Exploration of parental reflective function and mother-child interaction in a South African sample of women with peri- and postpartum psychosis

Voges, Juane (2020-12)

Thesis (PhD)--Stellenbosch University, 2020.

Thesis

ENGLISH 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.

AFRIKAANSE OPSOMMING : Geen oAgtergrond: Ernstige geestesongesteldheid in die peripartum periode mag 'n beduidende en nadelige uitwerking op versorging deur die moeder en die binding tussen ‘n moeder en haar baba uitoefen. Die ervaring van psigose tydens swangerskap of die postpartum periode kan verder bydra tot die ontwikkeling van bindingsprobleme en swak uitkomste. Bindingsteorie (“Attachment theory”) is gebruik as 'n leidende raamwerk om die ervaring en impak van peripartum-psigose op die moeder-baba diade te ondersoek. Babas van moeders met psigose loop die risiko om onseker of gedisorganiseerde bindingstyle te ontwikkel. Moeders met psigotiese steurnisse is geneig om gebrekkige sensitiwiteit en responsiwiteit in hul interaksie met hul babas te toon. Ouerlike reflektiewe funksionering (ORF) is die vermoë om ’n mens se eie geestestoestande, sowel as dié van jou kind, in gedagte te kan hou. Gebrekkige ORF kan 'n potensiële meganisme wees wat aanleiding gee tot gebrekkige binding en swak kwaliteit van moeder-baba interaksie. Peripartum-psigose mag ‘n risiko verteenwoordig vir die moeder-baba diade as gevolg van die aard van simptome, asook die nodigheid vir psigiatriese toelating en skeiding tussen ma en baba. Suid-Afrikaanse studies van moederlike psigopatologie en die invloed daarvan op babas, plaas die fokus op moeders met depressie of trauma. Na ons wete is daar tot dusver geen studies oor die impak van moeders se psigose op ouerskap in Suid-Afrika nie. Daar is beperkte studies wat ORF in Suid-Afrika ondersoek, maar geen studies wat spesifiek fokus op hoe hierdie kapasiteit versorgingsgedrag van moeders met psigose in die peripartum beïnvloed nie. Hierdie studie het ten doel gehad om die ORF en die kwaliteit van moeder-baba interaksie te ondersoek in ‘n steekproef moeders met peripartum-psigose. Ons hipoteses was dat ervarings van peripartum-psigose geassosieër sal wees met 1) laer ORF en 2) swakker kwaliteit van moeder-baba interaksie. ‘n Verdere hipotese was dat 3) inperkings in ORF gepaard sal gaan met verswakte moeder-baba interaksie. Metodes: Die studie het 'n verkennende, kwantitatiewe en beskrywende ontwerp gevolg. Veertig moeders met hoofsaaklik bipolêre steurnis of skisofrenie, wat ervarings van psigose tydens swangerskap of vroeë postpartum beleef het, is gewerf om hul vlak van ORF en kwaliteit van interaksie met hul babas te bepaal. ’n Gedetailleerde onderhoud is gevoer om relevante agtergrond-inligting te bekom. ORF is gekodeer vanaf die “Parent Development Interview” en die kwaliteit van interaksie is geassesseer op grond van ’n ongestruktureerde spel-interaksie tussen moeder en baba. Twee-steekproef t-toetse is uitgevoer om te bepaal of ORF en moeder-baba interaksie beïnvloed was deur demografiese, kliniese, swangerskap of postpartum veranderlikes. Pearson se korrelasiekoëffisiënte is bereken vir korrelasies tussen ORF en interaksieveranderlikes. Resultate: Psigososiale risikofaktore was algemeen waarneembaar onder hierdie groep moeders wat peripartum-psigose ondervind het. 'n Groot aantal gevalle van onbeplande swangerskap en van moederlike middelgebruik tydens swangerskap is ook waargeneem. Die meerderheid moeders het ‘n psigiatriese hospitaal-toelating gehad wat vroeë skeiding van hul babas genoodsaak het. Die oorgrote meerderheid moeders (65.00%) se ORF was laer as gemiddeld (Gemiddeld = 4.10). Hierdie kapasiteit was egter nie by alle moeders met peripartum-psigose ingeperk nie. Die meerderheid moeders (75.00%) het die potensiaal vir voldoende tot komplekse ORF getoon. Diades het gemiddelde tellings behaal vir algehele kwaliteit van interaksie, sensitiwiteit van die moeder en sosiale betrokkenheid van babas, en het lae tellings behaal wat betref diadiese wederkerigheid. Dit blyk dat hierdie bevindings ons hipoteses ondersteun dat moeders se ervaring van peripartum-psigose geassosieër sal wees met swakker ORF en die kwaliteit van moeder-baba interaksie sal hê. Sosio-demografiese risikofaktore en faktore wat verband hou met swangerskap en postpartum-ervaringe het ORF en die kwaliteit van moeder-baba interaksie beïnvloed. Daar was ’n lae positiewe korrelasie tussen ORF en die kwaliteit van interaksie (r = .40), wat swakker was as wat ons aanvanklike hipotese was. Gevolgtrekkings: Vir die meeste moeders het peripartum-psigose 'n assosiasie met laer ORF en swakker moeder-baba interaksie gehad. Moeders met ervarings van peripartum-psigose kan baatvind by intervensies wat gerig is op ORF sowel as die kwaliteit van moeder-baba interaksie. Daarbenewens word die voorsiening van gesamentlike opnames en pro-aktiewe psigo-opvoeding oor swangerskap beplanning en middelgebruik aanbeveel.

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