Mentalizing in adolescence: Psychometric properties of the reflective functioning questionnaire (RFQ) and links with mental health, psychological well-being, and suicidal behaviours.

In a Clinical Health Psychology perspective, which focuses on the promotion and maintenance of mental and physical health of the individuals, mentalization (operationalized as reflective functioning; RF) may be conceived as a psycho-social competence associated with psychological well-being and good outcome treatment. In the university contexts, some studies demonstrated that the students' academic achievements may be related, on one hand, to RF improvements, on the other, to psychological well-being. Nevertheless, there is a lack of studies exploring RF in relationship with both academic achievement and psychological well-being regarding university students. This study aims at assessing the effectiveness, in terms of RF, psychological well-being and academic performance, of ten counselling groups addressed to 63 underachieving university students lagging behind in their studies. The counselling adopted an innovative narrative methodology, the Narrative Mediation Path (NMP), which aims to improve mentalization and psychological well-being in order to produce an impact on the students' academic performance. The Reflective Functioning Questionnaire (RFQ), the Psychological General Well-Being Index (PGWBI), and the Academic Performance Inventory (API) were administered at the beginning and at the end of the counselling. Results showed an overall improvement of students in genuine mentalization, especially of the hypomentalizing dimension of RF, an increase of the psychological well-being index and its sub-dimensions (except for the General Health dimension) and an improvement of the academic performance. This study highlighted the effectiveness of the NMP methodology for students' success and suggests the utility of planning clinical psychology interventions aimed at enhancing mentalization in the university contexts.

<p>反思功能為近年來提出的一個關於個體之心智能力的概念，本研究欲探討教養態度與個體自尊之關聯，以及反思功能在其中所扮演的中介效果。研究方法採取問卷調查法，以臺灣成年初顯期個體為研究對象，總共蒐集495份有效樣本，以教養態度量表、反思功能問卷、Rosenberg自尊量表為研究工具。</p> <p>研究結果如下：（1）關懷的教養態度與自主支持的教養態度，對自尊與反思功能皆具有顯著的正向預測效果；而過度保護的教養態度與心理控制的教養態度，對自尊與反思功能皆具有顯著的負向預測效果。（2）反思功能對自尊具有顯著的正向預測效果。（3）反思功能在關懷的教養態度與自尊之間，具有中介預測效果，越高的關懷教養態度透過高反思功能的中介會具有更高程度的自尊。（4）反思功能在過度保護的教養態度與自尊之間，具有中介預測效果，越高的過度保護教養態度透過低反思功能的中介會具有較低程度的自尊。（5）反思功能在自主支持的教養態度與自尊之間，具有中介預測效果，越高的自主支持教養態度透過高反思功能的中介會具有更高程度的自尊。（6）反思功能在心理控制的教養態度與自尊之間，具有中介預測效果，越高的心理控制教養態度透過低反思功能的中介會具有較低程度的自尊。</p> <p>研究貢獻為提升臨床實務工作者或教育工作者關於個體反思功能的重視，並提供不同的觀點以檢視原生家庭的教養經由透過何種心理運作機制而影響到子女的未來發展。</p> <p> </p><p>Reflective function, a recently introduced concept in the field of individual mental abilities, is defined as the ability to understand the mental states behind one’s own or others’ behaviors, recognizing that these behaviors are expressions of one’s mental states, such as feelings, thoughts, fantasies, beliefs, and desires. Reflective functions allow individuals to understand their mental state and form the basis of self-construction. In academic research, reflective function is often considered an important mediating variable and is used to measure the effectiveness of psychotherapeutic interventions on case outcomes. As an individual’s reflective function is influenced by attachment, early traumatic experiences, parental reflective function, and parental parenting behaviors, primary caregivers play a crucial role in influencing a child’s reflective function. The parenting attitudes of a primary caregiver are apparent patterns of parent-child interaction. An individual’s reflective function impacts self-identity, mental health, and several other aspects. Self-esteem is an individual overall evaluation of self-worth, which can maintain their psychological well-being and may also be influenced by their reflective function. Based on the above, primary caregivers can affect an individual’s reflective function, mental ability development, and individual perception and evaluation of self-esteem. Several studies have confirmed the effect of parenting on self-esteem. However, whether the impact of parenting attitudes on individuals can extend to emerging adulthood, which is the period between 18 and 29 years of age, remains unclear. In addition, no studies have explored the mediating effect of reflective function on parenting attitudes and self-esteem in emerging adulthood. By clarifying the impact of parenting attitudes on individual reflective function and self-esteem, it will be possible to provide counseling or psychotherapy interventions, allowing them to use appropriate therapeutic techniques, such as mentalization-based therapy (MBT). Therefore, this will enable the opportunity to concomitantly improve individual self-esteem and alleviate the negative impact of vulnerable family factors on individuals. Based on the above research motives, the research objectives of this study are as follows:(1) To examine the relationship between parenting attitudes and reflective function in emerging adulthood. (2) To examine the relationship between reflective function and self-esteem in emerging adulthood. (3) To examine the relationship between parenting attitudes and self-esteem in emerging adulthood. (4) To examine the mediating effect of reflective function on parenting attitudes and self-esteem in emerging adulthood. This study employed a questionnaire survey method among emerging adults in Taiwan. A total of 495 valid samples were collected using the Parenting Attitudes Scale, Reflective Function Questionnaire, and Rosenberg Self-Esteem Scale as research tools. The research results are as follows:(1) Caring and autonomy-supportive parenting attitudes have significant positive predictive effects on selfesteem and reflective functions. Overprotective and psychologically controlling parenting attitudes have significant negative predictive effects on self-esteem and reflective function. (2) Reflective function has a significant positive predictive effect on self-esteem. (3) Reflective function has a mediating predictive effect between caring parenting attitudes and self-esteem. The higher the level of caring parenting attitudes, the higher the level of self-esteem that can be achieved through the mediation of a highly reflective function. (4) Reflective function has a mediating predictive effect on overprotective parenting attitudes and self-esteem. The higher the level of overprotective parenting attitudes, the lower the level of self-esteem that can be achieved through the mediation of a low reflective function. (5) Reflective function has a mediating predictive effect on autonomy-supportive parenting attitudes and selfesteem. The higher the level of autonomy-supportive parenting attitudes, the higher the level of selfesteem that can be achieved through the mediation of a high reflective function. (6) Reflective function has a mediating predictive effect between psychologically controlling parenting attitudes and self-esteem. The higher the level of psychologically controlling parenting attitude, the lower the level of self-esteem that can be achieved through the mediation of low reflective functioning. This study contributes to enhancing the attention of clinical practitioners or educators to individual reflective functions. Moreover, it provides different perspectives to examine the effect of parenting of the family of origin on the future development of children and the psychological mechanisms involved.</p> <p> </p>

A Global Call for Action to Prioritize Healthcare Worker Suicide Prevention During the COVID-19 Pandemic and Beyond.

The COVID-19 pandemic of 2020 is a major global health challenge. At the time of writing, over 11.6 million people around the world had been registered as infected and 538,000 had died (Worldometers, 2020, accessed July 7, 2020). Public health responses to COVID-19 need to balance direct efforts to control the disease and its impact on health systems, infected people, and their families with the impacts from associated mitigating interventions. Such impacts include social isolation, school closure, health service disruption stemming from reconfiguring health systems, and diminished economic activity. The primary focus of both the United Nations (UN) and the World Health Organization (WHO) has been on addressing COVID-19 as a physical health crisis, but the need to strengthen mental health action, including suicide prevention, is increasingly recognized, as is the need for mental health research to be an integral part of the recovery plan (UN, 2020a). The impacts of the pandemic on physical and mental health will unfold differently over time and will vary depending on the duration and fluctuating intensity of the disease. Research is needed to help ensure that decision-making regarding all aspects of health, including mental health (Holmes et al., 2020), is informed by the best quality data at each stage of the pandemic. The pandemic poses a prolonged and unique challenge to public mental health, with major implications for suicide and suicide prevention (Gunnell et al., 2020; Reger, Stanley, & Joiner, 2020). A rise in suicide deaths in the wake of the pandemic is not inevitable. There is consensus, however, that the mitigation of risk will be contingent upon a proactive and effective response involving collaborative work between the state, NGOs, academia, and local governments and coordinated leadership across government ministries, including health, education, security, social services, welfare, and finance. Countries have responded in different ways to the pandemic, effectively creating a series of natural experiments. Thus, regions of the world affected later in the pandemic can draw on lessons from countries, such as China and Italy, affected in its early phase. Likewise, lessons learned early in the pandemic (e.g., on the impact of lockdown and physical distancing measures) can be used to inform responses to any future surges in the incidence of COVID-19. Although there are important parallels between countries in the course of the pandemic, some stressors, responses, and priorities are likely to differ between high- and low–middle-income countries and between cultures and regions. As COVID-19 appears to be disproportionately affecting Black, Asian, and minority ethnic communities, the response – and suicide prevention research carried out to inform the response – needs to be sufficiently granular and account for the complexity of risks in these groups (O'Connor et al., 2020). Throughout this editorial, when we refer to suicide and suicidal behavior, we mean to include both fatal and nonfatal suicidal behaviors and self-harm.

Reflective functioning is the process of reflecting on the thoughts and feelings of oneself and others and is foundational to healthy human relationships. The 54-item Reflective Function Questionnaire (RFQ) is a self-report measure that assesses reflective functioning, initially developed while studying individuals with borderline personality disorder (BPD) . The purpose of the present study was to translate the RFQ from English to Persian and evaluate its reliability and validity among Iranian prisoners. The sample of this study included 509 (455 men and 54 women) Iranian prisoners. Findings confirm the translated measure had acceptable face and content validity. A confirmatory factor analysis (CFA) confirmed two dimensions of certainty (RFQ-c) and uncertainty (RFQ-u) of reflective functioning. The correlation analysis showed positive relationships between the dimensions of the RFQ and the borderline personality symptoms questionnaire and the emotional dissatisfaction questionnaire. Correlation analysis also showed negative associations between the dimensions of the RFQ and the Toronto Basic Empathy Scale (BES) and the Kentucky Inventory of Mindfulness Skills (KIMS) questionnaire, confirming the concurrent validity of the RFQ. The Cronbach's alphas of the RFQ-c and RFQ-u subscales were .69 and .7 respectively, which demonstrated relatively acceptable internal consistency. The results of the analysis demonstrated that the translated RFQ had desirable psychometric properties for evaluating reflective function among Iranian prisoners.

Reflective functioning or mentalizing is the capacity to interpret both the self and others in terms of internal mental states such as feelings, wishes, goals, desires, and attitudes. This paper is part of a series of papers outlining the development and psychometric features of a new self-report measure, the Reflective Functioning Questionnaire (RFQ), designed to provide an easy to administer self-report measure of mentalizing. We describe the development and initial validation of the RFQ in three studies. Study 1 focuses on the development of the RFQ, its factor structure and construct validity in a sample of patients with Borderline Personality Disorder (BPD) and Eating Disorder (ED) (n = 108) and normal controls (n = 295). Study 2 aims to replicate these findings in a fresh sample of 129 patients with personality disorder and 281 normal controls. Study 3 addresses the relationship between the RFQ, parental reflective functioning and infant attachment status as assessed with the Strange Situation Procedure (SSP) in a sample of 136 community mothers and their infants. In both Study 1 and 2, confirmatory factor analyses yielded two factors assessing Certainty (RFQ_C) and Uncertainty (RFQ_U) about the mental states of self and others. These two factors were relatively distinct, invariant across clinical and non-clinical samples, had satisfactory internal consistency and test–retest stability, and were largely unrelated to demographic features. The scales discriminated between patients and controls, and were significantly and in theoretically predicted ways correlated with measures of empathy, mindfulness and perspective-taking, and with both self-reported and clinician-reported measures of borderline personality features and other indices of maladaptive personality functioning. Furthermore, the RFQ scales were associated with levels of parental reflective functioning, which in turn predicted infant attachment status in the SSP. Overall, this study lends preliminary support for the RFQ as a screening measure of reflective functioning. Further research is needed, however, to investigate in more detail the psychometric qualities of the RFQ.

People with mild to borderline intellectual disabilities (MBIDs) face challenges in social functioning, possibly as a result of limited mentalising abilities such as reflecting on the behaviour of themselves and others. Reflective functioning in people with MBIDs has not yet been investigated due to a lack of instruments. The Reflective Functioning Questionnaire (RFQ) is a seemingly easy adaptable, short self-report questionnaire. The aim of the present, explorative study was to adapt the RFQ for people with MBIDs and investigate the psychometric properties and correlations with other mentalising related constructs. The formulation of the items was adapted to the target group and items were added to broaden the scope towards reflection on both the self and other. Participants were 159 adults with MBIDs who completed a Dutch-translated and easy-to-read RFQ with five supplemental items, a questionnaire for autistic traits, a self-report questionnaire assessing perspective taking and two performance-based measures assessing emotion recognition and Theory of Mind. Confirmatory factor analysis confirmed the factor structure of the RFQ and revealed a two-factor structure with a Self and Other subscale. Generally satisfactory internal consistency and test-retest reliability were found. Explorative results showed correlations of the RFQ-8 and RFQ subscales with autistic traits and between the RFQ Other and perspective taking. This explorative study is the first testing psychometric properties of the RFQ as a self-report questionnaire for assessing reflective functioning in adults with MBIDs. This step is relevant in gaining more scientific knowledge on assessing mentalising in people with MBIDs.

Objective: To describe the level of psychological, social and subjective well-being in victims of the armed conflict in the municipality of Chalán. Theoretical Framework: Mental health includes psychological, subjective and social well-being. Psychological well-being encompasses the satisfaction and optimal functioning of the individual. Subjective well-being refers to the perception of quality of life and personal satisfaction. Social well-being assesses the perception of social functioning and social context, including social integration and contribution. Method: A quantitative approach was adopted with a descriptive non-experimental cross-sectional cohort design. The participants were 75 victims of the armed conflict. The following scales were used: Ryff's Psychological Well-Being, Keyes' Social Well-Being and Sánchez Cánovas' Subjective Psychological Well-Being. Results and Discussion: 56% of the participants reflect a deficit in their psychological well-being, 36% are at a standard level and only 8% are at a high level, in line with research on victims of the armed conflict in Colombia. The 46.6% evaluate their subjective well-being negatively, while 57.3% evaluate it positively, highlighting the complex interaction between traumatic experiences and current satisfaction. 88% present a deficit in their social well-being. Research implications: The results have direct implications for the formulation of policies and intervention programs aimed at improving the comprehensive well-being of victims of the armed conflict. Originality/value: It lays the foundation for future research and practices focused on similar contexts, expanding knowledge and improving interventions in conflict and post-conflict situations globally.

Objective The objective was to analyze the moderating effect of self-esteem on the relationship between mental health difficulties and suicidal behavior in adolescence. Method The sample was composed of 1,790 Spanish adolescents (M = 15.70 years; SD = 1.26; 53.7% girls) through a stratified random sampling by cluster at classroom level. The participants completed questionnaires about emotional symptoms, behavioral problems, peer relationship difficulties, hyperactivity, suicidal behavior, and self-esteem. Results The results evidenced gender differences, showing that girls tend to have more emotional symptoms (t = −15.27; p ≤ .001; d = −0.71), more difficulties in peer relationship (t=−2.49; p = .013; d = −0.12) and less self-esteem (t = 12.15; p ≤ .001; d = 0.57), as well as more suicidal behaviors (t = −5.36; p ≤ .001; d = −0.25) than boys. It is also noted that emotional and behavioral difficulties influence suicidal behavior (R2 = 0.35; ΔF = 197.42; p ≤ .001). In addition, self-esteem appeared to act as a protective factor, buffering the relationship between emotional and behavioral problems and suicidal behavior (R2 = 0.39; F = 376.92; p ≤ .001). Conclusions Adolescents who present mental health difficulties might commit suicidal behavior if they have an unfavorable attitude toward themselves. However, the risk of committing suicidal behavior decreases if their attitude toward themselves is favorable. Thus, the development of self-esteem may be included in intervention programs for the prevention of suicidal behavior. HIGHLIGHTS Girls present more suicidal behaviors and less self-esteem than boys. Mental health difficulties influence the appearance of suicidal behavior. Self-esteem moderates the relationship between emotional problems and suicidal behavior.

In This Issue

Introduction: Reflective function refers to the capacity to comprehend emotions, beliefs, and behaviors in oneself and others. Mental disorders are frequently associated with deficits in mentalizing capabilities. These deficits compromise an individual’s capacity for self-reflection and understanding of mental states, impeding one’s ability to regulate both mental states and interpersonal relationships. The Reflective Functioning Questionnaire (RFQ) is a practical tool to measure reflective function, but it has not yet been adapted into Indonesian, a crucial step toward addressing the needs of local populations. This study aimed to develop an Indonesian version of the RFQ with robust validity and reliability. Methods: The English RFQ was translated into Indonesian using standard guidelines, including forward and backward translation by certified translators. Content and face validity were assessed through expert panel reviews to ensure cultural and linguistic relevance. Construct validity was evaluated using confirmatory factor analysis (CFA), and reliability testing was conducted using Cronbach’s Alpha. A pilot study with 10 subjects was conducted to refine the instrument, followed by testing with a sample of 100 participants. Results: The final Indonesian RFQ consists of 11 items across two subscales: RFQu and RFQc. CFA indicated a good model fit (χ² = 1.16, p = 0.55, and RMSEA = 0.041). Reliability testing showed strong internal consistency, with Cronbach’s Alpha values of 0.89 for RFQc and 0.87 for RFQu. Conclusion: The modified Indonesian RFQ demonstrated excellent validity and reliability, providing a robust tool for assessing reflective function in clinical and research settings.

This study aims to validate the Greek version of the 54-item Reflective Functioning Questionnaire (RFQ), a measure designed to assess an individual's capacity for understanding themselves and others based on internal mental states. This capacity, also known as Reflective Functioning (RF) or mentalizing, is believed to play a significant role in both typical and atypical development. The validation process examined the factor structure of the RFQ and its relationship with a variety of psychosocial and clinical constructs that have theoretical and empirical links to RF. Additionally, this research investigated the factor structure's invariance across gender and age groups to determine the robustness of the instrument. A unique contribution of this work lies in examining the application of the RFQ to attachment classifications through the use of cluster analysis. The sample consisted of 875 Greek adults from the general community with a mean age of 28.5 and a median age of 22. Participants completed the Greek RFQ along with a series of self-report questionnaires assessing psychosocial constructs, including attachment, epistemic trust, emotion regulation, and psychological mindedness, as well as clinical variables such as anxiety, depression, and borderline personality traits. Our findings suggest that a shorter, 31-item version of the questionnaire provides a robust three-factor structure across a non-clinical Greek adult population. The three identified subscales are (a) excessive certainty, (b) interest/curiosity, and (c) uncertainty/confusion, all demonstrating satisfactory reliability and construct validity. The uncertainty subscale was found to be associated with insecure attachment styles, epistemic mistrust and credulity, emotional suppression, and low psychological mindedness. In contrast, the certainty and curiosity subscales were linked to secure attachment, epistemic trust, emotion reappraisal, and psychological mindedness. Uncertainty was further shown to differ significantly across probable clinical and non-clinical groups, as distinguished by cut-off scores for anxiety, depression, and borderline personality disorder (BPD). However, the certainty and interest/curiosity subscales only varied between the two BPD groups. Our results provide the first evidence supporting the use of a 31-item version of the RFQ with three validated subscales to reliably assess reflective functioning in the Greek population, demonstrating stronger psychometric properties compared to other RFQ versions reported in previous studies. Findings suggest that impaired mentalizing capacity, as measured by the RFQ, is linked to insecure attachment, epistemic mistrust and credulity, poor emotion regulation, and low psychological mindedness, and potentially plays a role in adult mental health symptoms.

Introduction Difficulties in mentalizing (i.e., the ability to reflect on self and others’ internal mental states, operationalized as reflective functioning [RF]; Fonagy et al., 2012) have been associated with psychological symptoms (Luyten et al., 2020), including somatic symptoms (Bizzi et al., 2019). Therefore, the assessment of its dimensions may be clinically relevant for young patients with somatic symptoms, as with Primary Headache (PH), representing one of the most common somatic complaints in children and adolescents.ObjectivesThis study aimed to assess RF with a multi-method approach, exploring its relation with somatic symptoms.Methods 48 adolescents diagnosed with PH (Mage=14.83, SD=2.81; 67% females) were recruited from an Italian Child Neuropsychiatry Clinic. RF was measured both through the Child and Adolescent Reflective Functioning (CRFS) applied to the Child Attachment Interview transcripts and the self-report Reflective Functioning Questionnaire (RFQ), while the Children’s Somatization Inventory (CSI-24) was used to measure the perceived severity of somatic symptoms.ResultsDifferent relations with somatic symptoms depended on the method used to evaluate RF: no significant correlations were found with the CRFS subscales (General, Other, Self ), while a negative significant correlation was found with the RFQ subscale Certainty about mental states (RFQ_C) (r=-.46, p=.016). All subscales of CRFS were negatively correlated with RFQ_C (p=.05), but not with the other RFQ subscale (Uncertainty about mental states; RFQ_U).ConclusionsThis suggests that two measures may lead to different dimensions of the same construct, thus a multi-method assessment of RF would be advisable in clinical practice.DisclosureNo significant relationships.

Introduction: When it comes to mental health, traditional research has been revolving around risk factors and their repercussions on mental health. On the other hand, understanding positive factors underlies prevention strategies of self-improvement of these skills, and social and clinical interventions necessary to maintain good health and well-being. Social support, self-esteem and resilience have been the focus of several studies of this scope, having been associated with better mental health outcomes and lower suicidal behaviors. Objectives: With this study, our objectives are to assess the importance of social support, self-esteem and resilience in protecting mental health and suicidal behavior, to determine differences between countries of residence, to assess levels of association between variables, as well as determining the effect of sociodemographic variables, country of residence, social support, self-esteem and resilience in predicting mental health and suicidal behavior. Method: In this study participated 1006 citizens of the Community of Portuguese Language Countries (CPLC), between 18 and 80 years of age (mean = 41.76; SD = 14.19). 40.7% of the participants lived in Brazil, 29.9% lived in the ACPOL and 29.4% were from Portugal. For this study, we included a sociodemographic questionnaire that asked about the participants’ age, country of residence, gender, sexual orientation, ethnicity, professional status, educational attainment, socioeconomic status and marital status. To identify the presence of psychological symptoms (depression, anxiety, or somatization) and thus measure participants’ mental health, we utilized the Brief Symptom Inventory-18 (BSI-18). To assess suicidal behavior, we included the Suicidal Behaviors Questionnaire – Revised (SBQ-R). To check for social support (family, friends and significant others), the Portuguese version of the Multidimensional Scale of Perceived Social Support (MSPSS) was utilized. To measure self-esteem, we utilized the Rosenberg Self-Esteem Scale (RSES). To measure resilience, we utilized the Conner-Davidson Resilience Scale–10 (CD-RISC-10). A website was created for the purpose of the investigation, to disseminate the questionnaire online through mailing lists and social media, from May to October 2021, using a convenience sample method. Results: The results showed statistically significant differences between the CPLC countries for social support, self-esteem, resilience, mental health, and suicidal behavior. The positive factors were negatively correlated with mental health and suicidal behavior. When added to sociodemographic variables, social support, self-esteem, and resilience are good predictors of both mental health and suicidal behavior. Conclusion: We concluded that, as previously shown in other studies, social support, self-esteem, and resilience all constitute protective factors for mental health and suicidal behaviors. Self-esteem took on an especially relevant role, possibly due to its moderating effect in positive life outcomes, less prevalence of psychological symptomatology and general mental well-being, since a strong sense of self-esteem is also linked to better locus of control and higher personal psychological resources to handle adversity.

The Acceptability of Suicide Among Rural Residents, Urban Residents, and College Students from Three Locations in China