“C@nnected” : Group videoconferencing intervention to improve maternal sensitivity in mothers-infant dyads attending primary care in Chile: Protocol for a randomized feasibility trial (Preprint)

BACKGROUND Early childhood development is highly dependent on the sensitive care provided by their caregivers. Interventions focused on supporting parents to improve their sensitivity have been shown to be effective. The COVID-19 pandemic has had a great impact on mental health. Pregnant women and mothers of infants being an especially vulnerable group, and maternal sensitivity is particularly affected. On the other hand, access to face-to-face interventions is restricted, above all group interventions, so it is relevant to have remote interventions to support this group of mothers. OBJECTIVE The objective of the study is to evaluate the feasibility and acceptability of a group videoconferencing intervention : “C@nnected” to improve maternal sensitivity aimed at mother-infant dyads attended in Primary Health Care in vulnerable areas of Santiago , Chile. METHODS This is a randomized pilot feasibility study single-masked (outcome assessor) study with a qualitative component. It will involve a block randomization procedure to generate a 3:2 allocation (with more people allocated to the intervention arm). The intervention consists of four group videoconferencing sessions, adapted from a face-to-face intervention of proven effectiveness. The control group will receive treatment as usual plus educational brochures. Feasibility and acceptability of the study will be quantitatively and qualitatively assessed. Changes in clinical outcomes will also be evaluated: maternal sensitivity, depressive symptoms, postnatal maternal attachment, and infant socio-emotional development. RESULTS We have completed the adaptation of the face-to-face intervention to the videoconferencing format, our study is currently in the recruitment phase, which is expected to be completed by January 2022, the results of the study are expected by August 2022. CONCLUSIONS This study will contribute evidence for the use of eHealth interventions to promote maternal sensitivity. It will also inform the design and implementation of a future randomized clinical trial. CLINICALTRIAL ClinicalTrials.gov, NCT04904861.

Family dynamics. An exploration of parental sensitivity and depressive symptoms among mothers and fathers of toddlers

In studies of maternal sensitivity, the influence of mothers’ depressive symptomatology has been consistently highlighted. Additionally, the relevance of both maternal and paternal sensitive responses to children’s development has been recognized. However, literature regarding the dynamics of the mother-father-toddler triad is scarce. This is particularly true when understanding how parental sensitivity may be bidirectionally shaped by both parents’ (i.e., mothers’ and fathers’ depressive symptomatology) and children’s characteristics (i.e., age). Hence, the present study aims to describe and analyse the associations between parental depression, paternal sensitivity and children’s socioemotional difficulties and age with mothers’ sensitive responses to highlight the appropriateness of considering fathers’ depressive symptoms and sensitivity to better understand the impact of maternal depressive symptomatology on mothers’ sensitivity. The participants included 80 Chilean mother-father-child triads in which all children were between 1 and 3 years of age and presented some degree of socioemotional difficulty. The results reveal no differences in maternal and paternal sensitivity or higher depressive symptomatology in mothers than in fathers. Additionally, while mothers’ depression was significantly associated with their sensitivity, this was not the case for fathers. Paternal depressive symptomatology was associated with the mother’s depression. Finally, paternal sensitivity emerged as a mediator between maternal depressive symptoms and sensitivity. This result calls attention to the use of paternal variables to understand how maternal depression impacts mothers’ sensitivity and to thus develop appropriate interventions that expand the scope of such impacts from the dyad to the triad.

Contextual risks, child problem-solving profiles, and socioemotional functioning: Testing the specialization hypothesis

Guided by the evolutionary perspective and specialization hypothesis, this multi-method (behavioral observation, questionnaire) longitudinal study adopted a person-centered approach to explore children’s problem-solving skills within different contexts. Participants were 235 young children (M age = 2.97 years at the first measurement occasion) and their parents assessed in two measurement occasions spaced one year apart. Latent profile analyses revealed four unique problem-solving profiles, capturing variability in children’s performance, and observed engagement in abstract vs. reward-oriented (RO) problem-solving tasks at wave one. The four profiles included: (a) a high-abstract-high-RO, (b) a high-abstract-low-RO, (c) a low-abstract-high-RO, and (d) a low-abstract-low-RO classes. Contextual risks within and outside families during wave one, including greater neighborhood crime, impoverishment, and observed lower maternal sensitivity were linked to the elevated likelihood for children from the two profiles with low-abstract problem-solving, particularly those from the low-abstract-high-RO problem-solving profile. Furthermore, child problem-solving profiles were linked to meaningful differences in their socioemotional functioning one year later. The present finding has important implications in revealing the heterogeneity in child problem-solving within different contexts that responded differently to contextual risks. In addition, this study advanced the understanding of the developmental implications of child problem-solving capacity.

Major depression as a predictor of the intergenerational transmission of attachment security: Findings from a pregnancy cohort study

Objective: Understanding the relationship between attachment and mental health has an important role in informing management of perinatal mental disorders and for infant mental health. It has been suggested that experiences of attachment are transmitted from one generation to the next. Maternal sensitivity has been proposed as a mediator, although findings have not been as strong as hypothesised. A meta-analysis suggested that this intergenerational transmission of attachment may vary across populations with lower concordance between parent and infant attachment classifications in clinical compared to community samples. However, no previous study has examined major depression and adult attachment in pregnancy as predictors of infant–parent attachment classification at 12 months postpartum. Methods: Data were obtained on 52 first-time mothers recruited in early pregnancy, which included 22 women who met diagnostic criteria for current major depression using the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders. The Adult Attachment Interview was also administered before 20 weeks of pregnancy. A history of early trauma was measured using the Childhood Trauma Questionnaire and maternal sensitivity was measured at 6 months postpartum using the observational measure of the Emotional Availability Scales. Infant–parent attachment was measured using the Strange Situation Procedure at 12 months. Results: Overall, we found no significant association between the Adult Attachment Interview and the Strange Situation Procedure classifications. However, a combination of maternal non-autonomous attachment on the Adult Attachment Interview and major depression was a significant predictor of insecure attachment on the Strange Situation Procedure. We did not find that maternal sensitivity mediated parental and infant attachment security in this sample. Conclusion: While previous meta-analyses identified lower concordance in clinical samples, our findings suggest women with major depression and non-autonomous attachment have a greater concordance with insecure attachment on the Strange Situation Procedure. These findings can guide future research and suggest a focus on depression in pregnancy may be important for subsequent infant attachment.