Caregiving representations in war conditions: Associations with maternal trauma, mental health, and mother–infant interaction

Abstract

Risk features in mothers' caregiving representations remain understudied in dangerous environments where infants most urgently need protective parenting. This pilot study examines the feasibility of a novel coding system for the Parent Development Interview (PDI) interview (ARR, Assessment of Representational Risk) in assessing 50 war-exposed Palestinian mothers' caregiving representations. First, we explored the content and structure of risks in the representations. Second, we examined associations between the high-risk representations, mothers' pre-and postnatal exposure to traumatic war events (TWE), depressive and post-traumatic stress disorder (PTSD) symptoms, and self-rated emotional availability (EA) with their 1year-old infants. Following three dimensions of high-risk caregiving representations were identified: self/dyadic dysregulation, unavailable, and fearful. Mothers' prenatal depressive symptoms were associated with dysregulating and fearful representations, and their postnatal PTSD with fearful representations. TWE were not associated with the high-risk representations. Moreover, mothers of boys reported more fearful representations, and mothers with financial difficulties reported more unavailable representations. TWE and high-risk representations were not associated with EA. However, qualitative analysis of the representations indicated risks in the mother-infant relationship. Further, older mothers and mothers with postnatal PTSD reported lower EA. Cultural variance in caregiving representations and the use of self-report measures among traumatized mothers are discussed. K E Y W O R D Scaregiving representations, emotional availability, mental health, pre-and postnatal, war trauma 246

The assessment of representational risk (ARR): Development and psychometric properties of a new coding system for assessing risk in the parent–infant relationship

“…It is also likely that different factor structures are evident in different samples. Indeed, this has been shown to be the case in a recent application of the ARR coding in a sample of war‐exposed Palestinian mothers (Isosävi et al., 2020). Given the low internal consistency of some subscales and the likelihood of very different factor structures for different parenting populations, we recommend that the ARR total score be taken as the most robust indicator of risk.…”

Observed Emotional Availability<bold> (EA) in the Early Months and Adolescence and Self-Reported EA at Any Age: A Narrative Review</bold>

“…In contrast, Negrao et al (2016) found that preoccupied attachment (assessed with the Adult Attachment Interview) was associated with lower observed EA, studied in 1-4-year-old children and their mothers. In contrast to the above, but also implemented in the Palestinian context, Isosävi et al (2020) did not find a link between the mother's experience of traumatic war events and EA-SR, but mothers with postnatal post-traumatic stress disorder (PTSD) reported lower EA-SR, concurrently assessed at 1 year of age. It is also important to mention that the authors indicated possible unreliable results from traumatized mothers, mentioning that "self-reported interaction quality is a type of maternal representation of the relationship and hence subject to distortions" (p. 258).…”

Maternal caregiving representations of the infant in the first year of life: Associations with prenatal and concurrent reflective functioning

“…In clinical samples, distorted representations are often associated with interpersonal trauma, stress, and anxiety (Isosävi et al., 2020; Newman‐Morris, Simpson, et al., 2020; Sleed et al., 2021). Our sample is drawn from a diverse, urban community and the most common risk factors among participants was poverty and exposure to violence.…”