Bindung, Bindungsbeziehungen und psychosoziale Entwicklung von ehemals sehr kleinen Frühgeborenen (< 1500g) in der späten Adoleszenz

Walter, Carmen (2021): Bindung, Bindungsbeziehungen und psychosoziale Entwicklung von ehemals sehr kleinen Frühgeborenen (< 1500g) in der späten Adoleszenz: eine prospektive Längsschnittuntersuchung. Dissertation, LMU München: Medizinische Fakultät

Abstract

Background: Several investigations have revealed consistent evidence that attachment representations of infants born (very) preterm, are comparable with those of born at term, as measured by the Strange Situation Procedure. There is a growing body of research indicating that individuals born extremely or very preterm are at heightened risk for developing diverse socio-emotional deficits as well as increased vulnerability to psychiatric symptoms – summarised as “preterm behavioural phenotype”. These may occur with both childhood and adult onset, although none of these studies has examined the stability and change in the attachment of preterm-born youths, nor the transgenerational transmission of internal working models between mother and her offspring born very preterm. In light of one of the core tenets of contemporary attachment research, that is, that psychopathology is linked to attachment insecurity and disorganisation, this sparse scientific research is surprising and remarkable. The current prospective longitudinal NEO-L Preemie Study was thus designed to fill this research gap by exploring the long-term attachment development of adolescents born very preterm, focussing on maternal attachment, psychological distress and postnatal neurobiological risk. Methods: Sample: A total of N=70 adolescents born very preterm (<1500g), nearly two thirds of the original sample, were followed up in late adolescence (age: M = 18.77, SD = 1.11), together with their mother. Measures: Attachment of mothers and adolescents born very preterm were assessed with interviews (Adult Attachment Interview (AAI) and Friends and Family Interview (FFI) respectively); self-reported assessment of psychological distress with the Symptom-Checklist-Revised (SCL-90R); IQ via the Wechsler-Adult-Intelligence-Scale (WAIS-IV); postnatal neurobiological risk was rated by paediatricians before the infants born preterm were discharge from the hospital. Results: The majority of very preterm adolescents (56%) changed and revised their current state of mind regarding attachment, as hypothesised. In particular, a shift was found from security in early childhood towards insecurity, resulting in a high proportion of insecure-dismissive and to some extent disorganised attachment classifications. However, attachment was unrelated to neonatal parameters, neurobiological risk and intelligence. Furthermore, analyses confirmed intergenerational transmission of attachment in the sense that avoidance and social competence via attachment security of the mother were moderately transmitted to the very preterm adolescents (r = 0.32, 95% BCa (0.11, 0.50) respective r = 0.33, 95% BCa (0.11, 0.52)). Bivariate correlations indicated that attachment security of adolescents born very preterm were significantly and positively associated with their social competence and self-regard. Five attachment-based variables explained 44% of the variance in youth psychological distress, adjusted for familial socioeconomic status and neurobiological risk. Specifically, attachment avoidance of the mother, assessed 6 months postpartum, as well as disorganisation of the adolescents formerly born very preterm predicted a significant rise in psychological distress. Simple Mediation Model revealed that the internalised Secure-Haven-Support of the mother mediated the relation between (dimensional) attachment disorganisation and psychological distress. Conclusion: To best of my knowledge, these are the first results that stress the intergenerational transmission of maternal attachment as it impacts offspring attachment and psychological adjustment after prematurity and beyond. As a major public health concern, this suggests the need for early parent-child intervention that focuses on parenting to reduce the financial burden on society in the long run. In particular, promoting attachment security by internalising representations of trusting, reliable emotional support in times of need with the intention of breaking through the vicious cycle of intergenerational transmission and damping the adverse effects of caregiving on psychosocial outcome and preventing preterm behavioural phenotype-related disorders, should be taken into account.

• Dokumententyp: Dissertationen (Dissertation, LMU München)
• Keywords: preterm, attachment, parenting, psychosocial outcome, longitudinal study
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften ; 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• Fakultäten: Medizinische Fakultät
• Sprache der Hochschulschrift: Deutsch
• Datum der mündlichen Prüfung: 7. Juli 2021
• 1. Bericht­erstatter:in: Brisch, Karl-Heinz