The perinatal period it is characterized by numerous changes, that prepare the mothers to accurately perceive and interpret the emotional underpinnings of the infant's behavior. These abilities are sustained by mothers' parental reflective functioning, the mothers' capacity to recognize and reflect upon their own and their child's mental states. Among risk factors that may impair parental reflective functioning, research has paid attention to the role of maternal depression. Several authors have highlighted the importance to improve parental reflective functioning through mentalization-based interventions (MBIs). Despite a large amount of studies on MBIs, very few randomized controlled trials have assessed the longitudinal follow-up outcomes. The present research project is a randomized controlled trial that aims to prove the efficacy of an MBI on mothers with maternal peripartum depression. N = 100 mothers diagnosed with maternal peripartum depression will be recruited. Mothers will be randomly assigned to two conditions: (1) MBI (2) Supportive counseling. This longitudinal research, organized in 5 phases, will be carried out between the 7th month of pregnancy at the 12th month after childbirth. The interventions will be conducted from 3 to 9 months of the child. The project will entail the pre and postnatal assessment of depression, psychopathological profile, perceived social support, resilience, reflective functioning, attachment models, maternal representations, mother-child interactions, as well as the measurement of hair cortisol on both mothers and children. The outcomes of the intervention will be assessed at the child's 12 months in terms of maternal mentalization, mother-child interactions, and child emotional and behavioral functioning. We expect that, in the post-intervention, the MBI will increase: parental reflective functioning and maternal sensitivity, the quality of mother-child relationship, and their psychobiological response to stress.
This study adopted a multidimensional approach to study the impact of MPD on psycho-neuro-biological underpinnings of maternal functioning, mother-child relationship, and child socio-emotional development. This study may shed further light on the complex mosaic that links MPD to child development. Furthermore, this study allow to verify the efficacy of a 6-months MBI, regarding MPD, one of the most common mental disorders.
At the 7th month of pregnancy, we expect that mothers with MPD show biological alterations associated with high depression levels, reduced emotional regulation, and atypical preoccupations (either extremely poor or excessive) in mothers.
Furthermore, we expect that at 3th month of life, infants of intrusive mothers with MPD, would differ from infants of withdrawn mothers with MPD. Such differences would result from prolonged exposure to the two completely different maternal interactive styles observed in MPD: the first one characterized by excessive maternal preoccupations, high obsessive/compulsion, hostility, paranoid ideation symptoms, and nonintegrated ambivalent representations; whereas the second one characterized by poor maternal preoccupations, high interpersonal sensitivity, high phobic anxiety, and restricted/disengaged representations. Moreover, we assume that intrusive mothers will show different biological alterations compared with withdrawn mothers.
We expect that, in the post-intervention, the MBI will increase: PRF and maternal sensitivity, the quality of mother-child relationship, child socio-emotional development, and psychobiological response to stress in mothers and children. Such increase is expected to be significantly higher in the MBI group than in the SC group.
We also expect to identify risk and protective factors and their effects as mediators and/or moderators of psychological and physiological effects of MBI on emotion regulation and response to stress.
If our expectations will be confirmed, this study may also provide a strong evidence of the role played by the different interactive styles of mothers with MPD.
The scientific community will be reached through scientific publications in national and international open access journals. The study results will be presented as oral presentations and posters at national and international scientific conferences. Moreover, we will organize an international congress to share our project results with the scientific community. Items for dissemination in any format including publications will not contain any information that may lead to the identification of the participants. Results of this study may enlarge the knowledge about the longitudinal follow-up outcomes of MBI based randomized controlled trials on groups of mothers with MPD.