Browsing Doctoral Degrees (Psychiatry) by browse.metadata.advisor "Berg, Astrid"
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- ItemExploration of parental reflective function and mother-child interaction in a South African sample of women with peri- and postpartum psychosis(Stellenbosch : Stellenbosch University, 2020-12) Voges, Juane; Niehaus, Dana J. H.; Berg, AstridENGLISH SUMMARY : Background: Severe mental illness in the peripartum period may exert a significant and detrimental impact on maternal caregiving and infant attachment. The experience of psychotic symptoms during pregnancy or the postpartum period may further contribute to the development of attachment difficulties and poor outcomes. Attachment theory was used as a guiding framework to examine the experience and impact of peripartum psychosis on the mother-infant dyad. Infants of mothers with psychosis are at risk of developing insecure or disorganised attachment. Mothers with psychotic disorders are likely to display poor sensitivity and responsiveness in interaction with their infants. Parental reflective functioning (PRF) is the capacity to hold in mind one’s own and one’s child’s mental states. Impairments in PRF may be a potential mechanism for impairments in attachment and quality of mother-infant interaction. Peripartum psychosis may place the mother-infant dyad at risk due to the nature of symptoms, the frequent need for psychiatric admission and separation between mother and infant. Studies of maternal psychopathology and infant outcomes in South Africa have focussed on maternal depression or trauma. To our knowledge, there are no studies examining the impact of maternal psychosis on parenting in South Africa. There have been limited studies examining PRF in South Africa; however, none have focussed specifically on how this capacity influences caregiving behaviours among mothers who have experienced psychosis in the peripartum. This study set out to explore PRF and quality of mother-infant interaction in a sample of mothers with peripartum psychosis. We hypothesised that experiences of peripartum psychosis will be associated with 1) lower PRF and 2) poorer quality of mother-infant interaction. Further, we hypothesised that 3)impairments in PRF will be correlated with a poorer quality of mother-infant interaction. Methods: The study followed an exploratory, quantitative and descriptive design. Forty mothers with predominantly bipolar disorder or schizophrenia were recruited following experiences of psychosis during pregnancy or early postpartum in order to determine their level of PRF and quality of interaction with their infants. A detailed interview was conducted to obtain information pertaining to demographic and clinical characteristics, as well as pregnancy and postpartum experiences. PRF was coded from the Parent Development Interview and the quality of interaction was assessed following an unstructured play interaction between mother and infant. Two-sample t-tests were conducted to examine whether PRF or mother-infant interaction was influenced by demographic, clinical, pregnancy, or postpartum variables. Pearson’s correlation coefficients were calculated for correlations between PRF and interaction variables. Results: Psychosocial risk factors were prevalent among this group of mothers who experienced peripartum psychosis. High rates of unplanned pregnancy and maternal substance use during pregnancy was also observed and the majority mothers had a psychiatric admission, which necessitated early separation from their infants. The majority of mothers (65.00%) demonstrated a pre-mentalising level of PRF (Mean = 4.10). However, this capacity was not impaired in all mothers with peripartum psychosis. A large proportion of mothers (75.00%) exhibited the potential for adequate to complex PRF. Dyads achieved moderate scores for overall quality of interaction, maternal sensitivity, and infant social engagement and had a low level of dyadic reciprocity. These findings appear to support our hypotheses that mothers’ experience of peripartum psychosis was associated with poorer PRF and quality of mother-infant interaction. Socio-demographic risk factors and factors related to pregnancy and postpartum experiences influenced PRF and quality of mother-infant interaction. A low positive correlation between PRF and quality of interaction was found (r = .40), which was weaker than we hypothesised. Conclusions: Peripartum psychosis was associated with lower PRF and poorer mother-infant interaction for the majority of our sample. Mothers who experienced peripartum psychosis may benefit from interventions targeting both PRF and quality of mother-infant interaction. Additionally, the provision of joint admissions, and pro-active psychoeducation about pregnancy planning and substance use are recommended.
- ItemAn investigation of the relationship between PTSD, reflective functioning and caregiving sensitivity amongst mothers misusing substances(Stellenbosch : Stellenbosch University, 2020-03) Adams, Amy S.; Berg, Astrid; Suchman, Nancy; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Psychiatry.ENGLISH SUMMARY : Substance use has increased significantly in South Africa and has been associated with several risk factors for both maternal and infant mental health including dysfunctional parenting practices. Trauma has been shown to impact an individual’s ability to form stable attachments with early caregivers as well as on relationships formed later in life. Reflective functioning is postulated to moderate several different individual risk factors including the effects of trauma. However, the relationship between these factors has not been explored in the South African setting. Moreover, mothers misusing substances serve as a unique population within which to explore this interaction. The current study therefore represents a distinctive research endeavour. The primary aim of this study was to explore the relationship between PTSD, reflective functioning (RF) and caregiving sensitivity amongst mothers misusing substances. The objectives deriving from this were to (a) evaluate the levels of reflective functioning of mothers in both the exposed group and the non-exposed group (b) assess the caregiving sensitivity of mothers in both the exposed group and the non-exposed group and (c) compare the levels of reflective functioning and caregiving sensitivity in the exposed group with those found in the non-exposed group. The total sample consisted of 72 mother/child dyads and were recruited from those who had previously participated in the Safe Passage Study (SPS). Participants who presented with PTSD were assigned to an exposed group (PTSD group) and those who did not meet full diagnostic criteria for PTSD were assigned to a non-exposed group (No PTSD group). Thereby controlling for the effects of PTSD on outcome variables in an attempt to assess associations between these variables. Trauma exposure was assessed using the Life Events Checklist (LEC) and the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) was used to assess PTSD. Parental reflective functioning was assessed with the shortened version of the Parental Development Interview (PDI-S). Caregiving sensitivity was assessed with the use of the Coding Interactive Behaviour system (CIB) which was used to rate a video-recorded mother-child interactive play session termed the curiosity box paradigm. Findings of the present study revealed that only 20.8% of participants in the total sample presented with adequate RF and 79.2% presented with poor RF with no statistically significant difference between the exposed and non-exposed group. The level of caregiving sensitivity between the exposed and non-exposed group were mostly similar. Small-medium effect sizes suggested that mothers in the No PTSD group presented with a poorer quality of maternal behaviour with their child than those in the PTSD group. Little evidence of correlation between RF and caregiving sensitivity was found. No significant difference was found between mothers with higher levels of PTSD and lower levels of RF and their caregiving sensitivity. No statistically significant results were found suggesting a moderating effect of RF on PTSD and the outcome variable caregiving sensitivity. Overall, the findings confirmed the concerning extent of substance use and PTSD pathology in the given setting. It also revealed largely poor levels of reflective functioning and caregiving sensitivity in this specific population and highlighted the need for ongoing research and intervention.