competence but the pattern of relationship differed for different dimensions of PRF. PM was found to be positively associated with maternal depressive symptoms, and the relationship was partially mediated by higher level of parenting stress and lower level of parental sense of competence. CMS and IC were found to be negatively associated with maternal depressive symptoms, and the relationships were partially (CMS as IV) and fully (IC as IV) mediated by lower level of parenting stress and higher level of parental sense of competence. PM, CMS and IC were all found to predict levels of child mental health problems (internalizing and externalizing problems), being mediated through parenting behaviors but again the pattern of relationship was different for PM as compared to CMS and IC. Higher PM of the mother was associated with more internalizing and externalizing problems of the child, mediated by less supportive and more hostile parenting behaviors. On the other hand, higher CMS and IC of the mother were associated with less internalizing and externalizing problems of the child, mediated by more supportive behaviors only but not by less hostile parenting behaviors. In Study 2, twenty-three mothers with postnatal depression or adjustment disorder with depressive features and receiving services from two psychiatric settings in public local hospitals in Hong Kong were recruited to join the Circle of Security – Parenting (COS-P) program. Measures of maternal depressive symptoms, child internalizing and externalizing problems and various parenting variables were assessed before and after the 8-week COS-P. Results showed significant improvement in these mothers’ self-reported depressive symptoms, parenting stress and parental sense of competence, as well as CMS and IC. However, no significant change was found in PM, parenting behaviors, and children internalizing and externalizing problem after the intervention. The implications of the findings are discussed.