An investigation of the relationship between PTSD, reflective functioning and caregiving sensitivity amongst mothers misusing substances

Adams, Amy S. (2020-03)

Thesis (PhD)--Stellenbosch University, 2020.

Thesis

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.

AFRIKAANSE OPSOMMING : Dwelmgebruik in Suid-Afrika het aansienlik toegeneem en word met verskeie risikofaktore vir die geestesgesondheid van sowel moeders as babas geassosieer insluitend disfunksionele ouerpraktyke. Daar is vasgestel dat trauma ’n impak het op individue se vermoë om stabiele verbintenisse met ander (soos vroeë versorgers) te vorm, asook op die verhoudings wat hul later in die lewe aangaan. Daar word gepostuleer dat reflektiewe funksionering verskeie individuele risikofaktore verminder insluitend die effek van trauma. Hierdie verhouding is egter nie in die Suid-Afrikaanse omgewing ondersoek nie. Boonop dien moeders wat stowwe misbruik as 'n unieke populasie om die wisselwerking tussen hierdie verskillende faktore te ondersoek en bied die huidige studie 'n eiesoortige navorsingspoging. Die oogmerk van die huidige studie was om die verhouding tussen PTSD, reflektiewe funksionering en versorgingsensitiwiteit onder die unieke populasie moeders wat substanse misbruik te ondersoek. Die doelstellings wat hieruit voortspruit, was om (a) om die vlakke van reflektiewe funksionering van moeders in sowel die blootgestelde groep as die nie-blootgestelde groep te evalueer; (b) om die versorgingsensitiwiteit van moeders in sowel die blootgestelde groep as die nie-blootgestelde groep te evalueer; en (c) om die vlakke van reflektiewe funksionering en versorgingsensitiwiteit in die blootgestelde groep met dié wat in die nie-blootgestelde groep voorkom. Die totale steekproef het bestaan uit 72 moeder/kind dyades en was gewerf uit diegene wat voorheen aan die Safe Passage Study (SPS) deelgeneem het. Deelnemers met PTSD was aan die blootgestelde groep (PTSV groep) opgedra en diegene wat nie aan die volledige diagnostiese kriteria vir PTSV voldoen nie, was aan 'n groep wat nie blootgestel is nie, toegewys (geen PTSV groep). Daardeur word gekyk na die gevolge van PTSV op uitkomsveranderlikes in 'n poging om assosiasies tussen hierdie veranderlikes te beoordeel. Trauma-blootstelling is met behulp van die Life Events Checklist (LEC) beoordeel en die PTSV-skaal vir DSM-5 (CAPS-5) wat deur die kliniek toegedien is, is gebruik om PTSV te beoordeel. Ouers se reflektiewe funksionering is beoordeel aan die hand van die verkorte weergawe van die ouerontwikkelingsonderhoud (PDI-S). Versorgingsensitiwiteit is beoordeel aan die hand van die kodering-interaktiewe gedragstelsel (CIB), wat gebruik is om 'n video-opgeneemde moeder-kind interaktiewe speel sessie te beoordeel wat die nuuskierigheidsparadigma genoem word. Bevindings van die huidige studie het getoon dat slegs 20.8% van die totale steekproef was aangebied met voldoende RF en 79.2% met swak RF sonder statisties beduidende verskil tussen die bloodgestelde en nie-bloodgestelde groepe. Die versorgingsensitiwiteitsvlak tussen die blootgestelde en nie-blootgestelde groep het meestal ooreengestem. Klein-medium effekgroottes het aangedui dat moeders in die Geen-PTSV-groep 'n swakker gehalte moederlike gedrag met hul kind gehad het as dié in die PTSV-groep. Min korrelasie tussen RF en sensitiwiteit vir versorging is gevind. Geen beduidende verskil is gevind tussen moeders met hoër PTSV-vlakke en laer RF-vlakke en hul versorgingsensitiwiteit nie. Geen statisties beduidende resultate is gevind wat aan die hand doen dat RF ’n modererende effek op PTSV en die uitkomsveranderlike versorgingsensitiwiteit het nie.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/107943
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